Vespa velutina nigrithorax venom allergy: inhibition studies approach for the choice of specific immunotherapy.

Summary: Vespa velutina nigrithorax (VVN), commonly known as Asian wasp because endemic in Asia, represents an alien species in Europe. VVN can induce allergic reactions similar to those caused by other Hymenoptera and death after VVN stings, presumably due to fatal allergic reactions, has been reported. In the treatment of Hymenoptera venom hypersensitivity, specific immunotherapy (VIT) is highly effective. Currently, there is no specific available VIT for VVN, so it is relevant to assess if patients stung by VVN and showing allergic reactions could be treated with the Hymenoptera commercially available extracts Vespa crabro (VC) and Vespula spp (Vspp) or if they need the specific VIT with VVN venom extract. Methods. Four patients with a clinical history of systemic reactions after VVN sting were evaluated. Serum specific IgE were assayed quantitatively with an automated fluoro-enzyme immunoassay ImmunoCAP™ Specific IgE by Phadia™ 1000 System (Thermo Fisher Scientific, Uppsala, Sweden) for VC, Vspp and VVN. Cap inhibition assays were performed incubating serum samples with 200 µl of each venom at increasing concentrations and subsequently specific IgE against each of the venoms were determined in the samples by Phadia™ 250 System (Thermo Fisher Scientific, Uppsala, Sweden). Results. Our results suggested that both Vspp and VC venoms were able to inhibit the specific IgE for VVN, although the VC compared to the Vspp venom showed a higher inhibition. Conclusions. Our inhibition studies suggested that VIT with VC venom, nowadays when there is not specific available VIT for VVN, may be more effective than Vspp VIT in patients with VVN sting reactions.

Relationship Between Weather and Changes in Annual and Seasonal Abundance of Culicoides sonorensis (Diptera: Ceratopogonidae) in Alberta.

Factors influencing annual and seasonal abundance of Culicoides sonorensis (Wirth and Jones) (Diptera; Ceratopogonidae) were examined at 10 sites in southern Alberta using negative binomial regression. Annual abundance varied among locations with greatest abundance in a narrow geographic band between -112.17 and -112.64°W longitude and 49.32 and 50.17°N latitude. Sites were grouped depending on whether abundance was continuous and high; discontinuous and low; or sporadic and low without much loss of information. Maximum annual abundance declined with spring precipitation, increased with spring temperature, and was unrelated to spring relative humidity, suggesting that abundance is highest during years with early drought conditions. Seasonal abundance was associated with the same factors but was further influenced by temperature and relative humidity during the sample intervals. Lagged effects were apparent, suggesting abundance increased with warmer temperatures over a six-week period, and increased when relative humidity declined closer to the sampling period. Predicted values were slightly biased and tended to overestimate observed data, but this could be adjusted using calibration curves. The model can also be used to predict presence/absence of C. sonorensis and will be useful for developing risk assessments.

Ecology and Life Cycle Patterns of Echinococcus Species.

The genus Echinococcus is composed of eight generally recognized species and one genotypic cluster (Echinococcus canadensis cluster) that may in future be resolved into one to three species. For each species, we review existing information on transmission routes and life cycles in different geographical contexts and - where available - include basic biological information of parasites and hosts (e.g., susceptibility of host species). While some Echinococcus spp. are transmitted in life cycles that involve predominantly domestic animals (e.g., dog - livestock cycles), others are wildlife parasites that do or do not interact with domestic transmission. In many cases, life cycle patterns of the same parasite species differ according to geography. Simple life cycles contrast with transmission patterns that are highly complex, involving multihost systems that may include both domestic and wild mammals. Wildlife transmission may be primary or secondary, i.e., resulting from spillovers from domestic animals. For most of the species and regions, existing information does not yet permit a conclusive description of transmission systems. Such data, however, would be highly relevant, e.g., for anticipation of geographical changes of the presence and frequency of these parasites in a warming world, or for initiating evidence-based control strategies.

Urban park-related risks for Giardia spp. infection in dogs.

Giardia spp. is a common gastrointestinal (GI) parasite of multiple host species, including dogs and humans, with the potential for zoonotic transmission. The risk of GI parasitism in dogs (including Giardia spp.) may increase with park use in urban areas. This study aimed to (1) determine whether park attendance is a risk factor for Giardia spp. infection in dogs and (2) characterize the behavioural and demographic risk factors for Giardia spp. infection in park-attending and non-park-attending dogs. From August to September 2012, a total of 1293 dog owners completed a survey and 860 corresponding dog faecal samples were collected. Dog faeces were screened for Giardia spp. using a direct immunofluorescence assay and associations assessed among behaviours, demographics, and Giardia spp. infection. Main results included off-leash and swimming frequencies within parks as significantly positively associated with Giardia spp. infection in dogs. Dog-owner age was negatively associated with off-leash and swimming frequencies in parks. The results suggest some recreational behaviours in parks and certain demographics are risk factors for parasitism in pet dogs.

What attracts elk onto cattle pasture? Implications for inter-species disease transmission.

In Southwest Alberta, beef cattle and wild elk (Cervus elaphus) have similar habitat preferences. Understanding their inter-species contact structure is important for assessing the risk of pathogen transmission between them. These spatio-temporal patterns of interactions are shaped, in part, by range management and environmental factors affecting elk distribution. In this study, resource selection modeling was used to identify factors influencing elk presence on cattle pasture and elk selection of foraging patches; furthermore, consequences for inter-species disease transmission were discussed. Data on pasture management practices and observations of elk were collected from 15 ranchers during interviews. Pasture use by elk was defined based on telemetry data (from GPS collars deployed on 168 elk in 7 herds) and rancher observations. At the patch scale, foraging patches used by elk were identified by spatio-temporal cluster analysis of telemetry data, whereas available patches were randomly generated outside the area delimited by used patches. For pastures and patches, landscape and human-managed features were characterized using remote sensing data and interviews, respectively. Attributes of available and used pastures (or patches) were compared using resource selection functions, on annual and seasonal (or annual and monthly) time scales. Additionally, intensity of pasture use was modeled using negative binomial regression. Cultivated hay land and mineral supplements were associated with elk presence on cattle pastures, whereas pastures with manure fertilization and higher traffic-weighted road densities were less likely to be used by elk. The effects of landscape (elevation, aspect, water access) and vegetation (forest cover, Normalized Difference Vegetation Index) characteristics on patch selection were consistent with typical elk habitat requirements. The presence of cattle and the traffic-weighted road density were negatively associated with patch selection. The apparent avoidance of cattle by elk reduced the risk of direct transmission of pathogens, except during winter months. However, human-managed features attracting elk to cattle pastures (e.g. hay land and mineral supplements) may increase inter-species pathogen transmission through indirect contacts.

Egg intensity and freeze-thawing of fecal samples affect sensitivity of Echinococcus multilocularis detection by PCR.

Echinococcus multilocularis is one of the most relevant zoonotic parasites with about 18,000 human cases per year. Its detection in wild host is crucial for disease prevention. The present study aimed to determine factors affecting the sensitivity of E. multilocularis detection by PCR using DNA extracted from fecal samples of coyotes (Canis latrans). Fecal samples were screened for the presence of Taeniidae eggs through centrifugation and sedimentation. DNA was extracted from fecal samples with and without prior freeze-thawing of the sample and then subjected to PCR targeting a mitochondrial gene (nad1) and a multi-loci microsatellite marker (EmsB). The presence of PCR inhibitors was determined through internal amplification control. Subjecting the sample to repeated freeze-thaw cycles significantly increased the sensitivity of the PCR by 20%. Likewise, egg intensity had a significant effect on PCR, an effect which was more pronounced for samples not subjected to freeze-thawing. Two or more eggs per gram of feces significantly increased the odds for a positive PCR outcome. The presence of PCR inhibitors had no effect on PCR in samples subjected to freeze-thaw cycles, whereas in samples not subjected to freeze-thaw cycles, the presence of PCR inhibitors was associated with a 0.78 lower odds ratio of positive PCR outcome. Targeting a nuclear versus a mitochondrial gene did not have a significant effect on the sensitivity of PCR. We recommend freeze-thawing samples prior to DNA extraction to become a standard procedure for E. multilocularis detection in canid feces.

The contribution of sublingual immunotherapy to the achievement of control in birch-related mild persistent asthma: A real-life randomised trial

Background: Asthma control represents the main goal of asthma management and different strategies aim to avoid the long term downsides of inhaled corticosteroids. We investigated in real-life conditions the contribution of sublingual immunotherapy in achieving the control of birch-related mild persistent asthma compared to two usual step-up therapeutic options. Methods: A three-year open randomised study included 84 asthmatics, uncontrolled during the previous birch pollen season, despite a treatment with budesonide 400 μg/day. Patients randomly received budesonide 800 μg/day, budesonide 1600 μg/day, budesonide 400 μg/day plus montelukast 10 μg/day and budesonide 400 μg/day plus carbamylated allergoid of betulaceae pre-coseasonally. Asthma Control test, combined allergy symptoms and medications score, albuterol consumption, lung function, nasal eosinophils and nasal steroids usage were assessed as changes from the first to last pollen season. Result: Seventy-six patients concluded the study. All options, except budesonide 800 μg/day, produced an improvement of mean monthly Asthma Control test (p < 0.05). Patients undergoing low-dose budesonide plus immunotherapy achieved, after three years, an appreciable control (ACT mean score 24). A significant improvement was seen in all groups for allergy symptoms plus medications and bronchial reactivity. Albuterol consumption and lung function improved in all but the first group. Only budesonide plus immunotherapy reduced nasal eosinophils and nasal steroids usage. Two mild self-resolving adverse events were reported. Conclusions: For patients with respiratory allergy due to birch pollen and mild persistent asthma, sublingual immunotherapy added to low-dose inhaled corticosteroids appears effective in maintaining long-term seasonal asthma control, representing a safe opportunity to reduce the cumulative amount of delivered corticosteroids (AU)

The contribution of sublingual immunotherapy to the achievement of control in birch-related mild persistent asthma: a real-life randomised trial.

BACKGROUND: Asthma control represents the main goal of asthma management and different strategies aim to avoid the long term downsides of inhaled corticosteroids. We investigated in real-life conditions the contribution of sublingual immunotherapy in achieving the control of birch-related mild persistent asthma compared to two usual step-up therapeutic options. METHODS: A three-year open randomised study included 84 asthmatics, uncontrolled during the previous birch pollen season, despite a treatment with budesonide 400µg/day. Patients randomly received budesonide 800µg/day, budesonide 1600µg/day, budesonide 400µg/day plus montelukast 10µg/day and budesonide 400µg/day plus carbamylated allergoid of betulaceae pre-coseasonally. Asthma Control test, combined allergy symptoms and medications score, albuterol consumption, lung function, nasal eosinophils and nasal steroids usage were assessed as changes from the first to last pollen season. RESULT: Seventy-six patients concluded the study. All options, except budesonide 800µg/day, produced an improvement of mean monthly Asthma Control test (p<0.05). Patients undergoing low-dose budesonide plus immunotherapy achieved, after three years, an appreciable control (ACT mean score 24). A significant improvement was seen in all groups for allergy symptoms plus medications and bronchial reactivity. Albuterol consumption and lung function improved in all but the first group. Only budesonide plus immunotherapy reduced nasal eosinophils and nasal steroids usage. Two mild self-resolving adverse events were reported. CONCLUSIONS: For patients with respiratory allergy due to birch pollen and mild persistent asthma, sublingual immunotherapy added to low-dose inhaled corticosteroids appears effective in maintaining long-term seasonal asthma control, representing a safe opportunity to reduce the cumulative amount of delivered corticosteroids.

Children passive smoking jeopardises the efficacy of standard anti-allergic pharmacological therapy, while sublingual immunotherapy withstands

Background: The association between genetic predisposition and environmental risk factorssuch as passive smoke in determining respiratory allergies is still uncertain; even less is known about the role played by passive smoking in influencing the success of therapy for rhinitis and allergic asthma. Objective: The purpose of this prospective, randomised study was to determine whether passive smoking influences the outcome of therapies in paediatric patients with allergic respiratory diseases. Methods: The study included 68 children (mean age 11.51 years; range: 5-17) suffering from perennial rhinitis and intermittent asthma monosensitised to Dermatophagoides. Thirty-foursubjects were exposed to daily passive smoking in their families, 34 were not. The two groups have been then randomised to receive continuous treatment with cetirizine or SLIT for three years. Results: There were 3/34 (8.8%) dropouts in the SLIT arm and 4/34 (11.7%) in the cetirizine arm. After three years, the patients exposed to passive smoking showed higher nasal eosinophilia, aworse clinical-symptomatic and pharmacological score with a worsened bronchial reactivity and functional indices of persistent asthma, regardless of how they had been treated. Nevertheless, SLIT prevented the worsening of all the clinical parameters more than the antihistamine alone either among the children exposed to smoking or not. Conclusions: Exposure to passive smoking in children suffering from respiratory allergies dueto Dermatophagoides decreased the clinical response to both drug therapy and SLIT. Nonetheless, while the children submitted to drug therapy worsened or did not show any significant improvement, the ones treated with SLIT improved (AU)

Children passive smoking jeopardises the efficacy of standard anti-allergic pharmacological therapy, while sublingual immunotherapy withstands.

BACKGROUND: The association between genetic predisposition and environmental risk factors such as passive smoke in determining respiratory allergies is still uncertain; even less is known about the role played by passive smoking in influencing the success of therapy for rhinitis and allergic asthma. OBJECTIVE: The purpose of this prospective, randomised study was to determine whether passive smoking influences the outcome of therapies in paediatric patients with allergic respiratory diseases. METHODS: The study included 68 children (mean age 11.51 years; range: 5-17) suffering from perennial rhinitis and intermittent asthma monosensitised to Dermatophagoides. Thirty-four subjects were exposed to daily passive smoking in their families, 34 were not. The two groups have been then randomised to receive continuous treatment with cetirizine or SLIT for three years. RESULTS: There were 3/34 (8.8%) dropouts in the SLIT arm and 4/34 (11.7%) in the cetirizine arm. After three years, the patients exposed to passive smoking showed higher nasal eosinophilia, a worse clinical-symptomatic and pharmacological score with a worsened bronchial reactivity and functional indices of persistent asthma, regardless of how they had been treated. Nevertheless, SLIT prevented the worsening of all the clinical parameters more than the antihistamine alone either among the children exposed to smoking or not. CONCLUSIONS: Exposure to passive smoking in children suffering from respiratory allergies due to Dermatophagoides decreased the clinical response to both drug therapy and SLIT. Nonetheless, while the children submitted to drug therapy worsened or did not show any significant improvement, the ones treated with SLIT improved.

The clinical efficacy of a sublingual monomeric allergoid at different maintenance doses: a randomized controlled trial.

Sublingual immunotherapy is widely recognized as a viable treatment for allergic rhinitis and asthma, but the optimal dosage is still under debate, especially with modified allergens. We assessed the clinical effects of a monomeric allergoid across 3 different maintenance doses in mite-monosensitized patients with rhinitis and intermittent asthma. Eighty-nine patients allergic to HDM were randomized to 3 maintenance doses of monomeric allergoid (Lais, Lofarma) or medications only. All the patients recorded their symptoms and rescue drug consumption in a diary card from November to February. Additionally, nasal eosinophil count, spirometry and methacholine bronchial challenge were performed at the beginning of the study and after 3 years. The symptom scores showed a clear improvement in all the three active arms versus baseline and versus the controls, irrespective of the dose. Likewise, a similar improvement versus baseline was seen for nasal inflammation and bronchial hyperreactivity. The SLIT with monomeric allergoids produces clinically significant results across a wide range of doses. The absence of significant side effects, even at high doses, is probably due to their low level of allergeni city.

Randomized open comparison of montelukast and sublingual immunotherapy as add-on treatment in moderate persistent asthma due to birch pollen.

BACKGROUND: No studies have directly compared the effects of immunotherapy and antileukotrienes due to the long time required to appreciate the clinical effects of immunotherapy. We compared the effect of montelukast (MK) and SLIT added to standard therapy in moderate asthma over 5 years. METHODS: Open randomized controlled trial. Patients with moderate asthma (and rhinitis) solely due to birch pollen were randomized to receive either MK (10 mg/d) or birch sublingual immunotherapy (SLIT) in the pollen seasons, in addition to formoterol/fluticasone. All the patients also received salbutamol and cetirizine as rescue medications. Asthma and rhinitis symptoms were recorded on diary cards from February to May at baseline and after 3 and 5 years of study. In-season nasal eosinophils and bronchial hyperresponsiveness were also evaluated. RESULTS: Thirty-three adult patients were enrolled and 29 completed the study. The groups were homogeneous at baseline. Bronchial and nasal symptom scores were lower at 3 and 5 years compared to baseline in the SLIT group. Bronchial hyperresponsiveness and bronchodilator use decreased significantly in both groups at 5 years, but only in the SLIT group at 3 years. In the SLIT group there was a significant decrease in nasal eosinophils compared to baseline and to the MK group. CONCLUSION: In patients with birch pollen-induced moderate asthma and rhinitis, the addition of SLIT provides a greater clinical benefit than that of MK.

A prospective Italian survey on the safety of subcutaneous immunotherapy for respiratory allergy.

BACKGROUND: Subcutaneous immunotherapy is effective for the treatment of respiratory allergy, and it is largely used in Italy, but no systematic safety assessment has been carried out so far. OBJECTIVE: To assess prospectively the safety of injection immunotherapy in a multicentre, real-life survey. METHODS: Eleven Italian allergy departments recorded the clinical characteristics of systemic reactions (SRs) due to immunotherapy. Vaccines were prescribed according to guidelines; only standardized depot extracts were used. SRs were graded according to the EAACI recommendations, and were classified as immediate or delayed. RESULTS: One thousand seven hundred and thirty-eight patients (847 males, age range 5-71) received immunotherapy from eight different manufacturers, for a total of 2038 courses (300 patients received two extracts). A total of 60 785 injections were given over a mean immunotherapy duration of 3 years. Overall, 95 reactions were observed in 57 patients (3.28%), corresponding to 4.7% of the courses and 1.56/1000 injections. Twenty-five patients experienced more than one adverse event. There were 34 grade 2, 60 grade 3 and one grade 4 reactions and no fatality. SRs occurred more frequently in patients with asthma than in patients with rhinitis alone (4.1% vs. 1.1%), and were equally distributed between the build-up and the maintenance phase. Ragweed and grass extracts caused significantly more side effects than other allergens. CONCLUSION: In this large prospective study, the rate of SRs was low, thus confirming that injection immunotherapy has an acceptable risk/benefit ratio when prescribed and carried out according to recommendations.

Sublingual immunotherapy for allergic respiratory disease in elderly patients: a retrospective study.

BACKGROUND: Very few studies have evaluated the effects of sublingual immunotherapy (SLIT) in elderly adults with either rhinitis or bronchial asthma. The aim of this study was to ascertain whether SLIT is effective in these patients. METHODS: One hundred and sixty seven patients (aged 18-65 years) with persistent rhinitis and mild asthma, selected from 573 subjects allergic to house-dust mites, were treated with either standard chronic pharmacotherapy or SLIT plus drugs on demand. Monthly symptom/drug scores, respiratory function, methacholine (MCh) challenge and eosinophil count were scheduled at the beginning and end of the study. RESULTS: We analysed two age groups (18-28 years, 49 patients) and 55-65 years, 40 patients). There were no differences between the groups at baseline but MCh sensitivity was lower in the older patients. At the end of treatment, SLIT achieved improvement in all variables (p< 0.001) in both age groups, but the global symptoms were lower in the younger patients (p=0.0002). There were also fewer new sensitizations in the SLIT groups (p=0.03) than in the "control"patients given standard pharmacotherapy, but with no relation to age. Asthma became worse only in the control groups, regardless of age. CONCLUSIONS: SLIT reduces symptoms, drug consumption and the progression of the disease in both young and elderly subjects allergic to house-dust mites, with persistent rhinitis and mild bronchial asthma.

Efectos preventivos de la inmunoterapia sublingual en niños: un estudio abierto, aleatorizado y controlado / Preventive effects of sublingual immunotherapy in childhood: an open randomized controlled study

Objetivos. Evaluar los efectos clínicos y preventivos de la inmunoterapia sublingual (SLIT) con respecto a la aparición de asma persistente, nuevas sensibilizaciones, síntomas clínicos e hiperreactividad bronquial (HRB). Los objetivos secundarios fueron: evaluar la magnitud del efecto clínico y el efecto sobre la HRB; ver la seguridad y adhesión a la SLIT. Material y métodos: Participaron 216 niños, de ambos sexos, entre 5 y 17 años, pacientes del Hospital Cuasso al Monte, Varese, Italia, con rinitis alérgica de al menos 2 años de evolución, con o sin síntomas de asma intermitente, y con diagnóstico de etiología alérgica confirmado para ácaros, gramíneas, árboles y malezas. Se excluyeron pacientes con asma persistente o VEF1 <80%, uso previo de inmunoterapia, anormalidades anatómicas de las vías aéreas superiores, enfermedades sistémicas crónicas (malignas o autoinmunes) y sensibilizaciones a epitelios y hongos anemófilos. Para los diagnósticos de rinitis y asma se emplearon las guías actuales (ARIA, GINA). Se realizaron prick test con panel estándar de alérgenos relevantes (ALK Abelló), histamina 1% y control negativo al principio y al final del estudio. Las pruebas de función pulmonar consistieron en espirometría computarizada con cabina pletismográfica y prueba de provocación no específica con metacolina con dosis progresivas desde 30 a 1.290 µg, durante el período de máxima exposición alérgenica según sensibilidad de cada paciente, al inicio y al final del estudio. A los pacientes con prueba negativa (descenso del VEFI <20%) se los consederaba con diagnóstico de rinitis exclusivamente. El estudi tuvo un período basal de 1 año de observación y luego una fase de aleatorización de 3 años de tratamiento abierto con dos ramas. Un grupo de pacientes utilizó drogas exclusivamente, y otro grupo drogas más SLIT (con una distribución 1/2).

The type of sensitizing allergen can affect the evolution of respiratory allergy.

BACKGROUND: Numerous factors affect the evolution of respiratory allergy, in children, but little is known in adults. We assessed in a prospective study the influence of the type of allergen on the progression of disease. METHODS: Outpatients, with respiratory allergy underwent skin tests and pulmonary function/methacholine challenge at baseline and after 3 years. Patients were subdivided in pure rhinitis or rhinitis + bronchial hyperreactivity (BHR). In polysensitized subjects a single relevant allergen (mites, grasses, birch, Parietaria) was identified based on symptom distribution and when needed on nasal challenge. RESULTS: 6750 patients (age range 12-46) were studied. Of them, 17.8% were monosensitized but this percentage decreased to 10.4% after 3 years (P < 0.05). Subjects with pure rhinitis were 81% at the beginning and 48% at the end. After 3 years, the patients with bronchial responsiveness increased from 18% to 58% for mites, 22% to 49% for birch, 18% to 44% for grasses, 17% to 32% for Parietaria, with a significant difference among allergens (P < 0.05). Almost the same was seen in monosensitized subjects, being mites most likely to cause a worsening. All patients with BHR at baseline received immunotherapy. In these patients the onset of new sensitizations was significantly lower than in the group (pure rhinitis) receiving drugs only and lower airways symptoms disappeared more frequently. CONCLUSION: The different type of allergen influences the course of the disease, as well as the use of immunotherapy.

Rhinitis and asthma co-morbidity in respiratory allergy due to house dust mite: results of an observational open controlled parallel group study in real-life setting.

BACKGROUND: Some aspects of allergic progression still need to be addressed. To prevent the onset of the progression is not, at present, a very realistic aim, although therapeutic instruments are available to delay and, if possible, to stop it. We attempted to clarify these points in an observational open controlled three-parallel group study in a real-life setting. METHODS: 3838 patients with respiratory allergy due to house dust mite have been enrolled in this observational study. 2200 patients with rhinitis and/or intermittent or mild persistent asthma, poorly responsive to standard pharmacological therapy (SPT) were treated for three years with SPT associated or not with specific immunotherapy (SIT). Symptom medication scores, pulmonary function test (PFT) and methacholine (MCh) challenge were performed at the beginning and at the end of the study. 1638 pure rhinitics, responsive to SPT, enrolled as a control group, used self-medication (SM) on demand to assess the incidence of asthma in non-treated patients with standard therapeutic protocols. RESULTS: 694 patients have been treated with SPT+SIT, 1506 with SPT and 1638 with SM. Co-morbidity rhinitis-asthma incidence was higher in the SM group (an overall 69.27% including asthma and bronchial hyperreactivity). Persistent rhinitis proved more often to be associated with asthma than intermittent rhinitis. Likewise, the moderate-severe forms compared to the mild ones. The addition of SIT to SPT reduced the allergic progression in all patients. CONCLUSIONS: In everyday clinical practice too, SIT proves its efficacy in the treatment of allergic march. Patients with moderate-severe persistent rhinitis appear as the ideal candidates for this therapy.

Randomized controlled open study of sublingual immunotherapy for respiratory allergy in real-life: clinical efficacy and more.

BACKGROUND: Some aspects of sublingual immunotherapy (SLIT) still need to be addressed: magnitude of the clinical efficacy, effect on the bronchial hyperreactivity adherence to treatment, preventive effect. We attempted to clarify these points in a randomized open, controlled, two parallel group study in a real-life setting. METHODS: Five hundred and eleven patients with allergic rhinitis with or without intermittent asthma were randomized to drugs only or drugs + SLIT (rate 2 : 3) for 3 years. The clinical score (symptoms + drug intake) was measured each year during the allergen exposure. Pulmonary function test, methacholine challenge and skin tests were performed at the beginning and at the end of the study. Adherence to treatment was assessed by measuring the consumed extract. RESULTS: Three hundred and nineteen patients received SLIT and 192 drugs only. Dropouts were 15% in the SLIT group and 12% in the controls. There was a significant improvement of clinical scores in the SLIT group: baseline 147 +/- 3.3, first year 72.9 +/- 1.3, second year 68.3 +/- 1.8, third year 54.7 +/- 2.8 (P < 0.0001 vs baseline). CONTROL GROUP: baseline 138 +/- 2.3, first year 124.1 +/- 3.7, second year 111 +/- 3.3, third year 121 +/- 3.8 (P = NS). Only four patients reported systemic itching. Adherence was >80% in 72% and >60% in 18% of patients. The number of patients with a positive MCh challenge decreased significantly after 3 years only in the SLIT group. New skin sensitizations appeared in 38% of the controls and in 5.9% of the SLIT patients (P = 0.01). CONCLUSION: Sublingual immunotherapy approximately halved the clinical scores and significantly reduced the bronchial hyperreactivity. Similarly to subcutaneous immunotherapy, SLIT displayed a preventive effect on the onset of new skin sensitizations. The adherence rate was quantitatively satisfactory.

Non-fatal systemic reactions to subcutaneous immunotherapy: a 20-year experience comparison of two 10-year periods.

Aim of the study was to evaluate in a retrospective analysis the incidence and clinical characteristics of nonfatal systemic reactions (NSR) to subcutaneous immunotherapy over a 20-year period (1981-2000) and to compare two ten-year periods as regard to NSR rate and type as well as to identify risk factors for NSR. On the whole, 435,854 injections were administered to 4,600 outpatients, following the suggested precautionary guidelines. In the first 10-year period, 115 NSR were observed (5.2% of patients and 0.06% of injections) and no fatalities, while 26 NSR (1.08% of patients and 0.01% of injections) occurred in the second 10-year period, with no fatalities. The difference was statistically significant (p<0.0001). Such a difference was mainly due to the reduction of asthma and urticaria (isolated or combined), (p<0.0001 comparing 1991-2000 with 1981-1990), while no significant difference could be found as regard to angioedema, rhinitis and other NSR. Almost all adverse events occurred within 30 minutes after injection and they were promptly controlled by standard therapy. NSR reduction was independent from the administered allergens. Female gender was the only clinical risk factor for NSR. Age, pollen season or manufacturer did not predict NSR. In conclusion, our data confirmed safety of subcutaneous immunotherapy and demonstrated that such a safety has increased during the last ten years.

Variation in cuticular hydrocarbon signatures, hormonal correlates and establishment of reproductive dominance in a polistine wasp.

In many social insects the relationship between reproductive dominance and physiological correlates is poorly understood. Recent evidence now strongly suggests that cuticular hydrocarbons are important in reproductive differentiation in these societies where they are used as signals of ovarian activity in reproductive females. In this study we investigated the relationship between reproductive dominance, size of the corpora allata (CA, producer of Juvenile Hormone, JH) and the proportions of cuticular hydrocarbons present on the cuticle in overwintering foundresses and both associative (polygynous) and solitary (monogynous) pre-emergence colonies of the social wasp Polistes dominulus. Size of the CA was positively correlated with ovarian development in polygynous colonies. In contrast, solitary foundresses possessed significantly smaller CAs than dominant foundresses from polygynous nests, yet ovarian activity was similar for both female types. CA size variation was associated with variation in cuticular hydrocarbon proportions. Overwintering, solitary, dominant and subordinate (from associative nests) females all possessed distinctive cuticular chemical profiles revealed by multivariate discriminant analyses. Our data indicate that the social environment strongly affects reproductive physiology in this wasp, and we discuss the role of cuticular hydrocarbons in reproductive signaling in P. dominulus and other social insects.