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Background: The relationship between hypersensitivity to NSAID and atopic status is still incompletely defined. Previous studies found a high prevalence of atopic diseases in multiple NSAID reactors. The present study aimed to investigate whether this is the case also in Italian adults hypersensitive to NSAIDs., Methods: Skin tests with a large panel of seasonal and perennial airborne allergens were carried out in 252 patients with a clear-cut history of acute urticaria induced by nonsteroidal anti-inflammatory drugs. Patients were classified as single or multiple NSAID reactors based on clinical history, presence/absence of chronic urticaria, re-challenge with the reported offending drug in case of doubt history, and oral challenges with aspirin or propionic acid derivatives., Results: Single NSAID reactors showed a much higher prevalence of atopic diseases than multiple NSAID reactors either with or without chronic urticaria (61% vs 19% and 19%, respectively; p < 0.001)., Conclusion: As a difference from previous reports, in Italian patients hypersensitive to NSAID atopy is much more prevalent among single reactors, a finding that indirectly supports the possible IgE-mediated origin of this type of adverse drug reaction.

Background: Evaluation of possible photoallergic contact dermatitis in at-risk populations is often not undertaken, and an agreed methodology for investigation is uncommonly used., Objectives: We conducted a retrospective multicentre study to determine the prevalence of photoallergic contact dermatitis in Italy., Methods: A total of 1082 patients with histories and clinical features suggestive of photoallergic contact dermatitis were evaluated. All the patients had undergone photopatch testing with allergens proposed for Italy as well as other substances suggested by each patient's personal history., Results: 234 patients (21.6%) were positive to at least one test substance of the standard photopatch testing series or to added substances. 234 patients (21.6%) were positive to at least one substance with a total of 290 reactions. 204 of the reactions were typically photoallergic; 68 reactions were allergic and within this group 10 were photoaugmented reactions; 18 reactions were considered to be phototoxic., Conclusion: The predominant group of photoallergens was drugs, followed by organic UV filters and antimicrobial agents.

Objective: Latex allergy has become an increasing and clinically important problem. Several recommendation for secondary preventive measures have been advised. The aims of the study were to illustrate the results of the latex-safe protocol and to evaluate in allergic patients the role of risk factors for the development of latex allergy., Methods: Latex-safe treatment was divided into the following phases: anamnestic identification, allergologic assessment, patient selection, intervention programme, preventive medication, operating room equipment, postoperative management, patient and family training, follow-up., Results: Between 1998 and 2004, 6.832 patients underwent 7.333 operations. Anamnestic and diagnostic tests showed that 26 patients had latex allergy. 44 secondary perioperative latex-safe management have been accomplished in 26 children. No allergic event or complications linked to the procedure occurred. Atopy, congenital malformations frequently associated with latex allergy and the presence of 5 or more surgical procedures were the major risk factors recognized. Six out of the 26 patients (23%) had only one risk factor (atopy). Twenty out of 26 children (77%) had several associated risk factors: 8 of them had simultaneously 9 of the 10 analysed risk factors. Our data shows that, the higher their number, the higher the gravity of the allergy., Conclusions: Although latex allergy is a limited phenomenon, it is nevertheless quite frequent within risk groups. Most patients have simultaneously many risk factors for the development of such an allergy, and the occurrence of several risk factors increases severity of the allergy. Latex-safe perioperative management offers guarantees of safety against latex allergy phenomena.

The aim of our research was to evaluate the latex allergy prevalence in 1300 health care workers by means of a self-administered questionnaire, clinical evaluation and specific allergological tests to confirm this condition. The results showed that all the questionnaire were completed, 60 subjects reported work-related symptoms, and 35 subjects out of 60 had latex allergy, 2.7% out of 1300 workers, lower than others studies, all 35 subjects were also atopic. This study confirms that the atopy is an important risk for the development of latex allergy.

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.

Background: Natural rubber latex is a frequent cause of IgE-mediated allergy in hairdressers; but a non-IgE-mediated allergy to latex proteins can also occur. Sixty-one hairdressers, reporting latex glove-related symptoms, were enrolled in the study., Methods: They were evaluated for latex allergy by assessment of serum specific IgE and skin prick tests. Patients were patch tested to a rubber additive series and to latex. Proportions were compared by one-tailed Fisher's exact test; mean values of continuous variables were compared by Student's t-test., Results: A diagnosis of IgE-mediated latex allergy was made in 11 (18%) hairdressers; patch tests with rubber-related antigens were positive in 24 (39.3%) subjects. The most positive patch tests were those with para-phenylenediamine (33%). Two hairdressers (3.3%) showed delayed reactions to the latex sample. Hairdressers with IgE-mediated latex allergy were older and presented a personal history of atopy and local hives after exposure to latex; they were more likely to have a positive response to other allergens on prick or patch testing., Conclusions: Our study demonstrates a certain number of false-positive and false-negative results when reported symptoms of possible latex sensitivity were compared to prick and CAP tests to latex, indicating the problems of relying solely on self-report.

Background: Italian data on the prevalence of allergic rhinitis are sparse and with wide variations, maybe because of different diagnostic criteria and methods of investigation. This study analyzes the information on rhinitis collected in northern Italy through standardized methods within the European Community Respiratory Health Survey., Methods: A screening questionnaire was sent by mail to a random sample of the general population aged 20-44 years, and nonresponders were contacted again by phone, achieving a final response rate of 86% (6031/7000). Among the responders, 914 randomly selected underwent a standardized clinical interview, skin prick test (SPT) and total and specific immunoglobulin (Ig)E determination., Results: The overall prevalence of self-reported allergic rhinitis was 15.9% (95% CI 15.0-16.8%). Allergic rhinitis was more common in men below 35 years and in women older than that (P = 0.006), in urban areas (P < 0.001) and in early responders (P < 0.001). A larger percentage of subjects (37.7%) reported nasal symptoms when exposed to indoor or outdoor allergens. Atopy was present in 79% of the subjects reporting allergic rhinitis., Conclusions: This study demonstrates that the prevalence of allergic rhinitis in northern Italy is similar to the prevalence observed in other European countries and that this disease is more common in urban areas.

Background: Recent evidence suggests that asthma is not invariably related to atopy. The aim of this study was to evaluate the frequency of atopy, asthma and sensitization to eight common allergens in a large group of children with allergic symptoms., Methods: 1426 children referred to our Paediatric Asthma and Allergy Center because of allergic symptoms were examined. Bronchial asthma, allergic rhino-conjunctivitis, food allergy and atopic dermatitis were diagnosed with standardized methods. Atopy was diagnosed if at least one skin test was positive., Results: Of the 1426 children examined, 629 (44%) were atopic and 769 (56%) were non-atopic. Asthma was diagnosed in the same proportion (i.e., 64%) of atopic and non-atopic children. However, after division into age groups, non-atopic asthma was significantly more prevalent (chi2 = 8.46) in children between 0 and 3 years old (group 1). On the other hand, atopy was significantly associated with asthma only in group 3 (odds ratio 1.85). Furthermore, a significant association with asthma symptoms was found for house dust mite (HDM) in group 3 (odds ratio 4.8)., Conclusions: Asthma is related to atopy in pre-selected children only from the age of 7 years. House dust mite sensitization seems to be an important determinant of asthma in these "older" children.

The preemployment medical examination is a practice viewed as important by recently introduced Italian laws (D.L. 277/91 and 626/94), even if its efficacy with regard to atopy is frequently a matter of controversy. It has been assumed that atopy (with a prevalence in the general population around 30%) is a predictive discriminant in the prevention of occupational allergic asthma, but a review of the literature shows that the hypothetical exclusion of 23 per cent of total job applicants (because they are atypical) would seem to prevent only 55 per cent of asthma cases. At the present time, the concept of discrimination in employment founded on presence of atopy is scientifically unsubstantiated and ethically unacceptable.

In a group of 226 bakers and pastry makers and in 88 students of a training school for bakers, we evaluated skin sensitization to the common allergens, wheat and alpha amylase. Skin prick tests were positive to the enzyme in 17 exposed subjects (7.5%) and in one student with previous occupational exposure as a baker; 27 exposed subjects (11.9%) and 2 students were sensitized to wheat. Among the 42 exposed workers who complained of work-related symptoms, 12 (28.6%) cases were skin positive to amylase and 17 (42.9%) to wheat. Among the 17 workers who were positive to amylase, 16 were also sensitized to wheat and/or common allergens, 12 complained of symptoms at work but since in many cases there was a positive response to wheat, too, it is impossible to speculate on the role of each allergen in inducing symptoms. One case, with work-related rhinoconjunctivitis, had skin sensitization only to alpha amylase but no specific IgE in the serum. These findings confirm that bakers are at risk of sensitization not only to wheat allergen but also to amylase from Aspergillus oryzae. The enzyme should be included in the list of substances to be tested among bakers in whom an occupational allergy is suspected, but particular care should be taken in evaluating the cutaneous response, especially if compared to wheat wheals. Further investigations are also needed to identify the source of risk and to better define the characteristics of the enzyme and the relationship between skin reaction to amylase, sensitization to wheat and atopy.(ABSTRACT TRUNCATED AT 250 WORDS)

In 1985-90, 1612 subjects were submitted to allergic tests for respiratory diseases. In a retrospective survey we have evaluated clinical features, symptoms, diagnostic procedure and allergic tests of skin positives and skin negatives. Prick tests were supplemented by intradermal reaction and RAST under guideline of history. Allergens examined were Gramineae, Parietaria, Olea, house dust, Dermatophagoides farinae and pteronyssinus. 80% of patients were found positive to one or more allergens; their average age (30.1 +/- 13.7) was found lower (p < 0.001) and allergic family history prevalence higher (p < 0.01) than skin negatives. Skin positives prevalence was statistically significant under 50 yrs and skin negatives one over 50 yrs. Asthma or rhinitis only were prevalent among skin negatives while associated symptoms (asthma + rhinitis and/or conjunctivitis) were prevalent among skin positives. Considering skin results pollens were found positive in 34%, inhalants in 24% and pollens + inhalants in 42% of subjects. Gramineae were found positive in 57.8% of subjects, Parietaria in 39.8%, olea in 28.8%, Dermatophagoides farinae in 53.3%, house dust in 52.1% and Dermatophagoides pteronyssinus in 48.2%. Prick test showed a high sensitiveness in detecting pollens sensitization while intradermal reactions were often necessary in sensitization to inhalants; for the diagnosis RAST contribution was negligible.

We studied the relationship between parental smoking habits and atopy and bronchial responsiveness (BR) in 9-year-old, non-selected schoolchildren. A questionnaire on respiratory disease and maternal and paternal smoking habits was administered to one parent. Skin prick tests using the most common allergens present in central Italy, a flow-volume spirometric test, and a bronchial provocation test using carbachol in increasing doses were performed. Male children with smoking parents had significantly increased BR when compared to those whose parents did not smoke (Odds Ratio (OR) = 4.3, p = 0.009). No such significant increase in BR was found in female children of smoking parents (OR = 1.5, p = 0.4). The relationship between BR in children and smoking in parents was stronger in asthmatics (p = 0.02), but was still significant after controlling for asthma and atopy. Bronchial responsiveness was significantly correlated with atopy (p = 0.001). This was also true for nonasthmatic children and for both males and females separately. Male children of smoking parents had increased reactivity to allergens as assessed by the skin prick test index (p = 0.001). It is hypothesized that passive smoking, by increasing the frequency of BR and of atopy, may increase the risk of asthma in childhood and particularly in boys.