R Asero

University College Cork, Corcaigh, Munster, Ireland

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Publications (275)1119 Total impact

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    ABSTRACT: Hazelnut allergy is birch pollen-driven in Northern/Western Europe and lipid transfer protein-driven in Spain and Italy. Little is known about other regions and other allergens. Establishing a molecular map of hazelnut allergy across Europe. In 12 European cities, subjects reporting reactions to hazelnut (n = 731) were evaluated and sensitization to 24 foods, 12 respiratory allergen sources, and latex was tested by using skin prick test and ImmunoCAP. A subset (124 of 731) underwent a double-blind placebo-controlled food challenge to hazelnut. Sera of 423 of 731 subjects were analyzed for IgE against 7 hazelnut allergens and cross-reactive carbohydrate determinants by ImmunoCAP. Hazelnut allergy was confirmed in 70% of those undergoing double-blind placebo-controlled food challenges. Birch pollen-driven hazelnut sensitization (Cor a 1) dominated in most cities, except in Reykjavik, Sofia, Athens, and Madrid, where reporting of hazelnut allergy was less frequent anyhow. In Athens, IgE against Cor a 8 dominated and strongly correlated with IgE against walnut, peach, and apple and against Chenopodium, plane tree, and mugwort pollen. Sensitization to seed storage proteins was observed in less than 10%, mainly in children, and correlated with IgE to nuts, seeds, and legumes. IgE to Cor a 12, observed in all cities (10% to 25%), correlated with IgE to nuts, seeds, and pollen. In adulthood, the importance of hazelnut sensitization to storage proteins, oleosin (Cor a 12), and Cor a 8 is diluted by the increased role of birch pollen cross-reactivity with Cor a 1. Cor a 8 sensitization in the Mediterranean is probably driven by diet in combination with pollen exposure. Hazelnut oleosin sensitization is prevalent across Europe; however, the clinical relevance remains to be established. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
  • R Asero
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    ABSTRACT: The relationship between hypersensitivity to NSAID and atopic status is still incompletely defined. Previous studies found a high prevalence of atopic diseases in multiple NSAID reactors. The present study aimed to investigate whether this is the case also in Italian adults hypersensitive to NSAIDs. Skin tests with a large panel of seasonal and perennial airborne allergens were carried out in 252 patients with a clear-cut history of acute urticaria induced by nonsteroidal anti-inflammatory drugs. Patients were classified as single or multiple NSAID reactors based on clinical history, presence/absence of chronic urticaria, re-challenge with the reported offending drug in case of doubt history, and oral challenges with aspirin or propionic acid derivatives. Single NSAID reactors showed a much higher prevalence of atopic diseases than multiple NSAID reactors either with or without chronic urticaria (61% vs 19% and 19%, respectively; p < 0.001). As a difference from previous reports, in Italian patients hypersensitive to NSAID atopy is much more prevalent among single reactors, a finding that indirectly supports the possible IgE-mediated origin of this type of adverse drug reaction.
    European annals of allergy and clinical immunology 03/2015; 47(2):48-53.
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    ABSTRACT: Chronic urticaria (CU) is a skin disorder characterized by transient, pruritic wheals persisting longer than 6 weeks. According to European Academy of Allergy and Clinical Immunology (EAACI) guidelines, CU can be categorized into two main types: chronic spontaneous urticaria (CSU), in which the wheals appear spontaneously, and inducible urticaria, that is triggered by physical agents. CSU may be due to triggering factors such as food allergens or infections, but is in at least 40% of cases autoimmune in origin, caused by circulating autoantibodies anti--FcεR1 or anti--IgE, or autoreactive. In the present paper, re--evaluating the EAACI guidelines, we have developed a document containing some practical indications which are useful for diagnosis and management of CSU in the context of the Italian reality. Concerning CSU treatment, second generation antihistamines are the first line treatment; these drugs can be used, as second line treatment, at higher than licensed dose in patients who don't respond adequately at licensed doses. The third line treatment include leukotriene receptor antagonists which, however, don't have a specific indication for the treatment of CSU, cyclosporine, whose use in this disease is still off--label, and omalizumab. The latter is a recombinant monoclonal IgG antibody that binds free IgE, down regulates mast cell function and induces eosinophil apoptosis. Recently, it has emerged as an effective and safe treatment for antihistamine--unresponsive CSU of both autoimmune/autoreactive and non--autoimmune/non--autoreactive, and has been officially approved for the use in this disease.
    Giornale italiano di dermatologia e venereologia: organo ufficiale, Societa italiana di dermatologia e sifilografia 02/2015; · 0.86 Impact Factor
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    ABSTRACT: The EuroPrevall project aimed to develop effective management strategies in food allergy through a suite of interconnected studies and a multidisciplinary integrated approach. To address some of the gaps in food allergy diagnosis, allergen risk management and socioeconomic impact, and to complement the EuroPrevall population based surveys, a cross-sectional study in 12 outpatient clinics across Europe was conducted. We describe the study protocol. Patients referred for immediate food adverse reactions underwent a consistent and standardised allergy work-up that comprised collection of medical history, assessment of sensitisation to 24 foods, 14 inhalant allergens, and 55 allergenic molecules, and confirmation of clinical reactivity and food thresholds by standardised double-blind placebo-controlled food challenges (DBPCFC) to milk, egg, fish, shrimp, peanut, hazelnut, celeriac, apple and peach. A standardized methodology for a comprehensive evaluation of food allergy was developed, and implemented in 12 outpatient clinics across Europe. A total of 2121 patients (22.6% <14 years) reporting 8257 reactions to foods were studied, and 516 DBPCFC were performed. This is the largest multicentre European case series in food allergy, in which subjects underwent a comprehensive, uniform and standardised evaluation including DBPCFC, by a methodology which is made available for further studies in food allergy. The analysis of this population will provide information on the different phenotypes of food allergy across Europe, will allow to validate novel in vitro diagnostic tests, to establish threshold values for major allergenic foods, and to analyse the socioeconomic impact of food allergy. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Allergy 01/2015; DOI:10.1111/all.12585 · 6.00 Impact Factor
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    ABSTRACT: Although food allergy has universally been found to impair HRQL, studies have found significant differences in HRQL between countries, even when corrected for differences in perceived disease severity. However, little is known about factors other than disease severity which may contribute to HRQL in food-allergic patients. Therefore, The aim of this study was to identify factors which may predict HRQL of food-allergic patients and also to investigate the specific impact of having experienced anaphylaxis and being prescribed an EAI on HRQL. A total of 648 European food-allergic patients (404 adults, 244 children) completed an age-specific questionnaire-package including descriptive questions. Multivariable regression analyses were performed to develop models for predicting HRQL of these patients. For adults, the prediction model accounted for 62% of the variance in HRQL and included perceived disease severity, type of symptoms, having a fish or milk allergy and gender. For children, the prediction model accounted for 28% of the variance in HRQL and included perceived disease severity, having a peanut or soy allergy, and country of origin. For both adults and children, neither experiencing anaphylaxis nor being prescribed an epinephrine auto-injector (EAI) contributed to impairment of HRQL. In this study food allergy-related HRQL may be predicted to a greater extent in adults than in children. Allergy to certain foods may cause greater HRQL impairment than others. Country of origin may affect HRQL, at least in children. Experiencing anaphylaxis or being prescribed an EAI has no impact on HRQL in either adults or children. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Allergy 01/2015; DOI:10.1111/all.12582 · 6.00 Impact Factor
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    ABSTRACT: Background We tested the hypothesis that specific molecular sensitization patterns correlate with the clinical data/manifestation in a European peanut allergic population characterized under a common protocol.Methods68 peanut allergic subjects and 82 tolerant controls from 11 European countries were included. Allergy to peanut and lowest symptom-eliciting-dose were established by double-blind placebo-controlled food-challenge in all but anaphylactic subjects. Information of early or late (before or after 14 years of age) onset of peanut allergy was obtained from standardized questionnaires. IgE to peanut allergens rAra h 1-3, 6, 8-9, profilin and CCD were determined using ImmunoCAP.Results78% of peanut allergics were sensitised to peanut extract and 90% to at least one peanut component. rAra h 2 was the sole major allergen for the peanut allergic population. Geographic differences were observed for rAra h 8 and rAra h 9, which were major allergens for central/western and southern Europeans, respectively. Sensitisation to rAra h 1 and 2 were exclusively observed in early onset peanut allergy. Peanut tolerant subjects were frequently sensitised to rAra h 8 or 9 but not to storage proteins. Sensitisation to Ara h 2 ≥1.0 kUA/L conferred a 97% probability for a systemic reaction (p=0.0002). Logistic regression revealed a significant influence of peanut extract sensitization and region on the occurrence of systemic reactions (p=0.0185 and p=0.0436 respectively).Conclusion Sensitization to Ara h 1, 2 and 3 is usually acquired in childhood. IgE to Ara h 2 ≥1.0 kUA/L is significantly associated with the development of systemic reactions to peanut.This article is protected by copyright. All rights reserved.
    Allergy 01/2015; DOI:10.1111/all.12574 · 6.00 Impact Factor
  • Riccardo Asero
    Journal of Allergy and Clinical Immunology 12/2014; DOI:10.1016/j.jaci.2014.11.016 · 11.25 Impact Factor
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    ABSTRACT: Precautionary labeling is used to warn consumers of the presence of unintended allergens, but the lack of agreed allergen thresholds can result in confusion and risk taking by patients with food allergy. The lack of data on threshold doses below which subjects are unlikely to react is preventing the development of evidence-based allergen management strategies that are understood by clinician and patient alike. We sought to define threshold dose distributions for 5 major allergenic foods in the European population. Patients with food allergy were drawn from the EuroPrevall birth cohort, community surveys, and outpatient clinic studies and invited to undergo a food challenge. Low-dose, double-blind, placebo-controlled food challenges were undertaken with commercially available food ingredients (peanut, hazelnut, celery, fish, and shrimp) blinded into common matrices. Dose distributions were modeled by using interval-censoring survival analysis with 3 parametric approaches. Of the 5 foods used for challenge, 4 produced similar dose distributions, with estimated doses eliciting reactions in 10% of the allergic population (ED10), ranging from 1.6 to 10.1 mg of protein for hazelnut, peanut, and celery with overlapping 95% CIs. ED10 values for fish were somewhat higher (27.3 mg of protein), although the CIs were wide and overlapping between fish and plant foods. Shrimp provided radically different dose distributions, with an ED10 value of 2.5 g of protein. This evidence base will contribute to the development of reference doses and action levels for allergens in foods below which only the most sensitive subjects might react. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
    Journal of Allergy and Clinical Immunology 12/2014; DOI:10.1016/j.jaci.2014.10.047 · 11.25 Impact Factor
  • 12/2014; 3(4):191-196. DOI:10.1007/s13671-014-0088-8
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    ABSTRACT: Little is known about the prevalence and clinical relevance of sensitization to shrimp allergens other than tropomyosin.
    European annals of allergy and clinical immunology 09/2014; 46(5):172-7.
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    ABSTRACT: Background In many areas of Europe, double sensitization to ragweed and mugwort is common, and because of the overlapping flowering periods of the 2 plants, it is not possible to diagnose the primary sensitizing allergen source and hence to determine the proper immunotherapy. Objective To elucidate whether double-sensitized patients are cosensitized or cross-sensitized and, in the latter case, to define the primary sensitizer. Methods Serum samples from 34 patients with late summer respiratory allergy underwent skin prick testing with whole ragweed, and mugwort extracts were analyzed for their reactivity to recombinant Art v 1 and Amb a 1 by ImmunoCAP and then to Amb a 1, Art v 6, and Art v 1 isoforms by a proteomic approach. In double reactors, the primary sensitizing sources were detected by inhibition experiments. Results Serum samples from patients monosensitized to ragweed contained IgE to epitopes specific of all Amb a 1 isoforms. In contrast, serum samples from double reactors found to be primarily sensitized to mugwort reacted to Art v 1 and Art v 6 and cross-reacted to a few Amb a 1 isoforms. Finally, serum samples from double reactors found to be primarily sensitized to ragweed contained IgE reacting to all Amb a 1 isoforms, part of which cross-reacted to Art v 6. We did not find cosensitized patients. Conclusion This study found that Art v 6 plays an important role in mugwort allergy and that the cross-reactivity between Art v 6 and Amb a 1 is frequent, bidirectional, and clinically relevant in the area of Milan.
    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 09/2014; DOI:10.1016/j.anai.2014.06.009 · 2.75 Impact Factor
  • Riccardo Asero
    International Archives of Allergy and Immunology 07/2014; 164(2):149-150. DOI:10.1159/000363504 · 2.25 Impact Factor
  • R Asero
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    ABSTRACT: Lipid transfer protein (LTP) is a widely cross-reacting allergen in plant foods.
    European annals of allergy and clinical immunology 07/2014; 46(4):142-146.
  • Riccardo Asero
    International Archives of Allergy and Immunology 06/2014; 164(2):106-108. DOI:10.1159/000363448 · 2.25 Impact Factor
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    ABSTRACT: Background Sensitization to profilins and other cross-reacting molecules might hinder proper specific immunotherapy (SIT) prescription in polysensitized patients with pollen-related allergic rhinitis (AR). In these patients, component-resolved diagnosis (CRD) might modify SIT prescription by improving the identification of the disease-eliciting pollen sources. Objectives We sought to measure the effect of CRD on SIT prescription in children with pollen-related AR. Methods Children (n = 651) with moderate-to-severe pollen-related AR were recruited between May 2009 and June 2011 in 16 Italian outpatient clinics. Skin prick test (SPT) reactivity to grass, cypress, olive, mugwort, pellitory, and/or Betulaceae pollen was considered clinically relevant if symptoms occurred during the corresponding peak pollen season. IgE sensitization to Phl p 1, Phl p 5, Bet v 1, Cup a 1, Art v 1, Ole e 1, Par j 2, and Phl p 12 (profilin) was measured by using ImmunoCAP. SIT prescription was modeled on SPT responses first and then remodeled considering also CRD according to GA2LEN–European Academy of Allergology and Clinical Immunology guidelines and the opinions of 14 pediatric allergists. Results No IgE to the respective major allergens was detected in significant proportions of patients with supposed clinically relevant sensitization to mugwort (45/65 [69%]), Betulaceae (146/252 [60%]), pellitory (78/257 [30%]), olive (111/390 [28%]), cypress (28/184 [15%]), and grass (56/568 [10%]). IgE to profilins, polcalcins, or both could justify 173 (37%) of 464 of these SPT reactions. After CRD, the SPT-based decision on SIT prescription or composition was changed in 277 (42%) of 651 or 315 (48%) of 651 children according to the European or American approach, respectively, and in 305 (47%) of 651 children according to the opinion of the 14 local pediatric allergists. Conclusions In children with pollen-related AR, applying CRD leads to changes in a large proportion of SIT prescriptions as opposed to relying on clinical history and SPT alone. The hypothesis that CRD-guided prescription improves SIT efficacy deserves to be tested.
    The Journal of allergy and clinical immunology 05/2014; 02 may 2014(in press). · 12.05 Impact Factor
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    ABSTRACT: Sensitization to profilins and other cross-reacting molecules might hinder proper specific immunotherapy (SIT) prescription in polysensitized patients with pollen-related allergic rhinitis (AR). In these patients, component-resolved diagnosis (CRD) might modify SIT prescription by improving the identification of the disease-eliciting pollen sources. We sought to measure the effect of CRD on SIT prescription in children with pollen-related AR. Children (n = 651) with moderate-to-severe pollen-related AR were recruited between May 2009 and June 2011 in 16 Italian outpatient clinics. Skin prick test (SPT) reactivity to grass, cypress, olive, mugwort, pellitory, and/or Betulaceae pollen was considered clinically relevant if symptoms occurred during the corresponding peak pollen season. IgE sensitization to Phl p 1, Phl p 5, Bet v 1, Cup a 1, Art v 1, Ole e 1, Par j 2, and Phl p 12 (profilin) was measured by using ImmunoCAP. SIT prescription was modeled on SPT responses first and then remodeled considering also CRD according to GA(2)LEN-European Academy of Allergology and Clinical Immunology guidelines and the opinions of 14 pediatric allergists. No IgE to the respective major allergens was detected in significant proportions of patients with supposed clinically relevant sensitization to mugwort (45/65 [69%]), Betulaceae (146/252 [60%]), pellitory (78/257 [30%]), olive (111/390 [28%]), cypress (28/184 [15%]), and grass (56/568 [10%]). IgE to profilins, polcalcins, or both could justify 173 (37%) of 464 of these SPT reactions. After CRD, the SPT-based decision on SIT prescription or composition was changed in 277 (42%) of 651 or 315 (48%) of 651 children according to the European or American approach, respectively, and in 305 (47%) of 651 children according to the opinion of the 14 local pediatric allergists. In children with pollen-related AR, applying CRD leads to changes in a large proportion of SIT prescriptions as opposed to relying on clinical history and SPT alone. The hypothesis that CRD-guided prescription improves SIT efficacy deserves to be tested.
    The Journal of allergy and clinical immunology 04/2014; DOI:10.1016/j.jaci.2014.01.042 · 12.05 Impact Factor
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    ABSTRACT: This guideline is the result of a systematic literature review using the 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) methodology and a structured consensus conference held on 28 and 29 November 2012, in Berlin. It is a joint initiative of the Dermatology Section of the European Academy of Allergy and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA(2) LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) with the participation of delegates of 21 national and international societies. Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The life-time prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria do not only cause a decrease in quality of life, but also affect performance at work and school and, as such, are members of the group of severe allergic diseases. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).
    Allergy 04/2014; DOI:10.1111/all.12313 · 6.00 Impact Factor
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    ABSTRACT: Chronic urticaria (CU) is a widespread skin disease, characterized by the recurrence of transient wheals and itch for more than 6 weeks. Besides autoimmune mechanisms, coagulation factors, in particular tissue factor and thrombin, might also participate in the disease pathophysiology. Tissue factor expressed by eosinophils can induce activation of blood coagulation generating thrombin which in turn can increase vascular permeability both directly, acting on endothelial cells, and indirectly, inducing degranulation of mast cells with release of histamine, as demonstrated in experimental models. D-dimer, a fibrin degradation product, generated following activation of the coagulation cascade and fibrinolysis, has been found to be increased during urticaria exacerbations; moreover, it has been proposed as a biomarker of severity and resistance to H1-antihistamines in CU patients. The possible role of coagulation in CU is also supported by case reports, case series and a small controlled study showing the efficacy of anticoagulant therapy in this disease. The purpose of this review was to summarize the available data on the possible contribution of coagulation to the pathophysiology of CU focusing on clinical aspects and possible future therapeutic developments.
    Allergy 03/2014; DOI:10.1111/all.12389 · 6.00 Impact Factor
  • Journal of Allergy and Clinical Immunology 02/2014; 133(2):AB45. DOI:10.1016/j.jaci.2013.12.186 · 11.25 Impact Factor
  • Riccardo Asero, Alberto Tedeschi, Massimo Cugno
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    ABSTRACT: Second-generation antihistamines are unquestionably the first-line treatment for chronic urticaria and can be used at higher than licensed doses if normal doses fail to control the disease. A short course of oral corticosteroids should be considered for patients not responding to antihistamines before trying other immunosuppressive drugs. Ciclosporin is effective in most antihistamine-resistant patients who require long-term corticosteroid treatments to control their disease. Omalizumab is effective in most subsets of chronic urticaria sufferers who do not respond to other treatments but its high cost represents a limitation to its widespread use.
    Immunology and allergy clinics of North America 02/2014; 34(1):105-116. DOI:10.1016/j.iac.2013.09.013 · 3.18 Impact Factor

Publication Stats

5k Citations
1,119.00 Total Impact Points

Institutions

  • 2014
    • University College Cork
      Corcaigh, Munster, Ireland
  • 2013
    • Università degli Studi di Genova
      Genova, Liguria, Italy
  • 2006–2013
    • Azienda Ospedaliera Niguarda Ca' Granda
      Milano, Lombardy, Italy
    • Utrecht University
      • Department of Dermatology and Allergology
      Utrecht, Utrecht, Netherlands
  • 2005–2013
    • Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
      • • Allergology and Clinical Immunology
      • • Internal Medicine 3
      Milano, Lombardy, Italy
  • 2012
    • Charité Universitätsmedizin Berlin
      • Department of Pediatrics, Division of Pneumonology and Immunology
      Berlín, Berlin, Germany
  • 2009
    • Complesso Integrato Columbus
      Roma, Latium, Italy
  • 1988–2006
    • University of Milan
      • Department of Internal Medicine
      Milano, Lombardy, Italy