Visual-spatial training in patients with sub-acute stroke without neglect: a randomized, single-blind controlled trial.

Many people who have suffered a stroke will experience sensorimotor impairments that disrupt their performance of motor skills, including balance and gait. Furthermore, stroke-induced brain damage can Result in visual disorders that may significantly impact performance of normal daily activities. The primary aim of this study was to investigate the effects, on balance, of visual-spatial training as an add-on intervention to conventional neurorehabilitation in patients with subacute stroke without neglect; secondarily, it aimed to assess the effects of this training on activities of daily living. Thirty inpatients (17 M, age: 57.3±12.9 years) with a diagnosis of subacute stroke (< 180 days) were enrolled in this study and randomized into two groups: the visual-spatial training group and a control group. All patients were evaluated, using the Tinetti Balance and Gait Scale (TBG), the Berg Balance Scale, computerized posturography, and the Barthel Index (BI), both before (T0) and after (T1) four weeks of training sessions. In addition to conventional neurorehabilitation, each group performed a total of twelve 20-minute rehabilitation sessions (3 times/week for 4 weeks). Significant TIME x GROUP interactions were recorded in the experimental group with respect to the control group for the TBG score [F (1,18) =15.59; p = 0.0004] and BI score [F (1,28) =6.35; p = 0.01]. Both groups recorded non-significant improvements on the instrumental postural assessment. These data suggest that visualspatial training as an add-on intervention to conventional neurorehabilitation could be an effective complementary strategy to improve balance and activities of daily living.

Epinephrine autoinjector prescription in food-allergic adults: symptom-based only or allergen-based also? An Italian multi-centre study.

BACKGROUND: Epinephrine is the treatment of choice for acute food-allergic reactions but existing guidelines state that it should be prescribed uniquely to patients who already experienced at least one food-induced anaphylactic episode. OBJECTIVE: We investigated whether in Italy epinephrine auto-injector is prescribed uniquely following the existing guidelines only, or is allergen-informed as well (i.e., based on the potential risk associated with sensitization to certain food allergens), and hence preventive. METHODS: 1110 adult patients (mean age 31 years; M/F 391/719) with food allergy seen at 19 allergy outpatient clinics were studied. Patients with a history of probable anaphylaxis were identified. Subjects were classified as having primary (type 1) and/or secondary (type 2) food allergy and were divided into several subgroups based on the offending allergen/food. Epinephrine prescriptions were recorded and analyzed both as a whole and by sensitizing allergen. RESULTS: Epinephrine was prescribed to 138/1100 (13%) patients with a significant difference between subjects with type-1 and type-2 food allergy (132/522 [25%] vs. 6/629 [1%]; p < 0.001). The epinephrine group included most patients with a history of anaphylaxis (55/62 [89%]) or emergency department visits 106/138 (77%). In some specific subsets, namely fish-, tree nuts-, and lipid trasfer protein (LTP)-allergic patients, epinephrine was prescribed to patients without a history of systemic allergic reactions. CONCLUSIONS: Italian allergy specialists prescribe epinephrine auto-injectors both on the basis of clinical history of severe reactions and on a critical analysis of the hazard associated with the relevant protein allergens, which suggests a good knowledge of allergens as well as acquaintance with the guidelines for prescription of emergency medication.

Causes of food-induced anaphylaxis in Italian adults: a multi-centre study.

BACKGROUND: Data about food-induced anaphylaxis in Italy are missing. OBJECTIVE: It was the aim of this study to detect the main foods/food allergens causing anaphylaxis in Italy. METHODS: The frequency of anaphylaxis and the relative importance of many offending foods were assessed in 1,110 adult patients with food allergy diagnosed by common criteria at 19 allergy centres scattered throughout Italy from 1 January to 31 December 2007. RESULTS: Fifty-eight of 1,110 (5%) food-allergic patients experienced at least 1 episode of anaphylaxis. On average, they were older than other food-allergic patients (34 vs. 31 years; p < 0.05). The majority of anaphylactic episodes occurred in patients sensitized to lipid transfer protein (LTP; n = 19), followed by shrimp (n = 10), tree nuts (n = 9), legumes other than peanut (n = 4), and seeds (n = 2); peanut, spinach, celery, buckwheat, wheat, avocado, tomato, fish, meat, and Anisakis caused an anaphylactic reaction in single patients. Among LTP-hypersensitive patients, peach caused 13/19 anaphylactic episodes. Shrimp-allergic patients were significantly older than other patients with food-induced anaphylaxis (p < 0.05), whereas patients allergic to LTP experienced their anaphylactic episodes at a younger age (p < 0.001). The frequency of anaphylaxis among patients sensitized to LTP, shrimp or tree nuts did not differ between northern and central/southern Italy. CONCLUSION: LTP is the most important allergen causing food-induced anaphylaxis in Italy, peach being the most frequently offending food. Peanut-induced anaphylaxis seems very uncommon. Geographic and environmental differences both between Italy and other countries and within Italy seem to play a relevant role in the pattern of sensitization to foods.

EpidemAAITO: features of food allergy in Italian adults attending allergy clinics: a multi-centre study.

BACKGROUND: Studies of the prevalence of different types of food allergy in adults are lacking. OBJECTIVE: To define the prevalence of IgE-mediated food allergies in Italian adults attending allergy clinics and to assess possible differences associated with geographical position and/or dietary habits. METHODS: Seventeen allergy outpatient clinics scattered throughout Italy participated to a multi-centre study in 2007. The number of atopic subjects and of food allergic patients along with clinical features were recorded by pre-defined criteria. Patients with unequivocal history of food allergy confirmed by positive skin prick test were included as cases. RESULTS: Twenty five thousand six hundred and one subjects were screened; 12,739 (50%) were atopic, and 1079 (8,5%) had IgE-mediated food allergy. Sixty four percent of patients were females. Overall, the most frequent food allergy was the pollen-food allergy syndrome (55%), which was associated with oral allergy syndrome in 95% of cases and whose frequency decreased southbound. Forty-five percent of patients had a type 1 food allergy, in most cases (72%) caused by fruits and vegetables, and generally associated with a history of systemic symptoms. Type 1 food allergies represented 96% of food allergies in the South. Lipid transfer protein (LTP) accounted for 60% of sensitizations and caused most primary food allergies in all areas. CONCLUSION: Plant-derived foods cause most food allergies in Italian adults. The pollen-food allergy syndrome is the most frequent type of food allergy followed by allergy to LTP whose frequency increases southbound. The pattern of allergy to certain foods is clearly influenced by specific geographic features such as pollen exposure and dietary habits.

Exacerbation of asthma related to Eucalyptus pollens and to herb infusion containing Eucalyptus.

Eucalyptus is known as a potential cause of cutaneous diseases due to contact with oil or pollens, and of respiratory allergic diseases due to exposure to pollens. We report the case of a 30-year-old woman with asthma and rhinoconjunctivitis in which symptoms appeared to be exacerbated by Eucalyptus pollens and by ingestion of an infusion containing Eucalyptus. Specific IgE were positive for Eucalyptus pollens and negative for common aeroallergens. Our report shows that Eucalyptus may elicit asthma and rhinitis with an IgE-mediated mechanism both by inhalation of pollens and by ingestion of herb infusions, and suggests that care should be taken in administering herbal medications in asthmatic subjects.