Urticaria: recommendations from the Italian Society of Allergology, Asthma and Clinical Immunology and the Italian Society of Allergological, Occupational and Environmental Dermatology.

BACKGROUND: Urticaria is a disorder affecting skin and mucosal tissues characterized by the occurrence of wheals, angioedema or both, the latter defining the urticaria-angioedema syndrome. It is estimated that 12-22% of the general population has suffered at least one subtype of urticaria during life, but only a small percentage (estimated at 7.6-16%) has acute urticaria, because it is usually self-limited and resolves spontaneously without requiring medical attention. This makes likely that its incidence is underestimated. The epidemiological data currently available on chronic urticaria in many cases are deeply discordant and not univocal, but a recent Italian study, based on the consultation of a national registry, reports a prevalence of chronic spontaneous urticaria of 0.02% to 0.4% and an incidence of 0.1-1.5 cases/1000 inhabitants/year. METHODS: We reviewed the recent international guidelines about urticaria and we described a methodologic approach based on classification, pathophysiology, impact on quality of life, diagnosis and prognosis, differential diagnosis and management of all the types of urticaria. CONCLUSIONS: The aim of the present document from the Italian Society of Allergology, Asthma and Clinical Immunology (SIAAIC) and the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) is to provide updated information to all physicians involved in diagnosis and management of urticaria and angioedema.

Omalizumab in Chronic Urticaria: An Italian Survey.

Omalizumab is approved for use in chronic spontaneous urticaria (CSU); however, it is not approved for chronic inducible urticaria (CIndU). The aim of the present study was to assess the effectiveness of omalizumab in treating CSU and CIndU in Italy. This is a multicentre prospective observational real-life study involving patients with severe urticaria capable of undergoing omalizumab therapy. We enrolled 127 patients (59.1% females), ranging in age from 15 to 83 years, 69.3% had CSU alone, 26.8% had CSU and CIndU, and 3.9% had only CIndU (30.8% delayed pressure, 35.9% dermographic, 15.3% cholinergic, 12.8% cold, 5.1% aquagenic). After the first cycle of omalizumab (300 mg every 4 weeks for 24 weeks), 16 CSU patients and 10 patients (20.5%) with CIndU with or without CSU did not require a second cycle of omalizumab (300 mg every 4 weeks for 20 weeks). The patient with aquagenic urticaria achieved remission after the first cycle. None showed a lack of response to the second cycle of omalizumab. Omalizumab is a promising drug for both spontaneous and inducible chronic urticaria. Current evidence indicates that omalizumab may be approved also for CIndU.

Enhanced Molecular Typing of Treponema pallidum subspecies pallidum Strains From 4 Italian Hospitals Shows Geographical Differences in Strain Type Heterogeneity, Widespread Resistance to Macrolides, and Lack of Mutations Associated With Doxycycline Resistance.

BACKGROUND: Although syphilis rates have been relatively high in Italy for more than 15 years, no data on the molecular types of Treponema pallidum subspecies pallidum circulating in this country are yet available. Likewise, no data on how widespread is resistance to macrolide or tetracycline antibiotics in these strains exist. Such data would, however, promote comprehensive studies on the molecular epidemiology of syphilis infections in Italy and inform future interventions aiming at syphilis control in this and other European countries. GOALS AND STUDY DESIGN: Swabs from oral, genital, cutaneous, or anal lesions were obtained from 60 syphilis patients attending dermatology clinics in Milan, Turin, Genoa, and Bologna. Molecular typing of T. pallidum DNA was performed to provide a snapshot of the genetic diversity of strains circulating in Northern Italy. Samples were also screened for mutations conferring resistance to macrolides and tetracyclines. RESULTS: T. pallidum DNA was detected in 88.3% (53/60) of the specimens analyzed. Complete and partial T. pallidum typing data were obtained for 77.3% (41/53) and 15.0% (8/53) of samples, respectively, whereas 4 samples could not be typed despite T. pallidum DNA being detected. The highest strain type heterogeneity was seen in samples from Bologna and Milan, followed by Genoa. Minimal diversity was detected in samples from Turin, despite the highest number of typeable samples collected there. Resistance to macrolides was detected in 94.3% (50/53) of the strains, but no known mutations associated with tetracycline resistance were found. CONCLUSIONS: Genetic diversity among T. pallidum strains circulating in Northern Italy varies significantly among geographical areas regardless of physical distance. Resistance to macrolides is widespread.

Estudio genético de los virus dengue circulantes en los últimos años en Argentina / Genetic study of dengue viruses circulating in recent years in Argentina

INTRODUCCION: El virus dengue (VDEN) es uno de los más importantes virus emergentes. Según la Organización Mundial de la salud, más de dos quintos de la población mundial se encuentran en riesgo de infección. En Argentina se registró un gran brote en 2009, que se diseminó hacia regiones donde el VDEN no era endémico.OBJETIVO: Realizar un análisis filogenético de los aislamientos del brote 2009 y, por otra parte, analizar la prevalencia de anticuerpos Inmunoglobulina (IgG) anti-dengue en el banco de sangre.METODOS: Para la realización del análisis filogenético, el virus fue aislado en células C6/36, el ARN viral fue extraído y amplificado por RT-PCR. Los amplicones purificados fueron secuenciados. El estudio de prevalencia se realizó a partir de 5 ml de sangre. Las muestras fueron centrifugadas para la separación del suero, que se utilizó para determinar anticuerpos mediante el ensayo por inmunoabsorción ligado a enzimas (ELISA).RESULTADOS: Las secuencias obtenidas durante el brote de 2009 estaban relacionadas filogenéticamente con aislamientos de Paraguay y Brasil. Con respecto a la prevalencia de anticuerpos, se observó que el 15,7% de las muestras fueron positivas. La cercanía filogenética entre las secuencias obtenidas y los aislamientos provenientes de Paraguay y Brasil mostraron una correlación con datos epidemiológicos. Los pacientes informaron que habían realizado viajes a los mencionados países limítrofes. Los datos de prevalencia de anticuerpos anti-VDEN mostraron que un gran porcentaje de la población había tenido un encuentro con el virus; muy probablemente, las manifestaciones clínicas fueron inaparentes.CONCLUSIONES: Las dimensiones de la población positiva para IgG son relevantes para conocer la población susceptible a padecer infecciones primarias y reinfecciones. Esto es de suma importancia, puesto que las infecciones secundarias están asociadas a las manifestaciones más severas de la enfermedad.

INTRODUCTION: The dengue virus (DENV) is one of the most important emerging viruses. According to the World Health Organization, more than two fifths of the world population are at risk of infection. In Argentina, a large outbreak occurred in 2009, which spread to regions where DENV was not endemic.OBJECTIVE: To conduct a phylogenetic analysis of the 2009 outbreak isolates and study the prevalence of dengue IgG antibodies in the blood bank.METHODS: To perform the phylogenetic analysis, the virus was isolated in C6/36 cells, the viral RNA was extracted and amplified by RT-PCR. The purified amplicons were sequenced. The prevalence study was conducted from 5 ml blood. Samples were centrifuged to separate serum, which was used for determination of antibodies by enzyme-linked immunosorbent assay (ELISA).RESULTS: The sequences obtained during the 2009 outbreak were phylogenetically related to isolates from Paraguay and Brazil. With regard to the prevalence of antiboides, 15.7% of the samples were positive. The phylogenetic closeness between the obtained sequences and the isolates from Paraguay and Brazil had a corelation with epidemiological data. The patients reported travel history to those neighboring countries. The prevalence data of DENV antibodies showed that a large percentage of the population had encountered the virus, and most likely the clinical signs were inapparent.CONCLUSIONS: The dimensions of the IgG-positive population is relevant to know the population susceptible to primary infection and to reinfection. This is very important, since secondary infections are associated with the most severe manifestations of the disease.

Estudio genético de los virus dengue circulantes en los últimos años en Argentina / Genetic study of dengue viruses circulating in recent years in Argentina

INTRODUCCION: El virus dengue (VDEN) es uno de los más importantes virus emergentes. Según la Organización Mundial de la salud, más de dos quintos de la población mundial se encuentran en riesgo de infección. En Argentina se registró un gran brote en 2009, que se diseminó hacia regiones donde el VDEN no era endémico.OBJETIVO: Realizar un análisis filogenético de los aislamientos del brote 2009 y, por otra parte, analizar la prevalencia de anticuerpos Inmunoglobulina (IgG) anti-dengue en el banco de sangre.METODOS: Para la realización del análisis filogenético, el virus fue aislado en células C6/36, el ARN viral fue extraído y amplificado por RT-PCR. Los amplicones purificados fueron secuenciados. El estudio de prevalencia se realizó a partir de 5 ml de sangre. Las muestras fueron centrifugadas para la separación del suero, que se utilizó para determinar anticuerpos mediante el ensayo por inmunoabsorción ligado a enzimas (ELISA).RESULTADOS: Las secuencias obtenidas durante el brote de 2009 estaban relacionadas filogenéticamente con aislamientos de Paraguay y Brasil. Con respecto a la prevalencia de anticuerpos, se observó que el 15,7% de las muestras fueron positivas. La cercanía filogenética entre las secuencias obtenidas y los aislamientos provenientes de Paraguay y Brasil mostraron una correlación con datos epidemiológicos. Los pacientes informaron que habían realizado viajes a los mencionados países limítrofes. Los datos de prevalencia de anticuerpos anti-VDEN mostraron que un gran porcentaje de la población había tenido un encuentro con el virus; muy probablemente, las manifestaciones clínicas fueron inaparentes.CONCLUSIONES: Las dimensiones de la población positiva para IgG son relevantes para conocer la población susceptible a padecer infecciones primarias y reinfecciones. Esto es de suma importancia, puesto que las infecciones secundarias están asociadas a las manifestaciones más severas de la enfermedad.

INTRODUCTION: The dengue virus (DENV) is one of the most important emerging viruses. According to the World Health Organization, more than two fifths of the world population are at risk of infection. In Argentina, a large outbreak occurred in 2009, which spread to regions where DENV was not endemic.OBJECTIVE: To conduct a phylogenetic analysis of the 2009 outbreak isolates and study the prevalence of dengue IgG antibodies in the blood bank.METHODS: To perform the phylogenetic analysis, the virus was isolated in C6/36 cells, the viral RNA was extracted and amplified by RT-PCR. The purified amplicons were sequenced. The prevalence study was conducted from 5 ml blood. Samples were centrifuged to separate serum, which was used for determination of antibodies by enzyme-linked immunosorbent assay (ELISA).RESULTS: The sequences obtained during the 2009 outbreak were phylogenetically related to isolates from Paraguay and Brazil. With regard to the prevalence of antiboides, 15.7% of the samples were positive. The phylogenetic closeness between the obtained sequences and the isolates from Paraguay and Brazil had a corelation with epidemiological data. The patients reported travel history to those neighboring countries. The prevalence data of DENV antibodies showed that a large percentage of the population had encountered the virus, and most likely the clinical signs were inapparent.CONCLUSIONS: The dimensions of the IgG-positive population is relevant to know the population susceptible to primary infection and to reinfection. This is very important, since secondary infections are associated with the most severe manifestations of the disease.