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Early diagnosis of immunodeficiency makes possible early definitive therapy and avoids the complications of pretreatment infections. T-cell immunodeficiency defects become apparent as combined T- and B-cell deficiencies. Therefore, implementation of TRECs and KRECs into the newborn screening from dried blood spot will increase the preventive approach to early immunodeficiency diagnostics. Infants undergoing transplantation in the first 3 months of life have a much higher rate of survival than those undergoing transplantation later.

Krcmova I.,Ustav klinicke imunologie a alergologie
Alergie | Year: 2011

Allergen specific immunotherapy is now recognized as an integral part of standardized therapeutical guidelines which efficacy is proved by Evidence Based Medicine standards. The sublingual application of therapeutic allergens is now recognized as safe route of administration in comparison with subcutaneous administration with superior compliance. The principal guidelines of WAO addressing sublingual administration of allergen immunotherapy (SLIT) were launched in 2009 year. The both efficacy, and safety of SLIT comparable with subcutaneous route of immunotherapy were substantiated in this pivotal document. The last variant of SLIT is the form of tablets containing standardized content of allergen. Grazax 75 000 SQ-T tablets were released into large scale clinical application in 2006 year. Grazax 75 000 SQ-T is lyophilized standardized allergen extract of grass pollen Phleum pratense (Phl p5). The SQ-standardized grass allergy immunotherapy Grazax (ALK-AbellóA/S, Hoersholm, Denmark) is indicated in children older than 5 years, adolescents and adults with clinically significant manifestations of allergic rhinoconjunctivitis induced by pollen grass allergens in whom allergic reactivity is substantiated by positive skin prick tests and/or the presence of allergen specific IgE antibodies reacting with pollen grass allergens.

Microbiota represent a complex ecosystem with enormous microbial diversity. The gastrointestinal tract of a new born infant is sterile. Soon after birth it is colonized by numerous types of microorganisms. The gut flora is quantitatively the most important source of microbial stimulations and provides a primary signal for driving the postnatal maturation of the immune system. Over the past years, differences have been documented in the composition of the intestinal microflora between healthy infants in countries with a low and high prevalence of allergy. In developed countries slow colonization of the intestine with enterobacteria may reduce exposure to lipopolysaccharides. Microbial deprivation could be overcome by probiotics which may modify the immune development. Therapeutic or preventive effects of certain probiotics on infectious and inflammatory diseases in children are documented.

Krcmova I.,Ustav klinicke imunologie a alergologie
Interni Medicina pro Praxi | Year: 2013

Bronchial asthma is a significant condition of both childhood and adulthood. Chronic bronchial inflammation causes bronchial hyperresponsiveness that results in repeated episodes of wheezing on respiration, dyspnoea, chest tightness, and cough, predominantly at night and very early in the morning. This is accompanied by variable bronchial obstruction that is often reversible, either spontaneously or following treatment. The course of the disease is variable and, in terms of treatment response, it is crucial to determine the asthma phenotype. Phenotype changes caused by epigenetic mechanisms are characterized by high dynamism and reversibility. An increasing group of obese asthmatics and elderly asthmatics is becoming evident in the population; these aspects are dealt with in one part of the paper. The asthma phenotype associated with obesity is manifested by altered respiratory mechanics, a proinflammatory state of the metabolic syndrome, and reduced response to glucocorticoids. Obese asthmatic patients exhibit obstructive sleep apnoea, habitual snoring, hypoventilation, and gastro-oesophageal reflux. Weight reduction as part of tertiary prevention improves lung function and asthma symptoms. Senile characteristics modify the presentation of bronchial asthma in old age, with reduced sensitivity to symptoms and nonspecific presentation of the disease being typical. An originally allergic asthma appears in old age as nonallergic asthma sensitive to nonspecific and infectious stimuli. Reduced respiratory muscle strength, increased chest wall rigidity, and reduced lung elasticity all have a negative impact. The diagnosis is complemented by complicating comorbidities. When diagnosing bronchial asthma, you will find that it is not a definitive text, but a description of a condition that is evolving and subject to review throughout the life of an asthmatic.

Early diagnosis of immunodeficiency makes possible early definitive therapy and avoids the complications of pretreatment infections. B-cell defects constitute the majority of primary immunodeficiencies. All are characterized by the reduction in or absence of immunoglobulins and/or specific antimicrobial antibodies. Consequently, substitution of immunoglobulin G (IgG) is the pillar of treatment. T-cell immunodeficiency defects become apparent as combined T- and B-cell deficiencies.

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