@article {1793, title = {Adverse effects during specific oral tolerance induction: in home phase.}, journal = {Allergol Immunopathol (Madr)}, volume = {40}, year = {2012}, month = {2012 Jan-Feb}, pages = {41-50}, abstract = {

BACKGROUND: Specific oral tolerance induction (SOTI) is a promising approach for severe food allergies. There are little data in the literature regarding the home-phase of SOTI, not only with regard to type and frequency of adverse reactions but also regarding the most suitable treatment and protocol.

AIMS: To define the incidence and severity of adverse reactions, possible risk factors, and the safety and effectiveness of the home-phase of an original SOTI protocol in a large group of children with severe cow{\textquoteright}s milk (CM) allergy, after the hospital "rush" phase.

METHODS: The study was conducted by recording in-home phase adverse events, success and failure as reported by parents, and calling families. Adverse reactions were treated following the International Guidelines, arbitrarily modified by introducing nebulised epinephrine for respiratory reactions, oral beclomethasone for acute gastric pain and oral cromolyn for recurrent gastric pain.

RESULTS: Out of 140 patients, 132 were contacted; eight were inaccessible (follow-up 2-84 months). The number of adverse reactions was 1 in every 100 doses. The reactions were treated with nebulised epinephrine (221 reactions), IM epinephrine (6 reactions), and other drugs. Patients with high specific IgE levels (greater than 100 kU(A)/L) and lower CM dose (less than 5 ml) at the end of in-hospital phase showed a higher risk both for number of reactions and use of nebulised epinephrine.

CONCLUSIONS: The home phase of SOTI was characterised by a significant number of adverse reactions, mostly managed with an acceptable rate of side effects. Nebulised epinephrine played a pivotal role in respiratory reactions.

}, keywords = {Adolescent, Adult, Age Factors, Allergens, Child, Child, Preschool, Desensitization, Immunologic, Epinephrine, Female, Food Hypersensitivity, Humans, Immune Tolerance, Immunoglobulin E, Male, Milk Hypersensitivity, Nebulizers and Vaporizers}, issn = {1578-1267}, doi = {10.1016/j.aller.2011.05.004}, author = {Barbi, E and Longo, G and Berti, I and Matarazzo, L and Rubert, L and Saccari, A and Lenisa, I and Ronfani, L and Radillo, O and Ventura, A} } @article {1895, title = {Adverse effects during specific oral tolerance induction: in-hospital "rush" phase.}, journal = {Eur Ann Allergy Clin Immunol}, volume = {44}, year = {2012}, month = {2012 Feb}, pages = {18-25}, abstract = {

BACKGROUND: Specific oral tolerance induction (SOTI) is a promising approach in the treatment of severe food allergies. Different protocols have demonstrated its efficacy. Nevertheless, SOTI is still considered an experimental method and should be limited to highly controlled settings.

AIMS: To define the incidence and severity of adverse reactions, possible risk factors, and the safety and effectiveness of nebulized epinephrine as a first-line treatment of respiratory reactions during in-hospital SOTI for cow{\textquoteright}s milk allergy.

MATERIALS AND METHODS: A retrospective study was conducted by reviewing the medical records of patients admitted for SOTI beginning in 2001. Reactions were classified as mild, moderate and severe on a partially modified Clark scale. Adverse reactions were treated following the International Guidelines with the introduction of nebulized epinephrine for level four reactions.

RESULTS: Of 209 patients, 17 were excluded due to the absence of objective reactions. The remaining 192 were classified as follows: Mild Reactions (Clark Scale 1 to 3): 100 patients received either no treatment, oral antihistamines or nebulized steroids; Moderate Reactions (Clark Scale 4): 87 patients treated with nebulized epinephrine and, depending on their symptoms, oral antihistamines, corticosteroids (nebulized, oral or IV) or nebulized beta 2 agonists; Severe Reactions (Clark Scale 5): 5 children, 4 of whom initially underwent one nebulization of epinephrine and eventually required an IM dose. The fifth patient was immediately treated with IM epinephrine due to hypotension.

DISCUSSION: adverse reactions during this in-hospital SOTI protocol were frequent but easily manageable. Nebulized epinephrine can play a relevant role in the treatment of respiratory reactions.

}, keywords = {Administration, Inhalation, Anaphylaxis, Animals, Bronchodilator Agents, Child, Desensitization, Immunologic, Epinephrine, Humans, Milk, Milk Hypersensitivity, Retrospective Studies}, issn = {1764-1489}, author = {Barbi, E and Longo, G and Berti, I and Neri, E and Saccari, A and Rubert, L and Matarazzo, L and Montico, M and Ventura, A} } @article {1841, title = {Autoimmune-polyendocrinopathy-candidiasis-ectodermal-dystrophy in Calabria: clinical, immunological and genetic patterns.}, journal = {J Endocrinol Invest}, volume = {35}, year = {2012}, month = {2012 Nov}, pages = {877-81}, abstract = {

UNLABELLED: Autoimmune polyendocrinopathy-candidiasis-ectodermal- dystrophy (APECED), also known as autoimmune polyendocrine syndrome type 1 (APS-1), is a very rare disease. Diagnosis requires the presence of at least two of three major clinical features: chronic mucocutaneous candidiasis, chronic hypoparathyroidism, and Addison{\textquoteright}s disease.

DESIGN: In this study, we analyzed Autoimmune Regulator (AIRE) gene mutations and genotype-phenotype correlation in APECED patients originating from Calabria, a region in the south of Italy.

PATIENTS AND METHODS: Four patients and their first-degree relatives were evaluated for clinical manifestations, autoantibody presence and AIRE gene mutations.

RESULTS: Three patients carried a homozygous W78R mutation on exon 2, typical of patients with APECED from Apulia; the fourth patient had a homozygous R203X mutation on exon 5, typical of APECED patients from Sicily. Clinical disease expression showed wide variability. Analysis of relatives allowed the identification of 6 heterozygotes, none of whom showed major findings of APECED.

CONCLUSIONS: No AIRE gene mutations specific to Calabria were found in patients with APS-1, but mutations similar to those in patients from Apulia and Sicily. Heterozygosity for AIRE gene mutation is not associated with major findings of APECED.

}, keywords = {Adolescent, Adult, Autoantibodies, Child, Female, Genetic Association Studies, Heterozygote, Homozygote, Humans, Italy, Male, Mutation, Polyendocrinopathies, Autoimmune, Prognosis, Sicily, Transcription Factors, Young Adult}, issn = {1720-8386}, doi = {10.3275/8109}, author = {Betterle, C and Ghizzoni, L and Cassio, A and Baronio, F and Cervato, S and Garelli, S and Barbi, E and Tonini, G} }