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Vol 20, No 1 (2023)

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Original studies

Tablet-lyophilizate containing a mixture of house dust mites usage for skin prick testing to confirm house dust mites sensitization

Nazarova E.V., Primak A.S.


BACKGROUND: Since 2021, the production of water-salt allergens for skin allergy tests with household allergens has been suspended, which has led to the lack of an objective opportunity for skin prick tests in medical and preventive institutions in the Russian Federation. Quantitative determination of allergen-specific immunoglobulin class E in the blood serum by the ImmunoCAP method is currently difficult because of the lack of supplies in the laboratory.

AIMS: To assess the possibility of using a drug solution of a lyophilizate mixture of house dust mites (Acarisax®) containing house dust allergens Dermatophagoides pteronyssinus and Dermatophagoides farinae in equal amounts —12 SQ-HDM — for the skin hood tests to confirm the sensitization of patients with mites of home dusts.

MATERIALS AND METHODS: Skin prick tests were conducted with dilutions of one tablet per 2.5 and 5 mL of diluting liquid of the study drug with positive and negative controls. Statistical analysis was conducted using Statistica 13.3 or IBM SPSS 17.0. To analyze efficacy and safety, standard parametric tests were used: Student’s t-test for dependent/independent samples, analysis of variance for repeated measurements, Mann–Whitney U-test, and Shapiro–Wilk test. The analysis of AEs was based on an estimate of the frequency of undesirable phenomena/serious undesirable phenomena.

RESULTS: The correlation was estimated between the total level of specific IgE to tick-borne allergens D. pteronyssinus and D. farinae measured during screening and the papule size 20 min after applying the drug in breeding with one tablet per 2.5 mL and 5 mL of a diluting liquid. The correlation coefficients (R) in both groups (total) were 0.735 (high correlation) and 0.762 (high correlation). The result was statistically significant (p <0.05) in both groups. The clinical test showed that the lyophilizate drug, a mixture of domestic dust mites containing dermal dust allergens D. pteronyssinus and D. farinae in equal quantities — 12 SQ-HDM — is a safe and informative method when used in skin hood tests to confirm the sensitization of patients to domestic dust ticks.

CONCLUSIONS: For skin hood tests, to confirm the sensitization of patients to domestic dust ticks, the studied drug can be used in greater dilution — one tablet per 5 mL of the diluting fluid. The lyophilizate mixture of dust mites containing D. pteronyssinus and D. farinae homemade allergens — 12 SQ-HDM — is safe and well tolerated by patients when used in skin test tests.

Russian Journal of Allergy. 2023;20(1):9-18
pages 9-18 views

Cholinergic urticaria: search for predictors of course severity and response to therapy

Maltseva N.P., Fomina D.S., Serdotetskova S.A., Kovalkova E.V., Lebedkina M.S., Skvortsova A.Y., Chernov A.A., Karaulov A.V., Lysenko M.A.


BACKGROUND: Cholinergic urticaria has affected 0.02–11.2% of the population. Young adults are the most frequently affected age group, and the long-term duration of the disease is typical. Urticarial elements can often be generalized, and systemic reactions are often present in patients with cholinergic urticaria, significantly reducing their quality of life. At present, no clear predictors of anaphylaxis and a severe disease course have been identified.

AIM: To evaluate the clinical, laboratory, and pathogenetic features of patients with cholinergic urticaria and identify correlations between them, disease prognosis/severity, and effectiveness of therapy.

MATERIALS AND METHODS: A retrospective-prospective analysis of data from the Moscow EMIAS electronic medical data system recorded between 2017 and 2021 was performed, of which 613 patients were presumed to have cholinergic urticaria by outpatient specialists. During the interview, 86 people qualified for and accepted the screening. Between January 2022 and December 2022, patients were invited to outpatient appointments/hospitalization and underwent a comprehensive evaluation. In 38 patients with a relevant trigger-associated history, the diagnosis of cholinergic urticaria was verified by provocation testing.

RESULTS: Women predominated in the study (68.4%). The mean patient age was 26.5 years, the age at disease onset was 18 years, and the disease duration was 57.5 months. Allergic diseases were diagnosed in 50% of the patients. Anaphylaxis was recorded in 26% of the cases, and angioedema was significantly more frequently observed in these patients. Patients who tested positive with autologous serum were characterized by older age, longer disease duration, and lower efficacy with standard doses of antihistamines. In an analysis of the Dermatology Life Quality Index validated questionnaire, nearly 80% of the patients reported a moderate, strong, or extremely strong effect on their quality of life.

CONCLUSIONS: The results showed a significant effect of cholinergic urticaria on the quality of life. This analysis reveals important correlations and patterns — an association between early age at disease onset and longer disease duration, presence of angioedema and anaphylaxis, a positive test with autologous serum and duration of urticaria symptoms, and response to antihistamine therapy. Patients with a history of anaphylaxis must be identified as a separate high-risk group to increase the awareness of medical staff and educate such patients on the use of epinephrine.

Russian Journal of Allergy. 2023;20(1):19-28
pages 19-28 views

The results of the evaluation of the international testing “Acute reactions in children” among doctors of various specialties

Pampura A.N., Esakova N.V., Dolotova D.D., Zakharova I.N., Plavunov N.F., Lekmanov A.U., Kadyshev V.A.


BACKGROUND: Anaphylaxis is a situation at risk of death; thus, doctors should identify its symptoms and provide emergency assistance.

AIMS: This study aimed to conduct a comparative analysis of the level of knowledge on anaphylaxis in children among doctors of various specialties.

MATERIALS AND METHODS: The study was conducted anonymously using an online questionnaire (Google Forms) among five groups of doctors: allergologists-immunologists, resuscitators-anesthesiologists, emergency physicians, pediatricians, and students of accredited university graduates. The questionnaire included six tasks on anaphylaxis in children and four tasks on other diseases similar to anaphylaxis, and each had two questions (diagnosis and treatment) with three answer options; if one was correct, 1 point was given.

RESULTS: A total of 1871 respondents from nine countries filled out the questionnaire correctly. The average score of the allergists on anaphylaxis tasks was the highest (9 of 12 points) in comparison with other groups (p <0.001). The average score on non-anaphylaxis tasks was high in all groups (7 of 8 points). The level of knowledge of respondents did not correlate with age and work experience. In anaphylaxis tasks, allergists made the appropriate diagnosis in 83.7% of cases; resuscitators, pediatricians, and students in 2/3; and emergency physicians in 50%. For the treatment of anaphylaxis, allergists prescribed epinephrine in 66.7% of cases, and other groups in ≤50%. The percentage of correct answers in the tasks of food anaphylaxis (diagnosis) was the highest among allergists (80–96%), compared with other groups (36–82%) (p <0.001). In the treatment of food anaphylaxis, allergists prescribed epinephrine more often (up to 85%) than other groups (up to 77%). The percentage of correct responses of drug anaphylaxis among all groups was high; however, resuscitators responded better (diagnosis, 94%; treatment, 64%). All groups had the lowest level of knowledge on idiopathic anaphylaxis.

CONCLUSIONS: Anaphylaxis can be underdiagnosed in 50% of pediatric cases; however, even with correct diagnosis, epinephrine is not prescribed in half of the cases. Thus, increasing and maintaining the level of knowledge on anaphylaxis among doctors of various specialties, regardless of their length of service, are necessary.

Russian Journal of Allergy. 2023;20(1):29-40
pages 29-40 views

The role of modern emollients in prophylaxis of atopic dermatitis exacerbation during pollination season

Litovkina A.O., Smolnikov E.V., Elisyutina O.G., Fedenko E.S.


BACKGROUND: Skin epidermal barrier impairment in patients with atopic dermatitis facilitates percutaneous penetration of allergens and leads to persistent skin inflammation in sensitized patients and even primary sensitization to the allergens. We hypothesized that the use of skincare products that restore the structure of the skin barrier may positively affect the disease course in patients with atopic dermatitis and pollen sensitization during the pollen season.

AIMS: This study aimed to investigate the clinical efficacy and safety of La Roche Posay formulas, i.e., Lipikar Syndet and Lipikar Baume AP+M, in the prevention of atopic dermatitis exacerbations in children and adults sensitized to different pollen allergens during the pollination season.

MATERIALS AND METHODS: Sixty patients aged 5–60 years with a clinical history of mild-to-moderate atopic dermatitis sensitized to different pollen allergens were enrolled in a single-center, simple, open, prospective comparative study, and they were divided into two groups. The main group used Lipikar Syndet and Baume AP+M daily together with standard atopic dermatitis treatment for 28 days during the pollen season of their clinically significant allergens. The control group received only standard therapy without any use of moisturizers. The study required three visits. At each visit, the severity of atopic dermatitis (SCORing atopic dermatitis [SCORAD] index), quality of life (Dermatology Life Quality Index/and Children’s Dermatology Life Quality Index), pruritus intensity (numerical rating scale), and corneometry were assessed. SCORAD changes were considered the primary endpoint of the study.

RESULTS: A significant decrease in SCORAD in the main group was registered by day 14 of the study (p <0.0001), whereas no significant changes in the SCORAD index were noted in the control group even by day 28. The SCORAD index in the main group was significantly lower than that in the control group (p=0.005) by day 28. For the secondary endpoints, the quality of life significantly improved by day 28 (p=0.0005), the intensity of pruritus significantly decreased (p <0.0001), and the level of skin hydration increased (p <0.0001) by day 14 in the main group compared with those in the control group. No adverse events were reported during the study.

CONCLUSIONS: Daily use of Lipikar Syndet and Lipikar Baume AP+M by patients with atopic dermatitis and pollen allergy during the pollen season significantly improved the atopic dermatitis course, reducing skin itching and improving skin hydration and patients’ quality of life. The use of these skincare products together with atopic dermatitis therapy helped reduce atopic dermatitis severity associated with direct skin contact with pollen allergens. This indicates a protective effect of Lipikar skincare products on the epidermal barrier function.

Russian Journal of Allergy. 2023;20(1):41-51
pages 41-51 views

Systematic reviews

Tropomyosins of the helminthes: Sensitization and association with allergic diseases

Rovitskaya V.A., Fedorova O.S., Kamaltynova E.M.


The increase in the prevalence of allergic diseases has been a driver of the development of new technologies. Over the past two decades, significant progress in biochemistry and molecular allergology has contributed to the study of the structure of allergens and development of component-resolved diagnostics. Specifically, clinically significant families of allergens have been identified, including tropomyosin, which can cause various cross-IgE-mediated reactions. One of the risk factors for sensitization development is helminthiasis, which is common in different regions and population of endemic areas. The global prevalence of helminthiasis remains high. Approximately 1.5 billion people worldwide have chronic infections with at least one helminth.

This review aimed to analyze current studies determining the relationship between helminth infections and the development of sensitization to helminth tropomyosin and clinical course of allergic diseases.

The analysis of scientific publications described the relationship between helminth tropomyosin and the development of allergic diseases and sensitization in patients with parasitic infection. The PubMed database was used for the review. The review included original articles published between January 1, 2000, and December 31, 2021.

Russian Journal of Allergy. 2023;20(1):52-62
pages 52-62 views


Skin microbiome and modern treatment options for complicated forms of atopic dermatitis

Chernushevich D.D., Elisyutina O.G., Fedenko E.S.


Currently, atopic dermatitis is considered a systemic multifactorial disease, and its development involves various factors, mainly genetic disorders, epidermal barrier impairment, microbiome changes, allergen sensitization, and nonspecific environmental factors.

The microbial skin barrier in patients with atopic dermatitis has its characteristics due to changes in the species composition of the microflora toward contamination by conditionally pathogenic microorganisms, which have a significant effect on the disease course, leading to secondary skin infection and exacerbations. Microbes and allergens percutaneously penetrate the disrupted epidermal barrier, leading to sensitization to various proteins, including bacterial and fungal proteins, characterizing the t2 immune response.

The treatment of atopic dermatitis aims at achieving long-term control over the disease through an integrated approach, including external and systemic therapy.

Russian Journal of Allergy. 2023;20(1):63-73
pages 63-73 views

Chronic-induced urticaria; classification, actual aspects of diagnosis and therapy

Serdotetskova S.A., Danilychevа I.V., Fomina D.S., Maltseva N.P., Kovalkova E.V., Lebedkina M.S., Karaulov A.V., Namazova-Baranova L.S., Vishneva E.A., Levina J.G., Kalugina V.G.


Chronic-induced urticaria is a group of diseases characterized by the occurrence of itchy wheals and/or angioedema in response to specific triggers, such as mechanical irritation, exposure to high and low temperatures, vibration, and ultraviolet radiation of various spectra, appearing for ≥6 weeks. This group of diseases is characterized by a long duration, a significant effect on the patient’s quality of life, and the risk of severe life-threatening reactions.

The diagnosis of induced urticaria and patient-safe reproduction of symptoms by exposure to a trigger (temperature, mechanical, etc.). Currently, no medical devices have been registered in the Russian Federation for the threshold diagnosis of most physical forms of urticaria. Consequently, diagnosing and dynamic monitoring the state of these patients and their response to treatment are challenging. The question of therapy for chronic-induced urticaria also remains open due to the insufficient effectiveness of the recommended and available treatment methods. This article provides a review of current literature data.

This article provides a review of current literature data.

Russian Journal of Allergy. 2023;20(1):74-96
pages 74-96 views

Case reports

Eosinophilic esophagitis in children: Experience in diagnosis, clinical observation in a multidisciplinary hospital

Khakimova R.F., Kamalova A.A., Polyakov N.S., Khomyakov A.E., Nizamova R.A., Zaynetdinova M.S., Cheminava L.D.


This study presented the characteristics of seven patients with eosinophilic esophagitis from age 1 year and 2 months to age 17 years and 4 months. The follow-up duration ranged from 1 to 7.5 years.

Disease onset was observed at different ages: aged >2 years (n=6) and 2 months (n=1). The period between the occurrences of the first symptom to diagnosis ranged from 3 months to 9 years. In one patient, the symptoms were associated with cow’s milk allergy, whereas the cause was not identified in other cases. Allergic diseases (i.e., atopic dermatitis, allergic rhinitis, and asthma) were observed in six patients.

Treatment was provided according to the clinical guidelines. Six patients were prescribed topical steroids (budesonide) and an empirical elimination diet. One patient was prescribed only with an empirical elimination diet due to the steroid phobia of the parents. However, the ineffectiveness of the diet was the basis for topical steroid prescription. During the follow-up, a relapse was observed in two patients who required repeated treatments.

A clinical case of eosinophilic esophagitis in a 6-year-old child, with 7.5 years of follow-up, was described. According to the anamnesis, the patient visited a gastroenterologist 4 years after the onset of dysphagia symptoms. Endoscopy revealed cicatricial stenosis of the upper third of the esophagus (grades 2–3). A morphological study of the esophageal mucosa, which was performed after repeated endoscopic bougienage and a 5-month course of antisecretory therapy was deemed ineffective, revealed massive eosinophilic infiltration. Eosinophilic esophagitis was confirmed based on the anamnesis, clinical symptoms, and endoscopic and morphological data. An elimination diet and topical corticosteroids (budesonide) were prescribed. Following the treatment, the patient showed significant improvements. Subsequently, during the follow-up, a relapse of eosinophilic esophagitis was diagnosed twice (with an interval of 2.3 and 2.5 years), which required topical steroids (case 1) and proton pump inhibitors (case 2).

This paper highlights the importance of a multidisciplinary approach, involving an allergist-immunologist, pediatrician, gastroenterologist, endoscopist, and pathologist, in the management of eosinophilic esophagitis in children.

Russian Journal of Allergy. 2023;20(1):97-103
pages 97-103 views

Familial case of hereditary angioneurotic angioedema, caused by deficiency in the C1 inhibitor complement system

Kovzel E.F., Nurpeisov T.T., Gani B., Volodchenko S.A., Zhamanbaeva Z.Z., Syzdykova A.B., Batyrbaeva A.Z.


This study revealed primary immunodeficiency developing as a result of a genetically mediated quantitative deficiency or a decrease in the activity of the C1 component complement inhibitor in a family clinical case of patients with genetically confirmed hereditary angioedema, who were living in Taldykorgan, Almaty, Republic of Kazakhstan.

Anamnesis data and clinical and laboratory-instrumental indicators were evaluated. In addition to assessing the objective status and general clinical laboratory studies, all patients underwent studies to determine the quantitative content of C4 and C1 inhibitor of the complement component and the presence of a mutation in the SERPING1 gene.

The polymorphism of clinical and anamnestic data did not allow timely identification of specific syndromes and determination of a clinical diagnosis. As a result, specific basic treatment, preventive measures, and preventive intervention associated with traumatic life and medical situations were given late, leading to life-threatening conditions.

The main clinical manifestations of hereditary angioedema are recurrent dense edema, lasting 2–5 days. The skin, upper respiratory tract, and gastrointestinal tract are the organs most involved. Clinical manifestations in patients vary dramatically, from the absence of characteristic symptoms to life-threatening edema, leading to death.

Russian Journal of Allergy. 2023;20(1):104-111
pages 104-111 views

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