Urticaria (Amakhaza): Ngesikhathi Isikhumba Sakho Siphuma Ngaphandle Kwezixwayiso

Urticaria, eyaziwa kakhulu njengezikhukhula, ibonakala njengamakhaza aphakanyisiwe, anokukhathazeka (wheals) esikhumbeni abavela ngokuzumayo, ahlala imizuzu kuya kwamahora, bese enyamalala ngaphandle kokushiya umkhondo — kuphela ukuze avuke kwenye indawo. Amakhaza ngamunye ngokuvamile ayindilinga noma ayindilinga, anombala ophuzi kuya kokubomvu, aphakathi kwezimilimitha ezimbalwa kuya kumasentimitha ambalwa ububanzi, futhi ajolise eduze kokukhanya okubomvu. Ahlanzekile (ashintshe abe mhlophe) uma ecindezelwe.

Uphawu lwe-urticaria yisimo sayo esishintshashintshayo, esihambayo: amakhaza ngamunye awavami ukuhlala ngaphezu kwezinsuku eziyi-24, futhi amakhaza amasha avela njengoba amadala eshintshe. Amakhaza athuthukiswa lapho ama-mast cells esikhumbeni akhipha i-histamine nezinye izithako ezibangela ukukhathazeka, okwenza imithambo yegazi ikhiphe umswakama endaweni ezungezile. Le nqubo ingavulwa ngezindlela eziningi: izimpendulo zokuhlaselwa (izimpendulo ezihambisana ne-IgE zokudla, imishanguzo, ukuhlinzwa kwezinyoni), ukuvuselelwa kwe-mast cell ngokuqondile ngezikhuthazo zomzimba (pressure, ubanda, ukushisa, ukuzivocavoca), ukutheleleka (ukutheleleka kwe-viral kuyimbangela evamile ye-urticaria esheshayo ezinganeni), izinqubo ze-autoimmune (ama-autoantibodies akhuthaza ama-mast cells), futhi kaningi akukho msebenzi obonakalayo.

I-urticaria ithinta cishe u-15-25% wabantu ngasikhathi sinye empilweni yabo. Nakuba isipiliyoni ngokuvamile sishintsha futhi sikhawulelwe, singaba yingozi kakhulu futhi sikhathaza. Ukukhathazeka kwamakhaza kuhlukile kwezinye izimo zesikhumba — kubuhlungu, kuyashisa, futhi kuhlakazekile kunokukhathazeka okujwayelekile kwe-eczema, futhi kungaba kubuhlungu ngokwanele ukuphazamisa ukulala nemisebenzi yansuku zonke.

Ukuvuvukala okujulile okubizwa nge-angioedema kuvame ukuhambisana namakhaza, kubonakala njengokukhukhula okukhulu kwemilomo, amehlo, izandla, izinyawo, noma izitho zangasese. I-Angioedema ayinabuhlungu kunokukhathazeka futhi ingahlala izinsuku eziyi-24-72.

I-Urticaria ihlukaniswa njengezimo eziphuthumayo (ezihlala ngaphansi kwezinsuku eziyisithupha) noma eziphakeme (ezihlala nsuku zonke noma cishe nsuku zonke ezinsukwini eziyisithupha noma ngaphezulu), futhi le nhlobo ibalulekile ngoba izimbangela, ukwelashwa, nokuphathwa kuhluka kakhulu. I-urticaria esheshayo ivame kakhulu futhi ivame ukuvulwa yimbangela ebonakalayo: izimpendulo zokuhlaselwa kokudla (izilwane zasemanzini, ama-nuts, amaqanda, ubisi, soy, ufulawa), imishanguzo (ama-antibiotics, ama-NSAIDs afana ne-ibuprofen, i-aspirin), ukuhlinzwa kwezinyoni, noma i-latex yizimbangela ezivamile. Ukutheleleka kwe-viral — ukutheleleka kwe-ukuphefumula, i-hepatitis, i-HIV, i-Epstein-Barr virus — kuyimbangela evamile ye-urticaria esheshayo, ikakhulukazi ezinganeni, lapho ukutheleleka kwe-viral kungavula amakhaza ahlala ezinsukwini kuya ezinyangeni.

Ukuxhumana nezinto ezithile (ama-nettles, ama-jellyfish, ezinye izinto) kungadala i-urticaria yokuxhumana. Kwizigameko eziningi ze-urticaria esheshayo, umthombo uyatholakala futhi amakhaza ayashintsha uma umthombo ususwa futhi ukwelashwa kwe-antihistamine kunikezwa. Ukuhlolwa kokuhlaselwa okukhulu akuvamile ukuphumelela ezigamekweni ezilodwa, ezizixazululayo.

I-Chronic urticaria (CU) iyinto ehlukile ngokuphelele. Ihlala izinyanga kuya eminyakeni — isikhathi esijwayelekile sithi iminyaka engu-2-5, kanti abanye abagulayo bahlupheka iminyaka eminingi. Cishe u-80-90% wezimo ze-chronic urticaria, akukho umthombo ongaphandle ongatholakala; lokhu kubizwa ngokuthi i-chronic spontaneous urticaria (CSU).

I-CSU manje iqondwa njengezimo ze-autoimmune eziphakathi kwengxenye yezimo — ama-autoantibodies (ama-IgG antibodies aphikisana ne-IgE noma i-IgE receptor kuma-mast cells) avuselela ama-mast cells, akhipha i-histamine ngokuzumayo. Izigameko ezisele ze-CSU zingase zibe nezinye izinqubo zokuvikela ezingakazwakali kahle. I-chronic inducible urticarias iyisigaba esihlukile lapho izikhuthazo zomzimba ezithile zihlala zikhuthaza amakhaza: i-dermatographism (pressure/friction ebangela amakhaza), i-cold urticaria (ukuchayeka okubandayo), i-cholinergic urticaria (ukushisa, ukuzivocavoca, ingcindezi yokukhathazeka ebangela amakhaza amancane), i-solar urticaria (ukuchayeka kwelanga), i-pressure urticaria (ukucindezela okuqhubekayo okubangela ukuvuvukala okuphuthumayo), kanye ne-aquagenic urticaria (ukuxhumana namanzi — okungajwayelekile kakhulu). Lezi zimo ezivuselelwayo zihlolwa ngokuqhuba ukuhlolwa kokukhuthaza okukhethekile.

Ukuthola izimbangela kulula kwezinye izimo ze-urticaria futhi kuyaphazamiseka kwezinye. Izimbangela zokudla zibaluleke kakhulu ku-urticaria esheshayo: izigameko ezivamile zifaka izilwane zasemanzini, ama-nuts, amaqanda, ubisi, soy, kanye nofulawa. I-urticaria eyenziwa ukudla ivame ukuvela phakathi kwemizuzu emibili kuya kwamahora amabili kokudla okukhathazayo futhi iyaphindaphindwa ngokuqhubekayo.

Umqondo ophambene uvame ukuba ukuthi izithasiselo zokudla nezokugcina ziwumthombo omkhulu wezimbangela ze-urticaria — nakuba zikhona ngezikhathi ezithile, indima yazo incane kakhulu kunalokho okukholelwa. Imishanguzo ibalulekile: ama-NSAIDs (ibuprofen, naproxen, aspirin) angavula noma abangeze i-urticaria ngezindlela ezingahambisani nezokuhlaselwa, futhi zikhathaza i-urticaria eside kuze kube u-30% wabantu. Ama-antibiotics (ama-penicillins, ama-sulfonamides), ama-ACE inhibitors (abangeze i-angioedema kunokukhathazeka), kanye nama-opioids (abavuselela ama-mast cells ngokuqondile) yizimbangela ezithile ezibalulekile.

Ingcindezi nezici zokukhathazeka zivame ukuvezwa njengemithombo ye-urticaria eside, futhi kukhona ubudlelwano obuqinile phakathi kwengcindezi yokukhathazeka nokuvuselelwa kwe-mast cell. Ingcindezi ayibangeli i-urticaria eside, kodwa ingakhulisa isimo esikhona futhi ivule izikhukhula. Izikhuthazo zomzimba zenza i-urticarias ezivuselelwayo: i-cold urticaria ingaba yingozi ngoba ukuhamba emanzini abandayo kungavula ukukhishwa okukhulu kwe-histamine okuholela ku-anaphylaxis nokuphanga; i-cholinergic urticaria ivela nganoma yisiphi isikhuthazo esikhuphula izinga lokushisa lomzimba (ukuzivocavoca, ukugeza okushisayo, ingcindezi yokukhathazeka, ukudla okushisayo); i-dermatographism ithinta u-2-5% wabantu futhi ikhiqiza amakhaza akha ngendlela ethile yokuhlikihla noma yokuhlikihla isikhumba.

Ukutheleleka, ikakhulukazi i-Helicobacter pylori, ukutheleleka kwemiphakathi, kanye ne-sinusitis eside, kuhlotshaniswa ne-urticaria eside kwezinye izifundo, futhi ukwelashwa kokutheleleka ngezikhathi ezithile kuhlangabezana namakhaza. Izici ze-hormonal zingase zibe nendima — abanye abesifazane bahlupheka ngezikhukhula ezihambisana nezinsuku zokugcina.

Ukwelashwa kwe-urticaria kulandela indlela ethile ebekwe ezikhungweni zomhlaba. Isinyathelo sokuqala siyi-H1 antihistamines yesizukulwane sesibili (engathinti) ezindaweni ezijwayelekile: i-cetirizine, i-loratadine, i-fexofenadine, i-desloratadine, noma i-bilastine ethathwa nsuku zonke (hhayi kuphela uma unokukhathazeka). Le mishanguzo ivimba ama-H1 receptors emithanjeni yegazi nasezindaweni zezinzwa, yehlisa amakhaza nokukhathazeka.

Ku-urticaria eside, ukusetshenziswa kwansuku zonke kwe-antihistamine kubalulekile — ukuwathatha ngezikhathi ezithile uma amakhaza evela akusebenzi kahle ngoba umgomo uwukuvimbela imiphumela ye-mast cell ngokuqhubekayo. Uma ama-antihistamines ajwayelekile enganiki ukulawula okwanele ngemuva kwezinsuku ezi-2-4, isinyathelo sesibili siwukwandisa i-antihistamine efanayo ukuya kuze kube izikhathi ezine zesisekelo. Lokhu kuphephile futhi kuphakamisa kakhulu ezikhungweni ze-urticaria, nakuba kudlula umthamo wefektri weziningi ze-antihistamines.

Ukwandisa i-cetirizine ukuya ku-20-40mg nsuku zonke (kuqhathaniswa no-10mg ojwayelekile) noma i-fexofenadine ukuya ku-360-720mg nsuku zonke (kuqhathaniswa no-180mg ojwayelekile) kunikeza inzuzo eyengeziwe kubantu abaningi. Ama-antihistamines okuqala anokuthinta (i-diphenhydramine, i-hydroxyzine) angangezwa ngesikhathi sokulala ukuze kutholakale ukwelashwa kokukhathazeka kokuhlwa kodwa akukhethwa kakhulu ukuze kusetshenziswe ngosuku ngenxa yokuthinta nokuphazamiseka kokucabanga. Uma ama-antihistamines akhuphukile engasasebenzi, isinyathelo sesithathu siwukwengeza i-omalizumab (Xolair), i-monoclonal antibody ehambisana ne-IgE eyinikezela ngempumelelo enkulu eziphumeleni ze-chronic spontaneous urticaria.

Iphathwa njenge-injection ye-subcutaneous eyenzelwa njalo ngenyanga, i-omalizumab ifinyelela ukulawula okuphelele kwezimpawu cishe ku-60-70% wabantu futhi ithuthukisa kancane kwabanye. Impendulo ivame ukuba maphakathi, abanye abantu bahlupheka ukhululeka phakathi nezinsuku zokuhlinzwa zokuqala. I-Cyclosporine iyinketho yesinyathelo sesine ezimweni ezinzima — i-immunosuppressant evimbela umsebenzi we-T-cell futhi ivimbela ngokuqondile ukuvuselelwa kwe-mast cell.

Iyasebenza kodwa iletha imiphumela emibi ebalulekile (ukulimala kwezitho, ukucindezela, ukunciphisa ukuvikeleka) futhi igcinwe ezimweni ezinzima, eziphikisana ne-antihistamine ne-omalizumab. Ama-corticosteroids aphelele (i-prednisone) anikeza ukhululeka okusheshayo ezikhukhuleni ezinzima kodwa akufanele asetshenziswe isikhathi eside ku-urticaria eside ngenxa yemiphumela emibi emibi yokusebenzisa isikhathi eside. Ama-leukotriene receptor antagonists (i-montelukast) anikeza inzuzo encane eyengeziwe kubantu abanye, ikakhulukazi labo abane-urticaria ebuhlungu ngenxa ye-NSAIDs noma i-aspirin.

Ngenkathi iningi le-urticaria lingakhathazeki kodwa lingabuhlungu, amakhaza angase abe yisibonakaliso sokuqala se-anaphylaxis — impendulo yokuhlaselwa okukhulu, engaba yingozi empilweni edinga ukwelashwa okuphuthumayo. I-Anaphylaxis ibandakanya izimpawu ezisheshayo ezithinta izinhlelo eziningi zomzimba futhi ingaqhubeka ukusuka kokuncane kuya kokufa phakathi kwemizuzu. Ukuhlonza izimpawu zokuxwayisa kubalulekile.

Lezi zimpawu ezilandelayo ezihambisana namakhaza zikhombisa i-anaphylaxis engase ibe khona futhi zidinga ukufonelwa kwezinsizakalo eziphuthumayo ngokushesha: ubunzima bokuphefumula, ukuhlekisa, noma ukuzizwa sengathi umphimbo wakho uyavalwa; ukuvuvukala kolimi noma umphimbo; ubunzima bokudla noma ukukhuluma; ukuhamba, ukungakhululeki, noma ukuzizwa ungaphansi; ukuwa kwengcindezi yegazi (ukuphenduka okusheshayo, okuncane); ukuhamba, ukuhlekisa, noma ubuhlungu obukhulu besisu; umuzwa wokuphuma. I-Anaphylaxis ivame ukuvulwa yizifo zokudla (ama-nuts, izilwane zasemanzini), ukuhlinzwa kwezinyoni (ama-bee, ama-wasp, ama-hornet), kanye nemishanguzo (ama-antibiotics, ama-NSAIDs). Uma unama-risks athile e-anaphylaxis, kufanele ube ne-epinephrine auto-injector (EpiPen) ngaso sonke isikhathi futhi uyisebenzise ngesikhathi sokuqala sokuphendula okukhulu — ungabambezeli ukubona uma izimpawu ziba ngcono.

I-Epinephrine iyindlela yokuqala yokwelashwa ye-anaphylaxis futhi ingasindisa impilo. Ngisho nangemva kokusebenzisa i-epinephrine, ukuhlolwa kwezokwelapha okuphuthumayo kubalulekile ngoba izimpawu zingaphinda zivele (i-biphasic anaphylaxis). Ngesikhathi sokukhukhula okukhululekile ngaphandle kokuphazamiseka kokuphefumula, izimpawu ze-cardiovascular, noma ukungakhululeki kwe-gastrointestinal, ama-antihistamines afaneleka njengokwelashwa kokuqala, futhi ukunakekelwa okuphuthumayo akuvamile ukuba kudingeke.

Nokho, noma yisiphi isimo lapho amakhaza ehambisana nezimpawu ezingaphezu kwesikhumba kufanele kuthathwe ngokungathí sina futhi kuhlolwe ngokuphuthumayo. Abantu abake bahlupheka i-anaphylaxis kufanele bathunyelwe kumelaphi wezokwelapha ukuze bahlole kahle, bathole izimbangela, futhi bakhe uhlelo lokusebenza lwezimo eziphuthumayo.

Isigameko esisodwa, esifushane samakhaza esixazululwa ngama-antihistamines atholakala ngaphandle kokwelashwa akudingi ukuhlolwa kwezokwelapha. Nokho, kufanele ubone udokotela uma amakhaza eqhubeka ngaphezu kwezinsuku ezimbalwa naphezu kokwelashwa kwe-antihistamine, uma ephindaphinda njalo, noma uma ungakwazi ukuhlonza umthombo. I-Chronic urticaria (amakhaza ahlala ngaphezu kwezinsuku eziyisithupha) njalo idinga ukuhlolwa kwezokwelapha ukuze kutholakale kahle, ukuhlolwa kwezimbangela, nokwelashwa okukhululekile.

Uma amakhaza ngamunye ehla isikhathi eside kunamawashi angu-24 noma eshiya izikhumbuzo uma eshintshe, lokhu kukhombisa i-urticaria vasculitis — ukuvuvukala kwemithambo yegazi okukhombisa amakhaza ajwayelekile kodwa kuyisimo esihlukile esidinga ukuhlolwa kokuphila okungaphansi. Uma amakhaza ehambisana nobuhlungu bezitho, umkhuhlane, noma ukungakhululeki, ukuhlolwa kokuphila kubalulekile. Uma ucabanga ukuthi imishanguzo ethile ibangela amakhaza akho, ungawumisa ngokuphazima ngaphandle kokwelashwa kwezokwelapha (ngaphandle kokuthi uthola impendulo enkulu) — xoxa ngayo nomelaphi wakho.

Uma ama-antihistamines ajwayelekile engalawuleki izimpawu zakho, udokotela wezokwelapha noma umelaphi wezokwelapha angakuhlola i-chronic spontaneous urticaria futhi abhalele izindlela ezithuthukile ezihlanganisa ama-antihistamines akhuphukile, i-omalizumab, noma ezinye izindlela. Uma izinga lakho lokuphila lithinteka kakhulu — ukuphazamiseka kokulala, ukungakwazi ukusebenza, ukuhamba phansi, ukukhathazeka ngama-flare angalindelekile — lokhu kuphela kuyisizathu esanele sokufuna ukunakekelwa kwezokwelapha.

I-Urticaria ihlolwa ngokweqile ngokususelwa kubukeka obuhlukile bamakhaza aphakanyisiwe, kodwa ezinye izimo zingase zifane namakhaza — i-urticaria vasculitis, i-erythema multiforme, i-contact dermatitis, futhi ngisho ne-bullous pemphigoid yokuqala ingavela nezilonda ezifana namakhaza. I-Skinscanner ikusiza ukuhlola ukuthi impendulo yesikhumba sakho inezici ezihambisana ne-urticaria noma ezinye izimo ezidinga ukuhlolwa nokwelashwa okuhlukile. Ukuthwebula izithombe zamakhaza njengoba zivele — ukuthwebula amakhaza aphakanyisiwe, abomvu — kunikeza imibhalo kumhlinzeki wakho wezokwelapha, okubaluleke kakhulu njengoba amakhaza ngamunye angase ashintshe ngaphambi kokuhlangana kwakho.

Ku-urticaria eside, ukugcina idayari yezithombe ehambisana nemibhalo yokukhuthaza (idayari yokudla, i-log yokusebenza, amazinga engcindezi, izinguquko zemishanguzo) kusiza ukuthola amaphethini angase angaveli kumqondo kuphela. Ukuqopha isikhathi samakhaza ngamunye kubalulekile kakhulu: amakhaza ahlala ngaphansi kwezinsuku eziyi-24 akhombisa i-urticaria ejwayelekile, kanti lawo ahlala ngaphezu kwezinsuku eziyi-24 noma eshiya izikhumbuzo zikhombisa ukukhathazeka kwe-urticaria vasculitis edinga i-biopsy. I-Skinscanner ikunika imibhalo engokoqobo eyenza ukuhlangana kwezokwelapha kube nokusebenza kahle kakhulu futhi isize udokotela wakho ukwenza izinqumo ezichanile zokuhlola nokwelashwa.