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Portacci A, Dragonieri S, Carpagnano GE. Type-2 severe asthma comorbidities in the era of biologics: time to rethink clinical response? Expert Rev Respir Med 2024; 18:249-253. [PMID: 38845590 DOI: 10.1080/17476348.2024.2365841] [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: 02/21/2024] [Accepted: 06/05/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION The use of monoclonal antibodies in patients with severe asthma has led clinicians to explore new levels of clinical improvement, as testified by the growing interest on clinical remission achievement. In this context, a major role is played by asthma-related comorbidities, which can influence asthma pathophysiology and treatment response. AREAS COVERED In this special report, we highlighted how asthma-related comorbidities could deeply affect monoclonal antibody response as well as clinical remission achievement. As examples, we provided data from clinical trials and real-life experiences involving patients with severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), eosinophilic granulomatosis with polyangiitis (EGPA) or bronchiectasis. EXPERT OPINION Comorbidities associated with severe asthma development should be carefully assessed in everyday clinical practice, even with the help of new diagnostic technologies, artificial intelligence and multidisciplinary teams. Future studies should address the role of comorbidities in remission achievement, describing how these diseases could generate new trajectories of clinical and functional response in patient treated with monoclonal antibodies.
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Affiliation(s)
- Andrea Portacci
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", Bari, Italy
| | - Silvano Dragonieri
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", Bari, Italy
| | - Giovanna Elisiana Carpagnano
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", Bari, Italy
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Venditto L, Morano S, Ferrante G, Piazza M, Tenero L, Piacentini G, Pecoraro L. The Evolution of Scientific Knowledge in Childhood Asthma over Time: A Surprising History. CHILDREN (BASEL, SWITZERLAND) 2024; 11:262. [PMID: 38397374 PMCID: PMC10887562 DOI: 10.3390/children11020262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024]
Abstract
Asthma is a disease that has been described since the times of Hammurabi. However, it is only since the 1960s that effective therapeutic strategies have been available. Pathogenic mechanisms underlying the disease have been deeply studied, contributing to creating a "patient-specific asthma" definition. Biological drugs have been approved over the last twenty years, improving disease management in patients with severe asthma via a "precision medicine-driven approach". This article aims to describe the evolution of scientific knowledge in childhood asthma, focusing on the most recent biological therapies and their indications for patients with severe asthma.
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Affiliation(s)
| | | | - Giuliana Ferrante
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy; (L.V.); (S.M.); (M.P.)
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Castagnoli R, Brambilla I, Giudice MMD, Marseglia GL, Licari A. Applying the new guidelines to asthma management in children. Curr Opin Allergy Clin Immunol 2023; 23:132-136. [PMID: 36637070 DOI: 10.1097/aci.0000000000000892] [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: 01/14/2023]
Abstract
PURPOSE OF REVIEW This review aims to provide paediatricians with novel concepts from scientific evidence applicable to treating children with asthma. The latest guideline updates on paediatric asthma are discussed here, with a focus on the 2022 update of the GINA document. RECENT FINDINGS Mild asthma remains to be an important challenge for the paediatrician, and the introduction of new evidence-based treatment strategies, particularly those symptom-driven, could have a significant impact on the paediatric population. The identification of predictive biomarkers, the definition of biological treatment response, the possible duration of these therapies in this age group, as well as their potential action on airway remodelling are desirable in the short term. As the number of available biological treatment options expands, paediatricians should be supported by further evidence in decision-making. SUMMARY There is an urgent need to implement at multiple levels the latest therapeutic strategies proposed for asthma at all severities.
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Affiliation(s)
- Riccardo Castagnoli
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Ilaria Brambilla
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Michele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Napoli, Italy
| | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Amelia Licari
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia
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Escarrer-Jaume M, Juliá-Benito JC, Quevedo-Teruel S, Del Prado AP, Sandoval-Ruballos M, Quesada-Sequeira F, Álvaro-Lozano M. Changes in epidemiology and clinical practice in IgE-mediated Allergy in children. An Pediatr (Barc) 2021; 95:56.e1-56.e8. [PMID: 34183295 DOI: 10.1016/j.anpede.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022] Open
Abstract
In the last decades, allergic diseases have increased exponentially and although pediatric asthma prevalence is stabilizing, it is estimated around 10% in Spain. Not the same with food allergy and anaphylaxis which are clearly increasing, becoming a significant public health problem. Taking into account epidemiological trends, the European Academy of Allergy and Clinical Immunology (EAACI) estimates that in less than 15 years more than half of the European population will suffer from some type of allergic disorder. The advances in diagnostic methods in food allergy, especially component resolved diagnosis, allow us to know the patient's sensitization profile and explain possible cross reactivity, anticipate potential risk of food trangressions, and prescribe correct avoidance diet in each patient. Thus, the development of molecular biology and nanotechnology have led to the appearance of new technologies (microarrays) which facilitate the study, specially of the polysensitized patients, allowing allergen immunotherapy (AIT) to be more personalized. The latest advances in the use of biologics are having an impact, not only in disease evolution, but also in quality of life.
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Affiliation(s)
- Mercedes Escarrer-Jaume
- Unidad de Alergología y Neumología Pediátrica Clínica Juaneda, Palma de Mallorca, Spain; Centro de Salud San Agustín, Palma de Mallorca, Spain.
| | - Juan Carlos Juliá-Benito
- Centro de Salud República Argentina, Valencia, Spain; Unidad de Alergología y Neumología Pediátrica, Hospital IMED, Valencia, Spain
| | - Sergio Quevedo-Teruel
- Unidad de Alergia y Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Severo Ochoa, Leganés, Spain; Universidad Alfonso X el Sabio, Villanueva de la Cañada, Spain
| | - Ana Prieto Del Prado
- Unidad de Alergia Pediátrica, Hospital Regional Universitario de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga, IBIMA, Málaga, Spain
| | - Mónica Sandoval-Ruballos
- Servicio de Alergia y Inmunología Clínica Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - Montserrat Álvaro-Lozano
- Servicio de Alergia y Inmunología Clínica Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
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5
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Escarrer-Jaume M, Juliá-Benito JC, Quevedo-Teruel S, Prieto Del-Prado A, Sandoval-Ruballos M, Quesada-Sequeira F, Álvaro-Lozano M. [Changes in epidemiology and clinical practice in IgE-mediated allergy in children]. An Pediatr (Barc) 2021. [PMID: 34119433 DOI: 10.1016/j.anpedi.2021.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In the last decades, allergic diseases have increased exponentially and although pediatric asthma prevalence is stabilizing, in Spain is estimated around 10%. Not the same with food allergy and anaphylaxis which are clearly increasing, becoming a public health problem of the first magnitude. Considering epidemiological trends, the European Academy of Allergy and Clinical Immunology (EAACI) estimates that in less than 15 years more than half of European population will suffer from some type of allergy. The advances in diagnostic methods in food allergy, especially component resolved diagnosis, allow us to know the patient's sensitization profile and explain the possible cross reactivity, anticipate potential risk of food transgressions, and prescribe the correct avoidance diet in each patient. Thus, the development of molecular biology and nanotechnology have led to the appearance of new technologies (microarrays) which facilitate the study, specially of the polysensitized patients, allowing allergen immunotherapy (AIT) to be more personalized. The latest advances in the use of biologics are having an impact, not only in disease evolution, but also in patients quality of life.
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Affiliation(s)
- Mercedes Escarrer-Jaume
- Unidad de Alergología y Neumología pediátrica Clínica Juaneda, Palma de Mallorca, España; Centro de salud San Agustín, Palma de Mallorca, España.
| | - Juan Carlos Juliá-Benito
- Centro de salud República Argentina, Valencia, España; Unidad de alergología y neumología pediátrica, Hospital IMED, Valencia, España
| | - Sergio Quevedo-Teruel
- Unidad de Alergia y Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Severo Ochoa, Leganés, España; Universidad Alfonso X el Sabio, Villanueva de la Cañada, España
| | - Ana Prieto Del-Prado
- Unidad de Alergia Pediátrica, Hospital Regional Universitario de Málaga, Málaga, España; Instituto de Investigación Biomédica de Málaga. IBIMA, Málaga, España
| | - Mónica Sandoval-Ruballos
- Servicio de Alergia e Inmunología Clínica Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | | | - Montserrat Álvaro-Lozano
- Servicio de Alergia e Inmunología Clínica Pediátrica, Hospital Sant Joan de Déu, Barcelona, España; Institut de Recerca Sant Joan de Déu, Barcelona, España; Universitat de Barcelona, Barcelona, España
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De Filippo M, Votto M, Licari A, Pagella F, Benazzo M, Ciprandi G, Marseglia GL. Novel therapeutic approaches targeting endotypes of severe airway disease. Expert Rev Respir Med 2021; 15:1303-1316. [PMID: 34056983 DOI: 10.1080/17476348.2021.1937132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Severe asthma and chronic rhinosinusitis (CRS), with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP), are heterogeneous diseases characterized by different mechanistic pathways (endotypes) and variable clinical presentations (phenotypes).Areas covered: This review provides the clinician with an overview of the prevalence and clinical impact of severe chronic upper and lower airways disease and suggests a novel therapeutic approach with biological agents with possible biomarkers. To select relevant literature for inclusion in this review, we conducted a literature search using the PubMed database, using terms 'severe airways disease' AND 'endotype' AND 'treatment.' The literature review was performed for publication years 2010-2020, restricting the articles to humans and English language publications.Expert opinion: The coronavirus disease (COVID-19) pandemic has brought forth many challenges for patients with severe airway disease and healthcare practitioners involved in care. These patients could have an increased risk of developing severe SARS-CoV-2 disease, although treatment with biologics is not associated with a worse prognosis. Eosinopenia on hospital admission plays a key role as a diagnostic and prognostic biomarker.
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Affiliation(s)
- Maria De Filippo
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Martina Votto
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Amelia Licari
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Fabio Pagella
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Benazzo
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Gian Luigi Marseglia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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Sgrazzutti L, Sansone F, Attanasi M, Di Pillo S, Chiarelli F. Coaggregation of Asthma and Type 1 Diabetes in Children: A Narrative Review. Int J Mol Sci 2021; 22:ijms22115757. [PMID: 34071190 PMCID: PMC8198343 DOI: 10.3390/ijms22115757] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
Asthma and type 1 diabetes mellitus (T1DM) are two of the most frequent chronic diseases in children, representing a model of the atopic and autoimmune diseases respectively. These two groups of disorders are mediated by different immunological pathways, T helper (Th)1 for diabetes and Th2 for asthma. For many years, these two groups were thought to be mutually exclusive according to the Th1/Th2 paradigm. In children, the incidence of both diseases is steadily increasing worldwide. In this narrative review, we report the evidence of the potential link between asthma and T1DM in childhood. We discuss which molecular mechanisms could be involved in the link between asthma and T1DM, such as genetic predisposition, cytokine patterns, and environmental influences. Cytokine profile of children with asthma and T1DM shows an activation of both Th1 and Th2 pathways, suggesting a complex genetic-epigenetic interaction. In conclusion, in children, the potential link between asthma and T1DM needs further investigation to improve the diagnostic and therapeutic approach to these patients. The aim of this review is to invite the pediatricians to consider the potential copresence of these two disorders in clinical practice.
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Inborn errors of immunity with atopic phenotypes: A practical guide for allergists. World Allergy Organ J 2021; 14:100513. [PMID: 33717395 PMCID: PMC7907539 DOI: 10.1016/j.waojou.2021.100513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/22/2020] [Accepted: 01/11/2021] [Indexed: 12/19/2022] Open
Abstract
Inborn errors of immunity (IEI) are a heterogeneous group of disorders, mainly resulting from mutations in genes associated with immunoregulation and immune host defense. These disorders are characterized by different combinations of recurrent infections, autoimmunity, inflammatory manifestations, lymphoproliferation, and malignancy. Interestingly, it has been increasingly observed that common allergic symptoms also can represent the expression of an underlying immunodeficiency and/or immune dysregulation. Very high IgE levels, peripheral or organ-specific hypereosinophilia, usually combined with a variety of atopic symptoms, may sometimes be the epiphenomenon of a monogenic disease. Therefore, allergists should be aware that severe and/or therapy-resistant atopic disorders might be the main clinical phenotype of some IEI. This could pave the way to target therapies, leading to better quality of life and improved survival in affected patients.
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