Fourteen patients with allergy to drugs (4 to synthetic corticotrophin, 3 to insulin, 4 to pyramidon, 2 to penicillin, and 1 to iodine-containing contrast media) were submitted to specific desensitizing treatment using graduated doses of the drug. Therapy was completely successful in 11 of 14 cases: in one case, the authors were forced to suspend treatment because the patient allergic to pyramidon had become pregnant; in the other cases (allergic to corticotrophin and to penicillin) the treatment was suspended because of severe adverse reactions. On the basis of the present findings, immunotherapy in drug allergy is possible and should not present any special problems: it is necessary that the treatment be carried out by highly qualified staff and preferably on hospitalized patients.

Adult↗

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[Penicilloyl-polylysine (PPL) in the diagnosis of penicillin allergy].

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Antigens↗

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Adrenaline-induced platelet aggregation in patients with chronic urticaria and in patients with multiple drug intolerance.

It is now generally accepted that the beta-adrenergic system may play a role in the pathogenesis of allergic manifestations. One of the most interesting experimental models is the adrenaline induced platelet aggregation test, in which adrenaline selectively stimulates the beta-adrenergic receptors activating adenylcyclase. This test was considered as a model in the study of beta-receptor function in patients with allergic disorders. It therefore seemed worthwhile to submit two different groups of patients to this test, namely: a) Patients with chronic urticaria. Since in the large majority of cases no immunoallergic mechanism has been detected, various hypotheses have been proposed to explain its onset. b) Patients showing intolerance to several drugs: this is a large category of patients, predominantly females, presenting allergic-like reactions, mostly of the urticarioidangioedematous type, occurring following administration of various types of drugs. The investigation was performed on subjects of both sexes, grouped as follows: a) 33 patients with chronic urticaria. b) 31 patients with multiple drug intolerance. c) 28 normal volunteers (control subjects). From the results obtained it can be concluded that a tendency toward hyperagregation was more evident in patients with urticaria and less evident in those with multiple drug intolerance. The only finding of interest concerns the second aggregation wave, which was less frequent in patients with urticaria than in normal subjects, but the difference was not statistically significant. The adrenaline-induced platelet aggregation test does not appear to provide useful information on a deficit of beta-receptor function in the patients studied.

Chronic Disease↗

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Clinical and pathogenetic relationship between chronic urticaria and morphofunctional modifications of the digestive tract.

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Chronic Disease↗

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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↗

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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↗

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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↗