Le Vitamine - ideacongress.it vitamine... · Chi dei 2 sarà ... 2 Mitsuyoshi Urashima et ... –...

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Le Vitamine Anti Allergiche

Noi ce ne preoccupiamo adesso, ma …

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Già nel 2009 Valerio Pignattahttp://www.viviconsapevole.it/articoli/curare-le-allergie-con-le-vitamine.php

Una combinazione di cinque vitamine naturali è in grado di disintossicare in modo completo l’ organismo

SMS

9,80 euro

Già nel 2006 Henning Muller-Burzlerhttp://www.viviconsapevole.it/articoli/curare-le-allergie-con-le-vitamine.php

Chi dei 2 sarà Henning ?

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La Vitamina D

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Studio di popolazione cross-sectional in 1.115 bambini giapponesi della 4^ elementare

Più del 60% con livelli di Vitamina D insufficienti o deficienti

Nessuna associazione con asma, rinite, eczema

2013

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Vitamina D e Wheezing ricorrenteEda Özaydm, Indian J Pediatr 2013

• The index results did not show statistical significance between the groups in terms of the distribution of 25 (OH) D level

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Vitamina D e gravità dell’ asmaMenon et al, J Pediatr Endocrinol Metab 2012

• A retrospective, case-control study of 263 subjects of ages 2-19 years with asthma who were compared to 284 non-asthmatic controls of similar ages

• There was no difference in 25(OH)D between asthmatic patients and controls (28.64 +/- 10.09 vs. 28.42 +/- 11.47, p = 1.0)

• Mean 25(OH)D levels did not vary significantly among the five steps of asthma symptom severity

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< Filaggrina = > Vitamina D Jacob Thyssen et al, JACI 2012

• We showed significantly higher concentrations of serum 25-OH vitamin D in carriers of FLG mutations with homogeneity across the studies

• The effect of FLG mutations increased over the summer half year, supporting the hypothesis that the difference in vitamin D status was caused by UV exposure

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Annamaria e la Rinite Australiana Annmaree Hughes, PAI 2011

• There was no association between any of the UVR- or vitamin D-related measures and childhood asthma

• But greater time in the sun in winter between the ages 6-15 yr was associated with an increase in the odds of having hayfever [adjusted odds ratios (OR) 1.29; 95% CI 1.01-1.63]

• Oral supplementation with cod liver oil in childhood increased the odds of a history of having both asthma and hayfever (2.87; 1.00-8.32)

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La Vit. D promuove l’ allergia ? - 1 Ove Bach, Acta Derm Ven 2009

• In a prospective birth cohort study 123 six-year-old children were investigated for the cumulative incidence of atopic dermatitis, allergic rhinitis or asthma by means of a postal questionnaire– Their vitamin D3 intake during

infancy was recorded in a previous study and the relationship between lower or higher vitamin D3 intake and atopic illness later in childhood was assessed

• Atopic manifestations were more prevalent in the group with higher intake of vitamin D3

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• Although small, this study supports previous investigations suggesting a role of vitamin D intake during infancy in the development of atopic allergy later in childhood

• If these findings are confirmed in prospective controlled clinical trials, prevention through modified vitamin D3 supplementation in infancy could be discussed to reduce the burden of atopic illnesses

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Relationship between serum vitamin D, disease severity and airway remodeling in children with

asthma

• 36 STRA = Severe Therapy Resistant Asthma

• 26 MA = Moderate Asthma

• 24 Controlli

vit D VEF1, FVC, ACT vit D esacerbazioni vit D consumo di CSI vit D ASM (Airway Smooth

Muscle mass)

Gupta A et al. Am J Respir Crit Care Med 2011 Dec 15;184(12):1342-9

Grazie a Giuseppe Pingitore

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La Vitamina D e la Iolanda Chinellato et al, J Pediatr 2011

• Gli autori, tra le altre cose, riportano in 75 bambini asmatici– una distribuzione del controllo dell’ asma inversamente proporzionale ai

livelli di Vitamina D– una significativa , pur debolmente, correlazione tra livelli di Vitamina D e c-

ACT score– Nessuna differenza significativa in merito al trattamento ricevuto

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La Vitamina D e l’ Anna - 1Wu et al (CAMP Study), AJRCCM 2012

• Of the 1,024 subjects (ndr: bambini), 663 (65%) were vitamin D sufficient, 260 (25%) were insufficient, and 101 (10%) were deficient

– Our current study found that children with asthma who are deficient in vitamin D levels have less improvement in prebronchodilator FEV1 over the course of 1 year when treated with inhaled corticosteroids as compared with children who are sufficient in vitamin D

• These findings support the hypothesis that vitamin D supplementation may enhance the antiinflammatory function of corticosteroids in patients with asthma

Il punto di partenza è differente, il punto di arrivo uguale

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La Vitamina D e l’ Anna - 2James L. Kreindler, AJRCCM 2012

Is the Best Offense a Good D-fense?Should We Use Vitamin D as Adjunctive Therapy for Asthma?

The question of whether or not therapeutic use of vitamin D will be beneficial in asthma either as primary therapy or as adjunctive therapy to inhaled corticosteroids can only be answered with a prospective, blinded, randomized, placebo-controlled trial

As of July 2012, according to clinicaltrials.gov, a number of such trials are currently active nationally and internationally, though these appear to be primarily single-center studies of relatively small size given the prevalence of childhood asthma

Therefore, even after completion of these studies, there will likely be a need for a large, multicenter trial of vitamin D therapy in asthma with long-term follow-up similar to the CAMP study

Ndr: insomma, ne riparliamo tra 20 anni

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La Vitamina D e l’ Asma Acuta - 1Pawel Mayac et al, JACI 2011

• Forty-eight children from 5 to 18 years of age (mean [SD], 11.5 [3.3] years) with newly diagnosed asthma and sensitive only to house dust mites

• This was a randomized, double-blind, parallel-group, 6-month trial studying the effects of inhaled budesonide with or without vitamin D on clinical parameters of asthma control in children

• We found that during 6 months of treatment, the number of children who experienced asthma exacerbation was significantly lower in the steroid+D3 group than in the steroid group (n [%], 4 [17] vs 11 [46]; P = .029)

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La Vitamina D e l’ Asma Acuta - 2Mitsuyoshi Urashima et al, Am J Clin Nutr 2010

• We conducted a randomized, double-blind, placebo-controlled trial comparing vitamin D3 supplements (1200 IU/d) with placebo in schoolchildren. The primary outcome was the incidence of influenza A

• Influenza A occurred in 18 of 167 (10.8%) children in the vitamin D3 group compared with 31 of 167 (18.6%) children in the placebo group [relative risk (RR), 0.58; 95% CI: 0.34, 0.99; P = 0.04]

• In children with a previous diagnosis of asthma, asthma attacks as a secondary outcome occurred in 2 children receiving vitamin D3 compared with 12 children receiving placebo (RR: 0.17; 95% CI: 0.04, 0.73; P = 0.006)

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NON SOLO ASMA

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Caterina e il Ciallengie Solo AustralianoAllen et al, JACI 2013

• 577 infants (344 with challenge-proven food allergy, 74 sensitized but tolerant to food challenge, 159 negative on skin prick test and food challenge

– Infants of Australian-born parents, but not of parents born overseas, with vitamin D insufficiency (<_50 nmol/L) were more likely to be peanut (p <0.006) and/or egg (p<0.025) allergic than were those with adequate vitamin D levels independent of eczema status

– Among those with Australian-born parents, infants with vitamin D insufficiency were more likely to have multiple food allergies (>_2) rather than a single food allergy (non significativo)

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Correlation between serum 25-hydroxyvitamin D levels and severity of atopic dermatitis in children

Peroni D et al. British J Dermatol 2011;164, pp1078–1082

37 bb8m-12a


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Cose da Turchi !!!Akan et al, Pediatric Dermatology 2013

• Seventy-three children with AD (median age 33.0 mos) were enrolled in the study, 33 (45.2%) were found to have allergic sensitization

• In this group there was a negative correlation between SCORAD score and serum vitamin D level (p = 0.047), whereas there was no correlation in the group without sensitization

• Vitamin D was not correlated with total IgE and eosinophil percentage in either AD group

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La Vit D (+ la E) per la DA Iraniana Javanbakht et al, J Dermatol Treat 2011.

• 52 atopic dermatitis patients (13-45 years old) were included in a randomized, double-blind, placebo-controlled trial. They were randomly divided into four groups and treated for 60 days– group P, solo placebo– group D, vitamin D– group E, vitamin E– and group DE vitamin D plus vitamin E

• At baseline, the plasma level of vitamin E was no lower than the deficient level (< 5 mg/ml) in any of the patients. The prevalence of vitamin D deficiency was 72.7%, 91.7%, 81.8% and 100% in groups P, D, E and DE, respectively.

• Forty-five of 52 patients completed the 60-day trial (ndr: 87% dei randomizzati)

• SCORAD was reduced after 60 days in groups D, E and DE by 34.8%, 35.7% and 64.3%, respectively (p = 0.004)

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La Vit D (senza la E) per la DA Iraniana

Amestejani M, J Drugs Dermatol 2012testo integrale per me irreperibile

• Sixty AD patients were included in a randomized, double-blind, placebo-controlled trial study

• They were randomly divided into two groups and treated for 60 days: group vitamin D (n=30), and placebo group (n=30).

• According to SCORAD value index in the vitamin D group showed significant improvement in patients with mild, moderate and severe AD (P<0.05) and in patients who the intake placebo, this improvement didn't showed (P>0.05)

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La Vit D per la DA lieve e Bostoniana

Sidbury et al, Br J Dermatol 2008

• We enrolled 11 subjects, with a median age of 7 years (range 2–13)– Ten of the 11 subjects had mild AD, with Eczema Area and

Severity Index (EASI) scores ranging from 10 to 18

• The hospital pharmacy randomly assigned subjects to take ergocalciferol 1000 IU or an identical-looking placebo once daily for 1 month

• IGA score improved by 1 IGA category in four (80%) of five subjects on vitamin D vs. one (17%) of six on placebo (P = 0.04)

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Atopic dermatitis: A practice parameter update 2012 (AAAAI-ACAAI-JCAAI)

David Bernstein et al, JACI 2013

Vitamin D. Summary Statement 29

• Patients with AD might benefit from supplementation with vitamin D, particularly if they have a documented low level or low vitamin D intake. (B)

• Però, nella flow chart la Vitamina D non è riportata– Le TAR preparations sì e persino gli antiistaminici

Segnalato da Tiziana Maiello

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Position Paper ESPGHAN sulla Vit. DChristian Braegger et al, JPGN 2013

CONCLUSIONS

• Vitamin D plays a key role in calcium and phosphate metabolism and is essential for bone health in infants, children and adolescents

• There is insufficient evidence from interventional studies to support vitamin D supplementation for other health benefits in infants, children and adolescents

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E anche a casa nostra - 1Katia Cuppari et al, Commissione SIAIP Asma

RIAP Marzo 2012

• In conclusione, occorrono ulteriori studi pediatrici al fine di valutare la possibilità di utilizzo della Vitamina D nel trattamento dell’asma e delle malattie allergiche

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E anche a casa nostra - 2Peroni – Bonomo – Casarotto – Boner – Piacentini

Italian Journal of Pediatrics 2012

• There are two conflicting hypotheses linking vitamin D to an increasing incidence of asthma and allergic diseases, according to the so-called "paradox of vitamin D"– Both an excess (resulting from supplementation) and a deficiency (due to low

solar exposure and the inability to compensate with diet) of vitamin D have been associated with an increased risk of asthma and allergies in Western countries

• Further studies are necessary to clarify the role of vitamin D in the induction of immune tolerance and the subsequent risk of developing allergic diseases

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Un Peroni fresco fresco Diego G. Peroni and Attilio L. BonerCurr Opin All Immunol Giugno 2013

• In conclusion, evidence of the association among vitamin D and development of food allergy is rather scarce and conflicting

– Recent birth cohort studies showed no relationship between vitamin D deficiency and food allergy; the highest levels of vitamin D correlated with the higher risk of food allergy

– There is a lack of consistent data addressing the topic of vitamin D supplementation to prevent the development of food allergy

• Well designed trials on vitamin D supplementation are needed, particularly concerning food allergy, in order to give more strength and evidence to the hypothesis that vitamin D could really contribute to the prevention strategy

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Il Resto

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Grazie a Marcello Cottini

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AntiossidantiRosenlund et al, CEA 2012

Una immagine vale più di

1.000 parole

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Antioxidant intake and allergic disease in children - 1

Elena Rosenlund et al, CEA 2012

• Background. Antioxidant intake may reduce the risk of allergic disease by protecting against oxidative tissue damage. Major sources of antioxidants in the Western world are fruits, vegetables (vitamin C, b-carotene, a-tocopherol), meat and milk (selenium, magnesium, zinc).

– Children may exclude or eat less of some fruits and vegetables due to crossreactivity between pollen and these foods, complicating assessment of causal relationships

• Objective. To investigate the association between dietary antioxidant intake and allergic disease, taking potential reverse causation into account

• Methods. Data on 2442 8-year-old children from the Swedish birth cohort study BAMSE were analysed

– Children with completed parental questionnaires on exposures and health, including a food-frequency questionnaire and who provided a blood sample were included

– Associations between antioxidant intake during the past year and current allergic disease were analysed using logistic regression

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• Results. An inverse association was observed between intake of b-carotene and rhinitis (ORadj, highest vs. lowest quartile, 0.67, 95% CI 0.49–0.93). Magnesium intake was inversely related to asthma (ORadj, 0.65, 95% CI 0.42–1.00) and atopic sensitisation (ORadj, 0.78, 95% CI 0.61–1.00)

• Following exclusion of children who avoided certain fruits, vegetables or milk due to allergic symptoms (n = 285), the inverse association remained between magnesium intake and asthma (ORadj, 0.58, 95% CI 0.35–0.98), whereas all other associations became non-significant

• Conclusion and clinical relevance. Diet modifications due to allergy may affect the antioxidant intake and needs to be considered when investigating the relationship between diet and allergic disease. Magnesium intake seems to have a protective effect on childhood asthma

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La Vit C Iraniana e l’ AsmaNadi et al, Act Med Iran 2012

• In this double blind clinical trial study we evaluated 60 patients with chronic stable asthma. The patients were divided into two groups (A and B) including 30 patients in each group

• In addition to standard asthma treatment (according to stepwise therapy in 4th step of bronchial asthma) in which the patients were controlled appropriately, group A received 1000 mg vitamin C daily and group B received placebo

• Comparing PFT (FEV1, FVC and FEV1/FVC) in group B during the study period showed a significant increase in FEV1 (P<0.05), while the other two parameters remained unchanged

• In group A, who received 1000 mg/day vitamin C, none of the spirometry parameters changed after one month treatment, indicating no effect of vitamin C treatment in the spirometry parameters

SMSGrazie ad Attilio Boner

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Tutte le risposte sono giuste4 domande a scelta multipla

• Nel dubbio di non aver fornito informazioni sufficienti …

• Scegliete sempre l’ ultima

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verba volantscripta manent

SMS

Le Vitamine Anti Allergiche

Noi ce ne preoccupiamo adesso, ma …

SMS

Già nel 2009 Valerio Pignattahttp://www.viviconsapevole.it/articoli/curare-le-allergie-con-le-vitamine.php

Una combinazione di cinque vitamine naturali è in grado di disintossicare in modo completo l’ organismo

SMS

9,80 euro

Già nel 2006 Henning Muller-Burzlerhttp://www.viviconsapevole.it/articoli/curare-le-allergie-con-le-vitamine.php

Chi dei 2 sarà Henning ?

SMS

La Vitamina D

SMS

Studio di popolazione cross-sectional in 1.115 bambini giapponesi della 4^ elementare

Più del 60% con livelli di Vitamina D insufficienti o deficienti

Nessuna associazione con asma, rinite, eczema

2013

SMS

Vitamina D e Wheezing ricorrenteEda Özaydm, Indian J Pediatr 2013

• The index results did not show statistical significance between the groups in terms of the distribution of 25 (OH) D level

SMS

Vitamina D e gravità dell’ asmaMenon et al, J Pediatr Endocrinol Metab 2012

• A retrospective, case-control study of 263 subjects of ages 2-19 years with asthma who were compared to 284 non-asthmatic controls of similar ages

• There was no difference in 25(OH)D between asthmatic patients and controls (28.64 +/- 10.09 vs. 28.42 +/- 11.47, p = 1.0)

• Mean 25(OH)D levels did not vary significantly among the five steps of asthma symptom severity

SMS

< Filaggrina = > Vitamina D Jacob Thyssen et al, JACI 2012

• We showed significantly higher concentrations of serum 25-OH vitamin D in carriers of FLG mutations with homogeneity across the studies

• The effect of FLG mutations increased over the summer half year, supporting the hypothesis that the difference in vitamin D status was caused by UV exposure

SMS

Annamaria e la Rinite Australiana Annmaree Hughes, PAI 2011

• There was no association between any of the UVR- or vitamin D-related measures and childhood asthma

• But greater time in the sun in winter between the ages 6-15 yr was associated with an increase in the odds of having hayfever [adjusted odds ratios (OR) 1.29; 95% CI 1.01-1.63]

• Oral supplementation with cod liver oil in childhood increased the odds of a history of having both asthma and hayfever (2.87; 1.00-8.32)

SMS


• In a prospective birth cohort study 123 six-year-old children were investigated for the cumulative incidence of atopic dermatitis, allergic rhinitis or asthma by means of a postal questionnaire– Their vitamin D3 intake during

infancy was recorded in a previous study and the relationship between lower or higher vitamin D3 intake and atopic illness later in childhood was assessed

• Atopic manifestations were more prevalent in the group with higher intake of vitamin D3

SMS


• Although small, this study supports previous investigations suggesting a role of vitamin D intake during infancy in the development of atopic allergy later in childhood

• If these findings are confirmed in prospective controlled clinical trials, prevention through modified vitamin D3 supplementation in infancy could be discussed to reduce the burden of atopic illnesses

SMS

Relationship between serum vitamin D, disease severity and airway remodeling in children with

asthma

• 36 STRA = Severe Therapy Resistant Asthma

• 26 MA = Moderate Asthma

• 24 Controlli

vit D VEF1, FVC, ACT vit D esacerbazioni vit D consumo di CSI vit D ASM (Airway Smooth

Muscle mass)

Gupta A et al. Am J Respir Crit Care Med 2011 Dec 15;184(12):1342-9


Nei pazienti con bassi livelli di vit D basta metà concentrazione di metacolina ( rispetto pz con vit D buona) per ridurre del 20% FEV1

L’effetto della vit. D potrebbe essere quella di favoriere la produzione di IL10 che agirebbe modulando la risposta TH2 alterata nell’asma allergico

12

SMS

La Vitamina D e la Iolanda Chinellato et al, J Pediatr 2011

• Gli autori, tra le altre cose, riportano in 75 bambini asmatici– una distribuzione del controllo dell’ asma inversamente proporzionale ai

livelli di Vitamina D– una significativa , pur debolmente, correlazione tra livelli di Vitamina D e c-

ACT score– Nessuna differenza significativa in merito al trattamento ricevuto

SMS

La Vitamina D e l’ Anna - 1Wu et al (CAMP Study), AJRCCM 2012

• Of the 1,024 subjects (ndr: bambini), 663 (65%) were vitamin D sufficient, 260 (25%) were insufficient, and 101 (10%) were deficient

– Our current study found that children with asthma who are deficient in vitamin D levels have less improvement in prebronchodilator FEV1 over the course of 1 year when treated with inhaled corticosteroids as compared with children who are sufficient in vitamin D

• These findings support the hypothesis that vitamin D supplementation may enhance the antiinflammatory function of corticosteroids in patients with asthma

Il punto di partenza è differente, il punto di arrivo uguale

SMS

La Vitamina D e l’ Anna - 2James L. Kreindler, AJRCCM 2012

Is the Best Offense a Good D-fense?Should We Use Vitamin D as Adjunctive Therapy for Asthma?

The question of whether or not therapeutic use of vitamin D will be beneficial in asthma either as primary therapy or as adjunctive therapy to inhaled corticosteroids can only be answered with a prospective, blinded, randomized, placebo-controlled trial

As of July 2012, according to clinicaltrials.gov, a number of such trials are currently active nationally and internationally, though these appear to be primarily single-center studies of relatively small size given the prevalence of childhood asthma

Therefore, even after completion of these studies, there will likely be a need for a large, multicenter trial of vitamin D therapy in asthma with long-term follow-up similar to the CAMP study

Ndr: insomma, ne riparliamo tra 20 anni

SMS

La Vitamina D e l’ Asma Acuta - 1Pawel Mayac et al, JACI 2011

• Forty-eight children from 5 to 18 years of age (mean [SD], 11.5 [3.3] years) with newly diagnosed asthma and sensitive only to house dust mites

• This was a randomized, double-blind, parallel-group, 6-month trial studying the effects of inhaled budesonide with or without vitamin D on clinical parameters of asthma control in children

• We found that during 6 months of treatment, the number of children who experienced asthma exacerbation was significantly lower in the steroid+D3 group than in the steroid group (n [%], 4 [17] vs 11 [46]; P = .029)

SMS

La Vitamina D e l’ Asma Acuta - 2Mitsuyoshi Urashima et al, Am J Clin Nutr 2010

• We conducted a randomized, double-blind, placebo-controlled trial comparing vitamin D3 supplements (1200 IU/d) with placebo in schoolchildren. The primary outcome was the incidence of influenza A

• Influenza A occurred in 18 of 167 (10.8%) children in the vitamin D3 group compared with 31 of 167 (18.6%) children in the placebo group [relative risk (RR), 0.58; 95% CI: 0.34, 0.99; P = 0.04]

• In children with a previous diagnosis of asthma, asthma attacks as a secondary outcome occurred in 2 children receiving vitamin D3 compared with 12 children receiving placebo (RR: 0.17; 95% CI: 0.04, 0.73; P = 0.006)

SMS

NON SOLO ASMA

SMS

Caterina e il Ciallengie Solo AustralianoAllen et al, JACI 2013

• 577 infants (344 with challenge-proven food allergy, 74 sensitized but tolerant to food challenge, 159 negative on skin prick test and food challenge

– Infants of Australian-born parents, but not of parents born overseas, with vitamin D insufficiency (<_50 nmol/L) were more likely to be peanut (p <0.006) and/or egg (p<0.025) allergic than were those with adequate vitamin D levels independent of eczema status

– Among those with Australian-born parents, infants with vitamin D insufficiency were more likely to have multiple food allergies (>_2) rather than a single food allergy (non significativo)

SMS

Correlation between serum 25-hydroxyvitamin D levels and severity of atopic dermatitis in children

Peroni D et al. British J Dermatol 2011;164, pp1078–1082

37 bb8m-12a


Methods Using the SCORAD index, we evaluated the severity of disease in 37 children (17 girls and 20 boys) aged between 8 months and 12 years with AD, consecutively enrolled in the study. Serum levels of 25-hydroxyvitamin D [25(OH)D] were determined by a chemiluminescent method. Specific IgE (sIgE) to Staphylococcus aureus enterotoxins and sIgE to Malassezia furfur were assayed by the ImmunoCAP system. ANOVA and the Pearson correlation test were used for statistical evaluation.

Results We found severe, moderate and mild AD in nine (24%), 13 (35%) and 15 (41%) children, respectively. Mean ± SD serum levels of 25(OH)D were significantly higher (P < 0Æ05) in patients with mild disease (36Æ9 ± 15Æ7 ng mL ) compared with those with moderate (27Æ5 ± 8Æ3 ng mL or severe AD (20Æ5 ± 5Æ9 ng mL. The prevalence of patients with sIgE to microbial antigens increased in relation to vitamin D deficiency and AD severity.

Conclusions. These data suggest that vitamin D deficiency may be related to the severity of AD and advocate the need for studies evaluating the use of vitamin D as a potential treatment in patients with this disease.

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