POLLINOSIS

From Big Medical Encyclopedia

POLLINOSIS (pollinosis; lat. pollen, pollinis pollen + osis; synonym: hay fever, summer Qatar of the East, pollen allergy) — the allergic disease caused by pollen of plants and which is characterized by preferential damage of airways and a mucous membrane of eyes.

The first mentioning of the disease reminding P. meets in K. Galen's works. Made the message on hay fever in 1819. J. Bostock in London, and in Russia in 1889 — L. Silich. Faded (Ch. H. Blackley, 1873) connected developing of a disease with presence of pollen of herbs at air. Faded, Dunbar (W. Ph. Dunbar, 1903) and other researchers revealed sensitization to pollen not only mucous membranes of a nose, eyes and bronchial tubes, but also skin. Schittenhelm and J. W. Weichardt noted the expressed similarity of hay fever to experimental anaphylaxis (see). In 1911 L. Noon successfully carried out treatment of patients with hay fever with injections of extracts of pollen. Further study chemical structure of pollen allergens (see), role of allergic antibodies (see) at P., their properties, methods of detection, develop ways of treatment.

The highest incidence of P. is registered at inhabitants of the western hemisphere. So, in 50 — the 60th 20 century in Mexico P.'s frequency made for 1000 the population 391, in the USA — 167 — 192. Annually 11,4 — 15,2 people for 1000 the population get sick for the first time. P.'s prevalence in other countries in the 60th made for 1000 the population in England 10 — 32; in Spain 10 — 30; in Italy 2,3; in Luxembourg 7,98; in Switzerland 10 — 30; in Yugoslavia 10 — 48 among urban population, 3,6 among rural. High incidence of P. is registered in France, Sweden, Belgium, India, on the Hawaiian Islands. At aboriginals of Japan, Mongolia, Brazil, the Republic of South Africa P. either is not registered, or meets extremely seldom that connect with ethnographic features. The selective researches conducted in 60 — the 70th in the USSR, showed rather low incidence in the Baltics, in the north, in Krasnoyarsk Krai and higher in Georgia — 2,4 — 2,8, in the Rostov region — 0,23 — 0,3, to the Saratov region — 1,78, in Krasnodar Krai — 1,46, in North Ossetia — 1,67, in Uzbekistan — 0,52 (for 1000 the population). Most often P. meets aged from 30 up to 39 years. The disease of children up to 3 years meets extremely seldom; up to 14 years more often (by 2 — 3 times) males, and from 15 to 50 years — women's get sick. Among urban population incidence is 4 — 6 times higher, than among inhabitants of rural areas.

An etiology

allergens of pollen of anemogamous plants are P.'s Reason. Three basic groups of plants with allergenic properties are allocated. Trees and bushes (an oak, a plane tree, nut, an elm, an ash-tree, a birch, a poplar, a maple, a hazel grove, an alder, an English elm, very seldom a pine, a fir-tree) enter the first. Pollen causes them the spring peak of incidence of the Item. The second group includes wild-growing (a meadow grass, a wheat grass, a fire, a fescue, to a hedgehog, a foxtail) and cross-pollinated cultivated (rye and corn) cereals which cause spring and summer increase in concentration of pollen in air. Pollen of cereal herbs has more expressed allergenic properties, than pollen of trees. The third group plants with the highest allergenic activity — weeds (weeds), napr make, different types ambrosias (see), a wormwood (see. Medicinal plants ), representatives of family maryevy, orach, weed hemp, durnishnikolistny tsiklakhena. Local pollen allergens play a limited role, napr, walnut, the Syrian roses, mallows, a cotton in Uzbekistan, a mulberry in Georgia, a saxaul black, a purslane large-flowered, a prickly pear brown kolyuchkovaya, a rose Indian in Turkmenistan.

Assume that pollen allergens represent a complex of proteins with carbohydrates or pigments of pollen. Besides, protein-free nitrogen-containing fractions — polypeptides with various a pier. it is powerful — keep allergenic determinants. From pollen of trees, a wormwood, an orach, hemp from 3 to 6 antigenic components having different activity from pollen of cereal herbs — from 4 to 15 are allocated. Allergens are present not only at pollen, but also at other parts of a plant, napr, at seeds, leaves. By means of a precipitation test in gel (see. Immunodiffusion ) the general antigens in pollen of related plants, napr, such cereals as a timothy, a ryegrass, a fescue, a meadow grass are found; the general antigenic properties are available for an English elm and an elm, a poplar and an aspen, an ambrosia and sunflower, a tsiklakhena and an ambrosia. At hypersensitivity to pollen of cereal herbs cross sensitivity to the products containing breadstuff can be observed. Perhaps hron, P.'s current without clear seasonality since breadstuff are a part of many products which are eaten constantly. At patients with an ambroziyny pollinosis or with P. from pollen of sunflower the exacerbation of a disease at the consumption of seeds of sunflower or products received from them is possible. The general allergenic properties with pollen of a thistle family have such products as turnip, a garden radish, a radish, onions, a turnip, mustard, carrots, cabbage, etc. The sharp aggravation of P. can be caused by herbs, napr, the yarrow, a camomile appointed with to lay down. purpose.

For identification of species of pollen in allergology (see) use the simplified schemes and atlases, signs of a structure of allergenic pollen are the basis to-rykh. The most part of pollen is thrown out a plant in the morning. P.'s development requires the sufficient content of pollen in air. Pollen of plants possesses a factor of permeability, thanks to Krom it can pass through an epithelium of a mucous membrane of a nose. In a nasal secret of healthy people the substance of the proteinaceous nature braking activity of a factor of permeability of pollen is revealed.

At 50 — 60% of patients hereditary predisposition is revealed to allergies (see); among patients workers of brainwork prevail, higher incidence in the city is promoted by the general pollution of the atmosphere industrial and exhaust gases, chemical allergens, etc.

the Pathogeny

the Pollinosis — a classical example allergic diseases (see), to-rykh preferential allergic reactions of immediate type are the cornerstone (see. Atopy ). At these reactions inclusion of V-lymphocytes in an antibody response is carried out by T lymphocytes (helper); blocking of this inclusion is regulated by T lymphocytes — suppressors (see. Immunocompetent cells ). At deficit of T-suppressors stimulation of development of antibodies at contact with allergen is observed. The formed antibodies — reagins — are fixed on mast cells, basophiles. Reagins belong preferential to the class IgE, partly IgA and IgG. At repeated hit of pollen allergen in an organism he unites to reagins (the I stage — immunological). It leads to activation of cells and escaping them various mediators (the II stage — patokhimichesky), at the same time among mediators allergic reactions (see) major importance attach to a histamine (see). Influence of mediators is resulted by disturbance of functions of cells of tissues of airways, and also internals (the III stage — pathophysiological develops). It is possible sensitization (see) on the slowed-down type, development of a contact allergy (T-dependent reactions with participation of sensibilized lymphocytes). Development of a sensitization at the same time to pollen and bacterial allergens or other groups of noninfectious allergens (household, epidermal, food, medicinal, chemical) burdens disease. Neurogenic, emotional, endocrine and climatic factors exert impact on a current of the developed pollinosis.

The item in an active form is observed only at the person. Reproduction at experimental animals is complicated. Guinea pigs and rabbits by introduction of 5% of a suspension of native pollen in a Freund's adjuvant are easier sensibilized (see. Adjuvants ), administration of water extracts with the subsequent putting pollen on a mucous membrane of a nose is less effective.

Pathological anatomy

At experimental P. by means of electronic microscopic examination observe destruction of cilia of a ciliary epithelium, disintegration of epithelial cells of respiratory tracts, increase in permeability of vessels (see. Pronitsayemost ). It is followed by infiltration of a polinuklearama, preferential eosinophils. In the subsequent eosinophilic infiltration is replaced by macrophagic. In two weeks inflammatory reaction takes place, the quantity increases plasmocytes (see). Pollen is exposed to fragmentation and lysis.

The clinical picture

the Disease is characterized by strict seasonality. The most typical manifestation of P. is the rinokonjyunktivalny syndrome. Conjunctivitis (see) is followed by a severe itch in a nasal cavity and a nasal part of a throat, attacks of painful sneezing with liquid plentiful separated from a nose or attacks of almost full congestion of a nose (see. Rhinitis ). Mucous membranes of a nasopharynx, eustachian are gradually involved in process (acoustical, T.) pipes, at the same time there is ear pain, a hoarse voice, sensitivity to nonspecific irritants increases. The heaviest manifestation of P. is so-called pollen asthma (hay asthma), edges is observed at 20 — 38% of patients with other manifestations of the Item. Pollen asthma as the isolated P.'s syndrome occurs at 4% of sick Items. At their inspection the wedge, the picture typical comes to light for bronchial asthma (see). At 6% of sick P. note skin manifestations — small tortoiseshell (see), a Quincke's edema (see. Quincke hypostasis ), eczema (see), and also atopic and contact dermatitis (see) with the heavy current exhausting with an itch, diffusion vesicular eczematic elements on open parts of a body (a face, a neck, brushes, shins).

Defeats of a nervous system in the form of Menyer's syndrome are less often observed (see. Menyera disease ), migraines (see), small epileptic seizures — absentias epileptica (see. Epilepsy ), allergic cortical ares-noentsefalita; disorders of internals in the form of myocarditis, hepatitis, gastritis, colitis, and also a vulvitis, cystitis.

Most of patients in the period of aggravations has a headache, perspiration, weakness, sleeplessness; temperature more often remains normal, but can increase to 39 ° and have remittiruyushchy character. At nek-ry persons, sensibilized to pollen, positive skin tests without wedge, P.'s manifestations (a subclinical pollen allergy) can be observed.

The diagnosis

the Diagnosis is established on the basis of the anamnesis, clinical laboratory data, and also results skin tests (cm.). From data of the anamnesis seasonality, communication of a disease with stay in a certain area, an aggravation of symptoms in dry, hot and windy weather are important, at stay on the street, in the country, existence of allergic diseases in a family. At a rinoskopiya note a rhinedema, find polyps of a nose in 5 — 8% of patients, at 50 — 60% mucous membranes of subordinate clauses are involved in process (okolonosovy, T.) bosoms (see. Rhinosinusopathy ). In blood at the height of a disease reveal an eosinophilia from 6 to 35% (see. Eosinophilia ), a lymphocytosis to 55% (see. Leukocytosis ).

Specific diagnosis of P. is carried out in an allergological office (see. Office allergological ), where use allergy diagnostic tests (see). Skin tests are an integral part allergol. sick P. Odnovremenno's inspections it is possible to put skin tests at adults with 10 — 20 allergens, at children — with 5 — 6. At discrepancy of results of skin tests and the anamnesis inspection is supplemented provocative tests (see) — conjunctival, nasal and inhalation. According to indications apply Prausnittsa — Kyustnera reaction (see). Have auxiliary value at P. basphilic test (see), degranulation mast cells (see), radioallergosorbent method (see).

For diagnostic tests there are sets of pollen allergens which are prepared by a method by Cooks and Milforda. In the beginning carry out collecting, drying and purification of pollen. Allergens are prepared two types — with pollen oil and without it. At extraction pollen with liquid Cooks in the ratio 2: 100 or 3: 100 automatically stir up within 3 days at t ° 4 °. Filter via paper filters; lead up pH to 7,0 — 7,2; will sterilize, passing via Zeytts's filter; check for sterility and harmlessness; standardize on number of units of protein nitrogen (PNU) from 1000 to 20 000, carry out biol, standardization.

Differential diagnosis carry out with adenoviral diseases (see), rhinitis (see), conjunctivitis of not allergic nature (see. Conjunctivitis ).

Treatment

specific is Most effective desensitization (see), to-ruyu carry out by several methods. At a classical early method desensitization is begun not later than in 2 months prior to blossoming of the corresponding plants and repeated annually within 3 — 7 years, at the same time the initial dose is selected at allergometrichesky titration (cm.).

Nonspecific methods of desensitization yield non-constant positive takes. With relative effect use hystoglobulin (see). Antihistaminic drugs (see. Antihistaminic substances ), intal at P. is appointed as symptomatic means during the acute period, locally in the form of drops, insufflations (see), intranasal electrophoresis (see) and aerosols (see. Aerosoltherapy ).

In hard cases of P., napr, at development of the asthmatic status in a blooming period, and insufficient efficiency of other methods of treatment in the period of an aggravation appoint corticosteroid drugs inside, parenterally, in ointments, and also in the form of dry aerosols (4 mg of Triamcinolonum to 1 inhalation, the dosed aerosol for inhalations — Becotidum) or heatwet aerosols which, except hormones (25 mg of a hydrocortisone or 5 mg of Prednisolonum), can include antihistaminic drugs.

Prevention and the Forecast

Prevention — the termination of contact with allergen, e.g. change of the residence, stay on the sea coast.

Forecast favorable.

Pollinoses at children

At children of preschool age the so-called masked P. — a congestion in ears can be observed up to total loss of hearing without others a wedge, P. U signs of one children note only small reddening of conjunctivas, a frequent pochesyvaniye of a nose («an allergic salute»). At other children the disease proceeds in the form of heavy bronchial asthma without rhinitis, and such children usually have a sensitization both to pollen, and to house dust therefore attacks of suffocation are observed for all year. At nek-ry children in the period of P.'s heat the food and medicinal allergy is possible, the edge is not observed out of a season of blossoming (see. Medicinal allergy , Food allergy ). Children of the advanced school age have a wedge, P.'s manifestations same, as well as at adults.



Bibliography: Ado A. D. General allergology, M., 1978; Allergic diseases at children, under the editorship of M. Ya. Studenikin and T. S. Sokolova, M., 1971; Beklemishev N. D. and d river. Pollinoses, Hay katara, Alma-Ata, 1974; Poroshi-n and Yu. A., Polner A. A. and Lukianova F. F. Specific diagnosis and clinic of pollinoses (hay fever), Owls. medical, No. 3, page 42, 1964; Fradkin V. A. Allergens, M., 1978; Private allergology, under the editorship of A. D. Ado, M., 1976; Blackley Ch. H. Experimental researches of the causes and nature of cotarrhus aestivus, L., 1873; F e i n-berg S. M. Allergy in practice, p. 588, Chicago, 1946; Findeisen D. G. R. Allergie, B., 1971.


Century of A. Ado, H. G. Astafyeva, L. A. Goryachkin.

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