MINISTRY OF HEALTH OF UKRAINE
Vinnitsa National Medical University. MI Pirogov
"Approved uyu"
Vice Rector for Academic Affairs
Professor Huminskyy Yu.Y.
(Signature)
"__ 25 ___ '____ 6 ____ 0 20 1 3 y
Methodological development
5th year student of the Faculty of Dentistry
Post number 7
Academic discipline
"Clinical Immunology and Allergology"
Module number 1
"Clinical Immunology and Allergology"
Modules № 2
Allergic diseases in
treatment.
Study subject
Nerespiratorni allergic disorders: urticaria,
angioedema, differential diagnosis,
diagnosis, treatment and prevention. First
Aid w ith angioedema of the larynx. K at
ntaktnyy dermatitis in dentistry, age
characteristics, methods of diagnosis and
treatment. Food intolerance and food
allergy. Poll via "Step 2".
5th
"Medicine", "Pediatrics", "Medical and
preventive care"
4
Rate
Faculty
Number of hours
20 1 3 y
1.
Background:
dentistry - diagnosis,
Atopic dermatitis occurs in persons of either sex and different age groups. The incidence
varies from 2% to 6% of adults and 10% to 20% - among children. In children, the disease is a leading
structure allergic disease (50-60%). M astishe ill females (65%), the incidence of atopic dermatitis in
urban areas are more likely than in rural areas. Supervisory p ihayetsya increase in incidence
worldwide, due to the contamination of the environment by some allergic food, food additives
chovyh, reduce the term breastfeeding, vaccination and other causes.
In recent years, kl and n and h her practice z'ya vlya is t b would be all lshe and Dr.
Tei with complaints of urticaria with you and n ku - kr opyv'yanku. known ni at 3% of the board
and ln Fri and 2% of schools ravines strategy is giving b urticaria. Is even-known fact in the early
ni o omu Dr. ytyachomu IRC in pre prevail acute urticaria. Yes, and Dr. Tei 2 years LU p and b
be chayut I usually k, t and lk s Mr. Ostrom forms and cr drank at 'yanok, in on IRC from 2 to 12
years - Mr. Ostrom and cron and h with either p e re vazhannyam of p and x forms, and in e and
dren over 12 years Preval yuyut cron h and no forms and kropyv'yanok. dren in e and o of Rann
of ILA (from 1 to 36 m and syats in) g Ostra hives can cause u and x urgent situations, and at
Worms's A necessary and N of habitats and onarne ikuvannya l (0.4% of the sun's hospitalizations
and and and). Guo insurance urticaria stishe cha in s is is t b and d be in Tay from atop and h n
ymi
of
the
disease.
Despite te recorders at cron and h n th e ytyachomu hives in IRC at q and A is t ü be used at
insufficient attention, her district's Lake in the village yudzhenist imposes expenses with 0,1-3%.
horseradish and black or urticariasignificantly impair quality of life, ni o in s match the yet to be
kvolosti, crimped by Mr. Yahya CH, social and external social and and and zolyats uu, e stitutional
Motz violations by Mr. Yahya.
In adults, on the evidence of statistics, about 20% of the population at least once in a lifetime
there urticaria.
In 42% of cases of acute allergic urticaria combined with angioedema.
Lactose nutrients, which manifests itself in a variety of syndromes from mild skin and
gastrointestinal sudden death, long ago belonged to a group idiosynkraziy. With the introduction of
the concept into clinical practice of allergy, she was involved in the explanation of the pathogenesis
of food intolerance. However, the diagnosis of food allergies continue chewing remain unresolved
problem because the frequency of food allergy in the population, according to different authors, has
such a large amplitude - from 0.4 to 30%.
2. Learning Objectives (main teaching and learning issues for self pozaudytornoyi).
Know how to:
1.1 Know and be able to get a medical history and objective data describing food allergies,
urticaria, allergic dermatitis.
1.2 Know and be able to use additional methods of examination data used for diagnostics.
1.3 Be able to formulate a diagnosis and carry out differential diagnosis between the various forms
of urticaria, food allergies, etc. ..
1.4 Be able to identify the "guilty" allergen in food allergy.
1.5 Be able to provide first aid in angioedema.
1.6 Be able to assign elimination diet therapy with food allergies.
1.7 Read the minutes helping patients with urticaria and angioedema.
3. Be able to:
1. Collect the complaint history of the disease, history of life in patients with suspected neresp
and ratorn and allergies and ERs and disease ..
2. To conduct differential diagnostics of allergic dermatitis and Shimi diseases HQ and fish.
3. Recognize true allergy Cardiovascual other vydыv her intolerance and the food.
4. Assign appropriate and methods d and l and agnostics and forgings in various forms of
intolerance and the food th
4. Baseline training.
The names of the preceding disciplines
1. Human Anatomy
2. Normal physiology
3. Pathological Physiology
4. Pharmacology
5. General hygiene
6. Pathological anatomy
7. Gastroenterology
8. Dermatology
General plan of the
The value for the d
General pathology
The pharmacokin
membranostabiliza
The concept of occ
workers. Fundame
Tuberculosis as a c
Structure-specific g
Diseases of the gas
Structure and funct
5. Organization of the content of teaching material
1. Teacher introduces students to neresp and ratornoyu allergic pathologist Ia S, which includes
concepts such as allergic dermatitis, nettle 'Iancu and swelling April and nke and food allergies.
2. Ozhna M lerhichni select a disease that is clinically p royavlyayutsya changes of the skin:
atopichnyy dermatitis, occupational eczema and contact dermatitis.
Then the teacher gives the definition of each disease: a topichnyy dermatitis (ADT) - a chronic
allergic disease w Kira, which is formed in childhood, characterized by phasic re tsydyvuyuchym
flow that often occurs in individuals with atopy and probably has a g e- dependent mechanism. In
atopic dermatitis suffer other organs and systems, that it should be considered more broadly than
just Mat voryuvannya skin.
Occupational eczema - develops when exposed to allergens production in individuals predisposed to the
formation of allergic disease. Underlying pathology genesis of professional eczema are allergic reactions, mainly
3rd type(immunocomplex).
Allergic contact dermatitis - a skin disorder in OS new immunological reactions which are mediated
by T h 1 lymphocytes ter.
Urticaria (K) - Polyetiological syndrome that manifests character Terna skin elements (urticaria) with
fast dynamics.
It should be noted that Mr. ezalezhno of origin for hives is characteristic increase vascular
permeability and microcirculation acute development came across ment in the perivascular tissue. Any
damage as subcutaneous andsubmucosal dermis developing angioedema.
Angioedema (angioedema) characterized by the appearance of dense swelling of deep skin layers
(often in the face of hunt, neck, genitals) without the express itching.
The teacher stresses that's ronichnu urticaria should be attributed to allergic only at presence of the fact
that it is mediated by immunological mechanisms.
Next, the teacher explains that idomymy hives are caused by the action of cold, heat, vibration, both slidok system, infectious diseases due to cholinergic shall nisms, psychogenic factors and so on. The
most common is a recurrent or chronic urticaria violating activities ness of the gastrointestinal tract, where it
is difficult to separate one "in current "mechanism. According highly allergic urticaria as well (AKP) can
also have an acute, rarely - recurrent or chronic.
Students are introduced to the "official opinion of the problem commission on nomina klaturi eAAC
(2001), "which stated that the distorted reaction to food should be called fo tion hypersensitivity. If
it is caused by immunological mechanisms Mom - it should be treated as food allergies.
3.
After reading icy with the content of the concepts that will be studied, the teacher
moves to the classification of these diseases.
Urticaria and pod tions of acute and cron and CSSR.
Acute k ropyv'yanky 42% combined with angioedema.
There are options such as chronic urticaria and q in compression, cold, heat, and dermatohraf-old,
hall and nerh and Ceska and nfekts and yna, auto and munna, akvahenna, vibration, and other
psychogenic.
4.
Then the teacher introduces students to the details and clinic diagnosis of these
diseases.
By JK Skripkin et al. (2000), in the course of atopic dermatitis are three age periods. First age
period (0-2years): Lake Naki atopic dermatitis in 63-82% occur in the first year no rd, usually 3
to 4 months of age. The lesions of erythema and bright moknen of appearing on the cheeks, further
process extends to the forehead, BTE area, neck area, scalp, and trunk. Ha rakternoyu localization
is an early rash on the outer surface at r milok. Inearly childhood the clinical picture is dominated by
processes eksu mendations: pronounced redness, swelling, soak, there is the so-called cradle cap
(milk crust). Erythematous pockets with shiny surface, hot to the touch.Gradual process of exudation
hundred tion and less pronounced in the second year of life dominated areas of infiltration,
desquamation.
In the second age period (2 - 10 years) disease is a chronic inflammatory nature, mainly
erythematous-squamous, sometimes lihe nifikatsiyeyu. The rash is mainly localized in the elbow and
popliteal folds on the back of the neck, on the flexor surfaces of the ankle and wrist are in the outside
area. The skin is dry, tmya on the appearance, infiltrated with hrysovydnym desquamation,
excoriation. During this period, a decrease of hypersensitivity to food allergens, there is a tendency to
fluctuating course of atopic dermatitis.
For the third age period (older children and adults) ha rakterne prevalence ekskoriatsiy,
lihenoyidnyh papules, infiltration of skin lesions, sometimes - pruryhinoznyh changes. It is
characteristic skin lesion volume lychchya, neck and upper torso. Rash accompanied by
pronounced it itch.
The teacher explains that w ith atopic dermatitis often recorded comorbidities:
• of the gastrointestinal tract (GIT) - almost 100%, and neurological disorders - 80%, chronic
foci of infection - in 79.4%, allergic respiratory diseases - in 73.7% dismetabolic not fropatiyi 50% of patients.
• parasitic infections recorded in 69.1% of cases;
• dermatorespiratornyy syndrome is more than half us children with atopic dermatitis aged 4
to 15 years. Including: asthma - 20% of allergic rhinitis - 24%.
Weather. Majority of patients manifestations of atopic dermatitis quietly tion to the age of 30 and
50 - disappear altogether. The presence of atopy forecasting Zuya more severe atopic dermatitis: even
after 20-30 years, 30-70% of the manifestations of the disease may persist.
Then the instructor voiced the opinion of many authors, that the children an option atopic der
th matyt in can and bottle infant eczema. disease develops in wounds It infancy. The most frequent
localization - the face, scalp,yahodytsi, stomach. The skin of glass formed erythematous we infiltrated
areas of exudative papules, pustules, vezyku Lama, sometimes hemorrhagic crusts with soak, the
peeling. Sometimes there is a combination of manifestations of bronchospasm eczema, hay
fever. Other options for eczema in childhood - seborrheic, microbial, dyshidrotychnu - not be
attributed to allergies.
Then the instructor explains the basic diagnostic criteria for atopic dermatitis.
1. Pruryho or itchy skin, even in the presence of a minor rash.
2. Typical localization and nature of cutaneous manifestations:
a)
in early childhood - the face, neck and scalp of the
Chairman;
b)
in childhood - flexor surfaces of the extremities, the hands, feet;
c)
in adolescents and adults - on the extensor surfaces.
3. Allergic heredity, the appearance at an early age.
4. Recurrent and chronic.
Additional criteria:
a)
dry skin, ichthyosis, follicular keratosis, nonspecific derma
Titus hands and feet, eczema Nipple cheilitis;
b)
positive skin tests with allergens or elevated non-communicable
ing the level of specific and relevant to the § E allergens;
c)
elevated levels of total and § E;
d)
recurrent conjunctivitis;
e)
dark circles around the eyes, white dermographism, pallor or erythema
face, the folds on the front of the neck;
g) dependence clinical course of emotions, environmental factors;
i) skladchatist palms and soles;
k) whitish spots on the face, upper torso;
l) frequent infectious skin lesions.
For diagnosis of atopic dermatitis requires at least 3 major "big" and 3 "small" or additional criteria.
Students should be aware that a lhorytm diagnosis of atopic dermatitis should include: collected Early history - a review of the patient - Skin and laboratory tests in neinfek tional allergens and
allergen mushroom research tool gastrointestinal KOVO tract, liver, biliary tract, pancreas, blood tests
(level of eosinophils, bile pigments, general and § E) - Research fecal helminth eggs and dysbiosis.
Then the instructor on the example of a patient following a review of each student, explains that k linichna
picture occupational eczema manifests with erythema infiltra tive tissue changes, edema, papules, rash
pustular, this PLUG-exudative crusts, soak, erosions. The process is accompanied be severe
itching. Occupational eczema is often complicated PIO genetic infection that worsens the disease,
promotes the formation of crusts purulent, hemorrhagic nature, distribution pustules,
vesicles. Occupational allergens can be any chemicals.
Note that k ontaktnyy dermatitis often occurs in middle-or old age. Atopy or the patency of other
allergic diseases do not matter. In sensitized individuals after repeated exposure to allergens for you nyknennya corresponding changes in the skin must be at least 12-48 hours. This should be considered in
the formulation of skin tests. State sensitization may persist for several years. Keep in mind that particularly
harsh chemicals can and at the first contact with the skin cause allergic phenomena tech contact
dermatitis. In this case the substance is initially formed ryuye protein conjugate of the skin, which in 5 10 days forming cells to hypersensitivity to 10-12 day may already have clinical manifestations of
allergic contact dermatitis. Appendix 1 provides a list of body parts and substances that can cause
occupational eczema and allergic con Stroke dermatitis with prolonged or recurrent contact.
The teacher stresses that razhennya skin in allergic contact dermatitis is clearly limited, in the acute
phase vesicles are elements in the form scabs that peel, signs lichenification.
The teacher proposes to Dr. yferentsiynyy diagnosis of allergic contact dermatitis from seborrheic
dermatitis (SD), dermatitis, due to irritation of the nervous system (CS) fotokontaktnym dermatitis
(BKD).
Then the instructor offers to supply railway iahnoz allergic contact dermatitis on the basis of re tion gathering history (explain possible contact with a professional We allergens, metals (including
the mouth), dyes, cosmetics, drugs - ear, eye drops, elektropropro procedures, etc.).
For the diagnosis of occupational eczema and allergic contact der matytu The application can be
used to test intact skin areas with appropriate chemical allergens, laboratory tests (response inhibition
of leukocyte migration, blast transformation with the corresponding We chemical allergens), carrying
elimination measures.
At first Mr. Island of allergic second Krapivny these (HAKr) teacher explain to students that
helped prompt helps sometimes save the patient's life. HAKr n ochynayetsya acute, about half an
hour after getting to the organic nisms relevant allergen. Acute allergic urticaria lasts less than 6
weeks. Usually occurs itchy rash or urticaria. Items acute allergic urticaria often have a pale pink or red,
the edges are erythema, which disappears when pressed. Collect hayutsya within 1-6 hours, sometimes
accompanied by a rise of ature of the body, abdominal pain, joint pain. In 42% of cases of acute
allergic urticaria combined with angioedema. Children in 70-85% of cases the cause of acute hives
is an allergic foods (juices, chocolate, eggs, carrots), medications (analgesics, antibiotics). Cases
pollen, insect acute allergic urticaria. Angioedema is most often localized in the region of the lips,
eye orbits, genitalia. It is a tight formation.Approximately 20% of patients occurs as urticaria. Can
store 6 hours to 2-3 days. It is dangerous to bryak angioedema of the larynx when disturbed function
of respiration.
Next, students make their own algorithm first aid for angioedema.
Teacher notes that n ostiyna emergence of new elements urticaria or angioedema, their periodic
recurrence (in term of more than 6 months) indicates the form tion of chronic urticaria or
angioedema. They rarely have tion true allergic genesis and must be differentiated from diseases entities that have similar symptoms. Chronic urticaria is characterized by allergic rash
spotted something-papular character less pronounced compared with acuteurticaria exudation and
itching. Duration of disease gen Tea does not exceed 6 weeks, occurs 8-10 months, often
recurs. In 43% of patients with marked eosinophilia, 40% - leukocytosis in 32% - accelerated Rena
ESR. In 72% of patients the nasal pathology in 78% - pathology of the gastrointestinal tract.
Diagnostic tests for different versions kropyv'yanok
Types kropyv'yanok
Dermographism
Urticaria from compression
Solar
Cholinergic
Cold
Akvahenna
Vibration
Autoimmune
The technique of test
Skin irritation spatula
Walking for 20 minutes. with a weight of 6 - 7
kg, summed w enoyu shoulder
Light irradiation of the skin
1.
Acetylcholine skin test.
2.
Dive into the hot bath (42 ° C) for
pivyschennya body temperature to 0,7 ° C.
1.
Overlay 4 min. dice people on your forearm.
2.
Exercising in the cold.
Apply a compress of water (35 ° to thirty minutes).
Apply laboratory vibrator 4 min.
Introduction autosyrovatky blood
True allergic
Tests IP vivo and both n vitro with ekzoalerhenamy
Clinical manifestations of food allergy can var'yuvaty from minor skin reactions to the state
of anaphylaxis:
The structure of the clinical manifestations of food allergy
Clinical manifestations
Lesions of the mucous membranes of the
30-42%
gastrointestinal tract
Dyspepsia
Skin changes
The reactions of the respiratory
Visceral impression
Hemopatiyi
Anaphylactic reaction
Frequency in %
18-25%
40-60%
3-7%
1-4%
1-2%
0.5-1.5%
The teacher notes that the first clinical food allergy manifests pathological changes in contact with the
allergen antibodies. Sometimes clinical manifestations begin immediately upon contact with mucous nutrients
defense column was oral as catarrhal, aphthous ulcers or lesions of the Public Organisation: gingivitis, glossitis,
stomatitis, cheilitis, esophagitis.
However, often symptoms of food allergy is defined Ucha c u stomach and quiche echnyka. Abdominal
pain can sometimes be one of the NE ohm disease - "abdominal migraine". However, is observed more
often be much larger palette displays of pain or heaviness in the epigastric r l Asti, loss of appetite, bitter
taste in mouth, belching, heartburn, nausea, blyuvan n i. Abdominal pain can be significant, last from minutes
to railway ekilkoh hours, simulating "acute abdomen."
Rare, but possible option for food allergy is to defeat n idshlunkovoyi cancer symptoms of
pancreatitis.
Systemic allergic reactions (including skin symptoms), with food and lerhiyi observed in 21% of
patients. They can be a variety of m s: fever, generalized vasculitis, sometimes - as cheers tion of the
cardiovascular and nervous systems.The most terrible manifestation - and nafilaktychnyy shock,
which is extremely rare and requires corresponding region 's emergency measures. dangerous
perhaps angioedema in the area of the larynx caused by food allergies.
Then the instructor said that Dr. iahnostyka food allergy is very complicated. The leading role
belongs Lives meticulous history taking. A characteristic feature of the food and lerhiyi is irresistible and
progressive manifestations of the disease and not a fektyvnist symptomatic therapy as long as not
detected and eliminated from the diet for a patient allergenic foods. N the first place ered true food
allergy should be allocated among the other types of food neperenosymosti. They are based may lie
inflammatory gastrointestinal disease k ovo tract, dysbiosis, parasitic infestation,
enzymopathies. How was based, also has value and abnormalities in metabolism of histamine and N
tyrami in, for liver and gastrointestinal tract, excessive intakes of th appropriate foods.
Much more difficult to identify "causal" food allergens. Patients rarely district ahodyat
relationship between disease exacerbation and use of certain foods are especially if they ever make
up fo Volyn NGO diet. Not always observed effect of the exclusion of rational well suspect allergenic
products due to the continued use in foods for misunderstanding dishes and products containing them
in small kilkos tyah . On the other hand, after the acute illness often begins re frakternyy period (due to
temporary depletion of antibodies), at which time a proper use of the food does not cause allergic manifestations. It
is therefore necessary to conduct a food diary for patients with analysis of records in which the expert can make
the desired conclusion.
Dyskutabelnoyu is the value of skin tests with food allergens. Rather high value in food allergy research is
specific and g E in serum (immunoglobulin nofermentnym, radioalerhosorbentnym methods).
Now widely used provocative test with registration of this result by using endoscopic techniques. These
tests preferably conducted after previous remission food allergies double "blind" method where neither the doctor
nor the patient does not know the composition of the food mixture given patient. Registered appearance of
mucosal defense column was, gastric motility, quiche echnyka more.
5. Next, students discuss treatment prescribed for patients with allergic disease nerespiratorni.
Treatment regimen atonic dermatitis include:
a)
elimination measures (diet, limiting exposure to dust, pollen,
fungi, animals, chemical agents, etc.);
b)
detection and treatment of diseases of the gastrointestinal tract;
c)
timely treatment of chronic foci of infection;
d)
correction of psychological disorders in the family, educational activities;
e)
Basic and symptomatic therapy in acute (anti histaminni drugs is ubiotyky, tranquilizers,
protease inhibitors);
g) external therapy (moisturizing ointments, creams, ointments hlyukokortyko steroids);
g)
physical therapy;
c)
spa treatment.
Treatment of occupational eczema and allergic contact dermatitis must provrdyty as follows:
1. Elimination of relevant allergens.
2.
Prevention in manufacturing (selection of employees, sanitation produc tion, protective clothing,
protective creams).
3.
Local treatment (in allergic contact dermatitis - is this application of gels, ointments with
glucocorticosteroids, etc.).
4. The set of measures of general application.
Algorithm for the treatment of acute urticaria following:
Hunger for 2-3 days, with a gradual transition to a hypoallergenic diet - destination laxatives (in enema) chelators - PA parenteral administration of antihistamines - IV-drip corticosteroids (30-60 mg).
Failure of acute allergic skin manifestations of urticaria Provo reproduced examination of the patient (based
on previous input en- tyhistaminnyh drugs and corticosteroids) to identify "at current factor "acute allergic
urticaria. If you notice - its elimination. In the non-detection-extension hipoalerhennoyidiyety, maxi mal limit
contact with ekzoalerhenamy, trigger factors antihistamines. Treatment of comorbidities.
Chronic urticaria treatment episodes of exacerbation can drive in accordance with the above. When failure
additionally possible to assign multiple courses hemosorption, allergy injection rate immunoglobulin,
antihistamines. In complex cases, the possibility to switch to systemic corticosteroids (daily or intermittu- yucha
therapy) or cytotoxic agents, including sandymun neoral. When to achieving an effect - gradually reduce the
dose of drugs and to cancel or complete abolition of maintaining the minimum required dose.
Food allergy treatment regimen should include:
1. Treatment of acute manifestations of food allergy: hunger (2-3 days) enterosorbents purpose,
parenterally - antihistamine drugs rativ, expressed in forms - parenteral corticosteroids, hypoallergenic diet.
2. Prolonged treatment (continuously recurrent) manifestations of food allergy: a patient survey
to identify the causative allergen and destination of the diet, enzymes, treatment of pathology of the
gastrointestinal tract, intestine, liver, anti- histaminni drugs, if severe - hlyukokortyko oral steroids with Phaseshift and only the antihistamine drugs 3rd generation, try specific immunotherapy.
Then the instructor identifies common errors in the treatment of: Mr evirna interpretation of true food
allergy is not sufficient examination of patients, over the appointment of antihistamines.
6. Plan and organizational structure of educational classes Allergology
(240 minutes).
Number
Stages classes
Distribution
Types of control
c/o
time
*
1.
1.1.
The preparatory phase
Organizational matters.
35 min
5 min
1.2.
Formation of motivation
5 min
1.3.
Control of entry
level of training
(Standardized controls).
2.
The main stage (specify
all kinds of work that students perform under
during this phase).
Monitoring visits
practical classes
Familiarity with teache
students. Introdu
students with the clinic.
Structured written wo
25 min
120 min
Oral survey
poll by standardized l
of the patient with the
examination.
test control
criteria of knowledge
3.
The final stage
25 min
3.1.
Control endline
training.
15 min
3.2.
Overall training
student activities.
3.3.
Informing students
the topic of the next session.
5 min
5 min
Note:
* Forms of control and training tools specifically defined by the Department for each stage of training;
Controls ** theoretical and practical training of students need to be standardized.
7. Methods of educational process in the practice (seminar) class.
7.1. The preparatory phase.
Theory
Features of the clinical examination of patients with neresp and ratorn and allergies
and ERs and disease: complaints, history of disease course, ancestral history, past illnesses,
working and living conditions; Physical examination methods: the value of palpation, percussion
and auscultation in the examination of patients with no respiratory problems . Survey methods in
vivo in vitro
To acquaint students with specific goals and plan lessons.
Conduct initial control level of training students in an objective examination of patients with
atopic dermatitis, urticaria, food allergies. Identify the level of students in the provision of first aid
in emergency conditions (angioedema).
7.2. The main stage
This phase involves performing each student independently and under the supervision of the teacher
below mentioned practical work.
Task 1
Students carry out a thorough survey and objective examination of the patient with allergic
diseases nerespiratorni using inspection, palpation, auscultation.
assign students one
must i d and methods of survey data by disease.
Then students lane at dyat differential diagnosis of allergic dermatitis, urticaria with others, we
shk i rny tions we have the disease.
Task 2
Number
Task
1.
D and ahnstyka allergic dermatitis is base on IS ...?
2.
3.
4.
5.
6.
7.
8.
9.
10.
11
What he and znytsya m and is neurodermatitis and atop tions and dermatitis?
Similar sites and HQ ry lesions and in atop and chnomu Dermato those children early on I C
I?
What are the main criterion of AI and AD?
Acute allergic hives can last up to ...?
Elements of urticaria can Save and Gatis to ...?
Allergic edema April nke and can store up to ...?
The strong food allergens include ...?
Prior to products row m and large k and lk and d ty and Stam and well related ...?
To the product, releasing Mr. and Mr. Stam and include ...?
How to PHA and ambassadors and successively ty and diagnostic kropyv'yanok?
12.
When l and forging her badly and the food allergies th ... uu advisable?
Task 3
Solve tests:
1. At that time often arise is DR?
Answer - In the first years of life
2. SK lky and in term lane and one in the type and lyayutsya in AD?
Answer - Three (-0-2 first second - 2-12, and the third - 12 - 18 years and older and adults)
3. What is usually the prognosis of AD?
Answer - favorable, subject to the doctor's recommendations.
4. What diseases differentiating AD?
Answer - psoriasis, scabies, dermatitis Duhring, seborrheic dermatitis, contact dermatitis, toxic
and streptostaf and loderm Ia th, fungal infections, pruritus.
5. As AI reactions underlie and professions and yno her eczema?
Answer - 3 types (and munokompleks not)
6. As signs of HQ and ri in the CD?
Answer - defeat is black and tkyy limited, in hostrыy phases and vesicles are elements of crust,
features Lee Hyun and f and AI Katz.
7. In the case of chronic urticaria and allergies find chnoyu?
The answer is - if it is mediated and munoloh tions and mechanisms.
8. As n and Drozd and lyayutsya the food allergens and the degree of activity in children?
The answer - in ysoku, medium and weak.
Task 4
Challenges to self:
№/№
Task
1.
The nurse complains of itching, flushing, lihenifikatsiyu that occur after exposure to antibiot
of allergic contact dermatitis. What type of allergic reaction takes place?
2.
5.
In hospital hospitalized patients with recurrent urticaria. After an allergy test revealed a ca
treatment should be applied at the first stage?
After eating chocolate, the patient appeared bubbles: the hands, pain, itching, heada
antihistamines symptoms disappear. Eating small amounts of chocolate symptoms occur. Y
The patient complains of swelling of the face, voice hoarseness, shortness of breath, gene
hour before it took a small amount of strawberries. Your diagnosis?
Female patients with acute nettle "Iancu, which emerged after taking analhinu. Applying fo
6.
In adults with atopic dermatitis affects:
7.
Angioedema (angioedema) is dangerous because it leads to ...?
8.
In acute course of atopic dermatitis preference should be given to:
9.
Patient complains of intense itching of the skin of both limbs, monomorphic rash, blisters. F
used a new detergent. Your diagnosis?
In patients who underwent surgery for acute appendicitis during the third Trans "Relations su
of the skin around the wound, the presence of fire and erosion puhiriv. Focal lesions cle
diagnosis.
In hospital hospitalized patients with relapsed sprinkled "yankoy. After an allergy test revea
egg. Which treatment for this stage you give preference?
3.
4.
10.
11.
12.
13.
14.
The girl after tooth extraction there was a painful hard swelling of the face, abdominal pa
nausea.Similar symptoms occurred several times in the past when stress or before menstruat
3-4 days. In history - grandfather had unexplained swelling. Specify the cause of the patient
What antibodies play a major role in the pathogenesis of atopic dermatitis?
For any type of inherited atopic dermatitis?
15.
At what age is clinically manifested atopic dermatitis?
16.
17.
What is the most common complication of atopic dermatitis?
What course shows corticosteroids in the treatment of atopic dermatitis:
7.3. The final stage.
We estimate the current activities of each student during class, the analysis of student
achievement, announced evaluation of each student and put in the log of visits and student
achievement. Group leader at the same time puts assessment roll of the success and attendance of
students, teacher assures them his signature.
It is advisable to briefly inform students about the topic of the next lesson and instructional
techniques to prepare for it.
8. Applications.
8.1. Theoretical questions preparatory phase:
1. Features collect history of the disease and the history of life.
2. The main complaint of patients with atopic dermatitis, urticaria and food allergies and th.
3. Basic research methods in vivo in vitro.
4. Basic principles of forging capacity and allergic dermatitis.
5. L and forging allergic kropyv'yanok and emergency assistance swelling April and nke.
6. L and forging acute and prolonged expression and food allergies her uu
7. Model and errors in e and ahnostyts and and l and forging and neresp ratornyh and allergic
diseases.
8.2. To formulate a diagnosis according to the clinical classification.
Problem number 1.
A child of 7 years was diagnosed with atopic dermatitis, disseminated form. Doctor prescribed
diet with the exception of the most allergenic food produktiv.Efektu of diet was observed. Why?
A: X tions have started not followed the recommendations, leading to the patient are household
allergens were excluded from the diet cause and meaningful to the patient food allergens
Problem number 2.
The boy 9 years old leather trunk and limbs moderately hyperemic, infiltrated covered papular
elements excoriation. Ut voryuyetsya white dermographism. Sick of early
childhood. Zahos trennya disease occur in violation diet. What kind of disease you might think?
Answer: A topical dermatitis
Problem number 3.
In patients who underwent surgery for acute appendicitis during the third ligation
surgeons found a strong inflammatory skin ar lo wound, the presence of fire blisters and
erosions. Focal cheers tion clearly limited. Put a clinical diagnosis.
Answer:
Contact dermatitis
Problem number 4.
The patient complains of swelling of the face, voice hoarseness, utrud nennya breath,
generalized rash all over his body. An hour before tso ate a small amount of strawberries.
Answer: angioedema
Problem number 5.
'15 The patient appealed to the district physician complaining of shortness of breath,
swelling in the neck and face. Swelling developed gradually after tooth extraction, which was
performed 5 hours ago. The patient entered tavegil 2,0 ml / m, but the symptoms of
breathlessness and swelling continued to increase, reinforced by a cough, hoarseness of voice. In
compiling the history revealed that the patient of 8 years periodically developed swelling of
various sites, whose appearance has always been associated with emotional stress or
trauma. They never accompanied by urticaria and itching. Similar swelling was observed in
grandfather. Allergies, adverse reactions to medications history not found. OBJECTIVE:
swelling occupies a large surface of the neck and face, diffuse, pale, tight on palpation.
.
Answer: angioedema (hereditary) edema caused by C1-inhibitor deficiency of
complement.
Problem number 6.
Baby D, 12 years old, was admitted with complaints of skin rashes, swelling of the
face. Since food intake does not link these symptoms. Acutely ill. When treating perytolom
observed short-term effect, but during treatment persisted drowsiness, weakness. Allergic history
is not burdened.
OBJECTIVE: puffy face, swollen eyelids, on the face, limbs, trunk urticaria rash. There
carious teeth. Cardio-vascular and respiratory organs diseases have been identified.
Examination: blood: 37% eosinophils, with alerhoobstezhenni (methods in vitro) - etiologic agent
was not found.
Preliminary diagnosis of the patient?
A: Acute urticaria (probably not allergic).
Recommended: Survey on enterobiosis three times, giardia.
Problem number 7.
Patient C, 4 years old, appealed with complaints of skin lesions, accompanied by severe itching,
especially at night and morning hours. Sick of 2 years of age. The reduction or even disappearance
of symptoms marks the summer. Adherence to a strict diet to complete disappearance of symptoms
in other months does not.
OBJECTIVE: to elbow, knee bends, the back of the neck, eyelid skin excoriation prevail,
lihenoyidni papules focus lihenyfikatsiyi and infiltration of the skin. Alerhospadkovist burdened
maternal and paternal lines. A careful survey also found out that the boy is constantly stuffy nose
(which the parents were not paying attention). The skin is dry. White Dermographism resistant.
Your diagnosis, plan of survey, treatment plan?
A: Atopic dermatitis, atopic dermatitis, a local form of moderate severity, exacerbation
period. KING (easy course). You must consult your ENT doctor, to skin tests with food,
household, fungal AG. Identify specific IgE. To pass complete blood count, liver ultrasound
done and ZHVSH.
Shown diet therapy, drug therapy (HT, kromony, enzymes, probiotics, intranasal
corticosteroids). Local therapy. Objective: To reduce dryness HTB
9. Suggested Reading
Basic
1.
2.
3.
4.
5.
Learn more
6.
GN Drannyk: Clinical and ymmunolohyya allerholohyya. - C. - 2006.
G. Lolor Jr., T. wiped - Clinical ymmunolohyya and allerholohyya. - M. - 2000.
BM Puhlyk: lekarstvennaja alerhyya. - Kiev. - 2008.
BM Puhlyk: Эlementarnaya allerholohyya. - Vinnitsa. - 2002.
BM Puhlyk: Allergology. - Vinnitsa. - 2004.
Pыtskyy VI, NV Adryanova Allergic disease. - M., 2001.
7.
Roy Patterson, Leslie K. Hrezmer Paul. Allerhycheskye illness (diagnosis and
Treatment). - M. - 2000.
8.
GN Drannyk: Clinical and ymmunolohyya allerholohyya. - C. - 1999.
9.
Nohaller AM Pyschevaya al l erg s i. - On 19 9 3.
Guidelines prepared
Associate IV Korytska
Guidelines approved at a meeting of
"25" 6 0 "2013 , the Protocol № 1
Loading iduvach k afedr and
MD Professor BM Puhlyk