Hymenoptera venom allergy in outdoor workers: Occupational exposure, clinical features and effects of allergen immunotherapy

Objectives. To describe (i) the clinical characteristics of workers, exposed to hymenoptera stings, with an ascertained diagnosis of Hymenoptera Venom Allergy (HVA), (ii) the specific role of occupational exposure, (iii) the effect of Venom Immunotherapy (VIT) in reducing the severity of allergic episodes in workers exposed to repeated stings of hymenoptera, and (iv) the management of the occupational consequences caused by allergic reactions due to hymenoptera stings. Methods. Between 2000 and 2013 an observational study, including patients referred to the regional reference hospital of Liguria, Italy, with an ascertained diagnosis of HVA and treated with VIT, was performed. A structured questionnaire was administered to all patients to investigate the occupational features of allergic reactions. These were graded according to standard systems in patients at the first episode, and after re-stings, during VIT. Results. One-hundred and 8four out of the 202 patients referred had a complete data set. In 32 (17.4%) patients, the allergic reaction occurred during work activities performed outdoor. Of these, 31.2% previously stung by hymenoptera at work, and receiving VIT, were re-stung during occupational activity. The grades of reaction developed under VIT treatment resulted clinically less severe than of those occurred at the first sting (p-value = 0.031). Conclusion. Our findings confirmed the clinical relevance of HVA, and described its occupational features in outdoor workers with sensitization, stressing the importance of an early identification and proper management of the professional categories recognized at high risk of hymenoptera stings. The Occupational Physician should be supported by other specialists to recommend appropriate diagnostic procedures and the prescription of VIT, which resulted an effective treatment for the prevention of episodes of severe reactions in workers with a proven HVA

Triticum vulgare extract exerts an anti-inflammatory action in two in vitro models of inflammation in microglial cells

Triticum vulgare has been extensively used in traditional medicine thanks to its properties of accelerating tissue repair. The specific extract of Triticum vulgare manufactured by Farmaceutici Damor (TVE-DAMOR) is already present in some pharmaceutical formulations used in the treatment of decubitus ulcers, skin lesions and burns. It has been recently suggested that this Triticum vulgare extract may possess potential anti-inflammatory properties. In the light of these premises the aim of the present paper was to verify the anti-inflammatory role of TVE, using the LPS-stimulated microglia model of inflammation. In particular the effect of different concentrations of TVE on the release of several mediators of inflammation such as nitric oxide, IL-6, PGE2 and TNF alpha was evaluated. More important, the anti-inflammatory effect of TVE was confirmed also in primary rat microglia cultures. The results of the present study show that TVE exerts anti-inflammatory properties since it reduces the release of all the evaluated markers of inflammation, such as NO, IL6, TNF alpha and PGE2 in LPS-activated BV2 microglial cells. Intriguingly, TVE reduced microglia activation and NO release also in primary microglia. Indeed, to verify the pathway of modulation of the inflammatory markers reported above, we found that TVE restores the cytoplasmic expression of p65 protein, kwown as specific marker associated with activation of inflammatory response. The evidence for an inhibitory activity on inflammation of this specific extract of Triticum vulgare may open the way to the possibility of a therapeutical use of the Triticum vulgare extract as an anti-inflammatory compound in certain pathological states such as burns, decubitus ulcers, folliculitis and inflammation of peripheral nerv

Pest sensitization to cockroach, mouse, and rat: An Italian multicenter study

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A nationwide survey of hereditary angioedema due to C1 inhibitor deficiency in Italy

Introduction: Hereditary angioedema due to C1-inhibitor deficiency (C1-INH-HAE type I) or dysfunction (C1-INH-HAE type II) is a rare disease characterized by recurrent episodes of edema with an estimated frequency of 1:50,000 in the global population without racial or gender differences. In this study we present the results of a nationwide survey of C1-INH-HAE patients referring to 17 Italian centers, the Italian network for C1-INH-HAE, ITACA. Methods: Italian patients diagnosed with C1-INH-HAE from 1973 to 2013 were included in the study. Diagnosis of C1-INH-HAE was based on family and/or personal history of recurrent angioedema without urticaria and on antigenic and/or functional C1-INH deficiency. Results: 983 patients (53% female) from 376 unrelated families were included in this survey. Since 1973, 63 (6%) patients diagnosed with C1-INH-HAE died and data from 3 patients were missing when analysis was performed. Accordingly, the minimum prevalence of HAE in Italy in 2013 is 920:59,394,000 inhabitants, equivalent to 1:64,935. Compared to the general population, patients are less represented in the early and late decades of life: men start reducing after the 5th decade and women after the 6th. Median age of patients is 45 (IQ 28-57), median age at diagnosis is 26 years (IQ 13-41). C1-INH-HAE type 1 are 87%, with median age at diagnosis of 25 (13-40); type 2 are 13% with median age at diagnosis of 31 (IQ 16-49). Functional C1INH is ≤50% in 99% of patients. Antigen C1INH is 50% is 95%. This parameter should be therefore considered for initial screening in differential diagnosis of angioedema

Effect of TVE on NO, IL-6, PGE2 and TNFα release in BV2 cells.

<p>BV2 cells were exposed to TVE for 12 hours at different concentrations (1-2.5-5-10%). LPS was added 12 hours after TVE pre-incubations. The release was evaluated 24 hours after LPS exposure. Data were expressed as percentage of target release with respect to untreated cells (100%). N = 6 for each experimental group. * p<0.05 <i>vs</i> control non-treated cells; ** p<0.05 <i>vs</i> LPS treated cells. Graphs represented the results for the following markers: <b>A)</b> NO; <b>B)</b> IL-6; <b>C)</b> PGE2 and <b>D)</b> TNFα. All concentrations were expressed as (pg/mL).</p

Down-regulation of nuclear expression of NF-kB p65 subunit LPS-stimulated BV2 microglial cells.

<p>BV2 cells were stimulated with 100 ng/ml LPS as described before. Both nuclear and cytoplasmic localizations of p65 ware evaluated using anti-p65 polyclonal antibody and a FITC-labelled anti-rabbit IgG antibody (Green color, lines 2). DAPI was used in order to identify nuclei (Blue color, line 1). Images of cells were obtained by bright field light (BF, line 4) and UV light excitation lines 1,2 and 3). Nuclear translocation of p65 subunit is visible by detection of Aqua color (Merge, line 3). Cytoplasmic p65 expression was associated with different intensity of green color inside the cytoplasm. To visualize better the Aqua color co-localized into the nuclei, we overlapped the BF images upon merge of fluorescence (line 5). The bars reported different combinations of treatments in BV2 cells as follows: CTRL (LPS-/TVE10%-), LPS (LPS+/TVE10%), TV (LPS-/TV10%+) and LPS+TV (LPS+/TV10%+). The clear Aqua color was present only in LPS treated cells. No Aqua color significant differences were observed comparing CTRL <i>vs</i> TV and LPS+TV colums.</p