COMBINED DIFFERENTIATED THERAPY IN PATIENTS WITH URTICARIA

Abstract

Introduction: The necessity of the study of urticaria is called for by its high specific gravity in the structure of dermatoses, lack of effective therapies and, consequently, negative impact on the quality of life of patients and members of their families. Among the factors that initiate clinical manifestations of urticaria are autoimmune disorders, diseases of the gastrointestinal tract, nervous system, bacterial and viral infections, helminth infestation. However, the state of the internal secretion glands in such patients is understudied. Although, it is recognised that thyroid gland plays an important role in the development of allergic dermatitis, but its role in the formation of autoimmune processes at urticaria is still unclear. Such diversity of mechanisms of urticaria development considerably complicates the choice of rational ways of effective therapy. In particular, traditional agents (antihistamine and other hyposensitizing ones) often do not have the desired effect. Due to such complicated current condition of treatment of patients with urticaria, non-medicated methods of treatment seem to be getting more and more prospective. The aim:To develop differentiated treatment of urticaria patients, taking into account the functional state of the thyroid gland and its participation in the formation of autoimmune processes. Materials and methods: We had been supervising 127 patients with chronic idiopathic urticaria (49 men and 78 women) of the age range from 15 to 67 years old with the disease duration from 5 months to 29 years. The control group consisted of 20 healthy individuals. The mild degree of severity of dermatosis was diagnosed in 43 (33.9%) patients, the average degree of the disease severity – in 41 (32.2%), and severe form of the disease was observed in 43 (33.9%) patients. The functional state of thyroid gland was evaluated by determining the level of thyroxine, triiodothyronine, thyroglobulin, and autoantibodies to thyroperoxidase and thyroglobulin in serum. Results: It was discovered that in patients with urticaria, dysfunctional state of thyroid gland is observed, which is manifested by a probable increase in thyroxine content up to 107.52±4.20 nmol/l (in healthy individuals – 78.13±3.65 nmol/l; p<0.05) and thyroglobulin – up to 29.73±2.51 ng/ml (in healthy individuals – 20.16±1.34 ng/ml; p<0.05), which is associated with a decrease in the level of triiodothyronine – up to 1.33±0.06 nmol/l (in healthy individuals – 1.52±0.04 nmol/l; p<0.05). In order to evaluate the effectiveness of this approach, all patients were divided into 4 groups. The first group, with the total amount of 32 patients were prescribed only traditional standard treatment, according to the guidelines. The pations of second group (31 patients) were prescribed specific phototherapy (once a week, 6-8 sessions) after traditional medication and afterward absence of clinical manifestations of pathological process. 31 рatients of the third group were prescribed balneo- and halotherapy after traditional medication and no afterward clinical manifestations of urticaria. The fourth group (33 patients) prescribed combined treatment in the way of combined application of specific therapy, phototherapy, balneotherapy and halotherapy, after the elimination of clinical manifestations of dermatosis by means of 2 month traditional medication. It was established that patients with mild dermatosis were exposed to a probable correction of the functional state of the thyroid gland, improved clinical course and quality of life after medication, balneo- and halomethods of treatment, patients with moderate and severe degree – after combined application of medication, specific photo-, balneoand halotherapy Conclusions: Thus, the therapy of patients with urticaria requires a differentiated approach. Patients with mild dermatosis, after traditional medication, should be prescribed balneo- and halomethods of treatment. Patients with moderate to severe degree of the disease require more intensive medical intervention. They should be prescribed a combined application of specific photo-, balneo- and halotherapy. This approach allows eliminating the pathological process.