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Pseudo-allergic-reactions (PAR) are clinical manifestations including urticaria, angioedema, conjunctivitis, rhinitis, asthma, and anaphylaxis. The prevalence of PAR ranges from 0.1% to 75% according to various studies. The pathogenetic mechanism of these diseases is not immunologically mediated. Food, additives, and drugs are the main responsibilities for PAR. The diagnosis of PAR is characterized by the absence of specific IgE for the suspected products. The absence of immunological mechanisms is confirmed by in vitro and in vivo tests. The treatment of PAR is similar to that of allergic diseases (antihistamine drugs, steroids, B2 agonists, epinephrine).

Cerebral venous thrombosis is an infrequent cause of childhood stroke. It is reported most frequently in the setting of acute dehydration, cyanotic congenital heart disease, or the nephrotic syndrome and it is commonly found in patients with hereditary coagulation or immunologic disorders. Thrombotic tendencies may also occur in children with iron deficiency anemia. We describe a 11-months old boy with cerebral venous thrombosis likely attributable to dehydration and iron deficiency anemia by intestinal chronic blood loss, caused by food allergy.

Natural rubber latex allergy is responsible for a wide spectrum of clinical symptoms ranging from rhinoconjunctivitis to severe anaphylaxis both in adults and children. The aim of this study was to investigate the prevalence and clinical significance of latex sensitization in children evaluated for allergic disease. Four hundred fifty three consecutive children evaluated for allergic disease in a university outpatient allergy clinic were screened. A detailed clinical history with particular attention to the past surgical history and the use of natural dummies or pacifiers was obtained. Skin prick tests (SPT) for the more important inhalants and foods were performed on all children. In patients with positive latex SPT, latex challenge and RAST as well as patch test with latex were also done. Ten out 326 atopic children (3%) presented positive skin test to latex, but only five (1.5%) also had a positive clinical history to latex exposure. Latex challenge was positive in 3/9 positive latex SPT children. None of the non-atopic children had positive skin test to latex or symptoms to latex exposure. A history of previous surgery was found in 5/10 positive latex SPT children, in 63/316 negative latex SPT atopic children (p < 0.05) and in 23/127 non-atopic children. The use of natural dummies or pacifiers was similar in atopic (positive or negative latex SPT) and non-atopic children. RAST to latex was positive in 5/10 positive latex SPT children. Latex SPT sensitivity was demonstrated in a moderate proportion of atopic children (3%) even if only half of these patients had a positive clinical history to latex exposure. Latex challenge was positive in 3 out 9 latex SPT positive children. SPT to latex is a safe and simple method to detect sensitive patients and should be included in the routine PT series of inhalant allergens.

Two cases of pneumatocele are reported. As our cases suggest and as the literature reports, the pneumatoceles are almost always benign lesions, whose resolution is only partially influenced by the therapy. On contrary their worrying radiological aspect and their long persistence can induce erroneously to think not efficacious the started therapy and therefore to change it. The etiology and the pathogenesis of pneumatocele are not completely clarified, even if various theory have been proposed.

In this study, 65 allergic asthmatic children were evaluated for the presence of exercise induced bronchospasm (E.I.B.). Pulmonary function (volume at 1 second of forced expiration--FEV1; maximal mid-expiratory flow--FEF 25-75; peak expiratory flow--PEF) was assessed before and serially for 20' following treadmill exercise. Only 18 children (27.6%) presented a fall in FEV1 > or = 20%. There was a relationship between severity of asthma and incidence of E.I.B., as children with episodic, frequent and chronic asthma presented respectively 13/55 (23.4%), 2/6 (33.3%) and 3/4 (75%) of positive responses. The presence of E.I.B. cannot be predicted by clinical history, as 15/36 (41.7%) of subjects with positive clinical history had E.I.B., against 3/29 (10.3%) of subjects with negative clinical history (p = n.s.). E.I.B. in asthmatic children is less frequent as reported, correlates with severity of asthma and cannot be accurately predicted from the history.

The most important symptoms caused by food additives are urticaria and angioedema, but rhinitis, asthma and gastrointestinal disturbances are also reported. Only seldom food additives have been shown to induce symptoms in other organs such central nervous system or joints and with a sparse objective evidence. In this study, we report two cases of unusual reactions to food additives (tartrazine and benzoates) involving mainly the central nervous system (headache, migraine, overactivity, concentration and learning difficulties, depression) and joints (arthralgias), confirmed with diet and double blind challenge. The possible pathogenetic mechanisms are also discussed.

Bronchial provocation tests with allergens are becoming recognized as one of the most important diagnostic parameters for the detection and confirmation of the role of the allergic component directly on the reaction site. Twenty-seven children with positive skin tests and RAST for Dermatophagoides Pteronyssinus were challenged with solutions of the same antigen. Twenty-one (77%) had positive responses expressed by different patterns: Six (28.5%) showed isolated early reaction, seven (33.3%) had biphasic responses. Six (28.5%) showed dual response with prolonged (1-2 hours) late reaction. One child had dual late reaction after 35 hours (ultra-late reaction). Six (28.5%) patients had negative reactions. The results suggest that bronchial provocation tests with antigens performed as outlined in this study can also be applied in the diagnosis of pediatric allergy.

Some parameters of neutrophil function (NBT reduction, bactericidal activity, chemotaxis) have been examined in 15 children with selective IgA deficiency and recurrent infections of respiratory and/or intestinal tract. In no case a defect in NBT reduction was observed. Mean results of bactericidal activity were normal, but in one child bacterial killing was lower than 2 SD of normal values. In 7 out 12 of patients a severe defect in cellular chemotaxis was proved, and in 1 a poor chemotactic activity of the serum was observed. Correlations between the defect in neutrophil chemotaxis and selective IgA deficiency are discussed.

Both upper and lower respiratory tracts can be affected by food allergy. In infants these symptoms may be due exclusively to food allergy or may result from the effect of food allergy and another co-factor (gastro-esophageal reflux, immunodeficiency, concomitant allergy to inhalants, etc.). The incidence of food-induced asthma is not well know. In this study, using open and double blind food challenge, we found that the incidence of IgE-mediated, food-induced asthma in children is 5.7%. The most offending foods were milk, eggs, and peanuts. Food allergy respiratory symptoms were almost always associated with other clinical manifestations (cutaneous, gastrointestinal). In fact we have been able to demonstrate only one isolated case of cough due to food allergy. It follows that the recognition of food dependent-IgE-mediated asthma is essentially limited to these cases characterized by food allergy with asthmatic expression.

Replacing cow's milk with a soybean milk is one of the first measures which are commonly taken with babies suffering from cow's milk protein allergy. Unfortunately soybean can induce sensitization, too, with a variable percentage (ranging from 12 to 80%) according to the different Authors, due to the presence of allergenic proteins, among which the most important one seems to be S2 globulin. An excellent tolerability has been reported in a study carried out with 20 babies suffering from cow's milk protein allergy besides a good palatability of the product with a solution of symptoms in 87.3% of the cases. Only in 16.7% of the treated babies intolerance has been reported and therefore we can conclude that soybean milk has proved to be an excellent substitute of cow's milk in babies suffering from cow's milk protein allergy.

Neutrophil function has been studied in 12 patients with acute lymphoblastic leukemia by means of the NBT test and bactericidal assay against E. coli. Tests have been performed before and during treatment. In untreated patients the bactericidal activity of neutrophils was normal, in spite of the decreased number of cells reducing the NBT dye after activation with immuno-complexes. In remission, those patients showed normal reduction. No correlation was observed between the bactericidal power registered after cranial irradiation and the NBT test.

LDL preparations obtained from normal individuals of known genetic type have been added to neutrophils from healthy donors. After incubation at 37 degrees C for 30 min, and washing in Hank's solution, in order to evaluate metabolic and bactericidal activities neutrophils were assayed by the nitroblue tetrazolium (NBT) quantitative test, using latex particles, and by E. coli killing test. LDL in aliquots of 100-500 microgram/2 x 10(6) neutrophils, inhibited NBT reduction and reduced neutrophil killing of E. coli by more than 50%. No difference was observed in the degree of inhibition using LDL and neutrophils obtained from donors of either the same or of different Ag phenotype. These data suggest that the immunoregulatory activity of LDL affects lymphocyte as well as neutrophil function.

Sera from cholestatic patients have been found to interfere with lymphocyte rosette formation (E rosettes). Lymphocytes from patients with cholestasis showed a lower percentage (42.36%) of cells binding sheep red blood cells in comparison with a control group (62%). In the presence of cholestatic serum the number of E rosettes formed by lymphocytes from normal subjects declined to 44.16%. This behaviour, however, can reverse, since lymphocytes from cholestatic patients previously incubated with normal serum, showed a nearly normal capability of forming E rosettes (57.90%). Therefore, it is conceivable that among the several factors which are present in sera from patients with either chronic or acute hepatitis and which are able to interfere with T-lymphocyte function, there may be included also the factor which is present in sera from cholestatic patients. The possible role of bile salts and hyperlipoproteinaemia present in those patients requires further investigation.

From a psychological point of view as well as in regard to facilitating breast-feeding, the practise of rooming-in is most favorable to the wellbeing of the mother-newborn relationship. An important but little researched point is whether the mother may accept rooming-in in respect to time periods, space and the manner in which it is carried out. The results of this study have made evident that time demand by the mother for contact between mother and newborn is inferior to that which is provided by the hospital, this is probably due to the lack of private space available.

We examined the prevalence of abnormalities found by sinus X-Rays in 80 asthmatic children classified into three groups in relation to severity of their symptoms. All the children underwent skin tests and some of them methacholine challenge. 63.7% of asthmatics showed abnormalities in sinus X-Rays. No correlation was found between the severity of asthma, radiographic findings, and atopic status. Bronchial hyperreactivity studied using metacholine challenge according to the method of Chai was the same both in patients with asthma and sinusitis and in those with asthma only. In conclusion, abnormal sinus X-Rays do not seem to be an aggravating factor in asthmatic status.