Urticaria - disease manifested rash primary element is the blister, i.e. clearly limited portion of skin edema. Blister color red, diameter - from a few millimeters to a few centimeters.
Urticaria is third in the structure of allergic disease after asthma and drug allergies. 15-25% of the population over a lifetime transfers urticaria or angioedema at least once.
Types and symptoms of urticaria
The nature of the skin lesions of urticaria due to the peculiarities of the vascular network of the skin ( "shock organ"). The main element of any kind of hives - wheal accompanied by itching and characterized by "volatile", i.e. the ability to disappear within a few minutes or hours. Such blisters have a red hue, rise above the skin, fluid in itself does not contain. The area of their distribution may be different - from small localization coin-sized to large lesions.
acute urticaria
The acute form occurs simultaneously in direct contact with an irritant or allergen and passes through several hours. Perhaps a combination of acute urticaria angioedema.
chronic urticaria
The chronic form is retained for more than 6 weeks. It is caused by the increasingly non-immune mechanisms, including systemic diseases. Often (about 70% of cases), chronic urticaria, the cause remains unknown.
cold urticaria
It develops when exposed to cold. Cold urticaria common cause - effect of water or low temperature air. The reaction generally occurs within a few minutes after exposure to cold. In severe cases of cold urticaria is accompanied by weakness, headache, dizziness, shortness of breath, heart palpitations. There may be abdominal pain, and nausea.
Reflex cold urticaria - common or local reaction to the cold. Sometimes it arises only when the cooling of the body. The local reaction to cold manifested rash appearing around the chilled area of skin, whereas the skin, which is directly in contact with a cold, no infestation.
nervous urticaria
It occurs when severe or prolonged stress. In this case, symptomatic treatment brings only temporary relief, and with prolonged stress loses its effectiveness. To prevent chronic urticaria Nervous necessary to remove the source of stress, undergo psychotherapy or relaxation activities.
Contact urticaria
This form appears upon contact of the skin or mucosa with certain substances. Characterized by blisters, itching, burning. The most common cause of contact urticaria - latex. In severe cases there may be a complication in the form of anaphylactic shock.
mechanical urticaria
Dermograficheskaya (mechanical) urticaria - represents a linear elevation, and redness in the skin by mechanical stimuli (e.g., pressure belts, vibration of the cycling and et al.).
Similar to its shape - urticaria of impact pressure - occurs 4-6 hours after skin compression (elastic stockings, and shoes etc.). There are two forms of urticaria pressure effects - immediate and delayed. Immediately form - redness and blisters appear a few minutes after pressure on the skin (without rubbing and stretching). Rash accompanied by a burning sensation and held 30 minutes, but no more than 2 hours. Slow shape - dark, itchy and painful blisters appear on parts of the body subject to prolonged compression of: after a long walk, sit. The rash appears anywhere between 30 minutes to 9 hours after skin irritation and persists for about 36 hours. Perhaps malaise, chills, headache.
Less common forms of
Akvagennaya urticaria - a rare form. Small bumps appear after contact with water at any temperature. just itching without a rash may appear in some cases (akvagenny itching).
voltage triggered urticaria exercise; It is manifested as a rash, edema vessels, wheezing, decrease in blood pressure (hypotension).
Heat rash. For this form characterized by small elevations (5-10 mm) over the skin, arising after overheating, baths, hot shower.
Solar urticaria. It arises as a result of exposure to sunlight. It begins a few minutes after sun exposure; It passes through 1-2 hours after sun exposure.
Idiopathic urticaria - the cause of which is unclear.
analyzes
Diagnosis of acute urticaria is usually not difficult and can be performed by a general practitioner or a medical allergist-immunologist.
When the response to food intake or medications used provocative tests with suspected allergens after the elimination diet.
Inhaled allergens - are used skin testing, radioallergosorbent test (PACT)
Idiopathic urticaria, continuing for more than 6 weeks intended to exclude systemic diseases (for this skin biopsy is performed, the determination of ESR in the general analysis of blood, urine, anatomist, etc.)
provocation testing
- Cold urticaria - cold test: a piece of ice was placed on the skin for 5 minutes; observe the reaction over 10-15 minutes.
- Thermal or physical stress provoked urticaria: exercise stress test, skin test with methacholine (local reaction to intradermal injection of 0.1 mg of methacholine in a 0.9% solution of sodium chloride).
- The solar urticaria - solar irradiation is carried out a certain wavelength. Delayed urticaria resulting compression: applied pouch with sand 2-4 kg 3 hr.
- Akvagennaya urticaria - use tap water of different temperatures.
- Infectious urticaria - conduct bacteriological smear from the throat, the titer antistreptolisin, Vietnam, fecal analysis (for parasites), hepatic function tests on Mononucleosis test.
- Autoimmune urticaria - antinuclear antibodies (anatomist), Complement, cryoglobulins, serum protein electrophoresis.
urticaria treatment
In the treatment of acute urticaria is preferable to use antihistamines I generation - Tavegilum, Suprastinum (II generation drugs effect is mainly seen at a later date)
In chronic forms of treatment used
- Loratadine 10 mg 1 time per day,
- cetirizine by 0.01 g of 1 times a day (evening) or 0.005 g of 2 times a day (morning and evening)
- cyproheptadine or 4-8 mg every 4-8 hours (children - 0.25-0.5 mg / kg / day every 6-8 hours)
- or fexofenadine (telfast) - 180 mg 1 time per day for adults 10-20 ebastine or 1 mg once a day for children in the form of a syrup,
- additionally - cimetidine, ranitidine.
Course and prognosis
Ameliorating urticaria occurs less than 72 hours in 70% of patients. In the chronic form of improvement in the first day it is observed in 30% of patients.
The causes of urticaria
Factors causing hives set. Here are some of them:
- Sensitization: foods, including dietary supplements, medications, insect venom of stinging, pollen, cosmetics, cleaning products and others.
- Aspirin and other nonsteroidal anti-inflammatory drugs (ibuprofen, indomethacin, diclofenac, Ortophenum et al.)
- Iodinated contrast media
- Plasma expanders (dextran solution)
- Local anesthetics (lidocaine, procaine, etc).
- ACE inhibitors (captopril, enalapril, etc.).
- Codeine
- tubocurarine
- morphine
- thiopental sodium
- Blood transfusion
- Physical factors: heat, cold, sun exposure, pressure, etc.
- emotional stress
- Diseases in which urticaria - one of the syndromes
- Infections - viral (Infectious mononucleosis, hepatitis), Helminth infections
- Collagenosis (systemic lupus lupus, rheumatoid arthritis)
- serum sickness
- mastocytosis
- Tumors
- hyper- and hypothyroidism
