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Allergic rhinitis, allergic conjunctivitis, urticaria, Quincke edema



Acute allergic diseases are caused by increased sensitivity of the immune system to various exogenous antigens (allergens). They are characterized by a sudden onset, an unpredictable course, a high risk of developing life-threatening conditions.

ETHIOLOGY AND PATHOGENESIS

The most common allergens:

¦ food (fish, seafood, nuts, honey, milk, eggs, fruits, legumes, etc.);

¦ medicinal (analgesics, antibiotics, sulfonamides, vitamins, etc.);

¦ pollen of plants;

¦ household (latex, perfumes, household chemicals, dust, pet hair);

¦ substances that enter the body when stinging insects.

Acute allergic diseases are usually caused by immediate-type hypersensitivity reactions consisting of several stages:

¦ contact with an allergen (substances not dangerous in themselves, for example, pollen of plants, particles of house dust, medicines, etc.);

¦ synthesis of specific IgE (immunoglobulin E);

¦ fixation of IgE on the surface of mast cells (sensitization);

¦ repeated contact with the same allergen;

¦ binding of antigen to IgE on the surface of mast cells;

¦ release of mediators from activated mast cells (histamine, prostaglandins, leukotrienes, platelet activating factor, etc.);

¦ the effect of mediators on tissues and organs, leading to the rapid development of external manifestations of an allergic reaction (early phase);

¦ after 6-8 hours or more, the development of the late phase is possible due to the repeated release of mediators by other cells involved in the site of action of the allergen.

CLASSIFICATION

According to the course and risk of developing life-threatening conditions, acute allergic diseases are divided into two types.

¦ Light:

? allergic rhinitis;

? allergic conjunctivitis;

? localized urticaria.

¦ Severe (prognostically unfavorable):

? generalized urticaria

? Quincke's edema (angioedema)

? anaphylactic shock.

CLINICAL PICTURE

Allergic rhinitis manifests itself with profuse rhinorrhea, nasal blockade due to swelling of the mucous membrane, itching in the nasal cavity, repeated sneezing and, often, anosmia.

Allergic conjunctivitis is characterized by hyperemia and swelling of the conjunctiva, swelling of the eyelids, narrowing of the palpebral fissure, itching, lacrimation, and sometimes photophobia.

In a significant number of cases, a combination of allergic rhinitis and conjunctivitis (rhinoconjunctivitis) is noted.

Localized urticaria manifests itself by the sudden appearance on a limited area of ​​the skin of urticaria elements (towering above the surface of the skin) with clear boundaries, usually red, with a diameter of several millimeters to several centimeters, against the background of hyperemia, accompanied by skin itching.

Generalized urticaria is characterized by damage to the entire skin, often merging of the elements described above is observed.

Quincke's edema (angioedema) is manifested by local edema of the skin, subcutaneous tissue and / or mucous membranes. More often develops in the lips, cheeks, eyelids, forehead, scalp, scrotum, hands, dorsal surface of the feet. Allergic edema of the gastrointestinal mucosa is accompanied by intestinal colic, nausea, and vomiting. With Quincke's edema, localized in the larynx, a life-threatening condition is possible. In this case, cough, hoarseness, violation of swallowing, suffocation, stridor breathing are observed.

In 50% of cases, angioedema is combined with urticaria.

TIPS TO THE CALLER

¦ If breathing is difficult, help the patient breathe freely (open the collar, give a comfortable position);

¦ When stinging an insect or reaction to an injection, topically apply cold or a tourniquet;

¦ Take an antiallergic drug from a home medicine cabinet.

¦ In case of a life threat, it is necessary to give instructions for resuscitation and to keep in touch if necessary.

CALL ACTIONS

diagnostics

MANDATORY MATTERS

¦ Have you had any allergic reactions before?

¦ If yes, what caused them and how did they manifest? What drugs were used for treatment (antihistamines, glucocorticosteroids, adrenaline ')?

What could have caused the development of an allergic reaction this time (a food product that is not part of the normal diet, medication, an insect bite, etc.)?

¦ What measures were taken by the patient on their own, were they effective?

INSPECTION AND PHYSICAL EXAMINATION

¦ Assess the color of the skin (pale or hyperemic), the severity of nasal secretion and lacrimation, check for difficulty in nasal breathing (in some cases, the patient breathes through the mouth) and sneezing.

¦ Evaluate the skin and conjunctiva for the presence of hyperemia, elements of a rash, edema, characterize the rash and edema morphologically, and also indicate their localization and prevalence.

¦ Examine the oropharynx, evaluate the sonority of the voice, the possibility of swallowing to exclude life-threatening swelling of the mouth and pharynx.

¦ Check the airway, assess the presence of stridor, dyspnea, wheezing, shortness of breath or apnea.

¦ Auscultate the area of ​​the lungs and assess the presence of bronchial obstruction.

¦ Palpation of the abdomen (including the spleen) and lymph nodes.

¦ Clarify the presence of gastrointestinal symptoms (nausea, abdominal pain, diarrhea).

¦ Measure heart rate and heart rate.

¦ Measure blood pressure. A sharp decrease in blood pressure <100 mm Hg
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Allergic rhinitis, allergic conjunctivitis, urticaria, Quincke edema

  1. Allergic syndrome (urticaria, Quincke's edema, Lyell syndrome)
    Allergic conditions requiring emergency care include anaphylactic shock, urticaria, Quincke's angioedema, and Lyell syndrome. For anaphylactic shock, see the “Shock Syndrome Syndrome” section. Urticaria Urticaria is an allergic disease characterized by the rapid spread of itchy skin rashes, which are edema of a limited skin area
  2. LESSON 6 First aid for allergic reactions. Anaphylactic shock. Quincke's edema. Hives. Drug allergy.
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  3. Allergic Quincke Edema
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  4. Urticaria and Quincke's edema
    Urticaria (urticaria) is a disease characterized by a rapid, more or less common rash on the skin of itchy blisters, which are edema of a limited area, mainly the papillary layer of the skin. One type of urticaria is Quincke's edema (giant urticaria, angioedema), in which edema extends to the dermis or subcutaneous layer. This form
  5. Urticaria and angioedema
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  7. Urticaria and Quincke's edema
    S. Goldstein Urticaria is a transient rash with a blister as a morphological element — a clearly defined area of ​​edema of the dermis. The color of the blisters is usually red, with a diameter ranging from a few millimeters to several centimeters. The variety of clinical forms of urticaria is explained by the fact that they are based on different pathogenetic mechanisms. With Quincke's edema in the pathological process
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  12. Seasonal Allergic Rhinitis
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  13. Allergic rhinitis
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