Anaphylaxis related to avocado ingestion: a case and review

Anaphylaxis to avocado, independent of latex sensitization, has been rarely reported in the literature. This case report describes a 15 year old male who experienced anaphylaxis within half an hour after eating avocado-containing food. Avocado consumption is common in both North America and South America. It is important to consider avocado as a cause of anaphylaxis, even in patients not sensitized to latex

Espressione di tissue factor da parte degli eosinofili in pazienti con orticaria cronica

Sebbene numerosi casi di orticaria cronica siano attualmente considerati di origine autoimmune e associati alla presenza di autoanticorpi circolanti che inducono il rilascio di istamina, vi sono chiare evidenze sul ruolo fisiopatologico dell\u2019attivazione della coagulazione mediata dal tissue factor (TF), il principale iniziatore della cascata coagulatoria. E\u2019 stato di recente dimostrato che gli eosinofili, peraltro presenti nella cute lesionale di pazienti con orticaria cronica, sono la maggiore fonte di TF nel sangue umano. In questo studio abbiamo valutato se gli eosinofili esprimano TF nella cute lesionale di pazienti con orticaria cronica. Abbiamo studiato 20 pazienti con orticaria cronica grave, prelevando campioni bioptici cutanei da lesioni pomfoidi attive. Come gruppo di controllo sono stati utilizzati campioni di cute sana perilesionale ottenuti dall\u2019escissione chirurgica di diversi tipi di tumori cutanei (10 casi) e varie patologie cutanee caratterizzate da infiltrati usualmente privi di eosinofili, quali vasculite leucocitoclasica (7 casi), lichen planus (8 casi) e mastocitosi (3 casi). L\u2019espressione del TF \ue8 stata valutata con metodica immunoistochimica utilizzando un anticorpo monoclonale anti-TF. Sono stati inoltre eseguiti esperimenti di colocalizzazione del TF con la proteina cationica eosinofila (ECP), considerata un marcatore classico degli eosinofili, con la tecnica del doppio marcaggio mediante due anticorpi monoclonali specifici. In tutti i campioni di cute dei pazienti con orticaria cronica \ue8 stata osservata un\u2019intensa espressione del TF che era invece assente nei controlli normali (P=0.0001) e nelle malattie cutanee non eosinofilo-mediate (P=0.001-0.0001). Le indagini di doppio marcaggio per TF e ECP hanno dimostrato che le cellule positive per TF erano eosinofili. In conclusione, gli eosinofili rappresentano la principale fonte di TF nella cute lesionale di pazienti con orticaria cronica. I nostri risultati enfatizzano il ruolo di queste cellule nella fisiopatologia dell\u2019orticaria cronica fornendo il razionale per nuove strategie terapeutiche

Tolerance to coxibs in patients with intolerance to non-steroidal anti-inflammatory drugs (NSAIDs): a systematic structured review of the literature

Adverse events triggered by non-steroidal anti-inflammatory drugs (NSAIDs) are among the most common drug-related intolerance reactions in medicine; they are possibly related to inhibition of cyclooxygenase-1. Coxibs, preferentially inhibiting cyclooxygenase-2, may therefore represent safe alternatives in patients with NSAID intolerance. We reviewed the literature in a systematic and structured manner to identify and evaluate studies on the tolerance of coxibs in patients with NSAID intolerance. We searched MEDLINE (1966–2006), the COCHRANE LIBRARY (4th Issue 2006) and EMBASE (1966–2006) up to December 9, 2006, and analysed all publications included using a predefined evaluation sheet. Symptoms and severity of adverse events to coxibs were analysed based on all articles comprising such information. Subsequently, the probability for adverse events triggered by coxibs was determined on analyses of double-blind prospective trials only. Among 3,304 patients with NSAID intolerance, 119 adverse events occurred under coxib medication. All adverse events, except two, have been allergic/urticarial in nature; none was lethal, but two were graded as life-threatening (grade 4). The two non-allergic adverse events were described as a grade 1 upper respiratory tract haemorrhage, and a grade 1 gastrointestinal symptom, respectively. In 13 double-blind prospective studies comprising a total of 591 patients with NSAID intolerance, only 13 adverse reactions to coxib provocations were observed. The triggering coxibs were rofecoxib (2/286), celecoxib (6/208), etoricoxib (4/56), and valdecoxib (1/41). This review documents the good tolerability of coxibs in patients with NSAID intolerance, for whom access to this class of drugs for short-term treatment of pain and inflammation is advantageous

Cytoreductive Surgery (CRS) and HIPEC for Advanced Ovarian Cancer with Peritoneal Metastases: Italian PSM Oncoteam Evidence and Study Purposes

Ovarian cancer is the eighth most common neoplasm in women with a high mortality rate mainly due to a marked propensity for peritoneal spread directly at diagnosis, as well as tumor recurrence after radical surgical treatment. Treatments for peritoneal metastases have to be designed from a patient’s perspective and focus on meaningful measures of benefit. Hyperthermic intraperitoneal chemotherapy (HIPEC), a strategy combining maximal cytoreductive surgery with regional chemotherapy, has been proposed to treat advanced ovarian cancer. Preliminary results to date have shown promising results, with improved survival outcomes and tumor regression. As knowledge about the disease process increases, practice guidelines will continue to evolve. In this review, we have reported a broad overview of advanced ovarian cancer management, and an update of the current evidence. The future perspectives of the Italian Society of Surgical Oncology (SICO) are discussed conclusively

Allergenic Lipid Transfer Proteins from Plant-Derived Foods Do Not Immunologically and Clinically Behave Homogeneously: The Kiwifruit LTP as a Model

BACKGROUND: Food allergy is increasingly common worldwide. Tools for allergy diagnosis measuring IgE improved much since allergenic molecules and microarrays started to be used. IgE response toward allergens belonging to the same group of molecules has not been comprehensively explored using such approach yet. OBJECTIVE: Using the model of lipid transfer proteins (LTPs) from plants as allergens, including two new structures, we sought to define how heterogeneous is the behavior of homologous proteins. METHODS: Two new allergenic LTPs, Act d 10 and Act c 10, have been identified in green (Actinidia deliciosa) and gold (Actinidia chinensis) kiwifruit (KF), respectively, using clinically characterized allergic patients, and their biochemical features comparatively evaluated by means of amino acid sequence alignments. Along with other five LTPs from peach, mulberry, hazelnut, peanut, mugwort, KF LTPs, preliminary tested positive for IgE, have been immobilized on a microarray, used for IgE testing 1,003 allergic subjects. Comparative analysis has been carried out. RESULTS: Alignment of Act d 10 primary structure with the other allergenic LTPs shows amino acid identities to be in a narrow range between 40 and 55%, with a number of substitutions making the sequences quite different from each other. Although peach LTP dominates the IgE immune response in terms of prevalence, epitope recognition driven by sequence heterogeneity has been recorded to be distributed in a wide range of behaviors. KF LTPs IgE positive results were obtained in a patient subset IgE positive for the peach LTP. Anyhow, the negative results on homologous molecules allowed us to reintroduce KF in patients' diet. CONCLUSION: The biochemical nature of allergenic molecule belonging to a group of homologous ones should not be taken as proof of immunological recognition as well. The availability of panels of homologous molecules to be tested using microarrays is valuable to address the therapeutic intervention

Challenges for Allergy Diagnosis in Regions with Complex Pollen Exposures

Over the past few decades, significant scientific progress has influenced clinical allergy practice. The biological standardization of extracts was followed by the massive identification and characterization of new allergens and their progressive use as diagnostic tools including allergen micro arrays that facilitate the simultaneous testing of more than 100 allergen components. Specific diagnosis is the basis of allergy practice and is always aiming to select the best therapeutic or avoidance intervention. As a consequence, redundant or irrelevant information might be adding unnecessary cost and complexity to daily clinical practice. A rational use of the different diagnostic alternatives would allow a significant improvement in the diagnosis and treatment of allergic patients, especially for those residing in complex pollen exposure areas

Ragweed as an Example of Worldwide Allergen Expansion

<p/> <p>Multiple factors are contributing to the expansion of ragweed on a worldwide scale. This review seeks to examine factors that may contribute to allergen expansion with reference to ragweed as a well-studied example. It is our hope that increased surveillance for new pollens in areas not previously affected and awareness of the influence the changing environment plays in allergic disease will lead to better outcomes in susceptible patients.</p