One of the urgent problems of modern pediatric 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, but now there are more and more cases of rashes in newborns.
This article will look at the symptoms and treatment of allergic urticaria in children.
What is hives?
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 (an itchy blister of various sizes), which is an edema of the dermal layer of the skin with hyperemia along the periphery and a pale area in the center. The size of this edema in diameter can vary from 1 mm to 2 cm. This formation has a temporarycharacter and may disappear within a day. If the pathological process spreads to the deep 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 the acute form, characterized by spontaneous development, is approximately 1.5 months. If the child's rash persists for more than 7 weeks, the diagnosis is "chronic urticaria".
Photo of children with allergic urticaria presented.
Clinical Forms
Hives come in 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 (nuts, seafood, fruits, citrus fruits, nutritional supplements, etc.);
- insect poison;
- 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 pathology;
- worm infestations;
- bronchial asthma, atopicdermatitis, 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 tissues.
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 these areas are characterized by the most itching.
As a rule, allergic urticaria in children develops suddenly. Initially, severe 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. Just like papules, puffiness can last up to a day, but at the same time, in some cases, it can linger 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 giant urticaria. This condition is accompanied by the deepest swelling of the skin and loose subcutaneous tissue. A great danger is swelling of the mucous membranes of the respiratory organs. Its characteristic features include difficulty breathing, wheezing, blue nasolabial triangle andsevere paroxysmal cough. In such a situation, the child needs urgent medical care, because in the absence of adequate therapeutic measures, a fatal outcome 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 the inner ear, headache, inhibition of reactions, and nausea develop.
The disease in its acute form is accompanied by fever up to 38 °C, headache, malaise. If, while following the diet and following other medical recommendations, the skin rash in the child does not go away, chronic urticaria is diagnosed. This condition, which occurs, as a rule, with periods of remissions and exacerbations, when infected with a secondary infection, can turn into dermatitis.
Diagnosis of disease
Diagnostic studies include a list of the following activities:
- Collecting an anamnesis (determining the causes that provoked the development of allergic urticaria and clarifying the anamnesis of allergic diseases in the family).
- Physical examination, which evaluates the nature of the rash, localization and size of papules. In addition, during the consultation, the subjective sensations of the patient, the time of disappearance of pathological phenomena on the skin and the possible presence of age spots at the site of the rash are established.
- Assessment of the activity of the pathological process, whichproduced using a special scale Urticaria Activity Score.
- Tests and other laboratory tests that are necessary to determine the causes of skin rashes. These include clinical blood and urine tests, liver enzymes, tests with atopic allergens or autologous serum, total fibrinogen, immunoglobulin, cationic eosinophilic protein.
To clarify the diagnosis of "allergic urticaria", which occurs against the background of high body temperature, are carried out:
- exercise testing (provocative testing);
- dermographism is confirmed by mechanical skin irritation;
- solar urticaria by phototesting;
- aquagenic urticaria with water compresses;
- cold urticaria confirmed by Duncan test (applying an ice cube to the wrist area);
- delayed urticaria occurring several hours after pressure on the skin - suspension test.
If necessary, to determine the causes that could provoke the appearance of a skin rash, an extended examination is recommended (to determine the definition of a parasitic, fungal, bacterial or viral infection, autoimmune or endocrine pathology).
Auxiliary diagnostic studies: X-ray of the sinuses and chest, ultrasound of internal organs, ECG, endoscopy.
If diagnostic tests fail to identify the cause of allergic urticaria inchild, she 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 outside help. However, in such a situation, the main problem is not the rash, but the itching that it provokes. Therefore, when providing initial assistance, the actions of parents are recommended to be directed to its elimination.
The first step is to prevent exposure to an irritant, which can be food, medication or a pet. Further, to reduce the intensity of itching on the skin of a child, it is recommended to apply a non-hormonal antiallergic cream approved for use in children from a very young age (Fenistil, Skin Cap, Gistan, Elidel, Desitin, Potopik and etc.).
In the absence of medication, you can use sunburn creams that also relieve itching, or apply a cool compress to the affected areas of the skin.
If you have an allergic rash, you need to carefully monitor that the child does not scratch the skin, which is necessary to prevent scratching and secondary infection. Cotton clothing is good for reducing irritation and itching.
If a child develops swelling and other negative manifestations (dyspepsia, palpitations, cold sweat, respiratory failure, fainting), it is necessary to urgently call for medical assistance andprovide the child with a drink (slightly alkaline mineral water) and give an enterosorbent (a drug for binding and removing allergens from the digestive tract). In the event that swelling occurs after an injection or insect bite, it is necessary to tightly bandage the place over 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 taken into account in the first place. 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.
As basic therapy medicines, tableted antihistamines are used to relieve signs of acute urticaria. In severe forms of the disease, patients are shown parenteral use of classical first-generation antihistamine fat-soluble drugs, as well as glucocorticosteroids.
Currently, 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 short-term use of traditional antihistamines can lead to the development of side effects (dryness of the oral mucosa, increased sputum viscosity against the background of 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.
Than to treat allergic urticaria in children, every parent should know.
If the pathology was caused by food, along with the use of agents that suppress the effects of free histamines, the child is prescribed sorbents to cleanse the intestines (Laktofiltrum, Enterosgel, Smekta, etc.).
Therapy for urticaria involves the observance of special hypoallergenic diets and the use of pharmacological preparations that are recommended in the treatment of other types of acute urticaria. In the implementation of intoxication therapy, children are prescribed hemodez (drip), soft sorbents, and, if necessary, digestive enzymes. Simultaneously, symptomatic treatment is carried out.
Children with chronic urticaria need constant medication to suppress the effects of free histamine.
In case of a complicated course of autoimmune urticaria, the child needs hospitalization. In this case, plasmapheresis is performed during treatment (a technique for extracorporeal hemacorrection based on the removal of part of the plasma along with antibodies to category E immunoglobulins). With the development of resistance to classical therapy, intravenous administration of immunoglobulins is necessary,activating cyclosporine A and T-suppressors that inhibit mast cell degranulation.
Is it possible to bathe a child with allergic urticaria?
During the period of illness, bathing a child is possible, even necessary. It does not affect the spread of the rash.
Diet for allergic urticaria in children
The list of prohibited foods 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 with milk, cottage cheese, tea, green apple.
Lunch - vegetarian noodle soup, steamed beef patty, boiled rice, compote.
Snack - fermented milk drinks or yogurt.
Dinner - fresh cabbage salad with 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:
- Diet food for hives.
- Exclusion of cross-reactive pharmacological agents.
- Cutting contact with latex, pollen allergens, animals.
- Rehabilitation of foci of infection.
- Optimal room temperature.
- Exclusion of stressful situations.
- For some forms of urticaria, limitation of physical activity.
We reviewed the symptoms, treatment and prevention of allergic urticaria in children.
