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Biomedical subjects

E Nucera

Publications and source records attributed to E Nucera.

51 records · Page 3Linked to original sources
PubMed1986

ASA disease: the clinical relationship of nasal polyposis to ASA intolerance.

We studied the complex relationship between nasal polyposis and ASA (acetylsalicylic acid) intolerance in 154 patients with nasal polyps. The clinical histories of all patients were reviewed, and diagnostic tests for immune or allergic causes and the responsiveness of patients to challenges with ASA-substitutive drugs were analyzed. A third of our patients tested were found to have positive personal histories of atopy and 35% showed ASA intolerance. Although 40% had bronchial asthma, only 16.8% of all patients had positive tests for allergy. We were unable to find a specific mechanism to explain the relationship between nasal polyposis and ASA intolerance and further investigations are still required.

Adolescent↗
PubMedDate not supplied

Oral hyposensitization to nickel allergy: preliminary clinical results.

Fifty-one patients presenting a dermatological allergy (erythema, urticaria, angioedema, contact dermatitis) to nickel were treated over 3 years with oral doses of 0.1 ng nickel sulfate per day, following a low-nickel diet. Diagnostic tests comprised patch and oral provocation tests. In 7 cases, the treatment was interrupted because of symptom reactivation, and in 14 cases for other reasons. Among the 30 cases who went through the whole follow-up, symptomatology totally disappeared in 29 cases, and a partial alleviation was achieved in 1 case after 1 year of treatment. Oral provocation tests with these 30 patients showed an overall increase of tolerance. Patch tests showed no variation in 20 cases, a diminution in 5, and were negative in 5. Although the study was not conducted double blind, the results of this attempt to cure nickel allergy are statistically significant.

Administration, Oral↗
PubMedDate not supplied

An attempt of specific desensitising treatment with gliadin in celiac disease.

Gluten-free diet is the current treatment of celiac disease. We decided to verify the occurrence of histological and serological modification and/or clinical manifestations during a gradual and progressive introduction of gliadin in the diet and if it may induce a tolerance to food, as it occurs in allergic patients. We studied the case of a celiac woman with complete clinical and histological remittance after 10 years of gluten free diet. She took increasing daily doses of gliadin, reaching the final dose of 9 g of gliadin (15 g of gluten) in 6 months. Then she started a free dietary regimen. During the 15-month follow-up period esophago-gastro-duodenoscopy showed normal Kerckring folds and villi. Anti-gliadin, anti-endomysium and anti-tissue-transglutaminase antibodies, as well as the haematological and biochemical parameters remained normal. Our results represent a new approach in research concerning celiac disease, and could provide a future line of study for its management.

Adult↗
PubMedDate not supplied

A clinical trial of oral hyposensitization in systemic allergy to nickel.

Nickel allergy is the most common contact allergy. Some nickel-sensitive patients present systemic (cutaneous and/or digestive) symptoms related to the ingestion of high nickel-content foods, which significantly improve after a specific low nickel-content diet. The etiopathogenetic role of nickel in the genesis of systemic disorders is, furthermore, demonstrated by the relapse of previous contact lesions, appearance of widespread eczema and generalized urticaria-like lesions after oral nickel challenge test. The aim of this study is to investigate the safety and efficacy of a specific oral hyposensitization to nickel in patients with both local contact disorders and systemic symptoms after the ingestion of nickel-containing foods. Inclusion criteria for the recruitment of these patients were (other than a positive patch test) a benefit higher than 80% from a low nickel-content diet and a positive oral challenge with nickel. Based on the previous experiences, our group adopted a therapeutic protocol by using increasing oral doses of nickel sulfate associated to an elimination diet. Results have been excellent: this treatment has been effective in inducing clinical tolerance to nickel-containing foods, with a low incidence of side effects (gastric pyrosis, itching erythema).

Administration, Oral↗
PubMedDate not supplied

Delayed allergy to aminopenicillins: clinical and immunological findings.

Aminopenicillins are the most used beta-lactam antibiotics. Morbilliform or maculopapular rashes are rather frequent during therapy with aminopenicillins. The pathogenesis of these reactions is often due to a cell-mediated allergy. The aim of this work is to characterize patients with cell-mediated allergy to aminopenicillins and to identify alternative beta-lactam drugs that can be safely administered to these patients. We studied 27 subjects affected by cell-mediated allergy to aminopenicillins. The diagnosis was made on the basis of positivity of patch tests with aminopenicillins. These patients then underwent an allergological evaluation (skin and patch tests, oral and/or intramuscular challenge tests) with a wide spectrum of beta-lactam antibiotics. Our work highlights the following main characteristics of cell-mediated allergy to aminopenicillins: time elapsing between drug administration and onset of symptoms of about 2 days; the maculopapular rash and delayed appearance of urticaria/angioedema were the most typical symptoms (82.8 percent of cases); a cross-reactivity with aminocephalosporins is usually absent, or it is limited to cephalexin (in our study, in fact, just 3 out of 20 patients challenged with cephalexin showed a positive oral challenge test); all the beta-lactams, other than aminopenicillins, are well tolerated. Patch tests represent a specific diagnostic tool with a good predictive value of identifying alternative drugs that can be safely administered to patients with beta-lactam allergy. Our patients could tolerate other beta-lactam drugs after a complete allergological evaluation. On the basis of our study, cell-mediated allergy to aminopenicillins should be considered a well-defined nosologic entity.

Administration, Oral↗
PubMedDate not supplied

Effect of pre-treatment with inhaled furosemide on allergen nasal challenge.

The inhalation of furosemide has been reported to inhibit the bronchospasm induced by several agents. In the present study, we evaluated the effect of inhaled furosemide on the specific nasal challenge test in patients with allergic rhinitis. A total of 21 consecutive patients with allergic rhinitis (positive skin test and RAST) and a positive basal nasal provocation test (NPT) with the specific allergen were investigated. In each patient, we compared the changes in nasal air-flow (anterior rhinomanometry) during NPT after inhalation of placebo and 20 mg furosemide. The previously positive NPT response to the inhalation of the specific allergen became negative after the furosemide pretreatment in 16 patients (76.2%, p < 0.001, chi-square test). The nasal air flows during NPT were significantly increased after furosemide treatment with respect to placebo inhalation (F = 17.2, d.f. = 1 and 3; p < 0.03; covariance analysis). Our results suggest that the pretreatment with inhaled furosemide in atopic subjects is able to exert a protective effect on the nasal mucosa reactivity to the specific allergen. Therefore, the anti-reactive effect of the drug on the airways is not confined to the bronchial asthmatic response.

Administration, Inhalation↗
PubMedDate not supplied

Nasal lavage cytometry in the diagnosis of nonallergic rhinitis with eosinophilia syndrome (NARES).

The nonallergic rhinitis with eosinophilia syndrome (NARES) is a type of chronic rhinitis, characterized by intense (> 20%) eosinophilia of the nasal secretions. In this study, screening for NARES in 81 patients with nonallergic chronic rhinitis was performed using a modified nasal lavage cytometric method. Twenty-one of the 81 investigated individuals (25.9%) showed nasal eosinophilia greater than 20%, therefore being diagnosed as having NARES. No statistical difference in total serum IgE concentration (Prist Pharmacia) was observed between the NARES subjects and those with other forms of chronic rhinitis, confirming the seemingly nonallergic nature of NARES. In 28.6% of these cases the presence of anosmia was detected: in 19.0% of cases with NARES (all subjects complaining of long-lasting symptoms and suffering from anosmia), nasal polyposis coexisted. Our results confirm that nasal lavage cytometry may represent a useful clinical tool in the diagnosis of chronic rhinitis.

Adult↗
PubMedDate not supplied

Allergy to betalactams: relationship between chemical structure and antigenicity of molecules.

As betalactams (penicillins, cephalosporins, carbapenems, monobactams, betalactamase inhibitors) are the most widely used antibiotic drugs worldwide, allergy to betalactams is a frequent problem encountered in clinical practice, concerning from 0.7-8% of treated patients. It is now clear that the antigenicity of these drugs is strictly related to the chemical structure of the various molecules and of their constituent parts. In this paper we first describe the chemical structure of betalactams and then try to establish a correlation between this structure and their antigenicity.

Animals↗
PubMedDate not supplied

Nasal secretion specific IgE in rhinitis patients.

Forty-five subjects with rhinitis of suspected allergic origin underwent immune and allergy testing including skin-tests and immuno-enzymatic assay of serum and nasal secretion specific IgE (RAST). Nasal secretion was collected using a cotton tampon inserted in both middle meati. A statistical analysis comparing the results of skin-tests and serum RAST was performed: the results obtained with these two techniques were very homogeneous (86.7% accuracy). An overall concordance (82.2%) was also observed by comparing skin-tests and nasal secretion RAST. Finally, the results of serum and nasal secretion RAST were compared: in this case totally superimposed data were reported (overall accuracy: 93.3%). In all cases the comparison between RAST classes in serum and nasal secretion was carried out: the difference between the semiquantitative evaluation of reaginic concentration classes using these two methods is not statistically significant (chi-square test). This technique of nasal secretion collection is simple and with no risk involved.

Adolescent↗
PubMedDate not supplied

Status of patch and other skin tests in diagnosis of systemic penicillin allergy.

It is generally accepted that cell-mediated immunity is responsible for contact dermatitis, but controversy still exists about the involvement of Type IV immune-reactions in other clinical manifestations following inhalant, oral and parenteral administration of penicillin and semi-synthetic penicillin or cephalosporins. The aim of the present study was to contribute to a better understanding of the pathogenetic mechanism responsible for these reactions. Detailed history taking, clinical and immuno-allergological investigation on 161 patients with a history of an allergic reaction to penicillin and/or semisynthetic penicillins and/or cephalosporins was carried out with the following tests: skin tests, patch tests, RAST, PRIST and lymphocyte transformation test. The statistical evaluation of data was performed by X2 test. Comparative studies were focused on groups of patients who presented a positive reaction to patch test (37) skin test (scratch and intradermal) (42), simultaneous skin and patch test (5) and negative skin test (87). No significant difference was observed among the groups studied, although in positive and skin test, a higher frequency is observed to be associated with anaphylactic shock and eczematous type of reaction. It is not possible however not only, to establish whether this is due to a combined immune-reaction (Type I and IV), orto a causal coexistence of the two mechanisms but even to determine either of allergic or pseudoallergic phenomenon without any accurate immunoallergological test. It is suggested that patch tests be carried out as routine investigations on patients with a systematic reaction to penicillins and/or cephalosporins, regardless of the route of administration.

Adolescent↗
PubMedDate not supplied

Oral specific hyposensitization in the management of patients allergic to food.

Results are presented of a protocol of hyposensitizing treatment per os in 19 cases of food allergy (allergy to milk in 8, to egg in 8, to fish in 2, and to orange in one). Treatment, performed in the out-patients service, was successful in 14 out of the 15 patients who followed it correctly (i.e. 93.3% of cases). Treatment lasted between 3 and 12 months.

Adolescent↗
PubMedDate not supplied

Successful desensitization of a child with desferrioxamine hypersensitivity.

Desferrioxamine is produced by a type of actinomycetes. It reacts with trivalent iron ions and forms a hydrosoluble complex called ferrioxamine B. This complex is able to remove iron from ferrous protein, but not from hemoglobin. This feature permits its use for the treatment of chronic iron accumulation such as that which occurs in thalassemia. Only two cases of successful desensitization to desferrioxamine hypersensitivity have been previously described. This paper describes a case of desensitization in a six-year-old girl with desferrioxamine hypersensitivity. She suffered from Cooley's disease and had received blood transfusions since the age of three months. From the age of four years, the patient was treated with desferrioxamine, which was interrupted after the occurrence of urticaria-angioedema. Skin and patch tests an in vitro lymphocyte transformation test were negative, indicating a pseudoallergic reaction. The desensitization treatment lasted twenty-one days and, afterwards, the patient was able to tolerate desferrioxamine therapy at the dose previously administered (400 mg/day, subcutaneously).

Child↗
PubMedDate not supplied

Positive allergological tests may turn negative with no further exposure to the specific allergen: a long-term, prospective, follow-up study in patients allergic to penicillin.

Preliminary literature reports suggest the possibility that, in an allergic patient, a previously positive allergological test may turn negative after a long period of time with no further exposure to the specific allergen. The aim of this study was to evaluate the rate by which a previously positive skin test or RAST may turn negative in a group of patients allergic to penicillin if no further exposure to the specific allergen occurs. Sixty-three patients allergic to penicillin (48 with type I allergy and 15 with type IV allergy) were enrolled in a long-term, prospective, follow-up study, undergoing a successive complete allergological testing within 6 years of the first positive examination. During the follow-up period, skin tests progressively became negative in 28 (58.3%) type I allergic patients and in only one (6.7%) subject with type IV allergy. Similarly, the positive RAST turned negative in as many as 13 subjects (43.3% of cases). The cumulative skin test positivity (type I allergy) was significantly lower than that of patch tests (type IV allergy) (chi 2 = 10.4; d.f. = 1; p < 0.005, Logrank test). No significant difference in the progressive rate of decrease in skin test and RAST cumulative positivity was observed in the 30 patients showing both RAST and skin test positivity on entering the follow-up study. Our results provide strong evidence that a positive allergological test performed in a drug-allergic patient may become negative with time, in the absence of further exposure to the specific antigen. A negative allergological test cannot, therefore, rule out the immunological basis of a drug sensitivity. This is why we always suggest advising patients with a personal history of drug hypersensitivity against any further administration of the responsible drug, even in the presence of a completely negative allergological examination.

Adolescent↗
PubMedDate not supplied

Food allergy in children: results of a standardized protocol for oral desensitization.

BACKGROUND/AIMS: Food allergy in children is still an unresolved problem that merits investigation, particularly when the food is fundamental for the child's growth. Reports in the literature that deal with the possibility of a desensitizing treatment are sporadic and often inconsistent, and no standardized protocols are yet available. In this paper we propose a standardized oral desensitization program for food allergy in children. METHODOLOGY: The treatment was carried out in 14 cases with allergy to food (milk in 6 cases, egg in 5, fish in 2 and apple in 1 case). The control group consisted of 10 age and sex matched allergic subjects (5 to milk, 4 to egg and 1 to fish), who underwent a strict elimination diet regimen. RESULTS: Compliance to treatment was satisfactory, since 12 out of the 14 treated cases (85.7%) completed the program. Treatment was successful in 100% of the cases that completed the program: all the treated patients are now able to tolerate any food with no untoward effects or need for preventive drugs. CONCLUSIONS: The proposed standardized oral desensitization treatment may represent a safe and convenient alternative in the management of food-allergic subjects.

Adolescent↗