48 research outputs found
Living with chronic spontaneous urticaria in italy. a narrative medicine project to improve the pathway of patient care
Chronic spontaneous urticaria (CSU) is perceived as a difficult to manage disease with negative impact on quality of life. The aim of this study was to highlight how to improve the care of people with CSU, using the methodology of narrative medicine. From June 2014 to March 2015, CSU-diagnosed patients and their physicians were asked to record their experiences of the condition in writing. Fourteen healthcare teams participated: 41% considered CSU as a challenge to overcome, while 22% experienced CSU as a big commitment. The number of professional involved was evaluated as insufficient in 11 hospitals. Seventy-five percent of the 190 Italian patients had visited 3 or more physicians before receiving a final diagnosis, with a perceived waste of time and resources. The therapeutic pathways were described as unsatisfactory in 83% of cases. As a result, anger and frustration were life-dominant emotions in 92% of patients. The critical points of the care pathway are related to organizational issues and lack of awareness
Adherence issues related to sublingual immunotherapy as perceived by allergists
Objectives: Sublingual immunotherapy (SLIT) is a viable alternative to subcutaneous immunotherapy to treat allergic rhinitis and asthma, and is widely used in clinical practice in many European countries. The clinical efficacy of SLIT has been established in a number of clinical trials and meta-analyses. However, because SLIT is self-administered by patients without medical supervision, the degree of patient adherence with treatment is still a concern. The objective of this study was to evaluate the perception by allergists of issues related to SLIT adherence. Methods: We performed a questionnaire-based survey of 296 Italian allergists, based on the adherence issues known from previous studies. The perception of importance of each item was assessed by a VAS scale ranging from 0 to 10. Results: Patient perception of clinical efficacy was considered the most important factor (ranked 1 by 54% of allergists), followed by the possibility of reimbursement (ranked 1 by 34%), and by the absence of side effects (ranked 1 by 21%). Patient education, regular follow-up, and ease of use of SLIT were ranked first by less than 20% of allergists. Conclusion: These findings indicate that clinical efficacy, cost, and side effects are perceived as the major issues influencing patient adherence to SLIT, and that further improvement of adherence is likely to be achieved by improving the patient information provided by prescribers. © 2010 Scurati et al, publisher and licensee Dove Medical Press Ltd
Changing of Fecal Flora and Clinical Effect of L. salivarius LS01 in Adults With Atopic Dermatitis
GOAL: : To evaluate cytokine stimulation with 3 strains of Lactobacillus
salivarius in vitro and to assess changes in intestinal microflora and clinical
improvements in adults with atopic dermatitis (AD) induced by the strain showing
the best immunomodulatory features.
BACKGROUND: : AD is a common skin disease in children and adults. It is
characterized by chronic inflammation, eczema, and increasing intestinal
permeability. Various studies have shown that patients with AD presented some
modifications in the intestinal microbiota composition; as a result, intestinal
microflora is thought to have a pivotal role in this disease.
METHODS: : Thirty-eight patients aged from 18 to 46 years with moderate/severe AD
were recruited. Subjects were randomized in a double-blind placebo-controlled
study to receive active treatment with L. salivarius LS01: probiotic (n=19) or
placebo (n=19). Cytokine production was determined by means of specific
quantitative enzyme-linked immunosorbent assays. Intestinal bacterial groups were
quantified using conventional culture techniques, whereas L. salivarius LS01 was
identified using polymerase chain reaction and pulse field gel electrophoresis.
RESULTS: : L. salivarius LS01 showed the best immunomodulatory features and it
was chosen for the second phase of the study. AD subjects showed a reduction in
their SCORAD score after probiotic treatment and a significant decrease in the
staphylococci load compared with the placebo group. Moreover, L. salivarius LS01
showed the ability to reduce the production of Th2 cytokines, maintaining the
production of Th1 cytokines stable.
CONCLUSIONS: : Treatment with the L. salivarius LS01 strain seems to positively
modify clinical and immunologic status and dermatology life quality in a group of
adults affected by moderate/severe AD, leading to a rebalancing of altered
intestinal microbiota
Effects of Lactobacillus salivarius LS01 (DSM 22775) treatment on adult atopic dermatitis : a randomized placebo-controlled study
Atopic dermatitis (AD) is a common inflammatory skin disease characterized by
xerosis, pruritus and eczema. The role of probiotics in the prevention and the
treatment of AD have been extensively studied in children with controversial
results while there are few studies on an adult population. The aim of this
randomized, double-blind, placebo-controlled study is to evaluate the clinical
efficacy of the intake of a probiotic strain (Lactobacillus salivarius LS01) in
the treatment of adult patients with AD. A group of 38 patients was treated with
probiotics or placebo (maltodextrin) for 16 weeks. The study was performed from
January (T0) to May, 2009 (T16). The assessment of efficacy was based on change
in SCORAD (SCORing Atopic Dermatitis) index, dermatology life quality index
(DLQI) improvement, cytokine production by PBMCs and ability to modify faecal
microbial flora. No significant adverse events were recorded during the study.
Patients treated with probiotics showed a statistically improvement of both
clinical parameters (SCORAD p<0.0001 and DLQI p= 0.021) at the end of
treatment (T16) compared with the placebo group. Furthermore, after four months
of treatment there was a significant reduction of Th1 cytokines (IL-12+IFNgamma)
(p= 0.03) and Th1/Th2 ratio (IL-12+IFNgamma/IL-4+IL-5) (p= 0.019) only in
placebo-treated patients. A statistically relevant decrease of staphylococci in
faeces of the probiotictreated group was also observed at the end of treatment.
In our study, the administration of L. salivarius LS01 was well tolerated and was
associated with a significant improvement of clinical manifestation and QoL. This
probiotic strain could have an important role in modulating Th1/Th2 cytokine
profiles and could be considered as an important adjunctive therapy in the
treatment of adult AD
Valutazione di efficacia dell’Esperienza Immaginativa in pazienti con orticaria cronica spontanea : Dati preliminari
Le allergie multifattoriali sono sostenute anche da fattori psichici che condizionano il vissuto di malattia, i coping comportamentali, la ricaduta biologica. Nel lavoro vengono esposti i dati preliminari della valutazione quantitativa e qualitativa della psicoterapia breve con l\u2019Esperienza Immaginativa, in orticaria cronica idiopatica. RISULTATI: Il dato della correlazione fra ansia e depressione era atteso in quanto il fenomeno della comorbidit\ue0 fra le due aree sintomatologiche \ue8 notevole. Interessante \ue8 la riduzione della sintomatologia ansiosa e la conseguente normalizzazione. Da un punto di vista clinico va sottolineato il miglioramento in sonno, limitazioni e aspetto estetico certamente rilevanti per la qualit\ue0 della vita. Per quanto riguarda il Brief Cope non c\u2019\ue8 modifica negli stili di coping e si confermano in primo piano stili di coping orientati all\u2019azione (pianificare e affrontare operativamente) e a seguire quelli orientati alla gestione delle emozioni (es., accettazione). DISCUSSIONE: Alla luce dei risultati, il trattamento sembra risultare cost-effective per disturbi diffusi in pazienti ambulatoriali
Immune profiles of patients with chronic idiopathic urticaria
Background: The immunologic characterization of chronic idiopathic urticaria (CIU) is still incomplete. In particular, it is not known if positivity to the intradermal autologous serum skin test (ASST) identifies an immunologic subset of CIU patients. Methods: Nineteen CIU patients and 15 healthy controls were enrolled in the study. A diagnostic flowchart was designed to select CIU patients, who were then analyzed by ASST. Cytokine and chemokine production and the expression of adhesion molecules was measured in patients and controls. Results: In CIU patients compared to controls, it was found that (1) TNF-\u3b1, IL-10, MIP-1\u3b1 and RANTES production was augmented and IL-2 and INF-\u3b3 reduced, and (2) CD44, CD11a and CD62L expression on CD4 and CD8 cells was augmented. Additionally, TNF-\u3b1 and chemokine production was significantly increased in CIU patients with a negative ASST (p-; n = 10) compared to patients with a positive response to the test. Conclusions: The presence of an inflammatory process in CIU patients is suggested by the findings that the production of both TNF-\u3b1 and chemokines as well as the expression of adhesion molecules is increased in these patients. Similarly to what is seen in rheumatoid arthritis, augmented IL-10 production might be secondary to the attempt to hamper the inflammatory milieu. Immune profiles are particularly altered in CIU p- patients, in whom a more aggressive therapeutic strategy might be considered. Copyrigh