Relevance . There is a shortage of studies that would evaluate the effectiveness of allergen immunotherapy (AIT) in children with bronchial asthma (BA) and polysensitization. The aim of the study : to evaluate AIT effectiveness with house dust mite (HDM) allergens in the treatment of BA in children polysensitized to perennial allergens, based on the dynamics of the symptoms and medications score. Materials and methods . The open prospective controlled study included 36 children aged 9,6 [6,9; 12,3] years (from 6 years 1 months to 14 years 3 months) with moderate atopic asthma (21 children (58%) and mild asthma (15 children (42%) and polysensitization to household allergens. Each patient was observed in the study for 4 years: 1 year of preliminary observation and 3 years of sublingual AIT with D. pteronyssinus and D. farinae (Staloral, Stallergenes Greer, France). For each year of observation, asthma symptoms and medications used were assessed, and the combined Score was calculated. To confirm sensitization, a prick test was performed using a standard method with allergens: house dust, D. pteronyssinus , D. farinae , cat, dog, horse, pillow feather (Biomed, Russia). Results . Over 2 years of AIT, the decrease in the symptom and medication Score was 46,9%, and at the end of 3 rd year of therapy, 59,8% (р = 0,0001 from baseline). A decrease in the combined Score exceeding 34.9% compared to baseline was noted in all patients in the study. Conclusion . Sublingual AIT with HDM allergens is highly effective in the treatment of asthma in children with domestic polysensitization, in terms of reducing symptoms of the disease, the need for pharmacotherapy and the combined Score of symptoms and medications. A significant positive effect was registered already from the first year of AIT and continues to increase over subsequent years of therapy.

The aim was to compare effects of salmeterol/fluticasone propionate 50/100 μg bd (FSL) via Discus™ device with fluticasone propionate (FP) 100 pg bd via Dischaler or beclomethasone dipropionate (BDP 200 pg bid) via Dischaler in 12-week multtcentre randomised controlled trial involved 250 symptomatic children aged 4 to 10 yrs with moderate to severe asthma who had previosly received beclomethasone dipropionate less than 400 pg daily or cromones. The treatment effectiveness was assessed using a dairy card including measurement of asthma symptoms, peak expiratory flow (PEF), need in short-acting β 2 -agonists, and a patient's consideration of treatment. The patients receiving FSL had significantly more symptom-free days (64.8 ± 21.8) versus the patients receiving FP (55 ± 23.9, p < 0,05) or BDP (52 ± 24.8, p < 0.05). The FSL patients had fewer days with rescue medication (10.2 ± 12.6) in comparison with the FP (24.9 ± 21.7, p < 0.001) and the BD patients (23.8 ±20.1 p < 0.001). During first 4 weeks of the treatment the morning PEF rates were slightly higher in the FSL patients (114 ±7 % pred.) versus the FP ones (107 ± 8 %) and BDP (106 ± 8 %). Significantly more FSL children and their parents were satisfied with the treatment (97 %) compared with 82 % of the FP and 68 % of the BDP patients ( p < 0.001). Children did not have problems using the dry powder inhalers Discus and Dischaler. Adverse events were found in 4 FSL, 7 FP and 12 BDP patients (cold, cough after inhalation, sore throat). These effects were not severe. Thus, the combined treatment with low-dose FP and SL was more effective than two-fold higher dose BDP and the single therapy with low-dose FP in pediatric asthma patients.

Background. For practical health care, tools for assessing the effect of allergen-specific immunotherapy have not been developed. Aim. Approbation of the system for evaluating the effectiveness of sublingual immunotherapy with house dust mite allergens in patients with bronchial asthma with allergic rhinitis. Materials and methods. 28 cases of sublingual immunotherapy treatment in patients aged 5 to 13 years, (8,6 [6,7; 11,6]) with control in pairs-copies matched by age, sex, and asthma severity were analyzed. Thus, the study included 56 patients. Patients in the control group did not receive sublingual immunotherapy. For 1 year before the start of treatment, and for the first year of treatment, the complex of clinical signs of bronchial asthma and allergic rhinitis, the need for basic and emergency therapy was assessed. The scores were calculated for symptoms, for drugs, and a total Score of symptoms and drugs. Results. During 1 year of therapy, patients showed dynamics of the total Score from 23,32 1,21 points to 16,21 1,77 in the main group, and from 23,99 1,2 points to 20.92 2.09 in control group (p = 0.028). The greatest difference was found within medication domain. Conclusion. The developed system for assessing the symptoms and the need for medications makes it possible to show the difference between groups of patients, in favor of the sublingual immunotherapy group. For 1 year of sublingual immunotherapy therapy, a difference in the total Score dynamics and the domain of drugs was revealed between the groups. The proposed assessment system is recommended for further investigation.

Severe bronchial asthma is a serious healthcare and social challenge. Severe asthma in both in children and adults may have an unfavorable course, has heterogeneous clinical phenotypes and is very difficult to treat. Treatment of patients with inadequately controlled severe asthma requires significant resources from the healthcare system.At the same time, severe asthma in children, adolescents and adults has a number of specific features making it a separate phenotype. These groups of patients are at high risk of hospitalization and mortality.

This article reports results of a study of peak expiratory flow rate in 3640 healthy children and 272 children with bronchial asthma of varying severity. The results are presented on the European scale EN 13826 as the centile tables. The absence of differences in peak expiratory flow rate between healthy children and children with asthma in remission was presented.

The diagnosis of allergic disease related to the group of immediate hypersensitivity involves confirmation of IgE sensitization: positive skin tests with the suspected allergen and/or detection of allergen-specific IgE. Research over the past decades showed that IgE synthesis may occur exclusively in the tissues of the affected organ and derived allergen-specific antibodies may not enter the systemic circulation. In contrast to «atopy», this concept of local sensitization was termed «entopy». local production of IgE was detected in more then 47% of adults previously diagnosed as having non-allergic rhinitis. besides the nasal mucosa, local sensitization was found in lymphoid tissues of nasopharyngeal ring, bronchial mucosa in some patients with non-atopic asthma, esophageal mucosa in patients with eosinophilic esophagitis. The processes of local immune response is currently studied and probably one day the accumulated data will swing our understanding of atopic sensitization, that will be reflected in classification and therapeutic approaches.

Asthma is a topical issue in pediatrics and clinical medicine in general. Asthma in children reduces the quality of life and may cause disability. According to official statistics, the total number of children and adolescents with asthma in Russia is over 350 thousand. The introduction of uniform criteria of severity and elective therapy changed the severity pattern of asthma towards increased incidence of mild and moderate forms. The proportion of critically ill patients, their disability and mortality decreased.

Food allergies (fa), defined as an adverse immune response to food proteins, effect up to 3-5% of the popula- tion in westernized countries, and their prevalence appears to be rising. a variety of mechanisms underlie the allergic reactions, not all of them run through the IgE sensitisation. the absence of sIgE in peripheral circulation characterize a group of non-Ig-Emediated disorders, such as food protein-induced enterocolitis, enteropathy and prococolitis. In case of eosinophilic esophagitis, gastritis and enterocolitis IgE sensitization arises in nearly 50%, therefore these disorders are classified as mixed-type. In some cases of gastrointestinal fa local IgE production, when switching to IgE synthesis occurs only in one organ, have been proved. although systemic investigation of this phenomenon is still lacking. Immune inflammation coursed by food allergens can involve nearly all organs and systems. this review focuses on gastroenterological manifestations of food allergy, except of broad field of gluten intolerance that demands a separate thorough reviewing.

Aims of study: evaluation of immunological parameters in course of sublingual allergen-specific immunotherapy with tree pollen mixture in children with hay fever.Materials and methods: the study included one-hundred patients 5 to 18 years of age with hay fever (pollen rhinitis, rhinoconjunctivitis and/or asthma). Allergen-specific immunotherapy was administered pre-seasonally for three consecutive years. Cytokinechanges were studied in blood serum and in lavages from nasal cavity. Samples assessed before treatment and after 2nd and 3rd courses SLIT completion.Results: increased serum concentrations of IL-10, IFNγ, and decreased IL-4 contents were revealed in the course of treatment. No significant changes in cytokineconcentrations were detectable in nasal lavages.Conclusions: the changes revealed correspond to a shift of T cell response profile towards Th1 pathway, thus confirming pathogenetic effects of sublingual allergen-specific

A comparative study of effectiveness and safety of topical medications performed in two groups of children with moderate persistent allergic rhinitis. During treatment period of 2months and subsequent 1 month supervision treatment effectiveness was controlled with rhinoflowmetry. High effectiveness of intranasal corticosteroids in minimal daily dose was revealed. Intranasal corticosteroids safety was no less than that of cromoglycate. Their positive effect persisted 1month after treatment cessation

The results of pidotimod application in children with often respiratory infections are presented in the review and updated with the data collected by St. Petersburg Allergologic Society. The course application of pidotimod in children with allergic respiratory diseases (allergic rhinitis, bronchial asthma) is effective for often respiratory infections prophylaxis. Good medication tolerability and safety was noted in children with concomitant allergic diseases.

Background. To detect sixteen cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations most common to Russian populations in children with severe asthma (SA). Patients and Methods. S A group included 59 children aged 4-17 years old (43 boys and 16 girls). Cystic fibrosis (CF) group included 27 children aged 5-17 years old with a primary diagnosis of CF (15 boys and 12 girls). We used two kits developed by Center for M olecular Genetics (Moscow): «CF-5» kit (G542X, W1282X, N1303K, 3849+10kbC>T, R334W) and «CF-11» kit (del21 kb, F508del, I 507del, 1677delTA, 2143delT, 2184insA, 394delTT, 3821delT, L138ins, 604insA, 3944delTG). Results. I n the group of children with CF, the frequency a major mutation F508del was 85% (41% with genotype F508del/ F508del, 29% with genotype F508del/nomal and 15% with compound genotype F508del/others). I n 15% of the cases, there were identified some other mutations of the CFTR gene: N1303K, 394delTT, 2143delT, CFTRdele2, 3 (21kb). The rest 7% of the cases were not clarified. We have found neither «mild» nor «severe» the mutations of CFTR gene in the S A group. Conclusion. This study failed to show an association of mutations of CFTR gene with severe asthma in children.

The article presents the results of a comparative study of efficacy and safety of sublingual allergen (study group) and allergoids (control group) for treatment of children with sensitization to pollens of trees. All participants underwent 2 courses of the pre-immunotherapy. The total cumulative dose in the study group was 145,982 ± 120,886 PNU. Adverse events in this group were mild and required no medical therapy. Sublingual specific immunotherapy is an effective and safe method of treatment of hay fever in children.

The review is devoted to the latest results of scientific research and clinical trials in the field of allergen-specific immunotherapy (ASIT) in children, supported by the WHO and EAACI. The results of clinical trials of novel allergo-vaccines in Russian Federation are presented. The future perspectives in ASIT are reviewed.