The authors of the article describe the dependence of the effectiveness of any drug on the "correctness" of its choice for the patient and conclude that patient profiling can serve as an effective clinical method for selecting optimal therapy. When prescribing antihistamines, it is suggested to use the following main patient profiles: children, working adults, elderly patients. Each profile has its own specific purpose. The article presents own clinical experience of using fexofenadine based on patient profiling. Cases of fexofenadine therapy in patients with allergic rhinitis and chronic urticaria are given as specific examples. Fexofenadine has an optimal safety profile with minimal impact on concentration and cognitive abilities. In this regard, it can be recommended to employees whose activities are associated with the speed of psychomotor reactions, schoolchildren and university students, elderly patients with high drug load and comorbidity.
Quifenadine , a drug developed in the laboratory of M.D.Mashkovsky in the 1970s, is one of the first examples of the creation of a new class of nonsedative antihistamines of multifunctional action, combining high selective activity to block type 1 histamine receptors, the ability to block the action of serotonin and enhance histaminase activity in tissues. The article describes the latest data on the study of the pharmacokinetics of the drug, presents studies on the efficacy and safety of quifenadine. Currently, the question remains open to which generation of antihistamines to include quinuclidine, considering all the described characteristics.
Despite the evidence and logical fact that smoking and asthma are incompatible, many patients are smoke. The proportion of smokers among asthmatics is comparable to the proportion of smokers in the population. The proportion of smokers among asthmatics is comparable to the proportion of smokers in the population. Currently, the prevalence of tobacco use in the Russian Federation remains high at over 20%. In addition to active smoking, patients may be exposed to the negative effects of tobacco smoke through secondhand smoke. Smokers with asthma are more likely to have signs of poor disease control, and are more likely to seek exacerbation. However, a therapy strategy for them has not been worked out. For many randomized trials, patient smoking is the exclusion criterion, and therefore the effectiveness of a particular anti-asthma therapy in smokers is poorly understood. In addition, it is a known fact that smoking develops resistance to the main anti-asthma therapy, inhalation glucocorticosteroids. The article discusses the mechanism of exposure to tobacco smoke on lung tissue, the development of pathological processes under the influence of components of tobacco smoke and possible solutions to the problem. The mechanism of inflammatory and anti-inflammatory effects of various components of tobacco smoke. Particular attention is paid to the role of cysteinyl leukotrienes in the formation of inflammation in the lower respiratory tract in smoking patients with asthma and the possibility of treating these patients with leukotriene receptor antagonists. A review of studies conducted in patients with bronchial asthma and exposure to tobacco smoke in whom montelukast was used as therapy is presented. Provides information on the safety and side effects of the drug.
Atopic dermatitis is a chronic inflammatory skin disease characterized by a recurrent course, difficulty in individual selection of therapy, especially in patients with severe course. When examining and treating such patients, one of the routine diagnostic methods is to determine the level of total immunoglobulin E in the blood serum. The article is devoted to the analysis of available world practice data on published clinical cases of the use of biological therapy with dupilumab in real clinical practice in patients with severe atopic dermatitis, in whom high and very high levels of immunoglobulin E. The appointment of biological therapy for this cohort of patients often raises significant concerns. However, the use of a monoclonal antibody against IL-4/IL-13 proved effective, did not lead to serious adverse reactions in such patients and was accompanied by a decrease in the level of immunoglobulin E during treatment. It was noted that immunosuppressive treatment prior to biological therapy led to the development of adverse events in these patients. A separate group of patients with genetically determined hyper-IgE syndrome and severe atopic dermatitis is described, in which the positive experience of using dupilumab is also noted. The author presents his own clinical case of a patient with severe atopic dermatitis and a high level of immunoglobulin E receiving successful targeted therapy after a preliminary thorough examination except for lymphoproliferative and autoimmune diseases. Against the background of dupilumab therapy, there was a pronounced clinical regression of skin symptoms, a decrease in the level of immunoglobulin E, an increase in the patient’s quality of life, and the absence of side effects.
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