Artyus's phenomenon – a kind of local reaction of hypersensitivity which feature is formation of immune complexes in blood and damage of the microcirculator course of various fabrics and bodies. Most often the pathology form arising after introduction of medicines meets. Its symptoms are sharp reddening, pain, a swelling on the place of an injection, the necrosis of skin and underlying structures is possible further. Diagnostics is made by method of survey of skin, collecting the anamnesis of life of the patient, definition of what medicines he used recently. Treatment includes reception glucocorticoid and antihistamines, elimination of contacts with allergen.
Artyus's phenomenon is one of options of intolerance of drugs caused by immunological hypersensitivity to acting or to excipients in their structure. It was for the first time described in 1903 by the French doctor Maurice Artyus. Can arise at any age, introduction of medicines is usually shown in response to parenteral (hypodermic or intramuscular). The increased frequency of a disease is observed among persons with atopic states (bronchial asthma, dermatitis, pollinozy). Despite local character of a state, it poses a serious threat of the complications. Considerably the long contact (exposition) with provocative medicine aggravates manifestations of a phenomenon. It happens because of late emergence of symptoms (in weeks and even months) when pathology is found after repeated introduction of allergen – for example, within course treatment.
Reasons of a phenomenon of Artyus
Disease etiology multiple-factor, as well as at any other allergic state. Both specific internal features of an organism, and consequence of external influences (ecology, food, the postponed diseases) are its cornerstone. The nature of pathological process also depends by nature allergen – only some groups of medicines are capable to provoke emergence of a phenomenon. Most often Artyus's reaction arises at use of the following medicines:
- Immunological means. Carry to them serums, some vaccines, anatoksina and other drugs possessing a high immunogenicity. They can directly interact with immune system and sometimes provoke intolerance.
- Antibiotics. Separate groups of antibacterial means are capable to cause an allergy at parenteral introduction. Most often such reaction is exponentiated by penicillin, tetratsiklina, is extremely rare – macroleads.
- Vitamin complexes. The solutions of vitamins used in many schemes of the supporting treatment can react with specific antibodies. As well as in a case with antibiotics, pathology is complicated by course use of these medicines that increases amount of allergen in an organism.
- Insulin. At a small share of patients with diabetes Artyus's phenomenon arises because of injections of solutions of insulin. Hypersensitivity usually develops not to the hormone, and to impurity as a part of medicine.
Such reaction can be found also when using other proteinaceous and polypeptide substances. Sometimes the phenomenon is registered after the cosmetology procedures of injection character (a mesotherapy, biorevitalization, a botulinoterapiya). The main conditions are parenteral introduction of allergen, its solubility in biological liquids and a certain immunogenicity.
Artyus's phenomenon which is a special form of an allergy in too time has a bit different nature of pathogenesis. Processes of the third (immunocomplex) type of reaction of hypersensitivity are generally observed. At the first contact of an organism with provocative substance there is a sensitization – process of the immune answer and recognition of allergen is activated. Allocation of a plazmotsitama of immunoglobulins of classes G and M, specific to an anti-gene, becomes a result. At new receipt connection contacts these antibodies formation of immune complexes. At the same time there is a repeated stimulation of lymphocytes to synthesis of new portions of specific IgG and IgM.
The arisen immune complexes, unlike anti-genes and antibodies, are insoluble, settle on walls of vessels of the microcirculator course. There they activate system of a complement, damaging endometrium and starting fibrillation process. The formed microblood clots in combination with cytotoxic immune reactions lead to a necrosis of fabrics. Local injury of skin, hypodermic fatty cellulose, muscle fibers in the field of the greatest concentration of an anti-gene – in the place of an injection becomes a result of these processes. At a significant amount of immune complexes they are capable to be carried on an organism with blood current, leading to a clinical picture of the chronic serumal disease (CSD).
Symptoms of a phenomenon of Artyus
In the presence of a sensitization for development of pathology of rather single injection of the medicine containing allergen in the structure. In case of an intact organism emergence of a phenomenon is possible only at repeated introduction (course treatment) or reuse of medicine after a while (for example, a revaccination). The symptomatology of a disease is shown in 7-10 days from the moment of contact with an anti-gene, sometimes this term makes up to several months. Around the place of an injection there is a reddening, the hypostasis passing into dense and intense infiltrate. Patients complain of the expressed itch, morbidity in a zone of pathological process.
At insignificant amount of the entered allergen and low reactivity Artyus's phenomenon is limited to infiltrate which spontaneously resolves for several weeks. In hard cases the skin necrosis with formation develops it is long not healing ulcer. At intramuscular introduction of medicine can arise miozit. Because of organism intoxication products of a necrosis of fabrics body temperature increases, the feeling of weakness, a headache appears. The special threat is posed by a secondary bacterial infection, inflammatory process gets is purulent - necrotic character. Healing of the pathological center happens within 1-3 months to formation of a noticeable hem.
The most serious complication of a phenomenon of Artyus is development of a serumal disease – system immunocomplex reaction. The symptomatology includes severe fever, papular or eritematozny rash on all body, a swelling of joints, violations from heart and kidneys. Usually HSB arises in 1-3 weeks after introduction of the medicine containing provocative connections. Quite often infiltrate or the center of a necrosis of skin is surprised a bacterial infection, weight of symptoms depends on character of microflora. In extremely exceptional cases the phenomenon is combined with reactions as a small tortoiseshell or angioneurotic hypostasis. It is considered a disturbing sign as points out risk of anaphylactic shock.
The diagnosis is exposed on the basis of results of survey of the doctor of the allergist-immunologist and a number of laboratory researches. Often consultation of the dermatologist for an exception of other skin pathologies, and also opinion of the expert who appointed injection introduction of medicine is required. Some diagnostic technicians are directed to identification of early signs of complications – a bacterial infection or HSB. Definition of a phenomenon of Artyus is made on the following algorithm:
- Poll and collecting anamnesis. During the conversation with the patient it becomes clear when pathology symptoms appeared whether parenteral introduction of drugs was made before it. The clinical record (is studied at its existence), the type and a dosage of medicines is established.
- Survey. The visual research of area of pathological process is conducted – most often the phenomenon is shown on the lateral surface of a shoulder, in subscapular area or on buttocks. Availability of the localized infiltrate or a limited necrosis of skin indicates an allergic state.
- Laboratory researches. At uncomplicated forms the picture of the general blood test changes slightly – SOE increases, is registered small . At accession of a secondary infection the quantity of neutrophils increases. Changes in biochemical blood test (increase in concentration of S-jet protein, ASAT, ALAT) testify to the beginning of development of HSB.
- Immunoassays. Immunofermental blood test (IFA) on definition of the circulating immune complexes is necessary for early diagnostics of HSB. At easy options of a phenomenon of Artyus results usually negative. Also identification of antibodies to antibiotics or other drugs which were injected to the patient is carried out.
Differential diagnostics is performed with pustulous and inflammatory damages of skin (a streptodermiya, stafilodermiy) and other dermatological states. For confirmation of HSB carrying out the ECG, biochemical blood test, the general analysis of urine can be required.
Treatment of a phenomenon of Artyus
Main objectives of therapy are weakening of immunological reaction, elimination of the allergen which is available in an organism and prevention of further contacts with it. For this purpose in immunology apply a number of medical actions, their concrete plan depends on a set of factors – expressivenesses of a phenomenon, duration of an exposition of an anti-gene, its character and quantity in an organism. It is necessary to pay attention and to the local treatment directed to weakening of symptoms, acceleration of processes of healing and prevention of infection. Therapy of a phenomenon of Artyus includes use of the following medicines and techniques:
- Glyukokortikosteroidny means. Prednisolonum and other connections of this group promote effective weakening of allergic reactions, slow down both formation of immune complexes, and cytotoxic processes in fabrics. At early detection of a disease and purpose of corticosteroids practically it is always possible to avoid development of a necrosis and other complications.
- Infusional therapy. It is directed to acceleration of elimination of allergen from an organism, it is made by means of reception of a large amount of liquid, intravenous injections. It is sometimes corrected depending on character of a provocative anti-gene – for example, reception of certain diuretics, change of pH of urine for the best dissolution of provocative substance.
- Antihistaminic medicines. Are effective in most cases Artyus's phenomenon, considerably reduce risk of a necrosis and further distribution of pathological process. Are applied in a combination to steroid means.
- Local actions. Careful aseptic processing of the struck zone is necessary for prevention of infectious complications. For reduction of an itch and weakening of inflammatory process use ointments and gels with the maintenance of steroids (hydrocortisone). At an ulceration of skin put wound healing means.
At the first identification of signs of a phenomenon of Artyus introduction of any medicines except for vital before allergen definition is cancelled. Further any use of provocative substance and the connections similar to it on chemical structure is forbidden – for example, at intolerance of penicillin all antibiotics of this row are contraindicated. If insulin medicine became the reason of pathology, means is replaced with hormone from other producer then regular observation is required from the allergist-immunologist. Control lasts 3-6 months, it is necessary for confidence in lack of reaction to new medicine.
Forecast and prevention
In most cases Artyus's phenomenon has the favorable forecast. At the correct treatment pathology does not create threat of human life, skin violations disappear completely. At development of a necrosis after healing there is a noticeable hem. The main danger is constituted by complications, in particular HSB which is capable to lead to a system vaskulit with defeat of a set of bodies. The potential risk has also existence of hypersensitivity to some drugs – often it demands expensive treatment of infectious and other diseases. Prevention consists in use of better medicines – is established that high extent of purification of active ingredients reduces probability of undesirable reactions. With the confirmed intolerance of certain means it is necessary to avoid their application – in particular, at the address to the doctor always to inform on it the expert.