To date, there has been a steady increase in allergic diseases, which is a heavy burden on the population and the health care system. The high prevalence, chronic course and pronounced impact on the quality of life require specialists to take a rational approach to the treatment of allergic pathology. From the moment of its appearance to the present, antihistamines have been widely used in real clinical practice, without losing their relevance. This article examines the place of antihistamines in modern therapy of the most common allergic and other histamine-dependent diseases.

Introduction. Today there has been a steady increase in the allergic pathology of the respiratory tract - bronchial asthma and allergic rhinitis in pediatric practice. Despite the use of modern diagnostic approaches, we cannot say with certainty which combined effect of which factors leads to the development of allergic inflammation of the respiratory tract. The study of risk factors for the formation of allergic rhinitis and asthma in children is necessary for timely early diagnosis with the subsequent development of an individual strategy for preventive measures.

Objective: to study risk factors and markers of allergic inflammation in children with allergic rhinitis, rhinitis and bronchial asthma and only with bronchial asthma.

Materials and methods. The study involved 107 children suffering from allergic rhinitis, allergic rhinitis and bronchial asthma, and only bronchial asthma. All patients underwent clinical, laboratory, functional, allergological examination, analysis of the cellular composition of bronchial and nasal secretions.

Results. The analysis revealed factors influencing the development of bronchial asthma, allergic rhinitis and comorbid diseases, as well as markers of allergic inflammation. There were trends in detecting a higher level of eosinophils in blood, nasal and bronchial secretions in a group of children with a comorbid condition — bronchial asthma and allergic rhinitis.

Conclusion. Evaluation of the level of markers of allergic inflammation of nasal and bronchial secretions can be used as additional criteria for early diagnosis, prediction of the severity of bronchial asthma and allergic rhinitis in children, serve as a monitoring method, development of personalized preventive measures for this group of children.

Background. In the course of the ISAAC standardized survey, not only asthma-like symptoms are revealed, but also other atopy symptoms, the prevalence of which in their relationship with asthma-like symptoms is of great interest for determining the likelihood of developing BA. This work presents the first study of the frequency of symptoms occurrence in school students of the Khabarovsk Territory (Russia).

Materials and methods. The survey involved 696 teenagers living in the city of Khabarovsk and Khabarovsk rural district who meet the requirements of the ISAAC program method by age (13–14 years).

Results. The prevalence of symptoms of allergic rhinitis in all interviewed adolescents of the Khabarovsk Territory was 69.3 %. In the group with asthma-like symptoms it is significantly higher (77.2 % versus 56.6 %). Complications in the form of conjunctivitis with non-infectious rhinitis occurred in 12.6 % of cases, and also much more often in children with asthma-like symptoms (30.1 % versus 8.9 %). Symptoms of atopic dermatitis occur in 11.8 % of adolescents, 4.6 times more often when combined with asthma-like symptoms (22 % versus 4.8 %), and localize in typical places of atopic dermatitis in 5.3 % of cases, which happens more often in case of asthma-like symptoms (11.4 % versus 3.9 %).

Conclusion. Studies using the ISAAC standard continuous survey showed that prevalence of non-asthma-like symptoms of atopy among adolescents in Khabarovsk and Khabarovsk Krai is higher than in most countries where this study was conducted. The frequency and structure of non-asthma-like symptoms revealed in the course of the survey is characteristic of industrially developed countries. It should be noted that the prevalence and severity of non-asthma-like symptoms in Khabarovsk is significantly higher than in the Khabarovsk rural area, however, the symptoms of non-infectious rhinitis in the countryside are more severe. 

Introduction. Primary observation of children with (CU) in Russia is performed by pediatricians, dermatologists, and algologists. It is unclear how clinical guidelines are used in a heterogeneous group of specialists.

Materials and methods. Online survey of pediatricians, allergists, and dermatologists (n = 304) in the Russian Federation using a questionnaire, from 5 blocks of questions related to etiology, diagnosis, and therapy. 316 physicians with a median experience of 10 [5; 20] years were included in the questionnaire.

Results. 83.3 % of respondents observed no more than 2 children with CU per month. Self-education to expand knowledge (video lectures, special literature) was indicated by 72.6 % of participants. The clinical guidelines used by physicians were documents of pediatric and allergy associations of Russia (77.3 and 55.9 %, respectively), international guides were used by 27 % of respondents.

The most frequent deviations from the recommended algorithm were the prescription of biochemical blood tests (64.9 %), ultrasound examination of organs (56.9 %), consultations of specialists without indications: gastroenterologist (48.2 %), infectious disease specialist (31.8 %), rheumatologist (27.1 %). The autologous serum test in children is not used by 87.2 % of physicians for various reasons.

During allergy testing, respondents recommend: the concentration of total IgE in serum (63.9 %), the number of eosinophils in the blood (61.2 %). The importance of determining specific IgE was indicated by no more than one third of the respondents. Skin tests during remission period were supported by 59.1 % of all physicians, who considered allergologic examination to be necessary. Diet: 18.6 % of respondents do not recommend a special diet for children; 27.7 % exclude from the diet foods to which sensitization is detected, the rest recommend an nonspecific elimination diet.

Antihistamines of 2^nd generation (AG II) are the most used in clinical practice (86.5 %). Physicians named cetirizine (25.7 %) and levocetirizine (19.7 %) as the drugs of choice up to 12 years of age. The need to double the dose of AG II in the absence of response to the standard dose was supported by 59.5 % of physicians. The other physicians preferred a change of AG II molecule in the standard dose. Experience with the use of omalizumab was reported by 20 % of specialists, with 76.3 % understanding the significance and willingness to use biologic therapy. If omalizumab is ineffective, 44.1 % of physicians consider glucocorticosteroids to be the drug of choice; 38.8 % — cyclosporine A. About one third of physicians use alternative therapies not considered in the clinical guidelines.

Conclusion. A significant number of physicians do not use recommendations based on evidence-based studies in real practice. AG II are the basis of CU therapy in children in all age groups. 

Wiskott — Aldrich syndrome (WAS) is a rare, X-linked combined disease with immunodeficiency caused by mutations in the WAS gene that encodes the WAS protein (WASp). Manifestations range from a relatively mild form of the disease (intermittent X-linked thrombocytopenia), characterized by thrombocytopenia with or without minor immunodeficiency, to a severe form with deep immunodeficiency, episodes of bleeding, the development of autoimmunity and an increased risk of malignancy. Many patients have intermediate degrees of severity. It is precisely this heterogeneity in the clinical spectrum that makes it difficult to make a primary diagnosis of WAS. The article presents a clinical case of primary immunodeficiency detected in a 2-month-old child.