@IT2020: An innovative algorithm for allergen immunotherapy prescription in seasonal allergic rhinitis

Background: Allergen immunotherapy (AIT) is the only disease-modifying treatment in patients with seasonal allergic rhinoconjunctivitis (SAR). Its efficacy depends on the precise identification of the triggering allergen. However, diagnostics based on retrospective clinical history and sensitization to whole extracts (SWE) often leads to equivocal results. Objectives: To assess the usability and impact of a recently established algorithm for a clinical decision support system (@IT2020-CDSS) for SAR and its diagnostic steps [anamnesis, SWE (skin prick test or serum IgE), component resolved diagnosis, CRD, and real-time digital symptom recording, eDiary] on doctor's AIT prescription decisions. Methods: After educational training on the @IT2020-CDSS algorithm, 46 doctors (18 allergy specialists, AS, and 28 general practitioners, GP) expressed their hypothetical AIT prescription for 10 clinical index cases. Decisions were recorded repeatedly based on different steps of the algorithm. The usability and perceived impact of the algorithm were evaluated. Results: The combined use of CRD and an eDiary increased the hypothetical AIT prescriptions, both among AS and GP (p < .01). AIT prescription for pollen and Alternaria allergy based on anamnesis and SWE was heterogeneous but converged towards a consensus by integrating CRD and eDiary information. Doctors considered the algorithm useful and recognized its potential in enhancing traditional diagnostics. Conclusions and clinical implications: The implementation of CRD and eDiary in the @IT2020-CDSS algorithm improved consensus on AIT prescription for SAR among AS and GP. The potential usefulness of a CDSS for aetiological diagnosis of SAR and AIT prescription in real-world clinical practice deserves further investigation

Heterogeneous validity of daily data on symptoms of seasonal allergic rhinitis recorded by patients using the e‐diary AllergyMonitor®

Background: Patient-generated symptom and medication scores are essential for diagnostic and therapeutic decisions in seasonal allergic rhinitis (SAR). Previous studies have shown solid consistencies between different scores at population level in real-life data and trials. For clinicians, the evaluation of individual data quality over time is essential to decide whether to rely on these data in clinical decision-making. Objective: To analyze the consistency of different symptom (SS) and symptom medication scores (SMSs) at individual level in two study cohorts with different characteristics and explore individual patient trajectories over time. Methods: Within the pilot phase of the @IT.2020 project on diagnostic synergy of mobile health and molecular IgE assessment in patients with SAR, we analyzed data of 101 children and 93 adults with SAR and instructed them to record their symptoms and medication intake daily via the mobile app AllergyMonitor®. We then assessed the correlation between different SMS and a visual analogue scale (VAS) on the impact of allergy symptoms on daily life at population and individual level. Results: At population level, the Rhinoconjunctivitis total symptom score (RTSS) correlated better with VAS than the combined symptom and medication score (CSMS). At individual level, consistency among RTSS and VAS was highly heterogeneous and unrelated to disease severity or adherence to recording. Similar heterogeneity was observed for CSMS and VAS. Conclusions: The correlation of clinical information provided by different disease severity scores based on data collected via electronic diaries (e-diaries), is sufficient at population level, but broadly heterogeneous for individual patients. Consistency of the recorded data must be examined for each patient before remotely collected information is used for clinical decision making

Trapianti di briofite acquatiche per il biomonitoraggio dei metalli in traccia: risultati e prospettive della tecnica dei moss bags dopo 10 anni di studi fra Veneto e Friuli-Venezia Giulia

Fra gli obiettivi del monitoraggio chimico delle acque previsto dalla Direttiva Quadro 2000/60/CE vi \ue8 la sorveglianza delle sostanze prioritarie, fra le quali si annoverano alcuni metalli pesanti che spesso generano forme d\u2019inquinamento sporadiche o intermittenti. Ci\uf2, sommato alla promiscuit\ue0 dell\u2019utilizzo del territorio, all\u2019inadeguatezza della rete fognaria o degli impianti di trattamento ed all\u2019impossibilit\ue0 di controllare le sorgenti puntiformi, pu\uf2 determinare situazioni che generano rischi ambientali particolarmente insidiosi. Il monitoraggio biologico ed anche quello chimico basato sul campionamento dell\u2019acqua non possono procurare informazioni rappresentative sulla reale presenza di metalli nell\u2019ambiente, n\ue9 sulla loro disponibilit\ue0 biologica. L\u2019utilizzo di accumulatori, soprattutto quelli biologici come le briofite, consente invece di ottenere stime sensibili ed integrate del livello di alterazione ambientale da metalli nella sola frazione biodisponibile. Le briofite acquatiche sono utilizzate con successo da oltre 40 anni nei pi\uf9 svariati contesti ambientali d\u2019Europa e si configurano come i migliori strumenti oggi a disposizione per il monitoraggio dei metalli. Il Dipartimento di Scienze della Vita dell\u2019Universit\ue0 di Trieste \ue8 impegnato da circa dieci anni in attivit\ue0 di studio, calibrazione ed applicazione dei trapianti di muschio (moss bags) sul territorio veneto e friulano. Questa metodica semplice ed efficace \ue8 gi\ue0 a disposizione degli Enti locali grazie alla collaborazione con le Agenzie Regionali per la Protezione Ambientale ed attende ora di essere standardizzata attraverso un progetto nazionale patrocinato dall\u2019ISPRA