Allergic reactions to genus Morus plants: a review

Mulberry is a plant belonging to the family Moraceae, and genus Morus. Allergic sensitization to mulberries has been reported as both food allergy or respiratory allergy, and cross-reactivity between mulberries and other pollens or fruits was described. Clinically, in the articles reporting mulberry allergy, the reactions included respiratory allergy, airborne contact urticaria, anaphylaxis, oral allergy syndrome, and food induced urticaria. As far as cross-reactivity is concerned, the allergens identified thus far in mulberries include pathogenesis-related (PR)10 proteins, with sequence identity to Bet v 1 from birch, lipid transfer (LTP)1 proteins with identity with LTPs from Rosaceae family plants, panallergens groups, and also ubiquitin-like protein and cystatin-like protein. The two latter proteins account for cross-reactions with Parietaria judaica and Olea europaea. Such large cross-reactivity warrants to pay particular attention to the risk of systemic reactions to foods, particularly in subjects sensitized to birch, parietaria or olive pollens. In fact, the increasing use of mulberry as a food product, which is encouraged by its remarkable antioxidant power, expose sensitized patients to possible reactions after ingesting foods, dietary supplements or nutraceuticals containing mulberry. Mulberry allergenicity can vary according to the processing methods used since some allergens are thermostable and other loss their reactivity during heating.

IL-31 and IL-33 circulating levels in allergic contact dermatitis

Enhanced IL-31 expression in skin biopsies is present in allergic contact dermatitis (ACD). IL-33 expression is induced in keratinocytes and in skin of ACD patients. This overexpression is present in both allergic and irritant conditions. The aim of this work was to test the systemic involvement of IL-31 and IL-33 in ACD. IL-31 levels were significantly higher in patients than in controls. IL-33 serum levels, on the contrary, were similar in patients and controls. This work shows a possible systemic involvement of IL-31 and the absence of a systemic involvement of IL-33 in ACD. IL-31 levels do not seem related to the allergen involved, and did not change on the strength of the allergen involved. More likely, IL-31 levels are related to the itch. IL-33, instead, is secreted from damaged or inflamed tissue and might function as an early warning system at the site of skin damage. In the future, IL-31 could be a possible therapeutic target of all pruritic skin diseases resistant to conventional therapies.

Rosmarinus officinalis L. as cause of contact dermatitis

Because of the widespread use of botanicals, it has become crucial for health professionals to improve their knowledge about safety problems. Several herbal medicines contain chemicals with allergenic properties responsible for contact dermatitis. Among these, one is Rosmarinus officinalis L. (rosemary), a plant used since ancient times in folk medicine; at the present time it is used worldwide as a spice and flavouring agent, as a preservative and for medicinal and cosmetic purposes. The present article aims to revise and summarise scientific literature reporting cases of contact dermatitis caused by the use of R. officinalis as a raw material or as herbal preparations. Published case reports were researched on the following databases and search engines: PUBMED, MEDLINE, EMBASE, Google Scholar, Scopus. The used keywords were: R. officinalis and rosemary each alone or combined with the words allergy, contact dermatitis, allergic contact dermatitis, sensitisation and occupational dermatitis. The published case reports show that both rosemary extracts and raw material can be responsible for allergic contact dermatitis. Two cases related to contact dermatitis caused by cross-reactivity between rosemary and thyme were also commented. The diterpene carnosol, a chemical constituent of this plant, has been imputed as a common cause for this reaction. The incidence of contact dermatitis caused by rosemary is not common, but it could be more frequent with respect to the supposed occurrence. It seems plausible that cases of contact dermatitis caused by rosemary are more frequent with respect to the supposed occurrence, because they could be misdiagnosed. For this reason, this possibility should be carefully considered in dermatitis differential diagnosis.

Pityriasis rosea of Gibert: immunological aspects

More than 200 years after first description and 150 years after complete definition by Gibert, pityriasis rosea (PR) is still a clinical entity with many obscure aspects. Although great interest was focused on aetiology, studies on immunological mechanisms associated with this disease were rather discontinuous. We present a review of the literature on immunological features of PR, aimed to outline a unified picture of currently available knowledge in this field and create a useful starting point for future research.

Allergy and risk of hematologic malignancies: associations and mechanisms

Increasing evidence indicates that a dysregulated immune system, as the one found in allergic disorders, can affect survival of tumor cells. A possible association between allergies and risk of hematologic malignancies has been examined in several epidemiological studies; however, results were not always consistent. The aim of this review is to report the preclinical and clinical data, which support a correlation between allergy and hematologic neoplasms. Immune system modulation could represent a powerful tool in the prevention and treatment of hematologic malignancies.

Passiflora incarnata L.: ethnopharmacology, clinical application, safety and evaluation of clinical trials

ETHNOPHARMACOLOGICAL RELEVANCE

The genus Passiflora incarnata Linnaeus comprises approximately 520 species belonging to the Passifloraceae family. The majority of these species are vines found in Central or South America, with rare occurrence in North America, Southeast Asia and Australia. The genus Passiflora incarnata has long been used in traditional herbal medicine for the treatment of insomnia and anxiety in Europe, and it has been used as a sedative tea in North America. Furthermore, this plant has been used for analgesic, anti-spasmodic, anti-asthmatic, wormicidal and sedative purposes in Brazil; as a sedative and narcotic in Iraq; and for the treatment of disorders such as dysmenorrhoea, epilepsy, insomnia, neurosis and neuralgia in Turkey. In Poland, this plant has been used to treat hysteria and neurasthenia; in America, it has been used to treat diarrhoea, dysmenorrhoea, neuralgia, burns, haemorrhoids and insomnia. Passiflora incarnata L. has also been used to cure subjects affected by opiate dependence in India. This review aims to provide up-to-date information about the pharmacology, clinical efficacy and clinical safety of Passiflora incarnata L. based on the scientific literature. In particular, the methodological accuracy of clinical trials is analysed in accordance with current consolidated guidelines on reporting the clinical efficacy of herbal medicine, offering new insight into opportunities for future research and development.

METHODS

A bibliographic investigation was performed by examining the available data on Passiflora incarnata L. from globally accepted scientific databases and search engines (Pubmed, Scopus and Web of Science, SciFinder and Google Scholar). We selected studies, case reports, and reviews addressing the pharmacology and safety of Passiflora incarnata.

RESULTS

Although numerous Passiflora incarnata L. derivative products have been commercialised as alternative anxiolytic and sedative remedies based on their long tradition of use, their supposed efficacy does not appear to be adequately corroborated by the literature, with clinical studies often featuring inadequate methodologies and descriptions of the products under investigation. This medicinal plant has shown a wide spectrum of pharmacological activities in preclinical experiments, including anxiolytic, sedative, antitussive, antiasthmatic, and antidiabetic activities. The plant has a good safety profile. The clinical trials that we included in this review were designed to evaluate and in some cases confirm promising observations of preclinical pharmacological activity, and the methodological limits of these studies are characterised here.

CONCLUSION

In conclusion, clinical studies on the effects of products containing herbal preparations based on Passiflora incarnata reveal crucial weaknesses such as poor details regarding the drug extract ratio, limited patient samples, no description of blinding and randomisation procedures, incorrect definition of placebo, and lack of intention to treat analysis. In conclusion, the results of this review suggest that new clinical trials should be conducted using a more rigorous methodology to assess the traditional putative efficacy of Passiflora incarnata L.

Fatal hypersensitivity reaction to an oral spray of flurbiprofen: a case report

WHAT IS KNOWN AND OBJECTIVE

Safety of the anti-inflammatory drug flurbiprofen is comparable with that of other non-steroidal anti-inflammatory drugs of the propionic acid class, which are commonly associated with gastrointestinal and renal side effects. Here we report a case of a fatal hypersensitivity reaction to an oral spray of flurbiprofen taken for sore throat.

CASE SUMMARY

A 29-year-old man came to the emergency care unit reporting sore throat with an intense burning sensation associated with fever. Pharyngotonsillitis was diagnosed, and local treatment with oral flurbiprofen spray was prescribed. Immediately after using the spray, the patient experienced a severe reaction characterized by serious dyspnoea, followed by death. The cause of death was heart failure with acute asphyxia from oedema of the glottis. The cause of death was concluded to be hypersensitivity to flurbiprofen spray.

WHAT IS NEW AND CONCLUSION

Oral propionic acid derivatives have been associated with a relatively high frequency of allergic reactions. However, allergy to flurbiprofen has rarely been documented. Scientific literature reports two relevant cases of hypersensitivity reaction to flurbiprofen: in one case, a patient presented with a maculopapular rash 48 h after having taken oral flurbiprofen followed by angio-oedema and hypotension. In another case, a single oral dose of flurbiprofen caused itching and swelling around the eyes, redness and increased lacrimation. We describe, for the first time, a fatal case of hypersensitivity reaction to flurbiprofen oral spray. Hypersensitivity reactions to flurbiprofen are infrequent; however, health professionals should be aware of potential adverse reactions, even during topical administration as oral spray.

Airborne contact dermatitis to drugs

Contact dermatitis is defined as "airborne" when the causative factor is present in the environment and may determine irritative or allergic skin reactions. It is often work-related. In this review of the literature, we focus our attention on airborne contact dermatitis due to pharmaceutical compounds. Contact reactions to medications, often occupation-related, occur mainly in two exposed groups: employees of pharmaceutical industries involved in the production of the drugs and healthcare workers who use the drugs for therapeutic aims.

Differences in the behavior of advanced glycation end products and advanced oxidation protein products in patients with allergic rhinitis

BACKGROUND

The presence of oxidative stress in patients with asthma is well documented; however, the role of oxidative stress in allergic rhinitis has received less attention, although it is likely to be similar to that observed in patients with asthma. Advanced glycation end products (AGEs) and advanced oxidation protein products (AOPPs) are compounds formed by the transformation of macromolecules, including proteins, which can serve as densitometric markers of oxidative stress and inflammation in several diseases.

OBJECTIVE

The aim of this study was to investigate the role of AGEs and AOPPs as new markers of oxidative stress and inflammation in patients affected by allergic rhinitis.

METHODS

AGE and AOPP levels were determined in the sera of 25 patients with allergic rhinitis and 64 healthy controls. AGEs and AOPPs were detected using spectrofluorimetry and spectrophotometry, respectively.

RESULTS

AGE levels in patients were significantly higher than those in controls (P < .0001). These levels were not affected by the presence of asthma. No statistically significant differences were found between AOPP levels in patients or controls (P = .38).

CONCLUSIONS

Formation of AGEs and AOPPs may be accelerated in immunological and respiratory disorders such as asthma. Depending on the marker evaluated, the presence or absence of oxidative stress in allergic rhinitis is controversial. To our knowledge, this is the first study showing the possible involvement of AGEs in allergic rhinitis. The different behavior observed for these 2 biomarkers is very likely due to the activation of specific related biochemical pathways (eg, the myeloperoxidase pathway) associated with the condition under study.

Anaphylaxis caused by helminths: review of the literature

BACKGROUND

Anaphylaxis is a severe, life-threatening, generalized or systemic hypersensitivity reaction. In many individuals with anaphylaxis a pivotal role is played by IgE and the high-affinity IgE receptor on mast cells or basophils. Less commonly, it is triggered through other immunologic mechanisms, or through nonimmunologic mechanisms. The human immune response to helminth infections is associated with elevated levels of IgE, tissue eosinophilia and mastocytosis, and the presence of CD4+ T cells that preferentially produce IL-4, IL-5, and IL-13. Individuals exposed to helminth infections may have allergic inflammatory responses to parasites and parasite antigens.

AIM

To summarize the evidences about the role of helmiths in triggering anaphylaxis.

MATERIALS AND METHODS

PubMed search was performed by combining the terms (anaphylaxis, anaphylactic, anaphylactoid) with each one of the etiological agents of human helminthiasis for the period January 1950 to September 2012.

RESULTS

< The PubMed search identified 609 papers. Only four genera of helminths were associated with anaphylaxis. (Echinococcus spp, 302 papers; Anisakis spp, 73 papers; Taenia solium cysticercosis, 7 papers; and Ascaris spp., 243 papers).

CONCLUSIONS

The risk of anaphylaxis in patients with helminthiasis can vary according to the pathogens, occurring more frequently during echinococcosis of after anisakis infestation and being extremely rare after other helminth infestations. However, physicians, allergist and parasitologist in particular, should be aware of a potential anaphylaxis caused by helminths.

Allergic contact dermatitis: immune system involvement and distinctive clinical cases

The aim of this review is drawing the attention to the contact dermatitis, an inflammatory skin condition due to pro-inflammatory and toxic factors able to activate the skin innate immunity (irritant contact dermatitis) or caused by a T-cell- mediated hypersensitivity reaction (allergic contact dermatitis). The immune system involvement and a variety of clinical pictures are described in order to better diagnose, prevent and treat allergic contact dermatitis.

Is interleukin-22 a possible indicator of chronic heart failure's progression?

Chronic heart failure (CHF) is a complex and heterogeneous clinical syndrome and because of its rising incidence and prevalence, it can be considered a global epidemic. Interleukin (IL)-22 is a pro-inflammatory cytokine, belonging to the IL-10 family. Forty-seven consecutive older patients, hospitalized with an admitting diagnosis of CHF at the Geriatric Medicine Unit (University of Messina, Italy), from 01/01/06 to 30/06/06, were enrolled in the study. Serum concentrations of IL-22 were measured by a quantitative enzyme immunoassay technique. IL-22 levels in all CHF patients were significantly higher than those in controls, in particular, only the II and III NYHA class had IL-22 values significantly higher than the controls, whereas there was no difference between the IL-22 levels of NYHA class IV and the controls. The reason may be the declining immune function in CHF older patients, in fact we can hypothesize that the fall in IL-22 levels, with the progression of NYHA class, is due to the reduced ability in CHF patients to respond to infections, as IL-22 has anti-microbial properties. We detected different outcomes correlated to different IL-22 levels, and the Kaplan-Meier curves suggest a trend.

Cross-reactivity between Parietaria pollen and beet

Allergy to beet is very rare. Until now, only a few reports about asthma induced by inhaling the vapor of cooked beet have been published. We describe two patients with allergic rhinitis and positive skin prick tests to Parietaria and beet only. To investigate possible cross-reactivity between Parietaria pollen and beet, we performed laboratory assays that showed beet-specific IgE in the sera of both patients and possible cross-reactivity between Parietaria and beet in one patient.

Allergic contact angioedema to benzoyl peroxide

Benzoyl peroxide (BP) is commonly used for topical acne treatment and has long been known to be a weak allergen and a strong irritant. We report a case of a 26-year-old woman, who presented with an itchy erythematous reaction and strong oedema localized to the face. Two weeks before angioedema, the patient had started a new topical treatment with a gel containing 10% BP for acne. She was patch tested to European Standard Series, including BP 1% in white petrolatum, and to the 10% BP-containing gel previously used by herself, showing positivity on day 2 to BP 1% and to the 10% BP-containing gel. Factors that suggested an association between the severe angioedematous reaction and BP topical application include the strong reaction to BP in the patch-test, the temporal relationship, the complete resolution of symptoms after the drug was withdrawn and the absence of other identified explanations.

Muscle damage induced by black cohosh (Cimicifuga racemosa)

Extracts of black cohosh (Cimicifuga racemosa) are commonly used for the treatment of symptoms associated with menopause. Adverse events with black cohosh are rare, mild and reversible. A few number of serious adverse events, including hepatic and circulatory conditions, have been also reported, but without a clear causality relationship. We report the case of a woman with severe asthenia and very high blood levels of creatine phosphokinase and lactate dehydrogenase. The patient referred to take a dietary supplement derived from black cohosh for ameliorating menopause vasomotor symptoms. To exclude a possible involvement of this product, the patient was suggested to discontinue this therapy. After suspicion the patient showed a progressive normalization of biochemical parameters and improvement of clinical symptoms. We can hypothesise a causative role for black cohosh in the muscle damage observed in this patient. Factors suggesting an association between black cohosh and the observed myopathy included the temporal relationship between use of herbal product and asthenia and the absence of other identified causative factors. Rechallenge with the suspected agent was inadvisable for ethic reasons because of the risk of a serious relapse. This is the first time that asthenia associated with high muscle enzymes serum levels by black cohosh has been reported. In our opinion, this report is of interest because of the widespread diffusion of use of black cohosh as an alternative medicine for relief from menopausal symptoms.

'In vivo' time course of plasma myeloperoxidase levels after granulocyte colony-stimulating factor-induced stem cell mobilization

Administration of granulocyte colony-stimulating factor (G-CSF) is widely used for harvesting an adequate number of CD34+ stem cells by leukapheresis in normal donors. G-CSF is the most established agent for the mobilization of stem cells in current clinical practice, because it has been proven to be superior to any other agent tested to date in terms of not only mobilization capacity, but also of tolerance. However, although regulatory and accrediting agencies have provided guidelines to protect donors, the short- and long-term side effects of G-CSF need to be further studied. In this study, we evaluated the time course of plasma myeloperoxidase (MPO) levels measured in a group of donors given recombinant human G-CSF (rHuG-CSF) at different intervals: (i) before starting rHuG-CSF administration, (ii) on day 5 of rHuG-CSF administration, (iii) on the same day soon after the end of the first leukapheresis procedure and (iv) 1 week after rHuG-CSF withdrawal. Plasma MPO levels significantly increased in the donors after 5 days of rHuG-CSF treatment, returning to the baseline values within 7 days following rHuG-CSF withdrawal. These findings may contribute to a better understanding of G-CSF safety profile in stem cell donors.

A case of contact urticaria due to adigraf, a PVC-made material

Adigraf is a plastic material applied as thin sheets that may be incised and are used, also by children, to produce artistic drawing. The principal component of adigraf is polyvinyl chloride (PVC). Di-(2-ethylhexyl) adipate is added as a plasticizer. Herein we describe a case of a 14-year-old boy with facial angioedema and widespread urticaria, occurring 1h after contact with an adigraf sheet. Open patch-test with adigraf sheet showed swelling of the application site and widespread urticaria. To our knowledge, there are no similar reports of urticaria and angioedema from adigraf or similar PCV items.

Serum levels of malondialdehyde and 4-hydroxy-2,3-nonenal in patients affected by familial chronic nail candidiasis

Familial chronic nail candidiasis (FCNC.MIM 607644) is a rare disorder characterized by early onset infections caused by different species of Candida and restricted to the nails; this disorder is genetically associated with low serum concentration of intercellular adhesion molecule 1 (ICAM-1). Herein we report the evidence of high circulating levels of malondialdehyde (MDA) and 4-hydroxy-2,3-nonenal (HNE) in seven patients of a five-generation Italian family affected by FCNC.MIM 607644. The present data evidence, in these patients, an increase in circulating MDA and HNE levels. Only some merely speculative hypotheses may be suggested to explain the mechanisms subserving the oxidative stress condition observed in these genetically ICAM-1 deficient patients; however, one has to point out that a chronic oxidative stress condition could contribute to the development of concurrent pathological alterations in which an overproduction of free radicals may play a central role.

Vardenafil-induced generalized urticaria

Vardenafil is a potent selective and reversible inhibitor of the cGMP phosphodiesterase type 5 that has been shown to improve erectile function in men. Vardenafil is usually well tolerated; the most common adverse events are headache, flushing, rhinitis, sinusitis and dyspepsia. We report a case of a 48-year-old man with an acute episode of widespread urticaria following vardenafil consumption and in absence of other identifiable causative factors. The patient had no previous episodes of urticaria. This appears to be the first report of urticaria associated with vardenafil.

Lipid peroxidation and protein oxidation in patients affected by Hodgkin's lymphoma

A dysregulation of the redox homoeostasis has been reported in various neoplastic disorders. Malondialdehyde/4-hydroxy-2,3-nonenal (MDA/HNE) and protein carbonyl groups represent in vivo indexes of lipid peroxidation and protein oxidation, respectively, suitable to investigate radical-mediated physio-pathological conditions. We evaluated MDA/HNE and protein carbonyl groups in sera of untreated Hodgkin's lymphoma (HL) patients in advanced disease stages, in order to quantify the oxidative stress. HL patients displayed significantly higher levels of both MDA/HNE and protein carbonyl groups as compared with healthy controls. This is the first evidence that a strong increase in HL is one of the most common haematological malignancies, representing approximately 30% of all lymphomas in the circulating protein carbonyl content in HL. These findings may contribute to a better definition of the redox homoeostasis dysregulation in HL.

[Idiopathic hypereosinophilic syndrome associated with rheumatoid arthritis. A case report]

The idiopathic hypereosinophilic sindrome (HES) is a disease characterized by persistent blood eosinophilia (> 1500 eosinophils/mm3 > 6 months) -in absence of other ethiologies for eosinophilia (parasitic, allergic, immunological or malignant diseases)- associated with multiple organ involvement (heart, lung, central nervous system, skin, bone marrow, gastrointestinal tract). Reports on rheumatologic manifestations in patients with HES are very rare. In the case we report a typical rheumatoid arthritis developed in a 58-year-old woman with HES treated with glucocorticoids. Because of the marked glucocorticoids side effects shown by the patient (cushingoid habitus, hyperglycemia), we stopped this treatment and replaced it at first by methotrexate and later by cyclosporin, both of them associated with sulfasalazine. These drugs revealed very efficacious both on articular pathology and on the clinical and laboratory manifestations of HES. These data suggest that common pathogenetic mechanisms are likely acting in rheumatoid arthritis and idiopathic hypereosinophilic syndrome.

Protein carbonyl group content in patients affected by familiar chronic nail candidiasis

Familiar chronic nail candidiasis (FCNC) is a rare disorder characterized by early-onset infections caused by different species of Candida, restricted to the nail of the hands and feet, and associated with a low serum concentration of intercellular adhesion molecule 1. Host defense mechanisms against candidiasis require the cooperation of many immune cells through several candidacidal mechanisms, including oxygen-dependent killing mechanisms, mediated by a superoxide anion radical myeloperoxidase--H2O2--halide system, and reactive nitrogen intermediates. We analyzed protein carbonyl groups (considered a useful marker of oxidative stress) in the serum of patients belonging to a five-generation Italian family with an isolated form of FCNC. Serum protein carbonyl groups in FCNC patients were significantly lower than those measured in healthy donors. Also, if this hypothesis is merely speculative, we could suggest that the decreased circulating level of protein carbonyl groups in these patients is not a marker of a lower oxidative stress condition, but might be linked to a lower protease activity.

Serum levels of interleukin-18 and s-ICAM-1 in patients affected by psoriasis: preliminary considerations

OBJECTIVE

To find new aspects of the systemic involvement of the Immune System in psoriasis, we determined serum levels of interleukin-18 (IL-18) (Th1-inducing factor cytokine), CD30 (Th2 marker) and sICAM-1 (adhesion molecule). In addition we evaluated the correlation between these molecules and psoriasis area and severity index (PASI).

BACKGROUND

Psoriasis is associated to an overexpression of Th1 cytokines and a relative underexpression of Th2 cytokines. IL-18 plays an important role in inducing Th1 response because it is a potent inductor of synthesis of IFN-gamma, TNF and other mediators. The two major sources of IL-18 are monocytes and macrophages but also human keratinocytes constitutively synthesized IL-18.

SUBJECTS AND METHODS

We selected two groups of subjects: 16 healthy donors (HD) and 16 patients affected by psoriasis, matched for sex and age. Serum IL-18, CD30 and sICAM-1 levels were assayed by immunoenzymatic method with commercial kits.

RESULTS

IL-18 and sICAM-1 levels in the patients were significantly higher than in the HDs (385.94 +/- 193.89 vs. 227.38 +/- 92.76 pg/mL, P = 0.005 and 445.00 +/- 152.67 vs. 317.88 +/- 107.20 ng/mL, P = 0.02, respectively). On the contrary, no significant difference was found between serum sCD30 levels of patients in respect to those of HDs. A significant correlation was found between serum IL-18 and PASI (Rho = 0.695, P = 0.0071), serum IL-18 and sICAM-1 (Rho = 0.543, P = 0.0356) and between sICAM-1 and PASI (Rho = 0.659, P = 0.0107).

Involvement of interleukin-18 in patients on maintenance haemodialysis

Maintenance dialysis induces a clinical state of immunodeficiency. The pathway of circulating T cells from haemodialyzed patients is changed and characterized by an increase of Th1 cells. The unbalanced T helper differentiation derives from an altered regulation of interleukin-12 (IL-12), which represents an important inducer of Th1. IL-18 is a pro-inflammatory cytokine expressed by a variety of cell types that is structurally related to the Th1 family and shares biological properties with IL-12 as the promotion of Th1 responses. To explain the involvement of IL-18 in the typical disorders of dialysis, we analyzed IL-18 serum levels in a group of haemodialyzed patients. We enrolled 16 patients on chronic haemodialysis (HD) treatment for end-stage renal failure and 16 healthy volunteers as the control group. IL-18 levels were assessed by immunoenzymatic methods (detection limit was <12.5 pg/ml). HD patients strongly showed higher IL-18 serum levels compared to healthy donors (508.47 +/- 314.39 vs. 193.44 +/- 56.33 pg/ml, p < 0.005). Moreover, IL-18 levels in HD directly correlated to dialytic age (Rho = 0.544, p = 0.0419) and indirectly to Kt/V (Rho = 0.703, p = 0.0086). Our data represent the first evidence of the relation between IL-18 serum levels and HD. In the light of our results, we think that the unbalanced T helper differentiation may depend, at least in part, on an abnormality in the IL-18 production.

Burning mouth syndrome due to cadmium in a denture wearer

We report the case of a female denture wearer who was referred to our service due to burning of the lips and tongue but with no visible oral lesions. Her biochemical data, complete blood cell count, sedimentation rate, thyroid and sex hormones were normal. Tongue culture was negative. Patch tests, performed with a panel of 20 potential denture allergens, gave positive results (+++) only to a 2% petrolatum cadmium sulfate, which was present in the denture. Removal of the denture led to the clearing up of oral symptoms in 3 days. In light of these findings, carrying out patch tests with the allergens related to denture materials should be considered in these cases.

Aluminium allergy in a patient with occupational contact dermatitis

Case of a 57-year-old hospital attendant with hand eczema. Patch tests were read at 2 and 3 days using the 1+ to 3+ scoring system recommended by the Contact Dermatitis Research Group.