The PRIMA Consensus document developed by leading Russian experts reviews the principles of outpatient immunotherapy in children with frequent acute respiratory viral infections.
Anaphylactic shock is a severe life-threatening reaction, that may be caused by medicines, food, hymenoptera and animal poisons, etc. Therefore, anaphylactic shock (anaphylaxis) can develop both in a medical institution and outside it, and physicians of any specialties should be ready to treat this condition. In this regard, clinical guidelines for anaphylactic shock have been developed. These recommendations were approved by the Russian Association of Allergy and Clinical Immunology (Protocol No. 743/12 dated December 30, 2020) and the Federation of Anesthesiologists and Resuscitators (Protocol No. 1 dated January 13, 2021), approved at a meeting of the Scientific and Practical Council of the Ministry of Health of the Russian Federation (Protocol No. .2020 No. 743/12). The guidelines cover a number of nosologies that correspond to the codes of the International Statistical Classification of Diseases and Related Health Problems: T 78.0; T 78.2; T 80.5; T 88.6. The clinical guidelines systematize modern data on etiology, epidemiology, classification, clinical picture, diagnosis, treatment and prevention of anaphylactic shock. An algorithm for managing a patient with anaphylactic shock has been developed. Clinical guidelines for anaphylactic shock are intended for practitioners of all specialties, students and teachers of medical universities, residents, graduate students.
In many countries of the world and in Russia, in particular, the pharmacological use of antagonists of cysteinyl receptors LT1 (CysLTR) is a long-proven and well-proven pharmacotherapy of bronchial asthma (BA) and allergic rhinitis (AR) in adults and children. Among antileukotriene drugs the most commonly used medication for the treatment of these diseases is the original montelukast, which is considered a safe drug associated with the appearance of only a few adverse reactions, usually not differing in type and frequency from those that occur with placebo. Currently, there are a large number of generics of montelukast, therefore, practitioners have many questions regarding the benefits and risks of montelukast therapy for patients with BA and AR. In 2020 FDA (Food and Drug Administration USA) analyzed the risk of adverse events during Montelukast treatment and indicated them on the packaging of the drug (original montelukast and its generics). This contributed to the creation of an expert commission to study this issue and form an expert opinion, which is demonstrated in our publication.
This publication extends RAACI education in the field of allergology and immunology for allergologists, immunologists and other specialists, as well as for practitioners. It presents recent data and innovative approaches to the study of complex interactions of genetic, non-genetic and environment factors in allergies. It explains the importance of exposome-oriented approaches aimed to increase the treatment effectiveness and to decrease risks of allergy in addition to genome-oriented models of human diseases. Exposome concepts can be integrated into existing research programmes which are crucial in shaping new approaches to allergy treatment and prevention
With the widespread increase in the number of patients with allergic pathology, doctors in clinical practice increasingly have to observe the simultaneous development of several nosological forms in the same patient. Frequent occurrence of a combination of lesions of the skin and respiratory tract in patients with atopy (atopic dermatitis, allergic rhinitis, and atopic bronchial asthma) is traditionally considered within the framework of comorbidity and suggests a number of therapeutic interventions given the similarity of the pathogenesis. However, phenotypic or endotypic differences exist between patients (e.g., triggers, age, persistence of manifestations, degree and type of inflammation, severity of symptoms, and response to treatment), for which it is more correct to use the term multimorbidity. The strategy of precision medicine for patients with several immune-mediated diseases should focus on identifying not only the general features of the disease, but also the pathogenetic mechanisms in the target organs. Because of these differences, the sensitivity to therapeutic interventions by target organs can vary. Herein, a clinical case of a patient with comorbid pathology ― chronic spontaneous urticaria, allergic rhinitis, and bronchial asthma ―was analyzed. Respiratory manifestations (rhinitis and asthma) were mild to severe. Chronic urticaria had the most severe disease course and resistant to antihistamines, which are considered first and second lines of drugs according to federal and international clinical guidelines that required the use of monoclonal antibodies. Anti-IgE therapy with omalizumab had a rapid and complete effect on urticaria symptoms, but respiratory symptoms were less responsive to treatment. In patients with multimorbid pathology, therapy should be individualized in terms of targeted drugs and their dosage.
Significant progress has been made over the past decade in the treatment of allergic diseases such as atopic dermatitis and bronchial asthma. Dupilumab, which targets interleukin IL-4 and IL-13, has become an innovative targeted therapy. Immunobiologic therapy with the interleukin inhibitor is indicated for patients with moderate to severe uncontrolled atopic dermatitis, moderate to severe eosinophilic phenotype of uncontrolled Bronchial asthma and patients with poorly controlled severe chronic polyposis rhinosinusitis. A clinical case and recent data on the use of dupilumab for the treatment of type 2 inflammatory disease and prospects for its use are discussed.
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