home Auditorium 8 The meaning of desensitizing agents in the modern explanatory dictionary, BSE. Herbal remedies for phytoprevention of allergies

The meaning of desensitizing agents in the modern explanatory dictionary, BSE. Herbal remedies for phytoprevention of allergies

Desensitizing therapy. Occupies a prominent place in the treatment of periodontal diseases, since numerous modern research indicate a change in the specific reactivity of the body in this pathology. Dentists usually resort to nonspecific therapy.

Among the methods of specific desensitizing therapy1, vaccination should be mentioned, the use of which for periodontal disease, according to some authors, gives good results (Belousova R.I., Sosunov N.D., 1962; Gorchiev T.B., Puris Yu.Ya., 1964; Krekshina V. E., Morozenko M. A., 1966; Albanese, 1957).

Autovaccines are prepared from bacterial cultures obtained in cultures from pathological periodontal pockets. The vaccine is administered subcutaneously or intradermally according to the type therapeutic doses allergens (in increasing doses, starting from 0.1 to 1 ml with intervals of 3-4 days), 10-15 injections per course of treatment.

Calcium preparations are widely prescribed as desensitizing and anti-inflammatory drugs: 10% calcium chloride, calcium gluconate, calcium glycerophosphate.

Calcium chloride is prescribed as a 10% solution, 3 tablespoons per day or intravenously. Calcium gluconate is prescribed 1 teaspoon 3 times a day before meals or in the form of a 10% solution intramuscularly (can be along the transitional fold), for a course of 10-15 injections. Calcium glycerophosphate is prescribed 0.5 g 3 times a day, preferably simultaneously with phytin. Yu. A. Fedorov and V. V. Volodkina (1968) recommend this drug for periodontal disease accompanied by dentin hyperesthesia. In addition to this, they offer electrophoresis at 2.5% aqueous solution calcium glycerophosphate (7-10 procedures, from the anode at a current strength of 3-4 mA) and the use of “Pearl” toothpaste containing 2.5% calcium glycerophosphate. Efficiency complex method treatment of systemic dentin hyperesthesia is apparently explained by its effect on the processes of remineralization and permeability of hard dental tissues.

Sodium thiosulfate has a pronounced desensitizing, antitoxic and anti-inflammatory effect. The drug is prescribed as a 30% intravenous solution, 10 ml, 6-10 infusions per course. Plasmol, a drug made from human blood, has desensitizing and analgesic properties. It is administered subcutaneously, 1 ml, 8-10 injections per course.

Novocaine has an antihistamine (desensitizing effect); the latter is prescribed in the form of injections of 0.25-0.5% solution into the transitional fold, 10-15 injections per course. The desensitizing effect of novocaine is associated with its inhibition of antibody formation (Klemparskaya N. N., 1963).

Along with a pronounced anti-inflammatory effect, glucocorticoids also have a desensitizing effect due to their ability to inhibit antibody formation. Drugs that provide a desensitizing effect when applied topically include 5-10% formaldehyde solutions (applications for 7 days). The fact is that formalin also has antiseptic and astringent properties due to its ability to dehydrate tissue. Almost similar action provides a 40% solution of hexamine, which in acidic environment breaks down into ammonia and formaldehyde.

According to P.N. Andrianov (1968), the accumulation of histamine in blood serum and tissues with a simultaneous decrease in the activity of the histaminase enzyme is one of the main factors in the development of periodontal pathology against the background peptic ulcer duodenum and stomach, hyperacid gastritis. Therefore, the prescription of antihistamines (diphenhydramine, pipolfen, suprastin) for these and other diseases accompanied by an allergic component and changes in the periodontium is pathogenetic in nature.

The principle of complexity can be illustrated by the example of the treatment of certain types of gingivitis. For gingivitis in patients with cardiovascular diseases, the dentist's task should be to prevent the transition catarrhal gingivitis to necrotic. To do this, you need to sanitize the oral cavity, eliminate all irritating factors in the oral cavity, take measures to eliminate congestion (hydromassage, physiotherapeutic procedures relieve the phenomenon of blood stagnation in the gums). If areas of necrosis appear, then it is necessary to use enzyme preparations (trypsin, chymotrypsin, cocarboxylase, etc.) in the form of lotions, rinses, injections, lysozyme. If the course of the underlying disease is favorable, after cleansing the wound, the tissue defect is eliminated with flaps of adjacent tissue.

Damage to the mucous membrane of the gums by chemicals is treated with the help of neutralizers - weak solutions of acids or alkalis. Solutions of silver nitrate and arsenous acid are neutralized with 5% tincture of iodine or 3% solution table salt. Antiformin, ammonia are neutralized with 0.5% solutions of acetic, citric, hydrochloric acid. The effect of formaldehyde is eliminated with a 3% solution of baking soda. Timely use of neutralizers quickly weakens the effect of chemicals and improves the prognosis of gingivitis.

Ulcerative surfaces are cleaned with swabs soaked in hydrogen peroxide, saline or trypsin. Then they are covered with an emulsion of hydrocortisone with tetracycline or Shostakovsky balm.

For necrotic gingivitis, tampons soaked in trypsin or chymotrypsin are applied to the affected areas. After rejection of necrotic tissue, hydrocortisone emulsions should be applied.

It has proven itself well in the aerosol version for ulcerative gingivitis-galipt. Inhalipt contains norsulfazole, streptocide, thymol, eucalyptus and peppermint oil, alcohol, sugar, glycerin, stabilized with a surfactant. It is advisable to rinse your mouth before irrigating warm water and remove the necrotic plaque on the sero-ulcerative surface. After irrigation, the drug must be kept in the oral cavity for 5-7 minutes.

Applications and rinsing with lysozyme give good results. When lysozyme is administered with antibiotics (lysozyme in a 0.5% solution of ecmoline), an increase in the therapeutic effect of the latter is observed (Golosova T.V., 1969).

An important measure aimed at eliminating occupational gum damage is general prevention occupational diseases. It is necessary at enterprises and workshops to create special devices for periodic irrigation of the oral cavity, to recommend that workers in relevant industries use special chewing gum to remove professionally harmful substances from plaque on gums and teeth.

Regular examination of workers by a dentist (every 6 months) allows timely measures to be taken to prevent the development of gingivitis. Systematic use of a complex of vitamins with microelements (undevit) is necessary; the diet should contain lactic acid products, raw eggs, fresh vegetables.

In case of blood diseases, the dentist’s task is to make a timely diagnosis of the disease and, together with a hematologist, treat gingivitis. Treatment should begin with the elimination of irritating and traumatic factors, since the latter aggravate the course of the underlying disease. Excessive salivation and formed elements from the gums are eliminated by using a solution of atropine (1:1000) in the form of lotions and 8 drops orally 1 time per day. To relieve pain, use 5% anesthesia with sea buckthorn oil, 0.5% oxolinic ointment, 1% methylur* cil ointment. Bleeding should be stopped using diathermocoagulation or a hemostatic sponge with antibiotics, which is inserted into the periodontal pockets.

Tooth extractions are performed undercover specific drugs and antibiotics. All dental procedures in patients with blood diseases must be performed in a hospital setting.

Radiation damage in the oral cavity in the form of gingivitis can occur both when the gums are directly exposed to penetrating radiation, and when radiation sickness. Soon after irradiation, hyperemia appears on the gums, edema occurs, the epithelium undergoes necrosis, and sometimes extensive erosions form. The damaged surface bleeds and is sharply painful. Patients refuse to eat and cannot speak.

Gingivitis with radiation sickness appears in the third period of the disease. The gingival papillae become swollen, move away from the alveolar process, a pathological periodontal pocket is formed, tooth mobility appears, and ulcerative gingivitis develops. The diagnosis is made on the basis of anamnesis, and in case of radiation sickness - according to typical clinical signs(character shaped elements blood, general state organism).

Desensitization is a reduction or complete elimination of the body's increased sensitivity to the action of any substance (reduction or elimination allergic condition organism).

From this article you will learn how to prepare desensitizing agents at home to treat children and how to prepare anti-inflammatory medicines.

Desensitizing drugs

Among the drugs with a desensitizing effect are diphenhydramine, suprastin, tavegil, fenkarol, ketotifen, claritin, nalcrom, zaditen, etc.

Desensitizing agents indication

Desensitizing agents for children are effective for a variety of allergic diseases- for urticaria, allergic dermatoses, allergic conjunctivitis, allergic bronchitis, vasomotor rhinitis, hay fever, exudative-catarrhal diathesis, bronchial asthma, Quincke's edema, etc.

For the diseases mentioned above and painful conditions effective use of infusions prepared from the collections medicinal plants.

Desensitizing agents for children

Recipe for desensitizing agent for children No. 1

As a desensitizing agent, it is recommended that the child take a warm infusion of the following mixture orally:

tripartite succession herbs - 1 part,
horsetail herb - 1 part,
cinnamon rose hips - 1 part,
Sandy immortelle flowers - 1 part,
gray alder fruit - 1 part,
rhizomes with roots of elecampane - 1 part,
rhizomes with licorice roots - 1 part,
large burdock roots - 1 part,
dandelion roots - 1 part, Manchurian aralia roots - 1 part.

Preparation of the infusion: take one tablespoon of this dried, thoroughly crushed mixture, place in a thermos, preheated hot water, pour 200 ml of boiling water and leave for several hours, strain through two layers of gauze, squeeze out the remaining raw materials through the same gauze;

Children 7-10 years old take one tablespoon of infusion three to four times a day after meals;

Children aged 11-14 years - drink a desensitizing agent, one quarter glass of infusion three times a day after meals;

An older child can take this desensitizing agent, one-third of a glass of warm infusion three times a day after meals;

Desensitizing agent recipe for children No. 2

When treating a child suffering from any allergic diseases, the use of an infusion prepared from the following collection of medicinal plants can be very effective:

cinnamon rose hips - 10 parts,
common raspberry leaves - 5 parts,
rowan fruits - 5 parts,
stinging nettle herb - 5 parts,
tripartite succession herbs - 2 parts.

Preparation of a desensitizing agent

Preparation of the infusion: you need to take one teaspoon of this dried, thoroughly crushed mixture, pour a glass of boiling water and leave in a sealed container for about 45 minutes, strain through one or two layers of gauze, squeeze out the remaining raw materials.

Children aged 2-3 years take this desensitizing agent orally, one tablespoon four times a day;

Child 4-7 years old - take two tablespoons of warm infusion four to six times a day;

Children over 7 years old can drink one quarter glass of infusion four to six times a day;

The desensitizing agent has not only antiallergic, but also disinfectant, anti-inflammatory, sedative, and expectorant effects.

Anti-inflammatory drugs

Anti-inflammatory is one that has the ability to suppress the manifestations acute inflammation and ease the flow inflammatory process.

The anti-inflammatory effect of medicinal plants is due to the characteristics of their chemical composition- content essential oils, tannins, mucus, salicylic acid, ascorbic acid, carotenoids, etc.

Let us give as examples two collections from which a decoction and infusion with a very pronounced anti-inflammatory effect are prepared.

Anti-inflammatory recipe for children No. 1

A decoction of such a multicomponent mixture can be used externally medicinal substances:

chamomile flowers - 5 parts,
rhizomes with roots of creeping wheatgrass - 5 parts,
knotweed grass (the plant is also known as knotweed) - 5 parts,
creeping thyme herb - 3 parts,
black currant leaves - 3 parts.

You should take about 100 grams of this dried mixture, grind it as thoroughly as possible, add two to three liters of water to the powder and cook over low heat for about half an hour, then leave the product in a sealed container for at least a quarter of an hour, strain through one or two layers of gauze, squeeze out the remaining raw materials; ready-made decoction pour into bath water; The child should take the procedure at a water temperature of 36-37.5 ° C; The duration of the procedure is a quarter of an hour; 10 baths are enough for the full course of treatment; the decoction demonstrates not only anti-inflammatory, but also bactericidal and antipruritic effects; This decoction can also be used for children as lotions and for washing inflamed body surfaces; indications: exudative diathesis, urticaria, prickly heat, diaper rash, boils, etc.;

Anti-inflammatory recipe for children No. 2

For oral administration, use an infusion prepared from the following mixture of medicinal plant materials:

chamomile flowers - 6 parts,
peppermint leaves - 2 parts,
rhizomes with roots of valerian officinalis - 1 part,
fennel seeds - 1 part.

Preparation of an anti-inflammatory agent

Preparation of the medicine: pour one tablespoon of the dried mixture, crushed into powder, into a preheated container, pour a glass of boiling water and leave in a closed container for a quarter of an hour or a little more, strain through one or two layers of gauze, squeeze out the remaining raw materials through the same gauze; children under 14 years of age take one quarter glass of this infusion two to three times a day; a child over the age of 14 can drink one third of a glass of this infusion two to three times a day; the infusion can be used not only as an anti-inflammatory agent, but also as an antiseptic, antispasmodic and carminative;

Indications: the infusion can be taken orally by a child for various inflammatory diseases respiratory and digestive systems, for skin inflammation, acute and chronic tonsillitis, etc.

Before prescribing small child For any preparation prepared from the above-mentioned plants, the mother should consult with her doctor.

Mosquito repellent for children up to one year old

Are all mosquito repellents suitable for children under one year of age? Let's figure it out.

Fumigators - mosquito repellents for children

An electrofumigator is a small device into which a plate impregnated with a chemical is inserted. When plugged into the network, it heats up and the substance evaporates. There are liquid-based devices: instead of a plate, a rod lowered into a capsule with a substance is heated. The advantage of electrofumigators is that their fumes are slightly toxic. However, after treating a room with a fumigator, you should definitely ventilate it. After all, it is unknown how a child might react to these mildly toxic fumes.

Fumigation spirals are usually used outdoors. The spiral is set on fire and smolders, repelling insects with smoke.

Repellents - mosquito repellents for children

Repellents are substances that repel mosquitoes. Lotions, gels, creams, sprays, pencils are applied to the skin.

For children under one year old there are special means, in which the content chemical substance downgraded. But it is preferable even to apply them not to the child’s skin, but to his clothes.

Tricky move : repellents can be applied to the stroller! This is the safest option for the child. You can also generously sprinkle repellent on the adult who is accompanying the baby.

Ultrasonic mosquito repellent

Emits sound waves that are imperceptible to humans but unpleasant to mosquitoes. It is considered the safest and most environmentally friendly means of protection against mosquitoes.

Calcium preparations, unitol, histoglobulin, cocarboxylase, ATP, etc. have a desensitizing effect. Calcium preparations, in addition to their own desensitizing effect on the body, enhance the effect of antihistamines.

They are used in the form of a 10% solution of calcium chloride or a 10% solution of calcium gluconate intravenously, 5 or 10 ml, up to 8 - 10 injections per course daily or every other day; subcutaneously 0.25% calcium chloride, increasing the dose from 0.1 to 1.5 ml, and then reducing to 0.2 ml [Mrskovchenko N. A., Tatarinovich O. I., 1972]; orally 10% calcium chloride 3 times a day or calcium gluconate 0.25 - 0.5 ml 3 times a day. Unitol is administered intramuscularly at 2 - 5 ml of a 5% solution 2 times a week, for a course of 8 - 10 injections [Chetverikov T.N., 1976].

Rp.: Sol. Unitholi 5% 5.0 D.t. d. N. 6 in amp.
S. Administer 5 ml intramuscularly

Histoglobulin is prescribed to children in the form subcutaneous injections depending on age, 0.5 - 2 ml with an interval of 2 - 3 days. The course consists of 5 injections, it is recommended to carry out 2 - 3 courses with a break of 1 month.

The drug has a number of contraindications for use: fever, treatment with corticosteroids, collagenosis, kidney and liver diseases, indications in the anamnesis of allergic reactions with the introduction of gammaglobulin [Krugly I.M. et al., 1982].

The use of corticosteroids in general practice therapeutic measures for allergic chronic sinusopathies in children did not benefit widespread. Although corticosteroid drugs sharply reduce the activity of the allergic process, general hormonal therapy is not indifferent to the child’s body.

Corticosteroids are indicated only in cases where rapid therapeutic effect for allergic sinusopathies that have not yet developed into chronic form. At the same time, prescribing steroids to children requires great caution.

Local therapy for allergic sinusitis has a diverse focus and often depends on the prevalence in clinical picture diseases of certain signs of inflammation. Along with numerous methods of nonspecific desensitization of local tissues (nasal mucosa and paranasal sinuses), finds its application in infectious-allergic forms of sinusopathy and drug therapy, aimed at improving the outflow of contents from the sinus, fighting secondary infection, and sanitizing the sinus.

Currently, local administration of certain desensitizing agents is widely used both in clinics and in hospitals, and the method of their administration can be different and depends on the form and stage of the disease, the age of the child, treatment conditions and the technical capabilities of the medical institution.

"Inflammation of the paranasal sinuses in children"
M.Ya. Kozlov

DESENSITIZING DRUGS (anti-allergic drugs), medications, reducing increased sensitivity body to allergens. Desensitizing agents include antihistamines, mast cell membrane stabilizers, antileukotriene drugs, calcium salts and some other drugs.

Mast cell membrane stabilizers (ketotifen, oxatomide, cromoglycic acid, nedocromil) have an antiallergic and anti-inflammatory effect by reducing the sensitivity of target cells to degranulating agents, inhibiting the degranulation of mast cells by temporary nonspecific stabilization of their cytoplasmic membranes, which leads to a decrease in the number of allergy mediators ( mainly histamine) and preventing their action in the form of early and late allergic response of the body. The action of these drugs occurs slowly, and therefore they are not suitable for relieving acute allergic reactions. They are used for long-term (3-6 months) pathogenetic therapy chronic allergic diseases - bronchial asthma, allergic rhinitis, atopic dermatitis, chronic urticaria etc. Cromoglycic acid is prescribed orally for food allergies.

Anti-leukotriene drugs include leukotriene synthesis inhibitors (zileuton) and type I leukotriene receptor blockers (verlukast, zafirlukast, montelukast, cinalukast, etc.). These drugs weaken both early (immediate allergic reactions) and late (4-8 hours after exposure to the allergen) asthmatic responses of the body caused by leukotrienes and have an anti-inflammatory effect. They prevent attacks of bronchial asthma caused by antigens, aspirin, physical activity and cold air. Leukotriene receptor blockers are the basis pathogenetic treatment bronchial asthma, including in children. They are also effective in the treatment of allergic rhinitis and atopic dermatitis.

Calcium chloride and gluconate have a rapid antiallergic effect due to sharp increase histaminopexy, i.e. the ability of plasma to bind histamine. In addition, they stimulate the sympathetic nervous system, increase the secretion of adrenaline, reduce vascular permeability. Calcium salts are most effective for acute food or drug allergies, reactions such as urticaria or angioedema. With subcutaneous, intramuscular or intravenous administration Calcium salts may cause tissue necrosis, heart rhythm disturbances, nausea, vomiting, diarrhea and other side effects.

Histamine, by stimulating the H2-histamine receptors of T-lymphocytes and mast cells, causes the closure of calcium channels and a decrease in the release of histamine and other allergy mediators. Gamma globulins bind histamine in the vascular bed. Pyridoxine (vitamin B 6) when administered orally in the form of a solution in large doses(up to 1 g/day) in the early morning hours activates enzymes that hydrolyze histamine and normalizes the metabolism of tryptophan (a precursor to serotonin). Antioxidants (vitamin E, etc.), suppressing lipid peroxidation, help reduce the formation of leukotrienes and prostaglandins from arachidonic acid. Sodium thiosulfate has a desensitizing and anti-inflammatory effect in allergic skin diseases. Adsorbents ( Activated carbon, lignin), binding allergens in gastrointestinal tract, used for urticaria, angioedema, exacerbation of atopic dermatitis, food and drug allergies.

Lit.: Gushchin I. S. Allergic inflammation and its pharmacological control. M., 1998; Pytsky V. I., Adrianova N. V., Artomasova A. V. Allergic diseases. 3rd ed. M., 1999.

Desensitizing agents play an important role in the treatment of patients with eye tuberculosis. In the literature there are unanimous statements about the advisability of using desensitizing drugs for all forms of ocular tuberculosis [Azarova N. S., J965; Samoilov A. Ya-et al., 1963; Tetina G.F. et al., 1979]. Especially great importance given to calcium supplements. N. S. Azarova (1953), using a large amount of clinical and experimental material, covered in detail the issues of treating patients with eye tuberculosis with calcium, and also described methods of its administration.

Most effective way administration of calcium chloride is intravenous (10% solution; 10-20 infusions per course). The drug is also used orally (calcium gluconate 1 g 2-3 times a day) or intramuscularly (10% calcium gluconate solution), as well as by electrophoresis (3% calcium chloride solution). Calcium chloride has a beneficial effect in all forms of eye tuberculosis - it reduces swelling and infiltration, changes the body's tuberculin sensitivity. According to our data, treatment with calcium chloride is especially indicated in processes with an allergic component, hemorrhagic forms chlorioditis and peri-phlebitis, as well as hyperergic skin sensitivity to tuberculin.

In addition to calcium salts, they are used as desensitizing agents. antihistamines- dimedrol, pipolfen, diazolin, suprastin, tavegil, fen-carol, etc. in generally accepted doses (Table 5).

The principle of action of antihistamines is to block histamine receptors on cells.

TUBERCULINOTHERAPY

In the pre-antibacterial period, tuberculin was the most effective means treatment of tuberculous eye lesions. However, tuberculin therapy

The duration of treatment is determined individually.

required a long hospital stay (4-6 months) and had a number of contraindications (active extraocular tuberculosis, negative tuberculin tests). Tuberculin was used to a limited extent for the treatment of patients with progressive hemorrhagic forms of the disease with central localization of lesions. In the period after the discovery of effective antibacterial drugs, tuberculin therapy for ocular tuberculosis began to be used less frequently.

Currently, specific desensitization by tuberculin plays a significant role in complex treatment patients with tuberculosis of the organ of vision. The intensity of focal reactions decreased significantly against the background of desensitizing and antibacterial treatment. Indications for tuberculin therapy have been expanded and contraindications have been reduced.

Tuberculin is a drug that, influencing the immunobiological state of the body, has an effect on the tuberculosis focus in the eye, causing its activation. At the same time, antibacterial drugs are more effective.

At antibacterial therapy the use of tuberculin is possible within wider limits, since

Measured reactions in the eye during antibiotic treatment are much less common and less pronounced.

Proponents of tuberculin therapy for tuberculous eye lesions adhere to two directions:

1) carrying out tuberculin therapy with a clear reaction;

2) treatment with tuberculin in doses not exceeding
dim reaction.

Treatment with tuberculin in very high dilutions (1: 10 25 -1: 10 15) does not allow identifying minimal focal reactions in various departments eyes. Repeated administration of tuberculin in such doses can cause an excessive focal reaction (resolving dose after repeated sensitization). A safer and more expedient method should be considered the use of tuberculin in doses that cause the appearance of minimal but perceptible focal reactions.

In order to achieve minimal focal reactions, one should adhere to the dose of tuberculin that gives a therapeutic effect and does not lead to an unnecessary aggravation of the process.

According to E. Z. Mirzoyan (1970), outside the hyperergic phase of tuberculous inflammation, tuberculin can be used at any stage of antibacterial therapy, regardless of the form and extent of the process in pulmonary tuberculosis and other forms. In case of eye tuberculosis, more wide use tuberculin during chemotherapy, treatment with desensitizing and nonspecific agents, especially with sluggish, recurrent forms and processes with a predominance of productive reactions.

Tuberculin therapy is indicated for a positive skin tuberculin reaction and preserved activity in the eye lesion. It is advisable to start the course of treatment with a dose that caused a minimal focal reaction in the patient, and gradually increase the dose until a clinical effect is achieved. The dose that caused the first focal reaction is used until the lesion responds to it, and then the concentration of tuberculin is increased by 1.5-2 times.

The intervals between tuberculin administrations are 3-4 days.

Specific desensitization is aimed at reducing the sensitivity of tissues to tuberculin.

The immunological mechanism of the method of repeated injections of tuberculin in small doses different ways

(intradermally, subcutaneously, using electrophoresis) consists in the formation of protective, “blocking” antibodies.

The goal of tuberculin treatment is not only to relieve inflammation, but also to minimize the severity of productive reactions. Tuberculin therapy is indicated for patients who, despite long-term antibacterial treatment, it is not possible to eliminate multiple relapses of the disease, which increasingly reduce the functions of the organ of vision.

In cases where the initial positive impact antibacterial drugs are stopped, activation of inflammatory foci after the introduction of tuberculin contributes to its restoration.

If specific chemotherapy does not improve reduced visual functions, reactive tuberculin therapy causes partial resorption of rough scars and pigment accumulations in the choroid and retina. In this case, the neuroepithelial cells that have retained their function are obviously activated, which helps to improve sharply reduced visual acuity.

In case of active tuberculous changes in other organs, the issue of tuberculin therapy should be agreed upon with a phthisiatrician.

Before starting tuberculin therapy, patients with high sensitivity to tuberculin (Mantoux reaction + + +, papule diameter 30 mm or more) are prescribed calcium chloride and antihistamines. After such preparation, the intradermal Mantoux reaction (2TE) is repeated. Depending on the activity of intraocular lesions, after the skin reaction subsides, 0.1 ml of tuberculin is injected subcutaneously at a dilution of 1: 10 s - 1: 10 v. For hemorrhagic chorioretinitis, you should start with 0.1 ml of tuberculin in a dilution of 1:10 8 , for exudative ones - with 0.2 ml in a dilution of 1:10 7 . In patients with (less activity of the process and the Mantoux ++ reaction, you can start with 0.2 ml of tuberculin in a dilution of 1:10 e. If the first injection caused a pronounced reaction, then after 3-4 days the administration at this dose should be repeated until a weak reaction is obtained and carry out treatment against the background of desensitizing therapy.

Subsequently, the dose of tuberculin in the same dilution is increased by 1.5-2 times (0.2; 0.4; 0.6; 0.8 ml). In case of an intense reaction, the dose is reduced (0.2; 0.3; 0.4; 0.5;

0.6; 0.7 ml). For mild reactions, use tuberculin in the following dilutions: 0.2; 0.3; 0.5-0.7; 0.9; 1 ml.

Tuberculin therapy requires daily careful monitoring of the patient. If the reactions of the intraocular lesion to the introduction of tuberculin in a dilution of I: 10 3 - 1: 10 2 stopped, then we can assume that the specific process has lost activity. In cases where the remaining scar changes in the lesions do not interfere with the restoration of eye function, the course of tuberculin therapy can be completed by repeating the last dose several times. If the skin reaction to tuberculin (2 TU) turns out to be doubtful (±) or negative, then the patient can be transferred to dispensary observation. If the Mantoux reaction is positive, it is necessary to prescribe an additional desensitizing course of intravenous infusions of calcium chloride solution or 10% calcium gluconate solution intramuscularly. Tuberculin therapy should be carried out in a hospital,

In the 30-60s, when performing tuberculin tests, various dilutions of alt-tuberculin were used. Currently, in addition to the standard dilution of tuberculin 2 TE in 0.1 ml, various dilutions of dry purified tuberculin Linnikova (PPD-L) are used: 1: 10 7, 1: 10\ 1: 10-\ 1: 10 2. These tuberculin dilutions of 0.1 ml, as well as standard tuberculin dilutions of 2 TE in 0.1 ml, are used to perform the Mantoux test.

According to E.I. Ustinova et al. (1987), tuberculin dilution PPD-L 1: 10 3 - 1: 10 2 is used for subcutaneous samples. Subcutaneous and intracutaneous tuberculin is titrated to 20-50 TU. For exudative and exudative-hemorrhagic forms of diseases, tuberculin is administered in a dose of 0.1 ml in a dilution of 1: 10 5 (2 TU), subcutaneously - 5-10 or 20 TU (for diagnostic purposes).

A different range (20-50 TU) of tuberculin is used in dilutions from 1: 10 5 -1: 10 7. The following standard dilution doses correspond to dilutions of dry tuberculin:

The samples are assessed after 24, 48 and 72 hours. With an intradermal test, the size of the papule is determined in millimeters. Focal reactions during tuberculin therapy, as with tuberculin diagnostics, are revealed various methods(biomicroscopy, gonioscopy, ophthalmoscopy, ophthalmochromoscopy, bioophthalmoscopy, FA, functional tests- visometry, campimetry, perimetry, etc.).

Not all forms of hematogenous ocular tuberculosis can be effectively treated with antibiotics. This applies primarily to hemorrhagic forms of the disease and central chorioretinitis, in which visual functions, even in cases of cessation of inflammation, increase slightly.

We, together with M. S. Smirnova (1972), developed and implemented a method of local administration of tuberculin by electrophoresis in the complex treatment of patients with various forms tuberculous eye disease. The goals of treatment were maximum resorption of the lesion, changing the local specific reactivity of the eye tissue, and obtaining higher functional indicators.

Tuberculin was introduced into the eye by electrophoresis through the eyelids in various concentrations. Tuberculin was titrated in dilutions from 1: 10 8 to 1: 10 2 depending on the stage of the process, its activity, the nature of the lesion, and previous treatment. The results of cutaneous and intradermal tuberculin tests and the nature of the focal reaction in response to the introduction of tuberculin into the eye by electrophoresis were also taken into account. Treatment began with the dose to which a focal reaction was obtained. It was repeated until a response was observed, and then the concentration was increased. The exposure was 8-10 minutes, the current was 1-1.5 mA.

The clinical effect was manifested in the anterior part of the eye by a decrease in scleral injection and corneal infiltration, resorption of exudate, precipitates, in the rear - a decrease in edema, resorption of hemorrhage, a decrease in scotoma, and an increase in vision.

Since when administering tuberculin by electrophoresis, we observed the least pronounced focal reactions compared to reactions with other methods of administration (intradermal, subcutaneous), we also used this technique for central chorioretinitis and hemorrhagic forms of lesions, in which without

Using tuberculin, gross scar changes are formed.

For hemorrhagic forms of the disease, it is advisable to begin treatment with the introduction of tuberculin subcutaneously into the forearm, and then inject it according to Burguignon.

As a result of treatment, all patients noted the disappearance of inflammatory phenomena in the eye and an increase in visual functions. In 80% of patients with a relapsing course of the disease, relapses stopped. Studies have shown that this method reduces the specific reactivity of eye tissue, activates granuloma resorption processes, and increases visual functions.

Best results obtained from patients with an exudative active process with a pronounced allergic component.

Indications for local specific desensitivity
tuberculin infections are: ineffectiveness of chemotherapy
therapy; intolerance to antibacterial drugs
Comrade; insufficient increase in functions during treatment
antibacterial drugs; recurrent ones
treatment of the disease. ■ ,

Analysis of the results of local tuberculin therapy revealed its high effectiveness: in 75% of patients, visual acuity increased by 0.1-0.5, in 80% relapses stopped.

During tuberculin diagnostics, we found that 35% of patients with ocular tuberculosis react to the introduction of tuberculin not by an increase, but by a decrease in the inflammatory reaction (reaction of the opposite type). In such cases, tuberculin therapy is especially indicated, which causes effective desensitization without pronounced reactions to tuberculin.

Contraindications to tuberculin therapy using electrophoresis include neoplasms, hypertension, cardiovascular diseases in the stage of decompensation. Relative contraindications: recurrent hemorrhages of the choroid and retina until they stabilize.

NON-SPECIFIC ANTI-INFLAMMATORY THERAPY

Treatment of uveitis should be based on modern ideas about the mechanisms of the immune response. There is evidence of the participation of lipid peroxidation, the kinin system, prostaglandins, serotonin, histamine and other inflammatory mediators in allergic processes.

When treating uveitis, it is pathogenetically justified to use drugs with different mechanisms of action aimed at blocking the allergic reaction.

Pathogenetically oriented therapy for uveitis with an autoimmune component should include general and local application corticosteroids, antioxidants, antibradykinin, antikallikrein, antihistamines, antiprostaglandins. Drugs that inhibit inflammatory mediators are indicated: non-steroidal anti-inflammatory drugs, salicylic acid derivatives, prostaglandin biosynthesis inhibitors ( acetylsalicylic acid, amidopyrine, butadione, indomethacin), antihistamines, antioxidants (acetylsalicylic acid, ascorutin, vitamin E, dicinone); angioprotectors that have an antibradykinin effect - dicynon, prodectin, trental (Table 6).

Table 6. Nonspecific anti-inflammatory drugs and angioprotectors

According to T.V. Belikova (1987), for uveitis, including tuberculosis, in children good effect produces thordox, which inhibits kallikrein, trypsin and other enzymes. Hordox was administered by installation, subconjunctivally at 500 KE (per course of 10-15 injections), electro- and phonoforce. High efficiency was noted in the combined use of subconjunctival injections or phonophoresis of gordox with retrobulbar-mn injections of dexazone, especially with exudation in vitreous body and on the fundus, peripapillary and laramacular processes. Dehydration therapy is indicated for exudative processes, severe edema, and disturbances in the regulation of intraocular pressure.

TREATMENT WITH CORTICOSTEROIDS

Corticosteroids found wide application for uveitis of various etiologies, including for tuberculosis, as immunosuppressive, anti-inflammatory, desensitizing agents. They suppress the immune response and inflammatory reaction, interfere with the biosynthesis and release of histamine and its penetration through biological membranes, and reduce capillary permeability.

In case of ocular tuberculosis, corticosteroids are indicated for severe exudative and allergic processes, damage to the anterior part of the eyes (iridocyclitis, keratouveitis, keratoscleritis, keratosclerouveitis), periphlebitis, acute inflammatory phenomena with exudation, as well as in cases where it is advisable to reduce the severity of productive reactions.

The mechanism of action of steroids in allergic diseases is associated with the suppression of the formation of antibodies, a decrease in vascular permeability, and an effect on toxic substances released as a result of the antigen-antibody reaction.

Among the steroid drugs used are dexamethasone, dexazone, prednisolone, hydrocortisone, cortisone, triamenolone, kenologist, etc., locally (in the form of instillations, ointments, medicinal films, under the conjunctiva), parabulbar, retrobulbar, suprachoroidal, by electro- and phonophoresis, as well as orally and intramuscularly (Table 7). When active untreated processes are first identified, it is advisable to prescribe steroids

Costeroids are hypertonic disease, cardiac decompensation, anemia, diabetes. With local steroid therapy, complications may develop: subcapsular cataract, increased ophthalmotonus, mydriasis, changes in refraction [Nesterov A. P., 1960; Grishko N.I., 1960; Woods A., 1958].

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