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11. Adherence issues related to sublingual immunotherapy as perceived by allergists

Author

Scurati, S., Frati, F., Passalacqua, G., Puccinelli, P., Hilaire, C., Incorvaia, C., D Avino, G., Comi, R., Lo Schiavo, M., Pezzuto, F., Montera, C., Pio, A., Teresa Ielpo, M., Cellini, F., Vicentini, L., Pecorari, R., Aresu, T., Capra, L., Benedictis, E., Bombi, C., Zauli, D., Vanzi, A., Alberto Paltrinieri, C., Bondioli, A., Paletta, I., Ventura, D., Mei, F., Paolini, F., Colangelo, C., Cavallucci, E., Cucinelli, F., Tinari, R., Ermini, G., Beltrami, V., Novembre, E., Begliomini, C., Marchese, E., Solito, E., Ammannati, V., Molino, G., Galli, E., Baldassini, M., Di Michele, L., Calvani, M., Gidaro, M., Venuti, A., Li Bianchi, E., Benassi, F., Pocobelli, D., Zangari, P., Rocco, M. G., Lo Vecchio, A., Pingitore, G., Grimaldi, O., Schiavino, D., Perrone, N., Antonietta Frieri, M., Di Rienzo, V., Tripodi, S., Scarpa, A., Tomsic, M., Bonaguro, R., Enrico Senna, G., Sirena, A., Turatello, F., Crescioli, S., Favero, E., Billeri, L., Chieco Bianchi, F., Gemignani, C., Zanforlin, M., Angiola Crivellaro, M., Hendrick, B., Maltauro, A., Masieri, S., Elisabetta Conte, M., Fama, M., Pozzan, M., Bonadonna, P., Casanova, S., Vallerani, E., Schiappoli, M., Borghesan, F., Giro, G., Casotto, S., Berardino, L., Zanoni, G., Ariano, R., Aquilina, R., Pellegrino, R., Marsico, P., Del Giudice, A., Narzisi, G., Tomaselli, V., Fornaca, G., Favro, M., Loperfido, B., Gallo, C., Buffoni, S., Gani, F., Raviolo, P., Faggionato, S., Truffelli, T., Vivalda, L., Albano, M., Enzo Rossi, R., Lattuada, G., Bona, F., Quaglio, L., Chiesa, A., Trapani, M., Seminara, R., Cucchi, B., Oderda, S., Borio, G., Galeasso, G., Garbaccio, P., Marco, A., Marengo, F., Cadario, G., Manzoni, S., Vinay, C., Curcio, A., Silvestri, A., Peduto, A., Riario-Sforza, G. G., Maria Forgnone, A., Barocelli, P., Tartaglia, N., Feyles, G., Giacone, A., Ricca, V., Guida, G., Nebiolo, F., Bommarito, L., Heffler, E., Vietti, F., Galimberti, M., Savi, E., Pappacoda, A., Bottero, P., Porcu, S., Felice, G., Berra, D., Francesca Spina, M., Pravettoni, V., Calamari, A. M., Varin, E., Iemoli, E., Lietti, D., Ghiglioni, D., Alessandro Fiocchi, Tosi, A., Poppa, M., Caviglia, A., Restuccia, M., Russello, M., Alciato, P., Manzotti, G., Ranghino, E., Luraschi, G., Rapetti, A., Rivolta, F., Allegri, F., Terracciano, L., Agostinis, F., Paolo Piras, P., Ronchi, G., Gaspardini, G., Caria, V., Tolu, F., Fantasia, D., Carta, P., Moraschini, A., Quilleri, R., Santelli, A., Prandini, P., Del Giudice, G., Apollonio, A., Bonazza, L., Teresa Franzini, M., Branchi, S., Zanca, M., Rinaldi, S., Catelli, L., Zanoletti, T., Cosentino, C., Della Torre, F., Cremonte, L., Musazzi, D., Suli, C., Rivolta, L., Ottolenghi, A., Marino, G., Sterza, G., Sambugaro, R., Orlandini, A., Minale, P., Voltolini, S., Bignardi, D., Omodeo, P., Tiri, A., Milani, S., Ronchi, B., Licardi, G., Bruni, P., Scibilia, J., Schroeder, J., Crosti, F., Maltagliati, A., Alesina, M. R., Mosca, M., Leone, G., Napolitano, G., Di Gruttola, G., Scala, G., Mascio, S., Valente, A., Marchetiello, I., Catello, R., Gazulli, A., Del Prete, A., Varricchio, A. M., Carbone, A., Forestieri, A., Stillitano, M., Leonetti, L., Tirroni, E., Castellano, F., Abbagnara, F., Romano, F., Levanti, C., Cilia, M., Longo, R., Ferrari, A., Merenda, R., Di Ponti, A., Guercio, E., Surace, L., Ammendola, G., Tansella, F., Peccarisi, L., Stragapede, L., Minenna, M., Granato, M., Fuiano, N., Pannofino, A., Ciuffreda, S., Giannotta, A., Morero, G., D Oronzio, L., Taddeo, G., Nettis, E., Cinquepalmi, G., Lamanna, C., Mastrandrea, F., Minelli, M., Salamino, F., Muratore, L., Latorre, F., Quarta, C., Ventura, M., D Ippolito, G., Giannoccaro, F., Dambra, P., Pinto, L., Triggiani, M., Munno, G., Manfredi, G., Lonero, G., Damiano, V., Errico, G., Di Leo, E., Manzari, F., Spagna, V., Arsieni, A., Matarrese, A., Mazzarella, G., Scarcia, G., Scarano, R., Ferrannini, A., Pastore, A., Maionchi, P., Filannino, L., Tria, M., Giuliano, G., Damiani, E., Scichilone, N., Marchese, M., Lucania, A., Marino, M., Strazzeri, L., Tumminello, S., Vitale, G. I., Gulotta, S., Gragotto, G., Zambito, M., Greco, D., Valenti, G., Licitra, G., Cannata, E., Filpi, R., Contraffatto, M., Sichili, S., Randazzo, S., Scarantino, G., Lo Porto, B., Pavone, F., Di Bartolo, C., Paternò, A., Rapisarda, F., Laudani, E., Leonardi, S., Padua, V., Cabibbo, G., Marino Guzzardi, G., Deluca, F., Agozzino, C., Pettinato, R., Ghini, M., Scurati S., Frati F., Passalacqua G., Puccinelli P., Hilaire C., Incorvaia C., D'Avino G., Comi R., Lo Schiavo M., Pezzuto F., Montera C., Pio A., Teresa Ielpo M., Cellini F., Vicentini L., Pecorari R., Aresu T., Capra L., De Benedictis E., Bombi C., Zauli D., Vanzi A., Alberto Paltrinieri C., Bondioli A., Paletta I., Ventura D., Mei F., Paolini F., Colangelo C., Cavallucci E., Cucinelli F., Tinari R., Ermini G., Beltrami V., Novembre E., Begliomini C., Marchese E., Solito E., Ammannati V., Molino G., Galli E., Baldassini M., Di Michele L., Calvani M., Gidaro M., Venuti A., Li Bianchi E., Benassi F., Pocobelli D., Zangari P., De Rocco M.G., Lo Vecchio A., Pingitore G., Grimaldi O., Schiavino D., Perrone N., Antonietta Frieri M., Di Rienzo V., Tripodi S., Scarpa A., Tomsic M., Bonaguro R., Enrico Senna G., Sirena A., Turatello F., Crescioli S., Favero E., Billeri L., Chieco Bianchi F., Gemignani C., Zanforlin M., Angiola Crivellaro M., Hendrick B., Maltauro A., Masieri S., Elisabetta Conte M., Fama M., Pozzan M., Bonadonna P., Casanova S., Vallerani E., Schiappoli M., Borghesan F., Giro G., Casotto S., Berardino L., Zanoni G., Ariano R., Aquilina R., Pellegrino R., Marsico P., Del Giudice A., Narzisi G., Tomaselli V., Fornaca G., Favro M., Loperfido B., Gallo C., Buffoni S., Gani F., Raviolo P., Faggionato S., Truffelli T., Vivalda L., Albano M., Enzo Rossi R., Lattuada G., Bona F., Quaglio L., Chiesa A., Trapani M., Seminara R., Cucchi B., Oderda S., Borio G., Galeasso G., Garbaccio P., De Marco A., Marengo F., Cadario G., Manzoni S., Vinay C., Curcio A., Silvestri A., Peduto A., Riario-Sforza G.G., Maria Forgnone A., Barocelli P., Tartaglia N., Feyles G., Giacone A., Ricca V., Guida G., Nebiolo F., Bommarito L., Heffler E., Vietti F., Galimberti M., Savi E., Pappacoda A., Bottero P., Porcu S., Felice G., Berra D., Francesca Spina M., Pravettoni V., Calamari A.M., Varin E., Iemoli E., Lietti D., Ghiglioni D., Fiocchi A., Tosi A., Poppa M., Caviglia A., Restuccia M., Russello M., Alciato P., Manzotti G., Ranghino E., Luraschi G., Rapetti A., Rivolta F., Allegri F., Terracciano L., Agostinis F., Paolo Piras P., Ronchi G., Gaspardini G., Caria V., Tolu F., Fantasia D., Carta P., Moraschini A., Quilleri R., Santelli A., Prandini P., Del Giudice G., Apollonio A., Bonazza L., Teresa Franzini M., Branchi S., Zanca M., Rinaldi S., Catelli L., Zanoletti T., Cosentino C., Della Torre F., Cremonte L., Musazzi D., Suli C., Rivolta L., Ottolenghi A., Marino G., Sterza G., Sambugaro R., Orlandini A., Minale P., Voltolini S., Bignardi D., Omodeo P., Tiri A., Milani S., Ronchi B., Licardi G., Bruni P., Scibilia J., Schroeder J., Crosti F., Maltagliati A., Alesina M.R., Mosca M., Leone G., Napolitano G., Di Gruttola G., Scala G., Mascio S., Valente A., Marchetiello I., Catello R., Gazulli A., Del Prete A., Varricchio A.M., Carbone A., Forestieri A., Stillitano M., Leonetti L., Tirroni E., Castellano F., Abbagnara F., Romano F., Levanti C., Cilia M., Longo R., Ferrari A., Merenda R., Di Ponti A., Guercio E., Surace L., Ammendola G., Tansella F., Peccarisi L., Stragapede L., Minenna M., Granato M., Fuiano N., Pannofino A., Ciuffreda S., Giannotta A., Morero G., D'Oronzio L., Taddeo G., Nettis E., Cinquepalmi G., Lamanna C., Mastrandrea F., Minelli M., Salamino F., Muratore L., Latorre F., Quarta C., Ventura M., D'Ippolito G., Giannoccaro F., Dambra P., Pinto L., Triggiani M., Munno G., Manfredi G., Lonero G., Damiano V., Errico G., Di Leo E., Manzari F., Spagna V., Arsieni A., Matarrese A., Mazzarella G., Scarcia G., Scarano R., Ferrannini A., Pastore A., Maionchi P., Filannino L., Tria M., Giuliano G., Damiani E., Scichilone N., Marchese M., Lucania A., Marino M., Strazzeri L., Tumminello S., Vitale G.I., Gulotta S., Gragotto G., Zambito M., Greco D., Valenti G., Licitra G., Cannata E., Filpi R., Contraffatto M., Sichili S., Randazzo S., Scarantino G., Lo Porto B., Pavone F., Di Bartolo C., Paterno A., Rapisarda F., Laudani E., Leonardi S., Padua V., Cabibbo G., Marino Guzzardi G., Deluca F., Agozzino C., Pettinato R., Ghini M., Scurati S, Frati F, Passalacqua G, Puccinelli P, Hilaire C, Incorvaia I, D'Avino G, Comi R, Lo Schiavio M, Pezzuto F, Montera C, Pio A, Ielpo MT, Cellini F, Vicentini L, Pecorari R, Aresu T, Capra L, De Benedictis E, Bombi C, Zauli D, and et al

Subjects
medicine.medical_specialty, Pathology, genetic structures, efficacy, Alternative medicine, Medicine (miscellaneous), Adherence, Cost, Efficacy, Side effects, Sublingual immunotherapy, Settore MED/10 - Malattie Dell'Apparato Respiratorio, sublingual immunotherapy, ALLERGEN, cost, medicine, Subcutaneous immunotherapy, Sublingual immunotherapy, adherence, Clinical efficacy, Intensive care medicine, Pharmacology, Toxicology and Pharmaceutics (miscellaneous), sublingual immunoterapy, Original Research, Asthma, AEROALLERGENS, side effects, business.industry, Health Policy, medicine.disease, Slit, eye diseases, Clinical trial, Patient Preference and Adherence, immunotherapy, sense organs, Allergists, ADHERENCE TO TREATMENT, business, Social Sciences (miscellaneous)
Abstract

Silvia Scurati1, Franco Frati1, Gianni Passalacqua2, Paola Puccinelli1, Cecile Hilaire1, Cristoforo Incorvaia3, Italian Study Group on SLIT Compliance 1Scientific and Medical Department, Stallergenes, Milan, Italy; 2Allergy and Respiratory Diseases, Department of Internal Medicine, Genoa; 3Allergy/Pulmonary Rehabilitation, ICP Hospital, Milan, ItalyObjectives: Sublingual immunotherapy (SLIT) is a viable alternative to subcutaneous immunotherapy to treat allergic rhinitis and asthma, and is widely used in clinical practice in many European countries. The clinical efficacy of SLIT has been established in a number of clinical trials and meta-analyses. However, because SLIT is self-administered by patients without medical supervision, the degree of patient adherence with treatment is still a concern. The objective of this study was to evaluate the perception by allergists of issues related to SLIT adherence.Methods: We performed a questionnaire-based survey of 296 Italian allergists, based on the adherence issues known from previous studies. The perception of importance of each item was assessed by a VAS scale ranging from 0 to 10.Results: Patient perception of clinical efficacy was considered the most important factor (ranked 1 by 54% of allergists), followed by the possibility of reimbursement (ranked 1 by 34%), and by the absence of side effects (ranked 1 by 21%). Patient education, regular follow-up, and ease of use of SLIT were ranked first by less than 20% of allergists.Conclusion: These findings indicate that clinical efficacy, cost, and side effects are perceived as the major issues influencing patient adherence to SLIT, and that further improvement of adherence is likely to be achieved by improving the patient information provided by prescribers.Keywords: adherence, sublingual immunotherapy, efficacy, cost, side effects

Published
2010

14. Wheat IgE-Mediated Food Allergy in European Patients: alpha-Amylase Inhibitors, Lipid Transfer Proteins and Low-Molecular-Weight Glutenins

Author

Pastorello E.A., Farioli L., Conti A., Pravettoni V., Bonomi S., Iametti S., Fortunato D., Scibilia J., Bindslev-Jensen C., Ballmer-Weber B., Robino A.M., and Ortolani C.

Subjects
controlled food challenge - anaphylaxis, glutenins - thermal treatment, otorhinolaryngologic diseases, food and beverages, alpha-amylase inhibitor, lipid transfer protein - gliadins, wheat allergy - food allergens - double-blind placebo
Abstract

Background: three main problems hamper the identification of wheat food allergens: 1) lack of a standardized procedure for extracting all of the wheat protein fractions; 2) absence of double-blind, placebo-controlled food challenge studies that compare the allergenic profile of Osborne’s three protein fractions in subjects with real wheat allergy; 3) lack of data on the differences in IgE-binding capacity between raw and cooked wheat. Methods: sera of 16 wheat challenge positive patients and 6 with wheat anaphylaxis were used for SDS-PAGE/immunoblotting of the three Osborne’s protein fractions (albumin/globulin, gliadins, glutenins) of raw and cooked wheat. Thermal sensitivity of wheat LTP was investigated by spectroscopic approaches. IgE cross-reactivity between wheat and grass pollen was studied by blot inhibition. Results: The most important wheat allergens were the alpha-amylase/trypsin inhibitor subunits, which were present in all three protein fractions of raw and cooked wheat. Other important allergens were a 9-kd lipid-transfer-protein in the albumin/globulin fraction and several low-molecular weight glutenin subunits in the gluten fraction.........................

Published
2007

15. Lipid transfer protein and vicillin are important walnut allergens in patients not allergic to pollen

Author

Pastorello E.A., Farioli L., Pravettoni V., Robino A.M., Scibilia J., Fortunato D., Conti A., Borgonovo L., Bengtsson A., and Ortolani C.

Subjects
food allergy, Walnut, anaphylaxis, vicilin, lipid transfer protein, nuts allergy
Abstract

Walnut is the most common cause of allergic reactions to tree nuts, as reported by large population studies. Two major allergens of walnut have been identified up until now: a 2S albumin and a vicilin-like protein. OBJECTIVE: This study was designed to identify the walnut major allergens in the Italian population and to compare the walnut IgE-binding profile in patients with or without pollen allergy. METHODS: We selected 46 patients either with oral allergy syndrome confirmed by open oral challenge or with systemic symptoms after ingestion of walnut. These patients' sera were used for the immunoblotting of walnut extract; the identified allergens were purified by HPLC and sequenced. A peach-walnut cross-inhibition study was then performed. RESULTS: The only major allergen recognized by our study population was a 9-kd lipid transfer protein (LTP), recognized by 37 patients. Two other minor allergens of approximately 9-kd molecular weight, both belonging to the vicilin family, were recognized by 10 patients. IgE binding to walnut LTP was completely inhibited by peach LTP. CONCLUSION: In Italian patients with walnut allergy confirmed by documented history of severe systemic reactions or by open oral food challenge, the major allergen is an LTP. The sensitization to this protein seems to be secondary to the sensitization to peach LTP, which acts as the primary sensitizer. LTP and vicilins were able to sensitize patients not allergic to pollen.

Published
2004

16. Identification of hazelnut major allergens in sensitive patients with positive double-blind, placebo- controlled food challenge results

Author

Pastorello E.A., Vieths S., Pravettoni V., Farioli L., Trambaioli C., Fortunato D., Luttkopf D., Calamari M., Ansaloni R., Scibilia J., Ballmer-Weber B., Poulsen L.K., Wutrich B., Hansen K.S., Robino A.M., Ortolani C., and Conti A.

Subjects
immune system diseases, otorhinolaryngologic diseases, respiratory system, respiratory tract diseases
Abstract

Background. Hazelnut major allergens up to now identified are a 18 kd protein homologous to Bet v 1 and a 14-kd allergen homologous to Bet v 2. No studies reported hazelnut allergens as recognized by patients with positive double-blind placebo controlled food challenges (DBPCFCs) or allergic to hazelnut but not to birch. Objective. In this study we characterized the hazelnut allergens by studying the IgE reactivity of 65 patients with positive DBPCFC and of 7 patients with severe anaphylaxis to hazelnut. Methods. Hazelnut allergens were identified by SDS-PAGE and IgE immunoblotting. Further characterization was made by: a) amino-acid sequencing; b) evaluation, with EAST inhibition, of IgE binding properties of raw and roasted hazelnut, and c) assessment of cross- reactivity with different allergens by immunoblotting inhibition. Results. All the sera from the DBPCFC positive patients recognized a 18 and a 47 kd allergen; other major allergens were at a m.w. of 32 and 35 kd. The binding to the 18 kd band was inhibited by birch extract, demonstrating its homology with the birch major allergen, and was abolished in roasted hazelnut. The 47 kd allergen is a sucrose-binding protein; the 35 kd allergen is a legumin; the 32 kd allergen is a 2S albumin. The patients with severe anaphylactic reactions to hazelnut showed a specific IgE reactivity to a 9 kd allergen, totally inhibited by purified peach LTP, which was heat-stable. Conclusions The major allergen of hazelnut is a 18 kd protein, homologous to Bet v 1; the 9 kd allergen is likely a lipid transfer protein; other major allergens have a m.w. of 47, 32 and 35 kd.

Published
2002

17. Searching for allergens in maize kernels via proteomic tools

Author

Fasoli, Elisa, Pastorello, E. A., Farioli, L, Scibilia, J, Aldini, G, Carini, M, Marocco, Adriano, Boschetti, E, Righetti, Pier Giorgio, Marocco, Adriano (ORCID:0000-0001-5378-5591), Fasoli, Elisa, Pastorello, E. A., Farioli, L, Scibilia, J, Aldini, G, Carini, M, Marocco, Adriano, Boschetti, E, Righetti, Pier Giorgio, and Marocco, Adriano (ORCID:0000-0001-5378-5591)

Abstract

Up to the present, only one major allergen had been univocally identified by chemical analysis (N-terminal sequencing) in the salt-extractable (cytoplasmic) protein fraction of maize kernels (Zea mays): the lipid transfer protein (Pastorello et al., Allergy Clin. Immunol. 2000;106:744–751). In the present study, two-dimensional maps of kernel flour have been set up, the proteins transferred to nitrocellulose membranes and confronted with sera of various patients allergic to maize proteins. Via spot excision and Orbitrap mass analysis, the following new allergens have been identified: vicilin, globulin-2, 50 kDa gamma-zein, endochitinase, thioredoxin and trypsin inhibitor. Vicilin was found to be composed of a string of six spots, all of them allergenic; also globulin-2 was composed of a string of five spots, exhibiting equivalent allergenicity. The 50 kDa gamma-zein, found here in the maize flour soluble fraction, is identical to the 50 kDa allergen reported by Pasini et al. (Allergy 2002; 57:98–106), but present in the insoluble fraction and solubilized via -S-S- reducing agents. However, the form here described might be a truncated species, since it exhibits an apparent Mr, in SDS-PAGE, of ca. 35 kDa. The homology of three of them (vicilin, globulin-2 and thioredoxin) with other vegetable systems has been investigated via BLAST analysis, the ones with highest homology belonging to rice, wheat and barley. The present data add a non-negligible amount of previously unreported allergens to the scanty panorama of maize proteins.

Published
2009

18. Diagnostik I

Author

Becker, W., primary, Jappe, U., additional, Kreft, B., additional, Ludwig, A., additional, Przybilla, B., additional, Walker, A., additional, Biedermann, T., additional, Raulf-Heimsoth, M., additional, Sültz, J., additional, Petersen, A., additional, Seppälä, U., additional, Dauly, C., additional, Robinson, S., additional, Hornshaw, M., additional, Nedergaard, J., additional, Ipsen, H., additional, Seyfarth, F., additional, Hipler, U.-C., additional, Schliemann, S., additional, Elsner, P., additional, Ausner, E., additional, Seelinger, M., additional, Matthias, J., additional, Kirsch, A. I., additional, Oberhofer, E., additional, Möhrenschlager, M., additional, Ring, J., additional, Menz, G., additional, Kespohl, S., additional, Förster, T., additional, Maryska, S., additional, Brüning, T., additional, Neumeister, V., additional, Nemat, K., additional, Hauswald, B., additional, Spornraft-Ragaller, P., additional, Blank, S., additional, Seismann, H., additional, Michel, Y., additional, McIntyre, M., additional, Cifuentes, L., additional, Braren, I., additional, Grunwald, T., additional, Darsow, U., additional, Bredehorst, R., additional, Ollert, M., additional, Spillner, E., additional, Christensen, L. H., additional, Amondsen, P., additional, Henmar, H., additional, Bergmann, K., additional, Schmidt, A., additional, Staatz, A., additional, Strohner, P., additional, Becher, G., additional, Nährlich, L., additional, Rudloff, S., additional, Steiß, J.-O., additional, Lange, L., additional, Sonntag, H., additional, Buderus, S., additional, Wahl, R., additional, Kraus, R., additional, Urbanek, R., additional, Grychtol, R., additional, Meinicke, H., additional, Müller, C., additional, Heinzmann, A., additional, Schiller, D., additional, Kühne, Y., additional, Becker, S., additional, Ballmer-Weber, B., additional, Niggemann, B., additional, Scibilia, J., additional, Bindslev-Jensen, C., additional, Wackermann, O., additional, Reese, G., additional, Vieths, S., additional, Holzhauser, T., additional, Gröger, M., additional, Canis, M., additional, Kramer, M., additional, Beck, I., additional, Jochner, S., additional, Gilles, S., additional, Schmidt-Weber, C., additional, Menzel, A., additional, Behrendt, H., additional, Traidl-Hoffmann, C., additional, Waßmann, A., additional, Wichmann, K., additional, Heratizadeh, A., additional, Wedi, B., additional, Kapp, A., additional, and Werfel, T., additional

Published
2011
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21. Hazelnut allergy:a double-blind, placebo-controlled food challenge multicenter study

Author

Ortolani, C, Ballmer-Weber, B K, Hansen, K S, Ispano, M, Wüthrich, B, Bindslev-Jensen, C, Ansaloni, R, Vannucci, L, Pravettoni, V, Scibilia, J, Poulsen, L K, Pastorello, E A, Ortolani, C, Ballmer-Weber, B K, Hansen, K S, Ispano, M, Wüthrich, B, Bindslev-Jensen, C, Ansaloni, R, Vannucci, L, Pravettoni, V, Scibilia, J, Poulsen, L K, and Pastorello, E A

Abstract

BACKGROUND: Tree nuts are a common cause of food allergy in Europe. However, few studies deal with real food allergy to hazelnuts in subjects believed to be allergic to this food.OBJECTIVE: We sought to select subjects with a history of allergic reactions on ingestion of hazelnut and determine how many of these have true allergy by means of the double-blind, placebo-controlled food challenge (DBPCFC).METHODS: Eighty-six subjects with a history of symptoms after hazelnut ingestion were recruited from 3 allergy centers (Milan, Zurich, and Copenhagen). All subjects underwent skin prick tests (SPTs) with aeroallergens and hazelnut, as well as having their specific hazelnut IgE levels determined. Diagnosis of clinical relevant food allergy was made on the basis of the DBPCFC.RESULTS: Sixty-seven (77.9%) of 86 subjects had a positive DBPCFC result; 8 were placebo responders, and 11 were nonresponders. Of the 11 nonresponders, 4 had positive open-challenge test results. Of the DBPCFC-positive subjects, 87% also had positive skin test responses to birch pollen extract. Specific IgE determination for hazelnut (positive CAP response >/=0.7 kU/L [ie, class 2]) showed a sensitivity of 0.75, a positive predictive value (PPV) of 0.92, a specificity of 0.16, and a negative predictive value (NPV) of 0.05. Skin tests with commercial hazelnut extract produced a sensitivity of 0.89, a PPV of 0.92, a specificity of 0.05, and an NPV of 0.05. Skin tests with natural food produced a sensitivity of 0.88, a PPV of 0.94, a specificity of 0.27, and an NPV of 0.15.CONCLUSION: This study shows that hazelnut is an allergenic source that can cause real food allergy, as confirmed by DBPCFC. Skin and IgE tests demonstrated reasonable sensitivity and PPV but a very low specificity and NPV, thus implying that these should not be used to validate the diagnosis of food allergy to hazelnut.

Published
2000

22. Nahrungsmittelallergene

Author

Reuter, F., primary, Bade, S., additional, Hirst, T., additional, Becker, W., additional, Frey, A., additional, Adler, H. S., additional, Hofmann, C., additional, Christ, S., additional, Raps, C., additional, Scheurer, S., additional, Vieths, S., additional, Steinbrink, K., additional, Krüger, U., additional, Buhl, T., additional, Hänßle, H., additional, Fuchs, T., additional, Süß, A., additional, Treudler, R., additional, Averbeck, M., additional, Simon, J., additional, Gorris, H., additional, McIntyre, M., additional, Mohammad-Gholiei, M., additional, Eberlein, B., additional, Ollert, M., additional, Ring, J., additional, Darsow, U., additional, Dölle, S., additional, Schwarz, D., additional, Lehmann, K., additional, Bäßler, O., additional, Franken, P., additional, George, E., additional, Worm, M., additional, Stratmann, C., additional, Fölster-Holst, R., additional, Kühne, Y., additional, Ballmer-Weber, B., additional, Niggemann, B., additional, Scibilia, J., additional, Reese, G., additional, Holzhauser, T., additional, Lorenz, Y., additional, Le Quynh, L., additional, Mahler, V., additional, Foetisch, K., additional, Enrique, E., additional, Bartra, J., additional, and Biemelt, S., additional

Published
2007
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29. Why do children with diabetes die?

Author

Scibilia, J, Finegold, D, Dorman, J, Becker, D, and Drash, A

Abstract

While the treatment of children with Type I diabetes mellitus has dramatically improved since the introduction of insulin in 1922, significant acute mortality still remains. To better ascertain the causes of death in younger children and adolescents with diabetes mellitus, a retrospective review was undertaken of diabetes associated mortality in the patient population followed at the Children's Hospital of Pittsburgh between the years 1950 and 1985. Fifty-five deaths were identified of which 20 occurred during the initial presentation of diabetes and 35 occurred between 2 months and 11 years following the diagnosis of diabetes mellitus. Diabetic ketoacidosis (DKA) was associated with 64% of the total mortality with 85% of the early onset and 54% of the late onset deaths being ketoacidosis related. Of these ketoacidosis associated deaths, cerebral edema was documented in 31%, or 20% of the total group mortality. Non ketoacidosis deaths in both early and late onset groups were caused by heterogeneous events. There were no deaths associated with the traditional late vascular complications of diabetes mellitus. Since diabetic ketoacidosis is a potentially preventable acute complication of diabetes mellitus and represented a predominant cause of mortality in these children, early recognition and prompt treatment might substantially reduce childhood mortality in patients with Type I diabetes mellitus.

Published
1986
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35. Chronic Urticaria Atopic Dermatitis and Celiac Disease.

Author

Gallo, C., Vighi, G., Schroeder, J., Strozzi, M., Scibilia, J., Colafrancesco, M., Rota, E., Ortolani, C., Brusamolino, R., and Barberis, M.

Subjects
LETTERS to the editor, URTICARIA
Abstract

Presents a letter to the editor about a case of chronic urticaria and celiac disease.

Published
1992

36. The Severity and Frequency of Systemic Reactions to Hazelnut Are Significantly Higher in Hazelnut Allergic Patients Monosensitized to Cor a 8 than in Patients Polysensitized to Cor a 1, Cor a 8, and Cor a 9.

Author

Pastorello EA, Scibilia J, Rossi CM, Toscano A, Losappio LM, Nichelatti M, Aversano MG, and Farioli L

Subjects
Adult, Humans, Plant Proteins, Antigens, Plant, Immunoglobulin E, Allergens adverse effects, Corylus adverse effects, Nut Hypersensitivity diagnosis, Food Hypersensitivity diagnosis, Food Hypersensitivity epidemiology
Abstract

Introduction: Hazelnuts are a leading trigger of food allergy. To date, several molecular components of hazelnut are available for component-resolved diagnosis. However, little is known about how simultaneous sensitization to multiple allergens affects the severity of the hazelnut-induced reaction. In a previous study, our group demonstrated a lower risk of systemic reactions to peach in patients sensitized to both Pru p 3 and Pru p 1 than in the patient monosensitized to peach LTP. We aimed to assess whether this was also true in hazelnut allergy in a cohort of adult patients., Methods: Patients were selected based on a history of symptoms such as urticaria, vomiting, diarrhea, asthma, and anaphylaxis indicative of hazelnut IgE-mediated food allergy and graded according to a clinical severity scale. For all patients, specific IgE was determined for Cor a 1 and Cor a 8 and, for most patients, also Cor a 9. Patients were offered an oral food challenge in open format (OFC) with a cocoa-based roasted hazelnut spread on a voluntary basis in order to prescribe an appropriate diet., Results: A total of two hundred and fourteen patients were recruited. Among these, 43 patients were monosensitized to Cor a 8. One hundred and seventy-one patients were sensitized to Cor a 1 (79.9%), and, among them, 48/171 (28.1%) were also Cor a 8 positive. Cor a 9 was evaluated in 124/214 patients, testing positive in 21/124 (16.9%). Patients monosensitized to Cor a 8 experienced systemic reactions more frequently than those sensitized to Cor a 1 ± Cor a 8 (p < 0.00001), with significantly more severe reactions (p < 0.0005) and testing more frequently positive at OFC (p < 0.0001). Regarding Cor a 9, the sensitized patients were significantly younger (p = 0.0013) and showed reactions of similar severity to patients who tested Cor a 9 negative, and these reactions were milder than in patients monosensitized only to Cor a 8., Discussion/conclusion: Sensitization to Cor a 1 seems to protect from the development of the severe systemic reactions induced by Cor a 8 sensitization, Cor a 9 does not influence the severity of symptoms in adult patients. The OFC with roasted hazelnut may help in dietary guidance., (© 2023 S. Karger AG, Basel.)

Published
2024
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37. Ortho- perio- prosthetic interdisciplinary approach of an adult class II division 2 with multiple premolar agenesis: A case report.

Author

Fourneron M, Tourbah B, Scibilia J, and Frapier L

Subjects
Young Adult, Humans, Bicuspid surgery, Molar, Third, Esthetics, Dental, Malocclusion, Angle Class II diagnostic imaging, Malocclusion, Angle Class II surgery
Abstract

The aim of this case report is to illustrate the fixed orthodontic, surgical and periodontal implant management of a young adult with multiple agenesis associated with a class II division 2 malocclusion. The challenge here was the multidisciplinary synchronisation in order to achieve a coordinated treatment with the best possible aesthetic, prosthetic and functional prognosis. The patient suffered from a total of 10 agenesis including third molars and underwent implant replacement with bone grafting and periodontal planning of the 6 missing premolars. The orthodontic treatment lasted 22months and was followed by a period of just under a year for periodontal and implant prosthetic completion. The 3-year follow-up after the orthodontic phase showed an excellent prognosis in terms of aesthetics, function and stability., (Copyright © 2023 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Published
2023
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38. Role of Multiple Comorbidities and Therapies in Conditioning the Clinical Severity of DRESS: A Mono-Center Retrospective Study of 25 Cases.

Author

Toniato A, Gamba C, Schroeder JW, Fabbri V, Bernal Ortiz SV, Borgonovo L, Piantanida M, Scibilia J, Balossi L, Brusamolino E, Bonoldi E, Caputo V, Nichelatti M, and Pastorello EA

Subjects
Aged, Comorbidity, Female, Humans, Male, Retrospective Studies, Drug Hypersensitivity Syndrome epidemiology, Drug Hypersensitivity Syndrome therapy, Eosinophilia epidemiology, Eosinophilia therapy, Severity of Illness Index, Skin Diseases epidemiology, Skin Diseases therapy
Abstract

DRESS/DiHS is a complex and potentially fatal drug reaction. Little is known about risk factors and elements that can help to identify patients with a severe reaction early. The aim of the study was to investigate those factors favoring the disease and its severity by analyzing the clinical conditions and therapies preceding the reaction. We conducted a retrospective analysis on patients admitted to our center between 2010 and 2020 who were discharged with a diagnosis of DRESS. We used the RegiSCAR diagnostic criteria. We defined the severity of DRESS using the criteria of Mizukawa et al. We included 25 patients (15 females) with a median age of 66 years. Skin involvement, eosinophilia, and liver injury were the most important aspects. Allopurinol was found to be the most involved drug. Reaction severity was significantly associated with the number of daily medications (p=0.0067) and an age of at least 68 years (p=0.013). In addition, 75% of severe cases had at least three comorbidities in history, and most of the severe cases were female. In our study the advanced age, the high number of comorbidities and home therapies, and the inflammatory state were found to be predisposing elements to the development of the disease and its severity.

Published
2021
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39. Omalizumab Use in Chronic Spontaneous Urticaria during Pregnancy and a Four Years' Follow-Up: A Case Report.

Author

Losappio LM, Mirone C, Schroeder JW, Scibilia J, Balossi L, and Pastorello EA

Abstract

Chronic spontaneous urticaria (CSU) is a benign skin disorder usually responsive to treatment; however, at times it can be difficult to control and become very debilitating. We discuss the case of a woman with CSU that was unresponsive to H1-antihistamines who was treated with omalizumab and became pregnant during omalizumab treatment. We also considered the follow-up of the mother and newborn for 4 years after delivery. Our case report confirms that omalizumab is a safe and effective therapeutic option, after careful evaluations in terms of cost-effectiveness, in pregnant and lactating women with severe chronic urticaria. Assessment throughout follow-up confirmed a regular progression of pregnancy parameters and no adverse reaction was documented in the child from birth to 4 years of age., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2020 by S. Karger AG, Basel.)

Published
2020
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40. Dealing With the Caretaker Whose Judgment Is Impaired by Alcohol or Drugs: Legal and Ethical Considerations.

Author

Bondi SA and Scibilia J

Subjects
Child, Child Abuse, Child Welfare, Confidentiality, Humans, Mandatory Reporting, Parental Consent, Physician's Role, Physician-Patient Relations, Alcohol-Related Disorders psychology, Caregivers psychology, Judgment, Legal Guardians psychology, Parents psychology, Pediatricians ethics, Substance-Related Disorders psychology
Abstract

An estimated 8.7 million children live in a household with a substance-using parent or guardian. Substance-using caretakers may have impaired judgment that can negatively affect their child's well-being, including his or her ability to receive appropriate medical care. Although the physician-patient relationship exists between the pediatrician and the child, obligations related to safety and confidentiality should be considered as well. In managing encounters with impaired caretakers who may become disruptive or dangerous, pediatricians should be aware of their responsibilities before acting. In addition to fulfilling the duty involved with an established physician-patient relationship, the pediatrician should take reasonable care to safeguard patient confidentiality; protect the safety of their patient, other patients in the facility, visitors, and employees; and comply with reporting mandates. This clinical report identifies and discusses the legal and ethical concepts related to these circumstances. The report offers implementation suggestions when establishing anticipatory procedures and training programs for staff in such situations to maximize the patient's well-being and safety and minimize the liability of the pediatrician., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2019 by the American Academy of Pediatrics.)

Published
2019
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41. Tolerated drugs in subjects with severe cutaneous adverse reactions (SCARs) induced by anticonvulsants and review of the literature.

Author

De Luca F, Losappio LM, Mirone C, Schroeder JW, Citterio A, Aversano MG, Scibilia J, and Pastorello EA

Abstract

Background: Anticonvulsant hypersensitivity syndrome represents a rare but potentially fatal kind of adverse drug reaction. This clinical picture often hampers the flexibility with which alternative anticonvulsants or even other classes of drugs are prescribed in these patients, negatively affecting the efficacy of treatment and the course of the disease. The aim of this study was to analyse a group of six patients with severe cutaneous drug reactions induced by anticonvulsants and to report which alternative antiepileptic drugs and which drugs of other classes were tolerated., Case Presentation: A total of six patients (2 males and 4 females, age 11-73 years) are described in this study. In all the patients the onset of the severe cutaneous drug reactions was 2-4 weeks after initiating the anticonvulsant therapy: 2 out of 6 patients presented with a drug reaction with eosinophilia and systemic symptoms under therapy with phenytoin; 2 out of 6 presented with Stevens-Johnson syndrome under therapy with lamotrigine; and 2 out of 6 presented with a toxic epidermal necrolysis, one of them under therapy with valproic acid, and the other one under therapy with lamotrigine. Alternative anticonvulsants tolerated after the reaction were: clonazepam, levetiracetam, diazepam, delorazepam and lormetazepam., Conclusions: In our cases we observed that non aromatic anticonvulsants and benzodiazepines were well tolerated as alternative treatments in six patients with reactions to aromatic anticonvulsivants and that the risk of hypersensitivity reactions to other drug classes was not increased as compared to general population.

Published
2017
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42. Mite-Induced Asthma and IgE Levels to Shrimp, Mite, Tropomyosin, Arginine Kinase, and Der p 10 Are the Most Relevant Risk Factors for Challenge-Proven Shrimp Allergy.

Author

Farioli L, Losappio LM, Giuffrida MG, Pravettoni V, Micarelli G, Nichelatti M, Scibilia J, Mirone C, Cavallarin L, Lamberti C, Balossi LG, and Pastorello EA

Subjects
Allergens immunology, Animals, Antigens, Dermatophagoides immunology, Arginine Kinase immunology, Arthropod Proteins immunology, Cricetinae, Humans, Immune Tolerance, Immunization, Immunoglobulin E blood, Penaeidae, Pyroglyphidae, Risk Factors, Skin Tests, Asthma diagnosis, Food Hypersensitivity diagnosis, Tropomyosin immunology
Abstract

Background: Shrimp sensitization is common in the general population, but the presence of symptoms is only moderately related to sensitization. A point still at issue is which in vivo and/or in vitro tests (food challenge, component-resolved diagnosis, house dust mite [HDM] sensitization) can help in distinguishing shrimp-allergic subjects from subjects that are sensitized but tolerant., Methods: The aim of this study was to evaluate the role of IgE to the different shrimp and mite allergens in distinguishing shrimp challenge-positive from challenge-negative patients. Subjects with suspected hypersensitivity reactions to shrimp, positive skin prick tests (SPTs), and/or anti-shrimp IgE were submitted to open and double-blind placebo-controlled food challenges (DBPCFC). Specific IgE to shrimp, mites, and the recombinants rPen a 1, rDer p 1, 2, and 10 were tested using ImmunoCAP-FEIA. IgE immunoblotting was performed to identify the patients' allergenic profiles., Results: In total, 13 out of 51 (25.5%) patients with reported reactions to shrimp were truly shrimp allergic (7 DBPCFC positive and 6 with documented severe reactions). These patients had significantly higher skin test wheal diameters than nonallergic patients, as well as higher levels of IgE to rPen a 1 and rDer p 10. HDM-induced asthma and the simultaneous presence of anti-nDer p 1, 2, and 10 IgE levels increased the risk of true shrimp allergy., Conclusion: Food challenge tests are mandatory for the diagnosis of shrimp allergy. Tropomyosin is associated with clinical reactivity. HDM-induced asthma and anti-mite IgE are risk factors for shrimp allergy., (© 2017 S. Karger AG, Basel.)

Published
2017
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43. Identification of risk factors of severe hypersensitivity reactions in general anaesthesia.

Author

Mirone C, Preziosi D, Mascheri A, Micarelli G, Farioli L, Balossi LG, Scibilia J, Schroeder J, Losappio LM, Aversano MG, Stafylaraki C, Nichelatti M, and Pastorello EA

Abstract

Background: Hypersensitivity reactions to anaesthetic agents are rare but often severe, with a mortality ranging from 4 to 9% in IgE-mediated events. Identification of the risk factors may contribute to limit the incidence of these reactions. The aim of our study was to search for possible risk factors of severe perioperative hypersensitivity reactions in our study population., Methods: For this study we retrospectively reviewed data from 193 patients who experienced drug hypersensitivity reactions during general anaesthesia. The diagnostic protocol consisted of 1) history of the reaction, 2) measurement of serum baseline tryptase and specific IgE-assays for latex, beta-lactams and succinylcholine, 3) skin tests for the agents listed in the anaesthesia chart and for others likely to be safe for future use, latex, and others medications administered during the perioperative period (i.e. antibiotics), 4) subdivision of our patients on the basis of two criteria: a) grade of severity of clinical reactions according to the Ring and Messmer classification; b) results of skin tests and/or serum specific IgE-assays., Results: One hundred of 193 patients had reactions of grade I, 32/193 patients had reactions of grade II, 55/193 patients had reactions of grade III and 6/193 patients had reactions of grade IV. A diagnosis of IgE-mediated reaction was established in 55 cases (28.50%); the most common causes were neuromuscular blocking agents, followed by latex and beta-lactams. Severe reactions were associated with older age (p = 0.025), asthma (p = 0.042), history of hypertension (p = 0.001), intake of serum angiotensin converting enzyme inhibitor medication (p = 0.012) or serum angiotensin II antagonist (p = 0.033), higher levels of basal tryptase (p = 0.0211). Cardiovascular symptoms (p = 0.006) and history of hypersensitivity to antibiotics (p = 0.029) were more frequently reported in IgE-mediated reactions., Conclusions: We confirmed the relevance of several clinical features as risk factors for anaphylactic reactions induced by anaesthetic agents: older age, asthma, hypertension and antihypertensive drugs. We observed increased levels of serum basal tryptase in severe reactions: this finding may signify that this biomarker is useful for the identification of patients at risk.

Published
2015
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44. Two cases of elevated tryptase in abdominal aortic aneurysm.

Author

Pastorello EA, Schroeder JW, Veronese SM, Pravettoni V, De Gasperi A, Cantoni S, Losappio L, Farioli L, Qualizza R, Scarpati B, Mascheri A, and Scibilia J

Subjects
Aged, Anaphylaxis blood, Anaphylaxis diagnosis, Anaphylaxis enzymology, Anaphylaxis therapy, Animals, Aortic Aneurysm, Abdominal diagnosis, Aortic Aneurysm, Abdominal surgery, Biomarkers blood, Humans, Immunotherapy methods, Male, Skin Tests, Time Factors, Treatment Outcome, Up-Regulation, Wasp Venoms therapeutic use, Anaphylaxis immunology, Aortic Aneurysm, Abdominal enzymology, Insect Bites and Stings immunology, Tryptases blood, Wasp Venoms immunology, Wasps immunology
Abstract

Introduction: From the literature, patients with a history of anaphylaxis to hymenoptera venom and positive specific IgE have shown a correlation between elevated tryptase levels and two clinical situations: systemic mastocytosis and an increased risk of reactions to venom immunotherapy or hymenoptera sting. Other clinical scenarios could explain elevated tryptase levels., Material and Methods: A 67 year old male (P1) and a 77 year old male (P2) were evaluated for previous severe anaphylaxis to hymenoptera sting. They underwent standard diagnostic work-up for hymenoptera venom allergy. Having found elevated tryptase levels, these were followed by a bone marrow biopsy to rule out systemic mastocytosis., Results: P1: specific IgE and skin tests were positive for Vespula species; tryptase 52.8 ng/ml; P2: specific IgE and skin tests were positive for Vespa cabro and tryptase 153 ng/ml. Bone marrow biopsy results were negative for mastocytosis. We carried out magnetic resonance imaging, in P1 to better characterize the severe osteoporosis and in P2 because during physical examination a pulsating mass had been identified in the mesogastrium, and an aneurysm of the abdominal aorta which required surgical intervention in both patients was detected. Eight months after surgery, tryptase levels had diminished significantly (P1: 11.6 ng/ml and P2: 14.5 ng/ml)., Discussion: The elevated tryptase levels were correlated to abdominal aneurysm in both patients. In fact, post-surgery tryptase levels dramatically decreased. These two cases demonstrate that high tryptase levels in subjects with a history of hymenoptera venom anaphylaxis can be associated to undiagnosed aneurysmatic disease.

Published
2015

45. Hypersensitivity to Tomato (Lycopersicon esculentum) in Peach-Allergic Patients: rPrup 3 and rPrup 1 Are Predictive of Symptom Severity.

Author

Mascheri A, Farioli L, Pravettoni V, Piantanida M, Stafylaraki C, Scibilia J, Mirone C, Preziosi D, Nichelatti M, and Pastorello EA

Subjects
Adolescent, Adult, Aged, Biomarkers blood, Female, Food Hypersensitivity blood, Food Hypersensitivity immunology, Fruit, Humans, Immunoglobulin E blood, Intradermal Tests, Italy, Solanum lycopersicum immunology, Male, Middle Aged, Predictive Value of Tests, Prunus immunology, Recombinant Proteins immunology, Serologic Tests, Severity of Illness Index, Young Adult, Antigens, Plant immunology, Food Hypersensitivity diagnosis, Solanum lycopersicum adverse effects, Plant Proteins immunology, Prunus adverse effects
Abstract

Unlabelled: Background: The role of allergens in the severity of tomato allergy symptoms has not yet been studied., Objectives: To evaluate the relationship between severe allergic reactions to peach and tomato and between tomato allergy symptoms and the pattern of IgE positivity for rPru p 1, rPru p 3, rPru p 4, rBetv 1, rBetv 2, rBetv4, rPhl p 1, and rPhl p 12 in order to identify the role of recombinant allergens in the severity of reactions to tomato., Methods: We studied peach-allergic patients with clinical reactions to tomato by performing an open food challenge, skin prick test, and determination of serum specific IgE to tomato and to recombinant peach, birch, and grass allergens. Statistical analysis was carried out to evaluate the relationship between the severity of tomato symptoms and IgE positivity to the different allergens and to peach-induced symptoms., Results: We found a significant association between severe reactions to tomato and severe reactions to peach (P = .01 7) and levels of IgE to rPru p3 (P = .029) and between mild tomato allergy symptoms and levels of IgE to rPru p1 (P = .047), anti-rBetv 1 (P = .0414), anti-rBetv 2 (P = .0457), and Phleum pratense (P = .0022)., Conclusion: We observed a significant relationship between peach and symptoms of tomato allergy. IgE positivity for rPru p3 seems to be a surrogate biochemical marker for severe tomato allergy, whereas the presence of anti-rPru p 1 IgE may be an indicator of mild tomato allergy.

Published
2015

46. Wheat-dependent exercise-induced anaphylaxis caused by a lipid transfer protein and not by ω-5 gliadin.

Author

Pastorello EA, Farioli L, Stafylaraki C, Scibilia J, Mirone C, Pravettoni V, Ottolenghi AI, Conio S, Mascheri A, Losappio L, Capocchi A, Fontanini D, and De Giacomo C

Subjects
Adolescent, Adult, Anaphylaxis immunology, Antigens, Plant immunology, Asthma, Exercise-Induced immunology, Female, Gliadin immunology, Humans, Immunization, Immunoglobulin E metabolism, Male, Wheat Hypersensitivity immunology, Young Adult, Allergens immunology, Anaphylaxis diagnosis, Asthma, Exercise-Induced diagnosis, Carrier Proteins immunology, Triticum adverse effects, Wheat Hypersensitivity diagnosis
Published
2014
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47. Fennel allergy is a lipid-transfer protein (LTP)-related food hypersensitivity associated with peach allergy.

Author

Pastorello EA, Farioli L, Stafylaraki C, Scibilia J, Giuffrida MG, Mascheri A, Piantanida M, Baro C, Primavesi L, Nichelatti M, Schroeder JW, and Pravettoni V

Subjects
Adolescent, Adult, Aged, Allergens immunology, Antigens, Plant immunology, Cross Reactions, Female, Humans, Immunoblotting, Immunoglobulin E blood, Male, Middle Aged, Young Adult, Carrier Proteins immunology, Foeniculum chemistry, Food Hypersensitivity diagnosis, Food Hypersensitivity immunology, Prunus chemistry
Abstract

Fennel allergy has been rarely reported, and the association with peach allergy has never been described. Our aim was to (i) study the correlation between symptom severity of peach and fennel and (ii) identify fennel allergens and the role of rPru p 3 antibodies in severe reactions to fennel. In 148 patients with peach allergy, we investigated 58 patients with symptoms and IgE antibodies positive to fennel. IgE to rPru p 1, 3, and 4 and rBet v 1, 2, and 4 were measured by immunoblotting, and the N-terminal amino acid sequences and relevant allergens were determined. We found significant association between severe reactions to fennel and peach (p = 0.0009). A major allergen was ~9 kDa lipid-transfer protein (LTP), cross-reactive with Pru p 3, a 15 kDa protein identified as a pathogenesis-related protein 1 of the Bet v 1 family. In conclusion, peach and fennel severe allergic symptoms are significantly related, and LTP is a major fennel allergen. Fennel should be included in the LTP syndrome.

Published
2013
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48. Rice allergy demonstrated by double-blind placebo-controlled food challenge in peach-allergic patients is related to lipid transfer protein reactivity.

Author

Pastorello EA, Scibilia J, Farioli L, Primavesi L, Giuffrida MG, Mascheri A, Piantanida M, Mirone C, Stafylaraki C, Violetta MR, Nichelatti M, Preziosi D, Losappio L, and Pravettoni V

Subjects
Adult, Carrier Proteins chemistry, Carrier Proteins genetics, Chromatography, High Pressure Liquid, Double-Blind Method, Electrophoresis, Polyacrylamide Gel, Female, Humans, Immunoblotting, Immunoglobulin E blood, Male, Middle Aged, Plant Proteins immunology, Surveys and Questionnaires, Carrier Proteins immunology, Food Hypersensitivity immunology, Oryza immunology, Plant Preparations immunology, Prunus immunology
Abstract

Background: The risk factors for sensitisation to rice and the involved allergens are still partially unknown. In this study we evaluated the clinically relevant aspects of rice allergy in DBPCF-positive patients, the major rice allergens, the severity of peach- and rice-induced symptoms in respect to Pru p 3 sensitisation and the role of anti-rPru p 3 IgE levels as a risk factor for rice allergy., Methods: In 148 peach-allergic subjects, patients with allergic reactions to rice and rice-positive serum IgE were selected. Symptoms were verified by double-blind placebo-controlled food challenges (DBPCFCs), performed at a maximum dosage of 25 g. Rice allergens, identified by IgE immunoblotting, were characterised by N-terminal amino acid sequencing. The relationship between anti-rPru p 3, 1 and 4 IgE levels and rice symptoms were statistically analysed., Results: Eight out of 10 recruited rice-allergic patients had positive DBPCFCs, while 2 patients were not challenged due to their previously documented severe reactions. All patients with rice-induced symptoms were Pru p 3 positive and presented with higher anti-rPru p 3 levels than the rice-sensitised but tolerant patients. A 9-kDa lipid transfer protein, which was highly homologous to Pru p 3, was identified as the major rice allergen and elicited a positive response in all of the patients. Five patients reacted to a putative 15- to 17-kDa rice allergenic protein, and 3 patients reacted to an [alpha]-amylase/subtilisin inhibitor that was approximately 20 kDa., Conclusion: Rarely, allergic reactions to rice can arise in patients with peach allergies who are sensitised to Pru p 3, particularly in patients with high anti-rPru p 3 IgE levels., (Copyright © 2013 S. Karger AG, Basel.)

Published
2013
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49. Anti-rPru p 3 IgE levels are inversely related to the age at onset of peach-induced severe symptoms reported by peach-allergic adults.

Author

Pastorello EA, Farioli L, Stafylaraki C, Mascheri A, Scibilia J, Pravettoni V, Primavesi L, Piantanida M, Nichelatti M, and Asero R

Subjects
Adolescent, Adult, Age of Onset, Female, Humans, Male, Middle Aged, Antibodies, Anti-Idiotypic, Antigens, Plant immunology, Food Hypersensitivity immunology, Immunoglobulin E, Plant Proteins immunology, Prunus
Abstract

Sensitisation to peach lipid transfer protein (LTP; Pru p 3) is significantly associated with severe allergic symptoms in adults, but little is known about the age at onset of peach allergy. We investigated a possible correlation between specific IgE levels to Pru p 3 and the age at onset of peach allergy. One hundred and forty-eight patients allergic to peach were divided into 6 classes according to the age at onset. Sera were analyzed for IgE antibodies to peach, rPru p 3, rPru p 1, rPru p 4, rBet v 1, rBet v 2, total IgE titre, and tryptase; all collected data were statistically analysed. A significant inverse correlation was found between the age at onset of peach allergy and anti-rPru p 3 IgE levels at diagnosis (p < 0.0005; Spearman's ρ = -0.3833). In contrast, the age at onset was directly correlated with both anti-rPru p 1 IgE levels (p = 0.0001; Spearman's ρ = 0.3197) and anti-rBet v 1 IgE levels (p = 0.0006; Spearman's ρ = 0.2914) at diagnosis. No correlations were detected between the reported age at onset and anti-peach, anti-rPru p 4, anti-rBet v 2 IgE and total IgE values and serum tryptase levels. At diagnosis, when peach allergy starts at a younger age, it is likely associated with Pru p 3 sensitisation, and the younger the onset, the higher the IgE titres. When peach allergy starts at an older age, it is more likely the result of cross-reactivity to Bet v1., (Copyright © 2013 S. Karger AG, Basel.)

Published
2013
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50. Pru p 3-sensitised Italian peach-allergic patients are less likely to develop severe symptoms when also presenting IgE antibodies to Pru p 1 and Pru p 4.

Author

Pastorello EA, Farioli L, Pravettoni V, Scibilia J, Mascheri A, Borgonovo L, Piantanida M, Primavesi L, Stafylaraki C, Pasqualetti S, Schroeder J, Nichelatti M, and Marocchi A

Subjects
Adolescent, Adult, Cross Reactions immunology, Cross-Sectional Studies, Female, Food Hypersensitivity blood, Food Hypersensitivity diagnosis, Humans, Immunoglobulin E blood, Italy, Male, Middle Aged, Plant Proteins, Reference Values, Sensitivity and Specificity, Skin Tests, Young Adult, Allergens immunology, Antigens, Plant immunology, Food Hypersensitivity immunology, Immunoglobulin E immunology, Prunus immunology
Abstract

Background: The roles played by different peach allergens with respect to symptom severity have not been completely ascertained. We have evaluated the diagnostic efficacy of peach recombinant allergens ImmunoCAP compared to peach in the identification of subjects at an increased risk for severe reactions to peaches., Methods: 148 peach-allergic patients were divided based on their symptom severity into 2 groups: mild oral allergy syndrome (OAS) and severe OAS. Anti-rPru p 1, 3 and 4 IgE levels were measured. Statistical analyses were carried out using parametric and non-parametric tests., Results: anti-rPru p 1 and anti-rPru p 4 IgE levels were significantly higher in patients with mild OAS than in patients with severe OAS (p = 0.0001); in contrast, anti-rPru p 3 IgE levels were significantly higher in patients with severe OAS than in patients with mild OAS (p < 0.00005). Moreover, we found that any unitary increase in anti-rPru p 1 IgE values corresponded to a 2.48% reduction in the odds of having severe OAS (p = 0.048), whereas any unitary increase in anti-rPru p 3 IgE values corresponded to a 9.02% increase in the probability of having severe OAS (p = 0.001). Unexpectedly, we found that patients positive to rPru p 3 as well as rPru p 1 and 4 demonstrated a significant reduction of the odds of developing severe symptoms than those positive to rPru p 3 alone. Anti-rPru p 3 IgE levels were a significantly better indicator than anti-peach IgE values (p = 0.016) of patients with the highest risk for severe OAS. A cutoff of 2.69 kUA/l for anti-rPru p 3 IgE values better discriminated peach-allergic patients at a higher risk for symptoms., Conclusions: Italian patients with positive anti-rPru p 1, 4 and 3 IgE levels seemed less likely to experience the clinical effects of high anti-rPru p 3 IgE values., (Copyright © 2011 S. Karger AG, Basel.)

Published
2011
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