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77 Hi Phi Pháp-Vit  - Bnh lý d ng Chapitre 5 chung trong  BS. Michèle RAFFARD Chuyên khoa D ng Ce 75015, Paris mraffard@free.fr BS. Martine VIGAN Chuyên khoa Da liễu Unité Fonctio Hôpital Saint-Jacques  25030, BESANCON-CEDEX mvigan@chu-besancon.fr 78 Hi Phi Pháp-Vit  - Bnh lý d ng   (BS. 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Bnh lý d ng     : V             (                     1. da 2.      chàm 3.        4.       -  -  -  -  -                   -  -  80 Hi Phi Pháp-Vit  - Bnh lý d ng  1. Johansson SGO, Houriane JOB et al. A revised nomenclature allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy 2001;56:813-24. 2.        Allergol Immunol Clin. 2004;44:218-30. 3. Johansson SGO, Bieber T et al. Revised nomenclature for allergy for global use : report of the nomenclature review committee of the World Allergy Organisation, october 2003. J Allergy Clin Immunol 2004;113:832-6. 81 Hi Phi Pháp-Vit  - Bnh lý d ng Ch 5-a  (BS. Michèle RAFFARD)  -  -  o  o  o  o Da - Anamnèse o  -  o  o  -  Tìm d -  o  o  o  -  o  o  o Con cháu  -739)      -  -  -   -  o Nhóm prostaglandins + Aspirine và kháng viêm non steroid  o  o   - Môi trờng  o  82 Hi Phi Pháp-Vit  - Bnh lý d ng o  o   -  o Cây xanh o Côn trùng : éphestia, Dermestidés, Chironidés o  o      o   -  o   o  -  -  o Siêu vi    VRS Virus Respiratoire Syncitial   o Viêm xoang o -  -   -  o  o  o Pyrosis o  -   - 500  o  o  Test da  - Protéines o                -    -  o    o               (www.inrs.fr/htm/allergies_en_milieu_professionne) 83 Hi Phi Pháp-Vit  - Bnh lý d ng  5-b u tra v ng trong các b-k (BS. Michèle RAFFARD)     T  Th Th        Mùa   Tháng           84 Hi Phi Pháp-Vit  - Bnh lý d ng                                        85 Hi Phi Pháp-Vit  - Bnh lý d ng          -  Thông thoáng   -  :   :  :      nhà  Mèo   Chó          Gây     86 Hi Phi Pháp-Vit  - Bnh lý d ng                          Ng            :  [...]... 1 1 1 Trong nhng trng hp khỏc, nghim phỏp tr nờn thc t v bnh nhõn trong nhng iu kin nghiờm ngt, cựng iu kin vớ d nh ngh nghip ca h Nghim phỏp kớch thớch kt mc Vic s dng thuc nh mt v kinhs sỏt trũng phi tm hoón li ớt nht 48 gi Nghim phỏp c thc hin ngoi cn, trờn mt mt bỡnh thng, sau khi khỏm mt cn thn, nht l trong trng hp viờm giỏc mc v kt mc mựa xuõn (4-5) u tiờn cht pha (chng) c nh vo 20 L trong tỳi... glycol, sorbitane sesquiolộate, etc Cỏc nghim phỏp trờn da õy l mt k thut chớnh ca nghim phỏp da trong trng hp d ng theo kiu ph thuc lympho T bng cỏch thu hỳt t bo nh trong chm Cỏc sn phm c lng li trờn cỏc vt liu phc v cho cỏc nghim phỏp trờn da (Finn Chamber Epitestđ, Patch Test Chamber) Cỏc dóy bng s dng trong nghim phỏp ny s ỏp thng lờn phn cao ca lng Kt qua c c na gi sau khi thc hin, sau 48 gi,... Hi Phi Phỏp-Vit Sỏch chuyờn - Bnh lý d ng 98 Bng V : Nguyờn nhõn gõy phn ng õm tớnh gi Nng d nguyờn quỏ thp hay khụng d nguyờn trong cc Cht dc tỏ lng khụng giỳp d nguyờn thm qua da c M trong cỏc thnh phn tỏ dc ca m phm tuyt i cn cho vic bc l d nguyờn D nguyờn khụng cú trong sn phm c th : m phm th nghim khụng cựng lụ vi m phm gõy d ng, s bin cỏch ny khụng bao hm cỏc sn phm thoỏi hỏo gõy d ng Bnh phm... Nghim phỏp l thng Vic ngng tip xỳc vi cỏc sn phm cha cựng d nguyờn trong 3 tun s lm bnh nhõn lnh bnh Tỏi s dng li chỳng trong iu kin bỡnh thng v bnh nhõn s n tỏi khỏm do tỏi phỏt bnh Tỡm kim s thớch ng S thớch ng l mi tng quan gia nghim phỏp da dng tớnh v bnh s d ng Him khi thy s tng ng ca mt nghim phỏp da c thit lp mt cỏch chc chn trong thi im din gii kt qu: xỏc nh s thớch ng cho mt nghim phỏp da... bng cỏc nghim phỏp kớch thich d nguyờn ti ch Trong trng hp hen ph qun do mt, vic chn oỏn c t ra khỏ d dng nhng trỏi li cỏc nghim phỏp kớch thớch b cm do cú th rõt nguy him, chỳng c dnh riờng cho nghiờn cu v c thay th bng nghim phỏp kớch thớch mi bi vỡ hen ph qun kt hp vi viờm mi rt thng xuyờn Ngi ta thng thc hin nghim phỏp kớch thớch niờm mc mt trong hn trong trng hp cú s kt hp viờm kt mc v viem mi... xỳc v cn tuõn th cỏc phng phỏp ó c chp thun v hp thc húa Cỏc nhõn viờn phi chun b dng c cp cu trc ú Vic s dng thuc khỏng histamin v mt s thuc khỏc tm hoón li trong trng hp vi test chõm da (xem cỏc bng trong test da) Cỏc thuc cú tỏc cung ti ch trong iu tr hen vn c tip tc s dng Cỏc d nguyờn s dng, ó c chun húa, khụng cht bo qun, dng ụng khụ ch bin s dng ngay, do cỏc phũng xột nghim chuyờn bit cung... khụng, iu ny cú giỏ tr nht l vi trng hp d ng thc n M N C M KHễNG PH I L D NG IDR hay phn ng trong da Dng c - Bm tiờm 1 ml vi kim trong da mnh cú mộp ht nhn v ngn - L nc mui sinh lý lm chng - D nguyờn l nc loi cụn trựng b cỏnh mng (hymộnoptốres) ó c thng mi húa t cỏc phũng thớ nghim chuyờn bit - Thuc hũa tan trong nc mui sinh lý Hi Phi Phỏp-Vit Sỏch chuyờn - Bnh lý d ng 92 - Pha loóng t 10 thnh 10... tiờn ban u Bnh nhõn : ch cú thy thuc bit bnh nhõn dựng gỡ C bnh nhõn ln thy thuc u khụng bit Thc n giu trong sn phm tr (l ng tỏo hay trong mún khoai tõy nghin) Nghim phỏp cui cựng ỏp dng cho nghiờn cu lõm sng Kt qu o lng cht lng dung np (nh, va) ca mt thc n c th nghim cho phộp thit lp mt ch n thớch hp trong trng hp nghim phỏp dng tớnh õy l nghim phỏp duy nht chng minh bnh nhõn cú d ng vi thc n Nu õm... ty S thớch ng trong bnh s d ng tc thỡ d tỡm thõt nhng vi trng hp d ng mun, vic ny khú khn hn nhiu Cn khuyờn bnh nhõn mang theo cỏc loi m phm h s dng cỏc nhõn cng nh bao bỡ cha chỳng Hng dn loi tr d nguyờn Tt c cỏc nghim phỏp dng tớnh a n vic loi tr cỏc thnh phn v cỏc sn phm cha chỳng, iu ny nht thit phi thụng bỏo cho bnh nhõn bit Hng dn v cỏc thnh phn ằ da vo nhón mỏc v m phm v bt git chung Chõu u,... nguyờn cú trong danh mc Bnh nhõn cn phi bit h phi bỏo cho bỏc s khi ang thc hin cỏc nghim phỏp cú cm giỏc au hay núng rỏt nht nh trờn vựng da th nghim, hay sau khi thc hin xong 15 ngy m cựng da ú vn cũn khụng rừ nột ca tt c phn ng sau Cỏc bin chng ỏng ngi nht vn l bin chng so li v bin i sc t vựng so Nhng iu cn ghi nh S phõn tớch chớnh xỏc v triu chng hc giỳp a ra cỏc ch nh thc hin cỏc nghim phỏp da trong . 77 Hi Phi Pháp-Vit  - Bnh lý d ng Chapitre 5  chung trong  BS. Michèle RAFFARD Chuyên khoa D ng Ce. Hi Phi Pháp-Vit  - Bnh lý d ng  5-b u tra v ng trong các b-k (BS. Michèle RAFFARD) . 95 Hi Phi Pháp-Vit  - Bnh lý d ng -d Các nghim pháp da trong bnh da liu (BS. Martine VIGAN) -   