荨麻疹评估

荨麻疹也被称为风团，其特征为出现剧烈瘙痒性红色斑块。[1]Bernstein JA, Lang DM, Khan DA, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014 May;133(5):1270-7. http://www.ncbi.nlm.nih.gov/pubmed/24766875?tool=bestpractice.com 临床上表现为浅层真皮瘙痒、苍白、褪色性肿胀，持续时间长达 24 小时。病变皮损可能较小、较大、巨形、呈椭圆形或环状。[Figure caption and citation for the preceding image starts]: 急性荨麻疹：典型风团图片由 Adam Reich (MD, PhD) 提供 [Citation ends].[Figure caption and citation for the preceding image starts]: 急性或慢性荨麻疹中见到的典型皮损由Stephen Dreskin,MD,PhD提供 [Citation ends].[Figure caption and citation for the preceding image starts]: 荨麻疹：风团图片由 Adam Reich (MD, PhD) 提供 [Citation ends].

世界上有 10％ 至 25％ 的人口患有荨麻疹，并且可发生于任何年龄层。[2]Guldbakke KK, Khachemoune A. Etiology, classification, and treatment of urticaria. Cutis. 2007 Jan;79(1):41-9. http://www.ncbi.nlm.nih.gov/pubmed/17330621?tool=bestpractice.com ​​ 此病是肥大细胞驱动的疾病。尚未明确发生荨麻疹时肥大细胞活化的激活机制，但似乎是由多种不同因素导致。[3]European Dermatology Forum. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Sep 2021 [internet publication]. https://www.guidelines.edf.one//uploads/attachments/cl263w4y200oilajn3li6nqa1-urticaria-2021-gl.pdf

荨麻疹是根据症状持续时间进行分类的：

• 急性荨麻疹：出现自发性风团、血管性水肿或两者均出现，持续时间＜6 周​​​[1]Bernstein JA, Lang DM, Khan DA, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014 May;133(5):1270-7. http://www.ncbi.nlm.nih.gov/pubmed/24766875?tool=bestpractice.com [2]Guldbakke KK, Khachemoune A. Etiology, classification, and treatment of urticaria. Cutis. 2007 Jan;79(1):41-9. http://www.ncbi.nlm.nih.gov/pubmed/17330621?tool=bestpractice.com ​[3]European Dermatology Forum. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Sep 2021 [internet publication]. https://www.guidelines.edf.one//uploads/attachments/cl263w4y200oilajn3li6nqa1-urticaria-2021-gl.pdf

• 慢性荨麻疹：荨麻疹持续或间歇存在≥6 周。​[1]Bernstein JA, Lang DM, Khan DA, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014 May;133(5):1270-7. http://www.ncbi.nlm.nih.gov/pubmed/24766875?tool=bestpractice.com [3]European Dermatology Forum. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Sep 2021 [internet publication]. https://www.guidelines.edf.one//uploads/attachments/cl263w4y200oilajn3li6nqa1-urticaria-2021-gl.pdf [4]Sabroe RA, Lawlor F, Grattan CEH, et al. British Association of Dermatologists guidelines for the management of people with chronic urticaria 2021. Br J Dermatol. 2022 Mar;186(3):398-413. https://academic.oup.com/bjd/article/186/3/398/6705777 http://www.ncbi.nlm.nih.gov/pubmed/34773650?tool=bestpractice.com

慢性荨麻疹被分为 2 种亚型：[3]European Dermatology Forum. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Sep 2021 [internet publication]. https://www.guidelines.edf.one//uploads/attachments/cl263w4y200oilajn3li6nqa1-urticaria-2021-gl.pdf ​​

• 慢性自发性荨麻疹：由已知或未知原因导致的自发性风团、血管性水肿或两者同时出现，持续时间≥6 周。

• 诱导性荨麻疹，例如延迟性压力性荨麻疹、热性荨麻疹、日光性荨麻疹、症状性皮肤划痕症、振动性血管性水肿、水源性荨麻疹、胆碱能性荨麻疹和接触性荨麻疹。

荨麻疹并发血管性水肿

有些荨麻疹患者会并发血管性水肿、深层的真皮和组织（例如黏膜表面）肿胀，伴有可能导致呼吸窘迫和死亡的喉水肿。[3]European Dermatology Forum. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Sep 2021 [internet publication]. https://www.guidelines.edf.one//uploads/attachments/cl263w4y200oilajn3li6nqa1-urticaria-2021-gl.pdf ​​ 血管性水肿通常与荨麻疹有关，可能发生于任何年龄人群。[5]Katelaris CH, Peake JE. MJA practice essentials 5. Allergy and the skin: eczema and chronic urticaria. Med J Aust. 2006 Nov 6;185(9):517-22. http://www.mja.com.au/public/issues/185_09_061106/kat10399_fm.html http://www.ncbi.nlm.nih.gov/pubmed/17137459?tool=bestpractice.com 它可能未必会在荨麻疹首次发作时出现，但随着更多地暴露于过敏物质，血管性水肿的风险增加。[6]Grattan CEH, Black AK. Urticaria and angioedema. In: Bolognia JL, Jorizzo JL, Rapini RP ed. Dermatology (volume one). London, UK: Mosby; 2003;287-302.

血管性水肿的临床表现可能包括，唇部、面部、颈部和四肢的皮下组织和/或口腔、喉部和胃肠道系统黏膜膜下组织的非凹陷性水肿。[7]Depetri F, Tedeschi A, Cugno M. Angioedema and emergency medicine: From pathophysiology to diagnosis and treatment. Eur J Intern Med. 2019 Jan;59:8-13. http://www.ncbi.nlm.nih.gov/pubmed/30220453?tool=bestpractice.com ​ 也可能出现相关症状。这些取决于基础病因。例如潮红、支气管痉挛、腹痛、腹泻和呕吐。[7]Depetri F, Tedeschi A, Cugno M. Angioedema and emergency medicine: From pathophysiology to diagnosis and treatment. Eur J Intern Med. 2019 Jan;59:8-13. http://www.ncbi.nlm.nih.gov/pubmed/30220453?tool=bestpractice.com ​  对于无荨麻疹的血管性水肿，应行进一步评估。[1]Bernstein JA, Lang DM, Khan DA, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014 May;133(5):1270-7. http://www.ncbi.nlm.nih.gov/pubmed/24766875?tool=bestpractice.com [Figure caption and citation for the preceding image starts]: 荨麻疹患者的唇部血管性水肿由Stephen Dreskin,MD,PhD提供 [Citation ends].