ALLERGIYA

ALLERGIYA (Allergia; az yun. allos – di- gar, begona va ergon – tasir), hassosiyati balandi organizm, ki dar natichai tasiri baze omilhoi muhit, mas., moddahoi khimiyavi, mikrobho va mahsuli faoliyati hayoti onho, khurokvori, doru va g., ki onhoro allergen menomand, ba vuchud meoyad.
Istilohi «allergiya»-ro ba ilm s. 1906 dukhturi avstriyagi K. Pirke baroi ifodai aksulamali gayrimuqarrarii baze kudakon, ki badi tazriqi zardobi ziddi guluzindonak paydo meshud, chori kardaast. A. boisi inkishofi bemorihoi allergi megardad.
Bemorihoi allergi (ziqi nafas, polli- noz, sagles, zukomi allergi, dermatitho, A.-i khurok va doru) az davrahoi qadim malumand. Hanuz hakim Buqrot takid karda bud, ki baze khurokvoriho ba or- ganizmi odam nameforand va boisi paydoishi sagles va ikhtiloli kori meda me- gardand. Ba guftai tabib Jolinus bazan az bui gul zukom ba vuchud meoyad. Dar a. 19 isbot shud, ki sababi tablarzai khasbedagi tavassuti nafaskashi furu burdani gardi rastanihost (nig. Pollinoz); hamchunin farziyae paydo shuda bud, ki ba rohi nafas aftodani gardu chang boisi paydoishi bemorii ziqi nafas megardad.
Bemorihoi allergi dar tamomi chahon pahn shudaand. Dar baze mamlakatho to 10%-i aholi giriftori bemorihoi gunoguni allergi ast. Beshtar ziqi nafas, pollinoz va sagles gustarish yoftaand, ki natichai farovon istifoda burdani antibiotikho barin doruhost. Taraqqiyoti puravchi sanoati khimiya va istehsoli miqdori ziyodi moddahoi gunoguni sintezi, rangho, khokahoi chomashui va g. niz yake az omilhoi gustarish yoftani bemorihoi allergi meboshand.
1) Payvasthoi gunogun – az moddahoi so- dai khimiyavi (brom, yod) to moddahoi mu- rakkab (safedaho, polisakharidho) – metavonand chun allergen tasir rasonand. Ba- zei allergenho ba organizm az berun vorid shuda (allergenhoi ekzogeni), bazei digar dar khudi organizm tashakkul meyoband (allergenhoi endogeni yo autoallergenho). Allergenhoi ekzogeni du khel meshavand: gayrisiroyati (gardu changi khona, pashmi hayvonot, doru, moddahoi khimiyavi, gardi rastani, khurokvorihoi gushtivu shiri va naboti) va siroyati (bakteriyaho, virusho, zanburugho va mahsuli faoliyati onho). Allergenhoi ekzogeni ba organizm bo rohhoi gunogun vorid shuda, boisi osebi uzvho megardand. Onho ba chunin guruhho taqsim meshavand. Allergenhoi biologi – mikrobho (nig. Bakteriyaho), virusho, zanburugho (nig. Zanburughoi mikroskopi), gelmintho, vaksinaho va zardobho (nig. Vaksi- na, Zardob). A. boisi paydoishi brutsellyoz, makhav, sil, domana va g. barin bemoriho megardad. In namudi A.-ro A.-i siroyati va guruhi bemorihoero, ki az mikrobho, zanburugho yo virusho ba vujud meoyand (A. dar inkishofi onho mavqei khos dorad), bemorihoi allergiyu siroyati menomand. Hamchunin bazan mikrobu zanburughoe, ki dar pust yo rohhoi nafas, dahon va ruda vujud dorand, boisi inkishofi in guna bemoriho khohand shud. Mikrobhoi bemo- riovari dandonhoi pusida, javfi bini, talkhadon (hangomi gazaki onho) niz man- bai A. ba shumor meravand. Tazriqi zardobu vaksinaho bazan boisi anafilaksiya megardad. Hini gelmintozho boshad, dar natijai jabbida shudani mahsuli tajziya va mubodilai gelmintho A. ba vujud meoyad.
2) Allergenhoi dorui. Har doru metavonad reaksiyai allergiro paydo kunad (mas., kodein, aspirin, sulfanilamidho, penitsillin va g.). Istemoli novoka- in, vitamini V1 va dig. doruho boshad, beshtar bodi allergi meorad. Surati reaksiyai allergi ba miqdori istemoli doru vobasta ast. Antibiotikho (khususan penitsillin), ki solhoi okhir istemoli onho besh az pesh meafzoyad, tasiri badi allergi dorand. Davri muolija har qadar takror shavad, oqibati nokhushi A. hamon qadar ziyodtar ast. Penitsillin nisbat ba dig. doruho beshtar mujibi A. megardad. Dar khotir boyad dosht, ki istemoli doru biduni tavsiyai dukhtur baso khatarnok ast.
3) Allergenhoi ruzgor. CHangi gilem, sarulibos, kurpavu bolin, zanburughoi devori namkashidai khona, hasharot (kana, nonkhurak, kayk va g.), inchunin allergenhoi pust (muy, pashm, sabusaki hayvonot) ba allergenhoi ruzgor do- khil meshavand. Solhoi okhir reaksiyahoi allergi az mavodi khimiyavii ruzgor, khu- susan az vasoiti shustushu, ziyod shudaand. Allergenhoi ruzgor beshtar bemorihoi allergii rohi nafasziqi nafas va zuko- mi allergiro ba vujud meorand.
4) Allergenhoi gard. Dar natijai ba organizm vorid shudani gardi baze rastaniho amrozi allergi sar mezanand. Gardi nabotot beshtar tavassuti shamol pahn shuda, zukom, konyunktivit va dig. pollinozhoro ba vujud meorad.
5) Allergenhoi gizoi. Istemoli shir, gusht, mohi, pomidor, mevahoi sitrusi, shokolad, qulfinay, shohtuti zamini va g. beshtar sababi A. megardand. Illate, ki dar natijai tavassuti medayu ruda ba organizm vorid shudani allergen inkishof meyobad, A.-i gizoi nom dorad. On osebhoi allergie, ki dar khudi medayu ruda binobar ba organizm bo rohi digar vorid gashtani allergen paydo shudaand, A.-i medayu ruda menomand. Mas., allergene, ki ba organizm tavassuti pardai luobii rohi nafas vorid megardad, imkon dorad dar har qismi medayu ruda holati aller- giro ba vujud ovarad. Hangomi A.-i gizoi reaksiyai allergi badi chand daqiqai ba medayu ruda vorid shudani allergen zohir meshavad. Mas, agar odam ba shir A. doshta boshad, bad az chand daqiqai iste- moli on nogahon qay va ishol ruy medihad. Dertar alomathoi digari bemori (sagles, tablarza) niz ba vujud meoyand. Bazan nishonahoi nakhustini reaksiyai allergi dar medayu ruda bad az chand soat paydo meshavand. Odatan, A.-i gizoi dar zaminai ikhtiloli kori medayu ruda avj megirad. Barziyod khurondani kudakon niz ba inkishofi A. musoidat mekunad (aksar vaqt allergenhoi khurok dar onho diatezro ba vujud meorand; nig. SHirincha). Boyad guft, ki naforidani in yo on khurokvori hamesha ba A. vobasta nest. Ehtimol, sababi in norasoii baze fermenthoi hozima bo- shad, ki boisi vayron shudani hazmi khurok va ishol megardad (nishonahoi on ba A.-i gizoi monand meboshand).
6) Allergenhoi sanoati. Dar natijai taraqqiyoti puravji sanoati khimiya tamos (kontakt)-i odamon bo mod- dahoi gunogun ziyod shuda, boisi paydoi- shi reaksiyahoi allergi (asosan dar na- mudi bemorihoi pust) gardid. Skipidar, ravganhoi madani, nikel, khrom, margi- mush, zift, moddahoi dabbogi, ranguborhoi azonaftoli, lokho, insektofungisidho, formalin, karbamid, qatroni epoksidi, detergentho, aminobenzolho, hosilahoi khinolin, khlorbenzol va g. allergenhoi sanoati mahsub meshavand. Dar sartarosh- khona va choyhoi pardozgari rangubor baroi muy, abru, mijgon, moddahoi attori, dar fotolaboratoriyaho boshad, gidrokhi- non va payvasthoi brom tasiri allergi merasonand.
7) Omilhoi fiziki – garmi, khunuki va angezishi mekhaniki guruhi makh- susi allergenho meboshand. CHunin meshumorand, ki bisyor vaqt az tasiri onho dar organizm moddahoi makhsus hosil shuda, oqibat ba allergen tabdil meyo- band. Badi ba organizm vorid shudani allergen, reaksiyahoi allergi ba vuchud meoyand. Onho du khel meshavand: makhsus va nomakhsus. Inkishofi reaksiyai makh- sus az davrai nihoni iborat ast. Dar in davra hassosiyati organizm ba allergen meafzoyad (onro sensibilizatsiya menomand). Sensibilizatsiya dar natichai dar organizm hosil shudani moddahoi begona (safedaho, ki chavoban ba allergeni voridgashta hosil meshavand yo limfosithoe, ki bo allergen tasiri mutaqobila dorand) ba vuqu mepayvandad. Agar dar lahzai paydoishi onho allergen az organizm dur karda shavad, on goh nishonahoi bemori padid nameoyand. Hangomi takroran ba organizm tasir namudani allergen, organizm ba on hassos shuda, reaksiyai allergi (tasiri mutaqobilai moddahoi begona yo limfositho bo aller- gene, ki boisi hosil shudani onho gardi- daast) avch megirad. Dar natichai chunin tasiri tarafayni allergenu organizm moddahoi khimiyavi (gistamin, serotonin va g.) hosil shuda, ba bofta va huchayrayu uzvho oseb merasonand (oseb bahri tashakkuli bemorihoi allergi zamina faroham meorad). Dar surati bori avval ba organizm vorid gashtani allergen, reaksiyahoi nomakhsusi allergi ruy medihand. Dar in guna mavridho hassosiyati organizm baland nameshavad, ammo khudi allergen moddahoe hosil mekunad, ki onho huchayra, bofta va uzvhoro illati mesozand. Idiosinkraziya az chumlai reaksiyahoi nomakhsus ast. Reaksiyahoi allergi vobasta ba zamonai padidoi du khel meshavand: betakhir va sust. Bad az 15 – 20 daqiqai ba bemor tasir kardani allergen, reaksiyahoi allergii pust va uzvho zohir meshavand, ki onhoro, odatan, reaksiyahoi betakhir meguyand. Obilai pust, ikhtiloch (spazma)-i bronkhho va ikhtiloli kori medayu ruda az chumlai in guna reaksiyaho meboshand. Sada- mai anafilaksi, pollinozho, sagles, ziqi nafas, bemorii zardobi va obvaram (obvarami Kvinke) niz mansubi reaksiyahoi allergii betakhirand. Bemorii zardobi bad az tazriqi zardob yo gamma-globulin (pas az 2 – 12 ruz) sar mezanad (hangomi on hasba, khorish, varami girehhoi limfavi, tab va g. paydo meshavad). Varami zudguzaru mahdudi pust va pardahoi luobi, ki zeri tasiri in yo on allergen ba vuchud meoyand, alomathoi obvarami Kvinke meboshand. On beshtar dar ruy, bazan dar luobpardai dahon, hanchara (nig. Hurusak) va medayu ruda mushohida megardad. Reaksiyahoi susti allergi, odatan, pas az chand soat yo chand shaboruz avch megirand. Bemorihoi pust, ki dar korkunoni sanoati khimiya, dorusozi, kormandoni tib, inchunin hini hassosiyati balandi organizm nisbati bakteriyaho mushohida meshavand (mas., hangomi sil, brutsellyoz, manqagi, tulyaremiya va g.), aksulamalhoi susti allergi mahsub meyoband.
A. metavonad dar hama holathoi tamosi organizm bo allergen ba vuchud naoyad. Dar paydoishi on irsiyat, holati silsi- lai asab va gadudhoi endokrini maqomi muayyan dorand. Muqarrar kardaand, ki agar volidayn giriftori pollinozho, sadamai anafilaksi, ziqi nafas (shakli irsii on), baze namudhoi zukomi allergi boshand, pas imkon dorad, ki dar beshtar az 70 fisadi kudakoni onho niz bemorihoi allergi ba mushohida rasand. Dar oilahoe, ki yake az volidayn bemor ast, to 56 fisa- di kudakon giriftori amrozi allergi meshavand. Dar kudakon vobasta ba namudi allergen va tarzi ba organizm vorid gash- tani on, bemorihoi allergi shaklhoi gunogun megirand. Ikhtiloli kori silsilai asab, gadudhoi endokrini, zakhmi mayna, ehsosoti manfi va zafi kori gadudhoi boloi gurda ba inkishofi A. musoidat menamoyand. Qobiliyati ba safedahoyu hujayrahoi khudi organizm mutaassir budanro autoallergiya menomand. Dar asnoi on allergen endoallergen (az endo – daruni) nom megirad. Talimot oid ba au- toallergiya bo nomi olimi barjastai rus, mikrobiolog va immunolog I.I. Mechni- kov vobasta ast. Endoallergenho du nav – tabii (asli) va gayritabii meshavand. Ba endoallergenhoi tabii baze safedahoi boftaho khos meboshand.
Safedahoi baroi organizm begona (onho hangomi sukhtagi, bemorii shuoi, in- chunin dar natijai payvastan ba toksinho yo doruhoe, ki ba organizm vorid shuda- and, ba vujud meoyand)-ro endoallergenhoi iktisobi (dar jarayoni hayot paydoshuda) menomand. Organizm safedahoi khudiro az safedahoi begona farq mekunad. Dar asl boftahoi khususii organizm illat nado- rand, zero bar ziddi onho allergen (endo- allergen) hosil nameshavad. Hangomi au- toallergiya tasiri omilhoi muhofizatii organizm ba muqobili boftahoi khudi on nigaronida meshavand (mohiyati autoallergiya az hamin iborat ast). Dar mavridi az haddi muayyan guzashtani osebi boftaho ravandi autoallergiya ba bemorii autoallergiya tabdil meyobad. Baze namudhoi kamkhunii gemolizi, miasteniya va glomerulonefrit az jumlai chunin bemoriho meboshand. Olimon takhmin mekunand, ki autoallergiya dar inkishofi tarbod, resh- marazi ruda, ziqi nafas (shakli siroyatiyu allergii on) shirkat mevarzad. Hangomi tashkhisi bemorihoi allergi az mariz mufassal pursidani tarikhi kasali baso muhim ast. Bo in roh oid ba khususiyati bemori va sababhoi on metavon khulosa barovard (dukhtur takhmin mekunad, ki kadom guruhi allergenho boisi bemori gashta- and). Allergenhoi bemoriangezro tavassuti ozmoishi makhsus va tadqiqi laboratori oshkor mesozand. Odamoni ba bemorihoi allergi duchorshudaro faqat dukhtur tabobat mekunad. Qat namudani tamosi bemor bo allergeni oshkorgashta va kohish dodani hassosiyati organizm nisbati on iloji asosii peshgirii bemorist. Past kardani hassosiyati organizm ba allergen giposen- sibilizatsiya nom dorad. Giposensibilizatsiya dar natijai miqdori toraft ziyodi allergenro ba organizm vorid namudan va dar boftaho paydo shudani podtanhoi makhsuse, ki allergeni begonaro payvast mekunand, hosil megardad. Az hamin sabab tamosi allergen bo podtanhoi hujayrayu boftaho qat shuda, reaksiyai allergi ba vuqu nameoyad. Giposensibilizatsiyai makhsus ba sharte guzaronida meshavad, ki agar dar bemor alomathoi marizi ba mushohida narasand. Dar mavridi khuruji bemori az usulhoi muolijae istifoda mebarand, ki onho inkishofi A.-ro qat va alomathoi bemoriro raf mesozand (mas., dar mavridi past shudani fishori khun doruhoi tangkunandai rag va hangomi tashannuji bronkhho doruhoi vasekunan- dai bronkhhoro medihand).
Dar jumuri bisyor bemorkhonaho utoq va shubahoi makhsusi allergologi do- rand. Dar onho dukhturon – allergologho kor mekunand. Tashkhisi bemorihoi allergi, muolija, bistarigardonii marizon, kumaki mashvarati ba muassisahoi muolijavii digar, bahisobgiri va omorii bemorihoi allergi, targibi dastovardhoi allergologi dar bayni kormandoni tib va aholi az jumlai vazifahoi asosii utoqhoi allergologi mahsub meyoband.
Baroi peshgirii bemorihoi allergi andeshidani tadbirhoi zerin noguzirand: 1) jilavgiri az tamosi takrori bo mod- dahoe, ki hassosiyati balandi organizm- ro ba vujud meorand; 2) roh nadodan ba khalaldor shudani reaksiyai muhofizatii organizm. Ba tadbirhoi yakum mahdud na- mudani istemoli doruhoi gunogun (yane dar holathoi zaruri va faqat bo tavsiyai dukhtur istifoda kardani onho), korbasti tekhnologiyai peshqadam (tamosi korgaron- ro bo allergenho peshgiri mekunad) va toza nigoh doshtani manzili zist taalluq dorand. Ba tadbirhoi duyum bartaraf na- mudani manbai siroyat dar organizm do-
khil meshavad (tabobati dandonhoi illati, gazaki chavfi bini, iltihobi talkhadon, bronkhitho va g.). Mutadil gardondani faoliyati medayu ruda paydoishi A.-i gizoiro peshgiri mekunad. SHiri mo- dar muhimtarin vositai peshgirii A.-i kudakon ast (bisyor kudakon az istemoli gizohoi suni giriftori A. meshavand). Bahri duchor nagashtan ba A. rioyai nizomi durusti mehnat va istirohat niz ahamiyati kalon dorad.
Ad.: Ado A. D., Polner A. A., Sovre- mennaya prakticheskaya allergologiya, M., 1993; Sit- kevich A. E., Kazeko A. G., Profilaktika i lechenie allergicheskikh zabolevaniy koji, M., 1997; Obshaya allergologiya, S – Pb., 2001; Zoirov P. T., CHastnaya dermatologiya i venerologiya, D., 2007; Gaffarova M.A., Allergicheskie zabolevaniya v detskom vozraste, D., 2008.
M. N. Juraev.