JOURNAL OF HEPATO-GASTROENTEROLOGY RESEARCH | ЖУРНАЛ ГЕПАТО-ГАСТРОЭНТЕРОЛОГИЧЕСКИХ ИССЛЕДОВАНИЙ
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G'aniyev Abdurashid G'aniyevich,
gospital pediatriya kafedrasi dotsenti
Andijon davlat
tibbiyot instituti. Andijon, Oʻzbekiston
Temirova Oydin Husan qizi,
gospital pediatriya kafedrasi uchinchi kurs magistranti
Andijon davlat tibbiyot instituti. Andijon, Oʻzbekiston
Abdullayeva Shahnoza Nurulla qizi,
gospital pediatriya kafedrasi 2-kurs magistri
Andijon davlat tibbiyot instituti. Andijon, Oʻzbekiston
OZIQ-OVQAT ALLERGIYASINI KO'RSATISHNING XUSUSIYATLARI
ATOPIK DERMATITLI BOLALARDA ALLERGIYA
ANNOTATSIYA
Tadqiqotning maqsadi atopik dermatit (AD) bo'lgan bolalarda oziq-ovqat allergiyasining (FA) klinik va
immunologik individualligini aniqlash edi. Tekshiruvga turli xil orttirilgan patologiyaning o'jar kursidan aziyat
chekadigan 2 yoshdan 14 yoshgacha bo'lgan 88 bola (16% maktabgacha yoshdagi bolalar va 84% 8 yoshdan oshgan
bolalar) kiritilgan. Immunologik tekshiruv maxsus Allergopharma test tizimlari yordamida o'tkazilgan oziq-ovqat
allergenlariga (sigir suti oqsili, a-laktoalbumin, b-laktoglobulin, kazein, soya oqsili, echki suti oqsili) qon zardobida
allergenga xos IgE va IgG antikorlarini aniqlashni o'z ichiga oladi. . Biz 1,5 oylikdan 3 yoshgacha bo'lgan (o'rtacha
yoshi 14, 05 ± 1, 3 oy) AD bo'lgan 95 nafar bolani (52 o'g'il, 43 qiz) kuzatdik. 1,5 oydan 12 oygacha 55 (57,9%) bolalar,
1 yoshdan 3 yoshgacha mos ravishda 40 (42,1%) bolalar. Kasallik birinchi marta 78 (82,5%) 6 oygacha bo'lgan
bolalarda, 17 yoshda namoyon bo'ldi. Kasal bolalarning umumiy sonidan 48 tasi (50, 9%) noqulay kursga ega
(SCORAD indeksi 58, 14 ± 2, 63 ball); 32 (33, 3%) bola o'rtacha kursga ega (SCORAD indeksi - 32, 03 ± 1, 43 ball),
15 (15, 8%) bolalar og'ir kursga ega (SCORAD indeksi -12, 12 ± 1, 43). ball). Olingan natijalar asosida AD
immunopatogenezi asosan yallig'lanishga qarshi interleykinlar: IL-4, IL-5 ta'siri bilan tavsiflanadi va Th2-
hujayralarning kuchayishi bilan bog'liqligini tasavvur qilish mumkin. Shunday qilib, IgE va Ig G ni yanada keng
tarqalgan PA ga aniqlash bilan yosh bolalarning allergologik tekshiruvi AD klinik ko'rinishlarining xususiyatlarini
aniqlaydigan immunitet reaktsiyasining o'ziga xos xususiyatlarini aniqlashga imkon beradi.
Kalit so'zlar:
atopik dermatit, oziq-ovqat allergiyasi, namoyon bo'lish xususiyatlari, allergik reaktsiyalar
turlari
Ganiev Abdurashid Ganievich,
is an associate professor of the Department of Hospital
Pediatrics at the Andijan State
Medical Institute. Andijan, Uzbekistan
Temirova Oydin Husan qizi,
is a third-year Master of the Department of Hospital
Pediatrics of the Andijan State
Medical Institute. Andijan, Uzbekistan
Abdullayeva Shahnoza Nurulla qizi,
is a second-year master of the Department of Hospital
Pediatrics of the Andijan State
Medical Institute. Andijan, Uzbekistan
JOURNAL OF HEPATO-GASTROENTEROLOGY RESEARCH | ЖУРНАЛ ГЕПАТО-ГАСТРОЭНТЕРОЛОГИЧЕСКИХ ИССЛЕДОВАНИЙ
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PECULIARITIES OF THE MANIFESTATION OF FOOD ALLERGIES
ALLERGIES IN CHILDREN WITH ATOPIC DERMATITIS
ANNOTATION
The aim of the study was to determine the clinical and immunological individualities of food allergy (FA) in
children with atopic dermatitis (AD). Eighty-eight children with AD between 2 and 14 years of age (16% were
preschool children and 84% were children older than 8 years) suffering from a stubborn course of different acquired
pathology were included in the examination. Immunological examination included determination of values of allergen-
specific IgE and IgG antibodies in blood serum to food allergens (cow's milk protein, α-lactoalbumin, β-lactoglobulin,
casein, soy protein, goat milk protein) conducted with support of special Allergopharma test systems. We monitored 95
children with AD (52 boys, 43 girls) aged from 1, 5 months to 3 years (mean age 14, 05 ± 1, 3 months). From 1, 5 to 12
months there were 55 (57, 9%) children, from 1 to 3 years respectively 40 (42, 1%) children. The disease manifested for
the first time in 78 (82, 5%) children under 6 months of age, in 17 (17, 5%) children after 6 months. Of the total number
of ill children, 48 (50, 9%) had an uneasy course (SCORAD index was 58, 14 ± 2, 63 points); 32 (33, 3%) children had
a moderate course (SCORAD index - 32, 03 ± 1, 43 points), and 15 (15, 8%) children had an unsevere course
(SCORAD index -12, 12 ± 1, 43 points). On the basis of the results obtained, it is possible to imagine that the
immunopathogenesis of AD is characterized mostly by the impact of pro-inflammatory interleukins: IL-4, IL-5 and
associated with increased vigor Th2-cells. Thus, allergological examination of young children with determination of IgE
and Ig G to even more common PA allows us to detect the peculiarities of the immune response, which determine the
features of the clinical manifestations of AD.
Keywords:
atopic dermatitis, food allergy, features of manifestation, types of allergic reactions
Relevance.
Atopic dermatitis is characterized by
an early onset, polymorphism of the clinical picture,
complex pathogenesis and various causes of its
occurrence [1,2.10]. A triggering factor for the
development of AD in most cases is a food Allergy (PA),
which can not only exacerbate, but also to maintain a
severe course of the disease [3,5,10]. Among the
exogenous factors contributing to the manifestation of
clinical manifestations of atopic dermatitis in children of
early age, the first place belongs to the food allergies. In
children of early age with atopic dermatitis, the most
etiologically significant are cow milk proteins (casein,
bovine serum albumin, β-lacto globulin, α-lacto
globulin), egg (ovalbumin, ovomucoid), grains (gluten,
horde in), soybeans (s-protein), fish (M-par albumin)
[5,7,9].
Food can cause both true allergic and pseudo
allergic reactions. The clinical symptoms and the other is
the same, the main difference is that when about food
allergies production of biologically active substances in
food products occurs without immunological stage under
the influence of substances that contribute to liberally
histamine, serotonin [4,6].
Clarification of the nature of food Allergy in
children with atopic dermatitis is
fundamental in the definition of a rational diet,
the most important component of complex treatment of
the disease [3,4,8].
Objective
: to determine the frequency, risk
factors of developing food allergies,
particularly
its
etiological
structure
and
immunological manifestations in children with AD.
Materials and research methods
. The survey
included 88 children with AD in
age from 2 to 14 years (16% are children of pre-
school age and 84% are children over 8 years old) who
suffer from persistent flow of various chronic
pathologies. Moreover, 25% were patients who turned
directly to an allergist about their typical manifestations
of allergy (dermatitis, bronchial asthma). The majority
(75%) were patients who were treated in the somatic
departments for the underlying disease or were registered
by a pediatrician or narrowly specialized physicians
(neurologist,
rheumatologist,
otolaryngologist). All
children regularly (2-3 times a year) received planned
therapy for the underlying disease. Criteria for inclusion
of patients in the study - the duration of the disease is not
less than 6 months; continuous relapsing course of the
disease; frequency of exacerbations at least 1 time per
month; short-lasting effect of classical therapy. Standard
clinical and instrumental examination methods were
used.
The diagnosis of food allergy was made on the
basis of a comprehensive clinical and laboratory
examination of patients, taking into account the
allergological anamnesis data,
the analysis of the food diary, the results of skin
testing with allergies, elimination and provocation tests.
Skin tests were carried out with the nutritional allergens
of the company AOOT Biomed them. THEM.
Mechnikov. According to the main clinical manifestations
of the disease, 5 groups were singled out - 1st c. (n = 22)
- patients with arthralgia, 2nd gr. (n = 20) cephalalgia, 3rd
gr. (n = 18) - gastritis and / or gastroduodenitis, 4th gr. (n
= 17) - nasal bleeding, 5th gr. (n = 11) - enuresis. The
duration of the disease ranged from 6 months. up to 1
year - 17%, up to 2-3 years 35%, more than 3 years -
48% of cases. The frequency of diseases from weekly to
daily was recorded in 59% of patients and most often in
the group of patients suffering from cephalalgia (80%)
and enuresis (75%). In 22% of patients, exacerbations
occurred from 1 to 3 times a month; in 24%,
exacerbations were irregular (associated with
fatigue, hypothermia, meteorological conditions,
etc.). In 45% of patients, a combination of the underlying
disease with the skin (atopic dermatitis) or respiratory
JOURNAL OF HEPATO-GASTROENTEROLOGY RESEARCH | ЖУРНАЛ ГЕПАТО-ГАСТРОЭНТЕРОЛОГИЧЕСКИХ ИССЛЕДОВАНИЙ
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(bronchial asthma, allergic rhinitis) manifestations of
allergy was noted.
Results and discussion
. Analysis of the most
common clinical manifestations of
chronic pathology in children showed that in the
structure of cephalgia, chronic headache was determined
- 42%, headache with cerebral angiodystonia - 20%,
vegetovascular dystonia - 18%, migraine - 13%, residual
organically lesion of the central nervous system - 6%; in
the structure of arthralgia: arthralgia of unspecified
etiology - 58%, arthralgia with reactive arthritis - 42%; in
the structure of gastrointestinal manifestations, chronic
gastritis
with
normal
acidity
-
63%,
chronic
gastroduodenitis with normal acidity - 31%, erosive
gastroduodenitis - 6%. It is known that the main risk
factors for the development of food allergies are
aggravated atopic heredity and perinatal factors. A
detailed study of the risk factors for the development of
food allergy revealed that the possibility of allergic
reactions to food products is almost equally affected by
the burdened allergy and the pathological course of
pregnancy (65% and 52%, respectively). In addition to
hereditary burdens, the development of food allergies
requires sensitization of the div. In this regard,
significant results are presented by the results of skin
testing, which revealed in 84% of cases an increased
sensitivity to food allergens. A characteristic feature of
skin testing in all patients was the presence in the
overwhelming majority of cases (90%) of a weakly
positive degree of sensibilization. This, apparently, is one
of the reasons for the lack of a clear relationship between
taking the product and the appearance of complaints, in
connection with which patients do not associate their
suffering with food allergies. In the structure of the
etiological factors of food sensitization, chicken eggs
(80%), food grains (73%), meat (67%), cow milk (55%)
citrus fruits (42%), fish (45%) are identified. Moreover,
depending on the nosological form of the disease, the
etiological structure of food sensitization has its own
characteristics. Analyzing the structure of the etiological
factors of food sensitization, it was found that in all forms
of diseases, sensitization to the egg was practically the
same frequency (from 78% to 86%).
Sensitization to other food allergens occurred
with varying frequency. So, most often sensitization was
determined:
-in patients with cephalalgia: cereals (91%), egg
(75%), milk (63%), meat (56%);
-in patients with arthralgia: egg (85%), cereals
(70%), fish and meat (58%), milk (51%);
-in patients with nasal bleeding: meat (93%),
citrus fruits, egg (75%), cereals (69%);
-in patients with enuresis: egg (82%), meat
(64%), milk and cereals (55%);
-in patients with gastritis: cereals, egg (78%),
meat (69%).
Considering that these products are products of
daily consumption, it is impossible to establish a clear
connection between exacerbations and their intake
(according to anamnesis data) in most cases. In this
regard, in each individual case, food allergies were
confirmed by elimination and provocative tests,
according to the results of which 65% of the examined
children showed food allergies, and depending on the
clinical manifestations, they were recorded with a
different frequency. most often food allergies occur in
patients
with
cephalgia
(82%)
and
gastritis
/
gastroduodenitis (75%), slightly less often in patients
with arthralgia (63%), nasal bleeding (53%) and enuresis
(40%). The most frequent products that cause the
development of food allergies in this group of children
were egg (40%), food grains (39%), milk (22%) and food
additives (preservatives, dyes, etc.) (22 %). Products such
as meat, fish, citrus and nuts in rare cases caused
complaints (from 1.5% to 3% of cases). Moreover,
depending on the clinical manifestations of the disease,
the etiological structure of food allergies that cause an
allergic reaction is different. The most common cause-
significant allergens in patients with cephalalgia are milk
(36%), cereals (36%), and egg (29%); in patients with
arthralgia - cereals (67%), in patients with enuresis - an
egg (75%), in patients with nasal bleeding - an egg (62%)
and food additives (38%); in patients with gastritis
cereals (42%), food additives (33%). Thus, the same
product can cause an allergic reaction in any ―shock
organ. The study showed that the use of eggs most often
caused the appearance of nasal bleeding and enuresis;
eating cereals - arthralgia, gastritis / gastroduodenitis,
headaches; use of milk - headaches; the use of nutritional
supplements - the cause of nosebleeds, as well as
gastritis. It is interesting to note that in 59% of cases food
allergies to one product were determined, in 6% - to 2
products, and only 4% - to 3 or more products. It is
known that food allergy is a clinical manifestation of the
immunological process. In accordance with the
immunopathological basis for triggering an allergic
reaction (Cell P. and Coombs R., 2008), 4 types of
allergic reactions are distinguished. Based on the analysis
of clinical and immunological examination data, we have
identified the leading immunological mechanisms for the
development of atypical manifestations of food allergy.
The types of allergic reactions were confirmed:
-Type I: positive skin test results for 20 minutes,
early (within the first 2 hours) or delayed (from 2 to 6
hours) positive reactions during provocative tests.
-Type II: the presence of elevated levels of total
IgE and / or specific IgE / IgG
antibodies in the blood.
-Type III: delayed (from 6 to 12 hours) positive
reactions during provocation tests, the
presence of elevated levels of CIC and
immunoglobulins M, G in serum.
-Type IV: positive results of skin tests after
24.48.72 hours, slower (after 24.48.72 or
more
hours)
positive
reactions
during
provocative tests, elevated levels of immunoglobulins M,
G in blood serum. Immediatetype hypersensitivity was
found in 77% of patients, in 28% - immunocomplex, in
55% - delayed type of allergic response. Analysis of the
obtained data allowed us to identify the features of the
immune response within each clinical group. It has been
established that in each group of patients types of allergic
reactions are rarely seen in isolated form, since in most
cases there is a combination of pathogenetic mechanisms
of
food
allergy
development
(table).
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Table 1.
Types of allergic reactions in patients with a typical manifestations
of food allergies (%)
Clinical
manifestations
of food allergies
Types of allergic reactions according to the
classification of P. Gell and R. Coombs
I
III
IV
Nosebleeds
61
49
56
Cephalgia
51
33
45
Arthralgia
75**
22
54
Gastritis
100*
17
40
Enuresis
100**
20
80
Note: * - p <0.001; ** - p <0.01 in horizontal rowso.
In patients with gastritis and enuresis of food
etiology, it is statistically
significantly more often (p <0.001) that type I of
allergic reactions is recorded in comparison with patients
of other groups. patients with arthralgia (p <0.01),
enuresis (p <0.01) and gastritis, gastroduodenitis (p
<0.001) are more common to type I and IV types and
reactions. Patients with nasal bleeding and cephalgia do
not have statistically significant differences in the
prevalence of one or another type of immune response,
since they have I, III, and IV types with almost the same
frequency.
Findings. 1. The high frequency of food allergy
detection (65%) among children
with persistent course of various chronic
pathologies
indicates
a
variety
of
its
clinical
manifestations. The etiological structure of food allergies,
depending on the nosology of the disease, has its own
characteristics. 2.The detected changes in immunity
indices indicate that various types of allergic reactions are
involved in the development of food allergy, and in most
cases a combination of pathogenetic mechanisms is
noted.
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