with negative SPT at age 2 had a prevalence of asthma at age 11 of 14% (4/28), compared to 60% (29/49) for the early atopic ones (P,0.0003). AD is a common illness that develops early in childhood (4). iAD is a condition different from eAD, because allergy seems not to play a major role in its pathogenesis (1, 7). However, a strict distinction cannot be made because of the possibility that iAD may develop into eAD during the course of time. In fact, we have found in this study that more than half of patients SPT negative at the onset of AD, became SPT positive by the age of 11. Therefore, in many cases, the so-called iAD is not a true entity but only a transition stage in the natural history of AD. However, subjects with negative SPT at the onset of AD have a much lower risk of developing asthma much lower than the early atopics. On the other hand, the atopic status seems not to be important for AD persistence. In conclusion, children with SPT-negative AD by the age of 2 years have a significantly lower risk of developing asthma than SPT-positive ones. This feature might be useful to select children with AD who need prevention or early treatment of asthma. *Allergy and Clinical Immunology Unit Department of Pediatrics Anna Meyer Hospital Via Luca Giordano 13 50132 Florence Italy Tel. (+39-055) 5662461 Fax: (+39-055) 570380 Accepted for publication 8 January 2001 Allergy 2001: 56:452–453 Copyright # Munksgaard 2001 ISSN 0105-4538 References 1. WU ¨ THRICH B. Clinical aspects, epidemiology and prognosis of atopic dermatitis. Ann Allergy Asthma Immunol 1999;83: 464–470. 2. AKDIS CA, AKDIS M, SIMON D, et al. Role of T cells and cytokines in the intrinsic form of atopic dermatitis. Curr Probl Dermatol 1999;28:37–44. 3. OPPEL T, SCHULLER E, MODERER M, et al. Intrinsic atopic dermatitis is characterized by a low expression of the high affinity IgE receptor FCeRI on epidermal dendritic cells. Arch Dermatol Res 2000;292:108. 4. HANIFIN JM, RAJKA G. Diagnostic features of atopic dermatitis. Acta Derm Venereol 1980;Suppl 92:44–47. 5. NOVEMBRE E, CIANFERONI A, BERNARDINI R, et al. Epidemiology of insect venom sensitivity in children and its correlation with clinical and atopic features. Clin Exp Allergy 1998;28:834–838. 6. DREBORG S, BACKMAN A, BASOMBA A, et al. Skin tests used in type I allergy testing. Position paper prepared by Subcommittee on Skin Tests of EAACI. Allergy 1989;44 Suppl 10:1–59. 7. WOLLENBERG A, BIEBER T. Atopic dermatitis: from the genes to the skin lesions. Allergy 2000;55:205–213. SIT in Croatia V. Milavec-Puretic ´*, J. Lipozenc ˇic ´, N. Di Biagio, I. Lakos ˇ-Jukic ´ Key words: hypersensitivity; immediate diagnosis; immunologic tests; immunotherapy. . SPECIFIC immunotherapy (SIT) (hyposensitization) is the practice of administering gradually increasing quantities of a specific allergen to allergic patients (insect sting-induced reactions – anaphylaxis, rhinoconjunctivitis, bronchitis, asthma, and atopic dermatitis caused by inhalatory allergens) until a maintenance dose is reached or the symptoms disappear. The principle of preparing modified vaccines is to reduce or remove allergenicity and to preserve or increase immunogenicity. In this way, the capacity to modulate the immune system and to maintain clinical efficacy is preserved (1). Physical modification includes absorption and inclusion of allergens as depot vaccines, as with aluminum (2), calcium phosphate, tyrosine, and liposomes (3). Chemical modification refers to the so- called allergoids. Combinations of chemically and physically modified vaccines include tyrosine-adsorbed, glutaraldehyde-modified vaccines and aluminum hydroxide-adsorbed formaldehyde vaccines. Contraindications for SIT include immunodeficiency diseases, malignancies, severe uncontrolled asthma, cardiovascular disorders, age under 5 years, advanced age, and pregnancy. Hypersensitivity to Hymenoptera venom is an exception. During a 15-year period (1985–99) at the Department of Dermatology and Venereology (Allergy Unit), Zagreb University Hospital Center, Croatia, allergen SIT was used in 185 allergic patients with the following diagnoses: allergic rhinitis, allergic conjunctivitis, pollinosis, bronchial asthma, atopic dermatitis with sensitization to inhalatory allergens, and urticaria with Quincke’s edema. Allergen mixtures of tree and grass pollen and weeds, and single allergens (house dust and dust mite) were used (Table 1). Therapy was administered twice weekly with increasing doses of allergen vaccines in concentrations I to IV, followed by the maintenance dose, with due consideration of contraindications as recommended by WHO. Pretreatment examinations included the prick test and serologic analyses (total and specific IgE). During allergen SIT, the following clinical and laboratory examinations were regularly performed: A 15-year evaluation of immunotherapy. 453