Vol 11, No 6 (2014)

Background. To evaluate clinical features and to develop the diagnostic algorithm of perioperative drug’s hypersensitivity reactions. Methods. 40 patients who presented perioperative immediate drug’s hypersensitivity reactions were studied in the Central Clinical hospital of the Russian Academy of sciences during 2010-2012. The diagnostic protocol consisted of 2 steps: at the 1 step (during the acute clinical manifestation period) a case history, grade of severity of immediate hypersensitivity reactions, serum tryptase levels have been studied; at the 2 step (6-12 weeks after symptoms were over) inhibition test of natural emigration of leukocytes by Ado, sublingual, skin tests and drug provocation tests have been performed. Results. Clinical manifestations of drugs hypersensitivity were as follows: hypersensitivity reactions grade I (isolated cutaneous manifestations) - in 20 patients (50%), anaphylactic-type reactions - in 20 patients (50%): grade II (moderate anaphylaxis) - in 13 patients (32,5%), grade III (severe life-threatening anaphylaxis) - in 6 (15%), and grade IV (cardiac and respiratory arrest) - in 1 patient (2,5%). Positive tests at least with 1 drug had 28 patients (70%): neuromusculars blockers (22,5%); antibiotics (22,5%); lidocaine (10%); amidotrizoate (7,5%); NSAID (7,5%). Other 12 patients had negative tests (30%) with all suspected agents and moderate clinical symptoms if to compare with others 28 patients (p<0,05%). Clinical manifestations of perioperative reactions depend on the kind of used drug: neuromuscular blockers, lidocaine and amidotrizoate inducted more severe reactions then antibiotics (p<0,05%). Conclusion. Immediate perioperative drug hypersensitivity reactions manifest as anaphylaxis in 50% of cases and mostly were caused by neuromuscular blockers and antibiotics. The present protocol of allergological examination allows to detect etiological drug and to determine its clinical significance.

The patient’s perception of their illness is critical for effective treatment. Data on medical psychological testing of patients with allergic diseases are absent in Russia, therefore, the results of interviewing of patients by «focusgroup» method are of interest. The main issues of discussion: the perception of allergy and it’s manifestations / symptoms approach to the selection and choice of therapy, attitude to the various brands, especially Suprastin and Suprastinex. The article presents the results of the survey.

Recently the problem of low adherence of patients to treatment attracts more attention worldwide. WHO experts recognized the low adherence to therapy as a global international problem. In real life, the results of allergen-specific immunotherapy (ASIT) are not so beneficial first of all due to patient’s noncompliance. The cooperation between patient and physician helps to achieve positive results of the treatment. The solution of the problem of low adherence of patients requires the development of systematic approaches, and the medical community is ready to propose it.

Chronic recurrent herpes virus infection is a major problem of modern health care, not only due to its wide distribution among the reproductive age population, but also due to the complexity of the control of this disease, in spite of modern treatment methods. This situation is a result of the development of so called «vicious circle» - the severity of herpes virus infection depends on the degree of immunosuppression and on the nature of immune system disorders caused by immunosuppressive properties of the virus. Understanding of the pathogenesis of the disease and especially local and systemic immune response helps to shape immunopathogenetic approach to therapy of herpes virus infection. Study of immunomodulator Laennek® («Japan Bioproducts Co., Ltd», Japan) efficacy as adjuvant therapy of chronic recurrent viral infection caused by the herpes simplex viruses type 1, 2 showed good results.

Despite advances in understanding of mechanisms of development of hives, many patients and their physicians remain unsatisfied results of treatment, lack of control of the disease. Now treatment of patients with the chronic urticarial has landmark character. The new indication for omalizumab was registered in Russia in 2014, giving the chance to achieve the control on a refractory form of urticaria. Omalizumab demonstrated rapid and beneficial effects on the signs and symptoms of chronic spontaneous urticaria torpid to H1blockers in the numerous studies.

Intravenous immunoglobulin G preparation (IVIG) is an effective and safe therapeutic modality in the primary immunodeficiencies (PID) management. We investigated effectiveness and safety of the 10% preparation of IVIG Gamunex in treatment of 26 patients with primary immunodeficiencies at ages 8 months 17 years. Percentage of nonsevere reactions to Gamunex infusions was similar as to other 5% IVIG preparations (2,9 vs 2,8%). Average time of infusion was reduced from 88 minutes for 5% IVIG to 67 minutes for Gamunex. Average trough IgG level after Gamunex infusions was sufficient (6,8 g/l) and resulted in the absence of significant infectious episodes in PID patients during the study period. Our study demonstrated good efficacy and safety profile of Gamunex.