Vol 16, No 4 (2019)

Seasonal allergic rhinitis and conjunctivitis, caused by ragweed pollen in the south of Russia, are the most common reasons to take medical advice for sensitized patients from August to September. Sublingual immunotherapy (slASIT) using ragweed sublingual tablet «Ragvizax®», which was registered in Russia in 2019 provides qualified medical care for patients with ragweed pollen allergy. It is known that ASIT is the basic therapy, that modifies pollen allergy progression. Easy to use, high safety and efficacy profile of slASIT with «Ragvizax®» will help to improve allergists and patients compliance.

Genetic predisposition, twophase immune response, T1 and T2 lymphocytes dysbalance, epidermal barrier dysfunction, trigger factors, antigens play an important role in the atopic dermatitis pathogenesis. Recently, genotypes, phenotypes of the disease, as well as the relationship of genetic factors, pathogenesis and clinical features of AD, which determine the phenotype of the disease, are actively studied. The purpose of this research was to evaluate the clinical features of different AD phenotypes. Materials and methods. The research was conducted as an open prospective study. 86 patients suffered from moderate and severe AD, including 25 children aged 2 to 18 years and 61 adults aged 19 to 54 years were involved. Patients in the skin allergy and immunopathology department of «The Institute of Immunology of the FMBA of Russia» in the period from 2012 to 2016 were observed. The followup period was at least 1 year. The inclusion criteria of this group were the ability to collect a full anamnesis, the allergological examination, assessment of the severity of the disease and the response to the therapy, the adequacy of the fulfilment of the doctor’s recommendations by the patients, including compliance with elimination measures, diet, rational skin care, as well as the use of topical treatment. All patients received standard therapy according to Russian and international clinical guidelines. The severity of the disease was assessed on the basis of SCORAD and IGA scales, effectiveness of topical treatment and adverse events frequency. Results. The main criteria for determining of AD clinical phenotypes were established: severity of the disease (based on SCORAD, IGA); frequency and duration of exacerbations; age of onset of the disease; secondary skin infection; concomitant respiratory allergic diseases and sensitization to different groups of allergens; resistance to therapy. Recurrent course of AD and resistance to standard topical corticosteroids therapy were observed in 8 (32%) children and in 20 (32.7%) adults. The results of examination of representative sample of patients allowed to identify and characterize several AD phenotypes: isolated uncomplicated AD - in 15% of patients; AD complicated by secondary infection and the presence of sensitization to bacterial or fungal allergens - in 7% of patients; AD accompanied by the concomitant respiratory allergic diseases and the presence of sensitization to food and respiratory allergens - in 29% of patients; extremely severe AD, accompanied by secondary infection, respiratory allergic diseases and polyvalent sensitization, resistance to therapy - in 36% of patients. Conclusion. Identification of the clinical phenotype allows to determine the patients on the grounds of the clinical characteristics and AD features, which can be useful for understanding the etiopathogenesis of the disease in a particular patient and can be the basis for development of personalized approaches to the diagnosis and treatment of AD.

Relevance. Replacement therapy with human immunoglobulins is the leading pathogenetic method of treatment of primary immunodeficiency with impaired antibody synthesis. Currently, several preparations of human immunoglobulins for intravenous administration are available in Russia. Purposes. Evaluation of the efficacy and safety of Privigen immunoglobulin intravenous 10% liquid in real clinical practice within 12 clinical months. Methods. Twenty adults diagnosed with common variable immunodeficiency or X-linked agammaglobulinemia received intravenous Privigen® infusions (0.2-0.4 mg/kg) at 24±3 intervals over a 12-month period. The primary endpoint was the annual rate of infections and adverse events. Results. Sufficient level of IgG was achieved in most patients during the study. Severe adverse reactions during the treatment were not registered. Conclusions. High efficacy and safety of monthly replacement therapy in patients with primary immunodeficiency with impaired antibody synthesis has been demonstrated.