S. Imbesi

Oxidative stress in oncohematologic diseases: an update

An increased risk of cancer in various organs has been related to oxidative stress and several studies have revealed the mechanism by which continued oxidative stress can lead to chronic inflammation, which in turn could mediate most chronic diseases including cancer. A variety of transcription factors may be activated in consequence of oxidative stress, leading to the expression of over 500 different genes, including those for growth factors, inflammatory cytokines, chemokines, cell cycle regulatory molecules and anti-inflammatory molecules. In this review, the data related to the action of oxidative stress on the onset of various oncohematologic diseases are summarized, thus bringing together some of the latest information available on the pathogenetic role of oxidative stress in cancer. The authors evaluate the most recent publications on this topic, and, in particular, show the newest evidence of a relationship between oxidative stress and hematological malignancies, such as chronic lymphocytic leukemia, Hodgkin’s lymphoma, multiple myeloma and chronic Ph-negative myeloproliferative diseases. A separate section is devoted to the implications of a change of oxidative stress in patients undergoing bone marrow transplantation. Finally, particular attention is given to the new markers of oxidative stress, such as carbonyl groups, advanced glycation end products, advanced oxidation protein products and S-nitrosylated proteins, which are certainly more stable, reliable, cheaper and more easily identifiable than those already used in clinical practice. New approaches that aim to evaluate subcellular and microenvironment redox potential may be useful in developing cancer diagnostics and therapeutics.

Chronic idiopathic urticaria and Graves’ disease

Chronic urticaria is a common condition characterized by recurrent episodes of mast cell-driven wheal and flare-type skin reactions lasting for more than 6 weeks. In about 75% of cases, the underlying causes remain unknown, and the term chronic idiopathic urticaria (CIU) is used to emphasize that wheals develop independently of identified external stimuli. Although CIU affects about 1.0% of the general population, its etiopathogenesis is not yet well understood. It is now widely accepted that in many cases CIU should be regarded as an autoimmune disorder caused by circulating and functionally active IgG autoantibodies specific for the IgE receptor (FceRI) present on mast cells and basophils or for IgE itself. The well-known association of CIU with other autoimmune processes/diseases represents further indirect evidence of its autoimmune origin. Autoimmune thyroid diseases, especially autoimmune thyroiditis, represent the most frequently investigated diseases in association with CIU. Here we review this topic with particular regard to the association between Graves’ disease and CIU. The possible pathogenetic mechanisms and the clinical implications of such an association are discussed.

Serum levels of carbonylated and nitrosylated proteins in mobbing victims with workplace adjustment disorders

AIM Today the most important problem in the work place is psychological abuse, which may affect the health because of high levels of stress and anxiety. There is evidence that most psychiatric disorders are associated with increased oxidative stress but nothing is reported about the presence of oxidative stress in mobbing victims. METHODS This study has been carried out in a group of 19 patients affected by workplace mobbing-due adjustment disorders, in comparison with 38 healthy subjects, to evaluate whether oxidative stress may be induced by mobbing. RESULTS Serum levels of protein carbonyl groups and of nitrosylated proteins, biological markers of oxidative stress conditions, were higher than those measured in healthy subjects. CONCLUSIONS These findings may contribute to a better understanding of the redox homeostasis dysregulation occurring in victims of workplace mobbing.

Increased serum levels of interleukin‐23 circulating in patients with non‐segmental generalized vitiligo

Vitiligo is a common progressive depigmentation of the skin due to selective destruction of melanocytes. Nowadays increasing evidences support the hypothesis of an autoimmune etiology.

Allergic contact dermatitis: Immune system involvement and distinctive clinical cases

The aim of this review is drawing the attention to the contact dermatitis, an inflammatory skin condition due to pro-inflammatory and toxic factors able to activate the skin innate immunity (irritant contact dermatitis) or caused by a T-cell- mediated hypersensitivity reaction (allergic contact dermatitis). The immune system involvement and a variety of clinical pictures are described in order to better diagnose, prevent and treat allergic contact dermatitis.

Possible Link between History of Hypersensitivity to a Specific Non-steroidal Anti-inflammatory Drug (NSAID) and Positive Results Following Challenge Test to Alternative NSAIDs

INTRODUCTION In subjects with hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs), the choice of suitable alternative drugs with the lowest risk of reaction is imperative for therapeutic management. A safe method to exclude drug hypersensitivity is to perform a challenge test for an alternative drug. The present study was conducted to: obtain more information about the safety of NSAIDs; assess the risk of reaction following the administration of a selective or nonselective cyclooxygenase 2 (COX-2) inhibitor in patients with a history of adverse reactions to NSAIDs; investigate if age and/or gender play a role in the susceptibility to develop adverse reactions to NSAIDs. PATIENTS AND METHODS This retrospective study includes 524 patients with a history of hypersensitivity to NSAIDs admitted to undergo challenge test to an alternative anti-inflammatory drug. Statistical significance was achieved when odds ratio (OR) and risk ratio (RR) values were >1. RESULTS 8.39% of patients with hypersensitivity reactions to NSAIDs showed a positive challenge test for the alternative drug. Challenge tests for nonselective COX-2 inhibitors were positive in 16.2% of patients with previous reaction to a same drug class and in 12.9% of patients with a history of reaction to selective COX-2 inhibitors. No positive challenge test to a non-selective COX-2 inhibitor was found in patients with a history of hypersensitivity to nimesulide (CAS 51803-78-2). Challenge tests for selective COX-2 inhibitors were positive in 4.6% of patients with a previous reaction to nonselective COX-2 inhibitors and in 7.2% of patients with a history of reaction to selective COX-2 inhibitors. The RR of a positive challenge test to a non-selective COX-2 inhibitor was significant in patients who had a history of reaction to an analogous compound (P 0.21, OR 1.31, RR 1.26). DISCUSSION In this study, selective COX-2 inhibitors represented the class of NSAIDs less frequently reported as responsible of adverse reaction. These data underline that there is a higher risk to find a positive challenge test to a non-selective COX-2 inhibitor than to a selective one in patients with previous adverse reactions to a non-selective COX-2 inhibitor. Moreover, the data evidence that females could have a higher risk compared to males to develop an adverse reaction to selective COX-2 inhibitors. In conclusion, it appears necessary to pay attention to the kind of NSAIDs reported as the cause of hypersensitivity in anamnesis, because it must be considered a successful guide in choosing the alternative drug to administer to the patient during the challenge test.

Fatal hypersensitivity reaction to an oral spray of flurbiprofen: a case report

Safety of the anti‐inflammatory drug flurbiprofen is comparable with that of other non‐steroidal anti‐inflammatory drugs of the propionic acid class, which are commonly associated with gastrointestinal and renal side effects. Here we report a case of a fatal hypersensitivity reaction to an oral spray of flurbiprofen taken for sore throat.

Fatal Anaphylactic Shock Ceftriaxone-Induced in a 4-Year-Old Child.

Abstract One of the most used cephalosporin in clinical practice is ceftriaxone. Anaphylaxis due to the administration of ceftriaxone is considered a rare event. Here, we report a case of fatal anaphylactic shock after the administration of ceftriaxone in a child who had tolerated the drug in past exposures. The allergic pathogenesis is sustained by the clinical data (short time between the inoculation of the drug and the onset of the symptoms; past exposure to the same molecule and probable sensitization) and the postmortem examination findings (polivisceral congestion and intense eosinophilia found in the histological examination).

Cutaneous adverse reactions to lenalidomide

Lenalidomide is an immunomodulatory drug (IMiD) used principally in the treatment of multiple myeloma (MM), myelodysplastic syndromes (MS) and amyloidosis. Adverse reactions related to lenalidomide include myelosuppression (mainly neutropenia but also thrombocytopenia), gastrointestinal problems, skin eruption, atrial fibrillation and asthenia, decreased peripheral blood stem cell yield during stem cell collection, venous thromboembolism, and secondary malignances. In this review we focused our attention on the cutaneous adverse reactions to lenalidomide.