Holinergichesky small tortoiseshell
Holinergichesky small tortoiseshell – a rare autoimmune kind of an allergic small tortoiseshell. It is clinically characterized sharp (within an hour) by a rash of the small itching bubbles with serous contents on open sites of an integument. Rash tends to distribution, is followed by prodromy. It is diagnosed on the basis of the anamnesis, clinical manifestations, provocative tests on acetylcholine, artificial stimulation of allergic reaction, blood test on allergens, consultations of narrow-purpose experts. Treatment of a holinergichesky small tortoiseshell consists in neutralization of a provocative factor and correction of the accompanying pathology.
Holinergichesky small tortoiseshell
Holinergichesky small tortoiseshell – sharp itching , arising as the immune response to irritant action of acetylcholine produced by own organism of the patient. In structure of dermatological incidence about 7% of all kinds of "a krapivny dermatosis" fall to the share of a holinergichesky small tortoiseshell. In group only 50% of cases of pathology authentically have autoimmune genesis that is confirmed by the test from autosyvorotky (ASST), mechanisms of development of other 50% are still finally not found out. Pathological process has no age, gender, seasonal framework, does not possess an endemichnost. Feature of a holinergichesky small tortoiseshell is the possibility of control of a recurrence taking into account a provocative factor. Relevance of a problem for dermatology at the present stage is connected with the constant growth of quantity of the allergic dermatosis which is a basis of development of a holinergichesky small tortoiseshell which significantly breaks quality of life of patients.
Reasons of a holinergichesky small tortoiseshell
The trigger of a disease is acetylcholine which is allocated with organism cages in response to physical activity, a stress, reception of a hot bathtub etc. A half of cases of a holinergichesky small tortoiseshell has autoimmune genesis. Constant presence at blood of antibodies, related to immunoglobulin E (IgE) which is responsible for development of allergic reactions of immediate type is characteristic of its emergence. These antibodies settle down on receptors of corpulent cages and constantly stimulate them that causes IgE-an allergic mood of an organism of patients and a sensitization of integuments. Action of provocative factors on already allergizirovanny skin causes degranulation of corpulent cages which release vascular mediators including acetylcholine. The increased quantity of acetylcholine causes hypersensitivity of immune system, provokes development of acute holinergichesky autoimmune reaction.
The second half of cases of a holinergichesky small tortoiseshell develops according to the idiopathic scenario which arises against the background of chronic diseases (pathology of a digestive tract, endocrine violations, vegeto-vascular dystonia), a stress and the strengthened sweating. In this option of a holinergichesky small tortoiseshell sufficient is a destruction of corpulent cages (the main effector cells of any urticaria) of not clear genesis. Cages begin to develop the histamines and prostaglandins stimulating an inflammation and activating acetylcholine – a mediator of nervous excitement in response to which action there is an immune answer that is clinically shown by emergence of rash.
Symptoms of a holinergichesky small tortoiseshell
The sharp rashes on almost not changed, slightly edematous skin arising within several minutes, at most – from the moment of contact of the patient with provocative factors become hour the first clinical display of a disease. Primary elements of a holinergichesky small tortoiseshell represent small bubbles to 3 mm in the diameter, light pink in the center and scarlet on perimeter. Rash on a neck, a trunk and extremities is localized, is followed by a severe itch. As a starting irritant is "conductor" of nervous impulses acetylcholine, together with skin manifestations there are symptoms of pathology of nervous system: nausea, vomiting, dyspepsia, the raised salivation. Spontaneously temperature increases, there is an indisposition, the accompanying pathology becomes aggravated.
Severity of clinical manifestations depends on the level of increase in acetylcholine in an organism. Distinctive feature of clinic of a holinergichesky small tortoiseshell is spontaneous rather bystry permission of the skin manifestations and other symptoms connected with direct irritation of nervous system the high content of acetylcholine in combination with progressing of the accompanying pathology (diseases of digestive tract, endocrine violations).
Diagnosis of holinergichesky urticaria
Clinical displays of urticaria are typical. The detailed anamnesis of the patient, OAK, OAM, biochemical testing for S-jet protein, parasitological inspection, the analysis the calla on eggs a worm, dab from a nasopharynx on the infectious beginning, in combination with symptoms is enough for diagnosis of pathology by the dermatologist. At the same time confirmation of holinergichesky nature of a disease demands use of special techniques. Diagnosis of holinergichesky urticaria by means of provocative factors when hands of the patient lower for 2-3 minutes in hot water (> 50 degrees) is simplest that it immediately causes the holinergichesky answer. The provocative test consists in hypodermic introduction of acetylcholine that within 20 minutes gives symptoms of a holinergichesky small tortoiseshell. Skin testing by intracutaneous introduction of autologichny serum (ASST) belongs to screening methods.
Blood test on anti-nuclear antibodies is carried out for an exception of other kinds of an autoimmune small tortoiseshell. On the basis of IgE given about total and the proteins participating in development of an allergy exclude a chronic small tortoiseshell. Estimate a dermografizm of skin and its reaction to Ural federal district, carry out pressure upon skin for the purpose of an exception of a physical small tortoiseshell. In difficult cases because holinergichesky urticaria often proceeds on a photo of system diseases, carry out a biopsy of skin, ultrasonography of a thyroid gland and heart, EFGDS and the analysis on a bacterium of H. Pylori with assessment of results narrow experts. All analyses are never appointed at the same time, the decision on expediency of application of these or those techniques is made by the doctor. The Holinergichesky small tortoiseshell is differentiated from other species of a small tortoiseshell on the basis of results of diagnostic tests.
Treatment of a holinergichesky small tortoiseshell
Therapy of a disease has cascade character and consists of several lines designed to eliminate triggers of pathology and to apply the pharmacotherapy necessary taking into account weight of clinical manifestations. The first line of treatment assumes an exception of provocative factors (stresses, alcohol, an overheat) and training of patients in the correct behavior in life. At this stage involve antihistaminic medicines of the first generation including for reduction of an itch. Appoint a hypoallergenic diet, carry out correction of associated diseases.
The second line of therapy of a holinergichesky small tortoiseshell includes application of corticosteroids, antidepressants, sedative medicines, blockers of calcic channels, receptors to leykotriyena (ALR), dietary supplements and vitamins. The third line is connected at resistance of pathological process to the first two, assumes use of immunomodulators and a plasma exchange, sometimes in combination with immunodepressants. Outwardly appoint the medicines containing a belladonna. Prevention of a holinergichesky small tortoiseshell consists in an exception of provocative factors. The forecast rather favorable taking into account weight of an allergy and its complications.