Efficacy of the BNT162b2 mRNA COVID-19 Vaccine in Patients with Chronic Lymphocytic Leukemia: A Serologic and Cellular Study.

BACKGROUND: Antibody response following SARS-CoV-2 vaccination is somewhat defective in chronic lymphocytic leukemia (CLL). Moreover, the correlation between serologic response and status of cellular immunity has been poorly studied. OBJECTIVE: This study was undertaken to assess humoral immune and cellular responses to the BNT162b2 messenger RNA (mRNA) COVID-19 vaccination in CLL. METHODS: The presence of the spike antibodies was assessed at a median time of 14 days from the second vaccine dose of SARS-CoV-2 in 70 CLL patients followed up at a single institution. RESULTS: The antibody response rate (RR) in CLL patients was 58.5%, compared to 100% of 57 healthy controls of the same sex and age (p < 0.0001). Treatment-naïve patients and those in sustained clinical remission after therapy had the highest RR (87.0% and 87.7%, respectively). In contrast, patients on therapy with a pathway inhibitor as monotherapy and those treated with an association of anti-CD20 antibody were unlikely to respond to the SARS-CoV-2 vaccine (52% and 10%, respectively). In multivariate analysis, early Rai stage (OR, 0.19 [0.05-0.79]; p = 0.02) and no previous therapy (OR, 0.06 [0.02-0.27]; p < 0.0001) were found to be independent predictors of vaccination response. An increase in absolute NK cells (i.e., CD16/CD56 positive cells) in patients with a serological response was found following the second dose of vaccine (p = 0.02). CONCLUSIONS: These results confirm that serological response to the BNT162b2 vaccine in patients with CLL is impaired. A third boosting vaccine dosage should be considered for these patients.

Risk factors for severe pediatric food anaphylaxis in Italy.

BACKGROUND: Little is known about the cause of food-induced anaphylaxis in children or about the factors that might affect its clinical severity. OBJECTIVE: The aim of this study was to investigate the cause of food-induced anaphylaxis in children in Italy and to identify factors that could influence the appearance of symptoms and the severity of anaphylaxis. METHODS: One hundred and sixty-three children with anaphylaxis consecutively attending 29 outpatient allergy clinics throughout Italy were enrolled in this prospective study. Information about past anaphylaxis episodes was collected with a standardized questionnaire. Food sensitization was evaluated by skin-prick test. RESULTS: A clinical history of asthma increased the risk of wheezing [odds ratio (OR) 2.2; 95% confidence interval (CI) 1.1-4.5] and respiratory arrest (OR 6.9; 95% CI 1.4-34.2). A clinical history of chronic/relapsing gastrointestinal symptoms increased the risk of vomiting (OR 2.1; 95% CI 0.9-4.3), hypotension (OR 7.9; 95% CI 1.9-32.0), and bradycardia/cardiac arrest (OR 9.2; 95% CI 0.9-91.3). The severity of present and previous episodes was similar only in patients with mild or moderate anaphylaxis. Peanut and egg were the most frequent causes of severe anaphylaxis. CONCLUSIONS: A clinical history of asthma and chronic/relapsing gastrointestinal symptoms (probably linked to food allergy) may predict the development of respiratory and gastrointestinal symptoms and the severity of anaphylaxis.

[Clinical, virological and epidemiological aspects of acute B hepatitis in the Catania area (Italy)]. / Valutazione epidemiologica, virologica e clinica dell'epatite acuta B nella provincia di Catania.

Starting from January 1997 we prospectively evaluated all cases of acute hepatitis B admitted to two of the main Infectious Diseases Units in Catania (eastern Sicily). The survey was extended throughout a 10-year period up to December 2007. Between 1997 and 1999 we observed 21 cases of acute hepatitis B; between 2000 and 2002 18 cases; between 2003 and 2005 22 cases and, finally, 37 cases were reported in the period 2006-2007. We found an increase in acute hepatitis B cases among people aged 26 to 44 years (from 38% in 1997-99 to 70% in 2006-07). A progressive decrease in intravenous drug abuse as a risk factor for acute hepatitis B was also observed (from 61% to 14%) together with a parallel increase in cases due to sexual transmission (from 19% to 56%) and outpatient cosmetic surgical procedures. Mean time to serum HBsAg negativization was longer in the last period (2006-07), with 6 cases out of 37 showing HBsAg persistence beyond 12 months from the clinical onset. Furthermore, in 2006-07 there were 12 cases (42%) of acute hepatitis due to HBV genotypes A and F. In our area, a progressive drop of hepatitis B cases due to intravenous drug abuse occurred, whereas heterosexual and iatrogenic cases increased. Cases due to HBV non-D genotypes may well be related to migration from endemic areas towards Sicily.

Osteopathia striata-cranial sclerosis: otorhinolaryngologic clinical presentation and radiologic findings.

BACKGROUND: Osteopathia striata with cranial sclerosis (OS-CS) is a rare bone dysplasia that presents with variable symptoms mainly due to the associated CS. METHODS: The otorhinolaryngologic clinical presentation and temporal bone computed tomography (CT) findings of a new case of OS-CS are presented. Differential diagnosis is also discussed. RESULTS: Our study confirms the typical appearance of the temporal bone reported in previous CT studies and the utility of CT for evaluating the various etiologies of conductive-mixed hearing loss present in OS-CS. Radiographs of the femur and pelvis revealed the typical striations of OS-CS and allowed us to diagnose this rare form of generalized skeletal dysplasia involving the skull base. CONCLUSIONS: To our knowledge, this is the third reported case of OS-CS in which temporal bone CT evaluation corroborated the smallness of the middle ear cavities, abnormal ossicular fixation, and bone sclerosis of the mastoid cells. Other radiographic studies regarding the whole skeleton may, in combination, be very helpful in the differential diagnosis between the different forms of generalized skeletal diseases with bone sclerosis involving the skull base.

Correlation between skin prick test using commercial extract of cow's milk protein and fresh milk and food challenges.

The skin prick test (SPT) is regarded as an important diagnostic measure in the diagnostic work-up of cow's milk protein allergy. It is not known whether commercial extracts have any advantage over fresh milk. The aims of the study were to (i) compare the diagnostic capacity of SPTs for the three main cow's milk proteins (alpha-lactalbumin, casein and beta-lactoglobulin) with fresh milk and (ii) determine a cut-off that discriminates between allergic and tolerant children in a controlled food challenge. A study was carried out on 104 children consecutively attending two paediatric allergy clinics for suspected cow's milk allergy. A clinical history, SPTs with fresh cow's milk and commercial extracts of its three main proteins and a challenge test were performed on all the children. A study of the validity of the prick test was also performed by taking different cut-off points for fresh milk and its proteins. Twenty-eight of 104 challenge tests (26.9%) were positive. At a cut-off point of 3 mm, fresh milk showed the greatest negative predictive value (98%), whereas casein showed the greatest positive predictive value (PPV, 85%). Calculation of 95% predicted probabilities using logistic regression revealed predictive decision points of 12 mm for lactalbumin, 9 mm for casein, 10 mm for beta-lactoglobulin and 15 mm for fresh cow's milk. We found that the greater the number of positive SPTs for milk proteins, the more likely the positive response to challenge. Having a positive SPT for all three milk proteins had PPV of 92.3% and would seem more clinically useful than any cut-off. Both fresh milk and cow's milk extract of the three main proteins could be useful in the diagnostic work-up of cow's milk allergy. Finding positivity to all three cow's milk proteins seems to be a simpler and more useful way of avoiding oral food challenges.

Consumption of fish, butter and margarine during pregnancy and development of allergic sensitizations in the offspring: role of maternal atopy.

It has been suggested that changes in dietary habits, particularly increased consumption of omega-6 polyunsaturated fatty acids (PUFA) and decreased consumption of omega-3 PUFAs may explain the increase in atopic disease seen in recent years. Furthermore, it seems possible that it is mainly prenatal or very early life environmental factors that influence the development of allergic diseases. It has also been suggested that intrauterine risk factors may act differently if mother themselves suffer from allergic disease. The aim of this study was to investigate whether the consumption of fish, butter and margarine during pregnancy might influence the development of allergic sensitizations in the offspring. The study population was divided into the offspring of allergic and non-allergic mothers. This was a retrospective cohort study enrolling 295 offspring of allergic mothers and 693 of non-allergic mothers. Information regarding maternal intake of fish, butter and margarine during pregnancy as well as other prenatal and perinatal confounding factors were retrospectively assessed by parental report via a standardized questionnaire. Atopy was determined by skin-prick tests (SPT) to eight prevalent inhalant allergens and two foods. In the allergic mothers' group there is no clear correlation between maternal intakes of fish, butter and margarine and sensitizations to food or inhalants. In the non-allergic mothers' group there was no correlation between butter and margarine intake and food or inhalant sensitizations. On the contrary, a protective effect of fish intake on SPT positivity was observed. In particular, frequent maternal intake ('2-3 times/wk or more') of fish reduced the risk of food sensitizations by over a third (aOR 0.23; 95% CI: 0.08-0.69). A similar trend, even if not significant, was found for inhalants. Finally, even in the whole study population, i.e. allergic group plus non-allergic group, there was a similar trend between increased consumption of fish and decreased prevalence of SPT positivity for foods. This study shows that frequent intake of fish during pregnancy may contrast the development of SPT sensitizations for foods in the offspring of mothers without atopic disease. Therefore, larger prospective studies are needed, enrolling mothers with and without allergic disease, to confirm these results.