Volume 66 • Number 3 • September 2021

Articles: 5

Pages: 48

REVIEW

Place of anti-histamine in therapy of itching skin of children

S.S. Masalskiy, Yu.S. Smolkin

Abstract

Itching is a frequent condition at a doctor’s appointment of any speciality. A quarter of patients complain of itching of various etiology. In real practice, H1-histamine receptor blockers are prescribed for itching in the first place. The article considers a complex of diseases accompanied by itching of the skin. The itching is a reflex. The classification contains a lot of forms:local and systemic; prurigogenic, neuropathic and psychogenic. Itching has no stable pathogenesis and can be provoked by various conditions. The main types of sensory neurons are opiate and 5-HT-receptors. Urticaria and food allergy are associated with irritation of the skin receptors with histamine and other mast cell mediators. In these cases, antihistamines are the drug of choice regardless of the aetiology of urticaria. In atopic dermatitis, the itching has a complex aetiology: transepidermal water loss, chronic inflammation of the skin with the participation of many cells, secondary hyperinervation of the skin with the formation of a pathological activity focus in the brain. This requires a comprehensive approach to therapy. Xerosisis overcome by the use of emollients and rational skincare. The presence of exacerbation makes it necessary to prescribe topical steroids or calcineurin inhibitors for an acute period s. In the case of the addition of psychogenic itching, antiserotonin 5-HT-blockers drugs, hydroxyzine can be considered. H1-receptor blockers do not affect the intensity of skin lesions in dermatitis, but some molecules can reduce the itching. Quifenadine is the antihistamine dug of the second generation. It can be used in the treatment of allergic itching dermatoses. The rapid onset of action allows you to reach the maximum concentration in the tissues within 1 hour, activate monooxidase and neutralise histamine in the tissue. Quifenadine absence a sedative effect and no respiratory depression.Instructions for the use of the medicinal product can increase the dose by 1,5–2 times.It makes the drug useful for the treatment of manifestations of food allergies and urticaria. The dual antihistamine and antiserotonin action allow the successful use of quifenadine in the acute period of atopic dermatitis, especially provoked by contact with an allergen.

Allergy and obesity in children: is there any link?

N.B. Migacheva, O.V. Skvortsova, E.G. Mikhaylova, D.A. Rakcheeva

Abstract

The steady increase in the prevalence of non-communicable diseases in the population, including obesity and allergic diseases, dictates the need to study both common causal factors and mechanisms of their development, and to search for new effective treatment and prevention strategies. However the resultsof epidemiologic, clinical and laboratory studies are still inconclusive, especially in pediatric population. In this review we present and discuss current data that may help to understand the possible relationship and mechanisms of mutual influence of allergy and obesity in children.

The main aspects of the immunopathogenesis of atopic dermatitis in children

A.V. Zhestkov, O.O. Pobezhimova

Abstract

Research objective Atopic dermatitis (AtD) is the earliest and most frequent manifestation of the body’s hypersensitivity reaction to environmental allergens. Often manifested in severe form, affecting the skin, can occur in early infancy, childhood. The disease is genetically determined and is chronic. AtD is one of the most common skin diseases (from 20 to 40% in the structure of skin diseases), which occurs in all countries in people of both sexes. In recent years, there has been an increase in the incidence of AtD throughout the world. The disease is more common in highly developed countries and cities (less commonly in rural areas). AtD significantly reduces the quality of life of children, causing psychological discomfort and disrupting their social adaptation. AtD in children is a risk factor for the «atopic march» — the further sequential development of other allergic diseases: allergic rhinitis, pollinosis, allergic conjunctivitis, bronchial asthma. With a reduced immune response of the body, AtD in children can be complicated by the addition of a secondary infection (bacterial, viral, fungal). Such a high incidence rate, a debut in early childhood, a frequently recurring course of the pathological process, and a tendency towards an increase in the forms of the disease resistant to traditional therapy make the details of the pathogenesis of AtD particularly relevant. One of the main roles in the pathogenesis of AtD belongs to the cells of the immune system. The purpose of this article: to systematize the information available today on the immunopathogenesis of atopic dermatitis.

ORIGINAL ARTICLES

Prevalence of allergic diseases among teenagers 13–14 years old in Tyumen city

K.P. Kuzmicheva, E.I. Malinina, O.A. Richkova, L.V. Klimina, A.E. Rodionova, A.V. Tetyueva

Abstract

Introduction.
The prevalence of bronchial asthma and other allergic diseases, in particular atopic dermatitis and allergic rhinitis, nowadays can be estimated by global population studies, such as the International Study of Asthma and Allergy in Childhood (ISAAC), and the Global Asthma Network (GAN). There are some difficulties in epidemiological surveillance, diagnosis, treatment and prevention of these nosologies in most of the countries, especially in developing countries with low availability of medical care. Thanks to the GAN program, therapeutic recommendations were made to reduce the global burden of allergic pathology.

Purpose of the study.
To study the prevalence of clinical symptoms of allergic diseases in children 13–14 years old in the city of Tyumen, as well as highlight the main risk factors that contribute to the disease development.

Materials and methods.
This cross-sectional study was carried out in 2019 as part of the Global Asthma Network (GAN) project among adolescents 13–14 years of age in the city of Tyumen. The respondents filled out standardized Russified questionnaires, which contained 48 questions concerning the symptoms of allergic diseases and environmental factors.

According to the results of the analysis of 3007 questionnaires, it was found that asthma-like symptoms were ever observed in 19,2% of participants, current asthma-like symptoms were noted in 8,5% of respondents, 5,1% of adolescents had medical-verified bronchial asthma. The prevalence of lingering allergic rhinitis and current allergic rhinoconjunctivitis was 28,9% and 12,2% respectively, while only 5,4% of respondents had a verified diagnosis of allergic rhinitis. A quarter of the respondents had symptoms of atopic dermatitis at some point (25,6%), only 4,5% had symptoms of current atopic dermatitis, 3,8% had been diagnosed with atopic dermatitis. The negative impact of heavy freight traffic in the city of Tyumen, as well as the use of paracetamol, revealed the increase in the prevalence of allergic diseases.

Conclusion.
As a result of data analysis, it was found that the prevalence of current asthma-like symptoms, symptoms of atopic dermatitis and allergic rhinitis significantly exceed the numbers of official statistics. Often, adolescents with symptoms of an allergic disease do not have a correct diagnosis, which is confirmed by a low percentage of positive answers regarding the verification of the diagnosis by a doctor. Among children 13–14 years old in the city of Tyumen there is a high percentage of the prevalence of symptoms of allergic rhinitis, which is probably associated with climatic, geographical and environmental factors.

Clinical and anamnestic characteristics and results of allergological testing in children with bronchial asthma and allergic rhinitis in case of allergy to house dust mites

O.V. Trusova, A.V. Kamaev, N.L. Lyashenko, I.V. Makarova

Abstract

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.

ALLERGOLOGY and IMMUNOLOGY in PEDIATRICS

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