Higher frequency of early local side effects with aqueous versus depot immunotherapy for hymenoptera venom allergy.

Venom immunotherapy has proven a very effective method for the treatment of allergy to Hymenoptera venom. Aqueous instead of depot extracts are prevalently used for this immunotherapy. The advantage of using aqueous extracts has not been fully investigated. We made an open, non-controlled study on 45 subjects sensitized to either Apis mellifera or Vespula spp. Patients were assigned to either a depot (N=27) or an aqueous (N=18) immunotherapy regimen, and side effects were monitored during the induction and the 3-year maintenance phase. The effect of naturally occurring stings during the treatment and after its interruption was recorded as well. Side effects were less frequent with the depot extract both on a "per patient" (22.2% versus 50.0%) and on a "per dose" (2.9% versus 10,2%) basis (p=0.026 and p<0.000, respectively). Better tolerance was mainly due to the lower frequency of local side effects occurring at early times after vaccination. The efficacy of vaccination was comparable in the 2 cohorts, as expected. We conclude that depot immunotherapy to Hymenoptera venom should be preferred to aqueous immunotherapy for the lower occurrence of local side effects. This might influence a better compliance with this potentially life-saving treatment.

[Reactions caused by Hymenoptera: a first aid problem]. / Reazioni da imenotteri: un problema di pronto soccorso.

The incidence of reactions to insect bites both local (erythema, pemphigus, oedema, itching) and systemic (urticaria, angioedema, anaphylactic shock) in Borgomanero (NO) National Health Clinic 54 was assessed. The high incidence of medical treatments for this pathology encountered reflects the fact that in the summer and in a rural area a great many people are exposed to this type of emergency. The importance of careful diagnosis (anamnesis, skin allergy tests, RAST is emphasised as a means of identifying cases at allergic risk and providing the appropriate immunotherapy.

[Determination of fibrinogen-fibrin degradation factors in neoplasms]. / Determinazione dei fattori di degradazione fibrinogeno-fibrina (FDP) in corso di neoplasie.

Disseminated intravascular coagulation (DIC) and Primary Fibrinolysis (PF) are frequently reported in the literature as occurring in a wide variety of tumours whether subjected to chemotherapy or not and triggering a thrombohemorrhagic mechanism that is often fatal. It was therefore decided to assess the extent of the Fibrinogen-Fibrin Degradation Products (FDP) in a group of cancer patients in order to identify the primary, asymptomatic clinical expressions of these syndromes with a view to ascertaining the possibility of preventing more severe forms. The data confirm the presence of circulating FDP in a small percentage of the patients (26.9%) especially those with solid tumours metastasising to the liver. The involvement of that organ is therefore considered decisive for the onset of DIC and PF.

[Contact sensitization in eczema of the hands]. / La sensibilizzazione da contatto nell'eczema delle mani.

A personal series of patients with eczema on the hands arising in non-occupational conditions was examined (students, housewives, clerical workers, teachers, farm labourers). The data obtained indicate the presence of allergic sensitisation in 70% of the cases and especially among females (3 : 1). The most frequently encountered allergens were difenylguanadine (used in rubber manufacture) and nickel. It is therefore suggested that patch tests should be performed immediately on these patients so that contact with allergen can be prevented in addition to the usual topical treatment.

[Thrombopenia and cirrhosis. Study of 56 cases]. / Piastrinopenia e cirrosi. Studio di 56 casi.

Blood platelets were assayed in 56 cirrhosis patients divided into two groups: alcoholic cirrhosis (20 cases) and non-alcoholic cirrhosis (36 cases). Each group was also divided into two sub-groups: with and without clinical signs of portal hypertension. Low platelet counts were found in both groups (greater than 70%), the incidence being high in the sub-group with clinical signs of portal hypertension. Alcohol appeared to have no influence on the development of platelet insufficiency which was rather correlated with the severity of the hepatopathy, the presence of splenomegaly (splenic sequestration), immunological factors, (presence of circulating antiplatelet antibodies) and "consumption" phenomena (significant incidence of circulating FDP, and indicator of chronic Disseminated Intravascular Coagulation).

[Study of hypophyseal and gonadal hormones and cases of postmenopausal occurrence of bronchial asthma]. / Studio degli ormoni ipofiso-gonadici ad insorgenza post-menopausale in alcuni casi di asma bronchiale.

A study was conducted into the hormone profile of women with no previous history of allergy who developed bronchial asthma after menopause in order to discover any differences between these and patients of a similar age with allergic bronchial asthma. The serum levels of the following hypophyseal and gonadal hormones were therefore analysed: luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (PRL), 17 oestradiol (17BE2) in both groups of patients and in a control group of healthy postmenopausal volunteers. The results showed lower FSH and LH and higher 17B7(2) levels in the patients with bronchial asthma but no clinical history of allergy than in either the patients with allergic asthma or the healthy volunteers. When the hormone picture in some of the group 1 patients normalised, the clinical symptoms disappeared. One possible explanation is the following: excess oestrogen in the "non-allergy" patients might have caused an imbalance in the PgF/PgE ratio which is thought to contribute to the regulation of bronchomotor tone. The same phenomena might also have accelerated the release of arachidonic acid and its metabolites.