The Document contains fundamental provisions regarding allergen specific immunotherapy in children.International clinical recommendations on the methodology were used, adapted for use in real practice.In the absence of international recommendations, the authors present the consensus opinion of the project participants, based on data from clinical studies in this area.At the moment, we bring to your attention a position paper on allergen specific immunotherapy in children, created by experts from the Association of Pediatric Allergologists and Immunologists of Russia (APAIR) based on the 2021 consensus document, with the necessary data updates.

Multiple sclerosis (MS) is a chronic, demyelinating disease that leads to disability. Understanding the etiology of MS contributes to the development of pathogenetic methods of treatment, and the search for informative biomarkers of the effectiveness of treatment will allow the patient to adjust therapy in time. The aim of this work was to determine informative cytokines and cytokine profiles to predict the effectiveness of IFN-β1a therapy in children with MS.
Materials and methods. 66 children with MS aged 16 [14.2–17.5] years who are on INFß-1a therapy were examined: group 1 — patients with exacerbation of MS (with active foci of demyelination by MRI), n = 34; group 2 — patients in remission of MS (without active foci), n = 32. The content of cytokines in the blood serum of patients was assessed using the multiplex panel Human Th17 Magnetic Bead Panel.
Results: There was a significant increase in cytokine concentrations in patients with exacerbation of MS compared with children in remission: IL5, IL6, IL9, IL12p70, IL17E/IL25, IL21, IL28A, GM-CSF, TNFß. Threshold values for IL9 (AUC = 0,785), IL6 (AUC = 0,750), TNFß (0,740), IL28A (AUC = 0,744) were obtained above which it is possible to predict an exacerbation of MS in patients: IL9 — 3.9 pg/ml (Sn — 70.6, Sp — 71.9), IL6 — 4.0 pg/ml (Sn — 70.6, Sp — 68.8), TNFß — 6.6 pg/ml (Sn — 70.6, Sp — 71.9), IL28A — 243.0 pg/ml (Sn — 70.6, Sp — 71.9). Cytokine profiles associated with T-lymphocytes and their functions were evaluated using z-score.
Conclusions. For the first time, an increase in cytokine levels was demonstrated in children with active foci of demyelination compared to patients in remission of MS. An increase in proinflammatory cytokines and cytokine profiles associated with Th1 and Th17, as well as with Th2 and Th22 has been shown. The use of threshold values for IL9, IL6, TNFβ, IL28A will help predict the development of exacerbation in patients with MS.

Anaphylaxis is a life-threatening systemic hypersensitivity reaction with the rapid development of critical changes in hemodynamics and /or disorders of the respiratory system, which can lead to death. Despite the trend towards the spread of anaphylaxis among children, there are difficulties in monitoring statistical data, since there is no generally accepted cipher “Anaphylaxis” in the ICD-10, and designations from allergic urticaria to anaphylactic shock appear as a diagnosis. Epidemiological studies on anaphylaxis in the Russian Federation are isolated, so the assessment of data from each region is relevant.
Objective: to study the clinical features and medical care for anaphylaxis in children of the Ryazan region in real clinical practice.
Materials and methods: A retrospective analysis of medical documentation was carried out in 300 children who had suffered an “acute allergic reaction” over the past 5 years, followed by a telephone survey of patients’ parents about the disease, and based on the clinical criteria for the diagnosis of anaphylaxis presented by the World Organization of Allergists (WAO) in 2020 and in the Federal Clinical Guidelines for the Diagnosis and Treatment of anaphylaxis, 57 patients were selected for anaphylactic shock of the Russian Federation in 2022, whose data were compared in a spreadsheet and analyzed using SPSS V24.0, including descriptive statistics.
Results: It was revealed that the average age of first—time anaphylaxis is 3.5 years. Clinical manifestations from the skin and mucous membranes were present in 67.2 % of patients, symptoms from the respiratory system in 11.8 % of cases. The leading trigger for the occurrence of anaphylaxis in children is the nutritional factor (n = 27 (40 %), (χ2 = 4.56; p = 0.033)). In 29 % of cases, the causally significant allergen remained unknown. The most common drugs in the treatment of anaphylaxis in real clinical practice were glucocorticosteroids (n = 48 (84.2 %)) and antihistamines of the first and second generation (n = 47 (82.5 %)). The frequency of epinephrine use was only 3 cases (5 %).
Conclusion: The epidemiological study of anaphylaxis in the Ryazan region was a pilot project for our region. It showed difficulties both in the organization and in the interpretation of the data obtained. According to preliminary results, food allergy is a frequent trigger of anaphylaxis in children of the Ryazan region. Regional studies of anaphylaxis in children in real clinical practice make it possible to identify not only the features of this urgent pathology, but also to note the problems of providing primary medical care in order to improve it. Further study of population models of anaphylaxis, apparently, should be based on the creation of a unified questionnaire of the pediatric community, following the example of the ISAAC questionnaires or the creation of registers, which will more accurately help determine the true prevalence of anaphylaxis, determine the need to identify anaphylactogenic relevant molecules in the pediatric population, and improve the provision of assistance to children with these conditions.

Background. Primary agammaglobulinemia is the result of specific changes in B-cells that lead to low antibody production. A preliminary diagnosis is established if there is a history of frequent bacterial infections (otitis media, sinusitis, skin abscesses), including severe course, in some cases caused by opportunistic flora and atypical mycobacteria; low levels of immunoglobulins. The main symptoms of primary immunodeficiency in a child from this clinical example were frequent recidivating bronchial obstruction with the development of pneumonia.
Presentation of the clinical case.The publication presents a clinical case of autosomal recessive agammaglobulinemia with B-cell deficiency in a child of 2 years, 7 months. During the follow-up period from 4 months to 2 months, 7 months, the child had 3 episodes of pneumonia, 3 episodes of purulent otitis media. The child repeatedly underwent inpatient treatment, where he received broad-spectrum antibiotics as treatment. Based on the examination (IgA (0.02 g/l), IgG (0.3 g/l), IgM (0.07 g/l) and the absence of CD19+ cells), the diagnosis of “Primary immunodeficiency, agammaglobulinemia” was made, which was subsequently confirmed by the RDC of Moscow. From the moment of diagnosis, the child receives intravenous immunoglobulins at a dose of 7.5 g. and antibacterial therapy.
Conclusion. Early recognition and diagnosis of these conditions is crucial to improve outcomes and prevent complications.