Background: Biologicals use in severe asthma (SA) is associated with problem of targeted therapy (TT) availability. Ensuring availability of biologicals can be resolved within the territorial compulsory medical insurance program (TCMIP) in day-stay or round-the-clock hospital. Aims: development and implementation of program for introduction of immunobiological therapy (IBT) for SA in Sverdlovsk Region (SR). Materials and methods: Program for introduction of IBT for SA was developed in SR in 2018 to provide patients with expensive biologicals within the TCMIP. Program includes: SA prevalence study in SR; practitioners training in differential diagnosis of SA; organization of affordable therapy for patients with SA; register of SA patients сreation and maintenance; patients selection and management of patients with SA in accordance with federal clinical guidelines. Results: Atopic phenotype in SA was detected in 5%, eosinophilic - in 2.3% of all analyzed cases of asthma (n=216). Practitioners of SR were trained in differential diagnosis of SA. The orders of the Ministry of Health of SR were issued, regulating the procedure for referring patients with SA to IBT, a list of municipal medical organizations providing IBT in a day-stay or round-the-clock hospital; approved regional register form of SA patients requiring biologicals use; ungrouping of clinical and statistical groups of day-stay hospital was carried out depending on INN and dose of biologicals; patients with SA are selected for TT and included in the regional register. Initiating of TT in round-the-clock hospital and continuation therapy in day-stay hospital provides a significant savings in compulsory medical insurance funds. Conclusions: introduction of IBT for SA in SR is carried out within framework of developed program. Principle of decentralization brings highly specialized types of medical care closer to patients and makes it possible to provide routine medical care in allergology-immunology profile in context of restrictions caused by COVID-19 pandemic.

In many countries of the world and in Russia, in particular, the pharmacological use of antagonists of cysteinyl receptors LT1 (CysLTR) is a long-proven and well-proven pharmacotherapy of bronchial asthma (BA) and allergic rhinitis (AR) in adults and children. Among antileukotriene drugs the most commonly used medication for the treatment of these diseases is the original montelukast, which is considered a safe drug associated with the appearance of only a few adverse reactions, usually not differing in type and frequency from those that occur with placebo. Currently, there are a large number of generics of montelukast, therefore, practitioners have many questions regarding the benefits and risks of montelukast therapy for patients with BA and AR. In 2020 FDA (Food and Drug Administration USA) analyzed the risk of adverse events during Montelukast treatment and indicated them on the packaging of the drug (original montelukast and its generics). This contributed to the creation of an expert commission to study this issue and form an expert opinion, which is demonstrated in our publication.

Анафилаксия - это тяжелая системная реакция гиперчувствительности, которая характеризуется быстрым началом и жизнеугрожающими проблемами со стороны дыхательных путей и кровообращения. В настоящей статье описан клинический случай развития у трехлетнего ребенка поливалентной аллергии с повторными эпизодами пищевой анафилаксии, родившегося и постоянно проживающего в средней полосе России, но имеющего необычный для жителя Урала профиль сенсибилизации. Клинический случай подробно описан с целью продемонстрировать этапы жизни ребенка, на которых, вероятно, сначала формировалась сенсибилизация, а в дальнейшем возникала манифестация клинических симптомов. Определение профиля сенсибилизации с использованием методов компонентной аллергодиагностики (ISAC, ImmunoCAP) показало, что мальчик сенсибилизирован к большому количеству пищевых аллергенов, в том числе к молочным и яичным протеинам белкам хранения арахиса, сои, фундука и кунжута протеинам, относящимся к nsLTP-белкам. Полученные результаты позволили распознать и дифференцировать истинную IgE-опосредованную сенсибилизацию, предложить оптимальную терапевтическую тактику и подобрать элиминационную диету. Применение методов молекулярной аллергодиагностики оказывается полезным в клинической практике в случае ведения пациентов, имеющих поливалентную сенсибилизацию и страдающих, по данным анамнеза, тяжелыми аллергическими реакциями.Anaphylaxis is a severe systemic hypersensitivity reaction that is characterized by rapid onset and life-threatening respiratory and blood circulation problems. We present to your attention a clinical case of the polyvalent allergy development in a three-year-old child with repeated episodes of food anaphylaxis. The child was born and he constantly lives in central Russia, but has a profile of sensitization unusual for a Ural resident. The clinical case is described in detail in order to demonstrate the stages of a childs life, on which sensitization was likely to be first formed, and later the manifestation of clinical symptoms arose. Determination of the sensitization profile by means of the component allergy diagnostics methods (ISAC, ImmunoCAP) showed that the boy is sensitized to a large number of food allergens, including milk and egg proteins storage proteins for peanuts, soy, hazelnuts and sesame proteins related to the nsLTP-proteins. The obtained results made it possible to recognize and differentiate true IgE-mediated sensitization, to propose the optimal therapeutic tactics and to select an elimination diet. Application of molecular allergy diagnostic methods is useful in clinical practice in case of patients with multivalent sensitization and a history of severe allergic reactions.