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13IMMUNOLOGICAL ASPECTS OF TRANSMITTED ADENOIDITIS IN CHILDREN WITH ALLERGIC RHINITIS
Obidjon Olimjonovich Jahonov
Bukhara State Medical Institute
ABSTRACT
A scientific study was conducted on 60 children who applied to the ENT department. Group 1 included 30 children with allergic rhinitis and pharyngeal hypertrophy, and group 2 included 30 children with laryngeal hypertrophy.
The results of scientific research showed that adenoiditis in children on the background of allergic rhinitis is characterized by an increase in the number of mucosal immune nasal secretions and eosinophils in the larynx. Immunological changes showed an increase in IgA (38.2%) deficiency in 1/3 of patients, high IgG (13.7%) in 1/2 of patients, and increased IgM (8.8%) in 1/3 of patients.
Keywords: allergic rhinitis, adenoiditis, laryngeal hypertrophy, immunoglobulin
Relevance. Despite the tremendous advances made in medicine, the incidence of allergic rhinitis (AR) has increased rapidly in the last 20 years. Studies show that in the early twentieth century, the prevalence of AR in Europe was 0.82% of the population, in the 90-years - 4.8%, and in 2010 - from 9.6 % to 14.2% [1; 3]. According to the World Health Organization, to date, this figure ranges from 10% to 25% in different countries and up to 50% in some countries with clinical signs specific to AR, ranking 2nd in the population [2; 10; 12]. According to the Republican Allergology Center, AR accounts for 32.7% of all allergic diseases in Uzbekistan [4]. In addition, the clinical course of allergies is worsening from year to year, infectious complications develop as a result of polysensitization of the organism and impaired immune system function [5; 9]. It has also been found that AR leads to the development of acute and chronic otitis media in 24% of children and chronic rhinosinusitis in 28% of children [6; 8]. More than 80% of patients with bronchial asthma have symptoms of rhinitis, and 10-40% of patients with rhinitis have bronchial asthma [7;11]. Also, AR is often (88-98% of patients) accompanied by other organ and system diseases in the body.
So far, the involvement of the larynx in the allergic process has not been sufficiently studied. Patients aged 2 to 15 years with AR who complained of difficulty breathing through the nose were found to have had a history of adenotomy every 8-10 years. Difficulty breathing through the nose was confirmed by rhinometry. There is a decrease in airflow from 2.5 to 4 ml / sec, an increase in airflow resistance from 0.48 to 37.5. In most cases, an asymmetry is observed in the passage of airflow through the right and left nasal cavity, which makes nasal obstruction to think about the genesis of
"non-adenoid-dependent" [13]. The process of sensitization in adenoid tissue is active: an immunohistological examination of adenoid tissue in children reveals an increase in the number of Langerhans cells and eosinophils [7].
Many authors consider AR to be an important factor in the development of adenoid hypertrophy. Therefore, early diagnosis and loss of symptoms reduce the likelihood of its development [9]. Studies of a number of researchers in adenoid tissue show the state of IgE-fixation in adrenal tissue in IgE-producing cells and in fat cells, which is assessed as a preparatory condition for slow-type allergic reactions [8].
In most cases, adenoiditis with allergic rhinitis in children is complicated by infectious sinusitis, otitis media, chronic diseases of the lower respiratory tract [10].
Joint diseases are accompanied by pathological reactions that lead to new changes in the body, which in turn leads to changes in the classic symptoms of the disease, difficulties in the process of diagnosis and treatment [9]. In view of the above, the study of the transition characteristics of adenoiditis associated with allergic rhinitis in these children is one of the current problems of modern medicine.
The aim of the study was to determine the clinical and laboratory features of adenoiditis in children with allergic rhinitis.
Research materials and methods. In the period from 2020 to 2022, scientific research was conducted on 60 children who applied to the ENT department of the Bukhara Regional Children's Multidisciplinary Medical Center. The first group included 30 sick children: allergic rhinitis, persistent form. Adenoiditis. Stage II-III hypertrophy of the larynx, the second group also included 30 sick children: Adenoiditis. It consists of children being treated with a diagnosis of laryngeal hypertrophy grade II-III.
Research results. In patients with AR and adenoiditis, a recurrence of AR was found to occur after contact with inhaled allergens. This evidence is evidenced by skin tests and the detection of IgE-AT against allergens. Because skin lesions were detected in 3-4-year-old children, the IgE-AT detection method was mainly used; only 5 children of this age had the opportunity to have a skin test. IgE-AT against allergens was detected in almost all examined patients. Studies have shown positive skin tests in 60% of children and IgE-AT in 80% of children (relative to one or more allergens).
Based on the results of an allergological examination of children in group 1, it can be said that in most cases, house dust particles are one of the allergens that cause the symptoms of allergic rhinitis. Induction of IgE-antibodies in the examined children was also higher than the concentration of these allergens.
Sensitization to animal fur was detected in 35-43% of children, and high concentrations of IgE-antibodies to these allergens were found. IgE-antibody to fungal allergens was detected at a low rate in 10% of children.
41.2% of patients reported having pets in their homes. In 27.4% of cases, symptoms of the disease were observed in children living on the first floor of multi-
storey houses or in houses made of wood, indicating that house dust particles and fungi were also important in the development of the disease.
High levels of eosinophils in the nasal secretion, which are objective markers of AR, were detected in 74.5% of children in the first two groups. In contrast, in 5 children in the third group, a low level of eosinophils in the nasal secretion, ie up to 10%, was detected.
Changes in humoral immunity in children who have been monitored, sensitized to inhaled allergens have been identified, and have not been identified are shown in Table 1. It can be seen that a reliable difference across groups is observed only in terms of the total amount of IgE in the serum. In the first group of patients, above-normal rates were found in 79% of cases, and in nonatopic patients, in contrast, in 10% of cases. Other immunoglobulin levels in the serum were determined to be immune status specific for the chronic inflammatory process in all groups of patients with adenoiditis (Table 1).
IgG levels were found in 50% of patients and IgM levels were elevated in one-third of patients, indicating compensatory reactivity of the humoral response.
Table 1. Indicators of humoral immunity
Indicators of humoral immunity Changes in humoral immunity (%).
Decrease in indicators Indicators without change or norm Increase in performance
1-group 2-group 1-group 2- group 1- group 2- group
Blood immunoglobulin General IgE 13.7 % 9.0% 20.6% 45.1% 89.9% 33.5% 79.4% 41.2% 10.1%
Immunoglobulins in nasal secretions - IgA 38,2% 28/% 41,4% 31,5% 56% 60% 55,6% 57,9% 5,8% 12% 37,41% 10,6%
Note: Difference from the control group (p< 0.05, p>0.001).
IgA was detected in the nasal secretions of 25 patients with AR and 19 patients without atopy. IgA levels were normal in more than half of the patients examined, and low in one-third of the patients in the comparative group.
Conclusion. The results of scientific research showed that adenoiditis in children on the background of allergic rhinitis is characterized by an increase in the number of mucosal immune nasal secretions and eosinophils in the larynx. Immunological changes showed an increase in IgA (38.2%) deficiency in 1/3 of patients, high IgG (13.7%) in 1/2 of patients, and increased IgM (8.8%) in 1/3 of patients.
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