An approach to urticaria in the elderly patients.

The guidelines for the management of urticaria in adults and children have been published in outstanding position papers. By contrast, the onset of urticaria in the elderly has not yet had a clear definition. In order to approach diagnosis and treatment in a population of elderly patients, we have performed an epidemiological study on a population of elderly people observed in the Immuno Allergology Unit in Bari University Hospital. The patients underwent skin prick test for food allergy and laboratory and instrumental tests. From the data it resulted that 49% of cases have had urticaria because of adverse drug reactions (ADRs), 16% of cases were positive to food, while in 21% of cases systemic and metabolic diseases (SMDs) have been diagnosed. If we consider the young controls, urticaria for ADR was present in 48% of cases; however, in 28% it was possible to make the diagnosis of food allergy, 12% cases had a SMD. Our results show that the main cause of urticaria in the elderly is related to drug assumption because of the high number of drugs taken, followed by internal pathologies correlated to the typical immune and metabolic changes of the elderly. Furthermore, from the observation of our data it was possible to give guidelines for the treatment of urticaria in geriatric age.

Clinical data and inflammation parameters in patients with cypress allergy treated with sublingual swallow therapy and subcutaneous immunotherapy.

The clinical efficacy of immunotherapy, either by high dose sublingual-swallow therapy (SLIT) or subcutaneous immunotherapy (SCIT), has been demonstrated in patients with pollinosis but few studies have been carried out analysing differences in these treatments in terms of an improvement of clinical and allergic phlogosis parameters. The aim of this double-blind placebo-controlled study is to investigate the efficacy of high dose SLIT and SCIT using a purified standardized Juniperus ashei extract in a population of allergic patients monosensitized to cypress. Forty patients with cypress-allergic rhino conjunctivitis were administered therapeutic or placebo SLIT or SCIT for 12 months. Laboratory parameters were studied, namely the eosinophil cationic protein (ECP) level in nasal lavage and in serum, as well as the number of eosinophils (EOS) in peripheral blood and in nasal lavage and the level of eosinophil chemotactic activity (ECA). These parameters were correlated with clinical symptoms, evaluated by means of the clinical symptoms score (CSS). After SCIT and SLIT the levels of ECP and ECA were reduced in nasal lavage. We also observed a significant reduction in the values of ECP in serum in the patients treated with SLIT. EOS were unchanged in peripheral blood, but significantly reduced in nasal lavage. These data were in accordance with the improvement of clinical symptoms, supported by the close correlation between CSS and laboratory parameters. Our data confirm a clinical improvement correlated with a decline in inflammation parameters after one year of immunotherapy, supporting the hypothesis that treatment with a major allergen of cypress is able to change the course of allergic rhinitis.

Immediate and cell-mediated reactions in parasitic infections by Anisakis simplex.

BACKGROUND: Anisakis simplex is responsible for allergic symptoms after repeated ingestion or contact with parasitized fish. OBJECTIVE: To further analyze type I and IV immunologic mechanisms in a group of patients with allergic reactions to A simplex, we performed prick-by-prick testing with A simplex larvae and patch tests with live, cooked, or frozen larvae of the A simplex parasite. METHODS: Thirty-eight patients underwent skin prick test and radioallergosorbent test with inhalant allergens, foods, and A simplex. Prick-by-prick tests with A simplex and patch tests with live, cooked, and frozen larvae were carried out in 10 patients with evidence of allergy to A simplex. RESULTS: Prick-by-prick testing yielded a positive result in 100% of cases with live larvae and in 70% with cooked and frozen larvae. Patch tests with A simplex were positive in 8 patients for live larvae, in 3 patients for frozen larvae, and in 1 patient for cooked larvae. CONCLUSION: Our data emphasize that A simplex is responsible for both immediate allergic reactions and cell-mediated (delayed) reactions, in particular in subjects with occupational exposure. In addition, our data demonstrate that not only live but also frozen and cooked larvae can induce sensitization. This observation may be explained by differences in the allergenic proteins involved, and further studies will be required to address this possibility.

Statistical evaluation and parameters of phlogosis in patients sensitized to cypress.

To assess the increasing sensitivity to cypress, we evaluated a group of allergic subjects living in Apulia who had been referred for respiratory symptoms to the Section for Allergic and Immunological Diseases (SAID) of Bari University Hospital in the period between January and March 2006, and compared them with a group evaluated during the same months of 2003. We submitted all patients to Skin Prick Tests (SPT) and Radio-Allergo-Sorbent Tests (RAST). Our data show that the percentage of people sensitised to cypress has increased from 28.6 percent (2003) to 65.5 percent (2006). By contrast, we observed no variations in sensitisation to other substances. Since according to data furnished by the Italian Association of Areobiology (AIA), Monitoring Center of Brindisi 1, there was a variation in the quantity of pollen grains in 2006 as compared to 2003, it seems conceivable that an increase in the amount of pollen grains, together with other factors may influence the increasing sensitization, like the volume and the brittleness of the grain. In addition, other allergo-immunologic parameters are evaluated in order to better evaluate this allergic phlogosis.

Latex allergy and sensitization in cities: a survey in a population at risk.

The constant increase in allergic diseases in western countries is correlated with changes in lifestyle and with the deterioration of the air inhaled by the inhabitants because of the growing concentrations of pollutant substances present. Within a population at risk, i.e., the inhabitants of cities, a group of subjects at even higher risk was selected, whose job exposes them to automobile exhaust fumes for many hours a day. All the study subjects underwent allergological screening and spirometry. The results obtained show an overall increase of respiratory allergic diseases but no increased sensitisation to latex. It therefore seems plausible that, besides social and lifestyle changes, the deterioration of the quality of the air could be considered responsible, at least in part, for the growing numbers of allergic subjects. This study offers an opportunity to reconsider the validity of the hygiene hypothesis as an explanation for the increase of allergic disease in western countries, although recent reports have indicated that a sedentary lifestyle may also contribute, together with environmental degradation, to the notably increased prevalence of allergic diseases in large cities in industrialized nations.