The article is devoted to one of the most urgent problems of pediatrics — rhinitis in children. The difficulty of nasal breathing, being one of the most frequent complaints to pediatricians, can be caused by a banal respiratory infection, as well as be one of the systemic pathology’s symptoms. The economic burden of rhinitis is great for any health budget, the total direct and indirect costs are huge. The article shows the main phenotypic characteristics of rhinitis depending on the etiological factor; gives the modern principles of differential diagnostic search; points studies, use of which is not recommended in routine practice. The authors reflect the key components of a complex therapy and discuss in detail the tactics and possible pharmacological treatment strategies.

Background: It is known that concomitant diseases in adults with TB contribute to the development of intolerance to chemotherapy.

Objective: Our aim was to examine the association of concomitant diseases in children with tuberculosis with TB treatment tolerability.

Methods: Analyzing of the adverse events (AE) occurrence frequency in the background of the standard (RF Ministry of Health order № 109) treatment with anti-TB drugs in a continuous retrospective cohort research. AE were considered to be drug-induced hepatitis, gastritis, neurotoxic and allergic 
reactions.

Results: The authors analyzed the results of treatment of 231 children with active TB at the age from 0 to 14 years, 186 (80.5%) of which had concomitant somatic diseases. On the background of anti-tuberculosis therapy in hospital, 69 (37%) children with concomitant diseases and 22 (49%) children of the comparison group (p = 0.200) had AE. Differences in the structure of AE between the groups were not found. The most common AE were drug-induced hepatitis: they occurred in 58 (25%) children. The risk of AE on the background of anti-TB therapy was lower among girls and higher during treatment with cycloserine and fluoroquinolones.

Conclusion: Concomitant diseases in children with active TB are not associated with the development of AE on the background of the anti-TB drugs therapy.

Background: The increase in the occurrence of allergic dermatoses, especially in young children, is one of the urgent problems of pediatrics. The development of allergic reactions may be caused by changes in microelements balance of the body.

Objective: Our aim was to study the features of the microelement status in children with acute urticaria.

Methods: A comparative study included patients with acute urticaria of varying severity and healthy children (I and IIA groups of health). Study of microelement was carried out in hair samples by X-ray analysis.

Results: The study revealed lower content of zinc in hair in patients with urticaria (n = 40) (48 compared to 146 mcg/g in 23 children of control group, p < 0.001). It also revealed lower content of calcium (447 and 2428 mcg/g respectively; p = 0.001) as well as higher content of sulfur (33860 and 26447 mcg/g respectively; p = 0.001) and potassium (537 and 312 mcg/g respectively; p = 0.001). Differences in the iron, nickel, copper, and chlorine content in hair in comparable groups were not detected. There was no association of microelements content with a burdened hereditary allergologic anamnesis.

Conclusion: Children with urticaria have dismicroelemntosis, characterized by a decrease in zinc and calcium content, and an increase in the concentration of sulfur and potassium.

Drugs used during pregnancy simultaneously have an impact on 2 populations — fetal and maternal. The article is devoted to teratogenic drugs exposition; it points out the need for further research in the field of pharmaceutical safety during pregnancy. Authors analyzed the multiplicity of the congenital disorders in infants, including birth defects cuased by drug application. For ethical reasons, researchers can not conduct any studies on the safety of medicines during pregnancy. Authors suppose that collection of additional information during the marketing phase as a part of the routine pharmacovigilance program and the targeted pharmacoepidemiological trials with the current evaluation of the teratogenic risk of drugs will help to achieve the goals.

The article analyzes the international experience in the regulation of procedures for obtaining voluntary informed consent to immunization as well as voluntary refusal of it. The authors set up the necessity of changing the approach to certain aspects of the obtaining voluntary consent to vaccination or refusal of it procedure regulation in the Russian Federation.

The article describes the experience of using tocilizumab in a patient with systemic juvenile idiopathic arthritis (JIA) refractory to therapy with classical immunosuppressants, coupled with type 1 diabetes. Already after the first injection of tocilizumab there was a decrease in the severity of the disease’s systemic manifestations, pain in the affected joints and functional disorders. A 30% improvement by JADAS index, ACRPedi was reached. By the 8th week of therapy, proliferative changes in wrist joints and arthralgias reduced and the duration of morning stiffness decreased. After 3 months, JIA’s activity decreased (DAS 28 scale); erythrocyte sedimentation rate and serum concentrations of C-reactive protein decreased; hemoglobin concentration and the number of erythrocytes increased. After 6 months of treatment, clinical and laboratory remission (DAS 28 < 2.6) started. On the background of tocilizumab treatment, systemic manifestations of the disease stopped, laboratory and articular JIA’s activity decreased and there was no need for the introduction of glucocorticoids. There also has been a positive dynamics of glycemia, which allowed reducing the dose of insulin. There were no adverse events during treatment with tocilizumab. The disease’s activity on a visual analog scale has also decreased, as well as functional insufficiency by Children Heals Assessment Questionnaire.

Schwachman-Diamond syndrome is a disease characterized by exocrine pancreatic insufficiency, hematological disorders, growth retardation and bone abnormalities. The disease is caused by mutations in the SBDS gene. Early diagnosis and timely start of comprehensive treatment, including clinical nutrition, appointment of enzyme preparations and granulocyte colony stimulating factor, improve the quality of life and prognosis of these patients. The article describes the clinical observation of the Schwachman-Diamond syndrome’s family case.

The article shows the observation of rare NLPC4-associated autoinflammatory syndrome with enterocolitis and familial cold urticaria. Diagnosis is confirmed molecularly-genetically: previously not described mutation c.928C>T in the heterozygous state in NLRC4 gene is discovered by a method of the new generation sequencing. The use of a monoclonal antibody to the interleukin 1 canakinumab provided complete relief of fever and skin and intestinal symptoms in just 1 week of treatment. Later the signs of inflammation have disappeared completely; the patient’s quality of life improved and life-threatening complications were prevented. The above example demonstrates the high clinical efficacy of canakinumab in the patient with NLRC4-associated autoinflammatory syndrome and suggests promising therapeutic use of interleukin 1 blockers in such patients. There were no adverse events during canakinumab therapy.