Vol 14, No 3 (2017)

The article is based on the resolution of the Expert Council, including experts from Russian Association of Allergists and Clinical Immunologists (RAACI) and Russian Respiratory Society (RRS) dated November 20, 2016, and the review of clinical studies results and publications on the biomarker-based diagnosis and biological treatment of severe uncontrolled asthma. The aim of this work is to develop a phenotype-oriented algorithm of diagnostics and treatment of severe asthma, supported by the biomarker testing for subsequent selection of appropriate immunobiological treatment. The article constitutes the summary of results of clinical studies and expert opinions on the treatment of asthma in patients who do not achieve disease control with standard treatment regimens including high doses of inhaled corticosteroids in the combination with long-acting beta-agonists, tiotropium, and medications from other pharmacological groups according to Russian Respiratory Society (2016) and GINA (2016-2017) guidelines. The article summarizes the results of international randomized clinical studies performed to assess safety and efficacy of new class of biological treatments, monoclonal antibodies acting against major cytokines that are responsible for inflammation, in patients with severe asthma, including a new anti-IL-5 antibody, reslizumab (Cinqaero).

Background. To study tacrolimus 0,1% ointment influence on the skin local immune parameters in patients with moderate and severe atopic dermatitis (AD). Materials and methods. The study included 30 patients with moderate (n=20) and severe (n=10) AD. All patients underwent a topical continuous course of treatment with tacrolimus 0,1% ointment twice a day for 14 days. The clinical efficacy of tacrolimus 0,1% ointment was evaluated by the change of the following parameters: SCORAD index, Investigator Global Assessment (IGA) before and after the treatment. All patients underwent a study of local immune response before and after the treatment with the assessment of the expression of IL4, IL5, IL7, IL8, IL10, IL17A, IL23, IL23, IFNγ TGFB1, FOXP3 genes in irritated and treated skin lesions obtained by biopsy. Results. Positive clinical effect - reduction of infiltration, papular rash, dryness, intensity of itch, reflected in the significant decreasing of SCORAD index and IGA was found. The significant decreasing of TGFß (p=0,043308) and IL8 (p=0,038867) gene expression level was revealed, TGFβ and IL8 are the markers of chronic inflammation in atopic dermatitis. The decrease of these parameters during the topical tacrolimus treatment demonstrates local immune response changes in the skin, accompanied by improvement of AD symptoms. Conclusion. The study showed clinical efficacy as well as immunosuppressive activity of tacrolimus 0,1% ointment in patients with moderate and severe AD represented in decreasing of proinflammatory cytokines gene expression TGFβ and IL8 in skin lesions.

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization (WHO) workshop in 1999. The initial goals were to propose a new allergic rhinitis classification, to promote the concept of multi-morbidity in asthma and rhinitis and to develop guidelines with all stakeholders for global use in all countries and populations. ARIA - disseminated and implemented in over 70 countries globally - is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les MAladies Chroniques pour un Vieillissement Actif) - ARIA Sentinel NetworK] uses mobile technology to develop care pathways in order to enable the management of rhinitis and asthma by a multi-disciplinary group or by patients themselves. An App (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.

The article presents the concept of the severity of chronic idiopathic (spontaneous) urticaria, evaluation, disease control, masks of chronic urticaria, risks and treatment.