Extending the record of bis-γ-pyrone polypropionates from marine pulmonate mollusks

The isolation and structure elucidation of 10 unreported polypropionate metabolites (compounds 6-15), structurally related to either ilikonapyrone (1) or onchidione (3), from two onchidiid pulmonate mollusk species are discussed. Structure elucidation was achieved by NMR spectroscopy and chemical correlation with model compounds. Evaluation of in vitro growth-inhibitory properties in human cancer cells was also carried out on some of the isolated polypropionates including previously reported onchidione metabolites.

Methacholine bronchial challenge effects on nasal symptoms and function in patients with allergic rhinitis

BACKGROUND

Allergic rhinitis and asthma may be associated, bronchial hyperreactivity (BHR) is quite common in AR patients. It has been reported that allergen bronchial challenge induces nasal inflammation. Methacholine (MCH) is a stimulus able to elicit BHR. There is no study that investigated the effect of MCH bronchial challenge on the nose.

OBJECTIVE

The aim of this study was to evaluate whether MCH bronchial challenge is able to induce changes in nasal symptom perception and nasal function in patients with AR.

METHODS

122 patients (117 males, median age 28 years) suffering from AR were evaluated. Values for bronchial function (FVC, FEV1, FEF25-75, and FEV1/FVC ratio), MCH bronchial challenge, VAS for nasal and bronchial symptoms, and nasal airflow and resistance were assessed.

RESULTS

23 patients (18.9%) had BHR. MCH bronchial challenge induced a significant reduction of nasal obstruction perception (p<0.001), but did not affect the nasal function. Most of patients (91) did not perceive impairment of respiration. The perception of nasal obstruction was strongly related to the AR duration (r=0.65). The highest values of both baseline rhinoVAS and Δ bronchial VAS predicted BHR (OR 1.7 and 2.9 respectively).

CONCLUSIONS

The present study demonstrates that in AR patients MCH bronchial challenge does not substantially affect nasal symptoms and function, also in subjects with an acute bronchospasm, such as in BHR patients. However, severity of nasal obstruction perception might predict BHR.

Impaired FEF25-75 values may predict bronchial reversibility in allergic children with rhinitis or asthma

FEV1 is considered an important parameter for asthma diagnosis and follow-up. However, it has been proposed that FEF25-75 could be more sensitive than FEV1 to detect slight airways obstruction. Bronchial reversibility defined by positive response to bronchodilation test. The aim of the present study was to define whether an impaired FEF25-75 value (less than 65 percent of predicted) may be predictive for reversibility in a large cohort of allergic children with rhinitis or asthma. Six hundred allergic children were recruited: 300 with controlled asthma and 300 with allergic rhinitis. All of them were evaluated by performing spirometry, bronchodilation test, and skin prick test. Two predictors were significantly associated with bronchial reversibility: i) an impaired FEF25-75 value (less than 65 percent of predicted), and ii) sensitization to perennial allergens. It was more relevant in children with rhinitis (ORAdj:8.9 and 2.2 respectively). In conclusion, this study, conducted in real life, could suggest that an impaired FEF25-75 value (less than 65 percent of predicted) may be considered a reliable marker of bronchial reversibility, mainly in children with allergic rhinitis.

Impaired FEF25-75 may predict high exhaled nitric oxide values in children with allergic rhinitis and/or asthma

Allergic rhinitis and asthma are closely associated. Inflammation is a common pathological characteristic shared by both disorders. The measure of the fractional concentration of exhaled nitric oxide (FeNO) may be considered a surrogate marker for airway inflammation. Forced expiratory flow between 25 and 75 percent of vital capacity (FEF25-75) has been previously demonstrated to be able to predict BHR and bronchial reversibility. The aim of this study was to evaluate whether impaired FEF25-75 values may be related to FeNO values in a pediatric cohort of allergic subjects. 850 children with allergic rhinitis, allergic asthma, or both, were evaluated. Bronchial function (FEV1, FVC, and FEF25-75), FeNO, and sensitizations were assessed. Bronchial function and FeNO were significantly different in the 3 groups (p less than 0.001). A strong inverse correlation between FeNO and FEV1was found in patients with rhinitis, asthma and asthma with rhinitis (r= -0.72, r=-0.70 and r= -0.70, respectively). Impaired FEF25-75 values (such as less than 65 percent of predicted) were significantly associated with high FeNO levels (such as =34 ppb). In conclusion, this study provided evidence that FEF25-75 is strongly and inversely related with FeNO and FEF25-75 may predict high FeNO levels in children with allergic rhinitis, asthma or both.

Impaired spirometry may suggest sensitization

The present study confirms that sensitization is very frequent in the general population and suggests that impaired FEF25-75 may be a marker of sensitization. Therefore, when spirometry is abnormal, mainly concerning FEF25-75, sensitization should be suspected.

Visual analogue scale assessment of nasal obstruction might define patients candidates to spirometry

BACKGROUND

Asthma may be frequently associated with allergic rhinitis. Bronchial obstruction is a characteristic of asthma and spirometry is a cardinal step in asthma diagnosis. However, spirometry is rarely suitable in medical office. Visual Analogue Scales (VAS) is frequently used in common practice.

OBJECTIVE

This study aimed at evaluating the suitability of the use of VAS assessment of nasal obstruction to define patients with allergic rhinitis candidates for spirometry.

METHODS

1728 patients with allergic rhinitis were consecutively evaluated. Clinical examination, skin prick test, VAS assessment, and spirometry were performed in all patients.

RESULTS

7.9% of patients had impaired FEV1 values and 24.5% had impaired FEF25-75 values. A VAS value < 3.3 might identify with good reliability patients with impaired FEF25-75 values, such as having initial bronchial airflow limitation.

CONCLUSIONS

This study, performed in a large cohort of subjects, highlights the close link between upper and lower airways and shows the possible suitability of the use of nasal obstruction VAS assessment to define patients with allergic rhinitis candidates for spirometry.

Bronchodilation test in patients with allergic rhinitis

BACKGROUND

Allergic rhinitis (AR) may be considered a risk factor for the onset of asthma. Recently, it has been reported that forced expiratory flow between 25% and 75% of vital capacity (FEF₂₅₋₇₅) may predict a positive response to bronchodilation test in asthmatic children. The aim of this study was to evaluate a large group of adult AR patients to investigate the frequency of response to bronchodilation test and FEF₂₅₋₇₅ values.

METHODS

One thousand four hundred and sixty-nine consecutive patients suffering from persistent AR were evaluated. Clinical examination, spirometry, and bronchodilation test were performed in all patients.

RESULTS

In this study, 62.9% of patients had reversibility to bronchodilation test and 17.8% had impaired FEF₂₅₋₇₅ values (≤ 65% of predicted). Impaired FEF₂₅₋₇₅ values associated with longer rhinitis duration may predict reversibility to bronchodilation test (OR = 11.3; P < 0.001). In addition, a FEF₂₅₋₇₅ cutoff value ≤ 71% of predicted may already discriminate patients with reversibility.

CONCLUSIONS

This study highlights that about two-thirds of patients with persistent AR may be considered at risk of becoming asthmatic. This finding should be adequately considered as a precocious spirometry may allow the early detection of patients prone to develop asthma and consequently to treat them.

Rupatadine improves nasal symptoms, airflow and inflammation in patients with persistent allergic rhinitis: a pilot study

Nasal obstruction is the main symptom in patients with allergic rhinitis and may be measured by rhinomanometry. Rupatadine is a new antihistamine with potential antiallergic activities. The aim of this pilot study is to evaluate nasal symptoms, nasal airflow and nasal mediators in patients with persistent allergic rhinitis, before and after treatment with rupatadine. Twenty patients with persistent allergic rhinitis were evaluated, 15 males and 5 females (mean age 35 +/- 9.1 years), all of whom received rupatadine (10 mg/daily) for 3 weeks. Nasal and ocular symptoms (measured by VAS), rhinomanometry, and nasal mediators (ECP and tryptase) were assessed in all subjects before and after treatment. Rupatadine treatment induced significant symptom relief (both nasal and ocular, respectively p=0.005 and p=0.0004), including obstruction (p=0.0015) and significant increase of nasal airflow (p=0.0025). Moreover, there was a significant difference of nasal mediators. In conclusion, this pilot study demonstrates the effectiveness of rupatadine treatment in: i) improving nasal and ocular symptoms, ii) increasing nasal airflow, iii) exerting antiallergic activity in patients with persistent allergic rhinitis. These positive results could explain the effectiveness of rupatadine in the treatment of persistent allergic rhinitis, as reported in a previous study Further controlled studies need to be conducted to confirm these preliminary findings.

Assessment of the bronchodilation test by visual analog scale in the selection of patients with rhinitis for screening spirometry

BACKGROUND

The nose and bronchi are closely linked, and rhinitis often precedes the onset of asthma. Bronchial obstruction is a characteristic of asthma, and demonstration of its reversibility is a key element in diagnosis. However, reversibility testing requires a spirometer, which is rarely available in the doctor's office. Visual analog scales (VAS) are frequently used in daily practice.

OBJECTIVE

This study evaluated the suitability of a VAS for assessing bronchodilation in patients with persistent allergic rhinitis as a means of selecting candidates for screening spirometry.

METHODS

We evaluated 120 patients with moderate to severe persistent allergic rhinitis. All patients underwent a clinical examination, skin prick test, spirometry, bronchodilation test, and VAS.

RESULTS

Patients with rhinitis showed significantly increased forced expiratory volume in the first second (FEV1) after the bronchodilation test (median, 11.5%). Positive results were observed in 60%, and VAS values increased (>30%) after the test. There was a significant relationship between deltaVAS and deltaFEV1 (P<.0001; r=0.482).

CONCLUSION

This preliminary study shows that patients with moderate to severe persistent allergic rhinitis often experience an increase in FEV1 after the bronchodilation test. VAS assessment of the test might be useful when selecting candidates for spirometry for possible bronchial involvement.

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

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

Relationship between Responses to Bronchodilation Testing and to Nasal Decongestion Testing in Patients with Allergic Rhinitis Alone

A remarkable relationship exists between upper and lower airways. Bronchial obstruction is a paramount feature of asthma as well as nasal obstruction of allergic rhinitis (AR). This study aims to evaluate the response to both bronchodilation and decongestion testing and their relationships in a large group of patients with moderate-severe persistent AR alone. Two hundred eleven patients with moderate-severe persistent AR were prospectively and consecutively evaluated. Clinical examination, skin prick test, spirometry, bronchodilation test, rhinomanometry, and decongestion test were performed on all patients. Seventeen subjects (8%) did not respond to any of the tests, 55 subjects (26.1%) were responders only to the decongestion test, 31 (14.7%) only to the bronchodilation test, and 108 subjects (51.2%) responded to both these tests. Longer AR duration was significantly associated with positive response to both tests (p<0.01). In conclusion, this study provides the first evidence that patients with moderate-severe persistent AR may frequently show reversibility to both bronchodilation and decongestion tests.

Impact of allergic rhinitis on asthma: effects on bronchial hyperreactivity

BACKGROUND

Remarkable relationship exists between upper and lower airways. Bronchial hyperreactivity (BHR) is a paramount feature of asthma and may be considered a strong risk factor for the onset of asthma in patients with allergic rhinitis.

OBJECTIVE

This study is aimed at evaluating the presence of BHR in a large group of patients with moderate-severe persistent allergic rhinitis alone, and at investigating possible risk factors related to severe BHR.

METHODS

Three hundred and forty-two patients with moderate-severe persistent allergic rhinitis were prospectively and consecutively evaluated. Clinical examination, skin prick test, spirometry and bronchial methacholine (MCH) test were performed in all patients.

RESULTS

Twenty-two (6.4%) patients had severe BHR, 74 (21.6%) patients had mild BHR and 192 (56.2%) had borderline BHR; 54 (15.8%) patients had a negative MCH test. The logistic regression analysis evidenced that trees and house dust mites sensitization (ORAdj: 8.1), rhinitis duration > 5 years (ORAdj: 5.4) and FEV1 < or = 86% of predicted (ORAdj: 4.0) were significantly associated with severe BHR. The discriminative ability of this model is appreciably satisfactory, being the AUC = 0.90.

CONCLUSION

This study highlights the close link between upper and lower airways and the role of some risk factors, such as tree and mite sensitization, > 5-year duration, and < or = 86% FEV1 values, as risk factors for severe BHR in patients with moderate-severe persistent allergic rhinitis alone. Therefore, BHR is frequently present in patients with chronic rhinitis and should be suspected in the presence of defined risk factors.

Ebastine increases IFN-gamma production in patients with persistent allergic rhinitis

Nasal obstruction is a leading symptom in patients with allergic rhinitis and depends on inflammation characterized by Th2 polarization. Thus, IFN-gamma is typically deficient in allergic patients. It has been previously reported that ebastine is able to reduce Th2-dependent cytokines. The aim of this study is to preliminarily evaluate IFN-gamma production by peripheral blood mononuclear cells (PBMNC) and clinical changes after a treatment with lyophilized ebastine in patients with persistent allergic rhinitis (PER). Ten patients with PER were evaluated, 7 males and 3 females (mean age 32.4 +/- 6.2 years), all of whom received lyophilized ebastine (20 mg/daily) for 3 weeks. Total nasal symptom score (TSS), subjective evaluation score by visual analogue scale (VAS), and rhinomanometry were evaluated in all subjects before and after treatment. IFN-gamma production by peripheral blood mononuclear cells (PBMNC) was evaluated using different stimuli, in un-treated and ebastine-treated allergic patients by ELISPOT. Ebastine treatment induced significant increase of IFN-gamma production stimulated by grasses (p<0.0001) and Dermatophagoides farinae (p=0.0015). This effect was significantly related with TSS and VAS improvement after treatment (p=0.0038 and 0.004 respectively). In conclusion, this preliminary study demonstrates the effectiveness of ebastine treatment in increasing IFN-gamma production. The clinical relevance of this study is that the clinical improvement is related to the immunologic activity.

Impact of allergic rhinitis on asthma: effects on spirometric parameters

BACKGROUND

Close association exists between allergic rhinitis and asthma. Moreover, allergic rhinitis is a strong risk factor for the onset of asthma in adults. This study was aimed at evaluating a large group of patients with moderate-to-severe and persistent allergic rhinitis alone for investigating the presence of spirometric abnormalities and possible risk factors related to it.

METHODS

A total of 392 patients with persistent allergic rhinitis were prospectively and consecutively evaluated. Clinical examination, skin prick test and spirometry were performed in all patients.

RESULTS

There were 24 (6.1%) patients with forced vital capacity (FVC < 80%) of predicted, 50 (12.8%) with forced expiratory volume in the first second (FEV(1) < 80%) of predicted and 341 (87.0%) with forced expiratory flow at 25% and 75% of the pulmonary volume (FEF(25-75)) < 80% of predicted. The logistic regression analysis evidenced that rhinitis duration (OR(Adj): 1.9/year) and sensitization to house dust mites (OR(Adj): 8.2) were significantly associated with impaired values of 2 or 3 spirometric parameters.

CONCLUSION

This study highlights the close link between upper and lower airways and the role of some risk factors, such as duration and mites sensitization, as early prognostic markers of bronchial involvement in patients with moderate-to-severe and persistent allergic rhinitis alone.

Quality of life in allergic rhinitis: relationship with clinical, immunological, and functional aspects

BACKGROUND

The relationship among nasal obstruction, T-helper type 2-dependent inflammation, nasal airflow limitation, and reversibility to the nasal decongestion test has been evidenced in allergic rhinitis (AR). Moreover, quality of life (QoL) has been widely evaluated in AR and its evaluation is considered in numerous trials.

OBJECTIVE

The aim of this cross-sectional study was to identify the QoL as measured by the Quality of Life Questionnaire in a population of patients with AR and to compare it with clinical, immunological, and functional parameters.

METHODS

One hundred and twenty-three patients with persistent AR were prospectively and consecutively evaluated. Clinical evaluation, skin prick test, nasal scraping for cytology, rhinomanometry, decongestion test, and QoL questionnaire were performed in all subjects.

RESULTS

There was a significant relationship among QoL and functional and immunological parameters. Particularly, the multivariate analysis showed that having more than two sensitivities was a determinant of the QoL. The eosinophil count was significantly associated with QoL as well as the baseline nasal flow (mL/s) with the eye symptoms scale only.

CONCLUSIONS

This study provides the first evidence that QoL in AR is strictly associated with allergic inflammation and eye symptoms significantly contribute to impairment of QoL. QoL, moreover, represents an important aspect to consider in managing patients with AR as it has a relationship with clinical, immunological, and functional parameters.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Allergic Subjects Have More Numerous Respiratory Infections and Severe Gastrointestinal Infections Than Non-Allergic Subjects: Preliminary Results

Allergic disorders are characterized by Th2-polarization, thus physiological Th1-dependent mechanisms for fighting infectious diseases (ID) may be defective. This study aims at evaluating the number and duration of respiratory (RI) and gastrointestinal diseases (GI) in allergic and non-allergic subjects in a particular community: the crew of an operative warship consisting of 189 persons (171 males and 18 females). The study period lasted for 5 months during an operative mission. The number and duration (days) of RI and GI were evaluated. Allergic subjects experienced more numerous RI (p=0.0029) and more severe GI (p=0.0001) than non-allergic subjects. This preliminary study provides evidence that allergic subjects may have more numerous RI and prolonged GI than non-allergic subjects.

Screening spirometry to detect respiratory allergy

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A pharmacokinetic interaction study of docetaxel and cisplatin plus or minus 5-fluorouracil in the treatment of patients with recurrent or metastatic solid tumors

BACKGROUND

The purpose of this study was to look at the pharmacokinetics of docetaxel, cisplatin-derived platinum and 5-fluorouracil (5-FU), when used in combination, to exclude potential clinically relevant pharmacokinetic interactions.

METHODS

Fifteen patients with recurrent or metastatic solid tumors were randomized to receive docetaxel 75 mg/m2 and cisplatin 75 mg/m2 in the first treatment course on day 1 and the same combination plus 5-FU 750 mg/m2/day on days 1-5 in the second course, or the two treatment courses in reversed order. Cycles were repeated every 3 weeks. A pharmacokinetic analysis was performed during the first two cycles.

RESULTS

Full pharmacokinetic data was available for 12 of the 15 patients. Treatment was tolerated well, with frequency of toxicity consistent with the safety profile known for docetaxel, cisplatin and 5-FU. Mean clearance values for docetaxel and cisplatin showed no statistically significant difference across the "triple" and the "double" combination treatments, and the mean pharmacokinetic parameters of all agents were within the ranges for previously reported single agent treatment.

CONCLUSION

No clinically relevant pharmacokinetic interactions between docetaxel, cisplatin and 5-FU used in combination were noticed in this study.

Bronchial hyperreactivity and spirometric impairment in patients with allergic rhinitis

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Seasonal and perennial allergic rhinitis: is this classification adherent to real life?

BACKGROUND

Allergic rhinitis is traditionally subdivided into seasonal (SAR) and perennial (PAR), although the new definitions of persistent and intermittent were recently proposed. We assessed the validity of the traditional classification in a large group of subjects suffering from allergic rhinitis alone.

METHODS

Young males referred to a Navy Military Hospital for routine fitness visit, and reporting symptoms of rhinitis alone were selected. According to the sensitization they were subdivided into (i) sensitized to pollens only (seasonal, SAR), (ii) to perennial allergens only (perennial, PAR) and (iii) to both (mixed, MAR). Spirometry, methacholine challenge, severity and characteristics of symptoms were assessed in all participants.

RESULTS

Of 19 325 subjects, 2347 had allergic rhinitis. Seventy-two percent of the subjects had MAR, 17% SAR and 11% PAR. Ocular involvement and irritative symptoms were more frequent in SAR (P < 0.03), whereas obstruction was predominant in PAR (P < 0.01). Nasal symptoms varied according to the period of the year in SAR (P < 0.01) and PAR (P < 0.03). An overt bronchial obstruction was detected in 12% of PAR patients, in 7.8% of MAR, and in 4.2% of SAR. forced expiratory volume/1 s was significantly lower during season in SAR patients only (P < 0.05). The FEF25-75 was impaired in 22.5% MAR patients, 21% PAR, and 14% SAR, with a seasonal change in SAR (P < 0.05) and PAR (P < 0.001). Bronchial hyperreactivity was present in 82.2% of PAR, 73.6% of MAR, and 53.5% of SAR, with a seasonal change in SAR (P < 0.001) and MAR (P < 0.05).

CONCLUSIONS

This study provides evidence that up to 80% of allergic rhinitics have a mixed form, and SAR and PAR definitions are poorly adherent to real life. Lung involvement is frequent in patients reporting nose symptoms alone.

Sublingual specific immunotherapy reduces PBMC proliferations

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Nasal eosinophils correlate with FEV1 in patients with perennial allergic rhinitis associated to asthma

BACKGROUND

Eosinophil inflammation is present in nasal and bronchial mucosa and a clear link between upper and lower airways exists. Our aim was to evaluate whether nasal inflammation correlates with lung function in patients with perennial allergic rhinitis associated with asthma.

METHODS

Eighty perennial allergic rhinitics with mild asthma, aged from 18 to 46 years, were enrolled. Nasal scraping and spirometry were performed in all subjects.

RESULTS

A close relationship between the nasal eosinophil number and the percentage of predicted FEV1 was demonstrated (r = -0.76; p<0.0001). CONCLUSIONS Nasal cytology may be considered a non-invasive tool to assess airway inflammation in mild asthmatics with associated allergic rhinitis.

Levocetirizine improves nasal obstruction and modulates cytokine pattern in patients with seasonal allergic rhinitis: a pilot study

BACKGROUND

Allergic rhinitis is characterized by an IgE-dependent inflammation. Nasal obstruction is related to allergic inflammation. Some antihistamines have been demonstrated to be capable of improving this nasal symptom.

OBJECTIVE

The aim of this pilot study was to evaluate nasal symptoms, nasal airflow, inflammatory cells, and cytokine pattern in patients with seasonal allergic rhinitis (SAR), before and after treatment with levocetirizine, desloratadine, or placebo.

METHODS

Thirty patients with SAR were evaluated, 27 males and three females (mean age 26.9+/-5.4 years). All of them received levocetirizine (5 mg/day), desloratadine (5 mg/day), or placebo for 2 weeks. The study was double-blind, parallel-group, placebo-controlled, and randomized. Total symptom score (TSS) (including: rhinorrhea, nasal itching, sneezing, and nasal obstruction) was assessed before and after treatment. Rhinomanometry, nasal lavage, and nasal scraping were performed in all subjects before and after treatment. Inflammatory cells were counted by conventional staining; IL-4 and IL-8 were measured by immunoassay on fluids recovered from nasal lavage.

RESULTS

Levocetirizine treatment induced significant symptom relief (P=0.0009) and improved nasal airflow (P=0.038). Desloratadine also relieved TSS (P=0.01), but did not affect nasal airflow. Levocetirizine significantly reduced eosinophils (P=0.029), neutrophils (P=0.005), IL-4 (P=0.041), and IL-8 (P=0.02), whereas desloratadine diminished IL-4 only (P=0.044). Placebo treatment did not significantly affect any evaluated parameters.

CONCLUSIONS

This pilot study demonstrates the effectiveness of levocetirizine in: (i) relieving nasal symptoms, (ii) improving nasal airflow, (iii) reducing leucocyte infiltration, and (iv) diminishing cytokine levels. These findings are the first evidence of the effectiveness of levocetirizine in SAR.

Airway function and nasal inflammation in seasonal allergic rhinitis and asthma

BACKGROUND

Allergic rhinitis (AR) and asthma are frequently associated and characterized by a Th2-dependent inflammation. Nasal and bronchial obstruction may be objectively measured.

OBJECTIVE

The aim of this study was to evaluate the relationships among upper and lower airway function and nasal inflammation in subjects with seasonal allergic rhinitis (SAR) and asthma.

METHODS

Twenty out-patients (12 males and eight females, mean age: 23.4+3.6 years) with SAR and asthma were evaluated during the pollen season. All of them showed a moderate-severe grade of nasal obstruction. Total symptom score, rhinomanometry, spirometry, nasal lavage, and nasal scraping were obtained in all subjects. Eosinophils were counted by conventional staining; IL-4 and IFN-gamma were measured by immunoassay on fluids recovered from nasal lavage.

RESULTS

Functional parameters, i.e. nasal airflow and forced expiratory volume in 1 s (FEV(1)), were correlated with nasal eosinophils (R(2)>0.83, P<0.001). Inflammatory parameters, i.e. eosinophils were correlated with immunological parameters, i.e. IL-4 and IFN-gamma levels (R(2)=0.93, P<0.001). Nasal symptoms were correlated with nasal airflow (rho=-0.71, P< or =0.01) and eosinophils (rho=0.72, P<0.01). Nasal airflow was correlated with FEV(1) (r=0.89, P<0.0001).

CONCLUSIONS

This study demonstrates the close connection between Th2 cytokines and eosinophil infiltration in the nose. There is also clear evidence concerning the relationships between eosinophils infiltration and cytokines levels. Nasal eosinophils can be regarded as the most important predictors of upper and lower airway functions. These findings constitute first evidence of a relationship among nasal Th2-related inflammation and nasal and bronchial airflow in patients with SAR and asthma.

Underdiagnosis and undertreatment of asthma: a 9-year study of Italian conscripts

BACKGROUND

During the last 20 years, the epidemiology of asthma has been investigated in various populations, thus providing interesting data including the accuracy of diagnosis and the adequacy of treatment.

METHODS

We studied for 9 years the epidemiological features of asthma in a homogeneous population of 18-year-old males referred to La Spezia Military Navy Hospital for a call-up visit (conscripts).

RESULTS

During the period of 1990-1998, 91,700 men were screened at their call-up visit; out of them 5,371 (7%) had asthma, but in 7.4% the disease had not been previously diagnosed. During the observation period there was a significant decrease of the level III severity of asthma, but about one quarter of the asthmatic subjects received no treatment at all. On the other hand, a significant increase in the prescription of inhaled steroids was observed.

CONCLUSION

Despite educational efforts, a not negligible underdiagnosis and inadequate treatment of asthma in young adults still persist.

Increase of asthma and allergic rhinitis prevalence in young Italian men

Our previous studies have reported that the prevalence of asthma was 2.89% and of allergic rhinitis 1.54% in Ligurian conscripts for the army during 1983. Since several authors reported an increasing prevalence of these diseases in different geographic areas, the aim of the present study was to evaluate the trend of prevalence rates in a same homogeneous group of Ligurian conscripts. The prevalence of asthma and allergic rhinitis was assessed in a group of 4310 young Ligurian men (18 years old) who had undergone medical examination for call-up to the navy during 1993, 1994 and 1995. Subjects were investigated by history, clinic visit, spirometry, metacholine bronchial challenge and skin prick test. The prevalence of asthma is 4.39% and of allergic rhinitis 2.2%. Comparing these results with previous data, a significant increase appears in this area 12 years later (respectively, p < 0.001 and p < 0.006). In addition, the association with asthma in allergic rhinitics increases from 41 to 77%, as well as an increasing trend appears for perennial allergens (i.e. mites and cat) and the polysensitizations increase from 48 to 67%. Possible explanations for these phenomena might be due to environmental factors (i.e. pollutants, viral infections, changes in domestic microenvironment).