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Chronic spontaneous urticaria (CSU) is defined by the appearance of wheals and a variable presence of angioedema which persists for at least 6 weeks. It represents the most common subtype of chronic urticaria and is gaining importance in civil society because of its association with impaired quality of life. Moreover, CSU has a growing impact on national health systems representing a great burden due to its variable rate of response to the approved therapies. In this scenario, the identification of clinical and molecular biomarkers is of pivotal importance. Some groups are trying to detect molecules which would be able to help clinicians in reaching a proper diagnosis; additionally, the opportunity to describe disease severity which leads to cluster patients in different groups could fill the gap in the numerous unmet clinical needs. Several biomarkers are currently being studied with the purpose to predict the response to a defined therapy; unfortunately, none of them are ready to be translated from bench to bedside.

Background Prevalence of allergic diseases in infants, whose parents and siblings do not have allergy, is approximately 10% and reaches 20–30% in those with an allergic first-degree relative. Intestinal microbiota may modulate immunologic and inflammatory systemic responses and, thus, influence development of sensitization and allergy. Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention. Objective The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations about the use of probiotics in the prevention of allergy. Methods We identified the most relevant clinical questions and performed a systematic review of randomized controlled trials of probiotics for the prevention of allergy. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. We searched for and reviewed the evidence about health effects, patient values and preferences, and resource use (up to November 2014). We followed the GRADE evidence-to-decision framework to develop recommendations. Results Currently available evidence does not indicate that probiotic supplementation reduces the risk of developing allergy in children. However, considering all critical outcomes in this context, the WAO guideline panel determined that there is a likely net benefit from using probiotics resulting primarily from prevention of eczema. The WAO guideline panel suggests: a) using probiotics in pregnant women at high risk for having an allergic child; b) using probiotics in women who breastfeed infants at high risk of developing allergy; and c) using probiotics in infants at high risk of developing allergy. All recommendations are conditional and supported by very low quality evidence. Conclusions WAO recommendations about probiotic supplementation for prevention of allergy are intended to support parents, clinicians and other health care professionals in their decisions whether to use probiotics in pregnancy and during breastfeeding, and whether to give them to infants.

In adolescents and adults with moderate-to-severe asthma, the addition of formoterol to inhaled glucocorticoids was associated with a lower risk of asthma exacerbations than that with glucocorticoids alone and with a similar risk of serious asthma-related events. Current guidelines for the management of asthma suggest that inhaled glucocorticoids should be used as initial controller therapy, with a long-acting beta-agonist (LABA) then added if symptoms remain uncontrolled or increase in severity. 1 Although LABAs have been an available treatment option for asthma since 1990, 2 questions remain regarding the safety of this drug class. 3 These concerns originate mainly from the results of two large studies in which the effects of adding the LABA salmeterol to existing asthma treatment were reviewed. 4 , 5 These studies showed higher rates of asthma-related death and other serious outcomes related to asthma among patients receiving salmeterol . . .

Interleukins (IL)-4 and -13 play a pivotal role in the pathobiology of type-2 asthma. Indeed, IL-4 is crucially involved in Th2 cell differentiation, immunoglobulin (Ig) class switching and eosinophil trafficking. IL-13 cooperates with IL-4 in promoting IgE synthesis, and also induces nitric oxide (NO) production, goblet cell metaplasia and fibroblast proliferation, as well as elicits contractile responses and hyperplasia of airway smooth muscle cells. IL-4 and IL-13 share common signaling pathways, activated by the binding of both cytokines to receptor complexes including the α-subunit of the IL-4 receptor (IL-4Rα). Therefore, the subsequent receptor dimerization is responsible for the pathophysiologic effects of IL-4 and IL-13. By selectively blocking IL-4Rα, the fully human IgG4 monoclonal antibody dupilumab behaves as a dual receptor antagonist of both IL-4 and IL-13. Through this mechanism of action, dupilumab exerts effective therapeutic actions in type-2 inflammation, thus decreasing asthma exacerbations, FeNO (fractional exhaled NO) levels, and the intake of oral corticosteroids (OCS). In addition to being approved for the add-on biological therapy of severe asthma, dupilumab has also been licensed for the treatment of nasal polyposis and atopic dermatitis.

Objective To describe patients with severe asthma treated with or eligible for monoclonal antibodies, assessing the health and economic burden using the Italian National Healthcare Service (SSN) administrative data. Methods From 4.6 million inhabitants, among patients with asthma from 1 January to 31 December 2022, those with severe asthma were identified by monoclonal antibody dispensation (cohort A) and by eligibility for monoclonal antibodies, defined as continuous treatment with medium- or high-dose inhaled corticosteroids and long-acting beta agonists and the occurrence of exacerbations (cohort B-narrow and cohort B-broad according to “narrow” and” broad” definitions, respectively). One-year exacerbations, healthcare utilization, and direct costs were assessed. Results Of the 128,621 patients with asthma (51.8% women; mean age, 54 years), patients with severe asthma were identified as follows: cohort A (n = 3046; 2.4%), cohort B-narrow (n = 3517; 2.7%), and cohort B-broad (n = 7621; 5.6%). Compared with cohort A, patients in cohorts B-narrow and B-broad were older, had more comorbidities, experienced more moderate/severe exacerbations (70.9%–57.3% vs. 46.7%), and had higher hospitalization rates and greater drug use but fewer specialist visits. The annual SSN costs averaged €7512 for cohort A versus €2911–€2351 for cohorts B-narrow and B-broad. Cohort A incurred higher costs for asthma drugs, whereas cohorts B-narrow and B-broad incurred higher costs for concomitant drugs, hospitalizations, and specialist care. Conclusions A significant disease burden exists in patients with uncontrolled severe asthma who are potentially eligible for monoclonal antibodies in Italy.

[...]mast cells and basophils serve as specified effectors in type 2 immunity response under the influence of the type-2 cytokines environment in local tissue [7]. [...]the lack of IFN β results in viral replication, cell cytotoxicity, and mediator release associated with non-protective inflammation. [...]HDM is one of the most powerful allergens that could activate both innate and adaptive type 2 immune responses, thereby increasing asthma severity in sensitized individuals. [...]an early warning system for the outbreaks of thunderstorm asthma by accompanying meteorology and pollen counts has been evaluated recently but has shown limited practical applications and needs to be optimized [58–60].

Asthma is a common chronic disease characterized by episodic or persistent respiratory symptoms and airflow limitation. Asthma treatment is based on a stepwise and control-based approach that involves an iterative cycle of assessment, adjustment of the treatment and review of the response aimed to minimize symptom burden and risk of exacerbations. Anti-inflammatory treatment is the mainstay of asthma management. In this review we will discuss the rationale and barriers to the treatment of asthma that may result in poor outcomes. The benefits of currently available treatments and the possible strategies to overcome the barriers that limit the achievement of asthma control in real-life conditions and how these led to the GINA 2019 guidelines for asthma treatment and prevention will also be discussed.

Patients with mild persistent asthma are often advised to use inhaled corticosteroids on a regular schedule. In this trial, such patients treated themselves with inhaled beclomethasone (250 μg per puff) and albuterol (100 μg per puff) only when they had symptoms of asthma. The mean morning peak expiratory flow rate in this group was similar to that in the group receiving inhaled corticosteroids regularly. Controller treatments may not be needed on a regular basis in patients with asthma. In this trial, patients treated themselves with inhaled beclomethasone and albuterol only when they had symptoms of asthma. The mean morning peak expiratory flow rate in this group was similar to that in the group receiving inhaled corticosteroids regularly. Treatment guidelines for asthma 1 , 2 recommend regular treatment with inhaled corticosteroids for patients with mild persistent asthma, since this treatment regimen provides control of asthma, 3 – 7 suppresses airway inflammation, 8 , 9 and may prevent the progression of asthma. 4 – 6 , 10 Although the doubling of the dose of inhaled corticosteroids has been reported to be ineffective in preventing exacerbation of asthma, 11 , 12 high-dose inhaled corticosteroids administered at the onset of an exacerbation have been reported to enhance the control of asthma. 13 In addition, the control of mild persistent asthma achieved with the use of short courses of high-dose inhaled corticosteroids is similar . . .

This paper is aimed to (i) develop an innovative classification of COPD, multi-dimensional phenotype, based on a multidimensional assessment; (ii) describe the identified multi-dimensional phenotypes. An exploratory factor analysis to identify the main classificatory variables and, then, a cluster analysis based on these variables were run to classify the COPD-diagnosed 514 patients enrolled in the STORICO (trial registration number: NCT03105999) study into multi-dimensional phenotypes. The circadian rhythm of symptoms and health-related quality of life, but neither comorbidity nor respiratory function, qualified as primary classificatory variables. Five multidimensional phenotypes were identified: the MILD COPD characterized by no night-time symptoms and the best health status in terms of quality of life, quality of sleep, level of depression and anxiety, the MILD EMPHYSEMATOUS with prevalent dyspnea in the early-morning and day-time, the SEVERE BRONCHITIC with nocturnal and diurnal cough and phlegm, the SEVERE EMPHYSEMATOUS with nocturnal and diurnal dyspnea and the SEVERE MIXED COPD distinguished by higher frequency of symptoms during 24h and worst quality of life, of sleep and highest levels of depression and anxiety. Our results showed that properly collected respiratory symptoms play a primary classificatory role of COPD patients. The longitudinal observation will disclose the discriminative and prognostic potential of the proposed multidimensional phenotype. Trial registration number: NCT03105999, date of registration: 10th April 2017.

The risks of overusing short-acting β2-agonists (SABA), including an increase in asthma-related deaths, are many and well known. The Global Initiative on Asthma (GINA) 2019 and 2020 updates recommend as-needed inhaled corticosteroid (ICS)/formoterol as the preferred rescue medication in mild asthma as monotherapy and also in moderate to severe asthma when the maintenance and reliever therapy (MART) strategy is used. Using SABA for symptom relief, however, was the standard of treatment for many years, and consequently this practice persists, particularly in patients not taking ICS regularly. Here, we examine the rationale for this shift from a long-standing recommendation for as-needed SABA treatment to the use of as-needed ICS/formoterol and consider clinical evidence on strategies for asthma treatment and patient management.