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ребенка
КлУчна пед1атр1я / Clinical Pediatrics
УДК 616-079.3-053.2-616.39-616.2
KLYMENKO V.A., KARPUSHENKO J.V., SERVETNIK A.V. Kharkiv National Medical University, Ukraine
OPTIMIZATION OF THE LABORATORY DIAGNOSIS OF ALLERGIES WITH REGARD TO REGIONAL PECULIARITIES
Summary. Allergic pathology is one of the most pressing issues in contemporary medicine. The most important task during the treatment of allergic diseases is the determination of cause-significant allergens. Nowadays, the identification of specific IgE in the blood serum is widely used in Ukraine for the diagnostics of food and respiratory allergies. The majority of the laboratories offer the identification of specific IgE in the form of panels, the composition of which not exactly corresponds to our regional peculiarities. This article presents the results of the analysis of 790 medical histories of children aged 3—17 years with allergic pathology. Sensitization to allergens has been identified by determining the specific IgE in the blood serum and by skin prick testing. As a result, the following relevant food allergens were detected: fish, beans, strawberry, wild strawberry, apricot, peach, raspberry, cherry, sweet cherry, plum, apple, pear, citrus fruits, chicken protein, cow's milk protein. Representative pollen allergens of Kharkiv region are: ragweed, sagebrush, sumpweed, dandelion, buckwheat, sorrel, poplar, acacia, maple, alder, oak. To optimize laboratory diagnostics in the Kharkiv region when preparing test panels, it is recommended to separately identify food and pollen allergens based on their relevance. The composition of the panels of pollen allergens should be reviewed, taking into account the data of the regional aeropalynologic researches. Key words: children, allergy, laboratory diagnosis.
Allergic pathology is one of the pressing issues in contemporary medicine. The urgency of the problem is primarily due to the prevalence of allergic diseases — in particular, according to the data provided by the European Association of allergologists and clinical immunologists, 150 million Europeans suffer from allergy, and in the following decade this number will increase up to 300 million. In the Western countries the prevalence of allergic rhinitis reaches up to 30 %, of bronchial asthma — up to 20 %, of allergic dermatitis — up to 15 % and of food allergies — up to 8 % [2]. Allergic diseases significantly reduce the patient's quality of life and are often the cause of disability [3, 4]. These diseases are a heavy economic burden to both families and the society. It is estimated that only direct expenses for the treatment of asthma in Europe make up €3.6 billion on medicine and €4.3 billion on medical care [5].
The most important task during the treatment of allergic diseases is the determination of cause-significant allergens. The foregoing is necessary in case of food allergy for prescribing elimination diets as well as in the event of respiratory forms of allergies for conducting both elimination measures and allergen-specific immunotherapy.
Food allergy is the first temporal development form of sensitization and has significant influence on the formation and subsequent development of all allergic di-
seases of children. Different countries have their own regional food allergens, which depend on the climate and geographical location of the country and characteristics of the population's diet. Pursuant to the data provided by the World Organization of Allergists, different countries have different patterns of food sensitation: that is, in the USA and Switzerland, apart from egg and milk allergy, peanut allergy is also a common one, while in Germany and Japan the most prominent allergen is wheat, in Spain it is fish, and in Israel-sesame [6].
Allergens that play a part in the development of respiratory allergic diseases (bronchial asthma, allergic rhinitis) also have substantial regional distinctions due to the diversity of climate, flora, periods of plant pollination, properties of pollen (in particular, the change of its al-lergenic qualities depending on the ecological state of the environment). Significant differences in the spectrum of
Адреси для листування з авторами: Клименко Вжторш Анатоливна E-mail: [email protected] Карпушенко Юлш Валентишвна E-mail: [email protected]
© Klymenko V.A., Karpushenko J.V., Servetnik A.V., 2015 © «Child's Health», 2015 © Zaslavsky A.Yu., 2015
Клшнна пед1атр1я / Clinical Pediatrics
pollen sensitization, the time of the onset and the duration of clinical symptoms of pollinosis may also be observed even within the territory of one country.
Nowadays the identification of specific IgE by means of ELISA is widely practiced in Ukraine for the diagnostics of food and respiratory allergies. Most laboratories offer identification of specific IgE in the form of panels, the composition of which does not entirely correspond with our regional peculiarities. For instance, a pediatric panel includes: milk, chicken egg protein, home dust, a mixture of alder and birch pollen, oak pollen, wormwood pollen, mites, dog and cat epidermis, crabs, shrimp mixture, fungus, ambrosia, timothy, soya beans and rye. Nevertheless, it is known that food allergy prevails at an early age (children under 3 year old), and therefore the determination of sensitization to pollen does not make sense. On the other hand, it is also not necessary to determine sensitization to shrimps, cancroids, mushrooms and soya, because these products are not included in the diet of young children. Some food panels include products (peanuts, sesame, cocoa, shellfish, spinach, and others), the determination of sensitization to which is also irrelevant due to the fact that they are not typical for our population's diet.
A broad spectrum for pollen allergens is marked depending on the geographical zones — in particular, the main reason for polinosis in the central regions of the European part of Russia is the pollen of meadow grasses and trees (birch, alder, walnut, maple, oak); in Belarus it is the pollen of wild and cultivated cereals; in Kazakhstan — wormwood pollen, hemp and cereals, in Italy it is cereals, nettle, birch and olive; in India — eucalyptus and acacia [1, 7, 8]. The composition of the panels of pollen allergens should also be reviewed with regard to the data of regional airplane research.
Research objective
Determining the relevant food and pollen allergens in the Kharkiv region for the optimization of laboratory diagnosis of allergic diseases among children.
Materials and methods
A retrospective analysis of 790 medical histories of children aged 3—17 years with allergic diseases has been conducted; the children were examined during 2010— 2013 in the Regional children's allergy centre of Hospital № 1. The identification of food and pollen sensitization was carried out by means skin prick-testing and the identification of specific IgE in the serum through ELISA. The results were processed by methods of variation statistics using «Microsoft Excel» and «BIOSTAT» (2006) on a Pentium IV PC.
Results and their discussion
54 (51.4 %) of the patients had their causative food allergens determined by skin prick-tests, and 51 (48.6 %) of the patient had their specific IgE determined. The total number of identified allergens was 47. We have combined all the allergens in groups according to the generality of the antigenic structure: cow protein (milk, beef), chicken protein (albumen, yolk, meat), fish (carp, hake, pollack), gluten cereals (wheat, rye, oats, barley), gluten-free cereals (rice, buckwheat, millet, maize), Ro-saceae (strawberry, wild strawberry, apricot, peach, raspberry, cherry, sweet cherry, plum, apple, pear), citrus fruits (orange, lemon, mandarin), Solanaceous (tomato, potato), carrot, legumes (beans, peas, cocoa), pork, Cu-curbitaceae (watermelon, pumpkin, melon, cucumber), as well as cabbage, beetroot, onions, banana, currants, black tea, grapes (Fig. 1).
%
100 90 — 80 — 70 — 60 — 50 — 40 — 30 — 20 — 10 0
97
98
92
83
93 95 95 94 92
68
83
79
86
79
75
70
61 59
Figurel. Distribution of food allergen sensitization in the main group
Kaíhnhq neAiaTpifl / Clinical Pediatrics
As seen in Fig. 1, it was fish, legumes, berries and fruits of the Rosaceae family, citrus fruits, Solanaceous, chicken protein, cow's milk protein and cereals that most frequently caused sensitization among examined children; vegetables and fruits (banana, pumpkin, onion, beetroot, cabbage, currants) caused sensitization a little bit less frequently. The received data differs from the one presented in medical literature, according to which sensitization to peanuts, seafood, eggs is the most common one.
685 children were subjected to allergy testing with pollen allergens. Consequently, it was found that 311 children (45.04 %) had high sensitization to pollen allergens. The obtained results are presented in table 1, with plants ranked in descending order of their allergic properties.
Most of the children (276 patients, which constitutes 88.7 %) demonstrated polyvalent sensitization.
The analysis of pollen sensitization helped identify the most representative allergenic taxa for the Kharkiv
Table 1. Characteristic of pollen sensitization among children of the Kharkiv region
№ Name of allergens Number of detections Presence of sensitization
N %
1 Ambrosia artemisiifolia 305 168 55,08
2 Dandelion 306 140 45,75
3 Artemisia absinthium 306 122 39,87
4 Populous 397 118 39,73
5 Cyclachaena xantifolia 228 90 39,47
6 Helianthus annuus 305 120 39,34
7 Buckwheat satio 215 81 37,67
8 Lignorum setthim ante 215 80 37,21
9 Rumex 215 78 36,28
10 Festuca pratensis 306 111 36,27
11 Poa pratensis 301 100 33,22
12 Acer 248 82 33,06
13 Alnus aglutinosa 305 99 32,46
14 Lolium perenne 229 73 31,88
15 Plantago 291 92 31,62
16 Avis-cerasis lignum 215 67 31,16
17 Quercus 244 74 30,33
18 Salix 215 65 30,23
19 Tilia 292 85 29,11
20 Dactylis glomerata 285 79 27,72
21 Betula 306 84 27,45
22 Seniorem 291 79 27,15
23 Triticum 285 77 27,02
24 Chenopodiaceae 306 80 26,14
25 Juglans 292 73 25
26 Cinis 215 52 24,19
27 Alopecurus pratensis 301 72 23,92
28 Urtica diodica 288 65 22,57
29 Festuca pratensis 306 69 22,55
30 Aesculus hippocastanu 292 65 22,26
31 Corylus avellana 304 67 22,04
32 Item carpinus 215 42 19,53
33 Zea mays 306 58 18,95
34 Pinus silvestris 241 41 17,01
35 Picea 214 36 16,82
36 Phleum pratense 259 40 15,44
37 Agropyrum repens 241 26 10,79
Клш1чна пед1атр1я / Clinical Pediatrics
region — weeds (ambrosia, artemisia absinthium, cy-clachaena xantifolia). Among trees the populus, ligno-rum setthim ante, acer, alnus aglutinosa and quercus were ranked first by allergic properties. Betula pollen is a common cause of allergic rhinitis in many areas. In the Kharkiv region, it ranks 21st and is the cause of sensiti-zation among 28 % of patients with allergic diseases. In addition, an unusually high sensitization to pollen, dandelion (46 %) and rumex (36 %) is observed.
Conclusions
1. The identified relevant regional food allergens include: fish, legumes, berries and fruits of the Rosaceae family (strawberry, wild strawberry, apricot, peach, raspberry, cherry, sweet cherry, plum, apple, pear), citrus, chicken protein, cow's milk protein.
2. The regional differences in the spectrum of pollen sensitization were defined. In particular, the most representative allergenic taxa in the Kharkiv region are weeds (ambrosia, artemisia absinthium, cyclachaena xantifolia), dandelion, buckwheat satio, rumex and trees such as populus, lignorum setthim ante, acer, alnus aglutinosa, quercus.
3. During the preparation of test panels manufacturers are recommended to determine food and pollen allergens separately, because they have different significance for children depending on the nosological form and the period of childhood.
4. During the preparation of test panels manufacturers or specialists should arrange the allergens with regard
to the relevant regional factors which have specific climatic and geographical distinctions.
Literature
1. Довiдник з алергологй'/ Науково-методичне видання / За ред. Пухлика Б.М. — К..: ТОВ «Доктор-Медиа», 2011. — С. 158-160.
2. EAACI: A European Declaration on Immunotherapy. Designing the future of allergenspecific immunotherapy Calderonetal // Clinical and TranslationalAllergy. — 2012. — 2. — 20//http://www.ctajour-nal.com/content/2/1/20
3. Baiardini I., Braido F., Tarantini F., Porcu A., Bonini S., Bousquet P.J. et al. ARIA-suggested drugs for allergic rhinitis: what impact on quality of life? A GALEN review // Allergy. — 2008. — 63(6). — 660-669.
4. Wertz D.A., Pollack M., Rodgers K., Bohn R..L., Sacco P, Sullivan S.D. Impact of asthma control on sleep, attendance at work, norma lactivities, and disease burden // Ann. Allergy Asthma Immunol. — 2010. — 105(2). — 118-123.
5. European Respiratory Society (ERS): European Lung White Book. The First Comprehensive Survey on Respiratory Health in Europe, 2003.
6. World Allergy Organization (WAO) Special Committee on Food Allergy. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines / Fiocchi A., Brozek J., Schünemann H., Bahna S.L., von Berg A., Beyer K., Bozzola M, Bradsher J., Compalati E., Ebisawa M., Guzman M.A., LiH, Heine R.G., Keith P., Lack G., LandiM., Mar-telli A., Rance F., Sampson H., Stein A., Terracciano L., Vieths S. // Pediatr. Allergy. Immunol. — 2010. — Vol. 21, Suppl. 21. — P. 1-125.
7. Airborne allergenic pollens in Padua: 1991-1996/ Giorato M., Lorenzoni F. et al. // Aerobiologia. — 2000. — Vol. 16. — P. 453-454.
8. Kobzar V. Aeropalynological monitoring in Bishkek, Kyrgyz-stan //Aerobiologia. — 1999. — Vol. 15. — P. 149-153.
Отримано 10.10.15 ■
Клименко В.А., Карпушенко Ю.В., СерветникA.B. Харьковский национальный медицинский университет
ОПТИМИЗАЦИЯ ЛАБОРАТОРНОЙ ДИАГНОСТИКИ АЛЛЕРГИИ С УЧЕТОМ РЕГИОНАЛЬНЫХ ОСОБЕННОСТЕЙ
Резюме. Аллергическая патология является одной из наиболее актуальных проблем современной медицины. При лечении аллергических заболеваний наиболее важным является определение причинно-значимых аллергенов. Для диагностики пищевой и респираторной аллергии в настоящее время в Украине широко используют определение специфических IgE в сыворотке крови. Большинство лабораторий предлагают определение специфических IgE в виде панелей, состав которых не вполне соответствует нашим региональным особенностям. В статье представлены результаты анализа 790 историй болезни детей 3—17 лет с аллергопатологией. Сенсибилизация к аллергенам выявлялась путем определения специфических IgE в сыворотке крови и кожными прик-тестами. В результате выявлены релевантные пищевые аллергены: рыба, бобовые, клубника, земляника, абрикос, персик, малина, вишня, черешня, слива, яблоко, груша, цитрусовые, куриный белок, белок коровьего молока. Репрезентативные пыльцевые аллергены Харьковского региона: амброзия, полынь, циклахена, одуванчик, гречка посевная, щавель конский, тополь, акация, клен, ольха, дуб. Для оптимизации лабораторной диагностики в Харьковском регионе при составлении тест-панелей рекомендовано отдельно определять пищевые и пыльцевые аллергены с учетом их релевантности. Состав панелей пыльцевых аллергенов следует пересматривать, учитывая данные региональных аэропалинологических исследований.
Ключевые слова: дети, аллергия, лабораторная диагностика.
Кл1менко В.А., Карпушенко Ю.В., Серветник A.B. Хармвський нацюнальний медичний ун!верситет
ОПТИМ|ЗАЦ|Я ЛАБОРАТОРНО1 Д1АГНОСТИКИ АЛЕРГИ З УРАХУВАННЯМ РЕГЮНАЛЬНИХ ОСОБЛИВОСТЕЙ
Резюме. Алерпчна патолопя е одшею з найбшьш акту-альних проблем сучасно! медицини. При лшуванш алер-пчних захворювань найбшьш важливим е визначення причинно-значущих алергешв. Для дiагностики харчово! та ресшраторно! алерги тепер в Укра1Ш широко викорис-товують визначення специфiчних IgE в сироватщ кровь Бшьшють лабораторш пропонують визначення специфiч-них IgE у виглядi панелей, склад яких не зовшм вщповь дае нашим репональним особливостям. У статп наведет результата аналiзу 790 юторш хвороби дней 3—17 ротв з алергопатолопею. Сенсибшзац1я до алергешв виявляла-ся шырними тестами та визначенням специфiчних IgE в сироватщ кровь Виявлено релевантш харчовi алергени: риба, бобов^ полуниця, суниця, абрикос, персик, малина, вишня, черешня, слива, яблуко, груша, цитрусов^ курячий бшок, бшок коров'ячого молока. Репрезентативш пилковi алергени Харывського репону: амброз1я, полин, циклахена, кульбаба, гречка пошвна, щавель ынський, тополя, акацiя, клен, вшьха, дуб. Для оптимiзацii лабора-торно! дiагностики в Харывському репош при складанш тест-панелей рекомендовано окремо визначати харчовi та пилковi алергени з урахуванням !х релевантность Склад панелей пилкових алергешв слщ переглядати, враховуючи даш репональних аеропалшолопчних дослщжень.
Kro40Bi слова: дии, алергени, лабораторна дiагностика.
