Epinephrine autoinjector prescription in food-allergic adults: symptom-based only or allergen-based also? An Italian multi-centre study

BACKGROUND

Epinephrine is the treatment of choice for acute food-allergic reactions but existing guidelines state that it should be prescribed uniquely to patients who already experienced at least one food-induced anaphylactic episode.

OBJECTIVE

We investigated whether in Italy epinephrine auto-injector is prescribed uniquely following the existing guidelines only, or is allergen-informed as well (i.e., based on the potential risk associated with sensitization to certain food allergens), and hence preventive.

METHODS

1110 adult patients (mean age 31 years; M/F 391/719) with food allergy seen at 19 allergy outpatient clinics were studied. Patients with a history of probable anaphylaxis were identified. Subjects were classified as having primary (type 1) and/or secondary (type 2) food allergy and were divided into several subgroups based on the offending allergen/food. Epinephrine prescriptions were recorded and analyzed both as a whole and by sensitizing allergen.

RESULTS

Epinephrine was prescribed to 138/1100 (13%) patients with a significant difference between subjects with type-1 and type-2 food allergy (132/522 [25%] vs. 6/629 [1%]; p < 0.001). The epinephrine group included most patients with a history of anaphylaxis (55/62 [89%]) or emergency department visits 106/138 (77%). In some specific subsets, namely fish-, tree nuts-, and lipid trasfer protein (LTP)-allergic patients, epinephrine was prescribed to patients without a history of systemic allergic reactions.

CONCLUSIONS

Italian allergy specialists prescribe epinephrine auto-injectors both on the basis of clinical history of severe reactions and on a critical analysis of the hazard associated with the relevant protein allergens, which suggests a good knowledge of allergens as well as acquaintance with the guidelines for prescription of emergency medication.

Causes of food-induced anaphylaxis in Italian adults: a multi-centre study

BACKGROUND

Data about food-induced anaphylaxis in Italy are missing.

OBJECTIVE

It was the aim of this study to detect the main foods/food allergens causing anaphylaxis in Italy.

METHODS

The frequency of anaphylaxis and the relative importance of many offending foods were assessed in 1,110 adult patients with food allergy diagnosed by common criteria at 19 allergy centres scattered throughout Italy from 1 January to 31 December 2007.

RESULTS

Fifty-eight of 1,110 (5%) food-allergic patients experienced at least 1 episode of anaphylaxis. On average, they were older than other food-allergic patients (34 vs. 31 years; p < 0.05). The majority of anaphylactic episodes occurred in patients sensitized to lipid transfer protein (LTP; n = 19), followed by shrimp (n = 10), tree nuts (n = 9), legumes other than peanut (n = 4), and seeds (n = 2); peanut, spinach, celery, buckwheat, wheat, avocado, tomato, fish, meat, and Anisakis caused an anaphylactic reaction in single patients. Among LTP-hypersensitive patients, peach caused 13/19 anaphylactic episodes. Shrimp-allergic patients were significantly older than other patients with food-induced anaphylaxis (p < 0.05), whereas patients allergic to LTP experienced their anaphylactic episodes at a younger age (p < 0.001). The frequency of anaphylaxis among patients sensitized to LTP, shrimp or tree nuts did not differ between northern and central/southern Italy.

CONCLUSION

LTP is the most important allergen causing food-induced anaphylaxis in Italy, peach being the most frequently offending food. Peanut-induced anaphylaxis seems very uncommon. Geographic and environmental differences both between Italy and other countries and within Italy seem to play a relevant role in the pattern of sensitization to foods.

EpidemAAITO: features of food allergy in Italian adults attending allergy clinics: a multi-centre study

BACKGROUND

Studies of the prevalence of different types of food allergy in adults are lacking.

OBJECTIVE

To define the prevalence of IgE-mediated food allergies in Italian adults attending allergy clinics and to assess possible differences associated with geographical position and/or dietary habits.

METHODS

Seventeen allergy outpatient clinics scattered throughout Italy participated to a multi-centre study in 2007. The number of atopic subjects and of food allergic patients along with clinical features were recorded by pre-defined criteria. Patients with unequivocal history of food allergy confirmed by positive skin prick test were included as cases.

RESULTS

Twenty five thousand six hundred and one subjects were screened; 12,739 (50%) were atopic, and 1079 (8,5%) had IgE-mediated food allergy. Sixty four percent of patients were females. Overall, the most frequent food allergy was the pollen-food allergy syndrome (55%), which was associated with oral allergy syndrome in 95% of cases and whose frequency decreased southbound. Forty-five percent of patients had a type 1 food allergy, in most cases (72%) caused by fruits and vegetables, and generally associated with a history of systemic symptoms. Type 1 food allergies represented 96% of food allergies in the South. Lipid transfer protein (LTP) accounted for 60% of sensitizations and caused most primary food allergies in all areas.

CONCLUSION

Plant-derived foods cause most food allergies in Italian adults. The pollen-food allergy syndrome is the most frequent type of food allergy followed by allergy to LTP whose frequency increases southbound. The pattern of allergy to certain foods is clearly influenced by specific geographic features such as pollen exposure and dietary habits.

Comparison between local and general anaesthesia for carotid endarterectomy. A retrospective analysis

AIM

The aim of this study was to compare by a retrospective analysis local anesthesia (LA) versus general anesthesia (GA) for carotid endarterectomy (CEA).

METHODS

Two-hundred and 59 patients who underwent CEA, at the Ospedali Riuniti of Reggio Calabria in the period 2000-2001, were enrolled in this study. For analysis purposes, patients were divided into 4 groups, according to their neurological status and to the type of anesthesia. LA was induced either by deep and superficial cervical plexus block (side approach according to Moore). GA was induced with propofol and maintained with sevoflurane. Monitoring of the neurological status was achieved by simple clinical evaluation of the state of consciousness under LA, and by continuous EEG under GA.

RESULTS

With LA, a reduction in the duration of intervention and hospital stay, in the number of neurological complications and consequent intraoperative shunts was observed, and admission to the intensive care unit (ICU) was never required. With GA better blood pressure control was achieved, but more intraoperative shunts and admissions to ICU were required, thus increasing overall costs.

CONCLUSION

In our experience, LA seems to be the approach of choice for CEA because 1) by preserving the state of consciousness, it allows a simple clinical monitoring of cerebral perfusion maintenance; 2) it reduces the number of intraoperative shunts and the risk of admission to the ICU; 3) it is cost-effective.

Time-resolved fluoroimmunoassay for delta(9)-tetrahydrocannabinol as applied to early discrimination of Cannabis sativa plants

In the cultivations of Cannabis, it is important to be able to distinguish fiber-type plants from drug-type plants by an easy observation of their phenotype. This study required the screening of many samples for their cannabinoid content. A simple and highly sensitive time-resolved fluoroimmunological method was developed for the determination of Delta(9)-tetrahydrocannabinol in the leaf extracts. The useful range of the calibration curve was between 10 pg and 25 ng of standard. Matrix effects were minimized by a high dilution of samples.

Cell-type dependent sensitivity of herpes simplex virus 1 mutants to plaque development inhibition by an anti-gD monoclonal antibody

Herpes simplex virus 1 (HSV-1) mutants selected in Vero cells either for resistance to plaque development inhibition (PDI) (P1, P2 and P3) or for resistance to neutralization (N1, N2, and N3) against an anti-glycoprotein D (gD) monoclonal antibody (mAb) were characterized both in Vero and BHK cells. In Vero cells P mutants were completely resistant to PDI, while N mutants showed from moderate to good resistance. In BHK cells P mutants lost their resistance to PDI, while N mutants became fully resistant. Cell type influenced the plaque size of the mutants as well. In Vero cells P mutant plaques were larger, and N mutant plaques smaller than wild type virus plaques. In BHK cells all plaques were comparable. With one exception (N2 in BHK) resistance to neutralization could be clearly appreciated at high but not at low mAb:virus particles ratio. For most of the mutants the neutralization values remained approximately the same in Vero and BHK cells. P2 and N2 mutants were more resistant to neutralization in BHK than in Vero cells. However, only for N2 mutant did the change in neutralization resistance go in the same direction as the change in PDI resistance. The results show that it is possible to dissociate the neutralizing and the PDI activities of a mAb and that the sensitivity of a virus to plaque inhibition by an anti-gD mAb is cell-type dependent.