蕁麻疹
楊惟婷整理
您是否曾發現自己或家人的皮膚上，突然莫名地鼓出許多一塊塊粉紅色劇癢且類似蚊蟲咬傷的疹子？這樣的皮疹，很可能就是蕁麻疹。
雖然對多數的人來說，蕁麻疹是不會造成很大的危害，但約有四分之一的人，卻要經歷長達一至二個月、甚至半年以上才能完全擺脫蕁麻疹帶來的困擾。
一、何謂蕁麻疹?
蕁麻疹 (urticaria) 俗稱風疹塊，經常是急性發作，說來就來。
蕁麻疹是一種常見的因個人特殊體質引起的皮膚過敏，所以同桌吃飯的人，可能只有其中一人有對某種食物有過敏的反應。
二、蕁麻疹的症狀
大多數的急性蕁麻疹患者，皮膚上會突然出現搔癢性的浮腫紅疹，疹子大多在數小時內消失，但是新的疹子又不斷的在其他部位出現，整個病程通常在二至三週會痊癒，不需再接受藥物的治療，不過，少數人的病程會長達六週以上，這時就歸類為慢性蕁麻疹。
急性蕁麻疹的症狀除了皮疹以外，較嚴重者還會伴隨眼皮、嘴唇、耳朵或臉部腫脹，極少數個案會出現呼吸道緊縮，造成呼吸困難、甚至窒息。
三、蕁麻疹的病因
如何找出引起蕁麻疹的原因？
大約百分之二十五的蕁麻疹患者會有家族史，而曾有蕁麻疹病史的人，以後再接觸到相同的致病因子，還是很有可能再犯。
一般而言，急性蕁麻疹常因食物或藥物過敏所引起，慢性蕁麻疹則可能和一些慢性感染有關。
誘發蕁麻疹（特別是急性蕁麻疹）的原因有很多，常見的有食物（如海鮮、蛋奶類製品、豆類、核果類、茶、咖啡、巧克力、草莓、芒果等）、藥物、細菌或病毒感染、蚊蟲咬傷等，其它較少被注意到的因素有冷熱之刺激、情緒或是精神上的壓力等；然而，約有一半的的蕁麻疹患者，是找不出其誘發因子的。
在食物方面，現在可藉由抽血來檢驗是否是對某些食物過敏所造成的；另外，也可自行觀察所食用的食物或藥物與蕁麻疹出現時間有無關聯，再儘量避免這些致病因素。
引起慢性蕁麻疹的原因更難尋找，大多為”特異性”的（也就是找不到原因），找得到原因的，則多數與引起急性蕁麻疹的誘因類似，然而，要小心的是，也有極少部分的慢性蕁麻疹與血管炎或其它全身系統性疾病有關。至於其它的因素，可能需尋找醫師來評估了。
總之，引起尋麻疹的原因很多，下列是比較常見的原因：
1、飲食引起的蕁麻疹：
由食物引起的蕁麻疹過敏，只有某些特殊體質的人會發生，此不同於食物中毒。
反之，食物中毒是由食物本身的毒素（例如河豚）或是細菌的毒素（例如葡萄球菌）所引起，所以幾乎每個人都會發生。
食物引起蕁麻疹，例如食用章魚、螃蟹及貝類等，都會引起蕁麻疹；有些體質比較特別的人，甚至食用雞蛋、牛肉、豬肉，也會引起蕁麻疹。
2、寄生蟲、病菌感染引起的蕁麻疹：
感染寄生蟲時，也可能會引起蕁麻疹。例如海鮮中的寄生蟲也可能是引起蕁麻疹的原因（因為含有不同的的蛋白質，也就含有不同的過敏原）。而蕁麻疹也可能感染細菌，如感冒、鏈球菌喉嚨感染。
3、藥劑刺激引起的蕁麻疹：
例如服用或注射藥劑時也可能會引起蕁麻疹。藥物如阿斯匹靈、盤尼西林、磺胺類是引起過敏性或免疫性蕁麻疹的常見原因。
而輸血、血清或抗生素的使用不當，更容易引起蕁麻疹。
4、物理性刺激引起的蕁麻疹：
當皮膚受到各種物理的刺激時，也容易引起蕁麻疹。
如由緊身衣物經常性加壓所引起（如腰帶、襪帶、胸罩、束帶或緊身衣），使皮膚受到機械性的刺激而引起的蕁麻疹，稱為機械蕁麻疹；
如用手搔癢，症狀就會逐漸擴展，所以又稱為人工蕁麻疹；
5、溫風、溫水等所引起的蕁麻疹：
此又稱為溫熱蕁麻疹，可分為僅在熱作用的局部蕁麻疹，以及全身性的蕁麻疹二種，特別溼熱易令人流汗滿身。
6、冷水、寒風所引起的蕁麻疹：
身體接觸低温後所引發，此又稱為冷蕁麻疹，可分為寒風、冷水都會引起的蕁麻疹，以及只有其中之一會形成蕁麻疹二種。如突然跳入冷水游泳池、皮膚接觸冰塊。
7、心因性蕁麻疹：
情緒過度的緊張、不穩定，也有可能會引起蕁麻疹。
8、其他原因引起的蕁麻疹：
其他引發蕁麻疹的原因包括：例如當皮膚接觸到毛毛蟲、蜜蜂、螞蟻等，或吸入貓、狗、鳥的毛或吸入花粉等，也很容易引起蕁麻疹；
食物的新鮮度（例如吃新鮮的海鮮不會過敏，吃不新鮮的就會）；
食物的烹調方式也可能是引起蕁麻疹的原因，也許並不是對海鮮過敏，而是對調味料或是使用的油（例如花生油），或是添加的薑、蔥等辛香料過敏；不是對茶或是咖啡過敏，而是對加入的檸檬或是奶精過敏；
更有對豬肉或雞肉中殘留的抗生素過敏的可能性，使得探討食物的過敏與否更加複雜。
最近一些研究顯示有些慢性蕁麻疹是由自體免疫機轉所引起，病人對自己的皮膚成份產生免疫反應所致。某些自體免疫疾病如紅斑性狼瘡、乾燥症等，也可能以蕁麻疹的方式表現。
四、蕁麻疹的預防
麻疹的最佳治療為去除誘發因子，這不是一件簡單的事，而且不容易辦到。所以，蕁麻疹的患者最常問到的問題是：什麼食物不能吃？
一般而言，常見可能會引發蕁麻疹的食物：包括花生、巧克力、乾果、核桃；雞肉、雞肝、香腸、火腿；芋頭、香菇、筍子、青椒、菠菜、茄子、黃豆、小麥、花生油；蔥、薑、蒜、洋蔥、辣椒、肉桂，丁香、山葵等辛香調味料；水果中的番茄、草莓、芒果、柿子、奇異果、香蕉、酪梨、金瓜；養樂多、優酪乳、牛奶、蛋、魚鬆、肉鬆；
食品添加物：例如人工色素（果汁、汽水、糖果）、酵母（麵包、洋香腸、紅酒、啤酒、葡萄、醋、起司、酵母片），零食及泡麵等可能含防腐劑的食品。
為了找出食物中可能的過敏原，推薦患者可以做飲食紀錄，每次發作前24小時或最好48小時內（因為食物須經消化吸收，所以不一定吃後會馬上發作），所吃的東西都要巨細靡遺的紀錄。
如果每次蕁麻疹發作之前，都曾吃到某種食物，就要注意可能是引發的原因，最好暫時停吃該項食物，停止食用該項食物二至三週後蕁麻疹得到改善或消失，再次食用後蕁麻疹又加重或發作，則可以確立該食物和蕁麻疹發做的因果關係。這雖然是一種笨方法，卻也常是最有效的方法。
另外，也應詳細記錄可正在服用的藥物、居家環境等資訊，都有助於醫師尋找出蕁麻疹的誘發因子。
必要時，請過敏免疫科醫師為您安排血液、尿液常規、Ｘ光片檢查及皮膚試驗，和特殊的免疫檢查如抗細胞核抗體 (ANA)、類風濕因子 (RF)、血清免疫球蛋白Ｅ (IgE)、多重過敏原同時檢測試驗 (MAST)等，都有助於蕁麻疹誘發因子的鑑定。
另外，在藥物治療方面，以口服一種或合併使用二種抗組織胺為主，對於減少皮疹發作及控制搔癢的症狀有很好的效果，一般是建議使用抗組織胺至皮疹完全不再長出後二至三天才停止；對於已使用抗組織胺治療的患者，如果症狀仍然難以控制或是病程無法縮短，可以考慮再加上口服類固醇治療。若已引發呼吸困難，則須儘速送至急診處理。
只要能配合醫囑規則服藥，多數會在一至四抗組織胺週恢復，若是蕁麻疹時常反覆發生，最好還是能積極尋找可能的過敏原或致病因子。
慢性蕁麻疹在處理上較為棘手，病因也較複雜，病程有可能長達一至二年，治療的原則也是以口服抗組織胺為主，有些醫師會加上隔日使用口服類固醇；不過，對於慢性蕁麻疹之患者，建議還是尋求過敏免疫專科醫師的協助。
【蕁麻疹自我治療小妙方】
1.冷敷
2.塗抹鹼性物質，如氧化鎂乳液，可有些許效果
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