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Zanotti R.,Section of Hematology | Lombardo C.,Allergy Unit | Passalacqua G.,University of Genoa | Caimmi C.,Section of Rheumatology | And 13 more authors.
Journal of Allergy and Clinical Immunology | Year: 2015

Background: Systemic mastocytosis is a clonal mast cell (MC) disease that can lead to potentially fatal anaphylactic reactions caused by excessive MC mediator release. The prevalence of mastocytosis in patients with Hymenoptera venom allergy is high, and thus the disease should be suspected in patients with severe reactions caused by Hymenoptera stings and increased serum basal tryptase (SBT) levels. Objective: We sought to evaluate the presence of clonal MC disorders in patients seen at our mastocytosis center with Hymenoptera sting-induced anaphylaxis, documented hypotension, absence of urticaria pigmentosa, and normal SBT levels. Methods: Twenty-two patients with Hymenoptera sting- induced anaphylaxis, without skin lesions, and with tryptase levels of less than 11.4 ng/mL underwent bone marrow evaluation. Bone mineral density was assessed in those patients with ascertained mastocytosis. Results: In 16 of 22 patients, a diagnosis of indolent mastocytosis could be established, and 1 patient had a monoclonal MC activation syndrome. Patients with mastocytosis had higher SBT levels (P =.03) but only rarely had angioedema/urticaria associated with hypotension (P =.004). Conclusions: The absence of urticaria or angioedema in severe reactions to Hymenoptera stings with hypotension might represent the most relevant factor in identifying patients with mastocytosis, regardless of their serum tryptase levels. © 2015 American Academy of Allergy, Asthma & Immunology.


Loo E.X.L.,National University of Singapore | Shek L.P.-C.,National University of Singapore | Shek L.P.-C.,National University Hospital Singapore | Goh A.,Allergy Service | And 11 more authors.
International Archives of Allergy and Immunology | Year: 2015

Atopic dermatitis (AD) has been highlighted as a likely first step in the 'atopic march', emphasizing the need to define predisposing factors. Methods: We evaluated AD risk factors and phenotypes in an Asian mother-offspring cohort. We defined three phenotypes of doctor-diagnosed AD based on the time of onset of the disease: early AD occurring within the first 6 months of life, AD occurring between 6 and 12 months and late-onset AD starting after the age of 12 months. Results: Maternal allergic history was associated with an increased risk of developing early-onset AD (adjusted odds ratio (aOR) 20.46, 95% confidence interval (CI) 2.73-153.15, p < 0.01). Maternal allergic history and attendance at a daycare centre increased the odds of the development of AD between 6 and 12 months (aOR 4.19, 95% CI 1.01-17.45, p = 0.049 and aOR 11.42, 95% CI 1.49-87.50, p = 0.02, respectively). Risk factors associated with increased odds of late-onset AD from 12 months were the consumption of probiotics between the age of 9 and 12 months and antibiotic treatment in the first 6 months of life (aOR 4.32, 95% CI 1.07-17.45, p = 0.04 and aOR 3.11, 95% CI 1.10-8.76, p = 0.03, respectively). Early-onset AD was associated with an increased risk of developing allergic sensitization (aOR 46.51, 95% CI 3.44-628.81, p < 0.01). Conclusion: We found that early-onset AD was mainly associated with familial factors, while late-onset AD was associated with the consumption of antibiotics or probiotics. The findings support the concept that different phenotypes of AD exist in young children. © 2015 S. Karger AG, Basel.


PubMed | Complejo Hospitalario Of Jaen, Hospital Virgen del Valle, Consulta Privada, ALK Abello SA and 4 more.
Type: | Journal: Journal of asthma and allergy | Year: 2016

Sublingual allergen immunotherapy is an effective treatment against allergic respiratory disease. Many studies have shown the safety of this type of therapy, although the factors that might affect the tolerability of high-dose sublingual immunotherapy have not been well established. The aim of this study was to determine the factors that affect the tolerability of sublingual allergen immunotherapy.A total of 183 subjects aged 5 years, diagnosed with allergic rhinitis with/without mild to moderate asthma due to sensitization to grass, olive pollen, or mites, were included in this open, retrospective, multicentric, noninterventional study. Sublingual immunotherapy was administered for at least 3 months.The most frequent adverse reaction was oral pruritus (13.7% of the patients). Most of the reactions were local (84.7%) and immediate (93.5%) and occurred during the initiation phase (60.6%). All reactions were mild to moderate in severity. No serious adverse reactions were registered. When comparing factors with potential influence on the occurrence of adverse reactions, the results between the groups of subjects with and without adverse reactions showed no statistically significant differences in sex (P=0.6417), age (P=0.1801), years since the disease was first diagnosed (P=0.3800), treatment composition (P=0.6946), polysensitization (P=0.1730), or clinical diagnosis (P=0.3354). However, it was found that treatment duration had a statistically significant influence (3 months, >3 months: P=0.0442) and the presence of asthma was close to statistical significance (P=0.0847).In our study, treatment duration is significantly associated with the occurrence of adverse reactions after the administration of high doses of sublingual allergen immunotherapy.


Ibanez M.D.,Hospital Infantil Universitario Nino Jesus | Valero A.L.,Research Center Biomedica en Red en Enfermedades Respiratorias | Valero A.L.,Immunoallergia Respiratoria Clinica i Experimental IRCE Institute | Montoro J.,San Vicente Mártir Catholic University of Valencia | And 10 more authors.
Pediatric Allergy and Immunology | Year: 2013

Background: Allergic rhinitis (AR) is the most common chronic disease in children. The main objective of this study was to analyze the comorbidities and therapeutic approaches for AR in a Spanish pediatric population. Methods: Children aged 6 to 12 years with AR were included in an observational, cross-sectional, multicenter study. Results: 1,275 children were recruited from 271 centers. AR was intermittent in 59.5% of cases, persistent in 40.5%, seasonal in 60.7%, and perennial in 39.3% of patients. The most frequent comorbidities were conjunctivitis (53.6%), asthma (49.5%), atopic dermatitis (40%), rhinosinusitis(26.1%), otitis media (23.8%), and adenoid hypertrophy (17.3%). Overall, patients with persistent, moderate or severe, AR were more likely to present comobidities, except for food allergy and urticaria. The most common drugs used for treatment of AR were oral antihistamines(76%), nasal corticosteroids(49%) and a combination of both (45%). Antihistamines and nasal corticosteroids were used on demand (<18 days) in 38 and 41% of patients, respectively; for 18-30 days in 22 and 27%; for 1-3 months in 31 and 29%; and for more than 3 months in 8 and 3%, respectively. Eye drops were used in 32% and specific immunotherapy in 21% of patients. Conclusion: Comorbidities are frequent in children with AR, supporting the notion of allergy as a systemic disease. Severity and duration of AR were significantly associated with presence of most of comorbidities. The most common drugs used for AR treatment were oral antihistamines, followed by nasal corticosteroids and a combination of both used on demand. © 2013 John Wiley & Sons A/S.


Tripodi S.,Sandro Pertini Hospital | Frediani T.,University of Rome La Sapienza | Lucarelli S.,University of Rome La Sapienza | MacR F.,University of Rome La Sapienza | And 9 more authors.
Journal of Allergy and Clinical Immunology | Year: 2012

Background: The so-called component-resolved immunotherapy of allergies proposes an immunization tailored to the molecular sensitization profiles of individual patients. Objectives: We sought (1) to investigate the profiles of IgE sensitization to Phleum pratense in children with grass pollen allergy and (2) to define the compatibility of these profiles with a mixture of recombinant allergenic molecules of P pratense previously proposed for specific immunotherapy. Methods: We examined 200 children (age, 4-18 years; 126 boys) with allergic rhinitis, asthma, or both ascertained through validated questionnaires. Each child underwent skin prick testing (ALK-Abelló) and serum IgE assays (ImmunoCAP, Phadia) with 9 pollen extracts. Sera reacting against P pratense were tested for the individual molecules (rPhl p 1, rPhl p 2, rPhl p 4, nPhl p 4, rPhl p 5b, rPhl p 6, rPhl p 7, rPhl p 11, and Phl p 12). Through a combinatorial approach, the IgE individual sensitization profiles were matched against an experimental allergen-specific immunotherapy (SIT) preparation containing Phl p 1, Phl p 2, Phl p 5, and Phl p 6. Results: Among the 176 of 200 children with IgE sensitization to P pratense extract, 39 profiles of sensitization to the 8 allergenic molecules tested (cutoff, 0.35 kU/L) were identified. This high heterogeneity was reduced by considering only 6 or 4 P pratense molecules but not by increasing the cutoff levels of IgE positivity. The molecular profile of the experimental SIT preparation matched that of 7 (4%) of 176 patients only; the remaining 169 patients were classified in 4 mismatch categories: underpowered (29%), overpowered (32%), underpowered/overpowered (32%), and unrelated (3%). Conclusions: IgE sensitization profiles to P pratense are highly heterogeneous. Molecularly designed SIT preparations tailored to patients' needs should consider this high heterogeneity and be driven by locally performed population studies. © 2011 American Academy of Allergy, Asthma & Immunology.


Incorvaia C.,Allergy Pulmonary Rehabilitation | Frati F.,Stallergenes | Dell'Albani I.,Stallergenes | Robino A.,Niguarda Ca Granda Hospital | And 5 more authors.
Expert Opinion on Pharmacotherapy | Year: 2011

Introduction: The efficacy of venom immunotherapy (VIT) in patients with insect sting allergy is not questioned. However, its safety, especially when honeybee is used, is a matter of concern. Areas covered: A systematic review of the literature on VIT was done, with both aqueous and depot extracts, to compare the frequency of systemic reactions to honeybee and vespid venoms. A Medline search was performed using the keywords 'venom immunotherapy', 'safety' and 'tolerability'. The articles obtained were analyzed regarding the total number of patients treated with either honeybee or vespid VIT, the number and severity of systemic reactions during therapy, the type of extract used (aqueous or depot) and the administration regimen. Expert opinion: The incidence of systemic reactions to VIT was 25.1% for honeybee venom and 5.8% for vespid venom (p < 0.0001), while it was similar with aqueous and depot extracts in the whole population of patients. This confirms that during VIT systemic reactions are significantly more frequent with honeybee venom compared with vespid venom, while there are no significant overall differences in systemic reactions between aqueous and depot extracts. © 2011 Informa UK, Ltd.


Qualizza R.,Allergy Service | Makri E.,Allergy Pulmonary Rehabilitation | Losappio L.,University of Foggia
Review of Allergy and Clinical Immunology | Year: 2014

Infections from Toxocara species are much more common than believed and cause a number of clinical manifestations due to involvement of various tissues and organs. Here we report the case of a woman long suffering from rheumatoid arthritis, Sjogren syndrome and autoimmune thyroiditis who developed pleural effusion. The disease was considered related to the autoimmune pathology of the patients, but treatment with corticosteroids was unsuccessful. Due to the presence of peripheral eosinophilia, we performed in vitro testing (Western blotting and ELISA) for IgG antibodies to Toxocara, with positive results. Anti-helminthic treatment by mebendazol. for three days repeated after 20, 50 and 80 days achieved the complete recovery of pleural effusion. This suggests to consider also Toxocara infection in patients with persistent pleural effusion with eosinophilia. © Societa Italiana di Allergologia e Immunologia Clinica.


Morgado J.M.,Institute Estudios Of Mastocitosis Of Castilla La Mancha | Perbellini O.,Section of Haematology | Johnson R.C.,Stanford University | Teodosio C.,Red Espanola de Mastocitosis | And 20 more authors.
Histopathology | Year: 2013

Aims: CD30 expression by bone marrow (BM) mast cells (MC) has been reported recently in systemic mastocytosis (SM) patients. The aim of this study was to investigate the potential diagnostic and prognostic value of CD30 expression in SM as assessed by multiparameter flow cytometry. Methods and results: A total of 163 consecutive BM samples corresponding to 142 SM patients and 21 non-mastocytosis cases were studied. CD30 was positive in most SM patients (80%), but in only one non-mastocytosis case (4.8%). When combined with CD25, CD30 contributed to an improved accuracy over that of CD25 alone (98% versus 93%) mainly because most (eight of nine) of the well-differentiated SM (WDSM), who lacked CD25, were CD30+. Similar levels of expression of CD30 were observed among all different subgroups of SM except mast cell leukaemia; among indolent SM (ISM) patients, no significant association was observed between the levels of CD30 expression and other clinical and biological features of the disease. Conclusions: The increased expression of CD30 associated with absence of CD25 contributes to the diagnosis of WDSM and its distinction from other subtypes of SM. By contrast, CD30 expression did not contribute either to prognostic stratification of ISM or to the differential diagnosis between ISM and aggressive SM cases. © 2013 John Wiley & Sons Ltd.


PubMed | Allergy Service
Type: | Journal: International journal of general medicine | Year: 2011

Toxocara canis is an intestinal nematode affecting dogs and cats, which causes human infection when embryonated eggs excreted in dog feces are ingested. Humans are paratenic hosts. Although the larvae do not develop into adult worms in the human body, they may migrate to various tissues and organs where they can survive for several years, giving rise to several clinical symptoms, which can present in allergy-like form.Over 5 years, we examined 9985 patients referred for suspected allergies, based on symptoms such as dermatitis, urticaria, rhinitis, asthma, and conjunctivitis; 753 patients who had allergy tests negative or unrelated to clinical history were tested for seropositivity to T. canis by enzyme-linked immunosorbent assay (ELISA) or Western blotting (WB).In 240 patients (31.8%), ELISA or WB or both tests were positive for T. canis immunoglobulin G (IgG) antibodies: in particular, 64 of them (26.7%) were positive to ELISA, 110 (45.8%) to WB, and 66 (27.5%) to both tests. Asthma was the most common clinical presentation. Two thirds of patients underwent subsequent anthelmintic therapy and showed a complete remission of symptoms and, in 43% of patients retested by ELISA and WB, became negative to Toxocara.These findings strongly suggest that T. canis plays a significant role in inducing chronic symptoms presenting as suspected allergies.


PubMed | Allergy Service
Type: Case Reports | Journal: Iranian journal of allergy, asthma, and immunology | Year: 2010

Toxocara canis is an intestinal nematode affecting dogs and cats that causes human infestations by ingestion of embryonated eggs excreted in dogs faeces. Humans are transport hosts, in whom the larvae do not develop to adult worms, but may migrate to various tissues and organs, and survive for several years, giving rise to several clinical symptoms, which include allergy-like presentations. We report three cases presenting as dermatitis, rhinitis, asthma, and conjunctivitis which were diagnosed and unsuccessfully treated as allergy. The correct diagnosis was established after detecting anti-Toxocara antibodies by Western blotting. All clinical symptoms showed improvement after starting treatment with mebendazole and subsequent courses of the antiparasitic drug resulted in full recovery. This suggests the possible role of Toxocara canis in inducing chronic symptoms of allergic type. This is particularly important for asthma, where it has been demonstrated that Toxocara canis infection causes allergic inflammation in the lungs associated with bronchial hyperreactivity. On the other hand, in our patients with asthma and with dermatitis the positive results from allergy tests were a confounding factor in delaying the correct diagnosis, which was finally obtained by the detection of antibodies to Toxocara canis.

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