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Chronic urticaria refers to temporary inflammatory congestion and edema in the tissues caused by various factors, and those with a course of more than 6 weeks are called chronic urticaria. The cause is often uncertain. The clinical manifestation is that the patient develops wind masses and plaques on the trunk, face or limbs from time to time. Seizures range from several times a day to once a few days.

Basic Information

English name: chronic urticaria
Visiting department: dermatology

Common causes: Can be caused by drugs, food, physiology, physical and other reasons
Common symptoms: Itchy or tingling skin, rash, discomfort, headache, fever

Causes of chronic urticaria

Common causes of chronic urticaria are:

Diet

Food is common with fish, shrimp, crab, and eggs; some spices and condiments can also cause it.

2. Drugs

Drugs can cause the disease. Penicillin, sulfa, tetramine, and serum vaccines cause urticaria through immune mechanisms. And aspirin, morphine, atropine, vitamin B ₁ and other drugs are histamine releasers, which can directly cause mast cells to release histamine and cause urticaria.

3. infection

Includes viruses (such as upper virus, hepatitis virus), bacteria (such as golden grapes), fungi, and parasites (such as roundworms).

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 all cause it.

6. Other factors

Gastrointestinal disorders, metabolic disorders, endocrine disorders and mental factors can also be caused.

Clinical manifestations of chronic urticaria

Before the appearance of rubella, the skin was itchy or tingling, and the rash appeared quickly. Some patients develop systemic symptoms such as lack of appetite, general discomfort, headache, or fever within hours or 1 to 2 days of rubella. Rubella masses appear as flat, red or pale edema spots with redness on the edges. The rubella block is called ring-shaped urticaria, and several adjacent ring-shaped lesions can be connected or fused to form a map. When there is a blister in the rubella block, it is called vesicular urticaria.

Rubella masses often disappear naturally within a few hours or 1 to 2 days, and new skin lesions appear in other parts. Rubella masses have disappeared and no new damage occurs within 24 hours. After the rubella mass disappeared, the skin returned to normal. The size and number of rubella blocks can vary, and can appear on any part of the skin and mucous membranes. Rubella blocks cause sharp itch, acupuncture, or burning sensation, varying in degree to each person. In severe cases, there are systemic symptoms such as headache and fever. Especially in patients with acute urticaria, fever can reach about 40 ° C, blood pressure can be reduced, and even syncope and shock occur. Most patients only have itchy rubella patches without other symptoms.

The course of rubella block is uncertain, and some rashes occur several times within a day. After several days or 1 to 2 weeks to several weeks, the onset is stopped, which is called acute urticaria. Many patients develop rashes every day, or appear or worsen intermittently, repeatedly, or alleviate or disappear, which can last for months or years, known as chronic urticaria and special types of urticaria.

Chronic urticaria test

Chronic urticaria histopathological examination: simple localized edema, serous exudation of the nipple and upper dermis, papillary edema, infiltration of a small amount of lymphocytes around blood vessels, infiltration can also be dense and mixed with eosinophils.

Diagnosis of chronic urticaria

Diagnosis can be made based on medical history, clinical manifestations and examinations.

Chronic urticaria treatment

The etiology of chronic urticaria is complex, the pathogenesis is not clear, treatment is difficult, and the course of treatment is long. The correct treatment needs to do the following:

1. Find the cause

Inquire about the medical history in detail, try to find the cause of the disease, understand whether there is a family disease, history of acute and chronic infections, medication history, occupation, lifestyle habits and environmental changes. Check blood, urine, and stool routinely, and perform skin allergen test, ice cube test, acetylcholine skin test, serum IgE measurement, and serum complement measurement as needed. Individual patients should be examined for HBV-DNA, thyroid antibodies, and malignant tumors.

2. Avoid predisposing factors

Keep cold urticaria warm, acetylcholine urticaria reduces exercise, sweating, and mood swings, and contact urticaria reduces the chance of contact with allergens.

3. Use antihistamines

Most patients get satisfactory results after treatment with antihistamines, and a few patients are more stubborn. For refractory refractory urticaria, increase the dose or use it in combination. H ₁ receptor antagonists have strong effects on histamine and other inflammatory mediators, and are effective in treating all types of urticaria. Commonly used H ₁ receptor antagonists are diphenhydramine, cyproheptadine, chlorpheniramine, atorvastatin, cetirizine, mizolastine, loratadine, ebastine, azelastine And desloratadine. Two different types of H ₁ receptor antagonists can be used in combination or combined with H ₂ receptor antagonists (cimetidine, ranitidine). Antaral has strong antihistamine, anticholinergic, and sedative effects, and has a good antipruritic effect. It is effective for acute, chronic urticaria and cold urticaria. Doxepin is a tricyclic antidepressant, mainly used for the treatment of depression and anxiety neurosis. This drug also has a strong anti-H ₁ and H ₂ receptor effect. It is especially effective for chronic urticaria, with less side effects.

4. Select drugs that have the effect of inhibiting the degranulation of mast cells

Ketotifen can increase the concentration of cAMP in the body, inhibit degranulation of mast cells, prevent the release of inflammatory mediators, and have a stronger inhibitory effect than sodium cromoglycate, which can be taken orally. Tranilast reduces histamine release by stabilizing mast cell membranes.

5. Glucocorticoids

Has a strong anti-inflammatory, anti-allergic effect. Can stabilize mast cell membrane and lysosomal membrane, inhibit the release of inflammatory mediators and lysosomal enzymes; constrict blood vessels and reduce exudation. It has good curative effect on urticaria, especially suitable for acute urticaria, serotype urticaria, stress urticaria and autoimmune urticaria. Commonly used drugs include prednisone and depot pine. In emergencies, intravenous infusion with hydrocortisone, dexamethasone or methylprednisolone.

6. Immunosuppressive

When patients with chronic urticaria have an autoimmune foundation and their condition is repeated, and the above treatments are not effective, immunosuppressants can be applied. Cyclosporine has a good curative effect, and azathioprine, cyclophosphamide, methotrexate, and immunoglobulin can be tried. Tripterygium also has certain curative effects.

7. Non-specific anti-allergic therapy and other therapies

10% calcium gluconate injection, 10% sodium thiosulfate, 6-aminocaproic acid, reserpine, aminophylline and other drugs can be tried.

8. Handling of special circumstances

People with urticaria due to infection should be treated with anti-infective drugs. For cold urticaria, cyproheptadine, doxepin, ketotifen, hydroxyzine, and mizolastine are better in antihistamines; vitamin E, cinnarizine, and H ₂ receptor antagonists . Azastatin has a better effect on cold urticaria through its antihistamine, anticholine and anti-serotonin effects. For solar urticaria, in addition to the antihistamines hydroxyzine or chlorpheniramine, hydroxychloroquine, thalidomide, or perchlorcyclazine can also be taken.