The natural history of respiratory allergy: a follow-up study of 99 patients up to 10 years.

A strict relationship between allergic rhinitis and allergic asthma has been seen recently, and in many ways respiratory allergy could be seen as a single disorder of the airways. The link between rhinitis and asthma can be elucidated only by studying the natural history of the disease over long periods. We describe the follow-up of 99 allergic patients up to 10 years and the evolution of their disease. Ninety-nine patients (50 male, 49 female, mean age 31 years) out of 142, suffering from allergic rhinitis or allergic asthma, could be monitored up to 10 years after the initial diagnosis. Demographics, sensitizations and smoke habit were assumed as evaluation parameters. At baseline, 44 patients suffered from AR alone, 12 from AA alone and 43 from AR+AA. After 10 years, 31.8% of the AR patients developed developed AA and 50% of the patients with AA developed AR. Only the familial history for atopy significantly influenced the disease's evolution, whereas gender, age, smoking habit and skin sensitization did not. Sixty-five percent of patients with a single sensitization at the beginning developed new sensitizations. In conclusion, this long-term survey confirms that a relevant percentage of patients with AR alone or AA alone have a progression of the disease.

Inhibition of adhesion molecules by budesonide on a human epithelial cell line (lung carcinoma).

Inhaled corticosteroids in the treatment of asthma have been shown to produce marked reductions in the number of inflammatory cells (mainly mast cells and eosinophils) and their products at bronchial level (such as cytokines). Recently, it has been demonstrated that epithelial cells express ICAM-1/CD54 in allergic patients both during natural allergen exposure and after allergen challenge. We have previously demonstrated that deflazacort (a systemic steroid) reduces the expression of ICAM-1 on conjunctival epithelial cells. The present study aimed to evaluate the effects exerted by budesonide on adhesion molecule expression by a human epithelial cell line (lung carcinoma: DM) and on soluble ICAM-1. Budesonide was added at concentrations corresponding to 10(-8), 10(-7), and 10(-6) mol/l in cultured epithelial cells, either in the absence of any stimulus or in the presence of interferon-gamma (IFN-gamma) at 500 U/ml. After 24 h of incubation, cytofluorometric analysis was performed for ICAM-1 and CD29/VLA beta 1. The 24-h supernatants of the same cultures were collected and then evaluated for soluble ICAM-1 (sICAM-1). The results showed that budesonide inhibits ICAM-1 and CD29 basal expression on the cells studied (P < 0.05): budesonide was effective in a dose-dependent manner. In addition, budesonide reduced surface ICAM-1 upregulation induced by IFN-gamma at 500 U/ml (P < 0.05). Finally, cell cultures with budesonide showed decreased levels of soluble ICAM-1 in basal condition, but not after IFN-gamma stimulation.

Fibrous invasive (Riedel's) thyroiditis with critical response to steroid treatment.

The Riedel's thyroiditis is an uncommon form of chronic thyroiditis characterized by an invasive fibrosclerosis of the gland, often involving the surrounding tissues. Usually, the only possible treatment is the surgical decompression of the tissues. We describe a case of aggressive Riedel's thyroiditis with severe compression and dislocation of trachea and esophagus. The surgical approach was uneffective, while an "ex juvantibus" steroid treatment, resulted in a dramatic regression of fibrosclerosis and a complete clinical remission. This report points out the possible effectiveness of corticosteroids in the treatment of selective disorders involving increased fibrogenesis.

The effects of sumatriptan on pituitary secretion in man.

Sumatriptan, a new antimigraine drug with high affinity and selectivity for certain 5-hydroxytryptamine (5-HT1D) receptor subtypes, was administered to 12 normal subjects, in order to investigate the effects of 5-HT receptor activation on anterior pituitary secretion. Sumatriptan increased plasma growth hormone (GH) levels from 2.5 +/- 0.5 mIU/l in basal conditions to 17.3 +/- 2.6 mIU/l 30 min after administration of the drug. After pre-treatment with cyproheptadine, an anti-serotoninergic drug known to inhibit GH secretion, the mean integrated sumatriptan-induced GH response decreased from 14.8 +/- 3.9 muI/l*hr to 3.7 +/- 1.7 mIU/l*hr. Sumatriptan administration did not have any effect on the secretion of the other anterior pituitary hormones. It is concluded that sumatriptan selectively increases GH secretion in man, but the exact nature of the receptors involved is not yet known.

Effect of S-adenosyl-L-methionine on brain muscarinic receptors of aged rats.

The number of muscarinic receptors in the striatum and hippocampus of aged rats is significantly lower than the number measured in young animals. The treatment of aged rats for 30 days with S-adenosyl-L-methionine (SAM) restored the number of muscarinic receptors to levels found in the striatum and hippocampus from young animals. We did not observe a clear-cut difference between the dissociation constants of untreated young and untreated or SAM-treated aged rats, whereas the binding capacity varied. Moreover, in vitro addition of SAM to hippocampal membranes from aged rats resulted in a significant increase in the number of binding sites. This in vitro effect was antagonized by S-adenosyl-L-homocysteine, a specific in vitro inhibitor of methyltransferase activity. The reduction in the muscarinic receptor density could be related to a decrease in neuronal membrane fluidity induced by aging, while its increase after SAM treatment might be ascribed to the ability of this methyl donor to increase the fluidity of cell membranes by stimulating phospholipid synthesis.

Comparative study between two immunoassays for detection of allergen-specific IgG4.

In the present work two commercially available immunoassays for allergen-specific IgG4 detection were compared, IgG4 FAST Test and ALLERBLOCK-MS IgG4 EIA Kit. For this purpose 30 serum samples were tested for IgG4 antibodies (Abs) specific to Dermatophagoides pteronyssinus (Dp) by the two immunoassays. Eleven serum samples were collected from normal subjects, 6 from Dp-atopic patients never treated by specific immunotherapy (ITS) and 13 from Dp-atopic patients previously treated by ITS. Pearson's linear correlation analysis showed a significant correlation of results from the two immunoassays. However, a better discrimination of Dp-specific IgG4 values between ITS-treated and untreated patients or normal subjects was obtained by FAST than ALLERBLOCK-MS method; moreover, the former showed a better intra-assay coefficient of variation than the latter.

The surgical treatment of bronchial carcinoid adenoma: a personal experience.

Clinical and pathological observations on 7 resected cases of bronchial carcinoid have been reviewed. Bronchoscopy was the most definitive diagnostic procedure. Bronchoplastic procedures were the treatment of choice for these low-grade potentially malignant lesions. Indications for extensive lung resection were distal suppuration and tumor extention into the parenchyma. There were no operative deaths or major complications. All the patients are still alive (mean follow-up 39.4 months) with no recurrence of tumor.

Bronchoalveolar lavage and transbronchial lung biopsy in sarcoidosis and extrinsic allergic alveolitis.

Bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB) in the same endoscopic session were performed in 44 patients: 20 were affected by active sarcoidosis (AS), 15 by inactive sarcoidosis (IS) and nine by extrinsic allergic alveolitis (EAA). Compared with 12 healthy controls, in EAA and AS patients the total number of cells and the percentage of lymphocytes were increased both in smokers and non-smokers. TBLB showed sarcoid granulomata in 15 AS and six IS patients, interstitial fibrosis in four AS and seven IS patients, and normal lung tissue in two IS patients. In EAA, TBLB revealed granulomata or mononuclear infiltrates in four patients and fibrosis in a further four. Regarding the correlation between TBLB and BAL, sarcoid granulomata were more frequently found in patients with AS, as reflected by the increased number of lymphocytes in BAL. The procedure produced no significant complications.

Transbronchial lung biopsy with fiberoptic bronchoscope.

Transbronchial lung biopsy (TBB) was performed during fiberoptic bronchoscopy under fluoroscopic guidance in 133 patients with diffuse or peripherally localized lung diseases without endobronchial lesions. Histological diagnosis consistent with the clinical course and roentgenographic appearance was obtained in 96 patients (72%). In four cases specimens were inadequate for histological evaluation (3%). In 33 cases a diagnosis was not possible even though the specimens were adequate for histological examination. The low complication rate in this series seems due to the selection of patients and the technique used.