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Increased eosinophils in the blood of a child.

Audience 5 At least once a year, or even more often, the pediatrician gives a referral for testing. Mainly general analysis blood and urine. Imagine the surprise of parents when a deviation from the norm of at least one of the indicators is discovered. Especially if deviations from the norm concern any type of leukocytes. Everyone knows that it is these blood cells that are responsible for human immunity. These bodies contain eosinophils. A detailed blood test can show how much their indicator differs from the expected one, up or down. When Eosinophils are elevated in a child

– this requires special attention. Eosinophils are a subtype of granular leukocytes. They acquired their name for their ability to react to the reagent eosin. With his help in laboratory conditions it is possible to determine the number of these beneficial bodies in human blood. In view of them small size

, their number is determined not by quantity, but by percentage of the total mass of white bodies. For an adult without health problems, this norm in a blood test is 5%. In children it is 3% higher. This is due to the fact that the matured body is already familiar with the allergens that the child is exposed to. Eosinophils are created in the bone marrow and then they move into the bloodstream or capillaries. The ease of penetration is due to the small size and structure of the body. By appearance they resemble an amoeba with two nuclei. Thanks to the amoebic method of movement, these bodies easily penetrate into soft fabrics

, internal organs and human epithelium. They spend no more than one hour directly in the blood itself.

With a complete and detailed analysis, it may be discovered that eosinophils in the blood are increased. What does this mean and how to deal with it? Let's take a closer look.

Functions of eosinophils

To begin with, it is worth understanding why they exist in human blood and what functions they perform.

These small granular ones are needed to identify foreign bodies in cells and fight them. They react to histamines, toxins and pathogenic substances. The main function of eosinophils is to find and neutralize foreign body

. They do this in several ways: One of eosinophils is to regulate the level of histamine in the blood. If in a child it differs significantly from the norm in a larger direction, then eosinophils temporarily suspend activity. In addition, they produce many useful biological compounds in the blood.

In newborns, the number of eosinophils is higher than the permissible limit. Why and what is this connected with? It's simple: food allergies, skin irritation. An increase in white blood cells can be diagnosed as eosinophilia when their number exceeds the acceptable upper limit.

Normal in children

What are their norms for children? The ratio of eosinophilic cells in the blood of children to the total mass of leukocytes can be considered in a table compiled according to the norms of the leukocyte formula:

The highest numbers are for infants and 3 year olds. This level of eosinophils in a child is quite reasonable. But any shift from the permissible limit requires an immediate search for the reasons for the increase in the number of eosinophils, diagnosis and bringing them to normal.

Reasons for rejection

There are a number of factors that cause an increase in eosinophils in the blood of a child:

Antihistamine process. Leukocytes fight the allergen;
Response to helminth infection. There are many varieties of worms and almost all children become infected with them;
Various skin diseases, it doesn’t matter: whether it’s diaper rash or lichen;
Malignant tumors;
Diseases circulatory system and vessels;
Magnesium deficiency in the blood.

If a child’s level of these cells is exceeded by at least 15–20%, this indicates that there are foreign bodies. In this case, a more detailed blood test will be required to identify pathogenic organisms that cause the child has elevated eosinophils.

One of the most common causes in children is infection with pinworms or roundworms. Teaching a child about hygiene is not the easiest task. It is also impossible to control the ingress of microorganisms with food and water.

The second most important is allergic reaction. It can occur on absolutely any item: food, hygiene products, household chemicals or animal fur. It provokes an increase in eosinophilic bodies in the blood and can manifest itself on the body in the form of rashes, redness and irritation.

Eosinophilia as a disease

The disease eosinophilia can be diagnosed when the level of leukocyte cells is increased by at least a third of the norm. Describe it as independent illness, pretty hard. Basically, this disease manifests itself against the background of a more serious illness. Increased eosinophilic cells in the blood may mean that the child’s body is in this moment fighting another disease.

IN medical practice There have been cases where an infant was diagnosed with eosinophilia from birth. It could arise due to birth defect heart disease, immunodeficiency or cancer. Eosinophilia can also be observed in premature infants.

Signs of the disease

Sometimes, the presence of elevated eosinophils in a child’s blood can be determined by the child’s condition and external signs. Characteristic signs will be:

For allergies:

Redness, rashes;
Dermatitis, diaper rash;
dryness skin, itching;

Sleep disturbances;
Lack of appetite;
Itching in anus or genitals;
Change in body weight.

Caused by other diseases:

General malaise, weakness, lethargy;
Heart failure;
Anemia;
Increased body temperature.

These are not all the symptoms that occur when elevated level eosinophils. Basically, the symptoms of the disease are similar to the underlying disease. This means that only a blood leukogram will help determine the presence of eosinophilia.

There are three stages of eosinophilia: mild, moderate and high or major eosinophilia. I would like to draw your attention to the latter in more detail. This degree The disease is characterized by high levels of eosinophils in the blood. They can reach 15% or more. In this case, there is a risk of developing monocytosis or leukocytosis of the blood.

Monocyte level healthy person is within 13%. They, like eosinophils, belong to granular leukocytes and their meeting indicates the presence dangerous infection or infection with helminths.

An increased number of leukocytes and eosinophilic bodies can develop against the background of viral infections when treated with antibiotics. If a child gets sick with scarlet fever, tuberculosis or the same helminths, the risk of developing major eosinophilia is very high.

What measures to take

The first thing you need to do is take a closer look at your child. If there are no external manifestations disease, the child feels great and is not worried about anything, then you should take a repeat blood test. Perhaps, at the time of delivery, the child’s elevated eosinophils were not due to eosinophilia, but to something completely different. Only identifying the true cause will help solve the problem.

Be that as it may, the disease is easier to prevent than to treat. Timely examination and careful attitude towards the child’s health will be the key to a happy childhood.

The residence time of eosinophil cells in the blood does not exceed more than one hour, then they move into the tissue. An excess of the norm of eosinophil cells in the blood of a child indicates that the cells that are in the body are not enough to fight the pathological process.

Exceeding the norm

An increase in eosinophil levels in a child’s blood is called “eosinophilia.” Among them there are three main groups of increases:

Mild (reactive) eosinophilia – when the level of eosinophils does not exceed 15%.
Moderate eosinophilia - the level of eosinophils is 15-20%.
High eosinophilia - the rate exceeds 20%.

With the pathological process of eosinophilia in the child’s body, the indicators exceed more than 50%.

Reasons for rejection

An increase in eosinophils in the blood of a child under 3 years of age occurs with Quincke's edema on drugs and with atopic dermatitis. If the norm is increased in children over 3 years of age, this indicates that the body has allergic reactions, manifested in the form of:

bronchial syndrome;
seasonal diseases;
hypersensitivity to certain medical supplies;
dermatological infections;
chronic runny nose;
chicken pox;
appendicitis;
allergic rash.

The following factors can increase the level of eosinophils:

recovery from infectious diseases;
helminthic infestations (giardiasis, ascariasis, echinococcus and other chronic irritants immune system);
disease connective tissue(vasculitis, lupus erythematosus, as well as other provocateurs of an inflammatory nature);
consequences of antibiotic use.

The level of eosinophils can not only exceed the norm, but also significantly decrease.

The reasons for the decrease in eosinophil levels are:

spicy infectious diseases(eosinophil cells follow the source of infection, as a result of which their level in the blood decreases);
injuries, burns, sepsis (as with infectious diseases, eosinophil cells are sent to the site of injury to help heal the injury).

A sudden decrease in eosinophils in the blood (down to 0%) is observed with dysentery, typhoid fever And acute appendicitis. A constant slight decrease in the level of eosinophils is characteristic of Down syndrome, as well as for children with constant lack of sleep.

Measures to increase eosinophils in the blood

After a level of eosinophils above normal has been detected in a child’s blood, a more detailed medical examination should be performed. Only with their help will it be possible to discover the actual cause of eosinophilia. Such examinations include:

Ultrasound examination of the abdominal cavity.
General analysis of stool for the presence of harmful eggs.
Analysis for allergic reactions.
Nasopharyngeal swab for eosinophils.
X-ray of the lungs.
Spirometry and cold tests.
Functional tests to determine the performance of the kidneys and liver.

After the attending physician has in his hands clinical picture examination of the child’s body, he will be able to prescribe appropriate treatment. After the disease is cured, the level of eosinophils will return to normal.

Parents should understand the interpretation of the analysis and, if necessary, undergo full examination. This will help to detect the disease early initial stage and cure her.

Each parent is concerned about the level of eosinophils in the blood of their children. At the same time, they are all interested in deviations from the norm of eosinophils in children. The study of such indicators helps to timely identify the presence of certain diseases and begin their immediate treatment. To find out whether eosinophil levels are normal in children, specialists usually prescribe a blood test. When expanded, it more than clearly shows the number of these cells in the human body. Their presence, equal to the norm, indicates the body’s high resistance to various diseases.

The role of eosinophils in the children's body

These blood cells got their name because they can quickly absorb eosin, a coloring enzyme that is used in laboratory research. The main organ that produces protective cells in the child’s body is the bone marrow. Fully formed cells travel through the blood for several hours, after which they enter the gastrointestinal tract, lungs and exit through the tissues.

The main function of eosinophils is to protect the child from typical infections, as well as allergens, the origin of which is different.

Their other functions include:

ability to quickly recognize harmful cells;
stimulus absorption;
liberating the body from pathogens by digesting foreign proteins;
destruction of allergens due to the content of histamine in cells.

Indicators of normal eosinophils in children

So, for example, in newborns and infants they do not exceed 0.05 x 10⁹ per liter of blood, the remaining data are given in the table:

It is believed that as infants get older, the norm of eosinophils in children is percentage increases to adult levels. After children turn 16 years old, their normal levels are assessed on an adult scale. As a rule, if the body works correctly and without interruptions, eosinophil cells may be absent in the blood of children from 6 years of age.

Causes of increased eosinophils

Eosinophilia – increased content eosinophil cells in the blood of children, which has certain causes. It occurs much more often in young children than in teenagers.

It is caused by the following reasons:

fight against pathogenic proteins, as well as fungi and viruses;
deficiency of magnesium-containing substances in the body;
the appearance of malignant neoplasms;
the occurrence of blood diseases.

If we are talking about recently born children, then in their body increased amount eosinophils can be observed when they become infected with some kind of infection while in the womb, and also indicate the appearance of an allergic reaction to the protein cow's milk, medications or incorrect organized meals nursing mother.

If an increased level of eosinophils is recorded in older children, experts begin to talk about:

the presence of fungal infections of the body;
skin disease;
worm infestations;
availability pathogens and bacteria in children;
problems with the thyroid gland;
burns, as well as frostbite of thermal origin;
eosinophilia of a tropical nature - appears at such times of the year as summer, when we're talking about O high temperatures air, high humidity and failure to comply with simple hygiene rules.

Reasons for the decrease in eosinophils

A reduced number of eosinophils in the blood is called eosinopenia.

This condition of the body is not considered as dangerous as an increased number of eosinophils in it, but still requires close attention from specialists. In such cases, we can talk about the presence of serious pathologies in the body of children.

If the number of protective cells in the blood is reduced, we can talk about:

Purulent infections of various origins, sepsis.
Chronic state of stress.
Heavy metal poisoning.

In addition, a reduced number of these cells is observed in recently born children with Down syndrome, as well as in premature infants.

If the stage of leukemia reaches its culmination stage, the number of protective cells may drop to zero.

Eosinopenia is not isolated as a separate ailment of the body, however, it is necessary to monitor the number of protective cells in the body of children with special attention.

When the levels exceed the norm or are at a lower level, you need to contact a pediatrician, as well as a hematologist and nutritionist. An appointment is not always required medicines to normalize the level of cells that provide protection child's body.

What does an abnormal eosinophil level indicate in children?

In addition, eosinophils are able to accumulate and release inflammatory mediators that are involved in immune reactions. These blood cells can also destroy pathogenic organisms. Eosinophils are called microphages.

Norm

In the blood of an adult, eosinophils should make up no more than 5% of the total number of leukocytes. In the morning, the level of these immune cells can increase by 15% compared to normal, and at night - by 30%. Also, the level of eosinophils increases in women experiencing ovulation.

As for children, the normal level of eosinophils in their blood varies up to 5 years. In the first 2 weeks after birth, the number of these immune cells in the blood varies from 1 to 6%. In the first year of life, the normal content does not exceed 5%, and in the second year it can reach 7%. From 2 to 5 years it ranges from 1 to 6%. After 5 years, the level of eosinophils in the blood does not exceed 5%. If a child has a significantly increased level of this type of leukocytes (over 15%), this may indicate the development of some pathology.

Causes

The level of these components can be determined using a general blood test. In order for the result to be reliable, on the eve of blood donation it is necessary to limit the consumption of sweets, and the test itself must be performed in the morning on an empty stomach.

In a newborn baby, eosinophils may be elevated for the following reasons:

hemolytic disease;
atopic dermatitis;
Availability Staphylococcus aureus in the intestines;
serum sickness.

In a child under 3 years of age, an increase in the level of these immune cells occurs with Quincke's edema, allergic reactions to drugs and atopic dermatitis. The reasons for the increase in eosinophil levels in a child over 3 years of age are:

The child may also experience a simultaneous increase in the number of lymphocytes and eosinophils. The reasons for this phenomenon are viral infections caused by allergies, helminthic infestation, scarlet fever and Epstein-Barr virus. If a child experiences an increase in the level of not only eosinophils, but also monocytes, this may indicate the development of mononucleosis, as well as tuberculosis and sarcoidosis.

In infectious diseases, a slight increase in the level of these immune cells occurs during the recovery period.

What to do with elevated eosinophils?

If an increase in the level of these cells is detected in the child’s blood, it is necessary to undergo more complex medical research. Only in this way can we find out the reason for the increase in eosinophil levels. Such studies include:

After effective treatment underlying disease, the level of immune cells in the blood gradually returns to normal. In order to detect an increase in eosinophils in time, you need to regularly take a general blood test. If there are signs of illness, children should be immediately shown to a pediatrician.

Infectious diseases, changes in the quality of blood. Today we will talk about such a concept as eosinophils - we will find out what they are, how their number affects the overall physical state child, what are the norms of indicators for different ages.

What it is

Eosinophils are one of the types of leukocytes (white cells) in the blood, this is a special type of indivisible granules that “mature” in the bone marrow, and after some time move through the blood channels throughout the body. After 3 days of such circulation, these granulocytes settle in internal organs human: in the lungs, gastrointestinal tract. Eosinophils are necessary for the destruction of any foreign protein that has entered the body. They destroy protein by absorbing it and dissolving it in their enzymes.

Granulocytes are called eosinophils after the name of the dye, which they perfectly absorb for medical diagnostics. Their structure is similar to an amoeba, only with 2 nuclei. These nuclei can move freely outside the vessels and penetrate into various inflammatory processes, neoplasms and internal tissue damage.

Important! In some cases, the presence of a foreign protein in the body may indicate the formation of a tumor.

What is determined

Eosinophils are a kind of “markers” or tags that show what is currently predominant in the blood. Thus, depending on their number can be determined:

Properties of eosinophils

These granules have various antitoxic and functions in the body. Their main properties are:

due to their accumulation in areas of inflammation or tissue damage, they serve as a kind of “releaser” of inflammatory mediators;
absorption of small particles by enveloping them with its wall. For this, eosinophils were given a second name - microphages;
rapid migration to foci of infection;
formation of plasminogen (an important protein);
increased sensitivity to class E immunoglobulins (contained in blood serum and secretions);
powerful cytotoxic properties;
can play both a proallergic role (strengthening the existing reaction) and antiallergic (eliminating);
destruction of various microbial cells.

Eosinophils contain many unique components in their composition, for example, a special protein that protects against protozoan microbes and helminths.

Eosinophils appear in the body only when there is any inflammation, infection, allergy, etc.

How is a blood test performed?

The number of eosinophils in the blood and their location in the body can only be determined by taking the appropriate one. The most common methods are blood and urine tests. A general blood test is taken from a vein or finger, after which it is sent for examination.

Eosinophils themselves are colorless, so during examination they absorb eosin (a special dye), become red, and thus make it possible to easily count their number.

It is noteworthy that to take a blood test you do not need to adhere to any special diet or limit consumption - this does not affect the indications.

Eosinophil norms in young children

Indicators may depend on the time of day: as a rule, there are more of them at night, in daytime the quantity decreases. If for an adult an amplitude of 2 to 5% is considered normal, then for a child’s body the indicators will be different. Percentage rate for a child:

If the blood test results differ from the norm, then an appropriate diagnosis is made. An increase in eosinophils is called eosinophilia, and a decrease is called eosinopenia.

Reasons for deviations

The result of a blood test may be different, but you should know that for any deviation from the norm there is a reason. Depending on the number and location of granules, the causes of the disease or

Promotion

We found out what eosinophilia is. Now let's look at the reason why eosinophils in a blood test may be elevated. Increasing the level of indicators has its own stages. If the number of eosinophils in a child is above 6%, this is easy stage, if 10-12% is a moderate stage. If the percentage is even higher, this is a severe form of the disease.

Did you know?The heart of an adult pumps almost 10 thousand liters of blood in one day.

When eosinophils are elevated in a child - reasons may be as follows:

Important! An excessive increase in the level of indicators leads to the occurrence of hypereosinophilic syndrome - a complication affecting the heart area and affecting its cells. This syndrome creates the preconditions for thrombus formation in the heart. This disease mainly affects adults.

Demotion

If a blood test indicates eosinopenia, this indicates a weak protective function the body, that it cannot cope with the destructive effects of foreign factors. A decrease in granulocyte levels often indicates such pathologies:

spicy
devastation bone marrow;
various varying degrees severity (for example, typhoid fever);
acute inflammation;
severe purulent infections;
influence of adrenal hormones;
V in rare cases- psycho-emotional stress.

What to do

In order to bring the indicators back to normal, it is first necessary to find out the root cause of the deviation. Then proceed to treatment of the disease itself, having first found out its nature and area of damage.

In any case, the child cannot avoid careful clinical examination. The reasons for violation of the norms of these granules are quite extensive. An increase in level often signals the presence of inflammatory process requiring certain therapy - in this case, it is important to put it in time correct diagnosis and start treatment.

Consultation with a specialist is the first necessary step. Examination and testing will reveal the nature of the disease. Based on the indicators, the doctor will prescribe appropriate therapy - this may be treatment viral disease, vitamin therapy, physiotherapy and other types of treatment.

Retake the analysis

A repeat blood test to determine the number of eosinophils will be required after treatment. Also, a retake may be necessary if there is a suspicion of an erroneous diagnosis, when no positive change is observed during the treatment process. In this case, the doctor rechecks the data to establish the correct diagnosis and replace or supplement treatment.

How to get your numbers back to normal

So, the analysis showed that eosinophils are higher or lower than normal. However, not everyone knows that this does not always mean the appearance of a disease. The indicator is only an indicator that reflects the processes occurring in the body. The only exceptions are cancer.

Did you know? The only part human body which does not have a circulatory system to supply it with oxygen is the cornea of the eye

Treatment is prescribed directly by the doctor, often a pediatric hematologist. Correction is always aimed at cure concomitant illness, after which the indicators, as a rule, return to normal. The specialist selects the course of treatment based on the severity of the disease, age and condition of the child. Additionally, the doctor may prescribe biochemical analysis blood, nasal swab to detect infection, test for worms.

It is almost impossible to bring a child’s eosinophil levels back to normal on their own. Moreover, ignorance or improper therapy can only aggravate the physical condition and lead to the emergence of new diseases. Even if, as you think, the cause of the increase in granules is a certain allergic reaction, self-medication is highly not recommended. Remember: only a doctor should prescribe treatment!

Eosinophils in children: opinion of Dr. Komarovsky

Children's doctor and candidate of medical sciences Evgeniy Komarovsky is known for explaining to young parents about various childhood diseases, treatment methods and preventive actions. In his lectures, he also touches on the topic of increased eosinophils in children.

Regular blood donation for general analysis is necessary preventative measure, which will help you always keep your child’s eosinophil levels under control and prevent the appearance various diseases and pathologies. Be healthy!

Eosinophils are a type of leukocytes, the main function of which is to specifically fight foreign microorganisms, as well as reduce their toxic effect on the body. Normal quantity eosinophils are determined leukocyte formula, where their content usually does not exceed 5%. In adults, the usual concentration of these cells is, as a rule, 2–3% of the number of leukocytes. If elevated eosinophils in a child’s blood, this indicates specific features immunity. Such a deviation from standard indicators in a child’s blood occurs quite often, and parents begin to wonder why this happens and what it means.

The norm of eosinophils in the blood of children is presented in the following table:

in a newborn and an infant up to one year: 5 – 7%,
in a child from one year to 7 years: 2 – 7%,
in children from 8 to 16 years old: 2 – 6%.

There are no gender differences in these indicators.

Main functions of eosinophils:

detect and collect information about foreign substances entering the body,
transmit the received data to the immune system,
neutralize foreign proteins.

Therefore, it is quite acceptable to increase eosinophils in the blood of children, since, while exploring the world, they encounter big amount agents new to them.

It should be remembered that the concentration of these cells depends on the time of day. At night their number increases, during the day it returns to normal.

Eosinopenia

Situations where eosinophils are low are much less common than conditions with high eosinophils. The eosinophil level in children itself is quite low, and a drop in these indicators down to zero may not indicate anything serious. However, any deviation from the norm in children requires additional examinations. If eosinophils are low in a child, this is due to a general decrease in the number of leukocytes in the blood. Most often it happens:

due to taking strong medications (antibiotics, anticancer drugs),
due to severe poisoning,
in comatose states,
at diabetes mellitus and uremia,
severe infectious diseases with bright clinical manifestations(for example, influenza) in the initial period give the concentration of the blood cells in question below normal,
injuries, extensive burns,
in premature babies infants, whose condition is accompanied by sepsis,
sometimes with Down syndrome.

It is noted that when hard work adrenal glands and a number of other reasons that increase the level of corticosteroid hormones, the maturation of eosinophils is blocked and they cannot leave the bone marrow into the bloodstream.

Specific treatment aimed at normalizing reduced level Of course, there are no eosinophils in the blood. When conducting successful therapy underlying disease, the eosinophil values in the child level off to normal indicators.

Also, the reasons why eosinophils are elevated in a child may be vasculitis, a lack of magnesium ions, and a number of bacterial infections, most often staphylococcus.

In our country there is a fairly low detection rate bronchial asthma, since it can hide under the guise of other diseases. In this case, a more in-depth blood test is performed. If the disease is present, then eosinophilic cationic protein is increased to figures 3 or more times higher than normal. Cationic protein of eosinophils is the main active ingredient(mediator) accompanying the development of paradoxical immune reactions (atopic processes), including dermatitis of allergic origin, bronchial asthma, allergic rhinitis And food allergies. The concentration of this substance in the blood serum evaluates the activity of diseases and the processes of their treatment. Venous blood is used for the material.

A condition such as primary eosinophilia (a constantly increased number of eosinophils in the blood) can be either congenital or acquired, and its causes may be unknown.

Degrees of eosinophilia

There are 3 degrees:

mild (eosinophils are increased in a child by no more than 10% of the total number of leukocytes),
moderate (in a child, eosinophils make up 10% - 20% of leukocytes),
severe (the child has increased eosinophils by more than 20% of the total number of leukocytes).

A mild degree is not dangerous. It's more likely borderline state between normality and pathology, which may simply be a reaction to short-term contact with an aggressive substance or be a concomitant diagnostic sign chronic allergies.

A moderate degree creates the prerequisites for a more in-depth examination. In addition to determining the percentage of blood cells, it is necessary to determine the level of a specific peptide (cationic protein) and conduct an immunogram. This condition already requires correction.

Severe degree - pronounced pathological process, which is a direct threat to the life of the child. This condition is always a symptom of a severe disorder of the immune, hematopoietic or endocrine systems.

Symptoms of eosinophilia

In infants and children early age external manifestations are quite pronounced:

there is redness of the skin,
the skin is rough to the touch, increased density,
peeling, hair loss are observed on the scalp,
when assessing muscle tone, hypertonicity is often detected and contractions of the muscles of the limbs, similar to convulsive ones, may appear,
a wheezing cough is possible when breathing,
due to swelling of the nasal mucosa, impaired nasal breathing.
general manifestations are expressed in sleep disturbances and decreased appetite in infants.
on initial stages the baby is capricious; later, on the contrary, it becomes apathetic.

At an older age, when verbal contact is possible, both children and adults describe the symptoms of general malaise more colorfully:

headache,
heart rhythm disturbance,
dyspnea,
gastrointestinal disorders,
skin sensitivity disorders,
the appearance of yellowish spots on the face and limbs,
swelling of the face and limbs,
neurological disorders intensify.

Treatment for eosinophilia

If the levels of eosinophils in a child’s blood increase, treatment is primarily directed to the disease causing this symptom. The range of medications prescribed to the patient will depend on the type of underlying disease, its severity and stage, as well as the patient’s age. First line drugs will be steroid hormones, antihistamines, immunosuppressants and metabolic agents.