N. V. Zinovieva

Background. Food allergy is a serious, life-threatening condition that negatively impacts the quality of life of patients and their families, especially among children. In Europe, approximately 7 million people suffer from food allergy, while in Russia, the prevalence varies from 5% to 30%. Accurate diagnosis and treatment of food allergy are crucial to preventing complications and improving quality of life. Primary diagnostic methods include medical history, laboratory tests, and elimination diets, though each has its limitations. Globally, oral food challenges are considered the "gold standard" for food allergy diagnosis. It helps to establish a precise connection between the allergen and the reaction, reducing anxiety for patients and their families. Objective. To evaluate the feasibility of using oral food challenges as a diagnostic method for food allergies in children. Materials and methods. This single-center, prospective, interventional, non-randomized, uncontrolled study is being conducted from January 1, 2022, to December 31, 2024, at the G. N. Speransky Children’s Hospital No. 9 in Moscow. Children aged 6 months to 17 years, suspected of having an immediate allergic reaction to cow's milk protein and/or egg protein by a doctor or legal guardian, were invited to participate. The study involves using an open food challenge for diagnosing food allergies. An open food challenge involves consuming increasing amounts of the suspected allergen (milk, egg, etc.) in its natural form under medical supervision. To determine the necessity of a provocation test, a consultation is conducted, including a physical examination, medical history, and allergy testing (specific IgE blood tests, component diagnostics for milk and egg, and a prick test with the native allergen). Additionally, during the consultation, questionnaires on anxiety and quality of life were completed. Our patient selection and test procedure algorithm is an adapted version of existing protocols from international allergology organizations. Conclusions. Preliminary results indicate that the provocation test is a safe diagnostic method when following a strict patient selection and test procedure algorithm. Notably, parents of children undergoing these tests exhibit high anxiety levels. We plan to continue this study and assess personal and situational anxiety levels over time post oral food challenges.

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Patients with the 22q11.2 deletion syndrome (DiGeorge syndrome, DDS) suffer from T-cell lymphopenia, changes in function and subpopulation of T-lymphocytes. The bibliographical data conflicts on the characteristics of T-lymphocytes in patients with DDS and their changes during physiological maturation. The purpose of this research was to follow-up patients with emphasis on the dynamics of changes in T-lymphocyte subpopulations with age. Methods used: 117 patients observed during 2013-2023 who were administered at the Allergology and Immunology Department with the G.N. Speransky City Children’s Hospital No. 9 (Moscow, Russia) with a diagnosis of DDS and who had undergone blood sampling to assess T-lymphocyte subpopulations using flow cytometry. All patients (0 to 18 y/o) were divided into 4 age groups: 0 to 2 y/o, 2 to 5 y/o, 5 to 10 y/o and 10 to 18 y/o. In parallel, the blood samples of 185 apparently healthy children of the corresponding age were examined. Results: a decrease in CD3 T-lymphocytes, CD4 T-helper cells, CD8 T-cytotoxic lymphocytes, CD4 early thymic emigrants and CD4 naive T-lymphocytes was found in all age groups (p<0.05). CD8+ naive T-lymphocytes and CD8+ early thymic emigrants were reduced in all age groups, but in the 2 to 5 y/o age group their values were close to normal (p=0.072 and p=0.220, respectively). CD4+ central memory cells were elevated in all age groups (p<0.001), while CD8+ central memory cells, CD4+ and CD8+ effector memory cells differed in that they had normal values in the 2 to 5 y/o age group (p=0.229, p=0.457 and p=0.140, respectively). CD4+ TEMRA were significantly increased in the 0 to 2 y/o age group (p=0.002), and in older age groups they tended to normal values. CD8+ TEMRA did not differ from the control group and did not have age-related dynamics. The T-helper subpopulations were characterized by a significant increase in the percentage of T-helper type 1, T-helper 17, T-helper 17.1 and a decrease in T-helper type 2 compared to the population of healthy blood sample donors (p=0.001), except for patients from the 2 to 5 y/o age group. T-regulatory cells in absolute amount were reduced in all age groups (p<0.001), while their relative number corresponded to the norm in the 0 to 2 y/o age group (p=0.811) and decreased slightly in patients in older age groups, especially in the 2 to 5 y/o age group (p=0.030). Conclusion: the pathology of thymus development in patients with DDS leads to impaired maturation of T-lymphocytes, leading to an increase in the number of mature forms of T-lymphocytes, shifts towards the development of T-helper 1 and T-helper 17, and a decrease in T-regulatory cells. Disturbances in T-lymphocytes can cause changes (dysregulation) in subpopulations of B-cells. All these processes may underlie the progression of autoimmune and infectious complications in such patients that are increasing with aging.

Article represents a clinical case of severe combined immune deficiency (SCID), deficiency of MHC class II molecules which was coupled with normal levels of TREC and KREC in a pediatric patient. Simultaneous determination of TREC and KREC in dried blood spots during neonatal screening makes it possible to diagnose various forms of congenital immunodeficiency disorders. For example, a dramatic decrease in TREC is observed in most SCIDs and combined immune deficiencies. However, in some SCIDs associated with a defect primarily in T-cell function rather than T-cell differentiation, TREC levels do not exceed established threshold levels and therefore some rare forms of SCIDs may be missed by neonatal screening programs and consequently lead to its late diagnosis.

The article describes two clinical observations of the detection of chromosomally integrated human herpes virus type 6 (HHV-6). In both cases, the children were referred to an immunologist with a diagnosis of chronic infection caused by the human herpesvirus type 6, in order to exclude an immunodeficiency state and determine the strategies of treating this infection. However, during the molecular biological examination of children, a chromosomal integration of HHV-6 was determined, which led to a revision of the diagnostic search and abandoning massive antiviral therapy.

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