Volume 70 • Number 3 • September 2022
FROM THE EDITORS
Clinical case of early debut of food allergy in a child up to 6 months
S. S. Masalskiy, Yu. S. Smolkin, O. Yu. Smolkina
Introduction: It is believed that if the child ate only a cow’s milk formula (CMF), and сow’s milk allergy is the only possible at the age of <6 months. This approach leads to erroneous treatment tactics.
Presentation of the clinical case: a child aged 3 months with the debut of atopic dermatitis (AtD) of light degree (on the scale of the assessment of the researcher IGA 2). The patient was fed on artificial with a CMF from 1,5 months. Infant was examined at the place of residence. The CMF was changed to full hydrolysis CMF and without examination. Additionally, cosmetics were applied to the skin as needed. The child was examined by an allergologist after 3-4 weeks of diet. Negative dynamics were observed. Atopic dermatitis has become moderately severe with secondary infection complications (IGA 3, 50% affected skin). Prick-tests with allergens of milk, eggs, wheat, fish were carried out. High sensitization to egg and controversial to cow’s milk was found. The results were clarified during enzyme immunoassay: IgE ovomucoid – 0.78 IU/ml (norm <0.3 IU/ml); cow’s milk 0.01 kUA/ l; casein – 0.01 kUA / l (norm <0.1 kUA/l).
Considering the infected AtD, “hydrocortisone + natamycin + neomycin” 2 times a day was used in the therapy. Cosmetics on infected foci was canceled, while maintaining the treatment of dry unaffected skin. It is recommended to limit household contacts with eggs. After 2 weeks, the rash is residual (IGA 0-1). The cow’s milk formula was returned to the diet without exacerbations of the skin process.
Conclusion: The case illustrates that sensitization in children can begin and be maintained without oral ingestion of the allergen. Sensitization at the age of up to 6 months is likely with a moderate – severe recurrent course of dermatitis. A specific allergological examination can be conduct with a developed disease at an early age. Skin tests and enzyme immunoassay are applicable in infants. The appointment of a diet without examination is unreasonable and should not be used.
Experience with dupilumab in patients with atopic dermatitis
E. A. Glukhova, E. D. Kuvshinova, V. A. Revyakina
According to recent data, the key molecules in the pathogenesis of atopic dermatitis are the cytokines IL-4 and IL-13, which initiate and maintain Th2 inflammation. Targeted therapy with dupilumab inhibits the signaling function of these cytokines by binding to the IL-4Rα subunit, which is part of the IL-4 and IL-13 receptor complexes. The drug is approved for the treatment of patients over 6 years of age with moderate to severe AD. The efficacy and safety of dupilumab have been confirmed by the results of clinical studies.
Material and methods. 27 children with severe AD at the age of 8–18 years were under constant supervision. All patients received systemic treatment with dupilumab, topically used topical glucocorticosteroids (if necessary), emollients (twice a day). Dosing of dupilumab was carried out according to the instructions for the drug.
Results. After 26 weeks of complex therapy, 96,3% of patients achieved an IGA index value of 0/1 and an improvement of 75% according to the EASI-75 index. The SCORAD index dropped from an average of 78,8 points to 13,7. The average value of total IgE after 6 months decreased by 1518 kU/l. In 2 (7,4%) patients, conjunctivitis was noted, which was not a reason to discontinue the drug.
Conclusions. During treatment with dupilumab, there is a significant decrease in the severity of the main symptoms of atopic dermatitis, including itching, exacerbations.
Algorithm for selecting patients for house dust mite allergen specific immunotherapy in children with bronchial asthma and allergic rhinitis
O. V. Trusova, A. V. Kamaev, N. L. Lyashenko, I. V. Makarova, N. B. Platonova
Objective. Based on literature data and own research, on the selection of pediatric patients for the treatment of allergen immunotherapy (AIT) with house dust mite (HDM) allergens, to develop an Algorithm for selecting patients for AIT with HDM allergens in children with bronchial asthma (BA) and allergic rhinitis (AR).
Methods. Data from our own studies included 420 patients with AR and complaints indicating domestic sensitization (256 boys, 164 girls), aged 5 to 17,9 years (mean age 8,44 ± 3,06), of which 176 have had BA. Patients underwent skin prick tests (SPT) with household allergens, determination of sIgE for HDM allergens by the ImmunoCAP method, and nasal provocative test (NPT) with HDM. If the results were negative, the allergological examination was repeated again in 12–18 months.
Results: The Patient Selection Algorithm was constructed on the basis of the obtained data on the significance of the examination methods used. The primary role of SPT, the possibility of repeating the examination in case of negative results, indications for NPT with HDM allergens were taken into account. The algorithm makes it possible to organize an examination of a patient with HDM allergy in order to develop indications for AIT.
Three T2 inflammatory diseases in adolescents: asthma, eosinophilic esophagitis, and chronic polypous rhinosinusitis (clinical case)
D. Sh. Macharadze, B. G. Kulumbegov
It has long been known that comorbid diseases such as chronic polypous rhinosinusitis and obesity adversely affect the pathophysiology of asthma, impair response to therapy and reduce the quality of life of patients. Identification and effective treatment of comorbidities will improve asthma control and reduce the frequency of exacerbations. There are more and more studies that indicate a close pathophysiological relationship with allergic diseases of eosinophilic esophagitis. According to the latest data in the development of allergic diseases (asthma, allergic rhinitis, atopic dermatitis, food allergy), chronic polypous rhinosinusitis, and eosinophilic esophagitis, the key is the T2 immune response (T2 inflammation) in both children and adults.
Timely diagnosis of inflammatory states of T2 inflammation can help in choosing the optimal treatment for such patients. Here we describe the comorbid conditions that occur in an adolescent with controlled asthma and discuss the features of their clinical course.
The purpose of this work is to raise the awareness of practitioners about comorbid diseases — eosinophilic esophagitis and chronic polypous rhinosinusitis in children with bronchial asthma. Each of these comorbid diseases has clear diagnostic criteria, although they are underdiagnosed by medical specialists.
COMMUNICATIONS AND CORRESPONDENCE
Diagnostic value of TREC and KREC for detecting immune disorders in newborns
L. Y. Barycheva, L. S. Khachirova, V. A. Firsova, S. Yu. Farsiiants
Influence of allergic rhinitis and obesity on body composition in primary school children
V. V. Bekezin, A. E. Koroleva, I. N. Sergeeva, E. N. Volkova
The relationship of synonasal symptoms with systemic and local markers of inflammation in children with bronchial asthma and allergic rhinitis
K. V. Gorbunova, S. V. Krasilnikova, T. I. Eliseeva, D. Yu. Ovsyannikov, A. V. Shakhov, O. V. Khaletskaya
Allergic reactions to iodine during contrast-enhanced computed tomography
O. L. Perkova, T. A. Epishina, E. V. Stezhkina
Evaluation of the effectiveness of rehabilitation in children with bronchial asthma in day hospital in outpatient clinic
E. V. Stezhkina, N. E. Tukkaeva, N. M. Sharapina, A. V. Dmitriev, E. A. Gazetova, Yu. V. Alenina
Primary immunodeficiency in the practice of a pediatric doctor — a long diagnosis in pediatric?
E. V. Stezhkina, A. I. Agapova, I. E. Rybakova
The relationship of spirographic and hematological parameters in children with bronchial asthma
E. V. Tush, D. V. Azarnov, S. A. Pedchenko, M. V. Bogoroditskaya, T. E. Potemina, T. I. Eliseeva
Clinical case of primary combined immunodeficiency. Chronic mucocutaneous candidiasis in a 5-year-old girl
V. V. Shamraeva, G. V. Grigorenko, N. V. Fursova