RU2252785C1 - Method for preventing exacerbations of bronchial asthma - Google Patents

Abstract

FIELD: medicine, pediatrics, pulmonology.

SUBSTANCE: in blood serum under testing one should detect the level of specific IgE-AB to S. pneumoniae antigen and at its value being above 0 kU/l it is necessary to perform single vaccination with "Pneumo 23" preparation at the dosage of 0.5 ml intramuscularly regardless of the period of exacerbation at the background of basic therapy. The present innovation enables to increase immunity that in its turn increases efficiency of pharmacotherapy at bronchial asthma and decreases sickness rate at ARVI.

EFFECT: higher efficiency of prophylaxis.

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Description

The invention relates to medicine, pulmonology and pediatrics, and can be used to prevent exacerbation of infectious-allergic bronchial asthma (BA).

The frequency of AD on average in the Russian Federation is 4–9 per 1000 children. BA is most widespread in areas with high air humidity, large cities, and least in highlands, regions of the Far North, and rural areas. In 80-90% of patients, the first attack of AD develops before the age of 5 years. (Shabalov N.P. Children's diseases. St. Petersburg: Sotis, 1993, p. 195).

Bronchial asthma is a relapsing disease characterized by attacks of difficulty breathing (mainly on exhalation) due to generalized narrowing of the airways due to spasm of the smooth muscles of the bronchi, hypersecretion and dicrinia (thickening, changing properties) of mucus, edema of the bronchial mucosa. Hyperresponsiveness of the bronchi to various external stimuli - an essential pathogenetic component of AD can be due to both immunopathological and non-immune mechanisms, as well as their combination.

Immunological changes, in particular, are characterized by a significant increase in the concentration of immunoglobulins M (IgM) in the blood and a high phagocytic activity of neutrophils. These immunological changes were called the third form of the immune response. A certain role in the development of bronchial asthma is also assigned to a hereditary predisposition along the floor, i.e. boys are sick 2 times more often than girls (2).

The occurrence of asthma attacks in 70-95% of children is preceded by recurrent respiratory infections, which, affecting the walls of the bronchi, violate their barrier function and lead to the formation of locus minoris resistentiae in the lungs, facilitate the penetration of allergens through the altered epithelial cover of the bronchi.

The aim of the present invention is to reduce the frequency of exacerbation of bronchial asthma and the addition of respiratory diseases by eliminating bacterial antigens from the pathogenesis of bronchial asthma, which act as causative allergens.

The technical result of the present invention is an increase in the activity of the child’s immune system due to adequate vaccination.

There is a method for the prevention of bronchial asthma, which consists in eliminating potentially dangerous allergens, irritants and other unfavorable factors from the environment surrounding the patient, using a hypoallergenic diet, maintaining a rational lifestyle, physical education and sports (3).

However, this method has its drawbacks related to the fact that it is not always possible to identify allergens and irritants, it is difficult for children to follow a hypoallergenic diet and the child’s health does not always predispose to exercise.

A known method for the prevention of bronchial asthma in children, which consists in identifying children with allergic diathesis and children predisposed to it, i.e. people with allergic diseases among relatives of the 1st degree of kinship. At the same time, it is recommended to create a regime of maximum antigenic gentleness for these children, which provides for the exclusion of obligate allergens from everyday life and diet, to individualize the vaccination schedule and conduct them against the background of desensitizing therapy, in case of a cold, use the minimum set of medications for treatment and exclude such obligate drug allergens like penicillin, acetylsalicylic acid, biological products.

At the same time, children with respiratory allergies, pneumonia, and acute respiratory viral infections, complicated by broncho-obstructive syndrome, allergic diathesis, and other constitutional abnormalities, are considered to be at high risk for AD (4).

This method has its drawbacks, which are related to the fact that parents do not always follow the prescribed recommendations, it is not always possible to exclude obligate allergens such as penicillin, acetylsalicylic acid, etc., and it is not always possible to build an individual vaccination schedule.

A known method for the prevention of asthma, including conducting, identifying and sanitizing catarrhal-purulent foci of infection, treatment with immunocorrective agents - biostimulants outside the period of exacerbation against the background of combined sanitation of airborne airways (upper respiratory tract), combining various methods of drug administration; the specified treatment must be carried out necessarily in a hospital and with the participation of an otolaryngologist and a bronchologist (2).

This method is not effective enough, because not all hospitals in the state have pulmonologists and bronchologists, and the use of biostimulants gives a short-term effect.

A known method for the prevention of asthma, including unloading and dietary therapy under the control of clinical and laboratory parameters, as well as the determination of acetone in exhaled air, while the decrease in acetone after its maximum increase, stop the unloading period (5). This method helps to reduce treatment time and reduce complications, but only in the treatment of patients in the early stages of bronchial asthma.

A known method for the prevention of AD includes traditional therapy with the inclusion of a biologically active food supplement, succinic acid or its salt (6).

This method is effective only in relation to uncomplicated AD in the early stages of its development. The main disadvantage of this method is also that autosensitization is always present in patients with AD, which can lead to an allergic reaction to succinic acid or its salt and cause an exacerbation of the underlying disease.

A known method of treatment and immunoprophylaxis of allergic diseases by applying SIT (specific immunotherapy), which is the introduction of a patient a gradually increasing amount of an allergen or allergoid, followed by a dose that provides a high IgG response when in contact with etiologically significant allergens. The SIT course includes about 45 injections per year and is repeated for three years. From this source it follows that patients received the main accelerated course of SIT with serial water-salt extracts of allergens from plant pollen (produced by NPO “Allergen” of the USSR Ministry of Medioprom - Stavropol). In this case, SIT was performed subcutaneously under the supervision of a physician (1). This method is taken by us as a prototype.

The disadvantage of this method is that the level of specific IgE-AT to causally significant allergens during the SIT carried out before the season of exacerbation of the disease did not significantly change, i.e. conducting SIT with water-salt allergens does not contribute to a decrease in sensitization to pollen allergens, which is expressed in a smaller clinical effect of the course of the disease. Moreover, after completion of allergen-specific immunotherapy, a positive treatment result in the form of achieving a stable remission of the disease or improving its course was noted only in 80-85% of children (as the author himself notes).

The present invention is aimed at eliminating the disadvantages of the above, known methods for the prevention of AD, which is implemented by vaccination with the drug “Pneumo 23”.

The essence of the method lies in the fact that in children suffering from infectious-allergic bronchial asthma, the level of specific IgE-AT for S. Pneumoniae antigen is determined in the blood serum and when its value is greater than 0 ke / l (N 0 ke / l), the drug is vaccinated “Pneumo 23" once, intramuscularly, in a dose of 0.5 ml outside the period of exacerbation against the background of basic therapy.

Clinical examples

Example 1. Patient M., 5 years old.

Diagnosis: bronchial asthma, mixed form, moderate course, post-attack period. Food allergy. Chronic tonsillitis.

Anamnesis of the disease: a child from the 2nd pregnancy proceeding without pathology, delivery on time. Birth weight is 2900 grams. He was breastfed for up to 3 months. At the age of 5 months Kaposi’s eczema was diagnosed, from 3 months frequent ARVI, bronchitis, sometimes accompanied by bronchial obstruction. A history of 4 lacunar tonsillitis was noted. Clinical manifestations of allergic dermatitis up to 4 years.

The patient is weighed down by heredity - the father and paternal grandmother suffer from food allergies, they have expressed the phenomena of allergic dermatitis. Housing conditions are satisfactory, the elimination regime is respected.

From 8 months of age, year-round attacks of suffocation are noted, the condition worsens in the autumn-winter period, when the child suffers respiratory diseases every month. With regard to bronchial asthma, an allergist has been observed since 1 year. Exacerbations of the disease occur on average 1-2 times a month, not severe, stop within 1-2 days using inhaled β-2 adrenomimetics. The child received several courses of antibacterial therapy per year.

Manifestations of food allergies in the form of an allergic rash are associated with the use of whole cow's milk, chocolate, citrus fruits and nuts.

At the moment, the child is receiving basic therapy with inhaled anti-inflammatory drugs of the membrane-stabilizing series (Tyled) at an age dosage of 3 times a day.

Objective Status:

At the time of inspection, the condition is satisfactory. Complaints of a rare cough in the morning. The skin is clean. Difficulty breathing through the nose, mucous discharge, scanty. Above the lungs, percussion clearly pulmonary sound, wire rales in the upper sections are heard. NPV (respiratory rate) - 20 / min.

Examination:

FVD - violations of bronchial patency not detected.

When staging skin samples, a reaction was detected (+) - with 19 types of household, pollen, epidermal and food allergens.

Blood: in blood serum, the level of IgE-AT to S. pneumoniae antigen is 16 kE / L, the level of total IgE is 390 ke / L (N - 0 ke / L).

Treatment:

With the consent of the parents and the attending physician, against the background of basic therapy outside the period of exacerbation, vaccination with the Pneumo-23 preparation was carried out once, intramuscularly at a dose of 0.5 ml. Vaccination was carried out while taking antihistamines in an age-specific dosage 2-3 times a day the day before and 3 days after vaccination to reduce the likelihood of developing allergic reactions of an immediate type (anaphylactic shock, Quincke's edema, urticaria). The post-vaccination period was uneventful.

Over the next year, he twice suffered acute bronchitis, received two courses of antibiotic therapy. Phenomena of bronchial obstruction were noted only once against the background of acute respiratory viral infections, an asthma attack of moderate severity was quickly stopped by inhaled β ₂ -adrenomimetics (Ventolin). Remission subsequently persisted for a year.

The level of IgE-AT for S.pneumonia antigen 3 months after vaccination was 4 kE / L, the level of total IgE was 100 kE / L.

Thus, from the above example, a 4-fold decrease in the level of IgE-AT is clearly seen compared to the initial level due to vaccination with “Pneumo 23", which, in turn, led to a clear improvement in the patient's health.

Example 2

Patient D., 6 years old.

Diagnosis: bronchial asthma, mixed form, severe course. Chronic gastritis, bulbo-gastric reflux. Biliary dyskinesia. Reactive gastritis.

Anamnesis: a child from 3 pregnancies, proceeding against the background of chronic pyelonephritis, hypertension with hypertensive crises. Childbirth in 36 weeks, fast. At birth, jaundice of the newborn is diagnosed. Weight at birth 2800 g, artificial feeding from birth. At the age of 5 months he suffered acute bronchitis. Frequent SARS (about 10 times a year).

The patient is weighed down by heredity for allergic diseases: the father is sick with bronchial asthma. Housing conditions are good. The elimination regimen is not respected: the apartment has many flowers and a dog lives.

Since 2 years he suffers from bronchial asthma, asthma attacks all year round, 4-5 times a month, especially in the autumn-winter period and with high humidity. It provokes asthma attacks; contact with house dust, with a cat and a dog, with pollen from dandelion and linden. The most severe asthma attacks occur against the background of acute respiratory viral infections. AD attacks are stopped by inhaled β ₂ -adrenomimetics (Ventolin) and inhaled corticosteroids (Flexotide 100 μg 2 times a day).

Objective Status:

Upon receipt, the condition of the child is moderate. Complaints of a rare dry cough at night. The skin is clean. Percussion over the lungs is a pulmonary sound with a boxy tint. The vesicular breathing, isolated dry rales in the middle parts of the lungs are heard. NPV 20 / min.

Examination:

1. FVD - moderate respiratory disorders in the form of bronchial patency at the level of the middle bronchi.

2. After stabilization, the child was given skin tests with non-infectious allergens: with low skin sensitivity (+) with all types of household, pollen, epidermal, food allergens, except (++) - with house dust allergens of series 135, 91, 141 81 .

3. Samples with allergens of Staphylococcus aureus and Escherichia coli are expressed in (+++) for the immediate type and in (+) - for the delayed.

4. In the blood serum, the level of IgE-At to the S.pneumonia antigen is 2 kE / L, the level of total IgE is 5.3 kE / L.

Treatment: vaccination was not carried out. Within a year after the initial examination, the child suffered two tonsillitis and acute respiratory viral infections (2 times a month), which were accompanied by bronchial obstruction, which required the use of inhaled bronchospasmolytics. In the summer, asthma exacerbation was noted (2-3 times a month), which was stopped by inhaled bronchospasmolytics.

The level of IgE-AT to S.pneumonia antigen 3 months after vaccination is 2 kE / L, the level of total IgE is 2 kE / L.

Thus, against the background of a persisting level of IgE-AT compared with the initial severity of the patient’s state of health is preserved.

3 months after vaccination, all patients underwent a second study of the level of specific IgE-AT. The average IgE-AT level for S.pneumonia antigen was 2.62 ± 0.2 kE / L, respectively, before vaccination and 1.35 ± 0.08 kE / L, after vaccination (p <0.05). The average IgE-AT level for this antigen at the same time of the study in the comparison group (children with AD who received only basic therapy) was 4.47 ± 0.7 kE / L and 6.26 ± 1.09 kE / L ( p> 0.05), i.e. not significantly changed.

Thus, it can be seen that immunization with the Pneumo 23 vaccine in children with AD leads to a decrease in the sensitization of these patients to pneumococcus. Moreover, its most pronounced decrease is observed in patients with severe and moderate BA and in patients with an initially higher level of sensitization to the above antigen.

This method can be recommended for the prevention of exacerbation of AD in children.

References

1. Zhdanova E.A. Clinical and immunological control of specific immunotherapy of atopic respiratory diseases. Diss.k.s., M., 1991, 217 p.

2. Berbentsova E.P. The manual for pulmonology. M.: Editorial Board of Uspekhi Fizicheskikh Nauk, 1998, pp. 398, 410-411.

3. Handbook of pulmonology. / Ed. correspondent Academy of Medical Sciences of the USSR, prof. Putova N.V. et al. L .: Medicine. Leningrad Branch, 1988, p. 37.

4. Shabalov N.P. Childhood diseases. St. Petersburg: Sotis, 1993, p. 210.

5. RU 2057340 C1, ZAO “RIPM”, SSC from 03/27/1996.

6. RU 95111608 A1, Liakumovich A.G. and others from 07/10/1997.

Claims (1)

A method for the prevention of exacerbations of bronchial asthma, including the study of the body’s immune system, basic therapy and disease prevention, characterized in that the level of specific IgE-AT for S. pneumoniae antigen is determined in the blood serum and if it is greater than 0 ke / l, a single vaccination is carried out the preparation “Pneumo 23” in a dose of 0.5 ml intramuscularly outside the period of exacerbation against the background of basic therapy.