Журнал «Здоровье ребенка» 5 (65) 2015
Вернуться к номеру
Detection of latent food allergy in the children afflicted with bronchial asthma with ait constellation method
Авторы: Levitsky V.M., Yurchyshena E.V., Yurchyshen O.M., Mysko L.V., Mysko U.L.
Municipal Children Hospital , Khmelnytskyi, Ukraine
Рубрики: Педиатрия/Неонатология
Разделы: Справочник специалиста
Версия для печати
Introduction. Bronchial asthma (BA) is one of the most common chronic respiratory pathologies. At this stage, increased incidence of asthma in pediatric populations, an earlier manifestation of symptoms and significant disability [6]. Important among the causes of the problem of acute asthma takes late diagnosis and delayed the appointment of adequate treatment [1]. Asthma in children is one of the dangerous diseases, and in the first years of life trigger factor serves food allergy (HA) [8, 9]. In the diagnosis of AD is still a large proportion of false positive and false negative results because most children are no clear clinical signs that the condition is masked [4]. HA has a modulating effect on the clinical manifestations of asthma, the effectiveness of treatment - rehabilitation, is a common pathology, increasing its frequency due to environmental degradation, the use of food supplements, increasing digestive diseases and early artificial feeding of infants [2]. Despite the fact that asthma in children is a big social problem, many questions remain unresolved. In modern literature there are no data on its clinical features in children with AD disguised, the effectiveness of treatment and prognosis. It is believed that food genesis of asthma is more common than it is diagnosed [5]. This suggests that HA has a modulating effect on clinical manifestations as asthma, and the effectiveness of treatment - rehabilitation.
Materials and methods. We formed two clinical groups of children: the first clinical group (I) were 50 children with asthma who have a heightened sensitivity to food allergens; the second group (II) - control group were 50 patients with asthma without signs of food allergy. The criteria for the presence of AD in children surveyed were: clinical - medical history features strongly positive skin allergy tests with food allergens and available to the food allergen specific immunoglobulin E serum. By sex, age, duration of disease groups were comparable. Comprehensive survey of children include: general examination, immunological blood test I - II levels, determination of skin sensitivity to food and household allergens and detection of specific immunoglobulin E to trofalerheniv [7]. In addition to conventional in medical - biological research parametric and nonparametric statistical research methods to assess the epidemiological characteristics we used clinical - epidemiological methods of determining the absolute performance, relative risk and statistical evaluation of their significance [3].
Research results and discussion. Burdened maternal obstetrical history of the patient and the clinical group was detected more frequently, accounting for 14,0 ± 4,9% of patients in the second - in 8,0 ± 3,8% of patients (P <0.05). This burdened motivated the threat of miscarriage and preeclampsia And if the second half of pregnancy. In 10,0 ± 4,2% of patients and clinical groups in neonatal and perinatal periods we recorded congenital malnutrition, perinatal encephalopathy, have been found in 6,0 ± 3,3% of patients and birth trauma in 4,0 ± 2,8% newborns. These changes were caused by adverse pregnancy that led to the violation vnutrishnoplatsentarnoho circulation and physical development of the fetus. In children with asthma without HA (second group) prevailed: asphyxia II - III degree - 20,0 ± 5,7% newborns posthipoksychna encephalopathy - in 12,0 ± 4,6% (P <0.05) and prematurity - to 6,0 ± 3,5% (P <0.05).
Given the fact that most children of both clinical groups dominated allergic form of asthma, we studied the genealogical history of children at the comparison and found that 28,8 ± 4,3% of children and clinical group recorded recurrent bronchopulmonary pathology or chronic source of infection, and Children in the second group only 16,5 ± 4,0% confirmed these symptoms (P <0.05). In 8,0 ± 2,7% of patients with asthma in the background HA burdened family history Allergic found simultaneously in two or more relatives and children II clinical group, the figure was only 1,2 ± 1,0% of patients (P <0 , 05). Thus, the study of asthma in children were the most informative genetic factors and determination of Allergy burdened family history.
Therefore, we determined the sensitivity of the skin to the type of the immediate household allergens in children comparing groups to explore the possible link of food and household allergens as causal factors in the development of asthma in background covert HA. The results indicate that children with asthma signs and HA Clitopilus prunulus sensitivity to household allergens found in 72,0 ± 11,6% of children did not differ from those in the second group - 68,0 ± 11,2% (P > 0.05). Therefore, hypersensitivity to food and household allergens in children and clinical group forms they polyvalent allergy and the severity of skin allergy tests depends on the availability of food and immunity is independent of household allergens.
We found no significant differences in the frequency of "background" condition in infants comparison groups (exudative - catarrhal diathesis, rickets, anemia, malnutrition). Thus, the frequency of clinical signs of exudative - catarrhal diathesis in the first group was 62,0 ± 6,9%, rickets 16,0 ± 5,2%, anemia - 8,0 ± 3,8% of patients. Similar figures in the second group were equal to 54,0 ± 7,1%, 10,0 ± 4,2% and 10,0 ± 4,2% of patients (P> 0.05). However, we found features of asthma in children clinical comparison groups, so patients and clinical severity of an asthma attack (expressed in points) was significantly higher in the first day of hospitalization (18,3 ± 1,9 points) and was significantly different from the rate in children the second group (13,9 ± 0,86 points, P <0.05). Thus, during an attack of asthma symptoms in children with AD had marked clinical features observed lability and severity of bronchial obstruction by the vast number of children not accompanied by clinical signs of intoxication.
Given the possible involvement processes kysnezalezhnoyi mikrobotsydnosti neutrophilic granulocytes and eosinophilic blood to the development of asthma in children, we analyzed the relative blood levels of neutrophils and eosinophils formazanpozytyvnyh blood in the reaction of nitrosynim tetrazolium (NBT - test) in spontaneous and stimulated pirogenal versions. So in children with AD confirmed the presence of adverse reserve kysnezalezhnoyi mikrobotsydnosti blood eosinophils that vychyslyaly as the difference between the indices NST - test in stimulated and spontaneous versions for TSKH, which amounted to 0.07 cu Established tension processes kysnezalezhnoho eosinophilic granulocytes blood metabolism in children with asthma in a negative reserve kysnezalezhnoyi mikrobotsydnosti eosinophilic granulocytes blood. This tension was following indicators diagnostic value in detecting disguised HA: Se - sensitivity - 73,9%, Sp - specificity - 88,4%, Pv (+) - positive predictive value - 87.2% and Pv (-) - negative predictive value - 76.0%. Thus, the negative reserve kysnezalezhnoyi mikrobotsydnosti eosinophils by NST - test is highly significant with a positive predictive value and low sensitivity due to the large number of false positives.
On the basis of the results of a comprehensive survey of children with asthma using Kullback information measure [3] we formed konstelyatsiynu diagnostic table that with probability can be used to detect AD in children with asthma.
The essence of the diagnostic process is that when you reach the threshold (+) 12 points ascertain the presence of AD in children with asthma, and with the amount of (-) 12 points - it is no probability of error of less than 5%. Thus, to establish food sensitivity should use a constellation of features that make it possible to create a system like this pathology, and some clinical - paraclinical markers have little information.
Thus, we found that asthma in the background HA has the features that are more burdened hereditary allergic history, presence of congenital malnutrition, leading to digestive disorders and the presence of polyvalent allergy. These children bronchial obstruction more pronounced in the attack, but more labile using dezobstruktyvnoyi therapy. Patients with AD also noted the increasing rate of spontaneous kysnezalezhnoho metabolism eosinophilic granulocytes blood, reflecting a higher level of sensitization and negative reserve kysnezalezhnoyi mikrobotsydnosti eosinophils on indicators NST - test. The proposed diagnostic konstelyatsiyna table with sufficient probability can be used to identify food allergies in children with asthma.
Conclusions:
1. Asthma in children with food allergies has special clinical - paraclinical features that can be used to konstelyatsiynoho diagnosis of this form of the disease.
2. Some clinical or paraclinical parameters is not information to identify food allergies in children with asthma.
2. Some clinical or paraclinical parameters is not information to identify food allergies in children with asthma.