The aim: To determine the significance of multidisciplinary approach to management of pediatric patients with skin symptoms of food allergy.
Materials and methods: The study included of 36 patients aged 4 to 6 years with skin manifestations of food allergy, of which 18 were randomly included in the study group and had a multidisciplinary approach to treatment and the other 18 patients constituted a comparison group and used a standard therapy regimen. Observation of children was carried out for 3 months.
Results: Assessment of the severity of the cutaneous form of food allergy by SCORAD score showed the average degree of disease activity in the groups of the study at the beginning of treatment and significantly better dynamics in patients of the study group (p=0.0055). In 88.9% (n=16) of patients in the study group and 61.1% (n=11) of the control group, the process became mild.
Conclusions: The application of a multidisciplinary approach allows the integrated implementation of medical, nutritional, and psychological aspects, which significantly increases the effectiveness of treatment and improves the quality of life of patients and their parents.

УДК 616.914-06[616.24-09:616.94]-036.17

Вітряна віспа є одним з висококонтагіозних гострих інфекційних захворювань, які можуть перебігати тяжко, ускладнюючись залученням вісцеральних органів і центральної нервової системи, з розвитком загрозливих для життя станів у ВІЛ-інфікованих дітей. У наведеному клінічному випадку описано тяжкий перебіг генералізованої форми вітряної віспи з розвитком пневмонії, ускладненої гострим дистрес-синдромом. Тяжкість хвороби обумовлена ВІЛ-статусом дитини та відсутністю антиретровірусної терапії, що й призвело до летального завершення.

Висновки. Постмортальним дослідженням підтверджено VZV-інфекцію з вираженими альтеративними змінами внутрішніх органів і змінами в лімфатичних вузлах, характерними для ВІЛ-інфекції.

The case presents a severe form of generalized chickenpox in an 11-year-old HIV-positive child. Simultaneous lack of prior anti retro viral therapy, concealment of the child's HIV status, late request for medical help and many factors were seen. Delayed adequate specific treatment led to a dramatic lethal course of the disease. 

Інфекційні захворювання дихальних шляхів посідають провідне місце в структурі захворюваності дітей раннього віку. Основними збудниками гострих респіраторних вірусних інфекцій, які викликають симптоми гострого стенозуючого ларинготрахеїту (ГСЛТ), є парагрип, аденовірус, бокавірус, грип. Пандемія коронавірусної інфекції внесла свої корективи в етіологічну структуру хвороб, які ускладнюються ГСЛТ. Попередні штами COVID-19 спричиняли легкий перебіг захворювання, подібний до ГРВІ, або з відсутністю клінічної симптоматики. Проте в 0,8–1 % пацієнтів діагностовані тяжкі ураження легень із гострим респіраторним дистрес-синдромом. При появі штаму омікрон змінилася клінічна симптоматика коронавірусної хвороби: все частіше спостерігалися висока гарячка, що погано коригувалася антипіретиками та розвиток ГСЛТ.

УДК: 577.27:616-056.3:613.287.5]-053.3

Introduction. Cow’s milk protein allergy is an urgent problem in pediatrics and aff ects from 0.5% to 3% of infants under one year. IgE-dependent form is present in 60% of children with cow’s milk protein allergy and occurrence of symptoms is usually observed from several minutes to several hours from the time of allergen consumption. Molecular diagnostics opens many new opportunities for diagnosing diff erent forms of allergy and prognosticating effi cacy of treatment.
Purpose. To assess the eff ectiveness of molecular diagnostics in children with cow’s milk allergy in diff erent therapeutic tactics.
Materials and methods. Inclusion criteria of the investigation: children from six month to three years old, positive skin test to milk (papule ≥3 mm with prick method) and specifi cIgE to milk ≥0.35  kUa/L in the serum, positive oral provocation test (OPT). The children  had clinical changes associated milk consumption. The research did not include patienwith anaphylaxis in anamnesis, present severe concomitant or autoimmune diseasescontraindications to OPT. All 60 patients and their parents or custodians gave written consent to participation in the investigation. Assessment of a molecular profi le was performed for detecting major components of milk (Bos d 8 – casein, Bos d 5 – β-Lactoglobulin, Bos d 4 α-lactalbumin), minor (Bos d 6 – bovine serum albumin) and cross-reactive ones with serum albumin (Fel d 2 – felis domesticus allergen 2, Can f 3 – canis familiaris allergen 3).
Results. The study cohort consisted of 60 cow’s milk allergic patients, randomized into two groups, compared based on age (p=0.88) and gender (p=0.3).
Analysis of a molecular profi le of milk components permitted to detect the highest indices in the group of major molecules: Bos d 4 (2.10 kUa/L in specifi c oral tolerance group and 2.00 kUa/L in elimination diet group), Bos d 8 (1.90 kUa/L and 1.55 kUa/L respectively) and Bos d 5 (0.85 kUa/L and 1.60 kUa/L respectively). A skin prick test papule diameter had a statistically signifi cant correlation with sIgE to milk (r=0.51) and Bos d 8 (r=0.44). Bos d 8 had a statistically signifi cant correlation with papule diameter (r=0.44), as well as with Сan f 3 (r=0.39) and Bos d 4 (r=0.28). Bos d 6 had a statistically signifi cant correlation with Fel d  2 (r=0.64) and Can f  3 (r=0.44). The obtained data confi rm that bovine serum albumin indicates cross-reactivity with animals, particularly a cat and a dog. The children were observed for three years.

Conclusions. 1.Assessment of a molecular profi le is important for diagnosis and treatment of cow’s milk protein allergy irrespective of a choice of therapeutic tactics – specifi c oral tolerance induction or elimination diet. Identifi cation of individually signifi cant food allergens makes it possible to determine individual indications and contraindications for oral provocation test and select the most appropriate treatment, in particular, specifi c oral tolerance induction as a disease-modifying immunotherapy. 2. Cow’s milk protein allergy is basically accompanied by the presence of major molecules, in particular α-lactalbumin (Bos d 4), casein (Bos d  8) and β-lactoglobulin (Bos d  5). 3.  Casein (Bos d  8) is a major thermostable component of cow’s milk protein and has a statistically signifi cant positive correlation with a papule diameter (r=0.44), Сan f 3 (r=0.39) and Bos d 4 (r=0.28). 4. Bovine serum albumin (Bos d 6) is a minor component of milk and has a statistically signifi cant positive correlation with Fel d  2 (r=0.64) and Can f  3 (r=0.44), which indicates crossreactivity with animals, particularly a cat and a dog.