Urticaria, commonly known as rubella mass, is a localized edema reaction due to the expansion of small blood vessels in the skin and mucous membranes and increased permeability. It usually resolves within 2 to 24 hours, but new rashes occur repeatedly in other parts of the body, and the course of the disease is prolonged. Several days to several years and months.
Generally speaking, urticaria can be divided into two types: acute and chronic. Acute is the majority.
If the course of the disease does not exceed 6 weeks, it is called acute urticaria , and chronic urticaria is more than 6 weeks.
Many urticaria patients worry that this disease will accompany their lives, but a large-scale clinical study conducted by the Dermatology Branch of the Chinese Medical Doctor Association shows that:
90% of urticaria patients can survive within 5 years Internal recovery, only 10% of patients have a disease course of more than 5 years, rarely accompanied by life.
So, what is chronic refractory urticaria? Two conditions must be met:
1. Meet the diagnostic criteria for chronic urticaria;
2. After 2 weeks of treatment with a conventional dose of a second-generation antihistamine, the effect is not good, and the symptoms still exist, weekly ≥ Wind masses and itching occurred in 3 days, with or without angioedema.
The etiology of urticaria is very complicated. About 3/4 of patients cannot find the cause, especially chronic refractory urticaria.
is generally divided into exogenous and endogenous according to different sources.
Exogenous causes are mostly transient: including physical factors, food, drugs, implants, etc.
The endogenous causes are mostly persistent,Including chronic bacteria, fungi, viruses, parasitic infections, fatigue, autoimmune responses to IgE or high-affinity IgE receptors, and chronic diseases.
So how to treat refractory urticaria?
General treatment: Patients with chronic urticaria should try to find potential persistent causes and avoid exposure to pathogenic factors.
1. For induced urticaria, avoid corresponding stimuli or predisposing factors.
2. Chronic urticaria suspected to be related to various infections and/or chronic inflammations. Anti-infection or inflammation control treatments can be considered as appropriate when other treatments are resistant or ineffective.
3. For patients with urticaria suspected of being food-related, start with a simple diet and add samples slowly. At the same time, patients are encouraged to keep a food diary, look for possible foods and avoid them.
Drug therapy: Foreign guidelines recommend that the first-line treatment of chronic urticaria is a conventional dose of a second-generation antihistamine treatment. For chronic refractory urticaria that is ineffective in first-line treatment, the preferred second-line treatment is Increase the dose of antihistamine .
The study found that when the dose of antihistamines is increased by 2 or 3 times, the symptom relief rate is significantly increased. When it is increased to 4 times, nearly 75% of chronic urticaria patients can control their symptoms.
However, in my country, it is difficult to administer drugs beyond the drug instructions in actual diagnosis and treatment scenarios. Therefore, domestic guidelines suggest that if the conventional dose of second-generation antihistamines cannot effectively control symptoms after 1-2 weeks, 2-4 types of antihistamines should be preferred. Combination therapy with histamine drugs.
Finally, it is recommended not to stop the drug immediately after the drug treatment is effective.
Antihistamines recommended course of treatment:
1. The course of acute urticaria treatment is mainly to control symptoms;
2. The course of chronic urticaria treatment is generally not less than 1 month.If necessary, it can be extended to 3-6 months;
3. Chronic refractory urticaria is not less than 6 months;
4. Do not take the drug when the attack occurs, stop the drug asymptomatically; take the drug regularly for a long time and gradually reduce the dose .
Don't be discouraged when you hear "refractory" urticaria. If you take the medicine regularly for a long time, you will get rid of it one day.
Author: Zhang Zheng
, Huashan Hospital Affiliated to Fudan University.
