Complementary and alternative medicine for the treatment and diagnosis of asthma and allergic diseases

The use of Complementary/Alternative Medicines (CAM) is largely diffused and constantly increasing, especially in the field of allergic diseases and asthma. Homeopathy, acupuncture and phytotherapy are the most frequently utilised treatments, whereas complementary diagnostic techniques are mainly used in the field of food allergy- intolerance. Looking at the literature, the majority of clinical trials with CAMS are of low methodological quality, thus difficult to interpret. There are very few studies performed in a rigorously controlled fashion, and those studies provided inconclusive results. In asthma, none of the CAM have thus far been proved more effective than placebo or equally effective as standard treatments. Some herbal products, containing active principles, have displayed some clinical effect, but the herbal remedies are usually not standardised and not quantified, thus carry the risk of toxic effects or interactions. None of the alternative diagnostic techniques (electrodermal testing, kinesiology, leukocytotoxic test, iridology, hair analysis) have been proved able to distinguish between healthy and allergic subjects or to diagnose sensitizations. Therefore these tests must not be used, since they can lead to delayed or incorrect diagnosis and therapy

Fatal asthma; is it still an epidemic?

Asthma mortality has declined since the 1980s. Nevertheless the World Health Organization (WHO) identified asthma as responsible for 225.000 deaths worldwide in 2005, and 430.000 fatal cases are expected by 2030. Some unexpected and concentrated fatal asthma events all occurred between 2013 and 2015 in Veneto, a North Eastern region of Italy, which prompted a more in-depth investigation of characteristics and risk factors

Resensitization in suspected penicillin allergy

Background The diagnosis of allergic reactions to penicillins (AR-PEN) is very complex as there is a loss of sensitization over time, which leads to negative skin tests (STs) and specific IgE in serum, and even to tolerance to the drug involved. However, STs may become positive after subsequent exposure to the culprit drug (resensitization), with the risk of inducing potentially severe reactions. The exact rate of resensitization to penicillins is unknown, ranging from 0% to 27.9% in published studies. Objectives To analyze the rate of resensitization in patients with suggestive AR-PEN by repeating STs (retest) after an initial evaluation (IE). Material and Methods Patients with suspected AR-PEN were prospectively evaluated between 2017 and 2020. They underwent STs, and a randomized group also underwent a drug provocation test (DPT) with the culprit. Only patients with negative STs and/or DPT were included. All included cases were retested by STs at 2–8 weeks. Results A total of 545 patients were included: 296 reporting immediate reactions (IRs) and 249 non-immediate reactions (NIRs). Eighty (14.7%) cases had positive results in retest (RT+): 63 (21.3%) IRs and 17 (6.8%) NIRs (p < 0.0001). The rate of RT+ was higher in anaphylaxis compared with all other reactions (45.8% vs 9.1%, p < 0.0001). The risk of RT+ was higher from the fifth week after IE (OR: 4.64, CI: 2.1–11.6; p < 0.001) and increased with the patient's age (OR: 1.02; CI: 1.01–1.04; p = 0.009). Conclusions Due to the high rate of resensitization, retest should be included in the diagnostic algorithm of IRs to penicillins after an initial negative study, especially in anaphylaxis, to avoid potentially severe reactions after subsequent prescriptions of these drugs.he present study has been supported by Institute of Health “Carlos III” of the Ministry of Economy and Competitiveness (grants cofunded by European Regional Development Fund (ERDF): PI18/00095, RETIC ARADYAL RD16/0006/0001). Andalusian Regional Ministry of Economy and Knowledge (grants cofunded by European Regional Development Fund (ERDF): CTS-06603); Andalusian Regional Ministry Health (grants PI-0241-2016 and PE-0172-2018). GB holds a “Juan Rodes” (JR18/00054), Institute of Health “Carlos III” of the Ministry of Economy and Competitiveness (grants cofunded by European Social Fund [ESF]). ID is a Clinical Investigator (B-0001-2017), Andalusian Regional Ministry Health

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

Risk and safety requirements for diagnostic and therapeutic procedures in allergology : World Allergy Organization Statement

Peer reviewe

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

Sulla natura giuridica del concordato

SOMMARIO: 1. Le varie opinioni sulla natura giuridica dei concordati – 2. Osservazioni su alcune delle dette opinioni – 3. Le opinioni degli scrittori ecclesiastici – 4. Le opinioni di alcuni scrittori laici e i loro contrasti con i principii del diritto pubblico dello Stato italiano – 5. Lo scopo del concordato 11 febbraio 1929 e natura dei concordati dell’epoca moderna – 6. Efficacia giuridica del concordato – 7. In che consiste il carattere convenzionale del concordato – 8. L’esecuzione del concordato 11 febbraio 1929 e della convenzione 13 giugno 1939. La legge statale di approvazione e di esecuzione. La revoca del concordato da parte dello Stato – 9. Ancora dell’ordinamento superstatale e l’opinione di un terzo ordinamento che sarebbe creato dal concordato – 10. I principali difetti della teoria dominante sull’indole giuridica del concordato – 11. Definizione del concordato secondo il diritto positivo italiano – 12. La tradizione giuridica italiana. Il concordato del 1741 tra Ferdinando I di Borbone e papa Benedetto XIV – 13. Il concordato del 1741 regolava materie di diritto pubblico interno – 14. Il concordato 18 febbraio 1818 e le materie da esso regolate – 15. La convenzione 16 aprile 1834 e le conseguenze che da essa si deducono – 16. Il concordato austriaco del 18 agosto 1855 – 17. Il concordato 11 febbraio 1929 tra l’Italia e la Santa Sede – 18. Il concordato e la riforma della legislazione ecclesiastica. I principi confessionalistici accolti – 19. I principi giurisdizionalisti accolti dal concordato – 20. Se nel concordato si possano contenere disposizioni di carattere patrimoniale – 21. Conclusioni circa l’indole e l’efficacia giuridica del concordato – 22. La teoria legale sull’indole ed efficacia giuridica dei concordati seguita in Italia quando furono abrogati i concordati precedenti – 23. In che senso deve intendersi che il concordato è una legge ecclesiastica e civile – 24. Valore del concordato come legge speciale. Il can. 3 del codex iuris canonici – 25. Interpretazione e abrogazione del concordato. On the juridical nature of concordats ABSTRACT: Domenico Schiappoli wrote this essay in 1941 for the Italian scientific journal Archivio di Diritto ecclesiastico, but it never appeared in that or other issues of the review. In the essay, Schiappoli explains his ultimate thought on Church and State relations and, by considering the Concordato as an exclusive matter of national law, he marks a strong difference of perspective between his own understanding of the issue and the mainstream theories about the legal nature of agreements between Church and State

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"