The main goals of therapy are to weaken the immunological reaction, eliminate the allergen present in the body and prevent further contact with it.
For this purpose, a number of therapeutic measures are used in immunology, their specific plan depends on many factors – the severity of the phenomenon, the duration of exposure of the antigen, its nature and quantity in the body.
Attention should also be paid to local treatment aimed at alleviating the symptoms, accelerating the healing process and preventing infection.
Therapy of the Arthus phenomenon includes the use of the following drugs and techniques:
- Glucocorticosteroid means. Prednisolone and other compounds of this group contribute to the effective attenuation of allergic reactions, slow down both the formation of immune complexes, and cytotoxic processes in tissues. With the early detection of the disease and the appointment of corticosteroids is almost always possible to avoid the development of necrosis and other complications.
- Infusion therapy. Aims to accelerate the elimination of the allergen from the body, produced by taking a large amount of fluid, intravenous fluids. Sometimes it is adjusted depending on the nature of the provoking antigen – for example, by taking certain diuretics, by changing the pH of the urine to better dissolve the provoking substance.
- Antihistamines. Effective in most cases, the phenomenon of Arthus, significantly reduce the risk of necrosis and the further spread of the pathological process. Used in conjunction with steroid drugs.
- Local events. For the prevention of infectious complications requires careful aseptic treatment of the affected area. To reduce itching and reduce the inflammatory process, ointments and gels containing steroids (hydrocortisone) are used. When skin is ulcerated, wound healing agents are applied.
At the first detection of signs of the Arthus phenomenon, the introduction of any drugs, except those that are vital to the determination of the allergen, is canceled. In the future, any use of the provoking substance and compounds similar to it in chemical structure is prohibited – for example, in case of intolerance to penicillin, all antibiotics of this series are contraindicated.
If the cause of the pathology was an insulin preparation, the agent is replaced with a hormone from another manufacturer, after which regular allergy-immunologist supervision is required. The control lasts 3-6 months, it is necessary for confidence in the absence of a reaction to a new drug.
Phenomenon Arthuris one of the variants of drug intolerance, due to immunological hypersensitivity to the active or auxiliary substances in their composition. It was first described in 1903 by the French physician Maurice Arthus. It can occur at any age, usually manifests itself in response to parenteral (subcutaneous or intramuscular) administration of drugs. An increased incidence of the disease is observed among individuals with atopic conditions (asthma, dermatitis, pollinosis). Despite the local nature of the condition, it poses a serious threat with its complications. Significantly aggravates the manifestations of the phenomenon of prolonged contact (exposure) with the provoking drug. This is due to the late onset of symptoms (after weeks or even months), when the pathology is detected after repeated administration of the allergen – for example
The reasons
The etiology of the disease is multifactorial, as with any other allergic condition. It is based on both the individual internal features of the organism, and the consequences of external influences (ecology, nutrition, past diseases). The nature of the pathological process also depends on the nature of the allergen – only some groups of drugs can provoke the appearance of the phenomenon.
Most often Arthus reaction occurs when using the following drugs:
- Immunological agents. These include serum, some vaccines, toxoids and other drugs with high immunogenicity. They can directly interact with the immune system and sometimes provoke intolerance.
- Antibiotics. Some groups of antibacterial agents can cause allergies when administered parenterally. Most often such a reaction is potentiated by penicillins, tetracyclines, extremely rarely – macrolides.
- Vitamin complexes. Vitamin solutions used in many supportive treatment regimens can react with specific antibodies. As in the case of antibiotics, pathology is complicated by the course application of these drugs, which increases the amount of allergen in the body.
- Insulin. In a small proportion of patients with diabetes, the Arthus phenomenon occurs due to the injection of insulin solutions. Hypersensitivity usually develops not to the hormone itself, but to the impurities in the composition of the drug.
Such a reaction can be detected by using other protein and polypeptide substances. Sometimes the phenomenon is recorded after cosmetic procedures of an injectional nature (mesotherapy, biorevitalization, botulinum therapy).
The main conditions are the parenteral administration of the allergen, its solubility in biological fluids and a certain immunogenicity.
Pathogenesis
The phenomenon of Arthus, which is a special form of allergy, at the same time has a slightly different nature of pathogenesis. The processes of the third (immunocomplex) type of hypersensitivity reaction are mainly observed. At the first contact of the body with the provoking substance, sensitization occurs – the process of the immune response and recognition of the allergen are activated.
The result is the release of plasma cells specific for immunoglobulin G and M antigens. With a new supply, the compound binds with these antibodies to form immune complexes. At the same time, lymphocyte re-stimulation occurs with the synthesis of new portions of specific IgG and IgM.
The resulting immune complexes, unlike antigens and antibodies, are insoluble, deposited on the walls of blood vessels of the microvasculature. There, they activate the complement system, damaging the endometrium and starting the blood clotting process. Formed microthrombs in combination with cytotoxic immune responses lead to tissue necrosis.
The result of these processes is local damage to the skin, subcutaneous fatty tissue, muscle fibers in the area of the highest concentration of antigen – at the injection site. With a significant number of immune complexes, they are able to spread throughout the body with blood flow, leading to the clinical picture of chronic serum sickness (HSB).
Symptoms of the Artus Phenomenon
In the presence of sensitization, a single injection of a drug containing an allergen is sufficient for the development of pathology. In the case of an intact organism, the occurrence of the phenomenon is possible only with repeated administration (course treatment) or repeated use of the drug after some time (for example, revaccination).
Symptomatology of the disease manifests itself after 7-10 days from the moment of contact with the antigen, sometimes this period is up to several months. Around the injection site occurs redness, swelling, turning into a dense and intense infiltration. Patients complain of severe itching, pain in the area of the pathological process.
With a small amount of the introduced allergen and low reactivity, the Arthus phenomenon is limited to infiltration, which spontaneously resolves over several weeks. In severe cases, necrosis of the skin develops with the formation of a nonhealing ulcer. With intramuscular administration of the drug may occur myositis.
Due to the intoxication of the body with tissue necrosis products, the body temperature rises, a feeling of weakness, a headache. Secondary bacterial infection is a particular threat, the inflammatory process becomes purulent-necrotic. Healing of the pathological focus occurs within 1-3 months with the formation of a noticeable scar.
Complications of the Artus phenomenon
The most serious complication of the Arthus phenomenon is the development of serum sickness – a systemic immune complex response. Symptoms include severe fever, papular or erythematous rash all over the body, swelling of the joints, and heart and kidney problems. Usually, CSB occurs 1-3 weeks after the administration of a drug containing provocative compounds.
Often, the infiltration or lesion of skin necrosis is affected by a bacterial infection, the severity of the symptoms depends on the nature of the microflora. In extremely rare cases, the phenomenon is combined with reactions of the type of urticaria or angioedema. This is considered an alarming sign, as it indicates the risk of anaphylactic shock.
Diagnosis of the Artus phenomenon
The diagnosis is made on the basis of the results of the examination by the doctor of the allergist-immunologist and a number of laboratory tests. Consultation with a dermatologist is often required to rule out other skin pathologies, as well as the opinion of the specialist who prescribed the injectable medication. Some diagnostic techniques are aimed at identifying the early signs of complications – a bacterial infection or HSB.
The definition of the Arthus phenomenon is made according to the following algorithm:
- Survey and collection history. During the conversation with the patient, it becomes clear when exactly the symptoms of the pathology appeared, whether parenteral medication was administered before. The case history (if available) is studied, the type and dosage of the drugs are established.
- Inspection. A visual study of the area of the pathological process is carried out – most often the phenomenon manifests itself on the lateral surface of the shoulder, in the subscapularis area or on the buttocks. Localized infiltration or limited skin necrosis indicates an allergic condition.
- Laboratory research. In uncomplicated forms, the picture of the general analysis of blood changes slightly – ESR increases, a small leukocytosis is recorded. When joining a secondary infection, the number of neutrophils increases. Changes in the biochemical analysis of blood (increasing the concentration of C-reactive protein, AST, AlAT) indicate the beginning of the development of XB.
- Immunological tests. An enzyme immunoassay (ELISA) for the determination of circulating immune complexes is necessary for the early diagnosis of chronic bronchitis. In light cases of the Arthus phenomenon, the results are usually negative. Also performed is the identification of antibodies to antibiotics or other drugs that were administered to the patient.
Differential diagnostics is performed with pustular and inflammatory skin lesions (streptoderma, staphyloderma) and other dermatological conditions. To confirm the chronic bronchitis, an ECG, biochemical blood tests, and urinalysis may be required.
Prediction and prevention of the Artus phenomenon
In most cases, the Artus phenomenon has a favorable prognosis. With proper treatment, the pathology does not create a threat to human life, skin disorders disappear without a trace. With the development of necrosis after healing remains a noticeable scar. The main danger is represented by complications, especially HSB, which can lead to systemic vasculitis with damage to many organs. The presence of hypersensitivity to some drugs also has a potential risk – often this requires expensive treatment of infectious and other diseases.
Prevention is the use of higher-quality drugs – it is established that a high degree of purification of active substances reduces the likelihood of adverse reactions. If there are confirmed intolerances of certain drugs, their use should be avoided – in particular, when you go to a doctor, always inform a specialist about this.
