Vaccination is the main prophylactic measure to reduce the mortality caused by hepatitis B virus(HBV)infection in healthy subjects since the immune response to hepatitis B recombinant vaccination occurs in over 90%of ...Vaccination is the main prophylactic measure to reduce the mortality caused by hepatitis B virus(HBV)infection in healthy subjects since the immune response to hepatitis B recombinant vaccination occurs in over 90%of general population.Individuals who develop an antiHBs titer less than 10 mIU/mL after primary vaccination cycle are defined"no responders".Many factors could cause a non response to the HBV vaccination,such as administration of the vaccine in buttocks,impaired vaccine storage conditions,drug abuse,smoking,infections and obesity.Moreover there are some diseases,like chronic kidney disease,human immunodeficiency virus infection,chronic liver disease,celiac disease,thalassaemia,typeⅠdiabetes mellitus,down’s syndrome and other forms of mental retardation that are characterized by a poorer response to HBV vaccination than healthy subjects.To date it is still unclear how to treat this group of patients at high risk of hepatitis B infection.Recent studies seem to indicate that the administration of HBV recombinant vaccine by the intradermal route is very effective and could represent a more useful strategy than intramuscular route.This review focuses on the use of anti hepatitis B vaccine by intradermal route as alternative to conventional intramuscular vaccine in all non responder patients.A comprehensive review of the literature using PubMed database,with appropriate terms,was undertaken for articles in English published since 1983.The literature search was undertaken in September 2013.展开更多
Some studies showed that in celiac patients the immunological response to vaccination is similar to that one found in general population except for vaccine against hepatitis B virus (HBV).The non-responsiveness to HBV...Some studies showed that in celiac patients the immunological response to vaccination is similar to that one found in general population except for vaccine against hepatitis B virus (HBV).The non-responsiveness to HBV vaccine has also been described in healthy people,nevertheless the number of non-responders has been demonstrated to be higher in celiac disease (CD) patients than in healthy controls.Several hypothesis explaining this higher rate of unresponsiveness to HBV vaccine in CD patients have been described,such as the genetic hypothesis,according with CD patients carrying the disease-specific haplotype HLA-B8,DR3,and DQ2,show a lower response to HBV vaccine both in clinical expressed CD patients and in healthy people carrying the same haplotype.On the other hand,it has been demonstrated that the gluten intake during the vaccination seems to influence the response to the same vaccine.Moreover,it has been demonstrated a possible genetic predisposition to hepatitis B vaccine nonresponsiveness likely due to the presence of specific human leukocyte antigen haplotypes and specific single nucleotide polymorphism in genes of cytokine/cytokinereceptors and toll like receptors,but the pathogenic mechanism responsible for this low responsiveness still remains unclear.The aim of this review is to focus on the possible pathogenic causes of unresponsiveness to HBV vaccine in CD patients and to propose an alternative vaccination schedule in order to improve the responsiveness to HBV vaccine in this at-risk patients.展开更多
AIM:To review and conduct a meta-analysis of the existing literature on the relationship between Helicobacter pylori(H.pylori),atopy and allergic diseases.METHODS:Studies published in English assessing the prevalence ...AIM:To review and conduct a meta-analysis of the existing literature on the relationship between Helicobacter pylori(H.pylori),atopy and allergic diseases.METHODS:Studies published in English assessing the prevalence of atopy and/or allergic diseases in patients with H.pylori infection and the prevalence of H.pylori infection in patients with atopy and/or allergic diseases were identified through a MEDLINE search(1950-2014).Random-effect model was used for the meta-analysis.RESULTS:Pooled results of case-control studies showed a significant inverse association of H.pylori infection with atopy/allergic disease or with exclusively atopy,but not with allergic disease,whereas pooled results of cross-sectional studies showed only a significant association between allergic disease and H.pylori infection.CONCLUSION:There is some evidence of an inverse association between atopy/allergic diseases and H.pylori infection,although further studied are needed.展开更多
AIM:To compare intradermal(ID) and intramuscular(IM) booster doses,which have been used in healthy and high risk subjects,such as healthcare workers,haemodialysis patients,human immunodeficiency virus patients,and ren...AIM:To compare intradermal(ID) and intramuscular(IM) booster doses,which have been used in healthy and high risk subjects,such as healthcare workers,haemodialysis patients,human immunodeficiency virus patients,and renal transplant recipients unresponsive to initial hepatitis B vaccination,in celiac individuals.METHODS:We conducted our study on 58 celiac patients,vaccinated in the first year of life,whose blood analysis had showed the absence of protective hepatitis B virus(HBV) antibodies.All patients had received the last vaccine injection at least one year before study enrolment and they had been on a gluten free diet for at least 1 year.In all patients we randomly performed an HBV vaccine booster dose by ID or IM route.Thirty celiac patients were revaccinated with recombinant hepatitis B vaccine(Engerix B) 2 g by the ID route,while 28 celiac patients were revaccinated with Engerix B 10 g by the IM route.Four weeks after every booster dose,the anti-hepatitis B surface(HBs) antibody titer was measured by an enzyme-linked immuneadsorbent assay.We performed a maximum of three booster doses in patients with no anti-HBs antibodies after the first or the second vaccine dose.The cut off value for a negative anti-HBs antibody titer was 10 IU/L.Patients with values between 10 and 100 IU/L were considered "low responders" while patients with an antibody titer higher than 1000 IU/L were considered "high responders".RESULTS:No significant difference in age,gender,duration of illness,and years of gluten intake was found between the two groups.We found a high percentage of "responders" after the first booster dose(ID = 76.7%,IM = 78.6%) and a greater increase after the third dose(ID = 90%,IM = 96.4%) of vaccine in both groups.Moreover we found a significantly higher number of high responders(with an anti-HBs antibody titer > 1000 IU/L) in the ID(40%) than in the IM(7.1%) group,and this difference was evident after the first booster dose of vaccination(P < 0.01).No side effects were recorded in performing delivery of the vaccine by either the ID or IM route.CONCLUSION:Our study suggests that both ID and IM routes are effective and safe options to administer a booster dose of HBV vaccine in celiac patients.However the ID route seems to achieve a greater number of high responders and to have a better cost/benefit ratio.展开更多
Gullo's syndrome is a newly identified condition characterized by a chronic elevation of pancreatic amylase and/or lipase in the absence of pancreatic disease. Until now, only one case of benign isolated hyperlipa...Gullo's syndrome is a newly identified condition characterized by a chronic elevation of pancreatic amylase and/or lipase in the absence of pancreatic disease. Until now, only one case of benign isolated hyperlipasemia in children has been recorded. We describe two children with benign and not familial increase of serum lipase. Case 1: a six year old girl presented with occasional discovery of serum lipase elevation. Medical history was silent for pancreatic hyperenzymemia. The screening for possible causes for elevated lipase(genetic, autoimmune and infectious diseases) was normal. The serum lipase increased three fold over the upper limit(193 U/L; reference range 0-60 U/L), with daily fluctuation of values. Both ultrasound scan and magnetic resonance imaging were normal. The genetic mutation associated with chronic pancreatitis was negative. We followed up this patient for two years with blood tests every six months and she did not show any signs or symptoms of pancreatic disease, except for the high level of lipase serum. Case 2: an eight year old girl complained of nausea, vomiting and severe abdominal pain in theepigastric region after eating for the last two weeks. Full blood count, electrolytes, C-reactive protein, liver and renal function were normal. Serum lipase was 96 U/L(reference range 0-60 U/L). The screening for the possible causes of pancreatic disease was negative. Endoscopy of the upper gastrointestinal tract, ultrasound, computed tomography scan and magnetic resonance imaging were normal. One year after the presentation of the symptoms, the patient became asymptomatic although the level of serum lipase continued to be high.展开更多
Background Coeliac disease(CD)-an autoimmune systemic disorder elicited by gluten in genetically predisposed individuals-can be considered a major public-health issue.Its prevalence is increasing in areas such as Asia...Background Coeliac disease(CD)-an autoimmune systemic disorder elicited by gluten in genetically predisposed individuals-can be considered a major public-health issue.Its prevalence is increasing in areas such as Asian countries.The global seroprevalence of CD is 1.4%,the highest being in Europe and Oceania,and very low in Southern America;however,few data are available for Asian countries,especially for China[1].展开更多
文摘Vaccination is the main prophylactic measure to reduce the mortality caused by hepatitis B virus(HBV)infection in healthy subjects since the immune response to hepatitis B recombinant vaccination occurs in over 90%of general population.Individuals who develop an antiHBs titer less than 10 mIU/mL after primary vaccination cycle are defined"no responders".Many factors could cause a non response to the HBV vaccination,such as administration of the vaccine in buttocks,impaired vaccine storage conditions,drug abuse,smoking,infections and obesity.Moreover there are some diseases,like chronic kidney disease,human immunodeficiency virus infection,chronic liver disease,celiac disease,thalassaemia,typeⅠdiabetes mellitus,down’s syndrome and other forms of mental retardation that are characterized by a poorer response to HBV vaccination than healthy subjects.To date it is still unclear how to treat this group of patients at high risk of hepatitis B infection.Recent studies seem to indicate that the administration of HBV recombinant vaccine by the intradermal route is very effective and could represent a more useful strategy than intramuscular route.This review focuses on the use of anti hepatitis B vaccine by intradermal route as alternative to conventional intramuscular vaccine in all non responder patients.A comprehensive review of the literature using PubMed database,with appropriate terms,was undertaken for articles in English published since 1983.The literature search was undertaken in September 2013.
文摘Some studies showed that in celiac patients the immunological response to vaccination is similar to that one found in general population except for vaccine against hepatitis B virus (HBV).The non-responsiveness to HBV vaccine has also been described in healthy people,nevertheless the number of non-responders has been demonstrated to be higher in celiac disease (CD) patients than in healthy controls.Several hypothesis explaining this higher rate of unresponsiveness to HBV vaccine in CD patients have been described,such as the genetic hypothesis,according with CD patients carrying the disease-specific haplotype HLA-B8,DR3,and DQ2,show a lower response to HBV vaccine both in clinical expressed CD patients and in healthy people carrying the same haplotype.On the other hand,it has been demonstrated that the gluten intake during the vaccination seems to influence the response to the same vaccine.Moreover,it has been demonstrated a possible genetic predisposition to hepatitis B vaccine nonresponsiveness likely due to the presence of specific human leukocyte antigen haplotypes and specific single nucleotide polymorphism in genes of cytokine/cytokinereceptors and toll like receptors,but the pathogenic mechanism responsible for this low responsiveness still remains unclear.The aim of this review is to focus on the possible pathogenic causes of unresponsiveness to HBV vaccine in CD patients and to propose an alternative vaccination schedule in order to improve the responsiveness to HBV vaccine in this at-risk patients.
文摘AIM:To review and conduct a meta-analysis of the existing literature on the relationship between Helicobacter pylori(H.pylori),atopy and allergic diseases.METHODS:Studies published in English assessing the prevalence of atopy and/or allergic diseases in patients with H.pylori infection and the prevalence of H.pylori infection in patients with atopy and/or allergic diseases were identified through a MEDLINE search(1950-2014).Random-effect model was used for the meta-analysis.RESULTS:Pooled results of case-control studies showed a significant inverse association of H.pylori infection with atopy/allergic disease or with exclusively atopy,but not with allergic disease,whereas pooled results of cross-sectional studies showed only a significant association between allergic disease and H.pylori infection.CONCLUSION:There is some evidence of an inverse association between atopy/allergic diseases and H.pylori infection,although further studied are needed.
文摘AIM:To compare intradermal(ID) and intramuscular(IM) booster doses,which have been used in healthy and high risk subjects,such as healthcare workers,haemodialysis patients,human immunodeficiency virus patients,and renal transplant recipients unresponsive to initial hepatitis B vaccination,in celiac individuals.METHODS:We conducted our study on 58 celiac patients,vaccinated in the first year of life,whose blood analysis had showed the absence of protective hepatitis B virus(HBV) antibodies.All patients had received the last vaccine injection at least one year before study enrolment and they had been on a gluten free diet for at least 1 year.In all patients we randomly performed an HBV vaccine booster dose by ID or IM route.Thirty celiac patients were revaccinated with recombinant hepatitis B vaccine(Engerix B) 2 g by the ID route,while 28 celiac patients were revaccinated with Engerix B 10 g by the IM route.Four weeks after every booster dose,the anti-hepatitis B surface(HBs) antibody titer was measured by an enzyme-linked immuneadsorbent assay.We performed a maximum of three booster doses in patients with no anti-HBs antibodies after the first or the second vaccine dose.The cut off value for a negative anti-HBs antibody titer was 10 IU/L.Patients with values between 10 and 100 IU/L were considered "low responders" while patients with an antibody titer higher than 1000 IU/L were considered "high responders".RESULTS:No significant difference in age,gender,duration of illness,and years of gluten intake was found between the two groups.We found a high percentage of "responders" after the first booster dose(ID = 76.7%,IM = 78.6%) and a greater increase after the third dose(ID = 90%,IM = 96.4%) of vaccine in both groups.Moreover we found a significantly higher number of high responders(with an anti-HBs antibody titer > 1000 IU/L) in the ID(40%) than in the IM(7.1%) group,and this difference was evident after the first booster dose of vaccination(P < 0.01).No side effects were recorded in performing delivery of the vaccine by either the ID or IM route.CONCLUSION:Our study suggests that both ID and IM routes are effective and safe options to administer a booster dose of HBV vaccine in celiac patients.However the ID route seems to achieve a greater number of high responders and to have a better cost/benefit ratio.
文摘Gullo's syndrome is a newly identified condition characterized by a chronic elevation of pancreatic amylase and/or lipase in the absence of pancreatic disease. Until now, only one case of benign isolated hyperlipasemia in children has been recorded. We describe two children with benign and not familial increase of serum lipase. Case 1: a six year old girl presented with occasional discovery of serum lipase elevation. Medical history was silent for pancreatic hyperenzymemia. The screening for possible causes for elevated lipase(genetic, autoimmune and infectious diseases) was normal. The serum lipase increased three fold over the upper limit(193 U/L; reference range 0-60 U/L), with daily fluctuation of values. Both ultrasound scan and magnetic resonance imaging were normal. The genetic mutation associated with chronic pancreatitis was negative. We followed up this patient for two years with blood tests every six months and she did not show any signs or symptoms of pancreatic disease, except for the high level of lipase serum. Case 2: an eight year old girl complained of nausea, vomiting and severe abdominal pain in theepigastric region after eating for the last two weeks. Full blood count, electrolytes, C-reactive protein, liver and renal function were normal. Serum lipase was 96 U/L(reference range 0-60 U/L). The screening for the possible causes of pancreatic disease was negative. Endoscopy of the upper gastrointestinal tract, ultrasound, computed tomography scan and magnetic resonance imaging were normal. One year after the presentation of the symptoms, the patient became asymptomatic although the level of serum lipase continued to be high.
文摘Background Coeliac disease(CD)-an autoimmune systemic disorder elicited by gluten in genetically predisposed individuals-can be considered a major public-health issue.Its prevalence is increasing in areas such as Asian countries.The global seroprevalence of CD is 1.4%,the highest being in Europe and Oceania,and very low in Southern America;however,few data are available for Asian countries,especially for China[1].
