Get best of the week

What to drip in the eye, so as not to itch


Allergy tests. We are looking for the same bluegrass to which allergy

cats begin to rehearse joyful cries under the window, an abnormal starling again decided that air conditioning is a great place for a nest, and the sun stubbornly hints that winter is almost over.

Everyone is happy. And I suffer in anticipation of all the joys of an allergy to pollen, when I want to go out exclusively in a spacesuit. For some reason it seems to me that there are many brothers in misfortune in Habré, and they will be interested to figure out what kind of muck it is and how to live with it. And I’ll also tell you why in my handbag there is a box of Prednisolone and Blefarogel.

What is hypersensitivity?



Hashimoto's autoimmune thyroiditis in type IV hypersensitivity reactions. This is what the thyroid gland looks like when the body's immunity breaks down.

Actually, an allergy is just a small piece of what immunologists call hypersensitivity reactions.

The body should normally respond to everything that it eats, breathes in and resists the numerous attempts of some kind of penicillin mold to settle in the lungs. Everything is clear here. If the body for some reason does not react actively enough, they just start to eat everything. A typical example is opportunistic AIDS infections, which are caused by bacteria and fungi that are harmless to a healthy person.

The opposite option, when the body reacts excessively actively (hyperergically), is called a hypersensitivity reaction. Why is this a problem? Hypersensitivity can be compared with the use of napalm to solve the problem of cockroaches in the kitchen. It seems that they managed with cockroaches, and it seems that the result was mixed.

There are four main types of hypersensitivity. Sometimes five, but we will simplify it a bit so as not to get into the immunobiological wilds.

Type I - Anaphylactic / Allergic


The main culprit of the problem: IgE antibodies.

This immunoglobulin binds to a hostile antigen and triggers the immediate release of histamine and other active substances into the bloodstream. These are just our current all kinds of allergies and such formidable complications as anaphylactic shock.

Typical diseases: allergic asthma, atopic dermatitis, food allergies and hay fever.

Type II - cytotoxic


The main culprit of the problem: IgG and IgM antibodies, unfriendly macrophages with NK lymphocytes.

For example, a person suffers from chronic streptococcal tonsillitis for a long time and does not think to be treated. Sooner or later, the mortal remains of dead streptococcus will be confused with their own connective tissue cells due to the effect of molecular mimicry. Roughly speaking, immune cells are dull, and streptococcus pieces look like our own proteins. As a result, an NK lymphocyte floats to an innocent heart valve cell and makes a life-giving injection of perforin protein into the membrane. The remains eat up macrophages.

Typical diseases: rheumatic heart disease, autoimmune anemia.

III type - immunocomplex


The main culprit of the problem: antibodies of the IgG, IgM classes, which formed immune complexes and neutrophils with soluble antigens.

Normally, antigen-antibody complexes should be destroyed and eaten. In the case when they “stick” to the walls of blood vessels somewhere in the kidneys, neutrophilic white blood cells come in and begin to arrange acts of local intimidation of inflammation. In parallel, they can destroy a kidney or joints.

Typical diseases: post-streptococcal glomerulonephritis, systemic lupus erythematosus (the same, yes), rheumatoid arthritis.

Type IV - delayed-type hypersensitivity


The main culprit of the problem: T-lymphocytes.

An interesting mechanism is associated primarily with the cellular response. Upon initial contact, T cells learn to kill a specific enemy. Upon subsequent contacts, T-lymphocytes come and activate macrophages, which begin to kill anyone at the site of antigen penetration. For example, this mechanism underlies the reaction to the quinones of poison ivy and poison oak, which grow mainly in North America. Causes severe contact dermatitis.

Typical diseases: contact dermatitis, Mantoux reaction (not a disease, but a reaction of this type), rejection of the transplanted organ, multiple sclerosis.

How does allergy work?



House cricket. He lives somewhere in the country and can send you to the hospital if you are allergic to his scales.

Sometimes it seems that there is an allergy just to life. For example, did you know about orthopter allergy? This is when you can’t tolerate contact with orthoptera, and a house cricket scratched nearby can cause anaphylactic shock.

How does it all work? Let's look at an example of food allergies.

As we have already discussed, allergies are classified as type I hypersensitivity reactions, which are closely related to IgE antibodies and mast cells. So, for some reason, your body has decided that there is no greater danger to it than shrimp. And he began to carefully synthesize antibodies. And instead of normal immunoglobulins, IgM and IgG decides that he needs a completely wild amount of IgE, which he usually needs only when protecting against worms.

You eat Caesar with shrimp and start a cascade of reactions. IgE binds to the components of this most terrible shrimp, which got into the body, and then in the form of an antigen-antibody complex float to the mast cell.

Mast cells are those thick and large cells that are involved in many immune responses. And they also accumulate histamine, prostaglandins and other inflammatory mediators in their granules. After binding the shrimp-antibody complex, the mast cell immediately ejects everything that it has accumulated into the surrounding space. The key role here is played by histamine. It increases vascular permeability, causing diffusion of fluid from the vessels into the surrounding tissue. When you cannot breathe normally due to swelling of the nasal mucosa, histamine is to blame. At the same time, many local receptors are activated, which causes intolerable itching and irritation. You start sneezing and scratching your eyes.


Dust mite. He lives in your pillow, eats your skin, itches, sheds and causes allergies

By the way, allergies are also cross-related to similar molecules. The same shrimp most often gives a similar allergy to a dust mite cuticle.

How to save people with Quincke's edema and anaphylaxis


Quincke's edema

. , . . .

If you are unlucky, and too much histamine has been thrown, then, in addition to sneezing and other little things, you can get more dangerous complications - Quincke's edema and anaphylactic shock. I watched live, as in a person, after one spoonful of mayonnaise, the lip suddenly begins to swell, then the tongue and the entire lower half of the face.

I want to make a reservation right away: in medicine there is a key principle of “Do no harm”. Please do not do anything if you are 100% not sure that you understand what is happening. Just call an ambulance.

So what should be done in such situations?

1. The first thing you should do is ask: "How are you feeling?" If no answer is given, breathing problems may occur.
2. Then get someone nearbycall an ambulance. These are very dangerous conditions that can lead to death. Take care of the injured yourself.
3. We carry out the analysis according to the ABC system.
4. A - Airways (airways) . We make sure that they are passable, and the tongue or other tissues do not block the airways. If the person is conscious, we give several breaths of any glucocorticoid in the spray. For example, budesonide. Again, if you have at hand an “optimist” first-aid kit with the right inhaler. The shock itself and the pressure drop will not stop, but can prevent asphyxiation due to Quincke's edema.
5. B - Breathing . Stopping breathing during shock is not very typical, but we still monitor it and, if necessary, begin to do artificial respiration with indirect heart massage.
6.C - Circulation (blood circulation) . With shock, pressure drops. Your task is to maximize blood supply to the brain due to the lower extremities. We lay the patient horizontally, raise our legs higher.



7. If a person knows about his risks and carries an emergency syringe with adrenaline, enter the dose according to the instructions. Usually this is 0.2-0.5 ml of a 0.1% solution of adrenaline (0.2-0.5 mg) intramuscularly. You still will not get into a vein if you do not know how. According to national clinical guidelines , an intramuscular injection into the outer or front of the thigh should be given. However, in Russia it is very rare to meet a person with EpiPen and analogues. They are not easy to buy and can not be stored at temperatures above 25 degrees.
8. Be sure to tell the ambulance doctors what was administered and how.

If there is none of the drugs, we put the person, raise our legs higher so that the brain receives enough blood, and we monitor the breath so that the tongue does not sink, and we wait for an ambulance.

As a doctor, I always carry Prednisone in my purse, which is needed to suppress immune reactions and is always administered during Quincke's edema and anaphylactic shock. Glucocorticoids are not first-line drugs, but they can stop histamine release and allergen response.

Slow intravenous administration outside the hospital will not work with us, therefore, we administer, according to the same national recommendations, 150 mg intramuscularly. This is the whole box with three ampoules of 30 mg / ml, 3 ml in total. But, if you are not a doctor, then it is better to do breathing control and providing blood supply to the brain.

There is a very severe option, if there is no adrenaline, but the person begins to “leave”. Hurt him. Not in the sense of breaking your arm, but just heartily give a slap several times or massage the point on the back of your hand, between the base of your thumb and forefinger, with force. In response to pain impulses, the body will throw out a certain amount of its adrenaline from the adrenal glands, which can improve the situation for some time.

Ok, what about hay fever?



Pollen under the microscope. It is very small, it is electrified and sticks to hair and objects, causing allergies.

Pollinosis is a type of allergy that is caused by sensitization to pollen of various plants. The reaction is typical: the release of histamine begins in those areas where pollen penetrates the body. Mucus starts to flow from the nose, coughing and sneezing begin.

My most affected part is the eyes. Well, if they were just red, this is not so critical. But most of all I am exhausted by the ongoing itching, the sensation of eyelashes after the eyelid and the current tears. Tetrisoline-based drugs to drip into the eyes are pretty useless. They simply constrict the blood vessels, which improves the appearance, but does not help in any way to solve the problem of irritated receptors. Although the edema is slightly removed.

The main thing to do is to minimize the exposure of the allergen to the body. Ideally, if you move to where the muck that causes you these problems does not bloom. Of course, this option is not suitable for anyone, but taking a vacation during the allergy period and going to the mountains where there is no conditional ragweed is quite possible. If you still have to stay where the allergen flies in the air, then make it a rule to work with it as if you are in a focus contaminated with radioactive dust. They came home - all things are immediately washed, and you go to the shower yourself. The key problem is hair, especially long hair. You bring on yourself an incredible amount of pollen, and then also carry it on sofas and pillows. Therefore, rinse thoroughly.


FFP3 class respirator with valve

When you are outside, be sure to wear a mask. Just not the usual rag from the pharmacy, but a normal full-fledged respirator with a valve. Look for 3M respirators of class FFP1 and higher in construction stores. Now they will cost abnormal money and it will be difficult to buy because of the coronavirus epidemic, but then try to buy them.

I will not advise swimming glasses or a face mask, it is too severe. But, if we cannot wear protective masks for aesthetic reasons, then it is worth trying to limit the contact time of allergenic pollen with the conjunctiva of the eyes as much as possible. Actually, that is why a typical manifestation of allergies from the side of the eyes is profuse tearing. So the body tries to wash off the stimulus. A combination of cornea with “powdered” pollen and dry eye syndrome will be an extremely unpleasant option. Oh, these “magical” sensations of “sand” in the eyes, when everything itches, but it doesn’t work out.

The whole problem is that the tear film is extremely complex in composition and is formed not only due to the work of the lacrimal glands, but a large number of small modified sebaceous glands. They are called the meibomian glands and evolutionarily serve in mammals as a third-century replacement to protect the eyes from drying out. It is the normalization of their secretion that allows us to solve the problem with xerophthalmia - dry eye syndrome.



For this, you can use Blefarogel 1. Initially, our laboratory developed it as a means of stabilizing the tear film for the treatment of dry eye syndrome, but it turned out that it works well against pollen. Apparently, it is the normalization of secretion of glands that reduces the pollen residence time on the conjunctival surface and prevents its binding to IgE immunoglobulins. Protection is not absolute, but terrible itching is significantly reduced due to a decrease in the release of histamine and inflammatory mediators.

Just keep in mind that it is a gel in consistency, not a drop. It does not need to be dripped into the eyes , it is applied directly to the closed eyelids. Just one or two drops for both centuries, including the ciliary edge.

Here we must not forget that, although the gel itself has a positive effect on the functioning of the meibomian glands and improves the condition of the conjunctiva, it cannot completely eliminate contact with the allergen. Therefore, when you come home, also thoroughly rinse your eyes and eyelids to wash off adhering particles of pollen. Very good Blefarogel works in combination with drops based on sodium cromoglycate. At first, cromolyn sodium, then, after a few minutes, blefarogel. Cromoglycate allows you to suppress the reaction of mast cells, and they do not throw out inflammatory mediators, even if something nevertheless breaks the defense.

Well, it will not be superfluous to hide behind antihistamines. Decide with your doctor what suits you best. This is usually something from this list:

  1. Cetirizine (a mixture of isomers L and D).
  2. Levocetirizine is a more active L-isomer.
  3. Loratadine (converted in the body to desloratadine).
  4. Desloratadine (its active metabolite).
  5. Bilastine.

It makes sense to spray Mometasone in the nose. This is a hormonal drug, but it is practically not absorbed and works exclusively locally. Laura loves him very much.

If you also have a cough with an asthmatic component, Montelukast is often prescribed. At me it also perfectly removes all problems with the nose.

Summary


Be sure to see your doctor before taking any medications. This is always helpful. But you can safely apply barrier options of protection against pollen right now. They work great.

If you want to know more about the chronicles of our cozy laboratory, here is the telegram channel (or @geltek_cosmetics) with what is happening now.

More articles:


All Articles