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Caminati M, Senna G, Maule M, Di Sabatino A, Rossi CM. Diagnosis, management and therapeutic options for eosinophilic esophagitis. Curr Opin Allergy Clin Immunol 2024; 24:122-128. [PMID: 38656287 DOI: 10.1097/aci.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW Eosinophilic esophagitis is a chronic and commonly evolving condition leading to relevant and potentially irreversible burden in terms of tissue damage and related functional impairment, thus significantly impacting on quality of life. The aim of the present review is to summarize the recent advances in terms of diagnostic work-up and pharmacological and nonpharmacological management of the disease, under the broader perspective of type 2 inflammation. RECENT FINDINGS Two major novelties have prompted an innovative approach to EoE. In terms of diagnosis, it has been proposed to dissect the disease heterogeneity in three endotypes, independent from tissue eosinophil number: EoEe1, characterized by normal appearing oesophagus; EoEe2, associated with type 2 inflammation and steroid-refractoriness; EoEe3, whose features include adult onset, a more fibro-stenotic aspect and loss of epithelial gene expression. Concerning treatment, two recently licensed drugs for EoE, oro-dispersible budesonide and dupilumab represent the first treatment options specifically developed for EoE and addressing EoE-related peculiar pathobiological features. SUMMARY In the era of precision medicine, managing EoE according to a phenotype-driven approach might be helpful in defining the best treatment options in the different disease forms or stages. In addition, exploring the coexistence or the previous occurrence of other type 2 conditions may suggest the opportunity to specifically target type 2 inflammation through biologic therapy. The complex EoE pathobiology combining inflammatory and functional features, both at organ and systemic level, requires a multidimensional approach relying on the strict integration of gastroenterologists and allergist-immunologists.
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Affiliation(s)
- Marco Caminati
- Asthma Center and Allergy Unit, Center for Hyper-eosinophilic dysimmune conditions, Integrated University Hospital of Verona
- Department of Medicine, University of Verona, Verona
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Center for Hyper-eosinophilic dysimmune conditions, Integrated University Hospital of Verona
- Department of Medicine, University of Verona, Verona
| | - Matteo Maule
- Asthma Center and Allergy Unit, Center for Hyper-eosinophilic dysimmune conditions, Integrated University Hospital of Verona
- Department of Medicine, University of Verona, Verona
| | - Antonio Di Sabatino
- Department of Medicine and Medical Therapeutics, University of Pavia
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlo Maria Rossi
- Department of Medicine and Medical Therapeutics, University of Pavia
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Cutroneo PM, Arzenton E, Furci F, Scapini F, Bulzomì M, Luxi N, Caminati M, Senna G, Moretti U, Trifirò G. Safety of Biological Therapies for Severe Asthma: An Analysis of Suspected Adverse Reactions Reported in the WHO Pharmacovigilance Database. BioDrugs 2024; 38:425-448. [PMID: 38489062 PMCID: PMC11055782 DOI: 10.1007/s40259-024-00653-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The management of uncontrolled severe asthma has greatly improved since the advent of novel biologic therapies. Up to August 2022, five biologics have been approved for the type 2 asthma phenotype: anti-IgE (omalizumab), anti-IL5 (mepolizumab, reslizumab, benralizumab), and anti-IL4 (dupilumab) monoclonal antibodies. These drugs are usually well tolerated, although long-term safety information is limited, and some adverse events have not yet been fully characterized. Spontaneous reporting systems represent the cornerstone for the detection of potential signals and evaluation of the real-world safety of all marketed drugs. OBJECTIVE The aim of this study was to provide an overview of safety data of biologics for severe asthma using VigiBase, the World Health Organization global pharmacovigilance database. METHODS We selected all de-duplicated individual case safety reports (ICSRs) attributed to five approved biologics for severe asthma in VigiBase, up to 31st August 2022 (omalizumab, mepolizumab, reslizumab, benralizumab and dupilumab). Descriptive frequency analyses of ICSRs were carried out both as a whole class and as individual products. Reporting odds ratios (ROR) with 95% confidence intervals (CIs) were used as the measure of disproportionality for suspected adverse drug reactions (ADRs) associated with the study drugs compared with either all other suspected drugs (Reference Group 1, RG1) or inhaled corticosteroids plus long-acting β-agonists (ICSs/LABAs) (Reference Group 2, RG2) or with oral corticosteroids (OCSs) (Reference Group 3, RG3). RESULTS Overall, 31,724,381 ICSRs were identified in VigiBase and 167,282 (0.5%) were related to study drugs; the remaining reports were considered as RG1. Stratifying all biologic-related ICSRs by therapeutic indication, around 29.4% (n = 48,440) concerned asthma use; omalizumab was mainly indicated as the suspected drug (n = 20,501), followed by dupilumab, mepolizumab, benralizumab and reslizumab. Most asthma ICSRs concerned adults (57%) and women (64.1%). Asthma biologics showed a higher frequency of serious suspected ADR reporting than RG1 (41.3% vs 32.3%). The most reported suspected ADRs included asthma, dyspnea, product use issue, drug ineffective, cough, headache, fatigue and wheezing. Asthma biologics were disproportionally associated with several unknown or less documented adverse events, such as malignancies, pulmonary embolism and deep vein thrombosis with omalizumab; alopecia and lichen planus with dupilumab; alopecia and herpes infections with mepolizumab; alopecia, herpes zoster and eosinophilic granulomatosis with polyangiitis related to benralizumab; and alopecia with reslizumab. CONCLUSIONS The most frequently reported suspected ADRs of asthma biologics in VigiBase confirmed the presence of well-known adverse effects such as general disorders, injection-site reactions, nasopharyngitis, headache and hypersensitivity, while some others (e.g. asthma reactivation or therapeutic failure) could be ascribed to the indication of use. Moreover, the analysis of signals of disproportionate reporting suggests the presence of malignancies, effects on the cardiovascular system, alopecia and autoimmune conditions, requiring further assessment and investigation.
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Affiliation(s)
- Paola Maria Cutroneo
- Unit of Clinical Pharmacology, Sicily Pharmacovigilance Regional Centre, University Hospital of Messina, Messina, Italy
| | - Elena Arzenton
- Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Fabiana Furci
- Provincial Healthcare Unit, Section of Allergy, Vibo Valentia, Italy
| | - Fabio Scapini
- Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Maria Bulzomì
- Unit of Clinical Pharmacology, Sicily Pharmacovigilance Regional Centre, University Hospital of Messina, Messina, Italy
| | - Nicoletta Luxi
- Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona, Verona, Italy
- Asthma Centre and Allergy Unit, University of Verona and Verona University Hospital, Verona, Italy
| | - Ugo Moretti
- Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Gianluca Trifirò
- Section of Pharmacology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
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Latorre M, Rizzi A, Paggiaro P, Baiardini I, Bagnasco D, DelGiacco S, Lombardi C, Patella V, Nucera E, Parente R, Paoletti G, Pini L, Ridolo E, Senna G, Blasi F, Canonica GW, Aruanno A, Ballacchino C, Bonavia M, Calabrese C, Caminati M, Carbonara M, Cardini C, Caruso C, Cattani L, Crivellaro MA, Diana A, Durante E, Favero E, Barbaro MPF, Frateiacci S, Guarnieri G, Lofaro A, Losa F, Magarò N, Menzella F, Ricciardi L, Scioscia G, Testino E, Torracca F. Asthma management, focused on the use of oral corticosteroids: the opinions of Italian asthmatic patients. J Asthma 2024:1-26. [PMID: 38578082 DOI: 10.1080/02770903.2024.2338863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 03/31/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Patients' perceptions of asthma symptoms, and attitudes regarding diagnosis and management, can affect their ability to reach good asthma control. The aim of the study was to explore patients' perceptions of asthma management, with focus on treatment with oral corticosteroids (OCS). METHODS A DOXAPHARMA survey was conducted. A questionnaire with 46 multiple choice questions was completed by 50 patients with severe uncontrolled asthma, and 258 with mild-moderate controlled or partly controlled asthma. Participants were representative of Italian asthmatic patients-with medium age, long asthma duration, delayed diagnosis, poor asthma control, and frequent exacerbations. RESULTS Many asthmatics reported inadequate pharmacologic treatment. The majority but not all patients regularly used ICS/LABA. Oral treatment was common, mainly with OCS, particularly in severe asthmatics. One-fourth of patients did not regularly use inhaled therapy, and adherence was poor, resulting in frequent OCS use to treat exacerbations, which were common in mild-moderate cases. Patients were fairly satisfied with asthma therapies, but many had concerns about long-term corticosteroid use. Patients complained about poor management of comorbidities associated with asthma and OCS use, but were generally satisfied with their patient/doctor relationships. Many patients failed to achieve optimal health-related quality of life (HRQoL), mainly those with severe asthma who used OCS treatment and emphasized how OCS therapy impacted QoL. CONCLUSIONS The survey results confirmed many problems related to mild-moderate and severe asthma management in Italy and highlighted the overuse of OCS rather than more effective and safe treatments, which had strong negative effects on HRQoL.
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Affiliation(s)
- Manuela Latorre
- Pulmonology Unit, Department of Medical Specialties, Nuovo Ospedale Apuano, Massa, Italy
| | - Angela Rizzi
- UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche addominali ed endocrino metaboliche, Roma, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Ilaria Baiardini
- Respiratory Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Diego Bagnasco
- Clinica delle Malattie Respiratorie ed Allergologia, IRCCS Policlinico San Martino, Genova, Italy
- Dipartimento di Medicina Interna (DIMI), Università degli Studi di Genova, Italy
| | - Stefano DelGiacco
- Unit of Allergy and Clinical Immunology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Carlo Lombardi
- Departmental Unit of Allergology & Respiratory Diseases Fondazione Poliambulanza Brescia, Italy
| | - Vincenzo Patella
- Department of Internal and Respiratory Medicine, Division of Allergy and Clinical Immunology, "Santa Maria della Speranza" Hospital, Salerno, Italy
| | - Eleonora Nucera
- UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche addominali ed endocrino metaboliche, Roma, Italy
- Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Roberta Parente
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Salerno, Italy
| | - Giovanni Paoletti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Laura Pini
- Department of Clinical and Experimental Sciences, Spedali Civili di Brescia, University of Brescia, Italy
| | - Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - Francesco Blasi
- Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Arianna Aruanno
- UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche addominali ed endocrino metaboliche, Roma, Italy
| | | | | | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Marco Caminati
- Department of Medicine, Asthma, Allergy and Clinical Immunology Section, University of Verona, Verona, Italy
| | | | - Cristina Cardini
- Fondazione della Salute Respiratoria della Società Itaiana di Pneumologia SIP-IRS (via San Gregorio 12, 20124, Milano) Milan, Italy
| | - Cristiano Caruso
- UOSD DH INTERNAL MEDICINE AND DIGESTIVE DISEASE, Fondazione Policlinico A. Gemelli, IRCCS Rome Italy
| | - Luciano Cattani
- FederASMA e ALLERGIE OdV - Federazione Italiana Pazienti
- AsmaGrave OdV
| | - Maria Angiola Crivellaro
- Occupational Health Unit and Allergology Padova University Hospital, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alessandra Diana
- APACS APS - Associazione Pazienti della Sindrome di Churg Strauss
| | - Eugenia Durante
- APACS APS - Associazione Pazienti della Sindrome di Churg Strauss
| | - Elisabetta Favero
- Centro Allergologico e Malattie Rare, Dipartimento di Medicina Ospedale Ca' Foncello, Treviso, Italy
| | | | - Sandra Frateiacci
- FederASMA e ALLERGIE OdV - Federazione Italiana Pazienti
- ALAMA APS - Associazione Liberi dall'Asma, dalle Malattie Allergiche, Atopiche, Respiratorie e Rare
| | - Gabriella Guarnieri
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, Respiratory Pathophysiology Unit, University of Padova, Padova, Italy
| | - Alessia Lofaro
- FederASMA e ALLERGIE OdV - Federazione Italiana Pazienti
| | - Francesca Losa
- UO di Allergologia, Immunologia clinica e Reumatologia, Ospedale Carlo Poma, ASST Mantova, Italy
| | - Nadia Magarò
- FederASMA e ALLERGIE OdV - Federazione Italiana Pazienti
| | - Francesco Menzella
- Pulmonology Unit, S. Valentino Hospital, AULSS 2 Marca Trevigiana, Montebelluna, Treviso, Italy
| | - Luisa Ricciardi
- Allergy and Clinical Immunology Unit, A.O.U. Policlinico "G. Martino"; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Elisa Testino
- Clinica delle Malattie Respiratorie ed Allergologia, IRCCS Policlinico San Martino, Genova, Italy
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Menzella F, Munari S, Corsi L, Tonin S, Cestaro W, Ballarin A, Floriani A, Dartora C, Senna G. Tezepelumab: patient selection and place in therapy in severe asthma. J Int Med Res 2024; 52:3000605241246740. [PMID: 38676539 PMCID: PMC11056094 DOI: 10.1177/03000605241246740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/21/2024] [Indexed: 04/29/2024] Open
Abstract
Asthma is a disease characterised by heterogeneous and multifaceted airway inflammation. Despite the availability of effective treatments, a substantial percentage of patients with the type 2 (T2)-high, but mainly the T2-low, phenotype complain of persistent symptoms, airflow limitation, and poor response to treatments. Currently available biologicals target T2 cytokines, but no monoclonal antibodies or other specific therapeutic options are available for non-T2 asthma. However, targeted therapy against alarmins is radically changing this perspective. The development of alarmin-targeted therapies, of which tezepelumab (TZP) is the first example, may offer broad action on inflammatory pathways as well as an enhanced therapeutic effect on epithelial dysfunction. In this regard, TZP demonstrated positive results not only in patients with severe T2 asthma but also those with non-allergic, non-eosinophilic disease. Therefore, it is necessary to identify clinical features of patients who can benefit from an upstream targeted therapy such as anti-thymic stromal lymphopoietin. The aims of this narrative review are to understand the role of alarmins in asthma pathogenesis and epithelial dysfunction, examine the rationale underlying the indication of TZP treatment in severe asthma, summarise the results of clinical studies, and recognise the specific characteristics of patients potentially eligible for TZP treatment.
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Affiliation(s)
- Francesco Menzella
- Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
- Pulmonology and Otolaryngology Multidisciplinary Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
| | - Sara Munari
- Pulmonology and Otolaryngology Multidisciplinary Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
- Otolaryngology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
| | - Lorenzo Corsi
- Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
- Pulmonology and Otolaryngology Multidisciplinary Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
| | - Silvia Tonin
- Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
- Pulmonology and Otolaryngology Multidisciplinary Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
| | - Walter Cestaro
- Pulmonology and Otolaryngology Multidisciplinary Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
- Otolaryngology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
| | - Andrea Ballarin
- Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
| | - Ariel Floriani
- Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
| | - Cristina Dartora
- Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona & AOUI Verona, Policlinico GB Rossi, Verona, Italy
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Cameli P, Aliani M, Altieri E, Bracciale P, Brussino L, Caiaffa MF, Canonica GW, Caruso C, Centanni S, D’Amato M, De Michele F, Del Giacco S, Di Marco F, Pelaia G, Rogliani P, Romagnoli M, Schino P, Schroeder JW, Senna G, Vultaggio A, Benci M, Boarino S, Menzella F. Sustained Effectiveness of Benralizumab in Naïve and Biologics-Experienced Severe Eosinophilic Asthma Patients: Results from the ANANKE Study. J Asthma Allergy 2024; 17:273-290. [PMID: 38562251 PMCID: PMC10982664 DOI: 10.2147/jaa.s438981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/16/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Severe eosinophilic asthma (SEA) patients often present overlapping inflammatory features rendering them eligible for multiple biologic therapies; switching biologic treatment is a strategy adopted to optimize asthma control when patients show partial or no response to previous biologics. Patients and Methods ANANKE is a retrospective, multicenter Italian study (NCT04272463). Here, we outline the characteristics and long-term clinical outcomes in naïve-to-biologics and biologics-experienced patients treated with benralizumab for up to 96 weeks. Bio-experienced patients were split into omalizumab and mepolizumab subsets according to the type of biologic previously used. Results A total of 124 (76.5%) naïve and 38 (23.5%) bio-experienced patients were evaluated at index date; 13 patients (34.2%) switched from mepolizumab, 21 patients (55.3%) switched from omalizumab, and four patients (10.5%) received both biologics. The mepolizumab subset was characterized by the longest SEA duration (median of 4.6 years), the highest prevalence of chronic rhinosinusitis with nasal polyposis (CRSwNP) (76.5%), and the greatest oral corticosteroid (OCS) daily dosage (median of 25 mg prednisone equivalent). The omalizumab group showed the highest severe annual exacerbation rate (AER) (1.70). At 96 weeks, treatment with benralizumab reduced any and severe AER by more than 87% and 94%, respectively, across all groups. Lung function was overall preserved, with major improvements observed in the mepolizumab group, which also revealed a 100% drop of the median OCS dose. Asthma Control Test (ACT) score improved in the naïve group while its increment was more variable in bio-experienced patients; among these, a marked difference was noticed between omalizumab and mepolizumab subsets (median ACT score of 23.5 and 18, respectively). Conclusion Benralizumab promotes durable and profound clinical benefits in naïve and bio-experienced groups, indicating that a nearly complete depletion of eosinophils is highly beneficial in the control of SEA, independently of previous biologic use.
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Affiliation(s)
- Paolo Cameli
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Maria Aliani
- UO Pneumologia e Pneumologia Riabilitativa, ICS Maugeri, IRCCS Bari, Bari, Italy
| | - Elena Altieri
- Reparto di Pneumologia, P.O. Garbagnate Milanese, Garbagnate Milanese (MI), Italy
| | | | - Luisa Brussino
- Dipartimento di Scienze Mediche, Università degli Studi di Torino; SCDU Immunologia e Allergologia, AO Ordine Mauriziano Umberto I, Torino, Italy
| | - Maria Filomena Caiaffa
- Cattedra e Scuola di Allergologia e Immunologia Clinica, Dipartimento di Scienze Mediche, Università di Foggia, Foggia, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Personalized Medicine Center: Asthma and Allergology, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Cristiano Caruso
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Stefano Centanni
- Respiratory Unit ASST Santi Paolo e Carlo, Department of Health Sciences Universita’ degli Studi di Milano, Milano, Italy
| | - Maria D’Amato
- UOSD Malattie Respiratorie “Federico II”, Ospedale Monaldi, AO Dei Colli, Napoli, Italy
| | - Fausto De Michele
- UOC Pneumologia e Fisiopatologia Respiratoria, AORN A. Cardarelli, Napoli, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Fabiano Di Marco
- Department of Health Sciences, Università Degli Studi Di Milano, Pneumologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Girolamo Pelaia
- Dipartimento di Scienze della Salute, Università Magna Graecia, Catanzaro, Italy
| | - Paola Rogliani
- Division of Respiratory Medicine, University Hospital “Tor Vergata”, Roma, Italy
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, Roma, Italy
| | | | - Pietro Schino
- Fisiopatologia Respiratoria, Ospedale Generale Regionale, Ente Ecclesiastico “F. Miulli”, Acquaviva delle Fonti (BA), Italy
| | - Jan Walter Schroeder
- Allergy and Clinical Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Gianenrico Senna
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Alessandra Vultaggio
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Firenze, Italy
| | - Marco Benci
- Medical Affairs R&I, AstraZeneca, Milano, Italy
| | | | - Francesco Menzella
- Pulmonology Unit, Ospedale “S. Valentino”, AULSS 2 Marca Trevigiana, Montebelluna (TV), Italy
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6
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Lombardi C, Passalacqua G, Menzella F, Mauritz Canevari RF, Danesi G, Pusateri AM, Carone M, Vancheri C, Di Marco F, Micheletto C, Manzotti G, Di Gioacchino M, Bilò MB, Gelardi M, Senna G, Canonica GW. Chronic rhinosinusitis with nasal polyposis and biological agents: the ARIA-ITALY Survey. Eur Ann Allergy Clin Immunol 2024. [PMID: 38534135 DOI: 10.23822/eurannaci.1764-1489.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Summary Background. Chronic rhinosinusitis (CRS) is an inflammatory disease that affects the nasal mucosa and the paranasal sinuses. CRS can be associated by nasal polyposis (CRSwNP phenotype) in up to 30% of patients and it is frequently associated with bronchial asthma. CRSwNP shows predominantly an underlying activation of type 2 inflammatory pathways with the involvement of eosinophils, IgE, interleukin (IL)-4, IL-5 and IL-13. Biological drugs that target these inflammatory cytokines are currently a therapeutic option recognized by guidelines for the treatment of uncontrolled form of the disease. Methods. As part of the activity of the "ARIA-Italy" working group, a panel of 255 Italian Ear, Nose and Throat (ENT) specialists, pneumologists and immuno-allergologists actively participated in this national survey and answered a series of questions geared toward understanding the main criteria for patient characterization and therapeutic decision, highlighting multidisciplinarity, and the implementation of the management of CRSwNP patients, as a part of the precision medicine concept and the appropriate use of the biologicals. Results. Two hundred and fifty-five experts and specialists participated in the survey. Conclusions. The results of this survey obtained from an extensive number of active specialists throughout Italy allow some important concluding remarks to be drawn. The main points of agreement were that multidisciplinary care teams provide many benefits but that, once the team is established, meetings and communication between members must be coordinated. Finally, the dissemination of national disease registries and the continuous updating of guidelines and position papers related to CRSwNP and comorbidities should be encouraged.
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Affiliation(s)
- C Lombardi
- Co-Chairman ARIA ITALY; Unit of Allergology, Clinical Immunology and Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - G Passalacqua
- Co-Chairman ARIA-Italy Allergy and Respiratory Diseases, IRCCS Policlinico S. Martino, University of Genoa, Genoa, Italy
| | - F Menzella
- UOC Pulmonary, "S. Valentino" Hospital, AULSS 2 Marca Trevigiana, Montebelluna, Treviso, Italy
| | - R F Mauritz Canevari
- Department of DISC, Otolaryngologist Clinic-IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - G Danesi
- Unità Operativa di Otorinolaringoiatria e Microchirurgia della Base Cranica, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - A M Pusateri
- Unità Operativa di Otorinolaringoiatria e Microchirurgia della Base Cranica, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - M Carone
- Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Telese Terme, Benevento, Italy
| | - C Vancheri
- UOC Respiratory System Diseases, Università degli Studi di Catania, Catania, Italy
| | - F Di Marco
- UOC Respiratory System Diseases, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - C Micheletto
- UOC Pulmonary, Azienda Ospedaliera Universitaria Verona, Verona, Italy
| | - G Manzotti
- Unit of Allergology, Casa di Cura B. Palazzolo, Bergamo, Italy
| | - M Di Gioacchino
- Società Italiana di Asma Allergologia e Immunologia Clinica, University of Chieti, Chieti, Italy
| | - M B Bilò
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Italy
- Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy
| | - M Gelardi
- ENT Clinic, University of Foggia, Foggia, Italy
| | - G Senna
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - G W Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy
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7
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Turner PJ, Ansotegui IJ, Campbell DE, Cardona V, Carr S, Custovic A, Durham S, Ebisawa M, Geller M, Gonzalez-Estrada A, Greenberger PA, Hossny E, Irani C, Leung AS, Levin ME, Muraro A, Oppenheimer JJ, Ortega Martell JA, Pouessel G, Rial MJ, Senna G, Tanno LK, Wallace DV, Worm M, Morais-Almeida M. Updated grading system for systemic allergic reactions: Joint Statement of the World Allergy Organization Anaphylaxis Committee and Allergen Immunotherapy Committee. World Allergy Organ J 2024; 17:100876. [PMID: 38361745 PMCID: PMC10867340 DOI: 10.1016/j.waojou.2024.100876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/28/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024] Open
Abstract
There is a lack of consensus over the description and severity assignment of allergic adverse reactions to immunotherapy, although there seems to be a consensus at least in terms of using the World Allergy Organization (WAO) grading systems to describe local adverse events for Sublingual Immunotherapy (SLIT) and Systemic Allergic Reactions (SARs) to Subcutaneous Immunotherapy (SCIT) amongst the major national/regional allergy societies. In this manuscript, we propose a modification of the previous WAO Grading system for SARs, which aligns with the newly-proposed Consortium for Food Allergy Research (CoFAR) Grading Scale for Systemic Allergic Reactions in Food Allergy (version 3.0). We hope this can facilitate a unified grading system appropriate to SARs due to allergen immunotherapy, independent of allergen and route of administration, and across clinical and research practice.
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Affiliation(s)
- Paul J. Turner
- National Heart Lung Institute, Imperial College London, London, UK
| | | | - Dianne E. Campbell
- Discipline of Paediatrics and Child Health, School of Medicine, University of Sydney, Sydney, Australia
- DBV Technologies, Montrouge, France
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d’Hebron, Barcelona, Spain
| | - Stuart Carr
- Snö Asthma & Allergy, Abu Dhabi, United Arab Emirates
| | - Adnan Custovic
- National Heart Lung Institute, Imperial College London, London, UK
| | - Stephen Durham
- National Heart Lung Institute, Imperial College London, London, UK
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Mario Geller
- Division of Medicine, Academy of Medicine of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alexei Gonzalez-Estrada
- Division of Allergy, Asthma, and Clinical Immunology, Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Paul A. Greenberger
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elham Hossny
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Carla Irani
- Hotel Dieu de France Hospital, St Joseph University, Beirut, Lebanon
| | - Agnes S.Y. Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Michael E. Levin
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Antonella Muraro
- Department of Woman and Child Health, Food Allergy Referral Centre, Padua University Hospital, Padua, Italy
| | - John J. Oppenheimer
- Rutgers New Jersey Medical School, Atlantic Health System Morristown, NJ, USA
| | | | - Guillaume Pouessel
- Department of Paediatrics, Children's Hospital, Roubaix, France
- Paediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, CHU Lille, Lille, France
| | - Manuel J. Rial
- Allergy department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - Luciana K. Tanno
- Hospital Sírio Libanês, São Paulo, Brazil
- University Hospital of Montpellier, Montpellier, and Sorbonne Universités, Paris, France
| | - Dana V. Wallace
- Nova Southeastern University College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Margitta Worm
- Department of Dermatology and Allergology, Charite-Universitätsmedizin, Berlin, Germany
| | | | - the WAO Anaphylaxis Committee and WAO Allergen Immunotherapy Committee
- National Heart Lung Institute, Imperial College London, London, UK
- Dept. Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
- Discipline of Paediatrics and Child Health, School of Medicine, University of Sydney, Sydney, Australia
- DBV Technologies, Montrouge, France
- Allergy Section, Department of Internal Medicine, Hospital Vall d’Hebron, Barcelona, Spain
- Snö Asthma & Allergy, Abu Dhabi, United Arab Emirates
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
- Division of Medicine, Academy of Medicine of Rio de Janeiro, Rio de Janeiro, Brazil
- Division of Allergy, Asthma, and Clinical Immunology, Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
- Hotel Dieu de France Hospital, St Joseph University, Beirut, Lebanon
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
- Department of Woman and Child Health, Food Allergy Referral Centre, Padua University Hospital, Padua, Italy
- Rutgers New Jersey Medical School, Atlantic Health System Morristown, NJ, USA
- Universidad Autónoma del Estado de Hidalgo, Hidalgo, Mexico
- Department of Paediatrics, Children's Hospital, Roubaix, France
- Paediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, CHU Lille, Lille, France
- Allergy department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
- Hospital Sírio Libanês, São Paulo, Brazil
- University Hospital of Montpellier, Montpellier, and Sorbonne Universités, Paris, France
- Nova Southeastern University College of Allopathic Medicine, Fort Lauderdale, FL, USA
- Department of Dermatology and Allergology, Charite-Universitätsmedizin, Berlin, Germany
- Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal
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8
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De Corso E, Pipolo C, Caminati M, Cantone E, Seccia V, Cecchi L, Nettis E, Garzaro M, Ottaviano G, Gelardi M, Cavaliere C, Heffler E, Pagella F, Pasquini E, Trimarchi M, Gallo S, La Mantia I, Torretta S, Mattavelli D, Caruso C, Matucci A, Vultaggio A, Bellocchi G, Alicandri Ciufelli M, Fm P, Senna G. Multidisciplinary Decision-Making-ITAlian Consensus After Two Years of Real Practice on the Management of Severe Uncontrolled CRSwNP by Biologics (ITACA Study). Curr Allergy Asthma Rep 2024; 24:143-154. [PMID: 38472601 DOI: 10.1007/s11882-024-01135-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE OF REVIEW We aimed to reach an Italian multidisciplinary consensus on some crucial aspects of treatment decision making in CRSwNP, following 2 years of clinical experience in order to support specialists in the management of CRSwNP in clinical practice. We addressed issues relating to therapeutic decision-making and shared criteria for the treatment choice, as well as appropriate timing and criteria for evaluating treatment response, and highlighted the need for repeated multidisciplinary assessments. RECENT FINDINGS A national survey has been conducted recently to understand how rhinology practice has changed in Italy with the advent of biologics and how this affects patients with uncontrolled, severe CRSwNP. Despite the many published consensus documents, practical recommendations, and protocols on the use of biologics in CRSwNP, heterogenous behaviors in practice are still observed mainly conditioned by the novelty of the topic. The consensus procedure followed a modified Delphi approach. The scientific board included 18 otorhinolaryngologists and 8 allergists, who selected the 4 main topics to be addressed and developed overall 20 statements. Consensus on these statements was sought by a larger group of 48 additional experts, through two rounds of voting, the first web-based, the second in presence with discussion and possible refinement of the statements. The statements reaching an average score ≥ 7 at the second voting round were approved. Five statements were proposed for each of the following topics: baseline evaluation of patients eligible for biologic therapy; choice between different therapeutic options; assessment of the response to biologic treatment; multidisciplinary management. At the first voting round, 19 out of the 20 statements reached a mean score ≥ 7. Following the discussion and a few consequent amendments, at the second round of voting all the 20 statements were approved.
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Affiliation(s)
- Eugenio De Corso
- Otolaryngology, Head and Neck Surgery, Rhinology, A. Gemelli University Hospital Foundation, IRCSS, Rome, Italy.
| | - Carlotta Pipolo
- Department of Health Sciences, Otolaryngology Unit, ASST Santi Paolo E Carlo, University of Milan, Milan, Italy
| | - Marco Caminati
- Department of Medicine, Allergy Unit and Asthma Center, University of Verona, Verona University Hospital, Verona, Italy
| | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatological Sciences-ENT Section, Italy. Head and Neck Department-ENT Section, University of Naples, AOU Federico II, 29 Federico II, 80131, Naples, Italy
| | - Veronica Seccia
- Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Lorenzo Cecchi
- SOSD Allergology and Clinical Immunology, Ospedale S. Stefano, USL Toscana Centro, Prato, Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | - Massimiliano Garzaro
- Department of Otorhinolaryngology, Rhinology Unit, Eastern Piedmont University - Maggiore Hospital, Novara, Italy
| | - Giancarlo Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padua, Italy
| | - Matteo Gelardi
- Unit of Otolaryngology, University of Foggia, Foggia, Italy
| | - Carlo Cavaliere
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Enrico Heffler
- Personalized Medicine Asthma and Allergy Unit - IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Fabio Pagella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ernesto Pasquini
- Otorhinolaryngology Unit, Ospedale Bellaria Dip Chirurgie Specialistiche AUSL BO, Bologna, Italy
| | - Matteo Trimarchi
- Department of Otolaryngology-Head and Neck Surgery, Ente Ospedaliero Cantonale, Ospedale Regionale Di Lugano, Università Della Svizzera Italiana, Lugano, Svizzera, Italy
| | - Stefania Gallo
- Head and Neck Department, ASST Sette Laghi and UPLOAD Research Center, Otorinolaryngology Unit, University of Insubria, Varese, Italy
| | - Ignazio La Mantia
- Department of Medical - Surgical Sciences and Advanced Technologies-G.F. Ingrassia Director of E.N.T. Unit, P.O.G. Rodolico University of Catania, Catania, Italy
| | - Sara Torretta
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili Brescia, University of Brescia, 25123, Brescia, Italy
| | - Cristiano Caruso
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Matucci
- Immunoallergoly Unit, Careggi University Hospital, Florence-Largo Brambilla, 3-50134, Florence, Italy
| | - Alessandra Vultaggio
- Immunoallergoly Unit, Careggi University Hospital, Florence-Largo Brambilla, 3-50134, Florence, Italy
| | - Gianluca Bellocchi
- Department of Otolaryngology, San Camillo Forlanini Hospital, Rome, Italy
| | - Matteo Alicandri Ciufelli
- Department of Otolaryngology-Head and Neck Surgery, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | - Passali Fm
- Unit of ENT, Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Gianenrico Senna
- Department of Medicine, Allergy Unit and Asthma Center, University of Verona, Verona University Hospital, Verona, Italy
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9
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Caminati M, Scarpieri E, Maule M, Pinter P, Schiappoli M, Vaia R, Senna G. Successful switching from mepolizumab to dupilumab in a patient with EGPA in remission phase and persistent nasal polyposis. Rheumatology (Oxford) 2024; 63:e96-e98. [PMID: 37695303 DOI: 10.1093/rheumatology/kead479] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Marco Caminati
- Department of Medicine, University of Verona and Verona University Hospital, Verona, Italy
| | - Elena Scarpieri
- School of Specialization in Allergy and Clinical Immunology, Department of Medicine, University of Verona, Verona, Italy
| | - Matteo Maule
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - Patrick Pinter
- Unit of Otolaryngology, Head and Neck Department, University of Verona, Verona, Italy
| | - Michele Schiappoli
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - Rachele Vaia
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona and Verona University Hospital, Verona, Italy
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
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10
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Norelli F, Schiappoli M, Senna G, Pinter P, Olivieri B, Ottaviano G, De Corso E, Caminati M. Adherence to Intranasal Steroids in Chronic Rhinosinusitis with Nasal Polyposis Prior to and during Biologic Therapy: A Neglected Matter. J Clin Med 2024; 13:1066. [PMID: 38398379 PMCID: PMC10889709 DOI: 10.3390/jcm13041066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Adherence to treatment is essential in chronic rhinosinusitis with nasal polyposis (CRSwNP). Intranasal corticosteroids (INCS) are the first-line therapy, followed by systemic corticosteroids and surgery if needed. In cases of refractory disease, biologics are added to conventional treatment, making adherence to INCS crucial in assessing eligibility for these targeted therapies. The purpose of this review is to examine INCS adherence assessment and rate, before starting and during biologic therapy. We conducted a comprehensive literature review focusing on INCS adherence in CRSwNP treated with biologics, including randomized controlled trials and real-life studies. The search extended to studies on allergic and non-allergic rhinitis to provide broader insights into tools to assess the INCS adherence. The result was that adherence to INCS in CRSwNP is underexplored, with only a few studies addressing it directly. Various tools for adherence assessment have been identified, but none are universally accepted as standard. The review also highlights the complexity of factors influencing adherence rates. Effective CRSwNP management requires a paradigm shift to prioritize adherence in treatment guidelines and clinical practice. The review advocates for improved adherence assessment tools, a deeper understanding of influencing factors, and the integration of personalized medicine approaches, especially for biologic therapies.
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Affiliation(s)
- Francesca Norelli
- Department of Medicine, University of Verona, 37129 Verona, Italy; (F.N.); (G.S.)
| | - Michele Schiappoli
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 35134 Verona, Italy; (M.S.); (B.O.)
| | - Gianenrico Senna
- Department of Medicine, University of Verona, 37129 Verona, Italy; (F.N.); (G.S.)
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 35134 Verona, Italy; (M.S.); (B.O.)
| | - Patrick Pinter
- Division of Otorhinolaryngology, Department of Surgery, Dentistry, Gynecology, and Pediatrics, Verona University Hospital, University of Verona, 37129 Verona, Italy;
| | - Bianca Olivieri
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 35134 Verona, Italy; (M.S.); (B.O.)
| | - Giancarlo Ottaviano
- Otolaryngology Section, Department of Neurosciences, University of Padova, 35122 Padova, Italy;
| | - Eugenio De Corso
- Otorhinolaryngology Unit, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy;
| | - Marco Caminati
- Department of Medicine, University of Verona, 37129 Verona, Italy; (F.N.); (G.S.)
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 35134 Verona, Italy; (M.S.); (B.O.)
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11
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Caminati M, Maule M, Benoni R, Bagnasco D, Beghè B, Braido F, Brussino L, Cameli P, Candeliere MG, Carpagnano GE, Costanzo G, Crimi C, D’Amato M, Del Giacco S, Guarnieri G, Yacoub MR, Micheletto C, Nicola S, Olivieri B, Pini L, Schiappoli M, Vaia R, Vianello A, Visca D, Spanevello A, Senna G. Dupilumab Efficacy on Asthma Functional, Inflammatory, and Patient-Reported Outcomes across Different Disease Phenotypes and Severity: A Real-Life Perspective. Biomedicines 2024; 12:390. [PMID: 38397992 PMCID: PMC10886692 DOI: 10.3390/biomedicines12020390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Dupilumab is currently approved for the treatment of Type 2 severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). Few studies have specifically reported on dupilumab efficacy on asthma outcomes as a primary objective in a real-life setting, in patients with and without CRSwNP. Our study aimed to explore the efficacy of dupilumab on functional, inflammatory, and patient-reported outcomes in asthma patients across different disease phenotypes and severity, including mild-to-moderate asthma coexisting with CRSwNP. Data from 3, 6, and 12 months follow-up were analyzed. Asthma (FEV1%, Tiffeneau%, ACT, FeNO, oral steroid use, exacerbation rate, and blood eosinophilia) and polyposis (SNOT22, VAS, NPS) outcomes showed a rapid (3 months) and sustained (6 and 12 months) significant change from baseline, despite most of the patients achieving oral steroid withdrawal. According to the sensitivity analysis, the improvement was not conditioned by either the presence of polyposis or severity of asthma at baseline. Of note, even in the case of milder asthma forms, a significant further improvement was recorded during dupilumab treatment course. Our report provides short-, medium-, and long-term follow-up data on asthma outcomes across different diseases phenotypes and severity, contributing to the real-world evidence related to dupilumab efficacy on upper and lower airways T2 inflammation.
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Affiliation(s)
- Marco Caminati
- Department of Medicine, University of Verona, Piazzale L.A. Scuro, 37134 Verona, Italy (R.V.); (G.S.)
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 37126 Verona, Italy; (B.O.); (M.S.)
| | - Matteo Maule
- Department of Medicine, University of Verona, Piazzale L.A. Scuro, 37134 Verona, Italy (R.V.); (G.S.)
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 37126 Verona, Italy; (B.O.); (M.S.)
| | - Roberto Benoni
- Department of Diagnostics and Public Health, University of Verona, 37129 Verona, Italy;
| | - Diego Bagnasco
- Allergy and Respiratory Diseases Clinic, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy; (D.B.); (F.B.); (M.G.C.)
| | - Bianca Beghè
- AOU of Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Fulvio Braido
- Allergy and Respiratory Diseases Clinic, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy; (D.B.); (F.B.); (M.G.C.)
| | - Luisa Brussino
- SCDU Immunologia e Allergologia, AO Ordine Mauriziano di Torino, 10137 Torino, Italy; (L.B.); (S.N.)
| | - Paolo Cameli
- Respiratory Diseases and Lung Transplantation Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy;
| | - Maria Giulia Candeliere
- Allergy and Respiratory Diseases Clinic, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy; (D.B.); (F.B.); (M.G.C.)
| | - Giovanna Elisiana Carpagnano
- Institute of Respiratory Disease, Department Translational Biomedicine and Neuroscience, University “Aldo Moro”, 70121 Bari, Italy;
| | - Giulia Costanzo
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.C.); (S.D.G.)
| | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy;
- Respiratory Medicine Unit, AOU Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | - Mariella D’Amato
- Respiratory Department, Monaldi Hospital AO Dei Colli, Federico II University, 80131 Naples, Italy; (M.D.); (A.V.)
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.C.); (S.D.G.)
| | - Gabriella Guarnieri
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy;
| | - Mona-Rita Yacoub
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Claudio Micheletto
- Pulmonology Unit, Verona Integrated University Hospital, 37126 Verona, Italy;
| | - Stefania Nicola
- SCDU Immunologia e Allergologia, AO Ordine Mauriziano di Torino, 10137 Torino, Italy; (L.B.); (S.N.)
| | - Bianca Olivieri
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 37126 Verona, Italy; (B.O.); (M.S.)
| | - Laura Pini
- Respiratory Medicine Unit, ASST—“Spedali Civili” of Brescia, 25123 Brescia, Italy;
| | - Michele Schiappoli
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 37126 Verona, Italy; (B.O.); (M.S.)
| | - Rachele Vaia
- Department of Medicine, University of Verona, Piazzale L.A. Scuro, 37134 Verona, Italy (R.V.); (G.S.)
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 37126 Verona, Italy; (B.O.); (M.S.)
| | - Andrea Vianello
- Respiratory Department, Monaldi Hospital AO Dei Colli, Federico II University, 80131 Naples, Italy; (M.D.); (A.V.)
| | - Dina Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, 21049 Tradate, Italy; (D.V.); (A.S.)
| | - Antonio Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, 21049 Tradate, Italy; (D.V.); (A.S.)
| | - Gianenrico Senna
- Department of Medicine, University of Verona, Piazzale L.A. Scuro, 37134 Verona, Italy (R.V.); (G.S.)
- Allergy Unit and Asthma Center, Verona Integrated University Hospital, 37126 Verona, Italy; (B.O.); (M.S.)
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12
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Caminati M, Micheletto C, Norelli F, Olivieri B, Ottaviano G, Padoan R, Piacentini G, Schiappoli M, Senna G, Menzella F. Safety of dupilumab in T2 airways conditions: focus on eosinophilia across trials and real-life evidence. Expert Opin Biol Ther 2024; 24:15-23. [PMID: 38197326 DOI: 10.1080/14712598.2024.2304556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/09/2024] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha subunit, effectively blocks both IL-4 and IL-13 mediated pathways. Its introduction has represented a significant advancement in the treatment of severe asthma and other Type 2 (T2) conditions, including nasal polyps, atopic dermatitis, and eosinophilic esophagitis. To date, Dupilumab has demonstrated optimal efficacy and safety profile. AREAS COVERED The safety profile of dupilumab has been extensively studied, especially for its effects on blood eosinophil count. Transient eosinophil increase during treatment is typically insignificant from a clinical point of view and related to its mechanism of action. Rare cases of hyper-eosinophilia associated with clinical conditions like eosinophilic granulomatosis with polyangiitis (EGPA) and hypereosinophilic syndrome (HES) have been reported. Those cases are often related to the drug's steroid-sparing effect or the natural trajectory of the underlying disease rather than a direct cause-effect relationship with dupilumab. EXPERT OPINION The management of hyper-eosinophilia during dupilumab treatment requires comprehensive diagnostic work-up and strict follow-up monitoring for early detection of systemic disease progression in order to avoid unnecessary discontinuation of an effective treatment. This approach highlights the importance of a personalized treatment.
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Affiliation(s)
- Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Integrated University Hospital of Verona, Verona, Italy
| | | | | | - Bianca Olivieri
- Allergy Unit and Asthma Center, Integrated University Hospital of Verona, Verona, Italy
| | - Giancarlo Ottaviano
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, Padova, Italy
| | - Roberto Padoan
- Division of Rheumatology, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Michele Schiappoli
- Allergy Unit and Asthma Center, Integrated University Hospital of Verona, Verona, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Integrated University Hospital of Verona, Verona, Italy
| | - Francesco Menzella
- Pulmonology Unit, S. Valentino Hospital, AULSS 2 Marca Trevigiana, Treviso, Italy
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13
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Caminati M, De Corso E, Ottaviano G, Pipolo C, Schiappoli M, Seccia V, Spinelli FR, Savarino EV, Gisondi P, Senna G. Remission in Type 2 Inflammatory Diseases: Current Evidence, Unmet Needs, and Suggestions for Defining Remission in Chronic Rhinosinusitis with Nasal Polyps. Curr Allergy Asthma Rep 2024; 24:11-23. [PMID: 38085499 PMCID: PMC10789826 DOI: 10.1007/s11882-023-01118-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE OF REVIEW The development of biological therapies for type 2 inflammatory diseases raises the possibility of addressing remission in those dis-immune conditions. No consensus exists for a definition of remission in chronic rhinosinusitis with nasal polyps (CRSwNP). This review aims to critically evaluate the published data to provide the basis for defining remission in CRSwNP. RECENT FINDINGS The published evidence has yet to provide an unequivocal definition on remission in type 2 inflammatory diseases, in part reflecting differences in approaches to diagnosis and follow-up. A multidimensional evaluation is necessary when considering complete remission, including clinical, inflammatory, and histologic criteria, but how to combine or tailor the three perspectives according to disease severity at baseline or timing of assessment of treatment category is yet to reach consensus. We suggest defining remission starting from the approach taken in asthma and eosinophilic esophagitis, that is, including the resolution of symptoms and improvements in objective parameters of disease severity and/or inflammatory activity. Future studies and consensuses should provide validated criteria with cutoffs for the day-to-day definition of remission. The definition of remission in CRSwNP should include the following criteria, to be verified and maintained for a period of ≥ 12 months: absence of symptoms (nasal obstruction, loss of smell, rhinorrhea as the main ones); no impact of symptoms on quality of life; no need of surgery; no chronic or rescue medications (systemic corticosteroids or antibiotics); and recovery of smell function, possibly evaluated by objective test. Assessment of underlying inflammation should also be considered once accurate and feasible biomarkers are available in clinical practice.
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Affiliation(s)
- Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Eugenio De Corso
- Otorhinolaryngology, Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, do A. Gemelli 8, 00168, Rome, Italy.
| | - Giancarlo Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padua, Italy
| | - Carlotta Pipolo
- Otorhinolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università Degli Studi di Milano, 20142, Milan, Italy
| | - Michele Schiappoli
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Veronica Seccia
- Otolaryngology Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, 56124, Pisa, Italy
| | - Francesca Romana Spinelli
- Rheumatology Unit, Department of Clinical Internal, Anesthesiology and Cardiovascular Science - Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Edoardo Vincenzo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Gastroenterology Unit, Azienda Ospedale Università di Padova, Padua, Italy
| | - Paolo Gisondi
- Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
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14
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Canonica GW, Blasi F, Carpagnano GE, Guida G, Heffler E, Paggiaro P, Allegrini C, Antonelli A, Aruanno A, Bacci E, Bagnasco D, Beghè B, Bonavia M, Bonini M, Brussino L, Caiaffa MF, Calabrese C, Camiciottoli G, Caminati M, Caruso C, Cavallini M, Chieco Bianchi F, Conte ME, Corsico AG, Cosmi L, Costantino M, Costanzo G, Crivellaro M, D'Alò S, D'Amato M, Detoraki A, Di Proietto MC, Facciolongo NC, Ferri S, Fierro V, Foschino MP, Latorre M, Lombardi C, Macchia L, Milanese M, Montagni M, Parazzini EM, Parente R, Passalacqua G, Patella V, Pelaia G, Pini L, Puggioni F, Ricciardi L, Ridolo E, Rolo J, Scichilone N, Scioscia G, Senna G, Solidoro P, Varricchi G, Vianello A, Yacoub MR, Yang B. Severe Asthma Network Italy Definition of Clinical Remission in Severe Asthma: A Delphi Consensus. J Allergy Clin Immunol Pract 2023; 11:3629-3637. [PMID: 37558162 DOI: 10.1016/j.jaip.2023.07.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023]
Abstract
Severe asthma affects about 10% of the population with asthma and is characterized by low lung function and a high count of blood leukocytes, mainly eosinophils. Various definitions are used in clinical practice and in the literature to identify asthma remission: clinical remission, inflammatory remission, and complete remission. This work highlights a consensus for asthma remission using a Delphi method. In the context of the Severe Asthma Network Italy, which accounts for 57 severe asthma centers and more than 2,200 patients, a board of six experts drafted a list of candidate statements in a questionnaire, which has been revised to minimize redundancies and ensure clear and consistent wording for the first round (R1) of the analysis. Thirty-two statements were included in the R1 questionnaire and then submitted to a panel of 80 experts, which used a 5-point Likert scale to measure agreement regarding each statement. Then, an interim analysis of R1 data was performed, and items were discussed and considered to produce a consistent questionnaire for round 2 (R2) of the analysis. Then, the board set the R2 questionnaire, which included only important topics. Panelists were asked to vote on the statements in the R2 questionnaire afterward. During R2, the criteria of complete clinical remission (the absence of the need for oral corticosteroids, symptoms, exacerbations or attacks, and pulmonary function stability) and those of partial clinical remission (the absence of the need for oral corticosteroids, and two of three criteria: the absence of symptoms, exacerbations or attacks, and pulmonary stability) were confirmed. This Severe Asthma Network Italy Delphi analysis defined a valuable and independent tool that is easy to use, to test the efficacy of different treatments in patients with severe asthma enrolled into the SANI registry.
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Affiliation(s)
- Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | - Francesco Blasi
- Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giovanna Elisiana Carpagnano
- Department of Translational Biomedicine and Neuroscience DiBraiN, University of Bari Aldo Moro, Bari, Italy; Section of Respiratory Diseases, Policlinico Hospital of Bari, Bari, Italy
| | - Giuseppe Guida
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy; Severe Asthma and Rare Lung Disease Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology, and Critical Care, University of Pisa, Pisa, Italy
| | - Chiara Allegrini
- Unit Asma Grave, Ambulatorio Asma Grave Pneumologia e Fisiopatologia ToracoPolmonare, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Andrea Antonelli
- Responsabile SS Allergologia e Fisiopatologia Respiratoria, Ospedale S Croce e Carle, Cuneo, Italy
| | - Arianna Aruanno
- Allergologia dell'Istituto di Clinica Medica del Policlinico Gemelli, Università Cattolica di Roma, Rome, Italy
| | - Elena Bacci
- Fisiopatologia Respiratoria e Riabilitazione, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Diego Bagnasco
- UO Clinica Malattie Respiratorie e Allergologia, IRCCS-AOU San Martino, San Martino, Italy
| | - Bianca Beghè
- Section of Respiratory Diseases, Department of Medical and Surgical Sciences, Maternal, Infant and Adult, University of Modena and Reggio Emilia, Emilia-Romagna, Italy
| | - Marco Bonavia
- SS Pneumologia Riabilitativa, SC Pneumologia, Dipartimento Specialità Mediche, Ospedale la Colletta, Arenzano, Genoa, Italy
| | - Matteo Bonini
- UOC Pneumologia, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
| | - Luisa Brussino
- SSDDU Immunologia Clinica ed Allergologia, AO Mauriziano, Turin, Italy
| | - Maria Filomena Caiaffa
- Malattie Apparato Respiratorio, Dipartimenti delle funzioni Mediche e Sanitarie, Azienda Ospedaliero Universitaria, Ospedali Riuniti, Foggia, Italy
| | - Cecilia Calabrese
- UO Clinica Pneumologica SUN, Dipartimento Pneumologia ed Oncologia, Azienda Ospedaliera Specialistica dei Colli, Naples, Italy
| | - Gianna Camiciottoli
- Unit Asma Grave, Ambulatorio Asma Grave Pneumologia e Fisiopatologia ToracoPolmonare, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Marco Caminati
- USD Allergologia, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Cristiano Caruso
- Allergologia dell'Istituto di Clinica Medica del Policlinico Gemelli, Università Cattolica di Roma, Rome, Italy; UOSD DH Internal Medicine and Digestive Disease, Fondazione Policlinico A Gemelli IRCCS, Rome, Italy
| | - Mirta Cavallini
- Broncopneumologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Maria Elisabetta Conte
- Struttura Complessa di Pneumologia, Azienda per l'Assistenza Sanitaria n. 5 Friuli Occidentale, Pordenone, Italy
| | | | - Lorenzo Cosmi
- SOD Immunologia e Terapie Cellulari, AOUC Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Mariateresa Costantino
- Centro Day Hospital, Allergologia e Immunologia Clinica, Dipartimento Medico, Ospedale Carlo Poma, ASST-Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy
| | - Giulia Costanzo
- Allergologia e Immunologia Clinica, Policlinico Universitario di Cagliari, Cagliari, Italy
| | | | - Simona D'Alò
- UO Allergologia, Azienda Sanitaria Unica Regionale Marche, Civitanova Marche, Marche, Italy
| | - Mariella D'Amato
- UOC Pneumofisiologia Università Federico II, Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Aikaterini Detoraki
- UODS Allergologia ed Immunodeficienze, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | | | | | - Sebastian Ferri
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Vincenzo Fierro
- UOC Allergologia, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Maria Pia Foschino
- Malattie Apparato Respiratorio, Azienda Ospedaliera Universitaria, Foggia, Italy
| | - Manuela Latorre
- UO Pneumologia, Ospedale Nuovo Apuano di Massa, Massa, Italy
| | - Carlo Lombardi
- Unità di Allergologia, Immunologia e Malattie Respiratorie, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Luigi Macchia
- Unità Dipartimentale di Allergologia ed Immunologia Clinica, AO Universitaria Policlinico di Bari, Bari, Italy
| | - Manlio Milanese
- SC Pneumologia - Dipartimento Specialità Mediche, Ospedale S Corona, Pietra Ligure, Pietra Ligure, Savona, Italy
| | - Marcello Montagni
- Unità Dipartimentale di Allergologia, Ospedale Guglielmo da Saliceto AUSL Piacenza, Piacenza, Italy
| | | | - Roberta Parente
- UO di Diagnosi e Terapia delle Malattie Allergiche e del Sistema Immunitario, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Giovanni Passalacqua
- Clinica di Malattie Respiratorie e Allergologia, Dip. Medicina Interna, Univ degli Studi di Genova, IRCCS-AOU San Martino, San Martino, Italy
| | | | - Girolamo Pelaia
- UO Malattie dell'Apparato Respiratorio, AOU Mater Domini, Catanzaro, Italy
| | - Laura Pini
- Ambulatorio Asma Grave, UOC Medicina Generale 2, Spedali Civili di Brescia, Brescia, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luisa Ricciardi
- Allergologia e Immunologia Clinica, AOU Policlinico G Martino, Università di Messina, Messina, Italy
| | - Erminia Ridolo
- Ambulatorio di Allergologia ed Immunologia Clinica, UO Lungodegenza, Azienda Ospedaliero, Universitaria di Parma, Parma, Italy
| | - Joyce Rolo
- SC Pneumologia, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nicola Scichilone
- UOC Pneumologia, Azienda Ospedaliera Universitaria Policlinico P Giaccone di Palermo, Palermo, Italy
| | - Giulia Scioscia
- Malattie Apparato Respiratorio, Dipartimenti delle funzioni Mediche e Sanitarie, Azienda Ospedaliero Universitaria, Ospedali Riuniti, Foggia, Italy
| | - Gianenrico Senna
- USD Allergologia, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Paolo Solidoro
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gilda Varricchi
- Dipartimento di Scienze Mediche Translazionali, Centro per la Ricerca di Base ed Immunologia Clinica, Università Federico II, Naples, Italy
| | - Andrea Vianello
- UOC Fisiopaologia Respiratoria, Azienda Ospedaliera di Padova, Padua, Italy
| | - Mona Rita Yacoub
- Unità di Immunologia, Reumatologia, Allergologia e Malattie Rare, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Baoran Yang
- Centro Day Hospital, Allergologia e Immunologia Clinica, Dipartimento Medico, Ospedale Carlo Poma, ASST-Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy
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15
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De Corso E, Ottaviano G, Pipolo C, Cantone E, Mattavelli D, Alicandri-Ciufelli M, Lucidi D, Caminati M, Senna G, Cavaliere C, Ghidini A, Gallo S, Macchi A, Torretta S, Seccia V, Garzaro M, Fadda GL, Trimarchi M, Pasquini E, Pagella F, Canevari FR, Preti A, La Mantia I, Galli J. Chronic Rhinosinusitis with Nasal Polyps: A Survey on Routine Management and Evaluation of Disease Control in Practice. J Pers Med 2023; 13:1531. [PMID: 38003847 PMCID: PMC10672031 DOI: 10.3390/jpm13111531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease with a significant impact on quality of life. The overall goal of CRSwNP management, as with other chronic conditions, is to achieve "disease control", and for that reason, a definition of control of disease is pivotal in deciding the best treatment strategy. Although many staging systems have already been developed to evaluate the disease, disease control is not yet to be standardized, and a specific tool that is consistently applied and accepted by all practitioners is still missing in daily clinical practice. To gain an overview of the implementation and limitations of existing guidelines and to shed light on real-life definitions of control and disease severity, we conducted a nationwide survey of otorhinolaryngologists routinely treating CRSwNP to identify unmet clinical needs in Italy. The results showed homogeneous responses regarding the knowledge contained in international guidelines while highlighting the difficulty of their implementation in day-to-day practice. Respondents called attention to the importance of clinical symptoms, giving more weight to the patient's perspective. Among the symptoms to be considered, respondents emphasized nasal obstruction, followed by loss of sense of smell and rhinorrhea. Others also believe that the physician's perspective should be considered, and the inclusion of endoscopy as a measure of control was warranted by many. The need for a specific tool that is able to unequivocally ascertain disease control is increasingly pivotal in this new era of biologics for treating CRSwNP.
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Affiliation(s)
- Eugenio De Corso
- Otolaryngology, Head and Neck Surgery, Rhinology, A. Gemelli University Hospital Foundation, IRCSS, 00168 Rome, Italy;
| | - Giancarlo Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, 35122 Padova, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatological Sciences-ENT Section, University of Naples 29 Federico II, 80131 Naples, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25123 Brescia, Italy
| | - Matteo Alicandri-Ciufelli
- Department of Otorhinolaryngology Head and Neck Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41124 Modena, Italy
| | - Daniela Lucidi
- Department of Otorhinolaryngology Head and Neck Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41124 Modena, Italy
| | - Marco Caminati
- Department of Medicine, University of Verona and Verona University Hospital, 37134 Verona, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona and Verona University Hospital, 37134 Verona, Italy
| | - Carlo Cavaliere
- Department of Sense Organs, Sapienza University of Rome, 00185 Rome, Italy
| | - Angelo Ghidini
- ENT Department, Azienda USL Reggio Emilia-IRCCS, 42123 Reggio Emilia, Italy
| | - Stefania Gallo
- Otorinolaryngology Unit, Head and Neck Department, ASST Sette Laghi and UPLOAD Research Center, University of Insubria, 21100 Varese, Italy; (S.G.); (A.M.)
| | - Alberto Macchi
- Otorinolaryngology Unit, Head and Neck Department, ASST Sette Laghi and UPLOAD Research Center, University of Insubria, 21100 Varese, Italy; (S.G.); (A.M.)
| | - Sara Torretta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Veronica Seccia
- Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56124 Pisa, Italy;
| | - Massimiliano Garzaro
- Department of Otorhinolaryngology, Rhinology Unit, Eastern Piedmont University-Maggiore Hospital, 28100 Novara, Italy
| | - Gian Luca Fadda
- Department of Otorhinolaryngology, San Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy;
| | - Matteo Trimarchi
- Otorhinolaryngology Unit, Head and Neck Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Ernesto Pasquini
- Otorhinolaryngology Unit, Dip Chirurgie Specialistiche, Ospedale Bellaria AUSL BO, 47814 Bologna, Italy
| | - Fabio Pagella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Frank Rikki Canevari
- Otorhinolaryngology Unit, IRCCS Policlinico San Martino Genova, Dipartimento 1 DISC Università di Genova, 16124 Gernova, Italy;
| | - Andrea Preti
- Department of Otorhinolaryngology, Ospedale San Giuseppe IRCCS Multimedica Milan, 20099 Milan, Italy
| | - Ignazio La Mantia
- Department of Medical-Surgical Sciences and Advanced Technologies-“G.F. Ingrassia” Director of E.N.T. Unit P.O. “G. Rodolico” University of Catania, 95123 Catania, Italy;
| | - Jacopo Galli
- Department of Head, Neck and Sensory Organs, Catholic University of The Sacred Heart, 00168 Rome, Italy
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16
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Furci F, Luxi N, Senna G, Trifirò G. Anaphylaxis due to antiallergic and antiasthmatic biologics. Curr Opin Allergy Clin Immunol 2023; 23:364-369. [PMID: 37555938 DOI: 10.1097/aci.0000000000000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
PURPOSE OF REVIEW To provide a better understanding of the risk of anaphylaxis due to antiallergic and antiasthmatic biologics through an analysis of data reported in literature and in clinical trials, and by conducting a retrospective descriptive analysis of individual case safety reports on VigiBase, the WHO International Pharmacovigilance database. RECENT FINDINGS Analysis of the data, as described, demonstrated safety of the antiallergic and antiasthmatic biologics with a low incidence of anaphylaxis. SUMMARY Biologic therapies have revolutionized the treatment of many diseases, such as atopic dermatitis, nasal polyps, spontaneous chronic urticarial and severe asthma with a precise immunological action, in the sphere of precision medicine.Albeit these drugs are generally well tolerated, generating real-world evidence is crucial to re-evaluate clinically relevant adverse events, such as anaphylaxis, allowing to confirm their safety profile in particular in special populations such as paediatric patients.
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Affiliation(s)
- Fabiana Furci
- Provincial Healthcare Unit, Section of Allergy, Vibo Valentia
| | | | - Gianenrico Senna
- Department of Medicine, University of Verona
- Allergy Unit and Asthma Center, Verona University Hospital
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, Section of Pharmacology, University of Verona, Verona, Italy
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17
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Tanno LK, Worm M, Ebisawa M, Ansotegui IJ, Senna G, Fineman S, Geller M, Gonzalez-Estrada A, Campbell DE, Leung A, Muraro A, Levin M, Ortega Martell JA, Caminati M, Kolkhir P, Le Pham D, Darlenski R, Esteban-Gorgojo I, Rial M, Filipovic I, Chiarella SE, Cuervo-Pardo L, Kwong C, Pozo-Beltran CF, Trinh THK, Greenberger PA, Turner PJ, Thong BYH, Martin B, Cardona V. Global disparities in availability of epinephrine auto-injectors. World Allergy Organ J 2023; 16:100821. [PMID: 37915955 PMCID: PMC10616381 DOI: 10.1016/j.waojou.2023.100821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 11/03/2023] Open
Abstract
Background Anaphylaxis is the most severe clinical presentation of acute systemic allergic reactions and can cause death. Given the prevalence of anaphylaxis within healthcare systems, it is a high priority public health issue. However, management of anaphylaxis - both acute and preventative - varies by region. Methods The World Allergy Organization (WAO) Anaphylaxis Committee and the WAO Junior Members Steering Group undertook a global online survey to evaluate local practice in the diagnosis and management of anaphylaxis across regions. Results Responses were received from WAO members in 66 countries. While intramuscular epinephrine (adrenaline) is first-line treatment for anaphylaxis, some countries continue to recommend alternative routes in contrast to guidelines. Epinephrine auto-injector (EAI) devices, prescribed to individuals at ongoing risk of anaphylaxis in the community setting, are only available in 60% of countries surveyed, mainly in high-income countries. Many countries in South America, Africa/Middle-East and Asian-Pacific regions do not have EAI available, or depend on individual importation. In countries where EAIs are commercially available, national policies regarding the availability of EAIs in public settings are limited to few countries (16%). There is no consensus regarding the time patients should be observed following emergency treatment of anaphylaxis. Conclusion This survey provides a global snapshot view of the current management of anaphylaxis, and highlights key unmet needs including the global availability of epinephrine for self-injection as a key component of anaphylaxis management.
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Affiliation(s)
- Luciana Kase Tanno
- Division of Allergy, Department of Pulmonology, Allergy and Thoracic Oncology, University Hospital of Montpellier, Montpellier, France
- Desbrest Institute of Epidemiology and Public Health, UMR UA11 University of Montpellier - INSERM, France
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
- Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, 371, av. du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France
| | - Margitta Worm
- Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie, Campus Charité Mitte, Universitätsmedizin Berlin, Germany
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Ignacio J. Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
| | - Gianenrico Senna
- Department of Medicine, Allergy Asthma and Clinical Immunology Section, University of Verona, Verona, Italy
| | - Stanley Fineman
- Atlanta Allergy & Asthma, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mario Geller
- Section of Medicine of the Brazilian Academy of Medicine of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alexei Gonzalez-Estrada
- Division of Allergy, Asthma and Clinical Immunology, Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Agnes Leung
- The Chinese University of Hong Kong, Department of Pediatrics, Prince of Wales Hospital, Hong Kong Special Administrative Region of China
| | - Antonella Muraro
- Department of Mother and Child Health University of Padua Padua, Italy
| | - Michael Levin
- Division of Paediatric Allergology, University of Cape Town, Cape Town, South Africa
| | | | - Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy
| | - Pavel Kolkhir
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Duy Le Pham
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet nam
| | - Razvigor Darlenski
- Department of Dermatology and Venereology, Acibadem City Clinic Tokuda Hospital Sofia, 51B Nikola Vaptsarov Blvd., 1407, Sofia, Bulgaria
- Department of Dermatology and Venereology, Trakia University-Stara Zagora, Stara Zagora, Bulgaria
| | | | - Manuel Rial
- Allergology Section, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | | | - Lyda Cuervo-Pardo
- Division of Rheumatology, Allergy and Clinical Immunology, Department of Medicine, University of Florida, USA
| | | | | | - Tu HK. Trinh
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet nam
| | - Paul A. Greenberger
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA
| | - Paul J. Turner
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - Bryan Martin
- Medicine and Pediatrics, The Ohio State University in Columbus, Ohio, USA
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, and ARADyAL Research Network, Spain
| | - the WAO Anaphylaxis Committee and the WAO Junior Members Steering Group
- Division of Allergy, Department of Pulmonology, Allergy and Thoracic Oncology, University Hospital of Montpellier, Montpellier, France
- Desbrest Institute of Epidemiology and Public Health, UMR UA11 University of Montpellier - INSERM, France
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
- Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, 371, av. du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France
- Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie, Campus Charité Mitte, Universitätsmedizin Berlin, Germany
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
- Department of Medicine, Allergy Asthma and Clinical Immunology Section, University of Verona, Verona, Italy
- Atlanta Allergy & Asthma, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Section of Medicine of the Brazilian Academy of Medicine of Rio de Janeiro, Rio de Janeiro, Brazil
- Division of Allergy, Asthma and Clinical Immunology, Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA
- The University of Sydney, New South Wales, Australia
- The Chinese University of Hong Kong, Department of Pediatrics, Prince of Wales Hospital, Hong Kong Special Administrative Region of China
- Department of Mother and Child Health University of Padua Padua, Italy
- Division of Paediatric Allergology, University of Cape Town, Cape Town, South Africa
- Department of Immunology, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico
- Department of Medicine, University of Verona, Verona, Italy
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet nam
- Department of Dermatology and Venereology, Acibadem City Clinic Tokuda Hospital Sofia, 51B Nikola Vaptsarov Blvd., 1407, Sofia, Bulgaria
- Department of Dermatology and Venereology, Trakia University-Stara Zagora, Stara Zagora, Bulgaria
- Department of Allergy, Hospital General de Villalba, Madrid, Spain
- Allergology Section, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- University Hospital Dr Dragisa Misovic, Serbia
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN, USA
- Division of Rheumatology, Allergy and Clinical Immunology, Department of Medicine, University of Florida, USA
- Phoenix Children's Hospital, Phoenix, AZ, USA
- Hospital Infantil de México Federico Gómez, Mexico
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet nam
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
- Medicine and Pediatrics, The Ohio State University in Columbus, Ohio, USA
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, and ARADyAL Research Network, Spain
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18
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Senna G, Olivieri B, Castells M. Anaphylaxis: unraveling the mysteries and new perspectives. Curr Opin Allergy Clin Immunol 2023; 23:347-348. [PMID: 37641917 DOI: 10.1097/aci.0000000000000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Gianenrico Senna
- Allergy and Asthma Center, University Hospital of Verona
- Department of Medicine, University of Verona, Verona, Italy
| | | | - Mariana Castells
- Division of Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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19
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Abstract
PURPOSE OF REVIEW To understand the current global scale of anaphylaxis and identify possible strategies to increase the accuracy of epidemiological data. RECENT FINDINGS Anaphylaxis mortality and morbidity statistics may gain new perspectives with the global implementation of the ICD-11. Improving the quality of epidemiological data related to anaphylaxis should clarify some areas of uncertainty about risk factors, leading to better targeting of strategies to protect those patients at risk, and support decision-making to facilitate health care planning and implementation of public health measures to prevent anaphylaxis. SUMMARY The true rate of anaphylaxis is unknown due to a number of factors, such as misdiagnosis, miscoding and undernotification. Moreover, there is lack of information about anaphylaxis epidemiology in many countries. Difficulties on collecting accurate and comparable data should be acknowledged and anaphylaxis data can vary widely. Currently, most robust data are derived from hospitalization datasets and national mortality databases. Anaphylaxis accounts for up to 0.26% of overall hospital admissions. It is suggested that the number of hospital admissions for anaphylaxis is increasing in many countries, both with respect to all-causes of anaphylaxis and by trigger, but the mortality rate remains low. However, there are still great challenges in capturing quality anaphylaxis mortality and morbidity statistics. Better understanding of anaphylaxis trends should clarify some areas of uncertainty about risk factors and prospect effective prevention strategies. As the knowledge derived from populations is key information for more realistic decision-making, the construction of the new section addressed to anaphylaxis in the ICD-11 will allow the collection of more accurate epidemiological data to support high quality management of patients, and to better facilitate health care planning to implement public health measures, reduce the morbidity and mortality attributable to anaphylaxis.
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Affiliation(s)
- Luciana Kase Tanno
- Division of Allergy, Department of Pulmonology, Allergy and Thoracic Oncology, University Hospital of Montpellier, Montpellier
- Desbrest Institute of Epidemiology and Public Health, UMR UA11 University of Montpellier - INSERM
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - Marco Caminati
- Asthma Center and Allergy Unit, University of Verona, Verona, Italy
| | - Guillaume Pouessel
- Department of Paediatrics, CH Roubaix
- Paediatric Pneumology and Allergology Unit, CHRU Lille, France
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona, Verona, Italy
- Department of Medicine, University of Verona, Verona, Italy
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Allergy and Thoracic Oncology, University Hospital of Montpellier, Montpellier
- Desbrest Institute of Epidemiology and Public Health, UMR UA11 University of Montpellier - INSERM
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
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20
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Vianello A, Guarnieri G, Achille A, Lionello F, Lococo S, Zaninotto M, Caminati M, Senna G. Serum biomarkers of remodeling in severe asthma with fixed airway obstruction and the potential role of KL-6. Clin Chem Lab Med 2023; 61:1679-1687. [PMID: 36989607 DOI: 10.1515/cclm-2022-1323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/10/2023] [Indexed: 03/31/2023]
Abstract
Over 3% of asthmatic patients are affected by a particularly severe form of the disease ("severe asthma", SA) which is often refractory to standard treatment. Airway remodeling (AR), which can be considered a critical characteristic of approximately half of all patients with SA and currently thought to be the main mechanism triggering fixed airway obstruction (FAO), seems to be a key factor affecting a patient's outcome. Despite the collective efforts of internationally renowned experts, to date only a few biomarkers indicative of AR and no recognizable biomarkers of lung parenchymal remodeling have been identified. This work examines the pathogenesis of airway and lung parenchymal remodeling and the serum biomarkers that may be able to identify the severe asthmatic patients who may develop FAO. The study also aims to examine if Krebs von den Lungen-6 (KL-6) could be considered a diagnostic biomarker of lung structural damage in SA.
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Affiliation(s)
- Andrea Vianello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gabriella Guarnieri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alessia Achille
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Federico Lionello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Sara Lococo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Martina Zaninotto
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Marco Caminati
- Asthma Center and Allergy Unit, University of Verona, Verona, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona, Verona, Italy
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21
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Caminati M, Maule M, Benoni R, Micheletto C, Tecchio C, Vaia R, De Franceschi L, Guarnieri G, Vianello A, Senna G. Low-dose anti-IL 5 treatment in idiopathic hypereosinophilic syndrome: towards a precision medicine approach for remission maintenance. Orphanet J Rare Dis 2023; 18:302. [PMID: 37752586 PMCID: PMC10521477 DOI: 10.1186/s13023-023-02918-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023] Open
Abstract
Mepolizumab at the dose of 300 mg/4 weeks has been recently approved as an add-on therapy for patients with uncontrolled hypereosinophilic syndrome (HES) without any identifiable non-hematologic secondary cause. According to the available real-life evidence mepolizumab 300 mg and 100 mg, licensed for severe eosinophilic asthma, are comparable in terms of drug efficacy. However, the clinical rationale for selecting one dose or the other has not been explored. We investigated the efficacy and safety of mepolizumab 100 mg in idiopathic HES (I-HES) patients as a steroid sparing strategy for disease remission maintenance by assessing clinical conditions, blood eosinophil count (BEC) and adverse events at baseline and at 3-6-12 months follow-up. Overall, 11 patients were enrolled (females 4-36%) with a median age of 62 years (IQR 55.0-72.0). At 3-month visit both prednisone daily dose and BEC significantly decreased from baseline, whilst a substantial improvement of Brief fatigue inventory score (BFI) was not recorded before the 6 months assessment. More than 70% of patients completely stopped prednisone at 12-months follow-up, without any flare in terms of BEC and BFI. No adverse event was registered. Although larger studies are needed, our report firstly describes that in a well-defined population, diagnosed with I-HES and in disease remission, low dose mepolizumab is a safe and effective steroid-sparing option for remission maintenance. It suggests that a personalized treatment dose might be explored according to the disease classification and activity at the time of biologic treatment start.
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Affiliation(s)
- Marco Caminati
- Department of Medicine, University of Verona & AOUI Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
| | - Matteo Maule
- Asthma Center and Allergy Unit, AOUI Verona, Policlinico GB Rossi, Verona, Italy
| | - Roberto Benoni
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Cristina Tecchio
- Haematology Unit, AOUI Verona, Policlinico GB Rossi, Verona, Italy
| | - Rachele Vaia
- Asthma Center and Allergy Unit, AOUI Verona, Policlinico GB Rossi, Verona, Italy
| | - Lucia De Franceschi
- Department of Medicine, University of Verona & AOUI Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Gabriella Guarnieri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Andrea Vianello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona & AOUI Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
- Asthma Center and Allergy Unit, AOUI Verona, Policlinico GB Rossi, Verona, Italy
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22
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Bagnasco D, Nicola S, Testino E, Brussino L, Pini L, Caminati M, Piccardo F, Canevari RF, Melissari L, Ioppi A, Guastini L, Lombardi C, Milanese M, Losa F, Robbiano M, De Ferrari L, Riccio AM, Guida G, Bonavia M, Fini D, Balbi F, Caruso C, Paggiaro P, Blasi F, Heffler E, Paoletti G, Canonica GW, Senna G, Passalacqua G. Long-Term Efficacy of Mepolizumab at 3 Years in Patients with Severe Asthma: Comparison with Clinical Trials and Super Responders. Biomedicines 2023; 11:2424. [PMID: 37760865 PMCID: PMC10525371 DOI: 10.3390/biomedicines11092424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/23/2023] [Accepted: 08/04/2023] [Indexed: 09/29/2023] Open
Abstract
The efficacy mepolizumab in severe asthmatic patients is proven in the literature. Primarily to study the effect of mepolizumab on exacerbations, steroid dependence, and the continuation of efficacy in the long term. Secondarily to evaluate the effect of the drug on nasal polyps. Analyzing data from SANI (Severe Asthma Network Italy) clinics, we observed severe asthmatic patients treated with mepolizumab 100 mg/4 weeks, for a period of 3 years. 157 patients were observed. Exacerbations were reduced from the first year (-84.6%) and progressively to 90 and 95% in the second and third ones. Steroid-dependent patients decreased from 54% to 21% and subsequently to 11% in the second year and 6% in the third year. Patients with concomitant nasal polyps, assessed by SNOT-22, showed a 49% reduction in value from baseline to the third year. The study demonstrated the long-term efficacy of mepolizumab in a real-life setting.
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Affiliation(s)
- Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy (M.R.); (L.D.F.); (G.P.)
- Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy;
| | - Stefania Nicola
- SCDU Immunologia e Allergologia, AO Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy (L.B.)
| | - Elisa Testino
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy (M.R.); (L.D.F.); (G.P.)
- Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy;
| | - Luisa Brussino
- SCDU Immunologia e Allergologia, AO Ordine Mauriziano di Torino, C.so Re Umberto 109, 10128 Torino, Italy (L.B.)
| | - Laura Pini
- Respiratory Medicine Unit, ASST—“Spedali Civili” of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy;
| | - Marco Caminati
- Department of Medicine, University of Verona, 37134 Verona, Italy; (M.C.); (G.S.)
| | - Federica Piccardo
- Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy;
| | - Rikki Frank Canevari
- ENT Department, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy; (R.F.C.); (L.G.)
| | - Laura Melissari
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy (M.R.); (L.D.F.); (G.P.)
- Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy;
| | - Alessandro Ioppi
- ENT Department, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy; (R.F.C.); (L.G.)
| | - Luca Guastini
- ENT Department, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy; (R.F.C.); (L.G.)
| | - Carlo Lombardi
- Departmental Unit of Allergology, Immunology & Pulmonary Diseases, Fondazione Poliambulanza, 25124 Brescia, Italy;
| | - Manlio Milanese
- Department of Respiratory Diseases, S. Corona Hospital, ASL2, 17027 Pietra Ligure, Italy;
| | - Francesca Losa
- UO Allergology and Clinical Immunology, ASST Mantova, 46100 Mantova, Italy;
| | - Michela Robbiano
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy (M.R.); (L.D.F.); (G.P.)
- Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy;
| | - Laura De Ferrari
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy (M.R.); (L.D.F.); (G.P.)
- Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy;
| | - Anna Maria Riccio
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy (M.R.); (L.D.F.); (G.P.)
- Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy;
| | - Giuseppe Guida
- Department of Clinical and Biological Science, University of Torino, 10043 Orbassano, Italy;
| | - Marco Bonavia
- Department of Rehabilitation Pulmonology, Hospital Ge-Arenzano, ASL3, 16149 Genoa, Italy;
| | - Donatella Fini
- Department of Pneumologiy, Hospital Sarzana (SP), 19125 La Spezia, Italy;
| | - Francesco Balbi
- Department of Pneumologiy, Hospital Imperia, 18100 Imperia, Italy;
| | - Cristiano Caruso
- Department of di Medical and Surgical Science, Fondation Universitary Policlinic A. Gemelli IRCCS, University Cattolica Sacro Cuore, 20123 Rome, Italy;
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, 56126 Pisa, Italy;
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
- Respiratory Unit and Adult Cystic Fibrosis Center, Internal Medicine Department, Fondation IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Enrico Heffler
- Unit of Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Clinical and Research Hospital, 20089 Rozzano, Italy; (E.H.); (G.P.); (G.W.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Giovanni Paoletti
- Unit of Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Clinical and Research Hospital, 20089 Rozzano, Italy; (E.H.); (G.P.); (G.W.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Giorgio Walter Canonica
- Unit of Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Clinical and Research Hospital, 20089 Rozzano, Italy; (E.H.); (G.P.); (G.W.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona, 37134 Verona, Italy; (M.C.); (G.S.)
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, 16132 Genoa, Italy (M.R.); (L.D.F.); (G.P.)
- Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy;
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23
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Ridolo E, Nicoletta F, Barone A, Ottoni M, Senna G, Canonica GW. Causes of Non-Adherence to Allergen-Specific Immunotherapy: A Foundation towards a Patient-Personalized Approach. J Pers Med 2023; 13:1206. [PMID: 37623457 PMCID: PMC10455852 DOI: 10.3390/jpm13081206] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Allergen-specific immunotherapy (AIT) is the only disease-modifying therapy for allergic conditions, resulting in a long-lasting tolerance beyond the duration of the treatment. Due to the strong relationship between the effectiveness, its optimal duration (at least three years) and the observation of the correct administration protocol, appropriate adherence to the plan of treatment represents a critical factor for the therapeutical success of AIT. METHODS Analysis of studies about the rate of adherence in subcutaneous and sublingual immunotherapy, which are the main routes of administration of AIT. RESULTS There are different causes leading to a premature interruption of the therapy or to it being incorrectly carried out; the most reported include erroneous expectations of the effectiveness and the adverse effects, economic issues, inconvenience and unrelated clinical conditions. CONCLUSIONS An attentive analysis of the main causes of dropouts may be useful to improve the management of these patients and to develop new strategies for a personalized approach. These strategies should be dynamic, involving attentive communication between the physician and the patient about all the possible criticalities, especially in the initial phase of the therapy, and facilitating, as much as possible, access to healthcare providers over the course of the maintenance phase, including by exploiting technological tools.
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Affiliation(s)
- Erminia Ridolo
- Allergology Unit, Parma University Hospital, 43121 Parma, Italy
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | | | | | - Martina Ottoni
- Allergology Unit, Parma University Hospital, 43121 Parma, Italy
| | | | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
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24
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Furci F, Allegra A, Tonacci A, Isola S, Senna G, Pioggia G, Gangemi S. Air Pollution and microRNAs: The Role of Association in Airway Inflammation. Life (Basel) 2023; 13:1375. [PMID: 37374157 DOI: 10.3390/life13061375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/29/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Air pollution exposure plays a key role in the alteration of gene expression profiles, which can be regulated by microRNAs, inducing the development of various diseases. Moreover, there is also evidence of sensitivity of miRNAs to environmental factors, including tobacco smoke. Various diseases are related to specific microRNA signatures, suggesting their potential role in pathophysiological processes; considering their association with environmental pollutants, they could become novel biomarkers of exposure. Therefore, the aim of the present work is to analyse data reported in the literature on the role of environmental stressors on microRNA alterations and, in particular, to identify specific alterations that might be related to the development of airway diseases so as to propose future preventive, diagnostic, and therapeutic strategies.
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Affiliation(s)
- Fabiana Furci
- Allergy Unit and Asthma Center, Verona University Hospital, 37134 Verona, Italy
| | - Alessandro Allegra
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, 98124 Messina, Italy
| | - Alessandro Tonacci
- Clinical Physiology Institute, National Research Council of Italy (IFC-CNR), 56124 Pisa, Italy
| | - Stefania Isola
- School and Operative Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
| | - Gianenrico Senna
- Allergy Unit and Asthma Center, Verona University Hospital, 37134 Verona, Italy
- Department of Medicine, Verona University Hospital, 37134 Verona, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
| | - Sebastiano Gangemi
- School and Operative Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
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25
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Guarnieri G, Olivieri B, Senna G, Vianello A. Relative Humidity and Its Impact on the Immune System and Infections. Int J Mol Sci 2023; 24:ijms24119456. [PMID: 37298409 DOI: 10.3390/ijms24119456] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
Relative humidity (RH) represents an underestimated outdoor and indoor environmental parameter. Conditions below and above the optimal range could facilitate infectious transmission as well as the exacerbation of respiratory diseases. The aim of this review is to outline the consequences for health of suboptimal RH in the environment and how to limit this negative impact. RH primarily affects the rheological properties of the mucus, modifying its osmolarity and thus the mucociliary clearance. The integrity of the physical barrier, maintained by mucus and tight junctions, is critical for protection from pathogens or irritants. Moreover, the control of RH seems to be a strategy to prevent and control the spread of viruses and bacteria. However, the imbalance of RH in the outdoor and indoor environments is frequently associated with the presence of other irritants, allergens, and pathogens, and therefore the burden of a single risk factor is not clearly defined in different situations. Nonetheless, RHmay have a synergistic negative effect with these risk factors, and its normalization, if possible, may have a positive impact on a healthier environment.
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Affiliation(s)
- Gabriella Guarnieri
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, Respiratory Pathophysiology Division, University of Padova, 35128 Padova, Italy
| | - Bianca Olivieri
- Department of Medicine, University of Verona, 37134 Verona, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona, 37134 Verona, Italy
| | - Andrea Vianello
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, Respiratory Pathophysiology Division, University of Padova, 35128 Padova, Italy
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Vultaggio A, Aliani M, Altieri E, Bracciale P, Brussino L, Caiaffa MF, Cameli P, Canonica GW, Caruso C, Centanni S, D'Amato M, De Michele F, Del Giacco S, Di Marco F, Menzella F, Pelaia G, Rogliani P, Romagnoli M, Schino P, Senna G, Benci M, Boarino S, Schroeder JW. Long-term effectiveness of benralizumab in severe eosinophilic asthma patients treated for 96-weeks: data from the ANANKE study. Respir Res 2023; 24:135. [PMID: 37210543 DOI: 10.1186/s12931-023-02439-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/28/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND The efficacy of benralizumab has been broadly demonstrated in severe eosinophilic asthma (SEA), but only few real-life studies evaluated its long-term effects. Here we present novel data from the ANANKE study in which a large cohort of SEA patients was treated for up to 96 weeks. METHODS ANANKE (NCT04272463) is an observational retrospective Italian study investigating the key characteristics of SEA patients (collected during the 12 months prior to benralizumab initiation) and the clinical outcomes during benralizumab treatment (annual exacerbation rate [AER], lung function, asthma control, OCS use, healthcare resource utilization). A post hoc analysis was also conducted in groups of patients based on history of previous biologic therapy (bio-experienced versus naïve patients). Analyses were descriptive only. RESULTS Before benralizumab initiation, evaluable SEA patients (N = 162, 61.1% females, mean age 56.0 ± 12.7) showed a median blood eosinophil count (BEC) of 600 cells/mm3 (IQR: 430-890). Patients experienced frequent exacerbations (annualized exacerbation rate [AER]: 4.10, severe AER: 0.98), with impaired lung function and poor asthma control (median ACT score: 14) despite 25.3% reported oral corticosteroid (OCS) use. Nasal polyposis was present in 53.1% patients; 47.5% patients were atopic. After 96 weeks since the start of benralizumab, nearly 90% patients were still on treatment; benralizumab dramatically decreased exacerbations (AER: - 94.9%; severe AER: - 96.9%), improved respiratory parameters (median increase in pre-bronchodilator forced expiratory volume [pre-BD FEV1]: + 400 mL) and asthma control (median ACT score: 23) while eliminating OCS in 60% patients. Importantly, benralizumab effects were either maintained or progressively improved over time, accompanied by a nearly complete depletion of BEC. Benralizumab reduced AER both in naïve (any AER: - 95.9%; severe AER: - 97.5%) and bio-experienced patients (any AER: - 92.4%; severe AER: - 94.0%). CONCLUSIONS Profound and sustained improvements in all asthma outcomes were observed with benralizumab. The correct identification of patients' eosinophilic-driven asthma phenotype was essential to ensure the achievement of such remarkable results. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04272463.
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Affiliation(s)
- Alessandra Vultaggio
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Florence, Italy.
| | - Maria Aliani
- UO Pneumologia e Pneumologia Riabilitativa, ICS Maugeri, IRCCS Bari, Bari, Italy
| | - Elena Altieri
- Reparto di Pneumologia, P.O. Garbagnate, Milanese, Italy
| | | | - Luisa Brussino
- Dipartimento di Scienze Mediche, SSDDU Allergologia e Immunologia Clinica, Università degli Studi di Torino, AO Ordine Mauriziano Umberto I, Torino, Italy
| | - Maria Filomena Caiaffa
- Cattedra e Scuola di Allergologia e Immunologia Clinica, Dipartimento di Scienze Mediche, Università di Foggia, Foggia, Italy
| | - Paolo Cameli
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, Siena, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
- Personalized Medicine Center: Asthma and Allergology, Humanitas Research Hospital, Rozzano, MI, Italy
| | - Cristiano Caruso
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Maria D'Amato
- UOSD Malattie Respiratorie "Federico II", Ospedale Monaldi, AO Dei Colli, Naples, Italy
| | - Fausto De Michele
- UOC Pneumologia e Fisiopatologia Respiratoria, AORN A. Cardarelli, Naples, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Fabiano Di Marco
- Department of Health Sciences, Università degli Studi di Milano, Pneumologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Menzella
- UOC Pneumologia, Ospedale "S. Valentino", AULSS 2 Marca Trevigiana, Montebelluna, TV, Italy
| | - Girolamo Pelaia
- Dipartimento di Scienze della Salute, Università Magna Graecia, Catanzaro, Italy
| | - Paola Rogliani
- Division of Respiratory Medicine, University Hospital "Tor Vergata", Rome, Italy
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | - Pietro Schino
- Fisiopatologia Respiratoria, Ospedale Generale Regionale, Ente Ecclesiastico "F. Miulli", Acquaviva delle Fonti, BA, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Marco Benci
- Medical Affairs R&I, AstraZeneca, Milan, Italy
| | | | - Jan Walter Schroeder
- Allergy and Clinical Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Guarnieri G, Chiurato L, Baiardini I, Caminati M, Senna G, Scarpa B, Vianello A. A hierarchical cluster analysis of the psycological impact of the COVID-19 pandemic on Italian severe asthma patients. J Asthma 2023:1-7. [PMID: 36951668 DOI: 10.1080/02770903.2023.2188565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
INTRODUCTION In the context of COVID-19 pandemic a consistent medical concern raised among severe asthma patients though the studies excluded an increased risk of severe disease as well as an increased susceptibility.The aim of the study was to apply the Psychological General Well-Being Index (PGWBI) questionnaire to severe asthmatics during the COVID-19 pandemic and to evaluate data with a hierarchical cluster analysis. METHODS 114 severe asthmatics were asked to respond anonymously to the PGWBI questionnaire. The patients underwent lung functional test, fractional exhaled nitric oxide (FeNO) measurement, Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ6). A hierarchical cluster analysis was performed using an agglomerative approach and complete linkage to evaluate the results. RESULTS The study population predominantly included female (60%), middle-aged patients, with normal lung function parameters, mild signs of airway and satisfactory asthma control. The PGWBI score (82.46 ± 16.53) of the study population showed a good state of psychological well-being and was similar to that of a representative sample of healthy adult Italian subjects. Thus Hierarchical cluster analysis identified 3 groups of patients: Cluster 1 (32%), Cluster 2 (64%), and Cluster 3 (4%). Whilst the Cluster 2 patients' PGWBI score fell within the normal range, the Cluster 1 patients had a significantly lower total score (68.57 ± 7.2; p < 0.05), suggesting moderate distress. The Cluster 3 patients presented a total score markedly low.Conclusion Although the majority of the severe asthma patients studied demonstrated good mental well-being during the COVID-19 pandemic, some did indeed show moderate to severe psychological distress.
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Affiliation(s)
- G Guarnieri
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health University of Padova, Respiratory Pathophysiology Division, Padova, Italy
| | - L Chiurato
- Department of Statistical Sciences and Department of Mathematics Tullio Levi-Civita, University of Padova, Padova, Italy
| | - I Baiardini
- Allergy & Respiratory Diseases Department, Azienda Ospedaliera Universitaria IRCCS San Martino, Genoa, Italy
| | - M Caminati
- Department of Medicine, University of Verona and Verona University Hospital, Verona, Italy
| | - G Senna
- Department of Medicine, University of Verona and Verona University Hospital, Verona, Italy
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - B Scarpa
- Department of Statistical Sciences and Department of Mathematics Tullio Levi-Civita, University of Padova, Padova, Italy
| | - A Vianello
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health University of Padova, Respiratory Pathophysiology Division, Padova, Italy
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Caminati M, Marcon A, Guarnieri G, Miotti J, Bagnasco D, Carpagnano GE, Pelaia G, Vaia R, Maule M, Vianello A, Senna G. Benralizumab Efficacy in Late Non-Responders to Mepolizumab and Variables Associated with Occurrence of Switching: A Real-Word Perspective. J Clin Med 2023; 12:jcm12051836. [PMID: 36902623 PMCID: PMC10002580 DOI: 10.3390/jcm12051836] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/02/2023] Open
Abstract
Overlapping eligibility to different biologics for severe asthma is still challenging, especially when addressing the same target. We aimed to characterize severe eosinophilic asthma patients according to their maintained or reduced response to mepolizumab over time and to explore baseline variables significantly associated with the occurrence of switching to benralizumab. We performed a multicentre retrospective observational study evaluating OCS reduction, exacerbation rate, lung function, exhaled nitric oxide levels (FeNO), Asthma control test (ACT), and blood eosinophil concentrations at baseline and before and after switching occurrence among 43 female and 25 male patients with severe asthma aged 23 to 84 years. Younger age, higher OCS daily dose and lower blood eosinophils at baseline were associated with a significantly higher risk (odds) for switching occurrence. All the patients showed an optimal response to mepolizumab, up to six months. The need for switching, according to the above-mentioned criterion, occurred for 30 out of 68 patients after a median time of 21 months (Q1-Q3: 12-24) from mepolizumab initiation. At the follow-up time-point after the switch (median time: 31 months, Q-Q3: 22-35), all the outcomes substantially improved and no cases of poor clinical response to benralizumab were detected. Although the small sample size and the retrospective design represent major limitations, to our knowledge, our study provides the first real-word focus on clinical variables potentially predicting a better response to anti IL-5r in patients fully eligible for both mepolizumab and benralizumab and suggests that in late non responder patients to mepolizumab, more robustly targeting the IL-5 axis may be effective.
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Affiliation(s)
- Marco Caminati
- Department of Medicine, University of Verona, 37134 Verona, Italy
- Correspondence:
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
| | - Gabriella Guarnieri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35129 Padua, Italy
| | - Jessica Miotti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI), University of Genoa, 16132 Genoa, Italy
| | - Giovanna Elisiana Carpagnano
- Division of Respiratory Diseases, Department of Medical and Surgical Sciences, Respiratory and Critical Care Unit, University of Bari, Polyclinic University Hospital, 70124 Bari, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy
| | - Rachele Vaia
- Department of Medicine, University of Verona, 37134 Verona, Italy
- Allergy Unit and Asthma Center, Verona University Hospital, 37134 Verona, Italy
| | - Matteo Maule
- Allergy Unit and Asthma Center, Verona University Hospital, 37134 Verona, Italy
| | - Andrea Vianello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35129 Padua, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona, 37134 Verona, Italy
- Allergy Unit and Asthma Center, Verona University Hospital, 37134 Verona, Italy
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Furci F, Caminati M, Crisafulli E, Senna G, Gangemi S. The intriguing possibility of using probiotics in allergen-specific immunotherapy. World Allergy Organ J 2023; 16:100751. [PMID: 36852412 PMCID: PMC9958496 DOI: 10.1016/j.waojou.2023.100751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 02/22/2023] Open
Abstract
Allergen immunotherapy (AIT) can be considered the etiological therapy for allergic rhinitis and hymenoptera venom allergy. Its role is increasingly emerging in the context of IgE mediated food allergy, where the achievement of tolerance, or the permanent resolution of an allergy, represents the optimal goal of AIT. AIT treatment, indicated in adults and children with allergic rhinitis, has a preventative effect on the development of asthma and can also be used when asthma is associated to rhinitis; however, it is not the first choice for treatment of isolated asthma. While knowledge on immunological mechanisms, efficacy, and safety of AIT is known, an intriguing line of investigation has arisen on how the action of AIT is modulated by the use of probiotics, starting from awareness that the microbiome is altered in allergic conditions: the use of probiotics in inducing the stimulation of innate immunity via toll-like receptor activation, thus acting as adjuvants in AIT, is hereby examined. Therefore, by analyzing literature on AIT and probiotics, we intend to draw attention to how the role and use of AIT are emerging as being increasingly important for both the short- and long-term management of allergic diseases and how recourse probiotics may represent an additional therapeutic strategy to modulate the effectiveness of AIT. However, further investigations are needed to better identify which probiotics to use, the dosage, and the optimal duration to obtain correct immunomodulation, and how to best customize their use, including a "AIT + probiotics" strategy in the field of precision medicine.
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Affiliation(s)
- Fabiana Furci
- Asthma Centre and Allergy Unit, University of Verona and Verona University Hospital, Verona, Italy
| | - Marco Caminati
- Allergy, Asthma and Clinical Immunology, Department of Medicine, University of Verona and Verona University Hospital, Verona, Italy,Corresponding author. Department of Medicine, University of Verona and Verona University Hospital, Verona, Italy.
| | - Ernesto Crisafulli
- Respiratory Medicine Unit and Section of Internal Medicine, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Gianenrico Senna
- Asthma Centre and Allergy Unit, University of Verona and Verona University Hospital, Verona, Italy,Allergy, Asthma and Clinical Immunology, Department of Medicine, University of Verona and Verona University Hospital, Verona, Italy
| | - Sebastiano Gangemi
- School and Operative Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, Policlinico “G. Martino”, University of Messina, Messina, Italy
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30
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Maule M, Senna G, Batani V, Maiolini F, Friso S, Caminati M. Low dose mepolizumab as steroid sparing strategy in HES remission phase. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.351] [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: 02/05/2023]
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31
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Tenero L, Vaia R, Ferrante G, Maule M, Venditto L, Piacentini G, Senna G, Caminati M. Diagnosis and Management of Allergic Rhinitis in Asthmatic Children. J Asthma Allergy 2023; 16:45-57. [PMID: 36636703 PMCID: PMC9829985 DOI: 10.2147/jaa.s281439] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
Allergic rhinitis (AR) is a common upper airways inflammatory condition especially in paediatric population; its burden potentially impacts on quality of life, quality of sleep and daily performance, which can be difficult to perceive but not less relevant in the middle-long term. The present review aims to provide an updated overview on AR epidemiology, diagnosis and with a special focus on its connections with bronchial asthma. In fact, when considering asthmatic pediatric population, AR is probably the most important risk factor for asthma onset and the most impactful extra-bronchial determinant of asthma control. Under this perspective, allergen immunotherapy (AIT) should always be considered in the light of a precision medicine approach. In fact, AIT does represent a unique opportunity to specifically interfere with AR immunological background, improve both AR and bronchial asthma control and prevent allergic disease evolution. Verifying the patient's eligibility to that option should be considered as a priority for every physician managing children suffering from AR, especially when associated with bronchial asthma.
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Affiliation(s)
- Laura Tenero
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Rachele Vaia
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Giuliana Ferrante
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Matteo Maule
- Department of Medicine, University of Verona, Verona, Italy
| | - Laura Venditto
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Gianenrico Senna
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy,Department of Medicine, University of Verona, Verona, Italy
| | - Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy,Correspondence: Marco Caminati, Department of Medicine, University of Verona, Piazzala L.A. Scuro, 10, Verona, 37134, Italy, Email
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32
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Cardona V, Ansotegui IJ, Ebisawa M, El-Gamal Y, Rivas MF, Fineman S, Geller M, Gonzalez-Estrada A, Greenberger PA, Borges MS, Senna G, Sheikh A, Tanno LK, Thong BY, Turner PJ, Worm M. [Erratum : World Allergy Organization Anaphylaxis Guidance 2020 [Japanese Journal of Allergology Vol.70 (2021) No.9 p.1211-1234]]. Arerugi 2023; 72:314. [PMID: 37225475 DOI: 10.15036/arerugi.72.314] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, and ARADyAL research network
| | | | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital
| | - Yehia El-Gamal
- Pediatric Allergy and Immunology Unit, Ain Shams University
| | | | - Stanley Fineman
- Department of Pediatrics, Emory University School of Medicine
| | - Mario Geller
- Division of Medicine, Academy of Medicine of Rio de Janeiro
| | | | - Paul A Greenberger
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine
| | - Mario Sanchez Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad and Clinica El Ávila
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital
| | - Aziz Sheikh
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh
| | - Luciana Kase Tanno
- Hospital Sírio Libanês, Brazil and University Hospital of Montpellier, São Paulo, Montpellier, and Sorbonne Université, INSERM Paris, France, and WHO Collaborating Centre on Scientific Classification Support Montpellier, and WHO ICD-11 Medical and Scientific Advisory Committee Geneva
| | - Bernard Y Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital
| | - Paul J Turner
- National Heart Lung Institute, Imperial College London and Discipline of Paediatrics and Child Health, School of Medicine, University of Sydney
| | - Margitta Worm
- Department of Dermatology and Allergology, Charite-Universitätsmedizin
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Doña I, Guidolin L, Bogas G, Olivieri E, Labella M, Schiappoli M, Sáenz de Santa María R, Dama A, Salas M, Senna G, Bonadonna P, Torres MJ. Resensitization in suspected penicillin allergy. Allergy 2023; 78:214-224. [PMID: 36067012 PMCID: PMC10087608 DOI: 10.1111/all.15508] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/29/2022] [Accepted: 08/08/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The diagnosis of allergic reactions to penicillins (AR-PEN) is very complex as there is a loss of sensitization over time, which leads to negative skin tests (STs) and specific IgE in serum, and even to tolerance to the drug involved. However, STs may become positive after subsequent exposure to the culprit drug (resensitization), with the risk of inducing potentially severe reactions. The exact rate of resensitization to penicillins is unknown, ranging from 0% to 27.9% in published studies. OBJECTIVES To analyze the rate of resensitization in patients with suggestive AR-PEN by repeating STs (retest) after an initial evaluation (IE). MATERIAL AND METHODS Patients with suspected AR-PEN were prospectively evaluated between 2017 and 2020. They underwent STs, and a randomized group also underwent a drug provocation test (DPT) with the culprit. Only patients with negative STs and/or DPT were included. All included cases were retested by STs at 2-8 weeks. RESULTS A total of 545 patients were included: 296 reporting immediate reactions (IRs) and 249 non-immediate reactions (NIRs). Eighty (14.7%) cases had positive results in retest (RT+): 63 (21.3%) IRs and 17 (6.8%) NIRs (p < 0.0001). The rate of RT+ was higher in anaphylaxis compared with all other reactions (45.8% vs 9.1%, p < 0.0001). The risk of RT+ was higher from the fifth week after IE (OR: 4.64, CI: 2.1-11.6; p < 0.001) and increased with the patient's age (OR: 1.02; CI: 1.01-1.04; p = 0.009). CONCLUSIONS Due to the high rate of resensitization, retest should be included in the diagnostic algorithm of IRs to penicillins after an initial negative study, especially in anaphylaxis, to avoid potentially severe reactions after subsequent prescriptions of these drugs.
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Affiliation(s)
- Inmaculada Doña
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Gádor Bogas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Marina Labella
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Rocío Sáenz de Santa María
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Annarita Dama
- Allergy Unit, Verona University Hospital, Verona, Italy
| | - María Salas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | | | - María José Torres
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain.,Departamento de Medicina, Universidad de Málaga, Málaga, Spain.,Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain
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34
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Caruso C, Colantuono S, Ciasca G, Basile U, Di Santo R, Bagnasco D, Passalacqua G, Caminati M, Michele S, Senna G, Heffler E, Canonica GW, Crimi N, Intravaia R, De Corso E, Firinu D, Gasbarrini A, Del Giacco SR. Different aspects of severe asthma in real life: Role of Staphylococcus aureus enterotoxins and correlation to comorbidities and disease severity. Allergy 2023; 78:131-140. [PMID: 35922152 DOI: 10.1111/all.15466] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 05/05/2022] [Accepted: 05/19/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Asthma, with several phenotypes and endotypes, is considered particularly suited for precision medicine. The identification of different non-invasive biomarkers may facilitate diagnosis and treatment. Recently, Staphylococcus aureus and its enterotoxins (SE) have been found to have a role in inducing persistent type 2 airway inflammation in severe asthma, but also in such comorbidities as chronic rhinosinusitis with nasal polyposis (CRSwNP). METHODS The aim of this retrospective study was to evaluate the prevalence of SE-IgE sensitization in a multicentric Italian cohort of severe asthmatic patients and correlate it with demographic and clinical characteristics. RESULTS A total of 249 patients were included in the analysis, out of which 25.3% were staphylococcal enterotoxin B (SEB)-IgE positive. We found a meaningful association between SEB-IgE and female gender, a positive association was also measured between CRS and CRSwNP. No significant association was found between SEB-IgE sensitization and atopy, the occurrence of exacerbations and corticosteroid dosages. In the SEB-IgE-positive patient, blood eosinophil count does not appear to be correlated with the severity of the disease. Patients with SEB-IgE sensitization are, on average, younger and with an earlier disease onset, thus confirming the possibility to consider SEB-IgE sensitization as an independent risk factor for developing asthma. CONCLUSIONS Our data confirm that the search for SE in the initial screening phase of these patients is helpful to better phenotype them, may predict the evolution of comorbidities and lead to a targeted therapeutic choice; in this point of view this represents a goal of precision medicine.
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Affiliation(s)
- Cristiano Caruso
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Stefania Colantuono
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriele Ciasca
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica Del Sacro Cuore, Roma, Italy.,Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Umberto Basile
- Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | | | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Marco Caminati
- Department of Medicine, University of Verona and Verona University Hospital, Verona, Italy
| | - Schiappoli Michele
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - G Walter Canonica
- Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Nunzio Crimi
- Respiratory Medicine Unit, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy.,Department of Clinical and Experimental Medicine, Section of Respiratory Medicine, A.O.U. "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Rossella Intravaia
- Department of Clinical and Experimental Medicine, Section of Respiratory Medicine, University of Catania, Catania, Italy
| | - Eugenio De Corso
- Otolaryngology Institute-Department of Head and Neck, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Gasbarrini
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Stefano R Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Caminati M, Guarnieri G, Paggiaro P, Vianello A, Crisafulli E, Vaia R, Senna G. Relevance of Smoking Habit in Severe Asthma Patients: Evidence from the Severe Asthma Network in Italy (SANI) Registry. J Clin Med 2022; 11:jcm11247465. [PMID: 36556081 PMCID: PMC9784435 DOI: 10.3390/jcm11247465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/10/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
Smoking habit is still fairly common among asthmatics. So far, the impact of smoke on severe asthma burden has not been specifically investigated. We aimed to estimate the frequency of smoking habit among severe asthma patients, their clinical features, and the impact of smoke on asthma outcomes. The Severe Asthma Network in Italy (SANI) registry was analyzed. Demographic, clinical, and functional features of smokers, never and former smokers were compared. Data from 1194 patients were explored. Smokers were younger, with a lower asthma onset age. Atopy, BMI and respiratory/systemic comorbidities were equally distributed. In former smokers pre- and post-FEV1/FVC was significantly lower; no other significant differences were detected. Similar findings were confirmed when stratifying the former smokers by pack-years and length of smoking cessation. Among former smokers, lymphocytes and neutrophils were higher in the <15 years of smoking cessation group. Blood eosinophils were comparable in never and former smokers. When clustering the population by blood eosinophils, no significant differences in pulmonary function and exacerbations were observed. Our data suggest that a personal smoking history has a relatively low impact on disease burden. It remarks the importance of smoking cessation as a main intervention, particularly in severe asthma.
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Affiliation(s)
- Marco Caminati
- Department of Medicine, University of Verona, 37134 Verona, Italy
- Correspondence:
| | - Gabriella Guarnieri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35122 Padua, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, 56126 Pisa, Italy
| | - Andrea Vianello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35122 Padua, Italy
| | - Ernesto Crisafulli
- Respiratory Medicine Unit, Department of Medicine, University of Verona and Verona University Hospital, 37134 Verona, Italy
| | - Rachele Vaia
- Allergy Unit and Asthma Center, Verona University Hospital, 37134 Verona, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona, 37134 Verona, Italy
- Allergy Unit and Asthma Center, Verona University Hospital, 37134 Verona, Italy
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Guarnieri G, Bertagna De Marchi L, Marcon A, Panunzi S, Batani V, Caminati M, Furci F, Senna G, Alaibac M, Vianello A. Relationship between hair shedding and systemic inflammation in COVID-19 pneumonia. Ann Med 2022; 54:869-874. [PMID: 35341398 PMCID: PMC8959503 DOI: 10.1080/07853890.2022.2054026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: A higher risk for COVID-19 infection and severity for men compared to women has been described since the beginning of the pandemic. The role of androgens has been recently highlighted as they control two key steps of coronavirus infection mediated through the transmembrane protease serin 2 (TMPRRS2) and the angiotensin-converting enzyme 2 (ACE2) receptor in the lung tissue. Furthermore, a high incidence of androgenic alopecia among males with COVID-19 disease have been reported.Objective: This study aims to evaluate the telogen effluvium (TE) prevalence and its relationship with clinical and immunologic parameters in a sample of patients consecutively evaluated after recovery from COVID-19 pneumonia in Northern Italy.Methods: Overall 104 patients were recruited within three months from COVID-19 pneumonia recovery; 80 (77%) had been hospitalized in a Respiratory Intensive Care Unit and the remaining ones had been treated at home. The extent of TE was assessed with a visual analogic scale for thick bundle of hairs. Demographic and clinical data and systemic inflammation biomarkers were also evaluated.Results. Thirty-two patients reported a history of TE and their mean TE-VAS score was 5.78 ± 1.72 (range 3-9). Women had about a 5-fold higher risk (odds) of complaining of TE compared to males (OR = 4.69, 95%CI: 1.91, 11.49; p = .001), and the association became stronger when adjusted for COVID-19 severity (hospital admission vs home care: OR = 6.09, 95%CI: 2.34, 15.88; p < .001). Levels of C-reactive protein >1.90 mg/l (ORadj: 2.43, 95%CI 0.85, 7.05, p = 0.096) or IL 1β > 5 ng/l (ORadj 4.72, 95%CI: 1.31, 23.19, p = .03) were also significantly associated with TE.Conclusion: This exploratory study raises the hypothesis that hair shedding is more strictly related to the severity of COVID-19 disease and the underlying inflammation rather than to patients' hormonal status. KEY MESSAGESThe presence of Telogen effluvium (TE) was significantly more common in women.Higher severity of the Covid-19 disease seems to play a critical role, more important than the hormonal influence, in the development of TE.The severity of inflammation related to TE and Covid-19 could also play a role as suggested by the higher levels of CRP and platelets and IL1β.
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Affiliation(s)
- Gabriella Guarnieri
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, Respiratory Pathophysiology Unit, University of Padova, Padova, Italy
| | - Leonardo Bertagna De Marchi
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, Respiratory Pathophysiology Unit, University of Padova, Padova, Italy
| | - Alessandro Marcon
- Department of Diagnostics and Public Health, Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - Silvia Panunzi
- Department of Diagnostics and Public Health, Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - Veronica Batani
- Department of Medicine, University of Verona and Verona University Hospital, Verona, Italy
| | - Marco Caminati
- Department of Medicine, University of Verona and Verona University Hospital, Verona, Italy
| | - Fabiana Furci
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona and Verona University Hospital, Verona, Italy.,Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Mauro Alaibac
- Department of Medicine-DIMED, Unit of Dermatology, University of Padova, Padova, Italy
| | - Andrea Vianello
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, Respiratory Pathophysiology Unit, University of Padova, Padova, Italy
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Caminati M, Guarnieri G, Marchetti P, Furci F, Senna G, Vianello A, Poli A, Marchese‐Ragona R, Ottaviano G, Marcon A. COVID-19 pandemic and environment: Not only air pollution. Allergy 2022; 77:3699-3701. [PMID: 36441593 PMCID: PMC9878037 DOI: 10.1111/all.15394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Marco Caminati
- Asthma, Allergy and Clinical Immunology SectionDepartment of MedicineUniversity of VeronaVeronaItaly
| | - Gabriella Guarnieri
- Respiratory Pathophysiology Unit, Department of Cardiac‐Thoracic‐Vascular Sciences and Public HealthUniversity of PadovaPadovaItaly
| | - Pierpaolo Marchetti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public HealthUniversity of VeronaVeronaItaly
| | | | - Gianenrico Senna
- Asthma, Allergy and Clinical Immunology SectionDepartment of MedicineUniversity of VeronaVeronaItaly,Asthma Center and Allergy UnitVerona University HospitalVeronaItaly
| | - Andrea Vianello
- Respiratory Pathophysiology Unit, Department of Cardiac‐Thoracic‐Vascular Sciences and Public HealthUniversity of PadovaPadovaItaly
| | - Albino Poli
- Section of Hygiene and Preventive Medicine, Department of Diagnostics and Public HealthUniversity of VeronaVeronaItaly
| | | | - Giancarlo Ottaviano
- Otolaryngology Section, Department of NeuroscienceUniversity of PadovaPadovaItaly
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public HealthUniversity of VeronaVeronaItaly
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Furci F, Murdaca G, Allegra A, Gammeri L, Senna G, Gangemi S. IL-33 and the Cytokine Storm in COVID-19: From a Potential Immunological Relationship towards Precision Medicine. Int J Mol Sci 2022; 23:ijms232314532. [PMID: 36498859 PMCID: PMC9740753 DOI: 10.3390/ijms232314532] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
Coronavirus SARS-CoV-2 has represented, and still represents, a real challenge from a clinical, diagnostic and therapeutic point of view. During acute infection, the increased levels of pro-inflammatory cytokines, which are involved in the pathology of disease and the development of SARS-CoV-2-induced acute respiratory disease syndrome, the life-threatening form of this infection, are correlated with patient survival and disease severity. IL-33, a key cytokine involved in both innate and adaptive immune responses in mucosal organs, can increase airway inflammation, mucus secretion and Th2 cytokine synthesis in the lungs, following respiratory infections. Similar to cases of exposure to known respiratory virus infections, exposure to SARS-CoV-2 induces the expression of IL-33, correlating with T-cell activation and lung disease severity. In this work, we analyse current evidence regarding the immunological role of IL-33 in patients affected by COVID-19, to evaluate not only the clinical impact correlated to its production but also to identify possible future immunological therapies that can block the most expressed inflammatory molecules, preventing worsening of the disease and saving patient lives.
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Affiliation(s)
- Fabiana Furci
- Asthma Centre and Allergy Unit, University of Verona and Verona University Hospital, 37124 Verona, Italy
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, Policlinico G. Martino, University of Messina, 98100 Messina, Italy
| | - Giuseppe Murdaca
- Department of Internal Medicine, University of Genoa, 16126 Genoa, Italy
- Correspondence:
| | - Alessandro Allegra
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, 98122 Messina, Italy
| | - Luca Gammeri
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, Policlinico G. Martino, University of Messina, 98100 Messina, Italy
| | - Gianenrico Senna
- Asthma Centre and Allergy Unit, University of Verona and Verona University Hospital, 37124 Verona, Italy
- Department of Medicine, University of Verona and Verona University Hospital, 37124 Verona, Italy
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, Policlinico G. Martino, University of Messina, 98100 Messina, Italy
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Senna G, Aliani M, Altieri E, Bracciale P, Brussino L, Caiaffa MF, Cameli P, Canonica GW, Caruso C, D’Amato M, De Michele F, Del Giacco S, Di Marco F, Menzella F, Pelaia G, Rogliani P, Romagnoli M, Schino P, Schroeder JW, Vultaggio A, Rizzoli S, Zullo A, Boarino S, Palmisano M, Rossi A, Vitiello G, Centanni S. Clinical Features and Efficacy of Benralizumab in Patients with Blood Eosinophil Count Between 300 and 450 Cells/mm 3: A Post Hoc Analysis from the ANANKE Study. J Asthma Allergy 2022; 15:1593-1604. [PMID: 36387835 PMCID: PMC9661992 DOI: 10.2147/jaa.s383012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/03/2022] [Indexed: 04/23/2024] Open
Abstract
PURPOSE Benralizumab effectively reduces severe eosinophilic asthma (SEA) exacerbations in patients with a wide range of baseline blood eosinophil count (BEC). Patients included in real-world studies are often characterized by high mean/median BEC, while patients with BEC close to 300 cells/mm3 are poorly represented. This post hoc analysis from the Italian study ANANKE aims to define the clinical features and corroborate the efficacy of benralizumab in real world in the BEC 300-450 cells/mm3 subset of patients. PATIENTS AND METHODS Post hoc analysis of the Italian, multicenter, observational, retrospective real-life study ANANKE (NCT04272463). Baseline clinical and laboratory characteristics were collected in the 12 months prior to benralizumab treatment and presented for a BEC 300-450 cells/mm3 subgroup of patients. Change over time of BEC, annualized exacerbation rate (AER), asthma control (ACT), lung function and oral corticosteroid (OCS) use at 16, 24 and 48 weeks after benralizumab introduction were collected. RESULTS A total of 164 patients were analyzed, 34 of whom with a BEC of 300-450 cells/mm3. This subgroup was more likely to be female (64.7%), with lower rates of severe exacerbations at baseline when compared to the total population (0.69 vs 1.01). After 48 weeks of benralizumab treatment, the BEC 300-450 subset showed similar reductions in AER (-94.8% vs -92.2%) and OCS use (median dose reduction of 100% in both groups), as well as improvement in ACT score (median scores 22.5 vs 22) and lung function (pre-BD FEV1: +200 mL vs +300 mL) when compared to the total population. No discontinuations for safety reasons were registered. CONCLUSION At baseline, apart from lower severe exacerbation rate, the BEC 300-450 cells/mm3 subset of patients is comparable to the total population prescribed with benralizumab. In this real-life study, benralizumab is as effective in BEC 300-450 patients as in the total population.
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Affiliation(s)
- Gianenrico Senna
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Maria Aliani
- UO Pneumologia e Pneumologia Riabilitativa, ICS Maugeri, IRCCS Bari, Bari, Italy
| | - Elena Altieri
- Reparto di Pneumologia, P.O., Garbagnate Milanese, Italy
| | | | - Luisa Brussino
- Dipartimento di Scienze Mediche, SSDDU Allergologia e Immunologia Clinica, Università degli Studi di Torino, AO Ordine Mauriziano Umberto I, Torino, Italy
| | - Maria Filomena Caiaffa
- Cattedra e Scuola di Allergologia e Immunologia Clinica, Dipartimento di Scienze Mediche, Università di Foggia, Foggia, Italy
| | - Paolo Cameli
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Siena, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
- Personalized Medicine Center: Asthma and Allergology, Humanitas Research Hospital, Rozzano, MI, Italy
| | - Cristiano Caruso
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Maria D’Amato
- UOSD Malattie Respiratorie “Federico II”, Ospedale Monaldi, AO Dei Colli, Napoli, Italy
| | - Fausto De Michele
- UOC Pneumologia e Fisiopatologia Respiratoria, AORN A. Cardarelli, Napoli, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Fabiano Di Marco
- Department of Health Sciences, Università Degli Studi Di Milano, Pneumologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Menzella
- UOC Pneumologia, Ospedale “S. Valentino”, AULSS 2 Marca Trevigiana, Montebelluna, TV, Italy
| | - Girolamo Pelaia
- Dipartimento di Scienze della Salute, Università Magna Graecia, Catanzaro, Italy
| | - Paola Rogliani
- Division of Respiratory Medicine, University Hospital “Tor Vergata”, Roma, Italy
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, Roma, Italy
| | | | - Pietro Schino
- Fisiopatologia Respiratoria, Ospedale Generale Regionale, Ente Ecclesiastico “F. Miulli”, Acquaviva delle Fonti, BA, Italy
| | - Jan Walter Schroeder
- Allergy and Clinical Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Alessandra Vultaggio
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Firenze, Italy
| | - Sara Rizzoli
- Medineos Observational Research - An IQVIA Company, Modena, Italy
| | - Alessandro Zullo
- Medineos Observational Research - An IQVIA Company, Modena, Italy
| | | | | | | | | | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
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Guarnieri G, Batani V, Senna G, Dama A, Vianello A, Caminati M. Is mild asthma truly mild? The patients' real-life setting. Expert Rev Respir Med 2022; 16:1263-1272. [PMID: 36633404 DOI: 10.1080/17476348.2023.2167714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Asthma exacerbations and, more rarely, fatal asthma attacks have been reported in mild asthma patients, suggesting poor disease control and awareness of its potential burden. Our study aimed to explore outside the hospital/specialist setting the perspective and disease treatment behavior of patients self-reporting a mild asthma diagnosis. METHODS Computer-Assisted Personal Interviewing (CAPI) technique was used to investigate the identified study population. Questions about diagnosis, symptoms, comorbidities, treatment strategy, ongoing assessments, and quality of life were administered. RESULTS Overall, 258 patients were considered for the analysis. As the most relevant results, 22% of them reported severe respiratory symptoms, 52% experienced at least one exacerbation/year, and 7% needed Emergency Room care. Sixty-six percent of the respondents assumed as needing short-acting bronchodilators only. Of note, 22% of patients were using oral steroids (OCS) intermittently and 72% of them considered their quality of life unsatisfying. CONCLUSION Outside the hospital/specialist setting, mild asthma burden is still not negligible and the treatment approach is not correct. In particular, the reported OCS use is disproportionate. Our data suggest that mild asthma, especially when self-assessed might be other than mild, suggesting that efforts to increase disease awareness, improve the disease control limiting the OCS abuse are required.
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Affiliation(s)
- Gabriella Guarnieri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | | | - Gianenrico Senna
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Annarita Dama
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Andrea Vianello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy
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Giuliano AFM, Buquicchio R, Patella V, Bedbrook A, Bousquet J, Senna G, Ventura MT. Rediscovering Allergic Rhinitis: The Use of a Novel mHealth Solution to Describe and Monitor Health-Related Quality of Life in Elderly Patients. Int Arch Allergy Immunol 2022; 183:1178-1188. [PMID: 36067743 DOI: 10.1159/000525595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/27/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Allergic rhinitis (AR) is a disease characterized by IgE-mediated hypersensitivity responses akin to allergic asthma. Although common in children and young adults, AR can be particularly vexing in the elderly: several studies have underlined its impact on the patient's self-perceived health-related quality of life (HR-QoL). Available literature data on AR-affected elderly patients remain sparse and often focused on specific characteristics. mHealth solutions such as MASK-air® can be used in assessing salient clinical characteristics and unique shifts in self-perceived HR-QoL in old age people. With this pilot study, we aim to assess these variables in two cohorts of AR-affected elderly patients - one actively involved in the daily use of mHealth applications and the other having never used such a solution - by applying a widespread, validated, and standardized tool. METHODS AR-affected patients aged ≥65 years accessing the outpatient clinic of the Bari Geriatric Immuno-allergology Unit between March and July 2021 were enrolled and assigned to "mHealth" (MASK-air®) and "non-mHealth" cohorts accordingly. Each participant was given a 19-item questionnaire delivered via a custom software solution, with the EuroQoL EQ-5D-5L used to assess HR-QoL. RESULTS 93 patients (51 mHealth users, 43 non-mHealth users) were enrolled. AR was often either standalone or associated with asthma and conjunctivitis, and 57.4% of the participants reported a negative influence of AR on daily activities. Analysis of HR-QoL showed significantly worse scores in mobility and anxiety/depression dimensions for female patients regardless of app usage, while male non-mHealth users had worse self-care scores. Female mHealth users had worse scores for the self-care and activity dimensions, whereas female non-mHealth users showed worse scores on the pain scale. In general, mHealth users showed a greater degree of anxiety/depression when compared to non-mHealth users, relating to a greater awareness of their health status. CONCLUSION The use of an mHealth solution, along with a concise, clinically-validated, comprehensive HR-QoL assessment toolset such as the EQ-5D, can prove beneficial in defining the unique characteristics of AR in the elderly. It can enable a detailed exploration of the impact on specific aspects of quality of life in old age. Raising patient awareness towards a health condition can improve compliance to treatment as well as follow-up. A lack of uniformity in approach, along with missing data pertaining to the general population are critical issues that require further studies. A more thorough diffusion of mHealth usage is also necessary among the geriatric population.
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Affiliation(s)
| | - Rosalba Buquicchio
- Dermatology Section, IRCCS Istituto Oncologico Giovanni Paolo II, Bari, Italy
| | - Vincenzo Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, Agency of Health ASL Salerno, "Santa Maria della Speranza" Hospital, Battipaglia, Italy
| | | | - Jean Bousquet
- MASK-air, Montpellier, France.,Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,University Hospital Montpellier, Montpellier, France.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Gianenrico Senna
- Department of Medicine, University of Verona and Verona University Hospital, Verona, Italy.,Allergy Unit and Asthma Center, University of Verona and Verona University Hospital, Verona, Italy
| | - Maria Teresa Ventura
- University of Bari Medical School, Unit of Geriatric Immunoallergology, Bari, Italy
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Caminati M, Olivieri B, Dama A, Micheletto C, Paggiaro P, Pinter P, Senna G, Schiappoli M. Dupilumab-induced hypereosinophilia: review of the literature and algorithm proposal for clinical management. Expert Rev Respir Med 2022; 16:713-721. [PMID: 35703018 DOI: 10.1080/17476348.2022.2090342] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Dupilumab is a human monoclonal antibody that targets both IL-4 and IL-13 signaling. It is currently indicated for the treatment of asthma, moderate-to-severe atopic dermatitis, and chronic rhinosinusitis with nasal polyps (CRSwNP). Eosinophilia has been reported as a potential adverse event in treated patients. AREAS COVERED A selective search on PubMed and Medline up to January 2022 was performed, by focusing on dupilumab-induced hypereosinophilia described in clinical trials, real-life studies, and case reports. The possible mechanisms underlying dupilumab-induced hypereosinophilia and the eosinophil-related morbidity have also been explored. EXPERT OPINION Dealing with dupilumab-induced hypereosinophilia represents a clinical challenge for clinicians managing patients on dupilumab therapy. An algorithm for the practical management of dupilumab-induced hypereosinophilia has been proposed, in order to properly investigate potential eosinophil-related morbidity and avoid unnecessary drug discontinuation.
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Affiliation(s)
- Marco Caminati
- Department of Medicine, Asthma, Allergy and Clinical Immunology Section, University of Verona, Verona, Italy
| | - Bianca Olivieri
- Department of Medicine, Asthma, Allergy and Clinical Immunology Section, University of Verona, Verona, Italy
| | - Annarita Dama
- Allergy and Asthma Unit, Verona University Hospital, Verona, Italy
| | | | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Patrick Pinter
- Division of Otorhinolaryngology, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, Verona University Hospital, Verona, Italy
| | - Gianenrico Senna
- Department of Medicine, Asthma, Allergy and Clinical Immunology Section, University of Verona, Verona, Italy.,Allergy and Asthma Unit, Verona University Hospital, Verona, Italy
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Zuberbier T, Dörr T, Aberer W, Alvaro M, Angier E, Arasi S, Arshad H, Ballmer‐Weber B, Bartra J, Beck L, Bégin P, Bindslev‐Jensen C, Bislimovska J, Bousquet J, Brockow K, Bush A, Cianferoni A, Cork MJ, Custovic A, Darsow U, Jong N, Deleanu D, Del Giacco S, Deschildre A, Dunn Galvin A, Ebisawa M, Fernández‐Rivas M, Ferrer M, Fiocchi A, Gerth van Wijk R, Gotua M, Grimshaw K, Grünhagen J, Heffler E, Hide M, Hoffmann‐Sommergruber K, Incorvaia C, Janson C, Malte John S, Jones C, Jutel M, Katoh N, Kendziora B, Kinaciyan T, Knol E, Kurbacheva O, Lau S, Loh R, Lombardi C, Mäkelä M, Marchisotto MJ, Makris M, Maurer M, Meyer R, Mijakoski D, Minov J, Mullol J, Nilsson C, Nowak–Wegrzyn A, Nwaru BI, Odemyr M, Pajno GB, Paudel S, Papadopoulos NG, Renz H, Ricci G, Ring J, Rogala B, Sampson H, Senna G, Sitkauskiene B, Smith PK, Stevanovic K, Stoleski S, Szajewska H, Tanaka A, Todo‐Bom A, Topal FA, Valovirta E, Van Ree R, Venter C, Wöhrl S, Wong GW, Zhao Z, Worm M. Proposal of 0.5 mg of protein/100 g of processed food as threshold for voluntary declaration of food allergen traces in processed food-A first step in an initiative to better inform patients and avoid fatal allergic reactions: A GA²LEN position paper. Allergy 2022; 77:1736-1750. [PMID: 34741557 DOI: 10.1111/all.15167] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/15/2021] [Accepted: 11/01/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Food anaphylaxis is commonly elicited by unintentional ingestion of foods containing the allergen above the tolerance threshold level of the individual. While labeling the 14 main allergens used as ingredients in food products is mandatory in the EU, there is no legal definition of declaring potential contaminants. Precautionary allergen labeling such as "may contain traces of" is often used. However, this is unsatisfactory for consumers as they get no information if the contamination is below their personal threshold. In discussions with the food industry and technologists, it was suggested to use a voluntary declaration indicating that all declared contaminants are below a threshold of 0.5 mg protein per 100 g of food. This concentration is known to be below the threshold of most patients, and it can be technically guaranteed in most food production. However, it was also important to assess that in case of accidental ingestion of contaminants below this threshold by highly allergic patients, no fatal anaphylactic reaction could occur. Therefore, we performed a systematic review to assess whether a fatal reaction to 5mg of protein or less has been reported, assuming that a maximum portion size of 1kg of a processed food exceeds any meal and thus gives a sufficient safety margin. METHODS MEDLINE and EMBASE were searched until 24 January 2021 for provocation studies and case reports in which one of the 14 major food allergens was reported to elicit fatal or life-threatening anaphylactic reactions and assessed if these occurred below the ingestion of 5mg of protein. A Delphi process was performed to obtain an expert consensus on the results. RESULTS In the 210 studies included, in our search, no reports of fatal anaphylactic reactions reported below 5 mg protein ingested were identified. However, in provocation studies and case reports, severe reactions below 5 mg were reported for the following allergens: eggs, fish, lupin, milk, nuts, peanuts, soy, and sesame seeds. CONCLUSION Based on the literature studied for this review, it can be stated that cross-contamination of the 14 major food allergens below 0.5 mg/100 g is likely not to endanger most food allergic patients when a standard portion of food is consumed. We propose to use the statement "this product contains the named allergens in the list of ingredients, it may contain traces of other contaminations (to be named, e.g. nut) at concentrations less than 0.5 mg per 100 g of this product" for a voluntary declaration on processed food packages. This level of avoidance of cross-contaminations can be achieved technically for most processed foods, and the statement would be a clear and helpful message to the consumers. However, it is clearly acknowledged that a voluntary declaration is only a first step to a legally binding solution. For this, further research on threshold levels is encouraged.
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Nettis E, Brussino L, Patella V, Bonzano L, Detoraki A, Di Leo E, Sirufo MM, Caruso C, Lodi Rizzini F, Conte M, Yacoub MR, Triggiani M, Ridolo E, Macchia L, Rolla G, Brancaccio R, De Paulis A, Spadaro G, Di Bona D, D'Uggento AM, Ginaldi L, Gaeta F, Nucera E, Jaubashi K, Villalta D, Dagna L, Ciotta D, Pucciarini F, Bagnasco D, Celi G, Chieco Bianchi F, Cosmi L, Costantino MT, Crivellaro MA, D'Alò S, Del Biondo P, Del Giacco S, Di Gioacchino M, Di Pietro L, Favero E, Gangemi S, Guarnieri G, Heffler E, Leto Barone MS, Lombardo C, Losa F, Matucci A, Minciullo PL, Parronchi P, Passalacqua G, Pucci S, Rossi O, Salvati L, Schiappoli M, Senna G, Vianello A, Vultaggio A, Baoran Y, Incorvaia C, Canonica GW. Effectiveness and safety of dupilumab in patients with chronic rhinosinusitis with nasal polyps and associated comorbidities: a multicentric prospective study in real life. Clin Mol Allergy 2022; 20:6. [PMID: 35590407 PMCID: PMC9121619 DOI: 10.1186/s12948-022-00171-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Biologics are currently one of the main treatment options for a number of diseases. The IgG4 monoclonal antibody dupilumab targets the Interleukin-4 receptor alpha chain, thus preventing the biological effects of the cytokines IL-4 and IL-13, that are essential for the Th2 response. Several controlled trials showed that dupilumab is effective and safe in patients with atopic dermatitis (AD), severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), thus resulting in approval by regulatory agencies. Aim of the study was to evaluate the efficacy and safety of dupilumab in adult patients with CRSwNP stratified by common overlapping comorbid conditions. METHODS We performed a multicenter, observational, prospective study enrolling adult patients with severe CRSwNP who had started dupilumab treatment in the context of standard care from January 2021 to October 2021. Data were collected from twentynine Italian secondary care centers for allergy and clinical immunology, all of which were part of the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC). A number of efficacy parameters were used. Patient data were compared using the Wilcoxon test for paired data. All statistical analyses were performed with SPSS version 20 (IBM, Armonk, NY, USA). RESULTS In total, 82 patients with nasal polyposis were identified. A significant improvement was detected for all the applied efficacy parameters, i.e. 22-item Sino-Nasal Outcome Test (SNOT-22) and bilateral endoscopic nasal polyp score (NPS) scores for CRSwNP, Rhinitis Control Scoring System (RCSS) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores for allergic perennial rhinitis, Forced Expiratory Volume in the 1st second (FEV1) and Asthma Quality of Life Questionnaire (AQLQ) scores for asthma, Eczema Area and Severity Index (EASI) and Dermatology Life Quality Index (DLQI) scores for AD. A non-significant improvement was also obtained in the Urticaria Activity Score over 7 days (UAS7) for chronic spontaneous urticaria. Treatment with dupilumab was well tolerated. CONCLUSIONS These data suggest that dupilumab treatment in patients suffering from CRSwNP and associated comorbidities may be suitable. Such outcome, although confirmation by trials is warranted, suggests the possibility to treat different disorders with a single therapy, with favorable effects especially under the cost-effectiveness aspect.
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Affiliation(s)
- Eustachio Nettis
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Policlinico Di Bari, Bari, Italy
| | - Luisa Brussino
- Department of Medical Sciences, University of Turin, Corso Achille Mario Dogliotti, 14, 10126, Turin, Italy.,S.S.D.D.U. Allergologia E Immunologia Clinica, AO Ordine Mauriziano Umberto I, 10128, Turin, Italy
| | - Vincenzo Patella
- Division of Allergy and Clinical Immunology, Department of Medicine ASL Salerno, Santa Maria Della Speranza Hospital, Salerno, Italy
| | - Laura Bonzano
- Dermatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Aikaterini Detoraki
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology and Infectious Disease, Azienda Ospedaliera Universitaria Federico II, Napoli, Italy
| | - Elisabetta Di Leo
- Section of Allergy and Clinical Immunology, Unit of Internal Medicine, "F. Miulli" Hospital, Strada Provinciale per Santeramo Km 4.100, Acquaviva delle Fonti, Bari, Italy
| | - Maria Maddalena Sirufo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Cristiano Caruso
- Dipartimento di Scienze Mediche e Chirurgiche, Digestive Disease Center, Fondazione Policlinico A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabio Lodi Rizzini
- Facoltà Medicina e Chirurgia, Università Studi Brescia, SSVD Allergologia - Spedali Civili Brescia, Brescia, Italy
| | - Mariaelisabetta Conte
- Struttura Dipartimentale di Immunologia ed Allergologia Azienda Sanitaria Friuli Occidentale, Presidio Ospedaliero di Pordenone, Pordenone, Italy
| | - Mona-Rita Yacoub
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Fisciano, Italy
| | - Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Luigi Macchia
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Policlinico Di Bari, Bari, Italy
| | - Giovanni Rolla
- Dipartimento di Scienze Mediche, Università Di Torino, Turin, Italy
| | | | - Amato De Paulis
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology and Infectious Disease, Azienda Ospedaliera Universitaria Federico II, Napoli, Italy
| | - Giuseppe Spadaro
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology and Infectious Disease, Azienda Ospedaliera Universitaria Federico II, Napoli, Italy
| | - Danilo Di Bona
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Policlinico Di Bari, Bari, Italy
| | | | - Lia Ginaldi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100, L'Aquila, Italy.,Allergy and Clinical Immunology Unit, AUSL 04, 64100, Teramo, Italy
| | - Francesco Gaeta
- Dipartimento di Scienze Mediche e Chirurgiche, Digestive Disease Center, Fondazione Policlinico A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eleonora Nucera
- Dipartimento di Scienze Mediche e Chirurgiche, Digestive Disease Center, Fondazione Policlinico A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Kliljeda Jaubashi
- Facoltà Medicina e Chirurgia, Università Studi Brescia, SSVD Allergologia - Spedali Civili Brescia, Brescia, Italy
| | - Danilo Villalta
- Struttura Dipartimentale di Immunologia ed Allergologia Azienda Sanitaria Friuli Occidentale, Presidio Ospedaliero di Pordenone, Pordenone, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Domenico Ciotta
- Division of Allergy and Clinical Immunology, University of Salerno, Fisciano, Italy
| | | | - Diego Bagnasco
- Clinica Delle Malattie Respiratorie e Allergologia Dipartimento di Medicina Interna (DIMI), Università Degli Studi di Genova IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giorgio Celi
- UO Allergologia e Immunologia Clinica, ASST Mantova, Mantova, Italy
| | - Fulvia Chieco Bianchi
- UOC di Fisiopatologia Respiratoria, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Lorenzo Cosmi
- Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi di Firenze, Florence, Italy
| | | | - Maria Angiola Crivellaro
- Occupational Health Unit and AllergologyPadova University Hospital, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35128, Padova, Italy
| | - Simona D'Alò
- UOC Allergologia, Ospedale di Civitanova Marche, ASUR Marche Area Vasta 3, Civitanova Marche, Italy
| | - Pietro Del Biondo
- Scuola di Specializzazione in Allergologia ed Immunologia Clinica, Università Degli Studi "Gabriele d'Annunzio" di Chieti-Pescara, Chieti, Italy
| | - Stefano Del Giacco
- Allergologia e Immunologia Clinica - Dipartimento di Scienze Mediche e Sanità Pubblica, Università Degli Studi Di Cagliari, Cagliari, Italy
| | - Mario Di Gioacchino
- Center of Advanced Studies and Technology, G. d'Annunzio University, Chieti, Italy.,YdA - Institute for Clinical Immunotherapy and Advanced Biological Treatments, Pescara, Italy
| | - Linda Di Pietro
- Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi di Firenze, Florence, Italy
| | - Elisabetta Favero
- Centro Allergologico e Malattie Rare, Dipartimento di Medicina Ospedale Ca' Foncello, Treviso, Italy
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98124, Messina, Italy
| | - Gabriella Guarnieri
- Department of Cardiac Thoracic Vascular Science and Public Health, University of Padova, Padova, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | | | - Carla Lombardo
- Allergy Unit, Villa Igea Hospital. A.P.S.S. Trento, Trento, Italy
| | - Francesca Losa
- UO Allergologia e Immunologia Clinica, ASST Mantova, Mantova, Italy
| | - Andrea Matucci
- Immunoallergology Unit, Careggi University Hospital, Florence, Italy
| | - Paola Lucia Minciullo
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98124, Messina, Italy
| | - Paola Parronchi
- Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi di Firenze, Florence, Italy.,Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Giovanni Passalacqua
- Clinica Delle Malattie Respiratorie e Allergologia Dipartimento di Medicina Interna (DIMI), Università Degli Studi di Genova IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Stefano Pucci
- UOC Allergologia, Ospedale di Civitanova Marche, ASUR Marche Area Vasta 3, Civitanova Marche, Italy
| | - Oliviero Rossi
- Immunoallergology Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Salvati
- Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi di Firenze, Florence, Italy
| | - Michele Schiappoli
- UOC Allergologia E Asma Center, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Gianenrico Senna
- UOC Allergologia E Asma Center, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Andrea Vianello
- Department of Cardiac Thoracic Vascular Science and Public Health, University of Padova, Padova, Italy
| | | | - Yang Baoran
- UO Allergologia e Immunologia Clinica, ASST Mantova, Mantova, Italy
| | | | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
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D'Amato M, Menzella F, Altieri E, Bargagli E, Bracciale P, Brussino L, Caiaffa MF, Canonica GW, Caruso C, Centanni S, De Michele F, Di Marco F, Pastorello EA, Pelaia G, Rogliani P, Romagnoli M, Schino P, Senna G, Vultaggio A, Ori A, Simoni L, Boarino S, Vitiello G, Aliani M, Del Giacco S. Benralizumab in Patients With Severe Eosinophilic Asthma With and Without Chronic Rhinosinusitis With Nasal Polyps: An ANANKE Study post-hoc Analysis. Front Allergy 2022; 3:881218. [PMID: 35769575 PMCID: PMC9234857 DOI: 10.3389/falgy.2022.881218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/22/2022] [Accepted: 03/30/2022] [Indexed: 02/01/2023] Open
Abstract
Background Severe eosinophilic asthma (SEA) in the presence of chronic rhinosinusitis with nasal polyps (CRSwNP) indicates the presence of a more extensive eosinophilic inflammation. Post-hoc analyses from a pivotal clinical trial have demonstrated the enhanced efficacy of benralizumab on asthma outcomes in patients with CRSwNP as a comorbidity. Methods This is a post-hoc analysis from the Italian multi-center observational retrospective ANANKE study. Patients were divided into two groups based on self-reported CRSwNP. Baseline clinical and laboratory features in the 12 months prior to benralizumab prescription were collected. Data of change over time of blood eosinophils, annualized exacerbations rates (AER), asthma control, lung function, oral corticosteroids (OCS) use, and benralizumab discontinuation were collected during the observation period. Results At baseline, the 110 patients with CRSwNP were less frequently female (50.9% vs 74.2%) and obese (9.1% vs. 22.6%) with higher eosinophils (605 vs. 500 cells/mm3) and OCS use when compared to patients without CRSwNP. Similar reductions of AER were seen (-95.8% vs. −91.5% for any exacerbation and −99.1% vs. −92.2% for severe exacerbations in patients with and without CRSwNP, respectively). During benralizumab treatment, comorbid SEA+CRSwNP was associated with a lower risk of any exacerbation (p = 0.0017) and severe exacerbations (p = 0.025). After a mean ± SD exposure of 10.3 ± 5.0 months, half of the SEA+CRSwNP patients eliminated OCS use. No discontinuation for safety reasons was recorded. Conclusions This study helped to confirm the baseline clinical features that distinguish patients with and without CRSwNP being prescribed benralizumab. Numerically enhanced OCS reduction and lower exacerbation risk were observed in patients with SEA and comorbid CRSwNP treated with benralizumab.
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Affiliation(s)
- Maria D'Amato
- UOSD Malattie Respiratorie “Federico II”, Ospedale Monaldi, AO Dei Colli, Napoli, Italy
| | - Francesco Menzella
- UOC Pneumologia, Ospedale “S. Valentino”, Montebelluna (TV) - AULSS 2 Marca Trevigiana, Montebelluna, Italy
| | - Elena Altieri
- Reparto di Pneumologia, P.O. Garbagnate Milanese, Garbagnate Milanese, Italy
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Siena, Italy
| | | | - Luisa Brussino
- Dipartimento di Scienze Mediche, SSDDU Allergologia e Immunologia Clinica, Università degli Studi di Torino, AO Ordine Mauriziano Umberto i - Torino, Torino, Italy
| | - Maria Filomena Caiaffa
- Cattedra e Scuola di Allergologia e Immunologia Clinica, Dipartimento di Scienze Mediche, Università di Foggia, Foggia, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Asthma & Allergy Unit-IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Cristiano Caruso
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
| | - Fausto De Michele
- UOC Pneumologia e Fisiopatologia Respiratoria, AORN A. Cardarelli, Napoli, Italy
| | - Fabiano Di Marco
- Department of Health Sciences, University of Milan, Pneumology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Girolamo Pelaia
- Dipartimento di Scienze della Salute, Università Magna Graecia, Catanzaro, Italy
| | - Paola Rogliani
- Division of Respiratory Medicine, University Hospital “Tor Vergata”, Rome, Italy
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | | | - Pietro Schino
- Fisiopatologia Respiratoria, Ospedale Generale Regionale, Ente Ecclesiastico “F. Miulli”, Acquaviva delle Fonti, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | | | - Alessandra Ori
- Medineos Observational Research - An IQVIA Company, Modena, Italy
| | - Lucia Simoni
- Medineos Observational Research - An IQVIA Company, Modena, Italy
| | | | - Gianfranco Vitiello
- Medical Affairs R&I, AstraZeneca, Milano, Italy
- *Correspondence: Gianfranco Vitiello
| | - Maria Aliani
- UO Pneumologia e Pneumologia Riabilitativa, ICS Maugeri, IRCCS Bari, Bari, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Caminati M, Batani V, Guidolin L, Festi G, Senna G. One-year mepolizumab for Allergic bronchopulmonary aspergillosis: Focus on steroid sparing effect and markers of response. Eur J Intern Med 2022; 99:112-115. [PMID: 34998664 DOI: 10.1016/j.ejim.2021.12.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/26/2021] [Accepted: 12/29/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy.
| | | | - Lucia Guidolin
- Department of Medicine, University of Verona, Verona, Italy
| | - Giuliana Festi
- Pneumology Unit, Verona University Hospital, Verona, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona, Verona, Italy; Allergy Unit and Asthma Center, University of Verona and Verona University Hospital, Verona, Italy.
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Menzella F, Bargagli E, Aliani M, Bracciale P, Brussino L, Caiaffa MF, Caruso C, Centanni S, D’Amato M, Del Giacco S, De Michele F, Di Marco F, Pastorello EA, Pelaia G, Rogliani P, Romagnoli M, Schino P, Senna G, Vultaggio A, Simoni L, Ori A, Boarino S, Vitiello G, Altieri E, Canonica GW. ChAracterization of ItaliaN severe uncontrolled Asthmatic patieNts Key features when receiving Benralizumab in a real-life setting: the observational rEtrospective ANANKE study. Respir Res 2022; 23:36. [PMID: 35183167 PMCID: PMC8858449 DOI: 10.1186/s12931-022-01952-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/01/2022] [Indexed: 02/06/2023] Open
Abstract
Background Data from phase 3 trials have demonstrated the efficacy and safety of benralizumab in patients with severe eosinophilic asthma (SEA). We conducted a real-world study examining the baseline characteristics of a large SEA population treated with benralizumab in clinical practice and assessed therapy effectiveness.
Methods ANANKE is an Italian multi-center, retrospective cohort study including consecutive SEA patients who had started benralizumab therapy ≥ 3 months before enrolment (between December 2019 and July 2020), in a real-world setting. Data collection covered (1) key patient features at baseline, including blood eosinophil count (BEC), number and severity of exacerbations and oral corticosteroid (OCS) use; (2) clinical outcomes during benralizumab therapy. We also conducted two post-hoc analyses in patients grouped by body mass index and allergic status. Analyses were descriptive only.
Results Of 218 patients with SEA enrolled in 21 Centers, 205 were evaluable (mean age, 55.8 ± 13.3 years, 61.5% females). At treatment start, the median BEC was 580 cells/mm3 (interquartile range [IQR]: 400–850); all patients were on high-dose inhaled controller therapy and 25.9% were on chronic OCS (median dose: 10 mg/die prednisone-equivalent [IQR: 5–25]); 92.9% experienced ≥ 1 exacerbation within the past 12 months (annualized exacerbation rate [AER] 4.03) and 40.3% reported ≥ 1 severe exacerbation (AER 1.10). During treatment (median duration: 9.8 months [IQR 6.1–13.9]; ≥ 12 months for 34.2% of patients), complete eosinophil depletion was observed; exacerbation-free patients increased to 81% and only 24.3% reported ≥ 1 severe event. AER decreased markedly to 0.27 for exacerbations of any severity (− 93.3%) and to 0.06 for severe exacerbations (− 94.5%). OCS therapy was interrupted in 43.2% of cases and the dose reduced by 56% (median: 4.4 mg/die prednisone-equivalent [IQR: 0.0–10.0]). Lung function and asthma control also improved. The effectiveness of benralizumab was independent of allergic status and body mass index. Conclusions We described the set of characteristics of a large cohort of patients with uncontrolled SEA receiving benralizumab in clinical practice, with a dramatic reduction in exacerbations and significant sparing of OCS. These findings support benralizumab as a key phenotype-specific therapeutic strategy that could help physicians in decision-making when prescribing biologics in patients with SEA. Trial registration ClinicalTrials.gov Identifier: NCT04272463 Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-01952-8.
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Guarnieri G, Caminati M, Achille A, Vaia R, Chieco Bianchi F, Senna G, Vianello A. Severe Asthma, Telemedicine, and Self-Administered Therapy: Listening First to the Patient. J Clin Med 2022; 11:jcm11040960. [PMID: 35207233 PMCID: PMC8880352 DOI: 10.3390/jcm11040960] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 12/15/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 01/27/2023] Open
Abstract
Severe asthma patients are at an increased risk of major complications and they need to be monitored regularly. The COVID-19 pandemic has notably impacted on the health care resources. The telemedicine approach applied to the follow-up of asthmatic patients has been proven to be effective in monitoring their disease and their adherence to the therapy. The aim of our study was to investigate the satisfaction of severe asthma patients before the activation of a telemedicine management, as well as their current experience with self-administration of injection therapy. An ad hoc questionnaire was developed and sent by e-mail to 180 severe asthma patients. Most of subjects, 82%, were confident with the idea of doing self-measurements and self-managing their disease. Further, 77% of subjects favoured to carry out virtual visits and telemedicine. Regarding the home treatment, 93% of patients considered the self-injection therapy easy, 94% of subjects felt safe, and 93% were not worried while self-administering. Only mild adverse events were reported in 22% of patients after self-administration. Our results showed an agreement between what is considered necessary and practicable by healthcare personnel and what is perceived by the severe asthma patients in terms of treatment and monitoring of the disease with Telehealth. Biologics have a safety profile and can be easily self-administred at home.
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Affiliation(s)
- Gabriella Guarnieri
- Respiratory Pathophysiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35126 Padova, Italy; (A.A.); (F.C.B.); (A.V.)
- Correspondence:
| | - Marco Caminati
- Department of Medicine, University of Verona, Verona University Hospital, P.le L. Scuro 10, 37134 Verona, Italy; (M.C.); (G.S.)
| | - Alessia Achille
- Respiratory Pathophysiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35126 Padova, Italy; (A.A.); (F.C.B.); (A.V.)
| | - Rachele Vaia
- Allergy Unit, Asthma Center, Verona University Hospital, P.le L. Scuro 10, 37134 Verona, Italy;
| | - Fulvia Chieco Bianchi
- Respiratory Pathophysiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35126 Padova, Italy; (A.A.); (F.C.B.); (A.V.)
| | - Gianenrico Senna
- Department of Medicine, University of Verona, Verona University Hospital, P.le L. Scuro 10, 37134 Verona, Italy; (M.C.); (G.S.)
- Allergy Unit, Asthma Center, Verona University Hospital, P.le L. Scuro 10, 37134 Verona, Italy;
| | - Andrea Vianello
- Respiratory Pathophysiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35126 Padova, Italy; (A.A.); (F.C.B.); (A.V.)
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49
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Furci F, Caminati M, Genovese S, Gangemi S, Senna G. Upsides and downsides of a telecounselling model of integrated asthma management between general practitioners and specialists. Clin Transl Allergy 2022; 12:e12088. [PMID: 35140909 PMCID: PMC8811728 DOI: 10.1002/clt2.12088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/12/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 12/11/2022] Open
Abstract
Background Asthma control, one of the most important goals in the management of asthmatic patients, requires good adherence to guidelines and support at a territorial level, in particular on the part of general practitioners (GPs). A territorial hospital alliance can become a strength in asthma management, where control by GPs can also be carried out through a spirometric examination. Methods The realisation of a telecounselling model management of asthma between GPs and specialists was the aim of this study, to understand how to obtain good asthma control. A specific digital platform, the PneumoApp platform, was used for the insertion of clinical data and flow volume (F‐V) curves, performed in asthmatic patients by GPs, and for the subsequent evaluation of these data by specialists. Results GPs have shown to be able to perform a check‐up of respiratory function well using a portable spirometer, but the analysis of the collected data showed that GP assessment of the severity level of asthma is incorrect in patients with moderate‐severe asthma. Conclusions The effectiveness of a telecounselling collaboration between hospital and territory in the management of asthma patients can be improved by greater diffusion of the use of Global Initiative for Asthma (GINA) guidelines at a local level.
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Affiliation(s)
- Fabiana Furci
- Immunology Unit University Hospital Verona Italy
- Department of Clinical and Experimental Medicine School and Operative Unit of Allergy and Clinical Immunology, Policlinico “G. Martino”, University of Messina Messina Italy
| | - Marco Caminati
- Department of Medicine University of Verona and Verona University Hospital Verona Italy
| | - Sara Genovese
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB‐CNR), Messina Unit Messina Italy
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine School and Operative Unit of Allergy and Clinical Immunology, Policlinico “G. Martino”, University of Messina Messina Italy
| | - Gianenrico Senna
- Department of Medicine University of Verona and Verona University Hospital Verona Italy
- Asthma Centre and Allergy Unit University of Verona and Verona University Hospital Verona Italy
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Cardona V, Ansotegui IJ, Ebisawa M, El-Gamal Y, Rivas MF, Fineman S, Geller M, Gonzalez-Estrada A, Greenberger PA, Borges MS, Senna G, Sheikh A, Tanno LK, Thong BY, Turner PJ, Worm M. [World Allergy Organization Anaphylaxis Guidance 2020]. Arerugi 2022; 70:1211-1234. [PMID: 34759087 DOI: 10.15036/arerugi.70.1211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, and ARADyAL research network
| | | | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital
| | - Yehia El-Gamal
- Pediatric Allergy and Immunology Unit, Ain Shams University
| | | | - Stanley Fineman
- Department of Pediatrics, Emory University School of Medicine
| | - Mario Geller
- Division of Medicine, Academy of Medicine of Rio de Janeiro
| | | | - Paul A Greenberger
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine
| | - Mario Sanchez Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad and Clinica El Ávila
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital
| | - Aziz Sheikh
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh
| | - Luciana Kase Tanno
- Hospital Sírio Libanês, Brazil and University Hospital of Montpellier, São Paulo, Montpellier, and Sorbonne Université, INSERM Paris, France, and WHO Collaborating Centre on Scientific Classification Support Montpellier, and WHO ICD-11 Medical and Scientific Advisory Committee Geneva
| | - Bernard Y Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital
| | - Paul J Turner
- National Heart Lung Institute, Imperial College London and Discipline of Paediatrics and Child Health, School of Medicine, University of Sydney
| | - Margitta Worm
- Department of Dermatology and Allergology, Charite-Universitätsmedizin
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