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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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2
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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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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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4
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Caruso C, Ciasca G, Baglivo I, Di Santo R, Gasbarrini A, Firinu D, Bagnasco D, Passalacqua G, Schiappoli M, Caminati M, Canonica GW, Heffler E, Crimi C, Intravaia R, Basile V, Marino M, Colantuono S, Del Giacco S. Immunoglobulin free light chains in severe asthma patient: Could they be a new biomarker? Allergy 2024. [PMID: 38425088 DOI: 10.1111/all.16082] [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: 08/03/2023] [Revised: 01/31/2024] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Increasing evidence is available about the presence of increased serum concentration of immunoglobulin (Ig) free light chains (FLCs) in both atopic and non-atopic inflammatory diseases, including severe asthma, providing a possible new biomarker of disease. METHODS We analyzed clinical and laboratory data, including FLCs, obtained from a cohort of 79 asthmatic subjects, clinically classified into different GINA steps. A control group of 40 age-matched healthy donors (HD) was considered. Particularly, HD have been selected according to the absence of monoclonal components (in order to exclude paraproteinemias), were tested for total IgE (that were in the normal ranges) and were negative for aeroallergens specific IgE. Moreover, no abnormality of common inflammatory markers (i.e., erythrocyte sedimentation rate and C-reactive protein) was detectable. RESULTS FLC-k levels were significantly increased in the asthmatic population, compared to the control group. Despite the absence of statistically significant differences in FLC-λ levels, the FLC-k/FLC-λ ratio displayed remarkable differences between the two groups. A positive correlation between FLC-κ and FLC-λ levels was found. FLC- λ level displayed a significant negative correlation with the FEV1 value. Moreover, the FLC-κ /FLC- λ ratio was negatively correlated with the SNOT-22 score and a positive correlation was observed between FLCs and Staphylococcus Aureus IgE enterotoxins sensitization. CONCLUSIONS Our findings confirmed the role of FLCs in asthma as a potential biomarker in an inflammatory disease characterized by different endotypes and phenotypes. In particular, FLC-κ and FLC-k/FLC-λ ratio could be a qualitative indicator for asthma, while FLC-λ levels could be a quantitative indicator for clinical severity parameters.
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Affiliation(s)
- C Caruso
- UOSD DH Internal Medicine and Gastroenterology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Ciasca
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - I Baglivo
- CEMAD Digestive Diseases Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Di Santo
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - A Gasbarrini
- CEMAD Digestive Diseases Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - D Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - M Schiappoli
- Allergy and Asthma Unit, Verona University Hospital, Verona, Italy
| | - M Caminati
- Department of Medicine, Asthma, Allergy and Clinical Immunology Section, University of Verona, Verona, Italy
| | - G W Canonica
- Personalized Medicine, Asthma and Allergy-IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - E Heffler
- Personalized Medicine, Asthma and Allergy-IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - C Crimi
- Respiratory Medicine Unit, Policlinico "G. Rodolico-San Marco" University Hospital, Catania, Italy
| | - R Intravaia
- Unit of Cardiology, University Hospital Paolo Giaccone, University of Palermo, Palermo
| | - V Basile
- Clinical Pathology Unit and Cancer Biobank, Department of research and Advanced Technologies, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - M Marino
- Sezione di Patologia Generale, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - S Colantuono
- UOSD DH Internal Medicine and Gastroenterology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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5
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Baglivo I, Colantuono S, Lumaca A, Papa A, Gasbarrini A, Caruso C. The last step to achieve barrier damage control. Front Immunol 2024; 15:1354556. [PMID: 38415254 PMCID: PMC10897052 DOI: 10.3389/fimmu.2024.1354556] [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: 12/12/2023] [Accepted: 01/29/2024] [Indexed: 02/29/2024] Open
Abstract
Heterogeneity characterises inflammatory diseases and different phenotypes and endotypes have been identified. Both innate and adaptive immunity contribute to the immunopathological mechanism of these diseases and barrier damage plays a prominent role triggering type 2 inflammation through the alarmins system, such as anti-Thymic Stromal Lymphopoietin (TSLP). Treatment with anti-TSLP monoclonal antibodies showed efficacy in severe asthma and clinical trials for other eosinophilic diseases are ongoing. The aim of this perspective review is to analyse current advances and future applications of TSLP inhibition to control barrier damage.
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Affiliation(s)
- Ilaria Baglivo
- Centro Malattie Apparato Digerente (CEMAD) Digestive Disease Center, Fondazione Policlinico Universitario “A. Gemelli” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Roma, Italy
| | - Stefania Colantuono
- Unità Operativa Semplice Dipartimentale Day Hospital (UOSD DH) Medicina Interna e Malattie dell’ApparatoDigerente, Fondazione Policlinico Universitario “A. Gemelli” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Roma, Italy
| | - Arianna Lumaca
- Unità Operativa Semplice Dipartimentale (UOSD) di Allergologia, Ospedale Maria Santissima (SS) Dello Splendore, Teramo, Italy
| | - Alfredo Papa
- Unità Operativa Semplice Dipartimentale Day Hospital (UOSD DH) Medicina Interna e Malattie dell’ApparatoDigerente, Fondazione Policlinico Universitario “A. Gemelli” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Gasbarrini
- Centro Malattie Apparato Digerente (CEMAD) Digestive Disease Center, Fondazione Policlinico Universitario “A. Gemelli” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Roma, Italy
| | - Cristiano Caruso
- Unità Operativa Semplice Dipartimentale Day Hospital (UOSD DH) Medicina Interna e Malattie dell’ApparatoDigerente, Fondazione Policlinico Universitario “A. Gemelli” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Roma, Italy
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6
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Poto R, Fusco W, Rinninella E, Cintoni M, Kaitsas F, Raoul P, Caruso C, Mele MC, Varricchi G, Gasbarrini A, Cammarota G, Ianiro G. The Role of Gut Microbiota and Leaky Gut in the Pathogenesis of Food Allergy. Nutrients 2023; 16:92. [PMID: 38201921 PMCID: PMC10780391 DOI: 10.3390/nu16010092] [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: 11/23/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
Food allergy (FA) is a growing public health concern, with an increasing prevalence in Western countries. Increasing evidence suggests that the balance of human gut microbiota and the integrity of our intestinal barrier may play roles in the development of FA. Environmental factors, including industrialization and consumption of highly processed food, can contribute to altering the gut microbiota and the intestinal barrier, increasing the susceptibility to allergic sensitization. Compositional and functional alterations to the gut microbiome have also been associated with FA. In addition, increased permeability of the gut barrier allows the translocation of allergenic molecules, triggering Th2 immune responses. Preclinical and clinical studies have highlighted the potential of probiotics, prebiotics, and postbiotics in the prevention and treatment of FA through enhancing gut barrier function and promoting the restoration of healthy gut microbiota. Finally, fecal microbiota transplantation (FMT) is now being explored as a promising therapeutic strategy to prevent FA in both experimental and clinical studies. In this review article, we aim to explore the complex interplay between intestinal permeability and gut microbiota in the development of FA, as well as depict potential therapeutic strategies.
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Affiliation(s)
- Remo Poto
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (R.P.); (G.V.)
- Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131 Naples, Italy
- World Allergy Organization (WAO), Center of Excellence, 80131 Naples, Italy
| | - William Fusco
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy (E.R.); (M.C.); (F.K.); (P.R.); (C.C.); (M.C.M.); (A.G.); (G.C.)
- Department of Medical and Surgical Sciences, UOC Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Medical and Surgical Sciences, UOSD DH Internal Medicine and Digestive Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Emanuele Rinninella
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy (E.R.); (M.C.); (F.K.); (P.R.); (C.C.); (M.C.M.); (A.G.); (G.C.)
- Department of Medical and Surgical Sciences, Clinical Nutrition Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Marco Cintoni
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy (E.R.); (M.C.); (F.K.); (P.R.); (C.C.); (M.C.M.); (A.G.); (G.C.)
- Department of Medical and Surgical Sciences, Clinical Nutrition Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesco Kaitsas
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy (E.R.); (M.C.); (F.K.); (P.R.); (C.C.); (M.C.M.); (A.G.); (G.C.)
| | - Pauline Raoul
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy (E.R.); (M.C.); (F.K.); (P.R.); (C.C.); (M.C.M.); (A.G.); (G.C.)
- Department of Medical and Surgical Sciences, Clinical Nutrition Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Cristiano Caruso
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy (E.R.); (M.C.); (F.K.); (P.R.); (C.C.); (M.C.M.); (A.G.); (G.C.)
- Department of Medical and Surgical Sciences, UOSD DH Internal Medicine and Digestive Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Maria Cristina Mele
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy (E.R.); (M.C.); (F.K.); (P.R.); (C.C.); (M.C.M.); (A.G.); (G.C.)
- Department of Medical and Surgical Sciences, Clinical Nutrition Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Gilda Varricchi
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (R.P.); (G.V.)
- Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131 Naples, Italy
- World Allergy Organization (WAO), Center of Excellence, 80131 Naples, Italy
| | - Antonio Gasbarrini
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy (E.R.); (M.C.); (F.K.); (P.R.); (C.C.); (M.C.M.); (A.G.); (G.C.)
- Department of Medical and Surgical Sciences, UOC Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Medical and Surgical Sciences, UOSD DH Internal Medicine and Digestive Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giovanni Cammarota
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy (E.R.); (M.C.); (F.K.); (P.R.); (C.C.); (M.C.M.); (A.G.); (G.C.)
- Department of Medical and Surgical Sciences, UOC Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Medical and Surgical Sciences, UOSD DH Internal Medicine and Digestive Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Gianluca Ianiro
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy (E.R.); (M.C.); (F.K.); (P.R.); (C.C.); (M.C.M.); (A.G.); (G.C.)
- Department of Medical and Surgical Sciences, UOC Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Medical and Surgical Sciences, UOSD DH Internal Medicine and Digestive Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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7
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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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8
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Ledda AG, Costanzo G, Sambugaro G, Caruso C, Bullita M, Di Martino ML, Serra P, Firinu D, Del Giacco S. Eosinophil Cationic Protein Variation in Patients with Asthma and CRSwNP Treated with Dupilumab. Life (Basel) 2023; 13:1884. [PMID: 37763288 PMCID: PMC10532820 DOI: 10.3390/life13091884] [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: 07/24/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Asthma is a clinical syndrome characterized by recurrent episodes of airway obstruction, bronchial hyperresponsiveness and airway inflammation. Most patients with asthma present a "type 2" (TH2) inflammation. ILC2 and TH2 cells release cytokines IL4, IL-13 and IL-5. CRSwNP is a condition characterized by hyposmia or anosmia, nasal congestion, nasal discharge, and face pain or pressure that last for at least 12 weeks in a row without relief. Both asthma and CRSwNP are often characterized by a type 2 inflammation endotype and are often present in the same patient. Dupilumab is a fully human monoclonal antibody targeting the interleukin-4 receptor α (IL-4Rα) subunit, blocking IL4/IL-4Rα binding and IL13. It has been labelled for the treatment of moderate to severe asthma in patients from the age of 12 years with an eosinophilic phenotype, and it has demonstrated efficacy and acceptable safety. Our study aims to investigate the effects of dupilumab on type 2 inflammatory biomarkers, such as eosinophils and eosinophil cationic protein (ECP). ECP is an eosinophil-derived substance contained in granules that are released during inflammation and causes various biological effects, including tissue damage in asthmatic airways. METHODS ECP, Eosinophil counts (EOS), and total immunoglobulin E (IgE) levels were longitudinally measured using immunoassays in the serum of 21 patients affected by CRSwNP, of which 17 had asthma as a comorbidity, receiving 300 mg dupilumab every two weeks. RESULTS The EOS and ECP, after a first phase of significant increase due to the intrinsic characteristic of the block of IL-4 and IL-13, returned to the baseline 10 months after the initial administration of dupilumab. Fractional exhaled nitric oxide (FeNO) and serum total IgE decreased significantly after 9 months. Asthma Control Test (ACT) scores improved after dupilumab treatment. FEV1% and FEV1 absolute registered a significant improvement at 10 months. CONCLUSIONS Patients who received 300 milligrams of dupilumab every two weeks first experienced a temporary increase in eosinophils (EOS) and eosinophil cationic protein (ECP), then exhibited a gradual decline in these variables with a subsequent return to the initial baseline levels. When compared to the baseline, we observed that the levels of IgE and FeNO decreased over time, while there was an increase in both FEV1 and FEV1%.
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Affiliation(s)
- Andrea Giovanni Ledda
- Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, Italy; (A.G.L.); (G.C.); (G.S.); (M.L.D.M.); (P.S.); (S.D.G.)
| | - Giulia Costanzo
- Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, Italy; (A.G.L.); (G.C.); (G.S.); (M.L.D.M.); (P.S.); (S.D.G.)
| | - Giada Sambugaro
- Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, Italy; (A.G.L.); (G.C.); (G.S.); (M.L.D.M.); (P.S.); (S.D.G.)
| | - Cristiano Caruso
- UOSD DH Medicina Interna e Malattie dell’Apparato Digerente, Fondazione Policlinico A. Gemelli IRCCS, 20123 Rome, Italy;
- Department of Medical Sciences and Public Health, Faculty of Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Martina Bullita
- Faculty of Medicine and Surgery, University of Cagliari, 09100 Cagliari, Italy;
| | - Maria Luisa Di Martino
- Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, Italy; (A.G.L.); (G.C.); (G.S.); (M.L.D.M.); (P.S.); (S.D.G.)
| | - Paolo Serra
- Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, Italy; (A.G.L.); (G.C.); (G.S.); (M.L.D.M.); (P.S.); (S.D.G.)
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, Italy; (A.G.L.); (G.C.); (G.S.); (M.L.D.M.); (P.S.); (S.D.G.)
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, Italy; (A.G.L.); (G.C.); (G.S.); (M.L.D.M.); (P.S.); (S.D.G.)
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9
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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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10
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Romano A, Gaeta F, Caruso C, Fiocchi A, Valluzzi RL. Evaluation and Updated Classification of Acute Hypersensitivity Reactions to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAID-Exacerbated or -Induced Food Allergy. J Allergy Clin Immunol Pract 2023; 11:1843-1853.e1. [PMID: 36997117 DOI: 10.1016/j.jaip.2023.03.036] [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] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND There are hypersensitivity reactions (HRs) to foods in which nonsteroidal anti-inflammatory drugs (NSAIDs) act as aggravating factors (NSAID-exacerbated food allergy [NEFA]) or cofactors (NSAID-induced food allergy [NIFA]), often misdiagnosed as HRs to NSAIDs. Urticarial/angioedematous and/or anaphylactic reactions to two or more chemically unrelated NSAIDs do not meet current classification criteria. However, they may be considered part of a cross-reactive type of acute HR, which is NSAID-induced urticaria/angioedema with or without respiratory or systemic symptoms of anaphylaxis. OBJECTIVE To evaluate patients reporting acute HRs to NSAIDs and classify them according to updated criteria. METHODS We prospectively studied 414 patients with suspected HRs to NSAIDs. For all whom met these criteria, NEFA/NIFA was diagnosed: (1) mild reactions to (NEFA) or tolerance of (NIFA) the suspected foods without taking NSAIDs; (2) cutaneous and/or anaphylactic reactions to the combination foods plus NSAIDs; (3) positive allergy tests to the suspected foods; and (4) negative drug challenges (DCs) with the NSAIDs involved. RESULTS A total of 252 patients were given the diagnosis of NSAID hypersensitivity (60.9%), 108 of whom had NSAID-induced urticaria/angioedema with or without respiratory or systemic symptoms of anaphylaxis. We excluded NSAID hypersensitivity in 162 patients (39.1%) who tolerated DCs with the suspected NSAIDs, nine of whom received a diagnosis of NEFA, and 66 of NIFA. Pru p 3 was implicated in 67 of those 75 patients who received a diagnosis of NEFA or NIFA. CONCLUSIONS NEFA and NIFA account for about 18% of patients reporting HRs to NSAIDs, in which Pru p 3 is the main responsible food allergen. Therefore, patients with cutaneous and/or anaphylactic reactions to NSAIDs should be carefully questioned about all foods ingested within 4 hours before or after NSAID exposure, and targeted food allergy tests should be considered in the diagnostic workup of these patients. If testing is positive, DCs with the suspected NSAIDs should also be considered.
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Affiliation(s)
| | | | - Cristiano Caruso
- UOSD Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandro Fiocchi
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rocco Luigi Valluzzi
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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11
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Caruso C, Colantuono S, Tolusso B, Di Mario C, Fancello G, La Sorda M, Celi G, Caringi M, Volterrani A, Descalzi D, Gremese E, Sanguinetti M, Gasbarrini A, Canonica GW. Effects of house dust mite subcutaneous immunotherapy in real-life. Immunological and clinical biomarkers and economic impact analysis. World Allergy Organ J 2023; 16:100789. [PMID: 37484874 PMCID: PMC10362513 DOI: 10.1016/j.waojou.2023.100789] [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: 12/21/2022] [Revised: 05/09/2023] [Accepted: 05/24/2023] [Indexed: 07/25/2023] Open
Abstract
Background Etiology of allergic rhinitis and asthma is frequently associated with house dust mite sensitization and allergen immunotherapy (AIT) represents the only disease modifying treatment. In a real world setting, clinicians would benefit from biomarkers to monitor or predict response to AIT. Methods Twenty-four consecutive house dust mite (HDM) mono-sensitized rhinitic patients, treated with subcutaneous immunotherapy (SCIT) as per clinical practice, were enrolled. Multiple in vitro biomarkers such as basophil activation (BAT), IL-10 levels, and molecular allergen-specific IgE were performed during HDM SCIT, to monitor the effects of AIT and then correlated to in vivo scores (VAS, CMSS, RQLQ). Nasal cytology was performed at baseline and after 6 and 12 months of treatment. Finally, the economic impact of SCIT in this cohort of patients was evaluated. Results Clinical biomarkers confirmed to be useful to monitor AIT efficacy. As for laboratory biomarkers, BAT showed a reduction trend, particularly for D2C1, suggesting that this is a useful parameter in monitoring patients. IL-10 levels tend to remain stable or slightly decrease during treatment. The economic analysis confirmed the favorable impact of immunotherapy. Conclusions In this cohort of patients, SCIT confirmed its effectiveness in reducing symptoms and drug utilization. Clinical scores confirmed to be valid in monitoring patients and their response. BAT demonstrated to be useful in monitoring more than predicting response. Further studies are needed to better explore the usefulness of these biomarkers in AIT.
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Affiliation(s)
- Cristiano Caruso
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania Colantuono
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Barbara Tolusso
- Immunology Research Core Facility, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Division of Clinical Immunology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Clara Di Mario
- Immunology Research Core Facility, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giovanni Fancello
- Dipartimento Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Marilena La Sorda
- Dipartimento Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | | | - Mario Caringi
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Desideria Descalzi
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy
| | - Elisa Gremese
- Immunology Research Core Facility, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Division of Clinical Immunology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Antonio Gasbarrini
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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12
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Scioscia G, Nolasco S, Campisi R, Quarato CMI, Caruso C, Pelaia C, Portacci A, Crimi C. Switching Biological Therapies in Severe Asthma. Int J Mol Sci 2023; 24:ijms24119563. [PMID: 37298514 DOI: 10.3390/ijms24119563] [Citation(s) in RCA: 7] [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: 05/13/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Currently, three classes of monoclonal antibodies targeting type 2 inflammation pathways are available in Italy for the treatment of severe asthma: anti-IgE (Omalizumab), anti-IL-5/anti-IL-5Rα (Mepolizumab and Benralizumab), and anti-IL-4Rα (Dupilumab). Numerous randomized controlled trials (RCTs) and real-life studies have been conducted to define their efficacy and identify baseline patients' characteristics potentially predictive of favorable outcomes. Switching to another monoclonal antibody is recommended in case of a lack of benefits. The aim of this work is to review the current knowledge on the impact of switching biological therapies in severe asthma as well as on predictors of treatment response or failure. Almost all of the information about switching from a previous monoclonal antibody to another comes from a real-life setting. In the available studies, the most frequent initial biologic was Omalizumab and patients who were switched because of suboptimal control with a previous biologic therapy were more likely to have a higher baseline blood eosinophil count and exacerbation rate despite OCS dependence. The choice of the most suitable treatment may be guided by the patient's clinical history, biomarkers of endotype (mainly blood eosinophils and FeNO), and comorbidities (especially nasal polyposis). Due to overlapping eligibility, larger investigations characterizing the clinical profile of patients benefiting from switching to different monoclonal antibodies are needed.
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Affiliation(s)
- Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, 71121 Foggia, Italy
| | - Santi Nolasco
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy
- Respiratory Medicine Unit, Policlinico "G. Rodolico-San Marco", 95123 Catania, Italy
| | - Raffaele Campisi
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy
| | | | - Cristiano Caruso
- Department of Medical and Surgical Sciences, Digestive Disease Center, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy
| | - Corrado Pelaia
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Andrea Portacci
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University "Aldo Moro" of Bari, 70121 Bari, Italy
| | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy
- Respiratory Medicine Unit, Policlinico "G. Rodolico-San Marco", 95123 Catania, Italy
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13
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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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14
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Baglivo I, Colantuono S, Caruso C, De Fino C, Gasbarrini A, Capone M, D'Amore A, Peris K, Romano A, Parronchi P. Delayed hypersensitivity to dimethyl fumarate: Report of 1 case and literature review. J Allergy Clin Immunol Pract 2023; 11:1562-1563.e2. [PMID: 36706983 DOI: 10.1016/j.jaip.2022.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/12/2022] [Accepted: 12/27/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Ilaria Baglivo
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Rome, Rome, Italy
| | - Stefania Colantuono
- UOSD DH Medicina Interna e Gastroenterologia, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristiano Caruso
- UOSD DH Medicina Interna e Gastroenterologia, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Chiara De Fino
- UOC Neurologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Antonio Gasbarrini
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Rome, Rome, Italy
| | - Manuela Capone
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Alessandra D'Amore
- Department of Medical and Surgical Sciences, UOC Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ketty Peris
- Department of Medical and Surgical Sciences, UOC Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Paola Parronchi
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
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15
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Caruso C, Laterza L, Settanni CR, Colantuono S, Di Mario C, Tolusso B, Castrì F, Gremese E, Scaldaferri F, Armuzzi A, De Simone C, Peris K, Chiricozzi A, Gasbarrini A. Case report: Dupilumab treatment improved type 2 disorders in a patient with IPEX syndrome diagnosis. Front Immunol 2023; 13:995304. [PMID: 36713411 PMCID: PMC9875030 DOI: 10.3389/fimmu.2022.995304] [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: 07/15/2022] [Accepted: 11/18/2022] [Indexed: 01/13/2023] Open
Abstract
We described a case of IPEX syndrome successfully controlled with dupilumab, an anti-IL4 receptor alpha subunit inhibitor. IPEX syndrome is a rare and generally fatal genetic disorder characterized by immune dysregulation, polyendocrinopathy and enteropathy, mostly diagnosed in early childhood. Nonetheless, cases reported in the last 20 years demonstrated that IPEX clinical spectrum encompasses more than the classical triad of early-onset intractable diarrhea, type 1 diabetes and eczema. Atypical cases of IPEX include patients with late-onset of symptoms, single-organ involvement, mild disease phenotypes or rare clinical features. A 21-year-old caucasian man presented with immune dysregulation (hypereosinophilia and elevated IgE), protein-losing enteropathy, polyendocrinopathy (thyroiditis, osteoporosis, delayed puberty), weight loss, eczema manifestations and celiac disease. IPEX syndrome was diagnosed because of the presence of a hemizygous mutation in FOXP3 gene (c.543C>T (p.S181S) in the exon 5). During the course of the disease, the patient developed erosive proctitis, pyoderma gangrenosum, and erythema nodosum. Symptoms improved only after enteral and parenteral corticosteroid therapy and the patient soon developed steroid-dependence. Notwithstanding various therapies including azathioprine, sirolimus, tacrolimus, adalimumab, vedolizumab, the patient failed to achieve a good control of symptoms without steroids. Almost exclusive enteral nutrition with a hypoallergenic, milk-protein free, amino acid-based food for special medical purposes. He continued to lose weight (BMI 14.5 kg/m2) with a consequent high limitation of physical activity and a progressive worsening of the quality of life. In consideration of the poor response to conventional immunosuppressants and the presence of type 2 inflammatory manifestations, treatment with dupilumab at an initial dose of 600 mg, followed by a maintenance dose of 300 mg every other week, according to atopic dermatitis labeled dose, was started and combined to oral budesonide 6 mg/day and 6-mercaptopurine 75 mg/day. The patient experienced a rapid improvement in bowel and skin symptoms, leading to a progressive tapering of steroids. By our knowledge, this is the first report of IPEX syndrome successfully treated by antiIL-4/IL-13 therapy. In this case dupilumab demonstrated to be an effective, safe and steroid-sparing option.
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Affiliation(s)
- C. Caruso
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy,*Correspondence: C. Caruso,
| | - L. Laterza
- UOC di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C. R. Settanni
- UOC di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - S. Colantuono
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - C. Di Mario
- Immunology Core Facility, Gemelli Science Technological Park (GSTeP), Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - B. Tolusso
- Division of Clinical Immunology, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - F. Castrì
- Dipartimento di Anatomia Patologica, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - E. Gremese
- Immunology Core Facility, Gemelli Science Technological Park (GSTeP), Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Division of Clinical Immunology, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - F. Scaldaferri
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome, Italy,Faculty of Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - A. Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - C. De Simone
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - K. Peris
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A. Chiricozzi
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A. Gasbarrini
- Faculty of Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy,Faculty of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy,Internal Medicine and Gastroenterology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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16
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Quaranta VN, Dragonieri S, Vulpi MR, Crimi N, Crimi C, Santus P, Menzella F, Pelaia C, Scioscia G, Caruso C, Bargagli E, Scichilone N, Carpagnano GE. High Level of Blood Eosinophils and Localization of Bronchiectasis in Patients with Severe Asthma: A Pilot Study. J Clin Med 2023; 12:jcm12010380. [PMID: 36615179 PMCID: PMC9821283 DOI: 10.3390/jcm12010380] [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: 12/02/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023] Open
Abstract
Background. Severe asthma and bronchiectasis are heterogeneous diseases that frequently coexist. The location of bronchiectasis is generally determined by specific underlying pathophysiological mechanisms. The aim of this study was to determine whether in a population suffering from both severe asthma and bronchiectasis there was a correlation between eosinophilic inflammation and localization of bronchiectasis. Methods. We enrolled 41 patients with coexisting bronchiectasis from eight different severe asthma center outpatient clinics and collected the following data: baseline characteristics, Asthma Control Test, Asthma Control Questionnaire, IgE level, blood count, high-resolution computed tomography and bronchiectasis-related parameters, skin prick test, FeNO50 and flow-volume spirometry. The study was retrospectively registered. Results. The presence of eosinophils > 1000 cells/μL was related to distribution of lower pulmonary bronchiectasis (9.1% upper lobes vs. 53.3% lower lobes, p = 0.014). Indeed, the presence of eosinophilic counts > 1000 increased the probability of lower localization of bronchiectasis compared to upper lobes (ODD 0.088 (0.010−0.772), p = 0.028). Conclusions. An increase in blood eosinophils > 1000 cells/μL seems to be associated with lower preferential localization of bronchiectasis with sparing of the upper lung lobes. This could represent a new potential radiological phenotype that could have a dedicated therapeutic strategy in the future.
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Affiliation(s)
- Vitaliano Nicola Quaranta
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University “Aldo Moro” of Bari, 70124 Bari, Italy
| | - Silvano Dragonieri
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University “Aldo Moro” of Bari, 70124 Bari, Italy
- Correspondence:
| | - Maria Rosaria Vulpi
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University “Aldo Moro” of Bari, 70124 Bari, Italy
| | - Nunzio Crimi
- Department of Internal Medicine and Specialistic Medicine, Section of Respiratory Diseases, University of Catania, 95100 Catania, Italy
| | - Claudia Crimi
- Department of Internal Medicine and Specialistic Medicine, Section of Respiratory Diseases, University of Catania, 95100 Catania, Italy
| | - Pierachille Santus
- Department of Clinical and Biomedical Sciences, Division of Respiratory Diseases, “L.Sacco” University Hospital, Università degli Studi di Milano, 20100 Milan, Italy
| | - Francesco Menzella
- Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS 2 Marca Trevigiana, 31044 Montebelluna, Italy
| | - Corrado Pelaia
- Department of Health Sciences, Section of Respiratory Disease, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University Hospital Policlinico Riuniti of Foggia, University of Foggia, 71100 Foggia, Italy
| | - Cristiano Caruso
- Department of Medical and Surgical Sciences, UOSD DH Gastroenterology, Polyclinic Foundation a. Gemelli IRCCS Cattolica University del Sacro Cuore, 00186 Rome, Italy
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplant Unit, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, 53100 Siena, Italy
| | | | - Giovanna Elisiana Carpagnano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University “Aldo Moro” of Bari, 70124 Bari, Italy
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17
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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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18
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Romano A, Valluzzi RL, Gaeta F, Caruso C, Zaffiro A, Quaratino D, Ebo D, Sabato V. The Combined Use of Chronological and Morphological Criteria in the Evaluation of Immediate Penicillin Reactions: Evidence From a Large Study. J Allergy Clin Immunol Pract 2022; 10:3238-3248.e2. [PMID: 36108927 DOI: 10.1016/j.jaip.2022.08.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 08/10/2022] [Accepted: 08/26/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Immediate hypersensitivity reactions to penicillins are often labeled on the basis of a similar set of symptoms, but a key feature of these reactions that can be reproduced in diagnostic testing may be the timing of a reaction in relation to the dose administration. OBJECTIVE To determine whether the timing of a reaction in response to the last dose of a penicillin would predict the results of diagnostic testing. METHODS We evaluated 1074 patients by performing skin tests, serum specific IgE assays (ImmunoCAP), and challenges. Patients who were evaluated by us more than 6 months after their reactions and found negative were reevaluated within 2 to 4 weeks. RESULTS Patients who had reacted within 1 hour after the first dose, within 1 hour after subsequent doses, more than 1 hour to within 6 hours after the first dose, or more than 1 hour to within 6 hours after subsequent doses were classified as group A (758 individuals), B (92), C (67), or D (157), respectively. Penicillin hypersensitivity was diagnosed in 707 patients (65.8%) by skin tests (407 patients, 57.6%), ImmunoCAP (47, 6.6%), both tests (232, 32.8%), or challenges (21, 3%). A conversion to allergy-test positivity occurred in 7 of 10 patients with anaphylactic reactions and in 1 of 28 patients with other reactions who were reevaluated after negative challenges. The rate of penicillin-allergic patients in groups A, B, C, and D was 85%, 35.9%, 35.8%, and 3.8%, respectively. Only 1 of 107 patients reporting cutaneous reactions lasting more than 1 day had positive results to allergy tests. CONCLUSIONS IgE-mediated hypersensitivity can be diagnosed by skin tests in about 70% of subjects who react within 1 hour (eg, patients from groups A and B). This hypersensitivity can be lost over time, as demonstrated by the negativization of allergy tests in follow-up studies. In subjects with anaphylactic reactions, however, it is advisable to not consider this phenomenon definitive. In fact, a conversion to allergy test positivity can be observed in up to 20% of such subjects retested after negative challenges.
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Affiliation(s)
| | - Rocco Luigi Valluzzi
- Department of Pediatrics, Division of Allergy, Pediatric Hospital Bambino Gesù, Rome, Vatican City, Italy
| | - Francesco Gaeta
- Allergy Unit, Columbus Hospital, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Cristiano Caruso
- Allergy Unit, Columbus Hospital, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Didier Ebo
- Immunology-Allergology-Rheumatology, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Vito Sabato
- Immunology-Allergology-Rheumatology, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
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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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20
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Caruso C, Cameli P, Altieri E, Aliani M, Bracciale P, Brussino L, Caiaffa MF, Canonica GW, Centanni S, D’Amato M, Del Giacco S, De Michele F, Pastorello EA, Pelaia G, Rogliani P, Romagnoli M, Schino P, Caminati M, Vultaggio A, Zullo A, Rizzoli S, Boarino S, Vitiello G, Menzella F, Di Marco F. Switching from one biologic to benralizumab in patients with severe eosinophilic asthma: An ANANKE study post hoc analysis. Front Med (Lausanne) 2022; 9:950883. [PMID: 36117962 PMCID: PMC9478391 DOI: 10.3389/fmed.2022.950883] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 05/23/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSevere asthma is a heterogeneous inflammatory disease driven by eosinophilic inflammation in the majority of cases. Despite biologic therapy patients may still be sub-optimally controlled, and the choice of the best biologic is a matter of debate. Indeed, switching between biologics is common, but no official guidelines are available and real-world data are limited.Materials and methodsIn this post hoc analysis of the Italian, multi-center, observational, retrospective study, ANANKE. Patients with severe eosinophilic asthma treated with benralizumab were divided in two groups based on history of previous biologic therapy (biologic-experienced [suboptimal response] vs naïve). Baseline clinical and laboratory characteristics were collected in the 12 months prior to benralizumab treatment. Change over time in blood eosinophils, annualized exacerbation rate (AER), asthma control (ACT), lung function and oral corticosteroid (OCS) use following benralizumab initiation were collected in the two groups.ResultsA total of 147 biologic-naïve and 58 biologic-experienced (34 omalizumab, 19 mepolizumab, and 5 omalizumab-mepolizumab) patients were enrolled. Biologic-experienced patients were more likely to be atopic and have a higher AER despite more frequent OCS use. Similar reductions in AER (>90% in both groups), OCS use (≥49% reduction in dosage and ≥41% able to eliminate OCS), ACT improvement (≥7 points gained in 48 weeks) and lung function (≥300 mL of FEV1 improvement in 48 weeks) were observed after benralizumab introduction within the two groups. There were no registered discontinuations of benralizumab for safety reasons.ConclusionIn this post hoc analysis, patients who were switched to benralizumab because of suboptimal control with a previous biologic therapy were more likely to be atopic and more often treated with omalizumab. Benralizumab is effective in both naïve patients and those previously treated with a biologic.
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Affiliation(s)
- Cristiano Caruso
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- *Correspondence: Cristiano Caruso,
| | - Paolo Cameli
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences and Neurosciences, Siena University Hospital, Siena, Italy
| | - Elena Altieri
- Reparto di Pneumologia, P.O. Garbagnate Milanese, Garbagnate Milanese, MI, Italy
| | - Maria Aliani
- UO Pneumologia e Pneumologia Riabilitativa, ICS Maugeri, IRCCS Bari, Bari, Italy
| | | | - Luisa Brussino
- Dipartimento di Scienze Mediche, SSDDU Allergologia e Immunologia Clinica, Università degli Studi di Torino, AO Ordine Mauriziano Umberto I - Torino, Turin, 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
- Asthma and Allergy Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, 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
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Fausto De Michele
- UOC Pneumologia e Fisiopatologia Respiratoria, AORN A. Cardarelli, Naples, 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
| | - Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | | | - Alessandro Zullo
- Medineos Observational Research - An IQVIA Company, Modena, Italy
| | - Sara Rizzoli
- Medineos Observational Research - An IQVIA Company, Modena, Italy
| | | | | | - Francesco Menzella
- UOC Pneumologia, Ospedale “S. Valentino,” Montebelluna (TV) - AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Fabiano Di Marco
- Department of Health Sciences and Pneumology, University of Milan, ASST Papa Giovanni XXIII, Bergamo, Italy
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21
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De Corso E, Baroni S, Settimi S, Onori ME, Mastrapasqua RF, Troiani E, Moretti G, Lucchetti D, Corbò M, Montuori C, Cantiani A, Porru DP, Lo Verde S, Di Bella GA, Caruso C, Galli J. Sinonasal Biomarkers Defining Type 2-High and Type 2-Low Inflammation in Chronic Rhinosinusitis with Nasal Polyps. J Pers Med 2022; 12:jpm12081251. [PMID: 36013200 PMCID: PMC9410079 DOI: 10.3390/jpm12081251] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
The complex pathophysiology of chronic rhinosinusitis with nasal polyps (CRSwNP) generates a spectrum of phenotypes with a wide variety of inflammatory states. We enrolled 44 very-likely-to-be type 2 CRSwNP patients in order to evaluate the load of inflammation and to analyze human interleukins in nasal secretion. Clinical data were collected to evaluate the severity of the disease. High levels of IL-5, IL-4, IL-6, and IL-33 were detected in all type 2 CRSwNP patients. By analyzing type 2 cytokine profiles and local eosinophil count, we identified two coherent clusters: the first was characterized by high levels of IL-4, IL-5, IL-6, and a high-grade eosinophil count (type 2-high); the second had lower levels of cytokines and poor or absent eosinophilic inflammation (type-2 low). IL-5 levels were significantly higher within the type 2 cytokine and it was the most reliable biomarker for differentiating the two clusters. In type 2-high inflammatory profile clinical scores, the mean number of previous surgeries and need for systemic corticosteroids were significantly higher compared to type 2-low. Our research demonstrated the potential role of type 2 biomarkers, and in particular, of IL-5 in identifying patients with a more severe phenotype based on a high inflammatory load.
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Affiliation(s)
- Eugenio De Corso
- Unit of Otorhinolaryngology and Head-Neck Surgery, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy; (E.D.C.); (J.G.)
| | - Silvia Baroni
- Unit of Chemistry, Biochemistry and Molecular Biology, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy;
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.E.O.); (E.T.); (G.M.)
| | - Stefano Settimi
- Unit of Otorhinolaryngology and Head-Neck Surgery, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy; (E.D.C.); (J.G.)
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
- Correspondence: ; Tel.: +39-0630154439
| | - Maria Elisabetta Onori
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.E.O.); (E.T.); (G.M.)
| | - Rodolfo Francesco Mastrapasqua
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Eliana Troiani
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.E.O.); (E.T.); (G.M.)
| | - Giacomo Moretti
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.E.O.); (E.T.); (G.M.)
| | - Donatella Lucchetti
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Marco Corbò
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Claudio Montuori
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Alessandro Cantiani
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Davide Paolo Porru
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Simone Lo Verde
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Giuseppe Alberto Di Bella
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
| | - Cristiano Caruso
- Department of Medical and Surgical Sciences, Digestive Disease Center, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Jacopo Galli
- Unit of Otorhinolaryngology and Head-Neck Surgery, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy; (E.D.C.); (J.G.)
- Department of Head-Neck and Sensory Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.F.M.); (M.C.); (C.M.); (A.C.); (D.P.P.); (S.L.V.); (G.A.D.B.)
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22
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Ariza A, Mayorga C, Bogas G, Gaeta F, Salas M, Valluzzi RL, Labella M, Pérez-Sánchez N, Caruso C, Molina A, Fernández TD, Torres MJ, Romano A. Detection of Serum-Specific IgE by Fluoro-Enzyme Immunoassay for Diagnosing Type I Hypersensitivity Reactions to Penicillins. Int J Mol Sci 2022; 23:ijms23136992. [PMID: 35805992 PMCID: PMC9266290 DOI: 10.3390/ijms23136992] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 12/15/2022] Open
Abstract
Diagnosis of type I hypersensitivity reactions (IgE-mediated reactions) to penicillins is based on clinical history, skin tests (STs), and drug provocation tests (DPTs). Among in vitro complementary tests, the fluoro-enzyme immunoassay (FEIA) ImmunoCAP® (Thermo-Fisher, Waltham, MA, USA) is the most widely used commercial method for detecting drug-specific IgE (sIgE). In this study, we aimed to analyze the utility of ImmunoCAP® for detecting sIgE to penicillin G (PG) and amoxicillin (AX) in patients with confirmed penicillin allergy. The study includes 139 and 250 patients evaluated in Spain and Italy, respectively. All had experienced type I hypersensitivity reactions to penicillins confirmed by positive STs. Additionally, selective or cross-reactive reactions were confirmed by DPTs in a subgroup of patients for further analysis. Positive ImmunoCAP® results were 39.6% for PG and/or AX in Spanish subjects and 52.4% in Italian subjects. When only PG or AX sIgE where analyzed, the percentages were 15.1% and 30.4%, respectively, in Spanish patients; and 38.9% and 46% in Italian ones. The analysis of positive STs showed a statistically significant higher percentage of positive STs to PG determinants in Italian patients. False-positive results to PG (16%) were detected in selective AX patients with confirmed PG tolerance. Low and variable sensitivity values observed in a well-defined population with confirmed allergy diagnosis, as well as false-positive results to PG, suggest that ImmunoCAP® is a diagnostic tool with relevant limitations in the evaluation of subjects with type I hypersensitivity reactions to penicillins.
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Affiliation(s)
- Adriana Ariza
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, 29009 Malaga, Spain; (A.A.); (C.M.); (G.B.); (M.S.); (M.L.); (N.P.-S.); (A.M.); (T.D.F.)
| | - Cristobalina Mayorga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, 29009 Malaga, Spain; (A.A.); (C.M.); (G.B.); (M.S.); (M.L.); (N.P.-S.); (A.M.); (T.D.F.)
- Allergy Unit, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain
- Andalusian Center for Nanomedicine and Biotechnology-BIONAND, 29590 Malaga, Spain
| | - Gádor Bogas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, 29009 Malaga, Spain; (A.A.); (C.M.); (G.B.); (M.S.); (M.L.); (N.P.-S.); (A.M.); (T.D.F.)
- Allergy Unit, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain
| | - Francesco Gaeta
- Allergy Unit, Columbus Hospital, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - María Salas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, 29009 Malaga, Spain; (A.A.); (C.M.); (G.B.); (M.S.); (M.L.); (N.P.-S.); (A.M.); (T.D.F.)
- Allergy Unit, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain
| | - Rocco L. Valluzzi
- Department of Pediatrics, Division of Allergy, Pediatric Hospital Bambino Gesù, 00165 Rome, Italy;
| | - Marina Labella
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, 29009 Malaga, Spain; (A.A.); (C.M.); (G.B.); (M.S.); (M.L.); (N.P.-S.); (A.M.); (T.D.F.)
- Allergy Unit, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain
| | - Natalia Pérez-Sánchez
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, 29009 Malaga, Spain; (A.A.); (C.M.); (G.B.); (M.S.); (M.L.); (N.P.-S.); (A.M.); (T.D.F.)
- Allergy Unit, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain
| | - Cristiano Caruso
- UOSD DH Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Ana Molina
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, 29009 Malaga, Spain; (A.A.); (C.M.); (G.B.); (M.S.); (M.L.); (N.P.-S.); (A.M.); (T.D.F.)
| | - Tahia D. Fernández
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, 29009 Malaga, Spain; (A.A.); (C.M.); (G.B.); (M.S.); (M.L.); (N.P.-S.); (A.M.); (T.D.F.)
- Departamento de Biología Celular, Genética y Fisiología, Universidad de Málaga, 29010 Malaga, Spain
| | - María José Torres
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, 29009 Malaga, Spain; (A.A.); (C.M.); (G.B.); (M.S.); (M.L.); (N.P.-S.); (A.M.); (T.D.F.)
- Allergy Unit, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain
- Andalusian Center for Nanomedicine and Biotechnology-BIONAND, 29590 Malaga, Spain
- Departamento de Medicina, Universidad de Málaga, 29010 Malaga, Spain
- Correspondence: ; Tel.: +34-951290224
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23
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Agache I, Antolin‐Amerigo D, Blay F, Boccabella C, Caruso C, Chanez P, Couto M, Covar R, Doan S, Fauquert J, Gauvreau G, Gherasim A, Klimek L, Lemiere C, Nair P, Ojanguren I, Peden D, Perez‐de‐Llano L, Pfaar O, Rondon C, Rukhazde M, Sastre J, Schulze J, Silva D, Tarlo S, Toppila‐Salmi S, Walusiak‐Skorupa J, Zielen S, Eguiluz‐Gracia I. EAACI position paper on the clinical use of the bronchial allergen challenge: Unmet needs and research priorities. Allergy 2022; 77:1667-1684. [PMID: 34978085 DOI: 10.1111/all.15203] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/16/2021] [Accepted: 12/27/2021] [Indexed: 12/22/2022]
Abstract
Allergic asthma (AA) is a common asthma phenotype, and its diagnosis requires both the demonstration of IgE-sensitization to aeroallergens and the causative role of this sensitization as a major driver of asthma symptoms. Therefore, a bronchial allergen challenge (BAC) would be occasionally required to identify AA patients among atopic asthmatics. Nevertheless, BAC is usually considered a research tool only, with existing protocols being tailored to mild asthmatics and research needs (eg long washout period for inhaled corticosteroids). Consequently, existing BAC protocols are not designed to be performed in moderate-to-severe asthmatics or in clinical practice. The correct diagnosis of AA might help select patients for immunomodulatory therapies. Allergen sublingual immunotherapy is now registered and recommended for controlled or partially controlled patients with house dust mite-driven AA and with FEV1 ≥ 70%. Allergen avoidance is costly and difficult to implement for the management of AA, so the proper selection of patients is also beneficial. In this position paper, the EAACI Task Force proposes a methodology for clinical BAC that would need to be validated in future studies. The clinical implementation of BAC could ultimately translate into a better phenotyping of asthmatics in real life, and into a more accurate selection of patients for long-term and costly management pathways.
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine Transylvania University Brasov Romania
| | - Dario Antolin‐Amerigo
- Servicio de Alergia Hospital Universitario Ramón y Cajal Instituto Ramón y Cajal de Investigación Sanitaria Madrid Spain
| | - Frederic Blay
- ALYATEC Environmental Exposure Chamber Chest Diseases Department Strasbourg University Hospital University of Strasbourg Strasbourg France
| | - Cristina Boccabella
- Department of Cardiovascular and Thoracic Sciences Università Cattolica del Sacro Cuore Fondazione Policlinico Universitario A. Gemelli ‐ IRCCS Rome Italy
| | | | - Pascal Chanez
- Department of Respiratory CIC Nord INSERMINRAE C2VN Aix Marseille University Marseille France
| | - Mariana Couto
- Centro de Alergia Hospital CUF Descobertas Lisboa Portugal
| | - Ronina Covar
- Pediatrics National Jewish Health Denver Colorado USA
| | | | | | - Gail Gauvreau
- Division of Respirology Department of Medicine McMaster University Hamilton Ontario Canada
| | - Alina Gherasim
- ALYATEC Environmental Exposure Chamber Strasbourg France
| | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Catherine Lemiere
- Research Centre Centre Intégré Universitaire de santé et de services sociaux du Nord‐de‐l'île‐de‐Montréal Montréal Quebec Canada
- Faculty of Medicine Université de Montreal Montreal Quebec Canada
| | - Parameswaran Nair
- Department of Medicine Firestone Institute of Respiratory Health at St. Joseph's Healthcare McMaster University Hamilton Ontario Canada
| | - Iñigo Ojanguren
- Departament de Medicina Servei de Pneumología Hospital Universitari Valld´Hebron Universitat Autònoma de Barcelona (UAB) Institut de Recerca (VHIR) CIBER de Enfermedades Respiratorias (CIBERES) Barcelona Spain
| | - David Peden
- Division of Pediatric Allergy and Immunology Center for Environmental Medicine, Asthma and Lung Biology The School of Medicine The University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Luis Perez‐de‐Llano
- Department of Respiratory Medicine University Hospital Lucus Augusti Lugo Spain
| | - Oliver Pfaar
- Section of Rhinology and Allergy Department of Otorhinolaryngology, Head and Neck Surgery University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Carmen Rondon
- Allergy Unit Hospital Regional Universitario de Malaga Instituto de Investigacion Biomedica de Malaga (IBIMA) Malaga Spain
| | - Maia Rukhazde
- Center of Allergy & Immunology Teaching University Geomedi LLC Tbilisi Georgia
| | - Joaquin Sastre
- Allergy Unit Hospital Universitario Fundación Jiménez Díaz Center for Biomedical Network of Respiratory Diseases (CIBERES) Instituto de Salud Carlos III (ISCIII) Madrid Spain
| | - Johannes Schulze
- Department for Children and Adolescents, Division of Allergology Pulmonology and Cystic Fibrosis Goethe‐University Hospital Frankfurt am Main Germany
| | - Diana Silva
- Basic and Clinical Immunology Unit Department of Pathology Faculty of Medicine University of Porto and Serviço de Imunoalergologia Centro Hospitalar São João, EPE Porto Portugal
| | - Susan Tarlo
- Respiratory Division Department of Medicine University Health Network, Toronto Western Hospital University of Toronto Department of Medicine, and Dalla Lana Department of Public Health Toronto Ontario Canada
| | - Sanna Toppila‐Salmi
- Haartman Institute, Medicum, Skin and Allergy Hospital Hospital District of Helsinki and Uusimaa Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Jolanta Walusiak‐Skorupa
- Department of Occupational Diseases and Environmental Health Nofer Institute of Occupational Medicine Łódź Poland
| | - Stefan Zielen
- Department for Children and Adolescents, Division of Allergology Pulmonology and Cystic Fibrosis Goethe‐University Hospital Frankfurt am Main Germany
| | - Ibon Eguiluz‐Gracia
- Allergy Unit Hospital Regional Universitario de Malaga Instituto de Investigacion Biomedica de Malaga (IBIMA) Malaga Spain
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24
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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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25
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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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Caruso C, Giancaspro R, Guida G, Macchi A, Landi M, Heffler E, Gelardi M. Nasal Cytology: A Easy Diagnostic Tool in Precision Medicine for Inflammation in Epithelial Barrier Damage in the Nose. A Perspective Mini Review. Front Allergy 2022; 3:768408. [PMID: 35966227 PMCID: PMC9365292 DOI: 10.3389/falgy.2022.768408] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 08/31/2021] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Nasal cytology is a diagnostic tool that can be used in precision rhinology medicine. Particularly in non-allergic rhinitis and chronic rhinosinusitis forms it can be useful to evaluate biomarkers of both surgical or biological therapy and especially in the follow-up it must be used to predict the prognostic index of recurrence of nasal polyposis. All inflammatory cytokines are also linked to the presence of cells such as eosinophils and mastcells and nasal cytology is a non-invasive and repeatable method to assess the situation in real life.
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Affiliation(s)
- Cristiano Caruso
- Unit of Internal Medicine and Gastroenterology, Department of Medical and Surgical Sciences, Agostino Gemelli University Polyclinic (IRCCS), Rome, Italy
- Allergy Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
- *Correspondence: Cristiano Caruso
| | - Rossana Giancaspro
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O. S.Croce e Carle, Cuneo, Italy
- Giuseppe Guida
| | - Alberto Macchi
- Italian Academy of Rhinology Asst Settelaghi-University of Insubriae, Varese, Italy
| | - Massimo Landi
- Paediatric National Healthcare System, Torino, Italy
| | - Enrico Heffler
- Personalized Medicine Center: Asthma and Allergology, Humanitas Research Hospital, Rozzano (MI), Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Matteo Gelardi
- Unit of Otolaryngology, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, 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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28
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Colombino E, Zoppi S, Alborali G, Bonvegna M, Caruso C, Cucco I, Mioletti S, Sona B, Tarantola M, Tomassone L, Tursi M, Vercelli C, Dondo A, Capucchio M. Bacterial and Viral Pathogens in Swine of North-West Italy. J Comp Pathol 2022. [DOI: 10.1016/j.jcpa.2021.11.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Chiricozzi A, Gori N, Di Nardo L, Antonelli F, Caruso C, Caldarola G, Calabrese L, Guerriero C, De Simone C, Peris K. Therapeutic Impact and Management of Persistent Head and Neck Atopic Dermatitis in Dupilumab-Treated Patients. Dermatology 2021; 238:717-724. [PMID: 34710866 DOI: 10.1159/000519361] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Localization of atopic dermatitis (AD) in exposed areas such as the hands, head, and neck has been considered as a negative factor impacting on dupilumab response, although a comparison of exposed versus unexposed areas is not currently available. OBJECTIVES The aim of this study is to evaluate the clinical response to dupilumab depending on the presence or persistency of AD skin manifestations in specific body areas. METHODS The study retrospectively collected clinical and demographic data of adult patients affected by moderate to severe AD. Based on the anatomical sites involved, 5 subcohorts of patients were identified. RESULTS A total of 41 patients were included in the study. Disease amelioration was detected during the study period, although baseline head/neck and hand localization was associated with a significantly lower likelihood of achieving an Eczema Area Severity Index (EASI) ≤1. In addition, patients with head/neck persistency showed a significantly lower response when compared to patients without persistency of head/neck AD in terms of both mean EASI and Dermatology Life Quality Index (DLQI) reduction. CONCLUSION AD localization in exposed areas at the baseline and AD persistency at the head/neck may have a negative impact on certain treatment response parameters to dupilumab therapy.
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Affiliation(s)
- Andrea Chiricozzi
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Niccolò Gori
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lucia Di Nardo
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Flaminia Antonelli
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristiano Caruso
- Allergy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giacomo Caldarola
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Laura Calabrese
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina Guerriero
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Clara De Simone
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ketty Peris
- Dermatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
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30
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Pini L, Caruso C, Colantuono S, Bagnasco D, Maxwell A, Price RG, Howarth P, Canonica GW. Prospective Italian real-world study of mepolizumab in severe eosinophilic asthma validates retrospective outcome reports. Clin Transl Allergy 2021; 11:e12067. [PMID: 34691389 PMCID: PMC8517195 DOI: 10.1002/clt2.12067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Laura Pini
- Respiratory Unit Spedali Civili di Brescia Brescia Italy.,Department of Clinical and Experimental Sciences University of Brescia Brescia Italy
| | - Cristiano Caruso
- Department of Medical and Surgical Sciences Fondazione Policlinico A. Gemelli IRCCS Rome Italy.,Università Cattolica del Sacro Cuore Rome Italy
| | - Stefania Colantuono
- Department of Medical and Surgical Sciences Fondazione Policlinico A. Gemelli IRCCS Rome Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino University of Genoa Genoa Italy
| | - Aoife Maxwell
- Real World Study Delivery Value Evidence and Outcomes Global Medical GSK Stevenage Hertfordshire UK
| | | | - Peter Howarth
- Global Medical Global Specialty & Primary Care TA GSK House Brentford Middlesex UK
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences Humanitas University Milan Italy.,Personalized Medicine Asthma and Allergy Clinic Humanitas Research Hospital IRCCS Milan Italy
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31
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Caruso C, Colantuono S, Nicoletti A, Arasi S, Firinu D, Gasbarrini A, Coppola A, Di Michele L. Metabolomics, Microbiota, and In Vivo and In Vitro Biomarkers in Type 2 Severe Asthma: A Perspective Review. Metabolites 2021; 11:metabo11100647. [PMID: 34677362 PMCID: PMC8541451 DOI: 10.3390/metabo11100647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022] Open
Abstract
Precision medicine refers to the tailoring of therapeutic strategies to the individual characteristics of each patient; thus, it could be a new approach for the management of severe asthma that considers individual variability in genes, environmental exposure, and lifestyle. Precision medicine would also assist physicians in choosing the right treatment, the best timing of administration, consequently trying to maximize drug efficacy, and, possibly, reducing adverse events. Metabolomics is the systematic study of low molecular weight (bio)chemicals in a given biological system and offers a powerful approach to biomarker discovery and elucidating disease mechanisms. In this point of view, metabolomics could play a key role in targeting precision medicine.
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Affiliation(s)
- Cristiano Caruso
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCCS, Catholic University of the Sacred Heart, 00100 Rome, Italy;
- Correspondence:
| | - Stefania Colantuono
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCCS, Catholic University of the Sacred Heart, 00100 Rome, Italy;
- Digestive Disease Center, Medical and Surgical Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Sacred Heart, 00100 Rome, Italy;
| | - Alberto Nicoletti
- Internal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Department of Internal Medicine, Catholic University of the Sacred Heart, 00100 Rome, Italy;
| | - Stefania Arasi
- Area of Translational Research in Pediatric Specialities, Allergy Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, Italy;
| | - Antonio Gasbarrini
- Digestive Disease Center, Medical and Surgical Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Sacred Heart, 00100 Rome, Italy;
| | - Angelo Coppola
- Division of Respiratory Medicine, Ospedale San Filippo Neri-ASL Roma 1, 00100 Rome, Italy;
- UniCamillus, Saint Camillus International, University of Health Sciences, 00131 Rome, Italy
| | - Loreta Di Michele
- Pulmonary Interstitial Diseases Unit, UOSD Interstiziopatie Polmonari Az Osp. S. Camillo-Forlanini, 00100 Rome, Italy;
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32
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Eguiluz‐Gracia I, Berge M, Boccabella C, Bonini M, Caruso C, Couto M, Erkekol F, Rukhadze M, Sanchez‐Garcia S, Giacco S, Jutel M, Agache I. Real-life impact of COVID-19 pandemic lockdown on the management of pediatric and adult asthma: A survey by the EAACI Asthma Section. Allergy 2021; 76:2776-2784. [PMID: 33772815 PMCID: PMC8250685 DOI: 10.1111/all.14831] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The restrictions imposed by the COVID-19 pandemic impact heavily the management of chronic diseases like asthma. This study aimed to evaluate the management of adults and children with asthma during COVID-19-related lockdown. METHODS A survey was launched by the European Academy of Allergy and Clinical Immunology (EAACI) via e-mail, website, and social media to EAACI members and members of peer societies. RESULTS The survey was completed by 339 healthcare professionals from 52 countries. 79% of follow-up consultations were replaced by phone calls, whereas 49% of newly referred patients attended the clinic. 62%, 76%, 66%, 76%, and 87% of responders did not conduct spirometry, impulse oscillometry, bronchodilator test, FeNO, or methacholine provocation, respectively, for asthma diagnosis in adults. The numbers were similar for children. 73% of responders based the initial asthma diagnosis and the prescription of inhaled therapy on clinical parameters only. Lung function tests were used in 29% of cases to monitor asthma worsening, and only 56% of participants were recommended to their patients ambulatory peak expiratory flow (PEF) measurements. Using a 1 (not at all) to 5 (very much) scale, the responders considered that the quality of healthcare provided and the patients' asthma status had deteriorated during the lockdown with 3.2 points and 2.8 points, respectively. CONCLUSION Collectively, these results suggest that all necessary resources should be allocated to ensure the performance of lung function tests for initial diagnosis, whereas digital remote monitoring should be reinforced for the follow-up of children and adults with asthma.
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Affiliation(s)
- Ibon Eguiluz‐Gracia
- Allergy Unit Hospital Regional Universitario de Malaga Malaga Spain
- Allergy Group Instituto de InvestigacionBiomedica de Malaga (IBIMA) and ARADyAL Malaga Spain
| | - Maarten Berge
- Groningen Research Institute for Asthma and COPDUniversity Medical Centre GroningenUniversity of Groningen Groningen the Netherlands
- Department of Pulmonary Diseases University of GroningenUniversity Medical Centre Groningen Groningen the Netherlands
| | - Cristina Boccabella
- Department of Cardiovascular and Thoracic Sciences Fondazione PoliclinicoUniversitario "A Gemelli" – IRCCSUniversity of the Sacred Heart Rome Italy
| | - Matteo Bonini
- Department of Cardiovascular and Thoracic Sciences Fondazione PoliclinicoUniversitario "A Gemelli" – IRCCSUniversity of the Sacred Heart Rome Italy
- National Heart and Lung Institute (NHLIImperial College London UK
| | - Cristiano Caruso
- Allergy Unit Fondazione Policlinico Universitario “A. Gemelli” – IRCCS Rome Italy
| | - Mariana Couto
- Centro de Alergia Hospital CUF Descobertas Lisboa Portugal
| | - FerdaOner Erkekol
- Division of Allergy and Clinical Immunology Faculty of Medicine Ankara YildirimBeyazit University Ankara Turkey
| | - Maia Rukhadze
- Center of Allergy &Immunology Tbilisi Georgia
- Teaching University Geomedi LLC Tbilisi Georgia
| | - Silvia Sanchez‐Garcia
- Allergy Department Hospital Infantil Universitario del Niño Jesús Madrid Spain
- Allergy Group Instituto de Investigación del Hospital de la Princesa (IP) and ARADyAL Madrid Spain
| | - Stefano Giacco
- Allergy and Clinical Immunology Unit Department of Medical Sciences and Public Health University Hospital "DuilioCasula" Monserrato (Cagliari) Italy
| | - Marek Jutel
- Department of Clinical Immunology Wroclaw Medical University Wroclaw Poland
- ALL‐MED Medical Research Institute Wroclaw Poland
| | - Ioana Agache
- Faculty of Medicine Department of Allergy and Clinical Immunology Transylvania University Brasov Brasov Romania
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Voltolini S, Cofini V, Murzilli F, Bignardi D, Borro M, Calamari M, Caruso C, Cittadini G, Contatore M, Cortellini G, Desideri G, Di Paolo C, Lippolis D, Lobene M, Manzotti G, Meucci E, Necozione S, Ramirez GA, Yacoub MR, Bilò MB. Hypersensitivity reactions to iodinate contrast media in Italy: a retrospective study. Characteristics of patients and risk factors. Eur Ann Allergy Clin Immunol 2021; 54:60-67. [PMID: 34225444 DOI: 10.23822/eurannaci.1764-1489.225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Objective. The purpose of the study was to describe the characteristics of patients experiencing hypersensitivity reactions (HRs) to iodinated contrast media (ICM) in a large Italian population and to investigate potential risks factors in order to obtain a risk stratification, helpful in the management of these patients. Methods. Data of 407 patients investigated in 9 Italian Allergy Centers for suspected HRs to ICM were analyzed and compared with a control group of 152 subjects that tolerated one or more ICM-enhanced examinations. The univariate and multivariate logistic regression model was used to evaluate associated factors. Results. The mean age of reactive patients was 61 years and 60% were female; 67% of patients reported immediate reactions and 35% experienced the reaction, more frequently with immediate onset, at the first examination in life. Iomeprol, iopromide and iodixanol were the most frequent culprit agents and 20% of patients showed a positive skin test result. Previous adverse reactions to ICM were reported by 15.6% of patients, whereas 35% of subjects experienced the reaction, more frequently immediate, after the first ICM-enhanced examination in their life. The multivariate analysis showed that male gender and age > 65 were associated with ICM reactions as protective factors [ORadja = 0.51; 95% CI: 0.33-0.77 and ORadja = 0.60; 95% CI: 0.39-0.92 respectively]. Cardio-vascular disease [ORadja = 2.06; 95% CI: 1.22-3.50)], respiratory allergy [ORadja = 2.30; 95% CI: 1.09-4.83)] and adverse drug reactions [ORadja = 1.99; 95% CI: 1.05-3.77)] were identified as risk factors for ICM reactions. Food allergy was not significantly associated with reactions [ORadja = 1.51; 5% CI: 0.41-5.56]. Conclusions. This is the largest study on Italian patients experiencing hypersensitivity reactions to ICM. Most results are in line with other studies, showing some association with factors that could influence the incidence of hypersensitivity reactions but not allowing an easy risk stratification.
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Affiliation(s)
| | - V Cofini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | - F Murzilli
- Allergology U.O., Avezzano Hospital, ASL n. 1 Abruzzo, L'Aquila, Italy
| | - D Bignardi
- Allergology U.O.C., Polyclinic Hospital San Martino - IRCCS, Genoa, Italy
| | - M Borro
- Department of Internal Medicine, University of Genoa - Polyclinic Hospital S. Martino - IRCCS, Genoa, Italy
| | - M Calamari
- Allergy Unit, Castelli di Verbania Hospital, ASL VCO, Verbania, Italy
| | - C Caruso
- Allergy Unit, Fondazione Policlinico A. Gemelli - IRCCS, Rome, Italy
| | - G Cittadini
- Department of Radiology, Polyclinic Hospital San Martino - IRCCS, Genoa, Italy
| | - M Contatore
- Internal Medicine U.O., Polyclinic Hospital San Martino - IRCCS, Genoa, Italy
| | - G Cortellini
- Internal Medicine and Rheumatology U.O., Rimini Hospital, ASL Romagna, Rimini, Italy
| | - G Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | - C Di Paolo
- Allergology S.S.V.D., ASST Spedali Civili di Brescia, Brescia, Italy
| | - D Lippolis
- Internal Medicine and Rheumatology U.O., Rimini Hospital, ASL Romagna, Rimini, Italy
| | - M Lobene
- General and Interventistic Radiology U.O., Avezzano Hospital, ASL n. 1 Abruzzo, L'Aquila, Italy
| | - G Manzotti
- Allergy Clinic, Casa di Cura Beato Palazzolo, Bergamo, Italy
| | - E Meucci
- Allergy and Clinical Immunology Unit, S. Giovanni di Dio Hospital, AUSL Toscana Centro, Florence, Italy
| | - S Necozione
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | - G A Ramirez
- Life and health University S. Raffaele, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS S. Raffaele Hospital, Milan, Italy
| | - M R Yacoub
- Life and health University S. Raffaele, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS S. Raffaele Hospital, Milan, Italy
| | - M B Bilò
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.,Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy
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Caruso C, Colantuono S, Tolusso B, Di Mario C, Pentassuglia A, Rumi G, Gremese E, Romano A, Gasbarrini A. Basophil activation and serum IL-5 levels as possible monitor biomarkers in severe eosinophilic asthma patients treated with anti-IL-5 drugs. Allergy 2021; 76:1569-1571. [PMID: 33099778 DOI: 10.1111/all.14643] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/22/2020] [Accepted: 10/18/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Cristiano Caruso
- Allergy Unit Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - Stefania Colantuono
- Allergy Unit Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
- Department of Translational and Precision Medicine Sapienza University Rome Italy
| | - Barbara Tolusso
- Division of Rheumatology Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - Clara Di Mario
- Division of Rheumatology Università Cattolica del Sacro Cuore Rome Italy
| | | | - Gabriele Rumi
- Allergy Unit Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - Elisa Gremese
- Division of Rheumatology Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
- Division of Rheumatology Università Cattolica del Sacro Cuore Rome Italy
| | - Antonino Romano
- IRCCS Oasi Maria S.S. Troina Italy
- Fondazione Mediterranea G.B. Morgagni Catania Italy
| | - Antonio Gasbarrini
- UOC Medicina Interna e GastroenterologiaFondazione Policlinico Universitario A. Gemelli IRCCSUniversità Cattolica del Sacro Cuore Rome Italy
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Caruso C, Colantuono S, Urbani S, Heffler E, Canonica GW, Andriollo G, Di Michele L, Scarlata S, Zennaro D, Rigon A, Vadacca M, Moroni R, Nucera E, Gasbarrini A. Real-life survey on severe asthma patients during COVID-19 lockdown in Italy. Expert Rev Respir Med 2021; 15:1057-1060. [PMID: 33896350 DOI: 10.1080/17476348.2021.1917387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Introduction: The SARS-CoV-2 pandemic has deeply revolutionized our lives and consequently the management of patients, specifically ones with severe asthma.Objective: A survey was conducted to evaluate the effects on adherence, exacerbations and quality of life in patients with severe asthma during the COVID-19 pandemic period.Methods: 100 severe asthma patients, who accepted to participate to the survey, were asked to respond to different questionnaires in order to assess asthma symptoms (Asthma Control Test - ACT, and Asthma Control Quality - ACQ) and rino-sinusal ones (Sino-nasal outcome test - SNOT-22).Results: 31 out of 100 patients reported worsening of respiratory symptoms requiring a step-up in therapy dosage or frequency during the observational period; however, exacerbation rate was very low. Only 17 (17%) of the 100 participants experienced a severe asthma exacerbation. Moreover, there was no confirmed diagnosis of COVID-19 in this population.Conclusion: Patients with severe asthma did not show higher rates of exacerbations during the pandemic outbreak as well as no increased risk of contracting COVID-19 infection or developing the disease. Self-administration of biological drugs could be useful to maintain high rates of adherence to therapy, and, at the same time, to decrease the risk of exacerbations or Intensive Care Unit (ICU) room access.
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Affiliation(s)
- Cristiano Caruso
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - Stefania Colantuono
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy.,Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Sara Urbani
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Gloria Andriollo
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - Loreta Di Michele
- Pulmonary Interstitial Diseases Unit, UOS Interstiziopatie Polmonari Az Osp. S. Camillo-Forlanini, Roma, Italy
| | - Simone Scarlata
- Unit of Geriatrics, Campus Bio-Medico di Roma University, Rome, Italy
| | - Danila Zennaro
- Unit of Allergology, Clinical Immunology and Rheumatology, Department of Medicine, University Campus Bio-Medico di Roma, Rome, Italy
| | - Amelia Rigon
- Unit of Allergology, Clinical Immunology and Rheumatology, Department of Medicine, University Campus Bio-Medico di Roma, Rome, Italy
| | - Marta Vadacca
- Unit of Allergology, Clinical Immunology and Rheumatology, Department of Medicine, University Campus Bio-Medico di Roma, Rome, Italy
| | - Rossana Moroni
- Biostatistico Presso Direzione Scientifica, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - Eleonora Nucera
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - Antonio Gasbarrini
- Division of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Catholic University of the Sacred Heart, Rome, Italy
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Caruso C, Valluzzi RL, Colantuono S, Gaeta F, Romano A. β-Lactam Allergy and Cross-Reactivity: A Clinician's Guide to Selecting an Alternative Antibiotic. J Asthma Allergy 2021; 14:31-46. [PMID: 33500632 PMCID: PMC7822086 DOI: 10.2147/jaa.s242061] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/07/2021] [Indexed: 12/15/2022] Open
Abstract
β-Lactams which include penicillins, cephalosporins, carbapenems, and monobactams are the most common antibiotic classes reported to cause allergic reactions to drugs. This review is mainly about published studies assessing the cross-reactivity among β-lactams in penicillin- or cephalosporin-allergic subjects by carrying out diagnostic tests with alternative β-lactams and, if appropriate, graded challenges. Several studies demonstrated that cross-reactivity connected with the β-lactam ring, causing positive responses to allergy tests with all β-lactams, is infrequent in subjects with an IgE-mediated allergy and anecdotal in those with a T-cell-mediated allergy. Identities or similarities of β-lactam side-chain structures are mainly responsible for cross-reactivity among these antibiotics. For example, in aminopenicillin-allergic subjects, cross-reactivity with aminocephalosporins could possibly be over 30%. On the other hand, in a few prospective studies of penicillin-allergic individuals, less than 1% of cases show a cross-reactivity between penicillins and both aztreonam and carbapenems. Particular patterns of allergy-test positivity observed in some studies that assessed cross-reactivity among β-lactams seem to indicate that prior exposures may be responsible for coexisting sensitivities. Therefore, pre-treatment skin tests with the related β-lactams are suggested before administering them via graded challenges to β-lactam-allergic patients who need alternative β-lactams.
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Affiliation(s)
- Cristiano Caruso
- Allergy Unit, Columbus Hospital, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - Rocco Luigi Valluzzi
- Department of Pediatrics, Division of Allergy, Pediatric Hospital Bambino Gesù, Rome, Vatican City, Italy
| | - Stefania Colantuono
- Allergy Unit, Columbus Hospital, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - Francesco Gaeta
- Allergy Unit, Columbus Hospital, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - Antonino Romano
- Oasi Research Institute-IRCCS, Troina, Italy
- Fondazione Mediterranea G.B. Morgagni, Catania, Italy
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37
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Gerasia R, Cannataci C, Gallo GS, Tafaro C, Caruso C, Maruzzelli L, Miraglia R. FLUOROSCOPY-GUIDED BILIARY PROCEDURES IN A PREGNANT, LIVER TRANSPLANT PATIENT: FETUS RADIATION PROTECTION. Radiat Prot Dosimetry 2020; 192:396-401. [PMID: 33313869 DOI: 10.1093/rpd/ncaa204] [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] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/08/2020] [Accepted: 11/18/2020] [Indexed: 06/12/2023]
Abstract
We report three cases of clinically necessary, fluoroscopy-guided, percutaneous biliary procedures performed safely in a pregnant, liver transplant recipient using three different angiography suites. The uterine cumulative equivalent dose was 0.25 mSv, a value obtained by adding the doses of the three procedures described above, and which is relatively low when compared with the naturally occurring background radiation exposure for a 9-month pregnancy (~0.5-1 mSv). Our experience shows that staff knowledge, awareness and liaison promote the application of all dose reduction strategies possible while still achieving the clinical aim despite using different angiographic equipment.
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Affiliation(s)
- R Gerasia
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy
- Italian Association of Interventional Radiographers (AITRI), Milan, Italy
- Italian Federation of Scientific Radiographers Societies (FASTeR), Milan, Italy
| | - C Cannataci
- Medical Imaging Department, Mater Dei Hospital, Msida, Malta
| | - G S Gallo
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy
- Italian Association of Interventional Radiographers (AITRI), Milan, Italy
| | - C Tafaro
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy
- Italian Association of Interventional Radiographers (AITRI), Milan, Italy
| | | | - L Maruzzelli
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy
| | - R Miraglia
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy
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38
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Ciuffreda M, Caruso C, Romano A, Sarni A. Effect of mepolizumab alone in chronic eosinophilic pneumonia relapse: A case report. The Journal of Allergy and Clinical Immunology: In Practice 2020; 8:3640-3642. [DOI: 10.1016/j.jaip.2020.06.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/24/2022]
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Ramachandran V, Nguyen J, Caruso C, Rao D. Hirschsprung’s Disease: Two Cases of Total Intestinal Aganglionosis. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.159] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction/Objective
Hirschsprung’s disease is a disorder associated with an absence of ganglion cells in a segment of the bowel. Total colonic and small bowel aganglionosis occurs in less than 1% of all Hirschsprung’s disease patients. Even rarer is the finding of Haddad syndrome, the coexistence of congenital central hypoventilation syndrome and Hirschsprung’s disease. Congenital central hypoventilation syndrome has approximately 1,000 reported cases, with colonic aganglionosis being associated with 15-20% of those cases. The prevalence of Hirschsprung’s disease with congenital renal anomalies may be another underreported finding.
Methods
Here, we report two rare cases of Hirschsprung’s disease with significant extension in the small bowel. One case involves a 38-week gestational age male infant admitted for apnea and another case involves 39-week gestational age female infant admitted for vomiting.
Results
Both infants had rectal suction biopsies confirming the absence of ganglion cells. The male infant had mapping biopsies which histologically showed hypertrophic nerve fibers and an absence of ganglion cells in the colon extending up to 70 cm proximal to the ileocecal valve. Calretinin immunostaining confirmed aganglionsis. Genetic testing showed a PHOX2B gene mutation carrying 32 polyalanine repeat mutations, confirming a diagnosis of congenital central hypoventilation syndrome coexisting with Hirschsprung’s disease. The female infant had intraoperative frozen sections that identified ganglion cells throughout the colon. On permanent sections, there was an absence of ganglion cells in the upper rectum extending up to 65 cm proximal to the ileocecal valve. She also was noted to have agenesis of the left kidney and a urachal remnant. Genetic testing was negative for RET mutations.
Conclusion
Overall, these cases provide further information on a rare variant of Hirschsprung’s disease that includes significant portions of the small bowel. Additionally, this study adds to the documented reports of Haddad syndrome and the connections between renal anomalies with Hirschsprung’s disease. Last, this series alludes to the difficulties of frozen section diagnosis of this disease.
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Affiliation(s)
- V Ramachandran
- Pediatric Surgery, University of Missouri, Columbia, Missouri, UNITED STATES
| | - J Nguyen
- Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, UNITED STATES
| | - C Caruso
- Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, UNITED STATES
| | - D Rao
- Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, UNITED STATES
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40
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Caruso C, Colantuono S, Celi G, Salerno L, De Martino G, Ianiro G, Casale C, Nucera E, Del Giacco S, Gasbarrini A. Modulation of gut microbiota in patients with IBS and systemic nickel allergy after diet and probiotic supplementation: a pilot study. J BIOL REG HOMEOS AG 2020; 34:1929-1934. [PMID: 33103410 DOI: 10.23812/20-162-l] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C Caruso
- Allergy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - S Colantuono
- Allergy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Translational and Precision medicine, Sapienza University, Rome, Italy
| | - G Celi
- Clinica Villa Pia, Rome, Italy
| | | | | | - G Ianiro
- Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - E Nucera
- Allergy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - S Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - A Gasbarrini
- Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Rome, Italy
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Nicoletti P, Carr DF, Barrett S, McEvoy L, Friedmann PS, Shear NH, Nelson MR, Chiriac AM, Blanca-López N, Cornejo-García JA, Gaeta F, Nakonechna A, Torres MJ, Caruso C, Valluzzi RL, Floratos A, Shen Y, Pavlos RK, Phillips EJ, Demoly P, Romano A, Blanca M, Pirmohamed M. Beta-lactam-induced immediate hypersensitivity reactions: A genome-wide association study of a deeply phenotyped cohort. J Allergy Clin Immunol 2020; 147:1830-1837.e15. [PMID: 33058932 PMCID: PMC8100096 DOI: 10.1016/j.jaci.2020.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/27/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND β-lactam antibiotics are associated with a variety of immune-mediated or hypersensitivity reactions, including immediate (type I) reactions mediated by antigen-specific IgE. OBJECTIVE We sought to identify genetic predisposing factors for immediate reactions to β-lactam antibiotics. METHODS Patients with a clinical history of immediate hypersensitivity reactions to either penicillins or cephalosporins, which were immunologically confirmed, were recruited from allergy clinics. A genome-wide association study was conducted on 662 patients (the discovery cohort) with a diagnosis of immediate hypersensitivity and the main finding was replicated in a cohort of 98 Spanish cases, recruited using the same diagnostic criteria as the discovery cohort. RESULTS Genome-wide association study identified rs71542416 within the Class II HLA region as the top hit (P = 2 × 10-14); this was in linkage disequilibrium with HLA-DRB1∗10:01 (odds ratio, 2.93; P = 5.4 × 10-7) and HLA-DQA1∗01:05 (odds ratio, 2.93, P = 5.4 × 10-7). Haplotype analysis identified that HLA-DRB1∗10:01 was a risk factor even without the HLA-DQA1∗01:05 allele. The association with HLA-DRB1∗10:01 was replicated in another cohort, with the meta-analysis of the discovery and replication cohorts showing that HLA-DRB1∗10:01 increased the risk of immediate hypersensitivity at a genome-wide level (odds ratio, 2.96; P = 4.1 × 10-9). No association with HLA-DRB1∗10:01 was identified in 268 patients with delayed hypersensitivity reactions to β-lactams. CONCLUSIONS HLA-DRB1∗10:01 predisposed to immediate hypersensitivity reactions to penicillins. Further work to identify other predisposing HLA and non-HLA loci is required.
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Affiliation(s)
- Paola Nicoletti
- Icahn School of Medicine at Mount Sinai, New York, NY; Sema4, Stamford, Conn
| | - Daniel F Carr
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Sarah Barrett
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Laurence McEvoy
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Peter S Friedmann
- Dermatology Unit, Sir Henry Wellcome Research Laboratories, School of Medicine, University of Southampton, Southampton, United Kingdom
| | - Neil H Shear
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Anca M Chiriac
- Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | | | - José A Cornejo-García
- Allergy Research Group, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Malaga, Spain
| | - Francesco Gaeta
- Allergy Unit, Columbus Hospital, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Alla Nakonechna
- Liverpool University Hospitals Foundation National Health Service Trust, Liverpool, United Kingdom
| | - Maria J Torres
- Allergy Research Group, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Malaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga, Malaga, Spain
| | - Cristiano Caruso
- Allergy Unit, Columbus Hospital, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Rocco L Valluzzi
- Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Aris Floratos
- Department of Systems Biology, New York, NY; Department of Biomedical Informatics, Columbia University, New York, NY
| | | | - Rebecca K Pavlos
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Elizabeth J Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Centre for Clinical Pharmacology and Infectious Diseases, Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Australia
| | - Pascal Demoly
- Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France; Unité Mixte de Recherche en Santé (UMR-S) 1136 Institut National de la Santé et de la Recherche Médicale-Sorbonne Université, Equipe Epidemiology of allergic and respiratory diseases (EPAR)- Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Antonino Romano
- Istituto di Ricovero e Cura a Carattere Scientifico Oasi Maria SS, Troina, Italy; Fondazione Mediterranea GB Morgagni, Catania, Italy
| | - Miguel Blanca
- Allergy Unit, Hospital Regional Universitario de Málaga, Malaga, Spain
| | - Munir Pirmohamed
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom; Liverpool University Hospitals Foundation National Health Service Trust, Liverpool, United Kingdom.
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Canonica GW, Blasi F, Paggiaro P, Senna G, Passalacqua G, Spanevello A, Aliberti S, Bagnasco D, Bonavia M, Bonini M, Brussino L, Bucca C, Caiaffa MF, Calabrese C, Camiciottoli G, Caminati M, Carpagnano GE, Caruso C, Centanni S, Conte ME, Corsico AG, Cosmi L, Costantino MT, Crimi N, D’Alò S, D'Amato M, Del Giacco S, Farsi A, Favero E, Foschino Barbaro MP, Guarnieri G, Guida G, Latorre M, Lo Cicero S, Lombardi C, Macchia L, Mazza F, Menzella F, Milanese M, Montagni M, Montuschi P, Nucera E, Parente R, Patella V, Pelaia G, Pini L, Puggioni F, Ricciardi L, Ricciardolo FL, Richeldi L, Ridolo E, Rolla G, Santus P, Scichilone N, Spadaro G, Vianello A, Viviano V, Yacoub MR, Zappa MC, Heffler E. Oral CorticoSteroid sparing with biologics in severe asthma: A remark of the Severe Asthma Network in Italy ( SANI). World Allergy Organ J 2020; 13:100464. [PMID: 32999699 PMCID: PMC7509464 DOI: 10.1016/j.waojou.2020.100464] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 04/16/2020] [Revised: 08/24/2020] [Accepted: 09/03/2020] [Indexed: 11/30/2022] Open
Abstract
According to the data derived from several national and international registries, including SANI (Severe Asthma Network Italy), and considering the strong impact that frequent or regular use of oral corticosteroid has on quality of life (QoL) of severe asthmatics, as well as on the costs for managing corticosteroid-related diseases, oral corticosteroid sparing up to withdrawal should be considered a primary outcome in the management of severe asthma. New biologics have clearly demonstrated that this effect is possible, with concomitant reduction in the rate of exacerbations and in symptom control. Then, there is no reason for using so frequently oral corticosteroid before having explored all alternatives currently available for a large part of severe asthmatics.
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Key Words
- Biologics
- CRSwNP, chronic rhinosinusitis with nasal polyposis
- EMA, European Medicines Agency
- FDA, Food & Drug Administration
- FEV1, forced expiratory volume in the 1st second
- GINA, Global Initiative for Asthma
- GRADE, Grading of Recommendations Assessment, Development and Evaluation
- ISAR, International Severe Asthma Registry
- OCSs, Oral CorticoSteroids
- Oral corticosteroids
- RW, Real World
- Real-life
- Registr
- SA, severe asthma
- SANI, Severe Asthma Network in Italy
- SARP, Severe Asthma Research Program
- SHARP, Severe Heterogeneous Asthma Research collaboration, Patient-centred
- Severe asthma
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Affiliation(s)
- Giorgio Walter Canonica
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Francesco Blasi
- Respiratory Unit and Adult Cystic Fibrosis Center, And Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
| | - Gianenrico Senna
- Department of Medicine, Allergy Unit Asthma Center, University of Verona, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
| | | | - Stefano Aliberti
- Respiratory Unit and Adult Cystic Fibrosis Center, And Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
| | | | - Matteo Bonini
- Fondazione Policlinico Universitario A. Gemelli, IRCCS Catholic University of Rome, Italy
| | - Luisa Brussino
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Caterina Bucca
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Maria F. Caiaffa
- Department of Medical Sciences and Surgery, School and Chair of Allergology and Clinical Immunology, University of Foggia, Italy
| | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Gianna Camiciottoli
- Deptartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, Respiratory Unit, Careggi University Hospital, Florence, Italy
| | - Marco Caminati
- Department of Medicine, Allergy Unit Asthma Center, University of Verona, Italy
| | - Giovanna E. Carpagnano
- Respiratory Medicine Section, Policlinico of Bari, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Cristiano Caruso
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - Stefano Centanni
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maria E. Conte
- Respiratory Unit, Presidio Ospedaliero of Pordenone, Italy
| | - Angelo G. Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo, Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Italy
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria T. Costantino
- Allergy and Clinical Immunology Unit, Department of Medicine, “Carlo Poma” Hospital, Mantova, Italy
| | - Nunzio Crimi
- Division of Pneumology and Allergology, Policlinico, University of Catania, Italy
| | - Simona D’Alò
- Allergology Unit, AV3 ASUR Marche, Hospital Civitanova Marche, Macerata, Italy
| | - Maria D'Amato
- Respiratory Department, Division of Respiratory Diseases “Federico II” University, AO Dei Colli, Naples, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Alessandro Farsi
- SOS of Allergology and Clinical Immunology, Azienda USL Toscana Centro, Prato, Italy
| | - Elisabetta Favero
- Severe Asthma Multidisciplinary Outpatient Clinic, Vittorio Veneto Hospital, Treviso, Italy
| | - Maria P. Foschino Barbaro
- Section of Respiratory Diseases, Medical and Surgical Sciences Department, University of Foggia, Italy
| | - Gabriella Guarnieri
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Italy
| | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O. S. Croce & Carle, Cuneo, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
| | | | - Carlo Lombardi
- Departmental Unit of Allergology and Pneumology, Hospital Institute Fondazione Poliambulanza, Brescia, Italy
| | - Luigi Macchia
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | | | - Francesco Menzella
- Pneumology Unit, Santa Maria Nuova Hospital, Azienda USL di Reggio Emilia IRCCS, Italy
| | - Manlio Milanese
- Pulmonology Unit, ASL2 Savonese, Pietra Ligure, Savona, Italy
| | | | - Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine Catholic, University of the Sacred Heart Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora Nucera
- Catholic University S. Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberta Parente
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Salerno, Italy
| | - Vincenzo Patella
- Allergology and Clinical Immunology Unit, Department of Medical Science, “Santa Maria Della Speranza” Hospital of Battipaglia, Salerno, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University Magna Graecia, Catanzaro, Italy
| | - Laura Pini
- Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili, Brescia, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Luisa Ricciardi
- Allergy and Clinical Immunology Unit, University Hospital “G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Fabio L.M. Ricciardolo
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Luca Richeldi
- Fondazione Policlinico Universitario A. Gemelli, IRCCS Catholic University of Rome, Italy
| | - Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, Italy
| | - Giovanni Rolla
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Pierachille Santus
- Department of Clinical and Biomedical Sciences, University of Milan, Respiratory Diseases, Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Nicola Scichilone
- Division of Respiratory Diseases, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine (Promise) G. D'Alessandro, University of Palermo, Palermo, Italy
| | - Giuseppe Spadaro
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology and Infectious Diseases, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - Andrea Vianello
- Division of Respiratory Pathophysiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Vittorio Viviano
- Allergology, Pneumology and Respiratory Department 42 PTA Biondo-Regional Center for Allergy Prevention and Anaphylactic Shock, Palermo, Italy
| | - Mona R. Yacoub
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria C. Zappa
- Pulmonology Department, Sandro Pertini Hospital, Rome, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - SANI (Severe Asthma Network Italy)
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Respiratory Unit and Adult Cystic Fibrosis Center, And Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
- Department of Medicine, Allergy Unit Asthma Center, University of Verona, Italy
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
- University of Insubria, ICS Maugeri, IRCCS, Varese, Italy
- Respiratory Rehabilitation, ASL3, Genoa, Italy
- Fondazione Policlinico Universitario A. Gemelli, IRCCS Catholic University of Rome, Italy
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
- Department of Medical Sciences and Surgery, School and Chair of Allergology and Clinical Immunology, University of Foggia, Italy
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
- Deptartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, Respiratory Unit, Careggi University Hospital, Florence, Italy
- Respiratory Medicine Section, Policlinico of Bari, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
- Respiratory Unit, Presidio Ospedaliero of Pordenone, Italy
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo, Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Allergy and Clinical Immunology Unit, Department of Medicine, “Carlo Poma” Hospital, Mantova, Italy
- Division of Pneumology and Allergology, Policlinico, University of Catania, Italy
- Allergology Unit, AV3 ASUR Marche, Hospital Civitanova Marche, Macerata, Italy
- Respiratory Department, Division of Respiratory Diseases “Federico II” University, AO Dei Colli, Naples, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
- SOS of Allergology and Clinical Immunology, Azienda USL Toscana Centro, Prato, Italy
- Severe Asthma Multidisciplinary Outpatient Clinic, Vittorio Veneto Hospital, Treviso, Italy
- Section of Respiratory Diseases, Medical and Surgical Sciences Department, University of Foggia, Italy
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Italy
- Allergy and Pneumology Unit, A.O. S. Croce & Carle, Cuneo, Italy
- Department of Pneumology, Niguarda Hospital, Milan, Italy
- Departmental Unit of Allergology and Pneumology, Hospital Institute Fondazione Poliambulanza, Brescia, Italy
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
- Pneumology Unit, Santa Maria Nuova Hospital, Azienda USL di Reggio Emilia IRCCS, Italy
- Pulmonology Unit, ASL2 Savonese, Pietra Ligure, Savona, Italy
- UOC Allergology Department, Piacenza, Italy
- Department of Pharmacology, Faculty of Medicine Catholic, University of the Sacred Heart Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University S. Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Salerno, Italy
- Allergology and Clinical Immunology Unit, Department of Medical Science, “Santa Maria Della Speranza” Hospital of Battipaglia, Salerno, Italy
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University Magna Graecia, Catanzaro, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili, Brescia, Italy
- Allergy and Clinical Immunology Unit, University Hospital “G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, Italy
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
- Department of Medicine and Surgery, University of Parma, Italy
- Department of Clinical and Biomedical Sciences, University of Milan, Respiratory Diseases, Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
- Division of Respiratory Diseases, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine (Promise) G. D'Alessandro, University of Palermo, Palermo, Italy
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology and Infectious Diseases, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
- Division of Respiratory Pathophysiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
- Allergology, Pneumology and Respiratory Department 42 PTA Biondo-Regional Center for Allergy Prevention and Anaphylactic Shock, Palermo, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pulmonology Department, Sandro Pertini Hospital, Rome, Italy
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Bagnasco D, Brussino L, Bonavia M, Calzolari E, Caminati M, Caruso C, D'Amato M, De Ferrari L, Di Marco F, Imeri G, Di Bona D, Gilardenghi A, Guida G, Lombardi C, Milanese M, Nicolini A, Riccio AM, Rolla G, Santus P, Senna G, Passalacqua G. Efficacy of Benralizumab in severe asthma in real life and focus on nasal polyposis. Respir Med 2020; 171:106080. [PMID: 32917354 DOI: 10.1016/j.rmed.2020.106080] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Severe asthma occurs in 5-10% of asthmatic patients, with nasal polyposis as one of the most frequent comorbidity. Benralizumab was recently marketed, thus we could analyse its effects in real-life in severe asthma, and compare the effects of the drug in patients with and without polyposis. METHODS Patients with severe asthma, receiving Benralizumab were enrolled in Italian asthma centres. The efficacy criteria for asthma (exacerbation rate, oral corticosteroid intake, hospitalizations, pulmonary function, exhaled nitric oxide) were evaluated at baseline and after 24 weeks of treatment. Patients were then sub-analysed according to the presence/absence of nasal polyposis. RESULTS Fifty-nine patients with severe uncontrolled asthma (21 males, age range 32-78) and treated with benralizumab for at least 24 weeks has been evaluated, showing significant improvements in asthma-related outcomes, except for pulmonary function and exhaled nitric oxide. This included a reduction in the sino-nasal outcome-22 score versus baseline of 13.7 points (p = .0037) in the 34 patients with nasal polyposis. Anosmia disappeared in 31% patients (p = .0034). When comparing the groups with and without nasal polyposis, a similar reduction of exacerbations was seen, with a greater reduction of the steroid dependence in patients with polyposis (-72% vs -53%; p < .0001), whereas lung function was significantly more improved (12% vs 34%, p = .0064) without polyposis patients. CONCLUSIONS Benralizumab, after 6 months of treatment, confirmed its efficacy in severe asthma, and also in nasal polyposis, which is the most frequent comorbidity. The efficacy of Benralizumab in reducing steroid dependence was even higher in patients with polyposis.
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Affiliation(s)
- Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Department of Internal Medicine (DIMI), Genoa, Italy.
| | - Luisa Brussino
- Mauriziano Hospital, Department of Medical Science, University of Turin, Italy
| | - Marco Bonavia
- Pneumology Unit, Ospedale La Colletta, Arenzano, Italy
| | - Elisa Calzolari
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Department of Internal Medicine (DIMI), Genoa, Italy
| | - Marco Caminati
- Asthma Center and Allergy Unit, Verona University and General Hospital, Department of Medicine, University of Verona, Italy
| | - Cristiano Caruso
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCSS, Rome, Italy
| | - Maria D'Amato
- Department of Pneumology, AO "Dei Colli" Federico II University, Naples, Italy
| | - Laura De Ferrari
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Department of Internal Medicine (DIMI), Genoa, Italy
| | - Fabiano Di Marco
- Department of Health Sciences, University of Milan, Respiratory Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Gianluca Imeri
- Department of Health Sciences, University of Milan, Respiratory Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Danilo Di Bona
- School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Andrea Gilardenghi
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Department of Internal Medicine (DIMI), Genoa, Italy
| | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O. S.Croce e Carle, Cuneo, Italy
| | - Carlo Lombardi
- Departmental Unit of Allergology & Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - Manlio Milanese
- Division of Pneumology, S.Corona Hospital, Pietra Ligure, Italy
| | - Antonello Nicolini
- Respiratory Diseases Unit, Hospital of Sestri Levante, Sestri Levante, Italy
| | - Anna Maria Riccio
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Department of Internal Medicine (DIMI), Genoa, Italy
| | - Giovanni Rolla
- Mauriziano Hospital, Department of Medical Science, University of Turin, Italy
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), Division of Respiratory Diseases, Università degli Studi di Milano, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Via G.B. Grassi, 74-20157, Milano, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital, Department of Medicine, University of Verona, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Department of Internal Medicine (DIMI), Genoa, Italy
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44
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Fargnoli MC, Esposito M, Ferrucci S, Girolomoni G, Offidani A, Patrizi A, Peris K, Costanzo A, Malara G, Pellacani G, Romanelli M, Amerio P, Cristaudo A, Flori ML, Motolese A, Betto P, Patruno C, Pigatto P, Peccianti C, Stinco G, Zalaudek I, Bianchi L, Boccaletti V, Cannavo SP, Cusano F, Lembo S, Mozzillo R, Gallo R, Potenza C, Rongioletti F, Tiberio R, Grieco T, Micali G, Persechino S, Pettinato M, Pucci S, Stingeni L, Caruso C, Argenziano G. A 48-week update of a multicentre real-life experience of dupilumab in adult patients with moderate-to-severe atopic dermatitis. J DERMATOL TREAT 2020; 33:1146-1149. [DOI: 10.1080/09546634.2020.1773379] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- M. C. Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - M. Esposito
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - S. Ferrucci
- Unit of Dermatology, Fondazione IRCCS Ca’ Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - G. Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - A. Offidani
- Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - A. Patrizi
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - K. Peris
- Institute of Dermatology, Catholic University, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A. Costanzo
- Dermatology Unit, Department of Biomedical Sciences, Humanitas University and Humanitas Clinical and Research Center, Rozzano, Italy
| | - G. Malara
- Dermatology Department, Grande Ospedale Metropolitano, Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - G. Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - M. Romanelli
- Dermatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - P. Amerio
- Department of Medicine and Aging Science, Dermatologic Clinic, G. D’Annunzio University, Chieti, Italy
| | - A. Cristaudo
- Unit of Dermatology, San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - M. L. Flori
- Dermatology Section, Department of Clinical Medicine and Immunological Science, University of Siena, Hospital S. Maria Alle Scotte, Siena, Italy
| | - A. Motolese
- Department of Dermatology, IRCCS Santa Maria Nuova, Reggio Emilia, Italy
| | - P. Betto
- Department of Dermatology, ULSS8 Berica, Vicenza, Italy
| | - C. Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - P. Pigatto
- Department of Biomedical, Surgical and Dental Sciences, Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, University of Milan, Milan, Italy
| | - C. Peccianti
- Unit of Dermatology, Ospedale Della Misericordia, Grosseto, Italy
| | - G. Stinco
- Department of Medicine, Institute of Dermatology, University of Udine, Udine, Italy
| | - I. Zalaudek
- Dermatology Clinic, Hospital Maggiore of Trieste, Trieste, Italy
| | - L. Bianchi
- Department of Dermatology, University of Tor Vergata, Rome, Italy
| | - V. Boccaletti
- Section of Dermatology, Department of Clinical and Experimental Medicine, University Hospital, Parma
| | - S. P. Cannavo
- Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - F. Cusano
- Dermatology Unit, Gaetano Rummo Hospital Benevento, Benevento, Italy
| | - S. Lembo
- Unit of Dermatology, Hospital Santa Maria Incoronata Dell’Olmo, Cava De’ Tirreni, University Hospital San Giovanni di Dio e Ruggi di Salerno, Salerno, Italy
| | - R. Mozzillo
- Dermatology and Venereology, San Gennaro Hospital, Naples, Italy
| | - R. Gallo
- Dermatology Section, Department of Health Science, University of Genoa, Polyclinic Hospital San Martino, Genoa, Italy
| | - C. Potenza
- Dermatology Unit, Department of Medical and Surgical Sciences and Biotechnologies, Daniele Innocenzi, Sapienza University of Rome, Rome, Italy
| | - F. Rongioletti
- Section of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - R. Tiberio
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - T. Grieco
- Unit of Dermatology Clinic Umberto I, Sapienza University of Rome, Rome, Italy
| | - G. Micali
- Unit of Dermatology Clinic, University of Catania, Catania, Italy
| | - S. Persechino
- Unit of Dermatology, Sant’Andrea Hospital, NESMOS Department, Sapienza University of Rome, Rome, Italy
| | - M. Pettinato
- Unit of Dermatology, University Hospital, Policlinico Vittorio Emanuele, Catania, Italy
| | - S. Pucci
- Allergology, Hospital of Civitanova Marche, Civitanova Marche, Italy
| | - L. Stingeni
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - C. Caruso
- Unit of Allergy, Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome, Italy
| | - G. Argenziano
- Unit of Dermatology, University of Campania Luigi Vanvitelli, Naples, Italy
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45
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Bagnasco D, Massolo A, Bonavia M, Brussino L, Bucca C, Caminati M, Canonica GW, Caruso C, D’Amato M, De Ferrari L, Guida G, Heffler E, Lombardi C, Menzella F, Milanese M, Paoletti G, Riccio AM, Rolla G, Senna G, Testino E, Passalacqua G. The importance of being not significant: Blood eosinophils and clinical responses do not correlate in severe asthma patients treated with mepolizumab in real life. Allergy 2020; 75:1460-1463. [PMID: 31773742 DOI: 10.1111/all.14135] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/24/2019] [Accepted: 11/14/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Diego Bagnasco
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino University of Genoa Genoa Italy
| | | | | | - Luisa Brussino
- Allergy and Immunology AO Mauriziano Hospital University of Turin Turin Italy
| | - Caterina Bucca
- Azienda Ospedale‐Università Città della Salute e della Scienza, S.C. Pneumologia University of Turin Turin Italy
| | - Marco Caminati
- Asthma Center and Allergy Unit Verona University and General Hospital University of Verona Verona Italy
| | - Giorgio Walter Canonica
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino University of Genoa Genoa Italy
- Personalized Medicine Clinic Asthma and Allergy Humanitas Clinical and Research Center, Department of Biomedical Sciences Humanitas University Milan Italy
| | | | - Maria D’Amato
- Department of Pneumology Monaldi Hospital Federico II University Naples Italy
| | - Laura De Ferrari
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino University of Genoa Genoa Italy
| | - Giuseppe Guida
- Department of Medical Sciences University of Turin Turin Italy
| | - Enrico Heffler
- Personalized Medicine Clinic Asthma and Allergy Humanitas Clinical and Research Center, Department of Biomedical Sciences Humanitas University Milan Italy
| | - Carlo Lombardi
- Departmental Unit of Allergology & Respiratory Diseases Fondazione Poliambulanza Brescia Italy
| | - Francesco Menzella
- Pneumology Unit Arcispedale Santa Maria Nuova Azienda Ospedaliera di Reggio Emilia Italy
| | - Manlio Milanese
- Division of Pneumology S.Corona Hospital Pietra Ligure Italy
| | - Giovanni Paoletti
- Personalized Medicine Clinic Asthma and Allergy Humanitas Clinical and Research Center, Department of Biomedical Sciences Humanitas University Milan Italy
| | - Anna Maria Riccio
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino University of Genoa Genoa Italy
| | - Giovanni Rolla
- Allergy and Immunology AO Mauriziano Hospital University of Turin Turin Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit Verona University and General Hospital University of Verona Verona Italy
| | - Elisa Testino
- 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
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46
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Bagnasco D, Brussino L, Caruso C, Paoletti G, Heffler E, Guida G, Calzolari E, Nicola S, De Ferrari L, Passalacqua G, Canonica GW. Do the current guidelines for asthma pharmacotherapy encourage over-treatment? Expert Opin Pharmacother 2020; 21:1283-1286. [PMID: 32401551 DOI: 10.1080/14656566.2020.1759551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa , Genoa, Italy
| | - Luisa Brussino
- Mauriziano Hospital, Department of Medical Science, University of Turin , Turin, Italy
| | - Cristiano Caruso
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCSS , Rome, Italy
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center, IRCCS , Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University , Pieve Emanuele, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center, IRCCS , Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University , Pieve Emanuele, Italy
| | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O. S.Croce E Carle , Cuneo, Italy
| | - Elisa Calzolari
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa , Genoa, Italy
| | - Stefania Nicola
- Mauriziano Hospital, Department of Medical Science, University of Turin , Turin, Italy
| | - Laura De Ferrari
- 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
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center, IRCCS , Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University , Pieve Emanuele, Italy
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47
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Caruso C, Colantuono S, Pugliese D, Di Mario C, Tolusso B, Gremese E, Papparella G, Castrì F, Gasbarrini A, Romano A, Armuzzi A. Severe eosinophilic asthma and aspirin-exacerbated respiratory disease associated to eosinophilic gastroenteritis treated with mepolizumab: a case report. Allergy Asthma Clin Immunol 2020; 16:27. [PMID: 32336975 PMCID: PMC7178951 DOI: 10.1186/s13223-020-00423-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/03/2020] [Indexed: 01/31/2023] Open
Abstract
Background Mepolizumab (MEP) is the first anti Interleukin (IL)-5 add-on therapy approved for the treatment of severe refractory eosinophilic asthma. Case presentation We describe here the case of a 49 years-old woman with Aspirin-exacerbated respiratory disease (AERD), chronic rhinosinusitis, nasal polyposis and eosinophilic gastroenteritis successfully treated with MEP. Several laboratory and clinical items improved during therapy; moreover MEP showed to be useful as steroid sparing agent. Conclusions This case supports that the use of mepolizumab can be effective also in other eosinophilic conditions different from asthma and this opens to new therapeutic perspectives.
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Affiliation(s)
- C Caruso
- 1Allergy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - S Colantuono
- 1Allergy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,2Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - D Pugliese
- 3IBD UNIT Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C Di Mario
- 4Division of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - B Tolusso
- 5Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - E Gremese
- 4Division of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy.,5Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Papparella
- 6Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F Castrì
- 7Polo Scienze della Salute della Donna e del Bambino-Area Anatomia Patologica-Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Gasbarrini
- 8Department of Internal Medicine and Gastroenterology, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - A Romano
- Casa di Cura Quisisana, Rome & Fondazione Mediterranea G.B. Morgagni, Catania, Italy
| | - A Armuzzi
- 3IBD UNIT Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Romano A, Valluzzi RL, Caruso C, Zaffiro A, Quaratino D, Gaeta F. Tolerability of Cefazolin and Ceftibuten in Patients with IgE-Mediated Aminopenicillin Allergy. J Allergy Clin Immunol Pract 2020; 8:1989-1993.e2. [PMID: 32145403 DOI: 10.1016/j.jaip.2020.02.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 11/12/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Side-chain similarities or identities constitute the predominant factor for cross-reactivity between penicillins and cephalosporins, whereas differences in the side-chain structure seem to account for the absence of such cross-reactivity. OBJECTIVE We sought to assess the cross-reactivity between penicillins and 2 cephalosporins (ie, cefazolin and ceftibuten) that have side chains different from those of penicillins, as well as to evaluate the possibility of using these cephalosporins in penicillin-allergic subjects. METHODS We conducted a prospective study of 131 consecutive subjects who had suffered 170 immediate reactions (mostly anaphylaxis) to penicillins and had positive skin test results to at least 1 penicillin reagent. All patients underwent skin tests with cefazolin and ceftibuten. Patients with negative results were challenged with them. RESULTS One participant had positive skin test results to cefazolin and ceftibuten, as well as to all other reagents tested, including aztreonam and carbapenems. All 129 subjects who underwent challenges with cefazolin and ceftibuten tolerated them. One subject refused cephalosporin challenges. CONCLUSIONS Subjects with an IgE-mediated hypersensitivity to penicillins could be treated with cephalosporins such as cefazolin and ceftibuten, which are among the cephalosporins that have side-chain determinants different from those of penicillins. Nevertheless, in patients with such hypersensitivity who need these alternative β-lactams, pretreatment skin tests are advisable because of the possibility of coexisting sensitivities or, much less frequently, of a sensitivity to an antigenic determinant of the common β-lactam ring.
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Affiliation(s)
- Antonino Romano
- IRCCS Oasi Maria S.S., Troina, Italy & Fondazione Mediterranea G.B. Morgagni, Catania, Italy.
| | - Rocco Luigi Valluzzi
- Department of Pediatrics, Division of Allergy, Pediatric Hospital Bambino Gesù, Rome, Vatican City, Italy
| | - Cristiano Caruso
- Allergy Unit, Columbus Hospital, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Francesco Gaeta
- Allergy Unit, Columbus Hospital, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Bagnasco D, Menzella F, Caminati M, Caruso C, Guida G, Bonavia M, Riccio A, Milanese M, Manfredi A, Senna G, Passalacqua G. Efficacy of mepolizumab in patients with previous omalizumab treatment failure: Real-life observation. Allergy 2019; 74:2539-2541. [PMID: 31166605 DOI: 10.1111/all.13937] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/09/2019] [Accepted: 05/27/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Diego Bagnasco
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino, University of Genoa Genoa Italy
| | - Francesco Menzella
- Department of Medical Specialties, Pneumology Unit Arcispedale Santa Maria Nuova‐ IRCCS, Azienda USL di Reggio Emilia Reggio Emilia Italy
| | - Marco Caminati
- Asthma Center and Allergy Unit Verona University and General Hospital Verona Italy
| | - Cristiano Caruso
- Allergy Unit Fondazione Policlinico A. Gemelli, IRCSS Rome Italy
| | - Giuseppe Guida
- Department of Medical Sciences University of Torino Turin Italy
| | | | - Annamaria Riccio
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino, University of Genoa Genoa Italy
| | - Manlio Milanese
- Division of Pneumology S.Corona Hospital Pietra Ligure Italy
| | - Andrea Manfredi
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino, University of Genoa Genoa Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit Verona University and General Hospital Verona Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases IRCCS Policlinico San Martino, University of Genoa Genoa Italy
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Caruso C, Borgonovo L, Bramé B, Cocconcelli A, Colantuono S, Piantanida M, Scarpa S, Zisa G, Romano A. Safety of an Accelerated Build-up Phase With Pollen Allergoids: A Retrospective Study. J Investig Allergol Clin Immunol 2019; 28:283-284. [PMID: 30073970 DOI: 10.18176/jiaci.0269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C Caruso
- Allergy Unit - Fondazione Policlinico Gemelli -Presidio Columbus, Rome, Italy
| | - L Borgonovo
- Allergy and Clinical Immunology Department, ASST Fatebenefratelli Sacco, Milan, Italy
| | - B Bramé
- Clinical Allergy and Immunology Unit, Legnano Hospital, Legnano, Italy
| | - A Cocconcelli
- Allergy Outpatient Clinic, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - S Colantuono
- Clinical Medicine Department and Molecular Medicine Department, Sapienza University, Rome, Italy
| | - M Piantanida
- Clinical Allergy and Immunology Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - S Scarpa
- Clinical Allergy and Immunology Unit, AUSL Parma, Parma, Italy
| | - G Zisa
- Allergology and Immunology Unit, Novara Hospital, Novara, Italy
| | - A Romano
- Allergy Unit - Fondazione Policlinico Gemelli -Presidio Columbus, Rome, Italy
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