mimmunМедицинская иммунологияMedical Immunology (Russia)1563-06252313-741XSPb RAACI10.15789/1563-0625-AOA-2542mimmun-2542Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОценка уровня срыва толерантности к аллергенам при локальном и классическом аллергическом ринитеAssessment of allergen tolerance breakdown levels in local and classical allergic rhinitishttps://orcid.org/0000-0001-6673-7556КлимовА. В.KlimovA. V.

к.м.н., ассистент кафедры оториноларингологии

г. Томск

PhD (Medicine), Assistant Professor, ORL Depatment

Tomsk

СалахутдиноваЗ. В.SalakhutdinovaZ. V.

аспирант кафедры иммунологии и аллергологии

г. Томск

Postgraduate Student, Department of Immunology and Allergology

Tomsk

НайдинаО. А.NaidinaO. A.

к.м.н., ассистент кафедры иммунологии и аллергологии

г. Томск

PhD (Medicine), Assistant Professor, Department of Immunology and Allergology

Tomsk

КлимовВ. В.KlimovV. V.

Климов Владимир Васильевич, д.м.н., профессор, заведующий кафедрой иммунологии и аллергологии

634041, г. Томск, ул. Вершинина, 28, кв. 5Тел.: 8 (906) 950-63-35

Klimov Vladimir V. PhD, MD (Medicine), Professor, Head, Department of Immunology and Allergology

634041, Tomsk, Vershinin str., 28, apt. 5Phone: 7 (906) 950-63-35

klimov@mail.tomsknet.ruСвиридоваВ. С.SviridovaV. S.

к.м.н., доцент кафедры иммунологии и аллергологии

г. Томск

PhD (Medicine), Associate Professor, Department of Immunology and Allergology

Tomsk

ПронинаН. А.ProninaN. A.

к.м.н., ассистент кафедры иммунологии и аллергологии

г. Томск

PhD (Medicine), Assistant Professor, Department of Immunology and Allergology

Tomsk

СлёзкинМ. И.SlezkinM. I.

ординатор кафедры патологической анатомии

г. Томск

Clinical Resident, Department of Pathological Anatomy

Tomsk

ФГБОУ ВО «Сибирский государственный медицинский университет» Министерства здравоохранения РФРоссияSiberian State Medical UniversityRussian Federation202231102022245967978Copyright © Климов А.В., Салахутдинова З.В., Найдина О.А., Климов В.В., Свиридова В.С., Пронина Н.А., Слёзкин М.И., 20222022Климов А.В., Салахутдинова З.В., Найдина О.А., Климов В.В., Свиридова В.С., Пронина Н.А., Слёзкин М.И.Klimov A.V., Salakhutdinova Z.V., Naidina O.A., Klimov V.V., Sviridova V.S., Pronina N.A., Slezkin M.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.mimmun.ru/mimmun/article/view/2542

Локальный аллергический ринит – новый эндотип аллергического ринита, который был идентифицирован исследователями испанской аллергологической школы, в настоящее время оказался в поле интереса аллергологов на международном уровне. Особенностью локального аллергического ринита, который хотя и соответствует по клинической симптоматике классическому, но отличается отсутствием признаков системной атопии: нет повышения антитела IgE в крови и положительных кожных аллергопроб. С целью оценки уровня срыва толерантности к аллергенам при локальном и классическом аллергическом рините проведены исследования концентраций IL-4, IL-22 и IFNγ в трех биологических жидкостях: крови, носовом секрете и кожном экссудате. Группа обследованных состояла из 82 пациентов в возрасте от 18 до 60 лет с диагностированным аллергическим ринитом. Диагностика была основана на консультации аллерголога-иммунолога с учетом сбора аллергологического анамнеза и проведении видеориноскопии оториноларингологом. Процедура видеориноскопии позволяла выявлять аллергическую природу ринита и исключать больных с неаллергическими формами болезни, но не давала возможности дифференцировать классический и локальный аллергический ринит между собой. В последующем все больные были разделены на основе критериев системной атопии на две подгруппы: 1) с высоким содержанием IgE в крови и положительными кожными аллергопробами (n = 41) и 2) достоверно низкой концентрацией IgE и отрицательными аллергопробами (n = 41). Сделано заключение, что в 1-й подгруппе преобладали пациенты с классическим аллергическим ринитом, а во 2-й – локальным. Исследование концентраций IL-4, IL-22 и IFNγ в трех биологических жидкостях позволило определить, что в 1-й подгруппе наблюдались повышение относительно контроля содержания IL-4 и IL-22 и снижение IFNγ в крови и кожном экссудате, а во 2-й подгруппе все показатели не отличались от контрольных значений. В назальном секрете колебания концентраций цитокинов в подгруппах были непрезентативными. Результат был интерпретирован как отсутствие срыва толерантности к причинным аллергенам на системном уровне у больных с локальным аллергическим ринитом. Полученные данные могут быть использованы в разработке системы биомаркеров в диагностике этого особенного эндотипа болезни, что позволит избежать диагностических ошибок прошлого, когда он относился к неаллергическим формам ринита, и, пациентам не назначалось адекватное лечение, например аллерген-специфическая иммунотерапия.

Local allergic rhinitis, a new endotype of allergic rhinitis discerned by researchers of the Spanish Allergy School, is now in the focus of interest of international allergological community. A special feature of local allergic rhinitis, which, being similar to conventional signs of allergic rhinitis, is, however, characterized by absence of systemic atopy manifestations, e.g., an increased total serum IgE content and positive allergic skin tests. In order to assess the level of tolerance breakdown to allergens in local and classical allergic rhinitis, we have studyed concentrations of IL-4, IL-22, and IFNγ in three biological fluids, blood, nasal secretions, and skin exudate. The whole study cohort consisted of 82 patients aged 18 to 60 years with established allergic rhinitis. The diagnosis was based on counseling by allergologist/immunologist, including clinical case history and possible inheritance of atopy as well as videorhinoscopy performed by an ENT specialist. The procedure of videorhinoscopy allowed to specify allergic origin of rhinitis and exclude the patients with non-allergic forms of the disease, but it did not enable us to differentiate between the endotypes of classic and local allergic rhinitis. Subsequently, all patients have been divided into two subgroups based on the criteria of systemic atopy: (1) with a high content of serum total IgE and positive skin allergy tests (n = 41) and (2) with a significantly lower concentration of IgE and negative allergy tests (n = 41). It was concluded that the patients with classic allergic rhinitis prevailed in the 1st subgroup, whereas local rhinitis predominated in the 2nd group. The study of IL-4, IL-22 and IFNγ concentrations in the three biological fluids allowed us to presume that the 1st subgroup was characterized by increased content of IL-4 and IL-22 in blood and skin exudate in comparison with controls, and the 2nd subgroup showed a decrease in IFNγ to control values. The cytokine concentrations in nasal secretions were not representative for the subgroups studied. The result has been interpreted as the absence of tolerance breakdown to causal allergens in the patients with local allergic rhinitis at the systemic level. The obtained data could be used in development of a diagnostic biomarker system for this specific endotype of allergic rhinitis, thus avoiding potential diagnostic errors which occurred in the past, when this endotype was classified as non-allergic form of the disease, thus administering non-adequate treatment, e.g., allergen-specific immunotherapy, which could be prescribed in these cases.

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The authors declare that there are no conflicts of interest present.