Hypersensitivity reactions to aspirin (acetylsalicylic acid) and other nonsteroidal anti‐inflammatory drugs (NSAIDs) constitute only a subset of all adverse reactions to these drugs, but due to their ...severity pose a significant burden to patients and are a challenge to the allergist. In susceptible individuals, NSAIDs induce a wide spectrum of hypersensitivity reactions with various timing, organ manifestations, and severity, involving either immunological (allergic) or nonimmunological mechanisms. Proper classification of reactions based on clinical manifestations and suspected mechanism is a prerequisite for the implementation of rational diagnostic procedures and adequate patient management. This document, prepared by a panel of experts from the European Academy of Allergy and Clinical Immunology Task Force on NSAIDs Hypersensitivity, aims at reviewing the current knowledge in the field and proposes uniform definitions and clinically useful classification of hypersensitivity reactions to NSAIDs. The document proposes also practical algorithms for the diagnosis of specific types of NSAIDs hypersensitivity (which include drug provocations, skin testing and in vitro testing) and provides, when data are available, evidence‐based recommendations for the management of hypersensitive patients, including drug avoidance and drug desensitization.
Skin tests are of paramount importance for the evaluation of drug hypersensitivity reactions. Drug skin tests are often not carried out because of lack of concise information on specific test ...concentrations. The diagnosis of drug allergy is often based on history alone, which is an unreliable indicator of true hypersensitivity.To promote and standardize reproducible skin testing with safe and nonirritant drug concentrations in the clinical practice, the European Network and European Academy of Allergy and Clinical Immunology (EAACI) Interest Group on Drug Allergy has performed a literature search on skin test drug concentration in MEDLINE and EMBASE, reviewed and evaluated the literature in five languages using the GRADE system for quality of evidence and strength of recommendation. Where the literature is poor, we have taken into consideration the collective experience of the group.We recommend drug concentration for skin testing aiming to achieve a specificity of at least 95%. It has been possible to recommend specific drug concentration for betalactam antibiotics, perioperative drugs, heparins, platinum salts and radiocontrast media. For many other drugs, there is insufficient evidence to recommend appropriate drug concentration. There is urgent need for multicentre studies designed to establish and validate drug skin test concentration using standard protocols. For most drugs, sensitivity of skin testing is higher in immediate hypersensitivity compared to nonimmediate hypersensitivity.
Background
Hypersensitivity to acetylsalicylic acid (ASA) constitutes a serious problem for subjects with coronary artery disease. In such subjects, physicians have to choose the more appropriate ...procedure between challenge and desensitization. As the literature on this issue is sparse, this study aimed to establish in these subjects clinical criteria for eligibility for an ASA challenge and/or desensitization.
Methods
Collection and analysis of data on ASA challenges and desensitizations from 10 allergy centers, as well as consensus among the related physicians and an expert panel.
Results
Altogether, 310 subjects were assessed; 217 had histories of urticaria/angioedema, 50 of anaphylaxis, 26 of nonimmediate cutaneous eruptions, and 17 of bronchospasm related to ASA/nonsteroidal anti‐inflammatory drugs (NSAID) intake. Specifically, 119 subjects had index reactions to ASA doses lower than 300 mg. Of the 310 subjects, 138 had an acute coronary syndrome (ACS), 101 of whom underwent desensitizations, whereas 172 suffered from a chronic ischemic heart disease (CIHD), 126 of whom underwent challenges. Overall, 163 subjects underwent challenges and 147 subjects underwent desensitizations; 86 of the latter had index reactions to ASA doses of 300 mg or less. Ten subjects reacted to challenges, seven at doses up to 500 mg, three at a cumulative dose of 110 mg. The desensitization failure rate was 1.4%.
Conclusions
In patients with stable CIHD and histories of nonsevere hypersensitivity reactions to ASA/NSAIDs, an ASA challenge is advisable. Patients with an ACS and histories of hypersensitivity reactions to ASA, especially following doses lower than 100 mg, should directly undergo desensitization.
Each of ten batches of portion-size farmed European sea bass (overall number = 200, mean weight ± standard error = 312 ± 5 g; total length ± s.e. = 30.5 ± 0.3 cm) was randomly divided into four ...equally numbered subsamples (n = 5). Within batch, one subsample represented the raw reference (RW), while the others were allotted to oven broiling (OB), baking in aluminium foil (BF) or microwaving (MW), selected as mild cooking techniques and therefore among the preferred by Italian fish-eaters. Raw and cooked flesh composition as to proximates, fatty acids, selected minerals and water-soluble vitamins, as derived from OB, BF and MW, were combined with the relevant cooking yields to gain knowledge about the true retention values (TRVs) of these nutrients according to the “reference batch” approach, a well-established method for small-size seafood items as bivalve molluscs and crustaceans. Within the general context of high-yield cooking methods, BF proved to be the mildest, since it left the nutrient profile of sea bass flesh mostly unaffected compared to RW. The reference batch approach generated plausible TRVs for all the nutrients examined, most of which were significantly higher in BF than in OB, with MW data in between.
► Nutrients and true retentions on cooking (3 methods) in the flesh from farmed sea bass. ► The reference batch approach used to compute retentions as for bivalves and crustaceans. ► Nutrient profile mostly unchanged upon baking in Al foil compared to the raw flesh.
Abstract Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), the most common form of familial vascular dementia, is caused by mutations of the NOTCH3 ...gene. Approximately two hundred pathogenic mutations have been reported within five exons (exons 3, 4, 6, 11 and 19) which accounted for 78% of known mutations in worldwide series. We reported twenty-one NOTCH3 pathogenic mutations (including five novel ones) identified in 53 index Italian patients. Exons 4 (28%), 7 (21%) and 19 (24%) were the most frequently involved. To dissect genetic heterogeneity, we analyzed five haplotyped tagging single nucleotide polymorphisms (rs1044009, rs4809030, rs10426042, rs10423702 and rs3815188) in 95 patients, 39 unaffected pedigree members and 50 healthy controls. SNPs were analyzed using the Illumina VeraCode Universal Capture Beads technology by Allele Specific Primer Extension (ASPE). We identified ten different haplotypes named H1–H10; H1 was the most common haplotype in patients and controls and it was associated with at least twelve out of the twenty-one mutations. Detected mutations were not associated to specific haplotypes while genotyping was compatible with a possible founder effect for the novel p.S396C mutation which clustered in a restricted geographical area of northeast Italy. The results added on to the genetic heterogeneity of CADASIL and emphasized difficulties in designing algorithms for molecular diagnosis.
Sea bass Dicentrarchus labrax fillet quality was investigated after feeding with four diets (A, B, C or D) containing different levels of dietary vitamin E (139 mg kg–1, 254 mg kg–1, 493 mg kg–1 and ...942 mg kg–1, respectively). Six‐hundred and eighty fish (mean initial weight 208 g) were equally divided into four 20 m3 tanks and fed for 87 days. Filtered seawater with a temperature ranging from 18.2 to 26.3 °C was supplied continuously. At the end of the experiment, fish were stored at 1 °C for 12 days. At one, three, six, nine and 12 days, 20 fish per group were processed for proximate composition, vitamin E and induced thiobarbituric acid reactive substances (TBARs) analyses. No significant differences in proximate composition were registered between groups. The flesh lipid content ranged from 88.0 g kg–1 (group B) to 96.8 g kg–1 (group A). Vitamin E fillet content was significantly different between groups, reaching levels of 98.0, 150.7, 225.2 and 302.0 μg g–1 lipids for group A, B, C and D, respectively. Induced TBARs values were statistically different only for group A compared with the other groups. No significant variations were registered in relation to preservation time. Because of the positive influence of vitamin E on seafood quality and the correlation between its dietary level and flesh deposition, the α‐tocopherol content of the diet should be well above fish minimum requirements.
Aspirin hypersensitivity may represent a major problem in patients with ischemic coronary disease who need a stenting procedure. In those patients, clinically unsettled reasonably quick ...desensitisation procedures are needed. In our study we attempted to select the most suitable procedure on the basis of characteristics and severity of ASA hypersensitivity.
Thirty patients with a history of mild reactions to anti-inflammatory doses of aspirin (> 325 mg) were considered at low risk and underwent a tolerance test in 5 steps. Thirty-one patients, with a history of severe reactions to anti-platelet doses of aspirin 0 mg) underwent a slow desensitisation in 12 steps, reaching a cumulative dose of 150 mg ASA in 220 minutes.
In the first group, 29 patients tolerated the challenge. One developed urticaria, thus underwent challenge/desensitisation and achieved tolerance. In the second group, 3 patients did not tolerate the procedure and had to discontinue. CONCLUSION. Our approach to aspirin hypersensitivity in patients needing coronary stenting, based on a severity stratification, allowed to achieve an effective tolerance to aspirin in the majority of subject in a reasonable short time.
Sensory and physico-chemical freshness indices (QI score, Torrymeter readings, pH and WHC) were evaluated in gilthead sea bream of commercial size reared in Italy in: land based facilities ...(recirculation systems), lagoons and net-cages. Fish were stored under ice for 0, 1, 3, 6, 9, 12 and 16 days: at each sampling time analyses were performed to determine the evolution of each freshness index within sea bream sources. Significant differences emerged among farming conditions following the application of the Quality Index Method. Torrymeter readings gradually decreased with the number of days of ice storage. pH values remained practically constant over the 16 days of storage. For WHC the effect of both time of storage and farming conditions was statistically significant.
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