Allergy and the skin

Allergic skin disorders include urticaria, angioedema, contact dermatitis and atopic dermatitis, but the model fitting most closely the systemic concept of allergy is atopic dermatitis (AD), the pathogenesis of which is linked to a complex interaction between skin barrier dysfunction and environmental factors such as allergens and microbes. In particular, an important advance was the demonstration that the mutation of the skin barrier protein filaggrin is related strictly to allergen sensitization and to the development of asthma in subjects with AD. The altered skin barrier function, caused by several factors, results in the passage of allergens through the skin and to systemic responses. A pivotal role in such a response is exerted by Langerhans cells which, via their immunoglobulin E (IgE) receptor, capture the allergens and present them to T cells. When T helper type 2 (Th2) cells are activated, the production of a proinflammatory cytokines and chemokines pattern sustains the persistence of inflammation. Known AD-related cytokines are interleukin (IL)-5, IL-13 and tumour necrosis factor (TNF)-alpha, with emerging importance for IL-17, which seems to drive airway inflammation following cutaneous exposure to antigens, and IL-31, which is expressed primarily in skin-homing Th2 cells. Skin-homing is another crucial event in AD, mediated by the cutaneous lymphocyte-associated antigens (CLA) receptor, which characterizes T cell subpopulations with different roles in AD and asthma.

Clusterin in stool: A new diagnostic marker of colorectal cancer

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Background: Colon cancer is second only to lung cancer in men and to breast carcinoma in women, for incidence and mortality in western countries .The higher incidence per age is observed between the sixth and seventieth decade, while 60% of the patients survive up to five years. The most important reason for the low percentage of recoveries is due to the fact that when the primary tumour is removed, a high number of patients have already developed micro-metastases, principally at liver. Therefore, methods for early screening are requested. Molecular markers have emerged as an important strategy to evaluate the individual susceptibility for cancer insorgence and for clinical cancer therapy. Recent studies have demonstrated an increase in clusterin expression in breast carcinoma suggesting a possible role of this protein in tumour progression. Clusterin is an heterodimeric (a and β chains) ubiquitous glycoprotein implicated in a large number of physiological processes and in the control of cellular proliferation. Despite the original hypothesis that clusterin is a marker for programmed cell death, several experiments and clinical studies have demonstrated conflicting findings on its role in tumors. Methods: We have studied clusterin isoforms expression in tumour progression, in particular in the adenoma-carcinoma sequence of colorectal cancer. Results: the observation of 35 samples of human intestinal mucosa, such as endoscopic biopsies and surgical specimens, demonstrated that the progression towards high grade and metastatic colon carcinoma leads to a pattern shift of clusterin isoforms production, the complete loss of the proapoptotic nuclear form and an over expression of cytoplasmic secreted form correlateting to a phenotype with high metastatic potential. Moreover we observed in tumor biopsies the release of clusterin in the crypts lumen. The ELISA immuno-dosage of clusterin demonstrated that the sclusterin overexpression in tumours correlates to a significant increase of clusterin in the serum and stools of patients affected by tumoural pathologies and in particular by colorectal cancer. Conclusions: These data suggests a new role of secreted clusterin as a new diagnostic circulating marker and a potential new therapeutic target.

No significant financial relationships to disclose.

Economic evaluation of sublingual immunotherapy: an analysis of literature

Allergic rhinitis and asthma constitute a global health problem because of their very high prevalence and the consequent burden of disease, concerning medical and economical issues. Among the treatments of allergy, specific immunotherapy has the capacity to favourably alter the natural history of the disease both during and after its performance and thus to reduce the direct and indirect costs of allergic rhinitis and asthma. A number of studies reported such cost reduction for traditional, subcutaneous immunotherapy and recent data demonstrate that also sublingual immunotherapy (SLIT) is associated to economic advantages and/or monetary savings, specifically in terms of reduction of disease economic burden. Only few formal economic assessments of SLIT have been carried out so far, this article will present and discuss the published studies addressed to this issue. The data obtained, although the number of studies is still limited, provide preliminary evidence supporting a SLIT effect on sparing costs for respiratory allergy.

Pharmacoeconomics of subcutaneous allergen immunotherapy

The current burden of allergic diseases, estimated by both direct and indirect costs, is very relevant. In fact the cost estimation for rhinitis amount globally to 4-10 billion dollars/year in the U.S. and to an average annual cost of 1089 euros per child/adolescent and 1543 euros per adult in Europe. The estimated annual costs in Northern America for asthma amounted to 14 billion dollars. Consequently, preventive strategies aimed at reducing the clinical severity of allergy are potentially able to reduce its costs. Among them, specific immunotherapy (SIT) joins to the preventive capacity the carryover effect once treatment is discontinued. A number of studies, mainly conducted in the US and Germany demonstrated a favourable cost-benefit balance. In the nineties, most surveys on patients with allergic rhinitis and asthma reported significant reductions of the direct and indirect costs in subjects treated with SIT compared to those treated with symptomatic drugs. This is fully confirmed in recent studies conducted in European countries: in Denmark the direct cost per patient/year of the standard care was more than halved following SIT; in Italy a study on Parietaria allergic patients demonstrated a significant difference in favor of SIT plus drug treatment for three years versus drug treatment alone, with a cost reduction starting from the 2nd year and increasing to 48% at the 3rd year, with a highly statistical significance which was maintained up to the 6th year, i.e. 3 years after stopping immunotherapy, corresponding to a net saving for each patient at the final evaluation of 623 euros per year; in France a cost/efficacy analysis comparing SIT and current symptomatic treatment in adults and children with dust mite and pollen allergy showed remarkable savings with SIT for both allergies in adults and children.

[Hymenoptera stings in forestry department agents: evaluation of risk]

BACKGROUND

In sensitized subjects Hymenoptera stings may provoke the awakening of mediated systemic reactions of I type IgE, which can sometimes be serious. Considering the type of work performed activity and the high frequency of reported hymenoptera sting episodes, a sample of 206 Forestry Department agents was surveyed who worked outside urban areas in the Marche Region.

OBJECTIVES

The aim of the study was to analyse the prevalence of stings and their possible systemic reactions, as well as to evaluate the type of occupational risks involved.

METHODS

A total of 206 agents were examined and questioned about the number of stings suffered during work and about the kind of subsequent skin and systemic reactions; they were then classified according to the method proposed by H.L. Mueller.

RESULTS

179 agents reported having suffered from hymenoptera stings and, of these, 53 subjects (29,6%) remembered that one episode at least occurred during work. Among 175 operators (98%), 4 had a regular reaction, with appearance of a generalized urticaria and uneasiness. In the remaining 4 agents (2%) there was a local extensive reaction, which was not associated with systemic reactions and they were all referred to allergological examination. 19 agents (10,6%) suffered more than 5 stings altogether, but none developed a systemic reaction. 87% of the subjects practised self-medication, 7% reported to the casualty department of the local hospital or to their own doctor, and 6% undertook no cure at all.

CONCLUSIONS

Epidemiological studies agree in recognizing that, in the general population, the percentage of systemic reactions after one or more hymenoptera stings varies from 0,15% to 3,3%. In categories of workers occupationally at risk, the prevalence of systemic reactions varies from 4,5% to 26%. The prevalence of systemic reactions in Forestry Department agents was 2%, which is similar to the prevalence in the general population. Therefore, rather than occupational risk, there appeared to be a generic risk made more serious by working conditions for Forestry Department agents due to their possible exposure to hymenoptera stings. The occupational health physician needs to monitor these events, due to the fact that frequent exposure to stings, above all occurring within a short period of time (less than two months) favours an increase in the tendency to develop systemic reactions, with a more serious prognosis, especially when working in isolated conditions.

Practice parameters for sublingual immunotherapy

The efficacy and safety of sublingual immunotherapy (SLIT) are currently supported by clinical trials, meta-analysis and post-marketing surveys. Practice parameters for clinical use of SLIT are proposed here by a panel of Italian specialists, with reference to evidence based criteria. Indications to SLIT include allergic rhinoconjunctivitis, asthma, and isolated conjunctivitis (strength of recommendation: grade A). As to severity of the disease, SLIT is indicated in moderate/severe intermittent rhinitis, persistent rhinitis and mild to moderate asthma (grade D). SLIT may be safely prescribed also in children aged three to five years (grade B), and its use in subjects aged more than 60 years is not prevented when the indications and contraindication are ascertained (grade D). The choice of the allergen to be employed for SLIT should be made in accordance with the combination of clinical history and results of skin prick tests (grade D). Polysensitisation, i.e. the occurrence of multiple positive response does not exclude SLIT, which may be done with the clinically most important allergens (grade D). As to practical administration, co-seasonal, pre co-seasonal, and continuous schedules are available, being the latter recommended for perennial allergens or for pollens with particularly prolonged pollination, such as Parietaria (grade D). For pollens with relatively short pollination, such as grasses and trees (cypress, birch, alder, hazelnut, olive) the pre co-seasonal and perennial schedules are preferred (grade C). The build-up phases suggested by manufacturers can be safely used (grade A), but they can be modified according to the patient's tolerance (grade C). A duration of SLIT of 3-5 years is recommended to ensure a long-lasting clinical effect after the treatment has been terminated (grade C).

Quantitative variations of individual carotenoids in relationship with the leaflet development of six species of the genus Ceratozamia (Cycads)

The content and relative variations of individual carotenoids during the leaflet development stages (I, II, III, A and P) of six species of Ceratozamia (Cycads) were investigated. There is an unusual, transitory and marked presence of six red stroma keto-carotenoids in the first development stages, while the thylakoidal carotenoids showed a low concentration during the same period. As no official A1cm1% coefficients were available, it was necessary to calculate these for the following stroma carotenoids: semi-beta-carotenone (major component), triphasiaxanthin, ceratoxanthin, ceratozamiaxanthin, kuesteriaxanthin and ceratoxanthone. The stroma keto-carotenoids, which reached the highest content in the first development stage (average of 78% of total carotenoids), were always present in the five species: C. fuscoviridis, C. robusta, C. spinosa, C. kuesteriana and C. hildae, but never in C. mexicana. From stage II, the stroma keto-carotenoids decreased and finally disappeared in the green adult leaflets. The thylakoidal carotenoids showed a minimum at stage III, and then increased to a maximum in the perennial leaflets. Among these, beta-carotene showed an anomalous and characteristic behaviour, being a minor component during leaflet development (from stage I to A). In stage P it was markedly exceeded not only by lutein but also by alpha-carotene, neoxanthin and violaxanthin, and in C. robusta also by lutein-5,6-epoxide. Additionally, the alpha/beta ratio in these species is unusual: it increased from 0.3-0.5 to 1.5-3.0 during leaflet development. Moreover, antheraxanthin amounts are very small, while zeaxanthin was present only in the evergreen leaflets of C. mexicana in small quantities. Lutein-5,6-epoxide represented more than 5% of thylakoidal carotenoids in the leaflets of all the species. A revision of the taxonomic rank of C. fuscoviridis is recommended.

Chloroplast genetic diversity and biogeography in the serpentine endemic Ni-hyperaccumulator Alyssum bertolonii

• Chloroplast microsatellites (cpSSR) were used to analyze the patterns of genetic variation within and among populations of the serpentine endemic, Alyssum bertolonii . • Thirty-five different chloroplast haplotypes were identified in 90 plants sampled from nine populations originating from the four disjunct northern-Italian serpentine regions where the species is found. • High levels of genetic diversity were found within each of the populations sampled. Analysis of Molecular Variance (AMOVA) showed high degrees of differentiation among both different populations of the same serpentine region and different regions (Φ _ST = 0.622, Φ _CT = 0.252, respectively). • The results indicated that: each population was established by few founders and then subsequently differentiated the existing chloroplast haplotypes; each population is a distinct genetic entity; and populations within the same serpentine region are more related than populations from different regions.

Tumor specific modulation of KU70/80 DNA binding activity in breast and bladder human tumor biopsies

The Ku70/80 heterodimer is the regulatory subunit of the DNA-dependent protein kinase (DNA-PK) and its DNA-binding activity mediates DNA double-strand breaks repair. Although Ku80 was recently proposed as a caretaker gene involved in the control of genome integrity, no data are available on Ku70/80 DNA-binding activity in human tumors. Heterodimer DNA-binding activity and protein expression were assayed by electrophoretic-mobility-shift-assay (EMSA) and Western blot analysis, in nuclear and cytoplasmic extracts from eight breast, seven bladder primary tumors and three metastatic nodes from breast cancers. Corresponding normal tissues of the same patients were used as controls. Ten out of 15 tumors showed nuclear Ku-binding activity 3-10 times higher than in the normal tissues, irrespective of bladder or breast origin. Conversely, in 5/15 primary tumors and in all the metastatic nodes analysed, nuclear Ku-activity was 1.5-4.5-fold lower than in the corresponding normal tissues. Cytoplasmic heterodimer activity significantly differed between tumor and normal tissues, displaying a 2-10-fold increase in neoplastic tissues. Three different patterns combining both Ku expression and activity with tumor characteristics were identified. In low aggressive breast tumors p70/p80 proteins were expressed in tumor but not in normal tissues. The heterodimer binding-activity matched the protein levels. In non-invasive bladder carcinomas no significant differences in protein expression between tumor and the corresponding normal tissues were found, however heterodimer binding-activity was increased in tumor samples. In breast and bladder tumors, at the advanced stage and in node metastases, the binding activity was strongly reduced in tumor biopsies, however no differences were demonstrated between normal and tumor protein levels. Our results suggest a different modulation of Ku70/80 DNA-binding activity in human neoplastic tissues, possibly related to tumor progression. Findings provide further data on tissue-specific protein expression and post-translational regulation of heterodimer activity.

Determination of benzene at trace levels in air by a novel method based on solid-phase microextraction gas chromatography/mass spectrometry

A new method for the determination of benzene at trace levels in air is presented. The method consists of the collection of air samples on adsorbent cartridges with simultaneous adsorption of pre-established amounts of D6-labeled internal standard. Desorption from the cartridge is performed by solid-phase microextraction (SPME) with analysis by gas chromatography/mass spectrometry (GC/MS) using an ion trap mass spectrometer. The influence of several parameters (type of SPME fiber, temperature, time, for example) was investigated, and good linearity in the range 10-400 ng of C6D6, with a coefficient of variance (CV) around 3-5%, was obtained. The method was tested by sampling air in a town center in Italy, and a benzene concentration of approximately 50 microg/m(3) was determined. The maximum limit recommended by the European Community is 10 microg/m(3).

Investigation on the iodination reaction of methylene blue by liquid chromatography-mass spectrometry with ionspray ionisation

Radioactive iodine (131I and 123I) labelled methylene blue is used for the early diagnosis of melanoma metastases. We studied the iodination reaction of methylene blue (using "cold" iodine) in order to characterise the iodination product(s) as far as number and position of iodine atoms introduced on the aromatic ring(s) is concerned. The reaction was carried out under the same experimental conditions used for the radioactive one, that is in a large excess of methylene blue. The ionspray HPLC-MS analysis of the reaction mixture showed that the iodinated methylene blue was present only in a very small amount and the main iodinated product was a demethylated one, coming out from the iodination of an impurity azure B. We also studied the iodination reaction of azure B in order to better explain the reaction pathway. Commercial azure B contains impurities of methylene blue and all the possible demethylated derivatives. HPLC-MS analysis of the reaction mixture allowed a complete characterisation of the iodinated and bis-iodinated products.

Identification and characterization of fenton oxidation products of surfactants by ionspray mass spectrometry and solid-phase microextraction gas chromatography mass spectrometry 1. Lauryl sulphate

The Fenton reaction for the degradation of surfactants has been investigated and partial degradation products have been identified and characterized by mass spectrometry for the case of lauryl sulphate. The polar soluble products were investigated by liquid chromatography/mass spectrometry (LC/MS) with electrospray ionization (ESI), and the volatile products leaving the mixture during the reaction were trapped by means of solid-phase microextraction (SPME) and investigated by gas chromatography/mass spectrometry (GC/MS) with electron and chemical ionization. The oxidation leads to the formation of products with hydroxyl and epoxide groups due to insertion of oxygen atoms or to aldehydes derived from the loss of the hydrophilic sulphate group. The extent of mineralization is dependent on peroxide and iron concentrations. Copyright 1999 John Wiley & Sons, Ltd.

A simple method for the extraction of volatile organic compounds contained in air samples from adsorbent materials by solid phase microextraction and their analysis by gas chromatography/mass spectrometry

The monitoring of air pollution requires simple, rapid and sensitive sampling and analytical techniques with minimal sample manipulation that are usable for routine analyses. In our laboratories we have developed a method for the analysis of air samples collected by adsorbent cartridges based on solid phase microextraction (SPME) coupled to gas chromatography/mass spectrometry. We investigated the influence of some variables (time and temperature) using toluene as analyte (one of the most common air pollutants) and toluene-d(8) on the SPME extraction, and the sensitivity (LOQ) of the method. We then tested the method on an air sample collected in an industrial area and carried out characterisation of the volatile organic compounds present.

Inhibition of IL-2 production by Nil-2-a in murine T cells

The loss of IL-2 production is the main defect accounting for age-related immunodeficiencies. We have investigated the molecular mechanisms involved in the decrease of IL-2 production in CD4+ T cells from aging mice. Our results demonstrate that the stability of IL-2 mRNA increases in T cells from young mice, whereas it declines in T cells from old mice with the time of stimulation, suggesting the existence of different mechanisms of post-transcriptional regulation in young and old mice. We found that the IL-2 mRNA level in T cells from young but not from old mice increased up to 6- to 10-fold by addition of cycloheximide (CHX) while the stability of IL-2 mRNA is not affected. We then looked for IL-2 inducible inhibitory factors in T cells from young and old mice and demonstrated the presence of Nil-2-a, a zinc finger protein which negatively controls IL-2 gene transcription in human cells. This protein could be detected in T cells from both young and old mice, yet, in the presence of CHX, its binding activity was reduced by 75% in T cells from young but not from old mice. These findings show that Nil-2-a accounts for the negative control of IL-2 production in the mouse and explain the reduced IL-2 production in aging.

Role of mRNA stability in the different patterns of cytokine production by CD4+ cells from young and old mice

CD4+ cells from young (3 months) and old (19 months) mice were stimulated by plate-bound anti-CD3 monoclonal antibody (mAb) alone or also by soluble anti-CD28 mAb. Supernatants were analysed by enzyme-linked immunosorbent assay (ELISA) to determine cytokine concentrations. Total RNA was extracted from cells, reverse transcribed and the cDNA amplified by polymerase chain reaction (PCR) to evaluate the amount of specific mRNA. The results indicate that anti-CD3 alone is not sufficient to induce interleukin-2 (IL-2) production in CD4+ cells from both young and old mice. However, anti-CD28, together with anti-CD3 mAb, induces a much higher production of IL-2 in CD4+ cells from young as compared with old mice. Conversely, interferon-gamma (IFN-gamma) production is also induced by anti-CD3 alone and is higher in CD4+ cells from old as compared with young mice. Upon addition of anti-CD28 mAb, IFN-gamma production increases in both groups, but it remains much higher in old than in young mice. Also the production of IL-4 and IL-10 is induced by anti-CD3 mAb but it is increased by the addition of anti-CD28 mAb. CD4+ cells from old mice produce more IL-4 and IL-10 as compared with cells from young mice. The amounts of cytokine specific mRNA in CD4+ cells from young and old mice parallel the cytokine levels in culture supernatants. Results on the mRNA turnover indicate that when CD4+ cells are stimulated by anti-CD3 or costimulated also by anti-CD28 mAb, the IFN-gamma, IL-4 and IL-10 specific mRNAs are more stable in old than in young mice, suggesting that mRNA stability has a relevant role in the different patterns of cytokine production.

Cell proliferation and ku protein expression in ageing humans

Previous studies on DNA repair in ageing have demonstrated increased frequencies of single and double strand breaks in lymphocytes from elderly subjects and, as a consequence, decreased efficiency in DNA replication. We have investigated the relationship between cell proliferation and the nuclear expression of ku protein in a human population of 43 subjects of different ages. Ku is an heterodimeric protein composed of two subunits of 70 and 80 kDa, which is involved in the early steps of DNA damage recognition. In the present study, PBL from subjects of different ages were PHA-activated to evaluate the stimulation index and the production of Th1- and Th2-type cytokines. Moreover, nuclear extracts were obtained from activated lymphocytes to evaluate by a gel retardation assay the presence and the functional activity of the heterodimer ku 70/80. Our results indicate that ageing affects the mitotic responsiveness and cytokine production to a significant extent, but only marginally the expression of ku 70/80. These findings suggest that the age-related impairment in DNA repair mechanisms are only in part related to the reduced expression of ku protein able to recognize DNA damage.