The dissertation presents the solution of the current problem of modern allergology - clinical and immunological features and approaches to the treatment of persons with perennial allergic rhinitis, complicated by frequent exacerbations of herpes virus infection of the first type.
To select patients with year-round allergic rhinitis (CAR) complicated by frequent recurrences of herpes virus type 1 (HSV type 1), a survey of 3582 patients with allergic rhinitis (AR) was conducted using a specially designed questionnaire. The frequency of detection of frequent recurrent HSV-1 infection among the examined patients with CAR was 7,1%. After the questionnaire, 122 patients were selected for moderate CAR with frequent recurrences of HSV-1 type (main group), and 40 patients for moderate CAR without recurrence of HSV type 1 (comparison group).
Analysis of the spectrum and nature of sensitization in groups of patients with CAR shows that among all patients with CAR taken for the study, sensitization to house dust mites and fungi, in particular to Alternaria alternata, is most common. In the group of patients with CAR with FR HSV-1, the most significant allergens were fungal allergens and house dust mites, the incidence of which was 91% and 52%, respectively. The study included patients who were sensitized to Alternaria alternata - Alt a1, as the most numerous group.
The strength and nature of immune disorders in patients with moderate CAR in combination with frequent recurrent HSV-1 infection were determined. It was found that the course of CAR with HSV-1 in contrast to CAR without HSV-1 occurs against the background of disorders in the T-immune system, decreased T-cytotoxic (CD8+) lymphocytes and NK cells, decreased blast-transforming ability of T-lymphocytes, decreased phagocytic. In patients with CAR with HSV-1, as well as in patients with CAR without HSV-1, the course of the disease is accompanied by an increase in serum levels of total IgE and specific IgE to Alt a1.
It was also found that in patients with CAR with HSV-1 in contrast to patients with CAR without HSV-1 there is an increase in serum proinflammatory cytokines IL-1, IL-6, INFγ and a violation of the ratio of pro- and anti-inflammatory cytokines IL-1 / IL-10, IL-6 / IL-10.
Patients in the main group received basic therapy for treatment, which consisted of intranasal glucocorticosteroid and antihistamine, allergen-specific therapy, immunomodulator - ribonucleic acid and antiviral therapy. Depending on the nature of antiviral therapy, the main group was divided into two subgroups: subgroup 2A in exacerbated HSV-1 received an inducer of interferon synthesis - inosine pranobex, and the second - subgroup 2B - a specific inhibitor of herpes viruses - acyclovir. ASIT was performed with a highly purified allergen of the main mold protein Alternaria alternata - Alt a1, taking into account all diagnostic criteria.
Under the influence of the proposed complex therapy (ASIT + inosine pranobex) (subgroup 2A) in patients with CAR with HSV-1 CR disappeared the main symptoms of CAR (nasal congestion, rhinorrhea, frequent sneezing, bowel movements and itching in the nose), nasal breathing was restored, complaints (headache, low-grade fever) and clinical manifestations of recurrent HSV-1 infection. In patients treated with ASIT and acyclovir in combination (subgroup 2B), there was no complete recovery of clinical status, they remained partially isolated manifestations of CAR and HSV-1 infection.
Immunological studies have shown that basic therapy with ASIT in combination with ribonucleic acid and inosine pranobex more effectively corrects immune disorders in patients with CAR with HSV-1 than ASIT in combination with ribonucleic acid and acyclovir.
Thus, as a result of the work in the study, it was determined the presence of different types of changes in the immune system and clinical manifestations in patients with CAR with recurrence of HSV-1 and without them. Based on clinical and immunological studies, a comprehensive scheme of etiopathogenetic treatment of patients with CAR with HSV-1 using ASIT, immunomodulator - ribonucleic acid and inducer of interferon synthesis - inosine pranobex.
