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Aim: Napkin dermatitis or diaper dermatitis is one of the most frequent cutaneous disease in the pediatric age. The most common type of napkin dermatitis is the irritant contact form, which is frequently complicated by an overinfection with bacteria or Candida albicans., Methods: In this paper, 25 children (7 males and 18 females), aged between 1 month and 4 years and affected by napkin dermatitis, were treated with a barrier cream containing zinc oxide, vitamin E, panthenol (NoAll Bimbi Pasta Trattante, PSN Rottapharm, Milan, Italy). In 20 patients, a diagnosis of irritant contact diaper dermatitis was made, 3 patients suffered from atopic dermatitis, 1 patient was affected by psoriasis and 1 patient presented to a perianal streptococcal dermatitis. A candidal overinfection was diagnosed in 12 patients and was treated with a topical antifungal agent, applied twice daily for 2 weeks. NoAll Bimbi Pasta Trattante was applied at every diaper change. In all cases, we considered 2 subjective symptoms (burning and itching), and 3 objective parameters (erythema, oedema, exudation/vesiculation), at baseline and after 4 weeks of treatment., Results: One patient withdrew the study. In 13 patients clinical healing was observed, 9 patients showed marked improvement, in 2 patients we did not observe improvement. Tolerability was considered excellent in 13 patients, good in 9 and sufficient in 2., Conclusions: The results obtained demonstrated that NoAll Bimbi Pasta Trattante, applied at every change of the napkin, is very effective and well tolerated in the treatment of irritant diaper dermatitis. Moreover, NoAll Bimbi Pasta Trattante, applied in association with other pharmacological treatments, may accelerate healing in case of overinfection due to Candida albicans and in case of inflammatory dermatoses localized in the gluteo-perineal area.

Use of herbal medicine is increasing in Italy. Herbal preparations are generally used as self-medication, often in the wrong belief that "natural" can be equated with "harmless". Whereas use of these products has been associated with serious adverse events, due to the quality of the raw materials used, to interactions with synthetic drugs or to their use in particular conditions, such as pregnancy or lactation. To monitor herbal preparation use in the population is necessary in order to point out possible adverse reactions. This was the objective of this pilot study, together with the urgency to inform health personnel and patients on the correct use of these products. After this experience we strongly believe that a system to assess the safety of herbal preparations is needed.

Uroangiographic contrast media, as well as magnetic resonance or ultrasound contrast agents, are substances which are able to artificially enhance the contrast between different tissues, or between normal tissue and pathological areas. The design of ionic and nonionic, monomeric or dimeric, iodobenzene derivatives is outlined with attention given to historical developments and breakthroughs. Relationships between physicochemical properties (osmolality, viscosity, molecular structure, etc.) and pharmacological profile are described. Nonionic compounds display favourable physicochemical characteristics: high water solubility, low osmolality and viscosity and good systemic tolerability. Recent surveys on adverse reactions to uroangiographic iodinated contrast media have shown that the risk of severe reactions is about six times lower with nonionic than ionic X-ray contrast agents. The pathogenetic mechanisms of adverse reactions, generally classified as either anaphylactoid or osmotoxic and chemotoxic, are still not well understood. It has been proposed that leukotrienes, prostaglandins, kinins, etc., may be involved. Nitric oxide appears to play a crucial role in the final common pathway by which anaphylaxis-like reactions occur in response to contrast agent administration. The margin of safety (median lethal dose/diagnostic dose) for nonionic compounds is two- to three-fold greater than for ionic compounds. As a look at the future, an approach to molecules potentially useful as "blood pool X-ray contrast agents" is based on iodinated dendrimeric macromolecules, in which the core is triazacyclononane and branches are represented by trioodobenzene derivatives.

We evaluated the tolerance to NIM in patients with adverse reactions to NSAIDs, expressed by urticaria-angioedema, bronchial asthma or erythema polymorphous on 92 patients among which 32 atopics affected by asthma, rhinitis or contact dermatitis. Challenge test has been performed with increasing amounts of NIM per os every 2 hrs to a maximum of 100 mg/dose. The last dosage was repeated every 12 hrs for 4 times more. No reactions were observed in 86 patients (93.4%). Moreover we evaluated the efficacy of NIM in modulating pomphoid cutaneous reaction to histamine (HIS) and codeine (COD). Three subjects were prick tested with HIS and COD solutions at different concentrations (0.1 to 10 mg/ml), before and after a 5 days therapy with NIM at different dosages/kg/die. At NIM dosages of 3.7 and 2.7 mg/kg/die we observed a strong reduction of pomphoid activity of both HIS and COD. No clear effects were detected at 2.2 mg/kg/die dosage. We assume a dose-related in vivo inhibitory effect of NIM on cutaneous mast cells releasability or a direct anti-histaminic effect. We point out the possible therapeutic role of NIM in the treatment of allergic flogosis at steroid and cromon's side.

We studied 251 outpatients affected by chronic and acute urticaria-angioedema syndrome, triggered or exacerbated by drugs, to evaluate the prevalence of adverse reactions to each pharmacological group. Among these patients, 134 (53.4%) presented one or more adverse reactions to a single drug: 100 (74.7%) reacted to NSAIDs, 33 (24.7%) to antibiotics and 1 to B vitamin complex. The remaining 117 patients (46.6%) presented adverse reactions to more than one drug. Considering the patients all together, 123 (49%) had adverse reactions to ASA, 116 (46.2%) to pyrazones, 65 (25.9%) to antibiotics, 26 (10.3%) to NSAIDs different from ASA and pyrazones. In our experience, according to other reports, there is a greater frequency of drug reactions to NSAIDs vs other drugs. ASA is the more frequently involved drug.

The aim of this prospective study was to evaluate the incidence of allergic reactions to drugs compared to other kinds of medical emergencies admitted to the main Hospital in Milan during a 6 months period. At the same time we drew a list of drugs most frequently involved in allergic reactions, and a list of the most frequent symptoms. Using special forms, the medical staff collected patients' data: age, history of atopy, identification of the drug causing the reaction, and any previous reactions. Among 11,407 cases of medical emergencies, we found 163 (1.43%) patients showing drug reactions: the mean age was 27.3; 58.90% were female; atopy was present in 16.56%. The drugs most frequently involved were: pyrazon group (22%); ASA (20.86%); penicillin and derivatives (9.20%); sulfa drugs (6.14%); group B vitamins (4.30%); tetanus toxoid (4.30%); hyposensitizing extracts (3.68%); propionic acid derivatives (2.46%); paracetamol (1.84%); indomethacin (1.23%); rifampicin (1.23%); erythromycin (1.23%); glafenine (1.23%); others (17.80%). Urticaria and/or angioedema were the most frequent symptoms (86.51%), then anaphylactic shock (9.81%) and asthma (3.68%) with regard to anaphylactic shock only 6.20% of the patients had had a previous reaction to the same drug. From these data we can see that the incidence of drug reactions is very low compared to other medical emergencies; penicillin evidenced fewer reactions than expected, while the pyrazon group and ASA confirmed the data from literature.

The pathogenetic, clinical and epidemiological aspects of Pseudo-Allergic Reactions (PAR) are reported, as well as the diagnostic approach. PAR represent an emerging syndrome with increasing frequency, correlated to the increasing diffusion of drugs, foods and food-additives, which should draw the care and research of Allergologists.