Vol 9, No 6 (2012)

The application of the drug, as indicated in the dosage form, dosage regimen, in population or other application parameters that are not mentioned in the approved instructions, called the use of off-label treatment. The prevalence of this phenomenon is as high as 90% in some areas. The vast majority of drugs used for the treatment of chronic urticaria, have no indication for its treatment. To reduce the risk of drug administration off-lable it is necessary to evaluate the clinical situation, the quality of evidence for the efficacy and safety of the drug. There are three categories of situations to make a decision to use off-lable treatment: to use justifiable proof of the quality, to use in the context of scientific research, to use in exceptional cases justified by special clinical situations. Legal support can help the doctor to decide responsibly to treat a patient offlabel.

Aim of investigation. Production of immunologically active recombinant protein of Bet v 2 allergen ofbirch pollen. Materials and methods. mRNA was isolated from a sample ofbirch pollen. cDNA library was derived using SMART technology. Gene Bet v 2 was amplified by means of PCR with primers from the cDNA. The resulting PCR fragment of the gene was cloned into the vector pET29b(+). The recombinant protein Bet v 2 was expressed in cells E. coli, transformed with a plasmid. The recombinant protein was purified using NiNTA agarose. Immunological activity of the recombinant protein Bet v 2 was measured by ELISA and immunoblot methods. Results. The production system of the recombinant allergen Bet v 2 preparation suitable for immunological tests was developed during the research project. In the first phase allergen Bet v 2 gene was cloned from birch pollen collected in Russia. The gene was inserted into the vector pET29(+) for expression in bacterial cells. The expression cell strain E. coli was obtained with this plasmid. The synthesis of the recombinant protein that accumulates in inclusion bodies was activated in bacterial cells. The procedure of recombinant protein Bet v 2 isolation from inclusion bodies was developed by one round of chromatography purification. The recombinant protein isolation was carried out by chromatography on Niagarose. The highly purified preparation of the recombinant allergen was obtained as a result. The recognition of the recombinant protein Bet v 2 by sera varied in ELISA, indicating a different degree of patients sensitization to this allergen. In the immunoblot test the preparation was active only in 15% of cases. Apparently, reactive epitopes of the allergen are mainly conformational ones and are active in ELISA test, whereas linear epitopes, that are active in immunoblot, are in the minority. Conclusion.The system for production of recombinant allergen Bet v 2 preparation suitable for immunological tests has been developed.

Background. The purpose of our research was to study the influence of fungal microflora for perennial rhinitis in children to improve the treatment of this disease. Methods. 79 children aged from 7 to 18 years with perennial allergic rhinitis (PAR) with fungal colonization of the nasal mucosa were examined. Patients underwent clinical, allergy, culturing mycological examination of the mucous membranes of the nose, as well as determination of circulating Candida antigen in serum by ampero-metric enzyme immunoassay sensor. Results. Fungi Candida were dominated — in 75,9% of cases in the structure of mycotic colonization, while mold fungi Aspergillus were observed rarely (24,1%). Colonization of the nasal mucosa with fungi Candida in children with PAR makes disease severe and symptoms become more painful that manifest severe nasal congestion, abundant mucus. PAR patients with nasal colonization of the fungi genus Candida in 58,3% of cases in the circulating blood serum had Candida antigen, that indicating the development of invasive Candida infections. That's why therapy of this disease must be improved. Inclusion of antimicrobial agents to the treatment with further traditional therapy of PAR leads to an overall therapeutic effect in 77,1% of cases. Conclusion. In patients with PAR fungal microflora aggravates the disease and the treatment needs to be improved with the inclusion of antibiotics, which lead to high clinical improvement.

The role of small airways in severe asthma is discussed. The involvement of small airways in the inflammatory process increases the importance of the value delivery systems for effective anti-inflammatory therapy. Extrafine aerosol beclomethasone dipropionate / formoterol (Foster) delivers the drug in the small bronchi significantly improving patient outcomes.