S. Isola

Prevention of new sensitizations in monosensitized subjects submitted to specific immunotherapy or not. A retrospective study.

Background Specific immunotherapy is the only currently available allergen‐orientated treatment able to modify the natural history of respiratory allergic diseases. Safety and clinical efficacy of this treatment are well documented, but evidence about the ability to reduce new sensitizations is still poor.

Occupational asthma due to exposure to iroko wood dust

BACKGROUND Occupational asthma (OA) from iroko wood has been reported primarily in case reports. OBJECTIVE To improve understanding of the pathogenesis of OA induced by iroko wood dust. METHODS Three groups of woodworkers were included in this study: 9 workers who had clinically proven OA from iroko; 10 asymptomatic woodworkers; and 10 woodworkers with asthma. All patients underwent the following tests: a skin test with an iroko aqueous extract, specific IgE determination, and an iroko bronchial provocation test (IBPT). An eosinophil count was determined before and after the IBPT, and a methacholine inhalation test was performed after avoidance of exposure to iroko. Patients were asked to monitor their peak expiratory flow rates during a week at work followed by a weeks vacation. RESULTS In all patients with a personal history predictive of OA from iroko, a reduction of the peak expiratory flow rate and positivity to the IBPT while working with iroko were present. The latter test result showed a dual response, with a decrease in forced expiratory volume in 1 second from 25% to 32% at 10 minutes and a further decrease from 35% to 43% at 8 hours; at 24 hours, the eosinophil count was higher (P = .046). In 4 patients, the intradermal test results with iroko extract were positive, whereas the skin prick test result and the specific IgE determination were negative in all patients. The methacholine test result was also positive. In the control groups, all the test results with iroko extract were negative. CONCLUSIONS Our data suggest that OA due to iroko wood may be induced by immunologic mechanisms other than IgE-mediated immediate hypersensitivity reactions.

Increased protein carbonyl groups in the serum of patients affected by thalassemia major

High oxidative stress status is known to be one of the most important factors determining cell injury in thalassemic patients and causing other serious medical complications, including a continuous proinflammatory status. The quantification of protein carbonyl groups in peripheral blood is widely used to measure the extent of oxidative modification. Thus, we measured serum concentrations of protein carbonyl groups in 30 patients affected by thalassemia major and in 15 healthy subjects. Strongly higher levels of protein carbonyl groups were measured in the blood from thalassemic patients than in that from healthy controls. Our findings evidence that thalassemic patients suffer from protein oxidative stress; the possibility of a role for carbonyl stress in the progression and severity of the disease needs further investigation.

Systemic contact dermatitis to copper-containing IUD.

Although copper sulfate can cause systemic contact dermatitis, few such cases have been recorded among copper-releasing IUD users. Reported in this paper is a case of endometritis and urticaria-angioedema syndrome in a 32-year-old user of a copper IUD. Widespread urticaria, as well as angioedema of the eyelids and the labia majora and minora, persisted for about 6 months and were not responsive to corticosteroids and H1-antagonists. Copper sulfate positivity was demonstrated in 72-hour patch test, 48-hour application of the copper spiral to forearm, and in vitro lymphocyte-stimulating test. Histologic examination of the endometrial biopsy revealed vulvovaginitis with hyperplasia of the cervical canal and T-cell and eosinophilic granulocyte infiltration. Removal of the IUD caused complete symptom remission. In experimental animals with a radioactively labeled copper IUD, small amounts of copper sulfate are absorbed through the mucus membrane and carried to the cutis through the blood or lymph. In the cutis, the allergen is intercepted from antigen-presenting cells and recognized by T cells that migrate to the lymph nodes with blastic transformation, proliferation of cytotoxic lymphocytes, and cytokine production.

Immediate reaction to clarithromycin.

We present the case of bronchospastic reaction to clarithromycin had during a drug challenge test. Personal allergic history was negative for respiratory allergies and positive for adverse drug reactions to general and regional anesthesia and to ceftriaxone. After the administration of 1/4 of therapeutic dose of clarithromycin the patient showed dyspnea, cough and bronchospasm in all the lung fields. The positivity of the test was confirmed by the negativity to the administration of placebo. The quickness and the clinical characteristic of the adverse reaction suggest a pathogenic mechanism of immediate-type hypersensitivity. On reviewing the literature we have found no reports of bronchospastic reaction to clarithromycin. Macrolides are a class of antibiotics mainly used in the last years in place of beta-lactams because of a broad spectrum of action and a low allergic power. In fact, there are few reports on allergic reactions to these molecules. Clarithromycin is one of the latest macrolides, characterised by the presence of a 14-carbon-atom lactone ring as erythromycin, active on a wide spectrum of pathogens.

Nickel allergy, a model of food cellular hypersensitivity?

School and Division of Allergy and ClinicalImmunology, University of Messina, Messina, ItalyKey words: nickel; endogenous dermatitis; IL-12;IL-10.Dr Luisa RicciardiScuola di Specializzazione in Allergologia eImmunologia Clinica PoliclinicoPadiglione H98100 MessinaItalyTel: +39 090 2212080Fax: +39 090 694773

Adverse Reactions to Pantoprazole

Pantoprazole is a proton-pump inhibitor used, because of its efficacy and tolerability, in the treatment of various acid-peptic disorders, including gastro-oesophageal reflux disease, peptic ulcer disease and non-steroidal antiinflammatory drug-induced gastropathy. It is associated with antibiotics for Helicobacter pylori eradication (1). We report two cases of adverse reactions to pantoprazole in patients who had been prescribed this drug for asthmatic symptoms induced by gastro-oesophageal reflux disease (GORD). A 41-year-old woman had been under treatment with pantoprazole 40 mg for 13 days. Two hours after taking this drug on the 14th day of treatment she had generalized itching, which disappeared spontaneously after 3 h. Four days later, after having again taken a tablet of pantoprazole, she experienced after 2 h widespread urticaria, angioedema of the lips, dyspnea and low blood pressure (80/50 mmHg). The patient went to the first-aid unit, where she received intravenous betamethasone 8 mg and chlorphenamine maleate 10 mg i.m. and an ECG showed sinus tachycardia (115 b/m’) and T-wave abnormalities. After 1 h there was complete remission of the reaction, while the ECG showed reduction of the sinus tachycardia (90 b/m’) and normalization of the Twave. The patient’s personal history was negative for atopic diseases and for adverse drug reactions. A 38-year-old man had been taking pantoprazole 40 mg for 7 days; 45 min after administration of the 8th dose he suffered malaise and nausea which disappeared spontaneously after about 30 min. The next day, at the same interval of about 45 min, he developed widespread urticaria and facial oedema. He recovered from the reaction after being treated with betamethasone 4 mg, methylprednisolone i.v. and prometazine i.m. This patient had a positive history for allergic rhinitis and negative for adverse drug reactions. Proton-pump inhibitors (PPIs), the most potent inhibitors of gastric acid secretion, have revolutionized the treatment of acid-related disorders. If histamine-2-receptor antagonists (H2RAs), in fact, block the histamine receptors effectively, PPIs block the effects of stimulation of the histamine, gastrin and acetylcholine receptors. Pantoprazole, similar to other PPIs, is a benzimidazole derivative; it is a prodrug that, after administration, must be activated in an acidic environment. It diffuses into the gastric parietal cells through their basolateral membrane and there exerts its pharmacodynamic action by binding to the proton pump (H ,K -adenosine triphosphatase) (1–3). Pantoprazole is well tolerated, with the most common adverse effects being headaches, diarrhoea, flatulence and abdominal pain. Nevertheless, in the literature reactions such as a lichenoid eruption (4) have been reported and phototoxicity with subsequent progression to discoid lupus (5) as well as anaphylactic shock (6–8). A possible cross-reactivity has been hypothesized among different PPIs related to their similar substituted benzimidazole structure (4, 8). In the cases we reported, the strict correlation between drug assumption and the onset of symptoms permits a clinical diagnosis of anaphylactic shock in the first case and widespread urticaria angioedema in the second case both due to pantoprazole. The patients were advised not to take any PPIs even if different from pantoprazole, and were prescribed H2Ras, which have been well tolerated. As the reactions to pantoprazole we report are clinically relevant as well as the reactions reported by some other authors (6–8), the real incidence of systemic reactions to PPIs should be studied.(2003). Adverse Reactions to Pantoprazole. Scandinavian Journal of Gastroenterology: Vol. 38, No. 7, pp. 800-800.

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.

Systemic mastocytosis associated with recurrent paroxysmal atrial fibrillation.

no correlation between the presence of furry pets and either airborne or dust endotoxin levels. This suggests that animals were not responsible for endotoxin levels in either air or dust. This is consistent with the showing by Lieutier-Colas et al. (1) that airborne endotoxin levels were not correlated with the presence of the rats in rat quarters. Michel et al. also reported that the presence of furry pets in homes did not influence the HD endotoxin levels (5). We also found no correlation between dust and airborne endotoxin levels. This suggests that it seems necessary to measure endotoxin in both dust and air to obtain a relevant assessment of exposure.