RESUMEN
Summary: Background.Diagnosis of anisakis allergy (AA) is based on the skin prick test (SPT) and specific IgE (sIgE) determination. Anyway, false positivity cases are due to cross reactivity with numerous allergens. The aim of the study was to evaluate the reliability of a comprehensive diagnostic algorithm for the AA. Methods.An observational study was conducted on a sample of consecutive subjects accessing the allergology outpatient ambulatories of two hospitals located in Western Sicily. All the recruited outpatients were tested by Skin Prick Test performed using anisakis extracts by ALK-Abellò (Madrid, Spain). Specific IgE dosage for anisakis extracts was then performed by using ImmunoCAP250 (Immunodiagnostics Uppsala, Sweden). Consequently, outpatients who tested positive to first line tests underwent sIgE testing for ascaris and tropomyosin. Lastly, outpatients positive to the first line were invited to be further tested by basophil activation test (BAT) by using Flow CAST kit and anisakis commercial extract (Bühlmann Laboratories AG, Schönenbuch, Switzerland), as confirmatory analysis. Results.One hundred and eleven outpatients with an anamnesis suggestive of sensitization to anisakis (AS) and 466 subjects with chronic urticaria (CU) were recruited in the study. Of these, 22 with AS and 41 with CU showed a sensitization to anisakis allergens. The diagnostic algorithm revealed that 8.8% of outpatients who tested positive to sIgE determination were affected by CU, while 82.5% of all the sIgE positivity was related to cross-reactivity. Overall, a genuine anisakis seroprevalence of 2.3% was documented. Within a sub-sample of 15 subjects with clinical symptoms related to AA, n. 8 showed a real positivity after BAT. A greater response to A. pegreffii allergens as compared to A. simplex was reported. Conclusions.Our preliminary findings support the high clinical specificity of BAT for AA diagnosis, suggesting implementing this method in a comprehensive diagnostic algorithm.
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Anisakiasis/diagnóstico , Anisakis/fisiología , Urticaria Crónica/diagnóstico , Hipersensibilidad/diagnóstico , Adolescente , Adulto , Algoritmos , Alérgenos/inmunología , Animales , Anisakiasis/epidemiología , Antígenos Helmínticos/inmunología , Prueba de Desgranulación de los Basófilos , Urticaria Crónica/inmunología , Femenino , Humanos , Hipersensibilidad/epidemiología , Inmunoglobulina E/sangre , Italia/epidemiología , Masculino , Región Mediterránea , Persona de Mediana Edad , Estudios Seroepidemiológicos , Pruebas Cutáneas , Adulto JovenRESUMEN
Summary: Background and Objective. Sensitization and allergy to shrimp among Italian house dust mite allergic patients are not well defined and were investigated in a large multicenter study. Methods. Shrimp sensitization and allergy were assessed in 526 house dust mite (HDM)-allergic patients submitted to the detection of IgE to Der p 10 and 100 atopic control not sensitized to HDM. Results. Shrimp allergy occurred in 9% of patients (vs 0% of 100 atopic controls not sensitized to HDM; p minor 0.001). Shrimp-allergic patients were less frequently hypersensitive to airborne allergens other than HDM than crustacean-tolerant subjects (35% vs 58.8%; p minor 0.005). Only 51% of tropomyosin-sensitized patients had shrimp allergy, and these showed significantly higher Der p 10 IgE levels than shrimp-tolerant ones (mean 22.2 KU/l vs 6.2 KU/l; p minor 0.05). Altogether 53% of shrimp-allergic patients did not react against tropomyosin. Conclusions. Shrimp allergy seems to occur uniquely in association with hypersensitivity to HDM allergens and tropomyosin is the main shrimp allergen but not a major one, at least in Italy. Along with tropomyosin-specific IgE levels, monosensitization to HDM seems to represent a risk factor for the development of shrimp allergy among HDM allergic patients.
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Antígenos Dermatofagoides/inmunología , Proteínas de Artrópodos/inmunología , Hipersensibilidad a los Alimentos/epidemiología , Tropomiosina/inmunología , Adolescente , Adulto , Animales , Reacciones Cruzadas , Femenino , Hipersensibilidad a los Alimentos/inmunología , Humanos , Inmunoglobulina E/metabolismo , Italia/epidemiología , Masculino , Persona de Mediana Edad , Penaeidae , Prevalencia , Pyroglyphidae , Adulto JovenRESUMEN
AIM: In obese patients, the diet-induced weight loss markedly improves glucose tolerance with an increase in insulin sensitivity and a partial reduction of insulin secretion. The association with metformin treatment might potentiate the effect of diet alone. METHODS: From patients admitted to our Nutritional Division for diet programme, we selected obese, non-diabetic, uncomplicated patients with age 18-65 years and body mass index 35-50 kg/m(2) and studied the effects of a 6-month pharmacological treatment with either metformin (850 mg twice daily) or rosiglitazone (4 mg twice daily) on possible changes in body weight, fat mass, glucose and lipids metabolism. RESULTS: A significant weight loss and reduction of fat mass was demonstrated with metformin (-9.7 +/- 1.8 kg and -6.6 +/- 1.1 kg) and also with rosiglitazone (-11.0 +/- 1.9 kg and -7.2 +/- 1.8 kg), without fluid retention in either treatment group. Rosiglitazone administration induced a significant decrease in glucose concentration (4.7 +/- 0.1 vs. 4.4 +/- 0.1 mmol/l, p < 0.005) and insulin-circulating level (13.6 +/- 1.5 vs. 8.0 +/- 0.,7 microU/ml, p < 0.005), an increase in insulin sensitivity as measured by homeostatic model assessment (HOMA) of insulin sensitivity (68.9 +/- 8.8 vs. 109.9 +/- 10.3, p < 0.005) with a concomitant decrease in beta-cell function as measured by HOMA of beta-cell function (163.2 +/- 16.1 vs. 127.4 +/- 8.4, p < 0.005). In contrast, metformin did not produce any significant effect on blood glucose concentration, insulin level and HOMA2 indexes. No adverse events were registered with pharmacological treatments. CONCLUSION: Our study shows that in severely obese, non-diabetic, hyperinsulinaemic patients undergoing a nutritional programme, rosiglitazone is more effective than metformin in producing favourable changes in fasting-based indexes of glucose metabolism, with a reduction of both insulin resistance and hyperinsulinaemia. In spite of previous studies reporting rosiglitazone-induced body weight gain, in our study the joint treatment with diet and rosiglitazone was accompanied by weight loss and fat mass reduction.
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Hiperinsulinismo/tratamiento farmacológico , Hipoglucemiantes/farmacología , Metformina/farmacología , Obesidad/tratamiento farmacológico , Tiazolidinedionas/farmacología , Tejido Adiposo/efectos de los fármacos , Adolescente , Adulto , Anciano , Linfocitos B/efectos de los fármacos , Glucemia/efectos de los fármacos , Glucemia/metabolismo , Composición Corporal/efectos de los fármacos , Femenino , Humanos , Hipoglucemiantes/uso terapéutico , Resistencia a la Insulina , Metabolismo de los Lípidos/efectos de los fármacos , Masculino , Metformina/uso terapéutico , Persona de Mediana Edad , Obesidad/dietoterapia , Obesidad Mórbida/dietoterapia , Obesidad Mórbida/tratamiento farmacológico , Rosiglitazona , Tiazolidinedionas/uso terapéutico , Pérdida de Peso/efectos de los fármacosRESUMEN
In this work 437 fish samples of species belonging to the families Myctophidae (Electrona risso and Diaphus metopoclampus) and Phosichthyidae (Vinciguerria attenuata) were examined for the presence of Anisakidae larvae. The study was performed with fishes in the central Mediterranean Sea, particularly in the Strait of Sicily and in the Strait of Messina. The visual inspection and chloro-peptic analysis revealed the presence of nematode parasites with prevalence values between 2.9% in Electrona risso samples and 5.4% in Vinciguerria attenuata samples. A positive correlation was found between standard length (SL) and prevalence of infestation in D. metopoclampus samples (p<0.05). The larvae examined were morphologically ascribed, at genus level, to Anisakis morphotypes I and II and molecularly identified as Anisakis pegreffii, Anisakis ziphidarum and Anisakis physeteris, in 67%, 9% and 24% of the fish samples examined. Overall, A. pegreffii and A. ziphidarum larvae were isolated in 14 and 2 specimens of D. metopoclampus respectively, A. physeteris larvae were found in 3 E. risso and 2 V. attenuata. A positive correlation was found between standard length and prevalence of infestation in D. metopoclampus samples (p<0.05). First information is provided on the presence of Anisakis spp. larvae of the myctophid fish species E. risso, D. metopoclampus and V. attenuata from the Central Mediterranean. It is also confirmed the role of lanternfishes (Myctophidae) as paratenic hosts for Anisakis spp.
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Anisakiasis/veterinaria , Anisakis/aislamiento & purificación , Enfermedades de los Peces/epidemiología , Enfermedades de los Peces/parasitología , Peces , Animales , Anisakiasis/epidemiología , Anisakiasis/parasitología , Anisakis/clasificación , Italia/epidemiología , Larva , Mar Mediterráneo/epidemiología , PrevalenciaRESUMEN
Glycoprotein PC-1 inhibits insulin signaling and, when overexpressed, plays a role in human insulin resistance. Mechanisms of PC-1 overexpression are unknown. We have identified a haplotype in the 3'-untranslated region of the PC-1 gene that may modulate PC-1 expression and confer an increased risk for insulin resistance. Individuals from Sicily, Italy, carrying the "P" haplotype (i.e., a cluster of three single nucleotide polymorphisms: G2897A, G2906C, and C2948T) were at higher risk (P < 0.01) for insulin resistance and had higher (P < 0.05) levels of plasma glucose and insulin during an oral glucose tolerance test and higher levels of cholesterol, HDL cholesterol, and systolic blood pressure. They also had higher (P < 0.05-0.01) PC-1 protein content in both skeletal muscle and cultured skin fibroblasts. In CHO cells transfected with either P or wild-type cDNA, specific PC-1 mRNA half-life was increased for those transfected with P (t/2 = 3.73 +/- 1.0 vs. 1.57 +/- 0.2 h; P < 0.01). In a population of different ethnicity (Gargano, East Coast Italy), patients with type 2 diabetes (the most likely clinical outcome of insulin resistance) had a higher P haplotype frequency than healthy control subjects (7.8 vs. 1.5%, P < 0.01), thus replicating the association between the P allele and the insulin resistance-related abnormalities observed among Sicilians. In conclusion, we have identified a possible molecular mechanism for PC-1 overexpression that confers an increased risk for insulin resistance-related abnormalities.
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Regiones no Traducidas 3'/genética , Diabetes Mellitus/genética , Resistencia a la Insulina/fisiología , Glicoproteínas de Membrana/genética , Hidrolasas Diéster Fosfóricas , Polimorfismo de Nucleótido Simple/genética , Pirofosfatasas , ARN Mensajero/genética , Adulto , Animales , Glucemia/metabolismo , Índice de Masa Corporal , Células CHO , Estudios de Cohortes , Cricetinae , Dactinomicina/farmacología , Etnicidad/genética , Exones , Femenino , Tamización de Portadores Genéticos , Prueba de Tolerancia a la Glucosa , Haplotipos , Homocigoto , Humanos , Resistencia a la Insulina/genética , Italia , Masculino , Glicoproteínas de Membrana/metabolismo , Persona de Mediana Edad , Músculo Esquelético/metabolismo , Proteínas Recombinantes/metabolismo , Factores de Riesgo , Transcripción Genética/efectos de los fármacos , Transfección , Población Blanca/genéticaRESUMEN
An increased tissue content of PC-1, an inhibitor of insulin receptor signaling, may play a role in insulin resistance. Large scale prospective studies to test this hypothesis are difficult to carry out because of the need for tissue biopsies. The aim of this study was to investigate whether PC-1 is measurable in human plasma and whether its concentration is related to insulin sensitivity. A soluble PC-1, with mol wt and enzymatic activity similar to those of tissue PC-1, was measurable in human plasma by a specific enzyme-linked immunosorbent assay and was inversely correlated to skeletal muscle PC-1 content (r = -0.5; P < 0.01). The plasma PC-1 concentration was decreased (P < 0.05) in insulin-resistant (22.7 +/- 3.0 ng/mL; n = 25) compared to insulin-sensitive (36.7 +/- 4.5; n = 25) nondiabetic subjects and was correlated negatively with the waist/hip ratio (r = -0.48; P < 0.001) and mean blood pressure (r = -0.3; P < 0.05) and positively with high density lipoprotein/total cholesterol (r = 0.38; P < 0.01) and both the M value and the plasma free fatty acid level decrement at clamp studies (r = 0.28; n = 50; P = 0.05 and r = 0.43; n = 22; P < 0.05, respectively). A plasma PC-1 concentration of 19 ng/mL or less identified a cluster of insulin resistance-related alterations with 75% accuracy. In conclusion, PC-1 circulates in human plasma, and its concentration is related to insulin sensitivity. This may help to plan studies aimed at understanding the role of PC-1 in insulin resistance.
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Antígenos de Diferenciación de Linfocitos B/sangre , Resistencia a la Insulina/inmunología , Adulto , Anciano , Antígenos de Diferenciación de Linfocitos B/química , Antígenos de Diferenciación de Linfocitos B/metabolismo , Antígenos de Diferenciación de Linfocitos B/fisiología , Índice de Masa Corporal , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Insulina/fisiología , Resistencia a la Insulina/fisiología , Masculino , Persona de Mediana Edad , Músculo Esquelético/metabolismo , Concentración Osmolar , Pirofosfatasas/análisis , Valores de Referencia , Solubilidad , SíndromeAsunto(s)
Dieta Reductora , Hipoglucemiantes/uso terapéutico , Resistencia a la Insulina , Obesidad/dietoterapia , Tiazolidinedionas/uso terapéutico , Pérdida de Peso , Índice de Masa Corporal , Humanos , Monitoreo Fisiológico , Obesidad/tratamiento farmacológico , Rosiglitazona , Pérdida de Peso/efectos de los fármacosRESUMEN
To verify whether the short intravenous insulin tolerance test (ITT) (a safe, reproducible, inexpensive, rapid and easy to perform measurement of insulin sensitivity) is a suitable test for insulin resistance screening in a general population, we measured in 60 non diabetic subjects, either non-obese (no.=40) or obese (BMI>28, no.=20) the K of glucose disappearance from plasma after ITT (K(ITT)), plasma glucose (PG) and insulin (IRI) both fasting (FPG, FIRI) and at 120 min of OGTT (PG- 120, IRI- 120), and also triglycerides (Tg), cholesterol (Chol) and blood pressure (BP). Subjects were subdivided into quartiles according to K(ITT) values. Average FPG, PG-120, FIRI, IRI-120, Tg and Chol values were progressively increased, and average HDL/Chol was progressively decreased from quartile 1 (the most insulin sensitive) to 4 (the most insulin resistant) (p<0.05, by 1-way ANOVA test). Also BP was increased in the insulin resistant patients, but statistical significance was not reached. Three or more of the studied parameters (FPG and/or PG-120, FIRI and/or IRI-120, Tg, HDL/Chol, mean BP) were altered (below the worst 25 degree percentile) in 64% of subjects from quartile 4; none of the subjects in quartile 1 was affected by such a cluster of alterations. K(ITT) values < or =4.8 identified the cluster of insulin resistance related alterations with an accuracy of 82% (sensitivity=83.3%, specificity=80.5%). In healthy subjects with a wide range of BMI the ITT is a reliable procedure for screening for the cluster of metabolic alterations related to insulin resistance.
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Hipoglucemiantes , Resistencia a la Insulina/fisiología , Insulina , Adolescente , Adulto , Presión Sanguínea/fisiología , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Hiperinsulinismo/sangre , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To assess the relationship between weight cycling and some cardiovascular risk factors in a wide sample of obese subjects. DESIGN: Cross-sectional study with retrospective evaluation of weight and dieting history. SUBJECTS: In all, 459 obese subjects, 340 women and 119 men (age: 19-65 y; BMI: 30-69 kg/m2). MEASUREMENTS: Body composition and fat distribution (by bioelectrical impedance analysis and anthropometry), systolic and diastolic blood pressure, plasma glucose, total and HDL cholesterol, triglycerides, insulin and insulin resistance by HOMAir, various weight cycling indices. RESULTS: A positive correlation between weight cycling indices, BMI and percent body fat was found in both genders. Also, the maximum absolute amount of weight regained following a single diet episode was significantly associated to insulin and HOMAir in both genders. However, these correlations disappeared when the data were controlled for age and BMI. CONCLUSION: In obese subjects of both genders weight cycling, and in particular weight regain, does not appear to be associated with adverse effects on body composition, fat distribution or cardiovascular risk factors in an independent manner, but rather in relation to fat accumulation over years.