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Vol 15, No 3 (2018)

Articles
Monoclonal antibodies in the treatment of bronchial asthma
Ilina N.I., Kurbacheva O.M.
Abstract
The article discusses different phenotypes of heterogeneous bronchial asthma (BA), methods of identification of patients with severe bronchial asthma, based on clinical characteristics, biological and genetic markers. Definition of phenotypes/ endotypes of BA contributes to better understanding of the nature of the disease and is feasible for development of an individual approach to therapy, because some types of BA may differ in resistance response to the standard treatment. The article gives an overview of modern research focused on the use of monoclonal antibodies in the treatment of BA. It discusses the algorithm of selection of patients with severe BA for prescribing of biological therapy.
Russian Journal of Allergy. 2018;15(3):5-15
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Current view on studying of the role of tropomyiosin in the development of crossallergic reactions
Fedoskova T.G., Martynov A.I., Kobizskaya N.V., Shabanov D.V.
Abstract
Cross-reactivity to proteins is the issue of the day due to the severity of clinical symptoms, high prevalence of this phenomenon and the absence of preventive measures . Cross-reactivity is found in pollen, house dust, insects, food allergy, helminthes etc. Multiple studies have confirmed the important role of the protein tropomyosin in the development of sensitization to house dust mites allergens, food allergens and insects. The presence of tropomyosin is detected in the allergen spectrum of many arthropods, in particular insects and crustaceans. The researchers have noted the possibility of development of various cross-allergic reactions to tropomyosin protein. Arthropods are the main type of the Earth’s fauna. Clinical symptoms of allergic reactions to Arthropods differ in severity; this is the issue of studying of the the cross-reactivity to tropomyosin protein.
Russian Journal of Allergy. 2018;15(3):16-24
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Scale for efficacy and safety evidence based on design and methodological quality of treatments and preventive technologies trials
Rebrova O.Y.
Abstract
The quality of the evidence on the efficacy and safety of therapeutic and preventive interventions is analyzed in health technology assessment procedure (including the development of reimbursement lists such as the List of Vital and Essential Drugs in Russian Federation) and during development of clinical guidelines. The traditional approach to assess the evidence quality is based on the well-known pyramid of research designs (from meta-analyses to case descriptions), and now it is obsolete. The modern approach is to take into account also the methodological quality of studies. The methodological quality depends on risks of biases and the risk of incorrect data analysis. The article proposes a scale based on combinations of designs and three levels of methodological quality (high, medium, poor) for each of them. The scale differentiates meta-analyses based on randomized controlled trials and comparative studies of other designs. In the scale, the new design of indirect comparisons is envisaged, its’ evidence is lower than for RCT that are used for indirect comparisons. The scale can be used for assessing the absolute and relative effectiveness and safety of medical and preventive medical technologies. At present, the scale is included in the guidelines for the complex assessment of pharmaceuticals.
Russian Journal of Allergy. 2018;15(3):25-29
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The house dust mites significance in the development of atopy
Petrova S.Y., Khlgatian S.V., Berzhets V.M.
Abstract
Background. Knowledge of the structure and particularity of sensitization in the region allows us to choose the correct tactics of treatment and prevention of atopic reactions. Objective. To study the structure of sensitization to inhalation allergens in Moscow and Moscow region since 2009 to 2017 and to determine significance of sensitization to house dust mites Dermatophagoides pteronyssinus (Der p) and Dermatophagoides farinae (Der f) in it. Methods. Blood serum of Moscow region patients with atopy (n=2546) was examined by RIDA AllergyScreen method in the period from 2009 to 2017. Results. The allergosensitisation structure was determined. It was revealed that there was no decreasing of the frequency of house dust mites (Der р and Der f) sensitization in observation period. The features of monovalent, polyvalent and combined sensitization among patients with IgE reactions to Der р and Der f were analyzed. Conclusions. According to our research 20% of patients with atopy in Moscow region have sensitization to Der р and/or Der f. The percentage of allergosensitisation to Der р is higher than to Der f. Most often house dust mites sensitization combined with pollen sensitization.
Russian Journal of Allergy. 2018;15(3):30-34
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Anaphylaxis in infants
Esakova N.V., Konjukova N.G.
Abstract
Anaphylaxis is defined as a serious generalized allergic or hypersensitivity reaction that is rapid in onset and might cause death. Number of patients with anaphylaxis is increased over the last years in all age groups. However, data of anaphylaxis in infants is limited. The knowledge of anaphylaxis in this group of patients is based only on the description of clinical case-report, a retrospective analysis of registers for severe allergic reactions of emergency treatment units. However, children of the first years of life are extremely vulnerable and they have clinical features of the development of anaphylaxis. This article summarizes information on various aspects of anaphylaxis in infants.
Russian Journal of Allergy. 2018;15(3):35-42
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Predictors of efficacy of allergen immunotherapy in children with seasonal allergic rhinoconjunctivitis and pollen-food allergy syndrom
Makarova S.G., Namazova-Baranova L.S., Ereshko O.A., Vishneva E.A., Kogevnikova O.V., Snovskaya M.A., Alekseeva A.A., Efendieva K.E., Levina Y.G.
Abstract
Objective of the research. To study predictors of efficacy of AIT in relation to the symptoms of seasonal ARC and PFAS in children with different IgE profiles. Materials and methods. Open prospective observational study of 161 patients aged 5 to 17 years with clinical symptoms of ARC (the annual escalation in April-May, duration of the disease is not less than 2 years, the need for symptomatic therapy in the flowering season of cause-significant plants) and PFAS for products of plant origin. The examination included skin testing, as well as sIgE determination of birch pollen allergen extract, cross-food allergens of plant origin (apple, pear, cherry, peach, carrot) and recombinant birch pollen allergens allergens (rBet v 1, rBet v 2, rBet v 4, rBet v 6) on the automatic analyzer ImmunoCAP250. All patients received two courses of AIT, sublingual administration. Assessment of efficacy was performed using the modified scheme A.D. Ado and diagnostic introduction earlier unbearable product. Conclusion. Monosensitization to rBet v 1 is a clinical and laboratory marker of the high efficacy of AIT in children with seasonal ARC and PFAS. Conclusion. Monosensitization to rBet v 1 is a clinical and laboratory marker of the high efficacy of ACIT in children with pollinosis and cross-PAS. Daily high-dose immunotherapy with standardized extract of birch pollen allergen has a good therapeutic effect, including in relation to the manifestations ofPFAS.
Russian Journal of Allergy. 2018;15(3):43-52
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Features of innate immunity in children with moderate course of acute urticaria
Maltsev S.V., Sizyakina L.P., Lebedenko A.A.
Abstract
Background. The prevalence of acute urticaria in children remains high. Urticaria is polietiologic disease, maintaining the homeostasis of the body is carried out by close cooperation of various parts of the immune system. The aim of this investigation was to study the features of innate immunity in children with moderate acute urticaria. Methods. To achieve this goal 71 children with moderate acute urticaria were examined. The control group included 30 healthy children of both sexes of the same age. Clinical methods of the study included disease history analysis, phisical examination of the child with determination of the degree of urticaria severity (calculation of the urticaria activity index within 7 days). Immunological methods included NK-lymphocytes, CD14+CD282+, CD14+CD284+, CD14+CD289+, serum IgE level, lactoferrin, IFN-y, IL-4, IL-6, test with NBT rate. Statistical calculations were performed in R Foundation for Statistical Computing. Results. Urticaria with undetermined causal factor happend more often, urticaria with allergic or pseudo-allergic genesis, as well as parasitic infections were established only in 17% of patients, family allergic history was found in a third of patients, in 41% of children acute urticaria proceeded with angioedema, in 9,3% of children urticaria acquired chronic course. Statistically significant increase of CD14+CD284+, decrease of CD14+CD289+, high concentrations of lactoferrin, decrease of natural killers, increase total serum IgE level in the half of the patients, low microbicidal activity with a decrease in adaptation reserves and reduced levels of IL-4, increased the content of IFN-y were found. Conclusion. The revealed changes indicate an imbalance in innate immunity, the launch of the cytokine cascade of inflammation, which is accompanied by further activation of the regulatory components of the inflammatory process in children suffering from acute urticaria.
Russian Journal of Allergy. 2018;15(3):53-58
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Monitoring of immune mechanisms of pathogenesis and efficiency of immune therapy in children with various phenotypes of bronchial asthma
Prosekova E.V., Sitdikova T.S., Zhdanova O.L.
Abstract
Background. Peculiarities of the disease and effectiveness of therapy depend on changes in availability and functions of effector immunocompetent cells and cytokine profile. Purpose. To study the peculiarities of immune pathogenetic mechanisms of virus-induced and allergen-induced bronchial asthma phenotypes in children in order to justify the use of immune therapy and to analyze it’s effectiveness. Materials and methods. We have performed an integrated assessment of immunological parameters in 120 children at the age of 3-11 y.o. with virus-induced and allergen-induced phenotypes of bronchial asthma (BA) and in 30 healthy children. Withdrawal criteria: severe BA, immune therapy during preceding 6 months. We used flow flow cytometer COULTER EPICS XL (Beckman Coulter Inc.) for identification of venous blood cells, CYTOKINE-STIMUL-BEST sets (Vektor-Best JSC, Novosibirsk) for levels of spontaneous and mitogen-induced production of cytokines identification. The immunological effectiveness of treatment was analyzed in the open parallel prospective study using random sampling technique in subgroups on the basis of treatment regimen. Statistical data processing was performed by «Statistica 10» program with critical significance level p<0,05, correlations were analyzed using Spearman rank correlation coefficient, clustering with nonparametric analysis of variance «Kruskal-Wallis ANOVA». Results. Children with various phenotypes of BA demonstrated discrepancies between impairments of availability, proliferation, differentiation and functional activity of immunocompetent cells and cytokine production. The imbalance of cytokine production and impairments of availability and functioning of immunocompetent cells remained unchanged after treatment by inhaled glucocorticoids. When bacterial lysate was added to therapy the normalization of parameters of cellular immune response was observed in patients with virus-induced BA. When glucosaminylmuramyl dipeptide was administered, the recovery of the cells’ capacity for production of spontaneous and mitogen-induced IFN-y was noted in children with allergen-induced phenotype of the disease. Conclusion. Immune pathogenetic mechanisms of virus-induced and allergen-induced BA in children with different immune mechanisms of the disease phenotype justifies individual immunotropic therapy use.
Russian Journal of Allergy. 2018;15(3):59-67
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Correction of zinc insufficiency in children with atopic dermatitis
Revyakina V.A., Mukhortykh V.A., Kuvshinova E.D., Larkova I.A., Kravschova P.O.
Abstract
Atopic dermatitis is a complex multifactorial disease in which the essential microelement (zinc) is deficient, which adversely affects the course of the disease. The use of activated zinc pyrithione in the complex therapy of patients with atopic dermatitis is justified by a wide spectrum of it’s pharmacological action at the molecular level, which allows achieving it’s maximum absorption rate and increasing the ability to penetrate to deep layers of the skin. The use of activated zinc pyrithione in patients with atopic dermatitis leads to reduction of skin manifestations, and to decreasing of itch and the severity of the disease.
Russian Journal of Allergy. 2018;15(3):68-71
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Innovations in allergology
Goudima G.O.
Russian Journal of Allergy. 2018;15(3):72-76
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Goudima G.O. 60th Anniversary
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Russian Journal of Allergy. 2018;15(3):77-78
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Congresses, conferences
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Russian Journal of Allergy. 2018;15(3):79-79
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