Introduction. The Russian Federation has adopted international and national conciliatory documents and clinical guidelines covering the diagnosis and treatment of allergic rhinitis (AR). The extent to which doctors adhere to the guidelines remains unclear.
Methods: online survey of allergists (32.7%), pediatricians (54.4%) and others (total n = 364) in 2023–2024.
Results: Most specialists (81.6%) adhere to Russian official clinical recommendation, while about 4% of respondents adhere to international guidelines. A significant part of doctors actively uses the term “seasonal/perennial” AR (75.3%), less often the indication of the severity and course of the disease is used. Pediatricians don’t use the classification more often than allergists. To determine the severity of the visual analog scale is used only in 23.0% of cases.
Among laboratory diagnostic methods, allergists are more likely to prescribe a specific examination than pediatricians (87.8% vs. 56.8%). Only 53.8% of respondents consider it mandatory to conduct an allergological examination for patients with AR.
57.4% of respondents believe that the amount of initial therapy depends on the severity of the disease. The most popular drugs for starting therapy are intranasal steroids (40.2%), antihistamines (23.5%), montelukast 4.0%, and intranasal antihistamines 4,8%. If it is necessary to use concomitant therapy 56.4% of doctors choose a fixed combination of intranasal steroid + antihistamines as a first-line therapy, and an additional 20.9% consider this option in rare cases. 
In severe cases, 16.9% of doctors prescribe oral steroids, 20.4% choose the parenteral route of corticosteroid administration, and 33.6% of respondents do not prescribe systemic corticosteroids. The majority of doctors surveyed are aware of the immunobiological therapy of AR — 73.0%, and 26.7% actively support the appointment of biological therapy for AR. Allergen-specific therapy is recommended to be considered by 61.9% of the surveyed doctors.
Conclusion: The study shows the need to train physicians facing AR problems in accordance with current clinical guidelines and international practice.

Introduction. Despite a significant decrease in mortality from pneumonia, pneumonia remains the main cause of death in children outside the neonatal period. As a key component of the immune system, CD4+ T cells significantly affect lung tissue damage. Prior to the initiation of an adaptive immune response, NK cells not only produce cytokines associated with antiviral immunity, but are also directly involved in the rapid elimination of infected cells.
Objective. To determine changes in lymphocyte subpopulations in peripheral blood in children in different age groups with community-acquired pneumonia and and to assess their prognostic significance depending on the severity of community-acquired pneumonia.
Materials and methods. 117 children aged 1 to 18 years with radiologically confirmed diagnosis of community-acquired pneumonia were examined, severe (29 children) and mild (88 children). All children were divided into 4 age groups (1–3 years old, 4–7 years old, 8–12 years old, 13–18 years old). Blood levels of lymphocytes and their subpopulations were determined in all children using flow cytometry.
Results. According to the results of the study, a decrease in the number of NK-lymphocytes in the peripheral blood of children with severe community-acquired pneumonia was revealed compared with children with mild community-acquired pneumonia in all age groups, and an association of NK-lymphocytes and TNK-lymphocytes with the severity of community-acquired pneumonia in children was found.
Conclusions. A decrease in the number of NK-lymphocytes in peripheral blood in children with severe community-acquired pneumonia in all age groups compared with children with mild community-acquired pneumonia, as well as the association between a decrease in the number of NK-lymphocytes and TNK-lymphocytes and the severity of community-acquired pneumonia in children can be considered an independent marker of the severity of this disease.

Annotation. Taking into account the spread of asthma symptoms in dynamics in different regions using proven techniques allows you to get the most complete picture of this process and identify regional features.
Materials and methods. Monitoring of the spread of asthma symptoms was carried out within the confines of the ISAAC program from 2002 to 2019–2020. The results obtained were compared with the results of 1999. Udmurt teenagers aged 13–14, studying in schools of the republic, participated in the survey, a total of 12 856 people.
Results. By 2019–2020, the prevalence of asthma symptoms increased compared to 1999 and was 10.2%. The problem of underdiagnosis of the disease persists. There is a decrease in severe forms of asthma and the frequency of recurrence of night and daytime symptoms. The number of children who responded to physical activity with difficulty breathing, as well as respondents with frequent attacks of non-infectious cough, increased significantly. In general, a negative trend is observed in the statistics of bronchial asthma symptoms.
Conclusions. Long-term observation allowed us to obtain data that are an important contribution to understanding not only the trends of BA in the Udmurt Republic, but also in their further study.

Introduction. Vaccination remains the most effective measure to combat infectious diseases. The COVID-19 pandemic has made adjustments to the work of pediatric health services around the world, which has affected all aspects of life, including routine immunization of children.

Objective. To analyze the indicators of coverage and timeliness of vaccination of children of the first year of life in the pre-pandemic period and during the COVID-19 pandemic, to assess the frequency and severity of post-vaccination reactions in children of the first year of life.

Materials and methods. A retrospective single-center study of medical documentation (form 112/y) of 414 children was conducted on the basis of GBU RO “City Children’s Polyclinic No. 3” in Ryazan, who were divided into 2 groups: group 1 — children born in 2018 (n = 256), among whom 47.5% (n = 122) were girls, 51.5% (n = 134) are boys, group 2 are children born in 2020 (n = 158), of which 49% (n = 77) are girls, 51% (n = 81) are boys. The assessment of intergroup differences was carried out using the Pearson criterion (χ2), adjusted for small samples. The difference in values was considered statistically significant at p < 0.05.

Results. Vaccination coverage in 2018 and 2020 was 95% and 98%, respectively (p < 0.05). The post-vaccination period in the majority of vaccinated children in group 1 (85%, n = 208) and in group 2 (81%, n = 128) proceeded smoothly (p = 0.04).

Conclusion. The COVID-19 pandemic did not have a negative impact on routine vaccination in the population of children in the first year of life.

Introduction. Schimke immuno-osseous dysplasia (SIOD) is an autosomal recessive, ultrarare disorder characterized by multisystem involvement accompanied by spondyloepiphyseal dysplasia of the skeleton, steroid-resistant proteinuric nephropathy leading to progressive loss of renal function, impaired immunity, and vascular damage caused by atherosclerosis. SIOD is caused by biallelic pathogenic variations in the SMARCAL1 gene.
The clinical manifestations of SIOD are very diverse: from a rapidly progressive disease in which children die in the first years of life, to milder forms in which they survive to adulthood. The correlation between genotype and phenotype is extremely weak, so it is impossible to predict either the clinical course or the outcome of the disease. For this reason, patients with this pathology can be seen by various specialists.
Case report. The publication presents a clinical case of a 4-year-old boy with immunological deficiency, developmental disorders, and skeletal anomalies, indicating in favor of SIOD.
Whole exome sequencing in the SMARCAL1 gene revealed mutation variants с.2542G>T (p.Glu848Ter); c.1682G>T (p.Arg561Leu) in a heterozygous state.
Based on the results of the genetic study, and also taking into account that the disease is multisystemic, the child was examined by a nephrologist, orthopedist, endocrinologist and geneticist.
Conclusions of the nephrologist: glomerulopathy in Schimke syndrome: isolated proteinuria. Left calicectasis. Chronic kidney disease (CKD), stage 2. Glomerular filtration rate (Schwartz test) — 69.01 ml/min/1.73 m2.
Endocrinologist’s conclusion: syndromic short stature. Protein-energy malnutrition grade 2.
A telemedicine consultation was conducted with the Federal State Budgetary Institution National Medical Research Center for Pediatric Hematology and Oncology named after D. Rogachev, based on the results of which replacement therapy with intravenous or subcutaneous immunoglobulins was recommended, as well as hospitalization in the immunology department of this federal center.
Conclusion. This description is the first case of diagnostics of an ultrarare disease (1:1–3,000,000 live births) in Krasnodar region by regional specialists. In this patient, the course of the disease is characterized by a non-severe, non-progressive renal dysfunction, which gives reason to assume a milder form of the disease. Conducting replacement therapy with immunoglobulins makes it possible to improve the prognosis in this patient.

Introduction. Atopic dermatitis (AtD) is a genetically determined chronic dermatosis with heterogeneous manifestations that can significantly affect the quality of life of patients. The disease has a complex pathogenesis, which significantly complicates its treatment. The JAK-STAT signaling pathway plays a central role in the modulation of several immune axes involved in the immunopathogenesis of AtD. In particular, the action of Th2 cytokines, including IL-4, IL-5, IL-13, IL-31 and thymus stromal lymphopoietin, is mediated by transmission of the JAK-STAT signal, which makes this pathway a good target for targeted drugs.

Presentation of the clinical case. At the present stage, the problem of choosing tactics for the treatment of severe forms of ATD is important. In June 2021, the drug upadacitinib, a selective reversible type 1 janus kinase inhibitor, was registered in the Russian Federation for the treatment of moderate to severe AtD in adults and children 12 years and older. This publication presents our own successful experience of using upadacitinib in the form of a description of a clinical case in a 16-year-old child with uncontrolled severe AtD. Before the drug was prescribed, the patient’s disease course was continuously recurrent, with severe exacerbations and short periods of remission, as well as resistance to standard therapy.

Conclusion. The use of upadacitinib at a dose of 15 mg for 11 months allowed the teenager to achieve rapid remission of the disease and successfully control such a complex symptom as itching.