[The efficacy of cetirizine in the treatment of mild allergic asthma due to grasses]

We have evaluated the efficacy of cetirizine in 24 patients (18 males and 6 females, mean age 25.4 years) suffering from mild or moderate allergic asthma due to grass pollen. Cetirizine was given once a day at the dosage of 10 mg for four weeks. On a daily card patients had to record the number of asthmatic attacks, the usage of bronchodilatators and the values of peak expiratory flow measured in l/min in the morning and at the evening. The improvement of the parameters considered was statistically significant, and no side effects have been observed. Cetirizine is therefore an effective and safe drug in the treatment of mild and moderate asthma induced by grass pollen.

[Efficacy of nedocromil sodium in perennial allergic conjunctivitis]

We have evaluated the efficacy of nedocromil sodium 2% eye drops in 35 patients (18 males and 17 females, mean age 32.8 yrs) suffering from perennial allergic conjunctivitis due to Dermatophagoides pteronyssinus diagnosed on the basis of anamnesis, Skin Prick Test and RAST. Patients were treated for 8 weeks with nedocromil sodium one drop each eye, four times daily and had to report the severity of the symptoms considered (photophobia, lacrimation, hyperaemia and itching) on a daily card. During the study no other medication was allowed. After 4 weeks symptoms were statistically improved and this beneficial effect increased at the end of the treatment. No side effects were reported. Nedocromil sodium eye drops is therefore a useful treatment in perennial allergic conjunctivitis due to Dermatophagoides pteronyssinus.

Neutrophil functions and IL-8 in psoriatic arthritis and in cutaneous psoriasis

The aim of this study is to determine some functions of neutrophil in patients affected by psoriatic arthritis and to compare them to those of patients affected by cutaneous psoriasis and to normal controls. We used a model of experimental cutaneous inflammation allowing to separate a cluster of purified and viable PMN cells. Then we analyzed, within the three groups, the IL-8 concentration in serum and in the supernatant obtained from the inflammatory site to gather data on the possible pathogenic role played by this cytokine in psoriatic arthritis. We studied neutrophil functions in patients with cutaneous psoriasis and psoriatic arthritis, in acute phase, in comparison with healthy control subjects. We investigated in vivo neutrophil migration by Senn's skin window technique and measured adhesion assay and superoxide production in circulating and migrating neutrophils after different stimuli. We also measured IL-8 concentration in serum and in the supernatant obtained from the inflammatory site, artificially created through the skin window scrape. Neutrophil migration in vivo was significantly higher in both groups of patients than in controls. In the presence of fMLP, blood cells showed a burst of superoxide release, which was significantly more pronounced in patients when compared to healthy controls. Neutrophils from skin window scrape showed a much higher response to fMLP as compared to blood cells of all subject groups, but no differences were observed between patients and controls. No correlation was found between the three groups in adhesion ability under basal condition or in response to different stimuli by circulating and migrating neutrophils. Our results also show a great increase of IL-8 in the exudate from patients compared to controls. Our study shows that there is no difference in neutrophil functions between patients with psoriatic arthritis and cutaneous psoriasis; moreover we suggest that the source of high IL-8 levels are neutrophils rather than the keratinocytes.

Effects of dietary fish oil and soy phosphatidylcholine on neutrophil fatty acid composition, superoxide release, and adhesion

Fifty-seven healthy volunteers matched for sex and age were subdivided in 3 groups and their usual Western diets were supplemented according to three different protocols: group 1, fish oil supplement (20 ml/day); group 2, soybean phosphatidylcholine (PC) (25 g/day) and group 3, no supplementation (control group). After 2 weeks several important modifications of neutrophil fatty acid composition were observed: fish oil induced a significant decrease of linoleic (LA) and arachidonic acid (AA) and a significant increase of eicosapentaenoic (EPA) and docosahexaenoic acid (DHA), while soy PC induced significant increases of LA, total polyunsaturated fatty acid (PUFA) and PUFA/SFA ratio. Neutrophil superoxide generation and adhesion were not modified by fish oil diet, on the contrary a slight but significant increase of O2.- production in response to fMLP was measured after soy PC diet. Our study confirms the possibility of changing neutrophil fatty acid composition in vivo by dietary means, but also suggests that the manipulation of cell functions, like superoxide anion generation and adhesion, is not easily and directly achieved by controlling membrane lipid environment.

Neutrophil arachidonic acid level and adhesive capability are increased in essential hypertension

BACKGROUND

We recently demonstrated that arachidonic:linoleic acid ratio of erythrocytes of essential hypertension patients is greater than normal.

OBJECTIVE

To investigate fatty acid composition, capability for adhesion to biological substrate and expression of beta2 integrins of leucocytes obtained from peripheral blood and skin window exudate of essential hypertension patients.

DESIGN

Neutrophil activation state was evaluated by reproducing the various conditions occurring in vivo during the life of the cell (i.e. under the 'resting' condition, such as in peripheral blood, and 'primed' condition, such as after transmigration through the endothelium and after administration of specific chemo-attractants). Because both peripheral blood and skin window leucocytes of the subjects were obtained on the same day, we could be sure that there had been no dietary influences on changes in levels of fatty acid. Thus, the observed changes should reliably reflect the metabolic rate of utilization of fatty acids coupled to the activation and migration of cells.

RESULTS

Leucocytes from essential hypertension patients were richer in arachidonic acid than were the corresponding cells from normotensive subjects; this difference was also evident for functionally activated skin window leucocytes, in spite of there having been a greater loss of poly-unsaturated fatty acids and arachidonic acid after migration. Moreover, a greater than normal arachidonic acid:linoleic acid ratio was shown for the first time to apply for leucocytes of essential hypertension patients, so extending our previous findings on the erythrocytes. Leucocytes from essential hypertension patients, collected both from peripheral blood and from skin window exudate, proved far more adhesive than the corresponding cells from age-matched and sex-matched controls, but this was not associated with a quantitative hyperexpression of beta2 integrins.

CONCLUSIONS

The results suggest that an increase in availability of arachidonic acid in leucocytes could be a further expression of the generalized disturbance of fatty acid levels associated with essential hypertension and that a condition of hyperadhesion of neutrophils could occur spontaneously in vivo during the course of hypertension.

[Efficacy of topical azelastine in the treatment of allergic rhinitis caused by Parietaria officinalis]

We have evaluated the efficacy of azelastine, a new long acting antihistamine, in the topic treatment of seasonal allergic rhinitis to Parietaria officinalis. Forty five patients have been considered, 20 males and 25 females, mean age 28.5 years, suffering from seasonal rhinitis to Parietaria officinalis for at least 4 years. Azelastine was administered twice a day for 4 weeks in the pollen season. On a daily diary-card, patients had to record the severity of the symptoms considered: runny nose, sneeze, itching nose, nasal obstruction, following an arbitrary score from 0 to 3. At the end of the study, patients obtained a significant improvement of the symptoms considered without the addition of any other topical or systemic therapy. No side effects have been reported. Therefore azelastine is an effective drug in the treatment of seasonal allergic rhinitis to Parietaria officinalis.

[Topical cyclosporine in the treatment of oral pemphigus]

BACKGROUND

Pemphigus vulgaris presents the typical blistering lesions at the level of oral mucosa in nearly all patients. The main drugs used in the treatment of the disease are steroids and immunosuppressive agents. Among the latter, cyclosporine A plays a pivotal role.

METHODS

In this study the effects of topical cyclosporine have been evaluated in 12 patients (4 males and 8 females, mean age 65 years) suffering from oral pemphigus for at least 4 years non responsive to the previous treatments. Five ml of oral suspension (500 mg) were divided into three times a day; cyclosporine had to be kept in the oral cavity for 15 mins and no food nor drinks were allowed for 30 mins before and after the oral wash. The treatment lasted for 2 months.

RESULTS

At the end of the study a significant beneficial effect on erythema, oral lesions and pain was noticed. No side effects have been reported and the monitoring of full blood count, of renal and hepatic function and of blood pressure has not shown any variation from the baseline. Serum cyclosporine level has always been undetectable.

CONCLUSIONS

These encouraging results in the treatment of oral pemphigus need to be confirmed in controlled studies.

[Nedocromil sodium is effective in the treatment of mild and moderate allergic asthma caused by Dermatophagoides pteronyssinus]

We have evaluated the efficacy of nedocromil sodium in 38 patients (18 males and 20 females, mean age 37.2 yrs) suffering from mild or moderate allergic asthma due to Dermatophagoides pteronissinus. Nedocromil sodium was given twice a day at the dosage of 4 mg each time for two months. On a daily diary card patients had to record the severity and the number of asthmatic attacks, the usage of bronchodilators and the values of peak respiratory flow measured in 1/min in the morning and at night. The improvement of the parameters considered was statistically significant, and no side effects have been observed. Nedocromil sodium is therefore an efficacious and safe drug in the treatment of mild and moderate asthma induced by Dermatophagoides pteronyssinus.

[Combined drug therapy in recent-onset rheumatoid arthritis. Evaluation after 1 year of treatment]

The aim of our study is to evaluate the efficacy and safety of a combination therapy with hydroxycloroquine, gold sodium thiomalate and methotrexate in patients affected by recent onset active rheumatoid arthritis. Twenty-five patients (6 men e 19 women, average age 46.2 +/- 12.2) were enrolled in this study and 18 of them have been treated for 1 year with the three above-mentioned drugs at optimal doses. Drug toxicity was carefully monitored. Clinical and hematochemical parameters of efficacy were evaluated every three months. Radiographic joint study was performed at the beginning and at the end of the study. Seven patients dropped out, six of them for side effects, due to hydroxycloroquine in 1 case and to gold sodium thiomalate in 5 cases; 1 patient withdrew his consent. No life-threatening or irreversible adverse reactions were observed. The eighteen patients who completed the one year trial presented a remarkable improvement of clinical and hematochemical parameters. In only 1 case one erosion appeared at the end of the study. In conclusion, the combination therapy with hydroxycloroquine, gold sodium thiomalate and methotrexate seems to be effective and burdened by an acceptable level of toxicity.

Sjögren's syndrome with anticentromere antibodies

Clinical and laboratory findings in 10 women with Sjogren's syndrome and positive anticentromere antibodies were compared to those in 50 patients with Sjögren's syndrome and typical serologic features. The anticentromere antibody-positive patients were more likely to have Raynaud's phenomenon and less likely to have leukopenia polyclonal hypergammaglobulinemia, rheumatoid factor, and anti-SSA/Ro antibody. Four anticentromere antibody-positive patients developed limited cutaneous scleroderma during follow-up, but none had lymphoma; some of the other patients in this group exhibited stable symptoms typical for Sjögren's syndrome. Among our overall population of Sjogren's syndrome patients who met diagnostic criteria for primary Sjogren's syndrome at the first evaluation, 16.6% tested positive for anticentromere antibodies.

[Nedocromil sodium 1% nasal spray in the treatment of allergic rhinitis caused by Dermatophagoides pteronyssinus]

We have evaluated the efficacy of Nedocromil sodium 1% nasal solution in 36 patients (20 females and 16 males, mean age 29.5 years) suffering from perennial allergic rhinitis caused by Dermatophagoides pteronyssinus. Nedocromil sodium was given four times a day for 2 months. On a daily card patients had to report the severity of the considered symptoms (runny, nose, sneezing, itchy nose and stuffy nose) following an arbitrary score from 0 to 3 (0 = no symptom, 1 = mild, 2 = moderate, 3 = severe). Clinical evaluation was performed after 1 month and at the end of the treatment. We observed a statistically significant decrease of the considered symptoms already after a one month therapy. This improvement was higher after two months (p < 0.001). No side effects have been reported and no concomitant symptomatic therapy was needed. Nedocromil sodium is therefore a safe and efficacious drug in the treatment of allergic rhinitis caused by Dermatophagoides pteronyssinus.

Changes of neutrophil migration without modification of in vitro metabolism and adhesion in Behçet's disease

OBJECTIVE

Increase of neutrophil chemotaxis in Behçet's disease (BD) has been described, but it is not clear whether there is a correlation with other variables of neutrophil function and whether these modifications correlate with disease activity.

METHODS

We studied neutrophil functions in patients with BD in the acute phase in comparison with healthy control subjects and with the same patients during disease remission, with or without therapy. We investigated in vivo neutrophil migration by Senn's skin window technique and measured adhesion assay and superoxide production in circulating and migrating neutrophils after different stimuli.

RESULTS

Neutrophil migration in vivo was 101.3 +/- 17.9 x 10(6) polymorphonuclear lymphocytes (PMN)/cm2/24 h in patients with BD in the acute phase and 66.1 +/- 7.8 x 10(6) PMN/cm2/24 h in controls (p < 0.001). No correlation was found between leukocyte counts and neutrophil migration. Neutrophil migration evaluated in the same patients in a phase of disease remission was 58.3 +/- 10.3 x 10(6) PMN/cm2/24 h (p < 0.001 vs acute phase, not significant vs controls). The neutrophils of the exudate were normally primed to response to the chemotactic peptide fMLP. No differences between the 2 groups were found in superoxide production, adhesion under basal conditions, or in response to different stimuli by circulating and migrating neutrophils.

CONCLUSION

Abnormally high migration of neutrophils in the active phase of BD is the only consistent neutrophil dysfunction. Since this modification is reversed by therapy, the evaluation of in vivo neutrophil migration may be useful in diagnosing and monitoring disease activity. Blood neutrophils have normal responses to different stimuli, indicating they are not primed by the disease state.

Sjögren's syndrome associated with autoimmune hepatitis. A case report

Liver involvement in patients with primary Sjögren's syndrome is rare, usually without clinical significance and histologically characterized by a feature like stage 1 primary biliary cirrhosis. We describe herein a case of acute and severe autoimmune hepatitis in a patient suffering from primary Sjögren's syndrome. The diagnosis of Sjögren's syndrome was performed in 1989. In June 1995 the patient presented severe weakness, jaundice and elevation of transaminases; moreover IgG raised to 5560 mg/dl and ANA titre increased to 1:20480. The patient denied alcohol and drug use and a viral hepatitis was excluded. Antimitochondrial antibodies, anti-smooth muscle antibodies and antibodies against liver kidney microsomes were negative. An abdomen ultrasound examination revealed hepatomegaly, with irregular echogenic structure and lymphoadenomegaly near the celiac tripod. Liver biopsy demonstrated a picture of autoimmune hepatitis. The patient was treated with prednisone 50 mg/day and azathioprine 50 mg/day, with improvement in clinical and liver function indices. At present, the patient is given only 10 mg/day of prednisone. The association of Sjögren's syndrome with autoimmune hepatitis is very rare: in the literature only one other similar case has been reported.

Studies of skin-window exudate human neutrophils: increased resistance to pentoxifylline of the respiratory burst in primed cells

Human neutrophils were isolated both from peripheral blood (PB) and from aseptic inflammatory exudates obtained by the Senn's skin window technique (SW). The respiratory burst (O2- production) induced by in response to n-formyl-methionyl-lencyl-phenylalanine (fMLP) and by serum-treated zymosan (STZ) was investigated using a microplate assay. SW neutrophils were primed to enhanced fMLP-dependent O2- production in response to fMLP but not to STZ. Pentoxifylline, a cAMP-elevating drug, dose-dependently inhibited the respiratory burst in any experimental condition, but the dose-effect curves were markedly different according the stimulant used and the source of the cells. With fMLP as stimulant, a significant inhibition of the O2- production by PB neutrophils was obtained using doses of 10 micrograms/ml, while SW neutrophils were inhibited only by doses equal or higher than 100 micrograms/ml. With STZ as stimulant, the inhibition of the respiratory burst of PB neutrophils and of SW neutrophils was obtained only with doses higher than 400 micrograms/ml and 1 mg/ml respectively. Pentoxifylline dose-dependently (10 micrograms/ml to 1 mg/ml) increased the intracellular adenosine 3'-5'-cyclic monophosphate (cAMP) to the same extent in SW and in PB neutrophils. These data indicate that the priming of neutrophil oxidative metabolism by in vivo inflammation is associated with an increase in the resistance to the regulating effect of cAMP on the fMLP-dependent activation pathway of NADPH oxidase. The fact that therapeutic doses of pentoxifylline do not inhibit the respiratory burst of primed neutrophils may have relevance in the interpretation of the clinical effects of this drug.

Parvovirus B19 infection and rheumatic diseases

We reviewed the literature on relationships between human parvovirus B19 infection and rheumatic diseases. Parvovirus B19 causes erythema infectiosum in childhood, transient anemia in immunocompetent individuals, and potentially severe infections in fetuses; laboratory evidence that the virus is directly responsible for these disorders has been obtained. Acute arthropathy meeting American College of Rheumatology criteria for rheumatoid arthritis and disorders meeting some of the classification criteria for systemic lupus erythematosus are the most striking rheumatic manifestations of parvovirus B19 infection. Purpuric lesions have also been reported. Parvovirus B19 infection may be capable of inducing a number of manifestations that have not yet been described in the literature. Although the relationship between human parvovirus B19 infection and rheumatic diseases has been the focus of many studies, compelling evidence that the virus is directly involved in the pathogenesis of rheumatic diseases has not yet been obtained.

Neutrophil migration, oxidative metabolism, and adhesion in elderly and young subjects

OBJECTIVE

To evaluate neutrophil functions in the elderly.

METHODS

We investigated the PMN migration in vivo and PMN superoxide production and adhesion in response to a variety of compounds; PMN have been isolated both from blood and from a skin experimental exudate (obtained by Senn's skin window technique) of 25 normal elderly and of 25 normal young control subjects.

RESULTS

No difference was found in PMN migration in vivo (62.9 +/- 21.3 x 10(6) and 65.5 +/- 9.1 x 10(6) PMN/cm2/24 hours in elderly and young subjects respectively), neither were different the adhesion under basal condition and after some stimuli and the superoxide production in basal condition and in response to STZ and PMA in two groups. In elderly subjects superoxide production, in response to fMLP, markedly resulted lower than in young controls both by circulating PMNs (3.6 +/- 2.7 and 9.3 +/- 3.3 nMOLES O2-/10(6) PMN respectively, p < 0.0001) and by exudate PMNs (13.6 +/- 4.3 and 19.4 +/- 6 nMOLES O2-/10(6) PMNs respectively, p < 0.005).

CONCLUSION

Many PMN functions in the elderly do not differ from young people, suggesting that the overall defense function of these cells is not affected by aging. The only parameter that we have found to be different between the two groups is the poor superoxide production after fMLP stimulus of PMNs. The stimulus- and function-specificity of this defect in PMNs from elderly subjects indicates the existence of a dysregulation of the signal transduction pathway distal to fMLP receptor and proximal to NADPH oxidase activation.