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57СВЯЗЬ ПИЩЕВОЙ АЛЛЕРГИИ И АТОПИЧЕСКОГО ДЕРМАТИТА У ДЕТЕЙ
Ганиев А.Г.
Холматов Д.Н.
Мирзаева З.У.
Андижанский государственный медицинский институт
Андижан, Узбекистан
Представление в статье, результаты оценки частоты и факторов риска развития пищевой аллергии у детей с АД, имеющих несколько фармакологически устойчивые хронические заболевания. Пищевая аллергия была зарегистрирована у 65% детей. Полученные результаты позволяют рекомендовать детям, страдающим непрерывно-рецидивирующими различными хроническими заболеваниями, проведение специфической аллергологической диагностики с целью исключения пищевой аллергии.
Ключевые слова: Дети, атопический дерматит, пищевая аллергия
БОЛАЛАРДА ОЗИК-ОВКДТ АЛЕРГИЯСИ ВА АТОПИК ДЕРМАТИТНИНГ
МУНОСАБАТЛАРИ
Ганиев А.Г., Холматов Д.Н., Мирзаева З.У.
Ма;олада атопик дерматит билан огриган болаларда ози;-овк;ат аллергиялари ривожланишининг частотаси ва хавф омилларини бах,олаш натижалари келтирилган. Ози;-ов;ат аллергиялари болаларнинг 65 фоизида ;айд этилган. Олинган натижалар доимий сурункали, турли сурункали касалликларга чалинган болаларга ози;-ов;ат аллергиясини истисно ;илиш учун узига хос аллергологик ташхис куйиш имкониятини беради.
Калит сузлар: Болалар, атопик дерматит, ози;-ов;ат аллергияси.
RELATIONSHIP OF FOOD ALLERGY AND ATOPIC DERMATITIS IN CHILDREN
Submission the article is the results of the estimation of frequency and risk factors of food Allergy in children with AD, which has several pharmacologically stable chronic diseases. Food Allergy was detected in 65% of children. The obtained results allow recommending to children suffering from continuously-recurrent chronic diseases, to conduct specific Allergy diagnosis with the aim of eliminating food allergies.
Key words: Children, atopic dermatitis, food allergy
DOI: 10.24411/2181-0443/2020-10092
Relevance. A food allergy is an adverse immune response to food. Proteins are most often the allergen. At the moment, there is no exact information on the prevalence and geography of food allergies in adults and children [4,7.9]. Although a number of serious epidemiological studies have been conducted on the prevalence of allergies in children, the true number of food allergy sufferers is not known. An estimated 11 to 26 million people in Europe suffer from food allergies. In the world there are 6 659 040 000 people, respectively, the number of patients with food allergies is approximately 220-520 million people [2,3,7,9,10]. This is a serious global problem. The results of studies by many authors indicate the presence in children with atopic dermatitis of aggravated heredity in relation to allergic diseases [4,5,11]. Approximately 80% of children with
atopic dermatitis (AD) have a history of allergic diseases (food allergy, hay fever, bronchial asthma, recurrent allergic reactions in parents) [1,2,11]. Food sensitization involves, directly or indirectly, almost all organs and systems of the body. Localization and number of "shock organs" involved in the pathological process determines the clinical picture of the disease, which determines the variety of its clinical manifestations [1,2,6].
Clarification of the nature of food Allergy in children with atopic dermatitis is fundamental in the definition of a rational diet, the most important component of complex treatment of the disease.
Objective: to determine the frequency, risk factors of developing food allergies, particularly its etiological structure and immunological manifestations in children with AD.
Materials and research methods. The survey included 88 children with AD in age from 2 to 14 years (16% are children of pre-school age and 84% are children over 8 years old) who suffer from persistent flow of various chronic pathologies. Moreover, 25% were patients who turned directly to an allergist about their typical manifestations of allergy (dermatitis, bronchial asthma).The majority (75%) were patients who were treated in the somatic departments for the underlying disease or were registered by a pediatrician or narrowly specialized physicians (neurologist, rheumatologist, otolaryngologist). All children regularly (2-3 times a year) received planned therapy for the underlying disease. Criteria for inclusion of patients in the study - the duration of the disease is not less than 6 months; continuous relapsing course of the disease; frequency of exacerbations at least 1 time per month; short-lasting effect of classical therapy. Standard clinical and instrumental examination methods were used.
The diagnosis of food allergy was made on the basis of a comprehensive clinical and laboratory examination of patients, taking into account the allergological anamnesis data, the analysis of the food diary, the results of skin testing with allergies, elimination and provocation tests. Skin tests were carried out with the nutritional allergens of the company AOOT Biomed them. THEM. Mechnikov. According to the main clinical manifestations of the disease, 5 groups were singled out - 1st c. (n = 22) - patients with arthralgia, 2nd gr. (n = 20) cephalalgia, 3rd gr. (n = 18) - gastritis and / or gastroduodenitis, 4th gr. (n = 17) - nasal bleeding, 5th gr. (n = 11) - enuresis. The duration of the disease ranged from 6 months. up to 1 year - 17%, up to 2-3 years 35%, more than 3 years - 48% of cases. The frequency of diseases from weekly to daily was recorded in 59% of patients and most often in the group of patients suffering from cephalalgia (80%) and enuresis (75%). In 22% of patients, exacerbations occurred from 1 to 3 times a month; in 24%, exacerbations were irregular (associated with fatigue, hypothermia, meteorological conditions, etc.). In 45% of patients, a combination of the underlying disease with the skin (atopic dermatitis) or respiratory (bronchial asthma, allergic rhinitis) manifestations of allergy was noted.
Results and discussion. Analysis of the most common clinical manifestations of chronic pathology in children showed that in the structure of cephalgia, chronic headache was determined - 42%, headache with cerebral angiodystonia - 20%, vegetovascular dystonia - 18%, migraine - 13%, residual organically lesion of the central nervous system -6%; in the structure of arthralgia: arthralgia of unspecified etiology - 58%, arthralgia with reactive arthritis - 42%; in the structure of gastrointestinal manifestations, chronic gastritis with normal acidity - 63%, chronic gastroduodenitis with normal acidity - 31%, erosive gastroduodenitis - 6%. It is known that the main risk factors for
the development of food allergies are aggravated atopic heredity and perinatal factors. A detailed study of the risk factors for the development of food allergy revealed that the possibility of allergic reactions to food products is almost equally affected by the burdened allergy and the pathological course of pregnancy (65% and 52%, respectively).
In addition to hereditary burdens, the development of food allergies requires sensitization of the body. In this regard, significant results are presented by the results of
skin testing, which revealed in 84% of cases an increased sensitivity to food allergens. A characteristic feature of skin testing in all patients was the presence in the overwhelming majority of cases (90%) of a weakly positive degree of sensibilization. This, apparently, is one of the reasons for the lack of a clear relationship between taking the product and the appearance of complaints, in connection with which patients do not associate their suffering with food allergies. In the structure of the etiological factors of food sensitization, chicken eggs (80%), food grains (73%), meat (67%), cow milk (55%) citrus fruits (42%), fish (45%) are identified. Moreover, depending on the nosological form of the disease, the etiological structure of food sensitization has its own characteristics. Analyzing the structure of the etiological factors of food sensitization, it was found that in all forms of diseases, sensitization to the egg was practically the same frequency (from 78% to 86%). Sensitization to other food allergens occurred with varying frequency. So, most often sensitization was determined: -in patients with cephalalgia: cereals
(91%), egg (75%), milk (63%), meat (56%); -in patients with arthralgia:
egg (85%), cereals (70%), fish and meat (58%), milk (51%); -in patients with
nasal bleeding: meat (93%), citrus fruits, egg (75%), cereals (69%); -in patients
with enuresis: egg (82%), meat (64%), milk and cereals (55%); -in
patients with gastritis: cereals, egg (78%), meat (69%).
Considering that these products are products of daily consumption, it is impossible to establish a clear connection between exacerbations and their intake (according to anamnesis data) in most cases. In this regard, in each individual case, food allergies were confirmed by elimination and provocative tests, according to the results of which 65% of the examined children showed food allergies, and depending on the clinical manifestations, they were recorded with a different frequency. most often food allergies occur in patients with cephalgia (82%) and gastritis / gastroduodenitis (75%), slightly less often in patients with arthralgia (63%), nasal bleeding (53%) and enuresis (40%). The most frequent products that cause the development of food allergies in this group of children were egg (40%), food grains (39%), milk (22%) and food additives (preservatives, dyes, etc.) (22 %). Products such as meat, fish, citrus and nuts in rare cases caused complaints (from 1.5% to 3% of cases). Moreover, depending on the clinical manifestations of the disease, the etiological structure of food allergies that cause an allergic reaction is different. The most common cause-significant allergens in patients with cephalalgia are milk (36%), cereals (36%), and egg (29%); in patients with arthralgia - cereals (67%), in patients with enuresis - an egg (75%), in patients with nasal bleeding - an egg (62%) and food additives (38%); in patients with gastritis cereals (42%), food additives (33%). Thus, the same product can cause an allergic reaction in any "shock" organ. The study showed that the use of eggs most often caused the appearance of nasal bleeding and enuresis; eating cereals - arthralgia, gastritis / gastroduodenitis, headaches; use of milk - headaches; the use of nutritional supplements - the cause of nosebleeds, as well as gastritis. It is interesting to note that in 59% of cases food allergies to one product were determined, in 6% - to 2 products, and only 4% - to 3 or more products. It is known that food allergy
is a clinical manifestation of the immunological process. In accordance with the immunopathological basis for triggering an allergic reaction (Cell P. & Coombs R., 2008), 4 types of allergic reactions are distinguished. Based on the analysis of clinical and immunological examination data, we have identified the leading immunological mechanisms for the development of atypical manifestations of food allergy. The types of allergic reactions were confirmed:
-Type I: positive skin test results for 20 minutes, early (within the first 2 hours) or delayed (from 2 to 6 hours) positive reactions during provocative tests.
-Type II: the presence of elevated levels of total IgE and / or specific IgE / IgG antibodies in the blood.
-Type III: delayed (from 6 to 12 hours) positive reactions during provocation tests, the presence of elevated levels of CIC and immunoglobulins M, G in serum.
-Type IV: positive results of skin tests after 24.48.72 hours, slower (after 24.48.72 or more hours) positive reactions during provocative tests, elevated levels of immunoglobulins M, G in blood serum. Immediatetype hypersensitivity was found in 77% of patients, in 28% - immunocomplex, in 55% - delayed type of allergic response. Analysis of the obtained data allowed us to identify the features of the immune response within each clinical group.It has been established that in each group of patients types of allergic reactions are rarely seen in isolated form, since in most cases there is a combination of pathogenetic mechanisms of food allergy development (table).
Table 1.
Types of allergic reactions in patients with a typical manifestations _ of food allergies (%)_
Clinical manifestations of food Types of allergic reactions according to the classification
allergies of P. Gell & R. Coombs
I III IV
Nosebleeds 61 49 56
Cephalgia 51 33 45
Arthralgia 75** 22 54
Gastritis 100* 17 40
Enuresis 100** 20 80
Note: * - p <0.001; ** - p <0.01 in horizontal rowso.
In patients with gastritis and enuresis of food etiology, it is statistically significantly more often (p <0.001) that type I of allergic reactions is recorded in comparison with patients of other groups. patients with arthralgia (p <0.01), enuresis (p <0.01) and gastritis, gastroduodenitis (p <0.001) are more common to type I and IV types and reactions. Patients with nasal bleeding and cephalgia do not have statistically significant differences in the prevalence of one or another type of immune response, since they have I, III, and IV types with almost the same frequency.
Findings. 1. The high frequency of food allergy detection (65%) among children with persistent course of various chronic pathologies indicates a variety of its clinical manifestations. The etiological structure of food allergies, depending on the nosology of the disease, has its own characteristics.
The detected changes in immunity indices indicate that various types of allergic reactions are involved in the development of food allergy, and in most cases a combination of pathogenetic mechanisms is noted.
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