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Abstract Background Isocyanates are extensively used in the manufacture of polyurethane foams, plastics, coatings or adhesives. They are a major cause of occupational asthma in a proportion of exposed workers. Recent findings in animal models have demonstrated that isocyanate-induced asthma does not always represent an IgE-mediated sensitization, but still a mixed profile of CD4+ Th1 and TH2, as well as a CD8+ immune response. Despite immunologic similarities between this pathology and IgE-mediated food allergies, this co-morbidity is rarely reported. Case presentation A 50-year old man employed as vehicle body painter, for 8 years complained about breathlessness, wheezing, sneezing, nasal obstruction and excessive production of mucus during the use of DuPont Refinish Centari Tintings – an acrylic enamel tint. Symptoms occurred 15–20 minutes after workplace exposure and usually persisted until evening, or at times, up to two consecutive days. The above mentioned symptoms were associated with a decrease of lung functions parameters. The use of inhaled adrenergic bronchio-dilatators and steroids relived the symptoms. In addition, three years ago he developed an anaphylactic reaction due to peanut consumption, experiencing urticaria, angioedema and airway obstruction. He was successfully treated in the hospital. Later, the subject exhibited labial itching, as well as orbital and perioral angioedema, 20 minutes after stationary performance of challenge test with peanuts. Evaluating the reported data, this process might be developed rather due to induction of a TH2 profile, because in both cases have occurred IgE-mediated symptoms. A less plausible mechanism could be the presence of isocyanates in peanuts due to a probable contamination by pesticides resulting in an allergic reaction after "consumption" of di-isocyanate as long as the isocyanate contamination of peanuts has not been proven. Conclusion Despite the lack of relevant laboratory findings, this might be the first case of isocyanate-induced occupational asthma described in a patient who developed peanut allergy symptoms later in his life. However, in order to take further suitable precautions, further studies are necessary to elucidate the questions posed in this report.

Background: Although it has been shown that allergen immunotherapy (AIT) is well‐tolerated in children, systematic and prospective surveillance of AIT safety in real life settings is needed. Methods: The multinational Allergen Immunotherapy Adverse Events Registry (ADER) was designed to address AIT safety in real life clinical practice. Data on children ≤18 years old with respiratory allergies undergoing AIT were retrieved. Patient‐ and AIT‐related features were collected and analyzed. The characteristics of adverse events (AE) and risk factors were evaluated. Results: A total of 851 patients, 11.3 ± 3.4 years old, with rhinitis only (47.6%); asthma and rhinitis (44.5%); asthma (7.9%), receiving 998 AIT courses were analyzed. Sublingual immunotherapy (SLIT) accounted for 51% of the courses. In 84.5% of patients only one AIT treatment was prescribed. Pollen was the most frequent sensitizer (57.1%), followed by mites (53.4%), molds (18.2%) and epithelia (16.7%). Local and systemic AEs were reported in 85 patients (9.9%). Most AEs (83.1%) were mild and occurred in <30 min (87%). Respiratory and cutaneous symptoms were more frequent. Only 4 patients (0.47%) had severe AE (none after 6 weeks of maintenance). The risk of AE was higher in patients undergoing SCIT. Conclusions: AIT is safe and well tolerated in children and adolescents with respiratory allergies in real‐life clinical practice. Though SCIT is more prone to AE compared to SLIT, overall severe reactions are rare and occur during build‐up and early maintenance. [ABSTRACT FROM AUTHOR]

Allergic conjunctivitis (AC), rhinitis (AR), and bronchial asthma (BA) are allergic IgE-mediated pathologies, while their management consists on pharmacological treatment and specific immunotherapy (SIT). This study aims to evaluate clinical symptoms and monitor maintenance treatment of patients during. Subjects with AC, AR, or/and BA who initiated subcutaneous SIT during period 2008-2012 (Lofarma, Italy) are monitored along 3 years. A questionnaire that compromised a clinical score for relative symptoms and maintenance medicaments is filled out by every patient at beginning of SIT, as well as 1 and 3 years later (0 - absent, 4 - maximal expression of symptom; yes/no answer for treatment with a subclass medication). Data are shown in average (±SE), and comparisons are undergone due to t Student and Fisher exact. P < 0.05 was considered as significant. Study data demonstrated that both symptoms score and medicaments need were significantly reduced in the majority of cases during the first SIT, independently to allergen type or pathology. Oral glucocorticoids were completely eliminated from the treatment within the first year, whereas antihistamines were the mostly used during the SIT. In summary, this study demonstrates that symptom score and medication monitoring can be useful in the evaluation of SIT efficacy. [ABSTRACT FROM AUTHOR]

Allergic rhinitis (AR) is an allergen-induced, upper-airway inflammatory disease, highly coexistent in allergic asthma patients, characterized by hyperactive airway mucosa and episodes of chronic symptoms with periods of acute exacerbation, during exposure to highly allergen-concentrated environments. In our prospective study, we report results on allergic rhinitis in 116 asthmatic patients sensitized by house dust mites. Multidisciplinary Tirana polyclinics 1 and 3 have provided the study data on patients with asthma history of 2 years up to 20 years, all sensitized by house dust mites. We found persistent symptoms of allergic rhinitis in 67 patients; intermittent symptoms in 31, and 18 did not manifest any symptoms at all. Within the subgroup of patients with persistent rhinitis symptoms, almost 40% of the patients referred to have a minimal persistent nasal obstruction only when asked by the specialist. Within the group of 98 patients with persistent and intermittent rhinitis symptoms, we found that 73 patients or 74% reported rhinitis, cough and dyspnea symptoms when exposed to highly concentrated environments with house dust mites such as closed living and working places or air conditioned and not properly ventilated closed spaces. The purpose of this study is to show the high incidence of allergic intermittent or persistent rhinitis, in asthmatic subjects sensitized by house dust mites, and the importance of the environmental factors contributing to the severity and frequency of symptoms onset. [ABSTRACT FROM AUTHOR]

Gluten intolerance is an autoimmune enteropathy caused by heterogeneous mixture of wheat storage proteins. Malabsorption symptoms imply diarrhoea, abdominal pain/bloating and weight loss. This case describes a 22-year-old female subject, who had chronic headache, joint pain, urticaria and long period of amenorrhea. Skin prick tests revealed a sensitisation to α-gliadin, while neurological, gynaecological, endocrine and clinical-laboratory examinations did not justify the above-mentioned symptoms. Gluten-free diet resolved chronic symptoms and re-established the menstrual cycle, whereas a temporary gliadin daily diet re-exacerbated all clinical symptoms. Urticaria occurred 20 min and the chronic headache the next day after exposure to the gliadin-rich diet. In addition, the missing of the expected menstrual bleeding was observed. This case demonstrates that gliadin intake can induce malabsorption and 'idiopathic' neuronal or gynaecological symptoms. [ABSTRACT FROM AUTHOR]