Biomedical subjects

M Micera

Publications and source records attributed to M Micera.

14 recordsLinked to original sources

PubMed2003

Epidemiology of atopy in 220 children. Diagnostic reliability of skin prick tests and total and specific IgE levels.

BACKGROUND: We have prospectively studied 220 children attending our Division because they suffered from atopic dermatitis (AD), asthma, and allergic rhinitis (AR), to assess the epidemiology of atopic diseases, and effectiveness of the diagnostic tests commonly used in allergic children. METHODS: Among the 220 children there were 142 males (64.5%) and 78 females (35.5%) aged as follows: 57 (25.9%) 0-2 year-old, 48 (21.8%) 2-4 year-old, 49 (22.3%) 4-6 year-old, 66 (30%) >6 year-old. The diagnosis included family and personal history, physical examination, skin prick tests (SPT) and total and specific IgE (sIgE) levels. We tested inhalant and food allergens. RESULTS: There were 101 asthmatic, 88 with AD, and 31 children with AR. The analysis of variance confirmed the age influence of PRIST with a high significance (p=0.0001). SPTs were prevalent in all groups for Der p, but casein only in 1 group, and Lolium perenne only in 2 groups. RAST showed a higher uniformity, that is CM (cow's milk) and egg for one group, Der p and Lolium perenne for the remaining groups Several correlations among diagnostic tests and the age of children were evaluated with the analysis of variance. CONCLUSIONS: We emphasize that atopic diseases are genetically transmitted, that AD develops at a younger age than asthma (p=0.0052), and that SPTs have a greater effectiveness for inhalant allergens, positive at all age levels; in food allergy (FA) SPTs are less adequate and feasible.

Allergens↗

PubMed2001

Immunogenicity of hydrolysate formulas in children (Part 2): 41 case reports.

Hydrolysate formulas (HF) have been developed with the purpose of reducing the allergenicity of cow's milk proteins, thus providing a suitable formula for feeding babies with cow's milk (CM) allergy (CMA). More recently, used for the treatment of CMA HFs have provoked 211 reactions in babies at high risk of atopy . In this paper we report 81 babies, who attended the Allergy and Clinical Immunology Division of the Pediatric Department of Rome University "La Sapienza" (study children) between June 1997 and October 1998, 41 of whom were tested with Nidina HA (a whey partial HF) and 40 with whole CM. Ninety-seven healthy children with no history of atopy of comparable age and sex formed the control group. All study children reacted to Nidina HA and to CM with similar symptoms. All the control babies tested negative. With these 41 case reports the number of reactions to HFs totals 252. These data strongly indicate that partial HFs may be allergenic not only in an already sensitized individual, but also immunogenic in a predisposed baby.

Animals↗

PubMed2001

Transgenic foods, pesticides, dioxin, passive smoke. Consequences on breast milk.

In recent years the efforts of companies manufacturing cow milk (CM) formulas have led to the development and availability of special formulas, which have dramatically reduced the morbidity of infants with food allergy (FA). However, the safety of several infants and children with food allergy is put to a severe test by transgenic foods, pesticides, and dioxin entering the scenario, also provoking breast milk contamination. Regarding transgenic foods, it is significant the attitude taken against people attempting to call them Frankenstein food, whereas pesticides and dioxin present in dietary foods for infants and young children, after a first arising of alarmed and inflamed controversies, have almost fallen into oblivion. Several of these substances are able to trigger immune alterations. Recent reports have shown that pears can contain pesticides in 54% of cases, a finding which obliges us to review elimination diets devised for allergic babies. However, these foods are far from being ideal both from the nutritional adequacy and hypoallergenicity; moreover, passive smoke is now a genetic factor. We would like to stress, according to the Latin wisdom that stands on the portal of our Clinic in puero homo, which means. In infant is the seed of the future man, that our goal is not only to reduce morbidity and mortality, but mainly to insure the best quality of life both to infants and adults.

Dioxins↗

PubMedDate not supplied

Immunogenicity of hydrolysate formulas in children (part 1). Analysis of 202 reactions.

Cow's milk protein hydrolyzed formulas appeared in the 1940s with the aim of decreasing or eliminating the allergenicity of cow's milk proteins, in addition to reducing the risk of sensitization. In recent years, the so-called "hypoallergenic" formulas have been developed. The use of such hydrolyzed formulas is based on the premise that predigested proteins, when fed as amino acids and peptides, provide nutrients in a nonantigenic form. Thus, protein hydrolyzed formulas have been classified as hypoallergenic. These formulas are processed by heat and enzymatic hydrolysis, and the conformational and sequential structures are more or less changed. The formulas contain peptides of lower molecular weight than the native protein source, which are thought to be less immunogenic. Hydrolyzed formulas appear to be nutritionally adequate and infants generally gain weight until they refuse the formula because of its bad taste. However, caution should be taken when such formulas are given for prolonged periods since no data are available on nutritional assessment of infants exclusively fed hydrolyzed formulas for several months. In this paper we report and discuss more than 202 reactions to different hydrolyzed formulas, including cases of anaphylactic shock and apparent life-threatening events. The cross-reactivity between different hydrolyzed formulas and cow's milk proteins, and the potential immunogenicity of such formulas are discussed. We conclude that none of the hydrolyzed formulas are nonallergenic, both for allergic children and for high-risk babies. Moreover, we suggest that double-blind placebo-controlled food challenge studies in larger cohorts of babies evaluated with well-defined and well-validated diagnostic methods may establish a more reliable prevalence of allergy to hydrolyzed formulas.

Humans↗

PubMedDate not supplied

Is specific immunotherapy safe and effective in children?

BACKGROUND: The effectiveness and safety of specific immunotherapy (SIT) in allergic diseases such as asthma have been increasingly questioned, some authors practically advocate to eliminating SIT as a therapeutic option for allergic patients, since the risks associated with this form of asthma treatment might be higher than the possible positive effects. OBSERVATIONS: We emphasize that several authors comment on the frequency of reactions to SIT without a sound competence. Therefore, the scope of the present study was to ascertain whether this form of therapy is safe and effective in pediatrics. Denying SIT is a misleading issue since in children not cured with SIT a risk factor for persistence of respiratory symptoms is the ongoing sensitivity to allergens. CONCLUSION: SIT consists in the administration of specific allergic extracts at progressively higher doses, with the aim to achieve a state of immunological tolerance and subsequently a reduction of clinical manifestations caused to the patients by the same allergens. We demonstrate that SIT is safe and effective in children.

Adolescent↗

PubMedDate not supplied

Can skin prick tests provoke severe allergic reactions?

BACKGROUND: Studies have reported adverse reactions during skin prick tests (SPTs), however such reactions are almost non existent in children. On the contrary, there are controversial data on the effectiveness and reliability of diagnostic tools. SPTs are considered as the more rapid and effective tool for the diagnosis of pediatric allergies. SPTs, when employed either correctly or with standardized extracts, are rapid, safe, sensitive, inexpensive on a per test basis and the results are reliable, since they are largely experimented. OBSERVATIONS: SPT is the more employed method for the diagnosis of atopic disease elicited by type I immune reactions, where sensitizing antibodies are present. However, we discuss a study surprisingly reporting six generalized allergic reactions after prick tests with fresh foods in infants less than 6 months of age out of 1,152 tested during three years (0.17% for each year). CONCLUSIONS: In this study, all reactions were treated with epinephrine and/or antihistamines, plus steroids in three cases. Purpose of the present study was to assess whether the practice of performing SPTs, either in the usual manner, or in duplicate could be a risk factor in infants with extensive eczema. Moreover, excluding young babies from STPs or even applying only one SPT each visit delays an early diagnosis. In the same period of three years, we have done SPTs in at least 10,000 children, without seeing any generalized allergic reaction.

Eczema↗

PubMedDate not supplied

Genetically modified foods and children potential health risks.

AIM: Professor Pusztai was publicly humiliated over claims that genetically modified (GM) Frankenstein food may be harmful. He was stripped of his post and described as 'muddled' by his superiors after he referred to experiments in which rats had been damaged when fed genetically-altered potatoes. Who is in an unsound scenario, supported by verbal expressions ("substantially"), should even more expend further effort in conducting scientific investigation into the safety of GM varieties of plants. OBSERVATIONS: Of particular concern is the exposure of infants and children to GM foods (GMFs) because of their possible increased susceptibility for untoward effects. Several examples stress that the ascertainment of human disease emerged after certain materials were widely used. Studies show that some compounds were not adequately tested for toxicity before their commercial introduction, whereas proper premarked testing would have prevented a prolonged exposure. CONCLUSIONS: Too often the toxicity of these substances is untested and the potential hazards that they may pose to children have not been examined. Nobody has evaluated whether intrauterine and infant exposure to GMFs may have profound permanent and irreversible consequences even in adult life. In this paper we analyse issues pertaining to children's health that have been largely ignored.

Animals↗

PubMedDate not supplied

Natural history of cow's milk allergy. An eight-year follow-up study in 115 atopic children.

BACKGROUND: Cow's milk allergy (CMA) is a disease of infancy and usually appears in the first few months of life. The evaluation of infants for possible CMA is one of the more common problems shared by pediatricians. The role of foods in determining and/or aggravating the clinical features of atopic dermatitis (AD) has been stressed in the last decades. OBJECTIVE: The aim of the present study was to investigate, in children with food related AD, the development of tolerance to the offending food(s), clinical or laboratory data to predict the development of food tolerance, and whether there are clinical or laboratory data to predict the onset of respiratory allergy. MATERIALS AND METHODS: In this prospective study we report on 115 babies, first examined at a median age of 6 months, and followed-up for 8 years. We have investigated several factors as predictive of the outcome, as follows: early onset; widespread or not-typical (reverse pattern) skin lesions, family history positive for atopy; persisting FA, high levels of total and specific IgE antibodies, association with CMA and asthma. RESULTS: All these parameters were significantly predictive of a long-term morbidity of AD children with CMA. The median age for tolerance to cow's milk was 7 years + 11 months, to egg 6 years + 6 months, and to wheat 7 years + 2 months. However a great number of both tolerant and intolerant children developed multiple sensitizations. Only 66 children (57%) acquired food tolerance, but there was the onset of asthma in 54% of cases. CONCLUSION: The natural history of CMA is not well-known, since not many related studies have been done in children. The several predictive factors, all in a negative sense, may be the norm in atopic children. We suggest possible areas of intervention in children at risk due to parental atopy. Preventive measures may induce a dramatic improvement in children with food allergy, but we stress that the long-term prognosis is challenging, since asthma prevalence may increase up to 54% during a long follow-up. Therefore, the natural history of IgE-mediated AD in atopic children sensitized to several allergens may be less optimistic than generally reported.

Animals↗

PubMedDate not supplied

Epidemiology of passive smoke: a prospective study in 589 children.

BACKGROUND: Several studies have found that in children of smoking parents there is an increased incidence of respiratory illnesses and diminished pulmonary function. In infants of smoking atopic parents IgE levels are higher, atopic symptoms start earlier, and children are more likely to wheeze if the mother smokes than if she does not. Maternal smoking of 0.5 packs or more/day was identified as a risk for asthma developing in the 1st year of life. Among the environmental measures of our prevention program there is an absolute prohibition of smoking in the house of a "at risk" baby. MATERIALS AND METHODS: We have studied 289 atopic children, 169 males and 120 females, aged 3.5 to 7.5 years, attending our Division because affected by respiratory allergy. We have asked their parents if they smoked and if there were smoking relatives in their homes, independently of the number or the packs of cigarette smoked. The parents of 300 children comparable for age and sex visiting our outpatient clinic for non respiratory disease served as controls. RESULTS: Smokers were 175 fathers and 109 mothers of the asthmatic children and 153 fathers and 89 mothers of the controls. DISCUSSION: Analysis of data shows that passive smoking is significantly associated with the development of asthma in atopic children, and that males are more at risk than females. We stress that a high number of asthmatic children have atopic, and asthmatic parents. Cigarette smoke is not only a triggering factor of respiratory allergy in babies at risk of atopy, but especially an additional genetic factor, since asthma can be more easily provoked if an atopic parent smokes (more if both parents smoke), and even in children of not atopic, smoking parents.

Asthma↗

PubMedDate not supplied

Significant decrease of IgE antibodies after a three-year controlled study of specific immunotherapy to pollen allergens in children with allergic asthma.

BACKGROUND: Specific immunotherapy (SIT) in children being not an optional treatment should be administered as soon as possible, also in children aged 2-3 years, due to the very early asthma and rhinitis onset, contrarily to opponents continuing to stress the danger of anaphylactic reactions without displaying reliable data. MATERIALS AND METHODS: We report 56 children who underwent SIT and 56 controls seen consecutevely at the Allergy and Immunology Division, Department of Pediatrics, University of Rome "La Sapienza". The control group was treated with all appropriate medications. RESULTS: They were highly in favor of SIT with statistically significant differences. We stress that IgE antibodies significantly decreased after treatment only in the study group, and IgG antibodies very significantly increased after treatment only in the study group. DISCUSSION: We demonstrate that SIT is the only treatment which can alter the natural course of respiratory diseases, whereas drugs represent only a symptomatic treatment.

Allergens↗

PubMedDate not supplied

Allergenicity of a whey hypoallergenic formula in genetically at risk babies: four case reports.

BACKGROUND: Hydrolysate formulas (HF) have been developed with the goal of reducing the allergenicity of cow's milk (CM) proteins, thus providing a suitable formula for feeding babies with CM allergy (CMA). OBJECTIVE: More recently, whey HFs have provoked 208 reactions in babies at high risk of atopy when given for CMA prevention. MATERIAL AND METHODS: We report the clinical and immunologic findings of four babies apparentlly sensitized by a partially whey hydrolysate formula (PWHF) in the nursery. They were exclusively BM (breast milk)-fed by their mothers avoiding highly allergenic foods, but experienced anaphylaxis after a re-feeding with the PWHF. RESULTS: Sensitization to PWHF seems to have occurred in the first days of life. No baby suffered from allergic symptoms during BM-feeding. DISCUSSION: These case reports suggest that a PWHF may be allergenic not only in an already sensitized subject, but also sensitizing in a genetically predisposed baby being immunogenic in the IgE system. These data strongly indicate that maternal diets during BM-feeding, in two instances suggested by family doctors, are effective as a BM complement.

Female↗

PubMedDate not supplied

Neonatal cow milk sensitization in 143 case-reports: role of early exposure to cow's milk formula.

OBJECTIVE: Cow's milk (CM) allergy (CMA) is a disease of infancy, usually appearing in the first months of life. Symptoms triggered by CM at first introduction are not completely defined. The evaluation of infants for possible CMA is one of the more common problems encountered by pediatricians. Purpose of this study was to investigate the prevalence of severe reaction to CM and clinical manifestation triggered by CM administration in the nurseries. MATERIALS AND METHODS: The series includes 143 prospectively studied CM-allergic babies. RESULTS: At the first introduction of CM, at the age of 1-8 months (median 4 months) all infants had immediate symptoms The babies were probably sensitized during the first days of life. Particularly sensitizing appears to be the exposure to CM formulas in the neonatal nursery. DISCUSSION: Little doses of allergens are more sensitizing than larger ones. We provide clear evidence of the immunological effects of oral antigen administration during the neonatal period, and discuss the possible critical allergen transmission to the nursing baby via breast milk (BM).

Animals↗

PubMedDate not supplied

A prospective study of asthma desensitization in 1182 children, 592 asthmatic children and 590 nonatopic controls.

BACKGROUND: The aim of this prospective study was to evaluate the prevalence of allergic asthma and or rhinitis (AR) in 1182 children. Systemic reactions (SRs) to asthma desensitization, previously, specific immunotherapy (SIT) in children with allergic asthma and or AR are scarcely known. MATERIALS AND METHODS: Since 1999, we have consecutively enrolled all children ranging in age from 3 to 11 years attending our Division because affected with severe asthma (592). Controls were 590 nonatopic children matched for age and sex recruited from our outpatient clinic. The study children were treated with a personalized asthma desensitization, the controls were treated with all usual medications. The parents of all children gave their informed consent. Data were analyzed using the X2 method. RESULTS: The 592 atopic children with severe asthma, 370 males and 222 females, aged 3.5 to 10.5 years, tested positive for Der p and Der f (47.1%) or for pollen allergens (52.9%). We have demonstrated a high increase of ashma incidence, since at the start there were 135 asthmatic children and 215 during 2000, with a 62.5% increase. During 2001 there were 242 children, with a 88.8% increase compared to 1999. All of these children were subjected to asthma desensitization, previously SIT (SARM, Roma). At the third yearly control, the study children had a significantly greater reduction as regards days (p = 0.0001) and nights (p = 0.0005) without asthma and drug usage (p = 0.0003) compared with drug-treated children. The number of SPTs and/or sigE to inhalants also decreased, spirometry data were also notably improved The clinically adverse events only were mild or transient. DISCUSSION: The positive results obtained in this large study add to its safety in our opinion because the children were followed by their doctors also on the basis of "as frequently as needed". Accordingly, the early onset of childhood asthma emphasizes that an early treatment is the only means to significantly abate the march of atopic asthma. We have documented an unexpected prevalence of pediatric asthma that should by evaluated in light of the very early asthma development in children which is present even before asthma would be diagnosed based on clinical symptoms The causes of this dramatic increment (10.4%/month in the last six months) may be identified chiefly in the worldwide increase in air pollution and secondhand tobacco smoke.

Antigens, Dermatophagoides↗

PubMedDate not supplied

The prick by prick test is safe and reliable in 58 children with atopic dermatitis and food allergy.

The initial diagnostic approach of food allergy (FA) is to take a detailed history and to perform a careful physical examination in the gastrointestinal, cutaneous and respiratory systems. Subsequently, verification of the relationship between the symptom(s) and the ingestion of the offending food(s) is mandatory, and finally determination of the immunologic mechanisms involved with in vivo and in vitro tests should be performed. The diagnosis of FA in infancy and in childhood is a challenge both for the pediatrician and allergist because it can be easily accomplished only when there is a correlation between the ingestion of the offending food(s) and the onset of the symptoms, and when it can be demonstrated that these symptoms are the consequence of an immunological reaction. However the underlying immunologic mechanisms may be difficult to document, and the only immunologic mechanism easily to prove in current practice is the IgE-mediated one. In this paper on 58 food-allergic children and 60 nonatopic controls we demonstrate that the prick + prick (P+P) tests are very effective and easy to perform. In addition we stress that FA cannot be excluded only because skin prick tests (SPTs) are negative, as recently suggested.

Child↗