Difficult patient with bronchial asthma: a clinical case

Background. In recent years, there has been an understanding that atopic dermatitis (AD) and atopic bronchial asthma (BA) in childhood are diseases associated with T2 inflammation, which determines the development and introduction of pharmacological agents for biological therapy with monoclonal antibodies into clinical practice. However, this therapy is not always successful, which prompts the search for other methods of treatment to control allergic diseases. Description of the clinical case. This article presents a clinical case of the course and treatment options for BA combined with other intercurrent diseases and comorbid conditions. A clinical example of dermatorespiratory syndrome of atopic genesis in a 13-year-old patient is discussed, variants of basic therapy in the context of clinical response are presented, and algorithms for the clinical search for possible causes and conditions that impede the achievement of control over the course of a severe BA in combination with AD are demonstrated. The development of a side effect with the use of dupilumab, which led to the withdrawal of the drug, is described. Conclusion. Despite the developed therapy algorithms, the treatment of combined allergic pathology remains a challenge that requires an individual approach. The issue of prescribing immunobiological therapy for patients with a severe therapy-resistant course of the disease should be raised in a timely manner; however, it is necessary to take into account comorbid conditions and the possibility of adverse side effects that serve as an obstacle to targeted therapy. Thus, the therapy of BA and AD will remain complex and strictly personalized task.

bronchial asthma, atopic dermatitis, dupilumab