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Losappio LM, Mirone C, Schroeder JW, Scibilia J, Balossi L, Pastorello EA. Omalizumab Use in Chronic Spontaneous Urticaria during Pregnancy and a Four Years' Follow-Up: A Case Report. Case Rep Dermatol 2020; 12:174-177. [PMID: 33173477 PMCID: PMC7588681 DOI: 10.1159/000509179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/04/2020] [Indexed: 12/27/2022] Open
Abstract
Chronic spontaneous urticaria (CSU) is a benign skin disorder usually responsive to treatment; however, at times it can be difficult to control and become very debilitating. We discuss the case of a woman with CSU that was unresponsive to H1-antihistamines who was treated with omalizumab and became pregnant during omalizumab treatment. We also considered the follow-up of the mother and newborn for 4 years after delivery. Our case report confirms that omalizumab is a safe and effective therapeutic option, after careful evaluations in terms of cost-effectiveness, in pregnant and lactating women with severe chronic urticaria. Assessment throughout follow-up confirmed a regular progression of pregnancy parameters and no adverse reaction was documented in the child from birth to 4 years of age.
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Affiliation(s)
- Laura Michelina Losappio
- Unit of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milan, Italy
| | - Corrado Mirone
- Unit of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milan, Italy
| | - Jan Walter Schroeder
- Unit of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milan, Italy
| | - Joseph Scibilia
- Unit of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milan, Italy
| | - Luca Balossi
- Unit of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milan, Italy
| | - Elide Anna Pastorello
- Unit of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milan, Italy
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Scibilia J, Rossi Carlo M, Losappio Laura M, Mirone C, Farioli L, Pravettoni V, Pastorello EA. Favorable Prognosis of Wheat Allergy in Adults. J Investig Allergol Clin Immunol 2019; 29:118-123. [PMID: 31017108 DOI: 10.18176/jiaci.0296] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Wheat ingestion can lead to disorders such as IgE-mediated food allergy and wheat-dependent exercise-induced anaphylaxis (WDEIA), both of which are associated with impaired quality of life and significant morbidity. Allergy to wheat is relatively benign in children, although its natural history in adults is still unknown. Objective: We used placebo-controlled challenge to evaluate the natural history of wheat hypersensitivity in atopic patients with adultonset wheat allergy. METHODS We enrolled 13 patients from an initial cohort of adult patients with IgE-mediated wheat allergy (mean age, 40 years). After diagnosis, the patients observed a wheat-free diet and were followed as outpatients for 5 years to evaluate wheat exposure. Wheat-IgEtiters were determined at the end of follow-up, and a second wheat-challenge was performed. RESULTS Ten out of 13 patients took part in the study. The mean period of wheat avoidance was 4.2 years. Three patients had spontaneously reintroduced wheat before the second evaluation, after a mean (IQR) of 28 (18-36) months, with only mild gastrointestinal discomfort at reintroduction. At the end of follow-up, 9 of the 10 patients were wheat-tolerant. Two patients had a history of WDEIA. We observed a reduction in IgE levels, with median (IQR) IgE falling from 2.77 (0.35-100) kU/L at diagnosis to 0.88 (0.1-20.8) kU/L. The association between IgE and a negative challenge result was not statistically significant. CONCLUSION IgE-mediated wheat allergy in adults is benign and represents a temporary break in gastrointestinal tolerance. Future studies may improve our knowledge of wheat allergens, routes of and factors leading to sensitization, and prognostic biomarkers.
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Affiliation(s)
- J Scibilia
- Unit of Allergology and Immunology, Dipartimento Medico Polispecialistico, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - M Rossi Carlo
- Unit of Allergology and Immunology, Dipartimento Medico Polispecialistico, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - M Losappio Laura
- Unit of Allergology and Immunology, Dipartimento Medico Polispecialistico, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - C Mirone
- Unit of Allergology and Immunology, Dipartimento Medico Polispecialistico, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - L Farioli
- Department of Laboratory Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - V Pravettoni
- Clinical Allergy and Immunology Unit, Foundation IRCCS Ca´ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - E A Pastorello
- Unit of Allergology and Immunology, Dipartimento Medico Polispecialistico, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Schroeder JW, Folci M, Losappio LM, Chevallard M, Sinico RA, Mirone C, De Luca F, Nichelatti M, Pastorello EA. Anti-Neutrophil Cytoplasmic Antibodies Positivity and Anti-Leukotrienes in Eosinophilic Granulomatosis with Polyangiitis: A Retrospective Monocentric Study on 134 Italian Patients. Int Arch Allergy Immunol 2019; 180:64-71. [PMID: 31189169 DOI: 10.1159/000500544] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/24/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis associated with asthma, anti-neutrophil cytoplasmic antibodies (ANCA) positivity, and tissue eosinophilia. OBJECTIVE To describe the presenting clinical features, significant biochemical alterations, and also potential pathogenic factors in adult patients diagnosed in our Center over a period of >20 years. METHOD A retrospective study of EGPA patients diagnosed from 1994 to 2019 at ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milan (Italy), which was performed according to the 1990 American College of Rheumatology criteria and Chapel Hill Consensus Conference definition. A dataset was compiled, registering demographic and clinical features, biochemical analysis at onset, and also the therapies received 3 months prior to EGPA diagnose. Statistical analyses were subsequently conducted dividing patients in 2 groups based on ANCA positivity and comparing them. RESULTS Two groups were clearly identified by ANCA serology and specific organ involvement in accordance with literature reports; however, our data underline for the first time the association between anti-leukotriene receptor antagonists (LTRAs) and ANCA positivity. The group of previously treated patients presents an OR of 6.42 to be ANCA positive. This finding could be attributed to an imbalanced stimulation of leukotriene receptors, inducing both mast cells activation and an increased neutrophil extracellular traps release from neutrophils. CONCLUSION Despite the limitations of this retrospective study, the association between LTRAs and ANCA antibodies elucidates the mechanism by which innate immunity is directly involved in tolerance breakdown and autoantibodies production. Validation of our results with targeted studies could clarify the differences between ANCA-positive and ANCA-negative patients with important consequences on the use of some drug classes in the treatment of EGPA and asthmatic subjects.
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Affiliation(s)
- Jan Walter Schroeder
- Unit of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milan, Italy
| | - Marco Folci
- Department of Internal Medicine, Division of Clinical Immunology, Humanitas Research Hospital, Rozzano, Italy
| | - Laura Michelina Losappio
- Unit of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milan, Italy
| | - Michel Chevallard
- Unit of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milan, Italy.,DISCCO, University of Study of Milan, Milan, Italy
| | - Renato Alberto Sinico
- Department of Medicine and Surgery, Nephrology Unit, University of Milano-Bicocca, Monza, Italy
| | - Corrado Mirone
- Unit of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milan, Italy
| | - Fabrizio De Luca
- Unit of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milan, Italy
| | - Michele Nichelatti
- Service of Biostatistics, ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milan, Italy
| | - Elide Anna Pastorello
- Unit of Allergology and Immunology, ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milan, Italy, .,DISCCO, University of Study of Milan, Milan, Italy,
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Losappio LM, Mirone C, Chevallard M, Farioli L, De Luca F, Pastorello EA. Tryptase as a marker of severity of aortic valve stenosis. Clin Mol Allergy 2018; 16:17. [PMID: 30093839 PMCID: PMC6080360 DOI: 10.1186/s12948-018-0095-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 07/27/2018] [Indexed: 12/02/2022] Open
Abstract
Background Severe aortic valve stenosis is one of the most common cause of mortality in adult patients affected with metabolic syndrome, a condition associated with an active inflammatory process involving also mast cells and their mediators, in particular tryptase. The aim of this study was to characterize the possible long-term prognostic role of tryptase in severe aortic valve stenosis. Case presentation The baseline serum tryptase was measured in 5 consecutive patients admitted to our Hospital to undergo aortic valve replacement for severe acquired stenosis. Within 2 years after, the patients were evaluated for the occurrence of major cardiovascular events (MACE). The tryptase measurements were higher in patients experiencing MACE (10.9, 11.7 and 9.32 ng/ml) than in non-MACE ones (5.69 and 5.58 ng/ml). Conclusions In patients affected with severe aortic stenosis, baseline serum tryptase may predict occurence of MACE. Further studies are needed to demonstrate the long-term prognostic role of this biomarker.
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Affiliation(s)
- Laura M Losappio
- The Department of Allergology and Immunology, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Corrado Mirone
- The Department of Allergology and Immunology, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michel Chevallard
- The Department of Allergology and Immunology, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Farioli
- The Department of Laboratory Medicine, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabrizio De Luca
- The Department of Allergology and Immunology, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elide A Pastorello
- The Department of Allergology and Immunology, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy.,3Unit of Allergy and Immunology, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore, 3, 20162 Milan, Italy
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Farioli L, Losappio LM, Giuffrida MG, Pravettoni V, Micarelli G, Nichelatti M, Scibilia J, Mirone C, Cavallarin L, Lamberti C, Balossi LG, Pastorello EA. Mite-Induced Asthma and IgE Levels to Shrimp, Mite, Tropomyosin, Arginine Kinase, and Der p 10 Are the Most Relevant Risk Factors for Challenge-Proven Shrimp Allergy. Int Arch Allergy Immunol 2017; 174:133-143. [PMID: 29169170 DOI: 10.1159/000481985] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 10/05/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Shrimp sensitization is common in the general population, but the presence of symptoms is only moderately related to sensitization. A point still at issue is which in vivo and/or in vitro tests (food challenge, component-resolved diagnosis, house dust mite [HDM] sensitization) can help in distinguishing shrimp-allergic subjects from subjects that are sensitized but tolerant. METHODS The aim of this study was to evaluate the role of IgE to the different shrimp and mite allergens in distinguishing shrimp challenge-positive from challenge-negative patients. Subjects with suspected hypersensitivity reactions to shrimp, positive skin prick tests (SPTs), and/or anti-shrimp IgE were submitted to open and double-blind placebo-controlled food challenges (DBPCFC). Specific IgE to shrimp, mites, and the recombinants rPen a 1, rDer p 1, 2, and 10 were tested using ImmunoCAP-FEIA. IgE immunoblotting was performed to identify the patients' allergenic profiles. RESULTS In total, 13 out of 51 (25.5%) patients with reported reactions to shrimp were truly shrimp allergic (7 DBPCFC positive and 6 with documented severe reactions). These patients had significantly higher skin test wheal diameters than nonallergic patients, as well as higher levels of IgE to rPen a 1 and rDer p 10. HDM-induced asthma and the simultaneous presence of anti-nDer p 1, 2, and 10 IgE levels increased the risk of true shrimp allergy. CONCLUSION Food challenge tests are mandatory for the diagnosis of shrimp allergy. Tropomyosin is associated with clinical reactivity. HDM-induced asthma and anti-mite IgE are risk factors for shrimp allergy.
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Affiliation(s)
- Laura Farioli
- Department of Laboratory Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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De Luca F, Losappio LM, Mirone C, Schroeder JW, Citterio A, Aversano MG, Scibilia J, Pastorello EA. Tolerated drugs in subjects with severe cutaneous adverse reactions (SCARs) induced by anticonvulsants and review of the literature. Clin Mol Allergy 2017; 15:16. [PMID: 29026345 PMCID: PMC5627447 DOI: 10.1186/s12948-017-0072-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 09/04/2017] [Indexed: 12/16/2022] Open
Abstract
Background Anticonvulsant hypersensitivity syndrome represents a rare but potentially fatal kind of adverse drug reaction. This clinical picture often hampers the flexibility with which alternative anticonvulsants or even other classes of drugs are prescribed in these patients, negatively affecting the efficacy of treatment and the course of the disease. The aim of this study was to analyse a group of six patients with severe cutaneous drug reactions induced by anticonvulsants and to report which alternative antiepileptic drugs and which drugs of other classes were tolerated. Case presentation A total of six patients (2 males and 4 females, age 11–73 years) are described in this study. In all the patients the onset of the severe cutaneous drug reactions was 2–4 weeks after initiating the anticonvulsant therapy: 2 out of 6 patients presented with a drug reaction with eosinophilia and systemic symptoms under therapy with phenytoin; 2 out of 6 presented with Stevens–Johnson syndrome under therapy with lamotrigine; and 2 out of 6 presented with a toxic epidermal necrolysis, one of them under therapy with valproic acid, and the other one under therapy with lamotrigine. Alternative anticonvulsants tolerated after the reaction were: clonazepam, levetiracetam, diazepam, delorazepam and lormetazepam. Conclusions In our cases we observed that non aromatic anticonvulsants and benzodiazepines were well tolerated as alternative treatments in six patients with reactions to aromatic anticonvulsivants and that the risk of hypersensitivity reactions to other drug classes was not increased as compared to general population.
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Affiliation(s)
- Fabrizio De Luca
- Department of Allergology and Immunology, Ospedale Metropolitano Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20162 Milan, Italy
| | - Laura Michelina Losappio
- Department of Allergology and Immunology, Ospedale Metropolitano Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20162 Milan, Italy
| | - Corrado Mirone
- Department of Allergology and Immunology, Ospedale Metropolitano Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20162 Milan, Italy
| | - Jan Walter Schroeder
- Department of Allergology and Immunology, Ospedale Metropolitano Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20162 Milan, Italy
| | - Antonella Citterio
- Department of Burn/Intensive Care, Ospedale Metropolitano Niguarda Ca' Granda, Milan, Italy
| | - Maria Gloria Aversano
- Department of Allergology and Immunology, Ospedale Metropolitano Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20162 Milan, Italy
| | - Joseph Scibilia
- Department of Allergology and Immunology, Ospedale Metropolitano Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20162 Milan, Italy
| | - Elide Anna Pastorello
- Department of Allergology and Immunology, Ospedale Metropolitano Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20162 Milan, Italy
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Mirone C, Preziosi D, Mascheri A, Micarelli G, Farioli L, Balossi LG, Scibilia J, Schroeder J, Losappio LM, Aversano MG, Stafylaraki C, Nichelatti M, Pastorello EA. Identification of risk factors of severe hypersensitivity reactions in general anaesthesia. Clin Mol Allergy 2015; 13:11. [PMID: 26101469 PMCID: PMC4476085 DOI: 10.1186/s12948-015-0017-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 04/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypersensitivity reactions to anaesthetic agents are rare but often severe, with a mortality ranging from 4 to 9% in IgE-mediated events. Identification of the risk factors may contribute to limit the incidence of these reactions. The aim of our study was to search for possible risk factors of severe perioperative hypersensitivity reactions in our study population. METHODS For this study we retrospectively reviewed data from 193 patients who experienced drug hypersensitivity reactions during general anaesthesia. The diagnostic protocol consisted of 1) history of the reaction, 2) measurement of serum baseline tryptase and specific IgE-assays for latex, beta-lactams and succinylcholine, 3) skin tests for the agents listed in the anaesthesia chart and for others likely to be safe for future use, latex, and others medications administered during the perioperative period (i.e. antibiotics), 4) subdivision of our patients on the basis of two criteria: a) grade of severity of clinical reactions according to the Ring and Messmer classification; b) results of skin tests and/or serum specific IgE-assays. RESULTS One hundred of 193 patients had reactions of grade I, 32/193 patients had reactions of grade II, 55/193 patients had reactions of grade III and 6/193 patients had reactions of grade IV. A diagnosis of IgE-mediated reaction was established in 55 cases (28.50%); the most common causes were neuromuscular blocking agents, followed by latex and beta-lactams. Severe reactions were associated with older age (p = 0.025), asthma (p = 0.042), history of hypertension (p = 0.001), intake of serum angiotensin converting enzyme inhibitor medication (p = 0.012) or serum angiotensin II antagonist (p = 0.033), higher levels of basal tryptase (p = 0.0211). Cardiovascular symptoms (p = 0.006) and history of hypersensitivity to antibiotics (p = 0.029) were more frequently reported in IgE-mediated reactions. CONCLUSIONS We confirmed the relevance of several clinical features as risk factors for anaphylactic reactions induced by anaesthetic agents: older age, asthma, hypertension and antihypertensive drugs. We observed increased levels of serum basal tryptase in severe reactions: this finding may signify that this biomarker is useful for the identification of patients at risk.
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Affiliation(s)
- Corrado Mirone
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Donatella Preziosi
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Ambra Mascheri
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | | | - Laura Farioli
- Department of Laboratory Medicine Niguarda Ca' Granda Hospital, Milan, Italy
| | - Luca G Balossi
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Joseph Scibilia
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Jan Schroeder
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Laura M Losappio
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Maria G Aversano
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Chrysi Stafylaraki
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | | | - Elide A Pastorello
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital and Department of Clinical Science and Community Health Università degli Studi of Milan, Milan, 20162 Italy
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Pastorello EA, Stafylaraki C, Mirone C, Preziosi D, Aversano MG, Mascheri A, Losappio LM, Ortolani V, Nichelatti M, Farioli L. Anti-Amoxicillin Immunoglobulin E, Histamine-2 Receptor Antagonist Therapy and Mast Cell Activation Syndrome Are Risk Factors for Amoxicillin Anaphylaxis. Int Arch Allergy Immunol 2015; 166:280-6. [PMID: 25968421 DOI: 10.1159/000380950] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 02/16/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND β-Lactam antibiotics (mainly amoxicillin, AX) are the drugs that most frequently induce systemic drug allergy reactions. OBJECTIVE We attempted to identify the risk factors associated with systemic reactions to AX. METHODS All patients who were referred to our department for suspected hypersensitivity reactions to AX over a 6-month period were evaluated for anti-AX immunoglobulin E (IgE) levels and skin-test positivity for β-lactams. Age, sex, concomitant diseases, therapies, total IgE, serum tryptase levels and signs and symptoms suggesting mast cell activation syndrome (MCAS) were analyzed in relation to the severity of the reaction in accordance with the Mueller classification. RESULTS Sixty-seven patients were selected: 39 with mild reactions such as cutaneous or gastrointestinal symptoms (grades I and II) and 28 with severe systemic reactions (grades III and IV). Anti-AX IgE levels and total IgE were significantly higher in severe reactions than in mild ones (p < 0.00005, p = 0.0037). Treatment with histamine-2 receptor antagonists (anti-H2) was significantly related to severe reactions (p = 0.007). No significant correlations were found between the severity of the reactions and dyslipidemia or levels of angiotensin-converting enzyme and tryptase. CONCLUSION Anti-AX IgE levels were the most significant immunological parameter distinguishing patients who presented with severe reactions to AX and those with mild reactions. Higher values of total IgE, the use of gastroprotective drugs and signs and symptoms suggesting an MCAS significantly increased the odds ratio of having a severe reaction. The risk of serious adverse reactions to AX increased in older patients and in males, but this trend was not significant.
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Mascheri A, Farioli L, Pravettoni V, Piantanida M, Stafylaraki C, Scibilia J, Mirone C, Preziosi D, Nichelatti M, Pastorello EA. Hypersensitivity to Tomato (Lycopersicon esculentum) in Peach-Allergic Patients: rPrup 3 and rPrup 1 Are Predictive of Symptom Severity. J Investig Allergol Clin Immunol 2015; 25:183-189. [PMID: 26182684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
UNLABELLED Background: The role of allergens in the severity of tomato allergy symptoms has not yet been studied. OBJECTIVES To evaluate the relationship between severe allergic reactions to peach and tomato and between tomato allergy symptoms and the pattern of IgE positivity for rPru p 1, rPru p 3, rPru p 4, rBetv 1, rBetv 2, rBetv4, rPhl p 1, and rPhl p 12 in order to identify the role of recombinant allergens in the severity of reactions to tomato. METHODS We studied peach-allergic patients with clinical reactions to tomato by performing an open food challenge, skin prick test, and determination of serum specific IgE to tomato and to recombinant peach, birch, and grass allergens. Statistical analysis was carried out to evaluate the relationship between the severity of tomato symptoms and IgE positivity to the different allergens and to peach-induced symptoms. RESULTS We found a significant association between severe reactions to tomato and severe reactions to peach (P = .01 7) and levels of IgE to rPru p3 (P = .029) and between mild tomato allergy symptoms and levels of IgE to rPru p1 (P = .047), anti-rBetv 1 (P = .0414), anti-rBetv 2 (P = .0457), and Phleum pratense (P = .0022). CONCLUSION We observed a significant relationship between peach and symptoms of tomato allergy. IgE positivity for rPru p3 seems to be a surrogate biochemical marker for severe tomato allergy, whereas the presence of anti-rPru p 1 IgE may be an indicator of mild tomato allergy.
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Schroeder J, Aversano MG, Citterio A, Scibilia J, Gamba C, Mirone C, Preziosi D, Pastorello EA. New insights in Stevens Johnson syndrome/ toxic epidermal necrolysis syndrome. Clin Transl Allergy 2014. [PMCID: PMC4128295 DOI: 10.1186/2045-7022-4-s3-p92] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jan Schroeder
- Niguarda Ca' Granda HospitalAllergology and Immunology UnitItaly
| | | | | | - Joseph Scibilia
- Niguarda Ca' Granda HospitalAllergology and Immunology UnitItaly
| | - Chiara Gamba
- Papa Giovanni XXIII HospitalGISED Research CenterItaly
| | - Corrado Mirone
- Niguarda Ca' Granda HospitalAllergology and Immunology UnitItaly
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Pastorello EA, Farioli L, Stafylaraki C, Scibilia J, Mirone C, Pravettoni V, Ottolenghi AI, Conio S, Mascheri A, Losappio L, Capocchi A, Fontanini D, De Giacomo C. Wheat-dependent exercise-induced anaphylaxis caused by a lipid transfer protein and not by ω-5 gliadin. Ann Allergy Asthma Immunol 2014; 112:386-7.e1. [PMID: 24507829 DOI: 10.1016/j.anai.2014.01.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/10/2014] [Accepted: 01/13/2014] [Indexed: 01/04/2023]
Affiliation(s)
- Elide Anna Pastorello
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy; Department of Clinical Sciences and Community Health, Pisa, Italy, Universitá degli Studi of Milan, Milan, Italy
| | - Laura Farioli
- Department of Laboratory Medicine, Niguarda Ca' Granda Hospital
| | - Chrysi Stafylaraki
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Joseph Scibilia
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Corrado Mirone
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Valerio Pravettoni
- Clinical Allergy and Immunology Unit, Foundation IRCCS Cá Granda Ospedale Maggiore Policlinico
| | | | | | - Ambra Mascheri
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Laura Losappio
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
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Pastorello EA, Scibilia J, Farioli L, Primavesi L, Giuffrida MG, Mascheri A, Piantanida M, Mirone C, Stafylaraki C, Violetta MR, Nichelatti M, Preziosi D, Losappio L, Pravettoni V. Rice Allergy Demonstrated by Double-Blind Placebo-Controlled Food Challenge in Peach-Allergic Patients Is Related to Lipid Transfer Protein Reactivity. Int Arch Allergy Immunol 2013; 161:265-73. [DOI: 10.1159/000345974] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 11/19/2012] [Indexed: 11/19/2022] Open
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Mascheri A, Scibilia J, Farioli L, Stafylaraki C, Pravettoni V, Piantanida M, Primavesi L, Mirone C, Nichelatti M, Marocchi A, Pastorello EA. Severe allergic symptoms to peach are a risk factor for severe symptoms to other plant food allergens. Clin Transl Allergy 2011. [PMCID: PMC3354212 DOI: 10.1186/2045-7022-1-s1-p79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mirone C, Albert F, Tosi A, Mocchetti F, Mosca S, Giorgino M, Pecora S, Parmiani S, Ortolani C. Efficacy and safety of subcutaneous immunotherapy with a biologically standardized extract of Ambrosia artemisiifolia pollen: a double-blind, placebo-controlled study. Clin Exp Allergy 2005; 34:1408-14. [PMID: 15347374 DOI: 10.1111/j.1365-2222.2004.02056.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The allergological relevance of Ambrosia in Europe is growing but the efficacy of the injective immunotherapy for this allergen has been documented only in Northern America. OBJECTIVE We sought to study the safety and efficacy of injective immunotherapy in European patients sensitized to Ambrosia artemisiifolia. METHODS Thirty-two patients (18 M/14 F, mean age 36.78, range 23-60 years) suffering from rhinoconjunctivitis and/or asthma and sensitized to Ambrosia were enrolled and randomized in a double-blind, placebo-controlled (DBPC) study lasting 1 year. A maintenance dose corresponding to 7.2 microg of Amb a 1 was administered at 4-week intervals after the build-up. During the second and the third year, all patients were under active therapy in an open fashion. Symptom and medication scores, skin reactivity to Ambrosia (parallel line biological assay), and pollen counts were assessed throughout the trial. RESULTS Twenty-three patients completed the trial. No severe adverse event was observed. During the DBPC phase, actively treated patients showed an improvement in asthmatic symptoms (P=0.02) and drug (P=0.0068) scores days with asthmatic symptoms (P=0.003), days with rhinitis symptoms (P=0.05), and days with intake of drugs (P=0.0058), as compared to before therapy. No improvement for any of these parameters was detected in the placebo group. Moreover, the number of days with rhinitis and asthma was significantly higher in the placebo as compared to the active group (P=0.048 and P<0.0001, respectively). Patients who switched from placebo to active therapy improved in rhinoconjunctivitis, asthma, and drug intake. The skin reactivity decreased significantly (12.2-fold, P=0.0001) in the active group whereas a slight increase (1.07-fold, P=0.87) was observed in the placebo group after the DBPC phase. After switching to active therapy, patients previously under placebo showed a significant decrease of this parameter (4.78-fold, P=0.002). CONCLUSION Injective immunotherapy is safe and clinically effective in European patients sensitized to Ambrosia.
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Affiliation(s)
- C Mirone
- Dipartimento Multizonale di Allergologia ed Immunologia Clinica, Niguarda Cà Granda Hospital, Milan, Italy
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Ortolani C, Foresi A, Di Lorenzo G, Bagnato G, Bonifazi F, Crimi N, Emmi L, Prandini M, Senna GE, Tursi A, Mirone C, Leone C, Fina P, Testi R. A double-blind, placebo-controlled comparison of treatment with fluticasone propionate and levocabastine in patients with seasonal allergic rhinitis. FLNCO2 Italian Study Group. Allergy 1999; 54:1173-80. [PMID: 10604553 DOI: 10.1034/j.1398-9995.1999.00200.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Fluticasone propionate aqueous nasal spray (FPANS) is a topically active glucocorticoid which has been successfully used for the treatment of seasonal allergic rhinitis (SAR). Topical levocabastine is a highly selective H1 antagonist which has been proposed as an alternative treatment of SAR. The purpose of this study was to compare the clinical efficacy of two topical nasal treatments, FPANS and levocabastine, in the treatment of SAR. Additionally, the effect of treatments on nasal inflammation was examined during natural pollen exposure. A group of 288 adolescent and adult patients with at least a 2-year history of SAR to seasonal pollens participated in a multicenter, doubleblind, double-dummy, and placebo-controlled study. Patients were treated with either FPANS 200 microg, once daily (n = 97), or topical levocabastine, 200 microg, given twice daily (n = 96), or matched placebo (n = 95) for a period of 6 weeks, starting from the expected beginning of the pollen season. Clinically relevant pollens included Parietaria, olive, and grass. Assessment of efficacy was based on scores of daily nasal symptoms and on nasal cytology of nasal lavage. Nasal lavage was performed immediately before, during, and at the end of treatment in 39 patients. FPANS significantly increased the percentage of symptom-free days for nasal obstruction on waking and during the day, rhinorrhea, sneezing, and itching. FPANS provided a better control for night and day nasal obstruction (P<0.02 and P<0.01) and rhinorrhea (P<0.01) than levocabas tine. In addition, fewer patients treated with FPANS used rescue medication (P<0.025). The percentage of eosinophils in nasal lavage was reduced only during treatment with FPANS. The results of this study indicate that FPANS 200 microg, once daily, provides a better clinical effect than levocabastine 200 microg, twice daily, in patients with SAR. Unlike levocabastine, FPANS significantly attenuates nasal eosinophilia during pollen exposure, a feature which may explain its therapeutic efficacy.
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Affiliation(s)
- C Ortolani
- Divisione Bizzozzero di Medicina Interna, Ospedale Niguarda Milano, Italy
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Mirone C, Fontana A, Mosca S, Bosetti M, Sala A, Scibilia J, Ortolani C. Effects of nedocromil sodium on bronchospasm and HS-NCA release induced by allergen inhalation in asthmatic patients. Clin Exp Allergy 1994; 24:281-7. [PMID: 8012860 DOI: 10.1111/j.1365-2222.1994.tb00232.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The aim of this study was to assess the ability of nedocromil sodium (NS) to prevent the immediate asthmatic reaction and the increase in the serum level of heat stable neutrophil chemotactic activity (HS-NCA) induced by antigen inhalation. In a double-blind, cross-over study, 13 atopic subjects affected with seasonal asthma underwent a bronchial provocation test with a preselected dose of grass pollen allergen (enough to cause a decrease of > or = 20% in FEV1:FEV1 PD20) after pre-treatment with 4 mg NS or placebo. Serum samples were withdrawn from 11 subjects for HS-NCA determination. After NS administration the decrease in FEV1 was significantly less than after placebo administration at all time points after challenge (2 min P = 0.0004; 7 min, P = 0.0005; 17 min P = 0.0002 and 27 min P = 0.0005). The percentage increase in HS-NCA was significantly higher after placebo than after NS inhalation, both 10 (P = 0.0048) and 20 (P = 0.0068) min after challenge. Our study confirms previous investigations, showing that NS inhibits the immediate asthmatic response to allergen inhalation in atopic, asthmatic subjects and moreover it shows that this drug prevents in vivo the increase of the serum HS-NCA. This last finding has not been previously reported.
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Affiliation(s)
- C Mirone
- Bizzozero Department Niguarda Cà Granda Hospital, Milan, Italy
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Ortolani C, Pastorello E, Fontana A, Gerosa S, Ispano M, Pravettoni V, Rotondo F, Mirone C, Zanussi C. Chemicals and drugs as triggers of food-associated disorder. Ann Allergy 1988; 60:358-66. [PMID: 3358540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- C Ortolani
- Bizzozero Department of Medicine, Niguarda Cà Granda Hospital, Milan, Italy
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Ortolani C, Mirone C, Fontana A, Folco GC, Miadonna A, Montalbetti N, Rinaldi M, Sala A, Tedeschi A, Valente D. Study of mediators of anaphylaxis in nasal wash fluids after aspirin and sodium metabisulfite nasal provocation in intolerant rhinitic patients. Ann Allergy 1987; 59:106-12. [PMID: 3688566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Nasal histamine (H), leukotriene C4 (I-LTC4) and SRS-A activity were studied in seven aspirin-(ASA)-intolerant patients (AIR) with rhinitis and in five ASA-tolerant control patients with chronic rhinitis after nasal provocation (NP) with a lysine acetylsalicylate solution. The same parameters were also studied after metabisulfite (MBS) NP in four sulfite-intolerant patients with rhinitis and in six control patients with chronic rhinitis. In six ASA-intolerant subjects and in four controls, we studied the PGD2 levels in nasal washes after ASA NP 0.2 mL of lysine acetylsalicylate solution (10 mg/mL) was sprayed intranasally in ASA-intolerant patients and controls and a 25-mg/mL MBS solution in sulfite intolerant patients and controls. Nasal wash fluids were obtained using 5 mL of 0.15 M saline before and 7 1/2, 15, 30, and 60 minutes after nasal provocation. The nasal provocation with ASA induced itching and sneezing in four out of seven intolerant subjects. In this subgroup histamine values in nasal wash fluids were significantly higher versus the remaining ASA-intolerant patients at 30 and 60 minutes (P less than .05 and P less than .01, respectively) and versus controls at 60 minutes (P less than .01). We found significantly higher I-LTC4 (P less than .01) and SRS-A levels in nasal washes collected from ASA-intolerant subjects versus controls at 60 minutes after nasal provocation. There was no significant increase in the mean PGD2 values in either the ASA-intolerant or control groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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