The burden of chronic spontaneous urticaria is "second only to cancer"! Medical Exposure: The "3 Do's and 1 Don't" principle is expected to clear up lesions
Newcomers in society are under increased pressure and one of the four may suffer from “chronic spontaneous urticaria”
September is the job hunting season, and the pressure on newbies in society is doubled, and the risk of urticaria is also increased. Dr. Chen Junbin, director of the Drug Allergy Center of the Department of Dermatology and Immunology of Linkou Chang Gung Memorial Hospital, pointed out that Taiwanese people have about a 23.3% chance of developing urticaria in their lifetime, and an average of about one in four people is at risk. In addition to acute urticaria caused by food or drug allergies, In addition, there is also chronic spontaneous urticaria (CSU) that requires long-term treatment. During the onset of the disease, the symptoms of “redness, swelling, and itching” similar to mosquito bites may linger for decades.
Chen Junbin shared that in an era without biological agents, a female nurse in her 40s suffered from chronic spontaneous urticaria for a long time. Even if she took antihistamines stably, the symptoms could hardly be relieved. The uncontrollable itching sensation was not only It makes it difficult for her to sleep well and devote herself to medical services. Because she was tortured both physically and mentally, she was very insistent on getting rid of the itching quickly. She wanted to quickly relieve the itching, and she even did not hesitate to install an artificial blood vessel for chemotherapy so that she could administer anti-itching injections by herself, sometimes even every six hours. It takes one injection to sleep well and concentrate on work.
Although as a nurse, she knew that this was a very extreme way to treat the symptoms rather than the root cause, but in the past without drug control, she had no choice but to give in to the disease. Fortunately, with the advent of biological agents, she finally saw a glimmer of hope. Through stable treatment with biological agents, she finally got rid of the itchiness, and the anxiety caused by the disease gradually dissipated. Finally, with the encouragement of the medical team, she overcame her inner demons and removed the disease. Artificial blood vessels and biological agents are currently used to control the disease stably to this day.
What are the signs of chronic spontaneous urticaria? “3 Symptoms” Not getting better within 6 weeks is a big warning sign
Director Chen Junbin explained that chronic spontaneous urticaria is most common in those aged 20 to 40 years old, and the incidence rate in women is about twice that of men. There are about 40 million patients worldwide, and there are 200,000 to 250,000 patients in Taiwan. It is a disease of autoimmune system disorder and is not directly related to external allergens, but it may be induced or aggravated by allergens, stress, anxiety and other emotions. During the disease, the immune cells in the patient’s body abnormally secrete histamine, which causes blood vessels to dilate and tissue to swell, resulting in wheals and angioedema, which in turn causes the three major symptoms of “redness, swelling, and itching.”
These symptoms tend to disappear within a day or two, but can quickly reappear in a different location. Because the symptoms can easily be dismissed as a sporadic allergic reaction to eating stale food, patients often have to wait five months after the onset of the disease to enter the regular course of treatment, enduring nearly half a year of the disease in vain. The public is reminded that if the three major symptoms suddenly and repeatedly occur for more than six weeks, it may be chronic spontaneous urticaria, and they must go to a large medical institution for examination and treatment.
Director Chen Junbin emphasized that the impact of chronic spontaneous urticaria is by no means a simple change in appearance or itching. For example, with the arrival of the job search season, the interview pressure and anxiety that follow may increase the risk of the disease. If lesions occur On the face, such as swollen lips and rashes, etc., will undoubtedly affect the patient’s confidence in the interview. After successfully entering your ideal company, the uncontrollable itch will also become a hindrance to your work. According to research, about two out of every five people suffer from poor work performance due to itching, and their productivity is reduced by more than 20%. Not only that, 21.9% of patients are late or absent from work due to illness, and as many as 37.5% of them take more than 10 days off per week. Throughout the day, work performance and income will undoubtedly be affected.
Take the above-mentioned case as an example. The nurse suffered from long-term sleep deprivation due to itching that was like ants crawling all over her body. She was often late for work and found it difficult to concentrate on work. As a result, she was unable to show her talents and resorted to extreme measures to control the itching. . In addition, cases such as flight attendants, captains, and drivers whose jobs require concentration and cannot be late often break down in the clinic and express that the disease places a great burden on their work, and they are often even concerned about their supervisors, which makes them feel stressed.
Not only work but also mental health is affected! The patient’s “intimate relationship” also has a red alert
Director Chen Junbin further pointed out that in addition to work performance, more than half of the patients were itchy to the point of having difficulty sleeping, and the risk of anxiety and depression was 1.79 times and 1.61 times higher than that of ordinary people. In addition, at the level of intimate relationships, two out of every three female patients have sexual dysfunction, as high as 67.9%. Overall, more than half of patients suffer from high levels of mental stress, which is only slightly lower than cancer. If the disease cannot be effectively controlled, the patient’s life will be like a red alert, and he may fall into a vicious cycle of “redness, swelling, and itching symptoms → appearance changes, difficulty concentrating → insomnia, stress, anxiety, and depression → worsening of symptoms” at any time.
Professor Chen Yixing, attending physician at the Department of Allergy, Immunology and Rheumatology at Taichung Veterans General Hospital, emphasized that although chronic spontaneous urticaria has a comprehensive impact, most of the newly diagnosed patients are young adults. At this stage, they are struggling with their studies and careers, and may They will hold the idea of "treating when the disease occurs". However, this idea is often the main reason why patients fail to treat and cannot effectively control the disease. Because chronic spontaneous urticaria is by no means a temporary allergic reaction, it requires long-term and stable disease control. If medication is only used when an attack occurs, or even emergency steroids are used to suppress symptoms, it may not only prolong the course of treatment, but also cost more. It takes time to stabilize the disease and control it; patients have to face more severe disease counterattacks after stopping steroids.
The advent of multi-drugs to clear lesions has become a clinical treatment target. Biological agents can effectively relieve annoying itching and quickly clear symptoms.
Professor Chen Yixing explained in accordance with the treatment guidelines of the Taiwan Dermatology Association that the main first- and second-line treatments in clinical practice are antihistamines at different doses. If symptoms persist after two to four weeks, third-line treatment is initiated. According to statistics, more than half of patients cannot effectively control the disease after three months of first- and second-line treatment. Fortunately, biological agents are available for third-line treatment. After a period of treatment, most patients can get rid of the annoying itching and quickly clear up the disease. The chance of zero or three major symptoms is also nearly half.
Professor Chen Yixing encouraged patients that there is no need to worry after diagnosis. There are multiple drugs that can treat chronic spontaneous urticaria. From the past to the present, antihistamine drugs have been the mainstay of first- and second-line treatment. There have been breakthroughs in antihistamine drugs. In addition to the first-generation drugs that are prone to drowsiness and weakness, there are also second-generation antihistamine drugs with relatively mild side effects. However, there is still room for strengthening the frontline treatment. After three months of treatment, only half of the patients could not effectively control the course of the disease, and about 70% of the itching, red and swollen lesions still could not be improved.
Professor Chen Yixing went on to explain that don’t be discouraged if the response to frontline treatment is poor. Today, there are more biological agents for the treatment of chronic spontaneous urticaria. With the help of new weapons, the treatment front has expanded to the third line, and the treatment goal has been set to " All lesions were removed." If the patient still does not respond well to antihistamine therapy after two to four weeks, biologic agents may be considered. After a period of stable treatment, more than three out of every five patients get rid of the most tormenting itching problem, which is about twice as many as those with front-line treatment; nearly half of the patients can quickly clear up and get rid of symptoms. Get rid of the obstacles brought by it and regain your confidence and control of your life.
To combat chronic spontaneous urticaria, you must know the “Three Essentials and One Don’t” formula
Professor Chen Yixing reminded that when dealing with chronic spontaneous urticaria, remember the “three musts, one don’t” formula. First of all, if the three major symptoms of redness, swelling, and itching occur inexplicably for more than six weeks, it is recommended to go to a large medical hospital for examination and treatment. Secondly, if you “need to seek medical attention” and continue to use drugs, only through stable treatment can the disease be controlled early. , clear the lesions, and regain a free life; finally, “give back” your own expectations for treatment and discomfort during treatment, so as to help the attending physician create a personalized treatment course, and help patients improve the impact of side effects by adjusting dosage and administering medication early.
In addition, “not relying on steroids” is also very important. If you only use steroids to urgently control the disease during the attack, not only will you not be able to prescribe the right medicine, but you may face a more serious disease relapse after stopping the medication, and even cause buffalo shoulder, moon face, and even glaucoma. , cataracts and other side effects.
