Vol 23, No 1 (2026)

BACKGROUND: Congenital ichthyosis is a heterogeneous group of rare genetic skin diseases characterized by generalized keratinization disorders and epidermal barrier dysfunction. Among the various forms of ichthyosis, Netherton syndrome has been described as having the highest risk of developing allergies. However, the characteristics of sensitization and clinical manifestations of allergic diseases in other forms of congenital ichthyosis have not been studied.

AIM: To study the pattern of food sensitization in children with different forms of congenital ichthyosis.

METHODS: A retrospective analysis of the medical records of 43 children with congenital ichthyosis was conducted, in whom the levels of specific immunoglobulin E to food allergens were studied. The children were divided into 2 groups. Group I included 13 children with Netherton syndrome; the group II consisted of 30 children with other forms of ichthyosis. Children in group II were divided into subgroups: IIA (n = 17) with the autosomal recessive form of ichthyosis and IIB (n = 12) with the keratinopathic form of ichthyosis. One child with vulgar ichthyosis was also included in the study. The comparison group consisted of 40 children, comparable in age, without skin diseases and allergies. In groups I and II, allergological anamnesis and total immunoglobulin E levels were assessed. In all three groups, specific immunoglobulin E levels to 5 allergens were assessed. In children with Netherton syndrome, the level of antibodies to 10 allergens was additionally assessed.

RESULTS: The frequency of detection of elevated total immunoglobulin E levels in patients with Netherton syndrome in group I was significantly higher than in children in group II. Total immunoglobulin E levels exceeding 1000 IU/mL were also more common in group I. Sensitization to food allergens was detected in all children in group I and in 72.2 % of patients in group II, and was more common in children with the autosomal recessive form of ichthyosis. Sensitization to chicken egg white was detected in all children in group I and in 20.0 % of children in group II. Children with Netherton syndrome were also more often sensitized to cow’s milk proteins and other allergens compared to children with non-syndromic forms. In children with Netherton syndrome, specific immunoglobulin E levels were more often distributed from the low to moderately high class.

CONCLUSIONS: The data obtained during the study made it possible to estimate the frequency of sensitization to major food allergens in pediatric patients with various forms of congenital ichthyosis — in particular, such a rare disease as Netherton syndrome.

BACKGROUND: Allergic diseases are a serious global health problem. Approximately one-third of the world’s population has increased sensitivity to various types of allergens, leading to a wide spectrum of clinical manifestations affecting the respiratory, gastrointestinal, and skin systems. Allergy diagnostics, based on the detection of specific immunoglobulin E, aids in the development of effective treatment strategies. However, data on the prevalence of allergens in different geographical regions remains insufficient.

AIM: To identify features of the sensitization profile to allergens in patients with allergy living in Moscow and the Moscow region using modern methods of molecular diagnostics.

METHODS: Serum samples from 707 patients aged 5 to 78 years with complaints of allergic, clinically significant, reproducible reactions were tested for specific immunoglobulin E to 300 allergen extracts and allergenic molecules using microarray analysis. The main characteristics of the sensitization profile were determined using principal component analysis, according to Kaiser’s rule.

RESULTS: The sensitization profile in patients living in Moscow and the Moscow region is represented by 46 principal components, formed by various combinations of the detected allergens. This profile describes 87 % of the total data variance. The greatest influence on the formation of the sensitization profile is exerted by PR-10 proteins (Bet v 1 and its cross-reactive allergens) and uteroglobin (Fel d 1 — the cat allergen). Sensitization to the same allergen can have different effects on allergic reactions, and the frequency of detection of specific immunoglobulin E to allergens is not always comparable with their contribution to the formation of the sensitization profile.

CONCLUSION: The obtained data will serve as a basis for further in-depth analysis, which will prospectively allow for the integration of laboratory markers with clinical observations and a better understanding of the pathogenesis and features of allergic disease course.

Background: The goal of an allergist is to identify a causally significant allergen in a timely manner, which allows for the administration of modern treatment for allergic diseases. To confirm sensitization, diagnostics are performed using skin tests with allergen extracts or the detection of specific immunoglobulin E antibodies in the blood serum. Molecular diagnostic methods are considered more sensitive and specific than diagnostic tests based on natural allergen extracts. We used a domestic microchip technology in a pilot study, as it provides an analysis of a wide range of different sensitizations in a cohort of patients with atopic diseases. The first Russian allergy chip is a platform with 100 allergens (extracts and allergenic molecules) on it.

Aim: To analyze sensitization in adult patients from the Moscow region suffering from respiratory allergies using the Russian multiplex technology of molecular allergy diagnostics.

Methods: A single-center prospective, one-time study included 83 adult subjects (18 years and older) of both sexes living in the Moscow region. The first group consisted of 12 (14.4 %) healthy volunteers without atopy, the second group included 38 (45.8 %) patients with isolated allergic rhinitis, and the third group consisted of 33 (39.8 %) patients with allergic rhinitis and concomitant bronchial asthma. All study participants had allergen-specific immunoglobulin E antibodies to 100 allergens determined in the blood serum by the multiplex technology. Statistical processing of the results was carried out using the IBM SPSS Statistics 23.0 program package.

Results: No sensitization to any allergen component was detected in the comparison group. Molecular analysis of the spectrum of immunoglobulin E sensitization to aeroallergens in the group of patients with isolated rhinitis and in the group of patients with allergic rhinitis and concomitant bronchial asthma showed a predominance of immunoglobulin E detection to the following main molecules: birch pollen allergen Bet v 1 in 43 (60.5 %) patients, alder allergen Aln g 1 in 26 (36.6 %) patients, The main cat molecule was Fel d 1 in 23 (32.4 %) of the subjects, the first timothy pollen molecule was Phl p 1 in 20 (28.2 %), and the hazelnut allergen belonging to the PR protein family was Cor a 1.04 in 32 (45.0 %) patients. When assessing the type of sensitization, it was found that the majority of patients in the second and third groups had polysensitization, with 89.5 and 93.9 % of patients, respectively. Additionally, there was a significant correlation between the increased likelihood of developing a multimorbid phenotype of allergic rhinitis with concomitant bronchial asthma and the increased class of sensitization to the main molecules Bet v 1 (p = 0.020) and Fel d (p = 0.003).

Conclusion: As a result of the pilot study, sensitization to the main components of inhalation allergens was detected in adult patients with respiratory allergies in the Moscow region, which correlates with previous studies conducted on a similar patient population using other chip technologies.

BACKGROUND: There is limited real-world evidence on the burden of atopic dermatitis in patients receiving systemic or non-systemic therapies in clinical practice in Russia.

AIM: To understand severity of atopic dermatitis symptoms and quality of life of patients receiving systemic and non-systemic treatment in the routine clinical practice.

METHODS: ESSENTIAL AD was a cross-sectional, observational, retrospective chart review study in adult (18–65 years) patients with the confirmed atopic dermatitis. The results provided in this article are obtained in Russia as a part of the multicountry study. Primary variables included Eczema Area and Severity Index, Scoring Atopic Dermatitis and Dermatology Life Quality Index according to the assessment at the single visit performed at the study enrollment in. Patients were prescribed to and administered all treatments irrespectively to the study participation.

RESULTS: A total of 125 patients were analyzed, 63 of whom received systemic and 62 non-systemic therapy. Mean disease duration was 15.5 ± 14.5 years. In the overall population, Eczema Area and Severity Index, Scoring Atopic Dermatitis and Dermatology Life Quality Index total scores were 9.0 ± 10.1, 32.9 ± 16.1 and 8.9 ± 7.0, respectively, which corresponded to moderate disease severity and moderate effect of atopic dermatitis on quality of life. Disease burden was significantly higher in systemic treatment group vs non-systemic: Eczema Area and Severity Index was 12.4 ± 11.5 (moderate) vs 5.4 ± 6.8 (mild) (p < 0.0001) and Scoring Atopic Dermatitis was 38.6 ± 16.7 vs 27.0 ± 13.2 (moderate category for both groups) (p < 0.0001), respectively. Impact of the disease on quality of life was also more pronounced (p = 0.002) in systemic vs non-systemic treatment group with Dermatology Life Quality Index of 10.7 ± 7.1 (very large effect on quality of life) vs 7.1 ± 6.4 (moderate effect on quality of life), respectively.

CONCLUSION: According to the data obtained in real-world conditions of the Russian daily clinical practice, patients with atopic dermatitis have a prominent disease burden and impact on quality of life, despite receiving systemic treatment, which is consistent with the wider population of the multinational ESSENTIAL AD study. This reflects the unmet medical need for effective management of patients with moderate to severe atopic dermatitis in Russia.

The high efficacy and good tolerability of second-generation antihistamines in the treatment of idiopathic urticaria allow for their long-term successful use. Clinical experience accumulated over the past decades and data from modern studies, including meta-analyses, have convincingly demonstrated that many second-generation antihistamines have a wide therapeutic window and maintain a favorable benefit-risk ratio even when used significantly above standard doses. This has led to a reconsideration of previous restrictions and the establishment of a strategy for using high-dose second-generation antihistamines as the standard for patients with an inadequate response to first-line therapy. Currently, international and Russian guidelines have developed a strategy for using high doses of second-generation antihistamines (2–4 times the recommended dose) for resistant and severe forms of chronic spontaneous urticaria accompanied by frequent exacerbations, with the goal of completely eliminating symptoms and achieving sustained remission. It should be noted that increasing the dose is a preferable tactic over switching to a different second-generation antihistamines.

When selecting a specific drug for long-term therapy, especially in patients whose work requires increased alertness or in those with polypharmacy, the pharmacodynamic and pharmacokinetic characteristics of individual agents must be considered. Fexofenadine exhibits a predictable safety profile, lacks sedation, is non-cardiotoxic, and exhibits minimal risk of drug interactions. Furthermore, its efficacy within the high-dose strategy of second-generation antihistamine is among the highest. According to a 2016 meta-analysis evaluating the efficacy of increased doses of second-generation antihistamines, increasing the fexofenadine dose for the treatment of chronic spontaneous urticaria was effective in 83.1 % of cases ― the best result among all second-generation antihistamines studied.

Cryopyrin-associated periodic syndrome is a group of autoinflammatory diseases caused by mutations in the NLRP3 gene, which lead to uncontrolled inflammasome activation and, consequently, excessive production of the proinflammatory cytokine interleukin 1β. Diagnosis is challenging, since many patients have a heterogeneous multisystem clinical picture. This publication presents a familial case of the disease with variability of manifestations from “blurred” and asymptomatic to a detailed clinical picture with multisystem involvement (persistent inflammatory activity, fever and urticaria associated with cold exposure, erythema nodosum, poly- and monoarthritis, uveitis, aphthous stomatitis, scrotal ulcers, and headache). Two patients had an atypical presentation of symptoms with predominant involvement of the joints, eyes, and oral mucosa, due to which one of them was initially given an alternative diagnosis of Behcet’s disease (syndrome). Genetic testing made it possible to identify a pathogenic mutation in the NLRP3 gene, verify the diagnosis, and promptly prescribe pathogenetic therapy with an interleukin 1 inhibitor, which is necessary to prevent irreversible organ damage (amyloidosis, sensorineural hearing loss, vision loss, etc.) and reduce the burden of the disease.

On September 16, 2025, a meeting of an interdisciplinary Expert Council in the fields of allergology, otorhinolaryngology, and pediatrics was held in Moscow, dedicated to improving approaches to the treatment of allergic rhinitis. The primary goal of treating allergic rhinitis is to achieve control over the disease’s symptoms. The Visual Analogue Scale is recognized as a simple, convenient, and valid tool for symptom monitoring. Differences between national clinical guidelines for the treatment of allergic rhinitis and the international ARIA 2024 guidelines were analyzed. It was established that the ARIA 2024 guidelines are patient-oriented and offer the possibility of prescribing any group of pharmacological agents already at the first assessment of allergic rhinitis control using the Visual Analogue Scale. The national clinical guidelines do not prohibit initiating therapy at any step; however, the proposed algorithm limits the physician to a sequential prescription of drugs.

Current issues of allergic rhinitis in pediatric practice were discussed, including delayed diagnosis, low quality of life for patients, and insufficient attention to atopic multimorbidity. The role of surgical correction of anatomical abnormalities of the nasal septum in patients with allergic rhinitis, which hinder the effective delivery of intranasal medications, was examined in detail.

The problem of low patient adherence to allergic rhinitis therapy is considered one of the key factors in achieving disease control. Approaches to improving adherence were discussed, including transitioning from a paternalistic doctor-patient interaction model to a shared decision-making model regarding therapy, taking into account patient preferences.

Special attention was paid to the place of fixed-dose combinations of intranasal glucocorticosteroids and intranasal antihistamines in the treatment of allergic rhinitis. It was shown that in approximately two-thirds of patients, monotherapy does not provide control of allergic rhinitis symptoms, and they require combination therapy. Fixed-dose combinations demonstrate advantages such as effect potentiation, reduced incidence of side effects, synergistic action, and increased treatment adherence.

The Expert Council proposed an updated algorithm for choosing therapy for allergic rhinitis, considering the possibility of starting treatment at any step based on assessing the number and severity of symptoms using the Visual Analogue Scale. The use of fixed-dose combinations as initial therapy is recommended in the presence of persistent symptoms (more than 4 days per week) and a Visual Analogue Scale score of ≥ 5, especially in cases of severe nasal congestion. This algorithm is planned to be used as a basis for updating the national clinical guidelines for the treatment of allergic rhinitis.

In the article “Hereditary angioedema: modern approaches to modeling, diagnostics and therapy” published in Russian Journal of Allergy, vol. 22, issue 4, 2025 (https://doi.org/10.36691/RJA17058) on page 408, changes were made: agreement number was corrected from 075-15-2025-518 to 075-15-2025-522.

The implemented corrections do not affect the conclusions drawn by the authors. The amendments have also been incorporated into the online version of the journal.