ramaz RulaZe

alergia

• alergiuil daavadebaTa ganviTarebis meqanizmebi

da mkurnalobis principebi (alergiis axali
koncefcia)........................................................................5
• kanis sinjebis mniSvneloba alergiis
diagnostikaSi.................................................................17
• IgE-s klinikuri mniSvneloba .......................................26
• asTma ...............................................................................35
• alergiuli da ara alergiuli riniti ..........................81
• atopiuri dermatiti .....................................................98
• urtikaria da angioSeSupeba ........................................109
• anafilaqsia ..................................................................119
• alergia mweris nakbenze ..............................................125
• sakvebiT gamowveuli alergiuli reaqciebi ...............130
• medikamentozuri alergia ...........................................151
• mastocitozi ................................................................170
• eozinofilia da misi klinikuri mniSvneloba ............177

Tbilisi _ 2011
ramaz RulaZe.

alergia.

naSromi Sesrulebulia Tbilisis, g. Jvanias saxelobis,

pediatriul klinikaSi.

recenzenti: medicinis mecnierebaTa doqtori. profesori _

mixeil mWedliSvili

gamocemis redaqtori: eka gozaliSvili.

avtori : ramaz RulaZe.

g. Jvanias saxelobis pediatriuli klinikis eqimi,
alergolog-imunulogi; pediatri. medicinis doqtori.

ISBN 978-9941-0-3468-8
 winasityvaoba

me-20 saukunis meore naxevari da 21-e saukunis dasawyi-

si, mTel msofloSi, alergiuli xasiaTis daavadebaTa mniS-
vnelovani matebiT xasiaTdeba. dReisaTvis alergiul daavade-
baTa gavrcelebis maCvenebeli msoflios mosaxleobis mTel
populaciaSi 35%-s aRwevs da varaudoben, rom 21-e saukuneSi
es cifri kidev sagrZnoblad moimatebs.
alergiul daavadebaTa gansakuTrebiT mniSvnelovani mateba
ekonomikurad da kulturulad dawinaurebuli qveynebisTvisaa
damaxasiaTebeli. ufro metic, gamoirkva, rom rac ufro maRa-
lia ojaxis ekonomikuri da yofiTi kulturis done, miT meti
albaToba arsebobs am ojaxis wevrebSi alergiuli daavade-
bebis ganviTarebisaTvis.
alergiul daavadebaTa gavrceleba saqarTveloSi ar aris
iseTi maRali, rogorc esaa magaliTad avstraliaSi, merikis
SeerTebul StatebSi an dasavleT evropaSi. magram, bolo or
aTwleulSi, am tipis daavadebaTa matebis dinamika saqarT-
veloSic SemaSfoTebelia.
miuxedavad imisa, rom swored bolo 20 wlis ganmavloba-
Si, mTel msoflioSi, Catarda Zalian mniSvnelovani kvlevebi
alergiul daavadebaTa etiologiisa da paTogenezis dasa-
zusteblad da Seiqmna paTologiaTa marTvis efeqturi meqa-
nizmebi, problemis daZlevamde, rogorc Cans, mainc didi gzaa
gasavleli.
erT-erTi alergiuli daavadeba, romlis menejmentic Sedar-
ebiT srulyofiladaa damuSavebuli bronquli asTmaa. “asTmis
globaluri inciativa” (GINA) waroadgens uaRresad mniSvnelo-
van dokuments, romelic saSualebas aZlevs eqims maqsimalu-
rad efeqturad marTos es paTologia. mniSvnelovani nabijebia
gadadgmuli aseve atopiuri dermatitis, urtikariisa da angi-
oSeSupebis, polinozisa da alergiuli rinitis mkurnalobaSi.
Tumca am mxriv, kvlav rCeba mravali gadauWreli probleba.
erT-erTi mniSvnelovani sakiTxi, romelic gadamwyvet gavle-
nas axdens alergiul daavadebaTa mkurnalobasa da gamosavlis
efeqtze, aris drouli diagnistika. araa iSviaTi SeTxvevebi,
rodesac recidiuli bronqitis diagnozis qveS bronquli asT-
ma imaleba da mkurnaloba didi xnis gamnavlobaSi mimdinareobs
antibiotikebiT. aseve araa iSviaTi, rodesac daavadebis marT-
visas daSvebulia iseTi uxeSi tipiuri Secdomebi, rogoricaa

3
noSpisa da pirveli Taobis H1 blokatorebis (mag. pipolfeni)
gamoyeneba asTmis Setevis kupirebisaTvis da infuziuri Tera-
pia (“sisxlis gawmendis mizniT”) da naxSiri _ urtikariisa da
angioSeSupebis marTvisaTvis. yovelive es, bunebrivia, eqimis
informirebulobis naklebobiTaa gamowveuli.
Cvens mier mowodebuli informacia gankuTvnilia rogorc
alergologebis, ise zogadi profilis eqimebis, Terapevtebis,
pediatrebisa da gadaudebeli daxmarebis ganyofolebaSi mo-
muSave eqimebisaTvis.
Cven siamovnebiT miviRebT SeniSvnebsa da survilebs, rom-
lebic SeiZleba mkiTxvels gauCdes am naSromis wakiTxvisas.

ramaz RulaZe.

4
 ▶ alergiul daavadebaTa ganviTarebis meqanizmi
da mkurnalobis principebi.
alergiis ganviTarebis axali koncefcia _ “higienis hipoTe-
za” da lergiul daavadebaTa prevenciis Tanamedrove meTodebi.

imis Semdeg, rac 1906 wels avstrielma pediatrma pirkem

(Pirquet) pirvelma gamoiyena termini «alergia», rogorc «gan-
sxvavebuli reaqciis» sinonimi, daiwyo am fenomenis intensiuri
kvleva.
rogorc dRes irkveva, cnobebi alergiuli daaadebebis Ses-
axeb uxsovari droidan arsebobs. amis magaliTad kmara Tundac
is egvipturi papirusi, romelSic krazanas kbenis Sedegad gan-
viTarebuli anafilaqsiis SemTxvevaa aRwerili.
alergiis ganviTarebis meqanizmebis Seswavla gansakuTrebiT
intensiuri gaxda me-20 saukunis meore naxevridan, rodesac
prausnistisa (Prausnitz) da kiustneris (Kustner) mier Catarebu-
li klasikuri cdebis Sedegad dadasturda alergiis gamomwvevi
materialuri substratis, kanis masensibilizirebeli antis-
xeulebis _”reaginebis,” arseboba. SemdgomSi yvelaferi ufro
gasagebi gaxda, rodesac iaponeli mecnieris, iSizakas (Ishizaka)
mier, 1977 wels dadgenili iqna, rom reaginebi warmoadgenen
imunoglobulinebis er-erT klass da mas imunoglobulini E
(IgE) uwodes.
albaT Tavidanve unda aRvniSnoT, rom rodesac alergiul
reaqciaze vlaparakobT da ufro metad, rodesac alergiuli
procesis models vixilavT, pirvel rigSi vgulisxmobT I tipis,
dauyovnebel, imunologiul reaqcias, romelic alergiul daa-
vadebaTa absolutur umravlesobas udevs safuZvlad.
me-20 saukunis bolosaTvis, klasikuri saxelmZRvaneloebis
mixedviT, alergiuli procesis ganviTarebis meqanizmi sqemat-
urad ase gamoiyureboda: (sqema 1).

sqema 1.
IgE-s hiper produqciisa da alegiuli procesis ganviTarebis meqa-
nizmi.

Th/Ts → BE → IgE ( IgE + Ag = alergia )

aRniSnuli sqemis mixedviT, organizmis alergiuli ganwyoba

konkretuli antigenis (alergenis) mimarT genetikuria, deter-

5
minirebulia an sxva raime mizeziTaa gamowveuli da gansaz-
Rvrulia IgE-s sinTezis mimarT organizmis imunuri sistemis
saregulacio meqanizmebis darRveviT; kerZod _ Th/Ts Tanafar-
dobis darRveviT da Ts-is raodenobrivi klebis an funqciuri
ukmarisobis xarjze, B-limfocitebis Sesabamisi klonis mier,
IgE-s hiperproduqciiT vlindeba.
SemdegSi gamoirkva, rom IgE-s hiperproduqcia damokidebu-
lia ara imdenad Th/Ts subpopulaciebis disbalansze, aramed
Th1/Th2 Sefardebaze, Th2-is matebis sasargeblod. am proceSi
monawileobas iReben mravali saxis da funqciis citokinebi,
sxvadasxva mediatorebi da ujredebi.
dReisaTvis arsebuli monacemebis Tanaxmad, organizmSi
IgE-s sinTezs aregulirebs ujreduli imunitetis Th1 da Th2
mimarTulebaTa urTierT damokidebuleba. Tu am ori mimar-
Tulebis fiziologiuri proporcia daculia IgE-s Warbi ra-
odenoba ar gamomuSavdeba da dauyovnebeli alergiuli reaq-
cia ar viTardeba. e.w. “alergiul genotipebSi” anu “atopiur”
pirebSi Th pasuxi, organizmSi garkveuli antigenis SeWraze,
xorcieldeba Th2 predominanturi mimarTulebiT. amis gamo,
aseT individebSi, ara alergiuli pirebisagan gansxvavebiT,
mniSvnelovnadaa gaZlierebuli IgE-s produqcia.
organizmSi alergenis SeWris Semdeg, T-limfocitebi Sesa-
bamis signals gadascemeb B-limfocits; iwyeba B-limfocitis
transformacia plazmur ujredad da IgE-s gamomuSaveba.
sinTezirebuli IgE-s nawili cirkulirebs periferiul
sisxlSi. misi uidesi nawili ki fiqsirdeba kanqveSa da lorwo-
van garsebSi ganlagebul foyier ujredebze _ mastocitebze.
mastocitebze dafiqsirebul IgE-s molekulas rCeba 2 Tavisu-
fali fragmenti, romliTac igi Sesabamis, misTvis specifiur,
antigens (alegens) unda SeuerTdes.
Tu es procesi gamowveulia organizmSi konkretuli aler-
genis pirveli SeWriT, maSin alergiuli reaqciis klinikuri
gamovlineba ar xdeba. organizmis imunuri sistema ubralod
ecnoba am alergenis struqturas da emzadeba masTan meored
Sesaxvedrad. xdeba organizmis sensibilizacia. es procesi
daaxloebiT 2 kvira grZeldeba.
organizmSi am alergenis xelmeored SeWris SemTxvevaSi,
ukve Zalian swrafad gamomuSavdeba IgE-s didi raodenoba,
romelic Tavisi, Tavisufali, 2 fragmentiT (Fc-fragmenti)
ierTebs alergens, rasac mastocitebis degranulacia mohyveba

6
da iwyeba alergiuli reaqcia.
alergiuli reaqciis aRweril fazas imunologiuri faza ewo-
deba.
mastocitebze dafiqsirebuli IgE-s molekulasTan alerge-
nis SekavSirebis Semdeg iwyeba rTuli, energodamokidebuli,
biologiuri procesebi, romlebic mastocitebSi ujredis
membranis kalciumis arxebis aqtivaciiT, ujredSi kalciumis
ionebi SesvliT da mastocitebSi arsebuli, bioaqtiuri niv-
Tierebebis Semcveli, granulebis daSliT (degranulaciiT)
mimdinareobs.
mastocitebis degranulacis Semdeg, ujredebidan qsovi-
lebSi gadadis iseTi, biologiurad aqtiuri, nivTierebebi, ro-
gorebicaa histamini, serotonini, prostaglandinebi da lei-
kotrienebi.
alergiuli reqciis aRweril fazas bioqimiuri faza ewodeba.
bioaqtiuri nivTierebebi moqmedeben sisxlZarRvTa kapila-
rebis kedlebze, iwveven maTi ganvladobis gazrdas, ris gamoc
qsovilebSi gadadis plazma da sisxlis formiani elementebi.
xdeba neitrofilebis aqtivacia, proteolizuri fermentebis
gamoyofa da qsovilTa dazianeba. dazianebis keraSi migrireben
eozinofilebi da makrofagebi. viTardeba anTebis klasikuri
morfologiuri suraTi.
yvelaferi es, klinikurad, sxvadasxva formiT vlindeba.
SeiZleba gamoixatos kanisa da lorwovanis SeSupeba, eriTe-
matizacia, qavili, lorwos gaZlierebuli gamoyofa, bron-
qospazmi, wnevis daqveiTeba da sinkopec ki.
Sesabamisad viTardeba sxvadasxva alergiuli nozologia.
alergiuli reaqciis aRweril fazas paTofiziologiuri faza
ewodeba.
rodesac alergiul reaqciaze vlaparakobT, upirobod vgu-
lisxmobT reaqciis specifiurobas. anu organizmSi SeWril,
ucxo antigen (alergen) A-ze, Sesabamisi specifiuribis, A-
antixeulebis gamomuSavebas. alergen-B-ze unda gamomuSavdes
anti-B da a.S.
Tumca arsebobs SemTxvevebi, rodesac alergiuli daavade-
bis klinikuri suraTi araspecifiuri faqtoris gavleniT vi-
Tardeba. anu procesidan amovardnilia reaqciis imunlogiuri
faza. aseT SemTxvevaSi mastocitebis degranulacia xdeba ara
IgE + alergenis mier, aramed sxva, araspeciiuri faqtoris gav-
leniT.

7
 aRniSnuli movlenis magaliTia urtikariisa da angioSeSu-
pebis zogierTi forma, romelic SeiZleba iseTi faqtorebiT
iyos gamowveuli, rogorebicaa mag.: opiatebi, fizikuri dat-
virTva, qsovilebze zewola da vibraciac ki. zogierTi sakvebi
produqti, magaliTad marwyvi, zogjer, imunologiuri meqa-
nizmebis gareSec aTavisuflebs mastocitebidan histamins da
iwvevs urtikariis klasikur suras.
aseT reaqciebs fsevdoalergiuli reqciebi ewodeba.
aseve gamoirkva, rom iseTi daavadeba, rogoricaa magaliTad
atopiuri dermatiti, aseve SeiZleba mimdinareobles IgE-sagan
damoukidebeli reaqciiT. anu daavadebas axasiaTebs atopiuri
dermatitis klinikuri gamovlineba, magram laboratoriulad
ver dasturdeba atopiis arseboba. daavadebis am formas ato-
piformuls uwodeben.
Tavisi morfologiiT, energetikiTa da kinetikiT, imunuri
reaqciebi (da masTan erTad alergiuli reaqciebi) klasikurad,
4 tipad iyofa.
I tipis imunuri reaqcia _ es aris dauyovnebeli, hiperer-
giuli, tipis reaqcia, romelic organizmSi antigenis SeWris
Semdeg ramdenime wuTidan ramdenime saaTSi (uxSiresad < 3
saaTze) viTardeba. igi ganpirobebulia IgE antisxeulebiT,
Tumca SeiZleba IgG1 da IgG3 antisxeulebiTac iyos gamowveu-
li. am tipis reaqciis klasikuri magaliTia bronquli asTma,
urtikaria da anafilaqsia. mniSvnelovania am tipis reaqciis
roli atopiuri dermatitis paTogenezSic.
II tipis imunologiuri reaqcia aris e.w. citotoqsiuri rea-
qcia. igi viTardeba ujredis membranaze myarad fiqsirebuli
antigenisa da mis sawinaaRmdegod gamomuSavebuli antisxeulis
urTierTqmedebis Sedegad. aseTi antigeni SeiZleba iyos mag.
medikamenti, virusi, baqteriuli antigeni an TviT ujredis
struqtura da sxva. am tipis reaqciaSi monawile antisxeulebi
warmodgenilia IgG da IgM imunoglobulinebiT. reaqcia mimdi-
nareobs komplementis TanxlebiT da masSi monawileobas iRe-
ben sxvadasxva tipis efeqtoruli ujredebi. am tipis reaqciis
klasikuri magaliTia jgufuri (ABO) an Rh konfliqtiT ga-
mowveuli axalSobilTa hemolizuri daavadeba.
III tipis imunuri reaqcia, imunokompleqsuri tipis reaqciaa
da ganpirobebulia cirkulaciaSi myofi antigen+antisxeulis
kompleqsis qsovilebSi daleqviT da am qsovilTa dazianebiT.
mocirkulire, antigen+antisxeulebis kompleqsis warmoqmna

8
fiziologiur pirobebSic mimdinareobs. maTi eliminacia xde-
ba fagocitozis unaris mqone ujredebis saSualebiT. imunuri
kompleqsebis didi raodenobiT warmoSoba (intensiuri anti-
genuri datvirTva), fagocitozis Seferxeba an komplementis
deficiti, rac Tan axlavs fagocitozs, iwves imunuri kom-
pleqsebis eliminaciis procesis darRvevas da maT Calagebas
kapilaruli sisxlZarRvebis endoTelumSi. Sedegad viTarde-
ba kapilarTa kedlebis ganvladoba da vaskuliti. garda amisa
imunuri kompleqsebi ukavSirdebian leikocitebis membranaze
arsebul imunuglobulinebis receptorebs da iwveven am uj-
redebis degranuklacias. ris Semdegac ujredebSi arsebuli
biologiurad aqtiuri nivTierebebi (histamini, leikotriene-
bi, prostaglandinebi, triftaza da xva) qsovilebSi gadadi-
an da anTebiT reaqcias iwveven. imunuri kompleqsebis SeqmnaSi
monawileoben IgM; IgG da zogjer IgA imunoglobulinebi.
imunokompleqsuri reaqciis klasikuri magaliTia e.w “ar-
tusis fenomeni”, Sratis daavadeba da imunokompleqsuri tipis
glomerulonefriti.
rogorc I, ise II da III tipis imunologiuri reaqciebi, es aris
swrafi tipis, antisxeulebze damokidebuli reaqciebi. magram
Tu I tipis raqcia viTardeba antigenis SeWridan Zalian male _
ramdenime wuiTidan 1 – 2 saTSi, II da III tipis reaqciebis ganviTa-
reba xdeba 3 saaTze met droSi.
IV tipis imunologiuri reaqcia aris Senelebuli (dayov-
nebuli) zemgrZnobelobiTi reaqcia, romelic ganpirobebulia
sensibilizirebuli T-limfocitebiT. am tipis reaqcia viTar-
deba ujredSida infeqciuri agentebis (tipiuria mikobaqte-
ria), virusebis, simsivnuri warmonaqmnebis da transplantan-
tis winaaRmdeg. IV tipis imunologiuri reaqcia (ujreduli
tipis reaqcia) viTardeba organizmSi antigenis SeWridan 24
saaTs Semdeg. tipiuri klinikuri magaliTia tuberkulozi, ris
gamoc am tipis reaqcias tuberkulozur reaqcias uwodeben. am
tipis reaqciis roli aseve mniSvnelovania atopiuri dermati-
tisa da zogierTi sxva saxis egzemis ganviTrebaSi.
bolo xanebSi laparakoben V tipis imunologiuri reaqciis
arsebobis Sesaxeb, sadac SeiniSneba, rogorc ujreduli ise
humoruli imunitetis elementebi.
zogierTi Sexedulebis mixedviT V tipis imunlogiur re-
aqciaSi gulisxmoben ujreduli tipis orfazian reaqcias, ro-
desac reaqciis pirveli fazis damTavrebidan ramdenime dRis

9
Semdeg kvlav mwvaved iwyeba paTologiur simptomTa gamovli-
neba.
yovelive aRniSnulidan unda gamovitanoT daskvna, rom
imunologiuri reaqciebi Tavisi paTomorfologiuri Tavise-
burebis mixedviT iyofa: 1.humorul (I; II da III tipis reaqciebi)
da 2. ujredul (IV tipi) reaqciebad. kinetikisa da gamovlenis
siswrafis mixedviT: 1. dauyovnebeli (I tipis reaqcia). 2. nax-
evrad dauyovnebli (II da III tipis reaqcia) da dayovnebuli (IV
tipis reaqcia).
amasTan, aucilebelia gvaxsovdes, rom humoruli tipis
reaqciebi, miuxedavad imisa, rom mimdinareoben antisxeulebis
saSualebiT, regulirdebian T-maregulirebeli limfocitebis
mier. ase, rom T-sistemis dominanti, imunuri reaqciebis
formirebasa da mimdinareobis Taviseburebaze, yvela SemTx-
vevaSi SenarCunebulia.

alergiul daavadebaTa Tanamedrove menejmenti dafuZnebu-

lia daavadebis paTofiziologiaze. preparatebi, romlebic
dRes alergiul daavadebaTa samkurnalod gamoiyeneba moqme-
deben alergiuli reaqciis, zemoTganxilul, romelime erT an
ramdenime fazaze.
pirveli principi, rac alergiuli daavadebis mkurnalobis
dros unda gvaxsovdes, aris, SesaZleblobis mixedviT, aler-
genisagan Tavis arideba an misi eliminacia garemodan Tu or-
ganizmidan. es qmedeba, met-naklebi efeqturobiT, xels uSlis
alergiis imunologiuri fazis ganviTarebas. anu, Tu ar aris
alergeni, bunebrivia ar gamomuSavdeba Sesabamisi IgE-antisx-
euli.
bolo wlebSi SemuSavebuli IgE-sawinaaRmdego antisxeule-
bis Semcveli preparatebi, gamoiyeneba saineqcio formiT. isini
boWaven organizmSi gamomuSavebul IgE-s da xels uSlian mis
SeerTeba alergenTan, rac aferxebs mastocitebis degranula-
cias.
antihistaminuri preparatebi ablokireben histaminis re-
ceptorebs qsovilebSi, ris Sedegadac histamini veRar moqme-
debs sisxlZarRvTa kedlebze da aRar viTardeba (an sustdeba)
alergiis paTofiziologiuri faza. antihistaminuri prepa-
ratebi ver moqmedeben ukve ganviTarebul alergiul reqciaze.
isini xels uSlian alergiuli reaqciis Semdgom gamovlinebas
da progresirebas.

10
 membranostabilizatorebi xels uSlian mastocitebis de-
granulacias da amiT asusteben alergiis paToqimiur fazas.
leikotrienebis receptorTa blokerebs aqvT antihistamin-
uri preparatebis msgavsi efeqti. mxolod im gansxvavebiT, rom
aferxeben ara histaminis, aramed leikotrienebis zemoqmebas
qsovilebze da aseve aferxebeb daavadebis paTofiziologiur
fazas.
kortikosteroidebi, rogorc universaluri antianTebiTi
da imunodepresoruli saSualebebi, erTi mxriv, xels uSlian
ujreduli imunitetis mier IgE-s produqciis stimulirebas
da meore mxriv aferxeben qsovilebSi anTebiTi reaqciis gan-
viTarebas. anu, isini aferxeben alergiuli reaqciis, rogorc
imunologiur, ise paTofiziologiur fzas.
ukanaskneli 10 wlis ganmavlobaSi Catarebuli farTe masStab-
is kvlevebis Sedegad dagrovda Zalian sayuradRebo monacemebi,
romelmac mkvlevarebs saSualeba misca gamoetanaT Zalze sain-
terso daskvnebi alergiis ganviTarebis meqanizmebis Sesaxeb da
Sesabamisad daesaxaT alergiul daavadebaTa menejmentis axle-
buri perspeqtivebi.
zemoTaRniSnuli kvlebis dawyebas safuZvlad daedo is
aRiarebuli faqti, rom bolo 30 _ 40 wlis manZilze aler-
giul daavadebaTa gavrceleba mTel msoflioSi ramdenjerme
gaizarda.
aRniSnuli faqti bevrad ufro mkafiod dafiqsirda ekono-
miurad da kulturulad dawinaurebul qveynebSi, regionebSi
da calkeul ojaxebSic ki, vidre mesame samyaros qveynebSi da
ekonomiuri problemebis mqone, dabali kulturis ojaxebSi.
es movlena ar SeiZleba kavSirSi yofiliyo genetikur cvli-
lebebTan, radgan aseTi movlena ver Semoifargleboda mxo-
lod ekonomikurad dawinaurebuli qveynebiT. alergiis mateba
ar ukavSirdeboda haeris dabinZurebasac, radgan mkveTrad iyo
gamoxatuli swored iq, sadac samrewvelo narCenebis prob-
leba ufro kargad iyo mogvarebuli, vidre alergiis dabali
gavrcelebis zonebSi.
amitom daiwyo garemos kompleqsuri Seswavla, rogorc eko-
nomikuri, ise socialuri elementebis gaTvaliswinebiT. Sedar-
da dasavleTis ganviTarebuli qveynebis da e.w. mesame samyaros
qveynebis mosaxleobis SeswavliT miRebuli monacemebi. Semdeg,
amas daemata aRmosavleTis ganviTarebuli qveynebis (iaponia,
simgapuri, taivani) monacemebi, ramac kidev ufro damajerebe-

11
li gaxada miRebuli Sedegebi.
kvleva mimdinareobda didi xnis ganmavobaSi da erTdrou-
lad, didi sivrcis geografiul garemoSi.
kvlevis monacemebi mocemulia 1 cxrilSi.

cxrili N 1 gviCvenebs alergiul daavadebaTa gavrcelebis kavSirs

mosaxleobis social-ekonomiur mdgomareobasTan.

cxrili 1.
alergiis gavrcelebis garemo

ganviTarebadi qveyebi ganviTarebuli qveynebi

mravalwevriani ojaxebi mcirewevriani ojaxebi
cudad uzrunvebelyofili kargad uzrunvebelyofili
ojaxebi ojaxebi
soflis fermebSi mcxovrebi
qalaqSi mcxovrebi ojaxebi
ojaxebi
oro-fekaluri infeqciebiTa oro-fekaluri infeqciebiTa
da helminTebiT dainficire- da helminTebiT dainficire-
bis maRal done. bis dabali done.
antibiotikebis moxmarebis antibiotikebis moxmarebis
dabali done. maRali done.
dabali sanitaruli done maRali sanitaruli done

da rodesac am or garemos Soris asTmis gavrcelebis done

erTmaneTs Seadares, miiRes aseTi diagrama: (sqema 1).

sqema 1.

alergiis maRali
done

alergiis dabali
done

12
 anu, civilizaciis yvela damsaxureba: qalaqSi cxoveba, kargi
sanitaruli pirobebi, ekonomokuri keTildReoba, orofekaluri
infeqciebisa da helminTebisagan gaTavisufleba, cxovelebTan
kontaqtis ar arseboba da mcirewevriani ojaxebis arseboba, an-
tibiotikebis moxmarebis SesaZlebloba _ pirdapir proporci-
ulad asocirdeboda alergiis maRal donesTan.
aRniSnuli kvlevebi, ZiriTadad, atarebdnen epidemiolo-
giur xasiaTs. isini, Zalian did masalaze dayrdnobiT, ax-
dendnen faqtebis konstantacias mniSvnelovan geografiul
sivrceSi. magram es iyo mxolod faqtebis konstantacia da mas
aucileblad esaWiroeboda damajerebeli, laboratoriul kv-
levebze dafuZnebuli, axsna.
aseTi kvlevebiT gamoirkva rom IgE-s produqciis Tavise-
bureba damokidebulia imunur sistemaSi Th1/Th2 mdgomareo-
baze.
dadginda, rom adamianis nayofSi gamoxatulia Th2 pre-
dominanturi pasuxi, rac aseve rCeba dabadebis momentisaT-
vis. sicocxlis pirveli 18 Tvis ganmavlobaSi xdeba Th1-mimar-
Tulebis momwifeba da am procesSi Zalian didi mniSvneloba
aqvs nawlavTa mikrofloris mdgomareobas.
nawlavTa fiziologiuri mikroflora astimulirebs Th1
mimarTulebis momwifebas da es procesi miT ufro aqtiuria,
rac ufro efeqturia es stimuli. yvelaferi, rac xels uSlis
18 Tvemde asakis bavSvis nawlavTa mikrofloris fiziologi-
uri mdgomareobis (raodenoba, urTierT Sefardeba, funqcia)
SenarCunebas, aseve uSis xels Th1 imunuri pasuxis momwifebas
da ara alergiuli fenotipis pirovnebis Camoyalibebas. aseTi
faqtorebi SeiZleba iyos bunebrivi kvebis naadrevi Sewyveta,
saerTod araswori kveba da rac mTavaria antibiotikebis xSiri
da xangrZlivi gamoyeneba.
anu, sicocxlis pirveli 2 wlis periodSi antibiotikebis
xSiri gamoyeneba, xels uSlis Th1 imunuri pasuxis momwifebas
da aZlierebs Th2 mimarTulebas. yalibdeba e.w. alergiuli feno-
tipi.
da marTlac mravali dakvirvebiTaa dadasturebuli, rom
antibiotikebi da gansakuTrebiT, sicocxlis pirveli 2 wlis
periodSi miRebuli antibiotikebi, (gansakuTrebiT cefalo-
sporinebi) iwveven nawlavTa mikrofloris gamofitvas, mikro-
buli balansis darRvevas da aferxeben Th1 imunuri pasuxis
ganviTarebis SesaZleblobas, rac Tavis mxriv “alergiuli

13
fenotipis” Camoyalibebis da SemdgomSi alergiul daavadebaTa
ganviTarebis mizezi xdeba.
es monacemebi gasagebs xdis im faqts, rom alergiuli daa-
vadebebi upiratesad gavrcelebulia ekonomiurad dawinaure-
bul sazogadoebaSi, romelsac saSualeba aqvs moixmaros kargi
xarisxis da farTo speqtris Zvirad Rirebuli antibiotiki.
Th1 imunuri pasuxis momwifebisaTvis aseve didi mniSvnelo-
ba aqvs organizmis kontaqts orofekalur infeqciebTan, atip-
iur mikobaqteriebTan da helminTebTan.
orofekaluri infeqciebis (A-hepatiti, salmonela, Sisto-
somozi da sxva) gamomwvevi agentebi gamohyofen endotoqsins
_ lipopolisaqarids (LPS), romelic pirdapir astimulirebs
Th1 mimarTulebis imunuri pasuxis momwifebas.
mravali gamokvleviTaa dadasturebuli, rom mavSvebi, rom-
lebmac, 2 wlamde asakSi ramdenjerme gadaitanes orofekal-
uri infeqciebi, naklebad iyvnen midrekilni alergiuli daa-
vadebebis ganviTarebisaken momdevno asakSi, vidre maTi Tana-
tolebi, romelTac 2 wlamde asakSi orofelakuri infeqciebi
ar gadautaniaT.
igive SeiZleba iTqvas mikobaqteriebze, romelTaganac
yvelaze sayuradReboa niadagSi arsebuli atipiuri miko-
baqteriebi. amitom bavSvebs, romelTac 2 wlamde asakSi xSi-
rada aqvT kontaqti niadagTan (TamaSoben miwaSi), momdevno
asakSi naklebad unviTardebaT alergiuli daavadebebi, vidre
im bavSvebs, romelTac ara aqvT niadagTan kontaqti.
albaT calke saubris Temaa helminTebisa da alergiis urTi-
erT damokidebuleba. am sakiTxis irgvliv mravali publika-
cia arsebobs, Tumca aRniSnul urTierTobaTa bevri aspeqti
gaurkvevelia;
is, rom organizmis helminTebiT invaziasa da alergiis
klinikur gamovlinebas Soris ukuproporciuli damokideb-
uleba arsebobs, mravali publikaciiT dasturdeba. Zalian
saintereso faqtia, rom indoCineTis zogierT qveyanaSi, sadac
mosaxleobis helminTebiT invaziis done praqtilulad 100%-
ia, aseve praqtikulad ar fiqsirdeba alergiuli daavadeebi.
am movlenis arsi bolomde garkveuli ar aris. fiqroben, rom
saqme unda gvqondes helmimTebis mimarT IgE-s damokideb-
ulebis TaviseburebasTan:
serTod miaCniaT, rom IgE filogenezurad Seiqmna swored
helminTebTan sabrZolvelad. marTlac, cnobilia, rom

14
helminTizaciis procesi IgE-s hiperproduqciiT mimdi-
nareobs. im dros, rodesac adamianTa dainficireba helmi-
nTebiT praqtikulad mTel mosaxleobas moicavda, alergiuli
daavadebebis gamovlineba an ar xdeboda an xdeboda
minimaluri sixSiriT. imis Semdeg, rac gaumjobesda adamianTa
cxovrebis higienuri pirobebi da helminTizaciis sixSire
mkveTrad Semcirda, IgE-m dakarga Tavis funqcia, moxda misi
dezorientacia da daiwyo alergiuli procesebis ganviTareba.
amitom, iq, sadac IgE-m SeinarCuna Tavisi filogenezurad
gansazRvruli funqcia, alergiuli daavadebebis gamovlineba
ar xdeba.
Tumca am mxrivac yvelaferi garkveuli ar aris da upi-
ratesad miCneulia, rom helminTebiT masiuri dainficireba
asustebs alergiis ganviTarebis risks. maSin, roca Sedarebis
msubuqi dainficireba SeiZleba piriqiT, alergiis ganviTa-
rebis mizezic gaxdes.
es Teoria mTlianad dadasturebuli ar aris da arsebobs
rogorc misi sasargeblo, ise sawinaaRmdego argumentebi.
kidev erTi faqtori, romelsac sicocxlis pirveli 2 wlis
ganmavlobaSi SeuZlia stimuli misces Th1 mimarTulebis
imunuri pasuxis momwifebas, aris xangrZlivi kontaqti msxvil-
fexa rqian pirutyvTan (fermebSi mcxovrebi bavSvebi).
rogorc gamoirkva, msxvilfexa rqiani pirutyvis qertli
Seicavs cilovan nivTierebas, romelic astimulirebs Th1
mimarTulebis imunuri pasuxis momwifebas.
bolo xanebSi gamoqveynda Sromebi, romlebic miuTiTeben
ZaRlTan da katasTan adreuli kontaqtis dadebiT mniSvnelo-
baze alergiis prevenciisaTvis. magram es monacemebi asaxulia
erTeul publikaciebSi da naklebad sarwmunoa.
rac Seexeba soflis mravalwevrian ojaxebSi alergiis nak-
lebad gavrcelebis faqts, is ukavSirdeba amgvar ojaxebSi in-
feqciuri daavadebebis (rogorc orofekaluri, ise respira-
toruli) gavrcelebis maRal dones.
2 wlamde asaSi, respiratoruli virusuli infeqciebis maRal
sixSiresa da Semdgom wlebSi alergiis ganviTarebas Soris ka-
vSiris Sesaxeb monacemebi, xSirad, urTierT sawinaaRmdegoa.
avtorTa erTi jgufi miiCnevs, rom 2 wlamde gadatanili xSiri
respiratoruli infeqciebi asTmis ganviTarebis winapirobaa.
sxvebi ki fiqroben, rom es mdgomareoba alergiis prevencias
uwyobs xels.

15
 aRniSnuli monacemebis safuZvelze Seiqmna alergiis ganvi-
Tarebisa da bolo wlebSi misi mniSvnelovani matebis axsnisaken
mimarTuli hipoTeza, romelsac “higienis hipoTeza” ewodeba.
dReisaTvis, am hipoTezaSi Camoyalibebuli Sexedulebebi
ase gamoiyureba:
• alergiul da infeqciur daavadebaTa gavrcelebas Soris
arsebobs ukuproporciuli damokidebuleba.
• sicocxlis pirveli 2 wlis periodSi gadatanili nawla-
vuri infeqciebi amcireben alergiis ganviTarebis SesaZ-
leblobas sicocxlis momdevno etapze.
• “alergiuli” da “ara alergiuli fenotipis” formireba
damokidebulia sicocxlis pirveli 2 wlis ganmavlobaSi
Th ujredebis deviacis (Th1/Th) tipze.
• sicocxlis pirveli 2 wlis periodSi, garegani stimuli-
rebis saSualebiT, SesaZlebelia Th1 an Th2 mimarTule-
baTa momwifebis regulireba.

ujreduli meqanizmebi, romlebic zemoT aRwerili proce-

sebis ganviTarebis safuZvelia, Zalze rTuli da mravalmxrivia.

praqtikuli mimarTuleba, romelic dReisaTvis “higienis

hipoTezas” gaaCnia SemdegSi mdgomareobs:
• maqsimalurad vTqvaT uari sicocxlis pirveli 2 wlis
ganmavlobaSi antibiotikebis gamoyenebaze da yvela SesaZ-
lo saSualebebiT davicvaT nawlavTa mikrofloris fizi-
ologiuri balansi.
• sicocxlis pirveli 2 wlis ganmavlobaSi, vecadoT, gare-
gani stimulis saSualebiT, movaxdinoT Th1 imunuri pa-
suxis momwifebis aqtivacia.

rogorc uve aRvniSneT, Th1 imunuri pasuxis stimulacia

xorcieldeba baqteriuli toqsinis, helminTebisa da cxovel-
Ta qertlis SemadgenlobaSi arsebuli cilovani produqtebis
mier.
amdenad, sicocxlis pirveli 2 wlis periodSi, bunebasTan
da cxovelebTan urTierToba SeiZleba ganvixiloT, rogorc
alergiis prevenciis erT-erTi meTodi. Tumca ra Tqma unda,
XXI saukuneSi, adamianebi ver ityvian uars komfortsa da hi-
gienis dacvaze da ver daiwyeben helminTebiT, parazitebiTa
da orofekaluri baqteribiT Tu mikobaqteriebiT xelovnurad

16
dainficirebas.
2002 – 2003 ww.-dan, literaturaSi gamoCnda monacemebi
probiotikebis mier Th1 imunuri pasuxis aqtivaciis SesaZle-
blobis Sesaxeb. dReisaTvis, ara erT mkvlevars miaCnia, rom
aseTi aqtivacia SesaZlebelia da mas klinikuri mniSvnelobac
gaaCnia.
am mxriv, gansakuTrebiT sayuredReboa laqtobaqteriebis
Semcveli kulturebi, romelTa gamoyenebis Semdegac, “atopi-
uri mSoblebis” axalSobolebSi, sxva da sxva Sromis mixedviT,
2 jer Semcirda atopiuri dermatitis gamovlenis SesaZle-
bloba. preparatis gamoyeneba orsulobis mesame trimestris
mTeli periodis ganmavlobaSi, aseve mniSvnelovnad amcirebda
“atopiuri dedebis” axalSobilebSi alergiis gamovlenis Sanss.
dakvirvebebi am mimarTulebiT grZeldeba.
aseve qveyndeba monacemebi seriuli BCG vaqcinaciis Sesa-
Zlo antialergiul efeqtze. Tumca es monacemebi naklebad
sarwmunoa da maTi praqtikuli gamoyenebis SesaZlebloba, jer-
jerobiT, saeWvoa.

▶ kanis sinjebis mniSvneloba alergiis

diagnostikaSi
kanis alergiuli sinji pirvelad SemoiRo bleklim (Black-
ley)-1865 w. 1908 wels SemoRebuli iqna mantus (Mantoux) intra-
dermaluri sinji, romelic tuberkulozis diagnostikisaTvis
gamoiyeneboda. cota xnis Semdeg levisa da grantis (Lewis and
Grant) mier SemoRebuli iqna e.w. “prik-testi,” romelic, mcire
modifikaciiT, sruldeba dResac.

kanis alergiuli reaqciis paTofiziologia

IgE-damokidebuli kanis reaqcia vlindeba alergenis SeWri-
dan ramdenime wuTSi da ganviTarebis piks aRwevs 20 _ 30 wuTis
ganmavlobaSi. pozitiuri sinji, vizualurad, Cveulebriv,
gamoixateba kanis SeSupebiT, hiperemiiTa da qaviliT. es
yvelaferi gamowveulia, rogorc proanTebiTi, ise neiro-medi-
atorebis (dauyovnebeli) reaqciiT. mogvianebiTi tipis reaqcia
SeiZleba gamovlindes alergenis SeWridan 1 _ 2 saaTis Semdeg,
ganviTarebis piks miaRwios 6 _ 12 saaTSi da ukuganviTareba
moxdes 24 _ 48 saaTSi. aseTi reaqciis gamoxatuleba aris kanis
eriTematozul-anTebiTi cvlileba.

17
 dauyovnebeli alergiuli reaqcia.
dauyovnebeli tipis alergiuli reaqcia xorcieldeba mas-
tocitebis degranulaciis Sedegad. histamini da trift-
aza, romelic organizmSi alergenis SeWridan daaxloebiT 5
wuTSi Tavisufldeba mastocitebidan, arian am reaqciis mniS-
vnelovani, magram ara erTad-erTi, mediatorebi. reaqcia gan-
viTarebis piks aRwevs daaxloebiT 30 wuTSi. am tipis reaq-
ciaSi, histaminTan erTad, didi mniSvneloba aqvs neiro-regu-
latorul meqanizmebsac.

mogvianebiTi fazis reaqcia.

mogvianebiTi tipis alergiuli reaqcia anu naxevrad Senel-
ebuli reaqcia aris imunokompleqsuri tipis procesi. mis
ganviTarebaSi wamyvani mniSvneloba eniWeba IgG-antisxeulebs.
Tumca bolo droindeli monacemebi miuTiTeben IgE-s mniSvn-
elobazec. histaminis roli am reaqciaSi araa gadamwyveti. sam-
agierod Zalian mniSvnelovania T4 da T8-limfocitebis roli.
anTebad keraSi naxuloben iseT anTebiT mediatorebs, rogori-
caa: histamini, kalikreini, Tromboqsani, PGD2, LTC4, Trom-
bocitebis gamaaqtivebeli faqtori.

kanis alergiuli terstis Catarebis teqnika

da meTodika.
kanis sinjis SesaZlo riskebi da uzustobebi.
1. kanis alergiuli testi ar unda Catardes iseTi
kvalifikaciis eqimis gareSe, romelsac SeuZlia marTos
sistemuri alergiuli reaqciis (anafilaqsiis) gamovlineba
2. kanis alergiuli testis Catarebis adgilze unda
arsebobdes gadaudebeli daxmarebis saSualebebi da
gansakuTrebiT epinefrini.
3. uaRresad yuradRebiT da frTxilad unda viyoT im
pacientis mimarT, romelsac testis Catarebisas alergiis
klinikuri gamovlineba aReniSneba.
4. Semowmebuli da gansazRvruli unda iyos Sesayvani
alergenis koncentracia da stabiluroba.

5. darwmunebuli unda viyoT, rom alergenis koncentracia

misaRebia.

18
 6. unda tardebodes pozitiuri da negatiuri kontroli.
7. testi unda tardebodes jansaR kanze.
8. pacienti Semowmebuli unda iyos dermografizmze.
garkveuli unda iyos, ra medikamentebs iRebs pacienti da
9.
rodis miiRo bolo doza.
10. daafiqsireT kanis reaqcia testirebis Seabamis droSi.

prik-testi ( Prick-puncture tests )

prik-testi, romelic dReisaTvis yvelaze metadaa miRebuli,
pirvelad dainerga 1924 wels, xolo dRevandeli saxiT damuSav-
da 1970 wels. testi sruldeba Semdegnairad: saRi kanis zeda-
pirze (winamxris medialur zedapirze) vaTavsebT standartuli
alergenis wveTebs, erTmaneTisagan ara nakleb 2 sm. manZilze.
dadebiT kontrolisaTvis gamoiyeneba histaminis standar-
tili xsnari, xolo uaryofiTi kontrolisaTvis _ fiziolo-
giuri xsnari. wveTis SuagulSi vaxdenT Cxvletas specialuri
lancetis saSualebiT ise, rom ar daziandes kanis Rrma Sre da
ar miviRoT sisxldena. anu alergeni unda moxvdes kanis SreSi
da ara kanqveS. 2 _ 3 wuTis Semdeg wveTebi SeiZleba SevaSroT
specialuri qaRaldiT an bambiT. Sedegs vafasebT testirebi-
dan 10 da 20 wuTis Semdeg.

prik-testis Catarebisas daSvebuli uxSiresi Secdomebi.

1. alergenebis wveTebis aplikacia xdeba erTmaneTisagan

axlos ( < 2 sm. ) da Zlieri reaqciis dros gaugebari xdeba
romel alergenze ganviTarda reaqcia.
2. Rrma CxvletiT gamowveulma sisxldenam SeiZleba mogvces
cru-dadebiTi reaqcia.
3. subdermalurad aleregenis Seyvana (nemsis saSualebiT)
SeiZleba cru-uaryofiTi Sedegis mizezi gaxdes.
4. alergenis xsnaris gafantvam (gaSlam) did farTobze
SeiZleba Seaferxos misi moxvedra intradermalurad da
cru-uaryofiTi pasuxis mizezi gaxdes.

19
 gansakuTrebiT xazgasasmelia, rom prik-testi minimalurad
Seicavs sistemuri reaqciis ganviTarebis risks da isic arako-
merciuli alergenebis gamoyenebis SemTxvevaSi. erT-erTi mo-
nacemebiT, aseTi garTulebis sixSire meryeobs 0,26% _ 0,52%-s
Soris.

intradermaluri testi.
intradermaluri testis klasikuri magaliTia mantus sinji,
rodesac kanSi SehyavT tuberkulinis xsnari. procedura tar-
deba insulinis Spricis gamoyenebiT (kanis travmis Tavidan ac-
ilebis mizniT) kanis saR ubanSi SehyavT 0,05 _ 0,1 ml odenobis
(Cveulebriv _ 0,1 ml.) alergenis standartuli xsnari. ineqciis
adgilze unda gaCndes mcire zomis (2 _ 4 mm diametris ) amo-
burcva. ineqciamde Spricidan unda gamoidevnos haeri, radgan
haeris moxvedram kanSi, SeiZleba gamoiwvios amoburcva aler-
genis xsnaris kanSi moxvedris gareSec, rac saboloo jamSi
cru_uaryofiTi reaqciis mizezi xdeba.

intradermaluri alergiuli testis Catarebisas ganviTare-

buli darRvevevebi

1. erTmaneTTan axlos Catarebulma ineqciebma SeiZleba cru-

dadebiTi pasuxi mogvces.
2. 0,1 ml-ze meti raodenobis siTxis Seyvana SeiZleba cru-
dadebiTi reaqcii mizezi gaxdes.

3. alergenis maRali koncentraciiT Seyvanam SeiZleba cru-

dadebiTi raqcia gamoiwvios.
4. kanqveS haeris moxvedra SeiZleba gaurkveveli reaqciis
mizezi gaxdes.
5. alergenis kanqveS Seyvana iwvevs cru-uaryofiT reaqcias.

6. ara standartuli nemsiT Cxvleta da sisxldena SeiZleba

cru-dadebiRi reaqciis mizezi gaxdes.

7. erTdroulad mravali testis Cataraebam SeiZleba

sistemuri reaqcia gamoiwvios

intradermaluri testis dros xSiria tkivilis SegrZneba.

sistemuri reaqciis ganviTarebis SesaZleblbas aRniSnaven

20
0,02% _ 1,4%-Si. aRwerilia fataluri SemTxvevebi.
intradermaluri testi SeiZleba Caataros eqTanma, magram
aucileblad eqimis TandaswrebiT. dakvirvebis periodi Seadgens
20 wuTs da am periodis ganmavlobaSi pacienti aucileblad unda
imyofebodes eqimis ofisSi. gansakuTrebuli yuradReba unda mi-
eqces atopiur pacientes da pirebs, rimlebic b-blokerebs iRe-
ben, radgan es kontingenti gansakuTrebis midrekilia sistemuri
reaqciis ganviTarebisakn.
am mxris ufro usafrTxoa prik-testi. sistemuri reaqciis Ta-
vidan acilebis mizniT, zogierT riskis jgufSi Semaval pacents,
meore zemo kiduris mxris midamoSi, winaswar ukeTdeba 1:1000 gan-
zavebis epinefrinis adeqvaturi doza.

cxrili 2
intradermaluri da prik-testis Sedareba.
intradermaluri
prik-testi
testi
simartive +++ ++
Sedegis gamovlenis siswrafe. ++++ ++

pozitiuri da negatiuri ++++ ++

pasuxebis interpretaciis
SesaZlebloba
diskomforti + +++
cru-dadebiTi pasuxi. iSviaTia SesaZlebelia
cru-negatiuri pasuxi. SesaZlebelia iSviaTia.
raodenoba droSi da +++ ++++
ekonomiuroba.
sensitiuroba. +++ ++++
specifiuroba. ++++ +++
IgE antisxeulebis arsebobis SeiZleba SeiZleba.
dadastureba.
usafrTxoeba. ++++ ++
axalSobilebSi Catarebis SeiZleba rTulia.
SesaZlebloba.

aRniSnuli monacemebis gaTvaliswinebiT, yvela saerTaSori-

so alergologTa asociacia da organozacia, prik-tests Tvlis
pirveladi kvlevis saukeTeso saSualebad da saeWvo Sedegis Sem-

21
TxvevebSi, kvlevis momdevno etapze, saWirod miiCneven intra-
dermluri testis Catarebas. aseT SemTxvevaSi upiratesobas ani-
Weben intradermalurad alergenis 1:1000 _ 1:100 da Semdeg sruli
koncentraciis Seyvanas.

testis dadebiTi da uaryofiTi kontroli.

kanis alergiuli testis swori SefasebisaTvis aucilebe-
lia dadebiTi da uaryofioTi kontrolis arseboba, rac min-
imumamde amcirebs mcdari interpretaciis SesaZleblobas.
indiferentuli xsnaris aplikaciis (an punqciis) areSi kanis
dadebiTi reaqciis ganviTareba SeiZleba gamowveuli iyos
dermografizmiT da kanis hiperreaqtiulobiT, rac eWv qveS
ayenebs alergenebis aplikaciis areSi ganviTarebuli reaqciis
pozitiurobas. pozitiuri kontrolisaTvis gamoiyeneba hista-
minis standartuli xsnari da igi, Cveulebriv unda iwvevdes
kanis induracias, eriTemas da qavils. Tu histaminis aplika-
ciis areSi aRniSnuli reaqcia ar ganviTarda, alergenis ap-
likaciis areSi kanis uaryofiTi reaqciis Sedegi eWvqveS dgeba
da unda gairkves am movlenis mizezi (medikamentebi, histaminze
dabali mgrZnobeloba, araswori teqnika).

kanis sinjebis Sefaseba.

kanis testebi unda SevafasoT maTi ganviTarebis pikze, te-
stirebidan 10 _ 15 wuTis Semdeg. histaminze kanis reaqciis
piki viTardeba Seyvanidan 8 _ 10 wuTSi da alegenis Seyvanidan
_ 15 _ 20 wuTSi. alergiis mogvianebiTi fazis Sefaseba (Tu is
ganviTarda) yovelTvis araa SesaZlebeli da misi klinikuri
mniSvneloba arcaa cnobili.
rodesac kanis reaqcia gamoxatulia (pikis periodSi) vzom-
avT induraciisa da eriTemis diameters milimetrebSi. anTeba-
di reaqcia upiratesad mrgvali formisaa da misi diametris
gazomva rTuli araa. Tu reaqciis forma asimetriulia, maSin
vzomavT maqsimalur da minimalur diametrebs da vangariSobT
saSualo maCveneblebs. zogjer iyeneben kompiuteruli gamoT-
vlis meTodebs da Termografiasac ki.

“pozitiurobis” kriteriumebi. testis Sefasebis absolutu-

rad unificirebuli meTodi ar arsebobs. Pepys mixedviT, Tu
negatiuri kontrolis testi absoluturad uaryofiTia, maSin
1 _ 2 mm-is eriTematozuli induracia da qavili _ SeiZleba

22
pozitiur testad Sefasdes da Sesabamisi IgE antisxeulebis
arsebobas adasturebdes. zogierTi avtoris mosazrebiT, sus-
tad gamoxatuli dadebiTi reaqcia, ver gamodgeba klinikurad
sayuradRebo atopiuri procesis sadiagnostikod. prik-testis
SemTxvevaSi, Cveulebriv, dadebiTad Tvlian reaqcias, Tu anTe-
biTi cvlilebis diametri 3 mm-ze (7 mm kvadrati) ufro metia,
xolo eriTema vrceldeba > 10 mm diametrze.
arsebobs Sefasebebis sxva meTodebic, magram zemoT aRweri-
li meTodi, Tavisi simartivis gamo, yvelaze xSirad gamoiyeneba
klinikur praqtikaSi.

kanis sinjTa raodenoba da kvlevis dasaSvebi

sixSire.

kanis sinjebs raodenoba.

erTdroulad Catarebuli sinjebis dasaSvebi raodenoba da-
kavSirebulia iseT faqtorebze, rogoricaa: 1. pacientis asaki
(mcire asakSi xSiradaa saWiro kvebiTi alergenebis identifi-
kacia, aseve respiratoruli alergenebis kvleva). 2. geogra-
fiuli garemo, sadac cxovrobs pacienti (zogierT geografi-
ul zonas axasiaTebs specifiuri alergenebis arseboba), 3. pa-
cientis anamnezi (SeiZleba daaxloebiT migviTiTebdes SesaZlo
alergenis arsebobaze).

kanis sinjebis Catarebis sixSire.

kanis sinjebis Catarebis sixSire damokidebulia iseT fa-
qtorebze, rogoricaa: 1. asaki (bavSvTa asakSi xSiria axali, ro-
gorc kvebiTi, ise sainhalacio alergenebiT sensibilizacia,).
2. axal alergenebTan kontaqti (mag. sacxovrebeli adgilis
Secvlis gamo). 3. imunoTerapia (mweris Sxamis alergiis sam-
kurnalod Catarebuli imunoTerapiis procesSi, ganmeorebiTi
prik-tesi araa rekomendirebuli).

sinjis Catarebis are.

sinjis Catareba umetesad rekomendirebulia winamxris me-
dialur zedapirze, antikubitaluri aridan ara nakleb 5 sm
daSorebul areSi.

23
 pacientis asaki.
sinji SeiZleba Catardes yvela asakSi. gasaTvaliswinebe-
lia is garemoeba, rom Cvilobis periodSi, sinjiT gamowveuli
eriTema vrceldeba ufro farTo areze, vidre Semdgom asakSi,
xolo induracia aris SedarebiT mcire zomis.

sezonis mniSvneloba.
kanis alergiuli sinjis sezonuri cvalebadoba dakavSire-
bulia IgE-s sinTezis intensivobasTan sxvadasxva sezonSi. mag.
es procesi gansakuTrebiT intensiuria mcenareTa yvavilobis
sezonSi da Sesabamisad, am periodSi, kanis sinji ufro intensi-
urad vlindeba. am SemTxvevaSi, garTulebis riskic metia.

paTologiuri mdgomareobebi.
miaCniaT, rom egzema aqveiTebs kanis mgrZnobelobas his-
taminze da Sesabamisad, kanis testis gamovlenis intensiuroba
SeiZleba Semcirdes. Tumca sarwmuno monacemebi amis Sesaxeb ar
arsebobs. stresi, videoTamaSebi an mobiuri telefonis inten-
siuri gamoyeneba aZlierebs kanis reaqciis intensivobas. re-
gularul hemodializze myof da simsivniT daavadebul paci-
entebSi, kanis alergiuli testis intensivoba daqveiTebulia.

medikamentebis gavlena kanis alergiul sinjze.

zogierTi medikamenti gavlenas axdens kanis alergiuli
reaqciis ganviTarebaze da arTulebs testis Sedegis inter-
pretacias. sxva medikamentebi, romlebic asTmis an alergiuli
bunebis sxva daavadebis samkurnalod gamoiyeneba, ar axdenen
gavlenas kanis alergiuli testis gamovlinebaze.
H1-antihistaminuri preparatebis yvela formis gamoyeneba
amcirebs histaminis efeqts kanis Sesabamis receptorebze da
asustebs kanis alergiuli sinjis gamovlinebas.
H2-antihistaminuri preparatebi mcired asusteben kanis al-
ergiuli sinjis intensivobas.
kortikosteroidebis Terapiuli dozebis xanmokle gamo-
yeneba mniSvnelovnad ar cvlis, xolo xangrZlivi gamoyeneba
garkveulad asustebs kanis alergiuli sinjis intensivobas da
arTulebs misi Sedegis interpretacias.

24
 kanis alergiuli sinjebis interpreacia sxvadasxva
situaciaSi.
kanis pozitiuri alergiuli testebi im populaciaSi, sadac
alergiuli daavadeba klinikurad araa gamoxatuli.
dadebiTi alergiuli sinjis arseboba ar adasturebs al-
ergiuli daavadebis arsebobas, aramed gviCvenebs organizmis
sensibilizaciis faqts. 8%_30%-Si, kanis dadebiTi alergiu-
li testi araa korelaciaSi daavadebis arsebobasTan. Tumca am
dros ra Tqma unda, raime alergiuli daavadebis gamovlenis
riski gacilebiT metia, vidre negatiuri testis arsebobis Sem-
TxvevaSi. dadgenilia, rom sensibilizirebul, asimptomatur
pirebSi, 30% _ 60%-Si, mogvianebiT, adgili aqvs alergiuli
paTologiis klinikur gamovlinebas.

kanis alergiuli sinjis cru-dadebiTi da

cru-uaryofiTi Sedegebi.
kanis alergiuli sinjebis, rogorc cru-pozitiuri ise
cru-negatiuri Sedegi SeiZleba miviRoT maSinac ki, roca te-
sti Sesrulebulia teqnikurad sworad da gamoyenebuli masala
saukeTeso xarisxisaa. Tumca araswori Sedegis ZiriTadi mize-
zebi swored testirebis teqnikuri wuni da masalis xarisxis
problemaa.
sinjis cru-pozitiuri Sedegi SeiZleba gamowveuli iyos
alergenis dabinZurebiT, dainficirebiT, mastocitebis aras-
pecifiuri degranulaciis gamo, dermatografizmiT, rino-
sincitialuri virusis gavleniT (rsv aZlierebs histaminis
zemoqmedebiT gamowveul kanis anTebiT process) an sxva ara
specifiuri reaqciiT.
cru-uaryofiTi reaqcia SeiZleba gamowveuli iyos: 1. al-
ergenis dabali reaqtiulobiT an droTa ganmavlobaSi am rea-
qtiulobis SemcirebiT. 2. pacientis mier iseTi medikamentebis
miRebiT, romlebic ablokireben kanis alergiul reaqcias. 3.
daavadebebiT, romlebic amcireben kanis reaqtiulobas. 4. Cvi-
lebsa da moxucebSi kanis dabali reaqtiulobiT. 5. teqnikuri
wuniT (susti Cxvleta). 6. ultra iisferi sxivebis zemoqmede-
biT. 7. ara IgE-meqanizmiT gamowveuli alergiis arsebobiT. 8.
iseTi infeqcibiT, rogoricaa magaliTad helminTozi.
aRniSnulis gamo, kanis alergiuli sinjis dadebiTi da ua-
ryofiTi kontroli gvexmareba Sedegis, met naklebad, adeqva-
tur interpretaciaSi.

25
 saeWvo SemTxvevebSi, rodesac prik-testi uaryofiTia da
klinikuri monacemebi miuTiTeben pirovnebis sensibilizaciis
maRal albaTobaze, damatebiT tardeba kanSida testi, rac
ukeT avlens dabali sensibilizaciis arsebobas. garda amisa Se-
saZleblobas iZleva davadginoT IgG-antisxeulebis arsebobac
(prik-testi ver adgens IgG antisxeulebiT sensibilizacias).

kanis alergiuli sinjis sadiagnostiko Rirebulebis

done.
medikamentebis mimarT hipermgrZnobelobis Sefaseba kanis
testis mixedviT vareabeluri SedegiT xasiaTdeba. diagnozi xSi-
rad garTulebulia Tu: 1. pacienti alergiulia preparatSi Se-
mavali romelime, erTi metabolitis mimarT. 2. Tu adgili aqvs
standartizirebis arasrulfasovnebas. 3. Tu saxezea alergiis
ara IgE-damikidebuli varianti. amitom, kanis alergiuli testi
medikamentis mimarT, rTulad Sesafasebelia, misi sadiagnosti-
ko Rirebuleba, arcTu maRalia da misi Sefaseba kompleqsuradaa
saWiro.GmagaliTad penicilinze sensibilizaciis SemTxvevaSi ka-
nis sinji dadebiTia SemTxvevaTa daaxloebiT 20%-Si.
kanis alergiuli sinjis negatiuri pasuxi ar gamoricxavs ana-
filaqsiis ganviTarebis SesaZleblobas. ! !

▶ IgE-s klinikuri mniSvneloba

Ig E izotipi aris adamianis organizmSi arsebuli 5 izotipi-

dan erT-erTi. igi pasuxismgebelia I tipis (dauyovnebeli) imu-
nologiuri reaqciis ganviTarebaze.
IgE-s kvlevas mniSvnelovani roli eniWeba alergiul daava-
debaTa diagnostikaSi. Tumca aqve mxedvelobaSia misaRebi mra-
vali faqtoric, romlebic gavlenas axdenen adamianis orga-
nizmSi IgE-s doneze da romelTa gaTaliswinebac aucilebelia
laboratoriul monacemTa interpretaciisas:

1. adamianis organizmSi IgE-s gansazRvra xdeba ZiriTadad

sisxlis SratSi (Tumca mcire raodenobiT igi arsebobs
sxva bilogiur siTxeebSic).
2. organizmSi arsebobs, rogorc saerTo (totaluti), ise an-
tigen-specifiuri IgE.
3. sisxlis SratSi saerTi IgE-s raodenoba SeiZleba ganic-

26
 dides araspecifiur cvlilebebs, proteinebis gamomuSa-
vebis procesis an metabolizmis cvlasTan dakavSirebiT.
4. saerTi IgE-s donis cvlileba organizmSi SeiZleba dakav-
Sirebuli iyos imunuri sistemis funqcionirebisa da reg-
ulirebis TaviseburebebTan.
5. zogierTi daavadeba SeiZleba pirdapir iwvevdes IgE-s
produqciis stimulirebas.
6. zogierTi daavadebis ganviTareba SeiZleba pirdapir iyos
dakavSirebuli specifiuri IgE-s produqciaze, romelic
garkveuli antigenebis winaaRmdeg aris mimarTuli.

IgE-s normaluri produqcia.

IgE-s normaluri produqciis SemTxvevaSi, igi minimaluri
raodenobiTaa fiziologiur siTxeebSi. sisxlis SratSi misi
raodenoba bavSvebsa da mozrdilebSi, saSualod, Seadgens 2
dan 100 IU/mL.
adamianis nayofs unari aqvs gamoimuSaos IgE gestaciis me-
11 kviridan. Tumca misi koncentracia axalSobilis sisxlis
SratSi Zalian dabalia. Wiplaris sisxlSi, SemTxvevaTa mxolod
1% xerxdeba antigen-specifiuri IgE-s arsebobis dafiqsireba.
bavSvis dabadebis Semdeg, sisxlSi IgE-s koncentracia
imatebs da maqsimums aRwevs 10 _ 15 wlis asakSi. amis Semdeg,
adamianis asakis matebasTan erTad, IgE-s raodenoba sisxlis
SratSi TandaTan mcirdeba.
adamianis sisxlis SratSi IgE-s raodenoba dakavSirebulia
mraval faqtorze, rogorebicaa mag.: asaki, sqesi, rasa, siga-
retis weva, wlis sezoni, janmrTelobis mdgomareoba da sxva.
mcenareTa yvavilobis dasawyisSi IgE-s done organizmSi
imatebs da maqsimums aRwevs 4 – 6 kviris ganmavlobaSi; Semdeg
TandaTan mcirdeba momaval yvavilobamde. statistikuri mona-
cemebiT, alergiul pirTa jgufebSi, IgE-s done ufro maRalia,
vidre ara alergiul pirebSi. Tumca calkeul individebSi es
kanonzomiereba yovelTvis SenarCunebuli araa.
IgE-s yvelaze dabali done, romelic SeiZleba laborato-
riulad iyos dafiqsirebuli sisxlis SratSi, Seadgens 2,0 _
5,0 IU/mL. fiqroben, rom sisxlis SratSi IgE-s dabali done
SeiZleba ukavSirdebodes autoimunuri daavadebis an rekuren-
tuli infeqciis arsebobas.

27
 IgE da alergiuli daavadebebi.
mravali SromebiT dasturdeba, rom alergiuli daavadebis
mqone pirebSi, ara alergiul pirebTan SedarebiT, maRalia
sisxlis Sratis saerTo da specifiuri IgE-s done. da amisda
miuxedavad, saerTo IgE-s sadiagnostiko Rirebuleba Sez-
Rudulia.
yvela monacemi, romelic alergiul da ara alergiul pirTa
sisxlis SratSi totaluri (saerTo) IgE-s donis kvlevas exeba,
miuTiTebs, rom es maCvenebeli ufro xSiradaa maRali aler-
giul, vidre ara alergiul pirebSi. Tumca, calkeul, konkre-
tul, SemTxvevaSi, igi SeiZleba ufro maRali iyos im pirSi,
romelsac ar aReniSneba alergiuli daavadeba, vidre am tipis
daavadebis mqone individSi. amitom sisxlis SratSi IgE-s maRali
done, sxva maCveneblebisagad damoukideblad, ar aris alergiis
diagnozisa da miT umetes, konkretuli alergiuli nozologiis
arsebobis maCvenebeli.
sisxlis SratSi pecifiuri IgE-s arseboba gviCvenebs or-
ganizmis sensibilizaciis arsebobas konkretuli alergenis
mimarT. magram ar adasturebs am alergenis mimarT sensibili-
zaciasa da konkretuli alergiuli daavadebis mizez-Sedego-
briv kavSirs.
cnobilia, rom sisxlis Sratis saerTo IgE SeiZleba gansa-
kuTrebiT maRali iyos ara alergiuli daavadebebisa da aseve
ara alergiuli bunebis sxvadasxva mizezis zemoqmedebis Sede-
gadac.

cxrili 3.
mdgomareobebi, romlebic asocirebulia IgE-s gansakuTrebis maRal
donesTan.
1 alergiuli bronqopulmonaluri mikozi
2 alergiuli fungaluri sinusiti
3 atopiuri dermatiti
4 Sidsi
5 hiper IgE (Buckley-s) sindromi
6 IgE mieloma
7 Kimura-s daavadeba
8 limfoma
9 Netherton-is sindromi
10 sistemuri parazitozi
11 tuberkulozi

28
 IgE da asTmis ganviTarebis riski.
mravali SromiT dasturdeba, rom asimptomur adamianTa po-
pulaciis im jgufSi, sadac maRalia sisxlis Sratis saerTo
IgE-s koncentracia, maRalia SemdgomSi alergiul daavadebaTa
da maT Soris bronquli asTmis gamovlenis Sansi. amasTan, mi-
uTiTeben, rom kavSiri asimptomur pirTa sisxlis SratSi IgE-s
maRal donesa da SemdegSi asTmis ganviTarebas Soris ufro
maRalia, vidre kanis pozitiur testebsa da asTmis ganviTare-
bis albaTobas Soris. rinitis SemTxvevaSi ki saqme piriqiTaa
da kanis pozitiuri testebi ufro metadaa momavalSi rinitis
ganviTarebis prognozirebis maCvenebeli, vidre sixlis Sratis
maRali, saerTo IgE.
sisxlis SratSi saerTo IgE-sa da daavadebis klinikuri ga-
movlinebis simZafres Soris gansakuTrebiT TvalsaCino kavSi-
ri arsebobs alergiuli bronqo-pulmonaluri aspergileozis
dros. amis gamo, sisxlis SratSi IgE-s maRali done am daavade-
bis laboratoriuli diagnostikis kargi saSualebaa.
arsebobs monacemebi, romlebic adastureben rom, sisxlis
SratSi saerTo IgE-s maRali done, pirdapir proporciul da-
mokidebulebaSia xandazmul asakSi filtvis funqciis daqvei-
TebasTan.

alergen-specifiuri IgE da misi mniSvneloba.

imis Semdeg, rac cnobili gaxda, rom reaginebi warmodge-
nilni arian IgE izotipiT, male daiwyo alergen-specifiuri
antisxeulebis raodenobrivi gansazRvra in vitro. kvlevas sa-
fuZvlad daedo radioizotopuri meTodi.
mravali SromiTaa dadasturebuli, rom specifiuri IgE an-
tisxeulebis kvleva, saSualebas iZleva ganisazRvros mravali
kvebiTi alergiis mizezi. aseve dadgenilia specifiuri IgE an-
tisxeulebis gansazRvris klinikuri mniSvneloba respirtoru-
li alergozebis sadiagnostikod da mWidro korelaciuri
kavSiri specifiuri antisxeulebis maRal donesa da filtvis
funqciis daqveiTebas Soris.
alergen-specifiuri IgE-s koncentracia sisxlis SratSi
mniSvnelovnadaa dakavSirebuli adamianis asakze, garemoSi al-
ergenebis arsebobasa, maT koncentraciasa da zemoqmedebis xan-
grZlivobaze. aseve kros-reaqtiul (jvaredin) alergenebTan
urTierTobaze da imunoTerapiaze.
specifiuri IgE, Cveulebriv, ufro maRalia skolis asakis

29
bavSvebsa da mozrdilebSi da Zalian dabalia Cvil bavSvTa
asakSi, ris gamoc maTi aRmoCena am jgufSi problemuria.
IgE mniSvnelovnad imatebs, roca adamiani mcenareuli
mtvris garemoSia. IgE-s koncentracia mniSvnelovan matebas
iwyebs mcenareTa yvavilobis sezonis dawyebidan 4 kviris Sem-
deg, ris Semdegac TandaTanobiT mcirdeba momaval sezonamde.
adamianis organizmSi IgE-s koncentracia, zogjer, aseve izr-
deba mweris kbenis Semdegac.
rogorc bavSebSi, ise mozrdilebSi Catarebuli kvlevebiT
dadasturebulia, rom xSir SemTxvevaSi, sruliad asimptomur
pirebSic ki, alergiuli sinjebi (rogorc in vitro ise in vivo )
pozitiuria.
klinikis pirobebSi Zalian xSirad dgeba sakiTxi imis Sesa-
xeb, Tu ra meTodi unda gamoviyenoT alergiul daavadebaTa
sadiagnostikod da konkretuli alergenis mimarT organizmis
sensibilizaciis gamovlenis mizniT.
am mizniT gamoiyeneba ori meTodi:
1. kvleva in vitro (saerTo da specifiuri IgE-s kvleva sisx-
lis SratSi).
2. kvleva in vivo (kanis alergiuli testi).
TviToeul am meTods gaaCnia Tavisi pozitiuri da negatiu-
ri mxareebi, romelic unda gaiTvaliswinos eqimma kvlevis yvela
konkretul SemTxvevaSi. Tumca klinikis pirobebSi, uxSiresad,
upiratesoba kanis „prik-tests“ eniWeba.

cxrili 4.
sisxlis SratSi IgE-s testirebisa da kanis alergiuli sinjis Tavi-
seburebaTa Sedareba.
IgE-s kvleva
1 ar aris alergiuli reaqciis riski
2 mis Sedegze ar moqmedeben miRebuli medikamentebi
3 ara aqvs mniSvneloba kanis mdgomareobas
4 ar qmnis pacientisTvis diskomforts
5 mosaxerxebelia dokumentirebuli kontrolisaTvis
kanis testebi
1 xasiaTdeba maRali sensitiurobiT
2 iZleva alergenTa farTo speqtris kvlevis saSualebas
3 Sedegis Sefaseba xdeba swrafad
4 aris SedarebiT iafi

30
 rogorc wesi, klinikis pirobebSi, upiratesoba eniWeba kanis
alergiul sinjebs.

IgE, infeqciuri da parazituli daavadebebis dros.

sisxlis Sratis IgE imatebs mravali infeqciuri da parazi-
tuli daavadebebis dros. dadgenilia specifiuri IgE antis-
xeuebis arseboba zogierTi infeqciuri agentis mimarT. sxva
SemTxvevaSi IgE-s mateba araspecifiuria, Tumca SeiZleba Se-
fasdes, rogorc infeqciuri procesis arsebobis erT-erTi ni-
Sani.
cxrili 5.
ara-alergiuli daavadebebi, romlebic gavlenas axdenen saerTo IgE-
s doneze.

IgE-s maRali done

parazituli daavadebebi
1 askaridozi
2 parazitebis visceraluri migracia
3 kapilariazi
4 paragonimiazi
5 fasciolozi
6 Sistosomozi
7 ankilostomozi
8 triqinelozi
9 filariazi
10 strongiloidozi
11 eqinokokozi
12 onqocerciazi
13 malaria
infeqciebi
1 alergiuli bronqopulmonaluri aspergileozi
2 sistemuri kandidozi
3 kokcidiomikozi
4 keTri
5 EBV mononukleozi
6 CMV mononukleozi

31
7 respiratoruli virusuli infeqcia
8 adamianis imunodeficitis I tipis virus-infeqcia
9 yivanaxvela
kanis daavadebebi
1 budobrivi alopecia
2 bulozuri pemfigoidi
3 streptokokuli kvanZovani eriTema
sxva daavadebebi
1 nefrozuli sindromi
2 medikamentozuri intersticiuli nefriti
3 RviZlis daavadebebi
4 kistofibrozi
5 Kawasaki-s daavadeba
6 Cvil bavSvTa kvanZovani periarteriti
7 filtvis pirveladi hemosiderozi
8 Guillman-Barre-s sindromi
9 damwvroba
10 revmatoiduli arTriti
11 Zvlis tvinis transplantacia
12 sigaretis weva
13 alkoholizmi
neoplastiuri daavadebebi
1 Hodgkins-is daavadeba
2 IgE mieloma
3 bronqebis karcinoma
imunodeficitebi
1 Wiskott-Aldrich-is sindromi
2 Job-is (hiper IgE ) sindromi
3 Timusis hipoplazia (DiGeorge-s sindromi)
ujreduli inunodeficiti agamaglobulinemiiT
4
(Nezelof-is sindromi)
5 IgA-s seleqciuri deficiti
medikamentebis zemoqmedeba

32
 1 Enfuvirtide
2 Pholcodine
IgE-s dabali done
IgE-s ojaxuri deficiti da rekurentuli sino-
1
pulmonaluri infeqciebi
adamianis T-limfotropuli I tipis virusuli in-
2
feqciebi
3 pirveladi biliaruli cirozi

IgE da virusuli daavadebebi

dadgenilia, rom RSV-is mimarT SeiZleba gamomuSavdes spe-
cifiuri IgE antisxeulebi da es procesi asocirebulia bron-
qospazmis ganviTarebasTan, xmaurian sunTqvasTan („vizingTan“)
da qvemo respiratoruli traqtis dazianebasTan bavSvebSi. es
movlena aseve asocirebulia SemdgomSi rekurentuli „vizingis
ganviTarebasTan“, rac wlebis ganmavlobaSi SeiZleba grZel-
debodes. specifiuri IgE antisxeulebi SeiZleba aseve gamo-
muSavdes EBV-iT gamowveuli mononukleozis dros, romelTa
koncentraciac pacientis sisxlSi piks aRwevs daavadebis dawy-
ebidan me-7 _ me-10 dRes. Semdeg TandaTan iklebs da ramdeni-
me kviridan, ramdenime TveSi normas ubrundeba. specifiuri
IgE-s matebas aRniSnaven wiTelas infeqciis drosac. daavadebis
dasawyisSi, maTi koncentracia sakmaod maRalia. xolo gamo-
nayaris gaCenidam meore kviris bolos iklebs da ubrundeba
normas.

IgE da baqteriuli infeqciebi.

zogierTi baqteriuli infeqciis mimarT aRwerilia speci-
fiuri IgE antisxeulebis gamomuSavebis faqtebi. IgE antisxeu-
lebi oqrosferi stafilokokebis mimarT, gamomuSavdeba pirve-
ladi imunodeficitis erT-erTi formiT (iobis sindromi) daa-
vadebul pacientebSi. zogierTi avtori miuTiTebs bavSvebSi,
yivanaxvela infeqciis gadatanis Semdeg, saerTo da specifiuri
IgE-s matebis Sesaxeb. aseve dadgenilia, rom specifiuri antis-
xeulebi SeiZleba gamomuSavdes tetanusis gamomwvevis mimarT,
Sesabamis imunizaciis Semdeg.

33
 safuarebi da sxva fungaluri infeqciebi
sxvadaxva kvlevebiT dasturdeba, rom safuarisa da sxva-
dasxva fungaluri agentebis mimarT SesaZlebelia specifiueri
IgE antisxeulebis gamomuSaveba. atopiuri dermatitiT daava-
debul pacientebSi nanaxia candida albicans-is sawinaaRmdego
IgE antisxeulebis sakmaod maRali done. aseve, atopiuri der-
matiTiT daavadebul pirebSi, romelTac aReniSnebodaT Tavis,
saxisa da kisris aris dazianeba, nanaxia safuaris Pitirosporum
ovale-s sawinaaRmdego IgE antisxeulebi.

IgE da parazituli daavadebebi

IgE-s donis mateba damaxasiaTebelia metazoanuri parazitu-
li infeqciebis dros. IgE-gansakuTrebulad mkveTrad imatebs
parazitebis mier qsovilovani invaziis SemTxvevaSi. momatebu-
lia, rogoc saerTo, ise parazitebis antigenebis mimarT pro-
ducirebuli IgE-s done. parazitozis winaaRmdeg Catarebuli
efeqturi mkurnalobis Semdeg saerTo IgE-s done, rogorc
wesi, mcirdeba da normas ubrundeba.
IgE-s done adamianis sisxlis SratSi imatebs iseTi egzo-
parazitebis zemoqmedebis SemTvevaSic, rogoricaa magaliTad
moskitebis, krazanas an sxva mwerebis kbena. mweris SxamiT sen-
sibilizaciis SemTxvevaSi mosalodnelia anafilaqsiis ganvi-
Tareba. zogierTi eqtoparaziti (mag. munis gamomwvevi tkipa),
adamianSi iwveven kanis Zlier qavils, raSic mniSvneloani roli
IgE-s, mastocitebsa da bazofilebs ekuTvnis.

34
 ▶ asTma
asTma aris qronikuli avadobisa da sikvdilobis erT-erTi
xSiri mizezi mTel msoflioSi. amasTan, misi gavrcelebis six-
Sirem, bolo 20 wlis ganmavlobaSi, mniSvnelovnad moimata, rac
gansakuTrebiT SesamCnevia bavSvTa kontingentSi. asTmis sixSi-
ris mateba aRiniSneba praqtikulad mTel msoflioSi, Tumca es
movlena gansakuTrebiT intensiuria ekonomikurad da kultu-
rulad dawinaurebul qveynebSi.

definicia.
asTma aris daavadeba, romelic xasiaTdeba am paTologiisT-
vis specifiuri klinikuri, fiziologiuri da paTologiuri
TaviseburebebiT. klinikur monacemebSi dominantobs eqspira-
ciis perioduli gaZneleba, romelic uxSiresad gamoxatulia
RamiT da romelsac, aseve xSirad axlavs Tan mSrali xvela.
fizikaluri monacemebidan yvelaze xSiria eqspiraciuli viz-
ingi.
daavadebis umTavresi fiziologiuri niSania bronqebis
(wvrili da saSualo kalibris bronqebis) epizoduri obstruq-
cia, rasac Tan axlavs eqspiraciis SezRudva. dominanturi pa-
Tologiuri niSania sasunTqi gzebis qsovilebis anTeba, ro-
melic zogjer struqturul cvlilebebTanaa asocirebuli.
“asTma aris sasunTqi gzebis qronikuli anTebiTi daavadeba,
romlis ganviTarebaSic mravali ujredi da ujreduli media-
tori iRebs monawileobas. qronikuli anTebis procesi asocire-
bulia sasunTqi gzebis hiperreaqtiulobasTan, rac iwvevs vizin-
gis, qoSinis, gulmkerdis SeboWilobis da xvelis rekurentuli
epizodebis ganviTarebas upiratesad RamiT an gamTeniisas. bron-
qebis variabeluri obstruqcia uxSiesad spontanurad Seqceva-
dia an ixsneba samkurnalo saSualebebis gamoyenebis Sedegad”.

asTmis gavrceleba. avadobisa da sikvdilobis sixSire.

dReisaTvis arsebuli oficialuri statistikis mixedviT,
mTel msoflioSi aRricxulia asTmiT daavadebuli 300 milioni
adamiani. Tumca imis gamo, rom yvela qveyanaSi ar arsebobs asT-
mis diagnostikis erTiani kriteriumebi da aRricxvis sistemac
da SesaZleblobebic gansxvavebulia, daavadebis gavrcelebis
namdvili suraTi dadgenili araa. dReisaTvis Tvlian, rom
sxvadasxva qveyanaSi mcxovrebi mosaxleobis mTlian popula-

35
ciaSi, asTmis gavrcelebis sixSire meryeobs 1% dan 18%-amde.
jan.dacvis saerTaSoriso organizaciis monacemebiT, mTel
msoflioSi, yovelwliurad, asTmisagan iRupeba 250000 adami-
ani.

asTmis ganviTarebaze moqmedi faqtorebi.

asTmis gaanviTarebis risk-faqtorebi SeiZleba davyoT or
jgufad:
1. faqtorebi, romlebic xels uwyoben asTmis, rogorc daa-
vadebis ganviTarebas.
2. faqtorebi, romlebic xels uwyoben asTmis gamwvavebas
(asTmis Setevis trigerebi).

pirvel jgufs ZiriTadad ekuTvnis adamianis organizmis

Taviseburebebis ganmsazRvreli faqtoreni (mag. genetikuri
faqtorebi).
meore jgufs ZiriTadad ekuTvnis garemo faqtorebi.

cxrilSi mocemulia im faqtorTa CamonaTvali, romlebic

gavlenas axdenen asTmis ganviTarebasa da gamwvavebaze.

cxrili 5. asTmis ganviTarebasa da gamwvavebaze moqmedi faqtorebi

adamanis organizmis Tavisebureba.

genetikuri faqtorebi:
• atopiis genuri dispozicia.
• bronqebis hiperreaqtiulobis genuri dispozicia.
simsuqne.
sqesi.

garemo faqtorebi.
alergenebi:
• “oTaxis alergenebi” oTaxis tkipebi, cxovelebi (ZaRli,
kata, Tagvebi), tarakanebis alergenebi, sxvadasxva tipis
soko (maT Soris safuaris tipis).
• “oTaxis gareT arsebuli alergenebi”: mtveri
(gansakuTrebiT mcenaris mtveri), sxvadasxva tipis
soko.
infeqciuri agentebi (upiratesad virusebi).
okupaciuri xasiaTis (upiratesad saqmianobasTan

36
 dakavSirebuli) masensibilizirebeli faqtorebi.
Tambaqos moxmareba:
• pasiuri mweveloba.
• aqtiuri mweveloba.
haeris dabinZureba saxlSi an saxlis gareT.
kvebis xasiaTi.

asTmis ganviTarebis risk-faqtorad aseve miCneulia sim-

suqne, Tumca am movlenis meqanizmi bolomde garkveuli araa.
rac Seexeba sqess, cnobilia, rom 14 wlamde asakis vaJebSi
asTma gvxvdeba 2-jer ufro xSirad vidre gogonebSi. Tumca
mozrdil asakSi es Tanafardoba icvleba da qalebi ufro
xSirad avadmyofoben asTmiT vidre mamakacebi. alergenebi asT-
mis gamwvavebis erT-erTi yvelaze mniSvnelovani faqtorebia.
Tumca maTi roli asTmis ganviTarebaSi bolomde axsnili araa.
masStaburi kvlebebiTaa dadasturebuli, rom oTaxis mtvris
alergenebiT, katisa da ZaRlis qertliT da Aspergillus-iT sen-
sibilizacia warmoadgens damoukidebel risk-faqtors, 3 wel-
ze ufrosi asakis bavSvebSi asTmis msgavsi simptomebis gamov-
lenisaTvis. amasTan unda iTqvas, rom alergenebTan urTier-
Toba da sensibilizaciis ganviTareba bavSvebSi ar warmoadgens
pirdapir proporciul process. es movlena (sensibilizacia)
ufro metad damokidebulia alergenis Taviseburebaze, mis do-
zaze, urTierTobis xangrZliobaze, bavSvis asakze da individis
genetikur dispoziciaze. miuxedavad amisa, mkvlevarTa didi
nawili Tvlis, rom zogierT alergenebTan, rogorebicaa mag.
oTaxis mtvis SemadgenlobaSi arsebuli tkipebis da tarakanis
alergenebi, Sexvedra, umetes SemTxvevaSi organizmis sensibil-
izaciiT mTavrdeba, rac SemdgomSi asTmis ganviTarebis mizezi
SeiZleba gaxdes. Tumca arsebobs sawinaaRmdego monacemebic.
rac Seexena ZaRlisa da katis alergenebs, zogierTi epidemi-
ologiuri kvlevebis Tanaxmad, am alergenebTan urTierToba
sicocxlis pirveli 2 wlis ganmavlobaSi, aferxebs asTmis gan-
viTarebas. Semdgom periodSi ganviTarebuli sensibilizacia ki
asTmis risk-faqtoradaa miCneuli. im infeqciuri agentebidan,
romelTa kavSiri aqvT asTmis gamwvavebasTan da zogjer ganviTa-
rebasTanac aRsaniSnavia respiratorul-sincitialuri virusi
(RSV) da paragripis virusi. axalSobilobisa da Cvilobis pe-
riodSi am virusebiT gamowveuli bronqiolitebi, SemdgomSi,
daaxloebiT 40%-Si, asocirdeba recidiul vizingTan da asT-

37
mis ganviTarebasTanac ki. meore mxriv ki arsebobs monacemebi,
romlebic miuTiTeben, rom adreul asakSi gadatanili viru-
suli infeqciebi, SemdgomSi atopiis ganviTarebas (da asTmis
gaviTarebas) aferxeben.
daaxloebiT 300 dasaxelebis nivTiereba asocirdeba oku-
paciuri asTmis ganviTarebis riskTan. rogorc wesi, aseT niv-
TierebebTan urTierToba dakavSirebulia pirovnebis samsax-
uris specifikasTan. okupaciuri asTma ZiriTadad damaxasiaTe-
belia mozrdili asakis mosaxleobisaTvis. mozrdili, dasaqme-
buli, asTmiT daavadebuli 10 piridan, 1-s okupaciuri asTma
aReniSneba. okupaciuri asTmis SemTxvevebi gansakuTrebiT xSi-
ria maRalganviTarebul industrial qveynebSi.
okupaciuri asTmis prevenciisa da mkurnalobis saukeTeso
meTodi, aRniSnuli okupaciuri faqtorebis eliminaciaa.
Tambaqos mweveloba (aqtiuri an pasiuri) asocirebulia
adreul asakSi recidiuli vizingis ganviTarebasTan, filt-
vis funqciis daqveiTebasTan, asTmis mZime formebis Camoya-
libebasTan, sistemuri da sainhalacio kortikosteroidebiT
mkurnalobis efeqtis SesustebasTan da asTmis kontrolis
procesis garTulebasTan.
saxlSi an saxlis gareT haeris dabinZurebis kavSiri asTmis
ganviTarebasTan sakamaToa. damtkicebulia, rom dabinZurebu-
li haeris garemoSi cxovreba iwvevs filtvis funqciis dar-
Rvevas. Tumca ramdenad iwvevs es mdgomareoba asTmis ganviTa-
rebas _ cnobili araa.
kvebis Taviseburebis kavSiri asTmasTan bolomde garkveuli
araa. Tumca cnobilia, rom xelovnur kvebaze myof CvilebSi
gacilebiT xSiria recidiuli vizingebi, vidre bunebriv kve-
baze myof bavSvebSi.

asTmis ganviTarebis meqanizmebi.

asTma aris sasunTqi gzebis (upiratesad saSualo da wvrili
kalibris bronqebis) anTebiT gamowveuli daavadeba. anTebiTi
procesis ganviTarebaSi monawileobas iRebs mravali ujredi
da anTebiTi mediatori, rac sasunTqi sistemis qsovilebSi gan-
viTarebuli paTofiziologiuri cvlilebebis Taviseburebas
ganapirobebs. sasunTq gzebSi ganviTarebuli anTebiTi proce-
si asocirebulia bronqebis hiperreaqtiulobasTan da asTmis
klinikur simptomebTan.
miuxedavad imisa, rom asTmis paTofiziologiis Sesaxeb

38
uamravi kvlevebi arsebobs, es procesi, dReisaTis, mainc araa
bolomde Seswavlili da bevri sakiTxi mainc gaurkvevelia.
anTebiT procesSi monawile ujredebi. rogorc saerTod,
yvela alergiul daavadebaTa paTogenezSi, ise asTmis ganviTa-
rebaSic gadamwyveti roli eniWeba Th2-limfocitebs, mastoc-
itebs, eozinofilebs, dendritul ujredebs, makrofagebs da
neitrofiebs.
anTebiTi mdiatorebi. dReisaTvis cnobilia 100-ze meti
sxvadasxva anTebiTi mediatori, romelic asTmiT daavadebuli
pacientebis sasunTq gzebSi anTebiT procesebs aregulirebs.
sasunTq gzebSi ganviTarebuli struqturuli cvlilebebis
Tavisebureba dakavSirebulia am areSi ganviTarebuli anTebi-
Ti procesis intensivobasTan. mZime da xangrZlivi anTebiTi
procesis dros ganviTarebuli struqturuli cvlilebebi
SeiZleba gaxdes Seuqcevadi xasiTis da mniSvnelovnad gaar-
Tulos daavadebis marTvis procesi. im struqturuli cvli-
lebebidan, romlebic mniSvnelovan gavlenas axdenen sasunTqi
sistemis mdgomareobasa da Sesabamisad asTmis mimdinareobaze,
gansakuTrebiT aRsaniSnavia: subepiTeluri fibrozi, romelic
am areSi kolagenisa da proteoglikanebis Calagebis Sedegad
viTardeba da gluvkunTovani muskulaturis hipertrofia da
hiperplazia, rac bronqebis kedlebis gasqelebas da elasti-
urobis klebas iwvevs. garda amisa, izrdeba sasunTqi sistemis
sislZarRvTa kedlebis ganvladoba da sasunTq gzebSi lorwos
hipersekrecia, rac SemdgomSi, am areSi, lorwovani sacobebis
gaCenis mizezi xdeba.
umniSvnelovanesi paTofiziologiuri procesi, romlebic
asTmis klinikuri gamovlinebis Taviseburebas da simZimes
gansazRvravs, sasunTqi gzebis (upiratesad saSualo da mcire
kalibris bronqebis) Seviwroebaa. es procesi mraval faqtorzea
damokidebuli, romelTagan gansakuTrebiT mniSvnelovania:
• mravali saxis, bronqokonstriqtoruli moqmedebis medi-
atorebisa da neirotransmiserebis zemoqmedebis Sedegad
viTardeba bronqebis gluvkunTovani muskulaturis Sek-
umSva. es procesi umetes SemTxvevaSi srulad Seqcevadia
spontanurad an samkurnalo saSualebebis zemoqmedebis
Sedegad. daavadebis mZimed mimdinareobis SemTxvevaSi,
bronqokonstriqciis sruli Seqcevadoba ar xdeba.
• mravali saxis proanTebiTi mediatorebis zemoqmedebis
Sedegad ganviTarebuli kapilaruli sisxlZarRvebis ked-

39
 lebis ganvladobis zrda, sasunTq gzebSi lorwovanis
SeSupebis ganviTarebis mizezi xdeba.
• bronqebis kedlebis Sesqeleba da elastiurobis daqve-
iTeba, rac zogjer, daavadebis mZimed mimdinareobis
dros, mkurnalobis Semdegac ki, Seuqcevad xasiaTs atar-
ebs.
• sasunTq gzebSi ganviTarebuli anTebad-eqsudaciuri
procesebis gamo lorwos hipersekrecia, rac zogjer
lorwovani sekretis sacobebis gaCenas da bronqebis,
sxvadasxva xarisxiT, daxSobas iwvevs.

sasunTqi gzebis hiperreaqtiuloba. sasunTqi gzebis hier-

reaqtiuloba aris bronquli asTmis ganviTarebis mniSvnelovani
paTofiziologiuri meqanizmi, rac safuZvlad udevs bronqos-
pazmisa da sasunTqi gzebis Seviwroebis process. sasunTqi gze-
bis hiperreaqtiulobis SemTxvevaSi, fizikuri stimuli (aler-
geni an sxva saxis gamRizianebeli), romelic janmrTeli adamia-
nis sasunTq sistemaSi mniSvnelovan cvlilebas ar gamoiwvevs,
bronquli asTmiT daavadebulebSi, bronqospazmis, sasunTqi
gzebis lorwovanis anTebis da Sesabamisi klinikuri simptoma-
tikis gamovlinebis mizezi xdeba. sasunTqi gzebis hiperreaqti-
ulobis meqanizmebi bolomde garkveuli araa.
im meqanzmebidan, romlebic sasunTqi gzebis hiperreaqti-
ulobas da bronqebis gluvkunTovani struqturis kumSvado-
bis gaZlierebas iwveven, dReisaTvis, umTavresad, gamohyofen
Semdegs:
• bronqebis gluvi muskulaturis struqturis Semadgene-
li ujredebis raodenobrivi mateba an maTi kumSvadobis
unaris gaZliereba.
• sasunTq gzebSi ganviTarebuli qronikuli anTebiTi pro-
cesis Sedegad xdeba am areSi arsebuli sensoruli nerve-
bis sensibilizacia da sensoruli stimulis Semdeg –
bronqokonstriqcia.

bronquli asTmis gamwvaveba.

bronquli asTma warmoadgens sasunTqi gzebis qronikul
anTebiT daavadebas, romelsac perioduli gamwvavebebi axasi-
aTebs.
bronquli asTmis gamwvavebebi viTardeba organizmze garkveu-
li risk-faqtorebis anu “trigerebis” zemoqmedebis Sedegad.

40
aRniSnul “trigerebs” ekuTvnis: fizikuri datvirTva, haeris
dabinZureba, amindis cvlileba, zmo sasunTqi gzebis virusu-
li infeqciebi (gansakuTrebiT RSV da RV) da ra Tqma unda
sxvadasxva saxis alergenebi, romlebic qvemo respiratorul
traqtSi xangrZlivad mimdinare anTebiTi procesebis ganviTa-
rebas iwveven.

sasunTq gzebSi haernakadis moZraobis

SezRudvis Seuqcevadoba.
umetes SeTxvevaSi, bronquli asTmiT daavadebul pacien-
tebSi, sasunTq gzebSi haernakadis SezRudva Seqcevadi proce-
sia. Tumca, zogierT pacientTan, romelsac daavadebis mZime
forma aReniSneba, bronqospazmis sruli moxsna da haernaka-
dis moZraobis procesis mTliani aRdgena, verc spontanurad
da verc samkurnalo saSualebebis gamoyenebiT, ver xerxdeba.
aRniSnuli movlena, sasunTq gzebSi qronikuli struqturuli
cvlilebebis mizezi xdeba.

asTmis, mkurnalobis mimarT, rezistentuli formebi.

ra aris mizezi asTmis iseTi formebis Camoyalibebisa, rom-
lebic Zalian Znelad samarTavia da ar emorCileba arc kor-
tikosteroidebiT mkurnalobas, bolomde garkveuli araa.
fiqroben, rom zogierT SemTxvevaSi, am movlenis mizezi gene-
tikuri faqtorebia. aseT pacientTa umravlesobas, daavadebis
Tundac msubuqi an saSualo simZimis formis gamovlenis Semdeg,
mdgomareobis progesuli damZimeba da daavadebis, mkurnalo-
bis mimaT, rezistentuli formis Camoyalibeba aReniSneba.

bromquli asTmis diagnostika.

tipiur SemTxvevebSi, asTmis diagnostireba rTuli araa da
igi ZiriTadad davadebis anamnezur da klinikur monacemebs
efuZneba. Tumca arsebobs SemTxvevebi, rodesac aucilebelia
asTma gavarCioT iseTi daavadebebisa da mdgomareobebisa-
gan, rogorebicaa magaliTad mozrdilebSi sxvadasxva mizez-
iT gamowveuli vizingi, bronqiti, filtvebis qronikuli ob-
struqciuli daavadeba, xandazmulTa qoSini da sxva. bavSvebSi
asTmis diferencireba xSirad rTuldeba bronqitisa da kru-
pis sxvadasxva saxesTan, rac bunebrivia, arTulebs daavadebis
swor marTvas.

41
 anamnezi. Zalian mniSvnelovania ojaxuri da personaluri
atopiuri anamnezis arseboba. anu aRiniSneba Tu ara pacientis
sisxliT naTesavebSi asTma an sxva alergiuli (mag. atopiuri
dermatiti, urtikariis epizodebi, medikamentebis an sakvebis
mimarT alergiis gamovlinebebi) paTologiebi. xom ar aReniS-
neba pacients anamnezSi atopiis raime klinikuri gamovlineba.
im simptomebidan, romlebic yvelaze metad gvafiqrebineben
asTmis arsebobaze, gansakuTrebiT sayuradReboa epizoduri
eqspiraciuli qoSini, vizingi, mSrali xvela da gulmkerdis Se-
boWvis SegrZneba. aRniSnuli simptomebi upiratesad konkretul
trigerTan (mag. raime alergeni) Sexebisas vlindeba da xSirad
sezonuri xasiaTisaa. asTmis simptomebi xSiradaa asocirebli
rinitTan. simptomTa gamovlena an gamZafreba zogjer asoci-
rebulia araspecifiur gamRizianeblebTan, rogoricaa mag. si-
garetis boli, mkveTri suni, fizikuri datvirTvaQan amindis
cvlileba. asTmis sadiagnostikod Zalian mniSv-nelovani kri-
teriumebia iseTi monacemebi, rogoricaa Ramis gamwvavebebi da
mdgomareobis gaumjobeseba asTmis sawinaaRmdegi preparatebis
(gansakuTrebiT sainhalacio b2-agonisti an kortikosteroidi)
miRebis Semdeg.
cxril 6-Si mocemulia simptomebi, romlebic aTmis arsebo-
baze migviTiTebs.

cxrili 6.
kiTxvebi, romlebic unda davusvaT pacients asTmis doagnostirebi-
sas.
• aReniSneba Tu ara pacients anamnezSi rekurentuli vi-
zingi?
• aReniSneba Tu ara Zlieri xvela RamiT?
• aReniSneba Tu ara pacients xvela da vizingi fizikuri
datvirTvis Semdeg?
• aReniSneba Tu ara pacients vizingi, xvela an gulmker-
dis SeboWvis SegrZneba alergenebTan kontaqtis an dabin-
Zurebuli haeris garemoSi moxvedrisas?
• «gaciebisas» simptomebi xom ar gadadis qvemoT, gulm-
kerdisken? an «gaciebis» simptomebi xom ar grZeldeba 10
dReze meti xnis ganmavlobaSi?
• aRiniSneba Tu ara simptomTa Semcireba da mdgomareobis
gaumjobeseba asTmis sawinaaRmegi preparatebis miRebis
Semdeg?

42
 mxolod xveliT (eqspiraciuli qoSinis gareSe)
mimdinare asTmis varianti.
xveliT mimdinare asTmis variantis SemTxvevaSi, pacients,
upiratesad Ramis ganmavlobaSi, aReniSneba mSrali xvela.
sunTqvis gaZneleba da vizingi araa gamoxatuli. dRis ganma-
vlobaSi mdgomreoba praqtikulad damakmayofilebelia, pa-
cients Civilebi ara aqvs da fizikaluri kvleviTac paTologia
ar vlindeba. aseT SemTxvevaSi saWiroa spirigrafiuli kvleva
da bronqul lavaJSi eozinofilebis identificireba. am mxriv,
xveliT mimdinare asTmis varianti unda ganvasxvaoT e.w. eo-
zinofiluri bronqitisagan, romlis drosac broqul lavaJSi
momatebulia eozinifilebis raodenoba da normaSia spirogra-
fiuli monacemebi. maSin roca xveliT mimdinare asTmis SemTx-
vevaSi, aseve momatebulia bronqul lavaJSi eozinofilebis
raodenoba, magram gamoxatulia spirografiuli maCveneblebis
daqveiTeba.
sxva paTologiebidan, romlebic asTmis diagnostikisas
unda iyos ganxiluli, gasaTvaliswinebelia: angiotenzinis
gardamqmneli enzimis inhibitorebis miReba (hipotenziuri pre-
paratebis jgufi, romelic xvelas iwvevs), gastro-ezofaguri
refluqsi, postinfeqciuri xvela, postnazaluri gadadinebis
sindromi, sinusitebi, xmovani iogebis disfunqcia da RSV da
RV-iT gamowveuli bronqitebi adreuli asakis bavSvebSi.

fizikuri datvirTviT gamowvuli broqokonstriqcia.

fizikuri datvirTva iwvevs asTmis simptomebis gaZlierebas an
gamovlenas asTmiT daavadebul TiTqis yvela pacientSi. xolo
zogierT pirovnebaSi, SeiZleba uSualo fizikuri datvirTva
warmoadgendes asTmis gamwvavebis mizezs. am tipis asTis simp-
tomebi vlindeba seriozuli fizikuri datvirTvidan 5 _ 10
wuTis Semdeg, Zalian iSviaTad ki SeiZleba gamovlindes uSua-
lod fizikuri datvirTvis dros. klinikurad gamoxatulia
asTmis tipiuri suraTi _ eqspiraciuli qoSini da vizingi. zo-
gjer SeiZleba gamovlindes SeteviTi xasiaTis mSrali xela,
romelic spontanurad qreba 30 _ 45 wuTis ganmavlobaSi. am
tipis bronqokonstriqcia SeiZleba ganviTardes nebismieri
klimatis pirobebSi, magram ufro xSirad vlindeba mSrali da
civi haeris CasunTqvisa da naklebad, cxeli da nestiani haeris
pirobebSi.
b2-agonistis inhalaciis Semdeg mdgomareobis swrafi gau-

43
mjobeseba an am jgufis preparatebiT ganxorcielebuli warma-
tebuli prevencia aris fizikuri datvirTviT gamowveuli asT-
mis diagnostikis efeqturi meTodi. am tipis asTmis diagnos-
tikisaTvis aseve warmatebiT gamoiyeneba fizikuri datvirTvis
provokaciuli testi. testirebisaTvis mowodebulia 8 wuTiani
intensiri sirbili.

fizikaluri kvleva da fizikaluri monacemebi.

imis gamo, rom asTmis klinikuri simptomebi farTo varia-
belurobiT xasiaTdeba, gamokvlevis garkveul etapze, fizika-
luro monacemebi SeiZleba sruliad normaluric iyos.
asTmisaTvis damaxasiaTebeli fizikaluri monacemebidan,
yvelaze xSiria auskulptaciiT gamovlenili eqspiraciuli vi-
zingi, rac sasunTqi gzebis Seviwroebaze (haernakadis SezRud-
vaze) miuTiTebs. zog SemTxvevaSi, haernakadis Zleri SezRud-
vis gamo, Cveulebrivi sunTqvisas, vizingi SeiZleba arc iyos
gamoxatuli da vlindebodes mxolod forsirebuli amosunTq-
vis procesSi. amis gamo, mZimed mimdinare asTmis gamwvavebis
SemTxvevaSi, vizingi SeiZleba arc iyos gamoxatuli, rac asTmis
mZime mimdinareobaze miuTiTebs. Tumca aseT SemTxvevaSi, ra
Tqma unda, saxezea asTmis simZimis gamomxatveli sxva niSnebi,
rogorebicaa: cianozi, moduneba, taqikardia, laparakis gaZne-
leba, gulmkerdis retraqcia, sunTqvaSi damxmare kunTebis
monawileoba.

asTmis sadiagnostiko testebi da monitoringi.

filtvis funqciis Sefaseba. rogorc ukve aRvniSneT, asTmis
diagnozi ZiriTadad anamnezur monacemebs da klinikur simp-
tomatikas efuZneba. Tumca amasTan erTad Zalian mniSvnelova-
nia filtvis funqciis gansazRvra, bronqebSi moZravi haernaka-
dis dinamikis Sefaseba da bronqospazmis Seqcevadobis dada-
stureba. es monacemebi gansakuTrebiT informatiulia maSin,
rodesac klinikur monacemTa simwire an atipiuri gamovlineba
arTulebs asTmis diagnostirebas.
bronquli obstruqciis gamosavlenad da bronqebSi moZra-
vi haernakadis dinamikis gansazRvrisaTvis, dReisaTvis, kli-
nikaSi, ZiriTadad ori meTodi gamoiyeneba: spirometria, rom-
liTac forsirebuli amosunTqvis done (FEV1 ) da filtvis
forsirebuli sasicocxlo moculoba (FVC) izomeba da „pik-
floumetria“, risi saSualebiTac amosunTquli haernakadis

44
pikuri moculoba (PEF) izomeba. klvevis aRniSnuli meTodebi
gamoiyeneba 5 welze ufrosi asakis bavSvebSi (realurad _ 7
wlis asakis Semdeg). kvlevis Sedegebi damokidebulia pacien-
tis asakze, sqesze da sxeulis simaRleze. kvlevis aRniSnuli
meTodi saSualebas iZleva bronqebSi haernakadis moZraobis
dinamika SevafasoT ara mxolod kvlevis konkretul moment-
Si, aramed ganvsazRvroT ramdenad Seqcevadia bronqospazmi da
vawarmooT am procesis monitoringi. bronqospazmis Seqceva-
dobis gansazrvrisaTvis, spirometriis an „pik-floumetriis“
Catarebisa da monacemTa normasTan Sedarebis Semdeg, pacients
vutarebT swrafadmoqmedi b2-agonistis (200 – 400 mkg. sal-
butamoli) inhalacias da 10 wuTSi ganmeorebiT vawarmoebT kv-
levas. monacemTa gaumjobeseba adasturebs Seqcevadi xasiaTis
bronqospazmis arsebobas da aiolebs asTmis diagnozis dasmas.
ganmeorebiTi kvlevebi tardeba makontrolirebeli Terapiis
fonze (mag. sainhalacio kortikosteroidi) garkveuli drois
SualedSi (ufro xSirad mkurnalobis dawyebidan 2 kviris Sem-
deg).
sasunTqi gzebis hiperreaqtiulobis gansazRvra. zogierT
SemTxvevaSi, asTmis diagnostirebis procesSi, miuxedavad
saeWvo anamnezuri da klinikuri monacemebisa, spirometriuli
maCveneblebi SeiZleba iyos normaSi. aseT SemTxvevaSi dgeba
bronqebis hiperreaqtiulobis Sefasebis saWiroebis sakiTxi. am
mizniT, bronqebis hiperreaqtiulobas vafasebT metaqolinis,
histaminis, manitolis an fizikuri datvirTvis zemoqmedebis
pirobebSi. faqtorebs, romlebic bronqebis hiperreaqtiulo-
bis stimulirebas axdenen trigerebi ewodeba. Tu alergenebis
mier gamowveuli bronqebis hiperreaqtiuloba specifiuria da
viTardeba im SemTxvevaSi, Tu pacienti sensibilizirebulia am
alergenis mimarT, zemoTaRniSnli trigerebi ara specifiurad
iwveven asTmiT daavadebuli pacientis bronqebis hiperreaqti-
ulobas da gamoiyenebian am mdgomareobis diagnostikis mizniT.
provokaciuli fizikuri datvirTvis an zemoT naxsenebi tri-
gerebis inhalaciidan 10 wuTis ganmavlobaSi FEV1-is an PEF-s
20%-iani kleba miuTiTebs bronqebis hiperreaqtiulobis ar-
sebobaze da aadvilebs asTmis diagnostikas. Tumca testi ar
aris specifiuri da Tu uaryofiTi Sedegis SemTxvevaSi SegviZ-
lia asTmis diagnozis ignorireba, testis dadebiTi Sedegis
SemTxvevaSi, sxva monacemTa arsebobis gareSe, yovelTvis ver
daismeba asTmis diagnozi. sasunTqi gzebis hiperreaqtiuloba

45
aReniSnebaT alergiuli rinitis, kistofibrozis, bronqoeqta-
ziis da filtvis qronikuli obstruqciuli daavadebis mqone
pirebsac.
sasunTqi gzebis anTebiTi dazianebis arainvaziuri markerebi.
asTmasTan asocirebuli sasunTqi gzebis anTebiTi procesebis
identificirebisaTvis rekomendirebulia naxvelSi eozinofi-
lebis an neitrofilebis identifikacia. naxvelSi (ufro zu-
stia bronquli lavaJi) >3%-5%-ze eozinofilebis arseboba,
miuTiTebs bronqebSi alergiuli xasiaTis anTebiTi procesis
arsebobaze, rac asTmis da ara asTmuri eozinofiluri bronqi-
tisTvisaa damaxasiaTebeli. bolo xanebSi, asTmis diagnostika-
Si, did mniSvnelobas aniWeben amonasunTq haerSi azotis Jangis
(FeNO) da naxSirJangis (FeCO) donis kvlevas. asTmiani paci-
entebis (vinc ar iRebs sainhalacio k.s.-s) amonasunTq haerSi
aRiniSnena FeCO-s donis mateba. Tumca es maCvenebeli araa spe-
cifiuri asTmisaTvis da igi SeiZleba genetikuri faqtorebiT
an haeris dabinZurebiTac iyos gamowveuli.
alergiuli statusis Sefaseba. alergiuli statusis Sefa-
sebis dros aucileblad unda gaviTvaliswinoT ojaxuri da
personaluri alergiuli anamnezi. kanis alergiuli reaqciebi,
alergiuli rinitisa da koniuqtivitis arseboba, daavadebebis
sezonuroba, gamwvavebebis kavSiri geografiul garemosTan,
alergenebisa da sxva saxis trigerebis eqspoziciasTan da sxva.
kanis alergiuli testebi da sisxlis SratSi totaluri da
specifiuri IgE-s gansazRvra gvexmareba alergiuli statusis
dadgenaSi magram ar amtkicebs konkretuli daavadebis arse-
bobas an alergensa da daavadebas Soris mizez-Sedegobriv kav-
Sirs.

bonquli asTmis diagnozi da diferencialuri

diagnozi.
bronquli asTmis diagnozisa da diferencialuri diagnozis
kriteriumebi gansxvavebulia iseT asakobriv jgufebSi, rogo-
ricaa Cvilebi, skolamdeli da saskolo asakis bavSvebi da mo-
zrdili asakis pacientebi.

5 wlisa da naklebi asakis bavSvebi.

asTmis diagnozi 5 wlamde asakis bavSvebSi upiratesad kli-
nikur monacemebs emyareba da damokidebulia anamnezze, gamov-
lenil simptomebsa da fizikalur monacemebze. asTmis ZiriTa-

46
di klinikuri gamoxatuleba am asakSi vizingia. imis gamo, rom
aRniSnul asakSi vizingi SeiZleba sruliad sxvadasxva etiolo-
giis iyos, asTmis diagnostikisas saWiroa yvela im daavadebis
ganxilva, romelic konkretul SemTxvevaSi SeiZleba am mdgoma-
reobis (vizingis) mizezi gaxdes.
epizoduri vizingi da xvela xSiria 3 wlamde asakis bavS-
vebSi, romelTac asTma ar aReniSnebaT.
5 wlamde asakis bavSvebSi arCeven 3 tipis vizings:
• tranzitoruli vizingis adreuli gamovlineba, romelic,
uxSiresad 3 wlis asakis Semdeg aRar aRiniSneba. aseTi
vizingi xSiradaa asocirebuli dRenaklulobasTan da
mSoblebis mier sigaretis moxmarebasTan.
• persistuli vizingis adreuli gamovlineba (3 wlamde
asakSi). aseT bavSvebSi tipiuria rekurentuli vizingis
asociacia mwvave, respiratorul, virusul infeqciebTan
da amasTan adgili ara aqvs sarwmunod gamoxatul perso-
nalur an ojaxur atopiur anamnezs. umetes SemTxvevaSi,
respiratoruli simptomebi gamoxatulia 12 wlis asakam-
de. am tipis vizingis epizodebis uxSiresi mizezi, 2 wlam-
de asakis bavSvebSi, RSV-ia. Semdgom asakSi prevalirebs
sxva tipis respiratoruli virusebi.
• mogvianebiT gamovlenili vizingi/asTma. aseT bavSvebs
aqvT asTma, romelic xSirad persistirebs bavSvobis
asakidan mozrdilobamde. am bavSvebs, garda asTmisa,
xSirad aqvT sxva atopiuri gamovlinebebi (ufro xSirad
egzema) da ojaxuri atopiuri anamnezi.

asTmis arsebobaze mianiSnebs Semdegi simptomebi: vizingis

xSiri epizodebi (TveSi 1-ze meti), fizikur aqtivobasTan aso-
cirebuli xvela an vizingi, Ramis xvela virusuli infeqciis
gareSe. zogjer vizingi ar aris dakavSirebuli wlis sezonTan
da rogorc wesi, persistirebs 3 wlis asakis Semdegac.
eqimi uflebamosilia dasvas asTmis diagnozi Tu:
• vizingi gamoxatulia 3 wlis asakis Semdeg.
• saxezea “didi risk-faqtori”, rogoricaa: mSoblebSi
asTmis an egzemis arseboba an CamoTvlili sami “mcire
risk-faqtorebidan” (eozinofilia; vizingi, respirator-
uli virusuli infeqciis gareSe da alergiuli riniti)
saxezea minimum ori.

47
 bavSvebSi, romelTac asTmis ganviTarebis risk-faqtorebi
aReniSnebaT, magram ar aris gamoxatuli asTmis klinikuri su-
raTi, daavadebis ganviTarebis prevenciis mizniT, sainhalacio
kortikosteroidebis gamoyeneba ar iZleva sasurvel Sedegs.
vizingis ganviTarebis alternatiuli mizezebia:
• qronikuli rino-sinusiti.
• gastro-ezofaguri refluqsi.
• qvemo sasunTqi gzebis rekurentuli virusuli infeqcia.
• kisto fibrozi.
• bronqo-pulmonaluri displazia.
• tuberkulozi.
• intraTorakaluri sasunTqi gzebis Tandayolili Sevi-
wroeba.
• ucxo sxeulis aspiracia.
• pirveladi ciliaruli diskineziis sindromi.
• imunodeficitebi.
• gulis Tandayolili manki.

neonatalur periodSi ganviTarebuli rekurentuli an per-

sistuli vizingi, romelsac Tan axlavs ganviTarebaSi Camor-
Cena, Rebineba an filtvebisa da gulis dazianebis niSnebi,
saWiros xdian vizingis alternatiuli mizezebis Zebnas.
5 wlamde asakis bavSvebSi asTmis diagnostikis saukeTeso
meTodi, xanmokle moqmedebis sainhalacio b2-agonstebiT an
kortikosteroidebiT Catarebuli sacdeli mkurnalobaa.
am saxis mkurnalobis Semdeg, mdgomareobis gaumjobeseba da
mkurnalobis Sewyvetis Semdeg mdgomareobis gauareseba, adas-
turebs asTmis diagnozs.
asTmis diagnostikisaTvis spirometriis gamoyeneba, Sesa-
Zlebelia 5 welze ufrosi (upiratesad 6 _ 7 welze ufrosi)
asakis bavSvebsa da mozrdilebSi.

5 welze ufrosi asakis bavSvebi da mozrdilebi.

guldasmiT Sekrebili anamnezi, detaluri fizikaluri kvl-
eva da spirometriiT dadasturebuli Seqcevadi da variabelu-
ri bronqokonstriqciis arseboba asTmis diagnozis damadas-
turebelia. Tumca asTmis diagnistikisas gasaTvaliswinebelia
Semdegi alternatiuli daavadebebi da mdgomareobebi:
• hiperventilaciuri sindromi da mwvaved gamoxatuli
fsiqiuri SfoTvis mdgomareoba.

48
 • zemo sasunTqi gzebis obstruqcia da ucxo sxeulis inha-
lacia.
• xmovani iogebis disfunqcia.
• filtvebis ara obstruqciuli daavadebebi (mag. filtvis
parenqimis difuziuri paTologiebi).
• vizingis ara respiratoruli mizezebi (mag. gulis marc-
xena parkuWis paTologia).

asTmis klasifikacia.
dReisaTvis miRebuli, asTmis klasifilacia emyareba daava-
debis simZimis (msubuqi, saSualo da mZime) da simptomTa dro-
Si gamoxatul Taviseburebas (intermisiuli da persistuli).
daaavadebis simZimis Sefaseba xdeba sasunTq gzebSi harnakadis
SezRudvis xarisxisa da simptomTa gamovlenis intensiobisa da
sixSiris mixdviT.
asTmis klasifikacia mocemulia me-7 cxrilSi.

cxrili 7.
asTmis klasifikacia daavadebis simZimis mixedviT.

msubuqi intermisiuli
simptomebi gamoxatulia ufro iSviaTad, vidre kviraSi
1-jer.
gamwvavebebi xanmoklea.
Ramis simptomebi ufro iSviaTia vidre 2-jer TveSi.
• FEV1 an PEF mosalodnelis 80% an metia.
• FEV1 an PEF-s varabeluroba dRis ganmavlobaSi <
20%-ze.

msubuqi persistuli.
simptomTa gamovlena ufro xSiria, vidre kviraSi 2-jer,
Tumca ufro iSviaTia, vidre 1-jer dReSi.
gamwvavebisas darRveulia Zili da fizikuri aqtivoba.
Ramis simptomebi ufro xSiria, vidre TveSi 2-jer.
• FEV1 an PEF mosalodnelis 80% an meti.
• FEV1 an PEF variabeluroba dRis ganmavlobaSi <
20% _ 30%.
saSualo simZimis persituli.

49
 simptomebi gamoxatulia yoveldRiurad.
gamwvavebisas darRveulia Zili da fizikuri aqtivoba.
Ramis simptomebi ufro xSiria vidre kviraSi erTjer.
esaWiroeba swrafad moqmedi saihalacio b2-agonistis
yoveldRiuri gamoyeneba.
• FEV1 an PEF mosalodnelis 60% - 80%-ia.
• FEV1 an PEF variabeluroba dRis ganmavlobaSi >
30%-ze.

mZime persistuli
simptomebi gamoxatulia yoveldRiurad.
gamwvavebebi xSiria.
Ramis simptomebi xSiria.
fizikuri aqtivoba SezRudulia.
• FEV1 an PEF mosalodnelis 60% an naklebia.
• FEV1 an PEF variabeluroba dRis ganmavlobaSi >
30%-ze.

asTmis klasifikacia daavadebis mimdinareobis simZimis

mixedviT Zalian mosaxerxebelia erTi mxriv, konkretul mo-
mentSi, pacientis mdgomareobis Sesafaseblad da meore mxriv
daavadebis menejmentis meTodis SerCevisaTvis. amasTan es kla-
sifikacia gviCvenebs, rom, asTmis ZiriTadi maxasiaTebeli _
simZime, ar aris statikuri niSani (an niSanTa erToblioba) da
igi SeiZleba Seicvalos garkveuli drois periodSi. amis gamo,
asTmian pacients, diagnozis dasmisa da mkurnalobis dawyebis
Semdeg, drois garkveul SualedSi, aucileblad esaWiroeba
ganmeorebiTi kvleva, mdgomareobis Sefaseba da Sesabamisad _
marTvis meTodebis koreqcia.

asTmis kontroli.
termini “asTmis kontroli” SeiZleba ganvmartoT, rogorc
daavadebis manifestaciis prevencia. idialur SemTxvevaSi es
exeba ara mxolod klinikur, aramed laboratoriul da in-
strumentul kvlevaTa Sedegebis manifetaciasac. arsebobs
monacemebi, romlebic gviCveneben, rom klinikur simptomTa
kontroli damokidebulia sasunTq sistemaSi anTebiTi proce-
sis kontrolTan. Tumca, bronqebSi anTebiTi procesis mimdin-
areobis obieqturad Sesafaseblad, lorwovanis biofsia da ma-
salis morfologiuri kvlevaa saWiroa. garkveul informacias

50
gvaZlevs bronquli sekretis citologiuri kvlevac. samwuxar-
od, am tipis kvlevebis siZvirisa da Sesrulebis teqnikuri sir-
Tulis gamo, klinikur praqtikaSi maTi gamoyeneba ar xerxdeba.
amitom asTmis kontrolis SefasebisaTvis, zemoT ganxilul
klasifikaciaSi mocemuli maxasiaTeblebi gamoiyeneba.
asTmis kontrolis Sefasebis monacemebi mocemulia me-8
cxrilSi.

cxrili 8.
asTmis kontrolis doneebi.

mebi grZeldeba ram-

(garkveuli simpto-
(CamoTvlilTagan
kontrolirebadi

kontrolirebadi

ara kontroli-
denime kvira)
nawilobriv
daxasiaTeba

rebadi
yvela)

ara
nawilobriv
dRis simp- (kviraSi
> kviraSi 2-jer. kontolire-
tomebi. 2-jer an
badi
najlebad)

asTmis 3 an
aqtivobis
ara SeiniSneba meti niSani
SezRudva.
ramdenime

Ramis simp-
kviris ganma-
tomebi/ ara zogjer
vlobaSi.
iRviZebs.
sWirdeba ara
Semamsub- (kviraSi
> kviraSi 2-jer.
uqebeli sa- 2-jer an
Sualebebi. naklebad)

filtvis < mosalodne-

funq- lis (an indi-
normaSia
cia(FEV1 an vidualuris)
PEF) 80%-ze.

51
 erTi an
erTi yovel
gamwvaveebi. ara naklebi/
kviraSi.
weliwadSi

asTmis mkurnalobisaTvis rekomendirebuli

medikamentebi.
asTmis mkurnalobis mizania daavadebis sruli kontrolis
miRweva.
asTmis samkurnalo medikamentebi, Tavisi daniSnulebis
mixedviT, SeiZleba davyoT or jgufad:
• mdgomareobis (simptomTa) Sesamsubuqebeli saSualebebi.
• mdgomareobis makontrolebeli saSualebebi.

pirveli jgufis preparatebi gamoiyeneba simptomTa gamov-

lenis an gamwvavebis SemTxvevaSi, xanmokle droiT, mdgomareo-
bis gaumjobesebamde. maSin, roca meore jgufis (makontrole-
beli) saSualebebi gamoiyeneba yoveldRiurad, xangrZlivi
drois ganmavlobaSi. isini warmoadgenen antianTebiTi efeqtis
mqone saSualebebs da saWironi arian daavadebis gamwvavebis
prevenciisaTvis.
simptomTa Semamsubuqebel preparatebs pirvel rigSi mie-
kuTvneba swrafad moqmedi b2-agonistebi (oqros standartia
ventolini), sainhalacio antiqolinerguli preparatebi da
swrafad moqmedi Teufilini.
simptomTa makontrolebel saSualebebs ekuTvnis sistemuri
da sainhalacio glukokortikosteroidebi, gaxangrZlivebuli
moqmedebis b2-agonistebi, leikotrienebis modifikatorebi,
kromolinebi, anti-IgE monoklonaluri antisxeulebi da gaxan-
grZlivebuli moqmedebis Teufilinis preparatebi.
sainhalacio kortikosteroidebisa da gaxangrZlivebuli mo-
qmedebis b2-agonistebis kombinacia warmoadgens asTmis kontro-
lis yvelaze efeqtur saSualebas.

asTmis samkurnalo medikamentebis gamoyenebis

meTodebi.
preparatebi, romlebic asTmis samkurnalod gamoiyeneba, pa-
cients SeiZleba mivceT sainhalacio gziT, peroralurad an
parenteralurad (kanqveSa, intramuskularuli an intravenuri
ineqcia). umetes SemTxvevaSi, upiratesoba eniWeba sainhalacio
gziT miRebul preparatebs, radgan: isini pirdapir moqmede-

52
beb sasunTq sistemaze da uSualod anTebis keraSi, uSualod
paTologiis keraSi qmnian maqsimalur koncentracias; aqvT si-
stemuri moqmedebis minimaluri riski da sxva gziT miRebul
medikamentebTan SedarebiT, maqsimalur efeqts iZlevian mniSv-
nelovnad ufro mcire dozebiT.
sainhalacio preparatebi pacients SeiZleba mivawodoT wne-
viani dozirebuli inhaleriT, SesunTqviT aqtivirebadi do-
zirebuli inhaleriT, mSrali fxvnilis Semcveli inhaleriT,
mcired danotiavebuli inhaleriT da nebulaizeriT („sveli
inhalaciis“ wesiT).
yvela, CamoTvlil sainhalacio saSualebas aqvs Tavisi mox-
marebis wesi da sanam pacienti maT gamoyenebas daiwyebs, auci-
lebelia mas Cautardes Zalian zusti instruqtaJi da treningi
aRniSnuli medikamentis gamoyenebis Sesaxeb. aucileblad unda
vicodeT da pacientsac unda ganvumartoT, rom sainhalacio
gziT misaRebi medikamentis gamoyenebis teqnikur mxares aqvs
Zalian didi mniSvneloba daavadebis efeqturi marTvisaTvis.
wneviani inhalerebis gamoyenebisas saWiroa kanistris Zirze
xelis daWerisa (inhaleridan preparatis gamoSveba) da CasunT-
qvis sinqronizireba, rac mcire asakis (6 _ 7 wlamde) bavSvebSi
praqtikulad SeuZlebelia.
mcire asakis bavSvebSi, rodesac SeuZlebelia wneviani an
„SesunTqviT aqtivirebadi“ inhalerebis gamoyeneba, preparatis
miwodeba rekomendirebulia e.w. speiseris an nebulaizeris sa-
SualebiT. speiseri saSualebas iZleba mSral, wnebian inhaler-
Si moTavsebuli preparati mivawodiT yvela asakis pacients.
mSrali, wneviani inhalerebi gamoiyeneba yvela simZimis asT-
mis SemTxveaSi, maT Soris gamwvavebis drosac.

asTmis mkurnaloba bavSvTa asakSi.

bavSvTa asakSi asTmis mkurnalobis ZiriTadi meTodi sain-
halacio formis medikamentebis gamoyenebaa. Tumca, sxvadasx-
va asakis bavSvebSi, mkurnalobis am meTodis teqnikuri mxare
gansxvavebulia. bunebrivia, gansxvaebulia medikamentebis do-
zebic. sainhalacio saSualebis (medikamentis) da ihalaciis me-
Todis SerCevisas iTvaliswineben daavadebis simZimes da sim-
wvaves, bavSvis asaks, preparatis fass da inhaleris gamoyenebis
teqnikur Taviseburebas. cxril 9-Si mocemulia asTmiT daava-
debul, sxvadasxva asakis bavSvebSi inhalaciis upiratesad re-
komendirebul saSualebaTa CamonaTvali.

53
 cxrili 9.
sdainhalacio meTodikis Tavisebureba sxvadasxva asakis bavSvebSi.

alternatiuli
asaki sainhalacio saSualeba
saSualeba
wneviani, dozirebuli in-
nebulaizeri saxis
< 4 welze haleri + speiseri saxis
niRbiT.
niRabiT.
wneviani, dozirebuli nebulaizeri saxis
4 _ 6 weli inhaleri+speiseri niR- niRbiT an piris mun-
biT an piris munStukiT. StukiT.

wneviani, dozirebuli
inhaleri + speiseri an
piris munStuki. wnevi-
nebulaizeri piris
> 6 welze ani dozirebuli inhal-
munStukiT.
eri piris munStukiT an
„sunTqviT aqtivirebadi“
inhaleri.

anu, 6 wlamde asakis bavSvebSi (gansakuTrebiT 4 wlamde),

speiseri warmoadgens sainhalacio teqnikis erT-erT yvelaze
mosaxerxebel da efeqtur saSualebas. igi xels uwyobs sainha-
lacio preparatebis nawilakebis maqsimaluri koncentraciiT
moxvedras sasunTq gzebSi da amcirebs oralur da gastro-
intestinalur traqtSi mTi Sewovis SesaZleblobas. speiseri
warmoadgens plastmasis cilindrul mils, romelsac erT bo-
loSi umagrdeba inhaleri, xolo meore boloSi _ saxis niRa-
bi an munStuki. saWiro preparatis inhalacia tardeba Semdegi
wesiT: speiseris erT boloSi vamagrebT niRabs (an munStukis),
mere boloSi ki wnevian inhalers. pacients saxeze mWidroT
vafarebT niRabs (an pirSi idebs munStuks da mWidrod kumavs
tuCebs) da xels vaWerT inhaleris kanistris Zirs. preparati
gaifrqveva speiseris SigniT da bavSvi sunTqavs mas niRbis (an
munStikis) saSualebiT. im SemTxvevaSi, Tu speiseri ara gvaqvs,
am mizniT SesaZlebelia 500 ml. tevadobis plastmasis boTlis
gamoyeneba. Tumca, am dros, SeuZlebelia hermetizaciis dacva
da didia medikamentis danakargi.

54
 makontrolirebeli (bazisuri) medikamentebi.
bavSvebSi, asTmis makontrolirebel medikamentebs miekuTv-
neba sainhalacio da sistemuri glukokortikosteroidebi,
leikotrienebis modifikatorebi, gaxangrZlivebuli moqmede-
bis sainhalacio da peroraluri b2-agonistebi, Teufilini da
kromolinebi.

sainhalacio glukokortikosteroidebi.
sainhalacio glukokortikosteroidebi warmoadgenen asT-
mis kontrolis yvelaze efeqtur saSualebas da gamoiyenebian
asTmiT daavadebul, yvela asakis pacientSi. maTi dozireba da-
mokideblia asakze, asTmis simZimesa da preparatis dasaxele-
baze.
cxril 10-Si da 11-Si mocemulia sxvadasxva saxis sainhalacio
g.k.s.-is dozebi asTmiT daavadebul bavSvebsa da mozrdilebSi.

cxrili 10.
sainhalacio g.k.s.-is sxvadasxva preparatebis dRiuri dozebi (Mcg)
asTmiT daavadebul bavSvebSi.

dabali saSualo maRali

preparatis dasaxeleba
doza doza doza
Beclomethasone dipropionate 100 _ 200 > 200 _ 400 > 400
Budesonide 100 _ 200 > 200 _ 400 > 400
Ciclesonide 80 _ 160 > 160 _ 320 > 320
Flunisolide 500 _ 750 > 750 _ 1250 > 1250
Flutikasone 100 _ 200 > 200 _ 400 > 400
Mometasone furoate 100 _ 200 > 200 _ 400 > 400
Triamcilone acetonide 400 _ 800 > 800 _ 1200 > 1200

cxrili 11.
sainhalacio g.k.s.-is sxvadasxva preparatebis dRiuri dozebi (Mcg)
asTmiT daavadebul mozrdilebSi.
dabali saSualo
preparatis dasaxeleba maRali doza
doza doza
Beclomethasone dipropionate 200 _ 500 > 500 _ 1000 > 1000 - 2000
Budesonide 200 _ 400 > 400 _ 800 > 800 - 1600
Ciclesonide 80 _ 160 > 160 _ 320 > 320 - 1280
Flunisolide 500 _ 1000 > 1000 _ 2000 > 2000
Flutikasone 100 _ 250 > 250 _ 500 > 500 - 1000
Mometasone furoate 200 _ 400 > 400 _ 800 > 800 - 1200
Triamcilone acetonide 400 _ 1000 > 1000 _ 2000 > 2000

55
 mravali kvleviTaa dadasturebuli, rom, rogorc 5 wlamde,
ise 5 welze ufrosi asakis bavSvebSi, asTmis efeqturi kon-
trolisa da gamwvavebaTa minimumamde dayvanisaTvis sakmari-
sia sainhalacio k.s.-ebis dabali da saSualo dozebi. prepara-
tis maRali dozebi saWiroa iSviaT SemTxvevaSi _ asTmis mZime
formebisa da zog SemTxvevaSi, fizikuri datvirTviT induci-
rebuli asTmis kontrolisaTvis. asTmis simptomTa kontroli
da filtvebis funqciis gaumjobeseba, umetes SemTxvevaSi, xde-
ba sainhalacio k.s.-ebiT mkurnalobis dawyebidan 1 _ 2 kviris
periodSi, Tumca sasunTqi sistemis hiperreaqtiulobis minimu-
mamde SemcirebisaTvis SeiZleba ramdenime Tviani mkurnaloba
da k.s.-is SedarebiT maRali dozebi iyos saWiro. mkurnalobis
Sewyvetis Semdeg, ramdenime kviridan, ramdenime Tvis period-
Si, umetes SemTxvevaSi, asTmis kontrolis mdgomareoba uares-
deba.
virusebiT inducirebuli rekurentuli vizingis mkurnalo-
bisaTvis sainhalacio k.s.-ebis gamoyenebis Sesaxeb, arsebobs
azrTa garkveuli sxvaoba. zogierTi monacemiT, mozrdili asa-
kis bavSvebSi, mkurnalobis aseTi meTodi iZleva mcire efeqts,
xolo mcire asakis bavSvebSi aseTi efeqti ar aRiniSneba. aseve
naCvenebia, rom adreuli asakis bavSvebSi arsebuli epizoduri
vizingis prevenciaSi, sainhalacio k.s.-ebis roli umniSvneloa.
erT-erTi mniSvnelovani kiTxva, romelic yovelTvis ismeba
sainhalacio k.s.-ebiT xangrZlivi mkurnalobis dros, Seexeba
preparatis sistemuri moqmedebis efeqts. mkvlevarTa umete-
soba miuTiTebs, rom 5 welze ufrosi asakis bavSvebSi aseTi
negatiuri efeqti, praqtikulad, ar aRiniSneba.
amave dros ar arsebobs monacemebi, romlebic sainhalacio
k.s.-ebiT xangrZlivi mkurnalobis Semdeg osteoporozisa da
Zvlebis motexilobisken midrekilebis ganviTarebaze miuTi-
Tebdes.
leikotrienebis receptorTa antagonistebi. 5 welze ufrosi
asakis bavSvebSi, leikortienebis receptorTa antagonistebi
amsubuqeben asTmis simptomebs, daavadebis yvela formis (sxva-
dasxva simZimis) dros. es preparatebi iwveven bronqokonstriq-
ciis Semcirebas fizikuri datvirTviT gamowveuli asTmis
SemTxvevaSic. Tumca maTi efeqturoba, asTmis yvela formis
dros, mniSvnelovnad CamorCeba sainhalacio k.s.-ebis dabali
dozebis samkurnalo efeqts.
leikotrienebis receptorTa antagonistebis aRniSnuli

56
efeqti, gamoxatulia 5 welze mcire asaks bavSvebSic. 2 dan
5 wlamde asakis kontingentSi, am jgufis preparatebi, aseve
iwveven virusinducirebuli asTmis gamwvavebebis gamovlenis
Semcirebas.
gaxangrZlivebuli moqmedebis b2-agonistebi. gaxangrZlive-
buli moqmedebis b2-agonistebi sainhalacio k.s.-ebTan kombi-
naciaSi gamoiyeneba saSualo simZimis da mZime formis asTmiT
daavadebuli, 5 welze ufrosi asakis bavSvTa samkurnalod, Tu
sainhalacio k.s.-ebiT mkurnaloba ar iZleva daavadebis kon-
trolis saSualebas. am jgufis preparatebi, mono TerapiisaT-
vis, aseve gamoiyeneba fizikuri datvirTviT inducirebuli
asTmis mqone, ufrosi asakis bavSvebSi. sxva SemTxvevaSi, b2-
agonistebiT monoTerapia araa rekomendirebuli.
bronquli asTmis kontroli gaxangrZlovebuli moqmedebis
b2-agonistebi + sainhalacio k.s.-ebiT ufro efeqturia, vidre
izolirebulad sainhalacio k.s.-ebiT an gaxangrZlivebuli moq-
medebis b2-agonistebiT.
5 wlamde asakSi, b2-agonistebis izolirebulad an sainha-
lacio k.s.-ebTan kombinaciaSi gamoyenebis Sedegebis sarwmuno
monacemebi ar arsebobs.
Teufilini. Teufilini gamoiyeneba, rogorc monoTera-
piisaTvis ise sxva preparatebTan (upiratesad sainhalaci k.s.-
ebTan) kombinaciaSi 5 welze ufrosi asakis bavSvebSi. misi efe-
qti mniSvnelovnad aWarbebs placebos efeqts da aumjobesebs
rogorc daavadebis klinikur simptomebs ise filtvis funq-
cias. Tumca mniSvnelovnad CamorCeba k.s.-ebis efeqts. arse-
bobs monacemebi, romlebic 5 wlamde asakis, bronquli asTmiT
daavadebul bavSvebSi, Teufilinis pozitiur efeqtze miuTi-
Teben. Tumca es monacemebi sakmaod mcirea.
Teufilinis xangrZlvi gamoyenebis pirobad miCneulia pre-
paratis koncentraciis monitoringi pacientis sisxlis plaz-
maSi (preparatis koncentracia sisxlis plazmaSi ar unda aWar-
bebdes 5 _ 10 mg/ml). miaCniaT, rom plazmaSi Teufilinis aRniS-
nuli koncentraciis SenarCuneba SesaZlebelia preparatis 10
mg/kg/ dRiuri dozis miRebis SemTxvevaSi. aRniSnuli doza pa-
cients, dRis ganmavlobaSi, eZleva orjeradad. im SemTxvevaSi,
Tu bavSvs asTmis garda sxva paTologia ar aReniSneba, 10 mg/kg.
naklebi dRiuri dozis miRebis SemTxvevaSi, plazmaSi prepara-
tis koncentraciis monitringi saWiro ar aris. im SemTxvevaSi,
Tu dRiuri doza ufro maRalia an Tu darRveulia Teufi-

57
linis gamoyofis procesi, saWiroa preparatis koncentraciis
monitoringi sisxlis plazmaSi.
im gvediTi efeqtebidan, romelic Teufilinis miRebas SeiZ-
leba axldes Tan, aRsaniSnavia anoreqsia, gulisreva, Rebineba
da Tavis tkivili. garda amisa SeiZleba ganviTardes msubu-
qi agzneba, gulis cemis gaZliereba, taqikardia, ariTmia, mu-
clis tkivili, diarea da sisxldena kuW-nawlavis traqtidan.
aseTi negatiuri efeqtebi ZiriTadad dozadamokidebulia da
viTardeva 10 mg/kg. dRiuri dozis gadaWarbebis SemTxvevaSi.
garTulebis riskis Sesamcireblad mowodebulia mkurnalobis
dawyeba 5 mg/kg. dRiuri doziT da Semdgom dReebSi, dozis Tan-
daTanobiTi gazrda 10 mg/kg.-amde dReSi. Teufilinis Zalian
maRali dozebiT miReba SeiZleba fatalurad damTavrdes.
kromonebi: natriumis kromoglikati da nedakromil natriu-
mi. aRniSnuli preparatebis roli bronquli asTmiT daavade-
bul bavSvTa grZelvadian mkurnalobaSi SezRudulia. erT-erT
SromaSi Catarebuli metaanaliziT irkveva, rom natriumis kro-
moglikatiT bronquli asTmis grZelvadiani mkurnaloba pra-
qtiklad ar gansxvavdeba placebos efeqtisagan. sxva SromebSi
miuTiTeben, rom natriumis kromoglikatis an nedokromil na-
tris erTjeradi inhalaciebi SeiZleba civi haeriT an fizi-
kuri datvirTviT gamowveuli asTmis Setevis prevenciisaTvis
iyos gamoyenebuli.
gverdiTi efeqtebidan, romlebic am jgufis preparatebs
axasiaTebT, iSviaTad viTardeba xvela, xorxis gaRizianeba,
bronqokonstriqcia, Tavis tkivili da gulis reva.
oraluri formis, gaxangrZlivebuli moqmedebis, b2-agoni-
stebi. am tipis preparatebi, rogorebicaa gaxangrZlivebuli
moqmedebis salbutamoli, terbutalini da bambuteroli amci-
reben Ramis simptomebs asTmiT daavadebul pacientebSi. maTi
gverdiTi efeqti kardio-vaskularul sistemaze (taqikardia
da gulis cemis gaZliereba), agzneba da kunTTa tremori, ume-
tesad dozadamokodebulia da preparatis dozis individualu-
rad SerCevis SemTxvevaSi, maTi Tavidan acileba SesaZlebelia.
gaxangrZlivebuli moqmedebis b2-agonistebis efeqti, fiziku-
ri datvirTviT gamowveul bronqokonstriqciaze, an saerTod
ar aRiniSneba an minimaluria.
sistemuri moqmedebis glukokortikosteroidebi. miuxeda-
vad imisa, rom mravali gverdiTio efeqtis gamo, oraluri
g.k.s.-ebis xangrZlivi gamoyeneba SezRudulia, am jgufis pre-

58
paratebi mainc gamoiyeneba bronquli asTmis mZime gamwvavebe-
bis SemTxvevaSi. oraluri k.s. gamoyeneba SezRudulia asTmis
virusinducirebuli gamwvavebis SemTxvevaSi.

mdgomareobis (simptomTa) Semamsubuqebeli

saSualebebi.
swrafad moqmedi sainhalacio da oraluri b2-agonistebi.
swrafad moqmedi b2-agonistebi warmoadgeneb efeqtur bronqo-
dilatatorebs da warmatebiT gamoiyenebian bronquli asTmis
gamwvavebis periodSi, yvela asakis pacientebSi. preparatebis
sainhalacio formebi xasiaTdebian ufro swrafi da efeqtu-
ri moqmedebiT, vidre peroraluri an saineqcio. preparatebis
oraluri formebi upiratesad gamoiyeneba mcire asakis bavS-
vebSi, romlebic teqnikuri mizezebis gamo ver axerxeben pepa-
ratis inhalaciuri gziT miRebas.
preparatebis gverdiTi efeqtebidan aRsaniSnavia kunTTa
tremori, Tavis tkivili, gulis cemis gaZliereba da agzneba.
aRniSnuli gverdiTi efeqtebi upiratesad dozadamokidebulia
da mJRavndeba preparatebis maRali dozebiT miRebisas.
antiqolinerguli preparatebi. antiqolinerguli prepa-
ratebis sainhalacio formebi gamoiyeneba bronquli asTmis
Setevis wonaaRmdeg da araa rekomendirebuli daavadebis xan-
grZlivi marTvisaTvis.

asTmis menejmenti da prevencia.

asTmis warmatebuli menejmentis mizania:
• daavadebis simptomTa kontrolis miRweva.
• normaluri aqtivobis (maT Soris fizikuri aqtivobis)
miRweva da SenarCuneba.
• filtvebis funqciis maqsimaluri normalizacia.
• asTmis gamwvavebebis prevencia.
• medikamentozuri Terapiis gverdiTi efeqtebis arideba
an maqsimalurad Semcireba.
• asTmiT gamowveuli sikvdilis prevencia.

ramdenadac asTma aris sasunTqi gzebis qronikuli anTebiTi

daavdeba, romlis ganviTarebaSic Zalian didi mniSvneloba aqvs
bronqebis hiperraqtiulobas, xolo asTmis gamwvavebis mizezi
aris sxvadasxva bunebis trigeri _ daavadebis menejmenti mi-
marTuli unda iyos:

59
 • trigerebis eliminaciisaken.
• qronikuli anTebiTi (alergiuli anTeba) procesis Sem-
cirebisken.
• bronqebis hiperreaqtiulobis moxsnisaken.

sasunTqi sistemis sensibilizaciis gamomwvevi faqtorebis

drouli eliminacia mniSvnelovnad amcirebs anTebis ganviTa-
rebas, aiolebs asTmis marTvis process da amcirebs medikamen-
tozuri Carevis aucileblobas.
asTmis menejmentis praqtikuli ganxorcieleba emyareba
erTmaneTTan dakavSirebuli 5 komponentisgan Semdgri Ronis-
Ziebebis realizacias:
1. eqimisa da pacientis partnioruli urTierTobis Camoya-
libeba.
2. asTmis gamomwvevi da Setevis maprovocirebeli risk-faq-
torebis identificireba da eliminacia (an zemoqmedebis
Semcireba).
3. kvleva, mkurnaloba da daavadebis mimdinareobis moni-
toringi.
4. asTmis gamwvavebis marTva.
5. gansakuTrebuli mdgomareobebis analizi.

cxrili 12.
eqimisa da asTmiT daavadebuli pacientis (mSoblebis momvlelis)
partnioroba da asTmis TviT-monitoringis komponentebi.

• pacientis (mSoblebis, momvlelis) ganaTleba, rac gulisx-

mobs personisaTvis asTmis, rogorc daavadebis, arsis gan-
martebas da mdgomareobis TviTSefasebisa da TviTmarTvis
unarCvevebis miwodebas.
• mkurnalobis miznis dasaxva. diagnozis dasma, mdgomareobis
Sefaseba, trigerebis gamovlena da samoqmedo gegmis dasaxva.
• TviT-montoringi. asTmiT daavadebuli pacienti (pacientis
mSobeli an momvleli), daavadebis Sesaxeb garkveuli infir-
maciis miRebis Semdeg, TviTon unda axdendes mdgomareobis
Sefasebas, mdgomareobis interpretacias da marTvas.
• eqimis mier mdgomareobis regularuli ganxilva da kontro-
lis procesis koreqtireba.
• eqimis mier mkurnalobis werilobiTi gegmis Sedgena

60
 aRniSnuli midgoma saSualebas aZlevs eqimsa da pacients ma-
qsimalurad efeqturad marTon daavadeba. pacientis adeqvatu-
ri CarTuloba daavadebis marTvis procesSi ufro efeqturs
xdis mkurnalobas da amcirebs mkurnalobis xarjebs.

asTmis risk-faqtorebis identifikacia da maTi

Semcireba.
asTmis gamomwvevi risk-faqtorebis (an asTmis gamwvavebis
maprovocirebeli faqtorebis) gamovlena da Semcireba (sauke-
Teso variantia mocileba), aris eqimisa da pacientis upirvele-
si mizani da misi ganxorcieleba mniSvnelovnadaa damokide-
buli eqimisa da pacientis TanamSromlobis procesze. asTmis
risk-faqtorebis Semcireba aris asTmis prevenciis saukeTeso
saSualeba.
im mravalricxovani „risk-faqtorebidan“, romlebic asTmis
ganviTarebas an gamwvavebas uwyoben xels umniSvnelovanesia
alergenebi.
„oTaxis alergenebi“. „oTaxis alergenebi“ an e.w. „kars Sida
alergenebi“ arian alergenebi, romelTa koncentracia upira-
tersad maRalia daxurul sivrceSi (saxlSi, oTaxSi). maT mie-
kuTvneba oTaxis tkipebi, bewviani cxovelebi, tarakanebi, so-
koebi.
aRniSnuli saxis alergenebis siWarbe sacxovrebel garemoSi,
xels uwyobs pirovnebis sensibilizacias am faqtorTa mimarT
da asTmis Camoyalibebas. Semdeg ki, gamwvavebebis ganviTarebas.
amitom, gansakuTrebiT riskis jgufebSi (atopiis personaluri
an ojaxuri anamnezi), aRniSnuli alergenebisagan Tavis arideba
aris asTmis prevenciis erT-erTi efeqturi saSualeba. Tumca,
es procesi (alergenebis mocileba) sakmao sirTuleebTanaa da-
kavSirebuli.
cxril 13-Si mocemulia „oTaxis alergenebisagan“ dacvis
zogierTi meTodi.

miuxedavad imisa, rom CamoTvlili RonisZiebebiT gamowveu-

li efeqti ar aris sarwmuno, calkeul SemTxvevebSi igi mainc
aumjobesebs mdgomareobas da maTi ganxorcieleba sasurvelia.

61
 cxrili 13.
sacxovrebel garemoSi «oTaxis alegenebis» Semcirebis saSualebebi.

alergenebis
koncentraci- sarwmuno
meTodebi is sarwmunod klinikuri
Secirebis ef- efeqti
eqti

oTaxis mtvris tkipebi

mozrdileb-
sawoli oTaxidan xaliCebis,
Si _ ara.
rbili avejis da rbili saTa- garkveulad
bavSvebSi _
maSoebis gatana.
mcire.

TeTreulis, leibis, sabnisa

da baliSebis higienuri da-
garkveulad ara
muSaveba 50 _ 60 gradus cel-
siusze.

SeamcireT saxlSi yvela sa-

Sualebis arseboba, romelic ara ara
mtvers agrovebs.

oTaxis damuSaveba vakuumuri

mtversasrutiT, specialuri
erTi kviriT ara
filtriT da mtveris Sem-
grovebeli ormagi kameriT.

cxovelebi

gaiyvaneT cxovelebi saxli-

erTi kviriT ara
dan
moacileT cxovelebi saxxov-
erti kviriT ara
rebel/sawol oTaxs.

daamuSaveT oTaxi special-

garkveulad ara
uri mtversasrutiT.

abanaveT cxovelebi erTi kviriT ara

62
 “oTaxis gare alergenebi”. iseTi “oTaxgare alergenebisagan”
Tavis arideba, rogoricaa magaliTad mcenaris mtveri - praq-
tikulad SeuZlebelia. iseTi saSualebebi, rogoricaa fan-
jrebisa da karebis daxurva, kondincioneris gamoyeneba da ga-
reT gasvlisagan Tavis arideba, roca garemoSi am saxis aler-
genebis maRali koncentraciaa, amcireben adamianis organizmze
maTi zemoqmedebis efeqts, Tumca mTlianad ver xsnian mas.
haeris dabinZureba sacxovrebeli garemos SigniT. sacxovre-
beli garemos SigniT haeris dabiZureba, uxSiresad, sigaretis
wevasTanaa dakavSirebuli. asTmis gamwvaveba ukavSirdeba si-
garetis, rogorc aqtiur, ise pasiur mwevelobas. sigaretis
mwevelTa garemoSi mcxovreb mcire asakis bavSvebSi, xSirad
aRiniSneba rekurentuli vizingi. garda sigaretis bolisa,
asTmis ganwvavebaSi mniSvnelovani roli eniWeba garemos dam-
abinZurebel iseT faqtorebs, rogorebicaa: azotis Jangi, nax-
SirJangi, naxSirorJangi, gogirdis orJangi, formaldehidi da
endotoqsinebi.
sacxovrebeli garemos gareT haeris dabinZureba. faqtorebi,
romlebic sacxovrebeli garemos gare sivrces abinZureben da
amis gamo asTmis gamwvavebas iwveven mravali dasaxelebisaa.
epidemiologiurma kvlevebma aCvena rom asTmis gamwvavebas-
Tan gansakuTrebiT xSir kavSirSia atmosferul haerSi ozonis,
azotis Jangis da sxvadasxva mJavebis koncentraciis mateba.
garda amisa, iseTi bunebrivi movlenebi, rogorebicaa amindis
cvlileba da sxva atmosferuli movlenebi (qariani amindi an
moRrubluloba) xSirad aris asTmis gamwvavebis mizezi. fiqro-
ben, rom es movlenebi kavSirSia haerSi mtvris gadaadgilebas-
Tan, haeris tenianobis da temperaturis cvlasTan, rac uSua-
lod ukavSirdeba asTmis gamwvavebas.
okupaciuri faqtorebi. masensibilizirebeli okupaciuri
faqtorebis adreuli gamovlena da masTan kontaqtis Sewyveta
aris okupaciuri asTmis menejmentis umTavresi principi. ok-
upaciuri asTmisTvis damaxasiaTebelia is Tavisebureba, rom
sensibilizirebul pirSi, okupaciuri alergenis Zalian mcire
koncentraciamac ki SeiZleba asTmis mZime Seteva gamoiwvios.
amis gamo, trigeris identifikacia da eliminacia Zalian mniS-
vnelovania.
sakvebi da sakvebis danamatebi. sakvebi produqtebiTa da
sakvebis danamatebiT warmodgenili alergenebi iSviaTad ari-
an asTmis gamwvavebis mizezebi mozrdili asakis pacientebSi.

63
sakvebi produqtis miCneva asTmis trigerad da misi elimina-
cia kvebis racionidan gamarTlebulia mxolod maSin, rodesac
sakvebsa da asTmis gamwvavebas Soris mizez-Sedegobrivi kavSiri
provokaciuli (oraluri) testiTaa dokumentirebuli. rode-
sac aseTi kavSiri dadasturebulia, maSin kvebiTi racionidan
am produqtis eliminacia rekomendirebulia da Sedegic sarw-
munoa.
sakvebis danamatebidan, romlebic SedarebiT xSiradaa kav-
SirSi asTmis gamwvavebasTan, aRsaniSnavia sulfitebi (sakvebisa
da medikamentebis konservantebi), romlebic Sedian kartofil-
isa da moluskebis nawarmis da ludisa da Rvinis Semadgenlo-
baSi. sxva sakvebi nivTierebebi, rogorebicaa tartarinis yvi-
Teli saRebavi, benzoatebi, da natriumis glutamati _ zogjer
ukavSirdebian asTmis gamwvavebis SemTxvevebs.
medikamentebi. zogierTi medikamenti, rogoricaa magaliTad
aspirini an sxva arasteroiduli antianTebiTi saSualebebi,
zogjer asTmis mZime Setevis ganviTarebis mizezi xdebian. ami-
tom, kontingentSi, sadac anamnezSi msgavsi SemTxvevebia aRniS-
nuli, am jgufis medikamentebis gamoyeneba dauSvebelia.
gripis sawinaaRmdego vaqcina. pacientebi, romelTac asTmis
saSualo simZimis an mZime forma aReniSnebaT, weliwadSi erTx-
el unda iRebdnen gripis sawinaaRmdego vaqcinas.
simsuqne. sxeulis masis gadaWarbebuli mateba asocirebu-
lia asTmis gavrcelebis sixSiresTan, Tumca am movlenis mizezi
garkveuli araa. sxeulis Warbi masis mqone asTmian pacienebSi
sxeulis masis normalizacia asocirebulia asTmis gamwvave-
bebis gaiSviaTebasTan da daavadebis simZimis SemsubuqebasTan.
emociuri stresi. emociuri stresi (tirili, sicili, gabra-
zeba, SiSi) zogjer SeiZleba asTmis gamwvavebis mizezi gaxdes.
aRniSnuli movlenis safuZvlad miCneulia is faqti, rom emo-
ciuri stresis pirobebSi adgili aqvs hiperventilacias da hi-
pokapnias, rac bronqo-spazmis provocirebas iwvevs.
asTmis gamwvavebasTan asocirebuli sxva faqtorebi. iseTi
daavadebebi, rogorebicaa riniti, sinusiti da polipozi _
xSiradaa asocirebuli asTmasTan. asTmisa da sinusitis aso-
ciaciis SemTxvevaSi, sinusitis efeqturi mkurnalobis Semdeg,
aRiniSneba asTmis simZimis Semcireba. asTmis gamwvavebebis six-
Sire aseve asocirebulia gastro-ezofagur refluqsTan. anti
refluqsuri mkurnaloba iwvevs asTmis simZimis Semcireas. asT-
mis gamwvaveba aseve SeiZleba emTxveodes menstrualur da pre-

64
menstrualur periodebs. asTma SeiZleba gamwvavdes an piriqiT
_ Setevebi gaiSviaTdes, orsulobis periodSi.

asTmis medikamentozuri mkurnaloba da kontrolis

miRweva.
asTmis mkurnalobis procesSi mudmivad xdema daavadebis
simZimis da kontrolis donis Sefaseba (cxrili 2 da 3.). Tu
mkurnalobis garkveul etapze, asTma ara kontrolirebadia _
gadavdivarT medikamentozuri Terapiis ufro maRal safexur-
ze, sanam ar mivaRwevT kontrols. Tu, mkurnalobis konkre-
tul safexurze, daavadeba kontrolirebadia minimum 3 Tvis
ganmavlobaSi _ CamovdivarT ufro dabal safexurze. Tu asTma
nawilobriv kontrolirebadia, unda ganvixiloT mdgomareobis
gaumjobesebis SesaZlo variantebi (dozebis gazrda, prepara-
tis damateba an Secvla).
asTmis menejmentis principebi mocemulia me-8 cxrlSi.
aRniSnul cxrilSi moyvanili rekomendaciebi exeba 5 welze
ufrosi asakis bavSvebs, mozardebsa da mozrdil pacientebs.
rac Seexeba, asTmiT daavadebul, 5 welze umcrosi asakis
bavSvebs, am kontingentSi asTmis kontrolis miRwevis saukeTe-
so saSualebad, mkurnalobis sawyis etapze, sainhalacio kor-
tikosteroidebis dabali doza da me-2 safexurSi mocemuli
samkurnalo rekomendaciebi iTvleba.

SeniSvna: leikotrienebis modifikatorebSi igulisxmeba,

rogorc leikotrienTa receptorebis antagonistebi, ise lei-
kotrienebis sinTezis inhibitorebi.
ganxiluli mkurnalobis alternatiul gzad miCneulia sain-
halacio antiqolineruli preparatebis, zogierTi gaxangrZ-
livebuli moqmedebis b2-agonistebis da xanmokle moqmedebis
b2-agonistebis gamoyeneba. Tumca, gasaTvaliswinebelia, rom
xanmokle moqmedebis b2-agonistebis regularuli gamoyeneba
dasaSvebia mxolod sainalacio k.s.-Tan kombinaciaSi.

65
 cxrili 14.
daavadebis mimdinareobis kontrolze damyarebuli, asTmis menej-
menti. ( 5 welze ufrosi asakis bavSvebSi, mozardebSi da mozrdilbSi ).

konrtolis done kleba mkurnaloba

kontrolirebadi Seafase da Seufarde kontrolis mi-
nimaluri safexuri.
nawilobriv kontrolirebadi ganixile safexuriT «zemoT asvla»
kontrolis misaRwevad.
ara kontrolirebadi adiT «safexuriT maRla » sanam ar
miaRwevT kontrols.
gamwvaveba umkurnaleT gamwvavebas.
mateba

kleba mkurnalobis mateba

safexuri
safexuri 1 safexri 2 safexuri 3 safexuri 4 safexuri 5
pacientebisaTvis asTmis Sesaxeb informaciis miwodeba (pacientTa ganaTleba)
garemos kontroli (garemoSi asTmis trigerebis identifikacia da eliminacia)
swrafad moqmedi swrafad moqmedi b2-agonistebi, saWiroebisas.
b2 - agonistebi,
saWiroebisas.
SearCie erT-erTi SearCie erT-erTi gamoiyene erTi gamoiyene erTi
an meti an orive
kontroller option. s.k.s. dabali s.k.s. dabali do- s.k.s. saSualo an oraluri k.s.-is
doza za + gaxangrZli- maRali doza + dabali doza.
vebuli qmedebis gaxangrZlivebu-
b2-agonisti. li qmedebis b2-
agonisti.
leikotrienebis s.k.s.-is saSualo leikotrienebis anti- IgE.-mkur-
modifikatorebi an maRali doza. modifikatorebi. naloba.
s.k.s. dabali do- gaxangrZlivebu-
za + l.t.-is mo- li moqmedebis
difikatorebi Teufilini.

s.k.s.-is dabali
doza + gaxangr-
Zlivebuli moq-
medebis Teufili-
ni.

asTmis marTvis safeurebi.

safexuri 1. mdgomareobis Semamsubuqebeli saSualebebi, sa-
Wirobis dros.
Tu pacients dRis ganmavlobaSi, xanmokle droiT da 2-jer
an naklebi sixSiriT kviraSi, aReniSneba msubuqad gamoxatu-
li xvela, vizingi da dispnea, xolo amgvar gamwvavebebs Soris
mdgomareoba stabiluria, klinikuri simptomebi ar aRiniSnena
da filtvis funqcia normaluria _ mkurnaloba tardeba, mxo-

66
lod simptomTa gamovlenisas, 1 safexuris Sesabamisad, mdgoma-
reobis Semamsubuqebeli saSualebebiT (ZiriTadad sainhalacio
an peroraluri b2-agonistebiT). mkurnalobis alternatiul
meTodad miCneulia awrafad moqmedi sainhalacio antiqolin-
erguli preparatebi an swrafad moqmedi Teufilini. Tumca
am preparatebis gamoyeneba, maTi SesaZlo gverdiTi efeqtebis
gamo, garkeulad SezRudulia.
pacientebma, romelTac fizikuri datvirTvis dros asT-
mis gamwvaveba aReniSnebaT, xolo fizikuri datvirTvis gareSe
asTma srulad kontrolirdeba an Tu asTmis uSualo mizezi
fizikuri aqtivobaa, fizikuri datvirTvis win an fizikuri
datvirTvis Semdeg simptomTa gamovlenis SemTxvevaSi, unda
miiRon swrafad moqmedi an gaxangrZlivebuli moqmdebis sain-
halaci b2-agonisti.
safexuri 2. mdgomareobis Semamsubuqebeli + erTi makontro-
lebeli saSualeba. me-2 dan me-5 safexuramde, asTmis mkurnal-
oba iTvaliswinebs sabaziso makontrolebeli saSualebis da
saWiroebis SemTxvevaSi, mdgomareobis Semamsubuqebeli saSu-
alebis gamoyenebas.
mkurnalobis me-2 safexurze, yvela asakis pacientebSi, ro-
gorc asTmis makontrolebeli ZiriTadi saSualeba, rekomen-
direbulia sainhalacio k.s.-ebis dabali dozebi (sainhalacio
k.s.-ebis dozebi mocemulia cxrilebSi 15-16).
alternatiul makontrolebel saSualebad miCneulia lei-
kotrienebis modifikatorebi. aRniSnuli tipis preparatebi
pacients eniSneba im SemTxvevaSi, Tu raime mizezis gamo iz-
Rudeba misTvis sainhalacio k.s.-is micema (mag. persistuli
xmis CaxleCa s.k.s.-is miRebis Semdeg) sxva makontrolirebel
saSualebad rekomendirebulia gaxangrZlivebuli moqmedebis
Teufilini, romlis antianTebiTi da makontrolebeli efeqti
xanmoklea (1 – 2 kvira), xol gverdiTi efeqtebis gamovle-
nis Sansi maRali. kromonebis (nedakromil natri da natriumis
kromoglikati) makontrolebeli efeqti saeWvoa.
safexuri 3. mdgomareobis Semamsubuqebeli + erTi an ori
makontrolebeli saSualeba. mozardebsa da mozrdil pacien-
tebSi, upiratesad rekomendirebulia 2 makontrolebeli pre-
paratis _ sainhalacio k.s.-isa da gaxangrZlivebuli moqmede-
bis b2-agonistis gamoyeneba. rogorc wesi (yovel SemTxvevaSi
uxSirsad) es preparatebi pacients eZleva kombinirebuli sa-
xiT, specialuri inhaleris saSualebiT. Tu aRniSnuli doze-

67
biT mkurnalobis Semdeg, 3 _ 4 Tvis ganmavlobaSi, ver moxer-
xda asTmis kontrolis miRweva, dgeba k.s.-is dozis gazrdis
sakiTxi. gaxangrZlivebuli moqmedebis iseTi b2-agonisti, ro-
goricaa formoteroli, iseTive swrafi moqmedebis efeqtiT
xasiaTeba, rogorc swrafi da xanmokle moqmedebis sainhala-
cio b2-agonistebi, ris gamoc warmatebiT gamoiyeneba asTmis
gamwvavebis drosac. Tumca misi efeqti ufro mkafiodaa ga-
moxatuli sainhalacio k.s.-Tan kombinaciaSi, vidre monoTera-
piis dros. saerTod ki, unda iTqvas, rom gaxangrZlivebuli b2-
agonistebiT monoTerapiis mizanSewoniloba diskusiis sagania
da mkvlevarTa umravlesoba miuTiTebs, rom maTi gamoyeneba
bevrad ufro efeqturia saihalacio k.s.-ebTan kombinaciaSi.
5 wlamde asakis bavSvebSi gaxagrZlivebuli b2-agonistiTa da
sainhalacio k.s.-iT kombinirebuli mkurnalobis efeqti kar-
gad araa Seswavlili, ris gamoc am asakSi gaxangrZlivebuli
b2-agonistebis gamoyeneba (rogorc k.s.-Tan kombinaciaSi ise
izolirebulad) araa rekomendirebuli. am asakSi, bronquli
asTmis kontrolisaTvis, oqros standartad sainhalacio k.s.-
is dabali an saSualo dozaa miCneuli, romelic, umjobesia,
speiseris saSualebiT iyos miwodebuli.
asTmis kontrolis sxva varianti, romelic murnalobis me-3
safexurzea rekomendirebuli, warmodgenilia sainhalacio
k.s.-is dabali dozisa da leikotrienebis modifikatorebis
kombinaciiT. leikotrienebis modifikatorTa alternativad
miCneulia gaxangrZlivebuli moqmedebis Teufilini.
gxangrZlivebuli moqmedebis Teufilinis efeqti, 5 wlamde
asakis, asTmiT daavadebul bavSvebSi sakmarisad araa Seswav-
lili. ris gamoc am tipis medikamentis gamoyeneba aRniSnul
kontingentSi, araa rkomendirebuli.
safexuri 4. mdgomareobis Semamsubuqebeli + ori an meti ma-
kontrolebeli saSualeba. mkurnalobis am etapze medikamente-
bis SerCeva, damokidebulia me-2 da me-3 safexurebze gamoy-
enebuli medikamentebis efeqtze da daavadebis mimdinareobis
Taviseburebaze. Tu mkurnalobis me-3 safexurze gamoyenebuli
optimaluri Terapiis fonze, mdgomareobis kontroli ver xe-
rxdeba, saWiroa alergolog-imunologis ganmeorebiTi kon-
sultacia da asTmis alternatiuli diagnozebis ganxilva. dia-
gnozis amgvari reviziisa da asTmis diagnozis dadasturebis
SemTxvevaSi, gadavdivarT mkurnalobis me-4 safexurze.
bronquli asTmiT daavadebul pacientTa me-4 safexuris

68
mkurnalobis upiratesad rekomendirebuli midgoma, warmodge-
nilia sainhalacio k.s.—is saSualo da maRali dozisa da gaxan-
grZlivebuli moqmedebis b2-agonistis gamoyenebiT. imis gamo,
rom pacientTa umravlesobaSi, sainhalacio k.s.-is saSualo
dozis Secvla maRali doziT yovelTvis ar iZleva Sesabamis
efeqts, dozis aseTi cvlileba mkacrad iZulebiTi xasiaTi-
saa da unda ganxorcieldes mxolod maSin, Tu k.s.-is saSualo
dozebisa da gaxangrZlivebuli moqmedebis b2-agonistebis (an
leikotrienebis modifikatorebis an gaxangrZlivebuli mo-
qmedebis Teufilinis) kombinacia, 3 _ 6 Tviani mkurnalobis
Semdegac ver viRebT sasurvel efeqts. rTul SemTxvevebSi
ganixileba zogierTi dasaxelebis, sainhalacio k.s.-is ormagi
da meti dozis gamoyeneba 24 saaTis ganmavlobaSi (mag budeso-
nidi SeiZlba gamoyenebuli iyos dReSi 4-jer). Tuca, k.s.-ebis
maRali dozebis xangrZlivi gamoyenebisas yovelTvis gaTva-
liswinebuli unda iyos gverdiTi movlenebis ganviTarebis Se-
saZlebloba. sainhalacio k.s.-ebis saSualo da maRal dozebTan
erTad leikotrienebis modifikatorebis gamoyeneba xasiaTde-
ba kargi efeqtiT, Tumca am kombinaciis efeqti mainc Camor-
Ceba gaxangrZlivebuli moqmedebis b2-agonistebisa da k.s.-ebis
kombinaciis efeqts.
sxva SemTxvevaSi ganixileba sainhalacio k.s.-is saSualo an
maRali dozis + gaxangrZlivebuli moqmedebis b2-agonistis +
gaxangrZlivebuli moqmedebis Teufilinis dabali dozis ga-
moyenebis sakiTxi.
safexuri 5. mdgomareobis Semamsubuqebeli + makontrolebe-
li saSualebebi. sxva makontrolebel saSualebebze oraluri
k.s.-is damateba, umetes SemTxvevaSi, kargi efeqtiT xasiaTde-
ba da iZleva asTmis kontrolis saSualebas. Tumca, am dros,
aucileblad gasaTvaliswinebelia yvela is gverdiTi efeqti,
rac k.s.-ebis sistemur da xangrZiv gamoyenebas axlavs Tan. ami-
tom, mkurnalobis am meTodze arCevani keTdeba maSin, Tu me-4
safexuris Terapiis yvela saSualebis gamoyenebis miuxedavad,
asTmian pacients yoveldRiuri aqtivobis SezRudva da asTmis
xSiri gamwvavebebi aReniSneba.
sxva makontrolebel saSualebebTan erTad anti-IgE antis-
xeulebiT mkurnalobis sakiTxi dgeba im SemTxvevaSi, Tu mi-
uxedavad yvela makontrolebeli saSualebis (maT Soris per-
oraluri da sainhalacio k.s. maRali dozebis) gamoyenebis Sem-
degac asTmis kontroli ar umjobesdeba.

69
 asTmis monitoringi da mkurnalobis xangrZlioba.
asTma, rgorc qronikuli daavadeba, moiTxovs xangrZliv
mkurnalobasa da monitorings. perioduli monitoringi sa-
Sualebas iZleva ganvsazRvroT daavadebis simZime da marTvis
efeqturoba mocemuli momentisaTis da Sesabamisad SevcvaloT
marTvis strategia (gavagrZeloT mkurnaloba arCeuli safe-
xuris mixedviT an mkunalobis uefeqtobis SemTxvevaSi avideT
erTi safexuriT maRla an mdgomareobis 3 _ 4 Tviani stabili-
zaciis SemTxvevaSi CamovideT safexuriT dabla).
mdgomareobis monitoringi unda ganxorcieldes eqimis
mier, klinikuri monacemebisa da filtvis funqciis mdgoma-
reobis Sefasebis saSualebiT yovelTviurad. amasTan, pacienti
yoveldRiurad unda axdendes mdgomareobis TviTSefasebas.
asTmis marTvis procesSi, sworad SerCeuli mkurnalobis
dros, mdgomareobis klinikuri gaumjobeseba SeiZleba gamoi-
xatos ramdenime dRidan 2 kviris ganavlobaSi, magram myari
remisiis misaRwevad, umetes SemTxvevaSi, 3 _ 4 Tvea saWiro.
asTmis mZime formis SemTxvevaSi, es dro SeiZleba bevrad ufro
metic iyos. amitom, asTmis mkurnalobis dawyebis Semdeg, mdgo-
mareobis stabilizaciis SemTxvevaSi, konkretuli safexuris
mkurnaloba grZeldeba 3 _ 4 Tve. mdgomareobis gauaresebis
SemTxvevaSi gadavdivarT mkurnalobis ufro maRal safexurze
da mdgomareobis stabilizaciis Semdeg vagrZelebT am safexu-
ris Sesabamis mkurnalobas isev 3 _ 4 Tvis ganmavlobaSi. Tu 3
_ 4 Tvis ganmavlobaSi, mkunalobis garkveul safexurze, mdgo-
mareoba stabiluria _ CamovdivarT ufro dabal safexurze
da mkurnalobas kvlav 3 _ 4 Tve vagrZelebT. mkurnalobis es
meTodi saSualebas iZleva maqsimalurad efeqturad vmarToT
asTma. anu mTlianad movxsnaT an minimumamde SevamciroT asT-
mis klinikuri simptomatika, SevinaCunoT fizikuri da fsiqi-
kuri aqtivoba, movaxdinoT filtvis funqciis normalizacia
da minimumamde daviyvanoT sasunTq sistemaSi mimdinare anTe-
biTi procesebis aqtivoba.
mdgomareobis gamwvavebis SemTxvevaSi (asTmis Setevis peri-
odSi) makontrolebel medikamentebs aucileblad emateba md-
gomareobis Semamsubuqebeli saSualebebi (upirvelesad swrafi
da xanmokle moqmedebis sainhalacio b2-agonistebi).
zogjer, 5 wlamde asakis bavSvebSi da pubertalur peri-
odSi, asTmas axasiaTebs xangrZlivi remisia, romlis drosac
makontrolebeli medikamentebis gamoyeneba an saerTod wydeba

70
an minimumamdea dayvanili. Tumca am drosac aucilebelia re-
gularuli dakvirveba da monitoringi.

„sfexuriT qvemoT,“ rodesac asTma kontrolirebadia.

miuxedavad imisa, rom asTmis kontrolis pirobebSi mkur-
nalobis optimaluri xangrZliobisa da medikamentTa dozire-
bis Sesaxeb sarwmuno monacemebi sakmaod SezRudulia, am sakiT-
xebis mimarT mainc arsebobs garkveuli midgomebi, romlebic
asTmis mkurnalobis procesSi e.w. „safexuridan“ „safexurze“
gadasvlis proces aregulirebs:
• asTmis kontrlis yvelaze efeqtur saSualebad s.k.s.-isa
da gaxangrZlivebuli moqmedebis b2-agonistis kombinaciis xan-
grZlivi gamoyenebaa miCneuli.
• rodesac samkurnalod gamoiyeneba mxolod sainhalacio
k.s.-is saSualo an maRali doza, mdgomarebis 3 – 4 Tviani sta-
bilizaciis Semdeg, pacientma 3 Tvis ganmavlobaSi, unda miiRos
pirvandeli dozis 50%.
• rodesac kontroli miiRweva mxolod sainhalacio k.s.-is
dabali dozis gamoyenebiT, pacienti SeiZleba gadavides prepa-
ratis dRiuri dozis erTjerad miRebaze.
• rodesac asTma, 3 – 4 Tvis ganmavlobaSi, kontrolirdeba
sainhalacio k.s.-isa da gaxangrZlivebuli b2-agonistis kombi-
naciiT, mkurnalobis koreqcias viwyebT k.s.-is dozis 50%-iani
SemcirebiT da b2-agonistis pirvandeli dozis gagrZelebiT.
Tu medikamentebis aRniSnuli dozebis fonze asTma kontro-
lirebadia _ gadavdivarT sainhalacio k.s.-is dabal dozaze da
vwyvetT b2-agonistis gamoyenebas. amgvari midgomis alterna-
tivad ganixileba sainhalacio k.s.-isa da b2-agonistis dRiuri
dozis erTjeradi gamoyeneba.
• rodesac asTma kontrolirebadia sainhalacio k.s.-ebisa
da sxva makontrolebeli (ara gaxangrZlivebili moqmedebis
b2-agonistiT), saSualebebis gamoyenebiT, kortikosteroidis
dozas vamcirebT 50%-iT da mxolod asTmis kontrolis Senar-
Cunebis SemTxvevaSi gadavdivarT k.s.-is dabal dozaze. Sem-
degSi, kontrolis SenarCunebis SemTxvevaSi, gadavdivarT k.s.-
ebis dabal dozaze. Semdeg ki, asTmis kontrolis SenarCunebis
SemTxvevaSi, SesaZlebelia kombinirebuli Terapiis Sewyveta.
• makontrolebeli Terapia SeiZleba SevwyvitoT, Tu asT-
mis kontroli miiRweva preparatebis minimaluri dozebis ga-
moyenebiT da gamwvavebebi ar vlindeba bolo 1 wlis ganmavlo-

71
baSi.
„safexuriT zemoT“, rodesac asTma ara kontrolirebadia an
nawilobriv kontrolirebadia.
asTmis gamwvavebis an mdgomareobis damZimebasTan erTad, sa-
Wiro xdeba mkurnalobis koreqcia _ mdgomareobis Semamsubu-
qebeli saSualebebis CarTva da/an makontrolebeli preparate-
bis damateba an dozebis gazrda, anu mkurnalobis „safexuriT
maRla“ gadanacvleba.
aseT SemTxvevaSi saWiro xdeba:

• mkurnalobis procesSi CaerTos swrafi da xanmokle moq-

medebis b2-agonistebi da bronqodilatatorebi. am tipis pre-
paratebis efeqti droebiTia. amotom, maTi gamoyeneba unda
gavagrZeloT manam, sanam gamwvavebis (gauaresebs) simptomebi
ar moixsneba (an ar Semcirdeba). Tu mdgomareobis Semamsub-
uqebeli medikamentebis gamoyeneba saWiro xdeba 2 _ 3 dReze
meti drois ganmavlobaSi, unda gavzardoT makontrolebeli
medikamentebis dozebi an mkurnalobaSi CavrToT damatebiTi
makontrolebeli saSualebebi.
• mdgomareobis gauaresebis SemTxvevaSi, sainhalacio k.s-
ebis dozis gaormageba xanmokle drois ganmavlobaSi, ver iZ-
leva sasurvel efeqts da araa rekomendirebuli. sainhalacio
k.s.-is dozis gaoTxmageba an ufro maRali dozis gamoyeneba,
peroraluri k.s.-is mokle kursis eqvivalentur mkurnaloba-
daa miCneuli. k.s.-is ufro maRali dozebi SeiZleba gamoyene-
buli iyos 7 _ 14 dRis ganmavlobaSi, bronquli asTmis mZime
gamwvavebebis mqone, rogorc mozrdil pacientebSi ise bavS-
vebSi. Tumca mkurnalobis es meTodi, kidev moiTxovs Semdgom
dakvirvebasa da daxvewas.
• sainhalacio k.s.-ebisa da swrafi da xanmokle an gaxan-
grZlivebuli moqmedebi b2-agonistebis (mag. formoteroli)
kombinaciis gamoyeneba mniSvnelovnad aumjobesebs asTmis
kontrols, amcirebs gamwvavebaTa sixSires da intensiobas da
hospitalizaciis saWiroebas. mdgomareobis gauaresebis SemTx-
vevaSi, zogierTi avtori SesaZleblad Tvlis aRniSnuli me-
dikamentebis dozebis gaormagebas an gaoTxmagebasac ki 2 an
meti dReebis ganmavlobaSi. Tumca, mkurnalobis am meTodis
efeqturoba, 5 wlamde asakis baSvebSi sakmarisad Seswavlili
araa da amdenad, araa rekomendirebuli.
• daavadebis gamwvavebis SemTxvevaSi, Cveulebriv rekomen-

72
direbulia b2-agonistebis maRali dozebisa da glukokorti-
kosteroidebis sistemuri (peroraluri an intravenuri) gamoy-
eneba.
• asTmis gamwvavebis an kontrolis darRvevis SemTxvevaSi,
yovelTvis unda gadaixedos mkurnalobis safexuris Sesabami-
soba daavadebis simZimis monacemebTan. aucileblad unda
Semowmdes inhalaciuri teqnikis Sesrulebis siswore, risi
darRvevac Tavisuflad SeiZleba gaxdes asTmis kontrolis
darRvevis mizezi.

rTulad samkurnalo asTma.

zog SemTxvevaSi, miuxedavad adeqvaturi mkurnalobisa, asT-
mis sruli an Tundac nawilobrivi kontroli mainc ver miiR-
weva.
im SemTxvevaSi, Tu mkurnalobis me-4 safexurzec ki, asTmis
kontroli miuRwevelia, iTvleba, rom asTma Znelad samkurna-
loa. aseT pacientebs xSirad aReniSnebaT garkveuli toleran-
toba glukokortikosteroidebze da esaWiroebaT sainhalacio
k.s.-ebis bevrad maRali dozebi, vidre es Cveulebrivaa miRe-
buli. Tumca ar arsebobs sarwmuno monacemebi, romlebic aseT
SemTxvevaSi, s.k.s.-ebis maRali dozebis 6 Tveze xangrZlivi pe-
riodis ganmavlobaSi miRebis SemTxvevaSi, asTmis sruli kon-
trolis SesaZleblobaze miuTiTebs.
sainhalacio k.s.-is maRali dozebis gamoyenebiT, 3 – 4 Tvis
ganmavlobaSi, asTmis kontrolis miRwevis SemTxvevaSi, ukve
unda vifiqroT preparatis dozis Semcirebasa da optimaluri
efeqtis misaRebad minimaluri dozis SerCevaze.
amasTan, unda gvaxsovdes, rom asTmiT daavadebul pacient-
Ta mcire nawili sruliad rezistentulia k.s.-ebiT mkurnalo-
bis mimarT da dozis zrda ver gvaZlevs kontrolis miRwevis
imeds.
garda amisa, adeqvaturi mkurnalobis pirobebSi, asTmis
arakontrolirebadi mimdinareobis dros, saWiroa asTmis dia-
gnozis gadaxedva da alternatiuli diagnozebis kidv erTxel
ganxilva. aucilebelia iseTi komorbiduli mdgomareobebis
ganxilva, rogoricaa qronikuli sinusitebi, gastroezofagu-
ri refluqsi, simsuqne da Zilis apnea.
anti IgE-Terapiis Catarebis gadawyvetilebis miRebis Sem-
TxvevaSi, auclebelia sisxlis SratSi IgE-s donis gansazRvra
da amis mixedviT, Sesabamisi mkurnalobis kursis koregireba.

73
 asTmis gamwvavebis menejmenti.
asTmis gamwvavebis (Setevis) periodSi, sxvadasxva maprovo-
cirebeli faqtorebis zemoqmedebis gamo, viTardeba sasunT-
qi gzebis (wvrili da saSualo kalibris bronqebi) spazmi da
bronqebis sanaTuris lorwoTi daxSoba, ris gamoc adgili aqvs
eqspiraciis Seferxebas. viTardeba sxvadasxva xarisxis hipoq-
sia, xvela, qoSini da saerTo mgomareobis damZimeba.
asTmis Setevis (gamwvavebis) marTva iTvaliswinebs bronquli
obstruqciisa da masTan dakavSirebuli simptomebis moxsnas.
asTmis msubuqi (da zogjer saSualo simZimis) gamwvavebis
marTva SesaZlebelia binaze an hospitalis mimReb da Terapi-
ul ganyofilebaSi. saSualo simZimis (ufro xSirad) da mZime
Setevis (yovelTvis) marTva unda ganxorcieldes hospitalSi
(upiratesad gadaudebeli daxmarebis ganyofilebaSi).

asTmis gamwvavebis marTva ZiriTadad iTvaliswinebs sam etaps:

1. asTmis Setevis simZimis Sefaseba.
2. bronqospazmis moxsnis RonisZiebebi.
3. Setevis Semdgom periodSi, pacientis binaze gaweris dros,
misTvis micemuli rekomendaciebi.

asTmis simZimis Sefasebis kriteriumebi mocemulia me-10

cxrilSi.

SeniSvna:
simZimis Sefasebisas saWiro ar aris yvela CamoTvlili simp-
tomis arseboba. sakmarisia ramdenime maTganic.

cxrili 15.
asTmis Setevis simZimis Sefaseba
sunTqvis
parametrebi msubuqi saSualo mZime gaCerebis
safrTxe

74
 yvela asakSi:
mosvenebul
mozrdilebSi:
siaruli- mdgomareo-
laparakis
sas baSi.
dros.
Cvili bavS-
CvilebSi:
vebi: uars
susti da
amboben kve-
sulxuTva xanmokle
baze.
tirili. kveba
gaZnelebulia.
uWiravs
SeuZlia iZulebiTi,
urCevnia
wola mjdomare da
ijdes
winwaxrili,
mdgomareoba
winadade- mokle
laparaki sityvebiT
bebiT frazebiT
SesaZloa Cveuebriv Cveuebriv dabinduli
cnobiereba
agzneba. agznebulia. agznebulia an areuli
sunTqvis six- momate- momatebuli
momatebuli
SiSire buli > 30
sunTqvaSi
paradoq-
damate-
suli
biTi kunTebis
Cveuleb- Torako-
monawile-oba Cveulbriv Cveulebriv
riv ara abdominal-
da paras-
uri moZ-
ternalueri
raoba.
Caweva
zomieri.
xSirad,
mxolod Cveulebriv
xixini xmamaRali. ar ismis.
amo- xmamaRali.
sunTqvi-
sas.
bradika-
pulsi(wuTSi) < 100 100 _ 120 > 120
rdia.
misi ar
mozrdilebSi
arseboba
ar aris. SeiZleba iyos xSiria
paradoqsuli miuTiTebs
< 10 mm 12 _ 25 mm >25 mm Hg.
pulsi sasunTqi
Hg. Hg. bavSvebSi:
kun Tebis
20 _40 mmHg
gadaRlaze.

75
 < 60%
bronqodila- (mozrdi-
tatoriT sa- lebSi).
wyisi mkurna-
lobis Semd- daaxloebiT: an
> 80%
eg: PEF mosa- 60% _ 80% mkurnaloba-
lodnelis an ze pasuxi
personalur- grZeldeba 2
ris % saaTze
met xans.
normalu-
< 60 mm Hg.
PaO2 (haerSi) ria da
SesaZlevelia
da/an _ gazomva, > 60 mm Hg.
cianozis
Cveu-
arseboba.
lebriv,
ar aris
> 45 mm Hg
PaCO2 saWiro.
SesaZlebelia
(haerSi) < 45 mm Hg
sunTqvis
< 45 mm
SeCe- reba.
Hg
SaO2 (haerSi) > 95% 91% - 95% < 90%

SeniSvna:
cxrilSi gaTvaliswinebuli ar aris bavSvTa asakis gulis
cemisa da sunTqvis sixSiris asakobrivi normebi. amasTan, moz-
rdil pacientTa pulsisa da sunTqis sixSiris cvlileba asTmis
Setevis sxvadasxva simZimis SemTxvevaSi mocemulia ara nor-
masTan procentuli cvlilebis, aramed absoluturi ricxviTi
mniSvnelobis mixedviT. Cveni rekomendaciis mixedviT, sunTqvi-
sa da gulis cemis sixSire msubuqi Setevis dros imatebs daax-
loebiT 10% _ 15%-iT. saSualo somZimis dros _ 20% _ 30%-iT
da mZime Setevis SemTxvevaSi _ > 40% _ > 50%-iT.
sunTqvis sixSiris normebi mRviZare bavSvisaTvis.

cxrili 16.
asaki norma (wuTSi)
2 Tvemde < 60
2 _ 12 Tve < 50
1 _ 5 weli < 40
6 _ 8 weli < 30
> 12 weli < 20

76
 pulsis sixSiris normebi mRviZare banSvebisaTvis.

cxrili 17.
asaki norma (wuTSi)
2 _ 12 Tvemde < 160
1 _ 2 weli < 120
2 _ 8 weli < 80 – 90.
> 12 weli < 80

asTmis gamwvavebis SemTxvevaSi, mdgomareobis Sefasebisas,

aucileblad unda gamovyoT maRali riskis jgufebis pacien-
tebi anu is pacientebi, romelTac fataluri Sedegis Tavidan
asacileblad daxmareba gadaudebeli Terapiis ganyofilerbaSi
unda gaewioT.
aseT pacientebs ekuTvnis:
• pirebi, romelTac anamnezSi aReniSnebaT asTmis mZime Se-
tevebi, ris gamoc Catarebuli iyo intubacia da filt-
vis meqanikuri ventilacia.
• romlebic, asTmis Setevis gamo, ukanaskneli 1 wlis gan-
mavlobaSi hospitalizirebulebi iyvnen gadaudebeli
daxmarebis ganyofilebaSi.
• is vinc iRebs oralur k.s.-ebs an vinc cota xnis win Sew-
yvita oraluri k.s.ebis miReba.
• vinc, saWiroebis miuxedavad, uwyvetad ar iRebs sainha-
lacio k.s.-ebs.
• is vinc “damokidebulia” sainhalacio b2-agonistebze.
gansakuTrebiT maSin Tu 1 Tvis ganmavlobaSi iyenebs sal-
butamolis (an misi eqvivalenti preparatis) 1 kanistras.
• visac fsiqiatriuli an fsiqo-socialuri problemebi aR-
eniSneba. maT Soris isinic, vinc sedaciuri moqmedebis
medikamentebs iRebs.
• vinc asTmas ar mkurnalobs specialistTan da winaswar
Sedgenili gegmis mixedviT.

mdgomareobis Sefasebis Semdeg dauyovnebliv iwyeba medi-

kamentozuri Terapia (1-sqema) mkurnalobis dawyeba (garda Za-
lian mZime mdgomareobisa) sasurvelia Catardes gadaudebeli
daxmarebis ganyofilebaSi. mZime Setevis dros mkurnaloba Sei-
Zleba daiwyos gadaudebeli Terapiis ganyofilebaSi. magram,

77
Tu mkurnalobis Semdeg mdgomareoba ar umjobesdeba pacienti
unda gadaiyvanon intensiuri Terapiis ganyofilebaSi.
fataluri Sedegis saSiSroebis kriteriumia mdgomare-
oba, romelic intubaciasa da filtvis xelovnur ventilacias
moiTxovs.
nebismieri ganyofileba, sadac asTmis Setevis marTva xor-
cieldeba, arWurvili unda iyos pulsoqsimetriT, pik-floume-
triT, nebulaizeriT da Jangbadis miwodebis sistemiT.

sqema 2.
asTmis gamwvavebis (Setevis) menejmenti gadaudebeli daxmarebis gan-
yofilebaSi
sawyisi gamokvleva
x anamnezi, fizikaluri gamokvleva (auskulptacia, damxmare kunTebis monawileoba
sunTqvaSi, P., R., PEF an FEV1., 02-is saturacia, arteriuli sisxlis gazebi kid-
udebSi.
sawyisi mkurnaloba
x Jagbadi, sanam saturacia ar iqneba > 90 (95 bavSvebSi).
x b2-agonsti 1 saaTis ganmavlobaSi.
x sistemuri k.s. _ Tu ver miviReT swrafi gaumjobeseba an Tu pacienti manamde
iRebda k.s.-s peroralurad. an Tu Seteva mZimea.
x sedacia, epinefrini, mukolitikebi da respiratoruli fizioTerapia arc erT
SemTxvevaSi araa naCvenebi.

SeafaseT mdgomareoba 1 saaTis Semdeg

fizikaluri kvleva. PEF. 02-saturacia da saWiroebis mix-
edviT _ sxva testebi.

saSualo simZimis kriteriumebi: mZime Setevis kriteriumebi:

x PEF - normis an individualuri x fatalurobis safrTxis risk-faqto-
normis 60% _ 80%-ia. rebis arseboba anamnezSi.
x fizikaluri monacemebiT: zomieri x PEF < 60%.
simZimis simptomebi. sunTqvaSi mo- x fizikaluri kvleviT: mZime simpto-
naileobs damxmare kunTebi. mebi mosvenebul mdgomareobaSi.
gulmkerdis retraqcia.
mkurnaloba: x mkurnalobis Sedegad mdgomareoba
x Jangbadi. ar umjobesdeba.
x b2-agonisti + antiqolinerguli
preparatis inhalacia _ yovel 1 mkurnaloba:
saaTSi. x Jangbadi.
x oraluri k.s. x b2 agonisti + antiqolinerguli
x gaagrZeleT mkurnaloba 1 _ 3 sT., preparatis inhalacia
Tu mdgomareoba umjobesedeba. x sistemuri k.s.
x intravenurad magnezia.

gadaamowmeT mdgomareoba 1 _ 2 saaTSi

78
kargi Sedegi 1 – 2 sT. arasruli Sedegi 1 – Sedegi araa 1 _ 2
x Sedegi SenarCunebu- 2 saaTSi. saaTSi.
lia preparatebis x fatalurobis sa- x fatalurobis sa-
bolo miRebidan 60 frTxis risk-fa- frTxis risk-fa-
wT.-is qtorebi. qtorebi.
ganmavlobaSi. x fizikalurad:: x fizikaluri
x fizikaluri kvlev- msubuqidan mZim- monace- mebi mZimea.
is maCveneblebi emde simptomebi. gamoxat- ulia
nor- mis x PEF < 60%.@ SfoTva da/an
farglebSia. Zilianoba.
x 02-is saturacia
x PEF > 70%. ar umjobesdeba. x PEF < 30%
x 02-is saturacia > x PCO2 > 45 mm Hg.
90% (bavSvebSi – 95) x PO2 < 60 mm Hg.

gadaiyvaneT g.d.g.-Si. gadaiyvaneT int. T. g.

x Jangbadi. x Jangbadi.
x b2-agonisti + an- x b2-agonisti + anti-
tiqolierguli qolinerguli pre-
preparati. parati.
x sistemuri k.s. x intravenuri k.s.
x magnezia intra- x ganixileT i.v b2-ag-
venurad. onistis sakiTxi.
x PEF.,02-is satu- x ganixileT i.v. Teo-
raciis monito- filinis sakiTxi.
ringi. x SeiZleba saWiro
ga- xdes intubacia
da f.x.v.G

mdgomareoba SeafaseT Tavidan, mokle droSi.

gauSviT binaze Tu: Sedegi ar aris (ixileT zemoT):

x PEF > 60 %. x CaatareT intensiuri Terapia.
x SesaZlebelia peroraluri an sa- 6 _ 12 sT. ganmavlobaSi Sedegi
inhalacio preparatebiT mkurnal- arasrulia (ixileT zemoT).
oba. x Tu 6 _ 12 saaTSi mdgomareoba ar
umjbesdeba gadaiyvaneT intensiuri
Terapiis gan-yofilebaSi.

mkurnaloba binaze:
x b2-agonistis inhalacia grZelde-
ba.
x ufro xSirad ganixileba oralu-
ri k.s. micemis sakiTxi.
x ganixileT sainhalacio k.s.-is mi-
cemis sakiTxi.
pacientis ganaTleba:
x wamlebis sworad miReba.
x CamoayalibeT moqmedebis gegma.
x SeadgineT pacientze Semdgomi
dakvirvebis gegma.

mdgomareoba gaumjobesda

79
 I. Jangbadi. Jangbadi pacients miewodeba nazaluri kanuliT,
niRbiT an “Jangbadis karavis” saSualebiT (CvilebSi). Jangbadi
pacients eZleva manam, saman saturacia ar iqneba > 90% (95%
bavSvebSi).
II. swrafad moqmedi b2-agonistebi (mag. ventolini). pirveli 1
saaTis ganmavlobaSi pacienti akeTebs 2 _ 4 inhalacias, yovel
20 wuTSi. (1 inhalaciis dros pacienti iRebs 100 mkg preparats).
1 saaTis Semdeg, msubuqi Setevis SemTxvevaSi, pacienti akeTebs
2 dan 4 SesunTqvamde yovel 3 _ 4 saaTSi. mZime Setevis dros
_ 6 _ 10 SesunTqva yovel 1 – 2 saaTSi. mcire asakis bavSvebSi,
sadac SeuZlebelia standartuli, wneviani inhaleris gamoy-
eneba, medikamentis misawodeblad gamoiyeneba speiseri. vento-
linis inhalacia xorcieldeba Jangbadis saturaciis da PEF-s
maCveneblis monitoringis fonze.
nebulaizeris saSualebiT, bavSvebSi 18 Tvis asakidan, vento-
linis doza Seadgebs 2,5 _ 5,0 mg/24sT. mozrdilebSi _ maqsi-
maluri sadReRamiso doza aris 40 mg. nebulaizeriT miRebis
SemTxvevaSi (preparati xsnaris saxiT mTavsebulia blisterSi)
preparatis ganzaveba Cveulebriv ar xdeba. Tumca gnzaveba Ses-
aZlebelia mcire raodenobiT fiziologiur xsnarSi.
b2-agonistis intravenuri infuzia tardeba mxolod gansa-
kuTrebul SemTxvevaSi, mZime Setevis dros.

III. antiqolinerguli preparatebi. beroduali – dozirebu-

li aerozoli. 1 doza. 50 mkg. sainhalacio xsnari – 200 ml. 20
wveTi _ 1,0 ml. dozirebuli aerozoli gamoiyeneb 2 wlis asaki-
dan. asTmis Setevis periodSi rekomendirebulia erTjerze 2
dozis SesunTqva. 5 wuTis Semdeg, SesaZlebelia kidev 2 doz-
is miReba. momdevno 2 dozis miReba SeiZleba 2 saaTis Semdeg.
preparatis nebulaizeriT gamoyenebis SemTxvevaSi, 6 wlamde
asakSi, gamoiyeneba xsnaris 1 wvT./kg., 3-jer dReSi. 6 _ 14 wlis
asakSi _ 10 _ 20 wveTi 4 –jer dReSi. mZime SemTxvevebSi doza
SeiZleba gasammagdes.

IV. kortikosteroidebi
a) sainhalacio k.s. (cxrili 5 da 6).
b) sistemuri kortikosteroidi (mag. prednizoloni). per-
oraluri an intravenurad misaRebi doza Seadgens 0,5 _ 1,0 mg/
kg/24 saaTSi.
V. magniumis sulfati. ar gamoiyeneba rutinulad. (< 5

80
wlamde asakSi misi gamoyenebis Sesaxeb sarwmuno monacemebi ar
arsebobs). a) intravenurad – gamoiyeneba mozrdil pacien-
tebSi, im SemTxvevaSi, Tu FEV1 aris normis an saukeTeso indi-
vidualuri maCveneblis 25% _ 30%. mozrdilebSi da bavSvebSi,
rodesac asTmis Seteva ar emorCileba sxva saxis mkurnalobas
da bavSvebSi, Tu mkurnalobis dawyebidan 1 saaTis Semdeg FEV1
< normis an saukeTeso individualuri maCveneblis 60%-ze.
preparati, intravenurad gamoiyeneba 2,0 gr.-is raodenobiT,
yovel 20 wuTSi. preparatis gverdiTi efeqtebidan gansaku-
TrebiT sayuradReboa sunTqvis centris daTrgunvis SesaZle-
bloba.

▶ alergiuli da ara alergiuli riniti

riniti aris cxviris Rrus lorwovanis anTeba, romelic
klinikurad, rinoreiT an gaWedviT, cxviris qaviliT da ce-
minebiT vlindeba. rodesac riniti alergiuli warmoSobisaa,
mas xSirad erTvis Tan koniuqtiviti, Tvalebis qavili da
cremldena. es mdgomareoba gamowveulia organizmze garemo-
Si arsebuli alergenebis zemoqmedebiT. sezonuri simptomebi
upiratesad ganpirobebulia mcenareuli mtvris alergenebiT,
rogoricaa xeebis yvavilebis mtveri, balaxis da sarevelebis
mtveri. sxvadasxva feris yvavilTa mtveri ar aris alergiuli
rinitis gamomwvevi mizezi. sxva alergenebi, rogorebicaa mag-
aliTad oTaxis mtveri, katisa da ZaRlis qertli, aseve xSirad
arian alergiuli rinitis ganviTarebis mizezi. samsaxurebriv
saqmianobasTan dakavSirebuli alergenebidan gansakuTrebiT
sayuredReboa laboratoriuli cxovelebi, yvavilebi da late-
qsi. Tumca rinitis mizezi SeiZleba iyos ara alergeni, aramed
sxva araspecifiuri gamRizianebeli, rogorebicaa mtveri, qimi-
katebi, aerozolebi, aromatizatorebi, Tambaqos boli, haeris
temperaturis an sinotivis cvlileba.
cxviris gaWedva SeiZleba gamoiwvios anatomiurma da struq-
turulma cvlilebebma da hormonalurma disbalansma.

ZiriTadi debulebebi:
• riniti aris jan. dacvis globaluri probleba, rogorc
mozrdil, ise bavSvTa kontingentSi.
• rinitiT daavadebulia dasavleTis qveynebis mosaxleo-

81
 bis daaxloebiT 20%. daavadebis diagnostirebisaTvis
saWiroa guldasmiT Sekrebili anamnezi, sistematiuri
klinikuri kontroli da specifiuri testebi.
• rinits xSirad axasiaTebs iseTi komorbiduli mdgo-
mareobebis arseboba, rogoricaa koniuqtiviti, sinusiti,
otiti da asTma.
• alergiuli rinitis klasfikacia emyareba am daavadebis
klinikuri mimdinareobis simZimes da xangrZliobas.
• alergiuli riniti mniSvnelovan zegavlenas axdens
pirovnebis cxovrebis xarisxze da skolasa Tu samsaxur-
Si mis mdgomareobaze.

nazaluri hiperreaqtiuloba.
qronikuli an recidiuli rinitis mqone pacientebs xSir-
ad aReniSnebaT gaZlierebuli mgrZnobeloba garemoSi arse-
bul mraval araspecifiur trigerze, rogorebicaa magaliTad:
Tambaqos boli, mkveTri sunis sunamo an samrewvelo Tu say-
ofacxovrebo narCenebis suni. amgvar reaqcias hiperreaqtiu-
loba ewodeba da igi mniSvnelovnad ganisazRvreba neiroregu-
latoruli meqanizmebiT. Tumca araspecifiuri hiperreaqtiu-
loba ZiriTadad damaxasiaTebelia ara alergiuli rinitisaT-
vis. alergiuli statusis drosac adgili aqvs cxviris Rrus
lorwovanis araspecifiuri sensitiurobis matebas. normaluri
nazaluri funqciis cvlileba, romelic rinitiTaa gamowveu-
li, SeiZleba iyos lokaluri an centraluri warmoSobis ner-
vuli disfunqciis mizezi. aRniSnuli mdgomareoba SeiZleba
gamowveuli iyos cxviris lorwovanis receptorebze alergi-
uli an sxva saxis gamRizianeblis permanentuli zemoqmedebiT.
am mdgomareobis klinikuri gamovlineba SeiZleba warmodgeni-
li iyos lorwos sekreciis gaZlierebiT an vaskularuli rea-
qciiT da SeSupebiT.

alergiuli riniti.
tradiciulad, alergiul rinits yofen: 1. sezonur da
2. wliur (grZeldeba mTeli weli) daavadebad. yvelaze xSi-
ri trigerebi arian aero alergenebi. sezonuri simptomebi
gamowveulia balaxis, xeebis yvavilebis da sarevelebis mtvriT.
mTeli wlis ganmavlobaSi gamoxatuli alergiuli riniti, ux-
Siresad, gamowveulia “oTaxis mtveriT”, tarakanebis, tkipebis,
Sinauri cxovelebisa da frinvelebis alergenebiT.

82
 alergiuli rinitis “sezonurad” da “wliurad” dayofis
marTebuloba, dReisaTvis kiTxvis niSnis qveS dgeba da meti
yuradReba eqceva daavadebis simZimisa da simptomTa gamov-
lenis Taviseburebas.
mimdinareobis xangrZliobis Taviseburebis mixedviT, aler-
giul rinits yofen intermitentulad (xangamoSvebiTi) da per-
sistulad.
alergiuli riniti intermitentulia, Tu klinikuri simpto-
mebi gamoxatulia kviraSi 4 dReze naklebi drois ganmavlobaSi
an mTlianad grZeldeba 4 kviraze naklebi drois ganmavlobaSi.
alergiuli riniti iTvleba persistulad, Tu klinikuri
simptomebi gamoxatulia kviraSi 4 dReze meti drois ganmavlo-
baSi da grZeldea 4 kviraze met xans.
simZimis mixedviT, daavadeba iyofa msubuq, saSualo da mZime
mimdinarobad; imis mxedviT, Tu ramdenad mkveTradaa gamoxatu-
li klinikuri simptomebi da ramdenad arRveven isini cxovrebis
normalur xarisxs. (sqema 3 ).
sezonuri alergenebis gavrceleba haerSi, SeiZleba icv-
lebodes wlidan wlamde da amasTan, ramdenime maTganis mo-
nacvleoba mudmivad iyos gamoxatuli, weliwadSi, mTeli 10
Tvis ganmavlobaSic ki. amitom, mcenareuli alergenebi, rom-
lebic sezonuri aleriis gamomwvevad iTvlebian, SeiZleba daa-
vadebis trigerad mogvevlinon TiTqmis mTeli wlis manZilze.
meore mxriv, Sinauri cxovelebi, romlebic miCneulni arian
persistuli alergiis mizezad, SeiZleba, konkretul SemTxve-
vaSi, SexebaSi iyvnen pirovnebasTan mxolod xangamoSvebiT da
iwvevdnen alergiis gamovlinebas ara mudmivad, aramed iSvia-
Ti, uSualo kontaqtis SemTxvevaSi. es mdgomareoba qmnis se-
riozul sirTules sezonuri da wliuri alergiis gamomwvevi
faqto- rebis erTmaneTisagan gamijvnisaTvis. amas emateba is
faqtic, rom pacientTa didi nawili sensibilizirebulia erT-
droulad mravali alergenis mimarT, rac kidev ufro ar-
Tulebs savaraudo trigeris identifikacias. amitom gasage-
bia, rom mravali alergenis sezonuri zemoqmedeba SeiZleba
simptomTa persistirebis mizezi gaxdes da rinitis simptomebi
gamovlenili iyos praqtikulad mTeli wlis ganmavlobaSic.
garda amisa, pirovnebis mier geografiuli garemos perioduli
cvlac SeiZleba mniSvnelovan rols asrulebdes alergiuli
simptomebis gamovlenis TaviseburebaSi.

83
 sqema 3
alergiuli rinitis klasifikacia.

intermitentuli. . persistuli.

x < 4 dRe/kviraSi. x > 4 dRe/kviraSi.

x an < 4 kviraze. x da > 4 kviraze

msubuqi. . saSualo/mZime.

x Zili mSvidia. ar CamoTvlilTagan erTi an

aris darRveuli meti:
fizikuri aqtivoba
da sportuli saq- x darRveulia Zili.
mianoba. x darRveulia fizi-
x xeli ar eSleba kuri aqtivibias un-
skolasa Tu sam- ari, ver misdevs
saxurSi. sports, aqvs mous-
x simptomebi ar aris venroba.
Semawuxebeli. x xeli eSleba sko-
lasa da samsxurSi.
x simptomebi Semawu-
xebelia.

rinitis sakmaod mZime klinikuri gamovlineba SeiZleba

gamowveuli iyos kvebiTi alergenebiT. am dros, mas yovelT-
vis axlavs Tan intenstinaluri traqtis dazianebis esa Tu is
suraTi. garda amisa, rinitTan erTad SeiZleba ganviTardes
alergiis iseTi gamovlinebebi, rogoricaa asTma, sasunTqi gze-
bis angioSeSupeba da hipotenzia.
adre gazafxulze xSiria Wadris mtverze ganviTarebuli,
IgE damokidebuli, rinokoniuqtiviti da oralur/faringial-
uri qavili. es simptomebi SeiZleba gamovlindes sxvadasxva xi-

84
lis miRebis Semdegac, romelTac aero alergenebis msgavsi an-
tigenuri struqtura gaaCniaT (jvaredini aleriuli reaqcia).
“okupaciuri rinitis” ganviTarebis mizezia pirovnebis sa-
muSao garemoSi samrewvelo procesis produqtTa anaorTq-
lis inhalacia. daavadebisaTvis damaxasiaTebelia klinkur
simptomTa gamovlena samuSao adgilze an saRamos, samsaxuris
Semdeg. mdgomareoba umjobesdeba dasvenebis dReebSi da saer-
Tod, samsaxurisagan moSorebiT yofnisas. am tipis WeSmariti
sensibilizaciisaTvis saWiroa Sesabamis alergenebTan urTier-
Toba ramdenime Tvidan, 1 _ 3 wlamde.

ara alergiuli riniti

ara alergiuli rinitebi SeiZleba davyoT infeqciur da
anTebiTi kategoriebis paTologiebad. Tu anTebadi procesi
mimdinareobs infeqciuri agentis gareSe, am SemTxvevaSi ufro
advilia SesaZlo gamomwvevis dadgena da damaxasiaTebel simp-
tomTa identificireba. daavadebis mimdinareobis procesSi,
infeqciuri agentis CarTvis gamo, SeiZleba ganviTardes epi-
zoduri gamwvavebebi.
ara alergiuli rinitis mizezebi mocemulia 18 cxrilSi.

cxrili 18.
ara alergiuli rinitis gamomwvevi mizezebi

ara alergiuli anTebiTi ara alergiuli, ara anTebiTi

riniti riniti
emociuri.
okupaciuri. idiopaTiuri.
medikamentozuri. atrofiuli.
infeqciuri. degustaciuri (sakvebismieri).
aspirin-sensitiuri. vazomotoruli.
ara alergiuli, eozino- medikamentozuri.
filuri riniti (aaer). hormonaluri.

anTebiTi riniti
mikrobuli ifeqciebiT gamowveuli rinitebis dros, Cveu-
lebriv, saxezea zemo respiratoruli traqtis paTologiis
anamnezi da anti ifeqciuri mkurnalobis fonze swrafad xdeba
mdgomareobis gaumjobeseba.
organizmis hormonaluri speqtris disbalansma aseve SeZ-

85
leba gamoiwvios cxviris lorwovani garsis cvlilebebi. or-
suloba da pubertaluri periodi aris rinitis ganviTarebis
xelSemwyobi mdgomareobebi. oraluri kontraceptivebis miRe-
ba ar aris asocirebuli nazalur gaWedvasTan. naxuloben aso-
ciacias cxviris gaWedvasa da menstrualur cikls Soris.
ara alergiuli riniti, zogjer, SeiZleba ganviTardes Cveu-
lebrivi sakebi danamatebis miRebis gamo. am mxriv tipiuria
sulfitebis Semcveli sakvebi, rogoricaa magaliTad gargaris
Ciri da iaffasiani TeTri Rvino. saneleblebis miRebam SeiZ-
leba gamoiwios e.w. “degustatorTa rinorea”. alkoholi ara
iSviaTad iwvevs cxviris gaWedvas da Semdeg rinoreas. gansaku-
TrebiT im pirebSi, romelTac manamde riniti aReniSnebodaT.
mraval medikaments, rogorebicaa magaliTad anti hiperten-
ziuli saSualebebi, ara steroiduli antianTebiTi medikamen-
tebi da fsiqotropiuli agentebi, gaaCnia gverdiTi efeqtebi,
romlebic SeiZleba rinitis ganviTarebis mizezi gaxdes. garda
amisa, iseTi medikamentebis xSirma da xangrZlivma aplikaciam,
rogorebicaa mag. epinefrini an oqsimetazolini, SeiZleba ri-
niti gamoiwvios.

cxrili 19.
rinitTan asocirebuli medikamentebi

analgetikebi
arasteroiduli antianTebiTi preparatebi: aspirini da a.S.
antihipertenziuli saSualebebi
angiotenzinis gardamqneli enzimis inhibitirebi.
amiloride.
b-blokerebi
fsiqotropuli saSualebebi
respiridini
klorpromazini
amitriptilini
fosfodiesTerazas me-5 tipis inhibitorebi
sildenafili
tadalafili
verdenafili
sxva medikamentebi

86
 kokaini
gabapentini

ara alergiuli eozinofiluri riniti xasiaTdeba mTeli

wlis ganmavlobaSi persistuli mimdinareobis nazaluri simp-
tomatikiT, nazo-faringialuri qavilis SegrZnebiT, Txieri,
profuzuli rinoreiT da cxvirceminebis paroqsizmebiT. cxvi-
ris gamonadenSi naxuloben didi raodenobiT eozinofilebs.
sisxlis SratSi da nazalur sekretSi saerTo IgE-s done nor-
maSia. specifiuri IgE ar fiqsirdeba. umetes SemTxvevaSi (42%),
triger-faqtorebis identifikacia ver xerxdeba; 31%-Si gam-
wvavebas ukavSireben amindis cvlilebas; 15%-Si _ sxvadasxva
aromatul suns da 12%-Si sxva mZafr sunebs.

ara anTebiTi reaqciebiT mimdinare riniti.

am tipis rinitebs miekuTvneba medikamentozuri riniti,
romelic iseTi topikaluri dekongensant da vazokonstriq-
torebis xangrZlivi gamoyenebiTaa gamowveuli, rogorebicaa
mag. kateqolaminebi (fenilefrini) an imidazolebi (oqsimetazo-
lini). am mxriv, gansakuTrebiT sayuradReboa a-adrenorecep-
torebis agonistebi. amitom, aRniSnuli jgufis preparatebis
gamoyeneba unda moxdes Zalze frTxilad da SezRuduli drois
ganmavlobaSi. mkurnalobis kursSi k.s.-is spreis gamoyeneba af-
erxebs dekongensantebis gverdiTi efeqtebis ganviTarebas da
amcirebs maTi miRebis xangrZliobis saWiroebas.
zogjer, rinitis trigerisa da meqanizmis gaurkvevlobis
SemTxvevaSi, ismeba “idiopaTiuri rinitis” diagnozi. am Sem-
TxvevaSi xSiria lorwos sekreciis adgilobrivi disbalansi
da parasimpatikuri inervaciis dominireba, rac uxvi da Zlier
Txieri rinoreiT mimdinareobs. amgvari mdgomareobis Sesam-
subuqeblad naCvenebia ipratropium bromidi.
atrofiuli riniti gamowveulia cxviris lorwovanis
normaluri sekretoruli funqciis darRveviT da lorwovani
garsis gamoSrobiT. pirveladi atrofiuli riniti rogorc
wesi, Sedegia iseTi infeqciuri agentiT ganviTarebuli anTe-
biTi procesisa, rogoricaa Klebsiella ozaenae an sxva baqteria.
meoradi atrofiuli riniti, iatrogenuli warmoSobisaa da
gamowveulia cxvris Rruze an sinusebze Catarebuli operaci-
iT, romlis Sedegadac ziandeba cxviris Rrus lrwovani garsis
mniSvnelovani farTi da irRveva lorwos sekrecia.

87
 orive SemTxvevaSi irRveva ciliaruli funqcia. viTardeba
lorwovani garsis destruqcia da epiTeliumis dazianeba.
klinikurad gamoxatulia cxviris lorwovani garsis sim-
Srale, tkivilisa da Cxvletis SegrZneba, qerqebis gaCena da
ynosvis funqciis darRveva.
mkurnaloba xangrZlivi da rTulia. naCvenebia topikaluri
damarbileblebi, cxviris gamorecxva fiziologiuri xsnariT
da qerqebis gaCenis SemTxvevaSi - maTi mocileba; topikaluri
antibiotikebis malamoebis gamoyeneba.

sqema 4.
atrofiuli rinitis ganviTarebis meqanizmebi

pirveladi atriofiuli riniti meoradi atrofiuli riniti

x seriozuli operaciuli
x Klebsiella ozanae Careva.
x haernakadis turbulento- x sxivuri Terapia.
ba. x granulomatozuri da-
x klimaturi faqtorebi. avadeba.
x rasis Tavisebureba.

x ciliastazi (respirato-
ruli epiTelis stazi).
x Zvlebis demineraliza- cia.
x lorwovanis progresuli
atrofia.
x epiTelis destruqcia.

x superinfeqcia.
- Klebsiella ozanae.
- Moraxsella katarralis.
- Haemofilus influen-zae.
- Staphilococcus aure-us.

kvebiTi da emociuri faqtorebiT gamowveuli riniti ner-

vuli meqanizmebiTaa gapirobebuli; warmavalia da ar mimdin-
areobs mZimed. hormonaluri disbalansiT gamowveuli rini-
ti asocirebulia menstrualur ciklTan da orsulobasTan.
idiopaTiuri rinitis diagnozi, sxva, cnobili meqanizmebiT
gamowveuli rinitebis diagnozebis gamoricxviT ismeba maSin,

88
Tu cxviridan gamonadeni, cxvircemineba an cxviris gaWedva
grZeldeba dReSi minimum 1 saaTi da 2 kviris ganmavlobaSi
gamoxatulia sul mcire 5 dRe.

alergiuli rinitis diagnostika.

alergiuli rinitis diagnostikaSi wamyvani adgili uWiravs
daavadebis klinikur suraTs _ rinits, rinoreiT an gaWed-
viT; cxviris qavils, daavadebis qronikul mimdinareobas, pe-
rioduli (upiratesad sezonuri) gamwvavebebiT, personalur
da ojaxur alergiul anamnezs da mkurnalobis met-naklebad
gamoxatul efeqts antihistaminuri preparatebisa da kor-
tikosteroidebis nazaluri spreis mimarT. riniti upiratesad
bilateraluria. Tumca iseTma struqturulma problemebma,
rogoricaa mag. cxviris Zgidis gamrudeba, SeiZleba unilate-
raluri nazaluri blokireba gamoiwvios.

cxrili 20.
rinitis diagnozze saeWvo pacientis anamnezi
rinorea, gaWedva, ynosvis
ZiriTadi simptomebi
problemebi
mimdinareobis xangrZlivi mimdinareoba ( 4
xangrZlioba kviraze meti )

intermitentuli an
gamovlenis sixSire persistuli. gamwvavebebiT an
mis gareSe.

simptomTa gaZlierebis an
mag. sigaretis boli.
gamwvavebis trigerebi
koniuqtiviti, sinusiti,
Tanarsebuli simptomebi
faringiti, traqeiti
asTma, atopiuri dermatiti,
alergiuli anamnezi
urtikaria da sxva ...
garemoSi alergenebis mcenareuli, saxlis,
arseboba profesiuli da sxva.
axlo naTesavebSi alrgiuli
ojaxuri anamnezi
daavadebebis arseboba.

89
 medikamentis jgufi, miRebis
ra medikamentebs iRebs
xangrZlioba, efeqti.
cxovrebis xarisxis darRveva
gavlena cxovrebis xar- da misi gavlena samsaxursa
isxze an saswavlo dawesebulebaSi
pacientis aqtivobaze.

gamokvlevebi.
rinitis klinikuri gamovlinebis mqone pacientis gamokvle-
va xdeba pirvel rigSi otolarinologiuri sarkiT da cxviris
gamafarToebeliT. am tipis kvleva saSualebas iZleva daTva-
lierdes cxviris lorwovani garsi, Sefasdes SeSupebis xarisxi,
cxviris niJarebis da polipebis mdgomareoba. Zalian mniSvne-
lovania kanis alergiuli testebi an saerTo da specifiuro
IgE-s kvleva pacientis sisxlSi. zog SemTxvevaSi, saWiro xdeba
provokaciuli testis gamoyeneba. Zalze efeqturi sadiagno-
stiko saSualebaa nazalur sekretSi alergenis identifikacia
polimerza jaWvuri reaqciiT an specifiuri IgE-s aRmoCena ra-
dioalergosorbentuli meTodiT.

cxril 21-Si mocemulia rinitisa da sinusitebis diferen-

cialuri diagnozis gatarebisas gasaTvaliswinebeli mdgoma-
reobebi.
cxrili 21.

polipebi
meqanikuri faqtorebi
cxviris Zgidis gamrudeba.
ucxo sxeuli cxviris RruSi.
qoanebis atrezia.
adenoidebis hipertrofia.
granulomatozuri daavaebebi.
sarkoidozi.
Wegener-is granulomatzi.

90
 malignizaciuri granuloma.
ciliaruli funqciis paTologia.
pirveladi ciliaruli diskinezia (Kartagener-is sindromi,
Tu process Tan axlavs deqstrokardia)
neoplastiuri daavadebebi.
malignizaciuri procesi.
keTilTvisebiani simsivnuri warmonaqmni.
rinorea cerebrospinaluri siTxiT.
infeqciuri warmoSobis.
virusuli.
baqteriuli.
fungaluri.
parazituli.

Tumca klinikis pirobebSi yvelaze misaRebi meTodi kanis

“prik-testebia”, romelic siiafiT, atravmatulobiT, maRali
sensitiurobiT, maqsimaluri usafrTxoebiT da simartiviT xa-
siaTdeba. kargi sadiagnostiko saSualebaa nazalur sekretSi
eozinofilebis kvleva, romelTa raodenobac, alergiuli ri-
nitis SemTxvevaSi, > 5%-ze. sisxlis saerTo analizi ar iZle-
va mniSvnelovan informacias. Tumca eozinofiliis arseboba
zogadi alergiuli fonis maCvenebelia. Cveulebrivi R-gra-
fia, nazaluri paTologiis mqone pirebSi, ar iZleva sinuse-
bis mdgomareobis adeqvaturi Sefasebis saSualebas. am mxriv,
“oqros standarTad” iTvleba kompiuteruli tomografia.

rinitis mkurnaloba.
alergiuli rinitis menejmenti SeiZleba daiyos sam nawilad
an sam etapad: 1. alergenebTan Sexebisagan Tavis arideba, 2.
farmakoTerapia da 3. imunoTerapia.
alergiuli da ara alergiuli rinitis mkurnalobis princi-
pebi mocemulia me-6 da me-7 sqemebze.
alergiuli rinitis mkurnalobis pirveli etapi, romelic
alergenebis aridebas iTvaliswinebs, met-naklebad ganxorcie-
lebadia okupaciuri alergenebisa (samsaxuris an sxva saqmiano-

91
basTan dakavSirebuli alergenebis arseboba) da Sinauri cxove-
lebis alergenebiT gamowveuli rinitis SemTxvevaSi. rodesac
SesaZlebelia samsaxuris an sxva saqmianobis Secvla da Sinauri
cxovelebis mocileba. magram praqtikulad SeuZlebelia e.w.
tarakanebisa da tkipebis alergenebis Secveli, «oTaxis mtvris»
an sezonuri alergiis SemTxvevebaSi.

sqema 5.
alergiuli rinitis mkurnalobis meTodebi

saSualo/mZime

msubuqi
saSualo/mZime
msubuqi
intermitentuli intermitentuli persistuli persistuli

alergenebisagan Tavis arideba

intranazaluri dekongensantebi (< 10 dReze) an oraluri dekongen-
santebi.
oraluri an topikaluri antihistaminurebi.
leikotrienebis receptorTa blokatorebi
kromonebi
intranazaluri kortikosteroidi
specifiuri imunoTerapia

rodesac rinitis gamomwvevi alergenebisagan Tavis arideba

SeuZlebelia, saWiro xdeba farmakoTerapia, rac iTvaliswinebs
oraluri da topikaluri antihistaminuri preparatebis,
oraluri da topikaluri dekongensantebis, topikaluri kro-
molinis da topikaluri (Zalian iSviaTad oraluri) kortiko-
steroidebis gamoyenebas.
antihistaminuri preparatebi SeiZleba gamoviyenoT, ro-
gorc intermitentuli ise daavadebis persistuli formebis
dros; miuxedavad simptomTa gamoxatvis simZimisa. preparate-
bis topikalur formebi mimarTulni arian da uSualod moq-
medeben, dazianebuli organosa da aris modamoSi da gaaCni-
aT ufro maRali pozitiuri samkurnalo efeqti, vidre per-
oralurad an sxva saxiT miRebul medikamentebs. preparatebis
oralur formebs aqvT sistemuri moqmedeba da ufro efeqtur-
ni arian rinitTan erTad gamoxatuli, bronquli an okularu-
li simptomebis arsebobis pirobebSi.
I generaciis antihistaminuri preparatebi ablokireben
(Tumca ara srulad) H1 receptorebs da amasTan, gadian he-
92
matoencefalur bariers, ris gamoc garda antialergiulisa
sedaciuri efeqtiTac xasiaTdebian. garda amisa, garkveulad
aZlireben madas, rac sedaciur moqmedebasTan erTad, gverdiT
efeqtadaa miCneuli. II da III Taobos antihistaminuri preparate-
bi srulad ablokireben H1 receptorebs, ar gadian heato-
encefalur bariers da ar axasiaTebT gamoxatuli sedaciuri
efeqti.
antihistaminuri preparatebi, upiratesad efeqturni arian
cxviris qavilis, ceminebis da cxviridan didi raodenobiT, Za-
lian Txieri gamonadeniT mimdinare alergiuli rinitis SemTx-
vevaSi. cxiris gaWedvaze maTi efeqti, umetes SemTxvevaSi, sak-
mod mcirea. levocetirizini xasiaTdeba mniSvnelovani xarj-
efeqturobiT da cxovrebis xarisxis gaumjobesebiT, mTeli
wlis ganmavlobaSi, cxviris gaWedviT gamoxatuli, alergiuli
rinitis SemTxveavSi. dezloratadini da feqsofenadini aseve
efeqturni arian cxiris gaWedviT mimdinare alergiuli rini-
tis marTvisaTvis. amasTad, dezloratadins saerTod ar axa-
siaTebs sedaciuri efeqti.
oraluri dekongensantebi warmoadgenen kateqolaminebs.
xolo topikaluri dekongensantebi SeiZleba iyvnen, rogorc
kateqolaminebi ise imidazolebi. dekongensantebi arian va-
zokonstriqtorebi da iwveven nazaluri sisxlZarRvebis Se-
viwroebas, riTac aferxeben sisxlZarRvTa sanaTurida qsovi-
lebSi plazmisa da formiani elementebis gadasvlas; abloki-
reben anTebiT reaqcias da cxviris lorwovani garsis SeSupe-
bas. topikaluri dekongensantebi moqmedeben Zalian swrafad
da maTi efeqtis xangrZlioba Seadgens daaxloebiT 12 saaTs.
oraluri dekongensantebis moqmedeba iwyeba miRebidan daax-
loebiT 30 wuTSi da grZeldeba TiTqmis 24 saaTi. dekongensan-
tebi mniSvnelovnad amcireben cxviris gaWedvas magram nakle-
bad moqmedeben rinoreasa da cxvirceminebaze. intranazalu-
rad gamoyenebuli dekongensantebi, adgilobrivad iwveven
wvis, Cxvletis da simSralis SegrZnebas da iSviaTad _ sisxl-
denas. am tipis medikametebis xangrZlivi gamoyeneba SeiZleba
Tavad gaxdes “medikamentozuri rinitis” ganviTarebis mizezi.
es xdeba maSin, rodesac dekongensantebs uwyvetad iyeneben 2
_ 3 kviraze meti drois ganmavlobaSi. intranazaluri korti-
kosterodebis gamoyeneba amcirebs dekongensantebis gverdiTi
efeqtebis ganviTarebis risks da ufro efeqturs xdis mkur-
nalobas. per-oralurad miRebuli dekongensantebis gverdiTi

93
efeqtebi SeiZleba gamovlindes taqikardiiT, gaRizianebiTa da
agznebiT, tremoriT, SfoTviT, Zilis darRveviT da Tavis tki-
viliT. am jgufis preparatebis gamoyeneba rekomendirebuli
araa orsulebSi, xanSi SesulebSi, hipertoniuli daavadebis da
fsiqiatriuli problemebis mqone pirebSi; aseve mcire asakis
bavSvebSi. Tumca unda aRiniSnos isic, rom isini sakmaod efeq-
turni arian da warmatebiT gamoiyenebian e.w. “gaciebi” SemTx-
vevaSi.
leikotrienebis receptorTa antagonistebi, rogoricaa ma-
galiTad montelukasti, amcirebs rogorc cxviris qavilsa da
ceminebas, ise rinoreasa da gaWedvas, ris gamoc warmatebiT
gamoiyeneba alergiuli rinitis samkurnalod. Tumca misi efe-
qti aSkarad CamorCeba topikaluri k.s.-ebis an antihistaminuri
preparatebis klinikur efeqts. maTi gamoyeneba saSualebas iZ-
leva SevamciroT rogorc kortikosteroidebis ise antihist-
aminuri preparatebis dozebi.
ipratropium bromidi warmatebiT gamoiyeneba Zlier Txieri
rinoreis samkurnalod. preparati ablokirebs cxviris lor-
wovani garsis parasimpatikur inervacias da amcirebs Sesabami-
si jirkvlebidan lorwos sekrecias.
intranazaluri kortikosteroidi aris alergiuli rinitis
mkurnalobis yvelaze efeqturi saSualeba. misi efeqti aRe-
mateba, rogorc antihistaminuri preparatebisa da leikorti-
enebis receptorTa antagonistebis efeqts cal-calke, ise am
preparetbis kombinaciis efeqts. intranazaluri kortikoste-
roidi SeiZleba gamoyenebuli iyos alergiuli rinitis, ro-
gorc intermitentuli, ise persistuli formebis mkurnalo-
bisaTvis. rodesac daavadeba sezonuri da intermitentulia,
mkurnaloba unda daviwyoT sezonuri alergenebis gamoCenam-
de da gavagrZeloT garemoSi am alergenebis arsebobis mTeli
sezonis ganmavlobaSi. aRniSnuli midgoma saSualebas iZleva
maqsimalurad vakontroloT daavadebis simptomebi. intran-
azalurad gamosayenebeli k.s. iwarmoeba aerozolis, suspen-
ziisa da mSrali fxvnilis saxiT. am jgufis preparatebis adgi-
lobrivi gverdiTi efeqtebidan aRsaniSnavia cxviris lorwo-
vanis simSrale da qerqebis ganviTareba, lorwovanis atrofiis
gareSe. iSviaTad SeiZleba ganviTardes cxviridan sisxldena.
kortikosteroidebis topikaluri gamoyeneba alergiuli ri-
nitiT daavadebul pacientebSi, ar iwvevs hipoTalamopitui-
tarul-adrenaluri RerZis paTologias. am mxriv gamonaklisia

94
beklometazoni, romlis xangrZlivi gamoyenebac SeiZleba si-
stemuri garTulebis mizezi gaxdes. intranazaluri k.s. aseve
gamoiyeneba araalergiuli eozinofiluri rinitebis (aaer) da
nazaluri polipozebis mkurnalobisaTvis. sxva rinitebis sam-
kurnalod, topikaluri k.s.-ebis gamoyenebis efeqti saeWvoa.
gansxvavebiT topikaluri k.s.-ebisagan, am jgufis preparate-
bis peroraluri gamoyeneba, xanmokle droiT, naCvenebia aler-
giuli rinitis mZime da nazaluri polipozis iseTi formebis
dros, romlebic Cveulebriv, maT Soris topikaluri steroi-
diT, mkurnalobas ar emorCilebian.
bolo wlebSi SemuSavda IgE-damokidebl daavadebaTa marT-
vis principulad gansxvavebuli meTodi _ IgE–s sawanaaRmde-
go, monoklonaluri antisxeuklebis gamoyeneba. omalizumabi
aris adamianis rekombinantuli anti-IgE antisxeulebi. prepa-
rati adamianis organizmSi SehyavT intramuskularulad; ris
Semdegac xdeba IgE-antisxeulebis SeboWva, myari kompleqse-
bis formireba da organizmSi IgE-antisxeulebis mniSvnelovani
kleba. klinikuri efeqti gamoxatulia, rogorc sezonuri, ise
mTeli wlis ganmavlobaSi mimdinare alergiuli rinitis Sem-
TxvevaSi.
specifiuri imunoTerapia warmoadgens alergiuli rinitis
mkurnalobis efeqtur meTods. imunoTerapiis Catarebis ga-
dawyvetilebas iReben maSin, rodesac mkurnalobis sxva meTo-
debi, rogoricaa alergenisagan Tavis arideba an farmakoTe-
rapia, uefeqtoa. mkurnalobis es meTodi ufro efeqturia im
SemTxvevaSi, Tu saqme gvaqvs erTi alergeniT (an upiratesad
erTi alergeniT) sensibilizaciasTan
yovelive aRniSnulidan, SeiZleba davaskvnaT, rom alergiuli
rinitis mkurnaloba moicavs kompleqsur RonisZiebebs, dawye-
buli alergenisagan Tavis aridebiT da damTavrebuli farmako-
TerapiiTa da specifiuri imunoTerapiiT. topikaluri kortio-
steroidebi warmoadgenen alergiuli rinitis marTvis yvelaze
efeqtur saSualebas. Tumca mkurnalobisas gamoyenebuli unda
iyos yvela is meTodi, romelic daavadebis simptomTa Semsubu-
qebas uwyobs xels. mxedvelobaSia misaRebi, rom daavadebis gam-
wvaveba SeiZleba TandarTulma infeqciamac gamoiwvios da am Sem-
TxvevaSi saWiro xdeba mkurnalobis kursSi Sesabamisi koreqciis
Setana. qirurgiuli Careva saWiro xdeba im SemTxvevaSi, rodesac
mkurnalobis arc erTi konservatiuli meTodi efeqturi araa.
araalergiuli rinitebis formebi da maTi mkurnalobis me-

95
Todebi mocemulia me-6 sqemaze.
gamoyofilia ara alergiuli rinitis sami ZiriTadi forma:
anTebiTi, medikamentozuri da ara anTebiTi. mocemulia rini-
tis TviToeuli formis mkurnalobis mokle sqema.

orsulTa riniti.
“orsulTa riniti” SeiZleba iyos rogorc alergiuli, ise
vazomotoruli da medikamentozuri warmoSobis da gamovlin-
des, rogorc orsulobis mimdinareobis periodSi, ise mSo-
biarobis Semdegac. Tumca, WeSmariti orsulTa riniti aris
rinitis iseTi gamovlineba, rodesac daavadeba iwyeba orsu-
lobis meore an mesame trimestrSi, grZeldeba 6 kviris an meti
xnis ganmavlobaSi da aucileblad wydeba mSobiarobidan ara
ugvianes 2 kvirisa. “orsulTa rinitis” gamomwnevi mizezebi bo-
lomde dadgenili araa..
orsulTa rinitis diagnostika rTulia, radgan am mdgoma-
reobis klinikuri mimdinareoba praqtikulad ar gansxvadeba
Cveulebrivi alergiuli an sxva etiologiis rinitisagan da
diagnozis saboloo dadastureba SeiZleba mxolod maSin, Tu
riniti, orsulobis periodSi ganviTarda iseT pirSi, romel-
sac manamde es paTologoa ar aReniSneboda da mSobiarobis Sem-
deg rinitis simptomebi Sewyda.

sqema 6.
ara alergiuli riniti

anTebTi medikamentozuri ara anTebiTi

NARES okupaciuri

topikaluri k.s. alegenebisagan

dekongensantebi. Tavis arideba
antihistaminurebi.

96
 atrofiuli vazomotoruli hormonaluri medikamentozuri

- qirurgiuli - ipratropium - kromonebi - moxseniT

sanacia. bromidi. medikamenti.
- lavaJi. - topikaluri – SeamcireT
- topikaluri steroidi (Tu dekongensan-
antibiotiki gaWedvaa) ti steroid-
is fonze.

« orsulTa rinitis » etiologiis da paTogenezis amsaxveli

monacemebi mocemulia me-7 sqemaze.

sqema 7.

SesaZlo etiologia risk-faqtore-

bi.

estrogni mweveloba
orsulTa
proJesteroni riniti
oTaxis mtvris
placentis zrdis hor- mimarT arsebu-
moni. li specifiuri
IgE.

“orsulTa rinitis” mkurnalobisas aucilenlad unda iyos

gaTvaliswinebuli medikamentebisagan nayofis dazianebis Sesa-
Zlebloba. saukeTeso mTodi, romelic am tipis rintis sam-
kurnalod SeiZleba iyos gamoyenebuli, alergenebisagan Tavis
aridebaa, rac ra Tqma unda Zalze rTulia da xSir SemTxvevaSi
SeuZlebelic. orsuli aucileblad unda imyofebodes sigare-
tis bolisagan Tavisufal garemoSi. Tu aucilebelia medika-
mentebis gamoyeneba, unda moveridiT dekongensantebs. antihis-
taminuri preparatebidan misaRebia debloratadini da ceti-
rizini. usafrTxod iTvleba kromolinebis gamoyeneba. topi-
kaluri kortikosteroidis gamoyeneba orsulTa rinitis dros
araa efeqturi.

97
 ▶ atopiuri dermatiti
atopiuri dermatiti (a.d.) aris kanis qronikuli anTebiTa da
qaviliT mimdinare daavadeba, romlisTvisac klinikurad damaxa-
siaTebelia qronikuli an qronikulad recidiuli mimdinareoba;
bavSvebSi gvxvdeba ufro xSirad, vidre mozrdilebSi; xSirad aso-
cirdeba sisxlis Sratis IgE-s maRal donesTan da personalur
da ojaxur atopiur anamnezTan; atopiur rinitTan da bronqul
asTmasTan.
atopiuri egzema ( a.e. ) aris atopiuri dermatitis sinonimi.

atopiuri dermatitis etiologia da paTogenezi.

atopiuri dermatitis etiologiuri faqtorebi SeiZleba
warmodgenili iyos, rogorc alimentaruli an medikamento-
zuri, ise aero alergenebiT.
daavadebis paTogenezi sakmaod rTulia da bolomde
garkveuli araa. mniSvnelovani roli miewereba IgE-s, romelic
am paTologiiT daavadebulTa sisxlis SratSi, SemTxvevaTa
80%-Si, maRalia. specifiuri alergenis aRmoCenisas ki sisx-
lis SratSi yovelTvis naxuloben am alergenis sawinaaRmdego
specifiur IgE-antisxeulebs.

atopiuri dermatitis klinikuri simptomebi.

kanis hiperreaqtiuloba, intensiuri qavili da kanis da-
zianeba aris atopiuri dermatitis upirvelesi klinikuri niS-
nebi.
kanis mwvave dazianebisaTvis damaxasiaTebelia intensiuri
qavili, eriTematozul kanze gamoxatuli papulozuri da vezi-
kulo-papulozuri gamonayari. am dros xSiria eqskoriaciebis,
wylulebsa da serozuli eqsudatis arseboba.
qvemwvave dazianebisaTvis damaxasiaTebelia eriTema, eqs-
koriaciebi da aqercvla.
qronikuli dazianebisaTvis damaxasiaTebelia kanis Sesqele-
ba, gauxeSeba, liqenifikacia, fibrozuli papulebi, wvrili
kvanZovani gamonayari (Prurigo nodulis ), qaviliT.
qronikuli atopiuri dermatitis dros, sxvadasxva calkeul
SemTxvevaSi, kanis dazianebis modeli SeiZleba iyos gansxvave-
buli da gamoxatuli iyos sxvadasxva morfologiuri element-
ebis erToblioba, rac sxvadasxva periodSi ganviTarebuli gam-
wvavebebis Sedegia.

98
 atopiuri dermatiti SeiZleba gamovlindes sxvadasxva asak-
Si. 80% SemTxvevaSi es paTologia vlindeba 1 wlamde, 90%-Si ki
5 wlamde asakSi. daavadebis klinkuri gamovlineba uxSiresad
xdeba 2 dan 6 Tvemde asakSi.
axalSobilobis periodSi kanis dazianeba uxSiresad vrcel-
deba sxeulis farTe areebze _ saxis, kisris, gulmkerdis, mu-
clis da kidurebis areSi.
3 _ 4 wlis asakidan, mozardebsa da mozrdilebSi, upirates-
ad ziandeba kidurebis momxreli zedapirebi, antikubitaluri
da papilaruli fosoebi.
xSirad, atopiuri dermatitis intensivoba iklebs sqesobri-
vi momwifebis periodSi da zogjer, TiTqos, sruli klinikuri
gamojanmrTelebac ki xdeba. magram rCeba kanis hiperreaqti-
uloba garemo gamRizianebelTa mimarT..
atopiuri dermatitis diagnozi emyareba daavadebis klini-
kur suraTs _ klinikur kriteriumebs. praqtikulad ar arse-
bobs laboratoriuli testi, romelic damoukideblad daad-
gens atopiuri dermatitis arsebobas. pacientTa daaxloebiT
80%-s, sisxlis SratSi, aReniSneba saerTo IgE-s maRali done da
periferiuli sisxlis eozinofilia. Tu movaxerxebT specifi-
uri alergenis identifikacias, vnaxavT, rom sisxlis SratSi,
mis mimarT, yovelTvis arsebobs specifiuri IgE antisxeulebi.
arsebobs atopiuri dermatitis sadiagnostiko «didi» da
«mcire» niSnebi:
atopiuri dermatitis sadiagnostiko «didi niSnebia»:
• qavana dermatitis arseboba.
• kanis dazianebis lokalizacia da tipiuri morfologi-
uri suraTi (sxeulis farTe areebis CarTva axalSobi-
lebSi da kidurebis momxrelTa liqenifikacia da zolo-
vani dazianeba mozardebSi da mozrdilebSi).
• qronikuli an qronikulad morecidive dermatiti.
• personaluri an/da ojaxuri atopiuri anamnezi.
atopiuri dermatitis sadiagnostiko “mcire niSnebia”:
• adreul asakSi gamovlena
• kanis hiperreaqtiuloba.
• Keratitis pilaris.(kanis dvrilebis keratiti)
• mSrali kani.
• ixtiozi.
• piperkeratozi.

99
 • Seiliti.
• ZuZus dvrilebis dermatiti.
• kanis dadasturebuli xSiri infeqciebi (gansakuTrebiT
st.aur. da h.s.) an safuZvliani eWvi maT arsebobaze.
• recidiuli dermatofitia.
• meWeWovani moluski.
• saxis eriTrodermia an sifermkrTale.
• dermatografizmi.
• recidiuli koniuqtiviti.
• orbitaluri “Savi Crdilebi” (moSavo-molurjo Seferi-
loba Tvalbudis irgvliv).
• sisxlis SratSi maRali IgE.
• eozinofilia periferiul sisxlSi
Tu aRniSnulTagan, saxrzea 3 “didi” da 3 “mcire” niSani _
SeiZleba atopiuri dermatitis diagnozis dasma.

atopiuri dermatitis diagnozi.

atopiuri dermatitis diagnozis dasma xdeba anamnezuri,
klinikuri da laboratoriulo monacemebis gaTvaliswinebiT.
samedicino anamnezi gulisxmobs Semdeg momacemebs: aRiniS-
neba Tu ara pacientis ojaxis wevrebsa da axlo naTesavebSi
atopiuri dermatiti an sxva «atopiuri daavadebebi», autoi-
munuri paTologiebi an kanis sxva daavadebebi. romel asakSi
gamovlinda daavadeba; mimdinanareobs Tu ara daavadeba qron-
ikulad an recidiulad; gamovlenilia Tu ara triger-faq-
torebi; gamwvavebebi damokidebulia Tu ara kvebis xasiaTze
an aeroalergenebze; vlindeba Tu ara sxva garemo faqtorTa
roli daavadebis gamwvavebaze.
fizikaluri gamokvlevebi gulisxmobs Semdeg monacemTa Se-
fasebas: rogoria gamonayaris lokalizacia da gavrcelebis
are; rogoria morfologiuri elementebi; ramdenadaa gamoxat-
uli qavili da ramdenad mSralia kani. gamoxatulia Tu ara er-
iTrodermia, eqskoriaciebi, papulebi, qerqebi, liqenifikacia,
kanis atrofia, kanis infeqciis niSnebi da sxva mravali «mcire
niSani».
laboratoriuli testebidan mniSvnelovani sadiagnos-
tiko Rirebuleba gaaCnia kanis alergiul testebs, perifer-
iul sisxlSi eozinofilebis raodenobas da sisxlis SratSi
saerTo da specifiuri IgE-s dones. Tumca, specifiuri IgE-s
arseboba, romelime alergenis mimarT, ar aris imis absolu-

100
turi maCveneneli, rom atopiuri dermatiti am alergeniTaa
gamowveuli.
im SemTxvevaSi, Tu atopiuri dermatitis klinikur suraTs
(egzemasa da qavils) Tan ar axlavs daavadebis adreul asakSi gam-
ovlineba, ojaxuri da personaluri alergiuli anamnezi, sisx-
lis SratSi specifiuri IgE-s aseboba da saxezea “mcire niSnebis”
nakleboba –zogierTi avtori SesaZleblad miiCnevs “atopifor-
muli dermatitis” terminis gamoyenebas.

atopiuri dermatitis diferencialuri diagnozi.

cxrili 22.
kanis egzematozuri dazianebiT mimdinare zogierTi daavadebis di-
ferencialuri diagnozi.

daavadebis etio-paTogenezi da klinikuri gamovlinebis

dasaxeleba Taviseburebebi

gamovlenis klinikuri
etio-
upiratesi gamovlinebis ZiriTadi
paTogernezi
asaki niSnebi.
1. dermatiti
2. qavili.
3. gamovlena adreul
asakSi.
4. sxeulis farTe areeb-
atopiuri IgE-damokidebu-
5 wlamde. is dazianeba adreul
dermatiti li reaqcia
asakSi.
5. kidurebis mimxreli
da gamSleli zedapiris
dazianeba mozrdi-
lebSi.
SeiZleba iyos,
rogorc aler-
giuli ise 1. dermatiti _ savarau-
kontaqturi araalergiuli upiratesad do trigerTan Sexebis
dermatiti bunebis. ufros asakSi. adgilze.
alergiuli 2. zomieri qavili.
reaqcia mimdina-
reobs IV tipiT.

101
 etio-paToge-
nezi ucnobia. 1. dermatiti _ wiTeli,
CvilebSi.
savaraudoa aqerclili balTebi
pubertalur
seboreuli saofle jirkv- Tavze, saxeze da kanis
periodSi da
dermatiti lebis paTolo- naoWebSi. Tavze qertli.
mogvianebiT
gia da funga- 2. qavili zomieria an
asakSi.
luri infeqciis ar aRiniSneba.
darTva.

1. kanis ormxrivi, dazi-

aneba.
2. gamonayari _ aqercv-
lidan uxeS qerqebamde.
etio-paTogenezi upiratesad mo- 3.uxSiresad ziandeba
fsoriazi
ucnobia. zrdil asakSi. kidurebis gamSleli
are.
4. izomorfuli reaqcia:
intaqturi kanis fizi-
kuri gaRizianeba

yvela asakSi. 1. kanze ganviTarebuli

baqteriuli
St. aureus gansakuTrebiT vezikulur-papulo-
infeq ciuri
infeqcia saxifaToa 1 zuri da Cirqovani gam-
paTologia.
wlamde asakSi. onayari.

1. kanze an lorwovanze,
yvela asakSi. hiperemiul fonze gan-
virusuli
gansakuTrebiT viTarebuli jgufuri
H.S. infe- infeqciuri
saxifaToa 1 vezikulebi. 2.
qcia paTologia
wlamde asakSi. wva, qavili, sxvadasxva
intensivobis tkivili.

1. dermatiti, romelic
ar vrceldeba saxeze.
2. qavili, romelic in-
parazituli
muni yvela asakSi tensiuria RamiT.
paToligia.
3. kanze tkipas Semavali
da gmomavali xvrele-
bis arseboba.

102
 pirveladi
imunodeficiti.
1. dermatiti.
embriopaTia _
2. neonataluri teta-
Timusis suli
nia.
an nawlobrivi
di-jorjis axalSobilo- 3. saxis deformacia.
aplazia. paraTi-
sindromi bis periodi. 4. g.s. sistemis struq-
reoiduli jir-
turuli paTologiebi.
kvlebis aplazia.
5. mZime, sistemuri da
magistraluri
adgilobrivi infeqcia.
sisxlZarRveb-
is paTologia.

pirveladi
imuno-
deficituri 1. gavrcelebuli der-
mdgo mareoba. matiti.
viskot-
genetikuri axalSobilo- 2. Trombocitopenia.
oldriCis
paTologia. bis periodi. 3. adgilobrivi da
sindromi
antisxeulebis sis- temuri mZime
da T infeqciebi.
-limfocitebis
deficiti.

pirveladi 1. kanis recidiuli sta-

imunodeficiti. filokokuri infeqcia.
iobis sin- adreuli
gamoxatulia 2. mZimed mimdinare a.d.
dromi asakidan
IgE-s hiper dainficirebiT.
produqcia. 3. intensiuri qavili.

pirveladi imu-
mZime kom- nodeficituri 1. mZime sistemuri
dabadebidan
binirebuli mdgomareoba. infeqciebi.
ramdenime
imunodefi- imunitetis 2. simsivneebi.
dReSi.
citebi yvela rgolis 3. dermatiti.
defeqti.

103
 genetikuri
paTologia.
fenilalanin-
1. kanisa da Tmis Ria fe
transfer-
rebi.
azas deficiti dabadebidan
fenilketo- 2. tetania.
da fenilana- ramdenime Tve-
nuria 3. gonebrivi ganviTare-
ninis cvlis Si.
baSi CamorCena.
moSla. qsovi-
4. dermatiti.
lebSi grovdeba
piroyurZ- nis
mJava.

genetikurad
ganpirobebuli gamoxatulia ganvi-
metaboluri TarebaSi CamorCena,
vlindeba
paTologia. diarea, Rebineba, kanis
Tirozone- dab- adebidan
darRveulia siyviTle, sisxldenebi,
mia pir- velive
Tirozinis cvla. RviZlis, Tirkmlis, n.s-
Tveeb- Si.
aseve met-nakle- is paTologiebi. sxva-
bad _ sxva cile- dasxva xarisxis egzema.
bis sinTezi.

genetikurad
ganpirobebuli
metaboluri
paTologia.
vlindeba
darRveulia his- ganviTarebaSi Camor-
histidine- dabadebidan
tidinis cvla. Cena, poliorganuli
mia pirvelive
sisxlSi, SardSi paTologiebi. egzema.
TveebSi.
da T.z.t.-siTxeSi
momatebulia
histidinid
done.

upiratesad 50 1. gamoxatulia kanis

wels gadaci- depigmentirebuli
T-limfocitebis
kanis T- lebul pireb- ubnebi periferiuli
avTvisebiani sim-
ujredovani Si. Tomca Se- zrdiT.
sivne, kanze pir-
limfoma. iZleba Segvx- 2. am fonze Cndeba papu-
veladi keriT.
vdes yvela lebi da infiltrire-
asakSi. buli balTebi.

104
 atopiuri dermatitis mkurnaloba.

topikaluri kortikosteroidebi.
topikaluri k.s., romelic 1950 wels Seiqmna, ukve mravali
welia gamoiyeneba atopiuri dermatitis samkurnalod. prepa-
ratebi iwarmoeba malamos, kremisa da Jeles saxiT da gamoi-
yeneba, rogorc antianTebiTi da damarbilebeli saSualeba.
miuxedavad amisa, maTi gadaWarbebuli moxmareba mravali gver-
diTi efeqtiT xasiaTdeba.
maRali aqtivobis k.s.-ebis gamoyeneba, maTi advilad Sewovis
gamo, sasurveli araa saxis, genitaliisa da naoWebis areebSi.
amJamad fiqroben, rom preparatebi, romelTa aplikacia,
mwarmoeblis instruqciis mixedviT, dReSi 2-jeraa rekomen-
direbuli, analogiuri efeqtiT xasiaTdeba 1-jer aplikaciis
SemTxvevaSic.
Zalian mniSvnelovania t.k.s.-ebis aplikaciis teqnika (kanze
wasma Tu Sezelva), ris Sesaxebac eqimma dawvrilebiTi informa-
cia unda miawodos pacients.
amJamad fiqroben, rom k.s.-ebis xangrZlivi, magram inter-
mitentuli (wyvetili) gamoyeneba, iseTive pozitiuri efeqtiT
xasiaTdeba, rogoriTac xangrZlivi da uwyveti Terapia. Tum-
ca pirvel SemTxvevaSi, kanis mxriv garTulebebis ganviTarebis
Sansi naklebia.
aqtivobis mixedviT arCeven topikaluri kortikostero-
idebis 7 klass. rac ufro dabalia preparatis aqtivoba, miT
naklebia misi pozitiuri klinikuri efeqti, magram aseve nakle-
bia gverdiTi efeqtis gamovlenis albaToba.
maRali aqtivobis k.s. gamoiyeneba daavadebis mwvave period-
Si, xanmokle (maqsimum 3 kviris) drois ganmavlobaSi.
saSualo aqtivobis preparatebi, magaliTad 0,1% triamci-
lonis malamo, daavadebis qronikulad mimdinareobis dros,
SeiZleba gamoviyenoT xangrZlivad. maT Soris saxisa da geni-
talur areSic.
kortikosteroidebis Jele mzaddeba propilen-glikolis
bazaze da aRizianebs kans. igi SezRudulad gamoiyeneba saxisa
da Tavis areSi.

rekomendaciebi.
• topikaluri k.s. aplikacia aris atopiuri dermatitis
mkurnalobis standartuli meTodi da ufro efeqturia

105
 sxva meTodebTan SedarebiT.
• iseTi kanismieri garTulebebi, rogoricaa striebi,
atrofia an teleangieqtazia, zRudavs topikaluri k.s.-
ebis xangrZlivi gamoyenebis SesaZleblobas.
• kanis dazianebul areSi lokaluri garemos Secvla hidra-
ciis an okluziis saSualebiT, aumjobesebs k.s. adsorb-
ciis process da ufro efeqturs xdis mis gamoyenebas.
• topikaluri k.s.-ebis xangrZlivi da intermitentuli
(wyvetili) meTodiT gamoyeneba atopiuri dermatitiT
daavadebul pirebSi, aris mkurnalobis efeqturi saSua-
leba.

sxva topikaluri saSualebebi.

damarbileblebi da damanotieblebi (kanis hidrofilobis
aRdgena).
mSrali kani mniSvnelovnad uwyobs xels atopiuri dermati-
tis ganviTarebas. radgan am dros advilad irRveva epidermi-
sis mTlianoba da iSleba kanis barieruli funqcia, rac xels
uwyobs qvemo SreebSi sxvadasxva saxis alergenebisa da gamRi-
zianeblebis SeRwevas. kanis simSrale upiratesad wlis civ
TveebSi da garkveuli samuSaos Sesrulebisas (gamRizianebleb-
Tad da alergenenTan kontaqti) amwvavebs mdgomareobas.
damarbileblebi arian sxvadasxva saxis _ losionebi, kre-
mebi da malamoebi. losionebsa da kremebs SeiZleba hqondeT
kanis gamaRizianebeli efeqtic masSi Semavali korsenvantebis,
aromatizatorebisa da alkoholis gamo. amitom upiratesoba
unda mivaniWoT malamoebs. Tumca hidrofiluri malamoebis
gadaWarbebulma da xangrZlivma gamoyenebam SeiZleba kanis vis-
kozuri cvlilebebi gamoiwvios.

adgilobrivi imunodepresantebi.
medikamentTa am klass miekuTvneba pimekrolimusi da
takrolimusi. arsebobs mravali sarwmuno naSromi, romlebic
a.d. daavadebul pacientebSi am preparatebis dadebiT efeqts
adastureben. Tumca arsebobs garkveuli pasuxgaucemeli ki-
Txvebic, romlebic am preparatebis imunosupresiuli efeqtis
gamo, kanis simsivneebis ganviTarebis SesaZleblobas exeba. da-
sazustebelia uwyveti, xangrZlivi (> 1 welze) mkurnalobis
uaryofiTi efeqtis SesaZleblobis aspeqtebic.

106
 rekomendaciebi.
• damarbileblebis gamoyeneba aris a.d. mkurnalobis (mov-
lis) standartuli meTodi. kanis damarbileblebi gamo-
iyeneba, rogorc topikaluri kortikosteroidebis damx-
mare, atopiuri dermatitis rogorc prevenciis, ise sam-
kurnalo saSualeba.
• pimekrolimusi da takrolimusi amcireben kanze ganvi-
Tarebuli anTebis intensivobas, gavrcelebis areals da
a.d.-is klinikur simptomebs. es preparatebi gamoiyeneba,
rogorc 2 welze ufrosi asakis bavSvebSi, ise mozrdi-
lebSi.

antibiotikebi da antiseptikebi
atopiuri dermatitis mqone pacientTa did umravlesobaSi
aRiniSneba, rogorc dazianebuli, ise intaqturi kanis Warbi
kolonizacia st.aureus-iT. rac xSirad xdeba kanis baqteriuli
infeqciis ganviTarebis mizezi. am kontingentSi xSiria kanze
ganviTarebuli h.s.-infeqciebic. aRniSnulis gamo, zogjer
dgeba sakiTxi, atopuri dematitiT daavadebul pirebSi, anti-
biotikebis gamoyenebis Sesaxeb.

rekomendaciebi.
• a.d. daavadebul pacientebSi xSiria, rogorc dazianebu-
li ise intaqturi kanis kolonizacia st.aureus.-iT.
• im SemTxvevaSi, Tu kanis kolonizacias Tan ar axlavs in-
feqciis klinikuri gamovlineba, peroralurad miRebuli
antibiotikebis roli, dermatitis klinikuri suraTis
gaumjobesebis procesSi, minimaluria. Tu kanis infeq-
ciis niSnebi gamoxatulia _ peroralurad miRebuli an-
tibiotikis efeqtic SesamCnevia.
• topikaluri antibiotikebis efeqti, dermatitis klini-
kur mimdinareobaze, sagrZnobia im SemTxvevaSi, Tu kanis
infeqcia klinikurad gamoxatulia.
• topikaluri antibiotikis gamoyeneba Seicavs rezisten-
tuli baqteriuli floris formirebis saSiSroebas.

oraluri antihistaminuri preparatebi.

sarwmuno monacemebi, romlebic adastureben ad.-iT daa-
vadebul pacientebSi sedaciuri an ara sedaciuri moqmedebis
antihistaminuri preparatebis dadebiT efeqts, mcirea. sedaci-

107
uri moqmedebis a.h. preparatebis efeqti dakavSirebulia mis
saZile da soporozul moqmedebasTan, rac amave dros gverdiT
efeqtsac moicavs.
ara sedaciur a.h. preparatebs ar gaaCniaT qavilis sawinaaR-
mdego moqmedeba, magram amave dros aseve ar gaaCniaT Sesa-
bamisi gverdTi efeqtebic, romlebic sedaciasTanaa dakavSire-
buli. am tipis preparateebi ZiriTadad gamoiyeneba maSin, roca
a.d.-s Tan axlavs urtikaria, dermatografizmi da alergiuli
rinokoniuqtiviti.

rekomendaciebi.
• mcirea sarwmuno monacemebi imis Sesaxeb, rom a.d.-iT daa-
vadebul pacientebSi, sedaciur an arasedaciur a.h. pre-
paratebs raime klinikuri efeqti gaaCniaT.
• a.d. dros ganviTarebuli qavilis da amis gamo Zilis
darRvevis SemTvevaSi, sedaciur a.h. preparatebs SeiZle-
ba hqondeT garkveuli klinikuri efeqti.
• ara sedaciur a.h. preparatebs SeiZleba hqondeT garkveu-
li klinikuri efeqti.

dieta.
a.d. daavadebul pacientebSi, dietis rolis dasadgenad
mravali kvlevaa Catarebuli. magram SemzRudavi dietis roli
am daavadebis menejmentSi sabolood dadgenili araa. ra Tqma
unda sruliad cxadia da sarwmuno kvlevebis monacemebic
amasve adastureben, rom Tu a.d.-iT daavadebul pacientebSi
dadgenilia sakvebiT sensibilizacia da am konkretuli kve-
biTi alergenis roli daavadebis ganviTarebaSi, maSin masensi-
bilizirebeli sakvebis eliminacia kvebis racionidan, iwvevs
dermatitis klinikuri mimdinareobis gaumjobesebas. magram
aucileblad xazgasmiT unda aRiniSnos, rom Zalian Znelia der-
matitis gamomwvevi sakvebi alergenis dadgena, radgan in vitro an
in vivo meTodebiT alergenis identificireba, gviCvenebs zoga-
dad, am alergenze sensibilizaciis arsebobas, rac yovelTvis
ar niSnavs imas, rom a.d. swored am lergeniTaa gamowvuli.
2 wlamde asakSi, a.d. ganviTarebaSi, mniSvnelovan rols akis-
reben Zroxis rZisa da kvercxis cilas. aRniSnuli alergenebiT
sensibilizaciis dadasturebis SemTxvevbaSi, maTi sakvebidan
eliminacia, uxSiresad iwvevs dadebiT klinikur efeqts. aRsan-
iSnavia is faqtic, rom adreul asakSi Zroxis rZisa da kver-

108
cxis ciliT sensibilizaciis SemTxvevaSi, alergiis gamovlenis
albaToba 2 wlis asakis Semdeg iklebs da zrdasrul asakSi,
am kontingentis mxolod 20%-Si aRiniSneba reaqcia aRniSnu-
li sakvebi produqtebis mimarT. maSin, roca Tevzsa da zRvis
produqtebze adreul asakSi sensibilizacia, uxSiresad, mTeli
sicocxlis manZilzea gamoxatuli.

probiotikebi.
eqspertTa mosazrebebiT, 2 wlamde asakis bavSvebSi, pro-
biotikebma SeiZlea dadebiTi gavlena moaxdinon a.d.-is mimdi-
nareobaze. am mosazrebas gaaCnia Teoriuli safuZvlebi, rac
imaSi mdgomareobas, rom garkveul asakSi, probiotikebs unda
SeeZloT Th1-imunuri pasuxis inicieba da Sesabamisad IgE-s
produqciis Sesusteba

▶ urtikaria da angioSeSupeba
urtikaria aris kansa da lorwovan garsebze WinWris nasusx-
is da/an buStukebis msgavsi warmonaqmnebiT, mkveTrad gamoxat-
uli reaqciis gamovlineba.
urtikaria gvxvdeba yvela asakobriv jgufSi. igi sicocxlis
manZilze erTxel mainc aReniSneba mosaxleobis mTeli popula-
ciis 20%-ze mets. magram gansakuTrebiT xSirad vlindeba e.w.
“atopiur pacientebSi”.
Cvili asakis bavSvebSi urtikariis uxSiresi mizezi kvebiTi
alergenebia (62%). 22%-Si urtikarias iwvevs medikamenti. fizi-
kuri urtikaria gvxvdeba 8%-Si da kontaqturi – 8%-Si.
klinikuri mimdinareobis mixedviT urtikaria iyofa mwvaved
da qronikulad. umetes SemTxvevaSi, saqme gvaqvs mwvave urti-
kariasTan, romlis epizodebic SeiZleba gagrZeldes ramdenime
saaTidan, 6 kviramde. urtikarias, romelic 6 kviraze met xans
grZeldeba qronikuli urtikaria ewodeba.
angioSeSupeba xSirad Tan axlavs mwvave urtikarias da Se-
darebiT xSiria bavSvebsa da axalgazrda asakis mozrdil
pirebSi.
qronikuli urtikaria ufro xSiria saSualo asakis qalebSi.
miuxedavad imisa, rom urtikaria, umetes SemTxvevaSi, ar

109
warmoadgens sicocxlisaTvis saSiS mdgomareobas, misi gamov-
lineba mainc arasodes ar unda darCes eqimis yuradRebis miRma.
mwvave urtikariis SemTxvevaSi, met-naklebad, SesaZlebe-
lia misi gamomwvevi mizezebis dadgena, qronikuli urtikariis
gamomwvevi mizezebis dadgena SesaZlebelia SemTxvevaTa mx-
olod 5% _ 20%-Si.
qronikuli urtikariis mqone pacientebTan TiTqmis yov-
elTvis dgas diagnostikis, etiologiuri faqtoris identi-
ficirebis da menejmentis problema. amitom, didi mniSvneloba
aqvs dawvrilebiT da detalurad Sekrebil anamnezs. Tumca,
samwuxarod, es yovelTvis ver gvawvdis saTanado informacias
gamomwvevis an daavadebis konkretuli formis paTogenezis Ses-
axeb da samedicino daxmareba simptomTa Semsubuqebas ufro em-
saxureba vidre radikalur mkurnalobas.

definicia.
urtikaria aris sxeulis zedapirze ganlagebuli momrgvalo
formisa da sxvadasxva zomis, zedapiridan amoweuli, WinWris
nasusxis an buStukebis msgavsi warmonaqmnebi, eriTematozuli
an moTeTro feriTa da SemosazRvruli kideebiT, romelTac
axasiaTebT zomis periferiuli zrda an kleba da formisa da in-
tensivobis cvalebadoba drois mcire monakveTSi; gavrcelebis
lokaluri an farTo areali, msubuqidan intensiuramde qavili
da gamovlenis xangrZlivobis farTo meryeoba _ ramdenime saaTi-
dan, ramdenime Tvemde da wlamdec ki.
urtikariuli elementis SeSupebuli centraluri are Sei-
Zleba iyos mkrTali feris, irgvliv eriTematozuli garsiT.
siTxiT savse balTebi, romlebic dermidan subdermalur are-
Si siTxis transudaciis Sedegia, iwodeba, rogorc angioSeSupeba.
am tipis SeSupeba, zogjer, sxeulis did farTze vrcelde-
ba. igi SeiZleba ganviTardes sasunTq da saWmlis momnelebeli
traqtis lorwovan garsebze da safrTxe Seuqmnas adamianis si-
cocxles.
urtikariis ganviTareba dinamiuri procesia. am procesSi
Zveli elementebis uku ganviTarebasTan erTad SeiZleba axali
elementebi formirdebodes. urtikariuli elementebis gaCe-
nis mizezi kapilaruli vazodilatacia, kapilarTa kedlebis
ganvladobis gazrda da irgvliv mdebare qsovilebSi cilovani
eqsudatisa da sixlis formiani elementebis gadasvlaa.
aRniSnuli eqsudatis matebis an readsorbciis procesSi,

110
urtikariuli gamonayaris forma, zoma, Seferiloba da inten-
sivoba icvleba da sruli readsorbciis SemTxvevaSi elementi
qreba.

urtikariis klinikuri suraTi.

kanis dazianebis zomebi SeiZleba meryeobdes, qolinerguli
urtikariis dros ganviTarebuli, 2 _ 4 mm. diametris SeSu-
pebuli papulebidan, giganturi zomis buStebamde, romelic
zogjer mTel kidurs, saxes an sxeulis sxva nawils faravs.
buSti SeiZleba iyos momrgvalo an ovaluri; erT an mravalka-
meriani. warmonaqmnis forma, zoma, sazRvari da feri SeiZleba
swrafad icvlebodes. Tumca uxSiresad gamoxatulia zedapi-
ruli, eriTematozuli balTebi, romlebic mkrTali, moTeTro
zoliTaa SemosazRvruli.
siTxiT savse balTebs, romlebic dermidan subdermalur are-
Si siTxis transudaciis Sedegia, angioSeSupeba ewodeba.
angioSeSupebis kerebi SeiZleba ganviTardes sxeulis zeda-
piris nebismier ubanze. magram lokalizaciis tipiuri adgile-
bia tuCebi, Tvalbudis are, xorxi (rac iwvevs yelis tkivilsa da
disfonias) da gastrointestinaluri traqtis lorwovani garsi
(vlindeba muclis tkivili da gastro-enteritis movlenebi).
bula da papula SeiZleba gamovlindes intensiuri SeSupebis
adgilze. pustula, eqsudaciur-nekrozuli anTeba, aqercvla
da garqovaneba SeiZleba gamovlindes urtikariuli vaskuli-
tis dros. urtikariul elementebs, Cveulebriv, uwesrigo gan-
lageba aqvT. Tumca, maTi gaCena SeiZleba daemTxves sxeulis
garkveul ubanze fizikuri zemoqmedebis areals.
urtikaria SeiZleba gamowveuli iyos imunologiuri an ara
imunologiuri meqanizmebiT, rogoricaa magaliTad fizikuri
stimuli, kanTan kontaqti an mcire zomis sisxlZarRvebis
vaskuliti. zogjer SeiZleba imunuri da araimunuri urti-
kariis niSnebi erTdrouladac gamovlindes. angioSeSupeba Sei-
Zleba ganviTardes urtikariasTan erTad an mis gareSe. angio-
SeSupeba, romelic urtikariis gareSe viTardeba, upiratesad
C1-esTerazas inhibitoris deficitiTaa gamowveuli. urti-
kariis mniSvnelovani klinikuri maxasiaTebelia aseve, kanis da-
zianebis elementebis gamovlenis xangrZlivoba.

111
 cxrili 23.
urtikaris klinikuri klasifikacia.
1. Cveulebrivi (alergiuli an fsevdoalergiuli meqanzme-
biT ganpirobebuli) urtikaria (epizoduri an rekurentu-
li mimdinareobiT).
2. fizikuri urtikaria.
_ adrenerguli urtikaria.
_ aqvagenuri urtikaria.
_ qolinerguli urtikaria.
_ sicivis urtikaria.
_ zewolis mogvianebiTi urtikaria.
_ dermografizmi.
_ fizikuri varjiSiT inducirebuli urtikaria da ana-
filaqsia.
_ maRali temperaturis lokaluri zemoqmedebiT ga-
mowveuli urtikaria.
_ mzis urtikaria.
_ vibraciuli urtikaria.
_ kontaqturi urtikaria (kanTan biologiuri an qimi-
uri nivTierebebis kontaqti).
3. urtikariuli vaskuliti.
4. angioSeSupeba (urtikariis gareSe).

cxrili 24.
urtikariis daxasiaTeba kanis dazianebis gamomxatveli elementebis
gamovlenis xangrZlivobis mixedviT.

1. Cveulebrivi da fizikuri zewoliT gamowveuli urtika-

ria. _ elementebis gamovlenis xangrZlivoba umeteswilad,
4 dan 36 saaTamdea.
2. fizikuri urtikaria (garda zewolis mogvianebiTi urtika-
riisa). _ elementebis gamovlenis xangrZlivoba, fizikuri
zemoqmedebis Sewyvetis Semdeg, 30 wuTidan 2 saaTamdea.
3. kontaqturi urtikaria (SeiZleba hqondes mogvianebiTi fa-
zac). _ elementebis arsebobis xangrZlivoba, trigerTan
kontaqtis Sewyvetidan, 1 dan 2 saaTamdea.
4. urtikariuli vaskuliti. _ elementebis gamovlenis xangr-
Zlivoba 1 dan 7 dRemdea.

112
 urtikariis ganviTarebis paTofiziologiuri
meqanizmebi
histamini.
histamini aris urtikariis gamomwvevi umniSvnelovanesi me-
diatori. histamini gamomuSavdeba da inaxeba mastocitebSi.
arsebobs mastocitebidan histaminis gaTavisuflebis mravali
meqanizmi. sxva da sxva saxis stimuli, rogoricaa magaliTad
imunoloiuri (alergeni) an araimunologiuri (fizikuri an qi-
miuri) stimuli, SeiZleba gaxdes mastocitebis degranulaciis,
histaminis gaTavisuflebis da misi irgvliv mdebare qsovilebSi
gadasvlis mizezi. qronikuli urtikariis mqone pacientTa
1/3-is sisxlSi nanaxia mocirkulire IgG auto_antisxeulebi,
romlebic IgE-s Fc-receptorebTan maRali afinurobiT xasiaT-
debian da mastocitebidan histaminis gaTavisuflebas iwveven.
ujredebidan gaTavisuflebuli da intradermalur sivrceSi
gadasuli histamini iwvevs „sammag efeqts“: 1. lokalur eriTe-
mas (vazodilatacia). 2. anTebad eriTemas SemosazRvruli kide-
ebiT da 3. urtikariuli elementis gaCenas.
dReisaTvis aRwerilia histaminis 3 tipis receptorebi (H1,
H2 da H3). samive tipis receptorisaTvis agents histamini war-
moadgens. H1-receptorebi uxvad arian ganlagebulni lorwo-
van garsebSi (ZiriTadad sasunTq gzebSi), bronqebis gluv kun-
TebSi, sisxlZarRvebsa da kanqveSa qsovilebSi.
histaminis stimulis Semdeg, H1 receptorebi, aqsonuri
refleqsis saSualebiT, iwveven vazodilataciasa da qavils.
H1 receptorze zemoqmedebiT, histamini, respiratorul da
saWmlis momnelebel sistemaSi, iwvevs gluvkunTovani musku-
laturis spazms, kanze gamonayars da qavils. sensoruli ner-
vis stimulaciis gamo viTardeba cxvircemineba. am movlenebis
Seferxeba SesaZlebelia H1 receptorebis blokirebis gziT,
rac Sesabamisi antihistaminuri preparatebis saSualebiT xor-
cieldeba.

H2 receptorebi.
H2 receptorebi, ZiriTadad, kuWis mfarav epiTeliumSi
arian ganlagebulni. H2 receptorTa stimulacia iwvevs va-
zodilatacias. es receptorebi didi raodenobiTaa ganlage-
buli gastro-enteralur traqtSi da maTi stimulacia iwvevs
kuWis wvenis sekreciis stimulacias. kuWis wvenis sekreciis
damTrgunveli iseTi preparatebi, rogoricaa cimetidini, ra-

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nitidini da famitidini _ arian H2 blokatorebi. H1 da H2
blokatorebis erToblivi gamoyeneba urtikariis qronikuli
formebiT daavadebul pacientebSi, zogjer ufro efeqturia,
vidre H1 blokatorebis izolirebuli xmareba.
H3 receptorebi, ZiriTadad, centralur nervul sistemaSi
gvxvdeba da agzneba/blokirebis principiT aregulirebs ner-
vuli impulsebis gatarebis process.

urtikariis mqone pacientTa kvleva.

1. unda Seikribos dawvrilebiTi klinikuri anamnezi.

2. kargad unda daTvalierdes kani da Sefasdes _ saqme gva-
qvs urtikariasTan Tu mweris nakbenTan.
3. unda gamoiricxos fizikuri urtikariis arseboba.
4. unda gairkves _ urtikaria aris mwvave Tu qronikuli
(mwvave urtikarias axasiaTebs epiziduri gamovlinebebi,
romelTa saerTo xangrZlioba ar unda aRematebodes 6
kviras).
5. unda vecadoT, davadginoT urtikariis gamomwvevi mize-
zi.

urtikariis savaraudi gamomwvevi mizezebi.

1. sakvebiT gamowveuli. uxSiresi savaraudo trigerebia:

Tevzi, kiborCxala, Txili, Sokoladi, marwyvi, pomidori,
Roris xorci, Zroxis rZe, yveli, xorbali, safuari.
2. sakvebis danamatebi. salicilatebi, saRebavebi.
3. medikamentebi. penicilini, aspirini, sulfanilamidebi,
preparatebi, romlebic araimunologiuri gziT iwveven
histaminis gaTavisuflebas (morfini, kodeini, polimiq-
sini, deqstranebi, kurare da sxva).
4. infeqciebi. qronikuli baqteriuli infeqciebi (sinusi-
tebi, piris Rrus infeqciebi, gulmkerdis Rrus infeq-
ciebi, saSarde sistemisa da naRvlis buStis infeqciebi,
kampilobaqteriuli enteriti, fungaluri infeqciebi
(dermatofitozi, kandidozi), virusuli infeqciebi (B da
C hepatiti prodromul periodSi, infeqciuri mononu-
kleozi, koksakis virusi), protozouli da helminTuri

114
 infeqciebi (kuW-nawlavis helminTozi, malaria).
5. inhalaciuri agentebi. mcenareuli, sokos sporebi, cxo-
velis qertli, oTaxis mtveri, aerozolebi, aqroladi
qimikatebi.
6. Sinagani daavadebebi. Sratis daavadeba, sistemuri wiTeli
mglura, hiperTireoidizmi, autoimunuri Tireoiditi,
karcinoma, limfoma, iuveniluri revmatoiduli arTri-
ti, revmatiuli cxeleba, sisxlis transfuziis Semdgomi
reaqcia.
7. fizikuri stimuli (fizikuri urtikaria). dermografizmi,
zewolis urtikaria, qolinerguli urtikaria, fizikuri
varjiSiT gamowveuli urtikaria, mzis urtikaria, sici-
vis utikaria, sicxis urtikaria, vibraciuli urtikaria,
aqvagenuri urtikaria.
8. hormonaluri. orsulobis, premenstrualuri.

urtikariis samkurnalod saWiro medikamentebi.

1. antihistaminuri preparatebi.
urtikariasa da angioSeSupebaze antihistaminuri prepaar-
atebis gamovlenili efeqti, emyareba am tipis mdikamentebis
Tvisebas _ daablokiros histaminis receptorebi Sesabamis qso-
vilebSi da amiT Seaferxos histaminis, rogorc biologiurad
aqtiuri nivTierebis, efeqti am qsovilebze. rodesac pacienti
antihistaminur preparats iRebs imis Semdeg, rac mastocitebi-
dan ukve moxda histaminis gaTavisufleba da Sesabamisi recep-
torebis okupacia am nivTierebis mier – miRebuli preparatis
klinikuri efeqti minimaluria da urtikariul elementebsa
da angioSeSupebaze misi gavleva ar SeimCneva. amitom, kliniku-
rad gamovlenili urtikariisa da angioSeSupebis dros, anti-
histamiuri preparatis gamoyenebis efeqti dakavSirebulia ara
arsebuli procesis likvidaciis, aramed axali elementebis gan-
viTarebis blokirebasTan.

urtikariis mkurnalobis dasawyisi.

H1 antagonistebi arian urtikariisa da angioSeSupebis sam-
kurnalod mowodebuli pirveli rigis reparatebi. H1 antagoni-
stebis II da III Taoba xasiaTdeba minimaluri gverdiTi efeqtebiT.
cetirizini, loratadini, dezloratadini da feqsofenadini ar

115
xasiaTdebian sedatiuri efeqtebiT da gamoiyeneba 24 saaTSi 1
jer. maTi dozireba damokidebulia daavadebis klinikur mimdi-
nareobaze. saWiroebis SemTxvevaSi preparatebi SeiZleba gamovi-
yenoT 2 da 3 jer ufro maRali doziT, vidre es mwarmoebelsa aqvs
miTiTebuli.
qronikuli urtikariis mqone zogierT pacientSi karg Se-
degs iZleva H1+H2 antagonistebis kombinacia.

pirveli generaciis (sedaciuri) H1 antagonistebi.

pirveli generaciis H1 blokatorebi arian cximSi xsnadi,
gadian hemato-encefalur bariers da iwveven sedacias, madis
gaZlierebas, wonis matebas da aqvT atropinis msgavsi moqme-
deba (piris simSrale, mxedvelobis dabindva, yabzoba da dizu-
ria).
meore da mesame Taobis (mcired sedaciuri) H1 antagonistebi.
meore Taobis antihistaminuri preparatebi ar arian lipo-
filuri, ar gadian hemato-encefalur bariers da srulebiT
ara aqvT atropinis msgavsi efeqti.
_ feqsofenadini. aris II Taobis H1 antagonisti. mozrdil
pacientebSi gamoiyeneba 180 mg. 24 saaTSi 1 jer an 60 mg.
24 saaTSi 2-jer.
_ cetirizini. aris II Taobis H1 antagonisti. igi pirveli
Taobis H1 blokatoris _ hidroqsizinis metabolitia.
mozrdilTa standartuli doza aris 10 mg. dReSi.
_ loratadini. aris II Taobis, xangrZlivi moqmedebis H1
antagonisti. 10 mg. doziT miRebuli preparati axdens
urtikariuli elementis gamovlenis 12 saaTian blokire-
bas.
_ dezloratadini. aris III Taobis H1 antagonisti. aqvs 24
saaTiani moqmedeba. igi 2-jer ufro aqtiuria vidre ce-
tirizini da 1,7–jer _ vidre loratadini. preparatis
anTebis sawinaaRmdegi efeqtiT, utoldeba deqsametazo-
nis efeqts. maRali efeqtiT xasiaTdeba urtikariisa da
alergiuli rinitis mkurnalobaSi.

2. leikotrienebis modifikatorebi.
leikotrienebi (LT) arian proanTebiTi mediatorebi. ro-
gorc gamoirkva maTi raodenoba atopiur pacientTa biolo-
giur siTxeebSi maRalia. rogorc Cans, leikotrienebs gark-
veuli roli eniWebaT urtikariis ganviTarebaSic, ris gamoc,

116
dReisaTvis, urtikariis samkurnalod, mowodebulia e.w. (LT)
modifikatori preparatebi.
monteluasti da zafilukasti, romlebic leikotrienebis
receptorta antagonistebs warmoadgenen, urtikariis mqone
pacientebSi, gamoiyeneba 24 saaTSi 1-jer. Zilis win. upirate-
sad antihistaminur preparatebTan erTad.

3. tricikluri antidepresantebi.
tricikluri antidepresantebi arian H1 da H2 receptorTa
potenciuri blokatorebi. am mxriv ufro aqtiuria doqsepini.
10 _ 25 mg. doqsepini dReSi qronikuli idiopaTiuri urtika-
riis samkurnalo efeqturi saSualebaa.

4. epinefrini.
epinefrinis gamoyeneba saWiroa mZimed mimdinare urtika-
riisa da angioSeSupebis SemTxvevaSi. preparats aqvs swrafi
magram xanmokle efeqti. epinefrini, mozrdil pacientebSi,
gamoiyeneba 1 : 1000 (0,2 _ 1,0 ml) kanqveS an intramuskularu-
lad. epinefrinis suspenzias aqvs swrafi da amasTan xangrZlivi
efeqti (18 saaTi da meti). es preparati mozrdil pacientebSi
gamoiyeneba 1 : 200 ganzavebiT, 0,2 _ 0,3 ml. kanqveS.

5. kortikosteroidebi.
mwvave urtikariis dros SesaZlebelia k.s.-is intramuskula-
ruli gamoyeneba.
urtikariuli vaskulitis, qronikuli urtikariisa da an-
gioSeSupebis dros H1 da H2 antihistaminuri preparatebi xSi-
rad mcired efeqturi an saerTod uefeqtoa. am SemTxvevaSi,
dRis wesrigSi dgeba k.s. gamoyenebis sakiTxi. mozrdilebSi ga-
moiyeneba 40 mg. prednizoloni, diliT, erTjeradad an 20 _ 20
mg. 2-jer dReSi. bavSvebSi _ prednizoloni 1 mg/kg/24 sT. sxva
sqemis mixedviT, mozrdil pacientebs, 5 dRis ganmavlobaSi,
erTjeradad vaZlevT 60 mg. _ 40 mg. _ da Semdeg 20 _ 20 mg.
prednizolons. amis Semdeg zogierTi avtori saWirod miiCnevs
20 mg. SemanarCunebeli dozis gagrZelebas 2 _ 3 kviris ganma-
vlobaSi an ufro xangrZliv kurss, roca yovel 2 kvirSi 2,5
mg.-iT xdeba dozis Semcireba. miuTiTebeb 20 mg. prednizolo-
nis SemanarCunebeli dozis yovel meore dRes miRebis SesaZle-
blobazec, 2 kviraSi erTxel dozis 2,5 mg.-iT SemcirebiT.

117
 6. imunodepresantebi.
ciklosporini, qronikuli urtikariisa da angioSeSupebis
mqone pacientebSi, sxva preparatebiT mkurnalobis uefeqtobis
SemTxvevaSi, SeiZleba iyos efeqturi alternatiuli samkur-
nalo saSualeba. preparatis efeqti gamoxatulia maSin, Tu his-
taminis gaTavisufleba xdeba autoantisxeulebis produqciis
gamo. pacientebSi, romelTac xangrZlivi, mZime da Seupovari
urtikaria aReniSnebaT, romelic ar emorCileba sxva prepara-
tebiT mkurnalobas, ganixileba dRe-RameSi 4mg/kg. ciklospo-
rinis 4 kviriani kursis gamoyenebis SesaZleblobis sakiTxi.
mkurnalobis es meTodi zogjer sakmaod efeqturia. kortikos-
teroidebiT namkurnaleb pacientebSi ciklosporinis efeqti
saeWvoa.

metotreqsatis gamoyenebis sakiTxi SeiZleba ganvixiloT

urtikariis rezistentuli formebis arsebobis SemTxvevaSi.
per-oralurad 2,5 mg. dozis, kviraSi sami dRis ganmavlobaSi,
dReSi 2-jer miRebuli metotreqsatis 2 kviriani kursi, iwvevs
urtikariis yvela simptomis kupirebas.

7. topikaluri saSualebebi.
qavilis kontroli, met-naklebi warmatebiT, SesaZlebelia
iseTi topikaluri saSualbebis gamoyenebiT, rogoricaa Tbi-
li Sxapi, qeris naxarSis Tbili abazana, menTolis Semcveli
losionebi da promoqsinis topikaluri losioni. amave dros,
unda moveridoT iseTi saSualebebis gamoyenebas, romlebic qa-
vilis inicirebas iwveven (aspirini, alkoholi, uxeSi faqturis
qsovlis da elastiuri tansacmeli).
8. anti IgE –monoklonaluri antisxeulebi.
IgE-monoklonaluri antisxeulebi (omalizumabi) warmate-
biT gamioyeneba qronikuli urtikariis samkurnalod. bolo
xanebSi gamoCnda monacemebi sicivisa da qronikuli idiopaTiu-
ri urtikariebis dros am preparatis efeqturad gamoyenebis
Sesaxeb. preparati gamodis saineqcio formiT. gamoiyeneba 2
kviraSi an 1 TveSi 1-jer, intramuskularuli ineqciisaTvis.
mkurnalobis xangrZlioba Seadgens ramdenime Tves.

118
 ▶ anafilaqsia
definicia. anafilaqsia aris mwvave, sicocxlisaTvis saSiSi
reaqcia, romelic ZiriTadad, magram ara yovelTvis (IgE da-
moukidebuli anafilaqtoiduri reaqcia. mag fizikuri aqti-
vobiT gamowveuli reaqcia), gamowveulia mastocitebidan da
bazofilebidan, IgE damokidebuli, swrafad gamoTavisufle-
buli mediatorebiT. reaqcia xasiaTdeba klinikuri mraval-
ferovnebiT. magram respiratoruli komponenti da kardio-
vaskularuli kolafsi gansakuTrebiT mniSvnelovania; radgan
isini fataluri Sedegis ZiriTadi mizezi arian. urtikaria da
angioSeSupeba anafilaqsiis klinikuri manifestaciis yvelaze
xSiri gamolinebaa. Tumca es simptomrebi, swrafad ganviTa-
Tarebadi anafilaqsiis SemTxvevaSi, SeiZleba arc gamovlindes.
swrafad ganviTarebadi anafilaqsia yalibdeba organizmze
alergenis zemoqmedebis Semdeg da aris sicocxlisaTvis saSiSi.
anafilaqsiis niSnebi da simptomebi Cndena organizmSi aler-
genis SeWridan ramdenime wuTis Semdeg. Tumca zogjer, aR-
niSnuli reaqcia SeiZleba ganviTardes antigenuri stimulis
miRebidan 30 wuTze meti drois Semdeg. orfaziani reaqciis
mogvianebiTi faza an saerTod mogvianebiTi reaqcia, SeiZleba
grZeldebodes 32 saaTamde da moiTxovdes agresiul mkurna-
lobas.

etiologia.
dasavleTis ganviTarebul qveynebSi, anafilaqsiis ZiriTadi
mizezi hospitalSi an ambulatoriulad gamoyenebuli medika-
mentebia. am mxris, gansakuTrebiT sayuradReboa penicilinis
jgufi da lateqsis Semcveli saSualebebi. Semdeg modis sakve-
bi _ gansakuTrebiT araqisi, rac zogjer iwvevs fatalur an
masTan miaxloebul Sedegebs. pacientebs, romelTac deqstro-
zas mimarT aReniSnebaT alergia, SeiZleba anafilaqsia gnuvi-
TardeT iseT sakvebze, rogorebicaa banani, kivi, avokado da
wabli. aRniSnuli etiologiuri faqtorebi IgE damokidebuli
reaqciis mizezi xdeba da procesi mimdinareobs klasikuri
imunologiuri reaqciiT _ atopiis saxiT. garda amisa, SeiZ-
leba ganviTardes IgE-sagan damoukidebeli reaqciac _ anafil-
aqtoiduri reaqcia, rac zogierTi medikamentis an fizikuri
faqtorebis gavleniT xdeba. aseT SemTxvevaSi, bioaqtiuri
nivTierebebi Tavisufldeba uSualod gamomwvevi faqtoris

119
gavleniT (imunologiuri fazis gareSe). mag. morfini, sisxlis
produqtebi, radiokontrastuli nivTierebebi, komplementis
aqtivatorebi (sisxli, dializis membranebi), arasteroiduli
antianTebiTi preparatebi, fizikuri aqtivoba, yinva, mzis
sxivebi, imunologiuri fazis gareSe axdenen mastocitebidan
da bazofilebidan histaminis da sxva bioaqtiuri nivTierebe-
bis gaTavisuflebas da iwveven anafilaqtoidur reaqcias.

paTogenezi.
anafilaqsiis fataluri Sedegis paTogenezi gamoixateba
filtvis mwvave SeSupebiT, intraalveoluri hemoragiiT, tra-
qeis SeSupebiT, vazodilataciis mizeziT ganviTarebuli mwvave
hipotoniiT, kardialuri ariTmiiT da sinkopeTi.

anafilaqsiis pirveladi diagnostika. anamnezuri da obieq-

turi monacemebis Sekreba da Sefaseba.
simptomTagan, romlebic saSualebas gvaZleven eWvi mivita-
noT anafilaqsiaze, mniSvnelovania: c.n.s.-is mxriv _ cnobiere-
bis Secvla (cnobierebis dabindva an piriqiT _ agzneba, aJiti-
reba), Tavis tkivili, krunCxva, Tavbrus xveva. kanis mxriv _
urtikaria, angioSeSupeba, kanis siwiTle, gamonayari. respira-
toruli sistemis mxriv _ zemo an qvemo sasunTqi gzebis obs-
truqcia (xvela, qoSini, disfonia). saWmlis momnelebeli sisi-
temis mxriv _ gastroenteraluri simptomatika (gulis reva,
Rebineba, diarea). gul-sisxlZarRvTa sistemis mxriv _ sinkope,
hipotenzia.
arsebiTi kiTxvebi, romlebic am SemTxvevaSi pacients (an
mis axlobels) unda davusvaT aris Semdegi:
1. aReniSneba Tu ara pacients personaluri an memkvidruli
alergiuli anamnezi?
2. iyo Tu ara adre dasmuli anafilaqsiis diagnozi?
3. aRniSnul, konkretul SemTxvevaSi, iyo Tu ara gamovle-
nili cnobierebis Secvla (agzneba an cnobierebis da-
bindva)?
4. iyo Tu ara gamovlenili hipotonia da kolafsi, sinkope
an presinkope?
5. iyo Tu ara gamovlenili kanis simptomebi (qavili, gamo-
nayari, siwiTle, urtikaria, angioSeSupeba?)
6. iyo Tu ara gamovlenili niSnebi, romlebic miuTiTeben
zemo an qvemo sasunTqi gzebis obstruqciaze?

120
 7. iyo Tu ara gamoxatuli gastrointenstinaluri simp-
tomebi (gulis reva, Rebineba, diarea)?

anafilaqsiis diagnostika. sxva diagnozebi da niSnebi, romle-

bic anafilaqsiis msgavsia.
sxva mdgomareobaTa CamonaTvali, romlebic ganxiluli unda
iyos anafilaqsiis diagnostirebisas warmodgenilia qvemoT:

1. vazodepresiuli _ (vazovagusuri neiro-kardiogenuli)

sinkope.
2. sindromebi, romlebis asocirdebian kanis siwiTlesTan
(mag. sxvadasxva warmoSobis eriTemebi, metastazuri kar-
cinoidi).
3. mowamvla.
4. sistemuri mastocitozi.
5. fsiqiatriuli profilis paTologia, romelic SeiZleba
hgavdes anafilaqsiis dros gamoxatul agznebas (panikis
gamovlineba, xmovani iogebis disfunqciis sindromi ).
6. angioSeSupeba (memkvidruli angioSeSupeba).
7. Sokis sxva mizezebi (mag. kardiogenuli Soki).
8. sxva kardiogenuli an respiratoruli paTologiebi.

vazodepresiuli (vazo-vagusuri) reaqcia aris mdgomareoba,

romelic SeiZleba anafilaqsiis dros mniSvnelovani dabneu-
lobis mizezi gaxdes. am dros urtikaria ar aris gamoxatuli.
bronqospazmi an sasunTqi sistemis sxva paTologia, ZiriTadad,
ar vlindeba. sisxlis wneva normaSia an aweulia. kani Cveule-
briv civi da fermkrTalia. taqikardia, romelic anafilaqsiis
mniSvnelovani niSania, gulis kunTis gamtarebeli gzebis de-
feqtis gamo, SeiZleba saerTod ar iyos gamoxatuli da piriqiT
_ umetesad gamoxatulia bradikardia.
anamanezi aris anafilaqsiis gamomwvevi mizezis dadgenis um-
Tavresi saSualeba. detalurad Sekrebili anamnezi, peroralu-
rad miRebuli (sakvebi, medikamentebi) nivTierebebis Sesaxeb,
miRebidan mravali saaTis gavlis Semdegac ki, iZleva informa-
cias anafilaqsiis ganviTarebis mizezis Sesaxeb.
Tu anafilaqsiis gamomwvevi mizezis dadgena ver xerxdeba,
ganixileba idiopaTiuri anafilaqsiis diagnozi. anu, idiopa-
Tiuri anafilaqsiis diagnozi aris yvela savaraudo mizezis
gamoricxvis Sedegad dasmuli diagnozi.

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 anafilaqsiis diagnistikuri testebi da maTi mniSvneloba.
(kanis testi, IgE testi, provokaciuli testi).
kanis testi an specifiuri IgE-s kvleva sisxlis SratSi da
provokaciuli testebi mniSvnelovnad gvexmareba anafilaqsiis
diagnozis dadgenaSi. Tumca uxSirsad, kargad Sekrebili anam-
nezi gamoricxavs maTi Catarebis aucileblobas.

anafilaqsiis menejmenti.
rodesac anafilaqsiis diagnozi ismeba da gansakuTrebiT ma-
Sin, Tu dadgenilia misi gamomwvevi specifiuri faqtori (sakve-
bi, medikamenti mweris nakbeni) pacienti aucileblad srulyo-
filad unda iyos informirebuli amis Sesaxeb. mas unda auxs-
nan anafilaqsiisagan gamowveuli yvela safrTxis mniSvneloba,
gamomwvevis roli anafilaqsiis ganviTarebaSi da misgan Tavis
aridebis saSualebebis Sesaxeb, raTa Seamciron anafilaqsiis
riski.
pacientebs, romelTac anafilaqsia unviTardebaT sakvebze,
unda avuxsnaT, Tu rogor unda gaarkvion etiketze, sakvebSi
Semavali ingredientebis Tavisebureba da amiT aicilon saxi-
faTo nivTierebis miReba. pacientebs, romelTac anafilaqsia
medikamentebze aReniSnebaT, unda ganemartoT medikamentebis
jvaredini reaqciis SesaZlo ganviTarebis Sesaxeb. maT visac
reaqcia aReniSneba mweris nakbenze, unda ganemartoT, rom
saWiroa specifiuri imunoTerapia (desensibilizacia). uci-
lebelia ganmarteba, rom anamnezSi anafilaqsiis mqone pacien-
tebi mudmivad unda atarebdnen Tan saineqciod gamzadebul
epinefrins. Tan unda hqondeT markeri, sadac aRniSnuli iqne-
ba, rom igi anafilaqsiis riskis jgufs miekuTvneba da aRniS-
nuli iqneba anafilaqsiis gamomwvevis dasaxeleba.
ucilebelia ganmarteba, rom individi, romelic b-bloke-
rebs iRebs miekuTvneba anafilaqsiis maRal risks.

gadaudebeli intervencia
klinicists ucileblad unda axsovdes, rom anafilaqsia ar
aris erTmomentiani procesi da igi droSi gangrZobadia. simp-
tomebi, romlebic procesis dasawyisSi ar Cans, rogorc sico-
cxlisaTvis saSiSi, SeiZleba swrafad Seicvalos da mdgomareo-
ba dramatulad damZimdes. marTvis taqtika, romelsac am dros
eqimi irCevs, mniSvnelovnadaa damokidebuli mis Teoriul

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codnasa da praqtikul Cvevebze. agreTve samedicino ofisis
teqnikur aRWurvilobaze, rac mniSvnelovnad gansazRvravs
pacientis adgilze mkurnalobis an gadaudebeli daxmarebis
ganyofilebaSi gadayvanis Sesaxeb gadawyvetilebis miRebas.

anamnezuri da klinikuri monacemebis mixedviT, anafilaqsiis

diagnozis dadasturebis (an eWvis mitanis) SemTxvevaSi:

1. pacients vaTavsebT horizontalur mdgomareobaSi da

maRla vawevinebT orive qvemo kidurs, rac xels uwyobs hemo-
dinamikis gaumjobesebas. aRniSnuli RonisZieba aferxebs (Tu
ukve saxezea) an prevencias ukeTebs orTostatiul hipoten-
zias da aumjobesebs Tavis, gulisa da Tirkmlebis sisxliT
momaragebas.
2. sasunTqi gzebis ganvladobis dacvisa da aero momarage-
bis gaumjobesebisaTvis, pacients vawodebT Jangbads niRbiT
an kanuliT. saWiroebis SemTxvevaSi, amwovis saSualebiT, vax-
denT sasunTqi gzebis gaTavisuflebas lorwosa da naRebinebi
masisagan. saWiroebis SemTxvevaSi, aseve vaxdenT pacientis in-
tubirebas. Tu saintubacio mili ara gvaqvs, haeris miwodebis
gasaumjobeseblad, SeiZleba ambus balonis gamoyeneba. mozr-
dilebSi gamoiyeneba 700 ml.-iani moculobis ambus baloni.
endotraqealuri intubacia an traqeostomia keTdeba aucile-
blobis SemTxvevaSi da maSin, Tu eqimi srulyofilad flobs
aRniSnuli manipulaciebis teqnikas.
3. Jangbadi ZiriTadad gamoiyeneba gaxangrZlivebuli anafi-
laqsiis dros, roca gamoxatulia post-hipoqsiuri agzneba an
darRveulia miokardiumis funqcia. oqsigenoTerapiis regu-
lirebisaTvis saWiroa sisxlSi gazTa raodenobis monitoringi
pulsoqsimetriT an sxva meTodiT. bronqo spazmis mosaxsnelad
SeiZleba gamoyenebuli iyos b2-agonistebis ihalacia. zemo sa-
sunTqi gzebis SeSupebis mosaxsnelad rekomendirebulia epine-
frinis mravaljeradi ineqcia.
4. cirkulaciaSi arsebuli siTxis raodenobis Sevsebisa da
mJava-fuZovani mdgomareobis regulirebisaTvis (rogorc wesi
saWiroa metaboluri acidozis moxsna) gamoiyeneba deqstro-
zisa da ringer-laqtatis intravenuri infuzia. mozrdilebs
marilovani xsnarebi SeiZleba gadaesxas 1 _ 2 litris odeno-
biT. aqedan _ pirveli 5 wuTis ganmavlobaSi unda gadaesxas
5_10 ml/kg. sainfuzio siTxe bavSvebma unda miiRon 30 ml/kg _

123
pirveli 1 saaTis ganmavlobaSi.
5. pirveli rigis preparati, romelic anafilaqsiis dros
gamoiyeneba aris epinefrini (adrenalini). epinefrini gamoiye-
neba ganzavebiT – 1: 1000., 0,2 ml.-dan 0,5 ml.-amde (bavSvebSi
maqsimaluria 0,3 ml), kunTebSi an kanqveS. saWiroebis SemTxve-
vaSi, epinefrini SeiZleba gamoyenebuli iyos yovel 15 wuTSi.
am periodSi xdeba simptomTa Sefaseba da arteriuli wnevis
kontroli. ganixileba efeqturi dozis zRvari da saWiroe-
bis SemTxvevaSi SeiZleba moxdes ineqciaTa Soris periodis
Semcireba an gazrda. ineqcia TeZoze ufro efeqturia, vidre
mxarze. zog SemTxvevaSi gamoiyeneba epinefrinis Seyvanis al-
ternatiuli gza _ rogoricaa inhalacia (laringialuri SeSu-
pebis dros) an sublingvalurad Seyvana (Tu intravenuri ga-
moyeneba SeuZlebelia).
6. H1-blokatorebidan (rogorc II rigis preparati) rekomen-
direbulia difenhidramini (benadrili) _1,0_2,0 mg/kg an 25_50
mg. parenteralurad. benadrili izolirebulad ar gamoiyeneba
da ixmareba mxolod epinefrinTan kombinaciaSi da maSin, roca
Tvlian, rom epinefrinis efeqti araa sakmarisi anafilaqsiis
simptomebis mosaxsnelad.
7. H2-blokatorebidan gamoiyeneba ranitidini _ 50 mg. mo-
zrdilebSi da 12,5 _ 50 mg (1 mg/kg.) bavSvebSi, 5%-ian 20 ml.,
deqstrozasTan erTad, intravenurad, 5 wuTis ganmavlobaSi.
cimetidini (4 mg/kg.) intravenurad, mxolod mozrdilebSi.
ranitidini da difenhidramini jobia gamoyenebuli iyos kom-
binaciaSi. Tumca xazgasmiT unda aRiniSnos, rom orive meore
rigis preparatia epinefrinis Semdeg.
8. roca, miuxedavad epinefrinis gamoyenebisa, bronqospazmi
ar ixsneba, ganixileba b2-agonistebis gamoyenebis sakiTxi. am
mxriv rekomendirebulia albuteroli _ 2,5 _ 5,0mg., 3,0 ml.
siTxeSi, nebulaizeris saSualebiT. saWiroebis SemTxvevaSi
SesaZlebelia dozis ganmeorebac. Tu b2-blokatorebs aqvT
ukuCveneba _ ganixileb glukagonis (1 _ 5 mg. bavSvebSi maqsim-
aluro doza _ 1 mg.) gamoyenebis sakiTxi.
9. roca epinefrini ver xsnis hipotenzias, ganixileba do-
faminis infuziis sakiTxi. dofamini gamoiyeneba 400 mg.-is ra-
odenobiT _ 500 ml. 5%-ian deqstrozasTan erTad, 2 _ 20 mg/kg-
ze wuTSi, sistoluri wnevis 90 mm/Hg-isa metad momatebamde.
10. pacientebSi, romelTac aReniSnebaT mZime da gaxan-
grZlivebuli anafilaqsia, anamnezSi _ idiopaTiuri anafilaq-

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sia an bronquli asTma, ganixileba glukokortikosteroidebis
sistemuri gamoyenebis sakiTxi. g.k.s. rogorc wesi, ar moq-
medeben swrafad, magram SeuZliaT SeaCeron procesis gaxan-
grZliveba an ganmeoreba. intravenurad g.k.s. SeiZleba gamoviy-
enoT yovel 6 saaTSi _ 1 _ 2 mg/kg. per-oralurad _ 1 _ 2 mg/
kg. ( prednizoloni ).

mwvave reaqciis Semdeg:

1. H1 agonistebi (cetirizini, feqsofenadini, dizlorata-
dini an loratadini ) 3 dRis ganmavlobaSi.
2. prednizoloni _ 1_2 mg/kg. 3 dRis ganmavlobaSi.

▶ alergia mweris nakbenze.

mweris nakbenze ganviTarebuli alergiis uxSiresi mizezi
Hymenoptera-s (frTebfarflianTa) sxvadasxva saxeobaa. nestaris
specifiuri anatomiuri agebulebis gamo, kbenas anxorcielebs
mxolod mdedrobiTi sqesis mweri. mweri kbenas ZiriTadad anx-
orcielebs Tavdacvis mizniT.
Sxamiani WianWvelas nakbeni Zalian xSiradaa anafilaqsiis
mizezi amerikaSi, aziasa da avstraliaSi.

mweris nakbeniT gamowveuli alergiuli reaqciebis

epidemiologia
mweris nakbeniT gamowveuli alergiuli reaqcia SeiZleba
yvela asakSi gamovlindes. sistemuri alergiuli reaqciebi,
mozrdil asakSi, vlindeba daaxloebiT 3%, xolo bavSveb-
Si, daaxloebiT 1%-Si. adgilobrivi reaqcia, romelic did
farTobze vrceldeba, mozrdilebSi aReniSneba daaxloebiT
10%-SemTxvevaSi. amerikis SeerTebul StatebSi yovelwli-
urad aRiniSneba mweris nakbeniT gamowveuli 40-amade, xolo
safrangeTSi 16 _ 38 fataluri SemTxveva. Tumca varaudoben,
rom fatalur SemTxvevaTa garkveuli nawili, ubralod, ar
diagnostirdeba. fatalur SemTxvevaTa umravlesoba modis 45
wlis asaks gadacilebul adamianebze, Tumca zog SemTxvevaSi,
mweris nakbenisagan iRupebian mcire asakis bavSvbic. mweris nak-
beniT daRupul adamianTa daaxloebiT naxevars adre arasodes

125
ar aReniSneboda mweris nakbenze alergiuli reaqcia.
alergiuli sensibilizaciisTvis, klasikurad, aucilebe-
lia am alergenTan erTi winaswari Sexeba mainc (am SemTxvevaSi
mweris winaswari kbena). Tumca, Tu gaviTvaliswineT im gare-
moebas, rom sensibilizacia SeiZleba jvaredini antigenuri
struqturis saSualebiTac ganxorcieldes (mcenareuli an
kvebiTi alergenebi), maSin gasagebia, rom mweris Sxamis mimarT
sensibilizacia SeiZleba ganviTardes im SemTxvevaSic, rode-
sac pirovnebas Sexeba ar hqonia am mwerTan. amas adasturebs is
faqtic, rom mweris Sxamebze sensibilizacia xSirad aReniSne-
baT im adamianebs, romlebic amave dros, sensibilizirebulni
arian sxvadasxva mcenareuli alergenebiT.

mweris Sxami.
mwerebis SxamTa umetesoba Seicavs vazoaqtiur aminebs (his-
tamini, dopamini, norepinefrini), acetilqolins da kininebs,
romlebic organizmSi moxvedris Semdeg iwveven wvis SegrZne-
bas, tkivils, qavils, sxva da sxva saxis gamonayaris gaCenas
da iseT seriozul garTulebas, rogoric anafilaqsiaa. Tumca
sabednierod, umetes SemTxvevaSi, yvela es simptomi erTdrou-
lad da mZimed ar vlindeba da anafilaqsiis ganviTarebac Se-
darebiT ufro iSviaTi movlevaa vidre adgilobrivi reaqciebi.
zogierTi mweris Sxami Zlieri toqsiurobiT xasiaTdeba da am
meqanizmiT iwvevs sxadasxva sistemis, maT Soris Tirkmlisa da
nervuli sistemis, dazianebas.

mweris SxamiT gamowveuli alergiuli reaqciebis

klasifikacia.
mweris nakbeniT gamowveuli alergiuli reaqcia, klinikuri
gamovlenis mixedviT SeiZleba iyos adgilobrivi an sistemuri.
xolo droSi ganviTarebis mixedviT _ dauyovnebeli an dayo-
vnebuli.
adgilobrivi reaqcia viTardeba nakbenis (Sxamis moxvedris)
areSi kanis lokaluri reaqcia (SeSupeba, siwiTle, qavili vi-
Tardeba kbenidan ramdenime wamSi an wuTSi). lokaluri reaqci-
is gamovlenis areali gansakuTrebiT farTea IgE-damokidebuli
reaqciis mogvianebiTi fazis ganviTarebis SemTxvevaSi. aseTi
reaqcia viTardeba mweris kbenis gamo, organizmSi alergenis
SeWridan 12 _ 24 saaTis Semdeg da moicavs sxeulis daaxloebiT
20 sm. diametris areals. Tumca, iSviaTad, SeiZleba mTeli ki-

126
duric dafaros. process Tan axlavs limfuri sadinarebisa da
jirkvlebis SeSupeba, rac anTebiTi mediatorebis cirkulacii-
Taa gamowvuli da ara infeqciiT. amgvari lokaluri anTebiTi
reaqcia, SeiZleba gamoxatuli iyos 5 – 10 dRis ganmavlo-
baSi da igi ar qmnis raime gansakuTrebul saSiSroebas garda im
SemTxvevebisa, roca fizikur zewolas axdens romelime mniS-
vnelovan anatomiur struq-turaze, gansakuTrebiT kisrisa da
Tavis areSi.
mweris nakbenis gamo ganviTarebuli sistemuri reaqciis
simptomebi moicavs, nakbenis adgilidan daSorebul, or an met
anatomiur sistemas. mweris SxamiT gamowveuli sistemuri rea-
qciebi, TiTqmis yovelTvis IgE-damokidebuli reaqciebia da
safuZvlad udevs anafilaqsiis ganviTarebas. am dros SeiZleba
gamoixatis kanis dazianebis simptomebi (generalizirebuli
urtikaria, angioSeSupeba, egzanTema da gamonayari), respira-
toruli sistemis dazianeba (xaxis SeSupeba da daWimulobis
SefrZneba, disfagia, dispnea, stridori, vizingi, disfonia,
gulmkeris SeboWvis SegrZneba), gul-sisxlZarRvTa sistemis
paTologia (taqikardia an bradikardia, Tavbrusxveva, hipo-
tenzia, agzneba, gonebis dabindva, Soki da sinkope), gastro-
intestinaluri simptomebidan damaxasiaTebelia: gulisreva,
Rebineba, muclis tkivili da diarea. es simptomebi SeiZleba
gamovlindes cal-calke, TanmimdevrobiT an erTdrouladac
ki.
mweris nakbeniT gamowveuli sistemuri reaqciis diagnos-
tika, yovelTvis advili araa. radgan msgavsi reaqciebi Sei-
Zleba sakvebi alergenebiTac iyos gamowveuli. mweris SxamiT
gamowveuli sxvadasxva simptomTa gamovlenis sixSire bunebriv-
ia sxvadasxvaa: erT-erTi kvlevis mixedviT, kanis simptomebi
vlindeba daaxloebiT 16%-Si, xolo sicocxlisTvis saSiSi ana-
filaqsiuri reaqciebi gamoxatuli iyo 24%-Si. aqedan _ gonebis
dakargva gamoixata 15%-Si. 44% SemTxvevaSi gamoixata “zomieri
intensiobis” sistemuri reaqciebi. amasTan sayuradReboa, rom
kanis reaqciebi, mozrdilTa kontingentSi, vlindeba daaxloe-
biT 15%-Si, xolo bavSvebSi, daaxloebiT 60%-Si. bavSvebSi,
mozrdilebTan SedarebiT, iSviaTia vaskularuli da anafilaq-
siuri reaqciebi. pirebSi, romelTac mweris nakbenis Semdeg,
ramdenjerme ganuviTardaT sistemuri alergiuli reaqciebi
da sisxlis SratSi aReniSnebaT mweris Sxamis sawinaaRmdego
IgE-antisxeulebi, mweris kbenis Semdeg, SeiZleba ganviTardes

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persistulad mimdinare sicivis urtikaria, romelic Tveebis
ganmavlobaSi grZeldeba. mweris nakbenze ganviTarebuli sis-
temuri reaqciis simZime SeiZleba ukavSirdebodes ara mxolod
alergiul gamovlinebas, aramed mweris Sxamis toqsiur efeqt-
sac. mdgomareoba gansakuTrebiT mZimea, Tu pacienti masto-
citebis raime paTologiiTaa daavadebuli. mwerebis mier ma-
siuri dakbenis SemTxvevaSi, SeiZleba ganviTardes Tirkmlis
ukmarisoba, hemolizi, intravaskularuli hemokoagulacia da
mdgomareobam miiRos kritikuli xasiaTi. zog SemTxvevaSi vi-
Tardeba gaurkveveli meqanizmis iseTi reaqciebi, rogorebi-
caa: Sratismieri daavadebis msgavsi paTologia, encefaliti
da periferiuli an kranialuri neiropaTia, glomerulonefri-
ti, miokarditi da Guillain–Barré-s sindromi.

mweris nakbeniT gamowveuli alergiis diagnostika.

weris nakbeniT gamowveuli alergiis diagnostikis umniSvne-
lovanesi saSualeba anamnezi da klinikuri simptomebia. anamne-
zis Sekrebisas gasaTvaliswinebelia iseTi faqtebi: hqonia Tu
ara am pirovnebas adre raime alergiuli gamovlineba da gansa-
kuTrebiT _ hqonia Tu ara alergiuli reaqcia mweris nakbenze?
aRniSnavs Tu ara amJamad mweris kbenis faqts? rodis ukbi-
na mwerma? rodis igrZno paTologiur simptomTa gamovlena?
sxeulis ra areSi lokalizdeba nakbeni da ra mdgomareobaSia
es midamo? pacientis mdgomareobis Sefasebisas aucileblad
unda gaviTvaliswinoT ra medikamentebi miiRo man mweris kben-
is Semdeg (antihistaminuri preparatebi iwveven modunebas da
Zilianobas. xolo epinefrini _ taqikardias) radgan moduneba,
Zilianoba an agzneba da taqikardia SeiZleba am medikamentebiT
iyos gamowveuli.
mweris Sxamze semsibilizaciis sadiagnostikod gamoiyeneba
intradermaluri alergiuli testebi. testirebisaTvis mowo-
debulia Hymenoptera-s 5 saxeobis Sxamis eqstraqti.
sensibilizirebul pacientebSi, umetes SemTxvevaSi, kanis
testebi pozitiuria. Tumca gasaTvaliswinebelia is faqti,
rom kbenidan ramdenime dRis an kviris gamavlobaSi, kanis tes-
ti, droebiT ganviTarebuli «anergiis» gamo, SeiZleba negatiu-
ric iyos. aseT pacientebs, 4 _ 6 kviris Semdeg, ganmeorebiT
utardebaT testireba. sxva SemTxvevaSi, kanis negatiuri testi
SeiZleba imis maCvenebelic iyos, rom alegiuli reaqcia araa
IgE-damokidebuli da igi sxva meqanizmebiT viTardeba. aucile-

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blad gasaTvaliswinebelia is faqti, rom mweris nakbenze aler-
giuli reaqciis klinikuri anamnezis mqone pacientTa nawil-
Si, sisxlis Sratis specifiuri IgE antisxeulebis arsebobis
SemTxvevaSic ki, zogjer, kanis negatiuri testebi aRiniSneba.
amitom, mweris nakbenze alergiuli reaqciis anamnezis mqone
pacientebSi, kanis negatiuri testis SemTxvevaSi, 3 _ 6 Tvis
Semdeg, saWiroa ganmeorebiTi tetireba.
kanis alergiuli reaqciis intensioba ar gamodgeba mosa-
lodneli alergiuli reaqciis intensiobisa da klinikuri Ta-
viseburebis prognozirebisaTvis. radgan, sustad gamoxatuli
kanis pozitiuri sinji ar gamoricxavs SemdgomSi anafilaqsiis
ganviTarebis SesaZleblobas da piriqiT _ mkveTrad gamoxatu-
li kanis sinjis SemTxvevaSi, alergiis klinikuri gamovlineba
SeiZleba sruliad umniSvnelo iyos.
mweris Sxamze sensibilizaciis dasadgenad aseve warmatebiT
gamoiyeneba sisxlSi SratSi specifiuri IgE-s donis gansazR-
vra.
Zalian mniSvnelovan diagnostikur Rirebulebas aniWeben
mweris SxamiT Catarebul provokaciul tests. aseTi testi
SeiZleba Catardes, rogorc standartuli komerciuli prepa-
ratiT, ise uSualod mweris kbeniT. Tumca aucileblad gasa-
Tvaliswinebelia anafilaqsiis saSiSroeba, ris gamoc, testi-
rebisas, daculi unda iyos sifrTxilis yvela zoma.

mweris nakbeniT gamowveuli mwvave alergiul

reaqciis mkurnaloba.
mweris nakbenis Semdeg, lokalurad, farTe areze gamoxa-
tuli reaqciis SemTxvevaSi, gansakuTrebiT maSin, Tu procesi
Tavis an kisris areSia gamoxatuli, rekomendirebulia oralu-
ri kortikosteroidi (40 _ 60 mg/ 24 sT. 1 _ 5 dRis ganmavlo-
baSi). kortikosteroidebi xasiaTdebian maRali efeqturobiT.
efeqti miT ufro maRalia, rac adrea dawyebuli mkurnaloba.
adgilobrivad gamoiyeneba kortikosteroidis malamo an
kremi.
sistemuri reaqciis dros Careva ufro intensiuria da moi-
Txovs seriozul monitoringsac.
urtikariuli gamonayaris SemTxvevaSi, pirveli rigis prepa-
ratebad iTvlebian antihistaminuri saSualebebi. anafilaqsiis
SemTxvevaSi ki _ epinefrini. pirveli daxmareba undas Catardes
Zalian swrafad, yvelgan, sadac ki amis saSualebaa. Semdeg pa-

129
cienti, aucileblad, unda gadaiyvanon gadaudebeli daxmare-
bis ganyofilebaSi. pacientebi, romlebsac adre ukve aReniSne-
bodaT anafilaqsiis epizodi, Tan unda atarebdnen epinefrinis
autoiJeqtorebs da Sesabamis markerebs. zogi pacienti, ro-
melic b-blokatorebs iRebs, rezistentulia epinefrinis mi-
marT. aseT SemTxvrvebSi naCvenebia glukagonis ineqciis gamoy-
eneba. imis gamo, rom anafilaqsia SeiZleba persistirebdes an
recidivebiT mimdinareobdes 6 – 24 saaTis anmavlobaSi, am pe-
riodSi saWiroa pacientis mdgomareobis uwyveti monitoringi.
mdgomareobis gaumjobrsebis Semdeg pacientebi aucileblad,
detalurad unda iyvnen instruqtirenulni mweris nakbenis
Semdgomi garTulebebisa da TviTdaxmarebis wesebis Sesaxeb.
amasTan, pacients unda avuxnaT profilaqtikis ra saSualebebi
arsebobs sistemuri alergiuli reaqciebis Tavidan acilebisaT-
vis (specifiuri imunoTerapia. ezoebSi, baRebSi da futkris ske-
bis axlos yofnisa da muSaobisagan Tavis arideba. am arealSi fe-
radi tansacmlis tarebisagan Tavis Sekaveba da sxva).

▶ sakvebiT gamowveuli alergiuli reaqciebi.

ZiriTadi debulebebi, romelTac kvebiTi alergiis Sesaxeb
arsebuli monacemebi gansazRvraven ase gamoiyureba:
• alergiul daavadebaTa gamovlenis sixSire ukanaskne-
li 20 – 30 wlis ganmavlobaSi, ganviTarebul qveynebSi,
TiTqmis gaormagda da dReisaTvis a.S.S-Si, 5 wlamde asakis
bavSvTa daaxloebiT 6% da mTeli mosaxleobis 3,5%_4%-s
aReniSneba alergia sxvadasxva sakveb produqtze.
• sakveb produqtebze sensibilizacia da Semdeg aler-
giuli reaqcia SeiZleba ganviTardes “tradiciuli gziT”
_ gastrointestinaluri traqtidan, e.w. I klasis aler-
genebis (mag. kvercxi, rZe, araqisi) miRebis an “aratradi-
ciuli gziT” _ kvebiT alergenebTan jvaredini antige-
nebis mqone, respiratoruli alergenebiT (mag. aryis xis
an ambroziis mtvriT) sensibilizaciis SemTxvevaSi, e.w.
II tipis alergenebis (mag. umi stafilo, vaSli an nesvi)
miRebis Semdeg.
• sakvebiT gamowveuli reaqciebi SeiZleba iyos IgE-damo-
kidebuli, ara IgE-damokidebuli an am ori meqanizmis

130
 kombinaciiT gamowveuli da gamoixatos kanis, sasunTqi
sistemis, gastro-intestinaluri traqtis an kardio-vas-
kularuli sistemis dazianebiT.
• sakvebi produqtis antigenebis sawinaaRmdego IgE-an-
tisxeulebis donis mateba periferiul sisxlSi an kanis
alergiuli testis pozitiuri pasuxi, adasturebs kon-
kretul sakvebi produqtis mimarT sensibilizaciis ar-
sebobas. magram ar amtkicebs alerguli paTologiis kli-
nikur suraTsa da am alergeniT sensibilizacias Soris
mizez-Sedegobriv kavSirs. am mxriv, “oqros standartad”
iTvleba sakvebi produqtiT Catarebuli “provokaciuli
testi”.
• kvebiTi alergiis mkurnalobis saukeTeso (iafi da efe-
qturi) meTodad miCneulia kvebis racionidan trigeri
produqtis eliminacia.

definica.
sxvadasxva paTologiuri gamovlinebebi, romlebic sakvebi
produqtis miRebas axlavs Tan Sefasebulia, rogorc sakvebiT ga-
mowveuli mavne reaqciebi. aseTi reaqciebis mizezi SeiZleba iyos
konkretuli sakvebi nivTierebis mimarT arsebuli organizmis
intolerantuloba an hiperreaqtiuloba (alergia) an sxva imu-
nopaTologiuri reaqcia.
sakvebi produqtebiT gamowveuli mavne reaqciebis uxSiresi
mizezi intolerantulobis iseTi faqtorebia, rogoricaa mag.
toqsinebiT dabinZureba (skumbrias ojaxis zogierTi Tevzi
lpobis procesSi gamoyofs histamins. sakvebSi moxvedrisas Sal-
monella, Shigella, da Campy-lobacteria gamohyofen toqsinebs), zo-
gierTi farmakologiuri agentis Semcveloba garkveul kvebis
produqtSi (kofeini yavaSi an Tiramini Zvel yvelSi), adamianis
organizmis metaboluri paTologiebi (mag. laqtozas defici-
ti, rac rZis autanlobas iwvevs) da organizmis mier ganvi-
Tarebuli idiosinkraziuli reaqcebi garkveuli produqtebis
mimarT.
zog SemTxvevaSi adgili aqvs ara sakvebis WeSmarit autan-
lobas, aramed ama Tu im sakvebi produqtis mimarT ganviTare-
bul fsiqologiur zizRs. fsiqologiuri barieris daZlevis
Semdeg aseTi sakvebis miReba ar iwvevs raime garTulebas.
sakvebis mimarT arsebuli hipersensitiuroba, upiratesad
mcire asakis bavSvebSia gamoxatuli da IgE-meqanizmebiT xor-

131
cieldeba. Tumca aRwerilia kvebiTi antigenebiT gamowveuli,
ara IgE imunologiuri reaqciebi, romelTa klinikuri gamo-
xatulebac, ZiriTadad, gastro-intestinaluri traqtis paTo-
logiiT vlindeba.
sakvebiT gamowveuli, imunologiuri da ara imunologi-
uri bunebis, mavne reaqciebi, SeiZleba msgavsi klinikuri ga-
movlinebiTac xasiaTdebodes, rac aucilebladaa gasaTvalis-
winebeli daavadebis menejmentis procesSi.
sakvebi produqtebiT gamowveuli mavne reaqciebis magaliTe-
bi moyvanilia 25 -e cxrilSi.

kvebiTi alergiis gavrcelebis sixSire

kvebiTi alergia, aris alergiis yvelaze xSiri gamovline-
ba sicocxlis pirveli, ramdenime wlis, periodSi. dReisaTvis,
ganviTarebuli qveynebis monacemebiT, 3 wlamde asakis bavSvTa
daaxloebiT 8%-s aReniSneba kvebiTi alergiis esa Tu is ga-
movlineba. bavSvTa daaxloebiT 2,5%-s, sicocxlis I wels, aRe-
niSneba alergia Zroxis rZeze. alergiuli reaqcia kvercxis
mimarT aReniSneba 3 wlamde asakis bavSvTa daaxloebiT 1,6%.
araqisis mimarT - 0,8%-s. amasTan, Tu kvercxisa da rZis mimarT
arsebuli alergia 4 _ 5 wlis asakis Semdeg mniSvnelovan kle-
bas ganicdis, alergia miwis Txilsa da zRvis produqtebze,
umravles SemTxvevaSi, gamoxatulia mTeli cxovrebis ganmav-
lobaSi

cxrili 25.
sakvebiT gamowveuli, ara alergiuli, mavne reaqciebi.

paTologia simptomebi meqanizmebi

dozadamokidebuli
genetikurad ganpiro-
laqtozas autan- Seberiloba, meteori-
bebuli fermentuli
loba zmi, muclis tkivili,
deficiti.
diarea.

dozadamokidebuli
genetikurad ganpiro-
fruqtozas au- Seberiloba, meteor-
bebuli fermentuli
tanloba izmi, muclis tkivili,
deficiti.
diarea.
pankreasis uk- pankreasis enzimTa
maladsorbcia
marisoba deficiti.

132
 RviZlisa da
RviZlis enzimTa de-
sanaRvle gzebis maladsorbcia
ficiti.
daavadebebi

muclis tkivili, baqteriuli to-

sakvebiT mowamv-
Rebineba, diarea, cx- qsinebis arseboba
la
eleba. sakvebSi.

mowamvla skum- kanis egzanTema, angi- Tevzis lpobis pro-

briis ojaxis Te- oSeSupeba, urtikaria, cesSi histidini gar-
viT saxeobiT. muclis tki-vili. daiqmneba histaminad.

kofeinis farmakolo-
tremori, agzneba, giuri efeqti, Sesabam-
kofeini
krunCxva, diarea. isi, aweuli mgrZnob-
elobis pirebze.
Tiraminis farmak-
ologiuri efeqti,
Tiramini Sakiki Sesabamisi, aweuli
mgrZnobelobis pire-
bze.
saxis wamowiTleba,
samwvera nervis uxSiresad, samSobiari
auriko-tempora-
saproeqco areze, travmasTan dakav-
luri sindromi
rac dakavSirbulia Sirebuli, samwvera
(Frey-s sindromi).
saneleblebis miRe- nervis dazianeba.
basTan.
didi raodenobiT,
wyliseburi gamonade-
neirogenuli refle-
SeteviTi riniti ni cxviridan, rac da-
qsi.
kavSirebulia sanele-
blebis miRebasTan.
subieqturi reaqcia;
SiSis gamovlineba
panikis
sakvebis danaxvis fsiqogenuri
gamovlineba
an sunis SegrZnebis
dros.

rac Seexeba mozrdil mosaxleobas, araqissa da Txilze erT-

drouli alergia aReniSneba a.S.S.-is mosaxleobis 1,2%-s. zRvis
produqtebze _ 2,3%-s. inglisSi, kvebiTi alergia aReniSneba
zrdasruli mosaxleobis 1,4 _ 1,8%-s; daniaSi _ 2%-Si.

133
 Zroxis rZe, ZiriTadad, aris pirveli ucxo sakvebi proteini,
romelTanac bavSvs aqvs Sexeba. is aris kvebiTi alergiis ux-
Siresi mizezi mcire asakis bavSvebSi. Zroxis rZiT gamowveuli
alergia, uxSiresad, IgE-damokidebuli procesia. IgE–antisx-
eulebi gamomuSavdeba Zroxis rZis iseTi cilebis antigenebis
sawinaaRmdegod, rogorebicaa kazeini, β-laqtoglobulini da
α-laqtalbumini. aseve, Zalze sayuradReboa is faqti, rom
Zroxis, Txisa da cxvris rZis cilebis antigenebs aqvT msgavsi
struqturebi, ris gamoc maRalia maT Soris jvaredini imu-
nologiuri (alergiuli) reaqciebis ganviTarebis SesaZle-
bloba. garda amisa, daaxloebiT 10% SemTxvevaSi, Zroxis rZis
mimarT sensibilizirebul bavSvebSi, alergia SeiZleba saqon-
los xorcis miRebis Semdegac ganviTardes.
qaTmis kvercxi aris IgE-damokidebuli alergiuli reaqciis
gamomwvevi erT-erTi uxSiresi mizezi bavSvebSi. kvercxis guli
naklebad alergiulia, vidre cila. kvercxis cila Seicavs sx-
vadasxva saxis, 23 glikoproteins. maTgan gansakuTrebiT aler-
giulebia ovomukoidi, ovalbumini da ovotransferini.
sayuradReboa is faqti, rom maRali temperaturis zemo-
qmedebiT, SesaZlebelia kvercxis cilis antigenuri struq-
turis darRveva da amitom, kvercxze alergiis mqone bavSvTa
daaxloebiT 70%-s SeuZlia miiRos kvercxis Semcveli, maRal
temperaturaze damuSavebuli, produqti (mag. namcxvari da
sxva sakvevebi).
araqisi (miwis Txili) kvebiTi alergiis gamomwvevi erT-er-
Ti uxSiresi mizezia 4 welze ufrosi asakis bavSvebSi. araqi-
sis fqvili, zeTi da karaqi, inarCuneben alergiulobas, rac
aucileblad gasaTvaliswinebelia araqisze alergiis mqone in-
dividTa kvebis procesSi.
soias cila warmoadgens iaf da srulfasovan sakveb
produqts, ris gamoc igi farTod gamoyeneba sxvadasxva saxis
sakvebis warmoebaSi. soias cilisagan mzaddeba Cvil bavSvTa
kvebis sxvadasxva produqti, ris gamoc soias cilis mimarT
ganviTarebuli alergia gansakuTrebiT aqtualuria Cvil da
mcire asakis bavSvebSi. kargad rafinirebuli soias cximi nak-
lebad iwvevs alergias. Tumca mis SemadgenlobaSi nanaxia soias
proteinis antigenebi.
Txilis mimarT alergiulia amerikis SeerTebuli Statebis
mosaxleobis daaxloebiT 0,6%.
Tevzi aris alergiis ganviTarebis erT-erTi uxSiresi mizezi

134
mozrdilebSi da xSiri mizezi bavSvebSi. sakvebad gamoiyeneba
Tevzis aseulobiT saxeoba da yoveli maTgani SeiZleba iyos
alergiis ganviTarebis potenciuri mizezi.
kiborCxala aris mozrdilebSi kvebiTi alergiis ganviTare-
bis xSiri mizezi. alergia kiborCxalas produqtebze aReniS-
neba a.S.S.-is mozrdili mosaxleobis daaxloebiT 2,3%-s. am
jgufSi Sedis moluskebis mravali saxeoba da fexsaxsrianebi.
xorblisa da sxva marcleuli kulturis SemadgenlobaSi ar-
sebuli proteinebi, iSviaTad arian bavSvebSi alergiuli rea-
qciis ganviTarebis mizezi. proteinTa im rigidan, romelTac
aRniSnuli sakvebi produqtis mimarT IgE-damokidebuli rea-
qcia SeiZleba gamoiwvios, gansakuTrebiT sayuradReboa glob-
ulini da gluteinis fraqcia. celiakiiT daavadebul bavSvebSi,
gadamwyvetia gliadinis mimarT gamomuSavebuli antisxeulebi.
xolo e.w. “puris mcxobelTa asTmis” dros, alergia viTardeba
proteinis albuminur fraqciaze.

kvebiTi alergiis klinikuri gamovlineba.

kvebiTi alergiis klinikuri gamovlinebis Taviseburebebi
da meqanizmebi mocemulia 26-e cxrilSi.

cxrili 26.
kvebiTi alergiebis klinikuri da imunologiuri daxasiaTeba.

paTologiis Sereuli: IgE

IgE- ara-IgE
gamovlenis damokidebuli +
damokidebuli damokidebuli
Tavisebureba ujreduli

anafilaqsia.
garkveuli
sakvebis miRebis
general-
Semdeg, fizikuri
izirebuli
varjiSis dros
ganviTarebuli
anafilaqsia.
urtikaria,
kontaqturi der-
angioSeSupeba, atopiur derma-
matiti. herpeti-
kanis wamowiTleba, titi. kontaqtu-
formuli derma-
kontaqturi ri dermatiti
titi.
urtikaria.

135
paTologiis Sereuli: IgE
IgE- ara-IgE
gamovlenis damokidebuli +
damokidebuli damokidebuli
Tavisebureba ujreduli

alergiuli
proqtokoliti.
alergiuli eo-
oraluri aler- sakvebi ciliT
zinofiluri
giuli sindromi. inducirebuli
gastrointes- ezofagiti.
gastrointesti- enterokolitis
tinaluri alergiuli eo-
naluri anafila- sindromi.
zinofiluri ga-
qsia. celiakia.
stroenteriti.
Cvil bavSTa ko-
lika.

mwvave rinokoniu-
filtvis hemosid-
respirator- qtiviti.
asTma erozi. (Heiner’-is
uli mwvave bronqos-
sindromi).
pazmi.

kvebiTi alergiis gastrointestinaluri

gamovlineba.

mcenareuli mtvris da kvebiTi alergenebis jvaredini

reaqciebiT gamowveuli sindromis anu oraluri alergi-
uli sindromis (oas) ganviTarebis mizezia alergia sxvadasxva
mcenareuli proteinis mimarT, romelTac sxvadasxva mcena-
reuli mtvris antigenebTan struqturuli msgavseba gaaCniaT.
alergiis simptomebi vlindeba mcenareuli mtvriT sensibil-
izirebul organizmSi garkveuli antigenuri struqturis Sem-
cveli sakvebis moxvedris Semdeg da garda iSviaTi gamonakli-
sisa, lokalizdeba mxolod piris Rrusa da xaxaSi. daavadeba
50_70%-SemTxvevaSi, aRiniSneba aryis xis, ambroziis, da abzin-
das yvavilis mtvriT sensibilizirebul mozrdil pacientebSi.
lokaluri IgE antisxeulebis gaaqtiureba da mastocitebis
degranulacia iwvevs iseTi simptomebis ganviTarebas, rogore-
bicaa enis, tuCebis, piris Rrusa da xaxis lorwovanis SeSupeba
da qavili. viTardeba yurebis dagubebis SegrZneba, yurebisa da
xorxis qavili. simptomebi, rogorc wesi, swrafad warmavalia
da umetes SemTxvevaSi dakavSirebulia axali xilisa da bost-
neulis miRebasTan. ambroziis mimarT alergiis mqone pirebSi,

136
oas-sindromi SeiZleba ganviTardes nesvis, sazamTros, Taflis
produqtebis da bananis miRebis Semdeg. simptomebi upiratesad
viTardeba aryis xis yvavilobis sezonSi da korelaciaSia sisx-
lSi aryis xis mtvris sawinaaRmdego IgE-s koncentraciasTan.
am pacientebSi, oraluri alergiis sindromi, aseve SeiZleba
ganviTardes umi kartofilis, stafilos, vaSlis, kivis, ox-
raxuSis, msxlis da nigvzis miRebisas. aRniSnuli mdgomareo-
bis Tavidan acilebis mizniT, oraluri alergiuli sindromis
mqone pacientebma, ar unda miiRon axali bostneuli da baR-
Ceuli. maTi miReba SesaZlebelia moxarSul mdgomareobaSi.
daavadebis diagnozi emyareba anamnezur da klinikur monace-
mebs da kanis alergiul sinjebs. komerciuli test-sistemebiT
Catarebuli kanis „prik-testebi“ xilsa da bostneulze, umetes
SemTxvevaSi uaryofiTia, radgan eqstraqtebis damuSavebis
procesSi irRveva produqtis antigenuri struqtura.
daavadebis mkurnaloba iTvaliswinebs alergenebis elimina-
cias da specifiur imunoTerapias.
daavadebis mwvave gamovlinebis procesSi naCvenebia
simptomuri mkurnaloba antihistaminuri preparatebiT, kor-
tikostroidebiT da adrenaliniT.
gastrointestinaluri traqtis dauyovnebeli alergiu-
li reaqciebi, rogorc wesi, IgE-damokidebuli reaqciebia da
klinikurad, sxvadasxva organoTa dazianebiTa da simptomTa
mravalferovnebiT xasiaTdeba. simptomebi, rogorc wesi, vi-
Tardeva garkveuli sakvebi produqtis miRebis Semdeg ram-
denime wuTidan _ 2 saaTis ganmavlobaSi. gamoxatulia sxva-
dasxva intensivobis gulisreva, Rebineba, muclis tkivili da
faRaraTi. atopiuri dermatitis mqone bavSvebs, romelTac
alergia kvebiT alergenebze aReniSnebaT, periodulad axasi-
aTebT gulisreva, muclis tkivili da enteritis movlenebi,
rac gastrointestinalur traqtSi mimdinare alergiuli pro-
cesebiTaa gamowveuli. aseT pacientTa intestinalur traqtSi
darRveulia adsorbciis pocesebi, rac mcire asakis bavSvebSi
maladsorbciis ganviTarebis saSiSroebas qmnis.
gastrointestinaluri traqtis kvebiTi alergiis diagnozi
emyareba anamnezis klinikuri suraTisa da kanis alergiuli
sinjebis monacemebs. tardeba saeWvo produqtis, 2 kviriani
eliminaciuri dieta da mdgomareobis gaumjobesebis Semdg
provokaciuli testebi, kvebiTi alergenebis (sakvebi produq-
tis) gamoyenebiT.

137
 gastrointestinaluri traqtis Sereuli _ IgE da ara-IgE-da-
mokidebuli paTologiebi.
alergiuli eozinofiluri ezofagiti, gastriti an gas-
troenteriti SeiZleba mimdinareobdes, rogorc IgE, ise ara-
IgE- damokidebuli alergiuli reaqciebis gziT. aRniSnuli
daavadebebisaTvis damaxasiaTebelia saylapavis, kuWisa da/an
nawlavTa kedlebis lorwovanis eozinofiluri infiltracia,
bazaluri zonis hiperplazia, dvrilebis dagrZeleba da vasku-
litis ar arseboba. pacientTa 50%-s axasiaTebs periferiuli
sisxlis eozinofilia.
alergiuli eozinofiluri ezofagiti diagnostirdeba yve-
la asakSi. Tumca mozrdilebSi misi klinikuri suraTi ufro
gamokveTilia. gamoxatulia qronikuli gastroezofaguri
refluqsis suraTi. mcire asakis bavSvebSi, gulisrevasTan,
disfagiasTan, wamoqafebasa da RebinebasTan, zogad agzneba-
sa da sxeulis masis matebis SeferxebasTan erTad, SeiZleba
gamoixatos gaurkveveli etiologiis gaxangrZlivebuli xvela.
diagnozi emyareba saylapavis lorwovanis bioptatSi eozino-
filuri infiltraciis arsebobas. tipiuria > 20 eo- zino-
filis arseboba 40-ze met mxedvelobis areSi. 8 kviraze meti
xnis ganmavlobaSi, saeWvo sakvebi produqtis eliminaciis Sem-
deg, mdgomareobis klinikuri gaumjobeseba da 12 kviris Sem-
deg, lorwovani garsis histologiuri normalizacia, adas-
turebs diagnozs. aseve, SesaZleblad iTvleba, saeWvo kvebiTi
produqtebiT, provokaciuli testis gamoyeneba 3 _ 5 dRis gan-
mavlobaSi, ris Semdegac adgili unda hqondes simptomTa ganax-
lebas da lorwovanis eozinofilur infiltracias. daavadebis
diagnostirebis mizniT, SesaZleblad miiCneven, inhalaciur an
peroralur, sacdel kortikosteroidul Terapias. ris Sem-
degac, daavadebis alergiuli bunebis SemTxvevaSi, swrafad
unda moxdes mdgomareobis gaumjobeseba.

Cvil bavSvTa kolika warmoadgens iseT simptomTa paroq-

sizmul gamovlinebas, rogorebicaa „umizezo tirili,“ fexebis
krunCxviTi moZraobebi, muclis Seberiloba da daWimuloba,
gazebis didi raodenobiT dagroveba. aRniSnuli mdgomareo-
ba, ZiriTadad, mJRavndeba sicocxlis pirveli 2 _ 4 kviris
asakSi da uxSiresad grZeldeba 3 _ 4 Tvis asakamde. Tumca Sei-
Zleba gagrZeldes ufro met xansac. aRniSnuli mdgomareobis
etiopaTogenezi bolomde garkveuli araa. Tumca fiqroben,

138
rom garkveuli roli, IgE-damokidebul reaqcias unda ek-
uTvnodes. aRniSnuli mdgomareobis diagnostika (alergiuli
paTogenezis dadastureba) rTulia. erT-erT mniSvnlovan sa-
diagnostiko kriteriumad miCneulia simptomTa Semcireba an
mTlianad moxsna, Cvilis hipoalergiul sakveb narevze gaday-
vanis SemTxvevaSi.

gastrointestinaluri traqtis, ara-IgE damokidebuli,

alergiuli paTologiebi.
sakvebi proteinebiT gamowveuli enterokolitis sindromi
ZiriTadad gvxvdeba 1 kviridan 3 Tvemde asakis bavSvebSi da
vlindeba RebinebiTa da diareiT, rac sabolood dehidrataci-
is mizezi xdeba. Rebineba iwyeba kvebidan 1 _ 4 saaTis Semdeg.
viTardeba diarea. ganavalSi, zogjer, naxuloben sisxls.
gamoxatulia muclis daWimuloba da Seberiloba. SeiZleba gam-
ovlindes anemia da ganviTarebis Sefexeba. simptomebi upirate-
sad viTardeba Zroxis rZis an soias proteinis bazaze damzade-
buli sakvebi produqtis miRebis Semdeg. Tumca iSviaTad, vi-
Tardeba dedis rZis miRebis SemTxvevaSic.
aRniSnuli sindromis msgavsi movlenebi aRwerilia Sedar-
ebiT mozrdili asakis bavSvebSi kvercxis, xorblis da qeris
produqtis, brijis, Txilis, araqisis, qaTmis, indauris, Tevzis
da kiborCxalas poduqtis miRebis Semdeg. SemTxvevaTa daax-
loebiT 15%-Si SeiZleba gamovlindes hipotonia. klinika Sei-
Zleba Zalian mkveTrad iyos asocirebuli konkretuli sakvebis
miRebasTan da amavdroulad, kanis “prik-testebi”, aRniSnuli
sakvebis mimarT, iyos negatiuri; rac adasturebs sindromis
ara-IgE-damokidebuli meqanizmis arsebobas.
diagnozi emyareba eliminaciuri dietis Semdeg, 72 saaTis
ganmavlobaSi, mdgomareobis gaumjobesebas da provokaciuli
testis Semdeg, 1 _ 8 saaTis ganmavlobaSi, simptomTa gamovle-
nas.

sakvebi proteinebiT gamowveuli alergiuli koliti, ZiriTa-

dad, sicocxlis pirveli Tveebis ganmavlobaSi vlindeba. sin-
dromi SeiZleba, rogorc Zroxis rZiT an soias cilis bazaze
damzadebuli xelovnuri nareviT kvebas, ise dedis rZis miRebas
ukavSirdebodes. aseTi bavSvebi gamoiyurebian rogorc sruli-
ad janmrTelebi. ganavali monelebulia. magram Seicavs sisxls.
sisxlis kargva, Cveulebriv, umniSvneloa, Tumca zogjer ane-

139
mia viTardeba. diagnozi emyareba, eliminaciuri dietis Semdeg,
72 saaTSi, ganavalSi sisxlis gaqrobas. provokaciuli sinjis
Semdeg, ganavalSi isev Cndeba sisxli.
Zroxis rZiTa da soias proteiniT kvebiT gamowveuli
alergiuli kolitis simptomebi, spontanurad qreba 2 wlis
asakisaTvis.

sakvebi proteiniT gamowveuli enteropaTia (garda celia-

kiisa) viTardeba sicocxlis pirveli, ramdenime Tvis perodSi
da gamoxatulia msubuqi da saSualo intensivobis diareiT da
sxeulis masis cudi namatiT. garda amisa, pacientTa umeteso-
bas aReniSneba Rebineba. ganavalSi momatebulia cximebis ra-
odenoba. am movlenis mizezi, uxSiresad, Zroxis rZis mimarT
arsebuli hipersensitiurobaa. Tuma am tipis enteropaTia,
zogjer, soias, kvercxis, xorblis, brinjis, qaTmis xorcisa
da Tevzis SemadgenlobaSi arsebuli sakvebi proteinis mimarT
arsebuli hipersensitiurobiTacaa gamowveuli.
diagnozi emyareba saeWvo sakvebis eliminaciis Semdeg, mdgo-
mareobis gaumjobesebas. Tumca am process sakmaod didi dro
sWirdeba. mdgomareobis sruli stabilizaciisaTvis saWiroa
ramdenime Tve.

celiakia, aris maladsorbciis gamomwvevi enteropaTiis

erT-erTi yvelaze gavcelebuli forma. am daavadebis dros,
adgili aqvs marcvleul kulturaSi (xorbali, Svria, Wvavi) ar-
sebuli cilis _ gluteinis fraqciis Semadgeneli gliadinis
mimarT arsebul hiper-sensitiurobas, wamwamiseburi epiTelis
atrofias da nawlavTa lorwovanis ujredul infiltracias.
nawlavTa biofsiis dros naxuloben gluteinis mimarT sensibi-
lizirebuli T-limfocitarul infiltracias. sisxlis SratSi
nanaxia gliadinis sawinaaRmdego IgA antisxeulebi. daavadebis
ganviTarebaSi wamyvani mniSvneloba eniWeba genetikur faqtors,
Tumca garkveuli mniSvneloba eniWeba kvebis Taviseburebasac
(gliadiniT mdidari sakvebi).
ZiriTadi klinikuri simptomi warmodgenilia diareiT an
mniSvnelovani steatoriiT. muceli TvalSisacemad didia.
gamoxatulia muclis Seberiloba, gulisreva da Rebineba.
zogjer piris RruSi viTardeba wylulebi. gamoxatulia mal-
adsorbciis sxvadasxva niSani. TvalSisacemia CamorCena fizi-
kur ganviTarebaSi. cximis didi raodenobiT Semcvelobis gamo,

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ganavali aris priala Seferilobis da didi moculobis
daavadebis diagnozi emyareba klinikur monacemebs, gliadi-
nis Semcveli sakvebis eliminaciis Semdeg, 6 _ 12 kviris ganmav-
lobaSi, mdgomareobis TandaTan gaumjobesebas da provokaci-
uli sinjis Semdeg simptomTa Tavidan ganviTarebis faqts. sab-
oloo diagnozisaTvis saWiroa nawlavis lorwovanis biofsia.
daavadebis skriningisaTvis, 2 welze ufrosi asakis bavSvebSi,
gamoiyeneba antigliadinuri IgA antisxeulebis identifikacia.
daavadebis mkurnalobis erTad-erTi realuri saSualeba,
kvebis racionidan gliadinis Semcveli sakvebis eliminaciaa
(xorblis, Wvavisa da qeris nacvlad _ simindis fqvilis gamoy-
eneba), rac mniSvnelovnad amcirebs malignizaciis sarTxes.

kvebiTi alergiiT gamowveuli kanis paTologiebi.

rogorc IgE, ise ara-IgE alergiuli reaqciebi xSirad ari-
an kanis paTologiaTa mizezi. am tipis paTologiebi SeiZleba
gamovlindnen mwvaved (mag. urtikaria da angioSeSupeba) an mim-
dinareobdnen qronikulad (mag. atopiuri dermatiti an kon-
taqturi dermatiti).
herpetiformuli dermatiti warmoadgens qronikuli der-
matitis pustulozur formas, romelic asocirebulia glu-
teinis mimarT hipersensitiurobiT gamowveul enteropaTias-
Tan. gamoxatulia intensiuri qavili da kidurebsa da tanze
simetriulad ganlagebuli papulo-vezikuluri gamonayari.
viTardeba met-naklebi intensivobiT gamoxatuli celiakiis
klinikuri suraTi. nawlavTa lorwovanis biofsiiT naxuloben
celiakiisaTvis damaxasiaTebel morfologiur suraTs. da-
zianebuli kanis biofsiiT, dermalur da epidermalur areSi,
naxuloben IgA-s koncentracias.
sakvebis racionidan gliadinis eliminacia iwvevs mdgomare-
obis gaumjobesebas.
sulfanilamidebis gamoyeneba aumjobesebs kanis mdgomareo-
bas. magram ar moqmedebs gastrointestinaluri traqtis mdgo-
mareobaze.

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 kvbebiTi alergenebT gamowveuli respiratoruli
sistemis paTologiebi.
IgE damokidebuli, Sereuli da ara-IgE damokidebuli hiper-
sen-sitiuroba.
kvbis produqtebis mimarT arsebuli hipersensitiuroba
SeiZleba gaxdes, rogorc zemo, ise qvemo respiratoruli tra-
qtis alergiuli paTologiis ganviTarebis mizezi.
kvebiTi alergenebiT gamowveuli rino-koniuqtiviti araa
alergiis iSviaTi gamovlineba da rogorc wesi, igi yovelTvis
asocirebulia garkveuli sakvebis miRebasTan da sxva alergi-
ul simptomatikasTan. aseT SemTxvevebSi, rino-koniuqtivitis
gamovlineba, Cveulebriv, iwyeba kvebiTi alergenis miRebis
Semdeg, ramdenime wuTidan _ 2 saaTis ganmavlobaSi. viTardeba
periokularuli eriTema, koniuqtiviti, sklerebisa da perio-
kularuli aris qavili, cremldena, cxviris gaWedva an rino-
rea, cxvircemineba da cxviris qavili. am periodSi, nazalur
sekretSi histaminis done 10-jer aWarbebs normas.
kvebiTi alergenebi SeiZleba gaxdnen, rogorc asTmis ise
izolirebuli vizingisis (xmauriani sunTqva) mizezi. Tumca fi-
qroben, rom kvebiTi alergenebi naklebad arian WeSmariti asT-
mis ganviTarebis mizezi da am dros, upiratesad bronqebis war-
mavali hiperreaqtiuloba viTardeba. rigi kvleebis mixedviT,
asTmian bavSTa 6 _ 8,5%-Si Setevis ganviTardeba ukavSirdeba
garkveuli kvebiTi alergenebis miRebas. pacientebs, romel-
Tac aReniSnebaT asTma da atopiuri dermatiti, daaxloebiT
15%-SemTxvevaSi, Seteva unviTardebaT kvebiTi alergenebis
gavleniTac.
diagnozi emyareba anamnezur da klinikur monacemebs. mniSv-
nelovani sadiagnostiko testia saeWvo sakvebi produqtis
eliminaciuri dieta da mdgomareobis gaumjobesebis Semdeg
Catarebuli provokaciuli testi.

ara IgE-damokidebuli hipersensitiuroba.

sakvebiT gamowveuli filtvis hemosiderozi (Heiner-is sin-
dromi) aris iSviaTi sindromi, romlisTvisac damaxasiTaebelia
rekurentuli pnevmoniis epizodebi, filtvis infiltratebi,
hemosiderozi, gastrointestinaluri hemoragia da rkinadefi-
cituri anemia. mcire asakis bavSvebSi gamoxatulia ganviTare-
bis Seferxeba. aRniSnuli sindromis ganviTarebas, uxSiresad,
Zroxis rZis miarT ganviTarebul hipersensitiurobas ukavSi-

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reben. Tumca aRniSnaven iseTi sakvebi produqtebis rolsac,
rogorebicaa kvercxi da Roris xorci. periferiuli sisxlis
eozinofilia da Zroxis rZesTan sisxlis Sratis precipitaciis
unari, klinikur monacemebTan erTad, paTologiis diagnosti-
kis saSualebas iZleva. diagnostikaSi aseve didi mniSvneloba
aqvs saeWvo produqtis elminaciur dietas.

sakvebiT gamowveuli sistemuri reaqciebi

(anafilaqsia).
sakvebTan asocirebuli, fizikuri datvirTviT gamowveu-
li anafilaqsia warmoadgens anafilaqsiis iSviaT formas da
viTardeba mxolod zogierTi sakvebis miRebis Semdeg, 2 _ 4
saaTis ganmavlobaSi ganxorcielebuli Zlieri fizikuri dat-
virTvis pirobebSi. fizikuri datvirTvis gareSe, pirovneba
Cveulebrivad, yovelgvari garTulebis gareSe, miirTmevs am
sakvebs. aseve yovelgvari garTulebis gareSe asrulebs igi fi-
zikur varjiSs, im SemTxvevaSi, Tu es konkretuli sakvebi ara
aqvs miRebuli. pacientebs, anamnezSi, Cveulebriv aReniSnebaT
sxvadasxva alergiuli gamovlinebebi. paTologia ufro xSiria
qalebSi, vidre mamakacebSi da ZiriTadad viTardeba 30 wels
gadacilebul pirebSi. paTogenezi ucnobia. im sakvebi produ-
qtebidan, romlebic asocirebulia sindromis ganviTarebasTan,
ufro xSirad saxeldeba xorblis produqti, kiborCxala, Tev-
zi, xili da oxraxuSi.
diagnozi emyareba damaxasiaTebel klinikur suraTs _ ana-
filaqsiis ganviTarebas fizikuri varjiSis dros. kanis “prik-
testi” pozitiuria im sakvebi produqtis mimarT, romlis mi-
Rebac anafilaqsiaTan asocirdeba. provokaciuli testi unda
Catardes hospitalis pirobebSi.
murnaloba gulisxmobs im sakvebi produqtebisagan Tavis
Sekavebas, romlis mimarTac sensibilizaciaa gamoxatuli an
fizikuri datvirTvis SezRudvas.

sakvebiT ganpirobebuli hipersensitiurobis

sxva gamovlinebebi.
pasterizebuli, auduRari, Zroxis rZiT Cvil bavSTa kveba,
zogjer, kuW-nawlavis traqtidan sisxldenas da rkinadefi-
cituri anemiis ganviTarebas iwvevs. es movlena ufro dama-
xasiaTebelia 6 Tvemde asakis bavSvebSi. am bavSvebis gadayvana
xelovnur sakveb narevze, Tundac Zroxis rZis bazaze damz-

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adebul narevze, romelic Termuladaa damuSavebuli, 3 dRis
ganmavlobaSi iwvevs sisxldenis Sewyvetyas.
aRniSnuli mdgomareobis paTogenezi bolomde garkveuli
araa. cdiloben kavSiris dadggenas am sindromsa da “anTebiTi
nawlavis daavadebas” (Crohn-is daavadeba da wylulovani ko-
liti) Soris. pacientebis sisxlSi nanaxia kvebiTi antigenebis
Semcveli imunuri kompleqsebi. xolo saxsrebis sinovialur
siTxeSi _ mastocitebi. amis gamo fiqroben, rom adgili aqvs
Zroxis rZis mimarT ganviTarebul hipersensitiurobas, rac
garda intestinaluri sistemisa, saxsrebis dazianebis mizezic
xdeba.

sakvebiT gamowveuli mavne reaqciebis diagnostika.

sakvebiT gamowveuli mavne reaqciebis diagnostika, iseve,
rogorc zogadad yvela daavadebis diagnostika, iwyeba srul-
fasovani anamnezis SekrebiT da fizikaluri gamokvleviT, ris
Semdegac wydeba sxva saxis gamokvlevaTa Catarebis mizanSewo-
nilobis sakiTxi.
im anamnezur monacemTagan, romlebic aucileblad gasaT-
valiswinebelia kvebiTi hipersensitiurobis sadiagnostikod,
gansakuTrebiT miniSvnelovania Semdegi sakiTxebi:

• miiRo Tu ara pacientma sakvebi, romelsac SeeZlo arasas-

urveli reaqciis gamowveva?
• ramdeni dasaxelebisaa aseTi kvebis produqti da rogori
iyo TviToeuli maTganis raodenoba?
• ra dro gavida sakvebis miRebasa da paTologiur simptom-
Ta gamovlenas Soris ?
• rogori iyo calkeuli simptomebis gamovlenis Tavisebu-
reba kvebis procesSi an Semdeg ?
• garda sakvebisa, sxva ra faqtorebs SeeZloT emoqmedaT pa-
cientis mdgomareobaze (mag. fizikuri datvirTva) ?
• hqonda Tu ara adre adgili msgavsi simptomebis gamovle-
nas da ra dro gavida bolos ganviTarebuli amgvari reaq-
ciis Semdeg ?
• aReniSneba Tu ara pacients qronikulad mimdinare aler-
giuli daavadebebi (mag. asTma an atopiuri dermatitis) ?
• aReniSneboda Tu ara pacients saerTod, alergiuli gamo-
vlinebebi ?

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 msgavsi monacemebi gvaZleven garkveul mimarTulebas kvebi-
Ti alergiis mizezebis dasadgenad. magaliTad, miRebuli sakve-
bis identifikacia Tundac imitomaa saWiro, rom, rogorc cno-
bilia, mozrdil pirebSi kvebiTi alaergiis mizezi, uxSiresad,
aris araqisi, Txili, Tevzi da kiborCxala. xolo mcire asakis
bavSvebSi rZe, kvercxi, araqisi, soia da xorbali.
imis gamo, rom kvebiTi alergiiT gamowveuli simptomatika
ar xasiaTdeba unikalurobiT da msgavsi simptomebi SeiZleba
Tan axldes sxva etiologiis paTologiebsac, kvebiTi aler-
giiT gamowveuli mdgomareobebis diagnostikisas saWiroa sxva,
mravali, paTologiis gaTvaliswinebac.
kvebis racionis dRiuri warmoadgens sakvebiT gamowveuli
paTologiebis diagnostikis erT-erT gavrcelebul meTods.
pacienti, garkveuli drois ganmavlobaSi skrupulozurad
aRiSnavs miRebuli sakvebis dasaxelebas, raodenobas da gamo-
vlenili paTologiuri simptomebis Taviseburebas. aRniSnuli
monacemebi, xSirad aZlevs saSualebas eqims, daadginos kavSiri
sakvebsa da gamovlenil paTologiur simptomebs Soris.
eliminaciuri diata warmoadgens, sakvebiT gamowveuli pa-
Tologiis, rogorc sadiagnostiko, ise samkurnalo meTods.
eliminaciuri dietis dros, ramdenime dRis ganmavlobaSi,
sakvebi racionidan iReben erT an ramdenime saeWvo produqts
da akvirdebian pacientis mdgomareobas. aRniSnuli meTodi,
zog SemTxvevaSi, efeqturi sadiagnostiko saSualebaa. Tumca,
am dros, aucileblad gasaTvaliswinebelia gastrointestina-
luri paTologiis gamomwvevi, sxva faqtorebis zemoqmedebis
SesaZleblobac.
eliminaciuri dietis erT-erTi saxe iTvaliswinebs pacien-
tis mier, 3 _ 5 dRis ganmavlobaSi, mxolod moxarSuli batknis
xorcis, brinjisa da marilis miRebas. am periodSi mdgomareo-
bis gaumjobeseba adasturebs kvebiTi alergiis arsebobas. amis
Semdeg, pacients, TandaTan, paTologiur simptomTa gamovle-
namde, aZleven sxvadasxva sakveb produqts da adgenen alergiis
gamomwvev mizezs. samwuxarod, aReniSnuli meTodis gamoyeneba
mcire asakis bavSvebSi SeuZlebelia.
kanis “prik-testi” farTod gamoiyeneba kvebiTi alergenebiT
sensibilizaciis sadiagnostikod. Tumca masac, rogorc yvela
sadiagnostiko saSualebas, aqvs Tavisi pozitiuri da negatiu-
ri mxareebic: “prik-testi” teqnikurad advilad Sesasruler-
belia, atravmatulia, iafia da maRali specifiurobiT gamoir-

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Ceva, Tumca intradermalur testTan SedarebiT naklebad sen-
sitiuria. amasTan, kvebiTi alergenebis testirebisas, zogierT
SemTxvevaSi, adgili aqvs Sedegebis interpretaciis garkeul
sirTulesac; magaliTad: zogierTi kvebiTi alergeni, testi-
rebisas warmoqmnis 3 mm-amde diametris buStuks, rac aRema-
teba negatiuri kontrolis zomas, magram Znelad CaiTvleba,
rogorc pozitiuri pasuxi. amitom, sxvadasxva kvebiTi alerge-
nebis testirebiT miRebuli Sedegebis interpretacia SeiZleba
gansxvavebulic iyos. mag. dReisaTvis Tvlian, rom rZis, kver-
cxisa da araqisis testirebis Sedegi dadebiTia, Tu buStukis
diametric > 8 mm-ze. amasTan aucileblad gasaTvaliswinebelia
is faqti, rom kanis pozitiuri testi aCvenebs ara alergensa
da paTologias Soris mizez-Sedegobriv kavSirs, aramed aR-
niSnul alergenze sensibilizaciis faqts. kanis testirebiT
gamovlenili alergeni maSin iTvleba paTologis mizezad, Tu
dadgenilia kavSiri am antigenis Semcveli sakvebis miRebasa da
paTologiuri mdgomareobis ganviTarebas Soris. garda amisa,
gasaTvaliswinebelia erTi imniSvnelovani garemoebac: kanis
alergiuli testi da maT Soris “prik-testi” adasturebs IgE
damokidebuli reaqciis arsebobis SesaZleblobas, magram ver
gamoavlens II, III an IV tipis alergiuli reaqciis arsebobas.
garda amisa arsebobs sxva mizezebic, romlebic zRudaven
kvebiTi alergiis diagnostirebas kanis testebis saSualebiT:

• mravali xilisa da bostneulis antigenebi, (vaSli, ci-

trusi, banani, atami, kartofili, stafilo, nesvi) romle-
bic komerciuli formiT gamoiyeneba testirebisaTvis,
Zalian advilad inaqtivirdebian da kanis alergiuli
testirebis dros, ar iZlevian realur suraTs.
• zog SemTxvevaSi, komerciul eqstraqtebSi alergenebis
koncentracia mcirea, vidre axal bostneulSi an xilSi
da maTi saSualebiT Catarebuli testirebis Sedegi ar
aris realurad arsebuli mdgomareobis gamomxatveli.
• 1 wlamde asakis bavSvebSi, kanis testma SeiZleba ar gamoa-
vlinos IgE damokidebuli reaqcia. xolo 2 wlamde asa-
kis bavSvebSi, kanis reaqcia SeiZleba iyos ufro susti,
vidre SedarebiT mozrdilebSi.
• kvebiTi alergenebiT Catarebuli kanis testi, SeiZleba
seriozuli alergiuli garTulebis mizezi gaxdes.

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 intradermaluri testi ufro sensitiuria, magra nalkebad
specifiuri vidre “prik-testi.”
kvebiT alergenebze organizmSi arsebuli specifiuri IgE-
antisxeulebis identificirebis erT-erTi yvelaze zusti
meTodi, am antisxeulebis in vitro testirebaa (RAST, ELISA da
sxva). meTods axasiaTebs maRali sensitiuroba da speciciu-
roba. misi uaryofiTi maxasiTaeblebia siZvire da droSi, gark-
veulad, dagvianebuli pasuxi.
kvebiTi provokaciuli testi, ormagi-brma-placebo meTodiT,
warmoadgens kvebiTi alergiis diagnostikis oqros standarts.
testirebisaTvis saWiro sakvebis SerCeva xdeba anamnezis, kanis
testebisa da specifiuri IgE-s kvlevis Sedegebis mixedviT.
sakontrolod gamoiyeneba sakvebi, romlis mimarT toleran-
tulobac, arc erTi monacemis mixedviT, eWvs ar iwvevs. tes-
tirebis win, 7 _ 14 dRis ganmavlobaSi, vaxdenT saeWvo produq-
tis elminacias. pacienti ramdenime dRis ganmavlobaSi ar unda
iRebdes antihistaminur preparatebs. sasurvelia yvela saxis
medikamentis miRebis minimumamde Semcireba. zogierT asTmian
pacientebSi, Setevis prevenciisaTvis, sakvebiT provokaciuli
testis Catarebamde, rekomendirebulia k.s.-is mokle kur-si,
ise, rom FEV1 > 70%-ze.
provokaciuli testis Catareba xdeba liofilizirebuli
sakvebis 5 _ 25 mg-is raodenobis micemiT, yovel 15 _ 60 wuT-
Si. pacients sakvebi eZleva specialuri kafsulebis an xsnaris
saxiT. bunebrivia, rom pacientma, am etapze, ar icis _ iRebs
savaraudo alergens Tu sakontrolo sakvebs. Tu 10 g. kumu-
laciur dozaze alergiuli reaqcia ar gamovlinda _ Sedegi
negatiurad unda Sefasdes. anu konkretuli sakvebi produqti,
alegiuli daavadebis savaraudo gamomwvevTa rigidan unda amo-
vardes. amis Semdeg, sakvebis micema SesaZlebelia gagrZeldes
bunebrivi formiT, mcire ulufebiT da pacients vakvirdebiT
kidev ramdenime saaTis ganmavlobaSi, raTa gamoiricxos cru-
dadebiTi reaqciis arsebobis SesaZebloba. IgE-alergiis arse-
bobis sadiagnostikod, cda, saSualod, grZeldeba 2 saaTis gan-
mavlobaSi; rZiT gamowveuli enterokolitis sadiagnostikod
_ minimum 4 _ 8 saaTis ganmavlobaSi da alergiuli eozinofi-
luri gastroenteritis sadiagnostikod _ 3 _ 4 dRis ganma-
vlobaSi. cdis procesSi gaTvaliswinebuli unda iyos yvela is
faqtori (fizikuri, fsiqologiuri, medikamentozuri da sxva),
romelTa zemoqmedebamac SeiZleba gavlena moaxdinos testis

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Sedegze. testirebis procesSi, garda simptomTa klinikuri
gamovlinebis monitoringisa, SeiZleba gakontroldes sisxlis
plazmaSi histaminis done da bronqebSi haernakadis moZraobis
Tavisebureba (PEF).
ara-IgE damokidebuli kvebiTi alergiis gamosavlenad Cata-
rebuli provokaciuli testirebis dros, pacients, sxeulis
masis 1 kg.-ze, 1 an 2 miRebaze, vaZlevT saeWvo sakvebis 0,15
_ 0,3 g. iseTi, ara-IgE damokidebuli alergiuli daavadebe-
bis dros, rogorebicaa alergiuli eozinofiluri ezofagiti
an gastroenteriti, provokaciuli dieta SeiZleba 1 _ 3 dRe
gagrZeldes.
kvebiTi provokaciuli testis Catarebisas, yoveli axali
testi SeiZleba Catardes wina tetis Catarebidan, minimum 3 _
5 dRis Semdeg.
provokaciuli alergiuli testebi tardeba hospitalSi,
sadac yvela piroba arsebobs garTulebebis Tavidan acile-
bisa da anafilaqsiis ganviTarebis SemTxvevaSi, kvalificiuri
gadaudebeli daxmarebis CatarebisaTvis.

kvebiTi alergiis mkurnaloba.

sakvebiT gamowveuli alergiis ama Tu im formis diagno-

zis dasmisa da paTologiis gamomwvevi sakvebis identifikaciis
SemTxvevaSi, aulilebelia sakvebis racionidan am produqtis
(an produqtebis) eliminacia. eliminaciuri dieta, rigi fsiqo-
logiuri da sxvadasxva faqtorebis gamo, araa iolad Sesaru-
lelebeli mkurnalobis meTodi. amitom, pacients da/an mis
mSoblebs kargad unda avuxsnaT kvebiTi alergiis arsi da
eliminaciuri dietis mniSvneloba. aseve unda avuxsnaT aler-
giis gamovlenis simptomTa (gansakuTrebiT sistemuri aler-
giis simptomTa) Tavisebureba, SesaZlo Sedegebi da pirveli
daxmarebis principebi. pacientebma unda icodnen ras niSnavs
“jvaredini” alergiuli reaqciebi; ra risks Seicavs “ojaxuri
alergiis” anamnezi da unda SeeZloT saeWvo sakvebi produqtis
garCeva paketze arsebuli Strix-kodebis mixedviT.
eliminaciuri dieta gansakuTrebiT rTuli Casatarebelia
erTdroulad mraval sakveb produqtze arsebuli alergiisa
da mcire asakis bavSvebSi rZis mimarT gamovlenili alergiis
SemTxvevaSi. am dros, sakvebi produqtebis SezRudvis gamo,

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mcire asakis bavSvebSi, mosalodnelia proteinis naklebobisa
da malnutriciis ganviTareba. amitom, mcire asakis bavSvebSi
unda gamoviyeno specialuri hipoalergiuli sakvebi narevi,
romelic balansirebul kvebas uzrunvebelyofs.
eliminaciuri dietis daniSvnisas, aucileblad gasaTva-
liswinebelia is faqti, rom kvebiTi alergiis gamovlinebis
simZafre da droSi xangrZlioba, damokidebulia sisxlis Srat-
Si am produqtis antigenebis sawinaaRmdego IgE antisxeulebis
doneze, romelic droTa ganmavlobaSi SeiZleba Seicvalos.
mag. cnobilia, rom rogorc bavSvebSi, ise mozrdilebSi, aler-
gia rZeze, kvercxze, araqisze da Txilze droTa ganmavlobaSi
icvleba da zogjer ikargeba kidec. erT-erTi gamokvlevis Ta-
naxmad, Tu araqisis antigenebis sawinaaRmdego IgE-antisxeu-
lebis done sisxlis SratSi < 2 KUa/L, araqisis miRebis Semdeg,
alergiis klinikuri gamovlinebis SesaZleblobam SeiZleba
mniSvnelovnad daiklos.
iseTi medikamentebi, rogorebicaa H1 da H2 antihistaminuri
preparatebi, ketotifeni, kortikosteroidebi da leikotrien-
bis antagonistebi amcireben adgilobrivad gamoxatul aler-
giul simptomatikas, magram mniSvnelovan gavlenas ver axde-
nen sistemur alergiul reaqciaze. oraluri k.s. efeqturni
arian qronikuli alergiuli reaqciebis samkurnalod, magram
maTi seriozuli gverdiTi efeqtebi mniSvnelovnad zRudaven
am preaparatebis gamoyenebas. bolo xanebSi gaCnda mravali mo-
nacemi IgE-damokidebukli alergiuli reaqciebis dros anti-
IgE monoklonaluri antisxeulebis gamoyenebis efeqturobis
Sesaxeb.
kvlav mniSnelovan samkurnalo saSualebadaa miCneuli spe-
cifiuri imunoTerapia. bolo xanebSi warmoebulia kvebiTi
alergenebis rekombinantuli vaqcinebi, romlebic imunoTera-
piis peroraluri gziT Catarebis saSualebas iZlevian.
peroraluri imunoTerapia (desensibilizacia) SeiZleba Ca-
tardes ara mxolod komerciuli antigenebis, aramed natura-
luri sakvebi produqtebis saSualebiTac. erT-erTi avtoris
monacemebiT, rZis mimarT alergiis mqone bavSvTa 70%-Si da
kvercxis mimarT alergiis mqoneTa 80%-Si, am sakvebi produq-
tebis mcire dozebiT miReba mravali Tvis ganmavlobaSi, iwvevs
maTze tolerantobis ganviTarebas. Tumca am kontingentis Ti-
Tqmis naxevars, desensiblizaciis procesSi, aReniSneboda met-
naklebi intensiobiT gamoxatuli, hiperergiuli reaqciebi. am

149
gamokvlevebis mixedviT, bavSvebi tolerantulni rCebodnen
sakvebi produtis mimarT manamade, sanam agrZelebdnen daax-
loebiT 6,8g. raodenobis, dRiuri, oraluri, dozis miRebas.
desensibilizaciis Sewyveta 10-15 dRis ganmavlobaSi da Semdeg
sakvebis miReba, iwvevda seriozuli alergiuli reaqciebis gan-
viTarebas.

kvebiTi alergiis ganviTarebis prevencia.

kvebiTi alergiis ganviTarebis prevencia iseve rTulia,
rogorc alergiis nebismieri formis. bolo wlebSi Catare-
buli gamokvlevebi, romlebic tradiciulisagan gansxavavebiT
warmogvidgenen alergiis ganviTarebis meqanizms, iZlevian imis
imeds, rom SesaZlebeli gaxdeba alergiis prevenciis efeqturi
meTodebis SemuSaveba.
miuxedavad imisa, rom am sakiTxis mimarT erTiani midgoma
ar arsebobs da bolo xanebSi am mimarTulebiT garkveuli skep-
sisic aRiniSneba, mkvlevarTa didi nawili Tvlis, rom dedis
rZiT kveba, alergiis prevenciis erT-erTi yvelaze efeqturi
saSualebaa. iq, sadac dedis rZiT kveba SeuZlebelia, riskis
jgufis bavSvebSi an gamovlenili alergiis SemTxvevaSi, naCven-
ebia hipoalegiuli sakvebi narevebis gamoyeneba. aseve mniS-
vnelovnad iTvleba, riskis jgufis orsulebSi Zroxis rZis,
kvercxis da araqisis miRebis SezRudva. miaCniaT, rom amgvari
dietis Sedegad, axalSobilebSi da CvilebSi, mcirdeba ato-
piuri dermatitis ganviTarebis SesaZlebloba. aseve saWirod
miaCniaT Zroxis rZisa da kvercxis SezRudva riskis jgufis
(atopiuri ojaxuri da personaluri anamnezi) axalSobilebsa
da CvilebSi.
im faqtebis gamo, romlebic amtkiceben baqteriuli
produqtebis saSualebiT Th1 imunuri pasuxis aqtivaciis Sesa-
Zleblobas, ramdenime avtori, orsulobis bolo trimestrisa
da axalSobilobis periodis ganmavlobaSi, alergiis preven-
ciisaTvis, SesaZleblad miiCnevs laqtobaqteriebis Semcveli
kulturebis gamoyenebas. isini aRniSnaven, rom prevenciis es
meTodi, axalSobilebsa da CvilebSi, amcirebs atopiuri derma-
titis ganviTarebis SesaZleblobas.

150
 ▶ medikamentozuri alergia
medikamentebiT gamowveuli gverdiTi reaqciebi SeiZleba
daiyos:
1. mosalodneli reaqciebi _ romelTa ganviTarebac mosa-
lodnelia medikamentis farmako-qimiuri Taviseburebebidan
gamomdinare (toqsiuroba, sinergizmi da antagonizmi sxva me-
dikamentis mimarT, dozadamokidebuli toqsiuroba da sxva).
2. moulodneli reaqciebi _ romlebic naklebadaa damokide-
buli medikamentis farmako-qimiur specifikaze da ufro
damokidebulia pacientis organizmis Taviseburebebze (idi-
osinkrazia, alergia, fsevdoalergia).

cxrili 27.
medikamentebis gverdiTi reaqciebis klasifikacia.

medikamentis reaqcia gamovlenis forma da magaliTi

reaqcia aReniSneba normalur pacientTa umetesobas da dakavSi-
rebulia medikamentis dozasa da miRebis xangrZliobaze (reaqciis
A-tipi)

hiperdozireba RviZlis dazianeba (acetaminofeni)

gulisreva, Tavis tkivili

gverdiTi efeqti
(meTilqsantini).

kuW-nawlavis traqtis
meoradi an arapirdapiri
baqteriuli floris cvlileba
efeqti
antibiotikoTerapiis Semdeg

eriTromicini aferxebs
digoqsinisa da Teufilinis
medikamentebis urTierT-
gamoyofas, ris gamoc sisxlSi
qmedeba
imatebs am preparatebis kon-
centracia

medikamentebis mimarT arsebuli hipermgrZnobeloba, romelic ga-

moxatulia mosaxleobis mTliani populaciis mcire nawilSi (re-
aqciis B-tipi).

aspirinis erTjeradi dozis

intolerantuloba
miRebis Semdeg xmauri yurebSi.

151
 idiosinkrazia (farmakoge- g.6.f.d.-s deficiti: anemia
netikuri) antioqsidantebis miRebis Semdeg.

imunologiuri reaqcia (al- anafilaqsia β-laqtamuri

ergia) antibiotikis miRebis Semdeg.

eqimTa gamsakuTrebuli yuradRebis sagania alergiuli da

idiosinkraziuli reaqciebi, romlebic alergiis klinikuri
formiT vlindebian da ganixilebian, rogorc fsevdolergi-
uli reaqciebi.

epidemiologia.
medikamentebis gverdiTi reaqciebi aReniSneba hospital-
izirebul pacientTa 10% _ 20%-s da ambulatoriul pacientTa
25%-s. Tumca, ra Tqma unda, es monacemebi zusti araa, radgan
aseTi reaqciebis zusti aRricxva praqtikulad SeuZlebelia.
medikamentebis gverdiTi reaqciebis udidesi wili “A-tipze”
modis. “B-tipis” reaqciebi SedarebiT iSviaTia da Seadgens
mTlianad gverdiTi reaqciebis daaxloebiT 6% _ 10%-s. aqe-
dan, yvelaze xSiria hiperergiuli reaqciebi β-laqtamuri anti-
biotikebisa da arasteroiduli antianTebiTi medikamentebis,
radiokontrastuli, neiro-muskulatoruli blokerebis da an-
tipiretiuli preparatebis mimarT. dauyovnebeli alergiuli
reaqciebi adgilobrivi anestetikebis mimarT, SedarebiT iS-
viaTia.
medikamentebiT ganpirobebuli, alergiuli garTulebebis
uxSiresi klinikuri gamovlinebaa urtikaria. SedarebiT iSvia-
Tia anfilaqsia, toqsiuri epidero-nekrolizi, Stevens–Johnson-
is sindromi da imunuri hepatiti. a.S.S.-Si, medikamentebis gver-
diTi reaqciis gamo hospitarlizciis yoveli 300 SemTxvevidan
1 fatalurad mTavrdeba, ramac 1994 wels Seadgiana sikvdilis
106000 SemTxveva. aqedan, daaxloebiT 6% _ 10% alergiul rea-
qciebze modioda.

hiperreaqtiulobis ganviTarebis risk-faqtorebi.

cxrili 28.
medikamentebiT gamowveuli alergiis ganviTarebis risk-faqtorebi.

152
 mizezobrivi
risk-faqtorebi
faqtorebi
• polimerizacia an makromolekuluri kontami-
nacia.
• proteinuli reaqtiuloba.
• doza da mkurnalobis xangrZlioba.
• jvaredini reaqciis unaris mqone epitopis ar-
medikamentebi
seboba.
• medikamentis miRebis sixSire.
• medikamentSi raime Senarevis arseboba (mag. ace-
tilsalicilis mJavas anhidridis arseboba
acetilsalicilis mJavaSi (aspirinSi).
• moiTxovs xangrZliv an mravaljerad ganmeore-
biT mkurnalobas (mag. kistofibrozi, qroniku-
li sinusiti, imunodeficiti).
• sxvadasxva medikamentiT erTdrouli mkrnalo-
daavadeba
ba (mag. alopurinoli, amoqsicilini).
• konkretuli daavadebis dros konkretuli me-
dikamentis mier gamowveuli reaqcia ( mag. EBV
da amoqsicilini; SidSi da sulfanilamidi).
• medikamentozuri reaqcia anamnezSi.
• atopia anamnezSi.
• multimedikamentozuri alergiis sindromi.
•
individualu-
medikamentebze ganviTarebuli persistuli
ri.
imunuri reaqcia (imunuri pasuxi).
• mdedrobiTi sqesi (hemifloqsaciniT gamowve-
uli gamonayari).
qronikuli daavadebebi, romlebic garkveuli medikamente-
biT xangrZliv an xSirad ganmeorebad mkurnalobas saWiroeben
an jvaredini alergiuli reaqciis unaris mqone medikamente-
biT mkurnaloba, xSiradaa alergiuli reaqciebis ganviTare-
bis mizezi. alopurinolisa da meTilpenicilinis erTdrouli
gamoyeneba Zalian xSirad iwvevs egzanTemis ganviTarebas. aseve
xSiria alergiis gamovlenis SemTxvevebi SidsiT daavadebul pa-
cientebSi sulfanilamidebis miRebis Semdeg. medikamentozuri
alergiis ganviTarebis mniSvnelovani risk-faqtoria anamnez-
Si aseTi reaqciis arseoba. atopuri pacientebi warmoadgenen
riskis jgufs penicilinze mZime, da zogjer sicocxlisaTvis
saSiSi, alergiuli reaqciis (anafilaqsiis) ganiTarebisaTvis.
antibiotikebze alergiis mqone mSoblebis SvilebSi, saerTo
populaciasTan SedarebiT, 15-jer maRalia medikamentozuri

153
alergiis ganviTarebis riski. sxvadasxva medikamentebze aler-
giis ganviTareba gansakuTrebiT xSiria penicilinze alergiis
mqone individebSi. medikamentozuri alergiis ganviTarebis
imunogenetikuri safuZvlebis arsebobaze mravali faqti miu-
TiTebs. aRniSnuli kvlevebis safuZvelze Camoyalibda defi-
nicia: «multimedikamentozuri alergiis sindromi», romelic
individis metabolizmis TaviseburebiT gamowveuli polimedi-
kamentozuri alergiis daxasiaTebisaTvis gamoiyeneba.

fsevdoalergiuli reaqciebi.
alergiis klinikuri formiT gamovlenili medikamentozu-
ri reaqciebi, romelTa imunologiuri meqanizmebi gaSifruli
araa, cnobilia, rogorc «araalergiuli hipemgrZnobelobiTi
reaqciebi» an, rogorc «fsevdoalergiuli medikamentozuri
reaqciebi». aseTi reaqciebi mimdinareoben imunologiuri fa-
zis gareSe, Tumca paToqimiuri da paTofiziologiuri fazebi
iseTive meqanizmebiT viTardeba, rogorc WeSmariti alergiuli
reaqciebis dros. aseTi reaqciebis magaliTia radiokontras-
tul nivTierebebze ganviTarebuli urtikaria da anafilaqsia,
opiatebiT gamowveuli urtikaria da aspirin-inducirebili
asTma.
cxrili 29.
medikamentozuri hipermgrZnobelobis magaliTebi.
idiosinkraziuli
imunologiuri (alergiuli)
(fsevdoalergiuli)
• anafilaqsia β-laqtamebze. • radiokontrastuli nivTier-
• halotaniT gamowveuli hep- eebebiT gamowveuli Soki.
atiti. • aspiriniT gamowveuli asTma.
• protaminiT gamowveuli hi- • opiatiT gamowveuli urtika-
potonia. ria.
• sulfanilamidiT gamowveu- • protaminiT gamowveuli pul-
li dermatiti. monaluri hipertenzia.
• feniTioniT an cefaklor- • a.s.a.a.m.-iT gamowveuli urti-
iT gamowveuli Sratis daa- karia.
vadeba. • qolinebiT gamowveuli hemo-
• izoniazidiT gamowveuli lizuri anemia.
hepatitis. • likaluri anestetikebiT ga-
• qvinonebiT gamwveuli mowveuli sinkope.
Trombocitopenia • vankomicinis infuziis dros
• fenoftaleiniT gamowveu- ganviTarebuli wamowiTleba.
li fiqsirebuli gam- • ciprofloqsacinis miRebiT
onayari. gamowveuli mwvave reaqcia.

154
 radiokontrastuli nivTierebebiT gamowveuli anafilaqsi-
is da urtikariis paTogenezi bolomde garkveuli araa. Tumca
mravali monacemi miuTiTebs, rom aseTi reaqciebi, upirates-
ad, im pirebSi viTardeba, visac zRvis produqtebze aReniSne-
baT alergia. radio-kontrastuli nivTierebebiT gamowveuli
fsevdoalergiuli reaqciebis Tavis arideba SesaZlebelia di-
agnostikuri proceduris Catarebamde kortikosteroidisa da
antihistaminuri preparatis miRebiT. amgvari profilaqtika
naCvenebia maRali riskis mqone pacientebSi; gansakuTrebiT
maSin, rodesac saxezea atopiuri anamnezi da kardio-vasku-
laruli paTologia. ra Tqma unda riski Zalian maRalia Tu
sxezea medikamentozuri alergiis, zRvis produqtebis mimarT
gamoxatuliu alergiisa da gansakuTrebiT iodkontrastul
nivTierebebze alergiis (Tu fsevdo alergiis) gamovlenis an-
amnezi.
aspirini da misi msgavsi preparatebi (a.s.a.a.p) SeiZleba ori
saxis ara alergiuli hipemgrZnobelobis mizezi gaxdnen. asTmis
mqone pacientebSi aspirinma SeiZleba mwvave bronqospazmi an
rinosinusiti gamoiwvios. sxva msgavsi preparatebi, jvaredini
reaqtiulobis principiT iwveven msgavs sindromebs. lokaluri
saanesTezio saSualebebi iolad axdenen organzmis sensibil-
izacias topikaluri aplikaciis SemTxvevaSi. magram antisxe-
ulebze damokidebuli alergiuli reaqcia am tipis preparate-
bze Zalian iSviaTia. adgilobriv anestetikebze ganviTarebuli
fsevdo-alergiuli reaqciebi, romlebic uxSiresad stoma-
tologiur praqtikaSi gvxvdeba, eqimis seriozuli SeSfoTebis
mizezi xdeba. am tipis reaqciebis yvelaze saSiSi gamovlineba
vazo-vagusuri sinkopea, rac klinikuri gamovlinebis Tavise-
burebis gamo, SeiZleba anafilaqsiad iyos Sefasebuli. Tumca
es ar niSnavs, rom lokalur anestetikebze IgE damokidebuli
reaqcis ar viTardeba. kanis intra dermaluri testebi da pro-
vokaciul sinjebis seria aris, am SemTxvevaSi, swori diagnos-
tikisa da menejmentis safuZveli.

155
 cxrili 30.
medikamentozuri alergiuli da idiosinkraziuli reaqciebis gan-
masxvavebeli niSnebi.

gamoxatuleba alergiuli idiosinkrazia

upiratesad gamoxatu-
lia medikamentebis
aris ar aris
mimarT reaqciis ganvi-
Tarebis riski.

riskis persistireba icvleba droSi. variabeluria

damokidebulia damokidebulia
jvaredini reaqtiulo-
saerTo struq- saerTo funqci-
bis Tviseba.
turaze aze

medikamentozuri alergiis diagnostika.

medikamentozuri alergiis diagnostika iwyena anamnezisa
da klinikuri Taviseburebis gaanalizebiT. Tu pacienti iRebs
erT medikaments da alergiuli reaqcia gamovlinda prepara-
tis miRebidan 2 sa-aTis ganmavlobaSi, maSin diagnozis dasma
rTuli araa da es TviT pacients an misi ojaxis wevrsac Seu-
Zlia. roca saqme gvaqvs ramdenime medikamentis erTdroulad
miRebasTan, am SemTxvevaSi reaqciis gamomwvevi medikamentis
identificireba rTulia da aucileblad moiTxovs special-
istis konsultacias. aseT SemTxvevebSi saWiroa mdgomareobis
Sefasebis 6 safexuriani sistemis gamoyeneba.

cxrili 31.
ramdenime medikamentis miRebis pirobebSi ganviTarebuli alergi-
uli reaqciis Sefasebis 6 safexuriani sistema.

medikamentozuri alergiis kvlevis safexurebi pacientebSi, romle-

bic erTdroulad ramdenime medikaments iReben.

1. klinikuri monacemebi:
a) medikamentebis gverdiTi moqmedebis anamnezi.
b) atopiuri anamnezi.
g) aRricxeT miRebuli medikamentebi. maTi miRebis dasawyisi, da-
mTavrebis dro da dozis cvlileba.

156
 d) iRebda Tu ara adre analogiur medikamentebs an iseT
medikamentebs, romlebic jvaredini alergiuli reaqciis
SesaZleblobas qmnian amJamad miRebul medikamentebTan.
e) amJamad gamovlenili medikamentozuri reaqciis Taviseburebis
qronologiuri aRwera. rutinuli laboratoriuli kvlevis
(periferiuli sixlis leikocitebis raodenoba, ezinofilia,
e.d.s., triftaza, proteinuria) Catareba.
2. seriozuli yuradReba gaamaxvileT Semdeg momentebze:
a) klinikurad gamovlenili reaqciis kavSiri medikamentis mi-
Rebis an Sewyvetis momentTan.
b) ras ukavSirdeba simptomTa gamZafreba an Sesusteba?
3. ganixileT pacientis mier miRebuli medikamentebis farmakologi-
uri Taviseburebebi da alergiuli reaqciis unaris SesaZleblobebi.
4. SewyviteT yvela im preparatis miReba, romelTac SeuZliaT aler-
giuli reaqciis ganviTareba da romelTa miRebac, konkretul SemTx-
vevaSi, met-naklebad asocirebulia gamoxatul reaqciasTan.
5. ganixileT kanis alergiuli sinjis Catarebis SesaZleblobis
sakiTxi, Tu saeWvo medikaments SeuZlia IgE reaqcis gamowveva. kanis
testis Sefasebisas mxedvelobaSi miiReT, rom mwvave anafilaqsiis
Semdeg 14 dRis ganmavlobaSi, kanis alergiuli testi SeiZleba iyos
negatiuri (cru negatiuri testi).
6. isev ganaaxleT pacientisaTvis saeWvo medikamentis micema da daak-
virdiT movlenaTa ganviTarebas.

kanis alergiuli sinjebi.

dauyovnebeli reqciiT gamovlenili sinji.
β-laqtamur antibiotikebsa da sxva imunogenur medikamen-
tebze Catarebukli, kanis “prik” an intradermaluri testebi
warmatebiT gamoiyeneba medikamentozuri alergiis sadiagno-
stikod. Tumca igive preparatebze Catarebuli sinjebi, zog
SemTxvevaSi, “cru uaryofiT reaqciasac” avlenen. pacientebSi,
romelTac erTxel ukve aReniSnebodaT alergiuli reaqcia
penicilinze, am preparatiT ganmeorebiTi mkuralobis SesaZ-
leblobis sakiTxi unda ganixilebodes winaT ganviTarebuli
reaqciis anamnezis Taviseburebisa da kanis testebis Sedegebis
mixedviT. gamokvlevebiT dadasturebulia, rom penicilinze
alergiis anamnezis da amasTan erTad, kanis negatiuri teste-
bis mqone pirebSi am preaparatze ganviTarebuli alergia, Zi-
riTadad sustad gamoxatuli klinikiT SeiZleba gamovlindes.
amasTan, penicilinze alergiis anamnezis mqone pirTa 80%-Si
kanis sinjebi negatiuria. Tumca peniciliniT ganmeorebiTi

157
mkurnalobis da resensibilizaciis procesSi SesaZlebelia
kanis testebi gaxdes pozitiuri da alergiis klinikuri ga-
movlinebac gaZlierdes. pacientebSi, romelTac anamnezSi pe-
nicilinis mimarT alergia aReniSnebaT da gansakuTrebiT maSin,
Tu sisxlSi maRalia IgE-s koncentracia, penicilinis jgufis
preparatebiT mkurnalobis dawyebamde aucileblad unda Cau-
tardeT kanis alerguiul testi. garda penicilinis jgufis
antibiotikebisa, kanis alergiuli sinjis diagnostikuri Ri-
rebuleba aseve maRalia cefalosporinebis mimarT arsebuli,
IgE damokidebuli, hiperreaqtiulobis SemTxvevaSi. cefalo-
sporinebze kanis pozitiuri alergiuli testis arseboba ada-
sturebs am preparatis mimarT IgE hipersensitiurobas. Tumca
testis negatiuri pasuxi ar gamoricxavs preparatis miRebis
Semdeg hiperergiuli reaqciis ganviTarebis SesaZleblo-
bas. intradermaluri teqnikiT Catarebuli, kanis alergiuli
testis sadiagnistiko Rirebulebaze miuTiTeben imipemenisa da
sxva β-laqtamuri antibiotikebze ganviTarebeli alergiuli
reaqciebis drosac. Tumca dRemde araa SemuSavebuli kliniku-
ri protokoli, romelic kanis alergiuli testebis saSualebiT,
antibiotikebis mimarT arsebuli alergiis diagnostikisaTvis
iqneba mowodebuli.
kanis alergiuli sinjis mcire, magram mainc, sadiagnosti-
ko Rirebulebaze miuTiTeben sulfanilamidebze, ciproflo-
qsacinze, trimetoprimze, neiro-muskulatorul blokerebze,
triobarbituratebze, zogierT antikonvulsantebze da adgi-
lobriv anestetikebze alergiis arsebobis SemTxvevaSi.

IN VIRTO kvleva.
medikamentozuri alergiis laboratoriuli kvleva war-
matebiT xorcieldeba calkeul SemTxvevebSi. am mxriv gansa-
kuTrebiT gavrcelebulia specifiuri IgE-s identifikacia
RAST-is (radio-alergosorbentuli) meTodiT. aRniSnu-
li kvleva upiratesad tardeba kanis pozitiuri alergiuli
testis monacemis dasadastureblad. amasTan unda iTqas, rom
kanis alergiuli testebisa da in vitro kvlevis Sedegebis sruli
damTxveva ar xdeba da am SedegTa damTxvevis procenti sxva-
dasva medikamentebisaTvis sxvadasvaa.

provokaciuli testebi.
medikamentozuri alergiis sadiagnostikod, erT-erTi efe-

158
qturi (Tumca arc Tu uxifaTo) meTodia medikamentozuri
provokaciuli testi. testi gulisxmobs organizmSi medika-
mentis Seyvanas oraluri, parenteraluri, koniuqtivaluri an
lorwovani garsebis saSualebiT. testis Catareba saWiroa yve-
la im riskis gaTvaliswinebiT, rac am proceduras SeiZleba
axldes Tan (Zlieri adgilobrivi reaqcia, sistemuri reaqcia)
da procedura unda Catardes mosalodneli garTulebisa da
testirebiT miRebuli Sedegis sargeblianobis Tavisebureba-
Ta gaTvaliswinebiT. amasTan, testireba aucileblad unda Ca-
tardes Sesabamisi kvalifikaciis eqimis mier, iseT samedicini
dawesebulebaSi, sadac, sistemuri alergiuli reaqciis ganvi-
Tarebis SemTxvevaSi, yvela piroba arsebobs pacientis dasax-
mareblad. anamnezSi iseTi daavadebis arsebobisas, rogoricaa
eqsfoliaciuri dermatitis an stiven-jonsonis sindromi, medi-
kamentozuri provokciuli testi kategoriulad ukunaCvenebia.
testis Catarebisas gaTvaliswinebuli unda iyos anamnezSi
gamovlenili reaqciis simZafre da medikamentis miRebidan rea-
qcis gamovlenamde gasuli dro. Tu es dro < 1 saaTze, maSin
pacients preparati unda mivceT Terapiuli dozis 1 : 10 000
dan 1 : 10 ganzavebiT _ imis mixedviT, Tu rogori simZafriT
iyo gamoxatuli wina reaqcia (sistemuri an adgilobrivi). Sem-
degi sami doza pacientma unda miiRos samjeradad _ yovel
30 _ 60 wuTSi. testi unda damTavrdes 1 dRis ganmavlobaSi;
pereparatis, maqsimum, 5 dozis miRebiT. testirebis es forma
gamoavlens dauyovnebeli alergiuli reaqciis arsebobis fa-
qts. dayovnebuli tipis reaqciis gamosavlenad, testi SeiZ-
leba gagrZeldes ramdenime dRe da kvirac ki. testirebisas
mkacrad rekomendirebulia placebo meTodis gamoyeneba, rac
minimumamde amcirebs cru-dadebiTi reaqciis mcdarad Sefase-
bis saSiSroebas.

medikamentozuri alergiis klinikuri gamovlineba

da mwvave periodis marTva.
mwvave medikamentozuri alergiis marTva iTvaliswinebs al-
ergiuli reaqciis gamomwvevi medikamentis identificirebas
da misi miRebis Sewyvetas; pacientis sasicocxlo funqciebis
darRvevis SemTxvevaSi maT aRdgenas, paTologiuri simptome-
bis sawinaaRmdego specifiur Carevas da imunosupresiul Tera-
pias. yvela, calkeul SemTxvevaSi, aucilebelia mdgomareobis
detaluri da individualuri analizi. aseve individualuria

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aleriuli sidromis marTva. erT SemTvevaSi SeiZleba Semovi-
fargloT pacientisaTvis H1 antihistaminuri preparatis mi-
cemiT an lokaluri topikaluri saSualebebiT, maSin, rodesac
sxva SemTxvevaSi, sicocxlisaTvis saSiSi mdgomareobis ganvi-
Tarebisas, rogoricaa sistemuri alergiuli reaqciis mizeziT
ganviTarebuli Soki, cxeleba, hepatiti, Tirkmlis dazianeba,
eqsfoliaciuri dermatiti, toqsiuri epidermolizi da sxva,
gacilebiT energiuli Carevaa saWiro.

stiven-jonsonos sindromi da toqsiuri

epidermo-nekrolizi.
medikamentebiT gamowveuli, kanisa da lorwovanis mZime,
eriTematozuli da nekrozuli formis dazianebebi, vlindeba
stiven_jonsonis sindromisa da toqsiuri epidermaluri ne-
krolizis klinikiT.
kanis epidermaluri dazianeba, daaxloebiT 10% SemTxvevaSi,
miuTiTebs stiven_jonsonis sindromis, 30%-Si toqsiuri epi-
dermolizisa da 10%_30%-Si orive paTologiis erToblivad
arsebobaze.
stiven_jonsonis sindromisaTvis damaxasiaTebelia mowiTa-
lo (alis feri) makulozuri gamonayari saxisa da tanis areSi
da eroziebi lorwovan garsebze, rasac Tan axlavs cxeleba
da zogadi intoqsikacis niSnebi. mZime SemTxvevebSi, dazianebis
niSnebi viTardeba Tvalis lorwovan garsebze. procesSi SeiZ-
leba CaerTos RviZli, Tirkmlebi da filtvebi, rac mniSvne-
lovnad amZimebs mdgomareobas.
toqsiuri epidermo-nekrolizi viTrdeba kanisa da lor-
wovanis farTe areebze. gamoxatulia eriTema da epidermisis
nekrozi. mimdinareobs Zlieri intoqsikaciiT, Seicavs dain-
ficirebis maRal risks da Zalian saSiSia sicocxlisaTvis. am
dros kanis biofsiis monacemebi miuTiTeben subepiTeliarul
aSrevebaze, rac toqsiuri etiologiis epidermolizebisTvisaa
damaxasiaTebeli da viTardeba «damwvari kanis» sindromiT mim-
dinare paTologiebis dros, romlis magaliTicaa stafiloko-
kuri toqsiniT gamowveuli nekrozuli epidermolizi.
stiven_jonsonis sindromis mkurnaloba kortikosteroide-
biT sakamaToa. magam Tu am meTods gamoviyenebT, igi jobia
daviwyoT rac SeiZleba adre.
toqsiuri epidermolizis mkurnalobis SedarebiT efeqtur
meTodad, amJamad, miCneulia imunoglobulinis intravenuri
infuzia.

160
 zogadi saanesTezio saSualebebiT gamowveuli
alergiuli reaqciebi.
anafilaqsia SeiZleba gamoiwvios iseTma sanarkozo saSuale-
bebma, rogorebicaa Tiopentali an sarelaqsacio saSualebebma
mag. suqcinilqolini an pankuroniumi. kanis negatiuri testebi
ar gamoricxavs reaqciis ganviTarebis SesaZleblobas. Zalian
xSiria lateqsTan Sexebis Semdeg ganviTarebuli reaqciebi, rac
yovelTvis unda iyos gaTvaliswinebuli saoperacioSi an sama-
nipulacioSi dafiqsirebuli anafilaqsiis SemTxvevaSi.

lokaluri saanesTezio saSualebebiT gamowveuli

alergiuli reaqciebi.
adgilobrivi anesTeziis dros ganviTarebuli reaqciebi
asocirdeba toqsiur, fsevdo-alergiul da alergiul reaq-
ciebTan. xelSemwyobi faqtoria preparatis swrafi adsorbcia.
lokaluri saanesTezio saSualebebi iyofa or jgufad:
I. benzil mJavas eTerebi (benzokaini da prokaini).
II. amidebi (lidokaini da bupivakaini).
reaqciis klinikuri gamovlineba SeiZleba iyos adgilobrivi
(siwiTle, gamonayari, urtikaria qavili) da sistemuri (anafi-
laqsia).

insuliniT gamowveuli alergiuli reaqciebi.

insulinis gamoyeneba SeiZleba asocirdebodes iseT gver-
diT reaqciebTan, rogorebicaa kanis lokaluri da sistemuri
movlenebi, hemolizuri anemia, Sratis daavadeba da dayovnebu-
li tipis alergiuli reaqciebi.
umetes SemTxvevaSi, adamianis leikocitaluri insulini
naklebad alergiulia vidre Roris an msxvilfexa rqosani pi-
rutyvis. Tumca, konkretul SemTxvevaSi, SeiZleba moxdes pi-
riqiTac.
pacientebs, romlebic mkurnaloben cxovelebis ujrede-
bidan miRebuli (ara adamianis) insuliniT, adamianis rekombi-
nantuli insulinis Seyvanis Semdeg, SeiZleba sistemuri aler-
giuli reaqcia ganuviTardeT. insuliniT mkurnalobaze myof
pacientTa 50%-s, sisxlSi aReniSneba anti-insulinuri antisx-
eulebi. magram amas yovelTvis ar axlavs Tan klinikuri gamov-
lineba, rac albaT mablokirebeli antisxeulebis arsebobiTaa
gamowveuli.
insulinze ganviTarebuli, kanis adgilobrivi reaqciebi,

161
Cveulebriv sustia, mkurnalobas ar moiTxoven da ar SeiZleba
iyvnen insulinis Sewyvetis mizezi. ufro mZimed gamoxatuli
adgilobrivi reaqciebis dros, gamoiyeneba antihistaminuri
preparatebi an amcireben insulinis dozas da Sesabamisad, am-
cireben ineqciaTa Soris intervals. verc sistemuri d verc
adgilobrivi reaqcia, ver iqneba insulinis gamoyenebaze uaris
Tqmis mizezi. sistemuri reaqciis Semdeg, pacients ukeTeben
erTjeradi dozis 1/3-s, momdevno dozas ki zrdian manam, sanam
ar moxdeba efeqturi kontrolis SemanarCunebuli dozis dad-
gena.
kanis sinjebi da desensibilizacia tardeba maSin, Tu in-
sulinis moxmareba SeuZlebelia 24 _ 48 saaTis ganmavlobaSi,
drois am periodSi insulinis Seyvanis mcdelobisas ganviTare-
buli sistemuri reaqciis gamo.
insulinis mimarT rezistentoba viTardeba maSin, rodesac
saqme gvaqvs insulinis mimarT arsebuli IgG-bunebis antisxeu-
lebis maRali titris arsebobasTan.

antikonvulsiur preparatebze ganviTarebuli

alergiuli reaqciebi.
antikolvunsiur preparatebze ganviTarebuli gverdiTi
reaqciebi ZiriTadad fermentopaTiis Sedegia da uxSiresad
gamowveulia ferment hidroqsilazas deficitiT. klinikurad
es mdgomareoba SeiZleba gamovlindes mZime, sicocxlisaTvis
saSiSi, reaqciiT _ cxelebiT, makulo-papulozuri gamonaya-
riT, generalizirebuli limfadenopaTiiT da visceraluri
organoebis dazianebiT.

«wiTelkaniani adamianis» sindromi.

ZiriTadad viTardeba vankomicinis gamoyenebisas, romelic
araspecifiurad aTavisuflebs histamins. klinikurad gamoxa-
tulia totaluri egzanTema. profilaqtika da mkurnaloba Se-
saZlebelia antihistaminuri preparatebiT.

radiokontrastuli nivTierebebi.
reaqcia radiokontrastul nivTierebebze viTardeba maTi
intravaskularuli gamoyenebis, mielografiisa da pielogra-
fiis SemTxvevaSi. reaqciis meqanizmi araa mxolod erTi saxis.
magram yvela SemTxvevaSi xdeba mastocitebis degranulacia
da bioaqtiuri nivTierebebis gamoTavisufleba. SesaZlebelia,

162
rom reaqcia mimdinareobdes komplementis aqtivaciis Tanxle-
biT. dadgenilia, rom pirebs, romelTac sensibilizacia aRe-
niSnebaT zRvis produqtebze da iodze, advilad unviTardebaT
hiperergiuli reaqcia radiokontrastul nivTierebebze. maRa-
li riskis jgufs ganekuTvnenebian is pirebic, visac aReniSneba
atopia da pirebi romlebic iReben b-blokerebs.

narkotikebi.
opiatebi, rogoricaa morfini da misi msgavsi preparatebi
pirdapir moqmedeben mastocitebze da zogjer iwveven mis de-
granulacias. am dros, klinikurad gamoxatulia generalizi-
rebuli gamonayari, urtikaria, qavili, qoSini da xixini.

medikamentozuri alergiis mqone pacientebis

alternatiuli mkurnalobis gzebi.
medikamentozuri alergiis mqone pacientTa alternatiuli
mkurnalobis SesarCevad miRebulia sami saxis midgoma:
1. gamoviyenoT sxva jgufis medikamenti, im medikamentis ma-
gier, romlis mimarTac pacienti alergiulia. aseT SemTxve-
vebSi gaTvaliswinebuli unda iyos medikamentis toqsiuroba
da Rirebuleba. aseTi mgomareoba Zalian xSiradaa penicilinze
alergiis mqone pacientebTan mimarTebaSi. am dros proble-
mas qnmis is garemoebac, rom penicilinis alternatiuli anti-
biotikebi yovelTvis ufro toqsiuria da fasic ufro maRali
aqvT, vidre penicilins. bolo wlebis gamokvlevebi gviCvene-
ben, rom penicilinsa da cefalosporinebze alergiis mqone
hospitalizirebul, seriozuli infeqciis mqone, pacientebSi
warmatebiTaa SesaZlebeli vankomicinis gamoyeneba. ambulato-
riul pacientebSi, upiratesad gamoiyeneba makrolidebi.
2. gamoviyenoT medikamenti, romlis mimarTac pacienti ar
aRniSnavs alergiis arsebobas, magram romelsac axasiaTebs
jvaredini re-aqtiuloba im medikamentis mimarT, romelzec pa-
cienti alergiulia. amis magaliTia cefalosporinebisa da pe-
nemebis gamoyeneba, prenicilinze alergiis mqone pacientebSi.
am dros iTvaliswineben im garemoebas, rom jvaredini aler-
giuli reaqciis ganviTarebis albaToba < 25%-ze. pacientebSi,
romelTac anamnezSi stiven-jonsonis sindromi an toqsiuri
epidero-nekrolizi aReniSnebaT, am meTodis gamoyeneba (jva-
redini reaqtiuobis preparatis xmareba) dauSvebelia.

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 alergiuli reaqciis gamomwvevi preparatis
ganmeorebiT gamoyeneba.
alergiuli reaqciis gamomwvevi preparatis ganmeorebiT ga-
moyeneba yovelTvis aris garkveuli SiSis mizezi da umetes
SemTxvevaSi maqsimalurad cdiloben Tavi Seikavon amgvari mo-
qmedebisagan. Tumca cnobilia, rom penicilinze alergiis ga-
movlinebidan garkveuli drois gavlis Semdeg, SesaZlebelia
am preparatis mimarT arsebuli specifiuri reaqtiulobis Se-
susteba da sruli gaqrobac ki, rac saSualebas iZleva sru-
liad usafrTxod Catardes mkurnaloba peniciliniT. amitom,
rodesac dgeba sakiTxi _ Catardes Tu ara mkurnaloba im pre-
paratiT, romlis mimarTac pacients adre alergiuli reaqcia
aReniSna, saWiroa frTxili da individualuri midgoma. auci-
leblad unda ganisazRvros Tu ra tipis reaqciasTan gvqon-
da saqme ? iyo reaqcia alergiuli bunebis Tu saqme gvqonda
idiosinkraziasTan ? ra doza iyo gamoyenebuli da iyo reaqcia
erTjeradi Tu ganmeorebadi ? reaqcia iyo adgilobrivi Tu si-
stemuri ?. Tu pacients anamnezSi aReniSneba sistemuri aler-
giuli reaqciebi da gansakuTrebiT stiven-jonsonis sindromi
an nekrozuli epidermolizi, maSin saeWvo medikamentis gamoy-
eneba mkacrad ukunaCvenebia. sxva SemTxvevaSi sakiTxi unda ga-
dawydes individualurad, imis gaTvaliswinebiT, Tu ramdenad-
aa saWiro pacientisaTvis es medikamenti? SesaZlebelia Tu ara
misi Secvla sxva saSualebiT? garTulebis ra tipia mosalod-
neli? da iqneba Tu ara xarjefeqturi amgvari cvlileba? Tu
gadawydeba, rom saWiroa preparatis readministrireba, unda
Catardes kanis alergiuli sinji. kanis negatiuri sinjis Sem-
TxvevaSi preparatis gamoyeneba dasaSvebia. Tumca umjobesia
pacientma pirvelad miiRos Terapiuli dozis 1%. SedarebiT
usafrTxoa preparatis peroraluri miReba. SemdgomSi doza
izrdeba ise, rom sruli dozis gamoyeneba moxdes preparatis
samjeradi miRebis Semdeg. ufro usafrTxod iTvleba saeWvo
preparatis gamoyeneba specifiuri desensibilizaciis Catare-
bis Semdeg. aRniSnuli meTodis gamoyenebas mxolod maSin aqvs
azri, Tu alergiuli reaqcia ganpirobebuli iyo IgE antisxeu-
lebiT. desensibilizacia tardeba organizmSi preparatis aR-
mavali dozebis SeyvaniT, mcire dozidan srul Terapiul doz-
amde, yovel 30 _ 60 wuTSi. amasTan unda gvaxsovdes, rom yove-
li dozis Seyvanis Semdeg mosalodnelia alergiuli reaqciis
gamovlineba. aRniSnuli tipis desensibilizacia da alergiis
gamomwvevi medikamentis gamoyeneba xdeba gansakuTrebul Sem-

164
TxvevaSi, roca raime mizezis gamo aucilebeli da gardauvali
xdeba am medikamentis gamoyeneba (mag. insulinis SemTxvevaSi).
desen-sibilizacia tardeba gadaudebeli daxmarebis ganyofi-
lebaSi, specialistis mier, specialuri protokolis mixedviT.
alergiuli an fsevdoalergiuli reaqciis Tavidan acile-
bis mizniT, zogjer, saeWvo preparatis Seyvanamde, ganixilaven
pacientisaTvis k.s.-is an antihistaminuri preparatis micemis
sakiTxs. alergiuli reaqciisagan dacvis aseTi meTodis efe-
qturoba kargad araa Seswavlili da miuTiTeben misi, rogorc
dadebiT ise uaryofiT mxareebze. am meTodis gamoyeneba, ma-
galiTad, mowodebulia radiokontrastul nivTierebebze mo-
salodneli fsvdoalergiuli reqciis ganviTarebis Tavidan
asacileblad. meore mxriv, fiqroben, rom kortikosteroideb-
ma da antihistaminurma preparatebma SeiZleba SeniRbon aler-
giuli reaqciis adreuli faza, magram SemdgomaSi gamovlindes
mkveTri mogvianebiTi reqcia. amis gamo, saeWvo medikamentis
mzardi dozebiT Seyvanis an specifiuri desensibilizaciis pa-
ralerulad antihistaminuri preparatebisa da k.s.-ebis gamoy-
eneba dauSvebelia. arasteroduli antianTebiTi preparatebiT
inducirebuli asTmis (mag. aspirindamokidebuli asTma) gamwva-
vebis saprofilaqtikod, am tipis preparatebis miRebis win, re-
komendirebulia leikotrienebis receptorTa antagonistebis
miReba, rac mniSvnelovnad amcirebs asTmis Setevis ganviTare-
bis SesaZleblobas.

medikamentozuri alergiisaken midrekil pacientTa

profilaqtika.
cnobilia, rom zogierTi individi mravali sxvadasxva medi-
kamentis mimarT avlens alergiul reaqcias, rac genetikuri an
metaboluri procesebis TaviseburebasTan (multi medikamen-
tozuri alergiuli sindromi), garkveuli preparatebis xSiri
an mudmivi miRebasTan (mag. antibiotikebis miReba kistofi-
broziT daavadebulebSi) an imunodeficitur mdgomareobasTan
(mag. Sidsi.) aris asocirebuli. am tipis pacientebSi, mosalod-
neli medikamentozuri alergiis Tavidan asacileblad an Sesa-
susteblad mainc, saWiroa garkveuli profilaqtikuri Ronis-
Ziebis gatareba.
pacientebSi, romlebic sensibilizirebulni arian sxvadasx-
va antibiotikenze, am tipis alergiis profiklaqtikis sauke-
Teso saSualeba infeqciis prevencia da Sesabamisad antibio-
tikebisagan Tavis aridebaa. am mxiv, Zalian mniSvnelovania zo-

165
gierTi infeqciuri daavadebisagan Tavis dacva da Sesabamisad
antibiotikebis gamoyenebis SezRudva vaqcinoprofilaqtikis
saSualebiT, rac gansakuTrebiT efeqturia bavSvebSi. antibio-
tikebis dabalma dozebma SeiZleba erTi mxriv, desensibili-
zacia xolo meore mxriv _ mosalodneli infeqciis profila-
qtika gamoiwvios. infeqciis arsebobis gamo, antibiotikis mi-
Rebis saWiroebis SemTxvevaSi, preparati unda SeirCes mkacrad
racionalurad _ mikrobis identifikaciisa da antibiotikebis
mimarT arsebuli mgrZnobelobis mixedviT.

cxrili 32.
multimedikamentozuri hipersensitiurobis mqone pacientTa ga-
mokvleva da marTva.
gamokvleva:
1. medikamentozuri alergiis anamnezis guldasmiT gaanalizeba
(alergiis gamovlenis klinikuri Tavisebureba, medikamentis jgu-
fis daxasiaTeba, medikamentis miRebidan alergiis klinikur gam-
ovlinebamde gasuli dro da sxva).
2. validur medikamentebze (mag. penicilini, proteinis preparatebi
da sxva) kanis alergiuli sinjebis Catareba an Tu aseTi kvleva
ukve Catarebulia _ provokaciuli testi.
3. provokaciuli testebi tardeba im SemTxvevaSi, Tu kanis sinjebis
pasuxi aradamajerebelia an mkurnaloba am medikamentiT tardeba
ganmeorebiT.
4. provokaciuli testi tardeba placebo-kontroliT.
marTva:
1. infeqcis ganviTarebis prevencia.
2. axali medikamentis daniSvna mxolod mkacri aucileblobisas.
3. antolerantul pacientebSi sawyis etapze iniSneba Terapiuli
dozis 1/3 _ 1/4¼ doza.
4. pirveli dozis miRebis Semdeg samedicino kontroli.
5. yovelgvari (Tundac msubuqi an atipiuri) reaqciis gamovlenis
SemTxvevaSi tardeba samedicino monitoringi.
6. medikamentis micema mzardi dozebiT an SesaZleblobis SemTxveva-
Si desensibilizacia.
7. seriozuli alergiuli garTulebis (stiven-jonsoni, eqsfo-
liaciuri dermatiti, toqsiuri epidermo-nekrolizi) medika-
mentebis miRebis mTeli periodis ganmavlobSi tardeba uwyveti
monitoringi

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 medikamentozuri alergiuli reaqciebis ganviTarebis SiSi da
maTi prevencia aris praqtikos eqimTa yoveldRiuri saqmianobis
Tanmdevi problema.
is monacemebi, rom amgvari reaqciebi iSviaTad viTardeba
da maTi seriozuli garTulebebi, rogoricaa magaliTad
anafilaqsia, kidev ufro iSviaTia, ver amcirebs am problemis
aqtualobas, radgan yvela aseTi reaqcia sicocxlis riskTanaa
dakavSirebuli.
dReisaTvis ar arsebobs sayovelTaod miRebuli gaidlainebi
da protokolebi, romlebic aRniSnuli problemuri situaciis
marTvisTvisaa mowodebuli, rac sakmaod arakomfortul
mdgomareobas uqmnis praqtikos eqimebs.
viTvaliswinebT ra am mdgomareobas, gTavazobT Cvens mier
SemuSavebul protokols, romelic, vfiqrobT, garkveuli
daxmarebas gauwevs, rogorc hospitalSi, ise janmrTelobis
dacvis pirvelad rgolebSi momuSave eqimebs:

protokoli
medikamentozuri alergiis prevenciis RonisZiebebi
zogadi debulebebi:
• alergiuli an fsevdoalergiuli reaqciebi SeiZleba gamov-
lindes medikamentebis farTo speqtris mimarT. Tumca amg-
vari reaqciebis gamovlenis albaToba SedarebiT maRalia
β -laqtamuri antibiotikebis (gansakuTrebiT penicilinis
jgufis da ufro naklebad cefalosporinebis), a.s.a.a. prepa-
ratebis, radio-konrtastuli nivTierebebis, antipiretike-
bis, neiro-muskulatoruli blokerebis da naklebad _ ad-
gilobrivi anestetikebis mimarT.
• alergiuli an fsevdialergiuli reaqciebis gamovlenis
risk-faqtirebs warmoadgens atopiis personaluri an memk-
vidruli anamnezi. riski gansakuTrebiT maRalia medikamen-
tozuri alergiis (gansakuTrebiT konkretul SemTxvevaSi
gamosayeneblad gansazRvruli medikamentis) anamnezis Sem-
TxvevaSi.
• atopiuri anamnezi ar aris medikamentozuri reaqciis ganvi-
Tarebis aucilebeli piroba.
• atopiuri anamnezis ar arseboba ar warmoadgens alergi-
uli an fsevdoalergiuli reaqciis ganviTarebisagan Tavis
dazRvevis garantias.
• kanis pozitiuri alergiuli sinjebi an sixlis SratSi spe-

167
 cifiuri IgE-s gamovlena aris dauyovnebeli alergiuli
reaqciis ganviTarebis maRali albaTobiT gansazRvris sa-
Sualeba. kanis negatiuri sinji ki ar warmoadgens, Tundac
am konkretul antigenze (medikamenti), alergiuli reaqciis
Tavidan acilebis garantias da misi sarwmunooba, umetes
SemTxveaSi, ar aRemateba 30% _ 35%-s.
• kanis alergiuli sinjebi an sisxlSi IgE-s gansazRvra ar
gvaZlevs imunokomplesuri, citotoqsiuri an ujrduli
tipis alergiuli reaqciebis gamovlenis prognozirebis sa-
Sualebas.
• leikocitolizis reaqcia ar iZleva organizmis sensibili-
zaciis gamovlenis saSualebas da ar gamoiyeneba alergi-
uli reaqciis prognozirebisaTvis.
• kanis alergiuli sinjebi Catarebuli unda iyos special-
istis (alegologis) mier. testis interpretacia da Sesaba-
misi rekomendaciac xdeba alergologis mier.
• medikamentozuri alegiuli an fsevdoalergiuli reaqciis
Tavidan acilebis yvelaze efeqtur saSualebad miCneulia
saeWvo medikamentis gamoyenebaze uaris Tqma.
• im SemTxvevaSi, rodesac saeWvo medikamentis gamoyenebaze
uaris Tqma ar xerxdeba, zog SemTxvevaSi (mag. iod-kontras-
tuli nivTierebebis gamoyenebisas), naCvenebia, winaswar,
antihistamnuri preparatebisa da/an k.s.-is miReba. sxva ti-
pis seWvo medikamentebis gamoyenebisas aseve SesaZlebelia,
wanaswar, antihistaminuri preparatebisa da k.s.-is miReba.
magram aucileblad gasaTvaliswinebelia is faqti, rom amg-
vari meTodi ar aris alegiuli reaqciis ganviTarebisagan
dacvis garantia. amasTan, SesaZlebelia moxdes alergiuli
reaqciis droebiTi SeniRbva da mogvianebiT etapze reaqcis
mZlavrad gamovlineba.
• saeWvo anamnezisa (personaluri an memkvidruli atopiuri
anamnezi) da saeWvo medikamentebis (penicilinebi, cefalos-
porinebi, iod-kontrastuli nivTierebebi, antipiretikebi,
arasteroiduli antianTebiTi preparatebi, neiro-musku-
latoruli blokerebi da nawilobriv adgilobrivi aneste-
tikebi) gamoyenebisas eqimi unda atarebdes anafiaqsiisa da
sxva alergiuli garTulebebis simptomTa monitorings da
SeeZlos aseTi garTulebebis marva.
• yvela saeWvo SemTxvevaSi saWiroa alergologis konsulta-
cia.

168
 algoriTmi

SekribeT dawvrilebiTi anamnezi

x aRiniSneba Tu ara personaluri da/an ojaxuri atopiis an idiosink-
raziis anamnezi ?
x aRiniSneba Tu ara anamnezSi raime saxis reaqcia medikamentebze ?
x aRiniSneba Tu ara anamnezSi raime saxis reaqcia im medikamentze,
romlis gamoyenebasac apirebT ?
x aqvs Tu ara pacients qronikuli daavadebebi, ris gamoc xSirad da
xangrZlivad iRebs sxvadasxva medikamentebs ?
x aqvs Tu ara pacients raime metaboluri paTologia ?
x Tu pacienti 2 wlamde asakisaa gaarkvieT, xom ar iRebda deda orsu-
lobis an laqtaciis periodSi medikamentebs, romelTac nayofis an
bavSvis sensibilizacia SeiZleba gamoewviaT ?

Tu aris erT-erTi mainc : iodkontrastuli Tu pacients ar aRe-

x penicilinis da cefa- nivTierebebis niSneba arc erTi,
losporinebis. gamoyenebisas : zemoT mocemuli
x a.s.a.a. preparatebis. x miuxedavad risk-faqtori :
x neiromuskulatoruli anamnezisa, winaswar x penicilinis da
blokerebis. gamoiyeneT cefalosporinis jgu-
x adgilobrivi anesteti- antihistaminuri fis antibiotikebis.
kebis preparatebi an k.s. x a.s.a.a. prepara-
gamoyenebis saWiroebisas: (cxr. 4 ). tebis.
a) Tu SesaZlebelia uari x neiromuskukato-
TqiT gamoyenebaze. Tu pacients anam- ruli blokerebis.
b) Tu preparatis gamoyeneba nezSi aReniSneba x antipiretikebis.
aucilebelia, CaatareT kan- raime saxis reaqcia x adgilobrivi
isAalergiuli sinjiA(atarebs nebismieri, Tundac anestetikebis gamoyen-
alergologi). ara «riskis jgufis ebisas:
g) Tu sinji negatiuria, gamo- preparatis» mimarT : a) mzad iyaviT garTu-
iyeneT preparati. lebebis marTvisaTvis.
a) ecadeT uari TqvaT
upiratesoba mianiWeT b) alergiuli sinji an
mis gamoyenebaze.
peroralur formas da mzad alergologis kon-
b) Tu gamoyeneba auci-
iyaviT garTulebis sultacia CaatareT
lebelia CaatareT al-
marTvisaTvis. Tqveni Sexedulebis
ergiuli sinji da al-
d) Tu sinji pozitiuria _ mixedviT.
ergologis konsulta-
CaatareT alergologis kon-
cia.
sultacia.

169
 ▶ mastocitozi.
mastocitozi warmoadgens kansa da sxvadasxva organoebSi
mastocitebis didi raodenobiT dagrovebiT gamowveul daa-
vadebas, romlisTvisac, klinikurad, damaxasiaTebelia urti-
kariis msgavsi gamonayari, qavili, egzanTema, Rebineba, diarea,
muclis tkivili da vaskularuli paTologiebi. mastocitebis
hiperplazia yvelaze intensiurad xdeba kanSi, gastrointesti-
nalur traqtSi, Zvlis tvinSi, RviZlSi, elenTasa da limfur
jirkvlebSi. mastocitozi xSiradaa asocirebuli hematolo-
giur paTologiebTan.
mastocitozi SeiZleba ganviTardes yvela asakSi.
mastocitozis gavrcelebis Sesaxeb sarwmuno monacemebi
ara arsebobs. xSiria ojaxuri SemTxvevebi.
mastocitozis klasifikacia emyareba klinikuri gamovli-
nebis Taviseburebas, paTologiis simptomatikas da prognozis
xasiaTs.
mastocitozis klasifikacia mocemulia cxril 1-Si.

cxrili 1.
jan. dacvis saerTaSoriso organizaciis mier mowodebuli mastoci-
tozis klasifikacia.
• kanis mastocitozi
- pigmenturi urtikaria anu kanis makulo-papulozuri mas-
tocitozi.
- kanis difuziuri mastocitozi.
- kanis mastocitoma.

• duned mimdinare sistemuri matocitozi.

- minimalurad gamoxatuli sistemuri mastocitozi.
- Zvlis tvinis izolirebuli mastocitozi.

• sistemuri mastocitozi, romelic asocirebulia klonal-

ur, hematologiur, ara mastocituri rigis, ujredTa pa-
TologiasTan.
• agresiuli sistemuri mastocitozi.
• mastocituri leikemia.
• mastocituri sarkoma.
• eqstradermaluri mastocitozi.

170
 kanis mastocitozs SedarebiT keTilTvisebiani mimdin-
areoba axasiaTebs. sistemuri, agresiuli da hematologiur
paTologiebTan asocirebuli mastocitozis prognozi ufro
seriozulia. Tumca daavadebis es formebic SeiZleba wlobis
ganmavlobaSi mimdinareobdnen da swori menejmentis SemTxveva-
Si pacientis sicocxlis xangrZliobobam sam aTeul welsac mi-
aRwios. avTvisebian simsivneebTan da sistemur paTologiebTan
asocirebuli mastocitozebis SemTxvevaSi prognozi serio-
zulia da samedicino menejmenti _ uSedego.

mastocitozis etiologia, paTogenezi da klinikuri

mimdinareobis Tavisebureba.
mastocitozis yvela klinikuri formis dros gamoxatulia
daaxloebiT erTnairi klinikuri suraTi. Tumca sxvadasxva
SemTxvevaSi sWarbobs sxvadasxva simtomTa simZafre da gamov-
lenis simZime. rogorc wesi, dazianeba, upiratesad, gamoxatu-
lia kanze, gastrointestinalur traqtSi, RviZlSi, elenTaSi,
limfur jirkvlebSi, Zvlovan qsovilSi da Zvlis tvinSi. aseve
xSirad ziandeba sasunTqi, endokrinuli da Sardgamomyofi sis-
tema. zogjer gamoxatulia perioduli wamowiTleba da hipo-
tenziis epizodebi. hipotenzia SeiZleba ganviTardes alkoho-
lis an aspirinis miRebis, mweris kbenis, infeqciis zemoqmedebis
da iodis Semcveli kontrastuli nivTierebebis gamoyenebis
SemTxvevaSi. amitom, mastocitoziT daavadebul pirebSi, maqsi-
malurad unda moxdes yvela am faqtorisagan Tavis arideba.
kanis dazianebis yvelaze xSiri suraTi, mastocitoziT
daavadebul, rogorc bavSvTa ise mozrdilTa, kontingentSi,
gamoxatulia pigmenturi urtikariiT anu makulo-papularuli
urtikariiT. pigmenturi urtikaria aReniSneba kanis mastoci-
tozis mqone yvela pacients, duned mimdinare sistemuri mas-
tocitozis mqone pacientTa 90%-s da sxva saxis mastocitoze-
biT daavadebulTa daaxloebiT 50%-s.
urtikariuli elementebi warmodgenilia mcire zomis mow-
iTalo-moyavisfro-iisferi, kanidan amoweuli makulo-papulo-
zuri elementebiT. zogjer, SedarebiT xanmokle drois ganmav-
lobaSi, Cndeba balTebi da buStebi. gamonayari ar viTareba xe-
lis mtevnebze, fexis terfebze, saxesa da Tavis Tmiani nawile-
bze. pigmenturi urtikariis dros, zogjer viTardeba qavili,
romelic gansakuTrebiT Zlierdeba garemos temperaturis mo-
matebis, kanis adgilobrivi gaRizianebis, cxeli sakvebis, al-

171
koholis, eTanolis da zogierTi medikamentis miRebisas.
histologiurad, pigmenturi urtikariis dros, kanis
dvrilebis SigniT, naxuloben sxvadasxva intensivobiT gamox-
aatul mastocitur infiltracias, romelic kanis retiku-
larul da kanqveSa cximovan SreSic vrceldeba. rodesac kanis
mastocitebis raodenoba 10-jer aRemateba normas, sxva pa-
Tologiis ar arsebobis SemTxvevaSi, ismeba pigmenturi urti-
kariis diagnozi.
pigmentur urtikarias SeiZleba Tan erTvodes peteqiebi, eq-
qimozebi an teleangieqtaziebi.

kanis difuziuri mastocitozi aris kanis mastocitozis

iseTi forma, rodesac kani mTlianad infiltrirebulia mas-
tocitebiT. am tipis masticitozis gamovlineba, Cveulebriv,
xdeba 3 wlis asakis Semdeg. procesSi CarTulia kanis mTeli
zedapiri. kani SeiZleba iyos normaluri feris an moyviTalo-
moyavisfro. generalizirebuli eriTrodermia, romelic mZime
SeSupebis dros viTardeba, kans aZlevs dune, comisebur Ses-
axedaobas da konsistencias. gamoxatulia moyviTalo Seferi-
lobis papulebi, romlebic qsantomebsa da fsevdo-qsantomebs
mogvagoneben. mcire asakis bavSvebSi, zogjer, kanis bulozuri
da hemoragiuli dazianeba viTardeba. bulebis mTlianobis
darRvevis Semdeg, viTardeba eqsudaciur-anTebiTi ubnebi da
fufxiT dafaruli areebi. kanis amgvar dazianebas SeiZleba
imunizaciam an infeqciamac misces biZgi.
diagnozi emyareba, kanSi mastocitebis, morfologiurad
dadasturebul, difuzur infiltracias.

kanis solitaruli mastocitozi aris kanis mastocitozis

msubuqad mimdinare varianti (erTeuli elementebiT kanze).
mastocitozis es forma SeiZleba dabadebisTanave gamov-
lindes. Tumca, ufro xSirad, 3 Tvis asakis Semdeg viTardeba.
elementebis ukuganviTareba xdeba spontanurad, bavSvobis pe-
riodSi. filtvis solitaruli mastocitozis SemTxveva aRwer-
ilia mozrdil asakSi.

mastocitozis eqstradermaluri gamovlinebebi.

mastocitoziT daavadebul pacientebSi gastrointesti-
naluri simptomebis gamovlineba iseTive xSiria, rogorc kanze
gamonayaris an wamowiTlebis epizodebis arseboba. yvelaze

172
xSiri simptomi muclis tkivilia. damaxasiaTebelia diarea,
gulisreva da Rebineba. iSviaTad SeiZleba gamovlindes gas-
trointestinuli sisxldena. hiperhistaminemia SeiZleba hiper-
aciduli gastritisa da wylulis Camoyalibebis mizezi gaxdes.
gaxangrZlivebuli diareis SemTxvevaSi, bavSvTa asakSi, mosal-
odnelia maladsorbciis ganviTareba.
gastrointestinuli simptomebis ganviTarebis mizezad mas-
tocitebis degranulaciis Sedegad, qsovilebSi da sisxlSi
bioaqtiuri nivTierebebis gadasvla, lorwovani garsebis SeSu-
peba, nawlavTa spazmi da peristaltikis gaZliereba iTvleba.
diagnozi dasturdeba mastocitozis zogadi klinikuri su-
raTis arsebobiT da kuW-nawlavis traqtis lorwovanis biof-
siuri masalis morfologiuri kvlevis Sedgad.
sistemuri mastocitozis mqone pacientebSi, xSiria, kun-
Tovan da Zvlovan sistemaSi tkivilis gamovlineba. zog SemTx-
vevaSi adgili aqvs osteoporozsa da Zvlebis motexilobebs.
iSviaTad, es simptomebi, SeiZleba mastocitozis pirvelad gam-
ovlinebasac warmoadgendnen.
Zvlis tvinis mastocituri infiltrcia gvxvdeba TiTqmis
iseTive sixSiriT, rogorc am ujredebis dagroveba RviZlSi,
elenTaSi da limfur jirkvlebSi. splenomegaliis, hepatomeg-
aliisa da limfadenopaTiis klinikuri gamovlineba, mastoci-
toziT daavadebul pacientebSi, Sesabamisad 48%, 41% da 26%-
Si aRiniSneba.
mastocitebiT Zvlis tvinis infiltraciis diagnostika,
mxolod Zvlis tvinis punqciisa da SigTavsis aspiraciis saSu-
alebiT xdeba. aRniSnuli manipulacia, erTi mxriv, saSuale-
bas iZleva, davadginoT Zvlis tvinSi mastocitebis dagrovebis
faqti da ganvsazRvroT am procesis intensivoba, xolo me-
ore mxriv, SesaZleblobas gvaZlevs ganvsazRvroT hemopoez-
is Tavisebureba, rac mniSvnelovan informacias warmoadgens
daavadebis ganviTarebis Taviseburebis prognozisaTvis.
RviZlSi, elenTasa da limfuri jirkvlebSi mastocitebis
infiltraciis identificireba ioli araa. am procesis klini-
kuri gamovlineba SeiZleba mxolod maSin moxdes, rodesac
splenomegalia, hepatomegalia an/da limfadenopaTiaa gamoxat-
uli da am organoTa dazianebis klinikuri niSnebic saxezea.
mastocitoziT daavadebul mozrdil pacientebSi nevrolo-
giuri da fsiqiatriuli problemebi vlindeba mexsierebis
darRveviT, agznebiT, gaRizianebiT an depresiiT da TviT-

173
momsaxureobs unaris SezRudviT. zogierTi avtori, mastoci-
toziT daavadebul bavSvebSi ver naxulobs qcevis paTologiis
simptomens. Tumca, imis gamo, rom am daavadebis dros bavS-
vebi antihistaminur preparatebs (xSirad ramdenimesac) iReben,
SeiZleba gamoixatis, am medikamentebze damokidebuli, qcevis
cvlilebebi.

mastocitozis diagnozi da diagnostikisaTvis

saWiro kvlevebi.
mastocitozis sadiagnostiko kriteriumebi mocemulia
cxril 34-Si. daavadebis diagnostikisaTvs gamoiyeneba didi da
mcire kriteriumebi. ZiriTad sadiagnostiko saSualebad, yve-
la SemTxvevaSi, miCneulia kanis biofsia. mniSvnelovani sadi-
agnostiko testia sisxlis SratSi triftazis donis mateba >
20 ng/ml.

cxili 34.
mastocitozis sadiagnostiko kriteriumebi.
sistemuri mastocitozi.
“didi kriteriumebi”
• multifokaluri, mWidro, mastocituri infiltracie-
bi (15 da meti ujredis agregacia 1 monakveTSi). Zvlis
tvinSi da /an eqstradermalur organoSi da qsovilebSi
triftazas arsebobis dadastuteba imunohistoqimiuri
meTodis gamoyenebiT.

“mcire kriteriumebi”
• Zvlis tvinis an eqstradermaluri aridan (organodan)
aRebul bioptatSi mastocitebis > 25%-ze wagrZelebuli
formisaa an aqvT atipiuri morfologiuri struqtura.
an Zvlis tvinidan aspirirebul mastocitTa > 25%-ze,
moumwifebelia an atipiuri struqturisaa.
• Zvlis tvinSi, sisxlSi an sxva eqstra-dermalur organoSi
naxuloben mutaciis specifiur markers.
• Zvlis tvinis, sisxlis an sxva eqstradermaluri organo-
dan miRebuli mastocitebis zedapirze eqspresirebulia
CD2-Tan da an CD25-Tan asocirebuli CD117-receptori.
• sisxlis SratSi triftazas done > 20 ng/ml (Tu masto-
citozi asocirebulia klonalur mieloidur paTolo-
giasTan, maSin es maCvenebeli araa validuri).

174
 sistemuri mastocitozis diagnozisaTvis saWiro minimum 1
didi da erTi mcire kriteriumis an sami mcire kriteriumis ar-
seboba.

kanis mastocitozis diagnostikisaTvis saWiroa kanis biop-

tatSi mastocitebis aRmoCena.
pigmenturi urtikariis dros, mastocitebis maRali kon-
centracia aRiniSneba kanis dvrilebebSi, gansakuTrebiT sisx-
lZarRvebis irgvliv. mastocitebi didi raodenobiTaa kanze
warmoqminil makulo-papulozur elementebSi. am areebSi mas-
tocitebis raodenoba, zogjer, 20-jer aremateba normas.
aucileblad gasaTvaliswinebelia is garemoeba, rom ase-
Tive suraTi SeiZleba ganviTardes rekurentuli anafilaqsiis,
sklerodermiis, qronikuli urtikariis da antigenebTan gax-
angrZlivebuli kontaqtis SemTxvevaSi. amis gamo, pigmenturi
urtikariis diagnozi ar daismeba kanSi mastocitozis mcire
raodenobiT matebis SemTxvevaSi. garda amisa, ra Tqma unda,
gasaTvaliswinebelia TviToeuli, CamoTvlili paTologiis
klinikuri suraTis Tavisebureba.

mastocitozis mkurnaloba.
mastocitebis degranulaciiT gamowveuli simptomebis mar-
Tva gulisxmobs qavilis, SeSupebis, hipotenziis, kuWis sim-
Javianobis matebis da gluvkunTovani muskulaturis spazmis
sawinaaRmdego saSualebebis gamoyenebas.
kanis simptomebis samkurnalod, ZiriTadad, sayuradRe-
boa H1- (hidroqsizini, loratadini an feqsofenadini) da H2-
(cimetidini, famotidini, zantaki) antihistaminuri preparate-
bi. dRis ganmavlobaSi rekomendacias uweven ara sedaciur da
Ramis ganmavlobaSi _ sedaciur antihistaminur preparatebs.
zog SemTxvevaSi rekomendirebulia leikotrienebis receptor-
Ta antagonistebis gamoyeneba. natriumis kromolinebi aferx-
ebeb mastocitebis degranulacias da zogjer, gastrointes-
tinaluri sistemis gamoxatuli simptomebis dros, garkveuli
efeqtiT xasiaTdebian. aseve garkveuli efeqtiT xasiaTdeba
ketotifeni, Tumca misi efeqti ar aWarbebs hidroqsizinis
efeqts. hipotenziis SemTxvevaSi gamoiyeneba epinefrini. 8-me-
toqsifsoralenis peroraluri gamoyeneba, grZeltalRian ul-
traiisfer sxivebTan erTad, 1 – 2 Tvis ganmavlobaSi, amcirebs
SeSupebas da qavils da gamoiyeneba mozrdil pacientTa sam-

175
kurnalod. amgvari mkurnalobis Semdeg miiReba met-naklebi
efeqtis, 3 _ 6 Tviani remisia. Tumca, xazgasmiT unda aRiniSnos,
rom fotoTerapia gamoiyeneba mxolod gansakuTrebul situa-
ciebSi, roca mkurnalobis sxva meTodebi uefeqtoa. zogjer
miuTiTebn mzis naturaluri abazanebis efeqturobazec.
msxvili balTebis samkurnalod mowodebulia 0,05%-iani
betametazon dipropionatis (mag. diprosaliki) malamos oklu-
ziuri naxvevebi. pacients naxvevi ukeTdeba dRe-RameSi uwy-
veti, 8 saaTis ganmavlobaSi. mkurnalobis kursi grZeldeba 8
_ 12 kvira. mkurnalobis amgvari meTodi, zog SemTxvevaSi, 1
wlian remisias iwvevs.
gastrointestinaluri simptomebis mkurnaloba mimarTu-
lia kuWis simJavianobis matebis, diareis da maladsorbciis
winaaRmdeg. hiper-aciduli mdgomareobis da potenciuri wylu-
lis winaaRmdeg gamoiyeneba H2-antagonistebi da protonuli
arxebis inhibitorebi. diareis mkurnaloba rTulia. am mxriv,
zogjer, garkveuli efeqtiT xasiaTdebian antiqolinerguli
preparatebi. mZime maladsorbciis SemTxvevaSi rekomendirebu-
lia oraluri kortikosteroidebi.
mastocitoziT daavadebul pacientebSi, Zvlebis dazianebis
suraTi gamoxatulia osteoporoziT, rac SeiZleba didi xnis
ganmavlobaSi, klinikurad, arc gamovlindes. es gansakuTrebiT
xSirad xdeba maSin, rodesac mastocitozi msubuqad an saSu-
alo simZimiT mimdinareobs. amis gamo, mastocitoziT daavade-
bul pacientebs sistematiurad unda utardebodeT Sesabamisi
radiologiuri kontroli.
osteoporozis mkurnaloba iTvaliswinebs kalciumisa da
fosforis CanacvlebiT Terapias, rac gansakuTrebiT mniS-
vnelovania postmenopauzis mqone qalebSi. Zval-kunTovan
sistemaSi tkivilis sindromis ganviTarebis SemTxvevaSi, re-
komendirebulia narkotikuli analgetikebi. Tumca, am dros,
gasaTvaliswinebelia mastocitebze maT mier ganxorcielebuli
degranulaciis efeqtis ganviTarebis SesaZlebloba. ZvlebSi
tkivilis Sesamcieblad aseve rekomendirebulia lokaluri
radiaciuli Terapia. Tumca es meTodi gamoiyeneba mxolod
mZimed da agresiulad mimdinare mastocitozis SemTxvevaSi.
zog SemTxvevaSi miuTiTeben a-2b-interferonis gamoyenebis
SesaZleblobaze, romelic amcirebs tkivilis sindroms da aum-
jobesebs Zvlis mineralizacias.
mastocitozTan asocirebuli hematologiuri cvlilebebis

176
definireba da menejmenti specifiuri hematologiuri prob-
lemaa da hematologis mier unda xorcieldebodes.

prognozi.
mastocitozis prognozi damokidebulia misi gamovlineb-
is formaze da procesSi CarTuli organoebisa da sitemebis
lokalizaciasa da dazianebis xarisxze. sistemuri mastoci-
tozis prognozi seriozulia. prognozi gansakuTrebiT mZimea
hematologiuri paTologiis TandarTvis SemTvevaSi. izolire-
buli pigmenturi urtikariis SemTxvevaSi prognozi SedarebiT
keTilsaimedoa. mastocitozis am formiT daavadebul bavSv-
Ta daaxloebiT 50%-Si, mozrdil asakSi, xdeba mdgomareobis
gaumjobeseba da simptomTa sruli gaqroba.

▶ eozinofilia da misi klinikuri

mniSvneloba.
dReisaTvis, periferiul sisxlSi, eozinofilebis nor-
malur (fiziologiur) raodenobad miCneulia 450 ujredi/
mkl. eozinofilebis procentuli raodenoba periferiul si-
sxlSi mniSvnelovnad ar icvleba asakis cvlasTan erTad da
axalSobilobidan zrdasrul asakamde, saSualod meryeobs
1,5% dan 3%-s Soris.
zogadi debulebebi, romlebic eozinofilebis funqcias,
raodenobasa da masTan asocirebul mdgomareobebs Seexeba, mo-
kled ase SeiZleba davaxasiaToT:
• msubuqi xarisxiT gamoxatuli eozinofilia (< 1500/mkl)
asocirebulia sxvadasxva alergiuli daavadebis arsebo-
basTan.
• eozinofilia SeiZleba gamowveuli iyos sxvadasxva medi-
kamentozuri mkurnalobis gverdiTi efeqtiT.
• eozinofilia xSirad axlavs Tan helminTozs. am mxriv,
gansakuTrebiT sayuradReboa strongiloidozi, rome-
lic pacientTa kortikosteroidebiT murnalobis SemTx-
vevaSi, SeiZleba diseminizaciiTa da fataluri Sedegi-
Tac ki damTavrdes.
• maRali eozinofilia (> 1500/mkl), romlis gamomwvevi mi-
zezis identifikacia ver xerxdeba da romelic ramdenime
Tvis ganmavlobaSi grZeldeba, SeiZleba Sefasdes, rog-
orc hipereozinofiliis sindromi.

177
 cxrili 35.
eozinofiliasTan asocirebuli daavadeebi da paTologiebi.

I. alergiuli daavadebebi.
A. atopiuri da masTan dakavSirebuli daavadebebi.
B. medikamentebis miRebasTan dakavSirebuli eozinifilia.
II. infeqciuri daavadebebi
A. parazituli daavadebebi (upiratesad helminTozebi)
B. specifiuri fungaluri infeqciebi
C. sxva infeqciuri daavadebebi (ufro iSviaTia)
III. hematologiuri da neoplastiuri daavadebebi.
A. hipereozinofiluri sindromebi.
B. leikemia.
C. limfoma.
D. simsivnesTan asocirebuli mdgomareobebi.
E. mastocitozi.
IV. daavadebebi, konkretuli organoebis dazianebiT
A. kanisa da kanqveSa qsovilebis daavadebebi.
B. filtvebis daavadebebi.
C. gastrointestinaluri traqtis daavadebebi.
D. nervuli sistemis daavadebebi.
E. revmatiuli daavadebebi.
F. gulis daavadebebi.
G. Tirkmlis daavadebebi.
V. imunologiuri daavadebebi.
A. imunodeficituri mdgomareobebi.
B. transplantantis mocilebis reaqcia.
VI. endokrinuli daavadebebi.
A. hipoadrenalizmi.
VII. sxva mdgomareobebi da daavadebebi.
A. aTeroemboliuri daavadebebi.
B. serozuli garsebis gaRizianeba.
C. memkvidruli daavadebebi.

alergiuli daavadebebi.
eozinofiliis gamomwvevi yvelaze xSiri ori mizezia ato-
piuri daavadebebi da sxvadasxva medikamentebis gverdiTi
efeqtebi. am mxriv gansakuTrebiT sayuradReboa alergiuli
riniti. Tumca am daavadebis dros, periferiuli sisxlis eoz-
inofiliaze metad, nazaluri lorwovanis sekretSi ganviTare-
buli eozinofiliaa (bavSvebSi >4%-ze da mozrdilebSi >10–

178
25%-ze) damaxasiaTebeli. nazalur sekretSi eozinifilebis
mateba gansakuTrebiT damaxasiaTebelia sezonuri alergiuli
rinitisaTvis, mcenareTa yvavilobis sezonis periodSi da ko-
relaciaSia klinikuri simptomebis gamwvavebasTan. rinitiT
daavadebul pirTa nazalur sekretSi eozinofilebis raode-
nobis mateba, pirvel rigSi gamoricxavs rinitis infeqciur da
vazomotorul bunebas, mianiSnebs alergiuli an ara alergiu-
li eozinofiluri rinitis arsebobaze da warmoadgens topi-
kaluri kortikosteroidis gamoyenebis Cvenebas. garda amisa,
periferiuli sisxlisa da nazaluri sekretis eozinofilia
SeiZleba gamoxatuli iyos asTmian pacientebSi, romelTac ara
aqvT gamoxatuli nazaluri simptomebi da nazaluri polipoz-
is diagnozis mqone pirebSi.
periferiuli sisxlis eozinofilia, romelic iSviaTadaa
1500/ mkl-ze maRali, xSiradaa gamoxatuli bronquli asTmiT
daavdebul pacientebSi. naxvelSi eozinofilebis arseboba, pi-
rvel rigSi damaxasiaTebelia bronquli asTmisaTvis. Tumca igi
SeiZleba aReniSnebodes filtvebis qronikuli obstruqciuli
daavadebis, filtvebis intersticiuli fibrozisa da Churg-
Strauss-is sindromis mqone zogierT pacientsac.

medikamentebis miRebasTan asocirebuli eozinofilia.

zogierTi medikamentis, maT Soris herbaluri preparatebis
miRebis Semdeg, SesaZlebelia eozinofiliis ganviTareba. ami-
tom, pacientebs romelTac eozinofilia aReniSnebaT, kargad
unda gamovkiTxoT, ra saxis medikamentebs iReben amJamad an ra
medikamentebi aqvT miRebuli uaxloesi dReebisa da kviris gan-
mavlobaSi. zogierTi preparatis miRebis SeTxvevaSi, SeiZleba
ganviTardes qsovilTa eozinofiluri infiltracia, perif-
eriuli sisxlis eozinofiliis gareSe. amasTan, medikamentis
es reaqcia, klinikurad SeiZleba sruliad usimtomod ganvi-
Tardes. Tu organoebis dazianebis simptomebi araa gamoxat-
uli, izolirebulad ganviTarebuli, periferiuli sisxlis
eozinofilia ar saWiroebs im medikamentis miRebis Sewyvetas,
romelic am mdgomareobis gamomwvev mizezad SeiZleba iyos miC-
neuli. Tumca, yvela SemTxvevaSi, yuradRebiT unda iyos Sewav-
lili im organoebis mdgomareoba, romlebic yvelaze xSirad
ziandebian aseT SemTxvevaSi. aseT organoebs ekuTvnis filtve-
bi, RviZli, Tirkmlebi da guli. rodesac eozinofilias Tan
erTvis organoTa funqciis darRveva, saeWvo medikamentis

179
miReba dauyovnebliv unda Sewydes.
medikamentozuri eozinofiliis gamovlenis Taviseburebebi
asaxulia 36-e cxrilSi.

cxrili 36.

medikamentozuri reaqcia magaliTebi

citokin-damokidebuli GM-CSF, IL-2

ara-steroiduli antianTebiTi
filtvis infiltracia
saSualebebi.

plevro-pulmonaluri dantrolene

naxevradsinTezuri penicilinebi.
intersticiuli nefriti
cefalosporinebi

nekrozuli miokarditi ranitidini

naxevrad sinTezuri penicilini.

hepatitebi
tetraciklini.

hipersensitiuri vaskulitebi alopurinoli, feniTioni.

ara-steroiduli antianTebiTi
gastroenterokoliti
saSualebebi.

asTma, nazaluri polipozi aspirini

eozinofiluri mialgiuri L-triftofanis Semcveli

sindromi preparatebi.
ampicilini, penicilini,
asimptomuri
cefalosporinebi.
medikamentozuri gamonayari
antikonvulsantebi,
da eizinofilia, sistemuri
minociklini.
simptomebiT.

zogierTi antimikrobuli preparati, arasteroiduli anti-

anTebiTi medikamenti da asTmis sawinaaRmdego, iseTi saSua-
lebebi, rogorebicaa sainhalacio beklometazoni da intali,
SeiZleba pulmonaluri eozinofiliis ganviTarebis mizezi
gaxdes. klinikuri suraTi mravalferovania, magram wamyvania
mwvave an qronikuli eozinofiluri pnevmonia. periferiul

180
sisxlSi eozinofilebis raodenoba, Cveulebriv, maRalia. Tum-
ca SeiZleba iyos normaluric. rodesac periferiuli sisxlis
eozinofilia ar vlindeba, maRali diagnostikuri Rirebuleba
eniWeba naxvelSi da bronqo-alveolur lavaJSi eozinofilebis
identifikacias, romelic, rogorc wesi, yovelTvis gamoxatu-
lia. daavadebis simptomebi SeiZleba ganviTardes mwvaved, pre-
paratis gamoyenebidan Zalian male an TandaTan _ preparatis
mravalwliani gamoyenebis Semdegac ki. klinikurad gamoxatu-
lia dispnea, xmauriani sunTqva, xvela, cxeleba, urtikaria an
makulo-papulozuri gamonayari da sxeulis masis kleba. labo-
ratoriulad gamoxatulia periferiuli sisxlis eozinofilia
da maRali eds. IgE-s done SeiZleba iyos maRali an normaSi.
rendgenologiurad gamoxatulia periferiuli subplevralu-
ri infiltracia da difuziuri an bilateraluri alveoluri
da intersticiuli infiltracia
mkurnalobis efeqturi meTodia kortikosteroidebis sis-
temuri gamoyeneba, rac swrafad iwvevs klinikuri da rendge-
nologuri monacemebis gaumjobesebas.

intersticiuli nefriti.
miuxedavad imisa, rom medikamentozuri genezis intersti-
ciuli nefritis paTogenezi, dReisaTvis, bolomde garkveuli
araa, miaCniaT, rom am paTologiis ganviTarebaSi, erT-erTi
mniSvnelovani rgoli, eozinofiluri meqanizmia. am mosazrebis
sasargeblod metyvelebs, aRniSnuli daavdebis dros, uxSire-
sad ganviTarebuli, Tirkmlis qsovilis, saSarde sistemis sxva
nawilebisa da periferiuli sisxlis eozinofilia.
medikamentebs, romlebic mwvave intersticiul nefrits
iwveven, miekuTvneba meticilini, sxva saxis penicilinebi, sul-
fanilamidebi, kaptoprili, alopurinoli, rifampicini, cipro-
floqsacini, triazolamini, aztreonami, varfarini da araste-
roiduli antianTebiTi medikamentebi.

eozinofiluri miokarditi.
mwvave, manekrozirebeli, eozinofiluri endokarditi, aris
mZime, magram hipersensitiuri miokarditis gamovlinebis Seda-
rebiT iSviaTi saxeoba. daavadebis etiologia bolomde Seswa-
vlili araa. daavadeba iSviaTad asocirebulia iseTi mdikamen-
tebis miRebasTan, rogoricaa ranitidini an klozapini an yva-
vilis vaqcinaciasTan.

181
 hepatitebi.
eozinofiluri hepatiti SeiZleba ganviTardes iseTi medi-
kamentebis miRebis Semdeg, rogorebicaa monociklini, raniti-
dini, karbamazepini, sulfanilamidebi, fenitioni, salicila-
zosulfapiridini, halotani.
sxva, medikamentebTan asocirebuli, eozinofiluri reaqcie-
bi.
medikamentebiT gamowveuli qavilis sindromi, eozinofilia
da sistemuri simptomatika SeiZleba sxvadasxva medikamente-
bis miRebiT iyos gamowveuli. aRniSnuli mdgomareoba SeiZleba
ganviTardes iseTi medikamentebis miRebidan ramdenime kviris
Semdeg, rogorebicaa aromatuli antikonvulsiuri saSuale-
bebi, sulfanilamidebi, alopurinoli da nevirapini. kliniku-
rad gamoxatulia difuziuri, makulo-papulozuri gamonayari,
cxeleba da hepatitis movlenebi. laboratoriulad _ eozi-
nofilia da limfocitozi. SeiZleba ganviTardes Tirkmlis
dazianeba. Tirkmlis an RviZlis mZime dazianebis SemTxvevaSi,
mosalodnelia fataluri Sedegi. daavadebis marTva iTvalis-
winebs triger_medikamentis miRebis dauyovnebel Sewyvetas da
glukokortikosteroidis gamoyenebas. gastrointestinaluri
traqtis eozinofiluri dazianeba SeiZleba iseTi medikamente-
bis gamoyenebis gverdiTi efeqtis Sedegic iyos, rogorebicaa
mag. klozapini an arasteroiduli antianTebiTi preparatebi.
aspirin-damokidebuli asTmis dros, praqtikulad, yovel-
Tvisaa gamoxatuli eozinofilia. eozinofilia, aseve xSirad
axlavs Tan medikamentozuri warmoSobis, kanis sisxlZarRvTa
vaskulitebs.

infeqciuri daavadebebi.
zogierTi mwvave, virusuli da baqteriuli infeqciebisa-
Tvis damaxasiaTebelia periferiuli sisxlis eozinofilia.
sxva SemTxvevaSi, iseT pacientebSi, romelTac alergiuli an
parazituli daavaddebaTa gamo gamoxatuli aqvT eozinofi-
lia, baqteriuli an virusuli infeqciis ganviTarebis SemTxve-
vaSi, SeiZleba periferiuli sisxlis eozinofiliis daTrgunva
mosdes. es movlena, infeqciuri procesis sapasuxod ganviTa-
rebuli, kortikosteroidebis produqciis gaZlierebiTaa ga-
mowveuli.

182
 parazituli infeqciebi.
eozinofilia damaxasiaebelia iseTi specifiuri parazi-
tuli daavadebebisaTvis, rogoricaa helminTozebi. helmin-
Tebi arian mravalujrediani metazouri organizmebi, romelTa
arsebobac uxSiresad asocirebulia eozinofiliasTan. Tumca
eozinofilebis normaluri done periferiul sixlSi, ar gamo-
ricxavs helminTuri infeqciis arsebobas. helminTTa migracia
qsovilebSi iwvevs qsovilTa am areSi eozinofilebis mkveTr
matebas, rac yovelTvis ar aisaxeba periferiuli sisxlis eozi-
nofilebis doneze. es xdeba gansakuTrebiT, maSin, roca hel-
minTis antigenebi sekvestrirebulia organoTa qsovilebisagan
(mag. eqinokokis kista). eqinokokis kistidan siTxis qsovilebSi
moxvedram, momentalurad SeiZleba gamoiwvios periferiuli
sisxlis eozinofilia, urtikaria da anafilaqsiac ki. eozino-
filiis gamomwvev helminTur parazitTa Soris gansakuTrebu-
li yuradReba eqceva strongiloidozs. es daavadeba SeiZleba
didi xnis ganmavlobaSi mimdinareobdes klinikuri simptoma-
tikis gareSe; periferiul sisxlSi eozinofilebis maRali do-
niT. aseT SemTxvevaSi Catarebuli kortikosteroidoTerapia
ki SeiZleba pacientis imunokomprometaciis, infeqciis disemi-
nizaciis da fataluri Sedegis mizezi gaxdes. am SemTxvevaSic,
polimeraza-jaWvuri reaqciis meTodi, diagnostikis efeqturi
saSualebaa.
mravalujrediani helminTuri parazitebisagan gansxvaebiT,
erTujrediani protozouli parazitebi ar iwveven periferiu-
li sisxlis eozinofilias. am mxriv gamonaklisia ori parazi-
ti: Dientamoeba fragilis da Isospora belli. aRniSnuli parazitozis
dros gamoxatulia nawlavuri infeqciis simptomebi da perife-
riuli sisxlis eozinoilia. iseTi protozouli infeqcia, ro-
goricaa Giardia lamblia, ar iwvevs eozinofilias da periferiuli
sisxlis eozinofiliisa da ganavalSi am parazitis kvercxebis
naxvis SemTxvevaSi, eozinofiliis gamomwvevi sxva mizezebi unda
veZeboT.
fungaluri infeqciebiT gamowveuli eozinofilia.
iseTi fungaluri etiologiis infeqciuri daavadebebi, ro-
gorebicaa bronqopulmonaluri aspergileozi da kokcidio-
mikozi xasiaTdebian periferiuli sisxlis eozinofiliiT.
hematologiuri da neoplastiuri daavadebebis dros ganvi-
Tarebuli hipereozinofiluri sindromi.
hipereozinofiluri sindromi an ufro sworad _ idiopa-

183
Tiuri eozinofiluri sindromi, ar aris monokauzaluri da
erTi garkveuli paTogeneziT ganviTarebuli mdgomareba. Tum-
ca, uxSiresad mindinareobs leikoproliferaciuli procese-
bis TanxlebiT da eozinofilebis hiperproduqciiT. am sin-
dromis sadiagnostikod rekomendirebulia sami maCvenebeli: 1.
periferiuli sisxlis eozinofilebis raodenoba, 6 Tveze meti
xnis ganmavlobaSi > 1500/mkl. 2. ar vlindeba parazitozis an
alergiuli an sxva daavadebebis niSnebi, romlebic SeiZleba
iwvevdes eozinofilias. 3. ar vlindeba organoTa dazianebis
niSnebi. hipereozinofiliis pirveli 6 Tvis ganmavlobaSi, isme-
ba “persistuli eozinofiliis” an “myari eozinofiliis” da ara
“idiopaTiuri hipereozinofiliis sindromis” diagnozi.
hipereozinofiliis sindromis gamomwvevi mizezebi da meqani-
zmebi mocemulia 1 sqemaze.
hipereozinofiluri sindromis klinikuri manifestacia.
hipereozinofiluri sindromis klinikuri gamovlineba xSi-
radaa asocirebuli mieloproliferaciul da limfoproli-
feraciul procesebTan. hipereozinofiliis mieloprolife-
raciuli variantis SemTxvevaSi xSiria endo-miokardialuri
dazianebebi, maSin roca sindromis limfoproliferaciuli
variantis SemTxvevaSi, upiratesad, wina planze gamodis ara
kardialuri paTologia, aramed kanis dazianeba.
hipereozinofiluri sindromi bevrad ufro xSirad gvxv-
deba mamakacebSi, vidre qalebSi (9 : 1). ufro xSirad vlindeba
20 – 50 wlis asakSi, Tumca SeiZleba gamovlindes bavSvebSic.
davadeba SeiZleba mimdinareobdes usimptomod da gamovlindes
mxolod SemTxveviT, sisxlis analizis Sedegan. SesaZlebelia
gamovlindes uecrad, kardialuri an nevrologiuri simpto-
matikis saxiT. paTologiis gamovlenis uxSiresi simptomia
sisuste da daRlilobis SegrZneba (26%), xvela (24%), qoSini,
mialgia an angioSeSupeba (14%), gamonayari da cxeleba (12%)
da retinis dazianeba (10%). laboratoriulad gamoxatulia
eozinofilia > 1500/mkl. leikocitebis Zalian maRali done
(> 90000/mkl) mZime prognozis maCvenebelia da miuTiTebs daa-
vadebis mieloproliferaciul variantze. hipereozinofiliis
mqone bevr pacients aReniSneba absoluturi neitrofilia.
Zvlis tvinSi momatebulia, rogorc eozinofilebis ise misi
moumwifebeli formebi. qromosomuli speqtri, umetes SemTxve-
vaSi, normaluria.

184
 sqema 7.
hipereozinofiliis gamomwvevi mizezebi da ganviTarebis meqanizmebi
hipereozinofiluri sindromi

eozinofilia > 1500 mm 3.

persistuli ozinofilia da organoTa
dazianeba/disfunqcia.
gamoiricxos eozinofiliis meoradi mi-
zezebi

mielo prolifera- limfoci- ojaxuri gaurk- nawil- kavSir-

ciuli. turi veveli obriv Sia

limfocitebis gaurkveveli e.a.g.p. eozin- k.s.s. sar-

subpopulaciebi etiologiis ofiluri koido-
nakaduri cito- ojaxuri, pnevmonia. zi, anTe-
mertriT an T- persistuli mialgiuri biTi naw
limfocitebis eozinofili- sindromi an lavis
receptorebi is anamnezi. eozinifil- sindro-
p.j.r.-iT. uri infil- mi, Sids
traciiT da sxv.
gamoweveuli paT.
sxva organ-
oTa dazian-
eba.

keTilTvise- kompleqsuri epizoduri

F/P nega- F/P saxezea ci- biani.
tiuri pozi- togetikuri
tiuri paTologia
an/da blas-
tebis arse-
boba peri- asimptomuri. organoTa dis cikluri angi-
feriaze ar aris or- funqciis sim- oSeSupeba da
ganoTa dazi- ptomebi. ar eozinofilia
anebis simp- aris mielo
tomebi. da limfop-
rolofera-
ciuli paT.

e.a.g.p. _ eozinofilisTan asocirebuli gastroenteraluri paT.

k.s.s. _ kraS-stausis sindromi
F/P _genuri dispozicia

cxril 37-Si mocemulia hipereozinofiluri sindrmTan aso-

cirebuli, sxvadasxva organoTa dazianebis sixSiris Tavisebure-
ba.
cxrili 37.
organoebi/sistemebi %
sisxli 100

185
 kardio-vaskularuli 58
kani 56
nevrologiuri 54
pulmonaluri 49
elenTa 43
RviZli 30
Tvali 23
gastro-intestinaluri 23

hipereozinofiluri sindromis mqone pacientebSi, mdgo-

mareobis simZimesa da letalobis albaTobas, mniSvnelovnad
gansazRvravs gulis dazianebis Tavisebureba da xarisxi. hip-
ereozinofiliis SemTxvevaSi SeiZleba ganviTardes miokardiu-
mis nekrozi, Trombozi da fibrozi.
hipereozinofiluri sindromis dros, nervuli sistemis da-
zianeba viTardeba sam etapad; pirvel etapze, rogorc intra-
kardialuri Trombozis Sedegi, viTardeba cerebruli Trom-
boembolia an warmavali, cerebruli iSemiis epizodebi. meore
etapze viTardeba encefalopaTiis iseTi klinikuri gamovline-
ba, rogoricaa qcevis paTologia, SfoTva, SiSebi, ataqsia da
mexsierebis problebebi. SeiZleba gamoixatos iseTi movlenebi,
rogoricaa kunTTa tonusis momateba da babinskis dadebiTi
refleqsi. mesame etapze gamoxatulia periferiuli neiropaTa.
h.e.s.-is dros gamoxatulia kanis dazianebis ori tipi _ angi-
oSeSupeba/urtikaria an eriTematozuli papulebi da kvanZebi
da qavili. angioSeSupebisa da urtikariis gamovlenis SemTx-
vevaSi naklebadaa kardialuri da nevrologiuri garTulebis
saSiSroeba.
sasunTqi sistemis dazianeba, uxSiresad, gamoxatulia per-
sistuli, mSrali xveliT. radiografiuli gamokvleviT, ro-
gorc wesi, filtvis qsovilis paTologia ar aRiniSneba. bron-
quli asTmis arsebobis albaToba daaxloebiT iseTivea, rogorc
saerTo populaciaSi. respiratoruli simptomebis ganviTareba
SeiZleba gamowveuli iyos iseTi mizezebiT, rogoricaa gulis
dazianeba, filtvis embolia da filtvebis eozinofiluri in-
filtratis arseboba. hipereozinofiluri sindromis mqone
pacientebSi, filtvis infiltrati SeiZleba ganviTardes Sem-
TxvevaTa < 25%-Si. infiltrati SeiZleba iyos difuziuri an
fokaluri da qronikuli eozinofiluri infiltratisagan gan-

186
sxvavebiT, ar axasiaTebs gavrceleba filtvis sxvadasxva re-
gionSi.
hipereozinofiluri sindromis mqone pacientebSi mosalod-
nelia eozinfiluri gastritis, enterokolitis da/an kolitis
ganviTareba. SeiZleba ganviTardes qronikuli aqtiuri hepati-
ti, RviZlis qsovilis fokaluri eozinoilia, eozinofiluri
qolangiti da RviZlis venebis obstruqciiT ganpirobebuli
Budd-Chiari-is sindromi.
hipereozinofiluri sindromis prognozi seriozulia.
mdgomareoba gansakuTrebiT mZimea kardio-vaskularuli sis-
temis dazianebis SemTxvevaSi. sicocxlis saSualo xangrZlioba
Seadgens 9 Tvidan 3 wlamde. mieloproliferaciuli formiT
daavadebul pirebSi prognozi SedarebiT ukeTesia da sicocx-
lis xangrZliobam SeiZleba 10 _ 15 wels miaRwios.

hipereozinofiluri sindromis mkurnaloba.

idopaTiuri hipereozinofiluri sindromis mqone pacien-
tebs, romelTac ar aReniSnebaT sxvadasxva organoTa da sis-
temaTa dazianeba, ar esaWiroebaT mkurnaloba. gulis dazianeb-
is procesis ganviTarebis Seferxebis mizniT, saWiroa pacientis
monitoringi da sisxlis Sratis troponinebisa da eqokardio-
gramis kontroli 6 TveSi erTxel. imis gasarkvevad, ramde-
nad efeqturi SeiZleba iyos k.s. eozinfiliis supresiisaTvis,
SeiZleba Catardes sacdeli kortikosteroiduli Terapia (60
mg/24 sT.-Si an 1 mg/kg.),. es informacia saWiroa im SemTxvevi-
saTvis, Tu uecrad ganviTarda organoTa dazianebis suraTi da
saWiro gaxda kortikosteroidebiT mkurnaloba. radgan eozi-
nofilia, romelic advilad emorCileba k.s. Terapias ufro
keTilsaimedo prognoziT xasiaTdeba, vidre eozinofiliis is
forma, romelic amgvar mkurnalobas ar emorCileba.
pacientebs, romelTac hes-i da sisxlis sitemuri daavadebeb-
is kliniko-laboratoriuli suraTi aReniSnebaT gamokvleva da
mkurnaloba utardebaT Sesabamisi specialistebis mier.

mastocitozi.
sistemuri mastocitozi warmoadgens sxvadasxva organoebsa
da sistemebSi, mastocitebis gaZlierebuli proliferaciisa da
akumulaciis Sedegs. mastocitebis gaZlierebuli prolifera-
cia da akumulireba SeiZleba moxdes kanSi, RviZlSi, elenTaSi,
Zvlis tvinSi da limfur jirkvlebSi. mastocitoziT daavade-
bul, mozrdil pirTa, daaxloebiT 25%-s, aReniSneba periferi-

187
uli sisxlis eozinofilia. periferiuli sisxlis eozinofi-
lia SeiZleba gamoxatuli iyos mastocitozis iseTi formebis
drosac, rodesac kanis simptomebi araa gamovlenili.

kanis, kanqveSa qsovilebis da sxvadasxva organoTa

dazianebis dros ganviTarebuli eozinofilia.
eozinofilia damaxasiaTebelia mravali dermatologiuri
da atopiuri bunebis paTologiisaTvis. mag. atopiuri der-
matitisaTvis damaxasiaTebelia periferiuli sisxlisa da an-
Tebad qsovilTa eozinofilia. qsovilTa eozinofiluri in-
filtracia damaxasiaTebelia bulozuri pemfigoidisaTvis,
martivi pemfigusisaTvis, herpetiformuli dermatitisaTvis,
orsulTa herpesuli daavadebisaTvis da medikamentozuri gen-
ezis dermatitebisaTvis. eozinofilia an eozinofiluri gran-
ulebis Semcveli cilovani precifitatebia nanaxi kanSi qroni-
kuli urtikariis, mzis urtikariis da zewolis Sedegad gan-
viTarebuli urtikariis dros. eozinofiluri infiltratebi
Cndeba migraciis procesSi myofi moumwifebeli helminTebis
dislokaciis zonebSi.
eozinofiluri panikulitis dros, adgili aqvs kanqveSa cxi-
movani qsovilis eozinfilur infiltracias. am dros, ufro
xSirad gamoxatulia kanis kvanZovani dazianeba da naklebad vi-
Tardeba vezikulebi da balTebi. eozinofiluri panikuliti
xSiradaa asocirebuli gnatostomozTan, leikocitoklastur
vaskulitTan da kvanZovan eriTemasTan. eozinofiluri pani-
kuliti aseve xSirad asocirdeba atopiur da kontaqtur der-
matitTan, eozinofilur celulitTan, toqsokariazTan, kvan-
Zovan periarteritTan, qronikul rekurentul parotitTan da
diabetTan.
epizoduri angioSeSupeba da eozinofilia, ucnobi eti-
ologiis paTologiaa. klinikurad gamoxatulia gaurkvevli
mizeziT ganviTarebuli, epizoduri urtikaria, angioSeSupe-
ba, qavili, cxeleba da sxeulis masis mateba. laboratoriu-
lad _ sisxlis SratSi IgM-is maRali done, leikocitozi da
eozinofilia. eozinofiliis done, korelaciaSia daavadebis
aqtivobasTan. daavadeba kargad emorCileba glukokortikos-
teroidebiT mkurnalobas. aRweren intravenuri imunoglobu-
liniT mkurnalobis efeqtsac.
Shulman-is sindromi (eozinofiluri fasciti) warmoadgens
kidurebis areSi mwvaved ganviTarebul kanis eriTemas, SeSupe-

188
bas da induracias, romelic, xSir SemTxvevaSi, fizikuri var-
jiSis Semdeg viTardeba. gamoxatulia periferiuli sisxlis
eozinofilia.
Wells-is sindromi (eozinofiluri celuliti) warmodgenil-
ia kidurebis perioduli SeSupebiT. 50%-Si gamoxatulia per-
iferiuli sisxlis eozinifilia. gamoxatulia celuliti da
kanis minimaluri daWimuloba. SeSupebuli qsovilebi araa cx-
eli. antibiotikoTerapia ar iZleva Sedegs, rac am daavadebas
baqteriuli celulitisagan ganasxvavebs. SesaZlebelia proce-
sis spontanuri ukuganviTareba.
piris Rrus lorwovanis eozinofiluri wylulebi xSirad
lokalizdeba enaze. gamoxatulia tkivili. daavadebis gamom-
wvev mizezad miCneulia travma. wyluli ukuganviTarebas gan-
icdis erTi Tvis ganmavlobaSi.
eozinofiluri pustularuli folikulitisaTvis damaxasi-
aTebelia kanis folikulebis eozinofiluri da neitrofiluri
infiltracia da periferiuli sisxlis eozinofilia. paTolo-
gia xSiradaa asocirebuli, sxvadasxva mizeziT gamowveul, imu-
nokomprometaciasTan.
kanis rekurentuli manekrozirebeli vaskuliti warmoadgens
kanis wvrili sisxlZarRvebis dazianebiT mimdinare daavade-
bas, romlisTvisac, morfologirad, damaxasiaTebelia manek-
rozirebeli vaskuliti da sisxlZarRvTa kedlebisa da sana-
Turebis eozinofiluri infiltracia. kortikosteroiduli
Terapia efeqturia, Tumca daavadebas axasiaTebs qroniulad
morecidive mimdinareoba. eozinofiluri vaskulitis arseboba
aseve damaxasiaTebelia SemaerTebeli qsovilis paTologiisaT-
vis, romelic kanis manekrozirebeli vaskulitiT, hipokomple-
mentemiiT da periferiuli eozinofiliiT miminareobs.

eozinofiliiT mimdinare pulmonaluri paTologiebi.

filtvebis eozinofiluri paTologiebi wamoadgenen
daavadebaTa heterogenul jgufs, romelTaTvisac damaxasi-
aTebelia filtvis parenqimis da/an bronqebis eozinifiluri
infiltracia. klinikurad gamoxatulia sasunTqi sistemis da-
zianebis niSnebi _ taqipnea, qoSini, xvela, xmauriani sunTqva
da sxva. xolo rendgenologiurad _ cvlilebebi gulmkeris
rendgenogramaze. masTan, filtvis qsovilis eozinofilias,
yovelTvis ar axlavs Tan periferiuli sisxlis eozinofi-
lia an filtvis qsovilis rendgenlogiuri cvlilbebi. pul-

189
monaluri eozinofiliis gamomwvevi mizezebi da gamovlenis
Taviseburebebi mocemulia 38-e cxrilSi.

cxrili 38.
filtvis qsovilis eozinofiluri dazianebis mizezebi

medikamentebiTa da toqsinebiT gamowveuli pulmonaluri

1
eozinofilia
helminTebTan da fungalur infeqciebTan dakavSirebuli
2
pulmonaluri eozinofilia
a. helminTis (askaridozi, ankilostomozi, strongilo-
idozi) transpulmonaluri migracia (Löffler’-is sindromi)
b. pulmonaluri parenqimis helminTuri invazia: uxSiresad
helminTuri, paragonimiazi.
c. helminTebis didi raodenobiT moTesva sissxlSi: tri-
qinelozi, diseminirebuli strongiloidozi, Sistosomozi.

d. tropikuli pulmonaluri eozinofilia: filariazi.

e. bronqopulmonaluri aspergileozi.
3. qronikuli eozinofiluri pnevmonia.
4. mwvave eozinofiluri pnevmonia.
5. Churg-Strauss sindromi _ vaskuliti.
sxva mizezebi: neoplazma, idiopaTiuri eozinofiluri
6.
sindromi, bronqocentruli granulomatozi.

medikamentebiTa da toqsinebiT gamowveuli pulmonaluri

eozinofilia SeiZleba ganviTarebuli iyos sxvadasxva medika-
mentebisa da iseTi toqsikuri agentebis gavleniT, rogorebi-
caa mag. aluminis salicilatebi, sxvadasxva sulfatebi da sxva.
paTologia sxvadasxvagvarad vlindeba sxvadasxva etiologiu-
ri faqtoris arsebobis SemTxvevaSi. Tumca ZiriTadi gamovli-
neba mainc ori formaa: mwvave da qronikuli eozinofiluri
pnevmonia.
helminTebiTa da fungaluri infeqciebiT gamowveuli pul-
monaluri eozinofiliis klinikuri suraTi damokidebulia am
agentTa antigenuri struqturebis da sxva Tvisebebis Tavise-
burebeze da adamianis organizmis imunuri sistemis mdgoma-
reobaze _ imunuri pasuxis specifikaze.
Löffler-is sindromi gamowveulia helminTTa (askaridozi,

190
strongiloidozi, ankilostomozi) transpulmonaluri migra-
ciiT. nawlavTa sanaTuridan helminTi gadadis sisxlZarRvis
sanaTurSi da migrirebs alveolebsa da filtvis qsovilebSi,
saidanac isev hematogenuri gziT brundeba wvril nawlavebSi.
filtvebSi viTardeba sxvadasxva zomis, bilateraluli an uni-
lateraluri eozinofiluri infiltrati, romelic icvlis
mdebareobas, formas, zomas da qreba 1 _ 2 kviraSi. periferiul
sisxlSi gamoxatulia eozinofilia. klinikurad gamoxatulia
mSrali xvela, saerTo sisuste da diskomforti. sxva-dasxva
xarisxis qoSini da sunTqvis ukmaisoba aReniSneba pacintTa
daaxloebiT naxevars. sindromis ZiriTadi gamomwvevi askari-
daa. daavadeba viTardeba askaridebis kvercxebiT dainficire-
bidan daaxloebiT 9 _ 12 dRis Semdeg, askaridebiT ukve sensi-
bilizirebul pacientebSi. daavadebis diagnozi, Sesabamis kli-
nikur da laboratoriul monacemebTan erTad, mniSvnelovnad
amyarebs ganavalSi askaridebis kvercxebis aRmoCena. Tumca
ganavalSi kvercxebis ar arseboba ar gamoricxavs askaridebiT
gamowveuli filtvis eozinofiluri infiltraris arsebobas.
iSviaTad, msgavsi sindromi SeiZleba ganviTardes strongiloi-
dozisa da Sistosomozis SemTxvevaSic.
filtvis parenqimis helminTuri invazia, gansxvavebiT hel-
minTTa migraciiT gamowveuli daavadebisagan, gamowveulia
helminTis (Paragomimus) pirdapiri lokalizaciiT filtvis
parenqimaSi, ris Semdegac, parazitis lokalizaciis adgilze
viTardeba eozinofiluri infiltrati.
helminTebis an misi kvercxebis didi raodenobiT moTesvam
sisxlSi da hematogenuri gziT maTma migraciam, SeiZleba pul-
monaluri eozinofilia gamoiwvios. es mdgomareoba SeiZleba
ganviTardes Sistosomebis, triqinelebis, an askaridebis lar-
vebis kanSi an visceralur organoebSi migraciis Sedegad; aseve
Sistosomozis sawinaaRmdego qimioTerapiis Semdeg. erT-erTi
mniSvnelovani faqtori, romelic pulmonaluri eozinofiliis
seriozuli formis mizezi SeiZleba gaxdes aris Strongyloides.
am saxeobis helminTs axasiaTebs qronikuli persistuli mimdi-
nareoba da diseminirebis maRali unari. daavadeba didi xnis
ganmavlibaSi SeiZleba mimdinareobdes subklikuniuri formiT
da gamoxatuli eozinofiliiT. es mdgomareoba xSirad xdeba
pacientis kortikosteroidebiT mkurnalobis mizezi, rac in-
feqciis diseminizaciiTa da zogjer, fataluri gamosavliTac
SeiZleba damTavrdes. amis gamo, maRali eozinofiliis SemTxve-
vaSi, aucileblad unda gamoiricxos strongiloidozis arse-

191
boba da mxolod amis Semdeg gadawydes kortikosteroidebiT
mkurnalobis sakiTxi.
tropikuli pulmonaluri eozinifilia gamowveulia aziaSi,
afrikaSi da samxreT amrikaSi gavrcelebuli iseTi endemuri
parazitebiT, rogorebicaa Filariae, Wuchereria bancrofti da ufro
naklebad Brugia malayi. amdenad, am parazitebiT gamowveuli
pulmonaluri eozinofiliac upiratesad gvxvdeba am regio-
nebSi an am regionebidan emigrirebul mosaxleobaSi. klinikuri
suraTi xasiaTdeba saerTo sisustiT, daRlilobis SegrZnebiT,
subfebriluri temperaturiT, RamiT oflianobiT, mSrali
xveliT da sxeulis wonis klebiT. SeiZleba gamoixatos dis-
pnea da vizingi. iSviaTad vlindeba asTma. laboratoriulad
gamoxatulia periferiuli sisxlis eoizinofilia, sisxlis
Sratis IgE da IgG-s maRali done da antifilarialuri IgE da
IgG antisxeulebi. sisxlSi yovelTvis ar xerxdeba filariebis
aRmoCena. gulmkerdis rendgenogramaze damaxasiaTebelia 1 _
3 mm. miliaruli kerebis arseboba. SeiZleba gamoxatuli iyos
kerebis konsolidacia an Rruebis ganviTareba
alergiuli bronqopulmonaluri aspergileozis gamomwvevi
aris fungaluri agenti _ Aspergillus fumigatus. daavadebis gan-
viTareba dakavSirebulia, rogorc gamomwvevis garemoSi arse-
bobasTan, ise, gamomwvevze, adamianis imunuri sistemis pasuxis
TavisebulebasTan. klinikurad gamoxatulia asTma. rendgeno-
logiurad _ filtis qsovilis infiltracia. bronqoskopiiT
_ bronqoeqtaziebi. laboratoriulad _ periferiuli sisxlis
eozinofilia, saerTo IgE-s maRali done da anti- Aspergillus an-
tigenebis IgE da IgG antisxeulebi sisxlis SratSi.
qronikuli eozinofiluri pnevmonia aris ucnobi etiolo-
giis daavadeba. qalebSi gvxvdeba 2-jer ufro xSirad, vidre
mamakacebSi. pacientTa asaki, uxSiresad, 30 welze metia. pa-
cientTa naxevars aReniSneba atopiis, ufro xSirad ki, bron-
quli asTmis anamnezi. daavadebis simptomebia xvela, cxeleba,
dispnea da wonis mniSvnelovani kleba. SeiZleba gamovlindes
naxvelis gamoyofa, gulisreva, xmauriani sunTqva, Ramis
oflianoba, saerTo sisuste da daRlilobis SegrZneba. labo-
ratoriulad _ periferiuli sisxlis eozinofilia gamoxatu-
lia SemTxvevaTa 90%-Si. bronqoalveolur lavaJSi aRiniSneba
eozinofilia da limfocitozi. zog SemTxvevaSi Semcirebulia
filtvis sasicocxlo tevadoba da eqspiraciuli haernakadis
maCvenebeli. radiografiulad gamoxatulia filtvis qsovi-
lis periferiuli infiltracia, romelic kortikosteroi-

192
debis mkurnalobis fonze, swrafad ganicdis ukuganviTare-
bas. pacientTa 2/3-s aReniSveba filtvis zemo wilebis peri-
feriuli infiltracia. SeiZleba gamoixatos infiltratebis
bilateraluri konsolidacia, ateleqtazebi, unilateraluri
dazianeba, Rruebis Camoyalibeba da plevris RruSi siTxis ar-
seboba. SeiZleba gamoixatos Suasayaris limfuri jirkvlebis
hiperplazia. rendgenologiuri suraTi ver iZleva paTolo-
giis sruli asaxvis saSualebas, ris gamoc upiratesoba kom-
piuterul tomografias eniWeba. kortikosteroidebiT mkur-
nalobis dawyebidan 24 saaTSi umjobesdeba klinikuri suraTi
da iklebs periferiuli sisxlis eozinofilebis raodenoba.
60 – 70 saaTSi xdeba radiografiuli suraTis gaumjobeseba
xolo sruli gamojanmrTeleba xdeba 2 kviris ganmavlobaSi.
kortikosteroidebiT mkurnalobis minimaluri xangrZlioba
Seadgens 19 Tves. winaaRmdeg SemTxvevaSi, SemTxvevaTa 58%-
Si, mosalodnelia recidivis ganviTareba. 34% SemTxvevaSi
mosalodnelia rekurentuli mimdinareobis ganviTareba. es
xdeba gansakuTrebiT xSirad im pacientebSi, romelTac anam-
nezSi asTmis arseboba aReniSnebaT. Soreuli prognozi, umetes
SemTxvevaSi kargia. 75% SemTxvevaSi saWiroa xangrZlivi mkur-
naloba, kortikosteroidebis dabali dozebiT. mdgomareobis
stabilizaciis Semdeg, pacientebi saWiroeben xangrZliv moni-
torings, Churg-Strauss-is sindromis ganviTarebis Tavidan aci-
lebis mizniT.
mwvave eozinofiluri pnevmonia upiratesad viTardeba mama-
kacebSi da misTvis klinikurad damaxasiaTebelia mwvaved ganvi-
Tarebuli xvela, dispnea da cxeleba. daavadebis sadiagnostiko
kriteriumebi mocemulia 39-e cxrilSi. miuxedavad imisa, rom
daavadebis ganviTarebas xSirad ukavSireben sxvadasxva medika-
mentebis an sxva alergenebis mimarT hipermgrZnobelobas, Tam-
baqos wevas an sxvadasxva qimikatebisa da metalebis toqsiur
zemoqmedebas, mwvave eozinofiluri pnevmoniis etiologia da
paTogenezi dReisaTvis bolomde garkveuli araa.
mwvave eozinofiluri pnevmoniis diagnozi emyareba fun-
galuri, parazituli, medikamentozur da sxva, garkveuli
mizezebiT ganviTarebuli, eozinofiluri pnevmoniis arsebo-
bis gamoricxvas.

193
 cxrili 39.
mwvave eozinofiluri pnevmoniis sadiagnostiko krteriumebi
mwvaved ganviTarebui cxeleba, romelic grZeldeba 5 dRidan
ramdenime kviramde.
hipoqsemia da sunTqvis ukmarisoba
radiografiulad gamoxatulia difuziuri alveoluri an alve-
olur-intersticiuli infiltracia. limfuri jirkvlebis hiper-
plazia ar vlindeba.
periferiuli sisxlis eozinofiliis piki gamoxatulia daavadebis
klinikuri gamovlinebis me-7 _ 9 dRes.

bronqo-alveolur lavaJSi eozinofilebis raodenoba > 25%.

filtvis qsovilis biofsia adasturebs eozinofiluri infiltrate-
bis arsebobas.
ar mtkicdeba fungaluri, parazituli an sxva infeqciis arseboba.

kortikosteroidebiT mkurnaloba iZleva karg Sedegs.

kortikosteroidebiT mkurnalobis Sewyveta auaresebs
mdgomareobas.

kortikosteroidoTerapia, 24 _ 48 saaTSi iZleva karg efe-

qts. umjobesdeba, rogorc klinikuri, ise laboratoriuli da
radiografiuli monacemebi. amitom, steroidebiT mkurnaloba
unda daviwyoT maSinve, rogorc ki moxdeba daavadebis diagno-
stika. daavadebis dasawyis stadiaze, rodesac sunTqvis mwvave
ukmarisobaa gamoxatuli, saWiroa filtvis xelovnuri venti-
lacia. steroiduli Terapiis saWiroeba SeiZleba gagrZeldes
8 kviramde. aRwerilia fataluri Sedegebi. daavadebis ganmeo-
rebis SesaZlebloba mcirea.
filtvebis eozinofiluri granuloma (X-histiocitozi),
asocirebulia filtvebis intersticiul fibrozTan. daava-
debis umTavresi simptomia mSrali xvela, rasac Tan erTvis
dispnea, plevris dazianebiT gamowveuli tkivili gulmkerdis
areSi, cxeleba, wonaSi kleba da hemoptizi (sisxliani xvela).
gulmkerdis radiografiuli gamokvleviT naxuloben filt-
vis qsovilis retikulo-kvanZovan infiltracias, fiWisebur
suraTs, kistozur cvlilebebs da kvanZebs. kistebi da kvanZebi
gansakuTrebiT kargad fiqsirdeba kompiuteruli tomografi-
is SemTxvevaSi.

194
 aRniSnuli radiografiuli suraTi, zogjer sruliad Sem-
TxveviT xdeba asimptomur pacientebSi, daavadebaze eWvis mi-
tanis safuZveli. aseT SemTxvevaSi, diagnozi ismeba filtvis
qsovilis biofsiis saSualebiT. daavadebis dros ganviTarebu-
li eozinofilur granulomebs yovelTvis ar axlavs Tan pe-
riferiuli sisxlis eozinofilia. eozinofiliiT mimdinare,
sasunTqi sistemis sxva daavadebebisagan gansxvavebiT, gamoxa-
tuli araa bronqebis lorwovanis eozinofiluri infiltracia
an eozinofilebis arseboba bronqo-alveolur lavaJSi.
plevraluri siTxis eozinofilia (>10%) umetes SemTxvevaSi
warmoadgens araspecifiur reaqcias, romelic SeiZleba gan-
viTardes pnevmoToraqsis, Torakocentezis an gulmkerdis
RruSi Catarebuli operaciuli Carevis SemTxvevaSi. am dros,
umeteswilad viTardeba unilateraluri eozinofiluri eqsu-
dati. plevraluri eozinofiluri eqsudatis arseboba ar aris
asocirebuli periferiuli sisxlis eozinofiliasTan.
bronqoalveolur lavaJis (bal) eozinofilia ( > 5%) fiqsir-
deba bronqoskopiT miRebuli lavaJis kvlervis daaxloebiT
4,5% SemTxvevebSi da uxSiresad ar aris asocirebuli perife-
riuli sisxlis eozinofiliasTan. daavadebebs, romlebic ba-
lis, eozinofiliasTanaa asocirebuli, miekuTvneba filtvebis
intersticialuri daavadebebi (40%), Sids-Tan asocirebuli
pnevmonia (17%), idiopaTiuri eozinofiluri pnevmonia (15%) da
medikamentozuri etiologiis pulmonaluri paTolgiebi (12%).
filtvebis intersticiul daavadebebs, romelTa drosac balis
eozinifiliaa damaxasiaTebeli, miekuTvneba idiopaTiuri pul-
monaluri fibrozi, sarkoidozi, sistemuri wiTeli mglura
da hiperergiuli pnevmoniti. garda amisa balis eozinofilia
SeiZleba ganviTardes iseTi daavadebebisa da mdgomareobebis
drosac, roforebicaa: maoblitirebeli bronqioliti, Hodgkin-
is daavadeba, revmatoiduli arTriti, malignizaciuri proce-
sebi, eozinofiluri granuloma, post radiaciuli Terapia,
sistemuri sklerozi da transplantaciis Semdgomi garTuleba
(„transplantanti patronis winaaRmdeg“.

gastro-intestinaluri sistemis daavadebebis

dros ganviTarebuli eizinofilia.
rogorc qsovilTa, ise periferiuli sisxlis eozinofilia
SeiZleba ganviTardes gastrointestinaluri traqtisa da hepa-
tobiliaruli sistemis sxvadasxva daavadebebis dros.

195
 eozinofiluri ezofagiti viTardeba rogorc mozrdilebSi,
ise bavSvebSi da am dros damaxasiaTebelia qsovilTa da nakle-
bad, periferiuli sisxlis eozinofilia. kuWisa da Tormetgo-
ja nawlavis Helicobacter pylori infeqciis dros viTardeba qso-
vilebis eozinofilia, magram damaxasiaTebelia araa eozino-
filebis mateba periferiul sisxlSi. qsovilTa eozinofilia
damaxasiaTebelia wylulovani kolitisa da Crohn-is daavade-
bisaTvis. amasTan, rac ufro intensiuria anTebiTi procesi,
miT intensiuradaa gamoxatuli qsovilTa eozinofilia. qso-
vilTa eozinofilia damaxasiaTebelia celiakiisa da kola-
genozuri kolitisaTvis. eozinofiluri gastroenteriti an
enterokoliti, SeiZleba ganviTardes, rogorc hiperergiuli
reaqcia, romelime medikamentis an sakvebis miRebis Semdeg.
orive SemTxvevisaTvis damaxasiaTebelia qsovilovani da ufro
naklebad, periferiuli sisxlis eozinofilia.

nevrologiuri xasiaTis paTologiebi.

qsovilovani eozinofilia damaxasiaTebelia qronikuli
subduraluri hematomisaTvis. sxva nevralogiuri daavadebe-
bisaTvis naklebadaa damaxasiaTebeli qsovilovani an perife-
riuli sisxlis eozinofilia. Tumca, SesaZlebelia eozinofi-
luri meningitis ganviTareba. mizezebi, romelTac SeuZliaT
cerebrospinaluri siTxis eozinofilia gamoiwvion, mocemu-
lia me-40 cxrilSi.

cxrili 40.
cerebrospinaluri siTxis eozinofiliis gamomwvevi mizezebi.

parazitozebi
neirotropuli migraciuli Tvisebis nematodebi.
Angiostrongylus cantonensis
Gnathostoma spinigerum
Baylisascaris procyonis
cns-Si kistebis ganviTarebis Tvisebis mqone cestodebi

cns-is eqtopiuri lokalizaciis Tvisebis trematoduli

helminTebi
Paragonimus westermani
Schistosomiasis
Fascioliasis

196
 sxva infeqciuri bunebis mizezebi:
Coccidioidomycosis
Cryptococcus neoformans
Toxocariasis
Trichinellosis
Myiasis

ara infeqcuri mizezebi:

ventrikuloperitonialuri Sunti.
leikemia an limfoma, cns-is dazianebiT.
arasterioduli antianTebiTi medikamentebis miReba.
antibiotikbi.
mielografiis dros gamoyenebuli kontrastuli nivTierebebi.
hipereozinofiluri sindromi.

revmatiuli daavadebebi da eozinofilia.

eozinofiolia ar aris damaxasiaTebeli SemaerTebeli qso-
vilebis dazianebiT mimdinare revmatiuli daavadebebisaTvis.
Tumca periodulad SeiZleba ganviTardes dermatomiozitis,
revmatoiduli arTritis, progresuli sistemurio sklerozis
da polimiopaTiiTa da vaskulitiT garTulebuli Sjögren-is
sindromis SemTxvevaSi. revmatiuli arTritis dros ganviTare-
buli eozinofilia, SeiZleba gamowveuli iyos medikamento-
zuri (arasteroiduli antianTebiTi preparatebi, tetracil-
kini, oqros preparatebi) TerapiiT ganpirobebuli hiper-
ergiuli reaqciiT an Tanarsebuli vaskulitiT. eozinofilia,
Cveulebriv, axlavs Tan sistemur sklerodermias da xSirad
miuTiTebs eozinofiluri fascitis arsebobaze. kunTebis eo-
zinofiluri infiltracia iSviaTi movlenaa, magram Tu gamov-
linda, miuTiTebs triqinelozis, eozinofiluri miozitis da
hipereozinofiluri sindromis arsebobaze.

eozinofiluri vaskulitebi.
Churg-Strauss-is sindromi (alergiuli angiiti da granuloma-
tozi).
Churg-Strauss-is sindromi (CSS) warmoadgens qsovilovani
da periferiuli sisxlis eozinofiliiT mimdinare vaskulits,
romelsac xSirad axlavs Tan alergiuli rinokoniuqtivi-

197
ti, sinusiti da gansakuTrebiT asTma. imis gamo, rom aRniS-
nuli sindromi xSiradaa asocirebuli asTmasTan, arsebobs
mosazReba asTmis samkurnalod gamoyenebuli medikamentebisa
(leikotrienebis receptorTa antagonistebi, lipooqsigena-
zebis inhibitirebi, sainhalacio k.s. da salmeteroli) da sin-
dromis ganviTarebas Soris kavSiris arsebobis Sesaxeb. Tumca
es mosazreba dadasturebuli araa. aRniSnuli sindromisaT-
vis damaxasiaTebelia mcire da saSualo zomis arteriebisa da
venebis manekrozirebeli vaskuliti. sisxlZarRvTa kedlebis
da irgviv mdebare qsovilebis eozinofiluri infiltracia da
eqstravaskularuli granulomebi.
Hammersmith-is monacemebiT _ asTmis anamnezi, periferiuli
sisxlis eozinofilia (>1500/mkl), sistemuri vaskuliti da 2 an
meti eqstrapulmonaluri organos dazianeba miuTiTebs CSS-
is arsebobaze.
amerikis revmatologTa kolejis mier SemuSavebulia CSS-
is sadiagnostiko Semdegi kriteriumebi:
aRiSnuli 6 kriteriumidan 4 an meti miuTiTebs sindromis
arsebobaze:
- asTma.
- > 10%. sisxlis eozinofilia.
- mononeitropaTia an polineitropaTia.
- R-gramaze gamoxatuli, arafiqsirebuli infiltracia.
- paranazaluri sinusebis paTologia.
- eqstravaskularuli eozinofilia.
umetes SemTxvevaSi, CSS-is diagostika xdeba klinikuri
monacemebis safuZvelZe. Zalian xSirad, sindroms axasiaTebs
samfaziani mimdinaroba. pirvel, prodromul fazaSi, pacients
aReniSneba alergiuli riniti, sinusiti da sxvadasxva simZimis
asTma, romelic upiratesad mozrdil asakSi vlindeba. meore
fazaSi viTardeba periferiuli sisxlisa da qsovilTa eozino-
filia. mesame fazaSi SeiZleba ganviTardes sicocxlisaTvis
saxifaTo vaskuliti, romelmac SeiZleba mravali organo daa-
zianos. am procesSi upiratesad CarTulia filtvebi, guli,
gastroenteraluri traqti da nervuli sistema. Tumca pa-
Tologia yovelTvis amgvari klasikuri sqemiT ar viTardeba
(magaliTad SeiZleba ar gamovlides an atipiurad gamovlin-
lindes asTma) rac aZnelebs diagnistikas da xdeba dagvianebu-
li mkurnalobis mizezi.

198
 kardialuri paTologiebi da eozinofilia.
koronaruli arteriebis eozinofiluri infiltracia xSir-
ad axlavs Tan CSS-s. miokardiumis eozinofiluri infiltra-
cia da miokarditi, SeiZleba ganviTardes, rogorc imunizaci-
is an medikamentebiT ganpirobebuli hiperergiuli reaqciebi.
miokardiumis eozinofiluri infiltracia aseve SeZleba Tan
axldes hiperezinofilur leikemias, sarkomas, karcinomas da
limfomas; aseve parazitul daavadebebs da leikotrienebiT
mkurnalobas.

saSarde sistemis paTologiebi da eozinofilia.

eozinofiluria, pirvel rigSi migvaniSnebs medikamentozuri
intersticiuli nefritis arsebobis Sesaxeb. am paTologiis
dros, eozinofilebis raodenobam SardSi, SeiZleba Seadginos
leikocitebis saerTo raodenobis 10% – 60%. eozinofiluria
SeiZleba gamovlindes saSarde sistemis sxvadasxva paTologi-
is drosac. maT Soris iseTi infeqciis SemTxvaSi, rogoricaa
magaliTad mwvave, poststreptokokuli glomerulonefriti,
eozinofiluri prostatiti, eozinofiluri cistiti da sxva.
Tuca, ganxvavebiT, medikamentozuri intersticialuri nefri-
tisagan, saSarde sistemis infeqciebis dros, eozinofiluria
SeiZleba minimalurad iyos gamoxatuli( < 5% ).

imunuri sistemis paTologiebi, imunuri reaqciebi

da eozinofilia.
eozinofilia Tan axlavs zogierT imunodeficitur mdgo-
mareobas. magaloTad hiper-IgEimunodeficiti (Job-is sindro-
mi) xasiaTdeba periferiuli sisxlis, naxvelisa da qsovilebis
eozinofiliiT. eozinofilia damaxasiaTebelia mZime, kom-
binirebuli munodeicitis erT-erTi formis _ Omen-is sin-
dromisaTvis.

199
gamoyenebuli literatura:

1. Adkinson: Midleton’s Allergy. Principle and Practice. 7 th ed. 2008.

2. Habbif. clinical dermatology. 5 th ed. 2009.
3. Guideline. How the Allerggist – Immunologist cen help. 2006.
Amer. Acad. f Allergy Asthma and Immunol. – Med. spec. Society.
4. Guideline. Global Inciative for Asthma (GINA). 2010.
5. Kligman:Nelson’s Textbook of Perdiatrics. 8th. ed. 2010

200