Idiopathic urticaria (autoimmune): what it is, symptoms, causes, treatment and prevention

What is idiopathic urticaria?

Hives are a type of allergy to irritants.
It has characteristic symptoms - itching and rash, which cause severe discomfort. The diagnosis of “idiopathic urticaria” is made when it is difficult to identify the original cause of such a reaction. Most diagnoses sound like this. Even if the factors that provoked the disease are obvious, this does not mean that they are a catalyst for the formation of this form of urticaria.

If this form lasts more than six months, it is often called chronic or urticaria. When there is no stimulus, urticaria does not manifest itself in any way for a long period of time. But if the slightest allergen is present or there is a malfunction in the immune system, the processes will start again. Without identifying the exact cause, it is extremely difficult to eliminate the disease.

Symptoms

The main symptomatology of the disease is a skin reaction, which manifests itself in various forms and degrees of expression. Often the main symptom of the disease is the appearance of blisters on the surface of the body, which are aggravated by itching. Such blisters have pronounced contours that rise slightly above the skin.

The size of such formations varies: from 3-5 mm to 15 cm. This rash can cover the entire surface of the body, changing its location only in exceptional cases. Idiopathic urticaria is also characterized by relapses.

The symptoms are not life-threatening, but if blisters and itching all over the body are present, a decrease in the quality of life is observed. Patients complain of poor sleep, mood swings, and disruption of daily activities.

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Blisters or plaques have a pink tint and appear spontaneously on the skin. They appear on the skin, tongue, ears and throat. The duration of autoimmune urticaria reaches approximately 2 months.

The main symptoms of the disease are the following:

burning of the skin;
angioedema ;
increased temperature ;
anaphylactic reaction.

When anaphylactic reactions of urticaria occur in the throat, this leads to the appearance of suffocation or Quincke's edema.

Asphyxia can be found in approximately 35% of all those suffering from idiopathic urticaria. It is observed much more often in women. In males, autoimmune manifestations are found much less frequently.

In addition to the main symptoms of the disease, patients complain of the following signs:

general lethargy of the body;
the occurrence of nausea and gag reflex;
headache dizziness ;
neurotic disorders;
diarrhea.

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It should be noted that the idiopathic form of urticaria has both an acute form with characteristic symptoms and a chronic form.

The latter is characterized by mildly expressed above-mentioned symptoms, and its duration lasts up to 6 months. When it is possible to identify the exact root causes of the formation of the disease, the likelihood of complete healing increases.

Autoimmune

Skin damage can be isolated - that is, apart from blisters, no symptoms bother you. There are also combined flow options. This means the presence of manifestations of autoimmune pathologies - in particular, disorders of the thyroid gland (thyroiditis). In addition, patients often have an active Helicobacter pylori infection.

Autoimmune urticaria is manifested by the following symptoms:

The blisters are pink in color, sometimes porcelain with a “border” around the edges.
Intense itching of the skin.
Swelling, redness.

The rash can affect a large area of skin.

Main symptoms

As a rule, the external manifestations of autoimmune urticaria appear quite clearly. First, small watery blisters appear on the skin. Their occurrence is accompanied by severe itching. Secondly, if the physical irritant continues to affect the affected area of the body, the rash may form red tumors that have clear edges. Also, in addition to itching, a tingling sensation sometimes appears. Thirdly, destruction of the epidermis can reach such a stage when cracks form at the site of the swelling, which subsequently begin to bleed. Such symptoms indicate an advanced stage of chronic allergies.

Medical research by scientists has shown that urticaria develops due to the activation in the blood of substances that form a chronic infection. The factors described above (cold, poor diet, stress, etc.) can only aggravate the situation and give impetus to the development of an allergic reaction.

So, chronic urticaria in most cases develops against the background of a persistent infectious disease in the body. In children, such symptoms may indicate a diagnosis of helminthiasis.

Diagnosis of the disease

It is very difficult to diagnose this disease during remission. Due to mild symptoms, it is quite difficult to determine the presence of an allergy. Therefore, you should consult a doctor during the period of exacerbation of the rash.

However, it is possible to identify urticaria if there is detailed information about the strength of the reaction, irritants and duration of the allergy.

The most important thing in medical therapy is the choice of treatment method. If the doctor correctly identifies the factor causing urticaria, a big step will be taken on the path to recovery. To do this, the patient must undergo a series of tests and diagnostics.

Diet food

The diet initially involves excluding highly allergenic foods from the menu. Maintaining such a diet with idiopathic urticaria is quite difficult. The difficulty is that the allergen itself that provokes hypersensitivity has not been identified.

And the consumption of which specific products should be limited must be clarified together with a specialist. The body should not be allowed to feel a lack of various nutrients, so the doctor will recommend products that replace hypoallergenic eggs, nuts, honey, etc.

It would be optimal to keep a food diary, where all meals and drinks consumed throughout the day will be noted. Over time, the diary will provide an opportunity to clarify the factors causing idiopathic urticaria.

Idiopathic form

This variant of urticaria regularly becomes the reason for numerous discussions between practitioners and researchers. Statistics show that on average, from 30 to 55% of cases of idiopathic urticaria belong to the autoimmune type of pathology. For other episodes of recurring skin rashes, the cause may remain unclear for years.

Chronic recurrent urticaria is characterized by symptoms such as:

the appearance of a rash in the form of pink blisters;
severe itching of the skin;
redness, swelling, discomfort.

What are the features of this form of urticaria in adults and children? Firstly, blisters can be observed from 8 to 12 hours - this is a fairly long period compared to the “flying” rash due to allergies or physical urticaria caused by cold, heat, pressure, vibration. In addition, the itching intensifies at night, and the area of skin damage is extensive, with the presence of numerous itchy elements.

general information

Each of us knows about an allergy called urticaria. However, it compiles a numerous list of diseases that have red rashes on the skin accompanied by itching as the main symptom. The affected area of the body can be very different: from a few centimeters to large areas and affect different parts of the human body.

Urticaria (the scientific name for urticaria) can occur in an acute form. Then the coverage area is quite large, and there is also unbearable itching and other side symptoms, which we will discuss later. The acute form lasts no more than 10–15 days. Medicine also knows chronic allergies, which can bother the patient from several weeks to three to five years! Sometimes a remission may occur, when all the symptoms seem to disappear, but when irritating factors appear, the disease may return again.

Based on the nature of the redness, doctors divide recurrent urticaria (when there is a constant change of outbreaks and relapses) and peristing (when a rash is constantly present on the skin, a new one replaces the old one).

Therapeutic and preventive methods

Treatment of chronic urticaria can take a long time – up to six months. The doctor’s task is to draw up a plan of treatment procedures, based on the results of observations in the specific case of each patient.

Stages of treatment of chronic urticaria:

The cause of the rash is determined and eliminated
In the presence of severe swelling, symptoms are relieved
The treatment method is selected individually to prevent the return of allergies
A recommended list of measures for the prevention of urticaria is compiled. This may include the use of medicated ointments, diet, and avoidance of physical irritants.

Treatment for autoimmune urticaria:

This disease is often difficult to treat due to resistance to conventional treatment regimens. The main treatment is aimed at modifying the patient's lifestyle. Here are some recommendations from doctors to prevent the progression of the disease:

Changing your lifestyle to a healthier one, avoiding increased physical or mental stress, getting a good night's sleep.
Balanced diet. It must include white meat (chicken, turkey, rabbit), fermented milk products, vegetables and fruits, and grains. Limit the consumption of foods such as coffee, sweets, fast food, and processed foods.
A mandatory component of treatment is giving up bad habits.
The initial drug for all categories of patients is a second-generation H-2 histamine blocker. This line of medications has no significant side effects, and their effectiveness and safety have been proven by a series of studies. But it is not always possible to obtain a full response from the body to this therapy.
The second line of treatment includes leukotriene receptor antagonists, glucocorticosteroid hormones, and cytostatics. These drugs are used when the disease is clearly resistant to first-line drugs.
Plasmapheresis, herbal medicine, and local medications are used as adjuncts to reduce symptoms.

For complications, short courses of corticosteroids in high doses, so-called bolus or pulse therapy, can be used. Prescribed 30 mg per day for 5 days. Most often, after such therapy, patients manage to achieve a state of remission.

The general treatment regimen, according to the recommendations of the European Academy of Allergology and Clinical Immunology:

at the patient’s first visit, prescribe second-generation antihistamines in age-specific doses,
if symptoms persist for two weeks or more, increase the daily dose of the drug (maximum 4 times),
if the symptoms persist, add a leukotriene antagonist or cytostatic to the treatment,
in case of exacerbation of pathology, a short course of steroid hormones can be administered.

The use of folk remedies can help reduce the severity of urticaria symptoms. But we must remember that herbal medicine cannot be the only cure for idiopathic urticaria; it is used in combination with medications.

For itching, it is recommended to use dill and clover as lotions. A decoction of nettle flowers helps cleanse the blood of toxins and allergen components. Ledum is used as a bath remedy to help heal scratches and inflammation.

Chronic urticaria as a manifestation of autoimmune syndrome

For many years, chronic urticaria (CU) has remained a pressing problem in clinical allergology.
The social significance of the pathology is due to its prevalence, long-term and persistent course, leading to a decrease in the quality of life of patients. According to epidemiological studies conducted in the USA, urticaria is observed at least once during life in 15-25% of the population, in 25% of cases it takes chronic.

Epidemiological studies conducted in different countries have shown that the prevalence of CU in the general population is 0.1–3%. Thus, population studies conducted in Germany indicate that CU affects about 1.3% of the population, and the allergic form of CU occurs in less than 5% of patients.

Most of the chronic disease is idiopathic, the etiology and pathogenesis of which have not been sufficiently studied. Considering the polyetiological nature of HC, it is necessary to conduct a large volume of examinations aimed at finding the cause of the manifestation and maintenance of this disease.

There are exogenous (physical - temperature, mechanical; chemical - drugs, food products) and endogenous (pathological processes in internal organs - cholecystitis, gastritis, pancreatitis, etc.) etiological factors.

Many authors believe that infectious agents (mainly bacterial) play a leading role, with the source of bacterial sensitization most often being inflammatory foci in the digestive tract and hepatobiliary system, less often in the sinuses, tonsils, teeth, and genitals.

Intestinal dysbiosis as one of the important causes of urticaria is disputed, but the disappearance of urticaria symptoms after successful correction of dysbiosis speaks for itself.

Chronic inflammatory and infectious processes in the digestive organs and hepatobiliary system are considered as conditions that promote the accumulation of biologically active substances in the blood and tissues without the participation of immunopathological mechanisms, and the role of fundamental factors is assigned to such non-infectious allergens as food, medications, pollen, etc.

Endogenous factors that provoke urticaria include various somatic diseases. The high prevalence of autoimmune thyroiditis in patients with chronic thyroiditis (mainly in women) has long been known. According to American researchers, thyroid function (increased or decreased levels of T3, TSH) is impaired in 19% of patients with CU.

The level of antibodies to thyroglobulin was increased in 8% of patients with chronic chronic disease, thyroid peroxidase - 5%, and an increase in the level of both antibodies was noted in 14% of patients. In general, elevated levels of antithyroid antibodies occur in 27% of patients with CU.

There is every reason to regard HC as an autoimmune process, since we are talking about urticaria in systemic lupus erythematosus, gout, skin lymphomas, polycythemia, macroglobulinemia, and tumors of various locations.

If, upon careful examination of a patient with urticaria, no clinically significant pathological changes are detected, then the urticaria is considered idiopathic, and then traditional therapy is often unsuccessful.

It was in patients with chronic idiopathic urticaria (CIU) that the autoimmune genesis of the disease was identified, which is based on the activation of skin mast cells by autoantibodies of the IgG class (anti-IgE autoantibodies and antibodies to the alpha chain of the high-affinity IgE receptor (FcεR1). Allergic and autoimmune diseases many researchers classify diseases as one group: allergic - caused by the peculiarities of the immune system's response to allergies, as a result of which hypersensitivity reactions develop upon repeated contact with the antigen, and autoimmune - characterized by a breakdown, loss of tolerance to one's own antigens... At first glance, there is nothing between these reactions common, but in fact they are often parts of a pathological process leading to the development of an autoimmune syndrome.

Since allergic reactions are characterized by damage to the tissues of those organs through which the allergen penetrates, it is quite natural that they may be accompanied by the development of autoimmune reactions.

The formation of IgG autoantibodies against receptors for the high-affinity Fc fragment of IgE present on mast cells has been described. The binding of IgG autoantibodies to these receptors leads to degranulation of tissue basophils and maintenance of the chronic autoimmune process.

In the future, immune complexes can be deposited in the vessels, and vasculitis very often develops.

Shifts in the immunoregulatory link during allergic and autoimmune reactions are also similar: inhibition of CD8, increased activity of CD4, increase in the immunoregulatory index, which contributes to polyclonal activation of B cells, production of pathogenic autoantibodies and the development of autoimmune processes that complicate the course of allergic diseases.

The similarity of allergic and autoimmune processes is also evidenced by reactions to medications, since autoimmune diseases also develop as a result of systemic reactions to medications.

All this prompted us to search for a simple, accessible and sufficiently informative screening method to identify signs of autoimmune reactions in patients with persistent chronic chronic disease and generalized skin drug reactions.

As such a universal organ-nonspecific feature, we chose the content of antibodies to DNA - native, thermally denatured, formalinized [4, 6] using the enzyme-linked immunosorbent assay (ELISA). The content of total IgE in blood serum was also studied by ELISA, as well as IL-6 and TNF.

57 patients were examined: 25 with chronic chronic disease (group 1), 22 with drug-induced skin reactions (group 2), 10 patients had fever of unknown origin (group 3). Among those examined, women predominated (1:3); the average age of patients was 43.7±3.6 years.

Patients were asked to fill out the questionnaire presented below.

Questionnaire for a patient with acute and chronic recurrent urticaria and angioedema 1. Time of onset of symptoms (year(s), months, weeks, days).2. Frequency and duration of symptoms.3. Circadian rhythms of symptoms (night time, evening time, morning hours, etc.).4. Shape, size and distribution of rashes.

(If at the time of consultation you do not have rashes, you can photograph their elements with a digital camera, such as a mobile phone.)5. Presence of Quincke's edema.6. Subjective sensations from the rash: pain, itching.7. Family history of allergic diseases, urticaria in blood relatives.8.

Presence of drug, food, seasonal allergies, foci of chronic infection, chronic diseases of internal organs (digestive tract, endocrine and gynecological diseases), etc.9. Influence of physical factors or physical activity.10.

Use of NSAIDs, hormonal drugs, laxatives, rectal suppositories, ear and eye drops, injections, vaccinations, etc.11. Influence of food products.12. Smoking.13. Nature of work, presence of occupational hazards.14. Your hobby.15. Changes in symptoms on weekends, vacations and foreign trips.16.

Presence of surgical implants.17. History of reactions to stings.18. Impact of the menstrual cycle.19. Efficacy of antiallergic drugs.20. Impact of stress.

21. Impact of urticaria on quality of life.

In group 1, the reasons for the development of HC could not be established; In 13 patients, foci of chronic infection were identified (chronic tonsillitis, chronic sinusitis, caries).

The duration of the disease ranged from 1.5 to 12 years, with an average of 6.6±0.4 years.

Exacerbations were observed 2–3 times a year, the rash persisted for 10–15 days, in some cases up to 30 days, and was accompanied by a burning sensation and moderate itching; angioedema developed in 11 patients.

In group 2 (22 patients), skin rashes appeared during treatment with penicillin antibiotics (augmentin, amoxiclav, ospamox) - in 9 patients, during treatment with cephalosporins - in 3, during treatment with nitrofurans - in 4.

Taking B vitamins caused allergic dermatitis in 6 patients. Erythema multiforme was diagnosed in 5 patients, erythroderma in 3, maculopapular exanthema in 11, and exfoliative dermatitis in 2. Four patients had a fixed drug rash.

Cross-allergic reactions (ampicillin and cephalosporins) were detected in 4 subjects.

The 3rd group included 10 patients who were sent to the allergy department of the OKB to clarify the cause of the fever. In all patients, body temperature increased in the evening to 38–39 °C, and was not accompanied by chills or sweating; the patients' condition remained satisfactory.

Patients of all three groups were subjected to a thorough clinical examination, including FGDS, ultrasound of the abdominal organs, thyroid gland, heart, liver and kidney function tests, determination of T3, T4, TSH levels, consultations with a dermatologist, endocrinologist, gastroenterologist, gynecologist, urologist, etc. d.

In patients of group 3 (fever of unknown origin), no signs of pathology of internal organs were identified.

In groups 1 and 2, autoimmune thyroiditis (30 and 12.5%, respectively), chronic gastritis (65.3 and 42.3%, respectively), chronic persistent hepatitis (31.5 and 26.8%, respectively) were diagnosed. .

Arthralgia was noted in 65% of patients in group 1 and 40% in group 2; myalgia – in 45% of group 1 and 38% of group 2; low-grade fever – in 43% of group 1 and 31% of group 2; normochromic anemia – in 10% of the 1st group and 9.3% of the 2nd group (Fig. 1).

In 89% of patients with CC, 66% with drug-induced skin reactions and 6 out of 8 patients with fever of unknown origin, an increase in the titer of antibodies to native and thermodenatured DNA was found, significant compared with the control group (p

Source: //beauty.net.ru/public/khronicheskaya_krapivnitsa_kak_proyavlenie_autoimmunnogo_sindroma_/

Methods of therapy for autoimmune urticaria

The difficulty in treating urticaria, which occurs against the background of autoimmune diseases, lies in the weak therapeutic effect of the use of antihistamines. Therefore, if their use at the first stage does not bring the desired result, then it is recommended to use hormonal medications, such as Prednisolone, Dexamethasone.

Due to the fact that drugs containing glucocorticosteroids have many contraindications and side effects, they should be taken only as prescribed by a doctor, without exceeding the dosage and frequency of administration.

In addition, in severe cases of autoimmune urticaria, the following treatments are used:

plasmapheresis – blood sampling to purify it of toxic components and subsequent return;

intravenous administration of immunoglobulin to create “passive” immunity;
oral administration of Cyclosporine, a powerful immunosuppressant that can quickly eliminate the symptoms of urticaria.

Traditional methods of treatment will help speed up recovery: baths with nettle, string and chamomile, compresses made from raw potatoes, applications with oatmeal. In order not to cause a “reverse effect” and not to aggravate the patient’s condition, the use of home remedies must be coordinated with the attending physician.

What is thyroid aitis, signs and treatment methods

The thyroid gland is one of the most susceptible organs to aggressive environmental influences. In addition, the internal processes of the body sometimes have a less favorable effect on the thyroid gland. In this regard, diseases of the thyroid gland often occur, which can pose a direct threat to human life. These diseases include AIT of the thyroid gland (autoimmune thyroiditis).

AIT

AIT is a fairly common pathology. It most often occurs:

in women 45-60 years old - this is explained by the harmful effects of estrogens on the cells of the lymphoid system and X-chromosomal abnormalities;
Cases of detection of pathology in pregnant women are much less common;
after artificial termination of pregnancy and natural childbirth;
in women during menopause;
in adolescence.

In cases where the damage to the gland is not too large, the disease can be asymptomatic for a long time. If the body gives a powerful immune response, then the destruction of the follicles begins and everything becomes obvious. The organ is rapidly enlarging, this is due to the sedimentation of lymphocytes at the site of damaged gland structures. Such abnormal tissue growth leads to malfunctions of the thyroid gland: hormonal disorders appear.

Causes

The occurrence and development of the disease is influenced by a number of factors, including:

frequent stay in a state of stress and general emotional overstrain;
excessive concentration of iodine in the body, or, conversely, deficiency of this element;
the presence of any diseases of the endocrine system;
unauthorized and incorrect use of antiviral medications;
the harmful effects of an unfavorable environment;
lack of proper nutrition;
exposure to radiation;
severe infectious or viral diseases;
hereditary predisposition. This factor has an effect in 25-30% of all cases.

Classification

Chronic AIT – the occurrence of this form is influenced by heredity. The development of this form of the disease is always preceded by a decrease in hormone production - hypothyroidism.
Postpartum autoimmune thyroiditis often occurs due to a decrease in a woman’s immunity during pregnancy and its sharp activation after childbirth. During this increased functioning of the immune system, antibodies may be produced in excess. Because of this, destruction of organ cells will occur. A woman who has poor heredity in this regard needs to be especially careful after childbirth.
Cytokine-induced AIT develops as a result of taking medications based on interferon, as well as drugs used in the treatment of hepatitis C and diseases of the hematopoietic system.
Painless autoimmune thyroiditis still has no identified cause.

In addition to the main classification, this disease has forms:

The hypertrophic form of thyroiditis is characterized by a significant increase in the size of the thyroid gland. The clinical picture has a certain similarity with the symptoms of hyperthyroidism.
The atrophic form is a decrease in the synthesis of thyroid hormones. The size of the gland in this case will not correspond to the norm - it gradually decreases.

However, despite the form, severity and nature of thyroiditis, the thyroid gland continues to perform its functions. Her work can be classified as follows:

Hypothyroid type of work, when the production of hormones in the body is significantly reduced.
The euthyroid type is characterized by a stable hormonal background.
Hyperthyroid - this type is characterized by increased production of hormones.

Symptoms

It is easier to determine AIT after the thyrotoxic phase, which can last from three months to six months. Therefore, towards the end of this period, the patient feels the following changes:

a sustained increase in body temperature not exceeding 37.5 degrees. A higher increase indicates rapid development of the disease;
frequent mood swings;
excessively strong heart contractions;
trembling in the body;
heavy sweating;
joint pain and insomnia - the consequence of these manifestations is general weakness.

As autoimmune thyroiditis progresses, the symptoms worsen and become even more pronounced:

severe swelling of the face, yellowness of the skin;
clouding of consciousness, poor concentration, periodic or constant depression, inhibition of reactions, facial disturbances;
dryness and flaking of the skin, deterioration in the quality of nails and hair;
deterioration or complete loss of appetite;
increase in body weight - either a sharp jump or a gradual stable increase;
painful menstruation, decreased libido, infertility. Many patients are concerned about the question of whether it is possible to get pregnant with autoimmune thyroiditis. If the disease has gone too far and infertility has developed, conception becomes impossible;
decreased heart rate, risk of developing heart failure;
decreased body temperature, chills;
hoarseness of voice, hearing disorders;
an increase or decrease in the size of the thyroid gland;
discomfort in the neck, especially during night sleep.

Diagnostics

He will collect the patient’s family history, conduct a visual examination with palpation of the thyroid gland, prescribe additional research methods and indicate which tests to take. There are certain criteria that the doctor focuses on when making a diagnosis:

An increase in the size of the thyroid gland by more than 18 mm and 25 mm in women and men, respectively.
The appearance of antibodies and their high titer to thyroid hormones.
The level of hormones T3 and T4 is outside the normal range (both below and above the normal range).

What tests to take if you suspect a disease?

Diagnostic measures to identify AIT include:

A complete blood count is performed to determine the level of lymphocytes.
Immunogram - to detect the presence of antibodies to thyroid hormones.
Blood test for T3, T4, TSH. Based on their concentration and ratio, the doctor determines the degree and stage of the disease.
Ultrasound examination of the thyroid gland is one of the most important diagnostic methods; it can be used to determine the size of the organ and how far the changes in its structure have progressed.
A fine-needle biopsy can accurately determine the presence of lymphocytes. As a rule, this study is indicated in cases of suspected degeneration of benign nodular formations into malignant ones. The most dangerous thing is when tumors form in the tissues.
Scintigraphy is a highly informative method that allows you to obtain two-dimensional images of the affected organ by introducing radioactive isotopes into the body.

Based on the totality of data, the doctor will determine the echo structure of the gland, its shape and size, the ratio of the lobes of the thyroid gland and the shape of its isthmus.

Treatment

The main advantages of such drugs are that they have no contraindications even during pregnancy, breastfeeding, have no side effects and do not contribute to weight gain.

These medications cannot be taken in combination with other medications; they are always taken exclusively on an empty stomach 30 minutes before meals and washed down with plenty of water. All other medications can be taken no earlier than 4 hours after taking levothyroxine.

The best drugs in this group are Eutirox and L-thyroxine. Despite existing analogues, these two drugs are the best option. Their effect will be the longest. Switching to analogues will require consultation with a doctor to adjust the dosage and undergo blood tests every 2-3 months for TSH levels.

Nutrition for AIT

Proper nutrition for autoimmune thyroiditis is the key to a quick and successful recovery. The menu for the week should be compiled in such a way that it necessarily includes:

a sufficient amount of fermented milk products, this is very important for normalizing intestinal function;
Coconut oil;
a large number of fresh vegetables and fruits;
lean meat and broths made from it;
any fish, seafood, seaweed;
sprouted grains.

All of the above products have a positive effect on both the thyroid gland itself and the functioning of the immune system as a whole.

If there is an excess of iodine in the body, foods with a high iodine content are excluded from the diet.

Definition of urticaria

Urticaria or urticaria (from the Latin word “urtica” - blister) is an allergic disease with which about 20% of the world's population is familiar. Most often women from 20 to 45 years old, as well as young children, are affected.

Direct contact with the following irritants can provoke the appearance of papular rashes on the skin, accompanied by severe itching and burning:

plant pollen;
food products;
household chemicals;
clothing made of synthetic materials;
pet hair and excretions;
insect bites;
household dust;
medications.

In some cases, chronic diseases of the gastrointestinal tract, endocrine or central nervous system can cause symptoms of urticaria. If urticaria appears against the background of diseases such as systemic lupus, rheumatoid arthritis and others, then doctors talk about autoimmune urticaria.

Causes

Idiopathic urticaria differs from allergic urticaria in that it is impossible to establish the true causes of the disease. The chronic form can be an independent disease or a manifestation of other symptoms. An allergen is only a catalyst that provokes a rash.

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Such manifestations are the body’s reaction to the following diseases:

kidney diseases;
diabetes;
disorders ;
viral diseases;
arthritis;
lupus erythematosus;
oncological processes;
immune pathologies;
diseases of the gastrointestinal tract.

Allergens that provoke exacerbation of urticaria include:

Food . Fish, eggs, nuts, beans, citrus fruits, tomatoes, smoked meats, chocolate products, alcoholic beverages. In patients with food sensitization, food that has cross properties with pollen.
Medications . Antibiotics, opiates, vitamins containing iodine.
Bacteria. Helminths, etc.
Poison and bites . Bees, mosquitoes, mosquitoes.
Physical reasons. Temperature, pressure, vibration, voltage.
Mental. Stressful situations.
Various diseases. Diseases of the thyroid gland and digestion, infectious lesions.

Moreover, the idiopathic form of urticaria is often found in patients with alcohol poisoning or drug intoxication, during impaired metabolic processes and various types of infectious lesions. Situations of the appearance of rashes that are associated with diseases of the gums and teeth are also observed.

Doctors believe that this form of the disease can cause leukemia, myeloma and lymphoma. The initial symptoms of urticaria indicate that the body is producing antibodies that tend to destroy its own immune system.

This should immediately cause caution in patients in the process of developing rashes on the surface of the skin and contact a specialist. Timely therapy significantly reduces the likelihood of adverse consequences.

First aid for hives

When the first signs of urticaria appear: redness of the skin, swelling, blisters, the patient should be given emergency assistance as quickly as possible. It is as follows:

give an antihistamine: Suprastin, Tavegil, Diazolin, Cetrin, Zyrtec, Claritin;
apply Psilo-balm, Fenistil-gel, zinc ointment to the areas where the rash appears;
apply a soda compress to the affected areas (1 tablespoon of baking soda per 100 ml of water);
To stop intoxication of the body, give enterosorbent: activated carbon, Sorbex, Enterosgel.

If necessary, perform gastric lavage or enema. If clinical manifestations do not disappear, but worsen, it is necessary to immediately call an ambulance and hospitalize the patient in the intensive care unit.

Symptoms of autoimmune urticaria

The manifestations of idiopathic urticaria are no different from the chronic course of its allergic variant. Patients complain of urticarial skin rashes and note their tendency to merge. Food, insect, household, chemical, physical or psychogenic factors can provoke a deterioration of the condition or a new relapse of the disease.

Patients with severe urticaria are characterized by resistance to traditional treatment regimens, torpidity and variability of symptoms. During exacerbations, general weakness, decreased tolerance to physical activity, and digestive tract dysfunction may be observed.

Systemic signs

These are manifestations of a general nature, reflecting the involvement of various functional systems of the body in an unfavorable process. They accompany the onset of a rash - they usually manifest and disappear simultaneously with itchy blisters. Symptoms of urticaria in adults with idiopathic, including autoimmune forms include the following:

general weakness;
headache;
chills;
fever;
nausea;
vomit;
abdominal cramps;
joint pain;
diarrhea.

It is not always possible to observe all the signs at once. In most cases, weakness in combination with fever dominates. Digestive disorders are more typical for the allergic form of urticaria.

Stages of rash development

As mentioned earlier, a successful treatment result depends on the correct determination of the factors for the development of urticaria and the reasons for its appearance.

Let's look at the basic order in which the rash appears:

The inflammatory process most often originates in the gastrointestinal tract, less often in the teeth, nasopharynx and reproductive system. This focus of inflammation serves as the progenitor of biologically active microorganisms that increase the body’s sensitivity to various external factors and released neuroactive substances.
When an irritating element (medicines, sun rays, etc.) begins to actively affect a person, histamine is released by mast cells in the connective tissue, causing a rash to appear on the skin.

It has been proven that in some cases, dyes or preservatives in food products can be such an irritating factor. Therefore, the first point in a doctor’s recommendations for patients with chronic urticaria is the exclusion of unnatural products.

Also at risk are such delicacies as citrus, raspberries, strawberries, cocoa and chocolate-based desserts.

Among the drugs that cause urticaria are nefediline, non-steroidal anti-inflammatory drugs and a wide range of antibiotics. Non-steroids are the most aggressive of all, as they themselves increase the risk of allergies, and can also lead to bronchospasm.

In addition to the rash, an allergy sufferer may experience fatigue, headaches, a slight fever, as well as nausea and poor sleep.

The appearance of autoimmune urticaria can be triggered by disruptions in the body's immune responses. The course of the disease is of an allergic or pseudo-allergic type.

The allergic type is characterized by the destruction of skin tissue under the influence of mast cells, which is formed by the body through the production of antibodies. The more intense the impact of the irritating factor, the more pronounced the tissue swelling. After the rash disappears, it is necessary to touch the skin again in order to understand whether there are still antibodies in the body. If the reaction recurs, treatment must be continued;
The pseudoallergic form is distinguished by the fact that the irritating factor acts directly on the cell membrane, destroying its previous form and releasing histamine. It is important that this does not affect the severity of the disease.

Three-step system for diagnosing autoimmune urticaria

The stage of clarifying the anamnesis, collecting information to fill out a medical history and collecting primary samples.
These include: screening for the presence of congenital atopy (in other words, hereditary allergies to wool, plants, dust, etc. ); test for the presence of external physical factors; skin biopsy (if necessary); immunofluorescent analysis for the presence of immunoglobulins in the body.
The stage of determining the causes of allergy activation, as well as determining the type: chronic or isolated;
Food trial stage.
The purpose of this stage is to exclude an allergic reaction to the components included in the products. For such purposes, a two-stage diet is used.

It should be noted that sometimes the doctor fails to identify the causes of irritation. In such cases, it is referred to as idiopathic urticaria.

Diagnostics

It is necessary to contact a general practitioner , who will give you a referral to a dermatologist or allergist.

The specialist will prescribe the following tests :

General blood test (extended profile).
Clinical blood test (from a finger).
Blood test for syphilis, HIV, hepatitis B and C.
General urine analysis.
Test for thyroid hormones.
Antinuclear antibody test (to diagnose systemic lupus erythematosus).

Once a diagnosis of autoimmune urticaria is made, the goal of the patient and physician is to find the best combination of medications to reduce the frequency of outbreaks.

Very often, autoimmune urticaria becomes chronic and then goes into remission, and a specialist will likely prescribe a course of treatment with antihistamines every 6 months .

Elimination of background pathologies

This is an important stage of therapy, since diseases of the digestive and endocrine systems, autoimmune syndromes can both contribute to the development of urticaria and aggravate its course. Therefore, it is necessary to identify the pathologies that the patient suffers from and select an adequate treatment regimen. How to treat hives? Different approaches are practiced:

fight against Helicobacter pylori infection (De-Nol, Clarithromycin, Metronidazole, Omez);
correction of thyroid dysfunction (“L-thyroxine”);
elimination of intestinal dysbiosis syndrome (“Lacidofil”, “Hilak-forte”, “Yoghurt”).

These are just a few general examples - the treatment regimen is developed individually for each patient. Treatment may take anywhere from two to three weeks to months to complete, so results in the severity of your urticaria symptoms may not be immediately visible.

All about idiopathic and autoimmune forms of urticaria

Urticaria is one of the most well-known skin diseases. Its characteristic feature is the appearance of itchy blisters. In many cases, their occurrence is associated with allergies, but this is not the only reason.

Children and adults can suffer other forms of pathology. Thus, chronic idiopathic urticaria (CIU) or a disease caused by autoimmune processes is likely.

Let's find out why disorders develop and how to cope with symptoms.

articles

What is idiopathic urticaria?

This is a variant of the course of a skin disease in which the cause (etiology) of the development of the rash is not detected, but itchy blisters appear regularly at different intervals for 6 weeks or more. This process is considered chronic; it is also referred to as spontaneous urticaria. Another synonym is urticaria.

Constant exacerbations of the reaction (relapses) cause considerable discomfort and reduce the patient’s quality of life, but it is difficult to cope with them, since there is no “point of application” for targeted therapeutic measures.

Among urticaria that last a long time, the proportion of the idiopathic form is up to 80% of cases, which reflects the severity and scale of the problem.

The spontaneous occurrence of the rash and the inability to determine the range of specific provoking factors (triggers) of the reaction makes it difficult to prevent repeated exacerbations and control the course of the disease.

Autoimmune form

This definition refers to a special form of urticaria in which specific complexes – antibodies, or immunoglobulins (Ig) – are present in the patient’s blood.

The prefix “auto” is used to denote them. Of course, such formations are also involved in the mechanism of development of allergic reactions.

But in this case, their activity is directed not against foreign substances, but against the body’s own structures.

Autoimmune urticaria can be classified as a variant of the idiopathic form of the disease.

This is not considered an error - a combined definition can be found both in the medical literature and in publications of specialists. But there is still a difference between diseases, since the concept “autoimmune” clarifies the genesis of the disorders, and we are no longer talking about the unknown etiology of the unfavorable process.

The targets for autoantibodies are both complex complexes located on the surface of cells - IgE receptors, and class E immunoglobulins. As a result of pathological transformations, the active substance responsible for the symptoms of urticaria - histamine - is released.

Causes

Chronic urticaria is characterized by a recurrent course - with vivid manifestations and periods of remission, that is, subsidence of symptoms; it unites all variants of diseases with an itchy rash, the presence of constant exacerbations in which lasts longer than 6 weeks. But why do they develop?

We can name such probable causes of chronic urticaria as:

Infections (viral, bacterial, fungal).
Endocrine pathologies (hyperthyroidism, diabetes mellitus, ovarian dysfunction).
Diseases of the digestive system (including those accompanied by intestinal dysbiosis syndrome).
Massive medication intake, serum sickness.
Autoimmune pathologies (systemic lupus erythematosus, scleroderma).
Neoplasms.
Consumption of dyes, preservatives, and flavorings in food.

The cause of autoimmune urticaria, in addition to the factors listed above, is the presence of a genetic predisposition that creates the preconditions for the formation of damaging antibodies.

Symptoms

The reaction manifests itself acutely, but signs of skin damage persist for quite a long time (sometimes more than 10-12 hours) and can recur regularly over months and years. There have been cases of patients suffering from urticaria for years, the cause of which cannot be determined.

Idiopathic form

//www.youtube.com/watch?v=lWNJ41FVDCY

Chronic recurrent urticaria is characterized by symptoms such as:

the appearance of a rash in the form of pink blisters;
severe itching of the skin;
redness, swelling, discomfort.

Autoimmune

Autoimmune urticaria is manifested by the following symptoms:

The blisters are pink in color, sometimes porcelain with a “border” around the edges.
Intense itching of the skin.
Swelling, redness.

The rash can affect a large area of skin.

Systemic signs

general weakness;
headache;
chills;
fever;
nausea;
vomit;
abdominal cramps;
joint pain;
diarrhea.

It is not always possible to observe all the signs at once. In most cases, weakness in combination with fever dominates. Digestive disorders are more typical for the allergic form of urticaria.

Diagnostics

It consists of several stages:

Interview and examination of the patient.
Use of laboratory and instrumental methods.
Carrying out skin tests.

If a patient is suspected of having chronic urticaria, every effort should be made to find the true cause of the rash. For this purpose, various studies are used:

blood test to detect markers of sensitivity to allergens - food, dust mites, medications, chemicals, animal hair;
determination of hemoglobin, red blood cells, biochemical parameters, leukocyte count;
culture of discharge from chronic foci of inflammation to identify pathogens;
skin tests with potential allergens;
fecal analysis for helminth eggs;
search for markers of intestinal dysbiosis;
thyroid function test;
search for autoantibodies;
detection of Helicobacter pylori infection.

If a diagnosis of “autoimmune urticaria” is brought up for discussion, the examination program must include, in addition to the laboratory methods already described in the list, a provocative test with the patient’s own blood serum.

To carry it out, biological material is collected from a vein, it is processed properly, and the prepared liquid medium is injected through an intradermal injection into the area of the inner surface of the forearm.

The result is assessed after 30 minutes: the presence of a blister, redness and itching means a positive reaction.

48 hours before the test, you should stop taking antihistamines.

These medications may affect the quality of diagnostic results.

Treatment

Patients are supervised by a therapist; if necessary, highly specialized doctors are involved: endocrinologist, immunologist, rheumatologist, infectious disease specialist.

Treatment of chronic urticaria is carried out on an outpatient or inpatient basis: in the first case, it is a mild episode, the person continues normal life and, when required, visits the clinic; in the second, in case of severe symptoms, he is hospitalized in a hospital department.

It is difficult to cure urticaria of idiopathic origin, since the cause of its development must first be established - but it is possible to transfer the patient to a state of stable remission (no symptoms).

Elimination

This is the cessation of contact with factors that trigger the sensitivity reaction and cause the appearance of an itchy rash. To identify them, laboratory and instrumental diagnostic resources are used. Until triggers are identified, elimination treatment for idiopathic urticaria includes:

Caution in the use of pharmacological drugs (in particular, avoiding self-medication with antibiotics).
Correction of the diet - exclusion from the menu of dangerous additives (dyes, preservatives) and foods with a high allergen-provoking potential: citrus fruits, mushrooms, nuts.
Regular wet dust cleaning.
Avoiding contact with harsh chemicals (including for household purposes).

Elimination measures are the basis of therapy for any form of urticaria and are observed constantly, even without an exacerbation of the reaction.

Elimination of background pathologies

fight against Helicobacter pylori infection (De-Nol, Clarithromycin, Metronidazole, Omez);
correction of thyroid dysfunction (“L-thyroxine”);
elimination of intestinal dysbiosis syndrome (“Lacidofil”, “Hilak-forte”, “Yoghurt”).

Drug therapy

Recommended to improve the condition during exacerbation of skin sensitivity reactions. Treatment for idiopathic urticaria can be carried out using different drugs:

Antihistamines (Cetrin, Zirtec, Alerdez, Trexil Neo).
Glucocorticosteroids (“Prednisolone”, “Dexamethasone”).
Leukotriene receptor antagonists (Montelukast, Singulair).

Treatment of autoimmune urticaria requires the mandatory use of glucocorticosteroids. If in other forms of urticaria these drugs are used, as a rule, only occasionally for emergency care, in this case they represent the basis of therapy.

Their use is justified by a good clinical response and high effectiveness, while antihistamines are often ineffective.

In severe cases, additional methods are indicated: plasmapheresis, intravenous immunoglobulin and the use of cyclosporine-A.

Do not try to start taking glucocorticosteroids on your own - this can lead to weight fluctuations, stomach problems and a number of other side effects.

The prescription of medications in this group requires constant medical supervision. They have contraindications; The dose should be increased and decreased gradually, in accordance with the dynamics of the clinical picture.

Tatyana Torsunova

Sources: medscape.com, mdlinx.com, health.harvard.edu.

Papular urticaria

All about papular urticaria: causes, symptoms, treatment.

Allergic

Allergic urticaria and dysbiosis, diagnosis and symptoms.

Chronic urticaria

What is chronic urticaria, its types and methods of treatment.

Contact

What causes contact urticaria and how to get rid of it.

Source: //roddom32.ru/krapivnitsa/autoimmunnaya.html

Forms of autoimmune urticaria

Urticaria, like other dermatological diseases, can occur in acute or chronic form. The differences between them are as follows:

In acute cases, the symptoms of the disease appear suddenly and develop rapidly over a short period of time. As a rule, signs of the disease disappear after 5-7 days;

the chronic form can manifest itself over several months or even years. In some cases, symptoms of urticaria occur periodically throughout a person's life. The duration of remission depends on the presence of provoking factors and the possibility of repeated contact with the allergen.

Autoimmune urticaria, developing against the background of disturbances in the functioning of the immune system, is always chronic and is divided into the following types:

recurrent, when remissions are replaced by exacerbations;
persistent, in which the rash on the body is “renewed” and is constantly present.

Often, it is a patient’s visit to a dermatologist with complaints of urticaria that allows him to be diagnosed with an autoimmune disease. Therefore, if you notice symptoms, you must make an appointment with a doctor.

Understanding autoimmune urticaria. Why does it appear and how to treat it?

Reading time: 4 min.
The similarity of symptoms with the reaction to a nettle burn gave the name to one of the most famous dermatological diseases - urticaria. Of all the varieties of the disease, the most common is autoimmune urticaria, which is associated with disturbances in the functioning of the human immune system and a decrease in the body's defenses.

More information about the disease in the article from our expert.

Definition of urticaria

Direct contact with the following irritants can provoke the appearance of papular rashes on the skin, accompanied by severe itching and burning:

plant pollen;
food products;
household chemicals;
clothing made of synthetic materials;
pet hair and excretions;
insect bites;
household dust;
medications.

Causes of the disease

Severe nervous shock, stress, previous illnesses, radiation and other factors sometimes lead to a malfunction of the human immune system.

At the same time, lymphocytes, whose purpose is to fight pathogenic cells, begin to destroy healthy cells of the body. As a result, organs or even entire systems are affected.

Autoimmune diseases can also be hereditary and passed on from generation to generation.

Such diseases develop over many years, so their symptoms are most often “blurred” and difficult to diagnose. In most cases, autoimmune diseases become irreversible and lead to disability.

The most common autoimmune diseases are:

diabetes mellitus type I;
rheumatoid arthritis;
multiple sclerosis;
systemic lupus;
vasculitis;
Hashimoto's thyroiditis;
myasthenia gravis;
scleroderma.

In autoimmune diseases, the body produces so-called autoantibodies, which provoke “pseudo-allergy” and stimulate increased production of histamine. This leads to a change in the composition of the intercellular fluid in the subcutaneous layer, the appearance of itchy blisters and the development of autoimmune urticaria.

Forms of autoimmune urticaria

Urticaria, like other dermatological diseases, can occur in acute or chronic form. The differences between them are as follows:

In acute cases, the symptoms of the disease appear suddenly and develop rapidly over a short period of time. As a rule, signs of the disease disappear after 5-7 days;

the chronic form can manifest itself over several months or even years. In some cases, symptoms of urticaria occur periodically throughout a person's life. The duration of remission depends on the presence of provoking factors and the possibility of repeated contact with the allergen.

Autoimmune urticaria, developing against the background of disturbances in the functioning of the immune system, is always chronic and is divided into the following types:

recurrent, when remissions are replaced by exacerbations;
persistent, in which the rash on the body is “renewed” and is constantly present.

Symptoms of autoimmune urticaria

Autoimmune urticaria is characterized by all the signs of a chronic form of the disease. These include:

voluminous, bright pink blisters that rise above the surface of the body, which can increase in size and merge into large formations;

severe debilitating itching, as a result of which scratches and wounds appear on the skin;
pain on palpation;
burning sensation when the skin seems to be “burning”;
increased body temperature;
chills;
general malaise;
indigestion;
weakness;
headache.

In addition, the sick person experiences an increase in the symptoms of the underlying autoimmune disease that provoked the urticaria: joint pain with rheumatoid arthritis, muscle weakness with myasthenia gravis, heart pain and shortness of breath with systemic lupus, etc.

Urticaria, which occurs against the background of autoimmune diseases, often leads to Quincke's edema, which poses a threat not only to health, but also to human life.

Diagnostics

If a rash and other unpleasant symptoms appear, you must make an appointment with a dermatologist or allergist, who are seen in specialized medical centers or a dermatovenerological dispensary.

Diagnostic measures for urticaria include the following:

compiling an anamnesis based on a patient interview, the main purpose of which is to identify the causes that provoked the disease;
visual inspection of lesions;
performing allergy tests to determine a possible irritant.

To identify concomitant pathologies, the patient is given directions for the following laboratory tests:

general and biochemical blood test;
general urine analysis;
fecal analysis for the presence of helminths;
analysis of thyroid hormones (TSH, T3 and T4);
immunofluorescent microsporia to detect systemic lupus;
blood test for HIV.

Special testing with intradermal administration of autologous serum helps differentiate autoimmune urticaria from other forms. In order not to “smooth out” the clinical picture, the patient should stop taking antihistamines three days before the study.

If the diagnosis of autoimmune urticaria is confirmed, the patient is referred for additional consultations with an immunologist, cardiologist, endocrinologist, rheumatologist, hematologist and other specialists.

Treatment of autoimmune urticaria

As in the treatment of any allergic disease, the effectiveness of therapy for autoimmune urticaria depends on stopping a person’s contact with any irritants. To do this, the patient is recommended:

follow a special hypoallergenic diet;
wear clothes made from natural materials;
no smoking;
remove carpets, soft toys and other objects that accumulate dust from the room;
When washing dishes, cleaning and other work involving the use of chemicals, use protective gloves;
limit communication with pets.

It is also necessary to constantly ventilate the room, spend more time in the fresh air and engage in feasible physical exercise.

Drug therapy for urticaria includes first aid methods for a sudden attack and measures to get rid of the symptoms of the disease.

First aid for hives

When the first signs of urticaria appear: redness of the skin, swelling, blisters, the patient should be given emergency assistance as quickly as possible. It is as follows:

give an antihistamine: Suprastin, Tavegil, Diazolin, Cetrin, Zyrtec, Claritin;
apply Psilo-balm, Fenistil-gel, zinc ointment to the areas where the rash appears;
apply a soda compress to the affected areas (1 tablespoon of baking soda per 100 ml of water);
To stop intoxication of the body, give enterosorbent: activated carbon, Sorbex, Enterosgel.

Methods of therapy for autoimmune urticaria

In addition, in severe cases of autoimmune urticaria, the following treatments are used:

plasmapheresis – blood sampling to purify it of toxic components and subsequent return;

intravenous administration of immunoglobulin to create “passive” immunity;
oral administration of Cyclosporine, a powerful immunosuppressant that can quickly eliminate the symptoms of urticaria.

Complications

Although in most cases the symptoms of hives can be eliminated by taking an antihistamine, you should not neglect visiting a doctor. With each relapse of the disease, the risk of serious and dangerous complications increases. These include:

Quincke's edema. An acute condition characterized by swelling of the subcutaneous tissue on the lips, eyelids, mucous membranes of the mouth and larynx. Interferes with normal breathing and may lead to hypercapnic coma;
anaphylactic shock. A sharp narrowing of the blood vessels supplying the lungs and heart, a rapid decrease in blood pressure, loss of consciousness and death.

Both conditions require emergency medical attention. To prevent complications, it is necessary to take care of your health and follow preventive measures to prevent the occurrence of autoimmune urticaria and other chronic diseases. Read about generalized urticaria in this article.

Source: //KozhaExpert.ru/krapivnitsa/autoimunnaya-lechenie

Elimination

Caution in the use of pharmacological drugs (in particular, avoiding self-medication with antibiotics).
Correction of the diet - exclusion from the menu of dangerous additives (dyes, preservatives) and foods with a high allergen-provoking potential: citrus fruits, mushrooms, nuts.
Regular wet dust cleaning.
Avoiding contact with harsh chemicals (including for household purposes).

https://www.youtube.com/watch?v=W4YgK-OKFd8

Elimination measures are the basis of therapy for any form of urticaria and are observed constantly, even without an exacerbation of the reaction.