Chronic urticaria have you found the cause. Chronic urticaria - what is it and what are its symptoms? Types of chronic urticaria - myth or reality

Urticaria is a disease that is most often allergic in nature. It is accompanied by skin rashes caused by severe itching.

The size of the rashes can be from a few millimeters to up to two or three centimeters. Itchy spots can move around the body, merge into one continuous spot.

According to the duration of manifestation, the disease is divided into:

• acute form, which is allergic in nature. It flows both in a few days, and can drag on for two or three weeks;
• chronic form - lasts more than six weeks or many years, but there are periods of relapse.

Itchy patches are flat blisters with well-defined borders. Rashes can constantly be located in one place, or move throughout the body.

The period of exacerbation of the disease may be accompanied by headache, nausea and vomiting, sometimes fever may occur.

The reasons

If the cause of acute urticaria is an allergic reaction, then the causes of chronic urticaria are most often diseases. It can manifest itself as concomitant with acute infectious, viral and autoimmune disorders.

At certain moments, the main role of a provocateur is played by a bacterial agent, which manifests itself against the background of chronic diseases.

They can be diseases of the gastrointestinal tract, liver, disorders in the biliary tract. Sometimes even dental or oral problems can be harmful.

The presence of a focus of chronic inflammation in the body leads to the accumulation of active substances in the blood. However, the role of provocateurs is performed by external, non-infectious allergens. They can be pollen, food, dust, drugs.

There is a version that the cause of the chronic form of the disease can be preservatives, dyes and food additives, which are actively used in the food industry.

Video: Dermatologist consultation

Pathogenesis

The pathogenesis of this problem is not well understood. A few years ago, doctors diagnosed almost all patients with idiopathic urticaria.

But recently, the pathogenesis has been revised by specialists, and the diagnosis of "chronic urticaria" is increasingly being made.

The main element of the rash is a blister. It is formed due to swelling of the papillary dermis. The appearance of blisters is due to a local increase in the permeability of the vascular wall, followed by the release of fluid from the vascular bed into the intercellular space.

Edema occurs when mast cells are activated, and histamine is released, which directly increases the permeability of the vascular wall, various small venules.

Types of chronic urticaria - myth or reality

The chronic form of the disease is divided into:

• chronic constant (persistent) - with it there is a daily change of rashes;
• chronic relapsing - in the period of the disease there are long periods of remission.

Until now, there is no clear classification of urticaria in medicine. It can only be conditionally divided into the following forms, depending on the development and etiological factors.

The idiopathic form of the disease is classified as chronic, since it lasts at least six weeks.

Also, this diagnosis is established to the patient in the case when it is impossible to identify and accurately establish the cause that provoked the disease.

The appearance of the idiopathic form can be triggered by the following diseases:

• violation of the functionality of the kidneys;
• arthritis;
• malignant neoplasms;
• diabetes;
• thyroid disease.

Its possible manifestation is also with alcohol and drug intoxication, as well as in violation of the metabolic process in the body.

Recently, doctors have a theory that idiopathic urticaria can provoke the development of diseases such as leukemia, myeloma and lymphoma.

The result of this disease is that the patient's body begins to produce antibodies that destroy the immune system.

recurrent

If relapses appear in the chronic form, then we can talk about a more complex disease - chronic recurrent urticaria. Periods of exacerbations alternate with moments of remission.

During the period of exacerbation, severe itching does not allow the human body to fully function, rest, which causes the patient's irritability. All this can lead to nervous breakdowns and depression.

If the patient has this diagnosis, then doctors forbid visiting baths and saunas, taking hot baths.

Symptoms of manifestation

Rashes can appear due to climate change, stress suffered by SARS. They can be cyclical, for example, during the menstrual cycle, during the change of seasons.

Most often, the chronic form of the disease is accompanied by the following symptoms:

• spontaneous manifestation of rashes, for no apparent reason;
• watery blisters with well-defined edges;
• severe itching;
• swelling of the skin;
• if the edema has spread to the mucous membranes of the stomach and intestines, then nausea, vomiting, and stool disorders are likely.

Diagnostic methods

Diagnosis of the disease is as follows:

• exclusion of other types of urticaria;
• allergen detection;

If it is not possible to establish the cause of the disease, then doctors diagnose chronic urticaria. That is, in fact, only the factor that provoked the appearance of the rash is revealed, but not the cause.

If the cause is not identified, the results of the tests did not show the full picture, then you may need to contact specialized specialists - a dermatologist, urologist, gastroenterologist.

Treatment Methods

Treatment of chronic urticaria consists of a complex of actions. It includes:

1. establishing the cause of the disease, its elimination;
2. relief during exacerbations of manifestations with the help of antihistamines;
3. preparation of a course of treatment;
4. in case the disease is provoked by the disease, treatment of the provocative disease;
5. prevention.

As you can see, the treatment of the disease also includes drug treatment aimed at eliminating symptoms, improving the body, as well as eliminating the allergen.

Treatment can be carried out with drugs or traditional medicine. Medical treatment includes the use of:

• antihistamines;
• sorbents;
• ointments that contain glucocorticosteroids;
• enzymes for digestion;
• sedatives.

Why Diet Matters

A prerequisite for the treatment of the disease is diet, that is, the exclusion from food of all foods that can provoke an exacerbation.

However, it is quite difficult to independently identify the allergen in the diet. It is advisable to consult with a specialist.

You may need to test for food allergens. Most likely, the doctor will prescribe keeping a food diary.

When dieting, the following types of foods should be removed from the diet:

• fatty, fried, salty, spicy;
• limit dairy products, exclude completely fresh milk;
• flour and bakery products;
• chicken
• red fruits and vegetables;
• grape;
• sweet;
• alcohol, carbonated drinks;
• products containing a large amount of dyes, preservatives, additives;
• chocolate, cocoa.

Prevention

It is almost impossible to cure this disease completely.

In this regard, patients with a chronic form are required to constantly observe and implement preventive measures, which include:

• avoid contact with the allergen if it is external;
• exclude from the diet those foods that can provoke the acute phase of the disease;
• general control over the state of the body;
• prevent diseases of internal organs;
• the use of hypoallergenic cosmetics;
• it is recommended to replace household chemicals with natural ones - baking soda, mustard;
• carry out procedures for hardening the body. This will help strengthen the immune system, the body will become less susceptible to allergens;
• during the period of exacerbation of seasonal infectious diseases, avoid visiting public places.

The most important thing is to prevent the development of the chronic phase of the disease. Therefore, at the slightest sign, you should consult a doctor.

It is almost impossible to independently identify the allergen and establish the category of the disease.

If you are an opponent of drug treatment, then for the treatment of this problem there are many proven traditional medicine that will help to cope with the disease.

Thanks

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Diagnosis, tests and examinations for urticaria

The main complaint of a patient with urticaria is the presence of an itchy rash on the skin and mucous membranes. The rash is represented by small vesicles filled with a clear liquid. When pressed, the bubbles turn pale. The rash can migrate from one area of ​​the body to another. A special characteristic of the rash is its inconstancy - the rash can then reappear, then disappear during the day. The patient, as a rule, describes all these complaints at the doctor's appointment.

Which doctor treats hives? Which doctor should I contact for urticaria?

There are the following questions that the doctor asks during the examination:

• how long the patient has been bothered by rashes and itching on the skin;
• on which part of the body, and under what circumstances, the rash arose for the first time;
• whether the patient comes into contact with potential allergens ( chemicals, pollen, animal hair);
• whether the person is taking any medications, vitamins, or dietary supplements;
• Have you made any changes to your usual diet?
• Does the patient suffer from any chronic diseases?
• whether there are persons suffering from urticaria among the patient's relatives.

If urticaria occurs in an adult or a child against the background of an existing disease of the collagenosis group (for example, rheumatoid arthritis, rheumatism, systemic lupus erythematosus, systemic scleroderma, periarteritis nodosa, dermatomyositis), then the treatment of urticaria is not so much allergist (make an appointment) or dermatologist (make an appointment), How many rheumatologist (make an appointment), since in such a situation the skin symptom is a manifestation of another, systemic disease. Accordingly, success in the treatment of urticaria is determined by the effectiveness of therapy for the underlying pathology of the collagenosis group. This means that with urticaria against the background of diseases of the group of collagenoses, one should contact a rheumatologist, a dermatologist or an allergist, and doctors of these specialties will lead the patient collegially.

In addition, if urticaria is combined with a disease of the gastrointestinal tract (for example, gastritis, celiac disease, ulcerative colitis, etc.) or malnutrition, then, in addition to a dermatologist or allergist, you should contact gastroenterologist (make an appointment) which deals with the treatment of the digestive tract. It is necessary to consult doctors of two specialties, since the success of the treatment of urticaria also depends on the effective and properly selected therapy for diseases of the digestive tract.

In Russia, application tests are widespread, during which the allergen is applied to the patient's skin in liquid form. So, a drop of the allergen is applied to the skin of the patient's forearm and after a while the reaction is determined. The formation of a large red spot at the site of application of the allergen indicates that the patient has an allergy. Up to ten allergens can be tested at the same time.

In the diagnosis of allergies, blood tests are no less informative. As a rule, a general blood test is performed to determine the number of eosinophils, as well as tests to determine the level of immunoglobulins.

Tests performed for hives

What research can a doctor prescribe for urticaria?

During anaphylactic shock, swelling of the soft tissues occurs, including the tissues of the respiratory tract. Therefore, the main danger in this case is shortness of breath due to swelling of the larynx. Air in this case ceases to enter the respiratory tract and acute respiratory failure develops. Also under the influence of histamine ( main mediator of allergic reactions) there is a fall ( scientific collapse) vessels. As a result, blood pressure drops sharply and blood circulation is disturbed. This further exacerbates hypoxia ( oxygen starvation) organism. A disorder of cardiac and respiratory activity develops sharply, the patient's consciousness becomes cloudy and fainting occurs.

The stages of first aid include:

• Call an ambulance- anaphylactic shock is an emergency condition requiring immediate assistance, therefore, as soon as the patient has the first signs of anaphylaxis ( he blushed, began to choke), call an ambulance.
• Ensuring oxygen access to the respiratory tract- during anaphylactic shock, swelling of the airways occurs, as a result of which their lumen narrows and creates an obstacle to the penetration of air. Before the arrival of the ambulance, it is necessary to lay the patient horizontally and straighten the neck to restore airway patency. It is also necessary to check the oral cavity for the presence of chewing gum or other objects that can block the airways.
• Providing blood pressure support- for this, it is necessary to give a horizontal position to the patient with raised legs in order to increase the flow of venous blood.
• Injection of adrenaline and other drugs. As a rule, people prone to allergic reactions carry the necessary medicines with them. Most often, this is a disposable syringe with epinephrine or dexamethasone. Adrenaline is injected intramuscularly into the upper third of the thigh. If you do not have the necessary drugs with you, you must wait for the arrival of an ambulance.

Adrenaline, prednisolone, and other medicines used in first aid for hives

Injections used in first aid for hives

Urticaria treatment

The following treatments are relevant for urticaria:

• taking pharmacological agents injections, pills);
• use of topical drugs ointments and creams);
• diet therapy;
• physiotherapy procedures.

Pills and injections for hives

The injections prescribed for urticaria are:

• Adrenalin- is put exclusively as first aid for urticaria, which is a manifestation of anaphylactic shock. One milliliter intramuscularly, can be repeated after 5 to 10 minutes.
• Diphenhydramine- used both as first aid and as prolonged ( prolonged) treatment. It is administered intramuscularly in one ampoule, usually in the evening. It has such side effects as drowsiness, a sedative effect on the central nervous system. Despite the fact that it is only the first generation antihistamine, it has a pronounced antiallergic effect.
• Suprastin- is prescribed, as a rule, in the subacute period of the disease. The recommended dose is one milliliter intramuscularly two to three times a day.
• Fenkarol- recommended for urticaria, Quincke's edema and other allergic reactions. It is prescribed two milliliters twice a day for 5 days.

Tablets prescribed for urticaria are:

• tavegil- one tablet by mouth three times a day;
• diazolin- one tablet two to three times a day ( depending on the severity of the symptoms);
• claritin- once, inside, one tablet a day;
• zyrtec- one tablet per day, once;
• trexil- one tablet twice a day.

Diphenhydramine, zyrtec, claritin and other antihistamines for urticaria

To date, there are three generations of antihistamines that differ in their spectrum of action. The oldest representative of this group of drugs is diphenhydramine. It has a pronounced anti-allergic effect, but, unfortunately, provokes great drowsiness.

Generations of antihistamines

Antibiotics for hives

That is why antibiotics are prescribed with great care to people with a predisposition to allergies. In cases where urticaria is a concomitant symptom of a bacterial disease, the choice of antibiotic should be made very carefully. Under all circumstances, penicillin and sulfa drugs should be avoided. In this case, antibiotics can aggravate the course of urticaria and stimulate the development of anaphylactic shock.

Vitamins for hives

Vitamins prescribed for hives include:

• beta carotene or vitamin A- 25,000 IU each ( international units) of this vitamin daily ( what is the daily norm) will help reduce the symptoms of hives. Vitamin A is available in capsules.
• Vitamin PP ( nicotinamide) - prevents the release of histamine, which, in turn, determines the symptoms of urticaria. The daily norm is 100 milligrams. As a rule, this vitamin is always contained in a complex of vitamins.
• Vitamin C- reduces the permeability of capillaries and, thereby, reduces the development of edema. The average daily dose is 500 milligrams, and with profuse rashes with urticaria, the dose can be increased to 1000 milligrams.
• Magnesium- the lack of this element in the body can provoke the development of urticaria. Therefore, it is recommended to take magnesium at 250 milligrams daily.
• Vitamin B12- prevents the release of histamine. Reduces the symptoms of hives, dermatitis and other types of allergies. It is prescribed one ampoule intramuscularly for a month.

Polysorb, activated charcoal and other drugs used in the treatment of chronic urticaria

Chronic urticaria significantly reduces the quality of life of patients, as itching causes severe discomfort, especially at night. Skin rashes are a visible cosmetic defect that provokes a violation of the emotional background and various psychological problems. The lack of proper rest, combined with emotional disorders, leads to the fact that patients become irritable, complain of headaches, and their ability to work decreases. All this as a result leads to the progression of the disease, so some patients are prescribed antidepressants and other drugs to normalize the functioning of the nervous system.

Omalizumab ( xolair) with urticaria

Advantan, akriderm ( diprospan) and other ointments used in the treatment of urticaria

There are the following types of hormonal ointments for the treatment of urticaria:

• prednisolone;
• akriderm ( another name for diprospan);
• flucinar;
• histane-N;
• lorinden s.

The second group includes non-hormonal products that contain various components to moisturize and nourish damaged skin. An important role in the treatment of urticaria is played by zinc-based ointments, which have an antimicrobial and drying effect.

• salicylic-zinc ointment;
• skin cap ( zinc based);
• nezulin;
• la cree.

Diet therapy for hives

There are the following schemes for the development of cross-allergy:

• cow's milk- soy, veal and beef;
• chicken eggs- poultry meat ( chickens, ducks, quails), eggs of other birds;
• Strawberry- currant, raspberry;
• hazelnuts- sesame, poppy, oatmeal and buckwheat flour;
• peanut- potatoes, soybeans, plums, peaches.

There are the following provisions of the hypoallergenic diet:

• limited intake of traditional allergens ( milk, eggs, seafood, honey);
• refusal of exotic products ( shellfish, meat of rare animals, fruits such as guava, lychee);
• minimal consumption of food colors, flavor enhancers, flavorings ( found in large quantities in semi-finished products, products of bright color with a pronounced aroma);
• reduction in salt intake present in large quantities in chips, saltine crackers, dry beer snacks);
• refusal of canned vegetables of home or industrial production;
• the use of such cooking methods as boiling, baking;
• drinking at least 2 liters of water per day.

Physiotherapeutic procedures for urticaria

In chronic urticaria, the following physiotherapy is indicated:

• electrophoresis with various drugs;
• exposure to ultrasound on areas with rashes;
• darsonvalization ( exposure to weak currents);
• therapeutic baths ( based on sulfide and radon);
• ultraviolet irradiation.

Diet for hives

Exclusive ( elimination) diet for hives

General Elimination Diet Rules
The principle of the elimination diet is that for a certain time the patient completely refuses food or removes traditional allergen foods from the menu. Then food products are gradually introduced into the diet, and the patient's task is to monitor the body's reaction to the foods consumed. To do this, you need to keep a food diary, which records data on the composition of the diet and possible reactions of the body.

The list of data to be entered in the diary includes the following items:

• meal time;
• foods that were eaten;
• heat treatment method;
• the amount of food eaten;
• body's reaction rash, itching) if it appears.

In addition to the food diary, there are a number of provisions that are mandatory for compliance with the elimination diet. The system of eating should be fractional, which implies at least 5 meals a day. Portions should be small, otherwise a large load is created on the digestive system. All dishes are prepared with a minimum amount of salt and spices. Products prepared by frying, smoking, drying are prohibited. Out-of-season vegetables and fruits, as well as foodstuffs of exotic origin, are not allowed.

The elimination diet continues until the body's reaction to all the foods that make up the human diet is established. After that, the patient is transferred to a hypoallergenic diet, in which the products established as allergens for this patient are completely excluded.

Strict Elimination Diet Rules
A strict diet begins with fasting, which should last from 3 to 5 days. Therefore, resorting to this type of elimination diet is allowed only for adults who have undergone a comprehensive examination. In most cases, a strict diet is prescribed to patients who are in the hospital and all rules are followed under the guidance of medical personnel.

Foods for hives

Products are entered in the following sequence:

• vegetables ( zucchini, carrots, potatoes);
• dairy products ( cottage cheese, kefir, yogurt);
• porridge ( oatmeal, buckwheat, rice);
• low-fat varieties of fish;
• lean meats;
• eggs;
• milk and products from it.

The order in which products are not included in the list is determined by the patient. But at the same time, it is necessary to continue to adhere to the rule that a new product can be tried every 2 days. After fasting is completed, the patient must begin to keep a food diary, in which the body's reaction to each new food eaten should be displayed. Compliance with all the rules of a strict elimination diet allows you to identify food allergens and draw up a basic menu, which the patient with urticaria must subsequently adhere to.

The rules of a gentle elimination diet
A sparing elimination diet is relevant for young children, as well as for patients who, for health reasons or for other reasons, cannot follow a strict diet. First, from the patient's menu, it is necessary to exclude all products that modern medicine refers to the group of traditional allergens.

There are the following food allergens:

• milk and products made from it butter, cheese, ryazhenka, cream);
• cereal crops ( wheat, rye, barley);
• legumes ( peas, chickpeas, lentils);
• eggs ( chicken, goose, duck);
• all kinds of sea fish salmon, flounder, salmon);
• all kinds of seafood shrimps, mussels, caviar);
• meat ( beef and veal, chicken, meat of wild animals and birds);
• vegetables ( tomatoes, bell peppers, celery, eggplant);
• fruit ( all citrus fruits, peaches, red apples);
• berries ( strawberries, raspberries, red and black currants);
• nuts ( peanuts, walnuts, almonds, hazelnuts);
• chocolate and any of its derivatives ( cocoa, icing);
• sauces and salad dressings vinegar, soy sauce, mayonnaise, mustard, ketchup);
• any food that contains yeast ( yeast bread and other forms of baking);
• honey and other bee products ( propolis, royal jelly).

There are the following permitted foods with an elimination diet:

• dairy products with low fat content ( kefir, yogurt, cottage cheese);
• cereal crops ( corn, oats, millet);
• vegetables ( broccoli, cucumbers, zucchini, carrots, potatoes);
• meat ( turkey, rabbit, low fat pork);
• low-fat varieties of river fish ( walleye, pike, trout);
• fruit ( green apples and pears);
• berries ( white cherries and currants).

Hypoallergenic diet for urticaria in adults

There are the following provisions of the hypoallergenic diet for urticaria:

• the feeling of overeating should not be allowed, therefore, no more than 300 grams of food should be consumed at one time;
• the number of daily meals - at least 5;
• the temperature of the food consumed is moderate;
• at least 300 - 400 grams of vegetables and fruits should be consumed per day;
• the diet should contain a lot of fiber, which is found in cereals, vegetable and fruit dishes;
• sweets, cereals, meat and dairy products with high fat content should be consumed in the morning;
• after dinner, preference should be given to low-fat dairy products, vegetables, lean meat and fish;
• At least one and a half liters of liquid should be consumed per day.

There are the following categories of foods that contribute to the release of histamine:

• any exotic food products ( those that are not part of the patient's standard diet);
• all berries, fruits and vegetables are red and purple;
• any berries, fruits and vegetables in canned form ( jams, preserves, pickles);
• all varieties of citrus crops;
• honey and bee products;
• whole cow's milk, hard cheeses, cheese;
• chicken eggs, egg powder;
• any varieties of meat and fish that are prepared by smoking or drying;
• meat and fish canned food;
• any kind of seafood;
• chocolate and all products in which it is contained;
• coffee and caffeinated drinks;
• carbonated drinks.

Treatment of urticaria with folk remedies

How to treat hives with folk remedies?

There are the following rules for the collection and preparation of raw materials for herbal medicine:

• do not collect plants that are wet from rain or dew;
• collection should be carried out in areas that are at a sufficient distance from highways and industrial enterprises;
• dry raw materials should be in the sun or in the oven;
• dried plants must be crushed using a coffee grinder or other similar equipment;
• raw materials are not recommended to be stored in plastic or metal containers; it is best to use ceramic or glass containers for this.

Duration and dosage in herbal medicine
The positive effect of taking phytopreparations occurs, as a rule, after 2-3 weeks. This does not mean that treatment should be stopped, since for a sustainable result, it is necessary to take folk remedies for at least 3-4 months. At the same time, periods of constant medication should be alternated with pauses, which should be every month and last 7 to 10 days. Subsequently, after the completion of the course of treatment, for preventive purposes, 2 times a year, herbal remedies should be taken for 4 to 6 weeks.

It is necessary to start treatment of urticaria with those funds, which include 1 - 2 components. If no allergic reactions are noted within 5 to 7 days, you can switch to drugs with a more complex composition ( multi-component fees). The daily volume of drugs for oral administration is 200 milliliters, which should be divided into 2 to 3 doses. When using topical preparations, the amount is determined by the area of ​​\u200b\u200bthe skin on which rashes are present.

Forms of herbal remedies
Depending on the method of manufacture and subsequent use, there are several forms of folk remedies.

There are the following types of herbal medicines:

• Decoction. Indicated for internal use and is prepared from soft plant fragments ( leaves, inflorescences). For the daily norm of the medicine, a tablespoon of raw materials is steamed with a glass of water of 70 - 80 degrees and infused for half an hour.
• Infusion. It is also intended for oral administration, but differs from the decoction in that it is prepared from the hard segments of the plant ( roots, bark). In order for the raw materials to fully “give away” their beneficial substances, the infusion must be kept in a water bath for at least 20 minutes. To prepare the daily norm, a tablespoon of dry ingredients per glass of water is used.
• Juice. It is prepared from fresh plants and is taken at 50 - 100 milliliters per day. Drink the drink should be within 1 - 2 hours after its preparation, as then it significantly loses its healing effect.
• Concentrated decoction. This form of phytopreparation is used for therapeutic baths. A decoction of high concentration is prepared from 6 - 7 tablespoons of raw materials ( soft and/or hard plant parts) and 2 glasses of water 70 - 80 degrees. Water-herbal suspension must be kept in a water bath for about 20 minutes.
• Solutions. They are used for lotions and are prepared as a concentrated decoction of plants that have a drying effect. Also, other components with antipruritic action can be added to the solution. It could be salt a teaspoon per glass of broth), vinegar/lemon juice ( a tablespoon per glass of broth).
• Oil substances. Used for compresses, which are applied to those areas of the skin where blisters are present. Such preparations are prepared on the basis of natural oils ( castor, olive, burdock) and dry raw materials. To make the substance, you should combine a glass of oil with a glass of chopped herbs, and then infuse the suspension for 2-3 weeks. A tablespoon of some emollient component can be added to the real filtered oil ( glycerin, lanolin).
• Ointments. Designed for application to areas of the skin that are affected by a rash. They are prepared from dry plants and a fatty base, which can be used as butter, unsalted pork lard. First, the fat base should be melted, vegetable raw materials should be added and simmered in the oven for 2-3 hours at a low temperature. Then, depending on the recipe, various components with a drying effect can be added to the fat base. It can be birch tar, white clay, talc. Ingredients with a drying effect are added at the rate of a tablespoon per glass of the finished fat base.

Nettle and other folk remedies in the treatment of urticaria

There are the following groups of phytopreparations:

• bath products;
• drugs for internal use;
• preparations for external use.

Means for external use for urticaria

Medicines for internal use
This group includes decoctions, infusions and juices that must be taken orally. Before you start taking herbal remedies, the patient should consult a doctor. This requirement is mandatory, since with urticaria many remedies made on the basis of medicinal herbs may be contraindicated.
and chamomile ( 1 part).

Juices

Celery.

Fuck honey.

Beet ( not recommended if hives are due to a food allergy).

Urticaria - causes, symptoms, what to do and what will help? - Video

Urticaria is a skin disease of a toxic-allergic nature. Pathology is characterized by the appearance of a rash, severe itching, redness of the skin. It can occur as an independent disease or manifest as a symptom of a concomitant disease. There are acute and chronic urticaria, the recurrent form has less pronounced symptoms and is more difficult to treat.

The disease proceeds in waves, lasts for months or years, is diagnosed mainly in women of middle age 20–40 years old, and is much less common in men and children. The causes of the chronic form of urticaria in most cases remain unknown, but the main irritating factors are allergens of drugs, foods, insecticides. The pseudo-allergic type of the disease develops when exposed to external stimuli, eating food containing artificial additives.

Etiology

The main causes of hives:

• chronic infectious, viral diseases;
• ailments of the liver, gastrointestinal tract;
• long-term medication;
• contact with an allergen;
• hyperhidrosis (excessive sweating);
• hormonal disruptions;
• hypertonic disease;
• taking oral contraceptives;
• hormone replacement therapy;
• thyroid disease;
• cancerous tumors.

Provoking factors that cause relapses include cold air, water, scorching sun, stress, mechanical irritation of the skin, drinking alcohol.

Spontaneous urticaria occurs without any external influence, physical urticaria develops after contact with an allergen or irritant.

In about half of the cases, urticaria is autoimmune in nature. In this case, the work of the immune system is disrupted and the body begins to perceive its own cells as foreign elements, producing antibodies to them. The process is accompanied by the development of a histamine reaction and becomes the cause of chronic urticaria.

Clinical manifestations

The disease is considered recurrent if it lasts more than 6 weeks and occurs again after some time. External manifestations can persist for up to several months, accompanied by daily rashes, then there are short periods of remission. Any part of the body can be affected.

Symptoms of chronic urticaria recurrence:

• itching of the skin, worse at night;
• papular rash;
• elevated body temperature up to 37.5 °;
• pain, aching muscles and joints;
• general weakness, malaise;
• hyperemia of the epidermis:
• Quincke's edema is rarely observed.

The blisters appear within a few hours and can also quickly disappear without consequences. Sometimes in the area of ​​​​rashes, a vascular pattern, peeling, pigmentation may remain. Papules of large sizes in chronic urticaria are rarely formed, usually small blisters of light red color are formed, when pressed on the skin, they disappear.

The number of elements of the rash depends on the stage of the course of the disease. Papules can fill with blood, be located in isolation or combine into large foci with scalloped edges, in some cases the foci acquire an annular shape.

Clinical classification of chronic urticaria:

• dermographism - skin reaction to mechanical irritation;
• medicinal;
• thermal;
• the cholinergic form develops against the background of a reaction to acetylcholine;
• sunny;
• cold;
• the adrenergic form is diagnosed with an allergy to exogenous adrenaline;
• vibration Quincke's edema;
• urticaria on the background of arterial hypertension;
• contact;
• urticarial vasculitis - inflammation of the walls of small blood vessels, accompanied by a papular rash;
• Quincke's edema without puffiness.

Chronic recurrent urticaria worsens mainly in the cold season in autumn, winter and early spring. Symptoms of repeated relapses can occur when the skin is exposed to cold water.

The papular form of a chronic disease is manifested by the formation of nodular elements of a dense consistency, which are localized on the extensor surfaces of the limbs: on the elbows, wrists, and phalanges of the fingers. The rash has a different color, from light pink to dark red.

Diagnostics

To establish a diagnosis, a dermatologist conducts a survey, a physical examination of the patient. Assigns laboratory and instrumental studies to determine the cause of the disease. According to the results of a biochemical blood test, one can assume an infectious, medicinal or food nature of the pathology. In patients with Quincke's edema, a C4 compliment is found, indicating the autoimmune nature of the disease.

An x-ray of the maxillary sinuses, a provocative test for food additives, liver function tests are carried out. To exclude cancerous neoplasms, a biopsy of papules is made, a histological examination of the material obtained.

Therapy Methods

Since it is quite difficult to establish the exact cause of chronic urticaria, treatment is symptomatic. When rashes appear, patients take antihistamine and sensitizing drugs: Claritin, Cetrin, Zirtek, Allegra.

Patients need to stop drug therapy, limit contact with household allergens, detergents as much as possible, follow a special diet that includes crushed, hypoallergenic steamed foods.

Patients are prescribed blockers of H1 and H2-histamine receptors: Hydroxyzine, Doxepin. The drugs reduce itching, improve cognitive function, relieve muscle pain and tension, but have a sedative, hypnotic effect.

With severe inflammation of the skin, systemic corticosteroids are prescribed in short courses (Prednisolone, Dexamethasone). The affected epidermis is treated locally with Hydrocortisone ointment, Elokom, Advantan. If necessary, a course of antibiotics is prescribed, as well as eradication in patients infected with Helicobacter pylori bacteria.

If chronic urticaria appeared while taking non-steroidal anti-inflammatory drugs, then in addition to antihistamines, leukotriene receptor antagonists are prescribed: Montelukast, Zafirlukast. These tablets block the production of mediators of chronic inflammation, relieve spasm of smooth muscles, reduce swelling in angioedema.

With the ineffectiveness of antihistamines, chronic urticaria is treated with Cyclosporine. It is an immunosuppressant that suppresses the production of T-lymphocytes, reduces skin hypersensitivity, allergic manifestations. In this case, there is no suppression of the immune system, the process of hematopoiesis.

Treatment of chronic urticaria is carried out in long courses, it can last from several weeks to 3-6 months or longer, in half of the cases the symptoms of the disease disappear spontaneously. In combination with antihistamine therapy, it is necessary to treat chronic foci of infection, restore normal microflora and intestinal motility.

Possible Complications

The most common complication is Quincke's edema. Pathology causes swelling of the larynx, mucous membranes, breathing becomes difficult, suffocation may occur if the patient is not provided with timely assistance.

Chronic urticaria, the treatment of which is carried out according to the doctor's prescription, disappears within 3-5 years, sometimes it can last up to 10 years, and have a progressive course. Often patients suffer from nervous disorders, prone to depression.

The prognosis for the treatment of chronic urticaria depends on the severity of the manifestations of the disease and the reasons that caused its development. If a pathological condition is observed in patients suffering from oncological diseases, the prognosis is significantly worse. Prevention of concomitant systemic diseases, maintenance therapy reduce the number of recurrences of urticaria and facilitate its course.

papillomy.com

Causes and symptoms of hives

The development of urticaria is provoked by many exogenous (external), as well as endogenous factors (arising in the body). The latter include pathological processes occurring in the body, in which vital organs cannot function normally. As a result, histamine, a chemically active substance, is formed and accumulated in the tissues, which increases the permeability of capillaries and the walls of other, larger vessels. As a result, the papillary layer of the dermis swells, extensive itchy rashes and blisters form on the skin.

Allergies can be caused by toxins that enter the body with food or accumulate during kidney failure, disorders in the gastrointestinal tract, often urticaria occurs after the bites of various insects. The course and prognosis of the disease will vary, depending on the type of stimulus and its properties.

A characteristic symptom of urticaria is the sudden occurrence of numerous, dense, swollen, pink rashes that have a different shape and outline, protruding above the skin, painless, but causing severe itching. In their center, the skin is dull in color due to compression of the vessels. Blisters disappear without a trace after the cessation of the stimulus. Usually this happens quickly, but in some cases they can persist for a long time.

Urticaria, by the nature and duration of development, can have an acute or chronic form; in these cases, it is based on different causes.

Acute urticaria

Teenagers and children are more likely to suffer from this form of urticaria, while adults are more likely to suffer from chronic urticaria. This type of disease is characterized sudden onset, the formation of a rash on any part of the body, on the skin and mucous membranes. These rashes cause itching, burning and can lead to the development of urticaria and deterioration of the general condition of the patient. The acute form of the disease almost always develops as an allergic reaction to an external irritant, this condition disappears in 1-3 weeks, and sometimes in a matter of hours. In some cases, this type of urticaria can become chronic.

Factors provoking the development of urticaria:

• Medications: antibiotics, diuretics, relaxants and others;
• Food products such as dairy, fish and seafood, nuts, eggs and others;
• Insect bites, especially bees and wasps;
• Other irritants upon contact with the skin of the patient (plant juice, animal saliva, rubber, wool, latex, etc.)

In some cases, this disease develops according to other laws and manifests itself in the following situations:

1. With SARS, more often in children;
2. Radiopaque agents are often allergens;
3. With violations in the hormonal sphere, with the development of rheumatic diseases occurring in the body.

Angioedema

This condition can develop independently or occur as a complication of acute urticaria. It is also called giant urticaria or Quincke's edema. All layers of the skin are involved in the pathological process. . Suddenly, limited swelling develops in the subcutaneous adipose tissue on the face, skin and mucous membranes, on the genitals. The skin is densely elastic, stretched, white matte color. This condition is dangerous with the possible development of asphyxia (suffocation) with swelling of the larynx. Previously, such a complication was called false croup and often caused a fatal outcome.

Chronic recurrent urticaria

Urticaria is called chronic if its duration exceeds 6-7 weeks. Almost always, the cause of the disease remains unclear, doctors in such cases diagnose idiopathic urticaria. It is assumed that this disease is associated with autoimmune processes unknown to scientists so far. There are suggestions that its exacerbations may be associated with autoimmune thyroiditis, but no evidence has yet been found.

If there are chronic foci of infection in the body, pathology is noted in the work of the gastrointestinal tract, kidneys, liver, then as a result of this, an abnormal state of the immune system may develop, when relapses of urticaria are possible, then they are replaced by long or short periods of calm (remissions).

Varieties of urticaria

There are several types of urticaria, in addition, there are conditions that were previously also considered types of urticaria, but now they have begun to be distinguished into separate diseases. These include urticarial vasculitis, cutaneous mastocidosis (urticaria pigmentosa) and some other manifestations.

When the patient's skin is exposed to various factors, physical urticaria develops; many allergens can cause it. Annoying factors may include:

• Rubbing or squeezing areas of the skin. In these cases, mechanical irritation of the skin occurs;
• In the form of a reaction of the body to the light of the sun, solar urticaria develops. This disease is a type of photodermatosis. More often manifested in patients with impaired metabolism, chronic liver diseases, with increased sensitivity to UV rays. This species is seasonal, develops after exposure to bright sun, in some cases accompanied by nettle fever, in some cases, angioedema may develop.
• Aquagenic urticaria. A rather rare manifestation, when the onset of symptoms of the disease occurs in contact with water, regardless of its temperature;
• Physical activity, stressful situations provoke the development of cholinergic urticaria (itchy diathesis). In terms of manifestations, the disease is similar to acute urticaria, but the causes of its occurrence have not been fully identified. Presumably, it is based on abnormal reactions of the body to changing body temperature. Or an attack of this type of urticaria provokes increased sweating, resulting in the release of allergens. It usually develops with a fever that accompanies infectious diseases, or when visiting a bath, a hot bath, after physical exertion, with emotional stress. The size of the blisters does not exceed 3 mm, most of the rashes form on the upper half of the body and are detected when severe itching occurs immediately after exposure to provoking factors.
• Thermal urticaria - an infrequently occurring type, develops when the patient's skin comes into contact with warm, hot objects or objects;
• Cold urticaria is a common type, its development is provoked by the patient being in the cold, cold drinks and food, contact of the skin with cold objects;
• Contacts of the skin with irritants, which include foods, medications, insect bites, lead to the development of a contact and papular type of urticaria. Its difference is the formation on the skin of small rashes in the form of "papules" - nodules;

Other types of urticaria occur quite rarely. Under certain physical conditions of the patient, the course of the disease may carry certain features that must be taken into account when prescribing therapy. These conditions include pregnancy and childhood.

Urticaria and pregnancy

It happens that urticaria develops in women who are in an interesting position. In these cases, its development can be provoked by the reaction of the body both to drugs, to food, and to irritants from the outside and some diseases.

The most common cause of the disease in this case is complicated toxicosis.(preeclampsia), this is due to the production in the body of a pregnant woman of a large number of pregnancy hormones. During this period, urticaria often takes a chronic course and can accompany a woman throughout pregnancy. This condition is complicated by the fact that it is often not possible to find an antihistamine drug that is suitable and safe for the fetus to relieve symptoms, so traditional medicine recipes and local remedies have to be used to a greater extent, which is not effective enough. In some cases, after the symptoms of toxicosis disappear, all unpleasant symptoms disappear.

For the fetus, manifestations of urticaria are not dangerous., since allergens do not penetrate the placenta, in cases where its manifestations are not caused by taking medications, otherwise the fetus experiences their negative effects along with the mother. Much more harm to the child has a painful condition of the mother: fever, insomnia and nervousness.

Urticaria in children

The manifestations of this disease in children do not differ from its course in adults, but in these cases it is much more intense and poses a great danger, especially with the development of angioedema, when swelling of the mucous membranes of the respiratory tract can develop almost instantly. A characteristic sign: breathing is difficult, whistling is heard when inhaling, paroxysmal coughing, the nasolabial triangle turns blue. With swelling of the mucous membrane of the esophagus, persistent vomiting may occur; with swelling of the inner ear and membranes of the brain, headache, dizziness and other neurological disorders increase. The situation is complicated by the fact that the baby is frightened, crying, and this further aggravates the situation. . Such conditions are extremely dangerous - if help is not provided immediately, the child may die.. It is urgent to call an ambulance.

Is hives dangerous?

Once a urticaria has arisen, it is not capable of causing disturbances in the functioning of the body, but it itself can be their consequence, so you need to try to determine the cause of its occurrence and treat the underlying disease. Almost always, the manifestations of urticaria disappear without a trace and quickly, but in some cases resuscitation may be required.

Urticaria is not contagious and cannot be transmitted from person to person, however, if the root cause was an infectious disease, then the possibility of its transmission is not excluded, as well as symptoms.

How is urticaria diagnosed?

When visiting a doctor with complaints about urticaria, standard diagnostic measures are taken:

Diagnosis of urticaria is usually not difficult, it does not require special laboratory diagnostics, but there may be problems with the determination of the allergen. In such cases, allergen tests are performed to determine the presence of antibodies in the blood to possible irritants.

In case of recurring recurrences of urticaria, it is necessary to consult a doctor for examination, determination of the causes and appointment of appropriate therapy. The doctor determines the need for an examination and its nuances in each individual case, based on the patient's condition and the characteristics of the course of the disease. In the future, patients should be registered at the dispensary so that the doctor can track the course of the disease in dynamics, determine provoking factors and make timely changes in treatment tactics.

How is urticaria treated?

Treatment of this disease is aimed at reducing the body's hypersensitivity to the factors that cause its manifestation. In some cases, hospitalization of the patient is required to prevent the development of complications.

Treatment methods:

• The doctor prescribes antihistamines that help relieve the body's hypersensitivity to allergens.
• immunomodulators, hormonal agents are prescribed according to indications for complicated chronic urticaria.
• The development of angioedema requires special emergency intervention and, often, resuscitation.

Treatment should continue until the complete disappearance of the symptoms of the disease, especially itching, which is potentially dangerous, because when scratching the rashes, the upper layer of the epidermis is injured and favorable conditions arise for infection to enter the body.

To relieve itching, you can use local remedies that have anti-inflammatory, antihistamine and reparative effects to alleviate the patient's condition: ointments and creams, always as part of complex treatment. Local preparations should include components that relieve itching, burning, have antispasmodic, decongestant and cooling effects. The doctor must prescribe drugs and their dosage, based on the severity of the disease and the general condition of the patient.

Can hives be treated at home?

Self-medication is strictly not allowed, since with the development of allergic reactions, the possibility of a sudden onset of angioedema should not be ruled out, which will require urgent medical attention. Whenever itching and a rash appear on the skin, you should always consult a doctor so that he assesses the patient's condition and prescribes adequate treatment. It can be carried out at home under the supervision of a doctor, if the patient's condition does not cause concern, after prescribing a treatment regimen. Children and pregnant women require special attention in treatment; for each individual case, the doctor makes an individual decision - whether it is worth doing therapy at home or inpatient treatment should be preferred.

Traditional medicine for the treatment of urticaria

In addition to medical treatments, it is quite appropriate to use some folk recipes. to relieve local manifestations this disease, especially during pregnancy, when taking many drugs is unsafe for the fetus.

1. Remove the manifestations of urticaria flowers deaf nettle (white arborvitae): you need to take 1 tbsp. l. flowers per 1 tbsp. boiling water. Infuse for half an hour, strain through a sieve and drink ½ cup three times a day. Effectively relieves skin rashes, a good blood purifier.
2. Infusion of celery roots: 2 tbsp. l. roots need to insist 1-1.5 hours in 0.5 liters of water and drink 1/3 cup three times a day before meals. Also a good remedy for removing skin rashes and various dermatitis.
3. Calamus root can be taken in the form of ready-made powder for 1/tsp. overnight with warm water.

To relieve itching, it is useful for children and adults to take baths with medicinal herbs. For this, St. John's wort, celandine, sage, chamomile, medicinal valerian, tripartite succession, nettle are used. You can use these herbs separately, prepare or buy a collection at the pharmacy, where they will be present in equal proportions. For 1 liter of boiling water, you need 5 tbsp. l. chopped mixture of herbs. Insist for half an hour and add to the bath at 36-38 ° C. The course of treatment will be 2-3 weeks every other day for 5-7 minutes. These procedures will help reduce itching and relieve the condition.

Diet for hives

If the allergen is not identified, it would be advisable to prescribe a special hypoallergenic diet. with the exception of all products that can lead to the development of allergies. In the future, as the symptoms disappear, restrictions can be gradually removed, but you need to monitor the skin and try to catch the relationship between the manifestations of the disease and food intake. As necessary, additional laboratory tests may be carried out to identify the allergen.

The consumption of alcoholic beverages is strictly prohibited because they exacerbate the disease.

Prevention of urticaria

Most often, urticaria passes without a trace, therefore, speaking about the consequences, it is necessary to evaluate not the disease itself, but its cause - the state of the body or the root cause that causes it. There is no doubt that this abnormal state of the body needs attention and timely treatment, so that there are no prerequisites for the development of urticaria in the future.

There are a few simple rules that help to avoid the recurrence of the disease and minimize its manifestations:

• You should limit contact with highly allergenic foods, adhere to a hypoallergenic diet, even if there are no health problems;
• Do not drink alcohol;
• Try not to come into contact with household chemicals, it is better to replace them with natural cleaning products - for example, baking soda, etc.;
• It is necessary to maintain cleanliness in the house, remove dust in a timely manner, since it can also be a strong allergen;
• It is worth refraining from having pets;
• If urticaria occurs as a reaction to low temperatures, you need to dress warmer, protect your limbs and face when going outside in the cold season;
• During the ARVI epidemic, you need to take preventive measures, antiviral drugs, use a disposable mask in crowded places, wash your hands thoroughly when you come home;
• Use hypoallergenic cosmetics;
• Do not forget to undergo an ongoing examination by an allergist, timely sanitize foci of infection (caries, tonsillitis, rhinitis);
• Gradually, you need to try to harden in order to strengthen the body's resistance. This will benefit your overall health.

Patients with chronic urticaria should definitely have antihistamines in the medicine cabinet, which will help to quickly stop the attack. These include "Tavegil", "Suprastin" and other tablets prescribed by a doctor.

By following these simple tips, patients can improve their quality of life and minimize the manifestations of this unpleasant disease - urticaria.

sosudinfo.ru

Features of the disease

Urticaria is a disease that can be initiated by various reasons. It is based on the body's reaction to an allergen or other irritant. According to the duration of the manifestations of the signs of the disease, there are:

• sharp shape
• chronic course of the disease.

If the process of the appearance of blisters on the body, which are diagnosed as urticaria, occurs for six months, then experts determine that the patient suffers from chronic urticaria. Both adults and children are more likely to have this form of the disease. The chronic process can last up to five years.

• Children are exposed to the disease more at an early age.
• Among adults, women suffer from chronic urticaria more often than the male population.

Do they take to serve in the army with chronic urticaria? For men, a diagnosis on a chronic urticaria card with an explanation that lasts more than half a year is a reason for exemption from military service. What factors initiate this phenomenon does not matter.

The video below will tell you what chronic urticaria is:

Classification

The manifestation of urticaria is divided into groups of conditions according to pathogenetic mechanisms that provoke rashes on the surface of the skin:

• The idiopathic form is a manifestation of the disease that characterizes chronic urticaria, but the causes that caused the violation cannot be determined.
• Autoimmune form - the disease is long and difficult. The diagnosis is confirmed by a lack of response to antihistamines.
• Papular form - rashes appear as a response of the body to an insect bite.
• Spontaneous form - the appearance of rashes without any connection with any reasons, the disease is also called ordinary urticaria (chronic);
• Physical form:
  • cholinergic variety- rashes that have signs of urticaria appear after rubbing skin areas, physical contact;
  • cold variety- blisters appear in connection with a change in temperature (heat or cold);
  • psychogenic variety- skin reaction in the form of blistering initiates an emotional reaction to an event;
  • contact variety- the reaction of the body in the form of urticaria to contact with substances that are allergens for the patient.
• Hereditary variety - the patient inherited a reaction to some factors (cold, insect bites, contact with certain substances) with skin rashes with signs of chronic urticaria.

Chronic urticaria can have different forms of the course of the process:

• relapsing form- cyclic course of chronic urticaria, when periods of exacerbation are replaced by short breaks (several days);
• persistent form- the rash is constantly updated throughout the disease.

Causes

The factors that cause the disease are divided according to their nature into two categories:

• endogenous- the causes are associated with diseases of the organs:
  • inflammatory problems in the teeth, gums;
  • liver disease,
  • pancreatitis,
  • gastritis;
  • helminths.
• exogenous- external factors act on the appearance of blisters:
  • chemical (reaction to certain substances),
  • temperature (heat, cold),
  • mechanical (friction, vibration).

Chronic inflammatory processes in organs initiate bacterial infection. The response of the body may be chronic urticaria.

Symptoms of chronic urticaria

Signs of the disease are blisters on the skin of various sizes. The color of the rashes is reddish - it can be brighter or paler.

Urticaria affects the following areas:

• body surface,
• facial skin,
• limbs,
• soles,
• palms.

Blisters cause discomfort, itching. The following symptoms may be added to the general condition:

• dizziness,
• vomit,
• temperature rise,
• stool disorder.

Diagnostics

To identify the diagnosis, the following steps are carried out:

• Examination of the patient and analysis of all visible manifestations of the disease.
• Collection of analyzes and laboratory tests:
  • physical tests that make provocation factors:
    • light,
    • cold
    • warmth
    • dermographism,
    • pressure,
    • tension;
  • study that shows response to influence:
    • herbs,
    • cat hair,
    • house dust,
    • ticks.
• Research is being done to identify food allergens.
• If experts consider it necessary, then a skin biopsy is prescribed with the study of samples by immunofluorescence.
• A basic diet is recommended to rule out food allergies. Nutrition is adjusted to the formula: tea-potato-rice.
• An intensive examination includes:
  • identification of possible foci of infection,
  • testing for the presence of Helicobacter pylori,
  • It is recommended that you complete a food diary.

If there is a need to continue diagnostic studies, then carry out:

• Elimination diet- from the diet make a consistent exclusion of foods that are under suspicion as allergy provocateurs. Each time the patient is examined, determining his condition.
• If the previous event did not clarify the picture, then appoint provocative diet- the same as the elimination diet, but foods that may have allergens are added sequentially in this case. The reaction of the body is observed.

The specialist in this video talks about the diagnosis of chronic urticaria:

Treatment

With different forms of the disease, several different methods of assistance are used. But there is a general approach: if an allergen is revealed, remove it from your daily routine, diet (depending on what kind of allergen).

Therapeutic way

It is important that all inflammatory processes are treated. A diet is prescribed. If necessary, deworming is carried out.

In a medical way

The specialist prescribes drugs individually. The following drugs are usually recommended:

• calcium desensitizers,
• drugs that calm the nervous system, harmonize mood (sedatives),
• antihistamines,
• sodium hyposulfite,
• magnesium sulfate.

Whether chronic urticaria can be treated with folk remedies, read below.

Folk methods

There are proven folk recipes that help with hives. It is undesirable to use them on their own. It would be right to get advice from a specialist.

• The celery helps. The root is well crushed and insisted for two hours in water. You can use juice for treatment. Infusion is drunk three times a day half an hour before meals, a third of a glass. Juice is taken according to the same scheme, but half a teaspoon.
• You can use calamus root. They take folk medicine in the form of a powder. Dose to take: half a teaspoon. Time: before bed.

Diet

When looking for the cause of the disease, the specialist may prescribe a special diet. This method is used even in the case when it is known that the food allergen caused the problem.

The diet may contain such dishes and products:

• meat:
  • rabbit,
  • turkey;
• dairy products:
  • cottage cheese,
  • kefir;
• vegetables:
  • potatoes are useful, but they should be soaked beforehand;
  • salad,
  • zucchini,
  • broccoli,
  • dill;
• sugar: fructose,
• porridge:
  • corn,
  • rice,
  • buckwheat;
• bakery products:
  • hypoallergenic cookies,
  • unleavened bread
• oil (small amount):
  • creamy,
  • vegetable.

Disease prevention

To avoid pathology, you should strive to observe:

• load mode - rest,
• develop a friendly outlook on the world, try to avoid stressful situations;
• consume natural products
• prevent chronic inflammatory processes, treat inflammation in time.

About the exacerbation and complication of chronic urticaria is described below.

Complications

• It is dangerous not to treat hives in young children. The disease can be initiated by artificial formula for nutrition.
• Urticaria often manifests as blisters on the face, which can merge into one large blister that can develop into angioedema.

This situation poses a threat to the life of the child. Therefore, it is necessary to refuse in time the food to which the allergic reaction occurs, and to treat chronic urticaria.

Forecast

Favorable resolution of the situation if all the rules are followed. This means that they try to eliminate the factor indicated by the allergen, treat the disease and follow other doctor's advice.

You will find a lot of useful information about chronic urticaria in this video:

gidmed.com

Reasons for development

The main reason for the appearance of a skin inflammatory manifestation in this species is considered to be a kind of reaction to an allergen. Chronic idiopathic urticaria can be an independent disease or a manifestation of one of the symptoms of some other disease. Provoking factors can be sunlight, cold, stressful situations, food or medications.

The true cause of this disease lies much deeper. Its appearance can provoke the following diseases of internal organs and systems:

• impaired renal function;
• rheumatoid arthritis;
• malignant formations;
• gallbladder disease of an infectious nature;
• Sjögren's syndrome;
• diabetes;
• thyroid disease;
• lymphogranulomatosis;
• lupus.

In addition, often idiopathic urticaria is diagnosed in people with alcohol intoxication or drug intoxication, in violation of metabolic processes in the body and various infections. There have also been cases of rashes associated with diseases of the gums and teeth (caries).

There is an assumption among doctors that this form of urticaria (idiopathic, recurrent urticaria) can provoke diseases such as leukemia, myeloma and lymphoma. This is what should alert patients when a rash appears on the body and force them to consult a doctor. Timely treatment of the disease significantly reduces the risk of serious complications.

The result of this disease is the production of antibodies that destroy the immune system. In other words, we can say that autoimmune processes occur in the body.

Symptoms

The main symptoms of idiopathic urticaria are similar to the manifestation of this disease in other forms:

• rashes of pink or pale red color;
• the appearance of watery blisters with clearly defined outer edges;
• unbearable itching in the area of ​​skin lesions;
• swelling of the skin.

In some cases, the described manifestations may be accompanied by fever, headache, weakness, chills. In case of swelling of the mucous membranes of the stomach or intestines, nausea, vomiting, and upset stools may occur.

This form of urticaria is characterized by a prolonged rash on the body, which can gradually change its location. It can last more than 6 weeks. Often there are relapses, then it already makes sense to consider the chronic form of the disease.

At some point in life, 1 in 1,000 people develop recurrent hives. It is more common in women than in men

Chronic recurrent urticaria is a complex form of the disease. It is characterized by periods of exacerbations and remissions. During the period of relapse, the disease significantly exhausts patients. Severe itching interferes with proper rest and sleep, a person becomes irritable and aggressive, psychological disorders are noted.

Diagnostics

Diagnosis of the disease is mainly the exclusion of other types of urticaria and the identification of the allergen. If the cause of the disease cannot be determined, then the doctor diagnoses chronic idiopathic urticaria. Thus, the doctor can only identify an irritant that stimulates the appearance of a rash, but is not the true cause of the skin reaction. In this regard, idiopathic urticaria is classified as an autoimmune disease.

During the initial visit to the doctor, the following tests may be prescribed:

• blood tests: clinical, biochemical, analysis for venereal diseases;
• general urine analysis;
• research aimed at identifying helminths
• allergy tests and tests.

If the causes of the disease were not identified during the examination, a consultation of highly specialized specialists will be required: a urologist, dermatologist, gastroenterologist, etc. This is necessary to diagnose systemic diseases that could cause urticaria.

Only after studying the full history and in the case when the cause has not been established, is the idiopathic form of urticaria diagnosed.

Treatment

The success and effectiveness of treatment depends on understanding the nature of the disease and possible provoking factors and causes. Unfortunately, this is not entirely applicable to recurrent chronic urticaria. Even under the conditions of modern diagnostic systems, it is impossible to identify with a high degree of probability, and, accordingly, eliminate the main cause of the disease.

Treatment of the idiopathic form of the disease involves an integrated approach, which can be divided into several stages:

• identifying the cause and ways to eliminate it;
• relief of symptoms during an exacerbation with the use of antihistamines;
• appointment of the main treatment;
• treatment of a disease that could cause urticaria;
• preventive measures.

Medical treatment

When making a diagnosis of chronic recurrent urticaria, you need to be prepared for long-term treatment, which is aimed at stopping the symptoms of the disease. Sometimes drug therapy can last several months or even years.

Treatment with the use of drugs is aimed at detoxification, increasing immunity and treating the underlying disease. In chronic idiopathic urticaria, the following drugs are prescribed:

• sorbents for removing toxins from the body: Sorbex, activated carbon;
• antihistamines, to eliminate allergy symptoms: Tavegil, Telfast, Loratadin, Suprastin;
• topical hormonal preparations (creams and ointments);
• digestive enzymes: Mezim, Festal;
• drugs aimed at symptomatic treatment: anti-inflammatory, decongestant, antifungal, sedative.

New generation drugs are devoid of side effects, such as drowsiness, effects on the cardiovascular system. However, with prolonged use of antihistamines, a strong negative effect on the liver is possible. That is why the course of taking these drugs should not exceed 7 days.

In the case of existing diseases of the internal organs, antihistamines are taken under the supervision of a physician.

Physiotherapy

In some cases, to alleviate the course of the disease and eliminate symptoms, they resort to physiotherapy procedures:

• PUVA therapy;
• electrophoresis;
• ultrasound;
• UV irradiation;
• subaqueous baths.

These procedures are used in combination with the main treatment. The attending physician can judge the expediency of their use.

How to prevent a relapse

Chronic recurrent urticaria by itself will not be eliminated, and even treatment does not give 100% relief from the disease. However, following some rules will help increase the duration of the remission period and reduce the frequency of attacks of the disease.

Basic preventive measures:

• exclusion of contact with the allergen;
• adherence to a hypoallergenic diet during the recurrence of urticaria;
• healthy lifestyle;
• timely diagnosis of diseases of internal organs and treatment;
• the use of hypoallergenic cosmetics;
• the use of household chemicals is undesirable.

Patients with chronic recurrent urticaria are contraindicated in baths, saunas, swimming pools. Hot baths are not recommended

Chronic recurrent urticaria is a rather dangerous disease, the therapy of which must be carried out under medical supervision. A cure for urticaria cannot be guaranteed by any specialist. However, you can muffle the symptoms of the disease using traditional medicine and folk remedies.

Recurrent urticaria is dangerous with a high risk of angioedema. As soon as the patient has difficulty breathing, coughing, hoarseness, it is urgent to call an ambulance. It is necessary to compare all possible complications and not delay the treatment of urticaria.

Auth. Gavrilenko Yu.

Urticaria is a skin disease that is often itchy and presents as erythematous (red, pink), painless, blistering rashes that disappear within 24 hours and leave clear skin behind. It belongs to the 20 most common skin diseases, and it is faced not only by allergists and dermatologists, but also by therapists, pediatricians and doctors of other specialties.

Depending on the duration, urticaria is usually divided into two forms: acute (OK) and chronic (HC). The latter is characterized by daily or frequent symptoms (blistering, itching, angioedema (AO)) for 6 weeks or more. During life, 0.5-1% of the entire human population suffers from HC. Moreover, if OK is usually associated with the action of exogenous factors and allergens (food, drugs, insect bites, etc.), then the cause of chronic in many cases is another disease or condition (for example, rheumatoid arthritis, infection, etc.) and urticaria acts only as a “symptom” of this disease or its cause is not detected at all (chronic idiopathic urticaria (CUR)). At the same time, the diagnosis of the primary cause of HC often causes certain difficulties not only for therapists, but even for some narrow specialists (allergists, dermatologists). Many doctors do not know by what mechanisms urticaria can occur, what conditions, factors and conditions lead to its development, and as a result, patient consultation is reduced to prescribing symptomatic treatment and / or conducting various kinds of expensive studies, usually not substantiated by the course, form and clinical picture of the disease.

Thus, the purpose of this review is to briefly describe the currently known or currently suspected etiological factors of CU, which will allow physicians of various specialties to optimize the diagnosis and treatment in such patients.

It is important to remember that in typical HC, rashes often appear spontaneously, i.e., without apparent causes and association with specific triggers. Therefore, the term "chronic urticaria" is synonymous with the term "chronic spontaneous urticaria" (CSU); it is sometimes also called "chronic urticaria vulgaris". The last two terms distinguish HC from other long-term forms of urticaria with known precipitating factors (for example, from various types of physical urticaria).

Pathogenesis

It is believed that the symptoms of HC are primarily associated with the activation of mast cells (MC) of the skin. The mechanism by which skin MCs in urticaria are forced to release histamine and other mediators has long remained a mystery to researchers. The discovery and characterization of "reaginic" IgE by Ishizaka scientists made it possible to explain the development of acute and episodic allergic urticaria by an immediate type of reactions (type I reactions according to Gell and Coombs), accompanied by binding of IgE to skin MCs and specific allergens, which leads to the release of mediators.

In recent years, works have appeared that highlight the possible role of blood coagulation in the pathophysiology of the disease. It is known that when the coagulation cascade is activated, vasoactive substances, such as thrombin, are formed, leading to an increase in vascular permeability due to stimulation of the endothelium. In patients with CU, activation of the coagulation cascade was found due to the action of tissue factor, which is expressed by eosinophils that infiltrate skin rashes.

Currently, many studies have already been published confirming the role of autoreactivity and autoantibodies (anti-IgE and anti-FcεRIα) in autoimmune urticaria. It is believed that the binding of these functional autoantibodies to IgE or high-affinity IgE receptors on MCs can lead to degranulation of the latter and release of mediators. Autoimmune urticaria is described in more detail below.

At the end of 2011, Bossi et al. published interesting results of a study of serum in patients with CU. Scientists have evaluated the role of mediators of mast and endothelial cells in increasing the permeability of the vascular wall. It was found that in many patients, MC degranulation is not associated with stimulation of high-affinity IgE receptors and occurs through IgE- and IgG-unrelated mechanisms. This finding opens up additional possibilities for understanding the pathogenesis of CU and the discovery of new histamine-releasing factors, especially in patients without autoreactivity and circulating autoantibodies.

Etiology

The main etiological factors of urticaria and their frequency of occurrence are shown in the table. Each of the reasons is discussed in more detail below.

1. Infectious diseases

The role of infection in various forms of urticaria has been discussed for over 100 years and is mentioned in most scientific reviews. It is assumed that the occurrence of urticaria during infections is associated with the participation of TA in protection against infectious agents. However, the exact mechanism is still unclear. In addition, it is difficult to establish a causal relationship between urticaria and infection, since it is not yet possible to conduct a challenge test with a suspected pathogen.

Despite the fact that to date the relationship of HC with many infectious diseases has not been fully proven, there are a fairly large number of scientific studies, observations and reports that demonstrate an improvement in the course or the onset of remission of HC after eradication of the infectious process.

Bacterial infection and foci of chronic infection. From 1940 to 2011, there were only a few references to cases of infectious diseases, presumably associated with the occurrence of urticaria in adult patients: tooth abscess (9 cases), sinusitis (3 cases), cholecystitis (3 cases), prostatitis, rectal abscess (1 each case) and urinary tract infections (2 cases). In other studies, this relationship was less significant. For example, in a 1964 study, 32 of 59 patients with CU had sinusitis on x-ray and 29 of 45 had dental infection. In many patients, the infectious process was asymptomatic.

A retrospective follow-up of 14 adult patients with CU and streptococcal tonsillitis, published in October 2011, suggested a causal relationship between the two diseases. Most patients had a high titer of antistreptolysin-O and circulating immune complexes, as well as resolution of urticaria symptoms after antibiotic therapy or tonsillectomy, from which the authors of the study concluded that tonsillitis could be the primary cause of urticaria. In a study published in 1967, 15 of 16 children with CU had recurrent upper respiratory tract infections, pharyngitis, tonsillitis, sinusitis, and otitis media, often due to streptococcal or staphylococcal infections.

Some physicians believe that the causal relationship between local bacterial infections and HC is more random than permanent, moreover, the international recommendations for the treatment of urticaria EAACI/GA2LEN/EDF/WAO do not give precise indications of the role of bacterial infection in the development of urticaria. Nevertheless, many experts consider it necessary, after excluding other causes of HC, to conduct tests for infections and prescribe antibiotics if they are detected.

Helicobacter pylori. Participation in the development of HC of a new infectious agent - H. pylori– was considered by scientists back in the 1980s. This was due to its ubiquitous distribution and frequent detection in patients with CU. It is believed that infection H. pylori is detected in about 50% of people in the general population in most countries of the world and in at least 30% of patients with CSI.

H. pylori is a spiral gram-negative bacterium that infects various areas of the stomach and duodenum. It is assumed that many cases of gastric and duodenal ulcers, gastritis, duodenitis, and possibly some cases of lymphomas and gastric cancer are etiologically associated with infection. H. pylori. However, most H. pylori infected carriers show no symptoms of the disease.

In some studies, it was shown that in a number of patients with HC and peptic ulcer caused by H. pylori, treatment of the infection with antibiotics led not only to the healing of ulcers, but also to the disappearance of urticaria, in others there was no positive relationship between the eradication of the microorganism and HC. However, it should be noted that after eradication H. pylori some patients without peptic ulcer have also experienced remission or improvement in urticaria.

According to the systematic review Urticaria and Infections (2009) , there are 13 carefully designed and conducted studies in which a clear and statistically significant effect of eradication was confirmed H. pylori(performed in 322 patients) on the course of HC, and 9 studies in which no such effect was noted (eradication was performed in 164 patients). Evaluating all studies together (both for and against), the remission rate of urticaria after H. pylori eradication was observed in 61.5% (257/447) of patients compared with 33.6% (43/128) when eradication was not carried out. At the same time, the frequency of remission in the control group of patients with CC and without infection H. pylori was 29.7% (36/121). The review authors concluded that CU remission after H. pylori eradication was observed almost 2 times more often, indicating a clear benefit of such treatment for patients with urticaria (p< 0,001).

Thus, although the role H. pylori As the causative agent of UC has not yet been conclusively confirmed, the authors of the systematic review recommend to all clinicians, after excluding other causes of urticaria:

1) appoint testing to identify H. pylori;
2) treat with appropriate antibiotics if infection is detected;
3) it is obligatory to receive confirmation that the eradication of the infection has been carried out successfully.

Viral infection. In separate studies, scientists have suggested an association of HC with certain viral infections, such as hepatitis viruses (A, B, C), Epstein-Barr, herpes simplex (recurrent genital herpes), norovirus and HIV infection. It is believed that hepatitis B and C are more common in combination with urticarial vasculitis than with HC. Sometimes at the onset of some acute infectious diseases, including hepatitis and infectious mononucleosis, the appearance of rapidly passing urticarial rashes, usually not progressing to HC, is noted. Moreover, in a review looking at a possible association between hepatitis viruses and HC, the scientists concluded that there is as yet no conclusive evidence for such an association.

fungal infection. Intestinal yeast infections of the genus candida albicans was studied as a possible cause of HC, but after eradication therapy, confirmation of this was not received. A Turkish study suggested a role for microsporidia in the development of OC and CU. The authors recommended that this type of infection be taken into account in patients with CSI. However, there is no conclusive evidence that fungal infection can be etiologically associated with the development of CU.

2. Autoimmune urticaria

Indirect evidence that HC may be autoimmune has existed for many years. Back in 1983, Leznof et al. found an association between autoimmune thyroiditis and HC/AO, and in 1989 the same authors identified a combined syndrome - autoimmune thyroid disease + HC/AO - in 15% of patients with antithyroid antibodies (antimicrosomal and antithyroglobulin), which supported the assumption of a possible role autoimmunity in this disease.

It has also been thought that HC blistering is associated with the release of histamine and other mediators from skin MCs, so it has been hypothesized that HC may be the result of circulating histamine-releasing factors, particularly autoantibodies. The assumption of a causal role of antibodies in CSU appeared as early as 1962, when the Swedish dermatologist Rorsman reported severe basopenia (a decrease in the number of basophils in the blood of less than 0.01 × 10 9 /l) in some patients with CSU and its absence in physical urticaria. He also clarified that such basopenia may be associated with possible antigen-antibody reactions accompanied by degranulation of basophilic leukocytes. Grattan et al. in 1986 an important observation was made. The authors for the first time described the appearance of the “blister-hyperemia-itch” reaction with intradermal administration of the serum of some (but not all) patients with CU to the same persons in unaffected areas of the skin. Scientists found a positive response in 7 out of 12 patients and noted that such a result can only be obtained in the active phase of urticaria. The results of early studies of this reaction suggested its association with histamine-releasing autoantibodies with anti-IgE characteristics. It is believed that in patients with a positive response to autologous serum, blistering occurred due to the ability of these autoantibodies to cross-react with IgE associated with skin TK, thereby causing activation of TK and the release of histamine and other biologically active substances.

Indirect evidence for the involvement of class G antibodies to FcεRI receptors in TK in the pathogenesis of CC, observed with positive passive transfer and testing with autologous serum, supported the view that these antibodies cause blistering and itching in those patients in whom they are detected in the blood.

In view of the above scientific data, the term “autoimmune urticaria” has begun to be used more and more often, describing some forms of CU as an autoimmune disease.

Features of autoimmune urticaria:

• more severe course;
• long duration of the disease;
• lack or poor response to treatment with antihistamines;
• performing an intradermal test with autologous serum and a test for the release of histamine from donor basophils under the influence of the patient's serum is considered the "gold standard" for the diagnosis of autoimmune urticaria.

HC associated with autoimmune reactions is often prone to a long chronic course compared to other forms of HC. In addition, other autoimmune diseases are sometimes found in patients with autoimmune urticaria, such as autoimmune thyroiditis, systemic lupus erythematosus, rheumatoid arthritis, vitiligo, pernicious anemia, celiac disease, insulin-dependent diabetes mellitus, etc. Frequency of these diseases and detection of autoimmune markers characteristic of them higher in patients with confirmed histamine-releasing autoantibodies than without it. Autoimmune thyroiditis and CU often coexist, but there is no evidence yet that thyroid autoantibodies are of paramount importance in the mechanism of CU development. The importance of the link between the two diseases lies in the separate autoimmune mechanism that is present in both conditions and that remains to be explored. There is also currently no conclusive evidence that treatment of thyroid dysfunction can alter the course of concomitant urticaria.

3. Urticaria associated with food and drug intolerance

Patients often go to the doctor, suspecting that the symptoms of CU are related to the food they eat. Currently, most experts are inclined to believe that "a true food allergy is extremely rarely the cause of chronic urticaria or angioedema", however, there is some evidence that food pseudo-allergens can exacerbate CU. Several studies have shown that in 1 out of 3 patients with pseudo-allergic reactions, the introduction of a diet without nutritional supplements improves the course of urticaria. It is believed that this phenomenon is associated with a change in the permeability of the gastroduodenal mucous membranes.

With regard to drugs, as in the case of food, some of them are usually regarded not as causative, but as provoking agents of CU (for example, aspirin and other non-steroidal anti-inflammatory drugs), leading to an exacerbation of the disease through non-immune mechanisms.

4. Physical hives

There are a fairly large number of physical forms of urticaria, which some experts refer to as HK, while others are classified as a separate group. These are diseases such as symptomatic dermographism (dermographic urticaria), cold, cholinergic, pressure-delayed, thermal, vibrational, adrenergic, etc. (detailed in other publications). The causative factor is the effect of the physical stimulus on the patient's skin. Many types of physical urticaria can co-occur with CSU in the same patient.

5. Other reasons

Hormonal disorders. It is believed that HC occurs approximately 2 times more often in women than in men, which may be predisposed to by various disorders associated with sex hormones. Thus, urticaria may be associated with several diseases and conditions associated with hormonal disorders, including endocrinopathy, the menstrual cycle, pregnancy, menopause, and the use of oral contraceptives or hormone replacement therapy. Hypersensitivity reactions to endogenous or exogenous female sex hormones have been described in the form of estrogen-associated urticaria (estrogen dermatitis) and autoimmune progesterone dermatitis.

Oncological diseases. There are anecdotal reports in the scientific literature of various malignancies, such as chronic lymphocytic leukemia, occurring in patients with urticaria. However, a large Swedish retrospective epidemiological study did not find a clear association between urticaria and cancer, and a recent Taiwanese study, on the contrary, confirmed a tendency to more frequent occurrence of cancer, especially malignant hematological tumors, in patients with CU.

Diseases of the gastrointestinal tract and hepatobiliary system. The role of diseases of the gastrointestinal tract and the hepatobiliary system in the development of CU is discussed. According to a summary published in the World Allergy Organization Journal (January 2012), chronic inflammatory processes such as gastritis, peptic ulcer and gastroesophageal reflux disease, inflammation of the bile ducts and gallbladder should be regarded as possible causative factors for urticaria, for which the appointment of an appropriate treatment.

autoinflammatory syndromes. An autoinflammatory syndrome should be suspected when a child develops persistent urticaria and fever during the neonatal period. In these syndromes, an increase in the level of interleukin IL-1 is noted, therefore, an IL-1 antagonist, anakinra, is often used to treat diseases.

Common variable immunodeficiency. In a study published in 2002, in 6 adult patients with combined variable immunodeficiency, the first manifestation of the disease was CU with or without AO. Four of them had a history of recurrent infections and a decrease in the total level of IgM, the rest had a decrease in the total level of IgG and IgA. 4 patients were treated with intravenous immunoglobulin, after which the symptoms of urticaria significantly decreased.

Schnitzler Syndrome. This syndrome was first described by Schnitzler in 1972, and since then many cases of this disease have been mentioned in the scientific literature. In addition to HC, it is characterized by fever, bone pain, increased ESR, and macroglobulinemia. In most patients with Schnitzler syndrome, the prognosis is favorable, although in some patients it can be transformed further into a lymphoproliferative disease.

6. Chronic idiopathic urticaria

Urticaria is defined as idiopathic if no cause is found after careful review of the history, physical examination, and laboratory and other findings. It is believed that about 90% of cases of HC are idiopathic. In some studies, 40-60% of patients with CIU were assumed to have an autoimmune nature of the disease, confirmed by the administration of autologous serum and using in vitro tests. In other cases of idiopathic urticaria, the cause remains unclear, although a number of such patients may actually also have autoimmune urticaria, the diagnosis of which is not confirmed due to false negative results or insufficient test sensitivity. However, in the majority of patients with CCI, the disease still proceeds through other, as yet unknown, mechanisms.

Conclusion

To date, the etiology and pathogenesis of CI remain unclear. As a result, a large number of questions remain to be answered. For example, how can degranulation of skin MCs occur for no apparent reason, through an incomprehensible mechanism, and without an obvious precipitating factor? There have been many attempts to link the mechanism of degranulation and the onset of CU symptoms with the use of certain foods and supplements, chronic infections. However, none of these assumptions has yet received clear confirmation in clinical trials, and expanding the understanding of the etiology of the disease is a task for further study.

The format of the scientific article did not allow to give all the alleged causes of HC. Therefore, when writing the review, the goal was to highlight the main causative factors of the disease, the most common in clinical practice. For a deeper study of the problem, it is advisable to refer to other publications.

Literature

1. Kolkhir P.V. Urticaria and angioedema. Practical medicine. M, 2012.
2. Powell R. J., Du Toit G. L. et al. BSACI guidelines for the management of chronic urticaria and angio-oedema // Clin. Exp. Allergy. 2007; 37:631-645.
3. Magerl M., Borzova E., Gimenez-Arnau A. et al. The definition and diagnostic testing of physical and cholinergic urticarias-EAACI/GA2 LEN/EDF/UNEV consensus panel recommendations // Allergy. 2009; 64: 1715-1721.
4. Maurer M. Allergie vom Soforttyp (Type I) - Mastzellen und Frøhphasenreaktion. In: Allergologie-Handbuch Grundlagen und klinische Praxis. Ed. by J. Saloga, L. Klimek et al. Stuttgart: Schattauer; 2006: 70-81.
5. Ishizaka K., Ishizaka T., Hornbrook M. M. Physicochemical properties of reaginic antibody: correlation of reaginic antibody with IgE antibody // J. Immunol. 1966; 97:840-853.
6. Gell P. G. H., Coombs R. R. Clinical aspects of immunology. Oxford: Blackwell, 1963: 317-320.
7. Cugno M., Marzano A. V., Asero R., Tedeschi A. Activation of blood coagulation in chronic urticaria: pathophysiological and clinical implications // Intern. Emerg. Med. 2009; 5(2):97-101.
8. Bossi F., Frossi B., Radillo O. et al. Mast cells are critically involved in serum-mediated vascular leakage in chronic urticaria beyond high-affinity IgE receptor stimulation // Allergy. 2011, Sep 12. Epub ahead of print.
9. Wedi B., Raap U., Wieczorek D., Kapp A. Urticaria and infections // Allergy Asthma Clin. Immunol. 2009; 5:10.
10. Wedi B., Raap U., Kapp A. Chronic urticaria and infections // Curr. Opin. Allergy Clinic. Immunol. 2004; 4:387-396.
11. Wedi B., Kapp A. Urticaria and angioedema. In: Allergy: Practical Diagnosis and Management. Ed. by M. Mahmoudi. New York: McGraw Hill, 2008: 84-94.
12. Calado G., Loureiro G., Machado D. et al. Streptococcal tonsillitis as a cause of urticaria tonsillitis and urticaria // Allergol. Immunopathol. 2011, Oct 5. Epub ahead of print.
13. Buckley R. H., Dees S. C. Serum immunoglobulins. Abnormalities associated with chronic urticaria in children // J. Allergy. 1967; 40:294-303.
14. Zuberbier T., Asero R., Bindslev-Jensen C. et al. EAACI/GA2 LEN/EDF/WAO guideline: management of urticaria // Allergy. 2009; 64: 1427-1431.
15. Burova G. P., Mallet A. I., Greaves M. W. Is Helicobacter pylori a cause of chronic urticaria // Br. J. Dermatol. 1998; 139 (Suppl. 51): 42.
16. Magen E., Mishal J., Schlesinger M., Scharf S. Eradication of Helicobacter pylori infection equally improves chronic urticaria with positive and negative autologous serum skin test // Helicobacter. 2007; 12:567-571.
17. Cribier B. Urticaria and hepatitis // Clin. Rev. Allergy Immunol. 2006; 30:25-29.
18. Dover J.S., Johnson R.A. Cutaneous manifestations of human immunodeficiency virus infection (part 2) // Arch. Dermatol. 1991; 127: 1549-1558.
19. Ronellenfitsch U., Bircher A., ​​Hatz C., Blum J. Parasites as a cause of urticaria. Helminths and protozoa as triggers of hives? // Hautarzt. 2007; 58:133-141.
20. Karaman U., Sener S., Calik S., Sasmaz S. Investigation of microsporidia in patients with acute and chronic urticaria // Mikrobiyol. Bul. 2011; 45(1): 168-173.
21. Leznoff A., Josse R. G., Denburg J. et al. Association of chronic urticaria and angioedema with thyroid autoimmunity // Arch. Dermatol. 1983; 119:637-640.
22. Leznoff A., Sussman G. L. Syndrome of idiopathic urticaria and angioedema with thyroid autoimmunity: a study of 90 patients // J. Allergy Clin. Immunol. 1989; 84:69-71.
23. Rorsman H. Basophilic leucopenia in different forms of urticaria // Acta Allergologica. 1962; 17:168-184.
24. Grattan C. E. H., Wallington T. B., Warin A. P. et al. A serological mediator in chronic idiopathic urticaria: a clinical immunological and histological evaluation // Br. J. Dermatol. 1986; 114:583-590.
25. Grattan C. E. H., Francis D. M. Autoimmune urticaria//Adv. Dermatol. 1999; 15:311-340.
26. Di Lorenzo G., Pacor M. L., Mansueto P. et al. Food-additive-induced urticaria: a survey of 838 patients with recurrent chronic idiopathic urticaria // Int. Arch. Allergy Immunol. 2005; 138:235-242.
27. Kasperska-Zajac A., Brzoza Z., Rogala B. Sex hormones and urticaria // J. Dermatol. sci. 2008; 52(2): 79-86.
28. Lindelof B., Sigurgeirsson B., Wahlgren C. F. et al. Chronic urticaria and cancer: an epidemiological study of 1155 patients // Br. J. Dermatol. 1990; 123:453-456.
29. Zuberbier T. A Summary of the New International EAACI/GA2LEN/EDF/WAO Guidelines in Urticaria // W. AllergyOrg. J. 2012; 5: S1-S5.
30. Altschul A., Cunningham-Rundles C. Chronic urticaria and angioedema as the first presentations of common variable immunodeficiency // J. Allergy Clin. Immunol. 2002; 110: 1383-1391.

P. V. Kolkhir, Candidate of Medical Sciences

Research Center GBOU VPO of the First Moscow State Medical University. I. M. Sechenov of the Ministry of Health and Social Development of Russia, Moscow

When exposed to an allergen, a rash on the skin of red color in the form of blisters often appears. If the influence of the irritant is not stopped and the symptoms intensify, then recurrent urticaria may appear. This chronic form can be observed in both adults and children. Long-term treatment prescribed by an allergist will be required to reduce symptoms and prevent relapses.

Recurrent urticaria is a form of chronic disease.

Characteristics of the disease

Urticaria is a disease that manifests itself in the form of blisters on the surface of the skin. In some cases, it may resemble a simple allergic rash. Sometimes the rashes are extensive and strong, similar to a nettle burn. They form when fluid builds up that leaks from the blood vessels.

If the disease lasts up to 6 weeks, then the acute stage is determined. With repeated manifestations, chronic recurrent urticaria is diagnosed. Its treatment is often difficult due to frequent repetitions over several years or a lifetime. More often this form of the disease occurs in women and children. The reasons for its occurrence may be different.

Most often, chronic recurrent urticaria occurs in children and women.

Causes of recurrent urticaria

When a rash appears in the form of blisters on the surface of the skin, it is not always possible to identify the causes of chronic urticaria. It can be due to the influence of various factors, among which are:

hereditary predisposition;

chronic diseases of various organs and systems;

allergens.

Under their influence, a recurrent form of urticaria may appear much more often. There are other causes of the onset of the disease.

The disease can manifest itself under the influence of a failure in the immune defense of the body.

The occurrence of urticaria is affected by disorders in the endocrine, digestive system, pathology of the liver and kidneys.

Often a rash appears with a viral or bacterial infection, as well as helminthic invasion.

Rashes are formed in people who suffer from systemic diseases. These include rheumatoid arthritis, lupus erythematosus.

Food irritants have a great influence, which lead to sensitization of the body to certain foods.

An allergic reaction in the form of hives may be due to the effects of drugs.

The causes of recurrent urticaria can be expressed in the form of exposure to household allergens, physical environmental factors.

Often the disease appears in people with malignant neoplasms.

Often the cause of the appearance of rashes that recur after a while is not easy to identify. Therefore, it is necessary to conduct a serious diagnosis so that the treatment is prescribed correctly.

The true cause of recurrent urticaria can not always be identified.

Symptoms of the disease

At the initial stage of the onset of the disease in adults and children, rashes appear on the surface of the skin. They are expressed in the form of red blisters that resemble the effects of a nettle burn.

The rash can be localized on a separate area of ​​​​the skin, and also spread over the surface of parts of the body. It can be presented in the form of small pimples, as well as large watery elements. The area that has been irritated may be red and swollen. Most often, blisters appear in the area:

After the formation of a rash, a person begins to feel itchy. For repeated manifestations of urticaria, it is less characteristic. Therefore, its intensity is lower than in the acute stage.

If the rashes occupy large surfaces, then the general condition of the person may worsen. This period is characterized by the appearance of:

weaknesses;

headache;

rise in body temperature;

disorders of the digestive system;

insomnia;

nervous disorders.

A characteristic feature of the recurrent form of the disease is an undulating course. This is due to prolonged sensitization of the body to the irritant. The patient has the onset of periods of exacerbation and remission, when the symptoms are reduced and eliminated for a while.

Also one of the features of recurrent urticaria is a sharp elimination of symptoms in the acute stage. In this case, the skin acquires its original appearance, as if the disease did not exist at all.
The course of the disease in children

In children, recurrent urticaria is the result of acute urticaria in which treatment was given incorrectly or not at all.

In addition to rashes in childhood, the disease manifests itself in the form of:

pain in the abdomen;

rise in body temperature;

dry cough.

Relapses can occur every three months.

The disease in children is caused by various reasons. It occurs with digestive, autoimmune, endocrine disorders, diseases of the kidneys, liver, biliary tract, viral and bacterial infection. One of the common factors affecting the development of urticaria is allergic irritation.

Recurrent urticaria in children may be the result of improper treatment.

Complications in the disease

If the patient did not go to the doctor in time and did not start treatment for the acute stage of the disease, then it flows into a chronic relapsing one. The latter can lead to serious consequences, one of which is anaphylactic shock.

In case of its occurrence, the work of the heart and respiratory organs is disturbed. Due to the narrowing of the bronchi, there is a violation of the respiratory function, a drop in blood pressure.

Often, a chronic relapsing form flows into a progressive one. In this case, an undermining of the immune system can occur, which causes the appearance of:

lupus;

rheumatoid arthritis;

diabetes;

thyroid diseases;

gluten intolerance;

Sjögren's syndrome.

To prevent this from happening, it is necessary to consult a doctor when the first signs of the disease appear and begin treatment.

If treatment is not started on time, recurrent urticaria can cause serious complications.

Treatment of the disease

Treatment of a recurrent form of urticaria begins with the diagnosis of the disease. This is necessary not only to confirm the diagnosis, but also to find out the causes of rashes. The doctor can conduct a comprehensive examination of the body for various pathologies, as well as prescribe a blood test and skin tests to identify the allergen.

After determining the source of the rash, you need to act on it with therapy. If the urticaria appears under the influence of an irritant, it is necessary to exclude contact with it. To eliminate the influence of household dust, it is recommended to frequently wet clean the room using a vacuum cleaner with a water filter. If the reaction is caused by exposure to plant pollen, it is worth refusing to walk during their flowering period.

With food allergies, it is advisable to keep a food diary, in which all data on the body's reaction to various foods will be recorded. You can also use elimination (exclusive) and provocative methods during the preparation of the diet.

Chronic recurrent urticaria is sometimes very difficult to treat.

Medical therapy

When an allergen enters the body, treatment is carried out with the help of antihistamines. They help stop the production of histamine, which speeds up the process of eliminating the symptoms of hives.
Recently, doctors have been prescribing treatment with drugs to block H1 receptors in tissues. Among them are:

Astemizol;

Loratadine;

fexofenadine;

Cetirizine.

In combination with H2-receptor blockers, they eliminate the symptoms of urticaria and alleviate the patient's condition.

If there is no improvement after the use of antihistamines, then corticosteroids may be prescribed. Also, Prednisolone, Dexamethasone are needed at the time of angioedema.

In the presence of mental overstrain and, as a result, urticaria that has appeared, drugs with an antihistamine and sedative effect are prescribed. Among them are Atarax, Donormil. They help fight itching, insomnia.

With urticaria caused by food irritants, it is recommended to take enterosorbents. They bind allergens and remove them from the body. The most effective drugs in this group are:

Polysorb;

Enterosgel;

Filtrum.

Treatment also includes the use of local remedies. Often, non-hormonal preparations (La-cree, Psilo-balm, Fenistil-gel, Bepanten) are applied to irritated skin, which have a wound healing, antipruritic and anti-edematous effect. Also, doctors recommend using drugs that contain menthol (Menthol oil) to eliminate itching.

For the treatment of each specific type of urticaria, the doctor will select the remedy individually.

Other treatments

If drug therapy does not lead to positive dynamics, then physiotherapy can be performed. It can be expressed as:

therapeutic showers and baths;

ultraviolet irradiation;

wet wraps;

currents of different directions.

Elimination of the symptoms of the disease is complex. In addition to taking medication, the patient needs to visit resort places, the sea coast. It is also worth paying attention to the diet, eliminating junk food and enriching it with healthy foods.