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Allergic rhinitis (AR) and allergic rhinosinusitis (ARS) are typical upper airway pathologies (UAP) in children with bronchial asthma (BA) frequently accompanied with nasal obstructive diseases (NOD). In order to establish the effect of NOD on correlations between nasal and synonasal symptoms with clinical assessments of asthma control, 82 children, 9.8 [8.9; 10.7] years old, with atopic BA were assessed using ACQ-5 for the BA control level, TNSS for nasal symptoms, and SNOT-20 for synonasal quality of life in combination with rhinovideoendoscopy for NOD. All patients had AR/ARS; in 76.3% (63/82) of children, UAP had a multimorbid character with the presence of NOD. Significant correlations were found between ACQ-5 and TNSS ( R =0.40, p < 0.0001) and ACQ-5 and SNOT-20 ( R =0.42, p < 0.0001). Correlations between TNSS/ACQ-5 and SNOT-20/ACQ-5 were higher in patients who do not have a combination of AR/ARS with NOD ( R =0.67, p =0.0012; R =0.50, p =0.022, resp.) than in patients who have AR/ARS combined with NOD ( R =0.30, p =0.015; R =0.26, p =0.04, resp.). Thus, the association of BA control level with the expression of nasal and synonasal symptoms is higher in children who do not have multimorbid UAP.

Influence of bronchial asthma (BA) severity on physical development in children patients was evaluated in comparison with healthy population. Materials and Methods . 1042 children and adolescents (768 boys) with atopic BA were evaluated. All children underwent standard examination in a clinical setting, including anthropometry. The control group included 875 healthy children of a comparable age (423 boys). Results . The fraction of patients with the normal, lower, and increased height among the whole group of patients with BA is close to the corresponding values in the healthy population ( χ 2 = 3.32, p = 0.65). The fraction of BA patients with the reduced physical development is increased monotonically and significantly when the BA severity increases: healthy group, 8.2% (72/875), BA intermittent, 4.2% (6/144), BA mild persistent 9% (47/520), BA moderate persistent, 11.7% (36/308), and BA severe persistent, 24.3% (17/70) ( χ 2 = 45.6, p = 0,0009). Conclusion . The fraction of the children with the reduced height is increased monotonically and significantly in the groups of increasing BA severities. At the same time, the fraction of such children in groups of intermittent and mild persistent BA practically does not differ from the conditionally healthy peers.

Data on the pharmacogenetic markers of the effectiveness of treatment of children with atopic asthma are presented, which reveal a variability of the response to treatment with glucocorticosteroids, leukotriene receptor antagonists, and b2-adrenoreceptor agonists in children with bronchial asthma. The association of genotype Gly/Glyl6 gene b2-adrenergic receptor with insufficient effect of the therapy with short-acting b2-agonists is demonstrated. The Glyl6 allele, CYP2D6 - 1934GGd contributes to the formation of a phenotype with severe asthma and tolerance to therapy with b2-agonists and inhaled corticosteroids.

Atopic diseases is a group of pathologic conditions with polygenic inheritance the development of which is governed by familial predetermination to allergy. This review summarizes results of research on pathogenetic mechanisms of atopic diseases and their clinical features. Analysis includes the structure of hereditary predetermination to allergic reactions and diseases, risk of their development in subsequent generations, the role of age, sex, and ethnic background in pathogenesis of atopic diseases and formation of allergic constitution governed by genotype and environment. Polymorphisms of candidate genes responsible for atopic diseases are considered along with their response to basal pharmacotherapy.

In the study with participation of 96 children of 1-7 years age with recurrent herpetic stomatitis and allergic diseases therapeutic efficacy of Polioxidonium was investigated. Polioxidonium was used in combination with traditional methods and with He-Ne-laser irradiation. Local oral cavity immunity, indexes of cellular immunity (in the reaction of lymphocytes blast-transformation with phytohemagglutinin), indexes of humoral immunity (IgG and IgE) were studied, complement C(3)-component was determined. Polioxidonium in combination with traditional methods and with laser therapy for recurrent herpetic stomatitis treatment in children with allergic diseases influenced favourably upon clinical course of allergic diseases, let achieve stable remission, increased efficacy of their treatment, promoted immunological status and shorten the terms of medical rehabilitation.

Modern concept of the development of bronchial asthma (BA) is discussed based on original and reported findings with reference to specific features of its etiology, pathogenesis, clinical course, and drug therapy. Special emphasis is laid on the methods of allergen-specific immunotherapy of atopic BA. Up-to-date staged treatment of different forms of BA in children by inhalation of glucocorticosteroids is described.

The paper deals with the comparative characterization of the prevalence of goiter transformation in children with bronchial asthma (BA) in relation to the level of a technogenic load and natural iodine deficiency in case of the Perm Region. There was a wide distribution of goiter transformation in children, which did not correspond to natural iodine supply in the Perm Region, suggesting the contribution of anthropogenic strumogenic factors to the formation of goiter endemia. There was a high prevalence of thyromegaly in children with BA as compared with those with another disease and its high the incidence as man-made pollution increased particularly in the areas exposed to a combination of natural and technogenic factors as compared in relatively pure areas. The findings suggest that goiter transformation is a marker of ecological ill-being and an additional serious risk factor of the development and prolonged course of BA in predisposed children.

The efficiency of licopide in combination with traditional treatment was evaluated in 59 children aged 1-14 years suffering from allergic diseases and relapsing herpetic stomatitis. Immunological studies were carried out before and after a course of therapy: local oral immunity, cellular immunity (in the blast transformation test with phytohemagglutinin), lymphocyte populations and subpopulations, humoral immunity values (IgA, IgM, IgG, and IgE), and C3 complement component were evaluated. The results indicate that licopide in complex with traditional methods normalized the immunological values, had a favorable impact on the course of relapsing herpetic stomatitis, and led to a stable remission of allergic diseases (p<0.001).

The authors followed up (in outpatient conditions) a total of fifty 1-to-9-mounth-old infants with the diagnosis of atopic dermatitis, disseminated form, of subacute course. The infants were followed up for 3-12 months, with 83% of the 113 examined patients 1-3 weeks after the beginning of treatment having shown clinical improvement of cutaneous inflammatory processes. Of the 172 infants subjected to immunological examination, in 100--the level of total IgE in blood serum was significantly elevated. These children also had elevated level of the specific IgE antibodies to cow's milk proteins. The outcomes of the carried out dietotherapy using mixture "Nanny" showed that this therapeutic product resulted in remission in the majority of the followed up infants suffering from allergy to cow's milk proteins.

A contemporary understanding of evolution mechanisms and of therapy related with allergic diseases in children is defined on the basis of published data and independent research. A concept predetermining the significance of atopy in pathogenesis of allergic pathologies is outlined; an essential role of environmental factors and a genetic contribution to the role promotion are pointed out. Issues pertaining to the onset of both early and late phases of the allergic response and of allergic inflammation are touched upon. Finally, modern approaches towards therapy of allergic diseases in children are described.

135 pediatric patients receiving hypoallergic diet were included into the study group. The control group consisted of 20 children. The impact of PUFA omega-3 biologically active supplements (polyen, prima-Oil) was studied in hypoallergic rations. Biochemical indices were simultaneously investigated. The revealed dynamic changes of fatty acid spectrum in plasma and red cell membranes, cellular and humoral immunity status and eicosanoids synthesis were followed by positive clinical changes. Diets enriched with biologically active supplementation (PUPA omega-3) can be recommended for application in pediatric practice.

Aim: To test the efficiency and tolerance of the second generation antihistamine drug ebastin (kestine) in patients with seasonal allergic rhinitis (SAR)., Materials and Methods: Kestin was given for 3 weeks in doses 10 and 20 mg/day to 226 patients with SAR running for 6.8 +/- 6.1 years. SAR symptoms relief, subjective effects, side effects were studied., Results: The total index of rhinitis symptoms diminished from 11.6 to 1.2 scores. Subjective response was registered in 82% of the patients, objective in 77%. Neither treatment aggravations nor serious side effects occurred. 2 patients had drowsiness, head aches, dizziness and discontinued treatment., Conclusion: Kestin is effective in SAR, had no serious side effects, is well tolerated.

Multicomponent vaccine prepared from opportunistic bacteria, when administered intranasally and orally to patients with bronchial asthma and chronic bronchitis, was well tolerated by the patients. Side effects induced by the vaccine in a few patients lasted for a short time and were mainly local. Immunotherapy with the vaccine led to a decrease in the severity of the course of the disease, as well as in the frequency and severity of exacerbations. In 26 out of 35 adult patients (74.3%) good and excellent effect was noted; during the observation of 20 sick children aged up to 3 years for a period of 1 year similar effect was noted in 60% of cases. Vaccinal therapy, in addition to its main effect, also contributed to a considerable drop in the morbidity rate of acute respiratory diseases among susceptible children.

The results are available on introduction of interference therapy in 30 children with bronchial asthma versus control group of 20 untreated patients. Bronchoprovocative histamine and exercise tolerance tests have specified characteristic features of interference current effects on bronchial permeability and hyperreactivity.

The effects of supplementation of basic diets with 'Polyen' in daily doses of 2.5-4.0 g during 30-40 days together with antioxidants were studied in patients with kidney diseases (diet No7, n = 14), different allergies (hypoallergenic diet, n = 37) and in control children (n = 12). It was shown positive dynamics in fatty acid contents in plasma and red blood cell membranes, in humoral and cell immunity indicators and in improving of clinical symptoms of diseases. 'Polyen' is recommended for wide use in pediatric practice.

Immunization and booster immunization with adsorbed DPT-m vaccine was carried out, respectively, in 45 and 15 children with different severity of the course of an allergic disease, each child receiving simultaneously individually prescribed complex drug therapy. The postvaccinal period took a relatively favorable course. General and allergic reactions and complications observed after the injection of the preparation did not hinder the continuation of the course of immunization, while the appearance of neurological reactions provoked doubts on the expediency of the repeated injection of this preparation. A decrease in the content of diphtheria and tetanus toxoids in one immunization dose did not lead to the decreased synthesis of specific antibodies. The present investigation showed the possibility of using adsorbed DPT-m vaccine with reduced antigen content in cases of both the remission of an allergic disease and the subacute course of such disease.

The course of the vaccinal process was studied in 69 children with bronchial asthma and asthmatic bronchitis after the injection of adsorbed diphtheria-tetanus (DT) toxoid with reduced antigen content. After immunization all these children were found to form protective levels of anti-diphtheritic and antitetanus antibodies irrespective of the severity and duration of the remission of the main disease prior to vaccination; at the same time no obstructive changes in bronchial ventilation were observed after immunization with adsorbed DT toxoid with reduced antigen content. The schemes of the preparatory medicinal treatment of patients at the period of vaccination are given with due regard for the duration of the remissions of bronchial asthma and asthmatic bronchitis.

Therapeutic efficacy of vitamins B6, P and E was studied in children with allergic diseases. Bronchial asthma and atopic dermatitis were treated more effectively if maximal doses of vitamin B6 were used. Quercetin was found to be useful for treatment of children with pollinosis in order to correct impairments in metabolism of lymphocyte membrane lipids. Only slight efficacy of vitamin E was detected in atopic dermatitis of children.

Components of the intracellular mediators system: calmodulin in leukocytes, Ca2+ and cyclic nucleotides in leukocytes and blood plasma were studied in children with attack of bronchial asthma and heart failure. Alterations in content of these biologically active substances correlated with clinical manifestations of bronchial asthma: severity of the disease, duration of the attack, contractile activity of myocardium. Calmodulin, Ca2+ and cyclic nucleotides were demonstrated to be involved in development of the asthmatic attack. Alterations in the system calmodulin-Ca2+ were related to adaptation and contributed to realization of regulating effects responsible for a decrease of impairments in tissues.

Biopsies of the jejunum from 61 children, 6 months-4 years of age, including 35 with allergy to corn protein, 18 with celiac disease and 8 children without stomach and intestine pathology were studied. Biopsies were fixed in 10% formalin or in Carnois fixative, the sections were stained with hematoxylin and eosin, 0.5% toluidine blue (pH 0.5), and immunoperoxidase method was used for revealing IgA. The structure of the mucosa was not changed in the allergic patients, the content of the granulated and ungranulated labrocytes was increased, their number being decreased in the elimination diet. The number of plasma cells was diminished, and in only few of them IgA was found in children with severe alimentary malabsorption. A selective deficiency of IgA was diagnosed which determines the therapy of such children. Hyperregenerative atrophy of the mucous membrane and predominance of degranulated cells over undergranulated were noted in celiac disease.

Overall 180 children with bronchial asthma induced by sensitization to Dermatophagoides pteronyssinus and Dermatophagoides farinae were examined clinically and immunologically. The patients' age ranged from 1 to 14 years. A relationship was established between bronchial asthma exacerbation and the stay at home. In that disease pattern, asphyxia attacks were noted to occur more frequently in the evening and night hours. Emphasis is laid on the leading part played by the IgE-mediated mechanism in bronchial asthma induced by tick-borne sensitization. In children suffering from that pattern of bronchial asthma, specific hyposensitization with Dermatophagoides pteronyssinus allergens and antiallergic immunoglobulin were found to be highly effective.

Activity of lysosomal glycosidases beta-galactosidase, N-acetyl-beta-D-galactosaminidase and N-acetyl-beta-D-glucosaminidase was studied in lymphocytes and neutrophils of children with bronchial asthma. Alterations of the enzymatic activity were found to depend considerably on the disease stage, form, severity, duration and on the sensitization efficiency. Activity of these enzymes was markedly decreased after glucocorticoid treatment while clenbuterol did not affect their activity. The status of leukocyte lysosomal glycosidases appears to be of importance for development of bronchial asthma in children.

Small intestine absorption function was studied in 46 children with food allergy basing on the results of D-xylose test and estimating protein absorption by blood serum ovalbumin assay in circulating immune complexes. Decreased carbohydrate and increased protein absorption was recorded in the small intestine of the patients and the normalizing effect of the elimination diet on these changes was shown.

During a remission and drug therapy, 71 children suffering from allergic diseases were vaccinated with DT-M toxoid containing different dose of diphtheria (1, 2.5, 5 LF) and tetanus (1, 2.5, 5 EC) antigens. It has been shown that all the children responded to tetanus antigen by adequate serological tests, whereas as regards diphtheria toxoid, the patients immunized with the least dose of DT-M preparation (1 LF + + 1 EC antigens) produced specific antibodies later and at a lower level. During the postvaccinal period, they also manifested an increase of the content of IgE and exacerbation of the underlying disease in 17.8% of cases. The use of DT-M toxoid with 2.5 LF + EC antigens was shown to hold promise in vaccination of children suffering from allergic diseases.

Column chromatography followed by RIA was used to measure the blood plasma content of arachidonic acid metabolites (leukotrienes C4, B4, C4/D4/E4, prostaglandins F2 alpha, E2, 6-keto-prostaglandin F1 alpha, thromboxane B2) in 146 children aged 6 months to 14 years with atopic dermatitis. The data obtained were compared to the healthy children's parameters. The majority of the patients manifested activation of the system of arachidonic acid metabolism. The intensity of changes in the content of eicosanoids was found to depend on the clinical pattern and spreading of skin lesions.

A study was made of adrenocortical function by measuring blood plasma cortisol concentration and amount of glucocorticoid receptors in lymphocytes as well as thyroid function by measuring blood plasma triidothyronine and thyroxine concentration in 58 bronchial asthma children aged 1 to 14 years. The authors revealed alterations in the functional activity of the indicated endocrine glands depending on the intensity of bronchial patency disorders and the nature of the therapeutic measures carried out.

A total of 25 children with bronchial asthma and 40 children with cutaneous and dermato-respiratory + manifestations of allergy and concomitant injury to the gastrointestinal tract were under observation at an allergological clinic. In addition to the general clinical and allergological examination, radionuclide studies were performed by means of scintipneumography with 99mTc and hepatobiliscintigraphy with 99mTc HIDA. The data obtained indicate that radionuclide methods can be used in childhood allergological practice in the capacity of screening diagnosis as well as in the capacity of adjuvant + methods of examination, making it possible to perform investigations necessary for diagnosis establishment in a more precise and atraumatic manner.

As many as 11 children suffering from allergic diseases were vaccinated in 2 foci of diphtheritic infection. At the moment of immunization 3 children manifested a subacute course of atopic dermatitis, 4 children with bronchial asthma were vaccinated during a short-term disease remission (from 10 days to 2 months). Provided the children received combined therapy and were seen by the allergologist, the postvaccinal period ran its course without any side reactions. The children demonstrated high enough titers of antidiphtheritic and antitetanic antibodies, with IgE concentrations ranging within age norms. The authors suggest approximate schemes for medicamentous preparation of allergic children to be immunized whatever the course of the underlying disease.

Children with food allergy underwent allergologic and gastroenterologic examinations using esophagogastroduodenojejunoscopy. Impairment of the jejunum in the form of jejunitis associated with function abnormality as shown by the loading tests was revealed. It is concluded that the given patients: group should be examined for the morphofunctional status of the upper gastrointestinal tract.

The authors have developed a method for measuring histamine and serotonin in whole blood, based on reverse-phase high-performance liquid chromatography of 5-dimethylaminonaphthyl sulfonic (DNS) amine derivatives with fluorometric detection. Chromatography in a mini-column packed with polyamide was employed for the isolation and purification of DNS-histamine and serotonin. The lowest detectable level of histamine is 2-2.5 ng/ml of blood, that of serotonin 1-1.5 ng/ml. The method was tried with whole blood samples from children suffering from various allergic conditions. Whole blood histamine and serotonin concentration were found particularly elevated in the patients with gastrointestinal allergies.

Content of hexuronic acids, hexoses and hexosamines was studied in lymphocytes and polymorphonuclear leukocytes of 56 children with bronchial asthma. The disease step-dependent alterations of the patterns studied were detected. Treatment of these children with bronchospasmolytic drug clenbuterol and with immunomodulator taktivine affected positively the bronchial asthma attack, which was followed by specific alterations in the carbohydrates content. Structural modifications of glycosaminoglycans in lymphocytes and phagocytes appear to be of importance for formation and development of allergic reactions in children with bronchial asthma.

Children immunized with live measles vaccine, especially those immunized at the period of short-term remission and having had systemic or allergic reactions after the administration of the vaccine, have been found to develop more pronounced changes in the content of IgE. A high concentration of IgE is supposed to inhibit phasic changes in the content of IgM and IgG, which negatively affects the intensity of the formation of specific immunity.

Children with atopic dermatitis and the dermato-respiratory++ syndrome were examined for the status of the hepatobiliary system and efficacy of the bile-expelling therapy. The patients mainly demonstrated abnormalities of the gall-bladder, dyskinesias of the biliary tract, occurring by the hyperkinetic+ type, chronic cholecystitis and chronic persistent hepatitis. More pronounced deviations were discovered in children with the dermato-respiratory syndrome. The use of the multimodality therapy including the hepatotropic agents turned out fairly effective, primarily in children with dyskinesias of the biliary tract.

Allergic diseases occupy the leading position in the structure of childhood pathology. The rates of the growth of the allergic disease incidence among children are considerably higher than those among adults. It has been revealed that the prevalence and the course of allergic diseases in children are influenced by atmospheric air and house air medium pollution with chemical agents.

During vaccination of children suffering from allergic diseases with live measles vaccine, some characteristics of the clinical course of the postvaccinal period and specific immunity formation were defined. It has been shown that an individual approach to the immunization of the given children's group is very advantageous, since such a policy favours the lowering of the incidence of odd postvaccinal reactions and allergic complications as well as the output of measles antibodies.