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Latorre M, Rizzi A, Paggiaro P, Baiardini I, Bagnasco D, Del Giacco S, Lombardi C, Patella V, Nucera E, Parente R, Paoletti G, Pini L, Ridolo E, Senna G, Blasi F, Canonica GW. Asthma management, focused on the use of oral corticosteroids: the opinions of Italian asthmatic patients. J Asthma 2024:1-12. [PMID: 38578082 DOI: 10.1080/02770903.2024.2338863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 03/31/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Patients' perceptions of asthma symptoms, and attitudes regarding diagnosis and management, can affect their ability to reach good asthma control. The aim of the study was to explore patients' perceptions of asthma management, with focus on treatment with oral corticosteroids (OCS). METHODS A DOXAPHARMA survey was conducted. A questionnaire with 46 multiple choice questions was completed by 50 patients with severe uncontrolled asthma, and 258 with mild-moderate controlled or partly controlled asthma. Participants were representative of Italian asthmatic patients-with medium age, long asthma duration, delayed diagnosis, poor asthma control, and frequent exacerbations. RESULTS Many asthmatics reported inadequate pharmacologic treatment. The majority but not all patients regularly used ICS/LABA. Oral treatment was common, mainly with OCS, particularly in severe asthmatics. One-fourth of patients did not regularly use inhaled therapy, and adherence was poor, resulting in frequent OCS use to treat exacerbations, which were common in mild-moderate cases. Patients were fairly satisfied with asthma therapies, but many had concerns about long-term corticosteroid use. Patients complained about poor management of comorbidities associated with asthma and OCS use, but were generally satisfied with their patient/doctor relationships. Many patients failed to achieve optimal health-related quality of life (HRQoL), mainly those with severe asthma who used OCS treatment and emphasized how OCS therapy impacted QoL. CONCLUSIONS The survey results confirmed many problems related to mild-moderate and severe asthma management in Italy and highlighted the overuse of OCS rather than more effective and safe treatments, which had strong negative effects on HRQoL.
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Bousquet J, Schünemann HJ, Sousa-Pinto B, Zuberbier T, Togias A, Samolinski B, Bedbrook A, Czarlewski W, Hofmann-Apitius M, Litynska J, Vieira RJ, Anto JM, Fonseca JA, Brozek J, Bognanni A, Brussino L, Canonica GW, Cherrez-Ojeda I, Cruz AA, Vecillas LDL, Dykewicz M, Gemicioglu B, Giovannini M, Haahtela T, Jacobs M, Jacomelli C, Klimek L, Kvedariene V, Larenas-Linnemann DE, Louis G, Lourenço O, Leemann L, Morais-Almeida M, Neves AL, Nadeau KC, Nowak A, Palamarchuk Y, Palkonen S, Papadopoulos NG, Parmelli E, Pereira AM, Pfaar O, Regateiro FS, Savouré M, Taborda-Barata L, Toppila-Salmi SK, Torres MJ, Valiulis A, Ventura MT, Williams S, Yepes-Nuñez JJ, Yorgancioglu A, Zhang L, Zuberbier J, Abdul Latiff AH, Abdullah B, Agache I, Al-Ahmad M, Al-Nesf MA, Al Shaikh NA, Amaral R, Ansotegui IJ, Asllani J, Balotro-Torres MC, Bergmann KC, Bernstein JA, Bindslev-Jensen C, Blaiss MS, Bonaglia C, Bonini M, Bossé I, Braido F, Caballero-Fonseca F, Camargos P, Carreiro-Martins P, Casale T, Castillo-Vizuete JA, Cecchi L, Teixeira MDC, Chang YS, Loureiro CC, Christoff G, Ciprandi G, Cirule I, Correia-de-Sousa J, Costa EM, Cvetkovski B, de Vries G, Del Giacco S, Devillier P, Dokic D, Douagui H, Durham SR, Enecilla ML, Fiocchi A, Fokkens WJ, Fontaine JF, Gawlik R, Gereda JE, Gil-Mata S, Giuliano AF, Gotua M, Gradauskiene B, Guzman MA, Hossny E, Hrubiško M, Iinuma T, Irani C, Ispayeva Z, Ivancevich JC, Jartti T, Jeseňák M, Julge K, Jutel M, Kaidashev I, Bennoor KS, Khaltaev N, Kirenga B, Kraxner H, Kull I, Kulus M, Kuna P, Kupczyk M, Kurchenko A, La Grutta S, Lane S, Miculinic N, Lee SM, Le Thi Tuyet L, Lkhagvaa B, Louis R, Mahboub B, Makela M, Makris M, Maurer M, Melén E, Milenkovic B, Mohammad Y, Moniuszko M, Montefort S, Moreira A, Moreno P, Mullol J, Nadif R, Nakonechna A, Navarro-Locsin CG, Neffen HE, Nekam K, Niedoszytko M, Nunes E, Nyembue D, O'Hehir R, Ollert M, Ohta K, Okamoto Y, Okubo K, Olze H, Padukudru MA, Palomares O, Pali-Schöll I, Panzner P, Palosuo K, Park HS, Passalacqua G, Patella V, Pawankar R, Pétré B, Pitsios C, Plavec D, Popov TA, Puggioni F, Quirce S, Raciborski F, Ramonaité A, Recto M, Repka-Ramirez S, Roberts G, Robles-Velasco K, Roche N, Rodriguez-Gonzalez M, Romualdez JA, Rottem M, Rouadi PW, Salapatas M, Sastre J, Serpa FS, Sayah Z, Scichilone N, Senna G, Sisul JC, Solé D, Soto-Martinez ME, Sova M, Sozinova O, Stevanovic K, Ulrik CS, Szylling A, Tan FM, Tantilipikorn P, Todo-Bom A, Tomic-Spiric V, Tsaryk V, Tsiligianni I, Urrutia-Pereira M, Rostan MV, Sofiev M, Valovirta E, Van Eerd M, Van Ganse E, Vasankari T, Vichyanond P, Viegi G, Wallace D, Wang DY, Waserman S, Wong G, Worm M, Yusuf OM, Zaitoun F, Zidarn M. Concepts for the development of person-centred, digitally-enabled, Artificial Intelligence-assisted ARIA care pathways (ARIA 2024). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00682-2. [PMID: 38971567 DOI: 10.1016/j.jaip.2024.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/16/2024] [Accepted: 06/25/2024] [Indexed: 07/08/2024]
Abstract
The traditional healthcare model is focused on diseases (medicine and natural science) and does not acknowledge patients' resources and abilities to be experts in their own life based on their lived experiences. Improving healthcare safety, quality and coordination, as well as quality of life, are important aims in the care of patients with chronic conditions. Person-centred care needs to ensure that people's values and preferences guide clinical decisions. This paper reviews current knowledge to develop (i) digital care pathways for rhinitis and asthma multimorbidity and (ii) digitally-enabled person-centred care (1). It combines all relevant research evidence, including the so-called real-world evidence, with the ultimate goal to develop digitally-enabled, patient-centred care. The paper includes (i) Allergic Rhinitis and its Impact on Asthma (ARIA), a two-decade journey, (ii) Grading of Recommendations, Assessment, Development and Evaluation (GRADE), the evidence-based model of guidelines in airway diseases, (iii) mHealth impact on airway diseases, (iv) from guidelines to digital care pathways, (v) embedding Planetary Health, (vi) novel classification of rhinitis and asthma, (vi) embedding real-life data with population-based studies, (vii) the ARIA-EAACI strategy for the management of airway diseases using digital biomarkers, (viii) Artificial Intelligence, (ix) the development of digitally-enabled ARIA Person-Centred Care and (x) the political agenda. The ultimate goal is to propose ARIA 2024 guidelines centred around the patient in order to make them more applicable and sustainable.
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Bonini M, Barbaglia S, Camiciottoli G, Del Giacco S, Di Marco F, Matucci A, Micheletto C, Papi A, Pasqualetti P, Pelaia G, Ricciardolo FLM, Rogliani P, Senna G, Triggiani M, Vancheri C, Canonica GW. Asthma remission one, none and one-hundred thousand: the relevance of the patient's view. J Asthma 2024:1-10. [PMID: 38870405 DOI: 10.1080/02770903.2024.2366523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE Achieving remission in severe asthma holds paramount importance in elevating patient quality of life and reducing both individual and societal burdens associated with this chronic condition. This study centers on identifying pivotal patient-relevant endpoints through standardized, reproducible methods, while also developing a patient-centric definition of remission, essential for effective disease management. METHODS A discrete choice experiment (DCE) was conducted to assess patients' perceptions on the four primary criteria for defining severe asthma remission, as outlined by the SANI survey. Additionally, it investigated the correlation between these perceptions and improvements in the doctor-patient therapeutic alliance during treatment decision-making. RESULTS 249 patients (70% aged between 31-60, 59% women and 82% without other pathologies requiring corticosteroids) prioritize the use of oral corticosteroids (OCS, 48%) and the Asthma Control Test (ACT, 27%) in defining their condition, ranking these above lung function and exacerbations. This preference for OCS stems from its direct role in treatment, tangible tracking, immediate symptom relief, and being a concrete measure of disease severity compared to the less predictable and quantifiable exacerbations. CONCLUSIONS This study explores severe asthma remission from patients' perspectives using clinician-evaluated parameters. The DCE revealed that most patients highly value OCS and the ACT, prefer moderate improvement, and avoid cortisone cycles. No definitive preference was found for lung function status. Integrating patient-reported information with professional insights is crucial for effective management and future research. Personalized treatment plans focusing on patient preferences, adherence, and alternative therapies aim to achieve remission and enhance quality of life.
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Olivieri B, Günaydın FE, Corren J, Senna G, Durham SR. The combination of allergen immunotherapy and biologics for inhalant allergies: Exploring the synergy. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00365-X. [PMID: 38897405 DOI: 10.1016/j.anai.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
The development of monoclonal antibodies that selectively target IgE and type 2 immunity has opened new possibilities in the treatment of allergies. Although they have been used mainly as single therapies found to have efficacy in the management of asthma and other T2-mediated diseases, there is a growing interest in using these monoclonal antibodies in combination with allergen immunotherapy (AIT). AIT has transformed the treatment of allergic diseases by aiming to modify the underlying immune response to allergens rather than just providing temporary symptom relief. Despite the proven efficacy and safety of AIT, unmet needs call for further research and innovation. Combination strategies involving biologics and AIT exhibit potential in improving short-term efficacy, reducing adverse events, and increasing immunologic tolerance. Anti-IgE emerges as the most promising therapeutic strategy, not only enhancing AIT's safety and tolerability but also providing additional evidence of efficacy compared with AIT alone. Anti-interleukin-4 receptor offers a reduction in adverse effects and an improved immunologic profile when combined with AIT; however, its impact on short-term efficacy seems limited. The combination of cat dander subcutaneous immunotherapy with anti-thymic stromal lymphopoietin was synergistic with enhanced efficacy and altered immune responses that persisted for 1 year after discontinuation compared with AIT alone. Long-term studies are needed to evaluate the sustained benefits and safety profiles of combination strategies.
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Caminati M, Senna G, Maule M, Di Sabatino A, Rossi CM. Diagnosis, management and therapeutic options for eosinophilic esophagitis. Curr Opin Allergy Clin Immunol 2024; 24:122-128. [PMID: 38656287 DOI: 10.1097/aci.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW Eosinophilic esophagitis is a chronic and commonly evolving condition leading to relevant and potentially irreversible burden in terms of tissue damage and related functional impairment, thus significantly impacting on quality of life. The aim of the present review is to summarize the recent advances in terms of diagnostic work-up and pharmacological and nonpharmacological management of the disease, under the broader perspective of type 2 inflammation. RECENT FINDINGS Two major novelties have prompted an innovative approach to EoE. In terms of diagnosis, it has been proposed to dissect the disease heterogeneity in three endotypes, independent from tissue eosinophil number: EoEe1, characterized by normal appearing oesophagus; EoEe2, associated with type 2 inflammation and steroid-refractoriness; EoEe3, whose features include adult onset, a more fibro-stenotic aspect and loss of epithelial gene expression. Concerning treatment, two recently licensed drugs for EoE, oro-dispersible budesonide and dupilumab represent the first treatment options specifically developed for EoE and addressing EoE-related peculiar pathobiological features. SUMMARY In the era of precision medicine, managing EoE according to a phenotype-driven approach might be helpful in defining the best treatment options in the different disease forms or stages. In addition, exploring the coexistence or the previous occurrence of other type 2 conditions may suggest the opportunity to specifically target type 2 inflammation through biologic therapy. The complex EoE pathobiology combining inflammatory and functional features, both at organ and systemic level, requires a multidimensional approach relying on the strict integration of gastroenterologists and allergist-immunologists.
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Pini L, Bagnasco D, Beghè B, Braido F, Cameli P, Caminati M, Caruso C, Crimi C, Guarnieri G, Latorre M, Menzella F, Micheletto C, Vianello A, Visca D, Bondi B, El Masri Y, Giordani J, Mastrototaro A, Maule M, Pini A, Piras S, Zappa M, Senna G, Spanevello A, Paggiaro P, Blasi F, Canonica GW. Unlocking the Long-Term Effectiveness of Benralizumab in Severe Eosinophilic Asthma: A Three-Year Real-Life Study. J Clin Med 2024; 13:3013. [PMID: 38792553 PMCID: PMC11122375 DOI: 10.3390/jcm13103013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/24/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Benralizumab has been shown to restore good control of severe eosinophilic asthma (SEA). Robust data on benralizumab effectiveness over periods longer than 2 years are scarce. Methods: This retrospective multicentric study was conducted on 108 Italian SEA patients treated with benralizumab for up to 36 months. Partial and complete clinical remission (CR) were assessed. Data were analyzed with descriptive statistics or using linear, logistic, and negative binomial mixed-effect regression models. Results: At 36 months, benralizumab reduced the exacerbation rate by 89% and increased the forced expiratory volume in 1 second (FEV1) (+440 mL at 36 months, p < 0.0001). Benralizumab improved asthma control as well as sinonasal symptoms in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). Up to 93.33% of patients either reduced or discontinued OCS; benralizumab also decreased ICS use and other asthma medications. Overall, 84.31% of patients achieved partial or complete CR. Conclusions: Benralizumab improved asthma and sinonasal outcomes up to 36 months. These findings support the potential of benralizumab to induce CR, emphasizing its role as a disease-modifying anti-asthmatic drug for the management of SEA. Further research is warranted to expand these findings by minimizing data loss and assessing benralizumab's long-term safety.
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Cutroneo PM, Arzenton E, Furci F, Scapini F, Bulzomì M, Luxi N, Caminati M, Senna G, Moretti U, Trifirò G. Safety of Biological Therapies for Severe Asthma: An Analysis of Suspected Adverse Reactions Reported in the WHO Pharmacovigilance Database. BioDrugs 2024; 38:425-448. [PMID: 38489062 PMCID: PMC11055782 DOI: 10.1007/s40259-024-00653-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The management of uncontrolled severe asthma has greatly improved since the advent of novel biologic therapies. Up to August 2022, five biologics have been approved for the type 2 asthma phenotype: anti-IgE (omalizumab), anti-IL5 (mepolizumab, reslizumab, benralizumab), and anti-IL4 (dupilumab) monoclonal antibodies. These drugs are usually well tolerated, although long-term safety information is limited, and some adverse events have not yet been fully characterized. Spontaneous reporting systems represent the cornerstone for the detection of potential signals and evaluation of the real-world safety of all marketed drugs. OBJECTIVE The aim of this study was to provide an overview of safety data of biologics for severe asthma using VigiBase, the World Health Organization global pharmacovigilance database. METHODS We selected all de-duplicated individual case safety reports (ICSRs) attributed to five approved biologics for severe asthma in VigiBase, up to 31st August 2022 (omalizumab, mepolizumab, reslizumab, benralizumab and dupilumab). Descriptive frequency analyses of ICSRs were carried out both as a whole class and as individual products. Reporting odds ratios (ROR) with 95% confidence intervals (CIs) were used as the measure of disproportionality for suspected adverse drug reactions (ADRs) associated with the study drugs compared with either all other suspected drugs (Reference Group 1, RG1) or inhaled corticosteroids plus long-acting β-agonists (ICSs/LABAs) (Reference Group 2, RG2) or with oral corticosteroids (OCSs) (Reference Group 3, RG3). RESULTS Overall, 31,724,381 ICSRs were identified in VigiBase and 167,282 (0.5%) were related to study drugs; the remaining reports were considered as RG1. Stratifying all biologic-related ICSRs by therapeutic indication, around 29.4% (n = 48,440) concerned asthma use; omalizumab was mainly indicated as the suspected drug (n = 20,501), followed by dupilumab, mepolizumab, benralizumab and reslizumab. Most asthma ICSRs concerned adults (57%) and women (64.1%). Asthma biologics showed a higher frequency of serious suspected ADR reporting than RG1 (41.3% vs 32.3%). The most reported suspected ADRs included asthma, dyspnea, product use issue, drug ineffective, cough, headache, fatigue and wheezing. Asthma biologics were disproportionally associated with several unknown or less documented adverse events, such as malignancies, pulmonary embolism and deep vein thrombosis with omalizumab; alopecia and lichen planus with dupilumab; alopecia and herpes infections with mepolizumab; alopecia, herpes zoster and eosinophilic granulomatosis with polyangiitis related to benralizumab; and alopecia with reslizumab. CONCLUSIONS The most frequently reported suspected ADRs of asthma biologics in VigiBase confirmed the presence of well-known adverse effects such as general disorders, injection-site reactions, nasopharyngitis, headache and hypersensitivity, while some others (e.g. asthma reactivation or therapeutic failure) could be ascribed to the indication of use. Moreover, the analysis of signals of disproportionate reporting suggests the presence of malignancies, effects on the cardiovascular system, alopecia and autoimmune conditions, requiring further assessment and investigation.
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Bagnasco D, Bondi B, Caminati M, Nicola S, Pini L, Milanese M, Brussino L, Senna G, Canonica GW, Braido F. Evaluation of Clinical Remission in Best-Performing Severe Asthmatic Patients Treated for Three Years with Mepolizumab. Biomedicines 2024; 12:960. [PMID: 38790922 PMCID: PMC11118185 DOI: 10.3390/biomedicines12050960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 02/18/2024] [Accepted: 02/26/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND In its severe form, where possible, asthma is treated using biological drugs in order to reduce, as much as possible, the use of systemic steroids. Mepolizumab is effective for severe asthma based on key outcomes such as exacerbation and steroid dependence. Its efficacy in terms of the criteria for clinical remission in the short and long term has become of interest. OBJECTIVE We aimed to evaluate the effect of mepolizumab in the achievement of clinical remission after 3 years of administration. METHODS In this study, 71 patients who continued mepolizumab for 3 years were assessed for clinical remission according to six different published sets of remission criteria. RESULTS According to the criteria, 39-52% of patients experienced complete remission in the first year, increasing to 51-73% at 3 years. By classifying patients according to partial and complete remission criteria, proposed by the SANI, we observe 22% of patients in partial remission at one year, achieving complete remission after three years. The baseline factors associated with earlier remission were a higher FEV1, if we consider classifications requiring an FEV1 ≥ 80%, a low OCS dose, and low FeNO levels, in the patients requiring FEV1 stabilization. CONCLUSIONS Clinical remission is possible for patients treated with mepolizumab. The observations at three years compared with the first year indicated that the factors negatively affecting remission delayed rather than prevented it. Earlier treatment could increase the chances of remission.
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Menzella F, Munari S, Corsi L, Tonin S, Cestaro W, Ballarin A, Floriani A, Dartora C, Senna G. Tezepelumab: patient selection and place in therapy in severe asthma. J Int Med Res 2024; 52:3000605241246740. [PMID: 38676539 PMCID: PMC11056094 DOI: 10.1177/03000605241246740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/21/2024] [Indexed: 04/29/2024] Open
Abstract
Asthma is a disease characterised by heterogeneous and multifaceted airway inflammation. Despite the availability of effective treatments, a substantial percentage of patients with the type 2 (T2)-high, but mainly the T2-low, phenotype complain of persistent symptoms, airflow limitation, and poor response to treatments. Currently available biologicals target T2 cytokines, but no monoclonal antibodies or other specific therapeutic options are available for non-T2 asthma. However, targeted therapy against alarmins is radically changing this perspective. The development of alarmin-targeted therapies, of which tezepelumab (TZP) is the first example, may offer broad action on inflammatory pathways as well as an enhanced therapeutic effect on epithelial dysfunction. In this regard, TZP demonstrated positive results not only in patients with severe T2 asthma but also those with non-allergic, non-eosinophilic disease. Therefore, it is necessary to identify clinical features of patients who can benefit from an upstream targeted therapy such as anti-thymic stromal lymphopoietin. The aims of this narrative review are to understand the role of alarmins in asthma pathogenesis and epithelial dysfunction, examine the rationale underlying the indication of TZP treatment in severe asthma, summarise the results of clinical studies, and recognise the specific characteristics of patients potentially eligible for TZP treatment.
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Cameli P, Aliani M, Altieri E, Bracciale P, Brussino L, Caiaffa MF, Canonica GW, Caruso C, Centanni S, D’Amato M, De Michele F, Del Giacco S, Di Marco F, Pelaia G, Rogliani P, Romagnoli M, Schino P, Schroeder JW, Senna G, Vultaggio A, Benci M, Boarino S, Menzella F. Sustained Effectiveness of Benralizumab in Naïve and Biologics-Experienced Severe Eosinophilic Asthma Patients: Results from the ANANKE Study. J Asthma Allergy 2024; 17:273-290. [PMID: 38562251 PMCID: PMC10982664 DOI: 10.2147/jaa.s438981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/16/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Severe eosinophilic asthma (SEA) patients often present overlapping inflammatory features rendering them eligible for multiple biologic therapies; switching biologic treatment is a strategy adopted to optimize asthma control when patients show partial or no response to previous biologics. Patients and Methods ANANKE is a retrospective, multicenter Italian study (NCT04272463). Here, we outline the characteristics and long-term clinical outcomes in naïve-to-biologics and biologics-experienced patients treated with benralizumab for up to 96 weeks. Bio-experienced patients were split into omalizumab and mepolizumab subsets according to the type of biologic previously used. Results A total of 124 (76.5%) naïve and 38 (23.5%) bio-experienced patients were evaluated at index date; 13 patients (34.2%) switched from mepolizumab, 21 patients (55.3%) switched from omalizumab, and four patients (10.5%) received both biologics. The mepolizumab subset was characterized by the longest SEA duration (median of 4.6 years), the highest prevalence of chronic rhinosinusitis with nasal polyposis (CRSwNP) (76.5%), and the greatest oral corticosteroid (OCS) daily dosage (median of 25 mg prednisone equivalent). The omalizumab group showed the highest severe annual exacerbation rate (AER) (1.70). At 96 weeks, treatment with benralizumab reduced any and severe AER by more than 87% and 94%, respectively, across all groups. Lung function was overall preserved, with major improvements observed in the mepolizumab group, which also revealed a 100% drop of the median OCS dose. Asthma Control Test (ACT) score improved in the naïve group while its increment was more variable in bio-experienced patients; among these, a marked difference was noticed between omalizumab and mepolizumab subsets (median ACT score of 23.5 and 18, respectively). Conclusion Benralizumab promotes durable and profound clinical benefits in naïve and bio-experienced groups, indicating that a nearly complete depletion of eosinophils is highly beneficial in the control of SEA, independently of previous biologic use.
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Lombardi C, Passalacqua G, Menzella F, Mauritz Canevari RF, Danesi G, Pusateri AM, Carone M, Vancheri C, Di Marco F, Micheletto C, Manzotti G, Di Gioacchino M, Bilò MB, Gelardi M, Senna G, Canonica GW. Chronic rhinosinusitis with nasal polyposis and biological agents: the ARIA-ITALY Survey. Eur Ann Allergy Clin Immunol 2024. [PMID: 38534135 DOI: 10.23822/eurannaci.1764-1489.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Summary Background. Chronic rhinosinusitis (CRS) is an inflammatory disease that affects the nasal mucosa and the paranasal sinuses. CRS can be associated by nasal polyposis (CRSwNP phenotype) in up to 30% of patients and it is frequently associated with bronchial asthma. CRSwNP shows predominantly an underlying activation of type 2 inflammatory pathways with the involvement of eosinophils, IgE, interleukin (IL)-4, IL-5 and IL-13. Biological drugs that target these inflammatory cytokines are currently a therapeutic option recognized by guidelines for the treatment of uncontrolled form of the disease. Methods. As part of the activity of the "ARIA-Italy" working group, a panel of 255 Italian Ear, Nose and Throat (ENT) specialists, pneumologists and immuno-allergologists actively participated in this national survey and answered a series of questions geared toward understanding the main criteria for patient characterization and therapeutic decision, highlighting multidisciplinarity, and the implementation of the management of CRSwNP patients, as a part of the precision medicine concept and the appropriate use of the biologicals. Results. Two hundred and fifty-five experts and specialists participated in the survey. Conclusions. The results of this survey obtained from an extensive number of active specialists throughout Italy allow some important concluding remarks to be drawn. The main points of agreement were that multidisciplinary care teams provide many benefits but that, once the team is established, meetings and communication between members must be coordinated. Finally, the dissemination of national disease registries and the continuous updating of guidelines and position papers related to CRSwNP and comorbidities should be encouraged.
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Turner PJ, Ansotegui IJ, Campbell DE, Cardona V, Carr S, Custovic A, Durham S, Ebisawa M, Geller M, Gonzalez-Estrada A, Greenberger PA, Hossny E, Irani C, Leung AS, Levin ME, Muraro A, Oppenheimer JJ, Ortega Martell JA, Pouessel G, Rial MJ, Senna G, Tanno LK, Wallace DV, Worm M, Morais-Almeida M. Updated grading system for systemic allergic reactions: Joint Statement of the World Allergy Organization Anaphylaxis Committee and Allergen Immunotherapy Committee. World Allergy Organ J 2024; 17:100876. [PMID: 38361745 PMCID: PMC10867340 DOI: 10.1016/j.waojou.2024.100876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/28/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024] Open
Abstract
There is a lack of consensus over the description and severity assignment of allergic adverse reactions to immunotherapy, although there seems to be a consensus at least in terms of using the World Allergy Organization (WAO) grading systems to describe local adverse events for Sublingual Immunotherapy (SLIT) and Systemic Allergic Reactions (SARs) to Subcutaneous Immunotherapy (SCIT) amongst the major national/regional allergy societies. In this manuscript, we propose a modification of the previous WAO Grading system for SARs, which aligns with the newly-proposed Consortium for Food Allergy Research (CoFAR) Grading Scale for Systemic Allergic Reactions in Food Allergy (version 3.0). We hope this can facilitate a unified grading system appropriate to SARs due to allergen immunotherapy, independent of allergen and route of administration, and across clinical and research practice.
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De Corso E, Pipolo C, Caminati M, Cantone E, Seccia V, Cecchi L, Nettis E, Garzaro M, Ottaviano G, Gelardi M, Cavaliere C, Heffler E, Pagella F, Pasquini E, Trimarchi M, Gallo S, La Mantia I, Torretta S, Mattavelli D, Caruso C, Matucci A, Vultaggio A, Bellocchi G, Alicandri Ciufelli M, Fm P, Senna G. Multidisciplinary Decision-Making-ITAlian Consensus After Two Years of Real Practice on the Management of Severe Uncontrolled CRSwNP by Biologics (ITACA Study). Curr Allergy Asthma Rep 2024; 24:143-154. [PMID: 38472601 DOI: 10.1007/s11882-024-01135-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE OF REVIEW We aimed to reach an Italian multidisciplinary consensus on some crucial aspects of treatment decision making in CRSwNP, following 2 years of clinical experience in order to support specialists in the management of CRSwNP in clinical practice. We addressed issues relating to therapeutic decision-making and shared criteria for the treatment choice, as well as appropriate timing and criteria for evaluating treatment response, and highlighted the need for repeated multidisciplinary assessments. RECENT FINDINGS A national survey has been conducted recently to understand how rhinology practice has changed in Italy with the advent of biologics and how this affects patients with uncontrolled, severe CRSwNP. Despite the many published consensus documents, practical recommendations, and protocols on the use of biologics in CRSwNP, heterogenous behaviors in practice are still observed mainly conditioned by the novelty of the topic. The consensus procedure followed a modified Delphi approach. The scientific board included 18 otorhinolaryngologists and 8 allergists, who selected the 4 main topics to be addressed and developed overall 20 statements. Consensus on these statements was sought by a larger group of 48 additional experts, through two rounds of voting, the first web-based, the second in presence with discussion and possible refinement of the statements. The statements reaching an average score ≥ 7 at the second voting round were approved. Five statements were proposed for each of the following topics: baseline evaluation of patients eligible for biologic therapy; choice between different therapeutic options; assessment of the response to biologic treatment; multidisciplinary management. At the first voting round, 19 out of the 20 statements reached a mean score ≥ 7. Following the discussion and a few consequent amendments, at the second round of voting all the 20 statements were approved.
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Caminati M, Scarpieri E, Maule M, Pinter P, Schiappoli M, Vaia R, Senna G. Successful switching from mepolizumab to dupilumab in a patient with EGPA in remission phase and persistent nasal polyposis. Rheumatology (Oxford) 2024; 63:e96-e98. [PMID: 37695303 DOI: 10.1093/rheumatology/kead479] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023] Open
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Norelli F, Schiappoli M, Senna G, Pinter P, Olivieri B, Ottaviano G, De Corso E, Caminati M. Adherence to Intranasal Steroids in Chronic Rhinosinusitis with Nasal Polyposis Prior to and during Biologic Therapy: A Neglected Matter. J Clin Med 2024; 13:1066. [PMID: 38398379 PMCID: PMC10889709 DOI: 10.3390/jcm13041066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Adherence to treatment is essential in chronic rhinosinusitis with nasal polyposis (CRSwNP). Intranasal corticosteroids (INCS) are the first-line therapy, followed by systemic corticosteroids and surgery if needed. In cases of refractory disease, biologics are added to conventional treatment, making adherence to INCS crucial in assessing eligibility for these targeted therapies. The purpose of this review is to examine INCS adherence assessment and rate, before starting and during biologic therapy. We conducted a comprehensive literature review focusing on INCS adherence in CRSwNP treated with biologics, including randomized controlled trials and real-life studies. The search extended to studies on allergic and non-allergic rhinitis to provide broader insights into tools to assess the INCS adherence. The result was that adherence to INCS in CRSwNP is underexplored, with only a few studies addressing it directly. Various tools for adherence assessment have been identified, but none are universally accepted as standard. The review also highlights the complexity of factors influencing adherence rates. Effective CRSwNP management requires a paradigm shift to prioritize adherence in treatment guidelines and clinical practice. The review advocates for improved adherence assessment tools, a deeper understanding of influencing factors, and the integration of personalized medicine approaches, especially for biologic therapies.
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Caminati M, Maule M, Benoni R, Bagnasco D, Beghè B, Braido F, Brussino L, Cameli P, Candeliere MG, Carpagnano GE, Costanzo G, Crimi C, D’Amato M, Del Giacco S, Guarnieri G, Yacoub MR, Micheletto C, Nicola S, Olivieri B, Pini L, Schiappoli M, Vaia R, Vianello A, Visca D, Spanevello A, Senna G. Dupilumab Efficacy on Asthma Functional, Inflammatory, and Patient-Reported Outcomes across Different Disease Phenotypes and Severity: A Real-Life Perspective. Biomedicines 2024; 12:390. [PMID: 38397992 PMCID: PMC10886692 DOI: 10.3390/biomedicines12020390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Dupilumab is currently approved for the treatment of Type 2 severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). Few studies have specifically reported on dupilumab efficacy on asthma outcomes as a primary objective in a real-life setting, in patients with and without CRSwNP. Our study aimed to explore the efficacy of dupilumab on functional, inflammatory, and patient-reported outcomes in asthma patients across different disease phenotypes and severity, including mild-to-moderate asthma coexisting with CRSwNP. Data from 3, 6, and 12 months follow-up were analyzed. Asthma (FEV1%, Tiffeneau%, ACT, FeNO, oral steroid use, exacerbation rate, and blood eosinophilia) and polyposis (SNOT22, VAS, NPS) outcomes showed a rapid (3 months) and sustained (6 and 12 months) significant change from baseline, despite most of the patients achieving oral steroid withdrawal. According to the sensitivity analysis, the improvement was not conditioned by either the presence of polyposis or severity of asthma at baseline. Of note, even in the case of milder asthma forms, a significant further improvement was recorded during dupilumab treatment course. Our report provides short-, medium-, and long-term follow-up data on asthma outcomes across different diseases phenotypes and severity, contributing to the real-world evidence related to dupilumab efficacy on upper and lower airways T2 inflammation.
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Caminati M, Micheletto C, Norelli F, Olivieri B, Ottaviano G, Padoan R, Piacentini G, Schiappoli M, Senna G, Menzella F. Safety of dupilumab in T2 airways conditions: focus on eosinophilia across trials and real-life evidence. Expert Opin Biol Ther 2024; 24:15-23. [PMID: 38197326 DOI: 10.1080/14712598.2024.2304556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/09/2024] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha subunit, effectively blocks both IL-4 and IL-13 mediated pathways. Its introduction has represented a significant advancement in the treatment of severe asthma and other Type 2 (T2) conditions, including nasal polyps, atopic dermatitis, and eosinophilic esophagitis. To date, Dupilumab has demonstrated optimal efficacy and safety profile. AREAS COVERED The safety profile of dupilumab has been extensively studied, especially for its effects on blood eosinophil count. Transient eosinophil increase during treatment is typically insignificant from a clinical point of view and related to its mechanism of action. Rare cases of hyper-eosinophilia associated with clinical conditions like eosinophilic granulomatosis with polyangiitis (EGPA) and hypereosinophilic syndrome (HES) have been reported. Those cases are often related to the drug's steroid-sparing effect or the natural trajectory of the underlying disease rather than a direct cause-effect relationship with dupilumab. EXPERT OPINION The management of hyper-eosinophilia during dupilumab treatment requires comprehensive diagnostic work-up and strict follow-up monitoring for early detection of systemic disease progression in order to avoid unnecessary discontinuation of an effective treatment. This approach highlights the importance of a personalized treatment.
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Caminati M, De Corso E, Ottaviano G, Pipolo C, Schiappoli M, Seccia V, Spinelli FR, Savarino EV, Gisondi P, Senna G. Remission in Type 2 Inflammatory Diseases: Current Evidence, Unmet Needs, and Suggestions for Defining Remission in Chronic Rhinosinusitis with Nasal Polyps. Curr Allergy Asthma Rep 2024; 24:11-23. [PMID: 38085499 PMCID: PMC10789826 DOI: 10.1007/s11882-023-01118-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE OF REVIEW The development of biological therapies for type 2 inflammatory diseases raises the possibility of addressing remission in those dis-immune conditions. No consensus exists for a definition of remission in chronic rhinosinusitis with nasal polyps (CRSwNP). This review aims to critically evaluate the published data to provide the basis for defining remission in CRSwNP. RECENT FINDINGS The published evidence has yet to provide an unequivocal definition on remission in type 2 inflammatory diseases, in part reflecting differences in approaches to diagnosis and follow-up. A multidimensional evaluation is necessary when considering complete remission, including clinical, inflammatory, and histologic criteria, but how to combine or tailor the three perspectives according to disease severity at baseline or timing of assessment of treatment category is yet to reach consensus. We suggest defining remission starting from the approach taken in asthma and eosinophilic esophagitis, that is, including the resolution of symptoms and improvements in objective parameters of disease severity and/or inflammatory activity. Future studies and consensuses should provide validated criteria with cutoffs for the day-to-day definition of remission. The definition of remission in CRSwNP should include the following criteria, to be verified and maintained for a period of ≥ 12 months: absence of symptoms (nasal obstruction, loss of smell, rhinorrhea as the main ones); no impact of symptoms on quality of life; no need of surgery; no chronic or rescue medications (systemic corticosteroids or antibiotics); and recovery of smell function, possibly evaluated by objective test. Assessment of underlying inflammation should also be considered once accurate and feasible biomarkers are available in clinical practice.
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Canonica GW, Blasi F, Carpagnano GE, Guida G, Heffler E, Paggiaro P, Allegrini C, Antonelli A, Aruanno A, Bacci E, Bagnasco D, Beghè B, Bonavia M, Bonini M, Brussino L, Caiaffa MF, Calabrese C, Camiciottoli G, Caminati M, Caruso C, Cavallini M, Chieco Bianchi F, Conte ME, Corsico AG, Cosmi L, Costantino M, Costanzo G, Crivellaro M, D'Alò S, D'Amato M, Detoraki A, Di Proietto MC, Facciolongo NC, Ferri S, Fierro V, Foschino MP, Latorre M, Lombardi C, Macchia L, Milanese M, Montagni M, Parazzini EM, Parente R, Passalacqua G, Patella V, Pelaia G, Pini L, Puggioni F, Ricciardi L, Ridolo E, Rolo J, Scichilone N, Scioscia G, Senna G, Solidoro P, Varricchi G, Vianello A, Yacoub MR, Yang B. Severe Asthma Network Italy Definition of Clinical Remission in Severe Asthma: A Delphi Consensus. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3629-3637. [PMID: 37558162 DOI: 10.1016/j.jaip.2023.07.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023]
Abstract
Severe asthma affects about 10% of the population with asthma and is characterized by low lung function and a high count of blood leukocytes, mainly eosinophils. Various definitions are used in clinical practice and in the literature to identify asthma remission: clinical remission, inflammatory remission, and complete remission. This work highlights a consensus for asthma remission using a Delphi method. In the context of the Severe Asthma Network Italy, which accounts for 57 severe asthma centers and more than 2,200 patients, a board of six experts drafted a list of candidate statements in a questionnaire, which has been revised to minimize redundancies and ensure clear and consistent wording for the first round (R1) of the analysis. Thirty-two statements were included in the R1 questionnaire and then submitted to a panel of 80 experts, which used a 5-point Likert scale to measure agreement regarding each statement. Then, an interim analysis of R1 data was performed, and items were discussed and considered to produce a consistent questionnaire for round 2 (R2) of the analysis. Then, the board set the R2 questionnaire, which included only important topics. Panelists were asked to vote on the statements in the R2 questionnaire afterward. During R2, the criteria of complete clinical remission (the absence of the need for oral corticosteroids, symptoms, exacerbations or attacks, and pulmonary function stability) and those of partial clinical remission (the absence of the need for oral corticosteroids, and two of three criteria: the absence of symptoms, exacerbations or attacks, and pulmonary stability) were confirmed. This Severe Asthma Network Italy Delphi analysis defined a valuable and independent tool that is easy to use, to test the efficacy of different treatments in patients with severe asthma enrolled into the SANI registry.
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De Corso E, Ottaviano G, Pipolo C, Cantone E, Mattavelli D, Alicandri-Ciufelli M, Lucidi D, Caminati M, Senna G, Cavaliere C, Ghidini A, Gallo S, Macchi A, Torretta S, Seccia V, Garzaro M, Fadda GL, Trimarchi M, Pasquini E, Pagella F, Canevari FR, Preti A, La Mantia I, Galli J. Chronic Rhinosinusitis with Nasal Polyps: A Survey on Routine Management and Evaluation of Disease Control in Practice. J Pers Med 2023; 13:1531. [PMID: 38003847 PMCID: PMC10672031 DOI: 10.3390/jpm13111531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease with a significant impact on quality of life. The overall goal of CRSwNP management, as with other chronic conditions, is to achieve "disease control", and for that reason, a definition of control of disease is pivotal in deciding the best treatment strategy. Although many staging systems have already been developed to evaluate the disease, disease control is not yet to be standardized, and a specific tool that is consistently applied and accepted by all practitioners is still missing in daily clinical practice. To gain an overview of the implementation and limitations of existing guidelines and to shed light on real-life definitions of control and disease severity, we conducted a nationwide survey of otorhinolaryngologists routinely treating CRSwNP to identify unmet clinical needs in Italy. The results showed homogeneous responses regarding the knowledge contained in international guidelines while highlighting the difficulty of their implementation in day-to-day practice. Respondents called attention to the importance of clinical symptoms, giving more weight to the patient's perspective. Among the symptoms to be considered, respondents emphasized nasal obstruction, followed by loss of sense of smell and rhinorrhea. Others also believe that the physician's perspective should be considered, and the inclusion of endoscopy as a measure of control was warranted by many. The need for a specific tool that is able to unequivocally ascertain disease control is increasingly pivotal in this new era of biologics for treating CRSwNP.
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Furci F, Luxi N, Senna G, Trifirò G. Anaphylaxis due to antiallergic and antiasthmatic biologics. Curr Opin Allergy Clin Immunol 2023; 23:364-369. [PMID: 37555938 DOI: 10.1097/aci.0000000000000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
PURPOSE OF REVIEW To provide a better understanding of the risk of anaphylaxis due to antiallergic and antiasthmatic biologics through an analysis of data reported in literature and in clinical trials, and by conducting a retrospective descriptive analysis of individual case safety reports on VigiBase, the WHO International Pharmacovigilance database. RECENT FINDINGS Analysis of the data, as described, demonstrated safety of the antiallergic and antiasthmatic biologics with a low incidence of anaphylaxis. SUMMARY Biologic therapies have revolutionized the treatment of many diseases, such as atopic dermatitis, nasal polyps, spontaneous chronic urticarial and severe asthma with a precise immunological action, in the sphere of precision medicine.Albeit these drugs are generally well tolerated, generating real-world evidence is crucial to re-evaluate clinically relevant adverse events, such as anaphylaxis, allowing to confirm their safety profile in particular in special populations such as paediatric patients.
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Tanno LK, Worm M, Ebisawa M, Ansotegui IJ, Senna G, Fineman S, Geller M, Gonzalez-Estrada A, Campbell DE, Leung A, Muraro A, Levin M, Ortega Martell JA, Caminati M, Kolkhir P, Le Pham D, Darlenski R, Esteban-Gorgojo I, Rial M, Filipovic I, Chiarella SE, Cuervo-Pardo L, Kwong C, Pozo-Beltran CF, Trinh THK, Greenberger PA, Turner PJ, Thong BYH, Martin B, Cardona V. Global disparities in availability of epinephrine auto-injectors. World Allergy Organ J 2023; 16:100821. [PMID: 37915955 PMCID: PMC10616381 DOI: 10.1016/j.waojou.2023.100821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 11/03/2023] Open
Abstract
Background Anaphylaxis is the most severe clinical presentation of acute systemic allergic reactions and can cause death. Given the prevalence of anaphylaxis within healthcare systems, it is a high priority public health issue. However, management of anaphylaxis - both acute and preventative - varies by region. Methods The World Allergy Organization (WAO) Anaphylaxis Committee and the WAO Junior Members Steering Group undertook a global online survey to evaluate local practice in the diagnosis and management of anaphylaxis across regions. Results Responses were received from WAO members in 66 countries. While intramuscular epinephrine (adrenaline) is first-line treatment for anaphylaxis, some countries continue to recommend alternative routes in contrast to guidelines. Epinephrine auto-injector (EAI) devices, prescribed to individuals at ongoing risk of anaphylaxis in the community setting, are only available in 60% of countries surveyed, mainly in high-income countries. Many countries in South America, Africa/Middle-East and Asian-Pacific regions do not have EAI available, or depend on individual importation. In countries where EAIs are commercially available, national policies regarding the availability of EAIs in public settings are limited to few countries (16%). There is no consensus regarding the time patients should be observed following emergency treatment of anaphylaxis. Conclusion This survey provides a global snapshot view of the current management of anaphylaxis, and highlights key unmet needs including the global availability of epinephrine for self-injection as a key component of anaphylaxis management.
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Senna G, Olivieri B, Castells M. Anaphylaxis: unraveling the mysteries and new perspectives. Curr Opin Allergy Clin Immunol 2023; 23:347-348. [PMID: 37641917 DOI: 10.1097/aci.0000000000000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
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Tanno LK, Caminati M, Pouessel G, Senna G, Demoly P. Epidemiology of anaphylaxis: is the trend still going up? Curr Opin Allergy Clin Immunol 2023; 23:349-356. [PMID: 37548324 DOI: 10.1097/aci.0000000000000933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
PURPOSE OF REVIEW To understand the current global scale of anaphylaxis and identify possible strategies to increase the accuracy of epidemiological data. RECENT FINDINGS Anaphylaxis mortality and morbidity statistics may gain new perspectives with the global implementation of the ICD-11. Improving the quality of epidemiological data related to anaphylaxis should clarify some areas of uncertainty about risk factors, leading to better targeting of strategies to protect those patients at risk, and support decision-making to facilitate health care planning and implementation of public health measures to prevent anaphylaxis. SUMMARY The true rate of anaphylaxis is unknown due to a number of factors, such as misdiagnosis, miscoding and undernotification. Moreover, there is lack of information about anaphylaxis epidemiology in many countries. Difficulties on collecting accurate and comparable data should be acknowledged and anaphylaxis data can vary widely. Currently, most robust data are derived from hospitalization datasets and national mortality databases. Anaphylaxis accounts for up to 0.26% of overall hospital admissions. It is suggested that the number of hospital admissions for anaphylaxis is increasing in many countries, both with respect to all-causes of anaphylaxis and by trigger, but the mortality rate remains low. However, there are still great challenges in capturing quality anaphylaxis mortality and morbidity statistics. Better understanding of anaphylaxis trends should clarify some areas of uncertainty about risk factors and prospect effective prevention strategies. As the knowledge derived from populations is key information for more realistic decision-making, the construction of the new section addressed to anaphylaxis in the ICD-11 will allow the collection of more accurate epidemiological data to support high quality management of patients, and to better facilitate health care planning to implement public health measures, reduce the morbidity and mortality attributable to anaphylaxis.
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Vianello A, Guarnieri G, Achille A, Lionello F, Lococo S, Zaninotto M, Caminati M, Senna G. Serum biomarkers of remodeling in severe asthma with fixed airway obstruction and the potential role of KL-6. Clin Chem Lab Med 2023; 61:1679-1687. [PMID: 36989607 DOI: 10.1515/cclm-2022-1323] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/10/2023] [Indexed: 03/31/2023]
Abstract
Over 3% of asthmatic patients are affected by a particularly severe form of the disease ("severe asthma", SA) which is often refractory to standard treatment. Airway remodeling (AR), which can be considered a critical characteristic of approximately half of all patients with SA and currently thought to be the main mechanism triggering fixed airway obstruction (FAO), seems to be a key factor affecting a patient's outcome. Despite the collective efforts of internationally renowned experts, to date only a few biomarkers indicative of AR and no recognizable biomarkers of lung parenchymal remodeling have been identified. This work examines the pathogenesis of airway and lung parenchymal remodeling and the serum biomarkers that may be able to identify the severe asthmatic patients who may develop FAO. The study also aims to examine if Krebs von den Lungen-6 (KL-6) could be considered a diagnostic biomarker of lung structural damage in SA.
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