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]Schaefer P. Acute and chronic urticaria: evaluation and treatment. Am Fam Physician. 2017 Jun 1;95(11):717-24. https://www.aafp.org/afp/2017/0601/p717.html http://www.ncbi.nlm.nih.gov/pubmed/28671445?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。尚未明确荨麻疹中肥大细胞活化的激活机制，但似乎是由多个不同的因素导致的。[3]Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA(2)LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018 Jul;73(7):1393-414. https://onlinelibrary.wiley.com/doi/full/10.1111/all.13397 http://www.ncbi.nlm.nih.gov/pubmed/29336054?tool=bestpractice.com 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 6 周或更短时间[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]Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA(2)LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018 Jul;73(7):1393-414. https://onlinelibrary.wiley.com/doi/full/10.1111/all.13397 http://www.ncbi.nlm.nih.gov/pubmed/29336054?tool=bestpractice.com

• 慢性荨麻疹：荨麻疹持续或间歇存在>6 周。[3]Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA(2)LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018 Jul;73(7):1393-414. https://onlinelibrary.wiley.com/doi/full/10.1111/all.13397 http://www.ncbi.nlm.nih.gov/pubmed/29336054?tool=bestpractice.com

慢性荨麻疹被分为 2 种亚型：[3]Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA(2)LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018 Jul;73(7):1393-414. https://onlinelibrary.wiley.com/doi/full/10.1111/all.13397 http://www.ncbi.nlm.nih.gov/pubmed/29336054?tool=bestpractice.com

• 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。

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]Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA(2)LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018 Jul;73(7):1393-414. https://onlinelibrary.wiley.com/doi/full/10.1111/all.13397 http://www.ncbi.nlm.nih.gov/pubmed/29336054?tool=bestpractice.com 血管性水肿通常与荨麻疹有关，可能发生于任何年龄。[4]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 它未必可能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，它的发作风险将增加。[5]Grattan CEH, Black AK. Urticaria and angioedema. In: Bolognia JL, Jorizzo JL, Rapini RP ed. Dermatology (volume one). London, UK: Mosby; 2003;287-302. 症状通常为麻木、疼痛或感觉异常。[6]Kwong KY, Maalouf N, Jones CA. Urticaria and angioedema: pathophysiology, diagnosis, and treatment. Pediatr Ann. 1998 Nov;27(11):719-24. http://www.ncbi.nlm.nih.gov/pubmed/9826877?tool=bestpractice.com 无荨麻疹的血管性水肿应行进一步的评估。[7]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].