Vol 17, No 1 (2020)

One of the most common chronic upper respiratory diseases worldwide is allergic rhinitis (AR). Despite advances in understanding the mechanisms of allergic inflammation, the symptoms of AR in most cases are not completely controlled by modern treatment methods. Allergic rhinitis is a precursor and predisposing factor for the development of other respiratory diseases, one of which is asthma. Diagnosis of AR is being actively conducted, but there is still a serious problem of uncontrolled and chaotic treatment of patients, so it is necessary to provide comprehensive medical care within the national health system. ARIA aims to develop and apply internationally recommendations for the management of patients with allergic respiratory diseases. In collaboration with other international associations that deal with the treatment and diagnosis of allergies and respiratory diseases, regulations and programs have been developed for the treatment of patients with AR, as well as when it is combined with asthma, which form the basis of ARIA. This document has been adapted for use in the field of healthcare in the Russian Federation and covers key issues related to the management of patients with AR and in combination with AR and asthma.

Background. The combination of chronic rhinosinusitis with nasal polyps (CRSwNP) and bronchial asthma (BA) is currently considered as a separate phenotype characterized by similar features of inflammatory changes leading to an increase in the clinical course of both CRSwNP and BA. The aim of the study was to investigate the clinical features and characteristics of the local and systemic inflammatory process in patients having a combination of CRSwNP and BA. Materials and methods. The study included 96 volunteers, who were divided into 4 groups: group 1 consisted of healthy volunteers (Normal); group 2 consisted of volunteers with CRSwNP in combination with allergic BA (CRSwNP + aBA); group 3 - volunteers with PRS in combination with non-allergic BA (CRSwNP + nBA); and group 4 - CRSwNP without BA. Clinical, laboratory, instrumental and allergology examination methods were applied for all participants of the study. BA control status was determined using the asthma control questionnaire (ACQ-7), and CRSwNP control status was determined using the nasal and paranasal sinus clinical outcome control questionnaire (SNOT-22). At the same time, the quality of life of the patients was also evaluated using AQLQ (Asthma Quality of Life Questionnaire). Results. The results confirmed the interaction of BA and CRSwNP, where the combination of these diseases led to a more severe and uncontrolled clinical course of BA and CRSwNP based on the assessment using SNOT-22, ACQ-7 and AQLQ questionnaires. These results correlated with an increase in the absolute number of eosinophils in peripheral blood and pronounced eosinophilic cell infiltration of nasal polyp stroma. Data processing demonstrated that the combination of CRSwNP and nBA showed signs of more pronounced eosinophilic inflammation, which is an unfavorable prognostic factor. Conclusions. The comparison of the cellular characteristics of the local and systemic inflammatory process in patients with CRSwNP in combination with BA allowed us to conclude that polyp development follows a local inflammatory process. Further study of the pathogenesis of CRSwNP and BA will help to understand the mechanisms that connect these diseases and consider possible target molecules for biological therapy.

This article describes the clinical, biochemical and genetic features of hereditary angioedema (HAE) with normal level and functional activity of C1 esterase inhibitor. The discussion includes pathogenesis, diagnostics and case management of patients with hereditary angioedema without C1 esterase inhibitor deficiency. The materials of few scientific sources about patients with HAE without C1 esterase inhibitor deficiency in stages and our own clinical case (the female patient of fertile age with a confirmed mutation associated with factor XII (Hageman) deficiency) was given. The article describes the current state of the issue of the algorithm of primary diagnostics and differential diagnostics of HAE without C1 esterase inhibitor deficiency based on international and Russian data. It has been suggested that the new understanding of pathogenesis and treatment of patients with HAE without C1 esterase inhibitor deficiency is encouraging and becoming accessible to the medical society.

Introduction. Nowadays pollen allergy (hay fever) is one of the most common allergic diseases. Due to the ubiquity of grass species and the long pollination season, grass pollen allergy is an important social and economic problem. Summary. In this review we discuss the clinical data on the use of the SQ timothy grass sublingual immunotherapy (SLIT) tablet for the treatment of allergic diseases caused by grass pollen. The data of various studies demonstrate a significant long-term clinical effect after 1 course of SLIT with this allergen. Conclusions. Based on the studies, the SQ grass SLIT-tablet is established to be a disease-modifying therapy.