adenoid hypetrophy

Transcription

adenoid hypetrophy

JOURNAL OF BIOLOGICAL REGULATORS & HOMEOSTATIC AGENTS
Vol. 26, no. 1 (S), 1-7 (2012)
ADENOID HYPETROPHY: DEFINITION OF SOME RISK FACTORS
DE AMICI M1, CIPRANDI G2, MARSEGLIA A3, LICARI A3, MATTI E4, CAPUTO M4, BENAZZO M4,
CASTELLAZZI AM3, PUSATERI A4 , PAGELLA F4, MARSEGLIA GL3.
Pediatric Unit, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
Department of Internal Medicine, Azienda Ospedaliera Universitaria San Martino, Genoa, Italy
3
Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
4
ENT Department, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
1
2
Adenoids removed for airway obstruction and/or recurrent infections have been studied to identify a possible
mechanism to explain chronicity. In this regard, macrophages may play a relevant pathogenic role as well as
neutrophils during bacterial infections and eosinophils in allergic inflammation. Therefore, this study aimed
at investigating some mediators as surrogate markers of inflammation in children who had to undergo to
adenoidectomy. Globally, 67 children (25 females, 42 males, mean age 4.9 years), affected by persistent obstruction
caused by adenoid hypertrophy were consecutively enrolled into the study. Blood samples were collected from
patients and controls to determine serum CD163, Myeloperoxidase (MPO) and ECP. There were significant
differences between patients and controls for serum CD163 (p<0.0001); MPO (p<0.0001); serum ECP (p<0.0001).
This study demonstrated some risk factors for severe AH: apnoea, recurrent respiratory infections, and high
serum CD163
levels. REGULATORS & HOMEOSTATIC AGENTS
JOURNAL
OF BIOLOGICAL
Vol. 26, no. 1 (S), 9-14 (2012)
both mucosal-type and systemic-type adaptive immunity
Adenoids with obstructive hypertrophy are considered
(3). AUTOIMMUNITY IN CHILDREN
to be one of
the most
andFACTOR
common problem
in
ATOPY
ASancient
A RISK
FOR THYROID
Approximately one million adenoidectomy procedures
Paediatrics. Anatomically, adenoids are part of the
1
1
2 United States
wereVperformed
in Tthe
in the 1970s,A2but,
Waldeyer’s
ringMand,
since they may
mechanical
PEDULLÀ
, MIRAGLIA
DELcreate
GIUDICE
M1, FIERRO
, ARRIGO
, GITTO E2, SALPIETRO
,
in
the
last
20
years,
the
number
of
such
operations
has
Eustachian Tube
(ET)
obstruction,
they
are
relevant
in
3
2
3
1
1
LIONETTI E , SALPIETRO V , LEONARDI S , SANTANIELLO F , PERRONE L
dramatically decreased, mainly because of the several
the pathogenesis of Otitis Media (OM). In addition, to
discussions over the pros and cons for this procedure (4).
diagnose adenoid hypertrophy,
nowadays nasal endoscopy
1
Department of Pediatrics, Second University of Naples, Italy
Nevertheless, adenoidectomy remains one of the most
is considered
to
be
the
gold
standard
even
in
young
2
Pediatrics,
Genetics
and Immunology
Unit,
University
of Messina,
Italy
commonly
performed
paediatric
surgical
procedures in
kids, as this Department
technique is of
also
able
to
detect
a
possible
3
Department
of
Pediatrics,
University
of
Catania,
Italy
the world (5). In Paediatrics, the most common indications
association between adenoid inflammation/infection and
for such procedure include airway obstruction (often
OM, especially during infancy and early childhood (1).
Nasal-associated
lymphoid
tissues are major
inductive
combined with
tonsillectomy),
chronic
otitis media
(often
Recently,
there has
been considerable
interest
in the relationship
between
allergic and
autoimmune
diseases.
with bilateral
myringotomy
and
organs
in the the
mucosal
immune
systemautoimmunity
of the upperin 566combined
We
evaluated
prevalence
of thyroid
children affected
by atopic
dermatitis and
(AD),tubes),
urticaria,
medically
refractory
chronic rhinosinusitis
patients
respiratory
tract (2).
These
areOur
localized
a
rhinitis, chronic
cough,
andtissues
asthma.
resultsinsuggest
that allergy
and autoimmunity
can be (6).
twoInpotential
with that
healthy
earscells
andcan
adenoid
strategic
in order immunity.
to mediate local
and regional
outcomesposition,
of dysregulated
It is tempting
to speculate
NK Th2
favour hypertrophy,
asthma onset history
and at
of apnoea is the main indication for adenoidectomy,
immune
as they
are exposed
both to outside
the samefunctions,
time improve
thyroid
autoimmunity.
Vol. 26, no. 1 (S), 15-25 (2012)
together with a high frequency of upper
respiratory tract
air antigens and to alimentary antigens. Adenoids have
infections (7). Adenoids removed for airway obstruction
characteristics similar to lymphoid glands, and, together
Department at the Second University of Naples for evaluation
have
challenged thelymphoid
validity
and/or recurrent infections have been studied to identify a
withRecent
tonsils,observations
are part of the
mucosa-associated
of atopic symptoms.
Because of immunological immaturity
of
the
Th1/Th2
paradigm.
The
new
paradigm
identifies
IMPAIRED
SPIROMETRY
MAY
SUGGEST
SENSITIZATION.
possible mechanism
to explain chronicity, and they have
tissues, having a major role in the induction of immunity.
190
children
younger
than
24 months were excluded from our
additional
subsets,
Th17 cells
shown
the
presence
of was
bacterial
organized
into
biofilms
Indeed, theylymphocyte
actually play
a main such
role asaseffector
organs(1),
in
analysis
Informed
consent
from all the
patients
and
solubleCIPRANDI
factors suchGas
T cells S3, TOSCA MA4, MIRAGLIAobtained
1 IL-9 (2), and regulatory
5
, SALPIETRO A2, LEONARDI
DEL
GIUDICE
M
,
their parents.
(T reg) (3). Consequently, there2 has been considerable
3
8
Key-words:
Adenoids
hypertrophy,
CD163,
Risk children
Factors inGL
SALPIETRO
C Adenoidectomy,
, LA ROSA M
, CIRILLO
I6, We
SIGNORI
A
, MARSEGLIA
. a diagnosis of
includedChildren,
in 7the
study
whom
interest in defining the relationship between the expression
asthma, chronic cough, allergic rhino-conjunctivitis, atopic
of allergic
and autoimmune disease in patient populations.
dermatitis
and urticaria was
a paediatric
1
Corresponding
author: Gian
Marseglia
Department
ofLuigi
Internal
Medicine,
Azienda Ospedaliera
Universitaria
Sanconfirmed
Martino,byGenoa,
Italyallergist.
A
series
of clinical
reports
the coincidence
Department of 2Pediatrics,
University
ofaddressed
Pavia
We defined bronchial asthma as one episode from
2 years (2012)
of age
0393-974X
Department
ofMatteo
Pediatrics,
Genetics
and Immunology
Unit, University of Messina,
Italy
or co-prevalence
of atopy
with autoimmune
disease
Copyright
© byif
BIOLIFE,
s.a.s.
Fondazione
IRCCS
Policlinico
San
or any episodes of wheezing independent
of age
combined
This publication
and/or article
is for individual use only and may not be further
Department
of Pediatrics,
Catania,
Italy
P.le
2 – 27100 Pavia
(PV) Italy3arthritis,
suchGolgi,
as psoriasis,
rheumatoid
multiple
sclerosis University
with atopicofsymptoms
in
the
family
or
others
atopic
symptoms
reproduced without written permission from the copyright holder.
Phone
+39.0382.502818
and type
14 Pneumology
diabetes mellitus
(4). Nevertheless
and Allergy
Pediatric recent
Unit, IRCCS
Istituto
Giannina
Gaslini,
Italyand other penalties
in the
childUnauthorized
and/or areproduction
bronchodilator-test
confirmation
of the
may Genoa,
result in financial
FAX +39.0382.527976
DISCLOSURE:
ALL AUTHORS
NO CONFLICTS
OF
5
positive
response
ofNaples,
a 12%
increase REPORT
in the forced
expiratory
studies suggest that IL-4 and
IgE may beofinvolved
in the
1
(S)
Department
Pediatrics,
Second
University
of
Italy
E-mail: gl.marseglia@smatteo.pv.it
INTEREST RELEVANT TO THIS ARTICLE.
volume
(FEV1)
in
1
sec
(7).
Chronic
cough
was
defined
as
a
6
development, progression, and maintenance
of Graves’
Navy Medical
Service, La Spezia, Italy
cough
of
>4
weeks
duration
(9).
Allergic
rhino-conjunctivitis
disease (5) and a role for Treg in 7the
natural progression
of Sciences, Genoa University
Department
of Health
was diagnosed if sneezing nasal obstruction watery rhinorrhoea,
hyperthyroid
Graves’
disease
to
Hashimoto’s
thyroiditis
8
Department of Pediatrics, Foundation IRCCS Policlinico
Sanconjunctival
Matteo, University
of photophobia
Pavia, Italy
nasal itching,
hyperemia and
appeared
and hypothyroidism in humans (6), the occurrence of a
at least twice after exposure to a particular allergen and was
possible association between thyroid autoimmunity and
unrelated to infection. Atopic dermatitis was defined according
The
confirms
that sensitization is very frequent
in the general population and suggests that
atopy
haspresent
not beenstudy
extensively
investigated.
to Hanifin and assessed with the Scorad index (8). Urticaria
impaired
FEF
may
be
a
marker
of
sensitization.
Therefore,
when
spirometry is abnormal, mainly concerning
In order to 25-75
evaluate the independent effects of atopy
was defined as wheals consisting of three features: (I) central
FEF
,
sensitization
should
be
suspected.
on the
development of thyroid autoimmunity we describe
25-75
swelling of various sizes, with or without surrounding erythema;
our experience concerning atopic and non atopic children
(II) pruritus or occasional burning sensations; and (III) the skin
affected by atopic dermatitis, urticaria, rhinitis, chronic
returning to normal appearance, usually within 1-24 hours. (10).
The prevalence of allergic rhinitis, conjunctivitis,
is
impaired, subjects should be carefully evaluated.
The diagnosis of atopy based on clinical history was
cough and asthma, and associated thyroid autoimmunity.
and asthma is worldwide high: up to 40% of the general
confirmed by skin-prick test (SPT) as well as by measuring
population inMATERIALS
some countries
(1-3).
Moreover, there is a
AND METHODS
serum specificMATERIALS
IgE levels concentration
(ImmunoCAP Specific
AND
METHODS
Vol. 26, no. 1 (S), 0-0 (2012)
IMPAIRED FEF25-75 VALUES MAY PREDICT BRONCHIAL REVERSIBILITY IN ALLERGIC
CHILDREN WITH RHINITIS OR ASTHMA.
CIPRANDI G1, CAPASSO M2, LEONARDI S3, LIONETTI E3, LA ROSA M3, SALPIETRO C4, MIRAGLIA
DEL GIUDICE M5, CIRILLO I6, TOSCA M7, MARSEGLIA GL8.
Department of Paediatrics, Ospedale Civile “Ave Gratia Plena”, Piedimonte Matese (CE), Italy
3
Department of Pediatrics, University of Catania, Italy
4
Department of Pediatrics, Genetics and Immunology Unit, University of Messina, Italy
5
6
Navy Medical Service, La Spezia, Italy
7
Pneumology and Allergy Pediatric Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
8
1
2
FEV1 is considered an important parameter for asthma diagnosis and follow-up. However, it has been proposed
that FEF25-75 could be more sensitive than FEV1 to detect slight airways obstruction. Bronchial reversibility defined
by positive response to bronchodilation test. The aim of the present study was to define whether an impaired FEF25value (< 65% of predicted) may be predictive for reversibility in a large cohort of allergic children with rhinitis
75
or asthma. Six hundred allergic children were recruited: 300 with controlled asthma and 300 with allergic rhinitis.
All of them were evaluated by performing spirometry, bronchodilation test, and skin prick test. Two predictors
were significantly associated with bronchial reversibility: i) an impaired FEF25-75 value (< 65% of predicted), and ii)
sensitization to perennial allergens. It was more relevant in children with rhinitis (ORAdj:8.9 and 2.2 respectively).
In conclusion, this study, conducted in real life, could suggest that an impaired FEF25-75 value (<65% of predicted)
Vol. 26, no. 1 (S), 27-33 (2012)
may
be considered a reliable marker of bronchial reversibility, mainly in children with allergic
rhinitis
recognized
(7,8).
In addition,
reversibility
of airflow
Numerous epidemiological
have demonstrated
IMPAIRED
FEF
MAYstudies
PREDICT
HIGH EXHALED
NITRIC
OXIDE
VALUES
IN CHILDREN
obstruction is considered a main functional characteristic
that allergic rhinitis 25-75
may be closely associated with
WITH ALLERGIC RHINITIS AND/OR ASTHMA.
of asthma. This reversibility may be spontaneous or
asthma (1-4). In addition, allergic rhinitis may be
induced
by drugs, 4such as bronchodilators, mainly b2considered a risk
factor
for
both
onset
and
worsening
1
2
4
5
CIPRANDI
, TOSCA MA
, CIRILLO
I3, bronchial
LIONETTI Eagonists.
, LEONARDI
S , MIRAGLIA
GIUDICE
Mto
,
The bronchodilation
test isDEL
usually
prescribed
of
asthma (5).G Reversible
airflow
obstruction,
4
6
7
8
LA
ROSA
M
,
SALPIETRO
A
,
CAPASSO
M
,
MARSEGLIA
GL
.
demonstrate the reversibility of bronchial obstruction and
inflammation and hyper-reactivity characterize asthma.
a positive response defines a correct asthma diagnosis.
Asthma diagnosis is based on clinical and functional
1
Department
ofisInternal
Medicine,
Azienda
Ospedaliera
Martino,
Genoa,
OnUniversitaria
the other hand,San
asthmatic
patients
mayItaly
often have
evaluation.
Spirometry
mandatory
in asthmatic
patients
2
normal
FEVGiannina
values when
theyGenoa,
are clinically
and GINA (Global
Initiative
Asthma)
guidelines
(6) IRCCS
Pneumology
andforAllergy
Pediatric
Unit,
Istituto
Gaslini,
Italy stable (9).
1
3
Moreover,
small
state that the forced expiratory volume/1
second
(FEVService,
)
Navy
Medical
La Spezia,
Italyairways are deeply involved in the
1
4
pathogenesis
of asthma.
Even though there is no direct
represents the gold standard lung
function measurement
Department
of Pediatrics, University
of Catania,
Italy
marker
for
obstruction/inflammation
of small airways,
to evaluate bronchial obstruction.
Spirometric
parameters
5
it has been proposed that the forced expiratory flow
are well standardized
and their interpretation is commonly
6
Department of Paediatrics, Ospedale Civile “Ave Gratia Plena”, Piedimonte Matese (CE), Italy
Keywords: allergic asthma, rhinitis, children, FEV1, FEF25-75, spirometry, reversibility, bronchodilation test.
8
Department
of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
7
Allergic Author:
rhinitis and asthma are closely associated. Inflammation is a common pathological0393-974X
characteristic
Corresponding
(2012)
sharedCiprandi,
by both
disorders. The measure of the fractional concentration of exhaled nitric oxide
(FeNO)
mays.a.s.
be
Copyright
© by BIOLIFE,
Giorgio
M.D.
This publication and/or article is for individual use only and may not be further
Viale
BenedettoaXV
6, 16132 Genoa,
Italyfor airway inflammation. Forced
considered
surrogate
marker
expiratory
flow
between
25%
and
75%
of
vital
Phone
00 39(FEF
10 35338120
capacity
) has been previously demonstrated to be able to predict
BHR
and bronchial
reversibility.
The
Unauthorized
reproduction
may result in financial
and other penalties
25-75
FAX 00 39 10 3538664
DISCLOSURE:
ALL AUTHORS
REPORT
NO
CONFLICTS
OF
19
(S)
aim
of
this
study
was
to
evaluate
whether
impaired
FEF
values
may
be
related
to
FeNO
values
in
a
pediatric
25-75
E-mail gio.cip@libero.it
cohort of allergic subjects. 850 children with allergic rhinitis, allergic asthma, or both, were evaluated. Bronchial
function (FEV1, FVC, and FEF25-75), FeNO, and sensitizations were assessed. Bronchial function and FeNO were
significantly different in the 3 groups (p<0.001). A strong inverse correlation between FeNO and FEV1was found
in patients with rhinitis, asthma and asthma with rhinitis (r= -0.72, r=-0.70 and r= -0.70, respectively). Impaired
FEF25-75 values (such as <65% of predicted) were significantly associated with high FeNO levels (such as > 34 ppb).
In conclusion, this study provided evidence that FEF25-75 is strongly and inversely related with FeNO and FEF25-75
may predict high FeNO levels in children with allergic rhinitis, asthma or both.
Asthma is characterized by airway inflammation,
reversible bronchial obstruction, and bronchial
hyperreactivity (BHR) (1). Allergic rhinitis is similarly
concentration of exhaled nitric oxide (FeNO) during an
office visit and there is international consensus on this
testing methodology (4,5). There is evidence that the
Vol. 26, no. 1 (S), 35-40 (2012)
AIRWAYS ALLERGIC INFLAMMATION AND L. REUTERII TREATMENT IN ASTHMATIC
CHILDREN
MIRAGLIA DEL GIUDICE M1, MAIELLO N1, DECIMO F1, FUSCO N1, D’AGOSTINO B2, SULLO N2,
CAPASSO M1, SALPIETRO V3, GITTO E3, CIPRANDI G4, MARSEGLIA GL5, PERRONE L1.
Department of Experimental Medicine, Pharmacology Section, Second University of Naples, Italy
3
4
5
1
2
Recently, it has been hypothesized that the oral administration of specific live probiotic strains may have
therapeutic potential in the treatment of allergic inflammation. The aim of this study was to evaluate the effect of
the oral L. reuteri DSM 17938 administration (1X108CFU), in airways allergic inflammation in mild persistent
asthmatic children. In this DBPC randomized study we selected 50 children ( 6-14 years old), affected by mild
persistent asthma (GINA step 2) and allergic to HDM. At the run-in period (T-2), the children were submitted
to medical examination, prick tests for the main respiratory allergens, spirometry and children asthma control
test (C-ACT). We selected only the children with well controlled asthma (C-ACT >19 and FEV1> 80%). After two
weeks (T0) the children were allocated into two groups, the FeNO was measured and the breath condensate was
collected. Group A children were treated with the placebo (5 drops per day) and Group B children with L. reuteri
(108CFU =5 drops per day) for 60 days. After the treatment period (T1), all patients were evaluated by medical
examination, C-ACT, spirometry, FeNO measurement and exaled breath condensate analysis. The FeNO values
showed a significant reduction (p=0,045) in L. reuteri group but not in the placebo group at the end of the treatment
(T1). Furthermore, the cytokines exam showed an increase in IL-10 levels (p<0.05) and a significant reduction in
IL-2 levels (p<0.05) only in L. reuteri group at T1. No significant differences in FEV1 values and C-ACT score
were found in both groups. In conclusion, these data showed that L. reuteri (108 CFU) was effective in reducing
bronchial inflammation in asthmatic children. No significant effect was found on FEV1 values and C-ACT score,
probably because we selected children with well controlled asthma.
Over the past decades, an increase in the incidence of
in countries with the best hygienic-sanitary conditions
have a predisposition to allergies, because
the41-48
reduced
Vol. 26, no.of
1 (S),
(2012)
patients, in particular in the industrial countries. For this
environmental antigen stimulation. In these patients the
reason, nowadays, allergies are the most common chronic
physiological immune system “switch” Th2-Th1 turns out
diseases in children all FUNCTION
over the world.
Many
theories
to be damaged with
a lack of immunological tolerance.
OF THE AIRWAY EPITHELIUM
IN ASTHMA
have been suggested to explain this phenomenon and the
Another theory, the “microflora hypothesis”, said that
most plausible hypothesis is the
“hygiene hypothesis”,
the overuse of antibiotics and changes in the diet typical
LEONARDI S1, VITALITI G1, MARSEGLIA GL2, CAIMMI D2, LIONETTI E1,
elaborated by Strachan in 1989 (1). According
to
the
of the industrial
countries, have disrupted the normal
MIRAGLIA DEL GIUDICE M3, SALPIETRO C4, SPICUZZA
L1, CIPRANDI G5, LA ROSA M1.
“hygiene hypothesis”, the immune system lack of exposure
microbiota-mediated mechanisms of immunological
to microbial agents in the early years of life increases the
tolerance in the mucosa, which has led to an increase in the
1
Department
of Pediatrics,
Italy (2). A lot of studies indicate
risk of allergic diseases (1). Hence,
children
who live University
incidence of
of Catania,
allergic diseases
allergic diseases
and asthma
has been&observed
in pediatric
JOURNAL
OF BIOLOGICAL
REGULATORS
HOMEOSTATIC
AGENTS
3
Department
of asthma,
Pediatrics,
Second
University
of Naples,
Key words:
probiotics,
L.Reuteri
DSM 17938,
FeNO Italy
4
5
2
0393-974X (2012)
Copyright © by BIOLIFE, s.a.s.
Corresponding Author:
Asthma
is del
traditionally
bronchial
hyper-responsiveness
and lung
without
written permission from the copyright
holder.
Michele
Miraglia
Giudice MD defined as a chronic disease characterized byreproduced
Unauthorized
reproduction
result in financial
and other penalties
inflammation.
The Second
airwayUniversity
inflammation
likely explain
themay
clinical
manifestations
of
Department
of Pediatrics,
of Naples and remodelling together DISCLOSURE:
ALL AUTHORS REPORT NO CONFLICTS OF
e-mail:
michele.miraglia@unina2.it
asthma.
The mechanisms by which the external environmental cues, together with
the complex
INTEREST
RELEVANTgenetic
TO THIS actions,
ARTICLE.
35 (S)
propagate the inflammatory process that characterizes asthma are beginning to be understood. There is also an
evolving awareness of the active participation of structural elements, such as the airway epithelium, airway smooth
muscle, and endothelium, in this process; these structural elements within the lung and the bone marrow serve
as reservoirs for and the source of inflammatory cells and their precursors. Although often viewed as separate
mechanistic entities, so-called innate and acquired immunity often overlap in the propagation of the asthmatic
response. This review examines the newer information on the pathophysiologic characteristics of asthma and
focuses on the role of airway epithelium in the exacerbation of the disease.
Asthma is traditionally defined as a chronic disease
characterized by bronchial hyper-responsiveness (BHR)
and lung inflammation, particularly within the airways
[4-7]. Among alterations in the structure of the airways
that characterize airway remodelling, increased airway
smooth muscle (ASM) mass may represent a key feature
Vol. 26, no. 1 (S), 49-52 (2012)
COULD BE A LINK BETWEEN NON ATOPIC ASTHMA AND HP INFECTION?
PEDULLÀ M1, PERRONE L1, FIERRO V1, CAPRISTO C1, SALPIETRO C2, LEONARDI S3,
LA ROSA M3, ARRIGO T2, LICARI A4, LONGARETTI P4, MIRAGLIA DEL GIUDICE M1
3
4
1
2
A potential role of Helicobater Pylori (HP) infection in several extra-intestinal pathologies has been recently
suggested. The aim of our study was to assess the role of serology positive for HP in atopic and non atopic infants
and children affected by atopic dermatitis, urticaria, rhinitis and asthma. We included 615 children affected by
atopic diseases. According to prick test positivity and age, we divided the patients into two groups: atopic or
non-atopic patients and infants (0-2 years) or children (2-12 years). The serum levels of antibodies for H. pylori
immunoglobulin G were measured by using an ELISA test. We found a not significant difference between group
1 and group 2 about atopy. There was a significant higher frequency of HP positive serology in older children. As
for infants, a higher significant prevalence of HP positive serology was found in non-atopic patients. HP positive
serology was significantly higher only in non-atopic infants affected by atopic dermatitis and urticaria than in
atopic. In group 2, non atopic children shown a significant increase in the prevalence of HP serum positivity than
atopic children. As for asthma, there was an higher prevalence of HP serology positive in non atopic asthmatic
children group than in atopic asthmatics. On the contrary, the prevalence of positive HP serology was not
significantly different between atopic and non atopic children affected by dermatitis, urticaria, and rhinitis. The
present data confirm an inverse association between HP positive serology and atopy in both groups. However, the
higher prevalence of positive HP serology was observed in non atopic asthmatics children than in atopic asthmatics.
Vol. 26, no. 1 (S), 53-61 (2012)
We could speculate that HP infection can favour non atopic asthma onset.
MATERIALS AND METHODS
A potential role of Helicobater Pylori (HP) infection in
SERUM IL-23 IN ASTHMATIC CHILDREN
several extra-intestinal disorders, such as anemia, failure to
From January 2008 to December 2010, 615 children
thrive, idiopathic thrombocytopenic purpura, asthma and
1
2
2
CIPRANDI
CUPPARI
, SALPIETRO
, TOSCA
M3, GRASSO
, RIGOLI
L2, LA
ROSA Mof4, the
consecutively
referredL2to
the Paediatric
Department
allergic
disorders G
has, been
recentlyCsuggested
(1). TheAHP
University
of Naples for atopic
GL5, MIRAGLIA
GIUDICE
M6, SALPIETRO
C2. dermatitis, urticaria,
infection seems to be MARSEGLIA
able to induce chronic
inflammation DELSecond
rhinitis
and
asthma.
The
criteria
for
asthma
diagnosis were based
which cause remote effects from the primary site of
on a history of two or more episodes of wheezing within the last
1
infectionDepartment
(2). Recent of
data
suggestMedicine,
an inverseAzienda
association
Internal
Ospedaliera
Universitaria San Martino, Genoa, Italy
6 months if combined with atopic symptoms in the family or
between HP2 Department
infection andofasthma
(3). Furthermore
HPImmunology
Pediatrics,
Genetics and
Unit,
University
Messina,
others atopic
symptoms
in theof
child
and/or aItaly
positive response
3
positive serology
was
inversely
related
to
many
allergic
Pneumology and Allergy Pediatric Unit, IRCCS
Istituto
Gianninatest,
Gaslini,
Italy
to the
bronchodilation
such asGenoa,
a > 12%
increase in the
disease, as recent wheezing, 4allergic
rhinitis,
forced expiratory
volumeItaly
(FEV1) in 1 sec (4). Allergic rhinoDepartment
of dermatitis
Pediatrics, University
of Catania,
and eczema
(3).
conjunctivitis
diagnosed
if sneezing,
nasal Italy
obstruction,
5
San was
Matteo,
University
of Pavia,
The aim of this study was
to
assess
the
role
of
serology
watery
runny
nose,
nasal
itching,
conjunctiva
hyperemia
and
6
Department of Pediatrics, Second
University of Naples, Italy
photophobia appeared at least twice after exposure to a particular
positive for HP in atopic and non atopic infants and
allergen and were unrelated to infection (5). Atopic dermatitis
children affected by atopic dermatitis, urticaria, rhinitis,
according
Hanifin and
Rajka diagnostic
is defined
controlled
by atocomplex
cytokine
network.criteria
The
andAsthma
asthma. is characterized by airway inflammation thatwas
Th1/Th2 imbalance has been well documented in the pathogenesis of allergic asthma. Recently, Th17 cells and
regulatory T (Treg) cells have been found to participate in the pathogenesis of allergic asthma. This study aimed at
Key Words:
helicobater
pylorichange
infection,
asthma,
atopy,
children.
verifying whether anti-inflammatory
treatment
could
serum
IL-4,
IL-10
and IL-23 in asthmatic children.
Globally, 78 children (40 males and 38 females, median age 9.3±3.7 years), with asthma and monosensitized to
house dust mites, were evaluated. Lung function (such as FEV1) and serum IL-4, IL-10 and IL-23
levels(2012)
were
0393-974X
Copyright
© bytreatment.
BIOLIFE, s.a.s.
measured at baseline (T0), after 4 weeks (T1) and after 12 weeks (T2) of inhaled corticosteroid
(ICS)
Corresponding
The
controlAuthor:
group consisted of 40 healthy children (22 males and
18 females)
age matched. At baseline, IL-4 and
Michele Miraglia del Giudice MD
IL-23
levels
were
higher
in
severe
asthmatics
than
in
control
group
(p
<
0.001),
while
IL-10and
levels
were
Unauthorized
reproduction
mayserum
result in financial
other penalties
Department of Pediatrics, Second University of Naples
DISCLOSURE: ALL AUTHORS REPORT NO CONFLICTS OF
49 (S) to healthy
significantly
lower in group of asthmatic children as compared
control group
(p
<
0.001).
At
T2,
IL-4
and
e-mail: michele.miraglia@unina2.it
IL-23 significantly diminished (p < 0.001), while IL-10 significantly increased. There was significant relationship
between FEV1 and IL-4, IL-10 and IL-23 at T0 (r=-0.784; r=-0.735 and r=-0.787, respectively). Moreover, there
were correlations between FEV1 and IL-4, IL-10 and IL-23 in patients at T1 (r=-0.563; r=-0.539 and r=-0.583,
respectively) and at T2 (r=-0.549; r=-0.428 and r=-0.393, respectively). The present study provided evidence that:
i) serum IL-23 was up-regulated also in asthmatic children, ii) ICS treatment was able of reducing IL-23, and iii)
IL-23 change well related with lung function improvement. Thus, it is presumable that IL-23 could be a suitable
marker of allergic inflammation in asthma.
Asthma is the most common chronic disease of
childhood and the leading cause of childhood morbidity
as measured by school absences, emergency department
responses (3). Upon airway allergen challenge in allergic
patients, naïve CD4+ T cells differentiate to a prevailing
Th2 effector phenotype characterized by IL-4, IL-5, and
Vol. 26, no. 1 (S), 63-68 (2012)
SUBCLINIC CARDIAC INVOLVEMENT IN PAEDIATRIC PATIENTS WITH CELIAC DISEASE:
A NOVEL SIGN FOR A CASE FINDING APPROACH.
LIONETTI E1, CATASSI C2,3, FRANCAVILLA R4, MIRAGLIA DEL GIUDICE M5, SCIACCA P1,
ARRIGO T6, LEONARDI S1, SALPIETRO A6, SALPIETRO C6, LA ROSA M1.
Department of Paediatrics, Università Politecnica delle Marche, Ancona
3
Center for Celiac Research, University of Maryland School of Medicine, Baltimore
4
Department of Paediatrics, University of Bari
5
6
1
2
The aim of the present work was to assess the prevalence of early cardiac involvement in children with celiac
disease (CD), and the impact of a gluten free diet (GFD) on this issue. Sixty CD children was compared with
a control group of 45 healthy children by an echocardiographic examination. CD patients were re-evaluated
1-year after 1-year GFD. Main outcome measures were ejection fraction (EF), fractional shortening (FS), left
ventricular end-diastolic diameter (LVDD), left ventricular end-systolic diameter (LVSD), any regurgitating valve
lesions. Mild cardiac involvement was found in 13 CD children and in one control (21.7% vs. 2.2%; p=0.003),
and was secondary to regurgitation of mitral valve, aortic valve, pulmonary and tricuspid valve, or to impaired
ejection fraction. CD children as compared to controls had significantly lower contractility indices, and higher left
ventricular dimensions. In patients adhering to the GFD all valve regurgitations resolved, and the echocardiographic
parameters significantly improved. Subclinical cardiac involvement in CD children is quite frequent, and GFD
may exert a beneficial effect on the overall cardiac performance.
after gluten-free diet (GFD).
It is currently recognized that celiac disease (CD)
Vol. 26, no. 1 (S), 69-76 (2012)
We therefore performed a prospective case-control
can manifest with a wide range of clinical presentations,
study in which the primary objectives were to assess the
including the typical malabsorption syndrome (such as
prevalence of early cardiac involvement in a population
chronic diarrhoea, weight loss, abdominal distension) and
ANDaffecting
HELICOBACTER
INFECTION
CHILDREN
of CD children,
and the IN
impact
of a GFD on the overall
a spectrum of PROBIOTICS
symptoms potentially
any organ PYLORI
cardiac performance.
or system (1). Because CD presentation may be often
2
LIONETTI
E1, FRANCAVILLA
, CASTELLAZZI
AM3, ARRIGO T4, LABÒ E3, LEONARDI S1,
atypical
or even clinically
silent, many R
patients
remain
5
6
4
ANDCMETHODS
undiagnosed
and are
to theDEL
risk GIUDICE
of long-term
MIRAGLIA
M , SALPIETRO MATERIALS
V4, SALPIETRO
, LA ROSA M1.
CIPRANDI
G , exposed
complications, such as osteoporosis, infertility, or cancer
All consecutive
children
1 to CD is doubtless higher
(2). The burden of illness related
Department of Pediatrics, University
of Catania,
Italy with CD diagnosed in the
Department of Paediatric Gastroenterology of the University
than previously thought
(3)
and
there
is
growing
interest
2
Department of Biomedicina dell’Età Evolutiva,
University of Bari, Italy
of Catania (Italy) between November 2008 and June 2009 were
on the 3social dimensions of this disorder.
Matteo, in
University
of Pavia,
Italy
candidatesSan
for inclusion
the study. CD
diagnosis
was based
Recently,4 several studies have demonstrated a close
Department
of
Pediatrics,
Genetics
and
Immunology
Unit,
University
Messina,
Italy
on: i) positive
serology
(IgA of
and/or
IgG antibodies
to human
association
between CD and heart diseases in adults (45
tissue transglutaminase),
ii) Martino,
histologicalGenoa,
evidence
of villous
Department
of
Internal
Medicine,
Azienda
Ospedaliera
Universitaria
San
Italy
10). However, there is scarce information about cardiac
atrophy
with crypt
hyperplasia
and increase in intraepithelial
6
Department
of Pediatrics,
Second
University
of Naples,
Italy
involvement in CD in the paediatric
age (11)
and no study
lymphocytes at the small intestinal biopsy, and iii) disappearance
has prospectively evaluated cardiac function before and
Approximately 50% of the world population is infected with Helicobacter pylori (H. pylori), with the highest
Keywords:
Celiac disease,
echocardiography,
gluten the
free-diet,
prevalence rates in developing
countries.
The current
guidelines suggest
use ofhearth.
triple therapy as first choice
treatment
of
Helicobacter
pylori
infection,
although
the
eradication
failure
rate
is
more
than 30%. Current interest
in
probiotics
as
therapeutic
agents
against
Helicobacter
pylori
is
stimulated
by
the
increasing
resistance
of pathogenic
Elena Lionetti
0393-974X
(2012)
bacteria
to
antibiotics,
thus
the
interest
for
alternative
therapies
is
a
real
actual
topic.
Available
data
children
Copyright © byin
BIOLIFE,
s.a.s.
Department of Paediatrics
publication and/or
article is for individual
use onlyand
and may
not bebe
further
University
of Catania
indicate that
probiotics seems to be efficacious for the preventionThis
of antibiotic
associated
side-effects,
might
of
Via
78 95124 – Bari
helpSanta
forSofia
the prevention
of Italy
Helicobacter pylori complications by decreasing
Helicobacter
pylori
density
and
gastritis,
Unauthorized reproduction may result in financial and other penalties
Tel. ++39 095 3782684 Fax ++39 095 3781288
DISCLOSURE:
ALL AUTHORS
REPORT
NO CONFLICTS
OF
63
(S)
and
for
the
prevention
of
Helicobacter
pylori
colonization
or
re-infection
by inhibiting
adhesion
to gastric
epithelial
E-mail: elenalionetti@inwind.it
cells. There is no clear evidence that probiotics may increase the Helicobacter pylori eradication rate.
Probiotics were recently defined by FAO/WHO as
“Live microorganisms which when administered in
adequate amounts confer a health benefit on the host“ (1).
Several controlled clinical trials have shown in children
beneficial outcomes for the use of probiotics in some
different conditions as rotavirus infections, antibioticassociated diarrhoea, irritable bowel syndrome (2-4).
Microorganisms most commonly used in clinical
practice are lactic acid-producing bacteria such as
Lactobacillus spp, and microrganisms belonging to genus
clinical effects of probiotics in man are increasing rapidly.
A field in which particular interest is arising represents the
Helicobacter pylori infection.
Helicobacter pylori
The
gram-negative,
spiral-shaped
bacterium
Helicobacter pylori is a common human pathogen and
public health problem that causes gastritis and peptic
ulcers both in adults (7) and children (8) and is considered
an important cofactor in the development of gastric cancer
Vol. 26, no. 1 (S), 77-83 (2012)
NASAL POLYPOSIS IN CHILDREN
CAIMMI D1, MATTI E2, PELIZZO G3, MARSEGLIA A1, CAIMMI S1, LABÒ E1, LICARI A1, PAGELLA
F2, CASTELLAZZI AM1, PUSATERI A2, PARIGI GB3 , MARSEGLIA GL1.
2
ENT Department, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
3
Department of Pediatric Surgery, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
1
Nasal polyposis is a chronic inflammatory disease affecting the nasal cavity and the paranasal sinuses. It is a
relatively common disease, occurring in 1-4% of the general population, but it is rarely described in the pediatric
population. Most of the published series include children presenting with other underlying systemic diseases,
mainly cystic fibrosis. The aim of the present study was to describe the characteristics of the patients suffering
from nasal polyposis, evaluated at the Pediatric Clinic of the University of Pavia (Italy) over the last 17 years. 56
consecutive pediatric patients referring to our Pediatric Department had a diagnosis of nasal poyposis over the
last 17 years. All children underwent allergy evaluation, nasal endoscopy, CT scan of the paranasal sinus, and
Functional Endoscopic Sinus Surgery. The mean age of the present cohort was of 11.8 years and most of the patients
were male. 50% of the patients presented with unilateral, polyposis, mostly with a diagnosis of antrochoanal polyp.
4 patients presenting with bilateral polyposis suffered from cystic fibrosis. Main symptoms at diagnosis included
nasal obstruction, snoring and rhinorrhea 32% of the patients presented at least a positivity to skin prick test, for
major inhalant and food allergens. Nasal polyposis in children could represent an alert sign for other underlying
systemic diseases. Nasal endoscopy should therefore be prescribed when a diagnosis is suspected. To properly
treat a patient presenting with nasal polyposis, it is necessary to integrate medical and surgical skills through a
multidisciplinary approach.
Vol. 26, no. 1 (S), 85-93 (2012)
Nasal polyposis is a chronic inflammatory disease
Nasal polyposis is a relatively common disease,
affecting the nasal cavity and the paranasal sinuses, and
occurring in 1-4% of the general population, especially in
MUCOSAL
AND SUBLINGUAL
IMMUNOTHERAPY
INwhile
RESPIRATORY
characterized
by the IMMUNITY
presence of mucosal
congestion
subjects
older than 20 years,
it is less frequent in the
DISORDERS
associated to the presence of edematous inflammatory
pediatric population (< 1%) (3-5). It is to note, however,
growths: the nasal polyps. The polyps originate from the
that most of the published studies are based on patient1
paranasal
sinuses and
into theSnasal
cavity (1, 2).
reported data
questionnaires,
missing
VITALITI
G1,protrude
LEONARDI
, MIRAGLIA
DEL GIUDICE
M2, through
SALPIETRO
A3, ARTUSIO
L4,though
4
3
3
5
1
Through a mechanical
barrierDeffect,
the polyps
alter and
endoscopic
results,G which
are essential
CAIMMI
, ARRIGO
T , SALPIETRO
C , CIPRANDI
, LA ROSA
M . for diagnosis,
block the normal flow of air through the nose. Similarly,
and the real prevalence of the disease might therefore be
blocking the drainage pathways
underestimated.
NasalItaly
polyposis affects mostly males,
1 of the sinuses, they cause
Department of Pediatrics, University
of Catania,
sinu-nasal congestion. Clinically,
the
patient
experience
a
with
a
male-female
ratio
up to 4:1 (6).
2
Department of Pediatrics, Second University of Naples,ofItaly
nasal airway3 obstruction, which sometimes is so severe
The nasal polyps may be either isolated or associated
that is 4 accompanied by forced mouth breathing. Other
with other medical conditions. Isolated nasal polyposis
Department
of Pediatrics,
Foundation
IRCCS
Policlinico
Sanis Matteo,
University
of Pavia,
Italy
common
symptoms
include
rhinorrhea,
postnasal
drip,
in children
a rare condition,
being
most of
the times
5
Department
of
Internal
Medicine,
Azienda
Ospedaliera
Universitaria
San
Martino,
Genoa,
cough, facial pains, snoring at night, hypo/
associated with a systemic disease. Nasal Italy
polyps are
anosmia. Possible complications, though uncommon,
found in 5-15% of asthmatic subjects, in 5-8% of
include
periorbital prevalence
or orbital ofcellulitis
subpatients
withquality
non-steroidal
anti-inflammatory
drugs
The increasing
allergy which,
and its impact
on
individual
of life underline
the need of
an
periosteal abscesses,
cavernous
thrombosis.
(NSAIDs)
less frequently
(0.5improvement
of thecerebral
treatment
optionssinus
in order
to modify the
natural hypersensitivity,
course of allergicand,
diseases.
In this context,
specific sublingual immunotherapy (SLIT) represents an approach currently available to redirect inappropriate
Words :patients.
antrochoanal
children, cystic
fibrosis, nasal
endoscopy,
nasal
polyposis
immune response Key
in atopic
Thepolyp,
immunological
mechanism
that
underlies
SLIT
has only started to be
investigated. Oral mucosal tissue displays high permeability for allergens. It is conceivable that the sublingual
administration
route
might
induce immunological tolerance towards allergens involving cells and mediators
Corresponding
Author
Gian Luigi
Marseglia
Department
Pediatrics
specific ofoforal
and intestinal mucosa. Recent literature data stated the presence in oral mucosa of0393-974X
dendritic(2012)
cells
Copyright
© by BIOLIFE,
s.a.s.
Foundation
IRCCS
Policlinico
San Matteo - University
(DCs) which
express
the high-affinity
receptoroffor immunoglobulin (Ig)E (FceRI). Moreover some
studies
indicated
Pavia, Italy
that the mechanism of immunotherapy might be based on the increase
of
number
and
activity
of
regulatory
T
P.le Golgi, 2 - 27100 Pavia (PV) Italy
Unauthorized
reproduction
may resultis
in financial
and other penalties
cells.
Accumulating
evidences
suggest
that
the
generation
of
T
regulatory
cells
in
periphery
orchestrated
by
a
Tel: +39.0382.502818 Fax: +39.0382.527976
DISCLOSURE: ALL AUTHORS REPORT NO CONFLICTS OF
77
(S)
particular
subset
of
DCs.
It
seems
that
repeated
stimulation
of
naïve
CD4
T
cells
with
allogenic
immature
DCs
E-mail: gl.marseglia@smatteo.pv.it
induce Tr1 cells maturation. Nevertheless other cells are involved in this process, such as TLR, MHC of I and
II class and costimolatory molecules such as CD40, CD 80/B7.1 and CD 86/B7.2. An increase of serum IgG4 and
IgA, a reduced number of inflammatory cells infiltrating target organs, as well as a reduction of eosinophilic
cationic protein and a very heterogenous influence on T cells in the peripheral blood in terms of T cell suppression
also occur with SLIT. All these molecules orchestrate the immune response within the regional immune system,
recreating a favourite environment for the induction of tolerance operated by SLIT.
The increasing prevalence of allergy and its impact
on individual quality of life and social costs underline
the need of an improvement of the treatment options in
order to modify the natural course of allergic diseases. In
injections has limited the application of SCIT, especially
in children. Nowadays, other kinds of immunotherapy
such as sublingual-swallow immunotherapy (SLIT)
may represent a valuable alternative to SCIT. SLIT has
Vol. 26, no. 1 (S), 95-103 (2012)
EFFECT OF WEIGHT REDUCTION ON LEPTIN, TOTAL GHRELIN AND OBESTATIN
CONCENTRATIONS IN PREPUBERTAL CHILDREN.
ARRIGO T1, GITTO E1, FERRAÙ V1, MUNAFÒ C1, ALIBRANDI A1, MARSEGLIA GL2, SALPIETRO
A1, MIRAGLIA DEL GIUDICE M3, LEONARDI S4, CIPRANDI G5, SALPIETRO C1.
3
4
5
1
2
The aim of the study was to evaluate fasting levels of glucose, insulin, leptin, total ghrelin, and obestatin in a
group of prepubescent obese children before and after weight loss. We enrolled 64 prepubescent obese children,
but only 35 completed the study (mean age 7.6 ± 0.9 years, 19 females) and 20 normal-weight prepubescent
children as controls. Fasting plasma concentration of glucose, insulin, Homeostasis Model assessment for insulin
resistance (HOMA-IR), and leptin, total ghrelin, and obestatin levels were measured at baseline and after a
6-month lifestyle intervention (i.e. improved nutrition and increased physical activity). At baseline, obese children
showed significantly (p<0.001) higher leptin and obestatin levels, and lower total ghrelin concentrations than
control subjects. Weight loss significantly (p<0.001) diminished plasma leptin and insulin levels and increased
ghrelin and obestatin concentrations. Weight loss in prepubescent children is associated with a significant change
in leptin, ghrelin and obestatin concentrations. These results confirm the hypothesis that levels of these hormones
are closely associated with obesity in childhood and might take part, as consequence but not as a cause, in glucose,
fat, and energy metabolism.
fat. Adipose tissue and adipocytes are a site for storage
It is widely known that the prevalence of childhood
of energy, and also a source of many adipokines and
obesity is increasing in most industrialized countries
hormones (e.g. visfatin, adiponectin, leptin, resistin) (3).
and that it is associated a major risk factor for coThere have been several studies reporting the role of
morbidity and mortality during the adult life (1). A recent
insulin
and leptin on energy homeostasis
through control of
representative
survey,
conducted
in
Italy,
demonstrated
Vol. 26, no. 1 (S), 105-108 (2012)
appetite and energy expenditure: both hormones increase
that 24% of school children were overweight and 12%
were obese.In addition, the prevalence of obesity and
in direct proportion to adipose mass (4-7). Ghrelin, an
estimated metabolic diseases was about 2 times higher in
endogenous ligand of the growth (GH) secretagogue
PENTRAXIN 3 SERUM LEVELS IN CHILDREN
WITH ATOPIC DERMATITIS
receptor, is inversely correlated with BMI and insulin
the Southern Italy in comparison with the Northern Italy
concentrations in normal children (8). Therefore, ghrelin,
(2).
1
2
1
1
MARSEGLIA
, DE
AMICI
, MARSEGLIA
, CAIMMI
, MIRAGLIA
GIUDICE
M3,links
One
of the largest GL
health
problems
in M
obese
adolescents Ainsulin
and Sleptin
represent DEL
afferent
hormonal
1
4
5
1
6
, SALPIETRO
LEONARDIbetween
S , BRAMBILLA
I , CIPRANDI
G . central feeding
LEONI
and young adults
is theMC
development
of typeC2 , diabetes
peripheral energy
metabolism and
mellitus, preceded by insulin resistance during childhood
behavior (9,10). Additionally, there is evidence that ghrelin
and obestatin,
derived University
from a common
pro-hormone,
usually1 Department
associated with
visceral fat accumulation.
Waist Policlinico
of Pediatrics,
Foundation IRCCS
San Matteo,
of Pavia,
Italy are
2
circumference correlates
with
cardiovascular
morbidity
involved
in
appetite
stimulation
and
suppression
and in
Pediatric Unit, Foundation IRCCS Policlinico San Matteo, Pavia , Italy
as well as the body mass3 Department
index (BMI) of
or Pediatrics,
percent body
metabolism
(11).
Second University of Naples, Italy
5
Department
of Pediatrics,
University
of Catania,
Italy
Key
words: obesity,
insulin, leptin,
total ghrelin,
obestatin.
6
4
Gian Luigi Marseglia
0393-974X (2012)
PTX3 behaves as an acute-phase response protein as its blood levels rapidly and dramatically
increase during
Department of Pediatrics, University of Pavia
This
publication
and/or
article
is
for
individual
use
only
and may
not be further
endotoxic
shock,
sepsis,
and
other
inflammatory
and
infectious
conditions.
Therefore,
this
study
was
designed
to
Fondazione IRCCS Policlinico San Matteo
investigate
a possible
roleItaly
of PTX3 in children with Atopic DermatitisUnauthorized
(AD).
One-hundred-and-thirty-six
patients
P.le
Golgi, 2 – 27100
Pavia (PV)
reproduction may result in financial and other penalties
Phone
+39.0382.502818
FAX +39.0382.527976
(37 females,
99 males,
mean age 10.4 years) were enrolled
in the study.
One hundred
patients
(74%)
had only
DISCLOSURE:
ALL AUTHORS
REPORT
NO CONFLICTS
OF
95
(S)
E-mail:
gl.marseglia@smatteo.pv.it
respiratory
symptoms (allergic rhinitis and/or bronchial asthma); thirty-six patients
(26%) showed dermatitis
associated with respiratory allergy (allergic rhinitis and/or bronchial asthma). PTX3 levels were higher in children
with AD and there was a significant correlation between serum PTX3 levels and SCORAD index (p-value=0.0001,
rho=0.658). Therefore, this study may show that PTX3 might be a reliable marker for the severity of AD in children
with respiratory allergy.
Atopic dermatitis (AD) is an inflammatory skin
disease characterized by pruritus and chronic or relapsing
eczematous lesions that commonly present during early
infancy and affect up to 16% of children (1). AD is thought
to represent an interaction between both genetic and
environmental influences with trigger factors, including
leads to the development of a new population of Th9 cells
producing IL-9 and IL-10 (3).
Therefore, an immune-mediated inflammatory reaction
is involved in the pathogenesis of AD. In this regard,
Pentraxins are acute-phase reactants and are classified as
short and long pentraxins. C-reactive protein (CRP) and
Vol. 26, no. 1 (S), 109-112 (2012)
PENTRAXIN 3 IN CHILDREN SUFFERING FROM ALLERGIC RHINITIS
MARSEGLIA GL1, DE AMICI M2, LEONARDI S3, MIRAGLIA DEL GIUDICE M4, SALPIETRO A5, LA
ROSA M3, CAIMMI D1, CAIMMI S1, LICARI A1, CIPRANDI G6.
2
3
4
5
6
1
Allergic disorders are typically characterized by an inflammatory response to allergen exposure. PTX3
behaves as an acute-phase response protein as there is a relationship between PTX3 plasma levels and disease
severity. Therefore, this study was designed to investigate a possible role of PTX3 in children with allergic rhinitis.
One hundred patients (28 females, 72 males, median age 11 years) were enrolled in the study. All patients were
monosensitized: 43 (43%) to seasonal allergens (Graminaceae), 57 (57%) to perennial allergens (house dust mites,
cat and dog epithelium, alternaria tenuis). Patients’ blood samples for assessing serum PTX3 levels were performed
during the spring. Children with rhinitis had higher PTX3 levels and there was a significant relationship between
symptom severity and serum levels. Therefore, this study shows that PTX3 serum levels could be a reliable marker
for symptom severity in children with allergic rhinitis.
between humoral and cellular compartment to regulate
The innate immunity represents the first line of defence
and amplify the innate immune response.
towards pathogens, and exerts a pivotal role about the
Vol. 26, no. 1 (S), 113-117 (2012)
Pentraxins constitute a superfamily
of evolutionary
activation and orientation of adaptive immune response,
conserved (from arachnids and insect to humans) proteins,
and plays a key role in maintaining tissue integrity and
which have a cyclic multimeric structure and present
repair. The innate immune system consists of a cellular and
PATIENTS
ORAL
ALLERGIC SYNDROME
200 amino TO
acid APPLE
pentraxinHAVE
domainINTENSE
in the C terminus (4).
a humoral arm.
About theWITH
humoral
arm, Cell-associated
TO
V 1 reactans and are classified as
Pentraxins
areBET
acute-phase
pattern-recognition molecules PROLIFERATIVE
(PRMs) possess theRESPONSE
short and long pentraxins. C-reactive protein (CRP) and
characteristic of being strategically localized in different
1
2
2
amyloid P-component
(SAP) areDEL
wellGIUDICE
known short
cellular
compartment
(e.g.
plasma
membrane,
endosomes,
M3, LEONARDI
S4, MIRAGLIA
CIPRANDI G , FENOGLIO G , KALLI F , DE AMICIserum
5
6
4 pentraxins, 7maily CRP is produced
7
by
hepatocytes
in
cytoplasm) . PRMs belong
to
several
molecular
classes:
M , SALPIETRO C , LA ROSA M , CAIMMI S , MARSEGLIA GL .
response to pro-inflammatory mediators. Long pentraxins
the Toll-like receptors, the NOD- and RIG-like receptors,
are: PTX3, the first identified in the ’90, guinea pig apexin,
and the1 scavenger receptors (1,2). PRMs may be also shed
Department of Internal Medicine, Azienda Ospedaliera
Universitaria San Martino, Genoa, Italy
neuronal pentraxin 1 and 2.
and detected in several fluids, including blood.
Fluid-phase
2
CEBR
–
University
of
Genoa
PTX3 is the prototypic long pentraxin and is produced
PRMs belong to different
molecular families, including
3
Pediatric
Unit,
Foundation
IRCCS
Policlinico
Pavia , cells
Italyin peripheral tissues,
by residentSan
andMatteo,
innate immunity
collectins, ficolins, and pentraxins (3). Humoral PRMs
4
Department
of Pediatrics,
of Catania,
Italy signals and TLR activation
in response
to inflammatory
are functional ancestors of anticorpal
response
(ante- University
5
of Pediatrics,
Second
University
of Naples,
Italy “ready-to-use” form in
(5).
PTX3 is present
in a functional
antibodies). It is to note thatDepartment
humoral PRMs
share a basic,
of Pediatrics,
Genetics
and Immunology
Unit, University
Messina,
Italyreleased after
polymorphonuclear
granulesofand
is promptly
evolutionary6 Department
conserved mode
of action: such
as activation
adequate
activation
(6).
PTX3
behaves
as
an Italy
acute-phase
of the 7 Department
complement, ofagglutination,
neutralization,
and
Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia,
response protein as its blood levels rapidly and dramatically
opsonisation. In addition, there is a bidirectional cross-talk
Patients with pollen allergy may frequently present an additional food-related allergy (Oral Allergic Syndrome,
Key words: allergic
rhinitis,
serumallergens
Pentraxin 3,
symptom
severitiy
OAS), as consequence of cross-reactivity
between
pollen
(mainly
birch,
hazelnut, alder, mugwort) and
vegetable allergens. The aim of this study was to evaluate the effect on Bet v 1-induced T cell proliferation exerted
by the Ciprandi
presence of OAS in birch patients. Fourteen allergic patients were evaluated (6 males, mean0393-974X
age 35.8 years).
Giorgio
(2012)
All of them were monosensitized to birch and suffered from allergic rhinitis: 4 had also OAS toCopyright
apple.©Proliferation
by BIOLIFE, s.a.s.
DI.M.I.
publication and/or
article is for
individual
only andproliferation
may not be further
Viale
Benedetto XV
6, 16132 Genoa,
Italywas evaluated using Bet v 1 andThis
of peripheral
mononuclear
cells
non-specific
stimuli.
OAS
haduse
higher
Phone
+
39
10
35338120
than non-OAS patients. In addition, there were significant relationships
between
andotherclinical
Unauthorized
reproductionimmunological
may result in financial and
penalties
FAX + 39 382 527976
DISCLOSURE:
ALL
AUTHORS
REPORT
NO CONFLICTS
parameters in OAS patients. This study evidences that
OAS
characterizes
a more
severe
form
of birch
allergy: OF
as
109
(S)
E-mail gio.cip@libero.it
OAS patients had higher SI, circulating eosinophils, and IgE levels. Thus, this study confirms the previous report
and underlines the relevance of measuring recombinant birch allergen as higher values may suggest a reliable
prediction of OAS.
Patients with pollen allergy may frequently present
an additional food-related allergy, as consequence of
cross-reactivity between pollen allergens (mainly birch,
hazelnut, alder, mugwort) and vegetable allergens (1). The
IgE cross-reactivity between pollen and food allergens
constitutes the molecular basis for the Oral Allergy
Sindrome (OAS); pollen allergy represents the basis for
onset and maintenance of OAS (2). Moreover, apple
allergen (5,6). Previously, it has been demonstrated that
quantitative birch specific IgE level proved useful in
predicting clinical allergic symptoms with birch exposure
(7). In addition, it has been also reported that patients with
severe birch allergy had higher levels of serum IL-17 in
comparison with patients with mild form (8). Patients
with severe birch allergy have also higher total IgE levels
and circulating eosinophils than patients with mild birch
Vol. 26, no. 1 (S), 119-123 (2012)
TETANUS TOXOID IGE MAY BE USEFUL IN PREDICTING ALLERGY DURING CHILDHOOD
CIPRANDI G1, DE AMICI M2, QUAGLINI S3, LABÒ E4, CASTELLAZZI AM4, MIRAGLIA DEL
GIUDICE M5, MARSEGLIA A4, BIANCHI L4, MORATTI R6, MARSEGLIA GL4,
and Workgroup “Allergy Project”*
2
3
Department of Computer Engineering and Systems Science, University of Pavia, Italy
4
5
6
Scientific Direction, Foundation IRCCS Policlinico San Matteo, University of Pavia, Italy
1
*The other members of the Workgroup “Allergy Project” are: Bosio M, Fiorentini ML, (Direzione Sanitaria, Fondazione IRCCS
Policlinico San Matteo, Pavia, Italy), Alesina R, Luisetti M., (Respiratory Diseases, Fondazione IRCCS Policlinico San Matteo,
Pavia, Italy), Borroni G, Vignini M (Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Univerità degli Studi di Pavia;
Pavia, Italy), Spinillo A (Department of Obstretics and Ginecology, Fondazione IRCCS Policlinico San Matteo, Università degli
Studi di Pavia, Pavia, Italy), Perotti F (Department of Obstretics and Ginecology, Fondazione IRCCS Policlinico San Matteo, Pavia,
Italy), Stronati M, Bollani L (Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy), Cerra C,
Carugno B (ASL of Pavia, Sisetma Informativo Aziendale, Pavia, Italy)
Hypersensitivity reactions after immunization with tetanus toxoid are occasionally observed in atopic and
non-atopic individuals. High IgE levels in infancy may predict subsequent allergy. The aims of this study were:
i) to evaluate the role of specific IgE to tetanus toxoid in children in response to tetanus immunization and the
possible factors associated with specific IgE levels, and ii) to investigate the correlation between specific IgE levels
to tetanus toxoid and the late development of allergy (up to 12 years). Initially, 278 healthy infants (152 males and
126 females, aged 12 months) living in an urban city were screened for serum total IgE and specific IgE to tetanus
toxoid, after having obtained informed consent from parents. After 12 years, 151 children could be evaluated. Total
IgE summed with tetanus specific IgE were significantly associated with allergy at 12 years. In conclusion, this
JOURNAL
OF BIOLOGICAL
REGULATORS
& HOMEOSTATIC
AGENTS
Vol. 26, no.allergy
1 (S), 125-131
(2012)
study demonstrates
that
serum total
IgE and tetanus
specific IgE may be predictive of subsequent
onset.
Hypersensitivity reactions after immunization with
were found to be higher compared to non atopic individuals
OCCULT SINUSITIS MAY BE A KEY FEATURE FOR NON-CONTROLLED
tetanus toxoid are occasionally observed in atopic and
(6, 7). Additionally, it was found that older children with
non-atopic individuals. In the literature, a lowASTHMA
incidence ofIN CHILDREN
markedly elevated total serum IgE levels synthesized antiserious side effects after T immunization has been reported
tetanus IgE antibodies (7).
1
1
1
2
GLpreschool
, CAIMMI
, MARSEGLIA
, CIPRANDI
G3, showed
LA ROSA
M4,
(1,2). MARSEGLIA
In young infants,
andS school
children A , PAGELLA
Moreover, F
Dannemann
et al (8),
that 24-month1
LEONARDI
S4 reactions,
, MIRAGLIA
GIUDICE
M5, and
CAIMMI
. manifestation of atopic
reported side effects are mostly
minor local
while DELold
children with
without D
early
systemic reactions are quite rare (3, 4, 5). Elevated serum
symptoms were capable of producing IgE antibodies
1
IgE antibody
levels tooftetanus
toxoid may
be observed
after Policlinico
in response
tetanus University
immunization.
About 50%
Department
Paediatrics,
Foundation
IRCCS
SantoMatteo,
of Pavia,
Italy of the
2
booster immunization
with aluminum-adsorbed
tetanus
infants
that study
developedofdetectable
specific tetanus
ENT Department,
Foundation IRCCS
Policlinico
SaninMatteo,
University
Pavia, Italy
vaccine.
antibodies.
Children San
withMartino,
immunological
of
3 In cross-sectional studies on atopic adults as well as
Department of Internal Medicine, Azienda Ospedaliera
Universitaria
Genoa,indicators
Italy
4 to 17-year-old atopic children,4Department
tetanus IgE antibody
levels
atopy
such
as
specific
sensitizations
already
at
the
age
of
2
of Pediatrics, University of Catania, Italy
Department
of Pediatrics, Second University of Naples, Italy
Key words: Allergy, IgE, Pediatrics, Tetanus toxoid
5
Corresponding
SinusitisAuthor:
is frequently associated with asthma. The diagnosis and management of patients with asthma associated
Giorgio Ciprandi
0393-974X
(2012)
with
sinusitis
are often challenging, though sometimes unsatisfactory. Detection and treatment
of sinusitis
in
DI.M.I.
asthmatics
lead
to Genoa,
a better
control of asthma symptoms. Most
the studies
regarding
the relationship
between
Thisof
publication
and/or article
is for individual
use only and may not
be further
Viale
Benedettomay
XV 6,
16132
Italy
reproduced
without
written
thepresence
copyright holder.
sinusitis
asthma have been conducted in adults. The aim of the present
study
was
to permission
evaluatefrom
the
of
Phone
+ 39 and
10 35338120
Unauthorized reproduction may result in financial and other penalties
FAX
+
39
382
527976
sinusal comorbidity in children with un-controlled asthma
both
clinically
and
through
nasal
endoscopy
after
the
DISCLOSURE:
ALL
AUTHORS
REPORT
NO
CONFLICTS
OF
119 (S)
E-mail
INTEREST
RELEVANT
TO THIS
ARTICLE.
first 6 gio.cip@libero.it
months of treatment. The present study included 294 consecutive asthmatic
children
(97 males,
mean
age
7.3 years). Asthma diagnosis, severity assessment and treatment were performed according to GINA guidelines.
Twenty-one patients with non-controlled asthma presented with endoscopic features of sinusitis, but without
any clinical sign or symptom. We defined such condition occult sinusitis. Not only overt sinusitis, but also occult
sinusitis could be a significant comorbidity in asthmatic patients. For this reason, it may be beneficial to determine
the presence of sinus inflammation in children with non-controlled asthma, even when they don’t present clinical
signs or symptoms of upper airways involvement.
Sinusitis represents a frequent co-morbidity in patients
suffering from asthma and some studies pointed out that
there could be an association between these two diseases
(1-3). Upper respiratory airways diseases may induce a
hyperreactivity (6). Clinical manifestations include dry
cough, expiratory wheezing, chest tightness and dyspnoea,
which are triggered by several exogenous factors, such
as allergens, infections, airways irritants and overall in

adenoid hypetrophy

Transcription

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