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Biomedical subjects

A Fiocchi

Publications and source records attributed to A Fiocchi.

At least 19 recordsLinked to original sources
PubMed2006

A hydrolysed rice-based formula is tolerated by children with cow's milk allergy: a multi-centre study.

BACKGROUND: Children allergic to cow's milk are fed a soy- or a hydrolysed cow's milk-based substitute. Neither can rule out a sensitization risk. Previous studies have shown that hydrolysed rice is tolerated by animals and children with multiple food hypersensitivities. OBJECTIVE: A prospective clinical assessment of tolerance to a rice-based hydrolysed formula was carried out in children allergic to cow's milk. Patients and methods One hundred children (42 girls and 58 boys, mean age 3.17+/-2.93 years, median 2.20, range 0.18-14.6 years) with a history of immediate reactions to cow's milk and confirmed at double-blind, placebo-controlled food challenge (DBPCFC) when not contraindicated were assessed for clinical tolerance to cow's milk proteins. Their allergy work-up included skin prick tests with whole milk, alpha-lactalbumin (ALA), beta-lactoglobulin (BLG) and total caseins, and specific IgE determinations using CAP technology were performed against whole milk, ALA, BLG and casein. Sensitization to rice and rice-based hydrolysed formula was similarly investigated. Patients' sera were evaluated at immunoblotting for specific IgE to cow's milk proteins, rice and rice-based hydrolysed formula. DBPCFC was carried out with increasing doses of a rice-based hydrolysed formula. RESULTS: All patients were sensitized to cow's milk and/or at least one cow's milk protein fraction. Eighty-seven out of 99 were positive to cow's milk and/or a cow's milk protein fraction at skin prick test. Positive (>0.35 kUA/L) specific IgE determinations were found for cow's milk and/or milk fractions (92/95), rice (21/91) and hydrolysed rice infant formula (4/91). At immunoblotting, sera from 96 children were positive to alpha-casein (n=54), beta-casein (n=38), ALA (n=57), BLG (n=37) and bovine serum albumin (n=61). Similarly, although patients' sera often contained specific IgE against rice proteins at CAP (21/91) and immunoblotting (70/96), only six very weakly positive responses were observed against rice-based hydrolysed formula. All DBPCFC with rice-based hydrolysed formula were negative. CONCLUSIONS: Rice-based hydrolysed formula is a possible alternative not only for children with multiple allergies, but also for children with cow's milk allergy.

Adolescent↗
PubMed2006

Practice parameters for sublingual immunotherapy.

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

Administration, Sublingual↗
PubMed2005

Oral food challenges in children in Italy.

BACKGROUND: Epidemiological surveys identify a 900,000-strong potential paediatric population who may self-report with food allergy in Italy. As the reference test is the double-blind, placebo-controlled food challenge for diagnosis, we carried out a nation-wide questionnaire survey of hospital-based paediatric allergy centres between 1 January and 30 June 2003. METHODS: All registered centres received a 27-point questionnaire polling logistics and protocols of oral food challenge. Items polled included medical facilities and personnel, selection of patients, foods tested, blinding, placebo use, evaluation criteria, number of tests and positive outcome rates in 2002. RESULTS: Two hundred and two of 456 responders (44.3%) carried out food challenges (a ratio of one centre to 37,400 children in the general population). 11,728 challenges were performed in 2002 (an average of 58 procedures per centre; range: 1-500) and 3350 procedures were claimed positive (28.6%). Cow's milk was tested by all centres, egg by 77.2%, beef by 19.8% and cereals, peanuts, fish or fruit collectively by 37.6%. Twenty-nine of 202 centres performed blinded tests, 18 of which under double-blinded conditions. In cow's milk challenges, placebos included lyophilized cow's milk capsules, soy formula, extensive whey hydrolysate or extensive casein hydrolysate. CONCLUSION: Our survey reveals great differences in challenge test criteria, facilities and procedures and that many centres perform relatively few procedures. This argues in favour of greater rationalization in the allocation of tertiary-level resources before procedure standardization can be contemplated in the diagnostic workup of food allergy.

Child↗
PubMed2004

Characterization of bovine serum albumin epitopes and their role in allergic reactions.

OBJECTIVE: This review provides updated information on conformational and sequential epitopes identified in bovine serum albumin (BSA) and summarizes available data about the role of structural modifications on BSA antigenicity/allergenicity. DATA SOURCES: Data on beef allergy and BSA antigenicity are reported, with reference both to the basic literature and to clinical results obtained by our group. RESULTS AND DISCUSSION: BSA is an important allergen involved in milk and beef allergy. The presence of conformational epitopes has been suggested by indirect evidence, while at least one sequential epitope has been experimentally identified. The role of structural modifications on BSA antigenicity is discussed as well as the increased tolerance observed in allergic subjects consuming beef as strained (homogenized) and freeze-dried derivatives. CONCLUSION: Study of the molecular characteristics of a known major allergen allows the identification of technological processes that may be capable of improving the tolerance of allergic subjects to a specific food. Even though any hoped for reduced allergenicity must be verified under medical supervision, the use of new products could obviate the need to avoid important foods such as meat in childhood.

Allergens↗
PubMed2004

Dietary treatment of childhood atopic eczema/dermatitis syndrome (AEDS).

OBJECTIVE: This review summarizes the research and clinical evidence in favour of dietary intervention aimed at eliminating allergenic foods in the management of atopic eczema/dermatitis syndrome (AEDS). DATA SOURCES: The data source was PubMed, using a search algorithm selecting for clinical studies of AEDS, diet therapy and food allergy in all children to October 2003. Also included is a commentary based on the authors' clinical experience in the allergy unit of a university hospital in Italy. RESULTS: Fourteen prospective studies matched the entry criteria. Diverse trial designs, diagnostic criteria, types of dietary intervention and length of observation periods precluded meta-analytic methods. Allergenic food exclusion claimed efficacy in 13 of the 14 studies and was most useful in infants, in patients with elevated immunoglobulin E levels and/or multiple food sensitization and in patients with a diagnosis of food allergy. CONCLUSION: Dietary intervention in the form of an elimination diet is efficacious in children with AEDS when a specific diagnosis of food allergy has been made. Diagnostic evaluation of food allergy should be performed in all children with eczema, particularly in younger children and those with severe forms of the disease.

Child↗
PubMed2003

Tolerance to a rice hydrolysate formula in children allergic to cow's milk and soy.

BACKGROUND: Even hydrolysed cow's milk formulae may retain residual allergens and there are few nutritional options for children with cow's milk allergy (CMA) who also react to soy. OBJECTIVE: To assess clinical tolerance to a rice-based hydrolysate in children with such a clinical presentation. PATIENTS AND METHODS: Eighteen children (six girls and 12 boys; median age 5 years; range 1-9 years) with CMA, who developed clinical reactions to a soy-based formula after 2-18 months' treatment, were recruited between January 1998 and June 1999. Clinical evaluation was by skin prick test (SPT) with cow's milk, casein, lactalbumin, soy and rice allergen extracts, fresh cow's milk, soy and hydrolysated rice formula (HRF). Serology was investigated by CAP system technology and immunoblotting. Assessment of the rice formula was carried out by double-blind, placebo-controlled food challenge with rice hydrolysate. RESULTS: Thirteen children had positive SPT to casein, 10 to lactalbumin, eight to rice and two to rice hydrolysate. Positive serology was found in all patients' sera tested with cow's milk, with soy in 13 sera and with rice in seven. Double-blinded, placebo-controlled challenge with an HRF was negative in all cases. CONCLUSIONS: Children allergic to cow's milk and soy tolerate an HRF clinically. This suggests that rice hydrolysate may be used as a protein source for children with multiple food-induced reactions.

Allergens↗
PubMed2003

Evaluation of residual immunoreactivity in red and white wines clarified with gluten or gluten derivatives.

Gluten or hydrolyzed gluten could be a suitable alternative to animal proteins in the wine clarification process, but their residues could represent a risk for individuals suffering from coeliac disease or allergic to cereal proteins. The aim of this study was to investigate the presence of gluten in wines treated with gluten or its hydrolysate in the clarification process and to assess its antigenicity in commercial products. The presence of residual immunoreactive gluten was evaluated by electrophoresis (SDS-PAGE) and immunoblotting. Data obtained in several red and white wine samples showed that no residue was detectable in any of the red wines. In white wines, gluten reduced the protein content less completely, but most samples showed no immunoreactivity after the wine had been treated with gluten or its derivatives, either alone or combined with bentonite, silica gel or tannins. The use of gluten derivatives coupled with bentonite was the most effective method of removing immunoreactive protein in white wines. In conclusion, the use of gluten derivatives in wine clarification seems to exclude a risk for subjects susceptible to coeliac disease or gluten allergy. However, it is recommended that wine producers continuously monitor the clarification process in order to protect the most sensitive individuals.

Antigens↗
PubMed2001

Severe anaphylaxis induced by latex as a contaminant of plastic balls in play pits.

BACKGROUND: Latex causes anaphylaxis in specific contexts among children. We present 2 cases that show that severe reactions may occur in everyday circumstances with latex as a contaminant. OBJECTIVE: Because 2 cases of severe reactions to latex suggested similar circumstances of exposure, we investigated the immediate environment in which episodes occurred. METHODS: A 5-year-old girl presented to our casualty department with anaphylaxis after playing in a ball pit filled with approximately 10-cm diameter plastic balls in an American-style fast-food outlet. Two months later, a 9-year-old boy had severe anaphylaxis followed by an asthma attack with loss of consciousness while playing in the playpen of a different outlet belonging to the same company. Latex sensitization was confirmed in both cases by means of skin prick testing, latex glove skin prick testing, and 1-glove finger testing. Immunoblotting of elutions from a ball, the natural rubber latex foam pit lining, and its polyvinyl chloride sheet were performed. RESULTS: In the girl's immunoblot high levels of IgE specific to Hev b 4, Hev b 7, and Hev b 2 were found. The boy's immunoblot showed positivity to Hev b 7. The polyvinyl chloride ball sample showed a high concentration of specific Hevea species allergen similar to that of the foam layer sample. CONCLUSION: Severe anaphylaxis can result from contact with latex proteins as a contaminant, rather than as a component, of play area ball pits and therefore outside the reported settings. Emergency health care workers should be aware of this kind of risk. A latex-reduced environment might prevent potentially severe reactions in young customers of fast-food outlets.

Anaphylaxis↗
PubMed2001

Antigenic determinants of bovine serum albumin.

BACKGROUND: Bovine serum albumin (BSA) is one of the most widely studied proteins; its structure is well known and its antigenic characteristics have been described in several papers. The aim of this research was the identification of the BSA antigenic determinants. METHODS: This study was performed using limited proteolysis and an immunoblotting technique, in which a commercial murine antibody and sera from children sensitized to BSA were used. RESULTS: Findings suggest amino acids (aa) 524-598 as an epitopic area for human species. The most critical sequence seems to be aa 524-542, even if it must be included in a longer fragment to be recognized by antibodies. Murine IgG antibodies also recognize fragments contained in the first half (NH(2)-terminal portion) of BSA. CONCLUSIONS: The results presented in this study indicate that the epitopic sites of an antigenic protein can be different when different species are considered, so that data obtained with antibodies from animal species cannot be directly extrapolated to the behavior of human IgEs.

Amino Acid Sequence↗
PubMed2000

Beef allergy in children.

Beef allergy was poorly known before the '90s. Since then, a number of papers appeared elucidating the nature, epidemiology, and symptoms of beef allergy in children allergic to cow's milk and children suffering from atopic dermatitis. It is now clear that beef allergy is not an infrequent occurrence, with an incidence between 3. 28% and 6.52% among children with atopic dermatitis, its incidence may be as much as 0.3% in the general population. A diagnosis of beef allergy must be supported by skin prick tests, RASTs, and challenges. The specificity and sensitivity according to type of test and the type of extract, however, remains to be evaluated. Despite the fact that other allergens can be sensitizing, the major beef allergen is bovine serum albumin (BSA). Beef-sensitive children are also sensitized to ovine serum albumin, as well as to other serum albumins; therefore, the use of alternative meats in beef-allergic children must be carefully evaluated on an individual basis. Because industrial heat processing is more efficient than domestic cooking in reducing reactivity in beef-sensitive children, freeze-drying and homogenization may support the introduction of processed beef into the diet of beef-allergic children.

Allergens↗
PubMed2000

Growth pattern of breastfed and nonbreastfed infants with atopic dermatitis in the first year of life.

OBJECTIVE: The growth of infants with atopic dermatitis (AD) has been poorly investigated based on the early type of feeding. The aim of this study was to assess the growth pattern of AD infants during the first 12 months of life in comparison to healthy infants, according to the early type of feeding (breastfed or nonbreastfed). METHODS: Fifty-five term AD infants (36 breastfed and 19 nonbreastfed) and 114 term healthy infants (58 breastfed and 56 nonbreastfed) were evaluated by standardized growth indices (z scores; National Center for Health Statistics-World Health Organization data) through the first 12 months of life. RESULTS: No difference was found between AD and healthy groups at birth. In AD infants, weight (WA) and length (LA) z scores decreased with age and were significantly lower, compared with healthy infants from the second month of age onward. The difference of mean z scores between AD and healthy infants at 12 months of age was -.69 (95% confidence interval [CI]: -1.00 to -.38) for WA and -.67 (95% CI: -.98 to -.36) for LA. The growth pattern of AD infants was not influenced by the early type of feeding, whereas in the 6- to 12-month period, the delay in growth was more pronounced in patients with more severe dermatitis. CONCLUSIONS: In the first year of life, AD infants show a progressive impairment in growth irrespective of the early type of feeding. The severity of disease may be an independent factor negatively influencing growth.

Age Factors↗
PubMed1999

Carob is not allergenic in peanut-allergic subjects.

BACKGROUND: The antigenic potential of proteins from the carob bean, a member of the legume family used as a food additive, have not so far been investigated and legumes share antigenic proteins with peanut, a potent trigger of anaphylaxis. OBJECTIVE: To assess the carob protein determinants of sensitization in peanut-allergic children. METHODS: In a prospective, double-blind, placebo-controlled study 12 patients (median age 9.5 years) with a history of hyperreactivity to peanut (anaphylaxis) were assessed. Skin prick tests with a commercial peanut allergen, raw carob pulp, raw and cooked carob cotyledon formula were used to confirm the history. RAST for peanuts and cooked carob were used to evaluate sensitization to these proteins. Carob-specific IgE were identified by immunoblotting analyses. Allergic reactivity was evaluated during double-blind placebo-controlled food challenges (DBPCFC; 5.5 g carob extract and cooked carob cotyledon formula). RESULTS: Peanut allergen-induced skin prick test positivity in all children (confirmed during double-blinded challenge in 6/12 patients), carob pulp in 3/12 patients, raw carob bean in 6/12, and cooked carob cotyledon formula in none. RAST were positive for peanut in all cases but negative for carob beans in 9/12 cases. Immunoblot analyses found peanut-specific IgE in all cases and raw carob bean-specific IgE in eight cases. Carob allergens were identified in the 17.5, 48, and 66 kDa MW bands. The least allergenic density was found for cooked carob proteins. There was no clinical reactivity with either raw or cooked carob during DBPCFC. CONCLUSIONS: These data suggest that carob-specific sensitization, apparent both in vitro and in SPTs, can be concordant with peanut allergy and that cooked carob can be ingested by children who are allergic to peanuts. That heat-processing deactivates carob protein allergenicity has dietary implications for polyallergic children.

Adolescent↗
PubMed1999

Cross-reactivity between milk proteins from different animal species.

BACKGROUND: Cow's milk allergy is quite frequent in the first years of human life. When breast-feeding is not possible, a cow's milk substitute must be provided for allergic subjects. Different alternatives to cow's milk have been suggested as protein sources (soy, hydrolysed proteins, goat's milk, etc.), but all these dietetic solutions are not without risks for polyallergic or more sensitive subjects. OBJECTIVE: To obtain new information on the suitability of other mammalian milks for allergic children, we evaluated the cross-reactivity between milk proteins from different animal species. METHODS: Milk samples were analysed by sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). To detect antibody-antigen complexes, immunoblotting was performed by using sera from children allergic to cow's and ewe's milk (RAST class >/= 4) and monoclonal antibodies (MoAb) specific for bovine proteins (caseins and beta-lactoglobulin). RESULTS: IgEs from children allergic to cow's milk are capable of recognizing most part of milk proteins from mammals bred in European countries (ewe, goat, buffalo), while no serum used in this study contains IgEs reacting with camel's milk proteins. Camel's milk was also not recognized from circulating IgEs from a child specifically allergic to ewe's milk. Specific antibovine monoclonal antibodies cross-reacted with proteins from other mammalian species, apart from those of camel. CONCLUSIONS: Homologies in amino acidic composition could justify the cross-reactivity observed between proteins from different animal species. On the other hand, the phylogenetic difference could be responsible for the failed recognition of camel's proteins by circulating IgEs and monoclonal antibodies.

Animals↗