The remarkable progress in basic immunological research during the past 50 years can account for the emerging of medical or clinical immunology as a novel discipline, which may be defined as the application of basic immunology rules to the diagnosis, treatment, and prophylactics of patients with diseases in which immunological pathways may play an important etiological and/or pathogenetic role. The immune system has a central role not only in fighting infections, but also in many other diseases and disorders including cancer, AIDS, and organ transplantation. In addition, the immune system imbalance is responsible for primary and secondary immunodeficiencies, hypersensitive illnesses, such as asthma, dermatitis, and other allergies, as well as systemic and organ-specific autoimmune disorders, such as multiple sclerosis, lupus, rheumatoid arthritis and diabetes. Immune-mediated diseases such as autoimmune diseases and allergic diseases are important health problems in many countries. For instance, autoimmune diseases afflict up to 8% of the United States population; allergic diseases represent the sixth leading cause of chronic illness and disability in the United States, and the leading cause among children. Thus, immune-mediated diseases represent an enormous medical, social, and economical problem and require serious and instant attention from clinicians, scientists, pharmacists, and biotech professionals. The goal of the Second International Immune-Mediated Diseases (IMD) Congress was to advance medical and biomedical immunological sciences and clinical practice via the organization of multiple sessions and training courses as well as providing an environment for stimulating scientific discussions, the exchange of ideas, and consideration of novel clinical diagnostic and therapeutic approaches. Selected contributions from the participants of this Congress who are eager to share some of the academic and clinical enthusiasm are presented in this issue (and the subsequent issue) of the Journal of Immunotoxicology.
<b><i>Introduction:</i></b> Allergic rhinitis (AR) is a disease that affects ≤24% of people in Russia, significantly impairing quality of life (QoL). Intranasal corticosteroids, such as triamcinolone acetonide (TAA), are considered effective drugs for treatment. A post hoc analysis of data (phase III NASANIF trial) examined weekly QoL changes in patients receiving TAA for the treatment of perennial AR (PAR). <b><i>Methods:</i></b> NASANIF (NCT03317015) was a double-blind, parallel group, multicenter, prospective, noninferiority, phase III clinical trial. Patients with PAR were randomized (1:1) to receive TAA or fluticasone propionate (FP) for 4 weeks. Here, a post hoc analysis measures QoL using a shortened Rhinoconjunctivitis Quality of Life Questionnaire (miniRQLQ). Differences in miniRQLQ score were evaluated using a mixed linear model and descriptive statistics. A subgroup analysis was performed in patients with a previous diagnosis of allergic conjunctivitis. <b><i>Results:</i></b> Of 260 patients eligible for randomization, 128 each completed treatment with TAA or FP. Overall and individual domain scores progressively improved and were significantly different versus baseline at week 4 in both treatment groups: LS mean difference TAA: −30.92 (95% CI [−33.01 to −28.83]), <i>p</i> < 0.001, and FP: −31.13 (−33.23 to −29.04), <i>p</i> < 0.001. In both arms of the subgroup, there was a significant reduction in eye symptoms. There was no significant difference between the TAA and FP treatment groups in any analyses. <b><i>Conclusions:</i></b> TAA is effective in improving overall and individual domains of QoL in patients with PAR, over 4 weeks. Patients with a previous diagnosis of allergic conjunctivitis experienced significant improvements in QoL related to the resolution of these symptoms.
Новое определение атопического дерматита: хроническое рецидивирующее воспаление кожи, возникающее вследствие нарушения эпидермаль-ного барьера и влекущее дальнейшую его дисфункцию, что достигает максимального развития на фоне предрасположенности к иммуноглобулин E-опосредованной гиперчувствительности, реализуемой в сенсибилизацию к окружающим аллергенам. Ключевые положения, касающиеся пище-вой аллергии: 1. Аллергическая сенсибилизация не является единственной и главной причиной атопического дерматита. 2. Для доказательства непереносимости пищевых продуктов следует проводить специальное аллергологическое обследование. 3. Проведение элиминационно-провока-ционных тестов с пищевыми аллергенами является необходимым в случае сомнений по поводу аллергенности пищевого продукта. 4. Для установ-ления сенсибилизации используются кожные прик-тесты и определение специфического иммуноглобулина E методом твердофазного иммуно-ферментного анализа, который обеспечивает чувствительность 0,1–100 кЕдА/л. 5. При наличии доказанной аллергической реакции на пищу це-лесообразно исключить все продукты, в состав которых входит данный белок, на время, достаточное для развития толерантности. 6. Веро-ятность перекрестных реакций не должна являться причиной исключения продуктов питания без предварительного получения сведений об их явной непереносимости с помощью элиминационно-провокационной диеты (пробы). 7. Элиминационная диета – временная мера, поскольку после нескольких месяцев полного исключения аллергенного продукта из питания большинство детей могут употреблять ранее непереносимую пищу. 8. У грудных детей лучшим вариантом питания является грудное вскармливание длительностью 6 мес и более. Нецелесообразны отсроченное введение прикорма и ограничение высокоаллергенных продуктов, если к ним не доказана гиперчувствительность. Ключевые слова: атопический дерматит, хроническое рецидивирующее воспаление кожи, эпидермальный барьер, иммуноглобулин E-опосредо-ванная гиперчувствительность, пищевая аллергия, аллергическая сенсибилизация, аллергологическое обследование, гиперчувствительность, пи-щевой дневник, элиминационная диета. Для цитирования: Смолкин Ю.С., Масальский С.С., Чебуркин А.А., Горланов И.А. Роль пищевой аллергии в развитии атопического дерматита. Позиционная статья Ассоциации детских аллергологов и иммунологов России. Педиатрия. Consilium Medicum. 2020; 1: 26–35. DOI: 10.26442/26586630.2020.1.200019
Background. Leukotrienes play an important role in the pathogenesis of allergic rhinitis (AR) and eosinophilic type of chronic rhinosinusitis with nasal polyps (CRSwNP). There is a phenotype of CRSwNP in combination with AR, which has specifics of local inflammation.The aim of our study was to investigate the efficacy of using an antileukotriene drug in the treatment of AR in combination with CRSwNP.Materials and methods. 63 patients with AR and bilateral CRSwNP after endoscopic bilateral polypotomy were randomly divided into 2 groups. In the 1st group 32 people (age 50.28 ± 1.37 years) were prescribed a basic therapy with nasal spray of mometasone furoate at a daily dose of 400 µg in combination with montelukast 1 tab. 10 mg at night, in the 2nd group 31 people (age 50.31 ± 1, 16 years old) received only mometasone furoate monotherapy. Endoscopic examination of the nasal cavity was performed once every 3 months. The follow-up period was 1 year.Results. After 3 months in the 1st group of patients there was a recurrence of polyp growth was observed in 25% of cases, in the 2nd group in 35.5% of patients (p < 0.05). After 6 months, the number of relapses of CRSwNP decreased to 15.6% of cases in group 1 and to 22.6% in group 2 (p < 0.05). After 9 months in group 1 recurrence of NP was recorded in 12.5% of patients and nasal polyps were completely absent during endoscopic examination in 9.4% of cases, in the 2nd group, relapse was detected in 19.35% of patients (p < 0.05). 1 year after surgery, in group 1, relapse of NP was found in 12.5% of patients with AR and in 12.5% of cases was remission of the pathological process with cancellation of basic therapy. In group 2, recurrence of NP was in 16.1% of cases, there were no reasons for withdraw treatment of intranasal glucocorticosteroids in this group.Discussion. The clinical effectiveness of the addition of Montelukast to basic therapy has been reflected in a reduction in the growth rate of polyposic vegetation, the number of repeated operations and the stabilization of the flow of chronic inflammatory process.Conclusions. In the case of the clinical phenotype of AR with CRSwNP, the addition of a leukotriene receptor blocker montelukast to the basic therapy of intranasal glucocorticosteroids made it possible to improve drug control of both diseases and reduce the frequency of CRSwNP relapses.
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