Publications by authors named "Gianenrico Senna"

116 Publications

Importance of Cardiopulmonary Exercise Testing amongst Subjects Recovering from COVID-19.

Diagnostics (Basel) 2021 Mar 12;11(3). Epub 2021 Mar 12.

Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, 37134 Verona, Italy.

The cardiopulmonary exercise test (CPET) provides an objective assessment of ventilatory limitation, related to the exercise minute ventilation (V) coupled to carbon dioxide output (V) (V/V); high values of V/V define an exercise ventilatory inefficiency (EV). In subjects recovered from hospitalised COVID-19, we explored the methodology of CPET in order to evaluate the presence of cardiopulmonary alterations. Our prospective study (RESPICOVID) has been proposed to evaluate pulmonary damage's clinical impact in post-COVID subjects. In a subgroup of subjects (RESPICOVID2) without baseline confounders, we performed the CPET. According to the V/V, subjects were divided into having EV and exercise ventilatory efficiency (EV). Data concerning general variables, hospitalisation, lung function, and gas-analysis were also collected. The RESPICOVID2 enrolled 28 subjects, of whom 8 (29%) had EV. As compared to subjects with EV, subjects with EV showed a reduction in heart rate (HR) recovery. V/V was inversely correlated with HR recovery; this correlation was confirmed in a subgroup of older, non-smoking male subjects, regardless of the presence of arterial hypertension. More than one-fourth of subjects recovered from hospitalised COVID-19 have EV. The relationship between EV and HR recovery may represent a novel hallmark of post-COVID cardiopulmonary alterations.
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http://dx.doi.org/10.3390/diagnostics11030507DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7998697PMC
March 2021

Residual Lung Function Impairment Is Associated with Hyperventilation in Patients Recovered from Hospitalised COVID-19: A Cross-Sectional Study.

J Clin Med 2021 Mar 3;10(5). Epub 2021 Mar 3.

Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy.

Patients who have recovered from COVID-19 show persistent symptoms and lung function alterations with a restrictive ventilatory pattern. Few data are available evaluating an extended period of COVID-19 clinical progression. The RESPICOVID study has been designed to evaluate patients' pulmonary damage previously hospitalised for interstitial pneumonia due to COVID-19. We focused on the arterial blood gas (ABG) analysis variables due to the initial observation that some patients had hypocapnia (arterial partial carbon dioxide pressure-PaCO ≤ 35 mmHg). Therefore, we aimed to characterise patients with hypocapnia compared to patients with normocapnia (PaCO > 35 mmHg). Data concerning demographic and anthropometric variables, clinical symptoms, hospitalisation, lung function and gas-analysis were collected. Our study comprised 81 patients, of whom 19 (24%) had hypocapnia as compared to the remaining ( = 62, 76%), and defined by lower levels of PaCO, serum bicarbonate (HCO), carbon monoxide diffusion capacity (DL), and carbon monoxide transfer coefficient (K) with an increased level of pH and arterial partial oxygen pressure (PaO). K was directly correlated with PaCO and inversely with pH. In our preliminary report, hypocapnia is associated with a residual lung function impairment in diffusing capacity. We focus on ABG analysis's informativeness in the follow-up of post-COVID patients.
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http://dx.doi.org/10.3390/jcm10051036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7959299PMC
March 2021

Biologics for Eosinophilic Granulomatosis with Polyangiitis: one size does not fit all.

Arthritis Rheumatol 2021 Feb 18. Epub 2021 Feb 18.

Department of Medicine, University of Verona, Verona University Hospital, Verona, Italy.

We read with great interest the Brief Report "Use of Biologics to Treat Relapsing and/or Refractory Eosinophilic Granulomatosis with Polyangiitis: data from a European Collaborative Study" by Canzian et al, recently published in Arthritis & Rheumatology (1). It probably provides the largest real-life contribution on EGPA and biologic drugs. Despite the increasing evidence on the topic, including clinical trials and real life studies (2,3), identifying the most appropriate biologic treatment still represents a challenge.
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http://dx.doi.org/10.1002/art.41695DOI Listing
February 2021

Economic impact of mepolizumab in uncontrolled severe eosinophilic asthma, in real life.

World Allergy Organ J 2021 Feb 27;14(2):100509. Epub 2021 Jan 27.

Allergy and Respiratory Diseases, IRCCS Policlinico San Martino - University of Genoa, Italy.

Background And Aims: Severe asthma is burdened by frequent exacerbations and use of oral corticosteroids (OCS) which worsen patients' health and increase healthcare spending. Aim of this study was to assess the clinical and economic effect of adding mepolizumab (MEP) for the treatment of these patients.

Methods: Patients >18 years old, referred to 8 asthma clinics, starting MEP between May 2017 and December 2018, were enrolled and followed-up for 12 months. Information in the 12 months before mepolizumab were collected retrospectively. The evaluation parameters included: OCS use, number of exacerbations/hospitalizations, concomitant therapies, comorbidity, and annual number of working days lost due to the disease. The primary objective was to compare the annual total cost per patient pre- and post-MEP. Secondary outcomes included rates of exacerbations and number of OCS-dependent patients.

Results: 106 patients were enrolled in the study: 46 male, median age 58 years. Mean annual cost pre- and post-MEP (cost of biologic excluded) was €3996 and €1,527, respectively. Total savings due to MEP resulted in €2469 (95%CI 1945-2993), 62% due to exacerbations reduction and 33% due to productivity increase. Such savings could fund about 22% of the total cost of MEP for one year. The introduction of MEP induced a clinical benefit by reducing both OCS-dependent patients (OR = 0.12, 95%CI 0.06-0.23) and exacerbation rate (RR = 0.19, 95%CI 0.15-0.24).

Conclusions: Patients with severe eosinophilic asthma experienced a clinical benefit in asthma control adding MEP to standard therapy. Biologic therapy can be, partially, funded by the savings produced by patients' improvement.
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http://dx.doi.org/10.1016/j.waojou.2021.100509DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846931PMC
February 2021

COVID-19 vaccine-associated anaphylaxis: A statement of the World Allergy Organization Anaphylaxis Committee.

World Allergy Organ J 2021 Feb 3;14(2):100517. Epub 2021 Feb 3.

Department of Dermatology and Allergology, Charite-Universitätsmedizin, Berlin, Germany.

Vaccines against COVID-19 (and its emerging variants) are an essential global intervention to control the current pandemic situation. Vaccines often cause adverse events; however, the vast majority of adverse events following immunization (AEFI) are a consequence of the vaccine stimulating a protective immune response, and not allergic in etiology. Anaphylaxis as an AEFI is uncommon, occurring at a rate of less than 1 per million doses for most vaccines. However, within the first days of initiating mass vaccination with the Pfizer-BioNTech COVID-19 vaccine BNT162b2, there were reports of anaphylaxis from the United Kingdom and United States. More recent data imply an incidence of anaphylaxis closer to 1:200,000 doses with respect to the Pfizer-BioNTech vaccine. In this position paper, we discuss the background to reactions to the current COVID-19 vaccines and relevant steps to mitigate against the risk of anaphylaxis as an AEFI. We propose a global surveillance strategy led by allergists in order to understand the potential risk and generate data to inform evidence-based guidance, and thus provide reassurance to public health bodies and members of the public.
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http://dx.doi.org/10.1016/j.waojou.2021.100517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857113PMC
February 2021

Allergy and coronavirus disease (COVID-19) international survey: Real-life data from the allergy community during the pandemic.

World Allergy Organ J 2021 Feb 31;14(2):100515. Epub 2021 Jan 31.

Department of Medicine, Allergy Asthma and Clinical Immunology Section, University Hospital of Verona, Verona Italy.

Background: The COVID-19 outbreak brought an unprecedented challenge to the world. Knowledge in the field has been increasing exponentially and the main allergy societies have produced guidance documents for better management of allergic patients during this period. However, few publications so far have provided real-life data from the allergy community concerning allergy practice during the COVID-19 outbreak. Therefore, we proposed an international survey on the management of allergic patients during the current pandemic.

Methods: We performed an online survey undertaken to reach out the worldwide allergy community by e-mail and social media. The web-based questionnaire contained 24 questions covering demographic data from the participants, clinical practice during this period, and questions related to the new international classification and coding tools addressed for COVID-19. It was circulated for 8 weeks and had anonymous and volunteer context.

Results: Data are presented for 635 participants from 78 countries of all continents. Allergists with long-term professional experience were the main audience. As expected, we received many responses as "I have no data" or "I don't know" to the questions of the survey. However, most with more experience on managing allergic patients during the pandemic agreed that patients suffering from allergic or hypersensitivity conditions have no increased risk of contracting COVID-19 or developing SARS CoV-2. Also, participants mentioned that none of the allergy treatments (inhaled corticosteroids, allergen immunotherapy, biological agents) increased the risk of contracting COVID-19 infection including severe presentations.

Conclusion: The data presented are a starting point in the process of getting feedback on all the recommendations provided by the allergy societies; it could also be the basis of new strategies to support health professionals while new COVID-19 specific treatments and vaccines are being explored. The information here presented intends to be helpful to the community but represents a course of action in a highly specific situation due to the state of emergency, and it should be helpful to health systems.
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http://dx.doi.org/10.1016/j.waojou.2021.100515DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847410PMC
February 2021

Sex Differences in Severe Asthma: Results From Severe Asthma Network in Italy-SANI.

Allergy Asthma Immunol Res 2021 Mar;13(2):219-228

Department of Surgery, Medicine and Molecular Biology and Critical Care, Nuovo Ospedale Apuano, University of Pisa, Pisa, Italy.

Purpose: After adolescence, asthma is more frequent in females than in males due to different hormonal, immunologic, and occupational/environmental factors. The higher prevalence and severity of the disease in females have already been reported in international registries. The aim of this study was to explore the difference in terms of clinical, functional, and biological characteristics between male and female patients with severe asthma in a real-life, registry-based setting.

Methods: Baseline data from the Severe Asthma Network in Italy registry were analyzed in 1,123 patients with severe asthma, according to sex.

Results: Almost 2/3 of severe asthmatics were female. Late-onset asthma, obesity and gastro-esophageal reflux were more frequent in females than in males, while previous smoking habits and nasal polyposis were more frequent in males. Females had poor asthma control and a higher number of severe exacerbations leading to hospitalization, in comparison to males. Biomarkers of type 2 inflammation (blood eosinophil, exhaled nitric oxide, and serum immunoglobulin E levels) were significantly higher in males than in females. The type 2 profile (defined by a combination of these 3 biomarkers) was significantly more frequent in males than in females. In multivariate analysis, late-onset asthma and a normal body mass index were only independent variables associated with the type 2 profile, while male sex and age showed only a trend toward the association with the type 2 profile.

Conclusions: Significant differences may be observed between male and female patients with severe asthma, influencing the asthma pheno-endotyping in both sexes.
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http://dx.doi.org/10.4168/aair.2021.13.2.219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7840868PMC
March 2021

Who Is Really at Risk for Anaphylaxis Due to COVID-19 Vaccine?

Vaccines (Basel) 2021 Jan 11;9(1). Epub 2021 Jan 11.

Department of Medicine, University of Verona and Verona University Hospital, Piazzale L.A. Scuro, 10, 37134 Verona, Italy.

The vaccination campaign against the Severe acute respiratory syndrome coronavirus 2 (Sars-Cov-2) started on 8 December 2020 in UK, after the approval of BNT162b2 by the Healthcare products Regulatory Agency (MHRA) [...].
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http://dx.doi.org/10.3390/vaccines9010038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827676PMC
January 2021

Oral health in asthmatic patients: a review : Asthma and its therapy may impact on oral health.

Clin Mol Allergy 2020 Nov 7;18(1):22. Epub 2020 Nov 7.

Department of Medicine, University of Verona, Piazzale Scuro, Verona, Italy.

Different drugs used to treat asthma, such as beta 2 agonists and inhaled steroids, may promote a higher risk of caries, dental erosion, periodontal disease and oral candidiasis. This article reviews the evidences of mechanisms involved in oral diseases in patients affected by asthma. The main mechanism involved is the reduction of salivary flow. Other mechanisms include: acid pH in oral cavity induced by inhaled drugs (particularly dry powder inhaled), lifestyle (bad oral hygiene and higher consumption of sweet and acidic drinks), gastroesophageal reflux, and the impairment of local immunity. In conclusion asthma is involved in the genesis of oral pathologies both directly and indirectly due to the effect of the drugs used to treat them. Other cofactors such as poor oral hygiene increase the risk of developing oral diseases in these patients. Preventive oral measures, therefore, should be part of a global care for patients suffering from asthma.
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http://dx.doi.org/10.1186/s12948-020-00137-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648282PMC
November 2020

Physicians' prescribing behaviour and clinical practice patterns for allergic rhinitis management in Italy.

Clin Mol Allergy 2020 Nov 3;18(1):20. Epub 2020 Nov 3.

Asthma & Allergy Clinic-Humanitas University & Research Hospital Milan, Milan, Italy.

Background: Despite availability of clinical guidelines, underdiagnosis, undertreatment, and poor adherence are still significant concerns in allergic rhinitis (AR) therapeutic management. We investigated clinical practice patterns and prescribing behavior of Italian healthcare professionals (HCPs) specialized in AR.

Methods: One-hundred allergologists, 100 ear, nose and throat (ENT) specialists, and 150 general practitioners (GPs) were recruited. The survey assessed: socio-demographic, work experience, monthly caseload, prescription drivers. Next, HCPs were invited to retrospectively recover patients' clinical data to investigate: AR clinical characteristics, therapy management, prescription patterns, patient adherence. Descriptive statistics, Chi square, One-Way analysis of variance, and Two-Way Analysis of Variance were performed.

Results: Allergologists visited more AR patients (31% of monthly caseload) than ENTs (21%, p < 0.001), while GPs' caseload was the lowest (6%). Clinical information of 2823 patients were retrieved of whom 1906 (67.5%) suffered from moderate/severe AR (discomfort score: 7.7 ± 1.3) and 917 (32.4%) from mild AR (5.7 ± 1.9). About one-third of mild patients had a discomfort score ≥ 7. Main prescription drivers were "effective on all symptoms" (54.3% patients) and "quick symptom relief" (47.8%), whereas minor drivers were "affordable price" (13.4%) and "refundable" (8.7%). The most prescribed drugs were antihistamines and intranasal corticosteroids (79% and 55% prescriptions), followed by fixed-dose-combination of intranasal azelastine/fluticasone (19%). Polytherapy was the most common treatment strategy (59.6%). HCPs' believe that the majority of the patients was adherent to treatment (88% with score > 7).

Conclusions: This survey describes the therapeutic approach adopted by Italian physicians to cope with AR and shows that HCPs underestimated AR severity and had a non-realistic perception of patients' adherence. These findings suggest that further efforts are required to improve AR clinical management in Italy.
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http://dx.doi.org/10.1186/s12948-020-00135-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7640419PMC
November 2020

Comment on: Onset of eosinophilic granulomatosis with polyangiitis in a patient treated with an IL-5 pathway inhibitor for severe asthma: reply.

Rheumatology (Oxford) 2021 02;60(2):e79-e80

Department of Medicine, University of Verona and Verona University Hospital, Verona, Italy.

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http://dx.doi.org/10.1093/rheumatology/keaa799DOI Listing
February 2021

Asthma in a large COVID-19 cohort: Prevalence, features, and determinants of COVID-19 disease severity.

Respir Med 2021 01 26;176:106261. Epub 2020 Nov 26.

Department of Medicine, University of Verona, Verona, Italy.

Background: Asthma prevalence among COVID-19 patients seems to be surprisingly low. However the clinical profile of COVID-19 asthmatic patients and potential determinants of higher susceptibility/worse outcome have been scarcely investigated. We aimed to describe the prevalence and features of asthmatic patients hospitalized for COVID-19 and to explore the association between their clinical asthma profile and COVID-19 severity.

Methods: Medical records of patients admitted to COVID-Units of six Italian cities major hospitals were reviewed. Demographic and clinical data were analyzed and compared according to the COVID-19 outcome (death/need for ventilation vs discharge at home without requiring invasive procedures).

Results: Within the COVID-Units population (n = 2000) asthma prevalence was 2.1%. Among the asthmatics the mean age was 61.1 years and 60% were females. Around half of patients were atopic, blood eosinophilia was normal in most of patients. An asthma exacerbation in the 6 months before the Covid-Unit admittance was reported by 18% of patients. 24% suffered from GINA step 4-5 asthma, and 5% were under biologic treatment. 31% of patients were not on regular treatment and a negligible use of oral steroid was recorded. Within the worse outcome group, a prevalence of males was detected (64 vs 29%, p = 0.026); they suffered from more severe asthma (43 vs 14%, p = 0.040) and were more frequently current or former smokers (62 vs 25%, p = 0.038).

Conclusions: Our report, the first including a large COVID-19 hospitalized Italian population, confirms the low prevalence of asthma. On the other side patients with GINA 4/5 asthma, and those not adequately treated, should be considered at higher risk.
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http://dx.doi.org/10.1016/j.rmed.2020.106261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7688414PMC
January 2021

World allergy organization anaphylaxis guidance 2020.

World Allergy Organ J 2020 Oct 30;13(10):100472. Epub 2020 Oct 30.

Department of Dermatology and Allergology, Charite-Universitätsmedizin, Berlin, Germany.

Anaphylaxis is the most severe clinical presentation of acute systemic allergic reactions. The occurrence of anaphylaxis has increased in recent years, and subsequently, there is a need to continue disseminating knowledge on the diagnosis and management, so every healthcare professional is prepared to deal with such emergencies. The rationale of this updated position document is the need to keep guidance aligned with the current state of the art of knowledge in anaphylaxis management. The World Allergy Organization (WAO) anaphylaxis guidelines were published in 2011, and the current guidance adopts their major indications, incorporating some novel changes. Intramuscular epinephrine (adrenaline) continues to be the first-line treatment for anaphylaxis. Nevertheless, its use remains suboptimal. After an anaphylaxis occurrence, patients should be referred to a specialist to assess the potential cause and to be educated on prevention of recurrences and self-management. The limited availability of epinephrine auto-injectors remains a major problem in many countries, as well as their affordability for some patients.
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http://dx.doi.org/10.1016/j.waojou.2020.100472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607509PMC
October 2020

Frequency of Tiotropium Bromide Use and Clinical Features of Patients with Severe Asthma in a Real-Life Setting: Data from the Severe Asthma Network in Italy (SANI) Registry.

J Asthma Allergy 2020 10;13:599-604. Epub 2020 Nov 10.

Department of Medicine, University of Verona, Verona, Italy.

Purpose: Patients with uncontrolled asthma despite high doses of inhaled corticosteroid therapy plus another controller are defined as severe asthmatics. Tiotropium bromide respimat (TBR) is the only long-acting muscarinic antagonists (LAMA) approved for severe asthma. The aim of this study was to explore the frequency of severe asthmatics treated with TBR and characterize their clinical features in a real-life, registry-based setting.

Materials And Methods: Baseline data from the Severe Asthma Network in Italy (SANI) registry have been analyzed to determine the use of TBR and other LAMA, and to compare clinical, functional and inflammatory features associated with the use of LAMA.

Results: Among a total of 698 enrolled patients, 35.9% were treated with LAMA (23.3% TBR, 4.5% tiotropium bromide handihaler, 4.5% aclidinium, 3.4% glycopyrronium bromide 0.3% umeclidinium bromide). Age of asthma onset was higher in patients taking LAMA, whom, compared to others were more frequently former smokers. They also had a higher annual exacerbation rate, experienced worst asthma control, worst disease-related quality of life and poorer lung function. Bronchiectasis was more frequently found in LAMA users (25.9% vs 13.1%).

Conclusion: TBR is still underused in severe asthma in a real-life setting, while a relevant proportion of patients are treated with other LAMA that are not approved for severe asthma treatment. Patients taking LAMA have features characteristic of even more severe asthma.
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http://dx.doi.org/10.2147/JAA.S274245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667506PMC
November 2020

Clinical features associated with a doctor-diagnosis of bronchiectasis in the Severe Asthma Network in Italy (SANI) registry.

Expert Rev Respir Med 2021 Mar 3;15(3):419-424. Epub 2020 Nov 3.

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

Background: Several severe asthma comorbidities have been identified: an emerging one is bronchiectasis. We evaluated the frequency of bronchiectasis on severe asthma in a real-life setting, through the 'Severe Asthma Network Italy' (SANI) registry.

Methods: SANI registry encompasses demographic, clinical, functional and inflammatory data of Italian severe asthmatics. Data obtained by the enrolled patients were analyzed, focusing the attention on those patients with concomitant clinically relevant bronchiectasis.

Results: About 15.5% patients have bronchiectasis. Bronchiectasis diagnosis was associated with a higher prevalence of chronic rhinosinusitis with nasal polyps (54.6% vs. 38%, p = 0.001) and higher serum IgE levels (673.4 vs. 412.1 kUI/L, p = 0.013). Patients with bronchiectasis had worse asthma control (ACT: 16.7 vs 18.2, p = 0.013), worse quality of life (AQLQ: 4.08 vs. 4.60, p = 0.02) and lower lung function (FEV% predicted 67.3 vs. 75.0, p = 0.002). A higher rate of severe asthma exacerbations in the previous 12 months (85.2% vs. 61.5%, p < 0.001) was found in patients with bronchiectasis.

Conclusion: severe asthma associated with bronchiectasis represents a particularly severe asthma variant, possibly driven by an eosinophilic endotype. We, therefore, suggest that bronchiectasis should necessarily be assessed in severe asthmatic patients.
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http://dx.doi.org/10.1080/17476348.2021.1840983DOI Listing
March 2021

Biologics for the Treatments of Allergic Conditions: Severe Asthma.

Immunol Allergy Clin North Am 2020 11 12;40(4):549-564. Epub 2020 Sep 12.

Department of Medicine, Allergy and Clinical Immunology School, University of Verona & Asthma Center and Allergy Unit, Verona University Hospital, Piazzale Scuro 10, Verona 37134, Italy.

By selectively targeting specific steps of the immune inflammation cascade, biologic drugs for severe asthma have substantially contributed to increase the standard of care, to reduce drug-related morbidity. and most importantly to ameliorate patients' quality of life. Upcoming molecules are going to provide a chance for severe phenotypes besides Th2 high through the interaction with epithelial and innate immunity. Some practical aspects including optimal treatment duration, the possibility of a dose treatment modulation, the place and relevance of ICS in best responders are still under debate. Long-term safety, especially when interacting with innate immunity needs to be further investigated.
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http://dx.doi.org/10.1016/j.iac.2020.07.003DOI Listing
November 2020

Mepolizumab 100 mg in severe asthmatic patients with EGPA in remission phase.

J Allergy Clin Immunol Pract 2021 Mar 1;9(3):1386-1388. Epub 2020 Oct 1.

Department of Medicine, University of Verona and Verona University Hospital, Verona, Italy; Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy.

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http://dx.doi.org/10.1016/j.jaip.2020.09.025DOI Listing
March 2021

Oral CorticoSteroid sparing with biologics in severe asthma: A remark of the ().

World Allergy Organ J 2020 Oct 20;13(10):100464. Epub 2020 Sep 20.

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

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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http://dx.doi.org/10.1016/j.waojou.2020.100464DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509464PMC
October 2020

Onset of eosinophilic granulomatosis with polyangiitis in a patient treated with an IL-5 pathway inhibitor for severe asthma.

Rheumatology (Oxford) 2021 02;60(2):e59-e60

Department of Medicine, University of Verona and Verona University Hospital, Verona, Italy.

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http://dx.doi.org/10.1093/rheumatology/keaa572DOI Listing
February 2021

Efficacy of Benralizumab in severe asthma in real life and focus on nasal polyposis.

Respir Med 2020 09 3;171:106080. Epub 2020 Jul 3.

Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Department of Internal Medicine (DIMI), Genoa, Italy.

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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http://dx.doi.org/10.1016/j.rmed.2020.106080DOI Listing
September 2020

Editorial: Reconsidering anaphylaxis at the time of COVID-19 pandemic.

Curr Opin Allergy Clin Immunol 2020 10;20(5):429-430

Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

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http://dx.doi.org/10.1097/ACI.0000000000000682DOI Listing
October 2020

High-flow nasal cannula oxygen therapy to treat patients with hypoxemic acute respiratory failure consequent to SARS-CoV-2 infection.

Thorax 2020 11 23;75(11):998-1000. Epub 2020 Jul 23.

Department of Medicine DIMED, University of Padova, Padova, Italy.

This observational study aims to assess the outcome and safety of O-therapy by high-flow nasal cannula (HFNC) in 28 consecutive patients with severe hypoxemic acute respiratory failure (hARF) consequent to SARS-CoV-2 infection, unresponsive to conventional O-therapy. Nineteen patients had a positive response. Nine patients required escalation of treatment to non-invasive ventilation (five subsequently intubated). None of the staff had a positive swab testing during the study period and the following 14 days. Severity of hypoxemia and C reactive protein level were correlated with HFNC failure. These data suggest HFNC to be a safe treatment for less severe patients with SARS-CoV-2 hARF and efficacy will need to be assessed as part of a clinical trial.
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http://dx.doi.org/10.1136/thoraxjnl-2020-214993DOI Listing
November 2020

Asthmatic patients in COVID-19 outbreak: Few cases despite many cases.

J Allergy Clin Immunol 2020 09 22;146(3):541-542. Epub 2020 Jun 22.

Department of Medicine, Section of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy; Department of Medicine, Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.

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http://dx.doi.org/10.1016/j.jaci.2020.05.049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306702PMC
September 2020

Minimal clinically important difference for asthma endpoints: an expert consensus report.

Eur Respir Rev 2020 Jun 3;29(156). Epub 2020 Jun 3.

Personalized Medicine, Asthma and Allergy - Humanitas Research Hospital, Rozzano, Italy.

Minimal clinically important difference (MCID) can be defined as the smallest change or difference in an outcome measure that is perceived as beneficial and would lead to a change in the patient's medical management.The aim of the current expert consensus report is to provide a "state-of-the-art" review of the currently available literature evidence about MCID for end-points to monitor asthma control, in order to facilitate optimal disease management and identify unmet needs in the field to guide future research.A series of MCID cut-offs are currently available in literature and validated among populations of asthmatic patients, with most of the evidence focusing on outcomes as patient reported outcomes, lung function and exercise tolerance. On the contrary, only scant and partial data are available for inflammatory biomarkers. These clearly represent the most interesting target for future development in diagnosis and clinical management of asthma, particularly in view of the several biologic drugs in the pipeline, for which regulatory agencies will soon require personalised proof of efficacy and treatment response predictors.
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http://dx.doi.org/10.1183/16000617.0137-2019DOI Listing
June 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