Allergic diseases op. Mouth Allergy: Symptoms, Treatment and Tips

Allergic diseases of the oral cavity

What is Allergic Oral Diseases?

Allergic diseases are now widespread, and their number is constantly increasing and, which is especially dangerous, the severity of the course is aggravated.

Allergy- this is an increased and, consequently, altered sensitivity of the body to certain substances of an antigenic nature, which do not cause painful phenomena in normal individuals. An important role in the development of allergies is given to the state of the nervous, endocrine systems, pathology of the gastrointestinal tract.

What provokes / Causes of Allergic diseases of the oral cavity:

The reasons for such a wide spread of allergic diseases are different. Pollution plays a major role in this. environment waste emissions from industrial enterprises, exhaust gases, the use of pesticides, herbicides in agriculture, etc. The rapid development of the chemical industry and the associated appearance in everyday life and production of many synthetic materials, dyes, washing powders, cosmetics and other substances, many of which are allergens, also contribute to the spread of allergic diseases.

The widespread and often uncontrolled use of drugs also leads to an increase in the number of allergic reactions. Hypersensitivity to medicinal substances often occurs due to the unreasonable use of several drugs at the same time (polypharmacy), and sometimes due to insufficient knowledge by doctors of the pharmacokinetics of the prescribed drug, etc.

In the occurrence of allergic diseases, the influence of climatic factors (increased insolation, humidity), heredity, general somatic pathology, the nature of nutrition, etc., also play a role.

Allergies can be caused by various substances - from simple chemical compounds (iodine, bromine) to the most complex ones (proteins, polysaccharides, as well as their combinations), which, when ingested, cause an immune response of a humoral or cellular type. Substances that can cause an allergic reaction are called allergens. The number of allergens in nature is large, they are diverse in composition and properties. Some of them enter the body from the outside, they are called exoallergens, others are formed in the body and represent the body's own, but modified proteins - endoallergens, or autoallergens.

Pathogenesis (what happens?) during Allergic diseases of the oral cavity:

Exoalpergens There are non-infectious origin (plant pollen, household dust, animal hair, medicines, foodstuffs, washing powders, etc.) and infectious (bacteria, viruses, fungi and their metabolic products. Exoallergens enter the body through Airways, digestive tract, skin and mucous membranes, causing damage to various organs and systems.

Endoallergens are formed in the body from its own proteins under the influence of various damaging factors, which can be bacterial antigens and their toxins, viruses, thermal effects (burns, cooling), ionizing radiation, etc.

Allergens can be complete antigens and incomplete - haptens. Haptens can cause an allergic reaction by binding to body macromolecules that induce antibody production; in this case, the specificity of the immune reaction will be directed against the hapten, and not against its carrier. During the formation of complete antigens, antibodies are formed to the complexes, and not to their components.

Due to the large number of allergens found in nature and formed in the body, the manifestations of allergic reactions are also diverse. However, even allergic reactions that differ in clinical manifestations have common pathogenic mechanisms. There are three stages of allergic reactions: immunological, pathochemical (biochemical) and pathophysiological, or the stage of functional and structural disorders.

The immunological stage begins with the contact of the allergen with the body, resulting in its sensitization, i.e. the formation of antibodies or sensitized lymphocytes that can interact with this allergen. If by the time the antibodies are formed, the allergen is removed from the body, no painful manifestations occur. The first introduction of an allergen into the body has a sensitizing effect. With repeated exposure to an allergen in an organism already sensitized to it, an allergen-antibody complex or an allergen-sensitized lymphocyte complex is formed. From this moment, the pathochemical stage of the allergic reaction begins, characterized by the release of biologically active substances, allergy mediators: histamine, serotonin, bradykinin, etc.

The pathophysiological stage of an allergic reaction, or the stage of clinical manifestation of damage, is the result of the action of isolated biologically active substances on tissues, organs and the body as a whole. This stage is characterized by circulatory disorders, spasm of the smooth muscles of the bronchi, intestines, changes in the composition of blood serum, impaired coagulability, cell cytolysis, etc.

According to the mechanism of development, 4 types of allergic reactions are distinguished: I - reaction immediate type(reagin type); II - cytotoxic type; III - tissue damage by immune complexes (Arthus type); IV - delayed type reaction (cellular hypersensitivity). Each of these types has a special immune mechanism and a set of mediators inherent in it, which determines the features of the clinical picture of the disease.

Allergic reaction type I, also called anaphylactic, or atopic, type of reaction. It develops with the formation of antibodies, called reagins, belonging mainly to the class IgE and IgG. Reagins are fixed on mast cells and basophilic leukocytes. When reagins are combined with the corresponding allergen, mediators are released from these cells: histamine, heparin, serotonin, platelet-activating factor, prostaglandins, leukotrienes, etc., which determine clinical picture an immediate allergic reaction. After exposure to a specific allergen clinical manifestations reactions occur after 15-20 minutes; hence its name "immediate type reaction".

Allergic reaction type II, or cytotoxic, characterized by the fact that antibodies are formed to tissue cells and are mainly represented by IgG and IgM. This type of reaction is caused only by antibodies capable of activating complement. Antibodies bind to mutated cells in the body, which leads to complement activation, which also causes damage and even destruction of cells. As a result of the cytotoxic type of allergic reaction, cells are destroyed, followed by phagocytosis and removal of destroyed cells and tissues. The cytotoxic type of reactions include drug allergy, characterized by leukopenia, thrombocytopenia, hemolytic anemia.

Type III allergic reaction, or tissue damage by immune complexes (Arthus type, immunocomplex type), occurs as a result of the formation of circulating immune complexes, which include antibodies of the IgG and IgM classes. Antibodies of this class are called precipitating, since they form a precipitate when combined with the corresponding antigen. Allergens in this type of reaction can be bacterial, food.

This type of reaction is leading in the development of serum sickness, allergic alveolitis, in some cases drug and food allergies, a number of autoallergic diseases (systemic lupus erythematosus, rheumatoid arthritis, etc.).

Allergic reaction type IV, or a delayed-type allergic reaction (delayed-type hypersensitivity, cellular hypersensitivity), in which the role of antibodies is performed by sensitized

Tlymphocytes, having receptors on their membranes that can specifically interact with the sensitizing antigen. When such a lymphocyte is combined with an allergen, which can be in a dissolved form or be on the cells, mediators are released. cellular immunity- lymphokines. More than 30 lymphokines are known, which manifest their effect in various combinations and concentrations depending on the characteristics of the allergen, the genotype of lymphocytes and other conditions. Lymphokines cause the accumulation of macrophages and other lymphocytes, resulting in inflammation. One of the main functions of mediators is their involvement in the process of destruction of the antigen (microorganisms or foreign cells) to which lymphocytes are sensitized. If a transplant of foreign tissue acts as an antigenic substance that stimulated delayed-type hypersensitivity, then it is destroyed and rejected. A delayed-type reaction develops in a sensitized organism, usually 24-48 hours after contact with the allergen. The cellular type of reaction underlies the development of most viral and some bacterial infections (tuberculosis, syphilis, leprosy, brucellosis, tularemia), some forms of infectious-allergic bronchial asthma, rhinitis, transplantation and antitumor immunity.

The type of development of an allergic reaction is determined by the nature and properties of antigens, as well as the state of the body's reactivity.

Symptoms of allergic diseases of the oral cavity:

Specific Diagnosis allergic diseases consists of collecting an allergic history, conducting diagnostic tests and laboratory tests.

When collecting an allergic history, it is necessary to focus on identifying the totality of household and industrial contacts with various substances that can act as allergens. Along with this, the anamnesis allows you to establish the presence of an allergic predisposition (hereditary or acquired), as well as possible exogenous and endogenous factors affecting the course of the disease (climatic, endocrine, mental, etc.). When collecting an anamnesis, it is necessary to find out how the patient reacts to the introduction of vaccines, sera, medication, and the circumstances of the exacerbation, as well as housing and working conditions.

It is very important to identify professional contacts with various substances. Exposure to simple chemicals is known to be more likely to cause delayed-type allergic reactions ( contact dermatitis). Complex organic substances can cause immediate allergic reactions with the development of diseases such as Quincke's edema, urticaria, allergic rhinitis, bronchial asthma, etc.

A carefully collected history suggests a possible type of allergic reaction and a likely allergen. The specific allergen that causes the development of the disease is established using special diagnostic tests and laboratory tests.

Skin diagnostic tests are a method for detecting specific sensitization of the body.

Allergic diagnostic tests are performed outside the phase of exacerbation of the disease 2-3 weeks after the acute allergic reaction, during the period when the body's sensitivity to the allergen decreases.

Skin tests are based on the identification of a specific sensitization of the body by introducing an allergen through the skin and assessing the nature of the developing inflammatory reaction. There are the following methods for performing skin tests: application, scarification and intradermal. The choice of skin testing method is determined by the nature of the disease, the type of allergic reaction and the group affiliation of the tested allergen. Yes, for diagnosis. drug allergy the most convenient application tests. Determination of hypersensitivity to allergens of bacterial and fungal origin is carried out by the method of intradermal tests.

Provocative tests are carried out in cases where the data of the allergic anamnesis do not correspond to the results of skin tests. Provocative tests are based on the reproduction of an allergic reaction by introducing an allergen into an organ or tissue, the defeat of which is the leading one in the clinical picture of the disease. There are nasal, conjunctival and inhalation provocative tests. Provocative tests also include cold and heat, used for cold and heat urticaria.

Specific diagnostics of allergic reactions is also carried out by laboratory research methods: the degranulation reaction of basophilic leukocytes (Shelley test), the reaction of blast transformation of leukocytes, the reaction of damage to neutrophils, the reaction of leukocytolysis, etc. The advantage of in vitro diagnostic methods for allergic reactions is the absence of the risk of occurrence anaphylactic shock.

Which doctors should you contact if you have Allergic diseases of the oral cavity:

Allergist

Are you worried about something? Do you want to know more detailed information about Allergic diseases of the oral cavity, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can book an appointment with a doctor– clinic Eurolaboratory always at your service! The best doctors examine you, study external signs and help identify the disease by symptoms, advise you and provide needed help and make a diagnosis. you also can call a doctor at home. Clinic Eurolaboratory open for you around the clock.

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If you have previously performed any research, be sure to take their results to a consultation with a doctor. If the studies have not been completed, we will do everything necessary in our clinic or with our colleagues in other clinics.

You? You need to be very careful about your overall health. People don't pay enough attention disease symptoms and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific signs, characteristic external manifestations - the so-called disease symptoms. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to several times a year be examined by a doctor not only to prevent a terrible disease, but also to maintain a healthy spirit in the body and the body as a whole.

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Other diseases from the group Diseases of the teeth and oral cavity:

Motivational characteristics of the topic of the lesson: as a result of the practical lesson, the interns should acquire the following practical and theoretical skills: to study the basic and additional methods studies of children with allergic lesions of the oral mucosa; based on the data obtained and the collection of anamnesis, be able to make a preliminary diagnosis; draw up a treatment plan taking into account the age of the child; Know the indications and contraindications medicines with this pathology. It seems to be related to pollution...

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State budget educational

institution of higher vocational education

"Voronezh State Medical Academy

named after N.N. Burdenko" of the Ministry of Health

Russian Federation

Department of Faculty Dentistry

APPROVE

Department head

Faculty of Dentistry

MD prof. ____________ V.A. Kunin

"______" _________ 2014

PRACTICAL LESSON OF INTERNS #9:

Voronezh 2014

Lesson topic: Allergic lesions of the oral mucosa in children.

Target : to study the main manifestations of allergic lesions of the oral mucosa in children.

Motivational characteristics of the topic of the lesson:as a result of the practical training, interns should acquire the following practical and theoretical skills: to study the basic and additional methods of examining children with allergic lesions of the oral mucosa; based on the data obtained and the collection of anamnesis, be able to make a preliminary diagnosis; draw up a treatment plan taking into account the age of the child; know the indications and contraindications for the use of drugs in this pathology.

Chronocard.

Theory of occupation.

Classification of allergic lesions of the oral mucosa in children.

1) diseases associated with an immediate hypersensitivity reaction:

• anaphylactic shock;
• hives;

2) diseases associated with a delayed-type hypersensitivity reaction:

Common toxic-allergic stomatitis (catarrhal, catarrhal-hemorrhagic, erosive-ulcerative, ulcerative-necrotic stomatitis, cheilitis, glossitis, gingivitis);

3) systemic toxic-allergic diseases:

• Lyell's disease;
• Stevens-Johnson syndrome;
• Behçet's syndrome;
• Sjögren's syndrome.

Allergic diseases among children are now widespread, their number and severity are constantly growing. This is apparently due to environmental pollution with exhaust gases, waste from industrial enterprises, the appearance in everyday life of many synthetic materials, dyes and other substances that are allergens, and therefore contribute to the spread of allergic diseases.

The widespread and uncontrolled use of drugs also leads to an increase in the number of allergic reactions. Hypersensitivity to medicinal substances often occurs due to the unreasonable use of several drugs at the same time (polypharmacy), uncontrolled intake antibiotics, insufficient knowledge by doctors of the pharmacokinetics of the drug. In the occurrence of allergic diseases, the influence of climatic factors, heredity, general somatic pathology, the nature of nutrition, etc. play a role.

So allergy. it is a pathologically increased and perverted reaction of the body to certain substances of an antigenic nature, which in normal individuals do not cause painful phenomena.

An important role in the development of allergies is given to the state of the nervous, endocrine systems, pathology of the gastrointestinal tract, etc.

Allergies can be caused by various substances that, when ingested, cause an immune response of a humoral or cellular type.

So, substances that can cause an allergic reaction are called allergens.

It should be noted that some of them enter the body from the outside exoallergens ; non-infectious origin plant pollen, household dust, animal hair, medicinal substances, food products; infectious origin viruses, microorganisms, fungi, their metabolic products; through the respiratory tract, digestive tract, skin and mucous membranes. Other allergens endoallergens own, but modified body proteins (autoallergens), they are primary (natural) lens, thyroglobulin, which normally do not cause an immune response, since, apparently, they do not come into contact with lymphocytes or they have an innate tolerance. Under the influence of infection, enzymes or trauma, this physiological isolation is broken or the antigenic structure of these organs changes, they begin to be perceived as foreign, antibodies begin to be produced against them, autoimmune processes develop; there are secondary endoallergens that are formed in the body when metabolic processes are disturbed under the influence of non-infectious and infectious factors (burns, cooling, ionizing radiation, microorganisms, viruses, fungi, etc.). Allergens can be complete antigens and incomplete haptens. Haptens can cause: an allergic reaction by combining with body macromolecules that induce the production of antibodies, while the specificity of the immune reaction is directed against the hapten, and not against its carrier; the formation of antigenic complexes with body molecules, while antibodies are formed only to the complexes, and not to its components.

Starting a conversation about the pathogenetic mechanisms of allergic reactions, one cannot help but dwell on the basic concepts of allergology and immunology, as follows:

Antibodies globulin molecules specifically altered as a result of antigenic stimulation. Antibodies are:

• cellular, fixed in cells;
• anaphylactic (aggressive);
• blocking (block allergens without causing allergies);
• humoral or free (in the blood);
• witnesses (do not participate in the reaction).

Allergy is based on an antigen-antibody reaction ( AT AT ), during which AT specifically interact with AG.

pathogenic mechanisms.Allergic reactions are immediate, delayed and mixed type. In the pathogenesis of allergic reactions of the immediate type, A.D. Ado (1978) distinguishes three stages: immunological, pathochemical (biochemical) and pathophysiological (stage of functional and structural disorders).

1. Immunological stagebegins with the contact of the allergen with the body, resulting in the sensitization of the latter, i.e. education AT capable of interacting with the allergen. If by the time of formation AT the allergen is removed from the body, no painful manifestations occur. The first introduction of an allergen into the body has a sensitizing effect. With repeated exposure to the allergen in the body already sensitized to it, the “allergen AT” complex is formed. In other words, at this stage, on the territory of “shock tissues”, organs, the reaction of AG AT.

2. pathochemical stagecharacterized by the release of biologically active substances (BAS), allergy mediators: histamine, serotonin, bradykinin, acetylcholine, heparin, MRS Felberg ("shock poisons"). This process occurs as a result of allergic alteration by the AG complex. AT tissues rich in mast cells (skin vessels, serous membranes, loose connective tissue, etc.).

At the same time, the mechanisms of their inactivation are inhibited, the histamino- and serotonin-opectic properties of blood decrease, the activity of histaminase, cholesterase, etc.

3. Pathophysiological stageis the result of the action of "shock poisons" on tissue-effectors. This stage is characterized by a disorder of blood formation, spasm of the smooth muscles of the bronchi, intestines, a change in the composition of the blood serum, a violation of its coagulability, cell cytolysis, etc.

According to the mechanism of development, 4 types of allergic reactions are distinguished:

1. Type I allergic reaction (immediate type reaction,
reaginic, anaphylactic, atonic type).

It develops with the formation of AT-reagins belonging to the class IgE and IgG 4. They are fixed on mast cells and basophilic leukocytes. When reagins are combined with an allergen, mediators are released from these cells: histamine, heparin, serotonin, platelet-activating factor, prostaglandins, leukotrienes, etc., which determine the clinic of an immediate allergic reaction. After contact with a specific allergen, the clinical manifestations of the reaction occur through 15 -20 min.

2. Allergic reaction type 11 (cytotoxic type).

The type is characterized by AT are formed to tissue cells and are presented IgG and IgM . This type of reaction is called only AT capable of activating complement. AT combine with mutated cells of the body, which leads to a complement activation reaction, which also causes damage and destruction of cells, followed by phagocytosis and their removal. It is by the cytotoxic type that drug allergy develops.

3. Type III allergic reaction (tissue damage by immune complexes - Arthus type, immunocomplex type).

Occurs as a result of the formation of circulating immune complexes, which include IgG and IgM. AT This class is called precipitating, as they form a precipitate when combined with AG. This type of reaction is leading in the development of serum sickness, allergic alveolitis, drug and food allergies, in a number of autoallergic diseases (SLE, rheumatoid arthritis, etc.).

4. Type IV allergic reaction, or delayed-type allergic reaction (delayed-type hypersensitivity, cellular hypersensitivity).

In this type of reaction, the role AT perform sensitized T-lymphocytes that have receptors on their membranes that can specifically interact with sensitizing antigens. When a lymphocyte is combined with an allergen, mediators of cellular immunity, lymphokines, are released. They cause the accumulation of macrophages and other lymphocytes, resulting in inflammation. One of the functions of mediators is their involvement in the process of destruction of AG (microorganisms or foreign cells), to which lymphocytes are sensitized. Delayed-type reactions develop in a sensitized organism 24-48 hours after contact with the allergen. The cellular type of reaction underlies the development of viral and bacterial infections (tuberculosis, syphilis, leprosy, brucellosis, tularemia), some forms of infectious-allergic bronchial asthma, rhinitis, transplantation and antitumor immunity.

The pathogenesis of delayed-type allergic reactions is due to the interaction of sensitized lymphocytes with a specific allergen. The resulting mediators of cellular immunity act on macrophages, involve them in the process of destruction of AG, against which lymphocytes are sensitized. Clinically, this is manifested by the development of hyperergic inflammation: a cellular infiltrate is formed, the cellular basis of which is mononuclear cells - lymphocytes and monocytes. Mononuclear infiltration is expressed around small blood vessels. It should be noted that fibrinoid degeneration is most characteristic of this allergic inflammation. Allergic inflammation is regulated by the nervous system, and its intensity depends on the reactivity of the body.

Immediate type hypersensitivity reactions:

• anaphylactic shock;
• angioedema angioedema;
• hives.

Anaphylactic shock.

It does not have specific manifestations in the OM, but is the most formidable allergic disease, often leading to death. Its main feature is the suddenness of its occurrence. A well-known risk factor is the method of drug administration, so due to parenteral, especially intravenous, administration of drugs, shock develops more often, and the severity of the anaphylactic reaction is more pronounced. The rate of development of an anaphylactic reaction also depends on the degree of sensitization of the organism. For example, it can start in 1,5 hours after intramuscular injection streptomycin.

So, anaphylactic shock refers to an allergic reaction of an immediate type, which is based on the formation of AT-reagins.

Clinic.

Clinical manifestations of anaphylactic shock are varied, may have several clinical options:

1 .Hemodynamic variant with a predominance of symptoms of acute cardiovascular insufficiency: weak rapid pulse, hyperemia skin, alternating with blanching, profuse sweating, drop in blood pressure, the patient loses consciousness.

2. Cerebral variant. Sick children become restless, there is a feeling of fear, convulsions, symptoms of cerebral edema (headache, vomiting, epileptiform seizures, hemiplegia, aphasia, etc.).

3. Asphyxic variant dominated by respiratory disorders (bronchospasm, symptoms of laryngeal and pulmonary edema).

4. Abdominal variant gastrointestinal disorders prevail (nausea, vomiting, diarrhea, pain in the stomach, intestines).

The time of development of anaphylactic shock from the moment of administration of hypertension to the appearance of clinical signs ranges from several minutes to half an hour. The shorter the latent period, the more difficult it is. There are three degrees of severity of anaphylactic shock: mild, moderate, severe. According to the speed of the flow, fulminant, recurrent, abortive shock is distinguished.

Typical manifestations anaphylactic shock is characterized by the following clinical symptoms: there is a state of discomfort, anxiety with a feeling of fear of death. There is a "feeling of heat". Children complain of itching, tingling of the skin of the face, hands, sudden onset of weakness, headaches, dizziness, heaviness behind the sternum, pain in the heart, palpitations, interruptions, shortness of breath, pain in the abdominal region, nausea, sudden deterioration in vision, congestion in ears, paresthesia, numbness of the tongue.

Objective symptoms are hyperemia of the skin of the face and body, alternating with pallor and cyanosis, swelling of the eyelids, red border of the lips, oral mucosa. There are clonic convulsions of the extremities, extended convulsive seizures, motor restlessness. The pupils are dilated and do not react to light. Cardiovascular and hemodynamic disorders develop: profuse sweating, weakening of cardiac activity - muffled heart sounds, frequent thready pulse, tachycardia. Arterial pressure decreases rapidly, diastolic may not be determined. There is shortness of breath, shortness of breath with wheezing, foam from the mouth. Gastrointestinal disorders appear in the form of spastic abdominal pain, vomiting, diarrhea mixed with blood. There are spasms of smooth muscles, which is accompanied by neuropsychic disorders in the form of excitation, followed by indifference, headache, impaired vision, hearing, balance. The outcome of anaphylactic shock depends on the severity of the course, the severity of the clinical picture, the timeliness and usefulness of the therapy.

Differential Diagnosiscarried out with acute heart failure, myocardial infarction, epilepsy (in the presence of convulsions).

Treatment.

The fight against anaphylactic shock should begin immediately at the first signs of anaphylaxis and should be aimed at:

1) cessation of further entry of the allergen into the body
or a decrease in its absorption (if the drug has already been administered). For
which is higher than the injection site, a tourniquet is applied or chipped 0.3-0.5
ml of 0.1% adrenaline solution;

1. the child is given a horizontal position on his back with his head down, pushing lower jaw forward to prevent asphyxia due to retraction of the tongue or aspiration of vomit, release the neck, chest, stomach, provide an influx of oxygen. In the absence of spontaneous breathing, mechanical ventilation is started;
2. increase blood pressure by introducing sympathomimetics: subcutaneously or intramuscularly 0.5 ml of a 0.1% solution of adrenaline or 0.3-1.0 ml of a 0.1% solution of mezaton. This is done with the obligatory control of blood pressure.

4) Antihistamines are administered after normalization of blood pressure intramuscularly 1% diphenhydramine solution, 2.5% diprazine solution, suprastin, etc. In severe cases, glucocorticoid preparations are used: hydrocortisone hemisuccinate 50-150 ml intravenously in 5% glucose solution or physiological saline. The introduction of glucocorticoids is carried out to restore pituitary-adrenal insufficiency - prednisolone 1-2 ml per 1 kg of body weight, 4-2 0 ml of dexamethasone.

5) For the relief of bronchospasm, a 2.4% solution of aminophylline is used intravenously, 5-10 ml in 10 ml of isotonic sodium chloride solution, in 10 ml of 10% or 40% glucose solution.

6) In the presence of convulsions and increased arousal, antipsychotics and tranquilizers are used (seduxen, relanium, elenium, droperidol).

It should be noted that if first aid is provided on the spot, then further treatment requires the child to be hospitalized in a hospital, for which it is necessary to call an ambulance.

Quincke's angioedema.

This is a disease characterized by acute development of limited deep edema of the skin and subcutaneous tissue or OOP of the lips, eyes, larynx, bronchi, genitals. (This is swelling of the connective tissue layer and hypodermis or submucosal layer). First described by the German therapist Quincke (1862). Under the influence of biologically active substances released during an allergic reaction in a previously sensitized organism, an increase in the permeability of microvessels occurs and tissue edema develops. The reason for it may be exposure to food, drug allergens (sulfonamides, antibiotics, acetylsalicylic acid, bromides, etc.). Of particular importance in the pathogenesis is given to heredity, increased excitability of the autonomic nervous system, foci chronic infection, diseases of the gastrointestinal tract.

Clinic.

The disease begins suddenly. Within a few minutes, a pronounced limited edema develops in various parts of the face, oral mucosa. Skin color or RDA does not change. In the area of ​​edema, tissue tension of an elastic consistency is noted, with pressure, the fossa does not remain, palpation of the swelling is painless. Quincke's edema is most often located on the lower lip, eyelids, tongue, cheeks, larynx, and edema of the larynx and tongue can lead to the development of asphyxia - difficulty breathing occurs, aphonia develops, cyanosis of the tongue develops. When edema spreads to the brain and meninges, neurological disorders(epileptiform seizures, aphasia, hemiplegia, etc.).

Quincke's edema can last for several hours or days, then disappears without a trace, but may recur periodically. Edema is rarely accompanied by pain, more often children complain of a feeling of tissue tension.

Differential Diagnosisperformed with lymphostasis, collateral edema with periostitis, erysipelas, Melkerson-Rosenthal syndrome. In the Melkerson-Rosenthal syndrome, along with Edema of the lips of a chronic course, folding of the tongue and neuritis are detected facial nerve. With erysipelas of the lip there is hyperemia in the affected area in the form of flames.

Treatment:

1) elimination of contact with the allergen;

2)antihistamines(diphenhydramine, suprastin, tavegil, etc.) intramuscularly or orally;

3) vitamin therapy ascorutin to reduce vascular permeability;

4) in case of laryngeal edema, 25 mg of prednisolone hemisuccinate is injected intramuscularly;

5) with a decrease in blood pressure 0.1-0.5 ml of 0.1% adrenaline solution is injected subcutaneously Prevention recurrence is achieved by preventing contact with the allergen that caused it.

Hives.

This is a limited temporary swelling of the dermis or connective tissue layer of the mucous membrane. It is a disease characterized by a rapid and widespread eruption of the skin and mucosa of itchy blisters that result from increased permeability ICR vessels and accompanied by swelling of the surrounding tissue. Blisters appear on various parts of the skin and mucous membranes instantly, they last 1-2 hours on the oral mucosa. They look like sharply limited cakes of doughy consistency, they can be localized on the lips, less often on the cheeks.

Treatment:

Includes specific, immunological, pathogenetic, symptomatic therapy, local antiseptic treatment: applications and dressings using desensitizing drugs, keratoplasty. In severe cases of Quincke's edema, the attack is stopped by introducing 1 ml of 0.1% adrenaline solution under the skin.

Delayed type hypersensitivity reactions:

• fixed medical stomatitis;
• common toxic-allergic stomatitis (catarrhal, catarrhal-hemorrhagic, erosive-ulcerative, ulcerative-necrotic stomatitis, cheilitis, glossitis).

Drug allergy, toxic-allergic lesions of the oral mucosa fixed and widespread.

The problem of complications of pharmacotherapy in pediatric dental practice is particularly relevant at the present time, due to the growth of the arsenal of synthesized drugs that are strong allergens, and the sensitization of the child's body under the influence of adverse environmental factors. It is noted that drug allergy (6-25% of complications from pharmacotherapy) can be caused by any drug, but most common cause are antibiotics (penicillin and its derivatives, tetracycline, streptomycin), sulfa drugs, analgesics, novocaine, iodine, bromides, etc.

The rate of development and the severity of the allergic reaction are determined by the method of administration of the drug (when using it in the form of applications on the oral mucosa, there is the highest risk of sensitization), it has also been proven that sensitization develops more often with a high dosage of the drug.

In the pathogenesis of drug allergy, there is a combination of all types of allergic reactions, which, in turn, is due to the individual reactivity of the child's body, the presence of general somatic pathology, the nature of the drug allergen, the method of its administration, and other factors. The clinical manifestations and severity of the course of drug allergy are due to the predominance of any type of hypersensitivity in the general course of the disease (for example, drug allergy can manifest itself in the form of anaphylactic shock, which is a reaction of GNT).

So, the clinical manifestations of drug allergy in the oral cavity are diverse. IN depending on localization pathological changes on SOPR distinguish: stomatitis, cheilitis, glossitis; according to the severity of the inflammatory reaction, they are distinguished: catarrhal, catarrhal-hemorrhagic, erosive-ulcerative, ulcerative-necrotic stomatitis, cheilitis, glossitis; According to the degree of prevalence of lesions, they are distinguished: fixed and widespread drug-induced stomatitis.

According to the medical literature, it was found that in 2.47-4.24% of cases in children with drug treatment a painful reaction develops medications. The tissues of the oral cavity react to the side effects of drugs. Listed are 35 drugs that are most commonly given side effects. Reactions of the tissues of the oral cavity with the use of such drugs proceed according to the type of ulcerative stomatitis (39.06%); stomatitis, which develops with the activation of pathogenic fungal microflora (32.38%); xerostomia, hemorrhage (10.93%) and gingival hyperplasia (6.47%); acute aphthous stomatitis (5.32%). The most common side effects are cytostatic (17.88%), immunomodulators (12.55%), antibacterial (10.32%), antihypertensive (4.04%) drugs.

We examined 96 children aged 3-10 years with chronic periodontitis of various etiologies in order to study the possibility of sensitization of the child's body when using a resorcinol-formalin mixture during endodontic treatment. Groups of children were divided into 2 subgroups: 1) the body's reaction to possible allergens before treatment was determined (56 people), 2) to sensitizing factors (in this case, resorcinol-formals new drug) after 6 months. and 1 year after endodontic treatment of teeth with the use of resorcinol-formalin mixture. A method for testing for possible sensitization is described. It was established that even with repeated use of resorcinol-formalin preparations in endodontic treatment of teeth, no predisposition to allergic reactions was observed in children, and there was no allergic reaction to any other drugs due to the use of resorcinol-formalin preparations.

We observed 42 children from 6 months. up to 10 years with bright manifestations in the oral cavity of a laboratory-confirmed drug allergy. In all cases, the occurrence of an allergic reaction was facilitated by the use of sulfa drugs or antibiotics prescribed for acute respiratory diseases or pneumonia. By severity common symptoms and the nature of pathological changes in the skin and mucous membranes, 4 forms of drug allergy were identified: mild, moderate, severe, and very severe. Drug allergy is severe and requires rational local treatment in the complex of therapeutic measures. Children with severe and very severe forms of drug allergy must be hospitalized in pediatric hospitals to identify the allergic factor and timely conduct complex treatment.

Catarrhal and catarrhal-hemorrhagic stomatitis, cheilitis, glossitis.

It is the mildest form of drug allergy. Children complain of itching, burning, impaired taste sensitivity, dryness and soreness when eating.

In 1/3 of sick children, the lesions are isolated, but in most children, as a rule, changes in the oral mucosa are combined with damage to other organs. When examining the oral cavity, there is diffuse hyperemia, swelling of the mucosa, as indicated by the imprints of the teeth on the lateral surfaces of the tongue and cheeks. On the tongue there is a deep desquamation of the filiform papillae "lacquered tongue". Along with hyperemia on the mucosal mucosa, punctate hemorrhages are noted, mechanical irritation of the mucosal mucosa is accompanied by bleeding. The general condition is not broken.

Differential Diagnosisis carried out with similar changes in oral mucosa in case of hypovitaminosis C, B, gastrointestinal diseases, infectious and fungal infections.

Treatment:

Local: antiseptic rinses, painkillers, keratoplasty.

General: drug withdrawal or replacement with another, antihistamines (diphenhydramine, diprazine, suprastin, tavegil), calcium preparations. It is recommended to take non-irritating food and drink plenty of water.

Erosive and ulcerative stomatitis, cheilitis, glossitis.

This disease is accompanied by soreness, aggravated by eating and talking. Against the background of hyperemic and edematous mucosal mucosa in the region of the palate, gums, lips, cheeks, tongue, blisters with transparent contents appear, after opening of which erosions are formed, covered with fibrinous plaque.

Single erosions can merge, forming extensive erosive surfaces. The gingival papillae are hyperemic, swollen, and bleed easily. There is hyposalivation discomfort in the pharynx, perspiration. The child's condition may worsen: weakness appears, appetite decreases, body temperature rises to 38 ° C. Submandibular lymph nodes may be enlarged, painful on palpation. The severity of the course of the disease depends on the prevalence of pathological changes in the oral mucosa, the presence of foci of chronic infection.

Differential Diagnosiscarried out with acute herpetic stomatitis, erythema multiforme exudative, pemphigus.

Treatment consists in the abolition of an intolerable drug and the appointment of antihistamines. In severe cases, corticosteroids are prescribed. Local treatment: painkillers, antiseptic treatment of the oral cavity, applications of proteolytic enzymes on the oral mucosa, keratoplasty. Recommended

taking non-irritating food and drinking plenty of water.

Ulcerative necrotic stomatitis, cheilitis, glossitis.

The disease rarely occurs in isolation only on the OM. It usually develops against the background of severe general allergic reactions with damage to the skin, mucous membranes and internal organs, develops acutely with a decrease in the reactivity of the body as a hyperergic reaction to sensitization by fusospirillary symbiosis.

The disease proceeds with a violation of the general condition of the body. Children complain of general weakness, headache, loss of appetite, pain in the mouth, aggravated by eating, talking, bad breath, increased salivation, fever.

On examination, the children are adynamic, salivation is observed, the smell from the mouth is pronounced with a sweetish aftertaste. When examining the oral mucosa, a sharp hyperemia and swelling of the oral mucosa are detected, against which there are foci of necrosis of a yellowish-gray color. The interdental papillae are necrotic throughout, the remaining mucous membrane is covered with a dirty gray fibrinous coating, after removal of which an ulcerative, bleeding surface is exposed. With ulcerative-necrotic drug-induced stomatitis, the oral mucosa, as a rule, is completely affected (95% of cases).

Submandibular lymph nodes are enlarged, painful on palpation. There are changes in peripheral blood an increase in the level of leukocytes, in particular, eosinophils (12-15), an increase in ESR, etc.

Differential Diagnosiscarried out with Vincent's ulcerative necrotic stomatitis, ulcerative lesions of the oral mucosa in blood diseases (leukemia, agranulocytosis), trophic ulcers at cardiovascular diseases.

Treatment is to stop taking the drug that caused the disease. Appoint antihistamines, in severe cases, corticosteroids, hemodez, polyglucin, etc. Local treatment includes antiseptic treatment, removal of necrotic masses, through the use of proteolytic enzymes, painkillers, keratoplasty.

Fixed drug-induced stomatitis, which often occurs with hypersensitivity to sulfonamides, barbiturates, tetracycline, is characterized by the appearance of round or oval spots up to 1.5 cm, in the center of which a rapidly opening bubble with serous contents is formed, resulting in extensive confluent erosion.

After stopping the drug for 10 days, the process is allowed, but when you take the drug again, the process necessarily recurs at the same place. Many children simultaneously develop similar rashes on the external genitalia. The process is accompanied by burning. Rarely, the process proceeds without a visible inflammatory reaction, but is limited to the appearance of widespread tense blisters.

Differential Diagnosiscarried out with pemphigus and erythema multiforme exudative.

Common toxic-allergic stomatitis is characterized by a variety of clinical signs, most often occurs as a result of taking antibiotics.

Children, as a rule, complain of itching, burning, dry mouth, pain when eating.

So, when taking biomycin, streptomycin, penicillin, diffuse hyperemia, swelling of the mucous membrane of the tongue, cheeks, palate, gums, lips, phenomena catarrhal gingivitis, A "penicillin tongue" may appear when its back becomes smooth, shiny, swollen; similar changes are observed on the mucosa of the lips. Bubbles may appear on the RMS, the opening of which leads to the formation of erosion.

Changes in the oral cavity after taking tetracycline antibiotics are characterized by the development of glossitis, the tongue is covered with a brown coating, cracks and erosion appear in the corners of the mouth.

Synthomycin, levomycetin and biomycin, as a rule, have a toxic effect on the gastrointestinal tract. Hyposalivation develops, unpleasant sensations appear in the throat, a feeling of perspiration, mycotic stomatitis may develop.

Differential diagnosisshould be performed with lichen planus, erythema multiforme exudative, systemic lupus erythematosus, Lyell's syndrome.

Treatment is reduced to the abolition of the drug or its replacement with another, the prevention of secondary infection of allergic lesions and the study of the allergic status of the child.

We studied the functional state of neutrophils in 5 children with drug-induced lesions of the oral mucosa in terms of the activity of the enzyme systems of myeloperoxidase and alkaline phosphatase involved in phagocytosis. Studies have pointed to the ambiguity of the results of cytochemical reactions, reflecting the functional characteristics of peripheral blood neutrophils in children with drug-induced lesions of the oral mucosa. In a number of observations, the results indicated a violation of the phagocytic function of cells. The data obtained must be taken into account when deciding on the implementation of therapeutic measures aimed at activating the phagocytic systems of the body of sick children with drug allergies.

Systemic toxic-allergic diseases:

• Lyell's disease;
• multiform exudative erythema;
• Stevens-Johnson syndrome;
• chronic recurrent aphthous stomatitis;
• Behçet's syndrome;
• Sjögren's syndrome.

Lyell's disease.

The disease is one of the most severe forms of toxic-allergic reaction. It is characterized by severe damage to the skin and oral mucosa against the background of a pronounced deterioration in the general condition. The disease often occurs after taking medications (iodine, antibiotics, bromine, etc.), is considered as a syndrome of a toxic-allergic nature, is a hyperergic reaction of the body against the background of previous sensitization. In children, it is often the result of a toxic-allergic effect of poor-quality products or a staphylococcal infection.

Clinic: The disease begins acutely, with a rise in body temperature to 38-41 ° C, a sharp deterioration in well-being. Large erythema appears on the skin (the size of a palm). Hyperemic spots also appear on the oral mucosa, localized on the tongue, gums, and lips. Sometimes the lesion is diffuse diffuse in nature. After 2-3 days, blisters form in the center of the erythema, the epidermis and epithelium exfoliate and are rejected. The lesion resembles a IIIII degree burn. Painful extensive bleeding erosions are formed on the mucous membranes and skin when touched. Nikolsky's symptom is positive, acantholytic cells are not detected during cytological examination. The general condition of children is severe, high body temperature, drowsiness, headache, symptoms of dehydration. Dystrophic changes in internal organs and the nervous system may develop. The development of the disease is based on necrosis of the surface layers of the epidermis and epithelium, swelling of the germline (Malpighian) layer, disruption of intercellular connections with the formation of blisters, located both intro- and subepithelially.

Differential Diagnosiscarried out with multiform exudative erythema, pemphigus.

Treatment carried out in a hospital. It begins with stopping the drug that caused the disease. Desensitizing drugs are prescribed (diphenhydramine, suprastin, tavegil), corticosteroids, detoxification therapy (30% solution of thiosulfate, 10% chloride solution calcium, etc.), gemodez, vitamins C and P, intake of high-calorie non-irritating food with the exception of allergenic products. Local treatment includes anesthesia, antiseptic treatment, removal of necrotic tissues with proteolytic enzymes, and the use of keratoplasty.

The prognosis depends on the start of treatment, favorable, but in 30% of cases a fatal outcome is possible.

Multiform exudative erythema.

This is an inflammatory disease of the mucous membranes and skin, characterized by polymorphism of the elements of the lesion (blisters, spots, blisters).

ORM or skin can be affected in isolation, but their combined lesion often occurs. The disease is characterized by an acute onset and lasts for years, seasonality is noted.

diseases, exacerbations mainly occur in the autumn-winter period. Occurs in children older than 5 years.

Etiology and pathogenesisnot fully elucidated. According to the etiological principle, two varieties are distinguished: the true, or idiopathic, 2nd form has an infectious-allergic nature. Wherein great importance attached to bacterial allergies, as many children have sensitization to streptococcus and staphylococcus aureus. In 30% of cases, a viral etiology of the disease is assumed (herpes simplex viruses, coxsackie and ECHO ). There have been reports of the occurrence of the disease in children suffering from recurrent herpetic infection postherpetic exudative erythema multiforme.

The histological picture, methods of treatment and diagnosis of the disease are described. In an 11-year-old child, after a herpetic lesion of the mucous membrane of the eyelids, small ulcers began to appear in the oral cavity. Recurrence frequency 4 times a year. The same rashes were for centuries. Rinsing with nystatin did not give any results. Antiviral found in blood AT . Treatment consisted of local anesthesia, analgesics, antibiotics, steroids. Difficulty noted differential diagnosis herpetic gingivostomatitis and erythema multiforme exudative. Knowing the fact that recurrent herpes can transform into erythema multiforme exudative (EEE) will help to correctly establish the diagnosis and choose the method of treatment.

The source of sensitization are foci of chronic infection. A decrease in the body's reactivity due to hypovitaminosis, hypothermia, viral infections, and stress provoke an exacerbation of the MEE. The toxic-allergic, or symptomatic form, has a similar clinical picture with the true infectious-allergic form of MEE, but in fact it is a hyperergic reaction of the body to drugs (antibiotics, salicylates, amidopyrine, etc.). The etiology of MEE is unknown, although some factors , constraining its development, are established. The immunological mechanism of this disease was determined. We examined 13 children with MEE of unknown etiology, 24 children constituted the control group, and all children in both groups were determined by immunological tests AT . The results of skin tests showed the absence of any reaction to hypertension in 5 out of 13 children with this disease.

Clinic: The disease begins suddenly. There is malaise, chills, weakness, body temperature rises to 38 ° C and above. Children complain of headaches, aching pains in muscles and joints. After 1-2 days, bluish-red spots appear on the skin of the hands, forearm, lower leg, face, neck, rising above the surrounding skin. Their central part slightly sinks and takes on a bluish tint, while the peripheral part retains a pinkish-red color (cockades).

Subsequently, a subepidermal bladder filled with serous or hemorrhagic contents may appear in the central part. The appearance of skin elements is accompanied by itching and burning.

The mucous membranes of the lips, cheeks, floor of the mouth, tongue, and soft palate are often affected. In the oral cavity, diffuse hyperemia and mucosal edema are observed, against which subepithelial blisters appear. The defeat of the SOPR is accompanied sharp pains even at rest. With movements of the tongue and lips, the pain increases sharply, “as a result of which eating is difficult. The blisters quickly open, thereby forming painful erosions covered with fibrinous plaque. On the red border of the lips, erosions are covered with bloody crusts. Erosions can merge, forming large areas of damage. When pulling the epithelium from the edge of erosion, it is not possible to exfoliate it (negative symptom of Nikolsky). Secondary infection of erosive surfaces is possible.

Sick children have increased salivation, there is a sweetish sugary smell from the mouth, lymphadenitis of the submandibular lymph nodes. The gingival mucosa, as a rule, is not involved in the process. The unsatisfactory state of oral hygiene, the presence of carious teeth aggravate the course of MEE.

The picture of peripheral blood during the period of MEE exacerbation corresponds to an acute inflammatory process - an increase in the number of leukocytes, ESR, etc.

MEE of an infectious-allergic nature has a long relapsing course. Exacerbations are observed in the autumn-winter period. In the periods between exacerbations, there are no changes in the skin and oral mucosa.

Toxic-allergic MEE recurs if the child comes into contact with the etiological factor drug allergen.

The clinical course of MEE in 100 children was studied, of which 93% had an infectious-allergic form and 7% had a toxic-allergic form. In 32% of sick children, there was an isolated lesion of the oral mucosa and the red border of the lips. In 59 sick children, simultaneous lesions of the skin and mucous membranes were observed. Severe T-cell immunodeficiency was found. The use of ethacridine in combination with decaris gave a good therapeutic effect.

Diagnostics based on the data of anamnesis, clinical picture, cytological examination, in which a picture of acute nonspecific inflammation is revealed, histological examination subepithelial location of blisters, absence of acantholysis phenomena.

Differential Diagnosiscarried out with acantholytic and non-acantholytic pemphigus, acute herpetic stomatitis, secondary syphilis.

Stevens-Johnson Syndrome.

A severe variant of MEE with a violation of the general condition is Stevens-Johnson syndrome.

The disease begins suddenly, with high temperature and joint pain. Against the background of a severe general condition, blisters appear on the skin, after opening of which bleeding erosions form. Merging, they turn into a continuous bleeding sharply painful surface. Part of the erosion is covered

Has a fibrinous coating. The mucous membrane of the eye (bilateral conjunctivitis and keratitis), nose (rhinitis, epistaxis), and genital organs are also affected. Due to the generalized lesions of the oral cavity and lips, children cannot talk, eat, which leads to their exhaustion.

Histologically determined spongiosis, intracellular edema. Bubbles form under the epithelium. The rejected epithelium becomes necrotic. In the connective tissue there is edema and inflammatory infiltrate around the vessels.

Differential Diagnosiscarried out with pemphigus, candidiasis, acute lupus erythematosus, Duhring's disease.

Treatment: general and local, is carried out both with MEE and with Stevens-Johnson syndrome. Symptomatic treatment is aimed at reducing intoxication, desensitization, relieving inflammation and accelerating the epithelialization of the affected mucosa.

General treatment:

1. desensitizing drugs (diphenhydramine, suprastin, tavegil, phenkarol, claritin);
2. anti-inflammatory drugs (salicylates);
3. vitamin therapy(vit. B);
4. calcium preparations;
5. ethacridine lactate and levamisole to relieve exacerbations;

6) corticosteroids 20-30 (60-80 mg in Stevens syndrome-
Johnson);

7) detoxifying therapy.

Local treatment is aimed at eliminating inflammation, puffiness and accelerating the epithelization of the affected mucosa:

1. painkillers (trimecaine, lidocaine);
2. antiseptic preparations (furatsilin, chloramine, etc.);
3. proteolytic enzymes (trypsin, chymotrypsin);
4. keratoplasty (rosehip oil, sea buckthorn, etc.).

During the period of remission of the disease, children should be subjected to examination and sanitation of the oral cavity, non-specific hyposensitization with an allergen to which hypersensitivity has been established.

Chronic recurrent aphthous stomatitis (CRAS).

Is chronic inflammatory disease OSM, which is characterized by a recurrent rash of aphthae and ulcers, a long course with recurrent exacerbations. It occurs more often in children older than 4 years.

Etiology and pathogenesisnot definitively elucidated. Some authors consider the cause of the disease L -forms of streptococci, others are supporters of the viral nature of the disease. Certain importance in the occurrence of the disease are hereditary factors. Earlier, the occurrence of CRAS as a change in trophoneurotic nature was discussed, in this sense, the studies of Kulikov V.S. are interesting, confirming the role of reflex reactions in the pathogenesis of recurrent aphthous stomatitis associated with

liver pathology.

Currently, most scientists are inclined to the leading role of the immune system in the pathogenesis of the disease.

Thus, it was found that CRAS is characterized by reduced immunological reactivity and violations of nonspecific defense, the causes of which are foci of chronic infection in the body (tonsillitis, tonsillitis, pharyngitis, gastrointestinal diseases), the influence of chronic stress, climate change, etc.

It has been established that with an increase in the severity of the disease, T-suppression of immunity increases, characterized by a decrease in the number of T-lymphocytes and their functional activity. An increase in the number of T-suppressors is accompanied by a decrease in the number of T-helpers. On the part of humoral immunity, there is an increase in the number of B-lymphocytes and the concentration of immunoglobulins of the class IgG with a decrease in the level IgA, IgM.

The severity and duration of the disease corresponds to the severity of sensitization of the body by these antigens. Indicators of nonspecific humoral and cellular protection change (decrease in the concentration of lysozyme, increase in B-lysines in the blood serum, decrease in the content of complement fractions Cn C4 and increasing fractions C 5 ) . Against the background of a weakening of the phagocytic activity of leukocytes to most microbial allergens, its increase to Str. salivarius and C. albicans . Violation of local oral protection factors in children with CRAS is characterized by a decrease in the concentration of lysozyme, an increase in B-lysines, a decrease in the content of secretory and serum immunoglobulin A in the oral fluid. As a result, the protection of the oral mucosa from the effects of microorganisms is violated, the number and species composition of the resident microflora changes, the number of microbial associations in the oral cavity increases, their virulence increases (cocci: coagulase-negative staphylococcus, anaerobic cocci: peptococci, pepto-reptococci, bacteroids). With an increase in the virulence of microorganisms, the bacterial sensitization of the body of a sick child increases the circuit is switched on immunological reactions immediate and delayed type, causing frequent relapses diseases.

Also in the pathogenesis of CRAS, an important role is played by a cross-immune reaction: on the surface of the oral mucosa of children with CRAS, there is a large number of streptococci ( Str. mutans, sanguis, salivarius, mitis ) that have antigenic similarity to OM cells. It has been established that the OM is able to deposit antigens. Children with CRAS have a genetically determined disorder in the recognition of target cells by T-lymphocytes, and there is also a diverse antigenic spectrum on the surface of the oral mucosa. As a result, the mechanism of antibody-dependent cytotoxicity is activated, which is the cause of the disease.

Clinic.

There are two clinical forms diseases:

• light;
• severe (recurrent deep scarring aphthae - Setton's aphthosis).

The process of formation of aphthae on the mucosa begins with the appearance of a hyperemic, sharply limited spot, round or oval, painful, which rises above the surrounding mucosa after 1-2 hours. Children during this period become capricious. Then the element is eroded, covered with a fibrinous grayish-white, tightly seated coating. The fibrinous-necrotic focus is surrounded by a thin hyperemic corolla. Afta is very painful when touched. At its base, infiltration occurs, the aphtha rises above the surrounding tissues.

Rashes of aft are accompanied by lymphadenitis, fever. After 2-4 days, the necrotic masses are rejected, after another 2-3 days, the aphtha is resolved, in its place, congestive hyperemia lasts for 1-2 days.

Often, a few days before the onset of aphthae, children feel a burning sensation or pain at the site of future changes.

The frequency of occurrence of aphthae in CRAS varies from several days to months. Rashes are localized on the mucous membrane of the cheeks, lips, tip and lateral surfaces of the tongue, etc.

Factors provoking exacerbations are trauma to the oral mucosa, stress, overwork, viral infection and etc.

Clinical studies have shown that during the first three years, CRAS proceeds in a mild form, under the influence of chronic diseases of the gastrointestinal tract, liver, ENT organs, etc.

Histological examination reveals deep fibrinous-necrotic inflammation of the mucous membrane. The process begins with a change in the lamina propria and submucosa. Edema of the prickly layer of the epithelium appears, spongiosis, the formation of microcavities, alteration ends with necrosis of the epithelium and erosion of the mucosa. The epithelium defect is filled with fibrin, firmly soldered to the underlying tissues.

Differential Diagnosiscarried out with traumatic, herpetic erosion, syphilitic papules.

Afta Setton.

Varieties clinical course:

1. the element of the lesion is aphtha, the period of its epithelization is 14-20 days. The course of the disease is characterized by the occurrence of monthly exacerbations;
2. deep crater-like, sharply painful ulcers are formed on the oral mucosa, which have a long period of epithelization (25-30 days). Exacerbation of the disease occurs 5-6 times a year;
3. aphthae and ulcers are detected on the mucosa at the same time. The period of their epithelialization is 25-35 days.

Setton's aphthosis worsens 5-6 times or monthly. The course of the disease is chronic. A number of sick children aphthae appear paroxysmal within a few weeks, replacing each other or occurring simultaneously in large numbers.

Sick children suffer general state: Increased irritability bad dream, loss of appetite, regional lymphadenitis occurs.

The influence of seasonal factors on the occurrence of exacerbations is insignificant, since they occur monthly, the disease becomes permanent, and with an increase in the prescription of the disease, the severity of its course is aggravated.

The exacerbation of the disease begins with the appearance of a limited painful compaction of the oral mucosa, on which first a superficial, covered with fibrinous plaque, then a deep crater-like ulcer with hyperemia around, constantly increasing, is formed.

First, a subsurface ulcer is formed, at the base of which, after 6-7 days, an infiltrate is formed, 2-3 times the size of the defect, the aphtha itself transforms into a deep ulcer, the area of ​​necrosis increases and deepens. Ulcers epithelialize slowly, up to 1.5-2 months. After their healing, coarse connective tissue scars remain, leading to deformation of the oral mucosa. When aphthae are located in the corners of the mouth, deformations occur, subsequently leading to microstomy. The duration of the existence of scarring aphthae is from 2 weeks to 2 months. Rashes are more often located on the lateral surfaces of the tongue, mucous membranes of the lips and cheeks, accompanied by severe pain.

Diagnostics: histologically determined area of ​​necrosis with complete destruction of the epithelium and basement membrane, inflammation in the lamina propria and submucosa. Often at the affected area there are salivary glands with periglandular infiltration, which gave Sutton reason to call this disease recurrent necrotizing periadenitis of the mucosa. However, A. I. Mashkilleyson observed deep scarring aphthae and without the phenomena of periadenitis.

Differential Diagnosisis carried out with traumatic erosions, ulcers, recurrent herpes, Behcet's disease, Vincent's ulcerative necrotic stomatitis, ulcers with specific infections (syphilis, tuberculosis), malignant ulcers.

Treatment: general begins with an examination of a sick child by other specialists.

Comprehensive pathogenetic treatment includes the use of immunocorrective agents, metabolic correction drugs with sanitation of foci of chronic infection:

1. immunocorrection thymogen, levamisole (decaris), histaglobin;
2. metabolic agents calcium pantothenate, riboflavin mononucleotide, lipamide, cocarboxylase, potassium orotate, vit. bi 2, folic acid, pyridoxal phosphate, calcium pangamate. 4-6 courses of metabolic correction are carried out at intervals of 6 months;
3. reflexology, sedative therapy;
4. treatment of concomitant somatic diseases;
5. following a strict diet.

Currently, close attention is paid to the immune state of the body, in particular, local immunity of the oral cavity. There are reports of the effect of certain drugs on the immune status of sick children. Of interest are data on the effect of folic acid on the blastic transformation of lymphocytes in children suffering from CRAS. Encouraging results have been obtained, which explain the effect of folic acid on the mechanisms of cellular immunity. However, all

The therapeutic agents used for aphthous stomatitis are not effective enough, which can be explained by the ambiguity of its genesis. This fact necessitates a constant search for new chemotherapeutic drugs and their rational combinations.

Currently, specialists are interested in medicinal substances that stimulate or suppress the body's immune responses. In this regard, attention is drawn to the drug Decaris (levamisole), which increases the overall resistance of the body and can be used as a means for immunotherapy. Studies have shown that Decaris, by selectively stimulating the regulatory function of T-lymphocytes, can play the role of an immunomodulator that can enhance a weak response of cellular immunity, weaken a strong one and not affect a normal one.

These properties of decaris made it possible to use it for the treatment
various diseases, in the pathogenesis of which they attach importance
disorders of immunogenesis: primary and secondary immunodeficiency
conditions, autoimmune diseases, chronic and recurrent
common infections, tumors. Decaris has been successfully used in therapy
some dermatological diseases, infectious

allergic bronchial asthma, etc.

Treatment recurrent aphthous stomatitis decaris in most sick children gave positive results: the period of remission increased, aphthae took on an abortive character. best effect obtained by prescribing a combined course of treatment with anti-measles gammaglobulin, decaris and ascorbic acid. During therapy in sick children, it is necessary to carry out once a month clinical analysis blood. Local treatment:

1. sanitation of the oral cavity;
2. painkillers (lidocaine, trimecaine, etc.);
3. proteolytic enzymes (trypsin, chymotrypsin, etc.);

4) keratoplasty (solutions of vitamins A, E, carotolin, linetol and
etc.)

Behcet's syndrome.

First described by a Turkish dermatologist Behcet . Includes 3 symptoms: recurrent aphthae on the mucous membranes and external genitalia, eye damage leading to blindness. Arise skin manifestations(rashes of erythema nodosa, pyoderma, vasculitis), lesions of the joints and nervous system are detected.

Tourine described the disease large aphthosis, which is characterized by recurrent rashes of aphthae on the SOGTR, external genitalia, and intestines.

Etiology and pathogenesis.

Recurrent aphthous lesions are based on autoimmune processes. There is also an opinion about the genetic predisposition to the occurrence of Behçet's syndrome.

Clinic.

The disease is characterized by a chronic course with remissions lasting from several days to several years.

As the first symptom, aphthae are found on the oral mucosa, deep, long-term non-healing aphthae can form, forming after epithelialization rough connective tissue scars that deform the mucous membrane. Aphthae are sharply painful. Painful aphthous-ulcerative rashes appear in the area of ​​the external genital organs with a dense infiltrate at the base. The elements are raised above the surrounding skin, the bottom of the ulcers is covered with a grayish-yellow coating. Eye damage occurs in 75-80% of sick children.

Painful photophobia is noted, hypopyoniritis, cyclitis, hemorrhages in the vitreous body and in the fundus region develop. Relapse leads to temporary and then permanent visual impairment. The process ends in blindness. Recurrent erythema nodosum, MEE-type rashes, pyodermic elements appear on the skin. The process is complicated by rheumatoid lesions of soft tissues and joints, hemorrhages, recurrent thrombosis and thrombophlebitis. Aphthous rashes can spread to the mucous membrane of the larynx, trachea, uterus, esophagus, intestines, there is swelling of the salivary and lacrimal glands, changes in internal organs and the nervous system. Behçet's syndrome is characterized by a chronic relapsing course and an increase in clinical manifestations from relapse to relapse.

Diagnostics: histologically, during the formation of aphthous elements, penetration into the epithelium of lymphocytes and monocytes is revealed. After the destruction of the epithelium, erosion occurs, at the base of which there is an infiltrate of neutrophils, monocytes and lymphocytes. Vessel changes are determined in the form of obliterating endarteritis. In long-term elements, a picture of vasculitis is revealed, in fresh rashes such changes are less common.

Treatment: the use of antihistamines and detoxifying agents, cytostatics (colchicine).

The effect gives the use of corticosteroids, immunomodulators.

Sjögren's syndrome.

Sjogren's syndrome, Sjögren's (primary "dry" syndrome) a systemic autoimmune disease characterized by damage to the exocrine glands, mainly salivary and lacrimal. Currently, Sjögren's syndrome has been singled out as an independent nosological unit. Damage to the exocrine glands against the background of autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis, systemic scleroderma, chronic active hepatitis, Hashimoto's thyroiditis, etc.) is regarded as Sjögren's syndrome (secondary "dry" syndrome).

Etiology and pathogenesis.Assume an infectious-allergic genesis, the significance of endocrine disorders, a hereditary predisposition associated with impaired vitamin metabolism. However, the fact that hypergammaglobulinemia is found in sick children with Sjögren's syndrome and

antinuclear factors and precipitating antibodies, gives grounds to assert the autoimmune nature of the disease.

Clinic.In last years descriptions of Sjögren's syndrome in children appeared. The chronic course of the disease with frequent periods of exacerbation is the cause of long-term disability and leads to early disability of patients. Dental manifestations of Sjögren's syndrome (mumps, xerostomia, multiple caries followed by rapid loss of teeth) cause severe suffering in patients, lead to a change in mental status, their social maladjustment.

Clinical manifestations of Sjögren's syndrome in the oral cavity were studied by both domestic and foreign authors. However, there is no comprehensive clinical characteristic state of organs and tissues of the oral cavity in Sjögren's syndrome. The pathogenetic mechanisms of the dental manifestations of the disease have not been studied, which makes its diagnosis and treatment difficult.

A study of 8 3 sick children with Sjögren's syndrome was carried out. The examination included general clinical, dental, radiological, microbiological, biochemical, immunological, morphological (morphometric, cytological) studies. For the diagnosis of Sjögren's syndrome, criteria based on a comprehensive dental, ophthalmological, laboratory examination of sick children and biopsy of the minor salivary glands were used. Most of the children were hospitalized and treated. The stage of Sjögren's syndrome was assessed depending on the severity of dental manifestations: the degree of decrease in saliva secretion and the stage of xerostomia. The duration of the disease averaged 8.3±0.6 years.

The initial stage of the disease was diagnosed in 11 (13.3%) patients; a consequence of this, a late visit to the doctor.

During an objective examination, frequent clinical signs in children with Sjögren's syndrome, determined during an external examination, were dryness of the red border of the lips (89.2%) and seizures in the corners of the mouth (62.6%). Enlargement of the major salivary glands was found in 77.1% of children. Subjective signs of xerostomia were manifested in children by constant (69%) and recurrent (30%) dryness in the oral cavity, difficulty in speech (65%), difficulty in eating (81%), burning and pain of the oral mucosa when eating irritating food (55%) , decreased taste sensitivity (75%), hyperesthesia of hard dental tissues (53%). At the same time, the oral mucosa was characterized by atrophic changes in the form of thinning, smoothness of the papillary relief and folding of the tongue with the addition of elements of inflammation (56%). Inflammation of the oral mucosa of an infectious nature associated with a fungal infection candida albicans found in 30.7% of patients.

In children with Sjögren's syndrome, non-carious lesions of the teeth were also found in the form of pathological abrasion of enamel and dentin (42.2%), erosion of enamel (28.9%).

Determining the acid resistance of tooth enamel, a sharp decrease was revealed, while the indicator decreased by 21.1 + 2.7. A decrease in the acid resistance of tooth enamel indicates a significant decrease in the resistance of teeth to caries and non-carious lesions of the teeth in sick children.

Clinical examination of the periodontium revealed signs of periodontitis in children with Sjögren's syndrome (periodontal index 3.1+0.3). There were no deep periodontal pockets with granulation and suppuration, root exposure and tooth mobility. Local resorption prevailed, which was due to the action of local traumatic factors (overhanging edges of fillings, cervical carious cavities, artificial crowns and bridges, etc.). However, mineralized dental plaque was rare (8.5%) and was negligible.

At histological examination in the oral mucosa there is focal infiltration, a decrease in the secretory activity of the submucosal salivary glands. Histological changes in the salivary glands are characterized by infiltration with lymphocytes, plasma cells, and connective tissue proliferation.

Differential Diagnosisperformed with Plummer-Vinson syndrome.

Treatment of sick children with Sjögren's syndrome, along with basic drug therapy, should include a whole range of measures aimed at treating and preventing dental manifestations of the disease. Cytostatic drugs, glucocorticoids and non-steroidal anti-inflammatory drugs used for pathogenetic therapy have a general anti-inflammatory effect on the oral mucosa.

In recent years, a new drug encad has been proposed for the treatment of the disease, which is a complex of ribonucleotides obtained from yeast RNA by treating it with RNase. Enkad was used as a course of applications for ORM. It has been established that encad reduces the clinical manifestations of xerostomia, has an anti-inflammatory effect, contributes to the normalization of disturbed desquamative and regenerative processes in the mucosal epithelium, has an immunomodulatory effect, and normalizes the ratio of theophylline-sensitive and theophylline-resistant lymphocytes. To correct the reduced residual activity of the salivary glands, new drugs have been developed: benzylol for hydrophilization of the oral mucosa and bensylol with trimecaine for hydrophilization and treatment of paresthesia of the oral mucosa.

To increase the factors of antibacterial protection of the oral cavity, reduce dysbacteriosis and plaque formation on the teeth, 0.1% lysozyme solution in 0.6% sodium chloride solution is used in the form of oral baths after eating. For medicinal effect on bacterial plaque and prevention of plaque formation, as well as to reduce the adhesion of fungi of the genus Candida 0.02% solution of chlorhexidine in the form of oral baths is used to the surface of the fillings.

1) Class equipment:

clinical office, dental unit.

2) Control questions on topic number 9:

Name the classification of allergic lesions of the oral mucosa in children;

What are the mechanisms of development of allergic reactions?

Tactics of a dentist in the event of allergic reactions

3) Homework:

Topic number 10: "Congenital malformations maxillofacial area»

4) Application:

A set of test tasks of the initial level of knowledge with response standards;

A set of test tasks of the final level of knowledge with answer standards;

A set of situational tasks with sample answers

Main literature:1. Materials of lectures.

2.L.S.Persin, V.M.Elizarova, S.V.Dyakova "Stomatology of children's age" "Medicine", 2009.

additional literature

1. Kuryakina N.V. "Therapeutic dentistry of children's age", N.Novgorod, 2006;

2. Vinogradova T.F. "Stomatology of children's age", 2005.

Allergic stomatitis is a disease of the oral cavity. The course is often severe, the patient experiences noticeable discomfort due to swollen, irritated tissues of the palate and tongue. Negative reactions develop during the immunological conflict of the body with allergens that enter the mouth from the outside or from the inside.

What to do if allergic stomatitis is found in a child? Which doctor will help eliminate negative signs? What methods of treatment are effective in lesions of oral tissues?

Answers in the article.

Reasons for the development of the disease

A negative reaction develops after contact of the oral mucosa with various allergens. External agents are plant pollen, mold spores.

Often, allergic stomatitis develops in the following cases:

• a negative reaction to installed crowns, fillings, prostheses, especially those made from cheap, low-quality materials;
• in children, an acute response to certain types of food;
• irritation of the tissues of the oral cavity with a decrease in immunity against the background of a course of treatment with sulfonamides or antibacterial drugs;
• neglected caries, bleeding gums, inflammatory processes, accompanied by the reproduction of pathogenic microorganisms;
• as a complication of Lyme disease, recurrent aphthous stomatitis, systemic lupus erythematosus, hemorrhagic diathesis, Stevens-Johnson syndrome.

According to international classification diseases, a negative reaction in the oral cavity is highlighted in a special section.

Allergic stomatitis code according to ICD 10 - K12 "Stomatitis and other related lesions" and subsection K12.1 "Other forms of stomatitis".

Learn about the use of bay leaf in traditional medicine for the treatment of allergic diseases.

Read about the first signs and symptoms of a gluten allergy in a child here.

First signs and symptoms

The disease has general and local symptoms.

Even with mild form allergic stomatitis, the patient experiences discomfort during hygiene procedures in the oral cavity, eating, in advanced cases it is difficult to speak due to inflamed, swollen tissues.

Local signs:

• soreness, redness of the affected areas;
• an unpleasant odor is heard from the mouth (it persists even after brushing your teeth);
• swelling of the tongue, lips, palate, pharynx, cheeks;
• excessive salivation.

If you are allergic to medicines in the oral cavity, additional symptoms occur:

• blisters filled with liquid form on the mucous membranes in the mouth;
• tissues turn red;
• pain is felt.

At tick-borne borreliosis appear:

• blisters on mucous membranes;
• redness;
• bleeding wounds and erosion.

General signs:

• the disease often develops rapidly;
• body temperature often rises (especially if you are allergic to antibiotics);
• vesicles, blisters are formed in severe form not only in the mouth, but also on the skin, mucous membranes of the eyes, genitals;
• with Lyme disease, red spots with a border around the edges occur on various parts of the body;
• pain syndrome is pronounced;
• sometimes there are joint pains.

Diagnostics

If the mucous membranes and tongue are affected, it is important to consult a dentist in time.

The doctor will examine the oral cavity, clarify the clinical picture, listen to the patient's complaints. An analysis of background diseases is carried out, the doctor reveals the strength and nature of negative symptoms.

If allergic stomatitis is suspected, a comprehensive diagnosis is carried out:

• • verification of structures: prostheses, braces, fillings;
  • general clinical examination of urine and blood;
  • immunogram to monitor the state of the immune system;
  • determination of the level of acidity and composition of saliva;
  • detection of the activity of enzymes contained in saliva;
  • leukopenic test;
  • provocative tests with...

    Reasons for the development of the disease

    Such an unpleasant disease as an allergy affects both adults and children. And especially unpleasant is a kind of disease in which allergic reactions are observed in the oral cavity. This type of allergy is not only extremely painful, but also quite dangerous for the patient's health.

    Symptoms

    Not all inflammatory processes in the oral cavity are associated with allergies. They can also be caused by various bacteria and viruses, autoimmune diseases - systemic lupus erythematosus and pemphigus vulgaris, as well as erythema multiforme exudative.

    In addition, swelling of the oral cavity can be observed as a particular manifestation of generalized Quincke's edema.

    According to the localization of inflammation are divided into:

    • cheilitis - the area of ​​​​the lips and mucous membranes near the mouth,
    • glossitis - language,
    • gingivitis - gums,
    • stomatitis - oral mucosa,
    • palatinitis - soft or hard palate,
    • papillitis - papillae of the gums.

    in terms of severity and characteristic symptoms allergic stomatitis can be divided into:

    • catarrhal
    • catarrhal hemorrhagic,
    • bullous,
    • ulcerative necrosis,
    • erosive.

    The catarrhal type of allergic stomatitis is characterized by moderate symptoms.

    Patients usually complain of dry mouth, pain when eating. The disease is also accompanied by burning and itching. In the hemorrhagic form, small specks of hemorrhages on the mucous membrane are visible on examination. The bullous form is characterized by the formation of blisters with exudate. When they are destroyed, erosion can form. With ulcerative necrosis stomatitis, the formation of painful ulcers on the surface of the mucosa, with areas of necrosis, is observed.

    This type of stomatitis is the most severe, it can be accompanied by severe pain, damage to the lymph nodes and signs of general intoxication of the body.

    How to distinguish allergic reactions from inflammatory processes of infectious origin? First of all, you need to pay attention to symptoms such as dry mucous membranes and tongue. This symptom is typical for allergic processes. With a bacterial infection, increased salivation is usually observed or it remains within the normal range. With a bacterial infection, bad breath is also characteristic, while with allergic stomatitis it is absent.

    On the other hand, allergic stomatitis is characterized by a change in taste or the presence of an unpleasant aftertaste in the mouth, which usually does not occur with bacterial stomatitis.

    Other symptoms of allergic stomatitis also include small rashes in the mouth, the formation of small bubbles (vesicles), severe forms– Ulcers and areas of necrosis. The patient feels severe itching in the mouth, and sometimes severe pain. The process of eating and chewing is also difficult or even impossible due to severe pain.

    If left untreated, massive necrotic lesions of the oral mucosa, the addition of a bacterial infection are possible, which will greatly complicate the treatment.

    In children, allergic stomatitis is usually much more severe than in adults, it has a more acute onset and is often accompanied by intoxication of the body.

    This is due to the child's weaker immune system and higher metabolic rate. In this case, the disease can often be diagnosed only at the stage of development of complications. Often stomatitis in children is accompanied by an increase ...

    First signs and symptoms

    Allergic stomatitis: what is this disease and how to deal with it

    Stomatitis is the name of a group of diseases of the oral mucosa of an infectious, inflammatory or allergic nature.

    This term is also used to refer to local manifestations of immune, skin and other diseases.

    Stomatitis is quite common in both children and adults. The mucosa of the bottom of the mouth, cheeks, palate is affected in isolation or accompanied by glossitis (inflammation of the tongue), gingivitis (inflammation of the gums), and sometimes cheilitis (inflammation of the lips).

    Stomatitis develops independently or is a manifestation of other pathological processes.

    General characteristics of the disease

    Allergic stomatitis is a disease of the oral mucosa, which is based on complex immunological processes.

    Typical signs of the disease are hyperemia, swelling, bleeding wounds, erosive and ulcerative formations. Patients cannot eat normally due to pain and discomfort, indicating a deterioration in general well-being.

    The reason for such stomatitis is the ingestion of an allergen or direct contact of the traumatic element with the oral mucosa.

    Allergies can be triggered by plant pollen, medicines, and certain foods, resulting in a complex immune response. Stomatitis is one of the manifestations of such a reaction.

    With local exposure to a provoking factor (oral hygiene products, cough drops, dentures), irritation of the mucous membrane occurs, which again leads to illness.

    Contact stomatitis is associated with high sensitivity to dental treatment:

    • means for local anesthesia;
    • filling material;
    • bracket systems;
    • orthodontic plates;
    • crowns;
    • metal and other prostheses.

    

    More often, allergies are caused by acrylic implants, which contain residual monomers and dyes.

    When setting up a metal structure, an allergy develops to the alloy used (for example, nickel, chromium-containing, platinum). The course and outcome of the disease also depend on the presence of plastics and other components in the orthodontic construction.

    It has been established that persons suffering from chronic diseases gastrointestinal tract (dysbacteriosis, pancreatitis, cholecystitis, colitis, gastritis and others), as well as endocrine disorders ( diabetes, increased function thyroid gland, menopause).

    Due to various kinds of disorders, the listed diseases lead to a modification of the body's reactivity and sensitization to allergens of dental prostheses.

    In such patients, the neurological status changes.

    

    Carcinophobia (fear of cancer), neurasthenia, prosopalgia (pain in the facial area) appear, which is why people turn not to a dentist, but to a neuropathologist and other specialists.

    As practice shows, severe hypersensitivity reactions develop in individuals with a burdened allergic history ( vasomotor rhinitis, various forms of eczema, urticaria, angioedema, etc.). Most often they occur with drug allergies (30% of cases), food (30%), asthma and other pathologies.

    An important place in the mechanism of development of allergenic stomatitis is played by carious teeth, chronic tonsillitis, as well as the accumulation of various microorganisms in the area of ​​prostheses.

    Allergic stomatitis can occur in isolation or be part of systemic disorders:

    • systemic lupus erythematosus;
    • vasculitis;
    • scleroderma;
    • diathesis;
    • toxic epidermal necrolysis;
    • Reiter's disease;
    • exudative, malignant erythema and others.

    There are the following types of allergic stomatitis:

    • catarrhal (simple);
    • bullous;
    • catarrhal-hemorrhagic;
    • erosive;
    • ulcerative.

    A variation of the disease is anaphylactic stomatitis, which is the appearance of multiple aphthae and erythema in the mouth.

    It develops as a result of the use of any drugs.

    Intraoral fixed…

    

    Allergic stomatitis

    It is difficult for the patient not to notice the changes caused by the pathological process on the lips and tongue. Allergic reactions in this area can manifest themselves in various ways, starting with edema and ending with the appearance of rashes; some of them can be very painful. Mouth allergies often occur in childhood, although the possibility of developing in an adult cannot be ruled out.

    Causes

    The defeat of the lips, extending to the mucous membrane and the red border, is called cheilitis, and the pathological process, localized in the region of the tongue, is called glossitis.

    

    Both cheilitis and glossitis are more often distinguished as symptoms of various diseases and are considered as an independent pathology in very rare cases. Allergy on the lips and tongue occurs:

    1. In case of hypersensitivity to chemicals, which include components of dental materials (metal alloys, ceramics, cements, etc.), decorative cosmetics, oral care products (toothpastes, rinses), stationery (pencils, pens with the habit of holding them in the mouth), sweets and chewing gums.

    Also, the etiological factor may be the use of musical instruments, which require contact with the lips to create sound.

  • With increased sensitivity to sunlight.
  • In patients suffering from atopic dermatitis, eczema, chronic stomatitis.

Types of lesions of the lips and tongue of an allergic nature can be represented in the list:

• • • contact cheilitis;
    • contact glossitis;
    • actinic cheilitis;
    • atopic cheilitis;
    • eczematous cheilitis.

The area of ​​the lips and tongue is also involved in the pathological process with Quincke's edema, chronic aphthous stomatitis.

Symptoms

Contact allergic cheilitis is caused by a delayed-type reaction and is recorded mainly in women; lip allergy symptoms include:

• • • severe itching;
    • severe swelling;
    • redness;
    • burning sensation on the lips;
    • the appearance of small bubbles;
    • erosion after the opening of the bubbles;
    • peeling.

The disease worsens after repeated contact with the allergen.

With a widespread lesion, patients complain of pain that increases during eating, talking. Allergic contact glossitis, or allergy to the tongue, in many cases is combined with cheilitis; the tongue turns red, the papillae are atrophied during examination, taste sensitivity may be impaired.

Actinic cheilitis is an inflammation of the tissue on the lips caused by exposure to sunlight. The exudative form is manifested by the presence of a rash on the lips in the form of bubbles, after which erosions and crusts are found, painful on contact with food, with pressure, and movement of the lips.

There is also swelling and redness, itching different intensity. Patients suffering from the dry form of actinic cheilitis complain of severe dryness and burning on the lips, the appearance of peeling - gray, whitish scales. Redness is observed on the lips, erosion may appear.

Atopic cheilitis is a pathology that occurs most often in children who have been diagnosed with atopic dermatitis.

The changes are most pronounced in the corners of the mouth and are manifested by itching, pain when opening the mouth, a feeling of tightness, dryness and peeling, cracks that bleed when damaged.

Allergies around the mouth can be complicated by the addition of a bacterial, viral or fungal infection.

Acute eczematous cheilitis is characterized by:

• • redness and swelling of the lips;
  • intense itching;
  • the presence of a rash in the form of ...

It is difficult for the patient not to notice the changes caused by the pathological process on the lips and tongue. Allergic reactions in this area can manifest themselves in various ways, starting with edema and ending with the appearance of rashes; some of them can be very painful. Mouth allergies often occur in childhood, although the possibility of developing in an adult cannot be ruled out.

Causes

The defeat of the lips, extending to the mucous membrane and the red border, is called cheilitis, and the pathological process, localized in the region of the tongue, is called glossitis. Both cheilitis and glossitis are more often distinguished as symptoms of various diseases and are considered as an independent pathology in very rare cases. Allergy on the lips and tongue occurs:

1. In case of hypersensitivity to chemicals, which include components of dental materials (metal alloys, ceramics, cements, etc.), decorative cosmetics, oral care products (toothpastes, rinses), stationery (pencils, pens with the habit of holding in your mouth), sweets and chewing gums. Also, the etiological factor may be the use of musical instruments, which require contact with the lips to create sound.
2. With increased sensitivity to sunlight.
3. In patients suffering from atopic dermatitis, eczema, chronic stomatitis.

Types of lesions of the lips and tongue of an allergic nature can be represented in the list:

• contact cheilitis;
• contact glossitis;
• actinic cheilitis;
• atopic cheilitis;
• eczematous cheilitis.

The area of ​​the lips and tongue is also involved in the pathological process with Quincke's edema, chronic aphthous stomatitis.

Symptoms

Contact allergic cheilitis is caused by a delayed-type reaction and is recorded mainly in women; lip allergy symptoms include:

• severe itching;
• severe swelling;
• redness;
• burning sensation on the lips;
• the appearance of small bubbles;
• erosion after the opening of the bubbles;
• peeling.

The disease worsens after repeated contact with the allergen. With a widespread lesion, patients complain of pain that increases during eating, talking. Allergic contact glossitis, or allergy to the tongue, in many cases is combined with cheilitis; the tongue turns red, the papillae are atrophied during examination, taste sensitivity may be impaired.

Actinic cheilitis is an inflammation of the tissue on the lips caused by exposure to sunlight. The exudative form is manifested by the presence of a rash on the lips in the form of bubbles, after which erosions and crusts are found, painful on contact with food, with pressure, and movement of the lips. There is also swelling and redness, itching of varying intensity. Patients suffering from the dry form of actinic cheilitis complain of severe dryness and burning on the lips, the appearance of peeling - gray, whitish scales. Redness is observed on the lips, erosion may appear.

Atopic cheilitis is a pathology that occurs most often in children who have been diagnosed with atopic dermatitis.

The changes are most pronounced in the corners of the mouth and are manifested by itching, pain when opening the mouth, a feeling of tightness, dryness and peeling, cracks that bleed when damaged. Allergies around the mouth can be complicated by the addition of a bacterial, viral or fungal infection.

Acute eczematous cheilitis is characterized by:

• redness and swelling of the lips;
• intense itching;
• the presence of a rash in the form of bubbles;
• the presence of erosion and "serous wells", crusts;
• peeling.

"Serous wells" are called erosions that remain after the opening of the bubbles on the lips due to the presence of a serous discharge. Drying of the "well" leads to the appearance of yellowish crusts.

In the chronic course of eczematous cheilitis, the tissue of the lips thickens, a rash appears in the form of vesicles, nodules. There are painful cracks, crusts, areas of peeling.

Chronic aphthous stomatitis is a disease with a chronic relapsing course, the exact causes of which are unknown. It is characterized by the presence of aphthae - erosions or ulcers localized on the oral mucosa. Scientists are inclined to think that the development of aphthous stomatitis is due to allergic mechanisms in combination with a violation of the immune status. Of decisive importance is the presence of chronic pathology of the gastrointestinal tract, infection with viruses, bacteria and fungal agents. The vast majority of patients are children of various age groups. There are such symptoms of allergies in the mouth as:

1. Burning and itching in the affected area.
2. Pain during conversation, eating.
3. The presence of round or oval aphthae on the mucous membrane of the lips, tongue, cheeks, gums.

Aphthae are observed within two weeks, may become covered with a grayish tinge or transform into deeper lesions - ulcers that heal with scarring.

Diagnostics

One of the most important methods of examination is the collection of anamnesis, since in order to choose a rational therapy, it is necessary to establish causal factor, associated with the onset of symptoms, that is, the allergen or group of allergens that provoke the disease in the patient.

To do this, a survey is conducted with a detailed specification of aspects of professional activity, a description of episodes of exacerbations, if they happened in the past. So, the patient may notice that the rash and itching appeared after using a certain lipstick or a visit to the dentist.

Additionally, diagnostic tests such as general analysis blood, skin tests. In the case of aphthous stomatitis, it is necessary to search for foci of chronic infection, so the range of examination methods is greatly expanded, including biochemical analysis blood, electrocardiography, radiography of the chest cavity, determination of markers of chronic hepatitis, etc. Diagnosis and treatment of allergic cheilitis and glossitis are carried out by an allergist and a dermatologist, if necessary, patients are consulted by doctors of related specialties.

Treatment

In the case of allergic contact cheilitis and/or glossitis, it is necessary to find the allergen and further prevent contact with it (replace dentures, use other cosmetics). Antihistamines, cromones (cetirizine, ketotifen), ointments with glucocorticosteroids (elok) are used.

In actinic cheilitis, the main measure to prevent exacerbations is to reduce the duration of sun exposure, especially if professional activity the patient involves working in conditions of solar insolation. Assign creams with the effect of sun protection, ointments with glucocorticosteroids, vitamin therapy.

• In the treatment of atopic cheilitis use:
• antihistamines (tavegil, zirtek);
• desensitizing agents (sodium thiosulfate);
• glucocorticosteroids (prednisolone, mometasone);
• sedatives (seduxen).

Histaglobulin can also be used - a drug that is a complex human immunoglobulin and histamine. It has an anti-allergic effect by inactivating free histamine in the blood serum. It is administered intradermally.

Treatment of eczematous cheilitis is carried out with the help of antihistamines, desensitizing, sedative drugs. Mandatory local therapy using corticosteroid ointments. A helium-neon laser is also used.

In the treatment of chronic aphthous stomatitis necessary drugs are antihistamines (zaditen), vitamins (ascorutin), antiseptics (miramistin), local anesthetics(lidocaine), immunostimulants (imudon). Apply films with atropine, antibacterial agents, anesthetics. Solcoseryl is prescribed to restore the epithelium. Sanitation of foci of chronic infection, physiotherapy (helium-neon laser) are also required.

Like an allergy of any etiology, allergic stomatitis occurs in people of all ages. People with weakened immune systems, the elderly, as well as children, endure it hard. It is quite difficult to treat allergic stomatitis, the main thing is to correctly determine the cause of the disease and select a set of drugs as soon as possible.

Signs of allergic stomatitis with a photo

There are several forms of allergic stomatitis, each of which has characteristic symptoms. All of them can lead to the development of disorders in the functioning of the nervous system - the patient becomes irritable, emotionally unstable, sleeps poorly, cancerophobia (fear of getting cancer) may appear.

The most severe is the ulcerative necrotic variety. It is characterized by hyperemia of the mucous membranes of the mouth, the formation of multiple ulcers covered with a gray coating. On the latter there are necrotic foci. Submandibular lymph nodes increase, salivation increases. The patient's body temperature rises, he complains of headaches and severe discomfort in the mouth, which is aggravated by eating.

If vesicles filled with a clear liquid appeared on the mucous membranes, then this indicates a bullous form of stomatitis. Vesicles are vesicles that can be of different sizes. With the development of the disease, they burst, leaving behind erosion with a fibrous coating on their surface. At this stage, the patient notes an increase pain, which become especially intense while chewing food or when talking. Several erosions can merge into a single large wound. Then the patient's condition will deteriorate sharply. Headaches will begin, appetite will decrease, fever is often observed.

There is another form of the pathology under consideration - catarrhal-hemorrhagic or catarrhal. Its main symptom is xerotomia (excessive dryness of the mucous membranes). Another pronounced symptom is a "varnished" tongue. Usually, the imprints of the patient's teeth are clearly visible on it. You can clearly see how stomatitis manifests itself in the photo to the article. The following signs are also present:

Reasons for the development of the disease

The cause of the development of an allergic form of stomatitis is the effect of an allergen on a person. If an irritant enters the body, then the occurrence inflammatory process can be one of the symptoms of a general allergic reaction. In some cases, the allergen acts directly on the mucous membranes in the mouth, then we will talk about the manifestation of an allergy localized in the oral cavity.

A general allergic reaction, one of the symptoms of which can be stomatitis, develops when the body of a person prone to allergies is exposed to substances that cause individual intolerance. It can be plant pollen, bee products, food or, for example, medicines.

The development of the contact form of the disease is possible with local exposure to the allergen. In this case, common causes of stomatitis are dentures, mouth rinses, toothpaste or chewable/loose tablets. Some materials used in dentistry can cause mucosal sensitivity oral cavity:

There are categories of patients who are at risk for the development of contact allergic stomatitis. These include people suffering from carious lesions or tonsillitis in chronic form. There is also a high probability of pathology in people prone to other types of allergies, with impaired functioning. endocrine system or diseases of the gastrointestinal tract in a chronic form.

In children, allergic stomatitis often develops when an irritant substance enters the body from dirty hands - for example, after touching a flowering plant, a child may lick his fingers. In some cases, allergic stomatitis can act as a sign of severe pathological processes, which include:

• multiform exudative erythema;
• Behçet's disease;
• Stevens-Johnson syndrome;
• Lyell's syndrome;
• scleroderma;
• vasculitis;
• systemic lupus erythematosus;
• hemorrhagic diathesis.

Features of the course of the disease in children

Allergic stomatitis in children is important to differentiate from other forms of this pathology, which require a fundamentally different approach to treatment. This can only be done by a qualified specialist. The immune system the child is imperfect, so children suffer the disease much harder than adults. With absence timely treatment a secondary infection may join, then the patient's condition will worsen, and the duration of therapy will increase.

In the initial stages of the development of allergic stomatitis, the child complains of a burning sensation or soreness in the oral cavity. On visual inspection, you can see that the tongue, cheeks or lips are slightly swollen. The child is salivating intensely, a layer of plaque accumulates on the tongue. Sometimes there is a sour smell from the mouth.

In children, allergic stomatitis often develops as a symptom of a general allergic reaction. It can be triggered by pollen, food, or drugs. In the contact form, the irritant enters the body from orthodontic structures that the child wears on his teeth, with chewing sweets or with toothpaste. In younger schoolchildren and preschoolers, it can occur against the background of a carious lesion.

Ways to treat allergies in the mouth

Treatment of allergic stomatitis should be comprehensive. First, you need to determine the substance that caused the body's response to the stimulus, and eliminate contact with it. You also need to stop the reaction and eliminate unpleasant, painful symptoms.

In addition to consulting an allergist, you will need to get recommendations from a dentist. First of all, further contact with the allergen is excluded:

• hypoallergenic diet - exclude spicy spices, pickled and smoked foods, red fruits, rinse the mouth after eating clean water or an antiseptic solution;
• with a medical origin of the disease, a revision of the therapeutic course is required;
• if irritants are part of the prosthesis, the latter is removed, after the completion of the treatment of stomatitis, the patient is made a structure from another material;
• sometimes you need to change your mouthwash and toothpaste.

Also, the doctor will recommend taking medicines in tablet form and ointments for topical use. To eliminate pain in children, the use of drugs designed to facilitate teething is recommended. These are Dentol-baby, Kalgel, Dentinox. Since a bacterial infection is often associated with the development of allergic stomatitis in a child, antibiotic treatment may be required. The rest of the therapy is practically no different from the "adult".

If the disease is severe, the doctor may prescribe corticosteroid therapy. In some cases, their drip administration is carried out. Preparations of this group are extremely rarely used in the treatment of children, since in such cases there is a high risk of recurrence of the inflammatory process.

Treatment of allergic stomatitis at home

Facilities traditional medicine can be a great addition to drug therapy prescribed by a doctor, and a hypoallergenic diet.

Before using any homemade recipe, be sure to consult a doctor, as the substances themselves contained in folk remedies, in some cases can cause and exacerbate an allergic reaction.

When treating children, use active use home formulations are not recommended, while if we are talking about stomatitis in an adult who was caused by prosthetics, they will be useful and effective. The following recipes are among the most popular:

1. Potato compress. Grate a raw potato tuber on a fine grater and apply for 10-15 minutes. You can pre-wrap in sterile gauze.
2. Fresh carrot juice. Grate raw carrots, squeeze out the juice. Dilute with warm boiled water in a ratio of 1:1. Hold in mouth for 2 minutes and spit out.
3. Honey infusion. Use with caution, as bee products are highly allergenic. 1 tbsp chamomile pharmacy pour a glass of boiling water and insist for 5 minutes. Add liquid natural honey (2 tablespoons). rinse the mouth 3-4 times a day for 1 minute.
4. Herbal oil. Mix equal amounts of linseed and sea buckthorn oil with propolis and rosehip oil. Propolis pre-melt in a water bath. With the resulting composition, you need to lubricate the wounds, rinsing your mouth before that.
5. Infusion of calendula and chamomile. Mix 1 tsp. chamomile with 1 tsp. dried and crushed calendula Pour in a glass of boiling water. Insist for half an hour. Use for rinsing the mouth, but no more than four times a day. If you repeat the procedure more often, there is a risk of overdrying the mucous membrane.