1.

anafilaqsia
anafilaqsia aris mwvave I tipis zemgrZnobelobiT ganpirobebu-li alergiuli reaqciis sistemuri
gamovlineba. anafilaqsiuri reaq-ciis sinonimebia: generalizirebuli sistemuri reaqcia, sistemuri anafi-
laqsia, konstituciuri reaqcia, hipermgrZnobelobis gamoxatu-li re-aqcia da sxv. alergiis msoflio
organizaciis (WAO) mixedviT, ana-filaqsiis zusti gansazRvrebis Sesaxeb dRemde SeTanxmeba ar
aris miRweuli, rac arTulebs misi diagnostikis, mkurnalobis da menej-mentis procesebs. anafilaqsias
SesaZlebelia hqondes, rogorc aler-giuli, ise araalergiuli buneba. pirvel SemTxvevaSi anafilaqsiuri
reaqcia pirobiTad 3 etapad mimdinareobs: 1. antigenis (alergenis) da-kavSireba 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, ace-tilqolini, aseve de novo warmoqmnili mediatorebis – leikocitebi, citokinebi
da sxva masiuri gamonTavisufleba; 3. mediatorebis moqme-deba sisxlZarRvTa kedelze da sisxlis
Sededebis sistemaze; eozi-nofilebis, 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, ra-sac sicocxlisaTvis saSiSi sindromis – sistemuri anafilaqsiis gan-viTareba 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 saxel-wodebiT aris cnobili. anafilaqsiuri Soki mwvave, sicocxlisaTvis
saSiSi, swrafi tipis generalizirebuli alergiuli reaqciaa, rome-lic ZiriTadaT viTardeba wamlis
Seyvanis Semdeg im pirebSi, rom-lebsac konkretuli medikamentebisadmi specifiuri IgE klasis anti-
sxeulebi gaaCniaT; mweris Sxamisadmi alergiis mqone pirebSi, mweris kbenis Semdeg da a.S.
araalergiuli bunebis anafilaqsia IgE- antisxeulebisagan damo-kidebuli reaqciaa. misi
sinonimebia: `anafilaqtoiduri reaqcia~ (ana-filaqtoiduri, amJamad moZvelebuli terminia),
`fsevdoalergiuli~ da `araspecifiuri alergiuli reaqcia~. araalergiuli anafilaqsiis SemTxvevaSi
bioaqtiuri nivTierebebi poxieri ujredebidan da bazo-filebidan Tavisufldeba uSualod (imunologiuri
fazis gareSe) ga-momwvevi faqtorebis zegavleniT, rogorebicaa: arasteroiduli anTe-biTi preparatebi,
sisxlSi produqtebi, radiokontrastuli nivTiere-bebi, morfini, komplementis aqtivatorebi, fizikuri
datvirTva, yinva, mzis sxivebi.
etiologia. anafilaqsiis ganviTarebis yvelaze xSir mizezad samkurnalwamlo, vaqcinebi da
kvebiTi warmoSobis alergenebi gvevli-neba. anafilaqsiuri reaqcia SeiZleba ganviTardes mweris
nakbenze, diagnostikuri sinjebis dayenebis dros, specifiuri hiposensibili-zaciis pirobebSi. qvemoT mogvyavs
saqarTveloSi g. gurgeniZis da mi-si mowafeebis mier, im nivTierebaTa CamonaTvali, romlebic iwveven anafilaqsiur
reaqciebs (cxrili #79).

cxrili #79. nivTierebebi, romlebic iwveven anafilaqsiur reaqciebs

kvebiTi produqtebi sadiagnostiko saSualebebi antimikrobuli
saSualebebi
kvercxis cila+ rentgenokontrastuli saSualebebi+ penicilinebi+
rZe+ sulfabromoftaleini cefalosporinebi
moluskebi+ benzilpeniciloidi-polizini bacitracini
soio neomicini
nigozi+ cxenis Sratisagan momzadebuli prepa-ratebi polimiqsini B
kartofili tetraciklini
wiwibura tetanusis sawinaarmdego Srati qloramfenikoli
zuTxi difteriis sawinaarmdego Srati kanamicini
mango cilis sawinaarmdego Srati streptomicini
Warxali Sxamis sawinaarmdego Srati amfotericini B
Sokoladi antilimfocituri imunoglobulini sulfaminamidebi
gvirilis nayeni pentamidini
adgilobrivi saanesTezio saSualebebi
 forToxali tetrakaini vankomicini
mandarini lidokaini
mdogvi prokaini
araqisi+
kvebiTi danamatebi
tartrazini
polisaqaridebi hormonaluri saSualebebi fermentuli preparatebi
deqstrani insulini trifsini
gumiarabiki cxoveluri warmoSobis hipofizis hor-moni qimotrifsini
kortikotropini penicilinaza
vazopresini asparaginaza
eqstradioli qimopaini
cxoveluri warmoSobis paraTireoidu-li hormonebi
alergenTa eqstraqtebi+ sisxlis preparatebi sxvadasxva preparatebi
ambrozia imunomodulatorebi natriumis Tiopentili
sxva balaxeuli mcenareebi monoklonuri antisxeulebi opioidebi
obis sokoebi interleikini-2 vitaminebi
cxovelTa epidermisi interleikini , β, Y heparini
aspirini da anTebis sawinaaRmdego sxva saSualebebi +
Lateqsi
cxovelebis Sxami da nerwyvi
SeniSvna: + anafilaqsiuri reaqciebis yvelaze xSiri mizezebi
rogorc cxrilidan Cans, antimikrobuli saSualebebidan gansa-kuTrebiT sayuradReboa penicilinis jgufis preparatebi da
lateq-sis 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 he-moragiiT, traqeis SeSupebiT, mTels organizmSi
sisxlZarRvTa gamav-lobis gazrdis Sedegad ganviTarebuli sisxlis wnevis katastrofu-li dacemiT, kardialuri ariTmiiT da
sinkopeTi.
klinika. anafilaqsiuri reaqcia xasiaTdeba klinikuri gamovli-nebis mravalferovnebiT. sistemur gamovlinebebs Soris
aris sasun-Tqi da gul-sisxlZarRvTa sistemebis, kuW-nawlavis traqtis da kanis dazianebebi. urtikaria da angiodema
klinikuri manifestaciis xSiri gamovlinebaa. respiratoruli komponenti da kardiovaskularuli ko-lafsi gansakuTrebiT
mniSvnelovania, vinaidan isini fataluri Sede-gis ZiriTad mizezs warmoadgenen.
anafilaqsiis simZimis xarisxi da konkretuli gamovlinebani di-dad aris damokidebuli organizmSi alergenis SeWris
gzebze (paren-teraluri, peroraluri), aseve reaqciis ganviTarebis siswrafeze. rac ufro swrafad viTardeba anafilaqsiuri
reaqcia, miT ufro mZimed mimdinareobs da miT maRalia riski fataluri gamosavlis. rig Sem-TxvevebSi, 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 cxvi-ris lorwovanebis SeSupebiT. adgili aqvs qavils, cremldenas, cxvirceminebas,
simptomebi vlindeba alergenTan kontraqtis Semdeg 2 saaTis ganmavlobaSi. maTi xangrZlivoba ar aRemateba 1-2 dRes.
saSu-alo simZimis anafilaqsiuri reaqciebi – damaxasiaTebelia respirato-ruli komponenti (bronqospazmi, xorxis,
bronqebis SeSupeba), rome-lic vlindeba sunTqvis gaZnelebiT, xveliT. SesaZlebelia urtika-riis da angioSeSupebis
ganviTareba. xSiria mousvenroba, gulisreva, Rebineba, generalizirebuli qavili. Semdeg simptomebis dawyeba da
ganviTarebis xangrZlivoba iseTivea, rogorc msubuqi formis dros.
mZime anafilaqsiuri reaqciebi – iwyeba moulodnelad. ramodenime wuTis ganmavlobaSi viTardeba gamoxatuli
bronqospazmi, xorxis Se-Supeba, rac vlindeba xveliT, qoSiniT, cianoziT, disfoniiT – zog-jer 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 gan-vladobis momateba iwvevs arteriuli wnevis
dacemas, gulis riTmis darRvevas, Soks da komas. rac ufro swrafad viTardeba anafilaqsi-uri reaqciebi, procesebi miT
ufro mZimed mimdinareobs. sikvdilis yvelaze xSir mizezs bavSvebSi warmoadgens xorxis SeSupeba da mo-gudva.
gadatanili anafilaqsiuri reaqciis Semdeg, misi gamovlineba-ni TandaTan mcirdeba, Tumca 2-24 saTis Semdeg isini
SeiZleba kvlav gaZlierdes.
diagnozi. anamnezs gadamwyveti mniSvneloba eniWeba anafilaqsiis gamomwvevi mizezis dadgenaSi.
diagnostikuri Rirebuleba eniWeba ag-reTve 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 icod-nen anafilaqsiisagan gamomwvevi yvela safrTxis mniSvneloba, ukav-Sirdeba 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 miekuT-vneba da miTiTebuli unda iyos gamomwvevis dasaxeleba. pacientebs anafi-laqsiuri
reaqciebiT anamnezSi, yvela preparati eniSneba mkacri Cve-nebis gaTvaliswinebiT, upiretasoba eZleva per os misaReb
prepara-tebs. anamnezSi preparatze alergiis arsebobis SemTxvevaSi unda Ca-tardes kanis sinjebi da specifiuri IgE-s
gansazRvra SratSi.
anafilaqsiuri reaqciebis mkurnaloba – damokidebulia simZimis xarisxze. mZime anafilaqsia, rogorc sicocxlisaTvis
saSiSi mdgoma-reoba, moiTxovs gadaudebel intervencias. mimarTuli unda iyos sa-sicocxlos funqciebis aRdgenisaken,
poxieri ujredebidan gamoTavi-suflebuli mediatorebis neitralizaciisaken. saswrafod unda Se-fasdes sasunTqi gzebis
gamavloba, garegani sunTqvis da hemodinami-kis maCveneblebi.
- pacients aTavseben zurgze, ise, rom Tavi mdebareobs fexebTan Seda-rebiT ufro dabla, raTa gaumjobedes hemodinamika.
aRniSnuli RonisZieba orTostatuli hipotenziis prevenciaa da aumjobesebs Ta-vis, gulis da Tirkmelebis sisxliT momaragebas.
- aeromomaragebis gaumjobesebis mizniT pacients miewodeba Jangbadi niR-biT an kanuliT. amwovis saSualebiT awarmoeben
sasunTqi gzebis ganTa-visuflebas lorwosa da naRebinebi masisgan. zemo sasunTqi gzebis ga-moxatuli 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 singer-
laqtatis intravenuri infuzia. sainfuzio siTxe bavSvebma unda miiRos 30 ml/kg pirveli 1 saaTis ganmavlobaSi.
- anafilaqsiis dros arCevis preparati aris epinefrini, romelic gamoi-yeneba 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, ro-ca epinefrinis efeqti ar aris
sakmarisi anafilaqsiis simptomebis mo-saxsnelad).
- H2 – blokatorebidan (rogorc II rigis preparatebi) gamoiyeneba rani-tidini – 1 mg/kg wonaze bavSvebSi, 5%-ian 20 ml
deqstrozasTan erTad, intravenurad 5 wuTis ganmavlobaSi.
- im SemTxvevaSi, rodesac bronqospazmi ar ixsneba miuxedavad epinefri-nis gamoyenebisa, ganixileba β2-agonistebis
gamoyenebis sakiTxi (al-buteroli 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. SemanarCu-nebeli Terapiis mizniT gamoiyeneba H1
agonistebi da gk 3-5 dRis xan-grZlivobiT 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 monacvleo-biT. atopuri dermatitis (ad)
klinikuri niSnebi SesaZlebelia gamov-lindes mozrdil asakSic.
epidemiologia. SemTxvevaTa 45%-Si ad vlindeba sicocxlis pir-veli 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 kvle-vam 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 asak-Si SesaZlebalia gamoixatos rinitis da/an asTmis
ganviTareba e.w “alergiuli marSi”. ad-s mqone bavSvTa daaxloebiT 30-50%-s uviTar-deba asTma, 35%-s ki alergiuli
riniti.
etiopaTogenezi. ad paTofiziologia aris genebis, infeqciur agentebis, garemos, kanis barieruli funqciis defeqtisa da
imuno-logiuri pasuxis kompleqsuri urTierTqmedebis Sedegi, rac iwvevs kanis damaxasiaTebel dazianebas. ad-s dros
anTebiT procesSi mona-wileoben 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 (romle-
bic 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), aeroa-lergenebi (gansakuTrebiT 3 wlis Semdeg), alergenebTan
uSualo Se-xeba (oTaxis mtvris tkipebi, mcenareebi, cxovelis bewvi, adamianis qertli, obis sokoebi da sxv.). kvebiTi alergenebi
ad-s gamSveb faq-torad ZiriTadad adreul asakSi gvevlinebian.
 stresi – zusti meqanizmi ar aris cnobili, Tumca savaraudoa ne-iroimunologiuri faqtorebis (neiropeptidebi – P substancia, nei-
ronebis zrdis faqtori) moqmedeba.
 mikroorganizmebi –S. Aureus, martivi herpesis virusi, virusuli in-feqciebi (gansakuTrebiT zemo sasunTqi gzebis), safuaris
soko Malassezia, kandida (iSviaTad), dermatofitebi.
 autoantigenebi – autoreaqtiuloba sakuTari cilebis mimarT xSi-rad 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 virusu-li infeqciebiT, rogoricaa martivi herpesi,
kontagiozuri moluski da meWeWi.
klinika. ad-s dros kanis dazianebas Cvilebsa da bavSvebSi aqvs damaxasiaTebeli lokalizacia – Tavis Tmiani nawili,
warbebi, loye-bi, nikapi, aseve tani, kidurebis gamSleli zedapirebi, majebi da mtev-nebis zurgi (ix. suraTi #78).
axasiaTebs buStebis warmoqmna, gamona-deni, 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 moz-rdilebSi)
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 infraorbitaluri 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 # 78 atopuri dermatiti: a. eqskoriacia majis areSi; b. 4 Tvis Cvili, saxis midamoSi gamoxatulia anTeba

Cvilebs da bavSvebs axasiaTebT Zlieri qaviliT mimdinare papu-lovezikuluri dazianeba eqskoriaciebiTa da serozuli
eqsudaciiT. qavili gansakuTrebiT Zlierdeba Ramis saaTebSi. daavadebas simZimis mixedviT yofen:
  msubuqi – kanis mSrali ubnebi, iSviaTi qavili, yoveldRiur aqtivo-baze minimaluri gavlena, Zilis darRvevebis gareSe.
 saSualo simZimis - kanis mSrali ubnebi, xSiri qavili, siwiTle, eq-skoriacia, 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 egze-matozuri 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 paci-entis anamnezis Segrovebas, kanis da sisxlis
specifiur da provoka-ciul testebs.
atopuri dermatitis gamSvebi/maprovocirebeli faqtorebis dad-gena 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 infeq-ciuri daavadebis, agreTve imunodeficituri paTologiebis gamoric-xva. 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 Se-ferxebiT metad mniSvnelovania
histiocitozis gamoricxva. atopuri dermatitis gamonayaris msgavsi elementebiT xasiaTdeba viskotol-driCis sindromi (X
qromosomas SeWiduli recesiuli daavadeba), ro-melis 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 derma-titi da morecidive baqteriuli infeqciebi. atopuri
dermatitis di-ferencireba saWiroa agreTve kontaqturi, eqsfoliaciuri, seboreu-li 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 ga-uareseba
 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 faq-torebis identifikacias da maTi
moqmedebis Tavidan acilebas.
mkurnaloba damokidebulia daavadebis simZimeze da gulisxmobs mkurnalobis safexurebriv princips. mkurnaloba
iwyeba an dabali sa-fexuridan da mere xdeba maRla asvla an piriqiT.
 I safexuri: rodesac ar aris gamwvavebis niSnebi da saxezea mxo-lod kanis simSrale mimdinareobs bazisuri
mkurnaloba - kanis da-tenianeba, damarbileblebis gamoyeneba, gamRizianeblebis Tavidan aci-leba, specifiuri
gamSveb/maprovocirebeli faqtorebis identifika-cia da maTi moqmedebis Tavidan acileba.
II safexuri: msubuqi/saSualo simZimis ad-s dros bazisur Tera-piasTan 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 ultaiis-feri sxivebiT mkurnaloba da sxva.
nebismier safexurze SesaZlebelia antihistaminuri preparatebis gamoyeneba atopuri dermatitis Tanmxlebi qavilis
Sesamcireblad. rodesac romelime safexurze miiReba efeqti, saWiroa erTi safexu-riT qvemoT Camosvla.
ad-is mkurnalobaSi mniSvnelovania gamSvebi/maprovocirebeli faqtorebis eliminacia.
qavilis Semcirebis mizniT rekomendebulia uxSiresi gamRizia-neblebis (saponi, parfiumeria, Sali, qimiuri
nivTierebebi) moqmedebis Tavidan acileba. agreTve metad mniSvnelovania temperaturisa da te-nianobis kontroli.
aeroalergenebi, rogoricaa oTaxis mtvris tki-pasTan, cxovelur alergenebTan da mcenaris mtverTan kontaqti mini-
mumamde 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 sim-Srale, rac gamowveulia wylis dakargviT da kanis
barieruli fun-qciis darRveviT. simSrale iwvevs epiTeliumis dazianebas, is Semava-li xdeba kanis mikrobebisa da
alergenebisaTvis, viTardeba qavili da anTeba. damarbileblebis regularuli gamoyeneba kanis dateniane-basTan erTad ad-
s mkurnalobis safuZvelia. damarbileblebi losio-nis, 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 ganmav-lobSi da tenianobis
SesanarCuneblad damarbileblis wasma, Svebas aZlevs pacients.
topikuri (adgilobrivi) kortikosteroidebi: tks I rigis prepara-tia ad-s gamwvavebis dros. dabali potenciis
kotrikosteroidebi re-komendebulia SemanarCunebeli TerapiisTvis, saSualo da maRali po-tenciis steroidebi ki
gamoyenebuli unda iyos klinikuri gamwvave-bis dros xanmokle droiT. tks unda waesvas mxolod kanis daziane-bul
ubanze. lorwovani garsidan, genitaliebidan, quTuToebidan, sa-xidan, 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 Ta-vi unda SevikavoT sicxesa da tenian klimatSi. sadReisod
rekomen-debuli ar aris tks-is dReSi 2 jer metad gamoyeneba. ad-s gamwvave-bis samkurnalod tks SeiZleba
gamoyenebuli iqnas 4 kviris ganmav-lobaSi, 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
saSua-lo simZimis atopiuri dermatitis dros. bavSvebSi takrolimusis (0,03%) malamo gamoiyeneba 2 wlis Semdeg, dReSi
2-jer maqsimum 3 kvi-ris ganmavlobaSi, Semdeg gamoiyeneba dReSi erTxel sanam cvlilebe-bi 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 hidrokorti-zonze
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 Se-iZleba 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 rinokoniun-qtiviti, urtikaria _ arsebobis dros.
sedatiuri antihistaminuri preparatebi gamoiyeneba Zilis darRvevebis dros
sistemuri glukokortikosteroidebi SeiZleba gamoyenebuli iyos mZime, daumorCilebeli qronikuli ad-s dros
bavSvebSi. rekomende-bulia 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 antivi-rusuli Terapia acikloviriT an sxva antivirusuli
agentebiT. so-kovani kolonizaciisas saWiroa sistemuri Terapia antifunguri pre-paratebiT mag.: ketokonazoliT,
flukonazoliT da sxva.
pacientis ganaTleba ad-ze efeqturi kontrolis mosapoveblad mniSvnelovania pacientebis (maTi ojaxis ganaTleba)
ad-s mimdinare-obis, 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 gaTvalis-winebiT klasikurad 2 tipad iyofa: sakvebis
mimarT autanloba da sak-vebismieri alergia. sakvebismieri alergia warmoadgens darRvevTa jgufs, romelic
ganpirobebulia specifikur kvebiT alergenebze or-ganizmis sapasuxo imunologiuri 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 pir-vel 3 wlis ganmavlobaSi. zogierTi
kvlevis mixedviT bavSvTa daax-loebiT 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 pro-duqtebze alergia narCundeba mTeli cxovrebis manZilze.
etiopaTogenezi. sakvebismieri alergiuli reaqciebi SeiZleba iyos 2 saxis, IgE meqanizmiT ganpirobebuli da ara IgE,
anu ujreduli re-aqciebiT ganpirobebuli. IgE ganpirobebuli reaqcia gamowveulia sak-vebismieri alergenebis
SekavSirebiT poxieri ujredebisa da bazofi-lebis zedapirze IgE-s dafiqsirebasTan, rasac mosdevs maTi degranu-lacia da
anTebiTi mediatorebis gamoTavisufleba. IgE ganpirobebu-li reaqcia asocirdeba simptomebis swraf dauyovnebel
ganviTare-basTan. ara IgE meqanizmi ukavSirdeba ujredul reaqcias, aseT SemT-xvevaSi 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 ganpi-robebulia Sereuli IgE da ujreduli reaqciebiT, rac xSir SemTxve-vaSi vlindeba qronikuli paTologiebiT
(atopuri dermatiti, bron-quli asTma da sxv.)
klinika. sakvebis antigenebze alergiuli reqacia SeiZleba gamov-lindes respiraciuli darRvevebiT, kanisa da kuW-
nawlavis traqtis dazianebis simptomebiT. Cvilebsa da adreuli asakis bavSvebSi sakve-bimieri alergiis mraval
gamovlinebas Soris dominirebs kuW-nawla-vis traqtis darRvevaTa simptomebi.
oraluri alergiuli sindromi: pir-xaxis doneze alergenTan kon-taqtis SemTxvevaSi viTardeba qavili, yurebSi Suili,
tuCis, enis, sa-sis angionevrozuli SeSupeba, xSirad amas erTvis yuris qavilis Seg-rZneba. mocemuli simptomebTan
erTad SesaZlebelia ganviTardes ale-rgiis sxva gamovlinebebic. xSiria alergiuli reaqciebi mcenaris mtverze - e.w. Tivis
cxeleba. eriTema saxis areSi, romelic gamoixa-teba citrusTan an pomidorTan kontaqtis Semdeg ar ganixileba ro-gorc
imunuri pasuxi.
kuW-nawlavis traqtis anafilaqsia: sakvebi alergenis miRebis sa-pasuxod vlindeba gulisrevis SegrZneba, mwvave
SeteviTi muclis tkivili, Rebineba, SesaZlebelia gamoixatos agreTve diarea da de-hidratacia. yvelaze xSirad simptomebi
vlindeba iseT cilovani an-tigenebis mimarT, rogoricaa rZe, kvercxi, araqisi, soio, marcvleuli da Tevzi. SesaZlebelia
gamoxatuli iyos IgE ganpirobebul reaqcie-biT gamowveuli sxva simptomebic.
sakvebismieri alergiis sxva gamovlinebebi: sakvebismieri alergia SesaZlebelia gamoixatos kanis mxriv
gamovlinebebiT, kerZod, atopu-ri dermatitiT (egzema), mwvave urtikariiTa da angionevrozuli Se-SupebiT. Cveulebriv
atopuri dermatitis mqone bavSvTa mesameds uv-lindeba 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 SeiZ-leba gamoixatos respiraciuli gamovlinebebiT, romelic iSviTad
gvxvdeba izolirebuli saxiT. sakvebismieri alergiis dros SesaZle-belia gamovlindes rinokoniuqtivitis simptomebi (Tvalis
irgvlivi qavili, cremldena, nazaluri obstruqcia, cxvircemineba, rinorea), romlebic tipurad vlindeba alergiis sxva
uxSiresad kanismxriv gamovlinebebTan erTad. SemTxvevaTa 25 % vlindeba vizingi.
gasaTvaliswinebelia, rom sakvebismieri alergia yvelaze xSirad iwvevs anafilaqsiur reaqciebs. kanis, respiraciuli da
gastrointes-tinuri simptomebis swrafad ganviTarebasTan erTad SeiZleba gamov-lindes cvlilebebi kardiovaskuluri
sistemis mxriv, rogoricaa hi-potenzia, sisxlZarRvTa kolafsi, ariTmia, rac uxSiresad ganpirobe-bulia poxieri ujredebidan
anTebiTi mediatorebis masiuri gamoTa-visuflebiT. sicocxlisTvis saSiSi sakvebismieri anafilaqsiuri re-aqcia uxSiresad
vlindeba iseT sakvebze rogoricaa araqisi, Txili, Tevzi da zRvis produqtebi. aseT pacientebs xSirad aqvT bronquli asTmis
anamnezi.
Sereuli (IgE da ara IgE ganpirobebuli) hipersensitiuroba sak-vebze: mocemuli tipis darRvevebs axasiaTebs
procesSi CarTuli spe-cifiuri organos intensiuri eozinofiluri infiltracia, romelmac SeiZleba moicvas mag. kuWisa da
wvrili nawlavebis lorwovani, kun-Tovani an serozuli garsebi. kunTovani garsis CarTva anTebiT pro-cesSi iwvevs mis
gasqelebas da kvanZebis warmoqmnas, rasac moyveba obstruqciis simptomebi (muclis tkivili, Rebineba), maSin rodesac
serozuli infiltraciis SemTxvevaSi viTardeba eozinofiluri as-citi. 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 xasi-aTdeba saylapavi milis lorwovani garsis intensiuri
eozinofiluri infiltraciiT. paTologia SeiZleba gamovlindes nebismier asakSi Cvilobidan mozardobis periodamde. mcire
asakis bavSvebSi igi Ziri-Tadad 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 sa-winaaRmdego mkurnaloba araefeqturia. mcire asakis bavSvebSi
mkur-naloba 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,
Rebine-biT (naRebineb masaSi xSirad SeimCneva sisxliani minarevi), anoreqsi-iT, wonis dune namatiT, iSviaT
SemTxvevaSi kuWidan sakvebis gadas-vlis darRveviT. mcire asakis bavSvebSi man SeiZleba datovos pilo-rostenozis
STabeWdileba. atopiis gamovlinebebi - IgE donis momate-ba, periferiuli eozinofilia vlindeba pacientTa 50%-Si. kuWis
bi-ofsiiT dasturdeba lorwovani da lorwqveSa Sris mkveTri eozino-filuri infiltracia, gansakuTrebiT Sesaval nawilSi.
alergiuli eozinofiluri gastroenterokoliti: mocemuli prob-lemis mqone pacientebs uvlindebaT igive simptomebi,
romelic yurad-Rebas 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 si-cocxlis pirvel TveebSi (1-3 Tve) msubuqi diareiT, ganavalSi
Seim-Cneva sisxlis da lorwos minarevi, aseve SesaZlebelia gamovlindes ganavalSi leikocitebis raodenobis momateba,
xolo sisxlSi ki eo-zinofilia. tipurad vlindeba koliti, limfoiduri kvanZebis hiper-plazia, rac gamoxatulia SemTxvevaTa 25
%-Si. uxSiresad proqtoko-liti ganpirobebulia Zroxis rZeze hipersensiturobiT, SedarebiT iSviaTia momatebuli
mgrZnobeloba soios rZeze. mocemuli problema SeiZleba gamovlindes eqskluziur ZuZuTi kvebaze myof pacienetebSi
dedis dietis cvlilebebis da xSirad masSi rZis produqtebis gamo-yenebis Semdeg. xelovnur kvebaze myofi bavSvebi
saWiroeben kvebis cvlilebas da cilovan hidrolizebul formulaze gadayvanas.
sakvebiT ganpirobebli enterokoliti: enterokoliti vlindeba si-cocxlis pirveli kviridan 3 Tvemde asakSi persistiuli
RebinebiTa da diareiT, romelic xSirad iwvevs dehidratacias. Rebineba vlinde-ba Wamidan 1-3 sT-is Semdeg. ufrosi
asakis bavSvebSi daavadeba vlin-deba SedarebiT msubuqad. SeiZleba gamoxatuli iyos sisxliani dia-rea, muclis Seberva.
ganavali Seicavs sisxls, neitrofilebsa da eo-zinofilebs. msxvili nawlavis biofsiiT vlindeba xaoebis gadaswore-ba,
SeSupeba da anTebiTi ujredebi. entrokolitis simptomebi qreba sakvebi alergenis racionidan amoRebis Semdeg 72 sT-Si.
bavSvs Zro-xis rZis miRebis Semdeg SeiZleba gamouvlindes anemia, hipoproteine-mia da zrdis Seferxeba. Cveuli
gamovlinebaa eozinofilia. hidroli-zebuli an aminomJavebis Semcveli formula mocemuli paTologiis saukeTeso
samkurnalo saSualebaa.
sakvebiT ganpirobebuli enteropaTia: Cveulebriv vlindeba si-cocxlis pirvel TveebSi diareiT, RebinebiT,
araiSviaTad steatore-iT, muclis SeberviT, adre danayrebis SegrZnebiT, malabsorbciaiTa da zrda-ganviTarebis
SeferxebiT. wvrili nawlavis biofsiiT vlin-deba xaoebis araerTgvarovani atrofia da anTebiTi infiltracia mo-nonukleuri
ujredebiT. enteropaTiis gamomwvevi sakvebis amoRebis Semdeg daavadebis simptomebis gaqrobas SesaZlebelia
daWirdes ram-denime 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 epi-Teliumis dazianebiTa da xaoebis hoperplaziiT. celiakia gadaecema autosomur-dominanturi
damemkvidrebis tipiT. genetikuri predispo-ziciisas nawlavis lorewovan garsSi xdeba T limfocitebis aqtiva-cia da
ujreduli imunuri pasuxi glutenis SemadgenlobaSi myofi gliadinis fraqciis (transglutaminaza) mimarT. klinikurad
gamoxa-tulia malabsorbciis suraTi, qronikuli diarea, muclis Seberva, e.w. fsevdoasciti, polifekalia, wonis deficiti da
zrdaSi Sefer-xeba.
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 ce-liakiasTan. daavadebis mkurnlobis aucilebel princips kvebis raci-onidan glutenis Semcveli
sakvebis amoReba warmoadgens.
filtvismieri hemosiderozi (heineris sindromi): filtvismieri he-mosiderozi vlindeba infiltratebiT, gastroenteruli da
pulmo-nuri sisxldeniT, rkina-deficituri anemiiT, periferiuli eozinofi-liiT da zrda ganviTarebis SeferxebiT. daavadeba
uxSiresad asoci-rebulia Zroxis rZis proteinis gamoyenebasTan. daavadebis simptomebi ukuganviTarebas ganicdis
gamRizianebeli sakvebis dietidan elimina-ciis Semdeg.
diagnozi. sakvebismier alergiaze eWvis mitana SesaZlebelia, ro-desac vlindeba tipuri simptomebi specifikuri
sakvebis racionSi Se-tanis Semdeg. saWiroa sxva araalergiuli meqanizmebiT ganpirobebu-li sakvebis autanlobis
(monelebisa da Sewovis darRveva, sakvebis kontaminacia mikrobebiTa da toqinebiT, sakvebis farmakologiuri aq-
tivoba). Zroxis rZeze alergiis saeWvo SemTxvevebSi aucilebelia laqtozis ukmarisobis gamoricxva. eliminaciuri dieta da
Semdgom-Si 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 me-TodiT. Ria cda sakvebze (Open food challenges) marTalia gacilebiT uf-ro
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 radioalegosorbentis testis (RAST) gamoyene-biT SesaZlebelia ganisazRvros sakvebismieri alergia
IgE-ganpirobe-buli alergiuli reaqciiTaa ganpirobebuli, Tu ara. nebismier asakSi SesaZlebelia ganisazRvros IgE done,
vinaidan misi gamomuSaveba iw-yeba gestaciis 24 kviridan. negatiuri IgE testi gansakuTrebiT 1 wel-ze 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 hqon-daT dadebiTi reaqcia ormagi brma, placebo kontrolirebadi sakve-biT datvirTvaze. IgE
done ar aris informatiuli sakvebismieri alergiis diagnostikisTvis.
 CvilebSi hipersensiturobis uxSires mizezs warmoadgens Zroxis an soios rZis cila. ZuZuTi kveba axdens
sakvebismieri alergiis pre-vencias, Tumca aseT SemTxvevaSic SesaZlebelia gamovlindes alergi-uli proqtokoliti. ZuZuTi
kvebaze myof CvilebSi sakvebismieri alergiis uxSires mizezs warmoadgens dedis racionSi Zroxis rZis gamoyeneba,
SedarebiT iSviaTad misi mizezia araqisis, soios an kver-cxis miReba.
bavSvebSi sakvebismieri alergiis 90% ganpiroebebulia kvercxze, rZeze, araqisze, soiosa da xorbalze reaqciiT.
bavSvTa 75%-Si vlin-deba sakvebismiri alergia mxolod erT produqtze, gamonaklisia alergiuli eozinofiluri
gastroenteriti, rodesac vlindeba reaq-cia mravali sakvebis mimarT.
mkurnaloba da prognozi. saukeTeso mkurnalobis meTodia sakve-bi racionidan sakvebi alergenis eliminacia.
kuW-nawlavis traqtis simptomebis umravlesoba qreba ramdenime dReSi, zogjer – ramdeni-me kviraSi. bavSvs,
romelsac hqonda sicocxlisTvis saSiSi IgE-ganpi-robebuli reaqcia – anafilaqsia sakveb produqtze, mudam unda hqon-
des epinefrinis da antihisptaminuri 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 ga-zardon misi
raodenoba progresulad Tu igi sakvebs kargad aitans. SedarebiT ufrosma bavSvebma da mozrdilebmac SesaZlebelia
dakar-gon 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.

Ddefinicia: 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 mier biologiurad aqtiuri nivTierebebis swrafi da moulodneli
gamontavisuflebis Sedegad viTardeba. Am dros adgili aqvs kanis, respiraciuli, kardiovaskularuli da gastrointerstinaluri
simptomebis ganviTarebas.
pediatriul praqtikaSi anafilaqsiis mizezebi gansxvavebulia samedicino momsaxureobis 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, romelac SeZliaT alergiis
simptomebis gamovlena rogorc calkeul organoebSi aseve mTel organizmSi. Garda IgE- ganpirobebuli reaqciisa da
anafilaqsiis paTogenezSi. mniSvnelovania poxieri ujredebidan mediatorebis pirdapiri gamonTavisufleba (anafilaqtoiduri
reaqcia)- iseTi medikamentebiT rogoricaa morfini, darRvevebi leikotrienebis metabolizmSi – aspirini da arasteroiduli
anTebis sawinaaRmdego preparatebi komplementis aqtivaciis da imunuri agregacia – sisxlis produqtebi da SesaZlo
komplementis aqtivacia – 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 ZiriTad
saWmlis momnelebeli sistemis dazianebis simptomatikiT mimdinareobs. Pirveli simptomebis gamovlena damokidebulia
etiologiaze da moicavs Semdegs prioriteti piris irgvliv da saxeze, siTbos SegrZnebas, urtikaria, angioderma, yelis tkivili,
mSrali, Semawuxebeli xvela, sunTqvis gazneleba, cemineba, dispnoe, xmauriani gaZnelebuli amosunTqva (weezing).
gulisreva, Rebineba, kanis mxriv gamovlinebebi ar gvxvdeba anafilaqsiis 20%-Si.
 diagnostika: diagnozi ar warmoadgens sirTules kanisa da respiraciuli gamovlinebebis erTobliobis SemTxvevaSi,
gansakuTrebiT Tu hipotenziac vlindeba diferencialuri diagnozi moicavs sxva etiologiis Soks, hemoragiuli, kardiogenuri,
septiuri).
mkurnaloba: anafilaqsiuri Soki gadaudebeli samedicino daxmarebisa da intensiur mkurnalobas saWiroebs.
Gadaudebeli daxmareba moicavs intramuskularuli epinefrinis. Intramuskularuli an intravenuri 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 – 0.01mg/kg. SesaZlebelia gakeTdes o.3mg-mde, SesaZlebelia ganmeordes 10-15 wuTSi. Citirizini
(antihistamini) 0.25mg/kg/10mg-mde PO. siTxis Semavseblebi – kristaloidebi 30ml/kg-ze pirvel saaTebSi. Koloidebi-
10mg/kl-ze swrafad, Semdgom neli nakadiT. Beta agonisti – albuteroli 0,83mg/kg. niRbiTa da JangbadTan erTad.
Kortikosteroidebi – meTilprednizoloni 1-2mg/kg. 125 mg-mde intravenurad. Prednizoloni 1mg/kg. 75mg-mde PO.

5. Sratimieri daavadeba:

tipi III hipersensitiuri reaqcia, romelic vlindeba heterologiuri 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 zomebs. Agentis determinantebsa da organizmis fiziologiur Taviseburebebze antigenis Seyvanaze
organizmSi Sesabamis imunologiur 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, aseve bioteqnologiis ganviTarebis Sedegad mniSvnelovnad Semcirda
aucilebloba sufTa Sratisa da sisxlis preparatebis gamoyenebis 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 cxeleba, arTralgia, limfadenopaTia, kanis mxrivi reaqciebi infeqciis adgilas SesaZlebelia
kunTebis tkivili, tkivili gulmkerdis areSi da sunTqvis gaZneleba.
Ggasinjvisas vlindeba kanis mxrivi cvlilebebi, cxeleba, limfadenopaTia, SeSupeba, renaluri, kardiovaskularuli,
nevrologiuri da filtvismieri manifestaciebi.
Kkanismieri cvlilebebi gvxvdeba 95%-Si da moicavs urtikaria, qunTruSiseburi gamonayari, makulopapuluri da
purpuruli gamonayari, multiformuli eriTema.
cxeleba gvxvdeba SemTxvevaTa 10-20%-Si. arTriti da arTralgia 10-15%-Si SesaZlebelia alergia da miozitis
ganviTareba.
SeSupeba upiratesad lokalizebulia saxis da kisris areSi.
Tirkmlebis mxriv gvxvdeba- proteinuria, mikrohematuria da oliguria, Tumca Tirkmlis mxriv xiluli daavadebis
gamovlena ar aris.
gulsisxlZarRvTa sistemis mxriv mosalodnelia miokardiumisa da perikardiumis anTeba generalizirebuli vaskuliti
iSviaTia.
nevrologiuri cvlilebebi- periferiuli neiropaTia, mxris wnulis nevriti, optikuri nevriti, kranialuri nervebis parezebi,
gilen-baris sindromi encefalomieliti.
filtvis mxriv mosalodnelia cianozi da dispnoea mosalodnelia.
diferencialuri 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 damazianebis efeqtis Semcirebis
xarjze
antihistaminebi – histaminis gamonTavisuflebis Semcireba.
antipirentikebi – cxelebis, arTralgiis da mialgiis Sesamcireblad
kortikosteroidebi – anTebis sawinaaRmdego (kortikosteroidebi) da marilebis Semakavebeli (mineralokortikoidebi)
efeqtis gamo es es preparatebi imunuri pasuxis modificirebas iwveven.