How Can SMEs Use Crowdfunding Platforms to Internationalize? The Role of Equity and Reward Crowdfunding

Despite the exponential growth of crowdfunding in recent years, research on the role it plays in business internationalization is still embryonal. Building on the Resource Based View (RBV) and Knowledge Based View (KBV), this study explores how SMEs can use equity crowdfunding (ECF) and reward crowdfunding (RCF) to internationalize and the related potential limitations. Using an inductive qualitative research design, based on multiple case studies of Italian SMEs, our study showed that ECF and RCF models help SMEs in acquiring the financial resources needed to internationalize and, at the same time, offer significant added value to their internationalization. Our findings support the idea that ECF and RCF play a key role in helping companies to overcome their resource limitations in regard to internationalization, not only in terms of the provision of financial resources but, above all, by compensating for any lack of knowledge on aspects relevant to the internationalization process. Furthermore, our results show the limitations of SMEs use of crowdfunding in order to internationalize (i.e., a lack of ad hoc e-commerce policies in relation to equity crowdfunding and to the regulation of the pre-ordering mechanism in the reward model). This paper concludes by discussing the theoretical and managerial contributions to the international business domain, and highlighting fruitful avenues for future studies.

COVID‐19 Pandemic: The Interplay Between Firm Disruption and Managerial Attention Focus

Pandemics and epidemics occur regularly, yet their impact on firm behaviours is under‐researched. COVID‐19 provides a unique opportunity to examine the impact of a once‐in‐a‐century pandemic – given its scope, swift spread, health and economic devastation – on firms’ behaviours. Attention is the critical and initial step of the environmental adaptation process. In this paper, we draw on two complementary theories – contingency and attention‐based view – and examine the relationship between disruption experienced by firms and their COVID‐19 attention focus – a sudden exogenous shock. Industry environments may influence which signals attract managerial attention; hence, we examine if firm disruption–COVID‐19 attention focus is moderated by industry dynamism. Drawing on the publicly available data and using a sample of 1,861 US and 1,154 Chinese firms – two diametrically opposite situational contexts – we test the generalizability of our hypotheses. We find a positive relationship between firm disruption and COVID‐19 attention focus for the US sample and that industry dynamism negatively moderates this relationship. In the case of Chinese firms, these relationships were insignificant. Further analysis using topic modelling revealed that business–government relationships accounted for this difference.

Exploring entrepreneurial characteristics, motivations and behaviours in equity crowdfunding: some evidence from Italy

Purpose

This study explores entrepreneurial decision-making in the equity crowdfunding (ECF) context, and it aims to shed some light on the relationship among three aspects: entrepreneurial characteristics (i.e. entrepreneurial alertness and entrepreneurial self-efficacy), entrepreneurial motivations (i.e. promotion, improvement of networking and acquisition of product and market knowledge) and entrepreneurial behaviours (i.e. campaign characteristics in terms of communication and offerings).

Design/methodology/approach

The hypotheses testing and analysis were conducted using the partial least squares approach to structural equation modelling, and data were collected from the overall population of Italian ECF platforms.

Findings

Our results highlight that entrepreneurial characteristics may be central in ECF because of their significant impact on some motivation entrepreneurs have to adopt ECF, which in turn have an impact on meaningful campaign characteristics that can influence ECF performance.

Originality/value

The current literature is mainly focused on investors' decisions, while a neglected perspective until now has been that of entrepreneurs. This study is among the first to focus on entrepreneurs in the ECF context, and, to the best of our knowledge, it is the first study to investigate the entrepreneurial decision-making process. The added value of this research lies in the analysis of the entrepreneurial aspects underlying entrepreneurial decisions to use ECF.

A regional approach to unmet needs in anaphylaxis

Allergic diseases are under-diagnosed and undertreated despite their wide prevalence, and particularly anaphylaxis is often under-estimated. Evidence-based anaphylaxis guidelines developed by principal allergy organizations agree on increased prevalence of anaphylaxis, especially in patients younger than 18 years (18-27,30): this trend highlights the need for actions on anaphylaxis management and prevention (3,4). Lack of prompt connection between emergency department and allergy unit after discharge, and of a dedicated ICD-9th identification code (18-26), can delay diagnosis and treatment of anaphylaxis (28,29). Also in the experience of our Allergy Unit, patients reach the allergist office after several attacks treated in ED (17), without a previous evaluation and risk assessment. Keeping in mind unmet needs in anaphylaxis (4), we focused on regional approaches to health care delivery. The key point of our project was to establish an active collaboration between allergist clinicians and their counterparts in emergency medicine, with a system of quick filing report of patients discharged from ED with the suspect of anaphylactic reaction, directed to a central allergy unit, acting in a hub and spoke model with the Ligurian allergy network (31). Aim of the project was to improve epidemiological data collection via direct connection among ED and allergy network; moreover, we tried to provide a quick and proper evaluation of all reported patients, identifying, when possible, the agent responsible for anaphylaxis, to provide instructions on how to minimize future exposure; as all individuals at risk for anaphylaxis should carry and know how to self-administer epinephrine, we managed to provide auto injector and proper training when appropriate. A follow up on readmissions was carried out during the study and four months later. In a 20 months observation period (2013/2014), 205 patients were reported: it was possible to reach a diagnosis and risk assessment in 64.3%. Anaphylaxis diagnosis was considered likely if any 1 of 3 criteria is satisfied within minutes to hours: acute onset of illness with involvement of skin, mucosal surface, or both, and at least 1 of the following: respiratory compromise, hypotension, or end-organ dysfunction; 2 or more of the following occur rapidly after exposure to a likely allergen: involvement of skin or mucosal surface, respiratory compromise, hypotension, or persistent gastrointestinal symptoms; hypotension develops after exposure to a known allergen for that patient: age-specific low blood pressure or decreased systolic blood pressure more than 30% compared with baseline. Of 205 patients reported, 132 were classified as severe anaphylaxis; other 73 cases reported were 12 drugs related angioedema (mostly NSAID related), 9 ACEi related angioedema, 3 ereditary C1inh deficiency angioedema, 24 istaminergic idiopatic angioedema, 14 urticaria angioedema, 6 severe asthma, 2 latex reactions; in three patients a proper diagnosis was not achieved due to refuse / impossibility to perform diagnostic workout. Hymenoptera venom and food proved to be the main triggers, followed by drugs. 100% patients at risk of anaphylaxis received self-injectable adrenaline, pertinent education and individual action plan. In the same period, even though short, there were only two readmissions to ED. First result seems to confirm the usefulness of our approach to address some of unmet needs in anaphylaxis management, as recently pointed out by ICON guidelines (4).

OCCUPATION study (OCCUPationl asthma: a naTIONal based study): a survey on occupational asthma awareness among Italian allergists

Occupational asthma (OA) is the most common work-related respiratory disease. Case identification still remains underperformed. The present survey aimed at investigating the awareness about OA among Italian allergists. 538 Italian Allergists completed a web anonymous questionnaire concerning: patient profile, occupational history, disease features, diagnostic work-up, causal agents, management after diagnosis. 80 cases were registered by 14 members (2.4%). Patients were mostly between 30 and 62 years old; noteworthy, 19% were between 18 and 30. All the patients had a concomitant rhinitis, usually preceding asthma onset. Bakers, hairdressers and healthcare workers were more frequently involved. Diagnostic process included: skin prick test (85%), stop/resume test (57%), specific IgE dosage for occupational allergens (52.5%), peak expiratory flow monitoring (32.5%). Noteworthy, only 27,5% of patients underwent specific challenge. After the diagnosis 50% of patients did not change job. One third of the subjects were not referred to the national Workers Compensation Authority. Our data show that OA is quite neglected by Italian allergists, despite they have a pivotal role both in early identification and in primary prevention of OA. Thus, it is worth increasing awareness concerning OA and creating an easy-access network involving allergists and referral centers for Occupational respiratory diseases.

Phomentrioloxin, a fungal phytotoxin with potential herbicidal activity, and its derivatives: a structure-activity relationship study

Phomentrioloxin is a phytotoxic geranylcyclohexenetriol produced in liquid culture by Phomopsis sp. (teleomorph: Diaporthe gulyae), a potential mycoherbicide proposed for the control of the annual weed Carthamus lanatus. In this study, seven derivatives obtained by chemical modifications of the toxin were assayed for phytotoxic, antimicrobial, and zootoxic activities, and the structure-activity relationships were examined. Each compound was tested on nonhost weedy and agrarian plants, fungi, Gram+ and Gram- bacteria, and on brine shrimp larvae. The results provide insights into an investigation of the structural requirements for activity. The hydroxy groups at C-2 and C-4 appeared to be important features for the phytotoxicity, as well as an unchanged cyclohexentriol ring. A role seemed also to be played by the unsaturations of the geranyl side chain. These findings could be useful for understanding the mechanisms of action of new natural products, for identifying the active sites, and possibly in devising new herbicides of natural origin.

Agropyrenol, a phytotoxic fungal metabolite, and its derivatives: a structure-activity relationship study

Agropyrenol is a phytotoxic substituted salicylic aldehyde produced in liquid culture by Ascochyta agropyrina var. nana , a potential mycoherbicide proposed for the control of the perennial weed Elytrigia repens. In this study, six derivatives obtained by chemical modifications of the toxin were assayed for phytotoxic, antimicrobial, and zootoxic activities, and the structure-activity relationships were examined. Each compound was tested on non-host weedy and agrarian plants, fungi, Gram-positive and Gram-negative bacteria, and brine shrimp larvae. The results provide insights into the structure-activity relationships of agropyrenol. Both the double bond and the diol system of the 3,4-dihydroxypentenyl side chain as well as the aldehyde group at C-1 of the phenolic ring of agropyrenol proved to be important for the phytotoxicity. The lesser polar 3',4'-O,O'-isopropylidene of agropyrenol also showed significant zootoxic and slight antimicrobial activities. This finding could be useful in devising new natural herbicides for practical application in agriculture.

Agropyrenol and agropyrenal, phytotoxins from Ascochyta agropyrina var. nana, a fungal pathogen of Elitrigia repens

A strain of Ascochyta agropyrina var. nana, a fungal pathogen of the perennial weed Elytrigia repens, produced several toxins in a liquid medium, and its primary toxin, named agropyrenol, was characterized as a substituted salicylaldehyde on the basis of its chemical and spectroscopic properties. Its absolute stereochemistry was determined by Mosher's method. Two other minor metabolites were isolated from the same culture and named agropyrenal and agropyrenone, respectively. They were characterized as a trisubstituted naphthalene carbaldehyde and a pentasubstituted 3H-benzofuranone, respectively, using the same techniques. When assayed on leaves of several weed plants, i.e., Mercurialis annua, Chenopodium album and Setaria viridis, agropyrenol proved to be phytotoxic, causing the appearance of necrotic lesions, agropyrenal was less active, while agropyrenone was inactive. None of the compounds showed antibiotic, fungicidal or zootoxic activity.

Phomentrioloxin: A phytotoxic pentasubstituted geranylcyclohexentriol produced by Phomopsis sp., a potential mycoherbicide for Carthamus lanatus Biocontrol

A new phytotoxic geranylcyclohexenetriol, named phomentrioloxin, was isolated from the liquid culture of Phomopsis sp., a fungal pathogen proposed for the biological control of Carthamus lanatus, a widespread and troublesome thistle weed belonging to the Asteraceae family causing severe crop and pastures losses in Australia. The structure of phomentrioloxin was established by spectroscopic, X-ray, and chemical methods as (1S,2S,3S,4S)-3-methoxy-6-(7-methyl-3-methylene-oct-6-en-1-ynyl)cyclohex-5-ene-1,2,4-triol. At a concentration of 6.85 mM, the toxin causes the appearance of necrotic spots when applied to leaves of both host and nonhost plants. It also causes growth and chlorophyll content reduction of fronds of Lemna minor and inhibition of tomato rootlet elongation. Finally, in preliminary bioassays, phomentrioloxin did not show any antibacterial, fungicidal, or zootoxic activities.

Successful desensitization to natalizumab in a skin test--positive patient: a case report

Relevant interest has been focused on rapid desensitization for drug hypersensitivity and on its use for reactions to monoclonal antibodies. Natalizumab is a highly effective therapy for multiple sclerosis but its use can be limited by hypersensitivity reactions. Herein we present a case of a 36-year-old male patient with multiple sclerosis who started natalizumab therapy due to rapid neurological deterioration. During the second infusion he developed a reaction involving urticaria, erythema and angioedema. Natalizumab sensitization was demonstrated by a positive result on the intradermal test. The anti-natalizumab IgG neutralizing antibody assay was negative. Lacking any alternative, equally effective treatment, he underwent a rapid intravenous desensitization protocol. Desensitization was successfully repeated eleven times and the patient's neurological conditions improved and remained stable after one year. This case demonstrates that rapid desensitization is a safe and effective procedure in the treatment of natalizumab hypersensitivity.

Long-lasting effect of a monophosphoryl lipid-adjuvanted immunotherapy to parietaria. A controlled field study

BACKGROUND

The clinical efficacy of Monophosphoryl lipid A-adjuvanted immunotherapy (MPLA-SCIT) is ascertained, but there are no data on its possible long-lasting effect. We assessed in a real-life setting the persistence of the clinical effect five years after discontinuation.

METHODS

Patients with parietaria-induced respiratory allergy and fulfilling the criteria for immunotherapy prescription were evaluated at baseline, after the third year of MPLA-SCIT and five years after discontinuation. Visual analog scores, severity of the disease, pulmonary function and skin reactivity were assessed. Matched subjects who refused immunotherapy served as controls.

RESULTS

Twenty nine patients received MPLA-SCIT and 28 were the control group. There was a significant clinical improvement, as assessed by VAS only in the active group after 3 years that remained significant at 5 years versus baseline and controls. The distribution of severity of rhinitis was overall decreased at 3 and 8years as well. The number of patients with conjunctivitis in the active group decreased from 19 to 6 at the end of the treatment and to 9 after 5 years. There was also a decrease in the number of patients with asthma symptoms (from 6 to 2 to 4), which doubled in the control group. A significant reduction in the wheal of the Parietaria skin test was seen in the active group at the end of the treatment (9.5 +/- 2.1 mm vs. 6.4 +/- 2.6 mm; p = .01), but this reduction was lost at the 5-year. No relevant change was overall detected in pulmonary function.

CONCLUSION

MPLA-SCIT is effective, and the clinical efficacy is maintained after 5 years of discontinuation.

Phenobarbital-induced DiHS and ceftriaxone hypersensitivity reaction: a case of multiple drug allergy

Patients with DiHS show an increased risk of sensitization to multiple drugs. We report a case of a young woman who developed cutaneous rash, lymphoadenopathy, malaise and fever after the introduction of phenobarbitale. Because of these symptoms, she was treated with ceftriaxone and she experienced a severe flare-up of the cutaneous and general reaction. Allergological work-up, by cutaneous and lymphocyte transformation test, confirmed a double sensitization to phenobarbital and ceftriaxone. In conclusion, the high risk of DiHS during anticonvulsive therapy should suggest caution in using additional drugs, because of an increased risk of multiple reactions.

Chronic urticaria: importance of a medical-psychological approach

Chronic urticaria is often associated with psychological factors, such as depression, anxiety and stress, which may play a role not only in the genesis of the disease but also in its evolution. Aims of this study were to evaluate the utility of psychological assessments (presence of depression, impact on the quality of life and incidence of "life events" before the beginning of urticaria) in conjunction with the allergological evaluation and to provide appropriate treatment to the patients selected. Thirty subjects diagnosed as Chronic Urticaria patients were submitted to psychological assessments (semi structured interview, Beck Depression Inventory, Nottingham health Profile and Dermatology Life Quality Index). The results of the evaluation show that most of the patients experienced a "stressor" event within the six months before the onset of the cutaneous manifestation. The incidence of depression resulted very high in comparison with the general population and in three cases at a severe level. The impact on the quality of life results to be moderate, but involving different fields of life (physical image, social life, quality of sleeping and eating, etc). Despite these results, only six patients accepted to be assigned to an appropriate treatment. In conclusion, we demonstrate the usefulness of a medical- psychological approach in chronic urticaria and we confirmed the resistance of psychosomatic patients to undergo psychological treatment.

The Campi Flegrei caldera: unrest mechanisms and hazards

In the last four decades, Campi Flegrei caldera has been the world’s most active caldera characterized by intense unrest episodes involving huge ground deformation and seismicity, but, at the time of writing, has not culminated in an eruption. We present a careful review, with new analyses and interpretation, of all the data and recent research results. We deal with three main problems: the tentative reconstruction of the substructure; the modelling of unrest episodes to shed light on possible pre-eruptive scenarios; and the probabilistic estimation of the hazards from explosive pyroclastic products. The results show, for the first time at a volcano, that a very peculiar mechanism is generating episodes of unrest, involving mainly activation of the geothermal system from deeper magma reservoirs. The character and evolution of unrest episodes is strongly controlled by structural features, like the ring-fault system at the borders of the caldera collapse. The use of detailed volcanological, mathematical and statistical procedures also make it possible to obtain a detailed picture of eruptive hazards in the whole Neapolitan area. The complex behaviour of this caldera, involving interaction between magmatic and geothermal phenomena, sheds light on the dynamics of the most dangerous types of volcanoes in the world.

Psychological aspects of drug intolerance

A consecutive unselected series of 50 patients suffering from drug intolerance was evaluated by allergological and psychological tests. We wanted to verify the existence of a correlation between some psychological characteristics (hysteria, depression and Ego Integrity), and some clinical aspects (number and type of episodes, severity and probability of the reactions). We confirmed the prevalence of female sex in these disorders, particularly in middle-aged married women. The mean score of hysteria in the whole sample was lightly higher than normal. Moreover a relevant number of subjects (24%) scored higher than the cut off for clinical depression, with a significant difference in comparison to the overall prevalence of depression in the general population. Finally, the analysis of clinical variables considered in our patients showed that subjects with a history of less serious reactions and unlikely reactions scored higher in depression and hysteria scales. The importance of psychological evaluation of drug intolerance patients is discussed and confirmed.

Sublingual immunotherapy in tree pollen allergy. Double-blind, placebo-controlled study with a biologically standardised extract of three pollens (alder, birch and hazel) administered by a rush schedule

BACKGROUND

sublingual immunotherapy has been recognised as safe and effective but it is still poorly documented in tree pollen allergy. Allergy to alder, birch and hazel is important in Northern European countries but its clinical relevance is increasing in Southern Europe.

METHODS

thirty patients, selected and observed for one pollen season, were randomised to receive placebo (15 patients) or active treatment (15 patients). Twenty-seven patients completed the first year and 24 of them were treated with active therapy during the second year of the study in comparison to a parallel group of ten patients treated only with drugs. Symptom and drug scores during each pollen season, birch-specific IgE, changes in skin test reactivity, changes in specific Nasal Provocation Test and the daily average pollen count for the relevant trees were considered for the assessment of the efficacy of the treatment.

RESULTS

both active and placebo group showed a statistically significant improvement in scores in comparison to the previous year, under a lower allergenic pressure. The improvement was higher in the active group (76.04 % reduction of drugs) but not significantly different from that registered in the placebo group (37.05 % reduction). In the open phase of the study, treated patients showed significantly better scores in comparison to the control group. No significant changes in skin reactivity, specific IgE and Nasal Provocation Test were registered. SLIT tolerance was very good.

CONCLUSIONS

our data show a better but not statistically significant clinical outcome for patients actively treated with SLIT, but the placebo effect and the year-by-year variability of the environmental allergenic load in our small-size pilot study do not allow for a conclusive statement about the efficacy of this form of therapy.

Preventive symptomatic immunotherapy versus placebo in seasonal rhinitis due to grasses in children and to Parietaria in adult patients

BACKGROUND

EPD is the only preventive symptomatic immunotherapy available on the market and approved by competent bodies. Recent double-blind placebo controlled (DBPC) studies have demonstrated its efficacy in seasonal and perennial rhinitis. The aim of the study was to confirm the efficacy and safety of a single dose of immunotherapy administered six-eight weeks before the pollen season.

METHODS

Two simultaneous DBPC trials were carried out. The first consisted of 20 children with grass-pollen seasonal rhinitis (Bollate-Milano, Italy) and the second included 30 adult patients with Parietaria-pollen seasonal rhinitis (Genova, Italy). EPD was administered only to the active groups.

RESULTS

A significant difference in favour of the active treatment groups was seen in oral antihistamine use (p < 0.05) during the peak pollen seasons. Throughout the pollen seasons, rhinoconjunctivitis scores for the two groups in both studies presented no significant difference, even if the values were lower in the active groups.

CONCLUSIONS

The oral antihistamine reduction, observed in the active groups during the seasonal period, supports the efficacy of this treatment, although a significant improvement in the rhinoconjunctivitis symptoms was not observed, probably due to the use of oral antihistamine in the placebo groups. The overall profile of the EPD was good. It could be particularly suited for short term therapy to prevent seasonal symptoms in allergic patients.

Use of antagonist peptides to inhibit in vitro T cell responses to Par j1, the major allergen of Parietaria judaica pollen

Antigenic peptides with substituted side chains inhibit immune responses to a number of recall Ags from infectious agents in vitro. Here we show that the same strategy can be applied to peptides derived from a pollen protein, the major allergen of Parietaria judaica(Par j1), a plant responsible for most allergenic sensitization in the southern Mediterranean area. Three T cell lines responding to Par j1 protein were used to identify a stimulatory peptide. Two different monosubstituted altered peptide ligands (APL) were identified that bound to the HLA-DR of the responders, did not stimulate the T cell lines on their own, and decreased the response to subsaturating amounts of the unmodified stimulatory peptide. Most important, these APL were able to inhibit the response of these cell lines to intact Par j1 protein. A third monosubstituted peptide bound to the HLA-DR but did not show inhibitory activity. The two APL had a lower affinity than the unsubstituted peptide for the HLA-DR. The last two observations make MHC blockade an unlikely explanation for the observed effect. These results indicate the action of a specific peptide-mediated antagonism that may be useful in controlling the T cell component of an allergic response.

Management of patients at risk for adverse reactions to local anesthetics: analysis of 386 cases

Local anesthetics are among the most used drugs in clinical practice. Various types of reactions have been reported and many patients are told that they are allergic to caines or are at risk of allergic reactions. We report our experience with 386 patients using skin test and progressive subcutaneous challenge in order to select a local anesthetic that could be safely used. The patients underwent specific protocol including clinical history, prick and intradermal tests, and subcutaneous incremental challenge with a local anesthetic from the amide group which was free of preservatives and vasoconstrictors. Thirteen patients showed a positive skin test: 10 with positive prick test underwent the subsequent challenge with no reactions; the three who were also positive by the intradermal route were carefully evaluated with a different drug. Eight of the patients with negative skin tests complained of various clinical symptoms after the challenge. All the patients found the local anesthetic to be well tolerated and nobody reported reactions after the clinical use. These results show that skin tests and subcutaneous challenge are safe and sufficient to reliably identify a local anesthetic that patients with a prior history of adverse reaction or at higher risk could tolerate.

Oral antihistamine/decongestant treatment compared with intranasal corticosteroids in seasonal allergic rhinitis

This international, multicentre, randomized, double-blind, double-dummy, parallel-group trial was undertaken to compare the efficacy and tolerability of once-daily astemizole-D (10 mg astemizole plus 240 mg pseudoephedrine) with beclomethasone nasal spray (0.05 mg/ml) two puffs/nostril administered twice daily in a total of 204 patients with seasonal allergic rhinitis. Treatment duration was 4 weeks. Although investigator assessments of symptom severity were generally comparable in the two treatment groups throughout the trial, statistically significant differences in favour of astemizole-D for sneezing and ocular symptoms were apparent at the end of the 4-week treatment period (P < 0.05). Patient diary data support these findings, with significant differences in favour of the antihistamine/decongestant combination reported for ocular symptoms after 2 weeks of treatment (P < 0.05) and non-significant trends for sneezing after 2 weeks and ocular symptoms over the entire treatment period (P = 0.07). Use of rescue medication for ocular symptoms was also significantly lower in the astemizole-D treatment group (P < 0.05). A wide range of adverse experiences were reported, however, there were no statistically significant differences in the type or incidence of those between the two treatment groups. In conclusion, astemizole-D appears to be at least as effective and well tolerated as intranasal beclomethasone in the treatment of seasonal allergic rhinitis, providing at least comparable relief from all nasal symptoms including congestion and significantly greater relief from ocular symptoms than the topical steroid.

Sublingual immunotherapy in Parietaria pollen-induced rhinitis: a double-blind study

A double-blind, placebo-controlled study of immunotherapy was conducted in 31 patients with allergic rhinitis due to Parietaria pollen to evaluate the efficacy and safety of high doses of allergen via the sublingual route. The patients were assessed before and after a 10-month period of treatment by clinical (symptom-medication scores and specific nasal reactivity) and immunological (total IgE, specific IgE, IgG and IgG4 antibodies) parameters. High doses of Parietaria extract corresponding to a cumulative dose of 105 BU for each patient were administered with negligible side effects. The actively treated patients had significantly lower medication scores than those on placebo (p < 0.05) when the maximum pollen count was recorded, and at the end of the trial they showed a significant decrease in nasal reactivity (p < 0.02) and a significant increase in serum specific IgG4 (p = 0.02). No differences were detected in any of these parameters in the placebo group. Possible explanations for the mechanisms of sublingual immunotherapy are proposed.

Is the allergen-inhalation challenge predictive of the severity of seasonal asthmatic exacerbations?

Fifteen asthmatic patients sensitized to Parietaria pollen were studied. Before the pollen season they underwent an allergen-inhalation challenge which was preceded and followed by a methacholine-inhalation challenge. Pollen count, symptom score, and drug consumption were monitored daily throughout the study. A severity score was obtained by adding symptom score and drug consumption. Patients underwent a third methacholine challenge during the pollen season, after they had been exposed to a high atmospheric concentration of pollen. The severity score during the first period of the pollen season was significantly correlated with both the early and the late asthmatic responses to the allergen observed before the season (r2 = 0.50; P < 0.005). Bronchial sensitivity to methacholine was significantly increased both after allergen challenge and after seasonal exposure, but these increases correlated neither with each other nor with the severity score. We conclude that bronchial responses to experimental exposure to allergens, but not the changes in nonspecific airway responsiveness, can, in part, predict the severity of asthma exacerbation during the pollen season.

Allergy to pollens from Betulaceae and Corylaceae in a Mediterranean area (Genoa, Italy)--a ten-year retrospective study

Allergy to pollens from Betulaceae and Corylaceae is becoming a leading problem in Genoa, a northern Mediterranean area in Italy. The results of a 10-year retrospective study on combined observations both on the aerobiological presence of Betulaceae and Corylaceae pollens (Alnus, Corylus, Ostrya) and on the incidence of positive SPT in the allergic population living in the same area are reported. Among 3473 patients suffering from seasonal respiratory allergy with positive SPT to one or more pollens, 558 (16.06%) showed SPT positivity to Betulaceae and/or Corylaceae pollens, both isolated and associated with other allergens. These patients suffered from winter or early spring hay fever, with a high incidence of bronchial asthma. A statistically significant increase (0.02 < p < 0.05) in the number of these sensitizations from 1981 to 1990 has been observed. Some possible explanations for this phenomenon, including an increase in the total amount of local airborne pollens, are suggested. About 24% of the patients with positive SPT to these pollens referred oral allergic syndrome associated with the ingestion of some foods, especially apples and nuts, with or without other additional clinical symptoms.

Local immunotherapy with Dermatophagoides extract in asthma

Local immunotherapy (LIT) with Dermatophagoides extract or placebo were administered to two groups of 11 patients with allergic asthma in a double-blind fashion. All patients received cromolyn sodium (20 mg four times a day) during treatments. Bronchial provocation tests with allergen and methacholine were performed before, 1 week, and 4 weeks after the end of treatments. Symptom score, drug consumption, and peak expiratory flow were monitored daily from 2 weeks before to 4 weeks after treatments. Compared to baseline, early bronchial sensitivity to allergen was significantly reduced both 1 week (p less than 0.0005) and 4 weeks (p less than 0.01) after LIT but not after placebo administration. Late bronchial reaction to allergen occurred similarly after placebo administration and LIT. However, in the group with LIT, the severity of late reaction was unchanged after treatment in spite of the significantly larger doses of allergen administered to provoke the early asthmatic reaction. Neither symptom score, nor drug consumption, nor peak expiratory flow were significantly different in the two groups before and during the treatment period even though both symptom score and drug consumption tended to be reduced after LIT. We conclude that LIT may be an effective and safe alternative to traditional immunotherapy.

Effect of seasonal exposure to pollen on specific bronchial sensitivity in allergic patients

Bronchial provocation tests with aerosol of birch extract were performed before and after pollen season in 11 sensitized subjects. Changes of metacholine bronchial responsiveness and serum-specific IgE level were also assessed. In five patients who did not take steroids to control their symptoms, both early and late asthmatic responses to inhaled allergen were enhanced after season, whereas IgE serum level, but not methacholine sensitivity, was significantly increased. In six patients who needed steroids, neither responses to allergen nor IgE serum level and methacholine sensitivity were significantly changed after season. For the whole group, the increase in immediate bronchial sensitivity to allergen was positively correlated with the increase in specific IgE antibodies. We conclude that seasonal exposure to pollen has, in sensitized patients, a priming effect on bronchial mucosa that may be blunted by steroid treatment. The increased production of specific IgE antibodies appears to be an important mechanism for this priming effect.

A double-blind comparative trial of astemizole and terfenadine for the treatment of hay fever

Astemizole, a new long acting and non sedative antihistamine, and Terfenadine, an H1 antagonist widely used, were compared in a randomized double-blind study over 4 weeks in 55 patients suffering from hay fever. The clinical symptoms were recorded daily from each patient on a 4-point scale from 0 = none to 3 = severe. After 2 weeks of therapy and at the end, the total clinical score was evaluated and both the investigator and the patient made an overall assessment of the therapeutic effect. Both drugs were effective in reducing nasal and ocular symptoms, but the clinical response tended to be better with Astemizole than Terfenadine. The difference between the two drugs, however, was statistically significant (p less than 0.05) only after 2 weeks of treatment. Some side effects, including drowsiness, were observed with similar incidence in both treatment groups. Astemizole appears to be a simple, effective and safe therapy for hay fever.

Allergy to Parietaria pollen and month of birth

It has been suggested that the season of birth is a predisposing factor for allergic sensitization. In the last few years many authors in different countries have found a statistically significant correlation between the month of birth and the subsequent allergy for grasses and birch pollens and house dust mites. Nevertheless, other investigators failed to confirm these results. The aim of the present study is to assess the relationship between the season of birth and the development of respiratory allergy to pollen of Parietaria, an Urticacea plant characteristic of Mediterranean flora, which is the most important hay fever producing one in our country. Among the patients who visited the Servizio Autonomo di Allergologia at the St. Martino Hospital (Genoa, Italy) in the year 1986, 264 subjects (113 F and 151 M, 5-35 years of age, all born and living in Genoa and its suburbs) were selected. The birth month of these patients, affected by rhinitis and/or bronchial asthma and with positive prick-test only toward Parietaria pollen, was recorded and compared with that of the population born in Genoa in the same years. Statistical evaluation made by X2 test showed the absence of a statistically significant relationship between the birth in the pollen season (April-July) and the pollinosis, with the exception of the month of May. The reasons of the discrepances observed between the behaviour of Parietaria pollen and that of the other pollens, grasses and birch, described in the above studies, are discussed.

A simple and rapid method to evaluate lymphocyte response to mitogens

A new method to evaluate lymphocyte response to mitogens is proposed. The method is based on the observation in fluorescence of the stimulated cells after their supravital staining on slides prestained with acridine orange in alcoholic solution. The results are expressed as Blast Index (IB). The method is very practical, easy to reproduce and shows a good correlation with 3H-thymidine uptake.

Long-term hyposensitization and adverse immunologic responses. A laboratory evaluation

Ninety atopic patients with allergic asthma and/or rhinitis were classified into three groups: group A, consisting of 30 patients never subjected to immunotherapy; group B, 30 patients receiving immunotherapy for various allergies for 3 to 24 months; group C, 30 patients receiving immunotherapy for 5 or more years. The following studies were performed using standard techniques: quantitative determination of serum immunoglobulin concentrations IgA, IgG, IgM, rheumatoid factor, C3 and C4 concentrations, antinuclear antibodies (ANA). Circulating immune complexes were detected by a competitive immuno-enzyme assay. No statistical differences were found in the groups studied for every parameter considered. Although signs and symptoms of autoimmune disease were not present, an elevated incidence of ANA in the entire group (23.3%) was found.

ELISA in diagnosis of respiratory allergy. A comparison with RAST and skin tests

An enzyme-linked immunosorbent assay (ELISA), employing beta-galactosidase conjugated anti-IgE, was used for the determination of specific IgE antibodies to common inhalant allergens (Dermatophagoides pt. and f., Parietaria and four grass pollens) in serum samples from 82 adult patients with asthma and/or rhinitis. A total of 194 analysis were carried out and the results were compared with those of skin tests and RAST. The correlation coefficient (r) between ELISA and RAST results was high (r = 0.95); the correlation between skin tests and ELISA (r = 0.93) was greater than that between skin tests and RAST (r = 0.90). No significant differences were found among the allergens used. We conclude that the version of ELISA used develops an overall good correlation with skin tests and RAST and seems to provide a satisfactory alternative to RAST for allergy diagnosis.