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Abbreviated aerosol therapy has been suggested to increase compliance by delivering the same therapeutic dose, but more rapidly than traditional aerosol therapy. A new spacer mouth mask, which is recommended for use in abbreviated aerosol therapy, is now available in Italy. The aim of this study was to compare traditional and abbreviated salbutamol aerosol therapy in 30 asthmatic children using the new spacer mouth mask. Thirty asthmatic children (18 boys and 12 girls; aged 4-13 years) were evaluated during severe asthma attacks (forced expiratory volume at 1 second [FEV(1)] <60% of the predicted value) and randomly allocated to treatment with two different schedules of aerosol therapy. Aerosol therapy was administered to group A in the usual manner, with patients breathing in and out at tidal volume until the nebulizer bowl was empty. Group B received therapy with the new spacer mouth mask used in accordance with manufacturer's instructions, i.e., placing the mask tightly over the mouth and instructing the child to breathe in through the mouth and out through the nose a total of five times at tidal volume, keeping the mouth open. The amount of drug available to patients in group A was approximately 768 microg, whereas 176 microg was available to those in group B. The FEV(1) increased in all patients and there was no difference in the degree of improvement between the groups (p < 0.05). The results indicate equivalent bronchodilatation between abbreviated and traditional aerosol therapy but because abbreviated therapy takes less time, it may improve compliance.

Aerosol nebulization is and most effective ways of treating airway diseases especially in children. Failure of inhaled asthma treatment is mainly due to inadequate deposition of drugs in the peripheral area of the lungs. The aim of this study was to compare the efficacy of a traditional mask and that of a new spacer mouth-mask (Nebula, Markos Mefar, Italy) when used with a jet nebulizer, by measuring aerosol deposition in the lungs, oropharynx, upper airways, and gastrointestinal tract. Twelve children without respiratory disease aged between 8 and 13 years were included in the study. Aerosol inhalation was performed using a jet nebulizer with 2 mL of saline solution containing 20 Mci of Tc99m-DTPA. The first group initially performed aerosol inhalation using a traditional facemask and then, one week later, using the new spacer mouth-mask. The second group performed aerosol inhalation using the new spacer mouth-mask first and then, one week later, using a traditional mask. Scintigraphic ventilation images were then obtained, and aerosol deposition in the trachea, oropharynx, lungs and stomach was measured. In the first group, the radioaerosol deposition in the peripheral lung area using the new spacer mouth-mask was greater 97.8 +/- 7.0 vs. 68.5 +/- 7.9 (p = 0.04). On the other hand, the oropharyngeal radioaerosol deposition was greater using the traditional mask: 50.2 +/- 5.2 vs 20.3 +/- 11.8 (p = 0.028). Similarly, in the second group the peripheral lung deposition was greater and the oropharyngeal deposition was less using the new spacer mouth-mask: 97.3 +/- 9.4 vs. 70.2 +/- 11.2 and 20.7 +/- 8.9 vs. 46.3 +/- 16.8 (p = 0.028 and 0.046 respectively). In conclusion, the new design of the spacer mouth-mask allows greater aerosol deposition in the peripheral lung area and less in other parts such as the oropharyngeal area, the central airways and the stomach.

The authors examine and discuss some controversial points of allergologic literature concerning immunomodulation, pathogenesis, hygiene hypothesis, mixture of vaccines and treatment schedules.

Background: Local nasal immunotherapy (LNIT) is an effective and safe alternative to conventional subcutaneous immunotherapy. A specific nasal provocation test (SNPT) could be used to indicate the optimal subclinical dose to carry out LNIT., Objective: We hypothesize that LNIT could be carried out with only one predefined dose for all patients, so we have evaluated the efficacy and the tolerability of LNIT administered at steady dosages in patients with seasonal allergic rhinitis., Methods: Twenty grass pollen-sensitized patients suffering from seasonal allergic rhinitis were studied in a randomized, double-blind, placebo-controlled trial. The treatment was carried out according to a schedule based on the administration of a steady subclinical dosage of the allergenic extract, selected on the basis of the sensitivity threshold of the SNPT. The patients were divided into two groups of 10 people each, which were treated either with grass pollen extract in a hydroglyceric solution or with placebo., Results: During the peak pollen period, with regard to the placebo (P) group, in the grass treated (GT) group a significant decrease of both nasal symptoms (P = .021) and consumption of antihistamines (P = 0.047) was found. Furthermore, only in the GT group was the provocative dose assessed by the SNPT significantly lower (P = .049) at the end of the treatment. In this group of patients an inverse correlation between such provocative dose and the nasal symptom score reported during the peak pollen period was also evidenced (r = 0.708; P = .038). Adverse reactions to LNIT were mild, rare, and did not interfere with the completion of the therapeutic schedule., Conclusions: Our study indicates that LNIT, when administered at steady dosages, may be proposed as a treatment for grass pollen seasonal allergic rhinitis as it appears to be effective and well tolerated.

Control of seasonal symptoms by means of a preventive and easy to use (only one intradermal injection eight weeks before the pollen peak) immunotherapy, is recommended nowadays. We verified the clinical efficacy of E.P.D. (Enzyme Potentiated Desensibilization) in a double-blind, placebo-controlled study. This particular immunotherapy consists of an intradermal injection mix, made up of allergenic extracts at extremely low doses and an enzyme called beta-glucuronidase. The vaccine is administered once a year, eight weeks before pollen peaks. We studied a group of 40 patients allergic to grass pollen. The results, analysed statistically on the basis of a symptoms score, showed good clinical efficacy and a significant reduction of drug consumption during the high pollen period. Due to the clinical effectiveness, easy administration (only on injection) and excellent tolerance of the immunotherapy, E.P.D. is particularly suited for the prevention of seasonal symptoms in patients allergic to grass pollen.

Environmental control, especially means for blocking the release into the air of mite allergens embedded in padded furniture (mattress, pillows), represents the first important step in the treatment of IgE-mediated allergic diseases. New to the market is a home hygiene spray that creates a protective barrier on padded furniture and is thereby able to contain the dispersion into the air of allergic particles. We tested the effectiveness of the spray in vitro. Since mites, especially D. Pteronyssinus, are considered the foremost allergens, we verified the ability of the invisible barrier to impede the diffusion of the allergen and the mobile forms of these mites (Der p 1, Der 2). The product under exam created a barrier that totally blocked the passage of mobile forms and almost totally prevented the passage of allergens (> 99%).

In the vast area of qualitative pathologies caused by foods, real IgE-mediated allergic reactions are rather rare. More commonly observed and apparently on a constant rise in Western countries are reactions from food intolerance, especially in relationship with the massive exposure to additives used in industrial food products. This study involved a population of 582 adult patients with chronic pseudo-allergic dermatopathies. The link between symptoms and intolerance to food additives has been proved on the basis of the efficacy of a strict diet that eliminates certain foods and the positivity of the provocation test in double-blind trial controlled with a placebo in 165 patients (about 28% of the cases). These results lead us to conclude that additives are a frequent cause of chronic pseudo-allergic dermatopathies in adult patients and, in general, a problem of primary importance in the allergology practice.

Prilotest is a new disposable skin puncture test that has been recently produced and marketed by Laboratorio Farmaceutico Lofarma, Milan-Italy. The tip of the device is submerged in a well containing the allergen extract. As a result, the product is ready for use and there is no longer a need to place a drop of the allergen extract on the skin beforehand. Thus, the diagnostic procedure is simplified, the test offers excellent reproducibility. We made a comparative test of the reproducibility of the new method and Pepys' modified prick test on thirty patients (10 sensitized to Grass pollen, 10 to Pellitory pollen, and 10 to house dust mites); each test was repeated eight times. We also evaluated the specificity and sensitivity of the new method in 39 different allergic patients (13 sensitized to Grass pollen, 13 to Pellitory pollen, and 13 to house dust mites) and in 39 healthy subjects. The results show that the new method has a significantly higher level of reproducibility than Pepys' modified prick test. Furthermore, the reproducibility obtained is higher than results reported in literature for various standardized prick test methods. The sensitivity and specificity of the new method was excellent.

Eighty-five patients affected by chronic urticaria (45 females and 40 males) were submitted to intradermal tests with house and storage mites in order to evaluate a possible sensitization to these allergens. The same allergological tests were performed in an 80-subject control group. The results showed immediate cutaneous reactivity to one or more mites in 40 patients (47%) while only 6 positivities (7.5%) were found in the control group. 27 patients, out of the 40 allergic to mites, were submitted to specific desensitizing therapy. 6 of them showed a complete recovery, 20 good results and only 1 slight improvement of clinical manifestations. These data allow us to hypothesize that the allergy to mite allergens is an important etiopathogenic factor in several chronic so called "idiopathic" urticarias.

RIA dosages of specific IgE antibodies to cow milk, alpha-lactalbumin, beta-lactoglobulin, casein, cheddar and mould cheese were determined in 440 patients. Statistic analysis has been carried out with: 1) the linear regression and correlation coefficient r2: 2) U test of Mann-Whitney and then S test of Kendall Results show that casein has low allergenicity in comparison to other cow's milk proteins. It could be unnecessary to quantify specific IgE to cow milk and cheeses. From the observed data we could suppose that the formulas with casein/blood protein ratio similar to maternal milk may be more allergenic than casein based ones.

R.I.A. dosages of specific IgE antibodies to Dermatophagoides pteronyssinus, Dermatophagoides farinae (house dust mites), Acarus siro, Lepidoglyphus destructor, and Tyrophagus putrescentiae (storage mites) in 467 unselected patients were statistically analyzed. A significant noncorrelation between specific IgE antibodies to storage mites and those to house dust mites has been found, suggesting that storage mites have their own allergenic specificity.

For many years molds have considered to be important causes of rhinitis and asthma but since they have been poorly studied many questions remain unanswered. Allergological and epidemiological considerations have been made by the authors concerning the role of the Alternaria tenuis in respiratory diseases in children. 253 subjects were skin tested, 9.48 percent had an immediate reaction, 3.55 were also positive to the fungus only. Good correlation was observed between positive skin tests and RAST (66%). This study confirmed that probably Alternaria tenuis has an important role as immunopathogen for rhinitis and asthma in children. The authors discuss epidemiological considerations and related problems.

One hundred and fifty-two children affected by respiratory syndromes, probably due to allergy, underwent skin testing to a range of extracts including several different species of mites. The incidence of positive reactions to different allergens was studied in two groups: below and over 4 years, each including both outpatients and inpatients. The aetiologic role of mites has been evaluated considering positive skin tests to single species between and within families.

The presence of antibodies to rifampin was determined in sera of patients with tuberculosis on daily treatment one day after discontinuation of treatment, one week later, 3 weeks later, and 8 weeks later. The highest number of positive patients was found in the third week.

Thirty children with cow's milk protein intolerance were submitted to skin tests with either alpha-lactalbumin and casein commercial products or substitutes commonly used for infant feeding. This method showed helpful in choosing the proper milk substitute for affected children.

Purpose: Previous studies had reported that normal individuals do not have measurable levels of interferons in their circulation, whereas high levels have been found in patients in the early stages of AIDS (acquired immunodeficiency syndrome) and in those with AIDS-related complex (ARC). This study was undertaken to compare levels of interferon and interferon inhibitors in plasma samples from patients with AIDS, ARC, Kaposi's sarcoma, or varicella-zoster virus infection, and from control subjects., Patients and Methods: A total of 206 persons were tested for the presence of interferon and interferon inhibitors in their plasma: 76 with ARC or AIDS, with or without Kaposi's sarcoma or lymphoma; 32 with varicella-zoster infection; 12 with AIDS-unrelated Kaposi's sarcoma; and 86 normal control subjects at high or low risk of AIDS with or without positive antibody levels to human immunodeficiency virus-1. Total interferon activity was measured by bioassay and the subtypes were not separated., Results: Of 86 normal control subjects, 85 had no significant levels of interferon or interferon inhibitor. One disease-free homosexual exhibited measurable interferon levels. Patients acutely infected with varicella-zoster virus showed no measurable interferon or inhibitor levels except if they were in a high-risk group for AIDS. Seventy-six patients with ARC or AIDS exhibited measurable circulating interferon levels. Only patients with AIDS had interferon inhibitors in their circulation. Of 12 patients with Kaposi's sarcoma unrelated to AIDS, none had measurable interferon inhibitor levels, but some exhibited measurable interferon levels., Conclusion: It is suggested that levels of interferon inhibitor should be considered when interferon is used therapeutically in viral or neoplastic diseases.