Pulmonary microlithiasis. Report of two cases.

Pulmonary alveolar microlithiasis (PAM) is a rare disease characterized by widespread localization of calcispherites in the alveolar spaces. The patients are symptomless for a long time. Nevertheless, this disease slowly develops into pulmonary fibrosis and cardiac failure. The chest X-rays and high-resolution computed tomography strongly point towards a diagnosis of PAM. As for therapeutic approaches, repeated broncho-alveolar lavages (BAL) have been performed with improvement of symptoms but without recovery, and a new oral drug treatment is still under way. We report 2 familial cases of PAM. Both patients underwent chest X-ray examination showing diffuse bilateral micronodular opacities of calcific density. After 5 years, in May 1993, one of them developed exertional dyspnoea, cyanosis, dry cough and was admitted to our Division. Cardiokinetic and diuretic drugs as well as oxygen were administered with satisfactory results. Then repeated BAL were performed. The chest X-ray after 6 months of sodium etidronate (300 mg t.i.d.) administration was unchanged.

Respiratory allergy to parietaria pollen in 348 subjects.

We have revisited 348 records of allergic outpatients to Parietaria, ratio M/F 1:1 and mean age 29.46 +/- 12.49 yrs. 97 of them were skin positive to Parietaria only (A-group: M/F 37/60); 251 patients were skin positive also to other allergens (B-group: M/F 137/114). Mean age of A-group patients (35.41 +/- 12.91) was higher than B-group (27.16 +/- 11.54; p < 001). Dividing mono and polysensitized subjects by age decade, a different distribution was found between the two groups (p < 001): monosensitized patients showed an increasing number of subjects from the 3rd to the 4th decade and a decreasing trend in the following decades; polysensitized patients showed a prevalence in age < 20 yrs and a decreasing trend in the other decades. In B-group Gramineae were the most frequent allergens associated to Parietaria (84.8%) followed by Olea Europaea (41.1%), Dermatophagoides farinae (37.4%) and Dermatophagoides pteronyssinus (36.2%). Main symptoms were rhinoconjunctivitis (187 cases), rhinitis + asthma (141 cases) and bronchial asthma (20 cases). Comparing the clinical features of the two groups, we have found that monosensitized patients showed a female prevalence, a prevalence of rhinitis with late onset of symptoms while in patients suffering from isolated asthma the onset was early.

Prick and intradermal tests compared with specific IgE in allergic assessment.

Allergic assessment in symptomatic patients often requires more tests and they can be conflicting. Sixty outpatients, suffering from seasonal or periannal respiratory symptoms, underwent prick tests, intradermal reactions and specific IgE (IgEs) determination by enzime immunoassay for eight common allergens; in addition total IgE were measured. At the end of the study 512 tests were performed. Total serum IgE levels had no significance in the results. There was a statistically different behaviour among three methods; a positive or negative concordance was found in 64.1% of tests whereas in the others (35.9%) results were conflicting. In particular it was seen that a prick test positive was confirmed by intradermal reaction and a test prick and intradermal negative was not probably confirmed by IgEs. Serum specific IgE levels were higher in subjects prick and intradermal positive than in prick negative and intradermal or IgEs positive subjects. Intradermal reactions were found positive especially in mites and often they were not confirmed by prick or IgEs. So prick test is always the routine test; intradermal test ought to be used if there were prick tests negative and patient's history positive. If prick and intradermal test were found negative it is plausible that the measurement of specific IgE will be negative circumscribing even more the number of individuals where determination of serum specific antibody is necessary.

Allergic skin tests and respiratory diseases in 1612 subjects.

In 1985-90, 1612 subjects were submitted to allergic tests for respiratory diseases. In a retrospective survey we have evaluated clinical features, symptoms, diagnostic procedure and allergic tests of skin positives and skin negatives. Prick tests were supplemented by intradermal reaction and RAST under guideline of history. Allergens examined were Gramineae, Parietaria, Olea, house dust, Dermatophagoides farinae and pteronyssinus. 80% of patients were found positive to one or more allergens; their average age (30.1 +/- 13.7) was found lower (p < 0.001) and allergic family history prevalence higher (p < 0.01) than skin negatives. Skin positives prevalence was statistically significant under 50 yrs and skin negatives one over 50 yrs. Asthma or rhinitis only were prevalent among skin negatives while associated symptoms (asthma + rhinitis and/or conjunctivitis) were prevalent among skin positives. Considering skin results pollens were found positive in 34%, inhalants in 24% and pollens + inhalants in 42% of subjects. Gramineae were found positive in 57.8% of subjects, Parietaria in 39.8%, olea in 28.8%, Dermatophagoides farinae in 53.3%, house dust in 52.1% and Dermatophagoides pteronyssinus in 48.2%. Prick test showed a high sensitiveness in detecting pollens sensitization while intradermal reactions were often necessary in sensitization to inhalants; for the diagnosis RAST contribution was negligible.