Vol 18, No 3 (2021)

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.

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.

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.

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.

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.

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.

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.

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.