Possibilities of allergic reaction therapy in pediatric practice

Introduction. Allergic diseases are a global medical and social problem due to the adverse effect on the physical, psychological and social state of a person. The basic principle of pharmacological therapy of acute allergic diseases is acute urticaria, angioedema (Quincke) – control/elimination of syndromic complexes.
Aim. To evaluate the clinical efficacy of the antihistamine dimetindene in the treatment of acute allergic reactions in children.
Materials and methods. We analyzed 36 patients aged 3 to 17 years with diagnoses of acute urticaria and acute urticaria with angioedema in a state of moderate severity. Patients felt a violation of the general condition – malaise (88.89%), chills/fever (5.56% and 8.34%, respectively), joint pain (2.78%). All patients underwent general clinical, laboratory and instrumental examination with subsequent analysis of the data obtained. To assess the response to treatment, UAS 7, the CU-Q2oL quality of life questionnaire were used.
Results and discussion. The article discusses the main aspects of acute urticaria and angioedema, as the most common nosological forms in patients with atopy. The features of antihistamine therapy and its influence on the stages of the inflammation process are analyzed. The level of eosinophilia in the general blood test (median and interquartile range) was 6.5% (1.3%; 19.1%). An increase in total IgE was recorded in 80.56% of patients. The burden of allergic history was revealed in 86.12% of patients. By the end of the 1st day of treatment, symptoms were absent in every tenth patient (χ² = 1.2461, p = 0.0865), remained in every
fifth child (χ² = 53.6152, p = 0.0057) and significantly decreased in 2/3 children under study (χ² = 59.6281, p = 0.0062). By the end of the 3^rd day of therapy with dimetindene in the complex of treatment of acute urticaria and angioedema, a statistically significant improvement in clinical dynamics was recorded (χ² = 102.1364, p = 0.0041) in the combined assessment of symptoms in 4/5 of the subjects and a decrease in discomfort associated with sleep in the overwhelming majority of the subjects (χ² =51.4627, p = 0.0036).
Conclusion. As a result of our own research on the use of dimetindene in patients with acute allergic reactions, it was shown that dimethindene has characteristics that meet the requirements for the exposure of the therapeutic effect, the level of effectiveness and the safety profile.

1. Fomina D.S., Goryachkina L.A. The choice of an antihistamine from the perspective of evidence-based medicine. Effective Pharmacotherapy. 2012:(1):18–24. (In Russ.) Available at: https://umedp.ru/upload/iblock/802/802357cec6479b7dd97d515df4fa8838.pdf.

2. Revyakina V.A. Antihistamines in clinical practice. RMJ. Medical Review. 2014;(11):854–856. (In Russ.) Available at: https://www.rmj.ru/articles/allergologiya/Antigistaminnye_preparaty_v_klinicheskoy_praktike.

3. Nadey E.V., Nechaeva G.I. Antihistamines for allergic rhinitis: focus on the patients with allergic comorbidities. RMJ. 2019;(3):57–61. (In Russ.) Available at: https://www.rmj.ru/articles/allergologiya/Antigistaminnye_preparaty_v_lechenii_allergicheskogo_rinita_v_fokuse_vnimaniya_pacienty_s_komorbidnoy_allepgopatologiey/#ixzz7JkbCqZyG.

4. Shabanov D.V. Therapy with antihistamine medications with allergic rhinitis and urticaria in patients with atopia. RMJ. 2018;8(I):59–63. (In Russ.) Available at: https://www.rmj.ru/articles/allergologiya/Terapiya_antigistaminnymi_preparatami_pri_allergicheskom_rinite_i_krapivnice_u_pacientov_s_atopiey/#ixzz7JkcIHU00.

5. Gray C.L., Levin M.E., Du Toit G. Respiratory comorbidity in South African children with atopic dermatitis. S Afr Med J. 2017;107(10):904–909. Available at: http://www.samj.org.za/index.php/samj/article/view/12080.

6. Liccardi G., Calzetta L., Baldi G., Berra A., Billeri L., Caminati M. et al. Allergic sensitization to common pets (cats/dogs) according to different possible modalities of exposure: an Italian Multicenter Study. Clin Mol Allergy. 2018;16:3. https://doi.org/10.1186/s12948-018-0081-z.

7. Brożek J.L., Bousquet J., Agache I., Agarwal A., Bachert C., BosnicAnticevich S. et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017;140(4):950–958. https://doi.org/10.1016/j.jaci.2017.03.050.

8. Brozek G., Lawson J., Szumilas D., Zejda J. Increasing prevalence of asthma, respiratory symptoms and allergic diseases: Four repeated surveys fr om 1993–2014. Respir Med. 2015;109(8):982–990. https://doi.org/10.1016/j.rmed.2015.05.010.

9. Bousquet J., Bedbrook A., Czarlewski W., Onorato G., Arnavielhe S., Laune D. et al. Guidance to 2018 good practice: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma. Clin Transl Allergy. 2019;11(9):16. https://doi.org/10.1186/s13601-019-0252-0.

10. Fayzullina R.M., Shangareeva Z.A., Sannikova A.V., Valeeva Zh.A., Popova S.M. Clinical efficacy of basic anti-inflammatory therapy for allergic rhinitis in children. RMJ. Medical Review. 2020;4(1):15–18. (In Russ.) https://doi.org/10.32364/2587-6821-2020-4-1-15-18.

11. Nenasheva N.M. Current Therapy of Atopic Dermatitis: a Role of Emollients and Antihistamines. Effective Pharmacotherapy. Allergology and Immunology. 2016;1(6):16–24. (In Russ.) Available at: https://umedp.ru/upload/iblock/e5c/zodak.pdf.

12. Revyakina V.A. The role of antihistamines in clinical practice.A doctor’s perspective on common questions. Effective Pharmacotherapy. 2014;(1):51–55. (In Russ.) Available at: https://umedp.ru/articles/primenenie_antigistaminnykh_sredstv_v_pediatricheskoy_praktike.html.

13. Astaf′yeva N.G., Borzova E.Yu., Vishneva E.A., Danilycheva I.V., Yelisyutina O.G., Il′ina N.I. et al. Urticaria in children: clinical guidelines. Moscow; 2019. 57 p. (In Russ.) Available at: https://raaci.ru/dat/pdf/urticariaproject.pdf.

14. Baranov A.A., Namazova-Baranova L.S., Khaitov R.M., Il′ina N.I., Kurbacheva O.M., Novik G.A. et al. Food allergy: clinical guidelines. Moscow; 2018. 50 p. (In Russ.) Available at: https://www.pediatr-russia.ru/information/klin-rek/deystvuyushchieklinicheskie-rekomendatsii/%D0%9F%D0%B8%D1%89%D0%B5%D0%B2%D0%B0%D1%8F%20%D0%B0%D0%BB%D0%BB%D0%B5%D1%80%D0%B3%D0%B8%D1%8F%20%D0%B4%D0%B5%D1%82%D0%B8%20%D0%A1%D0%9F%D0%A0%20_2019%20%D0%B8%D1%81%D0%BF%D1%80.pdf.

15. Tuzlukova E.B., Ilyina N.I., Luss L.V. Antihistamines. RMJ. 2002;10(5):269. (In Russ.) Available at: https://www.rmj.ru/articles/allergologiya/Antigistaminnye_preparaty.

16. Bardenikova S.I., Snitko S.Yu., Dovgun O.B., Lobanova E.A., Drozdova N.I. Acute allergic reactions in children: initiating agents in focus. RMJ. 2019;1(II):66–70. (In Russ.) Available at: https://www.rmj.ru/articles/pediatriya/Ostrye_allergicheskie_reakcii_u_detey_v_fokuse_provociruyuschie_faktory.

17. Fayzulina E.V., Davydov Yu.F. Drug allergies: classification, treatment, prevention. Lechaschi Vrach. 2015;(11):16–19. (In Russ.) Available at: https://www.lvrach.ru/2015/12/15436368.

18. Belousova T.A., Goryachkina M.V., Pyatilova P.M. Antihistamines in clinical practice: optimization of choice from the standpoint of pharmacoeconomics. RMJ. Medical Review. 2015;23(4):230. (In Russ.) Available at: https://www.rmj.ru/articles/allergologiya/Antigistaminnye_preparaty_v_klinicheskoy_praktike_optimizaciya_vybora_s_poziciy_farmakoekonomiki.

19. Gough H., Grabenhenrich L., Reich A., Eckers N., Nitsche O., Schramm D. et al. Allergic multimorbidity of asthma, rhinitis and eczema over 20 years in the German birth cohort MAS Pediatr. Allergy Immunol. 2015;26(5):431–437. https://doi.org/10.1111/pai.12410.

20. Nenasheva N.M. Antihistamines in the treatment of chronic urticaria. RMJ. 2018;8(I):33–38. (In Russ.) Available at: https://www.rmj.ru/articles/allergologiya/Antigistaminnye_preparaty_vterapii_hronicheskoy_krapivnicy.

21. Zuberbier T., Aberer W., Asero R., Abdul Latiff A., Baker D., Ballmer-Weber B. et al. The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. The 2017 Revision and Update. Allergy. 2018;73(7):1393–1414. https://doi.org/10.1111/all.13397.

22. Guillen-Aguinaga S., Jauregui Presa I., Aguinaga-Ontoso E., GuillénGrima F., Ferrer M. Updosing nonsedating antihistamines in patients with chronic spontaneous urticaria: a systematic review and meta-analysis. Br J Dermatol. 2016;175(6):1153–1165. https://doi.org/10.1111/bjd.14768.

23. Tantilipikorn P., Siriboonkoom P., Sookrung N., Thianboonsong A., Suwanwech T., Pinkaew B., Asanasaen P. Prevalence of local allergic rhinitis to Dermatophagoides pteronyssinus in chronic rhinitis with negative skin prick test. J Allergy Immunol. 2019. Available at: https://apjai-journal.org/wp-content/uploads/2021/07/10_AP-170918-0408.pdf.ology

24. Bonertz A., Roberts G., Slater J.E., Bridgewater J., Rabin R., Hoefnagel M. et al. Allergen manufacturing and quality aspects for allergen immunotherapy in Europe and the United States: an analysis from the EAACI AIT Guidelines Project. Allergy. 2018;73(4):816–826. https://doi.org/10.1111/all.13357.

25. Mendelson M.H., Bernstein J.A., Gabriel S., Balp M., Tian H., Vietri J., Lebwohl M. Patient‐reported impact of chronic urticaria compared with psoriasis in the United States. J Dermatolog Treat. 2016;28(3):229–236. https://doi.org/10.1080/09546634.2016.1227421.

26. Balp М.М. Vietri J., Tian H., Isherwood G. The Impact of Chronic Urticaria from the Patient’s Perspective: a Survey in Five European Countries. Patient. 2015;8(6):551–558. https://doi.org/10.1007/s40271-015-0145-9.

27. Maurer M., Abuzakouk M., Berard F., Canonica W., Oude Elberink H., Giménez-Arnau A. et al. The burden of chronic spontaneous urticaria is substantial: Real‐world evidence from ASSURE‐CSU. Allergy. 2017;72(12):2005–2016. https://doi.org/10.1111/all.13209.

28. Astаfyeva N.G., Baranov A.A., Vishneva E.A., Daykhes N.A., Zhestkov A.V., Il′ina N.I. et al. Allergic rhinitis: clinical guidelines. Moscow; 2020. 84 p. (In Russ.) Available at: https://raaci.ru/dat/pdf/allergic_rhinitis-project.pdf.

29. Nikiforova G.N., Fedoskova T.G., Svistushkin V.M. Allergic rhinitis. Challenges of patients mangement. RMJ. 2018;8(I):46–52. (In Russ.) Available at: https://www.rmj.ru/articles/allergologiya/Allergicheskiy_rinit_Problemy_vedeniya_pacientov.

30. Nenasheva N.M. Stepwise Therapy for Reaching Control over Allergic Rhinitis. Effective Pharmacotherapy. Pulmonology & Otorhinolaryngology. 2015;(1):14–21. (In Russ.) Available at: https://umedp.ru/articles/dostizhenie_kontrolya_allergicheskogo_rinita_s_pomoshchyu_stupenchatoy_terapii.html.

31. Il′ina N.I., Kurbacheva O.M., Pavlova K.S., Pol′ner S.A. Allergic rhinitis: clinical guidelines. Moscow; 2018. 23 p. (In Russ.) Available at: https://nrcii.ru/docs/2.allergic_rhinitis.pdf.

32. Bass E.A., Tuzankina I.A. Allergic rhinitis in children and early exposure of cat allergens. RMJ. Medical Review. 2019;(5):12–14. (In Russ.) Available at: https://www.rmj.ru/articles/pediatriya/Rannyaya_ekspoziciya_allergenov_koshki_i_osobennosti_techeniya_allergicheskogo_rinita_u_detey