Chronic urticaria is a condition in which various factors cause temporary inflammatory congestion and tissue edema in the skin, mucous membranes, and blood vessels for more than 6 weeks. The cause is often uncertain. The clinical manifestations of urticaria are the erratic occurrence of wind clusters and plaques on the trunk, face or extremities. The episodes vary from several times a day to once every few days.
I. Common causes
1. Diet
Food such as fish, shrimp, crab and eggs are common; some spices and condiments can also cause the disease.
2, drugs can cause the disease.
Penicillin, sulfonamides, dysentery, serum vaccines, etc., through the immune mechanism to trigger urticaria. And aspirin, morphine, atropine, vitamin B1 and other drugs for histamine release, can directly make mast cells release histamine to trigger urticaria.
3.Infection
Including viruses (such as epizootic virus, hepatitis virus), bacteria (such as golden grape), fungi and parasites (such as roundworms, etc.).
4.Biological factors
Animal and plant factors, such as insect bites or inhalation of pollen, feathers, dander, etc.
5.Physical factors
Cold, heat, sunlight, friction and pressure can be caused.
6.Other factors
Gastrointestinal diseases, metabolic disorders, endocrine disorders and mental factors can also be caused.
Clinical manifestations
Before the appearance of rubella, local itching or tingling sensation on the skin, and a rash appears rapidly. Some patients develop systemic symptoms, such as poor appetite, general malaise, headache or fever, within a few hours or one to two days after the appearance of rubella. Rubella patches appear as flat, red or pale edematous patches with a red halo around the edges. The rubella masses may be ring-shaped and may be called ring urticaria. Several adjacent ring-shaped lesions may be joined or fused to form a map-like pattern, which may be called graphic urticaria. When there is blistering in the rash, it is called blistering urticaria.
Rubella blocks often disappear spontaneously within a few hours or 1 to 2 days, with new lesions appearing one after another in other parts of the body, and no new damage occurs within 24 hours after the rubella block has disappeared. The skin returns to normal after the rubella patches disappear. The size and number of rubella patches are variable and can appear on any part of the skin or mucous membranes. Rubella patches cause severe itching, pins and needles, or a burning sensation that varies from person to person. In severe cases, there are headaches, fever and other systemic symptoms, especially in patients with acute urticaria, who may have a fever of about 40°C. Blood pressure may decrease and even fainting and shock may occur. Most patients have only itchy rash patches and no other symptoms.
The course of urticaria varies, with some rashes occurring several times a day and stopping after a few days or 1 to 2 weeks to several weeks, called acute urticaria. Many patients have a rash that occurs daily, or repeatedly appears or worsens, remits or disappears intermittently for months or years, called chronic urticaria and special types of urticaria.
III. Examination
Histopathological examination of chronic urticaria: simple restrictive edema, plasmacytic exudate in the papillae and upper dermis, papillary edema, small amount of lymphocytic infiltration around the vessels, infiltration can also be dense and mixed with eosinophils.
Diagnosis
Diagnosis can be made based on medical history, clinical manifestations and examination.
V. Treatment
Chronic urticaria has a complex etiology and an unclear pathogenesis, making treatment more difficult and the course of treatment long. The correct treatment requires the following points.
1.Find the cause of the disease
Detailed medical history, trying to find the cause of each patient, to understand whether there is family morbidity, the history of acute and chronic infections, medication history, occupation, habits and environmental changes. Check blood, urine and stool routines, and perform skin allergen test, ice cube test, acetylcholine skin test, serum IgE assay and serum complement assay, etc. as needed. Individual patients should do HBV-DNA and thyroid antibody, malignancy and other tests.
2.Avoid triggering factors
Cold urticaria pay attention to keep warm, acetylcholine urticaria reduce exercise, sweating and mood swings, contact urticaria reduce the chance of contact, etc.
3.Medication
(1) Use anti-allergy drugs, but need to take them continuously and gradually reduce the dosage.
(2) Use traditional Chinese medicine to clear heat and cool blood, promote lung and relieve itching.
(3) Use glucocorticoids, especially for acute urticaria, serum sickness urticaria, stress urticaria and autoimmune urticaria.
(4) Non-specific anti-allergic therapy and other therapies include 10% calcium gluconate injection, 10% sodium thiosulfate, and anti-infective drugs are used to treat those caused by infection.
Acupoint injection therapy
Topical anti-itch Chinese and Western medicine drugs: ointment, application, lotion, etc.