M. De Amici

Immunoglobulin production pattern is allergen-specific in polysensitized patients.

Allergic rhinitis (AR) is characterized by Th2 polarized immune response, such as increased IL-4 and reduced IFN-γ production, and by a functional defect of T regulatory cells. This impaired immune response profile influences the pattern of immunoglobulin production in allergic patients. Therefore, the aim of this study is firstly to investigate the allergen-specific IgE, IgG, IgG4, and IgA serum level pattern in polysensitized AR patients with the same skin prick test positivity to some pollen allergens. Secondly, this study aims at relating immunoglobulin (Ig) values with some clinical and immunological parameters. Eighty polysensitized patients with AR were enrolled. Serum allergen-specific IgE, IgG, IgG4, and IgA for mites, Parietaria, grasses, and birch, TGF-β and sHLA-G were determined by the ELISA method. Allergic symptoms and drugs use were also assessed. Allergen-specific IgE, IgG, IgG4, and IgA serum levels were significantly different for each tested allergen (p=0.000T). There was a significant correlation between IgE levels and allergy severity, whereas IgA had an antagonistic behaviour, considering mite-specific immunoglobulins. In conclusion, the present study provides the first evidence that immunoglobulin production pattern depends on the specificity of the allergenic response.

Adverse reactions to anaesthetics prevented by the use of specific laboratory tests

Adverse reactions to general anaesthetics are quite rare, but may be very severe and even lethal. Unfortunately, the diagnosis is frequently based on medical history and few laboratory tests are reliable. A clinical case is presented: a patient, 75 years of age, was a candidate for urgent coronary artery bypass graft surgery due to the results of the coronary angiogram (severe stenosis of the main stem). The patient reported cardiac arrest in both operations with general anaesthesia, but there was a lack of clinical documentation. Thus, sulfidoleukotriene assay (CAST-ELISA, Bühlmann Laboratories) was used to determine the tolerability of general anesthetics in a single patient. The results of this in vitro test was useful in discriminating and excluding the administration of some widely-used standard anaesthetic agents.

Profiles of birch sensitization (Bet v 1, Bet v 2, and Bet v 4) and oral allergy syndrome across Italy

BACKGROUND Birch allergy (BA) is a common pollinosis caused by the allergens Bet v 1, Bet v 2, and Bet v 4. Oral allergy syndrome (OAS) is frequently associated with BA. A gradient of sensitization to birch allergen across Europe has been reported. Therefore, this study aimed to investigate the birch sensitization profile, including OAS, across Italy. METHODS We performed a retrospective study of 854 patients (391 males, mean age 35.9 years, range 18-93 years): 196 patients were recruited in Genoa, 188 in northern Italy, 359 in central Italy, and 111 in southern Italy. Serum IgE to Bet v 1, Bet v 2, and Bet v 4 was assessed, and OAS was analyzed. RESULTS With respect to the geographical path Genoa-North-Center-South, the frequency of sensitization to Bet v 1 decreased significantly (P<.0001) from Genoa (95.41%) to southern Italy (58.56%). The frequency of sensitization to Bet v 2 increased significantly (P<.0001) from Genoa (6.12%) to southern Italy (52.25%). The frequency of Bet v 4 also increased significantly (P=.0002) from Genoa (6.12%) to southern Italy (14.41%). The distribution of patients with OAS differed significantly across the areas (P<.0001), the most marked difference ranging between 33.5% in Genoa and 76.9% in northern Italy. The frequency of birch allergens correlated with OAS in central Italy only. CONCLUSIONS The present study demonstrated a significant difference between sensitization to birch and its clinical expression across Italy.

Serum IgE for Bet v 1 in patients affected by atopic dermatitis

Atopic dermatitis (AD) is a common allergic disorder and may be associated with respiratory allergy. In this study serum levels of IgE specific for the major allergen of birch (Bet v 1) were measured in two groups of AD patients with specific IgE to birch: the first with associated respiratory birch allergy and the second with cutaneous symptoms alone. The results show that the patients suffering from AD associated with respiratory allergy had the highest serum levels of IgE specific for Bet v 1. In conclusion, this study shows that the measurement of serum specific IgE for a major allergen may be useful in common practice as high levels are associated with complicated pathology.

Immunoglobulin Production Pattern in Allergic and Non-Allergic Subjects

Allergic rhinitis (AR) is characterized by Th2 polarized immune response, such as increased IL-4 and reduced IFN-γ production, and by a functional defect of T regulatory cells. This impaired immune response profile influences the pattern of immunoglobulin (Ig) production in allergic patients. However, no studies have compared the pattern of inhalant allergen-specific Ig classes between allergic patients and normal subjects. The aim of this study is to therefore investigate the allergen-specific IgE, IgG, IgG4, and IgA serum level pattern in a group of patients with pollen allergy and in non-allergic healthy subjects. One hundred and two allergic patients (evaluated both out of and in the pollen season) were enrolled. In addition, 50 healthy non-allergic subjects were recruited during the whole year. Serum allergen-specific IgE, IgG, IgG4, and IgA for Parietaria, grasses, and birch were quantitatively determined by the ImmunoCAP System method. Allergen-specific IgE, IgG, IgG4, and IgA serum levels were significantly different for each tested allergen (p=0.0001 for each class) among groups. Allergic patients, mainly during pollen season, showed the highest IgG, IgG4, and IgA levels. The present study therefore provides the preliminary evidence that Ig production pattern toward inhalant allergens may depend on the specificity of the allergenic response both in non-allergic subjects and allergic patients Allergic patients do not show a defect of IgG and IgA classes. In addition, this study is the first that quantitatively evaluates the Ig classes. However, further studies should include non-allergic subjects evaluated both during and out of the pollen season.

Serum IL-17 after one course of sublingual immunotherapy in allergic rhinitis to birch

Recently, it has been reported that IL-17 may be involved in allergic reaction. Sublingual immunotherapy (SLIT) is the unique curative treatment for allergic rhinitis. This study aims at investigating whether one course of birch SLIT could affect serum IL-17 levels. The findings provided show that some IL-17 producer patients had a reduction of serum IL-17 levels after one SLIT course. Therefore, this preliminary study shows that a single pre-seasonal SLIT course may induce a significant decreasing trend in serum IL-17 levels; further study should be carried out to define the role exerted by IL-17 in allergic rhinitis.

Prediction of allergy by total serum IgE measurements in infancy: A 10-year follow-up

Asthma, allergic rhinitis and atopic dermatitis are multifactorial disorders influenced by various familial and environmental factors. Cord blood IgE levels may be predictive for subsequent allergy onset. Serum IgE assessment has been rarely investigated. This study is aimed at evaluating serum IgE levels during the first year of life and relating to subsequent allergies. Total serum IgE levels were assessed in 102 newborns in the first days of life (2–3) and then again at 3, 5, 6, 11 and 12 months of age. After ten years, paediatricians and general practitioners caring for these children were tracked through the Local Healthcare Agency (LHA) database and asked about possible allergy of their patients, including transient ones. F Serum IgE increased in allergic infants at 1 year of life. The predictive model was significant. In conclusion, this study demonstrates that serum IgE may be predictive of subsequent allergy onset, preferably if assessed at 1 year of age.