Giuseppe Crisafulli

Oral Immunotherapy for Egg Allergy: A Double-Blind Placebo-Controlled Study, with Postdesensitization Follow-Up

BACKGROUND Oral immunotherapy (OIT) may be an effective treatment for food allergy in children. It is not clear if the OIT-induced effect is achieved by desensitization (transient state dependent on regular antigen exposure), or by tolerance (persistent condition where the ability to consume the food is retained even after a period of withdrawal). OBJECTIVE The aim of this study was to investigate the efficacy of OIT-egg desensitization in a double-blind placebo-controlled study, and to evaluate if, after desensitization, tolerance can be maintained. METHODS Children with egg allergy were randomized to OIT or placebo for 4 months. At the end of the controlled phase, a double-blind food challenge was repeated to confirm the achieved desensitization. Those subjects found to be desensitized were placed on an egg-containing diet for 6 months, followed by an egg avoidance phase for 3 months, when the food challenge was repeated to determine the maintained tolerance. RESULTS A total of 31 children were randomized to OIT with dehydrated egg white (n = 17) or placebo (n = 14). Of the 17 active patients (1 dropout), 16 achieved desensitization and started the 6-month egg-containing diet. After 3-month of egg avoidance, 31% remained tolerant. In the control group, only 1 passed the final food challenge. Egg-specific IgG4 increased only in the active group. Five active OIT patients had side effects. CONCLUSION Egg OIT results in desensitization in almost all subjects, although tolerance was maintained in only 1/3 of them after a 3-month period of withdrawal. Side effects were encountered, but the procedure appeared safe. In hen egg allergy, OIT is effective for desensitization.

Ass's milk in children with atopic dermatitis and cow's milk allergy: Crossover comparison with goat's milk

Cow milk allergy is a common disease of infancy, often associated with atopic dermatitis (AD). Avoidance of cow milk (CM) implies the use of alternative dietary supports such as mammalian milks. In this study, we assessed the tolerability and clinical effect of asss milk (AM), when compared with the largely used goats milk (GM) in a single‐blind, controlled, randomized crossover. Twenty‐eight children with AD and ascertained allergy to CM were enrolled. The children were randomized to AM or GM for 6 months, then switched to the other milk for further 3 months. The SCORAD index (SI) and a visual analog scale (VAS) were evaluated blindly. After termination of the study, food challenges with GM and AM were performed. An SDS‐PAGE analysis of different milks was performed. Two children from the GM group dropped out after randomization and 26 completed the study. Ass milk invariantly led to a significant improvement of SI and VAS of symptoms (p < 0.03 vs. baseline and inter‐group), whereas GM had no measurable clinical effect. At the end of the study 23 of 26 children had a positive food challenge with GM and one of 26 with AM. Asss milk had a protein profile closer to human milk than GM. Ass milk is better tolerated and more effective than GM in reducing symptoms of AD. It may represent a better substitute of CM than the currently used GM.

Direct comparison between continuous and coseasonal regimen for sublingual immunotherapy in children with grass allergy: a randomized controlled study.

To cite this article: Pajno GB, Caminiti L, Crisafulli G, Vita D, Valenzise M, De Luca R, Passalacqua G. Direct comparison between continuous and coseasonal regimen for sublingual immunotherapy in children with grass allergy: A randomized controlled study. Pediatr Allergy Immunol 2011: 22: 803–807.

Comparison between two maintenance feeding regimens after successful cow's milk oral desensitization

Cows milk allergy is common in infancy, and total avoidance of this food is the only effective approach. In alternative, oral immunotherapy has been proposed to achieve tolerance. Once desensitization is achieved, daily intake of milk is recommended to maintain it, but this may be impractical for children/parents. We assessed whether a twice weekly maintenance regimen is effective.

Direct comparison between continuous and co-seasonal regimen for sublingual immunotherapy in children with grass allergy. A randomised controlled study: 214

To cite this article: Pajno GB, Caminiti L, Crisafulli G, Vita D, Valenzise M, De Luca R, Passalacqua G. Direct comparison between continuous and coseasonal regimen for sublingual immunotherapy in children with grass allergy: A randomized controlled study. Pediatr Allergy Immunol 2011: 22: 803–807.

Subclinical hypothyroidism: The state of the art

Subclinical hypothyroidism (SH) is a common clinical problem, particularly in adulthood and the elderly. Its prevalence is conditioned by several etiological and risk factors. The highest age- and sex-specific rates are in women over 60. SH may be associated with manifestations of mild thyroid failure, which may reverse under levothyroxine (L-T4) therapy. The risk of progression to overt hypothyroidism is distinctly higher in cases with underlying thyroid disease. A population routine screening is not generally recommended, but screening is encouraged in high-risk groups. L-T4 therapy may be indicated in subjects with TSH levels which are repeatedly and consistently elevated (>10 μIU/ml) and may be considered in those with TSH ranging between 4.5–5.5 and 10 μIU/ml, particularly if anti-thyroid antibodies are positive and/or hypothyroid symptoms are present. Treatment should be based, at least initially, on L-T4 low doses.

Adherence to sublingual immunotherapy in preschool children.

Editor, Specific immunotherapy is the only effective causal treatment that can modify the natural history of respiratory allergy (1). This effect is important in children, where a secondary prevention is desirable. Sublingual administration (SLIT) is accepted as a valid therapeutic option (2), and children represent an ideal population for SLIT, because of the good safety profile (2). Nonetheless, as per all chronic treatments, adherence is essential, but no data are available in preschool children. We assessed the adherence to SLIT in children aged <6 yrs and analyzed the factors possibly affecting adherence itself. Children (age, 3–6 yrs) referred for respiratory diseases (bronchial asthma and/or rhinitis) and eligible for SLIT were enrolled. None had food allergy (possible confounding factor), and respiratory symptoms had to be present at least in the previous 6 months. The diagnosis of allergic asthma/ rhinitis was made according to guidelines (3, 4). Patients receiving SLIT were stratified according to age: group A (3£ yrs <4.0), group B (4.0£ yrs <5.0), group C (5.0£ yrs <6.0). All the procedures involved standard clinical approaches; thus, the study was simply notified to the Ethical Committee of the University of Messina, and all parents provided written informed consent. Children were followed up during the 2-yr observation period with 3-month regular visits. SLIT extracts were from Stallergénes, Lofarma, ALK– Abellò, Allergopharma. Parents were allowed to choose drops or tablets, and SLIT was given according to manufacturers’ recommendations. The administration technique was checked by pediatricians, using a placebo. Specific diary cards to assess the adherence (pre-compiled list), side effects, and reasons for discontinuation/temporary interruption of SLIT (free answers) were given to parents and collected at each visit. The time and reasons for interruption/discontinuation were carefully recorded. The remaining vials/tablets were checked at control visits. If >80% of the scheduled doses were taken, the patient was considered adherent. One hundred and fifty children (3–5.9 yrs, 86 boys) received SLIT for respiratory allergy (76% drops and 24% tablets). All suffered from allergic asthma and/or rhinitis from at least 6 months, and all received standard medications (antihistamines, intranasal corticosteroids, inhaled corticosteroids, bronchodilators). Mite SLIT accounted for 89.4% of prescriptions. Overall, 46% of 150 children discontinued SLIT. The percentage of discontinuations during the first year was significantly higher in group A than in groups B (52% vs. 18%, v = 12.7, p = 0.035) and C (52% vs. 13%, v 2 = 17.33, p = 0.032), whereas during the second year, there was no difference between groups (v 2 > 0.5). The reasons for discontinuation, as determined by parents’ interviews, are summarized in Table 1. The most common cause for withdrawal in group A was the subjective discomfort in keeping under the tongue drops/tablets, or children’s refusal, without apparent side effects. The refusal was generally attributed to unpleasant taste. For groups B and C, withdrawals were attributed to ineffectiveness, or to family problems, not better defined. All withdrawals occurred during the first 3 months of treatment in group A, and within the first 6 months in the other groups. In those patients who did not discontinue SLIT, short interruptions (all <5 days), as a

Treatment with omalizumab in a 16‐year‐old Caucasian girl with refractory solar urticaria

Based on recent evidence, including our results, we believe that the usefulness of the sIgE/total IgE ratio to predict tolerance to food allergens needs to be revisited in larger studies which can control for factors potentially influencing the results. In conclusion, in this cohort, the diagnostic performance of the OVA-sIgE/total IgE ratio was superior to sIgE or SPT to EW, OVA or OVM alone in predicting raw egg tolerance development in school-aged children and teenagers with IgE-mediated egg allergy. Acknowledgments The authors would like to thank Dr Paul Turner, MRC Clinician Scientist at Imperial College London, for his valuable comments on this letter.

Infantile spinal muscular atrophy with respiratory distress type I (SMARD 1): An atypical phenotype and review of the literature

Spinal muscular atrophy with respiratory distress (SMARD 1) is a very rare autosomal recessive motor neuron disorder that affects infants and is characterized by diaphragmatic palsy, symmetrical distal muscular weakness, muscle atrophy, peripheral sensory neuropathy and autonomic nerve dysfunction. SMARD 1 is inherited as an autosomal recessive trait and the mutations have been identified in the gene encoding immunoglobulin μ-binding protein 2 (IGHMBP2), located on chromosome 11q13. It is considered a fatal form of infantile motoneuron disease and most of the patients dies within the first 13 months of life. We present a female child with genetically confirmed SMARD 1 displaying a mild phenotype and no severe signs of respiratory involvement, typically found in this form, up to 38 months despite a diaphragmatic palsy diagnosed at 6 months of age. Therefore, our clinical observation suggests that respiratory failure is not secondary, in any case, to the diaphragmatic palsy but other pathogenetic mechanisms might be involved.

Menstrual cycle pattern during the first gynaecological years in girls with precocious puberty following gonadotropin-releasing hormone analogue treatment

Keywords Menarchetiming.Menstrualcycle.Centralprecociouspuberty.GnRHaOur aim was to longitudinally investigate menarche timingand menstrual cycle (MC) pattern during the first fivegynaecological years in 101 girls with idiopathic centralprecocious puberty (CPP) who had been treated withgonadotropin-releasing hormone agonists (GnRHa) for atleast two years. Our girls received Decapeptyl Depot(60