Exudative diathesis

Exudative diathesis is hereditary susceptibility of the organism to allergic reactions that occur in response to foodborne, bacterial, medication and other stimuli. Manifested exudative diathesis the skin, mucous membranes, lymph glands.
The first manifestations of exudative diathesis may appear in the neonatal period. The more clearly it is identified on the 2-3rd month. and becomes particularly acute in the second half of the child's life. Children with exudative diathesis pasty, with flabby turgor, phlegmatic or value irritable. Skin lesion appears chafing, the so-called breast skin on the scalp, eyebrows, cheeks, scrofulous (see Urticaria), eczema (see Eczema) and other Increase of the lymph gland. Skin symptoms subside in spring and summer and aggravated in the fall and winter. Children tend to rinita, bronchitis, asthma, pneumonia, the pyelitis. Recurrent Cathars nasopharynx lead to the widening of the adenoids and hypertrophy of the tonsils. There is often unstable chair. In the absence of a secondary infection, the prognosis is good. Three or five years of life are the symptoms of exudative diathesis weaken.
Treatment and care. The correct mode of the day, a long stay in the fresh air, good nutrition, taking into account individual tolerability of food products. Breastfeeding should be advised mother to sharply restrict in nutrition sweet (sugar, jam, honey and others), to exclude from the food spicy, salty, smoked, alcoholic drinks, including beer. With the introduction of complementary foods (food) note that cow's milk, the child can aggravate the skin. Instead, you need to give milk products (kefir, sour milk - up to 400 ml per day). Fruit juices and puree appointed with 1,5-2 months, 4 months and vegetable puree. Porridge 1 per day, it is better on vegetable broth, with 10 months - boiled meat. Boiled egg yolk, you can begin to give in with 1/4 part 1 once a week; if rash is not increased, to bring to 1/2-1 yolk per day. After a year, the child should receive black bread, enough meat, butter, and especially oil, rich in vitamin F, all the vegetables, fresh or boiled, all fruits except that the child cause aggravation rash (oranges, strawberries and others). Do not give ready dairy mixes, jellies, meat broths, chocolate, cocoa, honey, limit white bread. If you are hypersensitive to exclude fish, and caviar.
Inside systematically appoint vitamins a, C and b vitamins, especially B6. During exacerbation diathesis treatment Dimedrol, diasoline, promethazine, suprastin in a dosage of age on the background of the preparations of calcium. Given a quick adaptation to antigistaminnam drugs, you need to change them after 10 to 12 days. Locally with persistent diaper rash use a mixture: salicylic acid 1 g, boric acid 20 g, talc 79, you Can lubricate rash boiled sunflower oil. When the weeping and the infection of skin rashes apply lotions (see), which has an antiseptic, astringent, drying action, such as a lotion from 0,25-0,5% solution of nitrate of silver, or 0.5 - 1% solution of resorcinol, or Golyanovo water (boric acid, 12 g, rectified spirit 20 ml, lead water 200 ml). On the subsidence of the acute effects apply hormonal ointments (sinalar, lookeren, prednizolonovuyu)that you can use for no more than 10-15 days.
It is necessary to carefully monitor the cleanliness of the skin of the child, to respect the hygiene baths with the addition of tannins (chamomile, series). In acute skin rash physiotherapy treatments are contraindicated. Summer shows air baths, when remitting of the process is carefully sun.
Children with exudative diathesis is necessary to change the timing of vaccination at a later period, when symptoms will decrease, or to conduct them on the background of the desencibiliziruta therapy.

Exudative diathesis (synonym: exudative catarrhal diathesis, atopic diathesis) - a kind of functional state of the body, characterized by the tendency to inflammation, inadequate responses to various stimuli and willingness to certain pathological manifestations [mobiles (A. Czerny)].
Clinical manifestations of exudative diathesis can begin already from the first weeks and months of life; more clearly exudative diathesis manifest in 2-3 months. and most strongly in the second half of life. Gradual weakening of the manifestations observed after 3 - 5 years.
Laboratory studies produced with clinically severe exudative diathesis, showed a number of operational changes. So, was identified dystonia autonomic nervous system dominated parasympathetic tone; clinically, this is expressed in the tendency to spasms of smooth muscles, the change of constipation diarrhea, prolonged fever after infection. There are also significant violations of metabolism and first of all water-salt: delayed release extracellular electrolytes sodium and chlorine, a tendency to a delay of water and its rapid loss under the influence of the minor reasons, i.e. gidrolabilna that clinically expressed by uneven growth curve weight - steep slopes alternate with steep drops. The tendency to delay water determines pastoznost children. Only a small proportion of children suffering from exudative diathesis, sometimes low power - the so-called eroticheskiy habitus; these children closer to the neuro-arthritic diateza.
With such manifestations of exudative diathesis, as eczema, there Hypo - and dysproteinemia; the protein content of plasma reduced mainly due to albumin, A2 - and?-globulin is increased, '-globulin - can be reduced.
There are also aminoaciduria, and increased selection of products of incomplete oxidation of proteins, as broken pereaminirovanie and deamination of proteins in the liver. The number and activity of blood enzymes (amylase and lipase) reduced. Broken and fat metabolism. A tendency to acidotic direction of the exchange. There is increased need for vitamins b and F, unsaturated fatty acids (linoleic, linolenic, arachidonic).
This, combined with the slow movement of blood in the winding, mnogoatomnykh capillaries (M. S. Maslov) facilitates the sensitization of the body, as is more prolonged and close contact circulating in the blood antigen with tissues (M. A. Skvortsov). The ability to fast and easy sensitization in children with exudative diathesis is of great importance for the emergence of allergic conditions for infections and allergic diseases - eczema, asthma, etc.
The clinical manifestations of exudative diathesis often have to meet with skin. The earliest manifestation of excudative diathesis are spots of Maierhofer (vernix caseosa persistens), yellowish, located in the area of the knee and brow; they may appear in the first weeks of life. During this same period, there was marked tendency to hard chafing even with impeccable care. At the age of 1.5-2 months. may occur the so-called milk strup (gneiss) - reddening limited skin of the cheeks with pityriasis peeling and oily scalp, superciliary arches. The specified changes on the skin is not accompanied by itching, unlike dermatitis arising later, having already allergic origin. The latter include eczema, urticarnae rash in older age - neurodermit. These dermatitis are often manifestations of food Allergy, i.e., the result of heightened sensitivity to various food substances; such sensitization can occur even in utero. Eczema usually appears when gross errors in the diet lactating mother or after the introduction of cow's milk (the supplementary feeding, complementary feeding), some fruit juices, fish oil. Arising symmetrically on the cheeks, eczema may spread across the face, leaving forever and nasolabial triangle (as in skarlatines rash)on the scalp and sometimes and at all torso and limbs. Flowing in waves, eczema in exudative diathesis often ends to 12-18-mu months, leaving no traces on the skin.
Typical allergic dermatosis is children pocesuha (strophulus)- nodular rash, accompanied by severe itching. Scrofulous has external similarity with chickenpox, but, in contrast, usually localized in the legs and lower torso. This study is not available until the end of the first year of life, mostly 2-3-year, after the ingestion of eggs, chocolate or other food allergens.
Later in life, after three years, sometimes after some period free from skin manifestations may experience a dry eczema bend, neurodermit (see) with significant infiltration of the skin and racisim itching, sleep disorder and serious disturbances of the nervous system. Predisposition to eczema (see) can stay for life; it can be influenced by external stimuli.

In allergic dermatoses specific allergen is identified rare. Held skin tests with various food allergens usually indicate polysensorial; more help "food diary"that allow you to turn off the allergens that cause emergence or aggravation of skin lesions.
From mucous membranes marked tendency to desquamation of the epithelium, which facilitates the occurrence of inflammatory processes of bacterial and viral origin. Sometimes this tendency is evident and without the participation of infection - pityriasis linguae, the so-called geographic tongue. Microscopic examination of feces find a large number of intestinal epithelial cells and emigrated to the intestinal lumen of blood, and urine sediment - many epithelial cells of the urinary tract.
The tendency to ekssoudativee processes, high mobility neurovascular reactions cause more frequent occurrence of edema of the mucous membrane of the so - called false croup, asthmatic component for respiratory infections, a protracted course of pneumonia and intestinal infections with relapses and more frequent outcome in chronic forms of these diseases.
In exudative diathesis noted earlier adenoiditis, tinuity and tonsillitis.
M. S. Maslov showed that children with exudative diathesis incidence is almost 3 times higher than in children without anomalies of the Constitution.
Treatment of exudative diathesis must be balanced diet of a child, you take care of him, required careful hardening, creating the conditions for normalization of reactivity, increase nonspecific resistance to infections.
Food in exudative diathesis must be adequate, relevant age. Diet sharp reduction of those or other food ingredients has not justified itself and can be dangerous to a child's development (M. S. Maslov). As a rule, you should never abandon breastfeeding. We can not allow indiscriminate feeding, overfeeding, excessive number of individual food ingredients. To 2-3 years should not be given the strongest travelleres (eggs, honey, meat broth, chocolate, cacao); allergens that cause exacerbation of dermal manifestations of exudative diathesis, are excluded. It is recommended that early (from the end of the first year of life) introduction to the diet of vegetable oils contain unsaturated fatty acids; breastfeeding last necessarily included in the diet of nursing mothers. Food should be rich in vitamins a, B1, B2, B6, C, and D.
Local treatment of dermal manifestations of conduct on the General principles. For diaper rash is meticulous care, alternating baths with soda and potassium permanganate (see Baths for children), oil seal, baby cream, etc. With oily we must prevent the rise of thick crusts. Eczema treatment depending on its nature and stage. When hyperemia and edema of the skin used shaken medicine (for example, Zinci oxydati, Talci veneti aa 15,0; Glycerini 3,0; Aq. destill. 60,0).
With the strengthening of inflammation and weeping for a few days apply lotions (lead lotion in half with water, 0.5-1% solution of resorcinol). After remitting the above phenomena move on indifferent ointment. Washing the baby and the bath are doing with the addition of tanning substances - infusion dry chamomile (1 teaspoon per glass of water), infusion string (1 table spoon on 2 glasses of water), etc. In the acute period of eczema physiotherapy treatments are contraindicated. If summer is improving, valid careful ultraviolet irradiation. When dry and chronic eczema, where in addition to the infiltration of the skin, there are flaky, dry skin, cracked and itchy, appoint tar, Ichthyol, Naftalan paste; starting with the lowest concentrations of these drugs (no more than 2%), gradually increase her to 5-10%. The process of inflammation and itching weaken in applying creams and emulsions containing corticosteroids (1,5-2,5% hydrocortisone or prednizolonovuyu ointment, sinalar and others), but after cessation of their use eczema can resume. To combat itching assign inside antihistamines (Dimedrol, pipolfen, suprastin 0,005-0,015 g three times a day), sometimes together with neurologicznej drugs for 7-10 days. In the most severe cases, widespread eczema or neurodermite used short courses (7-12 days) and only in a hospital corticosteroids (prednisone inside of 0.1 mg/kg / day with a gradual reduction of dose). In recent years, for the treatment of eczema resort to injecting gistaglobina.
Prevention of exudative diathesis must begin antenatal. Should the prevention of prenatal sensitization by rational nutrition of pregnant and timely treatment abortion and infections, oxygen deficiency, endocrinopathy, etc. that contribute to increased permeability of placental barrier.
When identifying exudative diathesis must warning its clinical manifestations: rational nutrition with off strong travellergood (see above), the non-use of penicillin, which more often than other antibiotics gives you an allergic reaction. Prophylactic vaccination in children with exudative diathesis are made on the background of application of antihistamines. Cm. also Diathesis.