Acute urticaria and angioedema in children. What is the connection between urticaria and swelling?

Quincke's edema and urticaria develop for one reason - damage to the skin and adjacent tissues is provoked by one or another allergen. In the first case pathological process covers the subcutaneous tissue and causes severe swelling of the tissues. With urticaria, an allergic reaction manifests itself in upper layers skin - blisters form, painful, itchy and take a long time to heal. Urticaria in chronic form, periodically aggravating, becomes a source discomfort for months and years. In the case of Quincke's edema, minutes count - with swelling of the neck, the patient's life hangs in the balance due to possible asphyxia(choking).

Why does Quincke's edema occur?

Urticaria with angioedema appears after allergens enter the body, causing degranulation mast cells. Physical factors (cold, heat, solar radiation, insect bites), as well as chemical compounds in small doses, dissolved in ordinary water. Much more often, hives are triggered by food allergens and ingredients of popular medications.

Quincke's edema is essentially a complication of urticaria, when the pathological process covers not only the upper layers of the skin, but penetrates deeper and involves the mucous membranes, subcutaneous fatty tissue and muscles. Less commonly, Quincke's edema develops as independent disease.

In more than 25% of patients with urticaria, the leading role in its development and angioedema is played by a hereditary factor; in another third, such phenomena are acquired during life.

For any clinical variety urticaria, the permeability of small blood vessels. The surrounding tissues quickly swell, and under the influence of excess histamine, large blisters form on the surface of the skin. The allergic reaction gradually affects the deep layers of the skin and subcutaneous tissue - this is how angioedema begins.

Clinical manifestations

For allergens entering the body skin covering reacts very quickly. Bright pink blisters appear within just one hour. If urticaria occurs in an acute form, after three to five hours the skin is completely cleared of rashes.

Urticaria often occurs against the background of:

liver pathologies;
diseases of the digestive system;
infectious diseases;
helminthic infestation.

Urticaria with Quincke's edema, in addition to dermatological ones, is accompanied by other symptoms. Along with a rash on the skin, there is an increase in body temperature to 38 degrees, which is worrying headache, sleep is disturbed, and a feeling of powerlessness arises.

In chronic form, urticaria may last for long months With periodic exacerbations. In addition to the visible manifestations of urticaria, nausea and vomiting are periodically disturbing, increased nervousness.

If swelling occurs:

in the throat area - the victim’s voice becomes hoarse, breathing becomes wheezing, speech is impaired;
in the pleura - occurs sharp pain in area chest, severe shortness of breath;
in the brain - one of the most dangerous variations, leads to circulatory problems and seizures;
V digestive system- worries strong pain in the stomach, nausea and subsequent vomiting;
in the zone Bladder- its functionality is impaired, the process of urination is extremely painful.

Diagnostics

Diagnosis of angioedema on the face and neck special problems does not cause due to the severe severity of symptoms. With extensive damage, this area swells very much. The larynx and digestive tract are most often affected not by acquired, but by Quincke's edema with hereditary factor.

It is more difficult to diagnose angioedema if the process occurs during internal organs. Performed differential diagnosis Quincke's edema with other edema that occurs against the background of:

pathologies thyroid gland, in particular, with hypothyroidism;
disorders of the liver and kidneys;
inflammation of connective tissue (dermatomyositis);
blood diseases;
oncological pathology.

Angioedema allergic origin requires collecting anamnesis and identifying a hereditary predisposition to its occurrence.

What to do if Quincke's edema is detected

Urticaria with Quincke's edema can be fatal. If characteristic symptoms occur, you should immediately call an ambulance.

Before doctors arrive, the victim should be provided with a constant flow of air - open the window. It is necessary to relieve the pressure on the body of the wardrobe items - unbutton the collar of the shirt, the belt on the trousers. It is best to take a relaxed position while sitting.

It is necessary to immediately limit contact with the allergen if it is known what caused the swelling, and drink a large amount of liquid (preferably alkaline - Borjomi, Narzan) to eliminate it from the body. For Quincke's edema in the throat area, especially with rapid development, you need urgent hospitalization.

IN home medicine cabinet desirable to have antihistamines(for example, Diazolin, Fenkarol) and sorbents ( Activated carbon, Enterosgel).

Quincke's edema in many cases develops in a matter of minutes. To alleviate the condition, take an antihistamine, which will ease the symptoms and help the victim until the ambulance team arrives.

If we're talking about about a food allergen, take sorbents, but under no circumstances rinse the stomach because of the risk of choking on vomit.

Treatment of swelling and urticaria

The basic principle of treating urticaria and angioedema is eliminating the provoking factor. After cupping acute condition, when the patient’s life is no longer in danger, he is transferred depending on the type of edema and current state to one department or another. If the patient's condition is not dangerous, this may be in the therapeutic or allergy department.

Urgent Care

Quincke's edema with urticaria is a direct threat to life. During hospitalization, measures are taken promptly to relieve tissue swelling. If the swelling is localized in the throat area, tracheal intubation is performed - to ensure respiratory function, an endotracheal tube is inserted into the organ.

Under no circumstances should you attempt to make a tracheal incision on a patient yourself! These manipulations are performed only by doctors.

In a complicated situation, when there is no time and conditions for tracheostomy, in order to ensure breathing, a dissection of the larynx (more precisely, the conical ligament between the cricoid and thyroid cartilage) - conicotomy. In case of Quincke's edema in the digestive organs, the patient is referred to surgery department.

Elimination

Depending on the allergen, food provocateurs are completely excluded from the menu. Risky products include:

chocolate;
citrus;
seafood (crustaceans);
tomatoes;
strawberry;
peanut;
pork;
sauerkraut;
fermented cheese;
red wine.

This does not mean that you should give up all these products forever. After identifying the allergen, only it is excluded from the menu.

Drug therapy

Treatment of urticaria with Quincke's edema is carried out using:

antihistamines (Claritin, Suprastin);
diuretics (Lasix);
glucocorticosteroids (Prednisolone, Dexasone);
protease inhibitors (Contrical).

Sorbents are selected individually for the patient to cleanse the body of the allergen. Additionally, calcium supplements and vitamin C are prescribed to strengthen nervous system, multivitamin complexes, increasing the tone of blood vessels.

For angioedema with a dominant hereditary factor, a drug is individually selected to replenish the volume of the missing C1 inhibitor.

In the case of pseudoallergic angioedema, the patient is prescribed intravenous drip administration isotonic sodium chloride solution (for example, Contrikal).

Preventive measures and diet

The main rule for the prevention of angioedema is to avoid contact with allergens by any means. If it is household dust, keep the premises clean and carry out wet cleaning regularly. If there is plant pollen, avoid places where it blooms.

When it comes to food allergens, you should check the foods you eat for the presence of food additives. We are talking about:

flavor enhancers;
dyes;
preservatives.

Patients who have urticaria and angioedema due to poor heredity should be careful when undergoing any surgical interventions. When visiting the dentist, be sure to report the problem.

Before any procedure involving surgical intervention, the attending physician will prescribe a special course aimed at preventing possible occurrence Quincke's edema. For this purpose, patients with urticaria are prescribed tranexamic acid or androgens. Additional drugs are administered immediately before the operation itself.

Urticaria and Quincke's edema are pathologies of an allergic nature, the development of which is due to the mechanisms of immune sensitivity immediate type. They can occur in patients of any age and can have a significant impact on a person’s well-being, and in some cases even pose a threat to life. Let's figure out how to establish a diagnosis and what to do if characteristic disorders occur.

What is urticaria and Quincke's edema?

The first term refers to a group of skin pathologies in which itchy blisters are observed. The name of the disease is explained by the similarity appearance affected areas with consequences of nettle burn. Items have different shapes, sometimes take on bizarre shapes, appearing and disappearing suddenly.

As for angioedema, this definition implies damage to the subcutaneous fatty tissue and mucous membranes - a swelling of dense consistency occurs, the affected areas increase in size and become deformed. Quite often combined with urticaria. May pose a threat to the patient's life if localized in the respiratory tract.

Both urticaria and angioedema belong to immediate hypersensitivity reactions. This means that they develop very quickly from the moment of contact with the provocateur - sometimes the interval is only a few minutes or even seconds.

Causes

A prerequisite for the development of pathologies is often hereditary predisposition. The following factors are also important:

Factors that provoke symptoms should be separated from the causes (etiology) of the disease:

allergens ( food products, medicines, cosmetics, chemicals, pollen);
physical factors ( ultraviolet radiation, different levels temperatures, pressure, vibration);
contact with water;
stress.

An allergic reaction is the leading, but not the only reason for the development of disorders. In addition, there are so-called idiopathic forms of urticaria and angioedema, in which the etiology of the symptoms cannot be clearly explained.

Clinical picture

The manifestations of pathologies have similar features, regardless of the type of provoking factor. The rate of flow is episodic (recurrent). The main symptoms that characterize urticaria and angioedema can be described in the table:

Pathology	Signs			Character traits illnesses
	Typical	Additional
	Typical	Local (local)	System (general)
Hives	Edema red, later porcelain blisters (0.5 to 15 cm in diameter), rising above the skin level and capable of merging with each other. Itching, burning of affected areas	Weakness, fever, pain in muscles and joints without specific localization, sensation of a “heat wave”.	In the chronic form of the disease, in addition to the usual rash, nodules (papules) also appear	Sudden onset, contact with a provoking factor, absence of persistent changes in the skin and mucous membranes (scars, etc.) after recovery
Quincke's edema	Limited swelling in the area of the lips, cheeks, eyelids, and genitals. It has a dense consistency, there is a feeling of tension, swelling of the tissues, pain - very rarely. In case of damage to the mucous membranes respiratory tract There is a cough, difficulty breathing, hoarseness of the voice. Localization in the larynx threatens the patient with asphyxia (suffocation)	At isolated form not typical, when combined with urticaria - the same as for it	In case of defeat gastrointestinal tract(Gastrointestinal tract) vomiting, diarrhea, and abdominal pain appear. When edema spreads to the brain, a picture is formed neurological disorders(seizures resembling epileptic, etc.). When kidneys and organs are involved excretory system – acute delay urine	Fast development under the influence of a trigger, thickening of the tissue of the affected areas, the likelihood of an uneven increase in size

With the development of angioedema, there is no itching in the affected areas.

If it is not accompanied by a nettle rash, patients are concerned about dysfunction of the organs affected by the swelling. Speech and swallowing food and water may be difficult.

Diagnostics

Consists of several successive stages:

Collecting anamnesis (information about the disease) through a survey.
Objective examination of the patient.
Using additional methods.

Applicable wide range studies designed to clarify the nature of the origin of the pathology.

This is a study conducted to model the reaction to a trigger - be it an allergen, a physical factor, or another type of provocateur. For example, a suspected substance is applied to the skin. After this, the contact area is damaged (scratch, injection) and it is noted whether swelling, itching, or a blister appears. Applying a bag of ice, streak irritation with a special spatula, touching with a hot object, and other tests, selected depending on the type of potential trigger, are also practiced.

Due to the risk of developing a general (systemic) reaction skin tests require caution. If they are aimed at identifying the allergen, it should be determined whether the patient has previously suffered anaphylactic shock(this is a severe pathology caused by a sharp fall blood pressure), determine other contraindications (early childhood, pregnancy).

Lab tests

Include:

General examination of blood and urine.
Stool microscopy.
Biochemical tests (total protein, bilirubin, etc.).
Enzyme-linked immunosorbent assay, or ELISA, to detect antibodies (protein complexes) to allergens.
Cultures of discharge from the nasopharynx, tonsils and other areas of localization of foci chronic infection.
Search infectious agents(HIV, hepatitis, etc.).

Laboratory diagnostics has wide range techniques. In a particular case, individual tests are selected that are justified in terms of identifying the disease. If we are talking about allergies, it is necessary to find out the supposed triggering substances at the stage of collecting an anamnesis, and special tests can confirm their significance for the patient.

Instrumental methods

They do not help identify allergies or skin reactions related to physical factors, however, they make it possible to diagnose the disease that created the prerequisites for the development of urticaria and angioedema:

X-ray examination of the chest organs, paranasal sinuses nose;
esophagogastroscopy (examination of the upper sections digestive tract using an optical probe);
duodenal intubation (carried out to assess the function of the gallbladder and obtain discharge for bacteriological culture);
ultrasound examination of organs abdominal cavity and etc.

The patient can be advised by different specialists: therapist, allergist, gastroenterologist, rheumatologist.

Treatment

Held in acute period development of symptoms. If there is a history of episodes of urticaria and angioedema, it is necessary to determine whether accompanying pathologies, and develop a treatment program to eliminate them.

Elimination

This is the cessation of contact with a provoking substance/environment/factor, which is effective, first of all, for patients suffering from allergies. They are recommended:

Regular wet dust cleaning.
Refusal of carpets, upholstered furniture, toys.
Careful selection of cosmetics and medicines.
Minimizing contact with chemicals at home and in the workplace.
Diet with predominance hypoallergenic products and excluding foods that provoke a reaction.

Physical factors also require elimination, although ensuring there is no contact with cold, high temperature or the sun's rays is more difficult than with a certain dish or cosmetic cream. Patients are advised to wear covered clothing, avoid visiting baths and saunas, and apply products that protect against ultraviolet radiation to the skin.

Drug therapy

As base groups pharmacological drugs Antihistamines and glucocorticosteroids are used:

Loratadine;
Cetirizine;
Clemastine;
Fexofenadine;
Mebhydrolin;
Betamethasone;
Prednisolone;
Dexamethasone;
Hydrocortisone.

Diuretics (Furosemide), adrenergic agonists (Epinephrine), and saline solutions (0.9% sodium chloride) may also be required. The drugs are taken in tablets and administered by injection; in the case of an acute form of reaction, therapy is carried out by specialists from the ambulance team and doctors from the hospital department to which the patient is hospitalized.

Urgent Care

Required if:

Defeats large area skin.
Presence of respiratory disorders, loss of consciousness, convulsions.
If the patient is a small child.

Patients with Quincke's edema are at risk of closure of the mucous membranes of the respiratory tract as a result of severe swelling (blocking the lumen for air passage). You can do it yourself:

stop contact with the allergen;
give the patient an antihistamine - Tavegil, Suprastin (if he can swallow) or give an injection intramuscularly (if you have a syringe or ampoule with medicine on hand);
unbutton your shirt collar, remove heavy outerwear that restricts breathing;
Call an ambulance, follow the dispatcher’s instructions, wait for the team to arrive next to the patient.

If you have hives, follow the same steps. To stop contact with the allergen you can:

Apply ice or a heating pad cold water to the site of an insect bite or drug injection (if these factors caused the reaction).
Rinse your mouth.
Wash off the trigger substance from the skin.

Applying a tourniquet above the injection site of a medicine or insect bite is not performed without confident knowledge of this skill.

The maximum period is a quarter of an hour, every 10 minutes the pressure is reduced for 120 seconds. However, the method poses a threat when incorrect execution, since there is a risk of impaired blood flow and development necrotic changes in tissues. Therefore, it is better to use ice at home - the effect is similar, but the level of risk is not comparable. It is important to remember that the patient requires prompt assistance from specialists and hospitalization in medical institution, on your own you can only delay the critical moment for a while - but not stop the life-threatening reaction.

Characterized by the constant presence of a rash on the face, which can last for several months.

Distinguish hives from others similar diseases its characteristic symptoms will help:

severe headaches;
irritability;
have blisters different sizes and clearly defined edges;
elevated temperature bodies;
burning and itching in the area of the rash;
sleep problems;
feeling of weakness.

Most dangerous complication urticaria on the face is Quincke's edema. It is characterized by the following symptoms:

barking cough;
hoarseness;
urticaria, swelling of the face appears: on the tongue, tonsils, soft palate and lips;
pale or pinkish skin tone.

Causes

Hives on the face may have both an allergic and non-allergic nature. It can be caused by an allergy to food, high or low temperature environment( and ), for medications, for cosmetics, or for insect bites.

Besides, hives can occur for the following reasons:

Predisposition to disease.
Sarcoidosis.
Infection.
Tumors of internal organs.
Diseases of the digestive system.
Disturbances in the functioning of the endocrine system.

Allergic urticaria is characterized by the following features::

no general deterioration in health;
precedent of contact with an allergen;
severe itching;
The rash appears as bright pink or red spots, papules, or blisters.

As for those foods that most often provoke the occurrence of allergic urticaria, these include:

Alcohol.
Chocolate.
Citrus.
Eggs.
Spicy dishes.
Smoked meats.

If you notice that hives appear on your lips after eating one of the foods, try not to eat it again.

If you can't say that your facial hives are caused by an allergy, don't try to treat it yourself before consulting with your doctor!

Diagnostics: where to go, what tests will be taken?

Since hives on the head can be a symptom various diseases, That It is advisable to consult a doctor at the first symptoms. Diagnosis of this disease is carried out either by a doctor general practice, or an allergist-immunologist.

Tests consist of the following steps:

Collecting anamnesis of the patient’s life and illness.
Examination using clinical and laboratory methods.
Examination using allergological methods.
Examination using immunological methods.
Instrumental, functional and X-ray methods examinations.

All methods of examining a patient can be divided into basic and additional. The main methods include general analysis urine, as well as clinical analysis blood and blood biochemistry test. They are used after the patient has been diagnosed with urticaria.

If there is a need to clarify the causes of the disease and the mechanism of its development, the patient may be assigned additional methods examinations.

Photo

Let's see what urticaria looks like on the face of adults: photos are available below.

This type of urticaria also occurs: photo, face with Quincke's edema.

Treatment

Rubbing your face will help relieve itching due to hives. fermented milk products. You can also make lotions from black tea and herbal decoctions.

What should you do first and what should you avoid?

The first step in treating urticaria on the face is to eliminate contact with the allergen.. If the disease occurs while using cosmetics, you need to wash your face with cold water, and if you have allergies food nature- You need to do a cleansing enema.

Taking sorbents and antihistamines, as well as drinking plenty of water, will help speed up the removal of the allergen from the body.

What medications can I take?

For the treatment of urticaria, drugs such as Suprastin or Tavegil, Claritin or Fenistil, as well as Zyrtec, Erius and Telfast can be prescribed.

Drugs such as Tavegil and Suprastin can cause drowsiness.

As for external use products, they can be divided into:

hormonal ointments and creams(Advantan and Elokom). They have a quick effect, but have many contraindications. They should not be used without consulting a doctor;
m azis and creams with antihistamine effect(Fenistil gel);
non-hormonal creams and ointments(Elidel).

Folk remedies

They are quite effective in treating urticaria.

The most popular is chamomile infusion with string. To prepare it, you need to combine both herbs in equal proportions, and then pour a tablespoon of this mixture with a glass of boiling water and leave covered for an hour.

From the resulting infusion you need to apply lotions to the affected skin of the face at least three times a day.

Nettle also helps with urticaria quite well. One tablespoon of crushed dry or four tablespoons fresh leaves pour a glass of nettle cold water and bring to a boil, and then boil for three minutes. Turn off the heat, cover the broth with a lid and let it cool. Lotions with this decoction must be done several times a day.

A cure for hives can be ordinary potatoes. Raw potatoes are grated, and the resulting pulp is applied to the blisters and left for half an hour or an hour, covering the top with cling film.

We already know what urticaria is, photos, symptoms and treatment on the face are discussed. Let's talk about a diet for urticaria.

Diet

Treatment for urticaria will not work quick results, if you do not adhere to what your doctor prescribes to you. First of all, she implies the complete exclusion of the allergen if urticaria is caused by food allergies .

Features of the disease on the lips and eyes

If hives cover the eyes or lips, this indicates the onset of Quincke's edema.

Although hives on the face are considered quite unpleasant illness, the prognosis for recovery if you consult a doctor in a timely manner is favorable.

See the video below for advice from an allergist-immunologist.

Acute urticaria, as well as Quincke's edema, which is also called angioedema, are allergic diseases. According to statistics, every fifth person on our planet has encountered these phenomena at least once in their lives. These two conditions can be combined, or they can occur separately. Next, we will look at the causes of urticaria and angioedema, and also talk about methods of treating them.

Urticaria has earned its name due to quite characteristic manifestations– blisters that look like wounds left after a burn. Their occurrence is accompanied by swelling, redness and skin itching. Blisters are clearly defined elements that rise slightly above the skin surface.

Their size can vary from a few millimeters to several centimeters. Hives may get worse when they appear general state patient - possible headache, fever, malaise and weakness.

Urticaria can be both localized and generalized: it can affect only a certain area or spread over the surface of the entire body. In some cases, such symptoms are a symptom of some more serious disease.

Depending on the reasons for development urticaria can happen b:

Dermographic (in areas of skin irritation, for example, by scratching);

Physical (cold, heat, solar radiation, pressure);

Pollen;

Medicinal, etc.

If doctors cannot determine the cause of the rash, urticaria is called idiopathic.

The acute form of the disease is most often explained by exposure to some allergen; if the disease becomes chronic and constantly relapsing, then the connection with the allergen is very difficult to establish. The cause of the disease can be determined only in 5-30% of cases.

Quincke's edema differs from the manifestations of urticaria only in the depth of damage to the epidermis. Swelling of a significant size occurs first in places with loose fiber– on the eyelids, lips, oral mucosa, cheeks and genitals.

Most often, it goes away without a trace in about a couple of hours, and in severe cases it can last up to three days. Those patients who have a moderate or severe reaction are subject to mandatory hospitalization.

Acute urticaria most often develops due to exposure to a food or drug allergen, and angioedema is usually associated with certain drugs, aimed at treating hypertension and heart failure (the most common medications include Capoten, Enap, Renitek, Prestarium).

Doctors have found that there may be a connection between the development of urticaria and the presence in the body special organism– Helicobacter Pylori, which lives inside the stomach and duodenum for peptic ulcers and gastritis.

Nonspecific provoking factors include the use of alcoholic drinks, fever, heat, exercise, menstruation and emotional factors.

How dangerous are these allergic reactions?

Doctors classify local urticaria as a mild reaction, and its generalized form and Quincke's edema as a severe reaction. Swelling in the neck, face, larynx and mouth is considered particularly dangerous, as it can cause serious breathing difficulties and cause death from suffocation (if timely medical assistance is not received).

Treatment of urticaria and Quincke's edema

All patients with these ailments should stop taking aspirin and other non-steroidal anti-inflammatory drugs. In addition, you should not use antihypertensive drugs that can cause angioedema. Alcoholic drinks and hot baths should be avoided.

If it is possible to identify the food culprit of the allergic reaction, it is completely excluded from the diet.

If the patient has been hospitalized in a hospital, all necessary measures for symptom relief, as well as quick cleansing body from an allergen. For this purpose, enterosorbents are used: smecta, activated carbon, enteros-gel, polyphepam.

If necessary, cleansing enemas are also given. Intravenous infusions are carried out in parallel with the use of diuretics. A little later, antihistamines are added to therapy; they are administered either intramuscularly or intravenously.

Most often they use suprastin or tavegil, but they are particularly effective and lack side effects Antiallergic drugs of the second (Claritin, Kestin) and third (Aerius and Telfast) generations differ.

If treatment does not have the desired effect, hormones are used general action: dexamethasone, prednisolone or hydrocortisone, course of treatment for five to seven days.

If a person has suffered from urticaria or angioedema at least once, he must have all the information about his illness and carry with him information indicating accurate diagnosis and recommendations. In addition, you should always carry medications necessary for first aid and avoid possible contact with allergens.

Occurs at least once in a lifetime in 15-25% of the world's population and usually before the age of 40 years. Most often children under 3 years of age are affected, a little less often - children of preschool and early age. school age. The rash of urticaria resembles a nettle burn, hence the name of the disease. Primary element The rash is a blister, which is a local swelling of the papillary dermis. Such a rash is called urticarial (from lat. urtica – nettle) and is accompanied by significant itching, leading to deterioration of well-being and sleep disturbance. In half of the patients, urticaria occurs in isolation, in approximately 40% the disease is combined with angioedema(Quincke's edema), and isolated angioedema occurs only in 10-15% of patients and is a deeper swelling of the skin and subcutaneous tissue, the development of which is on the mucous membranes oral cavity and larynx can lead to asphyxia, which threatens the life of the child.

Urticaria can be acute and last for several days and weeks (no more than 6 weeks between the appearance of the first and disappearance of the last elements of the rash) or chronic, lasting months and years. Children are more likely to experience sharp forms diseases, and at the age of 20 to 40 years - chronic.

Causes acute urticaria and angioedema in children, in most cases, it can be clearly established. These may be the following factors:
- food products (milk, eggs, fish, nuts, legumes, citrus fruits, chocolate, strawberries, raspberries and others), and what younger child, the more often food allergens are the cause of the disease;
- medications (antibiotics from the groups of penicillins, cephalosporins, salicylates, non-steroidal anti-inflammatory drugs, blood products, X-ray contrast agents);
- insect bites (wasps, bees, spiders, fleas), jellyfish;
- infections (usually hepatitis viruses, Epstein-Barr, streptococci, helminths);
- physical factors (heat, cold, insolation, physical activity, pressure);
- direct contact of the allergen with the skin (animal hair, dyes, perfumes, latex, household chemicals).

Causes of chronic urticaria can be established in 20-30% of children, and more often they are physical factors, infections, helminthic infestations, nutritional supplements, inhalant allergens and medications.

Mechanisms of development of urticaria and angioedema are divided into two main groups - allergic and non-allergic. In both cases, the basis is the release from mast cell granules biologically active substances, the most studied of which is histamine, itchy, edema and hyperemia. In children, degranulation most often results from immediate-type allergic reactions (IgE-dependent), in which allergens interact with antibodies on mast cell membranes. When exposed to non-immune factors, an increase in histamine concentration occurs due to its direct release from cells upon consumption certain products, medications. In addition, non-immune mechanisms include the effects of physical factors, causing development cold, thermal, contact, solar, vibration urticaria.

For clinical picture urticaria is characterized by the appearance of round or round blisters oval shape sizes from a few millimeters to 10-20 cm; they can merge with each other, forming polycyclic figures. Elements of the rash rise above the surface of the skin, have a bright pink color, sometimes paler in the center; can appear in any part of the body, including scalp head, palms and feet, and are accompanied by itching varying degrees expressiveness. The rash turns pale when pressed. Children are characterized by an acute course of urticaria with profuse rash, accompanied by significant swelling and hyperemia.
Children often experience general symptoms: increase in body temperature up to 39 degrees Celsius, loss of appetite, pain in the abdomen, joints, stool disorders. Important feature urticaria is the complete reverse resolution of blisters without the formation of secondary elements (from several minutes to several hours, but not more than a day).

Special types of urticaria include aquagenic urticaria, which occurs immediately after contact with water of any temperature, characterized by a rash of small blisters surrounded by erythematous spots, and accompanied by severe itching.
In older children, more often in adolescence, there is a so-called cholinergic urticaria– the appearance of a large number of pale pink blisters with a diameter of 1-5 mm, surrounded by hyperemia. They are formed after physical activity, stress, sweating, a hot shower, accompanied by systemic manifestations: hot flashes, weakness, rapid heartbeat, shortness of breath, abdominal pain.

In children angioedema happens less often. It is characterized by the sudden onset of swelling of the skin and subcutaneous tissue, leading to deformation of the affected area. Quincke's edema is localized in areas of skin with scanty connective tissue prone to accumulation tissue fluid– on eyelids, lips, ears, hands, feet, genitals, mucous membranes of the gastrointestinal tract. Itching with Quincke's edema is less pronounced; burning and a feeling of fullness are more common. Resolution occurs more slowly - within 24-72 hours.
With angioedema, the process may involve the mucous membranes of the oral cavity, tongue, pharynx, larynx with the development of obstruction of the upper respiratory tract, life-threatening child. First, hoarseness of the voice and a barking cough occur, then difficulty breathing appears and increases, inspiratory shortness of breath (difficulty in inhaling) develops, then exhalation becomes difficult, cyanosis of the facial skin increases, giving way to severe pallor. In severe cases, the risk of asphyxia is high. When edema forms on the mucous membranes of the stomach and intestines, the child experiences abdominal pain, vomiting, and bowel movements.

Diagnostics urticaria and angioedema is based on the characteristic clinical picture diseases. Laboratory and instrumental examinations prescribed to identify causative factor. Skin testing with food allergens and specific diagnostic provocative tests are used. They also search for diseases that contribute to the development of urticaria - helminthic infestations, pathologies of the endocrine and digestive systems.

Treatment of urticaria and angioedema carried out in three main directions: eliminating contact with the provoking factor, prescribing drug therapy and creating a hypoallergenic environment to prevent relapse of the disease.

Of the medications, taking into account the mechanisms of disease development, the most effective are antihistamines in age dosages. For common forms of urticaria and Quincke's edema, parenteral administration is preferable, and then switching to tablet forms for a month or more. At chronic urticaria Treatment is prescribed for 3-6 months, and sometimes up to a year. If antihistamines are ineffective (increasing edema, generalization of the lesion), glucocorticosteroid hormones are used (intravenously).
For food allergies, sorbents are additionally prescribed, for cholinergic urticaria - anticholinergic drugs, for cold - membrane stabilizers, for solar - cyclosporine A. In some cases, plasmapheresis sessions are effective.

In severe forms of acute urticaria, ineffective outpatient treatment, angioedema of the larynx with a risk of asphyxia, swelling of the tongue, intestines and life-threatening complications, it is necessary to hospitalize the child in a hospital.
If your baby develops swelling of the larynx, some measures must be taken before the ambulance arrives. First of all, you should not give in to panic and calm the child, as anxiety will increase swelling and quickly lead to asphyxia. Next, you should stop contact with the allergen (if an insect bites, remove the sting, if you have a food allergy, rinse your stomach, if drug allergies– stop administering the drug), ensure maximum oxygen flow, remove all constricting objects from the neck and waist, and apply drops into the nose vasoconstrictor drops. You can independently give your child sorbents and antihistamines in age-appropriate dosages before the doctor arrives.

Prevention of recurrence of urticaria and angioedema
At the most frequent form diseases in children - allergic - contact with provoking factors should be avoided if possible. However, often exact reason cannot be detected or contact cannot be avoided. In this case, it is necessary to limit the influence on the child of all factors that can cause an allergic reaction. First of all, you must comply hypoallergenic diet, exclude all foods that can cause the release of histamine or contain it in large quantities. These include chocolate, citrus fruits, seafood, strawberries, eggs, preservatives, cheeses, smoked meats, nuts, tomatoes and others.
Also, you should not allow your child to come into contact with contact (animal hair, household chemicals, dyes, dust, latex) and inhalation (pollen, aerosols) allergens; you should wear loose clothing made from natural soft fabrics, avoid insect bites, and take medications, due to which previously observed the appearance of urticaria.

An important condition for effective elimination allergies is the treatment of foci of chronic infection, diseases of the gastrointestinal tract, including dysbiosis, the fight against helminthiases, high-quality therapy for colds and other infectious diseases. Moreover, it is necessary to carry out general measures to strengthen the baby's immunity.
In case of urticaria associated with exposure to physical factors, exclude their influence on the child - do not wear tight clothes, do not visit baths, do not drink too cold or hot drinks, do not be exposed to excessive physical activity; avoid direct contact sun rays, use sunscreen with high level UV protection.