The development of pollinosis in children and adolescents is determined by the influence of genetic and environmental factors. The pathogenetic basis of pollinosis in children and adolescents is the differentiation of Th0 to Th2, activation of Th2cells and increasing of the production of IL-4, IL-5, IL-13, sIgE, activation of mast cells, basophils, eosinophils, with following development of IgE-mediated allergic reaction after exposure to pollen allergens and the manifestation of clinical symptoms of pollinosis (allergic rhinitis, allergic conjunctivitis, bronchial asthma). Children and adolescents with pollinosis often develop cross-allergic reactions to plant-based foods. Pathogenetic pharmacotherapy (antihistamines of the second generation, topical corticosteroids, antileukotrienes, decongestants) allows to achieve control over the symptoms of pollinosis. Subcutaneous and sublingual ASIT are high effective, they reduce the severity of symptoms of pollinosis, decrease the risk of developing bronchial asthma and severe clinical forms of pollinosis. The sublingual ASIT is more safe than subcutaneous ASIT.

Relevance. Nasal allergen provocation test (NAPT) is useful for revealing the causative allergen in patients with allergic rhinitis (AR). Currently, NAPT is not sufficiently standardized, there is also doubt about its high safety.

Aim of the study. Safety assessment of NAPT with house dust mite (HDM) allergens in children with AR and AR in combination with bronchial asthma (BA) in daily clinical practice.

Materials and methods. For the analysis, cases of positive NAPT in 128 patients were taken: 69 boys (age 5 to 15 years, average 9.2±1.7) and 59 girls (age 5 to 17 years, average 11.6±2.1) with AR or AR in combination with BA, with positive skin prick tests with HDM. Positive NAPT was recorded according to clinical signs and a decrease in peak inspiratory flow rate through the nose at least 20% from baseline. The protocol of the test included the introduction of a control fluid into one nostril, then dilutions of the allergen 10–4, then 10–3, 10–2, 10–1, and the undiluted allergen. Post-trial follow-up included monitoring of complaints, adverse events, registration of required therapy, and control spirometry.

Results. In 128 cases of positive NAPT with HDM, there were no serious adverse events, systemic reactions, bronchospasm, and cases of treatment requirements higher than the standard. In 1 case, a patient aged 13 years had a voice hoarseness 2 minutes after the introduction of an allergen at a dilution of 10-2. The reaction was stopped with cetirizine within 25 minutes after administration. In all patients, reactions to the allergen were completely resolved within 30 minutes of observation after the test.

Conclusion. NAPT with HDM allergens is safe can be performed on an outpatient basis. It is safe to conduct NAPT according to a tested graduated method with a clinical and objective instrumental assessment of the reaction to an allergen and the observation of the patient after the test.

Introduction. A topical problem in pediatrics is bronchial asthma, which is characterized by a high prevalence, contributing to the formation of disability and a decrease in the quality of life in children. Possible triggers for exacerbation of the disease include external biotropic weather conditions. In this connection, it is necessary to study and develop new technologies for the correction and prevention of increased meteosensitivity in children with bronchial asthma.

Purpose. To study the regularities of the influence of biotropic weather conditions on the course of asthma in children with increased meteosensitivity and to assess the effectiveness of the meteorological influence of climatotherapy.

Materials and methods. An assessment was made of the bioclimatic potential of the territory of the Vulan sanatorium, taking into account the thermal regime, the biological effect of solar radiation, the degree of favorable weather conditions for carrying out climatotherapy. The degree of sensitivity to biotropic weather conditions and the features of manifestation of meteopathic reactions were studied in 119 children with asthma at the age of 5 to 15 years. The studies were carried out in a comparative aspect in two groups of children: children in the main group (95 children) in complex spa treatment received dosed climatotherapy procedures; children of the comparison group did not receive climatotherapy.

Results. The meteorological dependence of varying severity was found in all children. Weather-related exacerbations in most children developed during the formation of the hypoxic effect of the atmosphere caused by hyperthermia and high humidity, conditions of "stuffiness" and "overheating", increased symptoms of the disease, decreased physical activity, deterioration of the psychoemotional state of children, confirmed by a significant (p <0.05) decrease in values SAN test on average for the group. It was revealed that adequate metered climatic procedures have a positive effect on the clinical course of the disease, contribute to a decrease in severe meteopathic reactions and an increase in the percentage of their mild manifestations.

Conclusion. Complex spa treatment with the inclusion of strictly metered climatic procedures (sun and air baths) is one of the possible approaches to the prevention and correction of weather-related exacerbations.

Despite treatment of bronchial asthma, in accordance with current recommendations, inhaled corticosteroids as monotherapy or in combination with long-acting β₂ agonists, at least 40% of patients fail to achieve disease control. The long-acting anticholinergic drug Tiotropium (through a liquid inhaler Respimat) is recommended for use in adults and children over S years of age by experts from GINA, the Russian respiratory society and the Pediatric respiratory society as an additional strategy for achieving bronchial asthma control. The article highlights the pharmacological properties of Tiotropium and its mechanism of action in asthma. The results of the author's own research on the use of Tiotropium in children S–11 years of age with moderate and severe bronchial asthma in real clinical practice are presented.

The purpose of the work is to study the clinical and immunological effectiveness of using autoserotherapy, ultrasound, as well as their combined use in children with allergic bronchial asthma.

Materials and methods. During the work, 102 children aged 6 to 18 years with bronchial asthma were examined. Group A included 19 patients who received autoserotherapy. Group B patients (19 children) received ultrasound therapy in the spleen area. In group C (32 children), autoserotherapy was combined with ultrasound treatment. 32 patients with group D bronchial asthma made up the comparison group. All children included in the study received basic treatment (inhaled glucocorticosteroids).

Results. Carrying out autoserotherapy in patients with bronchial asthma caused a statistically significant decrease in CD4⁺CD25⁺ T-lymphocytes (p_{1-3 rel.}<0,05; p_{1-3 abs.}<0,05), as well as a significant increase in CD19⁺CD23⁺⁺ B-lymphocytes through 82–90 days from the start of the study (p_{2-3 abs.}<0,05). After ultrasound therapy, after 12–15 days, a statistically significant decrease in the absolute level of CD4⁺CD25⁺ T-lymphocytes was observed (p_{1-2 abs.}<0,05). The combined use of ultrasound exposure with autoserotherapy leads to an increase in the level of control of bronchial asthma, the indicators are statistically significantly higher in comparison with patients in whose treatment only basic therapy was used (p_C-AСT2 <0,05; p_C-AСT4<0,001; p_AСT2<0,05 ; p_AСT3<0,01; p_AСT4<0,001). In this group of children, the level of CD4⁺CD25⁺ T-lymphocytes, CD19⁺CD23⁺⁺ B-lymphocytes was statistically significantly reduced, was significantly lower than in the group of patients in whose treatment only basic treatment was used (p_{Е2-В2 abs.} CD4⁺CD25⁺<0,05; pE_{3-B3 abs.} CD19⁺CD23⁺⁺<0,05).