Vol 16, No 2 (2019)

Study goal. To analyse asthma therapy in pregnant women with bronchial asthma at a period since 2002 to 2017. Materials and methods. 3890 pregnant women with asthma were examined and followed up during pregnancy at a period since 2002 to 2017. Comprehensive clinicalfunctional examination was conducted. Patients were under surveillance of the obstetriciangynecologist during the whole pregnancy, standard procedures were carried out, and the frequency of complications of pregnancy was estimated. Basic therapy of asthma was compared in groups with the persistent asthma duration, followed up since 2002 to 2009 (1 group) and since 2010 to 2017 (2 group). Also, frequency of pregnancy complications was estimated in these groups. Results. The second group (2010-2017) demonstrated reliably lower frequency of threatening abortion, hypertension and preeclampsia. At the same time the frequency of inhaled corticosteroids (ICS) administration as a part of the combined therapy increased from 21.79% to 63.87% (almost to three times) in comparison with the first group (2002-2009). Conclusions. Combined therapy with ICS/LABA provides most complete control of bronchial asthma, and decreases frequency of pregnancy complications in pregnant women with BA.

Oral allergic syndrome is an IgEmediated allergic reaction to foods of plant origin in persons with sensitization to various pollen allergens. A clinical case of oral allergy syndrome caused by consumption of lemon in a 25-year-old woman with sensitization to many groups of allergens and presence of allergic otitis media and allergy-induced labyrinthitis is presented. The patient had a history of seasonal allergic rhinoconjunctivitis, bronchial asthma, contact allergic dermatitis, urticaria as a manifestation of drug allergy. In vivo (skin prick tests, prick-prick tests) and in vitro allergen specific diagnostics allowed to work out the individual diet and a hypoallergenic regime in this case.

Identification of offending allergens in patients with food allergy is a very important part of an allergist’s activity. Objective. To study the structure оf sensitization to food allergens among children in Moscow and Moscow region and to determine the significance of sensitization to milk proteins . Methods. The level and class of specific IgE in blood serum of children with IgEmediated allergic diseases were examined with RIDA AllergyScreen method. Serum of children with high level of specific IgE to milk allergenic proteins was studied. The level and ratio of specific IgE to individual milk allergens were revealed. Results. The structure of sensitization to food allergens was determined. It was revealed that cow’s milk allergens are the leading triggers of food allergy, especially in early childhood in Moscow and the Moscow region. The features of sensitization to cow’s milk proteins among children were analyzed. Conclusions. According to the study, about half of children with IgEmediated food allergies in Moscow and the Moscow region have sensitization to cow’s milk proteins. The leading role in the frequency of sensitization belongs to whey proteins of milk. Among them sensitization to а-lactalbumin was detected more often. The questions about the selection of hypoallergenic milk formulas for feeding of children with allergy to cow’s milk proteins were discussed.

Chronic rhinosinusitis with nasal polyps (CRSwNP) may vary in clinical manifestations and can often be associated with a number of comorbid diseases. For a practitioner it is important to forecast the development of the disease, evaluate the risk of relapse and select the most efficient method of treatment in each clinical case. At present, there are no standardized and validated diagnostic biomarkers that could be used as predictors of CRSwNP clinical course. Purpose of the study: to develop diagnostic and treatment algorithm for varies CRSwNP phenotypes based on clinical and laboratory parameters. Materials and methods, CRSwNP patients were split into 3 groups: group 1 - CRSwNP without allergy and asthma; group 2 - CRSwNP with allergic rhinitis and/or allergic asthma; group 3 - CRSwNP with non-allergic asthma. All patients were subjected to nasal cavity endoscopy and nasal polyps biopsy, allergological examination, histological analysis of polyp stroma to detect the leukocytes infiltration and eosinophil-neutrophil index (ENI). Results, CRSwNP phenotypes show significant difference in clinical manifestations of rhinosinusitis (p<0.005), eosinophil blood count (p<0.001), and polyps stroma leukocytes infiltration (p<0.004). At the same time, the combination of CRSwNP with allergic rhinitis, allergic and non-allergic asthma showed a more pronounced inflammatory response, which once again confirms the fact of the mutual influence of these pathological processes on each other. It was also found that the absolute eosinophil blood in peripheral blood does not correlate with the severity of eosinophilic cell infiltration degree in nasal polyps stroma, and, consequently, does not have correlate clinically relevant information on intensity of the local inflammatory response, contrary to previously proven relation between eosinophil count in blood and sputum in patients with asthma. Conclusion, Our study showed the feasibility of phenotyping CRSwNP depending on the comorbidity, which is a necessary tool in the selection of therapy in each case. Therefore, to improve the control and prevention of relapse of CRSwNP, a diagnostic and treatment algorithm for the management of patients depending on the phenotype of the disease is proposed.

Topicality. Severe asthma is a heterogeneous and cost-effective disease that requires a personalized treatment approach with inclusion of targeted therapy involving the phenotyping of asthma. Objective. Determine the dynamics of asthma prevalence in the Middle Ural, including severe asthma, and phenotype patients with severe asthma for the selection of targeted therapy. Materials and methods. Population studies of bronchial asthma prevalence were conducted in the Middle Ural from 2000 to 2012 using the standard ECRHS questionnaire. Also registers of patients with asthma were created. An analysis of outpatient records of patients with asthma was conducted in Ekaterinburg in 2018. The phenotyping of bronchial asthma was carried out by an allergist-immunologist. Results. The number of patients with bronchial asthma increased by 2.7 times over 17 years in the Middle Ural. Patients with mild asthma prevail in the population. The atopic asthma phenotype predominates in 70.8-81% of cases regardless of the population category. Severe uncontrolled bronchial asthma occurs in 10.2% of cases among all patients seeking medical care. Every second patient with severe uncontrolled asthma has an atopic phenotype, which is 5% of the total number of analyzed patients with bronchial asthma. Every fourth patient with severe uncontrolled bronchial asthma has an eosinophilic phenotype, which is 2.3% of all analyzed patients with bronchial asthma (n=216). Conclusion. Phenotyping of asthma has important practical significance for planning effective targeted therapy in a population of patients with severe uncontrolled asthma.

The review presents modern view on the immune system dysfunction growth, reduction of protective functions, inferiority of adaptation reactions and the adaptation of the humans to the negative effects of exogenous and endogenous damaging factors. The mechanisms of immune deficiency formation and modern methods of its correction are considered. The mechanisms of action of exogenous immunomodulators and their main advantages are presented by glucosaminylmuramyl dipeptide example.