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Allergen specific immunotherapy (AIT) has been the only pathogenetically relevant treatment of IgE-mediated allergic diseases (ADs) for many years. The use of AIT for atopic dermatitis (AD) treatment is dubious and has both followers and opponents. The improvement of subcutaneous AIT (SCIT) and introduction of Sublingual immunotherapy (SLIT) gives prospects of their application both for adults and children suffering from AD. This review presents results of scientific research, system and meta-analyses that confirm the clinical efficacy of AIT for children with AD who has the sensitization to allergens of house dust mite, grass and plant pollen suffering from co-occurring respiratory ADs and with moderate and severe course of allergic AD. There have been analyzed the most advanced achievements in AIT studies as well as there have been specified the unmet needs in AD. The preliminary diagnostics of IgE-mediated AD and pathophysiological disorders, including immune ones, will allow a doctor to develop appropriate comprehensive treatment algorithm for children’s AD aimed at its correction. The including of AIT to the children’s comprehensive therapy program is reasonable only if AD has the allergic form. It is necessary better to design the randomized research studies and to acquire extended clinical practice in children with AD. Use of the successes of molecular-based allergy diagnostics will help to optimize and personalize the process of selecting the necessary allergens to determine the most appropriate vaccines for children considering the results of the allergen component diagnostics. The strategy of treatment of children with AD in future will be based on individual target therapy. Keywords: Allergen specific immunotherapy, Subcutaneous specific immunotherapy, Sublingual specific immunotherapy, Aeroallergen, Atopic dermatitis, Children, Clinical efficacy

At present, apoptosis is considered as a result of intracellular genetic program independently of the reason, regular or pathological, which launched it. Apoptosis is essentially different from necrosis, when swelling and rupture of cells with the effusion of their contents take place, inevitably followed by the development of inflammation. In phagocytosis of apoptotic cells and bodies, the macrophages do not produce proinflammatory cytokines, but increase the production of antiinflammatory cytokines. A late sign of apoptosis is internucleosomal decomposition of nuclear DNA, which can be exploited to reveal apoptotic cells in situ by means of TUNEL (terminal deoxynucleotidyl transferase-mediated biotinylated deoxyuridine triphosphate nick end labeling) reaction. Caspases are the key enzymes involved in the intracellular cascade pathway of apoptosis. The damage of mitochondria results in the release of a potent activator of the caspases—cytochrome C—into the cytoplasm. This phenomenon is connected with a change in the expression of Bcl-2 family genes which are under the control of the p53 gene; the activity of the latter determines the start of a cell's advance to apoptosis. The completion of many immunological processes ends with apoptosis, which involves the interaction of Fas (CD95/APO-1) receptor and its FasL ligand both widely expressed in the cells of the immune system. This latter either independently or together with the perphorin–granzyme system represents the main mechanism of cytotoxic killing by T and NK cells. Elimination of immune effector cells which have already fulfilled their function is also carried out by FAS-mediated apoptosis. Clonal deletion of immature T cells in the thymus takes place without the assistance of the Fas/FasL system. Apoptosis is realized during such immunological reactions as deletion of B lymphocytes in germinal centers post antigen activation. Adequately regulated apoptosis maintains cellular balance in the immune system. Both decreases and increases in apoptosis rates lead to pathology of the immune system.

We have created the base of a new medical science - immunorehabilitology, dedicated to a study of the processes of restoration of the functional capability of the immune system to the physiological norm under the effect of a complex of treatment-prophylactic systematic measures in order to achieve the complete recovery of a patient (during acute course of the disease) or a stable clinical-immunological remission where relapses disappear or are minimized (during the chronic form). The process of restoration of disturbed functions of the immune system during immunological diseases with a relapsing course should include: basic, restorative and supportive immunorehabilitation, and should also provide the following main stages. First stage - clinical (duration from 14 to 45 days). This stage is usually carried out under hospital conditions with the aim of obtaining reliable clinical diagnosis and establishing the degree of immune pathology, or in the period of exacerbation of the main disease. Second stage - ambulatory. This stage of immunorehabilitation is the longest (up to three years) and consists of restorative treatment under ambulatory conditions (restorative immunorehabilitation). Third stage - sanatorium-health resort (annually, at least 24 days a year - supportive immunorehabilitation). This stage is carried out after disappearance of the features of exacerbation of the disease and may follow the clinical or ambulatory stages of immunorehabilitation.

Background All over the world, increases the incidence of allergy, asthma and autoimmune diseases. Both young and elderly people are at risk. Therefore, on time diagnostics of these changes and the improvement of patient's quality of life is the most important task for doctors worldwide. Methods Patients by random selection were interviewed and subsequently examined: 535 schoolchildren of Kutaisi, aged 7 to 14. Stepwise diagnostics of allergic factors included: 1. Questionnaire screening according to the international ISAAC questionnaire. 2. To identify the specific allergens in serum. 3. To define air pollutant concentration in the environment with the help of Burkard Trap (Burkhard Pollen Trap donated by the WAO). Results Investigation included questionnaire screening with the use of the international ISAAC questionnaire. The questionnaires for children aged 7 to 10 years were filled in by their parents; school children of 11 to 14 answered the questions themselves. Questionnaire screening allowed select the group of children with already diagnosed and with primarily diagnosed allergic diseases. From mentioned above 3 groups of children: I group 57 persons (10.7%) children with primarily diagnosed allergic diseases; II group-68 persons (12.7%) children with already diagnosed allergic diseases; III group-410 persons (77.6%) practically healthy children with no deviations according to ISAAC questionnaire. The next phase of the examination consisted of ImmunoCAP100 tests in II group 68 children with already diagnosed allergic diseases. There was determined the highest level of Phadiatop (inhaled environmental allergens) was positive in 35% of patient. We gave them the information and recommendation of air –pollens concentration according to Burkard Trap research. The use of allows accurately define the concentration of air pullutants in the environment including the pollen of trees, grass and weeds in particular geographical area in different seasons of the year. Conclusions Burkard Trap is committed to helping physicians identify the causative allergens in this complex mini environment, there are necessary condition for final verification of allergic diseases, which makes it posible to form successfully the basis of preventive therapy and appropriate undertake preventive measures.

Background In this study there has been analyzed the data from epidemiological studies on the prevalence and peculiarities of the course of bronchial asthma (BA) among the adult (Ad), children (Ch) and teenagers (Tg) in the CIS-region (CIS-R) over the past 5 to 10 years. Methods There has been used the results of studies of ISAAC, Statistical Reports (SR) of the Republic Ministries of Health and Medical facilities; the literature data. Results It has been established that BA is dominated in the structure of allergic diseases (ADs) of the CIS-R. BA, on average, suffer from 7 to 48.3% Ad and from 4 to 31% Ch. The highest incidence of BA among the population, especially Ad is observed in Armenia, Belarus, Moldova, Ukraine, Kyrgyzstan, Russia, Tajikistan. The actual incidence among Ch and Tg was 21 to 40%, for the Ad-23 to 48%. In this case, the diagnosis of BA was recorded by the SR in only 2.3% of children (Tg-3.2%, Ch-1.5%), and Ad-less than 1%. In the structure of the severity of BA among Ch and Tg, and Ad are dominated by mild forms of the disease (60 to 90% and 35 to 55% respectively) as mild intermittent or mild persistent BA, which in most cases are not diagnosed and do not receive adequate, timely assessment. The share of severe and moderate BA according to the age accounted for between 2 and 48%. The structure of BA recorded by statistical morbidity, dominated the moderate or severe forms of BA. Conclusions Thus, an analysis of existing data revealed that the mild forms of BA were dominated. The true incidence is much higher, as the uptake to the doctor takes place only in cases of the disease formed, earlier symptoms often go undetected. Often BA has been diagnosed at later stages with severe disease and complications. Unified account of the early features of ADs in a particular region will not only develop a National Prevention Program of ADs in the CIS-R, identify the main ways of their implementation, but also will allow to plan Allergic service in each region, important element of which is education and training of primary care physicians to identify early symptoms of ADs.

Asthma is caused or enhanced by environmental factors such as allergen exposure and/or chronic exposure to vapors. The precise mechanisms that drive asthma remain unclear. It is dominated by presence of eosinophils and CD4 (+) T lymphocytes which induced inflammation with secretion of interleukin-4 and interleukin-13 and triggers the development of airway hyperreactivity. It is identified a new subset of T cells, natural killer T (NKT) cells, which share some common features, but to conventional CD4 (+) T cells, NKT cells do not respond to peptide antigens, but to glycolipids. They have crucial role in several disease states, from autoimmune diseases to cancer. The aim of this study was to investigate role of NKT cells in patients’ exposure to industrial vapors and correlate with function of NK cells (cytotoxicity assay against tumor cell line-K562). Results: All exposed individuals demonstrated the increased number of NKT cells in peripheral blood lymphocytes and significant augmentation of NK-mediated cytotoxicity against human NK-sensitive target. Conclusion: These data suggest that NKT cells play an important role in pathogenesis of diseases which possible inducible etiological marker is exposure to vapors. Acknowledgement: This work was supported by grants from the Croatian Ministry of Science (No 0620096-0094 and 0621341-0308).

Cytotoxic T lymphocytes and natural killer (NK) cells represent two major types of immune cytotoxic cells that have a crucial role in innate immunity eliminating pathogen-infected cells. Both of these cells have a possibility to kill by two distinct signal transduction pathways. The first is the granule exocytosis pathway mediated by direct releasing of cytotoxic granules (perforin and granzymes) into the synapse between the effector and target cell. Perforin and granzymes are stored in the cytoplasmic granules of the cytotoxic cells. After release, they complexes with the proteoglycan serglycin and enter the target cell inducing apoptosis by splitting a selected set of cellular proteins. The objectives of this study were to examine the release of cytolitic molecule perforin from peripheral blood lymphocytes of individuals living in industrial areas with detected spyrometry's changes (restrictive and/or obstructive). Results: our preliminary date has shown significant augmentation in the amount of total perforin, as well as the number of double positive (perforin positive and cell surface antigens positive cells), implicating the distinct mechanisms of immunoregulation in individuals living in urban industrial areas. Acknowledgement: This work was supported by grants from the Croatian Ministry of Science (No 0621341-0308 and 0620096-0094).