Schaefer Paul
University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
Am Fam Physician. 2017 Jun 1;95(11):717-724.
Urticaria commonly presents with intensely pruritic wheals, sometimes with edema of the subcutaneous or interstitial tissue. It has a lifetime prevalence of about 20%. Although often self-limited and benign, it can cause significant discomfort, continue for months to years, and uncommonly represent a serious systemic disease or life-threatening allergic reaction. Urticaria is caused by immunoglobulin E- and non-immunoglobulin E-mediated release of histamine and other inflammatory mediators from mast cells and basophils. Diagnosis is made clinically; anaphylaxis must be ruled out. Chronic urticaria is idiopathic in 80% to 90% of cases. Only a limited nonspecific laboratory workup should be considered unless elements of the history or physical examination suggest specific underlying conditions. The mainstay of treatment is avoidance of triggers, if identified. The first-line pharmacotherapy is second-generation H1 antihistamines, which can be titrated to greater than standard doses. First-generation H1 antihistamines, H2 antihistamines, leukotriene receptor antagonists, high-potency antihistamines, and brief corticosteroid bursts may be used as adjunctive treatment. In refractory chronic urticaria, patients can be referred to subspecialists for additional treatments, such as omalizumab or cyclosporine. More than one-half of patients with chronic urticaria will have resolution or improvement of symptoms within a year.
荨麻疹通常表现为剧烈瘙痒的风团，有时伴有皮下或间质组织水肿。其终生患病率约为20%。虽然通常为自限性且良性，但可引起明显不适，持续数月至数年，罕见情况下代表严重的全身性疾病或危及生命的过敏反应。荨麻疹是由免疫球蛋白E介导和非免疫球蛋白E介导的组胺及其他炎症介质从肥大细胞和嗜碱性粒细胞释放所致。临床诊断；必须排除过敏反应。80%至90%的慢性荨麻疹病例病因不明。除非病史或体格检查提示特定的潜在疾病，否则仅应考虑进行有限的非特异性实验室检查。治疗的主要方法是避免已确定的触发因素。一线药物治疗是第二代H1抗组胺药，可滴定至高于标准剂量。第一代H1抗组胺药、H2抗组胺药、白三烯受体拮抗剂、高效抗组胺药和短期使用皮质类固醇可作为辅助治疗。对于难治性慢性荨麻疹患者，可转诊至专科医生处接受其他治疗，如奥马珠单抗或环孢素。超过一半的慢性荨麻疹患者症状会在一年内缓解或改善。
