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The Headache is a common symptom: 80% of the population suffers from headache at least one time per year. This work is a review of new theories on neurovascular pathophysiology of primary headaches in a particular manner on rhinogenic headache. Besides, the authors report the results of a study carried out in 2262 children, who where attending the primary school, in order to investigate the relation between allergic rhinitis and headache in children. The present study suggests that the headache in allergic patients is related to nasal dysfunction always present in these cases.

The presence of endonasal pathological conditions or headache accompanying symptoms involving the nose, show a bi-directional link between the latter and endocranial structures. Instrumental diagnostic procedures allow demonstration of anatomical variants of the bone. Frequently, surgical procedures addressed to correct such variants seem to resolve both headache and breathing disturbances. However, hyperactivity of nasal mucosa and microcirculation might be responsible for cephalic disturbance as a consequence of activation of neuro-vascular systems (trigeminal, sympathetic, parasympathetic) and explain both pain and attendant accompanying symptoms during migraine and cluster headache attacks. Peripheral triggering or aggravating factors may, therefore, be responsible for or, at least, contribute to pathophysiological mechanisms of certain headaches.

It has been demonstrated that: a) part of the inhalant allergenic particles we normally breath, adhere to the oropharyngeal mucosa, and eventually progress to the gastrointestinal tract; b) digestive tract mucosa is able to produce specific IgE against aeroallergens even before than respiratory tract mucosa. The case is described of a 5-year-old girl who presented a daily vomiting since she was 6 months. All clinical instrumental and laboratory findings had been unable to reach a definite diagnosis. SPT (inhalants and foods): Dermatoph. pteronyssinus: + (confirmed by RAST). The patient had an immediate, complete recover just following the clinician's instruction for HDM domestic prevention. Symptoms appeared again in response to a NPT performed with Dermatophagoides extract. The positivity of the exclusion-re-exposure test confirmed the diagnosis of HDM-induced gastrointestinal allergic syndrome, so far not described in literature (to my knowledge). Immunological considerations: since it is known that patients allergic to HDM do not usually present a specific IgE-mediated gastrointestinal allergic syndrome, it is suspectable that an immunological tolerance can be instaured toward inhalant allergens as it normally happens toward food allergens. In atopic individuals there is a high expression of ICAM-1, VCAM-1 and other adhesion molecules on the surface of HEV at BALT level. Adhesion molecules expression and immunocompetent cells activation are modulated by several mechanisms among which the cytokine network plays a major role. The author speculates that sensitized lymphocytes may migrate from intestinal to bronchial mucosa, via lymphocytic immunoallergic competence. In the described clinical case this mechanism did not work.

In this study we have evaluated the possible relationship between food allergens and hypersensitivity to grass pollens. One hundred-thirty patients with grass pollen pollinosis and symptoms probably related to adverse reaction to foods were selected. Skin prick test for food allergens was positive in 79 patients (60.7%) Statistical analysis using chi-square test showed a high significant relationship between grass pollen and nuts, peanuts, beans and peas (p less than 0.0001). Elimination diet and challenge test allowed us to identify the responsible foods in 61 out 79 patients (77.2%). Twelve patients were affected by food allergy (challenge test, skin prick test and RAST positive and concordant); 49 patients suffered from intolerance. Possible causes of this high relationship are discussed.

In this study we have considered the importance of house dust mites (Dermatophagoides farinae and pteronyssinus) in the pathogenesis of respiratory allergic diseases in Piedmont. We have identified, from 1980 to 1986, 1530 subjects with sensitization to at least one of the tested allergens; 479 of these (31.3%) were allergic to both or to one of the tested mites. Particularly 97 subjects (6.3%) were sensitized to Dermatophagoides farinae, 73 (4.8%) to Dermatophagoides pteronyssinus and 309 (20.2%) to both of them. This group included 258 males (53.9%) and 221 females (46.1%). Most of the examined subjects had shown the clinical symptoms before the 35th year of age (366 subjects, 76.4%). The mean age of beginning of clinical picture has come out to be of 27.377 +/- 11.527 SD year old. This result shows no significant differences with the mean age come out in allergic subjects to other allergens (26.939 +/- 10.755 SD); 196 subjects (40.9%) presented rhinitis-conjunctivitis, while 102 subjects presented bronchial asthma-rhinitis-conjunctivitis. We have found that bronchial asthma (alone or with other symptoms) was present in 186 subjects (38.8%), while in the allergic subjects sensitized to other allergens was present only in 299 out of 1051 (28.4%); 277 subjects had continuous symptoms (57.8%) while 202 subjects (42.2%) had symptoms only in some periods of the year.