Testing single/combined clinical categories on 5110 Italian patients with developmental phenotypes to improve array-based detection rate

Background

Chromosomal microarray analysis (CMA) is nowadays widely used in the diagnostic path of patients with clinical phenotypes. However, there is no ascertained evidence to date on how to assemble single/combined clinical categories of developmental phenotypic findings to improve the array‐based detection rate.

Methods

The Italian Society of Human Genetics coordinated a retrospective study which included CMA results of 5,110 Italian patients referred to 17 genetics laboratories for variable combined clinical phenotypes.

Results

Non‐polymorphic copy number variants (CNVs) were identified in 1512 patients (30%) and 615 (32%) present in 552 patients (11%) were classified as pathogenic. CNVs were analysed according to type, size, inheritance pattern, distribution among chromosomes, and association to known syndromes. In addition, the evaluation of the detection rate of clinical subgroups of patients allowed to associate dysmorphisms and/or congenital malformations combined with any other single clinical sign to an increased detection rate, whereas non‐syndromic neurodevelopmental signs and non‐syndromic congenital malformations to a decreased detection rate.

Conclusions

Our retrospective study resulted in confirming the high detection rate of CMA and indicated new clinical markers useful to optimize their inclusion in the diagnostic and rehabilitative path of patients with developmental phenotypes.

Validation of a method for noninvasive prenatal testing for fetal aneuploidies risk and considerations for its introduction in the Public Health System

OBJECTIVE

The aim of this study was to validate noninvasive prenatal testing (NIPT) for fetal aneuploidies by whole-genome massively parallel sequencing (MPS).

METHODS

MPS was performed on cell-free DNA (cfDNA) isolated from maternal plasma in two groups: a first set of 186 euploid samples and a second set of 195 samples enriched of aneuploid cases (n = 69); digital PCR for fetal fraction (FF) assessment was performed on 178/381 samples. Cases with <10 × 10⁶ reads (n = 54) were excluded for downstream data analysis. Follow-up data (invasive testing results or neonatal information) were available for all samples. Performances in terms of specificity/sensitivity and Z-score distributions were evaluated.

RESULTS

All positive samples for trisomy 21 (T21) (n = 43), trisomy 18 (T18) (n = 6) and trisomy 13 (T13) (n = 7) were correctly identified (sensitivity: 99.9%); 5 false positive results were reported: 3 for T21 (specificity = 98.9%) and 2 for T13 (specificity = 99.4%). Besides FF, total cfDNA concentration seems another important parameter for MPS, since it influences the number of reads.

CONCLUSIONS

The overall test accuracy allowed us introducing NIPT for T21, T18 and T13 as a clinical service for pregnant women after 10 + 4 weeks of gestation. Sex chromosome aneuploidy assessment needs further validation due to the limited number of aneuploid cases in this study.

Molecular Dissection Using Array Comparative Genomic Hybridization and Clinical Evaluation of An Infertile Male Carrier of An Unbalanced Y;21 Translocation: A Case Report and Review of The Literature

Chromosomal defects are relatively frequent in infertile men however, translocations between the Y chromosome and autosomes are rare and less than 40 cases of Y-autosome translocation have been reported. In particular, only three individuals has been described with a Y;21 translocation, up to now. We report on an additional case of an infertile man in whom a Y;21 translocation was associated with the deletion of a large part of the Y chromosome long arm. Applying various techniques, including conventional cytogenetic procedures, fluorescence in situ hybridisation (FISH) analysis and array comparative genomic hybridization (array-CGH) studies, we identified a derivative chromosome originating from a fragment of the short arm of the chromosome Y translocated on the short arm of the 21 chromosome. The Y chromosome structural rearrangement resulted in the intactness of the entire short arm, including the sex-determining region Y (SRY) and the short stature homeobox (SHOX) loci, although translocated on the 21 chromosome, and the loss of a large part of the long arm of the Y chromosome, including azoospermia factor-a (AZFa), AZFb, AZFc and Yq heterochromatin regions. This is the first case in which a (Yp;21p) translocation has been ascertained using an array-CGH approach, thus reporting details of such a rearrangement at higher resolution.

Novel α-actinin 2 variant associated with familial hypertrophic cardiomyopathy and juvenile atrial arrhythmias: a massively parallel sequencing study

BACKGROUND

Next-generation sequencing might be particularly advantageous in genetically heterogeneous conditions, such as hypertrophic cardiomyopathy (HCM), in which a considerable proportion of patients remain undiagnosed after Sanger. In this study, we present an Italian family with atypical HCM in which a novel disease-causing variant in α-actinin 2 (ACTN2) was identified by next-generation sequencing.

METHODS AND RESULTS

A large family spanning 4 generations was examined, exhibiting an autosomal dominant cardiomyopathic trait comprising a variable spectrum of (1) midapical HCM with restrictive evolution with marked biatrial dilatation, (2) early-onset atrial fibrillation and atrioventricular block, and (3) left ventricular noncompaction. In the proband, 48 disease genes for HCM, selected on the basis of published reports, were analyzed by targeted resequencing with a customized enrichment system. After bioinformatics analysis, 4 likely pathogenic variants were identified: TTN c.21977G>A (p.Arg7326Gln); TTN c.8749A>C (p.Thr2917Pro); ACTN2 c.683T>C (p.Met228Thr); and OBSCN c.13475T>G (p.Leu4492Arg). The novel variant ACTN2 c.683T>C (p.Met228Thr), located in the actin-binding domain, proved to be the only mutation fully cosegregating with the cardiomyopathic trait in 18 additional family members (of whom 11 clinically affected). ACTN2 c.683T>C (p.Met228Thr) was absent in 570 alleles of healthy controls and in 1000 Genomes Project and was labeled as Damaging by in silico analysis using polymorphism phenotyping v2, as Deleterious by sorts intolerant from tolerant, and as Disease-Causing by Mutation Taster.

CONCLUSIONS

A targeted next-generation sequencing approach allowed the identification of a novel ACTN2 variant associated with midapical HCM and juvenile onset of atrial fibrillation, emphasizing the potential of such approach in HCM diagnostic screening.

372 kb microdeletion in 18q12.3 causing SETBP1 haploinsufficiency associated with mild mental retardation and expressive speech impairment

Several cases of interstitial deletion encompassing band 18q12.3 are described in patients with mild dysmorphic features, mental retardation and impairment of expressive language. The critical deleted region contains SETBP1 gene (SET binding protein 1). Missense heterozygous mutations in this gene cause Schinzel-Giedion syndrome (SGS, MIM#269150), characterized by profound mental retardation and multiple congenital malformations. Recently, a 18q12.3 microdeletion causing SETBP1 haploinsufficiency has been described in two patients that show expressive speech impairment, moderate developmental delay and peculiar facial features. The phenotype of individual with partial chromosome 18q deletions does not resemble SGS. The deletion defines a critical region in which SETBP1 is the major candidate gene for expressive speech defect. We describe an additional patient with the smallest 18q12.3 microdeletion never reported that causes the disruption of SETBP1. The patient shows mild mental retardation and expressive speech impairment with striking discrepancy between expressive and receptive language skills. He is able to communicate using gestures and mimic expression of face and body with surprising efficacy. The significant phenotypic overlap between this patient and the cases previously reported enforce the hypothesis that SETBP1 haploinsufficiency may have a role in expressive language development.

Sphingosine 1-phosphate induces differentiation of mesoangioblasts towards smooth muscle. A role for GATA6

Different cells can contribute to repair following vascular injury by differentiating into smooth muscle (SM) cells; however the extracellular signals involved are presently poorly characterized. Mesoangioblasts are progenitor cells capable of differentiating into various mesoderm cell types including SM cells. In this study the biological action exerted by the pleiotropic sphingolipid sphingosine 1-phosphate (S1P) in human mesoangioblasts has been initially investigated by cDNA microarray analysis. Obtained data confirmed the anti-apoptotic action of this sphingolipid and identified for the first time a strong differentiating action toward SM cells. Quantitative mRNA and protein analysis corroborated the microarray results demonstrating enhanced expression of myogenic marker proteins and regulation of the expression of transcription factor GATA6 and its co-regulator, LMCD1. Importantly, GATA6 up-regulation induced by S1P was responsible for the enhanced expression of SM-specific contractile proteins. Moreover, by specific gene silencing experiments GATA6 was critical in the pro-differentiating activity of the cytokine TGFβ. Finally, the pharmacological inhibition of endogenous S1P formation in response to TGFβ abrogated GATA6 up-regulation, supporting the view that the S1P pathway plays a physiological role in mediating the pro-myogenic effect of TGFβ. This study individuates GATA6 as novel player in the complex transcriptional regulation of mesoangioblast differentiation into SM cells and highlights a role for S1P to favour vascular regeneration.

Serum IgE for Bet v 1 in Patients Affected by Atopic Dermatitis

Atopic dermatitis (AD) is a common allergic disorder and may be associated with respiratory allergy. In this study serum levels of IgE specific for the major allergen of birch (Bet v 1) were measured in two groups of AD patients with specific IgE to birch: the first with associated respiratory birch allergy and the second with cutaneous symptoms alone. The results show that the patients suffering from AD associated with respiratory allergy had the highest serum levels of IgE specific for Bet v 1. In conclusion, this study shows that the measurement of serum specific IgE for a major allergen may be useful in common practice as high levels are associated with complicated pathology.

Serum neopterin levels in spontaneous urticaria and atopic dermatitis

Serum neopterin may be considered a diagnostic marker of the degree of activation of the immune system. This preliminary study was performed to measure serum neopterin levels in patients with acute spontaneous urticaria (ASU), chronic spontaneous urticaria (CSU) and atopic dermatitis (AD). In total, 180 patients [96 men, 84 women; mean age 23.1 years; 41 with spontaneous urticaria (13 ASU and 28 CSU), 48 with AD] and 96 healthy controls were enrolled in the study. Patients with ASU had the highest neopterin levels, and all three groups of patients (ASU, CSU and AD) had higher values than normal subjects. This preliminary study demonstrates that serum neopterin could be a biomarker of immune activation in patients with SU or AD.

Immunoglobulin Production Pattern in Allergic and Non-Allergic Subjects

Allergic rhinitis (AR) is characterized by Th2 polarized immune response, such as increased IL-4 and reduced IFN-γ production, and by a functional defect of T regulatory cells. This impaired immune response profile influences the pattern of immunoglobulin (Ig) production in allergic patients. However, no studies have compared the pattern of inhalant allergen-specific Ig classes between allergic patients and normal subjects. The aim of this study is to therefore investigate the allergen-specific IgE, IgG, IgG4, and IgA serum level pattern in a group of patients with pollen allergy and in non-allergic healthy subjects. One hundred and two allergic patients (evaluated both out of and in the pollen season) were enrolled. In addition, 50 healthy non-allergic subjects were recruited during the whole year. Serum allergen-specific IgE, IgG, IgG4, and IgA for Parietaria, grasses, and birch were quantitatively determined by the ImmunoCAP System method. Allergen-specific IgE, IgG, IgG4, and IgA serum levels were significantly different for each tested allergen (p=0.0001 for each class) among groups. Allergic patients, mainly during pollen season, showed the highest IgG, IgG4, and IgA levels. The present study therefore provides the preliminary evidence that Ig production pattern toward inhalant allergens may depend on the specificity of the allergenic response both in non-allergic subjects and allergic patients Allergic patients do not show a defect of IgG and IgA classes. In addition, this study is the first that quantitatively evaluates the Ig classes. However, further studies should include non-allergic subjects evaluated both during and out of the pollen season.

Allergen-specific Ig classes in non-allergic individuals

Allergic rhinitis (AR) is characterized by Th2 polarized immune response, such as increased IL-4 and reduced IFN-gamma production, and by a functional defect of T regulatory cells. This impaired immune response profile influences the pattern of immunoglobulin production in allergic patients. However, there is no study that has explored the pattern of allergen-specific Immunoglobulin (Ig) classes in normal subjects. Therefore, the aim of this study is to investigate the allergen-specific IgE, IgG, IgG4, and IgA serum level pattern in a group of non-allergic individuals. Forty healthy non-allergic subjects were enrolled. Serum allergen-specific IgE, IgG, IgG4, and IgA for mites, cat, Parietaria, grasses, and birch were quantitatively determined by ELISA method. Allergen-specific IgE, IgG, IgG4, and IgA serum levels were significantly different for each tested allergen (p=0.0001 for each class). In conclusion, the present study provides the first evidence that immunoglobulin production pattern depends on the specificity of the allergenic response in non-allergic subjects as well as in allergic patients. In addition, this study is the first that quantitatively evaluates the Ig classes.

Soluble serum HLA-G in children with allergic rhinitis and asthma

Allergic rhinitis (AR) and asthma are characterized by Th2 polarized immune response. Soluble HLA (sHLA) molecules play an immunomodulatory activity. It has been reported that both molecules are increased in sera of patients with pollen-induced allergic rhinitis studied outside the pollen season. To date, however, no study has investigated them in AR children. The aim of this preliminary study is to evaluate serum sHLA-G levels in children with AR or asthma patients and in a group of healthy controls. Forty-seven symptomatic allergic patients were enrolled. A group of 50 healthy subjects was considered as control. Serum sHLA-G levels were determined by the immunoenzymatic method. Children with AR had significantly higher levels of sHLA-G molecules than normal controls or children with allergic asthma. However, there is no difference between children with AR and asthmatics. In conclusion, the present study provides the preliminary evidence that serum sHLA-G molecules are significantly increased in children with AR.

Elispot and Elisa Assessment of Interferon-Gamma after Sublingual Immunotherapy

Allergic rhinitis (AR) is characterized by a Th2 polarized immune response, and specific immunotherapy modifies this arrangement, restoring a physiologic Th1 profile. Sublingual immunotherapy (SLIT) is widely prescribed. The aim of the study is to evaluate two different methods for assessing IFN-γ, namely ELISPOT and ELISA, before and after a pre-seasonal SLIT course as marker for Th1 response. Thirty-eight AR patients with pollen allergy assumed pre-seasonal SLIT for 3 months. Patients' blood samples for assessing IFN-γ serum levels were collected before initiating SLIT (baseline – T0), after 3 months pre-seasonal SLIT course (T1), and three months after completion of SLIT (T2). IFN-γ-specific producing cells, after allergen stimulation, were assessed by cytokine ELISPOT at the same time points. IFN-γ-specific producing cells significantly increased after SLIT both at T1 and T2 (p=0.0002). On the contrary, ELISA assessment did not reveal an increase in IFN-γ serum levels at any time point. In conclusion, these results demonstrate that ELISA assessment of serum IFN-γ is not suitable for identifying an early response.

Peripheral TH-17 cells in children with allergic rhinitis: preliminary report

Th17 is a subset of T helper lymphocytes and exerts pro-inflammatory activities. Recently, it has been reported that serum IL-17 levels are high in the most severe patients with birch allergy studied both outside and during the pollen season. This study aims to compare the frequency of peripheral IL-17-producing T cells in children with allergic rhinitis and in healthy controls. Ten children with allergic rhinitis and 5 healthy non-allergic subjects were evaluated. Th17 were evaluated by intracellular staining in ex-vivo T cell compartment. Ex- vivo PBMNC evaluation showed that allergic patients had higher frequencies of IL-17 producing T cells, both concerning CD4+ and CD8+ cells. In particular, there is a subset co-expressing IL-17 and IFN-gamma both for CD4+ and CD8+ cells. In conclusion, this preliminary study suggests a possible role of Th-17 cells in the response to allergens in children.

Visual analogue scale assessment of respiration might be a surrogate for spirometry in allergic rhinitis

Allergic rhinitis (AR) may be frequently associated with or precede asthma. Bronchial involvement in AR is usually detected by spirometry, however, spirometers are rarely available. The aim of this study is to verify the suitability of the use of visual analogue scales (VAS) as a surrogate for screening spirometry in assessing respiration in AR patients. One hundred twenty patients with allergic rhinitis were studied. VAS for respiration assessment and spirometry were performed in all patients. There was a significant, though weak, relationship between VAS assessment of respiration and FEV(1) (p=0.0076; r=0.244). In conclusion, this preliminary study suggests the use of VAS as screening to assess the respiration of patients with allergic rhinitis who may be candidates for spirometry.

Fontaine-Farriaux syndrome: a recognizable craniosynostosis syndrome with nail, skeletal, abdominal, and central nervous system anomalies

Craniosynostosis is an etiologically heterogeneous malformation, which may present as an isolated finding or in association with other anomalies. The concurrence of craniosynostosis together with specific central nervous system, abdominal, genital, and limb malformations defines the Fontaine-Farriaux syndrome, described so far in only two patients. We report on a stillborn who mainly presented severe intrauterine growth retardation, bilateral coronal synostosis, generalized nail hypo/aplasia more evident on the posterior side, tapered digits, mild cutaneous syndactyly, abdominal muscle hypoplasia, micropenis and bilateral cryptorchidism. Skeletal radiographs revealed universal platyspondyly and necropsy findings comprised intestinal malrotation, abnormal cortical gyral formation, periventricular heterotopia, and cerebellar hypoplasia. Comparison between the present and the two previously described patients demonstrates that our case shows a combination of features strikingly resembling the original description. Conversely, the second reported patient shows a very atypical phenotype and is, most probably, affected by a distinct clinical entity. The triad of craniosynostosis, anonychia, and abdominal muscle hypo/aplasia emerges as the most consistent core phenotype, although skeletal and brain anomalies are relevant ancillary findings. An in-depth differential diagnosis with other partially overlapping conditions is carried out.

Serum interleukin-17 levels are related to clinical severity in allergic rhinitis

BACKGROUND

T helper (Th)-17 cells are a subset of T helper lymphocytes that exert regulatory activities. Recently, it has been reported that serum interleukin (IL)-17 levels are high in the most severe cases of birch allergy studied outside the pollen season.

OBJECTIVE

The aim of this study was to investigate a possible relationship between serum IL-17 levels and clinical parameters in patients with allergic rhinitis studied during the pollen season.

METHODS

In all, 56 patients with persistent pollen-induced allergic rhinitis were evaluated during the pollen season. Serum IL-17 levels were evaluated by enzyme-linked immunosorbent assay. Symptoms were assessed by visual analogue scale, drug use was monitored and peripheral eosinophils were counted.

RESULTS

Serum IL-17 levels were significantly related to clinical symptoms, drug use and peripheral eosinophil counts (P = 0.0001 for all).

CONCLUSION

This study provides evidence that serum IL-17 level assessment might be considered to classify allergy severity.

Serum Il-17 after one Course of Sublingual Immunotherapy in Allergic Rhinitis to Birch

Recently, it has been reported that IL-17 may be involved in allergic reaction. Sublingual immunotherapy (SLIT) is the unique curative treatment for allergic rhinitis. This study aims at investigating whether one course of birch SLIT could affect serum IL-17 levels. The findings provided show that some IL-17 producer patients had a reduction of serum IL-17 levels after one SLIT course. Therefore, this preliminary study shows that a single pre-seasonal SLIT course may induce a significant decreasing trend in serum IL-17 levels; further study should be carried out to define the role exerted by IL-17 in allergic rhinitis.

Reference values for IgG and IgG4 serum levels specific for inhalant allergens in non-atopic subjects

The IgG response to allergens is well-known, however few studies have investigated IgG and IgG4 production in normal subjects. Therefore, total IgG and IgG4 serum levels specific for 6 common inhalant allergens were measured in 282 non-allergic subjects to establish reference values at different ages and sex. Thus, 282 subjects were studied (141 female and 141 male) ranging from pre-school to adult age, all living in Northern Italy at the time of the study. Family history of first degree relatives and personal history were negative for allergic diseases. The findings obtained in this study indicate that: i) reference values for specific IgG4 and IgG levels against the allergen studied should take into account both the sex and age of the subject evaluated; ii) there is a difference in trend for age between seasonal and perennial allergens and iii) the relationships between age and specific IgG4 and IgG levels have different slopes. In conclusion, relevant differences exist in the distribution of IgG and IgG4 levels in normal subjects.

Role of respiratory pathogens in infants hospitalized for a first episode of wheezing and their impact on recurrences

In order to evaluate the infectious agents associated with the first episode of severe acute wheezing in otherwise healthy infants and to define the role of each of them in recurrences, 85 patients in Italy, aged <12 months, hospitalized because of a first acute episode of wheezing, were prospectively enrolled between 1 October 2005 and 31 March 2006. Upon enrollment, nasopharyngeal swabs were collected for the real-time PCR detection of respiratory syncytial virus (RSV) types A and B, influenza virus types A and B, adenovirus, parainfluenza viruses types 1, 2, 3 and 4, rhinovirus, human metapneumovirus, human coronavirus types 229E, OC43, NL63, and HKU1, bocavirus, enterovirus, and paraechovirus; nasopharyngeal aspirates were also obtained to detect atypical bacteria. At least one infectious agent was identified in 76 children (89.4%). RSV was the most frequently detected pathogen and its prevalence was significantly higher than that of the other pathogens in both age groups, and significantly higher in the children aged 3-12 months than in those aged <3 months. Only the children with RSV infection experienced recurrent wheezing. Viral load was significantly higher in children with than in those without recurrent wheezing. This study shows that RSV is the main reason for hospitalization during the first wheezing episode in infants, and that it appears to be the only pathogen associated with a high frequency of recurrences. A high viral load seems to be strictly related to the likelihood of recurrence.

Serum IL-4 as a marker of immunological response to sublingual immunotherapy

Allergic rhinitis (AR) is characterized by a Th2 polarized immune response. Specific Immunotherapy modifies this bias restoring a physiologic Th1 profile. Sublingual immunotherapy (SLIT) is widely prescribed, but there is no early, simple marker of response. This study was undertaken in order to determine whether serum IL-4 might be a possible marker of SLIT immunological response in order to quickly and easily detect responder patients. Thirty-nine AR patients with a pollen allergy assumed preseasonal SLIT for 3 months. VAS for symptoms and medication efficacy were evaluated. Serum IL-4 was assessed before and 3 and 6 months after SLIT initiation. Eighty-two percent of patients (32/39) showed a clinical response to SLIT. Serum IL-4 significantly decreased at 6 months post-therapy in responders, whereas it increased in non-responders. In conclusion, these results may be considered clinically relevant proof that SLIT treatment induces a quick reduction in Th2 polarization. Serum IL-4 appears to be an early marker of immunological response to SLIT.

Allergic patients have more numerous and prolonged respiratory infections than nonallergic subjects

BACKGROUND

Allergic disorders are characterized by type 2 helper T cell (Th2)-polarization, thus physiological type 1 helper T cell (Th1)-dependent mechanisms involved in fighting respiratory infections (RI) may be defective. It has previously been reported that allergic children have more numerous and severe RI than nonallergic ones.

OBJECTIVE

The aim of the study was to evaluate the number and duration of RI in adult allergic and nonallergic subjects.

METHODS

Six hundred and twenty-four subjects were studied; 202 of them were allergic (i.e. suffering from allergic rhinitis). The number of RI as well as the duration of the disease were recorded for 2 years.

RESULTS

Allergic subjects showed a significantly higher rate of RI episodes [adjusted incidence rate ratio (IRR) = 2.16, 95% confidence interval (CI) 1.94-2.41, P < 0.001] than subjects without allergy. The number of mild RI episodes was slightly higher in allergic subjects (IRR = 1.68, 95% CI 1.50-1.89, P < 0.001), while the number of severe episodes was markedly higher (IRR = 15.71, 95% CI 10.35-23.84, P < 0.001) when compared with nonallergic subjects. Moreover, allergic patients showed a longer total duration of RI than nonallergic subjects, with a mean difference of 17.4 days (95% CI 15.5-19.4, P < 0.001).

CONCLUSIONS

This study provides evidence that adult allergic patients have more numerous and prolonged RI than nonallergic subjects.

[Risk evaluation of contact with pesticides in Naples municipality gardeners]

Pesticide use still now is a remarkable risk for all cultivation operators, including farmers and flower-growing workers. Recently, pesticides use on ornamental plant has been demonstrated to be able to determine a risk extension to general population. Aim of the project was to elaborate and to apply a method for pesticides risk evaluation in ornamental plant cultivations, as to define workers exposure and its possible diffusion to not occupationally exposed populations. Main features of method will be sampling and analysis approach. The first will estimate air dispersion of pesticides in garden centre, skin and garment smarminess in nurserymen and leaf adhered amounts, in concomitance with treatment and periodically to estimate natural decay. The latter will characterize pesticides by means of different methods (liquid and gaseous chromatography, spectrophotometry and spectrometry). Final aim will also be to identify the most reliable analytic method, as concerns accuracy, sensitivity and specificity.

Practice parameters for sublingual immunotherapy

The efficacy and safety of sublingual immunotherapy (SLIT) are currently supported by clinical trials, meta-analysis and post-marketing surveys. Practice parameters for clinical use of SLIT are proposed here by a panel of Italian specialists, with reference to evidence based criteria. Indications to SLIT include allergic rhinoconjunctivitis, asthma, and isolated conjunctivitis (strength of recommendation: grade A). As to severity of the disease, SLIT is indicated in moderate/severe intermittent rhinitis, persistent rhinitis and mild to moderate asthma (grade D). SLIT may be safely prescribed also in children aged three to five years (grade B), and its use in subjects aged more than 60 years is not prevented when the indications and contraindication are ascertained (grade D). The choice of the allergen to be employed for SLIT should be made in accordance with the combination of clinical history and results of skin prick tests (grade D). Polysensitisation, i.e. the occurrence of multiple positive response does not exclude SLIT, which may be done with the clinically most important allergens (grade D). As to practical administration, co-seasonal, pre co-seasonal, and continuous schedules are available, being the latter recommended for perennial allergens or for pollens with particularly prolonged pollination, such as Parietaria (grade D). For pollens with relatively short pollination, such as grasses and trees (cypress, birch, alder, hazelnut, olive) the pre co-seasonal and perennial schedules are preferred (grade C). The build-up phases suggested by manufacturers can be safely used (grade A), but they can be modified according to the patient's tolerance (grade C). A duration of SLIT of 3-5 years is recommended to ensure a long-lasting clinical effect after the treatment has been terminated (grade C).

Screening spirometry to detect respiratory allergy

BACKGROUND

Recently, it has been evidenced that the forced expiratory flow at the 25 and 75% of the pulmonary volume (FEF25-75) might be considered as a possible marker of early bronchial impairment in patients with allergic rhinitis alone.

OBJECTIVES

The aim of this study was to determine whether a spirometric impairment may predict allergy during screening visit.

METHODS

The study included 283 Navy soldiers (255 males, mean age 27.1 + 8.2) who had to undergo spirometry for attending specific courses. Fifty-four showed slight spirometric anomalies. Thus, they referred to Navy Hospital of La Spezia for standardized tests: skin prick test, spirometry, and methacholine bronchial challenge.

RESULTS

Forty seven (87%) subjects were sensitized (47% monosensitized and 53% polysensitized). Allergic rhinitis was diagnosed in 25 subjects with median nasal TSS 5. FVC and FEV1 values were normal, whereas FEF25-75 values were reduced (61.8 + 14.8 % of predicted), bronchodilation test was significant for FEF25-75 (82.9 + 16.8% of predicted; p<0.001) only. Bronchial hyperreactivity (BHR) was detected in 28 subjects, all but 1 were sensitized.

CONCLUSIONS

This study provides evidence, relevant to clinical care, that mild spirometric impairment may generate the suspect of allergic disorders, thus spirometry could be more frequently performed in general population screening.

Bronchial hyperreactivity and spirometric impairment in patients with allergic rhinitis

BACKGROUND

The Link between allergic rhinitis and asthma is well known. Bronchial hyperreactivity (BHR) may be present in rhinitics. The present study is aimed at evaluating a large group of subjects suffering from allergic rhinitis alone to investigate the presence of spirometric impairment and BHR both during and outside the pollen season.

METHODS

360 rhinitics (subdivided in 3 groups: seasonal, SAR, perennial, PAR, and polysensitized, PolysR) were investigated by spirometry and methacholine challenge.

RESULTS

There was a significant seasonal difference concerning the number of rhinitics with impaired FEV1 (p<0.01 for SAR, p<0.02 for PAR, and p<0.03 for PolysR) and FEF25-75 (p<0.05 for SAR, p<0.03 for PAR, and p<0.05 for PolysR) as well as with BHR (p<0.05 for SAR and p<0.03 for PAR).

CONCLUSIONS

This study evidences that an impairment of spirometric parameters and BHR may be observed in patients with allergic rhinitis alone. Thus, careful evaluation of lower airways should be performed in patients with allergic rhinitis alone.

Sublingual specific immunotherapy reduces PBMC proliferations

BACKGROUND

Subcutaneous specific immunotherapy has been demonstrated capable of inducing T regulatory response. There is few evidence concerning immunological changes induced by sublingual immunotherapy.

OBJECTIVE

The aim of this study was to evaluate T cell proliferation in subjects successfully treated with SLIT for HDM.

METHODS

PBMCs were isolated from patients after at least 3 years of successful HDM SLIT and from matched untreated allergic and healthy control subjects. After 3 and 6 days of in vitro stimulation with PHA, Candida albicans, Dermatophagoides farinae, grasses, Parietaria judaica, and cat, proliferation.

RESULTS

Subjects treated with SLIT showed significant reduction of proliferation induced by Candida albicans, Parietaria, and grasses in comparison with untreated atopics (p=0.0002, 0.0033, and 0.009 respectively).

CONCLUSION

This pilot study confirms reduced T cell proliferation in allergic subjects treated with SLIT.

Long term persistence of anti-HBs protective levels in young patients with type 1 diabetes after recombinant hepatitis B vaccine

The aim of the present study was to evaluate the persistence of anti-hepatitis B protective levels in young patients with type 1 diabetes, successfully immunised with a recombinant hepatitis B vaccine. We re-evaluated, after a 4 year follow-up, 54 patients and 70 age and sex-matched healthy subjects. Protective antibodies levels were found in 50/54 (92%) patients and in 67/70 (96%) controls. Moreover, anti-HBs levels were similar in diabetic patients and controls (means of log-titre and (sd); 1.95 (0.88) and 2.18 (0.64) patients and controls, respectively; P=0.11). No cases of clinical hepatitis were reported and all patients and controls remained HBc negative. These data demonstrate the persistence of anti-HBs levels in children, adolescents and young patients with type 1 diabetes after recombinant hepatitis B vaccine showing evidence of longterm immunogenity and protective effect.

Acquired immune deficiency syndrome in childhood: impaired production of interleukin-2 by HIV (LAV/HTLV III) infected patients

The phenotype and functions of T lymphocytes and of natural killer (NK) cells have been investigated in four children and five adults from three Italian families infected with HIV (LAV/HTLV III). The results show a heterogeneous pattern of immunological derangements involving distribution of T and natural killer subsets, proliferation in response to T cell mitogens and natural killer activity. However, all infected patients tested showed a very low or absent phytohaemagglutinin induced interleukin-2 production regardless of age and clinical conditions, while concanavalin A-induced interleukin-2 production was within the normal range. The impaired interleukin-2 production in response to phytohaemagglutinin in some patients is not related to phytohaemagglutinin-induced proliferation, to clinical conditions or to a defective distribution of T cell subsets. These results suggest that, in our patients, both adults and children, HIV (LAV/HTLV III) has an "early" tropism for a subset of T cells involved in interleukin-2 production.

AIDS: outcome of children born to HTLV-III/LAV infected mothers. Report of 15 Italian cases

The characteristics of acquired immunodeficiency syndrome (AIDS) in children have been described in several reports. The occurrence of specific anti-HTLV-III/LAV seropositivity in children born to seropositive mothers is also becoming more frequent in Italy. We report 15 cases of seropositive children born to 14 seropositive, drug-addicted mothers. Among them, 5 died of AIDS, 8 developed a variable, non-progressive AIDS-related complex (ARC), while only two remained persistently asymptomatic. Liver disease was present in 2 patients, CNS disease in 4, gastrointestinal troubles were never a major problem. Only 2 cases of HBV infection and 3 of thrombocytopenia were observed. In our experience, homosexual behaviour of the parents was never a cause of family risk. Children presented with failure to thrive and/or signs of disease usually within the first five months of life. In one family the first child was affected by fatal AIDS while the younger child showed only passive, transient immunization by maternal specific IgG. One ARC patient, observed for over 3 years, showed apparently complete healing from the disease.

Association of neutrophil and complement defects in two twins with Shwachman syndrome

Immunological functions were studied in two 22-month-old dizygotic twins with the characteristic features of Shwachman syndrome. A severe defect of neutrophil motility was found in both children, but not in their parents. An impairment of the activity of the alternative pathway of complement was present in the sera of both patients. This defect, in association with the neutropenia and the chemotactic defect, might be related to the recurrent infections displayed by the twins.

Effects of aminoglycoside antibiotics on neutrophil chemotaxis

The inhibitory effect of neutrophil chemotaxis of gentamicin, tobramycin, and sisomicin was shown. The combined effect of aminoglycosides and histamine was not additive.