Personalized diagnostics and therapy of children with allergopathology in the Kaliningrad region

Allergopathology is a multifactorial group of diseases that includes clinical manifestations from the skin, gastrointestinal and respiratory systems. This group of diseases is based on the mechanisms of hypersensitivity types I, V and VI. These disorders can manifest with similar clinical features. In addition, they must be differentiated from infectious syndrome of primary immunodeficiencies, with onset of an autoimmune disorder, rhinopathy associated with endocrine diseases, enzymopathies. The cohort of children with allergic rhinitis is heterogeneous, due to potentially variable course of hypersensitivity and combination of various pathogenetic pathways. The aim of our study was to develop a personalized approach to diagnosis and therapy in children with manifestations of rhinitis and prolonged cough syndrome. The study included a group of 53 children aged 2 to 18 years who consulted an allergist-immunologist with leading complaints for nasal congestion and prolonged cough. We also excluded infectious factors of hypersensitivity. According to the results of examination and anamnesis, rhinitis was combined with postnasal drip in all patients (n = 53, 100%); episodes of broncho-obstruction and laryngospasm were observed in 20 patients (24%), bronchial asthma attacks – in 7 children (13.2%). Polyresistant bacterial microflora was detected in 20 patients. Allergosensitivity was revealed in 31 children. Rhinopathy associated with alactasia was found in 8 children, with hypolactasia against the background of regular consumption of dairy products – in 5 children. Sanation of chronic flora and dietary therapy was followed by remission of rhinopathy. In 7 patients, the iron deficiency conditions led to sensitivity to bacterial flora. In the structure of sensitization, allergens of house dust mites predominated (61.3%), along with food sensitization (48.4%), epidermal allergens of animals (45.2%), plant allergens (54.67%). In the cases where we identified diagnostically significant allergens, allergen-specific immunotherapy with sublingual (SLIT) drugs was recommended to children. During the year of observation, 12 subjects underwent treatment with house dust allergens; 5, with birch allergens; 3, with a mixture of meadow grass allergens, and one child with wormwood. Some patients still needed pharmacotherapy. After the first course of SLIT, all patients experienced a significant relief of the syndrome. Thus, personalized diagnostics should include a thorough examination: allergy diagnostics, exclusion of gastrointestinal pathology and enzymopathies, detection and sanitation of chronic foci of infections, including parasitic invasions. Such an algorithm may significantly alleviate the severity and duration of clinical manifestations of rhinopathy.