Urticaria is a disease caused by complex changes in the body’s allergic reactivity in response to the introduction of various allergens.
Development reasons
The causal factors for the development of urticaria, first of all, should be attributed to drugs (antibiotics, sulfonamides, salicylates, organopreparations).
In addition, urticaria develops with parenteral administration of a foreign protein, especially prophylactic and therapeutic sera.
Less often, urticaria occurs with the use of drugs of quinine, chlorpromazine, steroid hormones, aloe, insulin, B vitamins, digitalis.
Many domestic and foreign researchers note in the development of urticaria the important role of the functional states of the nervous and endocrine systems, which often cause allergic reactions to the administration of medications.
Another common cause of hives is food allergy. There is a whole group of foods that are more likely than others to cause urticaria. These are strawberries, crayfish, crabs, oysters, eggs, mushrooms, tomatoes, citrus fruits, fish (especially smoked), cheese, sausage, meat (usually fried), canned food, chocolate, coffee, cocoa, tea, hot spices, etc.
Usually, urticaria develops with repeated consumption of even small amounts of “forbidden” foods, but there are cases when intolerance to any food product manifested itself after the first intake.
Hives can develop in people who are hypersensitive to any ingredient in a product.
So, cookies, which include flour, eggs, butter, sugar, vanillin, can cause an allergic reaction if there is an intolerance to one of the listed components.
In rare cases, urticaria occurs after eating one food product, and later relapses appear after taking others that have not previously caused a similar reaction.
Sometimes urticaria develops as a result of incomplete digestion of food in patients with dysfunction of the gastrointestinal tract (peptic ulcer, chronic gastritis, colitis, dyspepsia, liver disease, gallbladder). This is due to the fact that in the intestine the products of insufficiently digested food, which have not yet lost their specificity, are absorbed into the bloodstream and, due to their foreignness, induce an allergic reaction to a certain food product.
Acute food poisoning can also be accompanied by rashes of urticaria, which in this case develops either directly to toxins, or is a consequence of the absorption of incompletely digested nutrients through the damaged wall of the gastrointestinal tract.
In persons suffering from chronic constipation, the development of urticaria is based on the same mechanism as in cases of acute poisoning, but the factors that determine the development of urticaria are toxic substances formed in the large intestine.
Rashes of urticaria can appear with diseases of the kidneys and urinary tract infections, which is explained by the accumulation of toxic substances (uric acid) due to impaired renal function.
Accession of infection with helminths (ascariasis, giardiasis, etc.) aggravates the course of urticaria.
In addition, the cause of urticaria may be the effect on the body of various physical factors (mechanical irritation; temperature influences – cold, heat; various types of radiant energy – light, X-rays, radiation).
Cold urticaria can appear even if the temperature drops slightly in summer (cool wind). There are reports of hives caused by both cold and heat.
Particularly noteworthy is the possibility of death when bathing persons with increased sensitivity to cold.
There are several types of heat urticaria: local urticaria, in which the rash occurs only at the site of exposure to heat, and generalized (diffuse), which occurs with local or general exposure to heat, as well as with physical stress and emotional arousal. In such cases, not only external thermal influences, but also any increase in temperature (due to the intake of hot dishes, alcohol, various mental emotions, physical and mental work, exercise, etc.), as a rule, causes urticaria.
Of particular interest are reports indicating the development of urticaria from sun exposure. As a rule, the rash is localized in places of sunburn and is absent in places protected from sunlight.
Clinic
The very name of the disease “urticaria” reflects the essence of the main morphological element, which looks like a blister that occurs upon contact with nettles.
Rashes in patients with urticaria – urticarial rash – occur quickly and resolve relatively quickly. In some cases, the urticaria rash persists for a long time, gradually transforming into nodules.
Clinically, there are four main types of urticaria:
– sharp;
– acute limited angioedema;
– chronic recurrent;
– persistent papular chronic urticaria.
Acute urticaria. Acute urticaria usually starts suddenly. First, there is a strong, unbearable itching, accompanied by scratching. Further, at the sites of skin scratching, bright erythema develops, against which blisters appear, rising above the level of the skin.
The center of each blister turns pale pink and subsequently takes on a matte hue. A strip of pinkish-red color with indistinct borders is formed along its edges, the so-called corolla of erythema. Blisters are usually round, less often elongated or irregular in shape.
In severe cases, there is a rapid peripheral growth of blisters and their fusion with each other with the formation of extensive lesions. In some cases, acute urticaria occurs with a violation of the general condition, which is expressed by the following symptoms: weakness, malaise, chills, fever up to 38-39 ° C. This condition is called “nettle fever”.
Acute urticaria may be complicated by angioneurotic angioedema or edema of the vocal cords.
Often, acute urticaria occurs in practice as the only manifestation of an allergic process or may occur as a symptom of another disease. For example, acute urticaria manifests itself as one of the symptoms of serum sickness with intravenous vaccines, therapeutic sera and blood transfusions. In addition, urticarial rashes can be observed in many skin diseases occurring with an allergic component: eczema, Duhring’s dermatitis, neurodermatitis, etc. Acute urticaria usually lasts 1.5-2.5 weeks.
Acute limited angioedema , or giant urticaria. Quincke’s edema is localized in limited areas of the body, arms, chest, less often it occurs in the face, lips, eyelids, scrotum.
The disease begins with the appearance of itching, burning sensation in limited areas of the skin. Then, in these places, pale edema rapidly develops, capturing the subcutaneous fatty tissue and mucous membranes. In severe cases, it is accompanied by functional disorders of organs and tissues, often very pronounced.
For example, with edema of the larynx, disorders leading to asphyxia develop, and with Quincke’s edema in the region of the eyeball, the number of its movements and visual acuity are sharply reduced.
Quincke’s edema can quickly and completely resolve, but it can also recur.
Chronic recurrent urticaria. Urticaria can turn into a chronic form with repeated administration of medications, lack of sanitation (disinfection) of chronic foci of infection (chronic tonsillitis, adnexitis, cholecystitis, etc.), disruption of the gastrointestinal tract.
With an exacerbation of chronic recurrent urticaria, urticarial eruptions are observed, occupying areas of the skin of different areas.
During this period, the general condition of patients is disturbed, which is manifested by malaise, headache, polyarthralgia, fever.
In a severe course of chronic recurrent urticaria, edema of the vocal cords with symptoms of asphyxia can be provoked.
Swelling of the stomach lining can cause nausea and vomiting. Swelling of the intestinal mucosa is manifested by diarrhea. Skin rashes can be accompanied by functional disorders of the nervous system, which is associated with excruciating itching, insomnia.
This form of the disease is characterized by repeated relapses of dermatosis. The disease lasts for many months and sometimes years.
Persistent papular chronic urticaria. This form of urticaria is characterized by frequent relapses. Urticarial eruptions become more persistent, last for several weeks or even months.
With persistent papular chronic urticaria, the elements of the rash are transformed into papules. In some cases, urticarial rashes are brightly colored. During frequent relapses, skin manifestations are accompanied by severe itching.
Treatment
Before proceeding with the treatment of urticaria, a comprehensive examination of the sick child should be carried out. A prerequisite is the exclusion of contact with the allergen that caused the disease (sanitation or elimination of the focus of infection, withdrawal of the drug, cleansing enemas, etc.).
For diagnostic purposes, it is necessary to conduct research for the presence of helminths, which can also contribute to the allergization of the body. If they are identified, the patient is dewormed.
Therapeutic measures are reduced to the use of non-specific desensitizing, antihistamines and sedatives. When an allergen is detected, specific desensitizing therapy is indicated.
Non-specific desensitizing therapy consists in the use of a 10% solution of calcium chloride, a 10% solution of calcium gluconate, and a 30% solution of sodium hyposulfite. To reduce vascular permeability, askorutin is prescribed.
With a complicated course of the disease, the use of corticosteroid hormones is indicated: prednisolone, triamcinolone (polcortolone), followed by a dose reduction.
For the treatment of urticaria, anti-histamines are prescribed (suprastin, pipolfen, diazolin, tavegil, histalong, fenkarol, etc.) in the generally accepted age dosage.
Recently, histaglobulin is increasingly prescribed for the treatment of patients with urticaria during the period of remission, but only if the patient does not have reactions to u- globulin.
With a rapid increase in edema, diuretics such as lasix or furosemide in age-specific doses are recommended.
Specific desensitizing therapy of patients with revealed hypersensitivity to a certain allergen (bacterial, food, etc.) is carried out with strepto- and staphyloid vaccines.
Such treatment is contraindicated for pulmonary tuberculosis, heart and liver diseases, acute renal failure, old age, pregnancy, hypertension and peptic ulcer disease. This method is recommended for use only in an allergy room.
Topical treatment for urticaria is not essential and only temporarily relieves itching by using liquid pastes.
A significant role in the treatment of urticaria is played by a properly selected diet and spa therapy (Matsesta, Crimea, Belokurikha).