Edema is characterized by
The keeper and the queen are characterized bymonomorphic rash whose primary element is the blister, is an acute edema of the papillary dermis. The disease begins suddenly with intense itching of the skin. Then, in areas of pruritus, hyperemic areas of the rash appear, protruding above the surface. If the total duration is more than 5-6 weeks, then talk about the chronic form of urticaria capable of relapse with excruciating itching, the attachment of papular rash, ulcers and other elements.
Quincke's edema is characterized by edema of the dermis andsubcutaneous tissue and even sometimes extends to the muscles. Edema Quincke is a giant urticaria. Local lesions are observed in places with loose fiber, favorite localization - lips, eyelids, mucous membranes of the mouth (tongue, soft palate, tonsils). Dangerous is the edema of the Quincke in the larynx, which occurs in 25% of all cases. When there is edema of the larynx - hoarseness of the voice, "barking" cough, then difficulty breathing, inspiratory-expiratory dyspnea, breathing noisy stridarose, cyanosis of the face, patients rush, restless. If the edema extends to the trachea, bronchi, then the bronchospastic syndrome develops and death from asphyxia. With mild and moderate severity, the laryngeal edema lasts from 1 hour to a day. After the subsidence of the acute period, some time remains hoarse voice, sore throat, shortness of breath, dry rales are heard in the lungs. With the localization of the edema on the mucous GIT - abdominal syndrome. which begins with nausea. vomiting, acute pain is attached, first local, then along the entire abdomen, accompanied by flatulence, intensified peristalsis. During this period, there may be a positive symptom of Schetkina-Blumberg. The attack ends with profuse diarrhea. Abdominal edema in 30% is accompanied by cutaneous manifestations. When localizing edema on the face, serous membranes may be involved in the process, with the appearance of meningeal symptoms and seizures.
Thus, the clinical picture and severityprocess is determined by the localization of the pathological process and the degree of its intensity. Skin lesion is the most common form of LB, it is characterized by various lesions: itching, erythematous rash, maculopapular, koreal, eczema-like rash, exudative erythema multiforme, exfoliative dermatitis, Lyell syndrome, etc. Usually, rashes appear 7-8 days after the start of medication. Most often they are caused by CA drugs, erythromycin, gentamicin, barbiturates, gold preparations. The rash disappears 3-4 days after drug withdrawal.
Of all the skin manifestations of LB, I want to stay on the Lyell syndrome. Lyell's syndrome Is a toxic epidermal necrolysis -A severe bullous disease with total damage to the skin and mucous membranes. The disease begins acutely for several hours or days after taking medication (amidopyrine, aspirin, bucarban, ab, analgesics), sometimes suddenly as an acute febrile infectious disease. there are bubbles the size of a walnut, which burst. forming erosions, later pour in, occupy large areas on the skin of the trunk, extremities, the necrotic epithelium tearing off forms large areas without a protective cover of the epithelium with the development of toxemia and the death of patients from sepsis.
MEDICINAL VASCULITIS refer to systemicvasculitis is a group of diseases based on generalized lesions of arteries and veins of different caliber with secondary involvement of internal organs and tissues in the process. The connection of systemic vasculitis with the administration of medications has been proved by Tareev. Medicinal vasculitis develops more often in persons with a burdened allergological anamnesis. There are more than 100 drugs known to cause systemic vasculitis. Medicinal vasculitis (arteritis, capillaritis, venuleum, phlebitis, lymphanaitis) rarely represent an independent disease. more often are one of the components of another pathological process. Medicinal vasculitis has acute and subacute course, can recur, but usually do not progress. The process is temporary and ends with complete recovery. The disease proceeds according to the type of hemorrhagic vasculitis (Schönlein-Henoch disease), necrotizing vasculitis, Wegener's granulomatosis, Mashkovitz syndrome, obliterating thromboangiitis, etc.
Lesion of internal organs in LB.
Respiratory organs - atopic form of asthma, allergic bronchospastic syndrome. aspirin (prostaglandin) asthma, bronchitis xr, allergic alveolitis.
Defeat of the heart - toxic-allergic myocarditis, pericarditis.
Lesion of the gastrointestinal tract - enterocolitis, ulcerative necrotic lesions and gangrene of the intestine as a result of drug vasculitis of the mesenteric arteries.
The defeat of the liver in the form of toxic-allergichepatitis and cholestatic hepatitis. Their clinical manifestation is jaundice, an increase in liver size, a change in functional liver samples. Cholestatic hepatitis is a consequence of intrahepatic cholestasis. Of the 1000 medications that can cause liver damage, the most important are methylandrostenediol, CA, chlorpropamide, dopegit, nitrifuran preparations.
Kidney damage - with LB is characterized bythe development of immunological glomerulonephritis, the development of interstitial nephritis, nephrotic syndrome. The defeat of the kidneys in LB especially often develops with the appointment of CA, penicillin, diuretics, polymyxins, nitropium, gold preparations, methicillin. Hematologic medicinal allergic syndromes - hypoplastic, hemolytic anemia, thrombocytopenia, agranulocytosis.
1. Carefully collected allergic anamnesis. The patient should be asked in detail what medications he took on the eve of the development of an allergic reaction, about the presence of drug sensitization to medicines. It should be remembered. That there is a "hidden sensitization" caused by the addition of antibiotics, hormones in the feed of animals, some substances in toning beverages. It should be borne in mind that many patients do not consider drugs for those drugs that they take daily (laxatives, sedatives, eye drops, nasal drops, analgesics).
2. Elimination tests consist in the abolition of all medications. With targeted elimination, it is necessary to take into account the possibility of cross reactions and the receipt of medications in combination preparations, in food and flavor additives, and remember that after long-term use of penicillin drugs, the symptoms of the drug allegory persist for several weeks or months after they are abolished .
3. Skin allergic tests (vk, scarification, application give sharply (+) with certain medicinal allergens.
4. Provocative tests (nasal, inhalation, conjunctival)
6. The reaction of hemagglutination - is the agglutination of the serum of a patient with erythrocytes loaded with an allergen.