Background. One of the topical issues of modern medicine is the widespread increase in the incidence of allergic pathology. Objective. The aim of the study is to investigate clinical and epidemiological features of allergies in schoolchildren of the Chechen Republic. Methods. We performed clinical and diagnostic verification of allergies according to clinical guidelines in patients who positively answered the ISAAC questionnaire (n = 80) — 46 first-grade and 34 eighth-grade pupils. The first diagnostic step on studying the clinical manifestations in observed children was the history taking, complaints, physical examination. Laboratory and instrumental diagnosis included: IgE total, detection of skin sensitivity to allergens via standard pollen, domestic, epidermal, and food allergens (produced by I.M. Mechnikov Research Institute of Vaccines and Sera, Stavropol Research Institute of Vaccines and Sera), revealing of allergen-specific antibodies, component-divided allergen diagnosis via indirect immunofluorescence with ImmunoCAP analyzer, respiratory function evaluation with CareFusion, nitric oxide level detection in exhaled air via portable NObreath analyzer. If needed, specialised medical consultation were performed. Results. Asthma was detected in 37 (46.3%) children, allergic rhinitis (AR) — in 37 (46.3%), atopic dermatitis (AD) — in 5 (6.3%) according to the results of our study. The most common combination of medical conditions in examined patients was combination of asthma and AR. There were no statistically significant differences in age groups. No gender differences were reported in the study. The highest incidence of asthma and AR was revealed in city residents (p < 0.05), while the AD incidence in the city and rural areas did not differ significantly. The sensibilization spectrum analysis in schoolchildren of the Chechen Republic revealed predominance of sensitivity to pollen (ragweed, herd grass) and domestic allergens (Dermatophagoides pteronyssinus, Dermatophagoides farinae). Sensitization to food allergens in children of the Chechen Republic did not have significant differences in the frequency of occurrence of individual allergens, that is, unlike pollen and household sensitization, a regional rating on the dominance of certain food allergens was not obtained. Sensibilization to epidermal allergens was also less common, the predominant one was the cat allergen. Conclusion. Thus, the first study on the territory of the Chechen Republic carried out according to the ISAAC program has revealed high prevalence of allergies in schoolchildren. Moreover, regional features of sensibilization structure have been identified. It will allow us to maintain economically optimal diagnosis of allergic diseases in children living in the Chechen Republic.

Background. Speech development impairment is urgent and common problem in pediatric neurology. Transcranial magnetic stimulation (TMS) is one of the promising treatment variants for children with speech disorders. Objective. The aim of the study is to evaluate efficacy and safety of the developed approaches to TMS usage in the management of children with speech disorders. Methods. It was non-randomized controlled study. It included 46 children with speech disorders aged from 3 to 6.5 years. All children were divided into two groups comparable by gender and age: 26 children of the treatment group received TMS course, 20 children of the control group received treatment with hopantenic acid. All patients with speech disorders underwent psychological and pedagogical evaluation of speech and cognitive development, electroencephalography (EEG) before and after treatment. Moreover, comparative analysis of TMS and nootropic therapy efficacy was carried out. Specialized examination of speech and cognitive development was also performed via E.A. Strebeleva method for psychological and pedagogical diagnosis of children development. Furthermore, we carried out side reactions / adverse events registration according to patients and/or their parents complaints confirmed by physical examination, patient’s behavior observation, data from specially developed questionnaire for assessing child’s behavior and well-being (filled up by parents). Finally, we evaluated brain bioelectric activity recorded by EEG. Results. The study results have shown that it is possible to achieve significant positive dynamics in cognitive and speech development in preschool children with speech disorders in both groups (TMS course and medical treatment). But hereby, TMS treatment has demonstrated significantly higher positive dynamics in two out of the three evaluated parameters. There were no cases of adverse events in TMS group leading to early course discontinuation. Conclusion. TMS is non-invasive and safe method for treatment of children with speech disorders. This study has demonstrated the efficacy of the method in the field of personalized management of children with impaired speech and cognitive development.

Background. Identification of the prevalence of pollen and food allergen molecules sensitization in children (considering regional characteristics) is relevant and crucial for personalized preventive and treatment measures development. Objective. The aim of the study is — study the prevalence of pollen and food allergen sensitization in children with different atopic phenotype variants. Methods. This cross-sectional study included 80 children aged from 4 months to 17 years 8 months with symptoms of allergic rhinitis, food allergy, atopic dermatitis living in the Moscow metropolitan area. All children were sensitized to 9 extracts of domestic, pollen and food allergens via the ImmunoCAP method, and molecular allergy diagnosis was carried out via the ImmunoCAP ISAC technology (n = 79). One patient with symptoms of allergic rhinitis during spring without any manifestations of cross-reactive food allergy received an unreadable result of ImmunoCAP ISAC. Results. The most common sensitization among all patients was to the birch pollen allergen extract — 65%, herd grass — 46%, common mugwort — 32%. The following sensitization to major allergens was most often detected according to molecular diagnosis: birch pollen Bet v 1 — 67%, herd grass Phl p 1 — 33% and Phl p 4 — 24%, and even less mugwort Art v 1 — 11%. The lowest sensitization was to the allergy component Amb a 1 of ambrosia — 8% of cases. Sensitization to wormwood pollen extract was revealed 2.5 times more often than to major components of this allergen. Spring allergic rhinitis was diagnosed in 45 children, and 27 of them had cross-reactive food allergy. Children with allergic rhinitis during the spring period (both with or without complaints on cross-reactive food allergy) most commonly had sensitization to the allergens components of hazelnut Cor a 1.0401 and apple Mal d 1, and least often to the component of the celery allergen Api g 1. Conclusion. Birch pollen is the most common primary allergen in children of the Moscow metropolitan area with allergy. Patients with spring allergic rhinitis despite the presence of cross-reactive food allergy usually have sensitization to the components of hazelnut and apple allergens.

Background. Nasal and nasopharyngeal pathology is one of the most important and widespread challenge in pediatrics and pediatric otorhinolaryngology. Prolonged nasal breathing difficulty can be caused by various diseases and their combinations. It requires multidisciplinary approach to diagnosis with the involvement of modern examination methods and pathogenetic treatment. Objective. The aim of the study is to develop complex technology for the management of children with nasal and nasopharyngeal pathologies. Methods. The study included 240 children aged from 6 to 18 years. All patients were divided into 3 groups, comparable by sex and age: Group 1 – 85 patients with confirmed ENT-organ disease, Group 2 — 104 patients with confirmed allergic disease, control group — 51 somatically healthy patients who did not have any ENT-organ or allergic diseases. Examination procedures: diagnostic nasopharyngeal endoscopy, rhinomanometry (RMM), rhinoresistometry (RRM), olfactometry. Results. The obtained results (RRM, RMM) have shown that air flow rate in nasal cavity increased due to nasal resistance decrease. Nasal resistance was higher and air flow rate was lower in all children with various ENT-organs or allergic diseases compared to the control group. Nasal resistance decreased in all study groups (significantly in children with aggravation of allergic diseases of airways and ENT-organs diseases) as well as air flow rate increased in all study groups (significantly in Group 1 and 2) after anemisation of nasal mucosa with decongestants. Apparently, it can be associated not only with anatomical features (nasal septum deviation), but also with inflammatory features of nasal cavity and nasopharynx (adenoid hypertrophy and inflammation, persistent swelling of nasal mucosa at allergic rhinitis). We would like to present the algorithm for diagnosis of children with nasal and nasopharyngeal pathologies according to the study results. The following practical guidelines have been proposed: 1) all patients with complaints on prolonged nasal breathing difficulties require not only otorhinolaryngologist examination, but also diagnostic endoscopy of nasal cavity and nasopharynx; 2) in case of nasal septum deviation and complaints on prolonged nasal breathing difficulties, it is necessary to perform functional methods for nasal breathing evaluating (RRM, RMM) to choose adequate treatment method; 3) the use of RRM, RMM would help to choose the optimal treatment approach in children with complaints on prolonged nasal breathing difficulties and confirmed diagnosis of allergic disease (allergic rhinitis, hay fever, etc.), also associated with adenoid hypertrophy and/or nasal cavity and nasopharynx inflammatory diseases; 4) all patients with confirmed chronic diseases of ENT-organs should be examined by allergist, and, if necessary, should undergo comprehensive allergological examination. Conclusion. The developed complex approach to the management of children with nasal cavity and nasopharynx pathology is innovative and represents the technology of personalized use of modern, objective methods for diagnosing the nasal cavity and nasopharynx state. The presented diagnostic algorithm and practical guidelines allow us to establish diagnosis and choose the treatment tactics within a short time. The use of these studies in clinical practice will allow to monitor the therapy efficacy (including various pharmacotherapeutic strategies) for nasal cavity and nasopharynx diseases in children. Timely examination and pathogenetic treatment will allow to prevent the chronization of pathological process in ENT-organs. This is especially crucial in childhood as it provides children with the best chance of healthy growth and development.

Every year more countries recommend vaccination for pregnant women. Nowadays, the spectrum of vaccines that can be used during pregnancy is expanding. Experts of the Union of Pediatricians of Russia have completely updated the section about the pregnant women immunoprophylaxis within updating clinical guidelines on normal pregnancy management. This section is presented in the following article.

Background. Infectious mononucleosis is acute viral disease that often forces pediatricians, especially in outpatient departments, to prescribe antibiotics. However, viral infections even with prolonged fever and marked intoxication symptoms do not require antibacterial therapy. Unreasonable antibiotics’ administration leads to increase in antibiotic resistance, increase of treatment cost, and development of incorrect therapy understanding in patients. Clinical case description. The authors presented 3 clinical cases of infectious mononucleosis with typical course in children. All patients were unreasonably administered antibacterial therapy with three or more drugs in absence of any clinical and laboratory signs of bacterial infection. Conclusion. Patients with infectious mononucleosis do not require antibacterial therapy due to viral origin of the disease, regardless disease course duration and severity, except the cases with confirmed comorbid bacterial infection.