Kasperska-Zajac Alicja, Grzanka Alicja, Kowalczyk Jacek, Wyszyńska-Chłap Magdalena, Lisowska Grażyna, Kasperski Jacek, Jarząb Jerzy, Misiołek Maciej, Kalarus Zbigniew
Department of Internal Diseases, Dermatology and Allergology, Medical University of Silesia in Katowice, Poland
Department of Internal Diseases, Dermatology and Allergology, Medical University of Silesia in Katowice, Poland.
Int J Immunopathol Pharmacol. 2016 Mar;29(1):112-20. doi: 10.1177/0394632015617770. Epub 2015 Dec 3.
Controversy surrounds the role of dental infection/inflammation in the oral cavity in chronic spontaneous urticaria (CSU) and atrial fibrillation (AF), which is mainly due to scarce literature in this area. Therefore, this case report and review of literature illustrate a possible association between the acute-phase response (APR) and clinical conditions, such as CSU and dental infection/inflammation of oral cavity and AF.We describe a 36-year-old man with an 8-year history of difficult-to-treat, uncontrolled CSU, co-existent with dental infection/inflammatory processes of oral cavity and permanent atrial fibrillation (AF). In the presented case, the most likely triggering or aggravating/maintaining factor of the symptoms was the inflammation/dental infection of the oral cavity because of rapid reduction of the urticarial symptoms, drug doses, and serum CRP levels after the dental therapy. Dental treatment may have a beneficial effect on the systemic inflammatory response, reducing/normalizing the circulating levels of APR markers. APR activation appears to worsen CSU course, early identification and treatment of infectious/inflammatory foci in the oral cavity would form the mainstay of supportive therapy for CU probably through reduction of the systemic inflammatory burden. APR associated with infectious/inflammatory foci in the oral cavity could be taken into account as a predisposing agents to AF.
口腔中的牙齿感染/炎症在慢性自发性荨麻疹（CSU）和心房颤动（AF）中的作用存在争议，这主要是由于该领域的文献稀缺。因此，本病例报告及文献综述阐述了急性期反应（APR）与临床病症之间的可能关联，如CSU、口腔牙齿感染/炎症以及AF。我们描述了一名36岁男性，患有8年难以治疗且控制不佳的CSU，同时伴有口腔牙齿感染/炎症过程及永久性心房颤动（AF）。在本病例中，最可能引发或加重/维持症状的因素是口腔炎症/牙齿感染，因为在牙科治疗后荨麻疹症状、药物剂量和血清CRP水平迅速降低。牙科治疗可能对全身炎症反应具有有益作用，降低/使APR标志物的循环水平正常化。APR激活似乎会使CSU病程恶化，早期识别和治疗口腔中的感染/炎症病灶可能是CU支持性治疗的主要手段，可能是通过减轻全身炎症负担。与口腔感染/炎症病灶相关的APR可被视为AF的诱发因素。
