| [Objective] The survey which about 100 patients of AU and 100 patients of CSU was conducted from February to December 2014 in our hospital and it through analyzing the clinical epidemiological feature in order to understand the epidemiological characteristics of two kinds of disease,the clinical characteristics in allergen examinations,the efficacy of standardized treatment, and offer some information for dermatologists on the evaluation of the severity, diagnosis and prognosis of urticaria as well.[Methods] The pathography from the national key clinical specialist construction experimental project:standardized diagnosis and treatment of acute and chronic urticaria, a multicenter open clinical study.The project was sponsored by the Chinese Medical University and 18 nationwide hospitals which including our hospital (Annex 1,2).200 subjects were diagnosed separately AU or CSU by dermatologists and required to fulfill the designed questionnaires. The basic information of the subjects included the general data, onset age, course of disease, clinical features, etiology and predisposing factors, disease development and evolution, accompanied by symptoms, family history of allergic diseases, laboratory examination, treatment and curative effect. EXCEL and SPSS22.0 were utilized for statistical analysis, including nonparametric statistics, descriptive statistics, chi-square test, and so on.[Results] Among the 100 patients of AU, the ratio of sex male to female wasl: 1.7.The mean age of subjects with AU was 31.6±11.9 years (range,8-57 years).The mean disease duration was 2.5±0.7 days (range,1-30 days).Epidemiological characteristics:77% of AU patients was at the first onset; the frequency of rash was 5-6 or 7-8 hours; the disease time focused on the night (18:00-24:00); the duration of a rash attack would not last more than 1 day; during each attack, most patients had more than 50 rashes and felt severe itching.Pathogeny and inducement:50% of patients had pathogeny and inducement. Among them,42%(21/50) of patients was due to disease factors, among which chronic gastritis/peptic ulcer relating to Hp infections were most common; no patient was because of drug factors; 50%(25/50) of patients was due to food factors, among which seafood was a factor of the highest rate; 40%(20/50) of patients was induced by inhaled allergens, among which dust had the highest rate.42% of patients’ progression and evolution of the disease were ingravescent; allergic shock was not an associated symptom; 11% of patients had family history of allergic diseases (urticaria or asthma).Laboratory examination:the positive rate of test of total IgE of serum was 65%; in the specific allergen detection of serum, the most sensitive allergen of edibility was the peanut (56%), and the most sensitive allergen of inhalation was tree combination (50%); in the MORA biology resonance allergen test, the most sensitive allergen of edibility was the albumen (41%), and the most sensitive allergen of inhalation was mite combination (18%). By comparison between these two tests, most allergens of edibility and a small number of allergens of inhalation were consistent; a small number of allergens of edibility and most allergens of inhalation were of significant difference.Treatment and efficacy:among 41 patients who took medicine regularly,85.3% (35/41) of patients were under control.Among 100 CSU patients, its male female ratio was 1:1.8, its age of onset was between 6-59 years old, and its average age of onset was (32.4±12.9) years old. The course of the disease was 2 months-44 years and its average course of the disease was (37±80) months.Epidemiological characteristics:66% of CSU patients had an attack everyday; the disease time of 72% of patients was at night (18:00～24:00); the duration of a rash attack of all patients would not last more than 1 day; during each attack, most patients had more than 50 rashes and felt severe itching.Pathogeny and inducement:72% of patients had pathogeny and inducement. Among them,25%(18/72) of patients were due to disease factors, among which allergic rhinitis and chronic gastritis/peptic ulcer relating to Hp infections were most common; 79.2%(57/72) of patients were due to food factors, among which seafood was a factor of the highest rate; 32.0%(23/72) of patients were induced by inhaled allergens, among which dust had the highest rate; 5.6%(4/72) of patients related to weekends, holiday and trips; 20.8%(15/72) of patients were due to mental factors relating to negative mental states; among 45 female patients who had pathogeny and inducement,8.9%(4/45) of them related to menstruation.Progression and evolution of the disease:skin damage of all patients resolved spontaneously; rashes of 94% of patients could not be completely cured for a long time; 18% of patients had an acute attack.16% of patients had family history of allergic diseases (urticaria, allergic rhinitis or eczema).Laboratory examination:the positive rate of test of total IgE of serum was 72%; in the specific allergen detection of serum, the most sensitive allergen of edibility was the peanut, and the most sensitive allergen of inhalation was tree combination and cockroaches; in the MORA biology resonance allergen test, the most sensitive allergen of edibility was the albumen, and the most sensitive allergen of inhalation was mite combination. By comparison between these two tests, most allergens of edibility and a small number of allergens of inhalation were consistent; a small number of allergens of edibility and most allergens of inhalation were of significant difference.Treatment and efficacy:among 51 patients who took medicine regularly,62.7% (32/51) of patients were under control.[Conclusion] 1.AU mostly struck young women. It attacked patients or aggravated mostly at night. Most patients had much skin damage during an attack and felt severe itching. It had a strong impact on patients’ sleep and daily life. In addition, pruritus is the main factor of impacting AU patients’ living quality.2..The pathogeny of AU was complex. Most of the time, its pathogeny could be found. Its main pathogeny was infections, drug allergy and food allergy successively. Most of the infections were upper respiratory infections, infection symptoms and signs of AU adult patients were soft, and most child patients related to streptococcal infections; non-steroid anti-inflammatory drugs and antibiotics were main drug allergens orderly.3.Conditions of AU patients who had drug and food allergy history and/or other allergic diseases were not easy to be controlled. Their attacks had long duration and it was easy for them to become CU patients.4.CSU mostly struck middle-aged women. It attacked patients or aggravated mostly at night with a long course. It is easy for patients to have repeated attack; Most patients had much skin damage during an attack and felt severe itching. It had a strong impact on patients’ sleep and daily life. In addition, most CU patients suffered from sleep disorder and emotional disorder (anxiety and depression).5.The pathogeny of CSU was complex. The pathogeny of some part of CSU could not be figured out. Its main pathogeny related to diseases, food allergens, inhaled allergens and mental factors. Among them, the pathogeny of female patients also related to menstruation.6.Among patients who received antihistamine treatment, only a few had resistance of antihistamine drugs. Conditions of most of them were under control after taking medicine; most patients who had resistance of antihistamine drugs suffered from other diseases at the same time. It was suggested that doses of these patients should be increased by 3 times during treatment.7.During the first treatment of some AU and CSU patients, non-standard treatment remained and most patients were not compliant. Medications should be as standard as possible clinically. After AU rashes were disappeared completely, the treatment needed to be continued for 1 week. For CUS, maintenance treatment of 3 to 4 months was advised after it was under control. At the same time, communications with patients should be strengthened.8.In allergen tests of AU and CSU, specific allergens of the MORA biology resonance allergen test and those of the specific allergen detection of serum were compared with each other. By comparison between these two tests, their allergens of edibility were highly consistent, while their allergens of inhalation were of significant difference. The MORA biology resonance allergen test could be used as a primary screening test of allergens of urticaria (especially for child and old patients). |
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