Vol 19, No 3 (2022)

The prevalence and severity of allergic diseases are dramatically increasing worldwide. In Russia, similar alarming trends are exacerbated by several problems in organizing the work of the allergic care service. For example, the number of patients with various allergopathologies still has no accurate data; in vitro diagnostics have serious difficulties; the issues of medical and instrumental support remain critical, including the habitual defect of some medicines; the percentage of prescribing allergen-specific immunotherapy remains low due to the inaccessibility and high cost of treatment; pollen and environmental monitoring is not conducted in all regions of Russia. These key issues are in constant focus of attention of the Russian Association of Allergologists and Clinical Immunologists (RAAKI), which is the leading scientific and professional organization in the field of allergology and clinical immunology in Russia.

The RAAKI is consistently implementing steps that enable knowledge accumulation and dissemination about allergology and immunology in the medical community, thereby harmonizing the interaction between fundamental science and clinical practice and optimizing patient treatment, including medical specialist training in regular schools on drug allergies, allergen-specific immunotherapy, hereditary angioedema, and other topics; developing clinical guidelines for major allergic diseases and related standards of care; regularly publishing guidelines and recommendations on various aspects of allergopathology for both doctors and patients, as well as the Russian Allergological Journal; holding the largest events in this area, including the Annual International Congress on Allergology and Clinical Immunology and the Andrey Dmitrievich Ado Prize of the Russian Allergological Journal; constantly working on the contact with the Ministry of Health, Rospotrebnadzor, the Ministry of Industry and Trade of Russia.

The allergy epidemic in Russia can only become predictable and manageable under the condition of a comprehensive progressive solution to the above problems by all participants in this area.

BACKGROUND: Omalizumab, by binding immunoglobulin (Ig) E in patients with atopic asthma, can improve clinical and functional parameters and patients’ quality of life.

AIM: To evaluate the efficacy of anti-IgE therapy in patients with allergic rhinitis treated with omalizumab for concomitant severe atopic asthma in real clinical practice

MATERIALS AND METHODS: This open, non-interventional, prospective, and non-randomized study in real clinical practice was conducted in the Sverdlovsk region in October 2021 based on a regional registry of adult patients with severe asthma with chronic nasal inflammatory diseases and receiving targeted therapy. Dynamics of nasal symptoms were assessed using the Sino-nasal-outcome test 22 (SNOT-22) questionnaire and visual analog scale (VAS) initially and after 4 and 12 months of omalizumab therapy. Peripheral blood eosinophil level was assessed before and after 4 months of omalizumab therapy.

RESULTS: The study included 26 patients. Assessment of nasal symptoms dynamics using the SNOT-22 questionnaire at baseline and after 4 months of omalizumab therapy revealed a decreased severity of symptoms (p <0.001) of 46.85±22.04 points at baseline (95% confidence interval [CI]: 37.94–55.75) and 30.65±14.81 points after 4 months (95% CI: 24.67–36.64). Additionally, improvement in SNOT-22 questionnaire score was revealed in 18 patients treated with omalizumab during 12 months, with 47.5 points before therapy (Q₁–Q₃: 35.7–59.3), 30.4 points after 4 months (Q₁–Q₃: 22.1–38.1), and 24.9 points after 12 months (Q₁–Q₃: 16.9–32.9) (p=0.001). Improvement in rhinitis symptoms control was observed according to the VAS scale, with 8.0 points before therapy (Q₁–Q₃: 6.2–9.0), 5.0 points after 4 months (Q₁–Q₃: 3.2–5.8), and 5.0 points after 12 months of treatment (Q₁–Q₃: 4.0–6.8). The eosinophil levels (n=16) decreased from 510.9±317.9 cells/µl (95% CI: 341.5–680.3) to 327.4±217.7 cells/µl (95% CI: 211.4–443.5) after 4 months of anti-IgE therapy (p <0.041).

CONCLUSIONS: Omalizumab in real clinical practice has demonstrated improvement of rhinitis symptoms and quality of life in patients with allergic rhinitis with concomitant severe atopic asthma. Additionally, a statistically significant decrease in peripheral blood eosinophils level was observed, which largely determines airway inflammation severity and clinical manifestations of allergic rhinitis and bronchial asthma.

BACKGROUND: Chronic inducible urticaria is a group of diseases that is characterized by the development of wheals, angioedema, or both in response to specific triggers for ≥6 weeks. According to global scientific international literature, the occurrence of chronic inducible urticaria is 0.5% in the general population and approximately 20%−30% in all chronic urticarias. The prevalence of chronic inducible urticaria has no statistical data in the Russian Federation.

AIM: This study aimed to evaluate the region-specific epidemiology of different forms of chronic inducible urticaria.

MATERIALS AND METHODS: The analysis is based on the number of unique cases extracted from the medical care records in the adults’ segment of the digital platform United medical information and analytical system (UMIAS) (outpatient forms) in Moscow from 2017 to 2021, including keyword search.

RESULTS: This study indicated that the prevalence of chronic inducible urticaria in Moscow is correlated with published global epidemiological data. Among patients with chronic inducible urticarial, females predominate (74.2%), and the median age was 43.8 years (37 years in males and 46.4 in females). The most common form in all verified cases of chronic inducible urticaria is symptomatic dermographism (11.12%), followed by contact urticaria (5.36%), cholinergic urticaria (2.28%), cold urticaria (1.92%), delayed pressure urticaria (0.36%), vibratory urticaria (0.11%), aquagenic urticaria (0.1%), and heat urticaria (0.08%). Chronic inducible urticaria rates in Moscow are high, which increase as in global practice. This research has limitations, including the lack of ubiquitous implementation of standard protocols of provocation testing in outpatient units and the low percentage of using validated questionnaires in the routine management of patients with chronic inducible urticaria.

CONCLUSIONS: Further studies dedicated to this topic are greatly necessary to answer a wide spectrum of questions, including the diagnosis process and evaluation of the severity of chronic inducible urticaria, comorbid conditions, and optimization of the treatment protocols adapted for the particular phenotype.

Laboratory methods of allergy diagnosis are an essential tool in the allergist’s daily practice. Molecular allergodiagnostics is an advanced examination method that detects individual allergocomponent sensitization. The risk prediction of severe allergic reactions is the main area of its application, as well as the creation of personalized dietary recommendations for patients with food allergies. Clinical and anamnesis data are fundamental, supplemented by the results of traditional methods of allergy examination (skin prick tests or the specific immunoglobulin E level to whole allergens), in determining the appointment of allergen immunotherapy indications. The widespread use of such resource-intensive examination as molecular allergodiagnostics for all patients is unjustified before prescribing allergen immunotherapy. Additionally, decisions on the allergen immunotherapy continue or the termination cannot be made based on the change data in the level of clinically relevant specific IgE. Concurrently, its use as a third-line diagnostic method can help in solving difficult clinical tasks related to the identification of a causally significant allergen in patients with respiratory allergy symptoms during the seasons of the simultaneous dusting of several plants, as well as differentiate the true from the cross-sensitization in polysensitized patients. The use of molecular allergodiagnostics will be mandatory in prescribing recombinant therapeutic allergens, due to the need for a personalized choice of the drug.

Since the last century, European countries began to actively use soybean seeds as food additives or for food production with 100% milk and animal proteins replaced with soy.

In Russia, soy is a relatively new agricultural crop, which recently began to be used in food production. Meanwhile, some proteins of soybeans have pronounced allergenic properties. The World Health Organization classified eight soy proteins (Gly m 1–Gly m 8) as allergens capable of causing clinically significant immunoglobulin (Ig)E-mediated sensitization in patients with allergic diseases. Moreover, most of these allergens were included in the World Health Organization nomenclature over the past 15 years. Additionally, the presence of other soybean allergens that can bind to sIgE has scientific evidence. Moreover, some soy allergens have homology in amino acid sequence and three-dimensional similarity to proteins of other plants and animals. Therefore, questions of IgE-cross-reactivity are becoming relevant.

Thus, this review aimed to analyze and summarize scientific data on the chemical structure, properties, and allergenic activity of soy and soybean proteins (soybean seeds) and their cross-reactions with proteins of animal and plant origin.

This article reflects the main issues discussed at the Advisory Board with the participation of leading dermatovenereologists, allergists, and immunologists. The Advisory Board has become a platform for discussing the accumulated clinical and organizational problems in the field of managing patients with chronic urticaria and other allergic dermatoses. The Advisory Board also discussed the possibility of long-term use of cetirizine and levocetirizine and the use of their high doses in clinical practice. The subject of discussion was the question of the algorithm for escalation and subsequent de-escalation of the dose of non-sedating H₁ antihistamines. An algorithm for escalation and de-escalation of doses of antihistamines was created based on the discussion, which can be recommended for use in clinical practice.

This article was simultaneously published in several journals with permission from authors and publishers. The parallel publication is available here: The use of cetirizine and levocetirizine in patients with chronic urticaria and other allergic dermatoses: Issues of dosage increasing and long-term use from the resolution of the Advisory Board. Effective Pharmacotherapy. 2022;18(25):6–14. DOI: https://doi.org/10.33978/2307-3586-2022-18-25-6-14. This article published with permission from authors and copyright holder.

Currently, titanium is widely used in implants, particularly in cardioresynchronizing devices, such as pacemakers, because it is well tolerated by patients and rarely causes allergic reactions. The low informative value of the allergy testing for titanium makes its allergy diagnosis difficult. Experts reported that false negative results of skin application tests with titanium may be associated with the use of titanium tetrachloride in allergy testing, which is not pure metal. The use of glucocorticoids in treating pacemaker component-related allergy is temporary and does not exclude recurrence of inflammation. The main treatment for patients is the replacement of the implantable system with a device made of the most hypoallergenic materials.

The present paper describes a case of a 14-year-old patient with an allergy to a titanium-coated pacemaker. This is the first time eosinophil cationic protein and tryptase are detected at the inflammation site while diagnosing allergy to a titanium-coated pacemaker. This study concludes that the level of eosinophilic cationic protein and tryptase in the inflammation site is a promising marker in metal allergy diagnosis and requires further research.

Timely diagnosis of titanium allergy and the reimplantation of a gold-coated pacemaker prevent the recurrence of inflammatory changes in the area of pacemaker insertion and infectious complications, thereby significantly improving patient prognosis.