Multiple pulmonary nodules and unexplained fever: when the pulmonologist fails.

We describe herein a difficult case of persistent and refractory fever, associated with multiple lung nodules, progressive respiratory failure and general deterioration. Our patient was carefully investigated for the possible causes of his symptoms, using current and advanced diagnostic procedures, either serological or by imaging. The confirmatory diagnosis of anaplastic T-cell lymphoma, was obtained only after an invasive procedure (with severe pneumothorax), although it was too late. This suggests that also very rare diseases should be considered in the presence of unexplained signs/symptoms, and that in such cases, aggressive diagnostic procedures should be applied as early as possible.

Cetirizine-induced downregulation of airway fibroblast proliferation and function: a rationale for a different approach to allergy treatment?

Recently, airway fibroblasts captured the attention of both allergists and basic scientists since they are no longer considered as mere bystanders, as far as allergic airway diseases are concerned. The aim of the present study was to assess the effects of different Cetirizine (Cet) concentrations (0.01, 0.05, 0.1 mg/ml) on human airway fibroblast proliferation and on CD54 expression. By means of flow cytometry analysis, we evaluated CD54 expression by airway fibroblasts in basal conditions or after gammaIFN stimulation in the presence of Cetirizine; we also evaluated the effect of the drug on cell proliferation by a [3H]thymidine incorporation assay. All of the tested doses of Cetirizine were able to significantly reduce CD54 upregulation induced by gammaIFN; concerning the fibroblast proliferation, we observed a dose-dependent inhibition of [3H]thymidine incorporation. These results show that Cetirizine exerts a biologic effect directly on human airway fibroblasts, suggesting a new rationale in the use of this compound.

Quantitative flow cytometric analysis of the effects of cetirizine on the expression of ICAM-1/CD54 on primary cultured nasal cells.

An in vitro flow cytometric model has been developed to evaluate the effects of antiallergic drugs such as cetirizine (CTZ) on the expression of surface molecules on primary cultured normal cells. Quantitative analysis demonstrated that HLA class I and ICAM-1/CD54 molecules are present on both epithelial and stromal cells, and that their expression is strongly enhanced by treatment with interferon-gamma (IFN-gamma). Nevertheless, the IFN-gamma-mediated upregulation of ICAM-1/CD54 was inhibited by treatment with CTZ, demonstrating a direct effect on both cell types. This finding is particularly interesting because ICAM-1/CD54 is the main rhinovirus receptor, and rhinoviruses are the principal cause of asthma exacerbation in children. Thus, according to data derived from this in vitro model, CTZ should have an important role in the reduction of infectious exacerbation of asthma in atopic patients.

Oral and sublingual immunotherapy: general aspects and critical considerations.

Local routes for immunotherapy (IT) such as oral (OIT) and sublingual (SLIT) have the primary aim of avoiding or minimizing the risk of adverse events and of improving the compliance of the patients with IT itself. About the possible mechanisms of action, only few information are available since local IT has been deeply studied only in the last ten years. The current data about pharmacokinetics are controversial and not conclusive, since they are mostly derived from animal models. However, very recent studies have demonstrated that the sublingual/swallow modality is the most promising way of mucosal immunotherapy. Thus, SLIT could be shown to lead to systemic immunological effects and to a decreased responsiveness of target organs. Furthermore, no severe adverse events were reported in the SLIT-studies. Some studies indicate that SLIT is as effective as subcutaneous IT, whilst OIT is not recommended for the clinical practice. SLIT would appear particularly suitable for pediatric patients. Administration schedules include a build-up phase and a maintenance phase which can be administered either preseasonally or continuously, and rush schedules for preseasonal IT are also available. Furthermore, SLIT reduces time and money expenses usually required by SIT since it is self-administered.

Aeropollinic sampling at three different heights by personal volumetric collector (Partrap FA 52).

BACKGROUND: Aeropollinic sampling is usually performed by volumetric pollen traps located on the top of buildings at a height of 15-20 m. The present study aimed to determine whether pollen concentration is similar, at the same time, at different heights. METHODS: Pollen concentrations were measured at the same time for 3 days each month (March-October 1997), with three Partrap FA 52 devices respectively located at 1.5, 5, and 15 m above the ground. A Burkard sampler was used as control at the 15-m level. RESULTS: No significant difference in either the total count or the single pollen counts was observed between the Partrap and Burkard samplers at 15 m. The total pollen count did not differ significantly between the Partrap at 1.5 m and 15 m (130+/-19 and 123+/-18, respectively), whereas the sampler at 5 m collected an amount of pollen (84+/-14) significantly lower than at 1.5 and 15 m (P<0.0001 and P<0.001, respectively). The amount of Urticaceae pollen was significantly higher at 1.5 m (97+/-17) than at 15m (80+/-12) and 5m (58+/-11); P<0.02 and P<0.001, respectively. Regarding grass pollen, the collector at 5 m captured significantly less pollen (4.5+/-0.8) than at 1.5m (9.5+/-1.3) and 15m (7.2+/-1.3) (P=0.002 and P=0.02, respectively). No significant difference was observed between the data obtained from samplers at 1.5 and 15 m. In addition, the Oleaceae, Cupressaceae, and Corylaceae pollen counts were significantly higher when collected at 15 than at 5 and 1.5 m. CONCLUSIONS: These data show that differences exist in pollen sampling performed at different heights.

Aerobiologic particle sampling by a new personal collector (Partrap FA52) in comparison to the Hirst (Burkard) sampler.

A new personal portable sampler of biologic particles (Partrap FA52, Coppa, Biella, Italy) was used for pollen sampling in comparison with Hirst's (Burkard) fixed device. The aerobiologic samplings were carried out simultaneously outdoors with the two devices coupled on the same axis, during the daytime of 10 dry, nonconsecutive spring days. The total amount and the percentages of the pollens most often trapped by the two collectors were compared by Student's t-test for paired samples. The Partrap FA52 showed a highly significant efficacy, quite comparable to that of the Burkard device, in pollen trapping for both the total number (P < 0.0001) and the percentages of Parietaria (P < 0.0001), pine (P < 0.002), and grass (P < 0.0001) pollens. Therefore, Partrap FA52 proved to be highly effective in obtaining quantitative and qualitative aerobiologic samples in comparison with the commonly used fixed samplers.

Continuous versus on demand treatment with cetirizine for allergic rhinitis.

BACKGROUND: Cetirizine is an antihistamine used in the treatment of allergic rhinoconjunctivitis, that has antiallergic activity. OBJECTIVE: The aim of this double-blind, placebo-controlled, parallel group study was to evaluate the clinical efficacy and the antiallergic activity of cetirizine, administered either continuously or on demand over a 4-week period of natural allergen exposure. METHODS: Twenty patients, with allergic rhinoconjunctivitis due to grass and/or Parietaria pollen, were enrolled. They were randomized into 2 parallel groups: one group received the standard dose of 10 mg cetirizine daily and the other received placebo, all patients were allowed to take an additional daily dose of cetirizine when needed. Variables evaluated were clinical symptoms (recorded on diary cards), number of additional on demand cetirizine doses, nasal inflammatory cells, and pollen counts. RESULTS: The results of the present study show that patients treated with continuous administration of cetirizine achieved significant symptomatic relief and inflammatory control (decreases in numbers of infiltrating neutrophils and eosinophils) in comparison to patients treated on demand. CONCLUSION: Continuous treatment with cetirizine is more effective than on demand treatment. Continuous treatment reduces clinical and inflammatory variables more than symptomatic treatment and the on demand therapy can determine acceptable clinical control, but does not reduce allergic inflammation.