Symptoms of a drug allergy

The most common symptoms of drug allergy in children:

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

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

Symptoms of drug allergy in children in terms of their rapid development and flow are divided into three groups:

1. Reactions of an acute type, which sometimes develop instantly.
2. Reactions subacute type, developing within the first day after taking the medicine (exanthema, fever).
3. Long-term reactions that develop within a few days and weeks after drug administration (serum sickness, allergic vasculitis, reactions in the lymph nodes, pancytopenia).

Acute symptoms of drug-induced allergies in children caused by drugs occur in the form of anaphylactic shock, urticaria, and angioedema of Quincke.

[1], [2], [3], [4], [5], [6], [7]

Anaphylactic shock

Acute, generalized (systemic) allergic reaction, rapidly developing after the introduction of an allergen. A threat to life is the peripheral collapse, bronchospasm, the arrest of blood circulation. It develops rapidly, after a few minutes there are symptoms of acute vascular insufficiency: a sharp decrease in blood pressure, tachycardia, a threadlike pulse. Pale cold skin indicates a decrease in blood flow. Acrocyanosis is typical for severe hypoxemia. Difficulty breathing, stridor due to edema of the larynx, bronchial obstruction. A different degree of impairment of consciousness from somnolence to coma. Cramps may occur. Reduction of the volume of circulating blood is manifested by tachycardia, a decrease in veins on the neck and behind the hands, a decrease in the systolic blood pressure.

Treatment

The sick child is laid horizontally with the raised foot end. With parenteral administration of the allergen, the injection site is split with 0.5% novocaine solution and 0.1% adrenaline solution at the dose (0.3-0.5 ml). Prednisolone is administered intravenously at a rate of 5 mg / kg body weight. At the same time, in / m antihistamines: dimedrol 1% solution 0.25-1 ml, suprastin 2% solution 0.25-0.5 ml, pipolfen 2.5% solution 0.25-0.5 ml, tavegil 1% solution 0.25-0.5 ml. Intravenously injected norepinephrine or dopamine in combination with 5% glucose solution or isotonic sodium chloride solution; or crystalloid blood substitutes (not protein!).

With persistent arterial hypotension, microfine dopamine 6-10 μg / kg / min and glucose-salt mixture in the volume of age requirement. With bronchial obstruction of iv, Iidrin 0.5 mg / kg / min and euphyllin 4-6 mg / kg with maintenance of 1 mg / kg / hour. With increasing asphyxia - Lasix 2 mcg / kg and if necessary - intubation of the trachea. With acute respiratory failure of III-IV degree, or with arterial hypotension persisting for 10-20 minutes, the patient is transferred to mechanical ventilation. Simultaneously, the administration of prednisolone and antihistamines is repeated in the same doses. The patient should receive oxygen all the time.

[8], [9], [10], [11], [12], [13], [14], [15]

Allergic edema (angioedema)

It develops by the type of allergic reactions of the immediate type after a few minutes of taking the allergen (food, medicine) or on the bite of insects. An acute, limited edema of the skin, subcutaneous tissue, mucous membranes develops. It is more often localized on the areas of loose subcutaneous fat (face, lips, eyelids, ears, genitals, limbs). Appears delimited, rapidly growing, swelling, the skin under it is not changed. Edema lasts several hours, sometimes days (less often) and disappears as quickly as it appears. Quincke's edema tends to recur. Quincke edema often occurs with hives.

Treatment

Identification and elimination of food or drug allergen. Elimination of the already existing allergen: abundant drink, enzyme preparations: antihistamines are prescribed: dimedrol, suprastin, pipolfen, klaritin, ketin, terfinadine.

[16], [17], [18], [19], [20], [21]

Hives

Urticaria is a classic IgE-mediated allergic reaction that occurs a few minutes after contact with the allergen (food, contact with plants, insect bites). There is an erythema, a blister. The rash rises above the level of the skin, in the center with a white papule, surrounded by hyperemia of the skin area. Rashes are accompanied by severe itching. The localization of the rash can be on any part of the skin, in places the rash may have a draining character. There may be general reactions: fever, abdominal pain.

Treatment

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

Symptoms of drug allergy in children of severe form

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

Multiforme exudative erythema

E ritematous patchy-papular skin rashes of different shapes. Stevens-Johnson syndrome is a severe, sometimes fatal variant of the course of multiforme exudative erythema.

Multiforme exudative erythema can occur in the form of light, spontaneous skin rashes ("kokardovye" spots of annular shape with a concentric hyperemic whisk of gray color, often with vesicles in the center) or progress to more serious vesicular or bullous lesions involving the mucosal process, damage conjunctiva and lesions of the liver, kidneys, lungs.

In severe course (Stevens-Johnson syndrome), the onset of acute, violent, with fever, lasting from a few days to 2-3 weeks. There are pains in the throat, soreness and hyperemia of the mucous membranes, conjunctivitis, hypersalivation, pain in the joints. From the first hours there are progressive lesions of the skin and mucous membranes: painful dark red spots on the neck, chest, face, limbs (even palms, soles are affected), along with which there are papules, vesicles, blisters. Rashes tend to merge, but large blisters with serous-bloody contents are rarely formed. Most patients have mucosal lesions (stomatitis, pharyngitis, laryngitis, tracheitis, conjunctivitis with keratitis, in girls - vaginitis). Quite often a secondary infection develops and pyoderma, pneumonia, and others develop. Kidneys and the heart are very rarely affected.

Lyell's Syndrome

The extreme severity of erythema multiforme is Lyell's syndrome (toxic epidermal necrolysis). The most common etiologic factors of these diseases are drug allergy, less often - a viral infection, an allergic reaction to an infectious (mainly staphylococcal) process, a transfusion of blood, plasma. Mechanisms of development are associated with allergic reactions, proceeding according to the type of Arthus reaction - the 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 auto-allergic reactions cause thrombovascular and thrombocapillaritis.

With Lyell's syndrome large, flat, flabby bubbles (bullous stage), hemorrhages form. In areas subject to friction with clothing, the surface layers of the skin exfoliate, regardless of the presence or absence of bubbles. Nikolsky's symptom is positive. As a result of pronounced epidermolysis, the child looks like a patient with a second degree burn. Mucous membranes can also be affected. The course of the disease is very difficult. In contrast to Stevens-Johnson syndrome, toxicosis is marked, myocarditis, nephritis, hepatitis are frequent. Characteristic of the development of infectious lesions (pneumonia, secondary infection of the skin), the development of hyperergic sepsis.

With a favorable course, the improvement usually occurs in the second-third week of the disease, erosions thrive after three to four weeks, but in their place remains pigmentation.