Vol 20, No 3 (2023)

BACKGROUND: Epidemiological studies have showed that severe asthma is observed in 5–10% of patients. It is considered as a major social and economic burden for the healthcare system.

AIM: to perform a comparative analysis of clinical features of allergic and non-allergic phenotypes of T2 asthma and determine the most important predictors of severity.

MATERIALS AND METHODS: We studied 150 patients with asthma (ages 18–65). Of these, 61 were diagnosed with T2 endotype of asthma. Clinical examination and allergy testing were performed. The potential predictors of severe asthma included: asthma phenotype, gender, age (including elderly age), daytime/nocturnal symptoms per week, asthma exacerbations that required systemic corticosteroid therapy and hospitalisations, the volume of forced exhalation in the first second (FEV₁; % of predicted value), body mass index (kg/m²), concomitant diseases, smoking status, sensitization to non-infectious allergens and blood eosinophil count.

RESULTS: Group 1 included 34 patients with allergic phenotype of asthma, group 2 ― 27 patients with non-allergic phenotype of T2 endotype of asthma. Univariate analyses revealed that subjects with non-allergic asthma were likely to have severe asthma (OR=3.14 [95% CI: 1.09–9.58]. Increased daytime symptoms per week, nocturnal symptoms per week, exacerbations that require systemic corticosteroids and hospitalisation were associated with asthma severity (OR=1.05 [95% CI: 1.01–1.11], 1.21 [95% CI: 1.05–1.45], 3.46 [95% CI: 1.68–10.19], 4 [95% CI: 1.75–12.32] and 4 [95% CI: 1.75–12.32], respectively), regardless of the disease phenotype. Lower FEV₁ was associated with severe asthma (OR=0.96 [95% CI: 0.93–0.99]. Multivariate analysis showed that age, increased frequency of nocturnal symptoms, and lower FEV₁ were associated with severe asthma.

CONCLUSION: The certain clinical differences of allergic and non-allergic asthma could be revealed when analyzing anamnestic data and clinical findings. Increased frequency of nocturnal symptoms, decreased FEV₁ and age are the most significant predictors of severe T2 endotype of asthma.

BACKGROUND: The problem of food allergy remains actual in pediatric practice.

AIM: to establish the prevalence, clinical features and risk factors of food allergy in infants predisposed to allergy diseases in a cohort prospective study with a follow-up period of 12 months.

MATERIALS AND METHODS: A prospective cohort study in children whose parents suffer from allergic diseases (n=151) was initiated. Prospective observation included: clinical examination at birth and at the age of 3, 9, 12 months, interviewing parents, assessment of allergen-specific IgE to food allergens in blood serum at the age of 12 months. Statistical analysis was performed using STATISTICA 13.3.

RESULTS: 141 children completed the prospective follow-up. Suspected food allergy (reactions associated with the use of food products) was registered in 48.9% of predisposed children. The symptoms of food allergy include skin lesions and gastrointestinal symptoms. Oral allergic syndrome and respiratory symptoms were recorded only in some cases. Prevalence of suspected food allergy progressively increase by 12 months, mainly due to skin symptoms, while the prevalence of gastrointestinal symptoms, on the contrary, decreased by this age. Mixed feeding was recognized as a risk factor for suspected food allergy in predisposed children. The prevalence of IgE ― mediated food allergy, was 13.9%. The use of antibiotics in the first year of life was shown as risk factor for IgE-mediated food allergy in predisposed children. Multivariate logistic regression showed that pets (cats) owners had lower risk of food allergy.

CONCLUSION: Primary allergy prevention and adherence to the principles of rational antibiotic therapy is necessary in children predisposed to allergic diseases.

BACKGROUND: Importance of optimizing strategy for treatment of chronic spontaneous urticaria is highly becoming relevance for the clinicians. Nowadays monoclonal antibodies are preferred option of treatment the refractory chronic spontaneous urticaria, main of that is omalizumab.

AIM: to establish comparative analysis of the efficacy and safety of Genolair (JSC Generium, Russia) and Xolair (Novartis Pharma AG, Switzerland) in the treatment of patients with chronic spontaneous urticaria.

MATERIALS AND METHODS: A 36-week, open parallel-group study was conducted. Were included 43 adult patients with chronic spontaneous urticaria who were resistant to ongoing therapy with standard and escalated doses of second-generation H₁-antihistamines. All patients were divided into 2 groups: the main group (MG; n=18) ― patients who administrated Genolair; the comparison group (CG; n=25) ― patients who firstly administrated Xolair and then switching therapy to Genolair. Throughout the study period, patients completed questionnaires on the assessment of disease activity (UAS 7), urticaria control (UCT), quality of life index (DLQI). Additionally, the level of total IgE in blood serum was assessed. For statistical data processing, EXCEL 2010 and STATISTICA 7.0 software packages were used.

RESULTS: After 4 weeks from the start of monoclonal antibody therapy, patients in both groups were responders to omalizumab. At the same time, there were no significant differences when comparing scores on the UAS 7, UCT scale between patients of the MG and the CG during the entire observation period (p >0.05). The change in treatment paradigm in CG also did not have a statistically significant effect on the indicators of urticaria activity and disease control (p >0.05). At the same time, the quality of everyday life changed more positively in the MG, which was reflected in a more pronounced change in the DLQI index at the time of the control assessment since 20 weeks of therapy (p=0.032). An increase in the level of total IgE in the blood serum of all patients with chronic spontaneous urticaria after the initiation of a course of immunobiological therapy was demonstrated, while there were no statistically significant intergroup differences in relation to changes in this laboratory parameter (p >0.05).

CONCLUSION: During the treatment of patients with severe chronic spontaneous urticaria, resistant to ongoing therapy with standard and escalated doses of second-generation H₁-antihistamines, comparable clinical efficacy and safety of the study drug Genolair and the reference drug Xolair were shown.

BACKGROUND: Food allergy is an urgent problem for public health around the world. One of the most promising methods of food allergy treatment is allergen-specific immunotherapy.

AIM: to analyze the results of clinical studies on the effectiveness and safety of modern allergen-specific immunotherapy technologies in the treatment of food allergies published over the past three years.

MATERIALS AND METHODS: A search and analysis of scientific publications was carried out using resources cataloging biomedical scientific literature: PubMed and eLibrary. The review includes original studies published between January 1, 2020 and December 31, 2022.

RESULTS: The review made it possible to systematize the data accumulated over the past three years, reflecting the main trends in allergen-specific immunotherapy of food allergy. The analysis of studies showed modern approaches to oral and epicutaneous immunotherapy and affected the efficacy and safety of these types of treatment. In food allergy cohorts, the allergen-specific immunotherapy approach of oral and epicutaneous allergen-specific immunotherapy has been shown to be highly effective in achieving tolerance and desensitization to the food trigger it was revealed that epicutaneous allergen-specific immunotherapy is characterized by a high level of adherence of patients to treatment.

CONCLUSION: It is necessary to continue conducting large-scale clinical studies on modern methods of allergen-specific immunotherapy in patients with food allergies to form standardized therapy protocols.

To date, a clear correlation has been revealed between disorders of the intestinal microbiota in childhood and immune and metabolic disorders in the later period. Experimental data, confirming the long-term health benefits caused by the intestinal microbiota of infants, indicate the participation of the intestinal microbiota of children in modulating risk factors associated with a specific state of adult health, which justifies the expediency of developing strategies for influencing the development, composition and activity of the intestinal microbiome of infants using probiotics and/or prebiotics, synbiotics and postbiotics.

The composition of the intestinal microbiome of a child depends on its gestational age, method of delivery, type of feeding, environmental conditions and plays a vital role throughout a person’s life.

The intrauterine and neonatal periods represent critical stages in the formation of the child’s microbiome, the violation of which is associated with the development of various pathological conditions in the child’s body, including allergic ones, while early correction of intestinal microbial communities can serve as a basis for preventing allergic sensitization.

The review article presents an analysis of current data on the role of the intestinal microbiota in the development of atopic diseases in children and discusses the possibilities of preventive and therapeutic use of nutraceuticals with pro-, pre- and postbiotic effects, their effects on the development, composition and activity of the intestinal microbiome in children with atopias.

This review summarizes the current understanding of the phenotypes (clinical manifestations) of atopic dermatitis based on morphological and some laboratory diagnostic tools (total IgE level, sensitization status, filaggrin mutations). The author gives a chronology of the study of atopic dermatitis phenotypes, including the use of modern statistical methods (clusters). Recent studies have described unique phenotypes in patients with atopic dermatitis colonized by Staphylococcus aureus; in patients with atopic dermatitis and food allergies; in patients with herpes eczema, including a history of herpes infection. At the same time, it is quite obvious that phenotypes are determined by molecular mechanisms (endotype), which are associated with the age of patients, the severity of the disease, persistence, etc. Recently, publications have appeared that confirmed the features of the course of the disease in different ethnic groups (European-American and Asian phenotypes), including immunopathogenetic differences characteristic of different races of people.

Together, studies on the endo- and phenotypes of atopic dermatitis will help to better identify the most optimal approach to personalized treatment of these patients. Ultimately, such studies are important for developing a classification of atopic dermatitis phenotypes.

Low awareness of doctors of various specialties about such an initial defect in immunity as hereditary angioedema leads to poor detection of this disease, as a result of which patients often receive ineffective drugs for a long time and are at risk of developing life-threatening complications.

A clinical case was presented of a patient whose diagnosis of hereditary angioedema was first established at the age of 65 despite a long history of edema. There were no urticarial rashes. For edema for 3 years, the patient took Loratadine, systemic glucocorticosteroids were repeatedly administered. In addition, for many years she was worried about abdominal syndrome with an episode rate of up to several times a week, for the purpose of stopping which she used Tempalgin. There is a burdened family history of angioedema. This hospitalization was due to the development of edema of the lower lip and left cheek, the appearance of which is associated with a bite of the inner side of the cheek in sleep, there was no effect from the use of systemic glucocorticosteroids and antihistamines. The examination revealed a decrease in both the amount and functional activity of the C1-inhibitor, thus, hereditary angioedema of type I was diagnosed. Genetic examination revealed a previously undescribed variant of mutations in the SERPING1 gene.

The pathogenesis of edema in hereditary angioedema is due to the accumulation of bradykinin, therefore, the use of glucocorticosteroids and antihistamines is ineffective. Currently, there are modern highly effective and safe means, both for stopping and for the prevention of such edema.

It is important to inform specialists of various profiles about this disease and the principles of its therapy.

The widespread, and not always justified, long-term prescription of a hypoallergenic diet for atopic dermatitis without allergy testing and verification of the diagnosis of food allergy has led to the “pendulum swinging” in the opposite direction: in recent years, the effectiveness and necessity of an elimination diet in therapy atopic dermatitis is frequently questioned. At the same time, it is generally accepted that in proven food allergy, the targeted elimination diet remains a necessary method in complex therapy.

A study was conducted, including a retrospective analysis of 430 case histories and an examination of 130 children with severe atopic dermatitis as part of the prospective part of the study. The analysis of the nutritional status, chemical composition of the diet, body composition, quality of life, eating behavior, as well as compliance of the patients’ parents was carried out which made it possible to analyze the complex interaction of these indicators with various factors as well as with each other. Risk factors for impaired nutritional status and eating behavior in children with severe atopic dermatitis were early onset of the disease, and long-term adherence to recommendations for limiting or excluding various foods from the diet, especially dairy and/or 4 or more food groups. It was revealed that it is an unbalanced diet, and not elimination itself, is the main factor that reduces the nutritional status of a child. Additional risk factors for impaired nutritional status are the traits of children’s eating behavior caused by the disease itself and adherence to dietary measures, making it difficult to form a complete diet if a diet is necessary and to expand it. As a result, an algorithm was formed, aimed at optimizing the nutritional support of children suffering from atopic dermatitis and food allergy.