Parental compliance level as a key factor in the management of atopy march

Background. Atopic dermatitis (AD) is one of the most common reasons for seeking primary health care for children. Being an immune-mediated dermatosis with a complex mechanism of genetic and environmental interaction, it currently has only a palliative nature of therapy.

Objective. Determination of the degree of influence of the compliance level in patients with atopy on the possibility of managing AM.

Methods. The retrospective cohort longitudinal study included 50 children (main group), who visited the clinic of allergology and immunology in the period from 2012 to 2014 with typical complaints of intestinal dysfunction, manifested by severe intestinal colic (IC), the appearance of pathological inclusions in the stool in the form of mucus, green mucus, in some cases - blood, a decrease in the frequency of bowel movements. The control group included 50 children who visited the clinic of allergology and immunology in the same period with absolutely identical baseline data and complaints. All patients underwent Stool Culture with Bacteria Identification and Antibiotic + Bacteriophage Susceptibility Testing to identify associations of Staphylococcus aureus and Klebsiella pneumoniae, oxytoca, followed by phage decontamination and monitoring the course of AM in dynamics.

Results. The study revealed the presence of excessive growth of Staphylococcus aureus and Klebsiella pneumoniae, oxytoca associations in all children in the study groups. The lg CFU/g levels in the main group were: Staphylococcus aureus – 5.82±1.00 lg CFU/g, Klebsiella pneumoniae – 3.98±0.91 lg CFU/g and Klebsiella oxytoca – 4.46±0.93 lg CFU/g. In the control group: Staphylococcus aureus – 5.78±0.95 lg CFU/g, Klebsiella pneumoniae – 4.12±0.93 lg CFU/g and Klebsiella oxytoca – 4.14±0.92 lg CFU/g. Efficiency monitoring carried out after the end of phage therapy (PT) revealed a significant decrease in the indicators. In the main group: Staphylococcus aureus – up to 2.20±1.19 lg CFU/g, Klebsiella pneumoniae – 1.99±1.19 lg CFU/g, Klebsiella oxytoca – 2.08±1.13 lg CFU/g; in the control group: Staphylococcus aureus – 2.18±1.17 lg CFU/g, Klebsiella pneumoniae – 2.14±1.06 lg CFU/g and Klebsiella oxytoca – 2.22±1.03 lg CFU/g. Initial data of total IgE level at the first control point at 1.6 years: in the main group - 23.92±8.46 IU/ml and 25.72±7.91 IU/ml in the control group. The decrease in the compliance level significantly affected the total IgE level at the second control point of 7 years: 60.28±28.61 IU/ml in the main group versus 103.74±70.19 IU/ml in the control group.

Conclusion. In children with a hereditary predisposition to atopy (based on clinical atopy biomarkers), preventive PT is the main therapeutic component capable of preventing the development of AD trigger reactions. The level of compliance is a determining condition for maintaining the clinical effect obtained from PT.