Epidemiology of cypress pollen allergy in Montpellier.

BACKGROUND: Cupressaceae pollen allergy is a worldwide winter pollinosis. Exposure to cypress pollen has increased enormously during recent decades, and cypress pollen allergy has become a major health problem, especially in Mediterranean countries. OBJECTIVES: We aimed to evaluate the prevalence of cypress pollen sensitization and allergy in the Montpellier area and the symptoms presented by sensitized patients. METHODS: We included all 6185 consecutive patients who were referred to our center for any allergic disorder during a 36-month period. For each patient, we evaluated skin prick test results, allergy symptoms, pulmonary function test results, and the need for allergen immunotherapy. RESULTS: We found that 20.7% of patients were sensitized to cypress pollen and 46.4% presented symptoms during the pollen season. The main symptoms were rhinoconjunctivitis and asthma. Oral allergy syndrome to peach was detected in 4% of sensitized and symptomatic patients. Allergen immunotherapy was necessary to control symptoms in 57.9% of cases. CONCLUSIONS: Cypress pollen allergy is one of the leading causes of respiratory allergy in the Montpellier area. Symptoms are often severe and include pollen-induced asthma. Moreover,many patients need allergen immunotherapy in order to achieve better control of their symptoms.

An IgE immediate reaction to thiocolchicoside.

Hypersensitivity reactions due to muscle relaxant drugs may be related either to a nonspecific release of allergic mediators or to allergic reactions induced by the molecules themselves. Rare cases of hypersensitivity reactions have been associated to thiocolchicoside, and no case of IgE-mediated immediate reaction has actually been reported to date. We report the first documented case of immediate anaphylaxis to thiocolchicoside.

Adipokines and their role in allergies.

Both allergic disorders and obesity keep increasing in industrialized countries. Even though a strong association between obesity and allergy- related diseases has been reported in several studies, no published data show a scientific and firm link in-between the two conditions. In general, obesity and weight gain have been associated with an increased risk of asthma and allergic rhinitis. Asthma, allergic rhinitis and obesity have a common inflammatory pattern that could therefore justify their association. In fact, the chronic inflammation that characterizes the increase in white adipose tissue typically pushes the immune system toward a Th2 pattern. Such a polarization might, consequentially, worsen a pre-existing allergic disease or even stimulate the evolution from a sensitization to a respiratory form of allergy. Several studies have been published on the role of different adipokines on allergic diseases. We focus our review on the role of adipokines on asthma and allergic rhinitis.

Preliminary evidence that etanercept may reduce radiographic progression in juvenile idiopathic arthritis.

OBJECTIVE: To investigate the rate of radiographic progression, as measured with the carpo-metacarpal ratio (Poznanski score), during etanercept (ETN) therapy in children with polyarticular juvenile idiopathic arthritis (JIA). METHODS: Patients included in the Italian ETN registry who had a standard radiograph of both hands and wrists in the posteroanterior view made at start of treatment and after 1 year were included in the study. The clinical response was assessed by means of the ACR Pediatric definition of improvement. Radiographic progression was determined by calculating the change in the Poznanski score between the baseline and the 1-year radiographs. RESULTS: A total of 40 patients were studied. The frequency of ACR pediatric 30, 50, and 70 response at 1 year was 77%, 72%, and 50%, respectively. The median change in the Poznanski score between baseline and 1 year was + 0.3 units, meaning that, on average, patients experienced improvement in radiographic progression. CONCLUSION: Our pilot study provides evidence that ETN is potentially capable of reducing the progression of radiographic joint damage in JIA. This finding deserves confirmation in a controlled trial.

Pisa syndrome in a cohort of Alzheimer's disease patients.

Three Alzheimer's disease patients with Pisa syndrome were presented. These patients were treated with cholinesterase inhibitors within a post-marketing surveillance study. The clinical and pharmacological histories of these patients suggest a relation between cholinesterase inhibitors and the pleurothotonus. The diffuse use of cholinesterase inhibitors in the treatment of dementia may cause an increasing number of Pisa syndrome cases.

Secondary prevention of coronary artery disease in high-risk diabetic patients.

BACKGROUND AND AIM: To compare guideline implementation and the actual delivery of secondary prevention for coronary artery disease in the cohort of Italian diabetic patients enrolled in the DAI study. METHODS AND RESULTS: The DAI study is a multicentre cohort study of the prevalence and incidence of macroangiopathic events among 19,570 type 2 diabetic patients attending 201 Diabetic Care Units. For this study, we selected 1,475 subjects with a history of myocardial infarction, coronary artery bypass graft or percutaneous transluminal coronary angioplasty at enrollment. Only 25% of the coronary patients in secondary prevention were receiving lipid-lowering drugs, and 20% were receiving beta-blockers. None of the patients in 54/185 Diabetic Care Units were on statins, and none in 82/185 Units were on beta-blockers. Multivariate analysis showed a positive correlation between the number of treatments and the taking of statins, and a negative correlation with age. CONCLUSION: Our data highlight a gap between the therapeutic guidelines and actual treatment, with wide variability in the delivery of secondary prevention across Units. The out-of-pocket cost of medication, daily treatment burden and geographic area can be ruled out as possible explanatory factors. Physicians' prescription attitudes may be a possible reason.

Active monitoring of adverse drug reactions in children. Italian Paediatric Pharmacosurveillance Multicenter Group.

An active monitoring system of adverse drug reactions (ADR) in children was developed through a network of family paediatricians. The reported Incidence of ADRs was 15.1 per 1000 children.

Reactogenicity in the elderly of nine commercial influenza vaccines: results from the Italian SVEVA study. Study for the evaluation of adverse events of influenza vaccination.

A 10-fold increase of reported adverse events following influenza vaccination in the 1995-1996 campaign was reported. To evaluate the relative reactogenicity of different influenza vaccines a prospective observational study was conducted in 72 Italian local health units (LHU) in the period October-December 1996. Of the 16,637 enrolled individuals aged 65 or more, 27.4% reported the occurrence of at least one adverse event within 72 h of vaccination. The odds ratios, adjusted through a multivariate logistic model, were highest for whole vaccine recipients. Most of the observed events were of moderate clinical severity and were mainly represented by local symptoms. None of the products was found to show an unusual or concerning reactogenicity profile, and no severe events associated with immunization were reported.

Suspected adverse drug events requiring emergency department visits or hospital admissions.

OBJECTIVE: To analyse the contribution of adverse drug events (ADEs) to the overall number of referrals or visits at an emergency department, to determine the proportion of more severe episodes requiring hospital admission and to characterize the different causes of drug-related visits or admissions. METHODS: A 1-year prospective collection of data on visits performed at an emergency department. All visits, observed during 1 week every month, were analyzed in order to identify suspected ADEs. The effects of age and sex on the frequency of ADE-related visits and admissions were evaluated. All patients hospitalized because of an ADE were followed up in order to collect information about progress and outcome of the events, which were also assessed in terms of avoidability. RESULTS: Among the 5497 patients who visited the Emergency Department over 1 year, 235 (4.3%) experienced an ADE, 45 of these (19.1%) were subsequently hospitalized, among whom there were five deaths. Dose-related therapeutic failures were the main causes of drug-related admissions (55.6%), whereas adverse drug reactions caused the most frequent drug-related visits to the Emergency Department (63.8%). Although the frequency of drug-drug interactions leading to a visit to the Emergency Department was small (3.8%), this type of event was more severe, because most of these patients were hospitalized. No age/sex effect was observed in the proportion of ADE-related hospital admissions. Twenty-five (1.4% of the total admissions) of the 45 ADE-related admissions were evaluated as preventable, contributing by more than 61% of the overall length of hospital stay. CONCLUSION: The high proportion of drug therapeutic failures leading to an admission highlights the need for public education, particularly to prevent non-compliance.

Mortality cancer risk in parkinsonian patients: a population-based study.

Cancer mortality in a population-based cohort of 10,322 parkinsonian patients (448 deaths observed during 1987 to 1994) was compared with that of the Italian province of Rome using the standardized mortality ratio (SMR). The overall cancer mortality risk was lower in this cohort than in the reference population (SMR, 56; 95% CI, 51 to 61). This reduction included most cancer sites as well as both smoking-related (SMR, 51; 95% CI, 42 to 60) and nonsmoking-related cancers (SMR, 58; 95% CI, 52 to 65). The observed reduction in cancer mortality risk in this cohort cannot be explained entirely by the hypothesis that smokers are less likely to develop PD.

Use of amoxicillin and amoxicillin-clavulanic acid and hospitalization for acute liver injury.

Increase of acute liver injury in patients taking amoxicillin-clavulanic acid (co-amoxiclav) as compared to those taking amoxicillin has been suggested. To further investigate the potential hepatotoxicity of the two drugs a historical cohort study was conducted in the Italian region of Friuli-Venezia Giulia. One hundred and eighteen potential cases of acute liver injury were identified through the regional hospital information system and medical records were reviewed for all of them. Overall, 12 cases of acute liver injury were identified: 3 cases occurred in the amoxicillin exposure category, 2 among co-amoxiclav group, and 7 in the non-use category. The adjusted estimate of the rate ratio was 5.7 (CI 95% 1.5-22.1) among users of amoxicillin alone and 6.2 (CI 95% 1.3-29.7) among users of co-amoxiclav.

[Evidence-based medicine and the diverse cultures of healing]. / La medicina delle evidenze scientifiche e le diverse culture della guarigione.

The term "unconventional medicine" refers to a remarkably heterogeneous group of theories and practices (homeopathy, herbal medicine, acupuncture, etc.) different from those peculiar to the dominant health system of a particular society. An unifying characteristic of these practices is that they have not been scientifically tested and that unconventional practitioners largely deny the need for such testing. However, established research procedures are to be considered adequate to address the majority of questions related to unconventional therapies and promising unconventional therapies should be subjected to the same level of scientific scrutiny that is required for drug therapies used within the official medicine. While many questions about the risk/benefit ratio of unconventional therapies remain unanswered, millions of people are spending millions of dollars each year in several developed countries, thus, to define strategies aimed at the careful evaluation of these practices is needed.