An allergic reaction such as urticaria is a common pathology that occurs in the practice of almost any modern allergist. The symptoms and causes of this disease, as well as the methods and methods of its treatment are described in detail in this article.
Features of the disease
An allergic reaction such as urticaria includes a fairly large heterogeneous group of conditions and diseases that are interconnected by similar symptoms and common primary skin elements, namely blisters.
It should be noted that in 40% of cases, in the course of its development, this pathological condition is accompanied by the development of characteristic angioedema. It is understood as edema of the deep layers of the dermis, as well as the submucosal layer and subcutaneous tissue, while the surface layers of the skin do not participate in this process.
In some patients, an isolated angioedema may develop, which will not be accompanied by an allergic reaction such as urticaria. This is a disease that requires treatment without fail, and when the first symptoms appear, which we will describe in detail in this article. As soon as the first symptoms appear, you should immediately consult a doctor. An allergic reaction such as urticaria in the ICD is present, it is an ailment well known throughout the world.
Epidemiology
Currently, from 15 to 25% of the inhabitants of planet Earth suffer from different types of urticaria all over the world. In this case, an acute allergic reaction of the type of urticaria is especially common. It manifests itself in approximately 60% of all cases.
In about a third of patients, this disease eventually becomes chronic, constantly manifests itself in the form of relapses. It is an acute allergic reaction of this type that is often found in juvenile patients, and chronic manifestations are observed mainly in women aged 20 to 40 years. In about a quarter of patients suffering from a chronic allergic reaction such as urticaria, symptoms persist for at least 10 years. In about half the cases, the chronic manifestation of this disease is due to the presence of an autoimmune problem, which should be established by a qualified specialist.
In the vast majority of cases, the cause of chronic urticaria in adult patients remains unclear.
Place in the international classification of diseases
An allergic reaction such as urticaria in the ICD-10 is officially registered. ICD-10 adopted in 2007, is currently the generally accepted classification for coding medical diagnoses. It was developed by the World Health Organization. In total, this classification consists of 21 sections or classes, each of which contains certain headings with codes of conditions and diseases. The number 10 in the title indicates that this international classification of diseases is the tenth revision.
In ICD-10, an allergic reaction of the type of urticaria refers to diseases of the skin and subcutaneous tissue. It is part of the subsection labeled L50-L54.
The allergic reaction type of urticaria is L50. His knowledge allows doctors around the world to identify a particular disease identically. The code of the ICD of an allergic reaction like urticaria greatly facilitates the work with the interaction of doctors from different countries. Classification helps them effectively find a common language and collaborate together.
According to the allergic reaction code by the type of urticaria, several more subsections can be determined. These types of urticaria fall here:
- Allergic
- Idiopathic.
- Provoked by exposure to high or low temperature.
- Dermatographic.
- Vibrating.
- Cholinergic.
- Contact.
- The other one.
- Unspecified.
All this allows you to accurately determine the allergic reaction by the type of urticaria in the ICD-10.
Unspecified
As a rule, in most cases, problems with diagnosis arise when identifying an allergic reaction of an unclear etiology of the type of urticaria.
In this case, the patient complains of itching of the skin, it is especially severe in the chest, neck, and arms. Rashes and hyperemia may appear on the skin. As a rule, the patient himself cannot associate his condition with any particular cause. Before that, he didn’t use any unusual products, and did not take medications of an unknown purpose.
In this case, an allergic reaction of the type of generalized urticaria manifests itself during a visual examination of the collar zone, the front surfaces of the chest and neck, thighs, and upper limbs. All of them are hyperemic. In this case, raised pink blisters are observed on the skin, which visually look like traces of nettle burns. In this regard, this disease got its name.
Rashes are polymorphic, their symmetry may be noted, when pressed, they begin to turn pale. The skin adjacent to the lymph nodes, as well as subcutaneous tissue, are not affected by changes.
All this indicates a urticaria of unclear etiology. It is recommended that the patient immediately hospitalize.
Similar diseases
It is worth noting that, in addition to the division into chronic and acute urticaria, this disease is divided depending on the factors that provoke this exacerbation. It is noteworthy that in the same patient fundamentally different forms of urticaria may appear. In addition, a number of conditions have been described in the medical literature that once belonged to this disease, but are now not considered to be it, however, include angioteka as one of the symptoms. Here is a list of such pathological conditions:
- Mastocytosis or pigmented urticaria. This disease is caused by the proliferation and accumulation of mast cells in tissues.
- Polymorphic skin rashes, including urticarial.
- Urticarial vasculitis. Classical vasculitis, which is accompanied by skin rashes, not only by angiotherapy, but also by blisters and nodules.
- Non-histaminergic angiotherapy. It can be hereditary, often associated with defects in the kinin and complement system.
- Anaphylaxis - urticaria, which is caused by exorbitant physical activity.
- Cryopyrine. This is a periodic syndrome characterized by headaches and increased fatigue.
- Schnitzler's syndrome is a chronic urticaria, which is accompanied by monoclonal gammopathy.
- Gleich syndrome - episodic angioedema with eosinophilia.
- Wells syndrome - granulomatous dermatitis with eosinophilia.
The main thing in describing an allergic reaction by the type of urticaria, the pathogenesis of this condition is the release of mast cell mediators, as well as the development of their effects. We are talking about increasing the permeability of the vascular wall, vasodilation, the appearance of hyperemia and edema.
Kinds
The diagnosis of an allergic reaction by the type of urticaria is made in the presence of one of three pathogenetic options. In each case, there are reasons that led to the development and progression of this disease.
Allergic urticaria. In this case, the key role is played by reagins, that is, immunoglobulins that appear when the allergen initially enters the body. They are fixed on basophils and mast cells. Repeated exposure to the allergen leads to mast cell degranulation. In particular, urticaria occurs in this form, the causes of which are food allergies.
There is also an allergic variety in which degranulation is caused by the activation of the complement system or the appearance of immune complexes that activate the complement and kinin system in the classical way.
Non-allergic urticaria can be associated with a whole list of all kinds of reasons. We list the main ones:
- violation of the exchange of arachidonic acid;
- increased concentration of histamine;
- accumulation of bradykinin;
- excessive allocation of acetylcholine;
- alternative activation of the complement system;
- exposure to certain neuropeptides;
- physical factors (dependence on cold or heat);
- the result of exposure to food or drugs, most often the catalysts are cheese, chocolate, nuts, strawberries.
The development of idiopathic urticaria is only expected if functional or structural defects of basophils or mast cells are present. At the same time, a close examination requires a blood coagulation system, which affects the development of pathological reactions.
Disease development
An allergic reaction like hives in a medical history almost always begins with a characteristic itch, after which various rashes appear. These can be blisters that rise above the surface of the skin. They can take various sizes and shapes. Rashes remain for half an hour to two days until they are completely resolved.
Most often, they suddenly appear and disappear in various places. In the presence of a chronic allergic reaction such as urticaria, the photo in this article will give you an idea about this disease, rashes appear in the evening. This should be taken into account, be sure to talk about the time of their appearance at the doctor’s appointment. At the same time, this practically does not affect the general condition of the patient. The quality of life is significantly reduced only due to prolonged and prolonged itching.
When angiotedema appears, it is characterized by diffuse swelling of friable subcutaneous connective tissue on the back of the feet and hands, lips, eyelids, genitals, mucous membranes. In this case, slight itching, asymmetric edema may appear, the skin integument remains unchanged.
Swelling of the pharynx, neck, and larynx threatens with dysphagia and breathing, and swelling of the intestinal wall causes diarrhea, vomiting, and abdominal pain. Resolution of these elements, as a rule, takes quite a long time - up to three days.
If this pathological condition is associated with an allergic reaction to physical factors, then a connection appears between the appearance of rashes and a specific negative effect. In this case, the local status of the allergic reaction by the type of urticaria and the appearance of the elements themselves have their own characteristic features.
In these cases, with cold urticaria, the rash will appear in those places that regularly come in contact with cold air or cold objects. Utticaria persist for a relatively short period of time, and when warmed up they disappear.
With the manifestation of demographic urticaria, the elements are a kind of linear blisters along the combs. Rashes with aquagenic urticaria appear after contact with water at any temperature. Outwardly, they look like small urticaria that arise against the background of erythematous spots. It is worth noting that this is an unpleasant, but very rare form of the disease.
Medical history
Given the ephemeral nature of the rashes that appear, great importance is attached to the correctness of the collection of history. The doctor needs to find out what is the cause of this pathological condition, which mechanisms provoke it, and which support it.
Therefore, it is necessary to establish all the unpleasant and uncomfortable sensations associated with urticaria, including burning, itching, pain. The time during which they arise, their cyclical nature, the existence of provoking factors, previous treatment. The presence of allergic diseases is of great importance not only in the personal history of the patient, but also in the family. It should take into account the patient's professional activities and hobbies, as well as the presence of concomitant pathologies.
At the initial examination, it is important to establish how much the existing rash is similar to the urticaria. Examine elements other than the blister, as well as secondary atypical formations. For example, erosion, crusts, persistent hyperpigmentation.
Diagnostics
There are many laboratory tools for the accurate diagnosis of this disease. In addition to common general clinical research, tests will be necessary to search for concomitant somatic pathology.
It must be remembered that patients with such ailments often suffer from problems with the gastrointestinal tract, autoimmune diseases, non-infectious and infectious genesis. In this case, the results of examinations may turn out to be within reference values, when it will be extremely problematic to associate any pathology with the manifestation of this condition.
Differential diagnosis is accompanied by a number of diseases, such as herpetiform dermatitis, urticarial vasculitis, contact urticaria, even bites of blood-sucking insects.
Treatment
The traditional treatment of an allergic reaction by the type of urticaria involves first of all the elimination of triggers and the causes that led to the appearance of this pathological condition. You should abandon drugs that could provoke the appearance of rashes, avoid exposure to physical triggers. It is important to observe a hypoallergenic diet, which may contribute to a decrease in the recurrence rate of this disease. However, without drug therapy, all this will have minimal effects.
Remediation of foci of chronic infection becomes an important task in determining the right direction of therapy. Sometimes it is enough for effective prevention of relapse.
Basically, with this disease, histamine receptor blockers are used. Following the recommendations of the World Allergological Organization, treatment should begin with second-generation antihistamines.
In the event that the symptoms persist for two weeks, it is recommended to increase the dose while continuing to take the medicine for another 10-14 days. In some cases, a sedative blocker is prescribed at night. If this does not bring any effect, a change of drug is recommended. With exacerbations, doctors prescribe a short course of systemic glucocorticosteroids lasting no more than one week.
If all this does not help eliminate the symptoms of urticaria, you should switch to second-line drugs. These are immunosuppressants, glucocorticosteroids, monoclonal antibody preparations. In the treatment of pigmented urticaria, which is caused by all kinds of physical factors, a mast cell membrane stabilizer called ketotifen is used.
Angioteks are treated according to the same principles. The only exception is the manifestation of hereditary forms that are associated with a kinin system or defects in complement systems. If the patient's condition becomes life threatening, mandatory therapy with the introduction of adrenaline should be performed so that it may turn into a need for a tracheostomy or emergency intubation.
Recently, there are more and more fundamentally new methods of treatment of this pathological condition. In particular, the effectiveness of using alternative drug groups against urticaria is being investigated. For example, androgens, antidepressants, slow calcium channel blockers, as well as methotrexate, sulfasalazine, colchicine.
The use of phototherapy and plasmapheresis in patients with solar urticaria is currently under active discussion in the medical community. Separately, it is worth considering the use of biological agents. For researchers, it has always been an attractive idea to link molecules involved in immune reactions to find an effective cure for this disease. Now in practice, monoclonal antibodies have appeared that make it possible to solve this problem with a high degree of ingenuity and high specificity. This led to the emergence of a number of biomedical studies, which are exploring the possibilities of treating immune-mediated diseases, including allergic ones.
In the Russian Federation, the drug Omalizumab is registered, which prevents the interaction of receptors on mast cells, reducing their total number on the surface of basophils. It is interesting that initially it was used exclusively in the treatment of severe atopic asthma, but later the medicine showed its effectiveness in the fight against chronic urticaria.