AN IMPACT ON A PATHOGENETIC ASPECT OF AN ALLERGIC INFLAMMATION OF PATIENTS WITH ACUTE RHINOSINUSITIS

Bezhshapochnyi S. B., Podovzhnyi O. G., Gryshyna I. S., Kutsenko B. A.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Acute rhinosinusitis constitute a significant part of calls to general practitioners and ENT. In recent years, a proportion of diseases of the nose and paranasal sinuses has increased. It is explained of an air pollution and a high allergization of a population, which is growing very rapidly. It is known that a great importance of the development of an inflammation has an intercellular adhesion molecule ICAM-1, which is the receptor for 90% of rhinoviruses. The patients with a history of allergies have significantly elevated levels of this molecule. Due to this fact they are more susceptible to get sick with SARS. The entire course of an inflammation is regulated mainly by endogenous chemicals that appear in the source of the damage and called the inflammatory mediators. A chemical nature of the mediators is various. The role of the inflammatory mediators perform monoamines, peptides, proteins, lipids, nucleotides and nukleozids, proteoglycans. Blood and interstitial fluid, all body cells, non-cellular elements of connective tissue can be sources of the inflammatory mediators proteins. A histamine induces an acute inflammatory response. The main sources of the histamine in the inflammation are basophils and mast cells of the blood. the mast cells and basophils are blood — highly specialized cells whose cytoplasm contains many granules that are based on proteoglycan matrix. A significant part of the mast cells is concentrated in the mucous membranes of the respiratory tract, skin, gastrointestinal tract, where they are located around the small blood, lymphatic vessels and nerves. Leukotrienes are products of a metabolism of an arachidonic acid formed during exposure cytoplasmic enzyme — 5 lipooxigenaza. In humans, this enzyme is found in leukocytes and the mast cells. The oxidation of the arachidonic acid under the influence of 5-lipoxigenaza turns it into LTA4. The unstable LTA4 quickly transformed on LTB4, or after connection of glutathione — a peptidolipid LTC4, which then gradually turns to LTD4 and LTE4. Due to the release of the inflammatory mediators in the acute phase of a reduction in bronchial smooth muscle, increased secretion of mucus in the bronchial tubes and increases vascular permeability, develops mucosal edema, which affects respiratory function. Late response associated with the release of cytokines and chemokines mast cells, stimulates proliferation, differentiation and chemotaxis of eosinophils and T-lymphocytes type 2 (Th2). Th2 lymphocytes, releasing cytokines maintain a chronic inflammation. A large number of mediators involved in the pathogenesis of RA, but histamine is the most important. However receptor blockade does not prevent release of leukotrienes activated macrophages, eosinophils and platelets. Due to that a blockade of histamine and leukotrienes prevents the inflammatory response in allergic inflammation. That is why the treatment of acute rhinosinusitis symptoms in patients with a history of allergy requires a combination of antihistamines and leukotriene receptor blockers. The clinic ENT — diseases «Ukrainian Medical Stomatological Academy» under the supervision's been 58 patients with a diagnosis of acute rhinosinusitis of viral and bacterial etiology, divided into two groups which received combined medicine «Glencet Advance», which contains montelukast sodium 10 mg, Levocetirizine dihydrochloride 5 mg. Montelukast is a selective leukotriene receptor blocker. Levocetirizine is a R-enantiomer of active cetirizine, an antihistamine agent. Its main effects are mediated by selective inhibition of H1-receptors. Because of its components this medicine is appropriate in all manifestations of allergic inflammation, accompanied by the release of histamine and leukotrienes. It is found that patients in the experimental group with having a history of allergy after ingestion «Glencet Advance» in the first hours occurred significantly improve the state of health by improving nasal breathing and reduction of rhinorrhea. It is established that in the experimental group patients have experienced more rapid reduction of subjective symptoms compared with patients in the control group, and faster recovery of an olfactory function. Due to this fact the use of combined medicine «Glencet Advance» in the treatment of acute rhinosinusitis, especially in patients with complicated allergic history, can speed up the healing process in comparison with standard methods, provide rapid reduction of subjective and objective clinical performance and shorten the temporary disability.

allergic inflammation, rhinosinusitis, pathogenesis

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«Bulletin of problems biology and medicine» Issue 1 part 1 (126), 2016 year, 125-129 pages, index UDK 616. 211 – 002.2 – 056