The role of skin tests with polyethylene glycol and polysorbate 80 in the vaccination campaign for COVID-19: results from an Italian multicenter survey.

Summary: Background. International guidelines suggested skin tests with Polyethylene-glycol (PEG) and polysorbate 80 (PS-80), to investigate a possible hypersensitivity to these excipients either to identify subjects at risk of developing allergic reactions to Covid-19 vaccines, or in patients with suspected IgE mediated hypersensitivity reactions (HR) to the Covid-19 vaccine. The main purpose of this study was to investigate the prevalence of PEG and PS sensitization in patients with a clinical history of HR to drugs containing PEG/PS and in patients with a suspected Covid-19 vaccine immediate HR. Methods. This was a multicenter retrospective study conducted by allergists belonging to 20 Italian medical centers. Skin testing was performed in 531 patients with either a clinical history of suspected hypersensitivity reaction (HR) to drugs containing PEG and/or PS-80 (group 1:362 patient) or a suspected HR to Covid-19 vaccines (group 2: 169 patient), as suggested by the AAIITO/SIAAIC guidelines for the "management of patients at risk of allergic reactions to Covid-19 vaccines" [1]. Results. 10/362 (0.02%) had positive skin test to one or both excipients in group 1, 12/169 (7.1%) in group 2 (p less than 0.01). In group 2 HRs to Covid-19 vaccines were immediate in 10/12 of cases and anaphylaxis occurred in 4/12 of patients. Conclusions. The positivity of skin test with PEG and or PS before vaccination is extremely rare and mostly replaceable by an accurate clinical history. Sensitization to PEG and PS has to be investigated in patients with a previous immediate HR to a Covid-19 vaccine, in particular in patients with anaphylaxis.

Impact of individual molecular components in determining primary sensitization to latex.

Allergy to natural rubber latex emerged as one of the main allergies at the beginning among some professional groups and the general population. Sensitization and development of latex allergy have been attributed to exposure to products containing residual latex proteins. The prevailing cross-reactivity of latex proteins with other food allergens is of great concern. Numerous purified allergens are currently available, which greatly help in patient management, thus determining their specific profile. We conducted a multicenter study to investigate changes, from the ROC analysis, in the characteristics of patients with latex allergy by measuring its major protein components. Sensitization to latex proteins is crucial because it highlights the cross reactivity to inhalants (pollen) and food (fruit). It is very essential in an accurate and specific clinical setting.

Sensitization to Gibberellin-Regulated Protein (Peamaclein) Among Italian Cypress Pollen–Sensitized Patients

Background: Peach gibberellin-regulated protein (peamaclein) has recently emerged as a relevant food allergen in cypress pollen–hypersensitive patients.Objective: We investigated monosensitization to peamaclein among Italian cypress pollen–allergic patients.Patients: A total of 835 cypress pollen–hypersensitive patients from 28 Italian allergy centers underwent a thorough work-up to determine food-allergic reactions and performed skin prick testing with a commercial peach extract containing peamaclein. IgE to rPru p 3 was measured in peach reactors, and those with negative results were enrolled as potentially monosensitized to peamaclein. IgE reactivity to rPru p 7 was evaluated using immunoblot and an experimental ImmunoCAP with rPru p 7.Results: Skin prick tests were positive to peach in 163 patients (19.5%); however, 127 (77.9%) were excluded because they reacted to Pru p 3. Twenty-four patients (14.7%) corresponding to 2.8% of the entire study population) were considered potentially monosensitized to peamaclein. No geographic preference was observed. Seventeen of the 24 patients (70.8%) had a history of food allergy, mainly to peach (n=15). Additional offending foods included other Rosaceae, citrus fruits, fig, melon, tree nuts, and kiwi. On peach immunoblot, only 3 of 18 putative peamaclein–allergic patients reacted to a band at about 7 kDa; an additional 4 patients reacted at about 50-60 kDa. Ten of 18 patients (56%) had a positive result for Pru p 7 on ImmunoCAP.Conclusion: Allergy and sensitization to peamaclein seem rare in Italy. Most patients react to peach, although other Rosaceae fruits and several citrus fruits may also be offending foods. Peach and cypress pollen probably also share cross-reacting allergens other than peamaclein (AU)

Antecedentes: La proteína del melocotón regulada por giberelina (peamacleina) ha sido descrita recientemente con alérgeno alimentarioen los pacientes con alergia al polen de ciprés.Objetivo: Determinar la presencia de monosensibilización a peamacleina en los pacientes italianos con alergia al polen de ciprés.Pacientes: Se estudiaron 835 pacientes italianos con alergia al polen de ciprés, provenientes de 28 centros hospitalarios. En todos ellosse realizó historia clínica dirigida a detectar alergia alimentaria así como prick test con extractos comerciales de melocotón que conteníanpeamacleína. En los pacientes sensibilizados a melocotón se determinó IgE específica a Pru p 3 y aquellos con resultado negativo seclasificaron como potencialmente monosensibilizados a peamacleina. Se realizó determinación de IgE específica a Pru p 7 medianteimmunoblot e ImmunoCAP con Pru p 7.Resultados: El prick test con melocotón fue positivo en 163 pacientes (19,5%), pero 127 de estos pacientes fueron excluidos por estarsensibilizados a Pru p 3. 24 pacientes (14,7%), que correspondían al 2,8% de la población global, fueron considerados como potencialmentemonosensibilizados a peamacleína. La distribución de estos pacientes no seguía ningún patrón geográfico. 17/24 (70,8%) tenían historiade alergia alimentaria, en la mayoría de los casos a melocotón (n=15). Los pacientes también referían síntomas con otros alimentoscomo otras frutas rosáceas, cítricos, higo, melón, frutos secos y kiwi. Solo 3/18 pacientes presentaban en el immunoblot una banda dealrededor de 7 kDa; otros 4 pacientes reconocían una banda de 50-60 kDa. 10/18 presentaron positividad en el ImmunoCAP a Pru p 7.Conclusión: En Italia, la alergia o sensibilización a peamacleina es baja. La mayor parte de los pacientes reaccionan con el melocotón,aunque otras frutas rosáceas y cítricos también desencadenan síntomas

Sensitization to Gibberellin-Regulated Protein (Peamaclein) Among Italian Cypress Pollen-Sensitized Patients.

BACKGROUND AND OBJECTIVES: Peach gibberellin-regulated protein (peamaclein) has recently emerged as a relevant food allergen in cypress pollen-hypersensitive patients. Objective: We investigated monosensitization to peamaclein among Italian cypress pollen-allergic patients. MATERIAL AND METHODS: A total of 835 cypress pollen-hypersensitive patients from 28 Italian allergy centers underwent a thorough work-up to determine food-allergic reactions and performed skin prick testing with a commercial peach extract containing peamaclein. IgE to rPru p 3 was measured in peach reactors, and those with negative results were enrolled as potentially monosensitized to peamaclein. IgE reactivity to rPru p 7 was evaluated using immunoblot and an experimental ImmunoCAP with rPru p 7. RESULTS: Skin prick tests were positive to peach in 163 patients (19.5%); however, 127 (77.9%) were excluded because they reacted to Pru p 3. Twenty-four patients (14.7%) corresponding to 2.8% of the entire study population) were considered potentially monosensitized to peamaclein. No geographic preference was observed. Seventeen of the 24 patients (70.8%) had a history of food allergy, mainly to peach (n=15). Additional offending foods included other Rosaceae, citrus fruits, fig, melon, tree nuts, and kiwi. On peach immunoblot, only 3 of 18 putative peamaclein-allergic patients reacted to a band at about 7 kDa; an additional 4 patients reacted at about 50-60 kDa. Ten of 18 patients (56%) had a positive result for Pru p 7 on ImmunoCAP. CONCLUSION: Allergy and sensitization to peamaclein seem rare in Italy. Most patients react to peach, although other Rosaceae fruits and several citrus fruits may also be offending foods. Peach and cypress pollen probably also share cross-reacting allergens other than peamaclein.

MRI Findings in Patients with Clinical Onset Consistent with Infantile Neuroaxonal Dystrophy (INAD), Literature Review, Clinical and MRI Follow-up.

Infantile neuroaxonal dystrophy (INAD) is a rare autosomal recessive neurodegenerative disorder characterized by infantile onset and rapid progression of psychomotor regression and hypotonia evolving into spasticity. The neuroradiologic hallmark of the disease is represented by progressive cerebellar atrophy. Prior to the discovery of mutations in the PLA2G6 gene in family with INAD, the clinical diagnosis of the disease had been confirmed by the presence of spheroid bodies (SB) in a peripheral nerve biopsy. Various studies have found that some patients with mutations lacked SB and some without mutations had SB, indicating incomplete detection using either pathologic or molecular methods (7). This, together with the observation that the spectrum of clinical features associated with mutations in PLA2G6 is broader than previously described, has increased the usefulness of Magnetic Resonance (MR) in INAD diagnosis, particularly in the frequent occurrence of atypical cases, especially in the early stages of the disease. We retrospectively reviewed the MR studies of eight patients in whom clinical and imaging onset met the typical criteria for INAD. Their clinical and MR imaging (MRI) onset and follow-up were evaluated together with the neuroradiological findings reported in the literature in order to identify MRI features useful in differentiating INAD from other diseases with similar clinical onset and to discuss which of them are the most important, thus suggesting INAD diagnosis. Our contribution included the use of Proton Spectroscopy ((1)H-MR), diffusion weighted MR imaging (DWI) and diffusion tensor imaging (DTI) in the follow-up of seven of the eight patients. The literature reviewed included attempts to correlate clinical and MR data with the genotype in the group of patients carrying PLA2G6 mutations. From the limited and inhomogeneous cohort of patients included in our study, a correlation between the MR features, phenotype and genotype was not exhaustive.

Continuous suture technique and impairment of the atrioventricular conduction after aortic valve replacement.

OBJECTIVE: Atrioventricular (AV) conduction impairment represents an infrequent complication following aortic valve replacement (AVR). Although several conditions have been considered as potential risk factors for such a postoperative event, the role of the surgical technique has not been evaluated. The aim of this study was to investigate if the suture technique for implantation of the prosthetic valve is a potential risk factor need of pacemaker (PM) implantation after AVR. METHODS: One hundred twenty-four patients undergoing AVR were enrolled in this study. A "continuous" suture technique was performed in 72 patients (58%; Group A), whereas an "interrupted" suture technique was used in 52 patients (42%; Group B). The incidence of "major," requiring PM implantation, as well as "minor," without PM implantation, impairment of the AV conduction was evaluated and compared in the two groups by means of univariate and multivariate analyses. RESULTS: The patients of the two groups were homogenous for all preoperative parameters except patient age. A longer clamp time was present in the patients of group B than those of group A (73 +/- 24 minutes and 60 +/- 24 minutes, respectively; p < 0.01). Postoperatively, hospital mortality consisted of four patients (3.2%) with no statistical importance between the two groups. Eleven patients of group A (17.5%) and one patient of group B1 (2.2%) required PM implantation (p < 0.05). Prolonged P-R interval was recorded in 15 patients of group A and in 5 patients of group B (p < 0.05). CONCLUSIONS: We showed that the continuous suture technique increases the need for postoperative PM implantation after AVR. No major differences have been observed, however, regarding in-hospital mortality and length of hospital stay, regardless of the type of prosthetic suture technique.

Predicting outcome after myocardial revascularization in patients with left ventricular dysfunction.

In order to identify the risk factors which could predict outcome after coronary artery bypass grafting in patients with left ventricular dysfunction, 80 consecutive patients with an ejection fraction < or = 30%, who underwent isolated coronary artery bypass grafting at the authors' centre between January 1994 and May 1996 were evaluated. Preoperatively, mean(s.d.) ejection fraction was 27.1(3.8)%, 56 patients (70%) had angina, and 56(70%) were in New York Heart Association (NYHA) functional class III or IV. There were five operative deaths, with a hospital mortality rate of 6.3%. Significant risk factors for hospital death were NYHA class IV, preoperative ventricular arrhythmias and left ventricular end-diastolic volume index > 110 ml/m2. At mean follow-up of 15(7) (range 6-30) months, there were six late deaths, five of which were from cardiac causes. Actuarial survival rate at 2 years was 82(5)% and freedom from cardiac death 84(5)%. Risk factors for overall mortality from cardiac causes were preoperative grade 2 mitral regurgitation, associated with left ventricular dilatation, and renal dysfunction (creatininaemia > or = 180 micromol/l). At follow-up, mean ejection fraction was 37.5(8.4)%, and the overall functional status had improved: 12 patients (18%) had angina and eight (12%) were in NYHA class III and IV. Myocardial revascularization in patients with left ventricular dysfunction can be performed with acceptably low operative risk, good survival rate at 2 years, and functional status improvement. Patients with extensive ventricular dilatation, associated with significant mitral regurgitation, have a lower life expectancy and less functional benefits from coronary artery bypass grafting. These patients are better treated by cardiac transplantation.

[Transmyocardial revascularization with a holmium laser: preliminary results]. / Rivascolarizzazione transmiocardica con laser ad olmio: risultati preliminari.

BACKGROUND: Transmyocardial laser revascularization (TMLR) aims to improve perfusion of the ventricular wall via laser-created transmural channels. We present the results of TMLR with a holmium laser as sole therapy in patients with angina refractory to medical treatment and extensive coronary artery disease unsuitable for angioplasty or coronary artery by-pass grafting. METHODS: From November 1995 to February 1997, twenty-two patients underwent isolated TMLR with a holmium laser. Five patients (23%) were female; the mean age was 67 +/- 7 years (range 53 to 74 years). Previous myocardial revascularization procedures had been performed in 17 patients (77%). Mean preoperative angina class was 3.4 +/- 0.5 and unstable angina was present in 7 patients (32%). RESULTS: There were no hospital deaths. The only postoperative complications were transient supraventricular arrhythmias in 6 patients (27%). Each patient received a mean of 33 +/- 8 channels in 27 +/- 13 minutes. There were two late deaths, 40 days and 4 months after TMLR, due to stroke and myocardial infarction, respectively. Mean follow-up duration was 8 +/- 5 months (range 40 days-15 months). The mean number of hospitalizations due to angina fell from 4.9 +/- 1.5 in the 6 months before TMLR to 1.5 +/- 1.0 in the 6 months following surgery (p < 0.001). At follow-up, mean angina class had significantly improved (1.8 +/- 0.6, p < 0.001), as well as effort tolerance, which increased from a mean of 3.5 +/- 1.4 minutes to 5.1 +/- 1.7 minutes (p = 0.01). 201Tl SPECT at 3 and 6 months did not show any significant changes in the segmental perfusion of the lased and unlased areas. CONCLUSIONS: TMLR with a holmium laser is a simple procedure with low operative mortality and morbidity. Short-term results confirm that clinical improvement is obtained in most patients, although this is not supported by significant changes in myocardial perfusion at short-term follow-up.

[Myocardial revascularization in patients with ischemic cardiomyopathy and left ventricular dysfunction]. / Rivascolarizzazione miocardica in pazienti con cardiopatia ischemica e disfunzione ventricolare sinistra.

In this study we evaluated the outcome of coronary artery bypass grafting (CABG) in patients with coronary artery disease and left ventricular dysfunction. The aim of the study was to identify the risk factors for operative and medium-term mortality. We evaluated 117 consecutive patients (98 men, 19 women, aged 42 to 84 years, mean 65 +/- 9) with ejection fraction (EF) < 40%, operated on from January 1994 to December 1995. Patients who had previously undergone CABG, or who had other procedures associated with CABG, were excluded. Preoperatively, mean EF was 32 +/- 5%; 65 patients (56%) had angina and 62 (53%) had congestive heart failure in NYHA functional class III and IV. Hospital mortality rate was 5% (i.e. 6 deaths). At multivariate analysis significant risk factors were: NYHA functional class IV and moderate/ severe mitral regurgitation. All patients were evaluated at a mean follow-up time of 13 +/- 8 months (range 3 to 30); 9 deaths occurred, 7 due to cardiac causes. Actuarial survival rate at 24 months was 85 +/- 4%; freedom from death due to cardiac causes was 87 +/- 4%. Significant risk factors for medium-term mortality at multivariate analysis were age, moderate/severe mitral regurgitation and marked impairment of regional myocardial contractile function, evaluated by the wall motion score index (> or = 2.25). At follow-up the majority of patients showed improved clinical conditions: mean EF was 40 +/- 8%; 8 patients (8%) had angina and 12 (12%) were in NYHA functional class III and IV. Myocardial revascularization in patients with coronary artery disease and left ventricular dysfunction is characterized by low operative risk and good survival rate at 2 years, with improvement of both angina and congestive heart failure. The best results were obtained in those patients who preoperatively showed the best regional contractile function, even though the global EF was poor, and in those with signs of reversible left ventricular dysfunction, such as angina or documented myocardial viability.

Survival despite almost complete occlusion by chronic thrombosis of a Björk-Shiley mitral prosthesis.

We report a patient who was successfully reoperated because of almost complete thrombosis of a Björk-Shiley tilting disc mitral prosthesis. Considering the usually acute presentation and the frequently catastrophic consequences of most similar cases in the literature, the unusual feature of this case is that the patient survived until reoperation with minimal symptoms despite almost total prosthetic occlusion by a chronic thrombus.

Intrinsic and antagonistic effects of beta-carboline FG 7142 on behavioral and EEG actions of benzodiazepines and pentobarbital in cats.

The methyl-beta-carboline-3-carboxamide FG 7142 (10 mg/kg i.p.) produced a pronounced state of alertness, attentive behavior and fearfulness in the cat. Electroencephalographic (EEG) desynchronization in the cortex and theta rhythms in the hippocampus occurred concomitantly. Behavioral and hippocampal EEG actions of FG 7142 were reduced by Ro 15-1788 (10 mg/kg i.p.). The benzodiazepines diazepam and quazepam produced behavioral and EEG effects which were completely antagonized by FG 7142. The pentobarbital effects also were partially antagonized. These findings suggest that the cat provides an interesting model to study the anxiogenic properties of beta-carbolines.