Allergology test. Indirect diseases. Principles of disease diagnosis. Features of anamnesis collection. Hereditary aspects of allergic diseases. Completing a medical history (rules) Allergological history, allergic eye diseases

When diagnosing allergic diseases in children and adults, doctors pay special attention to collecting the patient’s medical history. Sometimes knowledge about family diseases, predispositions to allergies and food intolerances greatly facilitates the diagnosis. The article discusses the concept of anamnesis about allergies, the features of its collection and significance.

Description

An allergy history is the collection of data about the allergic reactions of the organism being studied. It is formed simultaneously with the clinical history of the patient’s life.

Every year the number of complaints about allergies is growing. That is why it is important for every doctor a person consults to know his body’s past reactions to food, medications, odors or substances. Drawing up a complete picture of life helps the doctor quickly determine the cause of the disease.

This upward trend in allergic reactions is explained by the following factors:

• a person’s inattention to their health;
• taking medications uncontrolled by doctors (self-medication);
• insufficient qualifications of doctors in the periphery (distant from the center of settlements);
• frequent epidemics.

Allergies manifest themselves differently in each person: from mild forms of rhinitis to swelling and anaphylactic shock. It is also characterized by a polysystemic nature, that is, the manifestation of deviations in the functioning of several organs.

The Russian Association of Allergists and Clinical Immunologists is developing recommendations for the diagnosis and treatment of various types of allergic reactions.

Purpose of collecting anamnesis

An allergy history should be collected for each person. These are its main goals:

• determination of genetic predisposition to allergies;
• determining the relationship between the allergic reaction and the environment in which the person lives;
• search and identification of specific allergens that could provoke pathology.

The doctor conducts a survey of the patient to identify the following aspects:

• allergic pathologies in the past, their causes and consequences;
• signs that the allergy manifested itself;
• medications that were previously prescribed and the speed of their effect on the body;
• relationship with seasonal phenomena, living conditions, and other diseases;
• information about relapses.

Objectives of the anamnesis

When collecting an allergy history, the following tasks are solved:

1. Establishing the nature and form of the disease - identifying the connection between the course of the disease and a specific factor.
2. Determination of associated factors that contributed to the development of pathology.
3. Identification of the degree of influence of household factors on the course of the disease (dust, dampness, animals, carpets).
4. Determining the relationship of the disease with other pathologies of the body (digestive organs, endocrine system, nervous disorders and others).
5. Identification of harmful factors in professional activities (presence of allergens in the workplace, working conditions).
6. Identification of atypical reactions of the patient’s body to medications, food, vaccines, and blood transfusion procedures.
7. Assessing the clinical effect of previous antihistamine therapy.

When complaints are received from a patient, the doctor conducts a series of studies, interviews and examinations, after which he makes a diagnosis and prescribes treatment. Using tests, the doctor determines:

• Clinical and laboratory tests (general blood tests, urine tests, radiography, respiratory and heart rate indicators), which allow us to identify where the process is localized. This can be the respiratory tract, skin, eyes and other organs.
• Nosology of the disease - whether the symptoms are dermatitis, hay fever or other forms of pathologies.
• The phase of the disease is acute or chronic.

Data collection

Collecting an allergy history involves conducting a survey, which takes some time and requires attentiveness and patience from the doctor and the patient. Questionnaires have been developed for this purpose; they help simplify the communication process.

The anamnesis collection scheme is as follows:

1. Determination of allergic diseases in relatives: parents, grandparents, brothers and sisters of the patient.
2. Make a list of allergies that have occurred in the past.
3. When and how did allergies manifest themselves?
4. When and how reactions to medications occurred.
5. Determining the connection with seasonal phenomena.
6. Identification of the influence of climate on the course of the disease.
7. Identification of physical factors affecting the course of the disease (hypothermia or overheating).
8. The influence of physical activity and patient mood swings on the course of the disease.
9. Identifying connections with colds.
10. Identification of connections with the menstrual cycle in women, hormonal changes during pregnancy, breastfeeding or childbirth.
11. Determining the degree of allergy manifestation when changing places (at home, at work, in transport, at night and during the day, in the forest or in the city).
12. Determination of the relationship with food, drinks, alcohol, cosmetics, household chemicals, contact with animals, their impact on the course of the disease.
13. Determination of living conditions (presence of mold, wall material, type of heating, number of carpets, sofas, toys, books, presence of pets).
14. Conditions of professional activity (hazardous factors of production, change of place of work).

Typically, pharmacological and allergy histories are collected simultaneously. The first shows what medications the patient was taking before seeking medical help. Information about allergies can help identify drug-induced conditions.

Taking an anamnesis is a universal method for identifying a disease

The collection of an allergy history is carried out, first of all, for the timely detection of a pathological reaction of the body. It can also help determine which key allergens the patient's body reacts to.

By collecting information, the doctor establishes risk factors, accompanying circumstances and the process of development of an allergic reaction. Based on this, a treatment and prevention strategy is determined.

The doctor is required to take a medical history for each patient. Improper implementation may not only not help in prescribing treatment, but also aggravate the patient’s situation. Only after receiving correct test data, questioning and examination can the doctor decide to prescribe therapy.

The only disadvantage of this diagnostic method is the duration of the survey, which requires perseverance, patience and attentiveness from the patient and the doctor.

History is burdened / not burdened - what does this mean?

First of all, when examining a patient, the doctor asks about allergic reactions in his relatives. If there are none, then it is concluded that the allergy history is not burdened. This means there is no genetic predisposition.

In such patients, allergies may occur due to:

• change of living or working conditions;
• colds;
• eating new foods.

All physician concerns about allergens should be explored and determined through provocative skin testing.

Often patients have a family history of allergic reactions. This means that his relatives faced the problem of allergies and underwent treatment. In such a situation, the doctor pays attention to the seasonality of the disease:

• May-June – hay fever;
• autumn – allergies to mushrooms;
• winter – reaction to dust and other signs.

The doctor also finds out whether the reactions worsened when visiting public places: zoo, library, exhibitions, circus.

Data collection in the treatment of children

An allergy history in a child’s medical history is of particular importance, because the child’s body is less adapted to environmental risks.

When collecting information about diseases, the doctor pays attention to how the pregnancy proceeded, what the woman ate during this period and while breastfeeding. The doctor must exclude allergens from entering mother's milk and find out the true cause of the pathology.

An example of a child's allergy history:

1. Ivanov Vladislav Vladimirovich, born 01/01/2017, child from the first pregnancy, which occurred against the background of anemia, delivery at 39 weeks, without complications, Apgar score 9/9. In the first year of life, the child developed in accordance with his age, vaccinations were scheduled according to the calendar.
2. The family history is not burdened.
3. No allergic reactions have been observed previously.
4. The patient's parents complain of rashes on the skin of the arms and abdomen that appeared after eating an orange.
5. No previous reactions to medications have been observed.

Collecting specific, detailed data about the child’s life and condition will help the doctor quickly make a diagnosis and select the optimal treatment. We can say that with the increase in the number of allergic reactions in the population, information about this pathology becomes more significant when collecting a life history.

Methodological materials for practical classes for students

In clinical immunology and allergology.

Topic: Methods of allergy diagnostics.

Target: teach allergy diagnostics skills.

The student should know:

· Allergy diagnostic methods

The student must be able to:

§ Collect anamnesis and prescribe a clinical examination of a patient with allergy pathology

§ Interpret the results of basic diagnostic allergy tests

The student must own

An algorithm for making a preliminary allergological diagnosis with subsequent referral to an allergist-immunologist

Principles of diagnosing allergic diseases

Diagnosis of allergic diseases is aimed at identifying the causes and factors contributing to the emergence, formation and progression of allergic diseases. For this purpose, specific and nonspecific examination methods are used.

Diagnosis always begins with the collection of complaints, the features of which often suggest a preliminary diagnosis, and the collection and analysis of data from the patient’s life history and illness.

Clinical nonspecific examination methods include medical examination, clinical and laboratory examination methods, radiological, instrumental, functional research methods and others as indicated.

Specific diagnosis of allergic diseases involves a set of methods aimed at identifying an allergen or group of allergens that can trigger the development of allergic diseases. The basic principle of specific diagnosis of allergic diseases is the identification of allergic antibodies or sensitized lymphocytes and products of specific interaction of allergens (AG) and antibodies (AT).

The scope of a specific allergological examination is determined after collecting an allergic history and includes:

Carrying out skin tests;

Provocative tests;

Laboratory diagnostics.

Collecting an allergy history

Correct history taking is of great, sometimes decisive, importance in diagnosing allergies. When collecting anamnesis, a search is made for factors contributing to the development of this disease.

When interviewing a patient, special attention is paid to the features of the development of the first symptoms of the disease, the intensity and duration of manifestations, the dynamics of their development, the results of previous diagnostics and treatment, and the patient’s sensitivity to previously prescribed pharmacotherapeutic agents.

When collecting an allergy history, the following tasks are set:

Establishment of the allergic nature of the disease, presumably a nosological form (one of the probable signs of the presence of an allergic disease is the existence of a clear connection between the development of the disease and its manifestation with the influence of a certain causative factor, the disappearance of symptoms of the disease in the event of cessation of contact with this factor - the elimination effect - and the resumption of manifestations of the disease, often more pronounced upon repeated contact with the suspected causative factor);

Presumable identification of an etiologically significant allergen;

Identification of risk factors contributing to the development of allergic diseases;

Establishment of hereditary predisposition;

Assessment of the influence of environmental factors (climate, weather, physical factors) on the development and course of the disease;

■ identifying the seasonality of the manifestation of disease symptoms;

Identification of the influence of household factors (overcrowding, dampness in the room, carpets, pets, birds, etc.) on the nature of the development and course of the disease;

■ establishing a connection between the onset of the disease and its exacerbations with food and medication intake;

Identification of concomitant somatic pathology;

Identification of other allergic diseases the patient has;

Identification of the presence of occupational hazards;

■ assessment of the clinical effect of the use of antiallergic drugs and/or allergen elimination.

When collecting anamnesis, special attention is paid to family predisposition: the presence in close relatives of the patient of diseases such as bronchial asthma, year-round or seasonal rhinitis, eczema, urticaria, Quincke's edema, intolerance to foods, drugs, chemicals or biological drugs. It is known that at Those suffering from allergic diseases have a burdened allergic history (i.e. the presence of allergic diseases in relatives) occurs in 30-70% of cases. It is also necessary to find out whether there have been cases of tuberculosis, rheumatism, diabetes, mental illness among family members or close relatives of the patient.

A correctly collected anamnesis will not only clarify the nature of the disease, but also suggest its etiology, i.e. identify a suspected allergen or group of allergens. If exacerbations of the disease occur at any time of the year, but more often at night, when cleaning an apartment, staying in dusty rooms with many “dust collectors” (upholstered furniture, carpets, curtains, books, etc.), then we can assume that the patient has increased sensitivity to household allergens (house dust, library dust). House dust and the mites that live in it can cause the development of bronchial asthma and year-round allergic rhinitis, and less commonly, skin lesions (dermatitis). The year-round course of the disease with exacerbations in the cold season (autumn, winter, early spring) is associated with the saturation of dust in homes and an increase in the number of mites in them during this period. If symptoms of the disease regularly appear upon contact with animals (birds, fish), in particular in the circus, in the zoo, after purchasing pets, as well as when wearing clothes made of wool or fur, this may indicate an allergy to animal hair or dander. These patients may not tolerate the administration of drugs containing animal blood proteins (heterologous sera, immunoglobulins, etc.). The examination plan for such patients involves the inclusion of testing methods with dust and epidermal allergens.

The assumptions that have arisen must be confirmed by specific examination methods - skin, provocative and other tests.

Skin tests

Skin tests are a diagnostic method for identifying specific sensitization of the body by introducing an allergen through the skin and assessing the magnitude and nature of the resulting swelling or inflammatory reaction. There are different methods of skin testing with allergens: prick tests , scarification, application, intradermal tests.

For skin testing, standard commercial allergens containing 10,000 protein nitrogen units (PNU) in 1 ml are used, made from plant pollen, house dust , wool, down, epidermis of animals and birds, food products and other raw materials.

The technique of performing skin tests, indications and contraindications for their use, as well as evaluating the results of skin testing are carried out according to the generally accepted methodology proposed by AD.Ado (1969).

The indication for skin tests is medical history indicating the causal role of a particular allergen or group of allergens in the development of the disease. Currently, a large number of non-infectious and infectious diagnostic allergens are known.

Contraindications for skin testing are the presence of:

Exacerbation of the underlying disease;

■ acute intercurrent infectious diseases;

Tuberculosis and rheumatism during the period of exacerbation of the process;

Nervous and mental diseases during exacerbation;

Diseases of the heart, liver, kidneys and blood system in the stage of decompensation;

History of anaphylactic shock;

■ pregnancy and lactation.

It is recommended to refrain from performing skin tests in patients during treatment with steroid hormones, broncho-spasmolytics and antihistamines (these medications can reduce skin sensitivity), as well as after an acute allergic reaction, since during this period the tests may turn out to be negative due to the depletion of skin-sensitizing antibodies.

The principle of performing skin tests is based on the fact that a causally significant allergen applied to the skin interacts with antigen-presenting cells and T-lymphocytes. In the skin, antigen-presenting cells are Langerhans cells and macrophages. The result of such interaction in the presence of sensitization is the release of allergy mediators and the development of a local allergic reaction, the intensity of which is recorded by an allergist in a specific allergological examination sheet.

Skin tests are usually placed on the inner surface of the forearms, 5 cm away from the wrist joint. At a distance of 3-5 cm, samples are placed with test control liquid, histamine and standard water-salt uh allergen extracts for diagnostics.

An allergy is a reaction of the body to contact with any substance in an acute form. Any allergen can cause a reaction in the body. It is known that this predisposition can be congenital or acquired through prolonged exposure to an allergen.

Allergies are a big problem for modern people

Since the eye is highly sensitive and has a delicate mucous membrane, it is most susceptible to allergens, most of which are in the air.

An allergen can be:

• products ingested through food;
• decorative cosmetics (mascara, cream),
• dust, mold, fungus;
• household chemicals;
• animal hair;
• pollen of plants, flowers.

The World Health Organization states that every fifth person on the planet suffers from various types of allergies.

Data for allergy history

The ophthalmologist collects an allergy history in the same way as when examining a patient with any other diagnosis. The questions asked concern the topic of eye allergies and common allergic reactions. There are a lot of reasons for allergies, so it is important to create a survey correctly, without missing out on the smallest details and moments.

Collect information such as:

1. identifying a direct connection between the onset of the disease and exposure to a certain factor;
2. determination of hereditary factors, the presence of pathologies in close and distant relatives;
3. elucidation of the influence of the environment (weather, climate, seasonality) on the development of the disease;
4. the influence of domestic causes (dampness, presence of carpets, pets);
5. correspondence of connections between diseases of other organs;
6. identification of hazardous working conditions;
7. identifying reactions to medications;
8. consequences of physical overload and negative emotions;
9. the influence of past infectious and cold-related diseases;
10. list of food products that can cause allergies.

Based on the information obtained, it is possible to preliminarily establish the causes and factors influencing the manifestation of any allergic reaction.

Allergy history, allergic eye diseases

The form of any allergy usually begins with rhinitis and redness of the eyes. Most allergies of the eye organ manifest themselves in the form of eyelid dermatitis and inflammation of the conjunctiva. The reasons include the use of medicinal eye medications in the form of drops and ointments.

Allergic eye diseases

Allergic conjunctivitis begins with redness of the eyes, inflammation of the eyelids, redness, and itching (blepharitis). Less commonly, inflammation (keratitis) may develop.

The most extreme and susceptible part of the eyeball, due to its anatomical location, all allergic reactions are reflected in its condition.

Types of allergies:

• Allergic dermatitis occurs when there is direct contact between the skin and an allergic substance. Symptoms:

1. redness of the eyelids and skin around the eyes;
2. swelling of the eye;
3. rash on the surface of the eyelids, where the eyelashes are, in the form of bubbles;
4. the occurrence of itching and irritation.

• Allergic conjunctivitis can be acute or chronic. Has the following symptoms:

1. redness of the surface of the conjunctiva and the eyeball itself;
2. profuse lacrimation;
3. the presence of thick and mucous discharge;
4. in the advanced stage there is glassy edema of the eye mucosa (chemosis).

• Hay conjunctivitis develops during the period of abundant flowering of plants and flowers. Available symptoms:

1. eyes itch and water, turn red;
2. pain in the eyes, in bright light;
3. an allergic runny nose and continuous sneezing appear;
4. paroxysmal suffocation, skin rash on the body.

• Spring conjunctivitis is associated with an increased dose of ultraviolet radiation. Symptoms in a more pronounced form. The surface of the conjunctiva becomes heterogeneous.
• Allergy to the lens material and the solution with which they are treated.

Allergy tests

After visiting an ophthalmologist who takes an allergic history, a consultation with an allergist is necessary. He compiles his medical history, takes samples and analyzes the results.

For the allergy test procedure, special solutions are produced that contain small particles of different types of allergen. Scratches are made on the patient’s forearm with special plates and one type of solution is applied, numbered and written down.

After 15 minutes, the doctor examines the patient, his changes in the skin, if there is redness, swelling, this means that there is a reaction to this allergen.

The totality of all actions: medical history, collection of tests and samples gives a clear picture of the disease and its causes. By establishing the cause and eliminating irritating factors, the consequences of the disease can be cured.

What is a denoviral conjunctivitis, the doctor will explain:

JSC SPO "YELTSK MEDICAL COLLEGE"

SCHEME OF CLINICAL EXAMINATION OF A PATIENT

AND PLAN FOR WRITING AN EDUCATIONAL HISTORY OF A DISEASE

IN PEDIATRICS

Compiled by teacher

F.I. Zaitseva

Yelets, 2012

Preface

These guidelines are intended to help students of the specialty “General Medicine” when studying the discipline “Pediatrics with childhood infections”, as well as for students who are on practical training when writing an educational medical history.

Students of the specialty “General Medicine” must demonstrate the ability to examine a patient and describe in detail the results of the examination and observation, using all sections of the recommendations, including the identification of syndromes based on clinical trial materials.

When studying pediatrics, students need to supervise patients on the topics of the discipline and correctly fill out the educational medical history. It is necessary to identify syndromes, consolidating and developing the skills that were learned during the study of propaedeutics in pediatrics, and then justify a preliminary diagnosis and draw up an individual plan for further examination. Then, based on the materials of the paraclinical examination and the identified syndromes, a clinical diagnosis should be formulated within the framework of the accepted classification, and the sections “Treatment” and “Patient Observation Diary” should be drawn up. Students must show how much they have mastered practical diagnostic techniques.

Components of a medical history:

1. Passport part.

2. Patient complaints upon admission.

3. History of the present disease.

4. History of the patient's life.

5. Living conditions of the patient.

6. Family history.

7. Allergological history.

8. Epidemiological anamnesis.

9. Objective research on systems.

10. Diagnostic process.

11. Preliminary diagnosis

12. Clinical diagnosis

13. Treatment

14. Observation Diary

Passport part

1. Last name, first name, patronymic of the patient.

2. Age, exact date of birth.

3. Place of residence.

4. Place of study.

5. Who sent the patient for inpatient treatment.

6. Diagnosis upon referral.

7. Time of admission to the hospital.

8. Diagnosis upon admission.

9. Preliminary diagnosis.

10. Clinical diagnosis.

11. Complications.

2. Patient complaints upon admission

At the beginning, the complaints of the patient or his parents, expressed when they first contacted him with the question: “What is bothering you?” Then a detailed description of all complaints is carried out for the organ system whose damage seems to be the main one, or from which there is the largest number of complaints. It must be remembered that this hypothesis about the predominant defeat of one or another system may not be confirmed in the future. Therefore, further, through a targeted survey, one should get a clear idea of ​​the functioning of all body systems of the supervised patient. The recording of complaints in the medical history should be carried out for each organ system separately. To facilitate this task, symptomatology of systems is carried out.

3. History of present illness

The history of the present disease should reflect in detail the clinical development of the disease from the time of the first symptoms to the beginning of supervision. When, with what painful manifestations did the disease begin and how (suddenly, acutely, gradually). Indicate the causes of the disease suspected by the patient or relatives. When did you first go to the doctor, what diagnoses were made previously?

What medications and therapeutic methods were used, their effectiveness, were there any side effects of medications (antibiotics, cardiac glycosides, steroid hormones, etc.). How long were you treated in the clinic, when was you sent to the hospital, when was you hospitalized, the course of the disease before the start of supervision. If the patient is hospitalized again, find out when, where, for how long and with what methods he was treated before. The results of previously conducted laboratory and instrumental studies are also provided, as well as information about the impact of the disease on the patient’s ability to work.

4 . Anamnesis of life

When collecting a life history from children, it is necessary to clarify: how the pregnancy proceeded and the birth of the mother. What is the mother's illness? The child screamed immediately after birth or had to be revived. Whether the baby was born on time or premature. Was the birth accompanied by any injuries to the child?

It is necessary to pay attention to whether the newborn child had any diseases and what kind.

Pay much attention to the issues of feeding the child, neuropsychic and physical development, the tendency to frequently recurring diseases in the first year of life and beyond, as well as immunoprophylaxis.

Study: did you keep up with your peers in physical or mental development?

Find out previous illnesses: rickets, infectious diseases, pneumonia, tonsillitis, endocrine diseases, rheumatism, tuberculosis, etc. Determine whether there were injuries or surgical interventions.

This information is presented in chronological order. The duration and course of the diseases, their complications, and the treatment used are indicated.

Living conditions

Characteristics of the home, its living space, water supply, sewerage, heating. The size of the family and its total budget. The nature of clothing (widespread use of synthetic fabrics, the manner of dressing too warmly due to individual habit or passion for fashion, etc.).

Use of weekends or holidays. Physical education and sports (sports category).

Nutrition: regularity, dry eating, excess food intake. Bad habits: smoking (from what age, how many cigarettes per day).

Drinking alcoholic beverages (periodically, systematically, in what quantities, since when).

Abuse of tea or coffee. Taking analgesics, sleeping pills, sedatives, narcotics and other medications.

Family history

The age and health status of the parents at the time of the birth of the subject. Diseases of parents, brothers, sisters, uncles and aunts, grandparents, and if they died, then at what age and from what. It is important to keep in mind diseases to which there may be a genetic predisposition, obesity, diabetes mellitus, cholelithiasis and urolithiasis, blood diseases and neoplasms, arterial hypertension, psychoneurosis and vegetative dystonia, as well as allergic diseases and chronic infections (tuberculosis, toxoplasmosis, syphilis, etc. .)

Allergy history

Allergic diseases in parents and immediate family in the past and present. Reactions to the administration of serums and vaccines. How do allergic reactions manifest themselves, their frequency, and how they were stopped.

The main task of allergy history is to find out the connection of the disease with hereditary predisposition and the effect of environmental allergens.

Initially, the nature of the complaints is clarified. They may reflect different localization of the allergic process (skin, respiratory tract, intestines). If there are several complaints, the connection between them is clarified. Next, find out the following.

Hereditary predisposition to allergies - the presence of allergic diseases (bronchial asthma, urticaria, hay fever, Quincke's edema, dermatitis) in blood relatives.

Previously suffered allergic diseases by the patient (shock, rash and itching of the skin to food, medicines, serums, insect bites and others, what and when).

Environmental influence:

climate, weather, physical factors (cooling, overheating, radiation, etc.);

seasonality (winter, summer, autumn, spring - exact time);

places of illness attack: at home, at work, on the street, in the forest, in the field;

time of illness attack: day, night, morning.

Influence of household factors:

• contact with animals, birds, fish food, carpets, bedding, upholstered furniture, books;

  the use of odorous cosmetics, detergents, and insect repellents.

Connection of exacerbations:

with other diseases;

with menstruation, pregnancy, postpartum period;

with bad habits (smoking, alcohol, coffee, drugs, etc.).

Relationship between diseases and intake:

certain foods;

medicines.

Improvement of the course of the disease with:

elimination of the allergen (vacation, business trip, visiting, at home, at work, etc.);

when taking antiallergic drugs.

4. Specific methods of antiallergic diagnostics

Allergy diagnostic methods make it possible to identify whether a patient is allergic to a particular allergen. A specific allergological examination is carried out only by an allergist during the period of remission of the disease.

Allergy examination includes 2 types of methods:

provocative tests on the patient;

laboratory methods.

Laboratory tests on a patient involves the introduction of a minimal dose of an allergen into the patient’s body in order to provoke manifestations of an allergic reaction. Carrying out these tests is dangerous and can lead to the development of severe and sometimes fatal manifestations of allergies (shock, Quincke's edema, attack of bronchial asthma). Therefore, such studies are carried out by an allergist together with a paramedic. During the study, the patient's condition is constantly monitored (blood pressure, fever, auscultation of the heart and lungs, etc.).

According to the method of introducing the allergen, they are distinguished:

1) skin tests (cutaneous, scarification, prick test, intradermal), the result is considered positive if itching, hyperemia, edema, papules, necrosis appear at the injection site;

2) provocative tests on the mucous membranes (contact, conjunctival, nasal, oral, sublingual, gastrointestinal, rectal), a positive result is recorded in the event of clinical conjunctivitis, rhinitis, stomatitis, enterocolitis (diarrhea, abdominal pain), etc.

3) inhalation tests - involve inhalation administration of an allergen, are used to diagnose bronchial asthma, are positive when an attack of suffocation or its equivalent occurs.

When assessing test results, the occurrence of general manifestations of the disease is also taken into account - fever, generalized urticaria, shock, etc.

Laboratory tests are based on the determination of allergen-specific antibodies in the blood, hemagglutination reactions, degranulation of basophils and mast cells, and antibody binding tests.

5. Urticaria: definition, basics of etiopathogenesis, clinical picture, diagnosis, emergency care.

Urticaria is a disease characterized by a more or less widespread rash of itchy blisters on the skin, which are swelling of a limited area, mainly the papillary layer, of the skin.

Etiopathogenesis. The etiological factor can be any allergen (see question 2). Pathogenetic mechanisms – allergic reactions of type I, less often type III. The clinical picture of the disease is caused by an increase in vascular permeability with the subsequent development of skin edema and itching due to excessive (as a result of an allergic reaction) release of allergic mediators (histamine, bradykinin, leukotrienes, prostaglandins, etc.)

Clinic. The clinical picture of urticaria consists of the following manifestations.

for skin itching (local or generalized);

for a localized or generalized itchy skin rash with the size of skin elements from 1-2 to 10 mm with a pale center and hyperemic periphery, rarely with the formation of blisters;

to increase body temperature to 37-38 C (rarely).

History (see question 3).

Examination plays a big role in diagnosing the disease.

The onset of the disease is acute. A monomorphic rash appears on the skin. Its primary element is a blister. At the beginning it is a pink rash, the diameter of the elements is 1-10 mm. As the disease progresses (several hours), the blister in the center turns pale, the periphery remains hyperemic. The blister rises above the skin and itches. Less frequently detected are elements in the form of vesicles with serous contents (in the case of erythrocyte diepedesis - with hemorrhagic contents).

The skin elements are located separately or merge, forming bizarre structures with scalloped edges. Rashes on the mucous membranes of the mouth are less common.

An episode of acute urticaria most often lasts from several hours to 3-4 days.

Laboratory and allergological diagnostics – Laboratory data are nonspecific and indicate the presence of an allergic reaction and inflammation.

General blood analysis:

slight neutrophilic leukocytosis;

eosinophilia;

acceleration of ESR is rare.

Blood chemistry:

increase in CRP levels;

increase in glycoproteins;

increase in seromucoid level;

increase in globulin fractions of protein;

increase in the concentration of class E immunoglobulins.

After the acute phase of the disease has stopped, an allergological examination is carried out to determine the “culprit” allergen.

Emergency care for urticaria– in case of an acute attack, they should be aimed at eliminating the most painful symptom of the disease – itchy skin. For these purposes, it is usually sufficient to use internally (less often by injection) antihistamines - diphenhydramine, diazolin, fenkarol, tagevil, suprastin, pipolfen and others, rubbing itchy areas of the skin with lemon juice, 50% ethyl alcohol or vodka, table vinegar (9% acetic acid solution acids), hot shower. The main thing in the treatment of urticaria is to eliminate contact with the allergen.