RU2195314C1 - Method of treatment of patients with atopic dermatitis - Google Patents

Abstract

FIELD: medicine, dermatology. SUBSTANCE: invention relates to treatment of atopic dermatitis. Method involves administration of roncoleukin by intravenous route in the dose 500 000 IU, 2-5 injections per a course of treatment. Method decreases duration of disease exacerbation, prolongs remission period, reduces risk of development of medicinal allergy since the preparation is used by monotherapy scheme. EFFECT: enhanced effectiveness of treatment. 2 ex

Description

 The invention relates to medicine, in particular to clinical immunology and allergology. It can be used in a clinic for the treatment of patients with atopic dermatitis.

 It is known that one of the methods of treating patients with atopic dermatitis is the use of complex therapy with the inclusion of leukinferon. Leukinferon is a preparation containing a complex of cytokines (α-, β, -γ-interferons, interleukin-1, tumor necrosis factor, factors inhibiting the migration of macrophages and leukocytes). The treatment was carried out in patients with atopic dermatitis, moderate and severe, continuously - recurrent course. The treatment included antihistamines, desensitizing drugs, sedatives, selective phototherapy, injections of leukinferon, intramuscularly, 2 times a week, 6-10 injections per course and topical ointment (10 g of interferon with an activity of 10,000 ME +40 ml of sterile castor oil + 30.0 g lanolin). (A. Kerimova, A. Kubanova, V. Kuznetsov et al. "Bulletin of Dermatology and Venereology", 1991, 6, p. 8-11).

 The disadvantage of this method is that this drug includes many cytokines, which expands the list of contraindications and possible side effects.

 In addition, leukinferon in the treatment of atopic dermatitis is used as a component of complex therapy, and not a monotherapy drug.

 The essence of the proposed method is that the patient during the exacerbation of the disease is administered intravenously dropwise Roncoleukin (recombinant interleukin-2) at a dose of 500,000 ME, 1 time per day, slowly, for 4-6 hours. The course of treatment is 2-5 injections with an interval of 2-3 days.

 Systemic administration of roncoleukin allows balancing the ratio of Th1-Th2, and also participates in the regulation of production of immunoglobulins E by B-lymphocytes, affects the growth, differentiation and activation of CD-4 cells, monocytes, macrophages, NK-cells, cytotoxic T-lymphocytes. Interleukin -2 is involved in the regulation of the production of γ-interferons, a decrease in the level of which is observed in patients with atopic dermatitis.

 In addition, patients with atopic dermatitis are more sensitive to infections caused by herpes simplex virus, smallpox vaccine, molluscum contagiosum, human papilloma, which indicates inhibition of cellular immunity. The use of roncoleukin allows you to normalize the body's response to infectious agents that cause skin lesions.

 Intravenous administration of the drug is due to the fact that this route of administration of drugs is less anaphylactogenic compared with subcutaneous and intramuscular routes of administration, which is important in patients with an allergic disease.

 The number and frequency of injections is determined by the tolerance of the drug, the dynamics of the skin process: a decrease in the intensity of itching, a decrease in secondary infection, a decrease in the severity of hyperemia, and the presence of regenerative processes.

 The dose is medium therapeutic.

 The method is as follows: the drug roncoleukin is dissolved in several milliliters of an isotonic sodium chloride solution for injection, avoiding foaming, then diluted in 400 milliliters of an isotonic sodium chloride solution. The prepared solution is administered in a dose of 500,000 ME intravenously drop by drop for 4-6 hours. Repeated administration after 2-3 days. The course of treatment is from 2 to 5 injections.

 Example 1

Patient S., 15 years old. Diagnosis at admission:
"Atopic dermatitis, a common form, moderate, exacerbation.

 Related: Allergic perennial rhinitis. "

 The area of damage to the skin is widespread: the face is affected (mainly in the perioral and periorbital regions), neck, elbow bends, region of the wrist joints, popliteal fossae. At the time of receipt of the complaint, intense itching, peeling, moderate flushing of the skin in the lesions, wetting in the perioral region, papular rashes in the neck, elbow, wrist joints, lichenification of the neck, in the elbow, wrist bends, under the wrists. Also worried about the constant nasal congestion, sneezing in the morning, when cleaning the apartment.

 Data from additional examination methods.

1. General blood test at admission: Er. - 4.3 • 10 ¹² / l, GEM. - 138 g / l, C.P. - 1.0, Lake. - 6.1 • 10 ⁹ / l, E - 7%, P - 1%, C - 29%, Lf - 58%, M - 5%, ESR - 16 mm / h.

 2. Immunogram upon admission: CD3 - 70%, PI - 64%, PS - 8.0, Jg A - 0.82 g / l, Jg M - 0.28 g / l, Jg G - 5.47 g / l, Jg E - 130 IU / ml, CEC - 1.9 g / l.

 3. Sowing from the affected skin to the flora: no growth.

 The patient was injected intravenously with a solution of Roncoleukin in a dose of 500,000 ME once a day for 4-6 hours 2 after 2 days. The first administration was carried out for 4 hours, the second for 6 hours

 Tolerance to the drug is good, side effects were not observed. After the 1st injection, the patient noted a slight decrease in itching (on the 1st day after the administration of the drug), wetness in the perioral region, after the 2nd injection - a decrease in hyperemia, a decrease in the intensity of itching (4-6 days). As a result of treatment, the patient noted a decrease in the intensity of itching, relief of soaking, a decrease in the severity of hyperemia. In addition, the patient noted an improvement in breathing through the nose, a decrease in the frequency of sneezing in the morning).

Data from additional examination methods after treatment:
1. Complete blood count: Er. - 4.0 • 10 ¹² / l, GEM. - 134 g / l, C.P. - 1.0, Lake. - 61 • 10 ⁹ / l, E - 8%, P - 1%, C - 49%, Lf - 40%, M - 1%, ESR - 4 mm / h.

 2. Immunogram: CD3 - 70%, PH - 48%, PS - 7.0, CEC - 0.8 g / l, Jg A - 0.62 g / l, Jg M - 1.51 g / l, Jg G - 4.23 g / l; Jg E - 67 IU / ml.

 Example 2

Patient M., 18 years old. Diagnosis at admission:
"Atopic dermatitis, diffuse form, severe course, period of exacerbation.

 Complication: Pyoderma.

 Concomitant: Bronchial asthma, atopic, moderate, period of incomplete remission. Allergic year-round rhinitis. "

 The area of damage to the skin is diffuse: the face, neck, chest, back, stomach, limbs are affected. At the time of receipt of the complaint, intense itching, peeling, moderate hyperemia of the skin, wetting in the perioral region, papular rashes in the face, neck, limbs, back, lichenification on the neck, in the elbow, wrist bends, popliteal fossae, traces of scratching on the limbs, neck, yellow crusts in places of combing, elements with purulent contents.

 Data from additional examination methods.

1. General blood test at admission: Er. - 4.3 • 10 ¹² / l, GEM. - 154 g / l, C.P. - 1.0, Lake. - 4.5 • 10 ⁹ / l, E - 8%, P - 2%, C - 59%, Lf - 23%, M - 8%, ESR - 6 mm / h.

 2. Immunogram upon admission: CD3 - 70%, PH - 69%, PS - 7.5, Ig A - 1.71 g / l, Jg M - 0.4 g / l, Jg G -14.17 g / l, Jg E - 713 IU / ml, CEC - 3.1 g / l.

 3. Sowing from the affected skin to the flora: Staph. aureus 3 tbsp.

 The patient was injected intravenously with a solution of Roncoleukin in a dose of 500,000 ME once a day for 4-6 hours 5 after 2-3 days.

 Tolerance to the drug is good, side effects were not observed. After the 1st injection, the patient noted a slight decrease in itching, after the 2nd, 3rd injection - a decrease in weeping, hyperemia, a decrease in the intensity of itching (5-8 days). As a result of treatment, the patient noted a decrease in the intensity of itching, relief of soaking, a decrease in the severity of hyperemia. In addition, the patient noted a decrease in shortness of breath, a decrease in the intensity of use of adrenergic agonists.

Data from additional examination methods after treatment:
4. 1. General blood test: Er. - 4.2 • 10 ¹² / l, GEM. - 141 g / l, C.P. - 1.0, Lake. - 6.0 • 10 ⁹ / l, E - 8%, P - 6%, C - 55%, Lf - 26%, M - 5%, ESR - 5 mm / h.

 5. 2. Immunogram: CD3 - 64%, PH - 68%, PS - 8.0, CEC - 1.6 g / l, Jg A - 2.5 g / l, Jg M - 2.5 g / l Jg G -14.6 g / l; Jg E-470 IU / ml.

 Under observation were 14 patients aged 14 to 37 years. The average age was 20.14-2.2 years. The control group consisted of 5 people, whose treatment was carried out traditionally, including adsorbents, antihistamines, glucocorticoids, and infusion therapy.

 Patients of the main group were administered roncoleukin at a dose of 500,000 ME, intravenously, for 4-6 hours, for a course of 2 to 5 injections with an interval of 2-3 days. We observed the severity of symptoms of skin lesions: itching, hyperemia, weeping, desquamation, purulent complications and changes in immunogram parameters.

 As a result of treatment with parenteral administration of roncoleukin, there was a tendency to a decrease in the severity of clinical symptoms (a decrease in the intensity of itching, a decrease in skin hyperemia, mainly after the 2nd, 3rd injection), the relief of secondary infection without additional antimicrobial therapy (in patients with complications in the form of pyoderma there was a more rapid disappearance of purulent elements on the skin), as well as a tendency to a decrease in serum Jg E, eosinophils in peripheral blood. A number of patients with concomitant allergopathology in the form of allergic perennial rhinitis, atopic bronchial asthma showed improvement on the part of the respiratory system (decreased nasal congestion, the severity of expiratory dyspnea, the number of inhalations of bronchodilators).

Using this method provides the following benefits:
- Roncoleukin can be used as a monotherapy drug, which is important in patients with atopic disease, because in this case, the risk of drug allergy is reduced;
- the use of roncoleukin can reduce the intensity of symptoms of exacerbation of atopic dermatitis (itching, flushing of the skin, weeping), which reduces the duration of exacerbation of the disease, stop complications in the form of pyoderma without additional antibiotic therapy;
- intravenous administration of the drug is less anaphylactogenic compared with subcutaneous and intramuscular;
- prolongs the period of remission of the disease.

Claims (1)

 A method of treating patients with atopic dermatitis by administering an immunomodulator, characterized in that roncoleukin is used as an immunomodulator, which is administered at a dose of 500,000 IU, once a day, intravenously slowly, for 4-6 hours, the course of treatment is 2-5 injections with 2-3 days apart.