Thermal urticaria is one of the types of anomalous susceptibility of an organism to the action of thermal stimuli - the environment or objects with a high temperature, physical and emotional stresses or internal diseases that provoke pathological skin changes of the "immediate" type on fragments of the skin or throughout the body. This article will tell you in detail about the symptoms of the disease and the treatment of thermal urticaria in children and adults, about the best drugs from it, and also answer other questions.
Features of the disease
Skin pathology can occur already in the early years of life, for months giving recurrences and disappearing without a trace after the hormonal growth of the child. But sometimes the pathology drags on for decades.
In this type of allergy, the condition of young children should be monitored, since they have a thermal urticaria in most of the case histories coexisting with other allergic manifestations. In this case, it is able to serve as a "catalyst" for the development of edema Quincke, in which the larynx overlapping swollen tissues is fatal for children under three years old. Therefore, it is always important to know how to deal with such a disease.
In women suffering from menopause, expressed in active sweating and "flashes" of heat, thermal urticaria can exacerbate unpleasant symptoms, and vice versa - profuse sweat and even mild sweat on the skin of the chest, face, neck, combined with increased skin temperature and dilatedvessels, are capable of provoking a rash of itchy skin blisters. Such stresses further aggravate the condition of the patient.
Thermal urticaria( photos)
Classification of thermal urticaria
The classification provides for the isolation of two forms of thermal urticaria in the disease:
- A holinergic generalized ( affecting the entire skin).
- Local , in which the symptoms appear in areas that come into contact with an aggressive factor).
The first form is often considered separately. The second type refers to the manifestations of contact urticaria, which occurs in response to physical factors( heat, vibration, sun, cold, water, pressure, trauma).
- acute ( active) urticaria, the symptoms of which gradually disappear for 6 weeks, and
- chronic , lasting more than 45 days.
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Causes of
Important nuances
The exact reasons for the development of this type of disease have not yet been established. But it is proved that the signs of any form( both local and cholinergic) are observed only with the already existing susceptibility of the allergy patient. The greater part( more than 97%) is defined as: asthma, dermatitis, insufficiency of specific products, Quincke's edema, neurodermatitis.
Specificity of the heat form of the pathology is the connection of manifestations on the skin with the release of not only histamine, as an immediate-type allergy regulator, but also the neurotransmitter acetylcholine. Therefore, it is believed that the disease is caused by three important factors:
- Excessive reaction of skin cells to acetylcholine.
- Abnormally high susceptibility of thermoregulation centers to the release of acetylcholine.
- Supersensitivity of the body to allergens.
Only a combination of these underlying causes can "give" a skin and systemic reaction to a change in the temperature of the skin or the entire body, as well as the external environment.
Conditions for the development of the pathology of
In the local( local) form of thermal urticaria, acetylcholine begins to actively release if a certain area is exposed to a temperature above 40ºC.Acetylcholine immediately stimulates the release of histamine, which causes redness, swelling and urticaria( "nettle") rashes in the form of blisters( like nettle-like burns).
For the cholinergic type, manifestations of urticaria are characteristic after the body has been exposed to such factors as:
- muscle tension, which is accompanied by the release of sweat;
- hot( above 40C) water in shower, bath;
- high ambient temperature in the sauna, sauna, with heat;
- temperature rise during infectious, inflammatory diseases;
- stressful loads, strong emotions;
- use of spicy, hot food, drinks that dilate blood vessels;
- is a patient's disease, favorable for the development of a particular sensitivity to acetylcholine:
- vegetative dystonia, neuroses;
- disruptions in the endocrine system, including thyroid disease;
- disorders of the gastrointestinal system.
Symptoms of
Types of thermal urticaria have similar symptoms, and specific signs.
Cholinergic type:
- It manifests itself within 5 to 20 minutes after exposure to a provocative factor( stress or load with sweat, hot water, high temperature).
- Small, itchy whitish vesicles 2 to 3 mm in diameter appear on the skin, surrounded by a bright pink puffiness area, which tend to merge, forming large red swollen areas that flatten above the skin.
- Rashes and blisters tend to cover the skin of the neck, forearms, chest, face, but often affect the entire body.
- Itching with a typical development of the disease is quite intense, accompanied by a burning sensation.
- Skin rash is often accompanied by a general reaction of the nervous system to the release of acetylcholine in the form:
- nausea, salivation, vomiting;
- of headache and cramping abdominal pain;
- of a loose stool.
In most cases, when the provoking conditions are eliminated, the signs of a thermal allergy of the cholinergic type disappear within 30 to 90 minutes, but sometimes stay up to several days.
The local form of thermal allergy is characterized by:
- Appearing for 3 to 5 minutes at the site of heat exposure of flat pink blisters on the background of swollen skin, which in half the cases are not accompanied by itching.
- The preservation of changes on the skin is about 40 - 90 minutes.
Sometimes the symptomatology has a mild form with small, almost imperceptible vesicles, mild itching and mild redness. This leads to the fact that patients ignore the signs of the disease, late seeking medical help, and the illness turns into a chronic form. In addition, there are cases of a combination of thermal and cold urticaria, which should be emphasized.
Diagnosis
This kind of urticaria is not complicated for diagnosis with the use of provocative samples, that is special tests that induce a painful reaction on the skin.
To confirm the presence of local thermal urticaria apply a glass with hot( 40 - 45 C) water, which is applied to the body area( usually - on the forearm).In another test the patient drops the hands and forearms into the heated water for 3 to 4 minutes. If half an hour after the test on the skin there is an obvious reddening, bubbles appear, the reaction is seen as positive.
Diagnosis with suspected development of cholinergic type of thermal urticaria is confirmed with the appearance of swelling, hyperemia and urticarial vesicles against the background of acetylcholine release after taking a bath with warmed up to 40 C water or after physical exertion conducted before the appearance of sweating. The result is diagnosed in the range of 5 - 30 minutes.
The medicinal version of the sample provides intradermal administration of Carbachol, a pharmacological agent similar to that of acetylcholine.
About the preparations for thermal urticaria for children and adults and the methods of its treatment is described further.
Treatment
Therapeutic
Therapy for cholinergic and local forms of thermal allergy is similar in many respects, but there are also obvious differences due to the severity of the process and the time it takes to eliminate the cause of the pathology. The effect of heat on a specific area of the skin with a local form is easily eliminated by simply isolating the patient from the stimulus, thus stopping the further effect of heat. The cholinergic form affects a large surface of the skin and often causes concomitant signs of irritation of the nervous system with acetylcholine, including general malaise, fever, and vomiting.
Improve the patient's condition with a shower and a bath with cool water, immediate rest with muscular load, sedatives, if the patient is experiencing a stressful situation( Valoserdin, Pustyrnik-Forte, Novopassit, Milgamma, vitamins B1, B6, B12, Neuromultivitis).
Local
- Since a hot reaction induces an excess of acetylcholine, which is produced by the patient's body, in the case of thermal urticaria, gels, creams and ointments containing atropine and belladonna extract are used to remove irritation and blisters on the skin. These funds, when used two or three times a day, show a good effect: Fenistil-gel, La Cree, Gistan-N, Advantan.
- Recently, pharmacological external agents with the substance diphenhydramine, which is part of Psilo-balsam, have been used successfully. It is also possible to prepare 3-10% ointments with diphenhydramine in the pharmacy for application of the application to the rash( several times a day).
- In acute manifestations, local therapy involves the use of hormonal external ointments: Cinaph-ointment, Acriderm GK, Hydrocortisone, Elokom, Celestoderm, Bufeksamak.
On what drugs should be taken with hives, if you treat it in adults and children, read below.
Medicated
The complex of medicinal blocks provides for the introduction of the following pharmaceuticals into therapy.
Antihistamines
In the acute form of the disease, it is better to choose preparations of the first generation, since the action of the II generation drugs, as a rule, becomes noticeable at a later stage.
- For severe itching, Erius is prescribed( desloratadine): patients 12 years old - once 5 mg, children 1 to 5 years 1.25 mg( in syrup 2.5 ml), 6 to 11 to 2.5 mg( in syrup 5 ml) once.
- Diphenhydramine( 1st generation antihistamine with sedative and antiemetic effect).Inside from 12 years to 30 - 50 mg to 3 times a day, infants for 1 reception - 2 to 5 mg, from 2 to 5 years, a one-time dose will be 5 to 15 mg, and 15 to 30 mg give children 6 to 12 years.
- Hydroxyne, an antiallergic drug with mild sedative effect when developing a generalized form of thermal urticaria. Allowed for children from year. Dosage is prescribed by a doctor.
In cases that are difficult to treat, antihistamines are used intramuscularly( Suprastin, Tavegil, Pipolphen).
With a chronic course of urticaria:
- Ketotifen adult 0.001 g twice, children 6 months - 3 years - 0.0005 mg( long course 2 - 3 months).
- Ebastin: patients over 12 years of age single-fold 10 - 20 mg, younger children in the form of a syrup.
- Cyproheptadine 3 - 4 times for 4-8 mg( for children - from the calculation of a daily dose of 0.25-0.5 mg per kilogram of the weight of the baby, divided by 3-4 times)
- In addition to these drugs, use in age doses: Tsetrin, Alersin, Kestin, Elerthu.
Blockers H2-receptor histamine
Assign with a weak effect of antihistamine: Cimetidine - inside 300 mg 3 - 4 times a day( from 12 months of life the daily dose is calculated by the formula - 25 - 30 mg / kg body weight, infants - at a rate of 20 mg/ kg body weight), Ranitidine, famotidine.
In case of severe persistent itching, nervous system disorders that are more often observed against the background of cholinergic thermal urticaria, the following are shown:
- glucocorticosteroids: Dexamethasone, Prednisolone;
- choline blockers with a sedative effect: Bellaspon, Bellantaminal, Belloid;
- tranquilizers: Phenobarbital, Atarax.
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Prevention
Measures to prevent repeated cases of thermal allergy attack are aimed at limiting the maximum triggering factors and are as follows:
- , if possible, eliminate the effect on the skin of the environment or objects with increased temperature;
- when bathing in a bath, under the shower use water no higher than 36 - 37C;
- not to visit saunas and baths;
- to avoid exhaustion of the nervous system, emotional disorders;
- if it is impossible to avoid a stressful load in advance take a sedative;
- to reduce physical activity, the probability of the appearance of sweat, high sweating;
- , since helminths often serve as a provocateur of urticaria, internal infections and inflammations, accompanied by a persistent increase in temperature, require the diagnosis and timely treatment of these diseases;
- to exclude hot, spicy dishes, warming and expanding drinks, and to maximally adhere to a hypoallergenic diet, since the manifestations of urticaria are directly related to other allergies.
Complications of
Any manifestations of heat-affected urticaria can provoke the following complications:
- Deep infection of the dermis during the introduction of purulent bacteria into combs of blisters with severe itching.
- Swelling of the respiratory tract with probability of asphyxia, as the mechanism of urticaria and edema of Quincke are similar and cause expansion and permeability of vessels( with urticaria) and subcutaneous tissue( with edema Quincke).
- Bronchospasm and anaphylactic( allergic) shock, which in a few minutes can lead to death from suffocation and cardiac arrest.
Forecast
Improvement of the condition of 70% of patients with acute form in most cases occurs in 2 to 24 hours, sometimes the symptoms gradually subsided in 2 to 3 days. Competent treatment and prophylaxis in chronic course for 12 to 18 months leads to an improvement in the condition of 30% of patients.
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