Relevance. Food allergy (FA) is an important public health concern, particularly among children, with an increasing prevalence. It is associated with a significant decrease in the quality of life for patients and their families due to the need to avoid allergens and the risk of severe allergic reactions, such as anaphylaxis. Despite active research, the primary treatment remains elimination diets, which limit patients’ options and highlight the need for new therapeutic solutions.

Aim of the review. This review aims to summarize the current treatment methods for food allergy, discuss the challenges in evaluating the effectiveness of interventions, and highlight the importance of standardizing outcomes in clinical trials to improve comparability and practical relevance.

Content. The review discusses modern therapeutic approaches for food allergy, such as oral, epicutaneous, and sublingual immunotherapies, which have shown positive results in achieving tolerance to allergens. Special attention is given to safety concerns, particularly for children, emphasizing the need for further research. The potential use of biological agents, such as omalizumab, in food allergy treatment is also explored. The review addresses challenges in choosing and standardizing endpoints in clinical trials, where most focus on desensitization and immunological markers, while patient-centered outcomes, such as quality of life, remain under-researched. The implementation of “core outcome sets” is highlighted as an important step toward improving data comparability and forming a more objective basis for clinical recommendations.

Conclusions. The review emphasizes significant progress in food allergy treatment but notes the need for further research to ensure the safety of new therapies, particularly for children. Standardizing outcomes in clinical trials plays a key role in improving the quality and comparability of research, which will, in turn, help develop more effective clinical guidelines and improve patients’ quality of life. 

Introduction. Despite active research into the mechanisms of food allergies (FA), the main approach to managing patients with this condition remains the complete exclusion of causative allergens from the diet for a certain period. At the same time, the question of timely reintroduction of excluded food triggers into the diet is frequently raised, which is important both for maintaining oral tolerance and reducing the negative effects of long-term elimination diets, such as nutritional and eating behavior disorders, as well as financial burdens on families. However, clear recommendations on the reintroduction of previously excluded foods have not existed until recently. Regarding cow’s milk protein allergy (CMPA), such recommendations were provided in 2023 in the consensus document of the World Allergy Organization (WAO) — DRACMA.

Aim. The aim of this review is to present current approaches to the reintroduction of food allergens into the diets of patients with food allergies and to evaluate various reintroduction protocols, including those used for cow’s milk protein allergy (CMPA).

Material and methods. This review provides a concise summary of current approaches to reintroducing food allergens into the diet, covering both IgE-mediated and non-IgE-mediated forms of food allergy. The advantages of different patient management protocols are discussed, with special attention given to CMPA as one of the most common manifestations of FA in children.

Results. An analysis of modern approaches has demonstrated that modern recommendations regarding the reintroduction of allergens, including those presented in the document of the World Allergological Organization — DRACMA for allergy to cow’s milk proteins, allow for a more personalized and safe approach to the reintroduction of allergens, which helps reduce risks and maintain food tolerance.

Conclusions. The introduction of new guidelines for the reintroduction of food allergens is an important step in managing patients with food allergies. These recommendations provide a more personalized approach to treating food-allergic patients, including those with cow’s milk protein allergy, reducing the risks associated with reintroducing allergens into the diet. They also help to mitigate the negative effects of elimination diets and maintain oral tolerance in patients, which is particularly important for children with FA.

Introduction. The onset of allergic diseases most often occurs in early childhood with the onset of food allergies, which can subsequently lead to the implementation of the atopic march. Increased intestinal permeability with high production of zonulin, the main moderator of intestinal tight junctions, can be an important link in the development of comorbid allergic diseases.

Material and methods. In order to study the significance of fecal zonulin as a marker for predicting the atopic march in children with food allergy, a cross-sectional retrospective study was conducted on 73 children aged 5 years who were diagnosed with food allergy (FA) to cow’s milk proteins in the first year of life. In all children, when the diagnosis was made in the first year of life, the content of zonulin in feces was determined using the ELISA method.

Results. As a result of dynamic observation, all children with food allergy were divided into 2 groups: the first group consisted of children with food allergy who developed allergic rhinitis and/or bronchial asthma within 5 years (group I, n = 39), group 2 consisted of 34 children with food allergy who did not implement the atopic march within 5 years of observation (group II, n = 34). Our study showed statistically significant differences in the fecal zonulin level in the first year of life: group I Me = 2.39 ng/ml (Q1-Q3: 1.78–2.65 ng/ml), group II Me = 1.85 ng/ml (Q1-Q3: 0.49–0.91 ng/ml), p = 0.034. Strong direct correlations were found (Spearman correlation coefficient S = 0.681 (p < 0.05)) between the zonulin level in feces at the onset of the disease and the development of allergic rhinitis and/or bronchial asthma up to 5 years of age, the data were confirmed by comparing the areas under the curves during ROC analysis, AUC in the study of fecal zonulin as a prognostic marker of the risk of atopic march in children is 0.887, the optimal threshold (cutoff point) is 1.94 ng/ml.

Conclusions. Fecal zonulin level in children with food allergy can be an effective prognostic marker of atopic march development, its values in feces above 1.94 ng/ml allow us to predict with a high degree of probability the risk of atopic march development  in children with food allergy to cow’s milk proteins within 5 years

Relevance. Children with congenital heart disease (CHD) are at high risk of infectious complications with unfavorable outcomes, which is associated with inadequate immune responses. TREC and KREC are recognized biomarkers of T- and B-cell lymphopoiesis.

Objective of the study: to evaluate the number of circular DNA segments — TREC and KREC in children with congenital heart defects.

Materials and methods. The study used data from neonatal screening for primary immunodeficiencies in the Stavropol region from January 1, 2023, to June 30, 2024. An analysis of TREC and KREC was conducted in 43 newborns with CHD compared to healthy infants.

Results. The levels of TREC and KREC in children with CHD were lower than in healthy children. A correlation was established between TREC levels and absolute lymphopenia, as well as the development of infectious complications. A decrease in KREC was identified in infants with CHD and genetic syndromes. It was shown that a TREC level of less than 650 copies per 10⁵ cells may be a predictor of the development of infectious complications in newborns with CHD.

Conclusions. The reduction in the number of TREC and KREC copies in neonatal screening allows for the identification of children with CHD at high risk of infection, opening potential opportunities for preventive therapy. 

Introduction. The extracellular matrix protein periostin, expressed in a number of body tissues, is considered as a marker of type 2 T cell inflammation and of asthma control.
Objective. To study the relationship the serum periostin concentration in blood serum depending on the severity of asthma and indicators of respiratory function in children.
Materials and methods. The cross-sectional (simultaneous) study included 80 children aged 6 to 17 years (average age 12±3.2), who were divided into 2 groups: 1st — children with asthma (n=40); 2nd — comparison group (n=40). The concentration of periostin in the blood serum was determined by the ELISA method. The spirographic study was performed on a computer spirometer Spirolab 1, MIR (Italy).
Results. The Me of periostin in group 1 was within the normal range (730.2 ng/ml), but statistically significantly exceeded the indicator of group 2 (539.7 ng/ml, p<0.05) and did not depend on the age, duration and severity of asthma, anthropometric parameters of the examined. The level of periostin in the blood serum significantly correlated with the frequency of exacerbations of the disease during the year (r=0.74, p=0.000), with the status of asthma control (r=0.32, p=0.04). A moderate correlation was found between the level of periostin and FEV1 (r=−0.34; p=0.03).
Conclusions. In children with asthma, the median periostin in the blood serum increased in proportion to the severity of asthma, disease control and the frequency of exacerbation of the disease.