兒童急性蕁麻疹(Acute urticaria)

今天上午看診時，遇見一位小朋友起全身紅疹。紅色中帶有蒼白色，周圍伴隨紅暈，形狀不規則，有大有小。他覺得非常癢，想要一直抓，但紅疹卻越來越多。這是典型的蕁麻疹病灶。再仔細一問，媽媽說過往就有多次發生紀錄，似乎每次在學校午餐吃到魚時，都會發生這樣的情形。這次也不例外。

I saw a child with a red rash all over his body this morning. It was red with a pale tinge, surrounded by a red halo, and was irregular in shape, ranging from large to small. He felt very itchy and kept scratching, but the rash was getting worse. This was a typical urticaria. Upon further inquiry, his mother said that there had been a number of previous occurrences. It seemed to happen every time while his eating fish as the lunch at school. This time was no exception.

蕁麻疹是皮膚黏膜因血管通透性暫時增加，而發生的侷限性水腫。病因有時不容易找得到。常見原因有：
一、食物(如海鮮、奶、蛋)
二、感染(如病毒、細菌、真菌)
三、藥物(如Amoxicillin)
四、呼吸道吸入(如花粉、粉塵)
五、皮膚接觸(如昆蟲叮咬)
六、物理因素(如冷、熱、壓力)

Urticaria is a limited edema of the mucous membranes of the skin due to a temporary increase in vascular permeability. The cause is not always easy to find. Common causes include

1. Food (e.g. seafood, milk, eggs).

2. Infections (e.g. viruses, bacteria, fungi).

3. Drugs (e.g. Amoxicillin)

4. Respiratory inhalation (e.g. pollen, dust)

5. Skin contact (e.g. insect bites)

6. Physical factors (e.g. cold, heat, pressure).

急性蕁麻疹出現快，一般24小時內會消失。

Acute urticaria appears quickly and usually disappears within 24 hours.

若反覆發作六週以上，就要考慮慢性蕁麻疹。慢性蕁麻疹通常和食物無關，但與我們的自體免疫系統異常有關。

If it recur for more than six weeks, chronic urticaria is considered. Chronic urticaria is not usually related to food but the abnormality in our autoimmune system.

急性蕁麻疹患者常自覺癢感，接著在癢感部位出現大小不等的圓形、橢圓形或不規則病灶。可以各自獨立，或又擴大融合成片。手摸起來有突出的感覺，顏色偏紅，或呈現蒼白色。常見數分鐘至數小時後消失，然而有時一個區塊消失，另一個區塊又出現。嚴重者有過敏性休克症狀，可能聲音沙啞或呼吸困難。

Patients with acute urticaria often experience itchy sensation, followed by round, oval or irregular lesions of varying sizes on the itchy areas. They may be separate or enlarged to form patches. They might be prominent while touching and be reddish or pale in color. They usually disappear after a few minutes to a few hours. However, one area sometimes disappears, and the other appears. In severe cases, there are signs of anaphylaxis, which may be characterized by hoarse voice or short of breathing.

急性蕁麻疹治療以抗組織胺為首選。一般而言，第二代抗組織胺較無嗜睡感，適合已開始上學的兒童。嚴重者可以針劑藥物注射，類固醇可以考慮短期使用。

Antihistamines are the first choice for the treatment of acute urticaria. Generally speaking, the second generation Antihistamines are less drowsy and are suitable for children who have started school. For severe cases, injections can be given and steroids can be considered for short-term use.

預防方面，若找得到原因，就需要盡量在日常生活中避開。

For prevention, if you can find the cause, you need to avoid it as much as possible in your daily life.

兒童急性細支氣管炎(Acute bronchiolitis)

急性細支氣管炎常見於二歲以下的小朋友，由病毒感染造成。最常見者為呼吸道融合病毒，其他包括副流行性感冒病毒、流行性感冒病毒、腺病毒或黴漿菌等。

在開始三至五天，會以上呼吸道症狀，如咳嗽或流鼻水為表現。接著會有發燒，呼吸急促，甚至有多痰及「咻咻」的喘聲。咳嗽和呼吸困難發作後48-72小時內，出現呼吸危險的風險最高，但因此而致命的比例小於1%。症狀持續約二星期，有十分之一的小朋友可能會達到三星期。得過此病未來得到氣喘的機會上升。

治療上需要補充水分，若住院者，可給予氧氣帳。其他藥物的使用，在最新實證醫學上並無證據支持。預防總是勝於治療。均衡的營養、良好的衛生、勤洗手、避免公共場所暴露都可以減少得到急性細支氣管炎的機會。