Skin reaction to inhaled tiotropium bromide: a case report.

INTRODUCTION: Systemic reactions to inhaled drugs are rare. To the best of our knowledge, we report the first case of generalized itching related to the use of tiotropium bromide, a long acting inhaled anti-cholinergic agent commonly used to treat chronic obstructive pulmonary disease. CASE PRESENTATION: A 78-year-old Caucasian woman was referred to our facility for allergological evaluation. Our patient had been treated twice with tiotropium for chronic obstructive pulmonary disease and had experienced an allergic reaction with itching. We performed a double-blind placebo-controlled inhalation challenge for our patient with tiotropium and a placebo. Inhalation tests yielded positive results for tiotropium and negative results for the placebo. The results of a skin prick test with tiotropium were negative. CONCLUSIONS: These findings reveal that tiotropium may elicit immediate skin allergic reactions. The negative result from the skin test suggests that such a reaction is not immunoglobulin E-mediated.

Toxocariasis resulting in seeming allergy.

Toxocara canis is an intestinal nematode affecting dogs and cats that causes human infestations by ingestion of embryonated eggs excreted in dogs' faeces. Humans are transport hosts, in whom the larvae do not develop to adult worms, but may migrate to various tissues and organs, and survive for several years, giving rise to several clinical symptoms, which include allergy-like presentations. We report three cases presenting as dermatitis, rhinitis, asthma, and conjunctivitis which were diagnosed and unsuccessfully treated as allergy. The correct diagnosis was established after detecting anti-Toxocara antibodies by Western blotting. All clinical symptoms showed improvement after starting treatment with mebendazole and subsequent courses of the antiparasitic drug resulted in full recovery. This suggests the possible role of Toxocara canis in inducing chronic symptoms of allergic type. This is particularly important for asthma, where it has been demonstrated that Toxocara canis infection causes allergic inflammation in the lungs associated with bronchial hyperreactivity. On the other hand, in our patients with asthma and with dermatitis the positive results from allergy tests were a confounding factor in delaying the correct diagnosis, which was finally obtained by the detection of antibodies to Toxocara canis.

Incidence and characteristics of hospital-acquired pneumonia in a pulmonary rehabilitation setting.

BACKGROUND: The incidence of Hospital Acquired Pneumonia (HAP) varies according to the setting. It is estimated to be approximately 0.5% to 1% in hospitalized subjects but higher in mechanically ventilated patients in intensive care units. The incidence of HAP in a pulmonary rehabilitation unit has not been investigated. MATERIAL/METHODS: Patients with chronic obstructive pulmonary disease (COPD), admitted for pulmonary rehabilitation between January 1 and December 31, 2006, were included. HAP was defined by symptoms, signs, and radiograph imaging of pulmonary infiltrate. Chest radiography allowed us to distinguish HAP from COPD exacerbations. The disease course also was evaluated. RESULTS: In total, 143 subjects (85 men, 58 women; mean age, 74.2 years) were enrolled. Nine of them (6.3%; 6 men, 3 women; mean age, 72.8+/-3.2 years) developed HAP. Twenty-four (16.8%) had pneumonia signs and symptoms but no radiologic findings. In these patients, a diagnosis of COPD exacerbation was made. Seven of 9 patients with HAP were successfully treated with empiric antibiotic therapy, while the other 2 required a modification of the antibiotic regimen after resistant Klebsiella pneumoniae and Pseudomonas aeruginosa had been detected in sputum culture. CONCLUSIONS: The incidence of HAP in a pulmonary rehabilitation setting was approximately 6%, higher than that previously described in hospitalized subjects. The clinical course of HAP was favorable, no mortality occurred. This could be explained either by patient-related or by environment-related factors.

[Cut-off level of glycosylated hemoglobin indicating the development of complications in type 2 diabetes mellitus]. / Cut-off del livello di glicoemoglobina e complicanze del diabete mellito di tipo 2.

Prevention of chronic complications is very important in the management of type 2 diabetes, and the availability of a laboratory test individuating at risk subjects should have a marked usefulness. This study sought by the method of ROC curves the cut-off of glycated haemoglobin discriminating the subjects with microvascular, neurologic and renal complications from those without. The cut-off was identified at a glycated haemoglobin level of 7.95, showing a sensitivity of 74.8% and a specificity of 73.3%, which makes it a possible tool for evaluating the risk of complications in type 2 diabetes.