MINISTRY OF HEALTH OF UKRAINE
Vinnitsa National Medical University. MI Pirogov
"Approved uyu"
Vice Rector for Academic Affairs
Professor Huminskyy
__________________
Yu.Y.
(Signature)
"__ 25 ___ '___ 0 ___ 6 20 1
3y
Methodological development
for 5th year student of Faculty of Dentistry
Post number 9
Academic discipline
"Clinical Immunology and Allergology"
Module number 1
"Clinical Immunology and Allergology"
Modules № 2
Allergic diseases in dentistry - diagnosis,
treatment.
Study subject
Principles of treatment of allergic diseases:
SIT and pharmacotherapy (antihistamines,
corticosteroids, membranostabilizatory):
indications, contraindications, side
effects. Technology inhalation therapy for
respiratory AZ. Polls via "Step 2".
5th
"Medicine", "Pediatrics", "Medical and
preventive care"
4
Rate
Faculty
Number of hours
201 3 years
1.
Background:
With dignity to statistics the average annual increase in the incidence of allergic diseases
in Ukraine among children and adults is 0.3%.
Based on current understanding of the pathogenesis of allergic diseases (AZ) cure them by means
of pharmacotherapy is still impossible. Existing drugs - steroids, antihistamines, etc.
antyleykotryyenovi, although allowed to significantly increase the effectiveness of AS helped to
monitor their progress, but their influence, unfortunately, does not allow for drastically affect the
immunological aspects of these diseases and to cause long-term remission. According to an
official document of the WHO (1997) and the majority of domestic and foreign experts, the only
method that really affects every pathogenesis of AS, lets cut the development and course of AS is
specific immunotherapy (SIT) allergens (synonyms - "specific alerhovaktsynatsiya" " specific
hyposensitization, "etc.).
Some important abstract from an official of the World Health Organization - WHO POSIT
ION PAPER "A llergen immunotherapy therapeutic vaccines for allergic disease ", Genev a, J an
uary 27-29, 1997, confirming the above information:
• The use of allergen immunotherapy has shown its true effectiveness ity in patients with allergic
rhinitis, conjunctivitis, allergic asthma, allergic reactions to insect stings.
• The nasal, sublingual or oral immunotherapy, in which the injected be high doses of allergens
may also be effective.
• Immunotherapy is the only method that can influence the natural history of allergic diseases, it
can also prevent the transition of allergic rhinitis in asthma.
According to this document, the effectiveness of specific immunotherapy is:
When insect allergy
85-95%
In hay fever
80-90%
With year-round rhinitis
70-80%
In bronchial asthma
70-75%
Specific immunotherapy in the future retain the properties of a single method that can alter
immune-mediated hypersensitivity to certain allergens patient.
2. Learning Objectives (main teaching and learning issues for self pozaudytornoyi).
Know how to:
1. Know l Basic principles and forging chnyh allergies and diseases.
2. Know the treatment group farmakopreparativ AZ (corticosteroids, antihistamines,
membranostabilizatory, bronchodilators, and Immunotropic enzymes, probiotics, decongestants).
3. Know the mechanisms of specific immunotherapy.
4. Know the types and methods of specific immunotherapy AZ.
4. Know the methods of prevention AZ.
3. Be able to:
1. Assign and you pharmacotherapy for the treatment of AS.
2. Assign patients SIT.
4. Baseline training.
The names of the preceding disciplines
1. Human Anatomy
2. Normal physiology
3. Pathological Physiology
4. Pharmacology
General plan of the
Value breathe flax,
General pathology
The pharmacokine
enzymes, probiotic
6. General hygiene
7. Pathological anatomy
8. Dermatology
9. Gastroenterology
The concept of occ
of dermatitis amon
respiratory and ner
Structure and funct
Diseases of the gas
5. Organization of the content of teaching material
After pref Tanna and the students, the teacher conducts roll call and voiced topics in class.
1. By out-patient teacher introduces students to the basic principles of treatment of allergic
diseases:
1. Educated patients.
2. Elimination therapy.
3. Alerhovaktsynatsiyu (specific immunotherapy).
4. Pharmacotherapy.
2. Teacher then demonstrates the importance of each stage of treatment.
2.1 The teacher draws attention to the fact that education of patients and working with them is
unbreakable. Traces wires you by:
1) collective classes (known "school with asthma");
2) popular programs in the media;
3) publications.
Summary of key measures in allergic diseases should include:
a) elimination activities;
b) behaviors during specific immunotherapy;
c) the nature of pharmacotherapy;
d) the ability to control of respiratory function (ERF).
2.2 The teacher emphasizes that every doctor should know exactly Directions elimination
therapy. He should know the main allergens that are typical of its region, a calendar of deadlines
or pylkuvannya sporulation of fungi. In addition, it should take into account ty and availability of
ecologically dangerous enterprises in region nutrition population, its mentality, especially of
Ocho Health Care of and more that make it as a professional.
Elimination therapy (if it is not a short-term measure) really can take only the sick. Therefore,
education of patients, working with them ("komplayns") is a very important event and to some
extent affect the prognosis of allergic diseases.
Then the instructor explains what you need to carry out activities in various allergic
pathologies, such as:
Elimination measures for hay fever:
For an allergist is very important knowledge of regional plants with the terms pylkuvannya
nayvyrazhenishymy sensitizing properties (indicative calendar pylkuvannya plants in Ukraine,
see 6).
In the hay fever season in pylkuvannya as appropriate:
• limit exposure to air;
• wet gauze curtain vents;
• Do not open the windows in the car;
• conduct daily wet cleaning of rooms;
• remember that the air conditioning system does not rule on Java pollen in rooms, but this can
be accomplished in a special "Beza lerhennyh-wards";
• eliminate the consumption of food, medicines, which may include pollen or other parts of
plants.
The teacher said that the m IL pollen and certain types of vegetables and fruits can may be
cross-reactions. Yes, wormwood can be shared determinan you with cumin, anise, sweet pepper,
pollen of trees such as alder, hazel, birch, can provide cross-allergic reactions to allergens apples
and nuts. In individuals with hypersensitivity to grasses may be allergic to bread.
Off season pylkuvannya patients do not have to take in food:
- Honey, which, understandably, includes different pollen;
- Carefully take apples, citrus fruits, strawberries;
- Not desirable to use raw vegetables (carrots, beans). As an allergy to pollen is sometimes
combined with an allergy to certain species of fungi, the spores of which can also rapidly dissipate
in the air, it is appropriate at any time of year:
• do not work in the fall and spring in the garden in the country, because of rotten grass, leaves are
a source of mold I ref mushrooms;
• use caution in food dough, champagne, beer, brew;
• treat fungal diseases of the skin, nails, hair;
• the presence of air conditioning in the car should go to her after she warms up and will work at
least 5 minutes (release spores into the air conditioner machine).
To prevent breeding of mushrooms in the room is a special hooked-shuvachi air. You should not
start plants. Surfaces on which there are traces of fungal growth, it is advisable to handle
fungicides.
Air conditioners can reduce the amount of pollen in the air, but it applies to modern air conditioners
that need to be cleaned periodically according to the instructions. There are special devices to
reduce the concentration of the various particles in the air (filtration of mechanical, electrostatic
precipitate chewing), special filters for heating systems. There is also a little different manitni
filters are useful for both patients with hay fever, and the presence of house dust allergy
dokomponentiv.
If you are allergic to household allergens is recommended:
- Use a special coating on the bed (made in Ukraine);
- Wash clothes in hot water (not below 70 ° C);
- Maintain humidity in the apartment above 50%;
- Replace carpeting to linoleum, wood flooring, parquet;
- Do not sleep on upholstered furniture;
- Remove all "cleaners", ie objects and things that adsorption tion to dust ourselves;
- Vacuum cleaners cleaning 1 time per week with HEPA filters that for is supported allergens;
- Apply acaricide - special solutions for the destruction mikroklischiv (Asahozap, Asahsiyzi),
benzyl benzoate, 3% solution of tannin;
- Periodically make way for frost, UV irradiated. The living room should:
1. Do not smoke.
2. Exclude furniture, wool blankets, quilts (replaced by cotton or synthetic).
3. Do not keep domestic animals and fish.
4. Do not use air fresheners, insecticides, mothballs.
5. Have the kitchen hood.
6. Regularly (without the patient) to hold wet cleaning.
7. Relative humidity should be 35-50%, the temperature is not higher than 22 ° C.
8. It is desirable to have air conditioners.
Some acaricides (benzyl benzoate, taninova acid, etc.) at regular polar applying to some extent
destroy the population of mites. More effective is the use of special coatings and dense tissue.
The bedroom should be:
1. Remove furniture, carpets, drapes. The floor must be de made from wood or covered with
linoleum, furniture - wood or metal, for windows - blinds or curtains cotton. Everything should
wash or bathe.
2. The cabinet does not store blankets, felt hats, wool products and anything that collects
dust. Cabinet doors should be closed tightly.
3. Doors and windows should be well fitted, during the pollution of the air, the wind, they should
be tightly closed.
4. Wet cleaning 1-2 times a week. Patients on go to bed 3-4 hours after cleaning.
5. Have foam pillows, cushions and wash bedding should be 1 per week at or below 55 ° C.
6. Mattress to put a plastic bag with zipper "lightning."
7. A child should not play with soft toys.
If you are allergic to cats or dogs coat should do everything possible to get rid of animals in the
apartment. But a few months thereafter On the air in the room can be found the remains of
animal allergens. The greatest danger is the epidermis cats, which are volatile and delay is
formed only filters with pore diameter of 3 mm.
Persons who keep dogs should be aware that a different breed of animal allergens have different
strengths, but safe in this regard is not.
If you are allergic to cockroaches should always kill these insects. But the need but remember
dezinsektytsydiv danger for patients with allergies.
If you are allergic to epidermal allergens should remember also the possibility of cross-allergic
reactions to meat animals and serum preparations obtained from these species (eg, horse-chu,
bull, antidiphtheritic serum used with treated tion and diagnostic purposes, the presence of
certain types of horse meat sausages).
Also, keep in mind the general measures that will be useful for patients with any allergy, for
cause psevdoalerhichni, cross-reactions, nonspecific hiperreaktyvnisttoscho.
Thus, the presence of the parents (especially both) of allergic disease fluctuations should expect
the possibility of allergies in children. Therefore, the ne riod pregnant women should avoid
smoking, alcohol, drugs, likars cal means infections that increase the likelihood of allergies and
approximating the term of its clinical manifestations.
In early childhood are also important:
1. Features nutrition in childhood, particularly early switch to bottle-feeding;
2. The presence of flat domestic animals, fish and birds.
Keep in mind that the most dangerous in terms of food allergies at any age (especially in
children) are coffee, cocoa, chocolate, citrus fruits, strawberries, strawberries, eggs, honey, fish,
eggs, crabs, crayfish, milk , carrots, beets, tomatoes, nuts.
Common factors that may contribute to allergic diseases, including allergic rhinitis are: time of
year when the child was born, vaccinations, living conditions, smoking (passive and active), the
presence of domestic animals, fish, chemicals in the home and at work; manipulation mouth,
frequent introduction into the nose, inhalation drugs, surgery.
At the reception the students themselves, under the supervision of the teacher to give
patients advice elimination measures and bring patients to their great need.
Only working with patients is the key to effective specific immunoglobulin noterapiyi for the
understanding of the nature of this treatment, regular ness administration of allergen, duration of
treatment, the possibility of certain complications is very important. Since the conduct of
specific immunotherapy is built on the dosed administration of 'reasons them "allergens should
do everything possible to reduce nekontrolo-tion proceeds allergens relevant to the patient.
The patient must periodically (and in the event of significant changes in the state of
healthy care, the presence of large local reactions - immediately!) inform your doctor about all
the nuances of the disease, condition after administration of allergens like.
The bottom line pharmacotherapy of allergic diseases need roz'yas mates of patients to
ensure that they not only understand the basic mechanism of action of drugs which they are
appointed, but their side effects.We should not hide the fact that each farmakopreparat useful
enough to much higher ratio of "utility / side effects."
However, we believe that patients need to understand the essence of pharmacoeconomics, that
they should explain that the most effective drugs RAO is usually the most cost-effective.
Specifically, it is about antihistamines, patients should be aware of the duration of action, optimal
timing of application, opportunity, major side effects during the performance of their admission,
the major side effects (effects on the central nervous system, the conducting system of the heart).
It should allay their safety relevance to eufillina, Teofedrin and, contrary, overly cautious on (3agonists, inhaled hlyukokor-tykosteroyidiv (IGCC).
ENT should change the safety of many patients on prolonged use of decongestants, danger of
self independently destination for children. It should explain the high capacity mucosa ing
membrane of the nose quickly absorb drugs. By administering ing topical preparations should
be treated almost the same responsibilities as the introduction of a vein!
Teacher explains n ryznachayuchy kromony, inhaled corticosteroids, their effect will come no
earlier than 2-3 weeks and that these drugs are much safer than systemic corticosteroids. The
patient should be taught to use pre inhaled Paraty, or benefit from their use is negligible. They
are blame must rinse the mouth after use of inhaled corticosteroids. You nyknennya unusual
sensations, sudden ineffectiveness of drugs on guilty to get a patient to see a doctor.
Also, it is necessary to co ntrol respiratory function (ERF).
The ability of patients to use pikfluometry to control the functions this external respiration is a
very important event. This should develop ' yasnyuvaty patients, work in groups, teaching her's
to this method, SAG tosuvannyu (ß 2-agonists on the testimony FDD).
2.3. Specific immunotherapy
The teacher stresses that the district and even better drugs that affect the number of pathogenic
mechanisms of allergic reaction - an allergic inflammation, release of neurotransmitters - steroids,
for all its positive qualities, can not affect remedy the immunological stage of allergic reactions
and will not prevent the formation nude cell immune memory following famous cascade
effects. Tob a cancellation of these drugs will lead necessarily to restore symptom volumes of
allergic diseases.
There dynym method that can fundamentally change the status of patients with allergic diseases
remains specific immunotherapy.
Teacher benefits imposes expenses you specific immunotherapy allergic to pharmacotherapy diseases, such as:
- Maintaining long-term remission after successful completion of the course of specific
immunotherapy;
- Preventing the progression of the spectrum of allergens to which formuyet be hypersensitivity;
- Utyazhchennya disease prevention and transition milder clinical manifestations of severe
allergies;
- Reducing the need for allergy medications.
In the last decade, the efforts of scientists were able to establish a number of immunological
mechanisms of specific immunotherapy in force at all levels of an allergic reaction to contrast
farmakopreparativ.
Then the teacher introduces students to the composition of vaccines, indications for use and inputs
alerhovaktsyn.
Conduct SIT displayed when:
• confirmed and g E-mediated nature of the disease;
• disease has a long course of severe manifestations;
• no full elimination of allergens;
• there is any need standardized allergen;
• there is a clear confirmation of the role of allergens (pollen, household allergens, house dust
mites, hymenoptera venom).
Students are introduced to the inputs alerhovaktsyn in clinical diagnostic laboratories:
This parenteral methods (subcutaneous, intradermal and Application of skin-squares method) and
noninvasive: oral, sublingual, intranasal, con 'S ktyvalnyy, inhaled and some other methods
nerozpovsyudzheni SIT. Depending on the length of courses and rozriznyayuttsilorichnu
preseason SIT.
The teacher must be noted that each patient is individually regimen. Moreover, SIT can combine
with the base and symptomatic treatment of allergic disease.
teacher then demonstrates
the benefits of oral SIT method, its safety, efficiency, ease of use and affordability.
The effectiveness of SIT is very variable and depends on many factors.
Also a teacher of students with nayomyty with contraindications for SIT (absolute and relative),
and the restrictions to apply.
An important point is sensitized to students who can expect unwanted and reaction tion
and the introduction alerhovaktsyn complications and their prevention.
2.4. In this section, the teacher introduces students to the main areas of drug therapy of allergic
diseases.
They can be divided into three groups:
drugs acting on allergic inflammation - among the highest efficiency of these facilities are
corticosteroids (both local and systemic effects), but the first inhalation. The use of topical
corticosteroids is a safe method of inhalation therapy.
antymediatorni agents (antihistamines, antyleykotryyenovi);
symptomatic medications (decongestants, bronchodilators, vidharkuyuchi).
The teacher said that the development of drugs farmakoindustriyi acquire properties and broad
lines (combination therapy).
At present, more standards are implemented treatment of major diseases that allow all patients,
regardless of place of residence and qualifications of physicians to obtain current therapy.
6. Plan and organizational structure of educational classes Allergology
(240 minutes).
Number
c/o
Stages classes
Distribution
time
*
1.
1.1.
The preparatory phase
Organizational matters.
35 min
5 min
1.2.
Formation of motivation
5 min
1.3.
Control of entry
level of training
(Standardized controls).
Types of
Monitorin
practica
Familiarity wi
students
students with the
Structured wr
25 min
2.
The main stage (specify
all kinds of work that students perform under
during this phase).
120 min
Oral survey
poll by standa
analysis of the
of objective
examination.
test control
criteria of kno
3.
The final stage
25 min
3.1.
Control endline
training.
15 min
3.2.
Overall training
student activities.
3.3.
Informing students
the topic of the next session.
5 min
5 min
Theory
Note:
* Forms of control and training tools specifically defined by the Department for each stage of training;
Controls ** theoretical and practical training of students need to be standardized.
7. Methods of educational process in the practice (seminar) class.
7.1. The preparatory phase.
Bring about with the principles of restorative treatment of allergic diseases: education of
patients, elimination therapy alerhovaktsynatsiyu, pharmacotherapy
To acquaint students with specific goals and plan lessons.
Conduct initial control level of preparation of students as regards the treatment of allergic
diseases.
In conducting out-patient determine the extent necessary to assist a patient in each case.
7.2. The main stage
This phase involves performing each student independently and under the
supervision of the teacher below mentioned practical work.
Task 1
Students conduct surveys and objective examination of the patient with allergic diseases and
after the introduction of diagnostic methods prescribed treatment regimen,
poyasnyuyuchyvykladachu appropriateness of a particular method.
Task 2
Number
1.
Task
Specific immunotherapy is ...?
2.
4.
5.
In conducting specific immuno therapy allergens (SIT) of patients 10 years at a dose of 0.5 ml
of allergens 1:10 he encountered the phenomenon rhinitis. What should be done?
A woman who suffers from asthma caused by allergy to house dust after SIT achieved stable
remission. Which of any medical matters most to prevent a recurrence of the disease?
For drugs with antyleykotryyenovu action include ...?
According to the doctrine of the WHO treatment of allergic diseases should include ...?
6.
For drugs that seal the membrane of mast cells include ...?
7.
By short-acting bronchodilators are included ...?
8.
9.
In any type of allergic reactions advisable to use antihistamines?
By the combination of inhaled drugs include ...?
10.
When allergies which etiological factors observed the highest effect SIT?
11.
What methods of SIT you know?
12.
Indications for SIT:
3.
Task 3
Solve tests:
1.Chy complications arise during the SIT?
The answer is - yes. There are local and systemic adverse reactions
1. Over what period should be used decongestants?
The answer - 7 - 10 days
2. What should a patient after another, etc. 'injection alerhovaktsynoyu that zastostovuyetsya
scheme?
Answer - remain under medical supervision for 30 minutes.
Task 4
Challenges to self:
№/№
1.
Task
In which diseases shows specific hyposensitization with allergens?
2.
What are antihistamines 1st generation?
3.
How long is podovzhenist action of salbutamol?
4.
What Immunotropic drugs that are used during specific immunotherapy depressing?
5.
What are antihistamines 2nd generation?
6.
What are the stabilizers of membranes of mast cells:
7.
What topical glucocorticosteroid and has the highest anti-inflammatory activity?
8.
What nesedatyvni H1 histaminoblokatory?
9.
Indicate the main mechanism of action alerhovaktsynatsiyi?
10.
What topical inhaled corticosteroids?
11.
What preparation is fundamental to the basic treatment of patients with hereditary angioedem
12.
What Reparate n is used to treat seasonal allergic rhinitis moderate course?
13.
What are the benefits of second-generation antihistamines before the first?
14.
Podovzhuvanist action of formoterol and salmoterola is ...?
15.
Does salbutamol higher selectivity compared to fenoterol in action on ß 2 -receptors
16.
By topical antihistamines include ...?
17.
18.
What side effects may occur with the use of inhaled corticosteroids?
What basis antihistamine 2nd generation Telfast?
7.3. The final stage.
We estimate the current activities of each student throughout zanyatttya, the analysis of
student achievement, announced evaluation of each student and put in the log of visits and student
achievement. Group leader at the same time puts assessment roll of the success and attendance of
students, teacher assures them his signature.
8. Applications.
8.1. Theoretical questions preparatory phase:
1. Principles of treatment for AS WHO.
2. Features the treatment of allergic diseases in children.
3. Groups headlights makopreparativ treatment AZ
4. Antihistamines 1st generation: advantages, disadvantages, indications, however, your.
5. Antihistamines 2nd generation and their metabolites: advantages, disadvantages, indications,
however, your.
6. Antyleykotriyenovi drugs: indications, however, your destination for.
7. Topical corticosteroids: indications, contraindications for the purpose, side effects.
8. Methods of alerhovaktsynatsiyi.
8.2. Diagnosis and treatment.
Problem number 1.
Woman '38 for 6 years suffering asthma suffers year round. Works in a room where the walls are
covered with mold. Allergy d o aspirin aspirin. As now shniy time - 4 attacks of breathlessness at
night, chstishe at night. Bow shortness of breath. In the lungs breathing weakened, dry rales on
vydosi. Skin test to house dust - +, then on 'I Pillow - + on maple and alder - +. Prescribe treatment
based on the form and severity of the disease.
Answer: Budesonide * 2 inhalations 2 times a day after prior inhalation of fenoterol or - Symbicort
1 inhalation twice a day
Problem number 2.
The 9-year-old to 7-9 times a year there are asthma, which are rapidly removed inhaled
bronchodilator drugs, diagnosed asthma, atopic form, intermittent Which drugs should be set
as long basic therapy?
A: inhaled corticosteroids
Problem number 3.
Patients with severe asthma hormone to purchase an asthma attack ambulance surgeon appointed
in / aminophylline 2.4% -10.0. What mistake did the doctor?
A: Not found prophylactic doses of inhaled corticosteroids, aminophylline not shown
Problem number 4.
The patient was 48 years, admitted to the emergency department complaining of an attack of
asthma, a condition not facilitated after administration eufillina, cough with sputum difficult
leaving. In the history of bronchial asthma for 10 years. Objectively: respiratory rate - 30/hv.,
Percussion-box sound. Auscultatory - over lungs breathing does not listen. Your primary treatment
strategy?
Answer:
Glucocorticoids intravenously
Problem number 5.
The patient with the introduction of penicillin emerged feeling hot, flushing of the skin, anxiety,
fear of death, headache, buzzing in your ears, chest pain, blood pressure - 60/30 mercury The
introduction of the drug suspended, provided first aid. What type of allergic reaction has taken
place?
Answer: Reahinovyy (I type in Jelly and Coombs).
Problem number 6.
The patient complains of fever up to 38C, weakness, headache, intense itching, blisters appearing
on the chest. From history and in the evening took fish, eggs, and alcoholic beverages. What
medicine should be given to the patient?
A: Antihistamines (system, chelators).
Problem number 7.
The 6-year-old child who was suffering from intermittent asthma, recovering from SARS appears
infrequent cough, expiratory dyspnea during exercise. Indicators peak flow metria reduced while
at 20%. Which of the following drugs should assign the child to prevent an asthma attack during
physical activity?
1. Mucolytics
2. Inhaled beta2 ahonity short-acting
3. Antyleykotryyenovi drugs
4. Antihistamines nesedatyvni
5. Inhaled corticosteroids
Answer: Antyleykotryyenovi drugs
Problem number 8.
In patients with asthma who was treated for a year and bekotydom sereventom emerged redness
and swelling of the gums, white patches on the tongue. What could it be? Why did the patient and
what to do?
Answer : d rybkove lesion cavity mouth as a result of prolonged use bekotyda. Arose from the
fact that the patient's mouth after inhalation polokav bekotydu. Next (after treatment of mycosis)
it should be done
Problem number 9
Boy 13 years, complains of cough, shortness of breath. Ill for one year. Diagnosed asthma, asthma
developing 1-2 times a month. The doctor decided to assign basic treatment antyleykotryyenovyy
drug. Which of these drugs is on to this group?
1.
Eufilin
2.
Salbutamol
3.
Montelukast
4.
Cromoglycate sodium
5.
Nedocromil sodium
6.
Symbikort
A: Montelukast
9. Suggested Reading
Basic
1.
GN Drannyk: Clinical and ymmunolohyya allerholohyya. - C. - 2006.
2.
GN Drannyk, Yu.A.Hrynevych, GM Dyzyk: Ymmunotropnыe preparations. - Kiev
- 1994.
3.
G. Lolor Jr., T. Fyter - Clinical ymmunolohyya and allerholohyya. - M. - 2000.
4.
DC Novikov, PD Novikov - Clinical ymmunolohyya. - Vitebsk. - VSMU, 2006.
5.
B. M. Puhlyk: Guide to praktycheskoy ymmunodyahnostyke and immunotherapy. Vinnitsa. - 1992.
Learn more
6.
A. Sokolov: - Clinical ymmunolohyya and allerholohyya. - M. - 1998.
7.
Roy Patterson, Leslie K. Hrezmer Paul. Allerhycheskye illness (diagnosis and
Treatment). - M. - 2000.
8.
Gushchin: Antyhystamynnыe funds. Manual for doctors. - M. - 2000.
9.
B. M. Puhlyk: Favourites of the article, lecture, praktycheskye Recommendations,
vazhneyshye documents and peredovoy experience. - Vinnitsa. - 2000.
The aim cal recommendations prepared by
Guidelines approved at a meeting of
"25" 6 0 "201 3 y Protocol № 1
Loading iduvach k afedr and
MD Professor BM Puhlyk
Associate IV Korytska