A. The common causes of urticaria are.
1, food and additives.
2, drugs.
3, infections.
4, animals, plants and inhalants.
5, physical factors.
6, visceral diseases.
7, mental factors.
8, genetic factors.
In Chinese medicine, it is believed to be caused by “where the evil comes together, its qi must be weak”. Due to the relative weakness of the body’s vital energy, and the patient’s physical condition varies, or internal food stagnation, evil heat, wind cold, wind heat; or weakness, lack of Yin and blood, rash repeatedly, after a long time, blood and Qi is depleted; or suffer from chronic diseases (such as intestinal parasites, hepatitis, nephritis, menstrual disorders, etc.) resulting in internal can not drain, external can not penetrate, depressed in the skin between the couples, evil and positive fight and the onset. Clinically more often in women, especially in young and middle-aged people, urticaria is not what the sequelae, to be treated immediately!
Second, several special types.
(a) Artificial urticaria.
Also known as skin scratching disease. The tip of a blunt hard object such as a pencil tip or toothpick is scratched on the skin, and the scratched area gradually appears as a triad of red lines, redness and edema, manifesting as a clear red line of raised rubella blocks, while there are no rubella blocks that appear naturally elsewhere. Shortly thereafter, the skin scratches gradually disappear spontaneously.
(ii) Pressure urticaria.
It appears in the area of friction or hedgehog pressure, but can also occur in the clothing, belts, belts and other binding pressure. Mild pressure can cause swelling and deep painful rash blocks to occur at the site of pressure after 4 to 6 hours, only to disappear after 8 to 24 hours.
(iii) Contact urticaria.
It is not uncommon for urticaria to occur at the site of contact with an allergen. The most common allergens are food, food add-ons or spices. Drugs, plant pollen, certain chemicals, etc. Clusters often occur around the mouth and hands of the plant, but also in general. When accompanied by other allergic symptoms such as asthma, it is called contact urticaria syndrome.
(iv) Cold urticaria.
There are two types: hereditary and acquired.
Hereditary cold urticaria appears in infancy and can continue throughout life. Patients with cold urticaria occur about 0.5 to 4 hours after exposure to cold, with a less itchy but burning rash, accompanied by headache, fever, joint pain and increased white blood cells.
Acquired cold urticaria often begins in childhood or young adulthood. After a sudden drop in temperature, immersion in cold water, or contact with cold objects, edema and rashes occur within minutes on contact or exposed areas such as the face, hands, and feet, or in severe cases, on other parts of the body. Wind masses appear when it is warming up but not when it is cold, such as when an ice cube is placed on the forearm and it is warmed up after removal. Patients often have cold globulinemia, cold hemolysis, cold agglutinin, cold fibrinogenemia or syphilis, connective tissue disease. Vasculitis disease or malignant lesions of the hematopoietic system. In some patients, when bathing with cold water or suddenly encountering cold air, in addition to the occurrence of widespread rash blocks, there are nausea, vomiting, headache, rapid heartbeat and other systemic symptoms, and in severe cases, the whole body skin is red, and fainting or shock symptoms occur. Therefore, suffering from urticaria must be treated in a timely manner, and the best drug in the treatment is the Tibetan medicine Comfrey Dew.
(E) Heat urticaria.
Less common. The localized rash block occurs after the child is exposed to heat, and fainting or shock can occur when the whole body is suddenly exposed to heat.
(f) Water urticaria.
Any temperature of water contact with the skin within a few minutes to 30 minutes can trigger tiny punctate perifollicular rash, mostly involving the neck, arms and upper trunk, accompanied by pruritus, lasting 30 to 45 minutes. It should be distinguished from waterborne pruritus, which occurs after water contact without obvious skin lesions. Oral antihistamines taken 1 hour before bathing can reduce the formation of wind masses, and topical application of vancomycin or scopolamine can prevent the occurrence of skin lesions.
(vii) Sun urticaria.
Also known as photogenic urticaria. Within a few minutes after sun exposure, stinging and itchy erythema occurs at the sunburned area.
The urticaria and urticaria block, after avoiding sunlight after l to several hours to subside. In severe cases, the reaction may be accompanied by chills, lethargy, abdominal pain or even shock.
Ultraviolet light, visible light or invisible infrared rays can cause such urticaria, especially for the wavelength of 300nm ultraviolet light.
(H) Angioedema.
Formerly known as angioneurotic edema or giant urticaria, hereditary angioedema, also known as chronic familial giant urticaria, are considered urticaria idiosyncratic.
(ix) Cholinergic urticaria.
In emotional excitement, strenuous exercise or labor . It appears when the external temperature is high or when a hot diet is ingested, and is especially likely to occur when sweating. The rash is a large number of itchy wind masses, about 1 to 3 mm in diameter, surrounded by a red halo, which can be widely distributed in thousands of body parts, but is generally not seen in the palmoplantar. In severe cases, it is accompanied by symptoms such as headache, headache, abdominal pain, diarrhea and even shock. The flushes subside after half an hour to one to two hours, but can recur for months or years. Intradermal injections or oral cholinergic drugs can cause similar reactions.
(J) Adrenergic urticaria.
Adrenergic urticaria is a rare form of mental stress-induced urticaria associated with increased serum catecholamines. It occurs most often after a period of emotional stress in susceptible individuals. The size of the cluster is similar to that of cholinergic urticaria, with a pale halo surrounding it rather than an erythematous plaque being the difference. Intradermal (norepinephrine) injections can induce typical lesions, and treatment with adrenergic receptor blockers such as propranolol has good efficacy.
(xi) Serous urticaria.
Exogenous serum, drugs and animal vaccines are common causes of serum sickness urticaria. The onset is often preceded by an erythematous and edematous reaction at the site of injection. Widespread lymph node enlargement is the first sign of serum sickness, and body temperature is often elevated. 50% of patients present with joint pain and stiffness. Peripheral neuritis may occur in a small number of patients, sometimes with renal damage. Laboratory tests show decreased white blood cells and elevated eosinophils.
(XII) Urticarial vasculitis.
Urticarial damage and necrotizing vasculitis are clinical features. The lesions last 24 to 72 hours and may leave purpura, scaling and hyperpigmentation, and may be accompanied by a distinct burning sensation and pain, with mild itching. Sometimes there may be angioedema, fever and arthralgia symptoms. Laboratory tests: hypocomplementemia, positive antinuclear antibodies in 30% of patients, skin biopsy showing leukocyte fragmentation vasculitis changes. Antihistamine treatment is ineffective, and glucocorticoids must be applied systematically, or chlorphenesulfone can be used for treatment.
(XIII) Peptoid urticaria.
When overeating (pork and seafood) and mental excitement and people drink a lot of alcohol, the peptone in the food is absorbed through the gastrointestinal tract without being digested and causes the disease. The duration of this type of urticaria is very short, a wave for l to 2 days.
(XIV) Urticaria with neurological symptoms.
A chemical medium that causes urticaria affects the blood-brain barrier, causing cerebral edema due to increased capillary permeability in the brain, or symptoms of meningeal irritation, or even affecting the function of brain nerve cells, with headache, nausea, vomiting, and in severe cases, convulsions and coma. EEG may show disturbance of fast wave rhythm.
(xv) Cardiac urticaria.
With typical urticarial lesions accompanied by functional changes in the heart. It may manifest as palpitations, panic discomfort, chest pain. Chest tightness, shortness of breath, arrhythmias, etc. There are obvious non-specific changes in the electrocardiogram. The cardiac changes return to normal as the rash subsides.
Urticaria
(XVI) Joint and muscle urticaria.
The skin lesions may be generalized throughout the body, and the muscular symptoms are manifested by muscle pain, swelling and pressure and impaired movement of the extremities. Painful joints with limited movement but no swelling. The joint and muscle symptoms resolve with the resolution of the rash or persist for several days. The pathogenesis may be related to the combined effect of certain inflammatory and pain-causing mediators.
(XVII) Gastrointestinal urticaria.
Typical urticaria symptoms are accompanied by nausea, vomiting, abdominal pain, diarrhea, and occasionally a small amount of ascites formation. Abdominal pain is widespread, without fixed pressure points, diarrhea is usually watery, without pus and blood, without a sense of urgency. White blood cells may be mildly elevated.
Eosinophils may be increased in urticaria. Treatment with antihistamines in addition to oral atropine or belladonna, corticosteroids oral or intravenous drip is necessary.
(xviii) Arachidonic acid-mediated urticaria.
Aspirin is a common but sometimes overlooked cause of chronic urticaria. This type of urticaria is arachidonic acid-mediated urticaria. Many patients are intolerant to nonsteroidal anti-inflammatory drugs, preservatives, azo dyes, food additives, and their industrial compounds with aspirin properties.
(XIX) Urticaria in children (pediatric urticaria).
Urticaria is not only a frequent disease in adults, but also a frequent and common disease in children. The characteristics of urticaria in children are that it is mostly due to allergic reactions, and its common and frequent suspected causes are firstly food and secondly infection. The causes of urticaria vary depending on the age and type of diet. For example, infants are mainly fed with breast milk, milk and dairy products, which can trigger urticaria mostly with additives to milk and dairy products.
As they get older, infants and toddlers begin to add complementary foods, at which point eggs, meat loaf, fish loaf, fruit juices, vegetables, and fruits can be the cause of allergies. Preschool and school-age children, often like to eat snacks, snack types and more regular food, so the chances of food allergies increase, such as nuts, fish, crab, shrimp, peanuts, eggs, strawberries, apples, plums, citrus, various cold drinks, beverages, chocolate, etc. can be the cause of allergies.
Children between the ages of 2 and 7 lack autonomy and are prone to insect bites when they go outdoors, in the wild, in the bushes and under the street lights in the evening, or come into contact with pollen, dust, mites and pets such as cats and dogs’ fur, which can easily become the cause of allergies. Children in childhood and early childhood have low resistance and are prone to various infections, so diseases such as purulent tonsillitis, pharyngitis, enteritis, and upper respiratory tract infections can be triggering factors for urticaria throughout the year. Older children and adolescents begin to be allergic to medications, especially penicillin, which can cause hives.
Urticaria in children is triggered by drugs, cold, heat, sun exposure, stress, etc., and systemic diseases are far less common than in adults. From the point of view of the course of the disease, children’s urticaria is mostly acute urticaria, but with increasing age, children and adolescents with allergic eczema and asthma aggravated
III. Treatment.
Antihistamines
Antihistamines are important drugs for the treatment of various patients with urticaria and can control the symptoms of most patients. Although antihistamines cannot directly counter or neutralize histamine and cannot prevent the release of histamine, they have a scrambling effect on histamine and can rapidly inhibit the production of wind clusters. Antihistamines have various side effects, and it is best to use those with fewer side effects, especially workers working at height, drivers and other occupations should be used with caution, as they are prone to fainting and lead to accidents. There are many types of antihistamines, and the corresponding antihistamines can be used in combination with the disease and clinical manifestations.
Tips for medication administration.
When taking medication you must pay special attention to follow the doctor’s prescription and dosage exactly. You should not take it because it does not itch today, and then pick it up again tomorrow and continue to take it, which will not only fail to cure but also drag out the chronic hives. After taking the medication continuously for a period of time, the doctor will slowly lower the dose according to the patient’s condition (perhaps from daily to every other day) until he/she is completely well before stopping the medication, which should last at least one month during the acute phase. Do not stop or lower the medication during the medication period to avoid losing all the previous work. If you stop the medication in the middle of the period and the allergic reaction occurs again, you will have to start the medication again.
Some antihistamines can have the side effect of drowsiness, so if it is not good for your daytime work, you can talk to your doctor about switching to something that is less likely to cause drowsiness.
If not cured immediately during the acute phase, it can become chronic urticaria, that is, intermittent attacks that occur within a month and last for more than six months. Some people even last for more than a few years. Chronic is not incurable, but it requires patience and a longer period of time to take the medication as described above.