alergia bavSvebSi

1. anafilaqsia
anafilaqsia aris mwvave I tipis zemgrZnobelobiT ganpirobebuli alergiuli
reaqciis sistemuri gamovlineba. anafilaqsiuri reaqciis sinonimebia:
generalizirebuli sistemuri reaqcia, sistemuri anafilaqsia, konstituciuri reaqcia,
hipermgrZnobelobis gamoxatuli re-aqcia da sxv. alergiis msoflio organizaciis
(WAO) mixedviT, anafilaqsiis zusti gansazRvrebis Sesaxeb dRemde SeTanxmeba ar aris
miRweuli, rac arTulebs misi diagnostikis, mkurnalobis da menejmentis procesebs.
anafilaqsias SesaZlebelia hqondes, rogorc aler-giuli, ise araalergiuli buneba.
pirvel SemTxvevaSi anafilaqsiuri reaqcia pirobiTad 3 etapad mimdinareobs: 1.
antigenis (alergenis) dakavSireba poxieri ujredebis an bazofilebis membranaze
arsebul IgE-is sul mcire or molekulasTan da aRniSnuli ujredebis gaaqti-ureba; 2.
gaaqtivebuli poxieri ujredebisagan da bazofilebisagan anafilaqsiis pirveladi
mediatorebis – histamini, serotonini, acetilqolini, aseve de novo warmoqmnili
mediatorebis – leikocitebi, citokinebi da sxva masiuri gamonTavisufleba; 3.
mediatorebis moqme-deba sisxlZarRvTa kedelze da sisxlis Sededebis sistemaze;
eozinofilebis, neitrofilebis da Trombocitebis Semdgomi gaaqtiureba. im
SemTxvevaSi, Tu alergeni pirdapir sisxlSi xvdeba an Zalian male Seiwoveba
nawlavebidan, SesaZlebelia sisxlZarRvebTan asocirebuli SemaerTebelqsovilovani
poxieri ujredebis swrafi gaaqtiureba, rasac sicocxlisaTvis saSiSi sindromis –
sistemuri anafilaqsiis ganviTareba mohyveba. diseminirebul poxieri ujredebis
gaaqtiurebas Tan sdevs potenciurad fataluri efeqti (kardiovaskularuli ko-
lafsi, sasunTqi gzebis konstriqciis Sedegad sunTqvis gaZneleba; xorxis SeSupeba da
mogudva), romelic anafilaqsiuri Sokis saxelwodebiT aris cnobili. anafilaqsiuri
Soki mwvave, sicocxlisaTvis saSiSi, swrafi tipis generalizebuli alergiuli
reaqciaa, romelic ZiriTadaT viTardeba wamlis Seyvanis Semdeg im pirebSi,
romlebsac konkretuli medikamentebisadmi specifiuri IgE klasis antisxeulebi
gaaCniaT; mweris Sxamisadmi alergiis mqone pirebSi, mweris kbenis Semdeg da a.S.
araalergiuli bunebis anafilaqsia IgE-antisxeulebisagan damokidebuli reaqciaa.
misi sinonimebia: `anafilaqtoiduri reaqcia~ (anafilaqtoiduri, amJamad moZvelebuli
terminia), `fsevdoalergiuli~ da `araspecifiuri alergiuli reaqcia~. araalergiuli
anafilaqsiis SemTxvevaSi bioaqtiuri nivTierebebi poxieri ujredebidan da
bazofilebidan Tavisufldeba uSualod (imunuri fazis gareSe) gamomwvevi faqtorebis
zegavleniT, rogorebicaa: arasteroiduli anTebiTi preparatebi, sisxlSi produqtebi,
radiokontrastuli nivTierebebi, morfini, komplementis aqtivatorebi, fizikuri
datvirTva, yinva, mzis sxivebi.
etiologia. anafilaqsiis ganviTarebis yvelaze xSir mizezad samkurnalwamlo,
vaqcinebi da kvebiTi warmoSobis alergenebi gvevlineba. anafilaqsiuri reaqcia
SeiZleba ganviTardes mweris nakbenze, diagnostikuri sinjebis dayenebis dros,
specifiuri hiposensibilizaciis pirobebSi. qvemoT mogvyavs saqarTveloSi g.
gurgeniZis da misi mowafeebis mier, im nivTierebaTa CamonaTvali, romlebic iwveven
anafilaqsiur reaqciebs (cxrili #79).

cxrili #79. nivTierebebi, romlebic iwveven anafilaqsiur reaqciebs

kvebiTi sadiagnostiko saSualebebi antimikrobuli

produqtebi saSualebebi
kvercxis cila+ rentgenokontrastuli saSualebebi+ penicilinebi+
rZe+ sulfabromoftaleini cefalosporinebi
moluskebi+ benzilpeniciloidi-polizini bacitracini
 soio cxenis Sratisagan momzadebuli neomicini
nigozi+ preparatebi polimiqsini B
kartofili tetanusis sawinaaღmdego Srati tetraciklini
wiwibura difteriis sawinaaღmdego Srati qloramfenikoli
zuTxi cilis sawinaaღmdego Srati kanamicini
mango streptomicini
Sxamis sawinaaღmdego Srati
Warxali amfotericini B
antilimfocituri imunoglobulini
Sokoladi sulfaminamidebi
adgilobrivi saanesTezio
gvirilis nayeni pentamidini
saSualebebi
forToxali vankomicini
mandarini tetrakaini
mdogvi lidokaini
araqisi+ prokaini
kvebiTi danamatebi
tartrazini
polisaqaridebi hormonuლi saSualebebi fermentuli
preparatebi
deqstrani insulini trifsini
gumiarabiki cxoveluri warmoSobis hipofizis qimotrifsini
hormoni penicilinaza
kortikotropini asparaginaza
vazopresini qimopaini
eqstradioli
cxoveluri warmoSobis
paraTireoiduli hormonebi
alergenTa sisxlis preparatebi sxvadasxva preparatebi
eqstraqtebi+
ambrozia imunomodulatorebi natriumis Tiopentili
sxva balaxeuli monoklonuri antisxeulebi opioidebi
mcenareebi interleikini-2 vitaminebi
obis sokoebi interleikini , β, Y heparini
cxovelTa
epidermisi
aspirini da anTebis sawinaaRmdego sxva saSualebebi+
Llateqsi
cxovelebis Sxami da nerwyvi
SeniSvna: + anafilaqsiuri reaqciebis yvelaze xSiri mizezebi

rogorc cxrilidan Cans, antimikrobuli saSualebebidan gansakuTrebiT

sayuradReboa penicilinis jgufis preparatebi da lateqsis Semcveli saSualebebi;
sakvebismieri alergia – kvercxis cila, rZe, nigozi da gansakuTrebiT araqisi,
romelic zogierT SemTxvevaSi iwvevs fatalur Sedegs. im SemTxvevaSi, rodesac
pacients aReniSneba deqstrozas mimarT alergia, SesaZlebelia anafilaqsia
ganuviTardeT iseT sakvebze, rogorebicaa banani, kivi, wabli, avokado.
paTofiziologia. anafilaqsiis, rogorc alergiuli, ise araa-lergiuli
etiologiis SemTxvevaSi fataluri Sedegis ganviTarebis meqanizmi gamoixateba
filtvis mwvave SeSupebiT, intraalveoluri hemoragiiT, traqeis SeSupebiT, mTels
organizmSi sisxlZarRvTa gamavlobis gazrdis Sedegad ganviTarebuli sisxlis wnevis
katastrofuli dacemiT, kardialuri ariTmiiT da sinkopeTi.
klinika. anafilaqsiuri reaqcia xasiaTdeba klinikuri gamovli-nebis
mravalferovnebiT. sistemur gamovlinebebs Soris aris sasunTqi da gul-
sisxlZarRvTa sistemebis, kuW-nawlavis traqtis da kanis dazianebebi. urtikaria da
angiodema klinikuri manifestaciis xSiri gamovlinebaa. respiraciuli komponenti da
kardiovaskuluri kolafsi gansakuTrebiT mniSvnelovania, vinaidan isini fataluri
Sedegis ZiriTad mizezs warmoadgenen.
anafilaqsiis simZimis xarisxi da konkretuli gamovlinebani didad aris
damokidebuli organizmSi alergenis SeWris gzebze (parenteraluri, peroraluri),
aseve reaqciis ganviTarebis siswrafeze. rac ufro swrafad viTardeba anafilaqsiuri
reaqcia, miT ufro mZimed mimdinareobs da miT maRalia riski fataluri gamosavlis.
rig SemTxvevebSi, anafilaqsiuri reaqcia SeiZleba ganviTardes alergenTan kontaqtis
Semdeg 30 wuTis ganmavlobaSi, xolo orfaziani reaqciis mogvianebiTi faza
gagrZeldes 32 saaTamde.
gamoyofen (g. gurgeniZe da Tanaavt.) anafilaqsiuri reaqciis sam xarisxs: msubuqi,
saSualo simZimis da mZime anafilaqsiuri reaqciebi. msubuqi anafilaqsiuri reaqciebi
vlindeba kidurebSi CxvletiT da sicxis SegrZnebiT, Tvalis quTuToebis, piris Rrus,
yelisa da cxviris lorwovanebis SeSupebiT. adgili aqvs qavils, cremldenas,
cxvirceminebas, simptomebi vlindeba alergenTan kontraqtis Semdeg 2 saaTis
ganmavlobaSi. maTi xangrZlivoba ar aRemateba 1-2 dRes. saSualo simZimis
anafilaqsiuri reaqciebi – damaxasiaTebelia respiraciuli komponenti (bronqospazmi,
xorxis, bronqebis SeSupeba), romelic vlindeba sunTqvis gaZnelebiT, xveliT.
SesaZlebelia urtikariis da angioSeSupebis ganviTareba. xSiria mousvenroba,
gulisreva, Rebineba, generalizebuli qavili. Semdeg simptomebis dawyeba da
ganviTarebis xangrZlivoba iseTivea, rogorc msubuqi formis dros.
mZime anafilaqsiuri reaqciebi iwyeba moulodnelad. ramodenime wuTis
ganmavlobaSi viTardeba gamoxatuli bronqospazmi, xorxis SeSupeba, rac vlindeba
xveliT, qoSiniT, cianoziT, disfoniiT – zogjer sunTqvis gaCerebiT, kanis mxirv
aRiniSneba urtikaria, angiodema, kanis siwiTle, gamonayari. kuW-nawlavis gluvi
kunTebis spazmi da lorwovanis SeSupeba iwvevs disfagias. SesaZlebelia uneblie Sar-
dva, defikacia, cnobierebis darRveva an piriqiT aRgzneba, Tavbrus xveva, epilefsiuri
gulyrebi. sisxlZarRvTa gafarToveba da maTi ganvladobis momateba iwvevs
arteriuli wnevis dacemas, gulis riTmis darRvevas, Soks da komas. rac ufro
swrafad viTardeba anafilaqsiuri reaqciebi, procesebi miT ufro mZimed
mimdinareobs. sikvdilis yvelaze xSir mizezs bavSvebSi warmoadgens xorxis SeSupeba
da mogudva. gadatanili anafilaqsiuri reaqciis Semdeg, misi gamovlinebani TandaTan
mcirdeba, Tumca 2-24 saTis Semdeg isini SeiZleba kvlav gaZlierdes.
diagnozi. anamnezs gadamwyveti mniSvneloba eniWeba anafilaqsiis gamomwvevi
mizezis dadgenaSi. diagnostikuri Rirebuleba eniWeba agreTve kanis sinjebs,
specifiuri IgE-s kvlevas sisxlis SratSi da provokaciul testebs. Tumca, kargad
Sekrebili anamnezi gamoricxavs maTi Catarebis aucileblobas.
marTva, mkurnaloba, prevencia. pacientis da misi ojaxis wevrebis
informirebuloba (gansakuTrebiT maSin, roca misi gamomwvevi speci-fiuri faqtori
dadgenilia) aucilebeli pirobaa daavadebis Tavidan acilebis da menejmentis sworad
warmarTvis mizniT. maT unda icodnen anafilaqsiisagan gamomwvevi yvela safrTxis
mniSvneloba, ukavSirdeba igi sakvebs, medikaments, Tu mweris nakbens. mizanSewonilia,
rom anamnezSi anafilaqsiis mqone pacientebma mudmivad iqonion Tan saineqciod
gamzadebuli epinefrini, Tan unda hqondeT markeri, sadac aRniSnuli iqneba, rom igi
anafilaqsiis riskis jgufs miekuTvneba da miTiTebuli unda iyos gamomwvevis
dasaxeleba. pacientebs anafilaqsiuri reaqciebiT anamnezSi, yvela preparati eniSneba
mkacri Cvenebis gaTvaliswinebiT, upiretesoba eZleva per os misaReb preparatebs.
anamnezSi preparatze alergiis arsebobis SemTxvevaSi unda Catardes kanis sinjebi da
specifiuri IgE-s gansazRvra SratSi.
anafilaqsiuri reaqciebis mkurnaloba – damokidebulia simZimis xarisxze. mZime
anafilaqsia, rogorc sicocxlisaTvis saSiSi mdgomareoba, moiTxovs gadaudebel
intervencias. mimarTuli unda iyos sasicocxlos funqciebis aRdgenisaken, poxieri
ujredebidan gamoTavisuflebuli mediatorebis neitralizaciisaken. saswrafod unda
Sefasdes sasunTqi gzebis gamavloba, garegani sunTqvis da hemodinamikis maCveneblebi.
- pacients aTavseben zurgze, ise, rom Tavi mdebareobs fexebTan SedarebiT ufro
dabla, raTa gaumjobesdes hemodinamika. aRniSnuli RonisZieba orTostatuli
hipotenziis prevenciaa da aumjobesebs Tavis, gulis da Tirkmelebis sisxliT
momaragebas.
- aeromomaragebis gaumjobesebis mizniT pacients miewodeba Jangbadi niRbiT an
kanuliT. amwovis saSualebiT awarmoeben sasunTqi gzebis ganTavisuflebas
lorwosa da naRebinebi masisgan. zemo sasunTqi gzebis gamoxatuli SeSupebis
dros naCvenebia traqeis dauyovnebeli intubacia.
- oqsigenoTerapia tardeba gaxangrZlivebuli anafilaqsiis dros, roca
gamoxatulia posthipoqsiuri agzneba. oqsigenoTerapiis regulirebis mizniT
saWiroa gazTa cvlis monitoringi pulsoqsimetriiT.
- cirkulaciaSi arsebuli siTxis raodenobis Sevsebis da metaboluri acidozis
moxsnis mizniT gamoiyeneba deqstrozisa da ringer-laqtatis intravenuri
infuzia. sainfuzio siTxe bavSvebma unda miiRos 30 ml/kg pirveli 1 saaTis
ganmavlobaSi.
- anafilaqsiis dros arCevis preparati aris epinefrini, romelic gamoiyeneba
ganzavebiT – 1:1000, 0.2ml-dan 0.5 ml-mde (bavSvebSi maqsimaluria 0.3 ml) kunTebSi
an kanqveS. ineqcia TeZoze ufro efeqturia, vidre mxarze. saWiroebis SemTxvevaSi
epinefrini SesaZlebelia gamoyenebul iqnes yovel 15 wuTSi arteriuli wnevis
monitoringis pirobebSi. saWiroebis SemTxvevaSi gamoiyeneba epinefrinis Seyvanis
alternatiuli gza – inhalaciuri an sublingvaluri.
- H1 – blokatorebidan (rogorc II rigis preparatebi) rekomendebulia
difenhidramini (benadrili) – 1.0-2.0 mg/kg an 25-50 mg parenteralurad. igi
gamoiyeneba mxolod epinefrinTan kombinaciaSi (im SemTxvevaSi, roca epinefrinis
efeqti ar aris sakmarisi anafilaqsiis simptomebis mosaxsnelad).
- H2 – blokatorebidan (rogorc II rigis preparatebi) gamoiyeneba ranitidini – 1
mg/kg wonaze bavSvebSi, 5%-ian 20 ml deqstrozasTan erTad, intravenurad 5 wuTis
ganmavlobaSi.
- im SemTxvevaSi, rodesac bronqospazmi ar ixsneba miuxedavad epinefrinis
gamoyenebisa, ganixileba β2-agonistebis gamoyenebis sakiTxi (albuteroli 2.5-5.0
mg 3.0 ml siTxeSi nebulaizeris saSualebiT); xolo roca epinefrini ver xsnis
hipotenzias, ganixileba dofaminis infuziis sakiTxi. dofamini gamoiyeneba 400 mg-
is raodenobiT – 500 ml. 5%-ian deqstrozasTan erTad, 2-20 mg/kg-ze wuTSi.
 anafilaqsiis mZime da gaxangrZlivebuli formebis dros ganixileba
glukokortikoidebis sistemuri gamoyenebis sakiTxi (intravenurad gk
gamoiyeneba yovel 6 saaTSi 1-2 mg/kg; peroralurad 1-2 mg/kg-ze).
mkurnaloba grZeldeba mdgomareobis stabilizaciamde. SemanarCunebeli Terapiis
mizniT gamoiyeneba H1 agonistebi da gk 3-5 dRis xangrZlivobiT pacientis
mdgomareobis gaTvaliswinebiT.

2. atopuri dermatiti
atopiuri dermatiti (atopuri egzema) kanis qronikuli anTebiTi qaviliT mimdinare
daavadebaa, romelic ZiriTadad viTardeba adreul bavSvTa asakSi da xasiaTdeba
remisiisa da gamwvavebebis monacvleobiT. atopuri dermatitis (ad) klinikuri niSnebi
SesaZlebelia gamovlindes mozrdil asakSic.
 epidemiologia. SemTxvevaTa 45%-Si ad vlindeba sicocxlis pirveli 6 Tvis, 60%-Si
- pirveli wlis ganmavlobaSi, xolo 85%-Si 5 wlamde asakSi. ukanasknel periodSi
SeimCneva atopuri dermatitis zrdis tendencia, igi gvxvdeba adreuli asakis bavSvTa
15-20%-Si. aSS-Si atopiuri dermatitis gavrceleba 7-17%-s Seadgens. ISAAC-is kvlevam
aCvena rom ad gavrceleba 1-dan 20%-mde meryeobs, sixSire yvelaze metia CrdiloeT
evropaSi. pacientTa 16,8%-s daavadeba uvlindeba mozrdil asakSi.
ad-s xSirad Tvlian atopiis pirvel manifestaciad, Semdgom asakSi SesaZlebelia
gamoixatos rinitis da/an asTmis ganviTareba e.w “alergiuli marSi”. ad-s mqone
bavSvTa daaxloebiT 30-50%-s uviTardeba asTma, 35%-s ki alergiuli riniti.
etiopaTogenezi. ad paTofiziologia aris genebis, infeqciur agentebis, garemos,
kanis barieruli funqciis defeqtisa da imunuri pasuxis kompleqsuri
urTierTqmedebis Sedegi, rac iwvevs kanis damaxasiaTebel dazianebas. ad-s dros
anTebiT procesSi monawileoben IgE-s mtarebeli langerhansis ujredebi, atopuri
kerati-nocitebi, limfocitebi, monocitebi/makrofagebi, eozinofilebi da poxieri
ujredebi. ad-s mqone pacientTa umravlesobas aReniSneba Sratis IgE-s mateba. ad mqone
pacientebis periferiul sisxlsa da kanis dazianebis ubnebSi aRmoCenilia Th2
ujredebis mateba (romlebic gamoyofen IL-4, IL-5, IL-13-s) da interferon γ-s Semcireba.
ad-s klinikuri manifestaciis didi nawili swored Th2-is stimulaciasTan aris
dakavSirebuli, rac iwvevs eozinofilias da IgE sensibilizaci-as.
ad-s gamSvebi, maprovocirebeli faqtorebia
 alergenebi – kvebiTi alergenebi (gansakuTrebiT 3 wlamde), aeroalergenebi
(gansakuTrebiT 3 wlis Semdeg), alergenebTan uSualo Sexeba (oTaxis mtvris
tkipebi, mcenareebi, cxovelis bewvi, adamianis qertli, obis sokoebi da sxv.).
kvebiTi alergenebi ad-s gamSveb faqtorad ZiriTadad adreul asakSi
gvevlinebian.
 stresi – zusti meqanizmi ar aris cnobili, Tumca savaraudoa neiroimunuri
faqtorebis (neiropeptidebi – P substancia, neironebis zrdis faqtori)
moqmedeba.
 mikroorganizmebi –S. Aureus, martivi herpesis virusi, virusuli infeqciebi
(gansakuTrebiT zemo sasunTqi gzebis), safuaris soko Malassezia, kandida
(iSviaTad), dermatofitebi.
 autoantigenebi – autoreaqtiuloba sakuTari cilebis mimarT xSirad
amZimebs ad-s mimdinareobas.
 gamaRizianebeli faqtorebi – uxeSi da Salis tansacmeli, qimiuri
gamRizianeblebi (saponi, sadezinfeqcio saSualebebi, parfiumeriuli nawarmi),
klimati.
ad-s mimdinareoba SeiZleba garTuldes kanis morecidive virusuli infeqciebiT,
rogoricaa martivi herpesi, kontagiozuri moluski da meWeWi.
klinika. ad-s dros kanis dazianebas Cvilebsa da bavSvebSi aqvs damaxasiaTebeli
lokalizacia – Tavis Tmiani nawili, warbebi, loyebi, nikapi, aseve tani, kidurebis
gamSleli zedapirebi, majebi da mtevnebis zurgi (ix. suraTi #1). axasiaTebs buStebis
warmoqmna, gamonadeni, SeSupeba, fufxebi da qavili, rac iwvevs uZilobas, tirils, ag-
znebadobas. mozrdilebSi damaxasiaTebelia momxreli zedapiris da-zianeba.
mowodebulia ad-s Semdegi diagnostikuri kriteriumebi:
didi kriteriumebi:
1. qavili
2. kanis dazianebis tipuri lokalizacia (saxis da gamSleli zeda-pirebis
dazianeba bavSvebSi, momxreli zedapirebis dazianeba mozrdilebSi)
3. qronikuli mimdinareoba recidivebiT
 4. atopiis ojaxuri an individualuri anamnezi (asTma, alergiuli riniti,
atopuri dermatiti)
mcire kriteriumebi:
1. kanis simSrale/qserozi
2. mtevnisa da terfis araspecifikuri dermatiti
3. dvrilebis egzema
4. deni-morganis infraorbituli naoWi
5. iqtiozi/xelisgulis daxazulobis suraTis gaZliereba/keratozi
6. kanis dadebiTi testi (dauyovnebliv reaqciaze - tipi I)
7. Sratis IgE-s mateba
8. daavadebis dawyeba adreul asakSi
9. TeTri dermografizmi
10. tendencia kanis infeqciebisadmi
11. wina subkafsuluri kataraqta, keratokonusi
12. saxis kanis sifermkrTale/siwiTle
13. mimdinareobaze garemosa da emociuri faqtorebis gavlena.

suraTi # 1 atopuri dermatiti: a. eqskoriacia majis areSi; b. 4 Tvis Cvili, saxis

midamoSi gamoxatulia anTeba
Cvilebs da bavSvebs axasiaTebT Zlieri qaviliT mimdinare papulur-vezikuluri
dazianeba eqskoriaciebiTa da serozuli eqsudaciiT. qavili gansakuTrebiT Zlierdeba
Ramis saaTebSi. daavadebas simZimis mixedviT yofen:
 msubuqi – kanis mSrali ubnebi, iSviaTi qavili, yoveldRiur aqtivobaze
minimaluri gavlena, Zilis darRvevebis gareSe.
 saSualo simZimis - kanis mSrali ubnebi, xSiri qavili, siwiTle, eqskoriacia,
lokalurad kanis gasqeleba, yoveldRiur aqtivobaze zo-mieri gavlena, Zili
darRveuli.
 mZime – farTod gavrcelebuli kanis mSrali ubnebi, mudmivi qavili, siwiTle,
eqskoriacia, kanis intensiuri gasqeleba, Zilis da yovel-dRiuri aqtivobis
darRveva. cxovrebis xarisxis darRveva SeiZleba gamoiwvios aseve lokalurma
mZime egzemam.
diagnozi. ad-s diagnozi efuZneba klinikuri niSnebis arsebobas, wamyvania qavili
da qronikuli an gamwvavebebiT mimdinare kanis egzemuri dazianeba tipuri
morfologiiTa da gavrcelebiT atopiis anamnezTan erTad. ar arsebobs obieqturi
diagnostikuri testi ad-is klinikuri dadasturebisTvis. ad-s zusti diagnostika
gulisxmobs msgavsi simptomebis mqone sxva daavadebebis gamoricxvas.
ad-s gamwvavebis xelSemwyobi faqtorebis kvleva moicavs pacientis anamnezis
Segrovebas, kanis da sisxlis specifiur da provokaciul testebs.
atopuri dermatitis gamSvebi/maprovocirebeli faqtorebis dadgena SesaZlebelia
kanis testebiT da specifiuri IgE-s gansazRvriT. iSviaTad SeiZleba saWiro gaxdes
Sratis IgE-s kvleva. kanis biofsia ar tardeba rutinulad, Tumca zogjer saWiroa
diferenciuli diag-nostikisTvis.
diferenciuli diagnozi. atopiuri dermatitis diagnostikis dros metad
mniSvnelovania kanis zogierTi anTebiTi, genetikuri da infeqciuri daavadebis,
agreTve imunodeficituri paTologiebis gamoricxva. Cvilebi romelTac atopiuri
dermatitis niSnebi uvlindebaT 1 wlamde da amasTan erTad gamoxatulia zrda-
ganviTarebis Seferxeba, diarea, generalizebuli eriTemuli gamonayari da kanis
morecidive infeqciebi gamokveuli unda iyvnen mZime imunodeficitis sindromis
arsebobaze. amave dros bavSvebSi atopiuri dermatitiTa da zrdis SeferxebiT metad
mniSvnelovania histiocitozis gamoricxva. atopuri dermatitis gamonayaris msgavsi
elementebiT xasiaTdeba viskot-oldriCis sindromi (X qromosomas SeWiduli
recesiuli daavadeba), romelis drosac agreTve aRiniSneba Trombocitopenia,
morecidive mZime baqteriuli infeqciebi da imunodeficiti. ad-s msgavsi klinikiT
vlindeba agreTve hiperimunoglobulin E-s sindromi, romlis drosac gamoxatulia
Sratis IgE donis mkveTri momateba, qronikuli dermatiti da morecidive baqteriuli
infeqciebi. atopuri dermatitis diferencireba saWiroa agreTve kontaqturi,
eqsfoliaciuri, seboreuli dermatitisa da fsoriazisgan. SesaZlebelia saWiro
gaxdes ad-is diferencireba wamlismieri reaqciis, munis da fotosensitiuri gamo-
nayarisgan.
garTulebebi
 meoradi baqteriuli infeqcia – savaraudoa Tu saxezea
pustulebi, sisvele, qerqebi da mdgomareobis uecari gauareseba
 herpesuli egzema – sicocxlisaTvis saSiSi mdgomareobaa
 sokovani infeqcia
mkurnaloba. ad-s bazisur Terapia gulisxmobs kanis optimalur movlas, misi
barieruli funqciis aRdgenas kanis datenianebisa da darbilebis gziT, specifiuri da
arspecifiuri gamaRizianebeli faqtorebis identifikacias da maTi moqmedebis Tavidan
acilebas.
mkurnaloba damokidebulia daavadebis simZimeze da gulisxmobs mkurnalobis
safexurebriv princips. mkurnaloba iwyeba an dabali safexuridan da mere xdeba
maRla asvla an piriqiT.
 I safexuri: rodesac ar aris gamwvavebis niSnebi da saxezea mxolod kanis
simSrale mimdinareobs bazisuri mkurnaloba - kanis datenianeba, damarbileblebis
gamoyeneba, gamRizianeblebis Tavidan acileba, specifiuri gamSveb/maprovocirebeli
faqtorebis identifikacia da maTi moqmedebis Tavidan acileba.
II safexuri: msubuqi/saSualo simZimis ad-s dros bazisur TerapiasTan erTad unda
daiwyos mkurnaloba dabali-saSualo potenciis topikuri kortikosteroidebiT (tks),
sanam egzema ar gaqreba da unda gagrZeldes minimum 2 dRe simptomebis gaqrobidan.
amave safexurze tks-sTan erTad an mis nacvlad SeiZleba topikuri kalcineurinis in-
hibitorebis gamoyeneba.
III safexuri: saSualo simZimis/mZime ad dros mkurnaloba iwyeba saSualo-maRali
potenciis tks da/an topikuri kalcineurinis inhi-bitorebiT,
IV safexuri: daumorCilebeli/mZime ad-s dros bazisur da tks Terapias emateba
sistemuri Terapia (mag.: ciklosporini) an ultaiisferi sxivebiT mkurnaloba da sxva.
nebismier safexurze SesaZlebelia antihistaminuri preparatebis gamoyeneba
atopuri dermatitis Tanmxlebi qavilis Sesamcireblad. rodesac romelime safexurze
miiReba efeqti, saWiroa erTi safexuriT qvemoT Camosvla.
ad-is mkurnalobaSi mniSvnelovania gamSvebi/maprovocirebeli faqtorebis
eliminacia.
qavilis Semcirebis mizniT rekomendebulia uxSiresi gamRizianeblebis (saponi,
parfiumeria, Sali, qimiuri nivTierebebi) moqmedebis Tavidan acileba. agreTve metad
mniSvnelovania temperaturisa da tenianobis kontroli. aeroalergenebi, rogoricaa
oTaxis mtvris tkipasTan, cxovelur alergenebTan da mcenaris mtverTan kontaqti
minimumamde unda iyos dayvanili. pacientebSi, romlebsac aReniSnebaT sensibilizacia
sakveb alergenebze, gamwvvavebis periodSi saWiroa kvebis racionidan aRniSnuli
sakvebis eliminacia.
adgilobrivi mkurnaloba
damarbileblebi (emoliantebi): ad-s ZiriTadi niSania kanis simSrale, rac
gamowveulia wylis dakargviT da kanis barieruli funqciis darRveviT. simSrale
iwvevs epiTeliumis dazianebas, is Semavali xdeba kanis mikrobebisa da
alergenebisaTvis, viTardeba qavili da anTeba. damarbileblebis regularuli
gamoyeneba kanis datenianebasTan erTad ad-s mkurnalobis safuZvelia. damarbileblebi
losionis, malamos, kremis saxiT warmoadgens pirveli rigis Terapias da
gamoyenebuli unda iyos mudmivad, Tundac kanis anTebiTi dazianeba ar iyos
gamoxatuli. damarbileblis SerCeva xdeba individualurad. damatenianeblebi,
rogoricaa Tbili abazana, minimum 20 wT-is ganmavlobaSi da tenianobis
SesanarCuneblad damarbileblis wasma, Svebas aZlevs pacients.
topikuri (adgilobrivi) kortikosteroidebi: tks I rigis preparatia ad-s
gamwvavebis dros. dabali potenciis kotrikosteroidebi rekomendebulia
SemanarCunebeli TerapiisTvis, saSualo da maRali potenciis steroidebi ki
gamoyenebuli unda iyos klinikuri gamwvavebis dros xanmokle droiT. tks unda
waesvas mxolod kanis dazianebul ubanze. lorwovani garsidan, genitaliebidan,
quTuToebidan, saxidan, kanis fiziologiuri nakecebis aridan maRalia steroidis Se-
wovis xarisxi, amitom am ubnebSi rekomendebulia dabali potenciis tks gamoyeneba.
Cveulebriv, malamo ufro maRali potenciisaa, vidre kremi. malamos gamoyenebas unda
veridoT kanis mTlianobis darRvevis da gamonadenis dros da naoWebis areSi, aseve
misi gamoyenebisgan Tavi unda SevikavoT sicxesa da tenian klimatSi. sadReisod
rekomendebuli ar aris tks-is dReSi 2 jer metad gamoyeneba. ad-s gamwvavebis
samkurnalod tks SeiZleba gamoyenebuli iqnas 4 kviris ganmavlobaSi, Tumca umetes
SemTxvevaSi sakmarisia ufro xanmokle kursi.
 topikuri (adgilobrivi) imunomodulatorebi (kalcineurinis in-hibitori)
miCneulia meore rigis preparatad tks-s Semdeg. is amcirebs gamonayris intensivobas
da ad-s simptomebs rogorc bavSvebSi, ise mozrdilebSi.
adgilobrivi takrolimusis malamo efeqturi da SedarebiT usafrTxoa rogorc
bavSvebSi, aseve mozrdilebSi msubuqi da saSualo simZimis atopiuri dermatitis
dros. bavSvebSi takrolimusis (0,03%) malamo gamoiyeneba 2 wlis Semdeg, dReSi 2-jer
maqsimum 3 kviris ganmavlobaSi, Semdeg gamoiyeneba dReSi erTxel sanam cvlilebebi
alagdeba, Semdeg xdeba gadasvla hidrokortizonze maqs. 4 kvira sanam ar alagdeba
kanze cvlilebebi.
adgilobrivi pimekrolimusis malamo kalcineurinis inhibitoria, romelic
amcirebs atopuri dermatitis dros qavilsa da gamwvavebis sixSires da
kortikosteroidebis gamoyenebis saWiroebas. bavSvebSi pimekrolimusis (1%) malamo
gamoiyeneba 2 wlis Semdeg, dReSi 2-jer maqsimum 3 kviris ganmavlobaSi, Semdeg xdeba
gadasvla hidrokortizonze maqsimum 4 kvira, sanam ar alagdeba kanze cvlilebebi.
fotoTerapia. bunebrivi mzis sxivebis zemoqmedeba SeiZleba efeqturi iyos ad-s
dros, Tumca saWiroa damwvrobis da gadaxurebis Tavidan acileba. ultraiisferi
sxivebiT Terapia efeqturia. igi SeiZleba gamoyenebuli iyos mZime, daumorCilebeli
ad-s dros 12 wlam-de. bavSvebSi ultraiisferi sxivebiT Terapia ar gamoiyeneba
sistemuri Terapia
antihistaminuri medikamentebis gamoyeneba SeiZleba atopuri dermatitis Tanmxlebi
qavilis Sesamcireblad. maTi gamoyeneba aseve rekomendebulia Tanmxlebi daavadebebis
– alergiuli rinokoniunqtiviti, urtikaria _ arsebobis dros. sedatiuri
antihistaminuri preparatebi gamoiyeneba Zilis darRvevebis dros
sistemuri glukokortikosteroidebi SeiZleba gamoyenebuli iyos mZime,
daumorCilebeli qronikuli ad-s dros bavSvebSi. rekomendebulia sistemuri
kortikosteroidebis gamoyenebisgan Tavis Sekaveba.
imunosupresorebi, rogoricaa ciklosporini, interferon-gama SeiZleba
gamoyenebuli iyos mZime, refraqteruli ad-s dros
antimikrobuli Terapia - im pacientebSi, romlebsac aReniSnebaT meoradi
baqteriuli infeqcia, saWiroa sistemuri antibiotikoTerapia 7-10 dRiani kursi. am
dros saWiroa kanis nacxis gamokvleva.
Tu ad garTulda herpesuli infeqciiT saWiroa sistemuri antivirusuli Terapia
acikloviriT an sxva antivirusuli agentebiT. sokovani kolonizaciisas saWiroa
sistemuri Terapia antifunguri preparatebiT mag.: ketokonazoliT, flukonazoliT da
sxva.
pacientis ganaTleba ad-ze efeqturi kontrolis mosapoveblad mniSvnelovania
pacientebis (maTi ojaxis ganaTleba) ad-s mimdinareobis, gamSvebi faqtorebis da
mkurnalobis meTodebis Sesaxeb.
ad-s pirveladi da meoradi prevencia
pirveladi prevenciis savaraudo meTodebia
 ZuZuTi kveba
 maprovocirebeli faqtorebis Tavidan acileba
 probiotikebis gamoyeneba (Lactobacillus GG) dedis da Cvilis dietaSi
meoradi prevenciis savaraudo meTodebia
 cetirizinis xangrZlivi gamoyeneba.

3. sakvebismieri alergia
sakvebze arasasurveli reaqcia ganviTarebis meqanizmis gaTvaliswinebiT
klasikurad 2 tipad iyofa: sakvebis mimarT autanloba da sakvebismieri alergia.
sakvebismieri alergia warmoadgens darRvevTa jgufs, romelic ganpirobebulia
specifikur kvebiT alergenebze organizmis sapasuxo imunuri reaqciiT da vlindeba
sakvebis an sakvebi danamtis miRebisa da monelebis Semdeg.
epidemiologia. ukanasknel wlebSi atopuri daavadebebis sixSiris matebasTan
erTad gaizarda sakvebismieri alergiis sixSirec. bavSvTa daaxloebiT 6%-Si
sakvebismieri alergia vlindeba sicocxlis pirvel 3 wlis ganmavlobaSi. zogierTi
kvlevis mixedviT bavSvTa daaxloebiT 2,5%-s sicocxlis pirvel wels uvlindeba
alergia Zroxis rZeze, 1,5%-Si - kvercxze, 0,6%-Si miwis Txilze. bavSvTa umetesobam
sicocxlis me-2-3 wlisTvis SeiZleba daZlios alergiuli reaqcia rZesa da kvercxze,
maSin rodesac araqisze, Txilze da zRvis produqtebze alergia narCundeba mTeli
cxovrebis manZilze.
etiopaTogenezi. sakvebismieri alergiuli reaqciebi SeiZleba iyos 2 saxis, IgE
meqanizmiT ganpirobebuli da ara IgE, anu ujreduli reaqciebiT ganpirobebuli. IgE
ganpirobebuli reaqcia gamowveulia sakvebismieri alergenebis SekavSirebiT poxieri
ujredebisa da bazofilebis zedapirze IgE-s dafiqsirebasTan, rasac mosdevs maTi
degranulacia da anTebiTi mediatorebis gamoTavisufleba. IgE ganpirobebuli reaqcia
asocirdeba simptomebis swraf dauyovnebel ganviTarebasTan. ara-IgE meqanizmi
ukavSirdeba ujredul reaqcias, aseT SemTxvevaSi sakvebis alergenebis zemoqmedebiT
T limfocitebi axdenden didi raodenobiT sxvadasxva citokinis produqcias,
romelic iwvevs "dagvianebul" anTebiT process da simptomebis gamovlenas esaWiroeba
saaTebi an dReebi. SemTxvevaTa nawilSi sakvebismieri alergia ganpirobebulia
Sereuli IgE da ujreduli reaqciebiT, rac xSir SemTxvevaSi vlindeba qronikuli
paTologiebiT (atopuri dermatiti, bronquli asTma da sxv.)
klinika. sakvebis antigenebze alergiuli reaqcia SeiZleba gamovlindes
respiraciuli darRvevebiT, kanisa da kuW-nawlavis traqtis dazianebis simptomebiT.
Cvilebsa da adreuli asakis bavSvebSi sakvebismieri alergiis mraval gamovlinebas
Soris dominirebs kuW-nawlavis traqtis darRvevaTa simptomebi.
oraluri alergiuli sindromi: pir-xaxis doneze alergenTan kontaqtis
SemTxvevaSi viTardeba qavili, yurebSi Suili, tuCis, enis, sasis angionevrozuli
SeSupeba, xSirad amas erTvis yuris qavilis SegrZneba. mocemuli simptomebTan erTad
SesaZlebelia ganviTardes alergiis sxva gamovlinebebic. xSiria alergiuli
reaqciebi mcenaris mtverze - e.w. Tivis cxeleba. eriTema saxis areSi, romelic
gamoixateba citrusTan an pomidorTan kontaqtis Semdeg, ar ganixileba rogorc
imunuri pasuxi.
kuW-nawlavis traqtis anafilaqsia: sakvebi alergenis miRebis sapasuxod vlindeba
gulisrevis SegrZneba, mwvave SeteviTi muclis tkivili, Rebineba, SesaZlebelia
gamoixatos agreTve diarea da dehidratacia. yvelaze xSirad simptomebi vlindeba
iseT cilovani antigenebis mimarT, rogoricaa rZe, kvercxi, araqisi, soio,
marcvleuli da Tevzi. SesaZlebelia gamoxatuli iyos IgE ganpirobebul reaqciebiT
gamowveuli sxva simptomebic.
sakvebismieri alergiis sxva gamovlinebebi: sakvebismieri alergia SesaZlebelia
gamoixatos kanis mxriv gamovlinebebiT, kerZod, atopuri dermatitiT (egzema), mwvave
urtikariiTa da angionevrozuli SeSupebiT. Cveulebriv atopuri dermatitis mqone
bavSvTa mesameds uvlindeba sakvebismieri alergia. rac ufro mcire asakisaa bavSvi da
rac ufro mZimea atopuri dermatitis gamovlineba, miT ufro maRalia daavadebis
paTogenezSi sakvebze alergiis roli. mwvave urtikarias da angionevrozul SeSupebas
yvelaze xSirad iwvevs iseTi sakvebi, rogoricaa kvercxi, rZe, araqisi, Txili, agreTve
sxvadasxva marcvali da xili (mag., kivi). qronikuli urtikaria da angioedema iSviaTad
aris ganpirobebuli sakvebismieri alergiiT. sakvebismieri alergia SeiZleba
gamoixatos respiraciuli gamovlinebebiT, romelic iSviTad gvxvdeba izolirebuli
saxiT. sakvebismieri alergiis dros SesaZlebelia gamovlindes rinokoniuqtivitis
simptomebi (Tvalis irgvlivi qavili, cremldena, nazaluri obstruqcia,
cxvircemineba, rinorea), romlebic tipurad vlindeba alergiis sxva uxSiresad kanis
mxriv gamovlinebebTan erTad. SemTxvevaTa 25%-Si vlindeba mstvenavi sunTqva.
gasaTvaliswinebelia, rom sakvebismieri alergia yvelaze xSirad iwvevs
anafilaqsiur reaqciebs. kanis, respiraciuli da gastrointestinuri simptomebis
swrafad ganviTarebasTan erTad SeiZleba gamovlindes cvlilebebi kardiovaskuluri
sistemis mxriv, rogoricaa hipotenzia, sisxlZarRvTa kolafsi, ariTmia, rac
uxSiresad ganpirobebulia poxieri ujredebidan anTebiTi mediatorebis masiuri
gamoTavisuflebiT. sicocxlisTvis saSiSi sakvebismieri anafilaqsiuri reaqcia
uxSiresad vlindeba iseT sakvebzem, rogoricaa araqisi, Txili, Tevzi da zRvis
produqtebi. aseT pacientebs xSirad aqvT bronquli asTmis anamnezi.
Sereuli (IgE da ara IgE ganpirobebuli) hipersensitiuroba sakvebze
mocemuli tipis darRvevebs axasiaTebs procesSi CarTuli specifiuri organos
intensiuri eozinofiluri infiltracia, romelmac SeiZleba moicvas mag. kuWisa da
wvrili nawlavebis lorwovani, kunTovani an serozuli garsebi. kunTovani garsis
CarTva anTebiT procesSi iwvevs mis gasqelebas da kvanZebis warmoqmnas, rasac moyveba
obstruqciis simptomebi (muclis tkivili, Rebineba), maSin rodesac serozuli
infiltraciis SemTxvevaSi viTardeba eozinofiluri asciti. pacientebis udidesi
nawilis mdgomareoba umjobesdeba sakvebi racionidan antigenuri produqtis (mag., rZe)
amoRebis Semdeg, Tumca zogierT SemTxvevaSi saWiroa cilovani antigenis mTliani
SezRudva da mis magivrad hidrolizebuli cilis an aminomJavebis Semcveli
xelovnuri sakvebis gamoyeneba. SemTxvevaTa nawilSi saWiro xdeba
kortikosteroidebis gamoyeneba.
alergiuli eozinofiluri ezofagiti
mocemuli paTologia xasiaTdeba saylapavi milis lorwovani garsis intensiuri
eozinofiluri infiltraciiT. paTologia SeiZleba gamovlindes nebismier asakSi
Cvilobidan mozardobis periodamde. mcire asakis bavSvebSi igi ZiriTadad vlindeba
RebinebiT, ufross asakSi ki misi ZiriTadi niSania disfagia, gulZmarva da muclis
tkivili. iSviaT SemTxvevaSi SeiZleba ganviTardes saylapavi milis nawiburi. aseT
dros xSirad SecdomiT ismeba gastroezofaguri refluqsis diagnozi, Tumca
refluqsis sawinaaRmdego mkurnaloba araefeqturia. mcire asakis bavSvebSi
mkurnaloba moicavs dietis modifikacias, mcire droiT sakvebis Secvlas
aminomJavebis Semcveli produqtiT. mozrdil bavSvebSi Cveulebriv saWiro xdeba
kortiskosteroidebis gamoyeneba.
alergiuli eozinofiluri gastriti
mocemuli darRveva ufro xSirad vlindeba Cvilebsa da mozardebSi muclis
tkiviliT, RebinebiT (naRebineb masaSi xSirad SeimCneva sisxliani minarevi),
anoreqsiiT, wonis dune namatiT, iSviaT SemTxvevaSi kuWidan sakvebis gadasvlis
darRveviT. mcire asakis bavSvebSi man SeiZleba datovos pilorostenozis
STabeWdileba. atopiis gamovlinebebi - IgE donis momateba, periferiuli eozinofilia
vlindeba pacientTa 50%-Si. kuWis biofsiiT dasturdeba lorwovani da lorwqveSa
Sris mkveTri eozinofiluri infiltracia, gansakuTrebiT Sesaval nawilSi.
alergiuli eozinofiluri gastroenterokoliti
mocemuli problemis mqone pacientebs uvlindebaT igive simptomebi, romelic
yuradRebas ipyrobs alergiuli ezofagitebis da gastritis SemTxvevaSi. xSir
simptoms warmoadgens zrdis Seferxeba da atopiis sxva niSnebi. SesaZlebelia
ganviTardes mkveTrad gamoxatuli cilis dakargviT mimdinare enteropaTia, rac
vlindeba generalizebuli SeSupebiT da hipogamaglobulinemiiT.
ara IgE ganpirobebuli darRvevebi
alergiuli proqtokoliti
mocemuli paTologia vlindeba sicocxlis pirvel TveebSi (1-3 Tve) msubuqi
diareiT, ganavalSi SeimCneva sisxlis da lorwos minarevi, aseve SesaZlebelia
gamovlindes ganavalSi leikocitebis raodenobis momateba, xolo sisxlSi ki
eozinofilia. tipurad vlindeba koliti, limfoiduri kvanZebis hiperplazia, rac
gamoxatulia SemTxvevaTa 25%-Si. uxSiresad proqtokoliti ganpirobebulia Zroxis
rZeze hipersensiturobiT, SedarebiT iSviaTia momatebuli mgrZnobeloba soios rZeze.
mocemuli problema SeiZleba gamovlindes eqskluziur ZuZuTi kvebaze myof
pacientebSi dedis dietis cvlilebebis da xSirad masSi rZis produqtebis gamoyenebis
Semdeg. xelovnur kvebaze myofi bavSvebi saWiroeben kvebis cvlilebas da cilovan
hidrolizebul formulaze gadayvanas.
sakvebiT ganpirobebuli enterokoliti: enterokoliti vlindeba sicocxlis
pirveli kviridan 3 Tvemde asakSi persistiuli RebinebiTa da diareiT, romelic
xSirad iwvevs dehidratacias. Rebineba vlindeba Wamidan 1-3 sT-is Semdeg. ufrosi
asakis bavSvebSi daavadeba vlindeba SedarebiT msubuqad. SeiZleba gamoxatuli iyos
sisxliani diarea, muclis Seberva. ganavali Seicavs sisxls, neitrofilebsa da eo-
zinofilebs. msxvili nawlavis biofsiiT vlindeba xaoebis gadasworeba, SeSupeba da
anTebiTi ujredebi. entrokolitis simptomebi qreba sakvebi alergenis racionidan
amoRebis Semdeg 72 sT-Si. bavSvs Zroxis rZis miRebis Semdeg SeiZleba gamouvlindes
anemia, hipoproteinemia da zrdis Seferxeba. Cveuli gamovlinebaa eozinofilia.
hidrolizebuli an aminomJavebis Semcveli formula mocemuli paTologiis saukeTeso
samkurnalo saSualebaa.
sakvebiT ganpirobebuli enteropaTia
Cveulebriv vlindeba sicocxlis pirvel TveebSi diareiT, RebinebiT, araiSviaTad
steatoreiT, muclis SeberviT, adre danayrebis SegrZnebiT, malabsorbciaiTa da
zrda-ganviTarebis SeferxebiT. wvrili nawlavis biofsiiT vlindeba xaoebis
araerTgvarovani atrofia da anTebiTi infiltracia mononukleuri ujredebiT.
enteropaTiis gamomwvevi sakvebis amoRebis Semdeg daavadebis simptomebis gaqrobas
SesaZlebelia daWirdes ramdenime dRe an kvira.
celiakia (gluten-sensitiuri enteropaTia) da herpesisformis dermatiti
celiakia enteropaTiis mZime formaa, romelic vlindeba kvebis racionSi glutenis
Semcveli sakvebis (xorbali, Wvavi, Svria da qeri) miRebis Semdeg, wvrili nawlavis
proqsimaluri nawilis epiTeliumis dazianebiTa da xaoebis hoperplaziiT. celiakia
gadaecema autosomur-dominanturi damemkvidrebis tipiT. genetikuri predispoziciisas
nawlavis lorwovan garsSi xdeba T limfocitebis aqtivacia da ujreduli imunuri
pasuxi glutenis SemadgenlobaSi myofi gliadinis fraqciis (transglutaminaza)
mimarT. klinikurad gamoxatulia malabsorbciis suraTi, qronikuli diarea, muclis
Seberva, e.w. fsevdoasciti, polifekalia, wonis deficiti da zrdaSi Seferxeba.
herpesisformis dermatiti agreTve vlindeba glutenis Semcveli sakvebis miRebis
Semdeg qaviliT da simetriulad lokalizebuli papulur-vezikuluri gamonayariT,
romelic vizualurad Zlier hgavs herpesul gamonayars. daavadeba xSir SemTxvevaSi
asocirebulia celiakiasTan. daavadebis mkurnalobis aucilebel princips kvebis
racionidan glutenis Semcveli sakvebis amoReba warmoadgens.
filtvismieri hemosiderozi (heineris sindromi): filtvismieri hemosiderozi
vlindeba infiltratebiT, gastroenteruli da pulmonuri sisxldeniT, rkina-
deficituri anemiiT, periferiuli eozinofiliiT da zrda-ganviTarebis SeferxebiT.
daavadeba uxSiresad asocirebulia Zroxis rZis proteinis gamoyenebasTan. daavadebis
simptomebi ukuganviTarebas ganicdis gamRizianebeli sakvebis dietidan eliminaciis
Semdeg.
diagnozi. sakvebismier alergiaze eWvis mitana SesaZlebelia, rodesac vlindeba
tipuri simptomebi specifikuri sakvebis racionSi Setanis Semdeg. saWiroa sxva
araalergiuli meqanizmebiT ganpirobebuli sakvebis autanlobis (monelebisa da
Sewovis darRveva, sakvebis kontaminacia mikrobebiTa da toqsinebiT, sakvebis
farmakologiuri aqtivoba). Zroxis rZeze alergiis saeWvo SemTxvevebSi aucilebelia
laqtozis ukmarisobis gamoricxva. eliminaciuri dieta da SemdgomSi ormagi brma,
placebo kontrolirebadi sakvebiT datvirTvis cda sakvebismieri alergiis
diagnostikis oqros standartia. aseT dros saeWvo sakvebi pacients miewodeba
kafsulebiT progresulad mzardi dozebiT, monacvleobiT placebosTan da reaqciebi
fasdeba brma meTodiT. Ria cda sakvebze (Open food challenges) marTalia gacilebiT ufro
xSirad gamoiyeneba, Tumca mocemuli meTodi naklebad sandoa (garda Cvilobis
asakisa). simptomebi SeiZleba kvlav ganmeordes alergenebis mzardi dozis SeyvaniT
pacientTa 40%-Si, Tu vlindeba sakvebze anafilaqsiuri reaqcia cda saWiroa Sewydes
da bavSvi unda Sefasdes alergologis mier.
kanis testebis an radioalergosorbentis testis (RAST) gamoyenebiT SesaZlebelia
ganisazRvros sakvebismieri alergia IgE-ganpirobebuli alergiuli reaqciiTaa
ganpirobebuli, Tu ara. nebismier asakSi SesaZlebelia ganisazRvros IgE done,
vinaidan misi gamomuSaveba iwyeba gestaciis 24 kviridan. negatiuri IgE testi
gansakuTrebiT 1 welze meti asakis bavSvebSi sarwmunoa da miuTiTebs, rom reaqcia ar
aris IgE ganpirobebuli. dadebiTi testis sarwmunoeba ganisazRvreba pacientis
istoriiTa da asakiT. pozitiuri kanis testebi vlindeba 3 wlis asakis Semdeg 100%
SemTxvevaSi im pacientebTan romelTac hqondaT dadebiTi reaqcia ormagi brma,
placebo-kontrolirebadi sakvebiT datvirTvaze. IgE done ar aris informatiuli
sakvebismieri alergiis diagnostikisTvis.
CvilebSi hipersensiturobis uxSires mizezs warmoadgens Zroxis an soios rZis
cila. ZuZuTi kveba axdens sakvebismieri alergiis prevencias, Tumca aseT SemTxvevaSic
SesaZlebelia gamovlindes alergiuli proqtokoliti. ZuZuTi kvebaze myof CvilebSi
sakvebismieri alergiis uxSires mizezs warmoadgens dedis racionSi Zroxis rZis
gamoyeneba, SedarebiT iSviaTad misi mizezia araqisis, soios an kvercxis miReba.
bavSvebSi sakvebismieri alergiis 90% ganpirobebulia kvercxze, rZeze, araqisze,
soiosa da xorbalze reaqciiT. bavSvTa 75%-Si vlindeba sakvebismiri alergia mxolod
erT produqtze, gamonaklisia alergiuli eozinofiluri gastroenteriti, rodesac
vlindeba reaqcia mravali sakvebis mimarT.
mkurnaloba da prognozi. saukeTeso mkurnalobis meTodia sakvebi racionidan
sakvebi alergenis eliminacia. kuW-nawlavis traqtis simptomebis umravlesoba qreba
ramdenime dReSi, zogjer – ramdenime kviraSi. bavSvs, romelsac hqonda
sicocxlisTvis saSiSi IgE-ganpirobebuli reaqcia – anafilaqsia sakveb produqtze,
mudam unda hqondes epinefrinis da antihistaminuri preparatis gamoyenebis saSua-
leba.
Zroxis rZeze alergiis mqone Cvilebis minimum 30% alergiulia soios cilis
mimarTac. aseTi bavSvebis mdgomareoba umjobdesdeba hidrolizebuli cilis Semcveli
xelovnuri sakvebis gamoyenebisas, xolo 5%-Si gaumjobeseba miiRweva mxolod
aminomJavebamde daSlili formulis gamoyenebiT. ZuZuTi kvebaze myof proqtokolitis
mqone bavSvebis 50%-Tan mdgomareoba umjobesdeba dedis dietidan Zroxis rZis
amoRebis Semdeg. sxva SemTxvevaSi SesaZlebelia saWiro gaxdes hidrolizebuli
formulis gamoyeneba.
ara-IgE ganpirobebuli rZis cilaze hipermgrZnobelobis reaqciis mqone bavSvTa
85%-s simptomebi saerTod uqrebaT 3 wlis asakisaTvis. Zroxis an soios rZis cilaze
simptomebis Semcireba vlindeba ukve 1 wlis asakidan. rZis ganmeorebiT Setanisas
saWiroa Tavdapirvelad miawodon bavSvs mxolod 1 Cais kovzi an naklebi da
SemdgomSi gazardon misi raodenoba progresulad, Tu igi sakvebs kargad aitans.
SedarebiT ufrosma bavSvebma da mozrdilebmac SesaZlebelia dakargon maTi
momatebuli mgrZnobeloba sakvebis mimarT, romelic 1-2 wlis ganmavlobaSi amoRebuli
iqneba dietidan. araqisze, Txilze, Tevzsa da zRvis produqtebze alergiiT
ganpirobebuli simptomebi Cveulebriv ar qreba da mocemul produqtebze
sakvebismieri alergia grZeldeba mTeli cxovrebis manZilze.

4. wamlismieri alergia.
 definicia: wamlismieri alergia ganimarteba, rogorc organizmis
hipersensitiuroba farmakologiuri agentis mimarT. klinikuri manifestacia varirebs
zomieri simptomebidan anafilaqsiur reaqciamde. Simptomebis gamovlenis
mravalferovneba da xarisxi damokidebuli dozaze, farmakologiuri agentis
saxeobasa da organizmis individualur Taviseburebebze. yvelaze gavrcelebuli
farmakologiuri agenti wamlismier alergiebSi penicilinia. aseve mosalodnelia
alergiuli reaqciis ganviTareba aspirinze, lidokainze, kontrastul nivTierebasa da
sxva jgufis antibiotikebze.
anafilaqsia – poxieri ujredebisa da bazofilebidan biologiurad aqtiuri
nivTierebebis swrafi da moulodneli gamonTavisuflebis Sedegad viTardeba. am dros
adgili aqvs kanis, respiraciuli, kardiovaskuluri da gastrointerstinaluri
simptomebis ganviTarebas.
pediatriul praqtikaSi anafilaqsiis mizezebi gansxvavebulia samedicino
momsaxurebis safexuri mixedviT. pirveladi jandacvis dawesebulebebis doneze
anafilaqsiis mizezebi SesaZlebelia iyos medikamentebi an lateqsi. samedicino
dawesebulebis gareT anafilaqsiis mizezi SesaZlebelia iyos sakvebi da mwerebisa da
parazitebis toqsinebi. pediatriul praqtikaSi farmakologiuri agentiT
individualuri anafilaqsiuri reaqciis mizezi uxSiresad Semdegi medikamentebia:
penicilini, cefalosporinebi, sulfonamidebi, arasteroiduli anTebis sawinaaRmdego
preparatebi, opiatebi, miorelaqsantebi, vankomicini, deqstrani, Tiamini, vitamini B-12,
insulini, Tiopentali, adgilobrivi anestetikebi.
paTogenezi. anafilaqsiis uxSiresi mizezi poxieri ujredebis da bazofilebis
aqtivaciaa ujredebTan dakavSirebuli alergen – specifikuri IgE- molekulebis mier.
pacientebi unda Sexvedrilni iyvnen pasuxismgebel antigenTan, raTa Semdgom
warmoqmnan alergen-specifikuri antisxeulebi. umetes SemTxvevaSi bavSvi da mSobeli
ver ixseneben pirvel kontaqts alergenTan masensibilizebel agentTan ganmeorebiTi
Sexvedrisas, poxieri ujredebi da bazofilebi da aseve savaraudo makrofagebic
gamoimuSaveben mediatorebs (histamini, triptaza) da citokinebs, romelTac SeuZliaT
alergiis simptomebis gamovlena rogorc calkeul organoebSi, aseve mTel
organizmSi. IgE-ganpirobebuli reaqciis garda anafilaqsiis paTogenezSi
mniSvnelovania poxieri ujredebidan mediatorebis pirdapiri gamonTavisufleba
(anafilaqtoiduri reaqcia) iseTi medikamentebiT, rogoricaa morfini, aspirini
sisxlis produqtebi, radiaqtiuri preparatebi, dializis membranebi.
klinikuri manifestacia da diagnozi. klinikuri niSnebis gamovlena
mravalferovania da damokidebulia reaqciis mizezze. oraluri preparatebis
miRebisas ganviTarebuli anafilaqsia dagvianebulia (wuTebidan 2 saaTamde) da
ZiriTadad saWmlis momnelebeli sistemis dazianebis simptomatikiT mimdinareobs.
pirveli simptomebis gamovlena damokidebulia etiologiaze da moicavs Semdegs:
siTbos SegrZneba, urtikaria, angiodema, yelis tkivili, mSrali, Semawuxebeli xvela,
sunTqvis gaZneleba, cemineba, dispnoe, xmauriani, gaZnelebuli amosunTqva. kanis mxriv
gamovlinebebi ar gvxvdeba anafilaqsiis 20%-Si.
diagnostika. diagnozi ar warmoadgens sirTules kanisa da respiraciuli
gamovlinebebis erTobliobis SemTxvevaSi, gansakuTrebiT, Tu vlindeba hipotenziac.
diferenciuli diagnozi moicavs sxva etiologiis Soks - hemoragiuli, kardiogenuri,
septiuri.
mkurnaloba. anafilaqsiuri Soki gadaudebeli samedicino daxmarebisa da
intensiur mkurnalobas saWiroebs. gadaudebeli daxmareba moicavs intramuskularul
epinefrins, intramuskularul an intravenur H1 da H2 antihistamin-antagonistebs,
Jangbadis miwodebas, intravenuri siTxeebis tranfuzias, sainhalacio beta-agonistebis
gamoyenebas da kortikosteroidebs. pacientebs SesaZlebelia gamouvlindeT bifazuri
anafilaqsia - simptomebis xelaxali aRmoceneba xiluli gaumjobesebis Semdeg. am
fenomenis meqanizmi ucnobia. Tumca cxadia rom bifazur anafilaqsias adgili aqvs
gvian dawyebuli mkurnalobisa da mZimed mimdinare pirveli simptomebis SemTxvevaSi
bifazuri anafilaqsiis 90% vlindeba pirveli simptomebis gamovlenidan 4-saaTSi.
amitom pacientze meTalyureoba 4-saaTze metxans unda gagrZeldes misi gadaudebeli
daxmarebis ganyofilebidan gaweramde.
anafilaqsiis marTvisas medikamentebis dozireba.
epinefrini – 0.01 mg/kg. SesaZlebelia gakeTdes 0,3mg-mde, SesaZlebelia ganmeordes
10-15 wuTSi. cetirizini - 0.25 mg/kg/10 mg-mde PO. siTxis Semavseblebi – kristaloidebi
30 ml/kg-ze pirvel saaTebSi. koloidebi- 10 mg/kl-ze swrafad, Semdgom neli nakadiT.
beta agonisti – albuteroli 0,83 mg/kg. niRbiTa da JangbadTan erTad.
kortikosteroidebi – meTilprednizoloni 1-2 mg/kg. 125 mg-mde intravenurad.
prednizoloni 1 mg/kg. 75 mg-mde PO.

5. Sratismieri daavadeba:
tipi III hipersensitiuri reaqcia, romelic vlindeba ucxo cilis an Sratis
gadasxmis Sedegad. araSratis Semcvel medikamentebze tipi III hipersensitiurobis
reaqciiT mimdinare alergiul gamovlinebebs igive klinikuri gamovlinebebi aqvT, rac
Sratismier daavadebas.
yvela ucxo agents ar aqvs unari gamoiwvios Sratismieri daavadeba. reaqciis
ganviTareba damokidebulia agentis molekulur zomebze, agentis determinantebsa da
organizmis fiziologiur Taviseburebebze. antigenis Seyvanaze organizmi Sesabamis
imunur da alergiul pasuxze 4-10 dReSi ayalibebs. antisxeulebi kavSirdebian
antigenTan da mdgrad mocirkulire xsnad kompleqsebs qmnian. es kompleqsebi
xasiaTdebian sisxlZarRvebis kedelSi Calagebis unariT da Semdgom komplementis
aqtivacias iwveven.
Sratismieri daavadebis insidensi ukanasknel wlebSi Semcirda sayovelTao
vaqcinaciis gamo, radgan Semcirda specifiuri antitoqsiniT mkurnalobis
aucilebloba. bioteqnologiis ganviTarebis Sedegad aseve mniSvnelovnad Semcirda
sufTa Sratisa da sisxlis preparatebis gamoyenebis aucilebloba. dResdReobiT
Sratismieri daavadebebis ZiriTadi gamomwvevi mizezebi araSratis Semcveli
preparatebia. am SemTxvevaSi antigenis determinireba Zalian Znelia. dadgenilia
Sratismieri daavadebis Camoyalibeba sxvadasxva jgufis antibiotikebis mimarT.
simptomebi grZeldeba 1-2 kvira da Semdeg umetesad TavisiT alagdeba. mokvdaoba
Zalian iSviaTia da erTeuli SemTxvevebia aRwerili.
klinikuri niSnebi
pirveladi Sratismieri daavadeba vlindeba gamomwvevi agentis organizmSi
moxvedridan 6-21 dReSi. zogierTi agentis mimarT daavadebis klinikuri niSnebis
gamovlena SesaZlebelia ufro swrafad moxdes. klasikuri gamovlinebani moicavs
cxelebas, arTralgias, limfadenopaTias, kanis mxrivi reaqciebs infeqciis adgilas,
SesaZlebelia kunTebis tkivili, tkivili gulmkerdis areSi da sunTqvis gaZneleba.
gasinjvisas vlindeba kanis mxrivi cvlilebebi, cxeleba, limfadenopaTia, SeSupeba,
renuli, kardiovaskuluri, nevrologiuri da filtvismieri manifestaciebi.
kanismieri cvlilebebi gvxvdeba 95%-Si da moicavs urtikarias, qunTruSiseburi
gamonayars, makulopapuluri da purpuruli gamonayars, multiformuli eriTemas.
cxeleba gvxvdeba SemTxvevaTa 10-20%-Si, arTriti da arTralgia 10-15%-Si.
SesaZlebelia miozitis ganviTareba.
SeSupeba upiratesad lokalizebulia saxis da kisris areSi.
Tirkmlebis mxriv gvxvdeba proteinuria, mikrohematuria da oliguria.
gulsisxlZarRvTa sistemis mxriv mosalodnelia miokardiumisa da perikardiumis
anTeba, generalizirebuli vaskuliti iSviaTia.
nevrologiuri cvlilebebi - periferiuli neiropaTia, mxris wnulis nevriti,
optikuri nevriti, kraniuli nervebis parezebi, gien-baris sindromi, encefalomieliti.
filtvis mxriv mosalodnelia cianozi da dispnoe.
 diferenciuli diagnozi
multiformuli eriTema, mononukleozi, polimioziti, sistemuri wiTeli mglura,
dermatomioziti, vaskuliti, urtikaria.
laboratoriuli kvlevebi
komplementis gansazRvra, sisxlis saerTo analizi (leikocitozi an leikopenia,
eds-i momatebulia). Sardis analizi (proteinuria, hematuria).
mkurnaloba
gadaudebeli daxmarebis ganyofilebaSi mkurnaloba gulisxmobs mxolod im
preparatebis miRebis Sewyvetas, romelTac gamoiwvies Sratismieri daavadebis
ganviTareba.
Terapiis mizania klinikuri niSnebis eliminacia cirkulirebadi imunuri
kompleqsebis damazianebeli efeqtis Semcirebis xarjze
antihistaminebi – histaminis gamonTavisuflebis Semcireba.
antipiretikebi – cxelebis, arTralgiis da mialgiis Sesamcireblad
kortikosteroidebi – anTebis sawinaaRmdego (kortikosteroidebi) da marilebis
Semakavebeli (mineralokortikoidebi) efeqtis gamo es es preparatebi imunuri pasuxis
modificirebas iwveven.