I. Introduction
Urticaria (urticaria) is commonly known as wind clumps, rash clusters, wind bumps, and rash lumps (similar in name to rubella, but not the same disease). It is a common skin disease. It is caused by various factors that lead to temporary inflammatory congestion of the blood vessels of the skin and mucous membranes with a large amount of fluid exudation. This results in localized edematous damage. It occurs and subsides rapidly, with severe itching. There may be fever, abdominal pain, diarrhea or other systemic symptoms.
It can be divided into acute urticaria, chronic urticaria, angioneurotic edema, and papular urticaria. When you get urticaria, you should stay away from allergens and choose professional drugs for treatment, such as comfrey lotion with mugwort, to prevent the condition from deteriorating.
Second, the classification of urticaria
Urticaria can be divided into acute urticaria, chronic urticaria, artificial urticaria, peptic urticaria, cold urticaria, cholinergic urticaria, solar urticaria, pressure urticaria, serum urticaria, contact urticaria, water urticaria, adrenergic urticaria, urticarial vasculitis, angioneurotic edema, urticaria and angioedema, etc.
Three, urticaria care common sense
1.Find the allergen first. Suspected allergens should be avoided as far as possible, such as the injection site a erythema, whether the injection of drugs or disinfectants allergic, feasible patch test to identify.
2.Patients with acute illness should be prepared at home with finasteride, oxygen, corticosteroids, etc. to facilitate resuscitation, and closely observe changes in condition and be ready to send to hospital for resuscitation.
3, diet should be light, avoid stimulating and allergenic food, keep the bowels open, if necessary, apply laxative drugs and soap and water enemas. Do not put flowers and spray insecticide indoors to prevent re-sensitization to pollen and chemicals. In addition, go to a regular hospital for allergen testing to clarify what you are allergic to. Do targeted avoidance. Ask the patient to quit smoking and drinking.
4.After using antihistamine drugs, drowsiness, vertigo, and even mild hallucinations may occur. For elderly patients and patients with cardiovascular disease, the bedtime dosing method can be adopted to reduce the occurrence of accidents.
5. Patients should rest in bed, drink more water, pay attention to keeping warm, and keep the bowels open. Bed sheets and bedding should be clean, and the room should be kept quiet.
6, the patient should try to avoid scratching, so as not to cause increased lesions and increased itching. Mainly because when scratching locally, but let the local temperature increase, so that the blood release more histamine (allergen), but will be worse.
7. Do not apply heat, although heat can make the local temporary relief, but in fact, it is another kind of stimulation, because heat will make the blood vessels tense, releasing more allergens.
Four, the onset of causes
There are many factors that cause urticaria, the cause is more complex, about 3/4 patients can not find the cause, especially chronic urticaria. The common causes are
Food: such as fish, shrimp, eggs, milk is the most common, followed by meat and certain plant foods, such as strawberries, cocoa, tomatoes. Also spoilage foods break down into peptides, and alkaline peptides are histamine releasers. Protein foods are absorbed in the form of peptones or peptides before they are thoroughly digested, which can cause urticaria, which is more common in children and may also be due to the different permeability of the digestive tract mucosa in children compared to adults. Also added to the food coloring, flavoring, preservatives, natural or synthetic substances in the food can also cause urticaria.
Drugs: They can be divided into two categories, one for drugs that can form antigens, such as penicillin, serums, vaccines, sulfonamides, furazolidone, etc., and the other for histamine releasing agents, such as aspirin, morphine, codeine, pethidine, polymyxin, vitamin B, quinine, hydrazinpyridazine, etc.
Infection: Various infectious factors can cause this disease. The most common are viruses and Staphylococcus aureus that cause epizootic, followed by hepatitis, infectious mononucleosis and coxsackievirus; parasitic infections, such as roundworms, hookworms, schistosomes, filarial worms, amoebas and malaria parasites; bacterial infections such as acute tonsillitis, alveolar abscess, sinusitis, impetigo, sepsis, etc.
Inhalants: pollen, dust, animal dander, smoke, feathers, fungal spores, volatile chemicals (such as formaldehyde, acrolein, pyrethrum, cosmetics, etc.) and other airborne allergens, etc.
Physical factors: such as cold, heat, sunlight, friction and pressure and other physical and mechanical stimuli.
Animal and plant factors: such as insect bites, poisonous hair stings (such as caterpillars, beetles and moths’ hair scales into the skin) and contact with nettles, wool, etc.
Mental factors: mental stress or excitement, after exercise caused by acetylcholine release.
Genetic factors: certain types of urticaria are related to heredity, such as familial cold urticaria, hereditary familial urticaria syndrome, etc.
V. Clinical manifestations
According to the course of the disease is divided into acute and chronic, the former can be cured after a few days or weeks, the latter is recurrent episodes last for months.
Acute urticaria accounts for about 1/3 of all urticaria, and the onset of urticaria is acute, with lesions occurring suddenly as limited red bumps of varying size, most of which last from half an hour to several hours and subside naturally. The location is variable and can be generalized or confined to a certain area.
Chronic urticaria, which accounts for about 2/3 of all urticaria, occurs repeatedly, sometimes more and sometimes less, often over a period of years and months, and can last more than 2 months. The symptoms are generally mild and most patients cannot find the cause.
Artificial urticaria (factitious unicatia): When the skin is scratched with a nail or blunt instrument, a strip-like elevation in line with the scratch occurs, which soon subsides and is accompanied by itching.
Peptonic urticaria (acute protein allergic urticaria): caused by peptones from the decomposition of food proteins. The skin is red and congested, windy, with headache and weakness. The duration of the disease is usually short and can subside in 1 to 4 hours, sometimes lasting for a few hours or 1 to 2 days. It is an antigenic antibody reaction.
Cold urticaria: There are two types of cold urticaria: acquired and familial. Familial cold urticaria is inherited in an autosomal dominant fashion. It usually develops after 0.5 to 4 h of exposure to cold air or cold water. Acquired cold urticaria may be an autoimmune allergic reaction to cold, mostly idiopathic, and about 1/3 have a history of genetic allergy.
Cholinergic urticaria: Mostly seen in young people aged 23 to 28 years. The lesions are characterized by small clusters of 1 to 3 mm in diameter, surrounded by a red halo, sparsely distributed, not fused, and with severe itching.
Sunlight urticaria: After the skin is exposed to sunlight or artificial light for a few seconds to a few minutes, local itching, erythema, wind masses, and occasionally angioedema appear, and in severe cases, the rash may be accompanied by chills, fatigue, syncope, spasmodic abdominal pain, bronchospasm, etc.
Pressure urticaria: 4-8h after skin pressure, localized red edematous patches of skin, often deep edema, involving the dermis and subcutaneous tissue, similar to angioedema, with burning or painful sensation, lasting about 8-12h to subside.
Serous urticaria: erythema, pruritus, and wind masses occur at the injection site or all over the body, and also erythema annulare, erythema nodosum, etc. In addition, systemic symptoms such as fever, swollen lymph nodes, myalgia, arthralgia, purpura, and hypocomplementemia may occur and are called serum sickness.
Autoimmune urticaria: In some patients with chronic idiopathic urticaria circulating autoantibodies are found in the serum hence the name. According to statistics, autoantibodies are found in at least 30% of patients with chronic idiopathic urticaria. Intradermal injections of intrinsic autologous serum can cause wind and erythema reactions with IgG-type autoantibodies against IgE or anti- high affinity IgE receptors (FcεRla), both of which release histamine and can stimulate eosinophils in the blood. The condition of urticaria is directly related to the amount of autoantibodies FcεRIa in the serum.
Contact urticaria: skin contact with certain allergens after the occurrence of wind, erythema, can be divided into immune, non-immune and unknown mechanism of three, non-immune contact urticaria is caused by the primary urticaria-causing substances, without sensitization, almost all contacts can occur. Immune contact urticaria is an IgE-mediated tachyphylaxis in most cases. Those with unknown mechanisms have both immune and non-immune manifestations of a reaction.
Waterborne urticaria: Contact with water of any temperature can cause urticaria, with smaller clusters.
Pigmented urticaria: Mostly occurs 3 to 9 months after birth, but there are also those born immediately after birth. The initial damage is often a temporary appearance of rash blocks, which later often recur and disappear in the same place. Finally, they become persistent chloasma or pigmented nodules with an uneven surface. In a few patients, blisters may also appear on the lesions, and when scratched, they appear as a wind cluster.
Adrenergic urticaria: manifests as small, itchy wind masses surrounded by a white halo, which can be caused when emotionally agitated and when coffee is ingested.
Urticarial vasculitis: characterized by the presence of urticarial and necrotizing vasculitis damage. Patients have recurrent chronic urticarial damage, often lasting more than 24h, and a few have laryngeal edema.
Angioneurotic edema: presents as a single or multiple sudden, restricted swelling of the skin with indistinct borders. The skin is normal or mildly red or slightly pale in color. The swelling is elastic to the touch and lasts from a few hours to a few days and resolves on its own.
①Pediatric hereditary angioneurotic edema: Most of them develop before the age of 10, and can recur or even last a lifetime. Patients mainly present with limited subcutaneous edema with swelling and discomfort, without itching.
②Acquired angioedema: the lesions are acute limited swelling, involving subcutaneous tissues, with unclear borders, normal skin color or slightly red, shiny surface, and elastic feeling when touched. It often occurs in the eyelids, lips, earlobes, vulva (foreskin is the most common part) and other parts of the loose tissue, or the mouth, tongue, if it occurs in the larynx mucosa can cause respiratory difficulties, or even asphyxiation leading to death.
Often accompanied by urticaria, the damage is often solitary and lasts for 2 to 3 days before fading, and often occurs repeatedly in the same area. The disease often develops at night and is noticed upon awakening, often without itching, or with only a mild burning and discomfort. About 1/4 of the cases have a history of recurrent erythema, which may precede, coincide with, or be unrelated to the onset of edema. The disease can involve the visceral mucosa, and when the gastrointestinal tract is affected, acute intestinal obstruction such as abdominal cramps, fullness, nausea, vomiting, and inability to pass gas may occur. In severe cases, dehydration and decreased blood pressure may occur, and barium meal angiography may show mucosal edema.
Urticaria and angioedema: the two can occur separately or simultaneously; they manifest as non-finger-indentation edema of the skin, and sometimes involve the mucosa of the upper respiratory tract or gastrointestinal tract.
VI. Treatment
1.Medical treatment
Find the cause of the disease to eliminate the cause of the main, there are infections often have to apply antibacterial, allergies to certain foods temporarily do not eat. Chronic infections are often the cause of chronic urticaria, but in some patients with urticaria the cause is difficult to determine or cannot be found.
2, internal medication: antihistamines are important drugs for the treatment of various urticaria patients and can control the symptoms of most patients. antihistamines, although they cannot directly counter or neutralize histamine and cannot prevent the release of histamine, have a scrambling effect on histamine and can quickly 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 workers should be used with caution, as it is easy to cause accidents due to fainting. The use of an antihistamine for a long time is likely to cause drug resistance, so it can be replaced by another one. Or alternate or combine them. Children are more resistant than adults, so the relative dosage is also large.
There are many types of antihistamines, and Antares (hydroxyzine) can be used in combination with the condition and clinical manifestations to have a good stabilizing and antihistamine effect on artificial urticaria, cholinergic urticaria and cold urticaria.
Aminoacetic acid can be used for cold urticaria and giant urticaria, atropine or probenecid and chlorpromazine can be used for cholinergic urticaria.
Calcium can be used for acute urticaria, and drugs such as reserpine and anlagen for chronic urticaria.
Steroid hormones are used in severe acute urticaria and serous urticaria. Smaller doses are available for stress urticaria and complement-activated urticaria. Urticaria complicated by anaphylaxis is even more important. Some people apply the therapy of injection every 3 to 4 weeks to treat chronic urticaria.
VII. Disease care
Care measures.
1, first find the allergen. Suspected allergens should be avoided as far as possible, such as the injection site a erythema, whether the injection of drugs or disinfectants allergic, feasible patch test to identify.
2.Patients with acute illness should be prepared at home with finasteride, oxygen, corticosteroids, etc. to facilitate resuscitation, and closely observe changes in condition and be ready to send to hospital for resuscitation.
3, diet should be light, avoid stimulating and allergenic food, keep the bowels open, if necessary, apply laxative drugs and soap and water enemas. Do not put flowers and spray insecticide indoors to prevent re-sensitization to pollen and chemicals. In addition, go to a regular hospital for allergen testing to clarify what you are allergic to. Do targeted avoidance. Ask the patient to quit smoking and drinking.
4.After using antihistamine drugs, drowsiness, vertigo, and even mild hallucinations may occur. For elderly patients and patients with cardiovascular disease, the bedtime dosing method can be adopted to reduce the occurrence of accidents.
5. Patients should rest in bed, drink more water, pay attention to keeping warm, and keep the bowels open. Bed sheets and bedding should be clean, and the room should be kept quiet.
6, the patient should try to avoid scratching, so as not to cause increased lesions and increased itching. Mainly because when scratching locally, but let the local temperature increase, so that the blood release more histamine (allergen), but will be worse.
7, do not apply heat, although the heat can make the local temporary relief, but in fact is another kind of stimulation, because the heat will make the blood vessels tense, the release of more allergens.