After angioedema, urticaria does not go away. Depending on the course and manifestations, urticaria is divided into

Urticaria (urticaria) - a disease characterized by a rapid more or less widespread rash on the skin of itchy blisters. A blister is swelling of a limited area, mainly the papillary layer of the skin. One type of urticaria is angioedema(giant urticaria, angioedema), in which the edema extends to the dermis or subcutaneous layer. This form of urticaria was first described by N. Quincke in 1882.

Urticaria is a common disease - about one in three people have suffered at least once in their lives. In the structure of diseases of allergic origin, urticaria ranks second after bronchial asthma, and in some countries (Japan) even the first.
Urticaria and angioedema can occur at any age. Most often, the disease occurs between the ages of 21 and 60. Women are more often ill, which is associated with the peculiarities of their neuroendocrine system. Burdened allergic heredity, according to different authors, is observed in 25-56% of cases.

Classification Urticaria.

Etiopathogenetic classification of urticaria

I. Allergic

• food
• Medicinal and chemical substances
• household
• epidermal
• pollen
• Whey
• Insect
• infectious

II. Physical

• Mechanical
• Cold
• thermal
• Radiation
  a) light
  b) X-ray exposure
• Cholinergic

III. Endogenous

• Enzymopathic:
  a) deficiency or insufficient activity of the C1 inhibitor;
  b) deficiency of digestive enzymes
• dishormonal
• idiopathic

IV. Pseudoallergic.

Examples of possible diagnoses:
1) acute (pseudo) allergic drug urticaria;
2) chronic recurrent allergic urticaria (bacterial);
3) chronic recurrent endogenous urticaria (dyshormonal).

Each of the forms of urticaria indicated in the classification has its own mechanism of development. However, their common pathogenetic link is an increase in the permeability of the microvasculature and the development of acute edema in the surrounding area. Histopathologically, in the area of ​​the blister, there is a loosening of collagen fibers, intercellular edema of the epidermis, the appearance of perivascular mononuclear infiltrates with different rates of development and severity.

Allergic Urticaria.

Allergic mechanisms of tissue damage take part in the development of this form of urticaria. The most common allergens are drugs, foods, insect allergens.
The leading mechanism for the development of urticaria is the reagin mechanism of damage, in a small number of cases - immunocomplex. The latter can be activated when a number of drugs are introduced into the body (for example, penicillin), antitoxic serums, gamma globulins.

Physical Urticaria.

Physical urticaria is caused by various physical factors.
Heterogeneous in pathogenesis. Allergic, pseudo-allergic and other mechanisms can participate in its development.

Mechanical urticaria develops as a result of mechanical irritation of the skin.
There are the following types:
a) dermographism - the appearance of a linear blister after holding a hard object over the skin. The mechanism of development is probably allergic, since this reaction can be passively transferred to the skin of a healthy recipient by serum or IgE, and in some patients, after intensive scratching, an increase in the level of histamine is found in the blood;
b) pressure urticaria on the skin of buckles, ribbons, belts, etc. The mechanical factor plays a role here. Often accompanies dermographism or chronic urticaria;
c) vibrational angioedema, which is a variant of hereditary Quincke's edema.

Cold urticaria is also a heterogeneous group in terms of developmental mechanisms and clinical manifestations.
Allocate:
a) Hereditary family forms, immediate and delayed, each of which is inherited as an autosomal dominant trait. The immediate form cannot be transferred with serum. The delayed form develops 9-18 hours after exposure to cold. It also cannot be transmitted passively. Contact with cold does not cause histamine release and histologically mast skin cells are not degranulated. Neither immunoglobulins nor complement were found in the area of ​​edema. Thus, the pathogenesis remains unclear;
b) Acquired forms. In their development, the reagin mechanism of damage most often plays a role, which proves the possibility of passive transmission to healthy recipients.
An increase in the level of histamine was found in the blood. The reaction to contact with cold develops quite quickly.

Thermal urticaria.
The active factor is heat. One of the possible mechanisms of development is an alternative way of complement activation.

Radiation urticaria occurs under the action of visible light and X-rays. In the visible spectrum, rays with a certain wavelength are active. This is the basis for the division of light urticaria into subgroups. Mechanisms for the development of urticaria are different. The possibility of passive transfer in cases of urticaria caused by rays with a wavelength of 285-320 and 400-500 nm is described. X-rays generate free radicals that damage cell membranes.

Cholinergic urticaria.
The acting factor, obviously, is overheating of the body, which occurs after a warm bath, shower, physical activity or other influences. The leading role is attributed to the action of the mediator of the parasympathetic division of the nervous system - acetylcholine. At the same time, an increase in the content of histamine in the blood, as well as the possibility of passive transfer, have been established in a number of cases.

Endogenous Urticaria.

This group includes urticaria (and angioedema), in the development mechanism of which a genetically determined defect of any factors plays a role, or the mechanism of which is not yet known.

Enzymopathic urticaria presented two kinds.

one view associated with deficiency of the first complement component inhibitor. This defect is inherited as a dominant autosomal trait. The mutation frequency of this gene is 1:100,000. The result is the development of congenital angioedema (Quincke's edema).

There are three types of this disease, clinically indistinguishable.
First type- Inhibitor deficiency - accounts for about 85% of cases.
With the second type its level is normal, but the inhibitor is inactive.
With the third type the inhibitor level is increased by 3-4 times, but it is structurally changed and forms a complex with albumin. Deficiency of the inhibitor leads to the fact that various damaging effects that activate the Hageman factor lead to the activation of complement along the classical pathway.

Another kind enzymopathic urticaria is associated with dysfunction of the gastrointestinal tract. Urticaria develops against the background of gastroduodenitis, peptic ulcer. Alcohol intake under these conditions increases the permeability of the intestinal barrier and enhances the absorption of incompletely digested foods. The latter independently and through the activation of pseudo-allergic mechanisms lead to the development of urticaria. Due to the fact that this process is chronic, developing urticaria also has a chronic course.

Dishormonal urticaria.
Its development is associated with dysfunction of the endocrine glands. A typical example is urticaria in premenstrual syndrome. The ratio between cortisol and histamine plays a role in their effect on the level of microcirculatory vessels. Any shift towards the predominance of histamine action will lead to an increase in vascular permeability.

Idiopathic urticaria.
This diagnosis is made in cases where the doctor does not know either the cause or the mechanism of the development of the disease. Therefore, the more complete the examination of the patient, the less often this diagnosis appears. The disease is chronic. Often this form is enzymopathic and associated with dysfunction of the gastrointestinal tract. Sometimes idiopathic urticaria is a symptom of another disease, such as systemic lupus erythematosus, glomerulonephritis, infective endocarditis, cryoglobulinemia. In these cases, complement activation is often detected by the resulting immune complexes. During the biopsy, vasculitis with perivascular lymphocytic infiltration is found.

Pseudo-allergic forms of urticaria.

Often, urticaria is an expression of a pseudo-allergic reaction. Various acting factors can be histamine liberators, complement activators and kallikrein-kinin system. Among these factors are drugs (antibiotics, radiopaque agents, and many others), serums, gamma globulins, bacterial polysaccharides, physical, etc.

Clinical picture Urticaria.

The clinical picture of acute urticaria is characterized by a monomorphic rash, the primary element of which is a blister. The disease begins suddenly with intense itching of the skin of various parts of the body, sometimes the entire surface of the body. Soon, in places of itching, hyperemic areas of the rash appear, protruding above the surface. As the edema increases, the capillaries are squeezed and the color of the blister turns pale. With significant exudation in the center of the edema, a bubble may form with detachment of the epidermis.

Urticaria can become hemorrhagic in nature due to the release of blood cells from the vascular bed. In the future, erythrocytes, breaking up in the surrounding tissue, form age spots, which should not be confused with urticaria pigmentosa (mastocytosis).
The size of the elements of the rash is different - from a pinhead to gigantic sizes. Elements can be located separately or, merging, form elements with bizarre outlines and scalloped edges.

The duration of the acute period - from several hours to several days. Urticaria may recur. If its total duration exceeds 5-6 weeks, then the disease becomes chronic.
An attack of acute urticaria may be accompanied by malaise, headache, and often a rise in temperature to 38-39 ° C.

Chronic recurrent urticaria It is characterized by an undulating course, sometimes for a very long time (up to 20-30 years) with various periods of remissions. Very often it is accompanied by angioedema. In chronic urticaria, the transformation of urticarial elements into papular elements is occasionally observed. This form of urticaria is characterized by particularly painful itching. Patients comb the skin to the blood, infect the infection, resulting in the appearance of pustules and other elements. The monomorphism of the rash in this case is absent.

Quincke's edema.

If the edema spreads deeper and captures the entire dermis and subcutaneous tissue (sometimes spreading to the muscles), then a large, pale, dense, non-pruritic infiltrate appears, which does not leave a hole when pressed. This giant swelling is called Quincke's edema. With widespread rashes of this type, we are talking about giant urticaria.
They can also occur on mucous membranes. Their most frequent localization is lips, eyelids, scrotum, mucous membranes of the oral cavity (tongue, soft palate, tonsils).

Quincke's edema is especially dangerous in throat area, which occurs in about 25% of all cases. When laryngeal edema occurs, hoarseness of the voice, a “barking” cough are first noted, then difficulty in breathing increases with inspiratory dyspnea, and then inspiratory-expiratory nature. Breathing becomes noisy, stridor. The complexion acquires a cyanotic hue, then becomes sharply pale.

Patients are restless, rush about. When edema spreads to the mucous membrane of the tracheobronchial tree, the picture of acute laryngeal edema is accompanied by bronchial asthma syndrome with characteristic diffuse expiratory wheezing. In severe cases, in the absence of rational assistance, patients may die with symptoms of asphyxia. With mild to moderate severity, swelling of the larynx lasts from an hour to a day. After the acute period subsides, hoarseness of voice, sore throat, shortness of breath remain for some time, dry and wet rales are auscultated. Quincke's edema in the larynx requires immediate intensive care up to tracheostomy.

With the localization of edema on the mucous membrane of the gastrointestinal tract, abdominal syndrome. It usually begins with nausea, vomiting first food, then bile. There is an acute pain, initially local, then diffused throughout the abdomen, accompanied by flatulence, increased intestinal motility. During this period, a positive symptom of Shetkin may be observed. The attack ends with profuse diarrhea.
Microscopic examination of the feces reveals a significant number of eosinophils, Charcot-Leiden crystals may be present. Abdominal edema is combined with skin manifestations in 30% of cases.

When the pathological process is localized in urogenital tract a picture of acute cystitis develops, then urinary retention occurs. Edema of the genital organs is accompanied by an appropriate clinical picture.

When localizing processes on the face the serous meninges may be involved in the process with the appearance of meningeal symptoms, such as stiff neck, severe headache, vomiting, and sometimes convulsions. Occasionally, due to edema of the labyrinth systems, Meniere's syndrome develops. Clinically, it is manifested by dizziness, nausea, and vomiting.

Rare cases are described when, with the localization of Quincke's edema on the chest the heart was involved in the process with clinical manifestations in the form of attacks of paroxysmal tachycardia, extrasystole (Ado AD, 1976). Thus, the clinical picture and the severity of the course of edema are determined by the localization of the pathological process and the degree of its intensity.

Pathogenesis.

According to the pathogenesis, angioedema is allergic and hereditary. Clinical manifestations and their course are different.
Although hereditary angioedema is transmitted as an autosomal dominant trait, the absence of a family history does not preclude the diagnosis of this disorder. The combination of a characteristic clinical picture and laboratory examination data is of decisive importance. The clinical picture of hereditary angioedema is characterized by a long-term formation of very dense edema, with laryngeal edema and abdominal syndrome often occurring in the absence of indications of pruritus and urticaria, and there is no effect of antihistamines.

differential diagnosis.

The diagnosis of urticaria is generally straightforward in typical cases of the disease. However, there are many other diseases that masquerade as urticaria.

Due to a sharp edema, hemorrhages can be accompanied by a bluish, red and pink small urticarial rash, which is localized mainly on the extensor surfaces, around the joints.

Urticaria, accompanied by hemorrhages, must be differentiated from urticaria pigmentosa - mastocytosis, morphological expression of which are accumulations of mast cells in the dermis.

Chronic recurrent urticaria, which has elements of a papular rash, can be mistaken for in which the main elements are pale, skin-colored, papules that leave behind age spots.

It is accompanied by severe general symptoms, a symmetrical location of a non-itchy, often painful rash, its localization on the back of the hands and feet (which is rarely observed with urticaria), and lesions of the mucous membranes in the form of a vesicular rash. In severe cases, the skin rash may be vesiculobullous in nature, accompanied by a severe general condition of the patient.

Multiple insect bites or stings, causing local toxic reactions due to the histamine-like effect of toxic substances in saliva or poisons, can simulate acute urticaria.

sometimes accompanied by severe and persistently recurrent urticaria, not amenable to treatment with antihistamines and corticosteroids. After deworming, urticaria is completely stopped in the absence of antiallergic therapy.

Macular form of rash in the secondary period syphilis can sometimes be urticarial in nature. In the differential diagnosis with urticaria, it is necessary to take into account the absence of itching in a syphilitic rash, often its symmetrical location and confirmation of syphilis by positive specific serological reactions.

Often, symptomatic urticaria develops with latent diabetes, with diseases of the blood, liver, and chronic renal failure. Sometimes urticaria is the first symptom of an unrecognized neoplasm, collagenosis, which may appear in the prodromal stage of infectious hepatitis.

Specific allergic examination of patients with urticaria and Quincke's edema, in addition to collecting an allergic history, includes skin tests. For food and drug allergies, provocative tests with oral administration of a product or drug can be used for diagnostic purposes if there is no severe reaction to this product.

TREATMENT OF urticaria and angioedema.

At Acute urticaria and angioedema carry out the same treatment as in other acute allergic reactions, with an impact on various pathogenetic links of the process.

• Antihistamines administered orally (with food and drug allergies) after preliminary cleansing of the gastrointestinal tract or parenterally at a dose of 1-2 ml.
• With giant urticaria, hypotension may occur due to the release of plasma from the vascular bed; in this regard, injections of 0.1% are prescribed Adrenaline Solution at a dose of 0.1 to 0.5 ml subcutaneously, depending on the severity of the condition.
• With laryngeal edema, in addition to adrenaline and antihistamines, 60 mg should be administered Prednisolone intramuscularly or intravenously by stream in 20 ml 40% Glucose solution.
• In addition, hot foot baths, inhalation are prescribed. Euspirana,Izadrina, intramuscular injection of 2 ml of 1% solution Furosemide (Lasix).
• With laryngeal edema, the patient needs urgent hospitalization in the ENT department, where, if necessary, he Tracheostomy.

Chronic recurrent urticaria a requires persistent and long-term treatment. Treatment of chronic urticaria is divided into nonspecific and specific.

Nonspecific therapy.

• Appoint antihistamines, which must be changed every 2 weeks.
• Can recommend Sodium thiosulfate, Magnesium thiosulfate.
• Externally, to reduce itching, rub down with table vinegar or apply ointments with 2-5% anesthesin.
• Histoglobulin(foreign histoglobin) is prescribed according to the scheme, taking into account the tolerability of the drug. The usual scheme for chronic recurrent urticaria: 0.5-0.7-1 - 1.5-2-2-2-2-2-2 ml. Injections are made subcutaneously 2 times a week. With the effectiveness of treatment, the course can be repeated after 6 months - 1 year.
• Treatment clean Histamine start with a threshold dilution determined by allergometric titration. Treatment with histamine is best done in an allergological room.
• In especially severe cases of the disease, in the absence of the effect of other therapy, it is necessary to apply Corticosteroid drugs on an individual basis.
• If there is a hemorrhagic component (vasculitis) in the clinical picture of chronic recurrent urticaria, it should be prescribed Indomethacin and others NSAIDs.
• Effective in some cases Splenin(1 g daily, total 14-20 injections).

specific therapy.

• Held allergen elimination and/or Specific Hyposensitizing therapy. Elimination refers to the exclusion of a suspected (or identified) food product from food or medicine.
• It is necessary to sanitize the foci of focal infection with urticaria of bacterial or fungal origin. Complete remission of urticaria is possible after tonsillectomy, radical sanitation of the oral cavity, maxillary sinuses, etc. Specific hyposensitization by the identified allergen is carried out according to the generally accepted scheme for the treatment of allergic diseases.

During treatment hereditary angioedema angioedema antihistamines and corticosteroids are ineffective.

• To stop acute edema, urgent replacement therapy is needed to compensate for the deficiency of the C1 inhibitor. The patient is given fresh or fresh frozen blood plasma. Lyophilized C1-inactivator, which is administered at a dose of 3000 to 6000 IU (1-2 ampoules) depending on the severity of the case and body weight.
• Some effect is noted with the introduction adrenaline and ephedrine.
  Patients need urgent hospitalization: with laryngeal edema - in the ENT department, with abdominal syndrome - in the surgical department.
• To prevent relapse this disease is recommended Epsilon aminocaproic acid(plasminogen inhibitor): IV 5 g with 20 ml up to 40% Glucose solution or orally 7-10 g daily for a month
• Sometimes it is recommended to introduce Inhibitor Kallikrein-Trasilol at a dose of 30,000 IU in 300 ml of isotonic solution sodium chloride drip for 3 hours.
• Treatments also help. Methyltestosterone(activation in the liver of the synthesis of O inhibitor).
• In the treatment of dermographic urticaria, antihistamines are not always effective. Recommended application Sedative and restorative drugs. Good results from the use of ultrasound were noted. The treatment is carried out according to the method of Bogdanovich: total segmental treatment with ultrasound paravertebral along the entire spine on both sides. Treatment is carried out 3 times a week, up to 12 sessions in total. After a month break, the course of treatment is repeated.
• Effective reflexology.

Treatment needs a special approach Cholinergic urticaria. Since acetylcholine plays a leading role in the pathogenesis of this type of urticaria, antihistamines and corticosteroids are ineffective.

• The effect is provided by injections of 0.1% Atropine solution, Belladonna extract 0.015 g 3 times a day. Good results are obtained by treatment with dosed physical activity.

Great persistence requires treatment Cold urticaria .

• In some cases, the effect of the course is observed Histaglobulin (or histamine) sanitation of foci of focal infection.
• More efficient Autoserotherapy, which begins with the introduction of serum (under strictly sterile conditions) in dilutions of 10 ~ 2 or 10-1 according to the scheme 0.1-0.2-0.3-0.4-0.5-0.6-0.7 - "), 8-0.9 ml. The serum was obtained from the blood taken from the patient immediately after the strong cooling of the hand under a stream of cold water, which caused the appearance of urticaria.

During treatment Endogenous enzymopathic urticaria, associated with impaired function of the gastrointestinal tract, used according to indications

• Gastric juice, plantain juice, festal-type enzymes, treat dysbacteriosis. Patients with chronic recurrent urticaria with concomitant diseases of the gastrointestinal tract are recommended sanatorium treatment at resorts such as Essentuki, Gruskavets, Marshansk, etc.

Treatment of chronic recurrent urticaria is also complicated by the fact that there are combinations of etiologically different forms of urticaria.

Forecast.

The prognosis of allergic urticaria in most cases is favorable. Danger to life is Quincke's edema with localization in the larynx. Poor prognosis for hereditary angioedema. Families are described where several generations suffered from this disease and died at the age of 40 from asphyxia with angioedema of the larynx.
Prevention of chronic recurrent urticaria and Quincke's edema is the timely sanitation of foci of focal infection, deworming, treatment of chronic diseases of the gastrointestinal tract.

An acute allergic reaction in children can manifest itself as a skin rash of a bright red rash or as Quincke's edema. Both states can be interconnected and follow each other. Therefore, emergency care for urticaria and Quincke's edema in children should be provided without delay.

Any allergic reaction in a child can develop slowly or rapidly, so antihistamines in the form of tablets and ampoules for intramuscular injections should always be present in the home medicine cabinet. Most often, the time-tested "Suprastin" is used in children. The simplest skin test can save you from a drug allergic reaction. Scratch the inside of your forearm and put 2 drops of the drug you are about to give to the child on the scratch. If redness does not appear after 15 minutes, then you can use the drug without fear.

However, an allergic reaction can be to food, air, animals, flowers, and many other allergens. Therefore, we will talk about how first aid is carried out.

Severe allergic skin reaction in a child

Urticaria is a severe allergic reaction in a child, characterized by the rapid appearance of urticaria on the skin and less often on the mucous membranes.

This allergic skin reaction in a child occurs most often to drugs; food products; nutritional supplements; infectious agents; concomitant somatic diseases (digestive organs, endocrine glands, etc.); inhaled substances (plant pollen, house dust, fungal spores, detergents and other surfactants, acids, alkalis); psychological and emotional stress; insect bites and various physical effects on the skin (high and low temperatures, friction, prolonged pressure, vibration, insolation), as well as other causes. In some cases, the immediate cause may not be clear. Traditionally, according to the course of the disease, acute urticaria (duration less than 6 weeks) and chronic (duration more than 6 weeks) are distinguished.

Symptoms of an allergic reaction in children

There are such symptoms of an allergic reaction in children as a feeling of heat, itching, skin changes, as after a nettle burn. Urticaria elements - blisters and papules - can be of various shapes and sizes, often merge and become gigantic. The color of the urticaria elements is from pale pink to red. Rashes are localized on any part of the body, more often on the abdomen, back, chest, thighs. Symptoms of edema of the pharynx, larynx, walls of the bronchi, esophagus, stomach and other organs may appear on the mucous membranes. In such cases, in addition to the typical urticaria, breathing difficulties (laryngo- and bronchospasm), vomiting, abdominal pain, and diarrhea occur. Common symptoms are possible: fever, agitation, arthralgia, collapse.

The child has an allergic reaction: what to do

The first thing to do in case of an allergic reaction in a child, if an allergen is detected, it is necessary to stop its entry into the body. Introduce antihistamines intramuscularly or intravenously: (2.5% solution of pipolfen at the rate of 0.1-0.15 ml / year of life or 2% solution of suprastin - 0.1-0.15 ml / year of life) or orally (claritin , Kestin, Zyrtec, Telfast). With widespread urticaria with fever, inject a 3% solution of prednisolone - 1-2 mg / kg intramuscularly or intravenously. Give activated charcoal at a dose of 1 g/(kg-day). With signs of intoxication, prescribe infusion therapy (isotonic sodium chloride solution, hydroxyethyl starch derivatives).

Exclude from the diet foods with high allergenic activity (the so-called obligate allergens).

These include:

• Cow's milk,
• fish,
• Eggs,
• Citrus,
• nuts,
• Honey,
• Mushrooms,
• Chicken meat,
• strawberry,
• raspberries,
• strawberry,
• pineapple,
• melon,
• persimmon,
• grenades,
• blackcurrant,
• blackberry,
• Chocolate,
• Coffee,
• Cocoa,
• mustard,
• tomatoes,
• Carrot,
• beets,
• Celery,
• Grape.

All of these products can cause both IgE-mediated allergic reactions and directly spontaneous mast cell degranulation. Hospitalization in the somatic department (SO) is indicated in the absence of the effect of the therapy, and also on the condition that pre-hospital patients were administered prednisolone due to the severity of the condition.

How Quincke's edema manifests itself in children: emergency care

Quincke's edema is an allergic reaction of an immediate type, manifested by angioedema with its spread to the skin, subcutaneous tissue, and mucous membranes.

The causes of Quincke's edema are the same as with urticaria.

The clinical picture or how Quincke's edema manifests itself in children: characterized by a sudden appearance of a limited increase in volume in places with loose subcutaneous tissue, more often in the lips, auricles, neck, hands, feet. Edema can reach a significant size and deform the lesion. The immediate danger of this reaction is the frequent development of mechanical asphyxia due to edema of the upper respiratory tract. With swelling of the larynx in a child, a barking cough, hoarseness of voice, difficulty in inhaling and, possibly, exhaling due to joining bronchospasm are noted. In cases of swelling of the tongue, speech becomes difficult, the processes of chewing and swallowing are disturbed.

Emergency care for Quincke's edema in children begins with the fact that you should immediately stop the intake of the allergen into the body. Introduce antihistamines intramuscularly or intravenously: 2% solution of suprastin - 0.1 ml / year of life or 2.5% solution of pipolfen - 0.1 ml / year of life, or clemastine intramuscularly at 0.025 mg / (kg-day); 3% solution of prednisolone intramuscularly or intravenously at a dose of 1-2 mg / kg. For emergency relief of edema, diuretics (hydrochlorothiazide + triamterene, diacarb furosemide) can be used. With increasing laryngeal edema, inhalation therapy with the use of (32-adrenergic mimetics (salbutamol), glucocorticosteroids for inhalation administration through a nebulizer (budesonide) has a positive effect. If signs of respiratory failure (DN) III degree appear (diffuse cyanosis, severe tachycardia, arrhythmic, shallow breathing, drop in blood pressure) the child is immediately transferred to the RO, measures are taken to restore the patency of the respiratory tract (tracheal intubation, mechanical ventilation), in severe cases, a tracheostomy is applied. If there are signs of intoxication, infusion therapy is prescribed (isotonic sodium chloride solution, hydroxyethyl starch derivatives ) are hospitalized in CO.

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

Why does Quincke's edema occur?

Urticaria with Quincke's edema appears after allergens enter the body, causing degranulation of mast cells. Physical factors (cold, heat, solar radiation, insect bites), as well as chemical compounds in small doses dissolved in ordinary water, can also provoke an allergic reaction in urticaria. Much more often, hives are triggered by food allergens and ingredients of popular drugs.

Quincke's edema is inherently a complication of urticaria, when the pathological process covers not only the upper layers of the skin, but penetrates deep into and captures the mucous membranes, subcutaneous fat and muscles. Less commonly, Quincke's edema develops as an independent disease.

In more than 25% of patients with urticaria, the hereditary factor plays a leading role in its development and Quincke's edema, in another third such phenomena are acquired during life.

With any clinical variety of urticaria, the permeability of small blood vessels increases significantly. Surrounding tissues quickly swell, and under the influence of an excess amount of histamine, large blisters form on the surface of the skin. An allergic reaction gradually captures the deep layers of the skin and subcutaneous tissue - this is how angioedema begins.

Clinical manifestations

When an allergen enters the body, the skin reacts very quickly. Bright pink blisters appear literally within one hour. If the urticaria proceeds 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 invasion.

Urticaria with angioedema, in addition to dermatological, is accompanied by other symptoms. Along with a rash on the skin, there is an increase in body temperature up to 38 degrees, a headache worries, sleep is disturbed, and there is a feeling of impotence.

In chronic form, urticaria can drag on for many months with periodic exacerbations. In addition to the visible manifestations of urticaria, nausea and vomiting, increased nervousness periodically worries.

If swelling occurs:

• in the throat area - the voice of the victim becomes hoarse, breathing is wheezing, speech is disturbed;
• in the pleura - there is a sharp pain in the chest, severe shortness of breath;
• in the brain - one of the most dangerous variations, leads to circulatory disorders, the occurrence of seizures;
• in the digestive system - severe pain in the abdomen, nausea and subsequent vomiting worries;
• in the area of ​​the bladder - its functionality is disturbed, the process of urination is extremely painful.

Diagnostics

Diagnosis of Quincke's edema on the face and neck does not cause any special problems due to the pronounced severity of symptoms. With an extensive lesion, this area swells very strongly. The larynx and digestive tract often affects not acquired, but Quincke's edema with a hereditary factor.

It is more difficult to diagnose angioedema if the process takes place in the internal organs. A differential diagnosis of Quincke's edema is performed with other edema that occurs against the background of:

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

Angioedema of angioedema of allergic origin requires the collection of an anamnesis and the identification of a hereditary predisposition to its occurrence.

What to do if Quincke's edema is detected

Urticaria with angioedema can be fatal. If you experience symptoms characteristic of him, you should immediately call an ambulance.

Before the arrival of doctors, 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 wardrobe items - unbutton the collar of the shirt, the belt on the trousers. It is best to take a relaxed posture 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. With Quincke's edema in the throat area, especially with rapid development, urgent hospitalization is needed.

It is desirable to have antihistamines (for example, Diazolin, Fenkarol) and sorbents (activated carbon, Enterosgel) in a home medicine cabinet.

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

If we are talking about a food allergen, they take sorbents, but in no case do they wash the stomach because of the risk of choking on vomit.

Treatment of edema and urticaria

The basic principle of the treatment of urticaria and angioedema is the elimination of the provoking factor. After the relief of an acute condition, when the patient's life is already out of danger, he is transferred, depending on the type of edema and the current state, to one or another department. If the patient's condition is not dangerous, it may be a therapeutic or allergological department.

Urgent care

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

In no case do not try to make an incision in the trachea of ​​the patient yourself! These manipulations are performed only by physicians.

In a complicated situation, when there is no time and conditions for tracheostomy, in order to ensure breathing, the larynx is dissected (more precisely, the conical ligament between the cricoid and thyroid cartilages) - conicotomy. With Quincke's edema in the digestive organs, the patient is sent to the surgical department.

Elimination

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

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

This does not mean that you should permanently abandon all these products. 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, Dexazon);
• protease inhibitors (Kontrykal).

On an individual basis, the patient is selected sorbents to cleanse the body of the allergen. Additionally, calcium and vitamin C preparations are prescribed to strengthen the nervous system, multivitamin complexes that enhance the tone of blood vessels.

In Quincke's edema with a dominant hereditary factor, a drug is individually selected to replenish the volume of the missing C1 inhibitor.

In the case of pseudo-allergic Quincke's edema, the patient is prescribed an intravenous drip of an isotonic sodium chloride solution (for example, Kontrykal).

Preventive measures and diet

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

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

• flavor enhancers;
• dyes;
• preservatives.

Patients who develop urticaria and Quincke's edema due to poor heredity should be careful when performing any surgical interventions. At the appointment with 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 the possible occurrence of Quincke's edema. For this purpose, patients with urticaria are prescribed tranexamic acid or androgens. Additional drugs are administered immediately before the operation itself.

Hives- a heterogeneous disease, which is characterized by the appearance of urticaria on the skin.

Quincke's edema (giant urticaria)- hereditary or acquired disease, which is characterized by swelling of the skin and subcutaneous tissue. At angioedema possible development of edema of the mucous membranes.

Both diseases occur at any age, but more often in the period from 20 to 40 years. In almost half of the cases, urticaria is combined with angioedema.

Most often, blistering is associated with the release of histamine. Most often, degranulation of mast cells is due to the fixation of IgE on their membrane during atopy.

However, histamine liberation is also possible when immune complexes and complement fragments are fixed on the mast cell membrane, as is the case with immunocomplex urticaria. Mast cell degranulation can be associated with various cytokines, interleukins 1 and 8, neuropeptides (substance P, somatostatin), histamine-releasing proteins secreted by neutrophilic leukocytes in the focus of inflammation, and lymphokines.

Some drugs (codeine, coumarin anticoagulants, penicillin, various dextrans, morphine, polymyxin, indomethacin, sulfonamides, B vitamins, contrast agents), fixing directly on the mast cell membrane, can cause the release of histamine without involving immune mechanisms in the process . A genetically determined mast cell defect is also possible.

In such cases, various physical effects on the skin (pressure, high and low temperatures, etc.) lead to their degranulation.

In addition to histamine, acetylcholine, which is released during nervous excitement, can provoke blistering. Therefore, a cholinergic variety of urticaria is distinguished.

Thus, the allocation of allergic, autoimmune, non-allergic and idiopathic urticaria is pathogenetically justified.

Clinical manifestations.

For hives characterized by the appearance of itchy blistering rashes of various sizes and shapes. Rashes are more often localized on the skin of the trunk and extremities (including on the palms and soles), less often on the face. Blisters can be either single or multiple.

Often there is a fusion of rash elements in places of greatest friction (shoulders, hips, buttocks, lumbar region). At allergic urticaria the appearance of rashes is often accompanied by a rise in temperature, a decrease in blood pressure, and general weakness. Separate blisters exist for no more than 24 hours. However, against the background of the resolution of some elements, the appearance of new ones is often noted.

Quincke's edema can develop both acutely and gradually. Characterized by the formation of a dense painless edema of the subcutaneous fatty tissue. Characteristic localization - places where loose subcutaneous tissue is located: face (especially lips), oral cavity (soft palate, tongue). The color of the rash is often not changed, rarely pink. Itching, unlike urticaria, is not characteristic. In a quarter of cases, the respiratory system (larynx, trachea, bronchi) is affected. In such cases, hoarseness of voice, cough appear, there is a high risk of developing asphyxia. Possible swelling of the walls of the esophagus, stomach, intestines.

Consider the forms of urticaria and Quincke's edema.

Acute urticaria and Quincke's edema last no more than 6 weeks. More often they are observed in young people and are associated with the formation of an allergic reaction of type I (IgE-dependent). Medicines, food, insect bites have the greatest etiological significance. Such patients often have a history of other allergic diseases (atopic bronchial asthma, allergic rhinitis, etc.).

Chronic urticaria lasts over 6 weeks. The diagnosis of this type of urticaria is usually established on the basis of anamnesis of the disease and a characteristic clinical picture: itching, blistering, their sudden appearance and resolution without the development of any secondary eruptive elements are noted.

Chronic recurrent urticaria can be widespread and localized. For example, only the palms and soles may be involved in the process. According to the nature of the course, chronic urticaria is divided into recurrent (periods of exacerbations are replaced by periods of remission) and persistent (blisters appear constantly).

Combinations of chronic urticaria with Quincke's edema and pressure urticaria are often recorded. In more than half of the cases, it is not possible to determine the cause of the development of chronic urticaria. As a rule, chronic urticaria develops against the background of chronic foci of infection, diseases of the gastrointestinal tract, and helminthiases.

This type of urticaria can occur with leukemia, lymphogranulomatosis, non-Hodgkin's lymphomas as nonspecific hemoderma, act as a paraneoplastic condition. Cases of a combination of chronic urticaria with autoimmune thyroiditis, idiopathic thrombocytopenic purpura are described.

For physical urticaria characterized by the appearance of blisters on the skin as a result of exposure to various physical factors. Allocate mechanical, cold, thermal, aquatic, cholinergic, solar urticaria and urticaria from vibration. Chronic diseases of the gastrointestinal tract, foci of focal infection can act as a provoking factor in physical urticaria.

Mechanical urticaria occurs in response to a slight mechanical irritation of the skin. The mechanism of blistering is associated not only with non-specific degranulation of mast cells, but also with the release of acetylcholine. At the same time, mechanical urticaria occurs quite often in patients with chronic recurrent urticaria. Mechanical urticaria is diagnosed in individuals with acute and chronic infectious diseases (tuberculosis, hepatitis, etc.), helminthic invasion, hypovitaminosis. Feature is the absence of itching. Antihistamines are usually ineffective.

Cold urticaria accompanied by the appearance of blisters in the cold (most often, when swimming in cold water, less often - in frosty, windy weather, when drinking cold water). The development of this urticaria is associated with the formation of cryoglobulins and (or) cold hemolysins, which cause degranulation of mast cells and basophils.

The disease can be hereditarily caused or associated with other diseases (hepatitis, bacterial endocarditis, tuberculosis, syphilis, respiratory viral infections, diffuse connective tissue diseases, tumors of internal organs, etc.). The diagnosis is established on the basis of a characteristic anamnesis, as well as the results of a number of tests. The simplest test is the application of an ice cube on the patient's forearm for a period of 30 seconds to 5 minutes. This is characterized by the appearance of blisters when the skin is warmed.

Cholinergic urticaria accounts for 5% of all cases of urticaria. Provoking factors for the development of the disease are warming (high ambient temperature, taking a hot bath, hot shower, physical activity), emotional arousal, taking spicy and hot food.

Psychogenic urticaria observed with anxiety, in stressful situations. The mechanism of its development is similar to the mechanism of development of cholinergic urticaria, so many authors identify them. However, when exposed to a psychogenic factor, adrenaline and norepinephrine are released, which, in turn, change the sensitivity of receptors to acetylcholine, as a result of which a vascular reaction occurs.

Development solar urticaria associated with degranulation of mast cells against the background of photosensitivity. Blisters occur on open areas of the skin during the first insolation in the spring. By mid-to-late summer, the manifestations of the disease usually disappear. The diagnosis is established on the basis of anamnestic data and the results of a test with ultraviolet rays. As a rule, the development of solar urticaria is associated with liver pathology.

Extremely rare vibration urticaria in which blisters are formed when working with vibrating instruments, riding a motorcycle, etc. The disease can be inherited in an autosomal dominant manner.

At contact urticaria blisters appear at the site of direct skin contact with an allergen (typical for patients with an atopic background) or an irritant. In healthy people, contact urticaria can be caused by mosquito bites, bedbugs, flies, mosquitoes, bees, wasps, ants, touching jellyfish, silkworm caterpillars, contact with turpentine, primrose, etc. A blister appears at the site of contact with an irritant. In some patients, a local reaction may be accompanied by widespread urticaria, angioedema, an asthmatic attack, and even an anaphylactic reaction.

hereditary urticaria, or hereditary angioedema are inherited in an autosomal dominant manner. The disease often begins in childhood and is associated with a deficiency in the blood of neuraminoglycoprotein, which is an inhibitor of C1. As a result, the synthesis of C3a and C5a fragments of complement, which directly cause degranulation of mast cells, is enhanced.

Systemic steroids and antihistamines are ineffective in this form of urticaria. An estrogen-dependent form of hereditary angioedema can develop during pregnancy, while taking estrogen preparations (contraception, hormone replacement therapy).

Urticaria treatment

Urticaria treatment includes elimination measures and pharmacotherapy.

At acute urticaria it is possible to identify the allergen only as a result of a detailed study of the patient's history, as well as when setting vitral samples. To speed up the elimination of the allergen, diuretics are prescribed in combination with heavy drinking or the introduction of intravenous drip solutions, enterosorbents. Blockers are prescribed H1 receptors. In severe cases, the appointment of systemic glucocorticosteroids is indicated.

With Quincke's edema at the prehospital stage, the patient is administered intravenously 2 ml 2.5 % solution of prednisolone and intramuscularly 2 ml of tavegil. With the development of laryngeal edema, along with the above drugs, 0.5-10 ml of 1% is injected subcutaneously adrenaline solution.

The following shows the transition to oral antihistamines with a prolonged effect (second-generation drugs). In hereditary angioedema, an infusion of fresh frozen plasma containing C1 inhibitor. Less effective infusion e-aminocaproic acid. Androgen preparations are used as prophylactic agents.

At chronic recurrent urticaria a detailed examination of the patient is recommended in order to exclude the source of endogenous sensitization, treatment of the identified pathology, and diet. From medications prescribed antihistamines of the last generations long courses (at least several months). If there is no effect, it is possible to prescribe systemic steroids, cyclosporine A, antileukotriene drugs, carrying out plasmapheresis.

At contact urticaria it is necessary to exclude skin contact with factors that cause an urticarial reaction. External treatment indicated: apply topical steroids and antihistamines (eg, demitenden gel).

At cholinergic urticaria shown belladonna preparations, as an emergency administration of atropine(subcutaneously - 1 ml of a 0.1% solution).

At cold urticaria avoid swimming and washing in cold water. Apply antihistamines, in some cases - hemosorption, plasmapheresis. Sometimes methods of "desensitization" to low temperatures are effective: the patient is advised to first put his hand into water, the temperature of which is 15 ° C, for 5 minutes, increasing the exposure time daily. As the process subsides and adapts to cold, the area of ​​contact with cold water increases.

At heat urticaria occasionally, a technique of "desensitization" to heat, similar to that used for cold urticaria, is effective.

solar urticaria requires appointment photoprotectors, a detailed examination of the condition of the liver. It is recommended to take nicotinic acid preparations in early spring, antimalarial drugs, H2 receptor blockers.

Patients with psychogenic urticaria prescribe psychotherapeutic and psychopharmacological correction of their emotional status. Shown and antihistamines, especially the first generation, giving a sedative effect.

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, babies under 3 years old suffer, a little less often - children of preschool and early school age. Rashes with urticaria resemble a nettle burn, hence the name of the disease. The primary element of the rash is a blister, which is a local edema of the papillary dermis. Such a rash is called urticaria (from lat. urtica - nettle) and is accompanied by significant itching, leading to a deterioration in well-being, sleep disturbance. In half of the patients, urticaria occurs in isolation, in about 40% the disease is combined with angioedema (Quincke's edema), and isolated angioedema occurs only in 10-15% of patients and is a deeper edema of the skin and subcutaneous tissue, the development of which on the mucous membranes of the oral cavity and larynx can lead to asphyxia that 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, flowing for months and years. Acute forms of the disease are more common in children, and chronic forms of the disease between the ages of 20 and 40.

Causes of acute urticaria and angioedema in children, in most cases, it is possible to clearly establish. These could be the following factors:
- food products (milk, eggs, fish, nuts, legumes, citrus fruits, chocolate, strawberries, raspberries and others), and the younger the child, the more often food allergens are the cause of the disease;
- drugs (antibiotics from the groups of penicillins, cephalosporins, salicylates, non-steroidal anti-inflammatory drugs, blood products, radiopaque agents);
- insect bites (wasps, bees, spiders, fleas), jellyfish;
- infections (more often hepatitis viruses, Epstein-Barr, streptococci, helminths);
- physical factors (heat, cold, insolation, motor loads, 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, food additives, 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 of biologically active substances from the granules of mast cells, the most studied of which is histamine, which causes itching, swelling and hyperemia. In children, degranulation is most often caused by 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 the concentration of histamine occurs due to its direct release from cells when certain foods and drugs are consumed. In addition, non-immune mechanisms include the effects of physical factors that cause the development of cold, heat, contact, solar, vibration urticaria.

For clinical picture urticaria is characterized by the appearance of round or oval blisters ranging in size from a few millimeters to 10-20 cm; they can merge with each other, forming polycyclic figures. The elements of the rash rise above the surface of the skin, have a bright pink color, sometimes in the center - more pale; can appear in any part of the body, including the scalp, palms and feet, and are accompanied by itching of varying severity. The rash turns pale on pressure. Children are characterized by an acute course of urticaria with profuse rash, accompanied by significant edema and hyperemia.
Often, children also have general symptoms: an increase in body temperature up to 39 degrees Celsius, a decrease in appetite, pain in the abdomen, joints, and stool disorders. An important feature of 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 exertion, stress, sweating, hot showers, while being accompanied by systemic manifestations: hot flashes, weakness, palpitations, shortness of breath, abdominal pain.

In children angioedema happens less often. It is characterized by a sudden onset of edema of the skin and subcutaneous tissue, leading to deformation of the affected area. Quincke's edema is localized in areas of skin with sparse connective tissue prone to accumulation of tissue fluid - on the eyelids, lips, auricles, hands, feet, genitals, mucous membranes of the gastrointestinal tract. Itching with Quincke's edema is less pronounced, burning sensation and a feeling of fullness are more often disturbed. Resolution is slower - within 24-72 hours.
With angioedema, the mucous membranes of the oral cavity, tongue, pharynx, and larynx may be involved in the process with the development of impaired patency of the upper respiratory tract, threatening the life of the child. Initially, there is hoarseness of the voice, a barking cough, then difficulty in breathing appears and increases, inspiratory dyspnea (difficulty inhaling) is formed, then exhalation becomes difficult, cyanosis of the skin of the face increases, followed by a sharp pallor. In severe cases, the risk of developing asphyxia is high. When edema is formed on the mucous membranes of the stomach and intestines, the child is worried about abdominal pain, vomiting, and stool disorders.

Diagnostics urticaria and Quincke's edema is based on the characteristic clinical picture of the disease. Laboratory and instrumental examinations are prescribed to identify the causative factor. Use skin testing with food allergens, specific diagnostic provocative tests. They also search for diseases that contribute to the development of urticaria - helminthic invasions, pathologies of the endocrine and digestive systems.

Treatment of urticaria and angioedema It is carried out in three main directions: elimination of contact with the provoking factor, the appointment of drug therapy and the creation of a hypoallergenic environment to prevent recurrence of the disease.

Of the drugs, taking into account the mechanisms of the development of the disease, the most effective are antihistamines in age dosages. With common forms of urticaria and angioedema, parenteral administration is preferable, and then switching to tablet forms for a month or more. In chronic urticaria, treatment is prescribed for 3-6 months, and sometimes up to a year. With the ineffectiveness of antihistamines (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.

With a severe form of acute urticaria, ineffective outpatient treatment, angioedema of the larynx with the risk of asphyxia, swelling of the tongue, intestines and life-threatening complications, it is necessary to hospitalize the child in a hospital.
If the baby develops laryngeal edema, some measures must be taken before the ambulance arrives. First of all, you yourself 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 (in case of an insect bite, remove the sting, in case of food allergies, rinse the stomach, in case of drug allergies, stop administering the drug), ensure maximum oxygen supply, remove all squeezing objects from the neck and waist, drip vasoconstrictor drops into the nose. You can independently give the child sorbents and antihistamines in age dosages before the arrival of the doctor.

Prevention of recurrence of urticaria and angioedema
With the most common form of the disease in children - allergic - contact with provoking factors should be avoided whenever possible. However, often the exact cause cannot be identified 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 follow a 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, the child should not be allowed to meet with contact (animal dander, household chemicals, dyes, dust, latex) and inhalation (plant pollen, aerosols) allergens, one should wear spacious clothes made of natural soft tissues, avoid insect bites, taking medications, due to who previously observed the appearance of urticaria.

An important condition for the effective elimination of allergies is the treatment of foci of chronic infection, diseases of the gastrointestinal tract, including dysbacteriosis, the fight against helminthiasis, high-quality therapy for colds and other infectious diseases. Moreover, it is necessary to carry out general measures to strengthen the immunity of the baby.
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 undergo excessive physical exertion; avoid direct sunlight, use sunscreen with a high level of UV protection.