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0PHYSICAL DEVELOPMENT OF CHILDREN WITH DERMATO-RESPIRATORY ALLERGIES LIVING IN ECOLOGICALLY UNFAVORABLE REGIONS
1Otekeeva S.S., 2Jiemuratova G.K.
1Medical Institute of Karakalpakstan 2Nukus Branch of the Institute of Human Immunology and Genomics https://doi.org/10.5281/zenodo.13144758
Abstract. The close relationship between physical development and a child's condition highlights the necessity of studying the growth rates of the body under prolonged negative influences from adverse factors, including acute and chronic allergic diseases. Allergic diseases are significantly influenced by external factors, which classifies them as environmentally induced diseases. These conditions are characterized by clinical polymorphism, chronic stage-wise progression, and the development of accompanying pathological changes in various systems of the growing organism. Respiratory and dermatological allergies, in particular, have a significant impact on childhood morbidity. The interrelation of allergic diseases, such as atopic dermatitis (AD), allergic rhinitis, and bronchial asthma (BA), is well-established. In our country, many allergists and pediatricians refer to this combination as dermatologic-respiratory syndrome (DRS).
Keywords: children, physical development, respiratory allergies, allergic dermatitis, environmental factors.
Relevance. Physical development (PD) is one of the most important indicators of a child's health. The physical development of a child is a complex process of morphological and functional adaptations, which is externally manifested through changes in body size, proportions of different body parts, and the level of activity of the body's functions. The child's body has the greatest plasticity and is capable of changing under the influence of various exogenous and endogenous factors [3,14]. Physical development is directly related to the condition of the cardiovascular, respiratory, digestive, musculoskeletal, and other systems. The close relationship between PD and the child's condition underscores the need to study the growth rates of the body under prolonged negative influences from adverse factors, including acute and chronic allergic diseases [7,10].
Over the past decades, there has been a significant increase in allergic diseases worldwide [1,9]. This trend is particularly notable in the pediatric population. According to the European Academy of Allergy and Clinical Immunology, currently, one in four school-aged children suffers from allergies [7,11].
The objective of this study is to evaluate physical development in children with dermato-respiratory allergies based on data from current scientific research.
Scientific works focusing on allergic diseases and medical-environmental factors affecting the physical development of children and adolescents were reviewed and analyzed. Respiratory and dermatological allergies have a particularly high prevalence in the morbidity structure of children. The interrelation of allergic diseases, such as atopic dermatitis (AD), allergic rhinitis, and bronchial asthma (BA), has long been recognized.
According to the latest epidemiological data from the WHO (2020), over 40% of the global population shows signs of atopy, and scientific forecasts suggest a continuing rise in allergic diseases, indicating a potential non-infectious pandemic [11,14,20]. Allergic diseases include atopic dermatitis (AD), allergic rhinitis (AR), allergic conjunctivitis, often allergic enteritis, anaphylactic reactions, and eczema. According to Kaur et al. [23], the prevalence of AR increased from 10% in 1983 to 30% by the end of the century. The number of children showing signs of atopy from birth is also rising. Bronchial asthma (BA), being the most common and dramatic among allergic diseases, has a global prevalence exceeding 10%. This raises questions about the causes behind the rapid increase in allergic disease frequency. The impact of the environment on predisposing genetic factors is an area of intensive research that aims to improve our understanding of changes in modern human reactivity [13, 17, 25].
In our country, many allergists and pediatricians refer to this combination as the dermato-respiratory syndrome (DRS). In foreign literature, this combination of diseases is termed "atopic march," which is more appropriate, as the onset of DRS or atopic march typically begins in early childhood with the development of AD, which is subsequently followed by allergic rhinitis and then BA [2,10].
Reactive chemical compounds found in the air of ecologically disadvantaged areas can interact with the body's protein structures, potentially inducing the formation of specific IgE antibodies. This interaction may contribute to the development of sensitization to a broader range of allergens and a more severe progression of respiratory and skin manifestations of allergies in children and adolescents [11,19,21]. Significant risk factors for allergic diseases in adolescents include air pollution from industrial and chemical compounds [20]. Epidemiological studies reveal a higher prevalence of BA, AR, AD, and recurrent urticaria among adolescents living in ecologically disadvantaged areas [7, 9, 22, 24]. This increased prevalence in such areas may be linked to more frequent occurrences of immune dysfunctions, respiratory and digestive tract diseases, and neuroendocrine system disorders. The qualitative changes in environmental allergens due to chemical compounds also result in higher levels of allergenic activity [26].
The prevalence of atopic dermatitis (AD) varies significantly geographically, but in some countries, it can affect up to 20% of children [4,15]. In the Republic of Uzbekistan, the prevalence of asthma (BA) among adults is 6.9%, while among children and adolescents it is about 8-10% [5,19]. The prevalence of AD symptoms in different regions of Uzbekistan ranges from 6.2% to 15.5% [8,12].
A study conducted at the Institute of Nutrition of RAMN (2016) found a deficiency in the caloric value of the diet among patients with food allergies, associated with an elimination diet or caused by appetite disturbances and abdominal pain syndrome. Body weight deficiency in children with food allergies was observed in 45.4% of cases. Based on the obtained data, it was concluded that children with food allergies receive an unbalanced diet and are at risk for delayed physical development [6]. Data also indicate nutritional status impairments and delayed physical development in young children [7]. Persistent nutritional status impairments are often accompanied by delays in psychomotor development, speech and cognitive skills, and functions; high infection rates, which in turn exacerbate nutritional disorders [8]. Gastrointestinal food allergies are found in half of young children with delayed physical development and may be one of the factors contributing to its development [9].
AD and food allergies are most commonly observed in the first 2 years of life. Over time, the prevalence of AD and food sensitization decreases, and in later childhood, asthma, allergic rhinitis, and sensitization to inhalant allergens become more prominent. These conditions also differ in the variety of pathogenic impacts on other organs and systems, including physical parameters [8,17].
The highest prevalence of ENT diseases occurs in the toddler and preschool ages, with pharyngeal tonsil pathology (adenoids, chronic adenoiditis) accounting for 51.8% of the disease structure. In the preschool age, the second degree of physiological hypertrophy of adenoid vegetation is observed in approximately 70% of children. The role of allergy in the onset and progression of chronic adenoiditis in children has gained particular relevance in recent years [6,18].
Special scientific interest lies in the study of physical development in children with health deviations due to chronic nasopharyngeal pathology. In this context, bronchial asthma and atopic dermatitis are often accompanied by cognitive disorders, sleep disturbances, intellectual dysfunction, and limitations in children's activity, leading not only to physical but also psychological suffering [16,21].
O.V. Lavrova et al. [4] and others [4,11,21,25] consider skin and upper respiratory allergic diseases as indicators of an increased risk for the development and progression of asthma. Of 30 patients with atopic dermatitis, 20 with eczema, and 30 with vasomotor-allergic rhinosinusopathy, who considered themselves healthy regarding respiratory organs, 67.5% reported episodic dry cough and distant wheezing upon detailed questioning. Bronchospasm signs were detected in 42.5% of patients through spirometry, and a positive acetylcholine test was found in 80.1% of cases.
Several studies have shown that chronic tonsillitis can cause reproductive function disorders [4]. Other scientific data indicate a significant number of patients with obesity of grades I—III among these individuals [5].
According to global estimates by the WHO, from 1975 to 2016, the number of people suffering from obesity worldwide more than tripled, and the number of children and adolescents with obesity increased from 11 million in 1975 to 124 million in 2016. In 2016, approximately 41 million children under the age of 5 were recorded as being overweight or obese, and 340 million children and adolescents aged 5 to 19 were affected. Overweight and obesity, which were previously considered characteristic of high-income countries, are now becoming increasingly common in low- and middle-income countries, particularly in urban areas. The rise in overweight and obesity among children prompted the WHO to develop the "Global Strategy on Diet, Physical Activity, and Health" in 2004 [14,25].
Currently, the prevalence of overweight and obesity among school-aged children and adolescents reaches 25-30%. According to literature, obesity exacerbates the severity of atopic dermatitis (AD). It is known that both skin conditions, including itching dermatitis, and obesity affect not only the physical state of the patient but also reduce quality of life at any age [9,18].
There is a substantial amount of literature studying the relationship between obesity and skin conditions, although most of these studies focus on adult patients. Research specifically aimed at examining the prevalence and clinical features of dermatological pathology in children with obesity and excess weight is limited. For example, a study conducted by R. Soltani-Arabshahi et al. found that obesity occurring before the age of 18 increases the likelihood of developing
psoriatic arthritis [23]. Several studies have investigated the relationship between obesity and atopic dermatitis; however, the underlying mechanisms remain unclear [16, 17].
To date, a substantial body of scientific data confirms a certain relationship between asthma and obesity. It has also been established that among the spectrum of morphofunctional disorders in children with asthma and allergic rhinitis, disharmonic physical development associated with excess body weight is predominant [23,26].
There is information on the relationship between physical development and the characteristics of asthma in children; however, opinions on the impact of the disease on growth are mixed. Literature mainly discusses the impact of therapy on the growth rates of affected children, with virtually no data on the prevalence of physical development disorders in children with asthma compared to population-based indicators [1,18].
Current understanding suggests that the role of predisposing genetic factors in allergic diseases is complex and multigenetic, unlike monogenic diseases such as essential pulmonary emphysema, cystic fibrosis, and some others. Allergic diseases are significantly influenced by pollutants and other external factors, which classifies them as environmentally induced diseases [13,15].
Thus, the available data confirms the relationship between the presence of atopy, the severity of allergic diseases, and indicators of physical development in children. However, the limited and heterogeneous results highlight the need for further research.
Conclusion. The available data confirms the existence of a relationship between the severity of clinical characteristics of the dermato-respiratory syndrome and indicators of physical development in children. The identified clinical characteristics of dermato-respiratory syndrome in children and adolescents with excess body weight underscore the importance of further research. The systemic nature of atopy with the development of excess weight and obesity, as well as the associated respiratory allergies in patients with atopic dermatitis (AD), suggests that AD is a multifaceted pathology. At the same time, the association of the disease with endocrinopathies such as obesity requires further detailed study.
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