Allergen-specific immunotherapy: an update on immunological mechanisms of action

Specific immunotherapy (SIT) is the only treatment able to modify the natural history of the allergic subjects. Several aspects of the immunopathological response modified by SIT have been investigated; the first parameter historically studied was the production of allergen-specific antibodies. An increase of allergen-specific IgG4 and a decrease of IgE appear after SIT. A shift from Th2-polarized immune response toward Th1-oriented pattern has been reported after SIT. More recently, a crucial role for a subpopulation of T cells has been evidenced: T regulatory cells (Treg). Allergic patients have a defect of Tregs. SIT is able of inducing a specific Treg response. Sublingual immunotherapy is an alternative route of administration for SIT. Recent evidence shows that SLIT is also able of inducing a Treg response as detected by IL- 10 production

Relationship between rhinitis duration and worsening of nasal function

While it is well known that asthma is characterized by airway remodeling, few studies instead have investigated this issue in patients with allergic rhinitis (AR)

The nutraceuticals : a new therapeutic strategy in the management of digestive and respiratory disorders

Nutraceuticals represents an intriguing challenge in clinical practice. They are currently used worldwide in all fields of Medicine. The present Supplement reports two Italian surveys concerning a probiotic mixture employed in patients with chronic intestinal disorders and a Medical Device used in patients with upper respiratory diseases. These surveys were conducted on a group of Italian gastroenterologists and on a group of Italian otolaryngologists respectively. Both surveys demonstrated that these compounds may represent a useful therapeutic option in clinical practice

Neurotensin localization in adenomatoid cystic malformation versus normal lung: Preliminary report of six consecutive cases

Neuropeptides are considered a new class of neurotransmitters, several of which interact with the immune system as well as the macrophagic activity. Among these, neurotensin (NT) enhances the phagocitic response of macrophages and is the only neuropeptide that can enhance the cytolytic effects of activated macrophages. In this way, it may play a role as an inflammatory mediator. In order to investigate the possible relationship between NT and the defence mechanisms of the lung, we started to localize the presence of NT in pulmonary adenomatoid cystic malformation (CCAM). This series consists of 6 children affected by CCAM. In every case, at operation, we obtained specimens of both normal and pathological lung. Tissue sections from the pathological lung showed a significant increase of NT-like immunoreactivity in respect to sections of normal lung. NT influences and activates the macrophages, thus suggesting that it could represent a defence mechanism in children's lung activated in some malformative conditions. Finally, the increasing evidence of NT immunoreactivity in CCAM could explicate an in utero infectious pathogenesis of this malformation

Impact of allergic rhinitis on asthma: effects on bronchodilation testing

A remarkable relationship exists between the upper and lower airways. Bronchial obstruction is a paramount feature of asthma, and its reversibility is considered a main step in asthma diagnosis

Serum IL-17 after one course of sublingual immunotherapy in allergic rhinitis to birch

Recently, it has been reported that IL-17 may be involved in allergic reaction. Sublingual immunotherapy (SLIT) is the unique curative treatment for allergic rhinitis. This study aims at investigating whether one course of birch SLIT could affect serum IL-17 levels. The findings provided show that some IL-17 producer patients had a reduction of serum IL-17 levels after one SLIT course. Therefore, this preliminary study shows that a single pre-seasonal SLIT course may induce a significant decreasing trend in serum IL-17 levels; further study should be carried out to define the role exerted by IL-17 in allergic rhinitis

The impact of allergic rhinitis in clinical practice: an italian survey

Allergic rhinitis (AR) is a very common disorder. The current Survey was conducted on a sample of about 5,000 adult subjects in 5 Italian cities. A questionnaire, containing 15 questions, was administered on the road. AR affects about 20% of the general population. The most common diagnostic test was the skin prick test, but only 12% of patients performed an allergy test to confirm the diagnosis. About 50% of patients did not take any medicine. Even about 40% of treatments were suggested by friends or pharmacists. In conclusion, the current Survey demonstrated that AR is a common disorder in Italy, the diagnostic work-up is still incorrect, and the therapeutic approach does not adhere to the guidelines. Therefore, there is a need to implement adequate information on this topic in Italy

Olfactory dysfunction in patients with chronic rhinosinusitis with nasal polyps is associated with clinical-cytological grading severity

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory disorder, affecting about 4% of the worldwide population and strongly impacting the quality of life. CRSwNP is still a challenge for ENT specialists in terms of its unknown pathogenesis, difficulty in management and frequent relapse. Olfactory impairment frequently affects CRSwNP patients. We tested the hypothesis that clinical-cytological grading (CCG) could be associated with olfactory dysfunction. The study was cross-sectional, enrolling 62 patients (37 males, 25 females, mean age 49 years, range 18-83) suffering from newly diagnosed CRSwNP. Olfactory dysfunction was very frequent (about 90%) and did not depend on nasal obstruction as assessed by both polyp size and nasal airflow limitation. A CCG > 4 was the best cutoff value to suspect olfactory dysfunction [area under the ROC curve of 0.831 (0.715 to 0.914)]; in addition, the statistical risk of having dysosmia was over 7-fold higher in subjects with CCG > 4 compared with subjects reporting a CCG < 4 (adjOR 7.46). The present study underlines that olfactory dysfunction is common in CRSwNP patients and demonstrates an association between olfactory dysfunction and inflammation, suggesting that CCG could be useful in the work-up of CRSwNP patients and in suspecting olfactory impairment

Specific immunotherapy for allergic rhinitis in Italy: The patients' points of view

Specific immunotherapy (SIT) is the unique causal treatment for allergy, but its use is quite limited. A perspective, cross-sectional telephone interview survey was carried out in Italy to evaluate the characteristics of 500 patients with allergic rhinitis (250 of whom treated with SIT). Relevant differences were found concerning therapeutic management of allergic rhinitis, mainly regarding the use of drugs and co-morbidities. The allergist is the most important consultant who prescribes SIT. This study therefore provides evidence that the course of allergic rhinitis may depend on the therapy prescribed by and the level of allergy awareness of the physician