Giovanni Passalacqua

..Therefore these tests must not be used, since they can lead to delayed or incorrect diagnosis and therapy...

..There are also unresolved safety concerns. Therapeutic efficacy of complementary-alternative treatments for rhinitis and asthma is not supported by currently available evidence...

..Additionally, the mechanisms of action are beginning to be systematically studied. Some points need further investigation, such as the effect in asthma, the mechanisms of action, and the optimal dose to be administered...

..In the past 2 years, new data concerning clinical, immunological and practical aspects of sublingual immunotherapy have been published, and many critical points have been addressed...

..Some studies reported the possible induction of food allergy, caused by neo-sensitization to cross-reacting allergens, during immunotherapy with aeroallergens, while other studies ruled out such possibility...

..For the present article we collected and reviewed the more relevant experimental results concerning the asthma-rhinitis link in allergic diseases, published since January 2002...

..This paper reviews the up-to-date aspects about clinical efficacy, safety and pharmacokinetics of sublingual immunotherapy...

..The last frontier seems to be the manipulation of genoma with replicons and allergen-encoding plasmids...

..Several points still need to be elucidated, including: mechanisms of action, optimal dosages, and indications in pediatric patients...

..It has become clear that the QoL questionnaires measure the aspects of the disease that partially differ from the routinely evaluated parameters and that QoL should integrate, not replace, the objective measurements...

..Novel approaches for immunotherapy are currently under evaluation, including the use of adjuvants, peptides, and DNA-conjugated and recombinant allergens...

..Recently published studies have provided answers to some of these points...

..4%) for side effects probably related to therapy. These data obtained in a quite large sample of children and in real-life confirm that the compliance with SLITOne is good, despite the therapy managed at home...

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..We compared the effects of a single dose of the two drugs in the nose and skin over 24 h...

..The recent introduction of biological treatments (monoclonal antibodies) has allowed elucidation of some of the pathogenic features of allergic asthma...

..Local nasal immunotherapy is accepted as an alternative to the injection route for allergic rhinitis. Despite this, little is known about the kinetics of the allergen after nasal delivery in allergic subjects...

..Finally, one of the major goals is to modify the T(H)2-biased immune response by improving the characteristics and modes of action of allergen immunotherapy...

..The literature is reviewed to evaluate the available experimental data on this...

..Levocetirizine and desloratadine are newer antihistamines indicated for the treatment of allergic rhinitis and chronic idiopathic urticaria...

..The sublingual route (SLIT) seemed to be a good candidate for the clinical practice because of its satisfactory safety profile and is now considered an acceptable alternative to SCIT in adults and children...

..In such case, a measurable clinical benefit on asthma symptoms can be expected. On the other hand, SIT cannot be presently recommended as single therapy when asthma is the unique manifestation of respiratory allergy...

..We will review herein a brief history of SLIT, its indications and the safety aspects and will discuss the main unmet needs and the points to be developed in the field...

..The aim of this study was to detail the clinical and cytological characteristics of rhinitis in swimmers, and to assess the possible role of chlorine-induced symptoms...

..Thus, an intense research activity is presently ongoing with the aim of improving the characteristics and modes of action of this treatment...

..This review will examine the aforementioned aspects, with particular regard to the pharmacotherapy of rhinitis in pregnancy...

..According to the ARIA initiative, it is classified as intermittent and persistent, the latter being the most troublesome...

..Respiratory allergy is influenced and determined by genetic and environmental factors. Migration is a good model to indirectly evaluate the possible influence of environment...

..The indications for SLIT are similar to those for the subcutaneous route. A long-lasting effect has been demonstrated for the sublingual route, but data are needed to determine the optimal dose and the preventive effect in asthma...

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..The contribution of enteric absorption of the allergoid in the mechanism of action of sublingual immunotherapy remains to be defined...

..To evaluate the efficacy of allergen specific immunotherapy in the treatment of allergic asthma and rhinitis as derived by the available meta-analyses...

..In all patients, avoidance measures led to a complete remission within 1 month. We suggest that testing for contact sensitization can be helpful in the management of chronic urticaria...

..Its safety is also supported by pharmacokinetics and immunological data. Experimental data on the safety of sublingual and nasal immunotherapy will be reviewed...

..We evaluated the efficacy of SLIT in the treatment of allergic asthma in children by a metaanalysis of randomized, double-blind, and placebo-controlled (DBPC) clinical trials...

..Migration is a good epidemiological model to indirectly assess the influence of the environment. We assessed the clinical characteristics of respiratory allergy in immigrants in Brescia, Italy...

..CONCLUSION: The results of this meta-analysis showed that,compared with placebo, SLIT with standardized extracts is effective in pediatric patients with allergic rhinitis...

..From a clinical and functional point of view, asthma in adolescents did not differ from other age ranges. Nevertheless, the management (diagnosis and therapy) emerged to be unsatisfactory from many points of view...

..CONCLUSION: Eosinophils in the nasal smear display the best correlation with all the clinical and immunological parameters in allergic rhinitis and also correlate well with methacholine response...

..Finally, it seems that the occurrence of some adverse events, at variance with injection route, does not depend strictly on the dose of allergen administered...

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..Therefore, the management of AR patients should be rigorously careful and multi-disciplinary...

..The airways and the upper digestive tract have a common embryonic origin. In sensitized subjects they can respond to allergens with an immediate reaction (asthma, rhinitis, or oral allergy syndrome [OAS])...

..Sublingual immunotherapy (SLIT) has gained increasing interest for its efficacy comparable to traditional subcutaneous immunotherapy and its good safety profile...

..Asthma is an important co-morbidity of obesity. This study evaluated the impact of bariatric surgery on respiratory function in obese patients and compared the outcomes in asthmatic and non-asthmatic subjects...

..Some aspects, such as the dose-response relationship and preventive effect, will be a research challenge for future developments and better definition of indications in children...

..These data are potentially useful to improve immunotherapy treatment protocols by noninjectable routes...

..Although the long-lasting efficacy has been recently documented for the sublingual route, several points still need to be elucidated, including mechanisms of action, optimal dosage, cost-effectiveness, and adherence...

..In the active group, only two patients used rescue medications compared with 13 patients in the placebo group. Conclusions LCZ is clinically effective and capable of improving the rhinitis-asthma-related QoL...

..Thus, special attention to allergic diseases in elderly people has begun to emerge, but little is known about the effect and features of allergic rhinitis in elderly people...

..Finally, one of the major goals is to modify the TH2-biased immune response by improving the characteristics and modes of action of allergen immunotherapy...

..In hymenoptera allergy, the only trial available is a proof-of-concept study in large local reactions that needs to be confirmed in well-controlled studies...

..The results established that it is difficult to predict which patients will gain most benefit from treatment, according to pretreatment baseline characteristics...

..Adverse reactions to drugs are common in the clinical practice. Many outpatients are frequently referred to allergists in order to determine which drugs they can safely take in the future...

..This suggests that long-term continuous treatment be included in the global strategy of allergy treatment...

..During the last 20 years, the epidemiology of asthma has been investigated in various populations, thus providing interesting data including the accuracy of diagnosis and the adequacy of treatment...

..Topical corticosteroids have been accepted as a highly effective anti-inflammatory therapy for allergic rhinitis...

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..For this reason, even if ICS are superior to LTRAs in controlling asthma outcomes and in improving pulmonary function, in children and elderly patients LTRAs can be considered an alternative to low-dose ICS...

..In fact, it proved to reduce exacerbations and symptom scores, and to improve quality of life, with a very good safety profile...

..These findings suggest that more data are needed, derived from large-population-based high quality studies, and corroborated by objective outcomes, mainly for AA...

..It provides a short and simple assessment, and has overall psychometric properties. This is of relevance because of the frequent asthma-rhinitis comorbidity...

..The data obtained, although the number of studies is still limited, provide preliminary evidence supporting a SLIT effect on sparing costs for respiratory allergy...

..The need for extra visits was significantly lower in the active group (25%vs 43%). CONCLUSIONS: Sublingual immunotherapy was clinically effective and safe in mite-induced mild disease...

..We discuss some of the recent observations on the nose-lung interaction and some of the novel therapeutic approaches used to treat rhinitis and asthma that arise from this...

..In this article, therefore, we collected and reviewed the most relevant experimental results available to support the hypothesis for united airways disease and the studies conducted on the possible mechanisms of nose-lung interaction...

..Furthermore, SLIT reduces time and money expenses usually required by SIT since it is self-administered...

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..We speculate that the continuous exposure to saccharomyces in foods may have lead to an immunotolerance with a progressive reduction of symptoms, whereas why the allergens is active only in ready-baked foods remains unexplained...

..Key priorities for further investigation are the mechanisms of action, the efficacy in asthma, the cost/effectiveness and the identification of those patients who will achieve the maximum benefit with SLIT...

..This observation suggests a possible association between PB19 and HL, and opens the possibility of its association also with acute-onset MRS. Further investigations for the presence of PB19 in cases of MRS are warranted...

..05). CONCLUSIONS: This study provides evidence that up to 80% of allergic rhinitics have a mixed form, and SAR and PAR definitions are poorly adherent to real life. Lung involvement is frequent in patients reporting nose symptoms alone...

..It is intended to be used in association with proper pharmacological treatment, at the earliest stages of the disease, for optimal management of respiratory allergy...

..This document summarizes the recommendations for study design, patients' selection, appropriate outcomes and statistical treatment to be used in planning and performing clinical trials with specific immunotherapy...

..We suggest that, in selected cases of difficult diagnosis the presence of proximity allergens is suspected, aerobiological sampling with a portable device should be considered...

..Sublingual immunotherapy (SLIT) proved effective and safe in respiratory allergy, and thus its use in hymenoptera allergy can be hypothesized...

..Atopic dermatitis often has an allergic component, and immunotherapy may therefore prove beneficial...

..CONCLUSION: SLIT achieved a significant clinical benefit in birch pollinosis, reduced the eosinophil infiltration in nasal mucosa, and significantly improved pulmonary function during the pollen seasons...

..Once inflammation is established, potent anti-inflammatory agents or mediator antagonists could help control the phenomenon and reduce the characteristic symptoms related to severity...

..95 euros per patient in the build-up phase. The cluster up-dosing is as safe as the traditional one and allows a significant economical save...

..CONCLUSION: The increased sale of ICS and possibly the decrease of theophylline use seem to be the more relevant factors associated with decreased asthma mortality in Argentina...

..We review here the most recent literature on SLIT, with particular attention paid to the safety of children and to the additional clinical effects...

..A progressive increase in rabbit sensitization is expected in the future as consequence of the increased rabbit ownership...

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..They were clinically evaluated, after each regimen, by means of a visual analog scale and ice-cube test. The combination therapy was superior to the 2 drugs given alone, as testified by subjective and objective evaluations...