Search

Eosinophil infiltration may be considered characteristic of nasal allergic inflammation. However, a mild inflammatory infiltrate may be present in asymptomatic subjects exposed to specific allergen.We investigated the relationship between inflammation, specific hyperreactivity and clinical late phase reactions in allergic subjects using the ASNC model.Sixty allergic subjects (aged from 18 to 47 years) were enrolled among those sensitized to pollens (n=20) and those to house dust mite with (n=20) or without (n=20) known clinical nasal LPR. All subjects were asymptomatic. TNSS and eosinophil number were assessed at baseline, 30 min (early phase) and 6 hours (late phase) after ASNC.Eosinophil number was higher in LPR+ rhinitics than in other groups, at baseline and during the early and late phase (p0.001). ATD was lower in LPR+ rhinitics than in other groups (p0.001). In LPR+ rhinitics, at baseline there was a significant correlation between eosinophils and ATD (r=0.56, p=0.009). After allergen challenge, TNSS was significantly higher in LPR+ rhinitics than in other groups, both during early and late phase (p0.001 for all comparisons).In house dust mite sensitised subjects, LPR occurrence after allergen challenge is associated with higher inflammation and lower ATD at baseline. Therefore, in house dust mite allergy minimal persistent inflammation without symptoms can drive different clinical responses to allergen challenge.

Eosinophil inflammation is present in nasal and bronchial mucosa and a clear link between upper and lower airways exists. Our aim was to evaluate whether nasal inflammation correlates with lung function in patients with perennial allergic rhinitis associated with asthma.Eighty perennial allergic rhinitics with mild asthma, aged from 18 to 46 years, were enrolled. Nasal scraping and spirometry were performed in all subjects.A close relationship between the nasal eosinophil number and the percentage of predicted FEV1 was demonstrated (r = -0.76; p0.0001). CONCLUSIONS Nasal cytology may be considered a non-invasive tool to assess airway inflammation in mild asthmatics with associated allergic rhinitis.

Cetirizine has been demonstrated able of reducing nasal inflammatory infiltration in children with allergic rhinitis and cytokine production in in vitro studies. The aim of this double-blind, placebo-controlled, and randomized study was to evaluate cytokine pattern and inflammatory cells in children with perennial allergic rhinitis, before and after treatment with cetirizine or placebo. Twenty children with perennial allergic rhinitis were evaluated, 13 males and 7 females (mean age 13.4 years). Inflammatory cells and cytokines were evaluated by scraping and nasal lavage, before and after 2-weeks administration of cetirizine or placebo. IL4 and IL8 were measured by immunoassay and inflammatory cells were counted by conventional staining. Cetirizine treatment induced a significant decrease of IL4 (p0.01) and IL8 levels (p=0.01). A significant reduction of the inflammatory cells was detected in actively-treated children, both concerning neutrophils and eosinophils (p0.01). Moreover, cetirizine significantly reduced nasal obstruction score (p=0.007). This study shows the cetirizine effectiveness in exerting anti-inflammatory activity by modulating cytokine pattern and by reducing inflammatory infiltration in children with perennial allergic rhinitis.

Allergic rhinitis and asthma are characterized by chronic inflammation due to a Th2 cytokine polarization. Leukotrienes receptor antagonists have been shown to be effective in both diseases.Aim of the study was to evaluate the modulation by the antileukotriene montelukast on Th2 and Th1 cytokines in allergic rhinitis.Fourteen school children affected by persistent allergic rhinitis (PAR) and exercise-induced asthma (EIA) underwent a nasal lavage before and after a two-week treatment with montelukast. A panel of cytokines, including IL4, IL13, and IFN gamma, was measured by immunoassay on nasal lavage samples.Montelukast treatment induced a significant decrease of IL4 and IL13 levels (p0.001, for both comparisons), and a significant increase of IFN gamma (p0.001).Montelukast treatment reversed a typical Th2 cytokine pattern (IL4 and IL13) toward a Th1 (IFN gamma) predominance in children with PAR and EIA. This effect could be considered relevant for long term allergic inflammation control and of interest when treating EIA with concomitant PAR.

It is generally agreed that allergie rhinitis is sustained by an inflammatory process. Mucosal eosinophilic infiltration maybe actually regarded as one of the hallmarks of allergie inflammation. Several pathophysiologic mechanisms are involved in eosinophil recruitment: release of mediators and cytokines, exerting chemoattractant, activating, and prolonging survival effects, and adhesion molecule machinery activation [1].

Cognitive-behavioural therapy (CBT) programmes for bulimia nervosa (BN) have been considerably refined during the last 2 decades, and such a treatment is now extensively used. The present paper describes the treatment rationale and structure, and reviews the available evidence on its efficacy. Compared to any other psychological or pharmacological treatment for which controlled studies have been published, CBT is reported to be more effective (the majority of studies), or at least as effective. A CBT programme for binge eating disorder (BED) has been created by adapting that of BN, but it has been less extensively evaluated in field trials. Even here, however, no other treatment has proven to be of greater efficacy than CBT. Various methodological limitations reduce the possibility of generalizing these findings. Moreover, CBT was found to be completely satisfactory neither for BN nor for BED, with moderate effectiveness and some limits. However, at the present state of treatment, no other therapeutical procedure seems to be more effective, more specific or more promising. It is speculated therefore that CBT could be presently considered the first-choice remedy for these severely disabling disorders.

Background: The allergic reaction is characterized by an inflammatory response, which is correlated to the allergen exposure, and is detectable in mite allergic patients, even when symptoms are absent. Objective: The study was aimed at assessing the presence of inflammation in patients with pollen allergy during a long observation period. Methods: Six patients, sensitized only to Betula alba, were enrolled. Evaluated parameters were (1) nasal symptoms, (2) inflammatory markers (ie, neutrophil and eosinophil number and intercellular adhesion molecule-1 expression on nasal epithelial cells), and (3) pollen count. Patients were examined during the pollen season every 4 days for 40 days and were observed 3 times after the pollen season. Results: A significant inflammatory reaction was evident throughout the pollen season, even during the days with a low pollen count and low or absent symptoms. Conclusions: The results of this study indicate that the global therapeutic strategy for allergic rhinitis should be revised and targeted to inflammatory phenomena rather than to symptoms alone. (J Allergy Clin Immunol 2000;105:54-7.)

Anorexia nervosa (AN) has been reported to be associated with several chronic medical illnesses. In this study, we report two cases of women suffering from AN and celiac disease. The former received the diagnosis of celiac disease before the onset of the eating disorder. For the latter, the diagnosis of celiac disease followed that of AN. Authors discuss the complex relationships between celiac disease and AN. They suggest that in the first case the dietary restriction could act as a trigger for the eating disorder, whereas in the second case, the onset of celiac disease could have exacerbated the clinical symptoms of AN.

The development and validation of a self-reported measure of obesity-related quality of life, the Obesity Related Well-Being (ORWELL 97), were undertaken to examine the intensity and the subjective relevance of physical and psychosocial distress. The questionnaire was validated in a sample of 147 obese patients (99 females, 48 males). The Eating Disorder Examination 12.0D interview, a structured diagnostic interview for DSM-III-R (DSM-IV criteria for binge eating disorder), Beck Depression Inventory, Binge Eating Scale, and the State-Trait Anxiety Inventory 1 and 2 scales were also applied. Internal consistency and test-retest reliability were satisfactory. Factor analysis allowed the identification of two subscales: ORWELL 97-1 related to psychological status and social adjustment, and ORWELL 97-2 related to physical symptoms impairment. Obese female patients showed a lower quality of life, and the severity of obesity appeared to interfere with physical functioning rather than psychological status and social adjustment. The ORWELL 97 questionnaire appears to be a simple and reliable measure of obesity-related quality of life, which can be used in current clinical practice.

Background: Allergic reaction is characterized by a complex inflammatory process. Some of the new antihistamines have antiallergic effects and can affect the inflammatory cell recruitment via adhesion molecule downregulation. We aimed to assess in a 12-month study whether continuous treatment with an antihistamine (terfenadine) can reduce respiratory symptoms and local inflammation in children with mite allergy. Methods: The study was double-blind and placebo-controlled: it involved two parallel groups of children suffering from rhinoconjunctivitis and/or mild intermittent asthma due to mite allergy. They received either terfenadine (1 mg/kg per body weight per day) or placebo for 1 year. Nasal, conjunctival, and bronchial symptoms were recorded by diary cards; at each of the programmed control visits, a nasal scraping for inflammatory cells and ICAM-1 was performed. Some additional clinical parameters were also recorded: days of school absence, extra visits for acute respiratory symptoms, and days of hospital admission. Results: Only children treated with terfenadine achieved significant control of symptoms (P

Background Allergen specific nasal challenge (ASNC) is an optimal method to study the pathophysiological mechanisms sustaining the allergic inflammation and in particular the adhesion molecule system, which is involved in cellular infiltration of nasal mucosa. Topical steroids have been accepted as a highly effective anti-inflammatory therapy for allergic rhinitis. Objective The aim of this double-blind placebo- controlled study was the evaluation of clinical and cytological parameters, including ICAM-1 expression on nasal epithelial cells, after a 4 week treatment with nasal fluticasone propionate (200 μg/daily) or placebo, using the model of ASNC. Methods Twenty allergic rhinitics underwent nasal challenge before and after treatment. The following parameters were evaluated: (i) nasal symptoms (rhinorrhoea, itching, sneezing, obstruction), (ii) inflammatory cells (eosinophils and neutrophils), (iii) ICAM-1 expression on nasal epihelial cells at baseline, 30 min (early phase) and 6 h (late phase) after ASNC. Results Fluticasone propionate was capable of reducing: (i) clinical symptoms during both early (P

Allergen-specific nasal challenge is a valid and reliable tool for studying the pathophysiological mechanisms involved in allergic inflammation. Nasal challenge induces an immediate clinical response in allergic subjects and a concomitant appearance of an inflammatory infiltrate. The mucosal inflammation may persist up to 48–72 h after allergen exposure. If the subjects are rechallenged within this period the response is more pronounced: the so-defined priming effect. The aim of the study was to evaluate the effects of the nasal rechallenge, performed at different time intervals: 3 days, 1, 2 and 4 weeks after the first challenge. Forty allergic subjects underwent two nasal challenges: at baseline and after the periods mentioned above (10/group). Symptoms and inflammatory cells (eosinophils and neutrophils recovered by nasal brushing) were assessed. The 3-day-interval group showed a hyperreactive response (priming effect), the 1- and 4-week-interval groups showed a response similar to baseline, and the 2-week-interval group showed a hyporeactive response (‘tolerogenic effect’). The last phenomenon may be due to a possible immunologic response similar to that achievable during local specific immunotherapy. The present results further elucidate the kinetics of allergen-driven inflammatory events and highlight the importance of the time period chosen for rechallenge. The latter fact may be of primary importance in clinical trials involving specific challenge.

Cetirizine is an antihistamine, largely used in the treatment of allergic rhinoconjunctivitis, which also exerts anti-allergic activity.To evaluate cetirizine as treatment for children with rhinitis due to pollen allergy, and to evaluate its anti-allergic activity in such a clinical condition.The study was designed as parallel groups, double-blind, placebo-controlled, randomized. Twenty allergic children were enroled and subdivided in two groups, receiving a 4 week treatment during the pollen season. The following parameters were monitored: clinical symptoms evaluated by the allergist before and after treatment and by the patients through a daily diary card, inflammatory cells count, expression of ICAM-1 on nasal epithelial cells, inflammatory mediator levels in nasal lavage and peripheral blood before and after treatment, and pollen counts.This study shows that cetirizine treatment is able to reduce: clinical symptoms (P0.01), inflammatory cell infiltrate (P0.03), ICAM-1 expression on epithelial cells (P0.05), and soluble ICAM-1 (P0.05) and ECP (P0.05) in nasal lavage.Cetirizine is able to clinically improve nasal symptoms due to pollen allergy and to reduce allergic inflammation, which is related to allergen exposure.

Loratadine and cetirizine are new generation antihistamines, which are clinically effective in the treatment of allergic rhinitis.The aim of the study was to evaluate antiallergic activity of loratadine compared with cetirizine, over a 2 week period under natural allergen exposure, in a double-blind parallel groups, randomized, controlled trial.Twenty patients, sensitized to grass and/or Parietaria pollen, were subdivided into two groups, one receiving loratadine the other cetirizine respectively. Both were dosed at 10 mg/day. Evaluated parameters were: clinical symptoms, nasal inflammatory cell (such as neutrophil, eosinophil and metachromatic cells) counts, ICAM-1 expression on nasal epithelial cells, and nasal mediators (e.g. histamine, ECP, EPO and MPO).Loratadine and cetirizine significantly improved symptoms (P0.002), significantly reduced eosinophil (P0.016) and metachromatic cell (P0.01) infiltration, levels of ECP (P0.002), EPO (P0.006) and histamine (P0.01) and ICAM-1 expression on nasal epithelial cells (P0.02). No difference was demonstrated between the two drugs.The antiallergic activity of loratadine and cetirizine is documented by their actions on the inflammatory and clinical parameters, especially ICAM-1 modulation.

The preparation of chemically modified allergens, with a reduced IgE binding capacity (responsible for side effects with traditional immunotherapy) but with the same or greater immunogenic activity, is one of the paths followed to obtain better results with specific immunotherapy (IT). The aim of the study was to evaluate the tolerability and effects of an extract Phleum pratense, modified with glutaraldehyde and absorbed on aluminium hydroxide, in controlling the seasonal symptomatology induced by grass pollen in a group of 10 monosensitized patients, compared to a group of 10 similar patients not treated with specific IT but with drugs alone. The monitoring parameters were: 1) Clinical: a) symptomatology after specific conjunctival provocation test (pre and post seasonal) and during the natural exposure to the allergen b) drug consumption. 2) Immunological (peripheral blood eosinophils, total and specific IgE, total specific IgG). 3) Cytological, before, during and after the pollen season.In subjects treated with specific IT a) both the overall symptomatology and the drug consumption resulted significantly reduced compared to the controls (p = 0.045); b) the phlogistic infiltrate showed a tendency to decrease during the pollen season; c) the peripheral blood eosinophils, total and specific IgE and IgG did not show any significant variation compared to the controls; d) no systemic reactions occurred and there were only two slight local reactions.

Background Cetirizine is an antihistamine used in the treatment of allergic rhinoconjunctivitis, that has antiallergic activity. Objective The aim of this double-blind, placebo-controlled, parallel group study was to evaluate the clinical efficacy and the antiallergic activity of cetirizine, administered either continuously or on demand over a 4-week period of natural allergen exposure. Methods Twenty patients, with allergic rhinoconjunctivitis due to grass and/or Parietaria pollen, were enrolled. They were randomized into 2 parallel groups: one group received the standard dose of 10 mg cetirizine daily and the other received placebo, all patients were allowed to take an additional daily dose of cetirizine when needed. Variables evaluated were clinical symptoms (recorded on dietary cards), number of additional on demand cetirizine doses, nasal inflammatory cells, and pollen counts. Results The results of the present study show that patients treated with continuous administration of cetirizine achieved significant symptomatic relief and inflammatory control (decreases in numbers of infiltrating neutrophils and eosinophils) in comparison to patients treated on demand. Conclusion Continuous treatment with cetirizine is more effective than on demand treatment. Continuous treatment reduces clinical and inflammatory variables more than symptomatic treatment and the on demand therapy can determine acceptable clinical control, but does not reduce allergic inflammation.

BACKGROUND: It is well known that allergen-specific nasal challenge (ASNC) is a fruitful tool with which to evaluate antiallergic activity exerted by a drug. Azelastine is a new antihistamine also available in topical form (i.e., nasal spray). OBJECTIVE: The aim of the study was to evaluate the effects of azelastine nasal spray on inflammatory changes after ASNC in both the early-phase reaction and the late-phase reaction. METHODS: The study had a double-blind, placebo-controlled, randomized, and parallel-group design. Twenty patients with pollen allergy were enrolled out of pollen season. ASNC was performed at baseline (T0) and after 1 week of washout (T7). At T7, 10 patients sprayed azelastine (1 puff) into their nostrils, and 10 patients used placebo. ASNC was performed after 30 minutes. The considered parameters (evaluated during early- and late-phase reactions) were: (1) clinical signs and symptoms, (2) cytologic assessment (neutrophils and eosinophils), (3) assay of mediators (eosinophil cationic protein and myeloperoxidase), and (4) expression of intercellular adhesion molecule-1 (ICAM-1) on nasal epithelial cells. We focused our attention on ICAM-1 because it is the natural ligand of leukocyte functional associated antigen-1 and Mac-1, expressed on eosinophils. In addition, ICAM-1 is expressed on epithelial cells only on allergen exposure (both natural and experimental). RESULTS: Placebo did not exert any modification on the considered parameters. After azelastine administration, significant decreases in total symptom score, eosinophilic and neutrophilic infiltration, and ICAM-1 expression were observed during both early- and late-phase reactions. Furthermore, serum eosinophil cationic protein levels decreased during the late-phase reaction, whereas myeloperoxidase was not affected by the treatment. These findings were confirmed by the powerful Koch's split-plot statistical analysis. CONCLUSION: Azelastine exerts antiallergic activity, mainly affecting eosinophil function and downregulating ICAM-1 expression, on nasal epithelial cells. (J Allergy Clin Immunol 1996;98:1088-96.)

Aim of the present study is the evaluation of psychopathological and clinical features of these outpatients followed by the Outpatient Clinic of the Section of Metabolic Diseases and Diabetes, University of Florence. 84 obese patients and 217 non-obese control subjects were studied using the Structured Clinical Interview for DSM-III-R (SCID), and applying DSM-IV criteria for Binge Eating Disorder. BITE self-reported questionnaire, STAI inventory and Ham-D rating scale were also used. Lifetime prevalence of Binge Eating Disorder in obese patient was 11.9%, markedly lower than that reported in studies on North American samples. Prevalence of depressive disorder (Major Depression and Dysthymia) was significantly higher (p0.005) in obese patients than in control subjects. This confirms the important relationships between eating and mood disorders. The prevalence of subclinical eating disorders resulted to be significantly higher in obese patients (p0.01) when compared with control subjects. Significant correlations (p0.01) of BITE scores were observed with STAI and Ham-D scores, but not with body mass index. These results underline the need for an accurate psychopathological assessment in obese patients, in order to formulate a correct diagnosis and plan adequate therapeutical interventions.

The natural exposure to house dust mites causes sensitization in genetically susceptible patients. Persistent exposure of sensitized patients causes chronic inflammation, and consequently, hyperreactivity, thus promoting the development of clinical features. Recently, intercellular adhesion molecule-1 (ICAM-1)/CD54 expression on epithelial cells triggered by allergen has been demonstrated and related to the inflammation caused by the allergic reaction. Therefore we evaluated the possible presence of inflammation (i.e., inflammatory cell infiltrate and ICAM-1/CD54 expression on epithelium) at conjunctival and nasal levels in patients with asymptomatic allergic rhinitis caused by mites, in their relatives living in the same environment, and in healthy volunteers. In addition, the possible relationship between inflammation and house dust mite allergen exposure was evaluated. Conjunctival and nasal scrapings of allergic subjects enrolled in the study showed many inflammatory cells. A mild ICAM-1/CD54 expression on conjunctival and nasal epithelium was detectable in allergic subjects, whereas relatives and healthy volunteers showed few inflammatory cells and no ICAM-1/CD54 expression on epithelial cells. A detectable level of house dust mite, sufficient to cause sensitization, was found in all houses. This study demonstrates a minimal persistent inflammation at conjunctival and nasal levels constantly detectable in patients without symptoms who are sensitized to mites and continuously exposed to the natural allergens.

Rhinoconjunctivitis caused by pollen allergy is characterized by typical signs and symptoms and mucosal infiltration by inflammatory cells during pollen season. It has been recently demonstrated that the adhesion molecule system is deeply involved in cell-to-cell interaction during inflammatory response consequent to allergic reactions. The aim of this study was to evaluate the expression of intercellular adhesion molecule-1 (ICAM-1 or CD54) on nasal epithelial cells, before and during natural seasonal exposure, in 10 allergic patients (Parietaria judaica-sensitized) and in 10 healthy volunteers, correlating this parameter with clinical and cytologic involvement. Nasal epithelial cells of allergic subjects showed a significant expression of CD54 during pollen season (p < 0.001). On the contrary, no CD54 expression was observed out of pollen season. In healthy volunteers no CD54 expression was observed both before and during pollen season. Cytologic evaluation demonstrated an infiltration by eosinophils (mainly activated [EG2+]), (p < 0.001), neutrophils (p < 0.001), and metachromatic cells (p < 0.001) during pollen season only in allergic subjects. Therefore results indicate that seasonal allergic rhinitis is characterized by an infiltration of inflammatory cells correlated with CD54 expression on nasal epithelial cells. This phenomenon is specific, being restricted only to allergic patients during pollen season.

A group of 246 psychotic patients diagnosed on the basis of DSM III R was compared to standard parameters in order to define the so-called "middle cases". A group of 12 patients who matched these parameters was thus obtained independently of the initial diagnosis. This group was then compared with two other groups of similar sizes made up of schizophrenic patients and patients suffering from major depressive disorders respectively; neither of the latter groups corresponded to the above mentioned standard parameters. This comparison revealed a substantial equi-distance between the three groups, thus confirming the inadequacy of a method of classification into categories when applied to such a complex and articulated field as psychosis.

International audience

Sunto. - Enoto che facendo solidificare il bismuto in un campo magnetico, l’effettoHall in detto metallo, nella direzione del campo, e maggiore che nel bismuto ordinario, mentre e minore in direzione normale al campo. Questo comportamento viene spiegato ammettendo che il campo tenda ad orientare i cristalli con l’asse principale parallelamente alle linee di forza.

Sunto. - In questo lavoro viene studiata sperimentalmente la relazione esistente fra le variazioni Δi della corvente elettronica di un filamento incandescente nel vuoto e le variazioni ΔI e Δrispettivamente della corrente di riscaldamento del filamento e della differenza di Potenziale agli esiremi di esso, quando rimanga costante la corrente I di riscaldamento. Si trova cosi che l’andamento delle funzioni ΔI = f(i) e Δ= ϕ(i) dipende dalla disposizione adottata per il collegamento della placca col filamento. E precisamente si ha: col collegamento a) placca-estremo negativo del filamento, ΔI positiva per piccolissimi valori del Potenziale di placea, e quindi di i, negativa per valori piu grandi del potenziale di placca, analogamente per Δsalvo il segno che risulta opposto; colla disposizione b) placca-estremo positivo, ΔI sempre positiva, Δsempre negativa; colla disposizione placea-punto di mezzo di una resistenza posta in derivazione sul filamento, ΔI sempre positiva, Δsempre negativa. I valori ottenuti con la disposizione c) risultano uguali alla media algebrica di quelli ottenuti con le disposizioni a) e b). La differenza fra i valori di ΔI ottenuti con le disposizioni a) e b) (per gli stessi valori di I e i) e data in valore assoluto da i\(i\frac{{I\frac{{dr}}{{dI}}}}{R}\) (r resistenza del filamento corrispondente alla corrente I, R resistenza totale del circuito di filamento); la differenza fra i valori di Δrisulta invece uguale ad ir. Le funzioni ΔI = = F(V) e Δ= ϕ(V) ottenute con la disposizione a) presentano un massimo per V = Vm e si annullano per V = Vs, e i valori di Vm e Vs risultano entro larghi limiti indipendenti dal valore di I. Si trova inoltre che l’interpretazione dell’inesistenza e della costanza di Vm e Vs e subordinata alla conoscenza della legge di distribuzione della emissione elettronica nei vari punti del filamento.

Vengono presentati i risultati delie esperienze eseguite su un filamento di tungsteno incandescente. Con queste esperienze e stato possibile mettere in evidenza che l’effeto prodotto da un intenso fascio luminoso, costituito da radiazioni di frequenza molto minore delia soglia fotoelettrica, deve essere considerato come risultante di due effetti: l’uno, molto preponderante (circa i 9/10 dell’effetto totale), di origine puramente termica; l’altro di origine fotoelettrica e di intensita crescente col crescere delia frequenza dette radiazioni incidenti.