RU2542421C1 - Method of treating atopic dermatitis in children with secondary immunodeficiency syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: common therapy is conducted in the patient according to standard regimen. Additionally, from the first therapeutic day, Ananferon for kids and Virefon, suppositories are prescribed. Anaferon for kids is administered subglosally without regard to food in a dose of 1 tablet once a day for 2 months. Viferon, rectal suppositories are used 2 times a day every 12 hours for 30 days according to the schedule: for the first 10 days, 1 suppository of 1,000,000 international units, for the following 10 days, 1 suppository of 500,000 international units and then 1 suppository of 150,000 international units.

EFFECT: using the given method enables normalising the immune status values, prolonging the remission of clinical manifestations of atopic dermatitis in the children with secondary immunodeficiency syndrome.

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Description

The invention relates to medicine, specifically to clinical immunology and allergology, pediatrics, dermatology, and may find application for the treatment of atopic dermatitis in children with secondary immune deficiency syndrome.

Atopic dermatitis (AD) is one of the most common diseases found in all countries, in people of both sexes and in different age groups. The incidence of blood pressure in residents of megacities is higher than in rural residents. In children, AD occurs from 10% of cases to 30% of the entire population (Goryachkina L.A., Kashkin K.P. Clinical Allergology and Immunology: A Guide for Practitioners. - M .: Miklosh, 2011. - P.193-195 )

In recent decades, there has been not only an increase in blood pressure, but also an increasingly frequent combination of this pathology with secondary immune deficiency syndrome (VIN), which is characterized, as a rule, by reversible dysfunctions of the immune system, its adaptive mechanisms, namely, a decrease in the production of secretory immunoglobulins, gamma-interferon , a violation in the cellular link of the immune system, suppression of phagocytic functions (Lopukhin Yu.M., Arion V.Ya. Immunodeficiencies, immunocorrection // Proceedings of the VIII National Conference of Russian A associations of Allergologists and Clinical Immunologists. - M. 2007. - P.113-120; Luss L.V. Features of the course of allergopathology complicated by secondary immune deficiency syndrome // Proceedings of the VIII National Conference of the Russian Association of Allergists and Clinical Immunologists. - M. 2007 . - P.103). Clinically, these changes are manifested by frequent acute respiratory viral infections (ARVI), the formation of chronic foci of infection that cause chronic tonsillitis, chronic pyelonephritis, sinusitis, the occurrence of dysbiotic changes in the intestinal microflora.

In the presence of clinical signs of VIN in patients with AD, the course of the underlying disease is complicated, and the clinical effectiveness of conventional therapy is reduced (V. A. Bulgakova. Atopic dermatitis in children: possibilities of immunotropic therapy // Practice of a pediatrician. 2010. - P.58-60) .

Currently, there are many ways to treat children with atopic dermatitis. However, known methods of treatment, in some cases, are ineffective and can lead to the development of side effects. Thus, the development of new methods for the treatment of blood pressure in children is an urgent problem of clinical immunology and allergology, pediatrics and dermatology.

Conducted research on the medical-scientific and patent literature studied various methods of treating atopic dermatitis in children.

So, in the patent of the Russian Federation No. 2068696, published September 15, 1992, describes a "Method for the treatment of atopic dermatitis in children", which includes taking in the acute period of a disease of thymogen intranasally 4 times a day at an age dose for 10-14 days with a repetition course of treatment after 3-6 months. The age dose for children under 1 year is 20-25 micrograms, 1-5 years old - 40-45 micrograms, over 5 years old - 80-100 micrograms per day.

The disadvantages of this method are: the possibility of the formation of side effects, such as allergic reactions and flu-like syndrome, in debilitated patients with a burdened premorbid background, as well as the need for a second course of treatment after 3-6 months.

The well-known "Method for the treatment of atopic dermatitis" described in the patent of the Russian Federation No. 1638852, published 09/27/1995, Children with AD are prescribed conventional therapy. In addition, the patient’s immune status is examined and, with a decrease in the relative number of T-lymphocytes by 22% or more, an increase in the content of IgG by 15% or more, IgM by 20% or more, a decrease in IgA by 25% or more, ascorbic acid is administered in the daily course of treatment dose of 0.5-0.9 g and levamisole in a daily dose of 2 mg per 1 kg of body weight, alternating every other day with the administration of each drug for 3 weeks.

The disadvantage of this method is the high risk of developing an allergic reaction in the form of a skin rash or exfoliative dermatitis, which can aggravate the course of the underlying disease.

The well-known "Method for the treatment of atopic dermatitis in children with diagnosed cytomegalovirus infection" described in the patent of the Russian Federation No. 2402776, published October 10, 2010. The method provides for the administration of Viferon-150,000 ME together with conventional therapy - one suppository twice a day for 10 days, then one suppository every other day for 20 days and taking Famvir in a dose of 10-15 mg / kg body weight for 7 days.

The disadvantage of this method is the limited scope, because this method can only be used in the treatment of blood pressure in children with diagnosed cytomegalovirus infection.

The well-known "Method for the treatment of atopic dermatitis in children", protected by RF patent No. 21588617, published 10.11.2000, in which the patient is exposed to polychromatic polarized light with a wavelength of 450-2500 nm. Irradiation is carried out paravertebrally, to the right and to the left of the spinous processes of the spine, to reflex segmental zones and to lesions at a distance of 5-15 cm from the irradiator to the skin surface for 1-4 minutes per field, the total duration of the procedure is 4-24 minutes until the patient feels pleasant warmth, on a course of 8-12 daily procedures.

The disadvantage of this method is the complexity of the technical design due to the need to have special equipment and trained personnel.

The well-known "Method for the treatment of atopic dermatitis in children" described in the patent of the Russian Federation No. 2348423, published March 10, 2009. Children with blood pressure are treated with conventional therapy. Within 10 days, an additional dose of 1 mg daily is prescribed. After this, treatment with lycopid is continued a day later until a course dose of 20 tablets with simultaneous allergen-specific immunotherapy with causally significant allergens.

The disadvantage of this method is the limited scope, because it can be used only in the treatment of blood pressure in children with sensitization to inhaled allergens.

The closest in nature and taken as a prototype is a method of treating atopic dermatitis, provided for by the "Standard for Specialized Medical Care for Moderate Forms of Atopic Dermatitis", approved by order of the Ministry of Health of the Russian Federation dated December 28, 2012 No. 1587n. The method provides for conventional therapy according to standard modes.

The disadvantages of this method of treatment are the lack of effectiveness in the treatment of blood pressure in children with secondary immune deficiency syndrome, as well as an insignificant period of remission, which requires frequent repeated courses of therapy.

The objective of the invention is to develop a highly effective method of treating blood pressure in children with secondary immune deficiency syndrome.

The technical result that manifests itself in the implementation of this method of treatment is the normalization of indicators of immune status, i.e. an increase in the number of CD3, CD4 lymphocytes, a decrease in CD16 level, an increase in Th1 and a decrease in Th2 lymphocytes, as well as an increase in the period of remission of the clinical manifestations of blood pressure in children with secondary immune deficiency syndrome.

The technical result is achieved by conducting conventional therapy according to standard modes. Additionally, from the first day of treatment, children are prescribed anaferon for children and viferon - rectal suppositories. Anaferon children is administered sublingually out of meals, 1 tablet 1 time per day for 2 months. Viferon - rectal suppositories - is administered 2 times a day with a 12-hour interval for 30 days according to the scheme: the first 10 days, 1 suppository 1,000,000 ME, the next 10 days, 1 suppository 500,000 ME and then 1 suppository 150,000 ME.

Viferon - rectal suppositories. Registration number P N000017 / 01 dated July 14, 2006. It contains human recombinant interferon alpha-2b, which has an immunomodulating and antiviral effect. The immunomodulating properties of interferon, such as increased macrophage phagocytic activity, increased specific cytotoxicity of lymphocytes to target cells, determine its mediated antibacterial activity. In the presence of ascorbic acid and alpha-tocopherol acetate, the specific antiviral activity of interferon increases, its immunomodulatory effect is enhanced, which improves the efficiency of the body's own immune response to pathogenic microorganisms. When using the drug, the level of secretory immunoglobulins of class A increases, the level of immunoglobulin E is normalized, the functioning of the endogenous system of interferon is restored. Ascorbic acid and alpha-tocopherol acetate, being highly active antioxidants, have anti-inflammatory, membrane-stabilizing, and also regenerating properties.

Anaferon for children. Registration number P N000372 / 01 10/09/2006, It contains antibodies to human gamma interferon, affinity purified - 0.003 g, and is an immunomodulator and antiviral agent. The drug reduces the concentration of the virus in the affected tissues, affects the system of endogenous interferons and their associated cytokines, induces the formation of endogenous “early” interferons (IFN a / β) and gamma interferon (IFN γ). Stimulates the humoral and cellular immune response. Increases secretory IgA production, activates the functions of T-effectors, T-helpers (Th), normalizes their ratio. It is an inducer of a mixed Th1 and Th2 type of immune response: it affects the production of Th1 cytokines (IFNγ, IL-2) and Th2 (IL-4, 10).

The practical feasibility of the claimed method is illustrated by examples from clinical practice.

Example 1

Patient I., 12 years old, turned to the consultative diagnostic clinic of Rostov State Medical University (Rostov State Medical University) with a preliminary diagnosis of atopic dermatitis: adolescent form, stage of severe changes, exacerbation, common, moderate, with a predominance of food allergies.

Patient Y. complained of redness and itching of the skin, as well as dryness, peeling and thickening of the skin, disturbance of night sleep.

Objectively: the pathological process was widespread, localizing on the skin of the face, neck, upper limbs. By the predominance of morphological elements, blood pressure belongs to the erythematic-squamous form with lichenification. The severity of clinical manifestations on the SCORAD scale (Goryachkina L.A., Kashkin K.P. Clinical allergology and immunology: A guide for practitioners. - M .: Miklosh, 2011. - From 202-205) amounted to 48 points.

Immunological history:

- Infectious syndrome: SARS - 7-8 times a year, the course of which is often complicated by bronchitis, sinusitis;

- Allergic syndrome: suffers from atopic dermatitis from the 1st year of life, when the rash on the face first appeared. The course of the disease is chronic, recurring, with exacerbations in the autumn-winter period 5 times a year. Itchy skin is aggravated by exacerbation of acute respiratory viral infections, eating honey, milk, citrus fruits, and chocolate.

When contacting the clinic previously received conventional therapy according to standard regimens, while there was a slight positive effect.

- autoimmune syndrome - negative;

- lymphoproliferative syndrome - negative.

An immunological study of the blood of patient Y. revealed a decrease in the content of CD3 lymphocytes to 56.9% with a norm of 66% to 76%, CD4 lymphocytes to 30.2% with a norm of 33% to 41%, a sharp increase in the content of CD16 to 21 , 2% with a norm of 9% to 16% (Kalinina N.M., Ketlinsky S.A., Okovity S.V., Shulenin S.N. Diseases of the immune system. Diagnosis and pharmacotherapy. - M .: Eksmo, 2008 . - C 210-216). An increase in the content of Th2 is 3.6% at a rate of (1.5 ± 0.12)%, as well as a decrease in Th1 is 2.1% at a rate of (3.5 ± 0.18)% (Khaitov PM, Pinegin B.V. ., Yarilin A.A. Clinical Immunology Manual, Diagnosis of Immune System Diseases: A Manual for Doctors.- M: GEOTAR-Media, 2009. - C 212-214).

According to the results of the anamnesis and immunological examination of patient Y., the final diagnosis was made: atopic dermatitis with secondary immune deficiency syndrome.

Patient I. was treated according to the claimed method. Conventional therapy was carried out according to standard regimens: antihistamine - loratadine 10 mg - on 1 tablet 1 times a day in the morning - 2 weeks adsorbing preparation - polisorb - at 1 tablespoon planted in _^1/2 cup of water, taken for 1 hour before food intake and other medicines 3 times a day - 14 days, an external agent - Advantan cream - applied 1 time per day with a thin layer on the affected areas of the skin until relief of the exacerbation of the skin process and moisturizers for a long time. Additionally, from the first day of treatment, patient Y. was assigned anaferon for children and viferon - suppositories. Anaferon children was administered sublingually out of meals 1 tablet 1 time per day for 2 months. Viferon - rectal suppositories - was administered 2 times a day with a 12-hour interval for 30 days according to the scheme: the first 10 days, 1 suppository 1,000,000 ME, the next 10 days, 1 suppository 500,000 ME and then 1 suppository 150,000 ME.

Already in the second week of treatment in patient Y., the reverse development of morphological elements occurred. After 2 months, a significant improvement in the condition of the patient I. was noted: itchy skin decreased, skin rashes significantly decreased and did not recur, sleep was normalized. The severity of clinical manifestations on the SCORAD scale was 15 points, i.e. there was a decrease of 3.2 times. An immunological examination revealed a normalization of the cellular component of the immune status of the patient I.: the content of CD3 lymphocytes was 73%, the content of CD4 lymphocytes was 38%, CD16 lymphocytes was 10.2%, and the content of Th2 was 1.4% and Th1 - 3.6%. Further monitoring of patient Y. revealed: the period of remission of the clinical manifestations of blood pressure was 5.5 months, and there was also a decrease in the incidence of SARS up to 3 times a year.

Example 2

Patient S., 7 years old, turned to the consultative diagnostic clinic of Rostov State Medical University with a preliminary diagnosis of atopic dermatitis: infant form, stage of severe changes, exacerbation, widespread, moderate, with a predominance of inhalation allergy.

Patient S. complained of redness, rashes, and itching on the skin, dryness and peeling of the skin, and disturbance of night sleep.

Objectively: the pathological process was widespread, localized on the skin of the flexion surfaces of the upper and lower extremities, elbow and popliteal fossae. Morphological elements represented a papular rash of bright red color against the background of foci of lichenification and peeling. The severity of clinical manifestations on the SCORAD scale was 39 points.

Immunological history:

- Infectious syndrome: ARVI - 5 times a year, the course of which is sometimes complicated by bronchitis. Foci of chronic infection are noted: chronic tonsillitis;

- Allergic syndrome: suffers from atopic dermatitis from 6 months of life, when the rash on the face first appeared after switching to artificial feeding. The course of the disease is chronic, recurring, with exacerbations 3-4 times a year, seasonality is not observed. Itchy skin is amplified against the background of exacerbation of acute respiratory viral infections and in case of hypoallergenic life disorders.

When contacting the clinic, I previously received conventional therapy according to standard regimens, with a slight positive effect.

- autoimmune syndrome - negative;

- lymphoproliferative syndrome - negative.

An immunological study of the blood of patient C. revealed a decrease in the content of CD3 lymphocytes to 57.3% with a norm of 66% to 76%, CD4 lymphocytes to 29.3% with a norm of 33% to 41%, an increase in the level of CD16 to 18% at a rate of 9% to 16% (Kalinina N.M., Ketlinsky S.A., Okovity SV., Shulenin S.N. Diseases of the immune system. Diagnosis and pharmacotherapy. - M .: Eksmo, 2008. - C 210- 216). An increase in the Th2 content is 2.6% at the norm (1.5 ± 0.12)%, as well as a decrease in Th1 is 2.9% at the norm (3.5 ± 0.18)% (Khaitov PM, Pinegin B.V. ., Yarilin A.A. Clinical Immunology Guide, Diagnosis of Immune System Diseases: A Guide for Doctors.- M .: GEOTAR-Media, 2009. - C 212-214).

According to the results of the anamnesis and immunological examination, patient S. was given the final diagnosis: atopic dermatitis with secondary immune deficiency syndrome.

Patient S. was treated according to the claimed method. Conventional therapy was carried out according to standard regimens: antihistamine - loratadine 10 mg - in _^1/2 tablets 1 times a day in the morning - 2 weeks adsorbing preparation - polisorb - 1 dessert spoon bred to _^1/2 cup of water, taken for 1 an hour before meals and other medicines 3 times a day - 14 days, an external agent - Advantan cream - was applied 1 time per day with a thin layer on the affected areas of the skin until the exacerbation of the skin process was stopped and moisturizers were applied for a long time. Additionally, from the first day of treatment, patient S. was prescribed anaferon for children and viferon - suppositories. Anaferon children was administered sublingually out of meals 1 tablet 1 time per day for 2 months. Viferon - rectal suppositories - was administered 2 times a day with a 12-hour interval for 30 days according to the scheme: the first 10 days, 1 suppository 1,000,000 ME, the next 10 days, 1 suppository 500,000 ME and then 1 suppository 150,000 ME.

After 2 months, a significant improvement in the condition of patient C. was noted: itchy skin stopped, skin rashes significantly decreased and did not recur, sleep was normalized. The severity of clinical manifestations on the SCORAD scale was 11 points, i.e. it decreased by 3.5 times. An immunological examination revealed a normalization of the cellular link of the immune status of patient C.: the content of CD3 lymphocytes was 70%, CD4 lymphocytes - 37.2%, CD16 lymphocytes - 11%, the content of Th2 - 1.6% and Th1 returned to normal - 3.5%. Further monitoring of patient S. revealed: the period of remission of the clinical manifestations of blood pressure was 6 months, as well as a decrease in the incidence of acute respiratory viral infections to 2 times a year.

Using the proposed method, the authors treated 30 children aged 6 to 12 years with a diagnosis of atopic dermatitis with secondary immune deficiency syndrome.

Prior to going to the Polyclinic of Rostov State Medical University, these children underwent conventional therapy, which did not allow normalization of the immune status indicators, and the average time of remission of the clinical manifestations of blood pressure was 3.5 months.

After treatment according to the proposed method, all children had a normalization of their immune status indicators: CD3 - (70.2 ± 4.2)%, CD4 - (36.3 ± 3.1)%, CD16 - (13.2 ± 2 , 3)%, Th2 - (1.5 ± 0.1)%, Th1 - (3.4 ± 0.1)%, and an increase in the period of remission of the clinical manifestations of blood pressure up to (6 ± 0.3) months.

Thus, the proposed method for the treatment of atopic dermatitis in children with secondary immune deficiency syndrome allows normalizing the immune status indicators, as well as increasing the period of remission of the clinical manifestations of blood pressure in children with secondary immune deficiency syndrome.

Claims (1)

A method of treating atopic dermatitis in children with secondary immune deficiency syndrome, which provides for conventional therapy according to standard modes, characterized in that in addition from the first day of treatment, anaferon children and viferon suppositories are prescribed, while anaferon children are administered sublingually 1 meal 1 tablet 1 once a day for 2 months, viferon - rectal suppositories - is administered 2 times a day with a 12-hour interval for 30 days according to the scheme: the first 10 days, 1 suppository 1,000,000 ME, trace guides 10 days 1 suppository 500000 ME and then 1 suppository 150000 ME.