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Objective: The anti-COVID vaccination campaign has led to a significant increase in the demand for allergology consultations in patients considered at risk of reaction to anti-COVID-19 vaccines. This study aims to describe the experience of the vaccination campaign held in Piedmont (Italy) which developed a new service of Allergy Call Center (ACC) thus providing for the screening and management of allergy high-risk patients during pandemic., Study Design: A retrospective analysis was performed on all patients considered at high risk for the development of allergic reactions who were referred by the Immunology and Allergy Unit of Azienda Ospedaliera Ordine Mauriziano in Turin, Italy, between December 2020 and December 2022 and also on ACC consultations., Methods: During the COVID-19 pandemic, Piedmont Region instituted the ACC, active from May 10th, 2021 to December 31st 2022, to allow vaccinating doctors to require a telephonic consultation for patients who were considered at high risk for the development of allergic reactions. If further diagnostic evaluations were required, the ACC scheduled a visit with a Consultant of the Unit to better assess the clinical situation of the patient. Furthermore, patients referred by General Practitioners, Occupational Doctors and other consultants were also evaluated by the Unit when required., Results: During the operational period the ACC received a total of 15,865 calls and referred only 336 patients to the unit (27.4% of the total referrals), while General Practitioners referred 499 patients (40.8%), Occupational Doctors referred 61 patients (4.9%), and other consultants referred 326 patients (26.6%)., Conclusions: Evaluation and management of a large volume of requests seemed to be facilitated by a proactive framework for screening patients at high risk for allergic reactions as the ones referred by our ACC. This approach led to a prominent decrease in allergological visits to our tertiary care Centre, reducing the waiting times and providing additional support for both patients and healthcare providers, thus allowing the vaccinations to be more easily handled., Competing Interests: Declarations. Conflict of interest: The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royal-ties. Ethics Approval and Consent to Participate: The local Ethics Committee (Comitato Etico Territoriale interaziendale AOU Città della Salute e della Scienza di Torino) accepted the study, which was carried out in accordance with the Declaration of Helsinki’s principles., (© 2024. The Author(s).)

Background: Asthma control is the goal of asthma management. A nationwide study on this aspect was launched by the Italian Society of Paediatric Allergy and Immunology (ControL'Asma study)., Objective: To define variables associated with different asthma control grades in a nationwide population of asthmatic children and adolescents., Methods: This cross-sectional real-world study included 480 asthmatic children and adolescents (333 males, median age 11.2 years) consecutively enrolled in 10 third level pediatric allergy clinics. According to the Global Initiative for Asthma (GINA) document, history, medication use, perception of asthma symptoms assessed by visual analog scale (VAS), clinical examination, lung function, childhood asthma control test (cACT)/asthma control test (ACT), and asthma control level were evaluated., Results: Considering GINA criteria, asthma was well controlled in 55% of patients, partly controlled in 32.4%, and uncontrolled in 12.6%. Regarding cACT/ACT, asthma was uncontrolled in 23.2%. Patients with uncontrolled asthma had the lowest lung function parameters and VAS scores, more frequent bronchial obstruction and reversibility, and used more oral and inhaled corticosteroids (CS)., Conclusions: The ControL'Asma study, performed in a real-world setting, showed that asthma in Italian children and adolescents was usually more frequent in males. Asthmatic patients had an early onset and allergic phenotype with very frequent rhinitis comorbidity. Uncontrolled and partly controlled asthma affected about half of the subjects, and the assessment of asthma symptom perception by VAS could be a reliable tool in asthma management., Competing Interests: All authors declare that there is no conflict of interest.

The Italian Society of Paediatric Allergy and Immunology has developed the project "ControL'Asma," a nationwide study involved ten third-level pediatric allergy clinics across Italy. The first findings of the "ControL'Asma" project showed that asthma was more frequent in males, had an early onset and allergic phenotype with very frequent rhinitis comorbidity, uncontrolled, and partly controlled asthma affected about the half of subjects, and the assessment of asthma symptom perception by VAS could be a reliable tool in the asthma management., (© 2020 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)

Summary: Background. Diagnosis of anisakis allergy (AA) is based on the skin prick test (SPT) and specific IgE (sIgE) determination. Anyway, false positivity cases are due to cross reactivity with numerous allergens. The aim of the study was to evaluate the reliability of a comprehensive diagnostic algorithm for the AA. Methods. An observational study was conducted on a sample of consecutive subjects accessing the allergology outpatient ambulatories of two hospitals located in Western Sicily. All the recruited outpatients were tested by Skin Prick Test performed using anisakis extracts by ALK-Abellò (Madrid, Spain). Specific IgE dosage for anisakis extracts was then performed by using ImmunoCAP250 (Immunodiagnostics Uppsala, Sweden). Consequently, outpatients who tested positive to first line tests underwent sIgE testing for ascaris and tropomyosin. Lastly, outpatients positive to the first line were invited to be further tested by basophil activation test (BAT) by using Flow CAST kit and anisakis commercial extract (Bühlmann Laboratories AG, Schönenbuch, Switzerland), as confirmatory analysis. Results. One hundred and eleven outpatients with an anamnesis suggestive of sensitization to anisakis (AS) and 466 subjects with chronic urticaria (CU) were recruited in the study. Of these, 22 with AS and 41 with CU showed a sensitization to anisakis allergens. The diagnostic algorithm revealed that 8.8% of outpatients who tested positive to sIgE determination were affected by CU, while 82.5% of all the sIgE positivity was related to cross-reactivity. Overall, a genuine anisakis seroprevalence of 2.3% was documented. Within a sub-sample of 15 subjects with clinical symptoms related to AA, n. 8 showed a real positivity after BAT. A greater response to A. pegreffii allergens as compared to A. simplex was reported. Conclusions. Our preliminary findings support the high clinical specificity of BAT for AA diagnosis, suggesting implementing this method in a comprehensive diagnostic algorithm.

Nickel (Ni), the main responsible for allergic contact dermatitis worldwide, is also involved in systemic condition called "Systemic Nickel Sulfate Allergy Syndrome (SNAS)." Likewise, IgE-mediated reactivity to Lipid Transfer Protein (LTP) represents the main cause of primary food allergy in adults of Mediterranean countries. We evaluated the prevalence of SNAS in LTP allergic patients and investigated patients' clinical features with double sensitization (LTP and Ni). A retrospective, single-center, observational study was conducted performing a complete allergological work-up including: (1) skin prick tests; (2) serum specific IgE for plant food allergens and rPru p3 (LTP); (3) patch test with 5% Ni sulfate in petrolatum. We enrolled 140 LTP allergic patients of which 36 patients (25.7% of sample) showed additional positivity to Ni patch test. Patients with double sensitization were more frequently females and reported fewer cutaneous symptoms. Higher values of sIgE for peach, apple, peanut, walnut, grain, corn, and garlic were found in LTP allergic patients, while higher values for hazelnut in the other subgroup. The prevalence of SNAS in the LTP allergic population is clinically relevant. Moreover, the clinical and immunological profiles of patients with double sensitization were different from patients monosensitized to LTP.

Background: Although pollen-related food allergy occurs in all European populations, lipid transfer protein (LTP) allergy is considered to manifest mainly in Mediterranean countries. We aimed to characterize adults presenting with LTP allergy in a northern European country., Method: The clinical history and sensitization patterns of subjects born and residing in the United Kingdom (UK), with a prior diagnosis of LTP allergy and sensitization to the peach LTP allergen Pru p 3, were compared to UK subjects with pollen food syndrome (PFS). The sensitization patterns were also evaluated against a matched cohort of Italian subjects diagnosed with LTP allergy., Results: None of the 15 UK PFS subjects had a positive SPT to LTP-enriched peach reagent, compared to 91% of the 35 UK LTP subjects. The UK LTP cohort were also more likely to have positive skin prick tests to cabbage, lettuce and mustard and sensitization to the LTP allergens in peach, walnut, mugwort and plane tree These sensitization patterns to individual allergens were not significantly different to those obtained from the Italian LTP subjects, with significant correlations between Pru p 3 and the LTP allergens in peanuts, walnuts, plane tree and mugwort in both groups., Conclusion: Native UK subjects with LTP allergy are not dissimilar to those with LTP allergy in southern Europe. Testing to LTP-enriched peach SPT reagent and/or LTP allergens in peach, walnut, mugwort and plane tree may enhance diagnostic accuracy., (© 2019 The Authors. Allergy Published by John Wiley & Sons Ltd.)

Hymenoptera venom allergy is an epidemiologically underestimated condition and a major cause of morbidity worldwide. Preventing future allergic reactions in patients who experience a systemic reaction is based on the correct management of the emergency followed by an accurate diagnosis, prescription of adrenaline autoinjectors, and, where indicated, specific venom immunotherapy. Some epidemiological studies highlight our poor knowledge of this disease and the frequent inadequacy of its management. Moreover, they emphasize the importance of such a life-saving treatment as specific immunotherapy. The availability of high-quality hymenoptera venom extracts for diagnostic and therapeutic use has dramatically improved the prognosis and quality of life of allergic patients. Subcutaneous venom immunotherapy is currently the most effective form of allergen-based immunotherapy, with a carry-over effect lasting up to several years after its interruption. This report on the management of hymenoptera venom-allergic children and adults was prepared by a panel of Italian experts. The main objective of this consensus document is to review the scientific evidence related to diagnosis, therapy, and management of patients allergic to hymenoptera venom. Thus, we can improve our knowledge of the disease and promote good clinical practices. The present document provides practical suggestions for correct diagnosis, prescription of emergency therapy and immunotherapy, and strategies for patient care.

Summary: Prevalence of the Anisakis Simplex 's (AS) sensitization in children sensitized to Dermatophagoides pteronissynus (DP) is not known, neither it is to which percentage it might be due to cross-reactivity. The primary objective of the present retrospective cross-sectional study is to evaluate the prevalence of sensitization to AS in children sensitized or allergic to DP. Secondary outcomes were the prevalence of cross-reactivity and clinical relevance of the condition. The prevalence of sensitization to AS differs significantly among patients sensitized and not to DP (13.43% vs. 3.80%; p=0.019). The higher prevalence is mainly due to cross-reactivity with Der p10 (OR=8.86; 95% CI=4.33-40.74; p=0.0001). Currently, the sensitization to AS seems to have no clinical relevance in the pediatric population.

Objectives: To investigate the role of storage mites in the development of allergic diseases among ham production workers, and to search for early alterations in lung function tests and early inflammation markers in exhaled air. Respiratory allergies due to storage mites have been reported in people with various occupations but, although such mites are unavoidable when curing ham, there are no published data concerning ham production workers., Setting: Secondary care., Design: Experimental cross-sectional study., Participants: 220 participants (110 ham production workers and 110 controls) were recruited., Primary and Secondary Outcome Measures: Workers answered a medical questionnaire, and underwent spirometry and fraction of exhaled nitric oxide at 50 mL/s (FeNO₅₀) measurements. Those with allergic symptoms also underwent skin prick tests to determine their sensitisation to airborne allergens. A methacholine test was performed in symptomatic participants when spirometry was normal to assess airways hyper-responsiveness., Results: Symptomatic storage mite sensitisation was observed in 16 workers (14.5%) (rhinoconjunctivitis in 15 (63%) and asthma in (4%)) and 2 controls (1.8%; p=0.001). Higher FeNO₅₀ values in exposed symptomatic workers compared with healthy control participants (34.65±7.49 vs 13.29±4.29 ppb; p<0.001) suggested bronchial and nasal involvement, although their lung function parameters were normal. Regardless of exposure, a FeNO₅₀ value of 22.5 ppb seems to be 100% sensitive and 99.4% specific in distinguishing allergic and non-allergic participants. Multivariate analysis of FeNO₅₀ values in the symptomatic participants showed that they were positively influenced by IgE-mediated allergy (p=0.001) and reported symptom severity (p=0.041), and negatively by smoking status (p=0.049)., Conclusions: Ham processing workers, as well as workers involved in any meat processing work that includes curing, should be informed about the occupational risk of sensitisation to mites., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Aim: The prevalence of systemic reactions (SR) to Hymenoptera stings in children was estimated in values lower than 1% in early studies but much higher in recent surveys. We evaluated the current prevalence and the incidence of SR and large local reactions (LLR) to Hymenoptera stings in children in Italy., Methods: The data on children were collected from the database of the population study on the city of Cotignola, analyzing the answers to the part of the questionnaire about Hymenoptera stings, that concerned if the subject was ever stung by apids or vespids, if there has been a SR or a LLR, and if subjects with reactions received a diagnostic evaluation and a medical treatment., Results: Of the population of 1035 children, 173 (16.7%) were stung at least one time by Hymenoptera. Of them, 5 had had a SR and 9 had had a LLR. This defines a prevalence of SR of 0.5% and of LLR of 0.9%. Only one reaction was severe. Of the 14 subjects with SR or LLR, 5 (35.7%) underwent a diagnostic evaluation and one (7.1%) was treated with venom immunotherapy. The incidence of SR in the subsequent 2 years was 0.09% in the first year and 0.08% in the second year., Conclusions: These findings do not confirm the recent reports of an increased prevalence of Hymenoptera venom allergy in children. The incidence of SR to stings, thus far unreported for children, was very low both in the first and in the second year.

The Component Resolved Diagnostic (CRD) approach has been developed when highly purified or recombinant allergen molecules have become available. These molecules are the allergenic proteins toward which the specific and clinically relevant IgE immune response is directed. So, the identification of protein families and cross-reactivity patterns of importance in allergy have been possible. The Italian advisory BOARD for ISAC was born: to evaluate the advantages, disadvantages and placement in diagnosis of CRD studying its application in allergic patients; to facilitate the interpretation of molecular diagnostics for clinical allergists; to evaluate the effectiveness of CRD in improving diagnostic risk assessment and early preventive treatment of allergic diseases. In the last years, its fields of interest have been: the evaluation of the performance of CRD on multi-sensitized allergic patients with respiratory symptoms and on poly-sensitized athletes; the evolution of IgE repertoire directed to single allergenic components by evaluating allergic patients with different age at a molecular level; the relevance of results obtained using allergen microarray technique for describing the IgE repertoire in allergic patients by reviewing the main articles focused on CRD published in the last 2 years; the need for an educational program focused on this new diagnostic tool also through the creation of an exhaustive and interactive explanation of the laboratory report molecular allergy; the investigation of the performance and potential additional diagnostic values of the ISAC microarray in a real-life clinical setting, taking into account also the economic values.

Objectives: Few data on the incidence, aetiology, clinical features and management of patients with acute allergic reactions presenting to the Emergency Department are currently available. The aim of the study was to report the annual experience of a single Italian adult Emergency Department about anaphylaxis., Patients and Methods: This is a retrospective, case-based study of adult patients attending the Emergency Department in Alessandria, Italy, during the years 2009-2010. We evaluated the medical records of patients satisfying diagnostic codes involving acute allergic reactions. Incidence, demographic data, causative agents, clinical features, management and outcome were reported., Results: 390 patients with acute allergic reactions were evaluated during the year, corresponding to 0.7% of all Emergency Department visits. Causative agents were recognized in 55.1% of patients and more commonly included drugs (26.9%), insects (14.8%) and foods (8.9%). Cutaneous features were the single most common clinical presentation although two or more clinical features were frequently reported (17.7%). Anaphylaxis was diagnosed in 4.6% of patients. After therapy and a period of monitoring, 92.8% of patients were discharged directly from the Emergency Department, 7.0% were admitted and one patient died, corresponding to a fatality rate of 0.2%., Conclusions: Acute allergic reactions are common diseases referring to our Emergency Department. In the half of cases a precipitant agent was identified and cutaneous and/or mucosal changes were often the first feature. Most patients were definitely treated and discharged but about 7.0% of patients required hospitalisation. Observation Unit and Intermediate Care Unit were essential for clinical management of these patients.

The Allergology Hospital Network and Regional Register for Severe Allergic Reactions (Regional Observatory) is the Piemonte Health Authority new challenge. It satisfied the need to promote and monitor the best practice among a variegated pool of specialists and to define both state of the art and evolution of efficiency and efficacy of standard working process. Harmonization in clinical daily activities and report of severe allergic reactions notified to Regional Observatory, had been gained by mean of a customized Information Technology (IT) solution. The overall target is to ensure a correct diagnostic treatment to patients with severe allergic reactions preventing possible future reactions. Statistics data as a whole, provide basilar epidemiological information to allocate both economical and human resources and to fulfill the rising of health diseases. Piemonte Allergology Medical Network with the Regional Register are an Italian unique and innovative project. It would represent a benchmark for other medical branches.

Background: Several studies have shown the role of genetic factors in allergies, and ascertained that atopic diseases are transmitted by parents, especially by mothers., Materials and Methods: In order to explore the genetic risk of a child with a family history (FH) of allergy, we have enrolled into this prospective study 300 children, 173 males and 127 females, aged 3.5 to 7.5 years (median age 4.4 years), that included: family (FH) and personal history skin prick tests (SPTs) and specific IgE (RAST), who attended the Pediatric Allergy and Immunology Division of Rome University because affected with respiratory allergy We have studied the FH of these children asking whether their parents and brothers/sisters had atopic diseases, and detailing whether such diseases were respiratory or food allergies (FA). The parents of all children gave their informed consent. We analyzed data using the X2 method., Results: One hundred and twentyseven parents were atopic (42.3%), in addition to 20 brothers/sisters. In detail 90.2% of fathers, 84% of mothers and 65% of brothers/sisters had asthma or allergic rhinitis (AR). Very less parents had urticaria, especially the mothers and brothers/sisters suffered with atopic dermatitis (AD), and some mothers with FA. In 23 children from these parents most had AD and respiratory allergy. In 300 children comparable for age and sex with no respiratory illness recruited from our out-patient clinic 40 parents, 14 mothers and 26 fathers and 9 brothers/sisters had asthma or AR (p = 0.0001), some fathers had also urticaria and two brothers AD., Conclusion: A relevant part of respiratory allergy is not transmitted by mothers. Our prospective study stresses that 42.3% of parents are atopic, and FH of their children was positive for respiratory allergy in 82-92% of cases. Thus respiratory allergy can have an autosomal dominant mode of inheritance, but considering the other atopic diseases, the transmission can be polygenic. The impact of genetic factors in these children is emphasized by the high part of asthmatic brothers/sisters.

Background: Allergy places a considerable cost burden on society. Specific immunoglobulin E (spIgE) testing may improve the management of allergy patients. There is therefore a reason to quantify the economic consequences of the use of spIgE testing in the diagnosis of allergic conditions., Methods: The expected costs of spIgE testing versus no-testing were calculated using a clinical decision model based on a prospective clinical trial performed in primary care., Results: The expected costs per patient over 2 years decreased from 802 euros in the "no-test strategy" to 560 euros in the spIgE "test strategy". Cost savings persisted even after assumptions about the prevalence of allergy and the prices of medications were changed. The "test strategy" increased the percentage of patients correctly diagnosed from 54 to 87%., Conclusions: spIgE testing of children with respiratory and/or skin problems in primary care in Italy reduces overall costs to society. These cost savings mostly result from a reduction in the use of medications, particularly corticosteroids. The study indicates that spIgE testing of all children with respiratory and/or skin symptoms would be a cost-effective strategy.

Background: The availability of allergenic molecules and high-throughput microtechnologies allow the collection of a large number of IgE results at the same time in a single test. This can be carried out applying the test in the routine diagnostic work-up., Objective: The aim of this study was to make a cross-sectional evaluation of the raw prevalence of IgE reactivity to allergenic molecules in serum samples from a cohort of Italian patients using an innovative tool., Methods: The ISAC, a microarray system, has been used for specific IgE detection using 75 different allergenic molecules. Sera were collected from 23,077 unselected consecutive individuals complaining about any allergic disease., Results: Sixteen thousand four hundred and eight of 23,077 patients had IgE to at least one of 75 allergenic molecules. The top-ranked molecules in this cohort were Cup a 1 (42.7%), Der f 2 (38.7%), and Phl p 1 (37.9%), whereas all the other allergens tested scored in a range between 36.8% and 0.04%, including the first food allergen, Pru p 3, ranked 15th (9.79%). Prevalence varied quite markedly depending on the age range considered, and showing a different behaviour in the lifetime sensitization process. Unsupervised two-way hierarchical clustering analysis generated distinctive patterns of reactivity as the result of IgE recognition of either homologous allergens belonging to different biological sources or non-homologous belonging to the same biological source., Conclusions: Allergen-based microarray is a tool for the detection of IgE-related sensitization to panels of allergens and gives a more precise and comprehensive evaluation for an IgE-based epidemiology. This insight brings data for better understanding of the sensitization process.

Background: Climate changes may affect the quality and amount of airborne allergenic pollens. The direct assessment of such an effect requires long observation periods and a restricted geographic area., Objective: To assess variations in pollens and allergic sensitizations across 27 years in relation to climate change in a specific region., Methods: We recorded pollen counts, season durations, and prevalences of sensitizations for 5 major pollens (birch, cypress, olive, grass, and Parietaria) in western Liguria between 1981 and 2007. Pollen counts were performed using a Hirst-type trap, and sensitizations were assessed by means of skin prick testing. Meteorologic data for the same period included average temperatures, direct radiation, humidity, number of sunny days, and rainfall., Results: There was a progressive increase in the duration of the pollen seasons for Parietaria (+85 days), olive (+18 days), and cypress (+18 days), with an overall advance of their start dates. For Parietaria, there was an advance of 2 months in 2006 vs 1981. Also, the total pollen load progressively increased for the considered species (approximately 25% on average) except for grasses. Percentages of patients sensitized to the pollens increased throughout the years, whereas the percentage of individuals sensitized to house dust mite remained stable. These behaviors paralleled the constant increase in direct radiation, temperature, and number of days with a temperature greater than 30 degrees C., Conclusion: The progressive climate changes, with increased temperatures, may modify the global pollen load and affect the rate of allergic sensitization across long periods.

Background: Asthma is frequently found in athletes, often associated with rhinitis and allergy., Aim: To study the predictive value of allergy and pulmonary function tests for the diagnosis of asthma in athletes., Subjects and Methods: Ninety-eight national preOlympic athletes underwent an accurate medical examination including a validated questionnaire for asthma and rhinitis, spirometric recordings and skin prick testing with a panel of the most frequent inhalant allergens. Bronchodilator and/or exercise challenge were also performed in asthmatic subjects., Results: Clinical asthma was present in 20.4% of athletes, rhinitis in 35.3% (in 21.4% of cases alone and in 13.9% associated with asthma). Positive prick tests were recorded in 44.4% of athletes (in 60.5% of asthmatics, in 95.2% of rhinitics and in 21.0% of nonasthmatic - nonrhinitic subjects). Mean spirometric values and distribution of abnormal values were not different among asthmatics, rhinitics and nonasthmatics - nonrhinitic patients. Skin-tests positivity was not related to the abnormal spirometric data found in individual cases. Provocation tests with bronchodilators or exercise did not appear sensitive enough to diagnose mild forms of asthma in subjects with normal basal spirometric values., Conclusions: Allergy testing and spirometry should be performed routinely in athletes because of the high prevalence of allergy, rhinitis and asthma in this population. However, the predictive value of these tests and of the bronchial provocation tests performed in this study seems too low to document mild or subclinical asthma in athletes.

The Sentences of the Constitutional Court no 179/88 and 206/88 have of done modified the system insurance of the professional illnesses. To the old tabular system to the pathologies for which the legal conceitedness of origin is in force they are added those pathologies that need to be shown with burden of test of the applicant. And necessary to resort to the criterion pathogenetic for the geneses pathologies plurifactorialy or to non certain etiology. These innovations determine the necessity of a methodological iter forced for the recognition of the professional illness not table. The authors therefore they propose an iter diagnostic that passes through the recognition of the connection of cause. To such intention the authors examine meaning and limits of the suggested investigations.

Background: The in vivo skin prick test (SPT) is widely considered less expensive than in vitro gamma-immunoglobulin E (IgE) determination in the diagnosis of allergy. The aim of the present paper is to evaluate the relevance of component-resolved in vitro diagnosis in comparison to extract-based diagnosis and the relative global costs in relation to clinical outcomes., Methods: For 50 individuals with suspected seasonal allergic rhinitis, we compared the costs of skin testing with those of specific IgE antibody measurement., Results: The costs were higher for in vitro than in vivo testing. However, the clinical information obtained using recombinant reagents allowed correct identification of the sensitizing molecule., Conclusions: Recombinant allergens for specific IgE in vitro measurement provide more reliable information for immunotherapy prescription. This should be translated into a significant reduction in the overall costs sustained by the healthcare system.

Recent studies suggest that genetic polymorphism modulates immunoglobulin E (IgE)-mediated atopic reactions. Adenosine is an important local hormone influencing immune function and tissue reactivity; because adenosine concentration is regulated by adenosine deaminase (ADA), we have investigated the possible effect of ADA polymorphism on the relationship between IgE and positive prick test. A random sample of 160 schoolchildren from the population of Viterbo (Italy) were studied. Prick testing was performed with a panel of local allergens. Total IgE assay was performed according to standard clinical procedure. ADA phenotype was determined according to Spencer et al. A highly significant correlation between prick test and IgE was observed. However, the strength of correlation was moderate (eta2 = 0.16), indicating that positive prick testing depends on other variables besides IgE. The relationship between IgE and positive prick testing is stronger in carriers of ADA*2 allele than in ADA*1/*1 subjects. Also, sensitivity and predictive values are higher in ADA*2 carriers than in homozygous ADA*1/*1 children. The data suggest that the effect of IgE level on local reactivity is influenced by ADA polymorphism; at low level of IgE, the presence of the ADA*2 allele seems to protect from positive prick testing.

Background: Rabbits as pets are becoming popular in Italy, but few data are available on sensitization to rabbits in patients without occupational exposure. In a multicentre study, we assessed the prevalence of rabbit sensitization in atopic subjects and their modality of exposure., Methods: Allergists from the whole country were required to assess the presence of skin prick test positivity to rabbits in about 100 consecutive patients with allergic rhinitis and/or asthma. In the rabbit-positive patients, clinical history, pet ownership and modality of exposure were assessed., Results: Skin tests were performed on 2,329 outpatients, of whom 1,602 had at least one positivity. Among them, 39 (2.43%) were sensitized to rabbit dander (4 monosensitized). The prevalence of sensitization ranged between 0.65 and 4.72%. Nineteen patients reported direct rabbit contact (10 for ownership and 9 for occasional contact) and 5 patients only indirect exposure through the contact with rabbit owners. Fifteen subjects denied any direct or indirect exposure. All the monosensitized patients were rabbit owners and had persistent (moderate-severe) respiratory symptoms., Conclusions: Sensitization to rabbit in Italy is not to be neglected. In atopic subjects without occupational exposure, contact and indirect exposure to rabbits may induce sensitization. A progressive increase in rabbit sensitization is expected in the future as consequence of the increased rabbit ownership.

Background: Histamine skin reactivity (HSR, the dimension of the skin weal elicited by histamine 10 mg/mL) is a variable that differs in children from different European countries and increases over time in the same place (Italy)., Objective: In this epidemiologic study, we investigated to what extent differences in HSR influence the relationship between positive allergen skin prick tests (ASPTs) and serum-specific IgE concentrations., Methods: Between October 2001 and February 2002, 591 unselected 9-10-year-old schoolchildren drawn from five small towns in central Poland (Starachowice), central Italy (Ronciglione, Guardea) and Libya (Al-Azyzia, near the Mediterranean sea and Samno, 900 km south of the coast) were analysed for histamine, common ASPT and for serum total and specific IgE., Results: HSR differed markedly in children from the three countries (Libya>Italy>Poland) whereas serum total IgE concentrations remained the same. The prevalence of children with measurable serum specific IgE (> or = 0.35 kU) or with a positive ASPT for five common allergens was high in Italy, lower in Poland and far lower in Libya. A 3-mm ASPT weal corresponded to a serum-specific IgE concentration that was two to threefold higher in children with low HSR compared with children with high HSR (P = 0.008)., Conclusion: These findings suggest that HSR--a variable that differs in schoolchildren populations from the three countries studied--independently influences the results of ASPT and its influence should be considered when ASPT are assessed in international studies. The HSR differences found in the populations reported here probably reflect a complex, dynamic, environmental interaction that should be monitored in the different parts of the world.

House dust mites, pets, microorganisms such as fungi and bacteria are the main causes of indoor allergens. The diseases correlated to the presence of these allergens are of increasing importance in public health as well as in occupational medicine. Indoor allergens are widespread in residential buildings as well as in public and in office buildings. Surveys conducted in Italian office buildings demonstrated detectable allergen concentrations in most of these buildings. In some cases, the concentrations were higher than the proposed risk threshold for allergenic sensitisation or for the elicitation of symptoms in allergic individuals. The health effects of exposure to indoor allergens mainly include allergic asthma and rhinoconjunctivitis caused by IgE reactions in predisposed subjects. Moreover, exposure to indoor biological agents can cause extrinsic allergic alveolitis or other effects such as the so-called "humidifier fever" due to contaminated humidifiers. Standardized methods for the measurement of indoor allergen levels are available, and may be useful for the diagnosis and treatment of individual allergic patients or for group studies in order to evaluate the relationship between allergen indoor levels and health effects or to assess indoor allergen levels in private or public buildings for preventative purposes.

The Nordic Institute of Advanced Training in Occupational Health (NIVA), has been organising courses for around 10 years, aimed to the constant up-date of Occupational Medicine. The courses "Occupational dermatology" and "Occupational skin and respiratory allergies", held in 2001 and 2002, analysed some occupational medicine aspects such as allergic contact dermatitis in metal workers, latex disease, allergies in odontoiatric workers, correct patch test performing. The courses has underlined the importance of the cooperation between occupational physician and dermatologist or other specialists, and the project of a standard questionnaire monitoring the exposure to allergic substances. This article is a summary of an extended publication available on the following URLs: http://www.unibs.it/medlav http://www.gimle.fsm.it.

The association between respiratory disease and high levels of air pollution is well known. The most common risk factors associated with lung function decrease are air-borne particulates, ozone (O3), nitrogen dioxide (NO2) and sulphur dioxide (SO2). The aim of our study was to evaluate any difference in the prevalence of atopy and any possible early impairment in lung function in two groups of children exposed to different levels of air pollution. We studied 220 children in two cities in northern Italy: Milan (107 children), considered a metropolitan area with a high level of air pollution, and Erba (113 children), a small town, close to Lake Como, considered a rural area with a low level of air pollution. All subjects underwent respiratory function tests and skin-prick tests for the main inhalatory allergens. Parents were requested to fill in a questionnaire about parents' smoking habits and subjective evaluation of local motor traffic intensity. Aerobiological surveys showed a significantly higher grass pollen concentration in Erba than in Milan in the study year and in the three previous years. Schoolchildren in Milan and Erba showed similar pulmonary function results, except for forced expiratory flow at 75% of forced vital capacity (FEF75) values that, while within the range of normality, were significantly lower in Milan than in Erba. A high incidence of atopy was evident in both groups: 45% among the children living in Erba and 35% among those in Milan; skin-prick-test positivity for grass-pollen was statistically more frequent in Erba than in Milan. No evidence of a link between atopy and FEF75 reduction emerged, nor between FEF75 reduction and exposure to passive smoke. The association between FEF75 reduction and chronic high levels of air pollution is appealing, but further confirmation studies are necessary.

In this article the cases of occupational allergic diseases notified to 2 Occupational Health Units in Pavia in the period 1993-1998 are reported. A retrospective study was performed to obtain a descriptive analysis of the diseases. In the studied period 58 cases of occupational allergic diseases were notified. This datum probably underestimates the real occurrence of occupational diseases, because of the low accuracy of the notification system. Allergic skin diseases were more frequent (70.7%) than respiratory diseases.

Sensitivity to cats and exposure to cat allergen is a common cause of asthma exacerbation in children. To date, there is no data on the prevalence of cat sensitivity in children living in North Italy. Therefore, a 7-yr survey was performed in patients attending an allergy clinic for the first time. Skin prick tests (SPT) for perennial allergens and for pollens relevant to the region were performed in 4,957 children attending the outpatient clinic 1992-1998. A questionnaire on present or past cat ownership was presented to all cat-skin prick test positive children. An evaluation of cat ownership on the general population was made by telephone interview on a random sample of 1,268 families living in the same area. With a 3-mm wheal as a positive cut-off 439 (8.85%) children had a positive SPT to cats. Of these 103 (23.4%) had a cat at home and 336 (76.6%) never had a cat in the house. With a greater positive cut-off(a wheal diameter > or =4 mm) 140 (2.8%) showed a positive SPT to cats of these 35 (25%) had a cat at home and 105 (75%) had only an indirect exposure to the pet. Of the telephone interviewed families; 16% stated they had a cat at home. Cat sensitivity is less prevalent in Italy, in this hospital based population, compared with other European countries and this is in agreement with a lower rate of cat ownership. Cat sensitivity was three times more frequent in children who never had a cat at home, than in children living with cats, when the selected positive cut-off was either a wheal diameter of 3 mm or > or =4 mm. Thus in a population with a low prevalence of cat ownership public exposure seems to be more important than domestic exposure for the development of sensitivity.

The prevalence of sensitization to cockroach (CR) was evaluated by skin prick test (SPT) in 1299 patients consecutively referred for rhinitis and asthma to five allergy centers in northern, central, and southern Italy. In patients with positive SPT to CR, an SPT with D. pteronyssinus extract was made. RAST inhibition was performed with pooled sera of subjects with positive SPT and RAST of at least Class 3 for CR and D. Pteronyssinus, to assess the cross-reactivity between these two allergenic sources. The protein content of allergen extracts was assayed by isoelectric focusing (IEF). A total of 170 patients (13%) had a positive SPT with CR extract, and 133 of them (78.2%) were also positive for D. pteronyssinus. RAST inhibition showed a cross-reactivity between CR and D. pteronyssinus, and IEF detected in the extracts employed a series of bands focusing at the same pI of CR and D. pteronyssinus relevant allergens. Therefore, the prevalence of sensitization to CR in the population studied, corresponding to 13%, suggests that CR extract might be added to standard SPT panels for respiratory allergy. However, the cross-reactivity with D. pteronyssinus calls for careful evaluation of the clinical importance of this sensitization.

Mites have been recognized as the most important allergen in the house dust. This review deals with morphology, ecology and biology of house dust mites including factors affecting the distribution, abundance and seasonality of the species. Clinical, diagnostic and therapeutical aspects of the allergy to domestic mites are also reviewed. Finally, preventive and control measures against house dust mites are suggested.

In order to assess the distribution of asthma in Italy in the 1980s, we have compared the findings of three general population surveys carried out in the North and the Centre of the country. Two cross-sectional investigations were performed in the Po Delta area (North Italy), 6 yrs apart: 1) 3,285 subjects, aged 8-64 yrs, in 1980-1982 (PD1); and 2) 2,841 subjects, aged 8-73 yrs, in 1988-1991 (PD2). One cross-sectional survey was carried out in Pisa (Central Italy): 3,866 subjects, aged 5-90 yrs, in 1985-1988 (PI1). For this analysis we have used data from the standardized questionnaires of those subjects between 18-64 yrs, who were currently employed. The prevalence rate of ever asthma was 3.3-5.5%, that of current asthma 1.3-2.9%; almost all of the diagnoses were confirmed by a doctor. Taking into account only doctor-confirmed asthma, the age of onset of manifestations was most frequently over 18 yrs (41-79%). It also occurred more frequently after the onset of employment. As regards smoking, whilst most asthmatic males were current or former smokers (70-86%), most asthmatic females were nonsmokers. However, the situation changed in PD2, where females showed the same pattern as males. Considering asthmatic subjects with skin-prick test reactivity (data available only in PD2), the vast majority (67% in males, 75% in females) had an age of disease onset under 18 yrs. In conclusion, the prevalence of asthma in Italy in the 1980s was similar to that in other European countries and was affected by atopy and smoking differently in the two sexes.(ABSTRACT TRUNCATED AT 250 WORDS)

We evaluated the cord blood level of specific IgE in newborn having first grade relatives affected by allergic disease. We aimed: a) to look for a significant threshold (if any) of sp. IgE predictive of atopy; b) to verify the clinical reliability of the CAP System by Pharmacia. 9 out of 60 patients with positive family history had sp. IgE > 0.35 KU/L; 7 out of these 9 children were symptomatic to a clinical follow-up at 18 months. Moreover 65% of children with positive history but no sp. IgE and 100% of patients with both a negative history and no sp. IgE were completely free of allergic symptoms in the same period. We conclude that a careful history and cord blood sp. IgE measurement might be of value in early diagnosis of atopy.

The data obtained in this study suggest that eating Euparipha pisana (snail), a common food in Mediterranean countries, could give serious allergic reaction such as asthma. We describe here the identification and partial characterization of allergenic molecules form this new source. An aqueous extract of snail was obtained by homogenization in distilled water, centrifugation, dialysis and defatting with ethyl ether. Skin prick test (SPT) performed with the snail extract on 70 subjects allergic to the more common allergens of the Mediterranean area gave a SPT positivity in 61% of the subjects tested, with a mean value of histamine-equivalent prick (HEP) equal to 0.81 +/- 0.25 (n = 43), while no SPT-snail-positive reactions were obtained by using the same extract on 30 not allergic subjects. To ascertain if such a sensitivity was IgE-mediated, sera from SPT-snail-positive subjects were analyzed by RAST, coupling the snail extract to polystyrene balls and to paper discs. 19% of the sera tested were RAST-positive, mean value of binding 4.8 +/- 2.8% (n = 13), while when using sera from SPT-snail-negative subjects, the RAST mean value was 0.49 +/- 0.18% (n = 27). Histamine release (HR) was also performed. Basophils prepared from SPT-snail-positive subjects were incubated with a snail extract. All of the SPT-snail-positive subjects gave a significant value of HR, mean value 21.8 +/- 7% using 1 micrograms of snail extract (n = 16), while 1.41 +/- 1.1% (n = 10) was the mean value obtained when SPT-snail-negative subjects were analyzed.(ABSTRACT TRUNCATED AT 250 WORDS)