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Exudative-catarrhal diathesis



Exudative-catarrhal diathesis (ECD) is a constitutional feature of the child, in which there is a tendency to recurrent infiltrative-desquamous lesions of the skin and mucous membranes, the development of allergic reactions, the prolonged course of inflammatory processes, lymphoid hyperplasia, and the lability of water-salt metabolism.

Epidemiology According to domestic authors, ECD manifestations are observed in 55-60% of children and are most pronounced in the 1-2 year of life. Over the past 30 years, the incidence of ECD has increased 5 times.

Et and about l about d and I. Predisposing factors are: a family predisposition to allergic diseases, gastrointestinal pathology, chronic inflammatory diseases; unfavorable course of pregnancy (gestosis of pregnant women, the threat of termination of pregnancy, incompatibility of the mother and fetus according to the AB0 system; Rh-factor, etc.).

Errors in the organization of care and feeding are important: an unbalanced diet, early artificial feeding, violations of the sanitary-hygienic regimen.

Patentgen. Diathesis is based on metabolic disorders associated with hereditary changes in the activity of some enzyme systems. An excess of mineralocorticoids with a relative deficiency of glucocorticoids contributes to the delay in the child's body of sodium, chlorine and water. The development of diathesis is associated with insufficient differentiation of the gastrointestinal tract and food allergy. Low enzyme activity, deficiency of local IgA lead to incomplete cleavage of food proteins and their absorption through the increased permeable intestinal wall into the blood. There they play the role of foreign antigens, causing the pathochemical and pathophysiological phases (bypassing the immunological) of an immediate type allergic reaction with the release of histamine and other biologically active substances. Atopic (reagin) mechanism occurs only in 25-30% of children with ECD. In other cases, a non-immune (pseudo-immune) mechanism develops. It is caused by: 1) increased reactivity of mast cell receptors with easily occurring histaminoliberization and other mediators (under the influence of a number of substances - histamine liberals, such as egg white, cow's milk protein, chocolate, strawberries, preservatives, bacterial toxins, etc.) and action non-specific factors (overheating, acute respiratory infections, ultraviolet radiation, etc.); 2) insufficient inactivation of biogenic amines in the blood and intestinal wall (low histaminase activity and the ability to histaminopexy, etc.).

K l and n and with to and to kartin and. There are two types of ECD - pasty and heretical. With the pasty type, children are prone to overweight due to increased hydrophilicity of tissues. Outwardly, they are full, loose, inactive. The skin and mucous membranes are pale, the elements of diathesis on the skin are juicy, often weeping eczema is observed. With the eretic type, children are undernourished, restless, rashes on the skin dry, itchy.

Clinical manifestations of diathesis occur early, in the first weeks and months of life. The most characteristic lesions of the skin and mucous membranes.

The skin elements in ECD are represented by gray or yellow greasy scales on the head (gneiss), reddening of the skin and finely lamellar, scaly peeling on the skin of the cheeks (“milk crust”), weeping face eczema, pruritus, urticaria, strofulus and other persistent diaper rash in the skin. from the first month of life, despite the good care of the child. Mucous membranes are characterized by a “geographical language”, recurrent thrush of the oral cavity, frequent conjunctivitis and blepharitis, inflammatory diseases of the upper respiratory tract (rhinitis, pharyngitis, laryngitis, bronchitis, obstructive bronchitis in ARI), easily complicated by pneumonia, persistent in the vulva and persistent in the vulva balanitis in boys, urinary tract infections (pyelitis, pyelocystitis). Prolonged rhinitis in children with ECD occurs with abundant mucous-serous discharge at normal body temperature and a satisfactory condition. All these diseases easily develop in connection with the attachment of a secondary infection against the background of increased exudation of the mucous membranes.

Near the affected areas of the skin and mucous membranes (especially with eczema), an increase in regional lymph nodes is noted (a consequence of infection).

Often there is unstable stool with normal nutrition (exudative dyspepsia), an abundance of desquamated epithelium in excreta (urine, feces).

Children with ECD are characterized by allergic reactions to medicines and vaccines, the early formation of allergic diseases (atopic dermatitis, food allergies, bronchial asthma, etc.).

In children with ECD having simultaneously recurring infections, hereditary immunodeficiency conditions are possible; in children with severe non-infectious intestinal disorders - intestinal disaccharidase deficiency, exudative enteropathy; with a lag in mental development - phenylpyruvic oligophrenia (Felling's disease), Knapp-Komrover syndrome (hereditary xanthurenuria - vitamin B6-dependent), disturbances in tryptophan metabolism (Hartnup disease) and conditions caused by increased need for pyridoxine.

D and a g of n z ECD is usually not difficult, but it is necessary to differentiate it with atopic dermatitis (childhood eczema).

Laboratory diagnostics. Leukocytosis, lymphocytosis, eosinophilia, signs of anemia, and often thrombocytopenia are often observed in the blood. In the biochemical analysis of blood - hypo- and dysproteinemia, a decrease in the level of IgA, and an increase - IgE, hypocholesterolemia, a decrease in NEFA, metabolic acidosis, an increase in the content of Na and Cl. In the urine, epithelium, eosinophilic leukocytes, mucus are detected.

The same ECD is undulating, at the end of the second year of life, its manifestations soften and gradually disappear, however, in 25-30% of children, the ECD can transform into atopic dermatitis, bronchial asthma and other allergic diseases.

Treatment includes organization of the regimen and nutrition, correction of metabolic disorders, stabilization of the intestinal biocenosis, local treatment of lesions of the skin and mucous membranes. It is important to observe the sanitary-hygienic regimen, thorough skin care, frequent diaper changes, and regular bathing of the baby.
It is not recommended to use disposable cellulose diapers (diapers) in children in their first months of life.

The best for children of the first year of life is breastfeeding, provided that the nursing mother and the child follow a hypoallergenic diet (see Food Allergy).

With a proven allergy to cow's milk, children are transferred to feeding with soya mixtures, mixtures with protein hydrolyzate (Frisopep, Peptidi Tuteli, Pepti Junior, etc.).

The exclusion of milk-based products is especially important before the age of 1 year. By 2-3 years, children tolerate milk much better.

Nutrition for children with diathesis is given at the same time as healthy ones, 5.5-6 months. The first lure must be vegetable. For cooking mashed potatoes, zucchini, squash, white and cauliflower, turnips, potatoes, pumpkin (light varieties) are recommended. Vegetable oil is added to the vegetable dish. Potatoes must be soaked before cooking for 12-18 hours in cold water.

For the second feeding, low-allergenic cereals are recommended - corn, buckwheat, millet, rice. Semolina is excluded. Ghee is added to melted butter or vegetable oil. Porridge is prepared on water or a special mixture (soy mixture or hydrolyzate). Rice, like potatoes, is presoaked in water.

For the nutrition of children with diathesis, it is preferable to use dairy-free cereals of industrial production: Gerber, Beach-Nat - rice, oat, barley; Heinz firms - rice-corn, rice-corn with apple; Nestle firms - rice, rice-soybean, etc. These cereals are enriched with vitamins, mineral salts and iron and do not require cooking.

As a third feeding, a vegetable or vegetable-cereal dish is given (zucchini with corn grits, pumpkin with buckwheat and other combinations).

Meat puree for children with diathesis is recommended from beef, lean pork, rabbit, white meat of turkey, horse meat. Chicken meat usually causes an aggravation of the process.

To make mashed potatoes, the meat is boiled in two waters: for 30 minutes in one, then the water is drained and boiled for 1.5-2 hours in the other.

Instead of boiled meat, you can use special children's canned meat of domestic production - “Little Humpbacked Horse”, “Cheburashka”, “Winnie-the-Pooh”, as well as one-component canned meat companies “Gerber”, “Beach-Nat” and others. Fish dishes for children the first year of life is not recommended, in the future they are introduced with great care.

Of fruits and berries, apples of green and white color (Antonovka, white filling, Semirenko), pear, white currant, white cherry, yellow plum, gooseberry, blueberry, lingonberry are used.

Meat broths (they are replaced with vegetables), fried foods, meat and fish smoked meats, sausages, hot spices, and canned foods, with the exception of special canned foods for children, are excluded from the child’s diet. In the diet, sugar is limited by 50%, salt (food is not added), the proportion of vegetable fats is increased to 30%.

When ECD is important to keep a food diary, parents should write down in detail what and how much the baby ate, what his reaction was (skin condition, anxiety, itching, stool changes). The diary will help to identify exactly those products that the child does not tolerate.

Drug therapy of ECD includes the appointment of antihistamines and membrane stabilizers (ketotifen, sodium chromoglycate): claritin at 0.005 g (1 teaspoon 1 time per day), tavegil at 0.025 mg / kg per day for 2 doses or phencarol, suprastin 1-2 mg / kg per day for 5-7 days, alternating drugs if necessary. Ketotifen (zaditen) is used at 0.025 mg / kg per day in 2 divided doses, the course is 1.5-3 months. The purpose of vitamins is also shown: B6 (pyridoxalphosphate) at 0.01-0.05 g 3 times a day (up to 50-75 mg / day under the control of the reaction of urine to xanthurenic acid), B5 and B15 at 0.05 g 2-3 once a day, vitamin E (tocopherol) at 5 mg / kg per day, the course of treatment is 2-3 weeks, vitamin A for 3-4 weeks at a dose of 5000-10 000 IU per day. With unstable stool, along with enzyme preparations (abomin 1 / 4-1 / 2 tablets 3 times a day, pancreatin 0.1-0.2 g 3 times a day, creon, pancytrate, etc.) prescribe eubiotics (bifidum or lactobacterin 2-3 doses 3 times a day for 1-2 months), enterosorbents (Vaulen 50-100 mg / kg per day, carbolene 1 tablet 3 times a day, etc.).

For recurrent infections, biostimulants are prescribed: Eleutherococcus extract 2 drops per year of life, tincture of ginseng, Chinese magnolia vine and 1 drop per year of life for 3-4 weeks. For the same purpose, glycyrs are shown at a rate of 1-2 mg / kg per day or etimizol at a rate of 1 mg / kg per day in 2 divided doses, a course of 7-14 days.

The following measures are taken to treat skin and mucous membrane lesions:

a) daily bathe the child in boiled water with the addition of decoctions of plants (string, violets, nettle, valerian root, mint, oak bark, etc.), rye and wheat bran, starch, oat straw, taking into account individual sensitivity;

b) itchy, wetting rashes on the face are dried with lotions of 1% resorcinol solution, 0.1% rivanol solution, 0.25% silver nitrate solution, and also treated with 1% salicylic-zinc ointment, Panthenol aerosol, talkers with talc and zinc oxide . The topical use of corticosteroids in the form of ointments, creams, emulsions gives a good effect: dermozolone (betamethasone + clioquinol), celestoderm B (betamethasone + haramycin), pimafucort (hydrocortisone + neomycin + natamycin, used from 12 months), acriderm (tridermone) (betamethone) gentamicin + clotrimazole), advantan, elidel; prescribed 2 times a day, the average course of 7-14 days.

When infected with eczematous rashes, 1-2% aqueous solutions of aniline dyes (methylene blue, brilliant green, gentian violet) are used.

P r about f and l and t and to and. To prevent allergic reactions, it is important to individualize the vaccination plan and prepare the child for the vaccine with non-specific hypersensitizing therapy (antihistamines, vitamins C, P, B6, B5, E 2-3 days before and 5-7 days after vaccination), taking into account the individual reaction to vaccinations , including the previous one.

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Exudative-catarrhal diathesis

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