Frequency and clinical features of pollen-food syndrome in children

BackgroundPollen-food syndrome (PFS) is an allergic reaction to fresh fruits, vegetables and/or nuts that can occur in patients who are allergic to pollen. The prevalence of PFS in children is not clearly known.ObjectiveThe objective of this study was to determine the frequency and clinical features of PFS in pediatric patients with pollen-induced allergic rhinitis (AR).MethodThis study was conducted in the pediatric allergy outpatient clinic of our hospital. Pollen-induced seasonal AR patients who were evaluated for any symptoms appearing after consuming any fresh fruits and vegetables.ResultsSix hundred and seventy-two pollen-sensitized patients were included in this study. The symptoms related to PFS were reported in 22 (3.3%) patients. The median age of the patients was 12.3 years and 59% (n = 13) were female. Peach was the most common culprit (22%). There were isolated oropharyngeal symptoms in 20 (91%) patients and anaphylaxis in two (9%) patients with the suspected food. The multiple logistic regression analysis revealed that female gender, history of atopic dermatitis and allergic diseases in the family were the potential risk factors for PFS [Odds ratio 95%CI: 3.367 (1.344–8.435), 5.120 (1.935–13.550), 3.046 (1.239–7.492), respectively].ConclusionPFS can be seen in children who are followed up for pollen-induced AR. The symptoms of PFS are usually mild and transient. However, comprehensive evaluation of patients is important since serious systemic reactions such as anaphylaxis can also be observed.     

Laboratorial characteristics of patients with diarrhoea suffering from egg white allergy

BackgroundEgg allergy is associated with diarrhoeal symptoms. However, the mechanism underlying allergic diarrhoea remains unclear.ObjectiveTo determine whether egg white-specific IgE antibodies coexist with egg white-specific IgG antibodies in patients with egg allergy featuring diarrhoeal symptoms, and whether there is any relationship between these two antibody types.MethodsA total of 89 patients with egg allergy featuring diarrhoeal symptoms (average age, 23.2 years; range, 1–78 years), all of whom tested positive for egg white-specific IgG, were enrolled in this study. The concentration of total IgE, egg white-specific IgE and number of eosinophils in the serum were determined.ResultsAmong the 89 egg white allergic patients tested, 49 (55.1%) patients showed high reactivity to egg white-specific IgG, 48 (53.9%) patients had elevated serum total IgE levels, and 25 (28.1%) patients had elevated absolute eosinophil numbers. Out of the 89 egg white allergic patients, 25 showed elevated egg white-specific IgE antibody levels. Of the 25 patients who were positive for egg white-specific IgE antibody, 21 presented high sensitive reaction to egg white-specific IgG, three presented moderate sensitive reaction to egg white-specific IgG, and one presented mild sensitive reaction to egg white-specific IgG. A moderate correlation between egg white-specific IgG and egg white-specific IgE, egg white-specific IgG and absolute eosinophil number was found in the egg white allergic patients (r = 0.438, P = 0.000; r = 0.322, P = 0.002). Egg white-specific IgE levels varied in different age groups; the egg white-specific IgE concentration of younger patients (age ≤ 18 years, mean rank 54.29) was significantly higher than that of the adult patients (age > 18 years, mean rank 34.61) (Z = −3.629, P = 0.000).ConclusionEgg white-specific IgE antibody could coexist with egg white-specific IgG antibody in patients suffering from egg white allergy. Aberrant changes in the concentration of egg white-specific IgE antibody were associated with the presence of egg white-specific IgG antibody.     

Spring season birth is associated with higher emergency department admission for acute allergic reactions

BackgroundAcute allergic reactions are important causes of emergency department (ED) admission, imposing a significant clinical and organizational burden. Since the season of birth is linked with early exposure to allergens, this study was aimed to establish whether an association exists between season of birth and incidence and severity of acute allergic reactions in the ED.MethodsThe electronic hospital database was searched to identify all consecutive adult patients who were admitted to the ED for acute allergic reactions (acute urticaria, acute angioedema, urticaria–angioedema and anaphylaxis) during a 1-year period.ResultsThe final study population consisted in 588 patients (328 women and 260 men; mean age 43 ± 18 years, range 16–96 years). Increased frequency of ED admission was observed for patients born in spring, whereas the lowest frequency was found for those born in autumn. Patients born in spring exhibited 1.19 and 1.12 higher risk of ED admission for acute allergic reactions compared to those born in autumn and in all other seasons, respectively. This difference remained significant in patients with allergic reaction attributable to drugs and in those with unknown triggers, whereas no pattern of seasonality was observed in patients with allergic reactions attributable to aliments, hymenoptera, chemicals or inhalants. Patients born in spring also exhibited 1.86 and 1.52 higher risk of being admitted to the ED for severe acute allergic reactions compared to those born in autumn and in all other seasons, respectively.ConclusionsPatients born in spring appear particularly vulnerable to allergic reactions requiring ED visit.     

SLIT Improves Cedar Pollinosis by Restoring IL-10 Production from Tr1 and Monocytes~IL-10 Productivity Is Critical for Becoming Allergic ~

BackgroundAllergen-specific immunotherapy (SIT) is currently used for several allergic disorders and IL-10- producing regulatory T cells (Tr1) induced by SIT suppress allergic reactions. We investigated the relation between IL-10 production and acquiring allergy.MethodsA prospective study was undertaken to evaluate the effect of SIT on IL-10 production in T cells and other cell fractions in children with pollinosis. In addition, blood samples were collected from non-allergic healthy controls and patients with pollinosis to compare the levels of IL-10 production. PBMC were cultured with pollen peptides or control allergens, and the IL-10 production from monocyte and CD4 T cell was analyzed.ResultsMonocytes and CD4 T cells from SIT group of patients produced high levels of IL-10, suggesting that the induction of IL-10 is essential for inducing T cell tolerance. IL-10 production from monocytes and T cells was significantly increased in non-allergic controls compared to patients with pollinosis. This high IL-10 production was observed even when PBMC were stimulated with antigens other than pollen peptides.ConclusionsIL-10 is critical for induction of specific T cell tolerance, and increased production of IL-10 by monocytes and T cells during inflammatory responses or after SIT may influence effector cells in allergy. Present data implicates that the low productivity of IL-10 by monocytes and T cells is closely related with sensitivity to multiple allergens, and resistance to allergic diseases. Augmentation of constitutive IL-10 production from immune system is a potential therapeutic approach for allergic disorders.     

Asthma,allergic sensitization and lung function in sickle cell disease

BackgroundPulmonary disease is a frequent acute and chronic manifestation in sickle cell disease (SCD), presenting high morbidity and mortality.ObjectivesTo identify the prevalence and association of asthma, allergic sensitization and altered pulmonary function in patients with SCD (SS and Sβ^o).MethodsA single-center, cross-sectional study was conducted, in which 70 patients with SCD and 44 controls, aged six to 18 years, responded to the questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC), complemented with an anamnesis regarding the associated clinical outcomes. All patients underwent immediate hypersensitivity skin tests with aeroallergens and a pulmonary function evaluation (spirometry). Regarding the statistical analysis, parametric and non-parametric methods were used, depending on the variables studied. Tests were considered significant when p < 0.05.ResultsThere was no significant difference between the patients and controls regarding the prevalence of asthma and allergic sensitization (p > 0.05). The number of occurrences of acute chest syndrome per patient per year was significantly higher for asthmatic patients than for non-asthmatic patients (p = 0.04). Obstructive pulmonary function occurred in 30.9% of the patients and in 5.4% of the controls, and restrictive pulmonary function occurred in 5.5% of the patients and 5.4% of the controls. Asthma and wheezing in the last 12 months had significant associations with obstructive pulmonary function (p = 0.014 and p = 0.027, respectively).ConclusionsThe occurrence of asthma, allergic sensitization and alteration in lung function in patients with SCD reinforces the importance of routine monitoring of these diagnoses, which allows for early treatment and prevention of the evolution of pulmonary disease in adulthood.     

Venom allergy and knowledge about anaphylaxis among beekeepers and their families

BackgroundBeekeepers and their families are at an increased risk of life-threatening anaphylaxis due to recurrent bee-sting exposures.ObjectiveThe aim of this study is to evaluate the demographic features, previous history of anaphylaxis among beekeepers and their family members, and their knowledge about the symptoms and management of anaphylaxis.MethodsA standardized questionnaire was administered to beekeepers during the 6th International Beekeeping and Pine Honey Congress held in 2018, in Mugla, Turkey. Additionally, food-service staff from restaurants were surveyed as an occupational control group about their knowledge about anaphylaxis.ResultsSixty-nine beekeepers (82.6% male, mean age 48.4 ± 12.0 years) and 52 restaurant staff (46.2% male, mean age 40.5 ± 10.0 years) completed the questionnaire. Awareness of the terms ‘anaphylaxis’ and ‘epinephrine auto-injector’ among the beekeepers were 55.1% and 30.4% and among the restaurant staff were 23.1% and 3.8%, respectively. Of the beekeepers, 74% were able to identify the potential symptoms of anaphylaxis among the given choices; 2.9% and 5.8% reported anaphylaxis related to bee-stings in themselves and in their family members, respectively. None of the restaurant staff had experienced or encountered anaphylaxis before but 3.8% of their family members had anaphylaxis and those reactions were induced by drugs.ConclusionIt is essential that implementation of focused training programs about anaphylaxis symptoms and signs as well as practical instructions of when and how to use an epinephrine auto-injector will decrease preventable morbidities and mortalities due to bee-stings in this selected high-risk population of beekeepers and their family members, as well as other fieldworkers under risk.     

Characteristics of patients with allergic rhinitis in an outpatient clinic: A retrospective study

BackgroundAllergic rhinitis affects a significant proportion of the European population. Few surveys have investigated this disorder in Greek adults. Our objective was to describe the characteristics of patients with allergic rhinitis in an adult outpatient clinic in Thessaloniki, Greece.MethodsWe studied the medical records of adult patients referred to a Clinical Immunology outpatient clinic from 2001 to 2007. The diagnostic procedure was not changed during the whole study period, including the same questionnaire used at the time of diagnosis, skin prick tests, and serum specific IgE.ResultsA total of 1851 patient files with diagnosed allergies were analysed and allergic rhinitis was confirmed in 711 subjects (38.4%). According to ARIA classification, persistent allergic rhinitis was more prevalent than intermittent (54.9% vs. 45.1%), while 60.8% of subjects suffered from moderate/severe disease. In multivariable analysis, factors associated with allergic rhinitis were age (for every 10 years increase, OR: 0.84, 95% CI: 0.77–0.91; p < 0.001); working in school environment (teachers or students) (OR: 1.46, 95% CI: 1.05–2.02; p = 0.023); parental history of respiratory allergy (OR: 2.41, 95% CI: 1.69–3.43; p < 0.001); smoking (OR: 0.71, 95% CI: 0.55–0.91; p = 0.007); presence of allergic conjunctivitis (OR: 6.16, 95% CI: 4.71–8.06; p < 0.001); and asthma (OR: 2.17, 95% CI: 1.57–3.01; p < 0.001). Analysis after multiple imputation corroborated the complete case analysis results.ConclusionsAllergic rhinitis was documented in 38.4% of studied patients and was frequently characterised by significant morbidity. Factors associated with allergic rhinitis provide insight into the epidemiology of this disorder in our region. Further studies on the general population would contribute to evaluating allergic rhinitis more comprehensively.     

Clinical characteristics and outcomes of community-onset acute pyelonephritis caused by Escherichia coli in elderly patients

PurposeTo evaluate clinical characteristics and outcomes of community-onset acute pyelonephritis (APN) caused by Escherichia coli in elderly patients.Patients/methodsCases of adult patients with community-onset APN caused by E. coli were collected from 10 referral centres in Korea from November 2006 to August 2007. Demographic, clinical and microbiological data were analysed.ResultsDiabetes mellitus (38% vs 23%, P = 0.036), chills (83% vs 66%, P = 0.015), gastrointestinal symptoms (55% vs 34%, P = 0.008), altered mental status on admission (21% vs 9%, P = 0.032), acute renal failure (17% vs 3%, P = 0.004) and concomitant bacteraemia (34% vs 17%, P = 0.015) were more frequently observed in patients aged ≥ 65 years compared with those aged < 65 years. The overall intergroup mortality rates did not differ. However, diabetes mellitus (OR = 3.54, 95% CI = 1.40–9.00, P = 0.008) and age of ≥ 65 years (OR = 2.34, 95% CI = 1.05–5.19, P = 0.037) were significantly related to a longer duration of hospital stay (≥ 5 days).ConclusionElderly patients with APN have a higher frequency of atypical manifestations, such as gastrointestinal symptoms, altered mental status and longer durations of hospital stays. Age was independently associated with longer duration of hospital stays among patients with APN. Careful diagnosis and appropriate treatment are crucial in the management of elderly patients with APN.     

Asthma prevalence,but not allergic rhinitis nor atopic dermatitis,is associated to exposure to dogs in adolescents

BackgroundExposure to pets can be a predisposing factor in the development of certain diseases, including allergic diseases.ObjectiveWe analyzed the role that exposure to indoor dogs and cats plays in the prevalence of allergic diseases.MethodsWe examined the cross-sectional data of 1056 women and 936 men aged 15 to 18 years; these individuals were selected through stratified and cluster random sampling. We asked all participants about their exposure to indoor dogs and cats during the year that preceded our study. The prevalence of allergic diseases was determined through core questions taken from The International Study of Asthma and Allergies in Childhood questionnaire.ResultsThe prevalence was 12.7% (95% CI: 11.3%–14.2%) for asthma, 9.0% (95% CI: 7.8%–10.4%) for allergic rhinitis, and 5.2% (95% CI: 4.3%–6.2%) for atopic dermatitis. The multivariate analyses showed that exposure to indoor dogs, but not indoor cats, was associated with asthma prevalence (aOR 1.37; 95% CI: 1.03–1.83), as was male sex (aOR = 1.42; 95% CI: 1.08–1.86), a personal history of allergic rhinitis (aOR = 3.24; 95% CI: 2.25–4.66), and a maternal history of asthma (aOR = 3.06; 95% CI: 1.89–4.98). The population attributable risk for exposure to indoor dogs was 18%. Notably, neither allergic rhinitis nor atopic dermatitis was found to be associated with dog or cat exposure (p >  0.05).ConclusionExposure to dogs in late adolescence is a factor associated with asthma, although its contribution to the development of asthma should be investigated in new studies.     

Efficacy and safety of specific immunotherapy with a modified mite extract

BackgroundIn specific immunotherapy (SIT), modified extracts have been used to allow safe administration of higher allergen doses. Schedules reaching maintenance doses in approximately 1 month, which may have greater efficacy, have even been proposed.AimsTo assess the safety and efficacy of SIT with modified (depigmented and polymerized) Dermatophagoides pteronyssinus extract in the treatment of allergic rhinitis.Material and methodsFifty patients with moderate-to-severe persistent allergic rhinitis and who were monosensitized to Dermatophagoides were included in this controlled, pragmatic, 1-year open study. The patients were randomly allocated to receive treatment with a Dermatophagoides pteronyssinus 100% modified allergen vaccine (active group, n = 25) or pharmacological treatment only (control group, n = 25). All SIT-related adverse reactions were recorded. Efficacy was assessed primarily through the results of nasal allergen challenges, through visual analog scale (VAS) and symptom scores.ResultsIn SIT-treated patients, significant improvements were found in symptom scores (mean reduction > 40 %), VAS scores (mean improvement > 20%) and nasal challenges (mean increase in allergen concentration threshold > 500%). For symptom and VAS scores, statistically significant differences between control and SIT-treated patients were recorded at 12 months. In nasal challenges statistically significant differences were observed as early as at 6 months. Control patients showed no significant differences during the study period.Local reactions were observed in 28 % of SIT-treated patients (total 24 reactions). There was only one immediate grade I systemic reaction, which was successfully treated with an antihistamine.ConclusionsSIT with this modified extract appears to be a relatively safe treatment, which can rapidly improve nasal allergenic tolerance, reduce symptom scores and improve subjective self-evaluation measured through VAS, reflecting a general improvement in patients’ well-being.     

Infliximab trough levels may predict sustained response to infliximab in patients with Crohn's disease

Background and aimsOver 10% of Crohn's disease (CD) patients annually lose response to infliximab. Infliximab trough levels (TL), concomitant immunosuppressants and endoscopic healing were proposed as predictors of favourable infliximab outcome. We assessed infliximab TL measured after induction therapy as predictors of sustained clinical response. Furthermore, we tried to identify other predictors of long-term benefit of infliximab therapy.MethodsWe included CD patients treated with infliximab between October 2007 and March 2010 who responded to 3-dose induction followed by maintenance therapy and in whom blood samples taken at treatment week 14 or 22 were available in blood bank. Sustained response to infliximab was defined as absence of treatment failure due to loss of response or drug intolerance.ResultsEighty four patients were included. Sustained response to infliximab was observed in 47 (56%) patients during a median follow-up of 25 months (14–37). Infliximab TL > 3 μg/ml were associated with a decreased risk of treatment failure (HR 0.34; 95% CI: 0.16–0.75), whereas the presence of antibodies against infliximab and need for corticosteroids increased this risk (HR 4.34; 95% CI: 1.51–12.5 and HR 2.49, 95% CI: 1.08–5.73, respectively). No impact of concomitant thiopurines was observed, although patients receiving thiopurines had higher infliximab TL than those without immunomodulators (5.51 vs. 0.71 μg/ml; p = 0.01).ConclusionDuring a median follow up of 2 years sustained response to infliximab was observed in slightly more than half of CD patients. Infliximab TL > 3 μg/ml at the start of maintenance regime were predicative of sustained response to infliximab.     

Prevalence of asthma and associated factors in adolescents living in Belem (Amazon region), Para,Brazil

BackgroundThe prevalence of asthma in the Brazilian Amazon region is unknown. We studied the prevalence of asthma and associated factors in adolescents (13–14 years old) living in Belem, a large urban centre in this region.Methods3725 adolescents were evaluated according to the International Study of Asthma and Allergies in Childhood (ISAAC) protocol and a random sample of them (126 asthmatics and 254 non-asthmatics) were assessed for possible risk factors by a supplementary questionnaire (ISAAC Phase II) and skin prick tests with aeroallergens. The association between asthma and associated factors was determined by logistic regression analysis.Results3708 adolescents were enrolled, 48% were male. The prevalence of asthma in the last 12 months (identified as asthmatics) and the medical diagnosis of asthma were 20.7% and 29.3%, respectively. Risk factors significantly associated with asthma were: previous diagnosis of tuberculosis (odds ratio [OR] = 38.9; 95% confidence interval [95% CI]: 4.6–328.0) and measles (OR = 4.7; 95% CI: 2.3–9.8), breastfeeding for any length of time (OR = 4.2; 95% CI: 1.1–15.2), current rhinitis (OR = 3.2; 95% CI: 1.8–5.9), exposure to smokers (OR = 2.4; 95% CI: 1.2–4.5), moisture in home (OR = 1.8; 95% CI: 1.1–3.2) and rhinitis diagnosed by physician (OR = 1.7; 95% CI: 1.2–2.9). Sensitisation to at least one aeroallergen was significantly higher among asthmatic adolescents (86.5% vs. 32.4%; p < 0.0001).ConclusionsThe prevalence of asthma was similar to that observed in other Brazilian centres. Physician-diagnosed asthma was more frequent than the presence of symptoms suggestive of asthma. Infectious diseases, nutritional and environmental factors, as well as concomitant allergic rhinitis, were the main risk factors associated with the development of asthma in these adolescents.     

Prevalence of asthma and other allergic diseases in children born after in vitro fertilisation

BackgroundChildren born after in vitro fertilisation (IVF) are under greater risk of development of some health problems than those children born after spontaneous conception. Yet it is not exactly known what the prevalence of asthma and other allergic diseases among these children is.Aims of the studyTo investigate the prevalence of asthma, allergic rhinitis and atopic dermatitis in children born after IVF, and controls born after spontaneous pregnancy using questionnaires of International Study of Asthma and Allergies in Children (ISAAC).MethodsWe recruited 158 children (mean age: 4.60 ± 2.14 years) born after IVF pregnancies and 102 children (mean age: 5.27 ± 2.8 years) as control group to investigate the prevalences of asthma, atopic dermatitis and allergic rhinitis. The questions in the questionnaire were asked to the parents by telephone or face to face.ResultsWheezing ever has been reported in 19 % of the children born after IVF and in 17.6 % of the control group (p > 0.05). No significant differences were found between groups, in terms of use of any anti-asthma drugs, physician diagnosed asthma and admission to emergency room with wheezing (p > 0.05). In addition, prevalence of allergic rhinitis and atopic dermatitis were also comparable between two groups (p > 0.05).ConclusionsPrevalences of asthma, allergic rhinitis and atopic dermatitis are similar in children born after IVF and children born after spontaneous conception.     

Chronic pancreatitis: Report from a multicenter Italian survey (PanCroInfAISP) on 893 patients

BackgroundNo data on chronic pancreatitis in Italy are available yet.AimTo evaluate demographic, clinical, diagnostic and therapeutic aspects in patients suffering from chronic pancreatitis.Patients and methodsEligible patients were prospectively enrolled from 2000 to 2005. Information concerning demographic data, lifestyle risk factors, family and clinical history, associated factors (alcohol, autoimmunity, cystic dystrophy of the duodenal wall, obstruction, genetic mutations) concomitant diseases, diagnostic findings, and pharmacological, endoscopic and surgical therapy were gathered.Results893 patients (74% males, mean age 53.7 ± 15.2 years) were evaluated. 519/859 patients (60%) were drinkers and 555/840 (66%) were smokers. A strong positive correlation between drinking and cigarette consumption (R = 0.53; p < 0.0001) was found. Heavy alcohol consumption (>80 g of alcohol/day for more than 5 years) was considered the most important risk factor in 300 patients (34%), obstruction in 238 (27%), alcohol and obstruction in 82 (9%), autoimmunity in 34 (4%), cystic dystrophy of the duodenal wall/groove pancreatitis in 55 (6%), gene mutations in 36 (4%), and none (idiopathic) in 148 (17%). Bile stones were diagnosed in 287 patients (33%) and cholecystectomy was performed in 329 patients (38%). Pancreatic calcifications were diagnosed in 547/879 patients (62%). Pancreatic surgery was performed in 273 patients (31%). Endoscopic sphincterotomy was performed in 371 patients (42%). Exocrine and endocrine insufficiency were found, respectively, in 373/834 (45%) and 275/885 patients (31%).ConclusionsAn unexpected low frequency of alcohol abuse and new emerging associated risk factors for chronic pancreatitis were observed in Italy.     

Geoepidemiology,clinical manifestations and outcome of primary biliary cholangitis in Greece

Background & aimsPrimary biliary cholangitis (PBC) is a disease with rising prevalence and considerable geographical variation. To describe the prevalence, spatial and time distribution, baseline characteristics, response to treatment, outcome and the validity of GLOBE score in a large cohort of Greek PBC patients as an independent validation of this score has not been done so far.MethodsThe last 16 years, 482 PBC patients (86.5% females) were evaluated and analysed retrospectively, using a prospectively collected database. Special attention was paid to the assessment of treatment response according to GLOBE score.ResultsAge at initial evaluation was 56.3 ± 13.7 years. Among 432 Thessaly residents, prevalence was 582/million (non-homogeneous distribution). Nineteen districts showed a prevalence > 800/million. Symptomatic disease onset could be identified in 91 patients, with a significant peak during spring (P = 0.03). At diagnosis, 43.6% were asymptomatic and 16.2% cirrhotic. Male sex (P = 0.02), older age (P < 0.001), alcohol consumption (P < 0.01) and concomitant liver disease (P < 0.001) were negative prognostic factors for cirrhosis. During a median [interquartile range, range] follow-up of 5.1 (7.8, 15.7) years, 62 patients died or underwent liver transplantation. Patients with GLOBE score > 0.30 had significantly worse prognosis (P < 0.001) with 5-, 10-, and 15-year survival rates of 84%, 50% and 42%.ConclusionsThere is increased PBC prevalence in Thessaly with remarkable geographic clustering and seasonal variability. PBC is diagnosed at early stages although males had a more advanced disease. GLOBE score applies perfectly in Greek patients and this will likely help detecting patients that may benefit from new therapies.     

Study of the impact of viral load of hepatitis C on patients with concomitant psoriasis vulgaris

Background and study aimConcomitant hepatitis C virus (HCV) infection and psoriasis vulgaris (PV) are not uncommon coexisting diseases, especially in areas with high viral hepatitis endemicity. To date, data about the interaction between both diseases are scarce. Therefore, we aimed to describe the possible interplay between the HCV viral load and psoriatic activity in concomitant Egyptian diseased patients.Patients and methodsBetween December 2011 and August 2013, all psoriatic patients attending Assiut University Hospital outpatient clinics were tested for HCV serologic assay. Patients with positively coexisting diseases were further reevaluated for psoriasis area severity index (PASI) score assessment, liver function tests, HCV-RNA-polymerase chain reaction (PCR) assays, and sonographic examination of the liver. For comparative purposes, another matched group (n = 26) with psoriasis only (HCV-negative group) was enrolled as a control.ResultsDuring the period of the study, 20 patients with concomitant PV and HCV infection (HCV-positive group; 50% males, mean age of 44.15 ± 10.66 years) were recruited. The mean PASI score was 44.75 ± 10.38 and clinical signs of liver dysfunction were observed in 40% (n = 8), 100% had abnormal liver function tests (n = 20), and 75% had sonographic findings of cirrhosis (n = 15). The PASI score was significantly higher in the HCV-positive psoriatic group compared to the HCV-negative control (p < 0.001). Significant correlations were detected between the PASI score and the viral loads, and also with alanine aminotransferase (ALT).ConclusionWhen HCV was found concomitantly with PV, a high possibility of severe disease pattern will be expected that entails special precautions in the treatment process.     

The contribution of clinical and pathological predisposing factors to severe gastro-duodenal lesions in patients with long-term low-dose aspirin and proton pump inhibitor therapy

BackgroundPreventive strategies developed to avoid the complications of antiplatelet therapies recommend the evaluation of risk factors for gastrointestinal events and indicated gastroprotective strategies.AimWe aimed to assess the impact of predisposing factors - histological findings, concomitant drug consumption, comorbidities, symptoms, social habits, Helicobacter pylori infection - on severe gastro-duodenal lesions in patients with low-dose aspirin and concomitant protective therapy with proton pump inhibitors (PPI).MethodWe enrolled 237 patients with LDA and PPI therapy, referred for upper digestive endoscopy, divided into two groups according to the severity of their endoscopic lesions (172 patients with no or mild endoscopic lesions and 65 patients with severe endoscopic lesions).ResultsIn the univariate logistic regression model, the factors associated with severe gastro-duodenal lesions were gender (OR = 1.87, 95% CI: 1.04–3.41), anticoagulants (OR = 2.40, 95% CI: 1.26–4.53), gastric atrophy and/or intestinal metaplasia (OR = 1.85, 95% CI: 1.04–3.32), congestive heart failure (OR = 2.59, 95% CI: 1.16–6.62), anaemia (OR = 3.01, 95% CI: 1.67–5.47) and smoking (OR = 4.29, 95% CI: 1.57–12.32). In the final model, anticoagulants (p = 0.041 < 0.05) and anaemia (p = 0.019 < 0.05) were risk factors for severe lesions via multivariate regression analysis, while for active/inactive chronic gastritis and smoking a positive dependency with a tendency towards statistical significance (p < 0.10) was noticed for severe gastric lesions.ConclusionsIn patients treated with low-dose aspirin and gastroprotective therapy with proton pump inhibitors we have enough evidence to consider co-treatment with anticoagulants and anaemia important predictors for severe endoscopic lesions, while other factors such as inflammation in gastric biopsies, congestive heart failure, co-treatment with clopidogrel and smoking tended to have a positive influence on risk for severe gastro-duodenal lesions.     

Therapeutic Evaluation of Outpatient Submucosal Inferior Turbinate Surgery for Patients with Severe Allergic Rhinitis

BackgroundSurgical treatment for inferior turbinate (IT) is selected to treat severe allergic rhinitis (AR) that is unresponsive to conservative treatment. This study aimed to determine the clinical effects of outpatient sub- mucosal IT surgery (OSITS) on patients with severe AR.MethodsBetween January 2008 and August 2012, 95 patients with severe AR who underwent OSITS at the Department of Otolaryngology, Hyogo College of Medicine, were retrospectively analyzed. There were 53 men and 42 women. Their mean age was 27 years (11–75 years). OSITS was bilaterally performed using a bipolar radiofrequency electrocautery under local anesthesia. Symptoms, QOL, and physical findings were evaluated using scores from both pre- and postoperative periods (average: 12.4 months), according to Practical Guideline for the Management of AR in Japan 2009.ResultsIn perennial AR, all mean scores of nasal symptoms, QOL, and physical findings significantly improved after OSITS (p < 0.05, n = 83). Nasal obstruction, sleep problems, and IT congestion were the most strongly affected. Eye symptoms were not influenced by OSITS. OSITS also showed significant effects on nasal obstruction and IT congestion in seasonal AR (p < 0.05, n = 12), but not sneezing, nasal discharge, and QOL. In terms of the efficacy, OSITS was beneficial in 90% of perennial AR cases and 75% of seasonal AR cases. Epistaxis (1%), vestibulitis (1%), and IT atrophy (4%) were observed after OSITS.ConclusionsThese data indicate that OSITS using radiofrequency electrocautery could be a beneficial therapeutic option in patients with severe AR.