Publications by authors named "Cristoforo Incorvaia"

200 Publications

Cardiac rehabilitation outcome after transcatheter aortic valve implantation.

Monaldi Arch Chest Dis 2021 Apr 13;91(2). Epub 2021 Apr 13.

Cardiac/Pulmonary Rehabilitation, ASST Pini-CTO, Milan.

Patients with severe aortic stenosis are increasingly treated with transcatheter aortic valve implantation (TAVI) as a safer option to surgical aortic valve replacement (sAVR).  Similar to many other heart diseases, after the specific therapeutic intervention patients are eligible for cardiac rehabilitation (CR) for the purpose of functional recovery. Thus far, CR after both sAVR and TAVI has been used to a limited extent, as shown by the availability of only two meta-analyses including 5 studies and 6 studies, respectively. Recent observational studies reported a significant improvement in functional indexes such as the Barthel scale and the 6-minute walk test (6MWT). We evaluated the outcome of CR in patients after TAVI treatment by measuring changes in the commonly used Barthel scale and 6MWT and adding the short physical performance battery (SPPB) scale as an index to assess lower extremity function. All indexes demonstrated a significant improvement, namely p<0.001 with the Barthel scale, p=0.043 for the 6MWT, and p=0.002 for SPPB. These results confirm the significant improvement of the Barthel scale and 6MWT reported in the previous meta-analysis and suggest the utility of SPPB as a further index of efficacy of CR in patients with severe aortic stenosis treated with TAVI.
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http://dx.doi.org/10.4081/monaldi.2021.1621DOI Listing
April 2021

Dermatological manifestations during COVID-19 infection: a case series and discussion on the problem of differential diagnosis.

Acta Biomed 2021 02 9;92(1):e2021103. Epub 2021 Feb 9.

Cardiac/Pulmonary Rehabilitation, ASST Pini-CTO, Milan, Italy.

On March 11, 2019 the World Health Organization (WHO) declared Coronavirus disease-2019 (COVID-19), caused by SARS-CoV-2, as a pandemic. As of 15/01/2021, more than ninety million cases of infections have been confirmed, with almost two million related deaths. SARS-CoV-2 causes bilateral interstitial pneumonia, which can responsible of respiratory failure in the most severe cases, but the virus has also a wide range of other manifestations, including gastrointestinal, cardiovascular, neurological, and cutaneous signs and symptoms. Cutaneous manifestations are an important matter of study for allergy specialists, as they can be specific signs of the infection, but also manifestations of adverse reactions to the medical therapy in use. In this case series, we report four different cases of dermatological manifestations in COVID patients, two in hospitalised patients and two in patients with mild disease, treated at home. The first case reported is a woman, who develops urticaria while being treated at home with mild COVID-infection; the second and the third one case reported are drug- hypersensivity reaction to remdesevir and low molecular weight heparin. The last case reported is a man with mild covid with vasculitic sacral lesions. Key words: COVID pandemic, SARS-CoV-2, dermatological manifestation in covid infections, remdesevir hypersensitivity, covid and urticaria, covid and vasculitic lesions.
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http://dx.doi.org/10.23750/abm.v92i1.11236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7975949PMC
February 2021

Efficacy of Dupilumab in Concomitant Atopic Dermatitis and Chronic Rhinosinusitis With Nasal Polyps: A Preliminary Study.

Allergy Asthma Immunol Res 2021 Mar;13(2):347-349

Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.

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http://dx.doi.org/10.4168/aair.2021.13.2.347DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7840876PMC
March 2021

The safety of sublingual immunotherapy, can the rare systemic reactions be prevented?

Expert Opin Drug Saf 2021 Mar 21;20(3):259-264. Epub 2021 Jan 21.

Department of Sense Organs, Sapienza University, Rome, Italy.

: The safety of subcutaneous immunotherapy (SCIT), and particularly the dramatic issue of fatal reactions, has been an obstacle that limited the implementation of a therapy with unique characteristics of action on the causes of allergy. The introduction of sublingual immunotherapy (SLIT) was aimed at solving safety problems while maintaining clinical efficacy.: For more than 20 years, SLIT has been based on allergen extracts in drops at low average doses. As evidenced by meta-analyses, the typical adverse events (AE) have consisted of local reactions in the mouth and throat. Unlike the injection route, no correlation was observed between the administered dose and AEs. The development of SLIT products in tablets, based on higher doses than drops, has somewhat changed the concept of SLIT safety. Although large trials, performed to obtain regulatory agency approval, have shown overall high safety, rare anaphylactic reactions have been described.: SLIT is globally safe, and no fatal reactions have ever been reported, but with currently available high biological potency products it is necessary to follow prudential rules, such as the administration of the first dose under medical supervision and the thorough education of patients to avoid taking of higher doses than recommended.
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http://dx.doi.org/10.1080/14740338.2021.1874917DOI Listing
March 2021

ACEIs and beta blockers as a risk factor for severe reactions to Hymenoptera venom, facts or fictions?

J Allergy Clin Immunol 2021 Jan 24;147(1):414-415. Epub 2020 Nov 24.

Cardiac/Pulmonary Rehabilitation, ASST Pini-CTO, Milan, Italy.

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http://dx.doi.org/10.1016/j.jaci.2020.09.029DOI Listing
January 2021

Eosinophilic lingual tonsillitis induced by sublingual immunotherapy: A case series.

Clin Case Rep 2020 Nov 6;8(11):2211-2213. Epub 2020 Aug 6.

Department of Sense Organs Sapienza University Rome Italy.

The new observation of eosinophilic lingual tonsillitis as a possible adverse reaction to sublingual immunotherapy is likely to stimulate new investigations aimed at improving the understanding of the mechanisms of biodistribution of extracts placed at the sublingual level.
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http://dx.doi.org/10.1002/ccr3.3123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7669394PMC
November 2020

Personalized medicine for allergy treatment: Allergen immunotherapy still a unique and unmatched model.

Allergy 2021 Apr 19;76(4):1041-1052. Epub 2020 Oct 19.

Personalized Medicine, Asthma & Allergy - Humanitas Clinical and Research Center IRCCS, Rozzano, Italy.

The introduction of personalized medicine (PM) has been a milestone in the history of medical therapy, because it has revolutionized the previous approach of treating the disease with that of treating the patient. It is known today that diseases can occur in different genetic variants, making specific treatments of proven efficacy necessary for a given endotype. Allergic diseases are particularly suitable for PM, because they meet the therapeutic success requirements, including a known molecular mechanism of the disease, a diagnostic tool for such disease, and a treatment blocking the mechanism. The stakes of PM in allergic patients are molecular diagnostics, to detect specific IgE to single-allergen molecules and to distinguish the causative molecules from those merely cross-reactive, pursuit of patient's treatable traits addressing genetic, phenotypic, and psychosocial features, and omics, such as proteomics, epi-genomics, metabolomics, and breathomics, to forecast patient's responsiveness to therapies, to detect biomarker and mediators, and to verify the disease control. This new approach has already improved the precision of allergy diagnosis and is likely to significantly increase, through the higher performance achieved with the personalized treatment, the effectiveness of allergen immunotherapy by enhancing its already known and unique characteristics of treatment that acts on the causes.
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http://dx.doi.org/10.1111/all.14575DOI Listing
April 2021

Long-term omalizumab efficacy in allergic rhinitis.

Immunol Lett 2020 11 13;227:81-87. Epub 2020 Aug 13.

Department of Sense Organs, Sapienza University, Rome, Italy.

Background: Omalizumab therapy was found to be safe and effective as an add-on therapy for patients with poorly controlled severe asthma. Although several studies over the last decade have demonstrated its efficacy in other Immunoglobulin E related diseases, its use in such conditions is off-label.

Objective: This study aimed to assess the effectiveness of long-term therapy with Omalizumab in patients with persistent severe allergic rhinitis and inadequately controlled severe asthma.

Methods: Patients with poorly controlled severe asthma and persistent allergic rhinitis were enrolled and treated with Omalizumab for 36 months with every four-week subcutaneous administration. The efficacy assessment included the severity of AR symptoms every six months using Visual Analogue Scale, Asthma Control Test, nasal endoscopy, spirometry, and biomarkers (blood eosinophils and neutrophils, fractional exhaled nitric oxide, total IgE).

Results: Eleven patients aged between 26 and 70 years were enrolled, and 10 completed the study. A significant improvement of allergic rhinitis symptoms, Asthma Control Test, and lung function was observed. There was also a reduction in the status of the biomarkers at the end of the study.

Conclusion: Long-term therapy with Omalizumab was effective and safe in treating severe persistent allergic rhinitis and concomitant asthma.
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http://dx.doi.org/10.1016/j.imlet.2020.08.002DOI Listing
November 2020

SIRM-SIAAIC consensus, an Italian document on management of patients at risk of hypersensitivity reactions to contrast media.

Clin Mol Allergy 2020 31;18:13. Epub 2020 Jul 31.

IRCCS Oasi Maria S.S., Troina & Fondazione Mediterranea G.B. Morgagni, Catania, Italy.

Hypersensitivity reactions (HRs) to contrast media (CM) can be distinguished in immune-mediated (including allergic reactions) and non-immune-mediated reactions, even if clinical manifestations could be similar. Such manifestations range from mild skin eruptions to severe anaphylaxis, making it important for radiologists to know how to identify and manage them. A panel of experts from the Società Italiana di Radiologia Medica e Interventistica (SIRM) and the Società Italiana di Allergologia, Asma e Immunologia Clinica (SIAAIC) provided a consensus document on the management of patients who must undergo radiological investigations with CM. Consensus topics included: the risk stratification of patients, the identification of the culprit CM and of a safe alternative by an allergy workup, as well as the use of premedication and the correct procedure to safely perform an elective (i.e., scheduled) or urgent examination. The most important recommendations are: (1) in all patients, a thorough medical history must be taken by the prescribing physician and/or the radiologist to identify at-risk patients; (2) in patients with hypersensitivity reactions to CM, the radiologist must consider an alternative, non-contrast imaging study with a comparable diagnostic value, or prescribe a different investigation with another class of CM; (3) if such options are not feasible, the radiologist must address at-risk patients to a reference centre for an allergy evaluation; (4) if timely referral to an allergist is not viable, it is recommended to use a CM other than the responsible one, taking into account cross-reactivity patterns; in the case of patients with histories of severe reactions, the presence of an anesthesiologist is also recommended and a premedication is suggested.
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http://dx.doi.org/10.1186/s12948-020-00128-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395340PMC
July 2020

Allergen immunotherapy for respiratory allergy: to what extent can the risk of systemic reactions be reduced?

Expert Opin Drug Saf 2020 Jul 8;19(7):843-848. Epub 2020 Jun 8.

Allergy and Clinical Immunology, Medicine and Surgery Department, University of Parma , Parma, Italy.

Introduction: Allergen immunotherapy is an effective treatment for respiratory allergy, but the administration to patients of extracts of the causative allergen may elicit systemic reactions, which include, particularly with subcutaneous immunotherapy (SCIT), anaphylaxis. In the past, the occurrence (tough rare) of fatal reactions has represented a serious problem that has limited the prescription of SCIT.

Areas Covered: The authors analyzed in this review the safety data of SCIT, especially concerning the years following the identification of uncontrolled asthma at the moment of allergen injection as the major risk of life-threatening reactions and fatalities. The safety of SLIT, which is far better than SCIT, was analyzed and its specific risk factors for systemic reactions were highlighted.

Expert Opinion: Presently, the safety profile of SCIT and SLIT is satisfactory, provided the treatment is administered by physicians experienced in this treatment, who are aware of the known risk factors for severe reactions and who implement all measures to avoid them. For SLIT, which is self-administered by the patient, receiving the first dose under medical control is recommended.
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http://dx.doi.org/10.1080/14740338.2020.1773788DOI Listing
July 2020

Mabs for treating asthma: omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab.

Hum Vaccin Immunother 2020 10 13;16(10):2349-2356. Epub 2020 May 13.

Cardiac/Pulmonary Rehabilitation, ASST Pini-CTO , Milan, Italy.

The introduction of biologics for the treatment of patients with refractory asthma represented a marked therapeutic advance. For more than 10 y, the only biologic available has been the monoclonal anti-IgE antibody omalizumab, reserved for patients with asthma caused by perennial allergen. In recent years, other biologics have been licensed for the treatment of severe eosinophilic asthma. They include monoclonal antibodies that target the Th2-pathway cytokines, such as IL-5 (mepolizumab and reslizumab) or its receptor (benralizumab) and the IL-4 and IL-13 receptor (dupilumab). The effectiveness of these biologics was demonstrated in several placebo controlled trials, the main outcomes being the significant reduction of the rate of asthma exacerbation and the improvement of respiratory function in actively treated patients. Based on the further understanding of the pathogenesis of asthma, new cytokines network and new targets are emerging, such as thymic stromal lymphopoietin, which can activate Th2 cells, innate lymphoid cells, or both, or prostaglandin D2 (PGD2), to develop additional biologics.
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http://dx.doi.org/10.1080/21645515.2020.1753440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7644228PMC
October 2020

Urticaria: recommendations from the Italian Society of Allergology, Asthma and Clinical Immunology and the Italian Society of Allergological, Occupational and Environmental Dermatology.

Clin Mol Allergy 2020 6;18. Epub 2020 May 6.

5Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy.

Background: Urticaria is a disorder affecting skin and mucosal tissues characterized by the occurrence of wheals, angioedema or both, the latter defining the urticaria-angioedema syndrome. It is estimated that 12-22% of the general population has suffered at least one subtype of urticaria during life, but only a small percentage (estimated at 7.6-16%) has acute urticaria, because it is usually self-limited and resolves spontaneously without requiring medical attention. This makes likely that its incidence is underestimated. The epidemiological data currently available on chronic urticaria in many cases are deeply discordant and not univocal, but a recent Italian study, based on the consultation of a national registry, reports a prevalence of chronic spontaneous urticaria of 0.02% to 0.4% and an incidence of 0.1-1.5 cases/1000 inhabitants/year.

Methods: We reviewed the recent international guidelines about urticaria and we described a methodologic approach based on classification, pathophysiology, impact on quality of life, diagnosis and prognosis, differential diagnosis and management of all the types of urticaria.

Conclusions: The aim of the present document from the Italian Society of Allergology, Asthma and Clinical Immunology (SIAAIC) and the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) is to provide updated information to all physicians involved in diagnosis and management of urticaria and angioedema.
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http://dx.doi.org/10.1186/s12948-020-00123-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201804PMC
May 2020

Near-fatal anaphylaxis with Kounis syndrome caused by bite: a case report.

Clin Mol Allergy 2020 18;18. Epub 2020 Mar 18.

Cardiac/Pulmonary Rehabilitation Unit, ASST Pini-CTO, Milan, Italy.

Background: The pigeon tick is a temporary parasite of pigeons. It bites during night hours and lies briefly on its prey, as long as it takes the blood meal. When pigeons are not accessible, ticks look for other hosts, invading nearby flats and biting humans.

Case Presentation: We present the case of a woman aged 46 years who experienced severe anaphylaxis during the night which required emergency medical treatment, tracheal intubation and hospitalization in intensive care unit. Kounis syndrome was documented by transient ST depression and elevation of troponin. The allergological work up ruled out hypersensitivity to drugs, latex and foods containing alpha-gal, which is a cause of anaphylaxis. Basal serum tryptase was in normal range (8.63 ng/ml). When questioned about the presence of ticks, the patient brought into view various specimens of ticks that were recognized by an entomologist as .

Conclusions: An in vitro diagnosis of allergy to is currently not feasible because, though the major allergen Arg r 1 has been isolated, allergen extracts are not commercially available. Therefore, the diagnosis of anaphylaxis from , when other causes of anaphylaxis are excluded, must rely only on history and clinical findings, as well as on the presence of pigeons and/or pigeon ticks in the immediate domestic environment.
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http://dx.doi.org/10.1186/s12948-020-00121-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7079397PMC
March 2020

The safety of carbamylated monomeric allergoids for sublingual immunotherapy. Data from a pharmacovigilance study.

Immunotherapy 2020 02 23;12(3):195-202. Epub 2020 Jan 23.

Medical Department, Lofarma S.p.A., Milan, Italy.

Sublingual immunotherapy (SLIT) is significantly less concerned by systemic reactions than subcutaneous immunotherapy. Allergoids were introduced to reduce systemic reaction to subcutaneous immunotherapy, but may also be used for SLIT. This pharmacovigilance study evaluated the post-marketing reports collected in a safety database, including the number and the type (serious or not serious) of adverse drug reactions (ADRs) in Italy by SLIT with the carbamylated monomeric allergoid (CMA). More than 15,000,000 CMA tablets were administered, with 25 spontaneous reports of ADRs, only two being serious. The rate of ADRs to CMA we found in this pharmacovigilance survey, corresponding to 0.0004% of all administered doses, is far lower than the rates commonly reported for allergen SLIT products.
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http://dx.doi.org/10.2217/imt-2019-0095DOI Listing
February 2020

Advances in allergen immunotherapy as a treatment of asthma.

Expert Rev Respir Med 2019 12 18;13(12):1161-1167. Epub 2019 Oct 18.

Department of Rehabilitation and Functional Recovery, ASST Pini/CTO, Milan, Italy.

: Specific immunotherapy is the only treatment acting on causes and not only on symptoms of respiratory allergy. It was first introduced as subcutaneous immunotherapy (SCIT) with the aim to induce immunological tolerance to the administered allergen(s). In the 1980s, sublingual immunotherapy (SLIT) was developed, mainly to improve the safety, which was a critical issue at that time.: This article reviews the available literature, including a large number of randomized controlled trials, meta-analyses, and real-life studies as well, on the outcomes of SCIT and SLIT concerning the treatment critical issues of the two routes, that are efficacy, safety, cost-effectiveness, and compliance to treatment.: SCIT and SLIT are similarly effective in treating patients with respiratory allergy, providing, based on the induction of typical changes in the immunologic response, an early control of symptoms that steadily increases during the treatment and, once reached the recommended duration of 3 years, continues to work after stopping. This outcome is the major factor influencing the economic advantage of SCIT and SLIT over drug treatment.
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http://dx.doi.org/10.1080/17476348.2019.1676153DOI Listing
December 2019

Is there any further advance in bronchodilator combination therapy for COPD?

Curr Med Res Opin 2020 01 15;36(1):125-126. Epub 2019 Oct 15.

Allergy and Clinical Immunology, Medicine and Surgery Department, University of Parma, Parma, Italy.

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http://dx.doi.org/10.1080/03007995.2019.1676576DOI Listing
January 2020

What still prevents to acknowledge a major role for pulmonary rehabilitation in COPD treatment?

Acta Biomed 2019 09 6;90(3):218-224. Epub 2019 Sep 6.

Cardiac/Pulmonary Rehabilitation, ASST Pini/CTO, Milan, Italy..

Chronic obstructive pulmonary disease (COPD) is a major health issue, particularly in aging people. Despite an increasing availability of drugs to treat COPD, recent data indicate that an actual control of the disease is achieved in a minority of  patients. This makes apparent that additional treatments of COPD should be taken into account, such as pulmonary rehabilitation (PR), which was introduced in the 1960s and has large evidence of clinical effectiveness. PR is a non-pharmacologic therapy based on a comprehensive, multidisciplinary, patient-centered intervention comprising exercise training, self-management education and psychosocial support. PR treated patients develop an increased exercise tolerance and quality of life, reduced dyspnea and anxiety, and are concerned by less hospital admissions for disease exacerbations. Notwithstanding, the use of PR in COPD patients is negligible, being globally estimated in 2-5%. Here we update the evidence in favor of PR and the actual need to consider it as a treatment to be considered for COPD patients with significant impairment in daily living activities.
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http://dx.doi.org/10.23750/abm.v90i3.8369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233744PMC
September 2019

Large local reaction to Hymenoptera stings: Sound studies are needed to change a shared concept.

Immun Inflamm Dis 2019 12 7;7(4):258-259. Epub 2019 Sep 7.

Allergy Unit, Presidio Columbus, Rome, Italy.

The natural history of large local reactions to Hymenoptera stings allowed to estimate the risk to develop a systemic reaction after an initial large local reaction in about 4% of patients. A recently published study claimed that such risk concerns instead around one-fourth of patients. However, such study is flawed by serious imprecision, particularly the unreliable identification by patients of the culprit insect, as well as the dubious identification of the causative venom in multisensitized patients. Also, the authors criticized previous studied because of the limited number of patients, while they included in the study 662 patients. Indeed, when only patients clearly restung by the same insect according to their history data were considered, the number of patients fell to 35. These data are unable to change the current shared concept on the low risk of systemic reactions in patients with initial large local reaction.
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http://dx.doi.org/10.1002/iid3.268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6842820PMC
December 2019

The spectrum of therapeutic activity of mepolizumab.

Expert Rev Clin Immunol 2019 09 29;15(9):959-967. Epub 2019 Aug 29.

Cardiac/Pulmonary Rehabilitation, ASST Pini/CTO , Milan , Italy.

: The basis of the development of the anti-interleukin-5 monoclonal antibody mepolizumab was the acknowledgment of the crucial importance of this cytokine in promoting eosinophils production, activation, and survival, which is associated with the eosinophilic asthma phenotype, as well as with other disorders characterized by high levels of eosinophils. : All the available literature on the outcomes treatment with mepolizumab in eosinophilic disorders are reviewed, including asthma, chronic rhinosinusitis, esophagitis, granulomatosis with polyangiitis, eosinophilic chronic obstructive pulmonary disease, hypereosinophilic syndrome, and allergic bronchopulmonary aspergillosis. : The efficacy of mepolizumab in eosinophilic asthma is clearly demonstrated by a number of controlled trials and by meta-analyses. Among other eosinophilic disorders, controlled trials are available for chronic rhinosinusitis with nasal polyps, eosinophilic esophagitis, hypereosinophilic syndrome, eosinophilic granulomatosis with polyangiitis, and eosinophilic chronic obstructive pulmonary disease. Allergic bronchopulmonary aspergillosis, as well as other minor eosinophilic disorders, are backed only by case reports and are waiting controlled trials to verify the therapeutic role of mepolizumab.
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http://dx.doi.org/10.1080/1744666X.2019.1656065DOI Listing
September 2019

Immunotherapy and biologicals for the treatment of allergy to Hymenoptera stings.

Expert Opin Biol Ther 2019 09 21;19(9):919-925. Epub 2019 Jun 21.

c Cardiac/Pulmonary Rehabilitation Unit, ASST Pini-CTO , Milan , Italy.

: Venom immunotherapy (VIT) is an effective treatment for Hymenoptera venom allergy. The occurrence of severe reactions (SRs) to VIT, although infrequent, hampers the achievement of tolerance to insect stings. Risk factors for such reactions include allergy to honeybee venom, concomitant mast cell disorders, and the build-up phase of VIT. A role for omalizumab has come forward in recent years. : This article reviews the available literature on the efficacy of omalizumab in preventing SRs and allowing the attainment of VIT maintenance doses. Pre- and co-treatments with omalizumab were evaluated, with positive overall results. Adding omalizumab to VIT in patients with SRs generally results in tolerance to VIT, thus restoring its precious preventive value. : VIT is effective for patients with Hymenoptera venom allergy and is recommended to prevent further (possibly fatal) reactions to stings. Omalizumab has shown efficacy in protecting patients from VIT-related SRs, particularly in those at high risk of SRs because of mast cell disorders and/or honeybee venom allergy. Notwithstanding, the accepted dose and time course of omalizumab for achieving tolerability and ensuring safety during VIT are not yet defined. In the future, other biologicals may play a role in preventing SRs during VIT.
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http://dx.doi.org/10.1080/14712598.2019.1632286DOI Listing
September 2019

The many abilities of omalizumab and the unbeaten path.

J Allergy Clin Immunol 2019 06 20;143(6):2335-2336. Epub 2019 Apr 20.

Allergy and Clinical Immunology, Medicine and Surgery Department, University of Parma, Parma, Italy.

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http://dx.doi.org/10.1016/j.jaci.2019.02.035DOI Listing
June 2019

[Spontaneous rectus sheath hematoma as a complication of anticoagulant and antiplatelet therapy: a case report.]

Recenti Prog Med 2019 Feb;110(2):89-92

UOC Cardiologia Riabilitativa CTO, ASST Gaetano Pini/CTO, Milano.

Spontaneous rectus sheath hematoma (RSH) is an uncommon and often clinically misdiagnosed cause of abdominal pain, characterized by a presence of blood within rectus muscle sheath, with palpable mass. Hemorrhage may originate from the epigastric artery and branches or directly from rectus sheath rupture. The most frequent cause of hematoma is anticoagulant therapy. Diagnosis is based on ultrasonography and computed tomography. Conservative treatment and, in case of active bleeding, intravascular embolization is the treatment of choice, while surgery is indicated in case of failure of endovascular procedure or in patients with intra-abdominal rupture causing hemodynamic instability and abdominal compartment syndrome. Here we present a case of RSH that developed after hip replacement surgery in a patient on anticoagulant therapy and dual antiplatelet therapy.
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http://dx.doi.org/10.1701/3112.31004DOI Listing
February 2019

Recovery of smell sense loss by mepolizumab in a patient allergic to Dermatophagoides and affected by chronic rhinosinusitis with nasal polyps.

Clin Mol Allergy 2019 13;17. Epub 2019 Feb 13.

5Department of Sense Organs, Sapienza University, Rome, Italy.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) frequently presents with dysfunction or loss of the sense of smell, resulting in a significant impairment in quality of life. The medical treatments currently available may improve the olfactory function in patients with CRSwNP, but such an outcome is generally only transitory. We report the case of a patient with CRSwNP who completely recovered from smell sense loss by treatment with mepolizumab.

Case Presentation: The patient was a 62-year-old female who has severe asthma induced by allergy to Dermatophagoides and concomitant CRSwNP. Any treatment for the latter, including oral and injective corticosteroids, was unsuccessful in the loss of smell. Due to the satisfaction of admission criteria to mepolizumab treatment for severe asthma, treatment was initiated on March 2018, resulting in good clinical control of both asthma and CRSwNP, and particularly in complete recovery of the smell loss after 4 months of treatment and still persisting.

Conclusion: In this case report, the treatment with mepolizumab in a patient allergic to Dermatophagoides and affected by CRSwNP was associated with an improvement of anosmia. That finding may be explained by a reduction of the nasal obstruction by nasal polyps.
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http://dx.doi.org/10.1186/s12948-019-0106-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6373033PMC
February 2019

Assessing the Risk Factors for Refractory Eosinophilic Esophagitis in Children and Adults.

Gastroenterol Res Pract 2019 13;2019:1654543. Epub 2019 Jan 13.

Cardiac/Pulmonary Rehabilitation, ASST Pini/CTO, Milan, Italy.

Background: Up to one-third of the patients suffering from eosinophilic esophagitis (EoE) present a refractory form, as defined by nonresponsiveness in clinical, endoscopic, or histological assessment after first-line therapy. Several studies recently investigated which factors can influence the development of this disease, but very few analyzed the factors underlying refractory EoE.

Methods: Medical charts of patients affected by EoE were retrospectively evaluated. Phenotyping of patients was conducted according to demographic, clinical, histological, and treatment variables. Then, patients were divided into responder and nonresponder to therapy and distinguished among children and adults.

Results: Forty-five children and 35 adult EoE patients were included. In the pediatric population, female sex ( < 0.05) and a higher score of visual analogue scale (VAS) at the follow-up visit ( = 0.02) were significantly associated to the risk of refractory EoE. Among adults, statistical significance was reached for years of follow-up ( = 0.001), diagnostic delay ( = 0.03), use of antibiotics during infancy ( = 0.01), and food allergy ( = 0.04).

Conclusions: Our study highlighted female sex and a higher VAS score at the time of follow-up visits as risk factors for refractory EoE in children, while the risk factors in adults were identified as fewer years of follow-up, greater diagnostic delay, use of antibiotics during infancy, and food allergy.
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http://dx.doi.org/10.1155/2019/1654543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6348890PMC
January 2019

Patient-reported outcomes and considerations in the management of COPD: focus on indacaterol/glycopyrronium bromide.

Patient Prefer Adherence 2019 14;13:145-150. Epub 2019 Jan 14.

Cardiac/Pulmonary Rehabilitation Unit, ASST Pini-CTO, Milan, Italy.

Dual bronchodilation with long-acting beta-2 agonists and muscarinic antagonists is recommended in patients with severe to very severe COPD. Among dual bronchodilator combinations, indacaterol/glycopyrronium combination (IGC) received evidence of higher efficacy and good safety compared with monotherapy with either drug as well as with tiotropium. In randomized controlled trials, the primary outcome is usually the change in mean FEV resulting from treatment. However, the functional aspects that influence the physician's choice of the type of management may not be considered important by the patient, based on his perception of the disease. To address such issue, patient-reported outcomes (PROs) were assessed in recent studies. They include patient's perception of breathlessness, physical functioning, global health status, quality of life, use of rescue medications, and patient's report of COPD exacerbations. PRO data from the studies showed a clear improvement in patients' awareness of a better control of the disease in patients treated with IGC. In addition, the latest literature on two important issues influencing patient's preference and adherence, ie, the once-daily administration and the device to be used, confirmed the effectiveness of IGC and the ability of its device (Breezhaler) to result in patient's satisfaction, ease of use, less handling errors, and self-assurance to have inhaled the entire dose.
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http://dx.doi.org/10.2147/PPA.S166704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6338236PMC
January 2019

The Role of the Microbiome in Asthma: The Gut⁻Lung Axis.

Int J Mol Sci 2018 Dec 30;20(1). Epub 2018 Dec 30.

Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.

Asthma is one of the most common chronic respiratory diseases worldwide. It affects all ages but frequently begins in childhood. Initiation and exacerbations may depend on individual susceptibility, viral infections, allergen exposure, tobacco smoke exposure, and outdoor air pollution. The aim of this review was to analyze the role of the gut⁻lung axis in asthma development, considering all asthma phenotypes, and to evaluate whether microbe-based therapies may be used for asthma prevention. Several studies have confirmed the role of microbiota in the regulation of immune function and the development of atopy and asthma. These clinical conditions have apparent roots in an insufficiency of early life exposure to the diverse environmental microbiota necessary to ensure colonization of the gastrointestinal and/or respiratory tracts. Commensal microbes are necessary for the induction of a balanced, tolerogenic immune system. The identification of commensal bacteria in both the gastroenteric and respiratory tracts could be an innovative and important issue. In conclusion, the function of microbiota in healthy immune response is generally acknowledged, and gut dysbacteriosis might result in chronic inflammatory respiratory disorders, particularly asthma. Further investigations are needed to improve our understanding of the role of the microbiome in inflammation and its influence on important risk factors for asthma, including tobacco smoke and host genetic features.
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http://dx.doi.org/10.3390/ijms20010123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6337651PMC
December 2018

Parietaria Allergy: An Intriguing Challenge for the Allergist.

Medicina (Kaunas) 2018 Dec 7;54(6). Epub 2018 Dec 7.

Department of Otorhinolaryngology, Sapienza University, 00100 Rome, Italy.

pollen is the most important cause of pollen allergies in the Mediterranean area, as is widespread in this region. Many issues are associated with allergy, including the duration of the pollen season (many doctors in fact believe that it lasts throughout the year), pollen load (which seems to be increasing over time), the impact of age (on IgE production and symptom severity), inflammatory changes (after pollen exposure), and the choice of allergen immunotherapy (AIT). In addition, molecular diagnostics allows for the defining of a correct diagnosis, differentiating between mere sensitization and true allergy. This review considers these topics and will hopefully help the allergist in clinical practice. allergy is an intriguing challenge for the allergist in clinical practice, but it may be adequately managed by knowing the peculiarities of respective territories and the clinical characteristics of each patient.
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http://dx.doi.org/10.3390/medicina54060106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306946PMC
December 2018

The behavior of Italian allergists in prescribing allergen immunotherapy for house dust mites allergy.

Immunotherapy 2018 11;10(16):1343-1348

Istituto Giannina Gaslini, Genoa, Italy.

The meeting 'Clinical Evidence, Extracts Quality and Biotechnology Innovation in Allergen Immunotherapy' held in Trieste (Italy) on 1 October 2017 concerned the outcomes of a real-world survey conducted on a group of Italian allergists about allergen immunotherapy (AIT) for house dust mites allergy. It pointed out: allergist's confidence that AIT should be prescribed continuously; tablets seem to be well accepted by patients and effective in most subjects with a fast onset of action (3-6 months); combined score for symptom severity and medication use is universally assessed; there is disagreement about the diagnosis of house dust mites allergy, the quote of AIT prescription, the choice for AIT route of administration, assessment of serum IgE and perception of patient's adherence.
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http://dx.doi.org/10.2217/imt-2018-0066DOI Listing
November 2018

Two decades with omalizumab: what we still have to learn.

Biologics 2018 26;12:135-142. Epub 2018 Oct 26.

Department of Medicine and Surgery, University of Parma, Parma, Italy.

From its availability for clinical use nearly two decades ago for severe asthma, omalizumab has gained strong evidence of efficacy and safety in the treatment of severe asthma not controlled by standard-of-care therapy. It has been acknowledged by Global Initiative on Asthma guidelines as add-on therapy against severe uncontrolled asthma. Thanks to controlled trials supporting its efficacy, omalizumab has also been licensed for the treatment of chronic spontaneous urticaria. The optimal duration of treatment in either disease has not been established. Despite its high price, omalizumab appears to be cost-effective in severe uncontrolled asthma as well as in chronic urticaria. The literature suggests a wide range of applications for omalizumab in various disorders regardless of allergic or non-allergic pathophysiology.
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http://dx.doi.org/10.2147/BTT.S180846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208531PMC
October 2018