ALLERGOLOGIC EMERGENCIES IN DERMATOLOGY DIAGNOSTIC AND THERAPEUTIC PROCEDURES

Hitna stanja u alergologiji i kliničkoj imunologiji sve su češći medicinski javno zdravstveni problem u nas i u svijetu. Česte su alergijske reakcije od blagih simptoma kao što je svrbež do generaliziranih kožnih, gastrointestinalnih, respiratornih simptoma do anafilaksije i zatajenja kardiovaskularnog sustava. Pri tom su moguće reakcije na različite udisajne tvari, hranu i aditive u hrani, strane tvari (krv, lateks i drugo) te brojne poznate antigene i lijekove koji putem imunskih kompleksa i reakcija posredovanih oslobađanjem komplementa ili direktnim oslobađanjem histamina (opijati ili dekstran) te zbog modulatora metabolizma arahidonske kiseline (npr. NSAID) i drugo. NSAID često uzrokuju astmu, urtikarijski osip, angioedem i još 35 različitih dermatoloških reakcija, posebice kod primjene lijekova koji zahtijevaju hitan terapijski postupak. Reakcije od uboda insekata pojavljuju se ne samo s bolnim infiltratima, nego i diseminiranim osipima i edemom. Suvremene dijagnostičke metode, a posebice hitni terapijski postupci, sukladno internacionalnom k oncenzusu (npr. European Allergy White Paper) ukazuju na potrebu ujednačavanja stavova u kliničkoj praksi. Velik broj bolesnika se liječi zbog alergijskih kožnih bolesti neadekvatno, upućuje na testiranja često u fazi aktivne bolesti i kad su pod terapijom, a liječe se kortikosteroidima i antihistaminicima duže no što je potrebno. Suvremeno liječenje hitnih stanja zahtijeva izobraženu osobu, no svaki liječnik treba odgovarati za liječenje akutnih simptoma u svojoj ordinaciji i poznavati postupak za hitno liječenje točno određenim lijekovima. Anafilaktične reakcije su rijetke, ali svaki liječnik treba biti pripravan na najteže situacije i poznavati liječenje u hitnom postupku. U radu navodimo najčešće bolesti za koje je potreban hitan postupak liječenja, a u fazi regresije bolesti dijagnostički postupci.Emergencies in allergology and clinical immunology are quite common and pose a public health problem in Croatia and worldwide. Allergic reactions ranging from mild symptoms such as pruritus to generalized skin eruptions, gastrointestinal and respiratory symptoms to anaphylaxis with cardiovascular emergencies are very common. Reaction develops to inhalant substances, food and food ingredients, various foreign substances (blood, latex, etc.) and many other well known antigens and drugs which are frequent causes of anaphylactic reactions, asthma, generalized urticaria, angioedema. There are 35 different skin reactions induced by drugs through immune complexes, complement mediated reactions and direct histamine liberation (by opiates or dextran) and modulators of arachidonic acid metabolism (such as NSAID). Along with painful infiltrates, insect venom allergy manifests with disseminated exanthema and angioedema. Current diagnostic methods, especially therapeutic procedures for emergencies in concordance with the international consensus of the European Allergy White Paper, require the same procedure in clinical practice. Many patients with different allergic skin diseases are treated inappropriately, some are tested in active phase of the disease, during anti-allergic therapy, and some are administered corticosteroids and antihistamines longer than necessary. Sometimes, the treatment of emergencies requires a person experienced in intensive care medicine. However, any physician might be responsible for the treatment of acute symptoms in his office, and thus has to know the modalities and relevant drugs and treatment essentials. Anaphylactic reactions are rare, but every physician should be prepared for the worst. Due knowledge of the correct management should be a must for all of us. The most common emergencies require emergency treatment and diagnostic procedures upon disease regression