Allergic diathesis

Allergic diathesis (diathesis exudative-catarrhal) -anomalia of the constitution, characterized by predisposition of the organism to allergic, inflammatory diseases. This anomaly of the constitution is quite common. It is usually found at the age of 3-6 months, lasts for 1 -2 years and some children later disappears.

Etiology and pathogenesis are not completely elucidated, but an important role is played by hereditary predisposition, as well as the impact of environmental factors. Positive family "allergic anamnesis" is detected in 2 / 3-3 / 4 children with allergic diathesis. Often, such children determine a high level of immunoglubin E in the blood or excessive secretion and release of histamine from mast cells, inadequate inactivation, which determines the tendency to allergic reactions.

The provoking factors may appear early - toxicoses of the first and second half of pregnancy, infectious diseases, the use of drugs during pregnancy, the violation of the dietary regime as pregnant, especially in the last months of pregnancy (monotonous with the excessive use of one of the obligatory trophoallergens - eggs, honey, confectionery, Milk, mandarins), as well as during breastfeeding. The child still in the prenatal period can diaplacental (congenital allergy according to Ratner) to be sensitized to allergens circulating in the mother's body. In the extrauterine period, allergens are transmitted with breast milk and food (trophoallergens) through the intestinal wall, which has increased permeability, especially in infants, especially after gastrointestinal diseases, as well as during recovery from various diseases, with loss of body weight and Exhaustion. Potential sensitizing agent can be food not subjected to heat treatment (eg, mogul, raw milk, whipped with berries, etc.), as well as products such as fish, nuts and some others that do not reduce their allergenic properties and during heat treatment . Allergization can also be caused by conventional products if the child receives them in excessive amounts (overfeed), especially with a monotonous set of nutrients. It is easy to become allergens products that are consumed in a particular season or infrequently, when included in a diet in large quantities (berries, vegetables, nuts, etc.), as well as when introducing foods that are not age-appropriate products (caviar, shrimp, etc.) .). It means messy food, abuse of sweets, spicy, salty dishes, introduction of many new products into the ration of the child in a short period of time. A child with allergic diathesis easily acquires an increased sensitivity not only to food substances, but also to external allergens such as wool, house dust (Allergic respiratory syndrome according to Ratner).

Allergens can enter the baby through the skin and mucous membranes (conjunctiva, etc.), as well as during numerous injections, vaccinations.

In children of the first years of life, especially in infants, the main source of allergens is food (the ratio of increased sensitivity to food and to inhaled antigens is 20: 1); During this year of life, the number of antigens obtained by inhalation increases (ratio as 2: 1); To 4-5 years antigens act equally often both through food and by air.

In children with allergic diathesis, violations in the cortical-subcortical relationships are detected, parasympathetic mood or dystonia of the autonomic nervous system, functional changes in the liver, intermediate metabolism (fat, carbohydrate, protein, water, salt, vitamin, KHS), which is not indifferent to the organism in the processes Its adaptation to the external environment and nutrition. In children with allergic diathesis, there are also signs of dis- corticism-a relatively high secretion of mineralocorticoids, a violation of the metabolism of cortisol in the liver.

The development of an allergic reaction is accompanied by a rise in the blood of a number of biologically active substances (up to 12 species): histamine, serotonin, leukotrienes, etc. Autogenous processes play a role in pathogenesis, and the fastest occur in the course of the disease. The development of autoallergicization processes with a constant intake of autoallergens into the blood promotes a more torpid current of allergic diathesis.

Clinical picture. Characterized by a large body mass at birth, especially if this is the first child in the family; Early emerged and persistently preserved in the conditions of proper care of intertrigo; Disappearing and re-emerging seborrhea of ​​the scalp; Uneven exposure of the epithelium of the mucous membrane of the tongue - "geographical language"; Increased hydrolysis of tissues (McClure-Aldrich test accelerated to 5-15 min); Significantly exceeding the age norm of weight gain and its large fluctuations under the influence of unfavorable conditions; Positive skin tests for exogenous allergens in the absence of any clinical manifestations of allergic diathesis. On examination, attention is drawn to a puffy pale face, excessive body weight, decreased tissue turgor (pasty type) or thinness, a lag in physical development, nervousness.

Symptomatics is extremely diverse. It consists of the symptoms of mucosal lesions (rhinopharyngitis, stenosing laryngitis, blepharitis, flick-tenes, conjunctivitis, keratitis, vulvovaginitis, unstable stool, "geographical language"), lymphatic system (enlarged lymph nodes, adenoids, tonsillar hypertrophy), skin (seborrhea , Dairy scab, strobulus, eczema, neurodermatitis, etc.). These children may have bronchial asthma, pollinosis (hay fever), etc. In the blood - eosinophilia, there may be mild anemia, relative neutrophilia, monocytopenia. In urine, the cellular elements in the sediment are not ex- cessing, and the increased content of leukocytes is also excluded. In feces - a large amount of epithelium and eosinophils

Gneiss is found only in infants: dirty gray or brown seborrheic scales in the form of a cap or shell on the scalp, mainly on the crown and crown. The course of the gneiss is usually favorable, but in some children it is transformed into seborrheic eczema (swelling, redness, wetness, increased cortexation), which often extends to the ears, forehead, cheeks.

A frequent symptom of allergic diathesis, especially in children of the first year of life, is a dairy scab (or crust): on the skin of the cheeks, often near the auricles a sharply distinguished red from the healthy skin, puffiness often with signs of ecdysis. In some children, a dairy scab is accompanied by itching, often transformed into eczema.

Persistent form of intertrigo - intertrigo - one of the important symptoms of allergic diathesis. The roughness can be dry, in other cases, maceration of the skin (usually in obese, pastose infants) is observed. The most severe form of allergic diathesis is childhood eczema, which in children of older age can be transformed into neurodermatitis.

In the group of children with allergic diathesis, death rates from various acute diseases are also higher. Children with eczema sometimes have an unexpected lightning death ("death"), the cause of which is anaphylactic shock.

The diagnosis is based on anamnesis and clinical symptoms. Differential diagnosis is carried out with true eczema, erythroderms, dermatitis, psoriasis, immunodeficiencies, syndrome of impaired intestinal absorption.

Treatment. There is no standard diet. A rational diet is needed. Breastfeeding does not stop, although the presence of trophoallergens is not excluded. The mother's diet should be poor in carbohydrates, fats, table salt and possible trophoallergens. In some cases (fatty breast milk) expressed breast milk is subjected to pasteurization (for 30 minutes at 65 ° C) and the upper film is removed or put the milk for 3-4 hours in the refrigerator, and then the cream is removed, and then pasteurized. Older children are recommended to exclude jelly, mousse, pork, beef broth, fish, eggs in any form, legumes, nuts, spices, seasonings: moderately restrict fats and proteins, liquid. From buckwheat preference is given to buckwheat; In the evening vegetables, salads, casseroles are recommended. If eczema is caused by the use of trophoallergen, it can subside within 24 hours with the following diet: dishes from rice broth, 1 dish of fruit (not yellow color), 1 dish of vegetables (potatoes), 1 dish of rice with fruit juice (not Yellow color). Each subsequent day, a new dish is added to this basic diet, under the control of the dynamics of the disease. If against a background of an allergic diathesis diagnose a dysbacteriosis, then 10-day courses of lactobacterin and bifidumbacterin can be effective.

Assign medications that help reduce itching and permeability of the vascular wall, as well as sedatives: 3-5% solution of sodium bromide, diphenhydramine and other antihistamines at age dosage; 5-10% infusion (1 teaspoonful or 1 tablespoon 3 times a day) or a tincture of lagochilus intoxicating (1 drop per month for a child, but not more than 15 drops for children over 1 year old). Assign also vitamins B5, B6, B12, B15, A, C (ascorbic acid can enhance itching) in therapeutic doses for at least 3-4 weeks.

By stihanii sharpness of skin manifestations apply histoglobin (a preparation of histamine and immunoglobin). Sterile preparation (a single dose diluted with 2 ml of isotonic sodium chloride solution before injection) is injected subcutaneously into the shoulder area every 3-4 days (treatment course 3-5 injections). Contraindications - intercurrent diseases, simultaneous application of hormones (1-2 months after the application of the latter).

Local treatment, first lotions (Ichthyoli, 01. Cadini aa 10.0, Anaesthaesini 3.0, Zinci oxidati, Taici veneti, Amili tritici ai 10.0, Glycerini, 8.0, Aq. Plumbi 100.0), after disappearance Puffiness, wetness - ointment therapy. With non-healing diaper rash-Spiritus vini 90 gr. 100.0, Tanini 7.5, Fuxini 0.07. In addition, appoint moderately warm baths (no higher than 38 gr C) for 10-15 minutes with wheat bran or potato flour (400-600 g per bath), with oak bark, string, celandine, with the addition of lagolus (0.1 -0.5% solution), potassium permanganate (to light pink color). Apply a general ultraviolet irradiation from 1/4 to 1 erythematous dose 15-20 times (daily or every other day).

Elimination of foci of secondary infection also improves the general condition of the patient.

Prevention. The rational nutrition of the pregnant and lactating mother, especially if they have "allergic mood", with the use of moderate amounts of varied, well-cooked food, with the exclusion of eggs, the limitation of milk (up to 1-2 glasses per day), sugar, chocolate, Honey, sweets, nuts, as well as sausages, sausages, canned fish. Child's nutrition according to age. BOn the time of illness and during the period of convalescence it is recommended to give the child well-processed food in moderate amounts, to avoid introducing new food products. Compliance with vaccination rules, which is desirable only during the period of remission and after appropriate preparation. Hygienic care of an infant. Avoid the use of perfume, shampoos, toilet water.

The prognosis, provided that all measures of prevention and treatment are observed, are favorable.