Allergy- increased sensitivity of the body to various substances associated with changes in its reactivity. The peculiarity of allergic reactions is their diversity clinical forms and flow options.
Classified into two large groups: reactions immediate type and delayed reactions.
Immediate allergic reactions
Immediate type reactions include anaphylactic shock, Quincke's edema. They develop literally within a few minutes after a specific antigen (allergen) enters the body. Quincke's edema (angioedema) is characterized by its specific manifestation in the facial area in particular.
Angioedema (Quincke's edema)
Occurs as a result of action food allergens, various medications used orally, with local application. Localized accumulation of large amounts of exudate in connective tissue, most often in the area of the lips, eyelids, mucous membrane of the tongue and larynx. Swelling appears quickly and has an elastic consistency; tissues in the area of edema are tense; lasts from several hours to two days and disappears without a trace, leaving no changes. Angioedema of the face or just the lips is often observed as an isolated manifestation of drug allergy. It should be differentiated from: swelling of the lip with Melkersson-Rosenthal syndrome, Meige's trophedema and other macrocheilitis.
Quincke's edema, with manifestation on the upper lip:
With manifestation on the lower lip:
Delayed allergic reactions
Contact and toxicoallergic drug stomatitis
They are the most common form of damage to the mucous membranes due to allergies. They can occur when using any medications.
Complaints: burning, itching, dry mouth, pain when eating. The general condition of patients, as a rule, is not disturbed.
Objectively: hyperemia and swelling of the mucous membranes are noted; tooth marks are clearly visible on the lateral surfaces of the tongue and cheeks along the line where the teeth meet. The tongue is hyperemic and bright red. The papillae may be hypertrophied or atrophied. At the same time, catarrhal gingivitis may occur.
Differential diagnostics: similar changes in gastrointestinal pathology, hypo- and avitaminosis C, B1, B6, B12, endocrine disorders, diabetes mellitus, CVS pathology, fungal infections.
Drug-induced stomatitis, localized on the lower lip:
Drug-induced catarrhal gingivostomatitis, localized on the upper lip:
Ulcerative lesions of the oral mucosa
♠ Occur against the background of swelling and hyperemia in the area of the lips, cheeks, lateral surfaces of the tongue, and hard palate.
♠ Erosion of various sizes is observed, painful, covered with fibrinous plaque.
♠ Erosions can merge with each other, forming a continuous erosive surface.
♠ The tongue is coated and swollen. The gingival interdental papillae are hyperemic, swollen, and bleed easily when touched.
♠ The submandibular lymph nodes are enlarged and painful. The general condition is disturbed: elevated temperature, malaise, lack of appetite.
♠ Differential diagnosis: it is necessary to differentiate from herpetic stomatitis, aphthous stomatitis, pemphigus, erythema multiforme.
Drug-induced erosive stomatitis:
Ulcerative-necrotic lesions of the oral mucosa
♠ The process can be localized on the hard palate, tongue, and cheeks.
♠ Can be diffuse, involving not only the musculoskeletal system, but also palatine tonsils, back wall sips, or even everything gastrointestinal tract.
♠ Ulcers are covered with necrotic decay of white-gray color.
♠ Patients complain of severe pain in the mouth, difficulty opening the mouth, pain when swallowing, and increased body temperature.
♠ Differential diagnosis: ulcerative necrotizing stomatitis of Vincent, traumatic and trophic ulcers, specific lesions in syphilis, tuberculosis, as well as ulcerative lesions in blood diseases.
Drug-induced necrotizing ulcerative stomatitis localized on the lower surface of the tongue:
Specific allergic manifestations on the mucous membrane, when taking certain medicinal substances
♠ Often, as a result of taking a medicinal substance, vesicles or blisters appear on the oral mucosa, after opening of which erosions usually form. Such rashes are observed mainly after taking stepomycin. Similar elements on the tongue and lips may appear after taking sulfonamides and oletethrin.
♠ Changes in the oral cavity as a result of taking tetracycline antibiotics are characterized by the development of atrophic or hypertrophic glossitis
♠ Oral lesions are often accompanied by fungal stomatitis.
Changes in the oral cavity as a result of taking sulfonamides in the form of edema and hyperemia upper lip and the area of necrosis on the tongue:
Reaction of the mucous membrane to oletethrin in the form of erosions on the lateral surfaces of the tongue:
Reaction of the oral mucosa to antibiotics in the form of papillary hypertrophy, erosions on the tongue and papillary atrophy, after taking tretracycline (tetracycline tongue):
Allergic purpura or Schonlein-Genyukh syndrome
♠ Aseptic inflammation of small vessels caused by the damaging effect of immune complexes.
♠ Manifested by hemorrhages, intravascular coagulation disorders and microcirculatory disorders.
♠ Characterized by hemorrhagic rashes on the gums and cheeks. tongue, palate. Petechiae and hemorrhagic spots with a diameter of 3-5 mm to 1 cm do not protrude above the level of the mucous membrane and do not disappear when pressed with glass.
♠ The general condition of the patients is disturbed, they are worried about weakness and malaise.
♠ Differential diagnosis: Wergolf disease, homophily, vitamin deficiency C.
Schönlein-Genyukh syndrome:
Diagnosis of contact and toxic-allergic drug-induced stomatitis
♠ Allergological history.
♠ Features of the clinical course.
♠ Specific allergological, skin-allergic tests.
♠ Hemogram (eosinophilia, leukocytosis, lymphopenia)
♠ Immunological reactions.
Treatment of contact and toxic-allergic drug stomatitis
♠ Etiotropic treatment – isolation of the body from the influence of the expected antigen.
♠ Pathogenetic treatment – inhibition of lymphocyte proliferation and antibody biosynthesis; inhibition of antigen-antibody connection; specific desensitization; inactivation of biologically active substances.
♠ Symptomatic treatment– influence on secondary manifestations and complications (correction functional disorders in organs and systems)
♠ Specific hyposensitizing therapy is carried out according to special schemes after a thorough allergological examination and determination of the patient’s state of sensitization to a specific allergen.
♠ Nonspecific hyposensitizing therapy includes: calcium preparations, histoglobulin, antihistamines(Peritol, Tavegil), as well as ascorbic acid and ascorutin.
♠ In severe cases, corticosteroid drugs are prescribed.
♠ Local treatment is carried out according to the principle of treatment of catarrhal stomatitis or erosive-necrotic lesions of the oral mucosa: antiseptics with anesthetics, antihistamines and corticosteroids, anti-inflammatory drugs and proteinase inhibitors.
♠ For necrotic lesions, proteolytic enzymes are indicated;
♠ For restoration - keratoplasty preparations.
Behçet's syndrome
♠ Dento-ophthalmogenital syndrome.
♠ Etiology: infectious allergy, auto-aggression, genetic determination.
♠ Usually begins with malaise, which may be accompanied by fever and myalgia.
♠ Aphthae appear on the oral mucosa and on the external genital organs. There are many aphthae, they are surrounded by an inflammatory rim of bright red color, and have a diameter of up to 10 mm. The surface of the aphthae is densely filled with yellow-white fibrinous plaque.
♠ They heal without a scar.
♠ Eye damage occurs in almost 100% of patients, manifested by severe bilateral iridocyclitis with clouding of the vitreous, which leads to the gradual formation of synechiae and overgrowth of the pupil.
♠ In some cases, a rash appears on the skin of the body and limbs in the form of erythema nodosum.
♠ The most serious complication is damage to the nervous system, which occurs as meningoencephalitis.
♠ Other symptoms of Behcet's syndrome: the most common are recurrent epididymitis, gastrointestinal lesions, deep ulcers prone to perforation and bleeding, vasculitis.
Treatment of Behcet's syndrome
There are currently no generally accepted treatment methods. Corticosteroids do not have a significant effect on the course of the disease, although they may reduce the manifestation of some clinical symptoms. In some cases, colchicine and levamisole are used, which is effective only against the mucocutaneous manifestations of the syndrome. Antibiotics are prescribed wide range action, plasma transfusion, gamaglobulin.
Behçet's syndrome:
Erythema multiforme exudative
♠ A disease of an allergic nature with an acute cyclical course, prone to relapse, manifested by a polymorphism of skin rashes and mucous membranes.
♠ Develops mainly after taking medications (sulfonamides, anti-inflammatory drugs, antibiotics) or under the influence of household allergens.
♠ It appears as various morphological elements: spots, papules, blisters, vesicles and blisters.
♠ The skin and mucous membrane of the oral cavity can be affected in isolation, but their combined damage can also occur.
♠ Infectious-allergic form of MEE - begins as acute infection. Maculopapular rashes appear on the skin, lips, edematous and hyperemic mucous membranes. In the first stages, blisters and vesicles appear, released by serous or serous-hemorrhagic exudate. Elements can be observed within 2-3 days. The blisters rupture and empty, and in their place numerous erosions are formed, covered with a yellow-gray fibrinous coating (burn effect).
♠ Toxic-allergic form of MEE - occurs as increased sensitivity to medications when taking them or coming into contact with them. The frequency of relapses depends on contact with the allergen. In this form of MEE, the oral mucosa is the obligatory site for the eruption of lesion elements. The rashes are completely identical to those in the previous form, but are more common, and here the process is characterized by a fixed nature. Complications of this form are conjunctivitis and keratitis.
♠ When diagnosing MEE, in addition to anamnesis and clinical examination methods, you need to do a blood test, conduct cytological examination material from the affected areas.
♠ Differential diagnostics: herpetic stomatitis, pemphigus, Dühring's disease, secondary syphilis.
MEE. Erosions and crusts on the red border of the lips and facial skin:
MEE. Bubbles on the gums and mucous membrane of the lower lip:
MEE. Erosion on the mucous membrane of the lips, covered with fibrinous plaque:
MEE. Erosions covered with fibrinous film on the lips:
MEE. Extensive erosions covered with a fibrinous film on the lower surface of the tongue:
Cockades:
Treatment of exudative erythema multiforme
♠ Provides for identifying and eliminating the sensitization factor.
♠ To treat the infectious-allergic form, specific desensitization with microbial allergens is carried out.
♠ Severe course disease is a direct indication for the prescription of corticosteroids. Lysozyme course.
♠ Local treatment is carried out adhering to the principles of treatment of ulcerative-necrotic processes of the oral mucosa - irrigation with antiseptic solutions, solutions that increase immunobiological resistance, drugs that break down necrotic tissue and fibrinous plaque.
♠ A feature of the treatment of MEE is the use of drugs that have a local antiallergic effect (diphenhydramine, thymalin) - in the form of applications or an aerosol.
Stevens-Johnson syndrome
♠ Ectodermosis localized near the physiological openings.
♠ The disease is a super-severe form of exudative erythema multiforme, which occurs with significant disturbances in the general condition of patients.
♠ Develops as a drug-induced lesion. During development it can transform into Lyell's syndrome. Non-steroidal anti-inflammatory drugs can cause it.
♠ The main changes occur in the integumentary epithelium. They manifest themselves as spongiosis, ballooning dystrophy, in the papillary layer of the lamina propria - the phenomenon of edema and infiltration.
♠ Clinic: the disease often begins with high body temperature, accompanied by blistering and erosive elements of the lesion, severe eye damage with the appearance of blisters and erosions on the conjunctiva.
♠ A constant sign syndrome is a generalized lesion of the oral mucosa, accompanied by the appearance of widespread erosions covered with a white membranous coating.
♠ With generalized lesions, vulvoaginitis develops.
♠ Skin rash is characterized by polymorphism.
♠ Papules on the skin often sink in the center, reminiscent of “cockades”
♠ On the red border of the lips, tongue, soft and hard palate, blisters with serous-hemorrhagic exudate form, after emptying of which extensive painful erosions and lesions appear, covered with massive purulent-hemorrhagic crusts.
♠ Possible development of pneumonia, encephalomyelitis with fatal outcome.
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 when the body has an immunological conflict with allergens that enter the mouth from the outside or from the inside.
What to do if allergic stomatitis is detected in a child? Which doctor will help eliminate negative signs? What treatment methods are effective for damage to oral tissues?
The answers are 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 and mold spores.
Allergic stomatitis often develops in the following cases:
- 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 oral tissues due to decreased immunity due to a course of treatment with sulfonamides or antibacterial drugs;
- advanced caries, bleeding gums, inflammatory processes accompanied by the proliferation of pathogenic microorganisms;
- as a complication of Lyme disease, recurrent aphthous stomatitis, systemic lupus erythematosus, hemorrhagic diathesis, Stevens-Johnson syndrome.
According to the international classification of diseases, negative reactions in the oral cavity are included 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 application bay leaf V folk medicine for the treatment of allergic diseases.
Read about the first signs and symptoms of a gluten allergy in a child at this address.
First signs and symptoms
The disease has general and local symptoms.
Even with a mild form of allergic stomatitis, the patient experiences discomfort during oral hygiene procedures, eating, and in advanced cases it is difficult to speak due to inflamed, swollen tissues.
Local signs:
- soreness, redness of the affected areas;
- can be heard from the mouth bad smell(preserves even after brushing your teeth);
- swelling of the tongue, lips, palate, pharynx, cheek area;
- excessive salivation.
If you are allergic to medications 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 erosions.
General signs:
- the disease often develops rapidly;
- body temperature often rises (especially if you are allergic to antibiotics);
- bubbles and blisters form in severe cases not only in the mouth, but also on the skin, mucous membranes of the eyes, and genitals;
- with Lyme disease, red spots with a border around the edges appear on various parts of the body;
- pain syndrome is pronounced;
- Sometimes joint pain occurs.
Diagnostics
If the mucous membranes and tongue are affected, it is important to consult a dentist in a timely manner.
The doctor will examine the oral cavity, clarify the clinical picture, and listen to the patient’s complaints. Analysis in progress background diseases, the doctor identifies the strength and nature of the negative symptoms.
If allergic stomatitis is suspected, a comprehensive diagnosis is carried out:
- checking structures: dentures, braces, fillings;
- general clinical examinations of urine and blood;
- immunogram to monitor the state of the immune system;
- determination of the acidity level and composition of saliva;
- identification of the activity of enzymes contained in saliva;
- leukopenic test;
- provocative tests with...
Reasons for the development of the disease
Both adults and children are susceptible to such an unpleasant disease as allergies. And especially unpleasant is a type 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 to 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 exudative erythema multiforme.
In addition, swelling of the oral cavity can be observed as a private manifestation of generalized Quincke's edema.
According to localization, inflammation is divided into:
- cheilitis – area of the lips and mucous membrane near the mouth,
- glossitis - tongue,
- gingivitis - gums,
- stomatitis - oral mucosa,
- palatinitis - soft or hard palate,
- papillitis - gum papillae.
According to severity and characteristic symptoms, allergic stomatitis can be divided into:
- catarrhal,
- catarrhal-hemorrhagic,
- bullous,
- ulcerative-necrotic,
- erosive.
The catarrhal type of allergic stomatitis is characterized by moderate symptoms.
Patients usually complain of dry mouth and pain when eating. The disease is also accompanied by burning and itching. In the hemorrhagic form, upon examination, small spots of hemorrhages are visible on the mucous membrane. The bullous form is characterized by the formation of blisters with exudate. When they are destroyed, erosion can form. With ulcerative-necrotic 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 lymph nodes and signs of general intoxication of the body.
How to distinguish allergic reactions from inflammatory processes infectious origin? First of all, you need to pay attention to symptoms such as dry mucous membranes and tongue. This symptom is characteristic of allergic processes. With a bacterial infection, there is usually increased salivation or it remains within normal limits. 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 bad taste in the mouth, which usually does not happen with bacterial stomatitis.
Other symptoms of allergic stomatitis also include small rashes in the oral cavity, education small bubbles(vesicles), in severe forms - ulcers and areas of necrosis. The patient feels severe itching in the mouth area, and sometimes severe pain. The process of eating and chewing food is also difficult or even impossible due to severe pain.
In the absence of treatment, massive necrotic lesions of the oral mucosa and the addition of a bacterial infection are possible, which will significantly complicate treatment.
In children, allergic stomatitis is usually much more severe than in adults, it has a more acute onset and is more 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. Stomatitis in children is often 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 also refers to local manifestations of immune, skin and other diseases.
Stomatitis occurs quite often in both children and adults. The mucous membrane of the bottom of the mouth, cheeks, and 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 overall health.
The cause of this stomatitis is the entry of an allergen into the body or direct contact of a traumatic element with the oral mucosa.
Allergies can be triggered by plant pollen, medications, and some food products, resulting in a complex immune reaction. 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 treatments:
- local anesthetic agents;
- filling material;
- bracket systems;
- orthodontic plates;
- crowns;
- metal and other prostheses.
More often, allergies are caused by acrylic implants, which contain residual monomers and coloring substances.
When installing 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 structure.
It has been established that people suffering from chronic diseases gastrointestinal tract (dysbiosis, pancreatitis, cholecystitis, colitis, gastritis and others), as well as endocrine disorders (diabetes, increased function thyroid gland, menopause).
Due to various types of disorders, the listed diseases lead to modifications in the body's reactivity and sensitization to dental prosthetic allergens.
In such patients, the neurological status changes.
Cancerophobia (fear of cancer), neurasthenia, prosopalgia (pain in the facial area) appear, which is why people turn not to the dentist, but to a neurologist and other specialists.
As practice shows, severe hypersensitivity reactions develop in persons with a burdened allergic history (vasomotor rhinitis, various shapes eczema, urticaria, angioedema, etc.). Most often they occur with drug allergies (30% of cases), food allergies (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.
The following types of allergic stomatitis are distinguished:
- catarrhal (simple);
- bullous;
- catarrhal-hemorrhagic;
- erosive;
- ulcerative
A type of disease is anaphylactic stomatitis, which is the appearance of multiple canker sores and erythema in the mouth.
Develops as a result of the use of any medications.
Intraoral fixed…
Allergic stomatitis
Changes caused by the pathological process on the lips and tongue are difficult for the patient not to notice. Allergic reactions in this area can manifest themselves in various ways, from swelling to the appearance of rashes; some of them can be very painful. Mouth allergies often occur in childhood, although the possibility of development in an adult cannot be ruled out.
Causes
Damage to the lips that extends to the mucous membrane and red border is called cheilitis, and pathological process, localized in the area of the tongue - glossitis.
Both cheilitis and glossitis are often identified as symptoms of various diseases and are considered as an independent pathology in very rare cases. Allergies to the lips and tongue occur:
- When hypersensitivity chemicals, which include components of dental materials (metal alloys, ceramics, cements, etc.), decorative cosmetics, oral care products (toothpastes, rinses), stationery (pencils, pens if you are in the habit of holding them in your mouth) , sweets and chewing gum.
Also etiological factor may be use 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.
The types of lesions of the lips and tongue of an allergic nature can be presented 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 and chronic aphthous stomatitis.
Symptoms
Contact allergic cheilitis is caused by a delayed 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 opening of the bubbles;
- peeling.
The disease worsens after repeated contact with the allergen.
With widespread damage, patients complain of pain that worsens while eating or talking. Allergic contact glossitis, or tongue allergy, is in many cases combined with cheilitis; the tongue turns red, the papillae are atrophied upon examination, and taste sensitivity may be impaired.
Actinic cheilitis refers to inflammation of the tissue on the lips caused by exposure to sunlight. Exudative form is manifested by the presence of a rash on the lips in the form of blisters, after which erosions and crusts are found, painful upon contact with food, upon pressure, or 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. There is redness on the lips and erosions may appear.
Atopic cheilitis is a pathology that occurs most often in children who are diagnosed with atopic dermatitis.
The changes are most pronounced in the area of the corners of the mouth and are manifested by itching, pain when opening the mouth, a feeling of tightness, dryness and flaking, cracks that bleed when damaged.
Allergies around the mouth can be complicated by 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...
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This test is intended for children aged 10-12 years. It allows you to determine what place your child occupies in the group of peers. To correctly evaluate the results and get the most accurate answers, you should not give a lot of time to think; ask your child to answer what first comes to his mind...
Allergic diseases oral cavity
What are Allergic diseases of the oral cavity -
Allergic diseases are currently widespread, and their number is constantly increasing and, what is especially dangerous, the severity of the course is aggravating.
Allergy- this is an increased and, therefore, 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 played by the state of the nervous, endocrine systems, and pathology of the gastrointestinal tract.
What provokes / Causes of Allergic diseases of the oral cavity:
The reasons for such a widespread prevalence of allergic diseases are varied. First of all, pollution plays a big role in this. environment emissions of waste from industrial enterprises, exhaust gases, use in agriculture pesticides, herbicides, etc. The rapid development of the chemical industry and the associated appearance in everyday life and in production of a variety of 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 drugs 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, diet, etc. are also important.
Allergies can be caused by various substances - from simple chemical compounds(iodine, bromine) to the most complex (proteins, polysaccharides, as well as their combinations), which, when entering the body, cause an immune response of the humoral or cellular type. Substances that can cause an allergic reaction are called allergens. The number of allergens in nature is large, they are varied in composition and properties. Some of them enter the body from the outside, they are called exoallergens, others are formed in the body and are 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, food products, detergent powders, etc.) and infectious (bacteria, viruses, fungi and their metabolic products. Exoallergens enter the body through Airways, digestive tract, skin and mucous membranes, causing lesions 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 and etc.
Allergens can be complete antigens and incomplete ones - haptens. Haptens can cause an allergic reaction by combining with macromolecules in the body, inducing the production of antibodies; 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 produced in the body, the manifestations of allergic reactions are also diverse. However, even allergic reactions with different clinical manifestations have common pathogenetic 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 contact of the allergen with the body, which results in its sensitization, i.e. the formation of antibodies or sensitized lymphocytes that can interact with this allergen. If by the time 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. Upon repeated exposure to an allergen, an allergen-antibody or allergen-sensitized lymphocyte complex is formed in an organism already sensitized to it. From this moment the pathochemical stage of the allergic reaction begins, characterized by the release of biological 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 smooth muscles of the bronchi and intestines, changes in the composition of blood serum, impaired coagulation, cytolysis of cells, etc.
According to the mechanism of development, there are 4 types of allergic reactions: I - immediate type reaction (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 its inherent set of mediators, 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 IgE and IgG class. 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 the clinical picture of an immediate allergic reaction. After contact with a specific allergen clinical manifestations reactions occur within 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 represented mainly by IgG and IgM. This type of reaction is caused only by antibodies that can activate complement. Antibodies bind to the modified cells of the body, which leads to the activation of complement, which also causes damage and even destruction of cells. As a result of the cytotoxic type of allergic reaction, cell destruction occurs, followed by phagocytosis and removal of destroyed cells and tissues. The cytotoxic type of reactions includes drug allergies, characterized by leukopenia, thrombocytopenia, and hemolytic anemia.
Allergic reaction type III, or 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 class antibodies. 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 or 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 and 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 combines with an allergen, which can be dissolved or located on the cells, mediators are released cellular immunity- lymphokines. More than 30 lymphokines are known, which manifest their effects 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 antigen (microorganisms or foreign cells), to which lymphocytes are sensitized. If a foreign tissue graft acts as an antigenic substance that stimulates delayed-type hypersensitivity, 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 reactivity of the body.
Symptoms of Allergic Oral Diseases:
Specific diagnostics allergic diseases consists of collecting an allergic history, conducting diagnostic tests and laboratory tests.
When collecting an allergy 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 us to establish the presence of an allergic predisposition (hereditary or acquired), as well as possible exogenous and endogenous factors influencing the course of the disease (climatic, endocrine, mental, etc.). When collecting anamnesis, it is necessary to find out how the patient reacts to the administration of vaccines, serums, medications, and the circumstances of the exacerbation, as well as living and working conditions.
It is very important to identify occupational exposures to various substances. It is known that contact with simple chemicals more often causes delayed-type allergic reactions (contact dermatitis). Complex organic matter can cause immediate allergic reactions with the development of diseases such as angioedema, urticaria, allergic rhinitis, bronchial asthma, etc.
A carefully collected anamnesis suggests the possible type of allergic reaction and the likely allergen. The specific allergen that causes the development of the disease is determined using special diagnostic tests and laboratory tests.
Skin diagnostic tests are a method for identifying specific sensitization of the body.
Allergy diagnostic tests are performed outside the phase of exacerbation of the disease, 2-3 weeks after an acute allergic reaction, during a period when the body’s sensitivity to the allergen decreases.
Skin tests are based on identifying 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 of execution 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 of the allergen being tested. Thus, patch tests are most convenient for diagnosing drug allergies. Determination of hypersensitivity to allergens of bacterial and fungal origin is carried out by intradermal testing.
Provocative tests are carried out in cases where the allergy history data do not correspond to the results of skin tests. Provocative tests are based on reproducing an allergic reaction by introducing an allergen into an organ or tissue, the damage of which is leading in the clinical picture of the disease. There are nasal, conjunctival and inhalation provocative tests. Provocative tests also include cold and heat tests, used for cold and heat urticaria.
Specific diagnosis of allergic reactions is also carried out using laboratory research methods: the degranulation reaction of basophilic leukocytes (Shelley test), the blast transformation reaction of leukocytes, the reaction of neutrophil damage, the leukocytolysis reaction, etc. The advantage of methods for diagnosing allergic reactions carried out in vitro is that there is no danger of anaphylactic shock.
Which doctors should you contact if you have Allergic diseases of the oral cavity:
Allergist
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If you have previously performed any research, Be sure to take their results to a doctor for consultation. If the studies have not been performed, we will do everything necessary in our clinic or with our colleagues in other clinics.
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Other diseases from the group Dental and oral cavity diseases:
| Abrasive precancerous cheilitis Manganotti |
| Abscess in the facial area |
| Adenophlegmon |
| Edentia partial or complete |
| Actinic and meteorological cheilitis |
| Actinomycosis of the maxillofacial region |
| Allergic stomatitis |
| Alveolitis |
| Anaphylactic shock |
| Angioedema |
| Anomalies of development, teething, changes in their color |
| Anomalies in the size and shape of teeth (macrodentia and microdentia) |
| Arthrosis of the temporomandibular joint |
| Atopic cheilitis |
| Behçet's disease of the mouth |
| Bowen's disease |
| Warty precancer |
| HIV infection in the oral cavity |
| The effect of acute respiratory viral infections on the oral cavity |
| Inflammation of the tooth pulp |
| Inflammatory infiltrate |
| Dislocations of the lower jaw |
| Galvanosis |
| Hematogenous osteomyelitis |
| Dühring's dermatitis herpetiformis |
| Herpangina |
| Gingivitis |
| Gynerodontia (Crowding. Persistent primary teeth) |
| Dental hyperesthesia |
| Hyperplastic osteomyelitis |
| Hypovitaminosis of the oral cavity |
| Hypoplasia |
| Glandular cheilitis |
| Deep incisal overjet, deep bite, deep traumatic bite |
| Desquamative glossitis |
| Defects of the upper jaw and palate |
| Defects and deformations of the lips and chin |
| Facial defects |
| Defects of the lower jaw |
| Diastema |
| Distal occlusion (upper macrognathia, prognathia) |
| Periodontal disease |
| Diseases of hard dental tissues |
| Malignant tumors of the upper jaw |
| Malignant tumors of the lower jaw |
| Malignant tumors of the mucous membrane and organs of the oral cavity |
| Plaque |
| Dental plaque |
| Changes in the oral mucosa in diffuse connective tissue diseases |
| Changes in the oral mucosa in diseases of the gastrointestinal tract |
| Changes in the oral mucosa in diseases of the hematopoietic system |
| Changes in the oral mucosa in diseases of the nervous system |
| Changes in the oral mucosa in cardiovascular diseases |
| Changes in the oral mucosa in endocrine diseases |
| Calculous sialadenitis (salivary stone disease) |
| Candidiasis |
| Oral candidiasis |
| Dental caries |
| Keratoacanthoma of the lip and oral mucosa |
| Acid necrosis of teeth |
| Wedge-shaped defect (abrasion) |
| Cutaneous horn of the lip |
| Computer necrosis |
| Contact allergic cheilitis |
| lupus erythematosus |
| Lichen planus |
| Drug allergy |
| Macrocheilitis |
| Drug-induced and toxic disorders of the development of hard dental tissues |
| Mesial occlusion (true and false progeny, progenic relationship of the anterior teeth) |
| Exudative erythema multiforme of the oral cavity |
| Taste disturbance (dysgeusia) |
| Violation of salivation (salivation) |
| Necrosis of hard dental tissues |
| Limited precancerous hyperkeratosis of the red border of the lips |
| Odontogenic sinusitis in children |
| Herpes zoster |
| Tumors of the salivary glands |
| Acute periostitis |
TOPIC: Drug, bacterial and other allergies with manifestations in the cavity
mouth in children (Quincke's edema, chronic recurrent aphthous stomatitis,
exudative erythema multiforme, Stevens-Johnson syndrome, disease
Lyell's syndrome, Lyell's disease, drug-induced stomatitis, contact
allergy). Clinical manifestations. Diagnostics. The role of the dentist in
complex treatment.
Total lesson time: 7 hours
Motivational characteristics of the lesson. The increase in the prevalence of allergic diseases among the children's population is due to changes in the body's reactivity, the widespread introduction into production and everyday life of people of chemical compounds with antigenic properties, wide coverage of children and adults with active immunization, frequent reimmunization with predominantly live attenuated vaccines, the widespread use of antibiotics, various heterogeneous proteins and others. drugs that sensitize the body. A high prevalence of allergic processes is also observed in dental patients, since anesthetics, antiseptics, antibiotics, polymer components, and copolymers are widely used in dentistry. A dentist in his practice may encounter various manifestations allergic reactions. Some of them can have life-threatening consequences. Therefore, a dentist must know the clinical manifestations of allergic diseases in the oral cavity in children, methods for preventing allergic reactions during dental interventions and the role of the dentist in complex treatment, and be able to provide timely qualified assistance.
Target: learn to diagnose lesions of the oral mucosa caused by allergies, carry out diagnostics and differential diagnosis with similar diseases, provide emergency medical care for allergic reactions, carry out complex treatment and prevention of this pathology in children.
Lesson objectives:
As a result of mastering the theoretical part of the topic, the student must know:
1.
Clinical manifestations of immediate type reactions encountered in the practice of a dentist, a scheme for providing emergency care in children.
2.
Clinical manifestations of delayed-type reactions, diagnosis and treatment in children.
3.
Methods for the prevention of allergic diseases in children.
4.
Medicines used for local and general treatment of diseases of an allergic nature with manifestations on the oral mucosa in children.
As a result of completing the practical part of the lesson, the student must be able to:
1.
Collect an allergic history of the disease from the child and parents, identify complaints.
2.
Conduct a clinical examination of the child.
3.
Make a diagnosis taking into account the medical history, data from clinical and laboratory examination methods of the child.
4.
Provide emergency assistance a child with anaphylactic shock and other nosological forms of immediate allergic reactions.
5.
Draw up a treatment plan for a child with manifestations of delayed-type allergic reactions in the oral cavity.
6.
Prescribe medications for local and general treatment of diseases of the oral mucosa of an allergic nature.
7.
Fill outpatient card sick.
8.
Recommend consultations with other specialists: allergist, dermatologist, immunologist.
Requirements to original level knowledge
Students must have a sufficient level of basic knowledge from related disciplines to master this topic. To fully assimilate knowledge on the topic, students need to repeat:
–
From pathological physiology- allergic reactions of immediate and delayed type, etiopathogenesis of these reactions;
–
histology - morphological structure of the oral mucosa;
–
clinical pharmacology
- the mechanism of action of various medicinal substances used to treat manifestations of allergic reactions on the oral mucosa and general allergic reactions of the body; properties, dosages;
–
therapeutic dentistry
- etiology, pathogenesis, classification, clinical manifestations, treatment and prevention of allergic diseases;
–
dermatology - etiology, pathogenesis, classification, clinical manifestations, treatment and prevention of allergic dermatitis;
–
dentistry
children's
age
- anatomical and physiological age characteristics oral mucosa in children;
–
From general physiotherapy- mechanism of action of physical factors used with therapeutic purpose.
Control questions from related disciplines
1. Which elements of damage to the oral mucosa are considered primary: a) spot; b) erosion; c) ulcer; d) pustule; e) papule; f) crack; g) crust; h) scale.
2. Name the morphological elements characteristic of the following diseases: a) erythema multiforme exudative (EME); b) Stevens-Johnson syndrome; c) Lyell's syndrome; d) urticaria; e) chronic recurrent aphotic stomatitis:
- papules;
- foci of necrosis;
- bubbles;
- aphthae;
- erosion;
- petechiae;
- ulcers;
- grouped small-pointed bubbles.
3. Immediate allergic reactions include: a) exudative erythema multiforme; b) Behcet's syndrome; c) anaphylactic shock; d) Quincke's edema; e) medicinal stomatitis; e) urticaria.
4. Delayed allergic reactions include: a) exudative erythema multiforme; b) Behcet's syndrome; c) anaphylactic shock; d) Quincke's edema; e) medicinal stomatitis; e) urticaria.
5. Which of the following drugs are hyposensitizing: a) tavegil; b) ketotifen; c) Telfast; d) peritol; e) virolex; f) sumamed; g) claritin; h) fenkarol.
Allergic stomatitis is an inflammation in which, due to contact of the body with an antigen, damage to the oral mucosa occurs by its own immune agents.
Depending on the area in which the allergy is localized in the mouth, there are:
- - damage to the mucous membrane of the lips and their transition zone;
- - inflammation is localized on the tongue;
- palatinite— the inflammatory reaction occurs on the soft or hard palate;
- papillitis- inflammation of the gum papilla;
- — the process is localized in the gum area;
- — in this case, the mucous membrane in the area of the vestibule of the oral cavity and cheeks suffers.
Stomatitis of an allergic nature can be one of the symptoms autoimmune diseases or generalized hypersensitivity reactions, such as:
- angioedema of Quincke;
- systemic vasculitis (Behcet's disease or lupus erythematosus (SLE));
- pemphigus vulgaris (its most severe forms are s-Stevens-Johnson, or Lyell);
- bullous pemphigoid;
- erythema multiforme exudative (EME).
In this case, either symptoms of general intoxication of the body or damage to internal organs will also be present. For example, with multimorphic exudative erythema, a specific rash is observed (usually on the hands), and damage to the transition zone of the lips (also called the red border).
Mechanism of development and causes of allergic reaction
Allergic stomatitis occurs in response to re-entry of an antigen into the body. When the allergen is first introduced, T lymphocytes
T lymphocytes under a microscope
transmit information about its structure to B lymphocytes, which become plasma cells and begin to produce antibodies to a foreign protein compound.
This process is called sensitization of the body. When the antigen protein enters the bloodstream a second time, it binds to immunoglobulins and triggers the release of inflammatory mediators.
This is how a hypersensitivity reaction occurs. Depending on the speed of symptoms, hypersensitivity is classified as immediate or delayed hypersensitivity.
In the first case, the main cause of symptoms is the massive release of histamine from basophilic leukocytes. In the second - indirect reactions, in which a foreign protein “labeled” with antibodies interacts with cells, and they are lysed (destroyed) by cellular immune agents that recognize the antigen.
When an allergy manifests itself in the oral cavity, it is often necessary for a foreign agent to be repeatedly introduced into the body and “tease” the immune system, prompting it to produce more and more immunoglobulins. As a result, so many of them accumulate that when a minimal amount of antigen gets in, a violent allergic reaction can occur.
Substances that can provoke allergies in the oral cavity can be:
- antigens of microorganisms living in the oral cavity, this is especially important if there are or (foci of chronic infection);
- intolerance medicines, which occurs with their long-term use;
- contact allergic reactions to denture structures (most often, the so-called “prosthetic” contact allergic stomatitis).
The reaction itself goes through three main stages:
- Immunological. A foreign substance is introduced into the body, where the process of secreting exactly the protein against which antibodies can be produced occurs - antigen presentation. Subsequently, a cascade of reactions is launched aimed at sensitizing the body. When this substance enters the body again, it is conjugated with immunoglobulins.
- Pathochemical. The antigen-antibody complex stimulates the release of various mediators of the inflammatory response.
- Pathophysiological. The effect that occurs due to the release of inflammatory chemicals is what ultimately leads to symptoms.
In the photo, allergic prosthetic stomatitis
Classification of allergic stomatitis
According to the severity of symptoms, allergic stomatitis can be:
- catarrhal;
- erosive;
- erosive-ulcerative;
- ulcerative-necrotic.
Etiopathogenetic classification includes stomatitis:
- contact;
- autoimmune dermatostomatitis;
- medicinal;
- toxic-allergic;
- chronic recurrent aphthous stomatitis (CRAS, extreme manifestation - Setton's aphthosis).
Features of symptoms
Symptoms will vary depending on the type of allergen and the specific type of stomatitis:
Features of the course in children
The child's body is characterized by:
- unformed immune system;
- active cell division;
- high speed of metabolic reactions.
All this leads to the fact that any inflammation, including allergies in the mouth, will:
- begin acutely;
- be more severe than in an adult;
- have rapid development (complications develop earlier than in an adult);
- the body intoxication syndrome is clearly expressed;
- often diagnosed at the stage of development of complications.
In addition, a child’s body is more prone to allergies than an adult’s: an overly active response to any potential “danger” from the immune system leads to both true allergic and pseudo-allergic reactions.
The latter differ in that the degree of intensity of symptoms directly depends on how much antigen enters the body (as a rule, these are reactions to food of a certain color or composition).
Therefore, allergic stomatitis in children will:
- accompanied by a rise in temperature;
- lead to large swelling of surrounding tissues;
- progress rapidly.
If you have such symptoms, you should not self-medicate - you should take your child to the doctor on the same day on which the first signs of the disease appear.
Diagnosis and differentiation
When making a diagnosis, all systemic or infectious pathologies with a similar clinical picture.
Catarrhal stomatitis is characterized by the following picture, depending on the provoking cause:
- Anamnesis. In case of allergies - interaction with the antigen; in case of infection - non-compliance.
- Peculiarities. With allergic inflammation - itching, burning in the mouth, distortion of taste sensitivity (there is some kind of aftertaste). There are no special features for infectious diseases.
- Smell. The allergic reaction is “sterile”, so there is no bad reaction with it. At infectious process he is.
- Salivation. Allergies provoke a decrease in salivation and, with a microbial process, it is normal or increases.
The erosive form is differentiated as follows:
- Anamnesis. In allergies, the body is exposed to an antigen. With infection, there are sometimes prodromal symptoms and interaction with the sick person.
- Localization. Allergies - both in and around the mouth, as well as throughout the body (MEE, Stevens-Johnson, or Lyell). In case of infection - only the oral cavity, in case of acute syndrome - the skin of the lips is also sometimes affected.
- Smell. As with catarrhal stomatitis.
- Corolla of hyperemia. In case of allergies it is not present, in case of any infectious process it is present.
Erosive-ulcerative process:
Ulcerative-necrotic process:
- Anamnesis. The same as for catarrhal stomatitis.
- Localization. Lyell's syndrome: damage to the skin and all mucous membranes. Fusospirillary stomatitis is inflammation within the oral mucosa.
- Ulcers. Covered with a white or light gray coating in case of allergies, and brown, dirty gray and black necrotic masses in case of infection.
- Smell. With allergic inflammation there is no inflammation, with bacterial inflammation it is strong and pronounced.
Data clinical examination, as a rule, is not enough to accurately establish an accurate diagnosis.
Laboratory diagnostics
Detection of electrochemical processes in the mouth:
- chemical spectral analysis of oral fluid;
- determination of saliva pH;
- galvanometry.
Assessing the level of oral hygiene to exclude the infectious nature of stomatitis:
- biochemical analysis of saliva, as well as determination of the level of activity of its enzymes;
- scraping from the mucous membrane of fungi of the genus Candida;
- assessment of prosthetic hygiene.
Allergy diagnostics:
- exposure test: the denture is temporarily removed from the oral cavity, and then the dynamics of the pathological process are observed;
- immunogram;
- allergy skin test;
- provocative test: the use of the prosthesis is resumed under the supervision of a physician to assess the result.
Providing medical care
Treatment of allergic stomatitis consists of three main areas.
Etiotropic direction
Elimination of contact with the antigen. Replacement of orthopedic structures (, etc.), adjustment of the dose of medications or discontinuation of the drug.
Pathogenetic direction
Prescription of antihistamines (from 2nd generation: Loratadine, Chlorpyramin, etc.).
Maybe local application ointments with GCS: Hydrocortisone ointment, etc.
Diseases accompanied by massive lesions (pemphigus vulgaris, Stevens-Johnson and Lyell syndromes) require an urgent call to the resuscitation team followed by treatment in the intensive care unit!
Treatment is carried out through parenteral administration glucocorticosteroids.
Symptomatic direction
Prevention of infection is carried out: antiseptics are prescribed for rinsing (0.05%, chamomile decoction or 
sage, Furacillin solution 1:5000) - 5-6 times a day (not earlier than 3 hours after meals)
Relief of pain: local anesthetics - Anestezin 5%, Lidocaine 5-10% for topical anesthesia - 3 times a day before meals. Prescription mash with anesthesin in peach oil.
Stimulation of healing: oil solutions of vitamins E and retinol, rosehip oil, sea buckthorn, peach.
Relief of intonation symptoms: non-steroidal anti-inflammatory drugs (local - mephenamine sodium ointment 5%, general - Nimesil, Paracetamol, etc.)
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