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CLINICAL EVIDENCE OF ENTERIC FLORA CHANGES IN SYSTEMIC
ALLERGY TO NICKEL (SNAS): A RANDOMIZED DOUBLE-BLIND
PLACEBO CONTROLLED-STUDY
L. RICCIARDI, S. IMBESI, D.COMITO*, C. BUDA°, L. VENUTO, V. TIGANO AND C.
ROMANO*
ALLERGY AND IMMUNOLOGY UNIT, UNIVERSITY OF MESSINA
° ENDOSCOPY UNIT, UNIVERSITY OF MESSINA
*PEDIATRIC DEPARTMENT, UNIVERSITY OF MESSINA
Background : SNAS is characterized by cutaneous reactions and/or gastrointestinal (GI)
symptoms due to the intake of nickel in food. The GI clinical manifestations related to SNAS can
include dyspeptic symptoms, such as nausea and/or vomiting, heartburn, bloating, chronic
abdominal pain, diarrhoea and constipation. In some trials endoscopic findings have displayed
histological and immunohistochemical abnormalities with aspecific chronic inflammation (marked
lymphoplasmacellular inflammatory infiltrate, villus deformation and deepening of the crypta and
Th1-subset lymphocytes change). No studies have been conducted about modulations of the gut
microbial flora and clinical symptoms. Aim of the study: the purpose of this study was to assess
the usefulness of LCT reuteri DSM 17938 (NOOS, Italy) supplementation in patients with SNAS in
terms of reducing the percentage of relapse. Materials and Methods: a prospective double-blind
randomized placebo-controlled study was planned. From December 2009 to May 2010, patients
with clinical symptoms correlated to SNAS were enrolled and randomly assigned to receive either
active treatment or placebo. Of the total of 20 enrolled patients, all female patients mean age
34.12, 11 were assigned to the active treatment (L.Reuteri) whereas 9 received placebo. At
enrolment the clinical severity of each patient was evaluated as far as intensity of cutaneous
symptoms ( urticaria, eczema, itching) and gastrointestinal symptoms (heartburn, abdominal pain,
bloating, diarrhea, constipation) were concerned assigning a total symptom score. The impact of
symptoms on the quality of life of each patient was evaluated indicating a score on a Visual
Aanalogic Scale. Results: After the four weeks statistically significant changes in the severity
scoring index were recorded in patients who received the probiotic supplementation compared with
patients who received placebo (p<0.05) as well as a significant reduction in drug consumption
(antihistamines, antisecretory) and a significant increase in well days. Conclusion: Lactobacillus
reuteri in patients with SNAS is associated with a significant improvement of cutaneous and GI
symptoms. We are comparing these results with the study of the composition of microbiota . The
PCR-amplified of the 16S rRNA gene technique with bacterium specific primers by Denaturing
Gradient Gel Electrophoresis (DGGE) is used.