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Search Results: 1 - 10 of 54 matches for " Cristoforo Incorvaia "
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Sublingual immunotherapy in allergic asthma: Current evidence and needs to meet
Incorvaia Cristoforo,Riario-Sforza Gian,Incorvaia Stefano,Frati Franco
Annals of Thoracic Medicine , 2010,
Abstract: Allergen-specific immunotherapy is aimed at modifying the natural history of allergy by inducing tolerance to the causative allergen. In its traditional, subcutaneous form, immunotherapy has complete evidence of efficacy in allergic asthma. However, subcutaneous immunotherapy (SCIT) has a major flaw in side effects, and especially in possible anaphylactic reactions, and this prompted the search for safer ways of administration of allergen extracts. Sublingual immunotherapy (SLIT) has met such need while maintaining a clinical efficacy comparable to SCIT. In fact, the safety profile, as outlined by a systematic revision of the available literature, was substantially free from serious systemic reactions. A number of meta-analyses clearly showed that SLIT is effective in allergic rhinitis by significantly reducing the clinical symptoms and the use of anti-allergic drugs, while the efficacy in allergic asthma is still debated, with some meta-analyses showing clear effectiveness but other giving contrasting results. Besides the efficacy on symptoms, the preventive activity and the cost-effectiveness are important outcomes of SLIT in asthma. The needs to meet include more data on efficacy in house dust mite asthma, optimal techniques of administration and, as previously done with SCIT, introduction of adjuvants able to enhance the immunologic response and use of recombinant allergens.
Toxocariasis Resulting in Seeming Allergy
Rosanna Qualizza,Raffaella Megali,Cristoforo Incorvaia
Iranian Journal Of Allergy, Asthma and Immunology , 2009,
Abstract: Toxocara canis is an intestinal nematode affecting dogs and cats that causes human infestations by ingestion of embryonated eggs excreted in dogs' faeces. Humans are transport hosts, in whom the larvae do not develop to adult worms, but may migrate to various tissues and organs, and survive for several years, giving rise to several clinical symptoms, which include allergy-like presentations. We report three cases presenting as dermatitis, rhinitis, asthma, and conjunctivitis which were diagnosed and unsuccessfully treated as allergy. The correct diagnosis was established after detecting anti-Toxocara antibodies by Western blotting. All clinical symptoms showed improvement after starting treatment with mebendazole and subsequent courses of the antiparasitic drug resulted in full recovery. This suggests the possible role of Toxocara canis in inducing chronic symptoms of allergic type. This is particularly important for asthma, where it has been demonstrated that Toxocara canis infection causes allergic inflammation in the lungs associated with bronchial hyperreactivity. On the other hand, in our patients with asthma and with dermatitis the positive results from allergy tests were a confounding factor in delaying the correct diagnosis, which was finally obtained by the detection of antibodies to Toxocara canis.
Specific immunotherapy by the sublingual route for respiratory allergy
Cristoforo Incorvaia, Simonetta Masieri, Patrizia Berto, Silvia Scurati, Franco Frati
Allergy, Asthma & Clinical Immunology , 2010, DOI: 10.1186/1710-1492-6-29
Abstract: Allergic diseases have high and increasing world prevalence [1,2]. In particular, respiratory allergy is caused by sensitization to environmental aeroallergens such as pollens, house dust mites, moulds, and animal epithelia and is clinically expressed as rhinitis and asthma.The management of respiratory allergy relies upon, when possible, allergen avoidance, drug treatment, and allergen-specific immunotherapy (SIT) [3]. SIT is the practice of administering gradually increasing doses of the specific causative allergen to reduce the clinical reactivity of allergic subjects. SIT has central importance because of its ability to modify the natural history of the disease and to extend its effectiveness also after treatment withdrawal, provided it is administered for an adequate duration [4]. The subcutaneous route has been for decades the traditional route of administration, but in recent years the sublingual route emerged as an actual treatment option [5]. The main reason to introduce sublingual immunotherapy (SLIT) was the safety problems with subcutaneous immunotherapy (SCIT), which may include systemic reactions, sometimes severe and, though very rarely, even fatal [6].The first studies on SLIT used low allergen dosages [7,8] but it was soon apparent that doses much higher than those administered by SCIT were needed to ensure clinical efficacy. In consensus documents, an optimal dosage as high as at least 50 times the dose administered by injection was suggested [3], though this ratio may be not pertinent for all products.The high number of trials on SLIT conducted in recent years allowed an accurate evidence-based assessment of its effectiveness by several meta-analyses on the whole patient population as well as on subgroups defined by clinical expression (rhinitis and asthma) or age (adults and children) parameters [9-16]. At the same time, other studies evaluated important aspects defining the suitability of SLIT, such as the compliance and the cost-effectiveness.T
Idiopathic eosinophilic parotitis in an eight-year-old boy: a case report
Franco Frati, Rachele Boccardo, Silvia Scurati, Matteo Gelardi, Cristoforo Incorvaia
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-385
Abstract: The patient was an eight-year-old Caucasian boy who presented with a two-year history of recurring acute parotitis with no fever. He had had a total of five episodes with no response to antibiotics, but remission had been achieved with oral corticosteroid therapy. We performed allergy tests for inhalant and food allergens and for haptens, but the results were all negative. The results of echography ruled out sialodochitis. Instead, a swab from the parotid duct led to the detection of a high number of eosinophils.This report is first in the literature to describe a case of eosinophilic parotitis, and we suggest that a cytological assessment, which is quite simple yet rarely used by physicians, be performed when patients with parotitis of uncertain origin are under evaluation.A number of medical conditions are associated with increased production of eosinophils. A few of the most well known are eosinophilic pneumonia [1], eosinophilic bronchitis [2], and non-allergic rhinitis with eosinophilia syndrome nares and related disorders [3], but new entities such as eosinophilic esophagitis [4] and others are being added to this list. Very recently, a case of eosinophilic sialodochitis, that is, an inflammation of the parotid salivary duct was reported [5]. In this report, we describe the first case of eosinophilic parotitis in the literature. Parotitis is an inflammation of the parotid salivary gland that can be acute or chronic with acute exacerbations. Concerning the etiology, viral parotitis is more common than bacterial parotitis, and mumps is the most common viral cause of parotitis [6]. The diagnosis is made on the basis of the presence of firm, erythematous swelling in the pre- and post-auricular areas, intense local pain and tenderness, and high fever and chills. Later, massive swelling of the neck and respiratory obstruction may occur. Microbiological data may be obtained by collecting specimens by aspiration from the parotid duct orifice or, when this is not feasi
Skin reaction to inhaled tiotropium bromide: a case report
Cristoforo Incorvaia, Nicola Fuiano, Raffaella Megali, Gian Riario-Sforza
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-119
Abstract: A 78-year-old Caucasian woman was referred to our facility for allergological evaluation. Our patient had been treated twice with tiotropium for chronic obstructive pulmonary disease and had experienced an allergic reaction with itching. We performed a double-blind placebo-controlled inhalation challenge for our patient with tiotropium and a placebo. Inhalation tests yielded positive results for tiotropium and negative results for the placebo. The results of a skin prick test with tiotropium were negative.These findings reveal that tiotropium may elicit immediate skin allergic reactions. The negative result from the skin test suggests that such a reaction is not immunoglobulin E-mediated.Tiotropium bromide is a long-acting inhaled anti-cholinergic agent commonly used to treat chronic obstructive pulmonary disease (COPD) [1]. A recently published review on drug safety data obtained from 26 clinical trials involving approximately 17,000 patients reported that no difference was observed between patients treated with tiotropium bromide and those given a placebo, with respect to the rates of adverse events caused by cardiac, vascular, nervous, and lower respiratory disorders [2]. Instead, adverse events caused by the anti-cholinergic effect of tiotropium were much more common than those due to the placebo. These adverse effects included dryness in the mouth (observed in about 16% of the patients treated), constipation, dyspepsia, gastroesophageal reflux, dysuria, and urinary retention. The information provided on skin reactions is puzzling; in the patient information sheet for tiotropium the 'Possible side effects' section reports: 'Allergic reactions. Symptoms may include: itching, rash, swelling of the lips, tongue, or throat (trouble swallowing)'. However, these reactions have not been mentioned in the safety data review [2]. In addition, on performing a systematic literature search of the MEDLINE and EMBASE databases, we found only one study reporting a tiotropium-as
The current role of sublingual immunotherapy in the treatment of allergic rhinitis in adults and children
Cristoforo Incorvaia, Simonetta Masieri, Silvia Scurati, et al
Journal of Asthma and Allergy , 2011, DOI: http://dx.doi.org/10.2147/JAA.S16632
Abstract: urrent role of sublingual immunotherapy in the treatment of allergic rhinitis in adults and children Review (6402) Total Article Views Authors: Cristoforo Incorvaia, Simonetta Masieri, Silvia Scurati, et al Published Date February 2011 Volume 2011:4 Pages 13 - 17 DOI: http://dx.doi.org/10.2147/JAA.S16632 Cristoforo Incorvaia1, Simonetta Masieri2, Silvia Scurati3, Silvia Soffia3, Paola Puccinelli3, Franco Frati3 1Allergy/Pulmonary rehabilitation, Istituti Clinici di Perfezionamento, Milan, Italy; 2ENT Clinic, University La Sapienza, Rome, Italy; 3Medical and Scientific Department, Stallergenes, Milan, Italy Abstract: Allergic rhinitis is a very common disease affecting about 20% of people. It may be treated by allergen avoidance when possible, by antiallergic drugs such as antihistamines and topical corticosteroids, and by allergen-specific immunotherapy. The latter is the only treatment able to act on the causes and not only on the symptoms of respiratory allergy and is able to maintain its efficacy even after stopping, provided an adequate duration of treatment of 3–5 years is ensured. Sublingual immunotherapy (SLIT) was introduced in the 1990s as a possible solution to the problem of adverse systemic reactions to subcutaneous immunotherapy and has been demonstrated by more than 50 trials and globally evaluated thus far by five meta-analyses as an effective and safe treatment for allergic rhinitis. Life-threatening reactions are extremely rare. However, it is important to note that clinical efficacy occurs only if SLIT meets its needs, ie, sufficiently high doses are regularly administered for at least 3 consecutive years. This is often overlooked in the current practice and may prevent the same success reported by trials from being achieved.
Effect of noninvasive mechanical ventilation in elderly patients with hypercapnic acute-on-chronic respiratory failure and a do-not-intubate order
Paolo Scarpazza,Cristoforo Incorvaia,Giuseppe di Franco,Stefania Raschi
International Journal of COPD , 2008,
Abstract: Paolo Scarpazza1, Cristoforo Incorvaia2, Giuseppe di Franco1, Stefania Raschi1, Pierfranco Usai1, Monica Bernareggi1, Cristiano Bonacina1, Chiara Melacini1, Silvia Vanni1, Serena Bencini1, Chiara Pravettoni2, Giuseppe Di Cara3, Mona-Rita Yacoub4, Gian Galeazzo Riario-Sforza2, Enrico Guffanti5, Walter Casali11Divisione di Broncopneumotisiologia, Ospedale Civile, Vimercate, Italy; 2Pulmonary rehabilitation, Istituti Clinici di Perfezionamento, Milan, Italy; 3University Department of Medical and Surgical Specialties and Public Health, Perugia, Italy; 4Allergy and Immunology Unit, IRCCS San Raffaele Hospital, Milan, Italy; 5Pulmonary rehabilitation, INRCA, Casatenovo, ItalyAbstract: Noninvasive mechanical ventilation (NIMV) is effective in the treatment of patients with acute respiratory failure (ARF). It proved to reduce the need of endotracheal intubation (ETI), the incidence of ETI-associated pneumonia, and mortality compared to nonventilated patients. A particular aspect concerns the outcome of NIMV in patients referring to an emergency room (ER) for ARF, and with a do-not-intubate (DNI) status due to advanced age or critical conditions. The aim of our study is to assess the outcome of NIMV in a group of elderly patients with acute hypercapnic ARF who had a DNI status. An overall number of 62 subjects (30 males, 32 females, mean age 81 ± 4.8 years, range 79–91 years) referred to our semi-intensive respiratory department were enrolled in the study. The underlying diseases were severe chronic obstructive pulmonary disease (COPD) in 50/62 subjects, restrictive thoracic disorders in 7/62 subjects, and multiorgan failure in 5/62 subjects. Fifty-four/62 patients were successfully treated with NIMV while 2/62 did not respond to NIMV and were therefore submitted to ETI (one survived). Among NIMV-treated patients, death occurred in 6 patients after a mean of 9.9 days; the overall rate of NIMV failure was 12.9%. Negative prognostic factors for NIMV response proved to be: an older age, a low Glasgow Coma Score, a high APACHE score at admission, a high PaCO2 after 12 hours and a low pH both after 1 and 12 hours of NIMV. We conclude that elderly patients with acute hypercapnic ARF with a DNI status can be successfully treated by NIMV.Keywords: acute respiratory failure, noninvasive mechanical ventilation, endotracheal intubation, do-not-intubate, COPD, oxygen therapy
The current role of sublingual immunotherapy in the treatment of allergic rhinitis in adults and children
Cristoforo Incorvaia,Simonetta Masieri,Silvia Scurati,et al
Journal of Asthma and Allergy , 2011,
Abstract: Cristoforo Incorvaia1, Simonetta Masieri2, Silvia Scurati3, Silvia Soffia3, Paola Puccinelli3, Franco Frati31Allergy/Pulmonary rehabilitation, Istituti Clinici di Perfezionamento, Milan, Italy; 2ENT Clinic, University La Sapienza, Rome, Italy; 3Medical and Scientific Department, Stallergenes, Milan, ItalyAbstract: Allergic rhinitis is a very common disease affecting about 20% of people. It may be treated by allergen avoidance when possible, by antiallergic drugs such as antihistamines and topical corticosteroids, and by allergen-specific immunotherapy. The latter is the only treatment able to act on the causes and not only on the symptoms of respiratory allergy and is able to maintain its efficacy even after stopping, provided an adequate duration of treatment of 3–5 years is ensured. Sublingual immunotherapy (SLIT) was introduced in the 1990s as a possible solution to the problem of adverse systemic reactions to subcutaneous immunotherapy and has been demonstrated by more than 50 trials and globally evaluated thus far by five meta-analyses as an effective and safe treatment for allergic rhinitis. Life-threatening reactions are extremely rare. However, it is important to note that clinical efficacy occurs only if SLIT meets its needs, ie, sufficiently high doses are regularly administered for at least 3 consecutive years. This is often overlooked in the current practice and may prevent the same success reported by trials from being achieved.Keywords: allergic rhinitis, sublingual immunotherapy, efficacy, safety, compliance, meta-analysis
Allergen specificity is relevant for immunotherapy prescription in polysensitised children
Ciprandi Giorgio,Incorvaia Cristoforo,Puccinelli Paola,Dell’Albani Ilaria
The Italian Journal of Pediatrics , 2012, DOI: 10.1186/1824-7288-38-50
Abstract: The sensitization to more allergens, such as polysenitization, is becoming a frequent characteristic of allergic patients, since the childhood. However, this phenomenon is considered an obstacle to prescribe immunotherapy by many doctors. This study investigated the relevance of polysensitization in a cohort of allergic children and evaluated the number of allergen extracts prescribed for these children. There are allergens that are frequent, but not prescribed. This issue should be matter of adequate debate for Italian paediatricians.
Chloramine-induced anaphylaxis while showering: a case report
D’Alò Simona,De Pasquale Tiziana,Incorvaia Cristoforo,Illuminati Ilenia
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-324
Abstract: Introduction Sodium-N-chlorine-p-toluene sulfonamide, commonly known as chloramine-T, is a derivative of chlorine which is widely used as a disinfectant. For many years, chloramine-T has been described as a cause of immediate-type hypersensitivity, especially with regard to asthma and rhinitis, and as a cause of occupational dermatoses in cleaning personnel in hospitals, although no anaphylactic reaction has yet been reported. Hence, to the best of our knowledge we present the first case of anaphylaxis to chloramine-T with evidence of specific immunoglobulin E antibodies. Case presentation We describe the case of a 25-year-old Caucasian woman who was in good health and with a negative history for atopy, including no respiratory symptoms of rhinitis or asthma, and with no professional exposure to chloramine-T. She, while showering, applied a chloramine-T solution to a skin area with folliculitis on her leg, and within a few minutes developed generalized urticaria and angioedema, followed by vomiting and collapse with loss of consciousness. A skin prick test with a chloramine-T solution at 10mg/mL concentration was positive, and specific immunoglobulin E to chloramine-T was quantified at a value of 2.9 optical density as measured by the enzyme allergosorbent test technique. Conclusion The strict cause-effect relationship and the results of the skin test and the in vitro test make certain the causative role of chloramine-T in this case of anaphylaxis. This suggests that chloramine-T, based on its wide use as a disinfectant, should be considered a possible cause in anaphylaxis of unknown origin.
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