[OPTIMIZATION OF ALLERGEN-SPECIFIC IMMUNOTHERAPY IN CHILDREN WITH BRONCHIAL ASTHMA: SELECTION FEATURES, PATIENT...

The aim of the study was to optimize the method of selecting patients with bronchial asthma for the use of allergen-specific immunotherapy with allergens of house dust mites and to evaluate its effectiveness. The research was carried out based on the Municipal Non-Commercial Enterprise «City Children's Clinical Hospital» in Lviv. The study included 120 school-age children (aged 6-17) with bronchial asthma and sensitization to house dust mites. 60 patients were the main group of patients who received ASIT along with the basic treatment (30 sublingual sprays, 30 subcutaneous ASIT). The other 60 patients were in the comparison group and received only basic therapy for bronchial asthma. The presence of sensitization to house dust mites was proved based on skin prick testing. Optimization of patient selection consisted of molecular allergy diagnostics using the Immuno CAP method with the determination of sIgE to components of allergens of house dust mites rDer p1, rDer p2, rDer p10 to accurately assess patient sensitization for further use of ASIT. To assess the effectiveness of ASIT, asthma control test (ACT) indicators were analyzed, patients' quality of life was assessed, spirometric indicators were evaluated (FEV1 and PEF), and IFNγ and IL13 levels were assessed in patients with ASIT. After one year of treatment, the average asthma control test among patients receiving sublingual ASIT increased the most - by 26.32% (p <0.01). Also in this group of patients, there was the largest increase in PEF - by 9.82% (p <0.01). Regarding the increase in FEV 1, it was the highest in the group of patients receiving subcutaneous ASIT - by 9.85% (p <0.01). The quality of life of patients in the assessment of symptoms increased the most in patients who received sublingual ASIT by 28.7%. Based on our results, we can draw the following conclusions: The application of molecular allergy diagnostics using the definition of sIgE to the components of allergens of house dust mites rDer p1, rDer p2, rDer p10 allows optimizing the selection of patients for allergen-specific immunotherapy. Treatment of bronchial asthma with the involvement of ASIT during the first year allows obtaining higher efficiency indicators, which are manifested by a significant improvement in asthma control test, external respiration function and quality of life. Monitoring of immunological parameters showed a significant increase in IFNγ, which can be regarded as the activation of the process of switching the immune response from Th-2 to Th-1 indirect, and thus illustrates the positive effect of ASIT.