Vol 21, No 4 (2024)

BACKGROUND: Environmental factors have a direct impact on the course and spread of allergic disorders. In recent decades, there has been an increase in the number of patients with allergic pathology, which is partly due to global environmental changes on the planet and insufficient consideration of the specific climatic and geographic environmental factors of the region where the patient lives.

AIM: To study the characteristics of epidemiology, etiology and clinical course of allergic disorders in different regions of the Russian Federation.

MATERIALS AND METHODS: To achieve this goal, a questionnaire survey of the Chief Consultants was conducted in 2019. Questionnaires were sent to all district, regional, republican centers, and cities of federal significance. The received data were analyzed and structured.

RESULTS: Responses to the questionnaires were received from 49 regions of the Russian Federation, where a total of 1,468,105 patients with allergic diseases were registered during the study period. Significant discrepancies in the distribution of allergic disorders and the spectrum of etiologically significant allergens were revealed in different regions of the Russian Federation, reflecting their climatic and geographical peculiarities. There is an increase in respiratory forms of allergy, multisensitization and multi-organ allergic lesions. The Ural Federal District has the lowest number of cases of allergic rhinitis (p = 0.001) among the studied regions, and bronchial asthma is more common than other forms of respiratory allergy (p <0.001), while in the Southern Federal District the prevalence of this disease was statistically significantly lower than in the northern regions (p <0.001). Atopic dermatitis was more frequently registered in the Volga and Far Eastern Federal Districts (p = 0.009, p = 0.012), food allergy – in the Volga and Northwestern Federal Districts (p = 0.008, p = 0.003). In the North Caucasian and Siberian Federal Districts, food allergy was diagnosed least frequently (p = 0.001, p = 0.002). The Northwestern Federal District registered the smallest number of patients with sensitization to house dust allergens (p <0.001), and the Southern Federal District – to house dust mites (p = 0.004). The lowest number of patients with sensitization to weed pollen allergens was noted in the Northwestern Federal District (p <0.001). The Southern and North Caucasian Federal Districts dominate in terms of sensitization to weed pollen allergens (p <0.001, p = 0.001) and show a low percentage of sensitization to tree allergens (p <0.001) compared to other federal districts. Low sensitization of patients to mold allergens is noted in the Ural Federal District (p <0.001). The highest proportion of insect allergy is noted in the Siberian (p = 0.001), and the lowest – in the Central Federal District (p <0.001). The North Caucasian Federal District showed the lowest percentage of sensitization to food allergens (p = 0.04). Low availability of specialized care and insufficient prescription of pathogenetic allergen-specific immunotherapy were found in all federal districts of the Russian Federation.

CONCLUSION: Different climatic and geographic regions of the Russian Federation differ from each other in the structure of allergic diseases and sensitization spectrum, which should be taken into account in the development of preventive, diagnostic and therapeutic measures in these territories.

BACKGROUND: Allergens from the pollen of wormwood (Latin: Artemisia absinthium) are among the most dangerous in terms of allergization in central Russia, Europe and a number of other regions. The use of allergoids created using glutaraldehyde instead of native allergen extracts is due to the reduced risk of developing allergic reactions while maintaining immunogenicity and eliminating the highly toxic element formalin from the production process, which makes allergoids safer for use in allergen-specific immunotherapy.

AIM: Obtaining an allergoid from wormwood pollen by treatment with glutaraldehyde to evaluate its properties prior to preclinical testing.

MATERIALS AND METHODS: Purified extract of wormwood pollen, isolated by defatting and water-salt extraction, was dissolved in phosphate-buffered saline (PBS) pH 7.5, after which it was polymerized in 0.1 % glutaraldehyde solution. Stabilization was performed with sodium borohydride solution. The extract and allergoid of wormwood pollen were studied using chromatographic analysis and competitive enzyme-linked immunosorbent assay (ELISA). Then, intraperitoneal immunization with the obtained allergoid was carried out in CBA × C57Bl/6 (F1) mice.

RESULTS: After evaluation of the specific allergenic activity using competitive immune assay ELISA with biotinylated extract of wormwood pollen allergen, it was shown that the 50 % inhibition point for the allergoid is determined at a drug concentration of 0.03 mg/ml, and for the allergen – already at 0.0008 mg/ml. Consequently, the allergenicity of wormwood pollen allergoid is significantly reduced compared to that of the original extract. In addition, the immunogenic activity of the obtained allergoid was confirmed in mice: the average optical density of the ELISA reaction, indicating the amount of IgG, in the group immunized with the allergoid was more than at least 1.5 times higher than the values for the allergen extract.

CONCLUSIONS: During the work, an extract containing allergens of wormwood pollen was obtained. An allergoid was obtained on its basis by polymerization with glutaraldehyde. The obtained allergoid has a high molecular weight (the range shifted to 44–66 kDa), while it has low allergenic activity, in comparison with the original extract, and also retains immunogenicity. In this regard, this allergoid can become the basis for obtaining new ASIT treatments.

Cholinergic urticaria is a subtype of chronic inducible urticaria mediated by hyper sweating and clinically manifested by urticarial elements, pruritus and angioedemas. This form of urticaria is of scientific interest considering its high prevalence in particular age groups, prolonged duration, distinct reduction in the quality of life of patients and high risk of developing life-threatening systemic reactions. There are types of anaphylaxis, also occurring due to increased sweating during physical activity. However, although clinical and laboratory characteristics have been described for each of these types, distinct differential diagnostic algorithms between these pathologies and systemic reactions in cholinergic urticaria have not yet been developed. Also, clear recommendations for modification of life style and limitation/elimination of the causal trigger for patients are currently open. These interventions are at the centre of therapy for all inducible forms of chronic urticaria. This article presents a review of the current literature and practical development of recommendations for specialists and patients.

Ragweed pollen allergy is widespread in the South of Russia, the Far East and other regions, where 25 to 40 % of all weeds-allergic patients may be sensitized specifically to ragweed, representing an important public health problem. Drugs of various pharmacological groups used for the treatment of ragweed pollen allergy affect only the symptoms but not the cause of allergy. Existing pathogenetic therapy (allergen-specific immunotherapy with allergy vaccines based on water-salt extracts) requires long courses and can cause significant side effects. The development of more effective allergy vaccines requires the study of the structures of ragweed pollen allergens and the identification of their IgE epitopes. Based on these epitopes, new highly effective allergy vaccines can be developed using recombinant technologies that will lack the disadvantages of water-salt extracts and will possess the ability to enhance the induction of protective IgG.

This review is focused on the epidemiology of ragweed pollen allergy, as well as the latest approaches to the analysis of its allergens’ structures and development of allergy vaccines. Presented information is relevant for the development of new promising highly effective allergy vaccines for allergen-specific immunotherapy of ragweed pollen allergy.

In September 2024, a meeting of the Expert Council took place, featuring leading specialists in the fields of allergology, pediatrics, and dermatology. The main focus was on the issue of seasonal exacerbations of atopic dermatitis, including their manifestations during the winter period. Experts discussed the leading trigger factors that contribute to the deterioration of patients’ conditions, as well as the criteria that modern emollients for the skincare of patients with atopic dermatitis should meet.

During the discussion, the importance of emollients plus in preventing seasonal exacerbations was emphasized, based on the data from previously conducted studies. The participants concluded that further informational and organizational activities are necessary to raise awareness among both patients and physicians about seasonal environmental factors, such as temperature and humidity, atmospheric pressure, as well as contact with allergens and air pollutants that affect the condition of the epidermal barrier and contribute to the development of exacerbations of atopic dermatitis. Strategies for preventing these exacerbations using modern emollients plus were also proposed.

The results of the meeting underscore the importance of a comprehensive approach to managing atopic dermatitis, highlighting the role of lifestyle and environmental factors in controlling the disease. These results could serve as a foundation for further research and practical guidelines in the fields of allergology, pediatrics, and dermatology.

Atopic dermatitis is one of the most common diseases, occurring in 20 % of children in European countries and the USA, and in 7–14 % of adults according to various authors. The pathogenesis of atopic dermatitis is mainly based on the T2-associated type of the immune response. Various therapies are used, depending on the severity of AD. Targeted therapy is used for the treatment of moderate and severe atopic dermatitis, which is needed perform an assessment of possible contraindications to its administration. Among patients with HIV/AIDS has an increased incidence of atopic dermatitis, which is confirmed in serial studies. There is necessary to consider the pathogenetic mechanisms of the development of atopic dermatitis and HIV, to define rationally choice of the treatment for both atopic dermatitis and HIV. Modern treating methods of atopic dermatitis, which are selectively aimed at modeling T2-associated inflammation, have a relatively low risk of adverse events. One of these treatment methods is targeted therapy with biological drug dupilumab. Currently, there is limited scientific evidence for the effective use of dupilumab in patients with atopic dermatitis and HIV/AIDS.

The article presents a clinical case of severe atopic dermatitis in a HIV-patient, demonstrates the successful experience of using dupilumab over a long period of follow-up.

The development of new effective drugs has contributed to improving the quality of life and increasing its duration, but at the same time has led to an increase in drug hypersensitivity, including one of its most dangerous manifestations – anaphylaxis. Beta-lactams, and among them cephalosporins, and especially ceftriaxone, are among the leaders in the Russian Federation both in terms of frequency of prescription by various specialists, and among the causes of anaphylaxis and mortality associated with it. Anaphylaxis deserves special attention in the perioperative period, when the acute development of a life-threatening condition leads to cancellation of the operation or severe complications. To prevent recurrences of anaphylaxis, it is necessary to determine its specific cause, which often remains unclear, since several drugs are administered simultaneously and, in addition, there is contact with latex, components of medical equipment, etc.

The article describes a specific examination of a patient whose surgery was canceled due to the development of anaphylactic shock in the preoperative period after the administration of ceftriaxone and lidocaine. Using a clinical example, modern approaches to skin and provocation testing for diagnosing drug allergies and selecting the safest beta-lactams are presented, and the interpretation of results of determining the cross-reactivity of cephalosporins with identical R1 side chains, but different R2, is demonstrated. The examination made it possible to establish the cause of anaphylaxis and outline the range of drugs that are safest for the patient, including several beta-lactams as the drugs of choice for perioperative antibiotic prophylaxis and treatment of bacterial infections, if necessary.