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Vol 18, No 3 (2021)

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Original studies

Angioedema induced by angiotensin-converting enzyme inhibitors: an analysis of hospitalizations during the COVID-19 pandemic

Sabalenka T.М., Zakharava V.V., Prakoshyna N.R.

Abstract

BACKGROUND: The pathogenesis of angioedema induced by angiotensin-converting enzyme inhibitors is based on the accumulation of bradykinin as a result of angiotensin-converting enzyme blockade. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds to the angiotensin-converting enzyme 2 receptor, which may inhibit its production and thereby lead to an increase in bradykinin levels. Thus, SARS-CoV-2 infection may be a likely trigger for the development of angioedema.

AIMS: This study aimed to analyze cases of hospitalizations of patients with angioedema associated with the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers during the coronavirus disease 2019 (COVID-19) pandemic.

MATERIALS AND METHODS: This study retrospectively analyzed medical records of patients admitted to the Vitebsk Regional Clinical Hospital between May 2020 and December 2020 with isolated (without urticaria) angioedema while receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. In all patients, smears from the naso- and oropharynx for COVID-19 were analyzed by polymerase chain reaction.

RESULTS: Fifteen inpatients (9 men and 6 women) aged 44–72 years were admitted because of emergent events, of which 53.6% had isolated angioedema. In two cases, a concomitant diagnosis of mild COVID-19 infection was established with predominant symptoms of angioedema, including edema localized in the face, tongue, sublingual area, and soft palate. All patients had favorable disease outcomes.

CONCLUSIONS: Patients with аngiotensin-converting enzyme inhibitor-induced angioedema may require hospitalization to monitor upper respiratory tract patency. There were cases of a combination of аngiotensin-converting enzyme inhibitor-induced angioedema and mild COVID-19. Issues requiring additional research include the effect of SARS-CoV-2 infection on the levels of bradykinin and its metabolites, the triggering role of COVID-19 in the development of angioedema in patients receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, recommendations for the management of patients with аngiotensin-converting enzyme inhibitor-induced angioedema, and a positive result for COVID-19.

Russian Journal of Allergy. 2021;18(3):5-15
pages 5-15 views

Drug intolerance: age-related aspects

Grakhova M.A., Rychkova O.A., Braun A.V., Sagitova A.S., Nesterova M.A.

Abstract

BACKGROUND: Drug hypersensitivity is an adverse reaction caused by immune or non-immune mechanisms to the intake of adequate doses of drugs. To avoid a dangerous situation, correctly collected pharmacological history, taking into account all the characteristics of the patient (gender, age, concomitant pathology), and knowledge of the mechanism of action of drugs can help a practicing physician who does not currently have a reliable method for diagnosing drug hypersensitivity.

AIM: Identification of age-specific drug intolerance.

MATERIALS AND METHODS: The study was conducted from 2017 to 2020 and included 200 outpatient medical history forms of individuals diagnosed with an unspecified pathological reaction to a drug or medication. All drug reactions were based on patient’s own statements and were allocated as dichotomous variables. The results were analyzed by nonparametric statistics (Pearson’s chi-square).

RESULTS: Three groups of patients were identified: 18–44 years (n=49), 45–60 years (n=60), ≥61 (n=91). The odds of incomprehensible reactions were 2.2 times higher in patients in group 3 than in patients in the other groups. Group 3 patients were 12 times more likely to have an itchy reaction to medications than patients in the other groups. Group 1 patients were 3 times more likely to have urticaria than patients in groups 2 and 3. The odds of drug intolerance to angiotensin-converting enzyme (ACE) inhibitors were 2.6 times higher in patients in group 3 than in patients in the other groups. When comparing clinical manifestations of drug intolerance to penicillin and cephalosporin antibiotics, no significant differences were found in all patients. The presence of allergies and somatic pathology of ≥3 systems did not significantly affect the possibility of reactions of varying severity to ≥3 drugs in these groups.

CONCLUSIONS: Patient’s age has no effect on the possibility of reactions to certain groups of drugs. The exception was ACE inhibitors, which is most likely due to the higher frequency of prescribing antihypertensive therapy in patients in this age group. The aggravation of clinical manifestations and the occurrence of polypharmacy are not associated with age and comorbid background. Age and non-life-threatening clinical manifestations of drug intolerance were correlated, which indicates the absence of the reliable effect of age on the possibility of anaphylactic shock or angioedema.

Russian Journal of Allergy. 2021;18(3):16-34
pages 16-34 views

Some features of hematological parameters and production of cytokines regulating inflammation in allergic rhinitis

Iraklionova N.S., Belan E.B.

Abstract

BACKGROUND: Allergic rhinitis is a common IgE-mediated disease. Multiple mechanisms are involved in the regulation of IgE synthesis, and cytokines produced by immune cells play an important role in this process. In addition, the study of the features of immunological reactivity in seasonal allergic rhinitis is of interest both for getting new data about the pathogenesis of the disease and optimization of the treatment.

AIMS: This study aimed to determine the cytokine status and hematological parameters in patients with seasonal allergic rhinitis outside the exacerbation period.

MATERIALS AND METHODS: This study included 43 adult patients with seasonal allergic rhinitis (remission stage) and compared them with 47 healthy individuals. Patients with perennial symptoms and/or sensitization to perennial allergens were excluded. Complete blood cell count and serum interleukin (IL)-4, IL-5, IL-6, IL-8, IL-10, IL-18, monocyte chemoattractant protein-1 (MCP-1), total immunoglobulin (Ig) E, and eosinophil cationic protein levels were measured.

RESULTS: The remission stage in patients with seasonal allergic rhinitis is characterized by higher serum levels of total IgE and IL-8 compared with the healthy group. The normal serum total IgE level of patients with seasonal allergic rhinitis in remission is associated with activation of the monocyte–macrophage link (increased serum levels of MCP-1, IL-6, IL-8, and absolute and relative numbers of monocytes). Increased serum total IgE level is associated with the predominant signs of the Th2 phenotype of the immune response (increased serum levels of IL-4 and IL-5).

CONCLUSIONS: The immune reactivity of patients with natural remission of seasonal allergic rhinitis is characterized by Th2 phenotype features if the serum level of IgE is increased and features of activation of monocyte–macrophage system if the level of IgE is normal.

Russian Journal of Allergy. 2021;18(3):35-43
pages 35-43 views

Clinical practice guidelines

Atopic dermatitis

Kubanov A.A., Namazova-Baranova L.S., Khaitov R.M., Ilyina N.I., Alekseeva A.A., Ambarchian E.T., Artemyeva S.I., Arshinskiy M.I., Astafyeva N.G., Vishneva E.A., Volnukhin V.A., Danilycheva I.V., Elisyutina O.G., Epishev R.V., Zhestkov A.V., Zhilova M.B., Zhukova O.V., Zaslavsky D.V., Znamenskaya L.F., Karamova A.E., Korotky N.G., Kokhan M.M., Kruglova L.S., Kungurov N.V., Levina J.G., Lvov A.N., Materikin A.I., Mishina O.S., Monakhov K.N., Murashkin N.N., Nenasheva N.M., Pampura A.N., Plakhova X.I., Potekaev N.N., Prytulо O.A., Raznatovskiy K.I., Sapuntsova S.G., Selimzianova L.R., Skorokhodkina O.V., Fedenko E.S., Fomina D.S., Frigo N.V., Frolova Z.V., Khaitov M.R., Chikin V.V.

Abstract

Atopic dermatitis is one of the most common diseases (20‒40% among skin diseases) that occur in both genders worldwide and in different age groups. The problem urgency is caused by an increase in morbidity, a chronic relapsing course that often leads to a decrease in the quality of life and disability, low efficiency of traditional treatment methods, and limited access to contemporary effective targeted therapy. The clinical guidelines, which aimed to optimize care for patients with atopic dermatitis, contain up-to-date information on epidemiology, etiological factors, mechanisms of development and pathogenesis, aspects of the clinical presentation and disease course, current diagnostic methods (including allergological examination methods), as well as approaches to treatment (including traditional methods and modern targeted therapy). The indications for allergen-specific immunotherapy are determined, and the aspects of its implementation are described. The procedure for the provision of medical care, prevention, and follow-up monitoring is outlined. Clinical practice guidelines for atopic dermatitis are intended for practitioners of all specialties, students, teachers of medical schools, residents, graduate students, and researchers.

Russian Journal of Allergy. 2021;18(3):44-92
pages 44-92 views

Vaccination of patients with allergic disease against novel coronavirus infection: position paper of the Russian Association of Allergology and Clinical Immunology

Ilyina N.I., Kurbacheva O.M., Latysheva E.A., Latysheva T.V., Nazarova E.V., Nenasheva N.M., Fedenko E.S., Khaitov M.R., Shartanova N.V.

Abstract

One of the key tasks of the previous year is to stop the spread of coronavirus disease (COVID-19), which became a pandemic that led to the deaths of more than 4 million people worldwide and more than 140 thousand deaths in Russia. COVID-19 is caused by the severe acute respiratory syndrome coronavirus 2 (2019-nCoV) virus of the coronavirus family. Vaccination plays a leading role in ending the pandemic. Currently, five vaccines against COVID-19 have been registered in Russia, namely, Sputnik V, Sputnik light, EpiVacCorona, EpiVacCorona-Н, and СoviVak. The short follow-up period and absence of randomized placebo-controlled trials of COVID-19 vaccines in certain patients with chronic diseases lead to several questions about the effectiveness/safety of vaccination in these patients. Given the wide spread of allergic diseases and the heterogeneity of patients with allergopathology, experts of the Russian Association of Allergology and Clinical Immunology have developed and approved a position paper on vaccination of patients with allergopathology.

Russian Journal of Allergy. 2021;18(3):93-97
pages 93-97 views

Vaccination against COVID-19 for patients with primary immunodeficiency and hereditary angioedema: the position paper of the Russian Association of Allergology, Clinical Immunology, and the National Association of Experts in Primary Immunodeficiencies

Ilyina N.I., Kondratenko I.V., Latysheva E.A., Latysheva T.V., Manto I.A., Nazarova E.V., Fomina D.S., Khaitov M.R., Shcherbina A.Y.

Abstract

Since the end of 2019, the whole world has been suffering from the Corona virus-19 (COVID-19) pandemic due to the potentially severe acute respiratory infection caused by the SARS-CoV-2 virus. To date, the infection has led to more than 4 million deaths worldwide, and >140 thousand deaths in Russia. Vaccination against COVID-19 plays a key role in stopping the pandemic. According to the existing experience in infection prevention, mass vaccination will reduce the virus’s expansion and the risk of vaccine-resistant strains developing. In the context of COVID-19, the question of the feasibility and safety of vaccination for patients with primary immunodeficiency and hereditary angioedema arises. The Russian Association of Allergists, Clinical Immunologists, and the National Association of Experts in Primary Immunodeficiencies have developed and approved a position paper on the vaccination for patients with primary immunodeficiency and hereditary angioedema against COVID-19.

This position paper provides answers to key questions regarding vaccination for patients with these diseases.

Russian Journal of Allergy. 2021;18(3):98-104
pages 98-104 views

Case reports

Component allergy diagnostics as a tool for the management of patients with allergic diseases

Churyukina E.V., Dudareva M.V., Kolesnikova N.V., Filippov E.F., Ukhanova O.P.

Abstract

Molecular diagnostics makes it possible to determine true and cross-reactivity differentially, which is of great clinical importance not only for the diagnosis of the true spectrum of sensitization, but also for the reasonable choice of pathogenetic therapy and prediction of the effectiveness and risks associated with allergen-specific immunotherapy (ASIT). Several clinical cases are presented as examples demonstrating the clarifying nature of molecular allergodiagnostics. In the first case, the detection of primary sensitization, which was conducted using ASIT with a causally significant allergen, led to the elimination of not only respiratory but also skin symptoms. In other clinical cases, patients had similar anamnesis and data from skin and laboratory studies. To clarify the indications for ASIT, correct choice of a therapeutic allergen and method of its administration, and the prognosis of the effectiveness of ASIT, it is necessary to identify the primary allergenic source that causes IgE-mediated sensitization. For this purpose, the patients were recommended to undergo laboratory diagnostic examinations to clarify the spectrum of sensitization. Component allergodiagnostics of ImmunoCAP made it possible to develop an individual management strategy for these patients.

Russian Journal of Allergy. 2021;18(3):105-112
pages 105-112 views

New opportunities of therapy of severe atopic dermatitis

Demko I.v., Sobko E.A., Kraposhina A.Y., Shestakova N.A., Gordeeva N.V., Kasymova K.F.

Abstract

This paper presents a case of the successful use of dupilumab in a 21-year-old patient with severe atopic dermatitis, concomitant bronchial asthma, and allergic rhinitis. The patient was observed in the allergological department of the Krasnoyarsk Clinical Regional Hospital for 2 years. The disease was characterized by constant skin symptoms, frequent exacerbations, resistance to standard therapy, including systemic glucocorticosteroids and immunosuppressors. Considering the above factors, targeted therapy was started with dupilumab, registered in the Russian Federation for use in atopic dermatitis resistant to standard therapy. Against the background of biological therapy (13 injections were carried out), a stable significant decrease in skin syndrome activity was achieved (SCORAD index decreased from 72 to 9 points), and the patient’s quality of life significantly improved.

Russian Journal of Allergy. 2021;18(3):113-119
pages 113-119 views

Primary immunodeficiency in a child with heterotaxy

Pavlova T., Shinkareva V.M.

Abstract

Heterotaxy is a complicated symptom complex in which the location of the main internal organs differs from their normal and complete mirror reflection. Ivemark syndrome is a combination of spleen agenesis with congenital heart disease and abnormalities in the location of the abdominal organs. The exact reason is unknown, with mostly sporadic cases. This paper discusses the genetic, infectious, and toxic factors that damage the differentiation of embryonic tissues between days 31 and 36 of embryogenesis.

The article presents a clinical observation of a patient with Ivemark syndrome, illustrating the difficulties of diagnosing congenital malformations. The peculiarity of this clinical case was determined by the combination of the syndrome with primary immunodeficiency and vascular malformation. Ivemark syndrome is a rare disease; therefore, the awareness of primary care physicians in relation to this pathology is low. Early diagnosis of primary immunodeficiency before a child is at risk of infection is extremely important. A sample case of pharmacological correction, which prolonged the patient’s life, was presented.

This clinical case is published in the Russian Journal of Allergy to acquaint the readership with an extremely rare disease, with which, in all likelihood, the readers of the journal may not be familiar or not familiar enough. However, Ivemark syndrome in combination with a primary immunodeficiency, some evidence of which is given in the article, can be encountered in the practical work of an allergist-immunologist.

Russian Journal of Allergy. 2021;18(3):120-125
pages 120-125 views

Letters to the editor

Long-term prophylaxis therapy in patients with hereditary angioedema in Russia: resolution of the expert Council

Bodnya O.S., Demina D.V., Kuzmenko N.B., Latysheva E.A., Latysheva T.V., Milichkina A.M., Pampura A.N., Sizyakina L.P., Totolian A.A., Uhanova O.P., Fedotova N.V., Fomina D.S.

Abstract

Hereditary angioedema is a rare (orphan) disease associated with the development of angioedema of various localization caused by the action of bradykinin. The main symptoms of the disease are peripheral angioedema, abdominal attacks (accompanied by severe pain syndrome), edema of the upper respiratory tract, which may lead to asphyxia and death of the patient. Peripheral edema disrupts social and professional activity, the occurrence of facial edema complicates social adaptation, the unpredictability and potential threat to life of edema in the larynx, as well as the lack of effect from standard (systemic glucocorticoid and antihistamines) therapy regimens lead to a low quality of life of patients, a large number of days of disability, hospitalizations, in some cases, premature death of patients.

According to international studies, “on-demand” therapy does not reduce the burden of the disease, and therefore international guidelines emphasize the importance of timely and individualized selection of long-term prevention for patients with hereditary angioedema. Taking into account the appearance of a new drug for long-term prevention in Russia, an Expert Council was held to assess the burden of the disease in Russian patients, determine the proportion of patients who need long-term prevention, criteria for choosing a medication for prophylaxis and the place of Lanadelumab in it.

Russian Journal of Allergy. 2021;18(3):126-130
pages 126-130 views

Pediatric anaphylaxis: unresolved issues of diagnosis and patient management

Pampura A.N., Esakova N.V.

Abstract

The incidence of anaphylaxis is increasing in children. Children suffering from anaphylaxis represent a complex and ambiguous group of patients. The factors that cause difficulties in diagnosing anaphylaxis in children are as follows: a wide range of triggers, unpredictability of the nature, severity of clinical symptoms of systemic reactions, and their age-dependent interpretation. The first anaphylactic reaction always stuns parents and medical staff, which leads to a subjective description of the anamnesis and a delay in making a diagnosis and prescribing the correct treatment. For these patients, problems such as the lack of available diagnostic tests for verifying the diagnosis of anaphylaxis, restriction of standard doses of epinephrine autoinjectors, lack of predictors of the occurrence, and severity of systemic allergic reactions continue to be relevant.

The article focused on the most urgent difficulties and features of managing patients with anaphylaxis in pediatric practice and discussed possible prospects and ways to solve them.

Russian Journal of Allergy. 2021;18(3):131-136
pages 131-136 views

Book reviews

Book review on “Immunology” (2021) authored by academician of the Russian Academy of Sciences R.M. Khaitov

Gintsburg A.L., Gabibov A.G., Deyev S.M., Zverev V.V., Rumyantsev A.G., Tahchidi H.P., Tkachuk V.A., Yuschuk N.D., Ataullakhanov R.I.

Abstract

The textbook “Immunology”, 4th edition (published in September 2021), was prepared by a well-known Soviet and Russian scientist of world renown, immunologist, doctor of medical sciences, professor, academician of the Russian Academy of Sciences Khaitov Rakhim Musaevich. The new edition is an updated, revised and enlarged version of the textbook, which over the past 15 years has become one of the best textbooks on immunology. It is used all over the place. Throughout Russia and in the CIS countries, by medical and biological students, physicians, researchers in the field of immunology and allergology, microbiology, virology, infectology, vaccinology and others related fields of science. So, the textbook “Immunology” by R.М. Khaitov is one of the best in Russia, one of the most demanded and recognized textbooks.

Russian Journal of Allergy. 2021;18(3):137-140
pages 137-140 views

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