OPTIMIZATION OF THE TREATMENT OF PATIENTS WITH ACUTE URTICARIA COMBINED WITH GIARDIASIS

Abstract

SUMMARY. The aim – to improve the results of treatment of acute urticaria combined with giardiasis, to develop a scheme of complex therapy of this combined pathology.

Material and Methods. 46 patients with urticaria were under observation during 2019–2022. They were treated as outpatients and inpatients at the "Starokostyantinivska TsRP" KNP and Ternopil Regional Clinical Dermatological and Venereological Dispensary. The age of the patients ranged from 18 to 71 years. There 16 (34.8 %) men, 30 (65.2 %) women.

The Urticaria activity score (UAS7) was used to assess the activity of urticaria, which is based on the assessment of the main signs and symptoms of urticaria (blisters and itching), where 0 points mean the absence of blisters and itching; 1 point – itching is slightly expressed (present, but not bothersome and does not cause trouble), rash is slightly expressed (less than 20 blisters/24 hours); 2 points – moderately expressed itching (causes trouble, but does not interfere with normal daily activity or sleep), moderately expressed rash (presence of 21–50 blisters/24 hours); 3 points – intense (pronounced itching that causes a lot of inconvenience and interferes with normal daily activity and sleep), the rash is significantly expressed (>50 blisters/24h). Accordingly, the interpretation of severity of exacerbation is as follows: 0–2 points – mild exacerbation, 3–4 points – moderate severity, 5–6 points – severe exacerbation.

To detect giardia cysts, a smear of native fecal material was prepared, which was examined under a light-optical microscope at low and high magnification (approx. ×8, ×40, approx. ×10).

Complex treatment of patients with acute urticaria combined with giardiasis included the simultaneous appointment of ornidazole 500 mg twice a day in combination with a dry extract of Silybi mariani fructus 2 tablets 3 times a day orally for 10 days; followed by a 10-day course of bilastin (a second-generation non-sedating H1 antihistamine drug) at a dose of 20 mg once a day.

The effectiveness of the treatment was evaluated on the 5th, 10th, and 12th days from the start of therapy based on the dynamics of the main signs and symptoms of urticaria (blisters and itching) and the urticaria activity score UAS7 (Urticaria activity score), expressed in points.

Results. It was established that 10 (21.7 %) of the 46 examined patients with acute urticaria combined with giardiasis, indicated a history of atopic dermatitis, 5 (10.9 %) patients – bronchial asthma, 7 (15.2 %) persons – for allergic rhinitis. In the remaining 24 persons, which accounted for 52.2 % of 46 patients with acute urticaria combined with giardiasis, no history of allergic diseases was detected.

Our analysis of the severity of the main symptoms of the disease (blisters and itching) on the 12th day of therapy with the simultaneous appointment of ornidazole 500 mg twice a day in combination with a dry extract of the Silybi mariani fructus 2 tablets 3 times a day orally for 10 days, established that in patients with urticaria combined with giardiasis, a significant decrease in the severity of the disease according to UAS7 to a mild degree of severity was noted (p<0.05). Whereas in patients with urticaria combined with giardiasis with a history of allergic diseases, the activity of the process decreased to the average severity of the disease (p<0.05).

Consecutive administration of ornidazole 500 mg twice a day in combination with a dry extract of the Silybi mariani fructus 2 tablets 3 times a day orally for 10 days; followed by a 10-day course of bilastin made it possible to achieve the complete disappearance of blisters, and to achieve a decrease in the activity of urticaria (according to UAS7) to a mild degree of severity of the process.

Conclusions. Therapy of urticaria combined with giardiasis, with the simultaneous use of ornidazole and dry extract of Silybi mariani fructus is insufficient. If patients with acute urticaria combined with giardiasis have a history of other allergic diseases, it is advisable to supplement complex treatment with a second-generation H- antihistamine. The best results in the treatment of patients with acute urticaria combined with giardiasis, in case of the presence of other allergic diseases in their anamnesis, are achieved with the sequential administration of ornidazole in combination with a dry extract of the Silybi mariani fructus and bilastin.