| Abstract [eng] |
Urticaria is a condition characterized by the development of hives, angioedema or both. Based on the duration of the symptoms this disease is classified to acute, if occurrence of the symptoms is for six weeks or less, and to chronic, if it occurs for more than 6 weeks. Chronic urticaria is classified to induced, when the wheals and angioedema causing physical triggers are definite, and spontaneous, when symptoms‘ triggers are known or not known. Urticaria can be caused by many triggers such as cold, heat, pressure, contact with various substances, food, inhaling allergens, medications, systemic diseases and even emotional stress. Hives according to its patophysiological mechanism can also be classified into non-immune or immune origin. Immune urticaria can be caused by drugs or nutrients that induce an immunoglobulin E or other classes of antibodies production. Various physical factors (ultraviolet rays, cold, water), food additives, dyes can cause non-immune urticaria. 30-40% of all chronic spontaneous urticaria cases are autoimmune and they are caused by immunoglobulin G autoantibodies against immunoglobulin E or mast cell immunoglobulin E receptors - anti-Fc epsilon receptor I (FcεRI). The essential urticarias diagnostic principle is thorough history because it is necessary to identify the underlying causes, to monitor disease activity, to exclude other similar diseases and to identify the consequences such as sleeping disorders, stress, social problems. It is also significant to do physical examination which is decided according to anamnesis (if chronic induced urticaria is suspected, provocation testing can be made, complete blood count and C-reactive protein, if provocative factor is not found and chronic spontaneous urticaria is suspected, autologous serum skin test can be made as well as various biomarkers such as immunoglobulin E). The most essential thing while curing urticaria patient is to identify and eliminate the underlying causes and avoid elicting factors if it is possible. Pharmacological treatment is started with a standard dose of second generation antihistamines and increasing the dose up to four times if needed. If treatment is not sufficient for the chronic urticaria omalizumab is added and its dose can be corrected and if control is still inadequate, ciclosporin treatment is initiated. Less frequently used methods are immunosuppressive (methotrexate), immunomodulatory (plasmapheresis), glucocorticoids for maximum 10 days to treat an exacerbation, if prior treatments results are not adequate. Furthermore, it is essential to evaluate the activity of the disease, the impact on quality of life and the effectiveness of the treatment by calculating the Urticaria Activity Score before and during treatment. In this paper there will be discussed two women, who have difficult to treat chronic autoimmune urticaria, the course, diagnostic procedures and treatment of the disease. Also, after analyzing the latest literature in the work, the methods of diagnosis and treatment of the disease will be examined in more detail. |
