Urticaria in children: photos, symptoms, treatment
- What is hives?
- Causes of urticaria in children
- Symptoms of urticaria in children
- Diagnostics of urticaria in children
- First aid for hives
- Treatment of urticaria in children
- Hypoallergenic diet for urticaria in children (according to AD Ado)
- Prevention of exacerbations of urticaria in children
One of the most urgent problems of modern pediatric practice is urticaria , which occurs in 2.1-6.7% of children and adolescents. According to statistical data, the peak incidence falls on the age of 14-40 years, but at the present time there are more frequent cases of the occurrence of characteristic rashes in toddlers and preschool children. How does urticaria look like in children? What are the symptoms of urticaria and how to treat it? The answers to these and other questions will be found below.
What is hives?
Urticaria is a collective name that includes a group of heterogeneous pathologies characterized by the appearance of a diffuse or limited rash with a primary morphological element of the papule (an itching blister of various sizes). It is a limited edema of the dermal layer of the skin with characteristic hyperemia along the periphery and a pale central patch. Dimensions of the edema in diameter can range from a few mm to several cm. This formation has a temporary character, that is, it can disappear within 24 hours. In the case of puffiness spreading to deeper dermal layers, subcutaneous fat and mucous membrane, aponeurotic edema is formed ( Quincke's edema ).
According to the duration of the disease, urticaria is divided into acute and chronic. The duration of an acute form characterized by spontaneous development is no more than 1.5 months. In the event that the rash in a child persists for more than 6 weeks, a chronic urticaria is diagnosed.
Clinical forms of hives:
- Physical (arising under the influence of external factors);
Classification by nomenclature of allergic diseases
- Allergic (IgE-mediated) urticaria.
- Non-allergic (non-IgE-mediated) urticaria.
Causes of urticaria in children
Factors provoking the development of acute urticaria:
- Food products (seafood, nuts, citrus fruits, fruits, food additives, etc.);
- Poison of Hymenoptera;
- Toxins of stinging and poisonous plants;
- Viral infections;
- Intolerance to certain drugs, radiopaque substances and blood components.
Causes of chronic urticaria:
- Environmental factors (water, wind, cold air, insolation, vibration, external pressure, etc.);
- Autoimmune pathologies (collagenoses);
- Glistovye infestations;
- Endocrine pathologies;
- Allergic diseases ( atopic dermatitis , bronchial asthma, pollinosis);
- Chronic bacterial, fungal and viral infections.
The mechanism of development of urticaria is associated with activation of mast cells of the skin and the release of cytoplasmic granules contained in them (degranulation) into surrounding tissues. The histamine (mediator of inflammation) that enters the granules causes the development of clinical symptoms of the disease.
Symptoms of urticaria in children
Urticaria is a disease in which skin rashes are localized on any part of the body, including soles, palms and scalp. It should be emphasized that the greatest number of mast cells is in the region of the head and neck, which is why the itch of the greatest intensity is characteristic for this area.
As a rule, the disease in children begins suddenly. First, a pronounced itch appears on different parts of the skin, and then blisters begin to form. How they look you see in the photo. Papules can be formed not only on skin, but also on mucous integuments. Often, rashes are accompanied by swelling of the lips, eyelids, limbs and even joints. Just like blisters, swelling can persist for up to a day (from a few minutes), but at the same time, sometimes it can linger for up to 48-72 hours.
The most serious and risky condition is the formation of angioedema (Quincke's edema), which some clinicians call giant urticaria. This condition is accompanied by a deeper edema of the dermis and subcutaneous loose fiber. The greatest danger is the swelling of the mucous membrane of the respiratory tract. To its characteristic symptoms include hampered, with a whistling, breathing, cyanosis (cyanosis) of the nasolabial triangle and paroxysmal severe cough. In this situation, the child needs urgent medical assistance, since in the absence of adequate medical measures, a fatal outcome is possible.
If angioneurotic edema affects the mucous membrane of the digestive tract, the patient appears nausea, persistent vomiting, short-term diarrhea is possible. When the inner ear and brain membranes are affected, headache, dizziness, retardation of reactions, nausea and vomiting develop.
The acute form of the disease is accompanied by a rise in body temperature to 38-39 ° C, malaise, headache. Sometimes it is possible to develop Quincke's edema. If, following the recommended diet and other medical recommendations, skin rashes in the child do not pass, chronic urticaria is diagnosed. This condition, which occurs with periods of exacerbations and remissions, may become chronic dermatitis when secondary infection is attached.
Diagnostics of urticaria in children
Diagnostic research includes the following activities:
- Collection of anamnesis (finding out the cause that triggered the development of the disease and clarifying the family history of allergic diseases);
- Physical examination (evaluation of the nature of rashes, localization and size of papules). Also during the consultation, the subjective feelings of the patient, the time of disappearance of the blisters and the possible presence of pigmentation at the site of the rash are elucidated.
- Assessment of the activity of the disease. It is produced using a specially designed Urticaria Activity Score.
- Laboratory studies necessary to determine the cause of skin rashes (clinical blood and urine tests, tests with autologous blood serum and atopic allergens, hepatic enzymes, the level of total immunoglobulin, fibrinogen, eosinophilic cationic protein, etc.).
To confirm the diagnosis of "cholinergic urticaria", which occurs against the background of high body temperature, a test is performed with dynamic physical activity (provocative test);
- Dermographism is confirmed by mechanical skin irritation;
- Solar urticaria - phototesting;
- Aquatic urticaria - application of water compress (+25 C);
- Cold urticaria is confirmed by Duncan-test (ice cube on the wrist);
- Delayed urticaria, which occurs 6-8 hours after vertical pressure on the skin - a dough with suspension of the load;
- If necessary, to determine the causes that triggered the occurrence of skin rashes, it is recommended to undergo an extended examination (for the detection of parasitic, bacterial, fungal or viral infection, endocrine or autoimmune pathology).
- Additional diagnostic tests: ultrasound of internal organs, chest X-ray and paranasal sinuses, ECG, EGDS.
If during the diagnostic examination it was not possible to identify the cause of the disease, hives are considered idiopathic.
First aid for hives
As a rule, with acute urticaria skin rashes pass independently after a few hours or 1-2 days, without outside help. However, in this situation, the main problem is not the rash, but the skin itching that it causes. Therefore, in the provision of first aid, the efforts of parents should be directed at its elimination.
- First of all, it is necessary to prevent the action of an irritating factor (this can be food, medication or a pet). Further, to reduce itching, it is recommended to apply non-hormonal anti-allergic cream to the skin, which is allowed for use in children from an early age (Fenistil, Gistan, Skin Cap, Elidel, Potopik, Desitin, etc.). In the absence of medication, you can use a cream from sunburns that also relieve itching, or apply a cool compress (1 tablespoon of vinegar to 250 ml of water) on the affected area of the skin.
- In the presence of rashes, you must constantly ensure that the child does not comb the skin, to avoid the appearance of scratches, shorten the nails. Cotton clothing also helps to reduce the intensity of itching and irritation.
- In case of development of edema and other negative symptoms (nausea, vomiting, increased heart rate, respiratory failure, cold sticky sweat, fainting), an ambulance team should be urgently called.
- Before the arrival of the ambulance, after stopping contact with the allergen, provide the child with an abundant drink (preferably mineral slightly alkaline water or alkaline solution prepared at home (1 g of baking soda for 1 liter of water)) and give an enterosorbent (a preparation for binding and removing the allergen From the digestive tract). In the event that angioedema occurs after an insect bite or an injection, it is necessary to tightly bandage the place above the bite or injection.
Treatment of urticaria in children
When choosing the tactics of treatment, first of all, the causes and forms of the disease are taken into account. The main principles of therapy used in clinical practice in combating urticaria in children include elimination (exclusion or limitation of the effect of provoking factors), taking medications, as well as treating pathologies that can cause skin rashes.
As drugs of basic therapy, tablets are used antihistamines, which stop the symptoms of acute urticaria. In severe cases, patients are shown parenteral administration of classic fat-soluble antihistamines of the first generation and glucocorticosteroids.
To date, pediatricians rarely prescribe to their patients antihistamines of the first generation, preferring more modern blockers of histamine receptors. This is due to the fact that even a short-term intake of classical antihistamines can lead to the development of side effects (dryness of the oral mucosa, increased sputum viscosity in children with bronchial asthma, increased intraocular pressure, impaired psychomotor and cognitive functions, constipation, urinary retention, etc.). ). At the same time, antihistamines of the second generation are characterized by the absence of side effects, have a high level of safety and are quite convenient to use.
If the urticaria was provoked by food products, along with the intake of funds that suppress the action of free histamine, the child is assigned sorbents for cleaning the intestines (Enterosgel, Lactofiltrum, Smektu, etc.).
Treatment of idiopathic urticaria provides for strict adherence to a hypoallergenic diet and the use of medications recommended for the treatment of other acute urticaria. When carrying out intoxication therapy, the child is assigned soft sorbents, Hemodez (drip), and, if necessary, digestive enzymes. Parallel symptomatic treatment is performed.
Children suffering from chronic urticaria, need a long-term intake of drugs that suppress the action of free histamine.
In a severe course of chronic autoimmune urticaria, a sick child needs hospitalization. In this case, the treatment involves conducting plasmapheresis (an extracorporeal haemocorrection method based on the removal of part of the circulating plasma together with functional antibodies to class E immunoglobulins). With resistance to traditional therapy, intravenous immunoglobulin, activating T-suppressors and cyclosporin A, which suppresses the degranulation of mast cells, is shown.
Hypoallergenic diet for urticaria in children (according to AD Ado)
- Products with flavorings, preservatives and artificial food additives;
- Smoked meat;
- Fish dishes;
- Seasonings and spices (mustard, vinegar, mayonnaise, etc.);
- Butter biscuits;
- Poultry meat;
- Eggplants, tomatoes;
- Strawberries and strawberries;
- Nuts (almonds, peanuts);
- Vegetable and cereal soups (on vegetable or beef broth);
- Boiled beef;
- Boiled potatoes;
- Oil (cream, olive, sunflower);
- Porridge (buckwheat, rice, oatmeal);
- Fresh cucumbers;
- Parsley dill;
- One-day dairy products (cottage cheese, curdled milk);
- White bread (without baking);
- Compotes (cherry, apple, plum, currant, dried fruit);
- Apples (baked);
The diet in food-induced urticaria
If the cause of urticaria is a food allergen, it is recommended to fast for 3-5 days. In parallel, the bowel is cleaned with cleansing enemas. Before fasting, one-time administration of a laxative remedy prescribed by a doctor is possible. The average daily fluid demand in this period is 1.5 liters.
After the fasting is over, the following scheme of feeding the child is developed:
The first two days the patient is given an empty stomach for 100 grams of one kind of product, and then another 200 grams 4 times a day. Every 2-3 days a new ("clean") product is added to the previously assigned product.
For example, in the first 2 days - boiled potatoes, then add to it some other boiled vegetable, then - milk, then bread, beef, etc. Lastly, the child is introduced into the diet of the product that is most likely , Could trigger the occurrence of rashes. The appearance of papular rash after consuming one of the tested products confirms its role in the development of an allergic reaction. This day the child is shown hunger and cleansing enemas without using medicines. For the next 2 days, only previously tested products are allowed.
By means of elimination diets for each particular patient, a basic food ration is created, including the basic food products. On a mandatory basis, parents should maintain a food diary in which the state of the child will be displayed before and after meals, as well as after the introduction of a new food product.
Alternative diet for hives
In the event that skin rashes appear on the background of taking aspirin or NSAIDs (drug urticaria) treatment, first of all, provides for the cancellation of these drugs. At the same time, food products containing salicylates of natural origin (raspberries, strawberries, cherries, grapes, apricots, apples, peaches, cucumbers, tomatoes, potatoes, carrots) should be excluded from the food ration at the same time, and foods with food additives should be avoided (Е102, Е210,212, Е320.321).
Prevention of exacerbations of urticaria in children
- Complete elimination of contact with the allergen;
- Conducting support courses of allergen-specific immunotherapy;
- Compliance with elimination diet and exclusion from the diet of the child of products that cause the occurrence of skin rashes;
- Refusal to use drugs that trigger the development of allergic reactions;
- Timely treatment of pathologies of the nervous system and digestive tract.
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