АКТУАЛЬНЫЕ ВОПРОСЫ ДИАГНОСТИКИ ПИЩЕВОЙ АЛЛЕРГИИ В ПЕДИАТРИЧЕСКОЙ ПРАКТИКЕ

Food allergy (FA) in children, especially in infancy, is still a significant public health problem. The severity and prognosis of disease progression associated with FA considerably depends on the correct and early diagnostics of this pathology, as well as on the following management of a child. At the same time delayed elimination diet administration, unreasonable or overlong dietary intervention might have become abuse management of a patient and have a negative impact on the development of a child and reduce the quality of life. The article summarizes the current practical approaches to the diagnosis of FA based on evidence-based medicine and adopted European and Russian national consensus documents, as well as on our own experience of management of patients with this pathology. FA diagnosis in a child usually includes clinical laboratory tests and clarification of clinical and anamnestic data. Unfortunately, it is a fact that preference is given to laboratory methods for diagnosis based on specific IgE determination or skin samples. However, the basis for cause-significant allergen identifying is detecting detailed medical history and clinical picture of a disease which still appears to be the most reliable tool for FA diagnosis. Пищевая аллергия (ПА) у детей, особенно в раннем возрасте, до сих пор остается существенной проблемой здравоохранения. Тяжесть течения и прогноз заболеваний, связанных с ПА, во многом зависят от правильной и своевременной диагностики данной патологии, а также от дальнейшей тактики ведения ребенка. При этом как несвоевременное назначение элиминационной диеты, так и неоправданная диета или ее слишком длительное соблюдение могут являться ошибочной тактикой ведения пациента, негативно влиять на развитие и снижать качество жизни ребенка. В статье кратко изложены современные практические подходы к диагностике ПА, основанные на доказательной медицине и принятые в качестве Европейских и отечественных согласительных документов, а также на собственном опыте ведения больных с данной патологией. Диагностика ПА у ребенка, как правило, включает в себя проведение лабораторных исследований и выяснение клинико-анамнестических данных. К сожалению, часто приходиться сталкиваться с тем, что предпочтение отдается лабораторным методам диагностики, которые основаны на определении специфических IgE или кожных пробах. Однако основой идентификации причинно-значимого аллергена остается детальный сбор анамнестических данных, который вместе с клинической картиной заболевания до сих пор является наиболее надежным инструментом диагностики ПА.

Food allergies. Recommendations on supplementary feeding introduction in patients with food allergies and risk group children: what and when?

The article is dedicated to food allergies. There still is no accurate estimate of the socioeconomic burden of food allergies and its impact upon the healthcare budget despite increasing prevalence thereof and lack of clear prognostic criteria. The authors present a modern classification of predominant clinical manifestations based on pathogenetic mechanisms of development. They describe therapeutic approaches, propose recommendations on diet broadening for both patients with food allergy manifestations and risk group children, define cross-sensitization and discuss a problem of non-immune reactions to foods.Keywords: food allergy, tolerance, food allergens, cow milk protein, therapeutic formulae, panallergens, cross-sensitization, risk group children, elimination diet, supplementary feeding, diet, tolerance window

First example of the cascade acylation/IMDAV/ene reaction sequence, leading to N-arylbenzo[f]isoindole-4-carboxylic acids possessing anti-viral activity

The reaction between readily accessible N-aryl-3-phenylallylamines and maleic anhydride led to unexpected products – polysubstituted hydrogenated benzo[f]isoindole-4-carboxylic acids. This transformation proceeds through a previously unknown sequence of steps: N-acylation of the allylamine with maleic anhydride, intramolecular Diels-Alder reaction of the vinylarene in the intermediate N-maleamide, and Alder-ene reaction of the products of the previous two steps. Selected benzo[f]isoindoles displayed antiviral activity. © 2018 Elsevier Lt

First example of the cascade acylation/IMDAV/ene reaction sequence, leading to N-arylbenzo[f]isoindole-4-carboxylic acids possessing anti-viral activity

The reaction between readily accessible N-aryl-3-phenylallylamines and maleic anhydride led to unexpected products – polysubstituted hydrogenated benzo[f]isoindole-4-carboxylic acids. This transformation proceeds through a previously unknown sequence of steps: N-acylation of the allylamine with maleic anhydride, intramolecular Diels-Alder reaction of the vinylarene in the intermediate N-maleamide, and Alder-ene reaction of the products of the previous two steps. Selected benzo[f]isoindoles displayed antiviral activity. © 2018 Elsevier Lt