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Biomedical subjects

M Crivellaro

Publications and source records attributed to M Crivellaro.

At least 19 recordsLinked to original sources
PubMed2005

Anaphylaxis due to Brazil nut skin testing in a walnut-allergic subject.

The diagnosis and management of nut allergy can be difficult because of the possible severity of the clinical manifestations and the cross reactivity between different species. We report a case of anaphylaxis due to skin testing in a young adult with clinically ascertained walnut allergy. After an episode of anaphylaxis due to walnut ingestion, a routine diagnostic workup was carried out, involving skin prick test with commercial extracts, prick by prick with fresh food and CAP-RAST assay for different nuts. Immediately after pricking with fresh Brazil nut, a severe episode of anaphylaxis occurred, that required epinephrine and intravenous steroids. The subject had never eaten Brazil nut before. Therefore we hypothesize a cross reactivity effect, since this phenomenon is well known for tree nuts. Our case suggests that in vivo diagnosis, especially if fresh nuts are used, should be performed only if adequate equipment to treat anaphylaxis is available.

Adolescent↗
PubMed2004

Evaluation of the nocebo effect during oral challenge in patients with adverse drug reactions.

The nocebo effect is the onset of untoward reactions following the administration of an indifferent substance. The oral challenge with alternative drugs plays a central role in the management of drug allergy and the use of inert substances is part of this procedure. We evaluated the occurrence and clinical characteristics of nocebo effect in patients with adverse drug reactions. Six hundred patients, seen in three different centres (Genoa, Naples and Verona) with a history of reactions to drugs, underwent a blind oral challenge with the administration of an indifferent substance and active drugs. The administration of an inert substance provoked untoward reactions in 54 patients (27%) in Verona, 60 (30%) in Naples and 48 (24%) in Genoa. The overall occurrence of nocebo effect was 27%. The majority of reactions were subjective symptoms (itching, malaise, headache etc), perceived as troublesome by all subjects. The occurrence was significantly higher in women than in men. Our data, collected in a large population, confirm that the nocebo effect occurs frequently in clinical practice. In managing adverse drug reactions through oral challenge the nocebo effect is mandatory to recognize false positive responses.

Adolescent↗
PubMed2002

A double-blind, placebo-controlled study on the diagnostic accuracy of an electrodermal test in allergic subjects.

BACKGROUND: Many unconventional diagnostic procedures based on bioelectrical skin responses are presently widely used for allergic diseases, but rigorous experimental evaluations of their accuracy are still lacking. AIM: We assessed whether an electrodermal device can correctly diagnose respiratory allergy. METHODS: The diagnostic accuracy of the electrodermal device was assessed in double-blind fashion in 72 allergic patients and 28 healthy volunteers. A random sequence of substances in sealed vials, including histamine, allergens, immunoglobulins at various dilutions and physiological saline, were tested in duplicate in each subject. RESULTS: A wide variability of the measurements was found in most patients irrespective of their allergy status and of the substance tested. Allergic patients showed more negative skin electrical response at the second trial, compared to normal controls, independent of the tested substance. No significant difference in skin electrical response between allergens and negative controls could be detected. CONCLUSION: We conclude that the studied bioelectrical method, under blind testing, cannot correctly detect respiratory allergy.

Adolescent↗
PubMed1997

Use of the paediatric bronchoscope, flexible and rigid, in 51 European centres.

We have undertaken a survey to establish current practices and differences in the use of bronchoscopes in children in European centres. A questionnaire was sent to all 220 members of the Paediatric Assembly of the European Respiratory Society (ERS). The questions concerned the following points: indications for bronchoscopy; site of bronchoscopy; type of sedation; any oxygen supplementation during the procedure; number of procedures performed in the previous 12 months; number of procedures performed in the neonatal intensive care unit; number of bronchoalveolar lavages (BALs); side-effects during and after the procedures; and diagnostic yield. Fifty one European centres (40.8% of the European centres contacted) took part in the study. A total of 7,446 bronchoscopies had been performed in the last 12 months: 4,587 using the flexible bronchoscope and 2,859 using the rigid bronchoscope. At centres using only the fibreoptic bronchoscope, the most frequent indication was "recurrent/persistent pneumonia" (17%); at centres using only the rigid bronchoscope, it was "foreign body inhalation" (36.7%); at centres using both methods, the most frequent indication was "other indications" (23.9%). In 12 months, 2,231 BALs were performed: 1,419 in immunocompetent children and 812 in immunocompromised patients. In centres using only the fibreoptic bronchoscope, the highest yield was for "stridor" (81%); in centres using only the rigid bronchoscope, the highest yield was for "persistent atelectasis" (68%); and in centres using both instruments, it was for "foreign body inhalation" (93%). The results of the study suggest that bronchoscopy in children is now a well-established procedure at several European centres, while others are just beginning to use this technique.

Bronchoalveolar Lavage Fluid↗
PubMed1991

[Computerized tomography in the follow-up of inferior vena cava filters].

CT was employed to evaluate IVC filters in 37 patients; most devices (25) were Greenfield filters. Filters were localized below the renal veins in 26 patients; a suprarenal position was observed in 11 cases. Filter malpositioning was shown by CT in 1 case (filter partially located in the left renal vein); migration of the device into left pulmonary artery was detected in 1 patient. IVC perforation occurred in 11 cases--in 6 of them, the filter penetrated into adjacent structures (duodenum in 2 cases, abdominal aorta in 2, liver in 1, and right kidney in 1 patient). IVC thrombosis was seen in 16 patients; complete caval obstruction developed in 2 cases two or more years after filter positioning. IVC perforation caused by a filter is a frequent complication (30% of our series), but in most cases it is asymptomatic and has no significant clinical relevance; surgical removal of the filter had to be performed in 3 cases only. CT scanning is a valuable adjunct to plain abdominal radiography in the follow-up of IVC devices, when a complication (especially IVC perforation) is suspected.

Adolescent↗
PubMed1991

[Detection of small bone lesions with digital radiography using storage phosphors].

To date, the skeletal imaging capabilities of digital radiography with storage phosphors have been poorly investigated, and the diagnostic accuracy of this technique has not been thoroughly assessed. To evaluate the performance of storage phosphor digital radiography we compared 66 conventional and 66 digital radiographs of small abnormalities of the extremities (fractures, erosions, calcifications). Conventional images were obtained with a low-speed screen-film system while digital ones were acquired with high-resolution (5 lp/mm max) phosphors and laser-printed on a 8" x 10" film. Two experienced radiologists defined the gold standard (389 abnormalities) and four radiologists scored the findings (1,556 observations) on a five-point discrete scale. ROC analysis indicated film and storage radiography to be equally effective in the overall detection of abnormalities. No difference was found in the individual performances of the four readers, in the site subclasses (wrist, hand), and in the specific detection of fractures and erosions. Digital radiography proved to be superior to conventional radiography in the detection of calcifications in all sites and particularly in the wrist (p less than 0.05). Storage phosphor radiography may replace conventional radiography of the extremities without causing any significant decrease in diagnostic accuracy.

Bone Diseases↗
PubMedDate not supplied

Anaphylaxis due to carrot as hidden food allergen.

Carrot is frequently involved in food allergies and oral allergy syndromes, usually in association with other foods. Nevertheless, carrot alone is rarely responsible for severe systemic reactions. We report a case of anaphylactic shock due to the inadvertent ingestion of carrot as a hidden allergen contained in an ice-cream. The etiological role of carrot in provoking the symptoms was thoroughly ascertained through appropriate in vivo and in vitro assays and by excluding, through double-blind placebo-controlled challenge, the involvement of other ingredients of the food. We highlight once again the harm and risks due to hidden food allergens contained in commercial preparations and the importance of thorough patient education and information.

Adult↗
PubMedDate not supplied

Severe systemic reactions caused by poppy seed.

We describe a case of severe systemic reactions caused from poppy seed ingestion. Poppy seeds were suspected to be responsible for the symptoms on the basis of the clinical history. This suspicion was confirmed by skin testing and the prick-prick test. Moreover, a RAST assay was conducted with an extract of fresh food, confirming the presence of specific IgE to poppy seed. Although poppy seeds are not commonly used, we highlight the possible importance of such rare and often hidden sources of allergens.

Adult↗
PubMedDate not supplied

Beer-induced anaphylaxis due to barley sensitization: two case reports.

Despite the large worldwide beer consumption, allergic reactions have very rarely been reported. We describe two cases of severe systemic reactions due to beer ingestion: one case of anaphylaxis requiring emergency care and one of generalized urticaria and angioedema. The two patients underwent a detailed diagnostic procedure involving skin testing, oral challenge with additives, detection of specific IgE to the components of beer, and oral challenge with beer in one patient. The results of the tests, in the particular skin tests and IgE assay, allowed us to detect barley as the specific ingredient responsible for the observed allergic reactions to beer. Therefore, such a sensitization should always be taken into account in the case of suspected reactions following beer ingestion.

Adult↗
PubMedDate not supplied

[Occupational asthma induced by casein inhalation].

Reported cases of occupational asthma due to inhalation of milk proteins are rare. Our report is about the first evidence of occupational asthma in a health care worker, caused by an hidden exposure to casein, contained in a commercial dermatological powder widely used in geriatric patients treatment. The diagnosis is based on the case-history and on the positive skin prick test to a commercial and extemporary extract of the occupational allergen.

Adult↗
PubMedDate not supplied

Parenchymal brain leukemia. Case report: problems related to the diagnosis and treatment.

A case of intracerebral nodular leukemic mass that developed in a girl eight years after a diagnosis of acute lymphoblastic leukemia (ALL) and 18 months after second discontinuation of therapy for a central nervous system (CNS) relapse is reported. The morphologic picture and the long time that elapsed from the diagnosis raised the suspicion of a cerebral neoplasm; the immediate and dramatic effect of steroid treatment, on the contrary, indicated the presence of a leukemic infiltration and in the meantime, a bone marrow relapse occurred. The patient soon after received high-dose Cytosine Arabinoside (HD ARA C) + Vincristine (VCR) + Levo-Asparaginase (L-ASE) + Prednisone (PDN) without any intrathecal antiblastic drug. We observed a neurological recovery and a complete disappearance of the mass. After consolidation of the remission the patient began an ablative regimen for bone marrow transplantation. The efficacy of HD ARA C in the treatment of the intracerebral nodular leukemic mass is emphasized.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

[Epidemiology of allergic respiratory diseases: many questions, few answers].

Over the last twenty years an increase of allergic respiratory diseases has been observed, even if a broad variability of incidence has been reported. Asthma and allergic rhinitis are more common among young subjects, but there are data of an increase of allergic respiratory diseases in older patients. Moreover it has to be underlined the increase of the severity of these diseases, as shown by the higher use of anti-allergic drugs and by the increase of fatal asthma. The reasons of this trend are not understood. One reason can be the more appropriate diagnosis of asthma by the general practitioners. Other factors must be considered: the most important one can be air pollution; many air components (i.e. SO2, NO2, O3), particularly in industrialized countries, may play a role in allergic sensitization through an irritative-inflammatory mechanism. Socio-economic factors can also influence the incidence of allergic diseases. Other factors as cigarette smoke, foods, allergenic load have to be mentioned. Finally a viral etiology has been reported. Very recently, the allergic inflammation has been considered as the crucial event in the pathogenesis of allergic respiratory diseases. As allergic diseases can lead to chronic inflammation, an early and long-lasting treatment is mandatory.

Adolescent↗