Objective. To determine the diagnostic significance of methods of allergological diagnostics: skin prick tests (SPT), quantitative determination of specific immunoglobulin E (sIgE) and nasal provocative test (NPT) in children with allergy to house dust mites (HDM) diagnosed with allergic rhinitis (AR) or AR in combination with asthma. Methods. Patients underwent a targeted history taking for possible domestic sensitization, SPT with HDM allergens, NPT with HDM, and sIgE to HDM allergens was determined by the ImmunoCAP method. Results. The statistical processing group included 109 children (67 boys, 42 girls, aged 5 to 17,9 years (mean age 8,9±2,52 years)), in whom sensitization to HDM was confirmed by at least one of the methods used in the study. A higher sensitivity of SPT then of sIgE was determined (96,3% and 81,6%, respectively). According to SPT and sIgE results, sensitization to both types of mites (D. pteronyssinus and D. farinae) is more common than isolated. Coincidence of positive results of SPT and sIgE was obtained in 84 cases (77,1%). Conclusion. SPT can be considered as the first line of investigation. The use of a complex of examination methods is necessary to determine the role of sensitization to HDM, if NPT is taken as the «gold» standard of diagnosis.
Food allergies (fa), defined as an adverse immune response to food proteins, effect up to 3-5% of the popula- tion in westernized countries, and their prevalence appears to be rising. a variety of mechanisms underlie the allergic reactions, not all of them run through the IgE sensitisation. the absence of sIgE in peripheral circulation characterize a group of non-Ig-Emediated disorders, such as food protein-induced enterocolitis, enteropathy and prococolitis. In case of eosinophilic esophagitis, gastritis and enterocolitis IgE sensitization arises in nearly 50%, therefore these disorders are classified as mixed-type. In some cases of gastrointestinal fa local IgE production, when switching to IgE synthesis occurs only in one organ, have been proved. although systemic investigation of this phenomenon is still lacking. Immune inflammation coursed by food allergens can involve nearly all organs and systems. this review focuses on gastroenterological manifestations of food allergy, except of broad field of gluten intolerance that demands a separate thorough reviewing.
Acute respiratory infections are widespread in the pediatric population and represent a significant burden to the health care system and families of patients. Anatomic ans physiological features of preschool children and individual predisposition, especially atopic phenotype, determine high risk of complicated course of acute respiratory infections with bronchial obstruction syndrome. The etiological factors of recurrent AR are quite diverse from chronic infections to foreign bodies of the bronchi or genetically determined diseases, but the most common cause of recurrent AR in children remains bronchial asthma. Therapy of acute obstructive episode in real clinical practice is most often similar to therapy of bronchial asthma attack and includes effects on the main components of pathogenesis: contraction of smooth muscles, mucus hypersecretion and inflammatory edema of the bronchial wall. There has been accumulated a great practical experience of using combined preparation of fenoterol and ipratropium bromide, which currently exists also in the form of domestic medicinal product Astmasol-SOLOpharm. In addition to standard bronchodilator and mucoconstrictor therapy, hypertonic solutions, in particular Ingasalin 3%, are an important component of therapy of prolonged obstruction and relapse prevention. The possibilities of this remedy in shortening of terms of obstructive disorders and decrease of risk of antibiotic therapy are demonstrated by clinical example.
House dust mites (HDM) are a common cause of allergies, however, it is not always easy to suspect a mite allergy from a patient's history. Objective: to determine clinical characteristics of patients, tactics for demonstrating the role of HDM sensitization in pediatric patients with allergic rhinitis (AR) and bronchial asthma (BA) with domestic sensitization. Materials and methods. The study included 420 patients, 256 boys, 164 girls, aged 5 to 17,9 years (mean 8,44 ± 3,06 years), with AR (100%) and AR in combination with BA (41,9%). The prick test on the forearm skin with water-soluble extracts was carried out and evaluated according to the standard method. The test was considered positive with a maximum wheal diameter of ≥3 mm 15 minutes after applying the prick. Results. Among patients with HDM sensitization (n=268), sensitization to both mites was detected in 218 cases (81,3%), and in 139 cases (51,9%) polysensitization to HDM allergens, house dust and epidermal allergens (cat, dog) was found. Patients noted persistent symptoms of nasal congestion, and rhinorrhea; the provoking factor was not determined by history in 46% of cases. In 69,8% of cases (97 children), it was impossible to isolate the leading allergen according to the history, since patients had contact with cats, dogs, dust, and polysensitization according to the prick tests. Nasal provocation test (NPT) with HDM allergens was performed in 92 children. Positive NPT was obtained in 83 cases (90,2%), negative in 9 cases (9,8%). Conclusions. With HDM sensitization, often (46%) the provoking factor is not determined by history. Monotonous symptoms are characteristic with the absence of obvious relationships with allergens, the location and activities of the child. In terms of frequency, the leading variant is sensitization to both mites D.pteronyssinus, D.farinae (81,3%), and polysensitization to HDM, house dust and cat and dog allergens (51,9%). NPT allows in 90% of cases to show the causal role of HDM allergens in polysensitized patients with insufficiently convincing anamnesis data.
Relevance. The insufficient effect of sublingual allergen-specific immunotherapy (SLIT) is caused, first of all, by non-compliance with the treatment regimen and premature treatment termination. Purpose of the study. Determining the frequency of patient drop-out rate during SLIT with house dust mites (HDM) allergens in children with allergic rhinitis (AR) or AR in combination with bronchial asthma (BA), with an analysis of the drop-out reasons, and approbation of the developed visit-to-visit patient management plan (Plan). Materials and methods. We analyzed 274 cases of treatment with HDM SLIT in children. 218 patients: 67.4% (147) boys, median age 11.33 years [7.26; 15.46], the proportion of patients with BA 43.1% (94 children) received HDM SLIT in 20132020. 56 patients: 71.4% (40) boys, median age 9.29 years [6.13; 15.93], the proportion of patients with BA 78.6% (44 children) received treatment in accordance with the Plan. Results. A relatively low frequency of treatment withdrawal was noted in the first 2 years of therapy (2 years after the start of treatment, 72.47% patients continue it). However, only 52.29% complete 3 years of therapy, and 14.67% complete 4 years of therapy. Implementation of the Plan increased patient retention in treatment at the 3rd year of treatment to 69.64% (p=0.031). Conclusions. Only half of the patients receive the required three-year minimum of treatment. The daily plan optimizes the patient management schedule for HDM ASIT; reduces patient dropout from treatment and can be recommended for practical healthcare.
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