G. Senna

Recommendations for assessing Patient‐Reported Outcomes and Health‐Related quality of life in clinical trials on allergy: a GA2LEN taskforce position paper

To cite this article: Baiardini I, Bousquet PJ, Brzoza Z, Canonica GW, Compalati E, Fiocchi A, Fokkens W, van Wijk RG, La Grutta S, Lombardi C, Maurer M, Pinto AM, Ridolo E, Senna GE, Terreehorst I, Todo Bom A, Bousquet J, Zuberbier T, Braido F. Recommendations for assessing Patient‐Reported Outcomes and Health‐Related quality of life in clinical trials on allergy: a GA2LEN taskforce position paper. Allergy 2010; 65: 290–295.

Specific recommendations for PROs and HRQoL assessment in allergic rhinitis and/or asthma: a GA2LEN taskforce position paper

To cite this article: Braido F, Bousquet PJ, Brzoza Z, Canonica GW, Compalati E, Fiocchi A, Fokkens W, Gerth van Wijk R, La Grutta S, Lombardi C, Maurer M, Pinto AM, Ridolo E, Senna GE, Terreehorst I, Todo Bom A, Bousquet J, Zuberbier T, Baiardini I. Specific recommendations for PROs and HRQoL assessment in allergic rhinitis and/or asthma: a GA2LEN taskforce position paper. Allergy 2010; 65: 959–968.

Recommendations for assessing patient-reported outcomes and health-related quality of life in patients with urticaria: a GA2LEN taskforce position paper

To cite this article: Baiardini I, Braido F, Bindslev‐Jensen C, Bousquet PJ, Brzoza Z, Canonica GW, Compalati E, Fiocchi A, Fokkens W, Gerth van Wijk R, Giménez‐Arnau A, Godse K, Grattan C, Grob JJ, La Grutta S, Kalogeromitros D, Kocatürk E, Lombardi C, Mota‐Pinto A, Ridolo E, Saini SS, Sanchez‐Borges M, Senna GE, Terreehorst I, Todo Bom A, Toubi E, Bousquet J, Zuberbier T, Maurer M. Recommendations for assessing patient‐reported outcomes and health‐related quality of life in patients with urticaria: a GA2LEN taskforce position paper. Allergy 2011; 66: 840–844.

Administration regimens for sublingual immunotherapy to pollen allergens: What do we know?

The modalities of administration of sublingual immunotherapy (SLIT), including dosing, build‐up phase, duration of the treatment, and frequency of the maintenance dose are largely variable. In the case of pollen (SLIT), the complexity increases, since preseasonal, coseasonal and pre‐coseasonal regimens can be used. The administration regimens are of relevance from a practical point of view, but can also have economic implications. We review herein the available literature (randomized double blind controlled studies) on pollen SLIT, in order to derive experimentally‐supported suggestions about the regimens of administration that should be preferred.

The role of patient training in the management of seasonal rhinitis and asthma: clinical implications

Background: Allergic rhinitis is an inflammatory disease often associated with bronchial asthma. Intranasal corticosteroids and oral antihistamines are the first‐choice drugs. Patient training is relevant to asthma management, but little is known about its impact on rhinitis. We evaluated the role of patient training in the treatment of allergic rhinitis and its effects on nasal and bronchial symptoms.

Evaluation of the IgE cross-reactions among vespid venoms. A possible approach for the choice of immunotherapy.

Background:u2002 Hymenoptera venom allergy can be effectively cured with specific immunotherapy, thus the correct identification of the allergen is essential. In the case of multiple skin and serum positivities it is important to know if a cross‐reaction among venoms is present. We studied by CAP‐inhibition assays the degree of cross‐reactivity between Vespula vulgaris and Polistes dominulus.

Correlation among FEV1, nitric oxide and asthma control test in newly diagnosed asthma

Asthma is a multifaceted disease and therefore numerous markers or measurements of its severity and activity are available. Among them, functional parameters (spirometry), clinical assessment (symptoms and quality of life) and biomarkers of inflammation are the most widely used. Nonetheless, it is difficult to establish a clear correlation among the mentioned parameters, as each of them seems to measure a particular aspect of the disease and to be partially independent of the others. This fact has been demonstrated, for instance, for methacholine reactivity that weakly correlates with inflammation (1) or for quality of life that poorly correlates with symptoms (2). During the last years new evaluation parameters for asthma have been introduced. One of them is the measurement of exhaled nitric oxide (eNO) as an indirect marker of inflammation (3) that can be assessed through a proper apparatus with a simple expiratory manoeuvre. Another new instrument for asthma evaluation is the asthma control test (ACT), that allows a quick self-assessment of the degree of control of the disease (4). The ACT consists of five questions enquiring about the frequency of symptoms in the last 4 weeks. Each question has five possible answers scored from 1 (worst) to 5 (best). The higher the ACT score (25 points is the maximum achievable), the better controlled is asthma. We attempted to assess whether there is some correlation among asthma ACT score, eNO and forced expiratory volume at 1 s (FEV1) in outpatients receiving the first diagnosis of asthma, which was graded in severity according to GINA criteria (http://www.ginasthma.com). Patients, referred for the first time for respiratory complaints and without a previous diagnosis of asthma, underwent a detailed clinical history, clinical visit and spirometry (with methacholine test or reversibility test). Asthma was diagnosed on the basis of: (i) history of attacks of chest tightness, cough, wheezing, nocturnal awakenings, and (ii) impaired spirometry with a reversibility of at least 12% in the FEV1 after salbutamol or, in alternative a normal spirometry with a positive methacholine test. The severity of asthma was graded according to GINA guidelines. Before prescribing an adequate therapy, ACT was administered and eNO was assessed. Exhaled nitric oxide was measured by a CLD 88 sp (ECO-Medics, Duernten, Switzerland), the threshold value of eNO was 20 p.p.b. From April to May 2006, 27 patients (17 male, mean age 31.9, age range 16– 57 years) were diagnosed with asthma for the first time. The severity of the disease according to GINA was: intermittent in one, mild in six, moderate in 16 and severe in four. Their FEV1 ranged from 69% to 110% and eNO varied between 18 and 208 p.p.b. Looking at the four parameters (Fig. 1) there was no correlation between FEV1 and ACT (r 1⁄4 0.26, P 1⁄4 0.2) and between FEV1 and eNO AL LERGY 2 0 0 7 : 6 2 : 2 0 7 – 2 1 2 • a 2007 THE AUTHORS • JOURNAL COMPILAT ION a 2007 BLACKWELL MUNKSGAARD • CONTRIBUT IONS TO THIS SECT ION WILL NOT UNDERGO PEER REVIEW, BUT WILL BE REV IEWED BY THE ASSOCIATE EDITORS •

Sensitization to horse allergens in Italy: A multicentre study in urban atopic subjects without occupational exposure

Background: Horses play a significant role in people’s leisure time in Italy and other countries, but few data are available on IgE-mediated sensitization to horse allergens in patients without occupational exposure. We assessed, in a multicentric survey, the prevalence of horse sensitization in atopic subjects and its clinical characteristics. Methods: Allergists from the whole Italian territory were required to collect the results of skin prick tests from at least 100 consecutive subjects. Those patients with a positive skin test to horse dander underwent a detailed interview concerning clinical history, pet ownership and possible exposure. Results: Data from 3,235 outpatients were collected and 2,097 had at least 1 skin positivity. Among them, 113 (5.38%) were sensitized to horse dander (9 monosensitized). Thirty patients reported direct horse contact (4 owners and 26 for riding or occasional contact), 23 patients were sometimes in contact with horse owners and 60 subjects denied any direct or indirect exposure. Among 9 horse monosensitized patients, 6 had intermittent and mild rhinitis and 3 persistent moderate/severe rhinitis plus asthma. Three of them were horse owners or riders and the remaining had no contact with the animal. Conclusions: Our data evidence that the rate of sensitization to horse dander is not negligible and probably underestimated. In susceptible, not occupationally exposed individuals, horse contact, but also indirect or no apparent exposure, may induce sensitization. We recommend inclusion of horse allergen in the routine panel for the diagnosis of respiratory allergy.

Exercise-induced anaphylaxis to grape†

. EXERCISE-induced anaphylaxis (EIA) is characterized by airways obstruction urticaria, and hypotension following physical exercise, and it can be associated with food allergy (1, 2). We describe one case of EIA due to ingestion of grape, which rarely causes allergic reactions. A 33-year-old woman, with allergic rhinoconjunctivitis due to Parietaria and mugwort, reported in the past year facial flushing, edema of the lips, and dyspnea after drinking white or red wine, although she could eat fresh grapes without problem. The symptoms were reproducible and clearly related to wine; therefore, she was advised to avoid it. One month before, after eating white grapes, she had gone jogging. After the exercise, urticaria, facial/ pharyngeal edema, abdominal pain, and dyspnea appeared and rapidly worsened. At the emergency department, profound hypotension was found: her blood pressure was 70/52 mmHg, heart rate 130 bpm, and respiratory frequency 24/min. She received epinephrine, plasma expanders, and corticosteroids/antihistamines, and recovered within 3 h. We suspected EIA associated with grape allergy, and performed a detailed diagnostic procedure. The skin prick tests with commercial extracts (Stallergènes, Antony Cedex, France) with inhalants and foods were negative except for Parietaria and mugwort. Molds (Aspergillus fumigatus, Cladosporium herbarum, Alternaria alternata, Penicillium notatum, and Botrytis), which can be present on grape surfaces, were negative as well. The prick-to-prick tests with juice from white and red grapes were positive. The arithmetic means of wheal diameters were as follows: 8 mm for white grape, 5 mm for red grape, and 4 mm for histamine HCl 0.1%. The oral single-blind challenge with metabisulfite using increasing doses up to 75 mg (Test Dose, Lofarma, Milan, Italy) was negative. An in vivo challenge (food plus exercise) was not performed for ethical reasons. Serum tryptase (Tryptase UniCAP, Pharmacia, Uppsala, Sweden) in a blood sample obtained within 1 h after the onset of EIA was increased (18.2 ng/ml, normal value ,15 ng/ml). A grape extract was prepared for immunologic studies. Grape was homogenized and extracted at 10% w/v in 0.1 M potassium phosphate buffer, pH 7, for 1 h. After removing the particulate by centrifugation, the supernatant was dialyzed against 5 mM ammonium bicarbonate, lyophilized, and resuspended in 1/10 of the initial volume. Electrophoresis of the extract (12 mg/lane) was performed in a 10% polyacrylamide gel (Nupage Sis-Tris, Prodotti Gianni, Milan, Italy) at 180 mA for 1 h. The resolved proteins were stained with 0.1% Coomassie brilliant blue and transferred to a nitrocellulose membrane (Protann BA, 85, Scheicher and Schuell, Milan, Italy). The membrane was saturated with 5% defatted dried milk before incubation with patient’s serum or control sera diluted 1:2. Bound specific IgE was then detected by peroxidase-conjugated antihuman IgE serum. No grape-specific IgE could be demonstrated in the patient’s serum by the CAP-RAST technique. However, the assessment of IgE reactivity of serum against grape extract provided a positive result. The SDS–PAGE profile of grape extract showed the presence of a well-resolved band at about 67 kDa and a diffuse stain between 25 and 35 kDa. Immunoblotting showed that the patient’s serum had IgE antibodies against one specific component of the extract (approximate molecular mass 30 kDa), whereas control sera also reacted to the 67kDa band. IgE-mediated reactions to grape have been rarely reported (2, 3–6). The case herein described was a true food-associated EIA, since the patient remained asymptomatic when eating at rest great amounts of the sensitizing food. The prick-to-prick positivity and the increase of serum tryptase confirmed the mast-cell activation. Moreover, the immunoblot analysis suggested that the patient had specific IgE reacting to one component of the grape extract, despite the negativity of the CAPRAST assay.

Unconventional medicine: a risk of undertreatment of allergic patients

References 1. Moneret-Vautrin DA, Rance F, Kanny G, et al. Food allergy to peanuts in France. Evaluation of 142 observations. Clin Exp Allergy 1998;28:1113±1119. 2. Facchini G, Antonicelli L, Cinti B, Bonifazi F, Massei V. Paradoxical bronchospasm and cutaneous rash after metered-dose inhaled bronchodilator. Monaldi Arch Chest Dis 1996;3:201±203. 3. Nicolas F, GuimbretieÁre J, Nicolas G, GuimbretieÁre L. Six reactions dintolerance aÁ une eÂmulsion lipidique. Etude immunologique. Anesth Analg Reanim 1996;23:647±660. 4. Lavaud F, Perdu D, Prevost A, Vallerand H, Cossart C, Passemard F. Bakers asthma related to soybean lecithin exposure. Allergy 1994;49:159±162. 5. Renaud C, Cardiet C, Dupont C. Allergy to soy lecithin in a child. J Pediatr Gastroenterol Nutr 1996;22:328±329. 6. Porras O, Carlsson B, FallstroÈm SP, Hanson LA. Detection of soy protein in soy lecithin, margarine and occasionally soy oil. Int Arch Allergy Appl Immunol 1985;78:30±32. 7. Awazuhara H, Kawai H, Baba M, Matsui T, Komiyama A. Antigenicity of proteins in soy lecithin and oil in soybean allergy. Clin Exp Allergy 1998;28:1559±1564.