Influencing factors on the safety and effectiveness of venom immunotherapy.

Background And Objective: The safety profile of venom immunotherapy (VIT) is a relevant issue and considerable differences in safety and efficacy of VIT have been reported. The primary aim of this study was to evaluate the safety of ACE inhibitors and beta-blockers during VIT, which has already been published. For a second analysis, data concerning premedication and venom preparations in relation to systemic adverse events (AE) during the up-dosing phase and the first year of the maintenance phase were evaluated as well as the outcome of field stings and sting challenges.

β-blockers and ACE inhibitors are not a risk factor for severe systemic sting reactions and adverse events during venom immunotherapy.

Background: There is controversy whether taking β-blockers or ACE inhibitors (ACEI) is a risk factor for more severe systemic insect sting reactions (SSR) and whether it increases the number or severity of adverse events (AE) during venom immunotherapy (VIT).

Methods: In this open, prospective, observational, multicenter trial, we recruited patients with a history of a SSR and indication for VIT. The primary objective of this study was to evaluate whether patients taking β-blockers or ACEI show more systemic AE during VIT compared to patients without such treatment.

A survey of clinical features of allergic rhinitis in adults.

Background: Allergic rhinitis (AR) has high prevalence and substantial socio-economic burden.

Material/methods: The study included 35 Italian Centers recruiting an overall number of 3383 adult patients with rhinitis (48% males, 52% females, mean age 29.1, range 18-45 years).

Sublingual immunotherapy: World Allergy Organization position paper 2013 update.

We have prepared this document, "Sublingual Immunotherapy: World Allergy Organization Position Paper 2013 Update", according to the evidence-based criteria, revising and updating chapters of the originally published paper, "Sublingual Immunotherapy: World Allergy Organization Position Paper 2009", available at http://www.waojournal.org.

Subcutaneous allergen specific immunotherapy: best clinical practice as cornerstone for future development.

Allergen subcutaneous immunotherapy is a long lasting treatment which can modify the natural history of allergic respiratory diseases. Recommended administration is required for a minimum of three years. During this long term therapy the daily management is based on two crucial points, discussed in this review, such as the prevention and the treatment of side effects and the improvement and follow-up of patient adherence.

Evidence of adherence to allergen-specific immunotherapy.

Purpose Of Review: The main feature of allergen-specific immunotherapy is its capacity to modify the natural history of the disease, reducing the development of asthma and new sensitizations after 3-4 years of treatment. For this reason, adherence to the therapy is mandatory, as happens for all chronic medical treatment.

Recent Findings: Though subcutaneous immunotherapy is administered directly by physicians, the rate of adherence is surprisingly low, at less than 70%.

How much specific is the association between hymenoptera venom allergy and mastocytosis?

Background: The preferential association of mastocytosis with hymenoptera sting reactions is well known, but there is no data on the prevalence of clonal mast cell disorders in subjects with severe systemic reactions due to foods or drugs.

Methods: Patients with food- or drug-induced severe systemic reactions, including anaphylaxis, and increased serum tryptase were studied for the presence of mastocytosis, and compared with a population of patients with hymenoptera allergy. The aetiological role of foods or drugs was assessed according to current recommendations.

A prospective Italian survey on the safety of subcutaneous immunotherapy for respiratory allergy.

Background: Subcutaneous immunotherapy is effective for the treatment of respiratory allergy, and it is largely used in Italy, but no systematic safety assessment has been carried out so far.

Objective: To assess prospectively the safety of injection immunotherapy in a multicentre, real-life survey.

Methods: Eleven Italian allergy departments recorded the clinical characteristics of systemic reactions (SRs) due to immunotherapy.

Clonal mast cell disorders in patients with systemic reactions to Hymenoptera stings and increased serum tryptase levels.

Background: Anaphylaxis after Hymenoptera stings has been reported in subjects with mastocytosis, but few data exist regarding disease prevalence in populations allergic to these insects.

Objective: The incidence of clonal mast cell (MC) disorders in subjects with both systemic reactions to Hymenoptera stings and increased serum baseline tryptase (sBT) levels was assessed by using bone marrow (BM) aspirates and biopsy specimens.

Methods: Subjects with a history of a systemic reaction caused by a Hymenoptera sting underwent the standard diagnostic work-up for Hymenoptera allergy, and sBT levels were measured.

Delayed selective reaction to clavulanic acid: a case report.

Clavulanic acid, an inhibitor of beta-lactamases, is widely used for antimicrobial therapy in association with beta-lactam antibiotics. Despite this, very few adverse reactions to the molecule have been described so far. We report a case of not-immediate reaction to clavulanic acid in a young adult who previously tolerated it.

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.

Nimesulide and meloxicam are a safe alternative drugs for patients intolerant to nonsteroidal anti-inflammatory drugs.

Background: Pseudoallergic reactions to ASA and NSAIDs in general are frequent and difficult to manage. The challenge with the suspected drug is considered unethical, therefore the only possible approach is a challenge with alternative drugs. Selective COX2 inhibitors are considered the most suitable alternative drugs.

Treatment of acquired cold urticaria with cetirizine and zafirlukast in combination.

Acquired cold urticaria is an infrequent physical urticaria that can provoke severe systemic reactions. Histamine is the primary mediator, but leukotrienes are also involved in the pathogenesis. H(1) antihistamines are recommended as first-choice treatment, but their efficacy is sometimes unsatisfactory.

Dermatological powder as hidden cause of occupational allergy due to casein: a case report.

We report a case of occupational asthma due to hidden casein, contained in a dermatological powder. A 44 year old nurse reported the recent onset of rhinitis and asthma, clearly related to the work environment. Skin tests for food allergens revealed a positivity for milk proteins.

Anaphylaxis due to patent blue dye during lymphography, with negative skin prick test.

We report here a case of anaphylaxis due to patent blue dye, which was administered to an adult female during a lymphographic intraoperative procedure. The patient was not atopic, and other possible causes of anaphylaxis (anesthetics, latex) had been carefully excluded through routine tests. The skin-prick test and patch test carried out with patent blue (PB) dye were negative, but the intradermal test with 100 microliters of the dye showed a remarkable positivity.

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.

Cold-induced rhinitis in skiers--clinical aspects and treatment with ipratropium bromide nasal spray: a randomized controlled trial.

Cold-induced rhinitis (CIR) is common among skiers and is perceived as a troublesome disease. We studied the clinical characteristics of CIR in a population of skiers and we evaluated the effectiveness of ipratropium bromide nasal spray (IBNS) in relieving symptoms in a double-blind placebo-controlled fashion. By means of specific questionnaires, we evaluated 144 subjects (69% men; mean age, 42.

Nimesulide in the treatment of patients intolerant of aspirin and other NSAIDs.

Aspirin (acetylsalicylic acid) and other NSAIDs are responsible for many adverse effects. Among them, pseudo-allergic reactions (urticaria/angioedema, asthma, anaphylaxis) affect up to 9% of the population and up to 30% of asthmatic patients. The mechanisms provoking these reactions have not been fully elucidated, but it appears that inhibition of cyclo-oxygenase (COX) plays a central role.

Local nasal immunotherapy with extract in powder form is effective and safe in grass pollen rhinitis: a double-blind study.

Background: Local nasal immunotherapy has been studied, by means of an extract in powder form, in patients with allergic rhinitis caused by grass pollen.

Methods: Thirty-two patients allergic to grass were studied for 37 weeks in a double-blind controlled trial. Subjects were selected on the basis of a positive history, skin test result, RAST finding, and result of intranasal challenge to grass pollen.

Local nasal immunotherapy for birch allergic rhinitis with extract in powder form.

Background: Traditional subcutaneous immunotherapy has been proved effective in birch pollenosis. It has, however, some drawbacks as systemic reactions, which are rare but important. Local nasal immunotherapy (LNIT) represents a potential safer route of allergen administration.

Tolerability of imidazole salycilate in aspirin-sensitive patients.

Over the last few years, many studies have been carried out in order to individualize which nonsteroidal anti-inflammatory drug (NSAID) can be tolerated in aspirin sensitivity. Imidazole salicylate (IS) is a new NSAID that inhibits Tromboxane A2 synthesis, without interferring with cyclo-oxygenase pathway, whose inhibition was demonstrated to cause asthma and/or urticaria/angioedema in aspirin-sensitive patients. We enrolled 67 subjects with documented intolerance to aspirin, pyrazolones or NSAIDs, clinically manifested as urticaria/angioedema (68%), asthma, and/or rhinitis (32%).

Safety of specific immunotherapy: a retrospective study.

A large experience in specific immunotherapy is reviewed in order to assess the safety of this treatment. From 1968 through September 30, 1993, 300,086 injections were administered to 6,319 patients suffering from allergic asthma and/or rhinitis. Systemic reactions reported during the whole period were 184 (0.