Intestinal permeability, atopic eczema and oral disodium cromoglycate.

A dual sugar (lactulose-mannitol) absorption test was performed in 19 patients with atopic eczema before and after a 21 day elimination-diet. Moreover L/M test was carried out in 20 controls. The mean value of lactulose-mannitol urinary ratio (L/M) was 0.015 (+/- 0.018 SD) in the group of patients and 0.012 (+/- 0.011 SD) in the control group (p = 0.49). The mean clinical score improved significantly after elimination diet (41,6 +/- 12.9 SD before the diet, 21.7 +/- 10.4 SD after the diet, p less than 0.001) but no significant modification of intestinal permeability was recorded (L/M = 0.015 +/- 0.018 SD before the diet and 0.21 +/- 0.022 SD after the diet, p = 0.38). Using a double blind approach we were not able to demonstrate any significant effect of disodium cromoglycate on the clinical score and intestinal permeability. The connections between food allergy, intestinal permeability and atopic dermatitis have not been understood, but disodium cromoglycate doesn't seem to play a significant role in the treatment of atopic dermatitis nor in the modification of intestinal permeability.

The effect of bacterial infection in the worsening of atopic dermatitis: correlations with humoral immunologic patterns.

The contribution of secondary infection to severity and tendency to relapse in atopic dermatitis during childhood has been assessed. A total of 57 children aged between 4 months and 14 years were followed for an average of 4.73 months. A secondary infection was diagnosed in 22 (31.4%) of 70 relapses, since the lesions only subsided with antibiotics active on the bacteria isolated from the skin, usually a coagulase-positive Staphylococcus aureus. The eczema was more severe at presentation and hypogammaglobulinemia G more often found in those children who were more susceptible to secondary infections. The hypogammaglobulinemia G was present in 13 out of the 57 patients, but it normalized with age and was not correlated with IgE levels. In the children in whom the relapse or the worsening of the eczema could be attributed to secondary infection because of the positive response to the antibiotic treatment, the lesions had the appearance of pustules or showed more exudation, although in some cases only the worsening of the erythema and itching was observed. A secondary bacterial infection should be considered a likely cause of relapse or worsening of atopic dermatitis. Furthermore it may be that, at least in first year of life, hypogammaglobulinemia G is part of an immunologic impairment of atopic dermatitis which favors the susceptibility to secondary infections.

[Anti-alpha-gliadin antibodies. Sensitivity, specificity and correlation with blood xylose test in the 3 diagnostic stages of celiac disease in children]. / Anticorpi antialfagliadina. Sensibilità, specificità e correlazione con la xilosemia da carico nelle tre fasi diagnostiche della malattia celiaca nel bambino.

The specificity and sensibility of IgA and IgG alfagliadin antibody test (AaGA) for screening, diagnosis and follow-up of childhood coeliac disease has been evaluated. We have compared AaGA test to D-xylose blood test and at last we have examined the false positive and negative results given by the test. Two groups of subjects were considered: 1) 90 children with untreated coeliac disease (21 newly diagnosed (I stage), 50 in gluten withdrawal (II stage), 19 in challenge (III stage); 2) 255 disease controls including: 157 healthy controls; 31 children with gastroenterological disorders other than coeliac disease; 31 children with food allergy and atopic dermatitis; 36 children with "constitutional" short stature (without GH deficiency and with normal intestinal mucosa). The sensibility of AaGA test in the first stage of coeliac disease has been of 95.2% for the IgG class antibody and 90.4% for the IgA class; on the other hand the showed a specificity of 83.6% for IgG class antibody and 96.9% for IgA class. In only two newly diagnosed coeliac children we have found false negative results: in the first case the patient was IgA-deficient, in the second the age was above 3 years. AaGA IgA resulted positive only in the 12.9% of the group of gastroenterological and atopic controls; particularly most cases were affected by multiple food allergies and two patients by chronic autoimmune disease of small intestine.(ABSTRACT TRUNCATED AT 250 WORDS)

[Diagnosis of allergy to cow's milk proteins]. / Diagnosi di allergia alle proteine del latte vaccino (APLV).

The diagnosis of cow's milk proteins allergy can only be established if the symptoms disappear with an elimination diet and if a later controlled challenge leads either to a recurrence of symptoms or to some other clearly identified changes. At the moment there is not a specific immunological test surely effective in all cases. Anyway the three Gooldmann's tests are not necessary. In fact a single challenge with a cow's milk meal will be sufficient when clinical observation is accompanied by monitoring some simple laboratory tests (serum and nasal eosinophils, steathorrea, coproleucocytes, hemoccult, xylosemia and leucocytes PMN). The challenge must be tested in a double-blind trial only in patients with non specific symptoms (such as tension fatigue syndrome, hyperactivity, ecc...). The double-blind challenge is not necessary generally for the diagnosis of cow's milk proteins allergy in childhood, because at this time of life not only the symptoms are very clear (diarrhea, vomiting, skin symptoms) but also there is a prevalence of non reaginic reactions: this kind of reactions are usually delayed and they generally occur after a relatively high dose of food allergens. In the group of patients with specific anti-cow's milk IgE (RAST and prick tests) and severe reactions (anaphylaxis), the challenge is not necessary to confirm the diagnosis, but is usefully to verify the acquired tolerance, generally after the first year of life.

[Therapy of intolerance and allergy to cow's milk proteins]. / Terapia dell'intolleranza e allergia alle proteine del latte vaccino.

The authors report the main acquisitions from literature and their own experience concerning therapy of intolerance and allergy to cow's milk proteins, particularly referring to clinical gastrointestinal features. These points have been underlined: elimination diet is the most important step in therapy, even if intolerances to new aliments frequently arise (30% of cases), either when soy milk or hydrolysate formulas are used; pharmacologic agents inhibiting mediator release from the mast-cells thereby reducing gut permeability to macro-molecules (such as disodium cromoglycate) can be used as a "support" for a short period of time, but the drug can not replace the diet in the therapy; anyway, even if milk allergy may last for a long time, it is useful to test the possible acquired tolerance, beginning from the first year of life.

Intravenous immunoglobulin in immune neutropenia.

Three patients with immune neutropenia successfully treated with high dose intravenous IgG (IV IgG) are described. In the first case, the neutropenia had not responded to standard steroid therapy; in the second case, very high doses of steroids were required in order to obtain and maintain remission. In the last case, the steroids were contraindicated because of an underlying immunologic disorder. We suggest that these 3 forms of immune neutropenia might be a good indication for IV IgG treatment.