Showing papers by "Gennaro Liccardi published in 2018"

Allergic sensitization to common pets (cats/dogs) according to different possible modalities of exposure: an Italian Multicenter Study

Abstract: The query “are there animals at home?” is usually administered for collecting information on anamnesis. This modality to consider exposure to pet allergens constitutes a potential bias in epidemiological studies and in clinical practice. The aim of our study was to evaluate/quantify different modalities of exposure to cat/dog in inducing allergic sensitization. Thirty Italian Allergy units participated in this study. Each centre was required to collect the data of at least 20 consecutive outpatients sensitized to cat/dog allergens. A standardized form reported all demographic data and a particular attention was paid in relieving possible modalities of exposure to cat/dog. A total 723 patients sensitized to cat/dog were recorded, 359 (49.65%) reported direct pet contact, 213 patients (29.46%) were pet owners, and 146 subjects (20.19%) were exposed to pets in other settings. Other patients were sensitized by previous pet ownership (150–20.75%) or indirect contact (103–14.25%), in 111 subjects (15.35%) any contact was reported. Only 213 patients (29.46%) would be classified as “exposed to animals” and 510 (70.54%) as “not exposed” according to usual query. Our classification has shown that many “not-exposed” subjects (399–55.19%) were “really exposed”. The magnitude of exposure to pet allergens at home is not related exclusively to pet ownership. These considerations should be taken into account during the planning of epidemiological studies and in clinical practice for the management of pet allergic individuals.

Psychological Stress, Lung Function and Exacerbation Risk in COPD: Is an Increase of Cholinergic Tone a Possible Link?

Abstract: at a glance: On the hypothesis that psychological distress might interfere with airway reactivity in patients suffering of mild to moderate COPD through a cholinergic-mediated-bronchial reflex.

Critical aspects in dog allergen immunotherapy (DAI). May Component Resolved Diagnosis (CRD) play a role in predicting the efficacy

Abstract: We hypothesize that a pivotal condition determining the efficacy of dog allergen immunotherapy (DAI) might be the mono-sensitization to dog lipocalins (Can f 1-2) in individuals not directly or indirectly exposed to other furry animals. In fact, the concomitant sensitization to lipocalins and/or albumins, especially in those patients directly exposed to furry animals, may potentially stimulate patient's airways by inducing persistent inflammation and, thus, clinical symptoms. In these conditions, it is likely that DAI alone could be inadequate to reduce airway inflammation mediated by inhalation of dog allergens in patients with simultaneous exposure to other furry animals. Can f 5 has been found as exclusive allergen in about one third of dog-sensitized individuals. Considering the presence of different allergenic materials in extract of mammalian origin, it is evident that a standard DAI is not likely to be effective in Can f 5 prevalent or mono-sensitized individuals. Moreover, we would underline the need of collecting detailed information on the possible exposures to furry animals (other than the common pets), an information that usually is neglected in clinical practice. Furthermore, a detailed clinical history exploring the real significance of dog sensitization (mono or poly-sensitization, induction of clinical symptoms after exposure etc.) should be performed before prescribing DAI. In some patients, with potential high susceptibility to animal allergens, the use of CRD is essential to verify the presence of concomitant allergic sensitization to lipocalins and/or albumins belonging to other furry animals. The availability of CRD introduced the possibility of a better targeted prescription of DAI because it might be useful for point out the primary allergens and for the exclusion of cross-reactive ones.

Dog allergy: can a prevalent or exclusive sensitization to Can f 5 be considered a lucky or negative event in real life?

Abstract: Summary Recent studies have shown the increasing relevance of allergic sensitization to Can f 5 (a prostatic kallikrein), which is an androgen-regulated protein expressed in the prostate and detectable only in male dogs. Can f 5 can be a prevalent or exclusive sensitizing agent in a considerable percentage of dog-allergic patients. Its specific allergenic characteristics are able to induce possible negative as well as positive clinical effects in individuals sensitized to dogs. In the present article we pointed out the possible pros or cons of sensitization to this allergen in real life. Further studies should be carried out to correctly assess some peculiar characteristics of Can f 5, in order to support the most of positive aspects and remedy at best the negative effects.

Geographical characteristics influencing the risk of poisoning in pet dogs: Results of a large population-based epidemiological study in Italy.

Abstract: Pets can act as sentinels for human health and thus surveillance of pet dogs has the potential to improve awareness of emerging risks for animal and public health. The aim of this study was to investigate factors associated with the risk of canine poisoning. In a large population-based epidemiological investigation in Italy performed from January 2015 to January 2016 and April 2016 to April 2017, descriptive statistics were acquired and analysed to determine variables associated with poisoning events in pet dogs. Results were validated in a test population and forecast analysis of risk was performed. The cumulative incidence of poisoning events was low (10.2/1000 dogs/year). Anticoagulant rodenticides, organophosphate pesticides, metaldehyde and strychnine were the most frequent causes of intoxications. Territory characteristics significantly modulated both the frequency and the nature of the involved substances. The seashore area was associated with poisoning by rodenticides (odds ratio, OR, 1.81, 95% confidence interval, CI, 1.54–2.13) and metaldehyde (OR 1.61, 95% CI 1.16–2.28). The hill country area was associated with poisoning by organophosphate pesticides (OR 1.73, 95% CI 1.38–2.15), metaldehyde (OR 2.26, 95% CI 1.53–3.25) and strychnine (OR 1.86, 95% CI, 1.34–2.57). The mountain area was associated with strychnine poisoning (OR 3.79, 95% CI 2.84–5.06). The prospective cumulative incidence of poisoning over 10 years was 9.74% (95% CI 9.57–9.91). These results may be useful for predicting the risk of poisoning and for estimating the risk index related to specific toxic compounds in specific territories. This study suggests that poisoning events in dogs may represent a problem of public health with the potential to affect wildlife and human beings.

Anxiety and asthma in youth. Is a stress-induced increased cholinergic tone the possible link?

Abstract: To the Editor, We read with interest the excellent article of Dudeney et al dealing the crucial topic of anxiety and asthma co-morbidity in youth. The authors examined data of several studies and reported that youth with asthma has an anxiety disorder prevalence rate of 22.7%, and that anxiety disorders in youthwith asthma aremore frequent than in those without asthma. Dudeney et al results are described and discussed by a psychological point of view, on which we have nothing to add. Anxiety and asthma are two common clinical conditions and, consequently, the risk of overlap is high. However, further explanations are possible and they have been neither indicated in the manuscript nor included in the limitations already recognized by the authors. Since this is a pulmonology journal we wish to suggest some possible mechanisms in order to explain the high co-existence rate between stress/anxiety and asthma in youth. A fundamental premise is that asthmatic youth (particularly adolescents) may experience a period of physical and psychosocial changes that affect their health and well-being. Overall, adolescents with asthma are at increased risk for asthma morbidity and death. Increased rates of depression and anxiety, for the adolescent and their caregivers, can lead to non-adherence to their medical regimens, poor symptom control and poor treatment outcomes. Asthma during adolescence impairs health-related quality of life, especially if the asthma is uncontrolled. We have previously shown that about 63% of asthmatics reported the usual appearance of at least one non-respiratory symptom (n-RS) before an asthma attack. N-RSs were significantly more frequent in asthmatics suffering from persistent moderate/severe disease in comparison to those with intermittent/persistent mild asthma. Most patients (43.52%) reported an interval <3 hr between the appearance of n-RSs and the onset of an asthma attack, similar results have been demonstrated also in children. Behavioural symptoms such as anxiety and, to a lesser extent, depression, represented themost commonn-RSs in our study. This finding confirms the possible role of anxiety disorders in the development and triggering of an asthma attack. Studies have shown that psychological stress may enhance bronchial hyperreactivity through several mechanisms, such as mast cell activation and mediator release, inflammation and imbalance of the autonomic system. Both in vitro and clinical studies established a significant relationship between psycho-social stress and stimulation of the cholinergic system. Ritz and colleagues examined the respiratory responses of asthmatics after a psychological stress induced by vision of bloody films or other visual stimulations. The authors concluded that an increased vagal tone could be responsible for the increased airway resistance, via a faster vagalmediated onset response (after 1-2min following the stimulus). A case report has also demonstrated that an intensive psychological stress (being rejected by his girl-friend in facebook) is able to trigger severe bronchial obstruction in an adolescent suffering from mite-allergic asthma. Such severe aggravations of clinical symptoms are likely to be related to facebook-induced psychological stress. It is likely that some symptoms induced by cholinergic hyperactivity/hyperactivation, such as those determined by psychological stress, could be presented together with parasympathetic-associated RSs, as those elicited by airway narrowing themselves. On the basis of these considerations, we suggest that attention should be focused on considering the role of the parasympathetic system as a trigger of bronchial obstruction in asthmatic adolescents who report the usual onset of cholinergic-related n-RSs (particularly stress/anxiety) before an asthma attack. Indirectly, the results of our study confirmed the assumption that cholinergic pathway is a determinant bronchoconstrictor, at least in a group of asthmatic patients. We have hypothesized that, in some individuals, this condition might play a predominant role in determining airway obstruction, compared with other well-known factors such as allergens/air pollutants, infections, exercise etc. (a definite “asthma phenotype”?). The anxiety/stress-induced vagal hyperactivity in asthmatics constitutes the basis of important considerations from a therapeutic point of view. In fact, we could postulate that blocking muscarinic impulse transmission at the airway smooth muscle might be more beneficial to control airway obstruction and mucus secretions in these asthmatics. Although the tolerability and efficacy of anticholinergic agents (especially long-acting muscarinic antagonists [LAMAs]) have been investigated in adolescents suffering from asthma, we believe that LAMAs could be more useful in those patients characterized by increased cholinergic activity. Considering this background, we suggest also the necessity of an adequate phenotyping of asthmatic adolescents whocouldbenefit from theuseof tiotropiumor ipratropium through the evaluation of basal cholinergic tone. O2 inhalation, neck suction, slow deep breathing, metacholine inhalation, multiple frequency forced oscillation technique (FOT), measurement of resting heart rate and pupillometry constitute the most efficacious methods for evaluation of thedegreeof vagal tone.Thepositivityof this finding couldbeapossible prediction of clinical response to LAMAs. Finally, this possible increased Authorship: All authors contributed equally in the writing and revision of the manuscript.