«
Colloquium-journal
»
#11(63),2020 /
MEDICAL SCIENCES
5
MEDICAL SCIENCES
Devorova M.B.
Ph.D. assistant professor
Department of Ambulatory Medicine and Physical Education
Tashkent Pediatric Medical Institute. Tashkent city.
Shamansurova E.A.
MD. Professor of the
Department of Ambulatory Medicine and Physical Education.
Tashkent Pediatric Medical Institute. Tashkent city.
ALLERGIC DISEASES IN CHILDREN FROM MOTHERS WITH AN ALLERGIC HISTORY AND
ASPECTS FORMATION OF FOOD INTEGRABILITY
The article includes data from a literature analysis on aspects of allergopathology in children, which are
important for physicians, especially pediatricians, and the study of this problem remains an open question.
Key words:
young age, distribution, aspects, growth, diseases.
Allergic diseases are currently characterized by
steady growth, so the problem of diagnosis and treat-
ment remains the focus of attention of many researchers
and doctors. The particular relevance of this issue for
pediatricians is also due to the fact that more than half
of all new cases of allergic diseases have their first
manifestations from an early age.
As noted by the authors of the literature, the con-
cept of “tolerance” to dietary proteins can be consid-
ered in two aspects: Formation of tolerance of dietary
proteins during the formation of the immunological
phenomenon of “oral tolerance”, when the immune sys-
tem is utero and then learns not to respond to a born
baby active on a wide range of proteins that enter en-
terally.
This process begins in utero, continues actively in
the first months of life and in early childhood. The pos-
sibility of influencing the mechanisms of formation of
such a “primary” tolerance is the basis of modern ap-
proaches to the prevention of PA; In children who are
allergic to food proteins, tolerance to these proteins can
form over time. For different proteins, the frequency of
formation of such a “secondary” tolerance is different -
it is highest among proteins of cow's milk and chicken
eggs. The formation of tolerance is much less common
with allergies to peanuts, fish, and other allergens. The
formation of food tolerance primarily depends on a ge-
netic predisposition to the development of allergic dis-
eases.
An analysis of the literature showed that the dura-
tion of breastfeeding and, in the absence of breast milk,
the choice of a mixture, the timing of the introduction
of complementary foods, the choice of products for ad-
ministration, the state of the gastrointestinal tract and
the composition of the intestinal microflora, the state of
innate and humoral immunity, are of great importance.
Of course, children from the risk group for the for-
mation of allergic diseases (the presence of allergic dis-
eases in parents or siblings) are more likely to develop
them. So, in the case of an allergic disease in one of the
parents, the risk of developing an allergic disease ex-
ceeds the population by 30-40%, and if there is an al-
lergy in both parents, by 50-80%. According to some
reports, due to the presence of 25 burdened heredities
for allergic diseases, up to 30% of newborns have a
high risk of their development.
The authors noted the fact that during pregnancy,
in the ratio of T helper cells (Th1 / Th2) in the mother,
regardless of the presence or absence of an allergic dis-
ease, Th2 dominates. This physiological mechanism re-
duces the risk of T-associated placental rejection. The
immune system preserves the dominant Th2 type and
supports the production of immunoglobulin (Ig) E in
the baby during the prenatal period, and after birth, un-
der the influence of certain factors, the Th2 type of the
immune response switches to the Th1 type of the im-
mune response. Under the influence of genetic and ex-
ternal factors in some children, the balance between
Th1 / Th2 is disturbed, which can lead to a significant
imbalance in the immune response and an increase in
IgE production in the first year of a child's life.
According to most researchers, the early intake of
a foreign antigen and the state of its own intestinal mi-
crobiota affect the Th1 / Th2 balance through special
mechanisms of innate and acquired immunity. At the
same time, there is convincing evidence that strict elim-
ination of allergens can inadvertently contribute to an
increased risk of developing allergic diseases, includ-
ing due to the lack of the possibility of tolerance to
these allergens. This is true for both food and inhalant
allergens. Due to the lack of convincing data in favor
of the effectiveness of strict elimination measures dur-
ing pregnancy, the previous recommendations were
postponed until six months of age and strict elimination
measures for allergenic products during pregnancy
were rejected. It is also not recommended to avoid
probable inhalation allergens during pregnancy and
during the neonatal period.
Further analysis of literature showed that experi-
mental animal studies support the hypothesis of tolero-
genic properties of breast milk. This is mediated
through tolerogenic cytokines, such as transforming
growth factor (TGF), which contribute to the regulation
of the ratio of T cell populations in the intestines of the
newborn. Allergy to cow's milk proteins rarely devel-
6
MEDICAL SCIENCES
/
«
Colloquium-journal
»
#11(63),2020
ops in exclusively breast-fed infants. As well as a pro-
spective study of children from birth fed a standard for-
mula based on cow's milk during the first days of life,
showed an association with an increased risk of devel-
oping allergies to cow's milk proteins, especially in
children with a hereditary predisposition to allergies.
Introduction to the feeding of children in maternity hos-
pitals with standard mixtures based on cow's milk in-
creases the risk of allergies compared with children re-
ceiving breast milk or mixtures based on hydrolyzed
proteins. However, only breastfeeding also does not ex-
clude the risk of a possible allergy to cow's milk pro-
teins. Based on this, many experts strongly recommend
maintaining breastfeeding for as long as possible, but if
a mixture is needed, it is better to use a standard milk
mixture for children with a genetic predisposition to al-
lergies. In a large, multicenter, randomized trial con-
ducted by von Berg A. et al. 2252 newborns at risk who
received a mixture based on moderately hydrolyzed
whey protein or a mixture based on highly hydrolyzed
whey protein and highly hydrolyzed casein were in-
cluded. Newborns who were breastfed were excluded
from the analysis (N = 945). According to the results of
the study, it turned out that there was a significant de-
crease in the frequency of formation of the syndrome of
atopic 27 dermatitis / eczema at 1, 3, 6 and 10 years in
children who received hydrolyzed mixtures. Immuno-
logical mechanisms of oral tolerance Currently, den-
dritic cells (DC) currently play a key role in the for-
mation of either an allergic reaction to food allergens or
oral tolerance.
There are several subclasses of DC with regulatory
functions that are present in the intestine and therefore
are potentially important for the formation of oral tol-
erance. Conventional myeloid DCs and plasmacytoid
DCs of Peyer's patches have unique regulatory func-
tions and can contribute to the formation of oral toler-
ance. DCs have the ability to suppress the immune re-
sponse, most likely by inducing the differentiation of
naive T cells into regulatory T cells (Treg). CD103 +
DC, located mainly in the own plate of the mucous
membrane, capture the antigen and migrate to the mes-
enteric lymph nodes, where they initiate the formation
of regulatory T cells. It has been shown that the capture
of angiens in M cells of Peyer's patches is also involved
in the induction of oral tolerance, although it seems that
mesenteric lymph nodes are the main recognition zone
of T cells. In general, when the components of the ac-
cepted “harmless” food are captured by DC of the in-
testinal mucosa, regulatory T cells are formed that sup-
port the induction of oral tolerance. These cells sur-
round natural or induced CD 4 + CD25 + Foxp3 +,
TGF-β-producing Th3 and IL-10-producing Treg1
cells. In experimental studies in mice, it was shown that
CD103 + DCs cause differentiation of Foxp3 + - regu-
latory T cells due to mechanisms involving TGF-β and
retinoic acid (PK), which comes from food. Oral toler-
ance caused by a partial hydrolyzed mixture based on
serum proteins of cow's milk leads to the induction of
regulatory 28 Treg or Th1, a decrease in the relative
number of Th2 in mesenteric lymph nodes.
Treg and T-effectors accumulate in their own plate
of the mucous membrane, where they can participate in
an effective immune response directed against specific
antigens. In experimental studies, tolerance caused by
a partial hydrolyzed mixture based on serum proteins
of cow's milk was associated with an increase in the
percentage of Foxp3 + Treg and CD103 + DC in mes-
enteric lymph nodes. Previous studies have shown that
infant formula with the addition of indigestible oligo-
saccharides containing neutral short galactooligosac-
charides and long-chain fructooligosaccharides in a 9:
1 ratio cause functional suppression involving regula-
tory Treg. Mixtures containing neutral short galactooli-
gosaccharides and long-chain fructooligosaccharides in
combination with 9: 1: 1 pectic acid oligosaccharides
support the development of a population of tolerogenic
DC and regulatory T cells. Epithelial mediators, such
as PK and TGF-β, can indirectly contribute to this ef-
fect, since they induce CD103 + DC. In the case of al-
lergic sensitization, the plasmocytes produce specific
IgE, which rush to the mast cell membrane, followed
by their degranulation upon repeated contact with the
allergen. The timing of the formation of tolerance in
children allergic to BMD (Protein of cow's milk). The
timing of the formation of tolerance in these patients
with PA and, accordingly, the timing of elimination
measures for allergies to BMD are individual. The fre-
quency of formation of milk protein tolerance in chil-
dren who were allergic to BMD in the first year of life
with non-IgE-mediated form of allergy to BMD can
reach 100% by 5 years, while with an IgE-mediated
form these figures are significantly lower.
So, according to Saarinen KM. with co-authors, 29
with IgE-mediated allergy, tolerance to BMD develops
in 74% of children by 5 years old and in 85% by 8-9
years of age. According to Elizur A. et al, this occurs in
41% of children by 2 years of age and in 57% of chil-
dren by 4 years of age. The least optimistic prognosis
of the formation of tolerance to BMD in the IgE-medi-
ated form, gives J.M. Skripak, who co-authored the
largest number of clinical observations (807 patients),
was 19% at 4 years old, 64% at 12 years old and 79%
at 16 years of age. This means that every fifth child with
an IgE-mediated allergy to BMD, which started at an
early age, does not tolerate milk even at the age of 16.
Factors affecting the timing of the formation of toler-
ance to BMD and the duration of the elimination diet
Normally, priming by lymphocytes of BMD begins
prenatally. Subsequently, a pronounced immune re-
sponse to BCM and other dietary proteins is noted in
the first months of life. An increase in the level of IgG,
including the IgG1 subclass, is a physiological reaction
to the introduction of a foreign protein. The level of
specific IgG antibodies rises within a few weeks after
the introduction of infant formula into the diet and
reaches a peak after 3-4 months. Small amounts of spe-
cific IgE are also part of the physiological response to
foreign cow's milk proteins. However, significant pro-
duction of specific IgE for BMP in combination with
clinical manifestations is a diagnostic criterion for the
IgE-mediated form of PA for milk proteins, and is also
a predictor of its persistence. Moreover, a periodic ex-
amination with an assessment of the level of specific
IgE allows predicting the development of tolerance.
«
Colloquium-journal
»
#11(63),2020 /
MEDICAL SCIENCES
7
Thus, based on the literature data, we can say
about the appropriateness of further study of this prob-
lem in pediatrics.
Literature
1.E.A. Vishneva, L.S. Namazova-Baranova, T.V.
Turty, R.M. Torshkhoeva, A.A. Alekseeva, Yu.G.
Levin. Allergy to cow's milk proteins. Approaches and
treatment algorithms. The scientific and practical jour-
nal "Questions of modern pediatrics" - 2012 - T. 11 -
No. 3 - P. 65-69
2. Guzyr O.V., Klnsakh V.A., Shkztova A.N. and
cytokines and inflammation. 2002. No2. S. 93-94.
3. Gumilevskaya O.P., Gumilevsky B.Yu., An-
tonov Yu.V. // Cytokines and inflammation. 2002. No.
2. P. 94.
4. Makarova S.G., Namazova-Baranova L.S.,
Vishneva E.A., Gevorkyan A.K., Alekseeva A.A., Pe-
trovskaya M.I. Actual issues of diagnosing food aller-
gies in pediatric practice. Herald of the RAMS, 2015,
No. 1, 41-46.
5.Wood RA, Sicherer SH, Vickery BP, Jones SM,
Liu AH, Fleischer DM, Henning AK, Mayer L, Burks
AW, Grishin A, Stablein D, Sampson HA. The natural
history of milk allergy in an observational cohort. J Al-
lergy Clin Immunol. 2013 Mar; 131 (3): 805-812.
6. Woodcock A., Lowe L. A., Murray C. S., Simp-
son B. M., Pipis S. D., Kissen P. et al. Early life envi-
ronmental control: effect on symptoms, sensitization,
and lung function at age 3 years. Am. J. Respir. Crit.
Care Med. 2004; 170: 433–439.
7. Yanagida N, Minoura T, Kitaoka S. Butter Tol-
erance in Children Allergic to Cow's Milk. Allergy
Asthma Immunol Res. 2015 Mar; 7 (2): 186-189.
8. Yavuz ST, Buyuktiryaki B, Sahiner UM, Birben
E, Tuncer A, Yakarisik S, Karabulut E, Kalayci O,
Sackesen C. Factors that predict the clinical reactivity
and 146 tolerance in children with cow's milk allergy.
Ann Allergy Asthma Immunol. 2013 Apr; 110 (4): 284.
Азонов Д.А.
доктор медицинских наук,
профессор, ЦНИЛ ТГМУ им. Абуали ибн Сино
Гулзода М.К.
доктор медицинских наук, профессор, ректор
Таджикского государственного медицинского Университета им. Абуали ибн Сино
Ганиев Х.А.
Кандидат медицинских наук, доцент,
директор ЦНИЛ ТГМУ им. Абуали ибн Сино
Бобоев Дж.А.
соискатель ЦНИЛ ТГМУ им. Абуали ибн Сино
.
Центральный научно-исследовательский лаборатория
Таджикского государственного медицинского Университета им. Абуали ибн Сино
ЖЕЛЧЕГОННЫЕ СВОЙСТВА КОМПЛЕКСНОГО ВВЕДЕНИЯ ФЕРАЗОНА С
ЛИПОВИТОЛОМ, КАРВИОЛОМ И ЛИМОНЕОЛОМ НА ЗДОРОВЫХ КРЫСАХ И МОРСКИХ
СВИНКАХ
Azonov D.A.
Doctor of Medical Sciences, Professor,
Central Scientific Research Laboratory of TSMU named after Abuali ibn Sino
Gulzoda M.K.
Doctor of Medical Sciences, Professor,
Rector of the Tajik State Medical University. Abuali ibn Sino
Ganiev H.A.
Candidate of Medical Sciences, Associate Professor,
Director of the Central Scientific Research Laboratory of TSMU named after Abuali ibn Sino
Boboev J.A.
Applicant TSNIL Central Research Laboratory of
Tajik State Medical University named after Abuali ibn Sino
Central Research Laboratory of
Tajik State Medical University named after Abuali ibn Sino
CHOLERIC PROPERTIES OF COMPLEX ADMINISTRATION OF PHERASON WITH LIPOVITOL,
CARVIOL AND LIMONEOL ON HEALTHY RATS AND GUINEA PIGS
Резюме
Данная статья посвящена желчегонным свойствам комплексного введения Феразона+липовитола,
Феразона +лимонеола, Феразона+карвиола в дозах 0,5 -0,02 г/кг на здоровых белых крысах и морских свин-
ках. Экспериментальными исследованиями установлено, что испытуемые средства в указанных дозах
оказывают заметный желчегонный эффект как на белых крысах, так и на морских свинках. Наряду с
