Журнал «Здоровье ребенка» 8 (59) 2014
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Features atopic reactivity in scool-age children with with severe asthma
Авторы: U.I. Marusyk - Bukovinian State Medical University, Department of Pediatrics and pediatric infectious diseases; O.K. Koloskova - Head of Department – professor, MD, Department of nursing and higher nursing education, Chernivtsi
Рубрики: Педиатрия/Неонатология
Разделы: Клинические исследования
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Introduction. According to published data in 70-95% of children developing asthma that is difficult to treat. The ineffectiveness of inhaled corticosteroids, which is the basis of basic therapy of asthma, can be due, perhaps, the presence of different phenotypes of the disease, including phenotype “severe asthma”. Assigning controlling asthma therapy in children should be considered at its phenotype, characterized by different mechanisms of the disease, but, is almost identical clinical symptoms.
The arm of the research: to establish the diagnostic value of indicators atopic reactivity in the verification severe asthma phenotype to improve treatment outcomes in school-age children.
Methods: 60 school-age children with asthma examined in pulmonology department of Chernivtsi Regional Clinical Hospital. Over the course of the disease patients were divided into two clinical groups. The first clinical group consisted of 30 patients who had been registered severe asthma. The second clinical group formed 30 students who have asthma defined moderate. For the main clinical signs were matched comparison group.
All children performed immunological blood test II - III levels. Contents of serum total immunoglobulin E (IgE), IL-4 and IL-5 were determined by enzyme immunoassay (EIA). Identification of immediate type skin sensitivity to standard Nonbacterial allergens was performed by intradermal tests. Atopy household, epidermal, pollen and food allergens were used for research.
Results. The concentration of IL-4 in serum children first clinical group was 10,6 ± 2,1 pg/ml, and in those of the second group - 7,2 ± 2,5 pg/ml (P> 0,05). The average content of interleukin-5 in the clinical group was 35,8 ± 15,7 pg/ml and 8,6 ± 4,3 pg/ml (P>0,05), respectively. Almost every third patient first clinical group (36,4%) recorded significantly increased content of IL-4 (more than 10,0 pg/ml), whereas in the second group surveyed - only 15,5% of cases (Pφ<0,05).
Concentration of IgE, which exceeded 545,3 IU/ml, recorded in 56,6% of children first clinical group and only 43,4% of cases in the second (P>0,05) the comparison group.
In patients with severe asthma cases occurred significantly more frequently increased sensitivity of the skin to household allergens relative to the second group. Thus, the amount of hyperemia more than 15,0 mm was recorded in 81,5% of the first group and only 51,9% of persons (Rφ<0,05) second.
Conclusions. 1. Due to the low sensitivity of the content of IL-4 and -5 in serum them impractical for use on their own verification phenotype of severe asthma. 2. The concentration of immunoglobulin E in excess of 545,3 IU/ml, in 2 times increased the chances of the presence of severe asthma in children. 3. Increased sensitivity to domestic allergens (hyperemia over 15,0 mm) allows to verify the specificity of 81,5% severe asthma and personalize treatment policy in these patients.
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