OBJECTIVEWe evaluated, by means of a multicentre, prospective observational trial, the severity in term of symptoms and symptomatic drugs use and the presence of asthma in subjects with tree or cypress or olive, or ragweed or parietaria allergy and we evaluated also the efficacy of a consecutive 2-year specific sublingual immunotherapy treatment.PATIENTS AND METHODConsecutive patients suffering of respiratory allergies (rhinoconjunctivitis and/or mild moderate asthma) due to one of the described allergens were enrolled During the specific relevant pollen seasons for each allergens nose and eye symptoms and medication scores (SS and MS) were evaluated Global score (GS) was calculated as the sum of SS and MS. An Asthma symptom score if present, were also, calculated A total of 162 patients were enrolled in 14 Italian Allergic Clinics .Patients were treated with the relevant specific sublingual immunotherapy (SLITOne, ALK) for two consecutive pollen seasons.RESULTSAt baseline prevalence of allergies was the following: tree 18% (30 patients); ragweed 14% (23 patients); olive 7% (11 patients); cypress 7% (12 patients) and pellitory 53% (86 patients). At baseline asthma was detected in 65 patients (40%). Asthma was more common in poli-sensitive subjects in comparison with mono-sensitive (51% vs. 300/o). According to allergen type, asthma was present in 47% of pellitory allergic patients, in 45% of olive allergic subjects, in 38% of ragweed allergic patients, in 26% of tree allergic patients and only in 9% of cypress allergic subjects. In pellitory, olive and ragweed allergic patients the frequency of asthma was statistically significant (P=0.0055) higher in comparison with other groups. At baseline GS mean (SD) in the whole population was 17(7). GS during the following 2 consecutive seasons with SLIT treatment decreased significantly (P=0.0001) to 9 (5) and to 7 (5), respectively (a reduction of 59% in comparison with baseline). In patients with asthma the mean clinical score decreased significantly from baseline value of 2. 7 to 0.3 at the end of the observation period No serious adverse events were reported Local side effects, mainly oral itching, were reported by 14% of patients and were mild and transient in nature.CONCLUSIONIn this population pellitory, olive and ragweed allergies are associated with a more severe clinical picture in comparison with tree and cypress allergy. A two-year SLIT treatment was associated with a significant reduction in SS, MS, GS and asthma score in comparison with baseline. SLIT was also safe and well tolerated

We report the case of a 62-year old man who presented a wheat-dependent, exercise-induced anaphylaxis (WDEIA). The case illustrates the usefulness of skin prick test not only with wheat extract, but also with native gliadin extract. Moreover we confirm the value of recombinant IgE dosage with rTri a 19 omega-5 gliadin in the diagnostic pathway of this condition.

Background. Allergen-specific sublingual immunotherapy (SLIT) is considered a causal treatment of respiratory allergies. Compliance to the SLIT is an important aspect for a positive clinical outcome. Study Aim. To evaluate if compliance with grass Allergy Immunotherapy Tablet (AIT) can be increased by providing an electronic compliance device (CED) (Memozax; a tablet-container with a programmable daily acoustic alarm). Patients and Methods. 261 patients with grass allergy were enrolled and randomized (1 : 1) to 1-year treatment with AIT (Grazax) using a CED (group A; n = 122) or without (Group B, n = 139). Compliance was measured through tablet count at each visit. Results. The 12-month compliance, mean (SD), in group A was 83% (21) and 83% (24) in group B. A total of 81% of patients reported a significant clinical improvement of symptoms after treatment in comparison with the previous year. No severe adverse reactions were observed in the study. Conclusion. Compliance to the treatment with AIT administered for 12 consecutive months is in general good. The use of CED is not associated with a greater compliance. AIT treatment was associated with a significant clinical improvement in >80% of patients with a good tolerability and safety profile.

BACKGROUND Different in vivo methods are used to quantify the amount of allergens in products for skin prick testing. It is unclear how this impacts on the correct diagnosis of allergies. AIM OF THE STUDY We compared the allergenic potency of three commercial extracts for skin prick testing and evaluated batch-to-batch differences within each product. METHODS Patients with a mono-sensitization (specific IgE level > 0,70 KU/L, ImmunoCAP, Phadia) to Phleum pratense (N=21), Parietaria judaica (N=20) or Dermatophagoides pteronyssinus (N=28) were evaluated by standard skin prick testing and with the end-point dilution technique using commercial products from Stallergenes (A) (Antony, France), Lofarma Allergeni (B) (Milan, Italy) and ALK Abellò (C) (Hoersholm, Denmark). Results were expressed as mean areas of the wheal (cut-off for positive reactions: 7 mm2). RESULTS With standard prick testing, the following differences in wheal areas were found: Phleum, C higher than B (p=0.0454); Parietaria, C higher than A (p=0.094); Dermatophagoides, C higher than A (p=0.021). With limiting dilution testing, the following differences in dilutions yielding positive skin prick tests were found: Phleum, C and B higher than A (p=0.0391 and 0.0039, respectively); Dermatophagoides, C higher than A and B (p=0.0010 and 0.0156, respectively). In the batch-to-batch comparison, mean differences between wheal areas of compared undiluted solutions did not significantly differ in any allergen tested, although in single cases large differences were observed. At the 1 to 64 dilution, agreement was significant only with Dermatophagoides from Manufacturer C (p= 0.262). At the 1 to 16 dilution, agreement was significant with Phleum from Manufacturer C (p=0.0116) and with Dermatophagoides from Manufacturer B and C (p=0.0239 and 0.0001, respectively). At the 1 to 4 dilution agreement was significant with Dermatophagoides from the three considered Manufacturers (p=0.0189, 0.0052 and 0.0077, respectively) and with Phleum from Manufacturer B and C (p=0.0336 and 0.0113, respectively). CONCLUSION There are significant differences among commercially available diagnostic products for skin prick testing.

RATIONALE: Sensitization to Profilin, a pan-allergen, is observed in 40% of grass allergic patients. So far the are no data regarding the clinical relevance of sensitization to profilin, in term of severity of symptoms in these patients. A purified natural date palm profilin (Pho-d-2) Skin Prick Test (SPT) has been recently developped. We investigated the prevalence of profilin sensitization and compared symptom and symptomatic drug scores during pollen season in patients with grass rhinoconjuctivitis in relation with profilin sensitization. METHODS: 50 consecutive patients with rhinoconjunctivitis and/or asthma due to grass pollen (28 men, mean age 34 years) were enrolled. SPT for grass and profilin were evaluated before pollen season 2008. Symptom score during peak pollen season (May 2008) was rated evaluating 6-item for nose and eye symptoms using a 4-point ordinal scale (0= no symptoms; 3=severe symptoms). Medication score was evaluated assessing the use of oral/topic antihistamine or corticosteroid drugs. RESULTS: All patients were positive for grass SPT. A total of 21 subjects (44%) were positive to profilin SPT (wheal diameter >3 mm: P+). In P+ patients, seasonal symptom score was significantly (P=0.01) higher in comparison with P- subjects (155 vs. 71). Medication score, mean(SD) was 39(28) in P+ patients and 13(16) in P- subjects (P=0.0025). CONCLUSIONS: Our study confirms that in grass allergic patients profilin sensitization evaluated by a specific SPT is detected in 40% of the patients. In these patients profilin sensitization is also associated with an higher symptom and medication score during pollen season.

BACKGROUND:We previously demonstrated that one year of sublingual immunotherapy (SLIT) with natural rubber latex (NRL) was safe and efficacious in paediatric patients with NRL allergy.RESEARCH DESIGN AND METHODS:We studied 12 NRL-allergic children (age 4-15), previously assigned to the treated arm of a double-blind placebo controlled study, who received a commercial latex SLIT for three years. Adverse reactions were monitored. The primary end-point was the NRL glove-use test. As secondary end-points, skin prick test with NRL and NRL serum specific IgE were used.MAIN OUTCOMES MEASURES:No SLIT-related side effects were observed. A significant reduction of the glove-use score was observed after one-year treatment (5.1 +/- 4.2 vs. 14.8 +/- 5.7, p=0.0031). This parameter was further reduced in the second year since SLIT start (2.0 +/- 2.7, p=000007). After 3 years of SLIT all patients had a negative glove-use test (p<0.0001). Baseline wheal areas of skin prick test (6.8 +/- 2.5 mm2) were significantly reduced after 2 (5.3 +/- 1.8 mm2) and 3 years (4.0 +/- 1.8 mm2) of SLIT (p=0.039 and 0.027, respectively). Baseline values of serum specific IgE (23 +/- 34 KU/l) were significantly reduced after 3 years since SLIT start (6.4 +/- 5.0, p=0.0371).CONCLUSIONS:Three years of latex SLIT is safe and consolidates the efficacy previously observed after one year of treatment in paediatric patients.

We evaluated safety and clinical efficacy of sublingual immunotherapy (SLIT) for rhino conjunctivitis associated with sensitivity to Alternaria. Twenty-four subjects with clinical history of conjunctivitis or rhino conjunctivitis were enrolled in this open-labeled, non-placebo controlled study. All patients were mono-sensitized to Alternaria alternata by prick test, serum specific IgE and by conjunctival provocation test (CPT). Specific CPT, tear cytology, skin sensitivity were performed at baseline (T0), after the completion of one (T3) and two years (T5) of either SLIT (13 subjects) or standard pharmacological therapy (11 subjects) for rhinoconjunctivitis. All subjects completed a diary in which the intensity of their symptoms and the use of anti-allergic medications were identified. SLIT was well tolerated and no serious adverse events were reported. SLIT induced a significant improvement of the CPT score and from T0 to T3 (p = 0.002) and from T0 to T5 (p = 0.0078). The CPT score and the number of inflammatory cells in tears were both significantly reduced in patients treated with SLIT compared the control group at T3 and T5. After one year of SLIT therapy, the consumption of anti-allergic medication was significantly reduced. Comparing the diary data before and after SLIT, statistically significant reduction were observed for symptoms and drug consumption. SLIT significantly reduced the specific ocular clinical and cytological response to the Alternaria extracts as assessed with CPT. Two years of SLIT for allergy to Alternaria improved symptoms and drug consumption in the seasonal period after therapy.

RationaleWe evaluated three commercially available SPT (Product A: Lofarma, Product B: Stallergenes SA and Product C: Soluprick® SQ, ALK-Abellò) in a double-blind, randomized trial.Methods43 monosensitized patients (20 men) allergic to House dust mite (18 patients), Grass (11 patients) or Parietaria (14) were enrolled after written informed consent. Allergy was confirmed by history and IgE measurements. Patients were evaluated in two separate visits performed 15-days apart with all three SPT products using the relevant allergen. For each SPT product, two different batches were used. SPTs were performed with undiluted solution and with end point method using progressive dilutions. Histamine (H) (10 mg/mL) was used as positive control.ResultsH wheal mean (SD) area was 121 (77) mm2 and 116 (66) mm2 during first and second evaluation visits, (p = 0.76). With product A, B and C the wheal area at the first evaluation was: 87 (76), 103 (89) and 129 (88) mm2. A significant difference was observed between H and Product A (P = 0.03). No differences were observed between H and Product B and C. At second evaluation, the wheal area was: 109 (84) for product A (P = 0.05, vs. first evaluation), 125 (97) for product B (P = 0.04) and 125 (79) mm2 for product C (P = 0.68). With end point method, Product C showed higher potency in 59% of tests in comparison with Product B (28%) and Product A (16%) (P = 0.0001).ConclusionsOur trial results show that ALK Soluprick offers a greater batch-to-batch consistency and a higher potency in comparison with other commercially available SPT products. RationaleWe evaluated three commercially available SPT (Product A: Lofarma, Product B: Stallergenes SA and Product C: Soluprick® SQ, ALK-Abellò) in a double-blind, randomized trial. We evaluated three commercially available SPT (Product A: Lofarma, Product B: Stallergenes SA and Product C: Soluprick® SQ, ALK-Abellò) in a double-blind, randomized trial. Methods43 monosensitized patients (20 men) allergic to House dust mite (18 patients), Grass (11 patients) or Parietaria (14) were enrolled after written informed consent. Allergy was confirmed by history and IgE measurements. Patients were evaluated in two separate visits performed 15-days apart with all three SPT products using the relevant allergen. For each SPT product, two different batches were used. SPTs were performed with undiluted solution and with end point method using progressive dilutions. Histamine (H) (10 mg/mL) was used as positive control. 43 monosensitized patients (20 men) allergic to House dust mite (18 patients), Grass (11 patients) or Parietaria (14) were enrolled after written informed consent. Allergy was confirmed by history and IgE measurements. Patients were evaluated in two separate visits performed 15-days apart with all three SPT products using the relevant allergen. For each SPT product, two different batches were used. SPTs were performed with undiluted solution and with end point method using progressive dilutions. Histamine (H) (10 mg/mL) was used as positive control. ResultsH wheal mean (SD) area was 121 (77) mm2 and 116 (66) mm2 during first and second evaluation visits, (p = 0.76). With product A, B and C the wheal area at the first evaluation was: 87 (76), 103 (89) and 129 (88) mm2. A significant difference was observed between H and Product A (P = 0.03). No differences were observed between H and Product B and C. At second evaluation, the wheal area was: 109 (84) for product A (P = 0.05, vs. first evaluation), 125 (97) for product B (P = 0.04) and 125 (79) mm2 for product C (P = 0.68). With end point method, Product C showed higher potency in 59% of tests in comparison with Product B (28%) and Product A (16%) (P = 0.0001). H wheal mean (SD) area was 121 (77) mm2 and 116 (66) mm2 during first and second evaluation visits, (p = 0.76). With product A, B and C the wheal area at the first evaluation was: 87 (76), 103 (89) and 129 (88) mm2. A significant difference was observed between H and Product A (P = 0.03). No differences were observed between H and Product B and C. At second evaluation, the wheal area was: 109 (84) for product A (P = 0.05, vs. first evaluation), 125 (97) for product B (P = 0.04) and 125 (79) mm2 for product C (P = 0.68). With end point method, Product C showed higher potency in 59% of tests in comparison with Product B (28%) and Product A (16%) (P = 0.0001). ConclusionsOur trial results show that ALK Soluprick offers a greater batch-to-batch consistency and a higher potency in comparison with other commercially available SPT products. Our trial results show that ALK Soluprick offers a greater batch-to-batch consistency and a higher potency in comparison with other commercially available SPT products.

Compliance is a major determinant for allergy treatment, especially in children. Sublingual immunotherapy (SLIT) is self‐managed at home, and no quantitative data on pediatric adherence are available. We studied the compliance in a large real‐life setting. A simplified schedule of SLIT was used, consisting of a 10‐day updosing phase followed by maintenance treatment in monodose containers to be taken daily (SLITOne ® ). Italian specialists throughout Italy assessed the compliance in children who were newly prescribed SLIT according to guidelines. Parents were contacted with unscheduled telephone interviews at the third and sixth month of therapy and asked to count at that moment the remaining vials. Data from 71 children (38 boys, age range 2–13 yr) were enclosed in the database. Thirty had rhinoconjunctivitis, four asthma and 37 rhinoconjunctivitis + asthma. SLIT was prescribed for: mites in 57 (81%) subjects, grasses in 11 (15%) and 3 (4%) grass + olive mixture. Compliance data were available for all children at 3 months, and for 56 at 6 months. At 3 months, 85% of subjects had a compliance rate >75% (69% of them adhered >90%). At 6 months, 84% had a compliance rate >75% (66% of them adhered >90%). In four cases SLIT was discontinued for economical reasons, and in one case (1.4%) for side effects probably related to therapy. These data obtained in a quite large sample of children and in real‐life confirm that the compliance with SLITOne ® is good, despite the therapy managed at home.