Improvement of quality of life in allergic rhinoconjunctivitis patients using nasal filters, a preliminary study

BACKGROUND

Allergic rhinoconjunctivitis is a clinical condition that impairs quality of life. The use of traditional drugs in many cases is not enough to improve quality of life in these patients.

METHODS

In this pilot study we used the Sanispira Nasal filters in 15 patients (mean age 34,7 years) affected by allergic rhinoconjunctivitis for 18 days. At each follow-up visit, patients were assessed with a specific quality of life questionnaire, a symptoms form and a drugs form that evaluates the use of antiallergic drugs in the last week. Patients sensitive to environmental allergens wore Sanispira nasal filters during the day, while patients sensitive to domestic allergens wore the device during the night.

RESULTS

Thirteen patients completed the study. We found an improvement significative (p=0,0241) of the total score of RQLQ of 23,10 points between baseline and 18 days ( total score at baseline prior to nasal filter insertion= 60,60, at 1 week = 42, 28, at 18 days= 34, 10). A significative improvement in the nasal symptoms domain between baseline and 18 days (in particular stuffy nose p=0,047; runny nose p=0,012; sneezing p=0,0021; ) and one item of practical problems domain, the need to repeatedly blow the nose(p=0,082). The total score of symptoms evaluated with the symptoms form improved significantly from baseline to 18 days. Total symptoms score at baseline was 9,7; at 1 week it was 8,1 and at 18 days it was 4,7. The improvement was statistically significant (p=0,0092). Three of the thirteen patients that completed the study eliminated completely the use of drugs during of the study.

CONCLUSIONS

The use of SANISPIRA ®, has shown encouraging results, with an improvement in the quality of life in Rhinoconjunctivitis patients specially an improvement in nasal and ocular symptoms.

Reconstruction of severe atrophic jaws with Fresh Frized Bone Allografts: clinical histologic and histomorphometric evaluation

OBJECTIVES

Rehabilitation of maxillary edentulism with implant-supported prostheses has come into common clinical practice. Although autologous bone has osteoinductive, osteoconductive and osteogenetic properties, its use is subject to certain disadvantages such as: Increased morbidity Limited amount of bone harvested from each donor site.

AIM

The aim of this study is to analyze clinical, histological and histomorphometric results of homologous bone for implantoprosthetic rehabilitation in severe atrophic jaws.

PATIENTS AND METHODS

Twenty consecutive patients, 14 female and 6 males, were treated with homologous bone bank. Treatment protocol consist of: first surgycal step, trasversal and vertical volume restore, second surgycal step: screw remove, specimen biopsy and insert implant fixtures.

RESULTS

Data show that Fresh Frozen Bone Allografts (FFBA) could be a valuable substitute for autologous bone, in as much as histological and histomorphometric results are widely overlapping.

CONCLUSIONS

Homologous bone is a valuable option for its large availability with a low cost, good versatility, no morbidity at the donor site, shorter surgical time and hospital stay.

A relapse of near-fatal thunderstorm-asthma in pregnancy

Thunderstorm-related asthma is a dramatic example of the allergenic potential of pollen antigens. Pollen allergic patients who encounter the allergenic cloud of pollen during a thunderstorm are at higher risk of having an asthma attack. Relapse is also possible and we describe here the first case of relapse of near fatal thunderstorm-asthma occurred in a 36 years old, 20 weeks pregnant woman affected by seasonal asthma and sensitized to allergens released by Parietariapollen. Patients suffering from pollen allergy should be alerted of the danger of being outdoors during a thunderstorm in the pollen season and if they experienced an episode of severe thunderstorm-related asthma could be at risk of a relapse during a heavy precipitation event.

Sensitization to rodents (mouse/rat) in an urban atopic population without occupational exposure living in Naples, Italy

BACKGROUND

Until now no data on allergic sensitization to rodents allergens in Western Europe and Italy are available. The aim of this report was to investigate clinical significance and characteristics of IgE-mediated sensitization to mouse/rat (M/Rt) allergens in atopic subjects not occupationally exposed to these animals and living in urban area of Naples.

METHODS

In 1765 consecutive outpatients, we selected all subjects with an immediate skin reaction to M/WRt dander clinical history including a carefijul evaluation ofthe modality of exposure, the results of skin-prick tests (SPTs) and specific IgE antibodies were recorded.

RESULTS

Among 1185 SPT-positive patients, 22 were sensitized to M/Rt dander (respectively 1.60% and 0.59%). No patient was mono-sensitized Only three of 22 patients reported indoor conditions suggesting presence of rodents allergens at home. All patients exhibited low degree of SPT positivity and low levels of circulating IgE antibodies to M/WRt. Highfrequency of concomitant allergic sensitization to pet (and other animal) dander has been found.

CONCLUSIONS

Our results suggest that role of allergic sensitization to rodents is negligible in atopic subjects without occupational exposure living in urban area of Naples. However, highly atopic individuals especially those already sensitized to common pet dander should be tested by SPTs/evaluation of serum specific IgE to rodents in the case they could begin an occupational exposure to M/Rt or keeping these animals as pets.

Is there any relationship between allergic sensitization to milk and animal allergens in atopic adults?

No data on the relationship between allergic sensitization to animal dander and milk allergens are available in literature in adults. Considering the high rate of allergic sensitization to mammals in atopic adults living in Naples area, we aimed to evaluate if sensitization to milk allergens could be a risk factor for these subjects. From 755 consecutive outpatients examined between May 1 2009 and December 31 2010, we selected those with an immediate skin reaction to animal dander and milk. A clinical history including evaluation of pet exposure, the results of skin-prick tests (SPTs) and specific IgE antibodies for milk allergens were recorded. Among three hundred sixty SPT-positive patients, 140 were sensitized to animal dander (38.9%) and 9 to milk allergens (6.4%). Among one hundred forty patients sensitized to animals only one was sensitized also to milk allergens; among 9 milk-sensitized individuals 5 were allergic also to animal allergens (only one to cow dander) while 4 were not sensitized to mammals. Our results suggest that relationship between allergic sensitization to milk and animal allergens is negligible in adult atopic individuals living in urban area of Naples and that high rate of sensitization to animals is likely to be due to other mechanisms such as direct/indirect exposure, and allergen cross-reactions.

Nasal filters in prevention of seasonal rhinitis induced by allergenic pollen grains. Open clinical study

Nasal filters (Sanispira) might represent a novel approach in preventing exacerbations of symptoms of seasonal allergic rhinitis by reducing pollen access to nasal cavities. Female and male voluntary patients between the ages of 18 and 64 years living in Naples area and affected by allergic rhinitis were recruited in an open clinical study. All were allergic to Parietaria pollen as assessed by skin-prick and/or RAST test with or without associated sensitization to other pollens such as Gramineae and Olea europaea. A pollen count was also carried out from 10th April until 30th of June 2011. The results of our study show positive statistical differences between the scores of common nasal symptoms and the reduced use of antihistaminic drugs in patients using nasal filters in comparison to non users. Nasal filters constitute a useful mean to reduce symptoms of seasonal allergic rhinitis in patients suffering from pollen allergy.

Social networks: a new source of psychological stress or a way to enhance self-esteem? Negative and positive implications in bronchial asthma

The Internet and, in particular, social networks are an increasingly important part of daily life for both adolescents and adults who maintain a virtual relationship with others sharing interests and goals. Very often, they disclose more about themselves online than they do in person. However, cyberbullying and cyberostracism can be problematic for adolescents and sensitive individuals, who might be negatively affected by social networks. Some studies have shown an increased risk of depression, whereas others suggest beneficial effects through enhanced communication, social connection, and self-esteem. Bronchial asthma is an increasingly frequent disease in the industrialized world, and psychological implications play a role in increasing or in reducing its severity. One year after the case report of an asthma exacerbation that may have been triggered by Facebook, it seems reasonable to analyze the effects of social networks on bronchial asthma.

Sensitization to horse allergens in Italy: a multicentre study in urban atopic subjects without occupational exposure

BACKGROUND

Horses play a significant role in people's leisure time in Italy and other countries, but few data are available on IgE-mediated sensitization to horse allergens in patients without occupational exposure. We assessed, in a multicentric survey, the prevalence of horse sensitization in atopic subjects and its clinical characteristics.

METHODS

Allergists from the whole Italian territory were required to collect the results of skin prick tests from at least 100 consecutive subjects. Those patients with a positive skin test to horse dander underwent a detailed interview concerning clinical history, pet ownership and possible exposure.

RESULTS

Data from 3,235 outpatients were collected and 2,097 had at least 1 skin positivity. Among them, 113 (5.38%) were sensitized to horse dander (9 monosensitized). Thirty patients reported direct horse contact (4 owners and 26 for riding or occasional contact), 23 patients were sometimes in contact with horse owners and 60 subjects denied any direct or indirect exposure. Among 9 horse monosensitized patients, 6 had intermittent and mild rhinitis and 3 persistent moderate/severe rhinitis plus asthma. Three of them were horse owners or riders and the remaining had no contact with the animal.

CONCLUSIONS

Our data evidence that the rate of sensitization to horse dander is not negligible and probably underestimated. In susceptible, not occupationally exposed individuals, horse contact, but also indirect or no apparent exposure, may induce sensitization. We recommend inclusion of horse allergen in the routine panel for the diagnosis of respiratory allergy.

Is sensitization to furry animals an independent allergic phenotype in nonoccupationally exposed individuals?

BACKGROUND

Patients sensitized to common pets (cat, dog) frequently display an immunoglobulin (Ig) E-mediated response to allergens from other animals.

OBJECTIVE

To evaluate whether individuals sensitized to common pets might be at higher risk of developing allergic sensitization to other mammalian allergens.

METHODS

The study population comprised 900 consecutive patients (300 individuals sensitized to different allergens including those of cat and dog [group AL, 300 sensitized to allergens other than those derived from cat and dog [group B], and 300 nonsensitized individuals [group C, controls]). All patients underwent a physical examination, an interview (clinical history, pet ownership, possible exposure data), and skin prick test (SPT) with a standard panel of allergens including cat, dog, horse, rabbit, rat, mouse, guinea pig, hamster, and cow.

RESULTS

A significant difference in allergic sensitization to mammalian allergens was observed in groupA compared with group B (respectively, 244 vs. 17). No sensitization was found in group C.

CONCLUSION

Since sensitization to pet allergens increases the risk of developing allergy to other furry animals, we suggest performing SPTs with several mammalian allergens to identify allergic sensitization and thus prevent future exposure in individuals who are highly sensitized and environmentally exposed to common pets.

The risk of bronchospasm in asthmatics undergoing general anaesthesia and/or intravascular administration of radiographic contrast media. physiopatology and clinical/functional evaluation

It is well known that patients suffering from bronchial asthma undergoing to surgical procedures requiring general anaesthesia (GA) or the administration of water soluble radiographic contrast media (RCM) experience a risk of potentially severe bronchospasm. Nevertheless, little attention has been devoted on the possible preventive measures to reduce the occurrence of this potentially life-threatening event. It has been shown that the most important risk factor for bronchospasm during GA induction and/or the use of RCM is represented by a high degree of bronchial hyperreactivity with airway instability not adequately controlled by long-term anti-inflammatory treatment. The aim of this review is to underline the need for an accurate clinical and functional evaluation of asthmatics (especially those with a relevant degree of asthma severity) undergoing GA or administration of RCM. Guidelines shared by pulmonologists, allergologists, anesthesiologists and radiologists should be produced in the future for a better evaluation and management of these patients. General practitioner plays an important role in managing asthmatic patients in "Real Life". It is likely that "Real Life"--optimally controlled asthmatics could undergo GA/RCM with lower risks especially in emergency conditions when it is not possible to perform any preoperative evaluation.

Projections of the effects of climate change on allergic asthma: the contribution of aerobiology

Climate change is unequivocal and represents a possible threat for patients affected by allergic conditions. It has already had an impact on living organisms, including plants and fungi with current scenarios projecting further effects by the end of the century. Over the last three decades, studies have shown changes in production, dispersion and allergen content of pollen and spores, which may be region- and species-specific. In addition, these changes may have been influenced by urban air pollutants interacting directly with pollen. Data suggest an increasing effect of aeroallergens on allergic patients over this period, which may also imply a greater likelihood of the development of an allergic respiratory disease in sensitized subjects and exacerbation of symptomatic patients. There are a number of limitations that make predictions uncertain, and further and specifically designed studies are needed to clarify current effects and future scenarios. We recommend: More stress on pollen/spore exposure in the diagnosis and treatment guidelines of respiratory and allergic diseases; collection of aerobiological data in a structured way at the European level; creation, promotion and support of multidisciplinary research teams in this area; lobbying the European Union and other funders to finance this research.

Treating moderate-to-severe allergic asthma with anti-IgE monoclonal antibody (omalizumab). An update

Increased asthma severity is not only associated with enhanced recurrent hospitalisation and mortality but also with higher social costs. Most cases of asthma are atopic in nature, with the trigger for acute asthma attacks and chronic worsening of inflammation being allergens inducing an immune response through immunoglobulins of IgE class. Currently antiinflammatory treatments are effective for most of asthma patients, but there are subjects whose disease is incompletely controlled by inhaled or systemic corticosteroids and these patients account for about 50% of the healthcare costs of asthma. Omalizumab is a humanized recombinant monoclonal anti-IgE antibody developed for the treatment of allergic diseases and with clear efficacy in adolescent and adult patients with moderate-to-severe allergic asthma.. The anti-IgE antibody inhibits IgE functions blocking free serum IgE and inhibiting their binding to cellular receptors. By reducing serum IgE levels and IgE receptor expression on inflammatory cells in the context of allergic cascade, omalizumab represents a really new approach to the treatment of atopic asthma. Omalizumab improves quality of life of patients with severe persistent allergic asthma that is inadequately controlled by currently available asthma medications. This therapy is well tolerated and significantly improves symptoms, disease control, reducing asthma exacerbations and the need to use high dosage of inhaled corticosteroids. In other words, omalizumab may fulfil an important need in patients with moderate-to-severe asthma.

Respiratory allergy induced by exclusive polysensitization to serum albumins of furry animals

In this report we describe un unusual case of exclusive allergic sensitization to furry animals, as a possible study model to speculate about different modalities ofsensitization to allergens of common and less common mammalian species. A 27-year-old woman referred in our Allergological Centre for the occurrence of conjunctival and severe respiratory symptoms after contact with several animals such as cats, dogs, rabbits, horses, cows etc. Patient underwent clinical and anamnestic evaluation including a detailed information on the modality of exposure to different furry animals. Skin-prick-test (SPT) was performed with our routine panel of commercial standardized extracts (Lofarma Laboratories, Milan, Italy). Some animal allergenic extracts (rabbit, horse, rat, mouse, cavia, cow and hamster) have been tested by SPT one week after the routine SPT A blood sample was taken for measurement of total IgE and specific IgE (CAP System, Phadia, Uppsala, Sweden) as well as Immunoblotting procedures. The results of in vivo and in vitro procedures revealed allergic sensitization only to animal-derived allergens. Total IgE were 59.3 kU/L. Immunoblotting showed a specific IgE-mediated sensitization of the patient to cow's, rabbit's and horse's serum albumins (SA). In conclusion, our case report confirms the role of SA as cross-reacting agent in allergic sensitization to furry animals. This finding suggests to perform SPTs to several furry animal allergens in all individuals with high level of allergic sensitization to common pets (cats and/or dogs) in order to identify allergy to other animals and consequently to avoid future exposures at risk.

Urban air pollution and climate change as environmental risk factors of respiratory allergy: an update

The incidence of allergic respiratory diseases and bronchial asthma appears to be increasing worldwide, and people living in urban areas more frequently experience these conditions than those living in rural areas. One of the several causes of the rise in morbidity associated with allergic respiratory diseases is the increased presence of outdoor air pollutants resulting from more intense energy consumption and exhaust emissions from cars and other vehicles. Urban air pollution is now a serious public health hazard. Laboratory studies confirm epidemiologic evidence that air pollution adversely affects lung function in asthmatics. Damage to airway mucous membranes and impaired mucociliary clearance caused by air pollution may facilitate access of inhaled allergens to the cells of the immune system, thus promoting sensitization of the airway. Consequently, a more severe immunoglobulin (Ig) E-mediated response to aeroallergens and airway inflammation could account for increasing prevalence of allergic respiratory diseases in polluted urban areas. The most abundant components of urban air pollution in urban areas with high levels of vehicle traffic are airborne particulate matter, nitrogen dioxide, and ozone. In addition, the earth's temperature is increasing, mainly as a result of anthropogenic factors (e.g., fossil fuel combustion and greenhouse gas emissions from energy supply, transport, industry, and agriculture), and climate change alters the concentration and distribution of air pollutants and interferes with the seasonal presence of allergenic pollens in the atmosphere by prolonging these periods.

Sharing knowledge is the key to success in a patient-physician relationship: how to produce a patient information leaflet on COPD

BACKGROUND

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide, and its prevalence is rising. In Italy, respiratory diseases are the third most common cause of death. The aim of the study is to produce a patient information leaflet (PIL) designed to educate patients about COPD in accordance with the best recommendations based on evidence and guidelines for the production of good quality written information, and to evaluate the impact of this intervention on the patients' knowledge of COPD.

METHODS

The study was conducted in the Department of Chest Diseases of the Cardarelli Hospital, Naples, Italy. A total of 166 patients admitted with a diagnosis of COPD participated in the study. Patients were asked to answer 10 multiple-choice questions compiled to assess their knowledge of the disease and then to read the leaflet. Two days later they were asked to complete the questionnaire again to assess their post-intervention knowledge. Analysis of the data was performed using SPSS version 15.0.

RESULTS

After reading the leaflet, a statistically significant increase in the proportion of correct responses was noted (p < 0.001 by Wilcoxon signed rank test). Patients had retained the knowledge gained at the one year followup (p < 0.05 by Cochran's Q test).

CONCLUSIONS

An educational intervention directed at adults with COPD had a positive impact on the patients' knowledge of COPD and this effect is long lasting.

Effects of climate change on environmental factors in respiratory allergic diseases

A body of evidence suggests that major changes involving the atmosphere and the climate, including global warming induced by human activity, have an impact on the biosphere and the human environment. Studies on the effects of climate change on respiratory allergy are still lacking and current knowledge is provided by epidemiological and experimental studies on the relationship between asthma and environmental factors, such as meteorological variables, airborne allergens and air pollution. However, there is also considerable evidence that subjects affected by asthma are at an increased risk of developing obstructive airway exacerbations with exposure to gaseous and particulate components of air pollution. It is not easy to evaluate the impact of climate change and air pollution on the prevalence of asthma in general and on the timing of asthma exacerbations. However, the global rise in asthma prevalence and severity suggests that air pollution and climate changes could be contributing. Pollen allergy is frequently used to study the interrelationship between air pollution, rhinitis and bronchial asthma. Epidemiological studies have demonstrated that urbanization, high levels of vehicle emissions and westernized lifestyle are correlated to an increase in the frequency of pollen-induced respiratory allergy, prevalent in people who live in urban areas compared with those who live in rural areas. Meteorological factors (temperature, wind speed, humidity, etc.) along with their climatological regimes (warm or cold anomalies and dry or wet periods, etc.), can affect both biological and chemical components of this interaction. In addition, by inducing airway inflammation, air pollution overcomes the mucosal barrier priming allergen-induced responses. In conclusion, climate change might induce negative effects on respiratory allergic diseases. In particular, the increased length and severity of the pollen season, the higher occurrence of heavy precipitation events and the increasing frequency of urban air pollution episodes suggest that environmental risk factors will have a stronger effect in the following decades.

Severe respiratory syndrome induced by allergic mono-sensitization to European hamster (Cricetus cricetus) in a older woman

Although the increase in the rate of hamster ownership, no report of allergic sensitization to common hamster (Cricetus cricetus)-derived allergens as a consequence of domestic exposure has been published in Italy. A 64-year-old woman was referred to our Allergy Centre for the recent onset of conjunctival and severe respiratory symptoms (rhinitis, cough, wheezing and dyspnea). About three months ago she had purchased a common hamster as home pet. Another hamster had lived at patient's home for about four months nine years ago. The results of SPT revealed allergic sensitization to Cricetus cricetus dander only (wheal 6x7 mm, positive control 7x7 mm). Total IgE were 59.3 kU/L. Specific IgE only to Cricetus cricetus epithelia (2.10 kUA/L), were also detected. Spirometry revealed a moderate degree of bronchial obstruction. Some important considerations can be drawn from our report: a) few months of hamster ownership are probably sufficient to induce an allergic sensitization and clinical symptoms, b) older age of sensitization in comparison to other studies, c) rapid remission of clinical symptoms after the removal of hamster d) skin prick tests and/or evaluation of specific IgE for hamster allergens should be performed in all potentially susceptible individuals.

Strategies for the prevention of asthmatic, anaphylactic and anaphylactoid reactions during the administration of anesthetics and/or contrast media

General anesthetics and contrast media can cause anaphylactic as well as anaphylactoid reactions. These events are of great concern to radiologists and anesthesiologists because of their relatively high prevalence, possible threat to life, and medical-legal consequences. Points discussed in this review are the critical evaluation of risk factors affecting prevention strategies, the need to be aware of pathogenic mechanisms relevant to prevention strategies, the use of alternative products if a culprit agent is known, the recognition of early signs of a reaction, the need to keep records of reactions on a patient's medical chart, the planning of prophylactic therapy, recommended actions after a reaction to an anesthetic or contrast medium, and the suggested establishment of allergy-anesthesiology centers to improve cooperation, and medical-legal issues. As any drug or contrast medium administered during general anesthesia or a diagnostic procedure can induce a potentially life-threatening or fatal event even in the absence of any evident risk factor in the patient's medical history or clinical status, we usually premedicate susceptible individuals at least to attenuate the severity of an unpredictable reaction, although we cannot rely on the efficacy of premedication to completely prevent a severe event. These recommendations, which are based on the literature and on the experience of our working group, aim to provide useful information for physicians and other specialists who operate in the absence of an allergy consultant.

Allergenic pollen and pollen allergy in Europe

The allergenic content of the atmosphere varies according to climate, geography and vegetation. Data on the presence and prevalence of allergenic airborne pollens, obtained from both aerobiological studies and allergological investigations, make it possible to design pollen calendars with the approximate flowering period of the plants in the sampling area. In this way, even though pollen production and dispersal from year to year depend on the patterns of preseason weather and on the conditions prevailing at the time of anthesis, it is usually possible to forecast the chances of encountering high atmospheric allergenic pollen concentrations in different areas. Aerobiological and allergological studies show that the pollen map of Europe is changing also as a result of cultural factors (for example, importation of plants such as birch and cypress for urban parklands), greater international travel (e.g. colonization by ragweed in France, northern Italy, Austria, Hungary etc.) and climate change. In this regard, the higher frequency of weather extremes, like thunderstorms, and increasing episodes of long range transport of allergenic pollen represent new challenges for researchers. Furthermore, in the last few years, experimental data on pollen and subpollen-particles structure, the pathogenetic role of pollen and the interaction between pollen and air pollutants, gave new insights into the mechanisms of respiratory allergic diseases.