Аллергический ринит у детей — cогласительный документ Ассоциации детских аллергологов и иммунологов России

Введение. Аллергический ринит (АР) является самым распространенным аллергическим заболеванием в мире, особенно в детской популяции. Широкая распространенность и значительное влияние на качество жизни делают проблему актуальной среди врачей. Существуют отличия в ранней диагностике, понимании патогенеза и оптимизации терапевтических подходов, особенно у детей младшего возраста.
Цель. Представить современный обзор и консенсусные рекомендации Ассоциации детских аллергологов и иммунологов России (АДАИР) по ведению пациентов с аллергическим ринитом, охватывающие патогенетические механизмы, факторы риска, клиническую картину, диагностику и терапию.
Материалы и методы. В работе проанализированы современные отечественные и международные исследования, включая данные метаанализов и клинических рекомендаций, а также собственные данные экспертов АДАИР.
Результаты. Эксперты рассматривают АР как смешанное иммунное воспаление, включающее классический IgE-зависимый путь (I тип), клеточные реакции (IV) и эпителиальное воспаление (V). Подчеркивается роль факторов риска: генетика, микробиом, воздействие поллютантов и аллергенов. Приведены данные о значительной распространенности АР, включая его недооценку у детей раннего возраста и пациентов с коморбидными состояниями (атопический дерматит, пищевая аллергия). Предложено уточненное, более практичное определение АР. Детально освещены алгоритмы ступенчатой фармакотерапии, включая обоснованное применение антигистаминных препаратов в качестве стартовых препаратов для детей раннего возраста и пациентов с легким АР, интраназальных глюкокортикостероидов как основных препаратов для терапии и фиксированных интраназальных комбинаций в качестве базисной терапии и терапии по требованию. Особое внимание уделено персонализированному подходу в зависимости от возраста (от 0 до 18 лет) и клинического фенотипа. Эксперты АДАИР подчеркивают роль аллерген-специфической иммунотерапии (АСИТ) как единственного метода, модифицирующего течение заболевания, в отличие от фармакотерапии, позволяющей контролировать симптомы
Заключение. Своевременная диагностика и адекватная, этапная терапия АР у детей позволяют достичь контроля симптомов, значительно улучшить качество жизни пациентов и при использовании АСИТ предотвратить прогрессирование заболевания (включая развитие бронхиальной астмы). Представленный согласительный документ призван помочь практикующим врачам в принятии обоснованных клинических решений

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