monocytes with heterozygous mutations of TLR4 to endotoxin suggesting that other TLR4 ligands such as heat shock proteins, or defensins may display impaired binding to TLR4. Although the molecular mechanism remains undefined, our observation suggests that the TLR4 polymorphism may confer susceptibility to pneumonia in children. We thank A. Amoroso (Genetic section of Burlo Garofalo Children’s Hospital, Trieste, Italy) and P.K. Das (Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands) for their fruitful comments and suggestions. We are grateful to Antonietta Silini for reviewing the manuscript. This work is funded by Italian Ministry of Education (FIRB project), MIUR Cofinanziamento and Ministry of Health joint project IRCCS-Burlo Garofalo to LDN. R. Badolato and S. Fontana equally contributed to the work.

AllergyVolume 57, Issue 1 p. 52-53 Immediate hypersensitivity due to pseudoephedrine M. Venturini, M. Venturini Hospital Clínico Universitario “Lozano Blesa”Servicio de alergología C/San Juan Bosco, 15 50009 Zaragoza SpainSearch for more papers by this authorA. Lezaun, A. Lezaun Hospital Clínico Universitario “Lozano Blesa”Servicio de alergología C/San Juan Bosco, 15 50009 Zaragoza SpainSearch for more papers by this authorT. Abos, T. Abos Hospital Clínico Universitario “Lozano Blesa”Servicio de alergología C/San Juan Bosco, 15 50009 Zaragoza SpainSearch for more papers by this authorJ. Fraj, J. Fraj Hospital Clínico Universitario “Lozano Blesa”Servicio de alergología C/San Juan Bosco, 15 50009 Zaragoza SpainSearch for more papers by this authorS. Monzón, S. Monzón Hospital Clínico Universitario “Lozano Blesa”Servicio de alergología C/San Juan Bosco, 15 50009 Zaragoza SpainSearch for more papers by this authorC. Colas, C. Colas Hospital Clínico Universitario “Lozano Blesa”Servicio de alergología C/San Juan Bosco, 15 50009 Zaragoza SpainSearch for more papers by this authorF. Duce, F. Duce Hospital Clínico Universitario “Lozano Blesa”Servicio de alergología C/San Juan Bosco, 15 50009 Zaragoza SpainSearch for more papers by this author M. Venturini, M. Venturini Hospital Clínico Universitario “Lozano Blesa”Servicio de alergología C/San Juan Bosco, 15 50009 Zaragoza SpainSearch for more papers by this authorA. Lezaun, A. Lezaun Hospital Clínico Universitario “Lozano Blesa”Servicio de alergología C/San Juan Bosco, 15 50009 Zaragoza SpainSearch for more papers by this authorT. Abos, T. Abos Hospital Clínico Universitario “Lozano Blesa”Servicio de alergología C/San Juan Bosco, 15 50009 Zaragoza SpainSearch for more papers by this authorJ. Fraj, J. Fraj Hospital Clínico Universitario “Lozano Blesa”Servicio de alergología C/San Juan Bosco, 15 50009 Zaragoza SpainSearch for more papers by this authorS. Monzón, S. Monzón Hospital Clínico Universitario “Lozano Blesa”Servicio de alergología C/San Juan Bosco, 15 50009 Zaragoza SpainSearch for more papers by this authorC. Colas, C. Colas Hospital Clínico Universitario “Lozano Blesa”Servicio de alergología C/San Juan Bosco, 15 50009 Zaragoza SpainSearch for more papers by this authorF. Duce, F. Duce Hospital Clínico Universitario “Lozano Blesa”Servicio de alergología C/San Juan Bosco, 15 50009 Zaragoza SpainSearch for more papers by this author First published: 06 March 2002 https://doi.org/10.1046/j.0105-4538.2001.00001.x-i11 Three cases of probably nonallergic hypersensitivity. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume57, Issue1January 2002Pages 52-53 RelatedInformation

The Asthma Autonomy Questionnaire (AAQ) was designed to evaluate asthmatics' desire to learn about their disease and to make decisions. The AAQ consists of 26 items distributed in two scales: Preferences in the Search for Information (PSI, 8 items) and Preferences in Decision Making (PDM, 6 general items and 12 related to 3 scenarios depicting asthma in stable phase, during mild exacerbation and during severe exacerbation). The aim of this study was to analyze the internal consistency (Cronbach's-coefficient) and content validity (factorial analysis of principal components) of the AAQ. After translation and back translation, the Spanish version of the AAQ was administered to 115 adult asthmatics of both sexes and differing levels of severity. The alpha coefficients for the two scales and 3 scenarios ranged from 0.42 (PSI) to 0.73 (stable phase scenario); only for the stable-phase scenario were values high or statistically acceptable. Factorial analysis reproduced the content of the scales only approximately, with some items proving to relate to factors that were different from the scale they originally belonged to. These results indicate that, in its current formulation, the AAQ presents important measurement problems and revision is advisable.

The Asthma Autonomy Questionnaire (AAQ) was designed to evaluate asthmatics' desire to learn about their disease and to make decisions. The AAQ consists of 26 items distributed in two scales: Preferences in the Search for Information (PSI, 8 items) and Preferences in Decision Making (PDM, 6 general items and 12 related to 3 scenarios depicting asthma in stable phase, during mild exacerbation and during severe exacerbation). The aim of this study was to analyze the internal consistency (Cronbach's-coefficient) and content validity (factorial analysis of principal components) of the AAQ. After translation and back translation, the Spanish version of the AAQ was administered to 115 adult asthmatics of both sexes and differing levels of severity. The alpha coefficients for the two scales and 3 scenarios ranged from 0.42 (PSI) to 0.73 (stable phase scenario); only for the stable-phase scenario were values high or statistically acceptable. Factorial analysis reproduced the content of the scales only approximately, with some items proving to relate to factors that were different from the scale they originally belonged to. These results indicate that, in its current formulation, the AAQ presents important measurement problems and revision is advisable.

To assess the relationship between acute viral bronchiolitis and subsequent development of asthma, we studied retrospectively 97 index children, aged between 9 and 14 years, and 52 controls. The bronchiolitis group showed significantly lower values for mean expiratory flow at 50% of vital capacity (MEF50) higher incidence of atopy, and were more sensitive to methacholine than were controls, even if they had not shown recurrent wheezing episodes. It is suggested that an increased incidence of atopy, bronchial hyperresponsiveness, and reduced expiratory flows may be detectable in children with a history of acute bronchiolitis, regardless of the fact that they did not develop subsequent clinical symptoms suggestive of bronchial asthma.

Patient cooperation in controlling asthma is a key element for achieving the most efficient therapy possible according to current guidelines. Cooperation requires that the patient be adequately informed about his disease and able to make certain decisions. The aim of this study was to analyze whether patients really desire information about asthma and to what point they are disposed to cooperate actively in managing their disease. Ninety-five adult asthmatics with different levels of severity of disease were studied in stable condition. All responded to the Spanish version of the questionnaire on autonomy in asthma, an instrument with a scoring range of 0 to 100 and 26 items grouped in two subscales: preferences in the search for information (PSI) and preferences in decision making (PDM). The second subscale was based on three scenarios describing stable asthma, slight exacerbation and severe exacerbation. The results obtained indicate that although patients are greatly interested in receiving information (PSI scores of 86.4 +/- 8.7) they express substantially less desire to make decisions (PDM 45 +/- 10.2) (p < 0.01). Attitudes did not change in relation to education, number of exacerbations during the last year, duration of disease or severity as assessed by the patient. Only patient age (with older patients scoring higher on PSI) and presence of severe asthma (according to consensus guidelines) increased the desire for information (but not the preference for decision making). These data indicate the need to implement educational programs about asthma, components of which promote effective desire for self-management.

This study investigates the effects of moderate-high altitude on lung function and exercise performance in 46 volunteers (19 females, 27 males), with a mean age of 42.4 +/- 1.4 years (+/- SEM) and varying smoking and exercise habits, who were not previously acclimatized. Measures obtained in the base camp (1140 m) and at altitude (2630 m), in random order, included forced spirometry, maximal voluntary ventilation, maximal inspiratory and expiratory pressures, arterial oxygen saturation and capillary lactate concentration after a standardized exercise test. The smoking history, Fagerström test and degree of habitual physical activity were also recorded for each participant. The percentage of smokers was similar in males (19%) and females (21%) (P = n.s.). Mean habitual physical activity index was 8.2 +/- 0.2 (range, 5.88-11.63). At the base camp, all lung function variables were within the normal range. Lactate concentration after exercise averaged 3.7 +/- 0.3 mm l-1. No significant change was observed at altitude, except for a higher heart rate and a lower arterial oxygen saturation (SaO2) (both at rest and after inspiratory manoeuvres). The smoking history and the degree of physical activity did not influence lung function or exercise performance at altitude. The results of this study show that in middle-aged, healthy, not particularly well-trained individuals, lung function is not significantly altered by moderate-high altitude, despite the absence of any acclimatization period and independent of their smoking history and previous exercise habits.

Patient cooperation in controlling asthma is a key element for achieving the most efficient therapy possible according to current guidelines. Cooperation requires that the patient be adequately informed about his disease and able to make certain decisions. The aim of this study was to analyze whether patients really desire information about asthma and to what point they are disposed to cooperate actively in managing their disease. Ninety-five adult asthmatics with different levels of severity of disease were studied in stable condition. All responded to the Spanish version of the questionnaire on autonomy in asthma, an instrument with a scoring range of 0 to 100 and 26 items grouped in two subscales: preferences in the search for information (PSI) and preferences in decision making (PDM). The second subscale was based on three scenarios describing stable asthma, slight exacerbation and severe exacerbation. The results obtained indicate that although patients are greatly interested in receiving information (PSI scores of 86.4 +/- 8.7) they express substantially less desire to make decisions (PDM 45 +/- 10.2) (p < 0.01). Attitudes did not change in relation to education, number of exacerbations during the last year, duration of disease or severity as assessed by the patient. Only patient age (with older patients scoring higher on PSI) and presence of severe asthma (according to consensus guidelines) increased the desire for information (but not the preference for decision making). These data indicate the need to implement educational programs about asthma, components of which promote effective desire for self-management.

In this uncontrolled, multicenter study, 746 patients with asthma received 8 weeks of treatment with formoterol 12 or 24 μg BID to assess the relationship between indicators of ventilatory function and quality of life. In addition, 95.5% of patients received concomitant antiasthmatic drugs. Outpatient measurements of peak expiratory flow (PEF) were obtained, and quality of life was measured using the Spanish version of the Asthma Quality-of-Life Questionnaire (AQLQ) in 553 patients (286 women, 267 men; mean age, 46.3 ± 14.2 years). The mean number of symptom-free days per week increased from 6.0 ± 1.8 (week 1) to 6.3 ± 1.7 (week 8) (P < 0.0005) and the number of symptom-free nights per week increased from 6.0 ± 1.7 (week 1) to 6.3 ± 1.7 (week 8) (P < 0.0005). After 8 weeks of treatment, daytime PEF increased from 354.9 ± 122.0 L/min to 405.8 ± 123.2 L/min (P < 0.0005) and nighttime PEF increased from 369.0 ± 120.2 L/min to 403.0 ± 121.3 L/min (P < 0.0005). The AQLQ score improved from 4.7 ± 2.3 (initial) to 1.9 ± 2.1 (final) (P < 0.0005). A small relationship was found between the improvement in daytime or nighttime PEF and the improvement in quality of life over the course of the study (r = -.2574 and r = -.2467; P < 0.0005, in both cases). In addition to measuring PEF and counting daytime and nighttime symptoms, the AQLQ questionnaire provided useful information to assess the achievement of the therapeutic objective and to assist in decision making.

AllergyVolume 53, Issue 1 p. 105-106 Anaphylaxis from linseed A. Lezaun, A. Lezaun Avda San Juan Bosco 15 Department of Allergology Hospital Clinico Universitario 50009 Zaragoza SpainSearch for more papers by this authorJ. Fraj, J. Fraj Avda San Juan Bosco 15 Department of Allergology Hospital Clinico Universitario 50009 Zaragoza SpainSearch for more papers by this authorC. Colás, C. Colás Avda San Juan Bosco 15 Department of Allergology Hospital Clinico Universitario 50009 Zaragoza SpainSearch for more papers by this authorF Duce, F Duce Avda San Juan Bosco 15 Department of Allergology Hospital Clinico Universitario 50009 Zaragoza SpainSearch for more papers by this authorM. A. Dominguez, M. A. Dominguez Avda San Juan Bosco 15 Department of Allergology Hospital Clinico Universitario 50009 Zaragoza SpainSearch for more papers by this authorM. Cuevas, M. Cuevas Avda San Juan Bosco 15 Department of Allergology Hospital Clinico Universitario 50009 Zaragoza SpainSearch for more papers by this authorP Eiras, P Eiras Avda San Juan Bosco 15 Department of Allergology Hospital Clinico Universitario 50009 Zaragoza SpainSearch for more papers by this author A. Lezaun, A. Lezaun Avda San Juan Bosco 15 Department of Allergology Hospital Clinico Universitario 50009 Zaragoza SpainSearch for more papers by this authorJ. Fraj, J. Fraj Avda San Juan Bosco 15 Department of Allergology Hospital Clinico Universitario 50009 Zaragoza SpainSearch for more papers by this authorC. Colás, C. Colás Avda San Juan Bosco 15 Department of Allergology Hospital Clinico Universitario 50009 Zaragoza SpainSearch for more papers by this authorF Duce, F Duce Avda San Juan Bosco 15 Department of Allergology Hospital Clinico Universitario 50009 Zaragoza SpainSearch for more papers by this authorM. A. Dominguez, M. A. Dominguez Avda San Juan Bosco 15 Department of Allergology Hospital Clinico Universitario 50009 Zaragoza SpainSearch for more papers by this authorM. Cuevas, M. Cuevas Avda San Juan Bosco 15 Department of Allergology Hospital Clinico Universitario 50009 Zaragoza SpainSearch for more papers by this authorP Eiras, P Eiras Avda San Juan Bosco 15 Department of Allergology Hospital Clinico Universitario 50009 Zaragoza SpainSearch for more papers by this author First published: 29 April 2007 https://doi.org/10.1111/j.1398-9995.1998.tb03785.xCitations: 18AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1 Alonso L, Marcos ML, Blanco JG, et al. Anaphylaxis caused by linseed. J Allergy Clio Immunol 1996; 98: 469–70. 2 Black WC. Flax hypersensitiveness. JAMA 1930; 94: 1064. 3 Grant LR. A report of six cases of flaxseed sensitization with review of the literature. J Allergy 1931; 3: 469–77. Citing Literature Volume53, Issue1January 1998Pages 105-106 ReferencesRelatedInformation

La prueba de provocación bronquial específica (PPBE) representa el método clave en el diagnóstico etiológico del asma ocupacional (AO). Sus indicaciones son precisas e incluyen casos en los que existen varios agentes en el ambiente laboral potencialmente causantes de AO, reconocimiento de agentes ocupacionales nuevos o poco frecuentes, existencia de litigio médico-legal y como herramienta de investigación. La metodología de la PPBE no está universalmente estandarizada debido a la gran heterogeneidad de los diferentes agentes ocupacionales y a sus diversas propiedades físicoquímicas. Así, los agentes que se encuentran en forma de humos, gases o vapores podrán ser utilizados en PPBE dentro de cabinas especiales, en circuitos cerrados y monitorización constante de las concentraciones subirritantes. Los agentes que se encuentran en forma de polvo, la mayoría de sustancias de elevado peso molecular y algunas de bajo peso molecular, pueden ser adecuados para PPBE de rutina en un laboratorio de alergia. Sólo estos casos serán referidos en este trabajo. La PPBE debe ser realizada en centros especializados y por personal experimentado al ser una técnica sofisticada y potencialmente peligrosa. Presentamos una serie de 20 pacientes diagnosticados de AO en nuestro servicio en los últimos 2 años, sometidos a PPBE, gracias a la cual se obtuvo el diagnóstico etiológico. Todos estaban expuestos a material pulvígeno o aerosoles en su trabajo. En 17 casos el agente causal fue una sustancia de elevado peso molecular y en tres fueron sustancias de bajo peso molecular. Se describe la metodología llevada a cabo y se discuten los modelos de respuesta bronquial. Specific bronchial challenge (SBC) testing is a key technique for diagnosing the origin of occupational asthma (OA). SBC is indicated in specific circumstances, including whenever several agentes present in the work environment may be the cause of OA, when new or unusual occupational agents need to be identified, when evidence for legal action is required, or when research is conducted. SBC procedures are not standardized, because of the great diversity of occupational agents and the variety of physical and Chemical properties involved. Thus, SBC testing with agents found in fumes, gases or vapors can be administered in special cabins or in closed circuits with continuous monitoring of sub-irritant concentrations. Agents found in dust, most but not all of which have high molecular weights, may be appropriate for routine SBC testing in an allergy laboratory. This paper will treat only these cases. SBC must be formed in specialized centers by experienced personnel, as it is a sophisticated and potentially dangerous technique. We describe a series of 20 patients diagnosed of OA in our unit over the past two years in whom SBC provided an etiologic diagnosis. All were exposed to dust or aerosols at work. The cause was a substance of high molecular weight in 17 cases, and low molecular weight in 3. The procedure used is described and models of bronchial response are discussed.

Specific bronchial challenge (SBC) testing is a key technique for diagnosing the origin of occupational asthma (OA). SBC is indicated in specific circumstances, including whenever several agents present in the work environment may be the cause of OA, when new or unusual occupational agents need to be identified, when evidence for legal action is required, or when research is conducted. SBC procedures are not standardized, because of the great diversity of occupational agents and the variety of physical and chemical properties involved. Thus, SBC testing with agents found in fumes, gases or vapors can be administered in special cabins or in closed circuits with continuous monitoring of sub-irritant concentrations. Agents found in dust, most but not all of which have high molecular weights, may be appropriate for routine SBC testing in an allergy laboratory. This paper will treat only these cases. SBC must be formed in specialized centers by experienced personnel, as it is a sophisticated and potentially dangerous technique. We describe a series of 20 patients diagnosed of OA in our unit over the past two years in whom SBC provided an etiologic diagnosis. All were exposed to dust or aerosols at work. The cause was a substance of high molecular weight in 17 cases, and low molecular weight in 3. The procedure used is described and models of bronchial response are discussed.

A double-blind, randomized study was conducted to compare salmeterol aerosol 42 ttg twice daily with albuterol aerosol 180 pg four times daily for 12 weeks in patients with mild-to-moderate asthma.At baseline and at weeks 4, 8, and 12, the Asthma Quality of Life Questionnaire (AQLQ) was administered to 267 patients.Each question was scored on a scale from 1 to 7, with lower scores indicating greater impairment in quality of life.The efficacy population was used for all analyses.There were no differences between the groups at baseline for the AQLQ.The overall quality of life score was significantly greater in the salmeterol group than in the albuterol group at weeks 4, 8, and 12 (5.44,5.60, 5.62 vs 4.90, 5.09, 5.11, respectively; p<0.037).Significant within treatment group change from baseline scores was reported for both salmeterol and albuterol, however, only the salmeterol group change met the reported critcria for a minimally important change to the patient (a change of >0.5 from baseline score).For the Asthma Symptoms and Emotional Function domains, salmeterol was significantly higher than albuterol (p<0.05) at weeks 4, 8, and 12. Mean morning PEFR for salmeterol were greater (p<0.001)than albuterol at all treatment visits.The AM/PM PEFR differentials for salmeterol were significantly less (p<0.001)than albuterol at all treatment weeks.In summary, patients who received salmeterol 42 gg twice daily showed significantly higher asthma-specific quality of life scores and improvement from baseline than patients who received albuterol four times daily.These findings are consistent with clinical efficacy results reported from the study. 295

This report deals with clinical and immunologic studies in a butcher with work‐related asthma. Both the positive methacholine inhalation test and the significant changes observed in PEFR measurements supported the diagnosis of asthma. The significant fall observed in PEFR measurements when the patient handled aniseed supported the diagnosis of occupationa asthma. Skin prick tests carried out with 13 spices showed positive reactions only to aniseed extract. The patient had high levels of specific antianiseed IgE antibodies. The bronchial challenge test with an aniseed extract showed an immediate response without a late response. These findings suggest that the respiratory symptoms in our patient were induced by the inhalation of aniseed dust through an IgE‐mediated immunologic mechanism of immediate hypersensitivity. This study established the diagnosis of occupational asthma from aniseed dust sensitization.