Clinical and immunological features of severe acute urticaria in children

Objective: to identify clinical and immunological markers of severe acute urticaria in children. Materials and methods: 61 children with severe acute urticaria were examined, clinical methods (allergoanamnesis, urticaria activity index UAS7), immunological methods (quantitative indicators of the functioning of cellular and humoral links of the innate and adaptive immune response), statistical analysis (computer environment R). Results: it was determined that 31 children had severe acute urticaria without an established cause, urticaria with allergic or pseudoallergic genesis in the form of food hypersensitivity was noted in 15 children, in the form of drug hypersensitivity in 15 children. A hereditary allergic anamnesis was found in 31 children, and a personal allergic anamnesis in 54 patients. In 32 patients, severe acute urticaria was characterized by the presence of common symptoms, in 31 children – the development of angioedema. It was found that in children with severe acute urticaria, there was a significant increase in the expression of TLR2 and TLR4 monocytes and extremely low values of TLR9 monocyte expression, the number of NK cells was reduced, there were no changes in the spontaneous test in the phagocytic unit with a decrease in the adaptive reserves of phagocytes, increased levels of lactoferrin, IFNy, IL-6, IL-17, VEGF-A, and TGF-β1 with a decrease in IL-4 content. The processes of early activation and readiness of immunocompetent cells for apoptosis are reduced, as well as the number of regulatory T-lymphocytes. In the humoral link, with an increase in the number of B-lymphocytes, there is a decrease in the levels of secretory and serum IgА, hyperproduction of IgЕ, and accumulation of circulating immune complexes. Conclusions: the association of the incidence of severe acute urticaria in children with gender, age and with various types of hypersensitivity, hereditary and personal allergic anamnesis was revealed. Dysfunctional changes in the components of the innate and adaptive immune response in children are associated with the severity of acute urticaria and suggest their leading role in the pathogenesis of the disease, the possibility of creating a model for the prognosis of the disease.

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