Allergic reaction like urticaria is a common pathology encountered 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
A rather large heterogeneous group of conditions and diseases, which are united by similar symptoms and common primary skin elements, namely blisters, refers to an allergic reaction like urticaria.
It should be noted that in 40% of cases, in the course of its development, this pathological condition is accompanied by the development of a characteristic angioedema. It is understood as swelling 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, this may develop isolated angioedema, which will not be accompanied by allergicurticaria-type reaction. This is a disease that requires treatment without fail, and with the appearance of the first symptoms, 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 like urticaria in the ICD is present, this is a disease well known throughout the world.
Epidemiology
Currently, from 15 to 25% of the inhabitants of planet Earth suffer from different types of urticaria worldwide. In this case, an acute allergic reaction of the type of urticaria is especially common. It appears in approximately 60% of all cases.
In about a third of patients, this disease becomes chronic over time, constantly manifesting 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. Approximately a quarter of patients suffering from a chronic allergic reaction such as urticaria, symptoms persist for at least 10 years. In about half of the cases, the chronic manifestation of this disease is due to the presence of an autoimmune problem, which should be identified 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
Allergic reaction totype of 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 He alth Organization. In total, this classification consists of 21 sections or classes, each of which contains certain headings with codes for 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 like urticaria refers to diseases of the skin and subcutaneous tissue. It is included in the subsection labeled L50-L54.
The urticaria allergic reaction code is L50. Its knowledge allows physicians around the world to equally identify a particular disease. The ICD code for an allergic reaction of the type of urticaria greatly facilitates the work when interacting with doctors from different countries. Classification helps them communicate effectively and collaborate together.
A few more subsections can be identified by the code of an allergic reaction by the type of urticaria. These types of urticaria fall here:
- Allergic.
- Idiopathic.
- Triggered by exposure to high or low temperatures.
- Dermatographic.
- Vibrating.
- Cholinergic.
- Contact.
- Other.
- Unspecified.
All this allows you to accurately determine the allergic reaction according to the type of urticaria in the ICD-10.
Unspecified
As a rule, in most cases, problems in diagnosis occur when an allergic reaction of unknown etiology is detected, like urticaria.
In this case, the patient complains of itching of the skin, it is especially pronounced in the chest, neck, and arms. Skin rashes and redness may appear. As a rule, the patient himself cannot associate his condition with any particular cause. Before that, he did not use any unusual products, he did not take drugs of unknown purpose.
In this case, an allergic reaction of the type of generalized urticaria is manifested during a visual examination of the collar zone, the anterior surfaces of the chest and neck, thighs, upper limbs. All of them are hyperemic. At the same time, raised pink blisters are observed on the skin, which are visually similar to traces of nettle burns. In this regard, this disease has received such a name.
Rashes are polymorphic, their symmetry may be noted, they begin to turn pale when pressed. The skin adjacent to the lymph nodes, as well as the subcutaneous tissue, do not undergo changes.
All this testifies to urticaria of unknown etiology. It is recommended that the patient be hospitalized immediately.
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 fundamentally different forms may appear in the same patient.hives. In addition, the medical literature describes a number of conditions that were once related to this disease, but are no longer considered it, but include angioedema as one of the symptoms. Here is a list of such pathological conditions:
- Mastocytosis or urticaria pigmentosa. This disease is caused by the proliferation and accumulation of mast cells in tissues.
- Polymorphic skin rashes, including urticaria.
- Urticarial vasculitis. Classic vasculitis, which is accompanied by skin rashes, not only angioedema, but also blisters and nodules.
- Nonhistaminergic angioedema. It can be hereditary, often associated with defects in the kinin and complement system.
- Anaphylaxis - hives caused by excessive physical exertion.
- Cryopyrin. This is a periodic syndrome that is characterized by headaches and increased fatigue.
- Schnitzler's syndrome is a chronic urticaria accompanied by monoclonal gammopathy.
- Gleich syndrome - episodic angioedema with eosinophilia.
- Wells syndrome - granulomatous dermatitis with eosinophilia.
The main thing in describing an allergic reaction like 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 an increase in the permeability of the vascular wall, vasodilation, the appearance of hyperemia and edema.
Views
Diagnosis allergic reaction like urticariaput in the presence of one of three pathogenetic variants. Each of the cases has its own reasons that led to the development and progression of this disease.
Allergic urticaria. In this case, reagins, that is, immunoglobulins, which appear when the allergen first enters the body, play a key role. They are fixed on basophils and mast cells. Repeated contact with the allergen leads to degranulation of mast cells. In particular, urticaria occurs in this form, the causes of which are food allergies.
There is also an allergic variety, in which degranulation appears to be caused by activation of the complement system or 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 sorts of reasons. We list the main ones:
- disorder of arachidonic acid metabolism;
- increased histamine concentration;
- accumulation of bradykinin;
- excessive release of acetylcholine;
- alternative activation of the complement system;
- effect of some neuropeptides;
- physical factors (dependence on cold or heat);
- the result of exposure to food or drugs, most often cheese, chocolate, nuts, strawberries.
Development of idiopathic urticaria is suspected only if functional or structural defects in basophils or mast cells are present. Whereinclose study requires the blood coagulation system, which affects the development of pathological reactions.
Development of the disease
An allergic reaction like urticaria in the history of the disease almost always begins with a characteristic itch, followed by various rashes. These may be blisters that rise above the surface of the skin. They can take on various sizes and shapes. The rashes remain for half an hour to two days until they are completely resolved.
Most often they suddenly appear and disappear in a variety of places. If you have a chronic allergic reaction like 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 tell 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 angioedema appears, it is characterized by diffuse swelling of loose subcutaneous connective tissue on the back surface of the feet and hands, lips, eyelids, genitals, and mucous membranes. In this case, slight itching, asymmetric swelling may appear, the skin remains unchanged.
Swelling of the pharynx, neck, larynx threatens with violations of dysphagia and breathing, and swelling of the intestinal wall causes diarrhea, vomiting, abdominal pain. The resolution of these elements, as a rule, takes quite a long time.time - up to three days.
If this pathological condition is associated with an allergic reaction to physical factors, then there is a connection between the appearance of rashes and a specific negative impact. At the same time, the local status of an allergic reaction like urticaria and the appearance of the elements themselves have their own characteristics.
In these cases, with cold urticaria, the rash will appear on those places that are regularly in contact with cold air or cold objects. Urticaria persist for a relatively short period of time, and disappear when warmed up.
When demographic urticaria appears, the elements are a kind of linear blisters along the course of scratching. Rashes with aquagenic urticaria appear after contact with water of any temperature. Outwardly, they look like small urticaria that occur against the background of erythematous spots. It is worth noting that this is an unpleasant, but very rare form of the disease.
History taking
Given the ephemerality of emerging rashes, great importance is attached to the correct collection of anamnesis. The doctor needs to find out what is the cause of such a pathological condition, what mechanisms provoke it, and what 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 occur, their cyclicality, the existence of provoking factors,prior treatment. Of great importance is the presence of allergic diseases not only in the patient's personal history, but also in the family. The patient's professional activities and hobbies should be taken into account, as well as the presence of comorbidities.
At the initial examination, it is important to establish how similar the existing rash is to urticaria. Examine elements other than the blister, as well as secondary atypical formations. For example, erosion, crusting, persistent hyperpigmentation.
Diagnosis
There are enough laboratory tools to accurately diagnose this disease. In addition to the common general clinical studies, tests will need to be carried out to look 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 the 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 dermatitis herpetiformis, urticarial vasculitis, contact urticaria, even bites of blood-sucking insects.
Treatment
Traditional treatment of an allergic reaction such as urticaria involves, first of all, the elimination of triggers and causes that led to the appearance of this pathological condition. It is necessary to refuse medicines that could provoke the appearance ofrashes, avoid exposure to physical provoking factors. It is important at the same time to follow a hypoallergenic diet, which can help reduce the frequency of relapses of this disease. However, without drug therapy, all this will have minimal effects.
Rehabilitation of foci of chronic infection becomes an important task in determining the right direction of therapy. Sometimes it is enough for effective relapse prevention.
Basically, with this disease, histamine receptor blockers are used. Following the recommendations of the World Allergy Organization, treatment should begin with second-generation antihistamines.
If symptoms persist for two weeks, it is recommended to increase the dose while continuing to take medication for another 10-14 days. In some cases, a sedative blocker is prescribed at night. If this does not bring any effect, it is recommended to change the drug. For exacerbations, doctors prescribe a short course of systemic glucocorticosteroids lasting no more than one week.
If all this does not help to eliminate the symptoms of urticaria, you should move on to second-line drugs. These are immunosuppressants, glucocorticosteroids, preparations of monoclonal antibodies. In the treatment of urticaria pigmentosa, which is caused by all sorts of physical factors, a mast cell membrane stabilizer called ketotifen is used.
Angioedema is treated according to the same principles. The only exception is the manifestations of hereditary forms that are associated withkinin system or defects in complement systems. If the patient's condition becomes life-threatening, mandatory therapy with the introduction of adrenaline should be carried out, which may result in the need for a tracheostomy or emergency intubation.
Recently, there are more and more fundamentally new methods of treating this pathological condition. In particular, the effectiveness of the use of alternative groups of drugs against urticaria is being investigated. For example, androgens, antidepressants, slow calcium channel blockers, as well as methotrexate, sulfasalazine, colchicine.
There is a lot of discussion in the medical community about the use of phototherapy and plasmapheresis in patients with solar urticaria. Separately, it is worth considering the use of biological agents. Researchers have always been fascinated by the idea of linking molecules involved in immune responses in order to find an effective cure for a given disease. Now monoclonal antibodies have appeared in practice, which allow solving this problem with a high degree of ingenuity and high specificity. This has led to a slew of biomedical research exploring the possibilities of treating immune-mediated diseases, including allergic ones.
On the territory of the Russian Federation, the medical drug "Omalizumab" is registered, which prevents the interaction of receptors on mast cells, reducing their total number on the surface of basophils. Interestingly, it was originally used exclusively fortreatment of severe atopic asthma, but later the drug was shown to be effective in the fight against chronic urticaria.
