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Antonicelli L, Tontini C, Garritani MS, Piga MA, Bilò MB. Efficacy of Mepolizumab in Patients With Severe Eosinophilic Asthma and Concomitant Severe Chronic Urticaria: An Example of Personalized Medicine? J Investig Allergol Clin Immunol 2023; 33:54-56. [PMID: 34842174 DOI: 10.18176/jiaci.0770] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- L Antonicelli
- SOSD Allergologia, Dipartimento di Medicina Interna, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - C Tontini
- Lydia Becker Institute for Immunology and Inflammation, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - M S Garritani
- SOSD Allergologia, Dipartimento di Medicina Interna, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - M A Piga
- Dipartimento di Scienze Cliniche e Molecolari, Universita' Politecnica delle Marche, Ancona, Italy
| | - M B Bilò
- SOSD Allergologia, Dipartimento di Medicina Interna, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy.,Dipartimento di Scienze Cliniche e Molecolari, Universita' Politecnica delle Marche, Ancona, Italy
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Abstract
Summary Anaphylaxis is the most severe systemic hypersensitivity reaction, and it can be life-threatening or even fatal. It involves the activation of multiple immune and non immune pathways beyond IgE, thus exhibiting different phenotypes. New symptoms of hypersensitivity caused by chemotherapy drugs, monoclonal antibodies, and biological agents have been suggested to be recognized as anaphylaxis phenotypes. No biomarker has been described that allows an unequivocal diagnosis of anaphylaxis. Moreover, more biomarkers for specific endotypes are needed to stratify severity, to predict risk, and to optimaze tretament choice in the individual patient. Food, drugs and stinging insects represent the most commly identified triggers. Idiopathic anaphylaxis is a diagnosis of exclusion and it can hide a clonal mast cell disorder. Individual risk factors and co-factors may influence the severity of anaphylaxis or its onset, and they should be identified to implement the appropriate measures to prevent recurrence. Prompt recognition and treatment are critical in anaphylaxis, adrenaline being the first-line saving therapy. Individualized anaphylaxis action plan should include avoidance measures, prescription of an adrenaline autoinjector, education, optimal management of relevant comorbidities, venom specific immunotherapy, food oral immunotherapy, and drug desensitization, when appropriate. However, the quality of acute and long-term anaphylaxis management is variable influencing the poor outcomes experienced by many patients. Clinical practice guidelines have the potential to improve outcomes, but they often prove challenging to implement in routine clinical care.
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Affiliation(s)
- M B Bilò
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Allergy Unit, Department of Internal Medicine, University Hospital, Ancona, Italy
| | - M Martini
- Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Allergy and Clinical Immunology School, Polytechnic University of Marche Ancona, Italy
| | - C Tontini
- Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Italy
| | - A Corsi
- Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Allergy and Clinical Immunology School, Polytechnic University of Marche Ancona, Italy
| | - L Antonicelli
- Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Italy
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Tonacci A, Nettis E, Asero R, Rossi O, Tontini C, Gangemi S. Omalizumab retreatment in patients with chronic spontaneous urticaria: a systematic review of published evidence. Eur Ann Allergy Clin Immunol 2020; 52:100-103. [PMID: 32108461 DOI: 10.23822/eurannaci.1764-1489.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary A systematic review of the current literature on retreatment with omalizumab of patients with relapsing chronic spontaneous urticaria was performed. Published evidence shows that retreatment is safe and clinically effective, and that time to complete clinical response reduces as the number of retreatments increases.
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Affiliation(s)
- A Tonacci
- Institute of Clinical Physiology-National Research Council of Italy (IFC-CNR), Pisa, Italy
| | - E Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | - R Asero
- Allergology Clinic, Clinica San Carlo, Paderno Dugnano, Milan, Italy
| | - O Rossi
- ImmunoAllergology Unit, Careggi University Hospital of Florence, Florence, Italy
| | - C Tontini
- Allergy Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - S Gangemi
- School and Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Bilò MB, Tontini C, Martini M, Corsi A, Agolini S, Antonicelli L. Clinical aspects of hymenoptera venom allergy and venom immunotherapy. Eur Ann Allergy Clin Immunol 2019; 51:244-258. [PMID: 31594296 DOI: 10.23822/eurannaci.1764-1489.113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Hymenoptera venom allergy (HVA) is the most frequent cause of anaphylaxis in Europe, accounting for most of the severe reactions occurring in adults, and being the second cause of anaphylaxis in children. Prevention of further episodes in patients who developed a systemic reaction (SR) is based on the correct management of the allergic emergency, the referral to an allergist for a correct diagnosis, prescription of adrenaline auto-injectors (AAI) and specific venom immunotherapy (VIT), if recommended. Diagnosis is based on the classification of the type of reaction, confirmation of an IgE-mediated pathogenesis and the identification of the offending insect. The use of component resolved diagnostics may be helpful in case of poly-sensitization or negative allergy tests with a proven history of previous SRs. When a severe SR occurs, baseline serum tryptase levels should always be assessed. The prescription of AAI is recommended or suggested for untreated patients, patients undergoing VIT and after discontinuation of treatment, according to multiple evidence. VIT is the most effective treatment available for HVA patients, as confirmed by recent European guidelines. VIT has an early, sustained and persistent protective effect and modifies the natural course of the disease. Moreover, VIT proved to be safe and well tolerated. According to a recent systematic review, no treatment-related fatalities were recorded to date. Compared to AAI, VIT significantly improves the quality of life of HVA patients by reducing the anxiety and limitations in daily activities caused by the fear of stinging insects. The memory of a life-threatening experience is the most likely reason why adherence to VIT is higher compared to immunotherapy with inhalant allergens. Several risk factors in HVA have been identified that can influence not only the severity of sting reactions in untreated patents, but also the occurrence of side effects, treatment effectiveness and the risk of relapse after discontinuation of VIT. Patient and treatment-related risk factors must be considered while selecting the best candidates for VIT, the type and duration of treatment. In this paper we address the most important issues related to HVA and VIT that may have an impact on daily clinical practice.
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Affiliation(s)
- M B Bilò
- Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - C Tontini
- Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Italy
| | - M Martini
- Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Allergy and Clinical Immunology School, Polytechnic University of Marche, Ancona, Italy
| | - A Corsi
- Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Allergy and Clinical Immunology School, Polytechnic University of Marche, Ancona, Italy
| | - S Agolini
- Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Allergy and Clinical Immunology School, Polytechnic University of Marche, Ancona, Italy
| | - L Antonicelli
- Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Italy
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Tontini C, Marinangeli L, Maiello N, Abbadessa S, Villalta D, Antonicelli L. Ara h 6 sensitization in peanut allergy: friend, foe or innocent bystander? Eur Ann Allergy Clin Immunol 2017; 49:18-21. [PMID: 28120602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The clinical role of Ara h 6 sensitization in peanut allergy is a current matter of debate. We investigated the role of Ara h 6 sensitization patterns in a sample of young adults from different Italian cities. Sera of 33 patients with specific IgE against Ara h 6 were selected. According to clinical symptoms upon peanut ingestion, patients were divided into severe reaction (SR) and mild-tolerant (MT) subgroups. While the SR group mainly showed sensitization patterns involving Ara h 2 and other major allergenic components, a previously undescribed association between Ara h 6 and Ara h 9 was found in the MT group. This pattern seems to be clustered in Mediterranean Italy and associated with Pru p 3 sensitization. This finding might shed a new light on the role of Ara h 6 sensitization in peanut allergy.
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Affiliation(s)
- C Tontini
- Dipartimento di Medicina Interna, U.O. Allergologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona, Ancona, Italy. Phone: +39 071 596 5693 E-mail:
| | - L Marinangeli
- Dipartimento di Medicina Interna, U.O. Allergologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona, Ancona, Italy
| | - N Maiello
- Dipartimento della Donna, del Bambino, Chirurgia Generale e Specialistica, Seconda Università di Napoli, Napoli, Italy
| | - S Abbadessa
- Dipartimento di Biochimica, Biofisica e Patologia Generale, Seconda Università di Napoli, Napoli, Italy
| | - D Villalta
- Allergologia ed Immunologia Clinica, Azienda Ospedaliera Santa Maria degli Angeli, Pordenone, Italy
| | - L Antonicelli
- Dipartimento di Medicina Interna, U.O. Allergologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona, Ancona, Italy
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Corinaldesi G, Sentinelli R, Guglielmi S, Orsetti E, Castelletti S, Marigliano A, Riva A, Tontini C, Costantini A. CP-159 Direct acting antivirals (DAAS) for the treatment of HCV infection in HIV/HCV coinfected patients: A clinical experience. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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