诊断和治疗慢性自发性荨麻属ria
Chronic urticaria (hives)continues to be achallenging disorder for dermatologists and allergists. Some patients go through years of hopping from one doctor to another, searching for a cause of their recurring welts (hives), itching, and often, swelling (angioedema). The frustration many people go through is immeasurable, as they endure a disease that is sporadic, prolonged and cosmetically embarrassing.
慢性自发性荨麻疹（CSU）是一种慢性荨麻疹的形式尽管有完全评估和实验室测试，但其原因仍然是未知的。它被称为“慢性”一旦它持续六个或更多周或不断地持续六周或更长时间。CSU很少有危及生命，但对生活质量的影响不能夸大。工作生产力，睡眠质量，课堂纪要，社会活动，体育和人际关系都可能受到CSU的影响。
The bad news is doctors may not be able to figure out the cause of your recurring hives, but the good news is they can assist you with controlling them, as long as necessary.
慢性荨麻疹的余地包括详细的历史和体检。CSU是排除的诊断。您的医生将首先尝试通过询问导致荨麻疹发作的时期的几个问题来识别食品，药物或其他外部触发。其他潜在的医疗条件可以与荨麻疹有关。因此，历史和体检将专注于鉴定这些条件的迹象或症状（例如甲状腺疾病，狼疮或其他结缔组织疾病）。
CSU通常被过度诊断为，因为各种触发器逃避患者或医生的识别。由于重复暴露于这些物理因素中的一种或多种，但冷，热，振动，刮擦和压力可能会触发荨麻疹和几个月到几年。如果识别并确认外部触发，则不是CSU。然而，CSU可能与其他类型的荨麻疹共存。物理性荨麻疹是用于血液的术语，其引起的一种或多种上述（下划线）触发器。
Research on CSU has identified a subgroup of patients that have a particular autoimmune disorder that involves the development of auto-antibodies. There is evidence that in 30 to 50 percent of CSU patients, auto-antibodies account for hives and swelling. The auto-antibodies target IgE antibody, or the receptors for IgE antibodies located on cells (mast cells) that underlie the skin and lining of the mouth, throat, respiratory and gastrointestinal tract. These auto-antibodies can activate mast cells and subsequently cause the release of histamine.
诊断CSU
您的医生将确定您是否在完全评估和审查实验室结果后有CSU。您可能会要求您将食物日记保存一个月或两个月，寻找与特定食品或饮料相关的模式（如果您在临时时间中有一些荨麻疹的爆发）。
A particular blood testto confirm auto-immune CSUis available but not often positive. If you are diagnosed to have CSU, treatment will focus on suppressing hives, itching, and swelling.
Treating CSU
Stepped care levels for treating CSU begins with a long-acting, non-drowsy antihistamine or antihistamine with low risk for drowsiness. Some examples include:
Fexofenadine (Allegra)
Cetirizine（Zyrtec）
Loratadine (Claritin)
Desloratadine (Clarinex)
Levocetirizine (Xyzal)
Second line therapy is considered if first-line treatment fails. Your doctor may consider increasing the dose of one of the above medications (often 2-4 times the recommended dosages on the label of the drug). Risks of the above label use of these medications should be reviewed with your doctor. Never use more than the labeled dose of medication without consulting your doctor.
可以添加其他药物，其代表不同类型的组胺阻滞剂，包括：
Famotidine (Pepcid)
兰尼丹（Zantac）
Cimetidine (Tagamet)
第三行的考虑包括在睡前开始短起来的镇静抗组胺药：
Diphenhydramine (Benadryl)
Hydroxyzine HCl (Atarax)
Doxepin：一种常用作为抗抑郁药的药物，但由于其抗组胺药质量，过敏症和皮肤病学员已经在较低剂量下为CSU进行了规定。
有时蒙特洛斯特（Singulair），用于治疗哮喘的药物治疗CSU。Montelukast是一种非甾体类抗炎药，可以每天服用一次，以及一些上述药物，可能会减少CSU的发作。
Severe flare-ups of CSU may warrant a short course of an oral steroid (Prednisone or Methylprednisolone) or an injection of steroid. Most flare-ups will respond to steroids, but a plan must be in place to control CSU once the steroid is stopped.
环孢菌素是一种免疫抑制药物，可用于CSU，但具有包括肾脏损伤和免疫抑制的潜在不利影响。
Severe flare-ups of CSU may warrant a short course of an oral steroid (Prednisone or Methylprednisolone) or an injection of steroid. Most flare-ups will respond to steroids, but a plan must be in place to control CSU once the steroid is stopped.
Omalizumab (Xolair) was FDA-approved for the treatment of chronic spontaneous urticaria in March of 2014. Monthly injections of Xolair, a hybridized monoclonal antibody (combination of mouse and synthetic human antibody) may reduce the development of hives by clearing out circulating IgE antibody. Boxed warnings require all patients to have a source of epinephrine for use in case of a severe allergic reaction to an injection. Severe reactions have been rare.
Final words
CSU adequately responds to antihistamines about half the time. Second and third line treatment measures, as well as other alternative therapies, have helped an additional percentage of patients, but more research is needed to better serve those who continue to suffer. There is no cure for CSU, but fortunately, as outlined above, there are several treatment options available to prevent flare-ups.
