Urticaria is the main clinical sign of many allergic diseases, which manifests itself in a diffuse or limited rash in the form of blisters, papules of various sizes. Their appearance is accompanied by itching of the skin. Generalized urticaria can occur as an independent disease, or be a symptom of other diseases that differ in the mechanism of development and origin.
It is characterized by extensive areas of rashes, sometimes covering the entire human body. This variety can pose a threat to the patient's life, since it is often accompanied by Quincke's edema, generalized urticaria. ICD-10 L50 is the disease code in the International Classification of Diseases (2018).
Varieties of pathology
A disease can have two developmental options: non-immune and immune. The second option is more common. When an allergen enters the body, the immunoglobulin E immune system begins to intensively produce against it. During the interaction of antigens with it, mast cells are destroyed, a large amount of histamine is released into the bloodstream, enhancing the permeability of the vessel walls, and causes typical symptoms of urticaria.
The non-immune form of generalized urticaria is associated with exposure to mast cells in an allergen. The true causes of the disease today, scientists can not yet name. It has been established that the generalized form of urticaria often occurs in people with a history of atopic diseases of an allergic origin.
About 75% of officially recorded cases are acute urticaria. The rapid development and the duration of no more than one and a half months are characteristic of it. Often, its development is associated with improper use of drugs. It is often diagnosed in children.
Chronic generalized urticaria is diagnosed in 25% of cases. Depending on the clinical picture, it is divided into:
- recurrent;
- persistent (sluggish).
The disease is often diagnosed in childhood, and throughout life it can give a relapse every time an allergen enters the bloodstream.
Forms of the disease
In the last classification, the disease is divided according to the nature of the course, and also depending on the cause that caused it into clinical forms. By the nature of the course, the pathology can be acute and chronic. We will understand what their differences are.
Acute generalized urticaria
It is characterized by rapid development and lasting at least six weeks. With this form, rashes can disappear under the influence of drugs or after eliminating the allergen that caused it.
Chronic form
We already mentioned that the chronic form of generalized urticaria has several varieties: immune, non-immune, and idiopathic (when the cause is not established). In addition, the chronic form may be:
- Cold (acquired primary or secondary).
- Solar.
- Cholinergic, which is due to sensitivity to acetylcholine, which is an allergen. Excessive physical exertion, a psycho-emotional reaction, high air temperature, hot water, spicy or hot food can provoke such a reaction.
- Contact.
The pathogenesis of this disease is complex, it is associated with mast cell degranulation, during which inflammatory mediators are released . They cause the development of clinical symptoms.
Experts believe that the development of an allergic urticaria (generalized form) involves autoimmune reaction mechanisms, as half of patients with this diagnosis have autoimmune antibodies to the high affinity receptor alpha chain that interact with the immunoglobulin E Fc fragment. As a result, basophils and obese degranulate. cells and anaphylotoxin (toxic substance) is released.
The chronic course of the disease lasts more than six weeks. Generalized urticaria in children under two years of age occurs mainly in the acute form, up to 12 years of age - chronic and acute, the first prevailing. After 12 years, the chronic form is mainly found.
Diagnostics
Diagnosis of generalized urticaria is based on history and clinical presentation. If during a physical examination and history taking the causes of urticaria are not established, the doctor prescribes laboratory tests. In the acute form of the disease, as a rule, there is no need for laboratory tests, the only exceptions are cases when a history of provoking factors is indicated. In most cases, generalized urticaria in acute form is effectively stopped by H1-histamine blockers, and in especially severe cases with glucocorticosteroids.
Chronic laboratory tests
In this case, laboratory studies are aimed at identifying the causes of the disease. A mandatory examination includes: a blood test, the identification of the level of C-reactive protein contained in blood serum. With an extended examination, tests are performed to exclude the presence of infectious diseases, helminthic invasion.
The specialist will need the results of studies of thyroid gland indices (antithyroid antibodies, T4, TSH).
Provocative factors
The main causative factors of the development of the disease include food:
- meat and products from it (mainly pork and beef);
- fish;
- smoked fish and meat;
- milk;
- chicken eggs;
- stone fruits and berries (strawberries, strawberries);
- red apples
- melon;
- carrot;
- nutritional supplements;
- honey.
Medicines:
- antibiotics (often penicillin group);
- non-steroidal drugs;
- sulfonamides;
- iodine preparations;
- vitamins C;
- group B;
- antiseptics.
Physical factors:
- water treatments;
- Sun rays;
- thermal and cold factors;
- poison of some insects.
In addition, provoking factors include: chronic fungal, viral and bacterial infections, intestinal dysbiosis, gastric pathology caused by the bacterium Helicobacter pylori, psychogenic factors, chemical cosmetics.
Symptomatology
Generalized urticaria (a symptom photo we posted in the article) is characterized by vivid symptoms: the sudden appearance of red blisters throughout the body, severe skin itching, which intensifies in the evening, swelling of irritated and inflamed skin, and burning. Blisters can be of different diameters, which quite often merge into a solid red spot. They have raised edges and are limited by the papillary layer of the skin with a raised surface. Externally, the rash resembles a nettle burn, but it is very extensive. They rapidly spread throughout the body and form a large spot of irregular shape.
Rashes rarely appear on the mucous membranes and lips. During the first two days, the rash disappears in some places, but appears in other areas. Hemorrhagic and bullous forms of generalized urticaria are much less common. These forms are dangerous in severe course. The patient suffers from chills, fever, loss of appetite, malaise, nausea, joint pain, nosebleeds are possible.
With a sharp drop in pressure, shortness of breath and hoarseness, acute pain in the abdomen, loss of consciousness, swelling of the mucous membrane of the throat, mouth, tongue, urgent hospitalization is required.
Treatment methods
Therapy of generalized urticaria is aimed at:
- elimination of an allergic rash;
- prevention of complications;
- relapse prevention.
If signs of the disease appear, call an ambulance. Before the arrival of physicians, it is necessary to try to determine the allergen that caused this reaction and exclude contact with it.
Medications
The patient needs to take antihistamines:
- Tavegil.
- Suprastin.
- The Zodak.
- "Loratadine."
Antihistamines of the first generation can be taken only with a sharp exacerbation of symptoms. This will quickly stop the symptoms and prevent the development of Quincke's edema. An ambulance doctor will prescribe an injection (intravenous) of an antihistamine or, in a severe case, Prednisolone.
If there is a suspicion of the development of Quincke's edema, the patient will be administered “Epinephrine” intramuscularly. Blood pressure is restored using saline crystalloid solutions that are administered intravenously. When the pathology is accompanied by a convulsive syndrome, the doctor prescribes the introduction of "Diazepam" or "Relanium". Generalized urticaria, in which the general condition of the patient rapidly worsens, requires emergency treatment in the intensive care unit or intensive care.
Depending on the allergen that triggered the disease, in addition to antihistamine therapy, diuretics, sorbents, and plasmapheresis sessions may be required. If necessary, drugs acting on the central nervous system can be prescribed. "Amitriptyline" helps relieve anxiety. To reduce skin irritation and itching, externally non-steroidal agents are used:
- Bepanten.
- "Solcoseryl."
- "Vundehil."
- Desitin.
Hormonal ointments should not be used on large areas of the skin.
Preventive recommendations
Treatment of generalized urticaria is a long and complex process. Therefore, it is important to prevent the disease. Often this form of manifestation of an allergic reaction occurs due to untimely or self-medication. At the first signs of the disease, you must immediately visit a doctor. This will prevent systemic manifestations.
With a predisposition to allergies, contact with allergens must be avoided. For example, if you are intolerant of certain products, carefully study the composition of the dishes offered.
Medicines should be taken only as directed by a doctor. It is important to train resistance to all kinds of stimuli of the immune system. To do this, you must:
- administer complementary foods to babies in strict accordance with the recommendations of the pediatrician;
- exclude highly allergenic foods from the diet;
- get rid of bad habits;
- do sport;
- regularly ventilate and do wet cleaning.
Generalized urticaria is a serious disease that is difficult to treat. At the first signs of a relapse, all necessary measures should be taken to stop the symptoms, so as not to allow the inflammatory process to spread throughout the body. An antihistamine should always be on hand. After each exacerbation, a visit to the doctor is a prerequisite that guarantees successful treatment.