Etiology

The development of urticaria on an allergic basis is more often observed as a manifestation of drugs (penicillin, streptomycin, amidopyrine, analgin, novocaine, sulfazole, vitamin B1), food (consumption of chicken eggs, whole milk, fish, alcoholic drinks etc.), insect, pollen, helminth sensitization.

Pathogenesis

Depending on the course and manifestations, urticaria is divided into:

The development of urticaria on a pseudoallergic basis is more often associated with autonomic dysfunction of the cholinergic type, against the background of which, along with an excess of acetylcholine, there is an increased liberation of histamine, provoked by a number of nonspecific factors, irritants.

Clinical manifestations

With giant urticaria - Quincke's edema, the edema spreads to the deep-lying parts of the skin and subcutaneous tissue. Angioedema, like urticaria, along with the skin, can be localized on the mucous membranes, disrupting the function of various organs and systems. With swelling of the larynx, difficulty breathing may occur, up to asphyxia; if localized on the mucous membranes of other organs, dysuric phenomena, symptoms of acute gastroenteritis, and intestinal obstruction are possible.

Quincke's edema, like urticaria, lasts from several hours to several days and disappears without a trace. For food allergies, helminthic infestation, intolerance to acetylsalicylic acid, sodium benzoate, food additives, as with autonomic dysfunction with cholinergic reactions, they can take a recurrent, chronic course.

In chronic urticaria, in contrast to acute urticaria, perivascular lymphoid infiltrates occur with the subsequent development of acanthosis (skin hyperpigmentation in the knee, elbow, inguinal and intergluteal folds), hyperkeratosis.

Along with this, with urticaria, blisters may be observed, leaving behind hyperpigmentation due to a hyperergic reaction with the formation of blisters filled with hemorrhagic contents. This is due to acute vasopathy, lymphopathy of the papillary dermis with high permeability of the vascular walls.

Contact urticaria - the appearance of blisters after contact with nettle, cactus, ivy, cosmetics, deodorants, contents of the villi of caterpillars (especially from the moth family), nickel salts, synthetic materials, latex, etc.

Contact urticaria is characterized by localized rashes at sites of contact with an allergen or histamine liberators, up to the development of giant urticaria - Quincke's edema. Anaphylactoid reactions may develop.

With widespread, generalized urticaria, general reactions can be observed, as with toxicerma - sharp increase body temperature up to 38-39 ° C, hematological changes, parenchymal changes are possible.

An atypical type of acute and contact urticaria is cholinergic, mechanical urticaria, which occurs during mechanical irritation - in the process of studying the nature of dermographism, during mechanical irritation of clothing parts and is manifested by blister-type reactions.

In childhood urticaria, small blisters occur against the background of exudative diathesis and hypersensitivity to a number of foods.

Differential diagnosis

Attacks of erythromelalgia are accompanied by a burning sensation, burning pain skin, pronounced, often diffuse hyperemia with a cyanotic tint of a symmetrical nature on the limbs or trunk with hyperhidrosis. Erythromelalgia can develop as an acute crisis and pass quickly or drag on for a longer time.

It is advisable to differentiate allergic urticaria with allergic superficial vasculitis, in particular with simple purpura, which is initial stages development may manifest itself as limited purplish-red (erythematous) spots, sometimes merging with each other.

Against the background of such spots, often located symmetrically on the extensor surfaces, urticarial itchy elements may occur.

Unlike urticaria, such rashes do not disappear when pressed and undergo changes over time: first bluish-purple, then brown, yellow-green, disappearing without a trace or leaving behind persistent pigmentation on the skin.

Acute urticaria with manifestations in places of hemorrhage rashes is differentiated from urticaria pigmentosa, which is part (a composite whole) of mastocytosis. Mastocytosis is caused by the proliferation of mast cells in the form of limited areas (cutaneous form) or in the form of systemic lesions (cutaneous-visceral form).

Urticaria pigmentosa can manifest itself as many small, round, reddish-brown spots or raised papules that tend to coalesce, are slightly itchy and symmetrically scattered on the skin. When these rashes are rubbed with a finger or a spatula, they become brighter and swollen due to irritation of mast cells and the release of biologically active substances by them (the Uina-Darieu friction phenomenon).

At differential diagnosis allergic and pseudoallergic urticaria, it should be borne in mind that with the latter diseases are often detected gastrointestinal tract and hepatobiliary system; there is no increase in the content of specific IgE; no improvement with fasting or with a hypoallergenic diet; do not provide positive influence for manifestations-regression of urticaria antihistamines. The bilirubin test allows them to be differentiated, the essence of which is that with pseudoallergic urticaria, bilirubin parameters significantly increase on the 3rd-5th day of fasting (V.I. Pytsky, 1999).

Treatment

2. Hypoallergenic diet, including taking enterosorbents (activated carbon, or belosorb, up to 12-18 g per day, or pectins).

3. Antihistamines - claritin or ebastine (10 mg 1 time per day, if necessary, up to 2-3 weeks) or zaditen - 1 tablet. (1 mg) 2 times a day in cases of suspected food allergy with a course of treatment, if necessary, for up to 1-2 months. If ketotifen causes a pronounced sedative effect, then instead of one tablet, 1/2 tablet is prescribed 2 times a day. It should not be taken by drivers and other persons whose work requires increased attention and high physical activity, as well as by pregnant women.

4. In cases of laryngeal edema and abdominal syndrome, 0.5 ml of a 0.1% solution of adrenaline and 1 ml of a 5% solution of ephedrine are administered subcutaneously. Solu-medrol - 30-90 mg or hydrocortisone hemisuccinate - 125 mg intravenously or intramuscularly is indicated.

For angioedema localized in the larynx, additional dehydration therapy is required: 2 ml of Lasix (in the absence of allergies to the sulfonamide group) with 20 ml of 20% glucose solution intravenously. If asphyxia increases and there is no effect from the therapy, tracheostomy is indicated.

5. To improve microcirculation and reduce the permeability of the vascular wall, ascorbic acid and calcium gluconate can be prescribed.

6. In case of chronic urticaria, the patient should be carefully examined to identify concomitant diseases of the gastrointestinal tract, hepatobiliary system (including enteropathy), etc. Additionally, hyposensitizing therapy may be recommended - intravenous administration 100 mg of a 5% solution of aminocaproic acid in an isotonic solution of sodium chloride 1 time per day 5 times (in the absence of a threat of DIC syndrome or an increase in other blood clotting factors), or sodium thiosulfate - up to 20 ml of a 30% solution every other day 5 times, or histaglobulin subcutaneously according to the scheme 0.2-0.4-0.6-0.8-1.0 ml every other day, and then after 4-5 days up to 2 ml 5 times.

7. To combat itching, we can recommend local application aerosols of allergodil or histimet (especially with contact non-systemic urticaria) or wiping with a 0.5-1% menthol solution, 1% citric acid solution or 1% solution baking soda(sodium bicarbonate). Glucocorticosteroids in the form of an ointment or cream (elokom - once a day, applied to the most inflamed areas of the skin), radon baths or acupuncture have an antipruritic effect and a pronounced local anti-inflammatory effect.

Urticaria (urticaria) is a disease characterized by a rapid, more or less widespread rash of itchy blisters on the skin, which are swelling of a limited area, mainly the papillary layer of the skin.

One type of urticaria is Quincke's edema (giant urticaria, angioedema), in which the swelling extends to the dermis or subcutaneous layer. This form of urticaria was first described by the German neurologist N. Quincke in 1882.

EPIDEMIOLOGY. Urticaria is a common allergic skin disease in children and its incidence ranges from 15 to 30%. 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.

Girls are more likely to get sick, which is associated with the characteristics of their neuroendocrine system. According to various authors, burdened allergic heredity is noted in 25-55% of cases.

CLASSIFICATION. There are different classifications of urticaria. Clinically, acute and chronic urticaria are distinguished. Acute urticaria is most often accompanied by severe itching of the skin and extensive rashes on it. Elements of urticaria reach large sizes, quickly appear and disappear without a trace after a few hours or days (1-2 days).

If elements of urticaria persist for more than 2 weeks, then this condition is defined as chronic recurrent urticaria. Chronic urticaria is characterized by small rashes on the skin. The elements of the rash are usually small and last a long time. Following remission of varying duration, rashes reappear; the disease may last for months or years.

However, this division of urticaria does not highlight the leading pathogenetic mechanisms, which makes it difficult to prescribe pathogenetically based therapy and focuses primarily symptomatic treatment. Therefore, the most rational classification is based on the pathogenetic principle.

IN AND. Pycki et al. (1987) proposed a classification based on the pathogenetic principle. The initial premise of this approach was the idea of ​​common pathogenetic links in the development of pathological processes. In relation to urticaria, the common pathogenetic link is an increase in the permeability of microvasculature vessels and the acute development of edema in the area surrounding these vessels. The mediators that cause an increase in vascular permeability may be different in each specific case, but almost all of them relate to mediators of different types of allergic reactions. Similar mediators are also involved in the development of pseudoallergic reactions.

Therefore, based on these premises alone, it can be argued that there are two pathogenetic forms urticaria: 1) allergic urticaria (having an immunological mechanism for the formation of mediators); 2) pseudoallergic urticaria (the mediators are the same, but are formed without the participation of the immunological mechanism).

The allergic form is caused by allergens and has well-defined immunological mechanisms, mainly reagin. Pseudoallergic urticaria is more variable both in the factors that cause it and in the mechanisms of development, but the final link in all these mechanisms is the formation of the same mediators.

Allergic urticaria is detected in children in 70% of cases. In 65% of cases, this form of urticaria is characterized by a hereditary history of allergies.

ETIOLOGY. The causes of allergic urticaria can be various allergens - food, medicinal, pollen, bacterial, etc. Most often, drug-induced urticaria is detected in children (60% of cases). Most often, drug-induced urticaria is caused by antibiotics (penicillin, semisynthetic penicillins - ampicillin, oxacillin, ampiox; cephalosporins, less often tetracyclines - rondomycin, morphocycline: chloramphenicol), sulfa drugs(bactrim, biseptol, sulfadimethoxine), as well as drugs similar to them in chemical structure (novocaine, anesthesin, diacarb, PAS); non-steroidal anti-inflammatory drugs (naproxen, butadione, analgin, reopirin, voltaren), anticonvulsants (diphenyl, trimethin, carbamazepine).

A feature of drug-induced urticaria is the recurrence of the rash when even minimal doses of a drug to which there has already been a reaction are re-administered, or to a drug with a similar antigenic or chemical structure. It should also be taken into account that in such cases, the products of drug metabolism have a much stronger sensitizing effect than the drugs themselves.

Food urticaria most often occurs in dairy products, citrus fruits, coffee, chocolate, honey.

Pollen urticaria occurs with increased sensitivity to pollen from grasses and trees (pollen from birch, hazelnut, wormwood, timothy, ragweed). Pollen urticaria is often combined with respiratory manifestations (allergic rhinitis, allergic conjunctivitis).

Allergic urticaria also includes urticaria from insect bites, exposure to chemical agents, bacterial urticaria, which develops as a result of sensitization of the body to various viral, fungal, bacterial allergens, in the presence of foci of chronic infection (ENT pathology, diseases of the gastrointestinal tract, intestinal dysbiosis).

PATHOGENESIS. In the development of allergic urticaria, the leading mechanism is the reagin mechanism of damage. Type II damage mechanisms can be activated during blood transfusions. The immune complex mechanism can be activated when a number of drugs (for example penicillin) are introduced into the body; antitoxic serums, gamma globulins.

Allergic urticaria with an acute course is a classic manifestation of an IgE-mediated allergic reaction associated with the release and synthesis of biologically active compounds(histamine, bradykinin, serotonin, prostanoids, leukotrienes) in response to the action of various allergens. In this case, morphologically, swelling of the papillary layer of the dermis, expansion of the lumen of lymphatic and blood vessels (capillaries and arterioles), and a slight perivascular infiltrate, consisting mainly of lymphocytes, are noted. Clinically, these changes are manifested by skin rashes in the form of papules and blisters of various sizes (urtica), surrounded by a zone of hyperemia, rising above the surface of the skin, accompanied by severe itching and severe symptoms of microcirculation disorders.

In the development of chronic allergic urticaria, endogenous prostanoids and leukotrienes play an important role, and increased sensitivity of the skin to kallikrein has been noted. Histologically, a perivascular infiltrate is characteristic, which mainly consists of T and B lymphocytes; macrophages are rare. T lymphocytes are represented mainly by T helper cells. Acanthosis and hyperkeratosis may occur in the epidermis.

Pseudoallergic urticaria is an expression of a pseudoallergic reaction. Various operating factors can be histamine liberators, complement activators and kallikrein-kinin system. Among these factors are drugs (antibiotics, radiocontrast agents and many others), serums, gamma globulins, bacterial polysaccharides, physical, food products and the xenobiotics they contain.

The leading pathogenetic link in the development of this form of urticaria is a disease of the digestive organs and, first of all, dysfunction of the hepatobiliary system. The following observations support this position: 1) negative elimination test, i.e. exacerbation of signs of urticaria or absence of changes in its course against the background of a three- to five-day fast. This indicates that the immediate cause of urticaria is in the body itself; 2) bilirubin test - an increase in the level of bilirubin in the blood during an elimination test. It shows that the damaged body system is the hepatobiliary; 3) a combination of cases of exacerbation of urticaria with simultaneous exacerbation of processes in the hepatobiliary system; 4) good results in the treatment of the underlying disease of the digestive system.

It is known that the liver, performing a barrier function, participates in the processes of detoxification, inactivation of biogenic amines, kinins, and the exchange of prostaglandins and leukotrienes. Damage to the liver from toxic and infectious factors leads to impairment barrier function and in different ways - to the appearance in the skin of mediators that increase vascular permeability. For example, healthy people tolerate quite large loads of histamine - up to 2.75 mg/kg of weight when administered through a probe into duodenum. A total dose of histamine of 165-200 mg in adults only caused a feeling of flushing in the face lasting up to 10 minutes without a noticeable increase in the peripheral blood. In case of disorders of the intestinal-hepatic barrier, this dose causes the development of urticaria, headache, and sometimes diarrhea and is accompanied by a significant increase in histamine in the blood.

The most striking picture of pseudoallergy develops with a deficiency of the inhibitor of the first component of complement - the C1 inhibitor. It is an alpha-2 neuroaminoglycoprotein with molecular weight 90,000 daltons. Normally, its concentration in blood plasma is 18.0+5 mg%. C1 inhibitor deficiency is associated with a gene mutation (frequency 1:100,000) and is inherited as an autosomal dominant trait. In most cases, deficiency is associated with a violation of its synthesis in the liver, which leads to a sharp decrease in the concentration of the inhibitor in plasma (up to 17% of normal). However, in some cases, its level is normal, but the inhibitor is structurally changed, or the level of the inhibitor complexed with albumin is even increased. In these cases it is inactive. A deficiency of the inhibitor, as well as its reduced activity, lead to the development of a pseudoallergic form of Quincke's edema. General mechanism its development is shown in Fig. 124.

Under the influence of various damaging influences (for example, tooth extraction, etc.), physical activity, and emotional stress, the Hageman factor (blood coagulation factor XII) is activated. The latter turns on the plasmin system with the formation of plasmin, which, in turn, triggers the initial link of the classical pathway of complement activation, starting with C1. Activation goes up to SZ and stops here, since SZ has its own inhibitor. However, in the initial link, a kinin-like fragment is formed from C2, which causes an increase in vascular permeability and the development of edema. The same diagram also shows treatment methods. The best effect is obtained in an acute state by administering a C1 inhibitor obtained from blood plasma, or simply fresh or fresh-frozen blood plasma. The plasmin inhibitor β-aminocaproic acid works well. Testosterone drugs are prescribed during the remission stage; they stimulate the synthesis of the C1 inhibitor. It should be noted that the treatment of pseudoallergic Quincke's edema differs sharply from the treatment of its allergic form. Therefore, the differential diagnosis of the two forms of Quincke's edema plays an important role.

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. Pathohistologically, loosening is noted in the area of ​​the blister collagen fibers, intercellular edema of the epidermis, the appearance of perivascular mononuclear infiltrates with varying rates of development and severity.

CLINIC AND DIAGNOSTICS. The severity of clinical manifestations of urticaria depends on the intensity of the immunological antigen-antibody reaction and the characteristics of the body's reactivity.

Allergic urticaria is characterized by profuse rashes on the skin of papules and blisters of various sizes, often the merging of individual elements to form bizarre garland-shaped spots. Such a rash is usually accompanied by severe itching and severe symptoms of microcirculation disorders in the form of cyanotic spots and blisters with compaction in the center. If the pathological process is located deeper and involves the dermis and subcutaneous tissue, then the so-called giant urticaria develops.

Allergic urticaria, in addition to local symptoms, is also characterized by general symptoms: increased body temperature up to 38 ° C, pain in the joints (arthralgia) and in the abdomen, sometimes with vomiting and loose stools. At severe course Allergic urticaria may damage internal organs with the development of allergic myocarditis, allergic reactive arthritis, reactive pancreatitis.

When examining children with allergic urticaria, significant changes in the coagulation and anticoagulation systems of the blood are revealed in the form of hypercoagulation due to increased levels of prothrombin, fibrinogen in the blood, Hageman-dependent fibripolysis and increased tolerance to heparin. This may explain the presence of pronounced symptoms of microcirculation disorders in urticaria. Most often, acute allergic urticaria in children is combined with Quincke's edema (70-80% of cases).

Quincke's edema. Allergic and angioedema are distinguished. The reasons for the development of Quincke's edema are the same as urticaria.

Angioedema of allergic origin is characterized by the sudden development of limited swelling of the skin, which quickly increases. In this case, the skin in the areas of edema has a dense elastic consistency, white, and swollen. More often, swelling is localized in areas of the skin with loose subcutaneous tissue: on the face (eyelids, lips, nose), ears, tongue, hands, feet and genitals. Sometimes the swelling reaches large sizes.

In severe cases, there may be laryngeal edema, which occurs in approximately 10-20% of cases. With swelling of the larynx, hoarseness of the voice is first noted, barking cough, difficulty breathing further increases with shortness of breath of an inspiratory, and then inspiratory-expiratory nature. Breathing becomes noisy and stridorous. The skin of the face acquires a cyanotic tint, then suddenly turns pale. Laryngeal swelling of the lungs and medium degree severity lasts from 1 hour to 1 day. When the acute period subsides, hoarseness, pain in the larynx, and difficulty breathing remain for some time. In severe cases, Quincke's edema in the larynx requires immediate intensive care, up to tracheotomy, otherwise patients may die due to asphyxia.

So-called non-allergic urticaria occurs much less frequently in children.

Pseudoallergic urticaria is detected in children in 10-15% of cases and develops as a result of histamine liberation in response to various medications and foods. The most common medicinal liberators are atropine, iodine, radiocontrast agents and preparations containing bee and snake venom. Among food products, such liberators can be pickled herring, strawberries, strawberries, game, brewer's yeast, peanuts, and beans.

Pseudoallergic urticaria can also be caused by foods rich in histamine - sauerkraut, pork liver, smoked sausages, spinach, fermented cheeses, vinegar, mayonnaise. The histamine content in fish during marinating increases to 240-750 mg/100 g of product. Some types of cheese contain up to 130 mg/100 g, and salami sausage contains up to 1006-3540 mg/100 g of product.

True allergic urticaria should be differentiated from pseudoallergic urticaria (Table 170).

(G.I. Smirnova, 1998)

Non-allergic urticaria also includes cholinergic urticaria, which is caused primarily by functional disorders of the autonomic nervous system and its regulatory center - the hypothalamus, where switching occurs nerve impulses to humoral.

Cholinergic urticaria is associated with the release of large amounts of acetylcholine and decreased cholinesterase activity. Acetylcholine causes a vascular response similar to that of histamine. Autosensitization to acetylcholine with the development of an antigen-antibody reaction is also possible. Most often, cholinergic urticaria occurs with nervous excitement, physical or mechanical stress, exposure to heat, cold or solar radiation. It is characterized by rashes in the form of itchy spots and blisters on the skin of the upper extremities, which quickly disappear and reappear. In this case, the most significant provocative test is running in place in warm clothes until sweat appears or taking hot bath. Elements of the rash usually appear 20 minutes after sweating or a hot bath.

The following forms of cholinergic urticaria are distinguished: thermal, solar, physical, mechanical, cold.

Solar urticaria develops more often with liver diseases and disorders of porphyrin metabolism with pronounced sensitization to ultraviolet radiation. It is rare in children. The disease is characterized by the appearance of an urticarial rash on exposed areas of the body (face, upper limbs) after exposure to the sun (photodermatosis). The disease is seasonal (spring and summer).

Cold urticaria is the most common form of cholinergic urticaria. There are familial and acquired cold urticaria. Familial cold urticaria is autosomal dominant hereditary disease. When urticaria recurs, a large amount of acetylcholine, a decrease in cholinesterase activity and a sharp decrease in chymotrypsin in the blood are detected. Usually the rash appears with general cooling. Acquired cold urticaria is associated with cryoglobulinemia, cryofibrinogenemia and cold hemodialysis. Such urticaria is observed in children in the presence of foci of chronic infection, in some systemic diseases, and develops when the body is hypothermic.

Hereditary urticaria and hereditary angioedema are special forms of non-allergic urticaria that are associated with deficiency or functional inferiority of the inhibitor of the first component of complement C1 esterase. In this case, the complement system is activated along the classical pathway and biologically formed active substances, which are mediators of vascular angioedema and urticaria. The disease is characterized by a recurrent rash and/or dense, painful swelling of the skin of the face, torso, and limbs of the same location. The disease is inherited in an autosomal dominant manner with incomplete penetrance.

Diagnosis of diseases is complicated due to the similarity of the clinical picture, the presence of edema of allergic origin and the difficulties of laboratory diagnosis. As a result, angioedema is recognized quite rarely, and such patients, as a rule, receive inadequate therapy with anti-inflammatory and antiallergic drugs that do not have an effect. Only plasmin inhibitors are effective in treatment: epsilon-aminocaproic acid and fresh frozen plasma.

The above factors lead to high mortality of patients, mainly from asphyxia due to laryngeal edema (25% of cases). This disease is characterized by a clear connection with trauma, physical stress and psycho-emotional stress.

Diseases must be carefully differentiated taking into account characteristic signs (Table 171).

For the diagnosis of allergic urticaria great importance has a correctly collected allergic history, which in most cases reveals a hereditary burden of allergies. The second important step in the diagnosis of allergic urticaria is the conduct of elimination and provocative tests, which allow the detection of a causally significant allergen. The following are of greatest importance for identifying a causally significant allergen: 1) conducting skin tests with allergens during the period of remission; 2) conducting ELISA; 3) setting PACT and PR1ST (to determine the concentration of total IgE).

TREATMENT of acute and chronic urticaria in children should be pathogenetically substantiated and depend on the phase of the allergic reaction. In the acute period, it is necessary to influence the pathophysiological phase of the allergic reaction. For this purpose it is necessary:

1. Stop further entry of the allergen into the body (discontinue the drug that caused the urticaria; prescribe a strict hypoallergic diet for 1-2 days).

2. Remove the remaining allergen from the gastrointestinal tract (prescribe a cleansing enema, gastric lavage in the first hour after an allergic reaction).

3. Prescribe abundant silk drink to improve microcirculation and remove the allergen from the body. For this purpose, use a 1-2% solution of baking soda, mineral water (Borzhom and Narzan at the rate of 15-30 ml/kg body weight).

4. Carry out enterosorption to remove the remnants of allergens that caused an allergic reaction. For this purpose, enterodesis, activated carbon, polyphepane, smecta, molzyme, etc. are used.

5. Prescribe antihistamines in an age-specific dose. In the first 2 days it is better to use parenterally every 8 hours, then orally for 7-10 days. The most commonly used are suprastin, tavegil, pipolfen, astemizole, terfenadine, etc.

6. To reduce sensitization to food allergens, enzyme preparations are used (mezim-forte, oraza, pankurmen, digestal, festal, panzinorm).

7. If the rash and swelling increases, it is necessary to use diuretics as indicated, most often parenteral administration of Lasix.

This traditional treatment regimen for acute urticaria in children may not be effective enough in severe cases.

Taking into account the pronounced disorders of the blood coagulation and anticoagulant system, significant changes in microcirculation in urticaria, a method of pathogenetic treatment of severe forms of this disease was developed, including mandatory infusion therapy with the use of lezagregants and anticoagulants - rheopolyglucin (10-15 ml/kg body weight), 2. 4% solution of aminophylline (5-6 mg/kg) per 50-100 ml of isotonic sodium chloride solution, trental (5 mg/kg) per 50-100 ml of isotonic sodium chloride solution, heparin (200-300 U/kg) 6 times a day. Half daily dose It is advisable to administer the drugs intravenously, the rest of the dose is injected into the subcutaneous tissue of the abdomen 4 times a day.

In severe cases of urticaria and an increase in Quincke's edema, the administration of glucocorgicosteroids is indicated. More often, prednisolone is used at a rate of 1-2 mg/kg body weight parenterally, in a short course of 1-2 days. However, the most effective corticosteroid drug is betamethasone (celeston - sodium salt of betamethasone phosphate). The drug has a more pronounced anti-inflammatory effect, as it directly affects the production of cytokines and other biologically active mediators. The effect of celeston occurs much faster (after 1-2 hours), and can be longer (the half-life of the drug is 36-72 hours). The activity of celeston is 30 times greater than that of hydrocortisone and 6-7 times greater than that of prednisone. In children with severe urticaria, a single administration of an age-appropriate dose of celeston is sufficient, which corresponds to 0.02-0.125 mg/kg body weight per day or from 0.6 to 3.75 mg per square meter. m body surface.

After the acute manifestations of urticaria subside, drugs are prescribed that act on the pathochemical phase of the allergic reaction. For this purpose, the following drugs are used:

1) drugs with antimediator action (zaditen, nalcrom) in age-specific dosages in courses from 1.5 to 2-3 mss, and when chronic course- up to 6 months;

2) when visceral forms hives are shown vascular drugs and compounds acting on the kinin system (stugeron, cinnarizine, prodectin, parmidine) - for 1 month;

3) antioxidants and membrane stabilizers: 5% solution of sodium hyposulfite orally in an age-related dosage, xidifon, dimephosphone for 2 months, vitamin E in an age-specific dosage, Essentialefort (especially for pathology of the hepatobiliary system).

A prerequisite for effective treatment of acute urticaria and prevention of recurrence of the chronic process is complete sanitation of foci of chronic infection: treatment of pathology ENT organs(sinusitis, sinusitis, tonsillitis, adenoiditis), correction of pathology of the gastrointestinal tract (chronic gastroduodenitis, dyscholia, reactive pancreatitis, intestinal dysbiosis), which can significantly reduce the body’s sensitization to food allergens, which is an important link in the pathogenesis of urticaria in children. It has been proven that bacteria and their products (peptidoglycan and teichoic acid) enhance the release of histamine from basophils in the presence of allergens and prolong the allergic reaction.

In the future, in order to completely relieve and stop relapses of urticaria, in addition to prescribing hypoallergenic or individual diets and the listed methods of therapy, it is necessary to use drugs that act on the immunological phase of the allergic reaction. For this purpose, histaglobulin, allerglobulin, antiallergic immunoglobulin, as well as interferon and cytokine preparations (leukinferon, reaferon, viferon) are used. Leukinferon with an activity of 50,000 IU is used in the form of rectal suppositories, which are administered 8 times every other day and then 2 times a week for 2 weeks. Reaferon with an activity of 250,000-500,000 IU is used taking into account the age of patients according to a similar scheme.

For urticaria caused by pollen sensitization, specific immunotherapy is indicated.

PREVENTION. To prevent relapses of urticaria and increase the effectiveness of rehabilitation, you should pay attention to Special attention to provide gentle (allergologically) nutrition, conduct thorough sanitation of foci of chronic infection, prevent contact with environmental allergens and increase tolerance child's body to allergenic effects.

Hives - a disease of toxic-allergic nature with a monomorphic urticarial rash on the skin, sometimes mucous membranes. Endogenous causes can be diseases of the gastrointestinal tract, liver, kidneys, and nervous system. Exogenous, i.e.externalcauses may be chemical, physical, biological, drugs, food (eggs, cheese, chocolate, strawberries, mushrooms, tangerines, fish),serum and other factors,as well as irritants (insect bites, nettle stings, bee stings, bedbugs).

The peculiarity of the disease is that, in fact, it has several echelons, floors of causal factors. There are basic reasons, i.e. which are located, as it were, at the level of the foundation of the building, but there are reasons of the second order, i.e. at the building level. The first reasons are called sensitizing, i.e. predisposing to the disease, and the second are factors provoking the disease. So it is precisely the causes of the second echelon that doctors pay attention to, while the basic causes are not touched upon and do not try to eliminate them. This is the weakness of all medicine. For example, nutritional factors such as eating strawberries or other allergenic foods are just provoking factors. But they are possible only when there are basic reasons for this (predisposing). Most often, if there are no underlying reasons, then the provocateurs will not be able to manifest themselves through the gastrointestinal tract. Even exogenous causes: insect bites or other chemicals. drugs manifest themselves in many different ways if the body does not have a special predisposition to them. That is, of course, sometimes there is a certain natural allergenic reaction, but it does not occur so strongly, violently, without serious consequences. For example, the extreme degree of sensitization is when even factors that are weak for many people cause in some patients such a violent reaction as Quincke's edema. Therefore, in order to treat angioedema, one must first of all fight not only the causes that directly manifest it, i.e. its provocateurs, but to look for and treat deeper roots, including treating the entire gastrointestinal tract and excretory systems. So, all this explains why the disease must be treated not at just one level, but in several directions at once.

Urticaria is a disease characterized by itching and rash on the skin, less often on the mucous membranes. Sometimes, with severe urticaria, blisters appear on the skin and quickly disappear. Acute urticaria can occur as a symptom of a disease. Food products that cause urticaria include some types of canned meat and fish, strawberries, crayfish, eggs, etc., medicinal products include antibiotics, sulfonamides, salvarsan, morphine, santonin, etc. Urticaria can develop with the introduction of a foreign protein: medicinal serums, milk, vaccines, after blood transfusion. With regularly recurring urticaria, the cause of the disease should be sought in such concomitant diseases asdysbacteriosis, worms, colitis, enteritis, liver and biliary tract diseases , kidney diseases, diabetes etc. Such urticaria is only a secondary allergic-toxic manifestation of another disease. Moreover, doctors usually never look for or treat the root causes, and place all therapeutic emphasis on suppressing the “treatment” of allergies, that is, they act on secondary mechanisms and symptoms and do not affect the roots of the disease. It is not surprising that the “successes” of our medicine end only in muting acute conditions and transferring the disease to a persistent chronicle, where doctors with their drugs, antibiotics and hormones become helpless. Therefore you need to understand possible existence such root causes and if they exist, be sure to write me such a letter so that I can give and additional recommendations to treat the root causes of your illness.

The presence of allergens is always only a secondary manifestation of the disease, but it is these allergens that cause a whole cascade in the physiological processes of the body. Allergens develop immediate-delayed hypersensitivity and accumulate histamine. This happens as follows: during the antigen-antibody reaction, trypsin is released from mast cells histamine, which is formed from the amino acid histidine by histidine decarbo xidase. Histamine dilates capillaries, increases vascular permeability and leads to acute swelling of the papillary dermis, which is expressed in the appearance of urticarial rashes of varying sizes. At the same time, the release of serotonin, acetylcholine and bradykinin increases, which enhance the activity of histamine. With nervous excitement, the activity of acetylcholine increases, and it accumulates in tissues and causes a reaction similar to histamine. Among other factors in the pathogenesis of urticaria, immunological and neuroendocrine disorders should be taken into account.

With artificial urticaria, mechanical irritation can cause linear urticarial rashes that are not accompanied by itching.

Acute urticaria manifests itself suddenly with severe itching, profuse urticarial rash on the skin of the torso, limbs, and buttocks. Blisters the size of a pinhead or larger.

I would especially like to draw attention to the dysbacteriosis component of the disease.Imbalanceintestinal flora . The fermentation flora and putrefactive flora form a single human intestinal flora. Its quality depends on the balanced work of these two groups of microorganisms. Of course, fermentation microorganisms predominate, since they occupy a much larger part of the intestine than putrefactive bacteria: the entire small intestine (5 m) and a significant part of the colon (about 1 m) versus the descending colon (50 cm), given over to putrefactive microorganisms. It can be noted that healthy intestinal flora consists of 85% fermentation microorganisms and 15% putrefaction microorganisms. These natural proportions guarantee health, while any changes are, on the contrary, a sign of imbalance and deterioration in the quality of the intestinal environment. But with dysbacteriosis, most often it is the microflora of decay that begins to prevail.

Intestinal flora healthy person There are 400-500 species of microorganisms living in harmony with each other. Some of them are an obligatory component of the intestine, and some of them appear when putrefactive microflora prevails. It is she who treacherously opens the door to microflora that should not be in the intestines at all, for example, pathogenic enterobacteria and mold fungi. In this entire huge ensemble of microflora, a huge number of microorganisms begin to appear that clearly have allergenic properties. This allergy can manifest itself not only within the intestines in the form of chronic colitis etc., but also within the entire organism. It is not surprising that hives can be caused by dozens of foods that have nothing in common with each other. Obviously, each of them has specific substances that are beneficial for a specific group of microorganisms that normally do not manifest themselves. Balance is important in everything: in the size of populations, in the areas they occupy, in the parts of the intestines that they inhabit, and in the portions of food that each of them can claim.

The task of putrefactive flora - process food particles that have not yet been digested. At this level we are primarily talking about protein waste from meat, fish, eggs, etc., since carbon hydrates, as difficult to digest as fiber, have been processed slightly higher by the fermentation flora.

The result of decomposition through putrefaction is more or less toxic waste, which will be neutralized by the liver. Among them- ammonia, phenols, indole, scanols, sulfide hydrate, as well as amine substances - ptomaines and other specific substances not inherent in our body, which the liver often does not clear. In the blood they form new compounds that can also manifest themselves as allergens. Being alkaline, these substances form an alkaline environment (pH 8) in the descending intestine, which promotes the development of putrefactive microorganisms.

Fermentation flora - The fermentation flora inhabits the second half of the small intestine, the ascending and transverse colon, reaching highest concentration in the cecum and ascending colon. The most numerous representatives of this flora are lactobacilli acidophilus and bifidus.

As the name implies, the role of these microorganisms is to activate the fermentation mechanisms. Fermentation is necessary for long chains of carbon hydrate, which are the hard fibers that form the threads of plant tissue: the veins of lettuce leaves, the skin of fruits, the shell of cereals. Solid fibers such as cellulose, pectin and lignin cannot be digested by the digestive juices secreted by the stomach, liver and other digestive glands of the human body. Therefore, they enter the stomach in an almost unchanged state. Their transformation, however, can be carried out by microorganisms of the intestinal flora, and this process is similar to what occurs in the digestive tract of a herbivore.

As a result of fermentation, various acidic substances appear: lactic, acetic acids, succinic and carbonic acids. These substances oxidize the parts of the intestine in which they are located and create a weakly acidic environment (pH 6-6.8), which not only does not threaten their existence, but also favors them, supporting the development of intestinal fermentation flora. An additional positive effect of this oxidation is the stimulation of intestinal motility, which it also causes.

This is the flora of the final part of the small intestine, a small segment at the end of the transverse colon and the descending colon, where its concentration is highest. The primary task is to restore this orthoflora of health, which is adapted to exist on living foods such as vegetables, juicy fruits, herbs, and a minimum of that dead food that now dominates in modern man.

In the triggering mechanism of urticaria, an important role is played by various helminthic infestations, incl. and Giardia, which invade the liver. It is imperative that all such patients be treated for helminthic infestation using the Black Walnut tincture I offer.

You can read a whole lecture on liver health. But it can be argued that all such patients also need to improve their liver health. Most of these people have a sluggish, inactive liver. And this condition is not diagnosed by a medical examination, and a weak liver cannot cope with all functions and disrupts our overall health. Diseases develop only when poisons, due to contamination of the liver itself and its inadequate functioning, enter the general bloodstream and are spread throughout the body, and depending on the type of substance, they tend to settle in the lungs, then in the kidneys, then in the skin and others vital important organs, leading in each case to different diseases. If the liver kept the blood flow clean, a person could live much longer.

One of the reasons that slowly undermines the health of the liver is stagnation of blood in the hepatic (portal) vein, which is associated with the sedentary inactive lifestyle of a modern person. One can convincingly note the compatibility of urticaria with cholecystitis and gallstones - reliable indicators of liver dysfunction.Physical activity has also decreased significantly. All this, taken together, affects the functioning of the gallbladder and biliary tract, contributing to the development of chronic inflammatory process. The disease lasts for years, even decades, with periods of relief alternating with exacerbations.First of all, it is necessary to minimize, and if all recommendations are followed, completely eliminate the occurrence of exacerbations. Basically it depends on the patient himself. Since the very principle of the disease is stagnation of bile in biliary tract, then, first of all, it is necessary to conduct as much as possibleactive lifestyle . Those whose profession involves a sedentary activity should definitely find time during the day for short exercises,and even better, special physical therapy, walking for at least 2 hours a day.

Over time, the stagnation itself aggravates the condition of the liver, since there is no normal blood flow. Other reasons that undermine liver health are alcohol, incl. and such weak drinks as beer, viruses, toxic substances entering the body with food, air, and medications.

We all believe that if you don’t have bad habits, you don’t have to worry about your liver. In fact, the liver of any modern person works under increased load, as it daily cleanses the body of harmful substances that come in large quantities with food, water, and air. Medicines also complicate the functioning of the liver.

There is an opinion that if there is no pain in the right side, then everything is fine with the liver. In fact, the liver cannot hurt, that is the whole problem. There are no nerve endings inside the liver, so we cannot feel that the liver is “sick.” If the liver enlarges, we feel only heaviness and discomfort, and pain in the right side indicates problems in the bile ducts and pancreas, and the liver is silent, even when it is destroyed.

The following signs help to suspect problems with the liver: bitterness in the mouth, frequent belching after eating, weakness, decreased performance and “liver” signs on the skin.

Of no small importance here is the condition of the pancreas with its enzyme system, on which the condition of many subsequent systems and organs depends, incl. and dysbacteriosis.

We must not forget that urticaria is one of the types of allergic manifestations on the skin. Therefore, it is necessary to treat not only the root causes of the disease, but also to competently reduce skin allergies and itching. Itching is often an indicator of dirty blood, which indicates poor kidney function.

Chronic itching is a leading symptom in many diseases, especially skin diseases. It is often the leading sign when allergic diseases, and inflammatory skin diseases. Chronic itching can also be associated with diseases of the liver, kidneys, intestines, and worms, when, due to their poor functioning, metabolites penetrate into the blood, which, accumulating in the skin, can provoke itching. Most often this is due torenal or liver failure when they do not clean the blood well or whendysbacteriosis when toxins are constantly absorbed from the intestines - metabolites are negative intestinal microflora into the blood. To treat itching, it is necessary that the blood is clean, which means that the excretory organs, such as the liver, kidneys, and intestines, must work well. Therefore, first of all, we need to take care of their health.

1 . Liquid chlorophyll - Chlorophyll is a key enzyme, a so-called vector, which sets the specific direction of biochemical processes in one direction or another. That is, it regulates part of the biochemical processes. Our health will depend on this in the future, as well as success in the treatment of certain diseases. Only in the presence of chlorophyll can the body produce polyunsaturated fatty acid Omega-3, which is responsible for the construction of cell membranes. It is cells with irregular membranes that are targeted by immune cells to attack them. Absent-minded. sclerosis is a type of autoimmune disease. It is Omega-3 that helps resist autoimmune processes. Use this chlorophyll better in winter when it is not possible to make live green juice or a green smoothie.

Rationale for the need to use Omega-3 acids along with chlorophyll preparations . Dr. Johanna Budwig has gained international recognition for her use of flaxseed oil to treat a number of autoimmune and allergic diseases, and even cancer and other degenerative diseases including obesity. Almost every day, cells renew their membranes or die. Their place is replaced by new cells. Delayed division of cell membrane renewal or accelerated death of old cells leads to a weakening of the functional activity of the tissue. It is fish oil or flaxseed oil containing omega-3 acid that increases the stability of cells, normalizes their reproduction and renewal. This acid is responsible for the normal structure of membranes in healthy cells. Cell membranes consist of two fatty and one protein layers. So these fatty acids are formed from Omega-3 and Omega-6 PUFAs in a ratio of 3:1. This is an amazing mystery of nature that fatty substances flax and our cells have the same composition. It helps restore damaged cell membranes that may be damaged either due to autoimmune aggression on these cells or due to burns from acid waste. For many people, when they eat large amounts of saturated animal fats, the structure of cell membranes is disrupted and they stop functioning normally. Taking flaxseed oil with Omega-3 PUFAs restores the composition of cell membranes and their functionality. In terms of the amount of omega-3 PUFAs, flaxseed oil is far ahead of all other vegetable oils.

Let's consider what will happen to herbivores and animals if living greens are excluded from their diet.

It is known that eggs from chickens that are raised in poultry farms using compound feed do not contain the special Omega-3 polyunsaturated fatty acid in their yolks. Such eggs are not medicinal. A prerequisite for obtaining medicinal eggs is that they must be obtained exclusively from chickens that eat only green grass. Otherwise, there will be no therapeutic effect from these yolks! Consequently, it can be argued that without the constant, and not the random or periodic presence of chlorophyll in food, the formation of Omega-3 acids, essential for health, in the body is impossible.

This acid is responsible for the normal structure of membranes in healthy cells. A similar example. In China, animal organs are used for medical purposes. The pharmaceutical industry and many herbalists often offer animal adrenal glands, adrenal agents, or various animal tissue extracts. In recent decades, it has been observed that there is a significant decrease in the effectiveness of many drugs obtained from animal organs. Then they conducted research and found out that in order to save money, the animals were fed prepared dry food instead of fresh pasture grass. After autopsy, the organs of such animals turned out to be of a different color, larger in size, with tumors and cancer cells and other problems. Some animals grew and gained biomass more quickly, that is, their development accelerated. By the way, a similar acceleration in children is observed in modern civilized society. Children of our century reach puberty several years earlier and grow in weight and height faster than children two or three centuries ago. This is also associated with a complete transition to a new type of nutrition, which almost completely excludes the intake of live foods andespecially greens . In China, after these studies, an order was given to feed animals whose organs will be used for medical purposes only with fresh grass from wheat, barley, oats or alfalfa.

The absence of Omega-3 acids and chlorophyll in the body is perhaps the foundation, background, prologue and predisposition (or otherwise a sensitizing factor) for the delayed manifestation (quite remote) of a wide variety of degenerative symptoms, which obviously include obesity, different kinds autoimmune diseases, liver cirrhosis, arthritis, ankylosing spondylitis, adenomas, etc. Moreover, the mechanisms causing degenerative processes occur at a variety of levels. This is also due to the altered structure of cell membranes, hormonal imbalance and changes in the immune system. That is, changes occur across different systems and levels. This indicates changes in various chemical links of metabolism, and not in any one link.

Chlorophyll is an essential nutrient for us. . Let's compare this scattered information. Let's also consider the data from Dr. Noble's experiment on guinea pigs. Some of the animals were kept on a “modern diet”, that is, they were fed processed food, white bread, and sugar. The animals quickly became obese, their ability to remember decreased, their aggression increased, and their hair fell out. Life expectancy was reduced by 40%. Other animals were fed vegetables, herbs and green plants. These animals did not experience obesity, the incidence of chronic diseases decreased, the ability to remember increased, and life expectancy increased by 30%.

Behind all this scattered information, a pattern emerges, a general tendency, that without green chlorophyll, all higher warm-blooded animals cannot have a full metabolism. Without chlorophyll, the body loses some biochemical streams, processes responsible for the synthesis of certain substances, without which there cannot be a full-fledged balanced metabolism. Some chains of biosynthesis are torn off and cut off. That is, the entire range of necessary biosynthetic processes is not available; they will be turned off, and the volume of the homeostat and the biosynthetic complex that provides it will be curtailed. Consequently, the biochemical power of our foundation, that is, the homeostat, will be weakened and inferior. All these considerations apply to humans as well. Without chlorophyll, a person also cannot fully exist.

Therefore, we can conclude that chlorophyll complexes for higher animals are the sameirreplaceable , as well as a number of vitamins. Without them, there will be no full amount of health; it will be reduced. The potential of our life force will be limited. It is clear why with age it becomes possible manifestation a huge range of additional chronic and incurable diseases. Life expectancy decreases, aging begins prematurely, and diseases of old age, including oncology, manifest themselves rapidly. Unfortunately, official medicine I never classified chlorophyll as an essential ingredient for us.

Not seeing the reason why Omega-3 acid is not produced independently in our body and, without connecting this with the lack of consumption of living chlorophyll in food, scientific medicine is trying to compensate for its deficiency artificially, recommending additionally adding fish oil or flaxseed oil containing Omega-3 to food. 3 acid. But Omega-3 acid deficiency is a consequence, not a cause. Naturally, when they act on the consequences and not on the cause, the results will be limited. This perspective, highlighting chlorophyll in the category of essential nutrients for our body on a par with vitamins, and also that in the absence of chlorophyll Omega-3 acid cannot be produced, was proposed by me and discussed for the first time. In nature, Omega-3 acid is extremely rare as an essential nutrient. Sufficient quantities of it are contained in fish oil and flaxseed oil, which historically could not have been an obligatory component of the diet. It is natural to expect that in the phylogenesis of animals there could not be an orientation towards this acid entering the body from the outside. The focus should have been only on its autonomous production. And the presence of chlorophyll, of which there is an unlimited amount in nature, certainly helped her in this.

The signs and symptoms associated with chlorophyll deficiency, and therefore the subsequent failure and deficiency of Omega-3, are not as obvious as those associated with many other deficiencies nutrients, appear extremely “blurred” and delayed in time, that is, after many years. Naturally, it is extremely difficult to find a direct connection with them and chlorophyll deficiency.

In general, chlorophyll deficiency, and therefore the associated deficiency of essential acids, can be so subtle and extensive that the symptoms associated with it are usually attributed to some other cause. Suffice it to recall that, according to surveys, almost 90% of Americans are deficient in essential fatty acids. Hence all the so-called “diseases of civilization” - chronic and incurable.

Irreplaceable fatty acid, including Omega-3, play a decisive role in a huge number of intraorganismal processes, the most important of which are:

 regulate the synthesis of steroids and hormones; mediate the immune response;

 direct hormones of the endocrine system to target cells; are the main components of cell membranes; necessary to transport oxygen from red blood cells to body tissues.

So, how good is it to offer Omega-3 instead of taking chlorophyll? After all, it seems that the human body should also be able to synthesize this Omega-3 on its own, just like animal organisms. Isn't it better for him to do this on his own, rather than receiving it from the outside? Such endogenous synthesis is more favorable and natural for humans than the exogenous use of this substance. In addition, taking Omega-3 only partially compensates for the entire volume of disrupted mechanisms and biochemical chains that are disrupted in the absence of chlorophyll. That is, this only “patches up some holes”, but does not eliminate the true root cause that leads to the formation of these “holes”. The importance of chlorophyll for the body is much broader than the production of essential Omega-3 fatty acids.

At the same time, it can be expected, based on the fact that Omega-3 acid deficiency is a prologue, a foundation, a sensitizing factor for such diseases, including autoimmune ones, such as arthritis (joint disease), diabetes, lupus, multiple sclerosis, scleroderma, asthma, allergic reactions, as well as the main diseases of our civilization such as atherosclerosis, cancer, premature aging, diabetes, obesity, weakened immunity, acne on the skin and a huge list of other diseases and conditions can be more successfully prevented, as well as their treatment with the help regular intake of sufficient quantities of chlorophyll complexes, which will then, in turn, naturally increase the level of Omega-3 in the body. But at the same time, I will immediately note that there should be a lot of chlorophyll in food and constantly in order to transfer lipid metabolism towards the self-production of Omega-3 and other as yet unidentified substances.

In the meantime, acceptGreen puree . The use of homogenates (purees) from living green biomass of wheat sprouts, or other tender leaves, seems to be the most acceptable treatment option today, of all the other chlorophyll preparations I have described. Typically, the dose of live greens mashed into puree is from 100 to 300 g per day. In my practice, there are patients who have no difficulty exceeding this dose up to 600 g per day. When harvesting such greens, preference should be given to young, apical, underdeveloped shoots and young, not yet fully developed, tender foliage, which contain the maximum amount of special indoles that have an oncoprotective effect on hormone-dependent tumors in humans, such as breast tumors. In industry, special homogenizing devices are usually used for these purposes. This puree also contains a lot of enzymes and chlorophyll. All of them help restore the blood formula, increase hemoglobin, and prevent intoxication of the body. Chlorophyll has a stimulating effect on the body's defenses. To make purees or juices from greens, you can use the tops of blackberry shoots, young shoots of grapes, nettles, celery, parsley, horsetail, dill, onions, radishes, beet leaves, cabbage, alfalfa, lettuce, clover and many other non-poisonous and non-poisonous field herbs. stimulating herbs, as well as numerous leaves of trees, including exclusively young, newly emerged foliage of poplar, hornbeam, oak, beech, apple, rose, plum, as well as young needles of spruce, pine, etc. But it is better to mix bitter and low-poisonous leaves in smaller quantities with a large amount of absolutely neutral leaves that are harmless to us. Don't forget that live vegetables and fruits cannot replace green foliage. The taste of freshly mashed leaves in puree or the resulting green juice is quite pungent and unusual for modern people. Therefore, it is better to make cocktails from them, mixing 1:5 with banana puree. The taste changes radically, and even children can enjoy it.

2. Instructions : « Green smoothie treatment » . - here is the method of production, application and treatment. Even for me personally, it was a surprise that after drinking at least one cup of a green smoothie a day, there was a noticeable improvement in my health. Children should be taught from childhood to take such a cocktail in order to give them a supply of health and vitality from childhood to withstand numerous chronic diseases.In addition, this chlorophyll green juice smoothie is the best and most powerful alkalizer for the body. You need to know that a chronic disease like yours is associated with chronic over-acidification of the body. Therefore, it is necessary to remove excess acidity from the body. This can be judged by the urine pH, which is recommended to be checked using litmus papers. Read more about this in the instructions: “Treatment with cationides »

To help kidney function and cleanse the blood, I suggest taking it continuously for several months.Ultra-fresh melt water according to our instructions, to quickly cleanse and rinse the lymph, blood, intercellular space, and skin from the accumulation of harmful metabolites.Ultra fresh water - contains 100 times less salts than most plain water. It best cleanses our blood of allergens and metabolites, toxins, and waste products in the blood that cause itching. In this case, the water has the property of hypoosmolarity; such water enters the cells in excess, but will give preference to entering the diseased cells. We have proposed regular intake for several months or until the hypoosmolar water is restored. You need to drink such water taking into account the replacement of all the liquid that you usually drink during the day. The first signs of improvement will begin within a few months. You need to drink water in small sips throughout the day. Rain or melted snow water can be used as hypoosmolar water. Collect them from absolutely clean places in glass containers. Worst case scenario, you can get such water by distilling water. By the way, the distillate is also sold in pharmacies. You can obtain this water using a filter device that has reverse osmosis filters and purifies the water not only from dirt and microflora, but also from mineral salts. To improve the properties of such water, it is better to obtain it by passing it through a container with living medicinal leaves, on which it settles and creates water condensation, which flows into the bottle. Such water will be an analogue of natural dew. This water was used by some healers (including Vanga) to treat chronic diseases.With proper and timely treatment and active use of Ultra-Fresh Water, all of these symptoms can quickly disappear.

Sometimes the cause of this itching is increased sugar in the blood and urine. You should definitely get tested for sugar in your urine. Perhaps you haveprediabetes . In this case, it is recommended to additionally order a set of medications for the prevention and treatment of diabetes. In this case, you need to additionally write us a letter with an updated diagnosis or order a set of drugs for prevention and treatmentdiabetes . And you also need to drinkcourse of at least 3 months Ultra-fresh water , since this method also helps with diabetes.

At acute urticaria caused by ingestion of food ormedicinal substances, it is necessary first of all to prescribe laxatives: magnesium sulfate, castor oil and medicinal plant substances that disinfect the intestines: celandine, marigold decoction, seaweed preparations. Traditional medicine recommends the following remedies for suddenly appearing, acute urticaria (as with all skin diseases): * Constantly consume licorice root, the size of a bean, 1-2 times a day. * PEPPERMINT. An infusion is being prepared. Pour 2 tablespoons of mint into 300 ml of boiling water, leave for 1 hour. Take 50 ml 3 times a day.

* "DEAD" NETTLE. It is used for urticaria in the form of salads from young leaves or as an infusion or decoction of powdered flowers.

The most important thing, whatever the origin of this disease, is to cleanse the stomach: take a large dose of a laxative. And from traditional medicine I recommend the following.

Celery root grate, squeeze out the juice. Drink 2 tsp. 3 times a day half an hour before meals

Celery root infusion: 2 Art. l. fresh crushed roots per glass of cold boiled water, leave for 2 hours, strain. Drink 1/3 glass 3 times a day before meals. Has a strong

diuretic effect. Also serves as a pain reliever for allergic urticaria, skin diseases and poor digestion.

Washing the body with wood lye. Burn several logs, collect clean ash, wash with water and boil. Let it sit, drain the infusion, strain and wash with this lye.

In children, the disease can be cured with freshjuice of the common cocklebur herb. As a tincture, give from 2 to 10 drops, depending on age. Adults - 20 drops per dose.

Finally, if the rash is very profuse, take half-hour warm baths with soda twice a day, 400 g of soda per bath. Then wipe the body with almond oil with vodka or menthol, water with vinegar or fresh tomato juice.

BEET KVASS FOR HURTICS. Folk recipe: take beet kvass, heat it a little and bathe in it. If you don’t have enough kvass, you can simply wipe yourself off with it. Kvass recipe: there is a special “kvass” striped beet, but you can use red table or fodder beets. Beets cut into small pieces are placed in a 3-liter jar halfway and filled with cold water. When foam forms, it must be removed and water added (1 - 2 tablespoons). You can prepare kvass in a bucket or in any container. On the 6th day it is ready. By the way, you can drink it.

For severe rashes, do this twice a day for 30 minutes. warm baths with soda (400 g of soda per bath). After water procedure Wipe your body well with almond oil, and in your diet you must definitely reduce the amount of sugar consumed and exclude spicy foods.

Treatment of itchy dermatoses using celandine preparations

Bran decoction (250-1000 g) is used as a preventive measure to help “take care of the skin and prevent such excesses.” wheat bran boil in 4-6 liters of water for 30 minutes, filter and pour into the bath), decoctions of chamomile, string, linden blossom. But what should those who manage to become infected with a fungal disease do? An effective way to combat this unpleasant illness are preparations of celandine. We are talking, first of all, about celandine ointment. It is prepared on the basis of an alcoholic extract of celandine, the recipe for which is given below.

Celandine extract : Alcohol extract of celandine is prepared at the rate of 1 part herb to 2 parts 50% alcohol solution. Infuse in a dark place for 10-12 days.

Celandine ointment. Celandine ointment is prepared during the full moon using an alcohol extract. The alcohol extract is mixed with pork fat or petroleum jelly and heated in a water bath until the alcohol evaporates. The ointment is used to treat a variety of skin diseases. During therapy with this ointment, it is recommended to take 20 drops of the extract daily, diluting it with vodka or alcohol before taking it in order to reduce the concentration of celandine. It is useful to drink the extract with a quarter glass of plantain juice. As an additional and very effective remedy to eliminate pain, itching, burning and other unpleasant sensations that occur with dermatoses, it is recommended to use compresses and baths based on celandine decoction. These forms of therapy have worked very well. As a rule, the unpleasant sensations typical for this type of disease disappear 2-3 days after the first use of the drug. Over time, inflammatory processes also stop.

To treat this disease, I suggest ordering the following:

1. Infusion of balsam poplar - 3 bottles.

2. MYRTAbiotic 330 ml .– a new generation of harmless natural antibiotic wide spectrum, phytocomplex: colds, viruses, herpes, trophic ulcers, rhinitis, gastrointestinal diseases, urethritis, cystitis, prostatitis, rheumatism, cholangitis, pyelonephritis, polyarthritis. It is also possible for weakened children for whom chemicals are contraindicated. antibiotics, because it does not lead to bacteria becoming addicted to them and there are no side effects. Strengthening your immune system!

It is especially effective for suppressing staphylococci, streptococci, etc., which are almost impossible to get out of the blood and diseased organs with any medications. Unlike medical chemical antibiotics, it does not cause an addiction reaction to them. Take 1-2 teaspoons before meals, 2-3 times a day, course 1 month, break 1 month and repeat. It goes well with all my other medications.

3. Kurunga (probiotic) - 3 p. – the powder is fermented in milk, or crackers with jam, or taken after meals in the form of fermented kefir, 1-2 glasses a day, the course is at least 3-5 months, the break is the same and can be repeated. - For the treatment of the intestines from dysbiosis, which is a prologue for allergies and weakened immunity. Usually when taking black walnut, you skip taking Kurunga. Book Garbuzova G.A.: “ Dysbacteriosis - prevention and treatment without drugs" - 100 rub.

- take 1 tea before meals. spoon 2-3 times a day, course 1 month, repeat after 2 months.

5. Micellate - This is a new product, first created in Russia, of liquid micellate, that is, water-soluble and completely digestible calcium.It is absolutely necessary to alkalize the body, relieve over-acidification of the acid-base balance of the blood and remove and displace excess acid-type metabolites from the blood. These harmful metabolites also often cause itching due to a shift in the acid-base balance of the blood. With increased acidity, there is a violation of the immune system, viruses and bacteria that enter the blood quickly multiply, vitamins and microelements are poorly absorbed. This is how numerous diseases arise. One of the main chemical elements of the body is calcium. Its deficiency leads to acidification of the body and then to 150 diseases. Use temporarily natural powder from bird shells, where its content reaches up to 90%. The whitish film is removed from the inside of the shell. The powder can be taken 1/3-1 teaspoon orally. To improve results, you also need vitamin D and fish oil. That is, taking calcium water must be combined with fish oil.Calcium citrate (calcium citric acid) . Has good absorption in the gastrointestinal tract. To obtain it, you can use the following recipe: powder from egg shells is poured with a solution of citric acid or lemon juice, but you can also use apple cider vinegar, stir and hold until the shell dissolves. Take a solution daily in the amount of 1-2 egg shells. But you can also dry the solution and take it in powder form. Duration of taking calcium water: can be taken constantly, and even more so for seriously ill people and patients with incurable chronic conditions. Calcium, like sodium, prevents dehydration in our body, so they can and should be taken together. Therefore, everyone to whom we recommend taking courses of Ultra-Fresh water, alternating after 3-4 days or a week with increased consumption of lightly salted water, can do the latter together with calcium intake. Most of us are constantly in a state of chronic lack of fluid, without even knowing it. When we drink tea, coffee, alcohol, cola, we only make the situation worse. Avoid all boiled drinks during treatmentNecessarily refuse.

7. Succinic acid – Succivit – 3 packs in tablet form . - an effective treatment for chronic urticaria. Clinical trials of a similar, but liquid drug were conductedReamberin (RA).

As is known, biologically active inflammatory mediators play an important role in the pathogenesis of this disease: histamine, bradykinin, serotonin, etc., the possibility of autosensitization under the influence of one’s own insulin, endotoxin, kallikrein is possible. It is possible that nitric oxide plays a role in the occurrence of the disease. The most severe complication of HC is OC, which can lead to asphyxia and death of the patient. To treat patients, a solution of reamberin 1.5% was used - 400 ml daily for 7-10 days, depending on the severity of intoxication symptoms. A positive therapeutic effect was observed in 96.7% of patients. At the same time, by the end of treatment, the appearance of new urticarial rashes on the skin completely stopped. In addition, patients received chronic RA. urticaria, who developed OK during exacerbation of the disease. A positive effect was observed only in 53.8% of patients. Thanks to the introduction of RA into therapy in these patients, it was possible to stop the development of edema of the mucous membranes of the upper respiratory tract by the end of the 1st session (at the 2nd hour of treatment). But, despite the ongoing RA therapy, the attacks of suffocation recurred in the subsequent days of therapy, although their intensity noticeably decreased. The picture of urticarial rashes also noticeably regressed with each subsequent day: in 3 patients it decreased markedly, and completely disappeared in 4 patients. Therapy was ineffective in 46.2% of patients with Quincke's edema. These patients require the introduction of a coenzyme form of vitamin B 6 - pyridoxalphosphate or pyriditol.

RA therapy followed the previous regimen with simultaneous intramuscular administration of pyridoxal phosphate (the contents of the 0.01 ampoule were dissolved in 1-2 ml of water for injection). Against this background, already 10-15 minutes after the administration of 10 mg of pyridoxalphosphate in these patients, the increase in manifestations of OK stopped and regressed. Complete resolution of OK -58.3% by the end of the 1st hour of treatment, and by the end of the 2nd hour - in 33.3%, significant improvement in one (8.4%) patient.

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

Urticaria is a common disease - approximately every third person has suffered from urticaria at least once in their life. In the structure of diseases of allergic origin, urticaria ranks second after bronchial asthma, and in some countries (Japan) even first.
Urticaria and angioedema can occur at any age. The disease most often occurs between the ages of 21 and 60. Women are more often affected, which is associated with the characteristics of their neuroendocrine system. According to various authors, burdened allergic heredity is noted in 25-56% of cases.

Classification of Urticaria.

Etiopathogenetic classification of urticaria

I. Allergic

• Food
• Medicinal and chemical substances
• Household
• Epidermal
• Pollen
• Whey
• Insect
• Infectious

II. Physical

• Mechanical
• Cold
• Thermal
• Radial
  a) light
  b) for x-ray irradiation
• Cholinergic

III. Endogenous

• Enzymopathic:
  a) deficiency or insufficient activity of the C1 inhibitor;
  b) deficit digestive enzymes
• Dishormonal
• Idiopathic

IV. Pseudo-allergic.

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

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. Pathohistologically, in the area of ​​the blister, loosening of collagen fibers, intercellular edema of the epidermis, and the appearance of perivascular mononuclear infiltrates with varying rates of development and severity are noted.

Allergic Urticaria.

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

Physical Urticaria.

Physical urticaria is caused by various physical factors.
Heterogeneous in pathogenesis. Allergic, pseudoallergic and other mechanisms may participate in its development.

Mechanical urticaria develops as a result of mechanical irritation of the skin.
The following types are distinguished:
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 intense scratching, an increase in histamine levels is found in the blood;
b) urticaria from pressure 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 angioedema.

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

Heat urticaria.
The active factor is heat. One of the possible developmental mechanisms is the alternative pathway of complement activation.

Radiation urticaria occurs under the influence of visible and X-ray rays. In the visible spectrum, rays with a certain wavelength are active. This is the basis for the division of light urticaria into subgroups. The mechanisms of development of urticaria are different. The possibility of passive transfer has been described in cases of urticaria caused by rays with wavelengths of 285-320 and 400-500 nm. When in action x-rays Free radicals are formed, causing damage to cell membranes.

Cholinergic urticaria.
The active factor is obviously 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 nervous system - acetylcholine. At the same time, in a number of cases, an increase in the content of histamine in the blood, as well as the possibility of passive transfer, have been established.

Endogenous Urticaria.

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

Enzymopathic urticaria presented two types.

One kind associated with deficiency of the inhibitor of the first complement component. 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 3-4 times, but it is structurally changed and forms a complex with albumin. Inhibitor deficiency 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. Drinking alcohol 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 with premenstrual syndrome. The relationship between cortisol and histamine plays a role in their influence at the level of microcirculatory vessels. Any shift towards the predominance of histamine action will lead to increased vascular permeability.

Idiopathic urticaria.
This diagnosis is made in cases where the doctor does not know either the cause or the mechanism of 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, for example, systemic lupus erythematosus, glomerulonephritis, infective endocarditis, cryoglobulinemia. In these cases, complement activation is often detected by the resulting immune complexes. During a biopsy, vasculitis with perivascular lymphocytic infiltration is found.

Pseudoallergic forms of urticaria.

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

Clinical picture of 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, at the sites of itching, hyperemic areas of the rash appear, protruding above the surface. As the swelling increases, the capillaries are compressed and the color of the blister turns pale. With significant exudation, a blister with detachment of the epidermis may form in the center of the edema.

Urticaria can become hemorrhagic due to its release from the vascular bed shaped elements blood. Subsequently, red blood cells, disintegrating in the surrounding tissue, form dark spots, which should not be confused with urticaria pigmentosa (mastocytosis).
The size of the rash elements varies - from a pinhead to gigantic sizes. Elements can be located separately or, merging, form elements with bizarre outlines and scalloped edges.

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

Chronic recurrent urticaria characterized by an undulating course, sometimes for a very long time (up to 20-30 years) with various periods of remission. Very often it is accompanied by Quincke's edema. In chronic urticaria, transformation of urticarial elements into papular elements is occasionally observed. This form of urticaria is characterized by particularly painful itching. Patients scratch the skin until it bleeds, causing infection, resulting in the appearance of pustules and other elements. In this case, the rash is not monomorphic.

Quincke's edema.

If the edema spreads deeper and covers the entire dermis and subcutaneous tissue (sometimes spreading to the muscles), then the appearance of a large, pale, dense, non-itchy infiltrate is observed, which, when pressed, does not leave a hole. 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 common localization is lips, eyelids, scrotum, mucous membranes of the oral cavity (tongue, soft palate, tonsils).

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

Patients are restless and tossing around. When the edema spreads to the mucous membrane of the tracheobronchial tree, bronchial asthma syndrome with characteristic diffuse expiratory wheezing is added to the picture of acute laryngeal edema. In severe cases, in the absence of rational assistance, patients may die due to asphyxia. With mild and moderate severity swelling of the larynx lasts from an hour to a day. After the acute period subsides, hoarseness, sore throat, difficulty breathing remain for some time, and dry and moist rales are heard on auscultation. Quincke's edema in the larynx requires immediate intensive care, including tracheostomy.

When edema is localized on the mucous membrane of the gastrointestinal tract, abdominal syndrome. It usually begins with nausea, vomiting first food, then bile. Arises sharp pain, initially local, then spread throughout the abdomen, accompanied by flatulence, enhanced peristalsis intestines. During this period, a positive Shetkin's symptom may be observed. The attack ends with profuse diarrhea.
Microscopic examination of the stool reveals a significant number of eosinophils, and Charcot-Leyden crystals may be present. Abdominal edema is combined with skin manifestations in 30% of cases.

When the pathological process is localized in urogenital tract the picture is developing acute cystitis, then urinary retention occurs. Swelling of the genital organs is accompanied by a corresponding clinical picture.

When localizing processes on the face the process may involve the serous meninges with the appearance meningeal symptoms, such as stiff neck, severe headache, vomiting, and sometimes convulsions. Rarely, Meniere's syndrome develops as a result of swelling of the labyrinthine systems. Clinically, it manifests itself as dizziness, nausea, and vomiting.

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

Pathogenesis.

According to the pathogenesis, angioedema can be 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 exclude the diagnosis of this disease. The combination of the characteristic clinical picture and laboratory examination data is crucial. The clinical picture of hereditary angioedema is characterized by prolonged formation of very dense edema, with laryngeal edema and abdominal syndrome often occurring in the absence of indications of skin itching and urticaria, and there is no effect from antihistamines.

Differential diagnosis.

The diagnosis of urticaria is generally not difficult in typical cases of the disease. However, there are many other diseases that masquerade as urticaria.

Due to sudden swelling, hemorrhage may 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, the morphological expression of which is the accumulation 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-pruritic, often painful rash, its localization on the back of the hands and feet (which is rarely observed with urticaria), and damage to the mucous membranes in the form of a vesicular rash. In severe cases 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, which cannot be treated with antihistamines and corticosteroids. After deworming, urticaria is completely relieved in the absence of antiallergic therapy.

Macular form of the rash during the secondary period syphilis may 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, and can appear in the prodromal stage of infectious hepatitis.

A specific allergological examination of patients with urticaria and angioedema, in addition to collecting an allergic history, includes skin tests. In case of food and drug allergies, provocative tests with oral administration of a product or medication can be used for diagnostic purposes, if there is no severe reaction to this product.

TREATMENT OF HURTICS AND ANVINCE'S EDEMA.

At Acute urticaria and Quincke's edema carry out the same treatment as for other acute allergic reactions, with an impact on various pathogenetic links of the process.

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

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

Nonspecific therapy.

• Assign Antihistamines, which need to be changed every 2 weeks.
• Can be recommended Sodium thiosulfate, magnesium thiosulfate.
• Externally, to reduce itching, wipe with table vinegar or use ointments with 2-5% anesthesin.
• Histaglobulin(foreign histaglobin) is prescribed according to a regimen taking into account the tolerability of the drug. The usual regimen 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. If the treatment is effective, the course can be repeated after 6 months - 1 year.
• Treatment pure Histamine start with a threshold dilution determined by allergometric titration. Treatment with histamine is best carried out in an allergy department.
• In especially severe cases of the disease, in the absence of effect from other therapy, it is necessary to use Corticosteroid drugs according to an individual scheme.
• If the clinical picture of chronic recurrent urticaria has a hemorrhagic component (vasculitis), you should prescribe Indomethacin and others NSAIDs.
• Effective in some cases Splenin(1 g daily, 14-20 injections in total).

Specific therapy.

• Held allergen elimination and/or Specific Hyposensitizing therapy. Elimination means the exclusion of a suspected (or identified) food product from food or medicine.
• Sanitation of foci of focal infection is necessary for 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 with the identified allergen is carried out according to the generally accepted treatment regimen for allergic diseases.

During treatment Hereditary angioedema antihistamines and corticosteroids are ineffective.

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

Treatment requires 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. Treatment with dosed physical activity gives good results.

Treatment requires great persistence Cold urticaria .

• In some cases, there is an effect from the course 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 blood taken from the patient immediately after strong cooling of the hand under running cold water, which caused the appearance of hives.

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

• Gastric juice, plantain juice, festal type enzymes, Dysbacteriosis is treated. For patients with chronic recurrent urticaria with concomitant diseases of the gastrointestinal tract, sanatorium-resort treatment is recommended at resorts such as Essentuki, Gruskavets, Marshansk, etc.

Treatment of chronic recurrent urticaria is also complicated by the fact that combinations of etiological different forms hives.

Forecast.

The prognosis for urticaria of allergic origin is favorable in most cases. Quincke's edema localized in the larynx is life-threatening. The prognosis is unfavorable for hereditary angioedema. Families are described where several generations suffered from this disease and died before the age of 40 from asphyxia due to angioedema of the larynx.
Prevention of chronic recurrent urticaria and Quincke's edema is the timely sanitization of foci of focal infection, deworming, and treatment of chronic diseases of the gastrointestinal tract.

Acute urticaria occurs violently in the form of severely itchy urticarial rashes on the torso, upper and lower extremities. Blisters of pale pink or porcelain color of different sizes and different localization are raised above the level of the skin, round, less often - elongated, prone to merging, sometimes into large areas and with massive swelling of not only the dermis, but also the hypodermis (giant urticaria). At the height of the disease there is a violation general condition patient: increased body temperature, malaise, chills, joint pain (nettle fever). A distinctive feature of blisters is their ephemerality, as a result of which each element usually exists only for a few hours and disappears without a trace. Rashes may appear on the mucous membranes of the lips, tongue, and soft palate. In case of damage to the respiratory tract (larynx, bronchi), difficulty breathing and paroxysmal cough are noted; with rapidly increasing swelling, a threat of asphyxia is created.

Variants of acute urticaria are solar urticaria and cold urticaria. The development of solar urticaria is based on disorders of porphyrin metabolism in liver diseases. Porphyrins have photosensitizing properties, and therefore after long stay In the sun during the spring and summer, blisters appear on exposed areas of the skin (face, chest, limbs). Cold urticaria occurs as a result of the accumulation of cryoglobulins, which have the properties of antibodies. Blisters appear when exposed to cold and disappear when warm.

Acute limited angioedema

Acute limited angioedema is characterized by the sudden development of swelling of the skin, mucous membrane, subcutaneous fat (cheeks, eyelids, lips) or genitals. Single or multiple blisters of a dense elastic consistency, white or pink, appear. Often in practice, the simultaneous existence of ordinary urticaria and angioedema is noted. After a few hours or 2-3 days, the process resolves without a trace.

Chronic recurrent urticaria

Chronic recurrent urticaria occurs with prolonged sensitization, i.e. in the presence of foci of chronic infection, concomitant diseases of the gastrointestinal tract, and liver. Recurrence is observed daily with rashes of varying numbers of blisters, but with remissions of varying duration. Blisters appear on any part of the skin. Their appearance may be accompanied by weakness, temperature reaction, headache, malaise, and arthralgia. Excruciating itching can cause the development of insomnia and neurotic disorders. Eosinophilia and thrombocytopenia are observed in the blood.

Sometimes artificial urticaria occurs, which occurs after mechanical impact on the skin with a blunt object. The rash disappears spontaneously after some time.