{"id":8405,"date":"2013-06-26T15:42:04","date_gmt":"2013-06-26T15:42:04","guid":{"rendered":""},"modified":"2016-03-24T20:27:13","modified_gmt":"2016-03-24T20:27:13","slug":"dilgeline-siuolaikine-diagnostika-ir-gydymas","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/dilgeline-siuolaikine-diagnostika-ir-gydymas\/8405\/","title":{"rendered":"Dilg\u0117lin\u0117: \u0161iuolaikin\u0117 diagnostika ir gydymas"},"content":{"rendered":"<p><!-- [if gte mso 9]><xml>\n <w:WordDocument>\n  <w:View>Normal<\/w:View>\n  <w:Zoom>0<\/w:Zoom>\n  <w:HyphenationZone>19<\/w:HyphenationZone>\n  <w:Compatibility>\n   <w:BreakWrappedTables\/>\n   <w:SnapToGridInCell\/>\n   <w:WrapTextWithPunct\/>\n   <w:UseAsianBreakRules\/>\n  <\/w:Compatibility>\n  <w:BrowserLevel>MicrosoftInternetExplorer4<\/w:BrowserLevel>\n <\/w:WordDocument>\n<\/xml><![endif]--><\/p>\n<p><!-- [if gte mso 10]>\n\n\n<style>\n \/* Style Definitions *\/\n table.MsoNormalTable\n\t{mso-style-name:\"Table Normal\";\n\tmso-tstyle-rowband-size:0;\n\tmso-tstyle-colband-size:0;\n\tmso-style-noshow:yes;\n\tmso-style-parent:\"\";\n\tmso-padding-alt:0cm 5.4pt 0cm 5.4pt;\n\tmso-para-margin:0cm;\n\tmso-para-margin-bottom:.0001pt;\n\tmso-pagination:widow-orphan;\n\tfont-size:10.0pt;\n\tfont-family:\"Times New Roman\";}\n<\/style>\n\n\n<![endif]--><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Istoriniai tyrin\u0117jimai rodo, kad dilg\u0117line, kaip ir kitomis alergin\u0117mis ligomis, \u017emon\u0117s sirgo nuo neatmenam\u0173 laik\u0173. Termin\u0105 \u201eurticaria\u201c (<a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">dilg\u0117lin\u0117<\/a>), manoma, pirmasis pavartojo Viljamas Kulenas (William Cullen) 1769 metais, nors ligos, pasirei\u0161kian\u010dios \u012f odos nudilginim\u0105 pana\u0161iais simptomais, apra\u0161ym\u0173 randama pa\u010diuose seniausiuose istorijos \u0161altiniuose. Antai, Kinijoje X am\u017eiuje prie\u0161 Krist\u0173 \u012f nudilginim\u0105 pana\u0161ius odos b\u0117rimus \u017emon\u0117s vadino Feng Yin Zheng.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\"><span style=\"mso-spacerun: yes;\">\u00a0<\/span>Hipokratas (IV am\u017eius prie\u0161 Krist\u0173) vienas pirm\u0173j\u0173 pasteb\u0117jo, jog esama pana\u0161um\u0173 tarp \u201ekeistos odos ligos\u201c, kontakto su \u201egelian\u010diomis dilg\u0117l\u0117mis\u201c ir vabzd\u017ei\u0173 \u012fkandimo. T\u0105 liga Hipokratas pavadino knidoze (cnidosis), arba \u201edilg\u0117li\u0173 sukeltu b\u0117rimu\u201c.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Terminas \u201eurticaria\u201c kil\u0119s i\u0161 lotyni\u0161ko \u017eod\u017eio \u201eurere\u201c, rei\u0161kian\u010dio \u201edeginti\u201c. Beje, viduram\u017eiais skarlatininis b\u0117rimas taip pat buvo vadinamas \u201escarlatina urticaria\u201c!<span style=\"mso-spacerun: yes;\">\u00a0 <\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Dilg\u0117lin\u0117s prie\u017eastis ir atsiradim\u0105 praeityje bandyta ai\u0161kinti \u012fvairiomis teorijomis bei hipotez\u0117mis: humoraline (organizmo skys\u010di\u0173 disbalanso), meteorologine (1823 m.), \u017evaig\u017edyn\u0173 i\u0161sid\u0117stymo, menstruacine (1864 m.).<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Po to kai Paulis Erlichas 1879 metais atrado putli\u0105sias l\u0105steles (mastocitus), prasid\u0117jo alergologijos, kaip mokslo ir praktin\u0117s klinikin\u0117s disciplinos, era. Prad\u0117tos i\u0161samiai ir metodi\u0161kai tyrin\u0117ti alergini\u0173 lig\u0173, \u012fskaitant dilg\u0117lin\u0119, prie\u017eastys ir patogenez\u0117. Vis d\u0117lto ir m\u016bs\u0173 dienomis dilg\u0117lin\u0119, ypa\u010d l\u0117tin\u0119, gaubia daug neai\u0161kum\u0173.<span style=\"mso-spacerun: yes;\">\u00a0 <\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><strong><span style=\"font-size: 10pt; font-family: Arial;\">Klinika ir paplitimas<\/span><\/strong><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\"><a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">Dilg\u0117lin\u0117<\/a> paplitusi visuose pasaulio kra\u0161tuose, ja serga \u012fvairaus am\u017eiaus \u017emon\u0117s. Rizika susirgti dilg\u0117line per gyvenim\u0105 kiekvienam \u017emogui sudaro 1 \u2013 5 proc.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">B\u016bdingiausias dilg\u0117lin\u0117s po\u017eymis \u2013 odos b\u0117rimas rausvomis ar raudonomis nie\u017etin\u010diomis edemi\u0161komis papul\u0117mis, kuri\u0173 centras balk\u0161vas. B\u0117rimo element\u0173 dydis svyruoja nuo keli\u0173 milimetr\u0173 iki keli\u0173 centimetr\u0173. B\u0117rimai gali susilieti, sudarydami plok\u0161teles. Da\u017eniausiai dilg\u0117lin\u0117s b\u0117rimai i\u0161nyksta grei\u010diau nei per 24 valandas.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Dilg\u0117lin\u0117s b\u0117rim\u0173 gali atsirasti \u012fvairi\u0173 k\u016bno viet\u0173 odoje \u2013 plaukuotoje galvos dalyje (skalpe), ant deln\u0173, pad\u0173 ir kt. B\u0117rimai labai nie\u017etintys, nie\u017e\u0117jimas intensyviausias vakarais ir nakt\u012f. Kartais ligonis j\u012f apib\u016bdina kaip dilg\u010diojim\u0105 ar deginim\u0105. Dilg\u0117lin\u0117s sukelt\u0105 nie\u017e\u0117jim\u0105 geriau mal\u0161ina ne kasymas, o trynimas, tod\u0117l sergan\u010di\u0173j\u0173 dilg\u0117line odoje prakti\u0161kai neb\u016bna ekskoriacij\u0173, nudraskym\u0173, matomas odos paraudimas, sukeltas trynimo. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><strong><span style=\"font-size: 10pt; font-family: Arial;\">Klasifikacija<\/span><\/strong><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\"><a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">Dilg\u0117lin\u0117<\/a> da\u017eniausiai skirstoma atsi\u017evelgus \u012f klinikinius po\u017eymius, o ne \u012f etiologija. Daugelis dilg\u0117lin\u0117s atvej\u0173 priskiriami idiopatinei dilg\u0117linei, nes ligos prie\u017eas\u010di\u0173, kaip ir patogenez\u0117s, konkre\u010diam pacientui nepavyksta nustatyti. Dabartiniu metu dilg\u0117lin\u0119, kurios simptomai pasirei\u0161kia kasdien arba beveik kasdien daugiau negu 6 savaites, si\u016bloma vadinti l\u0117tine, o trunkan\u010di\u0105 trumpiau \u2013 \u016bmine. Urtikarinius b\u0117rimus nertai lydi <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/angioedema\/72635\">angioedema<\/a>. <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/angioedema\/72635\">Angioedema<\/a> be dilg\u0117lin\u0117s b\u0117rim\u0173 ver\u010dia \u012ftarti \u012fgyt\u0105 ar paveldim\u0105 ligos formas, ypa\u010d susijusi\u0105 su komlemento C \u2013 1 \u2013 inhibitoriaus nepakankamumu, kurios eiga sunkesn\u0117 ir kuri gali komplikuotis gerkl\u0173 pa\u017eeidim\u0173 (edema).<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">I\u0161skiriamos ir kitos dilg\u0117lin\u0117s formos: <\/span><\/p>\n<ul style=\"margin-top: 0cm;\">\n<li class=\"MsoNormal\" style=\"text-align: justify; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">kontaktin\u0117,<\/span><\/li>\n<li class=\"MsoNormal\" style=\"text-align: justify; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">dilg\u0117linis vaskulitas,<\/span><\/li>\n<li class=\"MsoNormal\" style=\"text-align: justify; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">fizin\u0117.<\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Fizin\u0117 <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">dilg\u0117lin\u0117<\/a> pasi\u017eymi simptom\u0173 atkaklumu ir intensyvumu, ji lemia ry\u0161k\u0173 paciento gyvenimo kokyb\u0117s pablog\u0117jim\u0105. \u0160i\u0105 ligos form\u0105 sukelia specifiniai trigeriai (provokatoriai). I\u0161skiriami fizin\u0117s dilg\u0117lin\u0117s potipiai: vandens (akvagenin\u0117), \u0161al\u010dio, cholinergin\u0117, u\u017etrukusio sl\u0117gio, susijusi su dermografizmu, kar\u0161\u010dio, saul\u0117s, vibracijos.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><strong><span style=\"font-size: 10pt; font-family: Arial;\">\u016amin\u0117 <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">dilg\u0117lin\u0117<\/a><\/span><\/strong><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">\u016amine vadinama <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">dilg\u0117lin\u0117<\/a>, kurios simptomai (<a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/odos-berimai\/43843\">odos b\u0117rimai<\/a> ir kt.) trunka ma\u017eiau negu 6 savaites. \u012eprastiniais atvejais simptomai praeina grei\u010diau nei per 24 valandas. \u016amine dilg\u0117line da\u017eniausiai serga vaikai, \u0161i ligos forma neretai b\u016bna susijusi su atopija. Kas antram pacientui \u016bmin\u0117 <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">dilg\u0117lin\u0117<\/a> b\u016bna idiopatin\u0117, turinti ry\u0161io su vir\u0161utini\u0173 kv\u0117pavimo tak\u0173 infekcijomis (40 proc. ligoni\u0173), vaist\u0173, ypa\u010d beta \u2013 laktamini\u0173 antibiotik\u0173, vartojimu (9 proc.), maisto produktais (1 proc.) ir kt. \u016amin\u0117 <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">dilg\u0117lin\u0117<\/a>, sukelta maisto, vaist\u0173, vabzd\u017ei\u0173, parazit\u0173, kitoki\u0173 i\u0161orini\u0173 veiksni\u0173 paprastai b\u016bna priklausoma nuo IgE. Opioidai, raumen\u0173 relaksantai, radiokontrastin\u0117s med\u017eiagos, vankomicinas dilg\u0117lin\u0119 gali sukelti tiesiai veikdami putli\u0105sias l\u0105stel\u0117s, sukeldami j\u0173 degranuliacij\u0105 ir u\u017edegimo mediatori\u0173 i\u0161siskyrim\u0105. Bakterin\u0117s ir virusin\u0117s infekcijos, transfuzin\u0117s reakcijos, serumin\u0117 liga gali sukelti dilg\u0117lin\u0117s simptom\u0173 veikdami per mechanizmus, susijusius komplementu.<span style=\"mso-spacerun: yes;\">\u00a0 <\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><strong><span style=\"font-size: 10pt; font-family: Arial;\">L\u0117tin\u0117 <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">dilg\u0117lin\u0117<\/a><\/span><\/strong><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">L\u0117tine vadinama tokia <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">dilg\u0117lin\u0117<\/a>, kai:<\/span><\/p>\n<ul style=\"margin-top: 0cm;\">\n<li class=\"MsoNormal\" style=\"text-align: justify; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">dilg\u0117linei b\u016bding\u0173 papulini\u0173 b\u0117rim\u0173 atsiranda reguliariai (da\u017eniausiai kasdien);<\/span><\/li>\n<li class=\"MsoNormal\" style=\"text-align: justify; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">tai trunka ne ma\u017eiau kaip 6 savaites;<\/span><\/li>\n<li class=\"MsoNormal\" style=\"text-align: justify; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">vieno b\u0117rim\u0173 epizodo trukm\u0117 nuo 4 iki 36 valand\u0173.<\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">L\u0117tin\u0117s dilg\u0117lin\u0117s simptomai kartais b\u016bna labai sunk\u016bs, varginantys ir gali labai pabloginti paciento gyvenimo kokyb\u0119.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Tiksli\u0173 duomen\u0173 apie \u012fvairi\u0173 l\u0117tin\u0117s dilg\u0117lin\u0117s form\u0173 paplitim\u0105 n\u0117ra. Moterys l\u0117tine dilg\u0117line serga du kartus da\u017eniau nei vyrai. Kai kuri\u0173 tyrin\u0117toj\u0173 duomenimis, fizin\u0117 <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">dilg\u0117lin\u0117<\/a> sudaro apie 35 proc., o dilg\u0117linis vaskulitas \u2013 apie 5 proc. vis\u0173 l\u0117tin\u0117s dilg\u0117lin\u0117s atvej\u0173. Tokios l\u0117tin\u0117s dilg\u0117lin\u0117s formos kaip infekcin\u0117 ar pseudoalergin\u0117, labai retos. Da\u017eniausiai pasitaiko neai\u0161kios kilm\u0117s, vadinamoji idiopatin\u0117, l\u0117tin\u0117 <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">dilg\u0117lin\u0117<\/a>, ta\u010diau manoma, kad nema\u017ea jos dalis yra autoimunin\u0117s kilm\u0117s. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><strong><span style=\"font-size: 10pt; font-family: Arial;\">Kontaktin\u0117 <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">dilg\u0117lin\u0117<\/a><\/span><\/strong><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Tai tokia <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">dilg\u0117lin\u0117<\/a>, kai urtikarini\u0173 b\u0117rim\u0173 atsiranda i\u0161orinio agento kontakto su oda ar gleivine vietoje. Kontaktin\u0117 <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">dilg\u0117lin\u0117<\/a> skirstoma \u012f:<\/span><\/p>\n<ul style=\"margin-top: 0cm;\">\n<li class=\"MsoNormal\" style=\"text-align: justify; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">alergin\u0119 (priklausom\u0105 nuo IgE) ir <\/span><\/li>\n<li class=\"MsoNormal\" style=\"text-align: justify; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">nealergin\u0119 (nepriklausom\u0105 nuo IgE).<\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Alergine kontaktine dilg\u0117line serga asmenys, jautr\u016bs aplinkos alergenams (\u017eol\u0117ms, gyv\u016bnams, maisto produktams ar profesiniams alergenams<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>(pavyzd\u017eiui, medikai gali b\u016bti jautr\u016bs darbe naudojamoms gumin\u0117ms pir\u0161in\u0117ms). Nealergin\u0117 kontaktin\u0117 <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">dilg\u0117lin\u0117<\/a> atsiranda nuo tiesioginio dirgikli\u0173 urtikant\u0173 poveikio kraujagysl\u0117ms. Toki\u0173 dirgikli\u0173 pavyzd\u017eiai \u2013 sorbin\u0117 r\u016bg\u0161tis, kurios dedama \u012f aki\u0173 la\u0161us, cinaminis aldehidas kosmetikos priemon\u0117se, gelian\u010di\u0173j\u0173 dilg\u0117li\u0173 (Urtica dioica) i\u0161skiriamos med\u017eiagos, kuri\u0173 sud\u0117tyje yra histamino, serotonino, acetilcholino.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><strong><span style=\"font-size: 10pt; font-family: Arial;\">Fizin\u0117 <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">dilg\u0117lin\u0117<\/a><\/span><\/strong><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">\u0160i dilg\u0117lin\u0117s forma labiausiai blogina pacient\u0173 gyvenimo kokyb\u0119. Sergant fizine dilg\u0117line odos simptom\u0173 atsiranda fizi\u0161kai stimuliuotos odos vietose, simptomai da\u017eniausiai praeina per 2 valandas, ta\u010diau dermaografizmo po\u017eymi\u0173 gali likti ilgiau. Jei b\u0117rimai i\u0161lieka trumpiau kaip 1 val., fizin\u0117s dilg\u0117lin\u0117s diagnoz\u0117 abejotina.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Da\u017eniausia fizin\u0117s dilg\u0117lin\u0117s forma \u2013 simptominis demografizmas kuris n\u0117ra susij\u0119s su sistemine liga, atopija, maisto alergija ar autoimuniniais procesais. Sergantieji vadinamojo ilgo spaudimo fizine dilg\u0117line gali sk\u0173stis ir sisteminiais simptomais \u2013 artralgijomis, silpnumu, greitu nuovargiu, \u012f gripo pana\u0161iais negalavimais.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><strong><span style=\"font-size: 10pt; font-family: Arial;\">Dilg\u0117linis vaskulitas<\/span><\/strong><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">\u0160 ligos forma pasitaiko 1 \u2013 10 proc. l\u0117tin\u0117s dilg\u0117lin\u0117s atvej\u0173. Dilg\u0117linio vaskulito simptomai gali b\u016bti labai pana\u0161\u016bs \u012f l\u0117tin\u0117s dilg\u0117lin\u0117s. Ta\u010diau esama ir skirtum\u0173: dilg\u0117linio vaskulito odos simptomai link\u0119 u\u017esit\u0119sti ilgiau negu 24 valandas, pacientas skund\u017eiasi ne tik pa\u017eeist\u0173 viet\u0173 nie\u017e\u0117jimu, bet ir deginimu, skausmu. B\u0117rimams gyjant odoje lieka purpura ar petechij\u0173, kuri\u0173 gali atsirasti ir nuo kasymosi. Histologi\u0161kai tiriant odos pa\u017eeidimus nustatomas leukocitoklastinis vaskulitas.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Specifiniai l\u0117tin\u0117s dilg\u0117lin\u0117s sindromai<\/span><\/p>\n<ul style=\"margin-top: 0cm;\">\n<li class=\"MsoNormal\" style=\"text-align: justify; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Schnitzler sindromas: pasirei\u0161kia pasikartojan\u010diais nie\u017e\u0117jimo nesukelian\u010diais papuliniais odos b\u0117rimais, intermituojan\u010diu kar\u0161\u010diavimu, kaul\u0173 s\u0105nari\u0173 skausmais, padid\u0117jusiu eritrocit\u0173 nus\u0117dimo grei\u010diu, antik\u016bnais IgG prie\u0161 citokin\u0173 interleukin\u0105, monoklonini\u0173 IgM gamopatija, kuriai tenka svarbus vaidmuo \u0161io sindromo patogenez\u0117je.<\/span><\/li>\n<li class=\"MsoNormal\" style=\"text-align: justify; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Muckle \u2013 Wells sindromas. Tai autou\u017edegimin\u0117 liga, susijusi su \u0161al\u010dio sukelto autou\u017edegiminio sindromo \u2013 1 geno mutacijomis. Reta \u0161eimin\u0117 liga, kuri\u0105 gali i\u0161provokuoti temperat\u016bros svyravimai. Pasirei\u0161kia dilg\u0117liniu b\u0117rimu, artralgijomis, amiloidoze, progresuojan\u010diu neurosensoriniu kurtumu.<\/span><\/li>\n<li class=\"MsoNormal\" style=\"text-align: justify; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-size: 10.0pt; font-family: Arial;\"><a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">Dilg\u0117lin\u0117<\/a> n\u0117\u0161\u010di\u0173j\u0173 dermatoz\u0117 (PUPPP), pasirei\u0161kia nie\u017etin\u010diais papuliniais odos b\u0117rimais, atsirandan\u010diais moterims tre\u010diojo n\u0117\u0161tumo trimestro metu. Da\u017eniausiai i\u0161beria liemen\u012f, ypa\u010d pilvo strij\u0173 vietoje. Ligos eiga gerybi\u0161ka, b\u0117rimai v\u0117liau savaime praeina.<\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><strong><span style=\"font-size: 10pt; font-family: Arial;\">Prie\u017eastys, patogenez\u0117<\/span><\/strong><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">L\u0117tin\u0117s dilg\u0117lin\u0117s prie\u017eastys da\u017eniausiai lieka ne\u017einomos, tod\u0117l daugumai pacient\u0173 nustatoma vadinamoji idiopatin\u0117 <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">dilg\u0117lin\u0117<\/a>. Naujausi tyrimai rodo, kad 35 \u2013 50 proc. l\u0117tin\u0117s dilg\u0117lin\u0117s atvej\u0173 susij\u0119 su autoimuniniais procesais, ypa\u010d su putli\u0173j\u0173 l\u0105steli\u0173 didelio afiniteto IgE pastovaus fragmento receptori\u0173 \u2013 1 (FceR1) autoantik\u016bnais. \u0160ie autoantik\u016bnai be paliovos stimuliuoja putli\u0105sias l\u0105steles, versdami jas vazoaktyvi\u0105sias med\u017eiagas. Autologinio serumo odos testu (ASST) autoimunin\u0119 dilg\u0117lin\u0119 galima atskirti nuo kitokios, idiopatin\u0117s. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">I\u0161skiriamos ir kitokios imunin\u0117s etiopatogenez\u0117s l\u0117tin\u0117s dilg\u0117lin\u0117s formos: priklausoma nuo IgE, susijusi su komplementu, imunini\u0173 kompleks\u0173 depozit\u0173 ir kt.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Kita grup\u0117 \u2013 neimunin\u0117s dilg\u0117lin\u0117s formos, susijusios su tiesiogine putli\u0173j\u0173 l\u0105steli\u0173 stimuliacija, vazoaktyvi\u0173 med\u017eiag\u0173 i\u0161skyrimu, prostaglandin\u0173 apykaitos sutrikimais: sukelta acetilsalicilo r\u016bg\u0161ties, nesteroidini\u0173 vaist\u0173 nuo u\u017edegimo, maisto pseudoalergen\u0173 (reta forma) ir kt. Apra\u0161yta l\u0117tin\u0117 <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">dilg\u0117lin\u0117<\/a> AKF inhibitori\u0173 vartojantiems asmenims, manoma, kad jos atsiradim\u0105 lemia bradikinino apykaitos pakitimai. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Maisto alergenai, konservantai, da\u017eai retai kada b\u016bna l\u0117tin\u0117s dilg\u0117lin\u0117s prie\u017eastis. Jei \u017emogus yra alergi\u0161kas maistui, odos simptom\u0173 atsiranda grei\u010diau nei per 30 min. po valgymo.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Su l\u0117tine dilg\u0117line gali b\u016bti susijusios skydliauk\u0117s ligos: Hashimoto tiroiditas, Graves liga ir kt. Apie 27 proc. sergan\u010di\u0173j\u0173 l\u0117tine dilg\u0117line nustatoma antitiroidini\u0173, antimikrosomini\u0173 antik\u016bn\u0173.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Kai kuri\u0173 tyrim\u0173 duomenimis, l\u0117tin\u0117 <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">dilg\u0117lin\u0117<\/a> imunologi\u0161kai gali b\u016bti susijusi su Helicobacter pylori infekcija.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">N\u0117ra \u012frodyta, kad l\u0117tin\u0117 <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">dilg\u0117lin\u0117<\/a> tur\u0117t\u0173 ry\u0161io su piktybiniais navikais, bet \u012frodytas jos ry\u0161ys su slaptomis infekcijomis: dant\u0173 p\u016bliniu, vir\u0161kinimo trakto kandidoze, parazit\u0173 invazijomis. N\u0117ra ai\u0161ku, ar l\u0117tin\u0119 dilg\u0117lin\u0119 gali provokuoti C hepatito, \u017dIV, citomegalo, Epstein &#8211; Barr viruso infekcija. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Putlioji l\u0105stel\u0117 (mastocitas) yra svarbiausia efektorin\u0117 l\u0105stel\u0117 dilg\u0117lin\u0117s patogenez\u0117je. Putli\u0173j\u0173 l\u0105steli\u0173 yra visame \u017emogaus k\u016bne, bet jos skirtingai reaguoja \u012f dirgiklius ir stimulus. Visos putliosios l\u0105stel\u0117s turi didel\u012f afinitet\u0105 IgE receptoriams, tod\u0117l aktyviai dalyvauja nuo IgE priklausomose alergijos reakcijose. IgE imuniniai kompleksai nus\u0117da ant putli\u0173j\u0173 l\u0105steli\u0173, sukelia j\u0173 degranuliacij\u0105 ir vazoaktyvi\u0173 med\u017eiag\u0173 i\u0161siskyrim\u0105. Tai klasikinis imunologinis dilg\u0117lin\u0117s mechanizmas, pastaruoju metu nustatyta ir kit\u0173. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Putli\u0173j\u0173 l\u0105steli\u0173 degranuliacij\u0105 gali sukelti ir neimunologiniai veikdami, stimuliuodami tiesiai putli\u0105sias l\u0105steles: tai opioidai, C5a<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>anafilotoksinas, neuropeptidai (P med\u017eiaga ir kt.), kamienini\u0173 l\u0105steli\u0173 veiksniai ir kt.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Degranuliavus putliajai l\u0105stelei i\u0161siskiria \u012fvairi\u0173 biologi\u0161kai aktyvi\u0173 med\u017eiag\u0173. Dilg\u0117lin\u0117s patogenezei svarbiausias yra<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>histaminas, ta\u010diau reik\u0161ming\u0105 vaidmen\u012f atlieka ir kiti alergijos, u\u017edegimo mediatoriai: tumoro nekroz\u0117s faktorius &#8211; alfa, interleukinai ir kiti citokinai, granuliocit\u0173 \u2013 makrofag\u0173 kolonijas stimuliuojantis faktorius, leukotrienas C4,<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>prostaglandinai ir kt. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Nustatyta, kad histaminas ir kiti mediatoriai kei\u010dia endotelio l\u0105steli\u0173 adhezijos molekuli\u0173 ekspresij\u0105 ir skatina imunines u\u017edegimo l\u0105steles i\u0161 kraujo migruoti \u012f dilg\u0117linius odos pa\u017eeidimus. Sergan\u010di\u0173j\u0173 l\u0117tine idiopatine dilg\u0117line odos pa\u017eeidimuose nustatoma latentinio u\u017edegimo po\u017eymi\u0173: limfocit\u0173 ir granuliocit\u0173 infiltrat\u0173, perivaskulin\u0117 nenekrozin\u0117 infiltracija CD4+ limfocitais, monocitais, bazofilais, eozinofilais, padid\u0117j\u0119s matrikso metaloproteinaz\u0117s \u2013 9 kiekis ir kt.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><strong><span style=\"font-size: 10pt; font-family: Arial;\">Gydymas<\/span><\/strong><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Dilg\u0117lin\u0117s gydymas susideda ir nemedikamentini\u0173 priemoni\u0173 (ligos trigeri\u0173 prevencija, vengimas) ir farmakoterapijos. Dilg\u0117lin\u0117s gydymas skirstomas \u012f pirmo, antro ir tre\u010dio eili\u0161kumo.<\/span><\/p>\n<ul style=\"margin-top: 0cm;\">\n<li class=\"MsoNormal\" style=\"text-align: justify; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Pirmos eil\u0117s terapija susideda i\u0161 paciento mokymo, trigeri\u0173 vengimo ir vaist\u0173. Pacientai turi \u017einoti, kad dilg\u0117lin\u0117s eiga sunkina perkaitimas, stresas, alkoholis. Patariama vengti vartoti aspirino, nesteroidini\u0173 vaist\u0173 nuo u\u017edegimo, AKF inhibitori\u0173. Skiriama vieti\u0161kai veikian\u010di\u0173 nie\u017e\u0117jim\u0105 slopinan\u010di\u0173 vaist\u0173: 1 \u2013 2 proc. vandeninio mentolo kremo, kalamino losjono ar kt.<\/span><\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"margin-left: 18.0pt; text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Histamino H1 receptori\u0173 blokatoriai antihistaminai<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 18.0pt; text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\"><span style=\"mso-spacerun: yes;\">\u00a0<\/span>Antihistamininiai vaistai yra inversiniai H1 receptori\u0173 agonistai. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 18.0pt; text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">H1 receptori\u0173 stimuliacija aktyvina G proteino porinius receptorius, kurie aktyvina inozitolio trifosfat\u0105 ir diacilglicerol\u012f bei NF transkripcijos faktori\u0173. Tai slopina u\u017edegimo ir alergijos mediatori\u0173 (P selektino, intral\u0105stelin\u0117s adhezijos molekul\u0117s \u2013 1, vaskulini\u0173 l\u0105steli\u0173 adhezijos melekul\u0117s \u2013 1, azoto oksido sintaz\u0117s, interleukino \u2013 1beta, interleukino \u2013 6, tumoro nekroz\u0117s faktoriaus &#8211; alfa ir kt. gamyb\u0105. <\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 18.0pt; text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Ypa\u010d aktyviai antihistaminai slopina histamino i\u0161siskyrim\u0105: trukdo<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>putli\u0173j\u0173 l\u0105steli\u0173 ir bazofil\u0173 histaminui veikti audinius taikinius. H1 receptori\u0173 blokada taip pat suma\u017eina alergen\u0173 stimuliuot\u0105 eozinofil\u0173 kaupim\u0105si.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 18.0pt; text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Naujieji, antrosios kartos, H1 antihistaminai pasi\u017eymi dar ir prie\u0161u\u017edegiminiu veikimu: slopina trombocitus aktyvinan\u010dio faktoriaus (PAF) sukelt\u0105 eozinofil\u0173 chemotaks\u012f, nuo PAF priklausom\u0105 eozinofil\u0173 adhezij\u0105 endotelyje, imunini\u0173 l\u0105steli\u0173 migracija pro dermos endotelio l\u0105steles ir kt. Konkretaus H1 antihistaminio preparato klinikinis efektyvumas priklauso nuo daugelio veiksni\u0173: farmakokinetikos, eliminacijos (pusperiod\u017eio ir kt.), afiniteto H1 receptoriams, preparato<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>molekuli\u0173 koncentracijos ties H1 receptoriumi ir kt.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 18.0pt; text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Klinikiniai tyrimai \u012frod\u0117, kad antihistaminai labai efektyviai gydo dilg\u0117linius odos pa\u017eeidimus ir slopina nie\u017e\u0117jim\u0105, ta\u010diau visi\u0161kai urtikariniai b\u0117rimai ir kiti dilg\u0117lin\u0117s simptomai i\u0161nyksta apie 40 proc. ligoni\u0173. Daliai dilg\u0117line sergan\u010di\u0173 pacient\u0173 antihistaminai sukelia dalin\u012f pager\u0117jim\u0105: suma\u017e\u0117ja nie\u017e\u0117jimas, odos b\u0117rim\u0173 intensyvumas, plotas ir trukm\u0117.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 18.0pt; text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Antihistamininiai preparatai n\u0117ra vienodi, tod\u0117l vienam i\u0161 j\u0173 esant neveiksmingam ar nepakankamai veiksmingam, reikia i\u0161m\u0117ginti kit\u0105. Efektyviausia jei antihistamin\u0173 vartojama kasdien, o ne \u201epagal poreik\u012f\u201c.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 18.0pt; text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Pirmosios kartos antihistamin\u0173 dabartiniu metu skiriam retai, nes jie blogai toleruojami: sukelia sedacij\u0105, mieguistum\u0105, burnos sausum\u0105 ir kitoki\u0173 anticholinergini\u0173 reakcij\u0173.<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>\u0160i\u0173 vaist\u0173 rekomenduojama skirti tiems pacientams, kuriems d\u0117l ligos simptom\u0173 (nie\u017e\u0117jimo)<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>sunku u\u017emigti.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 18.0pt; text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Antrosios kartos antihistaminai tokie pat veiksmingi kaip ir pirmosios kartos, bet daug geriau toleruojami: neturi klini\u0161kai pastebimo anticholinerginio poveikio, neslopina centrin\u0117s nerv\u0173 sistemos. Feksofenadinas pasi\u017eymi lipofobi\u0161kumu, tod\u0117l beveik nepatenka \u012f CNS pro hematoencefalin\u012f barjer\u0105, jo sedacinis ir anticholinerginis poveikis<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>silpnas. Desloratadinas antihistamini\u0161kai ir prie\u0161u\u017edegimi\u0161kai veikia stipriau negu loratadinas. Cetirizinas yra aktyvusis hidroksizino komponentas, sukelia ma\u017eesn\u0119 nei pastarasis sedacij\u0105. Levocetirizinas yra aktyvusis cetirizino enantiomeras, veikia aktyviau u\u017e pastar\u0105j\u012f. Mizolastanas, vartojamas su kitais citochromo P450 CYP inhibitoriais (cimetidinu, nifedipinu, ciklosporinu ) gali sukelti \u0161irdies aritmij\u0173 (QT pailg\u0117jim\u0105).<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 18.0pt; text-align: justify;\"><strong><span style=\"font-size: 10pt; font-family: Arial;\">Histamino H2 receptori\u0173 blokatoriai<\/span><\/strong><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 18.0pt; text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\"><span style=\"mso-spacerun: yes;\">\u00a0<\/span>Apie 15 proc. odoje esan\u010di\u0173 histamino receptori\u0173 yra 2 tipo (H2), tod\u0117l gydant l\u0117tin\u0119 dilg\u0117lin\u0119 kartu su H1 antihistaminais kai kuriems pacientams papildomai galima skirti ir H2 blokatori\u0173. Monoterapija H2 blokatoriais silpnai slopina nie\u017e\u0117jim\u0105 ir kitus <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/dilgeline\/4304\">urtikarijos<\/a>\u00a0simptomus, tod\u0117l esant dilg\u0117linei netaikoma.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 18.0pt; text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">** Antrosios eil\u0117s terapija taikoma, jei gydymas antihistaminais nepakankamai veiksmingas. Ji susideda i\u0161 nemedikamentini\u0173 priemoni\u0173 ir farmakoterapijos.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 18.0pt; text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Nemedikamentin\u0117s priemon\u0117s: fototerapija, fotochemoterapija (psoralenas + PUVA) efektyvesn\u0117s sergant fizine dilg\u0117line, realsacin\u0117 terapija.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 18.0pt; text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Vaistai: * tricikliai antidepresantai (pasi\u017eymi ry\u0161kiu H1 ir H2 antagonistiniu aktyvumu), * kortikosteroidai (trumpi sistemini\u0173 kortikosteroid\u0173 kursai gali b\u016bti rekomenduojami sergantiesiems sunkia dilg\u0117line, kai reikalinga greita ir visi\u0161ka simptom\u0173 kontrol\u0117; ilgalaikis dilg\u0117lin\u0117s gydymas kortikosteroidas nerekomenduojamas d\u0117l galimo tolerancijos, hiperglikemijos, hipertenzijos, osteoporoz\u0117s, vir\u0161kinimo trakto op\u0173 atsiradimo; kortikosteroid\u0173 rekomenduoja skirti tik tuomet, jei maksimalios terapin\u0117s<span style=\"mso-spacerun: yes;\">\u00a0 <\/span>H1 antihistamin\u0173 doz\u0117s nepadeda), * leukotrien\u0173 receptori\u0173 antagonistai (klinikiniai tyrimai rodo, kad leukotrien\u0173 antagonistai efektyviau negu placebas slopina l\u0117tin\u0117s dilg\u0117lin\u0117s simptomus, \u0161i\u0173 vaist\u0173 rekomenduojama skirti jei nepadeda antihistaminai, taip pat l\u0117tin\u0117s dilg\u0117lin\u0117s pasikartojim\u0173 prevencijai; kai kuriems pacientams antihistamin\u0173 deriniai su leukotrien\u0173 antagonistais veikia geriau negu monoterapija antihistaminais), nifedipinas (slopina kalcio jon\u0173 patekim\u0105 \u012f odos putli\u0105sias l\u0105steles; gali sustiprinti antihistamin\u0173 efekt\u0105, gali b\u016bti rekomenduojamas asmenims, sergantiems hipertenzija ir dilg\u0117line, ypa\u010d jei pacientas netoleruoja AKF inhibitori\u0173).<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 18.0pt; text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">*** Tre\u010diosios eil\u0117s terapija indikuotina, jei pirmosios ir antrosios eil\u0117s gydymas nepakankamai veiksmingas. Ji susideda i\u0161: * imunomoduliatori\u0173 (ciklosporinas, takrolimas, metotreksatas, mofetilio mikofenolatas, intraveniniai imunoglobulinai), * plazmaferez\u0117s, kolchicino, * dapsono, * salbutamolio, * terbutalino, * sulfasalazino, * plakvenilio, * warfarino.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 18.0pt; text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Tre\u010diosios eil\u0117s terapijos da\u017eniausiai prireikia sergantiesiems autoimunine ar kitokiam gydymui refrakteri\u0161ka l\u0117tine dilg\u0117line.<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-left: 18.0pt; text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">\u0160altiniai<\/span><\/p>\n<ol>\n<li class=\"MsoNormal\" style=\"mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; text-align: justify; line-height: 13.5pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; background: white;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Rook A. The historical background. In: Warin RP, Champion RH. Urticaria. London: Saunders, 1974: 1-9<\/span><\/li>\n<li class=\"MsoNormal\" style=\"mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; text-align: justify; line-height: 13.5pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; background: white;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Humphreys F. Major landmarks in the history of urticarial disorders. Int J Dermatol 1997; 36: 793-6<\/span><\/li>\n<li class=\"MsoNormal\" style=\"mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; text-align: justify; line-height: 13.5pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; background: white;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Czarnetzki BM. The history of urticaria. Int J Dermatol 1989; 28 (1): 52-7<\/span><\/li>\n<li class=\"MsoNormal\" style=\"mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; text-align: justify; line-height: 13.5pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; background: white;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Grattan C, Black AK. Urticaria and <a href=\"https:\/\/pasveik.lt\/lt\/ligos-ir-sindromai\/angioedema\/72635\">angioedema<\/a>. In: Bolognia JL, Jorrizo JL, Rapini RP, editors. Dermatology. Vol. 1. London: Elsevier, 2003: 287-302<\/span><\/li>\n<li class=\"MsoNormal\" style=\"mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; text-align: justify; line-height: 13.5pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; background: white;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Greaves M. Chronic urticaria. J Allergy Clin Immunol 2000; 105: 664-72<\/span><\/li>\n<li class=\"MsoNormal\" style=\"mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; text-align: justify; line-height: 13.5pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; background: white;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Schafer T, Ring I. Epidemiology of urticaria. In: Burr ML, editor. Epidemiology of clinical allergy: monographs in allergy. Basel: Karger, 1993: 49-60<\/span><\/li>\n<li class=\"MsoNormal\" style=\"mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; text-align: justify; line-height: 13.5pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; background: white;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Paul E, Greilich KD, Dominante G. Epidemiology of urticaria. Monogr Allergy 1987; 21: 87-115<\/span><\/li>\n<li class=\"MsoNormal\" style=\"mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; text-align: justify; line-height: 13.5pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; background: white;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Mortureux P, Leaute-Labreze C, Legrain-Lifermann V, et al. Acute urticaria in infancy and early childhood: a prospective study. Arch Dermatol 1998; 134: 319-23<\/span><\/li>\n<li class=\"MsoNormal\" style=\"mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; text-align: justify; line-height: 13.5pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; background: white;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Grob J, Revuz J, Ortonne JP, et al. Comparative study of the impact of chronic urticaria, psoriasis and atopic dermatitis on the quality of life. Br J Dermatol 2005; 152: 289-95<\/span><\/li>\n<li class=\"MsoNormal\" style=\"mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; text-align: justify; line-height: 13.5pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; background: white;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Dice JP. Physical urticaria. Immunol Allergy Clin North Am 2004; 24 (2): 225-46<\/span><\/li>\n<li class=\"MsoNormal\" style=\"mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; text-align: justify; line-height: 13.5pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; background: white;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Lipsker D, Spehner D, Drillien R, et al. Schnitzler syndrome: heterogeneous immunopathological findings involving IgM-skin interactions. Br J Dermatol 2000; 142 (5): 954-9<\/span><\/li>\n<li class=\"MsoNormal\" style=\"mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; text-align: justify; line-height: 13.5pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; background: white;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Saurat JH, Schifferli J, Steiger G, et al. Anti-interleukin-1 alpha autoantibodies in humans: characterization, isotype distribution, and receptor-binding inhibition: higher frequency in Schnitzler\u2019s syndrome (urticaria and macroglobulinemia). J Allergy Clin Immunol 1991; 88 (2): 244-56<\/span><\/li>\n<li class=\"MsoNormal\" style=\"mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; text-align: justify; line-height: 13.5pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; background: white;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Asli B, Bienvenu B, Cordoliani F, et al. Chronic urticaria and monoclonal IgM gammopathy (Schnitzler syndrome). Arch Dermatol 2007; 143 (8): 1046-50<\/span><\/li>\n<li class=\"MsoNormal\" style=\"mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; text-align: justify; line-height: 13.5pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; background: white;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Kanazawa N, Furukawa F. Autoinflammatory syndromes with a dermatological perspective. J Dermatol 2007; 34: 601-18<\/span><\/li>\n<li class=\"MsoNormal\" style=\"mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; text-align: justify; line-height: 13.5pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; background: white;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Matz H, Orion E, Wolf R. Pruritic urticarial papules and plaques of pregnancy: polymorphic eruption of pregnancy (PUPPP). Clin Dermatol 2006; 24: 105-8<\/span><\/li>\n<li class=\"MsoNormal\" style=\"mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; text-align: justify; line-height: 13.5pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; background: white;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Jorrizo J. Approach to the chronic urticaria patient. Texas Dermatologic Society meeting; 2004 May 15; Austin (TX)<\/span><\/li>\n<li class=\"MsoNormal\" style=\"mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; text-align: justify; line-height: 13.5pt; mso-list: l1 level1 lfo2; tab-stops: list 36.0pt; background: white;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Wisnieski JJ. Urticarial vasculitis. Curr Opin Rheumatol 2000; 12: 24-31<\/span><\/li>\n<\/ol>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Hide M, Francis DM, Grattan CE, et al. Autoantibodies against the high-affinity IgE receptor as a cause of histamine release in <\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p><!-- [if gte mso 9]><xml>\n <w:WordDocument>\n  <w:View>Normal<\/w:View>\n  <w:Zoom>0<\/w:Zoom>\n  <w:HyphenationZone>19<\/w:HyphenationZone>\n  <w:Compatibility>\n   <w:BreakWrappedTables\/>\n   <w:SnapToGridInCell\/>\n   <w:WrapTextWithPunct\/>\n   <w:UseAsianBreakRules\/>\n  <\/w:Compatibility>\n  <w:BrowserLevel>MicrosoftInternetExplorer4<\/w:BrowserLevel>\n <\/w:WordDocument>\n<\/xml><![endif]--><\/p>\n<p class=\"MsoNormal\" style=\"text-align: justify;\"><span style=\"font-size: 10.0pt; font-family: Arial;\">Istoriniai tyrin\u0117jimai rodo, kad dilg\u0117line, kaip ir kitomis alergin\u0117mis ligomis, \u017emon\u0117s sirgo nuo neatmenam\u0173 laik\u0173. Termin\u0105 \u201eurticaria\u201c (dilg\u0117lin\u0117), manoma, pirmasis pavartojo Viljamas Kulenas (William Cullen) 1769 metais, nors ligos, pasirei\u0161kian\u010dios \u012f odos nudilginim\u0105 pana\u0161iais simptomais, apra\u0161ym\u0173 randama pa\u010diuose seniausiuose istorijos \u0161altiniuose. Antai, Kinijoje X am\u017eiuje prie\u0161 Krist\u0173 \u012f nudilginim\u0105 pana\u0161ius odos b\u0117rimus \u017emon\u0117s vadino Feng Yin Zheng.<\/span><\/p>\n","protected":false},"author":1,"featured_media":8406,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[27313],"tags":[174,3551,1495,10,7432,6566,137,937,5972,24783,21,60,138,3550,727,132],"site":[],"post_item_type":[27345],"class_list":["post-8405","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-gydymo-naujienos","tag-alergija","tag-antihistaminai","tag-berimai","tag-berimas","tag-infekcija","tag-lasteles","tag-ligonis","tag-mediatoriai","tag-pacientas","tag-puppp","tag-sindromas","tag-terapija","tag-vaistai","tag-vaskulitas","tag-veiksmingas","tag-ziv"],"acf":{"post_sites":false},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/8405","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/comments?post=8405"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/8405\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media\/8406"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=8405"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=8405"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=8405"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=8405"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=8405"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}