Anaphylaxis to the anticoagulant acid citrate dextrose.
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Adult↗
Biomedical subjects
G G Riario-Sforza
Publications and source records attributed to G G Riario-Sforza.
Urticaria-angioedema reaction caused by propafenone.
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Angioedema↗
Guidelines versus clinical practice in the treatment of COPD: a reappraisal.
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Adult↗
Dose dependence of efficacy and safety of subcutaneous immunotherapy.
A number of experimental and clinical evidence has shown that exposure to high amounts of allergen molecules favours the development of tolerance. This is true also for subcutaneous immunotherapy (SCIT), for which a dose dependence of clinical efficacy was clearly demonstrated. The effective doses, measured as microg of major allergens, to be administered during maintenance treatment were established for the main allergens. Regarding pollens, the range of effectiveness corresponds to 25-41 and 13-20 microg of major allergens Phl p 5 and Phl p 6 for grasses, to 10-47 microg of Amb a 1 for ragweed, to 12 microg of Bet v 1 for birch, and to 6.2 microg of Par j 1 for Parietaria. With house dust mites, a maintenance dose of 5-11.5 microg of the major allergen from Dermatophagoides pteronyssinus Der p 1 is associated to clinically relevant effects, and with cat epithelium the clinical success is observed using a dose of 13-15 microg of Fel d 1. Nevertheless, there are adverse reactions facing SCIT, which are related to the amount of injected allergen. In fact, the safety decreases when the administered doses increase. This has led to "optimal doses" being defined which show a good balance between efficacy and safety (corresponding for example to a dose of 7 microg for Der p 1 and of 13 microg for Fel d 1). The dose dependency with respect to both efficacy and safety makes essential to accurately consider the risk/benefit ratio in each patient eligible for SCIT.
Allergens↗
Different outcomes of pulmonary rehabilitation in patients with COPD with or without exacerbations.
BACKGROUND: Pulmonary rehabilitation is recognised as an effective treatment in reducing disability and improving the quality of life in patients with COPD. We evaluated the effects of a course of pulmonary rehabilitation in improving the physical performance and lung function in patients with or without COPD exacerbations. METHODS: 74 patients with COPD were enrolled, 37 (24 males and 13 females, mean age 74.6 years) without exacerbations (group A), and 37 (23 males, 14 females, mean age 73.9 years) with exacerbations (group B). The latter must have had the latest exacerbation at least one month before the inclusion. All patients underwent to a rehabilitation programme of 8 visits in 4 weeks in a day-hospital setting, with exercise training, respiratory muscle training and education on COPD. The changes in physical performance and lung function in respect to baseline were measured by a 6-minute walking test, using phethysmography, and by an analogic manometer measuring maximal inspiratory and expiratory pressures (MIP, MEP). RESULTS: Patients of group A showed a mean increase in timed walk distance of 58.38 +/- 57.46 m, compared to a mean increase of 31.38 +/- 44.78 m in group B patients (p = 0.028). As to lung function, a mean increase of 178.92 +/- 132.28 ml in FEV1 in group A versus 67.84 +/- 102.04 ml in group B (p < 0.0001) and a mean increase of 22.36 +/- 25.06 cm H2O in MEP in group A versus 7.70 +/- 12.28 cm H2O in group B (p = 0.002) was found. CONCLUSIONS: These findings indicate that patients with COPD with exacerbations achieve a less favourable outcome of pulmonary rehabilitation, with a significantly lower improvement of physical performance, respiratory muscle strength and lung function in respect to subjects without exacerbations.
Aged↗
Atopy and intolerance of antimicrobial drugs increase the risk of reactions to acetaminophen and nimesulide in patients allergic to nonsteroidal anti-inflammatory drugs.
This study evaluated the risk factors for developing allergic reactions to alternative drugs such as acetaminophen and nimesulide in 367 patients intolerant of nonsteroidal anti-inflammatory drugs (NSAID) compared to 243 healthy controls. All subjects were given test doses (TD) of acetaminophen and nimesulide, and age, sex, atopy, and history of reactions also to unrelated drugs were compared in those who reacted and those who were tolerant of the challenge. TD was positive in 49 of 367 (14%) NSAID-allergic patients and in one (0.4%) of the controls (P<0.001). No difference was found in age and sex between the TD-positive and TD-negative subjects, although a significantly larger number of females were NSAID allergic (P<0.01). Of the 367 patients, 208 had a history of reactions only to NSAID, and 148 to NSAID and antimicrobial drugs (AMD). TD with acetaminophen or nimesulide was positive in 6% of patients intolerant only of NSAID and in 24% of those intolerant of both NSAID and AMD, with an odds ratio of 4.82. Atopy was more frequent among patients (36%) than controls (23%) (P=0.004), among TD-positive (51%) than TD-negative patients (33.5%) (P<0.02), and among patients intolerant of NSAID and AMD (48%) than those intolerant only of NSAID (P=0.006). The odds ratios were, respectively, 1.87, 2.57, and 3.16. This study provides evidence that atopy and history of allergic reactions to AMD increase the likelihood of intolerance of usually well-tolerated alternative drugs such as acetaminophen and nimesulide in subjects allergic to NSAID.
Acetaminophen↗
Cut off values of bone mineral density defining postmenopausal women with bone fractures.
OBJECTIVES: To define cut off values of bone mineral density (BMD), measured at different forearm sites by single photon absorptiometry, that discriminated postmenopausal women who have had fractures from those who have not, in order to provide an index of fracture risk for screening purposes. METHODS: BMD values were measured at distal third radius (DTR) and ultradistal radius (UDR) sites in two groups of postmenopausal women. Group 1 (n = 398) had not suffered fractures, and group 2 (n = 354) had appendicular fractures. Results were evaluated using receiver operating characteristic (ROC) curves. RESULTS: BMD values were significantly greater (p < 0.001) at both sites in group 1. Weight was lower in group 2 than in group 1 (p < 0.001). The BMD cut off value was 0.596 g/cm2 at DTR (sensitivity 63%, specificity 72%), and 0.310 g/cm2 at UDR (sensitivity 80%, specificity 80%). Values of area under ROC curves estimated for UDR were greater than for those DTR (p < 0.001). CONCLUSION: For screening purposes the BMD cut off value of 0.310 g/cm2 at the UDR may be useful in identifying women at high risk of fracture in an unselected postmenopausal population. BMD measured at UDR appeared to have a better predictive value than that at DTR.
Absorptiometry, Photon↗
Comparison of rhinomanometry, symptom score, and inflammatory cell counts in assessing the nasal late-phase reaction to allergen challenge.
Inspiratory nasal resistance, symptom score, and influx of inflammatory cells into the nose were evaluated before and after a nasal challenge in 15 patients with grass pollen rhinitis and in six nonallergic control subjects, to study the nasal late-phase reaction and its relationship with nasal cytology. All patients had an immediate positive reaction to specific nasal challenge. In seven allergic subjects we observed a later inspiratory nasal resistance increase, but only two had a significant late symptom score. Inflammatory cells increased by 8 hours in all the patients; the higher the cell influx, the higher the symptom score. Close correlations were found between the inspiratory nasal resistance increase, nasal obstruction at hours 8 and 24, and all cell counts. In control challenges there were no significant increases of symptom score or inspiratory nasal resistance either during the challenge or in the next 24 hours. A weakly significant increase was found only for neutrophil counts at 8 hours. These results indicate that an inflammatory reaction constantly occurs after a specific nasal challenge; its extent is closely related to inspiratory nasal resistance and to the intensity of nasal obstruction. Moreover, our data outline the pivotal role played by eosinophils and basophils in the genesis of an allergic late-phase reaction in the nose.
Adolescent↗
Importance of allergic etiology in nasal polyposis.
Sensitization to environmental allergens in nasal polyposis was evaluated in an in vitro study conducted on 90 patients undergoing polypectomy by measuring total and specific IgE for a panel of common allergens and levels of IgG, IgA and albumin in serum, and nasal secretions (NSe). Fifty healthy individuals were chosen as a control group. Total IgE concentrations were higher in patients with nasal polyps than in controls. RAST was positive in serum in 34 (38%), in NSe in 29 (32%), and exclusively in NSe in 10 patients (11%). Allergens most frequently involved were mites and cat dander. No differences were found between the study and control groups for serum and NSe IgA, albumin, and serum IgG, whereas IgG in NSe were significantly higher in patients with nasal polyps. Subjects with positive RAST only in NSe had significantly lower secretory IgA than did controls. Our data indicate that in nasal polyposis: 1) sensitization to aeroallergens is relatively common; 2) a local production of specific IgE may occur, especially for perennial allergens; 3) prolonged exposure to these allergens gives rise to chronic nasal inflammation, with altered local production of immunoglobulins.
Adolescent↗
Sensitization to cockroach in Italy: a multicentric study.
The prevalence of sensitization to cockroach (CR) was evaluated by skin prick test (SPT) in 1299 patients consecutively referred for rhinitis and asthma to five allergy centers in northern, central, and southern Italy. In patients with positive SPT to CR, an SPT with D. pteronyssinus extract was made. RAST inhibition was performed with pooled sera of subjects with positive SPT and RAST of at least Class 3 for CR and D. Pteronyssinus, to assess the cross-reactivity between these two allergenic sources. The protein content of allergen extracts was assayed by isoelectric focusing (IEF). A total of 170 patients (13%) had a positive SPT with CR extract, and 133 of them (78.2%) were also positive for D. pteronyssinus. RAST inhibition showed a cross-reactivity between CR and D. pteronyssinus, and IEF detected in the extracts employed a series of bands focusing at the same pI of CR and D. pteronyssinus relevant allergens. Therefore, the prevalence of sensitization to CR in the population studied, corresponding to 13%, suggests that CR extract might be added to standard SPT panels for respiratory allergy. However, the cross-reactivity with D. pteronyssinus calls for careful evaluation of the clinical importance of this sensitization.
Adolescent↗
Determination of cut-off positivity values in nasal challenge testing of patients with allergic rhinitis.
Nasal challenge testing with allergen extracts is currently used to diagnose nasal allergy and, to a greater extent, in studies of pathophysiology of allergic rhinitis. The resulting nasal obstruction, measured as nasal airway resistance (NAR), is determined by rhinomanometry (RMM). The aim of this study was to define a cut-off NAR value for a positive response in a nasal allergen challenge test. Forty-two, grass-allergic adult patients and 40 nonallergic adults were challenged out of the grass pollen season under standard conditions with timothy grass extract administered intranasally in doses increasing from 10 to 1500 IU/mL. Inspiratory NAR was determined by computerized anterior active RMM. The cut-off value for a positive test was determined from receiver operating characteristic curves plotted from these data with the LABROC1 computer program. In addition, the subjects' nasal cycle was recorded during the four hours preceding the allergen challenge. The patients' mean NAR value at baseline (0.33 Pa/cc/sec) and when challenged with normal saline solution did not differ from those of the control subjects. The patients, but not the control subjects, experienced typical nasal allergic symptoms when challenged with the grass extract. The control subjects had no symptoms and their NAR did not change significantly when they were challenged with the same extract. All 42 allergic patients had measurable increases in NAR at the 800 IU/mL allergen dose; 19/42 patients had complete obstruction (i.e., NAR unmeasurable) when challenged with the 1500 IU/mL dose. The maximum diagnostic value (= sensitivity + specificity at the discriminator position on the receiver operating characteristic curves) was 1.96 with the 800 IU/mL dose. At that dose, the NAR cut-off value was 0.91 Pa/cc/sec, which was 2.7 times greater than their mean value at baseline. NAR varied less than 1-fold between the maximum and minimum points of the normal nasal cycle in both groups of subjects. An increase of NAR of nearly three-fold during nasal allergen challenge compared to the baseline value determined by computerized anterior active RMM discriminates best patients with allergic rhinitis from nonallergic adults.
Adult↗