Immunological and non-immunological mechanisms of allergic diseases in the elderly: Biological and clinical characteristics

A better hygiene, a Westernized diet, air pollution, climate changes, and other factors that influence host microbiota, a key player in the induction and maintenance of immunoregulatory circuits and tolerance, are thought to be responsible for the increase of allergic diseases observed in the last years. The increase of allergic diseases in elderly is related to the presence of other factors as several comorbidities that should interfere with the development and the type of allergic reactions. A central role is played by immunosenescence responsible for modifying response to microbiota and triggering inflamm-ageing. In addition, in elderly there is a shift from Th1 responses vs. Th2, hence favouring allergic responses. Better understanding of the mechanisms of immunosenescence and its effects on allergic inflammation will most certainly lead to improved therapy

ALLUCINAZIONI VISIVE: TRA DEMENZA E PSICOSI

Le allucinazioni possono comparire in corso di varie patologie (psicosi, delirium, demenza, emicrania, neoplasia, epilessia) o possono essere altresì indotte da farmaci. Esse sono percezioni involontarie e ricorrenti di immagini in assenza di un corrispondente stimolo fisico esterno. Possono essere classificate in semplici o complesse. Si definisce allucinazione semplice quella in cui è attivata una singola modalità sensoriale e quindi la percezione non richiede un’elaborazione cognitiva per essere decodificata (ad es. vedere un oggetto in una stanza); complessa è invece l’allucinazione in cui sono attivate più modalità sensoriali (es. vedere un leone sentendo che ruggisce) o in cui la percezione viene elaborata in aree cerebrali diverse da quelle sensitive primarie (voci dialoganti sono percepite e decodificate nelle aree cerebrali deputate al linguaggio). In relazione alla loro prevalenza (stimata dal 4% al 76%) le allucinazioni sono considerate uno dei sintomi psicotici più frequenti nelle patologie neurodegenerative, specialmente in stadi moderati-severi di malattia. Risultano maggiormente presenti quelle visive e uditive, seguite da quelle somatiche, olfattive e tattili. Indipendentemente dalla loro modalità sensoriale, le allucinazioni sono associate a un maggiore e più rapido declino cognitivo e a un aumento del tasso di stress e depressione del tono dell’umore nel paziente

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