Background. Second-generation H1-antihistamines, such as cetirizine and levocetirizine, are widely used drugs of choice for the treatment of allergic diseases due to their high selectivity and safety. However, in recent years, clinical practice and pharmacovigilance systems (FDA) have accumulated data on a specific phenomenon — the occurrence of severe pruritus developing after the discontinuation of these drugs. In domestic literature, this withdrawal syndrome is virtually undescribed, which may lead to misdiagnosis of the underlying disease relapse. Aim. To conduct a comprehensive analysis of available data on the prevalence, clinical presentation, and onset timing, to develop a pathogenetic model, and to justify management algorithms for recurrent pruritus after cetirizine and levocetirizine withdrawal. Materials and Methods. An information search was conducted in international and Russian databases (PubMed/MEDLINE, Google Scholar, Scopus, eLibrary, and RSCI), official regulatory sources (FDA, GRLS), and open information networks (Google, Yandex) without language or time restrictions. Conceptual modeling was used to synthesize a pathogenetic hypothesis based on the analysis of clinical data, pharmacodynamics and pharmacokinetic parameters of the drugs. Results. The clinical features of the syndrome were systematized: onset within 1–5 days after discontinuation, distressing generalized pruritus, and a lack of correlation with the underlying disease. The assumption of significant underdiagnosis of this condition was formulated. An original pathogenetic concept was developed, explaining the withdrawal syndrome through the mechanism of compensatory hypersensitization of H1-receptor cascades during prolonged blockade. Management strategies for recurrent pruritus were proposed and justified, including symptom relief by resuming cetirizine or levocetirizine, a gradual dose tapering method, and therapeutic rotation to an antihistamine with different pharmacokinetic parameters. Conclusion. Recurrent pruritus following cetirizine withdrawal is a predictable pharmacodynamic effect. Understanding the mechanisms of receptor adaptation allows for optimizing the strategy for therapy completion, avoiding unnecessary systemic drug administration, and improving patient quality of life.
On September 16, 2025, a meeting of an interdisciplinary Expert Council in the fields of allergology, otorhinolaryngology, and pediatrics was held in Moscow, dedicated to improving approaches to the treatment of allergic rhinitis. The primary goal of treating allergic rhinitis is to achieve control over the disease’s symptoms. The Visual Analogue Scale is recognized as a simple, convenient, and valid tool for symptom monitoring. Differences between national clinical guidelines for the treatment of allergic rhinitis and the international ARIA 2024 guidelines were analyzed. It was established that the ARIA 2024 guidelines are patient-oriented and offer the possibility of prescribing any group of pharmacological agents already at the first assessment of allergic rhinitis control using the Visual Analogue Scale. The national clinical guidelines do not prohibit initiating therapy at any step; however, the proposed algorithm limits the physician to a sequential prescription of drugs. Current issues of allergic rhinitis in pediatric practice were discussed, including delayed diagnosis, low quality of life for patients, and insufficient attention to atopic multimorbidity. The role of surgical correction of anatomical abnormalities of the nasal septum in patients with allergic rhinitis, which hinder the effective delivery of intranasal medications, was examined in detail. The problem of low patient adherence to allergic rhinitis therapy is considered one of the key factors in achieving disease control. Approaches to improving adherence were discussed, including transitioning from a paternalistic doctor-patient interaction model to a shared decision-making model regarding therapy, taking into account patient preferences. Special attention was paid to the place of fixed-dose combinations of intranasal glucocorticosteroids and intranasal antihistamines in the treatment of allergic rhinitis. It was shown that in approximately two-thirds of patients, monotherapy does not provide control of allergic rhinitis symptoms, and they require combination therapy. Fixed-dose combinations demonstrate advantages such as effect potentiation, reduced incidence of side effects, synergistic action, and increased treatment adherence. The Expert Council proposed an updated algorithm for choosing therapy for allergic rhinitis, considering the possibility of starting treatment at any step based on assessing the number and severity of symptoms using the Visual Analogue Scale. The use of fixed-dose combinations as initial therapy is recommended in the presence of persistent symptoms (more than 4 days per week) and a Visual Analogue Scale score of ≥ 5, especially in cases of severe nasal congestion. This algorithm is planned to be used as a basis for updating the national clinical guidelines for the treatment of allergic rhinitis.
Atopic dermatitis is a chronic multifactorial inflammatory skin disease characterized by pruritus, a relapsing course, and characteristic morphological and topographical features that develops in genetically predisposed individuals against the background of a T2-immune response. Cytokines from T helper 2 and type 2 innate lymphoid cells — interleukins 4, 13, and 31 — play a key role in the pathogenesis of the disease, activating the JAK/STAT signaling pathways (primarily JAK1/STAT6). Despite the proven efficacy of selective Janus kinase inhibitors, including the selective Janus kinase inhibitor upadacitinib, in many inflammatory diseases, including atopic dermatitis, there remains a need to accumulate real-world clinical data, especially in patients with refractory atopic dermatitis and comorbid conditions. Aim — to evaluate the long-term efficacy, safety, and dynamics of potential biomarkers during upadacitinib therapy in patients with severe atopic dermatitis and comorbid pathology. This case series presents data from 5 adult patients (3 men, 2 women) with severe atopic dermatitis refractory to standard therapy. All patients received upadacitinib 30 mg once daily for 52 weeks. Efficacy was assessed by dynamics in Scoring Atopic Dermatitis Index, Eczema Area and Severity Index, Investigator’s Global Assessment scores, Numerical Rating Scale; Dermatology Life Quality Index. Safety was evaluated through monitoring of adverse events. Gene expression of cytokines (TARC/CCL17, MDC/CCL22, PARC/CCL18, CTACK/CCL27, eotaxin-3/CCL26, interleukins 4, 13, 17, 22, 25, 33, thymic stromal lymphopoietin) was analyzed using real-time polymerase chain reaction at baseline and at week 16 of therapy. Control over atopic dermatitis symptoms was achieved in all patients: by week 40, 100 % (5/5) of patients had achieved an Eczema Area and Severity Index 90 response, which was maintained until the end of the 52-week observation period. The median Scoring Atopic Dermatitis Index decreased from 65.3 to 2.6 by week 40, and the median Eczema Area and Severity Index score decreased from 47.6 to 0.7 by week 28. Numerical Rating Scale score decreased from 5 to 1 (median) by week 16. During the observation period, 26 mild adverse events were recorded; no serious adverse events were reported. Complete drug-induced remission was observed in one female patient with comorbid alopecia areata. No statistically significant changes were detected in the profile of the studied biomarkers. In this case series, upadacitinib demonstrated high efficacy and a favorable safety profile in patients with severe refractory atopic dermatitis over 52 weeks of therapy. The observed remission of comorbid alopecia areata expands understanding of the drug’s therapeutic potential. Larger prospective studies are needed to confirm these findings and to identify predictive biomarkers.
BACKGROUND: Seasonal asthma exacerbations in children remain a significant problem in pediatrics and allergology. Several studies in the Russian Federation demonstrate the successful use of the ammonium glycyrrhizinate) in addition to standard asthma therapy in children during the acute respiratory infections season. However, no studies have been conducted during the spring pollen season. AIM: To evaluate the efficacy and safety of ammonium glycyrrhizinate in the combination treatment of children aged 5–17 years with mild asthma during the spring pollen season. METHODS: Two groups of patients with mild asthma were observed during the pollen season: the main (n = 20) and the control (n = 20) groups. In the main group, ammonium glycyrrhizinate was added to standard asthma therapy for 18 weeks. Four clinical visits were conducted (day 1, weeks 6, 12, 18). At each visit, symptoms were assessed using a 4-point visual analog scale, asthma control tests, and peak flow measurements. From April to May, patients or their parents recorded daily symptoms in diaries. RESULTS: During the tree pollen season (March – May), the control group demonstrated an increase in daytime and nighttime cough, reaching maximum values at visit 3 (2.3 ± 0.3 and 1.25 ± 0.08 points, respectively). In the main group the severity of cough remained low and did not exceed 0.9 points (p 0.05). A similar pattern was observed for rhinoconjunctival symptoms: in the main group their severity remained at the level of mild manifestations (≤1.3 points), in the control group they reached moderate severity (up to 2 points). Asthma control test scores in the main group remained stable and corresponded to well-controlled asthma (23.5 ± 0.4 and 24.3 ± 0.8 points at visits 2 and 3, respectively), in the control group a decrease to 20.4 ± 0.9 points was observed at visit 3 (p 0.05). The mean duration of allergy symptoms in the main group did not exceed 15 days, in the control group it reached 18–25 days. CONCLUSION: Adding ammonium glycyrrhizinate to standard therapy of mild asthma in children during the spring pollen season effectively decreases the severity and duration of bronchial and rhinoconjunctival symptoms, and improves asthma control during periods of high pollen exposure.
Allergic rhinitis (AR) is a global health and social problem and a classic example of a multifactorial IgE-mediated disease. Despite significant progress in understanding the molecular basis of AR, many issues regarding the ethnic characteristics of the distribution of genetic markers and the specifics of epigenetic changes remain unresolved. The aim of the work was to comprehensively summarize modern concepts of the genetic and epigenetic mechanisms of the pathogenesis of allergic rhinitis. A systematic search of the literature was conducted in the PubMed, Google Scholar, eLibrary and CyberLeninka databases for the period 2000–2024. The inclusion criteria were original research, meta-analyses and reviews devoted to genetic associations, epigenetic mechanisms and epidemiology of allergic rhinitis. It has been established that polymorphisms in the genes of Th2 immune response effectors (IL13, IL4), epithelial barrier genes (ORMDL3, TSLP) and antigen presentation genes (HLA-DQ/DR) play a key role in the pathogenesis of AR. Epigenetic mechanisms, including hypomethylation of the IL4 and FOXP3 gene promoters, dysregulation of microRNA (increased miR-21, miR-155 and decreased miR-146a) serve as a link between genetic predisposition and environmental factors. Epidemiological data demonstrate heterogeneous prevalence of AR in the world (10–40%) and in Russia (10–24%), with regional characteristics, in particular, in the Altai region (12.3% among children). Integration of data from genetics, epigenetics and epidemiology opens the way for the development of personalized approaches to the diagnosis and therapy of AR. Promising areas are the organization of multicenter cohorts, the use of modern genomic technologies and the consideration of regional characteristics.
BACKGROUND: The problem of chronic spontaneous urticaria is relevant to study due to its prevalence primarily among people of working age, the reduced quality of life of patients, and the high costs to the government. Managing patients with severe form of this disease might be challenging and requires a personalized approach. AIM: To characterize the clinical and laboratory features and the effectiveness of therapy in patients with severe chronic spontaneous urticaria in real-world clinical practice. METHODS: An observational, single-center, retrospective, uncontrolled randomized study was conducted with analysis of medical records of patients with severe chronic spontaneous urticaria (n = 58). The created database included clinical data (patient age, phenotype of urticaria, presence of comorbidities, type and effectiveness of therapy) and laboratory data (complete blood count, C-reactive protein, total immunoglobulin E, immunoglobulin G antibodies to thyroid peroxidase). RESULTS: An analysis of a database of these patients revealed certain clinical features that may predict a severe course of the disease. These are age between 40 and 60 years (50 % cases), female gender (74 %), a combination of urticaria and angioedema (86 %), the presence of comorbidities (75 %), and insufficient efficacy of second-generation antihistamine therapy, in which only 29 % of patients achieved good control in symptoms. In 71 % of cases, the addition of omalizumab was required, which resulted in a complete and rapid response in 78 % of patients. Laboratory tests revealed elevated immunoglobulin E levels in this group, which may indirectly indicate an autoallergic endotype of the disease. In the group of patients with an incomplete response to omalizumab, the level of total immunoglobulin E was lower or within the reference range, while the immunoglobulin G level to thyroid peroxidase was higher, which may indicate the presence of an endotype associated with type IIb hypersensitivity. CONCLUSION: A combination of clinical and laboratory characteristics could help to determine the severity of the disease and its potential endotype. However, further research is needed to identify reliable markers that can differentiate the various pathogenetic variants of severe chronic spontaneous urticaria. The patients we examined likely had a predominantly autoallergic endotype, for which omalizumab was highly effective.
BACKGROUND: Severe asthma is a socially significant problem. Despite ongoing therapy, many patients fail to achieve control over their symptoms. Significant interregional differences may exist in both the prevalence and the clinical course of severe asthma. AIM: To assess the clinical and functional features of severe asthma in the Republic of Karelia in a real-world setting. MATERIALS AND METHODS: The study included 94 adult patients with severe asthma (71.2% female), whose baseline therapy corresponded to steps IV–V according to the clinical guidelines (2024). The following parameters were assessed: spirometry results (bodyplethysmograph Ganshorn, PowerCube series, Switzerland), blood eosinophil count (Systex XN-1000 hematology analyzer, Japan), sputum eosinophil count (microscopy method), and total IgE levels (Mindray CL 1200i analyzer, China). The ACQ-5 (Asthma Control Questionnaire) and ACT (Asthma Control Test) questionnaires were used. RESULTS: Uncontrolled course was established in 63 (67.0%) patients with severe asthma. The frequency of corticosteroid-dependent severe asthma was 14.8%. The majority of patients (94.6%) exhibited a T2 endotype of airway inflammation, with sensitization to ≥1 allergen in 58.5% of cases. In patients with severe asthma, the following comorbidities were registered: allergic rhinitis –48.9% patients, chronic rhinosinusitis with nasal polyps – 32.9%, and atopic dermatitis – 13.8%. Obesity was diagnosed in 49 (52.1%) patients. Biologic therapy for more than 12 months was administered to 15 (15.9%) patients. CONCLUSION: Patients with severe asthma in the Republic of Karelia are characterized by an uncontrolled disease course, a predominance of the T2 endotype of airway inflammation, and the presence of T2-associated multimorbid pathology.
The article presents the consensus opinion of experts on the role of 5% dexpanthenol preparations, particularly the original 5% dexpanthenol cream, in the comprehensive management of patients with inflammatory dermatoses such as atopic dermatitis and eczema. The material was prepared based on the results of the Expert Council held on December 17, 2025. The article reviews current concepts of the pathogenesis of these diseases with an emphasis on the central role of epidermal barrier disruption. The main approaches to restoring the skin barrier within existing therapy are described. Current clinical guidelines are analyzed and problem areas related to algorithms for the use of preparations that restore skin barrier function are identified. An overview of the evidence base for the multifaceted action of 5 % dexpanthenol, which has regenerating, anti-inflammatory, and epidermal barrier-restoring effects, is presented. The place of 5 % dexpanthenol in the treatment of atopic dermatitis is defined: as monotherapy in mild forms, and as part of combination and sequential therapy in moderate-to-severe cases. The final part of the paper formulates practical recommendations for the inclusion of dexpanthenol medicinal products in clinical algorithms for patient management.
Atopic dermatitis is one of the most common skin diseases (accounting for 20 to 40 %) and occurs in individuals of both sexes and across different age groups. The disease can significantly reduce quality of life, including serving as a cause of social maladaptation; therefore, the issue of studying effective methods for the treatment of atopic dermatitis remains relevant, aimed at minimizing its manifestations and prolonging periods of remission. The key components of the pathogenesis of atopic dermatitis are impairment of the skin barrier function, chronic T2-inflammation, and the development of immunoglobulin E specific sensitization to allergens. Along with allergic rhinitis and bronchial asthma, atopic dermatitis belongs to T2-associated diseases, for which one of the treatment options is allergen-specific immunotherapy. This method has proven successful in the treatment of atopic diseases and, due to its disease-modifying effect, the issue of its efficacy and safety in patients with atopic dermatitis has been actively studied in recent years. This review summarizes current data on the use of allergen-specific immunotherapy with house dust mite allergens in patients with atopic dermatitis and presents a case report illustrating the successful use of allergen-specific immunotherapy with house dust mites allergen in a patient with atopic comorbidities.
BACKGROUND: Due to the successful use of immunoglobulins, non-infectious complications have become the main cause of disability and mortality in patients with primary immunodeficiencies, necessitating the development of treatment protocols for complications of immune dysregulation. The development of lymphocytic infiltration of organs, granulomatous disease, autoimmune manifestations, and cancer exacerbates the course of the underlying disease and determines the patient’s life prognosis. Rituximab is one of the most commonly used medications. No large randomized controlled studies have been conducted on the use of rituximab in patients with common variable immune deficiency with signs of immune dysregulation. AIM: Evaluation of the effectiveness of rituximab therapy for the treatment of immune dysregulation complications in patients with common variable immune deficiency over the age of 18. METHODS: The study included 31 patients aged 19 to 62 years with a general variable immune deficiency, manifested by symptoms of immune dysregulation without an identified molecular genetic defect. Rituximab was included in the complex therapy of the disease for all patients. RESULTS: 31 case histories of patients with common variable immune deficiency aged 19 to 62 years were analyzed. The average age of the total sample was 38.13 ± 2.20 years. Of these, 18 (58.06 %) were women and 13 (41.94 %) were men. All patients showed symptoms of immune dysregulation: granulomatous-lymphocytic interstitial lung disease in 28 (90.32 %) patients, including 16 (88.88 %) women and 12 (92.30 %) men. Splenomegaly was observed in 26 (83.87%) of all patients. Splenectomy was performed in 5 (16.13 %) patients (all patients were male). Lymphadenopathy in 30 (96.77 %) patients, 12 (92.31 %) men and 18 (100 %) women. Thrombocytopenia in 22 (70.97 %) patients, 10 (76.92 %) men and 12 (66.67 %) women. Autoimmune hemolytic anemia in 5 (16.13 %) patients in the total sample, in 3 (23.07 %) men, 2 (11.11 %) women. Еighteen patients (58,06 %) in the anamnesis received other lines of therapy without effect or with a short-term effect. All patients received therapy with rituximab. Treatment regimen: 4-fold administration of rituximab at a dose of 375 mg/m2 at 7-day intervals, followed by 3 administrations every 3 months. After one year of treatment, 89.28 % of patients with granulomatous-lymphocytic interstitial lung disease experienced complete regression of symptoms and changes in instrumental examinations. Additionally, 63.33 % of patients reported a reduction in the size of their spleen and lymph nodes. Normalization of blood parameters (thrombocytopenia) in 59,09 % of patients. No adverse events were observed during the year-long use of rituximab. CONCLUSION: The efficacy and safety of rituximab in adult patients with common variable immune deficiency with immune regulation manifestations have been proven.
The thymus is a lymphoepithelial organ located in the upper part of the anterior mediastinum and is both the central organ of the immune system and the endocrine gland. An increase in the volume and mass of the thymus above the age limits while maintaining normal histoarchitectonics is called thymomegaly. Thymomegaly occurs mainly in children and can be both idiopathic and secondary, occurring as a rebound phenomenon after exposure to various stress factors or accompanying other diseases and conditions. The pathogenetic basis for this is considered to be the dysfunction of the hypothalamic-pituitary system. Thymomegaly, especially severe degrees, is often accompanied by a violation of T-cell immunity, as well as a decrease in the size of the adrenal glands with suppression of their hormonal function, and therefore individuals with thymomegaly are at risk of developing prolonged, complicated, and fulminant forms of infectious diseases. Instrumental methods for thymomegaly detecting are chest X-ray and thymic ultrasound. Thymomegaly can also be detected by computed tomography/magnetic resonance imaging of the chest. Thymic T-lymphocyte development is assessed by detection of T-receptor excision circles in the blood using polymerase chain reaction. The complex of therapeutic and preventive measures for thymomegaly includes T-cell immunity disorder correction (if present), a personalized vaccination approach, preoperative preparation, and careful monitoring in the postoperative period. The need for thymectomy is determined individually. The prognosis in children is more often favorable, in adults it depends on the cause.
BACKGROUND: The ability of native hemozoin isolated from O. felineus to alter the cytokine profile of cells can be used to correct conditions associated with T2 polarization of the immune response, which primarily include atopic diseases, including allergic bronchial asthma. AIMS: To evaluate the immunogenic effect of O. felineus hemozoin against diseases with T2 polarization of the immune response in a dendritic cell model. METHODS: A cross-sectional, open-label case-control study included adolescents aged 12 to 18 years living in Tomsk and the Tomsk region, patients with bronchial asthma and established sensitization to Dermatophagoides pteronyssinus allergens, and children without established atopic disease and without registered helminth infestation. Evaluation of the presence of dendritic cell maturation markers CD86, CD83, CD40 after stimulation with D. pteronyssinus antigen and D. pteronyssinus antigen in combination with O. felineus hemozoin was performed using flow cytometry. A simultaneous study of cytokine production in the cell supernatant during co-cultivation with T cells was conducted and the levels of IFNy and IL-4 cytokines were determined using a multiplex analysis method. RESULTS: When analyzing the immunophenotypic characteristics of DC in the bronchial asthma group, it was found that the content of CD86, CD83, and CD40 was higher after stimulation of DC with both Dermatophagoides pteronyssinus and Dermatophagoides pteronyssinus and hemozoin. In the group of BA patients, lower levels of IL-4 were recorded with stimulation with Dermatophagoides pteronyssinus and hemozoin than with stimulation with Dermatophagoides pteronyssinus alone . Regarding INFy, stimulation of DC with Dermatophagoides pteronyssinus and hemozoin in the BA group was associated with higher levels of the cytokine. However, stimulation of DC in BA patients with only an allergen did not lead to changes in INFy production. CONCLUSIONS: The results of a study using a DC model of children with allergic asthma demonstrate that exposure to hemozoin from the liver fluke Opistorchis felineus is associated with a decrease in IL-4 production (a T2 immune response) and an increase in INFy production (a non-T2 immune response) by these cells. Hemozoin is likely an immunogenic excretory product of the helminth, capable of influencing the polarization of the immune response.
BACKGROUND: Continuous monitoring studies of the regional spore and pollen aerospectrum for the southern part of the Tyumen Region have not been carried out. AIM: To identify regional characteristics of the spore and pollen spectrum in the air environment in Tyumen based on the results of five years of airborne pollen monitoring. METHODS: A volumetric pollen trap was used to collect pollen and spores from the city air during the spring and autumn of 2018–2022. Subsequent identification and counting of pollen grains and spores was carried out under a light microscope at × 400 magnification. RESULTS: Pollen from at least 13 anemophilous plants from different taxonomic groups was detected in the air mass of Tyumen. Spores from at least two fungal taxa were also detected. Cladosporium was the most prevalent. The number of tree pollen taxa was almost four times higher than the number of grass pollen taxa. Birch pollen was found to be the most productive in the city’s air spectrum, peaking during the first wave in May. Nettle pollen is the second most common allergen in terms of total pollen count. Its peak occurs during the second wave. The absence of ragweed pollen was demonstrated. The dynamics of pollen and spore frequency during the specified observation period were analysed. A regional pollen calendar was compiled. CONCLUSION: The spore-pollen spectrum is dominated by birch, pine, and nettle pollen, as well as Cladosporium fungus spores, but ragweed pollen is not present.
BACKGROUND: Despite the increasing number of patients with secondary immunodeficiencies, reliable data on their prevalence, diagnostic criteria, and treatment are lacking, which underscores the requirement for research in this area. AIM: To characterize the clinical and immunological features, and treatment approaches for various forms of secondary immunodeficiencies observed in clinical practice. METHODS: A retrospective analysis of medical records from 180 patients with a confirmed diagnosis of secondary immunodeficiency was conducted. The database included information on primary and comorbid conditions, the scope of administered therapy, characterization of secondary immunodeficiencies clinical signs, data from general clinical and immunological investigations, and specific treatment options for immunodeficiency. RESULTS: Three groups of patients with secondary immunodeficiencies were identified: group 1 — 51 (34.0 %) patients with oncohematological diseases, group 2 — 33 (22.0 %) patients with chronic bacterial infections, group 3 — 41 (27.3 %) patients with chronic viral infections. In group 1, lymphomas accounted for 82.3 % of the underlying pathologies. Manifestations of infectious syndrome in 80.3 % were associated with respiratory tract disorders, with pneumonia diagnosed in 21.5 %. This cohort showed a significant B-lymphocytopenia, associated with reduced immunoglobulin G levels, alongside phagocytosis depression. Immunodeficiency was managed with intravenous immunoglobulin. In group 2, respiratory tract, skin, and soft tissue lesions (57.6 % and 36.4 %, respectively) occurred in the setting of depressed phagocytosis, necessitating more frequent antibacterial therapy. However, patients with oncohematological diseases had 3.2 times higher odds of developing recurrent infections requiring prolonged or parenteral antibiotic therapy (odds ratio 3.257 [confidence interval 1.303–8.142]; p = 0.01300). For immunodeficiency correction, azoximer bromide was prescribed to 66.6 % of patients. The majority of patients in group 3 (97.5 %; n = 40) had infection induced by various types of herpes viruses, with frequent relapses and resistance to standard therapy. Laboratory assessment revealed reduced phagocytic indices CONCLUSION: The study demonstrates the relevance of the problem of secondary immunodeficiencies in clinical practice, which requires a multidisciplinary approach and the involvement of physicians of various specialties, followed by rational patient referral to a specialized clinical immunology center.
BACKGROUND: The lack of accessible screening for inborn errors of immunity in adults significantly complicates the diagnosis of these conditions. In more than half of the cases, this leads to delayed disease detection and the development of irreversible complications in patients. AIM: To determine reference intervals for TREC and KREC concentrations in adults and evaluate the possibility of their use for inborn errors of immunity screening using the “NeoScreen SMA/TREC/KREC” test system. METHODS: A single-center observational cross-sectional controlled non-randomized study was conducted involving 101 patients. The study included groups with humoral and combined immune defects, divided into subgroups with predominant humoral immune defects (antibody synthesis disorders) and combined immune defects, as well as a control group of conditionally healthy participants. TREC and KREC levels were determined using polymerase chain reaction. The study was conducted from September 2024 to August 2025. Statistical analysis included group comparisons (Mann–Whitney and Kruskal–Wallis tests), ROC analysis. Reference intervals were determined using the direct method according to International Federation of Clinical Chemistry and Laboratory Medicine recommendations. Statistical significance was confirmed at p 0,05. RESULTS: The study included 101 participants: 46 patients in the control group and 55 patients with inborn errors of immunity. Statistically significant differences in TREC and KREC levels were observed between healthy participants under 39 years and over 40 years (p 0,001 and p = 0,003, respectively). Subgroup analysis showed: in the humoral immune defects subgroup, KREC levels demonstrated area under curve — 0,87, specificity — 95 %, sensitivity — 68 %. In the subgroup with combined immune defects, the method did not show statistically significant differences with the control group when comparing TREC and KREC levels (p = 0,639 and p = 0,092, respectively). CONCLUSION: The development of separate threshold values for patients over 40 years of age is required. The method is effective for screening humoral immune disorders but is not suitable for combined forms of inborn errors of immunity. Despite the high specificity and sensitivity of KREC as a diagnostic marker, the method cannot be recommended as a replacement for existing diagnostic methods due to the availability of more accessible and effective screening approaches.
Background: The increasing intensity of modern immunosuppressive and biologic therapy protocols necessitates a revision of infection control strategies. Patients with secondary immunodeficiency states remain the most vulnerable group, requiring the development of personalized support technologies within a multidisciplinary hospital setting. Aim: To develop and implement a program of immunological support for immunocompromised patients in a therapeutic clinic. Methods: A retrospective analysis of the clinical profiles of patients with secondary immunodeficiency states was performed based on a database of 2,537 patients at the Sverdlovsk Regional Clinical Hospital No. 1 (2013–2018). The efficacy of the support technology was prospectively studied in patients with inflammatory bowel disease (n = 178) and insulin-requiring diabetes mellitus (n = 256). Immune status assessment included flow cytometry (lymphocyte subsets), turbidimetry (immunoglobulins), and phagocytosis evaluation (nitro blue tetrazolium test). Results: In inflammatory bowel disease, phagocytic defects and deficiencies of lymphocyte populations/subpopulations were the most common abnormalities; an increase in lymphocyte killer activity correlated with disease exacerbation. Patients with diabetes mellitus exhibited persistent lymphopenia and suppression of phagocytic activity, correlating with poor glycemic control. The implementation of the immunological support technology, including early screening for impairments and preventive vaccination, led to a 3-fold reduction in the frequency of all infectious episodes in patients with IBD and DM. Furthermore, the incidence of severe infectious complications, such as pneumonia, decreased nearly 10-fold in the IBD group and 5-fold in patients with insulin-requiring DM (p ≤ 0.05) when the developed technology was applied.The metabolic neutrality and safety of vaccination were demonstrated: glycated hemoglobin levels and endoscopic findings remained stable post-vaccination. Conclusion: Integrating immunological support technology into the management algorithms of medical patients transforms passive observation into active prevention, ensuring a significant reduction in the infectious burden and increasing the safety of high-tech medical treatment.
The high efficacy and good tolerability of second-generation antihistamines in the treatment of idiopathic urticaria allow for their long-term successful use. Clinical experience accumulated over the past decades and data from modern studies, including meta-analyses, have convincingly demonstrated that many second-generation antihistamines have a wide therapeutic window and maintain a favorable benefit-risk ratio even when used significantly above standard doses. This has led to a reconsideration of previous restrictions and the establishment of a strategy for using high-dose second-generation antihistamines as the standard for patients with an inadequate response to first-line therapy. Currently, international and Russian guidelines have developed a strategy for using high doses of second-generation antihistamines (2–4 times the recommended dose) for resistant and severe forms of chronic spontaneous urticaria accompanied by frequent exacerbations, with the goal of completely eliminating symptoms and achieving sustained remission. It should be noted that increasing the dose is a preferable tactic over switching to a different second-generation antihistamines. When selecting a specific drug for long-term therapy, especially in patients whose work requires increased alertness or in those with polypharmacy, the pharmacodynamic and pharmacokinetic characteristics of individual agents must be considered. Fexofenadine exhibits a predictable safety profile, lacks sedation, is non-cardiotoxic, and exhibits minimal risk of drug interactions. Furthermore, its efficacy within the high-dose strategy of second-generation antihistamine is among the highest. According to a 2016 meta-analysis evaluating the efficacy of increased doses of second-generation antihistamines, increasing the fexofenadine dose for the treatment of chronic spontaneous urticaria was effective in 83.1 % of cases ― the best result among all second-generation antihistamines studied.
We present a clinical case of early-onset and severe hereditary angioedema type 1, caused by a pathogenic variant in the SERPING1 gene, in a two-year-old girl. Hereditary angioedema onset occurred at 18 months, which is extremely early for this disorder. The disease onset was characterized by severe clinical manifestations: frequent, debilitating episodes of angioedema of the face, upper and lower extremities (over 8 months, the child experienced 14 episodes of angioedema: 5 in the face and 9 involving peripheral sites). Due to such an early onset and severe course of hereditary angioedema, long-term prophylaxis with lanadelumab was initiated. After more than 5 months of therapy, the child has not experienced a single episode of angioedema, despite exposure to provoking factors. No side effects were observed. In the literature, only five clinical cases with onset and a definitive diagnosis of hereditary angioedema in children under 24 months of age, with only one of the five requiring long-term prophylaxis. Thus, we present a unique clinical example of the successful use of lanadelumab as long-term prophylaxis in early childhood.
BACKGROUND: The goal of an allergist is to identify a causally significant allergen in a timely manner, which allows for the administration of modern treatment for allergic diseases. To confirm sensitization, diagnostics are performed using skin tests with allergen extracts or the detection of specific immunoglobulin E antibodies in the blood serum. Molecular diagnostic methods are considered more sensitive and specific than diagnostic tests based on natural allergen extracts. We used a domestic microchip technology in a pilot study, as it provides an analysis of a wide range of different sensitizations in a cohort of patients with atopic diseases. The first Russian allergy chip is a platform with 100 allergens (extracts and allergenic molecules) on it. AIM: To analyze sensitization in adult patients from the Moscow region suffering from respiratory allergies using the Russian multiplex technology of molecular allergy diagnostics. METHODS: A single-center prospective, one-time study included 83 adult subjects (18 years and older) of both sexes living in the Moscow region. The first group consisted of 12 (14.4 %) healthy volunteers without atopy, the second group included 38 (45.8 %) patients with isolated allergic rhinitis, and the third group consisted of 33 (39.8 %) patients with allergic rhinitis and concomitant bronchial asthma. All study participants had allergen-specific immunoglobulin E antibodies to 100 allergens determined in the blood serum by the multiplex technology. Statistical processing of the results was carried out using the IBM SPSS Statistics 23.0 program package. RESULTS: No sensitization to any allergen component was detected in the comparison group. Molecular analysis of the spectrum of immunoglobulin E sensitization to aeroallergens in the group of patients with isolated rhinitis and in the group of patients with allergic rhinitis and concomitant bronchial asthma showed a predominance of immunoglobulin E detection to the following main molecules: birch pollen allergen Bet v 1 in 43 (60.5 %) patients, alder allergen Aln g 1 in 26 (36.6 %) patients, The main cat molecule was Fel d 1 in 23 (32.4 %) of the subjects, the first timothy pollen molecule was Phl p 1 in 20 (28.2 %), and the hazelnut allergen belonging to the PR protein family was Cor a 1.04 in 32 (45.0 %) patients. When assessing the type of sensitization, it was found that the majority of patients in the second and third groups had polysensitization, with 89.5 and 93.9 % of patients, respectively. Additionally, there was a significant correlation between the increased likelihood of developing a multimorbid phenotype of allergic rhinitis with concomitant bronchial asthma and the increased class of sensitization to the main molecules Bet v 1 (p = 0.020) and Fel d (p = 0.003). CONCLUSION: As a result of the pilot study, sensitization to the main components of inhalation allergens was detected in adult patients with respiratory allergies in the Moscow region, which correlates with previous studies conducted on a similar patient population using other chip technologies.
BACKGROUND: There is no data on the nature of medical care provided to patients with chronic spontaneous urticaria from the patient’s perspective. AIM: To analyze the clinical and social aspects of chronic spontaneous urticaria and the patterns of healthcare delivery using data from an online survey of patients from 63 cities across Russia. METHODS: A structured online survey was performed among respondents with chronic spontaneous urticaria over the age of 18. The survey was conducted between April and June 2025 and included 40 questions covering demographic characteristics, disease severity, comorbidities, patient routing, medical visits, and treatment of chronic spontaneous urticaria. The data were analyzed quantitatively, with the calculation of the proportions of responses for each question from patients in 63 cities across Russia. IBM SPSS Statistics 21 was used for statistical analysis. RESULTS: The study involved 1,061 patients with chronic spontaneous urticaria. Most of them of working age; more than 60 % did not achieve control according to the chronic spontaneous urticaria test. Common comorbidities were sleep disorders and anxiety disorders. Patients consulted several specialists before diagnosis; an allergist-immunologist played a leading role in the management of chronic spontaneous urticaria. Satisfaction with standard-dose antihistamines was low, and the availability of second-line therapy was limited. CONCLUSION: The results highlight the need to improve patient referral pathways, increase physicians’ awareness of the principles of diagnosis and management of chronic spontaneous urticaria, enhance access to modern therapeutic options, and promote a multidisciplinary approach to chronic spontaneous urticariamanagement. Overall, the findings are consistent with international studies while also providing insight into the specific features of chronic spontaneous urticariamanagement in the Russian healthcare setting.
