How to treat "wind pimples"? Will long-term medication cause harm?

Author: Zhang Jianzhong, Chief Physician, Peking University People's Hospital

The 13th Chairman of the Chinese Medical Association Dermatology and Venereology Branch

Reviewer: Wang Aiping, Chief Physician, Peking University First Hospital

Do you always have sudden itchy rashes that come and go quickly without any reason? These rashes come and go without leaving any traces. This may be urticaria.

1. How should urticaria be treated?

The treatment of urticaria is mainly divided into three aspects:

Find the cause. Urticaria is an allergic disease that can be divided into many types according to the cause. It may be spontaneous or induced by some antigens, physical factors, etc. Only by knowing the clear cause can we carry out more targeted treatment. However, it is difficult to determine the exact cause of 70% of spontaneous urticaria, and finding the cause will also be a long-term task. Therefore, in order to treat urticaria, our first task is to find and determine the cause of urticaria, and then try to avoid it.

Figure 1 Original copyright image, no permission to reprint

Symptomatic treatment is the most important aspect in the treatment of urticaria. All symptoms of urticaria, whether it is wheals, bronchospasm, or gastrointestinal smooth muscle spasm, are caused by chemical mediators mainly composed of histamine, so antihistamine treatment, that is, anti-allergic treatment, is very important. In clinical practice, we can use a variety of antihistamine drugs to treat urticaria.

Avoid certain foods appropriately. According to research by scholars, less than 5% of people will have urticaria due to food allergies, especially infants and children. If urticaria occurs, it is important to check whether they are allergic to certain foods, and then avoid certain foods or limit the amount of food they eat. For adults, you can also check for allergens. If there are none, there is no need to avoid certain foods. In general, 95% of people do not need to avoid certain foods.

2. How to use antihistamines?

There are many kinds of antihistamines, which can be mainly divided into three generations. The first generation includes chlorpheniramine and promethazine, the second generation includes loratadine and cetirizine, and the third generation includes levocetirizine and fexofenadine. Among them, the first generation antihistamines are most likely to cause people to feel drowsy.

Therefore, if a person has a very severe attack, occurring both in the morning and at night, and needs to study or work during the day and cannot feel sleepy, we can use some second-generation antihistamine drugs in the morning, which can not only pass through the blood-brain barrier and inhibit the occurrence of wheals, but also prevent drowsiness and affect daytime study and work. At night, we can add some drugs that can make people a little sleepy. This can not only control urticaria, but also allow people to sleep well, so that they can wake up the next day with better energy.

In another case, some patients have very stubborn symptoms and the conventional antihistamines are not effective. In this case, studies have shown that stubborn urticaria is often related to insufficient dosage of antihistamines. Therefore, if the symptoms are not relieved after taking antihistamines at regular dosages for more than 1-2 weeks, the dosage can be gradually increased.

You can first increase it to two times and use it for two weeks. If it still cannot be controlled, increase it to three times. Europe and the United States even recommend increasing it to four times, but in our country, generally increasing it to two times can control the symptoms. If doubling the dosage of one drug is not good, we can also use different antihistamines for combination treatment, such as a combination of the first and second generations, or a combination of the second generation, or different types of drugs, antihistamines and other anti-inflammatory drugs, such as the antimalarial drug hydroxychloroquine, can also suppress urticaria.

If it doesn't work, we can also use some glucocorticoids or immunosuppressants for a short period of time. In recent years, there is a new method abroad, called biological agents, which are monoclonal antibodies against immunoglobulin E. They are artificially synthesized and can also treat urticaria.

Figure 2 Original copyright image, no permission to reprint

3. Are there any side effects from taking antihistamines for a long time?

Patients with urticaria, especially those with recurrent and severe symptoms, often need to take large doses of antihistamines for a long time. So do these drugs have side effects? Will they cause any harm to our bodies?

Antihistamines do have side effects. For example, the first-generation antihistamines can easily make people sleepy and want to sleep. Some antihistamines can also increase people's appetite and make people gain weight easily.

However, antihistamines are constantly being upgraded, and many new antihistamines have emerged. The dosages of these drugs are relatively safe, and the metabolic pathways are relatively clear, whether through the liver or the kidneys, so we can consider the patient's condition in advance and then make a choice; and after a period of continuous regular medication, reducing the dosage can also maintain the effect, which allows us to use the smallest dosage to control symptoms.

So in general, about 80%-90% of antihistamines are very safe, and you can even take one or two for the rest of your life.

4. What should I do if I get urticaria during pregnancy and breastfeeding?

Pregnant women do not need to be afraid if they suffer from urticaria, because we have dozens of antihistamines that have been proven to have almost no effect on the fetus when taken during pregnancy, such as chlorpheniramine, loratadine, and cetirizine.

Therefore, if you have urticaria during pregnancy, you can also take these drugs. Relatively speaking, these three drugs are relatively safe for pregnant women and fetuses, and you can take them as long as you have urticaria. However, for the treatment of urticaria during pregnancy, we generally do not increase the dosage for the sake of caution.

As for urticaria during breastfeeding, you can be more relaxed about taking medication, because most antihistamines are only excreted through the liver or kidneys, and the amount excreted through breast milk is negligible. Therefore, if women who are breastfeeding develop urticaria, they can boldly use antihistamines.