Allergosis respiratory

Allergosis respiratory. A group of diseases with allergic lesions of various parts of the respiratory tract. At the heart of their etiology and pathogenesis are allergic reactions of immediate and delayed type. The respiratory tract as a whole or its separate parts can be affected, which determines the form of allergosis.

Allergic rhinosinusitis is more common in children 2-4 years old, often combined with other respiratory allergies or precedes them. Distinguish seasonal rhinosinusitis (hay fever, pollinosis), chronic (with sensitization to household allergens) and infectious-allergic (mixed form). For each of these forms, the following stages of the development of the disease are inherent: paroxysmal, catarrhal, vasodilator.

Clinical picture. Itching and burning in the nose (this causes patients to constantly rub the nasal allergic salute), sneezing attacks, watery or foamy discharge from the nose, swelling of the nasal mucosa and soft palate, eustachiitis phenomena, eyelid puffiness, injection of sclera, sensation of foreign body in Eye. With seasonal rhinosinusitis, general malaise, headache, drowsiness, a rise in temperature to low-grade figures, and irritability are not uncommon. Quite often rhinosinusitis precedes the development of bronchial asthma.

Diagnosis is based on clinic data, rhinoscopy (mucosal appearance, edema of lower and middle nasal congestion, presence of discharge), radiography (thickening of the mucous membrane of the maxillary sinuses and the trellis labyrinth), detection of high immunoglobulin E level, skin test results,

Differential diagnosis is performed with rhinosinusitis of infectious genesis.

Treatment. Specific hyposensitization, antihistamines, endonasal administration of splenin, nasal electrophoresis with diphenhydramine, intalom, etc.

Allergic laryngitis develops more often at night and is manifested by croup syndrome-restlessness, labored by inhalation, barking cough, cyanosis of the lips and nasolabial triangle. The voice is saved. Depending on the severity of the child's condition, four are distinguished by the degree of development of the subglottic laryngitis: 1st degree - breathing is compensated, the attack is short; II degree (subcompensation) - in the act of breathing, auxiliary musculature participates, heart activity is increased; 111 degree (decompensation) - pronounced dyspnea with a sharp pull in the concave parts of the chest, local cyanosis; IV degree (asphyxia) - pronounced cyanosis, unconsciousness, cardiac arrest.

The diagnosis is based on the analysis of the clinical picture and the level of immunoglobulin E.

Differential diagnosis is carried out with cerebral infectious genesis. Treatment. At 1 degree, a sedentary warm bath is recommended with a gradual increase in the water temperature to 42-43 g. C, abundant drinking of warm Borjom solution, steam inhalation with 2% sodium hydrogen carbonate solution, orally or intramuscularly diphenhydramine, ephedrine; Hospitalization is not necessary. At the second degree, hospitalization is required; Parenterally injected desensitizing agents and antispasmodics, they add 10% calcium gluconate solution (1 ml per year of life), seduxen. At the third degree of the disease, additional dehydration and corticosteroids are additionally prescribed for this therapy; If ineffective, intubation or tracheotomy is performed; Hospitalization is compulsory.

The prognosis for the 1st degree is favorable; At II-IV degree depends on the correctness of the treatment.

Allergic tracheobronchitis. The clinical picture is characterized by attacks of dry nausea cough, more often at night. The disease flows undulating, continues for a long time. At the phenomena of bronchitis in the lungs dry and silent damp rales are heard. In the blood, eosinophilia. Positive scarification skin test with histamine. Diagnosis is the same as with laryngitis.

Differential diagnosis is performed with tracheobronchitis of infectious genesis.

Treatment. Warm alkaline inhalations, distracting leg thermal procedures, warm alkaline drink, cans, ledum boil, antihistamines, exercise therapy (see also Bronchial asthma).

The prognosis is favorable. Food allergy combines the numerous allergic reactions of a child to food. In the emergence of food allergies, a predominant role belongs to sensitization to cow's milk. However, sensitization to other products (cereals, juices, fish, etc.) can also be observed. Cross-reactivity between different allergens is also common. Hereditary predisposition is important. Food allergy is a common pathology that tends to progressive growth (the "disease of the century"), and its first manifestations in most cases are associated with artificial feeding or early supplementation.

The clinical picture of food allergy differs polymorphism and manifests itself as an isolated lesion of the skin, respiratory organs, gastrointestinal tract or combined syndromes - skin-respiratory, skin-intestinal. Most often, especially in infants, eczema is observed with rapid generalization of the process (damp crusts). The neurodermatitis, widespread or localized, with areas of peeling, pigmentation, infiltration and lichenification is found less frequently and at an older age. The favorite localization of the process is the fork and popliteal folds, the skin of the neck, wrists, etc. Children are concerned about the itching, especially at night, they are irritable, suffer from neurotic reactions and, as a rule, pathology of the ENT organs and gastrointestinal tract. At the same time, it can often be noted the edema of Quincke, hives. Less common are capillarotoxicosis, thrombocytopenic and leukopenic reactions, collapoid states, anaphylaxis.

The diagnosis of food allergy is based on the history and clinical picture and is confirmed by the detection of a causally significant allergen (food diary maintenance), elimination and provocation tests, scarification and intradermal testing, etc.), a high level of immunoglobulin E in the blood.

Differential diagnosis is performed in conjunction with diseases of infectious genesis, intoxications and poisonings.

Treatment. Elimination of the causally significant allergen, pathogenetically based diet, antihistamines, antimediator drugs (intal, zaden), histaglobulin, allergoglobulin, ointments with tar or naphthalan content.

The prognosis for timely diagnosis and treatment is favorable. Alveolitis allergic (hypersensitive pneumonitis, inhalation pneumopathy, "lung of poultry farmers", "farmer's lung", etc.) is a pathological process in the lungs that occurs in response to a known causative factor - allergen (organic or inorganic dust, fungi, bacteria, etc.) And is expressed by a hyperergic reaction. Both the antigenic structure of the causative factors and the characteristics of the response of the macroorganism are important.

Pathogenesis. The hydrolytic enzymes of the alveolar macrophages cause the cleavage of the complement with the formation of Cs-fractions and subsequently lead to the formation of the Cs-component, which through alternative routes leads to a greater intensity of C3 decay. Activation of the production of immunoglobulins by B lymphocytes leads to the formation of immune complexes that are subsequently deposited on the basal The membrane of the vessels of the lungs and when fixing complement on their surface become available for absorption by phagocytes. The liberated lysosomal enzymes have a damaging effect on the pulmonary parenchyma in the manner of the Arthus phenomenon.

The clinical picture is diverse and depends on the degree of antigenicity of the causative allergen, the massiveness and duration of the antigenic effect, the characteristics of the macroorganism. These factors determine the course of the disease (acute, subacute, chronic). The main signs: a rise in body temperature, chills, dyspnea, cough (often dry), weakness, chest pain, muscles, joints, headache. Possible shortness of breath, vasomotor rhinitis. Small- and medium-bubbly, dry wheezing are defined. When contact with the causative allergen ceases, these symptoms disappear after 12-48 hours. Repeated contact with the causative factor leads to an aggravation of the process. Prolonged and repeated effects of small doses of antigen contribute to the development of a fibrous process in the lungs: progressive dyspnea, cyanosis, weight loss, in the distant past cases, pulmonary hypertension joins right ventricular hypertrophy.

Diagnosis. At the heart of the diagnosis is a clinical picture, leukocytosis with a shift of the leukocyte formula to the left, accelerated ESR, mild eosinophilia, the detection of specific precipitating antibodies (IgG class, Ouhterloni positive test) and immune complexes, results of provocative inhalation tests, X-ray study. Differential diagnosis is performed with alveolitis of infectious genesis.

Treatment. Exclude contact with the causative allergen. Prednisolone at the rate of 1 -1.5 mg per 1 kg of body weight of the child, symptomatic therapy.

The prognosis for acute cases is favorable, with subacute and chronic-severe