Symptoms of drug allergies

The most common symptoms of drug allergies in children:

1. general allergic reactions (anaphylactic shock, erythema multiforme, epidermolysis bullosa, including epidermal necrolysis);
2. various skin lesions (urticaria, contact dermatitis, fixed eczema, etc.);
3. lesions of the mucous membranes of the oral cavity, tongue, eyes, lips (stomatitis, gingivitis, glossitis, cheilitis, etc.);
4. pathology of the gastrointestinal tract (gastritis, gastroenteritis).

Less frequently diagnosed drug allergy is hapten granulocytopenia and thrombocytopenia, hemorrhagic anemia, respiratory allergies (bronchial asthma attack, subglottic laryngitis, eosinophilic pulmonary infiltrate, allergic alveolitis). Even less frequently diagnosed drug allergy is the cause of myocarditis, nephropathy, systemic vasculitis, nodular periarteritis and lupus erythematosus.

Symptoms of drug allergies in children are divided into three groups according to the speed of their development and course:

1. Acute reactions, sometimes developing instantly.
2. Subacute reactions that develop within the first 24 hours after taking the drug (exanthem, fever).
3. Protracted reactions that develop over several days and weeks after drug administration (serum sickness, allergic vasculitis, reactions in the lymph nodes, pancytopenia).

Acute symptoms of drug allergy in children caused by medications occur in the form of anaphylactic shock, urticaria, and Quincke's angioedema.

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Anaphylactic shock

An acute, generalized (systemic) allergic reaction that develops rapidly after the introduction of an allergen. Life-threatening peripheral collapse, bronchospasm, and circulatory arrest. Develops quickly, and symptoms of acute vascular insufficiency appear within a few minutes: a sharp drop in blood pressure, tachycardia, and a thready pulse. Pale, cold skin indicates a decrease in blood flow. Acrocyanosis is characteristic of severe hypoxemia. Difficulty breathing, stridor due to laryngeal edema, and bronchial obstruction. Varying degrees of impaired consciousness from somnolence to coma. Convulsions may occur. A decrease in circulating blood volume is manifested by tachycardia, collapse of the veins in the neck and back of the hands, and a decrease in systolic blood pressure.

Treatment

The sick child is placed horizontally with the leg end raised. In case of parenteral administration of the allergen, the injection site is injected with 0.5% novocaine solution and 0.1% adrenaline solution in an age-appropriate dose (0.3-0.5 ml). Prednisolone is administered intravenously at a rate of 5 mg/kg of body weight. At the same time, antihistamines are administered intramuscularly: 1% diphenhydramine solution 0.25-1 ml, 2% suprastin solution 0.25-0.5 ml, 2.5% pipolfen solution 0.25-0.5 ml, 1% tavegil solution 0.25-0.5 ml. Norepinephrine or dopamine is administered intravenously in combination with 5% glucose solution or isotonic sodium chloride solution; or crystalloid blood substitutes (not protein ones!).

In case of persistent arterial hypotension, microjet dopamine 6-10 mcg/kg/min and glucose-salt mixture in the volume required by the age. In case of bronchial obstruction, intravenous isadrine 0.5 mg/kg/min and euphyllin 4-6 mg/kg with maintenance of 1 mg/kg/hour. In case of increasing asphyxia - lasix 2 mcg/kg and, if necessary, tracheal intubation. In case of acute respiratory failure of grade III-IV, or in case of persistent arterial hypotension for 10-20 minutes, the patient is transferred to artificial ventilation. Simultaneously, prednisolone and antihistamines are administered again in the same doses. The patient should receive oxygen at all times.

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Allergic edema (Quincke's edema)

It develops as an immediate allergic reaction after a few minutes of ingesting an allergen (food, medicine) or an insect bite. Acute, limited swelling of the skin, subcutaneous tissue, and mucous membranes develops. It is most often localized in areas of loose subcutaneous tissue (face, lips, eyelids, ears; genitals, limbs). A limited, rapidly increasing swelling appears, the skin underneath is unchanged. The swelling lasts for several hours, sometimes days (less often), and disappears as quickly as it appears. Quincke's edema tends to recur. A combination of Quincke's edema and urticaria is common.

Treatment

Identification and elimination of food or drug allergen. Elimination of an existing allergen: drinking plenty of fluids, enzyme preparations: antihistamines are prescribed: diphenhydramine, suprastin, pipolfen, claritin, ketoprofen, terfinadine.

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Hives

Urticaria is a classic IgE-mediated allergic reaction that occurs a few minutes after contact with an allergen (food, contact with plants, insect bites). Erythema and a blister appear. The rash rises above the skin level, with a white papule in the center, surrounded by hyperemia of the skin area. The rash is accompanied by severe skin itching. The rash can be localized on any area of the skin, in some places the rash can be confluent. There may be general reactions: increased body temperature, abdominal pain.

Treatment

Elimination of the allergen. Antihistamines. Calcium chloride solution 10% orally, ascorbic acid, rutin.

Symptoms of severe drug allergies in children

This group includes acute toxic-allergic reactions - Stevens-Johnson syndrome and Lyell's syndrome.

Erythema multiforme exudative

E rythematous maculopapular skin rashes of various shapes. Stevens-Johnson syndrome is a severe, sometimes fatal variant of erythema multiforme exudative.

Erythema multiforme exudative may present as mild, self-limiting skin rashes (ring-shaped spots with a concentric, hyperemic, grayish halo, often with a vesicle in the center) or progress to more severe vesicular or bullous lesions involving the mucous membranes, damage to the conjunctiva, and damage to the liver, kidneys, and lungs.

In severe cases (Stevens-Johnson syndrome), the onset is acute, violent, with fever lasting from several days to 2-3 weeks. Sore throat, tenderness and hyperemia of the mucous membranes, conjunctivitis, hypersalivation, and joint pain are noted. Progressive lesions of the skin and mucous membranes are observed from the first hours: painful dark red spots on the neck, chest, face, limbs (even the palms and soles are affected), along with which papules, vesicles, and blisters appear. The rashes tend to merge, but large blisters with serous-bloody contents are rare. Most patients have lesions of the mucous membranes (stomatitis, pharyngitis, laryngitis, tracheitis, conjunctivitis with keratitis, and vaginitis in girls). Often a secondary infection develops and pyoderma, pneumonia, etc. occur. The kidneys and heart are affected very rarely.

Lyell's syndrome

The extreme degree of expression of erythema multiforme is Lyell's syndrome (toxic epidermal necrolysis). The most common etiologic factors of these diseases are drug allergy, less often - viral infection, allergic reaction to an infectious (mainly staphylococcal) process, to blood transfusion, plasma. The mechanisms of development are associated with allergic reactions occurring according to the Arthus reaction type - an explosive release of lysosomal enzymes in the skin of both immune and non-immune genesis. A certain role is played by hereditary predisposition. Allergic and autoallergic reactions cause thrombovasculitis and thrombocapillaritis.

Lyell's syndrome is characterized by the formation of large, flat, flaccid blisters (bullous stage), hemorrhages. In areas subject to friction from clothing, the superficial layers of the skin peel off regardless of the presence or absence of blisters. Nikolsky's symptom is positive. As a result of pronounced epidermolysis, the child outwardly resembles a patient with a second-degree burn. Mucous membranes may also be affected. The course of the disease is very severe. Unlike Stevens-Johnson syndrome, toxicosis is sharply expressed, myocarditis, nephritis, and hepatitis are common. The development of infectious lesions (pneumonia, secondary infection of the skin), and the development of hyperergic sepsis are characteristic.

If the course is favorable, improvement usually occurs in the second or third week of the disease; erosions heal in three to four weeks, but pigmentation remains in their place.