Hives with edema
The term "urticaria" is used whenthe occurrence of blisters on the skin and mucous membranes, accompanied by itching. Hives can accompany many diseases with a variety of causes, have acute and chronic course, a different prognosis. The prevalence of urticaria ranges from 15.3 to 31%.
The blister is a localized edemapapillary layer of the skin or superficial layers of the submucosa, is characterized by short-term existence (from several minutes to several hours) and a complete disappearance. In the genesis of edema lies the expansion of arterioles, an increase in the permeability of capillaries and venules. Similar phenomena form the basis and edema of Quincke, but it is distinguished by a large area, spreading to deeper layers of the skin and mucous membranes due to the expansion of larger vessels, the absence of itching.
The reason for the change in caliber and increaseVascular permeability is provided by many vasoactive mediators: histamine, bradykinin, serotonin, acetylcholine, leukotrienes. One of the most important sources of histamine and other mediators are mast cells (labrocytes), localized in loose connective tissue of the dermis, subcutaneous adipose tissue, gastrointestinal tract, bronchi, along the course of blood vessels. Of no small importance in the development of urticaria may be a decreased deactivation of histamine and other allergenic substances in the liver, their excessive intake of food or synthesis in the intestine. It can cause different medications, high or low temperatures (with a congenital cell defect). The autoimmune mechanism of urticaria is assumed in a number of patients. Among the factors contributing to the emergence of urticaria, we can identify: food, food additives, drugs, concomitant infectious or somatic diseases, hereditary, psychological, physical factors, various inhalants.
Reaction to food can occur as withinvolving immune mechanisms, and without the involvement of the immune system (pseudoallergic reactions). The most common urticaria and edema are the following products: eggs, chocolate, nuts, fish, milk, wheat, strawberries, strawberries. Sauerkraut, some sorts of cheese, marinated fish, chocolate contain histamine and tyramine, which cause blisters without a typical allergy.
Nutritional supplements. Added to foods tartrazine, sodium benzoate, salicylates, various flavors can cause the development of urticaria.
Medicines. Many drugs cause hives through various mechanisms of allergy (penicillin, codeine, morphine, radiopaque substances, anticoagulants, dextrans, polymyxin, sulfonamides, B vitamins, cephalosporins, tetracycline, novocaine, diphenyl, carbamazepine). Non-steroidal anti-inflammatory drugs (aspirin, analgin, indomethacin, etc.) can alter metabolism, forming edema. The development of urticaria is sometimes associated with the introduction of blood products, vaccines and serums.
Infectious agents. Urticaria can accompany various infectious viral diseases, in particular, viral hepatitis B, helminth infections (ascariasis, toxocarosis, etc.), protozoal infections (for example, giardiasis), combined with foci of bacterial infection (dental caries, sinusitis, cholecystitis, tonsillitis, etc.) , with the presence of Helicobacter pylori, with sensitization to yeast fungi of the genus Candida.
Somatic diseases. Among the diseases associated with urticaria, systemic connective tissue diseases (dermatomyositis, systemic lupus erythematosus), malignant tumors of various localization, liver disease, gastrointestinal tract, and macroglobulinemia, thyroid disease can be distinguished.
Hereditary factors. Episodes of recurrent urticaria and angioedema may be the result of a congenital defect in the immune system.
Physical factors. Among the physical factors that cause such an allergic reaction, high and low temperatures, mechanical irritation of the skin, vibration, pressure, and ultraviolet radiation are released.
Psychological factors. Emotional overstrain can be noted as the cause of urticaria in some patients.
Inhaled allergens. Book, house dust, epidermal allergens, pollen of plants, spores of fungi can provoke urticarial reactions.
There are acute and chronic urticaria.
Acute urticaria is characterized by suddenthe appearance of itchy blisters, disappearing no later than 48 hours. Repeated episodes of rash are not observed. Clinical local manifestations of acute urticaria consist in point bubble eruptions on different parts of the body, often coalescing, migrating, with pronounced disorders of the microcirculation, blisters can have a cyanotic hue. In severe cases of urticaria, systemic manifestations are possible: fever up to 38 ° C, joint pain, abdominal pain, vomiting, diarrhea, in some cases reactive pancreatitis, swelling of the meninges, accompanied by meningeal symptoms. With a slight swelling in the dermis typical blisters may be absent, manifesting only reddish spots. With the localization of edema on the mucous membrane of the respiratory tract may cough with sputum, shortness of breath.
Chronic urticaria is determined by relapse.bubble eruptions lasting more than 6 weeks with remissions of varying duration. Changes in peripheral blood with urticaria can be expressed in eosinophilia, leukopenia, and increased clotting.
Quincke's edema, or giant urticaria, bythe developmental mechanism is similar to acute urticaria, differing in more pronounced swelling of the skin and subcutaneous tissue with no itching. Localized angioedema in tissues with developed subcutaneous tissue: on the eyelids, lips, limbs and abdomen, scrotum, foreskin, tissues of joints, meninges, inner ear, mucous membrane of the larynx, bronchi, gastrointestinal tract, urinary tract. The most dangerous development of asphyxia is swelling of the mucous membrane of the respiratory tract, which is manifested by hoarseness, cough with clear sputum, shortness of breath. When edema occurs in the gastrointestinal tract, abdominal pain, diarrhea, vomiting, dysuria, urinary retention are observed in the urinary tract. Focal neurological symptoms, dizziness, and convulsive seizures are observed in individual cases of angioedema, in detail about the symptoms can be found on the site www.03clinic.ru.
Mechanical urticaria (vesiculardermographism). Occurs with mechanical irritation of the skin, reproduction of dermographism, is localized at the site of the stimulus. The maximum manifestations - in 5-10 minutes, they disappear in 30-60 minutes. The disease is associated with a local release of acetylcholine and an increase in vascular permeability.
Cold urticaria. Bubbles occur when staying in cold water, in the cold, when special allergenic substances circulating in the body are activated. When drinking cold water, swelling of the mucous membranes of the mouth, esophagus is possible, systemic reactions are manifested by weakness, shortness of breath.
Thermal urticaria. Provoked by heating the skin, contact with hot objects. The mechanism of heat urticaria can be determined by the release of acetylcholine with a subsequent increase in vascular permeability or mast cell degranulation.
Solar urticaria. Occurs under the influence of ultraviolet radiation with a wavelength of 290-500 nm. One of its mediators is histamine. Solar urticaria is often combined with liver disease.
Cholinergic urticaria. Its occurrence is triggered by emotional and physical exertion, warming, eating hot food. It may clinically manifest as small (1-2 mm) urticaria, itching, increased sweating, weakness, headache.
Contact urticaria. It develops when skin comes in contact with an allergen of animal or plant origin, more often directly at the site of contact, however, systemic reactions are also possible with severe sensitization: common blisters, expiratory dyspnea, hypotension. This form of urticaria often affects adolescents with atopy.
Vibrating urticaria and angioedema. Appearance is associated with the release of histamine from mast cells under the action of vibration. Clinically, there may be swelling of the feet after a long walk, buttocks - after cycling, etc.
Hereditary angioedema. Autosomal dominant inheritance is due to insufficient or perverted synthesis of a particular substance, which is accompanied under certain circumstances (trauma, surgery) by the excessive formation of allergens. Edema dense, slowly growing, do not itch, keep for several days. They can occur on the face, limbs. When they are located on the gastrointestinal mucosa, abdominal pain is noted, transient intestinal obstruction is possible. Localization of edema in the larynx is most dangerous.
To clarify the causes of urticaria is neededcareful collection of anamnesis. It turns out a possible connection between the appearance of bubbles and the ingestion of food or drugs, the action of physical (friction, pressure, insolation, high or low temperature) and emotional factors, the presence of concomitant pathology. In the case of atopic genesis of urticaria, the provision of skin tests, the determination of specific ones in the blood can provide some help. For recurrent urticaria, a comprehensive examination is necessary: complete blood count, urine, liver function tests (bilirubin, AST, ALT, GGT), determination of hepatitis B markers, antinuclear antibodies and rheumatoid factor, detection of chronic foci of infection (consultation of an ENT doctor and a dentist), analysis of feces on helminth eggs, protozoa, elimination of neoplasms (ultrasound examination of the abdominal cavity, chest X-ray and other methods). In case of allergic reactions to food, parasitic or medicinal allergens, short-term eosinophilia of blood in the acute period is possible.
Treatment of urticaria and angioedema.
In all forms of urticaria, compliance is imperative.hypoallergenic diet: products with a high content of histamine or tyramine are excluded - chocolate, pickled fish, cheese, coffee, sauerkraut, etc. obligate allergens - citrus, red caviar, strawberries, eggs. In case of intolerance to aspirin, products with a high content of salicylates should be excluded - bananas, green peas, raspberries, apricots, oranges, various canned foods, and also containing yellow dye tartrazine. It is necessary to keep a food diary. When prescribing drugs, possible cross-allergic reactions should be taken into account. It is important to avoid the influence of the corresponding physical factors initiating the urticaria, heat, cold, pressure, mechanical irritation of the skin. Patients with contact urticaria are encouraged to avoid provoking stimuli as much as possible - insect bites, contact with certain animals and plants, the use of hypoallergenic cosmetics and detergents, clothing.
Can be used to reduce itching and swelling.outwardly 0.5% aqueous solutions of menthol, citric acid. It is possible to use antihistamines topically in the form of a gel - “Fenistil-gel” (fenistil), “Soventol” (bamipine). To avoid systemic side effects (dry mouth, difficulty urinating, etc.), it is not recommended to apply the gel on a large surface.
Given the important role of histamine in the developmentbubbles, it is advisable and, as shown by clinical practice, to apply them effectively. Among the first generation antihistamines can distinguish diphenhydramine (difengidromin) Tavegilum (clemastine) Suprastinum (Chloropyramine) Pipolphenum (promethazine) fenistil (dimethindene) primalan (mequitazine) Diazolinum (mebhydrolin) avil (pheniramine); with antiserotoninovoy activity - fenkarol (hifenadine), peritol (cipro-heptadine). Diphenhydramine is currently used quite rarely due to the presence of side effects. The rest of the dose will be selected by a doctor. The duration of taking the first generation of antihistamine drugs is 10-14 days; if necessary, further use requires replacement of the drug. The use of first-generation drugs is limited to their side effects (drowsiness, atropine-like effect). In the second generation of antihistamines, these properties are minimized. The most widespread use of such drugs as claritin, clargothil, clarothin, clridol, erolin (loratadine), zyrtec, cetrin, allertek (cetirizine), semprex (acrivastine), telfast, fexadin (fexofenadine), kestin (ethystine),). ).
Mast cell membrane stabilizers.
Drugs in this group impede degranulationmast cells and basophils and the subsequent release of vasoactive mediators (histamine, leukotrienes, bradykinin, etc.). When urticaria is used zadyden (ketotifen), which also has antihistamine properties. At the beginning of treatment, a sedative effect or agitation is possible, rarely with prolonged use an increase in body weight is noted. The duration of the drug should not be less than 1 month, as the effect develops only after 2-4 weeks. Another membrane stabilizer is tinset (oxatomide), which has more pronounced antihistamine properties. Side effects of the drug include drowsiness, dry mouth. Nalkrome (sodium cromoglycate) is applied orally, more often with urticaria of alimentary genesis, combined with manifestations of gastrointestinal allergy.
Possess anti-inflammatory effect, reducevascular permeability. They are used for severe urticaria and angioedema, their systemic manifestations (shortness of breath, abdominal pain, joint pain, intoxication), often by parenteral route. For this purpose, prednisone, hydrocortisone, dexamethasone, beta-methazone are used. Short-term (5-7 days) external use of glucocorticosteroids for contact urticaria is allowed. For this purpose, lokoid (hydrocortisone-17-butyrate), elokom (mometasone), advantan (methylprednisolone acepononate), celestoderm (betamethasone) in the form of cream or lotion can be used.
One method of treating urticaria is to increasethe body's ability to inactivate free histamine. For this purpose, histaglobulin (a combination of histamine with human gamma globulin) is used; it is injected subcutaneously according to the scheme 0.1-0.3-0.5-0.7-1.0 ml after 3 days. Electrophoresis with successively increasing concentrations of histamine may also contribute to an increase in histamine tolerance.
Urticaria treatment begins with removal.causative factor from the body. With the enteral route of entry of the allergen, the use of sorbents is necessary. For this purpose, it is possible to use enterosgel, polyphepane, filtrum. Enterosgel is a gel-like mass, which is dissolved in hot water before use. Polyphepan available in powder form. The drug Filtrum presented in pill form. Enterosorbents are consumed between meals and drugs for 5-10 days.
Treatment of various urticaria options
Requires cancellation of the drug,foodstuff or another allergen that caused the urticaria. Recommended intake of large amounts of fluid, cleansing enema. Enterosorbents (polyphepan, filtrum, activated carbon) contribute to the binding and removal of the allergen from the gastrointestinal tract. The drugs of choice are antihistamines prescribed parenterally (injections) and inside, according to indications (in cases of severe urticaria, the presence of systemic manifestations) glucocorticosteroids (prednisone, hydrocortisone, dexamethasone, betamethasone) are recommended. In case of pronounced microcirculation disorders, systemic manifestations, infusion therapy is carried out (10% glucose solution, saline, trental, heparin) in combination with glucocorticosteroids (prednisone) and antihistamine drugs.
With significant severity of edema, localizationit in the upper respiratory tract, gastrointestinal tract, hypotension. It is necessary to administer a 0.1% solution of epinephrine 0.01 mg / kg subcutaneously, repeated administration of adrenaline is possible after 20 minutes, the total dose of the drug should not exceed 1.0 ml The use of glucocorticosteroids, parenteral antihistamines (injections), an urgent emergency call and hospitalization of the child in the hospital are mandatory.
For the prevention of recurrence of bubbles is neededdetailed search for the causes of urticaria. The gastrointestinal tract is examined, the presence of chronic foci of infection, systemic, oncological diseases, parasitic invasion is excluded. For the purpose of drug prevention, mast cell stabilizers (ketotifen, dimephosphone, xyphon, sodium cromoglycate), second-generation antihistamines (loratadine, cetirizine, fexofenadine, ebastine, desloratadine) are used for a long course. In the absence of the effect of treatment with an antihistamine drug within 5-7 days, its replacement is required. Sodium thiosulfate, calcium preparations are used as concomitant therapy.
Recommended to eliminate contact with causalfactors, the local use of antihistamines ("Fenistil-gel", "Soventol"), with significant severity of lesions allowed the use of glucocorticosteroids (creams "Lokoid", "Advantan").
Avoid contact with cold objects.cold water. Histaminoreceptor blockers (for example, peritol), membrane stabilizers (ketotifen) are used. In some cases, it is possible to reduce the sensitivity through cold dosage sessions.
Principles of treatment are similar to those with cold urticaria.
Psychogenic urticaria. Medical and psychotherapeutic measures are carried out to correct emotional status, together with a psychologist a possible behavioral stereotype is determined to prevent the occurrence of stressful situations. With the ineffectiveness of psychotherapeutic correction, sedatives with antihistamine effect (atarax), first-generation antihistamines with a short course are used.
Prevention of urticaria and angioedema
Impact elimination recommendedprovoking agents, treatment of comorbidities. In the event of the occurrence of life-threatening conditions in the future, it is necessary to constantly carry the first aid kit and use it. It is necessary to timely warn health workers about drug and other types of intolerance in children.
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