Rationale: the problem of the growth of allergic diseases associated with plant pollination is urgent. At present, numerous works discuss the influence of global warming on the onset, intensity and duration of plant pollination. An increase in the total annual pollen concentration in the aeropalynological spectrum is noted. For the Central Federal District (CFD) of Russia, pollination of woody wind-pollinated plants, particularly birch, is of the greatest clinical significance.
Objective: to study the clinical characteristics of birch pollinosis in children of the city of Ryazan and Ryazan region in the season of 2023 in conditions of intensive dusting of birch (Betula).
Materials and methods. An open single-centre retrospective randomized uncontrolled cohort study was conducted. The study included 211 children who sought emergency medical care from 01.02.2023 to 30.06.2023 in hospital or polyclinic with symptoms of bronchial asthma, allergic rhinitis and atopic dermatitis. The time frame of the study was February to June 2023. In parallel, prospective aerobiological monitoring with the help of Lanzoni volumetric trap ‘VPPS 2000’ and analysis of search queries of residents of Ryazan and Ryazan region in the system ‘Yandex Wordstat’ were conducted. For statistical processing of the obtained results, Past 4.03 software and SPSS V24.0 package were used, including descriptive statistics.
Results. According to the data of aerobiological studies in the season 2023 record high concentration of birch pollen for the last 9 years of observations. This resulted in a high incidence of emergency visits to health care facilities with symptoms of pollinosis. The main age group of children who applied was from 7 to 12 years old, but there were also cases of children under 3 years old, which indicates rejuvenation of the pollynosis debut. There was a dependence on sex, as the number of boys who applied was 2.5 times higher than the number of girls who applied. Bronchial asthma predominated in the structure of clinical phenotypes of children urgently hospitalised, and half of all asthma cases were its manifestation. A moderate positive association (r = 0.4; p = 0.002) between airborne pollen concentration and the number of children who sought care was found in hospitalised patients when aeropalynological monitoring and clinic data were compared.
Conclusion. The peculiarity of the pollen season in 2023 in the Ryazan region (Central Federal District of the Russian Federation) is the record high concentration of birch pollen for the last 9 years of observations. This led to an increase in the number of children with emergency symptoms of respiratory and cutaneous pollinosis.

Patients with asthma are at increased risk of developing osteopenia due to decreased bone mineral density (BMD). Particular attention is given to the role of vitamin D, whose deficiency is associated with the management of symptoms and bone health.
Study Objective. To study BMD and its biochemical markers, with an emphasis on vitamin D status and intake in children with asthma in the Moscow region.
Materials and Methods. Anamnestic, questionnaire, and laboratory methods were used, including assessment of nutritional impact, grade D, biochemical markers of bone metabolism, and molecular genetic analysis. Mineral support was obtained using X-ray densitometry. Data were statistically processed using SPSS Statistics 26 (IBM) using parametric and nonparametric me­ thods at a significance level of p <0.05.
Results. The included study included 100 children with asthma, 15 % of whom had AD, and showed decreased BMD of varying severity. Most patients had low vitamin D levels, which were gradually adjusted and required oral cholecalciferol. High-dose inhaled glucocorticosteroids were associated with a more frequent decrease in BMD, while higher BMD values were recorded in children with moderate physical activity. The level of 25(OH)D was significantly lower in patients with asthma carrying the GG genotype of the VDR (FokI) gene polymorphism compared to those with the AA and AG genotypes. No relevant medical studies on bone health were identified.
Conclusion. This study confirms a significant decrease in BMD in children with asthma compared to those in medical settings and reveals significant changes in biochemical markers of bone metabolism. Low vitamin D levels and limited physical activity in this group of patients necessitate comprehensive treatment and correction of metabolic changes to prevent long-term complications, including osteoporosis. A multidisciplinary approach that combines stress management, nutritional status improvement, and physical activity is essential to BMD and reduce the risk of bone disease in adulthood.

Introduction. Identifying the causes of allergic diseases and allergen sensitization patterns in young children remains a challen­ ging task of significant interest to the medical community.
Objective. This study aimed to determine risk factors, sensitization profiles, and major allergens in children aged 2–4 years with allergic rhinitis (AR) residing in Beloretsk (Republic of Bashkortostan).
Materials and methods. In this open-label, single-center, prospective study, 113 children with persistent rhinitis were enrolled and divided into two groups: AR (n = 68, mean age 3.19±0.78 years) and non-AR (n = 45, 3.00±0.80 years). Evaluations included medical history, eosinophilic cationic protein levels, total and specific IgE (ImmunoCAP), and nasal cytology. Polysensitized children (n = 11) underwent further testing using the ISAC-112 molecular panel. Statistical analysis employed median (Me) with 95% confidence intervals (95% CI), Mann — Whitney U-test, Yates-corrected χ^² test, Spearman’s correlation coefficient, and Chaddock’s scale.
Results. AR developed by the age of three, with 54.41% of patients exhibiting mild persistent perennial symptoms (p = 0.019), predominantly sneezing (p < 0.001). Significant risk factors included family history of asthma (OR 11.9; 95% CI [2.8; 50.9]), seasonal AR (OR 2.5; 95% CI [1.1; 5.7]), maternal anemia (OR 2.3; 95% CI [1.1; 5.0]), cesarean delivery (OR 2.8; 95% CI [1.2; 6.8]), atopic dermatitis (OR 3.9; 95% CI [1.4; 10.3]), adenoid hypertrophy grade 2—3 (OR 3.2; 95% CI [1.3; 8.1]), animal exposure (OR 3.6; 95% CI [1.8; 7.3]), and passive smoking (OR 2.8; 95% CI [1.4; 5.8]). Sensitization was detected to cat dander (75.00%), dog dander (66.18%), birch (47.06%), timothy grass (20.59%), mugwort (36.76%), and house dust mites (D. p., D. f.) (41.18%). Molecular analysis (ISAC-112) confirmed sensitization to Fel d 1 (90.91%) and Bet v 1 (73.72%).
Conclusion. These findings highlight the importance of regional studies in understanding the clinical and risk factors of pediatric allergic diseases, contributing to improved diagnosis and prevention strategies.

Introduction. Eosinophilic gastrointestinal diseases are a group of chronic immune-mediated diseases of the gastrointestinal tract characterized by gastrointestinal symptoms and pathological eosinophilic infiltration of certain parts of the gastrointestinal tract in the absence of secondary causes of eosinophilia. Depending on the lesion level, eosinophilic esophagitis, eosinophilic gastritis, eosinophilic enteritis and eosinophilic colitis are distinguished. The absence of specific symptoms of eosinophilic gastrointestinal diseases complicate the diagnostic process, the key element of which is the morphological examination of biopsies of the mucous membrane of the corresponding part of the gastrointestinal tract to determine eosinophilic infiltration. To date, eosinophilic esophagitis in children is a well-defined disease with established recommendations, which facilitates the diagnosis and treatment of this pathology, which cannot be said about eosinophilic gastritis, which remains a clinical mystery with evidence based on limited individual case reports.
Presentation of the clinical case. The publication presents a clinical case of a 9-year-old girl with combined eosinophilic lesions of the esophagus and stomach. An endoscopic examination of the upper gastrointestinal tract performed on an outpatient basis, followed by a morphological assessment of biopsies of the esophageal mucosa, made it possible to diagnose eosinophilic esophagitis. A biopsy of the gastric mucosa and small intestine was not performed. The lack of stable positive dynamics against the background of prescribed treatment led to hospitalization and repeated examination, including morphological examination of the mucous membrane of the esophagus, stomach and intestines. The examination revealed eosinophilic infiltration not only of the mucous membrane of the esophagus (>15/1PH*400), but also of the antrum of the stomach (up to 67 eosinophils*5PH*400). As a result, eosinophilic esophagitis was diagnosed in combination with eosinophilic gastritis, for which diet therapy, proton pump inhibitors and glucocorticosteroids were prescribed, which led to an improvement in the child’s condition, relief of pain and symptoms of dyspepsia, and the formation of clinical remission.
Conclusion. Despite the increasing number of studies and publications on the problem of eosinophilic gastrointestinal disea­ ses, the criteria for diagnosis and treatment of such patients remain controversial. The presented clinical case demonstrated the difficulties that arise for a practicing physician in managing children with eosinophilic gastrointestinal diseases, in particular combined eosinophilic lesions of the esophagus and stomach, given the low symptoms and atypical clinical manifestations of this pathology, which necessitates further study of the mechanisms of development and improvement of the algorithm for the diagnosis and treatment of these diseases.

Relevance. The prevalence of shellfish allergy is estimated to be approximately 0.5–2.5 % among the population and varies depending on the patient’s age, the degree of seafood consumption in their diet, geographical regions, and the method of diagnosis. In most cases, severe anaphylactic reactions are recorded in clinical settings.
Materials and methods. The study is based on an analysis of medical records and personal supervision of a 12-year-old patient with polysensitization and recurrent episodes of anaphylaxis.
Results. The article describes a clinical case of cross-sensitization between shellfish and house dust mites in a child with comorbid polyallergy. A 12-year-old boy with a complicated allergic history. The onset of atopic march began with severe atopic dermatitis associated with sensitization to cow’s milk proteins, accompanied by recurrent angioedema and anaphylaxis. From the age of 2, he experienced persistent allergic rhinitis and bronchial obstruction syndrome due to sensitization to house dust mites. The most recent episode of anaphylaxis occurred in response to the consumption of cooked shrimp. The development of clinical symptoms in response to shellfish consumption in patients with primary sensitization to house dust mites is mediated by cross-reactivity of allergens from the tropomyosin family.
Conclusion. Assessment of cross-sensitization is crucial to properly inform the patient to avoid new episodes of allergic reactions. For this reason, patients with comorbid allergies should undergo component allergodiagnosis.

Introduction. Bronchial asthma (BA) is the most common chronic respiratory disease in children, exerting a significant impact on the quality of life of both the child and the family. The development of BA is influenced by both internal and external risk factors. Comorbidity remains a pressing issue in BA, frequently contributing to severe and uncontrolled disease courses. Currently, psychosomatic and psychopathological disorders in patients with severe manifestations of BA are being actively studied.
Presentation of the clinical case. We present a clinical case of uncontrolled BA in a 17‑year‑old adolescent hospitalized in the pediatric department. A comprehensive clinical and laboratory examination was performed, which confirmed the diagnosis, clarified the sensitization profile, allowed the development of elimination measures, and facilitated the selection of adequate controller therapy. Despite ongoing treatment and adherence on the part of the patient and his family, full control of BA could not be achieved. Given the patient’s complaints of sleep disturbances, difficulty falling asleep, shortness of breath associated with emotional stress, and pronounced vegetative symptoms, a psychiatric and psychotherapeutic consultation was deemed necessary. As a result of additional evaluation, a diagnosis of Generalized Anxiety Disorder was established, and antidepressant therapy was initiated, which led to significant clinical improvement and asthma control.
Conclusion. This clinical case illustrates the role of psycho‑emotional disorders as a factor contributing to the uncontrolled course of BA.

Introduction. Atopic dermatitis (AtD) is one of the most common skin diseases in the world and its frequency is increasing. This is one of the few diseases that debuts in infancy, and can persist throughout life, worsening its quality, and sometimes leading to disability. Therefore, the treatment of atopic dermatitis remains an urgent problem in allergology and pediatrics in general. Traditionally, the treatment of atopic dermatitis is based on elimination measures and local anti-inflammatory therapy for skin exacerbations, but often such a complex is insufficient to relieve the symptoms of the disease, which leads to the need to use targeted therapy with monoclinal antibodies, including in some cases upadacitinib.
Description of the clinical case. This publication presents our own successful experience of using upadacitinib in the form of a description of a clinical case in an 8-year-old patient with uncontrolled severe AtD. Before the drug was prescribed, the patient’s disease course was continuous, with severe exacerbations and no remission, as well as resistance to the recommended therapy at this age, including targeted therapy (Dupilumab, Omalizumab).Conclusion. In our opinion, the appointment of upadacitinib outside the age limits of the instructions may be justified in the most severe cases of atopic dermatitis, torpid to traditional therapy and other targeted drugs, since it carries fewer risks of side effects than the use of systemic glucocorticosteroids and cytostatics, but requires a consultation in an appropriate institution.