Судинні порушення у хворих на ревматичні хвороби після перенесеного COVID-19

Наведено узагальнені дані щодо ролі мікроциркуляторних і макроциркуляторних порушень у патогенезі COVID-19. Акцентовано увагу на схожості клінічних і патогенетичних рис ревматичних захворювань, COVID-19 та його ускладнень. В огляді проаналізовано і порівняно дані оцінки основних інструментальних досліджень функціонального стану судин у хворих на ревматичні захворювання взагалі та у хворих на ревматичні захворювання після перенесеного COVID-19 (капіляроскопії та оклюзійної проби). Зроблено висновок про наявність при ревматичних хворобах ендотеліальної дисфункції та її особливості в пацієнтів із ревматичними хворобами після перенесеного COVID-19. Зазначене наводить на думку про доцільність своєчасного виявлення вторинних порушень функціонального стану судин у пацієнтів, які є реконвалесцентами COVID-19, із ревматичними хворобами і обґрунтовує використання з цією метою оклюзійної проби. Автори заявляють про відсутність конфлікту інтересів

Modern features of the management of gastrointestinal food allergy in children

Food allergy affects millions of people, reduces the quality of life, can lead to fatal consequences, it is a serious problem for society. Today, much attention is paid to the researches on the development of optimal preventive measures to reduce the prevalence of food allergy. Until recently, it was believed that it was necessary to avoid the most common food allergens during pregnancy and breastfeeding for the prevention of food allergy in children. However, there is evidence that the early impact of potential food allergy can reduce the risk of food allergy developing. No special diet during pregnancy or for the lactating mother, exclusively breastfeeding for 4–6 months. It is recommended not to avoid the introduction of solid products after 46 months of life, even for children at high risk of allergic diseases. The clinical management of food allergy includes interventions to manage acute reactions and long-term strategies to minimize the risk of further reactions (dietary modification, education and measures approaches to avoid allergens and pharmacological and non-pharmacological management strategies). The article considers approaches to the management of children with gastrointestinal food allergy. At this time, the standard measures in the management of such patients are the elimination diet, control of systemic reactions caused by food allergens. Avoid using known food triggers is the main approach to the primary treatment of immunoglobulin (Ig) E-mediated gastrointestinal food allergy. Topical glucocorticosteroids remain the first-line drugs in the treatment of eosinophilic esophagitis. There are many controversial issues of managing children with non-IgE-mediated gastrointestinal food allergy. There is a need for new researches to develop effective therapeutic and prophylactic measures for managing patients with common and complex problem such as food allergy

Effectiveness of probiotic therapy for gastrointestinal forms of food allergy in children

Background. Intestinal microbiota is involved in the development of oral tolerance. Therefore, there is interest in using probiotics that will contribute to colonization of the intestine, as well as to the development of intestinal homeostasis. There is also a need for studies on the effectiveness of probiotics for the prevention and treatment of allergic diseases in children. The purpose of the study was to evaluate the effectiveness of using biopreparation created on the basis of the spore-forming microorganism Bacillus subtilis in the comprehensive therapy of children with gastrointestinal symptoms of food allergy. Materials and methods. We examined 34 children aged 3.5 to 12 years with food allergies with gastrointestinal complaints. The main group included 18 children, the comparison group consisted of 16 patients. Children of the main group in addition to basic therapy received probiotic on the basis of Bacillus subtilis (1 dose 2 times a day for 20 days). The effectiveness of therapy was assessed by the rate and completeness of reduction of gastrointestinal symptoms and manifestations of comorbid allergic pathology. Results. In patients of the main group, the reduction of gastrointestinal symptoms and symptoms of comorbid allergic pathology was faster. A gradual decrease in the level of specific IgE to food and inhalant allergens by 25–30 % was noted after 10 days of using comprehensive treatment, and by 35–40 % — in 21 days after taking the probiotic based on Bacillus subtilis. All children had changes in the bacteriological examination of the stool (the lack of bifido- and lactobacilli, an increase in the number and changes in the species ratio of the opportunistic flora). Normalization of the intestinal microbiocenosis was noted in 78 % of cases after repeated bacteriological study of stool in children of the main group. After taking the probiotic based on Bacillus subtilis, there were no complications or side effects in all patients, while episodes of abdominal pain and stool disorders were observed in children of the comparison group. There was a moderate improvement in the clinical symptoms of comorbid allergic pathology (allergic rhinitis, atopic dermatitis, bronchial asthma) during the 3-week course of using probiotic on the basis of Bacillus subtilis. Conclusions. The administration of the probiotic based on Bacillus subtilis in the comprehensive therapy of children with gastrointestinal form of food allergy promotes rapid regression of gastrointestinal manifestations and improves general condition of patients

Risk Factors and Pathogenesis of Gastrointestinal Food Allergy in Children

The literature review presents modern data on the views on risk factors of the development, etiology and pathogenesis of gastrointestinal food allergy in children. The article details the mechanism of some forms of gastrointestinal food allergy

Clinical manifestations of gastrointestinal form of food allergy in children and approaches to its diagnosis

Gastrointestinal food allergy is caused by the development of allergic inflammation in the mucosa of the gastrointestinal tract. The mechanisms of this inflammation are immunogflobulin E (IgE)-mediated (oral allergic syndrome, immediate gastrointestinal hypersensitivity), non-IgE-mediated (protein-induced enterocolitis syndrome, protein-induced enteropathy, protein-induced allergic proctocolitis) and mixed IgE- and non-IgE-mediated reactions (eosinophilic esophagitis, eosinophilic gastritis and eosinophilic gastroenteritis). Gastrointestinal manifestations of food allergy are also combined with symptoms of atopic diseases, more often with atopic dermatitis, urticaria and angioedema. Clinical manifestations of allergic lesions of the gastrointestinal tract are different and non-specific. Common signs of gastrointestinal allergy include: vomiting (occurs from a few minutes to 4–6 hours after eating); сolic (immediately or several hours after eating); constipation; diarrhea; refusal of food (from a specific product or complete refusal to eat); abdominal pain; flatulence, the presence of mucus and eosinophils in the stool; poor appetite; headache. Differential diagnosis of gastrointestinal food allergy should be carried out with diseases such as disease and abnormalities in the development of the digestive system, mental and metabolic disorders, intoxications, infectious diseases, pancreatic endocrine gland failure, celiac disease, cystic fibrosis, immunodeficiencies, disaccharidic insufficiency, side effects of medications, endocrine pathology, irritable bowel syndrome. Methods for diagnosing gastrointestinal allergy, which currently exist, are limited and imperfect. This requires further scientific researches aimed at timely detection of this pathology, prevention in genetically predisposed children, development of optimal diagnostic algorithms, prevention of the progression of clinical manifestations, the choice of individual diet therapy and adequate medication. The literature review presents modern views on the diagnosis of gastrointestinal food allergy in children. The article details clinical manifestations and diagnostic approaches to certain types of gastrointestinal allergy depending on the mechanism of their occurrence