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Giovannini M, Castagnoli R, Mori F, Arasi S, Barni S, Saretta F, Mastrorilli C, Pecoraro L, Liotti L, Caminiti L, Marseglia G, Novembre E. Hymenoptera venom allergy among children in Italy: time for pediatricians to take action. Allergol Immunopathol (Madr) 2020; 48:804-809. [PMID: 32653226 DOI: 10.1016/j.aller.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 10/23/2022]
Abstract
Hymenoptera venom allergy (HVA) is one of the most frequent causes of anaphylaxis following a bee, vespid or ant sting. Real-life data regarding the management of HVA in children are lacking. To address this unmet need, we carried out a survey defining the current management of HVA in children among pediatric allergists in Italy. Educational investments on the improvement of the management of pediatric patients with HVA are urgently needed, and our analysis represents a relevant instrument in targeting a roadmap with this aim. The time for pediatric allergists to take action has come, and a task force from the Rare Allergic Diseases Commission of the Italian Society of Pediatric Allergy and Immunology is working on the topic to improve pediatricians' knowledge and optimize the care of these patients.
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Piccorossi A, Liccioli G, Barni S, Sarti L, Giovannini M, Verrotti A, Novembre E, Mori F. Epidemiology and drug allergy results in children investigated in allergy unit of a tertiary-care paediatric hospital setting. Ital J Pediatr 2020; 46:5. [PMID: 31924232 PMCID: PMC6954623 DOI: 10.1186/s13052-019-0753-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/21/2019] [Indexed: 11/29/2022] Open
Abstract
Background and objective Drug Hypersensitivity Reactions (DHRs) are considered adverse effects of medications that resemble allergy symptoms. The reported positive clinical history of pediatric drug reactions is about 10%, however, after allergy investigations, only a small percent is confirmed as hypersensitivity. The aim of this study was to analyze the clinical history, allergy work-up results and sensitization profile of children and adolescents referred to our Allergy Unit for suspected DHRs. Methods The study evaluated data related to a group of children with a positive history of drug reactions during a two-year period. The allergy work-up consisted of in vivo and in vitro tests, in accordance with the recommendations of the ENDA/EAACI guidelines. Results Data from a group of 637 patients [348 M (54.6%); 289 F (45.4%)] were retrospectively analyzed. Beta lactams (BLs) were the most common drugs involved in the reported clinical history, followed by non-steroidal anti-inflammatory drugs (NSAIDs). Severe cutaneous adverse reactions (SCARs) were most frequently observed during BL treatment. The confirmation of BL hypersensitivity was higher for immediate reactions (IRs) [9.4%; 5.1% through positive skin tests (STs) and 5.5% through drug provocation test (DPT)] compared to non-immediate reactions (non-IRs) (8.1%; 2.2% through STs and 6.2% through DPT). A higher number of positive results was obtained for BLs and macrolides when the tests were performed within 12 months after the index reaction (p < 0.05). During DPTs with amoxicillin-clavulanic acid, four hypersensitivity reactions (including one anaphylaxis) occurred despite negative STs. Conclusion Our data demonstrated that only 9.1% of patients resulted in being positive to allergy tests which is in line with the data in literature. An allergy work-up is mandatory for excluding suspected hypersensitivity.
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Affiliation(s)
- A Piccorossi
- Department of Pediatrics, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - G Liccioli
- Allergy Unit, Anna Meyer Children's Hospital, Florence, Italy.
| | - S Barni
- Allergy Unit, Anna Meyer Children's Hospital, Florence, Italy
| | - L Sarti
- Allergy Unit, Anna Meyer Children's Hospital, Florence, Italy
| | - M Giovannini
- Allergy Unit, Anna Meyer Children's Hospital, Florence, Italy
| | - A Verrotti
- Department of Pediatrics, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - E Novembre
- Allergy Unit, Anna Meyer Children's Hospital, Florence, Italy
| | - F Mori
- Allergy Unit, Anna Meyer Children's Hospital, Florence, Italy
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Bilò MB, Pravettoni V, Bignardi D, Bonadonna P, Mauro M, Novembre E, Quercia O, Cilia M, Cortellini G, Costantino MT, Cremonte L, Lodi Rizzini F, Macchia L, Marengo F, Murzilli F, Patella V, Reccardini F, Ricciardi L, Ridolo E, Romano A, Savi E, Schiavino D, Severino M, Pastorello EA. Hymenoptera Venom Allergy: Management of Children and Adults in Clinical Practice. J Investig Allergol Clin Immunol 2018; 29:180-205. [PMID: 30183660 DOI: 10.18176/jiaci.0310] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Hymenoptera venom allergy is an epidemiologically underestimated condition and a major cause of morbidity worldwide. Preventing future allergic reactions in patients who experience a systemic reaction is based on the correct management of the emergency followed by an accurate diagnosis, prescription of adrenaline autoinjectors, and, where indicated, specific venom immunotherapy. Some epidemiological studies highlight our poor knowledge of this disease and the frequent inadequacy of its management. Moreover, they emphasize the importance of such a life-saving treatment as specific immunotherapy. The availability of high-quality hymenoptera venom extracts for diagnostic and therapeutic use has dramatically improved the prognosis and quality of life of allergic patients. Subcutaneous venom immunotherapy is currently the most effective form of allergen-based immunotherapy, with a carry-over effect lasting up to several years after its interruption. This report on the management of hymenoptera venom-allergic children and adults was prepared by a panel of Italian experts. The main objective of this consensus document is to review the scientific evidence related to diagnosis, therapy, and management of patients allergic to hymenoptera venom. Thus, we can improve our knowledge of the disease and promote good clinical practices. The present document provides practical suggestions for correct diagnosis, prescription of emergency therapy and immunotherapy, and strategies for patient care.
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Affiliation(s)
- M B Bilò
- U.O.C. Allergology, Department of Internal Medicine, University-Hospital Ospedali Riuniti di Ancona, Italy
| | - V Pravettoni
- U.O.C. General Medicine - Immunology and Allergology, Foundation IRCCS Ca´ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - D Bignardi
- U.O.C. Allergology, Ospedale Policlinico San Martino, Genova, Italy
| | - P Bonadonna
- U.S.D. Allergology, Integrated University-Hospital of Verona, Italy
| | - M Mauro
- U.O.S. Allergology, Hospital S. Anna Como ASST Lariana, Italy
| | - E Novembre
- Complex Organizational Unit of Allergology, University-Hospital A. Meyer, Firenze, Italy
| | - O Quercia
- High Specialization Unit of Allergology, Hospital of Faenza, AUSL (Local Health Unit) of Romagna, Italy
| | - M Cilia
- Allergology Practice, C.d.S. of Scilla, Reggio Calabria, Italy
| | - G Cortellini
- Allergology, O.U. Internal Medicine and Rheumatology, Rimini, Local Health Unit of Romagna, Italy
| | - M T Costantino
- Departmental Structure Day Hospital Center, Allergology and Clinic Immunology Local Health Unit of Mantova, Intercompany Allergology ATS Val Padana, Italy
| | - L Cremonte
- SS Allergologia ASL AL Alessandria, Italy
| | - F Lodi Rizzini
- S.S.V.D. Allergology Civil Hospitals of Brescia, Department of Clinical and Experimental Sciences University of Brescia, Italy
| | - L Macchia
- School and Chair of Allergology and Clinical Immunology, University of Bari, Italy
| | - F Marengo
- Allergology and Clinical Immunology, A.O.U. Città della Salute e della Scienza di Torino
| | - F Murzilli
- U.O.S.D. of Allergology Hospital S.S. Filippo and Nicola, Avezzano (AQ), Italy
| | - V Patella
- Allergy and Clinical Immunology Division, Department of Medicine, Civil Hospital of Battipaglia, Salerno, Italy
| | - F Reccardini
- SOC Pneumology, Respiratory Physiopathology, integrated University Health Authority of Udine, Italy
| | - L Ricciardi
- Allergy and Clinical Immunology Unit - University Hospital AOU Policlinico G.Martino, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - E Ridolo
- Department of Medicine and Surgery, University of Parma, Italy
| | - A Romano
- Unit of Allergology, Presidio Columbus, Rome, Italy
| | - E Savi
- Operating Departmental Unit of Allergology, Hospital G. Da Saliceto, Piacenza, Italy
| | - D Schiavino
- Complex Operating Unit of Allergology, Policlinico Gemelli - School of Specialization in Allergology and Clinical Immunology, Catholic University, Rome, Italy
| | - M Severino
- Allergy Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - E A Pastorello
- Complex Unit of Allergology and Immunology at ASST Grande Ospedale Metropolitano Niguarda - School of Specialization in Allergology and Clinical Immunology at University of Milan, Italy
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Mori F, Angelucci C, Cianferoni A, Barni S, Indolfi G, Casini A, Mangone G, Materassi M, Pucci N, Azzari C, Novembre E. Increase of natural killer cells in children with liver transplantation-acquired food allergy. Allergol Immunopathol (Madr) 2018; 46:447-453. [PMID: 29456038 DOI: 10.1016/j.aller.2017.09.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 09/14/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Transplantation-acquired food allergies (TAFA) are frequently reported and considered to be caused by immunosuppressive therapy. The aim of this study was to investigate the allergic and immunologic responses in children who had liver or kidney transplantations. METHODS Twelve children receiving liver transplantations and 10 children receiving kidney transplantations were investigated. All children underwent the allergy work-up and in most of them, lymphocyte screening and serum cytokine measurements were also performed. RESULTS TAFA were found in 7/12 (58%) children with liver transplantations and in none of the 10 children with kidney transplantations. The mean age at transplantation was significantly lower in children who underwent liver transplantations (p<0.001). The immunosuppressive therapy administered to children with liver transplantation was tacrolimus in 11 patients and cyclosporine in one patient, while all 10 children with kidney transplantation received tacrolimus plus mycophenolate. The most common antigenic food was egg. The natural killer (NK) cell numbers were significantly higher in liver-transplant children than in kidney-transplant children. No significant differences were found in the serum cytokine levels. CONCLUSIONS This study confirms that liver-transplant children treated with tacrolimus alone have a higher risk of developing TAFA than kidney-transplant children treated with tacrolimus plus mycophenolate. NK cells might be involved in this difference.
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Affiliation(s)
- F Mori
- Allergy Unit, Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - C Angelucci
- Allergy Unit, Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - A Cianferoni
- Allergy and Immunology Division, Children's Hospital of Philadelphia, PA, USA
| | - S Barni
- Allergy Unit, Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy.
| | - G Indolfi
- Pediatric and Liver Unit, Meyer Children's University Hospital of Florence, Florence, Italy
| | - A Casini
- Division of Immunology, Section of Paediatrics, Department of Health Sciences, Anna Meyer Children's University Hospital, Florence, Italy
| | - G Mangone
- Division of Immunology, Section of Paediatrics, Department of Health Sciences, Anna Meyer Children's University Hospital, Florence, Italy
| | - M Materassi
- Pediatric Nephrology Unit, Meyer Children's University Hospital, Florence, Italy
| | - N Pucci
- Allergy Unit, Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - C Azzari
- Pediatric and Liver Unit, Meyer Children's University Hospital of Florence, Florence, Italy
| | - E Novembre
- Allergy Unit, Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
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Liccioli G, Mori F, Barni S, Pucci N, Novembre E. Anaphylaxis to Polyvinylpyrrolidone in Eye Drops Administered to an Adolescent. J Investig Allergol Clin Immunol 2018; 28:263-265. [DOI: 10.18176/jiaci.0252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mori F, Sarti L, Barni S, Pucci N, Belli F, Stagi S, Novembre E. Donkey´s Milk Is Well Accepted and Tolerated by Infants With Cow´s Milk Food Protein-Induced Enterocolitis Syndrome: A Preliminary Study. J Investig Allergol Clin Immunol 2017; 27:269-271. [PMID: 28731417 DOI: 10.18176/jiaci.0167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- F Mori
- Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - L Sarti
- Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - S Barni
- Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - N Pucci
- Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - F Belli
- Nutrition Unit, Department of Pediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - S Stagi
- Department of Health Sciences, University of Florence, Anna Meyer Children´s University Hospital, Florence, Italy
| | - E Novembre
- Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital, Florence, Italy
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Pucci N, Massai C, Bernardini R, Caputo R, Mori F, De Libero C, Novembre E, De Martino M, Vierucci A. Eyelash Length in Children with Vernal Keratoconjunctivitis: Effect of Treatment with Cyclosporine Eye Drops. Int J Immunopathol Pharmacol 2016; 20:595-9. [PMID: 17880772 DOI: 10.1177/039463200702000317] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The upper eyelashes in vernal keratoconjunctivitis (VKC) patients have been reported to be longer than in healthy age- and gender-matched subjects. Eyelash length positively correlated to the severity of the disease and negatively to the employment of cyclosporine eye drops, suggesting that specific humoral factors could be involved in both ocular inflammation and elongation of the eyelashes. The aim of the present study is to evaluate a possible relationship between eyelash length and the duration of topical cyclosporine treatment. The length of the upper eyelashes of 34 VKC patients never treated with topical cyclosporine (Cyc-NT) was matched with that of 58 VKC patients treated with cyclosporine (Cyc-T). The latter group was divided into three subgroups, depending on the duration of therapy: 1–6 months (group 1; 21 subjects), 7–12 months (group 2; 19 subjects), >12 months (group 3; 19 subjects). Cyc-NT patients' eyelashes were significantly longer than those of VKC patients treated for 1–6 months (group 1). No significant difference was found between Cyc-NT and Cyc-T patients in group 2 and group 3. The differences between Cyc-T patients and group 1 and 2, group 2 and 3, and group 1 and 3 were not statistically significant. The eyelash shortening observed seems directly related to the rapid improvement of ocular symptoms induced by the treatment. A receptor down-regulation by mediators of ocular inflammation may explain this data, although different cytokines, hormones or other humoral mediators could be expressed on the ocular surface at different stages of the disease, mainly in periods of rapid change of the clinical course.
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Affiliation(s)
- N Pucci
- Allergy and Clinical Immunology Unit, Department of Pediatrics, University of Florence, Florence, Italy.
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Parri N, Bernardini R, Pucci N, Novembre E, Azzari C, Vierucci A. Drug Rash with Eosinophils and Systemic Symptoms Induced by Lamotrigine Therapy. Int J Immunopathol Pharmacol 2016; 20:643-5. [PMID: 17880778 DOI: 10.1177/039463200702000323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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9
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Novembre E, Calogero C, Mori F, Bernardini R, Pucci N, Neri P, Bonini M, Vierucci A, De Martino M. Biphasic Anaphylactic Reaction to Ketorolac Tromethamine. Int J Immunopathol Pharmacol 2016; 19:449-50. [PMID: 16831313 DOI: 10.1177/039463200601900223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ketorolac tromethamine is a recent injectable non-steroidal anti-inflammatory drug (NSAID) with analgesic properties approved for short-term pain management. In spite of its increasing use both in adults and children (1-2), relatively few allergic-like reactions have been reported (3–5). Reactions are often severe, and a death occurred following an intramuscular injection of ketorolac (6).
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Affiliation(s)
- E Novembre
- Allergy and Clinical Immunology Unit, Azienda Ospedaliero Universitaria A. Meyer, Via L. Giordano 13, 50132 Florence, Italy.
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Bernardini R, Mistrello G, Pucci N, Roncarolo D, Lombardi E, Zanoni E, Mori F, De Martino M, Novembre E, Massai C, Azzari C, Vierucci A. Diagnostic Value of Three Different Latex Extracts. Int J Immunopathol Pharmacol 2016; 20:393-400. [PMID: 17624253 DOI: 10.1177/039463200702000221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The diagnosis of latex allergy is made on clinical history, but a confirmatory skin prick test (SPT) or a serological assay based on a commercial latex extract is always recommendable. Different raw materials can be used in the preparation of commercial latex extracts. Such extracts can consequently show both different qualitative profiles and a different diagnostic potential. Therefore, the selection of a proper latex extract is essential for in vitro and in vivo diagnosis of latex allergy. In the present study three different latex extracts, prepared from different raw materials (ammoniated -AL-, serum -SL-, or rubber particles -RPE- latex), are compared by in vitro techniques using sera from twenty patients with latex allergy. SDS-PAGE technique was used to compare the antigenic profile of the three latex extracts. Subsequently, their allergenic profiles were evaluated by immunoblotting technique using the individual sera from the twenty latex allergic patients. The diagnostic potential of the three latex extracts was also evaluated using direct Radio-Allergo-Sorbent Test (RAST) as well as skin prick tests (SPTs). In order to establish the more appropriate latex extract in a perspective of in vivo diagnosis of latex sensitization, the same latex extracts were subsequently compared by an in vivo SPT involving ten of the above subjects. The SDS-PAGE profiles of the three latex extracts examined were quite different. SL extract showed numerous bands comprised between 10–100 kDa. RPE extract was characterized by two intense bands at 14 and 20 kDa while AL extract showed the poorer antigenic composition. Analogously, immunoblotting analysis evidenced a different profile in relation to both different patients and extracts. For only two out of the twenty sera, direct RAST results showed a same positive class in relation to the different latex extracts used. SPT with SL extract showed, in respect to the other extracts (AL, RPE), a significantly higher wheal. This study showed that SL extract is able to express the best in vitro and in vivo diagnostic potential. Thus, its use should be preferred for the diagnosis of patients affected by latex allergy.
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Affiliation(s)
- R Bernardini
- Pediatric Allergy and Pulmonology Center, Department of Pediatrics, Anna Meyer Children Hospital, University of Florence, Italy.
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Barni S, Mori F, Sarti L, Pucci N, Rossi EM, de Martino M, Novembre E. Utility of skin testing in children with a history of non-immediate reactions to amoxicillin. Clin Exp Allergy 2016; 45:1472-4. [PMID: 26178175 DOI: 10.1111/cea.12596] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Barni
- Allergy Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - F Mori
- Allergy Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - L Sarti
- Allergy Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - N Pucci
- Allergy Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - E M Rossi
- Allergy Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - M de Martino
- Infectious Diseases Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - E Novembre
- Allergy Unit, Anna Meyer Children's University Hospital, Florence, Italy
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Mori F, Pantano S, Rossi ME, Montagnani C, Chiappini E, Novembre E, Galli L, de Martino M. Skin prick test results to artesunate in children sensitized to Artemisia vulgaris L. Int J Immunopathol Pharmacol 2015; 28:411-4. [PMID: 26157064 DOI: 10.1177/0394632015589518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 05/08/2015] [Indexed: 11/16/2022] Open
Abstract
Artemisia vulgaris L and Artemisia annua L (Chinese: qinghao) are similar plants of the Asterbaceae family. Artesunate, a semi-synthetic derivate of artemisin which is the active principle extract of the plant qinghao, has antimalarial properties. Some cases of severe allergic reactions to artesunate have been described. The purpose of this study was to evaluate the association between positive skin tests to Artemisia vulgaris L allergen and a preparation of injectable artesunate. A total of 531 children were skin prick tested with inhalants (including Artemisia vulgaris L), foods, and artesunate. Among the 59 patients positive to Artemisia vulgaris L only one child was also positive to artesunate. No child was positive to artesunate in those negative to Artemisia vulgaris L. We conclude that Artemisia vulgaris L sensitization is not associated with sensitization to artesunate; consequently, skin test to artesunate should not be carried out before using the drug considering the rare allergic reactions.
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Affiliation(s)
- F Mori
- Allergy Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - S Pantano
- Department of Pediatrics, St Salvatore Hospital, University of Aquila, Italy Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - M E Rossi
- Allergy Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - C Montagnani
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - E Chiappini
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy Infectious Diseases Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - E Novembre
- Allergy Unit, Anna Meyer Children's University Hospital, Florence, Italy Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
| | - L Galli
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy Infectious Diseases Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - M de Martino
- Department of Health Sciences, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy
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Barni S, Butti D, Mori F, Pucci N, Rossi ME, Cianferoni A, Novembre E. Azithromycin is more allergenic than clarithromycin in children with suspected hypersensitivity reaction to macrolides. J Investig Allergol Clin Immunol 2015; 25:128-132. [PMID: 25997306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Macrolides are considered safe antibiotics with reduced allergenic activity. However, studies on the safety of macrolides are scarce, particularly in children. OBJECTIVE The aim of this study was to assess the frequency of hypersensitivity reactions to clarithromycin and azithromycin in a group of children referred to our allergy unit for suspected macrolide allergy. METHODS We retrospectively reviewed the charts of 90 children aged 1-17 years with symptoms suggestive of hypersensitivity reaction to clarithromycin or azithromycin between December 31, 2008 and December 31, 2013. The allergy workup included skin tests (ie, skin prick tests and/or intradermal tests), determination of serum specific IgE (sIgE) to clarithromycin and azithromycin, and, if necessary to reach a diagnosis, oral provocation tests. RESULTS Seventy-seven children completed the allergy workup. A reaction to clarithromycin was recorded in 58 children (75.3%): 21 (36.2%) had a history of immediate reactions, and 37 (63.8%) had a history of nonimmediate reactions. A reaction to azithromycin was recorded in 19 children (24.6%): 6 (31.5%) had a history of immediate reaction, and 13 (68.42%) had a history of nonimmediate reaction. Positive results in skin tests and oral provocation tests with the suspect drug confirmed the diagnosis in 15.5% of reactions to clarithromycin (9 of 58) and in 47.3% of reactions to azithromycin (9 of 19) (P = .004). CONCLUSION A complete allergy workup enabled us to confirm a diagnosis of clarithromycin and azithromycin allergy in 15.5% and 47.3% of cases, respectively. Azithromycin was more allergenic than clarithromycin in children.
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Affiliation(s)
- F. Mori
- Allergy Unit, A. Meyer Children's Hospital, Department of Pediatrics, the University of Florence, Italy
| | - L. Pecorari
- S. Anna Hospital, Department of Pediatrics, Ferrara, Italy
| | - S. Pantano
- S. Salvatore Hospital, Department of Pediatrics, the University of Aquila, Italy
| | - M.E. Rossi
- Allergy Unit, A. Meyer Children's Hospital, Department of Pediatrics, the University of Florence, Italy
| | - N. Pucci
- Allergy Unit, A. Meyer Children's Hospital, Department of Pediatrics, the University of Florence, Italy
| | - M. De Martino
- Pediatric Infectivology, A. Meyer Children's Hospital, Department of Pediatrics, the University of Florence, Italy
| | - E. Novembre
- Allergy Unit, A. Meyer Children's Hospital, Department of Pediatrics, the University of Florence, Italy
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15
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Sopo SM, Giorgio V, Iacono ID, Novembre E, Mori F, Onesimo R. A multicentre retrospective study of 66 Italian children with food protein-induced enterocolitis syndrome: different management for different phenotypes. Clin Exp Allergy 2012; 42:1257-65. [DOI: 10.1111/j.1365-2222.2012.04027.x] [Citation(s) in RCA: 150] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S. Miceli Sopo
- Department of Pediatrics; University of Sacred Heart Agostino Gemelli Rome; Rome; Italy
| | - V. Giorgio
- Department of Pediatrics; University of Sacred Heart Agostino Gemelli Rome; Rome; Italy
| | - I. Dello Iacono
- Unit of Paediatrics; Fatebenefratelli Hospital; Benevento; Italy
| | - E. Novembre
- Allergy and Clinical Immunology Unit; Anna Meyer Children's Hospital; Department of Paediatrics; University of Florence; Florence; Italy
| | - F. Mori
- Allergy and Clinical Immunology Unit; Anna Meyer Children's Hospital; Department of Paediatrics; University of Florence; Florence; Italy
| | - R. Onesimo
- Department of Pediatrics; University of Sacred Heart Agostino Gemelli Rome; Rome; Italy
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16
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Calogero C, Parri N, Baccini A, Cuomo B, Palumbo M, Novembre E, Morello P, Azzari C, de Martino M, Sly PD, Lombardi E. Respiratory impedance and bronchodilator response in healthy Italian preschool children. Pediatr Pulmonol 2010; 45:1086-94. [PMID: 20672294 DOI: 10.1002/ppul.21292] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To define normal values for respiratory resistance (R(rs)) and reactance (X(rs)) and bronchodilator response (BDR) in a population of healthy Italian preschool children using a commercially available forced oscillation device. METHODS R(rs) and X(rs) were measured in kindergartens in Viterbo, Italy. Regression analysis was performed taking into account height, weight, age, gender, and reference equations calculated. The coefficient of repeatability (CR) between two tests performed 15 min apart was calculated in a subset of children. BDR was assessed by repeating the measurements 15 min after the administration of 200 µg of inhaled salbutamol and calculated as an absolute change in R(rs) and X(rs) at 8 Hz, as a percent change in baseline, and as a change in Z-score calculated from the reference equations. RESULTS Lung function was attempted in 175 healthy children and successful in 163 (81 male, median age 4.8, range 2.9-6.1 years). R(rs) and X(rs) at 6, 8, and 10 Hz were related to height but not other variables. The CR was 1.53 hPa s L(-1) for R(rs8) and 0.91 hPa s L(-1) for X(rs8). The 5th percentile for absolute R(rs8) BDR was -3.16 hPa s L(-1), whereas the 95th percentile for absolute X(rs8) BDR was 2.25 hPa s L(-1). These cut-off values corresponded to a change in the Z-score of -1.88 and 2.48, respectively. CONCLUSIONS We have established reference equations for R(rs) and X(rs) in healthy Italian preschool children using forced oscillations. We recommend a change in Z-score of -1.88 for R(rs8) and 2.48 for X(rs8) as cut-off values for a positive BDR.
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Affiliation(s)
- C Calogero
- Section of Respiratory Medicine, Department of Paediatrics, University of Florence, Anna Meyer University Hospital for Children, Florence, Italy.
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17
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Pucci N, Caputo R, Mori F, De Libero C, Di Grande L, Massai C, Bernardini R, Novembre E. Long-Term Safety and Efficacy of Topical Cyclosporine in 156 Children with Vernal Keratoconjunctivitis. Int J Immunopathol Pharmacol 2010; 23:865-71. [DOI: 10.1177/039463201002300322] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Vernal keratoconjunctivitis (VKC) is a chronic and potentially sight-threatening disease. Topical corticosteroids (Cs) seem to be the only effective treatment for this condition, although severe side effects may occur owing to their prolonged use. More recently, cyclosporine (Cyc) eye drops have been reported as a valid alternative, but so far such treatment has only been successfully experimented for a short time and in small numbers of patients. The aim of our study is to evaluate the long term safety and efficacy of topical cyclosporine eye drops in children suffering from VKC. Over a period of 7 years we followed a large group of children suffering from severe VKC. They were selected to start cyclosporine eye drop treatment, because of the prompt relapse of their disease as soon as they stopped topical corticosteroids administration. All patients were followed-up in an ambulatory care assessment. A total of 156 children with VKC were treated with topical cyclosporine eye drops over a period ranging from two to seven years [mean time 3.8±1.09 years] during the seasonal relapse [range 9–66 months; mean time 24.7±10.4 months]. Two formulations, at 1% and 2% (82% and 18% respectively) concentrations, of cyclosporine eye drops were made. The dosage administered was one drop in each eye from two to four times a day, depending on the severity of the disease and the season. The ocular objective scores were determined and compared every year, at the beginning and at the end of each treatment period. Blood samples were collected once a year in order to check both kidney and liver functions, as well as cyclosporine serum levels. We enrolled 156 patients (mean age 8.31±2.79 years; 116 males and 40 females) who were followed-up over a period of 7 years [156 (100%) children during the first and the second year; 138 (88.5%) patients until the third year; 90 (57.7%) until the fourth year; 32 (20.5%) until the fifth year; 10 (6.4%) until the sixth year and 2 (1.3%) until the seventh year]. The ocular objective scores significantly improved (p<.001) over the years when comparing them at the beginning and the end of each seasonal treatment period, except for the last year. Over the treatment period, non-significant changes were recorded in terms of kidney and liver enzymatic activities and also in terms of cyclosporine serum levels. Cyclosporine eye drops, either at 1% or 2% concentrations, resulted safe and effective for long-term treatment of VKC in 156 children. The lack of significance of the score results during the seventh year can be explained by the small number of subjects treated for such a long period. A systematic ocular examination and both liver and kidney functional investigations allowed us to exclude the possibility of local or systemic side effects due to cyclosporine. If either transient or long-lasting, the occurrence of burning was referred by some of the patients treated, but none of them required to discontinue the drug. In conclusion, this is the first study showing that topical cyclosporine is easily handled even by children, with safe and effective results even when it is used over a long period of time. Our findings, though encouraging, need to be confirmed by further studies.
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Affiliation(s)
| | - R. Caputo
- Clinical Ophthalmology Unit, Anna Meyer Children's Hospital, Department of Pediatrics, University of Florence, Italy
| | | | - C. De Libero
- Clinical Ophthalmology Unit, Anna Meyer Children's Hospital, Department of Pediatrics, University of Florence, Italy
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18
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Mori F, Barni S, Pucci N, Rossi ME, Orsi Battaglini C, Novembre E. Upper airways disease: role of corticosteroids. Int J Immunopathol Pharmacol 2010; 23:61-66. [PMID: 20152084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Nasal topical steroids (INCSs) are well established effective therapy in allergic rhinitis both in children and adults. There is clear benefit in using INCSs over antihistamines in allergic rhinitis while short courses of oral corticosteroids (CSs) may be indicated in severe cases. The addition of INCSs to oral antibiotics has been proven to be more effective than antibiotics alone for achieving symptomatic improvement in patients with acute rhino sinusitis. INCSs as monotherapy are also effective in the treatment of allergic rhinosinusitis (ARS). Several randomized controlled trials have evaluated the role of INCSs in chronic RS with the majority demonstrating a beneficial effect. In adults, the clinical efficacy of oral corticosteroids in the management of chronic RS with nasal polyposis is well established. There are no randomized controlled trials evaluating the efficacy of systemic CSs in chronic RS without nasal polyposis.
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Affiliation(s)
- F Mori
- Allergy Unit, Azienda Ospedaliero-Universitaria A.Meyer, Florence, Italy.
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19
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Mori F, Bianchi L, Pucci N, Azzari C, De Martino M, Novembre E. CD4+CD25+Foxp3+ T Regulatory Cells are not Involved in Oral Desensitization. Int J Immunopathol Pharmacol 2010; 23:359-61. [DOI: 10.1177/039463201002300136] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Oral tolerance has been related to generation of T regulatory cells (Treg) or clonal anergy/deletion, respectively by administering low and high doses of fed antigens. CD4+CD25+ regulatory T cell clones can be induced by the antigen in Peyer's patches of animal models. We selected ten subjects (mean age: 89.4 ± 36.21 months; group A) with severe cow's milk allergy. They underwent oral desensitization (OD) according to the current protocols. In six months they reached a tolerance of 50 ml of cow's milk. CD4+CD25+Foxp3+ T(reg) blood levels were measured at the beginning of OD (A) and after 6 months (A'), but almost the same values were obtained: A = 0.36 ± 0.11%; A'= 0.59 ± 0.15%. These results were compared with a control group (C) of non-atopic children. Naturally outgrowing cow's milk allergy can be related to high blood levels of CD4+CD25+Foxp3+ T(reg), as previously reported in children. On the other hand, a forced oral desensitization through a progressive intake of the antigenic food seems not to be related to an enhancement of CD4+CD25+Foxp3+ T(reg) levels in peripheral blood, making the role of long-lasting systemic immunologic changes unlikely.
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Affiliation(s)
| | | | | | | | - M. De Martino
- Pediatric Infectivology, A. Meyer Children's Hospital, Department of Pediatrics, University of Florence, Italy
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20
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Affiliation(s)
- E Novembre
- Unitá di Allergologia, Complesso Integrato Columbus, Rome 00168, Italy
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21
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Novembre E, Mori F, Barni S, Pucci N, Rossi ME. Should the skin prick test to horse be included in the standard panel for the diagnosis of respiratory allergy? J Investig Allergol Clin Immunol 2009; 19:247-249. [PMID: 19610277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
- E Novembre
- Allergy Unit, Azienda Ospedaliero-Universitaria A Meyer Florence, Italy
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22
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Novembre E, Cianferoni A, Mori F, Barni S, Calogero C, Bernardini R, Di Grande L, Pucci N, Azzari C, Vierucci A. Urticaria and urticaria related skin condition/disease in children. Eur Ann Allergy Clin Immunol 2008; 40:5-13. [PMID: 18700329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Urticaria is a rash, that typically involves skin and mucosa, and is characterized by lesions known as hives or wheals. In some cases there is an involvement of deep dermis and subcutaneous tissue that causes a skin/mucosa manifestation called angioedema. Urticaria and angioedema are very often associated: urticaria-angioedema syndrome. The acute episodic form is the most prevalent in the pediatric population, and it is often a recurrent phenomenon (recurrent urticaria). Acute episodic urticaria it is usually triggered by viruses, allergic reactions to foods and drugs, contact with chemicals and irritants, or physical stimuli. In many instances it is not possible to identify a specific cause (idiopathic urticaria). Chronic urticaria is a condition that can be very disambling when severe. In children is caused by physical factors in 5-10% of cases. Other trigger factors are infections, foods, additives, aeroallergens and drugs. The causative factor for chronic urticaria is identified in about 20% of cases. About one-third of children with chronic urticaria have circulating functional autoantibodies against the high affinity IgE receptor or against IgE. (chronic urticaria with autoantibodies or "autoimmune" urticaria). It is not known why such antibodies are produced, or if the presence of these antibodies alter the course of the disease or influence the response to treatment. Urticaria and angioedema can be symptoms of systemic diseases (collagenopathies, endocrinopathies, tumors, hemolytic diseases, celiachia) or can be congenital (cold induced familiar urticaria, hereditary angioedema). The diagnosis is based on patient personal history and it is very important to spend time documenting this in detail. Different urticaria clinical features must guide the diagnostic work-up and there is no need to use the same blood tests for all cases of urticaria. The urticaria treatment includes identification of the triggering agent and its removal, reduction of aspecific factors that may contribute to the urticaria or can increase the itch, and use of anti-H1 antihistamines (and/or steroids for short periods if antihistamines are not effective). In some instances an anti-H2 antihistamine can be added to the anti-H1 antihistamines, even if the benefits of such practice are not clear. The antileucotriens can be beneficial in a small subgroup of patients with chronic urticaria. In case of chronic urticaria resistant to all the aforementioned treatments, cyclosporine and tacrolimus have been used with good success. When urticaria is associated to anaphylaxis, i.m epinephrine needs to be used, together with antihistamines and steroids (in addition to fluids and bronchodilatators if required).
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Affiliation(s)
- E Novembre
- Department of Pediatrics, University of Florence, Italy
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23
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Bernardini R, Pucci N, Rossi ME, Lombardi E, De Martino M, Mori F, Ciprandi G, Novembre E, Marcucci F, Massai C, Azzari C, Vierucci A. Allergen specific nasal challenge to latex in children with latex allergy: clinical and immunological evaluation. Int J Immunopathol Pharmacol 2008; 21:333-341. [PMID: 18547477 DOI: 10.1177/039463200802100210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023] Open
Abstract
There are no data concerning the significance of allergen specific nasal challenge to latex (ASNCL) in the pediatric population and the effect of mometasone furoate nasal spray (MFNS), topic corticosteroid exerting a potent anti-inflammatory activity in children with latex allergic rhinitis. The aims of this study are: to investigate the clinical and immune pathological effects of ASNCL in children with latex allergy; to study the effects of MFNS pre-medication on the clinical and immune pathological effects of ASNCL in children with latex allergy. Thirteen children: 6 male and 7 female, mean (SD) age 9.6 (2.9) years, with latex allergy and seven children: 3 male and 4 female, mean (SD) age 9.9 (3.8) years, without latex allergy underwent ASNCL. Nasal symptoms were recorded, nasal lavage fluid was collected to measure tryptase, eosinophil cationic protein (ECP), interleukin-5, interferon-gamma levels, and spirometric test was performed for each patient without or with premedication with MFNS. ASNCL induced a clinical allergic response and increased tryptase levels only in children with latex allergy. No serious adverse events occurred after ASNCL. MFNS premedication reduced both tryptase and ECP levels only in children with latex allergy. ASNCL is a simple, reliable and useful tool to make or confirm the diagnosis of nasal symptoms due to latex; it allows us to study both clinical symptoms and local immunological changes. MFNS premedication before an ASNCL may prevent some immunological responses induced by ASNCL without clinical allergic modifications.
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Affiliation(s)
- R Bernardini
- Pediatric Allergy and Pulmonology Center, Department of Pediatrics, University of Florence, Anna Meyer Children's Hospital, Via Luca Giordano 13, Florence, Italy.
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Abstract
Systemic acute rhinosinusitis therapy consists mostly of antibiotic treatment because pathogens play a major role. Amoxicillin is the drug of choice for treatment of acute rhinosinusitis, with second- and third- generation cephalosporins, azythromycin, clarithromycin, and telithromycin as possible options, especially in the case of allergy to amoxicillin. If the clinical course suggests that an anaerobic pathogen is more likely, clindamycin or metronidazole can be considered in combination with a broad-spectrum drug. In antimicrobial treatment of chronic sinusitis there is no consensus on treatment length, organism coverage, or which antibiotics are most effective because the bacteriology is variable with polymicrobial anaerobic and aerobic organisms present. Adjuvant therapies need to be proven by additional studies. Chronic rhinosinusitis is heterogeneous and treatment should vary according to the causative factor involved. Short courses of systemic steroids have been found very useful to decrease mucosal swelling and inflammation in chronic rhinosinusitis. However, no randomized controlled studies have been performed to validate their efficacy in children. A variety of other agents are used in the treatment of chronic rhinosinusitis including antihistamines, decongestants, and leukotriene modifiers. To date, there is no good evidence from randomized controlled studies to support the use of any of these agents in the treatment of this disease in either children or adults.
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Affiliation(s)
- E Novembre
- Allergy and Clinical Immunology Unit, Anna Meyer Children's Hospital, Department of Pediatrics, University of Florence, Italy.
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25
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Novembre E, Cianferoni A, Mori F, Calogero C, Bernardini R, Di Grande L, Pucci N, Azzari C, Vierucci A. Urticaria and urticaria related skin condition/disease in children. Eur Ann Allergy Clin Immunol 2007; 39:253-258. [PMID: 18237002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Marcucci F, Passalacqua G, Canonica GW, Frati F, Salvatori S, Di cara G, Petrini I, Bernini M, Novembre E, Bernardini R, Incorvaia C, Sensi LG. Lower airway inflammation before and after house dust mite nasal challenge: an age and allergen exposure-related phenomenon. Respir Med 2007; 101:1600-8. [PMID: 17482451 DOI: 10.1016/j.rmed.2006.06.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2005] [Revised: 06/05/2006] [Accepted: 06/09/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND Upper and lower airways allergic disease is currently considered unitarily. Allergic inflammation in one site can extend to other sites of the respiratory tract. OBJECTIVE To evaluate bronchial inflammation before and after allergen-specific nasal challenge (ASNC) in rhinitic and asthmatic children, considering the different levels of allergen exposure, i.e. summer (low) and winter (high). METHODS Fourteen children with rhinitis and 15 with rhinitis and asthma, all monosensitized to mites and 10 healthy controls were studied. Nasal IgE were measured before ASNC in summer and in winter season. Nasal clinical score, eosinophil cationic protein (ECP), nasal tryptase, bronchial clinical score, FEV(1), PEF, sputum ECP, sputum tryptase and exhaled nitric oxide (eNO) were evaluated before and after ASNC in summer and winter season. RESULTS Nasal scores significantly increased after ASNC in rhinitic and asthmatic children in both seasons. Nasal IgE were significantly higher in summer compared to winter. Bronchial symptoms, FEV(1) and PEF showed no mean differences in rhinitic and asthmatic children after ASNC, with an increase of bronchial symptoms and a decrease of FEV(1) and PEF occurring in 3/15 asthmatic children. In both groups nasal tryptase and ECP after ASNC significantly increased in summer and winter, while sputum tryptase was undetectable before or after ASNC in both groups. Sputum ECP and eNO at baseline were significantly higher in patients than in controls (summer P=0.002, winter P=0.001). Sputum ECP significantly increased after ASNC in 3/15 asthmatics in summer and in 11/15 in winter, as well as in 3/14 rhinitics in summer and in 4/14 in winter. eNO significantly increased after ASNC in 3/15 asthmatics in summer and in 10/15 in winter, and in 1/14 rhinitics in summer and in 4/14 in winter. A significant median increase of sputum ECP (P=0.0007) and eNO (P=0.0012) after ASNC in asthmatic and of eNO (P=0.013) in rhinitic children was also found in winter. CONCLUSIONS Basal sputum ECP and eNO values, significantly higher before ASNC in rhinitic patients compared to control subjects, confirm the inflammatory link of upper and lower airways. The more frequent detection of inflammatory changes induced by ASNC in winter suggests that allergen exposure favours the transfer of nasal inflammation to lower airways.
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Affiliation(s)
- F Marcucci
- Department of Obstetric, Gynaecologic, Pediatric Sciences, University of Perugia, Policlinico Monteluce, Via Brunamonti, 06122 Perugia, Italy.
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Novembre E, Mori F, Arcangeli F, Cianferoni A, Bernardini R, Pucci N, Annunziato F, Parronchi P, De Martino M, Vierucci A. High intracytoplasmatic levels of Il-4 and Il-5 in a patient with Gleichs syndrome: case report. Int J Immunopathol Pharmacol 2007; 19:935-8. [PMID: 17166416 DOI: 10.1177/039463200601900425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Gleichs syndrome is characterized by recurrent localized angioedema, hypereosinophilia, elevated levels of IgM, rapid weight gain, itchy urticaria and fever. Little is known about the pathogenesis of this disease. Increased serum levels for IL5, IL6 and C5a have been reported before and during clinical exacerbations. In order to better understand the role of the T cells in Gleichs syndrome we analyzed the intracellular cytokine expression in CD3+ cells of a patient affected by the disease. As hypereosinophilia was documented, we asked whether IL-4 and IL-5 levels were increased, and the intracytoplasmatic expression of these Th2-cytokines was determined. The percentage of T lymphocytes (CD3-gated cells) of both CD8- and CD8+ phenotype expressing different cytokines showed an unusually high percentage of Th2-related cytokine (IL-4, IL-5 and IL-13) expressing T lymphocytes. The two new variants (myeloproliferative and lymphoproliferative) seem to account for hypereosinophilia in patients with hypereosinophilic syndrome (HES). In the lymphroliferative variant, the presence of a clonal CD3-CD4+ Th2 like lymphocyte secreting IL-4 and IL-5 in peripheral blood, may explain the hypereosinophilia and the hyper-IgE. In our study we show that the patient had a lymphoproliferative variant and her T cell had a Th2 type phenotype. Moreover, we suggest that Th2 lymphocytes may play a role in the pathogenesis of Gleichs syndrome. Further studies are needed to evaluate the possibility that a polyclonal aspecific activation of Th2 type cells can lead to hypereosinophilia, IgE production and the other manifestations typical of Gleichs syndrome.
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Ciprandi G, Agostinis F, Amoroso S, Ariano R, Barbato A, Bassi M, Cadario G, Campi P, Cardinale F, Romano C, Incorvaia C, Danneo R, Dal Bo S, Di Gioacchino M, Fiocchi A, Galimberti M, Galli E, Giovannini M, La Grutta S, Lombardi C, Marcucci F, Marseglia GL, Mastrandrea F, Minelli M, Nettis E, Novembre E, Ortolani C, Pajno G, Piras PP, Passalacqua G, Patriarca G, Pucci S, Quercia O, Romano A, Schiavino D, Sforza M, Tosca MA, Tripodi S, Zambito M, Puccinelli P, Frati F. Economic evaluation of sublingual immunotherapy: an analysis of literature. Eur Ann Allergy Clin Immunol 2007; 39 Spec No:21-26. [PMID: 18924463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Allergic rhinitis and asthma constitute a global health problem because of their very high prevalence and the consequent burden of disease, concerning medical and economical issues. Among the treatments of allergy, specific immunotherapy has the capacity to favourably alter the natural history of the disease both during and after its performance and thus to reduce the direct and indirect costs of allergic rhinitis and asthma. A number of studies reported such cost reduction for traditional, subcutaneous immunotherapy and recent data demonstrate that also sublingual immunotherapy (SLIT) is associated to economic advantages and/or monetary savings, specifically in terms of reduction of disease economic burden. Only few formal economic assessments of SLIT have been carried out so far, this article will present and discuss the published studies addressed to this issue. The data obtained, although the number of studies is still limited, provide preliminary evidence supporting a SLIT effect on sparing costs for respiratory allergy.
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Affiliation(s)
- G Ciprandi
- Dipartimento di malattie immuno-allergologiche, Semeiotica medica I, Ospedale Universitario S. Martino, Genoa, Italy
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Incorvaia C, Agostinis F, Amoroso S, Ariano R, Barbato A, Bassi M, Cadario G, Campi P, Cardinale F, Romano C, Ciprandi G, D'Anneo R, Dal Bo S, Di Gioacchino M, Fiocchi A, Galimberti M, Galli E, Giovannini M, La Grutta S, Lombardi C, Marcucci F, Marseglia GL, Mastrandrea F, Minelli M, Nettis E, Novembre E, Ortolani C, Pajno G, Piras PP, Passalacqua G, Patriarca G, Pucci S, Quercia O, Romano A, Schiavino D, Sforza M, Tosca MA, Tripodi S, Zambito M, Puccinelli P, Frati F. Pharmacoeconomics of subcutaneous allergen immunotherapy. Eur Ann Allergy Clin Immunol 2007; 39 Spec No:17-20. [PMID: 18924462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The current burden of allergic diseases, estimated by both direct and indirect costs, is very relevant. In fact the cost estimation for rhinitis amount globally to 4-10 billion dollars/year in the U.S. and to an average annual cost of 1089 euros per child/adolescent and 1543 euros per adult in Europe. The estimated annual costs in Northern America for asthma amounted to 14 billion dollars. Consequently, preventive strategies aimed at reducing the clinical severity of allergy are potentially able to reduce its costs. Among them, specific immunotherapy (SIT) joins to the preventive capacity the carryover effect once treatment is discontinued. A number of studies, mainly conducted in the US and Germany demonstrated a favourable cost-benefit balance. In the nineties, most surveys on patients with allergic rhinitis and asthma reported significant reductions of the direct and indirect costs in subjects treated with SIT compared to those treated with symptomatic drugs. This is fully confirmed in recent studies conducted in European countries: in Denmark the direct cost per patient/year of the standard care was more than halved following SIT; in Italy a study on Parietaria allergic patients demonstrated a significant difference in favor of SIT plus drug treatment for three years versus drug treatment alone, with a cost reduction starting from the 2nd year and increasing to 48% at the 3rd year, with a highly statistical significance which was maintained up to the 6th year, i.e. 3 years after stopping immunotherapy, corresponding to a net saving for each patient at the final evaluation of 623 euros per year; in France a cost/efficacy analysis comparing SIT and current symptomatic treatment in adults and children with dust mite and pollen allergy showed remarkable savings with SIT for both allergies in adults and children.
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Affiliation(s)
- C Incorvaia
- Allergologia, Istituti Clinici di Perfezionamento, Milan, Italy
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Ortolani C, Agostinis F, Amoroso S, Ariano R, Barbato A, Bassi M, Cadario G, Campi P, Cardinale F, Ciprandi G, D'Anneo R, Di Gioacchino M, Di Rienzo V, Fiocchi A, Galimberti M, Galli E, Giovannini M, Incorvaia C, La Grutta S, Lombardi C, Marcucci F, Marseglia G, Minelli M, Musarra A, Nettis E, Novembre E, Pajno G, Patriarca G, Pezzuto F, Piras P, Pucci S, Romano A, Romano C, Quercia O, Scala G, Schiavino D, Senna G, Sforza G, Tosca M, Tripodi S, Frati F. Practice parameters for sublingual immunotherapy. Monaldi Arch Chest Dis 2006; 65:44-6. [PMID: 16700194 DOI: 10.4081/monaldi.2006.586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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).
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Affiliation(s)
- C Ortolani
- Casa di Cura Ambrosiana, Cesano Boscone, Milan, Italy
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Bernardini R, Mistrello G, Novembre E, Roncarolo D, Zanotta S, Lombardi E, Cianferoni A, Pucci N, De Martino M, Vierucci A. Cross-reactivity between IgE-binding proteins from Anisakis simplex and Dermatophagoides pteronyssinus. Int J Immunopathol Pharmacol 2006; 18:671-5. [PMID: 16388714 DOI: 10.1177/039463200501800408] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
An association was found between Anisakis simplex (As) and Dermatophagoides pteronyssinus (Dp) sensitization. One recent study shows a cross-reactivity between As and Dp and tropomyosin (tr)is suspected as being one of the proteins responsible of this cross-reaction. The aim of our study was: 1) to confirm the cross-reactivity between Dp and As; 2) to determine the importance of tr in this cross reaction. SDS-PAGE analysis of Dp and As (metabolic and somatic) extracts was carried out. Then an IgE immunoblotting test using serum from a patient who had specific IgE only to Dp and As and immunoblotting inhibition experiments using Dp extract and tr as inhibitors were performed. We found that patients serum reacted: 1) against larval As antigens with a molecular weight (mw) of 25 kilodalton (kD) and a mw > than 100 kD, 2) against various metabolic As antigens with a mw > than 100 kD, a mw ranging approximately from 35 to 50 kD, and a mw around 20 kD, and 3) against Dp proteins with mw between 35 and 55 kD. Preincubation of patient's serum with Dp extract caused the disappearance of reactivity against antigens with a mw > than 100 kD in both larval and metabolic As extracts and against proteins with mw ranging approximately from 35 to 50 kD in the metabolic As extract. Preincubation of patients serum with As extract caused the disappearance of reactivity against antigens with mw between 35 and 55 kD in the Dp extract. Pre-incubation of patients serum with tr did not induce any change in the immunoblotting profile. The results show that 1) cross-reactive components between Dp and As are some proteins with a mw ranging approximately from 35 to 50 kD and with a mw > than 100 kD, and 2) tr is not involved in cross-reactivity between As and Dp.
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Affiliation(s)
- R Bernardini
- Pediatric Allergy and Pulmonary Center, Anna Meyer Children's Hospital, Department of Pediatrics, University of Florence, Italy.
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Novembre E, Caparrelli C, Mori F, Calogero C, Vierucci A, De Martino M. Casein As An “Hidden” Allergen In Manufactured Foods. J Allergy Clin Immunol 2006. [DOI: 10.1016/j.jaci.2005.12.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Marcucci F, Frati F, Sensi L, Cara GD, Novembre E, Bernardini R, Canonica GW, Passalacqua G. Evaluation of food-pollen cross-reactivity by nose-mouth cross-challenge in pollinosis with oral allergy syndrome. Allergy 2005; 60:501-5. [PMID: 15727583 DOI: 10.1111/j.1398-9995.2004.00679.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Oral allergy syndrome (OAS) is often associated with pollen-induced rhinitis, and there are preferential associations between causative substances. If OAS and rhinitis are both immunoglobulin (Ig)E-mediated and there are cross-reacting proteins, it is expected that similar reactions can be elicited in the nose and mouth. In order to test this hypothesis we performed a series of 'cross-challenges' with foods and pollens in both the nose and the mouth. METHODS Nine patients with ascertained OAS due to vegetables and rhinitis due to pollens were studied. On the first day a nasal challenge with pollen extracts and an oral challenge with fresh food was carried out. After a week, washout nasal challenge with food and an oral challenge with pollens were performed. Immediate symptoms, mucosal tryptase and soluble eosinophil cationic protein (ECP) were assessed after each challenge. RESULTS The administration of pollen into the nose and food into the mouth elicited symptoms as expected, but the cross-challenge had no clinical effect. In parallel, tryptase and ECP increased after nasal challenge with pollens, whereas foods did not elicit a measurable response. CONCLUSION The cross-reactivity between foods and pollens, when evaluated at the shock organ, was not clinically evident. This data can be explained with a low concentration of cross-reagent epitopes in pollen extracts and food homogenized because of degradation. The different behaviour upon challenge suggests that different immunological mechanisms may act in the nose and mouth.
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Affiliation(s)
- F Marcucci
- Clinica Pediatrica, University of Perugia, Perugia, Italy
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Pucci N, Novembre E, Cammarata MG, Bernardini R, Monaco MG, Calogero C, Vierucci A. Scoring atopic dermatitis in infants and young children: distinctive features of the SCORAD index. Allergy 2005; 60:113-6. [PMID: 15575941 DOI: 10.1111/j.1398-9995.2004.00622.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) affects infants, children, and adults with a wide degree of severity; several scoring systems have been used in trials and clinical practice. Infants and young children have a typical distribution of the lesions, but a correlation among skin surface involvement, intensity and subjective symptoms has not been reported in age groups. AIMS OF THE STUDY To evaluate the clinical features of AD in infants and young children, by using the SCORAD index. A simplified scoring method for clinical practice is also discussed. METHODS The SCORAD index was assessed in 63 infants and young children with AD [mean age (+/-SD) 17.5 +/- 11.15 months]; the single parameters of the index were evaluated, and compared with each other. Serum eosinophil cationic protein (s-ECP) and urinary eosinophil protein X (u-EPX) levels were determined and correlated with the SCORAD index. RESULTS The presence of erythema, edema/papulation, and oozing/crust was significantly high in these patients. A strong positive correlation resulted among the three SCORAD index parameters (extent-intensity: P <0.001; extent-subjective symptoms: P <0.001; intensity-subjective symptoms: P <0.001). S-ECP and u-EPX levels positively correlated to almost every single parameter of the SCORAD index as well as to its total. CONCLUSIONS Distinctive intensity items were found in infants and young children with AD. A strong correlation resulted among the extent, intensity, and subjective symptoms; each of the three parameters was positively correlated with the total SCORAD. Immunologic parameters positively correlated to each of the SCORAD index items, which remains the gold standard for assessing disease severity in clinical trials.
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Affiliation(s)
- N Pucci
- Allergy and Clinical Immunology Unit, Department of Paediatrics, Anna Meyer Children's Hospital, University of Florence, Florence, Italy
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Marcucci F, Sensi L, Frati F, Bernardini R, Novembre E, Barbato A, Pecora S. Effects on inflammation parameters of a double-blind, placebo controlled one-year course of SLIT in children monosensitized to mites. Allergy 2003; 58:657-62. [PMID: 12823127 DOI: 10.1034/j.1398-9995.2003.00193.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Clinical documentation about effects on local markers of inflammation of sublingual immunotherapy (SLIT) in children is still poor. METHODS Twenty-four children (age range 4-16 years, average 8.5 years) monosensitized to house dust mites (HDMs) were randomized to receive active or placebo SLIT for this allergen according to a double-blind, placebo-controlled design. Before treatment and 10-12 months later the following parameters were checked: ECP and tryptase in sputum and nasal secretion, serum and nasal mite-specific IgE (sIgE), allergen-specific nasal challenge test (sNCT), nasal symptoms and tryptase after sNCT. RESULTS Nasal tryptase and nasal IgE in basal conditions were unchanged in treated children but significantly increased in untreated children (P = 0.0156 and P = 0.0313, respectively). The threshold for sNCT was unchanged in both groups of children, but the symptom score after sNCT was unchanged in the placebo group and significantly decreased in the active group (P = 0.0084). The nasal tryptase after sNCT was unchanged in the active group and significantly increased in the placebo group (P = 0.0218). Intergroup comparison showed a significant difference in oral tryptase and nasal tryptase after sNCT in favour of the active group. CONCLUSIONS These interim results after only 1 year of treatment show that SLIT in children monosensitized to HDMs is able to avoid the spontaneous increase in both nasal sIgE antibodies and in local allergic inflammation in basal conditions. These outcomes are confirmed and supported by the decrease of symptoms in the active group combined with the increase of nasal tryptase only in the control group in both cases after sNCT.
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Affiliation(s)
- F Marcucci
- Clinica Pediatrica, University of Perugia, Perugia, Italy
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Pucci N, Novembre E, Lombardi E, Cianferoni A, Bernardini R, Massai C, Caputo R, Campa L, Vierucci A. Atopy and serum eosinophil cationic protein in 110 white children with vernal keratoconjunctivitis: differences between tarsal and limbal forms. Clin Exp Allergy 2003; 33:325-30. [PMID: 12614446 DOI: 10.1046/j.1365-2222.2003.01538.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND A predominance of Th2 response has been suggested in vernal keratoconjunctivitis (VKC), and a high prevalence of IgE-sensitized (IgE-S) patients has been reported (positive skin prick test or serum-specific-IgE). Palpebral and bulbar VKC are considered to be expressions of the same disease and only occasional racial and histopathological differences are described between the two forms. Tear levels of eosinophil cationic proteins have been correlated with the severity of ocular symptoms; however, there is no published study that demonstrates the presence of serum markers of disease activity. OBJECTIVE This study was performed to evaluate the prevalence of IgE-sensitization in palpebral, bulbar and mixed VKC and to determine possible useful markers of disease activity in peripheral circulation. METHODS A total of 110 white VKC patients (mean age 8.3 years, range 3.2-18 years) were evaluated for ocular score in the active phase of the disease. Skin prick tests and serum-specific IgE for common allergens, serum-total IgE, peripheral blood eosinophil counts (PBECs) and serum eosinophil cationic protein (s-ECP) were determined. Fifteen age-matched non-IgE-S control children underwent the same determinations. RESULTS s-ECP, PBECs and s-total IgE were significantly higher in IgE-S than in non-IgE-S VKC patients and in non-IgE-S VKC patients than in controls. A lower prevalence of IgE-S patients was found in bulbar vs. tarsal (P = 0. 050) or mixed forms (P = 0.002). The score of giant papillae was strongly correlated with s-ECP levels (P < 0.001) and with PBECs (P = 0.001). CONCLUSIONS Our data suggest that an overall eosinophilic response is present in VKC independently of IgE-sensitization; bulbar forms, unlike tarsal and mixed forms, were associated with a low prevalence of IgE-sensitization. Serum ECP was a useful marker of disease activity in tarsal and mixed forms.
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Affiliation(s)
- N Pucci
- Allergy and Clinical Immunology Unit, Anna Meyer Children's Hospital, Department of Paediatrics, University of Florence, Via Luca Giordano 13, 50132 Florence, Italy.
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Marcucci F, Canonica G, Frati F, Sensi L, Riccio A, Garzi A, Tanganelli P, Novembre E, Bernardini R, Passalacqua G. Food-pollen cross-reactivity in oral allergy syndrome and rhinitis. J Allergy Clin Immunol 2003. [DOI: 10.1016/s0091-6749(03)80293-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cianferoni A, Novembre E, Bernardini R, Pucci N, Lombardi E, Vierucci A. Clinical features of anaphylaxis in children: 7 years' followup of 46 cases. J Allergy Clin Immunol 2003. [DOI: 10.1016/s0091-6749(03)80288-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cattaneo A, Ballabio C, Bernardini R, Bertelli AAE, Novembre E, Vierucci A, Restani P. Assessment of residual immunoreactivity in red or white wines clarified with pea or lupin extracts. Int J Tissue React 2003; 25:159-65. [PMID: 15244321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Vegetable proteins could be a suitable alternative to animal proteins in the clarification of wine, but their residues could represent a risk for subjects with food allergy or intolerance. The aim of this study was to investigate the presence of specific immunoreactivity in red and white wines treated, as must or wine, with vegetable proteins in the clarification process. The proteins considered were prepared from lupins and peas, which are not included among the allergens listed in annex Illbis of Directive 2003/89/EC. The presence of residual immunoreactivity to specific rabbit anti-lupin and anti-pea polyclonal antibodies in treated wines was assessed by electrophoresis (SDS-PAGE) and immunoblotting. Residual protein was not detectable in red wines clarified with lupin, pea or a mixture of pea and lupin proteins or in white wines clarified with pea proteins. A small number of musts treated with lupin or pea proteins and white wines treated with lupin proteins yielded equivocal results, probably because of the presence of interfering material (e.g., sugar-rich proteins from grape and yeast). The use of bentonite as a secondary clarifying agent is therefore recommended since its combination with vegetable proteins is particularly effective in removing overall protein immunoreactivity.
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Affiliation(s)
- A Cattaneo
- Department of Pharmacological Sciences, University of Milan, Italy
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Affiliation(s)
- E Novembre
- Az Osp A Meyer, V Luca Giordano, 13, 50132 Florence, Italy.
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41
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Affiliation(s)
- E Novembre
- The Pediatric Allergy Center, University of Florence, Via Luca Giordano 13, 50132, Florence, Italy.
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Falcini F, Simonini G, Battini ML, Franchi A, Novembre E, Cimaz R. Lipophagic granulomatous panniculitis misdiagnosed as purpura in an 8-year old girl. Clin Exp Rheumatol 2002; 20:432. [PMID: 12102487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Marcucci F, Sensi L, Caffarelli C, Cavagni G, Bernardini R, Tiri A, Riva G, Novembre E. Low-dose local nasal immunotherapy in children with perennial allergic rhinitis due to Dermatophagoides. Allergy 2002. [DOI: 10.1046/j.0105-4538.2001.00001.x-i3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Marcucci F, Sensi LG, Caffarelli C, Cavagni G, Bernardini R, Tiri A, Riva G, Novembre E. Low-dose local nasal immunotherapy in children with perennial allergic rhinitis due to Dermatophagoides. Allergy 2002; 57:23-8. [PMID: 11991284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Allergen specific immunotherapy was known to be useful in the treatment of respiratory allergic disease. Local nasal immunotherapy (LNIT) offers advantages such as a good efficacy/safety ratio and a more convenient allergen delivery. The aim of this study was to assess the safety and clinical efficacy of a modified scheduling of LNIT in 32 children with allergic rhinitis due to Dermatophagoides. METHODS A multicentre, randomized, double-blind placebo controlled study carried out for two years, with a modified schedule of LNIT treatment: a build-up phase at increasing dosages from 2.5 AU to 80 AU and a maintenance period at low dosage (80 AU) once a week. Symptom and medication scores. threshold dose with specific nasal provocation test (NPT) and immunological parameters (IgE and IgG4) were evaluated. RESULTS No important local or systemic side-effects were observed in children who completed the study. Compared to placebo, the active treatment group showed significant improvement in rhinitis symptoms and a reduction of drug consumption after 18 months of LNIT. These results were confirmed by a significant reduction of allergen specific nasal reactivity. Serum and nasal specific IgE and IgG4 did not show any difference in the two groups. CONCLUSIONS The safety and clinical efficacy of low-dose LNIT suggests that this therapy may be useful in the treatment of allergic rhinitis disease in children.
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Affiliation(s)
- F Marcucci
- Pediatric Department, Istituto di Pediatria, Università degli Studi di Perugia, Italy
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Marcucci F, Sensi L, Caffarelli C, Cavagni G, Bernardini R, Tiri A, Riva G, Novembre E. Low-dose local nasal immunotherapy in children with perennial allergic rhinitis due to Dermatophagoides. Allergy 2002. [DOI: 10.1034/j.1398-9995.2002.13149.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
BACKGROUND A high prevalence of TT virus (TTV) infection has been found in patients who received blood or blood components. Viral DNA was demonstrated in commercial preparations of FVIII and F IX, but very few data have been reported on immunoglobulins. The risk of TTV infection associated with intramuscular or IV immunoglobulin administration is unclear. STUDY DESIGN AND METHODS The prevalence of TTV infection in a group of patients undergoing lifelong therapy because of congenital immunodeficiency has been evaluated in a long term follow-up (median, 6 years). Seventeen patients with congenital immunodeficiency receiving monthly administration of IVIG were included in the study. TTV DNA was repeatedly evaluated by PCR in serum samples from each patient during the follow-up. Research of antibodies against TTV was not applicable, as the patients studied were unable to produce antibodies. The presence of TTV was also evaluated in 15 IVIG lots. RESULTS The total amount of immunoglobulin administered was 18,773 g. TTV infection was not found in any patients included in the study. None of the 15 immunoglobulin preparations analyzed was found positive for TTV DNA. CONCLUSION Despite the high prevalence of TTV in blood donors, commercial immunoglobulins are safe and unable to transmit TTV.
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Affiliation(s)
- C Azzari
- Pediatric Clinic III, University of Florence, and the A. Meyer Pediatric Hospital, Florence, Italy.
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Lombardi E, Sly PD, Concutelli G, Novembre E, Veneruso G, Frongia G, Bernardini R, Vierucci A. Reference values of interrupter respiratory resistance in healthy preschool white children. Thorax 2001. [DOI: 10.1136/thx.56.9.691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUNDInterrupter respiratory resistance (Rint) is reported to be useful in evaluating lung function in poorly collaborating patients. However, no reference values are available from large samples of preschool children using the standard interrupter method. The aim of this study was to define reference Rint values in a population of healthy preschool children.METHODSRint was assessed without supporting the cheeks in children with no history of wheeze from six kindergartens. To evaluate the effects of upper airway compliance on Rint in healthy children, an additional group of preschool children with either no history of wheeze or no respiratory symptoms at the time of testing underwent Rint measurements in our lung function laboratory with and without supporting the cheeks. Short term (about 1 minute apart) and long term (mean 2.5 months apart) repeatability of Rint measurements (2 SDs of the mean paired difference between measurements) was also assessed in children referred for cough or wheeze.RESULTSA total of 284 healthy white children (age range 3.0–6.4 years) were evaluated. Mean inspiratory and expiratory Rint (Rinti and Rinte) did not differ significantly in boys and girls. Age, height, and weight showed a significant inverse correlation with both Rinti and Rinte in the univariate analysis with linear regression. Multiple regression with age, height, and weight as the independent variables showed that all three variables were significantly and independently correlated with Rinti, whereas only height was significantly and independently correlated with Rinte. Supporting the cheeks had no significant effect on Rinti (n=29, median 0.673 v0.660 kPa/l.s, p=0.098) or Rinte (n=39, median 0.702v 0.713 kPa/l.s, p=0.126). Short term repeatability was 0.202 kPa/l.s for Rinti (n=50) and 0.242 kPa/l.s for Rinte (n=69). Long term repeatability was 0.208 kPa/l.s for Rinte (n=26).CONCLUSIONSWe have reported reference Rint values in preschool white children and have demonstrated the usefulness of this technique in assessing lung function in this age group.
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Lombardi E, Sly PD, Concutelli G, Novembre E, Veneruso G, Frongia G, Bernardini R, Vierucci A. Reference values of interrupter respiratory resistance in healthy preschool white children. Thorax 2001; 56:691-5. [PMID: 11514689 PMCID: PMC1746135 DOI: 10.1136/thorax.56.9.691] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Interrupter respiratory resistance (Rint) is reported to be useful in evaluating lung function in poorly collaborating patients. However, no reference values are available from large samples of preschool children using the standard interrupter method. The aim of this study was to define reference Rint values in a population of healthy preschool children. METHODS Rint was assessed without supporting the cheeks in children with no history of wheeze from six kindergartens. To evaluate the effects of upper airway compliance on Rint in healthy children, an additional group of preschool children with either no history of wheeze or no respiratory symptoms at the time of testing underwent Rint measurements in our lung function laboratory with and without supporting the cheeks. Short term (about 1 minute apart) and long term (mean 2.5 months apart) repeatability of Rint measurements (2 SDs of the mean paired difference between measurements) was also assessed in children referred for cough or wheeze. RESULTS A total of 284 healthy white children (age range 3.0-6.4 years) were evaluated. Mean inspiratory and expiratory Rint (RintI and RintE) did not differ significantly in boys and girls. Age, height, and weight showed a significant inverse correlation with both RintI and RintE in the univariate analysis with linear regression. Multiple regression with age, height, and weight as the independent variables showed that all three variables were significantly and independently correlated with RintI, whereas only height was significantly and independently correlated with RintE. Supporting the cheeks had no significant effect on RintI (n=29, median 0.673 v 0.660 kPa/l.s, p=0.098) or RintE (n=39, median 0.702 v 0.713 kPa/l.s, p=0.126). Short term repeatability was 0.202 kPa/l.s for RintI (n=50) and 0.242 kPa/l.s for RintE (n=69). Long term repeatability was 0.208 kPa/l.s for RintE (n=26). CONCLUSIONS We have reported reference Rint values in preschool white children and have demonstrated the usefulness of this technique in assessing lung function in this age group.
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Affiliation(s)
- E Lombardi
- Paediatric Allergy and Pulmonology Centre, "Anna Meyer" Children's Hospital, Department of Paediatrics, University of Florence, 50132 Florence, Italy.
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Abstract
Adverse reactions to cow's milk proteins are usually indicated as cow's milk allergy/intolerance (CMPA/CMPI) because no differentiation is possible on the basis of symptoms, and there is no reliable single laboratory test available for the diagnosis of CMPA or CMPI. Elimination and challenge tests for cow's milk proteins using strict, well-defined diagnostic criteria are required for the diagnosis of CMPA/CMPI. Atopic dermatitis (AD) is one of the most common symptoms of CMPA/CMPI. Approximately one third of AD children have a diagnosis of CMPA/CMPI according to elimination diet and challenge tests, and about 40-50% of children < 1 year of age with CMPA/CMPI have AD. Many children with AD and CMPA/CMPI develop a complete tolerance to CMP in a few years. Children with persisting forms of CMPA/CMPI have a more frequent history of familial atopic disease, change in CMPA/CMPI manifestations over time and very high frequency of multiple food intolerance and allergic diseases. Many children who outgrow their AD develop other allergic diseases, such as rhinitis or asthma. The simultaneous development of allergic tolerance in one organ and the intolerance or atopic disease in another organ suggest that genetic, immunologic and environmental factors play a complex role in the natural history of AD and other atopic diseases.
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Affiliation(s)
- E Novembre
- Centro di Allergologia, Clinica Pediatrica III - Azienda Meyer, Florence, Itlay.
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Cianferoni A, Novembre E, Mugnaini L, Lombardi E, Bernardini R, Pucci N, Vierucci A. Clinical features of acute anaphylaxis in patients admitted to a university hospital: an 11-year retrospective review (1985-1996). Ann Allergy Asthma Immunol 2001; 87:27-32. [PMID: 11476457 DOI: 10.1016/s1081-1206(10)62318-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although anaphylaxis is considered a life-threatening event, there is a lack of information on the clinical characteristics at presentation, both in adults and in children. OBJECTIVE To describe in a nonselected population the clinical characteristics and the treatments of acute anaphylaxis triggered by different agents. METHODS This is a retrospective review of the clinical features of 113 episodes of acute anaphylaxis resulting in admission to a university hospital. Initially, the 107 patients visited the emergency room and were then admitted to the hospital. RESULTS Most anaphylactic events (63%) occurred at home. The most frequent symptoms involved the respiratory system (78%) and the skin (90%). Drugs, especially nonsteroidal anti-inflammatory drugs and antibiotics, were the most frequent cause of anaphylaxis in adults (49%). Patients with drug-induced anaphylaxis were older and more often had cardiovascular symptoms (hypotension and tachycardia) (P = 0.0064). Hymenoptera venom was the second most frequent cause of anaphylaxis (29%). Most of the patients with hymenoptera venom anaphylaxis were male (80%) and more frequently they had no history of atopy (P = 0.012). In food-induced anaphylaxis, the cardiovascular system was less likely to be involved (P < 0.05) (39%). Seafood seems to be frequently involved in food-induced anaphylaxis in our area. Specific immunotherapy-induced anaphylaxis occurred more often in younger patients (P = 0.032). Epinephrine seems to be underused in Italy (only 15% of patients received it), especially for respiratory symptoms. CONCLUSIONS Anaphylaxis triggered by different agents may have different clinical presentations and may occur in different types of patients. In Italy, the inadequate use of epinephrine for anaphylaxis treatment needs to be publicized to both physicians and the general population.
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Affiliation(s)
- A Cianferoni
- Anna Meyer Children's Hospital, Department of Pediatrics, University of Florence, Italy.
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