The symptoms of chronic urticaria are analogous to that of acute urticaria. They are pale or pink, well "outlined" eruptions on the skin in the form of irregular spots or blisters, often surrounded by erythema / phot. poniżejżej /. The efflorescence and blistering appear constantly or disappear and recur, not necessarily in the same place; they can be itchy or burning.
But when they appear pink on our body
or porcelain-white itchy protuberances,
or bubbles with a flat surface, not caused by contact with common herb, which is a nettle - we have probably to do so with the so-called urticaria based on skin allergy.
What are the symptoms of angioneurotic edema?
Angioedema refers to deeper layers of subcutaneous tissue, and the symptoms are similar to those in urticaria, and sometimes difficult to distinguish, especially if they coexist with urticarial changes.
Chronic urticaria and angioneurotic edema - case reports
Case 1.
A middle-aged woman shortly after taking unwanted office work got hives. Nettle appeared for several months on the hands, just after leaving the house to the office and disappeared after a dozen or so hours. (On the woman's shoulder, clearly marked plaques are visible. / Photo /.) Over the course of weeks, the symptoms worsened causing severe pruritus. Attempts to determine the cause, despite the attempts of the allergologist doctor did not bring results. The disorder has relieved the use of antihistamines. Nettle disappeared from the moment the woman changed her job. The statement that the illness had only a purely psychosomatic cause would be too simplistic, though it could not be ruled out. It was also likely that in the room where the woman worked, or in the canteen where she ate there was a factor that caused urticaria.
Case 2.
A young man who had chronic urticaria and angioedema caused by contact with fish in childhood - he reported to the doctor with a strong swelling on his left cheek, which included lips, tongue and glottis (part of the larynx) and made breathing difficult. Despite the fact that he had remembered that he had been allergic to fish and tried to avoid it - he did not avoid contact with the fish again due to the kiss of a woman who had just consumed a portion of eel. Administration of adrenaline, an antihistamine and a corticosteroid resulted in the resolution of angioedema. The doctor determined with a strong allergy to eels and a few other fish.
How long is chronic urticaria and angioneurotic edema?
We define urticaria or angioneurotic edema as chronic, if the efflorescence, blisters and edema appear constantly or recur in a period longer than 6 weeks. Chronic recurrences of efflorescence, blisters and edema may occur daily, periodically, e.g. once or several times a month. Therefore, in contrast, for example, to acute urticaria, which lasts from several hours to 6 weeks and does not appear anymore - chronic urticaria or a tendency to its occurrence may last for many years.
What are these diseases?
Sometimes the ailments are not very onerous and boil down to the local sowing of efflorescence or bubbles, but sometimes the symptoms are so severe and annoying that they prevent professional work and lead a normal life (The case of man and woman). Sometimes chronic urticaria or angioedema is associated with anaphylactic shock, which is life-threatening (more detailed below) or sudden and severe facial edema and glottis in the form of so-calledQuincke edema threatens suffocation of the patient. Sometimes the symptoms of chronic urticaria and edema are a harbinger of severe systemic diseases.
Can we distinguish urticaria from angioedema?
It is best to indicate the appearance of characteristic symptoms on the face, eyelids, mucous membrane, lips, tongue, larynx, i.e. loose connective tissue. Then the expressive (caricatured swelling of lips, cheeks) indicates that we are dealing with the so-called Quincke's edema. Although it should also be noted that almost every place can be swollen, especially the hands and feet.
Is it easy to determine the cause of chronic urticaria and edema?
Unfortunately not. The cause of these diseases is relatively rare and only in less than 20% of patients. In spite of this discouraging statistics, the following typical causes should be taken into consideration - in accordance with the observed picture of the disease, the doctor can apply effective symptomatic treatment.
part 2
CHROMIUM CARTHILL AND VASCULAR CIRCUMSTANCES - CALLED BY COUPLING
The causes of chronic urticaria and edema are divided into:
- specific, ie different from the reasons of acute urticaria
- on common
- on unrecognizable - so-called idiopathic
But when they appear pink on our body
or porcelain-white itchy protuberances, or flat surface blisters, not caused by contact with the common herb, which is a nettle - we have probably to do so with the so-called urticaria based on skin allergy.
Specific causes of chronic urticaria and causes of angioneurotic edema:
- non-specific cause (idiopathic): stress and occupational exposure (the case of women discussed at the beginning),
including the difficult to diagnose ongoing infection, the presence of a parasite in the body, etc.,
- medicines taken by the patient during the last few weeks before the onset of symptoms,
- allergy to certain foods, e.g. the case of a man discussed at the beginning,
- direct contact of the skin or mucous membranes of the mouth and throat with food (also the case of a man sensitized to fish); in addition, contact with chemical agents (toothpaste, food additives, etc.); contact with saliva of animals (dogs, cats, etc.),
- hypersensitivity to physical factors (cold, hot, mechanical pressure,
- delayed reactions to insect stings - mosquitoes, wasps, etc.
- autoimmunization process (autoimmune hives),
- hormonal disorders, (when the occurrence of urticaria can be linked temporarily with the course of menses),
- malignant tumor.
WHEN CAUSE IS NOT FIXED ...
We say: chronic non-specific idiopathic urticaria and angioneurotic edema
Under this word are chronic urticaria and edema, the cause of which is hardly recognizable. Unfortunately, this is one of the most common adult urticaria. Often, physicians include psychosomatic background in this group: stress and frustration, ongoing infection, difficult to diagnose systemic diseases, the presence of a parasite in the body, difficult to detect allergens, reaction to chemicals, toxins.
Can emotions and stress cause chronic urticaria and angioneurotic edema?
Yes, it is one of the most common causes of chronic urticaria in adults, also known as idiopathic urticaria, as can be seen in the case of middle-aged women described at the beginning.
cd part 3
CAUSES OF DISEASE
What should the doctor and we should pay attention to when investigating the specific cause of chronic urticaria and angioedema?
First of all, we should remember and set up a list of medicines we have been taking in the last month. It should also be remembered whether after eating some food no urticaria or angioneurotic edema has occurred.
But when they appear pink on our body
or porcelain-white itchy protuberances, or flat surface blisters, not caused by contact with the common herb, which is nettle - we have probably to do so with the so-called urticaria based on skin allergy.
Which drugs are the most common causes of chronic urticaria and angioedema?
The list of suspicious drugs from which we should begin to identify the efflorescence of efflorescence and blisters on our skin opens with acetylsalicylic acid and other non-steroidal anti-inflammatory drugs (aspirin hives).Urticaria because of this is relatively common and occurs mainly in adults. The association of the use of acetylsalicylic acid or other non-steroidal anti-inflammatory drugs (ibuprofen, naproxen, etc.) with subsequent urticaria should be confirmed by an aspirin test. Penicillin is also a frequent and dangerous threat to our health. The urticaria caused by it may appear with a delay of 2-4 weeks.
How to prevent chronic urticaria caused by aspirin and other non-steroidal anti-inflammatory drugs?
We try to eliminate acetylsalicylic acid and other anti-inflammatory drugs and replace them with safe replacement medicines prescribed by a doctor.
Is it easy to detect a food allergen that causes chronic urticaria?
Although most patients are almost certain that the cause of urticaria is allergy to recently eaten food is so-called Undoubtedly, as mentioned at the outset - sensitization to eels and other fish - is not too much. From medical practice, it appears that the attempt to identify a food allergen in adults is in most cases futile. Allergic sensitization can be, for example, cross-headed, i.e. a set of two or more foods can be sensitized.
In this case, should we consider other reasons?
Yes, a common cause is hypersensitivity to the physical factors mentioned above. The influence of physical factors is easier to determine than others. This applies to: "cold" urticaria, physical oppression, vibration, physical exertion, overheating of the body, sunlight, dermatographism, i.e. a rash caused by scratching, delayed reactions to insect stings, contact of the mucous membrane with sensitizing foods, chemical substances, animal saliva , etc.
How to recognize the specific cause of chronic urticaria and edema and eliminate it?
It is easy to see that some of the causes of urticaria and edema are easily recognized and confirmed by self-testing. We can, for ourselves, confirm the pathogenic role of "cold" - applying ice to the body, carry out the "vibration" test with a massage apparatus, the role of "heat", sun, "scratching", etc. The elimination of this type of causes lies largely in our hands . With others, we should ask for help from a doctor. These include the causes that self-testing is dangerous to life. (eg possible anaphylactic shock on insect venom.) Moreover, there are reasons that we will not recognize without the help of a doctor and complicated diagnostics (autoimmune processes triggered by antithyroid antibodies, hormonal disturbances, if the woman's urticaria occurs cyclically), occupational exposure, neoplastic disease .
What medicines should we use to treat chronic urticaria and edema?
The latest-generation antihistamines, which do not interfere with perception and ability to concentrate, are particularly recommendable. In order to perform activities requiring high concentration - for example driving a car, without the symptoms of allergic conjunctivitis or urticaria, which are difficult to see - you should always have an antihistamine with you. Fexofenadine is particularly recommended, - available in a dose of 180 mg specially designed for urticaria, which causes a quick and long-lasting healing effect.
cd - part 4
CRANKED CIRCULAR VARIABLE WITHOUT GEL
Can you suffer from angioneurotic edema alone - without hives?
This eventuality is rare and initially easy to overlook due to the similarity of symptoms. The reason for the so-called chronic isolated edema may be some drugs, chemical toxins in the professional environment, insect stings, hypersensitivity to latex, physical factors - eg cold, sunrays, etc. In addition, the cause of edema can be physical effort, hypersensitivity to pressure (eg feet from shoes , etc.), less often on food.
Can chronic swelling, without hives, be a congenital feature?
Yes, the occurrence of such urticaria may indicate a rarely inherited genetic inheritance of a substance called a C1 esterase inhibitor. (Inhibitor from Latin - lock, brake). This deficiency may also be caused by lymphatic system disease or systemic connective tissue disease.
What are the typical symptoms of genetically determined chronic edema?
The basis for diagnosis is sometimes a characteristic symptom of local edema caused by dental injury - eg tooth extraction.
How to determine the cause of chronic isolated edema?
To confirm suspicions, detailed diagnostic tests are necessary. If, for example, we suspect an inherited C1 esterase inhibitor deficiency, then the concentration of one of the components - the so-called Complement C4 complement.