In the practice of an aesthetic medicine doctor, the number of allergic patients grows exponentially every year. Increasingly, their ranks include people who have not previously suffered from a specific reaction of the body. Why does this happen and what to do in this situation?
Allergies are similar to phobias, according to immunologist Dr. Michael Levi, who was awarded an IHA research award for his research into the immune system. Dr. Levy argues that under stress (e.g. psychological stress, work, family, etc.), the immune system is triggered in a similar way to the mechanism of phobic reactions and becomes so excited that it begins to attack its own body, although no danger threatens it1. That is why in megacities and growing cities, the incidence of allergies among the adult population is growing at a rapid pace, since the immune system is constantly provoked by stress factors.
Facts and statistics
- Allergies are classified as chronic diseases. In terms of prevalence, it is in “honorable” fifth place.
- According to research results, up to 40% of Russians have already encountered at least once manifestations of a “rebellion” of the immune system.
- The probability that a child of healthy parents will be allergic is about 15%, if the disease existed in the family, then the chances increase to 50%, but if the parents directly experience manifestations of a specific reaction, then allergists are confident that in 80% of cases the disease will be transmitted through inheritance.
- Doctors estimate that 90% of the population has a predisposition to allergies. This means that the reaction can occur at any time if several provoking factors coincide.
The first signs of allergies
Sneezing
Sneezing is the body’s natural way of getting rid of irritating substances (dust, sand, etc.), which are removed along with a small amount of secretory fluid. With allergies, this reaction becomes exaggerated. Sneezing attacks continue day after day without an obvious reason, in the absence of signs of a cold.
Nasal congestion, runny nose
With allergies, the nasal mucosa becomes inflamed and thickens. This leads to disruption of the normal flow of mucus from the nasal passages or even blocks it completely. Attempts to blow your nose lead nowhere and only increase nasal congestion. Allergies often manifest as continuous or episodic discharge of large amounts of clear, watery mucus from the nose (“watery nose”), whereas with a cold the discharge is usually yellowish and thicker.
Redness and itching of the eyes, watery eyes
Redness of the eye, tears, itching and burning can occur when a foreign object (mote, grain of sand, eyelash) gets into the eye, but as soon as the cause of the irritation is eliminated, the discomfort goes away. However, if you have allergies, the situation changes dramatically: itchy eyes occur for no external reason, and nothing can relieve it. This itching may continue for weeks. The eyelids are usually red and swollen. Characteristic is simultaneous and identical damage to both eyes.
Cough
A cough is “invented” by the body to remove microorganisms, dust and other foreign particles that have entered the bronchi. It is a normal protective reaction during a cold. However, in bronchial asthma, cough does not have a protective function, but is a consequence of narrowing of the airway lumen due to allergic inflammation in the bronchi. Such a cough is characterized by paroxysmal, “dryness” (i.e., lack of sputum), the cough can be debilitating, “to the point of vomiting.” Often with bronchial asthma, an attack of dry cough ends with copious discharge of light, slightly foamy sputum, after which relief occurs.
Shortness of breath, whistling when breathing
Shortness of breath is a well-known feeling of lack of air after a run, when working out in the gym, i.e. during intense physical activity. Pathological shortness of breath due to allergic inflammation in the bronchi occurs at rest or with minor physical exertion, and is often accompanied by a feeling of difficulty in exhaling. Often such shortness of breath is accompanied by whistling and wheezing when breathing, which can be heard by others.
Attacks of suffocation
An attack of suffocation is a painful, fear-inducing condition in which the inability to breathe is manifested to a greater extent by difficulty in exhaling. Often such an attack of suffocation is resolved by coughing with the discharge of white foamy sputum. During an attack, there is a desire to take a sitting position with a slight bend forward, drink hot water, which in some cases brings relief.
Itching, redness and rashes on the skin
Allergies are a common, but not the only cause of itching and skin rashes. At the same time, allergic skin diseases are always accompanied by itching. Skin manifestations of allergies can look like nettle burns or scratched insect bites (urticaria), swelling of the face and other parts of the body (Angioedema), and red, scaly spots of varying sizes (dermatitis). Urticaria rashes are usually not located symmetrically on the body, each blister stays on the skin for no more than a day, new blisters form in new places. The favorite location of foci of inflammation in allergic dermatitis is the elbow and knee bends, the inner surface of the arms from the elbow to the hands. Such lesions can persist for years, changing the structure of the skin.
A few words about physiology
The skin is an organ in contact with the external environment and capable of triggering many reactions to protect the body from damaging factors.
There are two types of immunity: innate and acquired.
The two main types of adaptive immune cells in the epidermis are keratinocytes and Langerhans cells. Neutrophils, macrophages and dendritic cells play a very important role in the innate immune system. When a foreign substance enters the body, innate immune cells are activated through the pattern recognition receptor (TLR) system. Activated innate immune cells produce cytokines and inflammatory mediators that influence the acquired immune system.
Activation of immune cells is one of the most important mechanisms for protecting the skin from antigens and toxins. Paradoxically, the defense mechanism easily becomes the cause of breakdown, and activation of immune mechanisms can be accompanied by inflammatory processes that result in the development of adverse events or complications in response to the introduction of fillers 2.
In cosmetology practice, the doctor has to pay more and more attention to collecting anamnesis and assessing the risks of any intervention in the body. And the statistics make you think.
According to research, in Russia in 2022, cosmetic services were provided using about 2,000,000 ml of dermal fillers.
Hyaluronic acid dermal filler should always be considered an “implant.” Once in the patient’s body, the filler can cause either a pronounced immediate allergic reaction or cause delayed manifestations of this process .
In pathophysiology, such reactions are usually called mechanisms of development of allergic reactions of delayed and immediate type hypersensitivity3.
Immediate hypersensitivity (IHT) is caused by antibodies against allergens. It develops a few minutes or hours after exposure to an allergen: blood vessels dilate, their permeability increases, itching, rash, and swelling develop. The late phase of HNT is complemented by the action of eosinophil and neutrophil products.
Delayed-type hypersensitivity (DTH) refers to type IV allergy (according to Jell and Coombs). It is caused by the interaction of the antigen (allergen) with macrophages and Thl lymphocytes, which stimulate cellular immunity. Develops a few days after exposure to an allergen: compaction and inflammation of the tissue occurs as a result of its infiltration by T-lymphocytes and macrophages4.
A cosmetologist must remember that all the main hyaluronic acid-based fillers used in practice are distinguished by the potential for the release of inflammatory mediators. The interleukins and chemokines released during this process can provoke an inflammatory reaction in tissues.
In August 2015, independent researchers conducted a retrospective analysis of patients who underwent 3D facial modeling with Juvederm Voluma between February 1, 2009 and September 30, 2014. Over 68 months, 4,702 procedures were performed using 11,460 ml of filler. In 23 patients, the formation of nodules at the injection sites was noted. The median time from injection to response was 4 months and time to resolution was 6 weeks. Nine of 23 patients (39%) had an identifiable immunological trigger 5.
What could be the consequences after lip augmentation with biopolymers?
What consequences do we face after the unsuccessful introduction of biopolymers?
First of all, this is the proliferation of fibrous tissue. It is a seal in the lips, which very noticeably spoils the life of its owner: inflammation, a person cannot eat or talk normally. There is no talk of beauty: dense, “frozen”, constantly swollen lips, naturally, do not decorate anyone.
Fibrosis can be reduced with injections of special drugs, but it can only be completely eliminated after surgery.
Gel migration can cause big problems. The drug can migrate, for example, to one side of the lips - then the lips turn out to be extremely asymmetrical. In such cases, patients talk about “dips” and “holes” in their lips.
However, the gel can migrate not only to the lip area, but also anywhere on the face - to the cheeks, chin. His movements are the most unexpected and unpredictable. These areas can also become inflamed, leading to health problems.
The insidiousness of biopolymers also lies in the fact that all the negative consequences do not appear immediately after administration, but after 5, 7, 10 years.
Therefore, Platinental doctors sincerely recommend: even if you are satisfied with your biogel in your lips, go for consultations with a plastic surgeon once every six months in order to catch the emergence of possible complications in time.
Do the quality and production technology of fillers affect the risk of developing allergic reactions?
In 2008–2009, at the Center for Plastic and Aesthetic Surgery (Cologne, Germany), a comparative study of tissue response to intradermal injection of various materials for injection contour plastic surgery based on stabilized hyaluronic acid and collagen was conducted6.
The study compared popular hyaluronic acid fillers: Belotero® Balance (Basic), Juvéderm® ULTRA 3, Restylane®, Surgiderm® 24 XP, and Teosyal® Global Action, as well as deeper injection fillers 30 HV, Restylane® Perlane, Surgiderm® 30, and Teosyal® Deep Lines, as well as collagen-based fillers.
The study included four patients (ages 39–69 years) who were scheduled to undergo abdominal liposuction. All volunteers were injected with 11 different fillers (0.2 ml each) into the abdominal skin 30 days before surgery.
On the 14th and 30th days after implantation, tissue samples were taken from the marked areas under local anesthesia. To detect possible acute reactions, tissue samples were taken from one patient four hours after the injections.
Further results were assessed on the 14th and 30th day after injection ( Fig. 1, 2
).
Fig.1.
Hematoxylin-eosin staining, x 20, E - epidermis, LY - lymphocytes, PZ - plasmacytes, EG - eosinophilic granulocytes, FM - foreign material.
Surgiderm® 24XP
Severe chronic inflammation, infiltration of lymphocytes and plasma cells LY, PZ.
Juvéderm® 30HV
Mild or moderate chronic inflammation: LY, PZ, EG.
Teosyal® Deep Lines
Pronounced chronic inflammation: LY, PZ, EG.
Belotero® Basic
There is no histomorphological inflammatory reaction.
Fig.2.
Hematoxylin-eosin staining, x 20, E - epidermis, LY - lymphocytes, PZ - plasmacytes, EG - eosinophilic granulocytes, FM - foreign material.
Juvéderm® 30HV
Mild or moderate chronic inflammation, increased levels of lymphocytes, plasma cells and eosinophils: LY, PZ, EG.
Restylane® Perlane
Severe chronic inflammation, significant infiltration of lymphocytes, plasma cells and eosinophils: LY, PZ, EG.
Teosyal® Deep Lines
Pronounced chronic inflammation, abnormally pronounced infiltration of lymphocytes and plasma cells: LY, PZ, EG.
Belotero® Intense
There is no histomorphological inflammatory reaction. Uniform distribution of material.
The results of the experiment showed no signs of an inflammatory reaction in response to the introduction of only two HA-based fillers - Belotero® Balance and Belotero® Intense ( Fig. 1, 2
), while all other fillers showed evidence of a chronic inflammatory response. There were no significant differences between samples taken 14 and 30 days after administration.
Types of cosmetics with hyaluronic acid
There is an opinion: the higher the percentage of hyaluronic acid in the cream, the higher the level of skin hydration it provides. But this is not so: the content of hyaluronic acid in cosmetics rarely exceeds 2-5%. Therefore, for effective moisturizing, it is not the percentage of the substance that is important, but the correct use of the product.
Creams, serums and toners with hyaluronic acid should be applied to clean and slightly damp skin. Let's consider the main types of products in which this component is found.
Tonics with hyaluronic acid
The ideal product format for oily, dehydrated skin (yes, oily skin can be dehydrated too!): the tonic is quickly absorbed and does not provoke the secretion of sebum. It is often produced in the form of a spray - this makes the tonic more convenient to apply to the skin.
Serums with hyaluronic acid
Serum is an express product for giving the skin a healthy glow and additional hydration. It is applied with light tapping movements onto clean, damp skin, after which the cream is used, literally “sealing” the serum (so that the moisture does not evaporate).
