Vol 16, No 3 (2019)


Associative relationship between atopy, HLA complex genes and other genes

Astafyeva N.G., Shamgunova B.A., Kobzev D.Y., Michailova I.A.


This review presents current data on the associative relationships of genes of the major histocompatibility complex (HLA) and other genes with atopy. Despite the long history of studying the role of HLA class genes in atopy and the introduction of modern technologies and methods, many unresolved issues remain, including the difficulties caused by the heterogeneity of the human population, the complex structure and disequilibrium of linkage between different HLA genes. Although phenotypic heterogeneity is considered as the main limitation in understanding the genetic determinants of atopy, only a few studies have examined the relationships of its typical clinical manifestations induced by aeroallergens with certain HLA genes. The identified molecular mechanisms and genetic characteristics open up the possibility of using new therapeutic targets and modifying existing drugs.
Russian Journal of Allergy. 2019;16(3):5-25
pages 5-25 views

Bronchial asthma: pharmacogenetic approaches to optimization of inhaled glucocorticosteroid therapy

Zastrozhina A.K., Zakharova I.N., Sychev D.A.


According to national and international clinical guidelines, inhaled glucocorticosteroids (IGCS) are the most effective drugs in bronchial asthma (BA) therapy. However, IGCS do not always contribute to the full asthma control. In addition to external factors, including low adherence to medical recommendations, errors in the inhalation technique, comorbid conditions, lack of control over the effectiveness of therapeutic measures, and sometimes incorrect diagnosis, recently, much attention has been paid to pharmacogenetic mechanisms in reducing the effectiveness of asthma therapy. The article presents overview data on the pharmacogenetic features of reducing the effectiveness of inhaled corticosteroids in bronchial asthma therapy.
Russian Journal of Allergy. 2019;16(3):26-34
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A comparison of different methods of the allergen-specific immunotherapy in patients with pollinosis: the results of open randomized study

Nasunova A.Y., Nenasheva N.M.


Background. Allergen-specific immunotherapy (ASIT) is viewed as the only treatment that influences all patho-genetically significant parts of the allergic process in the initial and late phases of the IgE-mediated allergic reaction and modifies the abnormal immune reactivity to a specific allergen. Currently, sublingual (SLIT) and subcutaneous (SCIT) immunotherapy are most commonly used in clinical practice. Despite long experience of sublingual and subcutaneous immunotherapy application, questions remain about the preferred ASIT method and comparative effectiveness of different ASIT methods. This article evaluates the efficacy, benefits of SCIT and SLIT and highlights new findings related mechanisms and potential biomarkers. The aim of the study. To evaluate the comparative efficacy of different methods of ASIT (subcutaneous and sublingual) based on clinical data and biomarkers in the blood serum and other biological fluids in adult patients with allergic rhinoconjunctivitis (with/without asthma). Materials and methods. 60 patients with allergic rhinoconjunctivitis (with/without asthma) aged 18 to 50 were randomly assigned to 3 groups treated by sublingual immunotherapy with extracts of allergens, subcutaneous immunotherapy with extracts of allergens and subcutaneous with modified allergens (allergoids) respectively. Results. The efficiency of the first course of preseason ASIT (SCIT and SLIT) with extracts of allergens and aller-goids in the control of symptoms of allergic rhinoconjunctivitis (with/without asthma) was demonstrated. After the end of the first year pre-season ASIT data analysis scales (Total Symptom Score -TSS, Medircation Score -MS) revealed the best performance in the group of patients receiving SCIT with allergoids compared with patients receiving the SLIT with extracts of allergens: the scales of the TSS (p=0.023), MS (p=0.002). In addition, at the end of the maintenance phase of ASIT in patients treated with SCIT with allergoids the level of eosinophilic cationic protein (ECP) in the nasal lavage decreased by 22% (p=0.012), secretory immunoglobulin A (sIgA) in the nasal lavage increased by 70% (p=0.001), interleukin-10 (IL-10) in serum increased by 126% (p=0.006), allergen-specific IgG4 increased by 42% (p=0.01) from the initial values, that correlates with a decrease in the severity of clinical manifestations. In pollen season ECP level in nasal lavage was significantly (p=0.007) lower in a group of patients who received SCIT with allergoids compared with patients who received the SLIT with extracts of allergens. The most significant changes of serum level of IL-10 in the pollen season occurred in a group of patients receiving SCIT with allergoids compared with patients who received SLIT (p=0.013) and SCIT (p=0.001) with extracts of allergens. Conclusion. The study results deepen the existing understanding of the mechanisms of SCIT and SLIT. They allow to develop a comprehensive assessment of the therapy efficacy scheme based on clinical parameters and on monitoring of local (ECP, sIgA) and systemic biomarkers (IL-10, allergen-specific IgG4) as well.
Russian Journal of Allergy. 2019;16(3):35-45
pages 35-45 views

Passport of sensitization of schoolchildren as a tool for the prevention of asthma

Dzhambekova G.S., Katsamaki S.P., Garib V.F.


Molecular allergy diagnosis allows to identify sensitization to a large range of respiratory allergens, which is important in the diagnosis of allergic asthma. Moreover, based on the reactive IgE profile detected at an early age, it is possible to predict the development of allergic respiratory diseases even at the preclinical stage. The goal of the pilot project was to create a children's passport sensitization using a multiplex panel to be able to identify groups at risk for the development of asthma in children of early school age. Materials and methods. Parents of 33 students studying in the second grade of the Tashkent gymnasium were questioned using the ISAAC questionnaire for the clinical manifestations of respiratory diseases in their children. Their children’s sera were tested for the presence of IgE to various allergenic molecules using the MeDALL research method. Results. 30% of children were sensitized to at least one allergen, and 30% of them were born by Caesarean section. and 30% of them were born by Caesarean section. In total, 68 of the 176 allergenic molecules located on the MeDALL microchip were recognized. 80% of sensitized children had a genuine polysensitization to 3 or more major allergens. In 18% of children, IgE to household molecules of the risk of developing asthma, such as Alt a 1, Bla g 1, Bla g 2, Can f 1, Fel d 1, were detected. Conclusions. In general, clinical manifestations in the form of wheezing and obstruction were detected in 60% of sensitized children, but only 40% of these children were under the supervision of an allergist or received symptomatic treatment. In 20% of already sensitized children, clinical symptoms were absent. Molecular testing of the profile of IgE sensitization and the creation of an allergic passport allows us to identify a group of children at risk for developing asthma. This information can be used to assign therapy and secondary prevention of asthma in the early school years.
Russian Journal of Allergy. 2019;16(3):46-51
pages 46-51 views

Assessment of cytokine profile and T-lymphocyte subpopulations in blood serum in children with allergic diseases of the respiratory system

Prosekova E.V., Turyanskaya A.I., Plekhova N.G., Dolgopolov M.S., Sabynych V.A.


Expansion of the range of examined T-helper clones has determined more complex immune mechanisms for the implementation of allergic inflammation. Objective. To characterize the parameters and relationships between the serum cytokine profile and T-lympho-cyte subpopulation in peripheral blood of children with bronchial asthma and allergic rhinitis. Materials and methods. 150 children aged between 3-11 years old with bronchial asthma, and allergic rhinitis and 30 healthy volunteers were examined. Immunological parameters were assessed by flow cytometry, the concentration of serum interleukins and IgE were determined by means of enzymelinked immunosorbent assay. Statistical analysis was performed with «Statistica 10» program with a critical level of significance p<0.05. Results. High levels of interleukins -4, -8, -13, 17A were determined, IL-7F level was not significantly different from that in control group and low level of IFN-y was found in the serum of children with allergic diseases. The number of CD3+CD8+CD45RO+, CD3+CD8+CD45RACD45RO+ T-lymphocytes, CD3+CD4+ T-helper cells and Th17 were increased and at the same time CD3+CD4+CD45RO+ memory cells were decreased In bronchial asthma and allergic rhinitis children. Number of Th17 cells in healthy children was 9.49±1.6%, in allergic children it was significantly higher - 14.5±0.77% (p<0.001). Analyses of serum cytokine count in children with isolated BA and in association with allergic rhinitis revealed multidirectional correlations differing in strength and direction from those in the group of healthy children. Conclusion. In children with isolated bronchial asthma and associated with allergic rhinitis the following parameters were found: CD3+CD4+ T-cells count was comparable to that in healthy children, the imbalance of T-helper subpopulation: prevalence of Th2 and Th17, activation of IL-17A, IL-4, IL-8, IL-13 synthesis and low level of serum IFN-y.
Russian Journal of Allergy. 2019;16(3):52-60
pages 52-60 views

Hereditary angioedema: experience of substitution therapy with a C1 esterase inhibitor in the Sverdlovsk region

Beltyukov E.K., Vedenskaya S.S., Skorokhodov I.S., Naumova V.V., Beltyukova M.V., Karakina M.L.


Hereditary angioedema (HAO) is rare disease, however, it's lifethreatening localization can be fatal. Antifibrinolytics and attenuated androgens used for the prevention of HAO attacks have side effects, which limit their use. The bradykinin B2 receptor antagonist, Icatybant is an effective but shortacting dmedication. The human C1 esterase inhibitor (berinert) is safe and effective for the prevention and relief of angioedema of lifethreatening localization, including in pregnant women. The management of patients with HAO is regulated by national guidelines, and the use of a human C1 esterase inhibitor is recommended by instruction of the drug and by the Ministry of Health of the Sverdlovsk region. Patients with HAO should be provided with patient’s passport and fill a diary of symptoms monitoring of HAO.
Russian Journal of Allergy. 2019;16(3):61-66
pages 61-66 views

Tiotropium bromide: additional options for the treatment of bronchial asthma

Kurbacheva O.M., Dyneva M.E.


Bronchial asthma (BA) is one of the most common chronic diseases, characterized by airway inflammation and bronchospasm. Symptoms of BA are wheezing, shortness of breath, a feeling of constriction in the chest and cough, the frequency and severity of which vary greatly over time. Today studies of BA phenotypes allow selecting treatment depending on the particular pathogenesis of each phenotype individually, thereby helping to achieve control, which is the main goal of BA therapy. However, it is necessary to take into account the peculiarities of airway innervation, since an increased parasympathetic tone is characteristics of all BA phenotypes and plays an important role in the development of bronchoconstriction and inflammation. Therefore, tiotropium bromide, which is a long-acting blocker of muscarinic cholinergic receptors, is one of the main bronchodilators in the treatment of BA. It blocks bronchoconstriction, hypersecretion and swelling of the mucous membrane of the airway, which in turn prevents the progression of inflammation, and the prolonged action of tiotropium bromide, which allows it to be used once a day helps to achieve control of asthma in addition to basic inhalation therapy - inhaled corticosteroids (ICS) long-acting P2-agonists (LABA). According to GINA (Global Initiative for Asthma), tiotropium bromide is recommended as an additional treatment, starting from step 4, and in accordance with the Russian Federal Clinical Guidelines for Bronchial Asthma - from step 3. Currently, according to clinical studies, much is known about the mechanisms of action and biological properties of tiotropium bromide, which made it possible to substantiate the needs for its administration to patients with BA regardless of its phenotype. This strategy will contribute to a more successful control of BA considering risk factors and comorbidity, thereby reducing needs of increasing ICS dose.
Russian Journal of Allergy. 2019;16(3):67-74
pages 67-74 views

Long-term prophylaxis in HAE patients

Latysheva T.V., Latysheva E.A., Manto I.A.


Hereditary angioedema (HAE) due to of C1-inhibitor deficiency is a rare disease, which causes a strong physical and psychological impact on patients’ lives. HAE affects daily life, career opportunities, and social activity. In addition, fear of the edema development, as well as the associated with it pain and risk of death leads to depressive disorders specific for chronic (especially life-threatening) diseases. The emergence of modern pathogenetic drugs can minimize the effect of HAE and improve the patients’ quality of life. There are three different therapeutic strategies that are used for HAE treatment: long-term prophylaxis, short-term and on-demand therapy for acute attacks. This article focuses on long-term prophylaxis.
Russian Journal of Allergy. 2019;16(3):75-83
pages 75-83 views

Hypersensitivity reactions to iodinated contrast media

Khludova L.G., Myasnikova T.N., Smirnov V.V., Latysheva T.V., Khaitov M.R.


Hypersensitivity reactions to iodinated contrast media are a pressing public health issue. Lack of understanding of pathogenetic mechanisms of such reactions leads to unjustified refuse of diagnostic and therapeutic procedures using iodinated contrast agents. Reactions of hypersensitivity to other iodine-containing medications are not a contraindication for use of contrast agents. Skin allergy tests are only performed in the patients who had a history of allergic reactions to iodinated contrast media. Usually it is possible to determine an alternative agent by means of skin tests. Premedication before a contrast-enhanced radiological examination has to be indicated to all patients with previous history of allergic disease.
Russian Journal of Allergy. 2019;16(3):85-91
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Russian Journal of Allergy. 2019;16(3):93-93
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Resolution of the United Immunological Forum 2019

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Russian Journal of Allergy. 2019;16(3):94-99
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Oongresses, conferences

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Russian Journal of Allergy. 2019;16(3):100-100
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