The thesis is devoted to the problem of increasing the efficiency of diagnosis and treatment of children with pollinosis associated with cross-food allergy based on the study of the sensitization of the primary and cross-reacting components of plant allergens, assessing the effectiveness of sublingual allergen-specific immunotherapy.
128 children age from 4 to 17 years old with pollinosis and 20 practically healthy children were examined. In the etiological structure of pollen sensitization, spring pollinosis are dominated by 37,5 % of children and their combination is 10,1 %.
The probable risk factors for the formation of the pollen–food allergy syndrome in children are: male gender, limited family anamnesis of allergic diseases, duration of breastfeeding less than 6 months, late manifestation of the disease (≥7 years), age of children with pollinosis older than 14 years, sensitization to plant pollen and birth during palynation season.
The pollen-food allergy syndrome was established in 46,9 % of children and most often represented by birch-food syndrome (hazelnut, peanut, apple, peach, carrot – in 71,7 % of patients).
Clinical course of pollinonsis among the children with pollen–food allergy syndrome in 100 % cases is characterized by oral allergy syndrome in which the most common symptom is pruritus in the throat after the intake of fresh fruits, vegetables and nuts.
24 patients (40 %) had oral allergy syndrome combined with systemic urticaria reactions and 5 patients (8,3 %) combined with the development of anaphylaxis after the consumption of hazelnut.
Among all children with pollinonsis, regardless the presence of cross-food allergy, sensitization is recorded to the major components of pollen allergens (birch – rBet v 1; timothy – rPhl p 1, rPhl p 5; ragweed – nAmb a 1; mugwort – nArt v 1) according to type of pollinosis. Identified a low frequency of sensitization to panallergens (birch – rBet v 2, rBet v 4, timothy – rPhl p 7, rPhl p12, mugwort – nArt v 3) which is associated with polysensitization and severity of pollinonsis in children.
Among children with oral allergy syndrome the sensitization profile is characterized by a significantly higher concentration and rate of determination by homologues Bet v 1 – hazelnut (rCor a 1, rs=0,76, p<0,05), apple (rMal d 1, rs=0,73, p<0,05), peach (rPru p 1, rs=0,47, p<0,05), carrot (rDau c 1, rs=0,33, p<0,05). Anaphylaxis among children with PFS is associated with the presence of sensitization to cross-reactive nonspecific lipid transfer proteins – rCor a 8 (hazelnut), rAra h 9 (peanut), nArt v 3 (mugwort); acute urticaria – with sensitization to proteins: rPru p 3 (peach), rAra h 9 (peanut), rJug r 3 (walnut).
The local allergic inflammatory process of the respiratory tract among children with pollinosis disease is characterized by an IgE-dependent mechanism of development by allergic reactions in the nasal mucosa and the pharynx, which is determined irrespective of the presence of cross-allergenic food allergies. Confirmed by the expression of IgE in the cells of the smears-prints from the nasal mucosa and is accompanied by secretory eosinophilia. Children with pollen-food syndrome compared to children with pollinonsis are characterized by a significantly higher marker of local inflammation (eosinophilia 30,4±1,76 % in the group 1, 17,4±0,50 % in group 2 compared with the control group 1,7±0,24 %, p<0,05 and expression of IgE (2,74±0,12 and 2,52±0,15 points in group 1 versus 2,22±0,15 and 2,0±0,11 points in group 2, respectively, p<0,05) compared with the control group (0,21±0,02 points and 0,19±0,01 points, p<0,05), in the stroke cells – results from the nasal mucosa). Direct correlation dependence of markers of local inflammation with severity of pollen-food syndrome in the examined children was established (rs=0,52, p<0,05).
Skin «prick to prick» test with fresh fruits and vegetables is an informative method for diagnostics of food allergy in children with pollinosis. The high sensitivity and prognostic value of the negative result for apples, peaches, carrots and nuts is established.
The positive effect of sublingual allergen–specific immunotherapy on the clinical course of the disease and the formation of tolerance to offending food allergens in children with birch–food syndrome has been proven in 76 %.
