Incorvaia C.,Pneumologia Riabilitativa |
Rienzo A.D.,Allergologia |
Celani C.,University of Rome La Sapienza |
Makri E.,Pneumologia Riabilitativa
Annali dell'Istituto Superiore di Sanita | Year: 2012
Objective: Allergic rhinitis (AR) is a disease with high and increasing prevalence. The management of AR includes allergen avoidance, anti-allergic drugs, and allergen specific immunotherapy (AIT), but only the latter works on the causes of allergy and, due to its mechanisms of action, modifies the natural history of the disease. Sublingual immunotherapy (SLIT) was proposed in the 1990s as an option to traditional, subcutaneous immunotherapy. Material and methods: We reviewed all the available controlled trials on the efficacy and safety of SLIT. Results and conclusion: Thus far, more than 60 trials, globally evaluated in 6 meta-analyses, showed that SLIT is an effective and safe treatment for AR. However, it must be noted that to expect clinical efficacy in the current practice SLIT has to be performed following the indications from controlled trials, that is, sufficiently high doses to be regularly administered for at least 3 consecutive years.
Cirilo A.,UOC Allergologia e Immunologia Clinica |
Incorvaia C.,Allergologia |
Rosi O.,SOD Immunoallergologia |
Netis E.,University of Bari |
And 7 more authors.
Italian Journal of Allergy and Clinical Immunology | Year: 2011
Anaphylaxis is an acute systemic hypersensitivity reaction which is potentially fatal. Usually, anaphylaxis is due to massive release of mediators from mast cells and basophils caused by an IgE-mediated mechanism induced by allergens, such as foods, insect venoms, or drugs. Other immunologic or non-immunologic mechanisms may be acting, with particular importance for the latter of physical exercise. Epidemiologic data seem to indicate an increase of prevalence and incidence of anaphylaxis in the latest decades. The clinical expression of anaphylaxis is variable, occurring with mild or subtle manifestations with spontaneous resolution but also with severe hypotension and collapse caused by vasodilation and altered vascular permeability, that may result in fatalities. The clinical diagnosis is based on physical examination, detailed clinical history and, possibly, on measurement of try ptase (i.e. marker of mast cell activation). The diagnosis is based on skin test, on in vitro specific IgE tests, or on other diagnostic tests. The management of anaphylaxis is mainly based on prevention, by avoidance when possible of the trigger factors and performance, if insect venoms are involved, of specific immunotherapy, and on emergency treatment of acute reactions. Drug treatment of anaphylaxis require as first step the use of epinephrin, also by selfadministration with pre-dosed injectors; antihistamines and corticosteroids, despite their frequent administration, are to be used in mild reactions or when epinephrin is not available, but are ancillary in respect to epinephrin in severe reactions.
Hymenoptera venom hypersensitivity. An update of Guidelines of the Italian society of allergy and clinical immunology [Ipersensibilità al veleno degli imenotteri. Aggiornamento delle Linee Guida della Società Italiana di Allergologia e Immunologia Clinica]
Cirillo Ag.,Allergologia e Immunologia Clinica |
Incorvaia C.,Allergologia Pneumologia Riabilitativa |
Bonadonna P.,Allergologia e Immunologia Clinica |
Cirillo Al.,U.O.C. Medicina e Chirurgia dUrgenza e dAccettazione |
And 6 more authors.
Italian Journal of Allergy and Clinical Immunology | Year: 2010
Allergic reactions to hymenoptera stings concern about 3% of the general population and are caused by antigens occurring in venom, such phospholipase, hyaluronidase and, for vespids, antigen 5. Diagnosis is based on skin tests and in vitro tests, while the challenge with live insect is not recommended. Cross-reactivity of IgE antibodies to some allergens or to carbohydrate epitopes may result in apparent polysensitization and in difficulties in venom choice for immunotherapy. Another useful in vitro data, especially in patients with severe reactions, is measurement of tryptase, that may reveal an unrecognized mastocytosis. Management of hymenoptera venom allergy is based on pharmacological treatment of anaphylactic reactions, that absolutely requires epinephrine by intramuscular injection (also by auto-injectors for self-administration), and on prevention of further reactions. This is optimally achieved by venom immunotherapy (VIT), which demonstrated the complete capacity to prevent fatal reactions and to prevent more than 90% of reactions of any type, though with a lower efficacy if honeybee venom is used. VIT can be safely stopped after 5 years in most patients, but the occurrence of adverse reactions to treatment, of incomplete protection to stings, or of a concomitant mastocytosis indicates the need to continue VIT even life-span. Increasing the interval between venom administration up to 16 weeks favours the long-term compliance. This document updates the recent advances in diagnosis and treatment of hymenoptera venom allergy and discuss the possible future development.
Ciprandi G.,IRCCS A.O.U. |
Incorvaia C.,Allergy Pulmonary Rehabilitation |
Dell'Albani I.,Stallergenes |
Di Cara G.,University of Perugia |
And 22 more authors.
Journal of Biological Regulators and Homeostatic Agents | Year: 2013
Allergic patients frequently suffer from infections. Allergen immunotherapy (AIT) usually improves respiratory symptoms, mainly in allergic rhinitis (AR). This study was aimed at evaluating the possible impact of AIT on extra-allergic outcomes in a cohort of Italian children with respiratory allergy patients. The study was performed on 77 children (43 males, mean age 10.5 years) with AR. The kind and the number of prescribed allergen extracts, type of diagnosis, severity of symptoms, and use of drugs were evaluated at baseline and after 2 year AIT. Globally 40 patients were treated with AIT, the remaining 37 children served as control. AIT-treated children had lower symptoms, drug use, and less severe extra-allergic surrogate markers of infection in comparison with children untreated with AIT. In conclusion, this study provides the first evidence that 2-year SLIT is able of exerting an adjunctive anti-allergic activity in AR children. Copyright © by BIOLIFE, s.a.s.
Antonelli A.,Allergologia |
Torchio R.,Laboratorio Of Fisiopatologia Respiratoria E Centro Disturbi Respiratori Nel Sonno |
Bertolaccini L.,Chirurgia Toracica |
Terzi A.,Chirurgia Toracica |
And 7 more authors.
Respiratory Physiology and Neurobiology | Year: 2012
Exercise in healthy subjects is usually associated with progressive bronchodilatation. Though the decrease in vagal tone is deemed to be the main underlying mechanism, activation of bronchial β2-receptors may constitute an additional cause. To examine the contribution of β2-adrenergic receptors to bronchodilatation during exercise in healthy humans, we studied 15 healthy male volunteers during maximum exercise test at control conditions and after a non-selective β-adrenergic blocker (carvedilol 12.5mg twice a day until heart rate decreased at least by 10beats/min) and inhaled β2-agonist (albuterol 400μg). Airway caliber was estimated from the partial flow at 40% of control forced vital capacity (V̇part40) and its changes during exercise from the slope of linear regression analysis of V̇part40 values against the corresponding minute ventilation during maximal exercise until exhaustion. At control, V̇part40 increased progressively and significantly with exercise. After albuterol, resting V̇part40 was significantly larger than at control increased but did not further increase during exercise. After carvedilol, V̇part40 was similar to control but its increase with exercise was significantly attenuated. These findings suggest that β2-adrenergic system plays a major role in exercise-induced bronchodilation in healthy subjects. © 2012 Elsevier B.V.
Macchia D.,UO Allergologia Immunologia Clinica |
Capretti S.,UO Allergologia Immunologia Clinica |
Cecchi L.,Allergologia |
Colombo G.,Unita di Allergologia |
And 15 more authors.
Italian Journal of Allergy and Clinical Immunology | Year: 2011
Food allergy (FA) is an important problem due to its increasing prevalence in general population and to its broad range of clinical manifestations (from mild symptoms to anaphylactic shock, sometimes fatal). The identification of the food responsible for symptoms, using all the available standardized diagnostic methods, must be the main goal. The diagnosis of food allergy should be based on a correct procedure, that starts from a thorough clinical history and proceeds through the performance of in vivo and in vitro diagnostic methods, with a progressive level of complexity. The recent development of molecular biology techniques, that implies the use of molecular allergens, has improved the knowledge of food allergens and designs a component resolved sensitization profile (CRD: Component Resolved Diagnosis) for each patient, with important clinical and therapeutic consequences. However, the increasing use of in vitro routine tests based on molecular allergens runs the risk of possible, potentially serious mistakes. The Specialist in Allergology and Clinical Immunology should manage this complicated matter, after an adequate training. Therefore, a shared and standardized diagnostic pathway is mandatory. The aim of this position statement is to suggest the basic points in the adult food allergy diagnosis.
Incorvaia C.,Istituti Clinici di Perfezionamento |
Barbera S.,Otorinolaringoiatria |
Makri E.,Istituti Clinici di Perfezionamento |
Recenti Progressi in Medicina | Year: 2013
Allergic rhinitis may appear of little value but at present its high and still increasing prevalence, its socioeconomic burden, the frequent association with asthma and the significant impairment of quality of life in affected patients make it a disease of general importance. The ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines allow to properly recognize the mild forms and the moderate/severe forms, and, based on the duration of symptoms, the intermittent and persistent forms. Etiologic diagnosis can be suspected by history data but the certainty can be achieved only by allergy testing. The treatment is mainly based on oral or nasal topical antihistamines and topical corticosteroids, that ensure in most cases a satisfactory control of symptoms. However, there are patients who have an insufficient response to drugs, event at high doses. Recent studies showed that patients not controlled by drug treatment achieve a significant benefit from allergen specific immunotherapy, currently available by the subcutaneous and sublingual route. This should be considered as a criterion to choose patients for specific immunotherapy, who must be referred to the allergy specialist.
Pingitore G.,Allergologia |
European Annals of Allergy and Clinical Immunology | Year: 2013
House dust mites (HDM) are one of the most important sources of indoor allergens worldwide. Exposure to high environmental levels of dust mite allergen is associated with an increased risk of sensitization, asthma and deterioration of lung function. On the basis of these data, it would be logical to assume that asthmatic patients with mite allergy could benefit from a reduction of exposure to these allergens. Several environmental prophylactic actions against HDM, either physical or chemical have been tried, alone or in different combinations.However, a recent Cochrane Systematic Review did not detect specific clinical benefits from the use of prophylactic environmental measures in asthmatic patients sensitive to HDM and concluded that such measures can no longer be recommended as they are ineffective.This paper presents the results of a web-based questionnaire, administered to more than 200 Italian paediatricians, and shows that physicians' behaviour in real life is very far from SR conclusions. It also summarizes the indications of the most authoritative guidelines, highlighting some contrasting evidence and some significant weaknesses of the SR, that could make the final conclusions at least uncertain. In the light of these findings, it seems that the recent Cochrane SR cannot be considered the definitive document on the uselessness of environmental prevention of mite-related asthma.