Chronic urticaria is a common skin disease, characterized by itching and wheal, which is usually induced by allergic and non-allergic mechanisms. About 15%~25% of patients have suffered from urticaria in their lifetime, and 80%~90% of urticaria can't find external causes. These patients are traditionally called chronic idiopathic urticaria. The average course of chronic urticaria is 3~5 years, and some patients can last for 20 years.
Disease classification of chronic urticaria
The classification of diseases is to better understand its pathogenesis and guide treatment. According to the medical history and laboratory examination, urticaria can be divided into allergic urticaria and non-allergic urticaria, in which allergic urticaria can be divided into allergen-specific IgE-mediated urticaria and non-IgE-mediated urticaria. The purpose of this in-depth classification is to try specific immunotherapy to treat IgE-mediated urticaria. The infiltration mode of inflammatory cells in chronic urticaria is similar to the delayed phase reaction induced by allergens, showing superficial perivascular inflammation. However, cytokine secretion patterns {Interleukin -4(IL-4), Interleukin -5(IL-5) and r-IFN)} indicate a Th0 or mixed th6+0/Th2 reaction pattern, rather than a simple Th2 reaction.
Frontier science of anti-allergic specific IgE antibody in the treatment of chronic urticaria;
At present, the pathogenesis of chronic urticaria is mostly studied by autoimmune theory, and the incidence of autoimmune urticaria has been paid more and more attention by clinical urticaria research. Although histamine is considered to be the most important mediator in the pathogenesis of urticaria, patients with acute and chronic urticaria will soon disappear after taking antihistamines, and urticaria will also be relieved. According to the above IgE-mediated immune theory, mast cells in tissues and basophils circulating or chemotactic to tissues are the two main sources of histamine production, while there are IgE high affinity receptors on the surfaces of mast cells and basophils, and allergen binding can lead to the cross-linking of the latter and induce the release of histamine, the main inflammatory mediator in cells. Histamine and other mediators can also be released through non-allergic mechanisms. Besides histamine, other mast cell mediators (alopecia) also play a role in urticaria.
Some studies believe that about two-thirds of chronic urticaria is related to autoimmunity, and there is sufficient evidence to prove that some patients with chronic urticaria have functional anti-IgE receptor antibodies and/or anti-IgE antibodies that can degranulate skin mast cells or basophils. In acute attack, about 58% patients have autoantibodies of IgE molecules, and 25% patients have anti-IgE antibodies. The increase of IgE antibodies in serum is the main reason for the secretion of inflammatory mediators such as histamine. Some cases have reported that anti-IgE antibodies and anti-leukotriene preparations are effective in treating some chronic urticaria.
Treatment of chronic urticaria
The severity and clinical types of chronic urticaria are quite different, and the treatment scheme should be individualized. As with other allergic diseases, if there are definite allergens, the treatment plan should include avoiding contact with allergens.
Antihistamines are commonly used in clinical treatment of urticaria. 1 generation Ruchlorpheniramine can effectively relieve symptoms and reduce the number of skin lesions, but it has adverse reactions such as drowsiness and anticholinergic. The second generation, such as loratadine and cetirizine hydrochloride, have weak sedative effect and are currently the first-line clinical drugs. However, we will find that antihistamines have a quick effect on urticaria, but they can be controlled after taking the medicine, and urticaria will still occur without taking the medicine. From acute urticaria to chronic urticaria, drug treatment is intermittent, and it still can't get rid of urticaria. In recent years, through the research on allergic diseases and IgE-mediated allergies, anti-IgE antibody immunotherapy has been introduced into some chronic allergic diseases, such as chronic urticaria, atopic dermatitis (eczema), perennial rhinitis and cough variant asthma.
Kangminyuan anti-allergic probiotics can participate in allergen-specific IgE-mediated immune allergic reaction. After human dendritic cells were co-cultured with Th 1, an antiallergic probiotic that regulates the secretion of interleukin (IL- 12), an antiallergic probiotic strain with antiallergic ability was screened out. Kangminyuan anti-allergic probiotics can use active and non-pathogenic microorganisms to improve the ecological balance of intestinal microorganisms, the largest immune organ of human body, and further promote immune tolerance. Lactobacillus salivarius has the international patent certification for reducing serum IgE allergic antibody. After continuous supplementation for more than three months, the concentration of IgE in the body is reduced, so that allergens cannot bind with IgE antibodies in the body, and a series of allergic biochemical reactions no longer occur. Therefore, Kangminyuan probiotics can resist IgE antibodies and regulate allergic constitution, while drugs can only relieve symptoms and cannot regulate allergic constitution. The effective combination of anti-allergic drugs and anti-IgE antibody immunotherapy with anti-allergic probiotics can also produce ideal rehabilitation effect, which can eventually shorten the treatment course of urticaria and reduce the recurrence rate of urticaria.
Urticaria, commonly known as "rash", is a localized edema reaction caused by the expansion and permeability of skin and mucosa. Urticaria can occur at any age, and it is most common in adults aged 20-40, with more women than men. According to the different course of disease, urticaria can be divided into acute and chronic. The course of acute urticaria's disease is less than 6 weeks, and the general course of disease is 1~2 weeks, which mostly occurs in children and young people, and the etiology of most patients is clear. Urticaria is characterized by wheal, which has the following clinical features: 1) wheal is a well-defined edematous lesion with bright red and pale color; 2) Different sizes, round, annular or spread around to form irregular shapes, which can be fused into pieces; 3) Sudden, generally disappearing within 1~24h, recurring, leaving no trace after disappearing; 4) with severe itching or burning sensation; 5) wheal can occur anywhere, as well as abdominal pain, diarrhea, laryngeal edema, etc. It occurs when mucous membrane is involved, which may be life-threatening if it occurs in critically ill patients; 6) Some patients are accompanied by fever, nausea, vomiting, chest tightness, palpitation, headache, dizziness, blood pressure drop and other systemic symptoms. In severe cases, symptoms of anaphylactic shock may occur.
Diagnosis of allergic urticaria
Urticaria can be diagnosed according to the history and clinical manifestations, but it is difficult to determine the cause, relying on detailed history, physical examination and necessary laboratory tests. The medical history inquiry should include the following aspects: onset time, duration and frequency of wheal, diurnal variation law, size, shape and distribution of wheal, whether accompanied by angioedema, accompanying symptoms, family history of allergic diseases, whether suffering from internal medicine diseases, infectious diseases, medication history, surgical history, therapeutic effect, personal hobbies, diet, smoking habits, living environment and work type, mosquito bites, female patients and menstrual cycle. In addition, the detection of antinuclear antibody and IgE antibody, and the increase of IgE antibody are also very helpful for the diagnosis of urticaria.
Treatment of allergic urticaria
(1) General treatment
The most important thing to treat urticaria is to eliminate or treat stimulating factors or causes, because urticaria may naturally subside after eliminating stimulating factors or suspicious factors. Conversely, urticaria recurs after re-exposure to related factors, which can provide evidence for determining the cause.
(2) Systematic therapy
At present, systemic treatment measures mainly include inhibiting mast cells from releasing mediators and controlling inflammatory reactions. Supplementing anti-allergic probiotics Kangminyuan to reduce serum IgE antibody and systemic anti-allergic comprehensive treatment are beneficial to shorten the treatment cycle of urticaria.
1, inhibiting mast cells from releasing mediators.
Mast cells release mediators, which is an important part of urticaria. Inhibition of mast cell release mediators plays a very important role in the treatment of urticaria, but there are few effective drugs that can stabilize mast cell membrane and inhibit mast cell release mediators. Adrenal cortical hormone has a strong inhibitory effect on mast cell mediators, but it must be used in large doses for a long time, so it may produce adverse reactions.
2, antihistamines
Commonly used drugs include cetirizine, loratadine, mizolastine and so on, which can compete with histamine in the body, thus effectively alleviating allergic symptoms. However, cetirizine can cause drowsiness in some patients, and mizolastine can cause adverse reactions such as prolonged Q-T interval of electrocardiogram and liver damage, so patients with kidney diseases should use it less.
Acute urticaria can choose 1~2 species.
For chronic urticaria, the administration time can be determined according to the time when wheal appears. If there are more windy masses in the morning, a slightly larger dose should be given before going to bed; When there is more wind before going to bed, give a slightly larger dose after dinner. When antihistamines are ineffective, two drugs can be used at the same time. Combined application of H 1 receptor antagonist and H2 receptor antagonist in the treatment of intractable urticaria.
3, adult anti-allergic probiotics formula Kangminyuan anti-allergic probiotics reduce allergen-specific IgE antibody immunomodulation anti-allergy:
At present, people only pay attention to the treatment of urticaria, but not to the allergic reaction itself: the stimulation of allergens leads to the disorder of human immune function and the abnormal increase of immunoglobulin E in the body. Repeated contact with allergens leads to a large number of IgE antibodies in the body and attached to immune cells for a long time, which leads to the secretion of inflammatory mediators such as histamine and harms itself. From the immunological point of view of urticaria, the fundamental treatment should be to control IgE. At present, the treatment of urticaria mostly stays in the inflammatory stage such as antihistamine, and some people will try to treat it by improving immunity, but allergy is not caused by low immunity, and the imbalance of five immunoglobulin secretion in human body is the fundamental cause of the disease. At present, the treatment method of IgE anti-human antibody to solve urticaria in international immunology research is to supplement anti-allergic probiotics Kangmin source to reduce IgE antibody in human body, and adjust immunoglobulin balance by stimulating interferon secretion, thus restoring human immune response. The effective combination of antiallergic drugs and antiallergic probiotics can also produce ideal rehabilitation effect.
(3) local treatment
Topical drugs with soothing, antipruritic and astringent effects, such as calamine lotion, are used several times a day.
(d) Non-drug anti-allergic immune regulation: lack of anti-allergic probiotics in the intestine.
There are many kinds of allergens, such as dust mites, bacteria, pollen, protein, milk, soybeans, wheat, mold, meat and so on. Many medical studies have pointed out that allergic problems caused by "excessive secretion of IgE due to immune tolerance" are closely related to good bacteria and bad bacteria in the intestine. Studies show that there are few beneficial bacteria in the intestine, such as lactobacillus, due to allergic constitution. Although there are tens of thousands of lactic acid bacteria strains in nature, only a few lactic acid bacteria strains have antiallergic properties. This strain, which has a special regulatory effect on "immune tolerance IgE secretion", is a Kangminyuan probiotic composed of Lactobacillus salivarius, Lactobacillus Grignard, Lactobacillus yoelii, Lactobacillus lactobacillus paracasei and Lactobacillus Roy. The effect of Lactobacillus salivarius is to reduce serum IgE antibody, promote interferon secretion and improve Th 1 immune response. The function of Lactobacillus Grignard is to reduce serum IgG, which is helpful to reduce the secretion of cytokine IL-5 related to allergic reaction, and can effectively improve the human immune system. Kangminyuan enhanced has the ability to assist in regulating allergic constitution.