efficacy and tolerability of montelukast as a therapeutic agent for severe atopic dermatitis in adults

Sir, (20% reduction) compared to the placebo group measThe pathogenesis of atopic dermatitis (AD) is only ured by SCORAD index, as shown in Fig. 1. The partly understood. Evidence supports the potential role combined score of daytime pruritus and sleep loss of soluble mediators as leukotrienes (LTs) (1). Drugs remained similar throughout the study and was not that selectively inhibit the formation or action of LTs statistically signi cant between the two treatments (F = have been introduced as a new form of anti0.08 p =0.92) and the diVerent times of observation in ammatory therapy in asthma. Montelukast is an (F =1.95 p =0.18). The blood-chemistry tests conducted antileukotriene agent known as CysLT1 receptor antagat the end of treatment revealed no changes in any of onist. Cysteinyl LTs (LTC4, LTD4, LTE4) are potent the studied patients and no adverse eVects were observed smooth muscle constrictors, and contribute to the onset by the investigator or reported by the patient, thereby of in ammation by their ability to cause plasma extracon rming the tolerability of montelukast. vasation and eosinophil recruitment (2). The objective of our study was to evaluate the eYcacy and tolerability DISCUSSION of montelukast as a therapeutic agent for severe AD in adults. Montelukast is generally a safe drug during long-term treatment; side eVects are minimal (4). Indeed, in our MATERIAL AND METHODS study montelukast was well tolerated, con rming observations by other authors of the safety of this drug (4–6). We enrolled 20 adult male patients with severe AD according This could be particularly relevant for patients aVected to the SCORAD index (severe AD: mean objective score > 40) with AD who may need treatment for long periods of (3). Their ages ranged from 18 to 28 years (mean age 22 ± 3.7). One month before treatment, the patients were asked to time. The anti-in ammatory potential of anti-LTs in discontinue all medication except emollients. The study was asthma has been con rmed in a number of studies (7, approved by the ethics committee and subjects signed an 8). The role of the LTs in AD remains unclear. A informed consent form to participate in the study. Exclusion prolonged elevation of the urinary levels of LTE4 has criteria were: pregnancy, pregnancy potential and current lactation; a history of liver disease; allergy to montelukast or cross-reacting medication; use of phenobarbital, phenytoin or rifampicin. Subjects were randomized into two groups of 10 to receive montelukast 10mg or placebo for 6 weeks in a double-blind study. Furthermore, during the study, all subjects were not allowed other treatment for AD. EYcacy was assessed by SCORAD index and subjective symptoms were evaluated separately at baseline, and after 3 and 6 weeks. The SCORAD index combines objective signs (extent and intensity of lesions) and subjective (daytime pruritus and sleep loss) criteria. Evaluations were made at each visit by the same investigator for each patient. Blood tests were performed for total blood cell count and blood chemistry (aspartate transaminase, total bilirubin, creatinine and urea). Baseline mean values were compared using Student's t-test for unpaired samples. The eYcacy of the two treatments at diVerent times was evaluated using a split-plot analysis of variance (ANOVA). Comparison between t0 and t2 (time of treatment at baseline and end of the study) was evaluated with Student's t-test for unpaired samples

Quality of life in patients with allergic and immunologic skin diseases: in the eye of the beholder

Allergic and immunologic skin diseases negatively impact the quality of life (QoL) of affected patients with detrimental consequences. Nonetheless, in everyday clinical practice the evaluation of QoL is often overlooked. Considering the increasing prevalence of atopic dermatitis, allergic contact dermatitis, hereditary angioedema, cutaneous mastocytosis, and urticaria, it is essential to determine the effects of allergic and immunologic skin diseases on QoL. A joint meeting (GET TOGETHER 2021) of the Italian Society of Allergology, Asthma and Clinical Immunology (SIAAIC) and the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) aimed to summarize the features of the main QoL tools used in these diseases and to describe the extent of QoL impairment as well as the impact of treatments on QoL, particularly biologic therapies. The assessment of QoL in patients with allergic and immunologic skin diseases relies on generic, organ-specific and disease-specific questionnaires. While generic and organ-specific questionnaires allow comparison between different diseases, disease-specific questionnaires are designed and validated for specific cohorts: the QoL Index for Atopic Dermatitis (QoLIAD) and the Childhood Atopic Dermatitis Impact Scale (CADIS) in atopic dermatitis, the ACD-11 in allergic contact dermatitis, the Angioedema QoL Questionnaire (AE-QoL) and the Hereditary Angioedema QoL questionnaire (HAE-QoL) in hereditary angioedema, the Mastocytosis QoL Questionnaires (MCQoL e MQLQ) in cutaneous mastocytosis, and the Chronic Urticaria QoL questionnaire (CU-Q2oL) in urticaria. Among the many factors that variably contribute to QoL impairment, pruritus can represent the leading cause of patient discomfort. Biologic therapies significantly ameliorate QoL in atopic dermatitis, hereditary angioedema, mastocytosis and chronic urticaria. In general, adequate management strategies are essential for improving QoL in patients with allergic and immunologic skin diseases

Mild/Moderate Asthma Network in Italy (MANI): a long-term observational study

Objective The prevalence of asthma in Italy is estimated to be around 4%; it affects approximately 2,000,000 citizens, and up to 80-90% of patients have mild-to-moderate asthma. Despite the clinical relevance of mild-to-moderate asthma, longitudinal observational data are very limited, including data on disease progression (worsening vs. improvement), the response to treatment, and prognosis. Studies are needed to develop long-term, observational, real-life research in large cohorts. The primary outcomes of this study will be based on prospective observation and the epidemiological evolution of mild and moderate asthma. Secondary outcomes will include patient-reported outcomes, treatments over time, disease-related functional and inflammatory patterns, and environmental and life-style influences. Methods This study, called the Mild/Moderate Asthma Network of Italy (MANI), is a research initiative launched by the Italian Respiratory Society and the Italian Society of Allergology, Asthma and Clinical Immunology. MANI is a cluster-based, real world, cross-sectional, prospective, observational cohort study that includes 20,000 patients with mild-to-moderate asthma. (ClinicalTrials.gov Identifier: NCT04796844). Results and conclusion Despite advances in asthma care, several research gaps remain to be addressed through clinical research. This study will add important new knowledge about long-term disease history, the transferability of clinical research results to daily practice, the efficacy of currently recommended strategies, and their impact on the burden and evolution of the disease