Background Atopic dermatitis (AD) patients may benefit from using textiles coated with skin micro... more Background Atopic dermatitis (AD) patients may benefit from using textiles coated with skin microbiome-modulating compounds. Chitosan, a natural biopolymer with immunomodulatory and antimicrobial properties, has been considered potentially useful. Objective This randomized controlled trial assessed the clinical utility of chitosan-coated garment use in AD. Methods Of the 102 patients screened, 78 adult and adolescents were randomly allocated to overnight use of chitosan-coated or uncoated cotton long-sleeved pyjama tops and pants for 8 weeks. The primary outcome was change in disease severity assessed by Scoring Atopic dermatitis index (SCORAD). Other outcomes were changes in quality of life, pruritus and sleep loss, days with need for rescue medication, number of flares and controlled weeks, and adverse events. Changes in total staphylococci and Staphylococcus aureus skin counts were also assessed. Comparisons were made using analysis of variance supplemented by repeated measures analysis for the primary outcome. Interaction term between time and intervention was used to compare time trends between groups.
Background: Dysautonomia has been independently associated with training and exerciseinduced bron... more Background: Dysautonomia has been independently associated with training and exerciseinduced bronchoconstriction. In addition, neurogenic airway inflammation was recently associated with swimmers-asthma. We aimed to assess the relation between autonomic nervous system and airway responsiveness of asthmatic elite swimmers. Methods: Twenty-seven elite swimmers, 11 of whom had asthma, were enrolled in this exploratory cross-sectional study. All performed spirometry with bronchodilation, skin prick tests and methacholine challenge according to the guidelines. Pupillometry was performed using PLR-200 TM Pupillometer. One pupil light response curve for each eye was recorded and the mean values of pupil's maximal and minimal diameters, percentage of constriction, average and maximum constriction velocities (parasympathetic parameters), dilation velocity, and total time to recover 75% of the initial size (sympathetic parameters) were used for analysis. Asthma was defined using IOC-MC criteria; subjects were divided into airway hyperesponsiveness (AHR) severity according to methacholine PD 20 in: no AHR, borderline, mild, moderate and severe AHR. Differences for pupillary parameters between groups and after categorization by AHR severity were assessed using SPSS 20.0 (p ≤ 0.05). In individuals with clinically relevant AHR, correlation between PD 20 and pupillary parameters was investigated with Spearman's correlation test. Results: No statistically significant differences were observed between asthmatic and nonasthmatic swimmers regarding parasympathetic parameters. When stratified by AHR, maximal and minimal diameters and percentage of constriction were significantly lower among those with severe AHR. Among swimmers with clinically relevant AHR (n = 18), PD 20 correlated with parasympathetic activity: maximal (r = 0.67, p = 0.002) and minimal diameters (r = 0.75, p < 0.001), percentage of constriction (r = −0.59, p = 0.011) and latency (r = 0.490, p = 0.039).
Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology, 2013
Atopic dermatitis (AD) is a relapsing inflammatory skin disease with a considerable social and ec... more Atopic dermatitis (AD) is a relapsing inflammatory skin disease with a considerable social and economic burden. Functional textiles may have antimicrobial and antipruritic properties and have been used as complementary treatment in AD. We aimed to assess their effectiveness and safety in this setting. We carried out a systematic review of three large biomedical databases. GRADE approach was used to rate the levels of evidence and grade of recommendation. Meta-analyses of comparable studies were carried out. Thirteen studies (eight randomized controlled trials and five observational studies) met the eligibility criteria. Interventions were limited to silk (six studies), silver-coated cotton (five studies), borage oil, and ethylene vinyl alcohol (EVOH) fiber (one study each). Silver textiles were associated with improvement in SCORAD (2 of 4), fewer symptoms, a lower need for rescue medication (1 of 2), no difference in quality of life, decreased Staphyloccosus aureus colonization (2 of 3), and improvement of trans-epidermal water loss (1 of 2), with no safety concerns. Silk textile use was associated with improvement in SCORAD and symptoms (2 of 4), with no differences in quality of life or need for rescue medication. With borage oil use only skin erythema showed improvement, and with EVOH fiber, an improvement in eczema severity was reported. Recommendation for the use of functional textiles in AD treatment is weak, supported by low quality of evidence regarding effectiveness in AD symptoms and severity, with no evidence of hazardous consequences with their use. More studies with better methodology and longer follow-up are needed.
cerning the underlying immunologic mechanism. 2-5 For instance, in immediate β-lactam drug allerg... more cerning the underlying immunologic mechanism. 2-5 For instance, in immediate β-lactam drug allergy, an IgE-mediated reaction can be demonstrated by a positive SPT and/or IDT after 20 minutes. 6,7 By contrast, non-immediate reactions to βlactams, presenting cutaneous symptoms and signs occurring more than one hour after last drug intake, are often T-cell mediated and a positive late-reading of an intradermal test could be found after several hours or days. 8 Therefore, IDT are used to study both immediate and non-immediate reactions. However, IDT are painful, which often precludes their use, especially in young children. 1
Background. Statins are known for their lipid-lowering effects and role in the treatment of ather... more Background. Statins are known for their lipid-lowering effects and role in the treatment of atherosclerotic disease. They also have anti-inflammatory and immunomodulatory properties which could benefit asthma patients. We aimed to review the evidence on the efficacy and safety of statins in asthma-related outcomes. Methods. A systematic review of the literature on the effects of statins on asthma-related outcomes was performed following a search of the National Guideline Clearinghouse, Cochrane, Scopus, and Pubmed Medline databases in January 2012. Randomized controlled trials (RCTs) and observational studies (cohort/case-control design) assessing the effect of statins were included. The Grading of Recommendations Assessment Development and Evaluation (GRADE) system was used to rate the levels of evidence and grade of recommendation. Results. Twenty-four of the 379 articles retrieved electronically and one article identified by hand search were selected for full-text scrutiny by two independent reviewers. Eight studies were included: six RCTs and two observational studies. Statin use was not associated with consistent, statistical significant improvements in patient outcomes (asthma control, quality of life, steroid-sparing effects) or disease outcomes (lung function, airway responsiveness), and all the studies analyzed had low or very low quality of evidence. Inflammatory outcome improvements were observed in mild allergic asthma. Conclusion. Statins do not seem to have any additional benefit in asthma control or steroid-sparing effect in asthma treatment. Considering the prevalence of both statin use and asthma, more, better designed studies are needed to determine whether a specific phenotype of asthma exists that could benefit from statin treatment.
RATIONALE: Proton pump inhibitors (PPI) are widely used for acidpeptic diseases treatment, moreov... more RATIONALE: Proton pump inhibitors (PPI) are widely used for acidpeptic diseases treatment, moreover, hypersensitivity reactions and crossreactivity between PPI exist. We aimed to describe a series of patients with suspicion of hypersensitivity reactions to PPI and evaluate cross-reactivity using skin-tests. METHODS: Patients referred to our drug allergy unit since 2007 to 2012 for PPI allergy suspicion were studied. Cross-reactivity was evaluated by skin-prick test(SPT), performed with endovenous PPI formulations (omeprazole 4mg/ml, esomeprazole 20mg/ml, pantoprazole 4mg/ml), crushed pill or diluted capsules in saline (rabeprazole 10mg/ml; lanzoprazole 15mg/ml). Intradermal tests(IDT) were done with omeprazole, esomeprazole and pantoprazole (dilutions from 1/1000 to 1/1). Oral challenges(OC) with PPI were performed, accordingly to anamnesis and skin-tests results. RESULTS: Seven patients were included (3 female, mean age 55y). Omeprazole allergy was suspected in 4 patients: 2 delayed urticarias, only positive to omeprazole(IDT1/1) and negative OC with lansoprazole and pantoprazole; 2 anaphylaxis, one tested positively to esomeprazole(IDT1/ 10) and omeprazole(IDT1/1000) and the other to esomeprazole(SPT), omeprazole(IDT1/100) and pantoprazole(IDT1/100), neither performed OC to PPI. A delayed urticaria to esomeprazole tested positively to esomeprazole(IDT1/10) and pantoprazole(IDT1/10). Lansoprazole allergy was suspected in two patients: one anaphylaxis, had positivity to omeprazole(IDT 1/1) with negative OC to omeprazole; one urticaria (reacted also to omeprazole) tested positively to omeprazole(IDT1/1) and esomeprazole(IDT1/1), but tolerated rabeprazole. CONCLUSIONS: Cross-reactivity group between omeprazole, esomeprazole and pantoprazole was identified with some patients tolerating lansoprazole or rabeprazole. The inverse also occurred. Chemical differences in structure, namely substitutes in pyridine rings, could explain cross-reactivity. More studies are needed to standardize diagnosis of PPI allergy.
Background: Dysautonomia has been independently associated with training and exerciseinduced bron... more Background: Dysautonomia has been independently associated with training and exerciseinduced bronchoconstriction. In addition, neurogenic airway inflammation was recently associated with swimmers-asthma. We aimed to assess the relation between autonomic nervous system and airway responsiveness of asthmatic elite swimmers. Methods: Twenty-seven elite swimmers, 11 of whom had asthma, were enrolled in this exploratory cross-sectional study. All performed spirometry with bronchodilation, skin prick tests and methacholine challenge according to the guidelines. Pupillometry was performed using PLR-200 TM Pupillometer. One pupil light response curve for each eye was recorded and the mean values of pupil's maximal and minimal diameters, percentage of constriction, average and maximum constriction velocities (parasympathetic parameters), dilation velocity, and total time to recover 75% of the initial size (sympathetic parameters) were used for analysis. Asthma was defined using IOC-MC criteria; subjects were divided into airway hyperesponsiveness (AHR) severity according to methacholine PD 20 in: no AHR, borderline, mild, moderate and severe AHR. Differences for pupillary parameters between groups and after categorization by AHR severity were assessed using SPSS 20.0 (p ≤ 0.05). In individuals with clinically relevant AHR, correlation between PD 20 and pupillary parameters was investigated with Spearman's correlation test. Results: No statistically significant differences were observed between asthmatic and nonasthmatic swimmers regarding parasympathetic parameters. When stratified by AHR, maximal and minimal diameters and percentage of constriction were significantly lower among those with severe AHR. Among swimmers with clinically relevant AHR (n = 18), PD 20 correlated with parasympathetic activity: maximal (r = 0.67, p = 0.002) and minimal diameters (r = 0.75, p < 0.001), percentage of constriction (r = −0.59, p = 0.011) and latency (r = 0.490, p = 0.039).
Background Atopic dermatitis (AD) patients may benefit from using textiles coated with skin micro... more Background Atopic dermatitis (AD) patients may benefit from using textiles coated with skin microbiome-modulating compounds. Chitosan, a natural biopolymer with immunomodulatory and antimicrobial properties, has been considered potentially useful. Objective This randomized controlled trial assessed the clinical utility of chitosan-coated garment use in AD. Methods Of the 102 patients screened, 78 adult and adolescents were randomly allocated to overnight use of chitosan-coated or uncoated cotton long-sleeved pyjama tops and pants for 8 weeks. The primary outcome was change in disease severity assessed by Scoring Atopic dermatitis index (SCORAD). Other outcomes were changes in quality of life, pruritus and sleep loss, days with need for rescue medication, number of flares and controlled weeks, and adverse events. Changes in total staphylococci and Staphylococcus aureus skin counts were also assessed. Comparisons were made using analysis of variance supplemented by repeated measures analysis for the primary outcome. Interaction term between time and intervention was used to compare time trends between groups.
Background: Dysautonomia has been independently associated with training and exerciseinduced bron... more Background: Dysautonomia has been independently associated with training and exerciseinduced bronchoconstriction. In addition, neurogenic airway inflammation was recently associated with swimmers-asthma. We aimed to assess the relation between autonomic nervous system and airway responsiveness of asthmatic elite swimmers. Methods: Twenty-seven elite swimmers, 11 of whom had asthma, were enrolled in this exploratory cross-sectional study. All performed spirometry with bronchodilation, skin prick tests and methacholine challenge according to the guidelines. Pupillometry was performed using PLR-200 TM Pupillometer. One pupil light response curve for each eye was recorded and the mean values of pupil's maximal and minimal diameters, percentage of constriction, average and maximum constriction velocities (parasympathetic parameters), dilation velocity, and total time to recover 75% of the initial size (sympathetic parameters) were used for analysis. Asthma was defined using IOC-MC criteria; subjects were divided into airway hyperesponsiveness (AHR) severity according to methacholine PD 20 in: no AHR, borderline, mild, moderate and severe AHR. Differences for pupillary parameters between groups and after categorization by AHR severity were assessed using SPSS 20.0 (p ≤ 0.05). In individuals with clinically relevant AHR, correlation between PD 20 and pupillary parameters was investigated with Spearman's correlation test. Results: No statistically significant differences were observed between asthmatic and nonasthmatic swimmers regarding parasympathetic parameters. When stratified by AHR, maximal and minimal diameters and percentage of constriction were significantly lower among those with severe AHR. Among swimmers with clinically relevant AHR (n = 18), PD 20 correlated with parasympathetic activity: maximal (r = 0.67, p = 0.002) and minimal diameters (r = 0.75, p < 0.001), percentage of constriction (r = −0.59, p = 0.011) and latency (r = 0.490, p = 0.039).
Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology, 2013
Atopic dermatitis (AD) is a relapsing inflammatory skin disease with a considerable social and ec... more Atopic dermatitis (AD) is a relapsing inflammatory skin disease with a considerable social and economic burden. Functional textiles may have antimicrobial and antipruritic properties and have been used as complementary treatment in AD. We aimed to assess their effectiveness and safety in this setting. We carried out a systematic review of three large biomedical databases. GRADE approach was used to rate the levels of evidence and grade of recommendation. Meta-analyses of comparable studies were carried out. Thirteen studies (eight randomized controlled trials and five observational studies) met the eligibility criteria. Interventions were limited to silk (six studies), silver-coated cotton (five studies), borage oil, and ethylene vinyl alcohol (EVOH) fiber (one study each). Silver textiles were associated with improvement in SCORAD (2 of 4), fewer symptoms, a lower need for rescue medication (1 of 2), no difference in quality of life, decreased Staphyloccosus aureus colonization (2 of 3), and improvement of trans-epidermal water loss (1 of 2), with no safety concerns. Silk textile use was associated with improvement in SCORAD and symptoms (2 of 4), with no differences in quality of life or need for rescue medication. With borage oil use only skin erythema showed improvement, and with EVOH fiber, an improvement in eczema severity was reported. Recommendation for the use of functional textiles in AD treatment is weak, supported by low quality of evidence regarding effectiveness in AD symptoms and severity, with no evidence of hazardous consequences with their use. More studies with better methodology and longer follow-up are needed.
cerning the underlying immunologic mechanism. 2-5 For instance, in immediate β-lactam drug allerg... more cerning the underlying immunologic mechanism. 2-5 For instance, in immediate β-lactam drug allergy, an IgE-mediated reaction can be demonstrated by a positive SPT and/or IDT after 20 minutes. 6,7 By contrast, non-immediate reactions to βlactams, presenting cutaneous symptoms and signs occurring more than one hour after last drug intake, are often T-cell mediated and a positive late-reading of an intradermal test could be found after several hours or days. 8 Therefore, IDT are used to study both immediate and non-immediate reactions. However, IDT are painful, which often precludes their use, especially in young children. 1
Background. Statins are known for their lipid-lowering effects and role in the treatment of ather... more Background. Statins are known for their lipid-lowering effects and role in the treatment of atherosclerotic disease. They also have anti-inflammatory and immunomodulatory properties which could benefit asthma patients. We aimed to review the evidence on the efficacy and safety of statins in asthma-related outcomes. Methods. A systematic review of the literature on the effects of statins on asthma-related outcomes was performed following a search of the National Guideline Clearinghouse, Cochrane, Scopus, and Pubmed Medline databases in January 2012. Randomized controlled trials (RCTs) and observational studies (cohort/case-control design) assessing the effect of statins were included. The Grading of Recommendations Assessment Development and Evaluation (GRADE) system was used to rate the levels of evidence and grade of recommendation. Results. Twenty-four of the 379 articles retrieved electronically and one article identified by hand search were selected for full-text scrutiny by two independent reviewers. Eight studies were included: six RCTs and two observational studies. Statin use was not associated with consistent, statistical significant improvements in patient outcomes (asthma control, quality of life, steroid-sparing effects) or disease outcomes (lung function, airway responsiveness), and all the studies analyzed had low or very low quality of evidence. Inflammatory outcome improvements were observed in mild allergic asthma. Conclusion. Statins do not seem to have any additional benefit in asthma control or steroid-sparing effect in asthma treatment. Considering the prevalence of both statin use and asthma, more, better designed studies are needed to determine whether a specific phenotype of asthma exists that could benefit from statin treatment.
RATIONALE: Proton pump inhibitors (PPI) are widely used for acidpeptic diseases treatment, moreov... more RATIONALE: Proton pump inhibitors (PPI) are widely used for acidpeptic diseases treatment, moreover, hypersensitivity reactions and crossreactivity between PPI exist. We aimed to describe a series of patients with suspicion of hypersensitivity reactions to PPI and evaluate cross-reactivity using skin-tests. METHODS: Patients referred to our drug allergy unit since 2007 to 2012 for PPI allergy suspicion were studied. Cross-reactivity was evaluated by skin-prick test(SPT), performed with endovenous PPI formulations (omeprazole 4mg/ml, esomeprazole 20mg/ml, pantoprazole 4mg/ml), crushed pill or diluted capsules in saline (rabeprazole 10mg/ml; lanzoprazole 15mg/ml). Intradermal tests(IDT) were done with omeprazole, esomeprazole and pantoprazole (dilutions from 1/1000 to 1/1). Oral challenges(OC) with PPI were performed, accordingly to anamnesis and skin-tests results. RESULTS: Seven patients were included (3 female, mean age 55y). Omeprazole allergy was suspected in 4 patients: 2 delayed urticarias, only positive to omeprazole(IDT1/1) and negative OC with lansoprazole and pantoprazole; 2 anaphylaxis, one tested positively to esomeprazole(IDT1/ 10) and omeprazole(IDT1/1000) and the other to esomeprazole(SPT), omeprazole(IDT1/100) and pantoprazole(IDT1/100), neither performed OC to PPI. A delayed urticaria to esomeprazole tested positively to esomeprazole(IDT1/10) and pantoprazole(IDT1/10). Lansoprazole allergy was suspected in two patients: one anaphylaxis, had positivity to omeprazole(IDT 1/1) with negative OC to omeprazole; one urticaria (reacted also to omeprazole) tested positively to omeprazole(IDT1/1) and esomeprazole(IDT1/1), but tolerated rabeprazole. CONCLUSIONS: Cross-reactivity group between omeprazole, esomeprazole and pantoprazole was identified with some patients tolerating lansoprazole or rabeprazole. The inverse also occurred. Chemical differences in structure, namely substitutes in pyridine rings, could explain cross-reactivity. More studies are needed to standardize diagnosis of PPI allergy.
Background: Dysautonomia has been independently associated with training and exerciseinduced bron... more Background: Dysautonomia has been independently associated with training and exerciseinduced bronchoconstriction. In addition, neurogenic airway inflammation was recently associated with swimmers-asthma. We aimed to assess the relation between autonomic nervous system and airway responsiveness of asthmatic elite swimmers. Methods: Twenty-seven elite swimmers, 11 of whom had asthma, were enrolled in this exploratory cross-sectional study. All performed spirometry with bronchodilation, skin prick tests and methacholine challenge according to the guidelines. Pupillometry was performed using PLR-200 TM Pupillometer. One pupil light response curve for each eye was recorded and the mean values of pupil's maximal and minimal diameters, percentage of constriction, average and maximum constriction velocities (parasympathetic parameters), dilation velocity, and total time to recover 75% of the initial size (sympathetic parameters) were used for analysis. Asthma was defined using IOC-MC criteria; subjects were divided into airway hyperesponsiveness (AHR) severity according to methacholine PD 20 in: no AHR, borderline, mild, moderate and severe AHR. Differences for pupillary parameters between groups and after categorization by AHR severity were assessed using SPSS 20.0 (p ≤ 0.05). In individuals with clinically relevant AHR, correlation between PD 20 and pupillary parameters was investigated with Spearman's correlation test. Results: No statistically significant differences were observed between asthmatic and nonasthmatic swimmers regarding parasympathetic parameters. When stratified by AHR, maximal and minimal diameters and percentage of constriction were significantly lower among those with severe AHR. Among swimmers with clinically relevant AHR (n = 18), PD 20 correlated with parasympathetic activity: maximal (r = 0.67, p = 0.002) and minimal diameters (r = 0.75, p < 0.001), percentage of constriction (r = −0.59, p = 0.011) and latency (r = 0.490, p = 0.039).
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