Roberta Olcese

Breathlessness perception assessed by visual analogue scale and lung function in children with asthma: a real-life study.

To cite this article: Tosca MA, Silvestri M, Olcese R, Pistorio A, Rossi GA, Ciprandi G. Breathlessness perception assessed by visual analogue scale and lung function in children with asthma: A real‐life study. Pediatr Allergy Immunol 2012: 23: 537–542.

Acute anaphylactic reaction after prick-by-prick testing for pine nut in a child.

e nuts are the seeds of Pinus pinea which are a fundantal ingredient of a variety of sauces, including ‘‘pesto’’. sto originated in Genoa, Italy, and the name comes from Italian word ‘‘pestare’’ (to pound or to bruise) since traditional way of making this sauce was with mortar d pestle. Typically, pesto is prepared with fresh basil, rlic, pine nuts, grated parmesan and sheep milk cheese, tra-virgin olive oil, and coarse salt. prick-by-prick testing, nasal and conjunctival itching was observed with congestion. Itching became rapidly systemic, associated with irritability, asthenia, cough and dyspnoea. The clinical examination demonstrated wheezing, SaO2 was 96% in room air and the blood pressure 90/65 mmHg (before testing 110/70). Symptoms rapidly remitted after adrenaline aerosol (10 mg) and parenteral antihistaminic (chlorfenamine 5 mg) and steroidal (betamethasone 1.2 mg) treatment. Anyway, the test was positive: wheal diameter was 4 mm × 4 mm. Further, we obtained the results of the level of serum IgE specific for pine nut 32 kU/L (ImmunoCap System, Phadia, Milan, Italy), thus confirming the IgE-dependent reaction. Acute anaphylactic reaction to pine nut following skin 9 tes bu pri tem

The impact of age on serum allergen-specific IgE to inhaled molecular components

BACKGROUND Respiratory allergy is characterised by an IgE-mediated reaction. The immune system functions, including IgE production, progressively decline over time, such as growing up and ageing. Molecular-based allergy diagnostic defines sensitisation profile. This study aimed to evaluate the impact of age on serum allergen-specific IgE to molecular component levels in a large sample of subjects. METHODS Serum IgE to: Phl p1, Bet v1, Ole e1, Cup a1, Par j2, Can f1, Der p2, and Fel d1 were assessed by ISAC method. Sera from 2788 patients, 1230 males (44.1%) and 1558 females (55.9%), median age 23 years (1st and 3rd quartiles: 9.7-49.7 years; age range: 1 month-103 years) were analysed. RESULTS The number of positive tests (i.e. sensitisation) tended to increase between birth and school-age till young adulthood and then decreased (p<0.0001) with the exception of Fel d 1 (p=0.14). A similar age-dependent trend was observed considering the levels of each allergen components: the levels of each allergen component, with the exception of Fel d 1, tended to increase till early adulthood and then to decrease reaching the lowest levels in the elderly. CONCLUSIONS Allergen-specific IgE production to inhaled molecular components trend to reduce with ageing, but with differences between allergens. This phenomenon should be adequately evaluated managing allergic patients.

Allergen-specific IgE to food molecular components and age : From early childhood to adulthood

BACKGROUND Respiratory allergy is characterised by an IgE-mediated reaction. The immune system functions, including IgE production, progressively decline over time with growing up and ageing. Molecular-based allergy diagnostic defines sensitisation profile. This study aimed to evaluate the impact of age on serum allergen-specific IgE to molecular component levels in a large sample of subjects. METHODS Serum IgE to: rCor a11, rPru p3, nJug r3, rAra h8, rGly m4, rCor a8, nPen m1, nAct d8, Bos d 8, and nGal d2 were assessed by ISAC method. Sera from 2795 patients, 1234 males (44.1%) and 1561 females (55.9%), median age 23 years (1st and 3rd quartiles: 9.7-43.7 years; age range: 1 month-103 years) were analysed. RESULTS The number of positive tests (i.e. sensitisation) tended to increase between birth and school-age until young adulthood and then decreased. A similar age-dependent trend was observed considering the levels of each allergen components: the levels of each allergen component tended to increase until early adulthood, but Gal d 2 and Bos d 8 (rapidly diminishing), and then to decrease over time. However, the pattern is significantly dependent on each single tested food. CONCLUSIONS Allergen-specific IgE production to food molecular components tend to reduce with ageing, but with differences between allergens. This phenomenon should be adequately evaluated managing allergic patients.

Two additional factors in the association between overweight and childhood asthma: inhaled corticosteroids and recurrent respiratory infections.

A cross-sectional study, performed by Okabe et al. involving a large cohort of Japanese school-aged children and adolescents (6–17 years of age), investigated whether associations could be detected between body mass index (BMI) and, respectively, current asthma, exercise-induced wheezing, and nocturnal cough. They showed that overweight was a risk factor for nocturnal cough, in the older age group (13–17 years), and that there was a clear association between obesity and current asthma in the whole subject group. This finding is in agreement with the current concept that both disorders share common biochemical and cellular pathways. Indeed, adipose tissue produces adipokines, such as leptin and adiponectin, which might initiate, maintain and/or amplify ongoing inflammatory reactions. As also recognized by Okabe et al. in the discussion, however, there were relevant limitations to that study: (i) BMI measurement may not be adequate in childhood, especially when measurements of bodyweight and height are self-reported; (ii) asthma diagnosis and symptoms were defined by questionnaires (even though validated); and (iii) no data were available on lung function and inflammatory markers. But there are at least three additional factors that should be considered in this type of study, because they may be relevant with regard to the relationship between obesity and asthma. First, young school children are frequently affected by recurrent upper and lower respiratory tract infections, a condition thought to be associated with lower BMI in asthmatic children. Second, the regular use of inhaled (and/or oral) corticosteroids may significantly affect lipid metabolism and consequently increase adipose mass. Third, diet and lifestyle characteristics, which may be considerably dissimilar in different nations, may have a significant impact on both adipose tissue formation and disease phenotypes, changing the relationship between overweight and asthma. Recently, we evaluated a pediatric Mediterranean population of 555 asthmatic children (365 boys), in whom reversible airway obstruction was diagnosed on spirometry. BMI was calculated and expressed in standard deviation score (SDS) units (z-score), determined as the difference between the BMI observed in a given subject and the reference mean for age and sex, divided by the corresponding standard deviation. We found that children under regular treatment with inhaled corticosteroids had a higher BMI as compared with the steroid-free population (P < 0.026; Fig. 1). In addition, a history of recurrent respiratory tract infections (such as >6 episodes/year) was associated with lower BMI (Fig. 1). No significant correlation between pulmonary function test parameters and BMI-SDS was observed. The findings here reported are easily explained considering the anabolic effects exerted by steroids and the catabolic effects induced by recurrent infections, but also confirm the healthy effects of the Mediterranean diet also in a young asthmatic population. In conclusion, asthma and obesity are two disorders that share complex interactions involving a variety of factors. In clinical practice, pharmacologic treatment, caloric intake, and physical activity should be adequately considered for avoiding weight increase that may eventually affect lung function and asthma symptoms. Correspondence: Giorgio Ciprandi, MD, Semeiotica e Metodologia Medica I, DIMI, Viale Benedetto XV 6, 16132 Genoa, Italy. Email: gio.cip@libero.it Received 1 July 2011; revised 20 September 2011; accepted 31 October 2011. 2 2.2 0.026 0.042

Subcutaneous and sublingual immunotherapy and T regulatory cells: there is clinical relevance

We read the paper of Eifan et al. [1] with great interest. These authors conducted an elegant study for comparing subcutaneous and sublingual immunotherapy (SLIT) in allergic children, also evaluating clinical, functional, and immunological parameters. This study confirmed that SLIT was able to increase IL-10 production induced by the causal allergen, thus confirming previous studies reviewed recently [2]. However, they failed to demonstrate changes concerning Th1and Th2-dependent cytokines. This fact might depend on several factors, such as the timing of observation after starting SLIT, the time of recovering supernatants after cell incubation, the dose of the stimulating allergen, the dose of the vaccine, and of course, the case-study characteristics. In fact, the study population investigated in this study seems to show singular features. Only 19 out of 41 asthmatic children had bronchial hyperreactivity: this is quite strange as BHR is a condicio sine qua non for asthma diagnosis in untreated patients. Moreover, only 11 out of 38 rhinitic children showed a positive response to an allergen-specific nasal challenge (ASNC) with the causal allergen. For definition, allergic rhinitis and asthma are characterized by the symptom occurrence after the exposure to the causal allergen; in other words, a positive relationship between history and sensitization should be demonstrated. This finding could suggest that the children with negative ASNC were sensitized alone or having a low allergy grade. Another possible explanation for the failure of significant cytokine changes might be the assay method. In fact, we reported recently that the ELISA method may be inadequate to precisely measure cytokines, mainly IFN-g, in the supernatants of stimulated T cells [3]. The study by Eifan et al. provided another interesting issue: the SLIT effect on TGF-b production, even though induced by a ‘control’ allergen, such as birch. This fact is firstly not surprising as it has been reported recently that SLIT is able to exert a ‘carryover’ effect on the response to

Immunotherapy and Asthma in Children

Allergen immunotherapy (AIT) is still the only disease-modifying treatment strategy for IgE-mediated allergic diseases, with consolidated evidence both in adults and children. AIT is effective in determining clinical improvement of allergic rhinitis and asthma, such as reduced symptoms, medication use, and improvement of quality of life, with a long-lasting effect after cessation of treatment. Results from recent clinical studies have implemented the evidence of effectiveness and safety of allergen immunotherapy for the treatment of allergic asthma, so that the current asthma guidelines now recommend sublingual immunotherapy as an add-on therapy for asthma in adults and adolescents with house dust mite allergy, allergic rhinitis, and exacerbations despite low-to-moderate dose ICS, with forced expiratory volume in 1 second more than 70% predicted. AIT may also reduce the risk of progression from allergic rhinitis to asthma in children and prevent the onset of new sensitizations, thus representing a potentially preventive method of treatment. The aim of this review is to present an updated overview of the clinical indications of AIT, with particular reference to pediatric asthma, of the mechanisms of clinical and immunological tolerance to allergens, and of the potential biomarkers predicting clinical response.