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Lombardi C, Passalacqua G, Menzella F, Mauritz Canevari RF, Danesi G, Pusateri AM, Carone M, Vancheri C, Di Marco F, Micheletto C, Manzotti G, Di Gioacchino M, Bilò MB, Gelardi M, Senna G, Canonica GW. Chronic rhinosinusitis with nasal polyposis and biological agents: the ARIA-ITALY Survey. Eur Ann Allergy Clin Immunol 2024. [PMID: 38534135 DOI: 10.23822/eurannaci.1764-1489.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Summary Background. Chronic rhinosinusitis (CRS) is an inflammatory disease that affects the nasal mucosa and the paranasal sinuses. CRS can be associated by nasal polyposis (CRSwNP phenotype) in up to 30% of patients and it is frequently associated with bronchial asthma. CRSwNP shows predominantly an underlying activation of type 2 inflammatory pathways with the involvement of eosinophils, IgE, interleukin (IL)-4, IL-5 and IL-13. Biological drugs that target these inflammatory cytokines are currently a therapeutic option recognized by guidelines for the treatment of uncontrolled form of the disease. Methods. As part of the activity of the "ARIA-Italy" working group, a panel of 255 Italian Ear, Nose and Throat (ENT) specialists, pneumologists and immuno-allergologists actively participated in this national survey and answered a series of questions geared toward understanding the main criteria for patient characterization and therapeutic decision, highlighting multidisciplinarity, and the implementation of the management of CRSwNP patients, as a part of the precision medicine concept and the appropriate use of the biologicals. Results. Two hundred and fifty-five experts and specialists participated in the survey. Conclusions. The results of this survey obtained from an extensive number of active specialists throughout Italy allow some important concluding remarks to be drawn. The main points of agreement were that multidisciplinary care teams provide many benefits but that, once the team is established, meetings and communication between members must be coordinated. Finally, the dissemination of national disease registries and the continuous updating of guidelines and position papers related to CRSwNP and comorbidities should be encouraged.
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Affiliation(s)
- C Lombardi
- Co-Chairman ARIA ITALY; Unit of Allergology, Clinical Immunology and Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - G Passalacqua
- Co-Chairman ARIA-Italy Allergy and Respiratory Diseases, IRCCS Policlinico S. Martino, University of Genoa, Genoa, Italy
| | - F Menzella
- UOC Pulmonary, "S. Valentino" Hospital, AULSS 2 Marca Trevigiana, Montebelluna, Treviso, Italy
| | - R F Mauritz Canevari
- Department of DISC, Otolaryngologist Clinic-IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - G Danesi
- Unità Operativa di Otorinolaringoiatria e Microchirurgia della Base Cranica, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - A M Pusateri
- Unità Operativa di Otorinolaringoiatria e Microchirurgia della Base Cranica, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - M Carone
- Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Telese Terme, Benevento, Italy
| | - C Vancheri
- UOC Respiratory System Diseases, Università degli Studi di Catania, Catania, Italy
| | - F Di Marco
- UOC Respiratory System Diseases, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - C Micheletto
- UOC Pulmonary, Azienda Ospedaliera Universitaria Verona, Verona, Italy
| | - G Manzotti
- Unit of Allergology, Casa di Cura B. Palazzolo, Bergamo, Italy
| | - M Di Gioacchino
- Società Italiana di Asma Allergologia e Immunologia Clinica, University of Chieti, Chieti, Italy
| | - 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, Ancona, Italy
| | - M Gelardi
- ENT Clinic, University of Foggia, Foggia, Italy
| | - G Senna
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - G W Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy
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2
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Guarnieri G, Chiurato L, Baiardini I, Caminati M, Senna G, Scarpa B, Vianello A. A hierarchical cluster analysis of the psycological impact of the COVID-19 pandemic on Italian severe asthma patients. J Asthma 2023:1-7. [PMID: 36951668 DOI: 10.1080/02770903.2023.2188565] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
INTRODUCTION In the context of COVID-19 pandemic a consistent medical concern raised among severe asthma patients though the studies excluded an increased risk of severe disease as well as an increased susceptibility.The aim of the study was to apply the Psychological General Well-Being Index (PGWBI) questionnaire to severe asthmatics during the COVID-19 pandemic and to evaluate data with a hierarchical cluster analysis. METHODS 114 severe asthmatics were asked to respond anonymously to the PGWBI questionnaire. The patients underwent lung functional test, fractional exhaled nitric oxide (FeNO) measurement, Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ6). A hierarchical cluster analysis was performed using an agglomerative approach and complete linkage to evaluate the results. RESULTS The study population predominantly included female (60%), middle-aged patients, with normal lung function parameters, mild signs of airway and satisfactory asthma control. The PGWBI score (82.46 ± 16.53) of the study population showed a good state of psychological well-being and was similar to that of a representative sample of healthy adult Italian subjects. Thus Hierarchical cluster analysis identified 3 groups of patients: Cluster 1 (32%), Cluster 2 (64%), and Cluster 3 (4%). Whilst the Cluster 2 patients' PGWBI score fell within the normal range, the Cluster 1 patients had a significantly lower total score (68.57 ± 7.2; p < 0.05), suggesting moderate distress. The Cluster 3 patients presented a total score markedly low.Conclusion Although the majority of the severe asthma patients studied demonstrated good mental well-being during the COVID-19 pandemic, some did indeed show moderate to severe psychological distress.
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Affiliation(s)
- G Guarnieri
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health University of Padova, Respiratory Pathophysiology Division, Padova, Italy
| | - L Chiurato
- Department of Statistical Sciences and Department of Mathematics Tullio Levi-Civita, University of Padova, Padova, Italy
| | - I Baiardini
- Allergy & Respiratory Diseases Department, Azienda Ospedaliera Universitaria IRCCS San Martino, Genoa, Italy
| | - M Caminati
- Department of Medicine, University of Verona and Verona University Hospital, Verona, Italy
| | - G Senna
- Department of Medicine, University of Verona and Verona University Hospital, Verona, Italy
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - B Scarpa
- Department of Statistical Sciences and Department of Mathematics Tullio Levi-Civita, University of Padova, Padova, Italy
| | - A Vianello
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health University of Padova, Respiratory Pathophysiology Division, Padova, Italy
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Abstract
Summary Allergic rhinitis (AR) is a common disease affecting up to 40% of the general population worldwide. In the Coronavirus 2019 (COVID-19) pandemic era, many observational studies analysing the effect of asthma and chronic obstructive pulmonary disease on the risk of developing COVID-19 were conducted, while data on AR are limited.In this paper, we review the risk of developing SARS-Cov-2 infection carried by AR patients, the outcomes of those with COVID-19 disease, and the COVID-19 influence on the allergic and nasal symptoms and the psychological status of AR patients, in both adult and paediatric populations.AR patients seem to be protected from COVID 19 infection. Even if data about the influence of AR on the severity of COVID-19 disease are still not conclusive, it seems that being an AR patient does not increase the risk of poor COVID-19 prognoses. The clinical manifestation of AR can be distinguished by COVID-19 symptoms. Treating AR adequately is also strongly recommended, especially during pandemic.
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Affiliation(s)
- F Gani
- Allergy Outpatient Clinic, Turin, Italy
| | - M Cottini
- Allergy and Pneumology Outpatient Clinic, Bergamo, Italy
| | - M Landi
- Pediatric National Healthcare System, Turin.,Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - A Berti
- Ospedale Santa Chiara, Trento, Italy.,Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, Trento, Italy.,Thoracic Disease Research Unit, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - P Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy.,Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - D Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - G Senna
- Department of Medicine, University of Verona - Verona University Hospital, Verona, Italy.,Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - C Lombardi
- Departmental Unit of Allergology, Immunology and Pulmonary Diseases, Fondazione Poliambulanza, Brescia, Italy
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4
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Caminati M, Cegolon L, Bacchini M, Segala N, Dama A, Bovo C, Olivieri B, Furci F, Senna G. The potential role of local pharmacies to assess asthma control: an Italian cross-sectional study. BMC Public Health 2021; 21:19. [PMID: 33402150 PMCID: PMC7784353 DOI: 10.1186/s12889-020-10080-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 12/16/2020] [Indexed: 12/20/2022] Open
Abstract
Background Asthma control and monitoring still represents a challenge worldwide. Although the international guidelines suggest the interplay between secondary and primary care services as an effective strategy to control the disease, community pharmacies’ are seldom involved in asthma control assessment. The present cross-sectional study aimed at providing a picture of the relationship between asthma severity and control in community pharmacies within the health district of the city of Verona (Veneto Region, North-Eastern Italy). Methods A call for participation was launched through the Pharmacists’ Association of Verona. Patients referring to the participating pharmacies with an anti-asthmatic drug medical prescription and an asthma exemption code were asked to complete the Asthma Control Test (ACT) and a brief questionnaire collecting information on their age, sex, smoking status, aerobic physical exercise and usual asthma therapy, which also defined asthma severity. A multinomial logistic regression model was fitted to investigate the risk of uncontrolled as well as poorly controlled vs. controlled asthma (base). Results were expressed as relative risk ratios (RRR) with 95% confidence interval (95%CI). Results Fifty-seven community pharmacies accepted to participate and 584 asthmatic patients (54% females; mean-age: 51 ± 19 years) were consecutively recruited from 1st January to 30th June 2018 (6 months). Based upon ACT score 50.5% patients had a controlled asthma, 22.3% a poorly controlled and 27.2% uncontrolled. A variable proportion of patients with uncontrolled asthma were observed for every level of severity, although more frequently with mild persistent form of asthma. Most patients (92%) self-reported regular compliance with therapy. At multinomial regression analysis, patients under regular asthma treatment course (RRR = 0.33; 95%CI: 0.15; 0.77) were less likely to have an ACT< 16 compared to those not taking medications regularly. Conclusions Overall, our findings highlighted an unsatisfactory asthma control in the general population, independently of the severity level of the disease. Community pharmacies could be a useful frontline interface between patients and the health care services, supporting an effective asthma management plan, from disease assessment and monitoring treatment compliance to referral of patients to specialist medical consultancies.
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Affiliation(s)
- M Caminati
- Department of Medicine, University of Verona, Verona, Italy
| | - L Cegolon
- Local Health Unit N.2 "Marca Trevigiana", Public Health Department, Treviso, Italy.
| | - M Bacchini
- Pharmacists' Association of Verona, Verona, Italy
| | - N Segala
- Pharmacists' Association of Verona, Verona, Italy
| | - A Dama
- Asthma Centre & Allergy Unit, Verona University Hospital, Verona, Italy
| | - C Bovo
- Medical Directorate, Verona University Hospital, Verona, Italy
| | - B Olivieri
- Residency Programme in Allergy & Clinical Immunology, Verona University Hospital, Verona, Italy
| | - F Furci
- Department of Clinical & Experimental Medicine, University Hospital G. Martino, Messina, Italy
| | - G Senna
- Department of Medicine, University of Verona, Verona, Italy
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5
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Caminati M, Furci F, Senna G, Delfino G, Poli A, Bovo C, Patella V. BCG vaccination and COVID-19: Much ado about nothing? Med Hypotheses 2020; 144:110109. [PMID: 32758899 PMCID: PMC7361052 DOI: 10.1016/j.mehy.2020.110109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/12/2020] [Indexed: 12/05/2022]
Affiliation(s)
- M Caminati
- Department of Medicine, Allergy and Clinical Immunology Section, University of Verona and Verona University Hospital, Verona, Italy.
| | - F Furci
- Allergy and Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University Hospital G. Martino, University of Messina, Messina, Italy
| | - G Senna
- Department of Medicine, Allergy and Clinical Immunology Section, University of Verona and Verona University Hospital, Verona, Italy
| | - G Delfino
- Division of Allergy and Clinical Immunology, Department of Medicine ASL Salerno, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy
| | - A Poli
- Department of Diagnostics and Public Health, Section of Hygiene and Preventive Medicine, University of Verona, Italy
| | - C Bovo
- Medical Direction, Verona University Hospital, Verona, Italy
| | - V Patella
- Division of Allergy and Clinical Immunology, Department of Medicine ASL Salerno, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy; Postgraduate Program in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy
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Caminati M, Senna G, Vianello A, Ricci G, Bellamoli R, Longhi S, Crivellaro M, Marcer G, Monai M, Passalacqua G. Thunderstorm Asthma: A Critical Appraisal Based on Clinical Practice. J Investig Allergol Clin Immunol 2019; 28:273-275. [PMID: 30073965 DOI: 10.18176/jiaci.0259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M Caminati
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - G Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - A Vianello
- Respiratory Pathophysiology Division, University-City Hospital of Padua, Padua, Italy
| | - G Ricci
- Emergency Department, Clinical Toxicology Unit, Verona University and General Hospital, Verona, Italy
| | - R Bellamoli
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - S Longhi
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - M Crivellaro
- Allergy Service, Department of Medicine and Public Health, University of Padua, Padua, Italy
| | - G Marcer
- Allergy Service, Department of Medicine and Public Health, University of Padua, Padua, Italy
| | - M Monai
- Meteorological Service, Veneto Regional Agency for Environment Protection and Prevention, Padua, Italy
| | - G Passalacqua
- Allergy and Respiratory Diseases, Policlinico San Martino, University of Genoa, Italy
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Adami G, Caminati M, Senna G, Fassio A, Schiappoli M, Idolazzi L, Viapiana O. Eosinophilic Granulomatosis With Polyangiitis and Cardiac Involvement: A Case Report. J Investig Allergol Clin Immunol 2019; 28:285-286. [PMID: 30073971 DOI: 10.18176/jiaci.0270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- G Adami
- Rheumatology Unit, Verona University, Verona, Italy
| | - M Caminati
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - G Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - A Fassio
- Rheumatology Unit, Verona University, Verona, Italy
| | - M Schiappoli
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - L Idolazzi
- Rheumatology Unit, Verona University, Verona, Italy
| | - O Viapiana
- Rheumatology Unit, Verona University, Verona, Italy
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8
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Caminati M, Senna G, Segala N, Bacchini M, Stefanizzi G, Bovo C, Schiappoli M, Canonica GW, Passalacqua G. Evaluation of asthma control in the pharmacy: an Italian cross-sectional study. Eur Ann Allergy Clin Immunol 2019; 49:225-230. [PMID: 28884990 DOI: 10.23822/eurannaci.1764-1489.03] [Citation(s) in RCA: 4] [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] [Indexed: 11/17/2022]
Abstract
Summary Background. In Western countries a large proportion of asthmatic patients remain uncontrolled, despite the availability of effective drugs. An involvement of pharmacies / pharmacists in asthma management has been suggested in guidelines, since this could provide a relevant support. Objective. The present cross-sectional study aimed at assessing the level of asthma control, by using ACT questionnaire, in the community pharmacies in the County of Verona, North East of Italy. Methods. A call for participation was sent by Verona Pharmacists' Association to all the pharmacies located in the Verona municipality. Patients with a medical prescription and an asthma exemption code were recruited in pharmacies. They were asked to fill the ACT questionnaire and to answer some additional questions on asthma treatment, smoke habits and comorbidities. Results. Thirty-seven community pharmacies recruited 239 patients. According to the ACT score, more than 50% of patients had a controlled asthma but 20% of them were totally uncontrolled and 12% were using oral steroid. Only 2.9% of patients had received an asthma action plan. Asthma was intermittent in 17.6% of patients, mild persistent in 13.8%, moderate persistent in 63.1% and severe in 5.4%. Discordance was observed between the self-perceived asthma control and objective parameters, when available. Of note, in the severe asthma group, most patients had an ACT > 20. Conclusion. This is the first Italian pharmacy-based study on asthma control. A better asthma control was recorded in this study in comparison with other trials, but about 50% of patients were insufficiently controlled. The community pharmacies can play a relevant role in the preliminary assessment of asthma control by using easy and not time consuming tools, such as ACT.
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Affiliation(s)
- M Caminati
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy. E-mail:
| | - G Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - N Segala
- Pharmacists' Association, Verona, Italy
| | | | - G Stefanizzi
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - C Bovo
- Medical Direction, Verona University and General Hospital, Verona, Italy
| | - M Schiappoli
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - G W Canonica
- Allergy and Respiratory Diseases, IRCCS San Martino-IST, University of Genoa, Italy
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino-IST, University of Genoa, Italy
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9
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Vianello A, Caminati M, Andretta M, Menti AM, Tognella S, Senna G, Degli Esposti L. Prevalence of severe asthma according to the drug regulatory agency perspective: An Italian experience. World Allergy Organ J 2019; 12:100032. [PMID: 31193146 PMCID: PMC6517682 DOI: 10.1016/j.waojou.2019.100032] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/03/2019] [Accepted: 04/11/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- A Vianello
- Respiratory Pathophysiology Division, University-City Hospital of Padua, Padua, Italy.,Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy.,Department of Medicine, University of Verona, Verona, Italy.,Health Technology Assessment Unit, Azienda Zero, Padova, Italy.,Respiratory Unit, Orlandi General Hospital, Bussolengo, Verona, Italy.,Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy.,CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | - M Caminati
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy.,Department of Medicine, University of Verona, Verona, Italy.,Health Technology Assessment Unit, Azienda Zero, Padova, Italy.,Respiratory Unit, Orlandi General Hospital, Bussolengo, Verona, Italy.,Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy.,CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | - M Andretta
- Health Technology Assessment Unit, Azienda Zero, Padova, Italy.,Respiratory Unit, Orlandi General Hospital, Bussolengo, Verona, Italy.,Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy.,CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | - A M Menti
- Health Technology Assessment Unit, Azienda Zero, Padova, Italy.,Respiratory Unit, Orlandi General Hospital, Bussolengo, Verona, Italy.,Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy.,CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | - S Tognella
- Respiratory Unit, Orlandi General Hospital, Bussolengo, Verona, Italy.,Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy.,CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | - G Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy.,CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | - L Degli Esposti
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
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10
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Bonizzoni G, Caminati M, Ridolo E, Landi M, Ventura MT, Lombardi C, Senna G, Crivellaro M, Gani F. Use of complementary medicine among patients with allergic rhinitis: an Italian nationwide survey. Clin Mol Allergy 2019; 17:2. [PMID: 30804711 PMCID: PMC6373013 DOI: 10.1186/s12948-019-0107-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 02/05/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A growing use of complementary alternative medicine (CAM) has been found in Europe as well in Italy for chronic diseases, including the allergic rhinitis. The study aims at investigating the prevalence and the pattern of use of CAM amongst patient with allergic rhinitis. METHODS A 12-item questionnaire was developed by a panel of experts and administered to patients with moderate/severe allergic rhinitis consecutively referring during the study time-frame to seven allergy clinics placed all around Italy. The items covered several topics including reason for choosing CAM, its clinical efficacy, schedule of treatment, costs, type of therapy. RESULTS Overall 359 questionnaires were analysed. 20% of patients declared CAM use. A significant correlation between the use of CAM and female sex (p < 0.01) and with a higher level of education (p < 0.01) was observed. CAM users were adults (36% in the range between 20 and 40 years and 32% between 41 and 60 years). Youngsters (< 20 years) (7%) and elderly (> 60) (25%) less frequently used CAM.The most used type of CAM was homoeopathy (77% of patients). 60% of users would recommend CAM despite a poor clinical efficacy according to 67% of them. CONCLUSIONS Although no evidence supports CAM efficacy and safety, the number of patients who relies on it is not negligible. As allergic rhinitis is not a trivial disease, the use of CAM as the only treatment for it should be discouraged at any level, but by general practitioner and specialist in particular.
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Affiliation(s)
- G. Bonizzoni
- Allergy Service AOU San Luigi Hospital Orbassano, Turin, Italy
| | - M. Caminati
- Asthma Center and Allergy Unit and Department of Medicine, Verona University Hospital, Piazzale Scuro, 37134 Verona, Italy
| | - E. Ridolo
- Experimental and Clinical Medicine, University of Parma, Parma, Italy
| | - M. Landi
- National Health Care System, Turin, Italy
| | - M. T. Ventura
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - C. Lombardi
- Department Unit of Allergology and Respiratory Diseases, Fondazione Poliambulanza Hospital Institute, Brescia, Italy
| | - G. Senna
- Asthma Center and Allergy Unit and Department of Medicine, Verona University Hospital, Piazzale Scuro, 37134 Verona, Italy
| | - M. Crivellaro
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - F. Gani
- Allergy Service AOU San Luigi Hospital Orbassano, Turin, Italy
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11
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Caminati M, Vianello A, Chieco Bianchi F, Festi G, Guarnieri G, Marchi MR, Micheletto C, Olivieri M, Tognella S, Guerriero M, Senna G. Relevance of TH2 Markers in the Assessment and Therapeutic Management of Severe Allergic Asthma: A Real-Life Perspective. J Investig Allergol Clin Immunol 2019; 30:35-41. [PMID: 30676321 DOI: 10.18176/jiaci.0379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Although blood eosinophils are currently recognized as the main clinical marker of TH2-type inflammation, their relevance in identifying asthma severity remains a matter of debate. METHODS Our retrospective real-life study on severe asthmatics included in the NEONet Italian database aimed to investigate the relevance of blood eosinophil count and fractional exhaled nitric oxide (FeNO) in the clinical assessment of severe asthma and their role as potential predictors of responsiveness to anti-IgE therapy. The cut-off values chosen were 300 eosinophils/mm3 and FeNO of 30 ppm. RESULTS We evaluated 132 adult patients. No significant differences were observed between the groups (high and low baseline eosinophil counts) in terms of demographic data, total IgE, lung function, patient-reported outcomes, or nasal comorbidities. The Asthma Control Test score and Asthma Quality of Life Questionnaire scores were poorer in patients with FeNO ≥30 ppb than in patients with FeNO <30 ppb. In the high FeNO subgroup, more frequent hospital admissions and a higher number of working days lost in the previous year were registered. A combined score including both eosinophils and FeNO did not improve the accuracy of the individual parameters. In the high-eosinophil subgroup, the proportion of responders to omalizumab was greater and increased at each follow-up time point. CONCLUSIONS Our findings show that blood eosinophil count is not an unequivocal marker of asthma severity, whereas a higher FeNO level is associated with more frequent hospital admissions and more working days lost. Blood eosinophils seem to act as a predictor of response to omalizumab.
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Affiliation(s)
- M Caminati
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - A Vianello
- Respiratory Pathophysiology Division, University-City Hospital of Padua, Padua, Italy
| | - F Chieco Bianchi
- Respiratory Pathophysiology Division, University-City Hospital of Padua, Padua, Italy
| | - G Festi
- Pulmonary Unit, Verona University Hospital, Verona, Italy
| | - G Guarnieri
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - M R Marchi
- Respiratory Pathophysiology Division, University-City Hospital of Padua, Padua, Italy
| | - C Micheletto
- Respiratory Unit, Mater Salutis Hospital, Legnago, Italy
| | - M Olivieri
- Unit of Occupational Medicine, Verona University Hospital, Verona, Italy
| | - S Tognella
- Respiratory Unit, Orlandi General Hospital, Bussolengo, Italy
| | - M Guerriero
- Department of Computer Science, University of Verona, Verona, Italy
| | - G Senna
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
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12
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Magnoni MS, Caminati M, Canonica GW, Arpinelli F, Rizzi A, Senna G. Asthma management among allergists in Italy: results from a survey. Clin Mol Allergy 2017; 15:11. [PMID: 28503097 PMCID: PMC5422900 DOI: 10.1186/s12948-017-0067-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/26/2017] [Indexed: 11/16/2022] Open
Abstract
Background In Europe more than 50% of asthmatic treated patients have not well-controlled asthma. Asthma affects about 2.5 million of patients in Italy. Aims and objectives The present survey aims at investigating how Italian allergists approach asthmatic patients, in order to highlight pitfalls and unmet needs concerning real-life asthma management. Methods An anonymous 16 item web questionnaire was available (April–October 2015) to all allergists who visited the web site of SIAAIC (Società Italiana di Allergologia, Asma Immunologia Clinica). Those who wished to give their contribution had the opportunity to answer about epidemiology, risk factors, treatment approaches, and adherence to therapy. Results One hundred and seventy four allergists answered the survey. 54% of them reported up to 10 patient visits per week and 35.3% between 10 and 30. The most frequent reasons of follow up visits are routine check-up (56.5% of allergists), and worsening of symptoms (41% of allergists). Nocturnal apnoeas, gastro-esophageal reflux and obesity are the most important comorbidities/risk factors of poorly controlled asthma. Bronchial hyper-responsiveness, increased NO levels and reduced exercise tolerance are the most important indicators of asthma severity. Concerning therapy, ICS combined with LABA is the treatment of choice suitable for the majority of patients. A rapid onset of action and a flexible ICS dosage are indicated as the optimal characteristics for achieving the therapeutic goals. Poor adherence to therapy is an important reason for symptom worsening for the majority of allergists. Complex dosage regimens and economic aspects are considered the most important factors impacting on adherence. Conclusions Allergists are involved in the management of asthma, regularly seeing their patients. Co-morbidities are frequent in asthmatic patients and may impact negatively on disease control, thus identifying patients who need a more careful and strict monitoring. Airway hyper-responsiveness to methacholine challenge test and nitric oxide are considered important indicators of asthma severity. The combination of LABA and inhaled steroids is considered the treatment of choice for most asthmatic patients, in keeping with broad evidence indicating that the combination therapy is more effective and rapid in gaining asthma control than inhaled corticosteroids alone. Adherence to medication regimens is considered of essence to achieve the therapeutic goals. Electronic supplementary material The online version of this article (doi:10.1186/s12948-017-0067-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M S Magnoni
- Medical and Scientific Department, GlaxoSmithKline, Verona, Italy
| | - M Caminati
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - G W Canonica
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University-Research Hospital, Rozzano, Milano, Italy
| | - F Arpinelli
- Medical and Scientific Department, GlaxoSmithKline, Verona, Italy
| | - A Rizzi
- Medical and Scientific Department, GlaxoSmithKline, Verona, Italy
| | - G Senna
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
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13
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Senna G, Guerriero M, Paggiaro PL, Blasi F, Caminati M, Heffler E, Latorre M, Canonica GW. SANI-Severe Asthma Network in Italy: a way forward to monitor severe asthma. Clin Mol Allergy 2017; 15:9. [PMID: 28400707 PMCID: PMC5385599 DOI: 10.1186/s12948-017-0065-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 03/27/2017] [Indexed: 12/27/2022] Open
Abstract
Even if severe asthma (SA) accounts for 5–10% of all cases of the disease, it is currently a crucial unmet need, owing its difficult clinical management and its high social costs. For this reason several networks, focused on SA have been organized in some countries, in order to select these patients, to recognize their clinical features, to evaluate their adherence, to classify their biological/clinical phenotypes, to identify their eligibility to the new biologic therapies and to quantify the costs of the disease. Aim of the present paper is to describe the ongoing Italian Severe Asthma Network (SANI). Up today 49 centres have been selected, widespread on the national territory. Sharing the same diagnostic protocol, data regarding patients with SA will be collected and processed in a web platform. After their recruitment, SA patients will be followed in the long term in order to investigate the natural history of the disease. Besides clinical data, the cost/benefit evaluation of the new biologics will be verified as well as the search of peculiar biomarker(s) of the disease.
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Affiliation(s)
- G Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital, Piazzale Stefani 1, 37126 Verona, Italy
| | - M Guerriero
- Department of Computer Science, University of Verona, Strada Le Grazie, 15, 37134 Verona, Italy
| | - P L Paggiaro
- Cardio-Thoracic and Vascular Department, University of Pisa, Via Paradisa, 2, 56124 Pisa, Italy
| | - F Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Cardio-thoracic unit and Cystic Fibrosis Adult Center Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy
| | - M Caminati
- Asthma Center and Allergy Unit, Verona University and General Hospital, Piazzale Stefani 1, 37126 Verona, Italy
| | - E Heffler
- Respiratory Diseases and Allergy - Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia, 78, 95123 Catania, Italy
| | - M Latorre
- Cardio-Thoracic and Vascular Department, University of Pisa, Via Paradisa, 2, 56124 Pisa, Italy
| | - G W Canonica
- Allergy & Respiratory Disease, DIMI-University of Genova, Largo Rosanna Benzi, 10, 16132 Genova, Italy.,Asthma & Allergy Clinic, Humanitas University, Via manzoni 56, 20089 Rozzano, Milano Italy
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14
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Idolazzi L, Ridolo E, Fassio A, Gatti D, Montagni M, Caminati M, Martignago I, Incorvaia C, Senna G. Periostin: The bone and beyond. Eur J Intern Med 2017; 38:12-16. [PMID: 27939043 DOI: 10.1016/j.ejim.2016.11.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/26/2016] [Accepted: 11/28/2016] [Indexed: 12/21/2022]
Abstract
In recent years the relationship between bone, metabolism and many pathophysiologic mechanisms involving other organs and the immune system, was increasingly apparent. This observation concerns vitamin D, osteopontin and periostin (PO). PO is expressed in the periosteum of long bones but also in many other tissues and organs, including heart, kidney, skin and lungs, being enhanced by mechanical stress or injury. PO has a relevant physiological function in promoting injury repair in a large number of tissues. However, its overexpression was observed in different diseases characterized by inflammation, fibrosis and tumorigenesis. Here we review the current knowledge on the role of PO in physiologic and pathologic pathways of different diseases. A specific focus regards the correlation between the level of PO and lung diseases and the identification of PO also as an inflammatory key effector in asthma, strongly associated with airways eosinophilia. In fact PO seems to be a useful biomarker of "Th2-high" asthma compared to "Th2-low" asthma phenotype and a predictor of response to therapeutic agents. Currently, a growing number of studies suggests a possible role of PO as a new diagnostic marker and/or therapeutic target for different diseases and its usefulness in clinical practice should be supported and confirmed by further and larger studies.
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Affiliation(s)
- L Idolazzi
- Rheumatology Unit, Department of Medicine, University of Verona, Italy.
| | - E Ridolo
- Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - A Fassio
- Rheumatology Unit, Department of Medicine, University of Verona, Italy
| | - D Gatti
- Rheumatology Unit, Department of Medicine, University of Verona, Italy
| | - M Montagni
- Departmental Unit of Allergology, AUSL of Piacenza,, "Guglielmo da Saliceto" Hospital, Piacenza, Italy
| | - M Caminati
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - I Martignago
- Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - C Incorvaia
- Allergy/Cardiac & Pulmonary Rehabilitation, ASST Gaetano Pini/CTO, Milan, Italy
| | - G Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
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15
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Caminati M, Senna G, Stefanizzi G, Bellamoli R, Longhi S, Chieco-Bianchi F, Guarnieri G, Tognella S, Olivieri M, Micheletto C, Festi G, Bertocco E, Mazza M, Rossi A, Vianello A. Drop-out rate among patients treated with omalizumab for severe asthma: Literature review and real-life experience. BMC Pulm Med 2016; 16:128. [PMID: 27562427 PMCID: PMC5000547 DOI: 10.1186/s12890-016-0290-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 08/18/2016] [Indexed: 11/29/2022] Open
Abstract
Background In patients with asthma, particularly severe asthma, poor adherence to inhaled drugs negatively affects the achievement of disease control. A better adherence rate is expected in the case of injected drugs, such as omalizumab, as they are administered only in a hospital setting. However, adherence to omalizumab has never been systematically investigated. The aim of this study was to review the omalizumab drop-out rate in randomized controlled trials (RCTs) and real-life studies. A comparative analysis was performed between published data and the Italian North East Omalizumab Network (NEONet) database. Results In RCTs the drop-out rate ranged from 7.1 to 19.4 %. Although the reasons for withdrawal were only occasionally reported, patient decision and adverse events were the most frequently reported causes. In real-life studies the drop-out rate ranged from 0 to 45.5 %. In most cases lack of efficacy was responsible for treatment discontinuation. According to NEONet data, 32 % of treated patients dropped out, with an increasing number of drop outs observed over time. Patient decision and lack of efficacy accounted for most treatment withdrawals. Conclusions Treatment adherence is particularly crucial in patients with severe asthma considering the clinical impact of the disease and the cost of non-adherence. The risk of treatment discontinuation has to be carefully considered both in the experimental and real-life settings. Increased knowledge regarding the main reasons for patient withdrawal is important to improve adherence in clinical practice.
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Affiliation(s)
- M Caminati
- Asthma Center and Allergy Unit, Verona General and University Hospital, Verona, Italy.
| | - G Senna
- Asthma Center and Allergy Unit, Verona General and University Hospital, Verona, Italy
| | - G Stefanizzi
- Asthma Center and Allergy Unit, Verona General and University Hospital, Verona, Italy
| | - R Bellamoli
- Asthma Center and Allergy Unit, Verona General and University Hospital, Verona, Italy
| | - S Longhi
- Asthma Center and Allergy Unit, Verona General and University Hospital, Verona, Italy
| | - F Chieco-Bianchi
- Respiratory Pathophysiology Division, University-City Hospital of Padua, Padua, Italy
| | - G Guarnieri
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - S Tognella
- Respiratory Unit, Orlandi General Hospital, Bussolengo, Verona, Italy
| | - M Olivieri
- Unit of Occupational Medicine, Verona General and University Hospital, Verona, Italy
| | - C Micheletto
- Respiratory Unit, Mater Salutis Hospital, Legnago, Verona, Italy
| | - G Festi
- Pulmonary Unit, Verona University and General Hospital, Verona, Italy
| | - E Bertocco
- Respiratory pathology Unit, Arzignano General Hospital, Vicenza, Italy
| | - M Mazza
- Pulmonary Unit, Pordenone General Hospital, Pordenone, Italy
| | - A Rossi
- Pulmonary Unit, Verona University and General Hospital, Verona, Italy
| | - A Vianello
- Respiratory Pathophysiology Division, University-City Hospital of Padua, Padua, Italy
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Ridolo E, Caminati M, Martignago I, Melli V, Salvottini C, Rossi O, Dama A, Schiappoli M, Bovo C, Incorvaia C, Senna G. Allergic rhinitis: pharmacotherapy in pregnancy and old age. Expert Rev Clin Pharmacol 2016; 9:1081-9. [PMID: 27177184 DOI: 10.1080/17512433.2016.1189324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Allergic rhinitis (AR) affects 20-30% of women in reproductive age and may worsen during pregnancy. About 10% of the elderly suffer from AR, and it could be under-diagnosed in these patients. Many drugs are currently available, however AR treatment during pregnancy and old age represents a challenging issue. AREAS COVERED A review of the literature on the topic has been performed. Expert commentary: In pregnancy, drug avoidance should be carefully balanced with the need for AR optimal control. Topical drugs are suggested as a first approach. The safety and tolerability profile of second-generation antihistamines is well supported. If allergen immunotherapy (AIT) is ongoing and well tolerated, there is no reason for stopping it. AIT initiation in pregnancy is not recommended. For elderly patients, no specific concerns have been highlighted regarding topical treatments, except from nasal decongestionants. Second generation antihistamines are generally well tolerated. Old age should not preclude AIT.
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Affiliation(s)
- E Ridolo
- a Clinical and Experimental Medicine , University of Parma , Parma , Italy
| | - M Caminati
- b Allergy Unit and Asthma Center , Verona University Hospital , Verona , Italy
| | - I Martignago
- a Clinical and Experimental Medicine , University of Parma , Parma , Italy
| | - V Melli
- a Clinical and Experimental Medicine , University of Parma , Parma , Italy
| | - C Salvottini
- c Department of Molecular Medicine , University of Pavia , Pavia , Italy
| | - O Rossi
- d Allergy Unit , Azienda Ospedaliera Universitaria Careggi , Firenze , Italy
| | - A Dama
- b Allergy Unit and Asthma Center , Verona University Hospital , Verona , Italy
| | - M Schiappoli
- b Allergy Unit and Asthma Center , Verona University Hospital , Verona , Italy
| | - C Bovo
- e Medical Direction , Verona University Hospital , Verona , Italy
| | - C Incorvaia
- f Allergy/Pulmonary Rehabilitation , ICP Hospital , Milano , Italy
| | - G Senna
- b Allergy Unit and Asthma Center , Verona University Hospital , Verona , Italy
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17
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Marzano AV, Pigatto P, Cristaudo A, Ayala F, Rossi O, Senna G, Triggiani M, Asero R. Management of chronic spontaneous urticaria: practical parameters. GIORN ITAL DERMAT V 2015; 150:237-246. [PMID: 25714626] [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: 06/04/2023]
Abstract
Chronic urticaria (CU) is a skin disorder characterized by transient, pruritic wheals persisting for longer than 6 weeks. According to the European Academy of Allergy and Clinical Immunology (EAACI) guidelines, CU can be categorized into two main types: chronic spontaneous urticaria (CSU), in which the wheals appear spontaneously, and inducible urticaria, that is triggered by physical agents. CSU may be due to triggering factors such as food allergens or infections, but in at least 40% of cases it is autoimmune in origin, caused by circulating autoantibodies anti-FcεR1 or anti-IgE, or autoreactive. In the present paper, re-evaluating the EAACI guidelines, we have developed a document containing some practical indications which are useful for diagnosis and management of CSU in the context of the Italian situation. Concerning CSU treatment, second generation antihistamines are the first-line treatment; these drugs can be used, as second-line treatment, at a higher than licensed dose in patients who do not respond adequately at licensed doses. The third-line treatment includes leukotriene receptor antagonists which, however, do not have a specific indication for the treatment of CSU, cyclosporine, whose use in this disease is still off-label, and omalizumab. The latter is a recombinant monoclonal IgG antibody that binds free IgE, down regulates mast cell function and induces eosinophil apoptosis. Recently, it has emerged as an effective and safe treatment for antihistamine-unresponsive CSU of both autoimmune/autoreactive and non-autoimmune/non-autoreactive, and has been officially approved for use against this disease.
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Affiliation(s)
- A V Marzano
- Unit of Dermatology, Department of Physiopathology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy -
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18
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Makatsori M, Scadding GW, Lombardo C, Bisoffi G, Ridolo E, Durham SR, Senna G. Dropouts in sublingual allergen immunotherapy trials - a systematic review. Allergy 2014; 69:571-80. [PMID: 24673502 DOI: 10.1111/all.12385] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2014] [Indexed: 11/27/2022]
Abstract
Participant dropouts can reduce the power of allergen immunotherapy clinical trials. Evaluation of the dropout rate and reasons for dropout are important not only in the planning of clinical studies but are also relevant for adherence to immunotherapy in daily clinical practice. A systematic review was carried out in order to establish the overall dropout rate among published double-blind, placebo-controlled randomized clinical trials of sublingual immunotherapy for respiratory allergic diseases. Dropouts were analysed in regards to allergen, formulation, treatment schedule, participant age, study size, number of centres and type of allergic disease. Relative dropout rates in placebo and active groups as well as reasons for dropout were also assessed. A total of 81 studies, comprising 9998 patients, were included. Dropout rates in sublingual immunotherapy controlled studies do not appear to be a major problem with a composite dropout percentage of 14% (95% CI:11.9-16). Furthermore, they are not different for active compared to placebo-treated participants. This lends support to the positive clinical outcomes seen in meta-analyses of these trials.
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Affiliation(s)
- M. Makatsori
- Allergy Department; Royal Brompton & Harefield NHS Foundation Trust; London UK
- National Heart & Lung Institute; Allergy & Clinical Immunology; Imperial College London; London UK
| | - G. W. Scadding
- Allergy Department; Royal Brompton & Harefield NHS Foundation Trust; London UK
- National Heart & Lung Institute; Allergy & Clinical Immunology; Imperial College London; London UK
| | - C. Lombardo
- Verona University Hospital; Allergy Unit; Verona Italy
| | - G. Bisoffi
- Verona University Hospital; Research Support Unit and Biostatistics; Verona
| | - E. Ridolo
- Department of Clinical and Experimental Medicine; University of Parma; Parma Italy
| | - S. R. Durham
- Allergy Department; Royal Brompton & Harefield NHS Foundation Trust; London UK
- National Heart & Lung Institute; Allergy & Clinical Immunology; Imperial College London; London UK
| | - G. Senna
- Verona University Hospital; Allergy Unit; Verona Italy
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Caminati M, Savi E, Villalta D, Passalacqua G, Triggiani M, Senna G. Component resolved diagnosis (CRD): how much is it presently used by Italian allergists? Eur Ann Allergy Clin Immunol 2014; 46:106-108. [PMID: 24853568] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Component resolved diagnosis (CRD) represents an innovative and revolutionary tool in allergy diagnosis. At the same time, some criticisms can be outlined. The present web survey aimed at investigating the role of CRD in daily clinical practice, according to a sample of Italian specialists who manage allergic patients. 127 physicians, mostly allergists, completed the questionnaire, mainly coming from North and Center of Italy. Most of them (80%) were allergists. One physician out of three regularly takes into consideration CRD, that is currently available about in a half of the hospitals where the specialists work. CRD is mostly prescribed in the diagnostic work-up of suspected food allergy, as it can drive risk assessment, epinephrine prescription and dietary advice. Concerning respiratory allergy, CRD is considered useful in investigating cross-reactivity and in defining the best treatment option, even if only 32% of patients treated with immunotherapy had been previously studied with CRD. The present survey points out the need for the specialists to develop a more practical know-how about CRD. Its diagnostic accuracy and its real impact on the clinical management need to be better defined. The lacking of CRD technology in many hospitals limits the possibility for many allergists to directly experience molecular diagnosis.
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Affiliation(s)
- M Caminati
- Allergy Unit, Verona University Hospital, Verona, Italy. Phone: +39 045 812 3525 Fax: +39 045 812 2048 E-mail:
| | - E Savi
- Allergy Unit, G. da Saliceto Hospital, Piacenza, Italy
| | - D Villalta
- Clinical Pathology Laboratory, Department of Laboratory Medicine, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino Hospital, IST, University of Genoa, Italy
| | - M Triggiani
- Immunoallergology Unit, University of Salerno, Salerno, Italy
| | - G Senna
- Allergy Unit, Verona University Hospital, Verona, Italy
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Abstract
Although avoidance of occupational triggers remains the primary step in the management of work-related allergies, immunological treatments (including biological agents and specific immunotherapy) can be regarded as potential therapeutic options for IgE-mediated diseases; for example, many studies with allergen-specific immunotherapy have been carried out on latex allergy, showing overall favorable results, at least with sublingual immunotherapy. On the other hand, only few case reports have suggested the efficacy of immunotherapy in baker's asthma as well as in laboratory animal-induced asthma. The new technologies, including component-resolved diagnosis and recombinant allergens, are expected to improve the quality and efficacy of specific immunotherapy in the future. Also the use of omalizumab may represent a suitable therapeutic choice in very selected cases of occupational allergy, as well as an approach to reduce side effects of venom immunotherapy in subjects with previous severe reactions to the treatment.
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Affiliation(s)
- M Crivellaro
- Allergology Service, Department of Medicine and Public Health, University of Padua, Padua, Italy
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21
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Nettis E, Bonifazi F, Bonini S, Di Leo E, Maggi E, Melioli G, Passalacqua G, Senna G, Triggiani M, Vacca A, Canonica GW. Molecular diagnosis and the Italian Board for ISAC. Eur Ann Allergy Clin Immunol 2014; 46:68-73. [PMID: 24739125] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The Component Resolved Diagnostic (CRD) approach has been developed when highly purified or recombinant allergen molecules have become available. These molecules are the allergenic proteins toward which the specific and clinically relevant IgE immune response is directed. So, the identification of protein families and cross-reactivity patterns of importance in allergy have been possible. The Italian advisory BOARD for ISAC was born: to evaluate the advantages, disadvantages and placement in diagnosis of CRD studying its application in allergic patients; to facilitate the interpretation of molecular diagnostics for clinical allergists; to evaluate the effectiveness of CRD in improving diagnostic risk assessment and early preventive treatment of allergic diseases. In the last years, its fields of interest have been: the evaluation of the performance of CRD on multi-sensitized allergic patients with respiratory symptoms and on poly-sensitized athletes; the evolution of IgE repertoire directed to single allergenic components by evaluating allergic patients with different age at a molecular level; the relevance of results obtained using allergen microarray technique for describing the IgE repertoire in allergic patients by reviewing the main articles focused on CRD published in the last 2 years; the need for an educational program focused on this new diagnostic tool also through the creation of an exhaustive and interactive explanation of the laboratory report molecular allergy; the investigation of the performance and potential additional diagnostic values of the ISAC microarray in a real-life clinical setting, taking into account also the economic values.
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Affiliation(s)
- E Nettis
- Section of Allergy and Clinical Immunology, Dept. of Internal Medicine, University of Bari, Bari, Italy
| | - F Bonifazi
- Allergy Unit, Dept. of Respiratory and Allergic Diseases, Azienda Ospedaliera Umberto I, Torrette, Ancona, Italy
| | - S Bonini
- Institute of Translational Pharmacology, Italian National Research Council, Second University of Naples, Naples, Italy
| | - E Di Leo
- Section of Allergy and Clinical Immunology, Dept. of Internal Medicine, University of Bari, Bari, Italy
| | - E Maggi
- Section of Immunoallergology, University of Florence, Florence, Italy
| | - G Melioli
- Laboratories of Analysis, Istituto Giannina Gaslini, Genoa, Italy
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS IST San Martino, University of Genoa, Genoa, Italy
| | - G Senna
- Allergy Unit, Azienda Ospedale Università, Verona, Italy
| | - M Triggiani
- Immunoallergology Unit, University of Salerno, Salerno, Italy
| | - A Vacca
- Section of Allergy and Clinical Immunology, Dept. of Internal Medicine, University of Bari, Bari, Italy
| | - G W Canonica
- Allergy and Respiratory Diseases, IRCCS IST San Martino, University of Genoa, Genoa, Italy
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22
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Caminati M, Magnoni MS, Rizzi A, Braido F, Foresi A, Bettoncelli G, Infantino A, D'Andria C, Antonicelli L, Paggiaro PL, Falcone F, Senna G. Asthma management among different specialists: results from a national Italian survey. Eur Ann Allergy Clin Immunol 2014; 46:74-82. [PMID: 24739126] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In Europe more than 50% of asthmatic treated patients have a not well-controlled asthma. The present survey aims at investigating how different specialists approach asthmatic patients. A web anonymous questionnaire was randomly administered to 604 General Practitioners (GPs), 241 Pneumologists and 131 Allergists. It concerned: epidemiology, diagnostic workup, follow-up and risk factors, treatment and future risk. A general agreement emerges about asthma diagnostic work-up. All categories are aware of the impact of comorbidities on asthma. LABA/inhaled steroids combination is considered the first choice treatment. Surprisingly, depot steroids and long-acting beta2 agonists (LABA) alone are still prescribed by GPs. Concerning monitoring tools, Allergists rely on inflammation biomarkers, whereas reduction of rescue medication is more relevant for GPs. Asthma Control Test (ACT) is considered time consuming by more than 50% of all physicians and is not known by most of GPs. Adherence is considered a crucial problem in asthma management. All categories seem to have a good knowledge about asthma. The cultural background may account for mild differences in asthma control tools and treatment options. GPs have a pivotal role in discriminating patients who need specific assessment by specialists. It is thus important that GPs and specialists share common tools for recognizing and managing those patients.
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Affiliation(s)
- M Caminati
- Allergy Unit, Verona University Hospital, Verona, Italy.
| | - M S Magnoni
- Medical and Scientific Department, GlaxoSmithKline, Verona, Italy
| | - A Rizzi
- Medical and Scientific Department, GlaxoSmithKline, Verona, Italy
| | - F Braido
- Allergy and Respiratory Diseases Clinic, Department of Internal Medicine and Biostatistics Unit, Department of Health Science, University of Genoa, Genoa, Italy
| | - A Foresi
- Division of Respiratory Medicine, A.O. Istituti Clinici di Perfezionamento, Sesto San Giovanni - Milano, Italy
| | | | - A Infantino
- Società Italiana Interdisciplinare per le Cure Primarie, Italy
| | - C D'Andria
- Internal and Respiratory Medicine, SS Annunziata Hospital, Taranto, Italy
| | - L Antonicelli
- Allergy Unit, Department of Immuno-Allergic and Respiratory Diseases, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - P L Paggiaro
- Cardio-Thoracic and Vascular Department, University of Pisa, Italy
| | - F Falcone
- Past President Associazione Italiana Pneumologi Ospedalieri and Consultant Pulmonologist GVM Care & Research, Bologna, Italy
| | - G Senna
- Allergy Unit, Verona University Hospital, Verona, Italy
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De Nettis E, Bonifazi F, Bonini S, Di Leo E, Maggi E, Melioli G, Passalacqua G, Senna G, Triggiani M, Vacca A, Canonica G. Molecular diagnosis and the Italian Board for ISAC. Eur Ann Allergy Clin Immunol 2014. [DOI: 10.23822/eurannaci.1764-1489.53] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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)
- E. De Nettis
- Section of Allergy and Clinical Immunology, Dept. of Internal Medicine, University of Bari, Bari, Italy
| | - F. Bonifazi
- Allergy Unit, Dept. of Respiratory and Allergic Diseases, Azienda Ospedaliera Umberto I, Torrette, Ancona, Italy
| | - S. Bonini
- Institute of Translational Pharmacology, Italian National Research Council, Second University of Naples, Naples, Italy
| | - E. Di Leo
- Section of Allergy and Clinical Immunology, Dept. of Internal Medicine, University of Bari, Bari, Italy
- Section of Allergy and Clinical Immunology, Internal Medicine Unit, Ente Ecclesiastico Ospedale F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - E. Maggi
- Section of Immunoallergology, University of Florence, Florence, Italy
| | - G. Melioli
- Laboratories of Analysis, Istituto Giannina Gaslini, Genoa, Italy
| | - G. Passalacqua
- Allergy and Respiratory Diseases, IRCCS IST San Martino, University of Genoa, Genoa, Italy
| | - G. Senna
- Allergy Unit, Azienda Ospedale Università, Verona, Italy
| | - M. Triggiani
- Immunoallergology Unit, University of Salerno, Salerno, Italy
| | - A. Vacca
- Section of Allergy and Clinical Immunology, Dept. of Internal Medicine, University of Bari, Bari, Italy
| | - G.W. Canonica
- Allergy and Respiratory Diseases, IRCCS IST San Martino, University of Genoa, Genoa, Italy
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Moscato G, Maestrelli P, Bonifazi F, Troise C, Caminati M, Crivellaro M, Olivieri M, Senna G. OCCUPATION study (OCCUPationl asthma: a naTIONal based study): a survey on occupational asthma awareness among Italian allergists. Eur Ann Allergy Clin Immunol 2014; 46:26-29. [PMID: 24702870] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Occupational asthma (OA) is the most common work-related respiratory disease. Case identification still remains underperformed. The present survey aimed at investigating the awareness about OA among Italian allergists. 538 Italian Allergists completed a web anonymous questionnaire concerning: patient profile, occupational history, disease features, diagnostic work-up, causal agents, management after diagnosis. 80 cases were registered by 14 members (2.4%). Patients were mostly between 30 and 62 years old; noteworthy, 19% were between 18 and 30. All the patients had a concomitant rhinitis, usually preceding asthma onset. Bakers, hairdressers and healthcare workers were more frequently involved. Diagnostic process included: skin prick test (85%), stop/resume test (57%), specific IgE dosage for occupational allergens (52.5%), peak expiratory flow monitoring (32.5%). Noteworthy, only 27,5% of patients underwent specific challenge. After the diagnosis 50% of patients did not change job. One third of the subjects were not referred to the national Workers Compensation Authority. Our data show that OA is quite neglected by Italian allergists, despite they have a pivotal role both in early identification and in primary prevention of OA. Thus, it is worth increasing awareness concerning OA and creating an easy-access network involving allergists and referral centers for Occupational respiratory diseases.
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Affiliation(s)
- G Moscato
- Fondazione "Salvatore Maugeri", Institute of Care and Research, Scientific Institute of Pavia, Allergy Unit, Pavia, Italy
| | - P Maestrelli
- University of Padova, Department of Environmental Medicine and Public Health, Padova, Italy
| | - F Bonifazi
- University Hospital, Ospedali Riuniti of Ancona, Department of Immunology, Allergy & Respiratory Diseases, Ancona, Italy
| | - C Troise
- San Martino Hospital, Allergy Unit, Genoa, Italy
| | - M Caminati
- Verona University Hospital, Allergy Unit, Verona, Italy.
| | - M Crivellaro
- University of Padua, Occupational and Environmental Medicine, Padua, Italy
| | - M Olivieri
- Verona University Hospital, Occupational Medicine Unit, Verona, Italy
| | - G Senna
- Verona University Hospital, Allergy Unit, Verona, Italy
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25
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Savi E, Peveri S, Senna G, Passalacqua G. Causes of SLIT discontinuation and strategies to improve the adherence: a pragmatic approach. Allergy 2013; 68:1193-5. [PMID: 23915164 DOI: 10.1111/all.12198] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2013] [Indexed: 11/28/2022]
Abstract
Sublingual immunotherapy (SLIT) is often discontinued, and many patients do not renew the prescription. We evaluated the reasons for discontinuation and set up an educational/follow-up plan to improve the adherence. In a first phase, the adherence at 4 months was directly assessed. Based on those results, an action plan (education, frequent contacts, and strictly scheduled visits) was developed and tested in other patients. A group of matched patients did not undergo the follow-up plan (controls). In the first phase, involving 252 subjects, at 4 months, there were 30% dropouts, mainly due to side-effects. In the second phase, 149 patients underwent education/follow-up and 90 received no intervention. In the first group, discontinuations at 4 months were 5%, vs 18% in the controls (P = 0.01). After one year, 12% of patients were lost in the first group and 35% in the control group (P < 0.001). An adequate education and a strict follow-up can significantly reduce SLIT's discontinuations.
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Affiliation(s)
- E. Savi
- Allergy Unit; G. da Saliceto Hospital; Piacenza; Italy
| | - S. Peveri
- Allergy Unit; G. da Saliceto Hospital; Piacenza; Italy
| | - G. Senna
- Allergy Unit; Azienda Ospedaliera Universitaria di Verona; Verona; Italy
| | - G. Passalacqua
- Allergy and Respiratory Diseases; IRCCS San Martino-IST-University of Genoa; Genoa; Italy
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Passalacqua G, Melioli G, Bonifazi F, Bonini S, Maggi E, Senna G, Triggiani M, Nettis E, Rossi RE, Vacca A, Canonica GW. The additional values of microarray allergen assay in the management of polysensitized patients with respiratory allergy. Allergy 2013; 68:1029-33. [PMID: 23889678 DOI: 10.1111/all.12194] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND The IgE response is directed against specific components from an allergenic source. The traditional diagnostic methods use whole extracts, containing allergenic, nonallergenic and cross-reactive molecules. This may pose diagnostic challenges in polysensitized patients. Microarray techniques detect specific IgE against multiple molecules, but their value in term of additional information and economic saving has not been yet defined. OBJECTIVE We assessed the additional diagnostic information provided by an allergen microarray in a large population of polysensitized subjects. METHODS In this multicentre study, allergists were required to carefully record diagnosis and treatment of consecutive patients referred for asthma/rhinitis, using the standard methodology (history, skin prick test, IgE assay). Then, a microarray allergen assay was carried out. Clinicians were required to review their diagnosis/treatment according to microarray results. RESULTS 318 allergic patients (30% reporting also nonrespiratory symptoms) and 91 controls were enrolled. The clinicians reported at least one additional information from the microarray in about 60% of patients, this resulting in therapeutic adjustments. In 66% of patients IgE to pan-allergens were detectable, being this clinically relevant in 38% of patients with polysensitization to pollens. CONCLUSION Microarray IgE assay represents an advancement in allergy diagnosis, as a third-level approach in polysensitized subjects, when the traditional diagnosis may be problematic.
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Affiliation(s)
- G. Passalacqua
- Allergy and Respiratory Diseases; IRCCS San Martino Hospital-University of Genoa-IST; Genoa; Italy
| | - G. Melioli
- Laboratorio Centrale di Analisi; Istituto Giannina Gaslini; Genoa; Italy
| | - F. Bonifazi
- Department of Respiratory and Allergic Diseases; Allergy Unit; Azienda Ospedaliera Umberto I; Ancona; Italy
| | - S. Bonini
- Institute of Translational Pharmacology; Italian National Research Council; Second University of Naples; Naples; Italy
| | - E. Maggi
- Section of Immunoallergology; University of Florence; Florence; Italy
| | - G. Senna
- Allergy Unit; Azienda Ospedale Università; Verona; Italy
| | - M. Triggiani
- Immunoallergology Unit; University of Salerno; Salerno; Italy
| | - E. Nettis
- Department of Internal Medicine; Section of Allergy and Clinical Immunology; University of Bari; Bari; Italy
| | - R. E. Rossi
- Rete di Allergologia Regione Piemonte; Azienda Sanitaria Cuneo 1; Cuneo; Italy
| | - A. Vacca
- Department of Internal Medicine; Section of Allergy and Clinical Immunology; University of Bari; Bari; Italy
| | - G. W. Canonica
- Allergy and Respiratory Diseases; IRCCS San Martino Hospital-University of Genoa-IST; Genoa; Italy
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Schiappoli M, Dama AR, Passalacqua G, Le Pera C, Senna G. The role of nasal endoscopy in the prescription of allergen immunotherapy. Eur Ann Allergy Clin Immunol 2013; 45:150-151. [PMID: 24067342] [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] [Received: 08/22/2013] [Indexed: 06/02/2023]
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Passalacqua G, Baiardini I, Senna G, Canonica GW. Adherence to pharmacological treatment and specific immunotherapy in allergic rhinitis. Clin Exp Allergy 2013; 43:22-8. [PMID: 23278877 DOI: 10.1111/j.1365-2222.2012.04052.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 05/17/2012] [Accepted: 05/29/2012] [Indexed: 11/30/2022]
Abstract
The term compliance simply indicates how much doses of the prescribed medication are taken, whereas the term adherence implies also an agreement between patient and physician about the therapeutic plan, and it is therefore preferred. Adherence is a main problem in all long-term treatments. Thus, it represents a problem also in the case of rhinitis, expecially concerning specific immunotherapy that must be assumed continuously for several years. Many factors can affect the adherence, depending on patient, on treatment itself and on the healthcare context, and all those factors usually interact. The adherence measured in controlled trials is usually good, but this does not reflect what happens in real life, where adherence should be preferably measured. There are few data on the adherence in real life for pharmacological treatments of allergic rhinitis (e.g. nasal steroids or antihistamines), whereas more data are available for specific immunotherapy. In this latter case, in real life, adherence seems to be far from optimal, for both sublingual and subcutaneous immunotherapy, although the recent studies agree on the fact that some interventions (i.e. patients' education, strict follow-up, regular contacts) could effectively improve the adherence. In this article, the literature concerning the adherence to pharmacological treatments and immunotherapy in allergic rhinitis was searched and reviewed.
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Affiliation(s)
- G Passalacqua
- Allergy and Respiratory Diseases, DIMI, University of Genoa, Genoa, Italy.
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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]
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Schiappoli M, Lombardo C, Bortolami O, Caruso B, Senna G. IgE to staphylococcal enterotoxins are undetectable in sera from patients with nasal polyposis. Eur Ann Allergy Clin Immunol 2012; 44:251-252. [PMID: 23441443] [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: 06/01/2023]
Abstract
Nasal polyposis is a frequent disease, sometime associated with asthma and non steroidal anti-inflammatory drugs intolerance. Staphylococcus aureus colonization can play a pathogenetic role in same cases by a severe eosinophilic inflammation, which can suggest new therapeutic approaches. Staphylococcus aureus colonization has been demonstrated by local specific enterotoxins IgE dosage in polyps homogenates. This study demonstrate lack of detection of serum enterotoxins specific IgE to staphylococcal in patients with nasal polyposis, compared with healthy subjects.
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Frati F, Incorvaia C, Lombardi C, Senna G. Allergen immunotherapy: 100 years, but it does not look like. Eur Ann Allergy Clin Immunol 2012; 44:99-106. [PMID: 22905590] [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: 06/01/2023]
Abstract
Allergen immunotherapy (AIT) is the only treatment able to act on the causes and not merely on the symptoms of allergy. AIT was introduced 100 years ago but remained an empirical treatment for more than 40 years, when the first controlled trial in 1954 opened the era of scientific evidence. A major advance was the introduction of venom immunotherapy to prevent anaphylaxis from insect stings in 1978. Concerning inhalant allergens, currently AIT may be administered in two forms, subcutaneous (SCIT), and sublingual immunotherapy (SLIT). A large number of trials, globally analyzed in a number of meta-analyses, gave sound evidence to the efficacy and safety of SCIT and SLIT in allergic rhinitis and asthma. Adverse systemic reactions are still a drawback for SCIT while safety and tolerability of SLIT are very good, provided recommended doses and schedules of administration are used A significant advance for SLIT development was the registration in Europe of the standardized quality tablets. New applications, such as food allergy and atopic dermatitis, as well as new routes of administration, are currently under evaluation. After 100 years of use, AIT has a central role in the management of allergy and the ongoing improvement seems able to warrant to AIT an even brighter future.
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Affiliation(s)
- F Frati
- Medical and Scientific Department, Stallergenes, Milan, Italy.
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Bonadonna P, Pagani M, Bircher A, Scherer K, Caruso B, Cocco C, Schiappoli M, Senna G, Lombardo C. Skin Test Predictive Value On The Proton Pump Inhibitors Allergy. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.749] [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: 11/28/2022]
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Senna G, Bonadonna P, Caruso B, Cocco C, Dama A, Conte M, Passalacqua G, Lombardo C. Skin Test And Specific IgE Predictive Value On The Chlorhexidine Allergy. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Antico A, Pagani M, Vescovi PP, Bonadonna P, Senna G. Food-specific IgG4 lack diagnostic value in adult patients with chronic urticaria and other suspected allergy skin symptoms. Int Arch Allergy Immunol 2010; 155:52-6. [PMID: 21109748 DOI: 10.1159/000318736] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 06/17/2010] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Specific IgG4 dosing against food is proposed to the public by a lot of commercial laboratories as a reliable method to diagnose food intolerance. Actually, few data on IgG4 responses to foods in adults are available in the literature. In this study we evaluated the clinical utility of specific IgG4 dosing against food in adult patients with suspected food allergy/intolerance. METHODS A case series of 73 adult patients with suspected food allergy and clinical manifestations of chronic urticaria or other allergy-supposed skin symptoms were tested for specific IgG4 against foods. An open food challenge was carried out for all IgG4-positive food. All positive open tests were controlled by double-blind placebo-controlled food challenge. RESULTS Forty-five patients (62%) were IgG4 positive for a number of foods, mainly egg, milk, casein and wheat. None of the patients with IgG4-positive testing showed adverse reactions, neither immediate nor delayed, to the corresponding food. CONCLUSIONS In adult patients, testing for specific IgG4 lacks clinical utility for the diagnosis of food allergy or intolerance. Dosing of IgG4 should not be part of the diagnosis and therapy of adult patients with allergy-like skin diseases.
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Affiliation(s)
- A Antico
- Allergy Unit, Department of Internal Medicine, Azienda Istituti Ospedalieri C. Poma, Mantova, Italy.
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35
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Liccardi G, Dente B, Restani P, Senna G, Falagiani P, Ballabio C, D'Amato G. Respiratory allergy induced by exclusive polysensitization to serum albumins of furry animals. Eur Ann Allergy Clin Immunol 2010; 42:127-130. [PMID: 20648777] [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
In this report we describe un unusual case of exclusive allergic sensitization to furry animals, as a possible study model to speculate about different modalities ofsensitization to allergens of common and less common mammalian species. A 27-year-old woman referred in our Allergological Centre for the occurrence of conjunctival and severe respiratory symptoms after contact with several animals such as cats, dogs, rabbits, horses, cows etc. Patient underwent clinical and anamnestic evaluation including a detailed information on the modality of exposure to different furry animals. Skin-prick-test (SPT) was performed with our routine panel of commercial standardized extracts (Lofarma Laboratories, Milan, Italy). Some animal allergenic extracts (rabbit, horse, rat, mouse, cavia, cow and hamster) have been tested by SPT one week after the routine SPT A blood sample was taken for measurement of total IgE and specific IgE (CAP System, Phadia, Uppsala, Sweden) as well as Immunoblotting procedures. The results of in vivo and in vitro procedures revealed allergic sensitization only to animal-derived allergens. Total IgE were 59.3 kU/L. Immunoblotting showed a specific IgE-mediated sensitization of the patient to cow's, rabbit's and horse's serum albumins (SA). In conclusion, our case report confirms the role of SA as cross-reacting agent in allergic sensitization to furry animals. This finding suggests to perform SPTs to several furry animal allergens in all individuals with high level of allergic sensitization to common pets (cats and/or dogs) in order to identify allergy to other animals and consequently to avoid future exposures at risk.
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Affiliation(s)
- G Liccardi
- Department of Chest Diseases, Division of Pneumology and Allergology, High Speciality Hospital A. Cardarelli, Naples, Italy
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Bonadonna P, Zanotti R, Pagani M, Caruso B, Perbellini O, Colarossi S, Olivieri E, Dama A, Schiappoli M, Senna G, Antico A, Passalacqua G. How much specific is the association between hymenoptera venom allergy and mastocytosis? Allergy 2009; 64:1379-82. [PMID: 19627274 DOI: 10.1111/j.1398-9995.2009.02108.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The preferential association of mastocytosis with hymenoptera sting reactions is well known, but there is no data on the prevalence of clonal mast cell disorders in subjects with severe systemic reactions due to foods or drugs. METHODS Patients with food- or drug-induced severe systemic reactions, including anaphylaxis, and increased serum tryptase were studied for the presence of mastocytosis, and compared with a population of patients with hymenoptera allergy. The aetiological role of foods or drugs was assessed according to current recommendations. Systemic reactions were graded in severity according to the procedure described by Mueller. Serum tryptase was considered increased if the level was >11.4 ng/ml. Subjects with increased tryptase had dermatological evaluation and Bone marrow(BM) aspirate-biopsy, which included histology/cytology, flow cytometry and detection of KIT mutations. RESULTS A total of 137 subjects (57 male, mean age 42 years) were studied. Of them, 86 proved positive for drugs and 51 for foods. Overall, out of 137 patients, only nine (6.6%) had a basal tryptase >11.4 ng/ml, and only two (1.5%) were diagnosed with mastocytosis. This was clearly different from patients with hymenoptera allergy, where 13.9% had elevated tryptase and 11.1% had a clonal mast cell disorder. CONCLUSION The association of clonal mast cell disorders with hymenoptera allergy seems to be more specific than that with food- or drug-induced systemic reactions.
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Lombardi C, Incorvaia C, Braga M, Senna G, Canonica GW, Passalacqua G. Administration regimens for sublingual immunotherapy to pollen allergens: what do we know? Allergy 2009; 64:849-54. [PMID: 19392995 DOI: 10.1111/j.1398-9995.2009.02063.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The modalities of administration of sublingual immunotherapy (SLIT), including dosing, build-up phase, duration of the treatment, and frequency of the maintenance dose are largely variable. In the case of pollen (SLIT), the complexity increases, since preseasonal, coseasonal and pre-coseasonal regimens can be used. The administration regimens are of relevance from a practical point of view, but can also have economic implications. We review herein the available literature (randomized double blind controlled studies) on pollen SLIT, in order to derive experimentally-supported suggestions about the regimens of administration that should be preferred.
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Affiliation(s)
- C Lombardi
- Pneumoallergology Unit, S. Orsola FBF Hospital, Brescia, Italy
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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.
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Affiliation(s)
- M Schiappoli
- Allergy Unit, Verona General Hospital, Verona, Italy
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Pagani M, Bonadonna P, Senna G, Antico A. The Role Of Skin Tests In The Prevention Of Hypersensitivity Reactions To Oxaliplatin. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.917] [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: 10/21/2022]
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40
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Liccardi G, Senna G, Piccolo A, Salzillo A, Foglia M, De Napoli I, D'Amato G. Severe respiratory syndrome induced by allergic mono-sensitization to European hamster (Cricetus cricetus) in a older woman. Eur Ann Allergy Clin Immunol 2008; 40:30-32. [PMID: 18700332] [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: 05/26/2023]
Abstract
Although the increase in the rate of hamster ownership, no report of allergic sensitization to common hamster (Cricetus cricetus)-derived allergens as a consequence of domestic exposure has been published in Italy. A 64-year-old woman was referred to our Allergy Centre for the recent onset of conjunctival and severe respiratory symptoms (rhinitis, cough, wheezing and dyspnea). About three months ago she had purchased a common hamster as home pet. Another hamster had lived at patient's home for about four months nine years ago. The results of SPT revealed allergic sensitization to Cricetus cricetus dander only (wheal 6x7 mm, positive control 7x7 mm). Total IgE were 59.3 kU/L. Specific IgE only to Cricetus cricetus epithelia (2.10 kUA/L), were also detected. Spirometry revealed a moderate degree of bronchial obstruction. Some important considerations can be drawn from our report: a) few months of hamster ownership are probably sufficient to induce an allergic sensitization and clinical symptoms, b) older age of sensitization in comparison to other studies, c) rapid remission of clinical symptoms after the removal of hamster d) skin prick tests and/or evaluation of specific IgE for hamster allergens should be performed in all potentially susceptible individuals.
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Affiliation(s)
- G Liccardi
- Department of Chest Diseases, Division of Pneumology and Allergology, A Cardarelli Hospital, Naples, Italy
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Bonadonna P, Schiappoli M, Dama A, Olivieri M, Perbellini L, Senna G, Passalacqua G. Is hymenoptera venom allergy an occupational disease? Occup Environ Med 2008; 65:217-8. [DOI: 10.1136/oem.2007.036400] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bonadonna P, Caruso B, Labardi D, Dama A, Senna G, Passalacqua G. Treatment with American Polistes venom was ineffective in an Italian patient allergic to European Polistes. Allergy 2007; 62:966-7. [PMID: 17620079 DOI: 10.1111/j.1398-9995.2007.01449.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Liccardi G, Barber D, Russo M, Canonica GW, D'Amato G, Senna G, Passalacqua G. Effectiveness of vacuum-cleaning in removing Fel d 1 allergen from cotton fabrics exposed to cats. Eur Ann Allergy Clin Immunol 2007; 39:167-9. [PMID: 17626332] [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: 05/16/2023]
Abstract
BACKGROUND The major cat allergen, Fel d 1, is ubiquitous, and clothes of cat owners are important vehicles for its distribution and dispersal in cat-free environments. OBJECTIVE We assessed the efficiency of a standard vacuum-cleaning in removing the cat allergen from cotton fabrics, experimentally contaminated by a prolonged contact with cats. METHODS Fifteen rectangles (80 x 100 cm) of a widely used cotton material were kept in baskets of male cats for 1 week. Afterwards, the squares were cut in half. One half was immediately sampled for cat allergen, and the other half was vacuum-cleaned for 15 minutes by a commercially available device before sampling. Five identical cotton rectangles not exposed to cats served as controls. Samples were collected with a high-volume vacuum air-sampler. Particulate material was harvested onto filters with 25-mm diameter and 2 microm pore size, extracted in phosphate buffer with BSA and then assayed for the Fel d 1 allergen with an ELISA method. The results were expressed as micrograms of allergen per filter. RESULTS After vacuum-cleaning the amounts of Fel d 1 extracted from cat-exposed fabrics were not significantly reduced ( t = 3.118; P > 0.005), with respect to the non vacuum-cleaned tissues. No Fel d 1 was found in control fabrics. CONCLUSIONS Our study suggest that vacuum-cleaning by using a commercially available device is not able to remove significant amounts of cat allergen from cotton fabrics exposed to cats.
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Affiliation(s)
- G Liccardi
- Department of Chest Diseases, Division of Pneumology and Allergology, A. Cardarelli Hospital, Naples, Italy
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Caruso B, Bonadonna P, Severino MG, Manfredi M, Dama A, Schiappoli M, Rizzotti P, Senna G, Passalacqua G. Evaluation of the IgE cross-reactions among vespid venoms. A possible approach for the choice of immunotherapy. Allergy 2007; 62:561-4. [PMID: 17441797 DOI: 10.1111/j.1398-9995.2007.01353.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hymenoptera venom allergy can be effectively cured with specific immunotherapy, thus the correct identification of the allergen is essential. In the case of multiple skin and serum positivities it is important to know if a cross-reaction among venoms is present. We studied by CAP-inhibition assays the degree of cross-reactivity between Vespula vulgaris and Polistes dominulus. METHODS Serum samples were obtained from consecutive patients with a clinical history of grade III-IV reactions to hymenoptera sting and with nondiscriminative skin/CAP positivity to both Vespula and Polistes. Inhibition assays were carried out with a CAP method, incubating the sera separately with both venoms and subsequently measuring the specific immunoglobulin E (IgE) to venoms themselves. RESULTS Forty-five patients (33 male, mean age 40 years, age range 12-74, total serum IgE 242 +/- 168 kU/l) were included. Their specific IgE to Vespula and Polistes were 12.03 +/- 5.70 kU/l and 10.7 +/- 2.0 kU/l (P = NS), respectively. At the CAP-inhibition assays, in 25 patients a >75% heterologous inhibition by P. dominulus venom against V. vulgaris-specific IgE was found. In six subjects V. vulgaris venom effectively inhibited the P. dominulus-specific IgE. In the remaining 14 cases the CAP-inhibition test provided intermediate and not discriminative results. CONCLUSION In 31/45 patients, the double sensitizations to venoms were probably the result of cross-reactions and the CAP-inhibition allowed identifying the true double sensitizations. This approach may be helpful for the correct prescription of immunotherapy in the case of V. vulgaris and P. dominulus double positivity.
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Affiliation(s)
- B Caruso
- Laboratory of Clinical Chemistry and Haematology, Verona General Hospital, Verona, Italy
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Affiliation(s)
- G Senna
- Allergy & Respiratory Diseases, Department of Internal Medicine, Padiglione Maragliano, L go R Benzi 10 16132, Genoa, Italy
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46
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Rotiroti G, Skypala I, Senna G, Passalacqua G. Anaphylaxis due to lupine flour in a celiac patient. J Investig Allergol Clin Immunol 2007; 17:204-5. [PMID: 17583113] [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: 05/15/2023] Open
Affiliation(s)
- G Rotiroti
- Allergy Service, Verona General Hospital, Verona, Italy
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Affiliation(s)
- C Lombardi
- Department of Internal Medicine Padiglione Maragliano, Genoa, Italy
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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).
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Affiliation(s)
- C Ortolani
- Casa di Cura Ambrosiana, Cesano Boscone, Milan, Italy
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Puccetti A, Bason C, Simeoni S, Millo E, Tinazzi E, Beri R, Peterlana D, Zanoni G, Senna G, Corrocher R, Lunardi C. In chronic idiopathic urticaria autoantibodies against Fc epsilonRII/CD23 induce histamine release via eosinophil activation. Clin Exp Allergy 2006; 35:1599-607. [PMID: 16393326 DOI: 10.1111/j.1365-2222.2005.02380.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic idiopathic urticaria is a common skin disorder characterized by recurrent, transitory, itchy weals for more than 6 weeks. An autoimmune origin has been suggested based on the findings of auto-antibodies (Abs) directed against either the alpha subunit of the high-affinity IgE receptor or the IgE molecule in nearly half of the patients. OBJECTIVE To identify other autoantigen targets in patients with chronic idiopathic urticaria. METHODS We used pooled IgG derived from 133 patients with chronic idiopathic urticaria to screen a random peptide library to identify disease-relevant autoantigen peptides. Among the identified peptides, one was recognized by the vast majority of patients' sera. Abs against this peptide were affinity purified from the patients' sera and assayed for their ability to induce histamine release from basophils. RESULTS We identified a peptide that showed similarity with the low-affinity IgE receptor (Fc epsilonRII/CD23) expressed on lymphomonocytes and eosinophils. Anti-peptide IgG Abs purified from the patients' sera bound cell surface CD23 and were able to induce histamine release from basophils. This effect appeared to be mediated by the release of major basic protein from eosinophils upon engagement of CD23. The same effects were obtained with the sera from mice immunized with the CD23 peptide. CONCLUSION Our results indicate that patients with chronic idiopathic urticaria have Abs against CD23 and that eosinophils, which infiltrate the skin of these patients, play a crucial role in maintaining the disease through the release of major basic protein upon engagement of the low-affinity IgE receptor by such auto-Abs.
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Affiliation(s)
- A Puccetti
- Department of Experimental Medicine, University of Genova, Genova, Italy
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Caruso B, Senna G, Rizzotti P. Analysis of the positivity rate in IgE positive patients to inhalant allergens in Verona Hospital Laboratory during 2002-2003. Eur Ann Allergy Clin Immunol 2006; 38:77-82. [PMID: 16752691] [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: 05/10/2023]
Abstract
BACKGROUND At present test tube allergy diagnosis is becoming increasingly more comparable to skin prick tests and is therefore increasingly more reliable, not only from an analytical point of view but also from a clinical one. The cost of test tube allergens has decreased over the years and the specific IgE dosage can quickly give a good diagnostic indication. OBJECTIVE To study the percentage of positive subjects for each individual allergen in cases of suspected allergy, the laboratory can easily identify, also by age bracket, the positivity for those well known allergens that are more commonly responsible for allergic pathologies by using the skin prick test. Our laboratory has studied the test tube diagnostic activity of 2002 and 2003. The inhaled allergens used to identify the positivity percentage were selected from those in our Allergy Unit and which literature identifies as those more commonly positive at skin prick tests. METHODS The positivity rate of specific IgEs (UniCAP100- Phamarcia) were analyses for two age brackets before and after the age of 12. The younger than 12 group was then subdivided further into pre-school age (3-5 years) and school age (6-12). RESULTS It can be stated that in the grass group, the seasonal allergens, the most commonly positive were cereals and pellitory, the latter increasing in adult age (above 12 years). In the tree group of seasonal allergens, positivity was found to increase in adult age for olive and cypress trees. The more commonly positive perennial allergens in the adult age (above 12) are dermathophagoides and cat. Below 12, there is a strong positivity to alternaria. CONCLUSIONS Such test tube studies on IgE positivity are not only useful for better defining diagnostic patterns to give an initial idea of suspected allergy, but also to highlight any changes in the IgE antibody count within different age brackets, with the possibility of documenting the progress of the pathology which is characteristic of the allergy in question.
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MESH Headings
- Administration, Inhalation
- Age Factors
- Allergens/immunology
- Alternaria/immunology
- Animals
- Cats
- Child
- Child, Preschool
- Female
- Fungi/immunology
- Humans
- Immunoglobulin E/blood
- Italy/epidemiology
- Male
- Poaceae/immunology
- Pollen/adverse effects
- Pyroglyphidae/immunology
- Radioallergosorbent Test
- Rhinitis, Allergic, Perennial/etiology
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Seasonal/etiology
- Rhinitis, Allergic, Seasonal/immunology
- Trees/immunology
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Affiliation(s)
- B Caruso
- Laboratory of Clinical Chemistry, Ospedale Civile Maggiore Borgo Trento, Verona
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