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Biomedical subjects

G Marseglia

Publications and source records attributed to G Marseglia.

13 recordsLinked to original sources

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↗

Screening spirometry to detect respiratory allergy.

BACKGROUND: Recently, it has been evidenced that the forced expiratory flow at the 25 and 75% of the pulmonary volume (FEF25-75) might be considered as a possible marker of early bronchial impairment in patients with allergic rhinitis alone. OBJECTIVES: The aim of this study was to determine whether a spirometric impairment may predict allergy during screening visit. METHODS: The study included 283 Navy soldiers (255 males, mean age 27.1 + 8.2) who had to undergo spirometry for attending specific courses. Fifty-four showed slight spirometric anomalies. Thus, they referred to Navy Hospital of La Spezia for standardized tests: skin prick test, spirometry, and methacholine bronchial challenge. RESULTS: Forty seven (87%) subjects were sensitized (47% monosensitized and 53% polysensitized). Allergic rhinitis was diagnosed in 25 subjects with median nasal TSS 5. FVC and FEV1 values were normal, whereas FEF25-75 values were reduced (61.8 + 14.8 % of predicted), bronchodilation test was significant for FEF25-75 (82.9 + 16.8% of predicted; p<0.001) only. Bronchial hyperreactivity (BHR) was detected in 28 subjects, all but 1 were sensitized. CONCLUSIONS: This study provides evidence, relevant to clinical care, that mild spirometric impairment may generate the suspect of allergic disorders, thus spirometry could be more frequently performed in general population screening.

Adult↗

Bronchial hyperreactivity and spirometric impairment in patients with allergic rhinitis.

BACKGROUND: The Link between allergic rhinitis and asthma is well known. Bronchial hyperreactivity (BHR) may be present in rhinitics. The present study is aimed at evaluating a large group of subjects suffering from allergic rhinitis alone to investigate the presence of spirometric impairment and BHR both during and outside the pollen season. METHODS: 360 rhinitics (subdivided in 3 groups: seasonal, SAR, perennial, PAR, and polysensitized, PolysR) were investigated by spirometry and methacholine challenge. RESULTS: There was a significant seasonal difference concerning the number of rhinitics with impaired FEV1 (p<0.01 for SAR, p<0.02 for PAR, and p<0.03 for PolysR) and FEF25-75 (p<0.05 for SAR, p<0.03 for PAR, and p<0.05 for PolysR) as well as with BHR (p<0.05 for SAR and p<0.03 for PAR). CONCLUSIONS: This study evidences that an impairment of spirometric parameters and BHR may be observed in patients with allergic rhinitis alone. Thus, careful evaluation of lower airways should be performed in patients with allergic rhinitis alone.

Adult↗

Sublingual specific immunotherapy reduces PBMC proliferations.

BACKGROUND: Subcutaneous specific immunotherapy has been demonstrated capable of inducing T regulatory response. There is few evidence concerning immunological changes induced by sublingual immunotherapy. OBJECTIVE: The aim of this study was to evaluate T cell proliferation in subjects successfully treated with SLIT for HDM. METHODS: PBMCs were isolated from patients after at least 3 years of successful HDM SLIT and from matched untreated allergic and healthy control subjects. After 3 and 6 days of in vitro stimulation with PHA, Candida albicans, Dermatophagoides farinae, grasses, Parietaria judaica, and cat, proliferation. RESULTS: Subjects treated with SLIT showed significant reduction of proliferation induced by Candida albicans, Parietaria, and grasses in comparison with untreated atopics (p=0.0002, 0.0033, and 0.009 respectively). CONCLUSION: This pilot study confirms reduced T cell proliferation in allergic subjects treated with SLIT.

Administration, Sublingual↗

Long term persistence of anti-HBs protective levels in young patients with type 1 diabetes after recombinant hepatitis B vaccine.

The aim of the present study was to evaluate the persistence of anti-hepatitis B protective levels in young patients with type 1 diabetes, successfully immunised with a recombinant hepatitis B vaccine. We re-evaluated, after a 4 year follow-up, 54 patients and 70 age and sex-matched healthy subjects. Protective antibodies levels were found in 50/54 (92%) patients and in 67/70 (96%) controls. Moreover, anti-HBs levels were similar in diabetic patients and controls (means of log-titre and (sd); 1.95 (0.88) and 2.18 (0.64) patients and controls, respectively; P=0.11). No cases of clinical hepatitis were reported and all patients and controls remained HBc negative. These data demonstrate the persistence of anti-HBs levels in children, adolescents and young patients with type 1 diabetes after recombinant hepatitis B vaccine showing evidence of longterm immunogenity and protective effect.

Adolescent↗

AIDS: outcome of children born to HTLV-III/LAV infected mothers. Report of 15 Italian cases.

The characteristics of acquired immunodeficiency syndrome (AIDS) in children have been described in several reports. The occurrence of specific anti-HTLV-III/LAV seropositivity in children born to seropositive mothers is also becoming more frequent in Italy. We report 15 cases of seropositive children born to 14 seropositive, drug-addicted mothers. Among them, 5 died of AIDS, 8 developed a variable, non-progressive AIDS-related complex (ARC), while only two remained persistently asymptomatic. Liver disease was present in 2 patients, CNS disease in 4, gastrointestinal troubles were never a major problem. Only 2 cases of HBV infection and 3 of thrombocytopenia were observed. In our experience, homosexual behaviour of the parents was never a cause of family risk. Children presented with failure to thrive and/or signs of disease usually within the first five months of life. In one family the first child was affected by fatal AIDS while the younger child showed only passive, transient immunization by maternal specific IgG. One ARC patient, observed for over 3 years, showed apparently complete healing from the disease.

Acquired Immunodeficiency Syndrome↗

Lymphocyte subpopulations in the neonate: in vitro proliferation, IL-1 and IL-2 production by a subset of HNK-1-, OKT3-, OKT8+ lymphocytes displaying NK activity.

Neonatal lymphocytes include a subset of E-, OKT3-, OKT4-, OKT8+, HNK-1-, OKM1- cells displaying natural killer (NK) activity. More than 50% of these cells react with the B73.1 monoclonal antibody, moreover most of them bear the DR antigen, the receptor for Peanut agglutinin (PNA) and react with the OKT10 monoclonal antibody. This neonatal subset displays a higher NK activity than unseparated cord blood lymphocytes (CBL) and the present study shows that it is sensitive to boosting effect of IFN-B preincubation. When stimulated with T cell mitogens E-, OKT3-, OKT8+ CBL both produce Interleukin-2 (IL-2) and proliferate. Moreover this neonatal subset produces Interleukin-1 (IL-1) both spontaneously and in response to lipopolysaccharide (LPS). It has been previously suggested that these neonatal cells include a common precursor of NK and T cells. The present study further strengthen this hypothesis.

Antibodies, Monoclonal↗

Association of neutrophil and complement defects in two twins with Shwachman syndrome.

Immunological functions were studied in two 22-month-old dizygotic twins with the characteristic features of Shwachman syndrome. A severe defect of neutrophil motility was found in both children, but not in their parents. An impairment of the activity of the alternative pathway of complement was present in the sera of both patients. This defect, in association with the neutropenia and the chemotactic defect, might be related to the recurrent infections displayed by the twins.

Chemotaxis, Leukocyte↗

Acquired immune deficiency syndrome in childhood: impaired production of interleukin-2 by HIV (LAV/HTLV III) infected patients.

The phenotype and functions of T lymphocytes and of natural killer (NK) cells have been investigated in four children and five adults from three Italian families infected with HIV (LAV/HTLV III). The results show a heterogeneous pattern of immunological derangements involving distribution of T and natural killer subsets, proliferation in response to T cell mitogens and natural killer activity. However, all infected patients tested showed a very low or absent phytohaemagglutinin induced interleukin-2 production regardless of age and clinical conditions, while concanavalin A-induced interleukin-2 production was within the normal range. The impaired interleukin-2 production in response to phytohaemagglutinin in some patients is not related to phytohaemagglutinin-induced proliferation, to clinical conditions or to a defective distribution of T cell subsets. These results suggest that, in our patients, both adults and children, HIV (LAV/HTLV III) has an "early" tropism for a subset of T cells involved in interleukin-2 production.

Acquired Immunodeficiency Syndrome↗