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"Child`s Health" 6 (66) 2015

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The Effectiveness of Sublingual Allergen-Specific Immunotherapy in Children with Allergic Rhinitis

Authors: Prokhorova M.P. - National Medical University named after O.O. Bohomolets, Kyiv, Ukraine

Categories: Pediatrics/Neonatology

Sections: Clinical researches

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Summary

У статті проаналізовано ефективність сублінгвальної алергенспецифічної імунотерапії суб-лінгвальними алергенами кліщів домашнього пилу та пилковими (суміш рання та пізня весняна трав та осіння) у пацієнтів із сезонним алергічним ринітом, цілорічним алергічним ринітом та цілорічним алергічним ринітом із бронхіальною астмою та легким персистуючим перебігом, бронхіальною астмою та середньотяжким персистуючим перебігом. Проведено оцінку динаміки показників клітинної, гуморальної і місцевої ланки імунітету до та після лікування сублінгвальними алергенами. Показано вплив сублінгвальної алергенспецифічної імунотерапії на алергічне еозинофільне запалення.

В статье проанализирована эффективность сублингвальной аллергенспецифической иммунотерапии сублингвальными аллергенами клещей домашней пыли и пыльцевыми (смесь ранняя и поздняя весенняя трав и осенняя) у пациентов с сезонным аллергическим ринитом, круглогодичным аллергическим ринитом и круглогодичным аллергическим ринитом с бронхиальной астмой и легким персистирующим течением, бронхиальной астмой и среднетяжелым персистирующим течением. Проведена оценка динамики показателей клеточного, гуморального и местного звена иммунитета до и после лечения сублингвальными аллергенами. Показано влияние сублингвальной аллергенспецифической иммунотерапии на аллергическое эозинофильное воспаление.

The article analyses the effectiveness of sublingual allergen-specific immunotherapy with sublingual house dust mite and pollen allergens (early and late spring and autumn grass mixture) in patients with seasonal allergic rhinitis, perennial allergic rhinitis and perennial allergic rhinitis with bronchial asthma with mild persistent course, bronchial asthma with moderate persistent course. The estimation of the dynamics of cellular, humoral and local immunity has been carried out before and after treatment with sublingual allergens. The influence of sublingual allergen-specific immunotherapy on the allergic eosinophilic inflammation is shown.


Keywords

алергічний риніт, бронхіальна астма, сублінгвальна алергенспецифічна імунотерапія, діти.

бронхиальная астма, cублингвальная аллергенспецифическая иммунотерапия, дети.

allergic rhinitis, bronchial asthma, sublingual allergen-specific immunotherapy, children.

Knowledge of modern methods of effective treatment of allergic diseases, their introduction into clinical practice is one of the primary tasks doctor allergist-immunologist. Absolute advantage in pathogenetic therapy of allergic rhinitis and asthma are allergenspecific immunotherapy (ASIT).

An effective method that can change the pathophysiological mechanisms of atopic diseases, pause a more severe form of the background to reduce the use of allergy medications, continue stable remission and prevent the development polisensybilizatsiyi, change the course of the disease and improve quality of life, is ASIT - is administering to the patient's Ig E - dependent disease increasing doses of allergens or their components (allergenic vaccines allergen extract), which found hypersensitivity, leading to the reduction or the complete disappearance of clinical symptoms.

Materials and methods

Under our supervision there were 95 children with allergic rhinitis aged 4 to 16 years of them, 32 children with seasonal allergic rhinitis, intermittent flow (SAR), 33 patients with perennial allergic rhinitis, persistent course (RAR), 20 patients with RAR and BALPC and 20 children of the king and BAMPC. In children with SAR was found in 63,7% of sensitization to different types of pollen allergens in 36,3% - up to one type of pollen allergens. In patients with RAR detected in 78, 2% of sensitization to pollen and household allergens in 21,8% - to different types of pollen allergens. In patients with RAR and BALPC82,4% in detected sensitization to different types of pollen and household allergens with 17,6% - to pollen allergens. In children with RAR andBAMPC 87,5% in  identified sensitization to different types of pollen and household allergens, 12,5% - to pollen allergens. We held general clinical (history of disease, allergic history, clinical examination data) laboratory examination of blood and nasal secretions of children in dynamics, the study definition sIgA in nasal secretions, saliva, determined indicators cellular immunity CD3 +, CD4 +, CD8 +, CD4 + / CD8 + SD16 +, CD22 +, by indirect imunoflyuyurestsentnoyi reaction with monoclonal antibodies produced byarrying out the formation antibodies.produced by "Sorbent-service" (m. Moscow) and humoral - the content of serum immunoglobulins (G, A, M) determined by method (Mancini et al., 1965).

Results and discussion

A statistical analysis confirmed a significant reduction the total score of clinical manifestations (TSCM)  the incidence of symptoms and taking drugs "emergency treatment" in the group of patients treated SlASIT. By the end of the study TSCM fell by 87,4% in patients with SAP 84,6% - from PAR 82,7% - from RAR and BALPC, 75,2% - from RAR and BAMPC and the number of days with symptoms - at 93,5% of the surveyed with SAR, 91,4% - from PAR 89,3% - from RAR and BALPC 87,4% - from RAR and BAMPC compared with the data prior to treatment. Reducing the frequency and intensity of clinical symptoms was accompanied by a statistically significant decrease in the need for symptomatic drugs compared to the data to SlASIT to 97, 3% in children with SAR 96,4% - from PAR 94,5% - from RAR and BALPC, 92,7 % - from RAR and BAMPC. In the control group of patients was noted a statistically significant increase in the frequency and intensity of clinical manifestations, which was accompanied by an increase in the need for drugs "emergency treatment." The results of the comparative analysis confirmed a statistically significant reduction TSCM  by 74, 2% in patientstreatedSlASIT, as compared with the control group. The number of days with symptoms was significantly lower (at 88,3%) in patients receiving SlASIT than in the control group. Also found a significant reduction in the number of days of preparations "emergency treatment" in the treatment group (at 95,2%) in comparison with the control group.

Conclusion

1. After treatment sublingual immunotherapy allergenspecific excellent effect was observed in 89, 5% of children with seasonal allergic rhinitis, 87, 3% of patients with perennial allergic rhinitis in 85.7% of patients with perennial allergic rhinitis with asthma mild persistent flow, 84.5% of surveyed children with perennial allergic rhinitis with moderate persistent asthma course, as evidenced by the high efficiency of this therapy.

2. Reduction significant( р< 0,05)  number of eosinophils in the nasal secretions of children with seasonal allergic rhinitis, perennial allergic rhinitis, perennial allergic rhinitis with asthma light persistent course, moderate persistent asthma duration may be an indirect confirmation of the impact of sublingualallergenspecific immunotherapy for allergic eosinophilic inflammation.

3. When prescribing sublingual allergenspecific immunotherapy observed significant positive dynamics of CD3 + - lymphocytes, CD4 + - cells, a subpopulation of CD8 + cells and CD22 + - lymphocytes and reduce the number of СD16 + cells and increased serum immunoglobulinsIgG, IgA, IgM in patients with seasonal allergic rhinitis, perennial allergic rhinitis, perennial allergic rhinitis with asthma mild persistent flow, moderate persistent asthma course.

4. The high therapeutic efficacysublingualallergenspecific immunotherapy and a good safety profile justify the widespread use of this method in clinical practice Allergic to conduct the treatment of patients at home, thereby reducing the number of patient visits to the doctor.


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