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IMMUNOHISTOCHEMICAL ASSESSMENT OF SIGNS OF INFLAMMATION OF
THE NASAL CAVITY AND PARANASAL SINUSES IN ALLERGIC RHINITIS
1 2 Ulmasov A.O. , Kosimov K.K.
1Ulmasov Alijon Obidovich - Assistant;
2Kosimov Kobil Kosimovich - Doctor of Medical Sciences, Professor, Head of the Department, DEPARTMENT OF OTORHINOLARYNGOLOGY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: in recent decades, allergy has become one of the most urgent medical and social problems due to the global prevalence and intensive growth of allergic diseases. Allergy occupies a leading place among other forms of pathology according to criteria such as prevalence, severity of course, complexity of diagnosis and therapy, rehabilitation, treatment costs, etc.
Keywords: nasal cavities, immunology, chemistry, paranasal sinuses, allergic rhinitis.
ИММУНОГИСТОХИМИЧЕСКАЯ ОЦЕНКА ПРИЗНАКОВ ВОСПАЛЕНИЙ ПОЛОСТИ НОСА И ОКОЛОНОСОВЫХ ПАЗУХ ПРИ АЛЛЕРГИЧЕСКОМ
РИНИТЕ Улмасов А.О.1, Косимов К.К.2
1Улмасов Алиджон Обидович - ассистент;
2Косимов Кобил Косимович - доктор медицинских наук, профессор, заведующий кафедрой, кафедра
оториноларингологии, Андижанский государственный медицинский институт, г. Андижан, Республика Узбекистан
Аннотация: в последние десятилетия аллергия стала одной из наиболее актуальных медико-социальных проблем в связи с глобальной распространенностью и интенсивным ростом аллергических заболеваний. Аллергия занимает ведущее место среди других форм патологии по таким критериям, как распространенность, тяжесть течения, сложность диагностики и терапии, реабилитация, затраты на лечение и др.
Ключевые слова: полости носа, иммунология, химия, околоносовых пазух, аллергический ринит.
UDC 616.211-002
Relevance. Allergic rhinitis (AR) is one of the most common chronic allergic diseases. In recent years, a strategic direction in the treatment of pathology has been the use of personalized medicine techniques and the creation of an individual treatment trajectory based on the determination of the AR phenotype [5]. Local immunological processes indicating the presence or absence of immunological tolerance and the development of allergic sensitization are determined by the work of mucosal immunity [2]. The lack of effective immunological tolerance towards nonpathogenic allergens, due to impaired functioning and interaction of adaptive and innate immunity, leads to impaired barrier function and the formation of inflammation, incl. and allergic. Numerous recent studies confirm that an adequate effect on the mucosal immunity system can effectively prevent or control the development of an allergic process.
A clear position on the need to control allergic inflammation in AR has been defined and approved. Moreover, to determine the therapeutic tactics, effective evidence-based monitoring of inflammation mediators is required, which makes it possible to assess the correctness of therapy at each stage of treatment.
The scientific medical community is actively studying biomarkers of inflammation in AR [1]. By biomarkers is meant a set of clinical and/or laboratory signs that can serve as an indicator of an inflammatory process. Moreover, the main requirements for biomarkers remain clinical relevance, sensitivity and specificity, reliability and reproducibility. Biomarkers are used for various purposes. The phenotype of the disease is determined. Also, biomarkers are a predictor of the severity of the process. An effective technique includes the determination of biomarkers as monitoring indicators of the effectiveness of ongoing therapy. Extremely important are not only clinical, but also laboratory biomarkers, highly informative in assessing the severity of the inflammatory allergic process [4]. Given the heterogeneity of AR, the emergence of universal criteria for assessing inflammation will, in turn, effectively address the issues of achieving control of allergic inflammation, which is a key issue in the treatment of AR [6].
Purpose of the study.To experimentally study the morphological structure of the nasal mucosa and paranasal sinuses in acute sinusitis occurring against the background of allergic rhinitis.
Material and research methods. We examined 47 patients aged 18 to 67 years (mean age 31.2±2.7 years), including 24 (51.06%) women and 23 (48.94%) men, with AR moderate (16 people) and severe (31 people).
All patients showed multisensitization to household, pollen, fungal and epidermal allergens. Allergy was diagnosed by determining specific IgE by ELISA (enzymatic immunoassay) and ImmunoCap ISAC.
The main reasons for patients repeatedly seeking specialized help from an allergist-immunologist are the lack of control over the symptoms of rhinitis, doubts about the accuracy of the diagnosis, and differential diagnosis. It should be noted that the majority of patients applied for an appointment during an exacerbation of AR, they previously received systemic antihypertensive therapy. In addition to standard general clinical studies and ENT consultation, functional tests were performed to assess nasal obstruction and UPSIT
Research results. The quantitative content of mites of the genus Dermatophagoides in 1 g of apartment dust of children with year-round allergic rhinitis is 2.83 times higher, and with a combination of year-round allergic rhinitis and atopic bronchial asthma, it is 4.4 times higher than in house dust of apartments in healthy children.
Thecombinationofyear-roundandseasonalallergicrhinitisinpatientswithnasalandparanasalsinusesischaracterizedby a highfrequencyofpolyvalentsensitization (in 64.1% and 84% ofcases, respectively).
The clinical features of allergic rhinitis in combination with inflammation in patients are: the predominance of moderate forms in the structure of morbidity in seasonal and mild forms in year-round allergic rhinitis; polysymptomaticity of clinical manifestations is higher with seasonal and less with year-round allergic rhinitis; high incidence of damage to JIOP organs in both seasonal and year-round forms of allergic rhinitis.
In patients with allergic rhinitis and inflammation of the nasal sinuses, a change in the immune system was revealed in the form of a decrease in the phagocytic activity of neutrophils, the number of T-lymphocytes due to a decrease in the proportion of the CD4+ subpopulation, as well as the functional activity of T-lymphocytes; a decrease in the number of medium and high affinity T-lymphocytes; an increase in the cytopathogenic effect of lymphocytes in tissue cell culture, the levels of circulating immune complexes and total Ig E in peripheral blood.
Evaluation of the severity of nasal obstruction and its positive reversibility by 35-50 l/min are objective quantitative criteria for the severity of AR and the prognosis of the effectiveness of symptomatic therapy.
Impaired sense of smell to the anosmic range in patients with AR indicates its severe course and the need to prescribe the full amount of pharmacotherapy in accordance with the 3rd-4th stage of the 2019 Federal Clinical Guidelines.
Dynamic monitoring of patients using possible additional tools for diagnosing nasal dysfunction, in our opinion, is a very informative, inexpensive and accessible method in practical allergology.
In patients with SAR, pre-season prophylaxis should be carried out, starting treatment with non-sedating antihistamines, leukotriene receptor antagonists, or inhaled corticosteroids 1 -2 weeks in advance. before the start of the active pollination season (when pollen grains appear in the ambient air). In the absence of pollen monitoring, treatment should be started at the first symptoms of SAD. SAR treatment should be continued throughout the entire flowering period of "allergenic" plants and drug withdrawal should be recommended after 2-4 weeks. after pollination
Conclusion. Evaluation of the local fraction of key cytokines is a highly effective technique in determining the treatment and diagnostic tactics for patients with AR and can be recommended as a mandatory method for determining the disease phenotype and monitoring the effectiveness of the treatment [3]. However, the currently available data are insufficient and further study is required to develop a unified sampling technique, to form a full-fledged algorithm for selecting cytokines for various AR phenotypes.
References / Список литературы
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4. Barnes P.J. The cytokine network in asthma and chronic obstructive pulmonary disease.J.Clin. Invest. 2008;118(11):3546-56.
5. Cosmi L., Liotta F., Maggi E. et al. Th17 cells: new players in asthma pathogenesis. Allergy, 2011; 66(8):989-98.
6. Diamant Z., Boot J.D., Mantzouranis E., Flohr R. et al. Biomarkers in asthma and allergic rhinitis. Pulm. Pharmacol.Ther., 2010;23:468-81.
