小结
定义
荨麻疹（urticaria/ hives）是一种以红斑、压之褪色、水肿性、无痛性、瘙痒性皮损为特点的皮肤疾病，通常在数分钟内迅速进展。典型的荨麻疹在 24 小时内消退，消退后不留痕迹。
大约 40% 的荨麻疹发作会伴发血管性水肿。血管性水肿是突发于皮下或黏膜的明显肿胀。为疼痛性而非瘙痒性，可持续长达 72 小时。[1] 肿胀主要累及面部、唇、口腔、上气道、生殖器和四肢。[2]
荨麻疹（伴或不伴血管性水肿）可能呈急性或慢性。急性发作的时间少于 6 周，通常由某种特定刺激引起，具有自限性。慢性荨麻疹的发作时间持续 6 周或以上，较少发现明确的特定刺激物。[3]
血管性水肿也可单独出现，不伴有荨麻疹。它是一种独立的临床疾病，需要的诊断方法也不同。患者病史、体格检查和实验室检查可用来确定血管性水肿是药源性、遗传性还是获得性。[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]: 荨麻疹患者的唇部血管性水肿由Stephen Dreskin,MD,PhD提供 [Citation ends].
病史和体格检查
关键诊断因素
- 红斑性水肿性皮损
- 瘙痒
- 24 小时内可消退
- 面部、舌或唇的水肿
其他诊断因素
- 压之褪色的皮损
- 喘鸣
危险因素
- 阳性家族史
- 女性
- 药物诱因的暴露
- 接触食物触发因素
- 近期病毒性感染
- 最近被昆虫叮咬或蜇伤
诊断性检查
首要检查
- FBC 和分类计数
- 红细胞沉降率 (ESR)
- C 反应蛋白 (CRP)
- C4水平
需考虑的检查
- 促甲状腺素 (TSH)
- 抗核抗体 (ANA)
- 皮肤点刺试验
- 避过敏原饮食
- 血清纤维蛋白溶酶
- 皮肤活检
- C1 酯酶抑制剂水平
- C1 酯酶抑制物功能
- C1q 水平
- 针对可疑过敏原的特异性 IgE 检测
治疗流程
急性荨麻疹 ± 血管性水肿
遗传性血管性水肿
慢性荨麻疹 ± 血管性水肿
药物诱导的无荨麻疹的血管性水肿
不伴荨麻疹的特发性血管性水肿
遗传性血管性水肿
撰稿人
作者
Jonathan Bernstein, MD
Professor of Medicine
Department of Internal Medicine
Division of Immunology/Allergy Section
University of Cincinnati
Cincinnati
OH
利益声明
JB is a consultant, contracted researcher, and speaker for Sanofi-Regeneron, AstraZeneca, Novartis/Regeneron, Genentech, Shire/Takeda, CSL Behring, Pharming and Biocryst. He is also a consultant and contracted researcher for Amgen, Allakos, Celldex, Kalvista, Biomarin and IONIS. JB is a consultant for Escient, Ono and Pharvaris, he is on the board of directors for AAAAI, and is a member of the Joint Task Force practice parameter. JB has spoken on this topic at National, International and Regional/Local Educational meetings. JB is an author of abstracts and manuscripts related to these topics and is an author of a number of references cited in this topic.
鸣谢
Dr Jonathan Bernstein would like to gratefully acknowledge Dr S. Shahzad Mustafa and Dr Stephen Dreskin, previous contributors to this topic.
利益声明
SM is on the speakers' panel and advisory board for Genentech. SD declares that he has no competing interests.
同行评议者
Frances Humphreys, MB BS, FRCP
Consultant Dermatologist
Warwick Hospital
Honorary Associate Professor
University of Warwick
Warwick Hospital
Warwick
UK
利益声明
FH has attended educational events organised and funded by Almrall and Schering Plough; has received a speaker's fee from Steibel, Leo, and Schering Plough; and is an author of references cited in this topic.
Alexander M. Marsland, MRCP
Consultant in Dermatology
University Hospital of South Manchester
Manchester
UK
利益声明
None declared.
Luz Fonacier, MD
Head of Allergy and Training Program Director
Winthrop University Hospital
Associate Professor of Clinical Medicine
SUNY at Stony Brook
Stony Brook
NY
利益声明
LF declares that she has no competing interests.
鉴别诊断
- 过敏反应
- 皮肤划痕症
- 特应性皮炎
更多 鉴别诊断指南
- WAO/EAACI 遗传性血管性水肿管理的国际指南——2021 年修订更新版
- 慢性荨麻疹患者的管理指南
更多 指南
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