Diagnostics and preventive therapy of allergic rhinitis in children: modern algorithm

P.V. Berezhanskiy1-4, A.B. Malakhov1,3,4, N.A. Geppe1, N.G. Kolosova1, N.S. Tataurshchikova2 1I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation 2RUDN University, Moscow, Russian Federation 3Morozov Children's City Clinical Hospital, Moscow, Russian Federation 4Research Clinical Institute of Childhood of the Moscow Region, Moscow, Russian Federation Background: allergic rhinitis (AR) is the leading pathology in pediatric practice. Improvement of the diagnostic accuracy and preventive measures in AR is the priority task. Aim: to evaluate the efficacy of the proposed cascade algorithm of diagnosis and preventive medicated therapy for children at high risk of AR. Patients and Methods: a retrospective epidemiological analysis was conducted in five regions of the Central Federal District for 2017–2021, where the main risk factors of AR were identified. The article proposes a screening cascade and a three-step diagnostic algorithm of AR, as well as high-risk group identification with the indication of preventive medicated therapy. The efficacy of the proposed technique was evaluated in the catamnestic study. Results: during the follow-up, there was a steady increase of AR in all regions — from 1,472 to 2,684%. 28 risk factors were identified, of which 12 were controlled factors. According to the highest risk factor probability, 4 age groups were identified: from birth to 5 years, 6–7 years, 8–12 years and children 13 years and older. In the group receiving preventive therapy, AR was verified in the catamnesis 2 times less common — in 12 instead of 24%. Thus, the patients at high risk of AR require preventive medicated therapy and constant follow-up at certain age periods. Conclusion: this article presents the evaluation of the proposed diagnostic cascade efficacy, the identification of the group at high risk of AR and the justification concerning the use of preventive medicated therapy of AR in this group during acute respiratory infection. Keywords: allergic rhinitis, preventive therapy, polymorphism, heart rate variability, microcirculation. For citation: Berezhanskiy P.V., Malakhov A.B., Geppe N.A., Kolosova N.G., Tataurshchikova N.S. Diagnostics and preventive therapy of allergic rhinitis in children: modern algorithm. Russian Journal of Woman and Child Health. 2023;6(3):276–282 (in Russ.). DOI: 10.32364/2618-8430-2023-6-3-11. </p

DIFFERENTIAL DIAGNOSIS IN JUVENILE SCLERODERMA

Scleroderma is a rare rheumatic disease. Clinical symptoms and syndromes of scleroderma in children are presented. Different tialbdiagnostic search in case of main clinical, instrumental and laboratory implications of disease is given. Peculiarities of children's scleroderma are shown.Key words: children, juvenile scleroderma, symptoms, syndromes, differential diagnosis

Effect of Nasal Obstructive Disorders on Sinonasal Symptoms in Children with Different Levels of Bronchial Asthma Control

Allergic rhinitis (AR) and allergic rhinosinusitis (ARS) are typical upper airway pathologies (UAP) in children with bronchial asthma (BA) frequently accompanied with nasal obstructive diseases (NOD). In order to establish the effect of NOD on correlations between nasal and synonasal symptoms with clinical assessments of asthma control, 82 children, 9.8 [8.9; 10.7] years old, with atopic BA were assessed using ACQ-5 for the BA control level, TNSS for nasal symptoms, and SNOT-20 for synonasal quality of life in combination with rhinovideoendoscopy for NOD. All patients had AR/ARS; in 76.3% (63/82) of children, UAP had a multimorbid character with the presence of NOD. Significant correlations were found between ACQ-5 and TNSS (R=0.40, p<0.0001) and ACQ-5 and SNOT-20 (R=0.42, p<0.0001). Correlations between TNSS/ACQ-5 and SNOT-20/ACQ-5 were higher in patients who do not have a combination of AR/ARS with NOD (R=0.67, p=0.0012; R=0.50, p=0.022, resp.) than in patients who have AR/ARS combined with NOD (R=0.30, p=0.015; R=0.26, p=0.04, resp.). Thus, the association of BA control level with the expression of nasal and synonasal symptoms is higher in children who do not have multimorbid UAP. © 2018 T. I. Eliseeva et al

Effect of Nasal Obstructive Disorders on Sinonasal Symptoms in Children with Different Levels of Bronchial Asthma Control

Allergic rhinitis (AR) and allergic rhinosinusitis (ARS) are typical upper airway pathologies (UAP) in children with bronchial asthma (BA) frequently accompanied with nasal obstructive diseases (NOD). In order to establish the effect of NOD on correlations between nasal and synonasal symptoms with clinical assessments of asthma control, 82 children, 9.8 [8.9; 10.7] years old, with atopic BA were assessed using ACQ-5 for the BA control level, TNSS for nasal symptoms, and SNOT-20 for synonasal quality of life in combination with rhinovideoendoscopy for NOD. All patients had AR/ARS; in 76.3% (63/82) of children, UAP had a multimorbid character with the presence of NOD. Significant correlations were found between ACQ-5 and TNSS (R=0.40, p<0.0001) and ACQ-5 and SNOT-20 (R=0.42, p<0.0001). Correlations between TNSS/ACQ-5 and SNOT-20/ACQ-5 were higher in patients who do not have a combination of AR/ARS with NOD (R=0.67, p=0.0012; R=0.50, p=0.022, resp.) than in patients who have AR/ARS combined with NOD (R=0.30, p=0.015; R=0.26, p=0.04, resp.). Thus, the association of BA control level with the expression of nasal and synonasal symptoms is higher in children who do not have multimorbid UAP. © 2018 T. I. Eliseeva et al

БРОНХИАЛЬНАЯ АСТМА

.Настоящие клинические рекомендации по наиболее распространенным детским болезням разработаны Союзом педиатров России в период с сентября 2004-го по август 2005 гг. и носят рекомендательный характер. Клинические рекомендации включают алгоритмы действий врача по диагностике, лечению, профилактике и реабилитации пациентов и позволяют врачу быстро принимать обоснованные клинические решения. Они предназначены для внедрения в повседневную клиническую практику наиболее эффективных и безопасных медицинских технологий (в том числе лекарственных средств), препятствуют принятию решений о необоснованных вмешательствах и, таким образом, способствуют повышению качества медицинской помощи. Кроме того, клинические рекомендации становятся основополагающим документом, на основании которого строится система непрерывного медицинского образования.(Педиатрическая фармакология. 2006; 3(2): 12-25