The safety of monoclonal antibodies in asthma

Introduction: In the last two decades the knowledge of the mechanisms of the inflammatory processes underlying asthma rapidly evolved, several key mediators (cytokines and receptors) were identified, and the laboratory techniques have allowed us to synthesize monoclonal antibodies highly specific for those target molecules. Nowadays, many biological agents are investigated in asthma (with anti IgE being the only commercially available). The clinical efficacy of some biologics was demonstrated in many cases, however, the safety issue has progressively emerged and has been recognized as a crucial aspect. Areas covered: We summarized the currently available knowledge on the safety and side effects of biologics in asthma, as derived by reviews, meta analyses and clinical trials. PubMed was searched with the terms anti IL-x [AND] safety [OR] side effects, within the categories \u201cclinical trial\u201d, meta-analysis\u201d and \u201creview\u201d. Case reports were excluded. The authors collegially selected the relevant entries to be included. Expert opinion: Overall, the safety of most of the investigated agents seems to be satisfactory, a certain risk of side effects remains present, and is variable for the different molecules. Thus caution must be paid in evaluating the risk to benefit ratio. Specific biomarkers to predict the response to each biological are urgently needed to improve the safety profile

Urban air pollution and emergency room admissions for respiratory symptoms: a case-crossover study in Palermo, Italy

<p>Abstract</p> <p>Background</p> <p>Air pollution from vehicular traffic has been associated with respiratory diseases. In Palermo, the largest metropolitan area in Sicily, urban air pollution is mainly addressed to traffic-related pollution because of lack of industrial settlements, and the presence of a temperate climate that contribute to the limited use of domestic heating plants. This study aimed to investigate the association between traffic-related air pollution and emergency room admissions for acute respiratory symptoms.</p> <p>Methods</p> <p>From January 2004 through December 2007, air pollutant concentrations and emergency room visits were collected for a case-crossover study conducted in Palermo, Sicily. Risk estimates of short-term exposures to particulate matter and gaseous ambient pollutants including carbon monoxide, nitrogen dioxide, and sulfur dioxide were calculated by using a conditional logistic regression analysis.</p> <p>Results</p> <p>Emergency departments provided data on 48,519 visits for respiratory symptoms. Adjusted case-crossover analyses revealed stronger effects in the warm season for the most part of the pollutants considered, with a positive association for PM₁₀(odds ratio = 1.039, 95% confidence interval: 1.020 - 1.059), SO₂(OR = 1.068, 95% CI: 1.014 - 1.126), nitrogen dioxide (NO₂: OR = 1.043, 95% CI: 1.021 - 1.065), and CO (OR = 1.128, 95% CI: 1.074 - 1.184), especially among females (according to an increase of 10 μg/m³in PM₁₀, NO₂, SO₂, and 1 mg/m³in CO exposure). A positive association was observed either in warm or in cold season only for PM₁₀.</p> <p>Conclusions</p> <p>Our findings suggest that, in our setting, exposure to ambient levels of air pollution is an important determinant of emergency room (ER) visits for acute respiratory symptoms, particularly during the warm season. ER admittance may be considered a good proxy to evaluate the adverse effects of air pollution on respiratory health.</p

Geographical heterogeneity of clinical and serological phenotypes of systemic sclerosis observed at tertiary referral centres. The experience of the Italian SIR-SPRING registry and review of the world literature

Introduction: Systemic sclerosis (SSc) is characterized by a complex etiopathogenesis encompassing both host genetic and environmental -infectious/toxic- factors responsible for altered fibrogenesis and diffuse microangiopathy. A wide spectrum of clinical phenotypes may be observed in patients' populations from different geographical areas. We investigated the prevalence of specific clinical and serological phenotypes in patients with definite SSc enrolled at tertiary referral centres in different Italian geographical macro-areas. The observed findings were compared with those reported in the world literature.Materials and methods: The clinical features of 1538 patients (161 M, 10.5%; mean age 59.8 +/- 26.9 yrs.; mean disease duration 8.9 +/- 7.7 yrs) with definite SSc recruited in 38 tertiary referral centres of the SPRING (Systemic sclerosis Progression INvestiGation Group) registry promoted by Italian Society of Rheumatology (SIR) were obtained and clustered according to Italian geographical macroareas.Results: Patients living in Southern Italy were characterized by more severe clinical and/or serological SSc phenotypes compared to those in Northern and Central Italy; namely, they show increased percentages of diffuse cutaneous SSc, digital ulcers, sicca syndrome, muscle involvement, arthritis, cardiopulmonary symptoms, interstitial lung involvement at HRCT, as well increased prevalence of serum anti-Scl70 autoantibodies. In the same SSc population immunusppressive drugs were frequently employed. The review of the literature underlined the geographical heterogeneity of SSc phenotypes, even if the observed findings are scarcely comparable due to the variability of methodological approaches.Conclusion: The phenotypical differences among SSc patients' subgroups from Italian macro-areas might be correlated to genetic/environmental co-factors, and possibly to a not equally distributed national network of information and healthcare facilities

Impact on Air Quality of the COVID-19 Lockdown in the Urban Area of Palermo (Italy)

At the end of 2019, the first cases of coronavirus disease (COVID-19) were reported in Wuhan, China. Thereafter, the number of infected people increased rapidly, and the outbreak turned into a national crisis, with infected individuals all over the country. The COVID-19 global pandemic produced extreme changes in human behavior that affected air quality. Human mobility and production activities decreased significantly, and many regions recorded significant reductions in air pollution. The goal of our investigation was to evaluate the impact of the COVID-19 lockdown on the concentrations of the main air pollutants in the urban area of Palermo (Italy). In this study, the trends in the average concentrations of CO, NO2, O3, and PM10 in the air from 1 January 2020 to 31 July 2020 were compared with the corresponding average values detected at the same monitoring stations in Palermo during the previous five years (2015&ndash;2019). During the lockdown period (10 March&ndash;30 April), we observed a decrease in the concentrations of CO, NO2, and particulate matter (PM)10, calculated to be about 51%, 50%, and 45%, respectively. This confirms that air pollution in an urban area is predominantly linked to vehicular traffic

ATR–FTIR Spectral Analysis and Soluble Components of PM10 And PM2.5 Particulate Matter over the Urban Area of Palermo (Italy) during Normal Days and Saharan Events

International audienceSeveral epidemiological studies have shown a close relationship between the mass of particulate matter (PM) and its effects on human health. This study reports the identification of inorganic and organic components by attenuated total reflectance-Fourier-transform infrared spectroscopy (ATR-FTIR) analysis in PM10 and PM2.5 filters collected from three air quality monitoring stations in the city of Palermo (Sicily, Italy) during non-Saharan dust events and Saharan events. It also provides information on the abundance and types of water-soluble species. ATR-FTIR analysis identified sulfate, ammonium, nitrate, and carbonate matter characterized by vibrational frequencies at 603, 615, 670, and 1100 cm–1 (SO42–); at 1414 cm–1 (NH4+); at 825 and 1356 cm–1 (NO3–); and at 713, 730, and 877 cm–1 (CO32–) in PM10 and PM2.5 filters. Moreover, aliphatic hydrocarbons were identified in the collected spectra. Stretching frequencies at 2950 cm–1 were assigned to CH3 aliphatic carbon stretching absorptions, while frequencies at 2924 and 2850 cm–1 indicated CH2 bonds. In filters collected during Saharan dust events, the analysis also showed the presence of absorbance peaks typical of clay minerals. The measurement of soluble components confirmed the presence of a geogenic component (marine spray and local rocks) and secondary particles ((NH4)2SO4, NH4NO3) in the PM filters. ATR-FTIR characterization of solid surfaces is a powerful analytical technique for identifying inorganic and organic compounds in samples of particulate matter