Педиатрическая фармакология, 2011, том 8, № 4
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ПЕДИАТРИЧЕСКАЯ ФАРМАКОЛОГИЯ /2011/ ТОМ 8/ № 4 Педиатрическая фармакология Научнопрактический журнал Союза педиатров России Издается с 2003 г. Выходит один раз в два месяца Учредитель Союз педиатров России Главный редактор НамазоваБаранова Л.С., д.м.н., проф. Заместители главного редактора Коростовцев Д.С., д.м.н., проф.; Чумакова О.В., д.м.н., проф. Научные редакторы Антонова Е.В., к.м.н.; Буслаева Г.Н., д.м.н., проф. Ответственный секретарь Маргиева Т.В., к.м.н. Секретариат редакции Вишнева Е.А., к.м.н., Алексеева А.А., к.м.н. Дизайн Архутик А.Б. Выпускающий редактор Пугачева У.Г. Отдел рекламы Тихолаз Т.В., rek@nczd.ru Сенюхина А.Б., rek1@nczd.ru Телефон (499) 1323043 Адрес редакции 119991, Москва, Ломоносовский проспект, д. 2/62 Телефон (499) 1327204 Факс (499) 1323043 еmail: pedpharm@nczd.ru www.spr-journal.ru Издатель Союз педиатров России 119991, г. Москва, Ломоносовский проспект, 2/62 Тел./факс: (499) 1327204 Жур нал «Педиа три че ская фар ма ко ло гия» зареги стри ро ван в Мини стер стве Рос сий ской Федера ции по делам печа ти, теле ра дио ве ща ния и средств мас со вых ком му ни ка ций 11.03.2002 г. Пере ре ги стри ро ван 15.12.2005 г. Реги страцион ный номер ПИ № ФС7722767. Ре дак ция не не сет от ве т ствен нос ти за со дер жание рек лам ных ма те ри а лов. Восп ро из ве де ние или ис поль зо ва ние дру гим спо со бом лю бой части из да ния без сог ла сия ре дак ции яв ля ет ся неза кон ным и вле чет от ве т ствен ность, ус та новлен ную действу ю щим за ко но да тель ством РФ. Отпечатано ООО «Ларго», 117342, Москва, Севастопольский проспект, д. 56/40. Тираж 7000 экземпляров. Подписные индексы в каталоге «Роспечать» Для физических лиц – 18100 Для юридических лиц – 18101 Редакционный совет Алексеева Е.И. (Москва), д.м.н., проф. Алиев М.Д. (Москва), д.м.н., проф., член.корр. РАМН Асанов А.Ю. (Москва), д.м.н., проф. Астафьева Н.Г. (Саратов), д.м.н., проф. Байбарина Е.Н. (Москва), д.м.н., проф. Балаболкин И.И. (Москва), д.м.н., проф., член.корр. РАМН Баранов А.А. (Москва), д.м.н., проф., акад. РАМН Белоусов Ю.Б. (Москва), д.м.н., проф., член.корр. РАМН Богомильский М.Р. (Москва), д.м.н., проф., член.корр. РАМН Боровик Т.Э. (Москва), д.м.н., проф. Ботвиньева В.В. (Москва), д.м.н., проф. Бочков Н.П. (Москва), д.м.н., проф., акад. РАМН Булатова Е.М. (СанктПетербург), д.м.н., проф. Вавилова В.П. (Кемерово), д.м.н., проф. Вялкова А.А. (Оренбург), д.м.н., проф. Гаращенко Т.И. (Москва), д.м.н., проф. Гедике Г. (Германия), проф. Горелко Т.И. (Кишинев, Молдова), к.м.н., доцент Горелов А.В. (Москва), д.м.н., проф. Джумагазиев А.А. (Астрахань), д.м.н., проф. Дулькин Л.А. (Челябинск), д.м.н., проф. Жерносек В.Ф. (Минск, Беларусь), д.м.н., проф. Захарова И.Н. (Москва), д.м.н., проф. Зырянов С.К. (Москва), д.м.н., проф. Ильина Н.И. (Москва), д.м.н., проф. Казначеева Л.Ф. (Новосибирск), д.м.н., проф. Караулов А.В. (Москва), д.м.н., проф., член.корр. РАМН Карпухин Е.В. (Казань), к.м.н., доцент Каульферш В. (Австрия), проф. Кешишян Р.А. (Москва), к.м.н. Китарова Г.С. (Бишкек, Кыргызстан), д.м.н., проф. Ковтун О.П. (Екатеринбург), д.м.н., проф. Кокуграш Ф.Ч. (Турция), проф. Колбин А.С. (СанктПетербург), д.м.н., проф. Конова С.Р. (Москва), д.м.н., проф. Константопоулос А. (Греция), проф. Конь И.Я. (Москва), д.м.н., проф. Коровина Н.А. (Москва), д.м.н., проф. Короткий Н.Г. (Москва), д.м.н., проф. Корсунский А.А. (Москва), д.м.н., проф. Кузенкова Л.М. (Москва), д.м.н., проф. Ладодо К.С. (Москва), д.м.н., проф. Лапшин В.Ф. (Украина), д.м.н., проф. Латышева Т.В. (Москва), д.м.н., проф. Лобзин Ю.В. (СанктПетербург), член.корр. РАМН Лукушкина Е.Ф. (Нижний Новгород), д.м.н., проф. Луцкий Я.М. (Москва), д.м.н., проф. Мазур Л.И. (Самара), д.м.н., проф. Макарова И.В. (СанктПетербург), к.м.н., доцент Мальцев С.В. (Казань), д.м.н., проф. Маслова О.И. (Москва), д.м.н., проф. Мойя М. (Испания), проф. Намазова А.А. (Азербайджан), д.м.н., проф., член.корр. РАМН Нисевич Л.Л. (Москва), д.м.н., проф. Новик Г.А. (СанктПетербург), д.м.н., проф. Огородова Л.М. (Томск), д.м.н., проф., член.корр. РАМН Петоэлло-Мантовани М. (Италия), проф. Печкуров Д.В. (Самара), д.м.н., проф. Пикуза О.И. (Казань), д.м.н., проф. Поляков В.Г. (Москва), д.м.н., проф., член.корр. РАМН Постников С.С. (Москва), д.м.н., проф. Потапов А.С. (Москва), д.м.н., проф. Решетько О.В. (Саратов), д.м.н., проф. Рубино А. (Италия), проф. Румянцев А.Г. (Москва), д.м.н., проф., член.корр. РАМН Сабо Л. (Венгрия), проф. Самсыгина Г.А. (Москва), д.м.н., проф. Середа Е.В. (Москва), д.м.н., проф. Сидоренко И.В. (Москва), к.м.н., доцент Симаходский А.С. (СанктПетербург), д.м.н., проф. Симонова О.И. (Москва), д.м.н., проф. Скрипченко Н.В. (СанктПетербург), д.м.н., проф. Смирнова Г.И. (Москва), д.м.н., проф. Солдатский Ю.Л. (Москва), д.м.н., проф. Таточенко В.К. (Москва), д.м.н., проф. Тимофеева А.Г. (Москва), к.м.н., доцент Уварова Е.В. (Москва), д.м.н., проф. Усонис В. (Вильнюс, Литва), д.м.н., проф. Учайкин В.Ф. (Москва), д.м.н., проф., акад. РАМН Цой А.Н. (Москва), д.м.н., проф. Цыгин А.Н. (Москва), д.м.н., проф. Шабалов Н.П. (СанктПетербург), д.м.н., проф. Шиляев Р.Р. (Иваново), д.м.н., проф. Эрих Й. (Германия) Яцык Г.В. (Москва), д.м.н., проф. Журнал входит в Перечень ведущих науч ных журналов и изданий ВАК, в которых должны быть опубликованы основные результаты диссертаций на соискание уче ной степени кандидата и доктора наук
ПЕДИАТРИЧЕСКАЯ ФАРМАКОЛОГИЯ ТОМ 8/ № 4/ 2011 СОДЕРЖАНИЕ ОБРАЩЕНИЕ К ЧИТАТЕЛЯМ Л.С. НамазоваБаранова РЕДАКЦИОННАЯ СТАТЬЯ ТЯЖЕЛЫЕ ХРОНИЧЕСКИЕ АЛЛЕРГИЧЕСКИЕ И АССОЦИИРОВАННЫЕ С НИМИ БОЛЕЗНИ: ЕДИНЫЙ ПОДХОД — МЕМОРАНДУМ MEDALL-GA2LEN-ARIA СОВМЕСТНО С ЦЕНТРОМ ВОЗ ПО БОРЬБЕ С АСТМОЙ И РИНИТОМ 2001-05-22 D3 (АНГЛИЙСКИЙ ВАРИАНТ) ТЯЖЕЛЫЕ ХРОНИЧЕСКИЕ АЛЛЕРГИЧЕСКИЕ И АССОЦИИРОВАННЫЕ С НИМИ БОЛЕЗНИ: ЕДИНЫЙ ПОДХОД — МЕМОРАНДУМ MEDALL-GA2LEN-ARIA СОВМЕСТНО С ЦЕНТРОМ ВОЗ ПО БОРЬБЕ С АСТМОЙ И РИНИТОМ 2001-05-22 D3 (РУССКИЙ ВАРИАНТ) НОВЫЕ МЕДИЦИНСКИЕ ТЕХНОЛОГИИ В.В. Омельяновский, М.В. Сура, Н.Д. Свешникова НОВЫЕ ЛЕКАРСТВЕННЫЕ ПРЕПАРАТЫ. КАК ОЦЕНИТЬ ИННОВАЦИОННОСТЬ? ФАРМАКОЭКОНОМИКА В ПЕДИАТРИИ А.С. Колбин, М.А. Проскурин, Ю.А. Балыкина, Н.Н. Климко ФАРМАКОЭКОНОМИЧЕСКИЙ АНАЛИЗ ПРИМЕНЕНИЯ МИКАФУНГИНА ПРИ ЛЕЧЕНИИ ИНВАЗИВНОГО КАНДИДОЗА У НОВОРОЖДЕННЫХ ДЕТЕЙ А.С. Колбин КОММЕНТАРИЙ К СТАТЬЕ И.Н. ЕРМАКОВОЙ, С.М. КУШНИР, Ю.Л. МИЗЕРНИЦКОГО «КЛИНИКО-ЭКОНОМИЧЕСКИЙ АНАЛИЗ ДЛИТЕЛЬНОЙ ПОДДЕРЖИВАЮЩЕЙ ТЕРАПИИ КОМБИНИРОВАННЫМИ ПРЕПАРАТАМИ БРОНХИАЛЬНОЙ АСТМЫ У ДЕТЕЙ ШКОЛЬНОГО ВОЗРАСТА — ЖИТЕЛЕЙ СЕЛА» И.Н. Ермакова, С.М. Кушнир, Ю.Л. Мизерницкий КЛИНИКО-ЭКОНОМИЧЕСКИЙ АНАЛИЗ ДЛИТЕЛЬНОЙ ПОДДЕРЖИВАЮЩЕЙ ТЕРАПИИ КОМБИНИРОВАННЫМИ ПРЕПАРАТАМИ БРОНХИАЛЬНОЙ АСТМЫ У ДЕТЕЙ ШКОЛЬНОГО ВОЗРАСТА — ЖИТЕЛЕЙ СЕЛА А.В. Рудакова ФАРМАКОЭКОНОМИЧЕСКИЕ АСПЕКТЫ ТЕРАПИИ ИНГИБИТОРАМИ ФАКТОРА НЕКРОЗА ОПУХОЛИ ХРОНИЧЕСКОГО УВЕИТА, РЕФРАКТЕРНОГО К БАЗИСНОЙ ТЕРАПИИ (В ТОМ ЧИСЛЕ АССОЦИИРОВАННОГО С ЮВЕНИЛЬНЫМ ИДИОПАТИЧЕСКИМ АРТРИТОМ) ВАКЦИНАЦИЯ В СОВРЕМЕННОМ МИРЕ Т.С. Дрозденко, С.М. Харит, И.Ф. Довгалюк ТАКТИКА ВАКЦИНАЦИИ ДЕТЕЙ С РАЗЛИЧНЫМИ ПРОЯВЛЕНИЯМИ ТУБЕРКУЛЕЗНОЙ ИНФЕКЦИИ E. Дэвид Дж. Макинтош НОВОЕ В ИММУНИЗАЦИИ В 2011 г. (АНГЛИЙСКИЙ ВАРИАНТ) E. Дэвид Дж. Макинтош НОВОЕ В ИММУНИЗАЦИИ В 2011 г. (РУССКИЙ ВАРИАНТ) НЕОТЛОЖНЫЕ СОСТОЯНИЯ У ДЕТЕЙ Р.Ф. Тепаев КОММЕНТАРИЙ К СТАТЬЕ «ГИПОНАТРИЕМИЯ У ДЕТЕЙ. В ФОКУСЕ — НЕВРОЛОГИЧЕСКИЕ ОСЛОЖНЕНИЯ» Р.Ф. Тепаев ГИПОНАТРИЕМИЯ У ДЕТЕЙ. В ФОКУСЕ — НЕВРОЛОГИЧЕСКИЕ ОСЛОЖНЕНИЯ ИММУНОПРОФИЛАКТИКА И ИММУНОТЕРАПИЯ В ПЕДИАТРИИ О.А. Рычкова, Н.В. Казакевич, Н.П. Сенникова, Д.С. Чемакина ОПЫТ ПРИМЕНЕНИЯ КОМБИНИРОВАННОЙ ВАКЦИНЫ ПРОТИВ ДИФТЕРИИ, КОКЛЮША, СТОЛБНЯКА, ПОЛИОМИЕЛИТА И ГЕМОФИЛЬНОЙ ИНФЕКЦИИ ТИПА B У ЗДОРОВЫХ И ДЕТЕЙ С РАЗЛИЧНЫМИ НАРУШЕНИЯМИ ЗДОРОВЬЯ М.Г. Галицкая, Л.С. Намазова-Баранова, Н.Е. Ткаченко, А.Г. Гайворонская ВАКЦИНАЦИЯ ПРОТИВ ПАПИЛЛОМАВИРУСНОЙ ИНФЕКЦИИ: БЕЗОПАСНОЕ РЕШЕНИЕ ГЛОБАЛЬНОЙ ПРОБЛЕМЫ ОБЗОР ЛИТЕРАТУРЫ В.Г. Багаев, В.Г. Амчеславский, Д.И. Леонов ПЕРСПЕКТИВЫ КСЕНОНОВОЙ АНЕСТЕЗИИ В ДЕТСКОЙ ХИРУРГИИ ОРИГИНАЛЬНЫЕ СТАТЬИ Л.С. Намазова-Баранова, И.В. Давыдова, Т.В. Турти, И.А. Беляева, В.В. Алтунин СОВРЕМЕННЫЕ ВОЗМОЖНОСТИ ИММУНОПРОФИЛАКТИКИ ТЯЖЕЛОГО ТЕЧЕНИЯ РЕСПИРАТОРНО-СИНЦИТИАЛЬНОЙ ВИРУСНОЙ ИНФЕКЦИИ У ДЕТЕЙ С ПОСЛЕДСТВИЯМИ ПЕРИНАТАЛЬНОЙ ПАТОЛОГИИ И.Н. Захарова, М.И. Пыков, З.В. Калоева, Л.А. Катаева, С.В. Шишкина, И.В. Бережная, Е.В. Резниченко, Н.В. Молоткова АПОСТЕРИОРНАЯ ЦЕННОСТЬ КЛИНИЧЕСКИХ И ЛАБОРАТОРНЫХ ПРОЯВЛЕНИЙ СИНДРОМА ЖИЛЬБЕРА У ДЕТЕЙ А.В. Горелов, Л.В. Феклисова, А.А. Плоскирева, Е.Р. Мескина, О.А. Литвинчук, Е.В. Черняева КОМПЛЕКСНАЯ ТЕРАПИЯ ВИРУСНОЙ ДИАРЕИ У ДЕТЕЙ: ПЕРВЫЕ РЕЗУЛЬТАТЫ ОТКРЫТОГО СРАВНИТЕЛЬНОГО РАНДОМИЗИРОВАННОГО КЛИНИЧЕСКОГО ИССЛЕДОВАНИЯ ЭФФЕКТИВНОСТИ ПРЕПАРАТОВ ИНТЕРФЕРОНА РЕДКИЕ БОЛЕЗНИ М.В. Туральчук, Г.А. Новик, А.Я. Гудкова ОСОБЕННОСТИ ТЕЧЕНИЯ КАРДИОМИОПАТИЙ С РЕСТРИКТИВНЫМ ФЕНОТИПОМ, ОБУСЛОВЛЕННЫХ МУТАЦИЯМИ ГЕНОВ СЕРДЕЧНОГО ТРОПОНИНА I И ДЕСМИНА, И АЛГОРИТМЫ ИХ ДИАГНОСТИКИ КЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИ ДЛЯ ПЕДИАТРОВ В.К. Таточенко, М.Д. Бакрадзе СИНДРОМЫ, СОПРОВОЖДАЮЩИЕСЯ ОСТРО ВОЗНИКШЕЙ ЛИХОРАДКОЙ В ПРАКТИКУ ПЕДИАТРА Л.А. Тарасова, В.Н. Данилова, Л.Н. Воронина ОПЫТ КОРРЕКЦИИ НАРУШЕНИЯ БАЛАНСА МИКРОБИОТЫ КИШЕЧНИКА У МЛАДЕНЦЕВ НА ФОНЕ ВТОРИЧНОЙ ЛАКТАЗНОЙ НЕДОСТАТОЧНОСТИ А.Б. Ресненко САХАРНЫЙ ДИАБЕТ 2-ГО ТИПА У ДЕТЕЙ И ПОДРОСТКОВ: ОТ ПАТОГЕНЕЗА К ЛЕЧЕНИЮ В.В. Черников ИСПОЛЬЗОВАНИЕ РИБОСОМАЛЬНО-ПРОТЕОГЛИКАНОВОГО КОМПЛЕКСА В КОМПЛЕКСНОЙ ТЕРАПИИ У ДЕТЕЙ С ЧАСТО РЕЦИДИВИРУЮЩИМИ РЕСПИРАТОРНЫМИ ИНФЕКЦИЯМИ ОБУЧЕНИЕ ОБУЧАЮЩИХ — ОБРАЗОВАТЕЛЬНЫЕ ПРОГРАММЫ ДЛЯ РОДИТЕЛЕЙ О.В. Иозефович ВИТАМИННО-МИНЕРАЛЬНЫЕ КОМПЛЕКСЫ ДЛЯ ДЕТЕЙ КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ Н.Н. Картамышева, Т.В. Вашурина, А.М. Мазо, А.Б. Сугак, Е.Н. Цыгина, М.И. Баканов, А.Н. Цыгин КАНАЛЬЦЕВЫЕ ДИСФУНКЦИИ С РАХИТОПОДОБНЫМ СИНДРОМОМ ПО МАТЕРИАЛАМ EPA/UNEPSA И IPA 5 6 20 30 36 46 48 55 60 64 66 68 69 76 82 87 92 101 106 112 117 122 125 130 135 140 146
ПЕДИАТРИЧЕСКАЯ ФАРМАКОЛОГИЯ /2011/ ТОМ 8/ № 4 Pediatric pharmacology The Union of Pediatricians of Russia Scientific Practical Journal Published since 2003 Issued once in two months Founder The Union of Pediatricians of Russia Editorinchief NamazovaBaranova L.S., PhD, professor Deputy editorsinchief Korostovtsev D.S., PhD, professor; Chumakova O.V., PhD, professor Research editors Antonova E.V., MD; Buslaeva G.N., PhD, professor Editorial secretary Margieva T.V., MD Secretariesgeneral Vishneva E.A., MD, Alekseeva A.А., MD Art director Arkhutik A.B. Publishing editor Pugacheva U.G. Advertising department Tiholaz T.V., rek@nczd.ru Senyuhina A.B., rek1@nczd.ru Phone: (499) 1323043 Correspondence address 2/62, Lomonosovsky pr., Moscow, 119991 Phone: (499) 1327204 Fax: (499) 1323043 email: pedpharm@nczd.ru www.spr-journal.ru Alekseeva E.I. (Moscow), PhD, professor Aliyev M.D. (Moscow), PhD, professor, RAMS cor. member Asanov A.Yu. (Moscow), PhD, professor Astafieva N.G. (Saratov), PhD, professor Baibarina E.N. (Moscow), PhD, professor Balabolkin I.I. (Moscow), PhD, professor, RAMS cor. member Baranov A.A. (Moscow), PhD, professor, RAMS academician Belousov Yu.B. (Moscow), PhD, professor, RAMS cor. member Bochkov N.P. (Moscow), PhD, professor, RAMS academician Bogomilsky M.R. (Moscow), PhD, professor, RAMS cor. member Borovik T.E. (Moscow), PhD, professor Botvinieva V.V. (Moscow), PhD, professor Bulatova E.M. (St. Petersburg), PhD, professor Сokugras F.C. (Turkey), PhD, professor Dzhumagaziev A.A. (Astrahan'), PhD, professor Dulkin L.A. (Chelyabinsk), PhD, professor Ehrich J. (Germany), prof. Gaedicke G. (Germany), рrof. Garaschenko T.I. (Moscow), PhD, professor Gorelko T.I. (Kishinev, Moldova), MD Gorelov A.V. (Moscow), PhD, professor Ilyina N.I. (Moscow), PhD, professor Karaulov A.V. (Moscow), PhD, professor, RAMS cor. member Karpukhin E.V. (Kazan), MD Kaulfersch W. (Austria), PhD, professor Kaznacheeva L.F. (Novosibirsk), PhD, professor Keshishian R.A. (Moscow), MD Kitarova G.S. (Bishkek, Kyrgyzstan), PhD, professor Kolbin A.S. (St.Petersburg), PhD, professor Kon I.Ya. (Moscow), PhD, professor Konova S.R. (Moscow), PhD, professor Konstantopoulos A. (Greece), PhD, professor Korotky N.G. (Moscow), PhD, professor Korovina N.A. (Moscow), PhD, professor Korsunsky A.A. (Moscow), PhD, professor Kovtun O.P. (Ekaterinburg), PhD, professor Kuzenkova L.M. (Moscow), PhD, professor Ladodo K.S. (Moscow), PhD, professor Lapshin V.F. (Ukraine), PhD, professor Latyisheva T.V. (Moscow), PhD, professor Lobzin Yu.V. (St. Petersburg), RAMS cor. member Lukhushkina E.F. (Nizhniy Novgorod), PhD, professor Lutsky Ya.M. (Moscow), PhD, professor Makarova I.V. (St.Petersburg), MD Maltsev S.V. (Kazan), PhD, professor Maslova O.I. (Moscow), PhD, professor Mazur L.I. (Samara), PhD, professor Moya M. (Spain), PhD, professor Namazova A.A. (Baku, Azerbaijan), PhD, professor, RAMS cor. member Nisevich L.L. (Moscow), PhD, professor Novik G.A. (St. Petersburg), PhD, professor Ogorodova L.M. (Tomsk), PhD, professor, RAMS cor. member Pechkurov D.V. (Samara), PhD, professor Pettoello-Mantovani M. (Italy), PhD, professor Pikuza O.I. (Kazan), PhD, professor Poliyakov V.G. (Moscow), PhD, professor, RAMS cor. member Postnikov S.S. (Moscow), PhD, professor Potapov A.S. (Moscow), PhD, professor Reshetko O.V. (Saratov), PhD, professor Rubino A. (Italy), PhD, professor Rumiantsev A.G. (Moscow), PhD, professor, RAMS cor. member Samsyigina G.A. (Moscow), PhD, professor Sereda E.V. (Moscow), PhD, professor Shabalov N.P. (St.Petersburg), PhD, professor Shilyaev R.R. (Ivanovo), PhD, professor Sidorenko I.V. (Moscow), MD Simakhodsky A.S. (St. Petersburg), PhD, professor Simonova O.I. (Moscow), PhD, professor Skripchenko N.V. (St. Petersburg), PhD, professor Smirnova G.I. (Moscow), PhD, professor Soldatsky Yu.L. (Moscow), PhD, professor Szabo L. (Hungary), PhD, professor Tatochenko V.K. (Moscow), PhD, professor Timofeeva A.G. (Moscow), MD Tsoy A.N. (Moscow), PhD, professor Tsygin A.N. (Moscow), PhD, professor Uchaikin V.F. (Moscow), PhD, professor, RAMS academician Usonis V. (Vilnius, Lithuania), PhD, professor Uvarova E.V. (Moscow), PhD, professor Vavilova V.P. (Kemerovo), PhD, professor Vyalkova A.A. (Orenburg), PhD, professor Yatsyik G.V. (Moscow), PhD, professor Zacharova I.N. (Moscow), PhD, professor Zhernosek V.F. (Minsk, Belarus), PhD, professor Zyryanov S.К. (Moscow), PhD, professor Editorial board Publishing group The Union of Pediatricians of Russia 2/62, Lomonosovsky pr., Moscow, 119991 tel./fax: (499) 1327204 Mass media registration certificate dated December 15 2005. Series ПИ № ФС7722767 Federal service for surveillance over nonviolation of the legislation in the sphere of mass communications and protection of cultural heritage. Editorial office takes no responsibility for the contents of advertising material. No part of this issue may be reproduced without permission from the publisher. While reprinting publications one must make reference to the journal «Pediatric pharmacology» Printed in the printing-office «Largo», 56/40, Sevastopolsky prospect, Moscow, 117342 Circulation 7000 copies. Subscription indices are in catalogue «Rospechat» For natural persons – 18100 For juridical persons – 18101 The Journal is in the List of the leading scientific journals and publications of the Supreme Examination Board (VAK), which are to publish the results of doctorate theses
PEDIATRIC PHARMACOLOGY 2011 volume 4 № 3 CONTENT EDITORIALS L.S. NamazovaBaranova AN EDITORIAL ARTICLE SEVERE CHRONIC ALLERGIC (AND RELATED) DISEASES: A UNIFORM APPROACH — A MEDALL-GA2LEN-ARIA POSITION PAPER IN COLLABORATION WITH THE WHO COLLABORATING CENTER FOR ASTHMA AND RHINITIS (ENGLISH) SEVERE CHRONIC ALLERGIC (AND RELATED) DISEASES: A UNIFORM APPROACH — A MEDALL-GA2LEN-ARIA POSITION PAPER IN COLLABORATION WITH THE WHO COLLABORATING CENTER FOR ASTHMA AND RHINITIS (RUSSIAN) NEW TECHNOLOGIES IN MEDICINE V.V. Omelyanovsky, M.V. Sura, N.D. Sveshnikovf NEW PHARMACEUTICALS. HOW CAN INNOVATIVENESS? PHARMACOECONOMICS IN PEDIATRICS A.S. Kolbin, M.A. Proskurin, Y.A. Balykina, N.N. Klimko PHARMACOECONOMIC ANALYSIS OF MICAFUNGIN USING IN THE TREATMENT OF INVASIVE CANDIDIASIS IN NEWBORNS A.S. Kolbin OPENING ADDRESS TO ARTICLE I.N. ERMAKOVA, S.M. KUSHNIR, J.L. MIZERNITSKY «CLINICAL AND ECONOMIC ANALYSIS OF THE LONG-TERM MAINTENANCE THERAPY BY COMBINED DRUGS OF BRONCHIAL ASTHMA IN SCHOOL CHILDREN, RESIDENTS OF THE RURAL REGIONS» I.N. Ermakova, S.M. Kushnir, J.L. Mizernitsky CLINICAL AND ECONOMIC ANALYSIS OF THE LONG-TERM MAINTENANCE THERAPY BY COMBINED DRUGS OF BRONCHIAL ASTHMA IN SCHOOL CHILDREN, RESIDENTS OF THE RURAL REGIONS A.V. Rudakova PHARMACOECONOMIC ASPECTS OF TREATMENT WITH THE INHIBITORS OF TUMOR NECROSIS FACTOR OF THE CHRONIC UVEITIS REFRACTORY TO THE BASIC THERAPY (INCLUDING AN ASSOCIATED WITH JUVENILE IDIOPATHIC ARTHRITIS) WORLD NEWS OF VACCINATION T.S. Drozdenko, S.M. Harit, I.F. Dovgalyuk VACCINATION IN CHILDREN WITH DIFFERENT MANIFESTATIONS OF TUBERCULOSIS INFECTION E. David G. McIntosh IMMUNISATION UPDATE 2011 (ENGLISH) E. David G. McIntosh IMMUNISATION UPDATE 2011 (RUSSIAN) URGENT CONDITIONS IN PEDIATRICS R.F. Tepaev OPENING ADDRESS TO ARTICLE «HYPONATREMIA IN CHILDREN. FOCUS — NEUROLOGICAL COMPLICATIONS» R.F. Tepaev HYPONATREMIA IN CHILDREN. FOCUS — NEUROLOGICAL COMPLICATIONS IMMUNOPROPHYLAXIS AND IMMUNOTHERAPY IN PEDIATRICS O.A. Rychkova, N.V. Kazakevich, N.P. Sennikova, D.S. Chemakina THE EXPERIENCE OF A COMBINED VACCINE AGAINST DIPHTHERIA, PERTUSSIS, TETANUS, POLIO AND HAEMOPHILUS INFLUENZAE TYPE B IN HEALTHY CHILDREN AND CHILDREN WITH VARIOUS DISABILITIES M.G. Galitskaya, L.S. Namazov-Baranova, N.E. Tkachenko, A.G. Gaivoronskaya VACCINATION AGAINST HUMAN PAPILLOMAVIRUS INFECTION: A SAFE SOLUTION TO THE GLOBAL PROBLEM REVIEW V.G. Bagaev, V.G. Amcheslavsky, D.I. Leonov PROSPECTS OF THE XENON ANESTHESIA IN PEDIATRIC SURGERY ORIGINAL ARTICLES L.S. Namazov-Baranova, I.V. Davydova, T.V. Turti, I.A. Belyaeva, V.V. Altunin MODERN POTENTIALITIES OF IMMUNOPROPHYLAXIS OF SEVERE COURSE OF THE RESPIRATORY SYNCYTIAL VIRAL INFECTION IN CHILDREN WITH THE CONSEQUENCES OF PERINATAL PATHOLOGY I.N. Zakharova, M.I. Pykov, Z.V. Kaloyeva, L.A. Kataeva, S.V. Shishkina, I.V. Berejnaya, E.V. Reznichenko, N.V. Molotkova GILBERT’S SYNDROME IN CHILDREN: CONTEMPORARY DIAGNOSTIC POTENTIALITIES A.V. Gorelov, L.V. Feklisova, A.A. Ploskireva, E.R. Meskina, O.A. Litvinchuk, E.V. Chernyaeva COMBINED THERAPY OF VIRAL DIARRHEA IN CHILDREN: FIRST RESULTS OF AN OPEN COMPARATIVE RANDOMIZED CLINICAL TRIAL OF INTERFERON EFFICIENCY RARE DISEASES M.V. Turalchuk, G.A. Novik, A.Ya. Gudkova CLINICAL FEATURES AND DIAGNOSTIC ALGORITHMS OF CARDIOMYOPATHIES WITH RESTRICTIVE PHENOTYPE CAUSED BY CARDIAC TROPONIN I AND DESMIN GENES MUTATIONS GUIDELINES FOR PEDIATRICIANS V.K. Tatochenko, M.D. Bakradze SYNDROMES ACCOMPANIED BY ACUTE FEVER FOR PEDIATRICIANS' PRACTICE L.A.Tarasova, V.N. Danilova, L.N. Voronina EXPERIENCE IN THE CORRECTION OF THE INTESTINE MICROBIOTADYS DYSBALANCE ON THE BACKGROUND OF SECONDARY LACTASE DEFICIENCY A.B. Resnenko TYPE 2 DIABETES IN CHILDREN AND ADOLESCENT: FROM PATHOGENESIS TO TREATMENT V.V. Chernikov THE USE OF RIBOSOMAL-PROTEOGLYCAN COMPLEX IN THE TREATMENT OF CHILDREN WITH FREQUENT RESPIRATORY INFECTIONS TRAINING FOR TRAINERS — EDUCATIONAL PROGRAM FOR PARENTS O.V. Jozefovich VITAMIN AND MINERAL SUPPLEMENTATION FOR CHILDREN CLINICAL CASE N.N. Kartamysheva, T.V. Vashurina, A.M. Mazo, A.B. Sugak, E.N. Tsygina, M.I. Bakanov, A.N. Tsygin TUBULAR DISORDERS WITH RICKETS-LIKE SYNDROME MATERIALS OF EPA/UNEPSA AND IPA 5 6 20 30 36 46 48 55 60 64 66 68 69 76 82 87 92 101 106 112 117 122 125 130 135 140 146
Обращение к читателям Дорогие друзья! Вы держите в руке очередной номер нашего журнала, и вас снова ждут интересные с научной и практической точки зрения публикации. Как всегда, вы первыми имеете возможность познакомиться с решенными или еще обсуждаемыми темами мировой медицинской науки: недавно принятым совместно с ВОЗ важнейшим документом — меморандумом MeDALL-GA2LEN-ARIA, провозглашающим единый подход к ведению аллергических болезней; а профессор Д. Макинтош (являющийся почетным профессором НЦЗД) расскажет о достижениях и перспективах в области вакцинации, — о создании так называемых «терапевтических» вакцин. Тема вакцинации продолжена в статьях, посвященных профилактике папилломавирусной инфекции, применению комбинированной пятикомпонентной вакцины, возможностям вакцинации детей с различными проявлениями туберкулеза… Наши российские коллеги поделятся с вами своим собственным опытом диагностики и лечения кардиомиопатий, синдрома Жильбера, сахарного диабета II типа, рахитоподобных болезней, вирусных диарей, лихорадочных состояний… Как никогда раньше широко представлена рубрика «Фармакоэкономика в педиатрии»: профессор А. С. Колбин знакомит с результатами фармакоэкономического анализа применения противогрибкового препарата микафунгин, И. Н. Ермакова — с клиникоэкономическим анализом комбинированной терапии бронхиальной астмы, А. В. Рудакова изучила фармакоэкономические аспекты лечения тяжелого хронического увеита… Дорогие коллеги! Мы призываем вас реализовать возможность управлять историей и активно участвовать в жизни нашего педиатрического сообщества. Присылайте нам статьи и свои комментарии к обсуждаемым на страницах журнала темам, поделитесь своим опытом с коллегами. Тем более, что пора отпусков закончилась… Хорошо отдохнув и набравшись сил, приступим к главному делу нашей жизни — охране здоровья детей! Успехов! С уважением, главный редактор журнала, профессор, заместитель директора по научной работе — директор НИИ профилактической педиатрии и восстановительного лечения НЦЗД РАМН, заведующая кафедрой аллергологии и клинической иммунологии педиатрического факультета Первого МГМУ им. И. М. Сеченова, заведующая кафедрой факультетской педиатрии педиатрического факультета РГМУ, советник ВОЗ, член Исполкома Международной педиатрической ассоциации Лейла Сеймуровна НамазоваБаранова Dear friends! Now you hold in your hands the next issue of our Journal with as ever interesting from scientific and practical points of view articles. As usual you have the opportunity for first discovering the solve or still debatable topics of world medical science. We would like to bring your attention for the recently adopted important document — united MeDALL-GA2LEN-ARIA and WHO memorandum, proclaiming a unified approach to the allergic diseases treatment. Professor D. McIntosh, honorary professor of Scientific center of children’s health, presents the achievements and challenges in the field of vaccination — the so-called «therapeutic» vaccine creation. Vaccination aspects are to be continued for discussion in the articles devoted to the prevention of HPV infection, using of a combined 5-companent vaccine, vaccination opportunity for children with various forms of tuberculosis. Russian colleagues will share the experience of diagnosis and treatment of cardiomyopathy, Gilbert’s syndrome, type II diabetes, rickets-like diseases, vital diarrhea, fever. As never before the column «Pharmacoeconomics in pediatrics» is widely represented. Professor A. Kolbin shows the results of the pharmacoecomonic analysis of antifungal drug micafungin, I. E. Ermakova presents the clinical and economic estimation of the asthma combined therapy, A. V. Rudakova investigates the pharmacoeconomic aspects of the severe uveitis’s treatment. Dear colleagues! We encourage you to implement the ability to rule over the history and actively participate in the life of our pediatric community. Please send articles and comments to be discussed in the Journal, share your experience with the colleagues, especially the vacation time is already over. Well rested, improved in strength let us continue our main lifework — children’s healthcare! Good luck! Yours faithfully, EditorinChief, Professor, Director of Institute of Preventive Pediatrics and Rehabilitation of Scientific Center of Children's Health, RAMS, Head of the Department of allergology and Clinical Immunology of Pediatric Faculty of I. M. Sechenov First Moscow State Medical University, Head of the Pediatric Department of the Russian State Medical University, Member of the International Pediatric Association (IPA) Standing Committee Leyla NamazovaBaranova
Severe chronic allergic (and related) diseases: a uniform approach — a MeDALL-GA2LEN-ARIA Position Paper In collaboration with the WHO Collaborating Center for Asthma and Rhinitis Редакционная статья * — Member of GA2LEN (Global Allergy and Asthma European Network, Grant Agreement FP6) ** — Member of MeDALL (Mechanisms of the Development of ALLergy, Grant Agreement FP7 N°264357, MeDALL paper N°5) *** — Member of ARIA (Allergic Rhinitis and its Impact on Asthma) $ — WHO Collaborating Center for Asthma and Rhinitis (Montpellier) — Espace Francophone de Pneumologie (Societe de Pneumologie de Langue Francaise) J. Bousquet*/**/ ***/$/ /1/2, J.M. Anto*/**/3/4/5/6, P. Demoly*/***/$/7/8, H.J. Schunemann*/***/9, A. Togias10, M. Akdis*/**/11, C. Auffray**/12, C. Bachert*/**/***/13, T. Bieber*/14, P.J. Bousquet*/***/$/1, K.H. Carlsen*/**/***/15, T.B. Casale***/16, A.A. Cruz***/17, T. Keil*/**/18, K.C. Lodrup-Carlsen*/**/***/15, M. Maurer*/**/***/19, K. Ohta***/20, N.G. Papadopoulos*/***/21, M. Roman Rodriguez22, B. Samolinski***/23, I. Agache***/24, A. Andrianarisoa /25, I. Annesi-Maesano*/**/***/26, F. Ballester27, C.E. Baena-Cagnani***/28/29, X. Basagana**/3/4/5, E.D. Bateman***/30, E.H. Bel*/31, A. Bedbrook*/**/ ***/$/7, B. Beghue***/32, M. Beji /33, A. Ben Kheder***/ /34, M. Benet**/3/4/5, K.S. Bennoor**/35, K.C. Bergmann*/***/19, F. Berrissoul /36, C. Bindslev Jensen*/**/ ***/37, G. Bleecker38, S. Bonini*/***/39, A.L. Boner40, L.P. Boulet***/ /41, C.E. Brightling42, J.L. Brozek***/9, A. Bush43, W.W. Busse44, P.A.M. Camargos***/45, G.W. Canonica*/***/46, W. Carr***/47, A. Cesario48/49, Y.Z. Chen***/50, A. Chin-Suorn /36, A. Chiriac***/1, D.J. Costa***/51, L. Cox52, A. Custovic***/53, R. Dahl***/54, U. Darsow*/55, T. Didi /55А, W.K. Dolen56, H. Douagui***/57, R. Dubakiene**/***/58, A. El-Meziane /59, J. Fonseca***/60, W.J. Fokkens*/***/61, E. Fthenou**/62, A. Gamkrelidze***/63, J. Garcia-Aymerich**/3/4/5/6, R. Gerth van Wijk***/64, E. Gimeno**/3, S. Guerra**/3/4/5/64А, T. Haahtela*/**/***/65, H. Haddad /66, P. Hellings***/67, B. Hellquist-Dahl***/54, C. Hohmann*/**/18, P. Howarth*/***/68, J.O. Hourihane69, M. Humbert***/70, B. Jacquemin*/2/71, J. Just72, O. Kalayci***/73, M.A. Kaliner74, F. Kauffmann*/**/2/71, M. Kerkhof**/75, G. Khayat /76, B. Koffi N’Goran***/ /77, M. Kogevinas**/3/4/5/77А, G.H. Koppelman**/78, M.L. Kowalski*/**/***/79, I. Kull*/**/80/81, P. Kuna***/82, D. Larenas***/83, I. Lavi**/3, L.T. Le***/84, P. Lieberman85, B. Lipworth***/86, B. Mahboub***/87, M.J. Makela*/**/***/65, F. Martin /88, F.D. Martinez**/89, G.D. Marshall90, A. Mazon /27, E. Melen*/**/91, E.O. Meltzer***/92, F. Mihaltan***/ /93, Y. Mohammad***/ /94, A. Mohammadi /95, I. Momas**/96, M. Morais-Almeida***/97, J. Mullol*/***/98, A. Muraro99, R. Naclerio***/100, S. Nafti /101, L. Namazova-Baranova*/***/102, M.C. Nawijn**/103, D. Nyembue***/104, S. Oddie**/105/106, R. O’Hehir***/107, Y. Okamoto108, M.P. Orru***/109, C. Ozdemir***/110, G.S. Ouedraogo***/111, S. Palkonen*/**/***/112, P. Panzner***/113, G. Passalacqua*/***/46, R. Pawankar***/114, B. Pigearias /115, I. Pin**/116/117, M. Pinart**/3, C. Pison*/**/118/119/120, T.A. Popov***/121/122, D. Porta**/123, D.S. Postma**/124, D. Price***/125, K.F. Rabe***/126, J. Ratomaharo /127, S. Reitamo*/**/65, D. Rezagui /128, J. Ring*/***/129, R. Roberts130, J. Roca***/131, B. Rogala*/***/132, A. Romano*/***/133, J. Rosado-Pinto***/134, D. Ryan135/136, M. Sanchez-Borges***/137, G.K. Scadding***/138, A. Sheikh139, F.E.R. Simons***/140, V. Siroux**/141/142, P. Schmid-Grendelmeier*/***/143, H.A. Smit**/144, T. Sooronbaev***/145, R.T. Stein3/145А, P.J. Sterk***/31/127, J. Sunyer***/3/4/5/6, I. Terreehorst*/***/146, E. Toskala*/**/***/147, Y. Tremblay /148, R. Valenta*/**/149, D. Valeyre /150, O. Vandenplas***/151, C. van Weel***/152, M. Vassilaki**/62, R. Varraso*/2/71, G. Viegi*/***/153, D.Y. Wang***/154, M. Wickman*/**/155, D. Williams***/156, S. Wohrl*/157, J. Wright*/**/105, A. Yorgancioglu***/158, O.M. Yusuf***/159, H.J. Zar***/160, M.E. Zernotti***/28, M. Zidarn161, N. Zhong***/162, T. Zuberbier*/**/***/19/163
ПЕДИАТРИЧЕСКАЯ ФАРМАКОЛОГИЯ /2011/ ТОМ 8/ № 4 1 University Hospital, Department of Respiratory Diseases, Hopital Arnaud de Villeneuve, Montpellier, France 2 Inserm, CESP Centre for research in Epidemiology and Population Health, U1018, Respiratory and Environmental Epidemiology team, Villejuif, France 3 Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain 4 Municipal Institute of Medical Research (IMIM-Hospital del Mar), Barcelona, Spain 5 CIBER Epidemiologia y Salud Publica (CIBERESP), Spain 6 Universitat Pompeu Fabra (UPF), Barcelona, Spain 7 HO Collaborating Center for Asthma and Rhinitis, Montpellier, France 8 University Hospital of Montpellier — Inserm U657, Hopital Arnaud de Villeneuve, Montpellier, France 9 Department of Clinical Epidemiology & Biostatistics and Medicine, McMaster University, Hamilton, Canada 10 National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA 11 Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland 12 Functional Genomics and Systems Biology for Health, CNRS Institute of Biological Sciences, Villejuif, France 13 RL (Upper Airways research Laboratory), University Hospital Ghent, Belgium 14 Department of Dermatology and Allergy, University Medical Center, Bonn, Germany 15 University of Oslo; Oslo University Hospital, Department of Paediatrics, Oslo, Norway 16 Division of Allergy and Immunology, Department of Medicine, Creighton University, Omaha, Nebraska, USA 17 ProAR — FMB, Federal University of Bahia School of Medicine, Salvador, Brazil 18 Institute of Social Medicine, Epidemiology and Health Economics, Charite — Universitatsmedizin Berlin, Berlin, Germany 19 Allergy-Centre-Charite at the Dept. of Dermatology, Charite — University Medicine Berlin, Germany 20 Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan 21 Allergy Dpt, 2nd Pediatric Clinic, University of Athens, Greece 22 on Pisa Primary Care Centre, IB-Salut Balearic Health Service, Palma de Mallorca, Spain 23 Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Poland 24 Faculty of Medicine, Transylvania University, Brasov, Romania 25 Public Hospital Medical Service, Ministry of Health, Antananarivo, Madagascar 26 EPAR U707 INSERM, Paris; EPAR UMR-S UPMC, Paris VI, Paris France 27 University of Valencia and Center for Public Health Research (CSISP), Valencia, Spain 28 Faculty of Medicine, Catholic University, Cordoba, Argentina; 29 School of Specialization, Respiratory Medicine, University of Genoa, Italy 30 Health Sciences Faculty, University of Cape Town, South Africa 31 Department of Pulmonology, Academic Medical Centre, University of Amsterdam, The Netherlands 32 Divisions of Human Genetics Infection, Inflammation and Repair, School of Medicine, University of Southampton, UK 33 Service de Pneumologie Allergologie, Centre Hositalo-Universitaire de la Rabta, Tunis, Tunisia 34 Hopital A Mami, Ariana, Tunisia 35 National Institute of Diseases of Chest & Hospital, Mohakhali, Dhaka, Bangladesh 36 IR KHMER, Cambodia 37 Odense University Hospital — Denmark 38 Wake Forest University Health Sciences, Winston-Salem, NC, USA 39 Institute of Neurobiology and Molecular Medicine — CNR, Rome, Italy and Department of Medicine, Second University of Naples, Naples, Italy 40 Department of Paediatrics, University of Verona, Verona, Italy 41 Institut de cardiologie et de pneumologie de l’Hopital Laval and Universite Laval, Quebec, Canada 42 Institute for Lung Health, Leicester, UK 43 Department of Paediatric Respiratory Medicine, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, UK 44 Professor of Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; George R. and Elaine Love Professor, Chair — Dept of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA 45 Dept of Pediatrics, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil 46 Allergy & Respiratory Diseases, DIMI, Department of Internal Medicine, University of Genoa, Genoa, Italy 47 Southern California Research, Mission Viejo, California, USA 48 Deputy Scientific Director, IRCCS San Raffaele Pisana, Roma, Italy and 49 Department of Thoracic Surgery, Catholic University, Rome, Italy 50 National Cooperative Group of Pediatric Research on Asthma. Asthma Clinic and Education Center of the apital Institute of Pediatrics, Peking, China Center for Asthma Research and Education, Beijing, P. R. China 51 Primary Care Dept., Montpellier I University, France 52 Nova Southeastern University Osteopathic College of Medicine, Davie, Florida, USA 53 University of Manchester, Manchester, UK 54 Aarhus University Hospital, Denmark 55 Department of Dermatology and Allergy Biederstein, Technische Universitat Munchen, Munchen, Germany 55A Service de pneumologie, Centre Hospitalier de la Region d'Annecy, Annecy, France 56 Medical College of Georgia, Augusta, GA, USA 57 Service de pneumo-allergologie, Centre Hospitalo-Universitaire de Beni-Messous, Algiers, Algeria
Редакционная статья 58 Vilnius University Faculty of Medicine, Lithuania, GA2LEN collaborating centre 59 Societe Marocaine des Maladies Respiratoires, BP1828, Derb Ghellaf, Casablanca, Maroc AND Centre of Respiratory Diseases and Allergy, Centre commercial Nadia, Casablanca, Maroc 60 Biostatistics and Medical Informatics Department & CINTESIS, and Allergy Division, Porto University, Portugal; Allergy, Hospital S. Joao & Instituto, CUF; CINTESIS, Porto University Medical School 61 Department of Otorhinolaryngology, University of Amsterdam, The Netherlands 62 Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece 63 HO CO in Georgia, Tbilisi, Georgia 64 Section of Allergology, Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands 64A University of Arizona, Tucson, AZ, USA 65 Department of Dermatology, Skin and Allergy Hospital, Helsinki University Hospital, Finland 66 Association Franco-Libanaise de Pneumologie (AFLP) and Service de pneumologie, Centre Hospitalier Tarbes- Lourdes, Bigorre, France 67 Department of Otorhinolaryngology, Head, and Neck Surgery, University Hospitals Leuven, Belgium 68 University of Southampton, England 69 University College Cork, Ireland, UK 70 Universite Paris-Sud, Service de Pneumologie, Hopital Antoine-Beclere, Clamart, France 71 University Paris Sud 11, UMRS 1018, Villejuif, France 72 Groupe Hospitalier Trousseau-La Roche-Guyon, Centre de l'Asthme et des Allergies, APHP, Universite Paris 6, France 73 Hacettepe University School of Medicine, Pediatric Allergy and Asthma Unit, Hacettepe, Ankara, Turkey 74 George Washington University School of Medicine, Washington DC — Institute for Asthma and Allergy, Chevy Chase, MD, USA 75 Department of Epidemiology, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands 76 Service de Pneumologie, Hotel-Dieu de France & Faculte de Medecine, Universite Saint-Joseph, Beyrouth, Liban 77 Service des Maladies Respiratoires, Centre Hospitaliere Universitaire, Abidjan, Ivory Coast 77A Department of Nutrition, National School of Public Health, Athens, Greece 78 Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children’s Hospital, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands 79 Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, Poland 80 Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden 81 Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institutet, Stockholm, Sweden 82 Barlicki University Hospital, Medical University of Lodz, Poland 83 Allergy Department, Hospital Medica Sur, Mexicocity, Mexico 84 University of Medicine and Pharmacy, Hochiminh City, Vietnam 85 Unversity of Tennessee College of Medicine, Memphis Tennessee, USA 86 Asthma and Allergy Research Group, Univeristy of Dundee, UK 87 Pulmonary and allergy unit, Dubai Health Authority and University of Sharjah, UAE 88 Compiegnes, Association Franco-Vietnamienne de Pneumologie 89 Arizona Respiratory Center, University of Arizona, Tucson, AZ, USA 90 Division of Clinical Immunology and Allergy, University of Mississippi Medical Center, Jackson, MS USA 91 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden 92 Allergy & Asthma Medical Group & Research Center, University of California, San Diego, USA 93 Institute of Pneumology Marius Nasta, Bucharest, Romania 94 Tishreen University School of Medicine, Department of Internal Medecine, Lattakia, Syria 95 Association Franco-Marocaine de Pathologie Thoracique (AFMAPATH), Marrakech, Morocco 96 Paris Descartes University, Department of Public health and biostatistics, EA 4064 and Paris municipal Department of social action, childhood, and health, Paris, France 97 Immunoallergy Department, CUF-Descobertas Hospital, Lisbon, Portugal 98 Rhinology Unit & Smell Clinic, ENT Department, Hospital Clinic, IDIBAPS. Barcelona, Catalonia, Spain 99 Department of Pediatrics — University of Padua, Padua, Italy 100 Professor and Chief of OHNS, University of Chicago, Chicago, Illinois, USA 101 Mustapha Hospital, Algiers, Algeria 102 Scientific Center for Children’s Health RAMS, Moscow, Russia 103 Laboratory of Allergology and Pulmonary Diseases, Department of Pathology and Medical Biology, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands 104 Kinshasa University, Congo 105 Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford, UK 106 Bradford Neonatology, Bradford Royal Infirmary, Bradford, UK 107 Alfred Hospital and Monash University, Melbourne, Australia 108 Dept. of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan 109 Pharmacist, Italy 110 Marmara University, Seher, Yildizi Sokak 16/10 Etiler, Istanbul, Turkey 111 Centre Hospitalier Universitaire Pediatrique Charles de Gaulle, Ouagadougou, Burkina Faso, West Africa
ПЕДИАТРИЧЕСКАЯ ФАРМАКОЛОГИЯ /2011/ ТОМ 8/ № 4 112 FA European Federation of Allergy and Airways Diseases Patients’ Associations, Brussels, Belgium 113 Charles University Prague, Medical School and Hospital in Plzen, Dept. of Allergy and Clin. Immunology, Plzen, Czech Republic 114 Nippon Medical School, Bunkyo-ku, Tokyo, Japan 115 NICE and Societe de Pneumologie de Langue Francaise, France 116 HU de Grenoble; 117 INSERM, U823, Institut Albert Bonniot, Grenoble; University Joseph Fourier, Grenoble, France 118 Department of Pulmonology, University Hospital of Grenoble; 119 Inserm 884; 120 University of Grenoble, France 121 Clinic of Allergy and Asthma, Medical University Sofia, Bulgaria Clinic of Allergy 122 Asthma, Alexander's University Hospital, Sofia, Bulgaria 123 Department of Epidemiology, Regional Health Service Lazio Region, Rome, Italy 124 Department of Pulmonology, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands 125 GPIAG, University of Aberdeen, Aberdeen, Scotland 126 Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands 127 PNEUMALGA and Societe de Pneumologie de l’Ocean Indien 128 Association Franco-Algerienne de Pneumologie (AFAP) 129 Technische Universitat Munchen — Germany 130 University of Wisconsin School of Medicine & Public Health, Madison, USA 131 Institut Clinic del Torax, Hospital Clinic, IDIBAPS, CIBERES, Universitat de Barcelona, Spain 132 Silesian University School of Medicine, Zabrze, Poland 133 Department of Internal Medicine and Geriatrics, UCSC-Allergy Unit, Complesso Integrato Columbus, Rome, Italy 134 Immunoallergy Department, Hospital da Luz, Lisboa, Portugal Hospital Dona Estefania, Lisboa, Portugal 135 Woodbrook Medical Centre, Loughborough, England 136 Clinical Research Fellow, University of Aberdeen, Scotland 137 Department of Allergy and Clinical Immunology, Centro Medico-Docente La Trinidad, Caracas, Venezuela 138 Royal National TNE Hospital, University College London, UK 139 Centre for Population Health Sciences, The University of Edinburgh, Medical School, Edinburgh, UK 140 Faculty of Medicine, University of Manitoba, Canada 141 INSERM, U823, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Grenoble; 142 Universite Joseph Fourier, Grenoble, France 143 Allergy Unit, Dept. of Dermatology, University Hospital, Zuerich, Switzerland 144 Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands 145 National Centre Cardiology and Internal Medicine, Bishkek, Kyrgyzstan 145A School of Medicine, Pontificia Universidade Catolica RGS, Porto Alegre, RS — Brazil 146 Dept of ENT and Paediatrics, AMC hospital, Amsterdam, the Netherlands 147 Finnish Institute of Occupational Health, Helsinki, Finland 148 Department of Obstetric and Gynecology, Axis in Reproduction, Perinatal and Child Health, Faculty of medicine, Laval University, Quebec, Canada 149 Christian Doppler Laboratory for Allergy Research, Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria 150 Universite Paris 13, PRES Sorbonne-Paris-Cite and Assistance publique-Hopitaux de Paris, Avicenne hospital, Bobigny, France 151 University Hospital of Mont-Godinne, Catholic University of Louvain, Yvoir, Belgium 152 Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, HB Nijmegen, The Netherlands 153 CNR Institutes of Biomedicine and Molecular Immunology (IBIM), Palermo, and of Clinical Physiology (IFC), Pisa, Italy 154 Yong Loo Lin School of Medicine, National University of Singapore, Republic of Singapore 155 Sachs' Children's Hospital, Stockholm; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden 156 School of Pharmacy, University of North Carolina, North Carolina, USA 157 Medical University of Vienna, Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases (DIAID), Wien, Austria 158 Celal Bayar University School of Medicine Dept. of Pulmonology, Manisa, Turkey 159 he Allergy & Asthma Institute, Islamabad, Pakistan 160 Department of Paediatrics and Child Health, University of Cape Town, South Africa School of Child and Adolescent Health, Red Cross Childrens Hospital, University of Cape Town, South Africa 161 University Clinic of Respiratory and Allergic Diseases Golnik, Slovenia 162 Guangzhou Institute of Respiratory Diseases and State Key Laboratory of Respiratory Diseases, Guangzhou Medical College, Guangzhou, China 163 Secretary General of the Global Allergy and Asthma European Network (GA2LEN), Network of Excellence, Charite — Universitatsmedizin Berlin, Berlin, Germany
Редакционная статья Concepts of disease severity, activity, control and responsiveness to treatment are linked but different. Severity refers to the loss of function of the organs induced by the disease process or to the occurrence of severe acute exacerbations. Severity may vary over time and needs regular follow up. Control is the degree to which therapy goals are currently met. These concepts have evolved over time for asthma in guidelines, task forces or consensus meetings. The aim of this paper is to generalize the approach of the uniform definition of severe asthma presented to WHO for chronic allergic and associated diseases (rhinitis, chronic rhinosinusitis, chronic urticaria, atopic dermatitis) in order to have a uniform definition of severity, control and risk, usable in most situations. It is based on the appropriate diagnosis, availability and accessibility of treatments, treatment responsiveness and associated factors such as co-morbidities and risk factors. This uniform definition will allow a better definition of the phenotypes of severe allergic (and related) diseases for clinical practice, research (including epidemiology), public health purposes, education and the discovery of novel therapies. Key words: IgE, allergy, severity, control, risk, asthma, rhinitis, rhinosinusitis, urticaria, atopic dermatitis. Correspondence: Jean Bousquet, Centre Hospitalier Universitaire, Montpellier 34295-Montpellier-Cedex 05, phone: +33-611-42-88-47, email: jean.bousquet@inserm.fr Accepted: 31.07.2011 г., submitted for publication: 05.08.2011 г. Abbreviations ACQ: Asthma Control Questionnaire ACT: Asthma Control Test AD: Atopic dermatitis ARIA: Allergic rhinitis and its impact on asthma ATS: American Thoracic Society CRS: Chronic rhinosinusitis CRSsNP: Chronic rhinosinusitis without nasal polyps CRSwNP: Chronic rhinosinusitis with nasal polyps EASI: Eczema Area and Severity Index EPR3: Expert report 3 ERS: European Respiratory Society FP: Framework Programme GA2LEN: Global Allergy and Asthma European Network (FP6) GINA: Global initiative for asthma LMIC: Low and middle-income country MeDALL: Mechanisms of the Development of Allergy (FP7) NAEPP: National Asthma Education Prevention Program POEM: Patient-oriented Eczema Measure SCORAD: SCORing Atopic Dermatitis SCUAD: Severe chronic upper airway disease U-BIOPRED: Unbiased BIOmarkers for the PREDiction of respiratory disease outcomes VAS: Visual analogue scale WAO: World Allergy Organiztion WHO: World Health Organization INTRODUCTION Allergic diseases represent the world’s most common diseases. Several mechanisms are involved, but many patients suffer from IgE-mediated reactions [1]. Over 400 million people suffer from allergic rhinitis and 300 from asthma [2]. Up to 50% of the population in certain age groups and countries are sensitized to allergens. Not all sensitized patients are symptomatic [3] and symptom severity varies widely from mild to severe and from intermittent to persistent. Most patients have an early onset of symptoms but the clinical phenotypes of allergic diseases vary with age [4]. Acute, IgE-mediated, severe reactions (e. g. anaphylaxis [5]) occurring in patients sensitized to drugs [6], foods [7] or hymenoptera venoms [8] may be life-threatening. Many types of acute non-IgE-mediated allergic diseases or non-allergic diseases [1] such as aspirin hypersensitivity, hereditary angioedema [9], cold urticaria [10] or skin reactions such as DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) or Lyell syndrome [11] may also be lifethreatening. Acute allergic (and related) diseases will not be considered in this document. Major IgE-mediated chronic diseases include rhinitis (and conjunctivitis) [12], asthma [2], atopic dermatitis [13] and gastro-intestinal diseases. However, allergy is not always involved [14–17]. Diseases such as contact dermatitis are linked with other immune reactions. The present document will propose the definition of the severity of allergic and related (non-allergic origin) diseases: asthma, rhinitis (conjunctivitis), rhinosinusitis [18, 19], atopic dermatitis and chronic urticaria [20, 21]. However, the list will be expanded later. Co-morbidities play a major role in severity adding to the complexity of the disease and its management [12]. However, in the current document, each disease will be considered separately since there may be patients with a severe disease (e. g. rhinitis) associated to a milder one (e. g. asthma). Concepts of disease severity, activity, control and responsiveness to treatment are linked. Severity refers to the loss of function of the organs induced by the disease process. It may vary over time and needs regular follow up. Activity refers to the current level of activation of the biological network perturbations that cause the disease and their clinical consequences. Control is the degree to which therapy goals are currently met. Disease activity and control can be viewed as opposite. These concepts have evolved over time for asthma in guidelines [23, 24], task forces [25] or consensus meetings [26]. Up to 2006, asthma was classified by severity alone [22–25]. Then, newer GINA guidelines replaced «grading by severity» with «grading by control» using the same items. Neither classification seems adequate when employed in isolation, nor is the classification of asthma by control alone sufficient [26]. The NAEPP-EPR3 guidelines [23] made key suggestions combining impairment, response to treatment and risks. This concept was adopted by GINA [27]. The uniform definition of severe asthma presented to WHO [28] used the NAEPP-EPR3 approach [23]. The aim of this paper is to generalize the approach of the uniform definition of severe asthma presented to WHO [28]
ПЕДИАТРИЧЕСКАЯ ФАРМАКОЛОГИЯ /2011/ ТОМ 8/ № 4 to allergic and related diseases in order to have a uniform definition of severity, control and risk usable in most situations. This uniform definition will allow to better define phenotypes of severe allergic (and related) diseases for clinical practice, research (including epidemiology), public health purposes, education and discovery of novel therapies (Table 1). 1. SEVERITY, CONTROL, RESPONSE TO TREATMENT AND RISK IN ASTHMA The stratification/grading of asthma severity includes several components (Table 2). The most useful concept of asthma severity is based on the intensity of treatment required to obtain control [26]. 1.1. Control The level of asthma control incorporates current clinical control and exacerbations over the past 6 to 12 months [26]. The measurement of current asthma control may be assessed by individual outcome measures such as daily or nocturnal symptoms, symptoms linked to activities or exercise, monitoring of peak flow or pulmonary function, as needed use of relievers, and exacerbations. Used individually these measures cannot accurately assess asthma control. A composite measure reflecting all key endpoints is more relevant [29] and has been used in guidelines (22, 2008 #27059, 23) (Table 3). Several scores for the control of asthma have been validated and translated in many languages in adults and adolescents. Examples are: The Royal College of Physicians three questions [32]. • The Juniper’s Asthma Control Questionnaire (ACQ) of Juniper • based on 6 questions (ACQ6) and FEV1 (ACQ7) [33], but ACQ6 is more predictive than ACQ7 for asthma control [34]. The Asthma Control Test (ACT) based on 5 questions • [35, 36]. In children, a few asthma control questionnaires have been validated [37, 38]. None of these questionnaires assess appropriately exacerbations that are of importance in the assessment of control of asthma and deserve further attention. Biomarkers hold promise to capture complementary information, but need to be validated with regard to control. Biomarkers are either not readily available or completely unavailable in most practice settings [39]. Although asthma therapy is primarily aimed at controlling the disease, the control level of asthma is independent of the step of asthma treatment. Control can be achieved at any severity level. A patient under total control may still have severe disease (e. g. oral corticosteroid-treated patient). Patients achieving control with treatment have a lower risk of exacerbation than those who are uncontrolled [39]. • The current document develops a common strategy to the severity of chronic allergic (and related) diseases taken individually. • It does not consider acute allergic reactions such as anaphylaxis. • It does not take into account co-morbidities [29]. • It is intended to be used by all stakeholders involved in the management or research of allergic (and related) diseases. Table 1. Goals of the current paper Table 2. Components contributing to asthma severity [23, 28] 1 Level of control • Current clinical control (impairment): Symptoms, health status and functional limitations over previous 2–4 weeks • Severe exacerbations over previous 6–12 months (use of oral or systemic corticosteroid) 2 Level of current treatment prescribed 3 Inhalation technique and compliance to treatment 4 Responsiveness to treatment 5 Exposure to aggravating factors 6 Risk Control level Well controlled** Partially controlled** Poorly controlled** Daytime symptoms in the past 2–4 weeks 2 days/week but not more than once a day > 2 days/week or more than once a day but 2 days/week Throughout the day Limitations of activities in the past 2–4 weeks None Some limitation Extremely limited Nocturnal symptoms/awakenings in the past 2–4 weeks None 2 nights/week > 2 nights/week Need for short acting inhaled 2-agonists in the past 2–4 weeks 2 days per week > 2 days per week Several times a day Lung function FEV1 or PEFR* FEV1/FVC (< 11 yrs of age) 80% predicted or personal best 80% 60–79% predicted or personal best 75–80% < 60% predicted or personal best < 75% Exacerbation(s) (requiring oral or systemic corticosteroids)*** 0–1/yr 2/yr Frequent (> 2/yr) Consider severity and interval since last exacerbation Table 3. Level of asthma control in patients 5 years of age [28] (Adapted from GINA 2006 [31] and 2007 NAEPP-EPR3 [23]) Any of the components places the patient in the category * — FEV1 or PEF may be 80% predicted in patients with severe persistent asthma; ** — For well controlled asthma, all components should be present; for partially or poorly controlled asthma, any of the components places the patient in the category; *** —At present, there are inadequate data to correspond frequencies of exacerbations with different levels of asthma control of severity.