The diseases that we now call allergies were known a long time ago. Back in ancient Egypt, the symptoms were described, which can be considered as clinical manifestations of allergies.
But mankind paid attention to allergies only in the XIX century, and understood the nature of this phenomenon only by the end of XX century.
This disease is one of the most common on Earth. According to statistics, today every fifth inhabitant of our planet suffers from it: every sixth American, every fourth German and from 5 to 30% are Russians. And if the XX century was the century of cardiovascular disease, the XXI century, according to WHO predictions, will be the century of allergies.
Today, in almost every house, in every working team there is at least one person who either suffers from an allergic disease, or someone from his relatives is sick. International statistics shows that over the past two decades, the incidence of allergies has increased by 3-4 times, and the disease often occurs in a severe, unusual form, which leads to difficulties in diagnosis and treatment.
Such a sharp spike in morbidity is associated with increased allergenic load on a person, with a change in his ability to respond to this load. Deteriorating environmental situation and, as a result, increased permeability to barrier tissue allergens, irrational nutrition, inadequate drug therapy, uncontrolled use of antibiotics, increased stress, sedentary lifestyle, changes in the climate lead to the fact that the exposure of the human body to allergens, even those that have always existed, significantly increases.
We are surrounded by synthetic materials everywhere. International statistics indicate that modern technologies used in the construction of homes, offices and businesses, their interior decoration, lead to the deterioration of small ecology and, therefore, the body's increased sensitivity to allergens.
Allergic diseases are among the most common diseases in childhood. This is due to an increase in antigenic effects on a child's body through the widespread use of various drugs, in particular, antibiotics, blood transfusions and blood products, and preventive vaccinations. In the conditions of irrational antibacterial therapy, many diseases take a prolonged course, which also sensitizes the child's body.
An important risk factor for allergy development is heredity. If one of the parents has an allergy, the probability of developing an allergy in a child reaches 30-40%. If both parents suffer from this disease, the risk is already 70-75%. Since it is not the disease itself that is inherited, but the predisposition to it, then breastfeeding the newborn, at least up to 6 months, could prevent or mitigate the manifestation of allergies in the future. But unfortunately, fewer and fewer mothers are breastfeeding their infants.
Allergic diseases in children
Notion of "Allergy"
Allergy is the hypersensitivity of the immune system to repeated effects of an allergen on a previously sensitized organism.
The term "allergy" is used to describe an unnecessarily strong reaction of the body to some substance coming from outside. Our body has a "defense system" against external aggressive factors, called the immune system. Alien substances called antigens, when they get inside, provoke an immune system reaction, which starts to produce antibodies to neutralize the antigen. This reaction is absolutely necessary when, for example, a virus enters the body. In case of allergy, the immune system begins to react strongly to substances known as allergens that are harmless to ordinary people.
This excessive reaction or hypersensitivity causes a chain of reactions in the internal organs and tissues of the body, in which inflammation occurs, and from certain cells (called "fat cells") a substance - histamine - is released, in turn, causing clinical manifestations of allergies. These manifestations can be different in different people, which is sometimes regarded as different diseases.
All allergens are usually divided into two groups:
Exoallergens enter the body from the outside, and endoallergens are formed in the body and therefore are called autoallergens.
In turn, the exoallergens are also divided into two groups:
- non-infectious allergens: domestic, industrial, food, pollen.
- allergens of infectious origin: bacterial, fungal.
There are two types of allergic reactions:
- immediate type
- lagged type.
Allergic reactions of the immediate type develop within 15-20 minutes after exposure to a specific allergen in the form of skin blisters, bronchial spasms, etc..
Slow-down allergic reactions develop within 1-2 days after exposure to the allergen. They include anaphylactic shock, hives, bronchial asthma and many other diseases.
Allergies are a clinical expression of the immediate type of immune reaction to the impact of various exogenous allergens, in which their own tissues are damaged.
An allergy does not develop in all cases of contact with an allergen. A certain role is played by heredity, the state of the endocrine and nervous systems. If there were cases of allergic diseases in the families of the child's parents and one of the parents suffers from them, the probability of developing this condition in the child is 50%. If both parents have allergies, it is more than 75%.
Allergy affects almost all organs and tissues of the child's body:
- skin - in the form of eczema, neurodermatitis, hives;
- eyes - in the form of conjunctivitis;
- nose - in the form of allergic rhinitis;
- lungs - in the form of bronchial asthma;
- kidneys - in the form of gromerulonephritis;
- heart - in the form of rheumatism;
- bones - in the form of arthritis;
- intestine - in the form of dyskinesia;
- blood - in the form of anemia, leukopenia.
Allergies in children occur at any age, and their symptoms change at each stage of maturity. Thus, an infant's allergy is more likely to show skin reactions, and respiratory symptoms prevail in babies after 3 years of age.
As the disease grows older, its manifestations become more dangerous, and with untimely help it can stay for life or pass into bronchial asthma and autoimmune pathologies.
Causes of allergic diseases in children
It is known that the sensitivity of people to environmental antigens is different and very individual. One person will gladly breathe in the fragrance of a flower, eat an egg, pet a cat and will not get sick, another person's spoonful of honey or an injection of "harmless" medicine may cost a life.
The phenomenon of excessive sensitivity to antigenic substances is called allergy, and to antigens of non-infectious nature - atopia. Every fourth child suffers from atopic diseases, the main ones being bronchial asthma, atopic dermatitis, allergic rhinitis, hives.
The biggest "contribution" to the allergy is made by the features of the genetic apparatus. In the chromosomes of some people found genes that predetermine the willingness to develop an allergy and the transfer of this willingness by inheritance. An inherited predisposition is detected in 70% of children with atopic diseases. At the same time, if both father and mother have atopic diseases, the risk of allergy development in their child is 45%, if one of the parents suffers from atopia - 20%, and if both parents are healthy, the risk will decrease to 10%.
However, genes do not guarantee the appearance of this or that disease; they only open the way for it. The transition from health to disease and the speed of this transition is largely determined by the influence of external forces. This is, above all, the effect on a child of high concentrations of antigens, as well as any (natural, anthropogenic, environmental, etc.) influences that degrade the body's natural defenses. A child may experience their adverse effects while still in the womb.
It has been noticed that allergies appear earlier and are more severe in those children, whose mothers during pregnancy were smoked, improperly fed, treated with antibiotics, hormones, and worked at harmful enterprises.
After birth, very important are the conditions in which the child lives: his or her nutrition, life, methods of treatment, etc.
In the first months of life, the most important "loophole" through which antigens invade the child's body is the gastrointestinal tract. Earlier it was mentioned that a child in the first six months of life does not have a sufficiently reliable immune system. Almost all immunity factors he receives from the mother through breast milk. Especially rich in protective immunoglobulins and immune cells is milk, which is released immediately after birth. In its highest protective capacity, it can be equated to a medicine. Breast milk "lubricates" the mucous membrane of the child's gastrointestinal tract, creating a reliable barrier to the penetration of any antigen - food, bacterial, viral.
No milk mix, even if it is created according to ultra-modern technologies, has no protective properties of breast milk. It will always be only "dead water" compared to "live water" - breast milk. Any food protein, except breast milk proteins, is an antigen for the child. Deprivation of breastfeeding will certainly lead to a massive flow of antigens into the bloodstream, which will trigger a response of the immature immune system.
A child is particularly exposed to antigens if he or she is fed porridges and vegetables before the proper age. Excess accumulation of antigens in the lumen of the intestine in this case occurs as a result of a mismatch between the level of maturity of digestive processes and the food that the child is offered to digest. The absurdity of feeding a 3-month-old child porridge, cow's milk or egg is not so clear, because the child's body in its quest to survive will desperately stress digestive enzymes, hormones, immunity and more or less long to create the illusion of prosperous development. Changes in the body in this case will be gradual, "accumulative" nature and will manifest, perhaps, in many months or even years. This condition should be regarded as chronic stress, in which sooner or later the reserves will be exhausted. All this can lead to the realization of hereditary predisposition at any age.
Scientists trying to answer an old question about the role of the environment in human life in a new way have come to the following conclusion: a lot of what makes a person healthy or sick is the result of the features of feeding in the first year of life.
A high concentration of antigens present in the home is considered as a significant risk factor for allergic disease.
Household antigens are present everywhere: in the air; on walls, floors and furniture; on toys and clothes; on carpets and books, etc.
But their highest concentration is in house dust. If you look at the dust under a microscope, you can find in it hair particles and scales of human skin, lint carpets, clothes, upholstery furniture, fragments of insects, mold fungi, down and wool of pets, the tiniest particles of their excrement and a lot of mineral impurities.
The antigenic activity of domestic dust is mainly determined by organic impurities and primarily by microscopic mites, which have 50 varieties. These insects are the most common parasites in our homes, living cushions, featherbeds, carpets, old upholstered furniture and toys, corners filled with dust. The number of ticks in the apartments of people suffering from allergies is 6-7 times higher than in the apartments of healthy people, and reaches 2000 specimens per 1 g of dust.
The dwellings, located in a damp climate, are often affected by mushrooms, whose spores and mycelias have the strongest antigenicity. Mildew grows wonderfully in old, for a long time not repaired and poorly ventilated rooms, in bathrooms, under peeling wallpaper and plaster, in domestic air conditioners. Mildew can germinate in abundantly watered soil flower pots, in bread, canned food, smoked fish, sausage, etc., if they are for a long time in an environment with high humidity.
Our favorites - dogs, cats, birds, fish, hamsters - make a significant contribution to the antigenic potential of life. No matter how well we keep them, they still scatter particles of their hair, down, feathers, saliva, and excrement. These highly antigenic proteins settle on the child's skin and get into his or her gastrointestinal tract and respiratory tract.
Natural antigens also catch up with your child in the open air. About 200 species of plants produce the tiniest pellets of pollen, which is carried by the wind over long distances. Plants affect a child's body according to the "schedule" of their flowering and pollination.
There are three pollen waves in the central regions of Russia: spring (April-June), associated with the flowering of trees; summer (June-July) - meadow grass dusting; summer-autumn (August-September), accompanied by the appearance of large amounts of pollen weeds in the air.
Immutable satellites of the plant world - insects also conceal potential antigenic danger. Poisons and cover tissues are the most allergenic:
- membrane wings (bees, bumblebees, wasps, hornets)
- two-wings (mosquitoes, gnats)
A special group of antigens acting on a child is associated with medications. It is unlikely there is a child who has never been treated with antibiotics, not vaccinated, not taking vitamins.
Unfortunately, many drugs, in particular, such as penicillin and its semi-synthetic derivatives, tetracyclines, sulfonamides, serums, gamma globulins, are highly antigenic. Especially often they cause allergies in the wrong mode of taking short, often repeated courses.
The action of a variety of external antigens will lead a child to an allergic disease more quickly if there are situations that facilitate their introduction into the body. The most active "helpers" of antigens are diseases that reduce the strength of already weak natural barriers - mucous membranes. These include recurrent acute respiratory viral and gastrointestinal infections, chronic inflammation in the tonsils, gallbladder, etc., and chronic diseases of the stomach and intestines (gastritis, colitis, dysbacteriosis, etc.).
The causes contributing to the development of allergic disease also include potentially pathogenic environmental factors - both natural and associated with human activity.
The air that people breathe in cities with industrial plants is saturated with fuel combustion products, aggressive gases, heavy metals and polymeric materials. Insufficient roads and vacant areas lead to high dust levels. One of the most dangerous and widespread air pollutants is tobacco smoke. Passive smoking, i.e., a child staying in the same room with smokers, is detected in more than half of children with bronchial asthma. Add to this a widespread passion for household chemicals (washing powders, enzymatic additives, perfumes in aerosol packaging), the use of furniture with synthetic panels that emit harmful vapors.
The rapid development of the food industry has brought unexpected troubles. The production of modern food products, their transportation and storage is unthinkable without so-called food additives. It turned out that many of them provoke allergic reactions in children. This happens especially often when consuming products containing benzoic acid and benzoates (E210-213), butylated oxyanisole (E 320), butylated oxytoluene (E 321), gallates (E 310-313), sodium glutamate (E 621), biphenyl (E 230), and others.
Contamination of drinking water by industrial waste, fertilizers leached from the soil, and animal waste is of equal concern.
All these factors create and increase aggressive environmental impacts. One way or another, all these factors predispose a child's body to develop an allergic disease.
Forms of allergies in children
Consider the most common forms of allergies in children.
Atopic dermatitis is the earliest manifestation of an allergy. In 60% of cases it manifests itself in the first year of life. Itching rashes appear on the skin of the face, torso, extremities. The child becomes restless, capricious. Without adequate treatment, the rash does not go away for a long time. The skin becomes dry and rough, flaky. Food allergy is leading to the development of the disease. In children of the first year of life, the most common cause-significant is sensitization to the proteins of cow's milk and cereals. In later age periods, the importance of sensitization to obligate food allergens (eggs, fish, chocolate, nuts, etc.), vegetables and fruits increases. Skin and intestinal mucosa colonize bacteria and yeastlike fungi pathogenic to the body, intestinal dysbacteriosis is formed, which increases the manifestation of dermatitis.
In the first year of life, the risk factor for atopic dermatitis is artificial feeding with milk formula. In the pathogenesis of atopic dermatitis essential importance is given to the hereditary predisposition to allergic reactions and diseases.
Hives is one of the most common allergies in children. Food, medicinal, household and pollen allergens are the most common causes of this disease. It is possible to develop hives after insect bites, the introduction of vaccines.
The disease is characterized by itching rashes all over the body, reminiscent of mosquito bites or a reaction to "burn" nettle. Blisters appear quickly and also pass quickly. These are reactions of skin vessels. The elements of nettle can be found on the neck, in the area of the chest, back, abdomen and extremities. When the individual elements merge, different sizes and forms of giant urticaria may occur. Allergic process may involve the mucous membrane of the gastrointestinal tract, which is manifested by abdominal pain, nausea, vomiting. In most cases, the flow of hives is acute. Sometimes, allergic swelling occurs simultaneously with hives.
Quinque edema (angioedema). Described by the German physician Kwinke in 1882.
The development of oedema is the result of exposure of tissues to allergic inflammatory mediators: allergens, vaccines, insect poisons, bacterial allergens.
Oedema is characterized by swelling of the skin and subcutaneous tissue of the face, lips, ears, limbs, genitals, torso. The skin in the lesions is pale. Allergic swelling of the larynx, brain, internal organs is possible. Emerging oedema is not accompanied by itching.
Pollinosis (from the English word "pollen", which means pollen) - seasonal allergic rhinitis. Pollinosis is most often caused by pollen allergens from trees, cereals and weeds.
Pollinosis is characterized by seasonality of emerging clinical manifestations with predominant involvement in the pathological process of the mucous membrane of the respiratory tract and eyes. Most often the disease is formed at the age after 5 years. The most frequent clinical manifestations of pollinosis in children are allergic rhinitis, allergic conjunctivitis, asthmatic bronchitis, bronchial asthma. They can occur either in isolation or in combination.
The main symptoms are conjunctivitis pruritus, tears, itching of the wings of the nose, abundant transparent discharge from the nose, sneezing attacks, stuffy nose.
Asthmatic bronchitis. Characterized by an allergic lesion mainly of medium and large caliber bronchi.
It is distinguished by atopic and infectious allergic forms of disease. In young children in the development of asthmatic bronchitis cause-significant may be sensitization to food, medicinal and bacterial allergens. In older age, a significant role is played by hypersensitivity to household, pollen and fungal allergens. The development of asthmatic bronchitis is promoted by hereditary predisposition to allergic reactions and repeated inflammatory diseases of respiratory organs of viral and bacterial origin.
At the heart of the clinical manifestations of asthmatic bronchitis is a violation of bronchial permeability, but in contrast to bronchial asthma, breathing difficulties in bronchitis are less pronounced or not observed. The appearance of the disease may be preceded by allergic rhinitis, seizure cough, occurring more often at night hours, an increase in body temperature. Then appears a small shortness of breath expiratory type. At the height of the exacerbation of the disease in the lungs found a significant number of different caliber wet and moderate amounts of dry wheezing.
Bronchial asthma - a disease in which allergic reactions occur on the mucous membrane of the bronchi. The initial manifestations of asthma may be a dry agonizing cough, whistling noisy breath. With the progression of the disease appears shortness of breath, attacks of suffocation. The main role in the development of asthma play domestic and epidermal allergens. Bronchial asthma risk factors in children are: hereditary burdening with allergic reactions and diseases; atopic dermatitis preceding; acute and chronic respiratory diseases; smoking in the family; poor housing conditions; living in regions with unfavorable ecological situation.
During the course of bronchial asthma, children are allocated the pre-, post- and interictal periods.
The pre-attack period is characterized by symptoms of allergic Rhino sinusitis (congestion of the nose, watery discharge from the nose) and the appearance of an attacking cough.
The accessory period of bronchial asthma is manifested by expiratory shortness of breath accompanied by whistling breath, heard from a distance. At the height of a bronchial asthma attack, children of younger age also listen to wet wheezing of different calibers. The duration of the attack may vary - from several minutes to several hours and days.
Bronchial asthma attacks can be distinguished by their severity: mild, medium severe, severe and asthmatic state (status asthmaticus). In case of a mild attack of bronchial asthma, a slight breathing difficulty is observed. A severe bronchial asthma attack is characterized by a pronounced asthmatic suffocation accompanied by participation in the act of breathing of all auxiliary muscles and violation of the patient's general condition. The most severe manifestation of bronchial asthma - asthmatic status may even lead to death.
Shock anaphylactic. The most severe manifestation of systemic allergic reactions.
In the structure of causal factors of anaphylactic shock in children the leading place belongs to medicines (antibiotics, non-specific anti-inflammatory drugs, anesthetics).
Anaphylactic shock is more likely to occur in children with a hereditary predisposition to allergic reactions and diseases and who before the development of systemic allergic reactions had some form of allergy.
Anaphylactic shock develops acutely and is characterized by general weakness, anxiety, confusion or loss of consciousness. There may be a feeling of tightness in the chest, pain in the heart, abdomen, accompanied by nausea, vomiting, urination calls; dizziness, low hearing and vision, a feeling of fever in the whole body, chills and itching of the skin.
Highlights are mild, moderate and severe anaphylactic shock.
In case of mild anaphylactic shock, there is not a pronounced vascular insufficiency, dizziness, headache, nasal congestion, hives.
Anaphylactic shock of medium severity is characterized by a developed clinical picture of the disease with the emergence of dizziness, decreased vision and hearing, acute weakness, difficulty breathing, nausea, vomiting. Examination shows pale skin, cold sweat, confusion or loss of consciousness, scattered dry wheezing in the lungs, tachycardia, low blood pressure.
Severe anaphylactic shock is characterized by lightning development of vascular insufficiency, in the form of collapse and coma with loss of consciousness, heart rate disorders and difficulty breathing, prostration, the appearance of seizures, involuntary urination and defecation. Objectively detected is a thready pulse, a sharp drop in blood pressure, muffled heart tone, dry wheezing in the lungs; in particularly severe cases, asphyxia occurs.
In acute benign course anaphylactic shock with timely and adequate treatment has a favorable outcome. Prolonged course of anaphylactic shock may be accompanied by resistance to therapy and development of severe post hypoxic complications from the brain, myocardium, intestines, lungs. Fatal outcome of anaphylactic shock may occur in cases of its malignant course, when there is an acute onset of the disease, a sharp drop in blood pressure, impaired consciousness and respiratory failure.
Whey disease. Represents manifestations of systemic allergic reactions to foreign protein.
Cause-significantly may be: anti-tetanus, antirabic, anti-diphtheria, antibotulinum serum. Immunoglobulins, tetanus anatoxin, less often transfused plasma and blood, hormones, a number of antibacterial drugs (penicillin, cephalosporin, sulfonamides, etc.), vaccines.
The development of serum disease is facilitated by repeated and course treatment with the same drug. Serum disease develops more often with intravenous injection of drugs. The disease develops more often in older children. Clinical manifestations of serum disease occur on the 7-12th day after administration of the drug. The incubation period is shortened to 1-5 days in cases of repeated serum injections and in the presence of child allergic reactions and diseases.
The mild form of serum disease is manifested by an increase in body temperature to subfebrilic numerals, a slight swelling of lymph nodes during 2-3 days. The duration of the medium severe form of serum disease is 2-3 weeks. Serious serum disease is characterized by short, up to 2-5 days, incubation period, the rise in body temperature to 39-40 ° C, the spread of rashes on the skin, an increase in lymph nodes, joint pain and peripheral nerves, detected changes in the cardiovascular system. Fatal outcome in such cases may come from cardiovascular failure and irreversible changes in vital organs.
Food allergy. Includes reactions caused by sensitization to food antigens.
The manifestation of food allergy can be atopic dermatitis, hives, eczantema, allergic oedema, bronchial asthma, allergic rhinitis and otitis, allergic lesions of various parts of the digestive tract, CNS. Its course may be accompanied by dyskinesia of the digestive tract, biliary tract, disorders of intestinal biocenosis.
Drug allergy. It is a drug intolerance, which has at its core different types of immunopathological reactions.
The most common causes of drug allergy are antibiotics, sulfonamides, non-specific anti-inflammatory drugs, blood products. It is manifested in the form of hives, exanthemia, allergic edema, dermatitis. It is less often manifested in the form of bronchial asthma, allergic rhinitis. It is possible to develop allergic reactions associated with drug therapy, from other organs and systems of the body.
Symptoms and signs of allergy in children. Diagnosis
The manifestations of the disease are different, so it is easy to confuse allergies with a number of other pathologies. Symptoms may occur on the respiratory, digestive system, skin.
Allergic reactions are diverse in the manifestations and severity of treatment; they can develop in different directions and involve different organs and tissues of the body.
Manifestations from the respiratory system, symptoms:
- Sneezing (sneezing attacks last from day to day for no reason);
- rhinitis (discharge from the nose is usually transparent and watery);
- allergic swelling of the nose (the mucous membrane in the nasal cavity becomes inflamed and thickens, causing a congestion of the nasal canal);
- itching or burning of the nose (this itching can be so intense that it causes great suffering to the child, sometimes depriving him of sleep);
- suffocation, shortness of breath, intrusive cough, wheezing in the lungs.
Skin reaction. Dermatosis is manifested by various irritations and rashes on the skin of any part of the body: on the cheeks, buttocks, back, abdomen, hands, legs, head, around the mouth. Less rashes can be seen in the groin, testicles, armpits, under the knees, palms and feet, behind the ears. The main signs:
- hyperemia of the skin, itching;
- dryness, peeling;
- severe swelling, blisters.
Allergic conjunctivitis. Signs of eye mucous membrane lesions:
- photosensitivity, lacrimation;
- swelling of the eyelids, burning of the eyes.
Manifestations from the gastrointestinal tract, symptoms:
- diarrhea or constipation, colic;
- nausea, vomiting;
- swelling of the lips, tongue.
Anaphylactic shock. The most dangerous manifestation of an allergy. It occurs after an insect bite or taking a drug allergen. Symptoms develop from a few seconds to 5 hours after allergen penetration:
- sudden shortness of breath;
- loss of consciousness;
- body rash;
- involuntary defecation, vomiting, urination.
Diagnostics. When diagnosing an allergy, it is necessary to identify the causal allergen, to assess the severity of the course of the disease, to identify the allergy target organs and related diseases. In the work of allergology departments and offices is widely used immunoenzyme method to determine the specific IgE antibodies to a variety of allergens.
Detection of causal allergens in children over 4 years of age is possible with the help of skin tests. A prik test is used (a small shot of the skin is taken through a drop of the allergen) and, less frequently, an application test (an allergen is placed on the untouched skin for a long time).
Another method is a blood test for specific E-class immunoglobulins (protein molecules produced in the body by immune system cells in response to contact with the allergen).
Basic principles of treatment of allergic diseases
In acute allergic diseases, emergency therapy is built on the following areas:
1. Termination of further entry into the body of the alleged allergen. Before starting specific treatment, it is necessary to eliminate the allergen causing the disease from the child's environment. Children on artificial feeding are recommended to administer hyp allergenic mixtures. Do not forget one thing: for a relapse you need only one allergen molecule.
For a quicker removal of the allergen from the intestine and reduce its absorption through the intestines in case of food or drug allergies use medicines-sorbents (activated carbon, "Smect", etc.). It should be remembered that allergic reactions may occur on any medications, including sorbents.
It is necessary to stop eating for 10-12 hours (hereinafter, a diet with the exception of chocolate, citrus, eggs, fish, canned food, sausages, sausages, nuts, preservatives and other allergens).
For any type of allergic disease, the child is offered a low-allergen diet, similar to the diet in food allergies, until the complete extinction of allergic symptoms, and if necessary, longer. Reduce the number of drugs used to a strictly necessary minimum.
In case of allergic airway disease, in the period of exacerbation, it is necessary to remove potential allergens from the premises.
To remove the allergen from the mucous membrane of the respiratory tract in case of acute allergic reaction, you need to wash the nasal passages with physiological solution or clean water, rinse your throat with clean water.
In case of contact allergy it is necessary to exclude contact of the affected skin or mucous membrane with potentially dangerous objects (synthetic clothes, cosmetics, diapers, toys, etc.), exclude or reduce friction with clothes of the affected skin. To remove the allergen from the affected surface, wash the inflamed area with clean water at room temperature (if the eyes or mouth are affected, wash the eyes or mouth rinse accordingly).
In case of reaction to the drug injected parenterally or in case of insect bite/restriction - apply a tourniquet above the place of injection or bite for 25 minutes (every 10 minutes you should loosen the tourniquet for 1-2 minutes); to the place of injection or bite - ice or heating with cold water for 15 minutes; chipping in 5-6 points and infiltration of the place of injection or bite of 0.3 - 0.5 ml 0.1% adrenalin solution with 4.5 ml of isotonic sodium chloride solution.
In drug allergy, the use of other drugs should also be reduced to a safe minimum (discussed with your physician), as there is a high risk of cross-allergy and to previously safe drugs.
With a mild degree of severity of allergic or atopic dermatitis the problem disappears within 2-3 days, provided that the culprit-allergen is excluded from the child's diet and the simple principles of low allergen diet are observed. Antiallergic medicines do not cure allergies, but only reduce their symptoms. It cures the removal of the allergen from the allergy.
2. Antiallergic therapy. Antihistamines (Loratadine, Phoenistyl, Zirtek, Suprastin, Claritin, Tavegil) - block or reduce the production of histamine. They are available in various dosage forms. Pills - for systemic administration, ointments - to relieve skin itching and inflammation, drops - to treat conjunctivitis or rhinitis of allergic etiology.
Antihistamines are used for the following diseases:
- allergic skin diseases (atopic dermatitis, hives, swelling Quinque);
- respiratory diseases (pollinosis, allergic rhinitis, atopic bronchial asthma) and eye diseases (allergic conjunctivitis);
- allergic reactions to insect bites and medications;
- prevention of allergic complications during preventive vaccination in children with predisposition to allergic diseases.
3. Preparations of cell membrane stabilizers. These drugs (Ketotifen, Xylomethasolin, Oximethasolin, Aerosols with sodium cromoglycate) are usually recommended in remission periods (fading allergic reactions) for diseases such as pollinosis (seasonal allergic rhinitis, seasonal allergic conjunctivitis), allergic skin diseases, for the prevention of bronchial asthma attacks. The effect of drugs of cell membrane stabilizers fully develops after the end of treatment - it is 10-12 weeks of intake.
4. Glucocorticoid (hormonal) drugs (Dexamethasone, Prednisolone) - used for severe allergies. Preparations of this group have a significant number of side effects, and therefore, any form of medication (even for local use) should be prescribed only on the recommendation of a doctor.
5. Homeopathy - medicines (Sulfur, Belladonna, Antimonium Krudum) are selected exclusively by a homeopathic doctor depending on the type of allergic reaction, prevailing symptoms, age of the child and its physiological features.
The most effective method of disease treatment is SIT - specific immunotherapy. The method is based on the gradual introduction of increasing doses of allergen until the body loses sensitivity to it.
6. Anti-shock measures. In case of anaphylactic shock the patient should be put down (head below the legs), turn his head to the side (to avoid aspiration of vomiting masses), extend the lower jaw, if there are removable dentures - remove. If there are no breathing movements, you should perform artificial respiration. If there is no pulse - indirect heart massage. Adrenalin is injected subcutaneously in a dose of 0.1 - 0.5 ml 0.1% solution, if necessary, the injections are repeated every 20 minutes for an hour under the control of AD level.
After emergency care, patients with severe and severe allergic reactions (anaphylactic shock, swelling of Quinke) should be hospitalized in the hospital for further observation.
Prevention of allergic diseases
Prevention of exacerbations is one of the main tasks of the therapy. Everything can be important: what a child eats, what he drinks, where he lives, whether he often walks, how the domestic life is organized, whether there are pets, what kind of sport he enjoys, etc.
1) Avoiding contact with causative allergens
After identifying allergens, the doctor makes recommendations for lifestyle changes in order to eliminate contact with these factors.
2) Control of environmental factors
The situation becomes acute in the period of exacerbation, when the child's body is in a state of hyperreactivity. At this time, even a slight irritant may increase the symptoms of the main allergic disease. It is necessary to exclude risk factors. Warn parents who smoke about the harm caused to the child by smoking. Exposure to tobacco smoke has an adverse effect on the course of diseases associated with bronchial obstruction.
Do not allow allergens such as pollen or fluff to enter the room. The highest concentration of pollen in the air is observed early in the morning and on dry hot days, so in this period of time it is better not to be outdoors, if possible not to open the windows, especially in the early hours, use air purifiers that capture pollen plants in the room, close the windows tightly in the car, especially when you are out of town.
In families with burdened allergic heredity, food allergy prevention should begin even before the birth of the child. In the diet of a pregnant woman is excluded or significantly restricted foods of high allergenic risk (citrus, chocolate, tomatoes, etc.).
Breastfeeding is a powerful preventive factor in the risk of a child's chronic allergic diseases. At the same time, during the period of breastfeeding, the mother should significantly limit the content of food allergens such as cow's milk, eggs, fish and nuts in her diet. In children with burdened hereditary allergies, early weaning (up to 1 year) and premature introduction of feed (up to 6 months of life) is not desirable.
Feeding in children with allergies usually starts with less allergenic dishes - gluthein-free silk porridge (rice, buckwheat). Kasha is introduced gradually, from a spoonful, just before breastfeeding or milk formula. If porridge is successfully tolerated, after 2-3 weeks you can offer your child the following dish - vegetable puree from one or two vegetables.
The introduction of fruit juices and mashed potatoes in children with allergic diseases is postponed until the period of complete disappearance or subsidence of allergies, because the hasty introduction of these dishes often leads to aggravation of the child's condition. The introduction of other dishes and products (kefir, meat, cottage cheese) to children with allergies is usually delayed, provided that the child tolerates the main dishes (porridge, vegetable puree).
Nutrition for children with allergic diseases aged over a year is based on the following principles:
- The diversity of the diet is achieved by increasing the range of dishes from a limited set of products, not at the expense of the variety of products;
- compromised products (milk, eggs, fish, red-colored fruits and vegetables, gluten-containing wheat and oat groats) are adequately replaced with authorized and safe products;
- a low-allergen diet should be a complete diet for each child.
4) Medicament therapy
Once the diagnosis is made, a permanent baseline therapy may be prescribed to prevent new exacerbations. You should know that such drugs should be taken regularly, in accordance with the doctor's recommendations. Occasional use often leads to the development of exacerbations.
5) Sanation of existing foci of infection
Often, one of the trigger factors for the development of exacerbations of allergic diseases is the presence of foci of infection in the body. Sometimes the infection may be asymptomatic and is detected only with a special examination. In other cases, the body has known foci of infection in the form of caries, inflammatory skin diseases, etc. That is why allergy sufferers should carefully control their condition.
6) Healthy Lifestyle
A healthy lifestyle includes competent organization of work and rest, sufficient sleep, healthy eating, regular walks in the fresh air and sports activities (a doctor's permission for the chosen sport must be obtained).
7) Scrupulous compliance with all prescriptions of the doctor
This rule is the most important. It is necessary to follow all the recommendations of the doctor. If a child has previously had severe allergic reactions (anaphylactic reactions, swelling of Quinque) or suffers from chronic allergic disease (e.g., bronchial asthma), the child or persons accompanying him/her should bring emergency medicines (antihistamines or others) and the telephone number of the attending physician for consultation.
Immunizing children with allergies
Vaccination tactics for children with allergies are based on an individual approach to each child. However, despite the polymorphism of atopic manifestations in immunizing these children, a number of general principles apply:
- Children with allergic diseases should be vaccinated against all infections included in the national vaccination calendar (tuberculosis, diphtheria, tetanus, pertussis, polio, measles, rubella, epidemic mumps, hepatitis B).
- Children with allergic diseases are vaccinated during remission (full or partial).
- Prophylactic vaccinations for children with this pathology should be conducted against the background of the necessary therapy.
- It is advisable to use the same series of drugs for the whole course of immunization in order to prevent reactions associated with the introduction of different series of drugs.
- During the vaccination period, it is recommended that children follow a diet with the exception of bonded allergens (fish, eggs, honey, chocolate, nuts, cocoa, citrus fruits, strawberries, strawberries), and abstain from taking other products to which allergic reactions have been previously noted.
- Children with pollinosis prophylactic vaccinations are made outside the flowering season of causative plants. Children with allergic diseases that have no seasonal nature are vaccinated at any time of year.
- Skin samples with infectious and non-infectious allergens can be delivered 1.5 weeks before the introduction of vaccines or 1-1.5 months after it.
- If a child receives a course of specific hyposensitizing therapy with infectious or non-infectious allergen, as well as a course of histoglobulin, antiallergic or normal immunoglobulin, the vaccination should be carried out not earlier than 1.5-2 months after the completion of the course.
- After Mantu's test, it is recommended to administer vaccines (except for BCG and BCG-M) no sooner than 10-12 days, since most children with allergic pathology have a positive reaction to tuberculin, indicating an allergic reactivity in the child. After administration of DPT, ADS, ADS-M drugs and vaccines against measles and epidemic parotitis, the Mantoux sample can be taken no sooner than 1.5 months.
- For children who have had a history of one shot of DPT-vaccines or ADS-M or ADS-M anatoxins, regardless of the time elapsed after the shot, it is sufficient to administer another dose of DPT or ADS-M anatoxin, followed by a revaccination after 6 months.
The high incidence of allergic diseases in children necessitates wide coverage of their preventive vaccinations. Their implementation in the period of clinical remission of the allergic process against relapse treatment promotes a favorable flow of postvaccinal period and reduces the frequency of exacerbations of allergic diseases associated with the introduction of vaccines.
While studying the scientific and methodological literature, I learned what is "allergy", the causes of allergy and what forms of allergic diseases are. I found out that in the treatment of a child, first of all, it is necessary to identify the allergen. It became clear to me that the success of treatment depends largely on timely allergist treatment. The less experience of the disease, the more chances to recover.
A great role is given to the prevention of allergic diseases. Especially important is the timely treatment of recurrent respiratory diseases. It is necessary to harden the body, observe a diet, conduct spa treatment, lead a healthy lifestyle.
Nursing care for children with allergic diseases
Bronchial asthma is a chronic disease that develops on the basis of an allergic inflammatory process in the child's airways. There is an acute bronchial spasm and increased mucus secretion. Concentration of mucus in bronchi against the background of their spasm leads to bronchial obstruction (obstruction of bronchi).
Bronchial asthma is divided into two types:
- atopic asthma (allergenic);
- atopic (non-allergenic).
Causes of bronchial asthma:
- The presence of an allergic disease in the child.
- Hereditary predisposition: if one of the parents suffers from bronchial asthma - the probability of asthma in the child is 25-30%, if both parents - up to 75-80%.
- Family members have an allergic disease (atopic dermatitis, pollinosis, food or drug allergy). In 60% of children with bronchial asthma, relatives suffer from allergic diseases.
- Allergens enter the body through the gastrointestinal tract (food allergy), and in older children pollinosis prevails.
- Microscopic mites living in house dust, carpets, soft toys and bedding can provoke bronchial spasms.
- Environmental factor: inhalation with air of harmful substances (exhaust gases, soot, industrial emissions, household aerosols).
- Smoking (for small children - passive smoking, or being near a smoker). Tobacco smoke is a strong allergen, so if at least one of the parents smokes, the risk of asthma in a child is significantly (dozens of times!) increases.
- Viruses and bacteria that cause damage to respiratory organs (bronchitis, ODS, ODS), contribute to the penetration of allergens into the walls of the bronchial tree and the development of bronchial obstruction.
- Allergic reaction to some drugs (the most common of them is aspirin).
- Factors of physical impact on the body (overheating, hypothermia, exercise, a sudden change in weather with changes in atmospheric pressure) can provoke a choking attack.
Clinical manifestations of bronchial asthma
The disease may begin invisibly, with atopic dermatitis, poorly treatable.
Manifestations of bronchial asthma:
- occasional whistling breath;
- coughing, mostly at night;
- coughing or whistling breathing after contact with an allergen;
- cough with whistling breath after emotional or physical activity;
- the absence of the effect of cough medicine and the effectiveness of anti-inflammatory drugs.
The attack develops by a certain algorithm:
Harbinger period: patient coughs, breathing becomes more difficult, skin pales, cold sweats may occur.
Heat of the attack: due to the bronchial spasm, suffocation develops with a characteristic feeling of contraction in the chest area. The patient takes short breaths and long exhalations. Breathing becomes fast, noisy and hoarse. During the attack, the chest is slightly swollen, the face becomes purple.
The child takes a forced position: sits, slightly leaning forward, leaning on the arms, the head is retracted, the shoulders are raised (the so-called "coachman position"). In the absence of timely assistance, asthmatic status may develop, threatening the patient's life.
The attack may last from several minutes to several hours. Coughing in this case is first dry, excruciating, and then a thick, viscous sputum may be released.
Older children complain about the lack of air, and the babies cry and show anxiety. The attack often develops very quickly, immediately after contact with the allergen.
With auscultation is determined rigid or weakened breathing with a lot of dry whistling wheezing.
At percussion - a boxed sound.
The cardiovascular system reveals tachycardia, increased blood pressure, muted heart tones. At the duration of a bronchial asthma attack from 6 hours and more, it is said that children develop asthmatic status.
Reverse development: sputum coughs up, the attack gradually subsides, the patient gets better. Immediately after the attack, the child feels sleepiness, general weakness; he is sluggish and dull. Tachycardia is replaced by bradycardia, high blood pressure - arterial hypotension.
3 degrees of bronchial asthma in children are distinguished by the severity of clinical course.
With a mild degree of bronchial asthma in children, choking attacks are rare (less than once a month) and are quickly bought.
The average bronchial asthma in children is 3-4 times a month; spirometry rates are 80-60% of the norm.
With severe bronchial asthma, children suffocate 3-4 times a month; spirometry rates are below 60% of the norm.
Participation of a nurse in the treatment and diagnostic process
To ensure quality care, middle-level health care workers must know the etiology, symptomatology and basic methods of disease treatment.
The nursing process contains several basic stages:
- anamnesis collection;
- identification of the patient's main problems;
- differential diagnosis, i.e., exclusion of pathologies with similar symptoms, such as heart disease;
- organization of care in in-patient conditions;
- performance of prescriptions made by the attending physician;
- receiving feedback, that is, assessing how effective the care is.
The actions of the nurse. First of all, it is necessary to collect data on the condition of a minor patient.
In this case, it is necessary to find out:
- from what age symptoms of bronchial asthma appeared;
- the frequency with which the attacks develop;
- what factors can provoke them;
- what is the intensity of the attacks of suffocation;
- whether the attack passes without any intervention;
- what drugs are used for treatment.
It is important to monitor whether the child is in a forced position, suffocating, cyanosis, tachycardia and other signs of respiratory failure. Since a child is not always able to answer the questions of the medical officer, interviewing his or her relatives becomes particularly important.
It is important for the nurse to remember that the child's parents are not always able to give comprehensive answers to the questions asked due to anxiety and confusion. It is important to try to calm down the parents, explain the situation to them and try to create a trusting atmosphere during the anamnesis collection.
The nurse needs to identify the patient's problems, such as sleep disorders, breathing disorders, depression due to forced hospitalization, etc.
Once the problems are identified, the nurse must develop ways to eliminate them and see if the goal is achieved. Important! To make the correct diagnosis, it is necessary to perform certain diagnostic procedures, such as taking blood and sputum for analysis. The nurse should not only explain to the child and his relatives the need for future manipulation and to reassure the minor patient, but also to obtain informed consent from the relatives for the intervention.
After the child is diagnosed, the doctor prescribes treatment and makes a plan to provide the necessary assistance.
The tasks of the nurse are as follows:
- to organize the right care that will ensure a speedy recovery;
- to make a plan for the care that will be provided;
- follow up on recommendations made by the attending physician.
A nurse's primary responsibilities may include the following:
- Informing the patient and parents about the disease and life with asthma;
- organizing proper nutrition for the patient and monitoring timely medication and attendance at necessary procedures;
- teaching proper breathing techniques to help cope with developing seizures;
- teaching techniques to relieve a choking attack;
- teaching how to use the inhaler;
- psychological assistance, which helps to get rid of fear - to die in the moment of an attack.
A nurse should provide help and psychological support not only to a sick child, but also to his parents, reassure them and encourage them to cooperate. The nurse should inform relatives about the risks and ways to eliminate them:
- train parents and the child (if their age allows) to control their condition independently;
- monitor the approaching attack;
- teach parents to keep a diary where picphyloometry data and the child's reaction to medications should be recorded;
- conversations about the need for regular therapeutic exercise at home;
- when a child develops an attack, it is necessary to ensure the correct position (with the head raised), give the child an inhaler, and introduce medications prescribed by the doctor.
Modern medicines for the treatment of this disease are divided into two groups:
- basic ones.
Symptomatic drugs (ventolin, berotec, salbutamol) are designed to relieve bronchial spasm and free air passage through the respiratory tract (bronchodilators). This includes products that are taken as an emergency aid in case of an asthmatic attack to allow a person to breathe normally. Drugs are used only when necessary, but not as a prevention.
Several groups of drugs are used as a basic therapy:
- antihistamines (tavegil, suprastin, claritin, etc.);
- drugs that stabilize the cell membrane (ketotifen, tyled);
- antibiotics (to sanitize chronic foci of infection).
Basis preparations are designed to relieve inflammation, remove the allergen from the body. These drugs are intended for continuous treatment or prevention of bronchial asthma attacks. Unlike the first group, they do not have immediate action to relieve bronchial spasm and do not relieve suffocation. Basis medications are aimed at minimizing inflammation in bronchi, suppressing it, as well as reducing or completely stopping asthma attacks.
Anti-inflammatory drugs are usually taken for a fairly long period of time. The result of taking the basic drugs does not appear immediately, but only after 2-3 weeks of continuous treatment.
In a severe course of treatment, corticosteroid drugs are also used. It is important not only the choice of a drug, but also the method of its administration.
The most commonly used method is inhalation (the drug enters the lungs in the form of an aerosol). But it is difficult for young children to use an inhaler can. In addition, with this method of administration, most of the drug remains on the back wall of the throat (no more than 20% of the drug reaches the bronchi).
Currently, there are a number of devices that can improve the delivery of the drug to the lungs.
Spacer - a special chamber, an intermediate reservoir for aerosol. The medicine enters the chamber from the spray can, and from it is already inhaled by the child. This allows you to take several breaths, in the lungs gets 30% of the medicine in the form of an aerosol.
Cyclohaler, diskhaler, turbulator - these are the same devices as the dispenser, only for the injection of powder.
Nebulizer (inhaler) - a device that allows you to transfer the drug into an aerosol.
Nurse's participation in rehabilitation process
The nurse is actively involved in the treatment and rehabilitation of patients suffering from bronchial asthma. It is important that the nurse not only helps the attending physician, but also morally supports patients, tune them to recovery and inspires optimism, while taking on an educational role. At the same time, the key to success is sincere sympathy for patients and a desire to help them get back to normal life as soon as possible.
The nurse should not only follow the implementation of the doctor's recommendations during the child's stay in the institution, but also explain to the patient's parents how to reduce the number of attacks in the future. Diet, daily routine, no stress, etc. are important for achieving this goal.
A child suffering from bronchial asthma needs a diet:
- vegetable and cereal soups must be cooked on beef broth;
- rabbit meat, lean beef in boiled form (or steamed);
- fats: sunflower, olive and butter;
- porridge: rice, buckwheat, oatmeal;
- potatoes in boiled form;
- fresh fruits and vegetables of green color;
- day-old fermented milk products.
You should limit the use of carbohydrates (confectionery, sugar, pastries, sweets). It is recommended to exclude from the diet allergens: honey, citrus fruits, strawberries, chocolate, raspberries, chicken eggs, fish, canned food, seafood.
Prescribed maintenance therapy or basic therapy should not be canceled by parents themselves. Also do not arbitrarily change the dosage of drugs. Dose reduction is performed when no seizures have occurred within six months. If the remission is observed for two years, the doctor cancels the drug completely. If after stopping taking the drug there is an attack - treatment begins again.
Among the non-medicamental methods of treatment should be mentioned physiotherapeutic treatment, exercise therapy, massage, acupuncture, different methods of breathing, hardening the child, the use of a special microclimate of mountains and salt caves. During the remission period, spa treatment is used.
Bronchial asthma that appeared in childhood, even its heavy form with frequent attacks, can disappear completely in adolescence. But the self-healing occurs, unfortunately, only in 30-50% of cases.
So, the treatment of bronchial asthma comes down to three main methods:
- Supporting drug therapy (which allows you to keep under control the inflammatory process in the respiratory tract and lead a normal life).
- Avoiding factors that can provoke bronchial asthma and suffocation (wet cleaning in the house, removal of all "dust collectors" such as carpets, libraries to the ceiling and window curtains with ruffles and brushes).
- Ability to use a pocket inhaler for emergency aid in case of an attack of bronchial asthma.
Timely diagnosed bronchial asthma in a child, the accurate implementation of all therapeutic and preventive measures is the key to success.
Rehabilitation activities are conducted everywhere. Their range is increasing and improving every year. The main advantages for patients are simplicity, accessibility and painlessness of rehabilitation methods.
After any illness, it is very important to restore your health. Rehabilitation for bronchial asthma is performed in the remission stage, when the disease is not visible, and the patient's condition is stable.
In bronchial asthma, measures are prescribed, which should reduce the frequency of bronchospasm and sputum synthesis, then the patient will feel well and feel healthy.
The rehabilitation plan is drawn up based on the data obtained:
- anamnesis of the patient;
- data from the examination of the patient;
- data from clinical trials;
- data on the effectiveness of previous therapy.
The patient's severity is determined, after which the doctor decides where and how the rehabilitation will be carried out:
- severe degree and attacks of suffocation are treated in hospital;
- mild and moderate form of severity - observation of health condition in the clinic.
- physical exercises;
- breathing exercises;
- immunity strengthening;
- medicament therapy;
Physical exercises must be performed during the period of remission, when there are no seizures. The exercises should be supervised by an instructor. Increased blood circulation and lymph flow provides faster resorption of accumulated exudate in bronchi.
Drainage massage promotes the removal of sputum from the bronchi.
Respiratory gymnastics will help the patient to strengthen the diaphragm and clear the airway from accumulated harmful substances.
Hardening of the body helps to cope with any disease. Only in this case, you must remember that excessively cold or hot temperature can provoke a choking attack.
Therapeutic exercise and massage also helps to strengthen the immune system.
Medicines are prescribed by a doctor to reduce and prevent attacks. Asthma patients are doomed to take medication permanently until the attacks and symptoms disappear completely.
The treatment is selected individually, which depends on the characteristics of the body and the severity of bronchial asthma.
Being in the clean air in the sanatorium and resorts has a positive effect on the respiratory system. The influence of allergens and the release of antibodies in the body is reduced, so the frequency of attacks decreases.
Children's organism is characterized by a greater ability to restore damaged structures, so recovery in children is quite possible.
But do not forget about the instability of the immune system in children, which can lead to the appearance of concomitant allergic diseases if not treated.
Parents should carry out exercises and massages with children in their spare time, as it is much better than drinking medications.
With constant adherence to rehabilitation methods, it will be faster to defeat the disease.
Bronchial asthma in Buryatia
Environmental factor is of great importance for the development and persistence of this disease. The higher prevalence of bronchial asthma among the population living in urban areas with a high level of air pollution has been established. But it is possible that the prevalence of bronchial asthma may depend on nationality. Obviously, genetic factors have the greatest importance as a predisposing factor for the development of atopy and, possibly, asthma. In this regard, it is of special interest to study the prevalence and peculiarities of the clinical course of bronchial asthma in Buryatia - a region with a pronounced climatic zoning and compact population of different races - Mongoloid and Caucasian.
No large-scale epidemiological studies on bronchial asthma have been conducted in the Republic of Buryatia, so the level of general and primary morbidity has been estimated based on patients' requests for medical care, which, of course, did not reflect the true prevalence of the disease in the region.
In order to identify the true prevalence of bronchial asthma in the region, a 2-stage epidemiological study was conducted among the urban population of Ulan-Ude and residents of Mukhorshibirsky Rural Raion of Bashkortostan.
At the first stage, a continuous survey of the population was conducted using a validated questionnaire.
At the second stage, an in-depth survey of identified individuals with asthma of similar symptoms was conducted to verify bronchial asthma using standard clinical, functional and laboratory examination methods.
The novelty of the conducted study was that for the first time in Buryatia, clinical and epidemiological features of this disease were studied. Besides, it is possible to create effective regional asthma control programs only on the basis of scientific data on true prevalence, severity structure and etiological characteristics of the disease.
The results of the screening survey among urban and rural residents of the Republic of Buryatia showed a reliably higher incidence of APS in the urban population regardless of sex and age (p<0.05).
Thus, higher than in terms of reversibility, the true prevalence of bronchial asthma in the region, comparable with the global data, and the revealed hypodiagnosis of the disease, dictate the need to introduce modern algorithms of diagnostics and treatment of bronchial asthma into the practical health care. Fuller and earlier detection of patients, especially at the initial stage of the disease, can contribute to the development of effective regional antiviral programs based on scientific data on the prevalence, structure, severity and etiological characteristics of bronchial asthma. Qualitative control of bronchial asthma symptoms will lead to a decrease in morbidity in this pathology.
So, the problem of allergic diseases over the past decade has become one of the most pressing in modern pediatrics. Bronchial asthma is a fairly common disease, poorly treatable. In the development of the disease there is a hereditary predisposition and a predisposition to allergies.
Having analyzed the main methods of treatment of bronchial asthma, I realized the importance of the nurse's participation in the treatment, diagnosis and rehabilitation process. Nurse not only helps the attending physician, but also morally supports patients, tune them to recovery and inspires optimism, while taking on an educational role. Therefore, nursing care is very important, both in treatment and prevention of this serious illness.
Statistical data of the Gusinoozerskaya Crb Gauzia
Analysis of statistical data on children's incidence of bronchial asthma according to the Gusinoozerskiy CRH
To reveal the prevalence of bronchial asthma, I went to the office of statistics at the Gusinoozerskaya CSB, where I received the necessary information.
The nature of bronchial asthma has not been fully studied. However, at present, it is established that the development of bronchial asthma prioritizes hereditary predisposition. According to most researchers, it is not the disease that is inherited, but the peculiarities of metabolism, the increased ability of the body to sensitization, the propensity for allergic reactions.
The doctors of the Gusinoozersk Children's Consultation found that 67% of sick children have bronchial asthma and other allergic diseases.
Having analyzed the statistical data, I came to the conclusion that in three years the number of children with bronchial asthma in Gusinoozersk, Selenga District, has slightly decreased. This was due to the work being done among medical staff and also among parents who have children with bronchial asthma.
The introduction of educational programs for parents of children with allergic diseases has helped increase the effectiveness of therapy for children with allergies. To this end, health improvement schools were organized at the children's consultation. The educational programs are aimed at teaching parents how to control the environment of a sick child, properly perform treatment and rehabilitation activities, and properly monitor the effectiveness of treatment. Patient education involves establishing a partnership between the patient, his or her family and a medical worker. Good understanding is very important as a basis for further good treatment exposure.
Classes at the children's health school (outpatient treatment) are conducted at the children's outpatient clinic. Patients are selected (7-10 people) who need to take the most training course. The training course usually includes 5 sessions; each of them lasts not more than 1 hour. Usually up to 5-6 courses are held during a calendar year.
Attendance of classes for the patient is purely voluntary. They are taught by doctors themselves or by specially trained nursing staff. At school children are taught the necessary skills, and useful information is provided in an accessible and understandable form for the children.
But it should be noted that at the moment there are the following problems: in Gusinoozersk CDC there is no allergist doctor and, as a consequence, late detection of allergic diseases in children, insufficient use of specific diagnostic and treatment methods.
Prevention and treatment of allergic pathology is a difficult task, as it requires an individual approach to minimize possible side effects, especially undesirable for a growing child's body. However, the quality control of symptoms of bronchial asthma may lead to a decrease in the incidence of this pathology.
Analysis of a sociological survey among parents
To analyze the effectiveness of the nurse's participation in the treatment, diagnosis and rehabilitation processes, I developed a questionnaire consisting of 11 questions. The questions in the questionnaire are aimed at identifying possible risks of relapse of bronchial asthma among children. Together with the head of the practice, 25 parents, whose children are on "D" registration in the State Institution "Gusinoozersky CRH" from a pediatrician with a diagnosis of "bronchial asthma.
Answering the question: did the child have allergy symptoms (nasal congestion, sneezing, tears, etc.)? 10 respondents answered yes (40%), 15 respondents answered no (60%).
Answering the question: does a child have choking attacks? 25 respondents answered yes (100%), 0 respondents (0%) answered no (0%).
Answering the question: Does your child take anti-allergic drugs? 20 respondents answered yes (80%), 5 respondents answered no (20%).
Answering the question: Does your child have a pocket inhaler? 20 respondents answered yes (80%), 5 respondents answered no (20%).
Answering the question: does the child know how to use a pocket inhaler? 20 respondents answered yes (80%), 5 respondents answered no (20%).
Answering the question: do you perform all prescriptions and recommendations of the attending physician? 15 respondents answered yes (60%), 10 respondents answered no (40%).
Answering the question: has the child been identified as allergic? 12 respondents answered yes (48%), 13 respondents answered no (52%).
Answering the question: do you take preventive measures to remove the allergen? 12 respondents answered yes (48%), 13 respondents answered no (52%).
Answering the question: do you do daily wet cleaning at home? 13 respondents answered yes (52%), 12 respondents answered no (48%).
Answering the question: does the child observe the diet and the daily routine? 12 respondents answered yes (48%), 13 respondents answered no (52%).
Answering the question: is there a diary, in which the data of picphyloometry is recorded, as well as the child's reaction to drugs is monitored? 7 respondents answered yes (28%), 18 respondents answered no (72%).
From the survey data we can see that there is a problem with helping parents whose children have bronchial asthma. 80% of respondents comply with the prescribed treatment, but 20% do not attach importance to medication therapy.
Not all children have a pocket inhaler. Parents need to explain how important it is to teach their child to use a pocket inhaler in order to relieve a choking attack in time.
40% of respondents do not follow the prescriptions and recommendations of the attending physician, i.e., parents do not realize that systematic and regular treatment is necessary for their children to live a full life without complications.
For the child to recover, it is necessary to identify the allergen, but from the data we see that 52% of respondents did not perform an allergen analysis. Thus, only 48% of respondents care about their children's health and take preventive measures to remove the allergen.
It is necessary to take timely preventive measures and train parents to keep a diary on treatment control. If parents follow the precise implementation of prescriptions and recommendations of the attending physician, teach their children to follow the diet and daily routine, and monitor physical exercise, this will reduce the number of cases of severe bronchial asthma.
Millions of people suffer from allergic diseases and represent a serious social, economic and medical problem.
A child suffering from bronchial asthma is deprived of many joys in childhood and further life. Only his relatives and the doctor treating him know about his physical and moral suffering during the whole life.
Fatal outcomes from insect bites or the introduction of an allergenic drug are not uncommon nowadays.
Severe asthma, lasting 3-4 days, may also result in death of the patient. Of course, compared to the number of patients with allergies, the percentage of deaths from them is small. In old age, the severity of allergic symptoms increases because of the addition of complications from which the patient suffers.
Allergic tests can detect a specific allergen in many allergic skin and respiratory tract diseases. Specific sensitization provides a good therapeutic effect. The use of glucocorticoids has given medicine a powerful weapon in the fight against serious allergic diseases, previously considered incurable. Reasonable use of these drugs for serious allergic diseases throughout the life of the patient allows to return "in the system" many patients who were previously considered hopeless.
The last word of science in allergology has not yet been said. Currently, research is underway to study substances that can inhibit the biosynthesis of histamine and accelerate its destruction. The use of depo-allergens allows reducing the number of injections with specific sensitization of the patient.
Thus, the arsenal of modern medicine has enough ways to combat allergic diseases. You only need to see a doctor in time. Untimely access to an allergist can lead to serious consequences.
First, without proper treatment, the disease takes a very heavy form, which can not be treated by existing methods. Secondly, one disease may go to another, heavier, which will require an intensive therapeutic burden on the patient.
According to the data of the survey conducted in Buryatia, 20-25% of the population suffer from allergic diseases, among which allergic rhinitis prevails - passing with inadequate treatment or its absence into bronchial asthma.
The fact that traditionally in Russia allergy is not considered a serious disease and is not given much attention by either the media or the public, as well as the lack of access to specialized medical care in some regions have led to the fact that allergy patients for many years are observed in other specialists or engaged in self-treatment. This confirms the huge gap between the real and registered incidence of allergies (according to the data of the Ministry of Health of Russia, the incidence of allergies in circulation does not exceed 0.5-1%, depending on the region).
In such a situation, one of the most important aspects in the complex of therapeutic and preventive measures is public education. It is necessary that everyone understands what an allergy is and what consequences self-treatment can lead to; that patients and their relatives know the essence of the disease, necessary therapeutic and preventive measures, understand the meaning of drug therapy.
For this purpose, it is necessary to develop a network of allergology offices across the country and create allergic schools. Such allergic schools already exist in almost every district of Moscow, where people suffering from one disease can share with each other the experience of fighting the disease and get information that they for various reasons can not get in the office of an allergist. One should also take into account the experience of developed foreign countries, where there is not only a large amount of literature for allergy patients, but also special TV programs with the participation of famous people who have achieved success in combating the disease and share their experiences with the audience.
Sanatorium and spa treatment has a favorable effect on the course of bronchial asthma and atopic dermatitis in children.
Summing up, we can say that at present there are successes in the treatment of many allergic diseases, and this allows us to look optimistically into the future.