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Papers by Riccardo Asero

European Annals of Allergy and Clinical Immunology

Up to 30% of cases of chronic spontaneous urticaria (CSU) are exacerbated by COX-1 inhibiting non... more Up to 30% of cases of chronic spontaneous urticaria (CSU) are exacerbated by COX-1 inhibiting nonsteroidal anti-inflammatory drugs (NSAID); this clinical picture is termed NECD (NSAID-exacerbated cutaneous disease). On the other hand, multiple NSAID hypersensitivity may occur in the absence of an underlying CSU also, a situation that is termed NIUA (NSAID-induced urticaria / angioedema). The present study reports a case of multiple NSAID hypersensitivity that occurred in a man much before he developed severe CSU. Omalizumab treatment eventually induced a remission of the cutaneous disease which was associated with aspirin tolerance, as assessed by open oral challenge with the drug. Altogether, this case suggests that it might be worth to investigate tolerance to aspirin or other strong COX-1 inhibitors in NECD patients showing a complete response to omalizumab, and maybe also the effects of omalizumab in NIUA patients as well.

European annals of allergy and clinical immunology, 2013

Nonsteroidal anti-inflammatory drugs are one of the most frequent causes of immediate drug-induce... more Nonsteroidal anti-inflammatory drugs are one of the most frequent causes of immediate drug-induced skin hypersensitivity reactions worldwide (1). While a proportion of patients show reactivity to single, specific drugs, many others are intolerant to multiple NSAIDs; about one half of multiple reactors suffer from chronic spontaneous urticaria, while in the remaining no underlying factor can be detected although these patients are often characterized by autoreactivity (2). Based on a number of studies carried out during the last 20 years it is generally believed that inhibition of cycloxygenase 1 (COX-1) enzyme by the offending drugs plays a relevant pathogenic role in multiple NSAID reactors (3-5). These subjects are in many cases able to tolerate NSAIDs and other drugs exerting little or no inhibition on COX-1, such as paracetamol, tramadol, nimesulide, benzidamine, meloxicam or selective COX-2 inhibitors (coxibs). Table 1 summarizes the results of one decade of challenge tests wit...

Journal of investigational allergology & clinical immunology, 2004

BACKGROUND There is increasing evidence that bird fanciers may develop airborne allergies to unus... more BACKGROUND There is increasing evidence that bird fanciers may develop airborne allergies to unusual allergens. OBJECTIVE To detect the allergen source in a bird fancier with a history of asthma associated with bird cage cleaning activities and with contact with a Brazil parrot. METHODS SPT with a large series of both airborne and food allergens were carried out. IgE reactivity to allergens causing wheal and flare reactions was confirmed by in-vitro investigations including ELISA/ELISA inhibition and immunoblot analysis. RESULTS Strong skin reactivity to sunflower seed was observed. Immunoblot analysis showed IgE reactivity to low m.w. proteins, most probably 2S albumin, and ELISA inhibition studies showed the absence of cross-reactivity to mustard. CONCLUSION Sunflower seed dust may sensitize patients via the respiratory tract. Differently from previously reported cases of sunflower seed allergy, no cross-reactivity to 2S albumin from botanically unrelated seeds was found.

Journal of investigational allergology & clinical immunology, 2006

BACKGROUND Some studies have suggested that specific immunotherapy (SIT) may cause de novo sensit... more BACKGROUND Some studies have suggested that specific immunotherapy (SIT) may cause de novo sensitization to allergenic proteins to which patients were not previously allergic. This event might theoretically involve cross-reacting pollen allergens, such as profilin or polcalcins, posing a risk of SIT-induced polysensitization to pollens in patients who were originally monosensitized. OBJECTIVES The aim of this study was to assess whether injection SIT with commercial pollen extract represents a risk factor for the de novo development of sensitization to different pollens in monosensitized patients. METHODS The study involved 142 subjects diagnosed as being monosensitized to a single pollen: 64 patients who were administered a 3-year course of injection SIT and 78 controls. Subjects underwent control skin prick tests (SPT) with a series of 8 seasonal airborne allergens at least 3 years after the first visit. Patients with 5 or more new sensitivities on SPT were considered to be de nov...

European annals of allergy and clinical immunology, 2017

Summary The first case of disappearance of apple-induced oral allergy syndrome in a birch pollen-... more Summary The first case of disappearance of apple-induced oral allergy syndrome in a birch pollen-allergic patient following omalizumab treatment is reported. This observation in a case of type 2 food allergy suggests that omalizumab is potentially an effective preventive treatment for patients with severe, type 1 food allergies.

European annals of allergy and clinical immunology, 2011

This study reports an unusual case of anaphylaxis induced by tomato. Inhibition studies carried o... more This study reports an unusual case of anaphylaxis induced by tomato. Inhibition studies carried out in-vitro showed the complete cross-reactivity between the relevant tomato allergen and purified peach lipid transferprotein (LTP). Tomato LTP may sometimes cause severe allergic reactions.

European annals of allergy and clinical immunology, 2012

BACKGROUND Extra-European immigrants are increasingly seen in allergy clinics. In view of their d... more BACKGROUND Extra-European immigrants are increasingly seen in allergy clinics. In view of their different genetic background they represent an opportunity to investigate the dynamics of sensitization to airborne allergens. OBJECTIVE We investigated the pattern of airborne sensitization among allergic extra-European immigrants living in two areas of northern Italy. METHODS Extra-European immigrants living in Milan and Verona were compared with age- and sex-matched or allergen-matched allergic Italians. Based on number of sensitizations to airborne allergens, patients and controls were divided into mono-/oligo-sensitized or multi-sensitized (1-3 or > 3, respectively). RESULTS In Milan grass pollen allergy was more frequent among immigrants than in controls (75% vs 49%; p < 0.01), whereas ragweed allergy prevailed among Italians (56% vs 20%; p < 0.001). In Verona, immigrants were rarely multi-sensitized (21% vs 43%; p < 0.01), more frequently sensitized to grass and birch. ...

European annals of allergy and clinical immunology, 2012

Allergen specific immunotherapy remains the only means to change the natural history of allergic ... more Allergen specific immunotherapy remains the only means to change the natural history of allergic disease. Thanks to the recent advances in molecular biology a large spectrum of purified allergen molecules are presently routinely available for diagnostic purposes. This review represents a practical guide on how to use these new diagnostic tools in order to detect precisely the primary sensitizing allergen sources in subjects showing a multiple sensitization to seasonal and/or perennial airborne allergens, thus avoiding the diagnostic mistakes that have been probably associated with the prescription and administration of several ineffective immunotherapies up to a recent past.

BACKGROUND Some patients seem to show a particular propensity to experience systemic reactions (S... more BACKGROUND Some patients seem to show a particular propensity to experience systemic reactions (SR) when undergoing SCIT. This study looked at their features. METHODS 423 adults submitted to subcutaneous immunotherapy (SCIT) with 583 depot allergens extracts were studied. A "slow" build-up schedule was followed, and maintenance doses were given monthly. No mixtures of allergens were employed; multi-sensitized patients were treated with two extracts at the same time. IgE to pollen allergen components were measured. Patients experiencing several SR and those showing repeated large local reactions preventing up dosing were analyzed. RESULTS Altogether, 14% of patients experienced at least 2 SR to SCIT and further 13% repeated local reactions. All SR involved the skin. Eight treatments were stopped. No reactor was using beta-blockers. SR were not associated with pollen season, use of freshly prepared vials, administration of 2 allergens, or extract producer, nor were preceded ...

BACKGROUND A recent study carried out in North of Milan, an area that was recently colonized both... more BACKGROUND A recent study carried out in North of Milan, an area that was recently colonized both by birch and ragweed pollen, showed that subjects developing allergies to these "new" allergens were much older than those becoming allergic to "traditional" airborne allergens, which suggests that predisposition to develop respiratory allergies is probably allergen-specific, persists throughout life, and does not occur until the patient encounters the appropriate allergen for a sufficiently long period. OBJECTIVE The present study aimed to test this hypothesis by following-up a large cohort of patients monosensitized to airborne allergens. METHODS The prevalence and characteristics of new sensitizations to airborne allergens after >2 years of follow-up were retrospectively assessed in 726 patients monosensitized to grass, pellitory, mite, birch, ragweed, Alternaria, mugwort, or plantain living North of Milan. RESULTS The overall prevalence of new sensitizations w...

Journal of Investigational Allergology and Clinical Immunology

This article has been accepted for publication and undergone full peer review but has not been th... more This article has been accepted for publication and undergone full peer review but has not been through the copyediting, types etting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

European Annals of Allergy and Clinical Immunology

Background: About 50% of patients with severe chronic spontaneous urticaria (CSU) show signs of a... more Background: About 50% of patients with severe chronic spontaneous urticaria (CSU) show signs of activation of the coagulation/fibrinolysis system, but the clinical significance of this phenomenon is unclear. Objective: The present study compared patients with severe CSU showing and not showing elevated D-dimer plasma levels. Methods: 132 adult patients (M/F 44/88; mean age 51, 5 years; range 14-89 years) with severe CSU (UAS-7 > 30) were included in a cross-sectional, real life study. The study group was divided based on baseline D-dimer plasma levels, and compared for age, sex, disease duration, disease activity, CRP, thyroid autoimmunity, total IgE, and atopic status. Results: Identical numbers of patients showed elevated and normal D-dimer plasma levels (50% and 50%, respectively). Patients showing elevated D-dimer levels were slightly older (p< 0.05), were more frequently females (p< 0.05), had a longer disease duration (p< 0.01), and had a significantly higher prevalence of elevated PCR (26/66 vs 4/66; p < 0.001). Conclusions: Only 50% of patients with severe CSU show elevated D-dimer plasma levels. The activation of the coagulation/fibrinolysis system is associated with a systemic inflammatory milieu, suggesting the existence of a specific phenotype. Whether this reflects the existence of different endotypes in patients showing and not showing the activation of the coagulation cascade has still to be established.

Allergy

Impact of ocular symptoms on quality of life (QoL), work productivity and resource utilisation in... more Impact of ocular symptoms on quality of life (QoL), work productivity and resource utilisation in allergic rhinitis patients-an observational, cross sectional study in four countries in Europe.

Allergy

Christian Lupinek Valérie Siroux Rachel Nadif Jocelyne Just Jean Bousquet Rudolf Valenta Thomas A... more Christian Lupinek Valérie Siroux Rachel Nadif Jocelyne Just Jean Bousquet Rudolf Valenta Thomas A. Platts-Mills Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands The Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Inserm, CNRS, Institute for Advanced Biosciences (IAB), U1209 Joint Research Center, University Grenoble Alpes, Grenoble, France INSERM U1168, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, Villejuif, France UMR-S 1168, Univ Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France Assistance Publique-Hôpitaux de Paris, Allergology Department, Hôpital Armand-Trousseau, Paris, France Université Paris, Paris, France University Hospital, Montpellier, France Asthma and Allergic Diseases Center, University of Virginia Health System, Charlottesville, Virginia

F1000Research

Chronic urticaria is a spontaneous or inducible group of diseases characterized by the occurrence... more Chronic urticaria is a spontaneous or inducible group of diseases characterized by the occurrence of wheals (and, in about half of cases, angioedema) for more than 6 weeks. These are rather frequent conditions that may severely affect patients’ quality of life and sometimes represent a challenge for doctors as well. The causes of chronic urticaria are still poorly defined, although there is growing evidence that different biologic systems including immunity, inflammation, and coagulation may take part in the pathomechanism eventually leading to mast cell and basophil degranulation and hence to wheal formation. This review will discuss the main findings that are (slowly) shedding light on the pathogenesis of this disorder.

Journal of Investigational Allergology and Clinical Immunology, 2016

BACKGROUND: Functionally active autoantibodies to IgE and to the high affinity IgE receptor (FcεR... more BACKGROUND: Functionally active autoantibodies to IgE and to the high affinity IgE receptor (FcεRI) can be detected in sera from about 40% of patients with chronic spontaneous urticaria (CSU). Recent studies showed that CSU sera can induce the activation of mast cells bearing or not the high affinity IgE receptors. OBJECTIVE: This study aimed at evaluating mast cell activation induced by CSU serum factors with a molecular weight lower than that of autoantibodies. METHODS: Eight CSU patients and 5 normal controls were evaluated. Whole sera and sera fractioned at 100, 50 and 30 kDa were used to stimulate in vitro LAD2 mast cells. The enzymatic activity of β-hexosaminidase was evaluated in supernatants and cell pellets as a measure of mast cell degranulation. RESULTS: Mast cell β-hexosaminidase release induced by whole sera from CSU patients (14.4±2.7 %, mean ± SEM) was higher than that induced by sera from normal controls (5.1±2.4%; p=0.027). Also serum fractions below 100 kDa and below 50 kDa from CSU patients induced a mast cell degranulation that was significantly higher than that induced by the corresponding fractions from normal control sera (10.2±1.4% vs 3.8±1.9% [p=0.024] and 10.1±1.2% vs 3.9±1.7% [p=0.012], respectively). In 4 CSU patients we evaluated serum fractions below 30 kDa which retained the same capacity to activate mast cells (11.0±0.7%). CONCLUSIONS: This study shows that sera from CSU patients may contain low molecular weight mast cell activating factors other than autoantibodies. This might be an additional mechanism contributing to the pathogenesis of CSU.

European Annals of Allergy and Clinical Immunology, Mar 1, 2011

Background: The allergenic profile of patients hypersensitive to pollen pan-allergens, profilin a... more Background: The allergenic profile of patients hypersensitive to pollen pan-allergens, profilin and polcalcin, has received little attention so far. Objective: To detect whether hypersensitivity to profilin and polcalcin follows sensitization to specific allergen sources or represents a primary phenomenon, and to examine the sensitization profiles of patients hypersensitive to pollen pan-allergens. Methods: IgE reactivity to markers of primary sensitisation to different pollen species including grass, mugwort, ragweed, pellitory, birch, olive, and cypress was detected in sera from 106 pollen-allergic subjects, 86 sensitised to profilin and 29 to polcalcin living in two distinct areas of Northern Italy. Results: In profilin hypersensitive patients the primary sensitizer was detected in 24/86 (28%) cases: grass (n= 15), ragweed (n=7), and birch (n=2). In 62 (72%) cases the primary sensitizing pollen was not detectable. In the polcalcin group the primary sensitizing pollen was detected in 8/29 (28%) cases: grass (n=6), ragweed and pellitory (1 each). All ragweed-allergic subjects were from the Milan area. In the 9 patients hypersensitive to both panallergens the primary sensitizing source could be identified in 2 (23%) cases (grass in both cases). Conclusion: A putative primary sensitizer to pollen pan-allergens can be detected only in ¼ of cases, as most patients show IgE specific for > 1 pollen species. In these patients the prevalence of the primary sensitizer parallels the prevalence of clinical allergy to the different pollen sources in that specific geographic area. Most pollen sources are probably able to cause sensitization to cross-reacting pollen pan-allergens.

PLOS ONE, 2016

Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria-Centro di ricerca per l... more Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria-Centro di ricerca per l'orticoltura,

Expert Review of Clinical Immunology, 2015

Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano (Milano), Italy; Ambulatorio di A... more Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano (Milano), Italy; Ambulatorio di Allergologia e Immunologia Clinica, U.O. Medicina Interna, A.O. Fatebenefratelli e Oftalmico, Milano, Italy; Unità di Dermatologia, Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy; Medicina Interna, Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy

European Annals of Allergy and Clinical Immunology, Jun 1, 2011

Background: Olive pollen sensitization is surprisingly frequent in Milan, an area that is virtual... more Background: Olive pollen sensitization is surprisingly frequent in Milan, an area that is virtually both olive-and ash-free. Objective: To establish the prevalence of olive pollen sensitization north of Milan, and to investigate the allergens involved. Methods: 300 pollenallergic patients living in this area were randomly selected. Based on SPT results, olive pollen reactors were classified as multi-sensitized, oligo-sensitized, or mono-sensitized. IgE to markers of primary sensitization to olive pollen (Ole e 1), as well as to pollen pan-allergens such as profilin (Phl p 12) or polcalcin (Phl p 7) were measured. Further, the putative cross-reactivity between grass group XI allergen and Ole e 1 was investigated. Results: 107 (36%) patients were sensitized to olive pollen; 67 (63%) were multi-sensitized, while only 4 (4%) were mono-sensitized. Specific IgE to Ole e 1 were found in 32/46 (70%) cases; 22 of them (69%) co-recognized pollen pan-allergens, as shown by IgE reactivity to Phl p 7 and/or Phl p 12. Sera from 14 (30%) patients did not react to Ole e 1; of these, 10 (71%) were pan-allergens reactors. No correlation was found between IgE levels to Phl p 11 and Ole e 1. Conclusions: A majority of olive pollen-sensitized subjects seen in the surroundings of Milan are truly allergic to Oleaceae. In the absence of both olive and ash trees exposure to privet pollen might represent the source of this kind of sensitization.

European Annals of Allergy and Clinical Immunology

Up to 30% of cases of chronic spontaneous urticaria (CSU) are exacerbated by COX-1 inhibiting non... more Up to 30% of cases of chronic spontaneous urticaria (CSU) are exacerbated by COX-1 inhibiting nonsteroidal anti-inflammatory drugs (NSAID); this clinical picture is termed NECD (NSAID-exacerbated cutaneous disease). On the other hand, multiple NSAID hypersensitivity may occur in the absence of an underlying CSU also, a situation that is termed NIUA (NSAID-induced urticaria / angioedema). The present study reports a case of multiple NSAID hypersensitivity that occurred in a man much before he developed severe CSU. Omalizumab treatment eventually induced a remission of the cutaneous disease which was associated with aspirin tolerance, as assessed by open oral challenge with the drug. Altogether, this case suggests that it might be worth to investigate tolerance to aspirin or other strong COX-1 inhibitors in NECD patients showing a complete response to omalizumab, and maybe also the effects of omalizumab in NIUA patients as well.

European annals of allergy and clinical immunology, 2013

Nonsteroidal anti-inflammatory drugs are one of the most frequent causes of immediate drug-induce... more Nonsteroidal anti-inflammatory drugs are one of the most frequent causes of immediate drug-induced skin hypersensitivity reactions worldwide (1). While a proportion of patients show reactivity to single, specific drugs, many others are intolerant to multiple NSAIDs; about one half of multiple reactors suffer from chronic spontaneous urticaria, while in the remaining no underlying factor can be detected although these patients are often characterized by autoreactivity (2). Based on a number of studies carried out during the last 20 years it is generally believed that inhibition of cycloxygenase 1 (COX-1) enzyme by the offending drugs plays a relevant pathogenic role in multiple NSAID reactors (3-5). These subjects are in many cases able to tolerate NSAIDs and other drugs exerting little or no inhibition on COX-1, such as paracetamol, tramadol, nimesulide, benzidamine, meloxicam or selective COX-2 inhibitors (coxibs). Table 1 summarizes the results of one decade of challenge tests wit...

Journal of investigational allergology & clinical immunology, 2004

BACKGROUND There is increasing evidence that bird fanciers may develop airborne allergies to unus... more BACKGROUND There is increasing evidence that bird fanciers may develop airborne allergies to unusual allergens. OBJECTIVE To detect the allergen source in a bird fancier with a history of asthma associated with bird cage cleaning activities and with contact with a Brazil parrot. METHODS SPT with a large series of both airborne and food allergens were carried out. IgE reactivity to allergens causing wheal and flare reactions was confirmed by in-vitro investigations including ELISA/ELISA inhibition and immunoblot analysis. RESULTS Strong skin reactivity to sunflower seed was observed. Immunoblot analysis showed IgE reactivity to low m.w. proteins, most probably 2S albumin, and ELISA inhibition studies showed the absence of cross-reactivity to mustard. CONCLUSION Sunflower seed dust may sensitize patients via the respiratory tract. Differently from previously reported cases of sunflower seed allergy, no cross-reactivity to 2S albumin from botanically unrelated seeds was found.

Journal of investigational allergology & clinical immunology, 2006

BACKGROUND Some studies have suggested that specific immunotherapy (SIT) may cause de novo sensit... more BACKGROUND Some studies have suggested that specific immunotherapy (SIT) may cause de novo sensitization to allergenic proteins to which patients were not previously allergic. This event might theoretically involve cross-reacting pollen allergens, such as profilin or polcalcins, posing a risk of SIT-induced polysensitization to pollens in patients who were originally monosensitized. OBJECTIVES The aim of this study was to assess whether injection SIT with commercial pollen extract represents a risk factor for the de novo development of sensitization to different pollens in monosensitized patients. METHODS The study involved 142 subjects diagnosed as being monosensitized to a single pollen: 64 patients who were administered a 3-year course of injection SIT and 78 controls. Subjects underwent control skin prick tests (SPT) with a series of 8 seasonal airborne allergens at least 3 years after the first visit. Patients with 5 or more new sensitivities on SPT were considered to be de nov...

European annals of allergy and clinical immunology, 2017

Summary The first case of disappearance of apple-induced oral allergy syndrome in a birch pollen-... more Summary The first case of disappearance of apple-induced oral allergy syndrome in a birch pollen-allergic patient following omalizumab treatment is reported. This observation in a case of type 2 food allergy suggests that omalizumab is potentially an effective preventive treatment for patients with severe, type 1 food allergies.

European annals of allergy and clinical immunology, 2011

This study reports an unusual case of anaphylaxis induced by tomato. Inhibition studies carried o... more This study reports an unusual case of anaphylaxis induced by tomato. Inhibition studies carried out in-vitro showed the complete cross-reactivity between the relevant tomato allergen and purified peach lipid transferprotein (LTP). Tomato LTP may sometimes cause severe allergic reactions.

European annals of allergy and clinical immunology, 2012

BACKGROUND Extra-European immigrants are increasingly seen in allergy clinics. In view of their d... more BACKGROUND Extra-European immigrants are increasingly seen in allergy clinics. In view of their different genetic background they represent an opportunity to investigate the dynamics of sensitization to airborne allergens. OBJECTIVE We investigated the pattern of airborne sensitization among allergic extra-European immigrants living in two areas of northern Italy. METHODS Extra-European immigrants living in Milan and Verona were compared with age- and sex-matched or allergen-matched allergic Italians. Based on number of sensitizations to airborne allergens, patients and controls were divided into mono-/oligo-sensitized or multi-sensitized (1-3 or > 3, respectively). RESULTS In Milan grass pollen allergy was more frequent among immigrants than in controls (75% vs 49%; p < 0.01), whereas ragweed allergy prevailed among Italians (56% vs 20%; p < 0.001). In Verona, immigrants were rarely multi-sensitized (21% vs 43%; p < 0.01), more frequently sensitized to grass and birch. ...

European annals of allergy and clinical immunology, 2012

Allergen specific immunotherapy remains the only means to change the natural history of allergic ... more Allergen specific immunotherapy remains the only means to change the natural history of allergic disease. Thanks to the recent advances in molecular biology a large spectrum of purified allergen molecules are presently routinely available for diagnostic purposes. This review represents a practical guide on how to use these new diagnostic tools in order to detect precisely the primary sensitizing allergen sources in subjects showing a multiple sensitization to seasonal and/or perennial airborne allergens, thus avoiding the diagnostic mistakes that have been probably associated with the prescription and administration of several ineffective immunotherapies up to a recent past.

BACKGROUND Some patients seem to show a particular propensity to experience systemic reactions (S... more BACKGROUND Some patients seem to show a particular propensity to experience systemic reactions (SR) when undergoing SCIT. This study looked at their features. METHODS 423 adults submitted to subcutaneous immunotherapy (SCIT) with 583 depot allergens extracts were studied. A "slow" build-up schedule was followed, and maintenance doses were given monthly. No mixtures of allergens were employed; multi-sensitized patients were treated with two extracts at the same time. IgE to pollen allergen components were measured. Patients experiencing several SR and those showing repeated large local reactions preventing up dosing were analyzed. RESULTS Altogether, 14% of patients experienced at least 2 SR to SCIT and further 13% repeated local reactions. All SR involved the skin. Eight treatments were stopped. No reactor was using beta-blockers. SR were not associated with pollen season, use of freshly prepared vials, administration of 2 allergens, or extract producer, nor were preceded ...

BACKGROUND A recent study carried out in North of Milan, an area that was recently colonized both... more BACKGROUND A recent study carried out in North of Milan, an area that was recently colonized both by birch and ragweed pollen, showed that subjects developing allergies to these "new" allergens were much older than those becoming allergic to "traditional" airborne allergens, which suggests that predisposition to develop respiratory allergies is probably allergen-specific, persists throughout life, and does not occur until the patient encounters the appropriate allergen for a sufficiently long period. OBJECTIVE The present study aimed to test this hypothesis by following-up a large cohort of patients monosensitized to airborne allergens. METHODS The prevalence and characteristics of new sensitizations to airborne allergens after >2 years of follow-up were retrospectively assessed in 726 patients monosensitized to grass, pellitory, mite, birch, ragweed, Alternaria, mugwort, or plantain living North of Milan. RESULTS The overall prevalence of new sensitizations w...

Journal of Investigational Allergology and Clinical Immunology

This article has been accepted for publication and undergone full peer review but has not been th... more This article has been accepted for publication and undergone full peer review but has not been through the copyediting, types etting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

European Annals of Allergy and Clinical Immunology

Background: About 50% of patients with severe chronic spontaneous urticaria (CSU) show signs of a... more Background: About 50% of patients with severe chronic spontaneous urticaria (CSU) show signs of activation of the coagulation/fibrinolysis system, but the clinical significance of this phenomenon is unclear. Objective: The present study compared patients with severe CSU showing and not showing elevated D-dimer plasma levels. Methods: 132 adult patients (M/F 44/88; mean age 51, 5 years; range 14-89 years) with severe CSU (UAS-7 > 30) were included in a cross-sectional, real life study. The study group was divided based on baseline D-dimer plasma levels, and compared for age, sex, disease duration, disease activity, CRP, thyroid autoimmunity, total IgE, and atopic status. Results: Identical numbers of patients showed elevated and normal D-dimer plasma levels (50% and 50%, respectively). Patients showing elevated D-dimer levels were slightly older (p< 0.05), were more frequently females (p< 0.05), had a longer disease duration (p< 0.01), and had a significantly higher prevalence of elevated PCR (26/66 vs 4/66; p < 0.001). Conclusions: Only 50% of patients with severe CSU show elevated D-dimer plasma levels. The activation of the coagulation/fibrinolysis system is associated with a systemic inflammatory milieu, suggesting the existence of a specific phenotype. Whether this reflects the existence of different endotypes in patients showing and not showing the activation of the coagulation cascade has still to be established.

Allergy

Impact of ocular symptoms on quality of life (QoL), work productivity and resource utilisation in... more Impact of ocular symptoms on quality of life (QoL), work productivity and resource utilisation in allergic rhinitis patients-an observational, cross sectional study in four countries in Europe.

Allergy

Christian Lupinek Valérie Siroux Rachel Nadif Jocelyne Just Jean Bousquet Rudolf Valenta Thomas A... more Christian Lupinek Valérie Siroux Rachel Nadif Jocelyne Just Jean Bousquet Rudolf Valenta Thomas A. Platts-Mills Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands The Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Inserm, CNRS, Institute for Advanced Biosciences (IAB), U1209 Joint Research Center, University Grenoble Alpes, Grenoble, France INSERM U1168, VIMA: Aging and Chronic Diseases. Epidemiological and Public Health Approaches, Villejuif, France UMR-S 1168, Univ Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France Assistance Publique-Hôpitaux de Paris, Allergology Department, Hôpital Armand-Trousseau, Paris, France Université Paris, Paris, France University Hospital, Montpellier, France Asthma and Allergic Diseases Center, University of Virginia Health System, Charlottesville, Virginia

F1000Research

Chronic urticaria is a spontaneous or inducible group of diseases characterized by the occurrence... more Chronic urticaria is a spontaneous or inducible group of diseases characterized by the occurrence of wheals (and, in about half of cases, angioedema) for more than 6 weeks. These are rather frequent conditions that may severely affect patients’ quality of life and sometimes represent a challenge for doctors as well. The causes of chronic urticaria are still poorly defined, although there is growing evidence that different biologic systems including immunity, inflammation, and coagulation may take part in the pathomechanism eventually leading to mast cell and basophil degranulation and hence to wheal formation. This review will discuss the main findings that are (slowly) shedding light on the pathogenesis of this disorder.

Journal of Investigational Allergology and Clinical Immunology, 2016

BACKGROUND: Functionally active autoantibodies to IgE and to the high affinity IgE receptor (FcεR... more BACKGROUND: Functionally active autoantibodies to IgE and to the high affinity IgE receptor (FcεRI) can be detected in sera from about 40% of patients with chronic spontaneous urticaria (CSU). Recent studies showed that CSU sera can induce the activation of mast cells bearing or not the high affinity IgE receptors. OBJECTIVE: This study aimed at evaluating mast cell activation induced by CSU serum factors with a molecular weight lower than that of autoantibodies. METHODS: Eight CSU patients and 5 normal controls were evaluated. Whole sera and sera fractioned at 100, 50 and 30 kDa were used to stimulate in vitro LAD2 mast cells. The enzymatic activity of β-hexosaminidase was evaluated in supernatants and cell pellets as a measure of mast cell degranulation. RESULTS: Mast cell β-hexosaminidase release induced by whole sera from CSU patients (14.4±2.7 %, mean ± SEM) was higher than that induced by sera from normal controls (5.1±2.4%; p=0.027). Also serum fractions below 100 kDa and below 50 kDa from CSU patients induced a mast cell degranulation that was significantly higher than that induced by the corresponding fractions from normal control sera (10.2±1.4% vs 3.8±1.9% [p=0.024] and 10.1±1.2% vs 3.9±1.7% [p=0.012], respectively). In 4 CSU patients we evaluated serum fractions below 30 kDa which retained the same capacity to activate mast cells (11.0±0.7%). CONCLUSIONS: This study shows that sera from CSU patients may contain low molecular weight mast cell activating factors other than autoantibodies. This might be an additional mechanism contributing to the pathogenesis of CSU.

European Annals of Allergy and Clinical Immunology, Mar 1, 2011

Background: The allergenic profile of patients hypersensitive to pollen pan-allergens, profilin a... more Background: The allergenic profile of patients hypersensitive to pollen pan-allergens, profilin and polcalcin, has received little attention so far. Objective: To detect whether hypersensitivity to profilin and polcalcin follows sensitization to specific allergen sources or represents a primary phenomenon, and to examine the sensitization profiles of patients hypersensitive to pollen pan-allergens. Methods: IgE reactivity to markers of primary sensitisation to different pollen species including grass, mugwort, ragweed, pellitory, birch, olive, and cypress was detected in sera from 106 pollen-allergic subjects, 86 sensitised to profilin and 29 to polcalcin living in two distinct areas of Northern Italy. Results: In profilin hypersensitive patients the primary sensitizer was detected in 24/86 (28%) cases: grass (n= 15), ragweed (n=7), and birch (n=2). In 62 (72%) cases the primary sensitizing pollen was not detectable. In the polcalcin group the primary sensitizing pollen was detected in 8/29 (28%) cases: grass (n=6), ragweed and pellitory (1 each). All ragweed-allergic subjects were from the Milan area. In the 9 patients hypersensitive to both panallergens the primary sensitizing source could be identified in 2 (23%) cases (grass in both cases). Conclusion: A putative primary sensitizer to pollen pan-allergens can be detected only in ¼ of cases, as most patients show IgE specific for > 1 pollen species. In these patients the prevalence of the primary sensitizer parallels the prevalence of clinical allergy to the different pollen sources in that specific geographic area. Most pollen sources are probably able to cause sensitization to cross-reacting pollen pan-allergens.

PLOS ONE, 2016

Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria-Centro di ricerca per l... more Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria-Centro di ricerca per l'orticoltura,

Expert Review of Clinical Immunology, 2015

Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano (Milano), Italy; Ambulatorio di A... more Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano (Milano), Italy; Ambulatorio di Allergologia e Immunologia Clinica, U.O. Medicina Interna, A.O. Fatebenefratelli e Oftalmico, Milano, Italy; Unità di Dermatologia, Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy; Medicina Interna, Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy

European Annals of Allergy and Clinical Immunology, Jun 1, 2011

Background: Olive pollen sensitization is surprisingly frequent in Milan, an area that is virtual... more Background: Olive pollen sensitization is surprisingly frequent in Milan, an area that is virtually both olive-and ash-free. Objective: To establish the prevalence of olive pollen sensitization north of Milan, and to investigate the allergens involved. Methods: 300 pollenallergic patients living in this area were randomly selected. Based on SPT results, olive pollen reactors were classified as multi-sensitized, oligo-sensitized, or mono-sensitized. IgE to markers of primary sensitization to olive pollen (Ole e 1), as well as to pollen pan-allergens such as profilin (Phl p 12) or polcalcin (Phl p 7) were measured. Further, the putative cross-reactivity between grass group XI allergen and Ole e 1 was investigated. Results: 107 (36%) patients were sensitized to olive pollen; 67 (63%) were multi-sensitized, while only 4 (4%) were mono-sensitized. Specific IgE to Ole e 1 were found in 32/46 (70%) cases; 22 of them (69%) co-recognized pollen pan-allergens, as shown by IgE reactivity to Phl p 7 and/or Phl p 12. Sera from 14 (30%) patients did not react to Ole e 1; of these, 10 (71%) were pan-allergens reactors. No correlation was found between IgE levels to Phl p 11 and Ole e 1. Conclusions: A majority of olive pollen-sensitized subjects seen in the surroundings of Milan are truly allergic to Oleaceae. In the absence of both olive and ash trees exposure to privet pollen might represent the source of this kind of sensitization.