Patient with polymorbid pathology. Possibilities of therapy with monoclonal antibodies

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Abstract

The widespread increase in the number of patients with allergic pathology, doctors in clinical practice increasingly have to observe the simultaneous development of several nosological forms in the same patient. Frequent combined lesions of the skin and the respiratory tract in atopy (atopic dermatitis, allergic rhinitis, atopic bronchial asthma) are traditionally considered within the framework of comorbidity and suggests a number of therapeutic interventions given the similarity of the pathogenesis of the processes. However, there are pheno / endotypic differences between patients (triggers, age, persistence of manifestations, degree and type of inflammation, severity of symptoms and response to treatment), for which it is more correct to use the term multimorbidity. The strategy of precision medicine for patients with several immune-mediated diseases should be focused on identifying not only the general features of the disease, but also on the pathogenetic mechanisms in the target organs.  Because of these differences, the sensitivity to therapeutic interventions by target organs can vary.

A clinical case of a patient with comorbid pathology - chronic spontaneous urticaria, allergic rhinitis and bronchial asthma - was analyzed.

Respiratory manifestations (rhinitis and asthma) were mild severe.  The most severe course of the disease was noted for chronic urticaria, which was resistant to the prescription of antihistamines - drugs of the first and second line of therapy (according to federal and international clinical guidelines), which required the use of monoclonal antibodies. Anti-IgE therapy with omalizumab had a rapid and complete effect on urticaria symptoms, but respiratory symptoms were less responsive to treatment.  In patients with multimorbid pathology, the choice of therapy requires a personalized choice of targeted drugs and their dosage.

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About the authors

Natalia Astafeva Natalia G. Astafyeva

Saratov State Medical University n.a. V.I. Razumovskiy” of the Ministry of Healthcare of the Russian Federation

Author for correspondence.
Email: astang@mail.ru
ORCID iD: 0000-0002-7691-4584
Scopus Author ID: 6506637441
ResearcherId: ResearcherID  AAI-3342-2020

MD, PhD, Doctor of Medical Sciences, professor

Natalia Astafieva graduated with distinction from Saratov Medical University in 1966 and completed her PhD programme in 1970; she also completed a higher level Doctor of Medical Sciences research “The role of platelets in the development of allergic diseases” in 1989 and became Professor of Medicine in 1991. She was the Head of Saratov Allergology Centre since 1969 and became the Leading Specialist in allergology and immunology at Saratov Region Department of Health in 1972. Since 2004 till present time Professor Astafieva is the Chair of Clinical Immunology and Allergology Department at Saratov State Medical University. Professor Astafieva is the author of more than 470 publications, published internationally and in Russia, 3 patents and 14 books. Many of them received prestigious awards, like “Allergy and Plants” – Silver Medal of The Exhibition of Achievements of National Economy, “Modern Trends in the Pharmacotherapy of Atopic Asthma” – an Award of International Book Fair (Moscow, 2014) and Golden Medal of 35th International Paris Book Fair (Salon Du Livre) / ESIC, European Scientific and Industrial Consortium (Paris, 2015), etc. Professor Astafieva was leading the development of more than 20 methodology and clinical recommendations, endorsed by professional associations and government bodies, and supervised 28 PhD and 2 Doctor of Medical Science research programmes to successful completions. She has been invited to speak at plenary, keynote, symposia and expert discussion sessions, workshops and industry sponsored meetings at the Russian Association of Allergologists and Immunologists (RAACI), thematic sessions European Academy Allergy and Clinical Immunology ( EAACI) , European Respiratory Society (ERS) . Major Honours & Awards: “Excellence in Health Care”, “Honoured Doctor of Russian Federation” (2003); Medal of the Order “For the Merit to the Fatherland” (2010); Medal of V.I.Rasumovsky (2013) , The Laureate of the Professional Completion for Lecturers, Readers and Professors (2017), The Certificate of Honour of the President of Russia (2018)

Russian Federation, 410012,Russia, Saratov Bol'shaya Kazach'ya, 112

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