Open Access Open Access  Restricted Access Access granted  Restricted Access Subscription or Fee Access

Vol 20, No 2 (2023)

Cover Page

Full Issue

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Clinical practice guidelines

Practical issues of using emollients for the prevention of exacerbations of atopic dermatitis during the flowering season: Expert resolution

Fedenko E.S., Zakharova I.N., Zaytseva O.V., Pampura A.N., Tamrazova O.B.


In February 2023, a meeting of the Council of Experts was held, attended by leading specialists in the fields of allergology, pediatrics and dermatology.

The Working Group discussed the problem of sensitization to pollen allergens in patients with atopic dermatitis and exacerbation of the disease during the pollination season of plants, as well as the formation of epicutaneous sensitization through a damaged epidermal barrier. The experts comprehensively considered the criteria that a modern emollient used for the care of atopic dermatitis patients' skin should meet, discussed the role of moisturizers in preventing seasonal exacerbations of atopic dermatitis based on previously conducted research, and developed unified recommendations on the principles of managing this type of patients.

Suggestions were made for further informational and organizational measures aimed at expanding the knowledge of patients and medical specialists about the problem of epicutaneous sensitization to aeroallergens in atopic dermatitis patients, their role in the development of seasonal exacerbations of atopic dermatitis, and the possibility of their prevention using modern emollients.

Russian Journal of Allergy. 2023;20(2):120-129
pages 120-129 views

Leukotriene receptor antagonists in the treatment of bronchial asthma: Consensus agreement “Bronchial Asthma and LEukoTriene receptor antagonists (BALET)”

Avdeev S.N., Geppe N.A., Ilina N.I., Demko I.V., Zhestkov A.V., Zaitseva O.V., Kondyurina E.G., Kukes I.V., Kurbacheva O.M., Malakhov A.B., Mizernitsky Y.L., Nenasheva N.M., Pampura A.N., Revyakina V.A.


Under the auspices of the Russian Association of Allergists and Clinical Immunologists and the Russian Pediatric Respiratory Society, an expert meeting on “Leukotriene receptor antagonists in the treatment of bronchial asthma” was held.

Asthma is a common noncommunicable chronic disorder of the airways, characterized by variable and recurring symptoms, airflow obstruction, bronchial hyper-responsiveness, and underlying inflammation.

The creation and widespread use of inhaled corticosteroids and other innovative classes of drugs for treating bronchial asthma have remarkably affected the ability to achieve control over the course of the disease. Regardless, in most European countries, more than half of patients with bronchial asthma have suboptimal disease control. Recently, a class of leukotriene receptor blockers that contribute to the suppression of chronic allergic inflammation in patients with asthma has been actively studied. The majority of studies confirmed the usefulness of montelukast as monotherapy and as an add-on therapy to inhaled corticosteroids in mild to moderate asthma across all age groups. However, experts noted that in practical medicine, healthcare providers continuously inquire about the effectiveness and safety of this class of medicines in patients with bronchial asthma.

In this consensus document, the experts considered the importance of providing an answer to several topical questions regarding the use of antileukotriene therapy in clinical practice.

Russian Journal of Allergy. 2023;20(2):130-142
pages 130-142 views

Original studies

A bioequivalence study of Allergostin compared to administration of Kestin in healthy volunteers

Vasilyuk V.B., Faraponova M.V., Verveda A.B., Fomichev A.V., Syraeva G.I., Kovalenko A.L.


BACKGROUND: Ebastine is widely used in medical practice for treating urticaria and allergic rhinitis. This compound is an antiallergic drug that belongs to the second generation of H1 histamine receptor blockers. The effectiveness of ebastine can be observed when it is orally administered. As a part of the registration of the trade name Allergostin, a clinical study of its bioequivalence with Kestin was conducted involving 26 healthy volunteers.

AIM: To summarize the results of the clinical study of the comparative pharmacokinetics and bioequivalence, safety, and the tolerability of Allergostin (film-coated tablets, 20 mg; NTFF POLYSAN LLC, Russia) and Kestin (film-coated tablets, 20 mg; Almirall S.A., Spain) among healthy volunteers after a single oral dose on an empty stomach.

MATERIALS AND METHODS: To confirm bioequivalence, we conducted an open, randomized, two-period crossover study of comparative pharmacokinetics and bioequivalence of drugs with a single oral administration on an empty stomach in healthy male and female volunteers aged ≥18. During the study, blood plasma samples were collected from volunteers. Each sample was tested using a validated high-performance liquid chromatography with tandem mass spectrometry method, and the concentrations of ebastine and the active metabolite carabastin were determined. Based on the obtained data, pharmacokinetic and statistical analyses were carried out, and 90% confidence intervals were calculated for the ratio of the geometric mean values of the pharmacokinetic parameters Cmax and AUC0-72 for carabastin.

RESULTS: Based on the results of statistical analysis, the pharmacokinetic parameters of the test (Allergostin) and reference (Kestin) drugs were characterized by high similarity. For the estimated pharmacokinetic parameters of carabastin, the 90% confidence intervals ranged from 80% to 125% for AUC0-t and Cmax.

CONCLUSION: Therefore, in accordance with the applied criteria, the drugs are recognized as bioequivalent.

Russian Journal of Allergy. 2023;20(2):143-151
pages 143-151 views

Clinical, functional and immunological characteristics of severe bronchial asthma

Kraposhina A.Y., Demko I.V., Sobko E.A.


BACKGROUND: Bronchial asthma is one of the most common and socially remarkable diseases in humans. The uncontrolled course of asthma remains a leading problem in the management of patients with this disease. Patients who cannot achieve control include a special group with severe asthma.

AIM: Comprehensive assessment of clinical, functional, and immunological features and the pharmacotherapy of severe bronchial asthma in real clinical practice to optimize basic pathogenetic therapy.

MATERIALS AND METHODS: In all, 83 patients diagnosed with severe asthma were examined. Patients with severe asthma were divided into two groups: patients with and without fixed airway obstruction. Plasma concentrations of interleukin (IL)-4, IL-5, IL-9, IL-13, periostin, cathepsin S, and transforming growth factor (TGF)-β were determined via solid-phase enzyme immunoassay. Immune status was investigated using a NAVIOS flow cytometer.

RESULTS: Both groups of severe bronchial asthma patients showed a decrease in helper T-cell and immunoregulatory index levels with simultaneous increases in cytotoxic T lymphocytes, natural killer T cells, naive T lymphocytes, activated T and B lymphocytes, and phagocytic index compared with the controls. No differences were observed in the immune status between the groups, and the resulting changes were independent of the presence or absence of fixed obstruction. Both study groups exhibited increases in the levels of cathepsin S and TGF-β in the plasma compared with the controls. We identified two remarkable risk factors for forming fixed obstruction: taking SABA more than four inhalations per day (odds ratio (OR)=4.2) and FeNO concentration >20 ppb (OR=6.0). A remarkable improvement was observed in the clinical condition of patients with severe asthma with fixed obstruction while receiving genetically engineered biological therapy for a year.

CONCLUSIONS: To date, no unambiguous explanation is available for the mechanisms of implementation of pathobiochemical reactions in the bronchial wall in severe asthma, leading to the development of fixed airway obstruction. Severe asthma is variable and depends on the correct choice of management tactics.

Russian Journal of Allergy. 2023;20(2):152-163
pages 152-163 views

Preliminary results of a non-interventional single-center study evaluating the efficacy of long-term use of lanadelumab in routine clinical practice in the Russian Federation

Latysheva E.A., Manto I.A., Aleshina L.V., Bobrikova E.N., Viktorova E.A., Gracheva E.M., Demina D.V., Fomina D.S., Shcherbina A.Y., Latysheva T.V.


BACKGROUND: Hereditary angioedema with C1 inhibitor deficiency is a rare disease caused by a deficiency and/or a decrease in the functional activity of the C1 inhibitor. The primary symptom of this condition is recurrent angioedema of various localizations. According to the modern concept of treatment, the therapy aims to stop emerging angioedema and prevent death as well as achieve complete control of the disease and a high quality of life. Lanadelumab is a modern medicine developed and used to prevent attacks in patients with hereditary angioedema aged ≥12 years.

AIM: A retrospective study (IISR-2021-200085) was conducted to evaluate the efficiency and safety of lanadelumab in real-life practice in Russia.

MATERIALS AND METHODS: In all, 16 patients with hereditary angioedema and C1 inhibitor deficiency were enrolled at the initiation of lanadelumab treatment. The patients were predominantly female (81%; 13/16). The average age of patients was 29.9 years; 19% (3/16) of the patients were adolescents. The effectiveness was evaluated by comparing the patient-reported attack rates. The following PROs for the adults only were assessed initially and during the treatment: angioedema activity score, angioedema control test (AECT), angioedema quality of life questionnaire (AE-QoL), and hereditary angioedema activity score. The incidences of adverse events were evaluated.

RESULTS: Before lanadelumab, 69% (11/16) of the patients received alternative long-term prophylaxis, which was canceled after the start of lanadelumab treatment. The average number of attacks per month and treated attacks per month prelanadelumab were 10 and 4.7 per patient, respectively. After 6 months of treatment, these values were 0.26 and 0.09, respectively (10 patients were symptom free at 6 months after the initiation of the treatment). After 3 months of treatment, the mean AECT values improved from 5.6 to 14.2 (p <0.001), and all patients showed adequate disease control. After 6 months of treatment, AE-QoL decreased from 58 to 19 (p <0.001). No serious adverse events related to lanadelumab were observed.

CONCLUSION: Our study demonstrated that the composite effect of lanadelumab minimizes the attack rate and improves the quality of life in patients with hereditary angioedema. A good safety profile of lanadelumab is shown.

Russian Journal of Allergy. 2023;20(2):164-176
pages 164-176 views

Organization of medical care for patients with hereditary angioedema and experience in treating patients with lanadelumab in the Sverdlovsk region

Bykova G.A., Beltyukov E.K., Naumova V.V., Karakina M.L.


BACKGROUND: Hereditary angioedema is a rare autosomal dominant disease that can cause edema of skin and mucous membranes, including life-threatening localization, in pathogenesis of which plasma kallikrein is also important. The main therapy aim is to achieve complete control over symptoms and improve quality of life. In Russia, the first available specialized drug for long-term prophylaxis is lanadelumab blocking plasma kallikrein.

AIM: The aim is to show principles of medical care for patients with hereditary angioedema in Sverdlovsk region and to determine lanadelumab efficacy in patients with hereditary angioedema in real clinical practice.

MATERIALS AND METHODS: We conducted a single-center prospective non-interventional study. There are 22 patients with hereditary angioedema in register of primary immunodeficiencies in Sverdlovsk region. The analysis of patients' therapy was performed. Lanadelumab efficacy was studied in 5 patients received drug for at least 4 months. The validated questionnaires AAS, AECT, AE-QoL were used to assess lanadelumab efficacy.

RESULTS: Educational program for practitioners and implemented diagnostic algorithm led to increase hereditary angioedema detection: the number of hereditary angioedema patients doubled over past 3.5 years (11 patients in 2019, 22 patients in 2023). School for patients’ education was organized. Lanadelumab has been introduced into clinical practice since December 2021. All patients included in lanadelumab efficacy study were female. According to AAS28 scale, patients had high disease activity before and there was an almost 10-fold decrease in disease activity in 4 month of lanadelumab therapy. A positive effect was observed after the first month of treatment with lanadelumab. Hereditary angioedema activity decreased to 0 after 4 months of therapy. The average score on AEST scale was 5.40±2.41, which indicated an uncontrolled course of hereditary angioedema. By the 4th month of therapy, control was achieved ― 13.60±2.61 points on AEST scale. Quality of life on AE-Qol scale improved from 81% to 38% by the 4th month of therapy (p=0.050).

CONCLUSION: Current system of medical care for patients with hereditary angioedema in Sverdlovsk Region makes it possible to improve hereditary angioedema detection and provide patients with special pharmacotherapy betimes. Lanadelumab significantly reduces hereditary angioedema activity, allows achieving controlled course and high quality of life in real clinical practice.

Russian Journal of Allergy. 2023;20(2):177-186
pages 177-186 views


Searching for predictive biomarkers of allergen-specific immunotherapy efficacy based on modern concepts of its mechanisms

Timoshenko D.O., Pavlova K.S., Kurbacheva O.M.


Allergen-specific immunotherapy is the primary pathogenetically substantiated method for treating allergic diseases.

This treatment decreases the severity of clinical symptoms, has disease-modifying effects, and prevents disease progression, asthma development, and the spread of sensitization. A complex interaction between various cells of innate and adaptive immunity mediates immunological tolerance driven by allergen-specific immunotherapy. Although the primary mechanisms of allergen-specific immunotherapy have been described to date, the understanding of these processes becomes more detailed at the cellular, molecular, and epigenetic levels each year. As a result, deep insights into the mechanisms underlying the development and maintenance of tolerance to allergens during allergen-specific immunotherapy can help reveal the predictive biomarkers of efficacy. These biomarkers can streamline the selection of patients via the identification of responders to allergen-specific immunotherapy.

This review presents the current concepts of allergen-specific immunotherapy mechanisms at various stages of the allergic process. Furthermore, the predictive biomarkers of the efficacy are described, with consideration of promising directions of research in this area.

Russian Journal of Allergy. 2023;20(2):187-200
pages 187-200 views

Is Quifenadine an antihistamine of the first generation? Do we know everything…

Sychev D.A., Nenasheva N.M., Sebekina O.V., Peredelskaya M.Y.


Quifenadine was developed in the 1970s in the laboratory of M.D. Mashkovsky and is one of the first examples of the creation of a new class of non-sedative antihistamine with polyfunctional action that combines high selective activity to block histamine receptor type 1 and the ability to block serotonin action and increase tissue histaminase activity.

There is a large experience in the use of quifenadine (based on scientific clinical studies and real clinical practice). The total number of patients involved in the trials reached approximately 2000. The studies evaluated the quifenadipharmacokinetics, pharmacodynamics, clinical efficacy, and safety of the grug. The results of a clinical study of quiphenadine showed high therapeutic efficacy in a variety of allergic diseases (allergic rhinitis, atopy and atom-atopic dermatitis, chronic urticaria).

Quiphenadine meets the current requirements for antihistamines, however, the question remains open, which generation of drugs can be classified as quinuclidine, taking into account all its characteristics and clinical effects.

Russian Journal of Allergy. 2023;20(2):201-209
pages 201-209 views

Case reports

Etiological diagnosis of acute drug contact allergic reaction occurred during ophthalmic surgery

Vorzheva I.I., Barachtenko I.V.


Drug allergy is one of the most common problems in clinical medicine including ophthalmology. The frequency and severity of drug-induced eye lesions continuously increase as the arsenal of active drugs increases.

Among the common causes of eye contact allergy, along with traditionally noted antibiotics and anesthetics, an expanded list of the most remarkable drug allergens, including mydriatics (tropicamide and phenylephrine), beta blockers, dorzolamide, latanoprost, and topical corticosteroids, have been registered recently. In addition to active ingredients, ophthalmic preparations contain various auxiliary substances, such as benzalkonium chloride, chlorhexidine, and thiomersal, which possess sensitizing properties.

This study presents a clinical case of a patient suffering from cataracts who developed an acute local allergic reaction during the introductory period of lens replacement surgery, resulting in the cancelation of surgical intervention. In addition, several drugs are used simultaneously, each of which can cause allergies and excipients in their composition. Approaches to specific diagnostics including the choice of skin tests are described depending on the clinical phenotype of drug allergy. After determining the cause of allergy, recommendations are given to the patient and ophthalmologist for further treatment, enabling the subsequent performance of the operation without complications.

Russian Journal of Allergy. 2023;20(2):210-217
pages 210-217 views

How to fit an antihistamine, taking into account the individual characteristics of the patient: From pharmacokinetics to profiling

Nenasheva N.M., Sebekina O.V., Peredelskaya M.Y., Akmalova K.A.


The authors of the article describe the dependence of the effectiveness of any drug on the "correctness" of its choice for the patient and conclude that patient profiling can serve as an effective clinical method for selecting optimal therapy. When prescribing antihistamines, it is suggested to use the following main patient profiles: children, working adults, elderly patients. Each profile has its own specific purpose.

The article presents own clinical experience of using fexofenadine based on patient profiling. Cases of fexofenadine therapy in patients with allergic rhinitis and chronic urticaria are given as specific examples. Fexofenadine has an optimal safety profile with minimal impact on concentration and cognitive abilities. In this regard, it can be recommended to employees whose activities are associated with the speed of psychomotor reactions, schoolchildren and university students, elderly patients with high drug load and comorbidity.

The article discusses approaches to choosing the optimal second-generation antihistamine in patients of these groups seeking primary medical care when symptoms of urticaria and allergic rhinitis occur.

Russian Journal of Allergy. 2023;20(2):218-228
pages 218-228 views

Myoferline gene mutation сan be associated with recurrent angioedema

Fomina D.S., Serdotetskova S.A., Bobrikova E.N., Alekseeva J.G., Roppelt A.A., Lysenko M.A.


Hereditary angioedema is a rare genetically determined disease characterized by the recurrent angioedema of various localizations with no response to systemic glucocorticosteroids, antihistamines.

In the majority of hereditary angioedema cases C1-inhibitor level or it’s functional activity is decreased due to a mutation in the SERPING1 gene. In recent years, the expansion of genetic diagnostic recourses significantly changed our understanding of the pathogenesis of hereditary angioedema without of C1-inhibitor deficiency with previously unknown mutations. Currently mutations in six different genes have been identified as causing hereditary angioedema: factor XII (F12), plasminogen (PLG), angiopoietin 1 (ANGPT1), Kininogen 1 (KNG1), Myoferlin (MYOF), and heparan sulfate (HS)-glucosamine 3-O-sulfotransferase 6 (HS3ST6). Moreover, the last 3 of them are referred to a separate phenotype ― intrinsic endothelial dysfunction.

In 2020 a series of clinical cases in patients with MYOF gene mutation in an Italian family were published. This type is exceptionally rare ― only 3 female relatives from the same family are described.

This article presents a review of the actual international literature and describes the first clinical case of a male patient with a mutation in the myoferlin gene confirmed by genetic testing.

Russian Journal of Allergy. 2023;20(2):229-237
pages 229-237 views

Janus kinase inhibitors efficacy for the treatment of adult atopic dermatitis in real clinical practice

Shatokhina E.A., Polonskaia A.S., Syryseva A.Y., Michenko A.V., Shatokhin M.N., Kruglova L.S.


Atopic dermatitis is a common chronic dermatosis characterized by a wide variability of endotypes and phenotypes.

Approaches to the treatment of atopic dermatitis are currently undergoing significant changes, especially in patients with moderate and severe forms of atopic dermatitis. JAK inhibitors according to the results of numerous studies have shown their efficacy in the treatment of various immune-mediated dermatological diseases such as atopic dermatitis, vitiligo, focal alopecia and psoriasis, etc.

The article presents the experience of treating adult patients suffering from a severe form of atopic dermatitis with the selective JAK-1 inhibitor upadacitinib. The observations presented are of particular interest due to the fact that the patients were treated with upadacitinib monotherapy. It should be noted that the drug is highly effective against itching. No adverse events (including the development of infectious diseases, hematological disorders) were registered during dynamic observation (according to the results of laboratory studies).

Russian Journal of Allergy. 2023;20(2):238-249
pages 238-249 views

Allergic rhinitis masks: Nasal polyposis in two preschool children

Macharadze D.S., Popadiuk V.I.


Nasal symptoms such as nasal congestion, rhinorrhea, and cough are especially common in children. Despite symptomatic treatment (various nasal sprays, physiotherapy, antibiotics and topical glucocorticosteroids), nasal congestion can persist for a long time. In such cases, several diseases are most likely: adenoids, allergic rhinitis, various anomalies in the structure of intranasal structures and sinuses (for example, curvature of the nasal septum), rhinosinusitis (acute, subacute). If a child has two main symptoms ― congestion and discharge from the nose ― and such additional symptoms as a headache with predominant localization in the paranasal sinuses and a deterioration in smell (possibly also the taste of food) for more than 3 months, it is necessary to exclude the diagnosis of chronic rhinosinusitis, which can be combined with a nasal polyp.

The purpose of this article is to analyze clinical cases of chronic rhinosinusitis with nasal polyp in two preschool children, including one of them with intolerance to non-steroidal anti-inflammatory drugs, and to raise physicians' awareness of this nosology.

In children with symptoms such as prolonged nasal congestion, rhinorrhea, possibly impaired sense of smell, headache, intolerance to non-steroidal anti-inflammatory drugs, in the absence of sensitization and immunodeficiency, a computed tomography scan of the paranasal sinuses is recommended to exclude nasal polyp.

Russian Journal of Allergy. 2023;20(2):250-258
pages 250-258 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies