Urticaria is the main clinical sign of many allergic diseases, which manifests itself as 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, different in their 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 life of the patient, since generalized urticaria is often accompanied by Quincke's edema. ICD-10 L50 is the disease code in the International Classification of Diseases (2018).
Varieties of pathology
The disease can have two variants of development: non-immune and immune. The second option is more common. When an allergen enters the body, it begins to intensivelyproduce against him immunoglobulin E immune system. During the interaction of antigens with it, mast cells are destroyed, a large amount of histamine is released into the blood, which increases the permeability of the walls of blood vessels, and causes typical symptoms of urticaria.
The non-immune form of generalized urticaria is associated with exposure to the allergen on mast cells. The true causes of the disease today, scientists can not yet name. It has been established that the generalized form of urticaria occurs more often in people with a history of atopic diseases of allergic origin.
About 75% of officially recorded cases of the disease represent an acute form of urticaria. Rapid development and a duration of no more than one and a half months are characteristic of it. Often, its development is associated with improper medication. Quite 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 relapse every time an allergen enters the bloodstream.
Disease forms
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, pathology can be acute and chronic. Let's figure out what they aredifferences.
Acute generalized urticaria
Characterized by rapid development and duration of at least six weeks. In this form, the rash may disappear under the influence of drugs or after the elimination of the allergen that caused it.
Chronic form
We have 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 (primary or secondary).
- Solar.
- Cholinergic, which is caused by sensitivity to acetylcholine, which is an allergen. Such a reaction can be provoked by excessive physical activity, psycho-emotional reaction, high air temperature, hot water, spicy or hot food.
- 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.
Specialists believe that autoimmune reaction mechanisms are involved in the development of allergic urticaria (generalized form), since half of the patients with this diagnosis have autoimmune antibodies to the high-affinity receptor alpha chain that interact with the Fc fragment of immunoglobulin E. As a result degranulation of basophils and mast cells occurs and anaphylotoxin (a 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 acute form, up to 12 years of age - chronic and acute, with the former predominating. After 12 years - mostly chronic form occurs.
Diagnosis
Diagnosis of generalized urticaria is based on the history and clinical picture. If the cause of urticaria is not established during the physical examination and history taking, the doctor prescribes laboratory tests. In the acute form of the disease, as a rule, there is no need to conduct laboratory tests, with the exception of cases when provoking factors are indicated in the anamnesis. In most cases, generalized urticaria in the acute form is effectively stopped by H1-histamine blockers, and in especially severe cases - by glucocorticosteroids.
Laboratory studies in chronic form
In this case, laboratory tests are aimed at identifying the causes of the disease. Mandatory examination includes: a blood test, detection of the level of C-reactive protein contained in the blood serum. With an extended examination, tests are carried out to exclude the presence of infectious diseases, helminthic invasion.
Specialist will need thyroid test results (anti-thyroid antibodies, T4, TSH).
Provoking factors
The main causative factors in the development of the disease include food:
- meat and meat products (mainly pork and beef);
- fish;
- fish and meat smoked products;
- milk;
- chicken eggs;
- stone berries and fruits (strawberries, wild strawberries);
- red apples;
- melon;
- carrot;
- food additives;
- med.
Drugs:
- antibiotics (often the penicillin group);
- non-steroid drugs;
- sulfonamides;
- iodine preparations;
- vitamins C;
- Group B;
- antiseptics.
Physical factors:
- water treatments;
- sunbeams;
- heat and cold factors;
- poison of some insects.
In addition, provoking factors include: chronic fungal, viral and bacterial infections, intestinal dysbacteriosis, stomach pathology caused by the bacterium Helicobacter pylori, psychogenic factors, chemical cosmetics.
Symptomatics
For generalized urticaria (we posted a photo of the symptoms in the article), vivid symptoms are characteristic: the sudden appearance of red blisters all over the body, severe skin itching, which intensifies in the evening, swelling of irritated and inflamed skin, burning. Blisters can be of different diameters, which often merge into a solid red spot. They have raised edges and are bounded by a papillary layer of skin with a raised surface. Outwardly, the rash resembles nettle burns, but very extensive. They rapidly spread throughout the body andform a large irregular spot.
Rash rarely appears on the mucous membranes and lips. During the first two days, the rash disappears in some places, but appears in other areas. Much less common is the hemorrhagic and bullous form of generalized urticaria. These forms are dangerous severe course. The patient suffers from chills, fever, loss of appetite, malaise, nausea, joint pain, nosebleeds.
In case of 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 necessary.
Treatment methods
Therapy for generalized urticaria aims to:
- eliminate allergic rash;
- avoiding complications;
- relapse prevention.
When signs of illness appear, call an ambulance. Before the arrival of doctors, it is necessary to try to determine the allergen that caused such a reaction and exclude contact with it.
Drugs
The patient needs to take antihistamines:
- "Tavegil".
- "Suprastin".
- Zodak.
- "Loratadine".
First-generation antihistamine blockers should only be taken if symptoms flare up. This will quickly stop the symptoms and prevent the development of Quincke's edema. The emergency doctor will prescribe an injection (intravenous)an antihistamine or (in severe cases) Prednisolone.
If there is a suspicion of the development of Quincke's edema, the patient will be injected intramuscularly with "Epinephrine". Blood pressure is restored with saline crystalloid solutions, which 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 patient's general condition deteriorates rapidly, requires emergency treatment in the intensive care unit or intensive care unit.
Depending on the allergen that provoked the disease, in addition to antihistamine therapy, the use of diuretics, sorbents, and plasmapheresis sessions may be required. If necessary, drugs that act on the central nervous system can be prescribed. Amitriptyline helps relieve anxiety. To reduce skin irritation and itching, non-steroidal agents are used externally:
- Bepanthen.
- Solkoseril.
- Woundheal.
- Desitin.
Do not use hormonal ointments on large areas of the skin.
Preventive advice
Treatment of generalized urticaria is a lengthy 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 sign of the disease, you should immediately visit a doctor. This will prevent systemicmanifestations.
If you are predisposed to allergies, avoid contact with allergens. For example, in case of intolerance to some products, carefully study the composition of the proposed dishes.
Medicines should only be taken as directed by a physician. It is important to train resistance to all sorts of irritants of the immune system. For this you need:
- introduce complementary foods to babies in strict accordance with the recommendations of the pediatrician;
- eliminate highly allergenic foods from the diet;
- get rid of bad habits;
- do sports;
- ventilate regularly and do wet cleaning of the room.
Generalized urticaria is a serious disease, difficult to treat. At the first signs of a recurrence of the pathology, all necessary measures should be taken to relieve symptoms in order to prevent the inflammatory process from spreading throughout the body. Always have an antihistamine on hand. After each exacerbation, a visit to the doctor is a prerequisite that guarantees successful treatment.
