Vol 20, No 4 (2023)

BACKGROUND: The decrease in the effectiveness of antibiotics against the background of resistance of microorganisms aggravates the therapy of atopic dermatitis complicated by bacterial infection and actualizes the development of new antimicrobial agents.

AIM: To develop, synthesize, and evaluate the antibacterial activity of cationic peptides and an aqueous solution of fullerene C60 to create drugs based on them that will have a spectrum of biological activity, including anti-inflammatory, antiallergic, and antibacterial activities.

MATERIALS AND METHODS: This study analyzed the developed linear and dendrimer cationic peptides, whose structure was confirmed by matrix-assisted laser desorption ionization–time of flight mass spectrometry. An aqueous solution of fullerene C60 was obtained using a uniquely developed and patented technology. Antibacterial activity was assessed by diffusion into agar using disks (screening) and serial dilution, which was used to determine the minimum bactericidal concentration of the studied compounds.

RESULTS: Moreover, 42 cationic peptides with various structures were developed and synthesized. The molecular weight of the peptides did not exceed 5,000 Da. They contained 7–25 amino acids with charges from +5 to +16. Screening was carried out through diffusion into agar using disks and revealed 15 peptides that showed activity against Escherichia coli Dh5a. Thus, using the method of counting colonies, the peptides AB-14, AB-17, and AB-18 showed bactericidal activity relative to E. coli Dh5a in concentrations of 0.03, 0.15, and 0.74 mM, respectively, which exceeded that of ampicillin (0.74 mM) several times. Analysis of an aqueous solution of fullerene C60 did not reveal its antibacterial activity.

CONCLUSIONS: The antibacterial activity of the resulting peptides makes them promising for the development of antibacterial therapeutic agents.

BACKGROUND: Skin damage in atopic dermatitis is caused by the participation of several immune cells and their inflammatory mediators. However, data on correlations between the severity of atopic dermatitis, combined with and without food allergies (severity of atopic dermatitis (SCORAD) index, etc.), and the levels of eosinophils and interleukin-5 are scarce and contradictory. No studies have compared the frequency of eczematous reactions occurring at different times or immediate allergic reactions in the above patients. Moreover, no studies or certain studies have reported results on the frequency of the combination of atopic dermatitis and food allergies, its various degrees of severity depending on these indicators, levels and relationships of the concentration of eosinophils, and interleukin-5 in the presence of psychosocial stress.

AIM: To study the frequency and severity of the course, skin reactions in patients with atopic dermatitis, with and without food allergies, and levels and correlations of interleukin-5 and eosinophils in the presence of psychosocial stress in patients in the Donbass region.

MATERIALS AND METHODS: A total of 165 patients with atopic dermatitis were examined. Questionnaire survey, anamnesis collection, and general clinical and specific allergological examinations were performed, and the levels of interleukin-5, absolute quantity, and percentage of eosinophils in the peripheral blood were determined. Two subgroups of patients with atopic dermatitis were analyzed: 1) those with food allergies and 2) those without food allergies. Persons living in areas with high and low shelling intensities were also identified. Data were statistically processed using the domestic program Medstat (Donetsk).

RESULTS: In patients with atopic dermatitis, randomly selected from those who applied for an appointment with allergists-immunologists, this disease was combined with food allergy in 81.2% of cases. The severity of atopic dermatitis and eosinophil levels were significantly higher in the group with food allergies. Stable direct reliable correlations of varying strength have been established between the severity of atopic dermatitis (SCORAD index and its indicators) and the absolute quantity, percentage of eosinophils, and interleukin-5 level, as well as between the above laboratory parameters. Differences were found in the frequency of recording eczematous and immediate skin reactions. The residence of patients with atopic dermatitis with and without food allergies in areas that differed in shelling intensity was associated with the severity of atopic dermatitis and the level of eosinophils and interleukin-5.

CONCLUSION: In most patients, atopic dermatitis is combined with food allergy, and the severity of its combination with food allergy increases. Therefore, reliable correlations of the SCORAD index with blood eosinophilia and interleukin-5 levels are revealed. The severity of atopic dermatitis and biomarkers in both subgroups increased when they lived in areas with high intensity of shelling.

BACKGROUND: The complexity of choosing a genetically engineered biological drug for the treatment of severe bronchial asthma is due to the intersection of disease endotypes and phenotypes. Mistakes in biological choice lead to the discontinuation and/or switching of the drug because of insufficient effectiveness of therapy.

AIM: To determine the reasons for stopping targeted therapy and biological switching effectiveness in patients with severe bronchial asthma in clinical practice.

MATERIALS AND METHODS: Patients with severe bronchial asthma (n=116) from the Sverdlovsk region register were divided into three groups: (1) continuous, (2) stoppers, and (3) switchers. Predictors of biological withdrawal and switching, reasons for the first biological stopping, switching schemes, therapy effectiveness after switching according to the asthma control test (ACT), asthma quality of life questionnaire (AQLQ), 22-item sinonasal outcome test [SNOT-22], forced expiratory volume in the first second, need for systemic glucocorticosteroids, and achievement of strong asthma control were determined.

RESULTS: Of the 116 patients in the registry, 17.2% were stoppers and 12.1% were switchers. Stoppers suffered from chronic rhinosinusitis with nasal polyps less often and had an earlier asthma onset. Switchers had higher blood eosinophil levels. Therapy was canceled for personal reasons in 45% of the patients. The ineffectiveness of therapy in severe bronchial asthma and/or chronic rhinosinusitis with nasal polyps was the main reason for switching (92.8%) from omalizumab and benralizumab. The drug of choice for switching was dupilumab. Indicators improved, namely, ACT by 86.4%, AQLQ by 52.5%, SNOT-22 by 48%, and forced expiratory volume in the first second by 21.2%), and the need for systemic glucocorticosteroids decreased to 0 in 12 months after switching. Strong control was achieved in 62.5% of the patients when excluding the forced expiratory volume in the first second, and 50% of patients when including the forced expiratory volume in the first second.

CONCLUSION: Careful selection of targeted therapy patients minimizes the failures of the starting drug to 12.1%. Switching the starting genetically engineered biological drug, aimed only at blocking eosinophils or only at blocking IgE, because of its inefficiency, to a drug with a dual mechanism of action leads to a significant improvement in ACT, AQLQ, SNOT-22, forced expiratory volume in the first second, and absence of systemic glucocorticosteroids.

BACKGROUND: Birch pollen allergy is widespread and is the main allergic disease in Russia. Cross-reactive food allergy, often found in patients with birch pollen allergy, is an underestimated problem that complicates the course of pollinosis and requires further study to improve the quality of diagnosis and personalized recommendations for such patients.

AIM: To study the features of the molecular sensitization profile of adult patients with birch pollen allergy and cross-reactive food allergy to PR-10 proteins.

MATERIALS AND METHODS: Twenty-five adult patients with confirmed birch pollen allergy, with or without cross-reactive food allergy, were included in an open single-center interventional prospective controlled nonrandomized study. Specific IgE to 112 allergens was determined by multiplex analysis using ImmunoCAP ISAC (ThermoFisher, Sweden). Patients with cross-reactive food allergy completed a validated questionnaire on cross-reactive food allergy symptoms and causative allergens. The primary endpoint of the study was the assessment of the sensitization profile to Bet v 1 and PR-10 proteins (Mal d 1, Ara h 8, Cor a 1.0101, Cor a 1.0401, Act d 8, Api g 1, Pru p 1, and Gly m 4) and the clinical characteristics of the sensitized patients. The secondary endpoint was the comparison of patients with and without cross-reactive food allergy and the evaluation of how sensitization to Bet v 1 and PR-10 homologs can affect clinical manifestations of cross-reactive food allergy in patients.

RESULTS: The study included 25 patients aged 18–55 years, from which two comparable groups were formed: group 1 consisted of 13 patients with cross-reactive food allergy symptoms and group 2 (without cross-reactive food allergy) consisted of 12 patients who had never experienced cross-reactive food allergy symptoms. Analysis of the sensitization profile to PR-10 allergens revealed similar patterns in both groups; however, sIgE concentrations to all allergens were significantly higher in group 1. A strong correlation was found between the number of triggering products and total IgE level with PR-10 proteins (r=0.81; p=0.001). The severity of cross-reactive food allergy symptoms correlated with the total level of IgE to PR-10 proteins (r=0.97; p <0.0001). The cutoff level for total sIgE to food PR-10 proteins, equal to 70 ISU-E, allowed us to distinguish patients with only oral allergic syndrome from those with systemic manifestations of cross-reactive food allergy.

CONCLUSION: The results of the study are applicable in clinical practice and have prognostic value in determining the severity of cross-reactive food allergy.

Celiac disease is a chronic autoimmune disorder that affects the small intestine. It is triggered in genetically predisposed individuals by consumption of gluten, a protein found in wheat, barley and rye. Celiac disease typically manifests in young pediatric patients as malabsorption of nutrients, gastrointestinal symptoms, and other health complications, which is associated with partial or total villous atrophy of the proximal small intestine. Food allergy, on the other hand, is an abnormal immune response to a specific food protein that causes inflammation and a range of symptoms, from mild hives to life-threatening anaphylaxis.

Although the mechanisms behind celiac disease and food allergy are different, both conditions involve an immune response to food proteins. The current study revealed the possibility of IgE-A coexistence in celiac disease and food allergy screening should be considered for people with celiac disease, especially when symptoms persist even after implementing a gluten-free. However, the relationship between celiac disease and food allergy is not fully understood, and more research is needed to explore this link.

This review aims to examine the available literature for the occurrence of food allergy in subjects with celiac disease.

Asthma is a heterogeneous, chronic, and recurrent inflammatory lung disease that also affects children. In recent decades, the incidence of bronchial asthma has been steadily increasing. In 2021, asthma affected 0.89% and 1.87% of Russian children aged 0–14 and 15–17 years, respectively; however, the prevalence of asthma according to official statistics is lower than the real data. Therefore, a significant proportion of patients do not receive proper treatment, which ultimately affects the quality of life of these patients and their parents. Early and accurate diagnosis of bronchial asthma and identification of children with an uncontrolled disease course will provide an opportunity to select/change therapy to achieve remission, thereby preventing possible negative consequences of the disease. In Moscow, according to Order No. 947n of the Ministry of Health of Russia, to improve the quality of medical services, including outpatient care, the Unified Medical Information and Analytical System (UMIAS) has been implemented, which has improved the availability and quality of medical services of public healthcare institutions in the city. This study proposes simple algorithms, and their integration into the UMIAS system will facilitate diagnosis verification for pediatricians and provide allergologists with tools for timely and structured routing of patients with uncontrolled bronchial asthma.

Anaphylaxis is a severe life-threatening systemic IgE-dependent hypersensitivity reaction that develops rapidly and can be fatal. As a rule, an anaphylactic reaction develops in response to food, insect stings, and medicine drugs. Sometimes, cofactors can modulate anaphylaxis and significantly reduce the required allergen dose for the development of an anaphylactic reaction. In such cases, anaphylaxis is considered cofactor-dependent. Alcohol consumption is a leading factor in cofactor-dependent anaphylaxis. This article presents a clinical case of cofactor-dependent anaphylaxis. Skin testing with extracts of inhalation allergens and molecular allergy diagnostics using the ImmunoCAP ISAC allergochip (112 allergy components) performed at the Institute of Immunology (Moscow) showed positive results with pollen allergens of deciduous trees and meadow grasses and an increase in the level of specific immunoglobulin E (sIgE) to the main inhalation allergens — birch, hazel, alder, Timothy, pigweed, and wormwood pollen, and to cross-reacting components of allergens from the PR-10 protein group, such as soya bean, kiwi, apple, peach, celery, peanut, and hazelnut. Based on the results of molecular allergy diagnostics, a personalized elimination diet was prepared and recommendations were made to the patient.

Atopic dermatitis is a global problem with increasing prevalence. Genetic predisposition to allergies, epidermal barrier dysfunction, and T2 immune response underlie atopic dermatitis. Xerosis, itchy skin, and exacerbation are the main atopic dermatitis symptoms, leading to increased permeability of allergens and microbes through the damaged epidermis and to the development of sensitization. The main purpose of atopic dermatitis therapy is to achieve long-term remission and improve quality of life. Topical treatment includes glucocorticosteroids, topical calcineurin inhibitors, and emollients to reduce inflammation, xerosis, and infection prevention. Daily use of effective emollients as basic skin care can improve epidermal barrier function, provide skin hydration, and reduce the need for topical glucocorticosteroids.