Vol 19, No 2 (2022)

BACKGROUND: According to the Federal Clinical Guidelines, patients with severe persistent allergic rhinitis and/or severe exacerbation who failed to respond to third-line pharmacotherapy (antihistamines, leukotriene receptor antagonists, nasal corticosteroids) are advised to consider the administration of omalizumab. However, there is a lack of practical recommendations guiding the regimens and duration of the omalizumab therapy in the severe exacerbation of seasonal allergic rhinitis.

AIMS: To assess the efficacy of omalizumab additional therapy in patients with severe exacerbation of allergic rhinitis during the pollen season, and to determine the optimal regimen and duration of treatment.

MATERIALS AND METHODS: This is an open observational uncontrolled prospective single-center study. 10 adult patients with severe exacerbation of seasonal allergic rhinitis due to birch pollen were selected for the study. All of them received the third-line of therapy according to Federal Clinical Guidelines and had absence or incomplete control: Total nasal symptom score ≥2. All of them were treated with omalizumab. The dose and regime were prescribed according to instructions that took into account the overall IgE level, as well as the patient’s weight. Daily symptom diaries and the need for rescue medication levels were evaluated. The primary endpoint had a decrease in the Combined Medical and Symptom Score mean.

RESULTS: The additional omalizumab treatment improved allergic rhinitis control for all patients and also reduced the rescue medication (ΔTNSS 1.8 [95% CI 1.56–2.04]; р <0.001, and ΔCMSS 2.12 [95% CI 1.74–2.5]; р <0.001, by the end of 1 week after the first omalizumab injection; ΔTNSS 2.53 [95% CI 2.05–3.01]; р <0.0001, and ΔCMSS 5.22 [95% CI 4.74–5.7]; р <0.001, by the end of four weeks, respectively). It was noted that the omalizumab effect realization occurs for some time (3–7 days). Due to short-season pollen for birch (1–2 months), the duration of treatment in our study did not exceed one month, so we managed to achieve complete control over the symptoms in all patients by the omalizumab with a small multiplicity of injections (1–2 injections). No adverse events were registered during the study.

CONCLUSION: Omalizumab additional therapy in patients with severe exacerbation of allergic rhinitis allows control of all symptoms. Taking into account the mechanism of its action, omalizumab should be administered at least a week before the expected pollen season in patients with severe exacerbation (according to the previous seasons) who did not complete their allergen-specific immunotherapy on time, and continue therapy till the end of the pollen season.

BACKGROUND: Food allergy is an actual problem in pediatric practice. In recent decades, there has been an increase in the prevalence of food allergies, as well as an increase in the number of severe cases.

AIM: To assess the prevalence of food allergy and the role of hereditary and environmental factors in food allergy development in children according to epidemiological cohorts and cross-sectional studies.

MATERIALS AND METHODS: A systematic review of epidemiological cohorts and cross-sectional studies published between January 1, 2000 and December 31, 2021, was conducted This review investigated the developmental factors and prevalence of food allergy.

RESULTS: This review made it possible to generalize and systematize the accumulated worldwide scientific data on food allergy. An analysis of epidemiological studies revealed a significant prevalence of food allergy, which reflected the natural course of the disease; the highest rates were found among young children, and by school age, the prevalence of symptoms and confirmed food allergy is gradually decreasing. Based on epidemiological data, the main risk factors for food allergy are hereditary predisposition and environmental factors that modify the microbial environment.

CONCLUSION: It is necessary to further study the genetic markers of food allergy, as well as the role of microbiotic factors in the implementation of hereditary predisposition to allergic diseases.

Allergen immunotherapy is the most common method of treating IgE-dependent allergic disorders in clinical practice. Despite the enormous amount of data from randomized placebo-controlled trials on allergen immunotherapy efficacy, a lot of questions regarding the efficacy of allergen immunotherapy in practice remain unanswered. These questions can be answered using real-world evidence.

In conducting real-world evidence investigations of allergen immunotherapy, it is necessary to follow a strict methodology and perform a multivariate analysis of the available data. The use of statistical methods reduces the risk of bias. The REACT study, which included more than 90,000 patients with allergic rhinitis from Germany, is currently the largest and the most comprehensive real-world evidence study of allergen immunotherapy. To ensure comparable groups and representative data, a propensity score match statistical adjustment procedure was applied. The REACT study provided results of fundamental clinical and public health significance: the allergen immunotherapy leads to a sustained and long-term reduction in drug prescription in patients with allergic rhinitis and asthma, improved control of asthma, and also prevents the development of exacerbations and respiratory infections in asthma patients.

The REACT study is a good quality real-world evidence study with strict methodology and representative results.

Further high-quality standard studies of real-world data may not only confirm the randomized trial evidence but also may become a source of new evidence of the efficacy and safety of allergen immunotherapy in clinical practice.

Currently, allergic rhinitis is one of the most common allergic diseases, and its significance is often underestimated by both doctors and patients, resulting in increased severity, decreased physical, professional, and social activity, sleep disturbance, and the impairment of the quality of life.

Despite modern drug availability, the control level over allergic rhinitis symptoms in routine clinical practice remains low. Patients who do not receive a quick result from using intranasal glucocorticosteroids, which have anti-inflammatory and pathogenetic properties, prefer fast-acting decongestants instead, which can lead to chronization and adverse events. The use of intranasal glucocorticosteroids and antihistamines combination, which have additive effects on the key pathogenesis stages of allergic inflammation, allows for rapid treatment of the most severe rhinitis symptoms and can improve adherence to therapy.

This review presents the results of clinical studies and key characteristics of the new nasal spray of the olopatadine and mometasone fixed combination, confirming the high efficacy and good safety profile of olopatadine + mometasone. The administration of olopatadine and mometasone fixed combination provides rapid relief from nasal and ocular symptoms in patients with allergic rhinitis, ultimately leading to an improvement in the quality of life.

Atopic dermatitis is a heterogeneous inflammatory skin disease, which is affected by many internal (genetic) and external factors. The interaction between genetic and environmental factors is a complex dynamic process. These factors affect each other and can be interrelated.

This article discusses data on filaggrin and some exposome factors affecting it.

The term “exposome” refers to the impact of external factors on the biological environment of the body. The impact range is varied and includes chemicals, psychosocial and physical factors, as well as associated biological reactions that occur throughout human life.

The article examines the link between filaggrin mutations and genetic predisposition, as well as how the defects of the skin barrier, immunological imbalance, and a variety of stimuli have a potential impact. The mechanisms of action of various factors on filaggrin in atopic dermatitis are also considered. Furthermore, environmental factors can influence the expression of various genes and, as a result, create epigenetic changes in patients with atopic dermatitis.

The study of epigenetic changes is critical for understanding the molecular bases of this skin disease and optimizing treatment strategies.

Leading experts in the field of dermatovenereology, cosmetology, and allergology took part in the meeting of the expert board. Following the discussion, the working groups of the Expert board assessed the role of filaggrin deficiency in the pathogenesis of atopic dermatitis and other diseases/conditions accompanied by xerosis. In addition, they formed recommendations for the use of emollient Admera, taking into account the role of filaggrin in the development of atopic dermatitis and xerosis. The experts comprehensively analyzed the best basic therapy for atopic dermatitis, xerosis of diverse etiologies secondary preventive options for atopic dermatitis and developed unified recommendations on the principles of managing such patients. In addition, they also established the place of emollients in clinical practice. Additional educational, informational, and organizational
activities were proposed to help patients and doctors understand the problem of using emollients in atopic dermatitis and xerosis of diverse etiologies.

This article was first published in the Kremlin Medicine Journal (Kruglova LS, Lvov AN, Araviyskaya ER, et al. Practical issues on the application of emollients containing filaggrin modulators in the management of patients with atopic dermatitis and xerosis. Resolution of the Council of experts. Kremlin Medicine Journal. 2022;1:87–94. doi: 10.26269/m4bj-f167). This article published with permission from authors and copyright holder.

Lemon allergy can be caused by both IgE-mediated and IgG-dependent mechanisms, or by a combination of the two. Allergic reactions to lemon are clinically evidenced by a variety of symptoms, including digestive system disorders (cheilitis, eosinophilic esophagitis, gastroenteritis, colitis, and irritable bowel syndrome). Contact dermatitis is the only condition included among delayed allergic reactions to components of the fruit or lemon essential oils. Data on reactions to lemon and its components from the gastrointestinal tract are scarce in modern publications, and most of what is available are either a description of a single case or an analysis of the frequency of sensitization to lemon among groups of patients with allergic pathology of the digestive system.

For the first time, a clinical instance of a simultaneous acute and delayed allergic reaction to eating a lemon, manifesting as an oral allergy condition and gastrointestinal symptoms, in a 31-year-old woman, was described. The patient was diagnosed with polysensitization to various food, household, and pollen antigens, and cross-allergy to fruits of the Rutaceae family (orange, tangerine, and grapefruit). She was diagnosed with allergy and sensitivity to the allergens in the lemon pulp after undergoing a prick + prick test and an enzyme-linked immunosorbent assay. It has been found that lemon pulp contains one or more thermolabile antigens that cause both acute and delayed allergic symptoms. It has also been demonstrated that thermolabile allergens and/or particular antigenic determinants can cause delayed allergy reactions, despite the action of proteolytic enzymes of the gastrointestinal tract and hydrochloric acid. To confirm these properties of allergenic epitopes, additional research, not limited to research on thermal effects alone, but also treatment with hydrochloric acid and enzymes, is highly recommended.

Thus, for the first time, we have demonstrated that allergic reactions to lemon, with the accompanying gastrointestinal manifestations, are not limited to IgE-dependent or cell-mediated types of hypersensitivity. Clarification of specific mechanisms of allergy development and characteristics of epitopes of molecules that cause allergic reactions necessitates comprehensive diagnostics research that includes both laboratory methods (including molecular-based methods) and conducting provocative tests.

Additional studies are required to determine the sensitivity of protein molecules of allergens to the effects of various factors in the gastrointestinal tract. This will enable us to further determine the resistance of individual antigenic epitopes of lemon allergens to these factors.