Influence of intestinal microbiota on the immunopathogenesis of atopic dermatitis in children

Particular attention is paid to atopic dermatitis (AD) as one of the earliest and most frequent clinical manifestations of allergy in children. AD is a multifactorial disease, the development of which is closely related to genetic defects in the immune response and adverse environmental influences. It was found that the action of these factors determines the rate of development of AD, especially in young children. One of these factors is a violation of the intestinal microbiota, which plays an essential role in the development of the child's immune system and has a protective effect in the formation of atopy. It has been shown that 80-95% of patients with AD have intestinal dysbiosis, while, along with a deficiency of lactobacilli and bifidobacteria, there is an excessive growth of Staphilococcus. The use of modern molecular genetics technologies made it possible to obtain a fairly complete understanding of the number, genetic heterogeneity and complexity of the bacterial components of the intestinal microbiota, while clinical studies have shown the importance of its interactions with the host organism in the formation of various forms of pathology. It has been established that the human intestinal microbiota is an evolutionary set of microorganisms that exists as a balanced microecological system in which the symbiotic microflora is in dynamic equilibrium, forms microbial associations that occupy a certain ecological niche in it, and is one of the most important factors affecting human health. The gut microbiota plays an important role in the pathogenesis of atopic dermatitis, which causes immunosuppression, but the exact mechanism of its action is still unclear. It is widely known that probiotics act on the immune system. These are living microorganisms with immunomodulatory effects that stimulate Th1 cytokines and suppress Th2 responses, which are being investigated for the treatment of several diseases. The most commonly used probiotics are part of the intestinal microflora such as lactobacilli, bifidobacteria and enterococci. The purpose of this article: to systematize the information available today on the influence of the composition of the intestinal microflora on the immunopathogenesis of atopic dermatitis.

Questions of immunodiagnostics in the teaching of phthisiology for students of the pediatric faculty

The quality of training of medical specialists is laid down during training at a medical university, where basic knowledge and the ability to manipulate them are laid, and, on the basis of the acquired competencies, to form practical skills. The issues of tuberculosis infection occupy a significant part in the work of a pediatrician. First of all, these are the issues of screening the child population for tuberculosis, early detection and specific prevention of tuberculosis. For the effective preparation of students of the pediatric faculty, it is necessary to lay theoretical knowledge in the program, to form practical skills and abilities. Since the detection of tuberculosis patients is carried out in medical institutions of the general pediatric network, it is necessary to master professional competencies. The preparation of students within the framework of the basic specialty "phthisiology" has its own nuances due to the specifics of medical education, the diversity of tuberculosis infection, the peculiarities of the organization and provision of anti-tuberculosis care to the child population. Training in the specialty "phthisiology" requires a large amount of special knowledge, skills, improvement of the interdisciplinary approach, in accordance with the requirements of the federal state educational standard. The article provides an analysis of the ongoing training system for students of the pediatric institute in the online system, presents the experience of the department in teaching students during the period of distance education during the spread of a new coronavirus infection. The assessment of the results of practical training among 6th year students of the pediatric faculty (n = 123). It was revealed that it is not always possible to predict in advance the degree of understanding of the educational material, and even the depth of understanding the questions in the test problems. The use of scientific evidence-based statistical methods for evaluating test items helps in optimizing and objectifying knowledge control and understanding the educational material.

Clinical, immunomodulating and anti-recidive effects of ozone therapy in persistent allergic rhinitis in children

Research оbjective.To determine the effect of ozone therapy on clinical indicators and the state of immunity in children with moderate persistent allergic rhinitis. Material and methods. The study included children aged 5-10 years with moderate persis-tent allergic rhinitis, which were divided into two groups depending on the therapy. The first group of patients with allergic rhinitis received complex conventional therapy, the second group of patients with allergic rhinitis received complex treatment in combination with ozone therapy. Clinical parameters were studied in patients with allergic rhinitis, parameters of im-munological reactivity were investigated during periods of exacerbation of the disease and clinical remission. Results. It was found that the inclusion of ozone therapy in the complex treatment of patients of the second group ensured a faster onset of complete clinical remission (3.7 days earlier than in the first group of patients) and normalization of most immunity parameters, and also increased the expression of toll-like receptors on leukocyte cells. The duration of complete clinical remission in the group of patients with allergic rhinitis who received complex treatment in combination with ozone therapy (9.3 + 2 months) more than doubled (2.4 times) its duration in the group of patients with allergic rhinitis who received complex conventional therapy (3.9 + 0.3 months).

Predictive significance of pro-inflammatory interleukins at newborns with hypoxic-ischemic encephalopathy

Relevance. Hypoxic-ischemic damage to the central nervous system is accompanied by overproduction of pro-inflammatory interleukins in newborns. Perinatal inflammatory responses contribute to unfavorable outcomes. Methods of investigation. The analysis of the cytokine profile in the blood serum was performed in 45 full-term newborns by the method of enzyme-linked immunosorbent assay within 4–96 hours after birth. 32 children had the signs of HIE stage 2, 13 children — HIE stage 3. Unfavorable neurological consequences were formed in 47,4% of children. Research results. Revealed an increase in the levels of IL1β — 17,7 [13,6; 25,4] and IL6 35,2 [24,9; 45,0] in newborns with HIE. A significant increase in pro-inflammatory cytokines was found in patients with unfavorable outcomes compared with favorable ones. When predicting the disabling consequences of DIE, a high predictive value was established for IL1β and IL6. Conclusion. In newborns with hypoxic-ischemic encephalopathy, an increase in serum IL1β and IL6 is observed. It is advisable to use an increase in IL1β >19,4 pg/ml (OR=12,80; 95% CI: 2,90–56,58) and IL6 >40,1 pg/ml (OR=11,33; 95% CI: 2,46–52,15).

Allergy and obesity in children: is there any link?

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

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.

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

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.

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

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.