Paolo Crimi

Increase of Asthma and Allergic Rhinitis Prevalence in Young Italian Men

Our previous studies have reported that the prevalence of asthma was 2.89% and of allergic rhinitis 1.54% in Ligurian conscripts for the army during 1983. Since several authors reported an increasing prevalence of these diseases in different geographic areas, the aim of the present study was to evaluate the trend of prevalence rates in a same homogeneous group of Ligurian conscripts. The prevalence of asthma and allergic rhinitis was assessed in a group of 4310 young Ligurian men (18 years old) who had undergone medical examination for call-up to the navy during 1993, 1994 and 1995. Subjects were investigated by history, clinic visit, spirometry, metacholine bronchial challenge and skin prick test. The prevalence of asthma is 4.39% and of allergic rhinitis 2.2%. Comparing these results with previous data, a significant increase appears in this area 12 years later (respectively, p < 0.001 and p < 0.006). In addition, the association with asthma in allergic rhinitics increases from 41 to 77%, as well as an increasing trend appears for perennial allergens (i.e. mites and cat) and the polysensitizations increase from 48 to 67%. Possible explanations for these phenomena might be due to environmental factors (i.e. pollutants, viral infections, changes in domestic microenvironment).

Predictive accuracy of late asthmatic reaction to Dermatophagoides pteronyssinus

Sixteen patients with asthma were challenged with solutions of Dermatophagoides pteronyssinus extracts. Fifteen patients demonstrated an early asthmatic reaction, and 10 patients also demonstrated a late asthmatic reaction, as demonstrated by a 15% decrease of FEV1 within 1 hour or between 3 and 8 hours after challenge, respectively. Airway responsiveness to inhaled methacholine, expressed as the dose causing a fall of FEV1 of 15% (Pd15), and the serum IgE level (RAST), expressed as percent of the total radioactivity added, were also measured. Multiple regression analysis of data demonstrated that both early asthmatic reaction, expressed as the allergen Pd15, and late asthmatic reaction, expressed as the FEV1 maximum fall from control values, can be predicted with similar accuracy (explained variance of 63% and 68%, respectively) by a model that incorporates simultaneously methacholine Pd15, percent of total radioactivity added by RAST, and baseline values of FEV1. We conclude that the late asthmatic reaction is more likely to occur and is more severe in patients with more severe underlying disease.

Sensitization to Airborne Allergens in Children with Respiratory Symptoms

BACKGROUND Allergy is one of the most common causes of respiratory symptoms in children and youth. OBJECTIVE Evaluate the presence and the type of allergic sensitization in a paediatric population with respiratory symptoms. METHODS We studied 564 consecutive children, 5 months to 17 years of age, with a male to female ratio (M/F) = 1.4, referred to our outpatient clinic in a 12-month period retrospectively. Patients were arbitrarily divided into four groups (grs) according to their age: gr1 = 5 months to 4 years old (181 patients), gr2 = 4 to 7 years (201 patients), gr3 = 7 to 10 years (96 patients), and gr4 = 10 to 17 years (86 patients). Sensitization to house dust mites, pollens, animal dander, and molds was determined by skin prick testing. RESULTS Sensitization to at least one class of allergen occurred in 304 of the 564 patients (53.9%, M/F ratio = 2.0); the percentage of allergic patients increased with age as follows: 29.8% (54 patients) of the patients in gr1, 55.2% (111 patients) in gr2, 68.8% (66 patients) in gr3 and 84.9% (73 patients) in gr4 (chi(2) = 84.1, P < .01). In the entire allergic population and in gr1 to gr3, the most common positive allergic reaction was to house dust mites (P < .01, chi(2) test each comparison). In contrast, gr4 patients showed a nearly equal percentage of sensitization to pollens and to house dust mites (79.5% and 78.1% respectively) (chi(2) = 0.0, P = >.1). Sensitization to only one class of allergen occurred in 51.3% of the allergic patients and the percentage of these monosensitized patients tended to decrease from gr1 to gr4 (chi(2) = 15.2, P < .1). In the monosensitized group, sensitization to house dust mites was the most frequent in gr1 to gr3 (age <10 years) as in the whole sample. In gr4, the frequency of sensitization to house dust mites was similar to that of sensitization to pollens. On the contrary, within the patient group sensitized to two or more allergens (polysensitized patients), sensitization to house dust mites was as frequent as sensitization to pollens already in gr2 as compared with monosensitized patients. CONCLUSIONS In children with respiratory symptoms, the percentage of allergic individuals was high and increased with the age of the patients. This phenomenon was associated with an age-related enhancement in the ratio of polysensitized to monosensitized patients and with an age-related increase in the frequency of sensitization to seasonal allergens (ie, pollens).

Effect of seasonal exposure to pollen on specific bronchial sensitivity in allergic patients

Bronchial provocation tests with aerosol of birch extract were performed before and after pollen season in 11 sensitized subjects. Changes of metacholine bronchial responsiveness and serum-specific IgE level were also assessed. In five patients who did not take steroids to control their symptoms, both early and late asthmatic responses to inhaled allergen were enhanced after season, whereas IgE serum level, but not methacholine sensitivity, was significantly increased. In six patients who needed steroids, neither responses to allergen nor IgE serum level and methacholine sensitivity were significantly changed after season. For the whole group, the increase in immediate bronchial sensitivity to allergen was positively correlated with the increase in specific IgE antibodies. We conclude that seasonal exposure to pollen has, in sensitized patients, a priming effect on bronchial mucosa that may be blunted by steroid treatment. The increased production of specific IgE antibodies appears to be an important mechanism for this priming effect.

Local immunotherapy with Dermatophagoides extract in asthma

Local immunotherapy (LIT) with Dermatophagoides extract or placebo were administered to two groups of 11 patients with allergic asthma in a double-blind fashion. All patients received cromolyn sodium (20 mg four times a day) during treatments. Bronchial provocation tests with allergen and methacholine were performed before, 1 week, and 4 weeks after the end of treatments. Symptom score, drug consumption, and peak expiratory flow were monitored daily from 2 weeks before to 4 weeks after treatments. Compared to baseline, early bronchial sensitivity to allergen was significantly reduced both 1 week (p less than 0.0005) and 4 weeks (p less than 0.01) after LIT but not after placebo administration. Late bronchial reaction to allergen occurred similarly after placebo administration and LIT. However, in the group with LIT, the severity of late reaction was unchanged after treatment in spite of the significantly larger doses of allergen administered to provoke the early asthmatic reaction. Neither symptom score, nor drug consumption, nor peak expiratory flow were significantly different in the two groups before and during the treatment period even though both symptom score and drug consumption tended to be reduced after LIT. We conclude that LIT may be an effective and safe alternative to traditional immunotherapy.

Effect of nedocromil sodium on the late asthmatic reaction to bronchial antigen challenge

The effect of inhaled nedocromil sodium (4 mg by pressurized aerosol) on the dual asthmatic reaction to bronchial antigen challenge was studied in eight patients with asthma. The following prechallenge/postchallenge treatment combinations were administered: nedocromil sodium/placebo, nedocromil sodium/nedocromil sodium, placebo/nedocromil sodium, and placebo/placebo. Each patient received three treatment combinations assigned with a balanced incomplete block design. Nedocromil sodium administered before antigen challenge was significantly more effective than placebo in blocking both the early (p less than 0.001) and late (p less than 0.01) fall in FEV1. Postchallenge administration of nedocromil sodium tended to delay the onset of late asthmatic reaction but did not provide significant protection compared to placebo. These results demonstrated that nedocromil sodium prevents both phases of the dual asthmatic reaction to bronchial antigen provocation when it is inhaled before challenge. Further investigation is necessary to elicit a definite answer to whether nedocromil sodium administered after bronchial challenge has an effect on late asthmatic reaction.

Adherence to international and national recommendations for the prevention of surgical site infections in Italy: Results from an observational prospective study in elective surgery

BACKGROUND An observational prospective study of the perioperative procedures for prevention of surgical site infections (SSIs) was carried out in a tertiary referral teaching hospital in Liguria, Italy, to evaluate their adherence to international and national standards. METHODS A 1-month survey was performed in all surgical departments, monitored by turns by trained survey teams. Data regarding presurgical patient preparation and intraoperative infection control practices were collected. RESULTS A total of 717 elective interventions were actively monitored in 703 patients who underwent surgery. Hair-shaving was performed mainly using a razor (92%) by the nurses (72.8%) on the day before the operation (83.5%). All of the patients showered, either with a common detergent (87%) or with an antiseptic solution (13%). Antimicrobial prophylaxis was administered properly in 75.7% of the patients at induction of anaesthesia; however, according to current Italian guidelines, inappropriate prophylaxis was provided in 55.2% patients. Appropriate antisepsis of the incision area was done in 97.4% of the operations, and nearly 90% of the interventions lasted less than the respective 75th percentile. The doors of the operating theatres were mostly open during the duration of the operation in 36.3% of the cases. CONCLUSIONS This review of infection control policies identified significant opportunities for improving the safety and the quality of routine surgical practice.

Frequency and Specific Sensitization to Inhalant Allergens Within Nuclear Families of Children with Asthma and/or Rhinitis

OBJECTIVE The purpose of this study was to investigate the frequency of allergy in 85 families of pediatric patients with asthma and/or rhinitis. METHODS Families enrolled were drawn according to a table of randomization, from those whose children were referred the outpatient clinic of the Pulmonology Department of Gaslini Institute (Genoa, Italy). In patients and in both their mothers and fathers, allergic sensitization to the three most common classes of inhalant allergens (house dust mites, pollens, and animal danders) was evaluated by skin prick test. RESULTS As compared with their parents, children showed a similar prevalence of positive skin prick test (50.0% and 58.8%, respectively; chi 2 = 1.4; P > .1), but a significantly higher frequency of specific sensitization to house dust mites, pollens, or pets (P < .05, each chi 2). These differences were at least partially related to the higher frequency of polysensitization (i.e., sensitization to more than one class of allergens) in children than in their parents [chi 2 = 4.2, odds ratio (OR) = 2.3, 95% confidence interval (CI95%) = 1.0 to 5.1; P < .05). In addition, both in children (chi 2 = 5.8, OR = 11.3, CI95% = 1.4 to 81.5; P < .05] and in their parents (chi 2 = 7.4, OR = 4.8, CI95% = 1.5 to 16.7; P < .01), allergy to pollens was less frequent in monosensitized than in polysensitized families, while the prevalence of sensitization to house dust mites was similar in monosensitized and in polysensitized families. The analysis of the role of parental sensitization in the development of allergy in the offspring demonstrated that the prevalence of allergic children: (1) seemed to be higher, without reaching statistical significance, in families with sensitized parents than in those with non-sensitized parents (chi 2 = 0.41, P > .1) and (2) was higher in families with one or both polysensitized parents than in those with one or both monosensitized parents (chi 2 = 4.5, OR = 4.0, CI95% = 1.1 to 15.6; P < .05). In addition, within each family, the coincidence of sensitization to house dust mites was more frequent than that to pollens (60.0% and 36.0%, respectively; chi 2 = 7.6, OR = 4.5, CI95% = 1.5 to 14.3; P < .01), and it was not influenced by the number of parents sensitized to same allergen. CONCLUSION These data support the concept that, in addition to genetic predisposition, other factors (i.e., environmental exposure) may influence the development of specific sensitization in children with respiratory symptoms. The different sensitization found in this study between children and their parents occurred in a generation span, so as it is more likely to be related to environmental changes than to genetic factors.

Differences in prevalence of allergic sensitization in urban and rural school children

BACKGROUND Environmental factors are important causes of sensitization, even though the effect of specific pollutants and the interaction between pollution and aeroallergens are not completely known. PURPOSE To evaluate whether the exposure to pollutants or to allergens is a more important contributing factor in causing sensitization. METHODS A group of 312 children living in the city and a group of 225 children living in a rural area, ages 11 to 14, were studied. All subjects underwent a skin prick test. The pollen counts were performed in the two different areas during the peak of the pollen season. At the same time the levels of ozone and suspended particulates were measured. RESULTS The students living in the rural area showed a significantly higher percentage of sensitization than those in the city (P = .046). Sensitization to pollen was more frequent in the rural area (P < .001) but pet sensitization was more frequent in the city. More rural area students were sensitive to multiple allergens (P = .034). Pollen levels were higher in the rural area (P = .001). Both ozone and suspended particulate levels were higher in the city (P = .001 and P < .001, respectively). CONCLUSIONS The degree of pollen exposure is a larger contributing pathogenic factor in inducing sensitization than air pollution.

Effect of nedocromil sodium on adenosine‐ and methacholine‐induced bronchospasm in asthma

The effect of nedocromil sodium on adenosine‐induced bronchospasm was investigated in eight asthmatic patients. Nedocromil sodium (4 mg) administered by aerosol 10 min before challenge, effectively inhibited adenosine‐induced bronchospasm. In another group of six asthmatic patients, nedocromil sodium administered in the same way did not reduce the bronchial response to methacholine. These results support the view that adenosine‐induced bronchospasm may be prevented by a membrane stabilizing drug and is not mediated through cholinergic pathways. The mechanism(s) by which nedocromil sodium inhibits adenosine‐induced bronchospasm requires further investigations.