Sergey F. GladkovLLC Clinic of Allergy and Immunology, Russian Federation
Title: Potential of bacteriophages in the therapy of atopic dermatitis in children
Today allergy, occupying a leading place in the structure of morbidity of all age categories, is a serious problem and represents a difficult task, the solution of which is of concern to the health care systems of many countries. According to the annual reports of WHO, World health statistics: monitoring health for the SDGs, sustainable development goals and experts of the World Allergy Organization WAO, more than 40% of the world population and more than 60% of the inhabitants of large metropolitan areas suffer from various manifestations of allergic diseases (AD) . The persistent trend of increasing number of allergic diseases in children, which has now acquired pandemic signs, is a serious public health problem. In addition, the existing reporting forms do not reflect the true picture of the prevalence of pathology, which in reality can be many times higher than the official figures. [2,3]. The main reason for this situation is the lack of atopic march (AM) management capabilities. The development of conceptually new approaches to therapy will significantly change the situation [4,5].
Purpose of the study: to determine the efficacy of selective phage decontamination (SPD) against overgrowth of Staphylococcus aureus, Klebsiella pneumoniae and Klebsiella oxytoca as the main trigger mechanism of atopic dermatitis (AtD) formation.
Material and methods: 47 children, whose mean age was 4.57±0.71 weeks, who were treated in the clinic of allergology and immunology with the diagnosis of AtD in the period 2019-2021 (group 1) were prospectively included in the study. All patients in this group received SFD in the form of monotherapy. A group of 38 children (mean age 13.92±3.44 months) who applied to the clinic of allergology and immunology with the diagnosis of AtD in the same period (2nd group) was also formed retrospectively. Patients of this group were not treated with SFD at the disease debut. In the course of the study, we evaluated the effectiveness of SFD in children at the onset of AM.
Results of the study: the conducted SFD, according to the results of fecal microbiologic examination, which revealed the presence of associations of S. aureus 6,59±0,90 lg CFU/g, K. pneumoniae 5,48±0,85 lg CFU/g and K. oxytoca 5,00±1,78 lg CFU/g in children of the 1st group., allowed to completely eliminate intestinal colic already on the 2-3rd day. Reduction of pathological impurities in feces and normalization of defecation frequency occurred after 3.82±0.63 days, objective reduction of skin syndrome severity - after 5.29±0.85 days of phagotherapy. The SCORAD index at the time of debut treatment in group 1 averaged 15.5±2.4 points, after the first course was 0 points in 36 (76.5%) children, after the second course - in 11 (23.4%). SFD performed in all children of group 1 prevented disease recurrence and stopped AM, which is confirmed by observation in catamnesis. Retrospective analysis of AM development in children of group 2 revealed the absence of positive dynamics due to the annual increase in the sensitization spectrum. Analysis of control bacterial isolations showed significant dynamics of S. aureus, K. pneumoniae and K. oxytoca titer reduction in group 1 children.
Conclusion: phagotherapy, even performed in the form of monotherapy, aimed at decontamination of the gastrointestinal tract from S. aureus, K. pneumoniae and K. oxytoca in children in the debut of AtD, allows to effectively reduce the titers of these microorganisms, which, in turn, makes it possible to effectively manage AM.
To be added...