First, the reasons for treatment
Eliminating the inducement or suspicious causes is beneficial to the natural disappearance of urticaria. Treatment is mainly considered from the following aspects:
1. Detailed medical history is the most important way to find possible causes or incentives.
2. For patients with induced urticaria, including physical and non-physical urticaria, avoiding corresponding stimuli or inducing factors can improve clinical symptoms and even heal themselves.
3. When drug-induced urticaria is suspected, especially non-steroidal anti-inflammatory drugs and angiotensin converting enzyme inhibitors, we can consider avoiding or replacing it with other drugs.
4. For chronic urticaria clinically suspected to be related to various infections and chronic inflammation, when other treatment methods are resistant or ineffective, anti-infection or inflammation control may be considered as appropriate, and some patients may benefit. Such as anti-Helicobacter pylori treatment, has a certain effect on urticaria associated with Helicobacter pylori-associated gastritis.
5. For patients suspected of food-related urticaria, encourage them to keep a diet diary, look for possible foods and avoid eating them, especially some natural food ingredients or some food additives, which can cause non-allergic urticaria.
6. For patients with positive autologous serum skin test (ASST) or confirmed IgE autoantibodies in the body, immunosuppressants, autologous serum injection therapy or plasma exchange may be considered as appropriate when routine treatment is ineffective and the condition is serious.
Second, medication.
Drug selection should follow the principle of safe, effective and regular use, with the goal of improving the quality of life of patients. It is suggested that the treatment plan should be formulated and adjusted according to the patient's condition and response to treatment.
1. First-line treatment: the second generation of non-sedative or low-sedative antihistamines is preferred, and the dosage is gradually reduced after effective treatment to achieve effective control of wheezing. In order to improve the quality of life of patients, the course of treatment of chronic urticaria is generally not less than 1 month, and can be extended to 3~6 months or longer if necessary. The first generation of antihistamines is effective in treating urticaria, but its clinical application is limited by adverse reactions such as central sedation and anticholinergic effect. On the premise of paying attention to contraindications, adverse reactions and drug interactions, you can choose as appropriate. The commonly used first-generation antihistamines include chlorpheniramine, diphenhydramine, doxepin, promethazine and ketotifen, while the second-generation antihistamines include cetirizine, levocetirizine, loratadine, desloratadine, fexofenadine, Avastin, ebastine, epinadine, mizolastine and olopatadine.
2. Second-line therapy: the conventional dose 1~2 weeks can not effectively control the symptoms. Considering the difference of treatment response of different individuals or urticaria types, we can choose to change varieties, or increase the dosage by 2~4 times with the informed consent of patients, or take it in combination with the first generation of antihistamines before going to bed to reduce adverse reactions; Combining with the second generation antihistamines, it is advocated to combine drugs with similar structures, such as loratadine and desloratadine, to improve the anti-inflammatory effect; Combined anti-leukotriene drugs are especially suitable for urticaria caused by non-steroidal anti-inflammatory drugs.
3. Third-line treatment: For patients who fail to respond to the above treatment, the following treatments can be considered:
1, cyclosporine: Because of its high incidence of adverse reactions, it is only used against critically ill patients who have failed to respond to any dose of antihistamines.
2, glucocorticoid: suitable for acute, severe or urticaria with laryngeal edema.
3, immunoglobulin: such as intravenous immunoglobulin, suitable for severe autoimmune urticaria.
4. Biological agents: Foreign studies show that omalizumab (anti-IgE monoclonal antibody) has a positive effect on refractory chronic urticaria.
5. Phototherapy: For patients with chronic spontaneous urticaria and artificial urticaria, besides antihistamine treatment, UVA and UVB can be tried.
Third, surgical treatment.
Chronic urticaria generally does not require surgical treatment.
Fourth, Chinese medicine treatment.
1, TCM treatment:
(1) Treatment of exterior syndrome of wind-heat offense: dispelling wind and clearing heat;
(1) Recommended prescription: Xiao Feng San He Fang Jing Fang. Herba Schizonepetae, Radix Saposhnikoviae, Periostracum Cicadae, Duckweed, Flos Lonicerae, Rhizoma Anemarrhenae, Radix Angelicae Sinensis, Radix Rehmanniae, Radix Glycyrrhizae, etc.
(2) Chinese patent medicines: Xiaofeng Zhiyang Granules, etc.
(2) Treatment of exterior syndrome of wind-cold bundle: expelling wind and dispelling cold;
(1) Recommended prescriptions: Mahuang decoction and Yupingfeng powder. Herba Ephedrae, Ramulus Cinnamomi, Herba Schizonepetae, Radix Astragali, Rhizoma Atractylodis Macrocephalae, Radix Saposhnikoviae, Radix Glycyrrhizae, Periostracum Cicadae, Fructus Jujubae, Mume, etc.
(2) Chinese patent medicines: Yupingfeng granules, Guizhi granules, etc.
(3) Syndrome and treatment of gastrointestinal damp-heat: clearing damp-heat;
(1) Recommended prescription: Wei Ping Sanhe Fangfeng Tongsheng Powder. Radix Saposhnikoviae, Fructus Gardeniae, Herba Schizonepetae, Pericarpium Citri Tangerinae, Rhizoma Atractylodis, Rhizoma Atractylodis Macrocephalae, Cortex Magnolia Officinalis, Radix Paeoniae Rubra, Gypsum Fibrosum (parched first) and Radix Astragali.
(2) Chinese patent medicines: Fangfeng Tongsheng Pills, etc.
(4) Syndrome and treatment of blood deficiency and wind excess: nourishing blood to extinguish wind;
(1) Recommended prescription: Jiawei Danggui Yinzi. Radix Angelicae Sinensis, Radix Paeoniae Rubra, Radix Rehmanniae, Radix Paeoniae Alba, Semen Persicae, Carthami Flos, Radix Saposhnikoviae, Herba Schizonepetae, Radix Glycyrrhizae Preparata and Solanum nigrum.
(2) Chinese patent medicines: Runzao Zhiyang capsules, etc.
2, Chinese medicine lotion: wind red itching, can be decocted with Chinese medicine (Notopterygium, Schizonepeta, Saposhnikovia divaricata, duckweed, Sophora flavescens, etc.). ).
3. Acupoint therapy:
(1) Take acupoints such as Dazhui, Hegu, Quchi, Xue Hai, Zusanli, Pishu and Shu Fei, and leave needles for 20-30 minutes once a day or every other day. Or acupoint injection, once a day or once every other day. Quchi is given priority to, with Fengchi, Hegu and Xue Hai points; Gastrointestinal heat accumulation plus diarrhea, stagnation and Zusanli; Fever and irritability will increase the puncture and bloodletting of vertebral and Weizhong points; Abdominal pain is matched with Tianshu point.
(2) According to different syndromes, cupping was performed in Dazhui, Fengmen, Shu Fei, Shu Ge, Pishu, Shu Wei, Quchi, Wang Shen, Xue Hai and Zusanli, with 65,438 00 minutes each time, once a day, and three times was 1 course of treatment. Cupping therapy at Shenfa point. Chronic urticaria seriously affects the physical and mental health of patients, and patients should be actively treated. The treatment method is as follows:
1, western medicine: taking anti-allergic drugs, such as cetirizine, chlorpheniramine, cyproheptadine, ketotifen, etc. Interferon is also injected to improve immunity;
2. Traditional Chinese medicine: treatment based on syndrome differentiation, oral administration of traditional Chinese medicine, external washing, acupuncture, acupoint injection, cupping, moxibustion and acupoint application. The specific medication should be combined with the clinic, and the face-to-face diagnosis of the doctor shall prevail.