Vol 18, No 4 (2021)

BACKGROUND: Allergic rhinitis is the most common chronic allergic disease worldwide, and bronchial asthma (BA) is one of the most severe complications of allergic rhinitis. Clinical studies reported that sublingual allergen-specific immunotherapy can reduce the incidence of bronchial asthma in children and adults. However, allergen-specific immunotherapy is rather expensive and is not reimbursed by the state, which transfers the cost of this therapy to patients.

AIMS: To evaluate the cost-effectiveness of allergen-specific immunotherapy in children and adults with allergic rhinitis and/or allergic rhinoconjunctivitis

MATERIALS AND METHODS: The study hypothesized based on study results by Devillier P. et al. in 2019, to which the incidence of asthma was 13.7% and 17.0% in the sublingual allergen-specific immunotherapy + symptomatic therapy and the symptomatic therapy group, respectively (odds ratio: 0.776, 95% confidence interval [0.622; 0.968]). Pharmacoeconomic study based on decision tree model. Costs taken into account are the following: allergen-specific immunotherapy, symptomatic therapy, diagnostics, and routine follow-up visits due to bronchial asthma, outpatient bronchial asthma drug therapy, and hospitalization due to bronchial asthma. The modeling horizon was 5 years, including 2 years of allergen-specific immunotherapy therapy and 3 years of follow-up.

RESULTS: The cost per patient when using allergen-specific immunotherapy in combination with symptomatic therapy was 166,711.93 rubles, whereas with symptomatic therapy was 101,700.35 rubles. The cost-effectiveness ratio for allergen-specific immunotherapy in combination with symptomatic therapy was 193,177.20 rubles per 1 prevented case of asthma, whereas 122,530.55 rubles for symptomatic therapy for 1 prevented case of bronchial asthma. Thus, the cost of 1 averted bronchial asthma case when using allergen-specific immunotherapy in combination with symptomatic therapy is 57.7% higher than with symptomatic therapy. The cost-benefit analysis result revealed that the incremental cost-utility ratio for an additional year of life adjusted for its quality when performing sublingual allergen-specific immunotherapy in combination with symptomatic therapy compared with symptomatic therapy alone in children and adults was 567,365.48 rubles, which is less than the calculated willingness to pay threshold (RUB 2,248,898.50).

CONCLUSIONS: The comparison results of the cost of 1 added quality adjusted life years and willingness to pay threshold concluded that sublingual allergen-specific immunotherapy in combination with symptomatic therapy compared to symptomatic therapy alone is potentially cost-effective in children and adults with allergic rhinitis.

BACKGROUND: Asthma and obesity have a close relationship: obesity is a risk factor for asthma, the link of its pathogenesis, a predictor of heavier flow and the worst control. One of the priorities of non-drug therapy of asthma is the fight against overweight. Preventive counseling allows doctors to teach patients the principles of a healthy lifestyle, including controlling body weight. There is no domestic population-based research that reflects the coverage of overweight persons with asthma of the counseling on weight loss in various socio-demographic groups. Thus our study is actual.

AIMS: Determine socio-demographic factors of overweight patients with bronchial asthma living in Russian urban areas associated with receiving counseling on weight loss.

MATERIALS AND METHODS: This study was based on a cross-sectional population-based study “Know Your Heart” (2015–2018, Arkhangelsk, Novosibirsk, n=4504). For this research, we selected overweight patients with asthma (n=167). We applied the CHAID (Chi-Squared Automatic Interaction Detection) decision tree to identify socio-demographic factors associated with receiving weight loss counseling. CHAID method allows for the automated classification of the sample and the detection of relationships between the predictors and the analyzed outcome.

RESULTS: The probability of obtaining counseling on weight loss increased by 1.39 times among retired women with obesity compared with the coverage level of counseling in the studied sample as a whole (61.7%). Among the men, the probability of obtaining counseling on weight loss increased 1.27 times in the presence of obesity. Reducing the likelihood of getting counseling both among women (1.39 times compared with the general indicator) and among men (2.2 times compared with the general indicator) was noted if their weight corresponded to the category of the excess body (BMI 25.0–29.9).

CONCLUSION: 61.7% of the overweight urban population of two regions of Russia with asthma received counseling on weight loss. Groups of overweight patients with asthma, which are statistically significantly less often obtaining counseling on weight loss: persons with BMI 25.0–29.9, regardless of gender, and non-retired women with BMI ≥30.0. The decision tree developed by us will allow allergists-immunologists and doctors of related specialities to be wary of patients from the population groups identified in the study where the activity of conducting preventive counseling is reduced. In turn, this will increase the coverage of preventive counseling for patients with bronchial asthma and, as a result, will contribute to improving asthma control.

Asthma is one of the most common respiratory tract diseases (approximately 7% of adults and 10% of adolescents and children suffer from asthma in the Russian Federation). The occurrence frequency of asthma does not depend on sex or age in the population. The number of patients with asthma worldwide increased annually. The majority of patients with asthma respond well to conventional therapies and successful disease control, but 20%–30% of patients have severe phenotypes of asthma resisting known medicines, therefore they rarely achieve asthma control. Patients with severe asthma frequently need hospitalizations (up to 30%) and intensive care (4%–7%).

The clinical asthma guideline aimed to optimize patient care, up-to-date information about the epidemiology, and disease etiology and pathogenesis. Herein, presented the actual data about asthma classification, its clinical signs, modern diagnostics (clinical, laboratory, and instrumental), and differential diagnostics of asthma. Studies reported asthma treatment, rehabilitation, and prevention in the guideline. The authors describe in detail the existing healthcare options for patients with asthma, diasgnostics features, and care in partial groups of population (adolescents, pregnant or nursing women, and persons with occupational, exercise-induced, or severe phenotype asthma).

The clinical guidelines are recommended for medical doctors (independently from qualification), under- and postgraduate students, universities tutors, residents, and researchers.

The progressively increased incidence of atopic dermatitis among children and increased persistence in adulthood, combined with an inevitably decreased quality of life of patients, determine the relevance of studying the development mechanisms of this disease not only for dermatology but also for the entire health care system. Thus, the prerequisites for the emergence of new pathogenetic concepts and the search for the most effective therapeutic modalities arise. Currently, atopic dermatitis is considered as the interaction of endogenous (impaired immune response and insufficient epidermal barrier function) and exogenous (exposure to allergens, chemical or physical irritants, and microorganisms) factors.

Environmental factors, such as temperature and humidity, genetic makeup, antibiotic use, and good hygiene, play a critical role in skin microbiome maintenance and stability. Normally, the skin microbiota is mainly formed by bacteria of the genus Staphylococcus, Propionibacterium, Corynebacterium, and Streptococcus. In 70% of patients with atopic dermatitis, colonization of Staphylococcus aureus is observed on the affected skin, whereas on the unaffected skin in 39%, which secondarily contributes to the development of immune imbalance and increased skin xerosis. This fact determines the importance of basic therapy, which, on one hand, helps to strengthen the epidermal barrier, and on the other, normalizes the microbiome of the skin, thereby reducing the colonization of Staphylococcus aureus.

The normal skin microbiome suppresses the activity of immune-inflammatory responses and regulates pH, lipid synthesis, and transepidermal water loss. Thus, skin microbiome normalization is the key to successful therapy and long-term remission of atopic dermatitis.

BACKGROUND: The growth of allergic diseases dictates the necessity to develop new forms of therapeutic allergens since therapy with native water-salt extracts of allergens is unsafe and convenient. The risk of systemic side effects during allergen-specific immunotherapy sets the task for researchers to create modern therapeutic forms of allergens with high immunogenic and low allergenic activity. Our laboratory has been developing preparations for the diagnosis and treatment of house dust mites allergies for many years.

AIMS: To create modern therapeutic forms of allergen preparations from house dust mites of the genus Dermatophagoides that are intended for allergen-specific immunotherapy

MATERIALS AND METHODS: Physicochemical and immunobiological methods, such as electrophoresis in polyacrylamide gel, micropoint immunoblot, solid-phase enzyme-linked immunosorbent assay, and the reaction of binding inhibition of allergen-specific immunoglobulin E in the sera of patients were used to study the obtained preparations.

RESULTS: A technology has been developed to obtain a granular dosage form of a mixed allergen from Dermatophagoides pteronyssinus and Dermatophagoides farinae mites for sublingual use. This treatment form has successfully passed preclinical tests, has a pronounced immunogenic activity, and reduced allergenicity, and is convenient for pediatric practice. Allergoids, which are chemically modified preparations, are obtained to reduce allergenicity and increase therapeutic allergen immunogenicity. A succinylated monomeric house dust mites allergoid Dermatophagoides pteronyssinus was created and studied with the National Research Center, Institute of Immunology Federal Medical-Biological Agency of Russia. The study of the immunobiological properties of the obtained preparation showed that the monomeric allergoid has increased immunogenic and decreased allergenic activity contrary to the native water-salt extract.

CONCLUSIONS: The created forms of mite allergens can be used to treat patients who are sensitized to house dust mites of the genus Dermatophagoides after clinical trials.

Based on clinical cases, the authors present their own experience of successful anti-Immunoglobulin E-therapy using omalizumab at 300 mg every 4 weeks with clinical manifestations of chronic inducible urticaria in children, such as cholinergic urticaria and cold urticaria, which was observed without chronic spontaneous urticaria symptoms. Concurrently, the patient with cold urticaria had a complete response after the first injection, with a total course of treatment of 6 months, whereas the patient with cholinergic urticaria did not immediately receive therapy and needed a 12-month course of treatment with strict administration regimen adherence for 4 weeks. All patients have achieved sustained disease remission.

Chronic spontaneous urticaria is the spontaneous appearance of blisters, angioedema, or both for >6 weeks that affects up to 0.5%–5% of the population, mainly females. Spontaneous wheals and/or angioedema, severe skin itching that leads to depression and anxiety, sleep disturbances, sexual dysfunction, and activity of daily life and work restrictions. Other diseases sometimes occur under the guise of chronic spontaneous urticaria.

Urticarial vasculitis is a vasculitis of the small skin vessels, characterized by the duration of persistent skin rashes in combination with histopathological features of leukocytoclastic vasculitis. Differential diagnosis of chronic spontaneous urticaria and urticarial vasculitis is conducted in the case of an atypical clinical picture of urticaria. Wheals lasted for >24 h, often accompanied by burning and pain, and leaving behind purpura or residual hyperpigmentation.

Herein, described a case of urticarial vasculitis in a patient that required a differential diagnosis of chronic spontaneous urticaria and urticarial vasculitis several years after the disease onset. Successful treatment was conducted with a combination of antihistamines, glucocorticosteroids, hydroxychloroquine, and omalizumab.

A landmark event for specialists in immunology and specialties related to immunology took place this year. A fourth edition of the textbook, “Immunology,” has been published by the famous Russian immunologist and academician of the Russian Academy of Sciences, Rakhim Musaevich Khaitov. Compared to the previous edition issued in 2018, this version is a substantially updated and revised version, replenished with information obtained during this relatively short period by world immunology, one of the most rapidly developing areas of scientific knowledge. With all the complexity of modern immunology, this training manual has achieved a perfect form, consistent, and accessible presentation of the material following the latest international data. Attention is drawn to the appropriate placement of perfectly done illustrations that explain the text material and create liveliness, interest, and accessibility to its development. Special attention should be paid since the reader is fully prepared for easier perception of special clinic-oriented information, particularly, on allergies in the chapter, “Allergic diseases,” which was presented following the principles of evidence-based medicine, modern international and national guidelines, and consensus documents after getting acquainted with the deeply and easily presented material on the structure and function of the immune system.

Undoubtedly, the textbook will be an irreplaceable guide for students and teachers of medical and biological educational institutions, researchers, and doctors of various specialties interested in immunology and allergology.