Клінічні аспекти гострої кропив’янки в дітей у практиці лікаря первинного та вторинного рівня надання медичної допомоги

Abstract

Purpose - to study the existing approaches of doctors to the diagnosis and treatment of acute urticaria in children at different stages of medical care. Materials and methods. Generalized experience of acute urticaria was presented in 89 children: retrospective analysis of medical records of 74 inpatients (group I) and 15 outpatients (group II). The data of anamnesis, complaints, objective examination of patients, results of laboratory research methods, composition of emergency therapy, treatment measures, monitoring of the dynamics of clinical symptoms were studied in detail. Results. The age structure of hospitalized patients is represented mainly by children of the first three years of life (43.24%), among whom infants of the first year of life predominated - 46.87%. Instead, among outpatients were mostly preschoolers and schoolchildren. The causes of urticaria were dominated by infectious factors (group I - 45.95%, group II - 40.0%), idiopathic variants were in 21.62% and 26.67% of cases, respectively. 36 patients (48.64%) of group I were taken to the clinic by the emergency medical team; parents of 13 children (17.57%) sought help on their own, the other were referred by a district doctor. However, 44.22% of patients were not diagnosed with urticaria at the initial examination. Combinations of urticaria with angioedema in both groups were not numerous (25.67% and 13.33%, respectively). It was found that parenteral taking of corticosteroids (80.55%) and first-generation of antihistamines (37.93%) was often used in children of group I at the prehospital stage. A similar situation occurred in patients with urticaria, which arose during hospital treatment for acute respiratory infections. In patients of group II, the appointment of second-generation antihistamines dominated (80.0%). Complete regression of urticaria in the first two days was observed in 56.8% of children of group I and 86.67% - group II. Conclusions. The generalization of the experience of managing children with acute urticaria demonstrates difficulties in making a differential diagnosis, in determining the indications for hospitalization, the choice of emergency medication by primary care physicians and emergency medicine. The high commitment of primary and secondary care physicians to the choice of parenteral route of appointment of emergency care (corticosteroids, first-generation antihistamines) is alarming. Provisions of international guidelines based on evidence-based medicine regarding the appointment of second-generation antihistamines as a first-line emergency, which have a good clinical effect and have no serious side effects, should be actively implemented. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests were declared by the authors. Key words: acute urticaria, children, emergency care, diagnosis.