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Curcio R, Poli G, Fabi C, Sugoni C, Pasticci MB, Ferranti R, Rossi M, Folletti I, Sanesi L, Santoni E, Dominioni I, Cavallo M, Morgana G, Mordeglia L, Luca G, Pucci G, Brancorsini S, Vaudo G. Exosomal miR-17-5p, miR-146a-3p, and miR-223-3p Correlate with Radiologic Sequelae in Survivors of COVID-19-Related Acute Respiratory Distress Syndrome. Int J Mol Sci 2023; 24:13037. [PMID: 37685844 PMCID: PMC10488112 DOI: 10.3390/ijms241713037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
We investigated the association between circulating microRNAs (miRNAs) potentially involved in the lung inflammatory process and fibrosis development among COVID-19-related acute respiratory distress syndrome (ARDS) survivors. At 4 ± 2 months from clinical recovery, COVID-19-related ARDS survivors matched for age, sex, and clinical characteristics underwent chest high-resolution computerized tomography (HRCT) and were selected based on imaging pattern evolution into fully recovered (N = normal), pulmonary opacities (PO) and fibrosis-like lesions (FL). Based on the previous literature, we performed plasma miRNA profiling of exosomal miRNAs belonging to the NLRP3-inflammasome platform with validated (miR-17-5p, miR-223-3p) and putative targets (miR-146a-5p), miRNAs involved in the post-transcriptional regulation of acute phase cytokines (miR128-3p, miR3168, miR125b-2-3p, miR106a-5p), miRNAs belonging to the NLRP4-inflammasome platform (miR-141-3p) and miRNAs related to post-transcriptional regulation of the fibrosis process (miR-21-5p). miR-17-5p, miR-223-3p, and miR-146a-5p were significantly down-regulated in patients with FL when compared to patients with PO. miR-146a-5p was also down-regulated in patients with FL than in N. The expression of the remaining miRNAs did not differ by group. In patients with long-term pulmonary radiological sequelae following COVID-19-related ARDS, a down-regulation of miR-17-5p, miR-146a-3p, and miR-223-3p correlated to fibrosis development in patients showing persistent hyper-reactivity to inflammatory stimulation. Our results support the hypothesis that NLRP3-Inflammasome could be implicated in the process of fibrotic evolution of COVID-19-associated ARDS.
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Affiliation(s)
- Rosa Curcio
- Unit of Internal Medicine, Santa Maria Terni Hospital, 05100 Terni, Italy
| | - Giulia Poli
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Consuelo Fabi
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Chiara Sugoni
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Maria Bruna Pasticci
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
- Infectious Diseases Unit, Santa Maria Terni Hospital, 05100 Terni, Italy
| | - Roberto Ferranti
- Unit of Radiology, Santa Maria Terni Hospital, 05100 Terni, Italy
| | - Monica Rossi
- Unit of Radiology, Santa Maria Terni Hospital, 05100 Terni, Italy
| | - Ilenia Folletti
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
- Section of Occupational Medicine, Santa Maria Terni Hospital, 05100 Terni, Italy
| | - Leandro Sanesi
- Unit of Internal Medicine, Santa Maria Terni Hospital, 05100 Terni, Italy
| | - Edoardo Santoni
- Unit of Internal Medicine, Santa Maria Terni Hospital, 05100 Terni, Italy
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Irene Dominioni
- Unit of Internal Medicine, Santa Maria Terni Hospital, 05100 Terni, Italy
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | | | - Giovanni Morgana
- Unit of Internal Medicine, Santa Maria Terni Hospital, 05100 Terni, Italy
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Lorenzo Mordeglia
- Unit of Internal Medicine, Santa Maria Terni Hospital, 05100 Terni, Italy
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Giovanni Luca
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Giacomo Pucci
- Unit of Internal Medicine, Santa Maria Terni Hospital, 05100 Terni, Italy
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Stefano Brancorsini
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Gaetano Vaudo
- Unit of Internal Medicine, Santa Maria Terni Hospital, 05100 Terni, Italy
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
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Porru S, Monaco MGL, Spiteri G, Carta A, Pezzani MD, Lippi G, Gibellini D, Tacconelli E, Dalla Vecchia I, Sala E, Sansone E, De Palma G, Bonfanti C, Lombardo M, Terlenghi L, Pira E, Mansour I, Coggiola M, Ciocan C, Godono A, Tardon A, Rodriguez-Suarez MM, Fernandez-Tardon G, Jimeno-Demuth FJ, Castro-Delgado RV, Iglesias Cabo T, Scapellato ML, Liviero F, Moretto A, Mason P, Pavanello S, Volpin A, Vimercati L, Tafuri S, De Maria L, Sponselli S, Stefanizzi P, Caputi A, Gobba F, Modenese A, Casolari L, Garavini D, D’Elia C, Mariani S, Filon FL, Cegolon L, Negro C, Ronchese F, Rui F, De Michieli P, Murgia N, Dell’Omo M, Muzi G, Fiordi T, Gambelunghe A, Folletti I, Mates D, Calota VC, Neamtu A, Perseca O, Staicu CA, Voinoiu A, Fabiánová E, Bérešová J, Adamčáková ZK, Nedela R, Lesňáková A, Holčíková J, Boffetta P, Abedini M, Ditano G, Asafo SS, Visci G, Violante FS, Zunarelli C, Verlato G. SARS-CoV-2 Breakthrough Infections: Incidence and Risk Factors in a Large European Multicentric Cohort of Health Workers. Vaccines (Basel) 2022; 10:vaccines10081193. [PMID: 36016081 PMCID: PMC9415790 DOI: 10.3390/vaccines10081193] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 12/23/2022] Open
Abstract
Background: The research aimed to investigate the incidence of SARS-CoV-2 breakthrough infections and their determinants in a large European cohort of more than 60,000 health workers. Methods: A multicentric retrospective cohort study, involving 12 European centers, was carried out within the ORCHESTRA project, collecting data up to 18 November 2021 on fully vaccinated health workers. The cumulative incidence of SARS-CoV-2 breakthrough infections was investigated with its association with occupational and social–demographic characteristics (age, sex, job title, previous SARS-CoV-2 infection, antibody titer levels, and time from the vaccination course completion). Results: Among 64,172 health workers from 12 European health centers, 797 breakthrough infections were observed (cumulative incidence of 1.2%). The primary analysis using individual data on 8 out of 12 centers showed that age and previous infection significantly modified breakthrough infection rates. In the meta-analysis of aggregated data from all centers, previous SARS-CoV-2 infection and the standardized antibody titer were inversely related to the risk of breakthrough infection (p = 0.008 and p = 0.007, respectively). Conclusion: The inverse correlation of antibody titer with the risk of breakthrough infection supports the evidence that vaccination plays a primary role in infection prevention, especially in health workers. Cellular immunity, previous clinical conditions, and vaccination timing should be further investigated.
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Affiliation(s)
- Stefano Porru
- Section of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy;
- Occupational Medicine Unit, University Hospital of Verona, 37134 Verona, Italy; (M.G.L.M.); (G.S.)
- Correspondence: ; Tel.: +39-0458124294
| | | | - Gianluca Spiteri
- Occupational Medicine Unit, University Hospital of Verona, 37134 Verona, Italy; (M.G.L.M.); (G.S.)
| | - Angela Carta
- Section of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy;
- Occupational Medicine Unit, University Hospital of Verona, 37134 Verona, Italy; (M.G.L.M.); (G.S.)
| | - Maria Diletta Pezzani
- Infectious Diseases Unit, University Hospital of Verona, 37134 Verona, Italy; (M.D.P.); (E.T.)
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy;
| | - Davide Gibellini
- Section of Microbiology, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy;
| | - Evelina Tacconelli
- Infectious Diseases Unit, University Hospital of Verona, 37134 Verona, Italy; (M.D.P.); (E.T.)
- Section of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy;
| | - Ilaria Dalla Vecchia
- Section of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy;
| | - Emma Sala
- Unit of Occupational Health, Hygiene, Toxicology and Prevention, University Hospital ASST Spedali Civili, 25121 Brescia, Italy; (E.S.); (G.D.P.)
| | - Emanuele Sansone
- Unit of Occupational Health and Industrial Hygiene, Department of Medical Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy;
| | - Giuseppe De Palma
- Unit of Occupational Health, Hygiene, Toxicology and Prevention, University Hospital ASST Spedali Civili, 25121 Brescia, Italy; (E.S.); (G.D.P.)
- Unit of Occupational Health and Industrial Hygiene, Department of Medical Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy;
| | - Carlo Bonfanti
- Department of Molecular and Translational Medicine, Institute of Microbiology, University of Brescia-ASST Spedali Civili, 25121 Brescia, Italy; (C.B.); (L.T.)
| | - Massimo Lombardo
- Chief Executive Office, ASST Spedali Civili di Brescia, 25121 Brescia, Italy;
| | - Luigina Terlenghi
- Department of Molecular and Translational Medicine, Institute of Microbiology, University of Brescia-ASST Spedali Civili, 25121 Brescia, Italy; (C.B.); (L.T.)
| | - Enrico Pira
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy; (E.P.); (I.M.); (C.C.); (A.G.)
- Occupational Medicine Unit, University Hospital Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy;
| | - Ihab Mansour
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy; (E.P.); (I.M.); (C.C.); (A.G.)
| | - Maurizio Coggiola
- Occupational Medicine Unit, University Hospital Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy;
| | - Catalina Ciocan
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy; (E.P.); (I.M.); (C.C.); (A.G.)
- Occupational Medicine Unit, University Hospital Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy;
| | - Alessandro Godono
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy; (E.P.); (I.M.); (C.C.); (A.G.)
| | - Adonina Tardon
- Health Research Institute of Asturias (ISPA), CIBERESP and Public Health Department of the University of Oviedo, Campus del Cristo s/n, 33006 Oviedo, Spain; (A.T.); (M.-M.R.-S.); (G.F.-T.); (F.-J.J.-D.); (R.-V.C.-D.); (T.I.C.)
| | - Marta-Maria Rodriguez-Suarez
- Health Research Institute of Asturias (ISPA), CIBERESP and Public Health Department of the University of Oviedo, Campus del Cristo s/n, 33006 Oviedo, Spain; (A.T.); (M.-M.R.-S.); (G.F.-T.); (F.-J.J.-D.); (R.-V.C.-D.); (T.I.C.)
| | - Guillermo Fernandez-Tardon
- Health Research Institute of Asturias (ISPA), CIBERESP and Public Health Department of the University of Oviedo, Campus del Cristo s/n, 33006 Oviedo, Spain; (A.T.); (M.-M.R.-S.); (G.F.-T.); (F.-J.J.-D.); (R.-V.C.-D.); (T.I.C.)
| | - Francisco-Jose Jimeno-Demuth
- Health Research Institute of Asturias (ISPA), CIBERESP and Public Health Department of the University of Oviedo, Campus del Cristo s/n, 33006 Oviedo, Spain; (A.T.); (M.-M.R.-S.); (G.F.-T.); (F.-J.J.-D.); (R.-V.C.-D.); (T.I.C.)
| | - Rafael-Vicente Castro-Delgado
- Health Research Institute of Asturias (ISPA), CIBERESP and Public Health Department of the University of Oviedo, Campus del Cristo s/n, 33006 Oviedo, Spain; (A.T.); (M.-M.R.-S.); (G.F.-T.); (F.-J.J.-D.); (R.-V.C.-D.); (T.I.C.)
| | - Tania Iglesias Cabo
- Health Research Institute of Asturias (ISPA), CIBERESP and Public Health Department of the University of Oviedo, Campus del Cristo s/n, 33006 Oviedo, Spain; (A.T.); (M.-M.R.-S.); (G.F.-T.); (F.-J.J.-D.); (R.-V.C.-D.); (T.I.C.)
| | - Maria Luisa Scapellato
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (M.L.S.); (F.L.); (A.M.); (P.M.); (S.P.)
- University Hospital of Padova, 35128 Padova, Italy;
| | - Filippo Liviero
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (M.L.S.); (F.L.); (A.M.); (P.M.); (S.P.)
- University Hospital of Padova, 35128 Padova, Italy;
| | - Angelo Moretto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (M.L.S.); (F.L.); (A.M.); (P.M.); (S.P.)
- University Hospital of Padova, 35128 Padova, Italy;
| | - Paola Mason
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (M.L.S.); (F.L.); (A.M.); (P.M.); (S.P.)
- University Hospital of Padova, 35128 Padova, Italy;
| | - Sofia Pavanello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (M.L.S.); (F.L.); (A.M.); (P.M.); (S.P.)
- University Hospital of Padova, 35128 Padova, Italy;
| | - Anna Volpin
- University Hospital of Padova, 35128 Padova, Italy;
| | - Luigi Vimercati
- Interdisciplinary Department of Medicine, University of Bari, 70124 Bari, Italy; (L.V.); (S.T.); (L.D.M.); (S.S.); (P.S.); (A.C.)
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, University of Bari, 70124 Bari, Italy; (L.V.); (S.T.); (L.D.M.); (S.S.); (P.S.); (A.C.)
| | - Luigi De Maria
- Interdisciplinary Department of Medicine, University of Bari, 70124 Bari, Italy; (L.V.); (S.T.); (L.D.M.); (S.S.); (P.S.); (A.C.)
| | - Stefania Sponselli
- Interdisciplinary Department of Medicine, University of Bari, 70124 Bari, Italy; (L.V.); (S.T.); (L.D.M.); (S.S.); (P.S.); (A.C.)
| | - Pasquale Stefanizzi
- Interdisciplinary Department of Medicine, University of Bari, 70124 Bari, Italy; (L.V.); (S.T.); (L.D.M.); (S.S.); (P.S.); (A.C.)
| | - Antonio Caputi
- Interdisciplinary Department of Medicine, University of Bari, 70124 Bari, Italy; (L.V.); (S.T.); (L.D.M.); (S.S.); (P.S.); (A.C.)
| | - Fabriziomaria Gobba
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, 41125 Modena, Italy; (F.G.); (A.M.)
| | - Alberto Modenese
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, 41125 Modena, Italy; (F.G.); (A.M.)
| | - Loretta Casolari
- Health Surveillance Service, University Hospital of Modena, 41125 Modena, Italy; (L.C.); (D.G.); (C.D.); (S.M.)
| | - Denise Garavini
- Health Surveillance Service, University Hospital of Modena, 41125 Modena, Italy; (L.C.); (D.G.); (C.D.); (S.M.)
| | - Cristiana D’Elia
- Health Surveillance Service, University Hospital of Modena, 41125 Modena, Italy; (L.C.); (D.G.); (C.D.); (S.M.)
| | - Stefania Mariani
- Health Surveillance Service, University Hospital of Modena, 41125 Modena, Italy; (L.C.); (D.G.); (C.D.); (S.M.)
| | - Francesca Larese Filon
- Unit of Occupational Medicine, Department of Medical Science, University of Trieste, 34149 Trieste, Italy; (F.L.F.); or (L.C.); (C.N.); (F.R.); (F.R.); (P.D.M.)
| | - Luca Cegolon
- Unit of Occupational Medicine, Department of Medical Science, University of Trieste, 34149 Trieste, Italy; (F.L.F.); or (L.C.); (C.N.); (F.R.); (F.R.); (P.D.M.)
| | - Corrado Negro
- Unit of Occupational Medicine, Department of Medical Science, University of Trieste, 34149 Trieste, Italy; (F.L.F.); or (L.C.); (C.N.); (F.R.); (F.R.); (P.D.M.)
| | - Federico Ronchese
- Unit of Occupational Medicine, Department of Medical Science, University of Trieste, 34149 Trieste, Italy; (F.L.F.); or (L.C.); (C.N.); (F.R.); (F.R.); (P.D.M.)
| | - Francesca Rui
- Unit of Occupational Medicine, Department of Medical Science, University of Trieste, 34149 Trieste, Italy; (F.L.F.); or (L.C.); (C.N.); (F.R.); (F.R.); (P.D.M.)
| | - Paola De Michieli
- Unit of Occupational Medicine, Department of Medical Science, University of Trieste, 34149 Trieste, Italy; (F.L.F.); or (L.C.); (C.N.); (F.R.); (F.R.); (P.D.M.)
| | - Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (N.M.); (M.D.); (G.M.); (T.F.); (A.G.); (I.F.)
| | - Marco Dell’Omo
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (N.M.); (M.D.); (G.M.); (T.F.); (A.G.); (I.F.)
| | - Giacomo Muzi
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (N.M.); (M.D.); (G.M.); (T.F.); (A.G.); (I.F.)
| | - Tiziana Fiordi
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (N.M.); (M.D.); (G.M.); (T.F.); (A.G.); (I.F.)
| | - Angela Gambelunghe
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (N.M.); (M.D.); (G.M.); (T.F.); (A.G.); (I.F.)
| | - Ilenia Folletti
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (N.M.); (M.D.); (G.M.); (T.F.); (A.G.); (I.F.)
| | - Dana Mates
- National Institute of Public Health, 050463 Bucharest, Romania; (D.M.); (V.C.C.); (A.N.); (O.P.); (C.A.S.); (A.V.)
| | - Violeta Claudia Calota
- National Institute of Public Health, 050463 Bucharest, Romania; (D.M.); (V.C.C.); (A.N.); (O.P.); (C.A.S.); (A.V.)
| | - Andra Neamtu
- National Institute of Public Health, 050463 Bucharest, Romania; (D.M.); (V.C.C.); (A.N.); (O.P.); (C.A.S.); (A.V.)
| | - Ovidiu Perseca
- National Institute of Public Health, 050463 Bucharest, Romania; (D.M.); (V.C.C.); (A.N.); (O.P.); (C.A.S.); (A.V.)
| | - Catalin Alexandru Staicu
- National Institute of Public Health, 050463 Bucharest, Romania; (D.M.); (V.C.C.); (A.N.); (O.P.); (C.A.S.); (A.V.)
| | - Angelica Voinoiu
- National Institute of Public Health, 050463 Bucharest, Romania; (D.M.); (V.C.C.); (A.N.); (O.P.); (C.A.S.); (A.V.)
| | - Eleonóra Fabiánová
- Occupational Health Department, Regional Authority of Public Health, 97556 Banská Bystrica, Slovakia;
| | - Jana Bérešová
- Epidemiology Health Department, Regional Authority of Public Health, 97556 Banská Bystrica, Slovakia;
| | - Zora Kľocová Adamčáková
- Health Promotion Department, Regional Authority of Public Health, 97556 Banská Bystrica, Slovakia;
| | - Roman Nedela
- Health Informatics Department, Regional Authority of Public Health, 97556 Banská Bystrica, Slovakia;
| | - Anna Lesňáková
- Infectology Clinic, Central Military Hospital, 03426 Ružomberok, Slovakia;
| | - Jana Holčíková
- Occupational Medicine Clinic, University Hospital, 83105 Bratislava, Slovakia;
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (P.B.); (M.A.); (G.D.); (S.S.A.); (G.V.); (F.S.V.); (C.Z.)
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY 11794, USA
| | - Mahsa Abedini
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (P.B.); (M.A.); (G.D.); (S.S.A.); (G.V.); (F.S.V.); (C.Z.)
| | - Giorgia Ditano
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (P.B.); (M.A.); (G.D.); (S.S.A.); (G.V.); (F.S.V.); (C.Z.)
| | - Shuffield Seyram Asafo
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (P.B.); (M.A.); (G.D.); (S.S.A.); (G.V.); (F.S.V.); (C.Z.)
| | - Giovanni Visci
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (P.B.); (M.A.); (G.D.); (S.S.A.); (G.V.); (F.S.V.); (C.Z.)
| | - Francesco Saverio Violante
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (P.B.); (M.A.); (G.D.); (S.S.A.); (G.V.); (F.S.V.); (C.Z.)
- IRCCS, Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Carlotta Zunarelli
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (P.B.); (M.A.); (G.D.); (S.S.A.); (G.V.); (F.S.V.); (C.Z.)
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy;
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Gambelunghe A, Aloisio B, Gambelunghe C, Folletti I, Chiodi M, Muzi G, Murgia N, dell’Omo M. Chronic use of Datura stramonium cigarettes and late diagnosis of bullous emphysema in a smoker of marijuana and tobacco. Respir Med Case Rep 2022; 40:101761. [DOI: 10.1016/j.rmcr.2022.101761] [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] [Received: 06/14/2022] [Revised: 09/26/2022] [Accepted: 10/24/2022] [Indexed: 11/07/2022] Open
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Gambelunghe A, Giuliani A, Russano A, Dell'omo M, Muzi G, Folletti I, Paolocci G, Murgia N. Standard beryllium lymphocyte proliferation test vs CFSE assay to detect beryllium sensitization, a comparative pilot study in dental technicians. Saf Health Work 2022. [DOI: 10.1016/j.shaw.2021.12.1606] [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: 10/19/2022] Open
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Paolocci G, Bussotti P, Pompili C, Muzi G, Gambelunghe A, Dell’Omo M, Murgia N, Folletti I. Impact of the COVID-19 pandemic and work-related stress in Umbrian healthcare workers during Phase 1 in Italy. Med Lav 2021; 112:486-495. [PMID: 34939615 PMCID: PMC8759046 DOI: 10.23749/mdl.v112i6.12525] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Depression, anxiety, psychological distress, and poor sleep quality increased in healthcare workers (HCWs) during the COVID-19 pandemic. The aim of the study was to assess levels of psychological distress in Umbrian HCWs during the COVID-19 Phase 1 lockdown along with exploring the relationship between sociodemographic/occupational factors. METHODS Data on sociodemographic and occupational characteristics, change of job description, economic losses and emergency involvement and SARS-CoV2 infections in the workplace were collected using an anonymous online survey sent by healthcare professional associations. Data concerning psychological healthcare distress, were collected anonymously using BIAS 20 (stress balance) and Depression Anxiety Stress Scales (DASS-21). RESULTS One thousand and one healthcare workers responded to the questionnaire. Biological risk at work was perceived by all HCWs, less so from psychologists and more so from those working in hospitals. Stress symptoms (DASS21 >14) were associated with a younger age group (OR 0.98; 95% CI 0.97-0.99) and less work experience (OR 0.98; 95% CI 0.96-0.99). Younger age was also associated with anxiety symptoms (DASS 21 >7) (OR 0.98; 95% CI 0.97-0.99), as well as graduate/post graduate education level (OR 2.04; 95% CI 1.14-3.63). Working as an independent contractor was a risk factor for high stress health impact (OR 2.00; CI 1.40-2.86) and stress (OR 1.87; CI 1.20-2.92), anxiety (OR 1.89; CI 1.22-2.92) and depression (OR 1.57; CI 1.10-2.22) symptoms. CONCLUSIONS Our study showed a possible relationship between healthcare type of employment and distress symptoms during Covid19 pandemic phase 1. Results of our study should be confirmed in other Italian healthcare settings and could serve as a preliminarily baseline for multidisciplinary Italian collaboration.
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Affiliation(s)
- Giulia Paolocci
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Pietro Bussotti
- Prevention and Protection Service, Usl Umbria 2, Terni, Italy
| | - Camilla Pompili
- Environment and Workplace Prevention techniques, University of Perugia, Perugia, Italy
| | - Giacomo Muzi
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Angela Gambelunghe
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Marco Dell’Omo
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Ilenia Folletti
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
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6
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Sposato B, Scalese M, Camiciottoli G, Carpagnano GE, Pelaia C, Santus P, Maniscalco M, Corsico A, Grosso A, Baglioni S, Murgia N, Folletti I, Pelaia G, Masieri S, Cavaliere C, Musarra A, Bargagli E, Ricci A, Latorre M, Paggiaro P, Rogliani P. Mepolizumab Effectiveness and Allergic Status in Real Life. Int Arch Allergy Immunol 2020; 182:311-318. [PMID: 33113532 DOI: 10.1159/000511147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is not clear whether mepolizumab is differently effective in allergic and nonallergic severe eosinophilic asthmatics (SEA) in real life. OBJECTIVE We tested mepolizumab effectiveness in allergic/nonallergic SEA in real life. A strict criterion to identify the 2 phenotypes was used. METHOD We retrospectively considered 134 consecutive patients divided into allergic, with a positivity to at least 1 allergen to prick tests and/or IgE values ≥100 UI/mL (severe allergic eosinophilic asthma [SAEA]; n: 97-72.4%), and nonallergic, with no prick test results and normal IgE levels <100 UI/mL (severe nonallergic eosinophilic asthma [SNAEA]; n: 37-27.6%). They had taken mepolizumab for at least 6 months. RESULTS After 10.9 ± 3.7 months, improvements in FEV1%, FEF25-75%, exacerbation numbers, blood eosinophil (BE) counts, fractional exhaled nitric oxide (FENO) (ppb), percentages of patients that stopped/reduced short-acting β2-agonists (SABAs) or oral corticosteroid (OC), observed after treatment, were similar in both groups. Only Asthma Control Test (ACT) increases were higher in SNAEA (8 [5-9]) than in SAEA (5 [2.5-8.5]; p = 0.016). However, no differences were found after treatment in percentages of subjects with ACT ≥20, as well as with FEV1 >80%, FEF25-75 >65%, exacerbations ≤2, BE <300 cells/µL, and FENO <25 ppb between SAEA and SNAEA. Besides, no significant relationships were found, comparing SNAEA with SAEA, for FEV1% (β = -0.110; p = 0.266), FEF25-75% (β = -0.228; p = 0.06), BE counts (β = -0.012; p = 0.918), FENO (β = 0.234; p = 0.085), ACT (β = 0.046; p = 0.660), and exacerbations (β = -0.070; p = 0.437). No different associations between lung function and SNAEA occurrence when compared to SAEA condition (FEV1 >80%: OR = 1.04 [95% CI: 0.43-2.55], p = 0.923; FEF25-75 >65%: OR = 0.41 [95% CI: 0.08-2.03], p = 0.272) were detected. Neither all other parameters, such as ACT >20 (OR = 0.73 [95% CI: 0.32-1.63], p = 0.440), presence of exacerbations (OR = 1.35 [95% CI: 0.55-3.27], p = 0.512), SABA discontinuation (OR = 1.16 [95% CI: 0.40-3.39], p = 0.790), and OC cessation/reduction (OR = 3.44 [95% CI: 0.40-29.27], p = 0.258), were differently associated with 1 or the other phenotype. CONCLUSION Mepolizumab can be considered as a valid therapeutic choice for either allergic or nonallergic SEA in real life.
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Affiliation(s)
- Bruno Sposato
- Azienda USL Toscana Sud-Est Pneumology Department, "Misericordia" Hospital, Grosseto, Italy, .,Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Rome, Italy,
| | - Marco Scalese
- Clinic Physiology Institute, National Research Centre, Pisa, Italy
| | - Gianna Camiciottoli
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Giovanna Elisiana Carpagnano
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy
| | - Corrado Pelaia
- Section of Respiratory Diseases, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Pierachille Santus
- Division of Pulmonary Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi di Milano, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - Mauro Maniscalco
- Institute Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Telese, Telese Terme, Italy
| | - Angelo Corsico
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | - Amelia Grosso
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | | | - Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Ilenia Folletti
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
| | - Girolamo Pelaia
- Section of Respiratory Diseases, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Simonetta Masieri
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Carlo Cavaliere
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Antonino Musarra
- Allergology Department, Casa della Salute di Scilla, Scilla, Italy
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplant Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Alberto Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Paola Rogliani
- Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Rome, Italy.,Respiratory Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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7
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Sposato B, Scalese M, Camiciottoli G, Carpagnano GE, Pelaia C, Santus P, Maniscalco M, Corsico A, Grosso A, Baglioni S, Murgia N, Folletti I, Pelaia G, Masieri S, Cavaliere C, Musarra A, Bargagli E, Ricci A, Latorre M, Rogliani P, Paggiaro P. Real-life Mepolizumab effectiveness in severe eosinophilic asthmatics with nasal polyposis. Respir Med Res 2020; 78:100791. [PMID: 33039948 DOI: 10.1016/j.resmer.2020.100791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022]
Affiliation(s)
- B Sposato
- Azienda USL Toscana Sud-Est Pneumology Department, "Misericordia" Hospital, Grosseto, Italy; Experimental Medicine and Systems, "PhD program" Department of Systems Medicine University of Rome "Tor Vergata", Rome, Italy.
| | - M Scalese
- Clinic Physiology Institute, National Research Centre, Pisa, Italy
| | - G Camiciottoli
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Largo A Brambilla 3, 50134, Florence, Italy
| | - G E Carpagnano
- Institute of Respiratory Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - C Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - P Santus
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi di Milano, Division of Pulmonary Diseases, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - M Maniscalco
- Institute Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Istitute of Telese, 82037 Telese Terme (BN), Italy
| | - A Corsico
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | - A Grosso
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | - S Baglioni
- Pneumology Department, Perugia Hospital, Perugia, Italy
| | - N Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - I Folletti
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
| | - G Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - S Masieri
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - C Cavaliere
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - A Musarra
- Allergology Department, Casa della Salute di Scilla, Scilla, RC, Italy
| | - E Bargagli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - A Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - M Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - P Rogliani
- Experimental Medicine and Systems, "PhD program" Department of Systems Medicine University of Rome "Tor Vergata", Rome, Italy; Respiratory Unit, department of Experimental Medicine, University of Rome "Tor Vergata" Rome, Rome, Italy
| | - P Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
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8
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Olivieri M, Murgia N, Spiteri G, Biscardo CA, Marchetti P, Folletti I, Verlato G. Exposure to additives or multigrain flour is associated with high risk of work-related allergic symptoms among bakers. Occup Environ Med 2020; 78:112-116. [PMID: 32855346 DOI: 10.1136/oemed-2019-106052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 06/08/2020] [Accepted: 08/01/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Wheat flour exposure in bakers can elicit respiratory and skin symptoms. Scarce data are available on the prevalence of such conditions in bakers. We investigated the prevalence of work-related rhinitis, asthma-like symptoms and dermatitis in bakers according to job task and type of allergens involved. METHODS Of the 229 traditional bakeries in Verona area who were invited to participate in a cross-sectional survey, 211 (92%) accepted; 727 employees in these bakeries answered a modified version of a questionnaire on job tasks; allergen exposure within the bakery; and work-related nasal, asthma-like and skin symptoms during 2010-2014. Determinants of work-related nasal, asthma-like or skin disorders were separately evaluated using different logistic models. RESULTS The prevalence of work-related nasal and asthma-like symptoms was, respectively, 15.1% and 4.2% in bakery shop assistants, increasing to 25.7% and 9.5% in bakers using only wheat flour, and further to 31.8% and 13.6% in bakers using flour and additives, and then to 34.1% and 18.2% in bakers using flour with additives and multigrain (p<0.001). The risk of work-related asthma-like symptoms was more than doubled in bakers using additives without or with multigrain than in shop assistants (OR 2.3, 95% CI 1.0 to 5.5 and OR 3.4, 95% CI 1.1 to 10.8, respectively). Making bread with additives alone or with multigrain significantly increased the risk of work-related nasal symptoms in shop assistants, while the risk of skin symptoms was not significantly affected. CONCLUSIONS Bakers using additives alone or with multigrain are at a high risk of experiencing nasal and asthma-like symptoms.
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Affiliation(s)
- Mario Olivieri
- Diagnostics and Public Health-Unit of Occupational Medicine, University of Verona, Verona, Italy
| | - Nicola Murgia
- Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Gianluca Spiteri
- Diagnostics and Public Health-Unit of Occupational Medicine, University of Verona, Verona, Italy
| | - Carlo Alberto Biscardo
- Diagnostics and Public Health-Unit of Occupational Medicine, University of Verona, Verona, Italy
| | - Pierpaolo Marchetti
- Diagnostics and Public Health-Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - Ilenia Folletti
- Clinical and Experimental Medicine, Occupational Medicine, University of Perugia, Terni, Italy
| | - Giuseppe Verlato
- Diagnostics and Public Health-Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
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9
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Sigsgaard T, Basinas I, Doekes G, de Blay F, Folletti I, Heederik D, Lipinska-Ojrzanowska A, Nowak D, Olivieri M, Quirce S, Raulf M, Sastre J, Schlünssen V, Walusiak-Skorupa J, Siracusa A. Respiratory diseases and allergy in farmers working with livestock: a EAACI position paper. Clin Transl Allergy 2020; 10:29. [PMID: 32642058 PMCID: PMC7336421 DOI: 10.1186/s13601-020-00334-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022] Open
Abstract
Farmers constitute a large professional group worldwide. In developed countries farms tend to become larger, with a concentration of farm operations. Animal farming has been associated with negative respiratory effects such as work-related asthma and rhinitis. However, being born and raised or working on a farm reduces the risk of atopic asthma and rhinitis later in life. A risk of chronic bronchitis and bronchial obstruction/COPD has been reported in confinement buildings and livestock farmers. This position paper reviews the literature linking exposure information to intensive animal farming and the risk of work-related respiratory diseases and focuses on prevention. Animal farming is associated with exposure to organic dust containing allergens and microbial matter including alive microorganisms and viruses, endotoxins and other factors like irritant gases such as ammonia and disinfectants. These exposures have been identified as specific agents/risk factors of asthma, rhinitis, chronic bronchitis, COPD and reduced FEV1. Published studies on dust and endotoxin exposure in livestock farmers do not show a downward trend in exposure over the last 30 years, suggesting that the workforce in these industries is still overexposed and at risk of developing respiratory disease. In cases of occupational asthma and rhinitis, avoidance of further exposure to causal agents is recommended, but it may not be obtainable in agriculture, mainly due to socio-economic considerations. Hence, there is an urgent need for focus on farming exposure in order to protect farmers and others at work in these and related industries from developing respiratory diseases and allergy.
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Affiliation(s)
- T Sigsgaard
- Department of Environment Occupation & Health, Dept of Public Health, Danish Ramazzini Centre, Aarhus University, Bartholins Allé 2, Build. 1260, 8000 Aarhus C, Denmark
| | - I Basinas
- Institute of Occupational Medicine, Edinburgh, UK
| | - G Doekes
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - F de Blay
- Division of Asthma and Allergy, Department of Chest Diseases, University Hospital, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg University, Strasbourg, France
| | - I Folletti
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
| | - D Heederik
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - A Lipinska-Ojrzanowska
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - D Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University, Munich, Germany.,Comprehensive Pneumology Center Munich, Member DZL, German Centre for Lung Research, Munich, Germany
| | - M Olivieri
- Unit of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - S Quirce
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ) and CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - M Raulf
- IPA Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum, Bochum, Germany
| | - J Sastre
- Department of Allergy, Fundación Jiménez Díaz, CIBER de Enfermedades Respiratorias (Ciberes), Madrid, Spain
| | - V Schlünssen
- Department of Environment Occupation & Health, Dept of Public Health, Danish Ramazzini Centre, Aarhus University, Bartholins Allé 2, Build. 1260, 8000 Aarhus C, Denmark
| | - J Walusiak-Skorupa
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - A Siracusa
- Formerly Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy
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10
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Sposato B, Camiciottoli G, Bacci E, Scalese M, Carpagnano GE, Pelaia C, Santus P, Maniscalco M, Masieri S, Corsico A, Scichilone N, Baglioni S, Murgia N, Folletti I, Bardi G, Grosso A, Cameli P, Latorre M, Musarra A, Bargagli E, Ricci A, Pelaia G, Paggiaro P, Rogliani P. Mepolizumab effectiveness on small airway obstruction, corticosteroid sparing and maintenance therapy step-down in real life. Pulm Pharmacol Ther 2020; 61:101899. [PMID: 31972327 DOI: 10.1016/j.pupt.2020.101899] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/19/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Mepolizumab (MEP) has been recently introduced to treat severe eosinophilic asthma. Trials have demonstrated a significant effectiveness in this asthma phenotype. We evaluated MEP efficacy on lung function, symptoms, asthma exacerbations, biologic markers, steroid dependence and controller treatment level in real-life. METHODS We retrospectively analyzed 134 severe asthmatics (61 males; mean age 58.3 ± 11; mean FEV1%:72 ± 21), treated with MEP for at least 6 months (mean duration:10.9 ± 3.7 months). RESULTS FEV1% improved significantly after MEP. Mean FEF25-75 also increased from 37.4 ± 25.4% to 47.2 ± 27.2% (p < 0.0001). Mean baseline blood eosinophil level was 712 ± 731/μL (8.4 ± 5.2%) decreasing to 151 ± 384/μL (1.6 ± 1.6%) (p < 0.0001), FENO levels decreased likewise. MEP treatment also led to a significant ACT improvement (mean pre:14.2 ± 4.4; mean post:20.5 ± 28) and exacerbations significantly fell from 3.8 ± 1.9 to 0.8 ± 1.1 (p < 0.0001). 74% of patients were steroid-dependent before MEP. 45.4% and 46.4% of them showed a suspension and dose reduction respectively (p < 0.0001). A significant number reduced also ICS doses. Only 67% of subjects used SABA as needed before MEP, falling to 20% after MEP. About 40% of patients highlighted a maintenance therapy step-down. Subjects showing an omalizumab treatment failure before MEP had a similar positive response when compared with omalizumab untreated patients. CONCLUSION In real-life, MEP improved significantly all outcomes even small airway obstruction, suggesting its possible role also in distal lung region treatment. Furthermore, it demonstrated its high effectiveness in OC/ICS-sparing, in reducing SABA as needed and in stepping-down maintenance therapy. MEP is a valid alternative for patients with previous omalizumab treatment failure.
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Affiliation(s)
- Bruno Sposato
- Azienda USL Toscana Sud-Est Pneumology Department, "Misericordia" Hospital, Grosseto, Italy; Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Italy.
| | - Gianna Camiciottoli
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Largo A Brambilla 3, 50134, Florence, Italy
| | - Elena Bacci
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Marco Scalese
- Clinic Physiology Institute, National Research Centre, Pisa, Italy
| | | | - Corrado Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi di Milano, Division of Pulmonary Diseases, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - Mauro Maniscalco
- Institute Clinic Scientific Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Telese, 82037, Telese Terme, BN, Italy
| | - Simonetta Masieri
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Angelo Corsico
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Italy
| | - Nicola Scichilone
- Biomedical Department of Internal Medicine and Medical Specialties (DIBIMIS), University of Palermo, Palermo, Italy
| | | | - Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Ilenia Folletti
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
| | - Giulio Bardi
- Internal Medicine Department, Azienda USL 6 Livorno, Piombino Hospital, Italy
| | - Amelia Grosso
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Italy
| | - Paolo Cameli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Antonino Musarra
- Allergology Department, Casa della Salute di Scilla, Scilla, RC, Italy
| | - Elena Bargagli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - Alberto Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant 'Andrea, Rome, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Paola Rogliani
- Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Italy; Respiratory Unit, Department of Experimental Medicine, University of Rome "Tor Vergata" Rome, Italy
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11
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Jeebhay MF, Moscato G, Bang BE, Folletti I, Lipińska‐Ojrzanowska A, Lopata AL, Pala G, Quirce S, Raulf M, Sastre J, Swoboda I, Walusiak‐Skorupa J, Siracusa A. Food processing and occupational respiratory allergy- An EAACI position paper. Allergy 2019; 74:1852-1871. [PMID: 30953601 DOI: 10.1111/all.13807] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 03/22/2019] [Indexed: 12/29/2022]
Abstract
Occupational exposure to foods is responsible for up to 25% of cases of occupational asthma and rhinitis. Animal and vegetable high-molecular-weight proteins present in aerosolized foods during food processing, additives, preservatives, antioxidants, and food contaminants are the main inhalant allergen sources. Most agents typically cause IgE-mediated allergic reactions, causing a distinct form of food allergy (Class 3 food allergy). The allergenicity of a food protein, allergen exposure levels, and atopy are important risk factors. Diagnosis relies on a thorough medical and occupational history, functional assessment, assessment of sensitization, including component-resolved diagnostics where appropriate, and in selected cases specific inhalation tests. Exposure assessment, including allergen determination, is a cornerstone for establishing preventive measures. Management includes allergen exposure avoidance or reduction (second best option), pharmacological treatment, assessment of impairment, and worker's compensation. Further studies are needed to identify and characterize major food allergens and define occupational exposure limits, evaluate the relative contribution of respiratory versus cutaneous sensitization to food antigens, evaluate the role of raw versus cooked food in influencing risk, and define the absolute or relative contraindication of patients with ingestion-related food allergy, pollinosis, or oral allergy syndrome continuing to work with exposure to aerosolized food allergens.
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Affiliation(s)
- Mohamed F. Jeebhay
- Occupational Medicine Division, and Centre for Environmental & Occupational Health Research, School of Public Health and Family Medicine University of Cape Town Observatory South Africa
| | - Gianna Moscato
- Department of Public Health, Forensic and Experimental Medicine, Specialization School in Occupational Medicine University of Pavia Pavia Italy
| | - Berit E. Bang
- Department of Occupational and Environmental Medicine University Hospital of North Norway Sykehusvegen, Tromsoe Norway
| | - Ilenia Folletti
- Occupational Medicine Terni Hospital, University of Perugia Perugia Italy
| | | | - Andreas L. Lopata
- Department of Molecular & Cell Biology, College of Public Health, Medical and Veterinary Sciences James Cook University Townsville Queensland Australia
| | - Gianni Pala
- Occupational Physician’s Division Healthcare Authority of Sardinia Area of Sassari Italy
| | - Santiago Quirce
- Department of Allergy Hospital La Paz Institute for Health Research (IdiPAZ), and CIBER of Respiratory Diseases CIBERES Madrid Spain
| | - Monika Raulf
- Institute of Prevention and Occupational Medicine of the German Social Accident Insurance Institute of the Ruhr University Bochum Bochum Germany
| | - Joaquin Sastre
- Allergy Department Hospital Fundación Jiménez Díazand CIBER de Enfermedades Respiratorias (CIBERES) Madrid Spain
| | - Ines Swoboda
- Molecular Biotechnology Section FH Campus Wien ‐ University of Applied Sciences Vienna Austria
| | | | - Andrea Siracusa
- Formerly professor of Occupational Medicine University of Perugia Perugia Italy
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12
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Vandenplas O, Godet J, Hurdubaea L, Rifflart C, Suojalehto H, Walusiak-Skorupa J, Munoz X, Sastre J, Klusackova P, Moore V, Merget R, Talini D, Kirkeleit J, Mason P, Folletti I, Cullinan P, Moscato G, Quirce S, Hoyle J, Sherson D, Kauppi P, Preisser A, Meyer N, de Blay F. Severe Occupational Asthma: Insights From a Multicenter European Cohort. J Allergy Clin Immunol Pract 2019; 7:2309-2318.e4. [PMID: 30914232 DOI: 10.1016/j.jaip.2019.03.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/13/2019] [Accepted: 03/08/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although sensitizer-induced occupational asthma (OA) accounts for an appreciable fraction of adult asthma, the severity of OA has received little attention. OBJECTIVE The aim of this study was to characterize the burden and determinants of severe OA in a large multicenter cohort of subjects with OA. METHODS This retrospective study included 997 subjects with OA ascertained by a positive specific inhalation challenge completed in 20 tertiary centers in 11 European countries during the period 2006 to 2015. Severe asthma was defined by a high level of treatment and any 1 of the following criteria: (1) daily need for a reliever medication, (2) 2 or more severe exacerbations in the previous year, or (3) airflow obstruction. RESULTS Overall, 162 (16.2%; 95% CI, 14.0%-18.7%) subjects were classified as having severe OA. Multivariable logistic regression analysis revealed that severe OA was associated with persistent (vs reduced) exposure to the causal agent at work (odds ratio [OR], 2.78; 95% CI, 1.50-5.60); a longer duration of the disease (OR, 1.04; 95% CI, 1.00-1.07); a low level of education (OR, 2.69; 95% CI, 1.73-4.18); childhood asthma (OR, 2.92; 95% CI, 1.13-7.36); and sputum production (OR, 2.86; 95% CI, 1.87-4.38). In subjects removed from exposure, severe OA was associated only with sputum production (OR, 3.68; 95% CI, 1.87-7.40); a low education level (OR, 3.41; 95% CI, 1.72-6.80); and obesity (OR, 1.98; 95% CI, 0.97-3.97). CONCLUSIONS This study indicates that a substantial proportion of subjects with OA experience severe asthma and identifies potentially modifiable risk factors for severe OA that should be targeted to reduce the adverse impacts of the disease.
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Affiliation(s)
- Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
| | - Julien Godet
- Groupe Méthode Recherche Clinique, Pôle de Santé Publique, Strasbourg University, Strasbourg, France
| | - Laura Hurdubaea
- Division of Asthma and Allergy, Department of Chest Diseases, University Hospital of Strasbourg and Fédération de Médecine translationnelle, Strasbourg University, Strasbourg, France
| | - Catherine Rifflart
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Hille Suojalehto
- Occcupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jolanta Walusiak-Skorupa
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Xavier Munoz
- Servei Pneumologia, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona and CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Joaquin Sastre
- Department of Allergy, Fundacion Jimenez Dıaz and CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Pavlina Klusackova
- Department of Occupational Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vicky Moore
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Rolf Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Ruhr University, Bochum, Germany
| | - Donatella Talini
- Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Jorunn Kirkeleit
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Paola Mason
- Unit of Occupational Medicine and Public Health, University of Padova, Padova, Italy
| | - Ilenia Folletti
- Department of Medicine, Section of Occupational Medicine, Respiratory Diseases and Occupational and Environmental Toxicology, University of Perugia, Perugia, Italy
| | - Paul Cullinan
- Department of Occupational and Environmental Medicine, Royal Brompton Hospital and Imperial College (NHLI), Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Gianna Moscato
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, and Allergy and Immunology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - Santiago Quirce
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ) and CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Jennifer Hoyle
- Department of Respiratory Medicine, North Manchester General Hospital, Manchester, United Kingdom
| | - David Sherson
- Department of Pulmonary Medicine and Occupational Medicine, Odense University Hospital, Odense, Denmark
| | - Paula Kauppi
- Department of Allergy, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Alexandra Preisser
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicolas Meyer
- Groupe Méthode Recherche Clinique, Pôle de Santé Publique, Strasbourg University, Strasbourg, France
| | - Frédéric de Blay
- Division of Asthma and Allergy, Department of Chest Diseases, University Hospital of Strasbourg and Fédération de Médecine translationnelle, Strasbourg University, Strasbourg, France
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13
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Folletti I, Gualtieri G, Dell'Omo M, Cuomo A, Coluccia A, Lancia M. Riflessioni medico-legali su un caso giudizario di mobbing. Riv Psichiatr 2018; 53:274-277. [PMID: 30353203 DOI: 10.1708/3000.30007] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Lo stress e le violenze morali nei luoghi di lavoro, come indicato dai dati epidemiologici, sono in costante aumento e rappresentano una causa di alterazione dello stato di salute dei lavoratori, con importanti ricadute negative sui soggetti, sulle aziende e sulla società. Nel caso descritto qui di seguito, le violenze morali e la disfunzionalità organizzativa, una delle principali fonti di stress correlato al lavoro, sono state intenzionalmente impiegate quale mezzo mobbizzante nei confronti di un lavoratore da parte dei suoi superiori (mobbing verticale). Attraverso il procedimento giudiziario, intrapreso dal lavoratore per vedersi riconosciuto vittima di mobbing, è stato possibile ripercorrere e identificare le ragioni e le modalità dell'azione mobbizzante, l'eziopatogenesi della conseguente psicopatologia, la sua strutturazione e la manifestazione sintomatologica. L'esame del caso permette di formulare delle considerazioni riguardo la necessità che i casi di mobbing siano trattati all'interno di un team multidisciplinare (medico di famiglia, medico del lavoro, psichiatra e medico legale) al fine di garantire un efficace trattamento terapeutico e la tutela del lavoratore nei diversi ambiti previsti dalla legge.
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Affiliation(s)
- Ilenia Folletti
- Dipartimento di Medicina, Sezione di Medicina del Lavoro, Malattie Respiratorie e Tossicologia Professionali e Ambientali, Università di Perugia
| | - Giacomo Gualtieri
- Dipartimento di Scienze Mediche, Chirurgiche e Neuroscienze, Università di Siena
| | - Marco Dell'Omo
- Dipartimento di Medicina, Sezione di Medicina del Lavoro, Malattie Respiratorie e Tossicologia Professionali e Ambientali, Università di Perugia
| | | | - Anna Coluccia
- Dipartimento di Scienze Mediche, Chirurgiche e Neuroscienze, Università di Siena
| | - Massimo Lancia
- Sezione di Medicina Legale, Scienze Forensi e Medicina dello Sport, Università di Perugia
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14
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Paolocci G, Folletti I, Torén K, Ekström M, Dell'Omo M, Muzi G, Murgia N. Occupational risk factors for idiopathic pulmonary fibrosis in Southern Europe: a case-control study. BMC Pulm Med 2018; 18:75. [PMID: 29784045 PMCID: PMC5963078 DOI: 10.1186/s12890-018-0644-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 05/08/2018] [Indexed: 12/24/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrosing interstitial pneumonia of unknown cause associated with the histopathologic and/or radiologic pattern of usual interstitial pneumonia (UIP). Occupational risk factors have been proposed to be associated with UIP. The aim of this case-control study is to evaluate the relationship between UIP pattern and occupational exposure in Southern Europe. Methods Sixty nine cases with a UIP radiological pattern at CT-scan were selected from a clinical database of the University Hospital of Perugia, Umbria, between January 2010 and December 2013. Controls (n = 277) not reporting doctor diagnosed pulmonary fibrosis, were ascertained casually among general population from the same catching area of cases. Data were collected by a questionnaire used previously in a similar study. Logistic regression models, adjusted for gender, age and smoking, were performed to evaluate the association between UIP and occupational exposure. Results Farmers, veterinarians and gardeners (OR = 2.73, 95%CI = 1.47–5.10), metallurgical and steel industry workers (OR = 4.80, 95%CI = 1.50–15.33) were occupations associated with UIP. Metal dust and fumes and organic dust were risk factors for UIP. Increasing the length of occupational exposure in jobs at risk of pulmonary fibrosis, increased the risk of having UIP. Conclusions This case control study confirm partially the results from previous similar studies. Some discrepancies could be explained by the different geographical origins of the population under study, reflecting also different occupational exposures. Electronic supplementary material The online version of this article (10.1186/s12890-018-0644-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giulia Paolocci
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Piazzale Gambuli, 06100, Perugia, Italy
| | - Ilenia Folletti
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Piazzale Gambuli, 06100, Perugia, Italy
| | - Kjell Torén
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Magnus Ekström
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Marco Dell'Omo
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Piazzale Gambuli, 06100, Perugia, Italy
| | - Giacomo Muzi
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Piazzale Gambuli, 06100, Perugia, Italy
| | - Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Piazzale Gambuli, 06100, Perugia, Italy. .,Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
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15
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Liccardi G, Calzetta L, Baldi G, Berra A, Billeri L, Caminati M, Capano P, Carpentieri E, Ciccarelli A, Crivellaro MA, Cutajar M, D'Amato M, Folletti I, Gani F, Gargano D, Giannattasio D, Giovannini M, Lombardi C, Schiavo ML, Madonna F, Maniscalco M, Meriggi A, Micucci C, Milanese M, Montera C, Paolocci G, Parente R, Pedicini A, Pio R, Puggioni F, Russo M, Salzillo A, Scavalli P, Scichilone N, Sposato B, Stanziola A, Steinhilber G, Vatrella A, Rogliani P, Passalacqua G. Allergic sensitization to common pets (cats/dogs) according to different possible modalities of exposure: an Italian Multicenter Study. Clin Mol Allergy 2018. [PMID: 29434523 DOI: 10.1186/s12948-018-0081-z.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background The query "are there animals at home?" is usually administered for collecting information on anamnesis. This modality to consider exposure to pet allergens constitutes a potential bias in epidemiological studies and in clinical practice. The aim of our study was to evaluate/quantify different modalities of exposure to cat/dog in inducing allergic sensitization. Methods Thirty Italian Allergy units participated in this study. Each centre was required to collect the data of at least 20 consecutive outpatients sensitized to cat/dog allergens. A standardized form reported all demographic data and a particular attention was paid in relieving possible modalities of exposure to cat/dog. Results A total 723 patients sensitized to cat/dog were recorded, 359 (49.65%) reported direct pet contact, 213 patients (29.46%) were pet owners, and 146 subjects (20.19%) were exposed to pets in other settings. Other patients were sensitized by previous pet ownership (150-20.75%) or indirect contact (103-14.25%), in 111 subjects (15.35%) any contact was reported. Conclusions Only 213 patients (29.46%) would be classified as "exposed to animals" and 510 (70.54%) as "not exposed" according to usual query. Our classification has shown that many "not-exposed" subjects (399-55.19%) were "really exposed". The magnitude of exposure to pet allergens at home is not related exclusively to pet ownership. These considerations should be taken into account during the planning of epidemiological studies and in clinical practice for the management of pet allergic individuals.
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Affiliation(s)
- G Liccardi
- 1Department of Pulmonology, Haematology and Oncology. Division of Pneumology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy.,2Postgraduate School of Respiratory Medicine. Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - L Calzetta
- 2Postgraduate School of Respiratory Medicine. Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy.,3Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - G Baldi
- Respiratory Medicine Unit, ASL (District 66), Salerno, Italy
| | - A Berra
- Respiratory Allergy Unit, G. Da Procida Hospital, Salerno, Italy
| | - L Billeri
- 6Department of Laboratory Medicine, University Hospital Padova, Padua, Italy
| | - M Caminati
- 7Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - P Capano
- Unit of Pulmonary Immunology and Respiratory Diseases Ospedale "Santa Maria Della Speranza", Battipaglia, Salerno Italy
| | - E Carpentieri
- Division of Pneumology, "Santa Maria Novella" Hospital, Galatina, Lecce Italy
| | - A Ciccarelli
- Allergy Unit, Loreto Crispi Hospital, Naples, Italy
| | - M A Crivellaro
- 11Unit of Allergy and Occupational Medicine, University Hospital Padova, Padua, Italy
| | - M Cutajar
- Allergy Center, Division of Internal Medicine, Ospedali Riuniti Penisola Sorrentina, Sorrento, Naples, Italy
| | - M D'Amato
- 13Department of Respiratory Disease, "Federico II" University - AO "Dei Colli", Naples, Italy
| | - I Folletti
- 14Department of Medicine, Section of Occupational Medicine, Respiratory Diseases and Toxicology, Terni Hospital, University of Perugia, Perugia, Italy
| | - F Gani
- Allergy Unit, S. Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - D Gargano
- 16Allergy Unit, High Speciality "San Giuseppe Moscati" Hospital, Avellino, Italy
| | - D Giannattasio
- Respiratory Physiopathology and Allergy, High Speciality Center, "Mauro Scarlato" Hospital, Scafati, Salerno, Italy
| | - M Giovannini
- Pulmonary Diseases Department, Mirandola Hospital, Modena, Italy
| | - C Lombardi
- 19Departmental Unit of Allergy, Clinical Immunology and Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - M Lo Schiavo
- Allergy and Clinical Immunology, "G. Fucito" Hospital, S. Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - F Madonna
- Allergy Unit, ASL (Sanitary District n°12), Caserta, Italy
| | - M Maniscalco
- Pulmonary Rehabilitation Unit, ICS Maugeri, Telese Terme, Benevento Italy
| | - A Meriggi
- 23Allergy and Immunology Unit, Fondazione "Salvatore Maugeri", Institut of Research and Care, Scientific Institute of Pavia, Pavia, Italy
| | - C Micucci
- Division of Pneumology and Allergology Hospital "Carlo Urbani", Jesi, Ancona Italy
| | - M Milanese
- 25Division of Pneumology, S. Corona Hospital, Pietra Ligure, Savona Italy
| | - C Montera
- Allergy and Clinical Immunology, "G. Fucito" Hospital, S. Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - G Paolocci
- 14Department of Medicine, Section of Occupational Medicine, Respiratory Diseases and Toxicology, Terni Hospital, University of Perugia, Perugia, Italy
| | - R Parente
- 26Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - A Pedicini
- 27Division of Internal Medicine and Allergy, Fatebenefratelli Hospital, Benevento, Italy
| | - R Pio
- Allergy and Clinical Immunology, "G. Fucito" Hospital, S. Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - F Puggioni
- Respiratory Diseases Department-IRCCS Humanitas Research and Clinical Center, Rozzano, Milan, Italy
| | - M Russo
- 1Department of Pulmonology, Haematology and Oncology. Division of Pneumology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - A Salzillo
- 1Department of Pulmonology, Haematology and Oncology. Division of Pneumology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - P Scavalli
- Unit of Respiratory Physiopathology, Allergy and Occupational Medicine, ASL Viterbo, Viterbo, Italy
| | - N Scichilone
- 30Biomedical Department of Specialistic and Internal Medicine, University of Palermo, Palermo, Italy
| | - B Sposato
- Pneumology Unit, Azienda Ospedaliera "Misericordia", Grosseto, Italy
| | - A Stanziola
- 13Department of Respiratory Disease, "Federico II" University - AO "Dei Colli", Naples, Italy
| | - G Steinhilber
- 32Division of Pneumology, Spedali Civili Brescia, Brescia, Italy
| | - A Vatrella
- 33Department of Medicine and Surgery, University of Salerno, Fisciano, Italy
| | - P Rogliani
- 2Postgraduate School of Respiratory Medicine. Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy.,3Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - G Passalacqua
- 34Allergy and Respiratory Diseases, Policlinico San Martino, University of Genoa, Genoa, Italy
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16
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Liccardi G, Calzetta L, Baldi G, Berra A, Billeri L, Caminati M, Capano P, Carpentieri E, Ciccarelli A, Crivellaro MA, Cutajar M, D'Amato M, Folletti I, Gani F, Gargano D, Giannattasio D, Giovannini M, Lombardi C, Schiavo ML, Madonna F, Maniscalco M, Meriggi A, Micucci C, Milanese M, Montera C, Paolocci G, Parente R, Pedicini A, Pio R, Puggioni F, Russo M, Salzillo A, Scavalli P, Scichilone N, Sposato B, Stanziola A, Steinhilber G, Vatrella A, Rogliani P, Passalacqua G. Allergic sensitization to common pets (cats/dogs) according to different possible modalities of exposure: an Italian Multicenter Study. Clin Mol Allergy 2018; 16:3. [PMID: 29434523 PMCID: PMC5796344 DOI: 10.1186/s12948-018-0081-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 12/04/2017] [Accepted: 01/22/2018] [Indexed: 12/28/2022] Open
Abstract
Background The query “are there animals at home?” is usually administered for collecting information on anamnesis. This modality to consider exposure to pet allergens constitutes a potential bias in epidemiological studies and in clinical practice. The aim of our study was to evaluate/quantify different modalities of exposure to cat/dog in inducing allergic sensitization. Methods Thirty Italian Allergy units participated in this study. Each centre was required to collect the data of at least 20 consecutive outpatients sensitized to cat/dog allergens. A standardized form reported all demographic data and a particular attention was paid in relieving possible modalities of exposure to cat/dog. Results A total 723 patients sensitized to cat/dog were recorded, 359 (49.65%) reported direct pet contact, 213 patients (29.46%) were pet owners, and 146 subjects (20.19%) were exposed to pets in other settings. Other patients were sensitized by previous pet ownership (150–20.75%) or indirect contact (103–14.25%), in 111 subjects (15.35%) any contact was reported. Conclusions Only 213 patients (29.46%) would be classified as “exposed to animals” and 510 (70.54%) as “not exposed” according to usual query. Our classification has shown that many “not-exposed” subjects (399–55.19%) were “really exposed”. The magnitude of exposure to pet allergens at home is not related exclusively to pet ownership. These considerations should be taken into account during the planning of epidemiological studies and in clinical practice for the management of pet allergic individuals.
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Affiliation(s)
- G Liccardi
- 1Department of Pulmonology, Haematology and Oncology. Division of Pneumology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy.,2Postgraduate School of Respiratory Medicine. Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - L Calzetta
- 2Postgraduate School of Respiratory Medicine. Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy.,3Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - G Baldi
- Respiratory Medicine Unit, ASL (District 66), Salerno, Italy
| | - A Berra
- Respiratory Allergy Unit, G. Da Procida Hospital, Salerno, Italy
| | - L Billeri
- 6Department of Laboratory Medicine, University Hospital Padova, Padua, Italy
| | - M Caminati
- 7Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - P Capano
- Unit of Pulmonary Immunology and Respiratory Diseases Ospedale "Santa Maria Della Speranza", Battipaglia, Salerno Italy
| | - E Carpentieri
- Division of Pneumology, "Santa Maria Novella" Hospital, Galatina, Lecce Italy
| | - A Ciccarelli
- Allergy Unit, Loreto Crispi Hospital, Naples, Italy
| | - M A Crivellaro
- 11Unit of Allergy and Occupational Medicine, University Hospital Padova, Padua, Italy
| | - M Cutajar
- Allergy Center, Division of Internal Medicine, Ospedali Riuniti Penisola Sorrentina, Sorrento, Naples, Italy
| | - M D'Amato
- 13Department of Respiratory Disease, "Federico II" University - AO "Dei Colli", Naples, Italy
| | - I Folletti
- 14Department of Medicine, Section of Occupational Medicine, Respiratory Diseases and Toxicology, Terni Hospital, University of Perugia, Perugia, Italy
| | - F Gani
- Allergy Unit, S. Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - D Gargano
- 16Allergy Unit, High Speciality "San Giuseppe Moscati" Hospital, Avellino, Italy
| | - D Giannattasio
- Respiratory Physiopathology and Allergy, High Speciality Center, "Mauro Scarlato" Hospital, Scafati, Salerno, Italy
| | - M Giovannini
- Pulmonary Diseases Department, Mirandola Hospital, Modena, Italy
| | - C Lombardi
- 19Departmental Unit of Allergy, Clinical Immunology and Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - M Lo Schiavo
- Allergy and Clinical Immunology, "G. Fucito" Hospital, S. Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - F Madonna
- Allergy Unit, ASL (Sanitary District n°12), Caserta, Italy
| | - M Maniscalco
- Pulmonary Rehabilitation Unit, ICS Maugeri, Telese Terme, Benevento Italy
| | - A Meriggi
- 23Allergy and Immunology Unit, Fondazione "Salvatore Maugeri", Institut of Research and Care, Scientific Institute of Pavia, Pavia, Italy
| | - C Micucci
- Division of Pneumology and Allergology Hospital "Carlo Urbani", Jesi, Ancona Italy
| | - M Milanese
- 25Division of Pneumology, S. Corona Hospital, Pietra Ligure, Savona Italy
| | - C Montera
- Allergy and Clinical Immunology, "G. Fucito" Hospital, S. Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - G Paolocci
- 14Department of Medicine, Section of Occupational Medicine, Respiratory Diseases and Toxicology, Terni Hospital, University of Perugia, Perugia, Italy
| | - R Parente
- 26Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - A Pedicini
- 27Division of Internal Medicine and Allergy, Fatebenefratelli Hospital, Benevento, Italy
| | - R Pio
- Allergy and Clinical Immunology, "G. Fucito" Hospital, S. Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - F Puggioni
- Respiratory Diseases Department-IRCCS Humanitas Research and Clinical Center, Rozzano, Milan, Italy
| | - M Russo
- 1Department of Pulmonology, Haematology and Oncology. Division of Pneumology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - A Salzillo
- 1Department of Pulmonology, Haematology and Oncology. Division of Pneumology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - P Scavalli
- Unit of Respiratory Physiopathology, Allergy and Occupational Medicine, ASL Viterbo, Viterbo, Italy
| | - N Scichilone
- 30Biomedical Department of Specialistic and Internal Medicine, University of Palermo, Palermo, Italy
| | - B Sposato
- Pneumology Unit, Azienda Ospedaliera "Misericordia", Grosseto, Italy
| | - A Stanziola
- 13Department of Respiratory Disease, "Federico II" University - AO "Dei Colli", Naples, Italy
| | - G Steinhilber
- 32Division of Pneumology, Spedali Civili Brescia, Brescia, Italy
| | - A Vatrella
- 33Department of Medicine and Surgery, University of Salerno, Fisciano, Italy
| | - P Rogliani
- 2Postgraduate School of Respiratory Medicine. Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy.,3Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - G Passalacqua
- 34Allergy and Respiratory Diseases, Policlinico San Martino, University of Genoa, Genoa, Italy
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17
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Sposato B, Scalese M, Latorre M, Scichilone N, Matucci A, Milanese M, Masieri S, Rolla G, Steinhilber G, Rosati Y, Vultaggio A, Folletti I, Baglioni S, Bargagli E, Di Tomassi M, Pio R, Pio A, Maccari U, Maggiorelli C, Migliorini MG, Vignale L, Pulerà N, Carpagnano GE, Foschino Barbaro MP, Perrella A, Paggiaro PL. Effects of omalizumab in severe asthmatics across ages: A real life Italian experience. Respir Med 2016; 119:141-149. [PMID: 27692136 DOI: 10.1016/j.rmed.2016.09.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/31/2016] [Accepted: 09/02/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND This retrospective study aimed at evaluating long-term effects of Omalizumab in elderly asthmatics in a real-life setting. METHODS 105 consecutive severe asthmatics (GINA step 4-5; mean FEV1% predicted:66 ± 15.7) treated with Omalizumab for at least 1 year (treatment mean duration 35.1 ± 21.7 months) were divided into 3 groups according to their age at Omalizumab treatment onset: 18-39, 40-64 and ≥ 65 years. RESULTS Comorbidities, number of overweight/obese subjects and patients with late-onset asthma were more frequent among older people. A similar reduction of inhaled corticosteroids dosage and SABA on-demand therapy was observed in all groups during Omalizumab treatment; a similar FEV1 increased was also observed. Asthma Control Test (ACT) improved significantly (p < 0.001) in the three groups, increasing from 15 [IQR:12-18] to 24 [IQR:22-25] in younger subjects, from 14 [IQR:10-16] to 21 [IQR:20-23] in the 40-64-year-group and from 15 [IQR:12-16] to 20 [IQR:18-22] in elderly patients where improvement was lower (p = 0.039) compared to younger people. Asthma exacerbations decreased significantly after Omalizumab but the percentage of exacerbation-free patients was higher in younger people (76.9%) compared to middle aged patients (49.2%) and the elderly (29%) (p = 0.049). After Omalizumab treatment, the risk for exacerbations was lower in subjects aged 40-64 (OR = 0.284 [CI95% = 0.098-0.826], p = 0.021) and 18-39 (OR = 0.133 [CI95% = 0.026-0.678], p = 0.015), compared to elderly asthmatics. Also, a significantly reduced ACT improvement (β = -1.070; p = 0.046) passing from each age class was observed. CONCLUSION Omalizumab improves all asthma outcomes independently of age, although the magnitude of the effects observed in the elderly seems to be lower than in the other age groups.
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Affiliation(s)
- B Sposato
- Pneumologia, Ospedale Misericordia, Grosseto, Italy.
| | - M Scalese
- Istituto di Fisiologia Clinica, CNR, Pisa, Italy
| | - M Latorre
- Cardio Thoracic and Vascular Department, Pathophysiology Unit, University of Pisa, Italy
| | - N Scichilone
- DIMPEFINU, Unit of Pneumology and Medicine, University of Palermo, Palermo, Italy
| | - A Matucci
- Immunoallergology Unit, Department of Medicine and Geriatric, AOU Careggi, Florence, Italy
| | - M Milanese
- Pneumologia, Ospedale S.Corona, Pietra Ligure, Italy
| | - S Masieri
- Clinica Otorinolaringoiatrica, Policlinico Umberto I, Università di Roma "Sapienza", Italy
| | - G Rolla
- Allergologia e Immunologia Clinica, Ospedale Mauriziano Umberto I, Università di Torino, Italy
| | | | - Y Rosati
- Pneumologia, Ospedale di Macerata, Italy
| | - A Vultaggio
- Immunoallergology Unit, Department of Medicine and Geriatric, AOU Careggi, Florence, Italy
| | - I Folletti
- Sezione di Medicina del Lavoro, Malattie Respiratorie e Tossicologia Professionale ed Ambientale, Dipartimento di Medicina, Università di Perugia, Az. Ospedaliera Santa Maria, Terni, Italy
| | | | - E Bargagli
- Pneumologia, Ospedale Le Scotte, Università di Siena, Italy
| | - M Di Tomassi
- Pneumologia, Ospedale Misericordia, Grosseto, Italy
| | - R Pio
- Allergologia e Immunologia Clinica, Ospedale G. Fucito, Mercato S. Severino, Salerno, Italy
| | - A Pio
- Allergologia e Immunologia Clinica, Ospedale G. Fucito, Mercato S. Severino, Salerno, Italy
| | - U Maccari
- Pneumologia e UTIP, Ospedale "S.Donato", Arezzo, Italy
| | - C Maggiorelli
- Pneumologia e UTIP, Ospedale "S.Donato", Arezzo, Italy
| | | | - L Vignale
- Pneumologia, Ospedale di Fivizzano, Italy
| | - N Pulerà
- Pneumologia, Ospedale di Livorno, Italy
| | - G E Carpagnano
- Institute of Respiratory Disease, Department of Medical and Occupational Sciences, University of Foggia, Italy
| | - M P Foschino Barbaro
- Institute of Respiratory Disease, Department of Medical and Occupational Sciences, University of Foggia, Italy
| | - A Perrella
- Pneumologia, Ospedale Misericordia, Grosseto, Italy
| | - P L Paggiaro
- Cardio Thoracic and Vascular Department, Pathophysiology Unit, University of Pisa, Italy
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Abstract
Background: The strong interactions between asthma and rhinitis, and the influence of rhinitis in the severity and/or control of asthma, have clearly been demonstrated. Nevertheless, no specific study has been conducted in the occupational setting. Objective: The aim of the study was to assess the severity of occupational asthma and rhinitis and evaluate whether rhinitis is a predictor for increased asthma severity. Methods: We retrospectively reviewed the clinical charts of 72 patients who received a diagnosis of allergic occupational asthma, with or without associated occupational rhinitis. Results: Our findings suggested that persistent asthma tended to be more common in subjects with associated occupational asthma and rhinitis, and occupational asthma severity was associated with occupational rhinitis severity. Moderate-severe persistent occupational rhinitis is a risk factor for persistent occupational asthma. Conclusions: We demonstrated, for the first time in the occupational setting, a significant association between occupational rhinitis and asthma severity.
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Affiliation(s)
- Gianna Moscato
- Formerly Head Allergy and Immunology Unit, Fondazione Salvatore Maugeri - Pavia
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19
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Stopponi R, Tacconi C, Folletti I, Calisti R, Siracusa A. Upper airway and eye involvement in polyurethane shoe sole production workers. G Ital Med Lav Ergon 2016; 38:89-95. [PMID: 27459841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This cross-sectional study was aimed to investigate the prevalence of work-related upper and lower airway and eye symptoms in 118 workers in polyurethane shoe soles (PSS) production. METHODS Workplace monitoring of methylene diphenyl diisocyanate (MDI) and solvents was performed. Subjects completed a study-specific questionnaire and underwent anterior rhinoscopy, skin prick tests for common aeroallergens, spirometry, nasal peak inspiratory (NPIF) and expiratory flow (NPEF). RESULTS MDI and solvent levels were below threshold limit value-time-weighted average (TLW-TWA) except for two measures of dichloromethane and tetrachloroethylene, respectively, and in one measure of acetonitrile, which were higher then TLW-TWA. In exposed workers the prevalence of cough (p < 0.05) and nasal congestion at rhinoscopy (p = 0.05) was more frequent than in non-exposed workers. Occupational exposure (OR 4.5, 95% CI 1.2-16.5) and a low FEV1 (OR 2.6, 95% CI 1.1-6.3) were significant predictors of cough. CONCLUSIONS In workers exposed to low levels of MDI and solvents in polyurethane shoe sole production there was a high prevalence of cough and nasal congestion. An improvement in the exhaust ventilation system and other preventive measures were needed.
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Abraha I, Cherubini A, Cozzolino F, De Florio R, Luchetta ML, Rimland JM, Folletti I, Marchesi M, Germani A, Orso M, Eusebi P, Montedori A. Deviation from intention to treat analysis in randomised trials and treatment effect estimates: meta-epidemiological study. BMJ 2015; 350:h2445. [PMID: 26016488 PMCID: PMC4445790 DOI: 10.1136/bmj.h2445] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine whether deviation from the standard intention to treat analysis has an influence on treatment effect estimates of randomised trials. DESIGN Meta-epidemiological study. DATA SOURCES Medline, via PubMed, searched between 2006 and 2010; 43 systematic reviews of interventions and 310 randomised trials were included. ELIGIBILITY CRITERIA FOR SELECTING STUDIES From each year searched, random selection of 5% of intervention reviews with a meta-analysis that included at least one trial that deviated from the standard intention to treat approach. Basic characteristics of the systematic reviews and randomised trials were extracted. Information on the reporting of intention to treat analysis, outcome data, risk of bias items, post-randomisation exclusions, and funding were extracted from each trial. Trials were classified as: ITT (reporting the standard intention to treat approach), mITT (reporting a deviation from the standard approach), and no ITT (reporting no approach). Within each meta-analysis, treatment effects were compared between mITT and ITT trials, and between mITT and no ITT trials. The ratio of odds ratios was calculated (value <1 indicated larger treatment effects in mITT trials than in other trial categories). RESULTS 50 meta-analyses and 322 comparisons of randomised trials (from 84 ITT trials, 118 mITT trials, and 108 no ITT trials; 12 trials contributed twice to the analysis) were examined. Compared with ITT trials, mITT trials showed a larger intervention effect (pooled ratio of odds ratios 0.83 (95% confidence interval 0.71 to 0.96), P=0.01; between meta-analyses variance τ(2)=0.13). Adjustments for sample size, type of centre, funding, items of risk of bias, post-randomisation exclusions, and variance of log odds ratio yielded consistent results (0.80 (0.69 to 0.94), P=0.005; τ(2)=0.08). After exclusion of five influential studies, results remained consistent (0.85 (0.75 to 0.98); τ(2)=0.08). The comparison between mITT trials and no ITT trials showed no statistical difference between the two groups (adjusted ratio of odds ratios 0.92 (0.70 to 1.23); τ(2)=0.57). CONCLUSIONS Trials that deviated from the intention to treat analysis showed larger intervention effects than trials that reported the standard approach. Where an intention to treat analysis is impossible to perform, authors should clearly report who is included in the analysis and attempt to perform multiple imputations.
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Affiliation(s)
- Iosief Abraha
- Health Planning Service, Regional Health Authority of Umbria, Department of Epidemiology, 06124 Perugia, Italy
| | - Antonio Cherubini
- Geriatrics and Geriatric Emergency Care, Italian National Research Centre on Aging Ancona, Italy
| | - Francesco Cozzolino
- Health Planning Service, Regional Health Authority of Umbria, Department of Epidemiology, 06124 Perugia, Italy
| | | | | | - Joseph M Rimland
- Geriatrics and Geriatric Emergency Care, Italian National Research Centre on Aging Ancona, Italy
| | - Ilenia Folletti
- Department of Clinical and Experimental Medicine, University of Perugia, Perugia
| | - Mauro Marchesi
- Transfusion Medicine Service, Azienda Ospedaliera di Perugia, Perugia
| | - Antonella Germani
- Transfusion Medicine Service, Azienda Ospedaliera di Perugia, Perugia
| | - Massimiliano Orso
- Health Planning Service, Regional Health Authority of Umbria, Department of Epidemiology, 06124 Perugia, Italy
| | - Paolo Eusebi
- Health Planning Service, Regional Health Authority of Umbria, Department of Epidemiology, 06124 Perugia, Italy
| | - Alessandro Montedori
- Health Planning Service, Regional Health Authority of Umbria, Department of Epidemiology, 06124 Perugia, Italy
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Liccardi G, Baldi G, Berra A, Carpentieri E, Cutajar M, D'Amato M, Del Donno M, Del Prato B, Folletti I, Gani F, Gargano D, Giannattasio D, Giovannini M, Infantino A, Lombardi C, Lo Schiavo M, Madonna F, Maniscalco M, Meriggi A, Milanese M, Montera C, Pio A, Russo M, Salzillo A, Scavalli P, Scichilone N, Sposato B, Stanziola A, Starace A, Vatrella A, D'Amato G, Passalacqua G. Non respiratory symptoms in asthma as possible predictors of exacerbations. J Allergy Clin Immunol Pract 2015; 3:798-800.e2. [PMID: 26004306 DOI: 10.1016/j.jaip.2015.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 03/28/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Gennaro Liccardi
- Division of Pneumology and Allergology, Department of Chest Diseases, High Speciality "A. Cardarelli" Hospital, Naples, Italy.
| | - Gennaro Baldi
- Respiratory Medicine Unit, ASL (district 66), Salerno, Italy
| | - Adriano Berra
- Respiratory Allergy Unit, G.Da Procida Hospital, Salerno, Italy
| | - Emanuela Carpentieri
- Division of Pneumology, "Santa Maria Novella" Hospital, Galatina, Lecce, Italy; Division of Pneumology, "Rummo" Hospital, Benevento, Italy
| | - Marina Cutajar
- Division of Internal Medicine, Allergy Center, Ospedali Riuniti Penisola Sorrentina, Sorrento, Naples, Italy
| | - Maria D'Amato
- Department of Respiratory Disease, "Federico II" University - AO "Dei Colli", Naples, Italy
| | | | - Bruno Del Prato
- Unit of Bronchial Endoscopy and Broncho-pulmonology Emergencies, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - Ilenia Folletti
- Department of Medicine, Unit of Occupational and Environmental Allergy, University of Perugia, Terni Hospital, Terni, Italy
| | - Federica Gani
- Allergy Unit, S. Luigi Gonzaga Hospital, Orbassano, Torino, Italy
| | - Domenico Gargano
- Allergy Unit, High Speciality "San Giuseppe Moscati" Hospital, Avellino, Italy
| | - Domenico Giannattasio
- Respiratory Physiopathology and Allergy, High Speciality Center, "S. Maria Incoronata dell'Olmo" Hospital, Cava dei tirreni, Salerno, Italy
| | | | - Antonio Infantino
- Respiratory Area, Società Italiana Interdisciplinare per le Cure Primarie, Italy
| | - Carlo Lombardi
- Departmental Unit of Allergy, Clinical Immunology and Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - Mario Lo Schiavo
- Allergy and Clinical Immunology, "G. Fucito" Hospital, S. Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | | | - Mauro Maniscalco
- Section of Respiratory Medicine, Hospital "S. Maria della Pietà", Casoria, Naples, Italy
| | - Antonio Meriggi
- Allergy and Immunology Unit, Fondazione "Salvatore Maugeri", Institute of Research and Care, Scientific Institute of Pavia, Pavia, Italy
| | - Manlio Milanese
- Division of Pneumology, S. Corona Hospital, Pietra Ligure, Savona, Italy
| | - Carmen Montera
- Allergy and Clinical Immunology, "G. Fucito" Hospital, S. Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - Antonio Pio
- Allergy and Clinical Immunology, "G. Fucito" Hospital, S. Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - Maria Russo
- Division of Pneumology and Allergology, Department of Chest Diseases, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - Antonello Salzillo
- Division of Pneumology and Allergology, Department of Chest Diseases, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - Patrizia Scavalli
- Unit of Respiratory Physiopathology, Allergy and Occupational Medicine, ASL, Viterbo, Italy
| | - Nicola Scichilone
- Biomedical Department of Specialistic and Internal Medicine, University of Palermo, Palermo, Italy
| | - Bruno Sposato
- Pneumology Unit, Azienda Ospedaliera "Misericordia", Grosseto, Italy
| | - Anna Stanziola
- Department of Respiratory Disease, "Federico II" University - AO "Dei Colli", Naples, Italy
| | - Antonio Starace
- Division of Pneumology and Physiopathology, Department of Chest Diseases, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | | | - Gennaro D'Amato
- Division of Pneumology and Allergology, Department of Chest Diseases, High Speciality "A. Cardarelli" Hospital, Naples, Italy
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Siracusa A, Folletti I, Gerth van Wijk R, Jeebhay MF, Moscato G, Quirce S, Raulf M, Ruëff F, Walusiak-Skorupa J, Whitaker P, Tarlo SM. Occupational anaphylaxis--an EAACI task force consensus statement. Allergy 2015; 70:141-52. [PMID: 25369880 DOI: 10.1111/all.12541] [Citation(s) in RCA: 43] [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: 10/30/2014] [Indexed: 12/26/2022]
Abstract
Anaphylaxis is a systemic allergic reaction, potentially life-threatening that can be due to nonoccupational or, less commonly, to occupational triggers. Occupational anaphylaxis (OcAn) could be defined as anaphylaxis arising out of triggers and conditions attributable to a particular work environment. Hymenoptera stings and natural rubber latex are the commonest triggers of OcAn. Other triggers include food, medications, insect/mammal/snake bites, and chemicals. The underlying mechanisms of anaphylactic reactions due to occupational exposure are usually IgE-mediated and less frequently non-IgE-mediated allergy or nonallergic. Some aspects of work-related allergen exposure, such as route and frequency of exposure, type of allergens, and cofactors may explain the variability of symptoms in contrast to the nonoccupational setting. When assessing OcAn, both confirmation of the diagnosis of anaphylactic reaction and identification of the trigger are required. Prevention of further episodes is important and is based on removal from further exposure. Workers with a history of OcAn should immediately be provided with a written emergency management plan and an adrenaline auto-injector and educated to its use. Immunotherapy is recommended only for OcAn due to Hymenoptera stings.
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Affiliation(s)
- A. Siracusa
- Formerly professor of Occupational Medicine; University of Perugia; Perugia Italy
| | - I. Folletti
- Occupational Medicine; Terni Hospital; University of Perugia; Perugia Italy
| | - R. Gerth van Wijk
- Section of Allergology; Department of Internal Medicine; Erasmus Medical Center; Rotterdam the Netherlands
| | - M. F. Jeebhay
- Centre for Occupational and Environmental Health Research; School of Public Health and Family Medicine; University of Cape Town; Cape Town South Africa
| | - G. Moscato
- Department of Public Health; Experimental and Forensic Medicine of the University of Pavia; Pavia Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz Institute for Health Research (IdiPAZ) and CIBER of Respiratory Diseases CIBERES; Madrid Spain
| | - M. Raulf
- Institute of Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr University Bochum; Bochum Germany
| | - F. Ruëff
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
| | | | - P. Whitaker
- Department of Respiratory Medicine; Leeds Teaching Hospitals NHS Trust; Leeds UK
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23
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Papi A, Marku B, Scichilone N, Maestrelli P, Paggiaro P, Saetta M, Nava S, Folletti I, Bertorelli G, Bertacco S, Contoli M, Plebani M, Barbaro MPF, Spanevello A, Aliani M, Pannacci M, Morelli P, Beghé B, Fabbri LM. Regular versus as-needed budesonide and formoterol combination treatment for moderate asthma: a non-inferiority, randomised, double-blind clinical trial. Lancet Respir Med 2014; 3:109-119. [PMID: 25481378 DOI: 10.1016/s2213-2600(14)70266-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Treatment guidelines for patients with moderate persistent asthma recommend regular therapy with a combination of an inhaled corticosteroid and a longacting β2 agonist plus as-needed rapid-acting bronchodilators. We investigated whether symptom-driven budesonide and formoterol combination therapy administered as needed would be as effective as regular treatment with this combination plus as-needed symptom-driven terbutaline for patients with moderate asthma. METHODS In this non-inferiority randomised clinical trial, we recruited adult patients (18-65 years of age) with stable moderate persistent asthma, according to 2006 Global Initiative for Asthma guidelines. Patients were recruited from outpatient clinics of secondary and tertiary referral hospitals and university centres. After a 6-week run-in period of inhaled regular budesonide and formoterol plus as-needed terbutaline, the patients were randomly assigned in a 1:1 ratio to receive placebo twice daily plus as-needed treatment with inhaled 160 μg budesonide and 4·5 μg formoterol (as-needed budesonide and formoterol therapy) or twice-daily 160 μg budesonide and 4·5 μg formoterol combination plus symptom-driven 500 μg terbutaline (regular budesonide/formoterol therapy) for 1 year. Randomisation was done according to a list prepared with the use of a random number generator and a balanced-block design stratified by centre. Patients and investigators were masked to treatment assignment. The primary outcome was time to first treatment failure measured after 1 year of treatment using Kaplan-Meier estimates, and the power of the study was calculated based on the rate of treatment failure. Analyses were done on the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT00849095. FINDINGS Between April 20, 2009, and March 31, 2012, we screened 1010 patients with moderate asthma and randomly assigned 866 eligible patients to the two treatment groups (424 to as-needed budesonide and formoterol therapy and 442 to regular budenoside and formoterol therapy). Compared with regular budesonide and formoterol therapy, as-needed budesonide and formoterol treatment was associated with a lower probability of patients having no treatment failure at 1 year (Kaplan-Meier estimates 53·6% for as-needed treatment vs 64·0% for regular treatment; difference 10·3% [95% CI 3·2-17·4], at a predefined non-inferiority limit of 9%). Patients in the as-needed budesonide and formoterol group had shorter time to first treatment failure than those in the regular therapy group (11·86 weeks vs 28·00 weeks for the first quartile [ie, the time until the first 25% of patients experienced treatment failure]). The difference in treatment failures was largely attributable to nocturnal awakenings (82 patients in the as-needed treatment group vs 44 in the regular treatment group). Both treatment regimens were well tolerated. INTERPRETATION In patients with moderate stable asthma, as-needed budesonide and formoterol therapy is less effective than is the guideline-recommended regular budesonide and formoterol treatment, even though the differences are small. FUNDING Italian Medicines Agency.
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Affiliation(s)
- Alberto Papi
- Department of Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Brunilda Marku
- Department of Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Nicola Scichilone
- Biomedical Department of Internal and Experimental Medicine, University of Palermo, Palermo, Italy
| | - Piero Maestrelli
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | | | - Marina Saetta
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Stefano Nava
- Respiratory and Critical Care, Department of Specialist, Diagnostic, and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Ilenia Folletti
- Department of Medicine, Section of Occupational and Environmental Allergy, University of Perugia, Perugia, Italy
| | | | - Stefano Bertacco
- Respiratory Medicine, Hospital of Bussolengo, Bussolengo (VR), Italy
| | - Marco Contoli
- Department of Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University of Padova, Padova, Italy
| | | | - Antonio Spanevello
- Respiratory Medicine, Fondazione Salvatore Maugeri, Tradate (VA), Italy; University of Varese, Varese, Italy
| | - Maria Aliani
- Respiratory Medicine, Fondazione Salvatore Maugeri, Cassano delle Murge (BA), Italy
| | | | | | - Bianca Beghé
- Section of Respiratory Disease, Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Leonardo M Fabbri
- Section of Respiratory Disease, Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy.
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24
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Abstract
OBJECTIVES Little is known about the Hymenoptera venom allergy impact on work ability and the effect of venom immunotherapy (VIT) on work. The objective of this study was to evaluate the prevalence and predictors of work disability in patients treated with VIT and the effects of VIT on occupational functioning. METHODS 181 patients, aged 18-71 years, treated with VIT while working, were investigated by questionnaire. Participants were classified into employed and self-employed and, based on work exposure to Hymenoptera, into three risk categories: high risk, occasionally high risk and low risk. Work disability was defined as having to have changed jobs/tasks and/or suffered economic loss because of Hymenoptera venom allergy. Predictors of work disability were assessed in logistic regression models. RESULTS 31 (17%) patients reported work disability. Being self-employed and having the severe reaction at work were associated with work disability (p<0.01). Having a high-risk job for exposure to Hymenoptera was a significant predictor of work disability (OR 2.66, 95% CI 1.04 to 6.75). 24% of patients referred a positive effect of VIT on work. Determinants of the positive effect of VIT on work were having a high-risk job for exposure to hymenoptera (OR 3.60, 95% CI 1.52 to 8.51) and having already concluded VIT (OR 2.82, 95% CI 1.30 to 6.14). CONCLUSIONS Hymenoptera venom allergy could determine work disability. Patients with Hymenoptera venom allergy having a high-risk job for exposure to Hymenoptera seem to have higher risk of work disability and refer more frequently a positive effect of VIT on work.
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Affiliation(s)
- Giulia Paolocci
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Ilenia Folletti
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Kjell Torén
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Giacomo Muzi
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
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25
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Moscato G, Pala G, Cullinan P, Folletti I, Gerth van Wijk R, Pignatti P, Quirce S, Sastre J, Toskala E, Vandenplas O, Walusiak-Skorupa J, Malo JL. EAACI Position Paper on assessment of cough in the workplace. Allergy 2014; 69:292-304. [PMID: 24428394 DOI: 10.1111/all.12352] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 11/25/2013] [Indexed: 12/13/2022]
Abstract
Cough is a nonspecific and relatively common symptom that can present difficulties in diagnosis and management, particularly when it is reported to be associated with the workplace. The present consensus document, prepared by a taskforce of the Interest Group on Occupational Allergy of the European Academy of Allergy and Clinical Immunology by means of a nonsystematic review of the current literature, is intended to provide a definition and classification of work-related chronic cough (WRCC) to assist the daily practice of physicians facing with this symptom. The review demonstrates that several upper and lower airway work-related diseases may present with chronic cough; hence, the possible link with the workplace should always be considered. Due to the broad spectrum of underlying diseases, a multidisciplinary approach is necessary to achieve a definite diagnosis. Nevertheless, more epidemiological studies are necessary to estimate the real prevalence and risk factors for WRCC, the role of exposure to environmental and occupational sensitizers and irritants in its pathogenesis and the interaction with both upper and lower airways. Finally, the best management option should be evaluated in order to achieve the best outcome without adverse social and financial consequences for the worker.
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Affiliation(s)
- G. Moscato
- Allergology and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia Italy
| | - G. Pala
- Allergology and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia Italy
| | - P. Cullinan
- Department of Occupational and Environmental Medicine; Imperial College; London UK
| | - I. Folletti
- Department of Clinical and Experimental Medicine; Occupational Allergy Unit; Terni Hospital; University of Perugia; Terni Italy
| | - R. Gerth van Wijk
- Section of Allergology; Department of Internal Medicine; Erasmus MC; Rotterdam the Netherlands
| | - P. Pignatti
- Allergology and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz Institute for Health Research (IdiPAZ), and CIBER de Enfermedades Respiratorias CIBERES; Madrid Spain
| | - J. Sastre
- Department of Allergy; Fundación Jiménez Díaz, and CIBER de Enfermedades Respiratorias CIBERES; Madrid Spain
| | - E. Toskala
- Department of Otolaryngology, Head and Neck Surgery; School of Medicine; Temple University; Philadelphia PA USA
| | - O. Vandenplas
- Department of Chest Medicine; Centre Hospitalier Universitaire de Mont-Godinne; Université Catholique de Louvain; Yvoir Belgium
| | - J. Walusiak-Skorupa
- Department of Occupational Diseases; Nofer Institute of Occupational Medicine; Lodz Poland
| | - J. L. Malo
- Department of Chest Medicine; Hôpital du Sacré-Coeur de Montréal; Université de Montréal; Montreal Canada
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26
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van Kampen V, de Blay F, Folletti I, Kobierski P, Moscato G, Olivieri M, Quirce S, Sastre J, Walusiak-Skorupa J, Raulf-Heimsoth M. Empfehlungen für Pricktestungen mit Berufsallergenen – Ergebnisse der europäischen Multicenterstudie und des daraus resultierenden Positionspapiers. Pneumologie 2014. [DOI: 10.1055/s-0034-1368016] [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: 10/25/2022]
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27
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Sposato B, Liccardi G, Russo M, Folletti I, Siracusa A, Scichilone N, Ventura MT, Rolla G, Raie A, Milanese M, Pio R, Pio A, Scala R, Pareo C, Micucci C, Micheletto C, Billeri L, Musarra A, Cavaliere C, Agolli G, Masieri S, Scalese M, Capitani D. Cypress pollen: an unexpected major sensitizing agent in different regions of Italy. J Investig Allergol Clin Immunol 2014; 24:23-28. [PMID: 24765877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES In this multicenter survey, we assessed the impact of sensitization to cypress in atopic patients in Italy and determined whether cypress pollen concentration changed over time. METHODS Allergists were required to collect the results of 100-200 consecutive skin prick tests (SPTs) performed during 2012. Seasonal symptoms were also recorded, as were airborne cypress pollen concentrations (data from the Italian Aerobiology Association) in 1998-2000 and 2010-2012. RESULTS We examined 2258 atopic outpatients (56% females; age, 2-84 years) sensitized to at least 1 of the aeroallergens tested (Dermatophagoides species, grass, pellitory, olive, cypress, birch, Alternaria tenuis, and dog and cat dander). We found that 62.9%, 16.1%, and 32.7% of patients living in central, northern, and southern Italy, respectively, were sensitized to cypress (P < .0001). The cypress pollen concentration peak was delayed from February to March in 1998-2000 and 2010-2012 in all 3 regions, with a shift in pollination towards spring. Patients who were monosensitized to cypress reported mainly rhinitis (90.7%-97.6%) and conjunctivitis (38.1%-100%). In polysensitized patients, the prevalence of rhinitis, conjunctivitis, and asthma increased progressively (P < .0001) from southern to northern Italy. The same trend was observed for the prevalence of reported winter symptoms typical of cypress allergy (28%-65%). CONCLUSIONS Today, cypress pollen is the most frequent sensitizing aeroallergen (assessed by SPT) in several areas of central Italy. Variations in the timing of the cypress pollination period may have favored this increased sensitization. Rhinitis and conjunctivitis are the predominant symptoms. The clinical impact of this allergy was poor in southern Italy and increased in central areas before reaching its peak in northern regions.
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Siracusa A, De Blay F, Folletti I, Moscato G, Olivieri M, Quirce S, Raulf-Heimsoth M, Sastre J, Tarlo SM, Walusiak-Skorupa J, Zock JP. Asthma and exposure to cleaning products - a European Academy of Allergy and Clinical Immunology task force consensus statement. Allergy 2013; 68:1532-45. [PMID: 24131133 DOI: 10.1111/all.12279] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [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: 09/02/2013] [Indexed: 11/28/2022]
Abstract
Professional and domestic cleaning is associated with work-related asthma (WRA). This position paper reviews the literature linking exposure to cleaning products and the risk of asthma and focuses on prevention. Increased risk of asthma has been shown in many epidemiological and surveillance studies, and several case reports describe the relationship between exposure to one or more cleaning agents and WRA. Cleaning sprays, bleach, ammonia, disinfectants, mixing products, and specific job tasks have been identified as specific causes and/or triggers of asthma. Because research conclusions and policy suggestions have remained unheeded by manufactures, vendors, and commercial cleaning companies, it is time for a multifaceted intervention. Possible preventive measures encompass the following: substitution of cleaning sprays, bleach, and ammonia; minimizing the use of disinfectants; avoidance of mixing products; use of respiratory protective devices; and worker education. Moreover, we suggest the education of unions, consumer, and public interest groups to encourage safer products. In addition, information activities for the general population with the purpose of improving the knowledge of professional and domestic cleaners regarding risks and available preventive measures and to promote strict collaboration between scientific communities and safety and health agencies are urgently needed.
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Affiliation(s)
- A. Siracusa
- Department of Occupational Medicine; University of Perugia; Perugia Italy
| | - F. De Blay
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital Strasbourg; University of Strasbourg; Strasbourg France
| | - I. Folletti
- Department of Occupational Medicine; Terni Hospital; University of Perugia; Perugia Italy
| | - G. Moscato
- Allergy and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia Italy
| | - M. Olivieri
- Unit of Occupational Medicine; University Hospital of Verona; Verona Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz Institute for Health Research (IdiPAZ) and CIBER of Respiratory Diseases CIBERES; Madrid Spain
| | - M. Raulf-Heimsoth
- Institute of Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr University Bochum; Bochum Germany
| | - J. Sastre
- Department of Allergy; CIBER de Enfermedades Respiratorias, Ciberes and Fundación Jiménez Díaz; Madrid Spain
| | | | | | - J.-P. Zock
- Centre for Research in Environmental Epidemiology (CREAL); Barcelona Spain
- Hospital del Mar Medical Research Institute (IMIM); Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP); Barcelona Spain
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Abstract
OBJECTIVE This article presents a systematic review of epidemiological studies linking cleaning work and risk of asthma and rhinitis. METHODS Published reports were identified from PubMed covering the years from 1976 through June 30, 2012. In total, we identified 24 papers for inclusion in the review. The quality of studies was evaluated using the Strengthening of the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist of 22 items for cross-sectional, cohort and case-control studies. RESULTS Increased risk of asthma or rhinitis has been shown in 79% of included epidemiological studies. In four studies the increased risk of asthma in cleaning workers was confirmed by objective tests, such as bronchial hyper-reactivity or airflow obstruction. Level of exposure to cleaning products, cleaning sprays, bleach, ammonia, mixing products and specific job tasks has been identified as specific causes of asthma and rhinitis. CONCLUSIONS Possible preventive measures encompass the substitution of cleaning sprays, bleach and ammonia, avoidance of mixing products, the use of respiratory protective devices, worker education and medical surveillance.
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Affiliation(s)
- Ilenia Folletti
- Occupational Allergology Unit, Department of Clinical and Experimental Medicine, University of Perugia , Perugia , Italy
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30
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van Kampen V, de Blay F, Folletti I, Kobierski P, Moscato G, Olivieri M, Quirce S, Sastre J, Walusiak-Skorupa J, Kotschy-Lang N, Müsken H, Mahler V, Schliemann S, Ochmann U, Sültz J, Worm M, Sander I, Zahradnik E, Brüning T, Merget R, Raulf-Heimsoth M. Evaluation of commercial skin prick test solutions for selected occupational allergens. Allergy 2013; 68:651-8. [PMID: 23421494 DOI: 10.1111/all.12116] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Skin prick testing (SPT) is an important step in the diagnosis of IgE-mediated occupational allergic diseases. The outcome of SPT is related to the quality of allergen extracts. Thus, the aim of the study was to assess different commercially available SPT solutions for selected occupational allergens. METHODS SPT was performed in 116 bakers, 47 farmers and 33 subjects exposed to natural rubber latex (NRL), all with work-related allergic symptoms. The SPT solutions from different manufacturers (n = 3-5) for wheat flour, rye flour, soy, cow hair/dander, storage mites (Tyrophagus putrescentiae, Lepidoglyphus destructor, Acarus siro) and NRL were analysed with respect to their protein and antigen contents. SPT was carried out in 16 allergy centres in six European countries using standardized procedures. Specific IgE values were used as the gold standard to calculate the sensitivity and specificity of SPT solutions. The optimal cut-point for each SPT solution was determined by Youden Index. RESULTS Protein and antigen contents and patterns of the SPT solutions varied remarkably depending on the manufacturer. While SPT solutions for wheat flour and soy reached overall low sensitivities, sensitivities of other tested SPT solutions depended on the manufacturer. As a rule, solutions with higher protein and antigen content showed higher sensitivities and test efficiencies. CONCLUSIONS There is a wide variability of SPT solutions for occupational allergens, and the sensitivity of several solutions is low. Thus, improvement and standardization of SPT solutions for occupational allergens is essential.
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Affiliation(s)
- V. van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr-University Bochum (IPA); Bochum; Germany
| | - F. de Blay
- Department of Chest Diseases; University Hospital Strasbourg; Strasbourg; France
| | - I. Folletti
- Occupational Medicine; Terni Hospital; University of Perugia; Perugia; Italy
| | - P. Kobierski
- Rehabilitation Clinic Tobelbad; Austrian workers compensation board; Tobelbad; Austria
| | - G. Moscato
- Allergy and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Research and Care; Scientific Institute of Pavia; Pavia
| | - M. Olivieri
- Unit of Occupational Medicine; University Hospital of Verona; Verona; Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz (IdiPAZ) and CIBER of Respiratory Diseases CIBERES; Madrid
| | - J. Sastre
- Department of Allergy; Fundación Jiménez Díaz and CIBER of Respiratory Diseases CIBERES; Madrid; Spain
| | | | | | - H. Müsken
- Institute for Pneumological and Allergological Expertises; Bad Lippspringe
| | - V. Mahler
- Department of Dermatology; University Hospital; Erlangen
| | - S. Schliemann
- Department of Dermatology and Allergology; Friedrich Schiller University Jena; Jena
| | - U. Ochmann
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-Universität
| | - J. Sültz
- Occupational Physician; Neusaess
| | - M. Worm
- Allergy Centre - Department of Dermatology; Charité; University Berlin; Berlin; Germany
| | - I. Sander
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr-University Bochum (IPA); Bochum; Germany
| | - E. Zahradnik
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr-University Bochum (IPA); Bochum; Germany
| | - T. Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr-University Bochum (IPA); Bochum; Germany
| | - R. Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr-University Bochum (IPA); Bochum; Germany
| | - M. Raulf-Heimsoth
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr-University Bochum (IPA); Bochum; Germany
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31
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van Kampen V, de Blay F, Folletti I, Kobierski P, Moscato G, Olivieri M, Quirce S, Sastre J, Walusiak-Skorupa J, Raulf-Heimsoth M. EAACI position paper: skin prick testing in the diagnosis of occupational type I allergies. Allergy 2013; 68:580-4. [PMID: 23409759 DOI: 10.1111/all.12120] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2012] [Indexed: 11/27/2022]
Abstract
Skin prick testing (SPT) in combination with the clinical history of the patient is one important step in the diagnosis of IgE-mediated occupational allergies. However, skin test performance is related to the quality of allergen extracts. The present consensus document was prepared by an EAACI Task Force consisting of an expert panel of allergologists and occupational physicians from Germany, Italy, Spain, France, Austria, and Poland. All members of the panel were also involved in the data collection within the European multicentre study STADOCA (Standard diagnosis for occupational allergy). The aim of this Task Force was the assessment of the quality of commercially available SPT solutions for selected occupational allergens under standardized procedure conditions in different European centres and institutes of Occupational Medicine. The data evaluation shows a wide variability among SPT solutions and also indicates that the sensitivity of several SPT solutions is low. Therefore, improvement and standardization of SPT solutions for occupational allergens is highly recommended. Clinical practitioners should also not presume that their SPT solutions are fully reliable. The main objective of the document is to issue consensus suggestions for the use of SPT with occupational allergens based on the European multicentre study STADOCA, on existing scientific evidence and the expertise of a panel of allergologists.
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Affiliation(s)
- V. van Kampen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Ruhr-University Bochum (IPA); Bochum; Germany
| | - F. de Blay
- Department of Chest Diseases; University Hospital Strasbourg; Strasbourg; France
| | - I. Folletti
- Occupational Medicine; Terni Hospital; University of Perugia; Perugia; Italy
| | - P. Kobierski
- Austrian workers compensation board; Rehabilitation Clinic Tobelbad; Tobelbad; Austria
| | - G. Moscato
- Allergy and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Research and Care; Scientific Institute of Pavia; Pavia; Italy
| | - M. Olivieri
- Unit of Occupational Medicine; University Hospital of Verona; Verona; Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz (IdiPAZ) and CIBER of Respiratory Diseases CIBERES; Madrid; Spain
| | - J. Sastre
- Department of Allergy; Fundación Jiménez Díaz and CIBER of Respiratory Diseases CIBERES; Madrid; Spain
| | | | - M. Raulf-Heimsoth
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Ruhr-University Bochum (IPA); Bochum; Germany
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Murgia N, Dell'Omo M, Gambelunghe A, Folletti I, Muzi G, Abbritti G. [Epidemiological evidence of possible musculoskeletal, cardiovascular and neoplastic effects in professional drivers]. G Ital Med Lav Ergon 2012; 34:310-313. [PMID: 23405649] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The road and rail transport sector, since the several work tipology and risk factors for workers safety and health, is an area where assessing exposure effects is very difficult. Muscoskeletal cardiovascular and neoplastic diseases are the disorders more frequently associated to professional drivers. The role of professional driving is rather well-defined in low back pain occurence, correlated to whole body vibration exposure. Professional drivers are at higher risk of ischemic cardiovascular diseases, but it is not clear whether the risk is attributable just to the occupational exposures or also to their life-style risk factors. Evidence of an excess of risk for lung, genito-urinary and hemolymphopoietic cancer is clear in the scientific literature for professional drivers. Anyway the lack in the control of confounding factors, in exposure assessment force to be very cautious in results interpretation.
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Affiliation(s)
- N Murgia
- Sezione di Medicina del Lavoro, Malattie Respiratorie e Tossicologia Professionali e Ambientali, Università degli Studi di Perugia.
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dell'Omo M, Abbritti G, Folletti I, Gambelunghe A, Muzi G, Rossi LE, Murgia N. [Reduction of tobacco smoking among physicians of a hospital in central Italy]. G Ital Med Lav Ergon 2012; 34:453-455. [PMID: 23405688] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study assessed the variations in smoking habit in physicians in a General Hospital in Central Italy in 12 years. Data were collected from medical records of workers who underwent health surveillance in 1998-99 and in 2010-11. The prevalence of smokers was 26.3% (male 25.6%, female 27.6%) in 1998-99 and 19.2% (male 19.8%, female 18.5%) in 2010-11. As compared to 1998-99, the prevalence of smokers in 2010-11 was reduced in both sex and in all age classes. Despite the relevant reduction, the prevalence of smokers among physicians remains still high. Occupational physicians could play an important role against tobacco smoking, as they can provide a brief counseling to all smoking physicians during medical health surveillance at workplace and take part in worksite health promotion programmes.
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Affiliation(s)
- M dell'Omo
- Istituto di Medicina del Lavoro, Malattie Respiratorie e Tossicologia Professionali ed Ambientali - Università degli Studi di Perugia
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Moscato G, Pala G, Barnig C, Blay F, Del Giacco SR, Folletti I, Heffler E, Maestrelli P, Pauli G, Perfetti L, Quirce S, Sastre J, Siracusa A, Walusiak-Skorupa J, Wjik RG. EAACI consensus statement for investigation of work-related asthma in non-specialized centres. Allergy 2012; 67:491-501. [PMID: 22257175 DOI: 10.1111/j.1398-9995.2011.02784.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2011] [Indexed: 11/28/2022]
Abstract
Work-related asthma (WRA) is a relevant problem in several countries, is cause of disability and socioeconomic consequences for both the patient and the society and is probably still underdiagnosed. A correct diagnosis is extremely important to reduce or limit the consequences of the disease. This consensus document was prepared by a EAACI Task Force consisting of an expert panel of allergologists, pneumologists and occupational physicians from different European countries. This document is not intended to address in detail the full diagnostic work-up of WRA, nor to be a formal evidence-based guideline. It is written to provide an operative protocol to allergologists and physicians dealing with asthma useful for identifying the subjects suspected of having WRA to address them to in-depth investigations in a specialized centre. No evidence-based system could be used because of the low grade of evidence of published studies in this area, and instead, 'key messages' or 'suggestions' are provided based on consensus of the expert panel members.
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Affiliation(s)
- G. Moscato
- Allergy and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia; Italy
| | - G. Pala
- Allergy and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia; Italy
| | - C. Barnig
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital Strasbourg; Strasbourg; France
| | - F. Blay
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital Strasbourg; Strasbourg; France
| | - S. R. Del Giacco
- Department of Medical Sciences ‘M. Aresu’; University of Cagliari; Cagliari; Italy
| | - I. Folletti
- Department of Clinical and Experimental Medicine; Occupational Allergy Unit; Terni Hospital; University of Perugia; Perugia; Italy
| | - E. Heffler
- Allergy and Clinical Immunology; University of Torino; ASO Mauriziano ‘Umberto I’; Torino; Italy
| | - P. Maestrelli
- Department of Environmental Medicine and Public Health; University of Padova; Padova; Italy
| | - G. Pauli
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital Strasbourg; Strasbourg; France
| | - L. Perfetti
- Allergy and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia; Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz-IdiPAZ and CIBER de Enfermedades Respiratorias CIBERES; Madrid; Spain
| | - J. Sastre
- CIBER de Enfermedades Respiratorias; Ciberes and Department of Allergy; Fundación Jiménez Díaz; Madrid; Spain
| | - A. Siracusa
- Department of Clinical an Experimental Medicine; University of Perugia; Perugia; Italy
| | - J. Walusiak-Skorupa
- Department of Occupational Diseases; Nofer Institute of Occupational Medicine; Lodz; Poland
| | - R. Gerth Wjik
- Section of Allergology; Department of Internal Medicine; Erasmus MC; Rotterdam; the Netherlands
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Moscato G, Pala G, Boillat MA, Folletti I, Gerth van Wijk R, Olgiati-Des Gouttes D, Perfetti L, Quirce S, Siracusa A, Walusiak-Skorupa J, Tarlo SM. EAACI position paper: prevention of work-related respiratory allergies among pre-apprentices or apprentices and young workers. Allergy 2011; 66:1164-73. [PMID: 21557751 DOI: 10.1111/j.1398-9995.2011.02615.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [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: 11/29/2022]
Abstract
Apprenticeship is a period of increased risk of developing work-related respiratory allergic diseases. There is a need for documents to provide appropriate professional advice to young adults aiming to reduce unsuitable job choices and prevent impairment from their careers. The present document is the result of a consensus reached by a panel of experts from European and non-European countries addressed to allergologists, pneumologists, occupational physicians, primary care physicians, and other specialists interested in this field, which aims to reduce work-related respiratory allergies (rhinoconjunctivitis and asthma) among allergic or nonallergic apprentices and other young adults entering the workforce. The main objective of the document is to issue consensus suggestions for good clinical practice based on existing scientific evidence and the expertise of a panel of physicians.
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Affiliation(s)
- G Moscato
- Allergy and Immunology Unit, Fondazione 'Salvatore Maugeri', Institute of Care and Research, Scientific Institute of Pavia, Italy
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Liccardi G, D'Amato G, Antonicelli L, Berra A, Billeri L, Canonica GW, Casino G, Cecchi L, Folletti I, Gani F, Lombardi C, Lo Schiavo M, Meriggi A, Milanese M, Passalacqua G, Pio R, Rolla G, Russo M, Scaccianoce S, Senna GE, Scavalli P, Scichilone N, Sposato B, Siracusa A, Ventura MT. Sensitization to horse allergens in Italy: a multicentre study in urban atopic subjects without occupational exposure. Int Arch Allergy Immunol 2011; 155:412-7. [PMID: 21346372 DOI: 10.1159/000321414] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 09/17/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Horses play a significant role in people's leisure time in Italy and other countries, but few data are available on IgE-mediated sensitization to horse allergens in patients without occupational exposure. We assessed, in a multicentric survey, the prevalence of horse sensitization in atopic subjects and its clinical characteristics. METHODS Allergists from the whole Italian territory were required to collect the results of skin prick tests from at least 100 consecutive subjects. Those patients with a positive skin test to horse dander underwent a detailed interview concerning clinical history, pet ownership and possible exposure. RESULTS Data from 3,235 outpatients were collected and 2,097 had at least 1 skin positivity. Among them, 113 (5.38%) were sensitized to horse dander (9 monosensitized). Thirty patients reported direct horse contact (4 owners and 26 for riding or occasional contact), 23 patients were sometimes in contact with horse owners and 60 subjects denied any direct or indirect exposure. Among 9 horse monosensitized patients, 6 had intermittent and mild rhinitis and 3 persistent moderate/severe rhinitis plus asthma. Three of them were horse owners or riders and the remaining had no contact with the animal. CONCLUSIONS Our data evidence that the rate of sensitization to horse dander is not negligible and probably underestimated. In susceptible, not occupationally exposed individuals, horse contact, but also indirect or no apparent exposure, may induce sensitization. We recommend inclusion of horse allergen in the routine panel for the diagnosis of respiratory allergy.
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Affiliation(s)
- G Liccardi
- Department of Chest Diseases, Division of Pneumology and Allergology, High Speciality A. Cardarelli Hospital, Naples, Italy
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Folletti I, Siracusa A. Re: allergy to rodents: an update. Clin Exp Allergy 2011; 41:292; author reply 292. [PMID: 21231977 DOI: 10.1111/j.1365-2222.2010.03652.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Moscato G, Vandenplas O, Van Wijk RG, Malo JL, Perfetti L, Quirce S, Walusiak J, Castano R, Pala G, Gautrin D, De Groot H, Folletti I, Yacoub MR, Siracusa A. EAACI position paper on occupational rhinitis. Respir Res 2009; 10:16. [PMID: 19257881 PMCID: PMC2654869 DOI: 10.1186/1465-9921-10-16] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 03/03/2009] [Indexed: 01/15/2023] Open
Abstract
The present document is the result of a consensus reached by a panel of experts from European and non-European countries on Occupational Rhinitis (OR), a disease of emerging relevance which has received little attention in comparison to occupational asthma. The document covers the main items of OR including epidemiology, diagnosis, management, socio-economic impact, preventive strategies and medicolegal issues. An operational definition and classification of OR tailored on that of occupational asthma, as well as a diagnostic algorithm based on steps allowing for different levels of diagnostic evidence are proposed. The needs for future research are pointed out. Key messages are issued for each item.
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Affiliation(s)
- Gianna Moscato
- Allergy and Immunology Unit, Fondazione 'Salvatore Maugeri', Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
| | - Olivier Vandenplas
- Service de Pneumologie, Cliniques de Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | | | - Jean-Luc Malo
- Center for Asthma in the Workplace, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche-Pneumologie, Montreal, Quebec, Canada
| | - Luca Perfetti
- Allergy and Immunology Unit, Fondazione 'Salvatore Maugeri', Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
| | | | - Jolanta Walusiak
- Department of Occupational Diseases, Institute of Occupational Medicine, Lodz, Poland
| | - Roberto Castano
- Center for Asthma in the Workplace, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche-Pneumologie, Montreal, Quebec, Canada
| | - Gianni Pala
- Allergy and Immunology Unit, Fondazione 'Salvatore Maugeri', Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
| | - Denyse Gautrin
- Center for Asthma in the Workplace, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche-Pneumologie, Montreal, Quebec, Canada
| | - Hans De Groot
- Department of Allergology, Erasmus MC, Rotterdam, The Netherlands
| | - Ilenia Folletti
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
| | - Mona Rita Yacoub
- Allergy and Immunology Unit, Fondazione 'Salvatore Maugeri', Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
| | - Andrea Siracusa
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
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Moscato G, Vandenplas O, Gerth Van Wijk R, Malo JL, Quirce S, Walusiak J, Castano R, De Groot H, Folletti I, Gautrin D, Yacoub MR, Perfetti L, Siracusa A. Occupational rhinitis. Allergy 2008; 63:969-80. [PMID: 18691299 DOI: 10.1111/j.1398-9995.2008.01801.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The present document is the result of a consensus reached by a panel of experts from European and nonEuropean countries on Occupational Rhinitis (OR), a disease of emerging relevance, which has received little attention in comparison to occupational asthma. The document covers the main items of OR including epidemiology, diagnosis, management, socio-economic impact, preventive strategies and medicolegal issues. An operational definition and classification of OR tailored to that of occupational asthma, as well as a diagnostic algorithm based on steps allowing different levels of diagnostic evidence, are proposed. The needs for future research are pointed out. Key messages are issued for each item.
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Folletti I, Forcina A, Marabini A, Bussetti A, Siracusa A. Have the prevalence and incidence of occupational asthma and rhinitis because of laboratory animals declined in the last 25 years? Allergy 2008; 63:834-41. [PMID: 18588548 DOI: 10.1111/j.1398-9995.2008.01786.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [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: 11/29/2022]
Abstract
BACKGROUND Data for time trends in the prevalence of occupational asthma (OA) and rhinitis (OR) are not known. OBJECTIVE To investigate the prevalence and incidence of OA and OR over time. METHODS We chose to review studies on the prevalence and incidence of OA and OR due to laboratory animals (LA) as a marker of changing OA and OR patterns over time and analysed 15 cross-sectional and 4 longitudinal studies published from 1980 to 2006. RESULTS The estimated prevalence of OA, defined as work-related chest symptoms (WRCS), declined from 8.2% in 1976 to 4.2% in 2001 (P < 0.005). When defined by WRCS and positive skin prick test (SPT) to LA, the estimated prevalence of OA was 6.7% in 1977 and 2.9% in 1999 (P < 0.02). The prevalence of OR, defined by WRNS or WRNS and SPT to LA, was not related to study date but was inversely associated with mean exposure duration. In four longitudinal studies no clear trend emerged over time. CONCLUSIONS This review suggests a trend toward a progressive decline in the prevalence of occupational asthma due to laboratory animals, which may be due to the reduction of exposure since the early 1980s. A further reduction of exposure is needed to prevent the onset of occupational rhinitis.
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Affiliation(s)
- I Folletti
- Occupational Allergology, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy
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Folletti I, Bussetti A, Armadori M, Giovannelli G, Paolocci G, Siracusa A. [Have the prevalence and incidence of occupational asthma and rhinitis due to laboratory animals declined in the last 25 years?]. G Ital Med Lav Ergon 2007; 29:619-620. [PMID: 18409867] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Data for time trends in the prevalence of occupational asthma (OA) and rhinitis (OR) are not known. To investigate trends in the prevalence and incidence of OA and OR over time, we reviewed the available literature. We analysed 15 cross-sectional and 4 longitudinal studies published from 1980 to 2006. In workers exposed to laboratory animals (LA) the prevalence of OA ranged from 2.2% to 11.7%; the prevalence of OR ranged from 6.7% to 41.7%. When we analysed prevalence by study date using a logistic model, the estimated prevalence of OA declined from 8.7% in 1976 to 4.2% in 2001 (p < 0.003), which is -1.8% every ten years. The prevalence of OR rose slightly from 18.5% in 1976 to 19.7% in 2001 (NS). In four longitudinal studies the incidence of OA ranged from 0.4 to 3.5/100 person years, while the incidence of OR ranged from 2.0 to 10.1/100 person years. No clear trend emerged over time. This review shows a trend toward a progressive decline in the prevalence of occupational asthma due to laboratory animals, which may be due to the reduction of exposure since the early 1980s. A further reduction of exposure is needed to prevent the onset of occupational rhinitis.
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Affiliation(s)
- I Folletti
- Allergologia Professionale e Ambientale, Università degli Studi di Perugia, Dip. Di Med. Clin e Sperim
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Bussetti A, Folletti I, Armadori M, Giovannelli G, Paolocci G, Siracusa A. [Latex allergy in hospital workers--follow-up of symptomatic subjects]. G Ital Med Lav Ergon 2007; 29:418-420. [PMID: 18409755] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Latex allergy may be manifested in a variety of clinical disturbances such as contact urticaria, angioedema, rhinoconjunctivitis, asthma, and anaphylactic reactions. The aim of this follow-up study was to determine whether a change in glove use from powdered to powder-free latex gloves at previously surveyed hospital workers reduced the work-related symptoms. 53 hospital workers with work-related symptoms where followed up 4,6 years after first investigation. On re-examination, 54.7% use both powdered and powder-free gloves, 37.7% used only latex free gloves and 7.6% stopped the glove use. At follow-up, in 68% of subjects there was the remission or the improvement of work-related symptoms. The improvement of symptoms was greater in workers using powder-free gloves than in others (p < 0.005). In conclusion our study shows that preventive measures, such as the use a powder-free latex gloves, are sufficient to induce a reduction of work-related symptoms.
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Affiliation(s)
- A Bussetti
- Medicina del Lavoro, Malattie Respiratorie e Tossicologia Professionale e Ambientale, Università degli Studi di Perugia
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Abstract
Cigarette smoking is a known risk factor for many chronic illnesses such as coronary heart and chronic obstructive pulmonary diseases. Smoking is often described as a risk factor for occupational asthma even though its effect on the development of asthma is still under debate and the links between smoking and occupational asthma, occupational rhinitis or occupational sensitization are elusive, controversial and contradictory. This review describes these relationships in a wide range of occupations, from laboratory, farm, brewery and hospital workers, to bakers, printers, cleaners, fish processors and others as observed in cross-sectional, cohort, and case-control studies published over the past thirty-five years i.e. from 1970 to 2005. Surprisingly, the data show there is little to support the view that the risk of occupational asthma is increased in workers who are smokers. However, evidence emerges of an increased risk of occupational sensitization in smoking workers exposed to several high and low molecular weight agents. This in-depth review confirms the relationship between smoking and occupational asthma is complex and contradictory. It deserves more attention and further studies, which need to be conducted without being influenced by selection bias or by the justifiable prejudice against smoking.
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Affiliation(s)
- A Siracusa
- Occupational Allergology, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy.
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Folletti I, Belardinelli V, Giovannini G, Cresta B, Fabrizi G, Tacconi C, Stopponi R, Ferrari L, Siracusa A. [Prevalence and determinants of low back pain in hospital workers]. G Ital Med Lav Ergon 2005; 27:359-61. [PMID: 16240595] [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] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This study evaluated the prevalence and determinants of low back pain (LBP) in Terni hospital workers. Each ward sister completed a questionnaire about potential determinants of LBP associated with physical loads. Moreover, a trained ward sister administered a questionnaire about the characteristics of low back pain to 512 subjects. In the previous year the prevalence of LBP was 58.8%. It was more common in subjects under 45 years of age. >3 LBP episodes annually were more frequent in operating rooms and medical wards. LBP lasted >1 week in 29% of females and in 23% of males. LBP caused change of duties or time off work in 11% of females and in 8% of males.
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Affiliation(s)
- I Folletti
- Medico del lavoro, Monteleone di Orvieto, Terni
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Siracusa A, Marabini A, Pace ML, Tacconi C, Folletti I, Bussetti A, Maestrelli P. [Occupational asthma: role of airway inflammation and remodelling in persistent respiratory symptoms and bronchial hyper-responsiveness]. Med Lav 2004; 95:275-81. [PMID: 15532960] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND Until the late 1970's occupational asthma (OA) was considered reversible once patients were removed from exposure. Unfortunately, respiratory symptoms and non-specific bronchial hyper-responsiveness (NSBH) persist in about two-thirds of patients for years after removal from the offending agent. OBJECTIVES AND METHODS This review focuses on the role of airways inflammation and remodelling in persistent respiratory symptoms and NSBH after cessation of occupational exposure. RESULTS Even though cessation of exposure does not always result in remission of OA, symptoms, airways calibre and NSBH do improve in many patients. Although improvements in FEV1 and NSBH tend to reach a plateau 1-2 years after workers leave exposure, reversing NSBH may take much longer and respiratory symptoms and NSBH can persist in subjects removed from exposurefor >10 yrs. Long-term treatment with inhaled corticosteroids (ICS) induces a small but significant improvement in respiratory symptoms and in quality of life and a decrease in NSBH. Prolonged exposure and respiratory symptoms, marked airway obstruction and NSBH, high total cell, eosinophil and neutrophil counts in bronchoalveolar lavage fluid, a strong reaction during specific inhalation challenge, and delayed treatment with ICS have been identified as prognostic factors of unfavourable outcome. If exposure persists, OA tends to deteriorate in many patients but regular long-term treatment with ICS and long-acting beta2-agonists seems to stabilize the outcome. Soon after the last exposure inflammatory cell infiltrates, including eosinophils, and increased thickness of sub-epithelial collagen have been observed. When time since removal from exposure was longer, persistence of respiratory symptoms and NSBH was associated with airway inflammation, remodelling and hypersensitivity to the offending agent. Thickness of sub-epithelial collagen and specific airway sensitivity were reduced after prolonged non-exposure to isocyanates, although NSBH and airway inflammation persisted. CONCLUSIONS Pathologic features are similar in OA and non-occupational asthma. The main factors of favourable outcome are early removal from exposure and a mild airway obstruction and NSBH at diagnosis. Persistence of airway inflammation years after removal from exposure suggests this process may become independent of the offending agent. The role of remodelling on persistence of OA needs to be clarified further.
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Affiliation(s)
- A Siracusa
- Allergologia Professionale e Ambientale, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Perugia.
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D'Alessandro A, Folletti I, Muzi G, Murgia N, Brugnami G, Abritti G. [Use of sputum in the follow-up of hypersensitivity pneumonia]. G Ital Med Lav Ergon 2003; 25 Suppl:284-5. [PMID: 14979187] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- A D'Alessandro
- Istituto di Medicina del Lavoro Università degli Studi di Perugia
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