IMMUNOLOGY TEXTBOOK - Mercury Podillia 2013

ACQUIRED IMMUNODEFICIENCY STATES

Application of Immunomodulators in Secondary Immunodeficiencies

The primary indication for prescribing immunomodulators is the presence of secondary immunodeficiency, diagnosed based on clinical and laboratory findings. Patients are initially divided into 3 groups: 1) individuals (patients) exhibiting clinical signs of immune system disorders combined with parameter abnormalities detected by immunological Methods; 2) patients presenting solely with clinical signs of immune dysfunction without laboratory confirmation; 3) individuals with abnormal immunological parameters who are clinically healthy. Immunomodulators are recommended exclusively for patients. Correcting immune status alterations (likely compensatory) in clinically healthy individuals is not advised (Manko V.M. et al., 2002).

When designing an Immunomodulatory therapy regimen, the initial prescription should generally target and address the primary immune defect. This is followed by agents with synergistic or similar directional action, albeit operating through a different mechanism to achieve a comparable therapeutic effect. Once the primary Treatment protocol for secondary immunodeficiency is completed, Background therapy is administered, the composition of which is determined by the specific Clinical presentation of the immunodeficiency state. The main objective of background therapy is continued immunorehabilitation. Thus, immunomodulatory therapy is conducted in distinct stages.

I. Stage of Immunomodulatory Therapy (Acute Period)

1. Virus-Induced T-Cell Secondary Immunodeficiencies

- antiviral agents (acyclovir);

- interferons-α, -°, leukinferon, viferon-1 (150 thousand IU) for children under 7 years and viferon-2 (500 thousand IU in suppositories) for children over 7 years in suppositories;

- T-mimetics - tactivin 0.01% 1 ml, thymoptin at a dose of 100 mcg, thymogen 0.01% - 1 ml i.m., thymalin 10 mg s.c. or i.m. for 3 days followed by every other day for 10 injections;

- immunofan 1 ml of 0.005% solution i.m. once daily, 10 doses;

- galavit 200 mg once daily i.m., 10 doses;

- T-cytokines (interleukin-2, roncoleukin, etc.);

- polyoxidonium at a dose of 6 to 12 mg.

- methyluracil at an age-appropriate therapeutic dose for 10 days, with a peripheral Blood test performed on the 7th day of treatment;

- vitamin A orally, for 10-14 days; vitamin E for 7-10 days (age-appropriate doses, injections);

- UHF therapy to the solar plexus area for 3-5 sessions;

- ultrasound therapy to the Thymus gland area for 3 sessions in children under 3 years, and 5-6 sessions in children over 3 years.

The aforementioned immunotherapy is also suitable for children with recurrent acute respiratory viral infections, prolonged subfebrile Temperature and febrile fever of unknown origin, as well as chronic non-bacterial diarrhea; it is also effective for perinatal Nervous system injuries.

For children who have suffered generalized intrauterine infections, as well as those suffering from recurrent respiratory viral infections combined with recurrent mucosal and cutaneous fungal infections, the following regimen can be recommended:

- amiksin, 2-week course; for young children, 0.03 per os once daily, up to 6-7 years at a single dose of 0.06; up to 12 years 0.1, over 12 years 0.125; or arbidol for a 3-week course (in early childhood 0.05 every 3 days per os, up to 6 years - 0.08, over 6-7 years - 0.1); in certain cases, a therapeutic dose of 3 times daily can be used for 5-7 days; if necessary, arbidol works well in combination with fluconazole or diflucan (age-appropriate therapeutic doses);

- tactivin or thymalin at an age-appropriate therapeutic dose, for a 10-day course;

- immunofan subcutaneously, 5 injections of a 0.005% solution every 2 days, 0.3 ml for young children, and 0.4-0.7 ml for others;

- membrane stabilization can be achieved by administering ketotifen (zaditen) for 1-1.5 months (age-appropriate therapeutic dose).

Another example of an immunomodulatory therapy regimen for an unspecified immunodeficiency state with T-lymphocytopenic syndrome:

- Polyoxidonium for children over 6 months intramuscularly at 0.1-0.15 mg/kg every 48-72 hours (course of 5-7 injections); for chronic conditions, 0.1-0.5 mg/kg twice a week (7-10 injections); for maintenance therapy, Polyoxidonium suppositories can be used after bowel cleansing (0.1-0.2 mg/kg for 3 days, then every 48 hours; course of 10 suppositories).

- Roncoleukin, 4 intravenous injections at 3-day intervals in saline solution (infusion rate as per the drug's package insert): 25,000 to 100,000 IU for infants and toddlers, and 100,000 to 500,000 IU per injection for older children.

- Viferon for a 5-day course: Viferon-1 suppositories (150,000 IU) for children under 7 years, and Viferon-2 (500,000 IU) for children over 7 years.

- UHF therapy to the solar plexus area alternating with ultrasound to the adrenal region; for young children, the course consists of 3 Procedures per modality, and for older children, 5-7 days for each type.

- Heparin subcutaneously or intradermally for a 4-day course (dosage ranging from 100 IU for young children to 200-350 IU for older children). For intradermal administration, multiple injection sites are used.

An example of a combined immunomodulatory therapy regimen for children with unspecified secondary immunodeficiency accompanied by lymphocytopenia that stabilized following generalized congenital infections.

- Leukinferon at 3,000-10,000 IU intramuscularly 3 times a week for a 3-week course (3,000 IU for children under one year, 5,000 IU for children up to 3 years, and 7,000-10,000 IU per injection for children over 3 years);

- T-activin intramuscularly, 10 injections every other day;

- Ketotifen 1/8 to 1/2 tablet twice daily (depending on age) for 1 month;

- Vitamin A at 3,000-6,000 IU once daily for 10 days;

- Zinc supplements orally for 3 weeks at a dose of 10-15-20 mg.

Following immunological reassessment, the course may be repeated in one to two months if lymphocyte subpopulations have normalized and a positive clinical effect is observed.

2. B-cell and secondary immunodeficiencies associated with bacterial infections:

- antibacterial (antifungal) medications;

- IMMUNOGLOBULINS (Antibodies) intravenously for severe cases:

IgG-containing: Sandoglobulin 1.0, 3.0, 6.0, 12 g per vial; Octagam 50, 100, 200 ml per vial; Intraglobin 2.5 g, 5.0 g; Normal human immunoglobulin for intravenous administration Biaven 1.0, 2.5.

IgM-containing: Pentaglobin 5% - 10.0 ml, 20.0 ml, 50.0 ml.

Replacement therapy is carried out in a loading regimen (immunoglobulin G level of at least 400 mcg/ml); maintenance therapy is managed under the supervision of an immunologist.

- intramuscular immunoglobulins;

- B-mimetics (Myelopid 0.003 g, Polyoxidonium at a dose of 6 mg to 12 mg);

- Cycloferon in an age-appropriate dosage for 10-14 days;

- Vitamin A orally for 10-12 days;

- Likopid in 1-5 mg tablets once daily for 10 days, or Humisol via Electrophoresis;

Another therapeutic option for persistent B-lymphocytopenia presenting with clinical manifestations of secondary immunodeficiency (recurrent Pneumonia and Bronchitis, chronic foci of infection, etc.) may include:

- Cycloferon at 0.07-0.15 daily for 10 doses administered every 1-2 days (or via injection);

- Licopid, 1-2 mg, for a 10-day course (0.25 mg for newborns);

- T-activin, 0.5 mcg/kg for young children, a course of 5 injections, and 1 mcg/kg for older children; supportive monthly courses of 2-3 injections should be administered;

- Yeast drink for 2 weeks for toddlers, 3-4 weeks for older children (5 g of yeast per 40 ml of Water with sugar), or a course of aloe (7-10 injections or electrophoresis);

In addition to the aforementioned, the following immunotherapy regimen has proven to be highly effective:

- Licopid, 1-2.5-5 mg once daily for 10 days (the dosage depends on age);

- ketotifen, 1/8 to 1/3 tab. twice daily for 1.5 months;

- Ribomunyl, for young children, 0.5 tablets twice daily, 4 days a week, for a 5-week course; for older children, According to the package insert.

Supportive therapy under immunological monitoring may be used.

- repeat ketotifen after 1 month;

- Immunofan, 5 administrations every 3 days, 0.3 to 0.7 ml per injection, depending on age;

- Dimexide - Applications of a 30% solution to the solar plexus area every other day or to the PROJECTION OF THE Shock organ.

3. Immunodeficiency with combined T- and B-lymphocytopenic syndrome

Immunocorrective therapy regimen:

- Tactivin subcutaneously at a dose of 10 mcg/m2 of body surface area once daily for 10 days, followed by 5 injections every 2-3 days; the course should be repeated in 2-3 months;

- methyluracil at a therapeutic dosage for 15-17 days;

- Licopid, 1-2.5-5 mg once daily for a 10-day course;

- vitamin E at a therapeutic age-appropriate dose (preferably by injection).

Stable T- and B-lymphocytopenia can also be managed with the following regimen:

- thymalin intramuscularly for 5-6 injections of 3-10 mg depending on age;

- IRS-19 (metered aerosol), 1-2 sprays daily for 10 days in combination with ketotifen.

Another immunocorrective therapy regimen for combined T- and B-lymphopenia:

- one of the intravenous immunoglobulin preparations (Selection is primarily based on hypogammaglobulinemia);

- recombinant granulocyte-macrophage colony-stimulating factor (Leukomax) subcutaneously at 1-3 mcg/kg daily, monitored for leukopenia compensation;

- Rhodiola rosea (golden ROOT) infusion; single dose - one drop per year of life, three times daily for 3-4 weeks.