Urticaria (angioedema angioedema)

Hives (angioedema angioedema) - an allergic disease of the skin and mucous membranes, characterized by the formation of blisters, accompanied by itching and burning. Distinguish acute, including acute limited edema Quincke, 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, etc.) and endogenous (pathology of internal organs - gastrointestinal tract, endocrine system) factors. In children, the causes of chronic urticaria are often helminthic invasion, in adults - amoebiasis, giardiasis. The development of urticaria, as a rule, is based on the allergic reaction of immediate type hypersensitivity, which is an anaphylactic skin reaction to biologically active substances. A crucial role in the formation of blisters in urticaria is played by functional vascular disorders in the form of an increase in the permeability of the capillary wall and inflammatory mediators - histamine, serotonin, bradykinin released by mast cells during the antigen-antibody reaction. In the development of urticaria from physical effects is involved acetylcholine (cholinergic urticaria).

[1], [2]

Acute urticaria

Acute hives occur violently in the form of highly itching urticaria rashes on the trunk, upper and lower extremities. Blisters of pale pink or porcelain color of different sizes and different locations are elevated above the level of the skin, rounded, rarely - elongated, inclined to merge, sometimes into vast areas and with massive edema not only of the dermis, but also of the hypodermis (giant urticaria). At the height of the disease, there is a violation of the general condition of the patient: fever, malaise, chills, joint pain (nettle fever). A distinctive feature of the blisters is their ephemeral nature, as a result of which each element usually exists only for several hours and disappears without a trace. There may be rashes on the mucous membranes of the lips, tongue, soft palate. In the case of the defeat of the respiratory tract (larynx, bronchi), difficulty in breathing and paroxysmal cough are noted, with a rapidly increasing edema a threat of asphyxia is created.

Options for acute urticaria are solar and cold urticaria. At the heart of the development of solar urticaria are violations of porphyrin metabolism in liver diseases. Porphyrins have a photosensitizing property, so after a prolonged exposure to the sun in the spring-summer period, blisters appear on the exposed areas of the skin (face, chest, extremities). Cold urticaria occurs as a result of the accumulation of cryoglobulins, which possess the properties of antibodies. Blisters appear while staying in the cold and disappear in the heat.

[3], [4], [5], [6], [7], [8], [9]

Acute limited edema of Quincke

Acute limited edema Quincke is characterized by sudden development of edema of the skin, mucous membrane, subcutaneous fat (cheeks, eyelids, lips) or genital organs. Single or multiple blisters of a dense elastic consistency of white or pink appear. Often in practice, there is a simultaneous existence of ordinary urticaria and angioedema. A few hours or 2-3 days the process is resolved without a trace.

[10], [11], [12], [13]

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 different number of blisters, but with different remissions in duration. Blisters appear on any areas of the skin. Their appearance may be accompanied by weakness, temperature reaction, headache, discomfort, arthralgia. Excruciating itching can cause the development of insomnia, neurotic disorders. In the blood there are eosinophilia, thrombocytopenia.

Sometimes there is an artificial urticaria, which occurs after a mechanical effect on the skin with a blunt object. After a while the rashes spontaneously disappear.

[14], [15], [16]

Treatment of angioedema angioedema Quincke

It is necessary to sanitize foci of chronic infection, correction of the gastrointestinal tract. Of great importance is diet, rational mode of work and rest. In acute urticaria and edema Quinck, measures are taken to remove the antigen (laxative, plentiful drink, etc.), prescribe antihistamines inwards or parenterally Tavegil, fenkrol, suprastin, fenistil (drops), analgesin, 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% solution of magnesium sulfate 10.0 ml intravenously or intramuscularly. A severe attack of urticaria is stopped by a 0.1% solution of epinephrine 1.0 ml subcutaneously or by administration of corticosteroid hormones. In persistent and severe urticaria, corticosteroids (prednisolone, etc.) are used in a gradual dose reduction mode or corticosteroids of prolonged action (kenalone or diprospan 1.0-2.0 ml intramuscularly once every 14 days) are used. External appoint "boltushki", corticosteroid ointments. There are reports of the effectiveness of extracorporeal detoxification hemoperfusion, plasmapheresis. With solar urticaria apply Delagil, plakvenil, photoprotective creams. From physiotherapeutic means for urticaria appoint warm baths with decoction of medicinal herbs, ultrasound and diadynamic currents paravertebrally, UV irradiation and PUVA therapy (with the exception of solar urticaria), sanatorium treatment.