Publications (20)115.35 Total impact
-
Article: The added value of allergen microarray technique to the management of poly-sensitized allergic patients.
[show abstract] [hide abstract]
ABSTRACT: To evaluate the relevance of results obtained using allergen microarray technique for the description of the IgE repertoire in allergic patients. Allergen microarray was introduced at the beginning of the last decade. Since then, an increasing number of allergens have been identified, correspondingly increasing the accuracy of the description of immunoglobulin (Ig)E repertoire. In the last 2 years, a large number of articles were published that accurately described not only the general features of this technique, but also the use of allergen microarray in specific situations. The recent availability of highly purified or recombinant allergen components has deeply modified the laboratory approach to allergy diagnosis that, now, it cannot be limited to the detection of IgE specific to extractive allergens. Indeed, these contain both specific components (i.e. molecules strictly associated to that allergen source) and pan-allergen or cross-reacting allergens (i.e. molecules that are present in different similar allergen sources or that are present in highly homologous structures in different species). Newer techniques such as recombinant allergen testing and allergen microarray allow a more detailed evaluation of IgE responses. Future research is needed to more clearly define their role in clinical practice.Current Opinion in Allergy and Clinical Immunology 05/2012; 12(4):434-9. · 4.11 Impact Factor -
Article: Evidences of efficacy of allergen immunotherapy in atopic dermatitis: an updated review.
[show abstract] [hide abstract]
ABSTRACT: To update and assess the quality of the evidence concerning the efficacy of allergen immunotherapy for atopic eczema. Desensitization for eczema as a clinical manifestation of food allergy was not a target of this review. In the past 5 years, from the last comprehensive systematic review of Bussmann et al., four controlled trials have been published on this topic, two using injection and two sublingual immunotherapy. The active treatment was compared with placebo, pharmacotherapy or different schedules of immunotherapy. The studies variably involved adults and children and showed an improvement of atopic dermatitis severity. Severe eczema seems less responsive to hyposensitization, and a minimal treatment duration of 9-12 months appears necessary. The efficacy of immunotherapy in patients with atopic eczema has been poorly investigated in the past 5 years. The available trials have small dimension and some methodological shortcomings, in addition to incomplete reporting. Clinical and methodological interstudy heterogeneity is apparent. Only one study adopted a placebo control. The evidence of efficacy has not critically changed from previous systematic observations. No long-term studies have been conducted to determine the disease-modifying potential of specific immunotherapy in the context of the 'allergy march'.Current Opinion in Allergy and Clinical Immunology 05/2012; 12(4):427-33. · 4.11 Impact Factor -
Article: Allergens and bacteria interaction in the induction of basophil activation: is this the lost ring between allergy and infections in pediatric patients?
[show abstract] [hide abstract]
ABSTRACT: The aim of this review is to describe the relationships between allergy and infectious diseases, with specific attention on bacterial infection. According to the most recent literature, bacteria could be considered also as one of the major causes of asthma exacerbations that we need to further explore. The availability of novel methods to detect large panels of pathogens, including viruses and bacteria specific for the upper respiratory tract, together with the capacity of evaluating how basophils are activated, has changed the point of view of the mechanisms related to asthma exacerbations. The recent finding that basophils are activated in the presence of suboptimal doses of allergens and bacteria has been recently described and may explain the clinical behavior of allergy exacerbation. Indeed the activation of basophils induces the secretion of mediators, which, at bronchial level, may cause bronchospasm that leads to an asthma exacerbation in patients with infection. The contrary is also true. Although the explanations for these facts are numerous, at present, bacteria seem to play a relevant role in the worsening of asthma in infected patients.Current Opinion in Allergy and Clinical Immunology 04/2012; 12(2):164-70. · 4.11 Impact Factor -
Article: Allergic diseases and asthma: a major global health concern.
Current Opinion in Allergy and Clinical Immunology 12/2011; 12(1):39-41. · 4.11 Impact Factor -
Article: The IgE repertoire in children and adolescents resolved at component level: a cross-sectional study.
[show abstract] [hide abstract]
ABSTRACT: It is well known that allergy evolves at clinical level from the birth to adulthood, and this has been clearly demonstrated also at a level of sensitization. However, little information is available on the evolution of the IgE repertoire directed to single allergenic components. In this cross-sectional, observational study, the evolution of the IgE repertoire was analysed at component level. Serum samples from 901 allergic patients, stratified in 6 groups according to age, were analysed by ImmunoCAP ISAC, a microarray chip that allows to identify the presence of specific IgE towards 103 different allergen components. Total IgE were also evaluated. The behaviour of total IgE according to age strictly paralleled that of the sum of specific IgE directed to molecular components. As expected, food-related components (in particular those of milk and egg) were the most frequently recognized in the earliest ages, whereas specific IgE to plant allergens appeared invariably later. Nonetheless, IgE specific to mite components was the most represented in all age classes. Of note, specific IgE against cross-reacting allergens was virtually absent in the first years and tended to appear only after the age of 6. Despite this was not a study performed on a cohort of patients followed up from birth to adolescence, the molecular patterns of allergen recognition resulted modified according to age. These findings may support, at molecular level, the clinical features of the allergic march.Pediatric Allergy and Immunology 11/2011; 23(5):433-40. · 2.46 Impact Factor -
Article: Turkish version of the chronic urticaria quality of life questionnaire: cultural adaptation, assessment of reliability and validity.
[show abstract] [hide abstract]
ABSTRACT: Chronic spontaneous urticaria has a substantial impact on patients' quality of life. The first disease-specific tool to assess quality of life impairment in this condition, the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL), was developed recently. The aim of this study was to adapt the original Italian version to the Turkish language and to evaluate its reliability, validity, and sensitivity to change. The Turkish version was developed by performing forward- and back-translation. It was then applied to 140 consecutive patients with chronic spontaneous urticaria, along with the Dermatology Life Quality Index and the Skindex-29. Disease activity was assessed using the Urticaria Activity Score. Sensitivity to change was measured in 101 patients, who completed the instruments twice at intervals of 4 weeks. Confirmatory factor analysis demonstrated that the six-scale structure of the original Italian version ("pruritus", "swelling", "impact on life activities", "sleep problems", "limits", "looks") can be retained in the Turkish instrument. Analysis regarding convergent validity showed good correlations of the Turkish CU-Q2oL with the other instruments. In addition, it was found to discriminate well between patients with different levels of urticaria activity, and to be sensitive to change. In conclusion, the Turkish version of CU-Q2oL is a reliable, valid, and sensitive instrument, which will help to characterize better the clinical impact of chronic spontaneous urticaria and treatment outcomes in Turkish patients. Its identical scale structure to that of other CU-Q2oL instruments makes it ideal for cross-cultural comparisons and for its application in future national and multinational studies.Acta Dermato-Venereologica 09/2011; 92(4):419-25. -
Article: Towards the Grade of Recommendations, Assessment, Development and Evaluation system: methods and results of budesonide/formoterol maintenance and reliever therapy research.
[show abstract] [hide abstract]
ABSTRACT: Guidelines for clinical practice are expected to gather evidence-based recommendations to support optimal medical behaviours. The aim of the current review is to explore how currently available research regarding the strategy of using budesonide/formoterol (BUD/FORM) as maintenance and reliever therapy (Symbicort SMART) covers the items considered by the Grade of Recommendations, Assessment, Development and Evaluation (GRADE) system, through a comparative analysis of methodological approaches, clinical outcomes, patient-reported outcomes and costs, in order to highlight uncovered areas. Thirteen trials providing data on 21 095 analysed patients were available. No serious limits in methodological study features were found. Evaluation of the clinical outcome was consistent with the efficacy of BUD/FORM maintenance and reliever therapy. As the time to first exacerbation was the primary outcome in most of the studies, conclusive indications cannot be drawn regarding other clinical outcomes or patient-reported outcomes, which were investigated as secondary outcomes. A comprehensive systematic review exploring all critical and important outcomes is desirable, but further research concerning the safety issues of Long Acting β2 Agonists (LABA) and patients' reported outcomes about the SMART in respect to alternative strategies is likely to affect a clear recommendation in the near future. The efficacy of BUD/FORM maintenance and reliever therapy in extending the time to first exacerbation appears consistent between studies. Further studies exploring all patients' important outcomes are needed. Clinical and economic assessments are worthy of being investigated to verify the directness of the evidence in respect to real life patients and different geographical realities.Current Opinion in Allergy and Clinical Immunology 06/2011; 11(4):361-74. · 4.11 Impact Factor -
Article: Sublingual immunotherapy for allergic rhinitis: an update.
[show abstract] [hide abstract]
ABSTRACT: Sublingual immunotherapy (SLIT) has progressively gained credibility. Randomized double-blind placebo-controlled trials, meta-analyses and mechanistic studies have accumulated rapidly in the last years. We will review herein a brief history of SLIT, its indications and the safety aspects and will discuss the main unmet needs and the points to be developed in the field. During the last year, new information on SLIT has become available, mainly from the so-called big trials, and some important aspects have been partially clarified. In addition, the possible indications to SLIT began to be expanded. The dose dependency of the efficacy of SLIT and the optimal maintenance dose have been identified at least for grass allergens. The safety is well demonstrated in both adults and children.Current opinion in otolaryngology & head and neck surgery 02/2011; 19(1):43-7. -
Article: Lack of neo-sensitization to Pen a 1 in patients treated with mite sublingual immunotherapy.
[show abstract] [hide abstract]
ABSTRACT: Some studies reported the possible induction of food allergy, caused by neo-sensitization to cross-reacting allergens, during immunotherapy with aeroallergens, while other studies ruled out such possibility. The aim of this study was to evaluate the development of neo-sensitization to Pen a 1 (tropomyosin) as well as the appearance of reactions after ingestion of foods containing tropomyosin as a consequence of sublingual mite immunization. Specific IgE to Tropomyosin (rPen a 1) before and after mite sublingual immunotherapy in 134 subjects were measured. IgE-specific antibodies for mite extract and recombinant allergen Pen a 1 were evaluated using the immunoenzymatic CAP system (Phadia Diagnostics, Milan, Italy). All patients had rPen a 1 IgE negative results before and after mite SLIT and did not show positive shrimp extract skin reactivity and serological rPen a 1 IgE conversion after treatment. More important, no patient showed systemic reactions to crustacean ingestion. Patients did not show neo-sensitization to tropomyosin, a component of the extract (namely mite group 10) administered. An assessment of a patient's possible pre-existing sensitisation to tropomyosin by skin test and/or specific IgE prior to start mite extract immunotherapy is recommended. This trial is registered in EudraCT, with the ID number of 2010-02035531.Clinical and Molecular Allergy 03/2010; 8:4. · 1.39 Impact Factor -
Article: Efficacy of desloratadine in persistent allergic rhinitis - a GA²LEN study.
[show abstract] [hide abstract]
ABSTRACT: The ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines proposed a classification for allergic rhinitis based on the duration of symptoms (intermittent or persistent) rather than on the time of allergen exposure (seasonal or perennial). There had been no placebo-controlled, randomized, clinical trial of desloratadine (DL) in patients with persistent allergic rhinitis to date. To assess the efficacy and safety of DL in patients with persistent allergic rhinitis based on the ARIA classification. Patients 12 years of age and older with persistent allergic rhinitis were assessed over 85 days of treatment with DL 5 mg once daily (n = 360) or placebo (n = 356). The primary endpoint was the AM/PM reflective total 5-symptom score (T5SS) averaged over days 1-29. Secondary endpoints included AM/PM instantaneous T5SS and individual symptoms, therapeutic response, symptom severity assessed by a visual analogue scale and quality of life. The mean reduction in AM/PM reflective T5SS was significantly greater with DL than placebo over days 1-29 (-3.76 vs. -2.87, p < 0.001) and on each individual day (p < 0.05). The mean AM instantaneous T5SS was significantly reduced with DL compared with placebo as early as day 2 (-1.90 vs. -1.46; p < 0.001). The therapeutic response and improvement in quality of life were significantly greater with DL than placebo (p < 0.001 for each). The frequency of treatment-related adverse events was low and similar between DL (10.0%) and placebo (8.4%). This study showed DL to be effective and safe in the treatment of persistent allergic rhinitis.International Archives of Allergy and Immunology 01/2010; 153(4):395-402. · 2.40 Impact Factor -
Article: Unmet needs in severe chronic upper airway disease (SCUAD).
[show abstract] [hide abstract]
ABSTRACT: Although the majority of patients with chronic upper airway diseases have controlled symptoms during treatment, many patients have severe chronic upper airway diseases (SCUADs). SCUAD defines those patients whose symptoms are inadequately controlled despite adequate (ie, effective, safe, and acceptable) pharmacologic treatment based on guidelines. These patients have impaired quality of life, social functioning, sleep, and school/work performance. Severe uncontrolled allergic rhinitis, nonallergic rhinitis, chronic rhinosinusitis, aspirin-exacerbated respiratory diseases, or occupational airway diseases are defined as SCUADs. Pediatric SCUADs are still unclear. In developing countries SCUADs exist, but risk factors can differ from those seen in developed countries. Comorbidities are common in patients with SCUADs and might increase their severity. The present document is the position of a group of experts considering that SCUADs should be considered differently from mild chronic upper airway diseases. It reviews the state of the art, highlighting gaps in our knowledge, and proposes several areas for a better understanding, prevention, and management of SCUADs. This document can also serve to optimize the pharmacoeconomic evaluation of SCUADs by means of comparison with mild chronic upper airway diseases.The Journal of allergy and clinical immunology 09/2009; 124(3):428-33. · 9.17 Impact Factor -
Article: Functionally relevant decreases in activatory receptor expression on NK cells are associated with pulmonary tuberculosis in vivo and persist after successful treatment.
[show abstract] [hide abstract]
ABSTRACT: Correlates for the initiation of Mycobacterium tuberculosis hominis (Mth) replication from latency are needed in order to improve Mth control. In order to analyze if perturbations of peripheral NK cells may be associated with exit from Mth latency, sequential patients with newly diagnosed lung tuberculosis (TB) were studied. Peripheral NK cells were analyzed by cytofluorometry, in vitro culture and functional assays. At the onset of lung TB, imbalances in NK cell subsets were evident. Decreased CD56(bright)CD16(+/-) subsets with significantly compromised NKp30 and NKp46 expression and with specifically decreased gamma-IFN production upon triggering were evident. These features were not completely restored when purified NK cells were cultured in vitro. Culture supplementation with alpha-IFN increased only NKp30 expression in TB and healthy donors. Extensive peripheral NK cell triggering was evident in these patients, as shown by the expression of NK cell activation markers and of the lymph node-homing chemokine receptor CCR7 on CD16(+) CD56(dull) cells. Significant persistence of decreased NKp30 and NKp46 after successful treatment with a standard four-drug regimen was detected after full recovery. NK cell function is deeply affected in patients at the onset of pulmonary TB. The involvement of multiple activatory receptors may provide a relevant contribution to the spread of mycobacteria exiting from latency.International Immunology 06/2009; 21(7):779-91. · 3.41 Impact Factor -
Article: Preventive effects of sublingual immunotherapy in childhood: an open randomized controlled study.
[show abstract] [hide abstract]
ABSTRACT: Sublingual immunotherapy (SLIT) has been proved to be effective in allergic rhinitis and asthma, but there are few data on its preventive effects, especially in children. To evaluate the clinical and preventive effects of SLIT in children by assessing onset of persistent asthma and new sensitizations, clinical symptoms, and bronchial hyperreactivity. A total of 216 children with allergic rhinitis, with or without intermittent asthma, were evaluated and then randomized to receive drugs alone or drugs plus SLIT openly for 3 years. The clinical score was assessed yearly during allergen exposure. Pulmonary function testing, methacholine challenge, and skin prick testing were performed at the beginning and end of the study. One hundred forty-four children received SLIT and 72 received drugs only. Dropouts were 9.7% in the SLIT group and 8.3% in the controls. New sensitizations appeared in 34.8% of controls and in 3.1% of SLIT patients (odds ratio, 16.85; 95% confidence interval, 5.73-49.13). Mild persistent asthma was less frequent in SLIT patients (odds ratio, 0.04; 95% confidence interval, 0.01-0.17). There was a significant decrease in clinical scores in the SLIT group vs the control group since the first year. The number of children with a positive methacholine challenge result decreased significantly after 3 years only in the SLIT group. Adherence was 80% or higher in 73.8% of patients. Only 1 patient reported systemic itching. In everyday clinical practice, SLIT reduced the onset of new sensitizations and mild persistent asthma and decreased bronchial hyperreactivity in children with respiratory allergy.Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 09/2008; 101(2):206-11. · 2.83 Impact Factor -
Article: Rescue use of beclomethasone and albuterol in a single inhaler for mild asthma.
[show abstract] [hide abstract]
ABSTRACT: Treatment guidelines recommend the regular use of inhaled corticosteroids for patients with mild persistent asthma. We investigated whether the symptom-driven use of a combination of beclomethasone dipropionate and albuterol (also known as salbutamol) in a single inhaler would be as effective as the regular use of inhaled beclomethasone and superior to the as-needed use of inhaled albuterol. We conducted a 6-month, double-blind, double-dummy, randomized, parallel-group trial. After a 4-week run-in, patients with mild asthma were randomly assigned to receive one of four inhaled treatments: placebo twice daily plus 250 microg of beclomethasone and 100 microg of albuterol in a single inhaler as needed (as-needed combination therapy); placebo twice daily plus 100 microg of albuterol as needed (as-needed albuterol therapy); 250 microg of beclomethasone twice daily and 100 microg of albuterol as needed (regular beclomethasone therapy); or 250 microg of beclomethasone and 100 microg of albuterol in a single inhaler twice daily plus 100 microg of albuterol as needed (regular combination therapy). The primary outcome was the morning peak expiratory flow rate. In 455 patients with mild asthma who had a forced expiratory volume in 1 second of 2.96 liters (88.36% of the predicted value), the morning peak expiratory flow rate during the last 2 weeks of the 6-month treatment was higher (P=0.04) and the number of exacerbations during the 6-month treatment was lower (P=0.002) in the as-needed combination therapy group than in the as-needed albuterol therapy group, but the values in the as-needed combination therapy group were not significantly different from those in the groups receiving regular beclomethasone therapy or regular combination therapy. The cumulative dose of inhaled beclomethasone was lower in the as-needed combination therapy group than in the groups receiving regular beclomethasone therapy or regular combination therapy (P<0.001 for both comparisons). In patients with mild asthma, the symptom-driven use of inhaled beclomethasone (250 microg) and albuterol (100 microg) in a single inhaler is as effective as regular use of inhaled beclomethasone (250 microg twice daily) and is associated with a lower 6-month cumulative dose of the inhaled corticosteroid. (ClinicalTrials.gov number, NCT00382889 [ClinicalTrials.gov].).New England Journal of Medicine 05/2007; 356(20):2040-52. · 53.30 Impact Factor -
Article: World Allergy Organization guidelines for prevention of allergy and allergic asthma.
International Archives of Allergy and Immunology 10/2004; 135(1):83-92. · 2.40 Impact Factor -
Article: The asthma-rhinitis association: between the clinical hypothesis and the scientific theory.
Current Allergy and Asthma Reports 06/2003; 3(3):191-3. · 2.50 Impact Factor -
Article: Requirements for medications commonly used in the treatment of allergic rhinitis. European Academy of Allergy and Clinical Immunology (EAACI), Allergic Rhinitis and its Impact on Asthma (ARIA).
Allergy 04/2003; 58(3):192-7. · 6.27 Impact Factor -
Article: Requirements for medications commonly used in the treatment of allergic rhinitis
Allergy 03/2003; 58(3):192 - 197. · 6.27 Impact Factor -
Article: Oral, nasal and sublingual immunotherapy: do they work, are they safe?
Arbeiten aus dem Paul-Ehrlich-Institut (Bundesamt für Sera und Impfstoffe) zu Frankfurt a.M 02/2003; -
Article: Single-dose oral tolerance test with alternative compounds for the management of adverse reactions to drugs.
[show abstract] [hide abstract]
ABSTRACT: Adverse reactions to drugs are common in the clinical practice. Many outpatients are frequently referred to allergists in order to determine which drugs they can safely take in the future. We set up an oral single-dose tolerance test procedure to find out for each patient one or more alternative drugs that can be taken when needed. 452 outpatients (130 male, 322 female) with well-documented reactions (urticaria/angioedema, respiratory symptoms, laryngeal edema, anaphylaxis, exfoliative skin diseases) underwent the challenge. All tests were preceded by a single-blind placebo: if a reaction occurred, a second placebo was administered. Otherwise, a single dose (1/10 of the therapeutic one) of an alternative drug was given blindly and the patient was then observed for 6 h. The drugs used were different in structure from those suspected of having caused the adverse reaction. The patients were followed up at 4- to 6-month intervals, in order to detect any reaction that may have occurred with the tested drugs. 98 patients (89 women) had untoward reactions after the first placebo and 34 out of them reacted to the second placebo, too. During challenges the reaction rate ranged between 4.6 and 9.0%; these reactions were easily managed and none of them was severe. We followed up 407 patients: 87.2% of them were able to use one or more of the suggested drugs without reactions, 9.3% did not take the drugs and only 3.5% reported reactions to the previously tested drugs. The challenge procedure proved to be a simple tool for managing patients with adverse reactions to drugs. Its safety and reliability were validated by a long-term follow-up.International Archives of Allergy and Immunology 12/2002; 129(3):242-7. · 2.40 Impact Factor
Top co-authors
Top Journals
Institutions
-
2002–2012
-
Università degli Studi di Genova
- Dipartimento di Medicina sperimentale (DIMES)
Genova, Liguria, Italy
-
