胆碱能性荨麻疹的治疗

Treatment of Cholinergic Urticaria

胆碱能性荨麻疹是由身体温度升高引起的,以剧烈瘙痒性小风团为特征的物理性荨麻疹,临床较为常见。本病常由锻炼、情绪激动和刺激性及过热饮食引起。与发病机制有关的因素包括乙酰胆碱、汗孔阻塞、胆碱能受体M3、汗液过敏、和出汗不良。胆碱能性荨麻疹的治疗措施根据患者是否存在排汗功能异常而有所不同。本病的治疗首选组胺H1受体拮抗剂,疗效不佳应增加剂量。对难治性病例推荐联合用药,可选择第二代H1受体拮抗剂联合第一代H1受体拮抗剂和H2受体拮抗剂,或第二代H1受体拮抗剂联合第一代H1受体拮抗剂和抗焦虑药(羟嗪)或抗抑郁药(多塞平)等方案。近年也有尝试用生物制剂如抗IgE单抗治疗难治性患者,并取得一定疗效。

Cholinergic urticaria is a common and unique inducible urticaria characterized by highly pruritic wheals following a rise in body temperature.The condition is usually caused by exercise,emotional stress or hot and spicy food.Acetylcholine,poral occlusion,cholinergic receptor M3,sweat allergy,and dyshidrosis are involved in the pathogenesis.The treatment for cholinergic urticaria differs largely based on the presence of sweating dysfunction.Some patients are refractory to standard doses,so increase the dose of Hl receptor antagonists.The combination therapy regimens are recommended for treatment of refractory patients.In recent years,there have also been attempts to treat refractory patients with biological agents,such as anti-IgE monoclonal antibodies,with certain results.