Effect of antimicrobial agents incorporated into resilient denture relines on the Candida albicans biofilm.

OBJECTIVE: The antimicrobial action of five drugs incorporated in temporary denture relines on the fungal biofilm was evaluated. MATERIALS AND METHODS: A Candida albicans biofilm (SC5314) was formed on specimens (10 × 1 mm) of materials (Trusoft and Softone) modified or not (control) by the drugs (nystatin, miconazole, ketoconazole, itraconazole, and chlorhexidine diacetate). Cell viability was determined spectrophotometrically by the tetrazolium salt reduction assay (XTT) after 24 h, 48 h, and 7 and 14 days of incubation. The minimum inhibitory concentrations (MICs) were those which inhibited 90% or more of fungal growth. Fungal susceptibility was confirmed by confocal laser scanning microscopy analysis. RESULTS: The MICs of drugs incorporated in the materials were 0.032, 0.256, 0.128, 0.256, and 0.064 g ml(-1) for nystatin, miconazole, ketoconazole, itraconazole, and chlorhexidine, respectively. Images from nystatin, chlorhexidine, and ketoconazole demonstrated no viable cells. CONCLUSIONS: The antimicrobials incorporated in the resilient materials inhibited fungal growth during 14 days, with lower MICs for nystatin and chlorhexidine.

Does a 'reverse' atopic march exist?

The classical description of the atopic march usually refers to the progression from atopic dermatitis towards asthma, but this pathway has been questioned. We assessed in a prospective observation the possible onset of atopic dermatitis in children with asthma alone at baseline, and evaluated retrospectively their characteristics. Seven hundred and forty-five children (360 male, 6-9 years of age) with asthma alone, without food allergy or atopic dermatitis, were followed-up with regular visits for 9 years. 692 children completed the 9-year observation, and 20% of them were found to have developed atopic dermatitis at 9 years. Comparing retrospectively the children who developed AD with the remaining, no significant difference existed at baseline concerning the demographic characteristics and family history. There was a significantly higher proportion ( chi2 = 0.01) of subjects with single sensitization to mites and a significantly lower proportion of polysensitized subjects ( chi2 = 0.01) within the children who developed AD. Sensitization to foods appeared in 9% of children who developed AD and in 3.8% in the other children (NS). According to these observations, the development of a particular allergic disease does not necessarily follow the classical paradigm of the atopic march.

Looking for immunotolerance: a case of allergy to baker's yeast (Saccharomyces cerevisiae).

We describe one case of baker's yeast true allergy in a boy with previously diagnosed mite-allergy and atopic dermatitis. At the age of 6, being atopic dermatitis and rhinitis well controlled by drugs, he began to experience generalized urticaria and asthma after eating pizza and bread, but only fresh from the oven. The diagnostic workup revealed single sensitization to baker's yeast (Saccharomyces cerevisiae), and a severe systemic reaction also occurred during the prick-by-prick procedure. After discussing with parents, no special dietary restriction was suggested but the use of autoinjectable adrenaline and on demand salbutamol. A diary of symptoms was recorded by means of a visual-analog scale. During the subsequent 2 years, the severity of symptoms was progressively reduced, and presently urticaria has disappeared. Only cough persists, invariantly after eating just-baked and yeast-containing foods. If bread, pizza and cakes are ate more than one hour after preparation, no symptom occur at all. Baker's yeast is a common component of everyday diet and it usually acts as an allergen only by the inhalatory route. We speculate that the continuous exposure to saccharomyces in foods may have lead to an immunotolerance with a progressive reduction of symptoms, whereas why the allergens is active only in ready-baked foods remains unexplained.

Efficacy of sublingual immunotherapy in asthma and eczema.

Sublingual immunotherapy (SLIT) is the local route of administration of allergen extracts investigated in several controlled clinical trials. In a number of countries, particularly Italy, France and Spain, this has become common in office practice. At variance with subcutaneous immunotherapy, the knowledge of mechanisms of action of SLIT is still at the beginning: some studies, in animal models, provided interesting information: the dendritic cells of oral mucosa act as efficient antigen-presenting cells and produce IL-12, which directs the immune response towards a Th1 profile away from IgE-Th2 profile. Its clinical efficacy (improvement of symptoms and reduction of drug intake) for both asthma and rhinitis has been assessed in detail for the most common allergens: house dust mites, grass pollen, Parietaria, birch pollen and olive tree. SLIT requires further evaluation concerning the treatment of the extrinsic form of atopic dermatitis. The induction of immunologic tolerance rather than immunoreactivity should be worth pursuing due to the immunologic pathway involved in the pathophysiology of atopic dermatitis. The safety profile of SLIT, derived from the clinical trials and postmarketing surveillance studies, turned out to be satisfactory in adults and children. SLIT represents an important step towards an efficacious and safe treatment of patients with allergic respiratory diseases; nevertheless, further studies are necessary to establish it as a viable alternative to subcutaneous immunotherapy.

Allergy to house dust mite and snails: a model of cross-reaction between food and inhalant allergens with a clinical impact.

A knowledge of cross-reactions between different allergens can facilitate the diagnosis of allergy. IgE cross-reactivity has been identified between house dust mite and snails. While most patients have mild symptoms, asthma and/or anaphylaxis may occur with these and other cross-reacting foods. It may be worthwhile to include measurement of IgE to some edible invertebrate animals in asthmatics, e.g. in mite allergic asthmatic patients who eat snails.

[Bronchoreactivity induced by physical exercise and methacholine in children with rhinitis and allergic asthma. A comparative study]. / La broncoreattività indotta da esercizio fisico e da metacolina in bambini con rinite ed asma allergico. Studio comparativo.

Bronchial provocation tests (TBP) allow to detect airways hyperreactivity in asthmatics. Twenty asthmatic children and sixteen rhinitics underwent a standard methacholine challenge and a free running exercise test on two separate days. Metacholine challenge pointed out bronchial hyperreactivity in 90% of the asthmatics. An exercise induced bronchospasm occurred in 70% of them. TPB resulted positive also in 18% of the rhinitics. Our study confirms diagnostic usefulness of the TBP and a good correlation between both tests.

[An assessment of middle ear involvement in children with allergic rhinitis: a comparison with chronic hypertrophic adenoiditis]. / Valutazione della compromissione dell'orecchio medio in bambini affetti da rinite allergica: confronto con adenoidite cronica ipertrofica.

The allergic inflammation may contribute to the development of otitis media with effusion (OME). For this reason we have examined two groups of children: the first (group A) formed by 12 children with allergic rhinitis, the second (group B) by 15 children with hypertrophic adenoids. We have found respectively: pathologic otoscopy in 75% and 93% of cases; pathologic tympanometry in 83% and in 90%; pathologic audiometry in 60% and in 83%. This values are not significant according to a statistic analysis. Instead, the degree of compromission has been significant: in fact 16% of the children belonging to group A had a retracted and atelectatic eardrum in comparison with 33% of the children belonging to group B. Also tympanometry has confirmed this aspect: in fact 33% of group A showed type C and B tympanograms in comparison with 77% of group B. Besides, audiometry has confirmed the presence of hearing loss in the subjects with tympanometry of type C and B, belonging to both groups. For this reason the allergic rhinitis, because it may cause OME, must be treated in order to limit the negative effects of allergic nasal obstruction on the functionality of the middle ear.

Investigation of the eotaxin gene -426C-->T, -384A-->G and 67G-->a single-nucleotide polymorphisms and atopic dermatitis in Italian children using family-based association methods.

BACKGROUND: Eotaxin plays an important role in atopic dermatitis (AD) as a potent chemoattractant and activator of eosinophils and T-helper 2 lymphocytes. AIM: To investigate whether single-nucleotide polymorphisms of the eotaxin gene are associated with AD, we investigated the genotype and allelic frequencies of -426C-->T, -384A-->G, and 67G-->A SNPs in 130 Italian families. METHODS: In total, 130 children with either the extrinsic allergic or intrinsic nonallergic forms of AD (EAD and IAD) were recruited from 130 families. Genotyping was performed using PCR and restriction fragment length polymorphism analysis. RESULTS: A significant difference was observed in the genotype frequency of the -426C-->T SNP between children with EAD and those with IAD (P = 0.01), and between children with EAD and controls (P = 0.01). The allele frequencies of the -426C-->T SNP were significantly different between children with EAD and those with IAD (P < 0.01), and between children with EAD and controls (P < 0.01). For children with EAD, the genotype frequency of the -426C-->T SNP was no different between the groups with mild, moderate and severe SCORAD (P = NS). No significant association was observed between the -384A-->G and 67G-->A SNPs and the two groups of children with EAD and IAD compared with the control group. In 32 trios selected from 68 EAD families, the transmission disequilibrium test showed a preferential transmission of the -426T allele from the parents to affected offspring (P < 0.01). CONCLUSIONS: Our results suggest that in our group of children with AD, the eotaxin gene may play a crucial role in the development of extrinsic AD, probably with other genetic factors.

Chronic urticaria and associated coeliac disease in children: a case-control study.

UNLABELLED: Celiac disease (CD) and chronic urticaria (CU) are both sustained by immune mechanisms, but there are so far few data on their clinical association. We performed a case-control study to determine the occurrence of CD in urticaria and matched control children, and to assess the clinical relevance of this association. Children and adolescents were diagnosed to have severe chronic idiopathic urticaria in the presence of hives for more than 6 wk poorly or not responsive to oral antihistamines. Other known causes of urticaria had to be excluded. A matched control group without urticaria was enrolled. In both groups, the presence of CD was searched by assaying antitransglutaminase and antiedomysial antibodies, and confirmed with endoscopic intestinal biopsy. Results. CD was diagnosed and confirmed in 4/79 (5.0%) of children with CU and in 17/2545 (0.67%) of the controls (p = 0.0003). In the four children with urticaria and CD the gluten free diet (GFD) lead to complete remission of urticaria within 5-10 wk, whereas the disappearance of serological markers occurred in longer times (5-9 months). CONCLUSIONS: The presence of CD in children with CU was significantly more frequent than in controls. GFD resulted in urticaria remission. CD may be regarded in such subjects as a cause of CU.

Hypoglycaemia and congenital adrenal hyperplasia.

We report the case history of a child with congenital adrenal hyperplasia which was complicated by recurrent hypoglycaemic episodes during common infections. There are few reports in literature on the association of hypoglycaemia and congenital adrenal hyperplasia. In accordance with others, we believe that hypoglycaemic attacks in adrenal hyperplasia are perhaps more frequent than recorded in literature.

[Can breast feeding prevent atopic dermatitis? Epidemiologic study of 144 cases]. / L'allattamento al seno può prevenire una dermatite atopica? Studio epidemiologico su 144 casi.

A retrospective epidemiological investigation was conducted on 144 infants in order to discover the connection between breast feeding and the appearance of allergic disease. The data obtained indicate that: mothers' milk offers no such protection and at most may delay the onset of symptoms in respiratory allergic diseases. In contrast, it seems that atopic dermatitis arises earlier in breast fed babies, particularly if the mother is atopic.

Clinical and immunologic effects of long-term sublingual immunotherapy in asthmatic children sensitized to mites: a double-blind, placebo-controlled study.

BACKGROUND: Immunotherapy through local routes is thought to be a valuable therapeutic option for respiratory allergy. We investigated the clinical efficacy and immunologic effects of sublingual immunotherapy (SLIT) in asthmatic children with mite-induced respiratory allergy. METHODS: Twenty-four patients (age range 8-15 years), suffering from mild to moderate asthma, with single sensitization to mite allergen, were enrolled. After a 1-year observation phase, patients were randomly allocated to one of two groups, and were given SLIT (sublingual-spit) as drops for 2 years according to a double-blind, placebo-controlled (DBPC) design. Symptoms/medication scores (diary card), visual analog scale, and immunologic parameters (house-dust-mite [HDM]-specific IgE, and total HDM-specific IgG and IgG4) were determined during the observation phase and during the DBPC treatment period. RESULTS: Twenty-one patients completed the study. At the beginning of the treatment, no difference in environmental allergenic pressure could be shown between the groups. After 2 years of therapy, there was a significant decrease in asthmatic symptoms (P=0.0001) and medication use (P=0.0001) in the active group compared to the placebo group. The visual analog score on overall asthma symptoms improved in the SLIT group (P=0.0001), but not in the placebo group. Nevertheless, the immunologic results did not show significant differences in HDM-specific IgE and total HDM-specific IgG or IgG4 between the active and placebo groups (P = NS). No relevant side-effects were recorded throughout the study. CONCLUSIONS: Our results suggest that treatment for 2 years with SLIT is clinically safe and effective in significantly decreasing respiratory symptoms in children with mild to moderate asthma sensitized to HDM. On the other hand, the lack of changes of the immunologic parameters calls for further investigations with special reference to kinetics and mechanism(s) of action of this mode of treatment.

Impact of sublingual immunotherapy on seasonal asthma and skin reactivity in children allergic to Parietaria pollen treated with inhaled fluticasone propionate.

BACKGROUND: Immunotherapy is a recognized treatment for allergic respiratory diseases. OBJECTIVE: To study the usefulness of immunotherapy in combination with optimal pharmacological therapy. METHODS: Thirty-eight children (8-14 years) suffering from seasonal asthma+/-rhinoconjunctivitis due to Parietaria poorly controlled by anti-allergic drugs treatment were selected. After randomization according to a double-blind placebo-controlled design they received active sublingual immunotherapy (15 children) or placebo (15 children) for 13 months combined with inhaled fluticasone twice a day during the pollen season. Eight children were taken as control, whereas all patients were instructed to take symptomatic drugs on need. Early and late skin response to the allergen were assessed in all patients before and after treatment. Drug and symptom scores, as well as visual analogue scores (VASs) and Parietaria pollen counts were assessed during the pollen season. RESULTS: Groups were well balanced for age, gender, early and late skin response before treatment. Four children dropped out, in one case in relationship with active sublingual immunotherapy (SLIT) administration. Chest and nose symptoms, as well as drug scores and VASs were significantly better in both the active or placebo SLIT+fluticasone (S+F) as compared to the control group (P between <0.001 and 0.043). Eye symptoms were significantly better in the active S+F group as compared to control (P=0.025). The VASs were significantly better in the active S+F group as compared to the placebo S+F group (P=0.037). The early skin response decreased significantly in the active S+F group (P<0.001), whereas the late skin response changed significantly in all groups, with an increase in the placebo+fluticasone group (P=0.019) and in the control group (P=0.037) and a decrease (P<0.0001) in the active S+F group. CONCLUSION: The clinical efficacy of S+F is equal to that of fluticasone alone, but the addition of SLIT has effects also on non-bronchial symptoms.

Sublingual immunotherapy abrogates seasonal bronchial hyperresponsiveness in children with Parietaria-induced respiratory allergy: a randomized controlled trial.

BACKGROUND: The use of immunotherapy in asthmatic children is still controversial. Sublingual immunotherapy (SLIT) may represent an advance, due to the good safety profile, but little is known about its effects on lung function and nonspecific bronchial responsiveness. OBJECTIVE: The aim of this study was to assess the effects of SLIT on these parameters, in children with Parietaria pollen-induced asthma. METHODS: Thirty children with asthma solely due to Parietaria who participated in a previous randomized, placebo-controlled trial with SLIT were studied: pulmonary function test and methacholine challenge were carried out at baseline in winter 1999 (out season), during the 1999 season (before randomization), and during the 2001 season. RESULTS: Before randomization, there was a significant fall in methacholine provocation concentration during the pollen season vs baseline in both groups (SLIT group 9.78 +/- 5.95 mg/ml vs 3.37 +/- 2.99 mg/ml; placebo 8.70 +/- 6.25 mg/ml vs 2.44 +/- 2.25 mg/ml; P =.005). In the second pollen season, the response to methacholine returned to baseline values in the active group (9.10 +/- 7.7 mg/ml; P = NS vs baseline), whereas in the placebo group a significant increase in reactivity was still present (2.46 +/- 2.26; P = 0.008 vs baseline). No significant difference in FEV(1) and FEF(25-75) between the two groups was observed at all times. CONCLUSIONS: Our data show that SLIT abrogates the seasonal bronchial hyperreactivity in children with asthma due to Parietaria. This may be regarded as an indirect evidence of the effect on bronchial inflammation.

Prevention of new sensitizations in asthmatic children monosensitized to house dust mite by specific immunotherapy. A six-year follow-up study.

BACKGROUND: Specific immunotherapy (SIT) is a recognized way of treating IgE-mediated respiratory diseases. The clinical outcome is usually better in allergic children than in adults. OBJECTIVE: To increase our knowledge of the ability of SIT to prevent the onset of new sensitizations in monosensitized subjects, so far poorly documented. METHODS: 134 children (age range 5-8 years), who had intermittent asthma with or without rhinitis, with single sensitization to mite allergen (skin prick test and serum-specific IgE), were enrolled. SIT was proposed to all the children's parents, but was accepted by only 75 of them (SIT Group). The remaining 63 children were treated with medication only, and were considered the Control Group. Injective SIT with mite mix was administered to the SIT Group during the first three years and all patients were followed for a total of 6 years. All patients were checked for allergic sensitization(s) by skin prick test and serum-specific IgE every year until the end of the follow-up period. RESULTS: Both groups were comparable in terms of age, sex and disease characteristics. 123 children completed the follow-up study. At the end of the study, 52 out of 69 children (75.4%) in the SIT Group showed no new sensitization, compared to 18 out of 54 children (33.3%) in the Control Group (P < 0.0002). Parietaria, Gramineae and Olea were the most common allergens responsible for the new sensitization(s). CONCLUSIONS: According to our data, SIT may prevent the onset of new sensitizations in children with respiratory symptoms monosensitized to house dust mite (HDM).