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Franco Frati,1 Lorenzo Cecchi,2,3 Enrico Scala,4 Erminia Ridolo,5 Ilaria Dell'Albani,1 Eleni Makrì,6 Giovanni Pajno,7 Cristoforo Incorvaia6 1Medical and Scientific Department, Stallergenes, Milan, Italy; 2Interdepartmental Centre of Bioclimatology, University of Florence, Florence, Italy; 3Allergy and Clinical Immunology Section, Azienda Sanitaria di Prato, Prato, Italy; 4Experimental Allergy Unit, IDI-IRCCS, Rome, Italy; 5Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy; 6Allergy/Pulmonary Rehabilitation, ICP Hospital, Milan, Italy; 7Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy Abstract: The molecular allergy technique, currently defined as component-resolved diagnosis, significantly improved the diagnosis of allergy, allowing for differentiation between molecules actually responsible for clinical symptoms (genuine sensitizers) and those simply cross-reacting or shared by several sources (panallergens), thus influencing the appropriate management of a patient's allergy. This also concerns allergen immunotherapy (AIT), which may be prescribed more precisely based on the component-resolved diagnosis results. However, the advance in diagnosis needs to be mirrored in AIT. According to consensus documents and to expectations of specialists, therapy should be based on standardized extracts containing measured amounts of the clinically relevant molecules, ie, the major allergens. The new generation of extracts for sublingual immunotherapy fulfills these requirements and are thus defined as biomolecular (BM). BM refers to natural extracts with a defined content of major allergens in micrograms. All Staloral BM products are indicated for the treatment of allergic rhinitis with or without asthma. The effectiveness of AIT is related to its ability to modify the immunological response of allergic subjects. The 5-grass and house dust mite extracts were evaluated addressing the T helper 1, T helper 2, and T helper 3 cells by polymerase chain reaction array on mRNA extracted from Waldeyer's ring tissue (adenoids). Sublingual immunotherapy with a defined content of major allergens in micrograms induced a strong downregulation of genes involved in T helper 2 and T helper 1 activation and function, allowing the definition of the immunologic effect as "bio-homeostatic". This clinical and immunological model must be implemented with respect to other allergens, thus expanding the application of a treatment with a unique disease-modifying capacity. Keywords: allergen immunotherapy, allergy, component resolved diagnosis, major allergens, allergen molecules

Matteo Gelardi,1 Diego G Peroni,2 Cristoforo Incorvaia,3 Nicola Quaranta,1 Concetta De Luca,1 Salvatore Barberi,4 Ilaria Dell'Albani,5 Massimo Landi,6 Franco Frati,5 Olivier de Beaumont7 1Otolaryngology Unit, Department of Neuroscience and Sensory Organs, University of Bari, Bari, Italy; 2Department of Pediatrics, University of Verona, Verona, Italy; 3Allergy/Pulmonary Rehabilitation, ICP Hospital, Milan, Italy; 4Department of Pediatrics, San Paolo Hospital, Milan, Italy; 5Medical and Scientific Department, Stallergenes, Milan, Italy; 6Department of Pediatrics, National Healthcare System, ASL TO1, Turin, Italy; 7Medical Affairs Department, Stallergenes, Antony, France Background: House dust mites (HDMs) are a major cause of allergic rhinitis (AR) and asthma worldwide. Recent studies suggested that the allergen load presents seasonal modifications, giving rise to seasonal variation in nasal inflammation and symptoms. The aim of this study was to evaluate by nasal cytology whether nasal inflammation in mite-allergic patients changes with the seasons of the year. Methods: The study included 16 patients (seven males and nine females, mean age 38.1 years) with persistent AR caused by monosensitization to HDMs. Nasal cytology was performed in all patients once monthly for 1 year. Results: Nasal cytology showed that the cells most commonly detected in the nasal mucosa were neutrophils. During the period from October to April, a peak in the number of neutrophils and also the presence of significant numbers of eosinophils, mast cells, and lymphocytes/plasma cells were found, which shows the occurrence of more intense inflammation during these months. Conclusion: Nasal cytology provides useful data in detecting nasal inflammation and its association with the clinical stage of AR. The seasonal variations in nasal cytology are likely to be induced by the fluctuations in the HDM allergen that have been uncovered in recent investigations. Keywords: allergens, allergic rhinitis, house dust mite, nasal inflammation

Elide Anna Pastorello,1 Laura Losappio,1 Stefania Milani,2 Giuseppina Manzotti,3 Valentina Fanelli,4 Valerio Pravettoni,5 Fabio Agostinis,6 Alberto Flores D’Arcais,7 Ilaria Dell'Albani,8 Paola Puccinelli,9 Cristoforo Incorvaia,10 Franco Frati81Allergy and Immunology Department, Niguarda Hospital, Milan, 2Allergy Department, San Marco General Hospital, Bergamo, 3Allergy Department, Treviglio Hospital, Bergamo, 4Allergy Department, Italian Institute for Auxology, Milan, 5Clinical Allergy and Immunology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 6Department of Pediatrics, Riuniti Hospital, Bergamo, 7Department of Pediatrics, Legnano Hospital, Milan, 8Medical and Scientific Department, Stallergenes Italy, Milan, 9Regulatory Department, Stallergenes Italy, Milan, 10Allergy/Pulmonary Rehabilitation, ICP Hospital, Milan, ItalyBackground: An important subpopulation in allergic rhinitis is represented by patients with severe form of disease that is not responsive to drug treatment. It has been reported that grass pollen subcutaneous immunotherapy is effective in drug-resistant patients. In a real-life study, we evaluated the efficacy of 5-grass pollen tablets in patients with grass pollen-induced allergic rhinitis not responsive to drug therapy.Methods: We carried out this multicenter observational study in adults and adolescents with grass-induced allergic rhinitis not responsive to drug therapy who were treated for a year with 5-grass pollen tablets. Clinical data collected before and after sublingual immunotherapy (SLIT) included Allergic Rhinitis and its Impact on Asthma (ARIA) classification of allergic rhinitis, response to therapy, and patient satisfaction.Results: Forty-seven patients entered the study. By ARIA classification, three patients had moderate to severe intermittent allergic rhinitis, ten had mild persistent allergic rhinitis, and 34 had moderate to severe persistent allergic rhinitis. There were no cases of mild intermittent allergic rhinitis before SLIT. After SLIT, 33 patients had mild intermittent allergic rhinitis, none had moderate to severe intermittent allergic rhinitis, seven had mild persistent allergic rhinitis, and seven had moderate to severe persistent allergic rhinitis. The mean medication score decreased from 4.2±1.3 before to 2.4±2.0 after SLIT (P

Franco Frati,1 Cristoforo Incorvaia,2 Marie David,3 Silvia Scurati,3 Simona Seta,4 Guglielmo Padua,4 Eleonora Cattaneo,1 Carlo Cavaliere,5 Alessia Di Rienzo,6 Ilaria Dell'Albani,1 Paola Puccinelli11Medical and Scientific and Regulatory Department, Stallergenes, Milan, Italy; 2Allergy/Pulmonary Rehabilitation, ICP Hospital, Milan, Italy; 3Laboratoire Stallergenes, Antony, France; 4Marketing Department, Stallergenes, Milan, Italy; 5Ear, Nose and Throat Department, University Sapienza, Rome, Italy; 6Azienda Sanitaria Locale, Allergology Service, Frosinone, ItalyAbstract: The house dust mite is a major cause of respiratory allergy worldwide. The management of mite allergy is based on avoidance measures, drug treatment, and allergen immunotherapy, but only allergen immunotherapy is able to modify the natural history of the disease. Injectable subcutaneous immunotherapy was introduced a century ago, while sublingual immunotherapy was proposed in the 1980s and emerged in the ensuing years as an effective and safe option to subcutaneous immunotherapy. However, the quality of the extracts to be used in allergen immunotherapy is crucial for the success of treatment. The mite extract for sublingual immunotherapy known as Staloral 300 was developed to offer optimal characteristics concerning the mite culture medium, standardization, and allergen dose. Double-blind, placebo-controlled trials with Staloral 300 have provided a substantial part of the clinical evidence analyzed in a meta-analysis of the efficacy of allergen immunotherapy in mite-induced rhinitis and asthma. Safety and tolerability are very good, mild local reactions in the mouth being the most common side effect. This makes it feasible to carry out sublingual immunotherapy for the 3–5-year duration needed to achieve long-lasting tolerance to the specific allergen. The performance of Staloral 300 may provide optimal conditions for an effective and safe sublingual immunotherapy in patients with mite-induced respiratory allergy.Keywords: house dust mite, rhinitis, asthma, allergen extracts, sublingual immunotherapy

Frati F, Cecchi L, Scala E, Ridolo E, Dell’Albani I, Makrì E, Pajno GB, Incorvaia C. Biologics: Targets and Therapy. 2014;8:221–226.On page 223, Figure 1 should be replaced with the revised version as shown below:On page 224, line 4 in the left column, "many" should be replaced with "all".On page 224, line 7 in the left column, "but only the major allergen Phl p 5 is measured in μg" should be replaced with "such as group 1 and group 5 allergens (Figure1, Table 2)".On page 224, line 9 in the left column, the reference to "(Figure 1)" should be removed.Read the original article