Mona Rita Yacoub

EAACI position paper on occupational rhinitis

The present document is the result of a consensus reached by a panel of experts from European and non-European countries on Occupational Rhinitis (OR), a disease of emerging relevance which has received little attention in comparison to occupational asthma. The document covers the main items of OR including epidemiology, diagnosis, management, socio-economic impact, preventive strategies and medicolegal issues. An operational definition and classification of OR tailored on that of occupational asthma, as well as a diagnostic algorithm based on steps allowing for different levels of diagnostic evidence are proposed. The needs for future research are pointed out. Key messages are issued for each item.

Effect of noninvasive mechanical ventilation in elderly patients with hypercapnic acute-on-chronic respiratory failure and a do-not-intubate order

Noninvasive mechanical ventilation (NIMV) is effective in the treatment of patients with acute respiratory failure (ARF). It proved to reduce the need of endotracheal intubation (ETI), the incidence of ETI-associated pneumonia, and mortality compared to nonventilated patients. A particular aspect concerns the outcome of NIMV in patients referring to an emergency room (ER) for ARF, and with a do-not-intubate (DNI) status due to advanced age or critical conditions. The aim of our study is to assess the outcome of NIMV in a group of elderly patients with acute hypercapnic ARF who had a DNI status. An overall number of 62 subjects (30 males, 32 females, mean age 81 ± 4.8 years, range 79–91 years) referred to our semi-intensive respiratory department were enrolled in the study. The underlying diseases were severe chronic obstructive pulmonary disease (COPD) in 50/62 subjects, restrictive thoracic disorders in 7/62 subjects, and multiorgan failure in 5/62 subjects. Fifty-four/62 patients were successfully treated with NIMV while 2/62 did not respond to NIMV and were therefore submitted to ETI (one survived). Among NIMV-treated patients, death occurred in 6 patients after a mean of 9.9 days; the overall rate of NIMV failure was 12.9%. Negative prognostic factors for NIMV response proved to be: an older age, a low Glasgow Coma Score, a high APACHE score at admission, a high PaCO2 after 12 hours and a low pH both after 1 and 12 hours of NIMV. We conclude that elderly patients with acute hypercapnic ARF with a DNI status can be successfully treated by NIMV.

Optimal management of DRESS syndrome in course of infectious endocarditis

[3] Bernstein JA, Herd ZA, Bernstein DI, Korbee L, Bernstein IL. Evaluation and treatment of localized vaginal immunoglobulin E-mediated hypersensitivity to human seminal plasma. Obstet Gynecol. 1993;82:667e673. [4] Lee-Wong M, Collins JS, Nozad C, Resnick DJ. Diagnosis and treatment of human seminal plasma hypersensitivity. Obstet Gynecol. 2008;111:538e539. [5] Freeman S. Woman allergic to husband’s sweat and semen. Contact Dermatitis. 1986;14:110e112. [6] Valyasevi MA, Maddox DE, Li JT. Systemic reactions to allergy skin tests. Ann Allergy Asthma Immunol. 1999;83:132e136.

Rituximab hypersensitivity in IgG4-related disease: Successful desensitization in a patient with IgG4 rheumatoid factor

Rituximab hypersensitivity in IgG4-related disease: successful desensitization in a patient with IgG4 rheumatoid factor Emanuel DELLA-TORRE,* Antonio CONTI,* Alvise BERTI, Mona Rita YACOUB and Massimo ALESSIO Universit a Vita-Salute San Raffaele, School of Medicine, Unit of Medicine and Clinical immunology, and Proteome Biochemistry, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy

Evaluation of basophil activation test in suspected food hypersensitivity

Food hypersensitivity is characterized by a wide range of symptoms. The relationship between symptoms and food is more frequently suspected than objectively proven. Basophil activation test (BAT) is based on the evaluation of activation markers on blood basophils in vitro stimulated with drugs or allergens.