Dupilumab Efficacy on Asthma Functional, Inflammatory, and Patient-Reported Outcomes across Different Disease Phenotypes and Severity: A Real-Life Perspective

Dupilumab is currently approved for the treatment of Type 2 severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). Few studies have specifically reported on dupilumab efficacy on asthma outcomes as a primary objective in a real-life setting, in patients with and without CRSwNP. Our study aimed to explore the efficacy of dupilumab on functional, inflammatory, and patient-reported outcomes in asthma patients across different disease phenotypes and severity, including mild-to-moderate asthma coexisting with CRSwNP. Data from 3, 6, and 12 months follow-up were analyzed. Asthma (FEV1%, Tiffeneau%, ACT, FeNO, oral steroid use, exacerbation rate, and blood eosinophilia) and polyposis (SNOT22, VAS, NPS) outcomes showed a rapid (3 months) and sustained (6 and 12 months) significant change from baseline, despite most of the patients achieving oral steroid withdrawal. According to the sensitivity analysis, the improvement was not conditioned by either the presence of polyposis or severity of asthma at baseline. Of note, even in the case of milder asthma forms, a significant further improvement was recorded during dupilumab treatment course. Our report provides short-, medium-, and long-term follow-up data on asthma outcomes across different diseases phenotypes and severity, contributing to the real-world evidence related to dupilumab efficacy on upper and lower airways T2 inflammation

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

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Latex allergy: natural story

Abstract. La sensibilizzazione IgE mediata a proteine presenti nei manufatti in latice naturale \ue8 responsabile non solo di manifestazioni cutanee come prurito od orticaria localizzata, spesso accompagnata da edema angioneurotico, ma anche di sintomi respiratori a carico delle alte come delle basse vie respiratorie, con quadri di oculorinite, di asma bronchiale e, talora, di edema della glottide. Si possono verificare inoltre manifestazioni cardiovascolari fino allo shock anafilattico. I sintomi compaiono in seguito a contatto ed assorbimento percutaneo, ma anche per via inalatoria. Gli antigeni presenti nei manufatti in latice possono infatti essere veicolati in aria dalla polvere lubrificante dei guanti per uso sanitario o di altri manufatti. Storia naturale. Le prime manifestazioni cliniche sono nella grande maggioranza a livello cutaneo, che in circa un terzo dei casi si complicano successivamente con interessamento delle vie respiratorie (Asma o rinite). In una piccola percentuale di soggetti, i sintomi possono tuttavia esordire a livello respiratorio, senza interessamento cutaneo. Dopo la cessazione dell'esposizione la sintomatologia cutanea regredisce prontamente, mentre i sintomi respiratori o l'iperesponsivit\ue0 alla metacolina possono persistere in oltre il 40% dei lavoratori affetti. Importanti fattori predisponenti la sensibilizzazione sono l'atopia e la preesistenza di patologie cutanee come la dermatite atopica, l'eczema da contatto e in genere tutte le situazioni che comportano soluzioni di continuo della cute. Frequente la sensibilizzazione crociata con alimenti vegetali, che pu\uf2 causare la cosiddetta "Latex-fruits Syndrome"