1
|
Bilò MB, Martini M, Antonicelli L, Aliani M, Carone M, Cecchi L, de Michele F, Polese G, Vaghi A, Musarra A, Micheletto C. Severe asthma: follow-up after one year from the Italian Registry on Severe Asthma (IRSA). Eur Ann Allergy Clin Immunol 2023; 55:199-211. [PMID: 37462932 DOI: 10.23822/eurannaci.1764-1489.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Summary Background. Asthma affects millions of people worldwide, with a subgroup suffering from severe asthma (SA). Biologics have revolutionized SA treatment, but challenges remain in managing different patient traits. This study analyzed data from the Italian Registry on Severe Asthma (IRSA) to investigate changes in SA characteristics and effectiveness of treatments after one year of follow-up, and to identify factors associated with response to treatments in a real-world setting. Methods. Data on SA patients with one year of follow-up were extracted from IRSA. Asthma control, exacerbations, lung function, and treatments, were assessed at follow-up and analyzed against baseline characteristics. Results. After one year of follow-up, notable improvements were observed in all the outcomes of SA of the included patients (n = 570). The effectiveness of biologic therapies was particularly evident, as they contributed significantly to these positive outcomes. Additionally, certain factors were found to be associated with improvement, namely T2 phenotype, baseline eosinophil count (BEC), and area of residence. On the other hand, comorbidities (obesity, gastro-esophageal reflux disease) and poor lung function were risk factors. Notably, poor-responders to biologics exhibited lower level of education, BEC, and exacerbations, and higher frequency of atopy and ACT score ≥ 20. Conclusions. The findings demonstrate the effectiveness of biologics in asthma management, when implemented as part of a planned follow-up strategy aimed at optimizing and fine-tuning the therapy. Moreover, the study highlights the importance of considering key traits such as the T2 phenotype, BEC, education, and comorbidities when tailoring SA treatment. Overall, this study contributes to enhancing our understanding of SA management and guiding the development of personalized treatment approaches for patients with SA.
Collapse
Affiliation(s)
- M B Bilò
- Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti, Ancona, Italy
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - M Martini
- Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti, Ancona, Italy
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | | | - M Aliani
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Pulmonary Disease and Respiratory Rehabilitation, Bari Institute, Bari, Italy
| | - M Carone
- Istituti Clinici Scientifici Maugeri IRCCS, Division of Pulmonary Disease and Respiratory Rehabilitation, Bari Institute, Bari, Italy
| | - L Cecchi
- SOS Allergy and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - F de Michele
- Pulmonology and Respiratory Pathophysiology Unit, A. Cardarelli Hospital, Naples, Italy
| | - G Polese
- Pulmonology Unit, Ospedale di Bussolengo, ULSS 9 Scaligera, Villafranca, Verona, Italy
| | - A Vaghi
- Former Head of Pneumology and Chief of Department of Medicine and Rehabilitation, Guido Salvini Hospital-ASSTRhodense,Garbagnate Milanese, Milan, Italy
| | - A Musarra
- Allergy Unit, Casa della Salute di Scilla, Scilla, Reggio Calabria, Italy
| | - C Micheletto
- Pulmonary Unit, Integrated University Hospital of Verona, Verona, Italy
| |
Collapse
|
2
|
Liccardi G, Maria Beatrice B, Calzetta L, Milanese M, Martini M, Bresciani M, Cilia M, Cucinelli F, D’Angelo R, Feliziani A, Filon FL, Longo R, Losappio L, Manzotti G, Minale P, Modica S, Murzilli F, Musarra A, Pingitore G, Polillo BR, Puggioni F, Quercia O, Rapone C, Rogliani P. Pest sensitization to cockroach, mouse, and rat: an Italian multicenter study. Allergy 2022; 78:1360-1363. [PMID: 36398484 DOI: 10.1111/all.15586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/24/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Gennaro Liccardi
- Postgraduate School of Respiratory Medicine. Department of Experimental Medicine. University of Rome "Tor Vergata" Italy
| | - Bilò Maria Beatrice
- Allergy Unit, Department of Internal Medicine University Hospital Ospedali Riuniti Ancona Italy
- Department of Clinical and Molecular Sciences Marche Polytechnic University ‐ Ancona Italy
| | - Luigino Calzetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit University of Parma Parma Italy
| | - Manlio Milanese
- Division of Pulmonology, S.Corona Hospital, Pietra Ligure Savona Italy
| | - Matteo Martini
- Department of Clinical and Molecular Sciences Marche Polytechnic University ‐ Ancona Italy
- Allergy Unit, Ospedali Riuniti Marche Nord Fano Italy
| | | | - Marcello Cilia
- Unit of Allergology, Casa della Salute di Scilla, ASP di Reggio Calabria Italy
| | - Francesco Cucinelli
- Department of Internal Medicine, Unit of Allergology, S.S. Filippo e Nicola Hospital Avezzano L’Aquila Italy
| | | | | | | | - Rocco Longo
- Allergy Unit, ASP Tropea, Vibo Valentia Italy
| | | | - Giusy Manzotti
- Allergy Unit, Division of Internal Medicine, ASST Bergamo Ovest, Treviglio Bergamo Italy
| | | | - Stella Modica
- Unit of Reumatology, Allergology and Clinical Immunology, Policlinico Tor Vergata Rome Italy
| | - Francesco Murzilli
- Department of Internal Medicine, Unit of Allergology, S.S. Filippo e Nicola Hospital Avezzano L’Aquila Italy
| | - Antonino Musarra
- Unit of Allergology, Casa della Salute di Scilla, ASP di Reggio Calabria Italy
| | | | | | - Francesca Puggioni
- Personalized Medicine, Asthma & Allergy ‐ Humanitas Clinical and Research Center IRCCS, Rozzano Milan Italy
| | | | | | - Paola Rogliani
- Department of Experimental Medicine, Unit of Respiratory Medicine University of Rome. "Tor Vergata" Italy
| |
Collapse
|
3
|
Cecchi L, Vaghi A, Bini F, Martini M, Musarra A, Bilò M. From triggers to asthma: a narrative review on epithelium dysfunction. Eur Ann Allergy Clin Immunol 2022; 54:247-257. [DOI: 10.23822/eurannaci.1764-1489.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
4
|
Lombardi C, Asero R, Bagnasco D, Blasi F, Bonini M, Bussi M, Canevari RF, Canonica GW, Castelnuovo P, Cecchi L, Cosmi L, Gelardi M, Heffler E, Indinnimeo L, Landi M, Licari A, Liotta F, Macchi A, Malvezzi L, Marseglia G, Micheletto C, Musarra A, Peroni D, Piacentini G, Poletti V, Richeldi L, Santoni A, Schiappoli M, Senna G, Vaghi A, Villani A, Passalacqua G. ARIA-ITALY multidisciplinary consensus on nasal polyposis and biological treatments. World Allergy Organ J 2021; 14:100592. [PMID: 34786034 PMCID: PMC8573187 DOI: 10.1016/j.waojou.2021.100592] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/05/2021] [Accepted: 09/06/2021] [Indexed: 12/22/2022] Open
Abstract
In the recent years, it was recognized that type-2 inflammation links many forms of nasal polyposis with severe asthma. Thus, some biological drugs developed for severe asthma appeared to exert an effect on nasal polyposis. So far, there are several trials supporting this concept; therefore, some monoclonal antibodies for severe asthma were assessed also in polyposis, with promising results. Since different specialists are involved in the management of nasal polyposis (eg, pulmonologists, ENT, allergists), it was felt that an educational and informative document was needed to better identify the indications of biologicals in nasal polyposis. We collected the main Italian Scientific Societies, and prepared (under the Allergic Rhinitis and its Impact on Asthma, ARIA) a document endorsed by all Societies, to provide a provisional statement for the future use of monoclonal antibodies as a medical treatment for polyposis. It is the first nationwide endorsed document on this aspect. The current pathogenic knowledge and the experimental evidence are herein reviewed, and some suggestions for a correct prescription and follow-up are provided.
Collapse
Affiliation(s)
- Carlo Lombardi
- Unit of Allergology, Clinical Immunology & Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, MI, Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico S.Martino, University of Genoa, Italy
| | - Francesco Blasi
- Dipartimento Fisiopatologia Medico-chirurgica e Trapianti Università di Milano, IRCCS Fondazione Cà Granda, Policlinico di Milano, Italy
| | - Matteo Bonini
- Dipartimento di Scienze Cardiovascolari e Toraciche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Mario Bussi
- Unità Operativa di Otorinolaringoiatria Ospedale Universitario I.R.C.C.S. San Raffaele, Milan, Italy
| | - Rikki F. Canevari
- Dipartimento DISC Clinica Otorinolaringoiatra IRCCS Policlinico San Martino, Università di Genova, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paolo Castelnuovo
- DBSV, Clinica ORL, Università Insubria, ASST-settelaghi, HNS&FDR Center, Varese, Italy
| | - Lorenzo Cecchi
- SOS Allergologia e Immunologia Clinica Prato, USL Toscana Centro, Italy
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Matteo Gelardi
- Clinica Otorinolaringoiatrica, Dipartimento di Medicina Clinica e Sperimentale, Università di Foggia, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luciana Indinnimeo
- Università degli Studi di Roma “Sapienza”, Direttore Scientifico di Area Pediatrica, Società Italiana di Pediatria, Italy
| | - Massimo Landi
- Pediatric National Healthcare System, Turin, Institute of Biomedical Research and Innovation Palermo, Italy
| | - Amelia Licari
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Francesco Liotta
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Alberto Macchi
- Clinica ORL, Asst Settelaghi Varese, Università degli Studi dell’ Insubria, Varese, Italy
| | - Luca Malvezzi
- Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical & Research Center, Rozzano, MI, Italy
| | - Gianluigi Marseglia
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | | | - Antonino Musarra
- Servizio di Allergologia, Casa della Salute di Scilla, ASP di Reggio Calabria, Italy
| | - Diego Peroni
- Pediatrics, Dept. of Experimental Medicine, University of Pisa, Italy
| | - Giorgio Piacentini
- Dipartimento di Scienze Chirurgiche, Odontostomatologiche e Materno-Infantili Università di Verona, Italy
| | | | - Luca Richeldi
- UOC DI PNEUMOLOGIA, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
| | - Angela Santoni
- Dipartimento di Medicina Molecolare, Università; “Sapienza”, Roma, Italy
| | - Michele Schiappoli
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | | | - Alberto Villani
- Unità Operativa Complessa di Pediatria Generale e Malattie Infettive, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico S.Martino, University of Genoa, Italy
| | - ARIA Italia
- Unit of Allergology, Clinical Immunology & Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
- Allergy and Respiratory Diseases, IRCCS Policlinico S.Martino, University of Genoa, Italy
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, MI, Italy
- Dipartimento Fisiopatologia Medico-chirurgica e Trapianti Università di Milano, IRCCS Fondazione Cà Granda, Policlinico di Milano, Italy
- Dipartimento di Scienze Cardiovascolari e Toraciche, Università Cattolica del Sacro Cuore, Roma, Italy
- Unità Operativa di Otorinolaringoiatria Ospedale Universitario I.R.C.C.S. San Raffaele, Milan, Italy
- Dipartimento DISC Clinica Otorinolaringoiatra IRCCS Policlinico San Martino, Università di Genova, Italy
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy
- DBSV, Clinica ORL, Università Insubria, ASST-settelaghi, HNS&FDR Center, Varese, Italy
- SOS Allergologia e Immunologia Clinica Prato, USL Toscana Centro, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Italy
- Clinica Otorinolaringoiatrica, Dipartimento di Medicina Clinica e Sperimentale, Università di Foggia, Italy
- Università degli Studi di Roma “Sapienza”, Direttore Scientifico di Area Pediatrica, Società Italiana di Pediatria, Italy
- Pediatric National Healthcare System, Turin, Institute of Biomedical Research and Innovation Palermo, Italy
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
- Clinica ORL, Asst Settelaghi Varese, Università degli Studi dell’ Insubria, Varese, Italy
- Otorhinolaryngology Unit, Humanitas University, Humanitas Clinical & Research Center, Rozzano, MI, Italy
- UOC Pneumologia, Azienda Ospedaliera Universitaria, Verona, Italy
- Servizio di Allergologia, Casa della Salute di Scilla, ASP di Reggio Calabria, Italy
- Pediatrics, Dept. of Experimental Medicine, University of Pisa, Italy
- Dipartimento di Scienze Chirurgiche, Odontostomatologiche e Materno-Infantili Università di Verona, Italy
- Dipartimento Toracico Azienda USL ROMAGNA (I), Italy
- UOC DI PNEUMOLOGIA, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
- Dipartimento di Medicina Molecolare, Università; “Sapienza”, Roma, Italy
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
- ASST Rodhense Pneumologia, Italy
- Unità Operativa Complessa di Pediatria Generale e Malattie Infettive, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| |
Collapse
|
5
|
Canonica GW, Paggiaro P, Blasi F, Musarra A, Richeldi L, Rossi A, Papi A. Manifesto on the overuse of SABA in the management of asthma: new approaches and new strategies. Ther Adv Respir Dis 2021; 15:17534666211042534. [PMID: 34587829 PMCID: PMC8488406 DOI: 10.1177/17534666211042534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The risks of overusing short-acting β2-agonists (SABA), including an
increase in asthma-related deaths, are many and well known. The Global
Initiative on Asthma (GINA) 2019 and 2020 updates recommend as-needed inhaled
corticosteroid (ICS)/formoterol as the preferred rescue medication in mild
asthma as monotherapy and also in moderate to severe asthma when the maintenance
and reliever therapy (MART) strategy is used. Using SABA for symptom relief,
however, was the standard of treatment for many years, and consequently this
practice persists, particularly in patients not taking ICS regularly. Here, we
examine the rationale for this shift from a long-standing recommendation for
as-needed SABA treatment to the use of as-needed ICS/formoterol and consider
clinical evidence on strategies for asthma treatment and patient management.
Collapse
Affiliation(s)
- Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Personalized Medicine, Asthma and Allergy, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Francesco Blasi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Luca Richeldi
- Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Rossi
- Pulmonary Unit, Azienda Ospedaliera Universitaria Integrata and University of Verona, Verona, Italy
| | - Alberto Papi
- Research Center on Asthma and COPD, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| |
Collapse
|
6
|
Paggiaro P, Barbaglia S, Centanni S, Croce D, Desideri E, Giustini S, Micheletto C, Musarra A, Scichilone N, Trama U, Zedda MT, Canonica GW. Overcoming Barriers to the Effective Management of Severe Asthma in Italy. J Asthma Allergy 2021; 14:481-491. [PMID: 34007186 PMCID: PMC8121981 DOI: 10.2147/jaa.s293380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/21/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction People with severe asthma (SA) often have poor disease control and quality of life, and are at high risk of exacerbations, lung function decline and asthma-related death. The present expert opinion article aimed to identify unmet needs in the management of SA in Italy, and propose possible solutions to address these needs. Methods At five multidisciplinary events in Italy, attendees identified factors that interfered with the effective management of SA and suggested how these barriers could be overcome. A core group of 12 Italian experts (pulmonologists, general practitioners, allergists, payers and patients) identified the main issues and proposed possible solutions based on the results from the meetings and relevant articles from the literature. Results and Conclusions We reviewed the gap between real-world practice and guidelines, oral corticosteroid overuse, SA-related mortality, and barriers to effective SA treatment. Common themes were lack of awareness about SA among both patients and clinicians, and lack of networking/information exchange between those involved in the treatment of SA. Participants agreed on the need to implement patient education and create multidisciplinary groups of specialists to improve SA management through multidisciplinary educational initiatives, meetings with local experts, development of a flow chart for referral/connection with local experts and specialized centers. Clinical instruments that might help specialists improve SA management included referral networks, integrated care pathways, phenotyping and treatment algorithms, exacerbation tracking, and examination of electronic medical records for patients with uncontrolled asthma. The following actions need to be implemented in Italy: i) maximize the use of advanced therapies, eg, biologics; ii) increase/improve education for physicians and patients; iii) improve multidisciplinary communication and care coordination; iv) introduce regional and local protocols for SA diagnosis and treatment; and v) change the structure of healthcare services to reduce specialist waiting times and facilitate access to biologic therapies.
Collapse
Affiliation(s)
- Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology, and Critical Care, University of Pisa, Pisa, Italy
| | - Simona Barbaglia
- Associazione Nazionale Pazienti "Respiriamo Insieme", Padova, Italy
| | - Stefano Centanni
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Davide Croce
- Center for Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
| | | | - Saffi Giustini
- Italian General Practitioners' Association "SIMG", Florence, Italy.,Local Health Unit of Montale, Pistoia, Italy
| | - Claudio Micheletto
- Cardio-Thoracic Department, Respiratory Unit, Integrated University Hospital, Verona, Italy
| | - Antonino Musarra
- Allergy Unit, National Healthcare System, Reggio Calabria, Italy
| | - Nicola Scichilone
- Biomedical Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy
| | - Ugo Trama
- Dirigente UOD 06 Politica del Farmaco e Dispositivi, Naples, Italy
| | - Maria Teresa Zedda
- Italian General Practitioners' Association "SIMG", Florence, Italy.,General Practice, Cagliari, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University and Research Hospital-IRCCS, Milan, Italy
| |
Collapse
|
7
|
Bilò MB, Antonicelli L, Carone M, De Michele F, Menzella F, Musarra A, Tognella S, Vaghi A, Micheletto C. Severe asthma management in the era of biologics: insights of the Italian Registry on Severe Asthma (IRSA). Eur Ann Allergy Clin Immunol 2021; 53:103-114. [PMID: 33728838 DOI: 10.23822/eurannaci.1764-1489.196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Background. The Italian Registry on Severe Asthma (IRSA) is the most recent and largestregistry in Italy. Objective. To improve the knowledge on the clinical and biological features of severe asthma (SA), and to monitor its treatments. Methods. To analyze clinical,functional, inflammatory, and treatment characteristics of severe asthmatics from the IRSA registry. Results. 851 subjects were enrolled. 31.8% and 64.5% of patients were submitted to oral corticosteroids (OCS), and monoclonal antibodies (MABs), respectively. At least tw ocomorbidities affected 77.4% patients. Asthma was uncontrolled in 62.2% patients. Uncontrolled patients had a higher frequency of exacerbations, and hospitalization, showing a highere osinophilic phenotype, a greater use of OCS, and being treated with MAB less frequently. However, uncontrolled patients treated with MAB had a lower use of OCS and a lower rateof hospitalization. Comparing SA patients with atopy and without atopy, the latter showeda greater use of OCS, and more frequent nasal polyposis and osteoporosis. Among SA patients with atopy treated with MAB, 36% were on a treatment targeting the IL-5 pathway. Conclusions and clinical relevance. This study shows the features of the greatest Italian registryof SA patients, revealing at the time of enrollment a poor disease control, and the use of OCSand MABs in about one third and two thirds of patients, respectively. SA is a complex diseasethat requires a more precise phenotyping and a greater disease control.
Collapse
Affiliation(s)
- M B Bilò
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Italy.,Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Italy
| | - L Antonicelli
- Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Italy
| | - M Carone
- Division of Pulmonary Disease, Istituti Clinici Scientifici Maugeri Spa SB, Pavia, and IRCCS of Bari, Bari, Italy
| | - F De Michele
- Pneumology I and Respiratory Pathophysiology Unit, A. Cardarelli Hospital, Naples, Italy
| | - F Menzella
- Pneumology Unit, Department of Medical Specialties, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - A Musarra
- Department of Allergology, Casa della Salute di Scilla, Scilla, Reggio Calabria, Italy
| | - S Tognella
- Respiratory Unit, Mater Salutis Hospital, AULSS 9 Scaligera, Legnago, Verona, Italy
| | - A Vaghi
- Respiratory Unit, ASST-Rhodense, Garbagnate Milanese, Milan, Italy
| | - C Micheletto
- Pulmonary Unit, Integrated University Hospital of Verona, Verona, Italy
| |
Collapse
|
8
|
Antonicelli L, Tontini C, Manzotti G, Ronchi L, Vaghi A, Bini F, Scartabellati A, Menzella F, De Michele F, Musarra A, Micheletto C, Bilò MB. Severe asthma in adults does not significantly affect the outcome of COVID-19 disease: Results from the Italian Severe Asthma Registry. Allergy 2021; 76:902-905. [PMID: 32794585 PMCID: PMC7436442 DOI: 10.1111/all.14558] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/20/2020] [Accepted: 08/07/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Leonardo Antonicelli
- Allergy Unit Department of Internal Medicine Azienda Ospedaliero Universitaria Ospedali Riuniti Umberto I G M Lancisi G Salesi Ancona Italy
| | - Chiara Tontini
- Allergy Unit Department of Internal Medicine Azienda Ospedaliero Universitaria Ospedali Riuniti Umberto I G M Lancisi G Salesi Ancona Italy
| | | | - Luca Ronchi
- Pneumology Unit ASST Franciacorta “Mellino Mellini” Hospital Chiari Italy
| | - Adriano Vaghi
- Pneumology Unit ASST Rhodense Garbagnate Milanese Hospital Garbagnate Milanese Italy
- Former Pneumology Unit ASST Rhodense Garbagnate Milanese Hospital Garbagnate Milanese Italy
| | - Francesco Bini
- Pneumology Unit ASST Rhodense Garbagnate Milanese Hospital Garbagnate Milanese Italy
| | | | - Francesco Menzella
- Pneumology Unit Department of Medical Specialties Arcispedale Santa Maria Nuova Azienda USL di Reggio‐Emilia IRCCS Reggio Emilia Italy
| | - Fausto De Michele
- Pneumology I and Respiratory Pathophysiology Unit A. Cardarelli Hospital Naples Italy
| | | | - Claudio Micheletto
- Respiratory Unit Cardio‐Thoracic Department Integrated University Hospital of Verona Verona Italy
| | - Maria Beatrice Bilò
- Allergy Unit Department of Clinical and Molecular Sciences Polytechnic University of Marche Ancona Italy
| |
Collapse
|
9
|
Passalacqua G, Musarra A, Senna G, Bousquet J, Ferrara C, Lonati C, Canonica GW. Physicians' prescribing behaviour and clinical practice patterns for allergic rhinitis management in Italy. Clin Mol Allergy 2020; 18:20. [PMID: 33292294 PMCID: PMC7640419 DOI: 10.1186/s12948-020-00135-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/16/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite availability of clinical guidelines, underdiagnosis, undertreatment, and poor adherence are still significant concerns in allergic rhinitis (AR) therapeutic management. We investigated clinical practice patterns and prescribing behavior of Italian healthcare professionals (HCPs) specialized in AR. METHODS One-hundred allergologists, 100 ear, nose and throat (ENT) specialists, and 150 general practitioners (GPs) were recruited. The survey assessed: socio-demographic, work experience, monthly caseload, prescription drivers. Next, HCPs were invited to retrospectively recover patients' clinical data to investigate: AR clinical characteristics, therapy management, prescription patterns, patient adherence. Descriptive statistics, Chi square, One-Way analysis of variance, and Two-Way Analysis of Variance were performed. RESULTS Allergologists visited more AR patients (31% of monthly caseload) than ENTs (21%, p < 0.001), while GPs' caseload was the lowest (6%). Clinical information of 2823 patients were retrieved of whom 1906 (67.5%) suffered from moderate/severe AR (discomfort score: 7.7 ± 1.3) and 917 (32.4%) from mild AR (5.7 ± 1.9). About one-third of mild patients had a discomfort score ≥ 7. Main prescription drivers were "effective on all symptoms" (54.3% patients) and "quick symptom relief" (47.8%), whereas minor drivers were "affordable price" (13.4%) and "refundable" (8.7%). The most prescribed drugs were antihistamines and intranasal corticosteroids (79% and 55% prescriptions), followed by fixed-dose-combination of intranasal azelastine/fluticasone (19%). Polytherapy was the most common treatment strategy (59.6%). HCPs' believe that the majority of the patients was adherent to treatment (88% with score > 7). CONCLUSIONS This survey describes the therapeutic approach adopted by Italian physicians to cope with AR and shows that HCPs underestimated AR severity and had a non-realistic perception of patients' adherence. These findings suggest that further efforts are required to improve AR clinical management in Italy.
Collapse
Affiliation(s)
- Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Antonino Musarra
- Allergy Unit, National Healthcare System, Scilla, Reggio Calabria, Italy
| | - Gianenrico Senna
- Unità Operativa di Allergologia-Asma Center-Azienda Ospedaliera, Universitaria Integrata di Verona, Verona, Italy
| | - Jean Bousquet
- Comprehensive Allergy Center, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Centre Hospitalier Universitaire de Montpellier, Montpellier, France
- MACVIA-France, Montpellier, France
| | | | - Caterina Lonati
- Center for Preclinical Research, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Pace 9, 20122, Milan, Italy.
| | | |
Collapse
|
10
|
Sposato B, Scalese M, Camiciottoli G, Carpagnano GE, Pelaia C, Santus P, Maniscalco M, Corsico A, Grosso A, Baglioni S, Murgia N, Folletti I, Pelaia G, Masieri S, Cavaliere C, Musarra A, Bargagli E, Ricci A, Latorre M, Paggiaro P, Rogliani P. Mepolizumab Effectiveness and Allergic Status in Real Life. Int Arch Allergy Immunol 2020; 182:311-318. [PMID: 33113532 DOI: 10.1159/000511147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is not clear whether mepolizumab is differently effective in allergic and nonallergic severe eosinophilic asthmatics (SEA) in real life. OBJECTIVE We tested mepolizumab effectiveness in allergic/nonallergic SEA in real life. A strict criterion to identify the 2 phenotypes was used. METHOD We retrospectively considered 134 consecutive patients divided into allergic, with a positivity to at least 1 allergen to prick tests and/or IgE values ≥100 UI/mL (severe allergic eosinophilic asthma [SAEA]; n: 97-72.4%), and nonallergic, with no prick test results and normal IgE levels <100 UI/mL (severe nonallergic eosinophilic asthma [SNAEA]; n: 37-27.6%). They had taken mepolizumab for at least 6 months. RESULTS After 10.9 ± 3.7 months, improvements in FEV1%, FEF25-75%, exacerbation numbers, blood eosinophil (BE) counts, fractional exhaled nitric oxide (FENO) (ppb), percentages of patients that stopped/reduced short-acting β2-agonists (SABAs) or oral corticosteroid (OC), observed after treatment, were similar in both groups. Only Asthma Control Test (ACT) increases were higher in SNAEA (8 [5-9]) than in SAEA (5 [2.5-8.5]; p = 0.016). However, no differences were found after treatment in percentages of subjects with ACT ≥20, as well as with FEV1 >80%, FEF25-75 >65%, exacerbations ≤2, BE <300 cells/µL, and FENO <25 ppb between SAEA and SNAEA. Besides, no significant relationships were found, comparing SNAEA with SAEA, for FEV1% (β = -0.110; p = 0.266), FEF25-75% (β = -0.228; p = 0.06), BE counts (β = -0.012; p = 0.918), FENO (β = 0.234; p = 0.085), ACT (β = 0.046; p = 0.660), and exacerbations (β = -0.070; p = 0.437). No different associations between lung function and SNAEA occurrence when compared to SAEA condition (FEV1 >80%: OR = 1.04 [95% CI: 0.43-2.55], p = 0.923; FEF25-75 >65%: OR = 0.41 [95% CI: 0.08-2.03], p = 0.272) were detected. Neither all other parameters, such as ACT >20 (OR = 0.73 [95% CI: 0.32-1.63], p = 0.440), presence of exacerbations (OR = 1.35 [95% CI: 0.55-3.27], p = 0.512), SABA discontinuation (OR = 1.16 [95% CI: 0.40-3.39], p = 0.790), and OC cessation/reduction (OR = 3.44 [95% CI: 0.40-29.27], p = 0.258), were differently associated with 1 or the other phenotype. CONCLUSION Mepolizumab can be considered as a valid therapeutic choice for either allergic or nonallergic SEA in real life.
Collapse
Affiliation(s)
- Bruno Sposato
- Azienda USL Toscana Sud-Est Pneumology Department, "Misericordia" Hospital, Grosseto, Italy, .,Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Rome, Italy,
| | - Marco Scalese
- Clinic Physiology Institute, National Research Centre, Pisa, Italy
| | - Gianna Camiciottoli
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Giovanna Elisiana Carpagnano
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy
| | - Corrado Pelaia
- Section of Respiratory Diseases, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Pierachille Santus
- Division of Pulmonary Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi di Milano, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - Mauro Maniscalco
- Institute Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Telese, Telese Terme, Italy
| | - Angelo Corsico
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | - Amelia Grosso
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | | | - Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Ilenia Folletti
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
| | - Girolamo Pelaia
- Section of Respiratory Diseases, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Simonetta Masieri
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Carlo Cavaliere
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Antonino Musarra
- Allergology Department, Casa della Salute di Scilla, Scilla, Italy
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplant Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Alberto Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Paola Rogliani
- Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Rome, Italy.,Respiratory Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| |
Collapse
|
11
|
Sposato B, Scalese M, Camiciottoli G, Carpagnano GE, Pelaia C, Santus P, Maniscalco M, Corsico A, Grosso A, Baglioni S, Murgia N, Folletti I, Pelaia G, Masieri S, Cavaliere C, Musarra A, Bargagli E, Ricci A, Latorre M, Rogliani P, Paggiaro P. Real-life Mepolizumab effectiveness in severe eosinophilic asthmatics with nasal polyposis. Respir Med Res 2020; 78:100791. [PMID: 33039948 DOI: 10.1016/j.resmer.2020.100791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022]
Affiliation(s)
- B Sposato
- Azienda USL Toscana Sud-Est Pneumology Department, "Misericordia" Hospital, Grosseto, Italy; Experimental Medicine and Systems, "PhD program" Department of Systems Medicine University of Rome "Tor Vergata", Rome, Italy.
| | - M Scalese
- Clinic Physiology Institute, National Research Centre, Pisa, Italy
| | - G Camiciottoli
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Largo A Brambilla 3, 50134, Florence, Italy
| | - G E Carpagnano
- Institute of Respiratory Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - C Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - P Santus
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi di Milano, Division of Pulmonary Diseases, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - M Maniscalco
- Institute Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Istitute of Telese, 82037 Telese Terme (BN), Italy
| | - A Corsico
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | - A Grosso
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | - S Baglioni
- Pneumology Department, Perugia Hospital, Perugia, Italy
| | - N Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - I Folletti
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
| | - G Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - S Masieri
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - C Cavaliere
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - A Musarra
- Allergology Department, Casa della Salute di Scilla, Scilla, RC, Italy
| | - E Bargagli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - A Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - M Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - P Rogliani
- Experimental Medicine and Systems, "PhD program" Department of Systems Medicine University of Rome "Tor Vergata", Rome, Italy; Respiratory Unit, department of Experimental Medicine, University of Rome "Tor Vergata" Rome, Rome, Italy
| | - P Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| |
Collapse
|
12
|
Celi G, Brusca I, Scala E, Villalta D, Pastorello E, Farioli L, Cortellini G, Deleonardi G, Galati P, Losappio L, Manzotti G, Pirovano B, Muratore L, Murzilli F, Cucinelli F, Musarra A, Cilia M, Nucera E, Aruanno A, Ria F, Patria MF, Varin E, Polillo BR, Sargentini V, Quercia O, Uasuf CG, Zampogna S, Carollo M, Graci S, Asero R. House dust mite allergy and shrimp allergy: a complex interaction. Eur Ann Allergy Clin Immunol 2020; 52:205-209. [PMID: 31594291 DOI: 10.23822/eurannaci.1764-1489.108] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Background and Objective. Sensitization and allergy to shrimp among Italian house dust mite allergic patients are not well defined and were investigated in a large multicenter study. Methods. Shrimp sensitization and allergy were assessed in 526 house dust mite (HDM)-allergic patients submitted to the detection of IgE to Der p 10 and 100 atopic control not sensitized to HDM. Results. Shrimp allergy occurred in 9% of patients (vs 0% of 100 atopic controls not sensitized to HDM; p minor 0.001). Shrimp-allergic patients were less frequently hypersensitive to airborne allergens other than HDM than crustacean-tolerant subjects (35% vs 58.8%; p minor 0.005). Only 51% of tropomyosin-sensitized patients had shrimp allergy, and these showed significantly higher Der p 10 IgE levels than shrimp-tolerant ones (mean 22.2 KU/l vs 6.2 KU/l; p minor 0.05). Altogether 53% of shrimp-allergic patients did not react against tropomyosin. Conclusions. Shrimp allergy seems to occur uniquely in association with hypersensitivity to HDM allergens and tropomyosin is the main shrimp allergen but not a major one, at least in Italy. Along with tropomyosin-specific IgE levels, monosensitization to HDM seems to represent a risk factor for the development of shrimp allergy among HDM allergic patients.
Collapse
Affiliation(s)
- G Celi
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - I Brusca
- U.O.C. di Patologia Clinica Ospedale Buccheri La Ferla F.B.F., Palermo, Italy
| | - E Scala
- Allergy Unit, Istituto dermopatico dell'Immacolata, IDI-IRCCS, Roma, Italy
| | - D Villalta
- SSD di Immunologia e allergologia, Ospedale S. Maria degli Angeli, Pordenone, Italy
| | - E Pastorello
- Struttura Complessa di Allergologia e Immunologia, ASST GOM Niguarda, Milano, Italy
| | - L Farioli
- Dipartimento di Medicina di Laboratorio, ASST GOM Niguarda, Milano, Italy
| | - G Cortellini
- Unità Operativa di Medicina Interna Rimini, Ambulatorio di Allergologia, Azienda Sanitaria Romagna, Rimini, Italy
| | | | | | - L Losappio
- Struttura Complessa di Allergologia e Immunologia, ASST GOM Niguarda, Milano, Italy
| | - G Manzotti
- Sevizio di Allergologia, Casa di Cura Beato Palazzolo, Bergamo, Italy
| | - B Pirovano
- Servizio Medicina di Laboratorio, ASST Bergamo Ovest, Bergamo, Italy
| | - L Muratore
- UOC Allergologia ed Immnologia Clinica ASL Lecce P.O.V. Fazzi, Lecce, Italy
| | - F Murzilli
- U.O.S.D di Allergologia, Ospedale S.S. Filippo e Nicola, Avezzano (AQ), Italy
| | - F Cucinelli
- U.O.S.D di Allergologia, Ospedale S.S. Filippo e Nicola, Avezzano (AQ), Italy
| | - A Musarra
- Servizio di Allergologia, Casa della Salute di Scilla, Scilla (RC), Italy
| | - M Cilia
- Servizio di Allergologia, Casa della Salute di Scilla, Scilla (RC), Italy
| | - E Nucera
- Servizio di Allergologia, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy
| | - A Aruanno
- Servizio di Allergologia, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy
| | - F Ria
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - M F Patria
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - E Varin
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - B R Polillo
- Servizio di Allergologia, UOC Medicina Interna, Polo Ospedaliero S. Spirito e Nuovo Regina Margherita, Roma, Italy
| | - V Sargentini
- Servizio di Allergologia di Laboratorio, UOC Patologia Clinica, Ospedale S. Filippo Neri, Roma, Italy
| | - O Quercia
- Unità di Allergologia, Medicina Interna, Ospedale di Faenza, Faenza (RA), Italy
| | - C G Uasuf
- Centro Malattie Allergiche Bonsignori, Istituto di Biomedicina e Immunologia Molecolare, CNR, Palermo, Italy
| | - S Zampogna
- Pronto Soccorso Pediatrico, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy
| | - M Carollo
- Patologia e Biochimica Clinica, Università Magna Graecia, Catanzaro, Italy
| | - S Graci
- Istituto Zooprofilattico Sperimentale della Sicilia A. Mirri, Palermo, Italy
| | - R Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| |
Collapse
|
13
|
Calzavara-Pinton P, Belloni Fortina A, Bonamonte D, Marseglia GL, Miraglia Del Giudice M, Musarra A, Nettis E, Neri I, Patruno C, Stingeni L, Peris K. Diagnosis and management of moderate to severe atopic dermatitis in adolescents. A Consensus by the Italian Society of Dermatology and Venereology (SIDeMaST), the Italian Association of Hospital Dermatologists and Public Health (ADOI), the Italian Association of Hospital and Territorial Allergists and Immunologists (AAIITO), the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC), the Italian Society of Pediatric Allergy and Immunology (SIAIP), the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA), and the Italian Society of Pediatric Dermatology (SIDerP). Ital J Dermatol Venerol 2020; 156:184-197. [PMID: 32438781 DOI: 10.23736/s2784-8671.20.06654-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disease with increasing global incidence, which has a multifactorial pathogenesis and a variable expressivity. Clinical features of AD are different in adults compared to children, but it is well recognized the substantial impact of the disease on patients' quality of life at any age. Indeed, little is known about AD in adolescence, a period of life generally associated with high psychological burden and vulnerability to depression. Guidelines for the management of AD are available for both children and adults but specific guidelines for the diagnosis and treatment of AD in adolescents are lacking. Seven Italian scientific societies of dermatologists, allergists, and pediatric allergists joined in a specific meeting to provide practical guidance for the diagnosis and management of moderate-to-severe adolescent AD suitable for the Italian clinical practice. Through a modified Delphi procedure, consensus was reached by 59 Italian experts in the management of AD on 20 statements covering five areas of interest about adolescent AD, including disease complexity, burden and social impact, diagnosis and definition of severity, current treatments, and new biologic therapies. This paper reports recommendations for the diagnosis and management of AD specifically in adolescents, pointing out some peculiar clinical features and focusing on the choice of medications. Dupilumab, the first biologic approved for the treatment of adolescents with AD, represents a useful treatment option due to its efficacy and reassuring safety profile.
Collapse
Affiliation(s)
| | | | - Domenico Bonamonte
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Gian L Marseglia
- Department of Pediatrics, IRCCS San Matteo Polyclinic Foundation, University of Pavia, Pavia, Italy
| | - Michele Miraglia Del Giudice
- Department of Woman and Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Antonino Musarra
- Unit of Allergy, National Healthcare System, Reggio Calabria, Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, Aldo Moro University, Bari, Italy
| | - Iria Neri
- Unit of Dermatology, Department of Specialistic, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Cataldo Patruno
- Unit of Dermatology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Luca Stingeni
- Section of Clinical Allergological Venereological Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Ketty Peris
- Unit of Dermatology, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | | |
Collapse
|
14
|
Calzavara-Pinton P, Belloni Fortina A, Bonamonte D, Marseglia GL, Miraglia Del Giudice M, Musarra A, Nettis E, Neri I, Patruno C, Stingeni L, Peris K. Diagnosis and management of moderate to severe atopic dermatitis in adolescents. A Consensus by the Italian Society of Dermatology and Venereology (SIDeMaST), the Italian Association of Hospital Dermatologists and Public Health (ADOI), the Italian Association of Hospital and Territorial Allergists and Immunologists (AAIITO), the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC), the Italian Society of Pediatric Allergy and Immunology (SIAIP), the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA), and the Italian Society of Pediatric Dermatology (SIDerP). Ital J Dermatol Venerol 2020. [PMID: 32438781 DOI: 10.23736/s0392-0488.20.06654-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disease with increasing global incidence, which has a multifactorial pathogenesis and a variable expressivity. Clinical features of AD are different in adults compared to children, but it is well recognized the substantial impact of the disease on patients' quality of life at any age. Indeed, little is known about AD in adolescence, a period of life generally associated with high psychological burden and vulnerability to depression. Guidelines for the management of AD are available for both children and adults but specific guidelines for the diagnosis and treatment of AD in adolescents are lacking. Seven Italian scientific societies of dermatologists, allergists, and pediatric allergists joined in a specific meeting to provide practical guidance for the diagnosis and management of moderate-to-severe adolescent AD suitable for the Italian clinical practice. Through a modified Delphi procedure, consensus was reached by 59 Italian experts in the management of AD on 20 statements covering five areas of interest about adolescent AD, including disease complexity, burden and social impact, diagnosis and definition of severity, current treatments, and new biologic therapies. This paper reports recommendations for the diagnosis and management of AD specifically in adolescents, pointing out some peculiar clinical features and focusing on the choice of medications. Dupilumab, the first biologic approved for the treatment of adolescents with AD, represents a useful treatment option due to its efficacy and reassuring safety profile.
Collapse
Affiliation(s)
| | | | - Domenico Bonamonte
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Gian L Marseglia
- Department of Pediatrics, IRCCS San Matteo Polyclinic Foundation, University of Pavia, Pavia, Italy
| | - Michele Miraglia Del Giudice
- Department of Woman and Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Antonino Musarra
- Unit of Allergy, National Healthcare System, Reggio Calabria, Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, Aldo Moro University, Bari, Italy
| | - Iria Neri
- Unit of Dermatology, Department of Specialistic, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Cataldo Patruno
- Unit of Dermatology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Luca Stingeni
- Section of Clinical Allergological Venereological Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Ketty Peris
- Unit of Dermatology, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | | |
Collapse
|
15
|
Platzgummer S, Bizzaro N, Bilò MB, Pravettoni V, Cecchi L, Sargentini V, Caponi L, Visentini D, Brusca I, Pesce G, Bagnasco M, Antico A, Montera MC, Quercia O, Musarra A, Bonazza L, Borrelli P, Cortellini G, Polillo BR, Valenti B, Zedda MT, Asero R, Villalta D. Recommendations for the Use of Tryptase in the Diagnosis of Anaphylaxis and Clonal Mastcell Disorders. Eur Ann Allergy Clin Immunol 2020; 52:51-61. [PMID: 31994369 DOI: 10.23822/eurannaci.1764-1489.133] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Tryptase is a serin-protease produced and released by mast cells after IgE-mediated or non-IgE mediated stimuli. We here review the various aspects related to the molecular characteristics of the enzyme and its biological effects, the genetic basis of its production and the release kinetics. Recommendations for the clinical use of tryptase measurement developed by a task force of Società Italiana di Patologia Clinica e Medicina di Laboratorio and Associazione Allergologi Immunologi Italiani Territoriali e Ospedalieri are given on the best procedure for a correct definition of the reference values in relation to the inter-individual variability and to the correct determination of tryptase in blood and other biological liquids, in the diagnosis of anaphylaxis (from drugs, food, insect sting, or idiophatic), death from anaphylaxis (post mortem assessment) and cutaneous or clonal mastcell disorders.
Collapse
Affiliation(s)
- S Platzgummer
- Laboratorio di Patologia Clinica, Ospedale Franz Tappeiner, Merano, Bolzano
| | - N Bizzaro
- Laboratorio di Patologia Clinica, Ospedale San Antonio, Tolmezzo, Azienda Sanitaria Universitaria Integrata, Udine
| | - M B Bilò
- Unità di Allergologia, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona
| | - V Pravettoni
- Dipartimento di Medicina Generale, Immunologia e Allergologia, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milano
| | - L Cecchi
- SOS Allergologia e Immunologia Prato, USL Toscana Centro, Prato
| | - V Sargentini
- UOC Patologia Clinica, Ospedale San Filippo Neri ASL Roma 1, Roma
| | - L Caponi
- Laboratorio di Patologia Clinica, Azienda Ospedaliero-Universitaria Pisana, Università di Pisa, Pisa
| | - D Visentini
- SOS Laboratorio di Immunopatologia e Allergologia, Azienda Sanitaria Universitaria Integrata, Udine
| | - I Brusca
- UOC Patologia Clinica, Ospedale Buccheri La Ferla Fatebenefratelli, Palermo
| | - G Pesce
- Laboratorio Diagnostico di Autoimmunologia IRCCS, Ospedale Policlinico S. Martino, Università di Genova, Dipartimento di Medicina Interna e Specialità mediche (DIMI), Genova
| | - M Bagnasco
- Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Università degli studi di Genova
| | - A Antico
- UOC Servizio Medicina di Laboratorio, AULSS 7 Regione Veneto, Santorso, Vicenza
| | - M C Montera
- Allergologia e Immunologia Clinica, Ospedale G. Fuscito, Mercato S. Severino, Az. Ospedaliero-Universitaria Ruggi D'Aragona, Salerno
| | - O Quercia
- S.S. Interdipartimentale di Allergologia, Ospedale di Faenza, Ravenna
| | - A Musarra
- Servizio di Allergologia, Casa della Salute di Scilla, Scilla, Reggio Calabria
| | - L Bonazza
- Divisione di Pneumologia, Ospedale di Bolzano
| | - P Borrelli
- Ambulatorio di Allergologia e Immunologia Clinica, Ospedale Beauregard, Aosta
| | | | - B R Polillo
- UOS Allergologia, PTP Nuovo Regina Margherita, Roma
| | - B Valenti
- Allergologia e Pneumologia, PTA Biondo, ASP, Palermo
| | - M T Zedda
- Libero professionista in Allergologia, Cagliari
| | - R Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Milano
| | - D Villalta
- SSD Immunologia e Allergologia, Presidio Ospedaliero S. Maria degli Angeli, Pordenone
| |
Collapse
|
16
|
Sposato B, Camiciottoli G, Bacci E, Scalese M, Carpagnano GE, Pelaia C, Santus P, Maniscalco M, Masieri S, Corsico A, Scichilone N, Baglioni S, Murgia N, Folletti I, Bardi G, Grosso A, Cameli P, Latorre M, Musarra A, Bargagli E, Ricci A, Pelaia G, Paggiaro P, Rogliani P. Mepolizumab effectiveness on small airway obstruction, corticosteroid sparing and maintenance therapy step-down in real life. Pulm Pharmacol Ther 2020; 61:101899. [PMID: 31972327 DOI: 10.1016/j.pupt.2020.101899] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/19/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Mepolizumab (MEP) has been recently introduced to treat severe eosinophilic asthma. Trials have demonstrated a significant effectiveness in this asthma phenotype. We evaluated MEP efficacy on lung function, symptoms, asthma exacerbations, biologic markers, steroid dependence and controller treatment level in real-life. METHODS We retrospectively analyzed 134 severe asthmatics (61 males; mean age 58.3 ± 11; mean FEV1%:72 ± 21), treated with MEP for at least 6 months (mean duration:10.9 ± 3.7 months). RESULTS FEV1% improved significantly after MEP. Mean FEF25-75 also increased from 37.4 ± 25.4% to 47.2 ± 27.2% (p < 0.0001). Mean baseline blood eosinophil level was 712 ± 731/μL (8.4 ± 5.2%) decreasing to 151 ± 384/μL (1.6 ± 1.6%) (p < 0.0001), FENO levels decreased likewise. MEP treatment also led to a significant ACT improvement (mean pre:14.2 ± 4.4; mean post:20.5 ± 28) and exacerbations significantly fell from 3.8 ± 1.9 to 0.8 ± 1.1 (p < 0.0001). 74% of patients were steroid-dependent before MEP. 45.4% and 46.4% of them showed a suspension and dose reduction respectively (p < 0.0001). A significant number reduced also ICS doses. Only 67% of subjects used SABA as needed before MEP, falling to 20% after MEP. About 40% of patients highlighted a maintenance therapy step-down. Subjects showing an omalizumab treatment failure before MEP had a similar positive response when compared with omalizumab untreated patients. CONCLUSION In real-life, MEP improved significantly all outcomes even small airway obstruction, suggesting its possible role also in distal lung region treatment. Furthermore, it demonstrated its high effectiveness in OC/ICS-sparing, in reducing SABA as needed and in stepping-down maintenance therapy. MEP is a valid alternative for patients with previous omalizumab treatment failure.
Collapse
Affiliation(s)
- Bruno Sposato
- Azienda USL Toscana Sud-Est Pneumology Department, "Misericordia" Hospital, Grosseto, Italy; Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Italy.
| | - Gianna Camiciottoli
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Largo A Brambilla 3, 50134, Florence, Italy
| | - Elena Bacci
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Marco Scalese
- Clinic Physiology Institute, National Research Centre, Pisa, Italy
| | | | - Corrado Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi di Milano, Division of Pulmonary Diseases, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - Mauro Maniscalco
- Institute Clinic Scientific Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Telese, 82037, Telese Terme, BN, Italy
| | - Simonetta Masieri
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Angelo Corsico
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Italy
| | - Nicola Scichilone
- Biomedical Department of Internal Medicine and Medical Specialties (DIBIMIS), University of Palermo, Palermo, Italy
| | | | - Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Ilenia Folletti
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
| | - Giulio Bardi
- Internal Medicine Department, Azienda USL 6 Livorno, Piombino Hospital, Italy
| | - Amelia Grosso
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Italy
| | - Paolo Cameli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Antonino Musarra
- Allergology Department, Casa della Salute di Scilla, Scilla, RC, Italy
| | - Elena Bargagli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - Alberto Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant 'Andrea, Rome, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Paola Rogliani
- Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Italy; Respiratory Unit, Department of Experimental Medicine, University of Rome "Tor Vergata" Rome, Italy
| |
Collapse
|
17
|
Celi G, Brusca I, Scala E, Villalta D, Pastorello E, Farioli L, Cortellini G, Deleonardi G, Galati P, Losappio L, Manzotti G, Pirovano B, Muratore L, Murzilli F, Cucinelli F, Musarra A, Cilia M, Nucera E, Aruanno A, Ria F, Patria MF, Varin E, Polillo BR, Sargentini V, Quercia O, Gabriela Uasuf C, Zampogna S, Carollo M, Graci S, Amato S, Mistrello G, Asero R. House dust mite allergy in Italy-Diagnostic and clinical relevance of Der p 23 (and of minor allergens): A real-life, multicenter study. Allergy 2019; 74:1787-1789. [PMID: 30887524 DOI: 10.1111/all.13776] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Giorgio Celi
- Ambulatorio di Allergologia, Clinica San Carlo Paderno Dugnano Italy
| | - Ignazio Brusca
- U.O.C. di Patologia Clinica Ospedale Buccheri La Ferla F.B.F. Palermo Italy
| | - Enrico Scala
- Allergy Unit Istituto dermopatico dell’Immacolata, IDI‐IRCCS Rome Italy
| | - Danilo Villalta
- SSD di Immunologia e Allergologia Ospedale S. Maria degli Angeli Pordenone Italy
| | - Elide Pastorello
- Struttura Complessa di Allergologia e Immunologia – ASST GOM Niguarda Milano Italy
| | - Laura Farioli
- Dipartimento di medicina di Laboratorio ASST GOM Niguarda Milano Italy
| | - Gabriele Cortellini
- Unità Operativa di Medicina Interna Rimini, Ambulatorio di Allergologia, Azienda Sanitaria Romagna Rimini Italy
| | | | | | - Laura Losappio
- Struttura Complessa di Allergologia e Immunologia – ASST GOM Niguarda Milano Italy
| | | | - Barbara Pirovano
- Servizio Medicina di Laboratorio ‐ ASST Bergamo Ovest Bergamo Italy
| | - Lionello Muratore
- UOC Allergologia ed Immnologia Clinica ASL Lecce "P.O. V. Fazzi" Lecce Italy
| | - Francesco Murzilli
- U.O.S.D di Allergologia, Ospedale S.S. Filippo e Nicola Avezzano (AQ) Italy
| | | | - Antonino Musarra
- Servizio di Allergologia, Casa della Salute di Scilla Scilla (RC) Italy
| | - Marcello Cilia
- Servizio di Allergologia, Casa della Salute di Scilla Scilla (RC) Italy
| | - Eleonora Nucera
- Servizio di Allergologia, Fondazione Policlinico Universitario A. Gemelli Roma Italy
| | - Arianna Aruanno
- Servizio di Allergologia, Fondazione Policlinico Universitario A. Gemelli Roma Italy
| | - Francesco Ria
- Istituto di Patologia Generale, Fondazione Policlinico Universitario A. Gemelli Roma Italy
| | - Maria Francesca Patria
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
| | - Elena Varin
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano Italy
| | - Battista Roberto Polillo
- Servizio di Allergologia UOC Medicina Interna, Polo Ospedaliero S. Spirito e Nuovo Regina Margherita Roma Italy
| | - Vittorio Sargentini
- Servizio di Allergologia di Laboratorio UOC Patologia Clinica, Ospedale S Filippo Neri Roma Italy
| | - Oliviero Quercia
- Unità di Allergologia Medicina interna Ospedale di Faenza (RA) Faenza Italy
| | - Carina Gabriela Uasuf
- Centro Malattie Allergiche Bonsignori Istituto di Biomedicina e Immunologia Molecolare, CNR Palermo Italy
| | - Stefania Zampogna
- Pronto Soccorso Pediatrico, Azienda Ospedaliera Pugliese Ciaccio Catanzaro Italy
| | - Michela Carollo
- Patologia e Biochimica Clinica Universita' Magna Graecia Catanzaro Italy
| | - Stefania Graci
- Istituto Zooprofilattico Sperimentale della Sicilia "A. Mirri" Palermo Italy
| | | | | | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo Paderno Dugnano Italy
| |
Collapse
|
18
|
Liccardi G, Calzetta L, Apicella G, Baldi G, Berra A, Califano F, Ciccarelli A, Cutajar M, D'Amato M, De Crescenzo G, Di Maro E, Gargano D, Giannattasio D, Inciso G, Lo Schiavo M, Madonna F, Maniscalco M, Montera C, Papa G, Pedicini A, Pio R, Salzillo A, Stanziola A, Rogliani P, Musarra A. Allergy in adolescent population (14-18 years) living in Campania region (Southern Italy). A multicenter study. Eur Ann Allergy Clin Immunol 2018; 51. [PMID: 30066997 DOI: 10.23822/eurannaci.1764-1489.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Adolescents (Ad) constitute a difficult to manage population among individuals suffering from asthma. The aim of our study was to assess the prevalence, clinical characteristics and age of onset of allergic sensitization and clinical symptoms in a sample of atopic Ad living in the Campania region (Southern Italy). Sixteen Allergy units or Centers belonging to the Italian Association of Hospital and Territorial Allergologists (AAIITO, Campania region) participated in this cross-sectional study. A case report form (CRF) was specifically designed for this study and commercial allergen extracts used for screening SPTs were provided by ALK-Abelló Group (Milan, Italy). A total of 443 patients were examined (females, f 220, 49.6 %; males, m 223, 50.3%). Dust mites represent the most common sensitizing agents in allergic Ad living in Campania region (Dermatoph. pteronyssinus 67.4% and Dermatoph. farinae 66.5%), followed by Parietaria (58.9%), grasses (45.8%), Artemisia vulgaris (16.7%), Olea Europaea (32.2%), dog dander (17.1%), cat dander (20.0%), Alternaria alternata (8.1%), Cupressus sempervirens (4.9%), Betula pendula (4.7%), other allergens (19.4%). An interesting comparison has been made between clinical data of our Ad with data of elderly patients (E). The role of allergic sensitization is significantly higher in Ad compared to E. Dermatophagoides pteronyssinus is the first sensitizing allergen in Ad and the last in E. Parietaria constitutes the first sensitizing pollen both in Ad and E, the percentage of sensitization is higher in Ad. Another important difference is the higher prevalence of As, as only symptom, in E compared to Ad (19.7% versus 7.6%). In conclusion, our findings confirm the high prevalence and clinical significance of airway allergic sensitization in the adolescents living in Campania region.
Collapse
Affiliation(s)
- G Liccardi
- Department of Pulmonology, Haematology and Oncology, Division of Pulmonology and Allergology. High Speciality A. Cardarelli Hospital, Naples, Italy.,Postgraduate School of Respiratory Medicine. Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - L Calzetta
- Postgraduate School of Respiratory Medicine. Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.,Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - G Apicella
- Department of Pulmonology, Haematology and Oncology, Division of Pulmonology and Allergology. High Speciality A. Cardarelli Hospital, Naples, Italy
| | - G Baldi
- Respiratory Medicine Unit, ASL (District 66), Salerno, Italy
| | - A Berra
- Respiratory Allergy Unit. G. Da Procida Hospital, Salerno, Italy
| | - F Califano
- Allergy and Clinical Immunology, G. Fucito Hospital and University Hospital, Salerno, Italy
| | - A Ciccarelli
- Allergy Unit, Presidio Sanitario Polispecialistico Loreto Crispi Naples, Italy
| | - M Cutajar
- Allergy Center, Division of Internal Medicine, Ospedali Riuniti Penisola Sorrentina, Sorrento (NA), Italy
| | - M D'Amato
- Department of Respiratory Disease, Federico II University, AO Dei Colli, Naples, Italy
| | - G De Crescenzo
- Allergy and Clinical Immunology Unit, High Speciality Sant'Anna and San Sebastiano Hospital, Caserta, Italy
| | - E Di Maro
- Department of Pulmonology, Haematology and Oncology, Division of Pulmonology and Allergology. High Speciality A. Cardarelli Hospital, Naples, Italy
| | - D Gargano
- Allergy Unit, High Speciality San Giuseppe Moscati Hospital, Avellino, Italy
| | - D Giannattasio
- Respiratory Physiopathology and Allergy, High Speciality Center Mauro Scarlato Hospital, Scafati (SA), Italy
| | - G Inciso
- Allergy Unit, ASL Na 3 (Sanitary District 59), Meta di Sorrento (NA), Italy
| | - M Lo Schiavo
- Allergy and Clinical Immunology, G. Fucito Hospital and University Hospital, Salerno, Italy
| | - F Madonna
- Allergy Unit, ASL (Sanitary District 12), Caserta, Italy
| | - M Maniscalco
- Pulmonary Rehabilitation Unit ICS Maugeri, Telese Terme, Benevento, Italy
| | - C Montera
- Allergy and Clinical Immunology, G. Fucito Hospital and University Hospital, Salerno, Italy
| | - G Papa
- ASL (Sanitary District), Avellino, Italy
| | - A Pedicini
- Allergology Unit, Division of Internal Medicine, Fatebenefratelli Hospital, Benevento, Italy
| | - R Pio
- Allergy and Clinical Immunology, G. Fucito Hospital and University Hospital, Salerno, Italy
| | - A Salzillo
- Department of Pulmonology, Haematology and Oncology, Division of Pulmonology and Allergology. High Speciality A. Cardarelli Hospital, Naples, Italy
| | - A Stanziola
- Department of Respiratory Disease, Federico II University, AO Dei Colli, Naples, Italy
| | - P Rogliani
- Postgraduate School of Respiratory Medicine. Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.,Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - A Musarra
- Allergy Unit, National Healthcare System, Reggio Calabria, Italy
| |
Collapse
|
19
|
Micheletto C, Bilò MB, Antonicelli L, Bresciani M, D'Amato G, De Benedictis E, De Michele F, Gasparini S, Giovannini M, Musarra A, Vaghi A. Severe asthma in adolescents and adults: a national, multicenter registry in real life. Eur Ann Allergy Clin Immunol 2018; 50:196-201. [PMID: 30039693 DOI: 10.23822/eurannaci.1764-1489.69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary The number of patients with uncontrolled asthma is growing especially in young people. Although current therapies improve the disease management, the heterogeneity of clinical outcomes results in patients whose asthma is refractory to standard therapies. To understand not responsive phenotypes, we instituted a web-registry aimed to collect real life data of adolescent and adult patients. One-hundred and five Italian medical Centers are part of the network. Participants above 14 years and affected by severe asthma will be included in the study. Demographic and clinical data will be collected for 5 years on a dedicated electronic database. For the first time in Italy, our study will provide information on epidemiological, clinical and therapeutic aspects related to the natural course of the disease, filling the gap between adolescents and adults.
Collapse
Affiliation(s)
- C Micheletto
- Unità di Pneumologia, Ospedale Mater Salutis, Legnago (VR), Italy
| | - M B Bilò
- Strutture Organizzative Dipartimentali di Allergologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - L Antonicelli
- Strutture Organizzative Dipartimentali di Allergologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - M Bresciani
- Unità di Allergologia, Ospedale San Paolo - ASL Roma 4, Civitavecchia (Roma), Italy
| | - G D'Amato
- Unità di Malattie Respiratorie e Allergiche, Dipartimento di Patologia Toracica, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, Napoli, Italy
| | - E De Benedictis
- Unità di Pneumologia e Terapia Intensiva Respiratoria, Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - F De Michele
- Unità di Pneumologia e Fisiopatologia Respiratoria, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, Napoli, Italy
| | - S Gasparini
- Università Politecnica delle Marche, e Unità di Malattie Polmonari, Dipartimento di Medicina Interna, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - M Giovannini
- Unità di Pneumologia, Azienda Unità Sanitaria Locale di Modena, Ospedale S. Maria Bianca di Mirandola, Mirandola (MO), Italy
| | - A Musarra
- Servizio di Allergologia, Casa della Salute di Scilla, Scilla (RC), Italy
| | - A Vaghi
- Unità Operativa Complessa di Pneumologia, ASST-Rhodense , Garbagnate Milanese (MI), Italy
| | | |
Collapse
|
20
|
Villalta D, Tonutti E, Bizzaro N, Brusca I, Sargentini V, Asero R, Bilò M, Manzotti G, Murzilli F, Cecchi L, Musarra A. Recommendations for the use of molecular diagnostics in the diagnosis of allergic dis-eases. Eur Ann Allergy Clin Immunol 2018; 50:51-58. [DOI: 10.23822/eurannaci.1764-1489.32] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- D. Villalta
- Allergologia e Immunologia Clinica, Ospedale S. Maria degli Angeli, Pordenone, Italy
| | - E. Tonutti
- Immunopatologia e Allergologia, Azienda Ospedaliero-Universitaria, Udine, Italy
| | - N. Bizzaro
- Laboratorio di Patologia Clinica, Ospedali di Tolmezzo, Gemona, San Daniele (UD), Italy
| | - I. Brusca
- Laboratorio Analisi, Ospedale Buccheri-La Ferla, Palermo, Italy
| | - V. Sargentini
- Laboratorio Analisi, P.T.P, Nuovo Regina Margherita, Roma, Italy
| | - R. Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano (MI), Italy
| | - M.B. Bilò
- UOC di Allergologia, Azienda Ospedaliera-Universitaria Ospedali Riuniti, Ancona, Italy
| | - G. Manzotti
- Ambulatorio di allergologia, Dipartimento Area Medica, Ospedale di Treviglio (BG), Italy
| | - F. Murzilli
- UOSD di Allergologia, Ospedale S.S. Filippo e Nicola, Avezzano (AQ), Italy
| | - L. Cecchi
- SOC Allergologia e Immunologia Clinica, USL Toscana Centro, Prato, Italy
| | - A. Musarra
- Servizio di Allergologia, Casa della Salute di Scilla, Scilla (RC), Italy
| |
Collapse
|
21
|
Braido F, Baiardini I, Scichilone N, Musarra A, Menoni S, Ridolo E, Gani F, Pravettoni V, Colombo G, Crivellaro M, Senna GE, Fumagalli F, Rossi O, Canonica GW. Illness perception, mood and coping strategies in allergic rhinitis: are there differences among ARIA classes of severity? Rhinology 2017; 52:66-71. [PMID: 24618631 DOI: 10.4193/rhino13.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study was designed to assess if illness perception, mood state and coping strategies differ according to allergic rhinitis (AR) persistence and severity. METHODS Illness perception, mood profiles, coping behaviors and rhinitis symptoms were assessed by means of validated tools inpatients classified according to the Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines. RESULTS Two hundred and thirty-one patients underwent data analysis. No difference in age, sex, socio-economic status, smoking habits was detected comparing patients according to AR severity, duration or 4 ARIA classes. Patients with intermittent AR reported higher scores than those with persistent AR in confusion-bewilderment of Profile of Mood States (POMS); patients with moderate/severe rhinitis had significantly higher scores than those with mild rhinitis in TSSS, Identity and Consequences. No differences were detected in all assessed outcomes in the 4 ARIA classes. CONCLUSIONS The patient's perspective about AR is independent of persistence and severity of symptoms. This may explain why AR remains under-diagnosed and under-treated, even in its most severe forms. Self-management plans should consider the patient's perspective.
Collapse
|
22
|
Braido F, Baiardini I, Scichilone N, Musarra A, Menoni S, Ridolo E, Gani F, Pravettoni V, Colombo G, Crivellaro M, Senna G, Fumagalli F, Rossi O, Canonica G. Illness perception, mood and coping strategies in allergic rhinitis: are there differences among ARIA classes of severity? Rhinology 2014. [DOI: 10.4193/rhin13.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
23
|
Sposato B, Liccardi G, Russo M, Folletti I, Siracusa A, Scichilone N, Ventura MT, Rolla G, Raie A, Milanese M, Pio R, Pio A, Scala R, Pareo C, Micucci C, Micheletto C, Billeri L, Musarra A, Cavaliere C, Agolli G, Masieri S, Scalese M, Capitani D. Cypress pollen: an unexpected major sensitizing agent in different regions of Italy. J Investig Allergol Clin Immunol 2014; 24:23-28. [PMID: 24765877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES In this multicenter survey, we assessed the impact of sensitization to cypress in atopic patients in Italy and determined whether cypress pollen concentration changed over time. METHODS Allergists were required to collect the results of 100-200 consecutive skin prick tests (SPTs) performed during 2012. Seasonal symptoms were also recorded, as were airborne cypress pollen concentrations (data from the Italian Aerobiology Association) in 1998-2000 and 2010-2012. RESULTS We examined 2258 atopic outpatients (56% females; age, 2-84 years) sensitized to at least 1 of the aeroallergens tested (Dermatophagoides species, grass, pellitory, olive, cypress, birch, Alternaria tenuis, and dog and cat dander). We found that 62.9%, 16.1%, and 32.7% of patients living in central, northern, and southern Italy, respectively, were sensitized to cypress (P < .0001). The cypress pollen concentration peak was delayed from February to March in 1998-2000 and 2010-2012 in all 3 regions, with a shift in pollination towards spring. Patients who were monosensitized to cypress reported mainly rhinitis (90.7%-97.6%) and conjunctivitis (38.1%-100%). In polysensitized patients, the prevalence of rhinitis, conjunctivitis, and asthma increased progressively (P < .0001) from southern to northern Italy. The same trend was observed for the prevalence of reported winter symptoms typical of cypress allergy (28%-65%). CONCLUSIONS Today, cypress pollen is the most frequent sensitizing aeroallergen (assessed by SPT) in several areas of central Italy. Variations in the timing of the cypress pollination period may have favored this increased sensitization. Rhinitis and conjunctivitis are the predominant symptoms. The clinical impact of this allergy was poor in southern Italy and increased in central areas before reaching its peak in northern regions.
Collapse
|
24
|
Musarra A, Senna G, Lombardi C. Antihistamines in daily practice: Italian allergologists' opinion. Eur Ann Allergy Clin Immunol 2013; 45:30-31. [PMID: 23678557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
25
|
Musarra A, Bilò MB, Bonini S, Canonica GW, Senna GE. Consensus on allergen specific immunotherapy. Eur Ann Allergy Clin Immunol 2013; 45 Suppl 3:1-49. [PMID: 26046171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
26
|
Madonini E, Musarra A. Allergen immunotherapy in asthma: current evidence and future requirements. Eur Ann Allergy Clin Immunol 2011; 43:103-110. [PMID: 21980797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The role of allergen-specific immunotherapy in asthma (AIT) is still a matter of debate. Actually, many controlled clinical trials have proved efficacy and safety of AIT in asthma, and some published meta-analyses, despite some methodological weaknesses, have confirmed these findings, the most recent and convincing being a meta-analysis on injection AIT studies. For sublingual AIT evidences do exist, but SLIT meta-analyses are mostly questioned due to some biases and inconsistencies. Most of these arise from methodological problems in single studies, usually small, underpowered and carried out with mixed populations. The main need, therefore, is to perform AIT clinical studies only in patients with asthma and following standardized protocols, as recommended by international Guidelines. Studies of AIT in asthma should also focus more on the long term and preventive effects of the treatment, rather than considering only the immediate efficacy on allergic symptoms. Furthermore, specific asthma features, such as lung function, bronchial reactivity, asthma control and exacerbations, should be included among the study outcomes.
Collapse
Affiliation(s)
- E Madonini
- Pneumology Unit, San Carlo Borromeo Hospital, Milan, Italy.
| | | |
Collapse
|
27
|
Asero R, Arena A, Cecchi L, Conte M, Crivellaro M, Emiliani F, Lodi Rizzini F, Longo R, Minale P, Murzilli F, Musarra A, Nebiolo F, Quercia O, Ridolo E, Savi E, Senna G, Villalta D. Are IgE Levels to Foods other than Rosaceae Predictive of Allergy in Lipid Transfer Protein-Hypersensitive Patients? Int Arch Allergy Immunol 2011; 155:149-54. [DOI: 10.1159/000318864] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 06/28/2010] [Indexed: 11/19/2022] Open
|
28
|
Musarra A, Bignardi D, Troise C, Passalacqua G. Long-lasting effect of a monophosphoryl lipid-adjuvanted immunotherapy to parietaria. A controlled field study. Eur Ann Allergy Clin Immunol 2010; 42:115-119. [PMID: 20648774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND The clinical efficacy of Monophosphoryl lipid A-adjuvanted immunotherapy (MPLA-SCIT) is ascertained, but there are no data on its possible long-lasting effect. We assessed in a real-life setting the persistence of the clinical effect five years after discontinuation. METHODS Patients with parietaria-induced respiratory allergy and fulfilling the criteria for immunotherapy prescription were evaluated at baseline, after the third year of MPLA-SCIT and five years after discontinuation. Visual analog scores, severity of the disease, pulmonary function and skin reactivity were assessed. Matched subjects who refused immunotherapy served as controls. RESULTS Twenty nine patients received MPLA-SCIT and 28 were the control group. There was a significant clinical improvement, as assessed by VAS only in the active group after 3 years that remained significant at 5 years versus baseline and controls. The distribution of severity of rhinitis was overall decreased at 3 and 8years as well. The number of patients with conjunctivitis in the active group decreased from 19 to 6 at the end of the treatment and to 9 after 5 years. There was also a decrease in the number of patients with asthma symptoms (from 6 to 2 to 4), which doubled in the control group. A significant reduction in the wheal of the Parietaria skin test was seen in the active group at the end of the treatment (9.5 +/- 2.1 mm vs. 6.4 +/- 2.6 mm; p = .01), but this reduction was lost at the 5-year. No relevant change was overall detected in pulmonary function. CONCLUSION MPLA-SCIT is effective, and the clinical efficacy is maintained after 5 years of discontinuation.
Collapse
Affiliation(s)
- A Musarra
- Allergy Unit, National Healthcare System, Reggio Calabria
| | | | | | | |
Collapse
|
29
|
Schiappoli M, Ridolo E, Senna G, Alesina R, Antonicelli L, Asero R, Costantino MT, Longo R, Musarra A, Nettis E, Crivellaro M, Savi E, Massolo A, Passalacqua G. A prospective Italian survey on the safety of subcutaneous immunotherapy for respiratory allergy. Clin Exp Allergy 2009; 39:1569-74. [PMID: 19486027 DOI: 10.1111/j.1365-2222.2009.03286.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Subcutaneous immunotherapy is effective for the treatment of respiratory allergy, and it is largely used in Italy, but no systematic safety assessment has been carried out so far. OBJECTIVE To assess prospectively the safety of injection immunotherapy in a multicentre, real-life survey. METHODS Eleven Italian allergy departments recorded the clinical characteristics of systemic reactions (SRs) due to immunotherapy. Vaccines were prescribed according to guidelines; only standardized depot extracts were used. SRs were graded according to the EAACI recommendations, and were classified as immediate or delayed. RESULTS One thousand seven hundred and thirty-eight patients (847 males, age range 5-71) received immunotherapy from eight different manufacturers, for a total of 2038 courses (300 patients received two extracts). A total of 60 785 injections were given over a mean immunotherapy duration of 3 years. Overall, 95 reactions were observed in 57 patients (3.28%), corresponding to 4.7% of the courses and 1.56/1000 injections. Twenty-five patients experienced more than one adverse event. There were 34 grade 2, 60 grade 3 and one grade 4 reactions and no fatality. SRs occurred more frequently in patients with asthma than in patients with rhinitis alone (4.1% vs. 1.1%), and were equally distributed between the build-up and the maintenance phase. Ragweed and grass extracts caused significantly more side effects than other allergens. CONCLUSION In this large prospective study, the rate of SRs was low, thus confirming that injection immunotherapy has an acceptable risk/benefit ratio when prescribed and carried out according to recommendations.
Collapse
Affiliation(s)
- M Schiappoli
- Allergy Unit, Verona General Hospital, Verona, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Passalacqua G, Musarra A, Pecora S, Amoroso S, Antonicelli L, Cadario G, Di Gioacchino M, Lombardi C, Ridolo E, Sacerdoti G, Schiavino D, Senna G. Quantitative assessment of the compliance with once-daily sublingual immunotherapy in children (EASY project: evaluation of a novel SLIT formulation during a year). Pediatr Allergy Immunol 2007; 18:58-62. [PMID: 17295800 DOI: 10.1111/j.1399-3038.2006.00471.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Compliance is a major determinant for allergy treatment, especially in children. Sublingual immunotherapy (SLIT) is self-managed at home, and no quantitative data on pediatric adherence are available. We studied the compliance in a large real-life setting. A simplified schedule of SLIT was used, consisting of a 10-day updosing phase followed by maintenance treatment in monodose containers to be taken daily (SLITOne). Italian specialists throughout Italy assessed the compliance in children who were newly prescribed SLIT according to guidelines. Parents were contacted with unscheduled telephone interviews at the third and sixth month of therapy and asked to count at that moment the remaining vials. Data from 71 children (38 boys, age range 2-13 yr) were enclosed in the database. Thirty had rhinoconjunctivitis, four asthma and 37 rhinoconjunctivitis + asthma. SLIT was prescribed for: mites in 57 (81%) subjects, grasses in 11 (15%) and 3 (4%) grass + olive mixture. Compliance data were available for all children at 3 months, and for 56 at 6 months. At 3 months, 85% of subjects had a compliance rate >75% (69% of them adhered >90%). At 6 months, 84% had a compliance rate >75% (66% of them adhered >90%). In four cases SLIT was discontinued for economical reasons, and in one case (1.4%) for side effects probably related to therapy. These data obtained in a quite large sample of children and in real-life confirm that the compliance with SLITOne is good, despite the therapy managed at home.
Collapse
|
31
|
Musarra A, Cilia M, Pecora S, Passalacqua G. Survey on the safety of a no-updosing regimen of sublingual immunotherapy. Eur Ann Allergy Clin Immunol 2006; 38:313-4. [PMID: 17191752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- A Musarra
- Servizio Allergologia ASL 11, Reggio Calabria
| | | | | | | |
Collapse
|
32
|
Ortolani C, Agostinis F, Amoroso S, Ariano R, Barbato A, Bassi M, Cadario G, Campi P, Cardinale F, Ciprandi G, D'Anneo R, Di Gioacchino M, Di Rienzo V, Fiocchi A, Galimberti M, Galli E, Giovannini M, Incorvaia C, La Grutta S, Lombardi C, Marcucci F, Marseglia G, Minelli M, Musarra A, Nettis E, Novembre E, Pajno G, Patriarca G, Pezzuto F, Piras P, Pucci S, Romano A, Romano C, Quercia O, Scala G, Schiavino D, Senna G, Sforza G, Tosca M, Tripodi S, Frati F. Practice parameters for sublingual immunotherapy. Monaldi Arch Chest Dis 2006; 65:44-6. [PMID: 16700194 DOI: 10.4081/monaldi.2006.586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The efficacy and safety of sublingual immunotherapy (SLIT) are currently supported by clinical trials, meta-analysis and post-marketing surveys. Practice parameters for clinical use of SLIT are proposed here by a panel of Italian specialists, with reference to evidence based criteria. Indications to SLIT include allergic rhinoconjunctivitis, asthma, and isolated conjunctivitis (strength of recommendation: grade A). As to severity of the disease, SLIT is indicated in moderate/severe intermittent rhinitis, persistent rhinitis and mild to moderate asthma (grade D). SLIT may be safely prescribed also in children aged three to five years (grade B), and its use in subjects aged more than 60 years is not prevented when the indications and contraindication are ascertained (grade D). The choice of the allergen to be employed for SLIT should be made in accordance with the combination of clinical history and results of skin prick tests (grade D). Polysensitisation, i.e. the occurrence of multiple positive response does not exclude SLIT, which may be done with the clinically most important allergens (grade D). As to practical administration, co-seasonal, pre co-seasonal, and continuous schedules are available, being the latter recommended for perennial allergens or for pollens with particularly prolonged pollination, such as Parietaria (grade D). For pollens with relatively short pollination, such as grasses and trees (cypress, birch, alder, hazelnut, olive) the pre co-seasonal and perennial schedules are preferred (grade C). The build-up phases suggested by manufacturers can be safely used (grade A), but they can be modified according to the patient's tolerance (grade C). A duration of SLIT of 3-5 years is recommended to ensure a long-lasting clinical effect after the treatment has been terminated (grade C).
Collapse
Affiliation(s)
- C Ortolani
- Casa di Cura Ambrosiana, Cesano Boscone, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Passalacqua G, Musarra A, Pecora S, Amoroso S, Antonicelli L, Cadario G, Di Gioacchino M, Lombardi C, Ridolo E, Sacerdoti G, Schiavino D, Senna G. Quantitative assessment of the compliance with a once-daily sublingual immunotherapy regimen in real life (EASY Project: Evaluation of A novel SLIT formulation during a Year). J Allergy Clin Immunol 2006; 117:946-8. [PMID: 16630956 DOI: 10.1016/j.jaci.2005.12.1312] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2005] [Revised: 12/06/2005] [Accepted: 12/07/2005] [Indexed: 10/24/2022]
|
34
|
Senna G, Musarra A, Pecora S, Passalacqua G. Quantitative Assessment of the Compliance with Sublingual Immunotherapy in Real Life: Easy Project. J Allergy Clin Immunol 2006. [DOI: 10.1016/j.jaci.2005.12.643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
35
|
Rienzo VD, Minelli M, Musarra A, Sambugaro R, Pecora S, Canonica WG, Passalacqua G. Post-marketing survey on the safety of sublingual immunotherapy in children below the age of 5 years. Clin Exp Allergy 2005; 35:560-4. [PMID: 15898975 DOI: 10.1111/j.1365-2222.2005.02219.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The age below 5 years is considered a prudential limit for immunotherapy in view of the possible severity of side-effects. Sublingual immunotherapy (SLIT) seems to be safe, but no study in very young children is available. We performed a safety post-marketing surveillance study in children below 5 years. METHODS Children aged 3-5 years with respiratory allergy receiving SLIT were followed-up for at least 2 years. A diary card for side-effects was filled by parents at each dose given. Local and systemic side-effects were graded as: mild (no intervention, no dose adjustment), moderate (medical treatment and/or dose reduction), severe (life-threatening/hospitalization/emergency care). The comparative safety of different allergens and regimens was also assessed. RESULTS One hundred and twenty-six children (mean age 4.2 years, 67 male) were included. Seventy-six (60%) had rhinitis with asthma, 34 (27%) rhinitis only and 16 (13%) only asthma. Immunotherapy was prescribed for mites (62%), grasses (22.2%), Parietaria (11.9%), Alternaria (2.4%) and olive (1.5%). Eighteen children underwent an accelerated build-up. The total number of doses was about 39,000. Nine side-effects were reported in seven children (5.6% patients and 0.2/1000 doses). Two episodes of oral itching and one of abdominal pain were mild. Six gastrointestinal side-effects were controlled by reducing the dose. All side-effects occurred during up-dosing phase. No difference in terms of safety among the allergens used was observed. CONCLUSION SLIT is safe also in children under the age of 5 years.
Collapse
|
36
|
Passalacqua G, Di Rienzo V, Minelli M, Musarra A, Sambugaro R, Pecora S, Canonica G. Post marketing survey on the safety of sublingual immunotherapy in children below the age of 5. J Allergy Clin Immunol 2005. [DOI: 10.1016/j.jaci.2004.12.1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
37
|
Purello D'Ambrosio F, Bagnato GF, Guarneri B, Musarra A, Di Lorenzo G, Dugo G, Ricciardi L. The role of nickel in foods exacerbating nickel contact dermatitis. Allergy 1998; 53:143-5. [PMID: 9826023 DOI: 10.1111/j.1398-9995.1998.tb04986.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
38
|
D'Ambrosio FP, Ricciardi L, Isola S, Savi E, Parmiani S, Puccinelli P, Musarra A. Rush sublingual immunotherapy in Parietaria allergic patients. Allergol Immunopathol (Madr) 1996; 24:146-51. [PMID: 8939269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Forty patients, monosensitized to Parietaria judaica with a clinical history of at least two years of rhinoconjunctivitis with or without asthma, were selected and randomly allocated in two groups. According to an open controlled experimental plan, twenty patients were submitted to sublingual immunotherapy (SLIT) with a solution of purified and biologically standardized extract of Parietaria judaica, following a preseasonal rush schedule. All patients, twenty belonging to the SLIT group and twenty belonging to the control group, were allowed to take authorized rescue drugs at need. At the end of the Parietaria pollen season. 15 patients for each group resulted to have complied with the criteria of the study. SLIT tolerance turned out to be excellent as no side effects were noticed in the group under treatment. No change could be detected in specific IgE and IgG4 in either group. According to the daily symptom and drug scores registered by each patient in a diary card, the SLIT group showed a statistically significant lower symptom score (p = 0.032) and lower drug plus symptom score (p = 0.037) during the peak pollen period (May-June 1994) in comparison to the group treated only with symptomatic drugs. Moreover, 13 out of 15 patients submitted to SLIT expressed a very favourable subjective opinion about the therapy and asked to continue the same treatment the following season. According to our results, the rush SLIT schedule, followed by maintenance during the pollen season, is simple, safe and effective for Parietaria pollen allergy and showed an excellent compliance.
Collapse
Affiliation(s)
- F P D'Ambrosio
- Policlinico Universitario di Messina, Scuola di Specializzazione in Allergologia ed Immunologia Clinica, Milano, Italia
| | | | | | | | | | | | | |
Collapse
|
39
|
Caiaffa MF, Iudice A, Macchia L, Tursi A, Vergallo G, Sacerdoti G, Venuti A, Della Torre F, Musarra A. Multicenter double-blind comparative study of terfenadine and cetirizine in hay fever. J Investig Allergol Clin Immunol 1992; 2:162-6. [PMID: 1342896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The efficacy and safety of terfenadine in the management of hay fever were compared with those of cetirizine in a multicenter, double-blind, parallel-group study, carried out during the 1990 spring pollen season. The patients were randomly assigned to one of two groups of treatment, 70 patients being given terfenadine 120 mg, and 72 patients cetirizine 10 mg, once daily for 7 days. The severity of the main symptoms was evaluated at baseline and after treatment by a 4-point rating scale. In addition, the overall symptom severity was recorded daily by the patient on a diary card. Both terfenadine and cetirizine produced significant relief of symptoms by the end of treatment, with a decrease in symptom severity ranging from 46 to 69% for terfenadine and from 40 to 55% for cetirizine. Adverse effects experienced by terfenadine- and cetirizine-treated patients were mainly drowsiness, with minor differences between the two groups. The results of this study confirmed previous experiences, showing that both terfenadine and cetirizine once daily should be regarded as effective drugs for the management of hay fever.
Collapse
Affiliation(s)
- M F Caiaffa
- Dept. of Allergology, University of Bari, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|