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We have studied the T-cell-mediated response to the major allergen of cow’s milk, in a group of newborns at risk of developing cow’s milk allergy, and in a control group. Before any atopic status has developed, we observe β-lactoglobulin-specific primary proliferation only in the group at risk for food-related allergies. In this group, the capability to proliferate is not due to placental transmission of ‘factors’ from allergic mothers. The recognition of the tested β-lactoglobulin peptides does not show major differences between the responder and nonresponder populations. In the responder population, the response to p145–161 appears linked to a primary response to ovalbumin, another frequent food allergen. On the basis of our findings, we propose a model in which development of allergic diseases is linked to an alteration of T-cell activation through the engagement by the antigen; the HLA phenotype determines the allergen(s) involved, and other genetic or environmental factors dictate the clinical characteristics of the disease.

Predictive factors of renal involvement or relapsing disease in children with Henoch-Schönlein purpura (HSP) are poorly known. We examined clinical and laboratory variables concerning HSP evolution in children hospitalized in the last decade to predict the possibility of renal complications or relapse occurrence. Periodic clinical evaluations with urinalysis were performed for 6 +/- 3.6 years. Simple logistic regression showed that persistent rash and severe abdominal pain at the onset of HSP are significantly related to renal involvement, while persistent rash is significantly related to relapsing disease. Multiple logistic regression showed that persistent rash remains related to renal involvement when adjusted for sex, age, and severe abdominal pain and conversely that severe abdominal pain is not related to renal involvement when adjusted for sex, age, and persistent rash. In conclusion, persistent rash over a period longer than 1 month seems to represent a significant predictor of renal sequelae and disease relapse in children with HSP.

IntroductionInterleukin-1 (IL-1) blockade is the treatment of choice of cryopyrin associated periodic syndromes (CAPS). Anti-IL-1 monoclonal antibody (canakinumab) was recently registered. However no clear data are available on the optimal schedule of administration of this drug. The aim of the present study was to analyse the impact of canakinumab on CAPS patients in daily clinical practice and to identify the best schedule of administration according to age and phenotype.Methods13 CAPS patients (10 children and 3 young adults) treated with canakinumab were followed for 12 months. Clinical and laboratory parameters were collected at each visit. Health-related quality of life (HRQoL) was recorded at month 12. Complete response was defined as absence of clinical manifestations and normal examinations. Clinical and laboratory variables at last follow-up were compared with those registered at the moment of anakinra discontinuation.Resultsseven patients with chronic infantile neurological cutaneous articular (CINCA) syndrome, four patients with Muckle-Wells syndrome (MWS) and two patients with an overlapping MWS/CINCA phenotype were analysed. CINCA patients experienced a higher number of modifications of the treatment (increased dosage or decreased dosing interval) in respect to MWS patients. At the end of the follow-up CINCA patients displayed a higher frequency of administration with a median dose of 3.7 mg/kg (2.1 mg/kg for MWS patients). Canakinumab was withdrawn in a patient with CINCA for incomplete response and poor compliance. The effect of canakinumab on HRQoL was similar to that observed during treatment with anakinra, with the exception of an improvement of the psychosocial concepts after the introduction of canakinumab.ConclusionsThe use of canakinumab in daily practice is associated with persistent satisfactory control of disease activity but needs progressive dose adjustments in more severe patients. The clinical phenotype, rather than the age, represents the main variable able to determine the need of more frequent administrations of the drug at higher dosage.