Allergological Examination Research Articles

Allergy mapping in children with allergic rhinitis in different subjects of the Russian Federation

Given the climatic and geographical location and differences in the change of seasons in the Russian Federation, there is a marked heterogeneity in the representation of respiratory allergens. Obviously, in the case of double or triple sensitization, the diagnosis of its true picture is a difficult task. In such cases, allergy-component analysis is an extremely necessary stage of allergological examination. Purpose of the study: to assess the sensitization spectrum of AR patients in the age group from 3 to 17 years inclusive, living in different regions of the Russian Federation. Comparative analysis of differences in the sensitization spectrum of AR patients in the Republic of Ingushetia in different age groups. The study involved 47 patients, 36 of them were children under 18 years of age: Moscow n = 9 (Central Federal District), Samara n = 8 (Volga Federal District), Magas n = 19 (North Caucasus Federal District, Republic of Ingushetia). Also, 11 patients aged 18 years and older from Magas city took part in the study. The results obtained by ImmunoCAP ISAC and ALEX2 immune solid-phase allergy test were analyzed. The numerical values of the main respiratory allergens were evaluated, in patients with clinical signs of AR in the period from 01.01.2023 to 27.01.2024. The diagnosis of AR was made according to generally accepted criteria for diagnosis. The main causative factor of AR formation is the major allergen of birch pollen (Bet v1). However, for the Central Federal District, heterogeneity of representation in the group of buciferous trees was noted, which should be taken into account when planning allergen-specific immunotherapy. The spectrum of sensitization of children with AR in the North Caucasian Federal District (Magas) differs significantly from the Central and Volga Federal Districts, where the main major allergen of Amb a 1 ragweed pollen forms the etiological basis of AR formation. When comparing patients with AR of different age groups from Magas city, no differences in the sensitization spectrum were found. The results indicate a high degree of importance of allergy-component diagnostics to improve the effectiveness of allergen-specific immunotherapy.

Personalized approach to immune system rehabilitation in patients with year-round allergic rhinitis suffering from recurrent ARVI and recurrent herpes virus infections

Introduction. The problem of treating patients with respiratory allergopathology associated with recurrent infectious diseases, such as rARVI, frequent exacerbations of rCHVI, is becoming urgent. The presence of persistent inflammation and co-infection significantly complicates the treatment of immunocompromised patients with year-round allergic rhinitis (YAR) and necessitates the development of personalized programs, with the inclusion of immunomodulatory agents for restoring disorders in the immune system (IS) and interferon system (IFN). Materials and methods. The study group (SG) included 65 patients of both sexes aged 23–60 years, suffering from YAR associated with rARVI and rCHVI. The comparison group (CG) consisted of 50 healthy individuals, comparable in sex and age. All patients underwent standard physical, immunological and allergological examinations, including the use of serological (ELISA, ImmunoCUP), molecular genetic (PCR-RV) methods, FC, etc. Voluntary informed consent was obtained from all patients. The StatPlus computer program was used for statistical analysis. Results and discussion. In patients with YAR associated with rARVI and rCHVI, two variants of disorders in IS have been established, which are defined as pathological immunophenotypes (PIF). The PIF1 is characterized by a deficiency in the induced production of IFNα, a decrease in CD3⁻CD16⁺CD56+ EKKs, and a decrease in neutrophil granulocytes (NG). In the PIF2, along with a shortage of IFNα production, a decrease in EKKs is observed in combination with a decrease in CTLs, as well as a decrease in NGs. The clinical criteria for immunocompromising in this cohort of patients were studied. The severity of YAR symptoms was assessed by VAS. In order to correct the identified disorders in the IS and IFN system, complex personified IFN- and immunotherapy programs have been developed for each PIF, including prolonged local and systemic therapy with rIFNα2b in combination with antioxidants, as well as GMDP for patients of SG1, and for patients of SG2 — GMDP and hexapeptide. The high immunological and clinical efficacy of IFN- and immunotherapy was shown, which was expressed in the tendency to restore existing disorders, as well as in achieving control over the symptoms of YAR, with the possibility of reducing the volume of basic antiallergic pharmacotherapy.

Latent sensitization as a mask of the problem of frequently ill preschool children in Rostov-on-Don

Objective: to identify the frequency and etiology of latent sensitization among frequently ill preschool children living in Rostov-on-Don.Materials and methods: 40 preschool-age children (5.3±1.2 years old) who are under medical supervision for frequent respiratory diseases of a protracted nature were examined. According to the nature of the clinical course, the following subgroups were identified: 1st subgroup — frequently ill children with recurrent respiratory tract pathology: adenoiditis, bronchoobstructive syndrome (n=19), 2nd subgroup — frequently ill children with different duration of episodes of acute respiratory diseases: from 3 to 5 days and from 5 to 10 days. The mandatory criterion for inclusion in the group was the absence of hereditary burden due to allergic pathology. All patients underwent an allergological examination, including the determination with the help of an automatic immunochemiluminescent analyzer (Immuno CAP 100 Phadia AB, Switzerland) of specific blood IgE to the antigens of Timothy's meadow, rPh1 p1, Phl p 5; antigens of Altenaria alternata, rAlt a1; antigens of ragweed, nAmb a1; to the antigens of wormwood nArt v1.Results: sensitization to the main allergens that are causally significant for the region is formed in 33–74% of cases in frequently ill preschool children living in Rostov-on-Don. The main causally significant allergen, sensitization to which is diagnosed in most of the subjects, is the major fraction of Ragweed Ragweed (nAmb a1). Sensitization to the major fraction of the common Wormwood allergen (nArt v1) is not diagnosed in a monovariant, but always accompanies hypersensitivity to high Ragweed ragweed.Conclusions: the presence of concomitant pathology of the respiratory tract in the form of adenoiditis, bronchoobstructive syndrome, as well as a long (more than 5 days) course of frequently recurrent acute respiratory diseases is a factor indicating a high probability of latent sensitization in frequently ill preschool children, which is formed in 33-74% of cases. It is recommended that frequently ill children with symptoms of recurrent respiratory tract pathology perform allergodiagnostics with the identification of specific IgE to the main causally significant allergens for the region.

Local manifestations of cross food allergy in children with clinical symptoms of respiratory allergy to birch pollen: solutions

Introduction. According to modern data, Oral Allergy Syndrome (OAS) is most often formed by patients sensitized to the birch family: up to 73% of patients allergic to birch experienced OAS. 86% of them experience their oral symptoms year-round, which significantly affects the quality of life of these patients. The effectiveness of AIT in the treatment of respiratory allergy symptoms is beyond doubt, while the effect on the manifestations of cross-food allergies requires additional study.Objective. To study the clinical effectiveness of the formation of oral tolerance to fruits and vegetables under the influence of allergen-specific immunotherapy (ASIT) with the allergen Staloral® “Birch pollen allergen” (Stallergenes Greer, France).Material and methods. The study (prospective open comparative longitudinal) included 184 patients with respiratory allergy to birch pollen aged 5 to 16 years with confirmed sensitization to the major molecule (Bet v 1). Children of the main group (n = 134, 7.0 [5.0; 9.0] years) had OAS. Children from the comparison group (n = 50, 7.0 [6.0; 10.0] years) did not have OAS. A clinical examination, general clinical and allergological examinations were carried out for each child. Component allergy diagnostics was performed using a multiplex panel (ISAC-112, ImmunoCAP) for children with OAS (n = 40) who had multiple manifestations of cross-food allergies. Patients of both groups (n = 184) received a three-year course of AIT with the allergen Staloral® “Birch pollen allergen”.Results. In patients with OAS, it was possible to achieve the formation of oral tolerance (total or partial) to fresh vegetables and fruits in 88.81% (n = 119, p = 0.000). There was a decrease in the intensity and duration of respiratory allergy symptoms during the pollination season, and the need for pharmacotherapy after a three-year course of AIT Staloral® “Birch pollen allergen” in children of both groups.Conclusions: three-year AIT with the allergen Staloral® “Birch pollen allergen” is able to form oral tolerance in children with cross food allergies to PR-10 proteins of vegetables and fruits.

Spectra of sensitization to aeroallergens in patients with allergy from the upper chirchik district of the Republic of Uzbekistan

BACKGROUND: Allergic airway diseases caused by hypersensitivity to aeroallergens are the most common manifestation of atopy in children and adults. However, sensitization in the population primarily depends on the allergenic composition of the air environment. Identification of sensitization is a prerequisite for successful treatment of allergic diseases, although the structure of sensitization may have regional characteristics.
 AIM: To study the spectrum of sensitization in people with allergic diseases, namely, allergic rhinitis, bronchial asthma of varying severity, and atopic dermatitis, in the Upperchirchik district of the Tashkent region, which is characterized by a long period of flowering of weeds (wormwood, saltwort, and quinoa, from the end of August to the end of November), cereals (timothy, foxtail, rye, and bluegrass), and herbs (from the end of February to the end of July); the duration of flowering is associated with the peculiarities of climatic and geographic conditions.
 MATERIALS AND METHODS: From January to May 2022, a clinical and allergological examination was conducted on 100 patients with allergic diseases; of these, 38 were children aged 2–18 years (including 20 children with allergic rhinitis, 12 with bronchial asthma, 6 with atopic dermatitis) and 62 were adults (including 32 patients with allergic rhinitis, 13 with bronchial asthma, 17 with atopic dermatitis). To study the total IgE in the blood serum, allergen-specific IgE and standard diagnostic allergens were used for skin testing.
 RESULTS: Among all examined patients, the most frequent were intermittent and persistent forms of allergic rhinitis in 52 (52%), bronchial asthma in 25 (25%), atopic dermatitis in 23 (23%), combination of allergic rhinitis + bronchial asthma in 13 (13%), allergic rhinitis + atopic dermatitis in 12 (12%), and atopic dermatitis + bronchial asthma in 9 (9%) patients. Combined sensitization to pollen and household and food allergens was detected in 90% of the patients, monosensitization to allergens of cereal grasses (meadow Timothy and meadow bluegrass) in 6% and to allergens of weeds (wormwood and quinoa) in 4%. Sensitization to house dust (h1) was detected in 29 children and 51 adults. The frequency of sensitization to food allergens was higher in children than in adults: to cow’s milk allergens in 28.9% of children and 8.1% of adults; to egg allergens in 44.7% of children and 24.2% of adults; and to nut allergens in 38.7% of children and 34.2% of adults.
 CONCLUSION: The spectrum of sensitization to allergens in patients with allergic diseases in the Upperchirchik district of the Tashkent region is characterized by a predominance of sensitization to pollens and household allergens in children and adults, with a significant proportion of polysensitized patients in all age groups.

Levels of eosinophils and interleukin-5 and severity of atopic dermatitis in the presence of psychosocial stress

BACKGROUND: Skin damage in atopic dermatitis is caused by the participation of several immune cells and their inflammatory mediators. However, data on correlations between the severity of atopic dermatitis, combined with and without food allergies (severity of atopic dermatitis (SCORAD) index, etc.), and the levels of eosinophils and interleukin-5 are scarce and contradictory. No studies have compared the frequency of eczematous reactions occurring at different times or immediate allergic reactions in the above patients. Moreover, no studies or certain studies have reported results on the frequency of the combination of atopic dermatitis and food allergies, its various degrees of severity depending on these indicators, levels and relationships of the concentration of eosinophils, and interleukin-5 in the presence of psychosocial stress.
 AIM: To study the frequency and severity of the course, skin reactions in patients with atopic dermatitis, with and without food allergies, and levels and correlations of interleukin-5 and eosinophils in the presence of psychosocial stress in patients in the Donbass region.
 MATERIALS AND METHODS: A total of 165 patients with atopic dermatitis were examined. Questionnaire survey, anamnesis collection, and general clinical and specific allergological examinations were performed, and the levels of interleukin-5, absolute quantity, and percentage of eosinophils in the peripheral blood were determined. Two subgroups of patients with atopic dermatitis were analyzed: 1) those with food allergies and 2) those without food allergies. Persons living in areas with high and low shelling intensities were also identified. Data were statistically processed using the domestic program Medstat (Donetsk).
 RESULTS: In patients with atopic dermatitis, randomly selected from those who applied for an appointment with allergists-immunologists, this disease was combined with food allergy in 81.2% of cases. The severity of atopic dermatitis and eosinophil levels were significantly higher in the group with food allergies. Stable direct reliable correlations of varying strength have been established between the severity of atopic dermatitis (SCORAD index and its indicators) and the absolute quantity, percentage of eosinophils, and interleukin-5 level, as well as between the above laboratory parameters. Differences were found in the frequency of recording eczematous and immediate skin reactions. The residence of patients with atopic dermatitis with and without food allergies in areas that differed in shelling intensity was associated with the severity of atopic dermatitis and the level of eosinophils and interleukin-5.
 CONCLUSION: In most patients, atopic dermatitis is combined with food allergy, and the severity of its combination with food allergy increases. Therefore, reliable correlations of the SCORAD index with blood eosinophilia and interleukin-5 levels are revealed. The severity of atopic dermatitis and biomarkers in both subgroups increased when they lived in areas with high intensity of shelling.

Оценка пищевого статуса у детей с атопическим дерматитом, ассоциированным с пищевой аллергией

Aim. To assess the nutritional status and body composition of children with atopic dermatitis (AD) and food allergy (FA). Design. Prospective comparative observational study. Materials and methods. We observed 129 children: 59 participants in the main group with AD, the exacerbations of which are associated with FA, and 70 children in the comparison group. Age — from 1 year to 6 years (mean age — 3.44 ± 1.61 years). In the main group, there were 32 (54.2%) boys and 27 (45.8%) girls. Mild AD was observed in 12 (20.3%), moderate — in 36 (61.1%), severe — in 11 (18.6%) children. All patients followed elimination diets. A comprehensive clinical, laboratory, instrumental, allergological (for specific IgE antibodies to food allergens) examination was conducted, as well as measuring the height and body weight of patients. Body composition was determined by bioimpedancemetry. Results. Assessment of nutritional status showed that Z-score indicators were normal in 24 (40.7%) patients of the main group and in 54 (77.1%) children from the comparison group. Mild and moderate body weight deficit was observed only in the main group — in 31 (52.5%) children. In the main group and in the comparison group, children with overweight and obesity were identified (6.8 and 22.9%, respectively, p = 0.0003). Anthropometric indicators according to Z-score corresponded to the parameters of body component composition. A detailed analysis of the body component composition showed that children with mild to moderate underweight had disorders in the form of decreased lean, fat, skeletal muscle and active cell mass, which most accurately reflects the nutritional status of these patients. Etiologically significant allergens were egg (47.5%) and cow's milk (35.6%), as well as soy (16.9%), cod (13.6%), and wheat (13.6%). Conclusion. Most children with AD and PA had nutritional deficiencies associated with alimentary factors (deficiency of nutrients due to long-term elimination diets). Some children, on the contrary, were overweight and obese, which is an alarming sign. The type of diet therapy in such patients should be selected depending on the nutritional status and body component composition. Keywords: children, atopic dermatitis, food allergy, nutritional deficiencies, body component composition.

Comparative Analysis of the Spectrum of Sensitization to Air Allergens in Patients with Respiratory Allergoses from the Republic of Karakalpakstan

Background: It has been known for a long time that the prevalence of allergy pathology throughout the world has been steadily increasing, this determines the need for regular screening epidemiological studies; high-quality allergy diagnostics makes it possible to identify the disease in the early stages of development, carry out timely selection of drug pathogenetic therapy, which, in turn, helps to significantly reduce the risk of exacerbation of an allergic disease and the onset of more severe forms of allergopathology. The general patterns of the formation of respiratory allergies include the age-related dynamics of the spectrum, the development of polysensitization, as well as the hierarchical value of aeroallergens. Purpose of the study: to study the spectrum of sensitization in people with respiratory allergies: allergic rhinitis (AR), bronchial asthma (BA) of varying severity, atopic dermatitis (AD) in the Republic of Karakalpakstan, which is characterized by a long period of flowering of weeds (wormwood, solyanka, quino ) - end of August end of November, cereal grasses (timothy, foxtail, rye, bluegrass). - end of February - end of July; The duration of flowering is related to the peculiarities of climatic and geographical conditions. Materials and methods: from January to May 2022, a clinical allergological examination was carried out on 120 patients with allergic diseases: of them 90 children aged 2-18 years, 36 children with AR, 24 with BA, 30 children with AD and 30 adult patients, 12 with AR, 12 with AD, 6 with AD. To study the total concentration in blood serum, we used Monobyte test systems manufactured in the USA; Allergen-specific IgE was determined using Alkor Bio test systems manufactured in Russia; standard diagnostic allergens were used for skin prick testing (JSC NPO Microgen, Stavropol). Results: In 75% of patients, combined sensitization to pollen, household and food allergens, 20% only to pollen and food allergens of different groups, and 5% have monosensitization to pollen allergens. Conclusion: Spectrum of sensitization to aeroallergens in the studied region of the republic Karakalpakstan is characterized to a greater extent by pollen sensitization in both children and adults with various allergic diseases, with a predominance of multiple sensitizations in all age groups.

Risk factors and markers of inflammation of comorbid allergic diseases: rhinitis and bronchial asthma

Introduction. Today there has been a steady increase in the allergic pathology of the respiratory tract - bronchial asthma and allergic rhinitis in pediatric practice. Despite the use of modern diagnostic approaches, we cannot say with certainty which combined effect of which factors leads to the development of allergic inflammation of the respiratory tract. The study of risk factors for the formation of allergic rhinitis and asthma in children is necessary for timely early diagnosis with the subsequent development of an individual strategy for preventive measures.Objective: to study risk factors and markers of allergic inflammation in children with allergic rhinitis, rhinitis and bronchial asthma and only with bronchial asthma.Materials and methods. The study involved 107 children suffering from allergic rhinitis, allergic rhinitis and bronchial asthma, and only bronchial asthma. All patients underwent clinical, laboratory, functional, allergological examination, analysis of the cellular composition of bronchial and nasal secretions.Results. The analysis revealed factors influencing the development of bronchial asthma, allergic rhinitis and comorbid diseases, as well as markers of allergic inflammation. There were trends in detecting a higher level of eosinophils in blood, nasal and bronchial secretions in a group of children with a comorbid condition — bronchial asthma and allergic rhinitis.Conclusion. Evaluation of the level of markers of allergic inflammation of nasal and bronchial secretions can be used as additional criteria for early diagnosis, prediction of the severity of bronchial asthma and allergic rhinitis in children, serve as a monitoring method, development of personalized preventive measures for this group of children.

The results of a survey of Russian doctors in order to identify the compliance of the management of children with chronic urticaria with clinical recommendations

Introduction. Primary observation of children with (CU) in Russia is performed by pediatricians, dermatologists, and algologists. It is unclear how clinical guidelines are used in a heterogeneous group of specialists.Materials and methods. Online survey of pediatricians, allergists, and dermatologists (n = 304) in the Russian Federation using a questionnaire, from 5 blocks of questions related to etiology, diagnosis, and therapy. 316 physicians with a median experience of 10 [5; 20] years were included in the questionnaire.Results. 83.3 % of respondents observed no more than 2 children with CU per month. Self-education to expand knowledge (video lectures, special literature) was indicated by 72.6 % of participants. The clinical guidelines used by physicians were documents of pediatric and allergy associations of Russia (77.3 and 55.9 %, respectively), international guides were used by 27 % of respondents.The most frequent deviations from the recommended algorithm were the prescription of biochemical blood tests (64.9 %), ultrasound examination of organs (56.9 %), consultations of specialists without indications: gastroenterologist (48.2 %), infectious disease specialist (31.8 %), rheumatologist (27.1 %). The autologous serum test in children is not used by 87.2 % of physicians for various reasons.During allergy testing, respondents recommend: the concentration of total IgE in serum (63.9 %), the number of eosinophils in the blood (61.2 %). The importance of determining specific IgE was indicated by no more than one third of the respondents. Skin tests during remission period were supported by 59.1 % of all physicians, who considered allergologic examination to be necessary. Diet: 18.6 % of respondents do not recommend a special diet for children; 27.7 % exclude from the diet foods to which sensitization is detected, the rest recommend an nonspecific elimination diet.Antihistamines of 2nd generation (AG II) are the most used in clinical practice (86.5 %). Physicians named cetirizine (25.7 %) and levocetirizine (19.7 %) as the drugs of choice up to 12 years of age. The need to double the dose of AG II in the absence of response to the standard dose was supported by 59.5 % of physicians. The other physicians preferred a change of AG II molecule in the standard dose. Experience with the use of omalizumab was reported by 20 % of specialists, with 76.3 % understanding the significance and willingness to use biologic therapy. If omalizumab is ineffective, 44.1 % of physicians consider glucocorticosteroids to be the drug of choice; 38.8 % — cyclosporine A. About one third of physicians use alternative therapies not considered in the clinical guidelines.Conclusion. A significant number of physicians do not use recommendations based on evidence-based studies in real practice. AG II are the basis of CU therapy in children in all age groups.

ЭТИОЛОГИЧЕСКИЕ И КЛИНИЧЕСКИЕ ОСОБЕННОСТИ АНАФИЛАКТИЧЕСКОГО ШОКА У ПАЦИЕНТОВ, ГОСПИТАЛИЗИРОВАННЫХ В КЛИНИКУ ЭКСТРЕННОЙ МЕДИЦИНЫ

Introduction. Anaphylaxis is a severe generalized hypersensitivity reaction affecting more than one organ system that can start very quickly and symptoms can be severe or life-threatening. The profile of triggers and cofactors for anaphylaxis is age dependent and varies across geographies. The clinical manifestations of anaphylaxis are diverse, one of its most severe clinical phenotypes is anaphylactic shock. Aim. To assess the significance of various groups of triggers, cofactors and clinical features of anaphylactic shock in patients hospitalized in the Department of Allergology and Immunology of the Kazan City Clinical Hospital No. 7. Material and methods. A retrospective analysis of 107 medical records of inpatients hospitalized in the Department of Allergology and Immunology of City Clinical Hospital No. 7 with a diagnosis of anaphylactic shock (T78.0, T78.2, T80.5, T88.6) was carried out for three calendar years (from 01.01.2018 to 31.12.2020). Statistical data processing was carried out using the Statistical Package for Social Sciences (v.18.0). Results and discussion. It has been shown that medicines were the most common trigger for anaphylactic shock in hospitalized patients, while food and insect bites led to the development of shock much less frequently and with approximately the same frequency. The vast majority of patients did not have concomitant diseases, and also did not take concomitant therapy, which are risk factors for the severe course of anaphylaxis. Skin changes were the most frequent symptom, supplementing the clinic of anaphylactic shock, followed, approximately with equal frequency, by gastrointestinal and respiratory symptoms, neurological symptoms were most rarely recorded. Conclusion. To verify the trigger as the cause of anaphylactic shock, it is necessary to conduct an allergological examination after the resolution of its symptoms. To assess the influence of exogenous and endogenous cofactors on the occurrence of anaphylaxis and the severity of its course, it is necessary to conduct prospective studies.

Dental materials and oral care products that can cause contact allergies

Various restorative and prosthetic materials, dental implants, medicines and cosmetic materials, such as toothpaste and denture cleaning products, are used in oral care. In principle, these materials can cause contact allergies, which can manifest as lichenoid reaction, cheilitis and angioedema. It is usually a local reaction of the oral mucosa and surrounding tissues, but a systemic reaction can also occur elsewhere in the body. If a patient develops complaints from dental materials that could be due to an allergy, it makes sense to investigate this allergologically, although these do not yet show full specificity or sensitivity. After a positive allergological examination, it is possible to examine more specifically whether the patient's complaints match the test result and it can be decided whether it is sensible to replace the dental material and, if so, which material could be an alternative. After removal of the causative allergens, the complaints should disappear completely.

Clinical features and risk factors of IgE-independent aтopic dermatitis in children

Relevance. Atopic dermatitis (AD) is an inflammatory disease characterized by a chronic course with periods of remissions and exacerbations. IgE-independent atopic dermatitis is a medical and social problem of our time, since the disease manifests itself most often in childhood and is one of the most frequent forms of dermatoses among the pediatric population. The prevalence of atopic dermatitis among children is up to 20 %, among adults - 2-8 %. Recently, there has been a significant increase in atopic diseases worldwide. The aim: to study specific features of IgE-independent atopic dermatitis in children living in a metropolis. Materials and Methods. A prospective cohort study was conducted, which included 451 children aged 5 to 14 years with a diagnosis of AD who applied for outpatient care at the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology for the period 2020-2021. All parents (guardians) have given voluntary informed consent to the participation of children in the study and the publication of personal data. Examination of patients included general clinical methods, assessment of the SCORAD index and laboratory allergological examination (total and 73 specific IgE in blood serum with the most common food and aeroallergens). In 103 (22.8 %) children (57 (55.3 %) boys and 46 (44.7 %) girls), the results of the allergological analysis did not confirm concomitant allergic sensitization. Atopic dermatitis in these children was defined as IgE-independent. Results and Discussion. Predictors of the development of IgE-independent AD were hereditary predisposition [odds ratio (OR) 2.42; 95 % confidence interval (CI) 1.12-5.25], artificial feeding [OR 4.04; 95 % CI 1.46-11.20], comorbidities [OR 1.42; 95 % CI 0.57-3.52], late onset [OR 1.67; 95 % CI 0.81-3.41]. According to the SCORAD index, the majority of patients (75.7 %) had a moderate degree of AD and no seasonality. Features of skin rashes corresponded to the age periods of the course of AD: erythematous-squamous forms with lichenification foci prevailed. For the first time, the features of IgE-independent atopic dermatitis in children were shown. The role of risk factors for the development of IgE-independent atopic dermatitis in children has been shown for the first time. Conclusion. IgE-independent type of AD can be diagnosed in every fifth child with AD. The study of risk factors will allow predicting the development of this type of disease.

Ефективність ентеросорбції та системної ензимотерапії у лікуванні хворих із загостренням бронхіальної астми та коморбідною патологією органів травлення

Ефективність ентеросорбції та системної ензимотерапії у лікуванні хворих із загостренням бронхіальної астми та коморбідною патологією органів травлення

Issues of specific <i>in vitro</i> allergological diagnosis of atopic conditions

There is a steady increase in the prevalence of allergic diseases of atopic origin worldwide, e.g., atopic bronchial asthma (ABA) and atopic dermatitis (AD). Identification of a causally significant allergen in allergic patients is crucial for the diagnosis, therapy and prevention of allergic diseases. Korea has developed the Allergy-Q multiplex test to detect specific IgE. Allergy-Q is based on an immunoblotting method using a nitrocellulose membrane as a solid phase for allergen immobilization and can detect allergen-specific IgE simultaneously to 107 allergens. Our aim was to conduct a comparative analysis for detectable allergen-specific IgE antibodies to food, fungal, pollen, household, epidermal allergens in blood serum by immunoblotting method using the Allergy-Q test system in patients with atopic dermatitis, atopic bronchial asthma and psoriasis.
 The study included patients with atopic dermatitis (AD, group 1, n = 9), atopic bronchial asthma (ABA, group 2, n = 14) and psoriasis (PS, group 3, n = 17). The concentration of total immunoglobulin E and allergen-specific immunoglobulins of class E in blood serum to 32 most common food, fungal, pollen, household, epidermal allergens was determined by the immunoblotting method using the Allergy-Q test system (Korea).
 We have found that sensitization of atopic origin was observed in all patients with AD (n = 9), in 85.7% (n = 12) of patients with atopic bronchial asthma, and in 47.1% (n = 8) of patients with psoriasis. Polyvalent sensitization was shown to prevail in all groups of the examined persons. When studying the spectrum of sensitization to food allergens, a significantly increased frequency of positive reactions to cows milk protein was found in the group of patients with AAA as compared with AD and PS groups. Among all studied groups, sensitization to the Alternaria fungi was found at the highest frequency in the group of patients with ABA. Sensitization to ragweed pollen was very common in all groups of patients. Sensitization to household and epidermal allergens in the groups with AD and AAA was noted for all studied allergens with the highest positivity rates for the feline epithelium and dog dander.
 In the present study, the Allergy-Q system showed an agreement with preliminary data from a specific allergological examinations. This relationship suggests a potential for usage of the Allergy-Q immunoblotting method as a highly effective alternative to other in vitro tests for diagnosing atopy. An advantage of the Allergy-Q Multiplex Serum Allergen-Specific IgE Detection Kit is a short processing time, small amount of blood sample, and broader clinical information on the causative allergens.

Esophageal stenosis in a child with eosinophilic esophagitis: diagnosis and positive dynamics against the background of conservative therapy

Introduction. Currently, eosinophilic esophagitis (EoE) is a big and urgent problem for modern pediatrics. Its pathogenesis is associated with the formation of stenoses and strictures of the esophagus during a long course of the disease without treatment, which leads to serious disorders in the nutrition of children. In widespread practice, X-ray contrast examination of the esophagus is used, however, it is also necessary to perform esophagogastroduodenoscopy (EGDS) with taking multiple biopsies with morphological examination to verify the diagnosis. Materials and methods. Boy Y. 12 years, was admitted in March 2021 with complaints of difficulty in swallowing solid food, as well as poor weight gain. From the anamnesis of the disease, it is known that the phenomena of dysphagia were noted from the preschool period. Symptoms have progressed over the past year. EGDS was performed. A biopsy was taken: 6 fragments of the esophagus, 2 fragments from each third. Results. Diagnosed with eosinophilic esophagitis, complicated by esophageal stenosis. Chronic gastritis, Helicobacter pylori-not associated, incomplete remission. Chronic duodenitis, incomplete remission. Protein-energy malnutrition, mild. Appropriate treatment was prescribed. An allergological examination of the child was carried out and recommendations for nutrition were given. Against the background of the therapy, the child’s condition with pronounced positive dynamics - the appetite improved, the phenomena of dysphagia were completely stopped. When the child was re-hospitalized a month later, there was an increase in body weight (900 g) and growth (3 cm). Conclusions. The high efficiency of complex conservative therapy has been shown. The prescribed conservative treatment made it possible to avoid dilatation and bougienage of the esophagus. In this case, all three components of EoE treatment were applied: elimination diet, proton pump inhibitors, and topical corticosteroids. In the future, it is necessary to observe the allergist, taking into account the data obtained on multiple sensitization with a decision on the question of further treatment.

Association of gene polymorphism and cytokine content in the blood serum in children with allergic bronchial asthma

The study of genes controlling cytokine activities of is among important tasks when assessing predisposition and revealing pathogenetic links of initiation and course of clinical disorders. Aberrant production of cytokines and dysregulation of immune response may be considered genetic predictors associated with differentiation and functioning of T helpers, being of decisive importance in pathogenesis of pediatric allergic bronchial asthma. Our objective was to evaluation of associations between polymorphic genotypes and serum levels of cytokines of various T helper profiles in the children with allergic bronchial asthma.
 We have observed 175 children aged 3 to 11 years. Of them, we have examined 75 patients diagnosed with allergic bronchial asthma (ABA) as well as 100 healthy children matched for age and gender. All children underwent general clinical and allergological examination. The contents of cytokines attributed to Th1, Th2 and Th17 profiles were determined in blood serum by means of ELISA technique. DNA samples isolated from peripheral venous blood were used for molecular genetic analysis. Using allele-specific PCR technique, the following mutation points were investigated: IFN (T-874 A), IL-4 (C-589 T), IL-6 (C-174 G), IL-17A (G- 197 A), TNF (G-308 A). The analysis of distribution and occurrence of the cytokine gene polymorphisms was carried out, and the odds ratio of the disease risk were calculated. Statistical data processing was carried out using the program Statistica 10 by methods of descriptive, parametric and non-parametric statistics, comparison of unrelated groups was performed by qualitative characteristics of HardyWeinberg equilibrium, and with Chi-square test ( 2).
 These studies have revealed differences in patterns and occurrence of polymorphic genotypes associated with aberrant production of cytokines typical for various Th profiles among the children with allergic bronchial asthma. A comparative analysis of the mutant allele frequencies and cytokine genotypes of various Th profiles, along with determination of the cytokine contents in blood serum of children with allergic bronchial asthma revealed a predominance of homozygous IFN 874A, IL-4 589T, IL-6 174G, IL-17A 197A, and TNF 308A genotypes. Studies of gene polymorphisms, features of production and content of the cytokines specific for T helpers 1, T helpers 2, T helpers 17 profiles in bronchial asthma in the children revealed differences in distribution and occurrence of mutant alleles associated with aberrant cytokine production, variable risk of developing allergic pathology and development of the distinct disease phenotype.

Algorithm for selecting patients for house dust mite allergen specific immunotherapy in children with bronchial asthma and allergic rhinitis

Objective. Based on literature data and own research, on the selection of pediatric patients for the treatment of allergen immunotherapy (AIT) with house dust mite (HDM) allergens, to develop an Algorithm for selecting patients for AIT with HDM allergens in children with bronchial asthma (BA) and allergic rhinitis (AR). 
 Methods. Data from our own studies included 420 patients with AR and complaints indicating domestic sensitization (256 boys, 164 girls), aged 5 to 17,.9 years (mean age 8,.44 ± 3.,06), of which 176 have had BA. Patients underwent skin prick tests (SPT) with household allergens, determination of sIgE for HDM allergens by the ImmunoCAP method, and nasal provocative test (NPT) with HDM. If the results were negative, the allergological examination was repeated again in 12-–18 months. 
 Results: The Patient Selection Algorithm was constructed on the basis of the obtained data on the significance of the examination methods used. The primary role of SPT, the possibility of repeating the examination in case of negative results, indications for NPT with HDM allergens were taken into account. The algorithm makes it possible to organize an examination of a patient with HDM allergy in order to develop indications for AIT.

Clinical case of early debut of food allergy in a child up to 6 months

Introduction: It is believed that if the child ate only a cow’s milk formula (CMF), and сow's milk allergy is the only possible at the age of <6 months. This approach leads to erroneous treatment tactics.
 Presentation of the clinical case: a child aged 3 months with the debut of atopic dermatitis (AtD) of light degree (on the scale of the assessment of the researcher IGA 2). The patient was fed on artificial with a CMF from 1,5 months. Infant was examined at the place of residence. The CMF was changed to full hydrolysis CMF and without examination. Additionally, cosmetics were applied to the skin as needed. The child was examined by an allergologist after 3-4 weeks of diet. Negative dynamics were observed. Atopic dermatitis has become moderately severe with secondary infection complications (IGA 3, 50% affected skin). Prick-tests with allergens of milk, eggs, wheat, fish were carried out. High sensitization to egg and controversial to cow’s milk was found. The results were clarified during enzyme immunoassay: IgE ovomucoid – 0.78 IU/ml (norm <0.3 IU/ml); cow's milk 0.01 kUA/ l; casein – 0.01 kUA / l (norm <0.1 kUA/l). 
 Considering the infected AtD, "hydrocortisone + natamycin + neomycin" 2 times a day was used in the therapy. Cosmetics on infected foci was canceled, while maintaining the treatment of dry unaffected skin. It is recommended to limit household contacts with eggs. After 2 weeks, the rash is residual (IGA 0-1). The cow’s milk formula was returned to the diet without exacerbations of the skin process. 
 Conclusion: The case illustrates that sensitization in children can begin and be maintained without oral ingestion of the allergen. Sensitization at the age of up to 6 months is likely with a moderate – severe recurrent course of dermatitis. A specific allergological examination can be conduct with a developed disease at an early age. Skin tests and enzyme immunoassay are applicable in infants. The appointment of a diet without examination is unreasonable and should not be used.

Sensitisation to molecular components of mites in atopic dermatitis patients

ABSTRACT Background and aim: To analyse the sensitisation profile to molecular components of mites allergens with the use of ALEX2 Allergy Explorer test in Atopic dermatitis (AD) patients. Method: The complete dermatological and allergological examination including the examination of the sensitisation to molecular components with ALEX2 Allergy Explorer testing was performed. For the statistical analysis, we used Fisher's Exact. Results and conclusion: The sensitisation to mites increases with AD severity. The central role in atopic march may play the molecular component Der f 2 and Der p 23. The results of our study confirm the important role of Der p 5 and Der p 7 in subgroup of patients suffering from bronchial asthma. The specific immunotherapy should focus on the components of NPC2 family and Der p 23 in AD patients. Our results may be helpful in planning hyposensitisation, treatment and immunotherapy.