[Effect of the elimination diet in psoriasis: a clinical case].

Psoriasis (PS) is a multifactorial disease with a dominant role of genetic predisposition, but the questions of PS etiology and pathogenesis still remain open. The development of PS can be facilitated by environmental factors, as well as a violation of the skin barrier and immune imbalance. In the literature of recent years, an association in clinical practice between PS and atopic diseases (atopic dermatitis, bronchial asthma, allergic rhinitis) has been increasingly reported. As a result of the increase in the prevalence of allergic diseases in the world, a special role is given to the study of nutrition, in particular food allergy in the development of PS. An elimination diet under food allergy is the main type of etiotropic therapy that prevents the launch of immunopathological inflammatory reactions. However, the literature does not provide data on the positive effect of the elimination effect in food allergy in patients with psoriasis. The purpose of this work was to present a clinical case of the effectiveness of the elimination diet for food allergy in a patient with PS. Methods. A specific allergological examination of a 65-year old patient with widespread PS (suffering from the age of 25) was carried out: determination of the concentration of total immunoglobulin E (IgE), eosinophilic cationic protein and allergen-specific IgE to food, pollen, fungal allergens in the blood serum by enzyme-linked immunosorbent assay, skin prick testing with food and pollen allergens. Taking into account the specific allergological examination, the patient was prescribed a diet with the elimination of causally significant allergens, including cross-reacting ones, for a period of 1-3 months (with the exception of chicken eggs, cereals, buckwheat, baker's yeast and products based on yeast fermentation, cereal products (bread, bakery, rolled oats, bran, oatmeal cookies, cereals, pasta); as well as peanuts, smoked sausages, coffee, cocoa, ice cream, sherbet, sesame, sorghum, honey and bee products, strawberries, wild strawberries, citrus, legumes, soybeans, sorrel, herbal teas, tree fruits (raw apples, peaches, cherries; nuts, exotic fruits), celery, raw carrots, tomatoes). Results. The demonstrated clinical case indicates that the appointment of an elimination diet in patients with PS with concomitant food allergies contributes to the rapid regression of the skin process. The increased concentration of total IgE in blood serum revealed during patient examination, the presence of positive reactions to food and pollen allergens according to the results of skin prick testing and the determination of allergen-specific IgE, the positive food elimination effect demonstrate the important role of allergic reactions in the development of skin lesions in PS. The presented observation demonstrates the importance of conducting a specific allergic examination in patients with PS, including an allergic history, determining the concentration of total and allergen-specific IgE, and eosinophilic cationic protein in blood serum, studying the spectrum of sensitization to food, pollen and fungal allergens by skin prick testing. Conclusion. Thus, as a result of the study, it was found that the appointment of an individual elimination diet, taking into account the results of a specific allergological examination, can contribute not only to the effective resolution of foci of psoriatic skin lesions, but also to the prevention of the progression of the systemic inflammatory process, reducing the risk of comorbid conditions and, therefore, improving the life quality of patients with psoriasis.

[The comparative analysis of the spectrum of sensitization to food, pollen and fungal allergens in patients with atopic dermatitis and psoriasis].

The relevance of the study of psoriatic disease is due to the insufficient effectiveness of existing etiotropic and pathogenetic methods of treatment, which confirms the necessity to search for new approaches in the research of psoriasis, including those from the standpoint of etiopathogenesis. In the literature, there is information about the combination of atopic dermatitis and psoriasis, which does not exclude a commonality of the causes and mechanisms leading to damage to the skin. The aim of the work was to study and conduct a comparative analysis of the sensitization spectrum of patients with psoriasis and atopic dermatitis to food, pollen and fungal allergens. Material and methods. A prospective study was conducted on patients with psoriasis (1st, n=20) and atopic dermatitis (2nd group, n=20) aged 18 to 57 years. A specific allergological examination was performed (collection of an allergological history, determination of the spectrum of sensitization to food, pollen and fungal allergens by prick testing). Statistical data processing was carried out by methods of variational analysis using the t-criterion for qualitative characteristics. Results and discussion. No statistically significant differences in sensitization to allergens of animal origin between the examined groups were detected. The sensitization to rice and soy was statistically significantly more often noted in patients with psoriasis, in comparison with patients with atopic dermatitis: 33.3 (n=6/18) vs 5.2% (n=1/19), p=0.03 and 66.7 (n=10/15) vs 29.4% (n=5/17), p=0.04. It was determined that sensitization to plant pollen allergens was statistically significantly more often detected in patients with atopic dermatitis compared to the group with psoriasis (72.5 vs 54.4%, p=0.02). It was noted that in the group of patients with psoriasis compared to the group of patients with atopic dermatitis, sensitization to fungi of the genus Candida albicans, Alternaria alternata, Penicillium notatum was more often, however, the differences did not reach statistical significance. Conclusion. Thus, in our study, we determined the presence of sensitization to food, pollen and fungal allergens not only in patients with atopic dermatitis, but also in psoriasis. So, sensitization to food and pollen allergens is more often determined in atopic dermatitis, and to some food and fungal allergens - in psoriasis. Preliminary prick testing guides us in further application of other methods of specific allergological diagnostics: elimination and provocative tests, and the appointment of personalized therapy.