Nasal response to a single antigen challenge in patients with allergic rhinitis — inflammatory cell recruitment persists up to 48 hours

BACKGROUND: Allergen challenge in some patients with respiratory allergy is followed by an early and a late reaction. OBJECTIVE: To evaluate the duration of mediator release and inflammatory cell recruitment during the late antigen-induced nasal response. METHODS: Eight patients with seasonal allergic rhinitis due to grass pollen underwent local challenge with the relevant allergen, a non-relevant allergen (Parietaria judaica), and nebulized saline solution. Nasal lavages were performed at baseline and 6, 24, 48, 72 h after challenge. Eosinophil cationic protein (ECP), leukotriene C4 (LTC4), leukotriene B4 (LTB4) myeloperoxidase (MPO) and prostaglandin D2 (PGD2) levels were radioimmunoassayed and histamine concentration was measured by an automated fluorometric method. RESULTS: Nasal challenge with the relevant antigen induced a response 6 h after stimulation, which subsided within 24 h. Eosinophilia, observed in the nasal lavages collected from 6 to 24 h after this challenge, was accompanied by ECP release. Neutrophilia were found in the nasal lavages collected from 6 to 24 h after challenge. The increase in neutrophil number correlated with MPO levels and LTB4 concentrations, but not with the intensity of nasal obstruction. Antigen challenge also induced significant recruitment of mononuclear cells 48 h after provocation. The challenge significantly raised histamine, but not PGD2, levels in the nasal lavages collected 6 h after provocation. A trend towards an increase in LTC4 levels in the nasal lavages collected 6 h after specific antigen challenge was also found. Nasal challenge with a non-relevant allergen or with saline solution did not cause either inflammatory cell recruitment or mediator release. CONCLUSION: Nasal challenge with the relevant antigen can induce a late response characterized by local accumulation of eosinophils, neutrophils and mononuclear cells persisting for 48 h and accompanied by release of ECP, MPO, LTB4 and histamine. These results indicate that a single antigen challenge in patients with allergic rhinitis causes prolonged inflammatory alterations which may contribute to the development of airway hyperreactivity.     

Sexual lifestyles in injecting drug users in Italy: potential for HIV infection transmission

To better target efforts aimed at modifying sexual behaviour among injecting drug users (IDUs), we conducted a detailed analysis of sexual partners and practices reported by 1214 Italian heterosexual drug users during the period June 1985–June 1987. Females were more likely to have only drug-using partners (42.8% vs 17.1%), while males were more likely to have only non drug-using partners (50.5% vs 21.4%). Female drug users were more likely to report either one partner or >10 partners, while males were more likely to report 2–10 partners. Nearly 90% of women with only drug-using partners had only one partner. Overall, 29% of women with only non drug-using partners reported that they always used condoms. This proportion increased to 65% among women with >10 non drug-using partners. In Italy, male IDUs may play a greater role than female IDUs in sexual transmission of HIV infection to the heterosexual non drug-using partners.     

A communicable disease network in Italy: Results from a pilot study

Communicable disease surveillance systems do not always provideaccurate or timely data. Furthermore, in Italy, data entry andmanagement are only performed centrally, making the completionof missing data and an improvement in the quality of data difficultto realize. To improve this system, the Istituto Superiore diSanita conducted a pilot trial in the region of Tuscany. Thetrial consisted of creating a network of persons responsiblefor surveillance in the region, conducting training coursesin surveillance and implementing an ad hoc computerized systemfor the management, transmission and rapid analysis of notifications.Standardized notification forms were computerized with Epilnfo5.0 software with quality control programmes. The system alsoprovided printouts with individual and aggregated case reportforms. The data were transmitted using an existing nationalnetwork. A set of standard tables was included in the monthlyregional epidemiologic bulletin for information feedback tothe local health staff. Following its implementation, the percentageof notified cases with errors in the diagnostic criteria reportedfor case definitions decreased from 2.8 (95% Cl: 0.8–4.8)to 0.15% and individual data were centrally available on magneticsupport two months after the notification date (compared to3–4 years delay previously). We also witnessed an overallimprovement in the timeliness and quality of routine notification.To create an effective national disease surveillance network,it would be beneficial to extend the system described in thispilot trial to all regions of Italy.