Oral allergic reactions sometimes appear simultaneously with skin lesions. Certain regions of the mouth are particularly sensitive to irritants because they penetrate easily through the tissue there. The key operation of these factors are: concentration of e.g. a chemical factor, duration or frequency, properties and reactivity, chemical structure, physical properties. In addition, genetic factors, hormonal status, and age have an influence. According to the findings of the International Allergology Committee, an allergy is the acquired qualitative altered reaction of living tissues following the action of a specific allergen.
Two concepts of these reactions are distinguished:
1) anaphylactoid or pseudo-anaphylactic reaction that occurs after the first contact with a sensitizing agent – mediators are released without the mediation of IgE,
2) anaphylaxis is an IgE reaction associated with the release of mast cell mediators and basophilic leukocytes, there is an expansion and increased permeability to
It is very difficult to establish a causal relationship with allergens of various origins. According to Gell and Coombs, there are four types of reactions that trigger allergic disease. Type I, II and III reactions are humoral reactions, and type IV reactions are delayed cellular reactions.
The type I reaction – immediate or anaphylactic – leads to the production of specific IgE antibodies in the organism, vasoactive amines participate here. The mediators of mast cells and basophilic leukocytes are released. It is most often formed after anesthesia. An early-phase reaction may appear 0-30 minutes after allergen exposure, and a late-phase reaction 6-8 hours later. The clinical picture develops: urticaria, Quincke’s edema, bronchospasm and anaphylactic shock.
Type II reaction – cytotoxic – the factors involved are: IgG, IgM, complement with the localization of the reaction in the membranes of blood cells. The clinical picture is dominated by: granulocytopenia, anemia, and immunological diseases.
The type III reaction is an immune complex-induced hypersensitivity. This mechanism contributes to the development of serum sickness. The factors involved are: IgM, IgG, IgA and IgE, complement, neutrophils. Complement activation affects blood vessels. In the clinical picture, for example, allergic vasculitis appears.
Type IV allergic reactions, usually found in dentistry, appear 24-72 hours after exposure to an allergen in the form of an acute allergic or chronic contact reaction. The reaction is produced during allergy of sensitized T lymphocytes, and involves lymphokines and Langerhans cells, from which the mediators typical for the reaction are triggered (interferon, interleukin 2).
Allergens can be:
• foods – the most common allergens include casein, egg white and yolk, cow’s milk, rice, soy, cocoa, apple, carrot and flour. Order a mail-order diagnosis of food allergy – tests for 10 allergens and eliminate products that cause allergic reactions from your diet,
• dust, gases, vapors,
• chemical compounds – chromates, phenols, hydroquinone, organic solvents, dyes, impregnation preparations, essential oils,
• metals – cobalt, nickel, mercury, titanium, palladium, chrome, gold,
• drugs: anesthetics, antibiotics, polopyrin, antipyrine, aspirin, barbiturates, sulfonamides, disinfectants, eugenol, camphenol, iodoform, rinses,
• medications and materials used in dentistry: formalin, formaldehyde, acrylate material, stabilizers, plasticizers, dyes, free monomer
– methyl methacrylate, benzoyl peroxide, impression mass catalysts, polyether impression masses, surgical cements, eugenol oxide cements, resins of composite materials, bleaching agents, urea peroxide, rarely amalgams, toothpaste ingredients.
In cases of allergic changes, subjective symptoms such as itching and burning appear. Symptoms of oral allergy may include: erythematous, edema, bullous, lichenoid changes, as well as erosions and ulcerations.
Treatment is desensitisation therapy and allergen removal.
Remember to properly care for your teeth and the entire mouth. Order the SeptOral Profilactic toothpaste for bleeding gums that strengthens the enamel and prevents the development of caries. Locally, on lesions in the oral cavity, use SeptOral Med Gel for irritated oral mucosa.
The disease entities associated with allergy are: Quincke’s angioedema, allergic mucositis, allergic contact cheilitis, erythema exudative multiforme, Stevens-Johnson syndrome, Melkersson-Rosenthal syndrome.
VASCULAR SWORD OF QUINCKI
Quincke’s angioedema (oedema angioneuroticum Quincke) is a clinical phenomenon, an isolated form of angioedema that can be modulated by many factors. It is a sharp swelling of the deeper layers of the skin and mucous membranes, associated with an increase in vascular permeability. The reaction is painless, but rapid onset and rapid progression are dangerous and pose a risk of airway obstruction, especially as patients panic. An IgE hypersensitivity reaction occurs. The rapid onset and disappearance of edema and relapses are characteristic. The swelling lasts from a few hours to 3 days. The swelling is sometimes accompanied by hives, a common allergic reaction characterized by blisters of the skin. Patients experience increased tension. Drooling may appear. The lips, tongue, and palate are special locations. Treatment is based on the administration of antihistamines and glucocorticosteroids, sometimes a tracheotomy is required.
Lymphatic edema of the lips
A similar disorder affecting the lips is lymphoedema of the lips (lymphoedema labiorum), which occurs as a result of an allergic lymph circulation disorder. Painless swelling and relapses lead to permanent lip enlargement and distortion.
Allergic Mucosal Inflammation
Allergic inflammation of the oral mucosa occurs due to local contact with an allergen (stomatitis venenata) or as a result of the action of systemic allergens (stomatitis medicamentosa). The former covers only tissues in direct contact with the allergen, the latter is more generalized. Irritation is a permanent phenomenon in these tissues and should be understood as a complex biological response with heterogeneous pathophysiology and a different clinical picture. The site of damage is the keratinocyte lipid membrane. Symptoms begin with tingling and burning, then there is swelling with a shiny waxy sheen, sometimes peeling, erythematous changes, and vesicles.
Contact Allergic Red Lip Inflammation
Allergic contact red cheilitis (cheilitis venenata) results from the use of lip liners. Patients experience troublesome itching and burning as a result of symptoms. There is soreness. It causes swelling, redness, blisters, and peeling of small scales and cracks. Treatment of allergic reactions occurring in the oral cavity consists in removing the causative agent, administering anti-inflammatory drugs, antiseptics and local disinfectants. Sometimes steroids, immunomodulators, calcium preparations, pantothenic acid preparations, drugs sealing the walls of blood vessels are used.
MULTI-FORMAT EFFORT FLAT
Erythema exsudativum multiforme (erythema exsudativum multiforme) is an acute mucocutaneous disease whose onset and course vary in severity. In the chronic form, there are cases of permanent changes that last for weeks and months, and they appear episodically in the recurrent changes. The disease is caused by a hypersensitivity reaction with the appearance of cytotoxic T lymphocytes in the epithelium, leading to keratinocyte apoptosis.
Polymorphic exudative changes are characteristic of exudative erythema multiforme. The disease especially affects young male people. It lasts 5-XNUMX weeks and may recur, especially in spring or autumn. The basic lesions on the skin are bright red spots of various sizes, widening to the circumference. As the eruptions continue, the very center becomes somewhat sunken and bluish. The changes are located on separate parts of the upper and lower limbs. The disease begins with general symptoms such as increased body temperature, weakness, joint and muscle pains.
Eruptions on the oral mucosa, initially erythematous in the form of spots of various shapes, pass through the follicular and bullous phases rather quickly into erosions of irregular shape, ring-shaped shapes, which tend to coalesce. The changes take a long time to heal without scarring. The histopathological picture shows necrotic changes in keratinocytes with intense epithelial transmigration of leukocytes, including neutrophils and mononuclear cells. Mouth eruptions are painful. There is also drooling, there is a bad smell from the mouth. Location – on the lips (possible haemorrhagic scabs), and on the cheeks, tongue, palate and gums.
The etiopathogenesis of erythema has not been fully elucidated. The possibility of an allergic reaction or hypersensitivity to many drug and bacterial antigens, including an immunological basis, is assumed. Lymph glands can be: enlarged, soft, painful.
Treatment consists of antibiotics and corticosteroids, local anesthetics and antiseptics.
STEVENS-JOHNSON SYNDROME
Stevens-Johnson syndrome is a severe form of exudative erythema multiforme. The disease begins with general symptoms: increased temperature, weakness, general breakdown and joint pains. It occurs in the course of some infectious diseases. Bubbles and blisters appear on the raised inflamed mucosa, then erosions merge into festoon formations. The lesions are located on the lips, mainly the lower ones, the mucosa of the cheeks, tongue and soft palate. The disease lasts for about 3 weeks, sometimes with relapses. The disease may also affect the genital mucosa.
On the skin, erythematous lesions include the hands and the extension of the forearms and lower legs. Changes in the organ of vision join the extensive lesions of the skin and the oral mucosa, often requiring hospitalization of patients. Catarrhal pseudomembranous or purulent conjunctivitis, superficial keratitis and keratitis can lead to blindness.
It is believed that the syndrome is the result of a hyperalergic reaction to many drugs, an immunological basis, bacterial background – staphylococcal-streptococcal and viral, odontogenic foci, drugs are assumed. A decrease in the reactivity of T lymphocytes has been found. There is no specific treatment of the disease, as well as erythema multiforme. They are administered: desensitizing drugs, antihistamines, corticosteroids, antibiotics, cyclosporine, and local anesthetics, disinfectants and antiviral drugs.
MELKERSSON-ROSENTHAL SYNDROME
Melkersson-Rosenthal syndrome is a constitutional disease, it is systemic, multi-organ in nature. The etiopathogenetic factors include: genetic factors; infectious, bacterial and viral; toxic to certain drugs; odontogenic foci, vasomotor disorders. Bacterial factors work by allergicizing the body.
The most significant is the swelling of the lips, more often the upper, with blistering lesions and cracks. On palpation, the lip is soft, flexible. Episodes of recurrent lip swelling lead to permanent lip enlargement, hardness, and a bluish red color. The monosymptomatic form of Melkersson-Rosenthal syndrome is granulomatous inflammation (macrocheilitis granulomatosa) of the lips.
The triad of symptoms in this syndrome, in addition to swelling of the lips, includes palsy of the facial nerve, which is observed in 30-35% of cases, and puffiness of the tongue. Occasionally, significant gingival hyperplasia is found. The histopathological features are characterized by vasodilation, interstitial edema, perivascular inflammatory infiltrates with the presence of lymphocytes, histiocytes and plasma cells.
Treatment consists of: removal of infection foci, use of antibiotics, corticosteroids and topical anti-inflammatory drugs, sometimes lip plastic surgery is required.
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