Sublingual immunotherapy in allergic asthma: Current evidence and needs to meet.

Allergen-specific immunotherapy is aimed at modifying the natural history of allergy by inducing tolerance to the causative allergen. In its traditional, subcutaneous form, immunotherapy has complete evidence of efficacy in allergic asthma. However, subcutaneous immunotherapy (SCIT) has a major flaw in side effects, and especially in possible anaphylactic reactions, and this prompted the search for safer ways of administration of allergen extracts.

Sublingual immunotherapy in polysensitized patients: effect on quality of life.

Background: Quality of life (QOL) is an important issue in allergic rhinitis and has been evaluated in a number of studies that have shown how it is impaired in untreated patients and improved by effective treatment. However, there are no data concerning QOL after sublingual immunotherapy (SLIT) in polysensitized patients.

Objective: To evaluate the effect, in real-life clinical practice, of SLIT on QOL in a population of polysensitized patients with allergic rhinitis.

Bridging allergologic and botanical knowledge in seasonal allergy: a role for phenology.

Background: Grass pollen is a worldwide cause of respiratory allergy. Identifying the causative species is essential, for example for choosing the appropriate immunotherapy, because not all grass allergens are totally cross-reacting, and the pollen calendars provide only a gross estimate. Phenologic analyses allow identification of the pollen release for each individual grass.

Development of a sublingual allergy vaccine for grass pollinosis.

Grass pollen is a very common cause of allergic rhinitis and asthma. The only treatment targeting the underlying causes of allergy is immunotherapy (IT). Sublingual immunotherapy (SLIT) has been introduced to solve the problem of systemic reactions to subcutaneous IT (SCIT).

Which allergen extract for grass pollen immunotherapy? An in vitro study.

Background: Grass pollen is a major cause of allergy throughout the world. The only treatment targeting the causes and not only the symptoms of allergy is specific immunotherapy (IT). A number of controlled trials demonstrated the efficacy of IT in grass pollen allergic subjects, most using extracts of multiple grasses but some using extracts of a single grass.

The POLISMAIL lesson: sublingual immunotherapy may be prescribed also in polysensitized patients.

Polysensitization is a feature of allergic rhinitis (AR) that significantly impairs the quality of life (QoL) of AR patients. Allergen-specific immunotherapy is the only causal therapy for AR. However, the polysensitization phenomenon may represent a crucial obstacle as far as it concerns the choice of the allergen extract which should be used for immunotherapy.

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.

Sublingual immunotherapy in children with allergic polysensitization.

Polysensitization is quite frequent in allergic children and may cause difficulties for the allergist in prescribing allergen-specific immunotherapy. This study aimed at evaluating the clinical effectiveness of 1 year of sublingual immunotherapy (SLIT) in a cohort of Italian allergic children with polysensitization. This open study was performed on 51 polysensitized children (34 boys; mean age, 11.

Maintenance venom immunotherapy administered at a 3-month interval preserves safety and efficacy and improves adherence.

Background: Hymenoptera venom immunotherapy (VIT) is a safe and effective approach to insect sting allergy. However, after discontinuation, relapses can occur in some patients, especially those with a high occupational risk, and they may need to prolong VIT indefinitely. In order to improve adherence, we propose extending the interval between injections of maintenance VIT (MVIT).

Lack of neo-sensitization to Pen a 1 in patients treated with mite sublingual immunotherapy.

Background: 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.

Objectives: The aim of this study was to evaluate the development of neo-sensitization to Pen a 1 (tropomyosin) as well as the appearance of reactions after ingestion of foods containing tropomyosin as a consequence of sublingual mite immunization.

Materials And Methods: Specific IgE to Tropomyosin (rPen a 1) before and after mite sublingual immunotherapy in 134 subjects were measured.

Pulmonary rehabilitation as evaluated by clinical trials: an overview.

During the 80' and the 90's, the role of pulmonary rehabilitation (PR) was still not clearly demonstrated. The following development of PR was mainly due to the increasing number of clinical studies providing proofs of its effectiveness, and convincing physicians, institutions, and regulatory agencies about its additional value to conventional pharmacological therapies. In the later years, PR has become an evidence-based non pharmacological treatment, designed for patients suffering from chronic obstructive lung disease (COPD).

Treatment of rhinosinusitis: other medical options.

Medical options other than antibiotics or corticosteroids for treating rhinosinusitis include non-specific treatments such as nasal decongestants, naso-sinusal washings, antihistamines, antileukotrienes, mucolytic agents, immunomodulators and immunostimulants, as well as specific agents such as antimycotics in fungal sinusitis or antireflux agents in sinusitis associated to gastroesophageal reflux. In subjects with chronic sinusitis and/or nasal polyposis related to aspirin hypersensitivity protocols of desensitization are available. The available scientific evidence is good for naso-sinus washings with saline solutions, antihistamines in acute allergic rhinosinusitis, antileukotrienes in chronic sinusitis, bacterial lysates for prevention of recurrent sinusitis, and aspirin desensitisation in subjects with aspirin-exacerbated respiratory disease with chronic sinusitis and nasal polyposis.

The clinical spectrum of rhinosinusitis in children.

Rhinosinusitis is an extremely common disease that is often underreported, especially in children. Its clinical spectrum includes acute rhinosinusitis (ARS) which may present in the forms of ARS with persistent symptoms and ARS with severe symptoms and chronic rhinosinusitis (CRS), characterized by a duration longer than 12 weeks and prevalence of symptoms such as nasal congestion and cough. Moreover, rhinosinusitis may present with associated disorders, that are nasal polyposis and aspirin sensitivity, asthma, otitis media with effusion, and gastroesophageal reflux.

Functional anatomy of the Eustachian tube.

The Eustachian tube (ET) is divided in 3 portions: a bony portion, a cartilaginous portion, and a junctional portion. From an anatomical-functional point of view, the bony portion of ET is the region of ventilation and clearance of secretions, and is lined by pseudostratified, ciliated, columnar epithelium, with an anti-gravitational direction of the drainage. The ET in the bony portion is in a state of forced opening.

Toxocariasis resulting in seeming allergy.

Toxocara canis is an intestinal nematode affecting dogs and cats that causes human infestations by ingestion of embryonated eggs excreted in dogs' faeces. Humans are transport hosts, in whom the larvae do not develop to adult worms, but may migrate to various tissues and organs, and survive for several years, giving rise to several clinical symptoms, which include allergy-like presentations. We report three cases presenting as dermatitis, rhinitis, asthma, and conjunctivitis which were diagnosed and unsuccessfully treated as allergy.

Anaphylaxis: an update on its understanding and management.

Anaphylaxis is the most concerning manifestation of hypersensitivity. Recent thorough investigations on the pathophysiology of anaphylaxis achieved important advances in its understanding, regarding in particular the emerging role of mediators such as platelet activating factor (PAF) and sphyngosine 1 phosphate (S1P) and the improved knowledge on the actors of the signaling cascade, from the contact between the specific allergen and the IgE fixed on the Fc-epsilon-RI receptor to the opening of calcium channels. These advances may provide new diagnostic and therapeutical tools.

The future of sublingual immunotherapy.

Sublingual immunotherapy (SLIT) is currently the most prescribed form of allergen immunotherapy in many European countries. Its use has been accepted in the international consensus publications, and recently also the scepticism of USA scientists is attenuated. Still, this treatment may be improved, and the possible developments consist of modification of the materials, use of adjuvants and use of recombinant allergens.

Economic aspects of sublingual immunotherapy.

Allergic rhinitis and asthma have a very high prevalence and constitute a health problem with a relevant burden of disease, concerning medical and economical issues. Among the treatments of allergy, specific immunotherapy (IT) has the capacity to favourably alter the natural history of the disease both during and after its performance, and thus to reduce the direct and indirect costs of allergic rhinitis and asthma. A number of studies reported a cost reduction for traditional, subcutaneous IT (SCIT).

Sublingual immunotherapy: administration, dosages, use.

Allergen extracts for sublingual immunotherapy (SLIT) are currently marketed by several manufacturers, with administration schedules and amount of allergen(s) quite variable in the different products, although almost all are standardized biologically or immunologically. The allergen extracts for SLIT are available in two main pharmaceutical forms: solution to be delivered by drop-counters, pre-dosed actuators (mini-pumps) or disposable single-dose vials; tablets with appropriate composition that allows a slow (1-2 minutes) dissolution in the mouth in contact with saliva. In Europe, SLIT is prescribed in general for one or a few allergens, and mixtures are less used, though there is no immunological contraindication to give multiple allergens.

Impact of coagulation-balance gene predictors on efficacy of photodynamic therapy for choroidal neovascularization in pathologic myopia.

Purpose: To investigate whether different coagulation-balance genetic backgrounds might explain the variable clinical outcomes detected, after a single photodynamic therapy with verteporfin (PDT-V), in Caucasian patients with subfoveal choroidal neovascularization (CNV) secondary to pathologic myopia (PM).

Design: Retrospective, consecutive, nonrandomized, interventional cases series.

Participants: Two hundred thirty-four patients exclusively treated with standardized PDT-V for the presence of PM-related classic CNV.

House dust mite-related allergic diseases: role of skin prick test, atopy patch test, and RAST in the diagnosis of different manifestations of allergy.

The atopy patch test (APT) was recently defined as an important tool in diagnosis of atopic dermatitis (AD) and also of rhinitis and asthma caused by hypersensitivity to the house dust mites. We evaluated 465 children (279 males and 186 females) aged 0.4-17.

Effectiveness of high dose sublingual immunotherapy to induce a stepdown of seasonal asthma: a pilot study.

Background: There is ample evidence to support the efficacy of sublingual immunotherapy (SLIT) on allergic rhinitis, while there is less solid data regarding asthma. We evaluated the effects of a high dose birch SLIT on birch-induced rhinitis and asthma in a controlled study.

Methods: This double-blind, placebo-controlled, randomised, single centre trial on SLIT with birch pollen allergen extract (Stallergenes, Antony, France) included 24 patients presenting severe rhinitis and slight to moderate asthma, 14 actively and 10 placebo treated.