摘要
背景
慢性荨麻疹(chronic urticaria,CU),也被称为慢性自发性荨麻疹(chronic spontaneous urticaria, CSU)被定义为自发风团和/或伴发血管神经性水肿超过6周及以上者,是皮肤科的常见过敏性疾病。它越来越成为世界范围内非常严重的健康问题与负担,并因环境和食品污染及工业化进程不断加快等因素而发病风险激增。其发病率逐年上升,目前全世界人口发病率为0.5-1%。慢性荨麻疹患者症状反复,迁延不愈,严重地影响了患者的睡眠、工作、私人生活和精神状态,降低了患者的生活质量。它直接和间接增加了医疗保健成本,对社会造成不利影响。H1-抗组胺药物治疗是目前的主要治疗方法,但其仅对部分患者有效,大多数的患者病因不明,症状反复,治疗棘手。因此,迫切需要新的治疗策略及其病因学研究。
目的
本课题拟通过循证医学的方法系统评价过敏原特异性免疫治疗(Allergen specific immunotherapy, SIT)和中药当归饮子治疗慢性荨麻疹的安全性及有效性；同时通过对兰州地区慢性荨麻疹的疾病复发相关因素调查,为兰州地区荨麻疹病因学研究及防治慢性荨麻疹复发提供临床资料及依据。
方法
计算机检索Cochrane图书馆、Pubmed、Science Citation Index Expanded, EMBASE. CNKI、VIP,手工检索有关引用文献,收集以过敏原特异性免疫治疗和中药当归饮子为干预措施治疗慢性荨麻疹(CU)的随机对照试验(RCT),按Cochrane系统评价方法,评价纳入研究的方法学质量并提取有效数据进行Meta分析。主要结局指标为有效率(包括治愈率、好转率)和生活质量,次要结局指标为复发率和不良反应事件。
采用病例对照方法,选择收集兰州地区慢性荨麻疹患者病例222例,同时收集163例非过敏性疾病患者作为对照人群,对两组人群首先进行性别、年龄等基线资料比较。然后对两组人群的饮食习惯,本次发病两周前的进食状况、用药情况、预防接种等信息进行回顾性调查,并采用SPSS13.0软件进行数据统计分析。
结果
对于过敏原特异性免疫治疗,共纳入14个研究(包括1838例患者),原始文献全部来自中国,无双盲安慰剂对照试验研究。Meta分析结果显示：过敏原特异性免疫治疗与常规治疗(conventional treatment, CT)相比有更高的好转率[OR=2.39,95%CI(1.73,3.30)I2=55%]和治愈率[OR=2.13,95%CI(1.55,2.91)I2=61%]。研究提示治疗后两周过敏原特异性免疫治疗也许可降低慢性荨麻疹的复发率[OR=0.38,95%CI(0.24,0.61)I2=36%]；但是在采用荨麻疹活动评分(UAS)的原始研究与未采用UAS评分的原始研究间合并研究结果存在差异；只有一个研究报道了生活质量评价数据；在不良反应方面,没有研究报道在过敏原特异性免疫治疗中有严重的不良反应。
对于中药当归饮子治疗,共纳入11个研究(包括1081例患者),原始文献全部来自中国,无双盲安慰剂对照试验研究。Meta分析结果显示：与常规抗组胺治疗相比中药当归饮子有更高的治愈率[OR=2.36,95%CI(1.80,3.10)I2=22%],好转率[OR=4.56,95%CI(2.65,7.87)I2=0%],在随访治疗后三个月较常规治疗复发率降低[OR=0.43,95%CI(0.22,0.82)I2=0%],没有研究报道中药当归饮子对生活质量评价数据。在不良反应方面,没有研究报道中药当归饮子治疗有严重的不良反应。
双录入《兰州地区慢性荨麻疹患者发病相关因素调查表》问卷调查数据,经logistic回归分析显示：兰州地区慢性荨麻疹患者组发病前在进食海鲜(P<0.001)、药物(P<0.002)、失眠(P<0.001)、遇冷(P<0.001)、热(P<0.036)、风(P<0.003)及摩擦(P<0.000)等因素方面与对照组的差异具有统计学意义。
结论
当前证据表明,IgE介导的过敏反应可能是部分慢性荨麻疹患者的发病原因,与常规抗组胺药物治疗方法相比,过敏原特异性免疫治疗可能对这部分患者有益。但是由于纳入的原始研究文献数量较少,方法学质量偏低,因此现有证据尚不能获得一个肯定的结论,需要有更多病例、更有说服力的数据和高质量的研究来确定该结论。
此外,当前证据还表明对比常规抗组胺药物治疗方法,中药当归饮子对慢性荨麻疹有更好的治愈率和好转率,可在治疗后三个月降低复发率。但是同样由于纳入原始研究文献的数量较少,方法学质量偏低,当前证据尚不能得出肯定结论,虽然如此,中药当归饮子的优势值得做进一步的研究,特别是需要严格设计的多中心、大样本、随机、双盲对照试验来支持这一结论。
慢性荨麻疹患者在发病前两周进食海鲜、药物、失眠、冷热变化、遇风、摩擦等因素是导致该病复发的危险因素。
BACKGROUND
Chronic urticaria (CU) also known as chronic spontaneous urticaria (CSU) is a common allergic disease of dermatology, characteristic by reoccurring itching and wheal lasting longer than six weeks, which accompanied by angioedema in40%of patients. It has became a very serious worldwide health problem and burden increasingly. The incidence of CU is increasing year by year because of environmental and food contamination, accelerating by the process of industrialization. By now,0.5-1.0%of the population suffers from CU in the world. CU impact patients'quality of life (QOL) seriously. There are high direct and indirect healthcare costs of this disease due to the large socioeconomic implications of reduction in performance. Although antihistamines as mainstay of treatment for CU can alleviate some symptoms, factors such as capricious course, intermittent attack, poor responsiveness to treatment, and ongoing recurrence trouble both clinicians and patients. Thus, new therapy strategies and etiology research of CU constitute our most urgent problem.
OBJECTIVES
The study systematically reviewed allergen specific immunotherapy (SIT) and Chinese angelica decoction (CAD) for CU by meta-analysis, to evaluate the efficacy and safety of SIT and CAD versus conventional treatment (CT) in the treatment of CU. To investigate relapse-related risk factors of patients with urticaria in Lanzhou area, provide clinical evidence and information to the prevention of relapse of this disease.
METHODS
The comprehensive search strategies of various electronic databases (MEDLINE, EMBASE, the Cochrane Library, ISI Web of Knowledge, China National Knowledge Infrastructure, CNKI, CBMWeb and Chinese Scientific Journals Full Text Database) were used in this study to evaluate the efficiency and safety of SIT and CAD versus conventional treatment (CT) in patients with CU. In addition, manual searched reference lists from original studies and review articles. Only randomized controlled trials (RCT) included our searching criteria but not limited language. Upon strictly included and excluded standard, the primary outcomes were efficacy and quality of life (QOL) and the secondary outcomes were relapse rate and adverse events (AEs).
Case-control study was used to collect the information from222CU cases and163controls that were all Lanzhou dwellers. The information including general social and demographic characteristics, eating habits, diet history, drugs using history, vaccination history, sleep and mental condition, physical stimulation, et al. were investigated retrospectively. Then, SPSS13.0software was used for statistical analysis.
RESULTS
Fourteen studies (1,838patients) were included in systematical review of SIT. Our study demonstrated that SIT seemed to show more clinical efficacy rate (OR2.39;95%CI,1.73to3.30;I2=55%), more complete recovery rate (OR2.13;95%CI,1.55to2.91;I2=61%), and less relapse rate two weeks after treatment (OR0.38;95%CI,0.24to0.61;I2=36%) than CT. However, the pooled results of studies using urticaria activity score (UAS) were different from those of studies using non-UAS. Only one study reported improved QOL and no study reported serious AEs after SIT.
Eleven studies (1,081patients) were included in systematical review of CAD. Our study demonstrated that CAD seemed to show more complete recovery rate (OR2.36;95%CI,1.80to3.10; I2=22%), more clinical efficacy rate (OR4.56;95%CI,2.65to7.87; I2=0%), and less relapse rate the third month after treatment (OR0.43;95%CI,0.22to0.82;I2=0%) than CT. No study reported QOL and serious AEs after CAD.
After logistic regression analysis, the results of the survey with double entry and validation showed:there were statistically significant different between the case and control group on eating seafood (P<0.001), insomnia (P<0.001), using drugs (P<0.002), and the physical factors, such as hot (P<0.036), cold (P<0.001), wind (P<0.003) and friction (P<0.000).
CONCLUSIONS
Current evidences indicate that IgE-mediated allergy may be causative in a small number of CU patients and specific immunotherapy with these allergens may be beneficial in those patients. However, the number of included studies was small and the quality was low. So, available evidence is not adequate to draw an affirmative conclusion and larger studies of high quality are needed to provide increasingly convincing data and cases.
CAD might show better clinical efficacy than CT for CU patients. However, the number of included studies was small and the quality was low. So current evidence is not adequate to draw an affirmative conclusion and larger studies of high quality are needed to provide increasingly convincing data and cases. Nevertheless, the advantages of CAD was considered worthy of further investigation, and the strict design of the multi-center, large sample, randomized, double-blind controlled trials to support this conclusion were extremely needed.
The relapse-related risk factors:seafood eating, drugs using, insomnia, physical stimulation such as encountered cold, heat and wind, friction were showed on patients with CU in Lanzhou area, which should be avoided to prevent disease recurrence.
引文
1. E, H.-K. Haufigkeit allergischer Krankheiten in Ost-und Westdeutschland[J]. Gesundheitswesen.1999,61:100-105.
2. Maurer, M., Weller, K., Bindslev-Jensen, C., et al. Unmet clinical needs in chronic spontaneous urticaria. A GA(2)LEN task force report[J]. Allergy.2011,66(3):317-330.
3. Zuberbier, T., Asero, R., Bindslev-Jensen, C., et al. EAACI/GA(2)LEN/EDF/WAO guideline:definition, classification and diagnosis of urticaria[J]. Allergy.2009,64(10): 1417-1426.
4. 金如钧,孙丽萍.慢性荨麻疹的研究进展[J].中华全科医学.2009,7(9)：997-999.
5. Maurer, M., Ortonne, J.P., Zuberbier, T. Chronic urticaria:an internet survey of health behaviours, symptom patterns and treatment needs in European adult patients[J]. British Journal of Dermatology.2009,160(3):633-641.
6. O'donnell, B.F., Lawlor, F., Simpson, J., et al. The impact of chronic urticaria on the quality of life[J]. The British journal of dermatology.1997,136(2):197-201.
7. Baiardini, I., Giardini, A., Pasquali, M., et al. Quality of life and patients'satisfaction in chronic urticaria and respiratory allergy[J]. Allergy.2003,58(7):621-623.
8. Ferrer, M. Epidemiology, healthcare, resources, use and clinical features of different types of urticaria. Alergologica 2005[J]. J Investig Allergol Clin Immunol.2009,19 Suppl 2: 21-26.
9. Delong, L.K., Culler, S.D., Saini, S.S., et al. Annual direct and indirect health care costs of chronic idiopathic urticaria:a cost analysis of 50 nonimmunosuppressed patients[J]. Arch Dermatol.2008,144(1):35-39.
10. Refaat, M.M., Ossman, E.N., Farres, M.N., et al. Assessment of the role of aeroallergens in patients with chronic urticaria[J]. Revue Francaise D Allergologie.2010,50(4): 394-397.
11. Kaplan, A.P., Greaves, M. Pathogenesis of chronic urticaria[J]. Clinical and Experimental Allergy.2009,39(6):777-787.
12. Maurer, M., Hanau, A., Metz, M., et al. Relevance of food allergies and intolerance reactions as causes of urticaria[J]. Hautarzt.2003,54(2):138-143.
13. Kozel, M.M., Mekkes, J.R., Bossuyt, P.M., et al. Natural course of physical and chronic urticaria and angioedema in 220 patients[J]. J Am Acad Dermatol.2001,45(3):387-391.
14. Kulthanan, K., Jiamton, S., Thumpimukvatana, N., et al. Chronic idiopathic urticaria: prevalence and clinical course[J]. J Dermatol.2007,34(5):294-301.
15. Humphreys, F., Hunter, J.A. The characteristics of urticaria in 390 patients[J]. The British journal of dermatology.1998,138(4):635-638.
16. Quaranta, J.H., Rohr, A.S., Rachelefsky, GS., et al. The natural history and response to therapy of chronic urticaria and angioedema[J]. Annals of allergy.1989,62(5):421-424.
17. Zuberbier, T., Asero, R., Bindslev-Jensen, C., et al. EAACI/GA(2)LEN/EDF/WAO guideline:management of urticaria[J]. Allergy.2009,64(10):1427-1443.
18. Staevska, M., Popov, T.A., Kralimarkova, T., et al. The effectiveness of levocetirizine and desloratadine in up to 4 times conventional doses in difficult-to-treat urticaria[J]. J Allergy Clin Immunol.125(3):676-682.
19. Dubertret, L., Zalupca, L., Cristodoulo, T., et al. Once-daily rupatadine improves the symptoms of chronic idiopathic urticaria:a randomised, double-blind, placebo-controlled study[J]. Eur J Dermatol.2007,17(3):223-228.
20. Kameyoshi, Y., Tanaka, T., Mihara, S., et al. Increasing the dose of cetirizine may lead to better control of chronic idiopathic urticaria:an open study of 21 patients[J]. Br J Dermatol.2007,157(4):803-804.
1. Maurer, M., Weller, K., Bindslev-Jensen, C., et al. Unmet clinical needs in chronic spontaneous urticaria. A GA(2)LEN task force report[J]. Allergy.2011,66(3):317-330.
2. Zuberbier, T., Asero, R., Bindslev-Jensen, C., et al. EAACI/GA(2)LEN/EDF/WAO guideline:definition, classification and diagnosis of urticaria[J]. Allergy.2009,64(10): 1417-1426.
3. Maurer, M., Ortonne, J.P., Zuberbier, T. Chronic urticaria:an internet survey of health behaviours, symptom patterns and treatment needs in European adult patients[J]. Br J Dermatol.2009,160(3):633-641.
4. O'donnell, B.F., Lawlor, F., Simpson, J., et al. The impact of chronic urticaria on the quality of life[J]. Br J Dermatol.1997,136(2):197-201.
5. Baiardini, I., Giardini, A., Pasquali, M., et al. Quality of life and patients'satisfaction in chronic urticaria and respiratory allergy [J]. Allergy.2003,58(7):621-623.
6. Delong, L.K., Culler, S.D., Saini, S.S., et al. Annual direct and indirect health care costs of chronic idiopathic urticaria:a cost analysis of 50 nonimmunosuppressed patients[J]. Arch Dermatol.2008,144(1):35-39.
7. Zuberbier, T., Asero, R., Bindslev-Jensen, C., et al. EAACI/GA(2)LEN/EDF/WAO guideline:management of urticaria[J]. Allergy.2009,64(10):1427-1443.
8. Morgan, M., Khan, D.A. Therapeutic alternatives for chronic urticaria:an evidence-based review, part 1[J]. Ann Allergy Asthma Immunol.2008,100(5):403-411; quiz 412-404, 468.
9. Bousquet, J., Lockey, R., Malling, H.J. Allergen immunotherapy:therapeutic vaccines for allergic diseases. A WHO position paper[J]. J Allergy Clin Immunol.1998,102(4 Pt 1): 558-562.
10. Huggins, J.L., Looney, R.J. Allergen immunotherapy[J]. Am Fam Physician.2004,70(4): 689-696.
11. Frew, A.J.25. Immunotherapy of allergic disease[J]. J Allergy Clin Immunol.2003, 111(2 Suppl):S712-719.
12. Compalati, E., Penagos, M., Tarantini, F., et al. Specific immunotherapy for respiratory allergy:state of the art according to current meta-analyses[J]. Ann Allergy Asthma Immunol.2009,102(1):22-28.
13. Skoner, D., Gentile, D., Bush, R., et al. Sublingual immunotherapy in patients with allergic rhinoconjunctivitis caused by ragweed pollen[J]. J Allergy Clin Immunol.125(3): 660-666.
14. Abramson, M.J., Puy, R.M., Weiner, J.M. Injection allergen immunotherapy for asthma[J]. Cochrane Database Syst Rev. (8):CD001186.
15. Severino, M.G., Cortellini, G., Bonadonna, P., et al. Sublingual immunotherapy for large local reactions caused by honeybee sting:a double-blind, placebo-controlled trial[J]. J Allergy Clin Immunol.2008,122(1):44-48.
16. Niebuhr, M., Kapp, A., Werfel, T. Specific immunotherapy in the treatment of atopic dermatitis[J]. Hautarzt.2007,58(3):232-236.
17. Wilson, D.R., Lima, M.T., Durham, S.R. Sublingual immunotherapy for allergic rhinitis: systematic review and meta-analysis[J]. Allergy.2005,60(1):4-12.
18. Higgins, J.P.T., Altman, D.G. Chapter 8:assessing risk of bias in included studies. In: Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions, Version 5.0.1[J]. The Cochrane Collaboration; updated September 2008.2010: http://www.cochrane-handbook.org. Accessed Oct.
19. 伍建华,韩春雷,伍明伦,等.80例慢性荨麻疹变应原皮试与脱敏治疗的观察[J].临床皮肤科杂志.1999,28(06)：359-360.
20. 曹传凤,宋树玲,朱思慧.脱敏疗法与抗过敏药物治疗慢性荨麻疹的临床观察[J].中国皮肤性病学杂志.1999,13(02)：94.
21. 任继勇.脱敏治疗慢性荨麻疹的临床疗效观察[J].临床皮肤科杂志.2001,30(04)：246.
22. 韦又铭,徐红兵,许志学.慢性荨麻疹变应原检测及免疫治疗分析[J].广西医学.2002,24(04)：474-475.
23. 高宇,李迎春,陈晓冰.脱敏治疗小儿慢性荨麻疹的疗效观察[J].温州医学院学报.2002,32(03)：200-201.
24. 鄂永安,郭英.89例慢性荨麻疹脱敏治疗疗效观察[J].青海医药杂志.2003,(09)：38.
25. 苏腾良,张佳贞,罗愈世.慢性荨麻疹过敏原测定及脱敏治疗疗效分析[J].现代医学.2003,31(03)：204.
26. 翁晖,柯常敏,陶莉.免疫疗法及常规药物疗法治疗302例慢性荨麻疹的对比分析[J].中国临床医药研究杂志.2004,121：12760-12762.
27. 李素敏,李素娟,王威.特异性脱敏治疗慢性荨麻疹患儿的效果观察[J].中国儿童保健杂志.2005,13(03)：199.
28. 唐慧.CC型趋化因子与慢性荨麻疹发病关系的探讨以及特异性免疫治疗的临床和实验室研究[博士学位论文].上海：复旦大学.2006.
29. 宋彪,魏丽虹,郑利雄,等.过敏原免疫疗法治疗慢性荨麻疹的临床研究[J].华夏医学.2006,19(03)：419.422.
30. 郭金梅.慢性荨麻疹特异性防治的疗效观察及护理[J].中国实用医药.2008,3(02)：130-131.
31. 王忠喜,李文静,刘光辉.特异性免疫疗法治疗慢性荨麻疹疗效研究[J].中国医院药学杂志.2008,28(20)：1771-1773.
32. 黄春,耿承芳,蒋伟,等.粉尘螨脱敏注射液与抗组胺药联合治疗慢性荨麻疹疗效观察[J].中国皮肤性病学杂志.2008,22(10)：597-598.
33. Nichols, K.M., Cook-Bolden, F.E. Allergic skin disease:major highlights and recent advances[J]. Med Clin North Am.2009,93(6):1211-1224.
34. Kaplan, A.P., Greaves, M. Pathogenesis of chronic urticaria[J]. Clin Exp Allergy.2009, 39(6):777-787.
35. Philpott, H., Kette, F., Hissaria, P., et al. Chronic urticaria:the autoimmune paradigm[J]. Intern Med J.2008,38(11):852-857.
36. Refaat, M.M., Ossman, E.N., Farres, M.N., et al. Assessment of the role of aeroallergens in patients with chronic urticaria[J]. Revue Francaise D Allergologie.50(4):394-397.
37. Kulthanan, K., Jiamton, S., Rutnin, N.O., et al. Prevalence and relevance of the positivity of skin prick testing in patients with chronic urticaria[J]. J Dermatol.2008,35(6): 330-335.
38. Vonakis, B.M., Saini, S.S. New concepts in chronic urticaria[J]. Curr Opin Immunol. 2008,20(6):709-716.
39. Nettis, E., Di Leo, E., Calogiuri, G., et al. The safety of a novel sublingual rush induction phase for latex desensitization[J]. Curr Med Res Opin.26(8):1855-1859.
40. Nettis, E., Colanardi, M.C., Soccio, A.L., et al. Double-blind, placebo-controlled study of sublingual immunotherapy in patients with latex-induced urticaria:a 12-month study[J]. Br J Dermatol.2007,156(4):674-681.
41. Tanaka, T., Ishii, K., Suzuki, H., et al. Cholinergic urticaria successfully treated by immunotherapy with partially purified sweat antigen[J]. Arerugi.2007,56(1):54-57.
42. Lodi, A., Di Berardino, L., Chiarelli, G., et al. Chronic urticaria and allergy to Acari. Experience with a specific desensitization therapy[J]. G Ital Dermatol Venereol.1990, 125(5):187-189.
43. Kasperska-Zajac, A., Brzoza, Z. Remission of chronic urticaria in the course of house dust mite immunotherapy-Mere coincidence or something more to it?[J]. Vaccine.2009, 27(52):7240-7241.
44. Abdo Rodriguez, A., Espino Anton, P., Zaldivar Estevez, J.C. Immunotherapy using Giardia lamblia extract in recurrent chronic sensitized urticaria[J]. Rev Alerg.1991,38(4): 113-116.
45. August, P.J., O'driscoll, J. Urticaria successfully treated by desensitization with grass pollen extract[J]. Br J Dermatol.1989,120(3):409-410.
46. Morgan, M., Khan, D.A. Therapeutic alternatives for chronic urticaria:an evidence-based review, Part 2[J]. Ann Allergy Asthma Immunol.2008,100(6):517-526; quiz 526-518, 544.
47. Akdis, M., Akdis, C.A. Mechanisms of allergen-specific immunotherapy[J]. J Allergy Clin Immunol.2007,119(4):780-791.
48. Garcia, N.M., Lynch, N.R., Di Prisco, M.C., et al. Nonspecific changes in immunotherapy with house dust extract[J]. J Investig Allergol Clin Immunol.1995,5(1):18-24.
49. Scala, G., Di Rienzo Businco, A., Ciccarelli, A., et al. An evidence based overview of sublingual immunotherapy in children[J]. Int J Immunopathol Pharmacol.2009,22(4 Suppl):23-26.
1. Maurer, M., Weller, K., Bindslev-Jensen, C., et al. Unmet clinical needs in chronic spontaneous urticaria. A GA(2) LEN task force report(1)[J]. Allergy.2011,66(3): 317-330.
2. Zuberbier, T., Asero, R., Bindslev-Jensen, C., et al. EAACI/GA(2)LEN/EDF/WAO guideline:definition, classification and diagnosis of urticaria[J]. Allergy.2009,64(10): 1417-1426.
3. O'donnell, B.F., Lawlor, F., Simpson, J., et al. The impact of chronic urticaria on the quality of life[J]. Br J Dermatol.1997,136(2):197-201.
4. Maurer, M., Ortonne, J.P., Zuberbier, T. Chronic urticaria:an internet survey of health behaviours, symptom patterns and treatment needs in European adult patients [J]. Br J Dermatol.2009,160(3):633-641.
5. Baiardini, I., Giardini, A., Pasquali, M., et al. Quality of life and patients'satisfaction in chronic urticaria and respiratory allergy[J]. Allergy.2003,58(7):621-623.
6. Delong, L.K., Culler, S.D., Saini, S.S., et al. Annual direct and indirect health care costs of chronic idiopathic urticaria:a cost analysis of 50 nonimmunosuppressed patients [J]. Arch Dermatol.2008,144(1):35-39.
7. Zuberbier, T., Asero, R., Bindslev-Jensen, C., et al. EAACI/GA(2)LEN/EDF/WAO guideline:management of urticaria[J]. Allergy.2009,64(10):1427-1443.
8. Morgan, M., Khan, D.A. Therapeutic alternatives for chronic urticaria:an evidence-based review, part 1[J]. Ann Allergy Asthma Immunol.2008,100(5):403-411; quiz 412-404, 468.
9. 刘文静,黄永菁.荨麻疹中医治疗进展[J].四川中医.2007,25(10)：40-43.
10. 李广瑞.慢性荨麻疹的中医治疗对策[J].中国中西医结合皮肤性病学杂志.2009,8(5)：325-326.
11. Frew, A.J.25. Immunotherapy of allergic disease[J]. J Allergy Clin Immunol.2003, 111(2 Suppl):S712-719.
12. 侯秀俊.中西医结合治疗慢性荨麻疹48例[J].山西中医.2000,16(02)：31.
13. 杜芙萍.当归饮子治疗慢性荨麻疹32例[J].山东中医杂志.2000,19(8)：466.
14. 肖红丽,陈汉章.当归饮子治疗慢性荨麻疹的临床观察[J].四川中医.2002,20(1)：62-63.
15. 冯霞.中药当归饮子治疗慢性荨麻疹疗效分析[J].中国皮肤性病学杂志.2004,18(1)：52-53.
16. 王朋军.当归饮子治疗慢性荨麻疹79例[J].光明中医.2006,21(3)：31.
17. 张刚,张建华.当归饮子治疗荨麻疹的临床观察[J].辽宁中医杂志.2007,34(3)：333.
18. 孙元亮.养血祛风法治疗慢性荨麻疹疗效观察[J].湖南中医学院学报.2007,22(4)：70.
19. 吕明富.中西医结合治疗慢性荨麻疹40例临床观察[J].中医药导报.2007,13(6)： 62-63.
20. 陈煜华.当归饮子治疗慢性荨麻疹42例临床观察[J].中医药导报.2008,14(9)：55、66.
21. 肖红丽,眭道顺,朱其杰,等.当归饮子治疗慢性荨麻疹的疗效及对患者血清白三烯B4的抑制作用研究[J].辽宁中医杂志.2008,35(4)：545-547.
22. 陈训军.当归饮子加味治疗慢性荨麻疹的疗效观察[J].湖北中医学院学报.2009,11(3)：49.
23. Altrichter, S., Boodstein, N., Maurer, M. Matrix metalloproteinase-9:a novel biomarker for monitoring disease activity in patients with chronic urticaria patients?[J]. Allergy. 2009,64(4):652-656.
24. Kaplan, A.P., Greaves, M. Pathogenesis of chronic urticaria[J]. Clinical and Experimental Allergy.2009,39(6):777-787.
25. 代淑芳,刘爱民.慢性荨麻疹中医病因证型研究进展[J].中国中西医结合皮肤性病学杂志.2009,8(3)：197-199.
26. Qi, C. Relationship between T cell subsets and traditional Chinese medicine type in patients with ovarian tumor.[J]. Chinese Journal of Dermatovenerology of Integrated Traditional and Western Medicine.1994,14:334-336.
27. Yang, T.H., Lu, B.H., Jia, M., et al. Angelica polysaccharides on mice immune function[J]. Chinese Pharmacological Bulletin.2003,19(4):448-451.
28. Lin, A.H.,Li, Y.R. Astragalus on mice immune function [J]. J Fourth Mil Med Univ.2003, 24(17):201.
1. Zuberbier, T., Asero, R., Bindslev-Jensen, C., et al. EAACI/GA(2)LEN/EDF/WAO guideline:management of urticaria[J]. Allergy.2009,64(10):1427-1443.
2. Delong, L.K., Culler, S.D., Saini, S.S., et al. Annual direct and indirect health care costs of chronic idiopathic urticaria:a cost analysis of 50 nonimmunosuppressed patients[J]. Arch Dermatol.2008,144(1):35-39.
3. 金如钧,孙丽萍.慢性荨麻疹的研究进展[J].中华全科医学.2009,7(9)：997-999.
4. Baiardini, I., Giardini, A., Pasquali, M., et al. Quality of life and patients'satisfaction in chronic urticaria and respiratory allergy[J]. Allergy.2003,58(7):621-623.
5. Kaplan, A.P., Greaves, M. Pathogenesis of chronic urticaria[J]. Clinical and Experimental Allergy.2009,39(6):777-787.
6. Romano, A. Possible interaction among hypersensitivity to lipid transfer proteins, chronic urticaria, and hypersensitivity reactions to nonsteroidal anti-inflammatory drugs[J]. European annals of allergy and clinical immunology.2011,43(1):3-4.
7. Asero, R. Hypersensitivity to lipid transfer protein is frequently associated with chronic urticaria[J]. European annals of allergy and clinical immunology.2011,43(1):19-21.
8. Wedi, B., Kapp, A. Current position of the role of allergic and non-allergic food hypersensitivity in urticaria[J]. Hautarzt.2006,57(2):101-107.
9. Magerl, M., Pisarevskaja, D., Scheufele, R., et al. Effects of a pseudoallergen-free diet on chronic spontaneous urticaria:a prospective trial[J]. Allergy.2010,65(1):78-83.
10. Mathelier-Fusade, P. Drug-induced urticarias[J]. Clin Rev Allergy Immunol.2006,30(1): 19-23.
11. Asero, R. Etoricoxib challenge in patients with chronic urticaria with NSAID intolerance[J]. Clinical and experimental dermatology.2007,32(6):661-663.
12. Inomata, N., Tatewaki, S., Ikezawa, Z. Multiple H(1)-antihistamine-induced urticaria[J]. Journal of Dermatology.2009,36(4):224-227.
13. Ozkan, M., Oflaz, S., Kocaman, N., et al. Psychiatric morbidity and quality of life in patients with chronic idiopathic urticaria[J]. Ann Allergy Asthma Immunol.2007,99(1): 29-33.
14. Iamandescu, I.B. Urticaria, angioedema, and their psychogenic triggers-A clinical approach[J]. Allergy & Clinical Immunology International-Journal of the World Allergy Organization.2007,19(4):146-150.
15. Kaminski, E., Chung, M., Symons, C., et al. The role of psychological stress in chronic idiopathic urticaria[J]. Allergy.2009,64:516-517.
16. Malhotra, S.K., Mehta, V. Role of stressful life events in induction or exacerbation of psoriasis and chronic urticaria[J]. Indian Journal of Dermatology Venereology & Leprology.2008,74(6):594-599.
17. Shertzer, C.L., Lookingbill, D.P. Effects of relaxation therapy and hypnotizability in chronic urticaria[J]. Arch Dermatol.1987,123(7):913-916.
18. Kozel, M.M., Mekkes, J.R., Bossuyt, P.M., et al. Natural course of physical and chronic urticaria and angioedema in 220 patients[J]. J Am Acad Dermatol.2001,45(3):387-391.
19. Kulthanan, K., Jiamton, S., Thumpimukvatana, N., et al. Chronic idiopathic urticaria: prevalence and clinical course[J]. J Dermatol.2007,34(5):294-301.
20. Humphreys, F., Hunter, J.A. The characteristics of urticaria in 390 patients[J]. The British journal of dermatology.1998,138(4):635-638.
21. Sibbald, R.G., Cheema, A.S., Lozinski, A., et al. Chronic urticaria. Evaluation of the role of physical, immunologic, and other contributory factors[J]. International Journal of Dermatology.1991,30(6):381-386.
22. Tanaka, T., Kameyoshi, Y., Hide, M. Analysis of the prevalence of subtypes of urticaria and angioedema[J]. Arerugi.2006,55(2):134-139.
23. 石春蕊,任万明,高军,等.兰州地区1287例荨麻疹患者过敏原检测分析[J].中国麻风皮肤病杂志.2008,24(9)：740-741.
1. Zuberbier, T., Asero, R., Bindslev-Jensen, C., et al. EAACI/GA2LEN/EDF/WAO guideline:definition, classification and diagnosis of urticaria[J]. Allergy.2009,64(10): 1417-1426.
2. Maurer, M., Weller, K., Bindslev-Jensen, C., et al. Unmet clinical needs in chronic spontaneous urticaria. A GA(2)LEN task force report[J]. Allergy.2011,66(3):317-330.
3. 金如钧,孙丽萍.慢性荨麻疹的研究进展[J].中华全科医学.2009,7(9)：997-999.
4. Maurer, M., Ortonne, J.P., Zuberbier, T. Chronic urticaria:an internet survey of health behaviours, symptom patterns and treatment needs in European adult patients[J]. British Journal of Dermatology.2009,160(3):633-641.
5. O'donnell, B.F., Lawlor, F., Simpson, J., et al. The impact of chronic urticaria on the quality of life[J]. The British journal of dermatology.1997,136(2):197-201.
6. Baiardini, I., Giardini, A., Pasquali, M., et al. Quality of life and patients' satisfaction in chronic urticaria and respiratory allergy[J]. Allergy.2003,58(7):621-623.
7. Delong, L.K., Culler, S.D., Saini, S.S., et al. Annual direct and indirect health care costs of chronic idiopathic urticaria:a cost analysis of 50 nonimmunosuppressed patients[J]. Arch Dermatol.2008,144(1):35-39.
8. Nichols, K.M., Cook-Bolden, F.E. Allergic skin disease:major highlights and recent advances[J]. Med Clin North Am.2009,93(6):1211-1224.
9. Kaplan, A.P., Greaves, M. Pathogenesis of chronic urticaria[J]. Clinical and Experimental Allergy.2009,39(6):777-787.
10. Zuberbier, T., Bindslev-Jensen, C., Canonica, W., et al. EAACI/GA(2)LEN/EDF guideline:management of urticaria[J]. Allergy.2006,61(3):321-331.
11. Glinski, W., Silny, W., Czarnecka-Operacz, M., et al. Diagnostic and therapeutic guidelines in urticaria[J]. Postepy Dermatologii I Alergologii.2007,24(1):1-10.
12. Magerl, M., Altrichter, S., Boodstein, N., et al. Urticaria-classification and strategies for diagnosis and treatment.[J]. CME Dermatol.2008,3(1):2-18.
13. Wedi, B., Kapp, A. Current position of the role of allergic and non-allergic food hypersensitivity in urticaria[J]. Hautarzt.2006,57(2):101-107.
14. Romano, A. Possible interaction among hypersensitivity to lipid transfer proteins, chronic urticaria, and hypersensitivity reactions to nonsteroidal anti-inflammatory drugs[J]. European annals of allergy and clinical immunology.2011,43(1):3-4.
15. Asero, R. Hypersensitivity to lipid transfer protein is frequently associated with chronic urticaria[J]. European annals of allergy and clinical immunology.2011,43(1):19-21.
16. Magerl, M., Pisarevskaja, D., Scheufele, R., et al. Effects of a pseudoallergen-free diet on chronic spontaneous urticaria:a prospective trial[J]. Allergy.2010,65(1):78-83.
17. 邹红云,王惠妩,余伍忠,等.食物不耐受在慢性荨麻疹病因诊断中的临床意义[J].标记免疫分析与临床.2010,17(6)：375-377.
18. 张弘,刘江波.慢性特发性荨麻疹患者食物不耐受检测[J].中国麻风皮肤病杂志. 2009,25(8)：596-597.
19. 俞颖,李笑笑.251例慢性荨麻疹患者食物不耐受结果分析[J].浙江中医药大学学报.2009,33(6)：802-803.
20. 张晓云,王建美,朱敬先.食物过敏原特异性IgG检测在慢性荨麻疹中的临床意义[J].山西医科大学学报.2008,39(9)：782-784.
21. 牟慧珺.慢性荨麻疹患者食物特异性IgG抗体检测回顾性分析[硕士学位论文].山东：山东大学.2008.
22. 徐文斌,周虎,李会平.慢性荨麻疹与食物不耐受相关性研究[J].中国麻风皮肤病杂志.2007,23(8)：701.
23. 潘德军,吴国英,郭绪晓.食物不耐受与慢性荨麻疹的相关性研究[J].医学检验与临床.2007,18(6)：52-53.
24. Mathelier-Fusade, P. Drug-induced urticarias[J]. Clin Rev Allergy Immunol.2006,30(1): 19-23.
25. Asero, R. Etoricoxib challenge in patients with chronic urticaria with NSAID intolerance[J]. Clinical and experimental dermatology.2007,32(6):661-663.
26. Inomata, N., Tatewaki, S., Ikezawa, Z. Multiple H(1)-antihistamine-induced urticaria[J]. Journal of Dermatology.2009,36(4):224-227.
27. H, M. Autoserumtest[J]. Nordisk Med.1946,29:150-151.
28. Ce, G, Tb, W., Rp, W., et al. A serological mediator in chronic idiopathic urticaria-a clinical, immunological and histological evaluation[J]. Br J Dermatol.1986,114(5): 583-590.
29. 冯林,宋志强,郝飞.自体血清皮肤试验在慢性荨麻疹的应用进展[J].临床皮肤科杂志.40(8)：508-510.
30. 王德旭,苏东宝,于秉伦,等.慢性荨麻疹患者自体血清皮肤试验的检测[J].中国皮肤性病学杂志.2006,20(2)：90-91.
31. 孙蔚凌,夏济平,毕志刚.慢性荨麻疹患者血清中抗FcεR I a自身抗体及其功能性的检测[J].中国麻风皮肤病杂志.2007,23(4)：280-282.
32. Grattan, C.E.H., Sabroe, R.A., Greaves, M.W. Chronic urticaria[J]. Journal of the American Academy of Dermatology.2002,46(5):645-657.
33. Doutre, M.S. Urticaria and auto-immunity[J]. Revue Francaise D Allergologie.2010, 50(5):456-459.
34. Soundararajan, S., Kikuchi, Y., Joseph, K., et al. Functional assessment of pathogenic IgG subclasses in chronic autoimmune urticaria[J]. Journal of Allergy and Clinical Immunology.2005,115(4):815-821.
35. Kaplan, A.P., Finn, A. Pathogenesis and treatment of chronic urticaria[J]. Postgraduate medicine.1999,106(7 Suppl):12-17.
36. O'donnell, B.F., Francis, D.M., Swana, G.T., et al. Thyroid autoimmunity in chronic urticaria[J]. Br J Dermatol.2005,153(2):331-335.
37. Kikuchi, Y., Fann, T., Kaplan, A.P. Antithyroid antibodies in chronic urticaria and angioedema[J]. Journal of Allergy and Clinical Immunology.2003,112(1):218-218.
38. Grattan, C., Powell, S.,Humphreys, A. Management and diagnostic guidelines for urticaria and angio-oedema[J]. British Journal of Dermatology.2001,144(4):708-714.
39. Luquin, E., Kaplan, A.P., Ferrer, M. Increased responsiveness of basophils of patients with chronic urticaria to sera but hypo-responsiveness to other stimuli[J]. Clinical and Experimental Allergy.2005,35(4):456-460.
40. Lourenco, F.D., Azor, M.H., Santos, J.C., et al. Activated status of basophils in chronic urticaria leads to interleukin-3 hyper-responsiveness and enhancement of histamine release induced by anti-IgE stimulus[J]. Br J Dermatol.2008,158(5):979-986.
41. Eckman, J.A., Hamilton, R.G., Gober, L.M., et al. Basophil phenotypes in chronic idiopathic urticaria in relation to disease activity and autoantibodies[J]. J Invest Dermatol. 2008,128(8):1956-1963.
42. Confino-Cohen, R., Aharoni, D., Goldberg, A., et al. Evidence for aberrant regulation of the p21Ras pathway in PBMCs of patients with chronic idiopathic urticaria[J]. J Allergy Clin Immunol.2002,109(2):349-356.
43. Macdonald, S.M., Rafnar, T., Langdon, J., et al. Molecular identification of an IgE-dependent histamine-releasing factor[J]. Science.1995,269(5224):688-690.
44. Claveau, J., Lavoie, A., Brunet, C., et al. Chronic idiopathic urticaria:possible contribution of histamine-releasing factor to pathogenesis[J]. The Journal of allergy and clinical immunology.1993,92(1 Pt 1):132-137.
45. Sabroe, R.A., Fiebiger, E., Francis, D.M., et al. Classification of anti-Fc epsilon RI and anti-IgE autoantibodies in chronic idiopathic urticaria and correlation with disease severity[J]. Journal of Allergy and Clinical Immunology.2002,110(3):492-499.
46. 李润祥,朱慧兰,梁碧华,等.荨麻疹患者外周血淋巴细胞亚群和IL-15,IL-21,IgE检测[J].中国皮肤性病学杂志.2010,24(8)：708-711.
47. 李迎.T-细胞亚群动态对慢性荨麻疹患者评估病情的探讨[J].中国实验诊断学.2006,10(11)：1354-1355.
48. 李润祥.外周血淋巴细胞亚群和IL-15、IL-21、IgE水平变化在荨麻疹发病机制中的作用[硕士学位论文].广东：广东医学院.2008.
49. 朱慧兰,李润祥,郭庆,等.T、B、NK细胞亚型与慢性荨麻疹发病机制的关系[J].中华皮肤科杂志.2008,41(6)：391-393.
50. 李廷慧,侯晓彬,肖漓,等.慢性特发性荨麻疹患者外周血T及Th淋巴细胞亚群的表达[J].中国美容医学.2009,1 8(8)：1118-1121.
51. 江振友,邹林,史毓杰,等.辅助性T细胞在慢性荨麻疹发病中的研究现状[J].岭南皮肤性病科杂志.2009,1 6(4)：270-272.
52. Ferrer, M., Luquin, E., Sanchez-Ibarrola, A., et al. Secretion of cytokines, histamine and leukotrienes in chronic urticaria[J]. International Archives of Allergy and Immunology. 2002,129(3):254-260.
53. Hidvegi, B., Nagy, E., Szabo, T., et al. Correlation between T-cell and mast cell activity in patients with chronic urticaria[J]. Int Arch Allergy Immunol.2003,132(2):177-182.
54. Piconi, S., Trabattoni, D., Iemoli, E., et al. Immune profiles of patients with chronic idiopathic urticaria[J]. Int Arch Allergy Immunol.2002,128(1):59-66.
55. Garmendia, J.V., Zabaleta, M., Blanca, I., et al. Total and biologically active serum-soluble CD 154 in patients with chronic idiopathic urticaria[J]. Allergy and Asthma Proceedings.2004,25(2):121-125.
56. Caproni, M., Volpi, W., Macchia, D., et al. Infiltrating cells and related cytokines in lesional skin of patients with chronic idiopathic urticaria and positive autologous serum skin test[J]. Exp Dermatol.2003,12(5):621-628.
57. Caproni, M., Giomi, B., Volpi, W., et al. Chronic idiopathic urticaria:infiltrating cells and related cytokines in autologous serum-induced wheals[J]. Clinical Immunology.2005, 114(3):284-292.
58. 冯欢,郭胤仕.慢性荨麻疹患者外周血CD4+CD25+调节性T细胞的表达[J].临床皮肤科杂志.2011,40(3)：136-138.
59. 冯欢,郭胤仕.CD4+CD25+Treg细胞在慢性荨麻疹发病中的作用[J].临床皮肤科杂志.2011,40(5)：313-315.
60. 史毓杰,杨健,杨文林,等.慢性特发性荨麻疹患者血清甲状腺过氧化物酶抗体及甲状腺球蛋白抗体的测定[J].岭南皮肤性病科杂志.2009,16(4)：235-236.
61. 林德儒,邓微,朱甫津,等.慢性荨麻疹患者甲状腺功能的相关性分析[J].现代中西医结合杂志.2009,18(21)：2494-2495.
62. 郑文军,林有坤,韦凤鲜,等.慢性荨麻疹患者甲状腺功能的研究[J].中华皮肤科杂志.2004,37(2)：103-104.
63. Nettis, E., Dambra, P., D'oronzio, L., et al. Reactivity to autologous serum skin test and clinical features in chronic idiopathic urticaria[J]. Clin Exp Dermatol.2002,27(1):29-31.
64. Bakos, N., Hillander, M. Comparison of chronic autoimmune urticaria with chronic idiopathic urticaria[J]. Int J Dermatol.2003,42(8):613-615.
65. Staubach, P., Onnen, K., Vonend, A., et al. Autologous whole blood injections to patients with chronic urticaria and a positive autologous serum skin test:a placebo-controlled trial[J]. Dermatology.2006,212(2):150-159.
66. Sabroe, R.A., Seed, P.T., Francis, D.M., et al. Chronic idiopathic urticaria:comparison of the clinical features of patients with and without anti-FcepsilonRI or anti-IgE autoantibodies[J]. Journal of the American Academy of Dermatology.1999,40(3): 443-450.
67. Wedi, B., Raap, U., Kapp, A. Chronic urticaria and infections[J]. Current opinion in allergy and clinical immunology.2004,4(5):387-396.
68. Wedi, B., Raap, U., Wieczorek, D., et al. Infections and chronic spontaneous urticaria[J]. Hautarzt.2010,61(9):758-764.
69. Wedi, B., Raap, U., Wieczorek, D., et al. Urticaria and infections[J]. Allergy, asthma, and clinical immunology:official journal of the Canadian Society of Allergy and Clinical Immunology.2009,5(1):10.
70. Magen, E., Mishal, J., Schlesinger, M., et al. Eradication of Helicobacter pylori infection equally improves chronic urticaria with positive and negative autologous serum skin test[J]. Helicobacter.2007,12(5):567-571.
71. Kanuga, M., Axelrod, D. Effect of Helicobacter pylori Eradication on Chronic Urticaria: A Meta-Analysis[J]. Journal of Allergy and Clinical Immunology.2010,125(2): AB95-AB95.
72. 莫惠芳,汤勇军,钟卫红,等.慢性特发性荨麻疹与幽门螺杆菌关系和治疗的研究[J].中国中西医结合皮肤性病学杂志.2006,5(2)：83-85.
73. 麻荣武,胡鲜香.慢性荨麻疹与幽门螺旋杆菌感染相关性的探讨[J].中国实用医药.2009,4(19)：63-64.
74. 吕静,李惠.幽门螺杆菌致慢性荨麻疹的发病机制[J].国际皮肤性病学杂志.2007,33(5)：284-286.
75. 毕鸣晔,田珥,施和建.儿童慢性荨麻疹与幽门螺杆菌感染关系的初探[J].中国微循环.2009,13(5)：394-396.
76. 刘向萍,朱莹,刘明,等.小儿荨麻疹与幽门螺杆菌的关系探讨[J].第四军医大学学报.2006,27(8)：694.
77. 曹燕玺.幽门螺杆菌感染与慢性荨麻疹相关性研究的Meta分析[硕士学位论文].河北：河北医科大学.2008.
78. Ertam, I., Biyikli, S.E.Y., Yazkan, F.A., et al. The frequency of nasal carriage in chronic urticaria patients[J]. Journal of the European Academy of Dermatology and Venereology. 2007,21(6):777-780.
79. Baturo, A.P., Romanenko, E.E., Mokronosova, M.A. Microflora of nasopharynx in patients with urticaria[J]. Zhurnal Mikrobiologii Epidemiologii i Immunobiologii.2006, (7):82-85.
80. Jirapongsananuruk, O., Sangacharoenkit, P., Pongpreuksa, S., et al. Is Silent Sinusitis a Cause of Chronic Urticaria in Children?[J]. Asian Pacific Journal of Allergy and Immunology.2009,27(2-3):103-106.
81. Hellmig, S., Troch, K., Ott, S.J., et al. Yersinia enterocolitica:another factor in the pathogenesis of chronic urticaria?[J]. Clinical and experimental dermatology.2009,34(7): e292-e292.
82. Karamchandani-Patel, G, Wall, L., Kumar, P. CHRONIC URTICARIA AND ANGIOEDEMA:THE FORGOTTEN PARASITE[J]. Journal of Investigative Medicine. 2010,58(2):372-373.
83. 王黎,李红文.弓形虫感染所致慢性荨麻疹45例治疗分析[J].新乡医学院学报.2006,23(2)：197-180.
84. Hameed, D.M.A., Hassanin, O.M., Zuel-Fakkar, N.M. Association of Blastocystis hominis genetic subtypes with urticaria[J]. Parasitology Research.2011,108(3):553-560.
85. 黄樱樱.慢性荨麻疹和HBV/HCV感染的临床研究[硕士学位论文].广州：中山大学.2007.
86. 黄樱樱,陈明春.慢性荨麻疹和肝炎病毒感染的相关性研究进展[J].热带医学杂志.2007,7(3)：296-297.
87. 陈明春,黄樱樱,邹勇男.慢性荨麻疹与乙型肝炎病毒感染的关系[J].中国热带医学.2009,9(9)：1717-1718.
88. Cribier, B. Urticaria and hepatitis[J]. Clinical Reviews in Allergy & Immunology.2006, 30(1):25-29.
89. Karaman, U., Sener, S., Calik, S., et al. Investigation of Microsporidia in Patients with Acute and Chronic Urticaria[J]. Mikrobiyoloji Bulteni.2011,45(1):168-173.
90. Ergon, M.C., Ilknur, T., Yucesoy, M., et al. Candida spp. colonization and serum anticandidal antibody levels in patients with chronic urticaria[J]. Clinical and experimental dermatology.2007,32(6):740-743.
91. Godse, K.V., Zawar, V. Chronic urticaria associated with tinea infection and success with antifungal therapy-a report of four cases[J]. International Journal of Infectious Diseases. 2010,14:E364-E365.
92. Maurer, M., Hanau, A., Metz, M., et al. Relevance of food allergies and intolerance reactions as causes of urticaria[J]. Hautarzt.2003,54(2):138-143.
93. Refaat, M.M., Ossman, E.N., Farres, M.N., et al. Assessment of the role of aeroallergens in patients with chronic urticaria[J]. Revue Francaise D Allergologie.2010,50(4): 394-397.
94. Kulthanan, K., Jiamton, S., Rutnin, N.O., et al. Prevalence and relevance of the positivity of skin prick testing in patients with chronic urticaria[J]. J Dermatol.2008,35(6): 330-335.
95. Vonakis, B.M., Saini, S.S. New concepts in chronic urticaria[J]. Curr Opin Immunol. 2008,20(6):709-716.
96. Lodi, A., Di Berardino, L., Chiarelli, G., et al. Chronic urticaria and allergy to Acari. Experience with a specific desensitization therapy[J]. G Ital Dermatol Venereol.1990, 125(5):187-189.
97. Kasperska-Zajac, A.,Brzoza, Z. Remission of chronic urticaria in the course of house dust mite immunotherapy-Mere coincidence or something more to it?[J]. Vaccine.2009, 27(52):7240-7241.
98. 唐绍生,郑学毅,孙广政.慢性荨麻疹患者过敏原特异性IgE与特异性1gC分析[J].实验与检验医学.2009,27(2)：121-122.
99. 禹卉千,李振鲁,朱钵.慢性荨麻疹患者血清特异性IgE及过敏原检测分析[J].临床皮肤科杂志.2006,35(12)：777-778.
100. 李志根,韩军林,方铃,等.皮肤点刺试验检测慢性荨麻疹变应原的临床意义[J].皮肤病与性病.2007,29(3)：3-4.
10 I. 刘辉,罗平,莫冬红,等.皮肤点刺试验检测变应原在慢性荨麻疹病因筛查及治疗中的价值[J].实用医学杂志.2006,22(18)：2151-2152.
102. 曾碧冰,李俊杰,李丹,等.慢性荨麻疹患者血清特异性IgE的检测[J].中国热带医学.2006,6(4)：613、609.
103. 刘劲松,王红,刘菡,等.生物共振治疗仪对慢性荨麻疹的检测及治疗分析[J].中国医师杂志.2008,10(12)：1701-1702.
104. 张英,项燕.204例慢性荨麻疹患者血清特异性IgE及总IgE检测分析[J].中国中西医结合皮肤性病学杂志.2011,10(2)：19.
105. 孙测.大连地区262例慢性荨麻疹患者变应原皮肤点刺试验结果分析[硕士学位论文].大连：大连医科大学.2009.
106. 刘志军,张焕梅,刘丽丽.衡阳地区953例常见慢性湿疹、荨麻疹过敏原分析[J].汕头大学医学院学报.2007,20(1)：49.
107. 王勉,黄一锦,杨萍娥,等.厦门地区慢性荨麻疹变应原检测与脱敏治疗分析[J].中华全科医师杂志.2010,9(3)：207-208.
108. Kasperska-Zajac, A., Brzoza, Z., Rogala, B. Sex hormones and urticaria[J]. Journal of Dermatological Science.2008,52(2):79-86.
109. Kasperska-Zajac, A., Brzoza, Z., Rogala, B. Serum concentration of dehydroepiandrosterone sulphate in female patients with chronic idiopathic urticaria[J]. Journal of Dermatological Science.2006,41(1):80-81.
110. Brzoza, Z., Kasperska-Zajac, A., Rogala, B. Lower serum concentration of dehydroepiandrosterone sulphate in patients with chronic idiopathic urticaria (CIU)[J]. Journal of Investigative Dermatology.2006,126(7):1681-1681.
111. 杨西群,杜宇,陈跃,等.女性慢性荨麻疹患者血清性激素水平的检测[J].中华皮肤科杂志.2002,35(1)：55.
112. Asero, R., Tedeschi, A., Coppola, R., et al. Activation of the tissue factor pathway of blood coagulation in patients with chronic urticaria[J]. Journal of Allergy and Clinical Immunology.2007,119(3):705-710.
113. Asero, R., Tedeschi, A., Riboldi, P., et al. Plasma of patients with chronic urticaria shows signs of thrombin generation, and its intradermal injection causes wheal-and-flare reactions much more frequently than autologous serum[J]. Journal of Allergy and Clinical Immunology.2006,117(5):1113-1117.
114. Wang, F., Tang, H., Xu, J.-H., et al. Activation of the blood coagulation cascade is involved in patients with chronic urticaria[J]. Journal of Allergy and Clinical Immunology. 2009,123(4):972-973.
115. 梁碧华,肖常青,林路洋,等.凝血、抗凝血以及纤溶系统与荨麻疹发病的关系[J].中国麻风皮肤病杂志.26(2)：3.
116. Cugno, M., Marzano, A.V., Asero, R., et al. Activation of blood coagulation in chronic urticaria:pathophysiological and clinical implications[J]. Internal and Emergency Medicine.2010,5(2):97-101.
117. Takeda, T., Sakurai, Y., Takahagi, S., et al. Increase of coagulation potential in chronic spontaneous urticaria[J]. Allergy.2011,66(3):428-433.
118. 朱慧兰,李润祥,郭庆,等.荨麻疹患者血浆D二聚体、活化凝血因子Ⅶ及组织因子途径抑制物-活性凝血因子X复合物与症状的关系[J].中华皮肤科杂志.2008,41(10)：660-662.
119. 刘小明,盛晚香,宋继权,等.慢性荨麻疹患者血浆凝血酶原片段F1+2水平的研究[J].中国麻风皮肤病杂志.2008,24(2)：105-107.
120. 梁碧华,朱慧兰.凝血因子与荨麻疹的关系[J].国际皮肤性病学杂志.2009,35(4)：234-236.
121. Asero, R. Chronic idiopathic urticaria:a family study[J]. Annals of Allergy Asthma & Immunology.2002,89(2):195-196.
122. Coban, M., Erdem, T., Ozdemir, S., et al. HLA class I and class II genotyping in patients with chronic urticaria[J]. International Archives of Allergy and Immunology.2008,147(2): 135-139.
123. Pacor, M.L., Di Lorenzo, G., Mansueto, P., et al. Relationship between human leucocyte antigen class I and class Ⅱ and chronic idiopathic urticaria associated with aspirin and/or NSAIDs hypersensitivity[J]. Mediators of Inflammation.2006,2006(5):62489.
124. Aydogan, K., Karadogan, S.K., Akdag, I., et al. HLA class I and class II antigens in Turkish patients with chronic ordinary urticaria[J]. Clinical and experimental dermatology. 2006,31(3):424-429.
125. 谭志建,陈静,李家文,等.慢性荨麻疹与HLA-DRB1、DQB1基因的相关性研究[J].中国麻风皮肤病杂志.2006,22(5)：369-371.
126. Staubach, P., Eckhardt-Henn, A., Dechene, M., et al. Quality of life in patients with chronic urticaria is differentially impaired and determined by psychiatric comorbidity[J]. Br J Dermatol.2006,154(2):294-298.
127. Uguz, F., Engin, B., Yimaz, E. Axis I and Axis II diagnoses in patients with chronic idiopathic urticaria[J]. Journal of psychosomatic research.2008,64(2):225-229.
128. Engin, B., Uguz, F., Yilmaz, E., et al. The levels of depression, anxiety and quality of life in patients with chronic idiopathic urticaria[J]. J Eur Acad Dermatol Venereol.2008, 22(1):36-40.
129. Ozkan, M., Oflaz, S., Kocaman, N., et al. Psychiatric morbidity and quality of life in patients with chronic idiopathic urticaria[J]. Ann Allergy Asthma Immunol.2007,99(1): 29-33.
130. Iamandescu, I.B. Urticaria, angioedema, and their psychogenic triggers-A clinical approach[J]. Allergy & Clinical Immunology International-Journal of the World Allergy Organization.2007,19(4):146-150.
131. Kaminski, E., Chung, M., Symons, C., et al. The role of psychological stress in chronic idiopathic urticaria[J]. Allergy.2009,64:516-517.
132. Malhotra, S.K.,Mehta, V. Role of stressful life events in induction or exacerbation of psoriasis and chronic urticaria[J]. Indian Journal of Dermatology Venereology & Leprology.2008,74(6):594-599.
133. 何荣国,田华,张锡宝,等.慢性荨麻疹患者负性情绪与血清神经生长因子水平的相关性研究[J].中国麻风皮肤病杂志.2007,23(9)：783-784.
134. 吕薇,马丽俐.精神因素致慢性荨麻疹发病机制的研究进展[J].中国皮肤性病学杂志.2010,24(7)：669-670.
135. 王庆毅,史同新,王建英,等.慢性特发性荨麻疹患者血清中P物质和神经生长因子检测[J].中华皮肤科杂志.2005,38(4)：239-240.
136. Shertzer, C.L., Lookingbill, D.P. Effects of relaxation therapy and hypnotizability in chronic urticaria[J]. Arch Dermatol.1987,123(7):913-916.
137. Nebiolo, F., Bergia, R., Bommarito, L., et al. Effect of arterial hypertension on chronic urticaria duration[J]. Annals of Allergy Asthma & Immunology.2009,103(5):407-410.
138. Sagdic, A., Sener, O., Bulucu, F., et al. Oxidative stress status in patients with chronic idiopathic urticaria[J]. Allergologia Et Immunopathologia.2011,39(3):150-153.