Atopy patch tests are useful to predict oral tolerance in children with gastrointestinal symptoms related to non-IgE-mediated cow's milk allergy.

Atopy patch tests (APTs) have been proposed for the diagnostic approach in children with non-IgE-mediated cow's milk allergy and gastrointestinal symptoms. We aimed to investigate the benefit of APTs in predicting oral tolerance in these patients. We prospectively evaluated 172 subjects with a sure diagnosis of non-IgE-mediated CMA and gastrointestinal symptoms (97 boys, 56.4%; age, 6.37 m; range, 2-12 m). At diagnosis, 113/172 (65.7%) children had positive APTs to cow's milk proteins (CMP). After 12 months of exclusion, diet APTs were repeated immediately before OFC. APTs significantly correlated (P < 0.001) with the OFC outcome (r 0.579). Diagnostic accuracy was sensitivity of 67.95%, specificity of 88.3%, PPV of 82.81%, NPV of 76.85%, and a +LR of 5.80. APTs are a valuable tool in the follow-up of children with non-IgE-mediated CMA-related gastrointestinal symptoms by contributing in determining whether an OFC can safely be undertaken.

Very late heart transplant rejection is associated with microvascular injury, complement deposition and progression to cardiac allograft vasculopathy.

In heart transplants, the significance of very late rejection (after 7 years post-transplant, VLR) detected by routine endomyocardial biopsies (EMB) remains uncertain. Here, we assessed the prevalence, histopathological and immunological phenotype, and outcome of VLR in clinically stable patients. Between 1985 and 2009, 10 662 protocol EMB were performed at our institution in 398 consecutive heart transplants recipients. Among the 196 patients with >7-year follow-up, 20 (10.2%) presented subclinical ≥3A/2R-ISHLT rejection. The VLR group was compared to a matched control group of patients without rejection. All biopsies were stained for C4d/C3d/CD68 with sera screened for the presence of donor-specific antibodies (DSAs). In addition to cellular infiltrates with myocyte damage, 60% of VLR patients had evidence of intravascular macrophages. C4d and/or C3d-capillary deposition was found in 55% VLR EMB. All cases of VLR associated with microcirculation injury had DSAs (mean DSA(max) -MFI = 1751 ± 583). This entity was absent from the control group (p < 0.0001). Finally, after a similar follow-up postreference EMB of 6.4 ± 1 years, the mean of CAV grade was 0.76 ± 0.18 in the control group compared to 2.06 ± 0.26 in the VLR group respectively, p = 0.001). There was no difference in patient survival between study and control groups. In conclusion, VLR is frequently associated with complement-cascade activation, microvascular injury and DSA, suggesting an antibody-mediated process. VLR is associated with a dramatic progression to severe CAV in long-term follow-up.

[The microbiological aspects of AIDS-related respiratory infections]. / Aspetti microbiologici delle infezioni respiratorie AIDS correlate.

Main etiologic agents of AIDS-related infections pneumonia and diagnostic tools useful to identify microorganism are discussed. Bronchoalveolar lavage (BAL) remains the most important performed technique to collect pulmonary secretions, but it needs to be completed by colorimetric, immunological (monoclonal antibodies), serological (ELISA vs. mycobacterial antigens), molecular (DNA probes) techniques. These tools are very useful to identify pathogen agents.

[AIDS and the respiratory apparatus: a bibliographic review (I)]. / AIDS ed apparato respiratorio: rassegna bibliografica (I Parte).

The acquired immunodeficiency syndrome (AIDS) is characterized by severe abnormalities of cellular immunity with a marked reduction of helper/inducer T lymphocyte from peripheral blood and, clinically, by a high incidence of infection caused by opportunistic or more common pathogen organisms and by development of Kaposi's sarcoma in previously healthy young patients. The AA. underline epidemiologic, pathogenetic and immunologic points of this syndrome.

[AIDS and the respiratory apparatus: a bibliographic review (II)]. / AIDS ed apparato respiratorio. Rassegna bibliografica (II Parte).

The authors describe the clinical-radiological aspects of the most frequent lung infections during AIDS and point out the methods actually applied to define the correct etiological diagnosis of these complications. Therapy problems are widely reported at the ending part of the review together with useful parameters for the prognostic evaluation of respiratory infections in AIDS patients.