Urticaria (Hives): Xa Iskin Yakho Iphakanyiswa Ngaphandle KweSaziso

I-Urticaria, eyaziwa ngokuba yi-hives, ibonakala njengezikhumbuzo eziphakanyisiweyo, ezinokubangela ukungakhululeki (wheals) esikhumbeni ezivela ngokuqhwanyaza, zihlala imizuzu ukuya kwiiyure, emva koko zinyamalale ngaphandle komkhondo — kuphela ukuze zibuyele kwenye indawo. I-wheals nganye ivame ukuba yindilinga okanye i-oval, ipinki ukuya kumnyama, ibalelwa kwiimilimitha ezimbalwa ukuya kwiisentimitha ezininzi ububanzi, kwaye ibhiyozela ngombala obomvu. Ziyahlula (ziguqule zibe mhlophe) xa zicinezwa.

Iimpawu ze-urticaria zihlala zihlala zikhumbuza: i-wheals nganye ayihlali ngaphezu kweeyure eziyi-24, kwaye i-wheals ezintsha zivelisa njengoko ezindala zixazululwa. I-Hives zenzeka xa i-mast cells esikhumbeni zikhulula i-histamine kunye nezinye iimeko zokuphazamiseka, zenza ukuba iivenkile zegazi zikhuphe umphunga kwi-tissue ezizungezileyo. Le nkqubo ingavulwa ngamaqela amaninzi: iimpembelelo zokungabikho (iimpembelelo ze-IgE kumatyala, imithi, ukungqubana kwezinyosi), ukucinezela kwe-mast cell ngemicimbi ye-physical (pressure, ubanda, ubushushu, umthambo), iintshukumo (iintshukumo ze-viral zihlala zenzeka kwi-hives ezikhawulezayo kubantwana), iimeko ze-autoimmune (i-autoantibodies ezikhuthaza i-mast cells), kwaye ngamanye amaxesha akukho mngcipheko ubonakalayo.

I-Urticaria ithintela malunga ne-15-25% yabantu ngexesha elithile lobomi babo. Nangona umphumo uvame ukuba mfutshane kwaye uzithintela, unokubangela ukungakhululeki okukhulu kunye nokukhathazeka. Ukungakhululeki kwe-hives kuhluke kwezinye iimeko zesikhumba — kukhulu, kubhiyozela, kwaye kuhluke kunokungakhululeki kokuphosa kwe-eczema, kwaye kungaba nzima ngokwaneleyo ukuphazamiseka kokulala kunye nemisebenzi yemihla ngemihla.

Ukuphakama kwesikhumba okubizwa ngokuba yi-angioedema kuhlale kuhlangene ne-hives, kubonakala njengokuphakama okuphakanyisiweyo kwemilebe, amehlo, izandla, iinyawo, okanye iindawo zokuzala. I-Angioedema ayinabungozi kunokungakhululeki kwaye ingahlala iiyure eziyi-24-72.

I-Urticaria ihlukaniswe njenge-acut (ihamba ngaphantsi kweeveki eziyi-6) okanye i-chronic (iqhubeka rhoqo okanye phantse rhoqo kwiiveki eziyi-6 okanye ngaphezulu), kwaye ukwahlula kubalulekile kuba iimpembelelo, ukucwangciswa, kunye nolawulo zihluke kakhulu. I-urticaria ekhawulezayo ivame kakhulu kwaye ivame ukuvulwa ngempembelelo ebonakalayo: iimpembelelo zokungabikho kokutya (i-shellfish, i-nuts, amaqanda, ubisi, i-soy, i-wheat), imithi (i-antibiotics, i-NSAIDs ezifana ne-ibuprofen, i-aspirin), ukungqubana kwezinyosi, okanye i-latex zihlala zihlala zikhumbuza. Iintshukumo ze-viral — iintshukumo eziphezulu zokuphefumla, i-hepatitis, i-HIV, i-Epstein-Barr virus — zihlala zenzeka kwi-hives ezikhawulezayo, ngakumbi kubantwana, apho iintshukumo ze-viral zingavula i-hives ezihlala iintsuku ukuya kwiiveki.

Ukuthintela nemithombo ethile (i-nettles, i-jellyfish, ezinye iikhemikhali) kungabangelwa i-urticaria yokuthintela. Kwimeko ezininzi ze-urticaria ezikhawulezayo, umphumo uyaziwa kwaye i-hives zixazululwa xa umphumo ususwa kwaye ukwelashwa kwe-antihistamine kunikwe. Ukuhlolwa kwe-allergy okukhulu akuvamile ukuncedwa kwiimeko ezilula, ezizithintelayo.

I-urticaria eziqhubekayo (CU) iyinto ehlukile ngokupheleleyo. Iqhubeka iminyaka emininzi — ixesha eliphakathi kwe-2-5 iminyaka, kwaye abaninzi bahlupheka iminyaka emininzi. Kwi-80-90% yeemeko ze-urticaria eziqhubekayo, akukho mngcipheko ubonakalayo; oku kubizwa ngokuba yi-urticaria ezizenzekelayo (CSU).

I-CSU ngoku iqondwa njengemeko ye-autoimmune kwi-nto engama-50 yeemeko — i-autoantibodies (i-IgG antibodies ezichasene ne-IgE okanye i-IgE receptor kwi-mast cells) zihlala zikhuthaza i-mast cells, zikhulula i-histamine ngokuzithandela. Iimeko eziseleyo ze-CSU zingabandakanya ezinye iimeko zomzimba ezingakabi ziqondwa ngokupheleleyo. I-urticaria ezivulwayo zihlala zihlukaniswa kwiimeko ezithile apho iimpembelelo ezithile zihlala zikhumbuza i-hives: i-dermatographism (pressure/friction ibangela i-wheals), i-cold urticaria (ukubanda), i-cholinergic urticaria (ukushisa, umthambo, ingxaki yokuziva ibangela i-wheals ezincinci), i-solar urticaria (ukukhanya kwelanga), i-pressure urticaria (ukucinezela okuqhubekayo kubangela ukunyuka okuphuthumayo), kunye ne-aquagenic urticaria (ukuthintela amanzi — okungavela kakhulu). Le mikhwa ivulwayo ibonwa ngokuqhuba ukuhlolwa kokuphosa.

Ukufumanisa iimvelaphi kulula kwiimeko ezithile ze-urticaria kwaye kuyabheda kakhulu kwiimeko ezinye. Iimvelaphi zokutya zibaluleke kakhulu kwi-urticaria esheshayo: iimpempe ezidumileyo ziquka iintlanzi, iintsimbi zomthi, iipeanut, iintlanzi, amaqanda, ubisi, isoya, kunye ne-wheat. I-urticaria eyenziwa kukutya ibonakala ngokufanelekileyo phakathi kwemizuzu ukuya kwiiyure ezimbini zokutya ukutya okukhathazayo kwaye iyaphindaphindwa ngexesha ngalinye lokuchaphazeleka.

Umqondo ophosakeleyo ocommon kukuba i-additives zokutya kunye ne-preservatives zihlala zikhokelela kwi-urticaria — nangona zikhona amaxesha zisebenza, indima yazo ayibalulekanga njengoko abantu abaninzi bekholelwa. Iimveliso zonyango zibalulekile: i-NSAIDs (ibuprofen, naproxen, aspirin) zingakhokelela okanye zomeleze i-urticaria ngeendlela ezingekho kwi-allergic, kwaye zomeleza i-urticaria eqhubekayo kwi-30% yabatyeleli. I-antibiotics (i-penicillins, i-sulfonamides), i-ACE inhibitors (ezibangela i-angioedema kunokuba zibe ne-hives), kunye ne-opioids (ezivula ngqo i-mast cells) zii-drug triggers ezibalulekileyo.

Uxinzelelo kunye neempempe zengqondo zihlala zixhaphakile kwiimeko ze-urticaria eqhubekayo, kwaye kukho ubudlelwane obuqinileyo phakathi koxinzelelo lweengqondo kunye nokuvulwa kwe-mast cell. Uxinzelelo alubangeli i-urticaria eqhubekayo, kodwa lungaphucula imeko esele ikhona kwaye lukhokelele kwi-flare. Iimvelaphi zomzimba zivelisa i-urticarias ezingenakuphikiswa: i-urticaria ebanda ingaba yingozi kuba ukuhamba emanzini abandayo kungakhokelela ekukhululeni i-histamine enkulu edala i-anaphylaxis kunye nokuphosa; i-urticaria ye-cholinergic ibonakala ngexesha lokukhuthaza elikhuphula ubushushu bomzimba (ukuzilolonga, i-sitshisi esishushu, uxinzelelo lweemotions, ukutya okumnandi); i-dermatographism ithinta i-2-5% yabantu kwaye ikhulisa i-wheals ezakha ngendlela efanayo yokukhuhla okanye yokukhuhla.

Iintshukumo, ngakumbi i-Helicobacter pylori, iintshukumo zokugula zihlala zixhaphakile kwi-urticaria eqhubekayo kwiimfundo ezithile, kwaye ukunyanga iintshukumo ngamanye amaxesha kuphucula i-hives. Iimeko ze-hormonal zingaba nendima — abaninzi babafazi baphoswa kwi-urticaria ngexesha le-perimenstrual.

Ukunyanga i-urticaria kulandela indlela ethile eyasungulwa kwiimigaqo yehlabathi. Inyathelo lokuqala kukusebenzisa i-H1 antihistamines yeqela lesibini (engayithathi) kwiimilinganiselo ezisemgangathweni: i-cetirizine, i-loratadine, i-fexofenadine, i-desloratadine, okanye i-bilastine ezithathwa rhoqo (hhayi kuphela xa unempempe). Ezi mveliso zonyango zivimba i-H1 receptors kwiivenkile zegazi kunye nezikhumbuzo, zinciphisa i-wheals kunye ne-itch.

Kwi-urticaria eqhubekayo, ukusetyenziswa kwe-antihistamine rhoqo kubalulekile — ukuthatha ngexesha elithile xa i-hives zivelayo akusebenzi kakuhle kuba injongo kukuthintela iimpempe ze-mast cell ngokuqhubekayo. Ukuba i-antihistamines ezisemgangathweni aziniki ukulawula okwanele emva kweeveki ezi-2-4, inyathelo lesibini kukuphucula i-antihistamine efanayo ukuya kwiimeko ezine ezisemgangathweni. Oku kuphephile kwaye kuphakamisa kwiimigaqo ze-urticaria, nangona kudlula umthamo wombhali kwi-antihistamines ezininzi.

Ukuphucula i-cetirizine ukuya kwi-20-40mg rhoqo (kuqhathaniswa ne-10mg ezisemgangathweni) okanye i-fexofenadine ukuya kwi-360-720mg rhoqo (kuqhathaniswa ne-180mg ezisemgangathweni) kunika umvuzo owongezelelweyo kwiingcali ezininzi. I-antihistamines zokuqala ezithathayo (i-diphenhydramine, i-hydroxyzine) zingongezwa ngexesha lokulala ukuze kuphuculwe iimpempe zexesha lokulala kodwa azikhethwa ukuba zisetshenziswe ngexesha lokusebenza ngenxa yokuthatha. Ukuba i-antihistamines eziphuculiweyo zihlala zinganelisi, inyathelo lesithathu longeza i-omalizumab (Xolair), i-monoclonal antibody ebopha i-IgE yasimahla kwaye ithintele iimpumelelo eziphucukileyo kwi-urticaria eqhubekayo.

Iphathwa njenge-injection ye-subcutaneous ngenyanga, i-omalizumab ifezekisa ukulawula ngokupheleleyo iimpempe kwi-60-70% yabatyeleli kwaye iphucula ngokweqile kwiimeko ezininzi. Impendulo ikhawuleza, kunye nabanye abatyeli bephuma kumphumo kwiintsuku ezimbalwa emva kokufaka i-injection yokuqala. I-Cyclosporine yindlela yesithathu kwiimeko ezinzima — i-immunosuppressant evimba umsebenzi we-T-cell kwaye ivimba ngqo ukuvulwa kwe-mast cell.

Iyasebenza kodwa ibandakanya iimpempe ezibalulekileyo (ukulimala kwezinso, uxinzelelo lwe-gazi, i-immunosuppression) kwaye igcinwe kwiimeko ezinzima, ezine-antihistamine kunye ne-omalizumab. I-systemic corticosteroids (i-prednisone) zikhupha ukhululeko ngokukhawuleza kwi-flare ezinzima kodwa akufanele zisetshenziswe ixesha elide kwi-urticaria eqhubekayo ngenxa yeempempe ezibi ezivela ekusebenziseni ixesha elide. I-leukotriene receptor antagonists (i-montelukast) zikhupha umvuzo ophakathi kwiingcali ezininzi, ngakumbi kwiimeko apho i-urticaria ibi ngaphezulu kwe-NSAIDs okanye i-aspirin.

Nangona i-urticaria ezininzi ingakhathazi kodwa ingaba yingozi, i-hives zingaba ngokuqhelekileyo uphawu lokuqala lwe-anaphylaxis — impendulo ye-allergic enzima, engaba yingozi empilweni, efuna unyango lwezempilo olukhawulezayo. I-anaphylaxis ibandakanya iimpawu ezikhawulezayo ezichaphazela iimeko ezininzi zomzimba kwaye zingakhula ukusuka kwiimeko ezilula zibe yingozi kwiiyure. Ukuqonda iimpawu zokuxhalaba kubalulekile.!!

Iimpawu ezilandelayo ezihambelana ne-hives zibonisa i-anaphylaxis enokubangela ukufowuna iinkonzo zonyango ngokukhawuleza: ubunzima bokuphefumla, i-wheezing, okanye ukuzwa ngathi umphunga wakho uyavala; ukuvuvukala kolwimi okanye umphunga; ubunzima bokugaya okanye ukukhuluma; ukungaphumli, ukungaziva, okanye ukuzwa ungakhululeki; ukwehla kwegazi (i-pulse esheshayo, ethambileyo); i-nausea, ukuvuvukala, okanye ubuhlungu obukhulu bebelly; umuzwa wokuphuma. I-anaphylaxis ikhokelwa kakhulu yi-allergies zokutya (i-peanuts, iintsimbi zomthi, iintlanzi), iintshukumo zezinambuzane (i-bees, i-wasps, i-hornets), kunye nemveliso zonyango (i-antibiotics, i-NSAIDs). Ukuba unamaqondo obungozi obaziwayo be-anaphylaxis, kufuneka uthathe i-epinephrine auto-injector (EpiPen) ngexesha lonke kwaye uyisebenzisa xa ubonisa uphawu olukhulu — ungabambeleli ukubona ukuba iimpawu ziya zaphucuka.

I-Epinephrine yonyango lokuqala lwe-anaphylaxis kwaye ingasindisa ubomi.!! Nokuba emva kokusebenzisa i-epinephrine, ukuhlolwa kwezempilo okukhawulezayo kubalulekile kuba iimpawu zingaphinda zivele (i-anaphylaxis ye-biphasic). Kwi-hives ezisoloko zikhona ngaphandle kokuphazamiseka kokuphefumla, iimpawu ze-cardiovascular, okanye ukungonwabi kwe-gastrointestinal, i-antihistamines zifanelekile njengezinyango zokuqala, kwaye unyango lwezempilo alufuneki ngokubanzi.

Nangona kunjalo, nayiphi na iimeko apho i-hives ihambelana neempawu ezingaphezulu kwesikhumba kufuneka zithathwe ngokungathandabuzekiyo kwaye zihlolwe ngokukhawuleza. Abatyeli abake bahlala bephila i-anaphylaxis kufuneka bathunyelwe kwi-allergist ukuze bahlolwe ngokubanzi, ukufumanisa iimvelaphi, kunye nokuphuhlisa icebo lokusebenza lwezempilo.

Iimeko ezisodwa, ezimfutshane ze-hives ezixazululwa nge-antihistamines ezithengiswa ngaphandle kokuba zifuna ukuhlolwa kwezempilo. Nangona kunjalo, kufuneka ubonane nogqirha ukuba i-hives zihlala zihlala ngaphezu kweentsuku ezimbalwa nangona zisebenzisa i-antihistamine, ukuba zibuya rhoqo, okanye ukuba awukwazi ukufumanisa i-velaphi. I-urticaria eqhubekayo (i-hives ezihlala ngaphezu kweeveki ezi-6) ihlala ifuna ukuhlolwa kwezempilo ukuze kufumaniswe ngokuchanekileyo, ukuhlolwa kweemvelaphi, kunye nendlela yokunyanga.

Ukuba i-wheals ezithile zihlala ngaphezu kweeyure ezi-24 okanye zishiya i-bruising xa zixazululwa, oku kukhombisa i-urticaria vasculitis — ukuxhaphaza kweemithambo yegazi okukhumbuza i-hives ezilula kodwa kuyimeko eyahlukeneyo efuna umsebenzi wokufumanisa i-sistim. Ukuba i-hives zihambelana nobuhlungu bezitho, umkhuhlane, okanye ukungonwabi, ukuhlolwa kwe-sistim kubalulekile. Ukuba ucinga ukuba umphumo othile ubangela i-hives zakho, ungayeki ngokukhawuleza umphumo ngaphandle kokuqondiswa kwezempilo (ngaphandle kokuba ubonisa impendulo enzima) — xoxa ngayo nogqirha wakho ophumelele.

Ukuba i-antihistamines ezisemgangathweni azilawuli iimpawu zakho, umgibeli okanye i-allergist ingakuhlola kwi-urticaria eqhubekayo kwaye ibhale iindlela eziphucukileyo ezifana ne-antihistamines eziphuculiweyo, i-omalizumab, okanye ezinye iindlela. Ukuba umgangatho wakho wobomi uphazamisekile kakhulu — ukungaphumli, ukungakwazi ukusebenza, ukuhamba kude, uxinzelelo malunga ne-flare ezingalindelekanga — oku kuphela kukhumbuza ukuba ufune unyango lwezempilo.

I-urticaria idluliselwa ngokwempilo ngokusekelwe kumphumo ophawulekayo we-wheals eziphumayo, kodwa ezinye iimeko zingakhumbuza i-hives — i-urticaria vasculitis, i-erythema multiforme, i-contact dermatitis, kunye ne-bullous pemphigoid yokuqala ingabandakanya i-lesions efana ne-hive. I-Skinscanner ikunceda ukuba uhlolisise ukuba impendulo yakho yesikhumba inezinto ezihambelana ne-urticaria okanye ezinye iimeko ezifunekayo zonyango olwahlukileyo. Ukuthatha imifanekiso ye-hives xa zivelayo — ukugxila kwi-wheals eziphakanyisiweyo, ezibomvu — kunika ubungqina kumphakathi wakho wezempilo, obaluleke kakhulu kuba i-wheals ezithile zingaphuma ngaphambi kokuhlangana kwakho.

Kwi-urticaria eqhubekayo, ukugcina i-diary yeefoto ehambelana ne-dokumenteshini yeemvelaphi (i-diary yokutya, i-log yezenzo, iimeko zoxinzelelo, utshintsho lwezinto) kunceda ukufumanisa iindlela ezingavela kumkhumbulo kuphela. Ukudokhweba ixesha le-wheals ezithile kubaluleke kakhulu: i-wheals ezihlala ngaphantsi kweeyure ezi-24 zikhumbuza i-urticaria ezilula, ngelixa ezi zihlala ngaphezu kweeyure ezi-24 okanye zishiya i-bruising zikhumbuza i-urticaria vasculitis efuna i-biopsy. I-Skinscanner ikunika ubungqina obungakhethiweyo obwenza ukuba iingxoxo zonyango zibe nemveliso ngakumbi kwaye zuncede ugqirha wakho ukwenza izigqibo ezichanekileyo zokufumanisa kunye nendlela yokunyanga.