montelukast and Hypotension

The approach to clinical conundrums by an expert clinician is revealed through the presentation of an actual patient's case in an approach typical of a morning report. Similarly to patient care, sequential pieces of information are provided to the clinician, who is unfamiliar with the case. The focus is on the thought processes of both the clinical team caring for the patient and the discussant.

Topics: Acetates; Aged; Anti-Inflammatory Agents; Cyclopropanes; Diagnosis, Differential; Humans; Hypotension; Leukotriene Antagonists; Male; Mastocytosis, Systemic; Prednisone; Quinolines; Sulfides; Tachycardia

Cold urticaria is characterized by the development of urticaria, usually superficial and/or angioedematous reaction after cold contact. It was found predominantly in young women. The diagnosis is based on the history and ice cube test. Patients with a negative ice cube test may have represented systemic cold urticaria (atypical acquired cold urticaria) induced by general body cooling. The pathogenesis is poorly understood. Cold urticaria can be classified into acquired and familial disorders, with an autosomal dominant inheritance. Idiopathic cold urticaria is most common type but the research of a cryopathy is necessary. Therapy is often difficult. It is essential that the patient be warned of the dangers of swimming in cold water because systemic hypotension can occur. H1 antihistamines can be used for treatment of cold urticaria but the clinical responses are highly variable. The combination with an H2 antagonists is more effective. Doxepin may be useful in the treatment. Leukotriene receptor antagonists may be a novel, promising drug entity. In patients who do not respond to previous treatments, induction of cold tolerance may be tried.

Topics: Acetates; Adrenal Cortex Hormones; Aminophylline; Cold Temperature; Cyclopropanes; Doxepin; Drug Therapy, Combination; Female; Genes, Dominant; Histamine H1 Antagonists; Humans; Hypotension; Male; Quinolines; Stanozolol; Sulfides; Terbutaline; Urticaria