Preventive counseling on weight loss in patients with bronchial asthma according to population-based study

Background: asthma and obesity have a close relationship: obesity is a risk factor for asthma, the link of its pathogenesis, a predictor of heavier flow and the worst control. One of the priorities of non-drug therapy of asthma is the fight against overweight. Preventive counseling allows doctors to teach patients the principles of a healthy lifestyle, including controlling body weight. There is no domestic population-based research reflects the coverage of overweighted persons with asthma of the counseling on weight loss in various socio-demographic groups. Thus our study is actual. Aims: Determine socio-demographic groups among overweighted patients with asthma that doesnt receive a counseling on weight loss. Materials and methods: This study based on cross-section population-based study "Know Your Heart" (2015-2018, Arkhangelsk, Novosibirsk, n=4504). For this research we selected overweighted patients with asthma (n=167). We applied the decision tree to identify socio-demographic groups that havent received a counseling on weight loss. Results: The probability of obtaining a counseling on weight loss increased by 1.39 times among obesity and pension status in women compared with the coverage level of counseling in the studied sample as a whole (61.7%). Among the men, the probability of obtaining a counseling on weight loss increased 1.27 times in the presence of obesity. Reducing the likelihood of getting counseling both among women (1.39 times compared with the general indicator) and among men (2.2 times compared with the general indicator) was noted if their weight corresponded to the category of excess body. Conclusion: 61.7% of the overweighted urban population of Russia with asthma received a counseling on weight loss. Groups of overweighted patients with asthma, which are statistically significantly less often obtaining counseling on weight loss: persons with BMI=25.0-29.9, regardless of gender, and non-retired women with BMI30.0. The decision tree developed by us will allow allergists-immunologists and other doctors to be wary of patients from the population groups identified in the study who are not covered by counseling. In turn, this will increase the coverage of patients from risk groups with counseling and, as a result, will contribute to improving asthma control.

Active formation of tolerance in case of allergy to cow's milk proteins

Food allergy is a potentially life-threatening condition in which there are no approved pathogenetic treatments other than elimination of the causal allergen and relief of acute allergic conditions. IgE- mediated form of food allergy remains a serious and growing problem worldwide. Its prevalence is steadily increasing, and is a severe psychosocial and economic burden for patients and their families. Cow's milk and products based on it are important components of a child's diet, which are introduced into the diet of children of the first year of life, but can cause allergic reactions. The traditional management of children with cow's milk allergy consists in prescribing an elimination dairy-free diet and a significant part of patients form tolerance to milk proteins by the age of 5 years. However, with persistent forms of allergy to cows milk proteins, the question is raised about the need for "active" tactics of patient management in order to form tolerance. Oral immunotherapy is a promising approach to the treatment of food allergies based on a gradual increase in the allergen taken, by analogy with standardized immunotherapy for respiratory allergens, until a maintenance dose is reached. Each stage of oral immunotherapy should be considered as a personalized therapy. This review contains an analysis of available studies on the effectiveness of oral immunotherapy in the treatment of allergy to cow's milk proteins.

Features of the course of chronic spontaneous urticaria in patients with Common variable immune deficiency and hypogammaglobulinemia.

Chronic spontaneous urticaria is a common disease that can be associated with various autoimmune, infectious (viral, bacterial, parasitic) and non-infectious inflammatory diseases, as well as occur in the symptom complex of other diseases, such as primary immunodeficiencies (PID). Currently, data about the features of the course of chronic spontaneous urticaria in patients with PID are accumulating. In this article we present two clinical cases of patients with common variable immune deficiency and one clinical case of a patient with hypogammaglobulinemia, suffering from chronic spontaneous urticaria. The article describes peculiar properties of IVIG replacement therapy at the course of urticaria in these patients. The discussion section presents data from the world literature and offers key provisions for further investigations.

An altered skin microbiome is the most important symptom of atopic dermatitis.

Fast traslate Icon translate Fast traslate Icon translate The progressive increase in the incidence of atopic dermatitis among children, an increase in persistence in adulthood, combined with an inevitable decrease in the quality of life of patients, determine the relevance of studying the mechanisms of the development of this disease not only for dermatology, but also for the entire health care system. Thus, the prerequisites for the emergence of new concepts of pathogenesis and the search for the most effective therapeutic modalities arise. At the moment, atopic dermatitis is considered as the interaction of endogenous (impaired immune response, insufficient function of the epidermal barrier) and exogenous (exposure to allergens, chemical or physical irritants, microorganisms) factors. Environmental factors such as temperature and humidity, genetic makeup, antibiotic use, and good hygiene play a critical role in the maintenance and stability of the skin microbiome. Normally, the skin microbiota is mainly formed by bacteria of the genus Staphylococcus, Propionibacterium, Corynebacterium and Streptococcus. While in patients with AD, in 70% of cases, there is colonization of Staphylococcus aureus on the affected skin, in 39% on intact skin, which secondarily contributes to the development of immune imbalance and increased skin xerosis. This fact determines the importance of the use of basic therapy, which, on the one hand, helps to strengthen the epidermal barrier, and on the other hand, normalizes the microbiome of the skin, reducing the colonization of Staphylococcus aureus.

Pharmacoeconomic analysis of bronchial asthma prophylaxis in adults and children with allergic rhinitis with sublingual allergen-specific immunotherapy

AIMS: to evaluate the cost-effectiveness of sASIT in children and adult patients with allergic rhinitis and / or allergic rhinoconjunctivitis. MATERIALS AND METHODS: the hypothesis of the study was based on results of the study by Devillier P. et al., 2019, according to which the incidence of asthma was 13.7% and 17.0% in the sASIT + symptomatic therapy groups and the symptomatic therapy group (odds ratio - 0.776, 95% confidence interval (0.622; 0.968)). Pharmacoeconomic study based on decision tree model. Costs taken into account: cost of sASIT, symptomatic therapy, diagnostics and routine follow-up visits due to BA, outpatient BA drug therapy, the cost of hospitalization due to BA. The modeling horizon was 5 years, including 2 years of sASIT therapy and 3 years of follow-up. RESULTS: the cost per patient when using sASIT in combination with symptomatic therapy was 166,711.93 rubles, with symptomatic therapy - 101,700.35 rubles. The CER for sASIT in combination with symptomatic therapy was 193,177.20 rubles. per 1 prevented case of asthma, for symptomatic therapy - 122,530.55 rubles. for 1 prevented case of BA. Thus, the cost of 1 averted AB case when using sASIT in combination with symptomatic therapy is 57.7% higher than with symptomatic therapy. According to the results of the cost-benefit analysis, ICUR for an additional year of life adjusted for its quality (QALY) when performing sASIT in combination with symptomatic therapy compared with symptomatic therapy alone in children and adults was 567,365.48 rubles, which is less than calculated willingness to pay threshold (WTPT) (RUB 2,248,898.50). CONCLUSIONS: based on the results of comparing the cost of 1 added QALY and WTPT, it can be concluded that sASIT in combination with symptomatic therapy compared to symptomatic therapy alone is potentially cost-effective in children and adults with AR.

Chronic spontaneous urticaria or urticarial vasculitis?

Differential diagnosis of chronic spontaneous urticaria (CSU) and urticarial vasculitis (UV) is carried out in the case of an atypical clinical picture of urticaria. Wheals lasting longer than 24 hours, often accompanied by burning and pain, leaving behind purpura or residual hyperpigmentation. This article describes a case of urticarial vasculitis in a patient that required differential diagnosis of CSU and UV several years after the onset of the disease. Successful treatment was carried out with a combination of antihistamines, glucocorticosteroids, hydroxychloroquine and omalizumab.

Аsthma

Asthma is one of the most common respiratory tract diseases (about 7% of adults and about 10% of adolescents and children suffer from asthma in the Russian Federation). Astma frequencies of occurrence dont depend from sex or age in population. Numbers of asthmatic patients in the world increase every year. The majority of patients suffering asthma well respond to conventional therapies and successful control disease, but 20-30% of the patients have severe phenotypes asthma resisting for known medicines, therefore they achieve control for asthma very rare. Patients with severe asthma frequently need hospitalizations (up to 30%) and intensive care (4-7%). The clinical asthma guideline has goals to optimize patient care, up-to-date information about the epidemiology, etiology and pathogenesis of the disease. The text contains actual data about asthma classification, its clinical signs, modern diagnostics (clinical, laboratory and instrumental) inclunded the differential diagnostics of astma. There are chapters about asthma treatment, rehabilitation and prevention in the guideline. Authors detailed describe existing healthcare options for asthmatic patients and the features of diasgnostics and care in partial groups of population (adolescents, pregnant or nursing women, persons with occupational or exercise-induced or severe phenotype asthma). The clinical guideline are recommended for medical doctors (independendently from qualification), under- and postgraduate students, universities tutors, residents and researchers.

To the publication of the textbook "Immunology" (2021, 4th ed., Revised and enlarged) authored by academician of the Russian Academy of Sciences R.M. Khaitov

A pleasant event for specialists in immunology and specialties related to immunology took place this year. A new, 4th edition of the textbook "Immunology" has been published, prepared by the famous Russian immunologist, Academician of the Russian Academy of Sciences Rakhim Musaevich Khaitov. Compared to the previous edition, issued in 2018, this version is a substantially updated and revised version, replenished with information obtained during this relatively short period by world immunology, one of the most rapidly developing areas of scientific knowledge. With all the complexity of modern immunology, this training manual has achieved a perfect in form, consistent and at the same time accessible presentation of the material in accordance with the latest international data. Attention is drawn to the appropriate placement of perfectly done illustrations that explain the text material and create liveliness, interest and accessibility to its development. Special attention should be paid to the fact that after getting acquainted with the deeply and easily presented material about the structure and function of the immune system, the reader is fully prepared for an easier perception of special clinic-oriented information, in particular, on allergies in the chapter "Allergic diseases" presented in in accordance with the principles of evidence-based medicine, modern international and national guidelines and consensus documents. Undoubtedly, the textbook will be an irreplaceable guide for students and teachers of medical and biological educational institutions, researchers, doctors of various specialties interested in immunology and allergology.

HOUSE DUST MITE ALLERGENS: FROM NATIVE EXTRACTS TO MODIFIED PREPARATIONS

The growth of allergic diseases dictates the need to develop new forms of therapeutic allergens with high immunogenic and low allergenic activity. For many years, our laboratory has been developing drugs for the diagnosis and treatment of house dust mites (HDM) allergies. The purpose of this study is to summarize the results of the five-year development of therapeutic preparations of HDM allergens. During this period, we obtained the following forms of therapeutic allergens: a granular sublingual dosage form of a mixed allergen from Dermatophagoides pteronyssinus (Der.p) and Dermatophagoides farinaе (Der.f) and a succinylated monomeric HDM allergoid Der.p. The physicochemical and immunobiological properties of the obtained preparations were studied by methods: electrophoresis in PAGE in the presence of SDS-sodium, micropoint immunoblot, ELISA, inhibition of the binding reaction of allergen-specific IgE in the sera of patients. The research results showed that the obtained preparations have a reduced allergenic and increased immunogenic activity in comparison with native extracts. The created forms of mite allergens can be further used to treat patients sensitized to HDM of the genus Dermatophagoides.

PLANT POLLINATION CALENDAR AND ITS IMPORTANCE FOR OPTIMIZATION OF THE TREATMENT AND REHABILITATION OF PATIENTS WITH SENSITIZATION TO PLANT POLLEN ON THE SOUTHERN COAST OF THE CRIMEA

Air-aerosol pollen of plants can influence the results of climatotherapy and elimination therapy of respiratory allergic diseases. The diversity of the flora, the poorly studied prevalence and etiology of pollinosis on the Southern coast of the Crimea determine the need for aeropalinological studies of this region to optimize the treatment and rehabilitation of patients with respiratory sensitization. Objective To determine the content of plant pollen in the air, to develop a calendar of palination of plants in the Yalta resort, to identify periods that are potentially unfavorable for the stay of patients with pollen sensitization on the Southern coast of the Crimea. Material and methods Plant pollen in the air was determined gravimetrically. The taxonomic affiliation was identified and the amount of pollen deposited on the glass-traps in the coastal and foothill areas of Yalta city was calculated. The data obtained were averaged over the city as a whole. Results In 2011-2013, 19 pollen taxa were identified in the air of the resort, including 10 with sensitizing properties. Of these, cypress pollen accounted for 49.7% of the average annual amount, deciduous trees with allergenic pollen 4.7%, cereals and weeds 1.6% each. 79.0% of pollen was recorded in spring, 7.7% in summer, 8.6% in autumn, 4.7% in winter. In the air of the coastal area of the city, 2.2 times less pollen was detected than in the air of the foothill. Three waves of plants pollination were revealed: winter-spring pollination of trees and shrubs, late spring pollination of cereals, summer-autumn pollination of weeds. The calendar of pollination of plants of the Yalta resort has been developed. Conclusion The greatest risk of sensitization and exacerbation of respiratory allergies in the Yalta resort is created by cypress pollen in March April. The most favorable for the treatment and rehabilitation of patients with respiratory allergies is the coastal area of the resort. The developed plant pollination calendar allows predicting unfavorable aeropalinological periods, optimizing the treatment and rehabilitation of patients with pollen sensitization at the Yalta resort.