Urticaria (Quincke's angioedema)

Urticaria (angioedema Quincke) is an allergic disease of the skin and mucous membranes, characterized by the formation of blisters, accompanied by itching and burning. A distinction is made between acute, including acute limited Quincke's edema, and chronic urticaria.

Causes and pathogenesis of urticaria

Acute urticaria and Quincke's edema develop under the influence of exogenous (temperature, mechanical irritation, drugs, food products, etc.) and endogenous (pathology of internal organs - gastrointestinal tract, endocrine system) factors. In children, chronic urticaria is often caused by helminthic invasions, in adults - amebiasis, giardiasis. The development of urticaria is usually based on an allergic reaction of immediate hypersensitivity, which is an anaphylactic reaction of the skin to biologically active substances. The decisive role in the formation of blisters in urticaria is played by functional vascular disorders in the form of increased permeability of the capillary wall and inflammatory mediators - histamine, serotonin, bradykinin, released by mast cells during the antigen-antibody reaction. Acetylcholine (cholinergic urticaria) is involved in the development of urticaria from physical effects.

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Acute urticaria

Acute urticaria occurs violently in the form of intensely itchy urticarial rashes on the trunk, upper and lower extremities. Blisters of pale pink or porcelain color of different sizes and different localizations are raised above the skin level, round, less often - elongated, tend to merge, sometimes into large areas and with massive edema of not only the dermis, but also the hypodermis (giant urticaria). At the height of the disease, a violation of the general condition of the patient is noted: an increase in body temperature, malaise, chills, joint pain (urticaria). A distinctive feature of blisters is their ephemerality, as a result of which each element usually exists only for a few hours and disappears without a trace. Rashes may appear on the mucous membranes of the lips, tongue, soft palate. In case of damage to the respiratory tract (larynx, bronchi), difficulty breathing and paroxysmal coughing are observed; with rapidly increasing edema, there is a risk of asphyxia.

Variants of acute urticaria are solar and cold urticaria. Solar urticaria is caused by porphyrin metabolism disorders in liver diseases. Porphyrins have a photosensitizing property, which is why blisters appear on exposed skin areas (face, chest, limbs) after prolonged exposure to the sun in the spring and summer. Cold urticaria occurs as a result of the accumulation of cryoglobulins, which have antibody properties. Blisters appear when exposed to cold and disappear in the heat.

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Acute localized Quincke's edema

Acute limited Quincke's edema is characterized by the sudden development of edema of the skin, mucous membrane, subcutaneous fat (cheeks, eyelids, lips) or genitals. Single or multiple blisters of dense elastic consistency of white or pink color appear. In practice, the simultaneous existence of common urticaria and angioedema is often noted. After several hours or on the 2-3 day, the process resolves without a trace.

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Chronic recurrent urticaria

Chronic recurrent urticaria occurs with prolonged sensitization, i.e. in the presence of foci of chronic infection, concomitant diseases of the gastrointestinal tract, liver. Recurrence is noted daily with rashes of varying numbers of blisters, but with remissions of varying duration. Blisters appear on any areas of the skin. Their appearance may be accompanied by weakness, temperature reaction, headache, malaise, arthralgia. Painful itching can cause the development of insomnia, neurotic disorders. Eosinophilia and thrombocytopenia are noted in the blood.

Sometimes artificial urticaria occurs, which occurs after mechanical impact on the skin with a blunt object. The rash disappears spontaneously after some time.

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Treatment of Quincke's angioedema

It is necessary to sanitize foci of chronic infection, correct the activity of the gastrointestinal tract. Diet, rational work and rest regimen are of great importance. In acute urticaria and Quincke's edema, measures are taken to remove the antigen (laxatives, plenty of fluids, etc.), antihistamines are prescribed orally or parenterally (tavegil, fencorol, suprastin, fenistil (drops), analergin, loratal), hyposensitizing agents - 10% calcium chloride solution 10.0 ml intravenously or 10% calcium gluconate solution 10.0 ml intravenously (or intramuscularly), 30% sodium thiosulfate solution 10.01 ml intravenously, 25% magnesium sulfate solution 10.0 ml intravenously or intramuscularly. A severe attack of urticaria is stopped with a 0.1% solution of adrenaline 1.0 ml subcutaneously or by the introduction of corticosteroid hormones. In case of persistent and severe urticaria, corticosteroids (prednisolone, etc.) are used in a mode of gradual dose reduction or prolonged-action corticosteroids are used (kenalon or diprospan 1.0-2.0 ml intramuscularly once every 14 days). "Talkies" and corticosteroid ointments are prescribed externally. There are reports on the effectiveness of extracorporeal detoxifying hemoperfusion, plasmapheresis. In case of solar urticaria, delagyl, plaquenil, and sunscreen creams are used. Physiotherapeutic measures for urticaria include warm baths with decoctions of medicinal herbs, ultrasound and paravertebral diadynamic currents, UV irradiation and PUVA therapy (except for solar urticaria), and spa treatment.