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Meglio P, Caminiti L, Pajno GB, Dello Iacono I, Tripodi S, Verga MC, Martelli A. The oral food desensitization in the Italian allergy centres. Eur Ann Allergy Clin Immunol 2015; 47:68-76. [PMID: 25951144] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Attempts aimed at inducing food tolerance through oral food desensitization (OFD) for the treatment of IgE-mediated food allergies are increasing. In Italy, a number of allergy centres offer this procedure. OBJECTIVE To collect information on how these centres are organized, how patients are selected, the methods used to administer OFD and how adverse reactions are managed. METHODS A questionnaire was e-mailed to all the Italian allergy centres offering OFD. RESULTS The survey shows a high degree of variability between centres. A correct diagnosis of food allergy is crucial for selecting patients for OFD. In the Italian allergy centres, oral food challenges are mostly open label (84%), but in 16% of cases they are single-blind (8%) or double-blind (8%). A high proportion of allergy centres (83%) offer OFD to children presenting forms of anaphylaxis triggered by traces--or very low doses--of food allergen. The majority of allergy centres (76%) enroll patients over 3 years of age, with 44% enrolling patients above the age of 5. Not-controlled asthma, unreliability of parents in the management of OFD and/or risk of adverse events, are the main reasons for exclusion from the procedure. CONCLUSION Although OFD may sometimes be successful and may be considered a valid alternative to an elimination diet, further randomized controlled trials are needed, in order to clarify some controversial points, such as the characteristics of the child undergoing OFD, and the methods of food preparation and administration. Moreover, further studies should further investigate OFD safety, efficacy and costs.
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Affiliation(s)
- P Meglio
- Primary Care Pediatrics, Rome, Italy. E-mail:
| | - L Caminiti
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - G B Pajno
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - I Dello Iacono
- Pediatric Department, Fatebenefratelli Hospital, Benevento, Italy
| | - S Tripodi
- Pediatric Department and Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy
| | - M C Verga
- Primary Care Pediatrics, Salerno, Italy
| | - A Martelli
- Pediatric Department, Garbagnate Santa Corona Hospital, Milan, Italy
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Galli E, Rocchi L, Carello R, Giampietro PG, Panei P, Meglio P. Serum Vitamin D levels and Vitamin D supplementation do not correlate with the severity of chronic eczema in children. Eur Ann Allergy Clin Immunol 2015; 47:41-47. [PMID: 25781193] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Eczema is one of the most common chronic inflammatory skin diseases, affecting about 20% of children. The pathogenic mechanisms of eczema are still not fully understood, and current treatment of moderate-severe eczema is often difficult. Recently, it has been suggested that Vitamin D plays a key role in this disease, even if mechanisms are only partially known. OBJECTIVE The purpose of our study was to assess the 25-Hydroxyvitamin D serum levels in a pediatric population suffering from chronic eczema (IgE-mediated and non-IgE-mediated), and to correlate these phenotypes with the SCORAD severity and selected clinical and biological parameters. Moreover, we aimed to evaluate whether a supplementation of Vitamin D3 could affect the same clinical and laboratory parameters. METHODS 89 children with chronic eczema were enrolled in the study. Severity of eczema was assessed with the SCORAD index. Past and present history was taken, and patients were divided into two groups according to the state of sensitization. According to a randomization schedule, the enrolled children were assigned to the following groups: supplementation group, which received a daily oral Vitamin D3 supplementation (2000 IUs) for 3 months; control group which received no supplementation. RESULTS Vitamin D concentrations in patients with moderate and severe eczema were not statistically different from Vitamin D concentration detected in the serum of patients with mild eczema. Furthermore, we did not find any correlation between Vitamin D levels, total IgEs and SCORAD index, both in the Sensitized and in the Not-Sensitized group. The Vitamin D3 supplementation did not influence the SCORAD severity or the total IgEs concentration. CONCLUSION To our knowledge, our study is the first one that shows no correlation between serum levels of Vitamin D, eczema severity and IgE sensitization in a pediatric population suffering from chronic eczema.
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Affiliation(s)
- E Galli
- Department of Pediatric Allergy, Research Centre, San Pietro Hospital - Fatebenefratelli, Via Cassia 600, Rome, Italy. Phone: +39 06 335 822 80 Fax: +39 06 332 512 78 E-mail:
| | - L Rocchi
- Department of Pediatric Allergy, Research Centre, San Pietro Hospital - Fatebenefratelli, Rome, Italy
| | - R Carello
- Department of Pediatric Allergy, Research Centre, San Pietro Hospital - Fatebenefratelli, Rome, Italy
| | - P G Giampietro
- Department of Pediatric Allergy, Research Centre, San Pietro Hospital - Fatebenefratelli, Rome, Italy
| | - P Panei
- Dipartimento del Farmaco e Terapie Sperimentali, Istituto Superiore di Sanità, Rome, Italy
| | - P Meglio
- Department of Pediatric Allergy, Research Centre, San Pietro Hospital - Fatebenefratelli, Rome, Italy
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Giannetti A, Meglio P, Ricci G. Skin prick test: the only predictive tool of anaphylaxis? A case report. Eur Ann Allergy Clin Immunol 2014; 46:49-52. [PMID: 24702877] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Currently, in the literature there is a lack of definite predictive values parameters to identify patients with the risk to develop anaphylaxis. The controlled oral food challenge remains the gold standard for food allergy diagnosis. We report a case of a girl allergic to cow's milk with low levels of specific IgE and large skin prick test wheal sizes for cow's milk. In some cases the high diameter of skin prick test wheal may be more reliable than specific IgE levels in predicting an anaphylactic reaction.
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Affiliation(s)
- A Giannetti
- Pediatric Unit, Department of Gynecologic, Obstetric and Pediatric Sciences, University of Bologna, Bologna, Italy
| | - P Meglio
- Research Centre, Department of Pediatric Allergy, San Pietro Hospital - Fatebenefratelli, Rome, Italy
| | - G Ricci
- Pediatric Unit, Department of Gynecologic, Obstetric and Pediatric Sciences, University of Bologna, Bologna, Italy.
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Abstract
OBJECTIVES To desensitize children with severe immunoglobulin (Ig)E-mediated cow's milk allergy in a period of 6 months by introducing increasing daily doses of cow's milk (CM) in order to enable the child to assume 200 ml of CM daily, or to induce tolerance of the highest possible CM dose. STUDY DESIGN Twenty-one children at least 6 years old with severe IgE-mediated CM allergy were admitted to the study. A convincing history of IgE-mediated CM allergy or a positive double-blind placebo-controlled food challenge with CM confirmed the diagnosis. Oral desensitization was performed with increasing doses starting from 0.06 mg of CM proteins. RESULTS Overall, 15 of 21 children (71.4%) achieved the daily intake of 200 ml during a 6-month period; three of 21 children (14.3%) tolerated 40-80 ml/day of undiluted CM; three of 21 children (14.3%) failed the desensitization because they presented allergic symptoms after ingesting minimal amounts of diluted CM. CONCLUSIONS We successfully desensitized 15 of 21 children with severe IgE-mediated CM allergy in a period of 6 months. We stress the importance of the partial outcome in those three of 21 children who could not reach the maximum amount of 200 ml/day of whole CM, but were able to tolerate 40-80 ml/day of CM. In this way we dramatically reduced the risk of severe reactions after accidental or unnoticed introduction of low quantities of CM. We do not propose generalizing this method beyond trained staff.
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Affiliation(s)
- P Meglio
- Division of Allergy and Immunology, Department of Pediatrics, University of Rome La Sapienza, Italy
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Affiliation(s)
- P Meglio
- Department of Pediatrics, University of Tor Vergata, Via Ezio 19, 00192 Rome, Italy.
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Pascale E, Tarani L, Meglio P, Businco L, Battiloro E, Cimino-Reale G, Verna R, D'Ambrosio E. Absence of association between a variant of the mast cell chymase gene and atopic dermatitis in an Italian population. Hum Hered 2001; 51:177-9. [PMID: 11173969 DOI: 10.1159/000053339] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [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: 11/19/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic dermatitis which belongs to the group of atopy-related diseases together with asthma and rhinitis. IgE and mast cell chymase (MCC) play a key role in atopic or allergic inflammation of the skin. An association between AD and a genetic variant of the MCC has been reported in a Japanese population, but failure of confirmation has rendered this association questionable. We have tested for genetic association to an MCC variant in relation to AD in an Italian population. No significant association was found between AD and MCC genotypes. These data suggest that BstXI MCC polymorphism may not be involved in AD.
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Affiliation(s)
- E Pascale
- Dipartimento di Medicina Sperimentale, Università di L'Aquila, Roma, Italia
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Businco L, Marziali M, Furcolo G, Meglio P. [From atopic dermatitis to asthma]. Minerva Pediatr 1997; 49:477-81. [PMID: 9557493] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Atopic dermatitis (AD) is the most common chronic skin disorder in infancy and childhood and is the main hallmark of atopic constitution. The disease is multifactorial, and although genetic predisposition is certainly a prerequisite, a number of environmental factors modulate the phenotypic expression of AD. The majority of affected children shows IgE sensitisation towards a large variety of foods and aeroallergens. Since at least 1600, it has been recognized that patients with AD have a high predisposition to develop asthma. Recent epidemiological studies show that AD is commonly seen in individuals from families with a history of asthma. In addition, in population where asthma is uncommon, AD is also uncommon. The sex distribution of AD and asthma is the same, with boys affected significantly more often by these two atopic diseases and in similar proportions. The ETAC project (Early Treatment of the Atopic Child) is a large multicenter, multi-national, double blind, placebo controlled, randomised trial. The main objective of the study is to stop the progression from AD to asthma in young children with AD using early therapeutic intervention with Cetirizine and the second objective is to investigate the main risk factors for the onset of asthma. The results of this study indicate that exposure to potent allergens such as cat or mite significantly increased the risk of sensitisation to these allergens. Prolonged breast feeding was associated with a lowest sensitisation rate to cow milk proteins and to egg. Therefore environmental factors seem to play a crucial role in IgE sensitisation in children with AD.
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Affiliation(s)
- L Businco
- Cattedra di Clinica Pediatrica VI, Università degli Studi di Roma La Sapienza
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Meglio P, Milita O, Businco L. Patch test response to house dust mites is positive in children with atopic dermatitis and in their parents. J Investig Allergol Clin Immunol 1996; 6:190-5. [PMID: 8807510] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We studied the patch test response to Dermatophagoides pteronyssinus in 79 atopic children and in their parents. The atopic children were divided into 3 groups: 1) children with atopic dermatitis (group 1); 2) children who had suffered from atopic dermatitis but the disease was cured (group 2); and 3) atopic children with asthma and without atopic dermatitis (group 3). Our data show that a significantly higher proportion of children with atopic dermatitis (groups 1 and 2) have positive patch tests to Dermatophagoides pteronyssinus in comparison to atopic children without atopic dermatitis (group 3) and the controls (p < 0.001). In addition, we have shown that a positive patch test to Dermatophagoides pteronyssinus is significantly more common in parents of children with atopic dermatitis with respect to parents of children with asthma or parents of control children.
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Affiliation(s)
- P Meglio
- Department of Pediatrics, University of Rome La Sapienza, Italy
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Businco L, Meglio P, Amato G, Balsamo V, Cainelli T, Cantone P, Castro M, Coletta A, Corrias A, Giorgi PL, Grazioli I, Longo-Papadia L, Marcucci F, Masi M, Pavesio D, Scotta S, Seidenari S, Vierucci A. Evaluation of the efficacy of oral cromolyn sodium or an oligoantigenic diet in children with atopic dermatitis: a multicenter study of 1085 patients. J Investig Allergol Clin Immunol 1996; 6:103-9. [PMID: 8727267] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
One thousand eighty-five children with atopic dermatitis were enrolled in a multicenter study to evaluate the efficacy of 4 weeks of oral sodium cromoglycate or 4 weeks of a restricted diet. One thousand-eleven children (93%) concluded the study. At the end of the trial there was a significant improvement in skin lesions in the two groups: 61% of the patients in the sodium cromoglycate group and 69% in the restricted diet showed a significant improvement in atopic dermatitis. We concluded that, at least in our experimental design, both sodium cromoglycate and a restricted diet are equally effective in atopic dermatitis.
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Affiliation(s)
- L Businco
- Ped. Dpt., La Sapienza University of Rome, Italy
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Affiliation(s)
- L Businco
- Department of Pediatrics, University of Rome, La Sapienza, Italy
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Cantani A, Paganelli R, Meglio P, Ferrara M, Fameles-Belasio E, Businco L. Effect of flunisolide on nasal eosinophils and IgE, and symptom score in children with allergic rhinitis. J Investig Allergol Clin Immunol 1992; 2:181-6. [PMID: 1342898] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We evaluated the effect of treatment with flunisolide nasal spray (100 micrograms/day for 3 months) in 24 children with allergic rhinitis on the following parameters: clinical symptoms, absolute number of peripheral and nasal eosinophils, and total IgE levels in nasal secretion. Therapy with flunisolide induced a significant reduction of clinical symptoms (p < 0.001), nasal eosinophils (p < 0.001) and nasal IgE concentration (p < 0.02), while it did not affect the number of peripheral eosinophils. These results indicate that flunisolide can reduce the allergic inflammation of the nasal mucosa.
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Affiliation(s)
- A Cantani
- Department of Pediatrics, University of Roma La Sapienza, Italy
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Paganelli R, Quinti I, di Sabatino A, d'Offizi GP, Scala E, Meglio P, Aiuti F. Topical flunisolide treatment of perennial rhinitis: clinical and immunological effects. Allergol Immunopathol (Madr) 1992; 20:124-6. [PMID: 1414859] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We studied the clinical and immunological effects of three months' treatment with intranasal flunisolide (100 micrograms daily) in 18 allergic patients with perennial rhinitis. 17 were hypersensitive to house dust mite and one to Parietaria pollen only. We found no significant changes in white blood cell count, serum levels of IgE and nasal IgA. However the treatment induced a marked improvement of clinical symptoms in all cases, and we observed a significant reduction of total IgE in nasal secretion. Flunisolide seems to exert this effect through its antiinflammatory action on the nasal mucosa.
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Affiliation(s)
- R Paganelli
- Department of Allergy & Clinical Immunology, University La Sapienza, Roma
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Paganelli R, Quinti I, di Sabatino A, d'Offizi GP, Scala E, Meglio P, Aiuti F. Topical flunisolide treatment of perennial rhinitis: clinical and immunological effects. Allergol Immunopathol (Madr) 1991; 19:194-6. [PMID: 1811415] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We studied the clinical and immunological effects of three months' treatment with intranasal flunisolide (100 micrograms daily) in 18 allergic patients with perennial rhinitis. 17 were hypersensitive to house dust mite and one to Parietaria pollen only. We found no significant changes in white blood cell count, serum levels of IgE and nasal IgA. However the treatment induced a marked improvement of clinical symptoms in all cases, and we observed a significant reduction of total IgE in nasal secretion. Flunisolide seems to exert this effect through its antiinflammatory action on the nasal mucosa.
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Affiliation(s)
- R Paganelli
- Department of Allergy & Clinical Immunology, University La Sapienza, Roma
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Paganelli R, Fanales-Belasio E, Carmini D, Scala E, Meglio P, Businco L, Aiuti F. Serum eosinophil cationic protein in patients with atopic dermatitis. Int Arch Allergy Appl Immunol 1991; 96:175-8. [PMID: 1769747 DOI: 10.1159/000235490] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disease of the skin, frequently associated with a family history of atopy, raised serum IgE levels and other immunological abnormalities. Both eosinophils and their basic proteins have been detected in the skin lesions of AD patients. We measured the levels of eosinophil cationic protein (ECP) in sera of 24 children with AD and found them to be increased, compared to nonatopic controls, both children and adults. High ECP values were also obtained in 3 patients with the hyper-IgE syndrome. However, no direct relationship between IgE and ECP serum levels could be established. We found no correlation between serum ECP and the number of circulating eosinophils, suggesting that part of ECP was produced by cells infiltrating the tissues. Measurement of ECP might represent a noninvasive tool to assess the activity of AD in relation to eosinophil involvement in this disease.
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Affiliation(s)
- R Paganelli
- Department of Allergy and Clinical Immunology, University La Sapienza, Rome, Italy
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Meglio P, Farinella F, Trogolo E, Giampietro PG, Cantani A, Businco L. Immediate reactions following challenge-tests in children with atopic dermatitis. Allerg Immunol (Paris) 1988; 20:57-62. [PMID: 3395430] [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: 01/05/2023]
Abstract
It has been shown that atopic dermatitis improves in children when certain foods are eliminated from the diet. Because of the unreliability of the history and the low sensibility of the total and specific IgE and skin tests, at present the elimination-provocation test is the most definitive means to establish which are the offending food(s). Although many authors claim that reactions following the challenge test in atopic dermatitis are only of the delayed type, others assert that immediate reactions are frequent and can sometimes threaten life. The pathogenesis of such reactions is not yet completely understood. However, it has been suggested that a direct IgE-mediated mechanism, inducing a release of anaphylactic mediators, could play some role. The aim of our study is to investigate the incidence of immediate reactions which can follow the food challenge in children with atopic dermatitis who have never experienced such reactions and, in addition, to investigate the reliability of total and specific IgE and skin tests in predicting immediate reactions after the challenge test. Our preliminary data indicate that immediate reactions following food challenge are frequent. Moreover they can be severe and cannot be predicted by the history, by the total and specific IgE levels and by the skin tests' results.
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Affiliation(s)
- P Meglio
- Department of Pediatrics, University La Sapienza, Rome, Italy
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Businco L, Cantani A, Meglio P, Bruno G. Prevention of atopy: results of a long-term (7 months to 8 years) follow-up. Ann Allergy 1987; 59:183-6. [PMID: 3688572] [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: 01/06/2023]
Affiliation(s)
- L Businco
- Department of Pediatrics, University of Roma La Sapienza, Italy
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