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Intramuscular vs intradermal route for hepatitis B booster vaccine in celiac children

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World Journal of Gastroenterology 2012年第40期18卷 5729-5733页

作者： salvatore leonardi Andrea Domenico Praticò Elena Lionetti Massimo Spina Giovanna Vitaliti Mario La Rosa Department of Pediatrics University of Catania

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 pa- tients, vaccinated in the first year of life, whose blood analysis had showed the absence of protective hepati- tis 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 μg by the ID route, while 28 celiac patients were revaccinated with Engerix B 10 μg by the IM route. Four weeks after every boost- er dose, the anti-hepatitis B surface （HBs） antibody titer was measured by an enzyme-linked immune- adsorbent 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/*** 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, du- ration of illness, and years of gluten intake was found between the two groups. We found a high percent- age 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. Mloreover we found a significantly higher num- ber 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 firs

关键词： Hepatitis B virus Non responders Intradermal route Intramuscular route Celiac disease

Focus on gastroesophageal reflux disease in patients with cystic fibrosis

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World Journal of Gastroenterology 2020年第41期26卷 6322-6334页

作者： Annarita Bongiovanni Sara Manti Giuseppe Fabio Parisi Maria Papale Enza Mulè Novella Rotolo salvatore leonardi Department of Clinical and Experimental Medicine Pediatric Respiratory UnitSan Marco HospitalUniversity of CataniaCatania 95123Italy

Gastroesophageal reflux disease(GERD) is a common gastrointestinal disorder in cystic fibrosis(CF), and based on various studies, its prevalence is elevated since childhood. There are several pathogenetic mechanisms on the basis of association between CF and GERD. However, there are no specific guidelines for GERD in CF patients, so diagnosis is based on guidelines performed on patients not affected by CF. The aim of this review is to provide the pathophysiology, diagnostic and therapeutic options, complications, and future directions in the management of GERD patients with CF.

关键词： Adult Children Cystic Fibrosis Gastroesophageal reflux

Hepatitis B vaccine by intradermal route in non responder patients:An update

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World Journal of Gastroenterology 2014年第30期20卷 10383-10394页

作者： Martina Filippelli Elena Lionetti Alessia Gennaro Angela Lanzafame Teresa Arrigo Carmelo Salpietro Mario La Rosa salvatore leonardi Department of Medical and Pediatric Science University of Catania95100 CataniaItaly Department of Pediatric Sciences University of Messina98100 MessinaItaly

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 anti-HBs 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, type I diabetes 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.

关键词： Hepatitis B virus Vaccine Intradermal route Non responders Update

Helicobacter pylori infection and atopic diseases:Is there a relationship? A systematic review and meta-analysis

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World Journal of Gastroenterology 2014年第46期20卷 17635-17647页

作者： Elena Lionetti salvatore leonardi Angela Lanzafame Maria Teresa Garozzo Martina Filippelli Stefania Tomarchio Viviana Ferrara Carmelo Salpietro Alfredo Pulvirenti Ruggiero Francavilla Carlo Catassi Department of Pediatrics University of Catania95100 CataniaItaly Department of Pediatrics Unit of Pediatric Genetics and ImmunologyUniversity of Messina98125 MessinaItaly Department of Clinical and Molecular Biomedicine University of Catania95100 CataniaItaly Department of Developmental Medicine University of Bari70124 BariItaly Department of Pediatrics Università Politecnica delle Marche60123 AnconaItaly

AIM: To review and conduct a meta-analysis of the existing literature on the relationship between Helicobacter pylori (H. pylori), atopy and allergic diseases.

关键词： Atopy Allergic diseases Helicobacter pylori Hygiene hypothesis Infection

The cross-talk between family and pediatrician: The case of bronchial asthma

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Health 2013年第2期5卷 307-312页

作者： salvatore leonardi Rossella Pecoraro Maria Teresa Garozzo Alfina Coco Mario La Rosa Department of Pediatrics Bronchopneumoallergology and Cystic Fibrosis Unit University of Catania Catania Italy

Today the most important challenge facing the pediatrician is the increasing prevalence of chronic diseases. With this regard, pediatricians play a key role in the management of these conditions. The closeness with the family, the knowledge of the clinical case and the care continuity allow the pediatrician to acquire a position of director of every case. When pathological events have a chronic feature, suddenly the quality of life of the whole family changes. For this reason the first communication of chronic disease is very important and the task of the pediatrician should be to provide a positive message to help the family in facing the difficulty of this new challenge. The bronchial asthma is the most common chronic disease worldwide. The incidence, the prevalence, and the mortality of the disease have increased in children over the past decades. These trends are particularly marked above all in preschool children. The success reached by Pediatricians is closely related to the compliance and the implementation of the therapy followed by the little patient and his family. With this regard authors, in this review, focus on the illustration of several strategies, based on the pediatrician’ skills and medicine documents, that can be used for the improvement of communication among pedia- trician-family and child, never forgetting the hu- man aspect of the same doctor, that should con- ciliate with the scientific knowledge in the taking care of a specific chronic disease.

关键词： Cross-Talk Bronchial Asthma Children

A Retrospective Study on Standard Regimen for Vaccination in Celiac Children

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World Journal of Vaccines 2011年第2期1卷 29-32页

作者： salvatore leonardi Giovanna Vitaliti Andrea Pratico’ Rossella Pecoraro Mario La Rosa Department of Pediatrics University of Catania Italy

Background: HLA system plays an essential role in the human immune system activity and the expression of some spe-cific HLA antigens could modify the immune response to vaccinations. Celiac Disease is included among the diseases associated to specific HLA profiles, principally characterized by the expression of the HLA DQ2 antigen. Object: Our study was a retrospective study, leaded on a group of celiac children, with the object to evaluate their immunological response to both obligatory and recommended vaccinations in childhood. Materials and methods: It was a retrospec-tive study, including 66 patients affected by celiac disease, between 3 and 15 years of age, and a control group of 50 children of the same age. All patients performed both obligatory and recommended vaccinations as indicated in the Italian standard regimen for vaccinations. The immunologic response to each vaccine was analysed and compared in the two groups. Moreover, authors also studied the immunologic response to vaccines in celiac children comparing patients whose diagnosis was made before 18 months of age with those whose disease was diagnosed after 18 months of age. Results: Our results showed that in celiac patients the immunological response to vaccine is similar to that one found in general population, except for HBV vaccine. Conclusions: the valuation of immunological response to HBV vaccine should be regularly effectuated in celiac children and revaccination should be recommended.

关键词： Immune System-Response to Vaccine-Celiac Disease

The airway epithelium dysfunction in the pathogenesis of asthma: The evidence

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Health 2013年第2期5卷 331-338页

作者： salvatore leonardi Alfina Coco Michele Miraglia Del Giudice Gianluigi L. Marseglia Mario La Rosa Clinical Pediatric 2nd University of Naples Naples Italy IRCCS University Hospital San Martino University of Pavia Pavia Italy Pediatric Bronchopneumology and Cystic Fibrosis Unit Department of Medical and Paediatric Sciences University of Catania Catania Italy

Asthma is traditionally defined as a chronic, multisystem, multicellular disease characterized by bronchial hyper-responsiveness (BHR) and lung inflammation. In this illness is particularly involving the airway epithelium as the place where the inflammation begins, develops and often returns through airway remodelling. In specific way there is also an evolving awareness of the active participation of structural elements, such as the airway epithelium, airway smooth muscle, and endothelium, in this process. The airway inflammation and remodelling together likely explain the clinical manifestations of asthma that is demonstrated by complicated respiratory manifestations in which wheeze occurring secondary to bronchoconstriction in the setting of airway hyper-responsiveness and mucous hypersecretion. This is confirmed by also the histopathological analyses of bronchial biopsies from asthmatic subjects. For this reason is very important to understand the physiological role of the airway epithelium and their changes during the exacerbation of disease.

关键词： Airway Epithelium Dysfunction Asthma Evidence

Hepatitis B vaccine in celiac disease:Yesterday,today and tomorrow

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World Journal of Gastroenterology 2013年第6期19卷 838-845页

作者： Giovanna Vitaliti Andrea Domenico Praticò Carla Cimino Giovanna Di Dio Elena Lionetti Mario La Rosa salvatore leonardi Department of Pediatrics University of Catania

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 *** 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 *** the other hand,it has been demonstrated that the gluten intake during the vaccination seems to influence the response to the same ***,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 *** 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.

关键词： Celiac disease Non responders Hepatitis B vaccine Vaccination schedules

Two rare cases of benign hyperlipasemia in children

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World Journal of Clinical Cases 2014年第1期2卷 16-19页

作者： Elena Lionetti Ruggiero Francavilla salvatore leonardi Stefania Tomarchio Alessia Gennaro Chiara Franzonello Mario La Rosa Department of Medical and Pediatric Science University of Catania 95123 Catania Italy Department of Paediatrics University of Bari 70100 Bari Italy

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.

关键词： Amylase Lipase Pancreatic hyperenzymemia Gullo’s syndrome Benign hyperlipasemia