One of the urgent problems of modern pediatrics practice is allergic urticaria in children, which occurs in 2.3-6.8% of cases. According to statistics, the peak incidence occurs at the age of 1-13 years, however, now there are more and more cases of rash in children of newborn age.
In the article, we consider the symptoms and treatment of allergic urticaria in children.
What is urticaria?
Urticaria is a common name that includes a group of heterogeneous pathological phenomena characterized by the development of a limited or diffuse rash with the presence of a primary morphological element - a papule (itchy blister of various sizes), which is a swelling of the dermal layer of the skin with hyperemia on the periphery and a pale area in the center. The dimensions of this edema in diameter can vary from 1 mm to 2 cm. This formation is temporary and may disappear within a day. In the case of the spread of the pathological process to the deeper layers of the skin, subcutaneous tissue and mucous membranes, aponeurotic edema develops.
According to the duration of the course, allergic urticaria in children is divided into chronic and acute. The duration of the pathology in acute form, characterized by spontaneous development, is approximately 1.5 months. If the rashes in the child persist for more than 7 weeks, the diagnosis of chronic urticaria is made.
A photo of children with allergic urticaria is presented.
Clinical forms
Urticaria is of several varieties:
- physical, which occurs under the influence of external factors;
- spontaneous
- contact.
Acute allergic urticaria in a child can be an independent disease or a symptom of another pathology.
Causes of occurrence
Factors that provoke the development of acute allergic urticaria in children:
- food products (nuts, seafood, fruits, citrus fruits, food additives, etc.);
- insect venom;
- toxins of poisonous and stinging plants;
- viral and bacterial infections;
- intolerance to certain medications, radiopaque substances;
- environmental factors (wind, water, cold air, vibration, insolation);
- autoimmune diseases (collagenoses);
- endocrine pathologies;
- helminthic infestations;
- bronchial asthma, atopic dermatitis, hay fever.
The mechanism of development of allergic urticaria is due to the activation of mast cells and the release of cytoplasmic granules present in them into the surrounding tissue.
Symptoms
Urticaria is a pathological process in which skin rashes are located on any part of the body, including the feet, palms and head. It should be noted that the largest number of mast cells is localized in the neck and head, and therefore itching is most characteristic of these areas.
As a rule, allergic urticaria in children develops suddenly. Initially, pronounced itching occurs in different parts of the skin, and then blisters begin to form. Papules can form not only on the skin, but also on the mucous membranes. Often, such an allergic rash is accompanied by swelling of the lips, eyelids, legs, and even joints. Like papules, puffiness can persist for up to a day, but at the same time, in some cases, it can be delayed up to 72 hours.
Symptoms of allergic urticaria in children should not be ignored. The most risky and serious condition is the development of angioedema, which some doctors call a giant urticaria. This condition is accompanied by the most profound swelling of the skin and loose subcutaneous tissue. A great danger is the swelling of the mucous membranes of the respiratory organs. Its characteristic features include difficulty breathing, with a whistle, a bluish nasolabial triangle and a strong paroxysmal cough. In such a situation, the child needs urgent medical attention, since in the absence of adequate therapeutic measures, death is possible.
If angioedema affects the mucous membrane of the digestive tract, the patient develops persistent vomiting, nausea, and short-term diarrhea is possible. With damage to the meninges and inner ear, headache, inhibition of reactions, and nausea develop.
The disease in acute form is accompanied by fever up to 38 ° C, headache, malaise. If, following the dietary regimen and other medical recommendations, skin rashes in the child do not go away, the urticaria of a chronic form is diagnosed. This condition, which occurs, as a rule, with periods of remissions and exacerbations, when infected with a secondary infection, can go into dermatitis.
Diagnosis of the disease
Diagnostic tests include a list of the following activities:
- Anamnesis (identification of the reasons that provoked the development of allergic urticaria and clarification of the anamnesis for allergic diseases in the family).
- Physical examination, in which the nature of the rashes, localization and size of the papules are assessed. In addition, during the consultation, subjective sensations of the patient, the time of disappearance of pathological phenomena on the skin and the possible presence of pigment spots on the site of the rash are established.
- Assessment of the activity of the pathological process, which is performed using a special scale Urticaria Activity Score.
- Analyzes and other laboratory tests that are necessary to determine the causes of skin rashes. These include clinical studies of blood and urine, liver enzymes, tests with atopic allergens or autologous blood serum, the level of total fibrinogen, immunoglobulin, cationic eosinophilic protein.
To clarify the diagnosis of "allergic urticaria", which occurs against a background of high body temperature, are carried out:
- physical exercise tests (provocative testing);
- dermographism is confirmed by mechanical skin irritation;
- solar urticaria using photo testing;
- aquagenic urticaria by applying water compresses;
- cold urticaria is confirmed with the help of the Duncan test (application of an ice cube to the wrist);
- Slow urticaria, occurring several hours after pressure on the skin, by testing with suspension of loads.
If necessary, to establish the reasons that could provoke the occurrence of a skin rash, it is recommended to conduct an extended examination (to determine parasitic, fungal, bacterial or viral infections, autoimmune or endocrine pathologies).
Ancillary diagnostic tests: X-ray of the sinuses of the nose and chest, ultrasound of the internal organs, ECG, endoscopy.
If during the diagnostic tests it is not possible to identify the cause of the allergic urticaria in the child, it is considered idiopathic.
First aid
As a rule, in acute forms of this pathological process, skin rashes disappear on their own after 2 days, often without assistance. However, in such a situation, the main problem is not rashes, but skin pruritus, which it provokes. Therefore, when providing initial assistance, the actions of parents are recommended to be directed to its elimination.
First of all, it is necessary to prevent the effect of an irritating factor, which may be a food, medication or pet. Further, to reduce the intensity of itching on the skin of the child, it is recommended to apply a non-hormonal anti-allergic cream that is approved for use in children from a very young age (Fenistil, Skin Cap, Gistan, Elidel, Desitin, Potopik and other).
In the absence of medications, you can use sunburn creams that also relieve itching, or apply a cool compress to the affected areas of the skin.
In the presence of an allergic rash, it is necessary to carefully monitor that the child does not scratch the skin, which is necessary to prevent scratching and secondary infection. Cotton clothing well helps reduce irritation and the intensity of itching.
If the child develops puffiness and other negative manifestations (dyspepsia, palpitations, cold sweat, respiratory failure, fainting), urgent medical attention must be given and the child should be given a drink (slightly alkaline mineral water) and given enterosorbent (a medication to bind and remove allergens from the digestive tract) tract). If swelling occurs after an injection or an insect bite, it is necessary to tightly bandage the area above the injection or bite.
Treatment of allergic urticaria in children
When choosing a therapeutic tactic, the main causes and forms of the pathological process are primarily taken into account. The main principles of treatment used in clinical practice to combat allergic urticaria in a child include elimination (limiting or eliminating the influence of provoking factors), taking medications, as well as treating other pathologies that could cause the development of skin rashes.
Tablets of antihistamines that stop the signs of acute urticaria are used as basic therapy drugs. In severe forms of the disease, patients are shown parenteral use of the classic first-generation antihistamine fat-soluble drugs, as well as glucocorticosteroids.
At the moment, pediatricians in the treatment of allergic urticaria in children rarely prescribe first-generation antihistamines, preferring more modern histamine receptor blockers. This is due to the fact that even a short-term intake of traditional antihistamines can lead to the development of side effects (dry oral mucosa, increased sputum viscosity due to bronchial asthma, increased intraocular pressure, changes in cognitive and psychomotor functions, stool disorders, urinary retention, etc. .). At the same time, second generation antihistamines are distinguished by the absence of adverse reactions, have high safety and are very convenient to use.
How to treat allergic urticaria in children, every parent should know.
If the pathology was caused by food products, along with the use of drugs that suppress the effects of free histamines, sorbents are used for cleansing the intestines (Lactofiltrum, Enterosgel, Smecta, etc.).
Therapy of urticaria involves the observance of special hypoallergenic diets and the use of pharmacological drugs, which are recommended in the treatment of other varieties of acute urticaria. When carrying out intoxication therapy, children are prescribed hemodesis (drip), soft sorbents, and, if necessary, digestion enzymes. At the same time, symptomatic treatment is carried out.
Children with chronic urticaria need constant use of medications that suppress the effects of free histamine.
With a complex course of autoimmune urticaria, the child needs hospitalization. In this case, plasmapheresis is performed during treatment (extracorporeal hemacorrection technique, based on the removal of part of the plasma together with antibodies to immunoglobulins of category E). With the development of resistance to classical therapy, intravenous administration of immunoglobulins that activate cyclosporin A and T-suppressors that suppress mast cell degranulation is necessary.
Can I bathe a child with allergic urticaria?
During the period of the disease, it is possible, even necessary, to bathe the child. This does not affect the spread of the rash.
Diet for allergic urticaria in children
The list of products prohibited for allergic urticaria includes:
- chocolate;
- seafood;
- smoked meats;
- fish;
- spices and seasonings;
- eggs
- spices;
- muffin;
- honey;
- mushrooms;
- poultry meat;
- citrus;
- Tomatoes
- berries;
- nuts.
Approximate Menu
Breakfast - buckwheat porridge in milk, cottage cheese, tea, green apple.
Lunch - vegetarian noodle soup, steamed beef cutlet, boiled rice, stewed fruit.
Snack - sour-milk drinks or yogurt.
Dinner - fresh cabbage salad in vegetable oil, boiled potatoes, meat.
Prevention of symptoms of allergic urticaria in children is very important.
Prevention
Its purpose is to eliminate all factors that cause an allergic response. It is important to do the following:
- Dietary nutrition for urticaria.
- Exclusion of cross-reactive pharmacological agents.
- Termination of contact with latex, pollen allergens, animals.
- Remediation of foci of infection.
- Optimum temperature in the room.
- Exclusion of stressful situations.
- In some forms of urticaria, a limitation of physical activity.
We examined the symptoms of treatment and prevention of allergic urticaria in children.