medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-477medsovet-8100Research ArticleАЛЛЕРГОЛОГИЯ И ИММУНОЛОГИЯALLERGOLOGY AND IMMUNOLOGYДупилумаб в лечении тяжелого атопического дерматита и респираторной аллергии: клиническое наблюдениеDupilumab in the treatment of severe adopic dermatitis and respiratory allergy: a case reporthttps://orcid.org/0000-0001-9147-169XАфонинаИ. А.AfoninaI. A.

Афонина Ирина Александровна, к.м.н., доцент кафедры иммунологии и специализированных клинических дисциплин Медицинского института

302026, Орел, ул. Комсомольская, д. 95

Irina A. Afonina, Cand. Sci. (Med.), Associate Professor of the Department Immunology and Specialized Clinical Disciplines of the Medical Institute

95, Komsomolskaya St., Orel, 302026

shmaneva@list.ruhttps://orcid.org/0000-0001-5622-5960ШкодкинаС. А.ShkodkinaS. A.

Шкодкина Светлана Анатольевна, старший преподаватель кафедры иммунологии и специализированных клинических дисциплин Медицинского института

302026, Орел, ул. Комсомольская, д. 95

Svetlana A. Shkodkina, Senior Lecturer of the Department Immunology and Specialized Clinical Disciplines of the Medical Institute

95, Komsomolskaya St., Orel, 302026

   

Орловский государственный университет имени И.С. ТургеневаРоссияOryol State University after named I.S. TurgenevRussian Federation20242702202401222–226Copyright © Афонина И.А., Шкодкина С.А., 20242024Афонина И.А., Шкодкина С.А.Afonina I.A., Shkodkina S.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8100

Возросшая частота развития аллергических заболеваний представляет собой значительную медико-социальную проблему. В частности, атопический дерматит, являющийся хроническим зудящим иммуноопосредованным воспалительным дерматозом, характеризуется Th2-фенотипом иммунного ответа, нередко ассоциирован с другими формами аллергопатологии и может являться пусковым механизмом развития атопического марша. Таргетная терапия препаратами моноклональных антител, направленная на ключевые звенья патогенеза аллергических заболеваний, показывает достаточную эффективность и высокий профиль безопасности. Так, дупилумаб, α-антагонист рецептора интерлейкина 4, ингибирует передачу сигналов ИЛ-4 и ИЛ-13 посредством блокады общей субъединицы ИЛ-4α, что приводит к отрицательной модуляции Th2-иммунного ответа. В статье рассмотрены современные представления о патогенезе аллергического Th2-зависимого воспаления, о ключевых механизмах формирования атопического дерматоза и его роли в индуцировании прогредиентного течения атопии. Приведен клинический пример успешного лечения ребенка 8 лет с атопическим дерматитом тяжелого течения, среднетяжелой, частично контролируемой бронхиальной астмой, аллергическим ринитом и мультисенсибилизацией к пищевым и пыльцевым аллергенам. Достигнутые результаты позволяют оценить проводимое лечение как высокоэффективное. На фоне включения в комплексную терапию дупилумаба удалось добиться устойчивой ремиссии в течении атопического дерматита и бронхиальной астмы. Индекс SCORAD, составляющий до начала лечения дупилумабом 66,8 баллов, снизился до 8,9 баллов. Включение в арсенал лечения новых терапевтических опций, таких как таргетная терапия препаратом дупилумаб, позволяет эффективно управлять течением аллергических заболеваний, снижая их тяжесть и увеличивая продолжительность ремиссии. Дупилумаб в качестве монотерапии или при одновременном применении топических кортикостероидов может значительно улучшить клинические исходы и качество жизни у пациентов, страдающ их бронхиальной астмой и атопическим дерматитом средней и тяжелой степени.

The use of biological targeted therapy for allergic diseases has significantly increased the effectiveness of the treatment of patients with atopic dermatitis, bronchial asthma, and combined allergopathology. Dupilumab, a monoclonal antibody drug that blocks signaling from IL-4 and IL-13, is one of the options for biological therapy aimed at modifying the Th2 immune response. The article discusses current ideas about the pathogenesis of allergic Th2-dependent inflammation, about the key mechanisms of the formation of atopic dermatosis and its role in inducing the progressive course of atopy. A clinical example of successful treatment of an 8-year-old child with severe atopic dermatitis, moderate partially controlled bronchial asthma, allergic rhinitis, and multisensitization to food and pollen allergens is given. The use of biological targeted therapy with dupilumab made it possible to achieve sustainable remission in the course of atopic dermatitis and bronchial asthma. The SCORAD index, which was 66.8 points before dupilumab treatment, decreased to 8.9 points. Immunobiological therapy with an IL-4Rα inhibitor, dupilumab, is indicated for patients with moderate to severe allergic diseases when it is not possible to achieve adequate control with standard treatment methods. The presented clinical case of the use of the drug contributes to the study of the clinical efficacy and safety of dupilumab during its long-term use.

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The authors declare that there are no conflicts of interest present.