Vol 20, No 1 (2023)

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.

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.

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.

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.

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.