Vol 16, No 2 (2019)


The diagnosis of chronic inducible urticarias

Borzova E.Y.


Chronic inducible urticarias are characterized by the risks of systemic reactions and a significant impairment of patient’s quality of life. The diagnosis of chronic inducible urticarias relies on the patient’s history and the challenge tests. A treatment algorithm for the management of chronic inducible urticarias includes nonsedating antihistamines as a first-line treatment. The international guidelines for the management of chronic inducible urticarias recommend updosing of nonsedating antihistamines up to four fold if standard doses are not effective. The meta-analysis suggests the efficacy of omalizumab in chronic inducible urticarias. In the prospect, the novel options of biological therapy for chronic inducible urticarias are expected.
Russian Journal of Allergy. 2019;16(2):5-13
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Features of asthma treatment during pregnancy

Lavrova O.V., Petrova M.A., \\Fedoseev G.B.


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.
Russian Journal of Allergy. 2019;16(2):14-19
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The response variability of the asthma patients to the standard pharmacotherapy

Pavlova K.S., Mdinaradze D.S., Kurbacheva O.M.


Background. The aim of this study was to analyse the group of patients with asthma, who prefer to use short-acting anticholinergics (SAMA) for relief of asthma attacks. At the same time, these patients are prescribed inhaled glucocorticosteroids (ICS) in combination with long-acting P2-agonists (LABA) as a basic therapy according to the standards. Tha aim. To study the cause of low efficacy of LABA in patients with asthma who do not have a sufficient response to SABA, as well as the probability of reducing of bronchial obstruction with LAMA. Materials and methods. 12 non-smoking adults with moderate to severe asthma (III-IV stage of GINA), receiving medium or high doses of ICS in combination with LABA as a basic therapy without adequate control over asthma symptoms were included in the study. First group of patients showed the efficacy of salbutamol (FEV1 reversibility was more than 12% and more than 200 ml after 400 ^g of salbutamol) and ipratropium bromide (SABA+SAMA+). Second group included patients with low response to salbutamol and positive test (FEVt reversibility) with ipratropium bromide (SABA-SAMA+). Spirometry was performed at baseline point and in 5, 10, 15, 30, 60, 120 and 240 min after inhalation of bronchodilator (salmeterol 50 ^g, formoterol 12 ^g and tiotropium bromide 18 ^g in the different days). Results. It was shown that SABA-SAMA+ phenotype asthma patients demonstrated low response to LABA: FEV1 increased up to 7.64±1.67%, 156.0±16.0 ml after salmeterol inhalation and up to 9.4±5.8%, 166.7±103.1 ml after formoterol inhalation (compared with a group of SABA+SAMA+, where the response to salmeterol was 20.81±2.42%, 551.43±93.94 ml and the response to formoterol was 30.21±6.75%, 718.57±140.78 ml, p<0.05), and a good response to LAMA (13.7±5.8% and 250.0±61.6). Conclusion. The results of the study allowed to define asthma phenotype with low bronchial obstruction reversibility to SABA and sufficient reversibility to SAMA (SABA-SAMA+). This group of asthma patients need the basic treatment with the combination of ICS and LABA and LAMA (tiotropium bromide).
Russian Journal of Allergy. 2019;16(2):20-24
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Allergy to lemon: case of oral allergic syndrome associated with allergic otitis media and labyrinthitis in a patient with polysensibilization and multiple manifestations of allergy

Prilutskiy O.S., Lyhina Y.A.


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.
Russian Journal of Allergy. 2019;16(2):25-32
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Polymorphic variants of matrix metalloproteinases genes in children with atopic dermatitis

Semernik O.E., Lebedenko A.A., Shkurat T.P., Mashkina E.V., Dreyzina T.K.


Matrix metalloproteinases (MMP) play a special role in the pathogenesis of atopic dermatitis (AD). Therefore, the study of the features of genes responsible for the synthesis of MMP in children with AD is of great scientific and practical interest. Background. To study the role of polymorphic variants of matrix metalloproteinase genes (MMP 9 and MMP20) in the pathogenesis of AD in children. Materials and methods. Allelic variants of320A>C gene MMP20,837T>C gene MMP20, -8202 A>G gene MMP9 in children with AD were studied using the method of allele-specific polymerase chain reaction. The control group consisted of I and IIa the health groups patients of the corresponding sex and age. Results. The results of genetic studies showed that the incidence of alleles and genotypes in the polymorphisms 320A>C of the gene MMP20, 837T>C of the gene MMP20 in patients had no significant differences from the control group (p>0.05). It was established that the A/A-genotype of polymorphism -8202 A>G of the MMP9 gene, prevailed among children suffering from AD at a frequency of 69.2%, whereas in the group of healthy children the frequency of this genotype was 3 times lower (p=0.003). At the same time A/G-genotype (55.7%) was predominant in the control group, while G/G genotype was 2 times lower (21.3%). Thus the risk of AD increased by 7.55 times (OR=7.55 [95% Cl - 2.97-19.21; p<0.001] in children with genotype A/A. Conclusion. The most significant polymorphism in the pathogenesis of AD in children is 8202 A>G of the MMP9 gene, in particular the risk of developing of skin manifestations of allergy is increased by more than 7 times in A-allele homozygotes.
Russian Journal of Allergy. 2019;16(2):33-37
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The significance of cow’s milk proteins in the development of IgE-mediated food allergy among children

Petrova S.Y., Khlgatian S.V., Berzhets V.M., Pishchulina L.A., Vasilyeva A.V.


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.
Russian Journal of Allergy. 2019;16(2):38-44
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Serum periostin level in children of preschool age with recurrent wheezing episodes and in healthy children: a cross-sectional study

Shakhova N.V., Kamaltynova E.M., Kolesnikova O.I., Kashinskaya T.S.


Background. The level of serum periostin in preschool children with recurrent wheezing episodes has been studied. Objective. To determine the serum periostin level in preschool children with recurrent wheezing episodes, compared to healthy children. Results. 101 children of 3-4 years old took part in the study, 72 of them had recurrent wheezing episodes (more than 3 episodes over the past year) and 29 - healthy individuals. Statistically significant differences in serum periostin level between children with recurrent wheezing episodes and healthy children were not found. The level of serum periostin (median, quartile) is 3.0 (1.8; 4.0) ng/ml in children with recurrent wheezing episodes and 2.7 (1.7; 3.6) ng/ml in healthy children (p=0.296). The area under the ROC curve (AUC) was 0.56 (95% CI 041-0.68). Conclusion. The level of serum periostin in children with recurrent wheezing episodes does not differ from the level in healthy children.
Russian Journal of Allergy. 2019;16(2):45-49
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Diagnostic and treatment algorithm for different phenotypes of chronic rhinosinusitis with nasal polyps

Savlevich E.L., Dyneva M.E., Gaganov L.E., Egorov V.I., Gerasimov A.N., Kurbacheva O.M.


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.
Russian Journal of Allergy. 2019;16(2):50-60
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Retention adherence to therapy as a guarantee of the SLIT efficacy

Pavlova K.S., Mdinaradze D.S.


According to WHO at last 50% of the patient don't follow doctor’s recommendations. Ultimately, this leads to a decrease or absence of the treatment effect. In this regard, all the latest international and national guidelines mention the need to take into account the patient’s preferences in the choice of therapy. Allergen-specific immunotherapy (AIT) is one of the main methods of treatment of allergic diseases such as allergic rhinitis, allergic conjunctivitis and atopic asthma, and has disease modifying properties and the long-term efficacy after stop treatment. AIT refers to a preventive and long-term method (recommended for at least 3 years), that is often the cause of reduced adherence to therapy. Various studies have confirmed the dose-dependent effect of AIT, and, consequently, changes in regimens or shortening of therapy may affect the end result. In case of insufficient effectiveness of AIT, the probability of low compliance should be considered first of all. Sublingual AIT (SLIT) requires the patient to be highly involved in the treatment process. The task of the doctor in this case is increasing therapeutic cooperation, as one of the most important factors to ensure the effectiveness of SLIT. The main methods in this case are to improve the patient’s understanding of the purpose of the therapy and regular monitoring by the doctor.
Russian Journal of Allergy. 2019;16(2):61-66
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Prevalence of severe bronchial asthma phenotypes in the Middle Urals

Beltyukov E.K., Naumova V.V., Abdullaev V.C., Styazhkina Y.A., Vedenskaya S.S.


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.
Russian Journal of Allergy. 2019;16(2):67-74
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Current approaches to diagnostics and treatment of angioedema in pediatric patients

Denisova A.R., Pampura A.N.


Angioedema often occurs in childhood. The effectiveness of the management of children with angioedema is determined by understanding the pathogenesis of the disease and the selection of personalized therapy. This article provides information on the classification, clinical manifestations, diagnostics and therapy of both bradykinin and histaminergic angioedema.
Russian Journal of Allergy. 2019;16(2):75-81
pages 75-81 views

The main causes and factors of immune dysfunctions in humans and modern approaches to their correction

Luss L.V., Ilina N.I., Shuljenko A.E., Nazarova E.K., Shartanova N.V., Sidorovich O.I.


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.
Russian Journal of Allergy. 2019;16(2):82-92
pages 82-92 views

Indicators of activin A in patients with external genital endometriosis. Materials of 15th International Interdisciplinary Congress on Allergology and Immunology (May 22-24, 2019, Moscow)

Levkovich M.A., Ermolova N.V., Krukier I.I., Avanesova T.G., Nikashina A.A.


Actuality. External genital endometriosis (EGE), leading to functional and structural changes in the reproductive system and infertility, takes the 3rd place in the structure of gynecological pathology. Objective. To determine the local and systemic level of activin A in patients with external genital endometriosis. Materials and methods. The study included 71 patients with EGE, who were divided into two groups: 1 group - patients with I-II stages (n=31); 2 - patients with III-IV stages (n=40). The control group included 24 patients without EGE. The determination of the level of activin A in the serum and peritoneal fluid was performed by enzyme immunoassay using DSL test systems (USA). Results. In the blood serum the level of activin A exceeded in patients of both studied groups compared the control group, but the most evident changes were observed in patients with stage III-IV of EGE. In the study of peritoneal fluid an increase in activin A was found only in patients in the 2nd group. Conclusion. An increase of serum and peritoneal fluid activin A level was associated with the risk of developing of EGE in patients of reproductive age.
Russian Journal of Allergy. 2019;16(2):93-95
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Congresses, conferences

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Russian Journal of Allergy. 2019;16(2):96-97
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Fedoseev Gleb Borisovich (04.09.1930 - 11.05.2019)

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Russian Journal of Allergy. 2019;16(2):98-99
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