Urticaria: causes, types, symptoms, treatment

Published: 06/17/2021 12:50:00 Updated: 06/17/2021

Gout is a systemic disease characterized by impaired purine metabolism in the body and the deposition of urate crystals in the joints. The main manifestation of the disorder is considered to be repeated attacks of arthritis with intense pain in the joints and the appearance of tophi - gouty nodules. Also, with this disease, accumulation of salts in the kidneys is possible with the development of urolithiasis and renal failure.

The prevalence of the disease among adults in Europe ranges from 0.9 to 2.5%, and in the United States reaches 3.9%. Gout is most often diagnosed in men over 40 years of age. Among women, the pathology occurs 6-7 times less often.

What is a stroke

The essence of a stroke is the cessation of blood supply and functioning of a part of the brain as a result of damage to a vessel.
The larger the affected area, the more severe the stroke. Necrosis of a portion of the brain substance is called an infarction [3]. There is a high risk of death in the first few hours, and then in the period up to 28 days after a vascular accident. The annual mortality rate from stroke in the Russian Federation is 374 cases per 100,000 [10]. In 2018, 35% of patients died in the acute period of stroke; by the end of the first year, this figure increases by 15%, and in general, in the first 5 years, the mortality rate of strokes is 44% [11]. The mortality rate from stroke was 92.9 per 100,000 population, and the hospital mortality rate was 19.1% [5].

Long-term disability is most likely for patients who have suffered a stroke. The prevalence of primary disability due to stroke in 2018 was 3.2 per 10 thousand population [2]. Of these, 31% need constant care, 20% have severe mobility limitations, and only 8% return to work [3]. The prevalence of recurrent strokes in 2014 was 0.79%, of which ischemic

strokes account for 87.5% [9].

Causes of stroke

Depending on the cause of cerebrovascular accident, ischemic and hemorrhagic strokes are distinguished.

Ischemic stroke occurs as a result of blockage of cerebral vessels by a blood clot, when gradually less and less blood flows to an area of ​​the brain. Hemorrhagic stroke develops as a result of rupture of a vessel and hemorrhage in the brain tissue, as a result of which the blood supply to its area abruptly stops. Hemorrhage can be into the subarachnoid space (SAS) or directly into the cerebral substance (ICH). The ratio of ischemic and hemorrhagic strokes is 4-5:1 [4].

Pathologically, a stroke can be cardioembolic, lacunar, atherothrombotic, or another, including unknown, etiology (TOAST classification) [10].

Predisposing factors:

• men from 45 to 59 years old;
• age 70 years and older (for both sexes) [4];
• arterial hypertension;
• atrial fibrillation;
• atherosclerosis of cerebral vessels;
• coagulopathy, thrombophilia, anemia;
• arteriovenous malformations;
• osteochondrosis with damage to the vertebral artery;
• brain tumors;
• dyslipoproteinemia;
• obesity;
• diabetes;
• intermittent claudication;
• mechanical prostheses of heart valves and blood vessels;
• IHD, myocardial infarction less than 6 months before the stroke;
• other cardiac diseases;
• smoking, alcoholism;
• family history of stroke;
• sedentary lifestyle;
• stress [1, 3].

Causes of gout

The main cause of gout is considered to be a violation of uric acid metabolism, leading to its excess in the blood - hyperuricemia.
This condition occurs when the intake of purines from food increases, when their metabolites simply do not have time to be excreted in the urine, or when the excretory function of the kidneys is impaired, as well as in the case of accelerated destruction of cells containing the nucleosides adenine and guanine in RNA and DNA, from which urinary tract is formed. acid in the human body. In this case, uric acid salts (urates) accumulate in the soft tissues of various organs, mainly in the joints, provoking their inflammation. Gout is also known as the “disease of feasting kings.” It received this name because the main source of its occurrence was considered to be excess in food and alcoholic beverages.

Now the disease has been studied in more detail and the following factors predisposing to the development of the pathology have been identified:

• consumption of foods rich in purines - meat, fatty fish, legumes, caffeine-containing products, offal (kidneys, liver, brain), seafood, as well as alcohol in large quantities;
• consumption of carbonated, sweet drinks and fruit juices;
• obesity;
• hemolytic anemia, leukemia, lymphoma;
• genetic defects (usually in men) and reduction of enzymes involved in the metabolism of uric acid;
• the use of medications such as diuretics, cytostatics, salicylates.

In women, gout usually develops in postmenopause, so the disease is also associated with hormonal changes in the body.

Signs of an incipient stroke

The onset of a hemorrhagic stroke is characterized by the following symptoms:

• severe headache;
• increased blood pressure;
• vomit;
• dizziness;
• loss of consciousness;
• weakness in the limbs;
• visual impairment;
• seizures [1].

The onset of ischemic stroke is gradual; within an hour, some of the following symptoms appear:

• facial asymmetry, numbness;
• difficulty speaking – incoherent, impaired understanding;
• double vision, visual disturbances;
• headache;
• numbness, limited mobility in the limbs, often on one side;
• dizziness, imbalance, staggering, staggering gait;
• confusion with disorientation, subsequently there may be loss of consciousness [3].

If one or more of these signs appear, you should:

1. Sit the patient down, providing access to fresh air.
2. Call emergency medical help immediately.
3. If the patient is conscious and able to chew and swallow, give him one aspirin tablet.

The patient must be hospitalized in a neurological or neurosurgical department, where stroke treatment will be carried out. The sooner the patient is in the hospital, the more effective the therapy.

Symptoms of urticaria

The main manifestation is the appearance on the skin of red or pink spots of various shapes, and blisters, the size of which can reach several centimeters.
A slight swelling may appear, which gradually disappears over the course of a day, rarely two. If the swelling affects the deeper layers of the skin or mucous membranes, angioedema may result - a life-threatening condition that requires immediate medical intervention.

The rash of allergic urticaria is always accompanied by unbearable itching, and some patients describe it as an unbearable burning sensation. Violent scratching of such areas can lead to infection of the epidermis with further complications in the form of pustules and wounds.

Minor manifestations of urticaria include:

• headache;
• elevated temperature;
• sleep disorder;
• anxiety;
• loss of appetite.

According to the nature of the course, allergic diseases are divided into two types.
Acute urticaria is diagnosed most often. Blisters and swelling of the skin in this form appear completely suddenly, sometimes against the background of a person’s excellent health. Most often caused by some external reasons, food. It also happens after using medications, especially when self-medicating. Symptoms go away on their own within a few days to several weeks.

Chronic urticaria is a condition in which symptoms continue to persist for more than 6 weeks after the first rash on the skin. This variant is characterized by a wave-like course, when periods of complete absence of symptoms (recovery) are abruptly replaced by exacerbations with the appearance of a new portion of spots and blisters. This is accompanied by unbearable itching and rapid development of Quincke's edema. The emerging elements of the rash can merge with each other, covering more and more new areas of the skin.

Sometimes periods of complete well-being without symptoms can last for a long time - up to 10 years.

Children's urticaria is an allergic skin disease, which most often develops against the background of an existing exudative diathesis and appears due to food products introduced as complementary foods.

It has been noticed that this type of allergy mainly develops in babies who are bottle-fed or eat foods that are not appropriate for their age.

Symptoms of a stroke

Stroke leads to various brain injuries, depending on the location of the lesion and the pathological type of cerebrovascular accident:

• disturbances of movement in the limbs: from restrictions (paresis) to complete paralysis. When the lesion is localized on the right, the left limbs suffer; with a left-sided lesion, right hemiparesis is formed; in some cases, movements in all limbs may stop (tetraparesis or double hemiparesis);
• sensory disturbances on one or both sides;
• speech disorders (dysarthria - poor articulation; aphasia - inability to pronounce and understand words, write and read);
• ataxia (impaired coordination of movements, “overshooting”, unsteadiness, imbalance, tremor);
• visual impairment: from blindness to double vision and gaze paresis;
• hearing impairment and dizziness;
• violation of mental functions (consciousness, thinking, attention, memory, will, behavior);
• paresis of the soft palate and pharynx, swallowing disorders;
• disorders of urination and defecation;
• depression of respiration and vascular tone;
• increased intracranial pressure;
• patients complain of headaches, vomiting, hiccups, yawning, shoulder pain;
• consciousness is gradually depressed to the point of coma [1, 3].

Causes of death may include cerebral edema, pneumonia, heart failure, and recurrent stroke. In severe cases, “locked-in syndrome” may develop: the patient is conscious, but cannot move, swallow or speak [3].

Consequences of a stroke

There are transient ischemic attack (less than a day), minor stroke (from 1 day to 3 weeks) and stroke with persistent residual effects. The consequences of a stroke are expressed mainly in motor and sensory disorders, the formation of muscle contractures (pronounced constant restriction of movements in the joints), speech and swallowing disorders. General symptoms may also remain, including confusion, disturbances in thinking, will, and emotional regulation. Complications can develop: from epilepsy to bedsores, encephalopathy and anxiety-depressive syndrome [1, 3].

Diagnosis of strokes

First of all, it is necessary to conduct a detailed neurological examination. Instrumental diagnostic studies and laboratory tests are also prescribed. In case of a stroke, in the first hours, an MRI or CT scan of the brain is performed, if necessary, CT or MR angiography, color Doppler mapping of blood flow, ECG or Holter monitoring, echocardiography as indicated, monitoring of blood pressure, saturation, assessment of the risk of developing bedsores, assessment of swallowing function [ 1, 3, 6].

Tests for stroke

• Complete clinical blood test, including erythrocyte sedimentation rate (ESR).
• Biochemical blood test with determination of C-reactive protein and homocysteine, glucose level, platelet count, activated partial thromboplastin time, INR.
• Interleukin 10.
• Extended coagulogram.
• Determination of acid-base status.
• General urine analysis.

To prepare for neurosurgical intervention, a blood test is additionally performed for hepatitis, syphilis, HIV, blood group and Rh factor determination.

Diagnosis of urticaria

Before starting treatment, it is important to understand what exactly a person has such a strong allergic reaction to.
Only by removing this provoking factor from your usual life can you not be afraid that the symptoms of urticaria will appear again, and this is possible even after proper therapy. Most often, this type of allergy appears to food. It is possible to determine what exactly caused the rash by a blood test: the level of IgE antibodies to a mixture of food allergens is detected. First of all, you need to diagnose the presence of an allergic reaction to:

• nuts;
• vegetables and legumes;
• citrus fruits and fruits;
• seafood;
• cereal and sesame flour;
• fruits and melons;
• baby formula;
• fish;
• meat;
• mushrooms;
• loose leaf tea;
• goat milk.

In addition to food, allergic manifestations can also occur to other substances that surround us almost everywhere in life:

• mold fungi;
• pollen from early flowering trees;
• pollen of late-flowering trees;
• weed pollen;
• epithelium of domestic animals;
• house dust;
• house dust mite;
• poultry feather.

To identify the exact type of allergen, allergy tests are performed on certain foods.
It often happens that rashes appear due to seasonings and herbs used in cooking: paprika, cumin, cloves, basil, ginger, tarragon, thyme, marjoram, dill, bay leaf, black pepper, vanilla. Some types of fish may also be allergenic: cod, halibut, mackerel, and squid meat. But sometimes an allergic reaction in the form of urticaria develops to such familiar products as:

• cucumber;
• apricot;
• cherry;
• tomato;
• plum;
• grape;
• persimmon;
• carrot;
• beet;
• watermelon.

All tests are carried out only by a specialist laboratory technician. You cannot independently determine the presence of an allergy in the form of urticaria to a particular food product or substance. This can be life-threatening, since it is possible to develop not only Quincke's edema, but also anaphylactic shock.

Stroke treatment

Treatment of stroke is regulated by relevant clinical guidelines and the Procedure for providing medical care to patients with acute cerebrovascular accident. In the first hours, thrombolytic therapy is carried out and subsequently - prevention of thrombus formation. For hemorrhagic stroke, neurosurgery may be performed. They normalize blood pressure, water-electrolyte balance, glucose levels in peripheral blood and urine, support the basic vital functions of the body and prevent complications. Drug therapy is also aimed at improving the affected functions of the nervous system [1, 3, 6].

Complications of urticaria

It is important to know what hives look like and to be able to provide first aid correctly.
This will help prevent the development of severe complications that can lead to death. Often urticaria is accompanied by Quincke's edema, which is also called angioedema. Its development in the larynx area is especially dangerous, as it can compress the trachea and impair breathing.

Another serious complication is anaphylactic shock. This is a life-threatening immediate allergic reaction that occurs when the human body is hypersensitive to a particular allergen. Usually develops upon repeated contact with the allergen and requires immediate medical attention.

Stroke rehabilitation

Stroke is a disease in which rehabilitation and care are of the utmost importance.
Recovery from a stroke begins in intensive care, from the moment vital functions are stabilized. A multidisciplinary rehabilitation team works with the patient, which includes a rehabilitation doctor, physical therapist or exercise therapy instructor, speech therapist, massage nurse, physiotherapist and physical therapy nurse, psychologist, occupational therapist, guard and rehabilitation nurse. Diagnosis is carried out using special scales that reflect the degree of dysfunction and limitations in the patient’s activity, the influence of environmental factors on the rehabilitation potential. The rehabilitation process continues throughout the entire period of hospitalization. At the second stage, patients with serious disabilities who are unable to move independently are sent to rehabilitation departments or specialized hospitals. Those who can walk independently or with support are rehabilitated in outpatient centers based in clinics and sanatoriums.

The rehabilitation process should not be interrupted, so classes must be continued at home. Of course, there are no high-tech robotic complexes or physiotherapeutic equipment at home, but exercise therapy, massage, and work with a psychologist, speech therapist and occupational therapist are possible. For this purpose, telemedicine technologies are used and visits to rehabilitation specialists are organized.

The individual rehabilitation program includes not only a referral for rehabilitation treatment, but also technical means of rehabilitation. However, usually relatives also have to devote significant physical and financial resources to achieve the best effect [7].

First aid for hives

It is important that you always have allergy medications in your home medicine cabinet, since urticaria in adults, and in children too, can appear at any time.
Allergy medications can be in the form of drops or tablets. Modern remedies do not cause drowsiness and have virtually no side effects. Doctors recommend having in your home medicine cabinet to eliminate urticaria and itching, Fenistil drops, which can be used from childhood, Erius tablets, which have a long-lasting antihistamine effect after administration, Loratadine, which helps cope with Quincke's edema, which often accompanies urticaria.

It is important to take the medicine at the first symptoms, without waiting for the general condition to worsen. If after 20 minutes from the moment of administration there is no improvement, you should call an ambulance.

Prevention of strokes

Hereditary predisposition to stroke, the presence of cardiac diseases, pathology of blood vessels and blood composition, age over 40 years, obesity and diabetes require a number of preventive measures:

1. Maintaining normal blood pressure, taking antihypertensive drugs as prescribed by a doctor, monitoring blood pressure.
2. Maintaining a normal level of physical activity, exercise, walking 30-40 minutes a day (for example, walking the dog).
3. Conducting preventive examinations, including a standard set of laboratory parameters. During a preventive examination, the following tests are additionally required: gene diagnosis of CADASIL syndrome using the PCR method, plasma factors of the blood coagulation system, antibodies to prothrombin of the IgG and IgM classes to determine the risk of thrombosis, determination of polymorphisms associated with the risk of arterial hypertension, diabetes mellitus, lipid disorders exchange, in order to identify a predisposition to diseases that increase the risk of stroke, von Willebrand factor (a glycoprotein that ensures the formation of blood clots), complex laboratory tests for preclinical diagnosis of cardiovascular diseases are offered (“ELI-ANKOR-Test-12”, “Cardiorisk”).
4. Avoiding chronic and acute stress, maintaining mental hygiene.
5. Normalization of weight (BMI <25 kg/m2).
6. Healthy eating (for example, Mediterranean diet, limiting salt to 5 5 g/day).
7. Quitting smoking and taking psychoactive substances.
8. Treatment of diseases that are a risk factor for stroke [8, 11].

Treatment of urticaria

The only way to get rid of the disease is to avoid contact with the allergen, which is previously detected by laboratory tests.
If testing does not reveal a provoking factor, and the urticaria is episodic, then taking antihistamines will quickly eliminate the symptoms. During treatment, it is recommended to follow a diet that, in case of urticaria, will help prevent the recurrence of the disease. The menu should include only hypoallergenic products: lean boiled meat, soups with recycled meat broth or vegetarian. It is better to choose rice, buckwheat, and oatmeal from cereals. Low-fat cottage cheese, natural yogurt, apples, dried fruit compote, excluding raisins, and whole grain bread are recommended.

Citrus fruits, nuts, fish and all seafood, chocolate products, smoked meats, coffee, eggs, honey, and store-bought baked goods should be excluded from the menu during treatment.

Treatment is carried out by a dermatologist and an allergist-immunologist. For topical application, ointments for urticaria are effective; they not only relieve itching, but also eliminate swelling, redness and a burning sensation on the skin. One of the most effective is Dimetinden gel, which must be applied in a thin layer to the affected area of ​​the skin up to 4 times a day.

A course of antihistamines is prescribed in the form of tablets. Your doctor may also prescribe calcium gluconate or calcium chloride for urticaria. They help reduce the symptoms of allergies, but they should only be administered under the supervision of a doctor in the treatment room.

If antihistamines do not provide the desired effect quickly, or for severe forms of hives, corticosteroids are used, which can be applied to the skin or taken in the form of tablets or injections.

Bibliography

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Author:

Pugonina Tatyana Alekseevna, Therapist