Cẩm nang sức khỏe
Dễ “mắc” như… dị ứng
Không chỉ là dị ứng thức ăn, viêm da dị ứng do
tiếp xúc…, viêm xoang, viêm tai giữa, hen phế quản… cũng đều là một dạng
dị ứng thường gặp. Theo đó, tại Mỹ, xấp xỉ 25% dân số bị mắc các chứng
dị ứng.
Phản ứng dị ứng là gì?
Dị ứng là phản ứng bất thường của hệ miễn dịch với vật chất đối với người bình thường không gây hại.
“Dị
nguyên” là chất kích thích đáp ứng dị ứng của cơ thể. Khi dị
nguyên (thức ăn, mạt bụi nhà…) xâm nhập vào cá thể có cơ địa dị
ứng, cơ thể sản xuất một loại kháng thể gọi là immunoglobulin E
(IgE). IgE đặc hiệu gắn trên bề mặt tế bào mast (tế bào này đặc
biệt có nhiều ở da, mũi, mắt, phổi, dạ dày ruột) sẽ bắt giữ dị
nguyên, tạo thành tổ hợp kháng thể - kháng nguyên. Tổ hợp này làm hoạt
hóa tế bào mast và giải phóng ra histamine và các chất trung gian
hóa học, gây phản ứng dị ứng làm phù nề các mô, tổ chức, cơ
quan, dẫn đến triệu chứng của dị ứng: mề đay, hắt hơi, khò khè, ho…
Do đó biểu hiện của dị ứng rất đa dạng và khó lường!
Con đường dẫn đến dị ứng
Bạn có bao giờ đặt câu hỏi: Tại sao cùng tiếp xúc với dị nguyên mà có người bị dị ứng còn người khác lại không?
Thực
tế, tiền sử gia đình dị ứng là yếu tố quan trọng nhất trong sự
tiến triển của dị ứng. Bởi nếu bố mẹ cùng mắc bệnh dị ứng thì con
có nguy cơ 50-80%; bố/mẹ bị dị ứng, nguy cơ ở con là 20-40%. Trẻ sinh ra
trong gia đình dị ứng có thể có các biểu hiện của dị ứng ngay từ nhỏ
như chàm, mề đay, khi lớn lên lại chuyển sang khò khè, viêm mũi dị ứng,
hen...
Các biểu hiện lâm sàng thường gặp
Ở từng dạng dị ứng sẽ có biểu hiện khác nhau. Cụ thể:
Viêm mũi dị ứng: ngạt mũi, hắt hơi, xung huyết, ngứa và chảy mũi.
Viêm kết mạc dị ứng: mắt đỏ, ngứa, sưng và chảy nước mắt.
Viêm xoang, viêm tai giữa: đau
nhức xoang, chảy mũi, nghẹ, ngứa, điếc mũi là biểu hiện thường gặp ở
người viêm xoang, thường kết hợp trên người có viêm mũi dị ứng. Đau
tai, ù tai… là biểu hiện của viêm tai giữa và đây là bệnh trẻ em phải
đi khám bác sĩ phổ biến nhất.
Hen phế quản:.
Triệu chứng ho, khò khè, khó thở, nặng ngực tái diễn là biểu hiện lâm
sàng của hen. Viêm mũi dị ứng được coi là yếu tố nguy cơ tiến
triển thành hen.
Viêm da dị ứng (eczema), viêm da tiếp xúc: triệu
chứng ngứa, đỏ da, tróc da hoặc lột da. Viêm da dị ứng là triệu
chứng tiền trạm của rối loạn dị ứng khác. Một số nghiên cứu cho
rằng trên 50% trẻ viêm da dị ứng sau này phát triển thành hen.
Mày đay, phát ban: đặc
trưng bởi sưng, đỏ, ngứa, xuất hiện từng mảng đa hình thái. Mày
đay thường do dị ứng thức ăn hoặc thuốc như lạc, cà chua, cá biển
và tôm cua, penicillin, sulfa, thuốc chống co giật.
Dị ứng thức ăn: phản
ứng với thức ăn có thể nhẹ (mề đay, tiêu chảy) đến nặng, đe dọa
đến tính mạng (sốc phản vệ). Những thức ăn thường gây dị ứng là
protein sữa bò, trứng, lạc, lúa mì, đậu tương, cá, tôm cua. Tỷ
lệ dị ứng thức ăn ở trẻ nhỏ cao hơn ở người lớn và có xu hướng
giảm dần theo lứa tuổi.
Dị ứng khác: thuốc,
nọc côn trùng (ong, kiến lửa), cao su… đều có khả năng gây phản
ứng dị ứng từ nhẹ đến rất nặng như hội chứng Steven-Johnson, sốc phản
vệ.
Sốc phản vệ (anaphylaxis): phản
ứng dị ứng của toàn cơ thể, liên quan đến hệ thống quan trọng như
tim mạch, hô hấp, thần kinh... Triệu chứng của phản vệ bao gồm
cảm giác trong miệng nóng đỏ ngứa, ban đỏ ngứa, cảm giác lo
sợ, bồn chồn, khò khè, khó thở, kiến bò ở bụng hoặc nôn, tiêu
chảy. Trường hợp nặng: hạ huyết áp, ngừng thở, mất ý thức.
Nếu không điều trị kịp thời tiêm epinephrine, sốc phản vệ có thể
dẫn tới tử vong.
Bạn có bị dị ứng?
Để
xác định liệu bạn có dị ứng hay không, bác sĩ khai thác bệnh
sử, thăm khám, làm một số test lảy da với các dị nguyên, thăm dò chức
năng hô hấp, xét nghiệm máu (IgE đặc hiệu)… để xác định chính xác
chất nào là nguyên nhân gây dị ứng. Khi xác định được nguyên nhân
gây dị ứng, bác sĩ sẽ lập kế hoạch cho từng trường hợp cụ thể với
nguyên tắc điều trị là:
- Kiểm soát môi trường giúp giảm tối thiểu tiếp xúc với dị nguyên gây dị ứng.
- Dùng thuốc giảm các triệu chứng dị ứng và giảm viêm mãn tính.
- Điều trị giải mẫn cảm.
Tuy
nhiên, một khi đã xảy ra dị ứng thì vấn đề điều trị sẽ gặp nhiều khó
khăn, thường xuyên tái phát, gây tốn kém cho gia đình và xã hội. Do đó
vấn đề đặt ra là làm thế nào để chủ động phòng ngừa dị ứng, làm giảm
nguy cơ mắc dị ứng, đặc biệt là đối với các trẻ em có nguy cơ bị dị ứng
cao.
TS. Lê Minh Hương
Bệnh viện Nhi TƯ
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