Desensitizing Therapy

Principles and objectives of therapy

Desensitizing therapy belongs to non-specific treatment methods. Unlike etiotropic therapy, which directly destroys the pathogen, desensitization works with the body's own reactivity.

The main tool is systemic antihistamines. Their prescription ensures systemic desensitization effects by suppressing allergic manifestations, itching, and burning. In severe cases (e.g., in specific ophthalmological pathologies), calcium preparations (calcium chloride) are added to antihistamines. The administration of these drugs is fully compatible with other drug groups and does not reduce the efficacy of etiotropic treatment.

Role in the treatment of acute respiratory viral infections (ARVI) and mucosal lesions

In acute respiratory viral infections (ARVI) and the management of patients with oral mucosal lesions (including pain symptoms), desensitizing therapy is part of comprehensive supportive care.

Since highly effective specific drugs against most viruses are practically unavailable (the development of RNA "uncoating" inhibitors and receptor blockers is still ongoing), treatment is based on non-specific agents (intranasal $\alpha$-interferon, oxoline ointment or drops, which inactivate adeno-, rhino-, and myxoviruses outside the cell) and a powerful symptomatic block:

• Detoxification: plenty of warm fluids.
• Vitamin therapy: vitamin C.
• Antipyretics: anilides, propionic and acetic acid derivatives. Indicated strictly at temperatures above 38.0°C.
• Local anesthesia: 2% lidocaine gel before meals to relieve pain in the mouth.

Systemic antihistamines are introduced into this regimen when hypersensitivity reactions to medications occur. It is important to remember: antibiotics are never used to treat a primary viral infection, fungi, or allergies. They are prescribed exclusively when a secondary bacterial infection is confirmed.

Use in tuberculous metastatic keratitis

Desensitizing therapy plays a critically important role in the treatment of severe eye pathologies, such as tuberculous metastatic keratitis. The disease occurs when a bacterial metastasis from the sclera or uveal tract enters the cornea and is usually unilateral.

There are three main clinical forms where the lesion foci are located predominantly in the deep or middle layers of the stroma (but not limited to the superficial epithelium or Descemet's membrane):

1. Deep diffuse keratitis: large isolated yellowish-gray foci, stromal edema, and neovascularization (vessels have specific dichotomous branching).
2. Deep corneal infiltrate: diffuse lesion with indistinct borders, foci merge into a solid mass against the background of iridocyclitis.
3. Sclerosing keratitis: infiltration spreads from the limbus in the form of a "tongue". It has a prolonged course, and opacity can acquire a characteristic chalky-white color.

The outcome of such keratitis is unfavorable — dense vascularized leukomas are formed. Treatment takes about a month, is carried out in conjunction with a phthisiatrician, and includes strict adherence to a diet.

The drug regimen consists of:

• Specific therapy: anti-tuberculosis drugs in age-appropriate doses (ftivazide, isoniazid, PAS, streptomycin).
• Systemic non-specific therapy: anti-inflammatory drugs and desensitizing therapy (calcium chloride and antihistamines).
• Local therapy: mydriatics and instillations of 0.1% dexamethasone solution (4 times a day).

Class and exam questions

What else to study on this topic

• Etiotropic therapy for ARVI: non-specific agents (oxoline, alpha-interferon) and promising developments.
• Pathogenesis and complications of tuberculous stromal keratitis.
• Differential diagnosis of sclerosing and deep diffuse keratitis.
• Criteria for prescribing antipyretic and local anesthetic therapy (lidocaine) for mucosal lesions.

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.