Publications by authors named "Marco Caminati"

90 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

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

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

Vitamin B12 and Atopic Dermatitis: Any Therapeutic Relevance For Oral Supplementation?

J Diet Suppl 2020 Dec 21:1-5. Epub 2020 Dec 21.

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

In vitro experimental studies have demonstrated the anti-inflammatory and immune-regulatory potential of vitamin B 12. Nevertheless, few studies have explored so far the relevance of topical products containing vitamin B12 as a treatment option for atopic dermatitis, and the association between blood levels of Vitamin B12 and the severity of atopic dermatitis has never been investigated. Thus the effect of Vitamin B12 oral supplementation in atopic dermatitis is unknown. We describe the case of a 18 years old boy affected by severe refractory atopic dermatitis requiring continuous topical steroid therapy and 5-6 oral steroid trials per year to achieve satisfactory control. During a three years follow-up, an association between Vitamin B12 blood levels and atopic dermatitis severity was detected, as well as a clinically significant SCORAD improvement following Vitamin B12 oral supplementation. Although the cause-effect relationship between Vitamin B12 deficiency and AD severity or relapse needs to be confirmed in larger studies, our case report suggests that Vitamin B12 levels deserve to be assessed in patients with difficult to control atopic dermatitis and points out the potential therapeutic relevance of Vitamin B12 oral supplementation.
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http://dx.doi.org/10.1080/19390211.2020.1860180DOI Listing
December 2020

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

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

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

Biological treatments in allergy: prescribing patterns and management of hypersensitivity reactions.

J Allergy Clin Immunol Pract 2021 Mar 5;9(3):1396-1399.e2. Epub 2020 Nov 5.

Division of Allergy, Département de Pneumologie et Addictologie, University Hospital of Montpellier, Montpellier, France; Sorbonne Université, INSERM UMR-S 1136, IPLESP, Equipe EPAR, Paris, France; WHO Collaborating Centre on Scientific Classification Support, Montpellier, France. Electronic address:

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http://dx.doi.org/10.1016/j.jaip.2020.10.044DOI Listing
March 2021

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 Treatment of Allergic Conditions: Eosinophil Disorders.

Immunol Allergy Clin North Am 2020 11 12;40(4):649-665. Epub 2020 Sep 12.

Department of Medicine, University Hospital GB Rossi, University of Verona, Piazzale LA Scuro, 10, Verona 37134, Italy. Electronic address:

Eosinophil-associated diseases are characterized by a common pathogenetic background, represented by eosinophil-led inflammation and overexpression of interleukin (IL)-5. IL-5 and its receptor are excellent therapeutic targets for eosinophil-associated diseases. Three monoclonal antibodies targeting IL-5 currently are available: mepolizumab and reslizumab block circulating IL-5 preventing the binding to its receptor, whereas benralizumab binds to IL-5 receptor α. They have a steroid-sparing effect in eosinophil disorders, such as eosinophilic granulomatosis with polyangiitis, hypereosinophilic syndrome, allergic bronchopulmonary aspergillosis, eosinophilic esophagitis, and chronic eosinophilic pneumonia. The biotechnological drugs targeting IL-5 are promising therapies; however, further studies are needed.
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http://dx.doi.org/10.1016/j.iac.2020.07.001DOI Listing
November 2020

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

Self-injectable epinephrine: doctors' attitude and patients' adherence in real-life.

Curr Opin Allergy Clin Immunol 2020 10;20(5):474-481

Division of Pulmonary, Allergy and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA.

Purpose Of Review: Epinephrine is the only life-saving treatment of anaphylaxis. Prescription and administration rates of self-injectable epinephrine are generally low. It is unclear whether this is because of availability, low prescription rates, fear of using epinephrine, or a combination of these issues.

Recent Findings: This review focuses on what self-injectable epinephrine devices (SIED), such as auto-injectors and prefilled syringes, are preferred by patients and healthcare professionals (HCP). Our findings suggest that a device's ease to use, proper and frequent training on its operability, and availability have an impact on preferences and adherence to treatment with SIEDs. After prescribing a patient with a SIED, clinicians should emphasize its use in anaphylaxis, educate patients/caregivers to identify anaphylaxis and on how to use the SIED, and encourage constant practicing with training devices.

Summary: Epinephrine is the sole recommended anaphylaxis treatment and SIEDs are of critical usefulness in the community setting. Further studying of these devices is needed to optimize education for HCPs and patients and their accessibility to SIEDs.
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http://dx.doi.org/10.1097/ACI.0000000000000664DOI Listing
October 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

COVID-19, asthma, and biological therapies: What we need to know.

World Allergy Organ J 2020 May 16;13(5):100126. Epub 2020 May 16.

Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona Health Sciences, Tucson, AZ, USA.

Managing patients with severe asthma during the coronavirus pandemic and COVID-19 is a challenge. Authorities and physicians are still learning how COVID-19 affects people with underlying diseases, and severe asthma is not an exception. Unless relevant data emerge that change our understanding of the relative safety of medications indicated in patients with asthma during this pandemic, clinicians must follow the recommendations of current evidence-based guidelines for preventing loss of control and exacerbations. Also, with the absence of data that would indicate any potential harm, current advice is to continue the administration of biological therapies during the COVID-19 pandemic in patients with asthma for whom such therapies are clearly indicated and have been effective. For patients with severe asthma infected by SARS-CoV-2, the decision to maintain or postpone biological therapy until the patient recovers should be a case-by-case based decision supported by a multidisciplinary team. A registry of cases of COVID-19 in patients with severe asthma, including those treated with biologics, will help to address a clinical challenge in which we have more questions than answers.
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http://dx.doi.org/10.1016/j.waojou.2020.100126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7229954PMC
May 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

Adverse reaction to local anaesthetics: Is it always allergy?

Oral Dis 2020 Feb 24. Epub 2020 Feb 24.

Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy.

Objective: Local anaesthetics are very commonly used drugs in dentistry, and people who undergo procedures with local anaesthetics often refer adverse reactions that are not of allergic origin. Considering that in dentistry contact with allergens is very frequent, it is essential to assess the real incidence of allergy to local anaesthetics.

Subjects And Methods: We evaluated a group of 159 patients in whom adverse reaction occurred after procedures with local anaesthetics.

Results: The reactions between allergy to local anaesthetic (immediate and delayed) and certain symptoms presented by patients were investigated. Allergy to latex and chlorexidine were investigated in all patients. Only one patient, who previously presented a constant erythema at the wrist after procedure with local anaesthetics, was positive to Mepivacaine patch test. Two patients were positive to latex and one to chlorexidine.

Conclusions: The main finding of this study was that a reaction registered in the medical history and reported by a patient is rarely allergic but the use of vasoconstrictors or emotional factors may account for it. However, a complete allergological investigation is necessary for a correct diagnosis and future management.
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http://dx.doi.org/10.1111/odi.13310DOI Listing
February 2020

Evolving phenotypes to endotypes: is precision medicine achievable in asthma?

Expert Rev Respir Med 2020 02 3;14(2):163-172. Epub 2020 Jan 3.

Department of Biomedical Sciences, Humanitas University, Milan, Italy.

: The development of biologic molecules led to a drastic change in the therapeutic approach to asthma. With the prospect of acting on different pathophysiological mechanisms of the disease, the idea of precision medicine was developed, in which a single molecule is able to modify a specific triggering mechanism. Thus, it seemed limiting to stop at the distinction of patients phenotypes and the concept of endotypes became more relevant in the therapeutic approach.: This review deepened the topic of precision medicine through the transition from phenotyping to endotyping. We performed a review of the literature, preferring articles quoted in Medline and published in journals with an impact factor. Results showed that it is fundamental to take into consideration the role of biomarkers and the related therapies currently available for precision medicine.: The possible overlap of patients in different phenotypes requires a more precise classification, which considers endotypization. With the development of biological drugs able to modify and modulate some pathophysiological mechanisms of the disease, the theoretical concept of endotyping becomes practical, allowing the clinician to choose the specific mechanism to 'attack' in order to control the disease.
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http://dx.doi.org/10.1080/17476348.2020.1703675DOI Listing
February 2020