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Bolzano, Italy

Marogna M.,Pneumology Unit | Spadolini I.,Anallergo | Massolo A.,University of Calgary | Canonica G.W.,Allergy and Respiratory Diseases | Passalacqua G.,Allergy and Respiratory Diseases
Journal of Allergy and Clinical Immunology | Year: 2010

Background: Data on the long-term effects of sublingual immunotherapy (SLIT) are sparse, and the optimal duration of treatment is a matter of debate. Objective: We sought to prospectively evaluate the long-term effect of SLIT given for 3, 4, or 5 years and to compare the effect of those different durations. Methods: In this prospective open controlled study we followed up patients with respiratory allergy who were monosensitized to mites for 15 years. The subjects were divided in 4 groups receiving drug therapy alone or SLIT for 3, 4, or 5 years. Clinical scores, skin sensitizations, methacholine reactivity, and nasal eosinophil counts were evaluated every year during the winter months. The clinical effect was considered to persist until clinical scores remained at less than 50% of the baseline value, and then patients underwent another course of SLIT. Results: Seventy-eight patients were enrolled, and 59 completed the study. In the 12 control subjects no relevant change in clinical scores was seen throughout the study. In the patients receiving SLIT for 3 years, the clinical benefit persisted for 7 years. In those receiving immunotherapy for 4 or 5 years, the clinical benefit persisted for 8 years. New sensitizations occurred in all the control subjects over 15 years and in less than a quarter of the patients receiving SLIT (21%, 12%, and 11%, respectively). The second course of vaccination induced a benefit more rapidly than the first course. The behavior of bronchial hyperreactivity and nasal eosinophils paralleled the clinical score. Conclusion: Under the present conditions, it can be suggested that a 4-year duration of SLIT is the optimal choice because it induces a long-lasting clinical improvement similar to that seen with a 5-year course and greater than that of a 3-year vaccination. © 2010 American Academy of Allergy, Asthma & Immunology. Source

Soler-Catalua J.J.,Pneumology Unit | Rodriguez-Roisin R.,University of Barcelona
COPD: Journal of Chronic Obstructive Pulmonary Disease | Year: 2010

Exacerbations are important events in the natural history of chronic obstructive pulmonary disease (COPD). The higher the number of COPD exacerbations, the worse are the clinical and economical consequences. The distribution of COPD exacerbations is however highly variable. Some patients do not exhibit exacerbations at all whereas others suffer frequent events (i.e., "frequent COPD exacerbators"). We review the scientific evidence regarding the impact of COPD exacerbation frequency and assess whether or not these frequent exacerbators represent a unique population of COPD patients with higher morbidity and mortality risks. A definition of "frequent COPD exacerbators" is suggested to differentiate it from other related terms, such as "treatment failure" and "recurrence." The standardization of this terminology seems to be necessary to further identify COPD phenotypes in patients who have an individual susceptibility to develop frequent exacerbations. It can also be of help to refine the most appropriate therapeutic and preventative measures. © 2010 Informa Healthcare USA, Inc. Source

Madonini E.,Pneumology Unit | Musarra A.,Allergy Unit
European Annals of Allergy and Clinical Immunology | Year: 2011

The role of allergen-specific immunotherapy in asthma (AIT) is still a matter of debate. Actually, many controlled clinical trials have proved efficacy and safety of AIT in asthma, and some published meta-analyses, despite some methodological weaknesses, have confirmed these findings, the most recent and convincing being a meta-analysis on injection AIT studies. For sublingual AIT evidences do exist, but SLIT metaanalyses are mostly questioned due to some biases and inconsistencies. Most of these arise from methodological problems in single studies, usually small, underpowered and carried out with mixed populations.The main need, therefore, is to perform AIT clinical studies only in patients with asthma and following standardized protocols, as recommended by international Guidelines. Studies of AIT in asthma should also focus more on the long term and preventive effects of the treatment, rather than considering only the immediate efficacy on allergic symptoms. Furthermore, specific asthma features, such as lung function, bronchial reactivity, asthma control and exacerbations, should be included among the study outcomes. Source

Zielen S.,Frankfurt University | Kardos P.,Group Practice and the Center for Pneumology | Madonini E.,Pneumology Unit
Journal of Allergy and Clinical Immunology | Year: 2010

Background: Asthma control is now recognized as the main goal of asthma therapy. Guidelines recommend finding the lowest effective dose of inhaled corticosteroids in children with persistent asthma. Objective: The aim of this study was to investigate the efficacy of an allergen-specific immunotherapy with a high-dose hypoallergenic mite preparation (allergoid) as steroid-sparing agent in children with allergic asthma. Methods: Sixty-five children with asthma (Global Initiative for Asthma treatment levels II and III; 6-17 years old), after reaching asthma control with inhaled steroids during a 5-month baseline period, were randomized for subcutaneous mite allergoid immunotherapy (SCIT) plus fluticasone propionate (FP) or FP therapy alone for 2 years. During 2 subsequent 5-month winter periods, steroid therapy was adjusted according to predefined dose steps, determining and comparing the changes in FP dosages and the lowest FP dose sufficient to maintain asthma control. Immunologic and functional investigations were also carried out. Results: Children treated with house dust mite SCIT plus FP were able to significantly reduce the FP dose by more steps (P < .05), compared with the control group on FP alone. The mean daily dose in the immunotherapy group decreased from 330.3 μg in the baseline period to 151.5 μg after 2 treatment years, whereas in the control group the dose decreased from 290.6 μg to 206.3 μg. Compared with the control group, significant improvement was also observed in morning peak expiratory flow (P = .0315). Significantly increased levels of specific IgG1 (P = .0001) and IgG4 (P < .0001) were also observed. Conclusion: Adding a mite allergoid SCIT to pharmacologic treatment is an effective and safe strategy to reduce corticosteroid doses while maintaining disease control in children with mite-induced allergic asthma. © 2010 American Academy of Allergy, Asthma & Immunology. Source

De Benedetto F.,Pneumology Unit | Sevieri G.,University of Padua
Multidisciplinary Respiratory Medicine | Year: 2013

Respiratory tract infections (RTIs) are a leading cause of morbidity and also represent a cause of death in some parts of the world. The treatment of RTIs implies a continuous search for stronger therapies and represents an economical burden for health services and society. In this context the prevention of infections is absolutely required. The use of bacterial lysates as immuno-modulators to boost immunological response is widely debated. Aim of this review is to summarize the main clinical studies on the effect of the bacterial lysate OM-85 in treating RTIs in susceptible subjects - namely children and chronic obstructive pulmonary disease (COPD)-affected adults. Results from clinical trials and recent systematic reviews are reported. The results show that mean number of RTIs decreases upon treatment with OM-85, as measured by frequency of exacerbations or number of antibiotic courses. Data from systematic reviews indicated that OM-85 is particularly beneficial in children at high risk of RTIs. In COPD-affected adults, clinical studies showed that treatment with OM-85 reduced exacerbations, although systematic reviews did not legitimate the protective effect of OM-85 toward COPD as significant. The use of OM-85 could be efficacious in reducing exacerbation frequency of RTIs in children and adults at risk. However further high-quality studies are needed to better explain the mechanism of action and confirm the beneficial results of OM85. © 2013 De Benedetto and Sevieri; licensee BioMed Central Ltd. Source

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