Features of Upper Respiratory Tract Inflammation Phenotypes in Children with Various Skin, Respiratory, and Gastrointestinal Diseases (Preliminary Research Results)

Background. The management of patients with multifactorial autoimmune diseases (inflammatory bowel diseases (IBD) and chronic dermatoses) is currently impossible without taking into account the clinical and biological phenotypes of the disease. To develop optimal disease control, it is necessary to study the factors that influence the manifestation, course, and relapse of the diseases. In addition, it is required to understand the phenotypic clinical and immunological parameters of inflammation, which depend on the underlying pathological process, the therapy, and the condition of other organs and systems involved in the underlying pathological process, including the upper respiratory tract. The aim of the study was to determine the main phenotypic clinical and immunological parameters of inflammation in pediatric patients with immune-inflammatory diseases associated with upper respiratory tract pathology (using psoriasis and IBD as an example). Methods. The study included 60 children: 20 patients with psoriasis and 20 children IBD, as well as 20 patients in the control group (conditionally healthy children) aged 6 years to 17 years 11 months. All patients in the study groups were consulted by a pediatrician, an otolaryngologist, an audiologist, and an allergist (if indicated). Patients with psoriasis were examined by a dermatologist, and children with IBD were examined by a gastroenterologist. Instrumental examination methods included nasal and nasopharyngeal endoscopy, otoscopy, tympanometry, and tonal threshold audiometry. Laboratory methods of research: clinical blood test, determination of antistreptolysin O, IL-1α, IL-1β, IL-6, IL-7, IL-8, IL-10, IL-12, IL-15, IL-17, IL-18, IL-19, IL-20, IL-23, and TNF-α levels in blood serum; determination of serum proteins (MDC/CCL22) and TLSP/kallikrein in blood serum. All patients in the target groups underwent rapid fecal testing for Helicobacter pylori and microbiological studies (mycological examination of oropharyngeal discharge for Candida albicans fungi; bacteriological examination of nasopharyngeal discharge for Staphylococcus aureus; and examination of intestinal microbiocenosis). Results. The obtained data allow us to identify the leading comorbid pathology of the upper respiratory tract in both study groups was chronic tonsillitis. Analysis of the intestinal microbiota composition revealed an imbalance of commensals and pathobionts in both children with IBD and patients with psoriasis. Immunologically, the presence of chronic tonsillitis in children with IBD was accompanied by increased levels of IL-23 and MDC/CCL22, while in patients with psoriasis it was accompanied by increased levels of IL-18 (p < 0.05). Another association identified for children with psoriasis — with allergic rhinitis — was also characterized by a significant increase in IL-18 (p < 0.05). The immunophenotype of IBD patients demonstrated an increase in IL-23 (p < 0.05), while in children with psoriasis, an increase in IL-18 (p < 0.05). Conclusion. At this stage of the study, the primary clinical and immunological markers of inflammation phenotypes in children with autoimmune diseases (using the example of psoriasis and IBD) and their relationship with the presence of comorbid pathology of the upper respiratory tract have been obtained. The study is currently ongoing; the results of this work will help improve the principles of managing children with immune-inflammatory pathology.

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