RESUMEN
BACKGROUND: Increasing evidence is available about the presence of increased serum concentration of immunoglobulin (Ig) free light chains (FLCs) in both atopic and non-atopic inflammatory diseases, including severe asthma, providing a possible new biomarker of disease. METHODS: We analyzed clinical and laboratory data, including FLCs, obtained from a cohort of 79 asthmatic subjects, clinically classified into different GINA steps. A control group of 40 age-matched healthy donors (HD) was considered. Particularly, HD have been selected according to the absence of monoclonal components (in order to exclude paraproteinemias), were tested for total IgE (that were in the normal ranges) and were negative for aeroallergens specific IgE. Moreover, no abnormality of common inflammatory markers (i.e., erythrocyte sedimentation rate and C-reactive protein) was detectable. RESULTS: FLC-k levels were significantly increased in the asthmatic population, compared to the control group. Despite the absence of statistically significant differences in FLC-λ levels, the FLC-k/FLC-λ ratio displayed remarkable differences between the two groups. A positive correlation between FLC-κ and FLC-λ levels was found. FLC- λ level displayed a significant negative correlation with the FEV1 value. Moreover, the FLC-κ /FLC- λ ratio was negatively correlated with the SNOT-22 score and a positive correlation was observed between FLCs and Staphylococcus Aureus IgE enterotoxins sensitization. CONCLUSIONS: Our findings confirmed the role of FLCs in asthma as a potential biomarker in an inflammatory disease characterized by different endotypes and phenotypes. In particular, FLC-κ and FLC-k/FLC-λ ratio could be a qualitative indicator for asthma, while FLC-λ levels could be a quantitative indicator for clinical severity parameters.
RESUMEN
SUMMARY: Background. In Western countries a large proportion of asthmatic patients remain uncontrolled, despite the availability of effective drugs. An involvement of pharmacies / pharmacists in asthma management has been suggested in guidelines, since this could provide a relevant support. Objective. The present cross-sectional study aimed at assessing the level of asthma control, by using ACT questionnaire, in the community pharmacies in the County of Verona, North East of Italy. Methods. A call for participation was sent by Verona Pharmacists' Association to all the pharmacies located in the Verona municipality. Patients with a medical prescription and an asthma exemption code were recruited in pharmacies. They were asked to fill the ACT questionnaire and to answer some additional questions on asthma treatment, smoke habits and comorbidities. Results. Thirty-seven community pharmacies recruited 239 patients. According to the ACT score, more than 50% of patients had a controlled asthma but 20% of them were totally uncontrolled and 12% were using oral steroid. Only 2.9% of patients had received an asthma action plan. Asthma was intermittent in 17.6% of patients, mild persistent in 13.8%, moderate persistent in 63.1% and severe in 5.4%. Discordance was observed between the self-perceived asthma control and objective parameters, when available. Of note, in the severe asthma group, most patients had an ACT > 20. Conclusion. This is the first Italian pharmacy-based study on asthma control. A better asthma control was recorded in this study in comparison with other trials, but about 50% of patients were insufficiently controlled. The community pharmacies can play a relevant role in the preliminary assessment of asthma control by using easy and not time consuming tools, such as ACT.
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Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , Servicios Comunitarios de Farmacia , Pulmón/efectos de los fármacos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antiasmáticos/efectos adversos , Asma/diagnóstico , Asma/epidemiología , Asma/fisiopatología , Niño , Preescolar , Estudios Transversales , Empleo , Femenino , Encuestas de Atención de la Salud , Estado de Salud , Humanos , Italia/epidemiología , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Fumar/efectos adversos , Fumar/epidemiología , Resultado del Tratamiento , Adulto JovenAsunto(s)
Asma Ocupacional/etiología , Chenopodium quinoa/efectos adversos , Harina/efectos adversos , Adulto , Asma Ocupacional/diagnóstico , Asma Ocupacional/metabolismo , Asma Ocupacional/fisiopatología , Volumen Espiratorio Forzado , Humanos , Masculino , Óxido Nítrico/metabolismo , Exposición Profesional/efectos adversos , Pruebas CutáneasRESUMEN
Nasal polyposis is a frequent disease, sometime associated with asthma and non steroidal anti-inflammatory drugs intolerance. Staphylococcus aureus colonization can play a pathogenetic role in same cases by a severe eosinophilic inflammation, which can suggest new therapeutic approaches. Staphylococcus aureus colonization has been demonstrated by local specific enterotoxins IgE dosage in polyps homogenates. This study demonstrate lack of detection of serum enterotoxins specific IgE to staphylococcal in patients with nasal polyposis, compared with healthy subjects.
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Anticuerpos Antibacterianos/sangre , Enterotoxinas/inmunología , Inmunoglobulina E/sangre , Pólipos Nasales/inmunología , Staphylococcus aureus/inmunología , Superantígenos/inmunología , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pólipos Nasales/sangre , Pólipos Nasales/microbiologíaRESUMEN
Allergen subcutaneous immunotherapy is a long lasting treatment which can modify the natural history of allergic respiratory diseases. Recommended administration is required for a minimum of three years. During this long term therapy the daily management is based on two crucial points, discussed in this review, such as the prevention and the treatment of side effects and the improvement and follow-up of patient adherence. This review specifically focuses on subcutaneous immunotherapy.
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Desensibilización Inmunológica , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Hipersensibilidad Respiratoria/tratamiento farmacológico , Desensibilización Inmunológica/métodos , Desensibilización Inmunológica/tendencias , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Humanos , Inyecciones Subcutáneas , Cooperación del Paciente , Guías de Práctica Clínica como Asunto , Hipersensibilidad Respiratoria/inmunología , Factores de TiempoRESUMEN
BACKGROUND: Subcutaneous immunotherapy is effective for the treatment of respiratory allergy, and it is largely used in Italy, but no systematic safety assessment has been carried out so far. OBJECTIVE: To assess prospectively the safety of injection immunotherapy in a multicentre, real-life survey. METHODS: Eleven Italian allergy departments recorded the clinical characteristics of systemic reactions (SRs) due to immunotherapy. Vaccines were prescribed according to guidelines; only standardized depot extracts were used. SRs were graded according to the EAACI recommendations, and were classified as immediate or delayed. RESULTS: One thousand seven hundred and thirty-eight patients (847 males, age range 5-71) received immunotherapy from eight different manufacturers, for a total of 2038 courses (300 patients received two extracts). A total of 60 785 injections were given over a mean immunotherapy duration of 3 years. Overall, 95 reactions were observed in 57 patients (3.28%), corresponding to 4.7% of the courses and 1.56/1000 injections. Twenty-five patients experienced more than one adverse event. There were 34 grade 2, 60 grade 3 and one grade 4 reactions and no fatality. SRs occurred more frequently in patients with asthma than in patients with rhinitis alone (4.1% vs. 1.1%), and were equally distributed between the build-up and the maintenance phase. Ragweed and grass extracts caused significantly more side effects than other allergens. CONCLUSION: In this large prospective study, the rate of SRs was low, thus confirming that injection immunotherapy has an acceptable risk/benefit ratio when prescribed and carried out according to recommendations.
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Asma/terapia , Inmunoterapia , Vacunas/administración & dosificación , Vacunas/efectos adversos , Adolescente , Adulto , Anciano , Alérgenos/administración & dosificación , Alérgenos/efectos adversos , Niño , Preescolar , Humanos , Inyecciones Subcutáneas , Italia , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Estudios ProspectivosRESUMEN
BACKGROUND: The preferential association of mastocytosis with hymenoptera sting reactions is well known, but there is no data on the prevalence of clonal mast cell disorders in subjects with severe systemic reactions due to foods or drugs. METHODS: Patients with food- or drug-induced severe systemic reactions, including anaphylaxis, and increased serum tryptase were studied for the presence of mastocytosis, and compared with a population of patients with hymenoptera allergy. The aetiological role of foods or drugs was assessed according to current recommendations. Systemic reactions were graded in severity according to the procedure described by Mueller. Serum tryptase was considered increased if the level was >11.4 ng/ml. Subjects with increased tryptase had dermatological evaluation and Bone marrow(BM) aspirate-biopsy, which included histology/cytology, flow cytometry and detection of KIT mutations. RESULTS: A total of 137 subjects (57 male, mean age 42 years) were studied. Of them, 86 proved positive for drugs and 51 for foods. Overall, out of 137 patients, only nine (6.6%) had a basal tryptase >11.4 ng/ml, and only two (1.5%) were diagnosed with mastocytosis. This was clearly different from patients with hymenoptera allergy, where 13.9% had elevated tryptase and 11.1% had a clonal mast cell disorder. CONCLUSION: The association of clonal mast cell disorders with hymenoptera allergy seems to be more specific than that with food- or drug-induced systemic reactions.
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Venenos de Artrópodos/inmunología , Hipersensibilidad/epidemiología , Mastocitosis/epidemiología , Adolescente , Adulto , Anciano , Animales , Niño , Preescolar , Femenino , Humanos , Himenópteros/inmunología , Hipersensibilidad/inmunología , Masculino , Mastocitosis/inmunología , Persona de Mediana Edad , Triptasas/sangre , Adulto JovenAsunto(s)
Desensibilización Inmunológica/métodos , Endoscopía/métodos , Cavidad Nasal/patología , Selección de Paciente , Pyroglyphidae/inmunología , Rinitis Alérgica/patología , Rinitis Alérgica/terapia , Adolescente , Adulto , Animales , Femenino , Humanos , Pruebas Intradérmicas , Masculino , Persona de Mediana Edad , Cavidad Nasal/inmunología , Obstrucción Nasal/inmunología , Obstrucción Nasal/patología , Obstrucción Nasal/terapia , Valor Predictivo de las Pruebas , Rinitis Alérgica/inmunología , Adulto JovenRESUMEN
INTRODUCTION: Allergic rhinitis (AR) affects 20-30% of women in reproductive age and may worsen during pregnancy. About 10% of the elderly suffer from AR, and it could be under-diagnosed in these patients. Many drugs are currently available, however AR treatment during pregnancy and old age represents a challenging issue. AREAS COVERED: A review of the literature on the topic has been performed. Expert commentary: In pregnancy, drug avoidance should be carefully balanced with the need for AR optimal control. Topical drugs are suggested as a first approach. The safety and tolerability profile of second-generation antihistamines is well supported. If allergen immunotherapy (AIT) is ongoing and well tolerated, there is no reason for stopping it. AIT initiation in pregnancy is not recommended. For elderly patients, no specific concerns have been highlighted regarding topical treatments, except from nasal decongestionants. Second generation antihistamines are generally well tolerated. Old age should not preclude AIT.
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Antagonistas de los Receptores Histamínicos/administración & dosificación , Complicaciones del Embarazo/tratamiento farmacológico , Rinitis Alérgica/tratamiento farmacológico , Administración Tópica , Anciano , Desensibilización Inmunológica/efectos adversos , Desensibilización Inmunológica/métodos , Femenino , Antagonistas de los Receptores Histamínicos/efectos adversos , Humanos , Descongestionantes Nasales/administración & dosificación , Embarazo , Complicaciones del Embarazo/inmunología , Rinitis Alérgica/inmunologíaRESUMEN
Clavulanic acid, an inhibitor of beta-lactamases, is widely used for antimicrobial therapy in association with beta-lactam antibiotics. Despite this, very few adverse reactions to the molecule have been described so far. We report a case of not-immediate reaction to clavulanic acid in a young adult who previously tolerated it. The patient complained of generalized itchy erythema two days after completing a course of amoxicillin-clavulanate therapy, and had no previous clinical history of adverse reactions to drugs. Intradermal and skin prick tests with beta-lactam determinants were negative, as well as the oral tolerance test with amoxicillin. Since no commercial preparation of clavulanic acid alone is available, we performed intradermal and skin prick test with the association amoxicillin-clavulanate, that elicited a delayed (24 and 48 hours) response. IgE-mediated reactions to clavulanic acid are rare, since this molecule is poorly allergenic. Based on the onset time and the specificity of the response we hypothesize that a delayed (possibly T-cell mediated) reaction has occurred.
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Antibacterianos/efectos adversos , Ácido Clavulánico/efectos adversos , Hipersensibilidad Tardía/inducido químicamente , Adulto , Amoxicilina/uso terapéutico , Hipersensibilidad a las Drogas/inmunología , Inhibidores Enzimáticos/efectos adversos , Femenino , Humanos , Pruebas Intradérmicas , Pruebas del Parche , Inhibidores de beta-LactamasasRESUMEN
The diagnosis and management of nut allergy can be difficult because of the possible severity of the clinical manifestations and the cross reactivity between different species. We report a case of anaphylaxis due to skin testing in a young adult with clinically ascertained walnut allergy. After an episode of anaphylaxis due to walnut ingestion, a routine diagnostic workup was carried out, involving skin prick test with commercial extracts, prick by prick with fresh food and CAP-RAST assay for different nuts. Immediately after pricking with fresh Brazil nut, a severe episode of anaphylaxis occurred, that required epinephrine and intravenous steroids. The subject had never eaten Brazil nut before. Therefore we hypothesize a cross reactivity effect, since this phenomenon is well known for tree nuts. Our case suggests that in vivo diagnosis, especially if fresh nuts are used, should be performed only if adequate equipment to treat anaphylaxis is available.
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Anafilaxia/etiología , Bertholletia/efectos adversos , Juglans/efectos adversos , Hipersensibilidad a la Nuez/complicaciones , Pruebas Cutáneas , Adolescente , Anafilaxia/inmunología , Bertholletia/inmunología , Reacciones Cruzadas/inmunología , Humanos , Inmunoglobulina E/sangre , Inmunoglobulina E/inmunología , Juglans/inmunología , Masculino , Hipersensibilidad a la Nuez/inmunología , Prueba de Radioalergoadsorción , Serina Endopeptidasas/sangre , TriptasasRESUMEN
The use of Complementary/Alternative Medicines (CAM) is largely diffused and constantly increasing, especially in the field of allergic diseases and asthma. Homeopathy, acupuncture and phytotherapy are the most frequently utilised treatments, whereas complementary diagnostic techniques are mainly used in the field of food allergy-intolerance. Looking at the literature, the majority of clinical trials with CAMS are of low methodological quality, thus difficult to interpret. There are very few studies performed in a rigorously controlled fashion, and those studies provided inconclusive results. In asthma, none of the CAM have thus far been proved more effective than placebo or equally effective as standard treatments. Some herbal products, containing active principles, have displayed some clinical effect, but the herbal remedies are usually not standardised and not quantified, thus carry the risk of toxic effects or interactions. None of the alternative diagnostic techniques (electrodermal testing, kinesiology, leukocytotoxic test, iridology, hair analysis) have been proved able to distinguish between healthy and allergic subjects or to diagnose sensitizations. Therefore these tests must not be used, since they can lead to delayed or incorrect diagnosis and therapy.
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Asma/diagnóstico , Asma/terapia , Terapias Complementarias , Hipersensibilidad/diagnóstico , Hipersensibilidad/terapia , Ensayos Clínicos como Asunto , HumanosAsunto(s)
Alérgenos/uso terapéutico , Himenópteros/inmunología , Hipersensibilidad/terapia , Inmunoterapia Activa/métodos , Extractos de Tejidos/uso terapéutico , Venenos de Avispas/uso terapéutico , Adolescente , Adulto , Anciano , Alérgenos/administración & dosificación , Alérgenos/efectos adversos , Animales , Niño , Bases de Datos Factuales , Femenino , Humanos , Inyecciones , Italia , Masculino , Persona de Mediana Edad , Extractos de Tejidos/administración & dosificación , Extractos de Tejidos/efectos adversos , Resultado del Tratamiento , Venenos de Avispas/administración & dosificación , Venenos de Avispas/efectos adversosRESUMEN
BACKGROUND: Patients with aspirin-sensitive respiratory and cutaneous diseases experience cross reactions to all nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclo-oxigenase (COX) enzymes. As are now available drugs which selectively inhibit COX-2, questions are raised whether cross-reactivity occurs between aspirin and these COX 2 inhibitors. OBJECTIVE: The aim of this study was to evaluate the tolerability of three COX-2 inhibitors (meloxicam, celecoxib and rofecoxib) in subjects with previous pseudoallergic respiratory and cutaneous reactions to NSAIDs. METHODS: 76 subjects with documented previous cutaneous and respiratory pseudoallergic reactions to aspirin and/or other NSAIDs underwent a single blind challenge with celecoxib, meloxicam and rofecoxib. RESULTS: All subjects with previous respiratory reactions tolerated all drugs. Three subjects with multiple-drug induced urticaria complained of a generalized reaction after challenge (Two due to celecoxib and one due to meloxicam). Among the group of patients with NSAIDs-induced urticaria five complained of a relapse of the disease due to rofecoxib (one subject), celecoxib (two subjects and meloxicam (two subjects). CONCLUSIONS: According to these results the cross-reactivity between aspirin and these COX-2 inhibitors does not occur in subjects with previous respiratory pseudoallergic reactions. A good safety profile was also demonstrated in patients with cutaneous reactions, being few reactions observed. However for this reason a controlled oral challenge with these drugs is useful for the proper management of patients sensitive to classic NSAIDs.
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Antiinflamatorios no Esteroideos/efectos adversos , Inhibidores de la Ciclooxigenasa/efectos adversos , Isoenzimas/antagonistas & inhibidores , Lactonas/efectos adversos , Sulfonamidas/efectos adversos , Tiazinas/efectos adversos , Tiazoles/efectos adversos , Adolescente , Adulto , Anciano , Angioedema/inducido químicamente , Aspirina/efectos adversos , Asma/inducido químicamente , Celecoxib , Reacciones Cruzadas , Ciclooxigenasa 2 , Inhibidores de la Ciclooxigenasa 2 , Hipersensibilidad a las Drogas/etiología , Femenino , Volumen Espiratorio Forzado/efectos de los fármacos , Hemodinámica/efectos de los fármacos , Humanos , Masculino , Meloxicam , Proteínas de la Membrana , Persona de Mediana Edad , Prostaglandina-Endoperóxido Sintasas , Pirazoles , Recurrencia , Rinitis Alérgica Perenne/inducido químicamente , Método Simple Ciego , Sulfonas , Urticaria/inducido químicamenteRESUMEN
Reported cases of occupational asthma due to inhalation of milk proteins are rare. Our report is about the first evidence of occupational asthma in a health care worker, caused by an hidden exposure to casein, contained in a commercial dermatological powder widely used in geriatric patients treatment. The diagnosis is based on the case-history and on the positive skin prick test to a commercial and extemporary extract of the occupational allergen.
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Asma/inducido químicamente , Caseínas/toxicidad , Enfermedades Profesionales/inducido químicamente , Adulto , Femenino , Humanos , InhalaciónRESUMEN
Blood lymphocyte subset evaluation was performed before after oral challenge with 10 mg of Ni, in 9 healthy women and in 15 allergic to Ni. Following challenge, 7 allergic showed a flare up of eczema and/or urticaria. In the controls, CD4+ lymphocytes were modified 24 hours after Ni challenge: CD4+/CD44RO- "virgin" cells were reduced while CD4+/CD45RO+ "memory" cells increased. The allergic women, not sensitive to oral Ni, showed an increase of B lymphocytes after the test. On the contrary, the oral Ni reacting patients presented a reduction of monocytes 4 hours after Ni ingestion and marked reduction (ranging from 20 to 50%) of T and B lymphocytes after 24 hours. These significant T and B lymphocytes changes suggest a migration of the cells in peripheral tissues, likely skin and GUT mucosa.
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Dermatitis Alérgica por Contacto/etiología , Eccema/inducido químicamente , Memoria Inmunológica , Antígenos Comunes de Leucocito/análisis , Recuento de Linfocitos , Níquel/efectos adversos , Urticaria/inducido químicamente , Administración Oral , Adulto , Linfocitos B/inmunología , Linfocitos T CD4-Positivos/clasificación , Linfocitos T CD4-Positivos/inmunología , Dermatitis Alérgica por Contacto/inmunología , Eccema/inmunología , Femenino , Humanos , Antígenos Comunes de Leucocito/biosíntesis , Antígenos Comunes de Leucocito/genética , Persona de Mediana Edad , Monocitos/inmunología , Neutrófilos/inmunología , Níquel/administración & dosificación , Níquel/orina , Subgrupos de Linfocitos T/inmunología , Regulación hacia Arriba , Urticaria/inmunologíaRESUMEN
No disponible
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Humanos , Masculino , Adulto , Asma Ocupacional/etiología , Chenopodium quinoa/efectos adversos , Harina/efectos adversos , Asma Ocupacional/diagnóstico , Asma Ocupacional/metabolismo , Asma Ocupacional/fisiopatología , Volumen Espiratorio Forzado , Óxido Nítrico/metabolismo , Exposición Profesional/efectos adversos , Pruebas CutáneasRESUMEN
No disponible