The epidemic growth of allergic diseases over the past 30-40 years is obvious. The results of numerous Russian and foreign epidemiological studies objectively reflect the steady increase in allergic pathology , especially in children.

The prevalence of asthma in children and adolescents in industrialized countries has increased 3-4 times over the past 20 years.

The development of allergies is a complex and multifactorial process that depends not only on a genetic predisposition, but also on the effects of food and aeroallergens in the environment, as well as on a number of non-specific factors (smoking, air pollution, infections).

Obviously, there is a complex effect of various environmental factors on the human body, their interweaving, potentiation. The study of these is extremely important for basic and applied allergology, as it can provide the key to effective prevention.

Respiratory allergic diseases are based on chronic persistent inflammation of the mucous membrane and submucous layer of the respiratory tract, which is of an immunological nature and arises from genetic prerequisites and sensitization of the body.

Hyperreactivity of the bronchi and the associated bronchial obstruction syndrome in asthma is only a consequence of allergic inflammation of the airways.

It has been proven that specific inflammatory changes in the bronchial tree persist even against the background of clinical well-being.

Therefore, the most rational is the use of regular preventive treatment aimed at preventing the development of symptoms of the disease, and not at stopping an exacerbation that has already arisen.

The modern therapeutic approach to repressive allergies is based on the use of pharmacological agents capable of suppressing the chronic inflammatory allergic process.

Only traditional treatment has been thought out and widely introduced, which, of course, taking into account the pathogenesis of the disease, is basic, but does not provide a long-term effect on all mechanisms of the pathological process.

In addition, the growth of drug intolerance is important, as well as the presence of serious side effects in many drugs used to relieve clinical manifestations.

The damaging effect of urban pollutants and other air pollutants on the respiratory system can help suppress the local defense system against viral and bacterial agents, facilitate the penetration of air allergens through damaged mucous membranes, maintaining acute and chronic bronchopulmonary inflammation According to the literature, in ecologically unfavorable regions, the prevalence of bronchial asthma among children the population is 1.8 times higher. There is a clear relationship between the level of environmental pollution and the incidence rate of acute pneumonia, recurrent laryngotracheitis, bronchitis, and chronic lung diseases.

In areas where the ecological shutdown is associated with the release of harmful chemicals, the incidence rates of the respiratory system are significantly higher than those in the control zones; the frequency of respiratory diseases in children in industrial areas is higher than in rural areas. Armenian researchers have revealed a direct, statistically reliable, moderately strong correlation between air pollution in Yerevan and the incidence of bronchial asthma in children. Kovzel E.F. (2003) found a positive correlation between the concentration of carbon monoxide, nitrogen oxides and hydrocarbons that pollute the air on the one hand and the prevalence of asthma-like symptoms on the other.

In Azerbaijan, the prevalence of allergic diseases in children living in ecologically unfavorable conditions is 1.8 times higher than the same indicators in children from an ecologically safe zone.

The data obtained confirm the relevance of using measures aimed at improving the quality of the air environment, eliminating allergens and other air pollutants and the child’s body in the treatment of respiratory allergies .

Allergy is an increased sensitivity of the body to the effects of certain environmental factors (chemicals, microbes, foods) called allergens. Allergy is the basis of so-called allergic disease, which is believed to be more predisposed to of the world population. Allergic diseases are not contagious, but the predisposition to them is inherited.   

If there were cases of allergic diseases in the families of the child’s parents and one of the parents suffers from it, the probability of the child developing this condition is 50%. If both parents have allergies – more than 75%.

All allergens can be divided into a number of groups: biological (microbes, viruses, fungi, helminths, vaccines); medicinal (almost any drug can cause an allergic reaction – codeine, aspirin, penicillin, etc.); household (house dust, which includes dust particles from carpets, clothes, linen, particles of domestic insects, etc.); pollen (plant pollen); food allergens (any food) and industrial.

The earliest manifestation of food allergy is exudative diathesis, which can appear in a child as early as the 2nd week of life and, within a few months, go to another form of skin disease.

Allergy affects almost all organs and tissues of the child’s body:

skin – in the form of eczema, neurodermatitis, urticaria;

eyes – in the form of conjunctivitis;

nose – in the form of allergic rhinitis;

lungs – in the form of bronchial asthma;

kidneys – in the form of gromerulonephritis ;

the heart is in the form of rheumatism;

bones – in the form of arthritis;

intestines – in the form of dyskinesias ;

blood – in the form of anemia, leukopenia.

When in contact with an allergen, an allergic reaction develops in the human body, which is of a specific nature. According to the time of occurrence, allergic reactions are usually divided into 2 groups: immediate and delayed reactions.

Reactions of an immediate type can appear 15-20 minutes after exposure to a specific allergen in the form of skin blisters, bronchial spasms, etc.

Allergic reactions of delayed type include anaphylactic shock, urticaria, bronchial asthma and many other diseases.

Allergy does not develop in all cases of contact with an allergen. A certain role is played by heredity, the state of the endocrine and nervous systems.

Causes of allergic diseases in children

If the interaction of the immune system and infection is based on the logic of “who will beat whom,” then the relationship of the organism with antigens of a non-infectious nature is based on different principles.

It is known that the sensitivity of people to environmental antigens is different and very individual. One person will be happy to breathe in the scent of a flower, eat an egg, pet the cat and not get sick, while another spoonful of honey or an injection of a “harmless” medicine can cost his life. These are people who perceive the structure of the world around them with painful subtlety and react dramatically to it.

The phenomenon of excessively hypersensitivity to antigenic substances is called allergy, and to antigens of a non-infectious nature – atopy . Atopic diseases, the main of which are bronchial asthma, atopic dermatitis, allergic rhinitis, urticaria, affect every fourth child.

The greatest “contribution” to the formation of allergies is made by the features of the genetic apparatus. In the chromosomes of some people, genes have been found that determine the readiness to develop allergies and the transmission of this readiness by inheritance. Hereditary predisposition is detected in 70 percent of children with atopic diseases. At the same time, if the father and mother have atopic diseases at the same time, then the risk of developing allergies in their child is 45 percent, if one of the parents suffers from atopy – 20 percent, if both parents are healthy, then the risk will decrease to 10 percent.

However, the readiness to develop a disease is not a disease yet. Genes do not guarantee the appearance of a particular disease, they only open the way for it. The transition from health to illness and the speed of this transition are largely determined by the influence of external forces. This is, first of all, the effect on the child of high concentrations of antigens, as well as any (natural, technogenic, environmental, etc.) influences that worsen the natural defenses of the body. The child can begin to experience their adverse effect on himself while still in the womb.

It has been noticed that allergies appear earlier and are more severe in those children whose mothers smoked during pregnancy, ate improperly, were treated with antibiotics, hormones, and worked in hazardous enterprises.

After birth, the conditions in which the child lives are very important: his food, life, methods of treatment, etc.

In the first months of life, the most important “loophole” through which antigens invade the child’s body is the gastrointestinal tract. It has already been said that a child in the first six months does not have a sufficiently reliable immune system. He receives almost all the factors of immunity from the mother through breast milk. Colostrum is especially rich in protective immunoglobulins and immune cells – the milk released immediately after birth. In its highest protective capabilities, it can be equated to a medicine. Breast milk “lubricates” the mucous membrane of the child’s gastrointestinal tract, creating a reliable barrier to the penetration of any antigens – food, bacterial, viral. If, for some reason, the baby cannot suckle at the breast, the milk has to be expressed and boiled before feeding, then all his natural protection is lost.

A child who is completely deprived of breast milk falls into an even worse situation. No natural formula, even state-of-the-art technology, has the protective properties of breast milk. It will always be only “dead water” in comparison with “living water” – mother’s milk. Any food protein other than breast milk proteins is an antigen for a baby. Depriving a baby of breastfeeding will inevitably lead to a massive influx of antigens into the bloodstream, which will trigger a response from the immature immune system.

A child is exposed to a particularly intense antigenic effect, who was fed cereals and vegetables earlier than the prescribed age. Excessive accumulation of antigens in the lumen of the intestine in this case occurs as a result of a mismatch between the level of maturity of digestion processes and the food that the child is offered to digest. The absurdity of the advice to feed a 5-month-old baby with a steak is obvious (what will he chew without having teeth?). The absurdity of feeding a 3-month-old baby with porridge, cow’s milk or an egg is outwardly not so clear, since the child’s body, in its quest to survive, will desperately strain digestive enzymes, hormones, immunity and create the illusion of successful development for more or less a long time. At the same time, changes in the body will be gradual, “cumulative” and will manifest themselves, possibly, after many months and even years. This condition should be regarded as chronic stress, in which sooner or later the depletion of reserves will occur. All this can lead to the realization of a hereditary predisposition at any age.

Scientists, trying to answer in a new way the old question about the role of the environment in human life, have come to the following conclusion: a lot of what makes a person healthy or sick is the result of the characteristics of feeding in the first year of life.

The high concentration of antigens present in the home is considered a significant risk factor for the occurrence of an allergic disease.

Household antigens are found everywhere – in the air, on the surface of walls, floors, furniture, toys, clothes, dishes, carpets, books, etc. But their concentration is highest in house dust. The dust of our housing is a mixture that reflects the peculiarities of the family life, the hygienic qualities of the housing. If you examine the dust under a microscope, you can find in it particles of hair and human skin scales, fibers of carpets, clothes, furniture upholstery, fragments of domestic insects, mold fungi, down and hair of domestic animals, the smallest particles of their excrement and many mineral impurities.

The antigenic activity of house dust is mainly determined by organic impurities and, above all, by microscopic mites, which have 50 varieties. These insects are the most common parasites in our homes, living on pillows, feather beds, carpets, old upholstered furniture and toys, corners clogged with dust. The number of ticks in the apartments of people with allergies is 6-7 times higher than in the apartments of healthy people, and reaches 2000 copies per 1 g of dust. The chitinous cover and excrement do not lose their antigenicity even in dead ticks.

Dwellings located in damp climates are often infested with fungi, the spores and mycelium of which are highly antigenic . Mold grows well in old, not repaired for a long time and poorly ventilated rooms, in bathrooms, under peeling wallpaper and plaster, in household air conditioners. Mold can grow in the abundantly watered soil of flower pots, bread, canned food, smoked fish, sausage, etc., if they are in a high humidity environment for a long time.

A significant contribution to the antigenic potential of everyday life is made by our pets – dogs, cats, birds, fish, hamsters. No matter how well we keep them, they still scatter particles of their wool, fluff, feathers, saliva, excrement over their dwellings. These highly antigenic proteins are deposited on the baby’s skin, entering the child’s gastrointestinal tract and respiratory tract.

Natural antigens overtake the child in the open air. About 200 plant species produce tiny pollen granules that are carried over long distances by the wind. Pollen is the male reproductive cells of plants. Its antigenic properties are due to the presence of proteins. Pollen of trees has 6 antigens, meadow and weed grasses – up to 10.

In the central zone of the European part of Russia, allergies most often occur to weeds (timothy, fescue, hedgehog), trees (alder, birch, hazel), weeds (wormwood and swan).

In the Krasnodar and Stavropol Territories, the main allergens are pollen of ragweed, wormwood, sunflower, and corn. Plants affect the child’s body according to the “schedule” of their flowering and pollination.

Three pollen waves are observed in the central regions of Russia: spring (mid-April-end of June) associated with flowering trees; summer (early June-late July) – dusting of meadow grasses; summer-autumn (August-September), accompanied by the appearance in the air of a large amount of weed pollen.

Indispensable companions of the plant world – insects also conceal a potential antigenic danger. The most allergenic are the poisons and integumentary tissues of hymenoptera (bees, bumblebees, wasps, hornets), dipterans (mosquitoes, midges, biting midges), cockroaches.

A special group of antigens acting on a child is associated with drugs. There is hardly a child who has never been treated with antibiotics, has not been vaccinated, has not taken vitamins. Unfortunately, many drugs in particular, such as penicillin and its semi-synthetic derivatives, tetracyclines, sulfonamides, serums, gamma globulins, are highly antigenic. Especially often they cause manifestations of allergies in the wrong regimen of taking short, often repeated courses.

The action of a variety of external antigens will quickly lead the child to an allergic disease if situations arise that facilitate their introduction into the body. The most active “helpers” of antigens are diseases that reduce the strength of the already weak natural barriers – mucous membranes. These are repeated acute respiratory viral and gastrointestinal infections, and chronic foci of inflammation in the tonsils, gallbladder, etc., and chronic diseases of the stomach and intestines (gastritis, colitis, dysbiosis, enzymatic insufficiency).

Among the reasons contributing to the development of allergic diseases, to treat potentially pathogenic environmental factors – both natural and human-caused.

The air that people breathe in cities with industrial enterprises is saturated with fuel combustion products, aggressive gases, heavy metals, and polymeric materials. Insufficient level of improvement of roads i free areas leads to high dust content. One of the most dangerous and common air pollutants is tobacco smoke. Passive Kure of , that is, the child’s stay in the same room with smokers people revealed more than half of children with asthma. Add to this} the widespread fascination with household chemicals (washing powders <enzymatic additives, perfume in aerosol containers), the use of furniture, synthetic panels of which emit harmful vapors, and you will agree that it is impossible to breathe such air without harm to health. But human lungs, with their huge surface, absorb any pollution in the air.

The rapid development of the food industry brought unexpected troubles. The production of modern food products, their transportation and storage are unthinkable without the so-called food additives. It turned out that many of them provoke allergic reactions in children. This happens especially often when using products containing benzoic acid and benzoates (E210-213), butylated oxyanisole (E 320), butylated oxytoluene (E 321), gallates (E 310-313), sodium glutamate (E 621), diphenyl (E 230) and some others. A high degree of contamination with antibiotics and hormone-like substances is detected in food raw materials.

No less concern is caused by the pollution of drinking water by industrial effluents, fertilizers leached from the soil, and animal waste.

All these factors create and enhance the aggressive influences of the external environment. Some of them, long acting on the body in relatively small concentrations (for example, small doses of radiation), can “wake up” for the time being “silent” genes, which will begin their pathological effect. Others, creating chronic inflammation of the mucous membranes, will open the gate for the entry of antigens. Still others modify the chemical structure of antigens and increase their antigenic potency. One way or another, the action of all these factors predisposes the child’s body to the development of an allergic disease.

An important form of predisposition is the formation of the readiness of certain organs for a pathological response. A striking example of this is the constantly increased readiness of the bronchi to spasm in a patient with bronchial asthma. This condition is called bronchial hyperreactivity and can occur both during an active infectious process and after prolonged inhalation of atmospheric pollution. An inflammatory, infectious or non-infectious process destroys the integrity of the mucous membrane and exposes nerve receptors. Open to all kinds of influences, these receptors react sharply to many stimuli and reproduce an attack of suffocation as if it had developed through the mechanisms of an allergic reaction.

Sometimes increased irritability of the airways is a hereditary biological defect that facilitates the formation of bronchial asthma.

The influences that provoke the occurrence of allergic reactions are called triggers. Interestingly, the triggers can be cold and hot air, sudden changes in weather, psycho-emotional reactions, physical activity, that is, factors that do not belong to antigens.

Diagnosis of allergies and this large group of diseases is carried out both on the basis of the signs of the disease and using laboratory methods. Parents often complain about the duration of the stage of diagnosis of allergic diseases and are wrong. The more accurately the spectrum of allergens is determined, the wider the range of foods allowed for the child’s nutrition or the conditions of his environment will remain. 

Allergy treatment . In the treatment of allergic diseases, the most important factor is to remove the allergen causing the disease from the food or the environment of the child. A common mistake of parents and relatives of a child is to allow him to eat “a little” of the product that is prohibited to him. One thing to keep in mind is that relapse requires only one allergen molecule. In the treatment of allergies, antiallergic drugs for external and internal use, including hormonal ones, are used.

Vaccination of children with allergies

The widespread prevalence of allergic pathology in children, the annual increase in the number of patients in the pediatric population, the early, often in the 1st year of life, onset and the chronic nature of the disease led to the fact that pediatricians constantly need to vaccinate children with allergic diseases.

The tactics of vaccination of children with allergic diseases are based on an individual approach to each child. However, despite the polymorphism of manifestations of atopy , immunization of these children is guided by a number of general principles:

1. Children with allergic diseases are subject to vaccination against all infections included in the national vaccination schedule (tuberculosis, diphtheria, tetanus, whooping cough, poliomyelitis, measles, rubella, mumps, hepatitis B). For immunization, both domestic and foreign vaccine preparations are used.

Vaccination against influenza, hepatitis A, rubella, meningococcal and hemophilic B infections is also desirable. Influenza immunization is especially necessary for children with bronchopulmonary pathology, regardless of taking corticosteroid drugs.

2. Vaccination of children with allergic diseases is carried out during the period of remission (full or partial).

3. Prophylactic vaccinations for children with this pathology should be carried out against the background of the necessary therapy, the volume and duration of which depends on the clinical picture and the severity of the allergic disease. In all cases, one of the anti- mediator drugs is prescribed in an age-specific dosage 2 times a day for 5-6 days before and after vaccination.

4. It is advisable to use drugs of the same series for the entire course of immunization in order to exclude the possibility of developing reactions associated with the introduction of different series of the drug.

5. During the vaccination period, children are advised to follow a diet with the exclusion of obligate allergens (fish, eggs, honey, chocolate, nuts, cocoa, citrus fruits, strawberries, strawberries), as well as refrain from taking other products to which allergic reactions have previously been noted, not including while adding new foods to the diet. The diet is followed for at least 1 week before vaccination and from 1 to 3 months after it (depending on the length of the post-vaccination period).

6. Children with hay fever are vaccinated outside the flowering season of causally significant plants. Vaccination of children with allergic diseases that are not seasonal in nature is carried out at any time of the year. It is advisable to vaccinate children who often suffer from ARVI during the warm season.

7. Skin tests with infectious and non-infectious allergens can be delivered 1.5 weeks before the introduction of vaccines or 1-1.5 months after it.

8. If a child receives a course of specific hyposensitizing therapy with an infectious or non-infectious allergen, as well as a course of therapy with histaglobulin , antiallergic or normal immunoglobulin, then vaccination should be carried out no earlier than 1.5-2 months after the completion of the course of treatment, with the exception of a situation caused by epidemiological indications … After the introduction of vaccine preparations, the course of therapy can be started no earlier than 1.5-2 months later.

9. After setting the Mantoux test, the introduction of vaccines (with the exception of BCG and BCG-M) is recommended to be carried out no earlier than 10-12 days, since most children with allergic pathology have a positive reaction to tuberculin, indicating the presence of an allergic reactivity in the child (for immunization according to epidemiological indications, this period may be shorter). After the introduction of DPT, ADS, ADS-M drugs and vaccines against measles and mumps, the Mantoux test can be put no earlier than after 1.5 months, i.e. the period after the restoration of indicators of immunological reactivity in children with allergic diseases.

10. For children who have had a history of one DTP vaccine or DTP, DTP-M toxoid, regardless of the time that has passed after it, it is enough to administer another dose of DTP or DTP-M toxoid followed by revaccination after 6 months. The choice of vaccine depends on the age of the child. Children with a history of 2 vaccinations with DPT-vaccine or ADS, ADS-M toxoid should also be revaccinated with ADS or ADS-M drug without taking into account the time elapsed after the last vaccination, but not earlier than 6-12 months.

The experience we have accumulated in vaccinating children with allergic diseases indicates that immunization carried out during the period of complete remission of the disease in accordance with the formulated recommendations is practically not accompanied by post-vaccination complications or exacerbation of allergic pathology . Moderate exacerbation of the underlying disease was recorded only in patients with atopic dermatitis, in whom vaccination was carried out with unstable remission or with a subacute course. The frequency of exacerbation of atopic dermatitis was 8.6% after the administration of the DPT vaccine, 10-21% after immunization with ADS-M toxoids, 4.5% after vaccination against measles and mumps. Revaccination of BCG-M in no case caused a worsening of the underlying disease.

It is characteristic that the content of total IgE in the post-vaccination period increased for a short time and after 1.5-2 months its level was comparable to the initial values. A transient increase in total IgE was observed mainly in children who had general or allergic reactions in the post-vaccination period.

The administration of vaccine preparations to children with allergic diseases, as well as to healthy children, is accompanied by the synthesis of specific antibodies at the level of protective values.

Traditional medicine for the treatment of allergies offers a range of herbs and treatments to reduce the body’s response to an allergen. But do not forget that often the most effective effect on the disease is either fasting or switching to a specially balanced diet suggested by an allergist. 

Prevention of allergic diseases

Prevention of allergic diseases consists in observing measures to prevent repeated contacts with substances with a pronounced sensitizing effect, and measures to prevent violation of the body’s defenses. To achieve the first goal, medication is limited, prescribing them only when necessary and under the supervision of a doctor. An important role is played by the introduction of advanced technology at industrial enterprises, which excludes the contact of workers with allergens. House dust must not accumulate in apartments. The second group of measures includes the elimination of possible foci of infection in the body, which are a source of sensitization. Such foci can be sick teeth, inflamed paranasal sinuses, bronchitis, cholecystitis and other inflammatory processes. Normalization of gastrointestinal tract function reduces the possibility of developing food allergies. The most important preventive measure is breastfeeding. It is noted that in children who were bottle-fed, allergic diseases subsequently develop more often. The correct mode of work and rest is of great importance.

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