Allergic diseases of the mucous membrane of the mouth and lips

Currently, allergic and pseudo-allergic reactions are distinguished. Pseudo-allergic reactions are called drug intolerance, which in its clinical manifestations is similar to allergic, but does not have an immunological basis.

Without a special laboratory study, it is impossible to say whether the reaction is allergic with the involvement of the immunological antigen-antibody complex or pseudo-allergic, in which the mediators are the complementary system, histamine and other substances released from tissue basophils and basophilic granulocytes with direct exposure to the administered drug.

Pseudo-allergic reactions are characterized by: 1) the absence of a specific immunoglobulin class E; 2) the manifestation of an intolerance reaction after taking drugs that are different in chemical structure; 3) the occurrence of immediate reactions after their first intake.

In many cases, pseudo-allergic reactions result from the direct release of histamine from tissue basophils under the influence of drugs without the involvement of complement or the immune system, while the severity of reactions depends on the rate of administration of the drug, its concentration, the location of tissue basophils in the vascular system, or a combination of these factors.

The number of externally used medicinal and hygiene products exceeds 5000 items, and adverse reactions occur not only to the drug, but also to fillers. Classic fillers (vaseline, lanolin, zinc paste, ethyl alcohol) sometimes contain up to 10 different chemical compounds - fats, waxes, oils, solvents, emulsifiers, stabilizers, preservatives, fragrances, dyes.

Topical preparations are often applied to damaged skin and mucous membranes, which increases the risk of complications.

Lesions of the mucous membrane of the oral cavity and lips of an allergic or infectious-allergic nature most often manifest themselves as exudative erythema multiforme, contact cheilitis, eczematous cheilitis and chronic recurrent aphthous stomatitis.

Treatment of erythema multiforme exudative depends on the etiology and clinical course of the disease.

In the pathogenesis of exudative erythema multiforme, a significant role belongs to staphylococcal infection, which develops against the background of previous sensitization with insufficient immunological protection of the body. According to A. A. Mashkilleison, A. M. Alikhanov, in 93% of patients with erythema multiforme exudative, an infectious-allergic form of the disease was established. These patients were diagnosed with T-cell immunodeficiency. In an infectious allergy, bacteria secondarily affect an organ already sensitized by another allergen.

Since infectious and allergic factors are important in the pathogenesis of erythema multiforme, therapeutic measures should be directed to each of them. The most effective treatment for allergic inflammation is specific hyposensitization. However, in the acute phase of the disease, treatment with allergens is not indicated. Specific hyposensitization should be carried out in specialized allergological rooms and hospitals. In polyclinic conditions, methods of nonspecific hyposensitizing therapy are used.

A complex effect should be directed to all mechanisms of the pathogenesis of this disease - infectious, allergic, hormonal, neurovegetative. The minimum number of drugs should be prescribed, taking into account strict indications, so as not to cause additional drug allergies.

When the infectious-allergic nature of the disease is established, antibiotics, sulfa drugs, antihistamines, and vitamins are prescribed. In severe forms of the disease (Stevens-Johnson syndrome, Lyell's syndrome-epidermal-toxic necrolysis), treatment is carried out in a hospital with the inclusion of detoxification therapy (glucose, rheopolyglucin, hemodez, isotonic sodium chloride solution) and corticosteroids. During the period of remission, foci of chronic infection are sanitized, and if a specific allergen is established, bacterial therapy (staphylococcal, streptococcal or proteus toxoid) is carried out. In addition, it is recommended to prescribe non-specific therapeutic agents that normalize the immunobiological state of the body and increase its reactivity (vitamins, pentoxyl, methyluracil, sodium nucleinate) and levamisole.

With multiform exudative erythema, which is a manifestation of an allergic reaction to drugs (usually antibiotics, sulfa drugs, salicylic acid derivatives, pyrazolone, etc.), treatment begins with the elimination of the causative factor, antihistamines are prescribed, with a severe form of the clinical course in a hospital - corticosteroids.

The appointment of antibiotics should be carried out taking into account the sensitivity of microorganisms to the drug, prescribe a sufficient therapeutic dose, take into account the possibility of an allergic reaction to the antibiotic, concomitant disease and the age of the child.

Almost all antibiotics are capable of suppressing specific immunity and nonspecific resistance of the organism to infection, and the longer antibiotics are prescribed, the more pronounced the inhibition. Therefore, the most rational duration of administration of these drugs is 7-10 days, and in severe diseases 2-3 weeks.

In connection with the violation of the synthesis of vitamins in the body due to the inhibition of the intestinal microflora during the period of antibiotics, as well as the increased need for them during the development of the infectious process, it is rational to prescribe vitamins A, C, B2, B1 B6, folic acid.

Broad-spectrum semisynthetic penicillins (ampicillin, ampioks, carbenicillin) are widely used, which act bactericidal on most antibiotic-resistant staphylococci.

The main means in the fight against antibiotic-resistant staphylococcal infection are penicillinase-resistant antibiotics (methicillin, oxacillin, dicloxacillin). Antistaphylococcal agents include macrolide antibiotics, lincomycin, fusidine sodium. Modern aminoglycoside antibiotics (gentamicin, sisomycin, tobramycin) are also used.

In children, it is advisable to prescribe two beta-lactam antibiotics, they are usually used until the diagnosis is established and the pathogen is isolated. If it is assumed that the pathogen is a gram-positive microflora, use oxacillin or methicillin with benzylpenicillin, if it is gram-negative, it is advisable to prescribe a combination of oxacillin with ampicillin or carbenicillin. They are among the least toxic antibiotics. Allergic reactions with the introduction of antibiotics are possible in 3-6% of cases and depend on the previous sensitization of the body, cross-allergy is also possible, so they must be prescribed with caution to sensitized patients.

According to Ya. L. Povolotsky and G. L. Ermakov and co-authors, from the group of penicillins, oxacillin is the most effective (72% of staphylococcus strains were sensitive to it); from the group of aminoglycosides - gentamicin (86% of staphylococcus strains are sensitive to it); from the group of macrolides - oleandomycin (45% of staphylococcus strains are sensitive to it).

Antibiotics of the penicillin group. Penicillinase-resistant penicillins.

Methicillin sodium salt(Methicillinum-natrium) is a representative of semi-synthetic penicillins. Its main feature is that it is not inactivated by penicillinase and therefore is effective against pathogens (staphylococci) that produce this enzyme and, as a result, acquire resistance to the action of benzylenenicillin salts. Methicillin also acts on staphylococci resistant to other antibiotics. The drug is administered intramuscularly. Children aged 3 months to 14 years - at the rate of 100 mg / kg of body weight per day. Solutions for injection are prepared immediately before use. The contents of the vial (1 g of the drug) are diluted in 1.5 ml of water for injection, isotonic sodium chloride solution or 0.5% novocaine solution.

Oxacillin sodium salt(Oxacillinum-natrium). A feature of the drug is its effectiveness against strains of organisms resistant to penicillin, which is associated with its resistance to penicillinase. Oxacillin remains active in the acidic environment of the stomach, so it can be used both intramuscularly and orally. Inside appoint 1 hour before a meal or 2-3 hours after a meal. Oxacillin preparations are widely used in pediatric practice. They are better tolerated than methicillin. When taken orally, the average daily dose for children aged 1 month -3 years is 150 mg / kg; 4-6 years - 100-150 mg / kg; 7-9 years - 100 mg / kg; 10-44 years - 75-100 mg/kg of body weight 4-6 times a day. Intramuscular dose for children aged 1 month - 3 years - 50-100 mg / kg; 4-6 years-100-150 mg/kg; 7-9 years-100 mg/kg; 10-14 years - 100 mg/kg of body weight 4-6 times a day.

Semi-synthetic broad-spectrum penicillins.

Ampicillin(Ampicillinum). The drug is not destroyed in the acidic environment of the stomach, well absorbed when taken orally. It is used for diseases caused by mixed infection. Assign inside 100 mg/kg of body weight 4-6 times a day.

Ampiox(Ampioxum) is a combined preparation consisting of a mixture of sodium salts of ampicillin and oxacillin in a 2:1 ratio. Its spectrum of action combines the spectrum of antimicrobial action of ampicillin and oxacillin. It is used for mixed infections caused by benzylpenicillin-sensitive and resistant staphylococci or staphylococci and gram-negative bacteria, which is especially important in dental practice. Apply inside and intramuscularly. The daily dose for children under the age of 1 year is 200 mg / kg, from 1 year to 6 years - 100 mg / kg, from 7 to 14 years - 50 mg / kg of body weight.

Aminoglycosides are among the broad-spectrum antibiotics.

Aminoglycoside antibiotics.

Gentamycin sulfate(Gentamycini sulfas) is the main means of combating severe purulent infection, especially caused by antibiotic-resistant gram-negative flora. The drug can be used intravenously. At the beginning of treatment, before the pathogen is isolated, gentamicin is combined with semi-synthetic penicillins (ampicillin, carbenicillin). Gentamicin has a bacteriostatic effect on many gram-positive and gram-negative microorganisms, including Proteus, Escherichia coli, Salmonella, etc. It acts on strains of staphylococci resistant to penicillin. Resistance to gentamicin develops slowly, but strains resistant to neomycin and kanamycin are also resistant to this antibiotic.

Due to the wide spectrum of action, the drug is often prescribed for mixed infections, as well as when the pathogen is not identified. In some cases, gentamicin is effective in case of insufficient activity of other antibiotics. Enter intramuscularly at the rate of 3 mg/kg of body weight per day. The daily dose is divided into 2-3 doses. The course of injections is 7-10 days. Topically applied ointment or cream containing 0.1% gentamicin sulfate.

Kanamycin sulfate(Kanamycini sulfas) has a wide spectrum of activity, has a bactericidal effect on most gram-positive and gram-negative microorganisms. Children are administered intramuscularly at the rate of 15 mg / kg (15,000 IU / kg) of body weight per day. The daily dose is divided into 2-3 times.

These drugs for young children are prescribed extremely rarely, only for health reasons in case of sensitivity of the pathogen to it.

Macrolide antibiotics.

Erythromycin(Erythromycinum) is active against gram-positive and gram-negative cocci, it also acts on a number of gram-positive bacteria, brucella, rickettsiae. It has little or no effect on most gram-negative bacteria, myco-bacteria, small and medium viruses and fungi. In therapeutic doses, erythromycin acts bacteriostatically. Assign 25-30 mg / kg of body weight per day. The daily dose is divided into 4-6 doses.

In severe cases, it is advisable to use erythromycin phosphate for injection, which is often as effective as semi-synthetic penicillins. It is prescribed at a dose of 15-20 mg / kg (15,000-20,000 IU / kg) of body weight per day. The daily dose is divided into 2-3 times.

Oleandomycin phosphate(Oleandomycini phosphas) ​​inhibits the growth and development of gram-positive bacteria, rickettsia and large viruses. Active against staphylococci resistant to penicillin and other antibiotics. In therapeutic doses, it acts bacteriostatically. Assign to children aged 1 month - 3 years at a dose of 20 mg / kg of body weight, 3-6 years - 0.25-0.5 g; 6-14 years - 0.5 g per day. The daily dose is divided into 4-b receptions.

Olethetrin(oletetrinum). Combined preparation consisting of a mixture of 1 part of oleandomycin phosphate and 2 parts of tetracycline. 1 tablet containing 0.125 g or 0.25 g of oletethrin consists, respectively, of 41.5 or 83 mg of oleandomycin and 83.5 or 167 mg of tetracycline. Oletethrin combines the antibacterial properties of oleandomycin and tetracycline. Assign 20 mg / kg of body weight per day. The daily dose is divided into 4-6 doses.

Fusidin-sodium ( Fusidinum-natrium) - a representative of antibiotics of different groups - acts on staphylococci, meningococci, gonococci, anaerobes. It is less active against pneumococci and streptococci. Staphylococci resistant to penicillins, streptomycin, chloramphenicol, erythromycin and other antibiotics remain sensitive to fusidine. The drug is not active against gram-negative bacteria, fungi and protozoa. It acts bacteriostatically, the mechanism of action is associated with the rapid suppression of protein synthesis. In the stomach, the drug is not destroyed and is rapidly absorbed. The maximum concentration in the blood is observed after 2-3 hours and remains at a therapeutic level for 24 hours. With prolonged use, cumulation occurs. The drug is prescribed for children aged 1 month - 3 years - 60-80 mg / kg; 3-6 years -40-60 mg/kg; 6-9 years-30-40 mg/kg; 9-14 years - 20-30 mg / kg of body weight per day. The daily dose is divided into 2-3 doses. To reduce side effects, the drug is taken with liquid food or milk. In rare cases, allergic reactions are possible. The course of treatment is 7 days.

Sulfanilamide preparations are derivatives of sulfanilic acid. The mechanism of their action is based on the inhibition of folic acid synthesis in microorganisms. The antimicrobial activity of various sulfa drugs is determined by the degree of their affinity for microbial cell receptors, i.e., their ability to compete for these receptors with para-aminobenzoic acid, which is necessary for most microorganisms to synthesize folic acid, which is used by the microbial cell to form nucleic acids. Thus, sulfa drugs are typical bacteriostatic agents.

It is essential that all these drugs, including the most active of them, have a significantly lower affinity for the microbial cell than para-aminobenzoic acid. Therefore, to obtain a bacteriostatic effect, it is necessary to create their concentration in the blood and tissues of the patient, which is many times higher than the concentration of para-aminobenzoic acid.

For this, loading doses of drugs are used at the beginning of the course of treatment with further constant maintenance of high concentrations in their blood.

The mechanism of action of sulfanilamide drugs explains their low effectiveness in environments with a high content of para-aminobenzoic acid (pus, focus of tissue destruction).

A significant increase in the prevalence of secondarily resistant strains has narrowed the indications for the use of sulfa drugs. The main reason for the development of secondary resistance to drugs of this group is their use in insufficient doses to obtain a bacteriostatic effect, "broken" courses of treatment (1-day).

Compared to antibiotics, sulfonamides are in some cases more effective and less dangerous for children, especially in cases where the disease is caused by strains of pathogens that are resistant to antibiotics, or when allergic reactions to the latter.

According to the duration of action, short-acting sulfa drugs (streptocid, etazol, norsulfazol, sulfacyl, sulfadimezin) are distinguished, the daily dose of which for children over the age of 1 year is 0.15-0.1 g / kg of body weight; preparations of medium duration of action (sulfazine) and long-term action (sulfapyridazine sodium, sulfamonomethoxin, sulfamethoxine and sulfalene), the daily dose of which is: the first single dose - 0.025 g / kg and the maintenance dose - 0.0125 g / kg of body weight. Sulfanilamide preparations are taken on an empty stomach, washed down with alkaline solutions.

Etazol(Aethazolum). The drug is slightly toxic, rapidly absorbed, less acetylated than other sulfonamides, and therefore does not lead to the formation of crystals in the urinary tract. Assign to children under the age of 2 years, 0.1-0.3 g; from 2 to 5 years - 0.3-0.4 g each; from 5 to 12 years - 0.5 g every 4 hours.

Currently, combined preparations containing trimethoprim, which is a synergist of sulfonamides, are more often used.

It should be borne in mind that these drugs may precipitate in the tubules of the kidneys. For the purpose of prevention during their administration, it is necessary to prescribe a plentiful drink of alkaline solutions. They are contraindicated in children with hypersensitivity to them, although in general there are fewer side effects when taking them than when prescribing antibiotics.

Bactrim(Bactrim). Synonym: Biseptol (Biseptol). A combined preparation containing two active ingredients: the sulfanilamide preparation sulfamethoxazole and a diaminopyrimidine-trimethoprim derivative. Its antimicrobial activity is 20-100 times greater than that of sulfamethoxazole. The bactericidal effect against gram-positive and gram-negative microbes, including bacteria resistant to sulfanilamide drugs, is explained by the double blocking effect of the drug on bacterial metabolism.

For children, the drug is available in tablets containing 100 mg of sulfamethoxazole and 20 mg of trimethoprim. Assign inside to children in the morning and evening after meals; at the age of 2 to 5 years - 2 tablets for children 2 times a day; and at the age of 5 to 12 years - 4 tablets for children 2 times a day. The course of treatment is from 5 to 12-14 days, with chronic infections - for a longer time, depending on the nature of the disease. The drug should not be given to premature babies and newborns. Bactrim suspension is applied topically in the form of applications to the affected areas of the oral mucosa.

"Poteseptil" contains trimethoprim and sulfadimezin. It has the same spectrum of action as conventional sulfonamides. Produced by VNR. Tablets for children contain 20 mg of trimethoprim and 100 mg of sulfadimesine. It is prescribed in the same dosages as Bactrim.

Antihistamines reduce the body's response to histamine, relieve spasms of smooth muscles caused by histamine, reduce capillary permeability, prevent the development of tissue edema, reduce the hypotensive effect of histamine, prevent the development and reduce the manifestations of the course of allergic reactions. Under the influence of antihistamines, the toxicity of histamine decreases. The drugs of this group have a sedative effect, have a central anticholinergic and anti-inflammatory effect. Some are used in the complex treatment of erythema multiforme, chronic recurrent aphthous stomatitis, angioedema (Quincke) and other allergic manifestations in the oral cavity.

With prolonged use of H1-histamine lytics (diphenhydramine, suprastin, diprazine, tavegil), the therapeutic effect of the drugs gradually weakens, significantly decreasing by the 5th day. Therefore, it is recommended to replace one drug with another every 5 days.

The use of antihistamines in children should be treated with caution. In allergic diseases, the sensitivity of histamine receptors to drugs is reduced, and it is often necessary to increase their doses. Endurance to them is not changed, and such children often experience toxic effects of drugs due to an overdose. The child develops depression of the central nervous system, convulsions, and there may be a decrease in blood pressure.

Diphenhydramine(DimedroIum) appoint children under the age of 1 year to 0.005 g; 1 year - 3 years - 0.01-0.015 g; 3-7 years - 0.015-0.02 g; 7-14 years - 0.025-0.03 g per dose 2-3 times a day with meals.

In severe clinical course, a 1% solution of Diphenhydramine is administered intramuscularly in a dose of 0.15-1 ml (depending on age).

Diprazine(Diprazinum). Synonym: Pipolphen. It has strong antihistamine and sedative activity. Assign to children aged 1 to 3 years at 0.005-0.01 g; 3-7 years -0.01 g; 7-14 - 0.015 g 2 times a day. Intramuscularly injected 2.5% solution of 0.25-1 ml, previously dissolved in 1 ml of 0.25% solution of novocaine, children aged 1 year - 2 years - 0.3 ml; 3-4 years -0.4 ml; 5-6 years - 0.5 ml; 7-9 - 0.7 ml; ΙΟΙ 4 years - 0.8-1 ml 2-3 times a day.

Suprastin(Suprastin) is an antihistamine drug. Has a sedative effect. Assign inside during meals to children under the age of 1 year - 0.005 g, 1 year - 3 years - 0.008-0.015 g; 3-7 years - 0.015-0.02 g; 7-14 years -0.025 g 2-3 times a day.

Tavegil(Tavegil) is more active than diphenhydramine and acts longer (8-12 hours) after a single dose. Assign to children 6-12 years old 1/2-1 tablet 2 times a day. The drug has a moderate sedative effect.

Corticosteroids- hormones of the adrenal cortex - act on all links in the pathogenesis of allergic inflammation. In severe clinical course (Lyell's syndrome, Stevens-Johnson syndrome), prednisolone, hydrocortisone, dexamethasone are prescribed intramuscularly, intravenously at 2-4 microns / kg of body weight (calculated according to prednisolone) per day in 2-4 doses.

With local application of glucocorticosteroids, the permeability of the capillaries of the mucous membrane decreases, tissue infiltration with eosinophilic granulocytes, local hyperemia is eliminated, and the content of class E immunoglobulins in the blood decreases.

Local therapy in the hydration stage begins with anesthesia of the oral mucosa before therapeutic manipulations with local anesthetics. For this purpose, anesthesin, pyromecaine are used. Thoroughly clean the teeth and interdental spaces from food debris and plaque, at the same time irrigate the oral cavity with a 0.5-1% solution of sodium bicarbonate or herbal products that have an enveloping (decoction of leaves of mallow, sage and marshmallow root) and anti-inflammatory action.

Enveloping agents protect the mucous membrane from the action of irritating factors and thereby have some non-specific anti-inflammatory effect. Enveloping agents include, first of all, plant mucus, which form colloidal solutions in water, adsorbed on the surface of the mucous membrane. Mucous substances are found in flax seeds, mallow leaves and flowers, marshmallow root and leaves, as well as in the root of comfrey.

marshmallow root(Radix Althaeae) contains about 35% mucous, 37% starch, 11% sugars, 11% pectin, 2% asparagine. It has an enveloping and local anesthetic effect, accelerates epithelialization. In the form of a decoction, it is used to rinse the mouth.

Flax seed(Semen Lini) is rich in mucous substances, linseed oil and linimarin glycoside. It is used for rinsing the mouth in acute inflammatory processes in the form of a decoction or in the form of mucus (Mucilago seminis Lini), which is prepared from 1 part of whole flaxseed and 30 parts of ex tempore hot water.

Mallow forest(Malva silvestris). The flowers and leaves of the plant contain mucus and malvin. It is used for acute inflammatory processes in the oral cavity. An infusion of leaves is prepared at the rate of 2 teaspoons of crushed leaves per cup of boiling water, infused for 3-5 hours.

Comfrey officinalis(Symphytum officinale). The root contains mucus, 6.5% tannin, 3% asparagine, choline. It is used in acute inflammatory processes in the oral cavity as an enveloping and stimulating agent for regeneration.

Starch(Amylum) is obtained from grains of wheat, corn, rice and potato tubers. In hot water, it forms a colloidal solution (Mucilago Amyli), which is used as an enveloping agent to protect the mucous membrane from the effects of irritants and to slow down the absorption of drugs. It is widely used in pediatric dentistry in the form of fruit jelly in case of damage to the oral mucosa.

As an enveloping and anti-inflammatory agent, it can be used to prepare mucus. A collection of equal parts of marshmallow leaves, chamomile flowers, mallow, flax seeds and comfrey root.

With exudative erythema multiforme and other allergic lesions of the oral mucosa, there is increased permeability and fragility of capillaries, exudation associated with the release of histamine and histamine-like substances (serotonin, acetylcholine, heparin), as well as with the activation of hyaluronidase. In this regard, the use of phenolic compounds with P-vitamin activity is justified, both inside - rutin, ascorutin, galascorbin, and locally in the form of rinses, irrigations, aerosol irrigation with decoctions, extracts and infusions of medicinal plants containing them.

After irrigation of the oral cavity with cotton swabs soaked in an antiseptic solution, carefully remove the remnants of necrotic epithelium, soak and remove crusts on the lips and apply applications, and it is better to prescribe aerosol irrigation with solutions of drugs that have antimicrobial, anti-inflammatory and anti-edematous effects. For this purpose, preparations of the nitrofuran series (furagin), quaternary ammonium compounds (0.5% solution of ethonium), 0.1% solution of decamine, solution of proteolytic enzymes (trypsin, chymotrypsin), natural antibacterial drugs (novoimanin), sodium usninate, ectericide are used. .

In the genesis of diseases of an allergic nature, kinin systems play a certain role. Conditions are created for an increased formation of kinins both as a result of the activation of proteolytic enzymes that form kinins, and as a result of a decrease in the activity of enzymes that inactivate kinins as a result of acidification of the medium. Since proteolytic enzymes play a role in the pathogenesis of allergic diseases, H. F. Danilevsky and co-authors suggested using proteinase inhibitors that inhibit the activity of a number of proteolytic enzymes (kallikrein, trypsin, plasmin) for the treatment of patients with erythema multiforme exudative and erosive and ulcerative stomatitis. The drug mixture proposed by the authors included heparin, which improves blood circulation in the affected tissues, prevents thrombosis in small vessels, and is also a histamine antagonist, a competitive inhibitor of hyaluronidase, and an inhibitor of a number of other enzymes.

In severe forms of damage to the oral mucosa, accompanied by an inflammatory reaction, destructive processes in the lesion and general phenomena - intoxication, fever - medicinal mixtures of the following composition are used: trasilol - 5000 IU, heparin - 300-500 IU, hydrocortisone - 2.5 mg, 1% solution of novocaine - 1-1.5 ml or contrical - 2000 IU, dissolved in 1 ml of isotonic sodium chloride solution, heparin - 500 IU, hydrocortisone - 2.5 mg and 1% solution of novocaine - 1 ml.

After abundant irrigation of the oral mucosa with an antiseptic solution, removal of plaque and easily removable films from the affected areas, cotton swabs are applied, abundantly moistened with the indicated mixtures for 3-5 minutes (applications are changed three times). The mixture can be used in the form of an aerosol, for this, 3 ml of a 1% solution of novocaine is added to it.

With the onset of epithelialization of erosion of the oral mucosa, keratoplastic agents are used (oil solutions of vitamins A and E, rosehip oil, carotene, sea buckthorn oil, solcoseryl ointment and jelly, linetol and Livian aerosol).

Chronic recurrent aphthous stomatitis is more common in children aged 10-14 years, according to L. Sugar et al., in 15% of cases and is in most cases the result of autoallergic processes caused by sensitization of the body to opportunistic intestinal microorganisms, worms or viruses , less often exogenous antigens of food origin.

Treatment of children with chronic recurrent aphthous stomatitis should begin with an examination of the digestive system with a mandatory bacteriological examination of feces. In case of detection of diseases of this system, complex treatment must be carried out together with the pediatrician. Of no small importance is the identification and sanitation of foci of chronic infection. It is advisable to carry out specific hyposensitizing therapy with an allergist. If a connection is established between relapses of a rash on the oral mucosa with a food-borne antigen, it must be excluded. Since these patients have impaired immunological homeostasis, which leads to increased sensitivity to an infectious allergen, it is recommended to prescribe levamisole 50 mg per day for 10 days.

The complex of treatment includes antihistamines, B vitamins, the appointment of a rational diet.

It is necessary to carry out sanitation of the oral cavity and nasopharynx. Local therapy involves the use of local anesthetics, especially before meals, proteolysis inhibitors, anti-inflammatory agents in combination with antibacterial drugs to prevent secondary infection, in the stage of regeneration, epithelialization stimulators.

Eczematous cheilitis (atonic dermatosis). This disease only in 25% of cases manifests itself in isolation on the red border and skin of the lips, and the skin of the body is most often affected. In the pathogenesis of this disease, a special place is occupied by violations of the immunobiological balance, in which there is a congenital immunodeficiency state, manifested in a decrease in cellular and humoral immunity. The functional activity of T-lymphocytes decreases and the level of immunoglobulins of all classes increases. As a result, the process is complicated by the development of pyodermatitis or aggravated under the influence of infectious factors.

Treatment of eczematous cheilitis should be complex and strictly individual. It is advisable to refer the child for a consultation with an allergist, and in case of skin lesions - with a dermatologist.

Assign hyposensitizing drugs, B vitamins and especially pyridoxal phosphate in combination with immunomodulators (levamisole), stimulants of metabolic processes (pentoxyl, methyluracil). A diet with the exclusion of food allergens and the restriction of easily digestible carbohydrates is recommended.

Pyridoxal phosphate(Pyridoxalphosphatum) - coenzyme form of vitamin B6 (pyridoxine). It has a rapid therapeutic effect, can be used in conditions associated with impaired pyridoxine phosphorylation processes in eczematous cheilitis, neurotrophic and allergic reactions. Assign inside 10-15 minutes after eating. A single dose for children is 0.01-0.02 g, daily - 0.02-0.06 g. For children with allergic reactions, the drug is prescribed at the age of 5-7 years, 0.01 g 3 times a day ft for 10-30 days. The course of treatment is repeated 2-3 times with a monthly break.

Local therapy is carried out depending on the clinical manifestations: in the acute form, lotions with Burov's liquid, a solution of ethacridine lactate (rivanol) are used.

After the cessation of weeping, ointments containing corticosteroids are prescribed; 0.5% prednisolone ointment, Polcort ointment containing hydrocortisone acetate 0.5%, Fluorocort containing 0.1% triamcinolone acetonide; "Sinalar", containing 0.025% fluocinolone acetonide; "Lokakorten", containing 0.02% flumethasone pivalate; "Cortinef", containing 0.1% fluoxyprednisolone (kenacort, lederkort), etc.

Triamcinolone ointments are 10 times, and dexamethasone 20-100 times more active than hydrocortisone ointments. Ointments containing corticosteroids are highly effective anti-inflammatory and antiallergic drugs.

Many drugs, including corticosteroids, are absorbed from ointments through the skin and especially mucous membranes, enter the blood and lymphatic channels and have both general and selective effects on individual organs and pathological processes occurring in the internal organs. Ointments applied to the mucous membrane can provide a rapid therapeutic effect.

In the chronic form of eczematous cheilitis, ointments containing birch tar are prescribed. The therapeutic effect of their use is determined not only by local action (improvement of blood supply to tissues, stimulation of epidermal regeneration, increased keratinization processes), but also by reflex reactions that occur when skin receptors are irritated.

Vulnuzan("Vulnusan") - an ointment containing 12% of the mother liquor from salt lakes (near the town of Pomorie), which includes a number of macro- and microelements (Mg, Ca, K, Na, Cl, Br, F, Mn, Zn, So and others). The ointment has a stimulating effect on cellular and humoral factors of immunity. The ointment is applied to the lips with a thin layer 1-2 times a day for 7 days.

Contact cheilitis. Contact allergic cheilitis develops from contact of the mucous membrane of the lips with various chemicals. In school-age children, it is often the result of a bad habit of holding and chewing colored pencils and pens in the mouth; it can also be caused by the presence of mercury in amalgam and oral care products (tooth powder, elixirs).

According to our observations, contact cheilitis is quite common in school-age children playing brass instruments, and is a consequence of contact of the mucous membrane of the lips with a metal mouthpiece.

Treatment of contact allergic cheilitis consists, first of all, in the elimination of the factor that caused pathological changes in the tissues of the lips. In these cases, non-specific anti-inflammatory therapy leads to the elimination of cheilitis after a few days. In rare cases, in the absence of results from such therapy, ointments containing glucocorticoids can be applied for 4-6 days.

Prevention of allergic lesions. To prevent the occurrence of allergies, it is necessary to avoid the topical use of antibiotics, especially those administered parenterally, sulfonamides and other chemotherapeutic drugs in the absence of strict indications. According to L. Sugar and co-authors, in approximately 20% of cases, sensitization of the body is due to the local use of drugs of both protein nature and haptens.

It is necessary to carefully and thoroughly collect an allergic history in children who have applied for dental care, and accordingly plan the use of certain drugs.

Eliminate adverse endogenous factors (metabolic disorders, diseases of the digestive and other systems) by referring the child to the appropriate specialist for examination and treatment.

Of no small importance is the hygienic cleaning of the home, which prevents the accumulation and formation of dust.

Attention should be paid to the proper storage of medicines in the home first aid kit.

A necessary measure is the sanitation of the oral cavity and hygienic care of the oral cavity. A pediatric dentist should pay special attention to the sanitation of foci of chronic infection.

In carrying out sanitary and educational work among schoolchildren, their attention should be drawn to the danger of a bad habit of chewing pens and pencils.

To prevent the occurrence of foci of chronic infection as a source of endogenous sensitization, hardening of children in compliance with the principles of consistency and gradualness is of great importance.

The most common complaints of patients with allergic stomatitis are swelling of soft tissues in the oral cavity (tongue, palate, etc.). Due to severe swelling, it becomes more difficult for a person to swallow, the enlarged tongue does not fit in the oral cavity, which is why patients often bite it.

The disease usually occurs as a result of a general allergic reaction. An allergy makes the body as sensitive as possible, as a result of which symptoms characteristic of stomatitis develop. Most often, allergic stomatitis is a reaction to drugs (antibiotics, sulfonamides). Usually, in this case, allergy develops at a slower pace, i.e. the first symptoms appear 20 days after taking the drugs. Also, allergic stomatitis can be provoked by some foods, usually this is observed in young children. An allergic reaction in the oral cavity can be caused by direct contact with an allergen (dentures made of plastic, special alloys).

ICD-10 code

K12 Stomatitis and related lesions

K12.1 Other forms of stomatitis

Causes of allergic stomatitis

Allergic reactions in a person can appear at any age, even if there were no such reactions to pollen, plants, medicines, etc. before. was not observed. The manifestation of such reactions may be associated with genetic changes in the body, malfunctions of the immune system. Responsible for the formation of antibodies to various pathogenic bacteria and viruses, blood cells, at a certain point, begin to react to a substance that has entered the body as an "enemy", as a result of which a typical allergy appears.

At a certain point, a product familiar to a person (honey, chamomile tea) can become the strongest allergen that causes a severe reaction in the body. It is now established that about 1/3 of the world's population suffers from severe manifestations of allergies. Approximately 20% of all allergic rashes are observed in the oral mucosa, when allergic stomatitis manifests itself.

Conventionally, the causes of allergic stomatitis are divided into two groups: substances that penetrate the body and substances that come into contact with the oral mucosa. Substances entering the body include medications, mold, pollen, etc., substances in contact with the mucous membrane - various objects that act directly on the mucous membrane, thereby provoking irritation. Dentures made from poor quality materials are a fairly common cause of allergic reactions in the mouth. In addition to low-quality materials, the cause of the development of the disease can be bacteria and their metabolic products, which accumulate in the prosthetic bed and irritate the delicate mucosa. Small cracks, wounds are a good environment for the life of such microorganisms. Medical preparations that are used during dental treatment or that need to be absorbed can also provoke contact-type allergic stomatitis.

Substances that enter the body can cause a kind of immune reaction, which will manifest itself in the form of rashes, itching, burning on the soft tissues and mucous membranes of the oral cavity. Immunity thus can react not only to antibiotics or potent drugs, it is quite possible to react to any other medicines, including antihistamines. Also, rashes can provoke a variety of factors - ecology, hormonal failure, etc.

Symptoms of allergic stomatitis

If allergic stomatitis is caused by medications, then the symptoms of the manifestation of the disease are quite diverse. Typically, patients complain of burning, itching, dry mouth, soreness during meals. When visually inspecting the oral cavity, you can see severe redness, swelling. Puffiness can affect the membrane of the lips, cheeks, gums, tongue, palate. One of the characteristic features of allergic stomatitis is a smooth and shiny tongue with slight swelling. This kind of change can also occur on the lips.

A widespread symptom of the disease is vesicular lesions of the oral mucosa, which eventually burst and ulcers appear in their place, which can merge with each other, forming rather large foci of inflammation.

When the body reacts to tetracycline, a white or brownish coating may appear on the tongue, painful deep cracks appear in the corners of the lips.

Allergic stomatitis can develop after a visit to the dental office, when preparations for treating carious cavities, hemostatic, whitening gels, etc. accidentally get on the mucous membrane.

The contact form of allergic stomatitis is widespread, which develops as a result of prolonged exposure to the mucous membrane and gums of polymer removable dentures.

Allergic stomatitis in children

The oral cavity is connected to the internal organs (digestive system, lungs, etc.) and is designed to humidify the incoming air, protect against various pathogenic microorganisms and other adverse environmental influences. The mucous membrane of the mouth is updated quite quickly, in the human body it is responsible for many functions: taste, protection from external factors, salivation, etc. The normal functioning of the oral cavity can be disturbed by various diseases, malnutrition, overheating, drugs, etc., which As a result, it will lead to the development of the disease, which is especially susceptible to young children.

Allergic stomatitis in childhood, as a rule, does not act as an independent disease, it is a symptom of a general allergic reaction of the body to an irritant (food, medicine, etc.). Disease-prone children with a predisposition to allergic reactions. In some cases, allergic stomatitis in children develops due to contact of the mucosa with dental materials (filling), braces. Quite often in childhood, allergic stomatitis develops due to carious teeth.

At the initial stage of the disease, the child may complain of soreness in the mouth (itching, burning). There may be swelling of the tongue, lips, cheeks. In some cases, plaque appears in the oral cavity, more often on the tongue, a sour smell from the mouth appears, increased salivation.

In childhood, stomatitis can develop limitedly or extensively (throughout the entire oral cavity). If the entire mucous membrane in the mouth is affected, a longer treatment will be required, especially if the child's immunity is reduced.

Allergic stomatitis in adults

The most frequent complaints of patients who have allergic stomatitis are swelling in the oral cavity (lips, pharynx, tongue, cheeks, palate). Due to swelling, swallowing is difficult, patients often bite on soft tissues in the mouth (tongue, cheeks). Allergy is the main cause of the disease, it increases the sensitivity of the body to the irritant, which is manifested by the characteristic signs of stomatitis. Often, allergic stomatitis is a reaction to medications, in some cases, the development of the disease can begin 15 to 20 days after taking medications (usually sulfonamides).

There are frequent cases of the development of allergic reactions to the mucous membranes of the oral cavity due to food products, various irritants in the oral cavity (dentures, crowns, etc.). Alloys such as cobalt, gold, chromium, and acrylic plastics can provoke allergic stomatitis.

Diagnosis of allergic stomatitis

Diagnosis of patients who are suspected of allergic stomatitis, first of all, begins with the identification of allergies and factors that could provoke it (bronchial asthma, chronic diseases, urticaria, heredity, etc.). It also takes into account diseases of the digestive system, menopause in women, endocrine dysfunction, helminthiasis. Particular attention is paid to the existing dentures, as well as the period of their wearing.

On examination, the doctor notes, first of all, the moisture content of the oral cavity, the type of saliva (liquid, foamy, etc.). As can be seen from the observations, the type of saliva depends on the existing diseases of the salivary glands, wearing dentures, taking medications. If you react to allergic dentures, it is recommended to exclude their use for several days, usually after the denture stops interacting with the oral mucosa, salivation returns to normal, foam disappears, and the general condition of the oral cavity improves. When examining dentures, attention should be paid to the materials used in the manufacture (gold, chrome-cobalt, alloys, plastics, stainless steel, etc.), existing pores, length, number of rations, change in shade.

The main direction in the diagnosis of allergic reactions in the oral cavity is the identification of an allergen, a background disease. Of decisive importance in the diagnosis of allergic stomatitis are diseases in the patient's past, complaints, and the general clinical picture.

Evaluation of the quality and accuracy of the manufacture of dentures, allows you to determine the cause of inflammation of the oral cavity (mechanical, toxic-chemical, etc.). Mechanical irritation is caused by too sharp and long edges of the prostheses, a rough surface of the inner part, a changed basis, incorrect distribution of pressure on some parts of the prosthetic bed, as a result of inaccurate taking of casts, etc.

A visual examination of the oral cavity reveals focal lesions or extensive inflammation (the absence of inflammatory processes is also possible). Damage to the oral cavity in some places (focal) is mainly caused by mechanical impact, trauma, etc. If inflammation is observed throughout the mucosa, then in this case we are talking about the general reaction of the body to the irritant. In the absence of visible signs of inflammation, the process of atrophy of the mucous membranes may have begun.

A chemical-spectral analysis of saliva for trace elements present is mandatory. With an increased content of iron, copper, gold, etc. and the appearance of impurities unusual for a person (cadmium, lead, titanium, etc.), an electrochemical process begins in the body.

Among the diagnostic samples and tests that are prescribed to patients with suspected allergic stomatitis, the following are distinguished:

• a blood test, which is taken first without a denture, then after 2 hours of wearing a denture;
• denture removal test. For several days, the prosthesis is removed from the oral cavity, usually after that the patient's condition improves;
• a provocative test is carried out after the test with the removal of the prosthesis, when it is re-introduced into use, if all clinical manifestations resume, the reaction is considered positive.
• scarifying-film test, which is safe and easy to perform. This test allows you to determine the reaction of the body to salts (alcohol saline solutions are applied to the scratch, which are then covered with a film-forming composition, after 2 days the reaction is evaluated);
• a leukopenic test is determined by a blood test from a finger, the level of leukocytes without prostheses in the oral cavity (in the morning, on an empty stomach), then after three hours of wearing the prosthesis, the blood is donated again and the results are compared. If the level of white blood cells has dropped, this may indicate a sensitivity to the plastic. The test should not be carried out with an exacerbation of an allergic reaction, high temperature.
• test of chemical silvering of the surface of an acrylic denture. The reaction to the test will be positive, in case of disappearance (or significant reduction) of discomfort in the oral cavity, usually the state of the prosthetic bed also normalizes.
• test for the activity of saliva enzymes (toxic reactions to acrylic increase activity by 2-4 times).

Treatment of allergic stomatitis

In conditions such as allergic stomatitis, it is necessary to carry out complex treatment. If a reaction to dentures occurs, the action of the allergen should be excluded (i.e., stop wearing a denture), and measures should also be taken to prevent the development of the disease in the future (prosthesis replacement). The patient must follow a diet that includes the required amount of trace elements and vitamins; spicy, salty, sour and allergy-provoking foods (eggs, coffee, strawberries, citrus fruits, etc.) should be completely excluded. You also need to stop drinking mineral water.

The main principle of the treatment of allergic stomatitis is to exclude contact or use of the allergen as soon as possible. With all sorts of unpleasant sensations in the oral cavity (itching, burning, soreness, swelling, redness, rashes, etc.), you need to see a dentist who will help determine the cause of irritation, prescribe effective treatment, if necessary, he will refer you to other specialists (endocrinologist, therapist etc.).

Usually, in the treatment of allergic stomatitis, antihistamines (clarotadine, suprasin, fenistil, etc.) are used together with vitamins of groups B, C, PP, folic acid. Inflamed areas of the oral mucosa are treated with antiseptic, analgesic, healing solutions and agents (actovegin, kamistad, sea buckthorn oil, etc.).

Treatment of allergic stomatitis in children

Allergic stomatitis in childhood, as well as in adults, is usually a general reaction of the body to an allergen. Irritation in the oral cavity is the result of the interaction of body antibodies with allergic particles. Treatment should be aimed at the early identification of the allergen and its elimination. If you have a drug allergy, you should avoid taking the medicine, if you are allergic to certain products, you should exclude the use of these products, if the body reacts to the composition of the fillings, you should contact your dentist and replace the filling.

The oral cavity must be rinsed with special antiseptics, preferably with an analgesic effect (lysozyme, urotropin with novocaine, etc.). Sores can be cauterized with aniline dyes or a mixture of an antibiotic with vitamins B1 is applied.

Treatment of allergic stomatitis in adults

Treatment of allergic stomatitis is primarily aimed at eliminating the factors provoking allergies. Hyposensitizing agents (reducing the body's sensitivity to the allergen) are often used in treatment. In the event that stomatitis has become more severe, inpatient treatment and drip administration of special preparations are recommended. During treatment, it is necessary to maintain oral hygiene at a high level, rinse after each meal. Also important is nutrition. During the treatment period, you should stop drinking alcohol, salty, spicy and sour foods and dishes, since such food provokes even more irritation in the oral cavity.

Allergic stomatitis is accompanied by severe lesions of the oral mucosa. In this case, in order to alleviate the condition, you can supplement the main treatment with effective folk methods that will help speed up the healing and tissue regeneration process. Aloe or Kalanchoe juice has good healing properties, so it is recommended to lubricate the inflamed areas in the mouth with plant juice, and rinsing with solutions containing such plants will help reduce inflammation. Some experts even advise their patients to occasionally chew aloe leaves.

Raw potatoes also have a good anti-inflammatory effect. Potato juice or gruel from it (grate on a fine grater) should be applied for a while to the affected areas of the mucosa.

It helps to get rid of soreness and discomfort by rinsing with cabbage or carrot juice (1: 1 diluted with water).

Garlic has an antiviral and healing effect; for the treatment of stomatitis in adults, garlic, grated or pressed through the garlic, is diluted with yogurt (yogurt). The heated mixture is evenly distributed throughout the oral cavity with the help of the tongue and held for some time. The procedure can be carried out once a day.

Propolis is known for its medicinal properties. Propolis tincture can be used from the first days of the disease. Before using the product, the inflamed areas are washed with hydrogen peroxide, dried a little, after which a few drops of tincture are applied, and dried again to form a film.

Chamomile has good antiseptic and anti-inflammatory qualities, therefore, with stomatitis, it is good to rinse your mouth with tincture from this plant (200 ml of boiling water, 2 tablespoons of chamomile, leave for 20-25 minutes).

Sea buckthorn oil is known for its wound healing properties, with stomatitis it is recommended to lubricate sores in the mouth with such oil, this will contribute to tissue regeneration and speedy healing.

Prevention of allergic stomatitis

Preventive measures for a tendency to allergic stomatitis are good oral care. Caries, gum disease, etc. needs to be treated promptly. It is necessary to visit the dentist regularly for preventive purposes (removal of various deposits, adjustment of uncomfortable dentures, polishing of sharp edges of crowns, etc.).

Proper, nutritious nutrition is also a good way to prevent allergic manifestations. Allergen foods should be excluded from the diet. Also, a healthy lifestyle significantly reduces the risk of developing allergic reactions, since allergies often appear as a result of malfunctions in the body. First of all, you need to stop smoking, since nicotine is extremely harmful not only to the oral mucosa, but also to the whole organism as a whole.

Allergic stomatitis is a rather dangerous disease that, if ignored or the wrong approach to treatment, can lead to severe damage in the oral cavity. The disease at the initial stage is cured quite quickly (in about 2 weeks), more severe and advanced cases may require special treatment in a hospital. In order not to bring yourself to such a state, it is necessary to contact a specialist for advice in a timely manner, as well as follow the recommended preventive measures.

Such an unpleasant disease as an allergy affects both adults and children. And especially unpleasant is a kind 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 for 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 erythema multiforme exudative.

In addition, swelling of the oral cavity can be observed as a particular manifestation of generalized.

According to the localization of inflammation are divided into:

• cheilitis - the area of ​​​​the lips and mucous membranes near the mouth,
• glossitis - language,
• gingivitis - gums,
• stomatitis - oral mucosa,
• palatinitis - soft or hard palate,
• papillitis - papillae of the gums.

According to the severity and characteristic symptoms, allergic stomatitis can be divided into:

• catarrhal
• catarrhal hemorrhagic,
• bullous,
• ulcerative necrosis,
• erosive.

The catarrhal type of allergic stomatitis is characterized by moderate symptoms. Patients usually complain of dry mouth, pain when eating. The disease is also accompanied by burning and itching. In the hemorrhagic form, small specks of hemorrhages on the mucous membrane are visible on examination. The bullous form is characterized by the formation of blisters with exudate. When they are destroyed, erosion can form. With ulcerative necrosis 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 to the lymph nodes and signs of general intoxication of the body.

How to distinguish allergic reactions from inflammatory processes of infectious origin? First of all, you need to pay attention to symptoms such as dry mucous membranes and tongue. This symptom is typical for allergic processes. With a bacterial infection, increased salivation is usually observed or it remains within the normal range. 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 of an unpleasant aftertaste in the mouth, which usually does not occur with bacterial stomatitis.

Other symptoms of allergic stomatitis also include small rashes in the mouth, the formation of small vesicles (vesicles), in severe forms - ulcers and areas of necrosis. The patient feels severe itching in the mouth, and sometimes severe pain. The process of eating and chewing is also difficult or even impossible due to severe pain.

In the absence of treatment, massive necrotic lesions of the oral mucosa, the addition of a bacterial infection are possible, which will greatly complicate the treatment.

In children, allergic stomatitis is usually much more severe than in adults, it has a more acute onset and is 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. Often, stomatitis in children is accompanied by an increase in body temperature and a large swelling of the surrounding tissues.

Causes of the disease

Factors contributing to the occurrence of allergic reactions in the oral cavity are a low level of immunity, smoking. However, the main causes of the disease, experts include the entry into the oral cavity of certain substances that cause a pathological reaction of the immune system - allergens.

The mechanism for the development of an allergic reaction involves various cells of the immune system - T-lymphocytes and B-lymphocytes, due to which antibodies are produced to foreign agents. Usually, an allergic reaction occurs after repeated exposure to the allergen in the body, which triggers the release of inflammatory mediators, histamines, into the blood.

Allergens can enter the body as a result of:

• chewing gum, certain foods;
• the use of toothpastes, rinses;
• the presence in the oral cavity of dentures, fillings, overlays made of allergenic materials;
• chronic infectious diseases of the oral cavity (, periodontal disease).

As an unusual, but still common cause of allergies in the oral cavity, one can point to the constant playing of wind musical instruments.

Most often, allergic stomatitis occurs after dental operations, the installation of new crowns, prostheses, braces. The most allergenic material used in dentistry is acrylic. However, an allergy to other materials is also possible - steel, gold. Allergies can also occur as a result of the use of drugs during dental procedures, for example, due to the administration of painkillers.

Allergy around the mouth

Allergies around the mouth usually manifest as small rashes, redness of the skin. Such phenomena are usually accompanied by itching and soreness. Allergies around the mouth can be caused by various factors:

• intake of foods containing allergens;
• taking medications;
• inhalation of dust or pollen;
• exposure to sunlight.

Allergies around the mouth need to be differentiated from infectious diseases such as herpes caused by viruses.

Allergy on the lips

Inflammation of the lips is called cheilitis. Cheilitis can be both infectious and allergic in nature, so cheilitis should not be considered an independent disease, it is just a symptom. With allergic cheilitis, swelling, sores, rash, blisters, peeling of the lips can be observed. As a rule, inflammatory processes are accompanied by itching. Eating is very difficult due to pain. The cause of allergic cheilitis may be the use of cosmetics (for example, lipstick), smoking.

How to treat lip allergies

The method of treatment of allergic cheilitis differs from the methods of treatment of cheilitis of infectious origin. First of all, contact with the allergen should be avoided, unless, of course, it is identified. In many cases, the elimination of the allergen alone allows you to cope with the situation. If this method does not help, then it is recommended to use antihistamines or anti-inflammatory drugs. Treatment must be carried out under the supervision of a physician.

Allergy on the tongue

Inflammatory processes in the tongue are called glossitis. It can be both infectious and allergic in nature. In the latter case, the tongue usually becomes dry and smooth, and teeth marks are well imprinted on it.

Diagnostics

It is necessary to differentiate allergic stomatitis from infectious, as well as from autoimmune diseases, such as systemic lupus erythematosus or erythema multiforme exudative. In autoimmune diseases, lesions of other organs are usually observed, or signs of intoxication of the whole organism, since these pathologies are systemic in nature. With erythema multiforme exudative, one can observe not only stomatitis, but also a rash on the hands.

In some cases, the doctor can determine the cause of the allergy by asking the patient, while in other cases, tests to identify the allergen, such as skin tests, are performed. To differentiate from bacterial diseases, a biochemical analysis of saliva or mucus of the mucous membrane is performed. Of great importance is the consideration of the anamnesis, the presence of cases of allergic reactions in it in the past.

General principles of treatment of allergic stomatitis

First of all, it is necessary to exclude contact with the allergen. It can be some medicines, food, toothpaste. If the allergy appeared as a result of the installation of any dental structures - crowns, prostheses, etc., then you need to contact the dentist so that he selects a less allergenic material.

If the symptoms of allergies continue to be observed, then you should resort to medical methods. The main category of medications taken for allergies is antihistamines. They are able to block the negative effects of inflammatory mediators - histamines. The main drugs of this class are Suprastin, Tavegil, Diphenhydramine, Cetirizine, Loratadin. Hormonal preparations with prednisolone may also be prescribed. Also, to prevent the attachment of a bacterial infection, solutions with antibacterial action can be used to rinse the mouth, for example, a solution of chlorhexidine or miramistin. It is also possible to rinse the mouth with decoctions of herbs with antibacterial and anti-inflammatory effects - chamomile, sage. With severe pain, pain medication is needed.

Allergic diseases of the oral cavity

What is Allergic Oral Diseases?

Allergic diseases are now widespread, and their number is constantly increasing and, which is especially dangerous, the severity of the course is aggravated.

Allergy- this is an increased and, consequently, 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 given to the state of the nervous, endocrine systems, pathology of the gastrointestinal tract.

What provokes / Causes of Allergic diseases of the oral cavity:

The reasons for such a wide spread of allergic diseases are different. First of all, a large role in this is played by environmental pollution with emissions from industrial enterprises, exhaust gases, the use of pesticides, herbicides, etc. in agriculture. The rapid development of the chemical industry and the associated appearance in everyday life and in the production of many synthetic materials, 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 medicinal substances 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, the nature of nutrition, etc., also play a role.

Allergies can be caused by various substances - from simple chemical compounds (iodine, bromine) to the most complex ones (proteins, polysaccharides, as well as their combinations), which, when ingested, cause an immune response of a humoral or cellular type. Substances that can cause an allergic reaction are called allergens. The number of allergens in nature is large, they are diverse in composition and properties. Some of them enter the body from the outside, they are called exoallergens, others are formed in the body and represent the body's own, but modified proteins - endoallergens, or autoallergens.

Pathogenesis (what happens?) during Allergic diseases of the oral cavity:

Exoalpergens are of non-infectious origin (plant pollen, household dust, animal hair, medicines, foodstuffs, washing powders, etc.) and infectious (bacteria, viruses, fungi and their metabolic products. Exoallergens enter the body through the respiratory tract, digestive tract, skin and mucous membranes, causing damage to 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, etc.

Allergens can be complete antigens and incomplete - haptens. Haptens can cause an allergic reaction by binding to body macromolecules that induce antibody production; 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 formed 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 the contact of the allergen with the body, resulting in its sensitization, i.e. the formation of antibodies or sensitized lymphocytes that can interact with this allergen. If by the time the 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. With repeated exposure to an allergen in an organism already sensitized to it, an allergen-antibody complex or an allergen-sensitized lymphocyte complex is formed. From this moment, the pathochemical stage of the allergic reaction begins, characterized by the release of biologically 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 the smooth muscles of the bronchi, intestines, changes in the composition of blood serum, impaired coagulability, cell cytolysis, etc.

According to the mechanism of development, 4 types of allergic reactions are distinguished: I - an immediate type reaction (reaginic 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 a set of mediators inherent in it, 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, mainly belonging to the class IgE and IgG. 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, the clinical manifestations of the reaction occur after 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 mainly represented by IgG and IgM. This type of reaction is caused only by antibodies capable of activating complement. Antibodies bind to mutated cells in the body, which leads to complement activation, which also causes damage and even destruction of cells. As a result of the cytotoxic type of allergic reaction, cells are destroyed, followed by phagocytosis and removal of destroyed cells and tissues. The cytotoxic type of reactions include drug allergy, characterized by leukopenia, thrombocytopenia, hemolytic anemia.

Type III allergic reaction, or tissue damage by immune complexes (Arthus type, immunocomplex type), occurs as a result of the formation of circulating immune complexes, which include antibodies of the IgG and IgM classes. 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, 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, 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 is combined with an allergen, which can be in a dissolved form or be on the cells, mediators of cellular immunity - lymphokines - are released. More than 30 lymphokines are known, which manifest their effect 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 the antigen (microorganisms or foreign cells) to which lymphocytes are sensitized. If a transplant of foreign tissue acts as an antigenic substance that stimulated delayed-type hypersensitivity, then 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 the body's reactivity.

Symptoms of allergic diseases of the oral cavity:

Specific Diagnosis allergic diseases consists of collecting an allergic history, conducting diagnostic tests and laboratory tests.

When collecting an allergic 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 you to establish the presence of an allergic predisposition (hereditary or acquired), as well as possible exogenous and endogenous factors affecting the course of the disease (climatic, endocrine, mental, etc.). When collecting anamnesis, it is necessary to find out how the patient reacts to the introduction of vaccines, sera, medication, and the circumstances of the exacerbation, as well as housing and working conditions.

It is very important to identify professional contacts with various substances. It is known that contact with simple chemicals is more likely to cause delayed-type allergic reactions (contact dermatitis). Complex organic substances can cause immediate allergic reactions with the development of diseases such as Quincke's edema, urticaria, allergic rhinitis, bronchial asthma, etc.

A carefully collected history suggests a possible type of allergic reaction and a likely allergen. The specific allergen that causes the development of the disease is established using special diagnostic tests and laboratory tests.

Skin diagnostic tests are a method for detecting specific sensitization of the body.

Allergic diagnostic tests are performed outside the phase of exacerbation of the disease 2-3 weeks after the acute allergic reaction, during the period when the body's sensitivity to the allergen decreases.

Skin tests are based on the identification of a 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 for performing 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 affiliation of the tested allergen. So, for the diagnosis of drug allergies, application tests are most convenient. Determination of hypersensitivity to allergens of bacterial and fungal origin is carried out by the method of intradermal tests.

Provocative tests are carried out in cases where the data of the allergic anamnesis do not correspond to the results of skin tests. Provocative tests are based on the reproduction of an allergic reaction by introducing an allergen into an organ or tissue, the defeat of which is the leading one in the clinical picture of the disease. There are nasal, conjunctival and inhalation provocative tests. Provocative tests also include cold and heat, used for cold and heat urticaria.

Specific diagnostics of allergic reactions is also carried out by laboratory research methods: the degranulation reaction of basophilic leukocytes (Shelley test), the reaction of blast transformation of leukocytes, the reaction of neutrophil damage, the reaction of leukocytolysis, etc. The advantage of in vitro diagnostic methods for allergic reactions is the absence of the risk of anaphylactic shock.

Which doctors should you contact if you have Allergic diseases of the oral cavity:

Allergist

Are you worried about something? Do you want to know more detailed information about Allergic diseases of the oral cavity, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can book an appointment with a doctor– clinic Eurolaboratory always at your service! The best doctors will examine you, study the external signs and help identify the disease by symptoms, advise you and provide the necessary assistance and make a diagnosis. you also can call a doctor at home. Clinic Eurolaboratory open for you around the clock.

How to contact the clinic:
Phone of our clinic in Kiev: (+38 044) 206-20-00 (multichannel). The secretary of the clinic will select a convenient day and hour for you to visit the doctor. Our coordinates and directions are indicated. Look in more detail about all the services of the clinic on her.

(+38 044) 206-20-00

If you have previously performed any research, be sure to take their results to a consultation with a doctor. If the studies have not been completed, we will do everything necessary in our clinic or with our colleagues in other clinics.

You? You need to be very careful about your overall health. People don't pay enough attention disease symptoms and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific signs, characteristic external manifestations - the so-called disease symptoms. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to several times a year be examined by a doctor not only to prevent a terrible disease, but also to maintain a healthy spirit in the body and the body as a whole.

If you want to ask a doctor a question, use the online consultation section, perhaps you will find answers to your questions there and read self care tips. If you are interested in reviews about clinics and doctors, try to find the information you need in the section. Also register on the medical portal Eurolaboratory to be constantly up to date with the latest news and information updates on the site, which will be automatically sent to you by mail.

Other diseases from the group Diseases of the teeth and oral cavity:

Abrasive precancerous cheilitis of Manganotti

Abscess in the face

Adenophlegmon

Adentia partial or complete

Actinic and meteorological cheilitis

Actinomycosis of the maxillofacial region

Allergic stomatitis

Alveolitis

Anaphylactic shock

angioedema angioedema

Anomalies of development, teething, discoloration

Anomalies in the size and shape of the 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 mouth

Impact of acute respiratory viral infections on the oral cavity

Inflammation of the dental pulp

Inflammatory infiltrate

Dislocations of the lower jaw

Galvanosis

Hematogenous osteomyelitis

Duhring's dermatitis herpetiformis

Herpangina

Gingivitis

Gynerodontia (Crowding. Persistent baby teeth)

Hyperesthesia of the teeth

Hyperplastic osteomyelitis

Hypovitaminosis of the oral cavity

hypoplasia

Glandular cheilitis

Deep incisal overlap, deep bite, deep traumatic bite

Desquamative glossitis

Defects of the upper jaw and palate

Defects and deformities of the lips and chin

Facial defects

Mandibular defects

Diastema

Distal bite (upper macrognathia, prognathia)

periodontal disease

Diseases of the hard tissues of the teeth

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 deposits

Changes in the oral mucosa in diffuse diseases of the connective tissue

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 the teeth

Wedge-shaped defect (abrasion)

Cutaneous horn of the lip

computer necrosis

Contact allergic cheilitis

lupus erythematosus

Lichen planus

drug allergy

Macrocheilitis

Drug and toxic disorders of the development of hard tissues of the tooth

Mesial occlusion (true and false progeny, progenic ratio of the anterior teeth)

Multiform exudative erythema of the oral cavity

Taste disorder (dysgeusia)

salivation disorder (salivation)

Necrosis of hard tissues of teeth

Limited precancerous hyperkeratosis of the red border of the lips

Odontogenic sinusitis in children

Shingles

Tumors of the salivary glands

Acute periostitis

Acute purulent (abscessing) lymphadenitis

Publication date: 26-11-2019

Why is there an allergy on the lips and in the mouth?

An allergy that manifests itself on the oral mucosa can become a very serious problem. About what causes these diseases and how to deal with them, we will tell in this article.

Why can there be an allergy in the oral cavity and around it?

Allergy on the lips

As you know, any allergy develops due to the fact that the human immune system cannot adequately perceive certain substances. It gives a signal to the whole body to get rid of the allergen. As a result, mast cells begin to produce a special protein histamine, which is distributed in the blood throughout the body and activates inflammatory processes. This is how allergies begin.

The way the allergen enters the body depends on what the symptoms and manifestations of an allergic reaction will be. Pollen affects the respiratory tract and the mucous membranes of the nose and eyes. The chemicals can damage the skin. The body reacts completely to animal hair. Food allergens cause a reaction from the gastrointestinal tract and skin. From this we can conclude that allergies in the mouth are caused by those substances that are in direct contact with the oral mucosa, as well as the skin around the lips.

A very common cause of a reaction is medication. These can be antibiotics, analgesics, iodine preparations. In addition, a reaction in an adult can be caused by dental implants or prostheses. In a child, allergies are often caused by foods of the first complementary foods, while the reaction can also develop in the mouth and around the lips. In addition, the emergence of problems provokes the widespread use in the production of dyes, preservatives, and other chemicals that are added to finished products, and are also used to grow vegetables and fruits. Allergies to them are very common.

Types of allergic diseases of the oral mucosa

Allergic nature have the following diseases, which are quite common:

Disease pathogenesis

Allergy in the mouth: on the front lip from the inside

There are several classifications of allergens. All of them make up two large groups: exogenous and endogenous. Exogenous enter the body from the outside, while they can be infectious and non-infectious in nature. The second group is formed by those allergens that the body itself produces due to any damaging factors. The method of its treatment depends on the nature of the disease.

When an allergen gets inside, or a factor affects the body, several types of reactions may occur:

Anaphylactic (atopic type)

Cytotoxic

immunocomplex

Delayed

The type of development of an allergic reaction depends on the state of the body, as well as the nature of the allergens.

Allergy symptoms in the mouth and around the lips

Allergic diseases of the oral mucosa and skin around the lips may have signs that are not similar to typical allergies. Usually they are accompanied by the appearance of small ulcers, lesions of the mucous membrane on the cheeks, lips, swelling of the tongue. In addition, the lips can peel and swell, painful sores form on them, and the skin around the oral cavity is affected.

Allergic conjunctivitis may occur

At the same time, other symptoms of an allergic reaction are observed, which are most common:

allergic rhinitis

allergic conjunctivitis

Atopic dermatitis, eczema, urticaria

Narrowing of the lumen of the bronchi, cough, shortness of breath

Quincke's edema

Anaphylactic shock

It is important to recognize allergies in time, not to try to treat the disease on your own, as this can lead to a worsening of the condition. If you notice signs of an allergy in your child, be sure to contact an allergist to solve the problem effectively and without consequences.

Diagnostics

Diagnosis is an important step in the treatment of allergies, since it is necessary to understand which substance the body reacts so violently to. Be sure to tell your doctor what you have eaten in the last few days, what medications you are taking, what chemicals may have come into contact with the oral mucosa. This information is very important.

Allergists use several methods for diagnosing diseases. They are based on the same mechanism by which any allergy develops: the allergen must enter the bloodstream, after which the results are recorded. In laboratory conditions, it is easy to determine which substance causes an increase in histamine in the blood, and which does not affect the composition of the blood in any way.

You need to see a pediatric allergist

After the initial examination, the allergist will select the diagnostic method that is right for you. These can be provocative tests, skin tests, a blood test for immunoglobulin levels. It makes no sense for children under 3 years of age to take tests, since their immune system is not sufficiently formed. Therefore, it is easier to adjust the child's nutrition, as well as his environment, so that there are no irritants. Then the baby will grow up healthy and will not feel allergy symptoms.

Treatment Methods

In order for the treatment to be effective, it is necessary to exclude contact with the allergen. That is why diagnosis is so important. Once the doctor understands what caused such an immune system reaction, a treatment plan can be drawn up. This is especially true when allergies are caused by medications. Therefore, you can not treat a child with those drugs that the doctor did not prescribe!

Therapy mainly consists of antihistamines, which normalize the composition of the blood, freeing it from histamine. This leads to the relief of all allergy symptoms that occur during the reaction. If the case is very severe, it is necessary to prescribe corticosteroid hormones. In addition, it would be advisable to take sorbent preparations so that the allergen is quickly eliminated from the body. This will speed up your recovery.

Apply allergy cream (prescription)

In order to reduce discomfort in the mouth, you can use special ointments, gels, as well as antimicrobials, painkillers and antiseptics to treat the oral mucosa. It is important not to start the process so that the disease does not become chronic. It is important to moisturize the skin around the lips to speed up the healing process.

A special treatment is selected for the child, since babies cannot take many drugs, so the main thing is to maintain a stable condition and prevent deterioration. If you notice that the baby's face begins to swell, call an ambulance immediately! So Quincke's edema can begin.

Prevention and Precautions

In order to protect yourself and your child from allergies, which manifest themselves not only in the mouth, but can also have completely different symptoms, it is important to observe the following precautions:

For a child, choose only those products that do not have artificial additives. It is best to use vegetables and fruits from your own garden for complementary foods. Toys should always be clean, use only hypoallergenic powders for washing. Do not use perfumed cosmetics, especially on the face and hands.

Do not take without consulting a doctor those medicines that you have never taken. Never self-medicate yourself or your child. It may be dangerous.

During the flowering period, wash your hands thoroughly, and also rinse your face after each walk. The same goes for contact with animals.

If you notice that your child has any redness on the face, around the mouth, on the body - analyze what foods the baby ate during the day. Report this information to the pediatrician to find out what could have provoked such a reaction.