Alpha-1-antitrypsin deficiency asthma and allergy.

The biochemistry, genetics and pathology of alpha-1-anti-trypsin deficiency are reviewed. The geographical distribution in Europe of more current phenotypes M, SZ is discussed. Two cases of alpha-1- anti-trypsin are presented one homozygotic ZZ non-smoker without any respiratory pathology and one heterozygotic SZ heavy smoker with a severe chronic obstructive pulmonary disease and reversibility to Beta-2-mimetics suggesting asthma. The relationship between alpha-1-antitrypsin and asthma is discussed and general measures of treatment or prevention suggested.

"In vivo" and "in vitro": tests in the diagnosis of trichophyton allergy.

A group of 100 patients with Trichophyton allergy and a control of group of 100 without fungal allergy have been compared in order to evaluate the diagnostic value of skin prick and intradermal tests and assay of Trichophyton specific IgE. The evaluation of sensitivity, specificity efficacy, positive and negative predictive values suggests that skin tests in two steps, prick and intradermal and research of specific IgE must be used to a better diagnostic approach. In cases were allergy is not cleared by antifungal therapy specific immunotherapy is worthwhile to be tried with a great percentage of success.

Drug allergy and asthma.

The prevalence of drug induced asthma in a series of 347 patients with drug induced adverse effects has been evaluated corresponding to 10% of drug adverse effects always due to NSAIDS.

"In vivo" and "in vitro" tests in the diagnosis of Beta-lactams allergy.

The results of "in vivo" and "in vitro" diagnostic tests in 114 patients reporting an allergic reaction to Beta-lactams are presented. Skin test gave an overall positivity of 85% and determination of specific IgE of 42%. Skin tests have a greater sensitivity but "in vitro" tests are an useful associated diagnostic method.

Drug allergy and pollinosis. A short report.

2 series of patients with pollinosis and drug allergy studied 10 years apart and comprising 115 cases are presented. In both series grass pollens and parietaria are as usual the most common cause of pollinosis but Parietaria was more common in the first series. Beta-lactams were the major cause of drug allergy in the first group, supersed by NSAID in the second group. Rhinitis was the more frequent symptom on pollinosis and urticaria/angioedema on drug allergy.

Trichophyton allergy: review of 89 cases.

A serie of 89 cases (55 men 34 women) of Tricophyton allergy is presented. All the patients had a clinical history and in 86 out of 89 lesions of dermatophytosis urticaria/angioedema was present in 57, eczema in 8, rhinitis in 12, conjunctivitis in 1 and asthma in 12. Skin prick tests to Tricophyton were positive in 53 (59,6%) of the patients and intradermal test in all. Specific IgE was found in 45 (69,3%) out of 70 patients. Antifungal treatment was effective at mean term in 18 cases. Specific immunotherapy was evaluated in 54 with good or very good results in 41 (83,3%). Tricophyton dermatophytosis must be looked for in all the cases of urticaria/angioedema and most cases of respiratory allergy without clear allergy to inhalants.

Prevalence of drug allergy in an out-patient population.

The prevalence of drug allergy in an out-patient population has been studied, 448 cases were diagnosed mainly to NSAIDS and beta-lactams and local anesthetics, sulfa drugs, quinolones and others. Clinical history and skin tests are sufficient to diagnose most cases of drug allergy.

Skin tests in NSAIDS hypersensitivity.

Prick tests are more specific but less sensitive than ID which can give false positive results. 3 NSAIDS groups can be considered: Aspirin, diclofenac and metamizol with a higher percentage of positivity. For others NSAIDS including the newer coxibs positivity around 50%. Nimesulid and acetaminophen with a lower of positivity. Skin tests can be used in NSAIDS hypersensitivity to confirm clinical history but also to choose, case by case, a drug less prone to give hypersentivity reactions.

Monoid sublingual immunotherapy.

Sublingual monoid immunotherapy with monomeric allergoids has been largely used in Europe in the last few years. An open trial of allergoid in tablets has been done in rhinitic patients allergic to house dust mites, grass pollens and Parietaria with clear improvement in clinics and drug consumption scores. In a second phase a double blind placebo controlled trial of grass pollens allergoids have been done in hay fever patients with significant decrease on the scores of rhinorrea, sneezing and conjunctivitis nasal steroid consumption and clinical score after serial nasal challenges. Monomeric allergoids are an efficace and safe immunotherapy in allergic rhinitis.

Solar urticaria and porphyrias.

The importance of disturbances of porphyrin metabolism in solar urticaria is discussed. 15 cases of porphyrias with sun sensitivity are presented comprising 5 cases of erythropoietic protoporhyria, 8 cases of coproporphyria hereditaria and 2 cases of porphyria variegata, 9 out of these 10 patients presented neuroabdominal symptoms and in 4 cases contraceptive pills have triggered the disease. Due to the risk of severe forms of disease sometimes drugs induced porphyrias must be considered in all cases of solar urticaria and a correct laboratory study done in the suspected cases.

Chronic urticaria and thyroid auto-immunity.

Purpose was to evaluate thyroid auto-immunity and thyroid function in chronic urticaria (CU). Evaluation of antibodies Ab to thyroglobulin (TG) thyroid peroxidase (TPO) and of TSH, FT3, FT4, and of intra-dermal self test with patients own serum in 56 patients presenting chronic idiopathic urticaria and in a matched control group of 56 subjects without CU. Ab to TG positive in 13 (22.2%) to TPO in 15 (26.8%). Overall thyroid antibodies 28.5%. Thyroid function normal in 52 patients, TSH increased in 2, FT3 decreased in 1, TG and TPO Abs and thyroid function results always normal in control group. Self test positive in 4 out of 56 patients. Therapy with thyroid extract was effective in 2 out of 5 cases. CU is associated with thyroid autoimmunity in most cases. Thyroid Ab and function must be evaluated in all the cases of chronic urticaria.

Allergy to sunflower seeds.

A case of oral syndrome after eating sunflower seeds is reported. Sensitization has been probably through inhalant route when using these seeds to feed birds. Skin prick tests with a fresh macerate of sunflower seeds has been clearly positive (greater than histamine control) but commercial extracts have given borderline positivity and specific IgE to sunflower was strongly positive.

Immunoblot studies in allergic patients to hymenoptera venom before and during immunotherapy.

BACKGROUND: Hymenoptera venom immunotherapy (VIT) is immunologically effective in patients with systemic allergic reactions after hymenoptera stings. OBJECTIVE: To evaluate the effect of VIT on specific IgE and IgG4 immunoblotting bands in VIT-treated patients. MATERIAL AND METHODS: Specific IgE and IgG4 immunoblotting bands for hymenoptera venom were performed with ALABLOT in sera of 17 patients (8 allergic to honeybee venom, 8 to wasp and 1 to polistes venom) before and during successful VIT (1 and 3 years). Before immunotherapy, all patients had experienced moderate/severe systemic reactions to a hymenoptera sting, with positive skin tests and venom-specific IgE. During immunotherapy all patients suffered field stings, without any systemic reaction. RESULTS: Before VIT we detected several immunoglobulin-binding bands in different regions, with different individual patterns. After VIT, we observed in some patients (5/8 for honeybee venom, 6/8 for wasp and 1/1 for polistes) complete disappearance of some IgE-binding bands, mainly the 15 kDa region (honeybee) and 23 and 44 kDa regions (wasp and polistes). All patients showed decreased intensity of IgE-binding bands, most pronounced in regions 16, 44 and 52 kDa (honeybee); 44 and 35 kDa bands (wasp) and 23 kDa (polistes). Some patients showed de novo appearance of IgG4-binding bands (4/8 for honeybee and 8/8 for wasp venom), mainly in 52 kDa (honeybee) and in 23 and 44 kDa regions (wasp). All patients showed increased intensity of IgG4 bands that were already present before VIT, more pronounced in 52 and 44 kDa (honeybee) and in 44 and 35 kDa regions (wasp). CONCLUSIONS: During successful VIT there are changes in intensity and number of IgE and IgG4 binding bands, which could reflect the immunological improvement induced by VIT. These changes are more pronounced/frequent in wasp VIT, a fact that could explain the best results usually seen in these patients.

Nasal provocation and immunotherapy.

Nasal mucosa is heavily exposed to inflammatory and allergic stimuli, rhinitis being the most common form of allergic respiratory disease. The nose is an easily accessible organ and a good model for the study of allergies as it makes it possible to monitor the effects of specific challenges as well as therapeutic interventions, namely specific immunotherapy (SIT). Injectable, nasal or sublingual SIT are useful therapeutic strategies in the management of allergic rhinitis patients. Monitoring the evolution of parameters such as clinical scores, nasal peak flow variation or drug requirements during SIT provides important information on its clinical efficacy. Laboratory measurement of tryptase and eosinophil cationic protein in the target organ after specific nasal provocation makes it possible to record changes in the release of mast cell and eosinophil mediators, thus providing objective evidence of the immunological efficacy of this therapy on these cell populations and providing data which eventually will contribute to a better understanding of the multiple mechanisms of action of allergen desensitization therapy.

Soluble intercellular adhesion molecule 1 in the peritoneal fluid of patients with endometriosis correlates with the extension of peritoneal implants.

OBJECTIVE: To investigate the correlation of the concentrations of soluble intercellular adhesion molecule 1 (sICAM-1) in the peritoneal fluid (PF) with the extent of peritoneal endometriotic lesions and with the presence of red lesions (RLs). STUDY DESIGN: Sixty-seven patients with endometriosis and 19 controls with normal pelvis had PF samples collected during laparoscopy. RESULTS: The concentrations of sICAM-1 in the PF of patients and controls were not different. Patients with peritoneal implant scores 4 or more had higher concentrations of sICAM-1 in the PF than those with implant scores less than 4 (P=0.018) and controls (P=0.031). No significant difference was found in sICAM-1 levels in patients with and without RLs. No correlation was detected between sICAM-1 and interleukin 1beta (IL-1beta) in either patients or controls. CONCLUSIONS: The increased concentrations of sICAM-1 in the PF of patients with greater implant scores may indicate an active shedding of the molecule from the endometriotic peritoneal tissue. No significant association was found with the presence of RLs. The levels of IL-1beta in the PF were not a relevant factor influencing the concentrations of sICAM-1.

The effect of levocabastine nasal spray in nasal provocation tests.

The effect of levocabastine, a new specific H1 antagonist, has been investigated against a placebo in nasal provocation tests on 42 allergic patients divided into two parallel groups. The results obtained show that it significantly inhibited the nasal reaction to the allergen and seems to have a long-lasting effect in allergic patients.

Local and systemic immunotherapy in nasal allergy.

Two assays have been done to evaluate the effect of immunotherapy in nasal allergy. First, a trial of nasal immunotherapy and second, the study of mediator release after vaccines. Local immunotherapy, applied directly, triggers different response mechanisms. Specific nasal immunotherapy started before seasonal or perennial symptoms peak, has been done by increasing the doses of allergen three times a week during a 3-month period and a manutention period of a weekly nasal puff of the same allergen. Symptom scores and drug consumption have been registered. The results have been compared with the scores obtained in the same patients over the same period of the same year before immunotherapy. In perennial rhinitis blockage, rhinorrea, sneezing and itching scores all decreased. In seasonal rhinitis, a similar score decrease was obtained for blockage, rhinorrea, sneezing and itching. Pharmacological scores also decreased. These data point to a short-term effect of nasal immunotherapy. Tryptase release has been evaluated in nasal washings after nasal challenge with a Parietaria (Pellitory wall) extract before and after specific systemic immunotherapy, in order to evaluate changes in mast cells reactivity. Eight patients were studied, all allergic to Parietaria. Nasal provocation tests have been done before the season with increasing doses of 10, 100 and 1000 PNU and tryptase assayed in nasal washings at 10, 20 and 30 min after provocation. Immunotherapy decreased tryptase release after nasal challenge. The data point to the effect of systemic specific immunotherapy on mast cell reactivity.

Candida and human disease.

A general review on candida and human disease emphasizing Candida Species, clinical manifestations, immune response NK failure and immunotherapy.

Lung function in asthma: relation to clinics, challenge tests and immunotherapy.

BACKGROUND: In the last few years the consensus on asthma, guidelines and GINA have introduced a classification based on clinical criteria, PFR or FEV1 values and reversibility. However the relation of clinical classification with the functional data is not well defined. PURPOSE: To correlate the clinical evaluation of asthma with the most usual parameters of larger and smaller airways bronchial obstruction, PFR and FEV1.n MATERIAL AND METHODS: 153 patients have been studied by spirometry on absence of bronchodilator or anti inflammatory therapy in the last few days. Clinically, they were classified following the 2002 revised strategy for asthma management (NIH), 66 as mild intermitent, 61 mild persistent and 26 moderate persistent asthmas. RESULTS: In mild intermitent asthma PFR was decreased in 53 patients (80.3%) and FEV1 in 51 (77.2%). In mild persistent PFR and FEV1 were decreased in 59 (96.7%). In medium persistent asthma PFR was decreased in 25 (96.0%) and FEV1 in 24 (92%). The values of PFR and FEV1 were statistically different in intermitent and persistent asthma. For PFR square chi X2 = 8.91, p < 0.01 and for FEV1 X2 = 9.0 p < 0.01. In contrast there were no statistically differences between mild and moderate persistent asthmas. For PFR X2 = 0.02 p < 0.8 and for FEV1 X2 = 0.039, p < 0.9 (tables 1, 2, 3, 4). DISCUSSION: The occurrence of 77.2% and 80.3% of decreased FEV1 and PFR values in non dyspnea as reported by the patients. There were also no functional differences between patients in the different groups of persistent asthma. Clinical and functional data must be correlated, case by case in order to establish a correct classification of asthmatic patients and improve therapy and the relation between lung function and clinic reevaluate.

Correlation between clinical classification, PEF and FEV1: guidelines and reality.

The currently proposed guidelines and consensus for asthma include Peak expiratory flow (PEF) and forced expiratory volume in the first second (FEV1) as two criteria to classify asthma severity. The report between these functional data and clinical classification degrees has been evaluated in 153 asthmatic patients. Concordance between functional evaluation and clinical degree has been found only for moderate persistent asthma but not for intermittent or mild persistent asthma. These results suggest that the correlation between clinical evaluation and lung function proposed in the guidelines must be reevaluated.