The increasing prevalence of atopic dermatitis (AD) over recent decades suggests that environmental factors play an important role in the etiology and pathogenesis of the disease. Nonspecific factors refer to external (or exposomal) factors and include human and natural factors that influence the health of a population: for example, the socioeconomic status of the patient; climate, including air temperature, exposure to ultraviolet radiation, air pollution; and living in a city or rural area. Although studies have shown the influence of these factors on the course of AD, in general, none of them significantly increases or decreases the risk of developing the disease. This review briefly discusses studies on the role of nonspecific environmental risk factors and their impact on the course of AD in children and adults.

   Introduction. Asthma is a widespread disease in childhood and has a persistent tendency to increase. Therefore, the search for factors influencing this process, as well as biomarkers reflecting the degree of asthma control, is an urgent problem.

   Objective. To study the relationship of vitamin D levels with the serum periostin and TGF-β1 concentration in children with asthma.

   Materials and methods. The cross-sectional (one-stage) study included 80 children aged 6 to 17 years (average age — 12 ± 3.2 g). The subjects were divided into 2 groups: children with asthma — group 1 (n = 40); group 2 — the control group (n = 40). In all children, the assessment of the concentration of 25(OH)D, periostin and TGF-β1 in the blood serum was studied.

   Results. Median (Me) 25(OH) in patients with asthma was statistically significantly lower than in children of the comparison group (16.7 ng/ml, versus 25.7 ng/ml, p = 0.017), and did not depend on the severity of the disease, corresponded to a deficiency condition in both mild (16.2 ng/ml) and with an average severity of asthma (16.8 ng/ml) (p = 0.041). Me of periostin in 1st group was within the normal range (730.2 ng/ml), but statistically significantly exceeded the indicator of 2nd group (539.7 ng/ml, p < 0.05) and did not depend on the age and duration of asthma. High rates of periostin were observed in children with moderate severity of asthma with a disease experience of 4–6 years (617.2 ng/ml). Me of TGF-β1 in both groups corresponded to normal values (309.0 and 369.6 pg/ml, respectively, p > 0.05) and did not depend on the age and duration of asthma.

   Conclusions. VD deficiency is registered in children with asthma 2 times more often than in healthy children in Ryazan region. The serum concentration of periostin increased in proportion to the severity of asthma. Vitamin D deficiency can be one of the risk factors for the development of asthma and lead to an imbalance in the periostin and TGF-β system.

   Introduction. The instructions for the drug dupilumab indicate that the administration of a single loading dose on the first day leads to the rapid achievement of clinically effective concentrations within 2 weeks, which we saw in the example of our patient and her real clinical response to the first injection.

   Presentation of a clinical case. Under our medical supervision was a 17-year-old patient with severe atopic dermatitis, resistant to traditional therapy. Heredity for allergic pathology is burdened: the girl’s mother suffers from pollen allergy. Initially before the start of therapy: SCORAD — 88 points, EASI — 48.8 points, IGA — 4, blood eosinophils — 11 % (1188 cells/ml), total IgE — 1102.0 IU/ml; the content of nitric oxide in exhaled air (FeNO) is 30 ppb. On April 28, 2021, the patient was administered dupilumab at a dose of 600 mg. Assessment of atopic dermatitis control in points upon admission to the hospital 2 weeks after the first administration of dupilumab: on the SCORAD scale — 44.5 points; EASI — 13.8 points; IGA — 2 points, eosinophils — 9 % (1070 cells/ml); total IgE — 840 IU/ml; FeNO — 5 ppb.

   Conclusion. This clinical observation clearly illustrates the fact that patients with severe atopic dermatitis who don’t respond to first-line therapy can achieve positive clinical results after the first use of a recombinant human monoclonal antibody (IgG4).

   Introduction. Jacobsen syndrome (JS) is a rare genetic disease associated with the deletion of chromosome 11q, characterized by multiple malformations, hematological and immune disorders. The development of immunodeficiency in JS is often underestimated, which leads to recurrent infectious complications.

   Presentation of a clinical case. The article presents a clinical case of a patient with a deletion of chromosome 11q and combined immunodeficiency. Our patient had recurrent infections, cytopenic syndrome, combined immunodeficiency, as well as other clinical manifestations of Jacobsen syndrome. In addition to a decrease in serum immunoglobulins, a deep deficiency of the T-cell link of immunity with a low content of T-lymphocytes, recent emigrants from the thymus, has been established.

   Conclusions. The peculiarity of the presented clinical case is that with a relatively small amount of deletion 11q, the child realized a complete clinical phenotype of the disease and a deep combined immunodeficiency. The article was written to improve doctors’ knowledge about this rare form of congenital immunodeficiency.