European annals of allergy and clinical immunology最新文献

Summary: Background. We aimed to describe the clinical heterogeneity (infectious and noninfectious manifestations) and the impact of immunoglobulin replacement therapy on the reduction of infections in patients given a diagnosis of common variable immunodeficiency. Methods. This was a descriptive case series study. Medical charts were retrospectively reviewed based on demographics, clinical presentation, immunoglobulin replacement therapy and laboratory findings at diagnosis. Results. Thirty six common variable immunodeficiency patients were enrolled. Nineteen of them were male (53%). The median age at onset of symptoms was 8 years and at common variable immunodeficiency diagnosis was 19 years. Family history for immunodeficiency was observed in 2 patients (5%). Recurrent infections were present in 35 patients (97%) and they were the first clinical manifestations in 31 patients (86%). Respiratory infections were the most frequent, followed by gastrointestinal infections. Noninfectious manifestations were present in 32 patients (89%), including bronchopulmonary disease, allergy, autoimmunity, lymphoproliferation, gastrointestinal disorders and malignancy. Chronic pulmonary disease and lymphoproliferation were the most common. There was an important reduction of infections 1 year after begining immunoglobulin replacement therapy, mainly pneumonia and sinusitis. Conclusions. Although the diagnosis of common variable immunodeficiency has improved over the last decade, many patients are still being referred and diagnosed late. Physicians must recognize that both infectious and noninfectious manifestations can be the initial signs of common variable immunodeficiency and are very common in these patients. Immunoglobulin replacement therapy significantly reduces respiratory infections.

Summary: Background. Mites are responsible for allergic diseases, such as asthma and rhinitis, in nearly 1.5% of the world population. It is known that nowadays, besides House Dust Mites (HDM), Storage Mites (SM) are important sensitisers in urban non-occupational dwellings, predominantly in the Mediterranean area. The main objective of our study was to analyse the clinical relevance of the most prevalent SM, Lepidoglyphus destructor, by assessing the relationship between sensitisation to the major molecular allergen Lep d 2 and allergic respiratory disease phenotype in an urban population monosensitised to this molecular allergen. Methods. Cross-sectional study which included consecutive patients evaluated in our Allergy Department between 2012 and 2018, from urban non-occupational setting, with rhinitis and/or asthma, perennial symptoms and proven sensitisation to SM Lep d 2, tested using ImmunoCAP Immuno Solid-phase Allergen Chip (ISAC) technology, which detects 112 allergens. Results. A total of 37 allergic patients were included (23 female), aged 20.1 ± 12.8, min-max 5-58 years-old. The molecular sensitisation profile showed 18.9% of L. destructor mite monosensitised patients, having only sIgE to Lep d 2. This subset of patients mainly had allergic rhinitis, with 28.6% also being asthmatic. Regarding severity, most patients showed a persistent moderate phenotype of respiratory disease. The mean value of Lep d 2 sIgE was 8.3 ± 9.8 ISU-E, lower than in mite polysensitised patients (21.7 ± 21.5, p = 0.049). Conclusions. Our proof-of-concept study focused on Lep d 2 monosensitisation, showed that SM may have clinical relevance in perennial allergic asthma and rhinitis, and should be taken into account when assessing and treating allergic respiratory disease. Conclusions. The present survey demonstrated that Italian primary care pediatricians accomplish ARIA guidelines and adapt treatment on the basis of the intensity of symptoms. Corticosteroids and antihistamines are the most common prescribed medications. Nasal lavages are also popular.

Summary: Background. Allergic rhinitis (AR) is a widespread condition. The Italian Society of Pediatric Allergology and Immunology (SIAIP) promoted an initiative to update the knowledge on AR in children and adolescents. The present survey directly addressed primary care pediatricians, thus reflecting the real-world management of AR in children and adolescents. The aim was to investigate common practice in managing AR children. Methods. A panel of experts drafted a series of questions concerning the practical management of children with AR in clinical practice. The questionnaire was administered to a large sample of primary care pediatricians (864). Results. 864 primary care pediatricians participated to the survey. Each pediatrician on average follows 94 children with AR; globally 81,231 children. More than 70% of participants follow ARIA guidelines. Accordingly, 42% of children have mild AR and 58% moderate/severe. Asthma, conjunctivitis and adenoid hypertrophy are the most common comorbidity. Most pediatricians autonomously follow their patients. The intensity of treatment (use of medication) is directly proportional to the symptom severity.  Intranasal corticosteroids are the most common medication used followed by oral antihistamines and nasal lavages (with hypertonic or isotonic solution). Up to 20% of participants prescribe the fixed association topical corticosteroids plus antihistamine. Conclusions. The present survey demonstrated that Italian primary care pediatricians accomplish ARIA guidelines and adapt treatment on the basis of the intensity of symptoms. Corticosteroids and antihistamines are the most common prescribed medications. Nasal lavages are also popular.

Summary: Background.Atopic dermatitis (AD) is a chronic pruritic inflammatory skin disease that causes sleep disturbances and worsens quality of life. However, few studies have been conducted on sleep in adults with atopic dermatitis. This study aimed to evaluate sleep and quality of life in adults with AD. Methods. A cross-sectional study was conducted with 36 adults diagnosed with AD and 21 healthy volunteers (controls), who completed questionnaires on sleep, itching, and quality of life. Disease severity was estimated using SCORing Atopic Dermatitis (SCORAD). All participants wore actigraphy watches for one week to objectively assess sleep quality. Results. Adults with AD slept worse than controls as measured by self-report (Global Pittsburgh Sleep Quality Index, mean ± SD, 9.33 ± 3.59 vs 5.00 ± 2.30, p < 0.001) and by actigraphy (sleep efficiency, SE), mean ± SD, 74.48 ± 11.63 vs 85.6 ± 6.53, p < 0.001). Actigraphy showed that adults with AD slept, on average, almost one hour less (p = 0.010), stayed awake during sleep for almost 44 minutes more (p < 0.001), and woke up 25% more than the controls (p = 0.047). In the AD group, SE and total sleep time were significantly inversely correlated with SCORAD (rs = -0.601, p < 0.001 and rs = -0.604, p < 0.001, respectively), but no significant correlation was found between itch and SE. A decreased quality of life was observed in adults with AD (DLQI, mean ± SD, 8.75 ± 6.7). Conclusions. Adults with AD slept worse than the controls and had a diminished quality of life. Actigraphy is a useful tool to objectively measure sleep quality in adults with AD especially those with moderate to severe disease.

Summary: Background. Allergen immunotherapy (AIT) is the only disease-modifying treatment in allergy. Its efficacy has been demonstrated in the treatment of Local Allergic Rhinitis (LAR) in adults. This study intends to evaluate the effectiveness of AIT in specific nasal reactivity of paediatric patients with LAR. Methods. Patients diagnosed with LAR to Dermatophagoides pteronyssinus (Dp) were submitted to subcutaneous AIT (SCIT) (depigmented-polymerized Dp allergen extracts) for 3 years. Nasal allergen challenge (NACs) with Dp extract were performed before and 3 years after AIT. NAC response was assessed with peak nasal inspiratory flow (PNIF) and symptom score of Lebel. NACs were considered positive when there was a flow decrease of ≥ 20% in PNIF and a score of symptoms ≥ 3 points. Demographic data and NAC results were analysed. Results. We included 32 paediatric patients (mean age 9.9±3.08 years, 18 female) and 10 adult patients, (mean age 30.4±12.2 years, 7 female). The symptom score obtained at the 1^st minute, 5^th minute, 15^th minute and 30^th minute in response to NAC, were reduced after AIT. The nasal inspiratory flow decrease induced by NAC was also reduced after AIT.  This reduction in nasal reactivity was observed in paediatric and in adult patients, both with statistical significance. Conclusions. AIT induced a decrease in Dp-nasal specific reactivity in children with LAR. This decline of nasal response to allergen exposure, after AIT treatment, emphasis the interest of this therapeutic approach in LAR, even in paediatric patients.