Search

Different drugs used to treat asthma, such as beta 2 agonists and inhaled steroids, may promote a higher risk of caries, dental erosion, periodontal disease and oral candidiasis. This article reviews the evidences of mechanisms involved in oral diseases in patients affected by asthma. The main mechanism involved is the reduction of salivary flow. Other mechanisms include: acid pH in oral cavity induced by inhaled drugs (particularly dry powder inhaled), lifestyle (bad oral hygiene and higher consumption of sweet and acidic drinks), gastroesophageal reflux, and the impairment of local immunity. In conclusion asthma is involved in the genesis of oral pathologies both directly and indirectly due to the effect of the drugs used to treat them. Other cofactors such as poor oral hygiene increase the risk of developing oral diseases in these patients. Preventive oral measures, therefore, should be part of a global care for patients suffering from asthma.

The coronavirus disease 2019 (COVID-19) pandemic, caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), provoked the most striking international public health crisis of our time. COVID-19 can cause a range of breathing problems, from mild to critical, with potential evolution to respiratory failure and acute respiratory distress syndrome. Elderly adults and those affected with chronic cardiovascular, metabolic, and respiratory conditions carry a higher risk of severe COVID-19. Given the global burden of asthma, there are well-founded concerns that the relationship between COVID-19 and asthma could represent a “dangerous liaison”.Here we aim to review the latest evidence on the links between asthma and COVID-19 and provide reasoned answers to current concerns, such as the risk of developing SARS-CoV-2 infection and/or severe COVID-19 stratified by asthmatic patients, the contribution of type-2 vs. non-type-2 asthma and asthma-COPD overlap to the risk of COVID-19 development. We also address the potential role of both standard anti-inflammatory asthma therapies and new biological agents for severe asthma, such as mepolizumab, reslizumab, and benralizumab, on the susceptibility to SARS-CoV-2 infection and severe COVID-19 outcomes.

Summary: Allergic rhinitis (AR) is a common disease affecting up to 40% of the general population worldwide. In the Coronavirus 2019 (COVID-19) pandemic era, many observational studies analysing the effect of asthma and chronic obstructive pulmonary disease on the risk of developing COVID-19 were conducted, while data on AR are limited.In this paper, we review the risk of developing SARS-Cov-2 infection carried by AR patients, the outcomes of those with COVID-19 disease, and the COVID-19 influence on the allergic and nasal symptoms and the psychological status of AR patients, in both adult and paediatric populations.AR patients seem to be protected from COVID 19 infection. Even if data about the influence of AR on the severity of COVID-19 disease are still not conclusive, it seems that being an AR patient does not increase the risk of poor COVID-19 prognoses. The clinical manifestation of AR can be distinguished by COVID-19 symptoms. Treating AR adequately is also strongly recommended, especially during pandemic.

Background: There are few studies regarding severe chronic upper-airway disease (SCUAD) that represents an important socioeconomic problem for the treatment of rhinitis and associated comorbidities, particularly asthma. Objectives: The aim of our study is to evaluate the prevalence of this pathology in patients with allergic rhinitis (AR) in real life, to phenotype allergic patients with SCUAD, and to identify which factors are related to the severity of the disease. Methods: We studied 113 patients with uncontrolled AR despite optimal adherence to therapy according to the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines in a multicenter Italian study, analyzing comorbidity, use of additional drugs, not scheduled visits, and the number of emergency room admissions. Results: Our data suggest that polysensitization is the only statistically significant factor correlating with SCUAD. Asthma does not seem to represent a correlating factor. An important finding is the poor use (20%) of allergy immunotherapy (AIT), although patients were suffering from AR and the ARIA guidelines recommend the use of AIT in moderate/severe AR. Conclusions: The SCUAD population seems not to have a specific phenotype; there is a greater presence of SCUAD in polysensibilized patients, perhaps a sign of greater inflammation.

Background Allergic Rhinitis (AR) is a high-prevalence disease. In Europe about 25% of the general population is affected, and in Italy the prevalence is estimated to be 19.8%. The Allergic Rhinitis and its Impact on Asthma (ARIA) international document underlined that the prevalence of severe or refractory or overlapping rhinitis is increasing and represents a non-negligible socio-economic burden. In general, despite the social healthcare costs, allergic rhinitis remains underestimated, not sufficiently controlled and often undertreated. Aim of the study In this multi-center Italian observational and prospective study we assessed the control of AR in patients (> 16 years) without previous asthma diagnosis, referred to Allergy Centers. Methods Patients of both sexes and older than 16 with rhinitis symptoms and without asthma were studied. A Visual Analogue Scale (VAS) and the CARAT (Control of Allergic Rhinitis and Asthma Test) were used as patient reported outcome. The possible causes of poor control of AR, as per protocol, were assessed accordingly. Results We observed 250 patients in a real-life setting: more than 60% of them had an uncontrolled AR, only about 50% used multiple medications, and only a minority were receiving allergen immunotherapy. Conclusion This survey, conducted in a real-life setting, confirmed that AR is overall poorly controlled. The VAS assessment well correlates with the structured CARAT questionnaire and with the relevant symptoms of AR.

Nasal cytology is an easy, cheap, non-invasive and point-of-care method to assess nasal inflammation and disease-specific cellular features. By means of nasal cytology, it is possible to distinguish between different inflammatory patterns that are typically associated with specific diseases (ie, allergic and non-allergic rhinitis). Its use is particularly relevant when other clinical information, such as signs, symptoms, time-course and allergic sensitizations, is not enough to recognize which of the different rhinitis phenotypes is involved; for example, it is only by means of nasal cytology that it is possible to distinguish, among the non-allergic rhinitis, those characterized by eosinophilic (NARES), mast cellular (NARMA), mixed eosinophilic-mast cellular (NARESMA) or neutrophilic (NARNE) inflammation. Despite its clinical usefulness, cheapness, non-invasiveness and easiness, nasal cytology is still underused and this is at least partially due to the fact that, as far as now, there is not a consensus or an official recommendation on its methodological issues. We here review the scientific literature about nasal cytology, giving recommendations on how to perform and interpret nasal cytology.

Alexithymia is a personality trait characterized by a limited ability to identify and express emotions and it represents a possible risk factor for disease development and management. The objective of the study is to evaluate alexithymia in patients with persistent asthma and comorbid rhinitis and its relation with patient-reported outcomes (PROs).Alexithymia, quality of life, illness perception, and stress were assessed, as well as rhinitis symptoms and asthma control in out-patients classified according to GINA and ARIA guidelines.Out of 115 patients, 19% turned out to be alexithymic (TAS-20 ≥ 61). Concerning alexithymia level, no difference was detected between males and females (χ(2) = 0.317) and among GINA levels (χ(2) = 0.22). Alexithymics had significantly lower Asthma Control Test scores when compared with non-alexithymics (15.86 vs. 19; p = .02). Alexithymics had a worse quality of life (p.001) and, concerning illness perception, they ascribed to respiratory allergy symptoms that are not strictly disease related and referred to asthma and rhinitis more serious negative consequences (p.001) and emotional representations (p.035). Moreover, they had lower illness coherence (p.001) and lived their disease as a cyclical rather than a chronic disorder (p.035). As regards stress, alexithymics reported less energy (p.001), higher levels of tension (p.001), depression (p.001), confusion (p.001), and inertia (p.001).Alexithymia is present in a relevant percentage of subjects and, as it can modulate illness perception, quality of life, and stress, it should be considered in disease management.

Little is known about the management of asthma in adolescents. We aimed at evaluating these aspects, through a specific questionnaire, in the real life of adolescents with allergic asthma. The questionnaire was administered to a group of adolescents after a diagnosis of allergic asthma. The diagnosis was based on history, clinical examination, pulmonary function tests and allergy tests. One hundred and fifteen adolescents (65 males, mean age 16.5 years) fulfilled the criteria for allergic asthma. The questionnaire explored demography, family history, clinical history, previous diagnosis, therapy, attitude towards therapy and social aspects. The mean actual FEV1 was 87 +/- 10%. Methacholine challenge was carried out in 79 patients and was always positive (PD20 < 1,200 microg), whereas 36 patients underwent reversibility test. According to GINA guidelines, severity of asthma resulted intermittent in 62, mild persistent in 31, moderate in 19 and severe in three patients. In 61% of cases teachers were not aware of the disease. Asthma was managed by general practitioners, allergists and pulmonologists, but PFT/allergy tests had never been performed in 14% of patients. Forty-two per cent of the adolescents received no therapy at all, and only 15% of those with persistent asthma were receiving a stable treatment. Seventy-four per cent of adolescents preferred the inhaled, as against the oral, route. 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.

Anxiety 34 37 36 Headache 28 23 26 Abdominal pain 1 3 2 Weakness 13 4 9 Depression 5 0 3 Impaired sleep 4 8 7 Nicturia 7 0 5 Chest pain 11 7 9 Excitement 13 6 10 Nonlocalized pain 4 4 4 Hunger 3 4 3 Lack of appetite 5 5 5 Fever 1 3 2 Nausea 1 5 4 Urticaria 3 0 2 Palpitation 28 23 26 Heartburn 11 7 10 Generalized itching 22 30 25 Non respiratory symptoms in asthma as possible predictors of exacerbations Gennaro Liccardi, MD, Gennaro Baldi, MD, Adriano Berra, MD, Emanuela Carpentieri, MD, Marina Cutajar, MD, Maria D’Amato, MD, Mario Del Donno, MD, Bruno Del Prato, MD, Ilenia Folletti, MD, Federica Gani, MD, Domenico Gargano, MD, Domenico Giannattasio, MD, Michele Giovannini, MD, Antonio Infantino, MD, Carlo Lombardi, MD, Mario Lo Schiavo, MD, Francesco Madonna, MD, Mauro Maniscalco, MD, Antonio Meriggi, MD, Manlio Milanese, MD, Carmen Montera, MD, Antonio Pio, MD, Maria Russo, PhD, Antonello Salzillo, MD, Patrizia Scavalli, MD, Nicola Scichilone, MD, Bruno Sposato, MD, Anna Stanziola, MD, Antonio Starace, MD, Alessandro Vatrella, MD, Gennaro D’Amato, MD, and Giovanni Passalacqua, MD

We have made use of a stepped doping profile to improve the performance of strained-Si ultra-short MOSFETs. Electron mobility curves are calculated by a Monte Carlo simulator including electron quantization and Coulomb scattering, in addition to phonon and surface roughness scattering. In the first part of the paper, the effect of Coulomb scattering due to both interface charges and bulk impurities is carefully analyzed. We show that the strain enhances the Coulomb-limited mobility due to the interface-trapped charges as a consequence of a better screening of these charges by mobile carriers. However, we also show that this improvement in the Coulomb-limited mobility does not occur if the Coulomb scattering is due to bulk doping impurities, since they share the same physical spare with the carriers, and therefore the screening is the same for the same inversion charge concentration. Nevertheless, we have shown that the use of a stepped doping profile bypasses this inconvenience. The introduction of a low doped layer below the oxide reduces the scattering produced by the bulk ionized impurities, enhancing Coulomb-limited mobility in deep-submicron devices. On the other hand, we have seen (by using MINIMOS-NT) that the use of the low doped silicon layer significantly improves the drain current while degrade the turn-off behavior of very short-channel devices only moderately. This design provides the possibility of taking full advantage of the great reduction in phonon scattering produced by the strain in the Si layer in these MOSFETs.

Background: This study was designed to assess if illness perception, mood state and coping strategies differ according to allergic rhinitis (AR) persistence and severity. Methods: Illness perception, mood profiles, coping behaviors and rhinitis symptoms were assessed by means of validated tools inpatients classified according to the Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines. Results: Two hundred and thirty-one patients underwent data analysis. No difference in age, sex, socio-economic status, smoking habits was detected comparing patients according to AR severity, duration or 4 ARIA classes. Patients with intermittent AR reported higher scores than those with persistent AR in confusion-bewilderment of Profile of Mood States (POMS); patients with moderate/severe rhinitis had significantly higher scores than those with mild rhinitis in TSSS, Identity and Consequences. No differences were detected in all assessed outcomes in the 4 ARIA classes. Conclusions: The patient's perspective about AR is independent of persistence and severity of symptoms. This may explain why AR remains under-diagnosed and under-treated, even in its most severe forms. Self-management plans should consider the patient's perspective.

Orthokeratinised jaw cyst (OJC) is an entity distinct from odontogenic keratocyst (OKC) that has not been fully characterised at the molecular level.To compare the proliferative activity of the epithelial linings of OKC and OJC immunohistochemically, using Ki-67 and cyclin D1 as markers of cellular proliferation and activity.The total numbers of positively stained cells per 10 consecutive lengths of a light microscope calibration ruler were counted in each case (OKC, n = 15; OJC, n = 15) and the composite data were statistically compared.OJC showed significantly fewer Ki-67 and cyclin D1 positive cells than OKC, a finding consistent with the clinically more indolent behaviour of the OJC. Ki-67 expression was mainly detected in the suprabasal cell layers in OKC. Expression of Ki-67 was more uniform in OJC and notably without a significant predilection for the supra-basal compartment. The accumulation of Ki-67 positive cells supra-basally in OKC raises the possibility that a process of asymmetrical cell division may be operational in OKC. Expression of Ki-67 and cyclin D1 differed significantly quantitatively and by distribution pattern in OKC and OJC respectively thereby suggesting that the presence of cyclin D1 protein in OKC and OJC may not necessarily reflect production of this molecule by cycling cells.

Background The present study aimed to develop a short validated patient-completed questionnaire, the RhinAsthma Patient Perspective (RAPP), to assess the health-related quality of life (HRQoL) in patients with asthma and comorbid allergic rhinitis in clinical practice. Methods A provisional RAPP questionnaire was formed from candidate items identified through retrospective analysis of 333 RHINASTHMA questionnaires. This was then tested on 150 asthma patients with allergic rhinitis. Results Psychometric analyses identified eight items fitting a unidimensional model to form RAPP. Internal consistency (Cronbach's alpha coefficient > 0.8) and agreement with RHINASTHMA (r = −0.31, P = 0.0001) were excellent. Criterion, discriminant, and convergent validity were good. Reliability in 47 stable patients was very good (intra-class and concordance correlation coefficients were 0.90 and 0.89, respectively). Responsiveness in 103 patients with health improvement or deterioration was significantly associated with changes in Global Rating Scale (r = −0.4965, P

About 30% of women suffer from nasal symptoms during pregnancy. The hormonal changes occurring during pregnancy favour per se mucosal oedema and relaxation of smooth muscles, thus contributing to nasal congestion. The most common forms of rhinitis are allergic, drug-induced, infectious and vasomotor rhinitis. In addition to the detrimental effects that rhinitis can have on quality of life, it is important to correctly treat rhinitis itself since it can influence concomitant asthma, as underlined in ARIA document. In pregnancy, the safety profile of drugs is the primary item to be considered. The American FDA pointed out that foetal damage could not be totally excluded with the majority of antirhinitis drugs. It is recommended to use "older drugs" because more data about their safety are available. Cromones are the safest drugs but, although they need multiple daily administrations. Antihistamines should be considered as second choice drugs, and their use is not recommended during the first three months of pregnancy. Topical steroids are useful in moderate-severe rhinitis, being beclometasone the most documented molecule. Topical vasoconstrictors should not be used continuously because they can induce pharmacological rhinitis. It is not recommended to start specific immunotherapy in pregnancy but it can be continued in patients who benefit from its use. Infective rhinitis should be treated with beta-lactams, cephalosporins or macrolides. Finally it is important to evaluate the cost/usefulness ratio before any drug prescription.

In the recent years, the importance of sports in everyday life has rapidly increased. Asthma and respiratory allergy are among the most common problems to be afforded in those individuals practising sports and therefore, the diagnostic and therapeutic aspects of allergy in athletes have received in recent times a great interest. The experimental studies performed on allergy and sport have lead to take in consideration a more general aspect, that is the effects of exercise on the immune system. In fact, it has been observed that exercise can induce significant and measurable immunological changes, involving a transient immune suppression (changes in number and activity of neutrophils, lymphocytes, macrophages, and secretion of cytokines). This is probably the reason why athletes seem to be more prone to upper respiratory viral infections. These infections usually appear after exercise discontinuation (within 3 days) particularly in those athletes practising sports which require a long term effort and resistance. The problem is further complicated by the effect of nutrition, since nutrition regimen itself and dietary supplementation were demonstrated able to interfere with the immune response. In the present article we will review the present knowledge and experimental data concerning the effects of sport on immune system and some of the most important clinical implications.

Parameter estimation for a combination of a polynomial phase signal (PPS) and a frequency modulated (FM) signal is addressed. A novel approach is proposed that allows one to decouple estimation of the FM parameters from that of the PPS parameters, exploiting the properties of the multi-lag high-order ambiguity function (ml-HAF). Performance analysis is carried out and Cramer-Rao bounds are compared with simulation results.

Anisakis simplex is a nematode which can parasitize many different kinds of fish or cephalopods (codfish, salmon, tuna, mackerel, hake, etc). Anisakis simplex can cause different diseases in humans. The human being acquires the larvae by eating raw or undercooked seafood. Acute anisakiasis is probably caused by an inflammatory and/or allergic response in the digestive tract mucosa with abdominal pain. It can also induce IgE-mediated reactions with several clinical manifestations ranging from urticaria/angioedema to anaphylaxis. Chronic anisakiasis results from abscesses or eosinophilic granulomas caused by parasite invasion. This later form can mimic appendicitis, duodenal ulcer, inflammatory bowel diseases and intestinal obstruction. An early gastroduodenoscopy can confirm the diagnosis and prevent the complications. Serodiagnosis of anisakiasis is difficult since many Anisakis antigens show cross-reativity complications. In fact many people have high IgE titles in the absence of obvious allergic reactions to seafoods. As preventive measures heating for 10 min over 65 degrees C or freezing (minus 20 degrees for 24 h) destroys the infectivity of the larval stage but not always prevent allergic reactions.

A close anatomical and functional relationship between superior and inferior airways is well documented. A typical example is offered by the close relationship between allergic rhinitis and asthma whose close connection is documented by epidemiological and pathological data. The mechanisms which can explain this phenomenon are not fully known but naso-bronchial reflexes, mouth-breathing due to nasal obstruction and aspiration of nasal secretions seem all to be important. Moreover it has been recently proved that the treatment of rhinitis can improve the concomitant asthma thus confirming their relationship. Another less frequent association is between sinusitis and asthma. Such a connection seems to be frequent in patients suffering of atopic rhinitis but also in patients presenting a nasal obstruction of different nature such as deviations of the nasal septum, adenoid hypertrophy etc. Also in this case a correct medical or surgical treatment of sinusitis can improve asthma symptomathology. Finally a classic example of involvement of superior and inferior airways is represented by the syndrome of ASA intolerance. These patients in fact initially complain of rhinitis which afterwards is complicated by the onset of nasal polyposis and asthma which can prove clinically very severe. Nowadays, anyway, there is no evidence that the treatment of rhinitis or polypectomy can improve the clinical course of asthma. In conclusion, diseases of superior and inferior airways must be considered in strict connection and need the same global treatment.

Asthma is a chronic inflammatory lung disease in which eosinophils are one of the most important involved cells. These cells accumulate in the lung because of cytokines, which are able to regulate cellular responses. The role of cytokines is well known in allergic asthma: IL4, IL5, IL3, GMCSF are the principally cytokine involved. IL4 regulate IgE synthesis while IL5, (and IL3) cause the activation and accumulation of eosinophils. In non allergic asthma, whilst only IL5 seemed to be important recent data, shows that also IL4 plays an important role. Therefore nowadays no relevant difference seems to exist between allergic and non allergic asthma; instead the primer is different: the allergen in allergic asthma and often an unknown factor in the non allergic asthma. Recently other cytokines have been proved to play a role in the pathogenesis of asthma. IL8 is chemotactic not only for neutrophils but also for eosinophils and might cause chronic inflammation in severe asthma. IL13 works like IL4, while RANTES seems to be a more important chemotactic agent than IL5. Finally IL10, which immunoregulates T lymphocyte responses, may reduce asthma inflammation. In conclusion cytokine made us to learn more about the pathogenesis of asthma even if we do not yet know when and how asthma inflammation develops.

Over the last twenty years an increase of allergic respiratory diseases has been observed, even if a broad variability of incidence has been reported. Asthma and allergic rhinitis are more common among young subjects, but there are data of an increase of allergic respiratory diseases in older patients. Moreover it has to be underlined the increase of the severity of these diseases, as shown by the higher use of anti-allergic drugs and by the increase of fatal asthma. The reasons of this trend are not understood. One reason can be the more appropriate diagnosis of asthma by the general practitioners. Other factors must be considered: the most important one can be air pollution; many air components (i.e. SO2, NO2, O3), particularly in industrialized countries, may play a role in allergic sensitization through an irritative-inflammatory mechanism. Socio-economic factors can also influence the incidence of allergic diseases. Other factors as cigarette smoke, foods, allergenic load have to be mentioned. Finally a viral etiology has been reported. Very recently, the allergic inflammation has been considered as the crucial event in the pathogenesis of allergic respiratory diseases. As allergic diseases can lead to chronic inflammation, an early and long-lasting treatment is mandatory.

The drugs recently available for the treatment of allergic respiratory diseases include: 1) topical steroids as fluticasone and budesonide; 2) nasal and ocular sodium nedocromil; 3) nasal N-acetyl-aspartyl-glutamic acid; 4) topical antihistamines as levocabastine and azelastine; 5) antileukotrienes and anti PAF (experimental). Topical steroids are the most effective drugs; the new molecules have a low gastric absorption and a rapid liver-metabolism which decreases the risks of systemic side effects. In the treatment of allergic conjunctivitis ocular sodium nedocromil seems to be more effective than cromoglycate, however further studies are needed to evaluate the effectiveness of the nedocromil nasal formulation. In allergic rhinitis good clinical results are obtained using NAAGA. In the treatment of allergic rhino-conjunctivitis topical antihistamines seem as effective as the antihistamines administered by oral route; moreover they cause less side effects. The anti-leukotrienes drugs can be used in the treatment of moderate asthma. In the treatment of bronchial asthma no clinical and functional improvement has been reported using PAF or thromboxane A2 receptor antagonists.

ObjectivesAsthma trials suggest that patients reaching total disease control have an optimal Health Related Quality of Life (HRQoL). Moreover, rhinitis is present in almost 80% of asthmatics and impacts asthma control and patient HRQoL. We explored whether optimal HRQoL was reachable in a real-life setting, and evaluated the disease and patient related patterns associated to optimal HRQoL achievement.Methods and findingsAsthma and rhinitis HRQoL, illness perception, mood profiles, rhinitis symptoms and asthma control were assessed by means of validated tools in patients classified according to GINA and ARIA guidelines. Optimal HRQoL, identified by a Rhinasthma Global Summary (GS) score ≤20 (score ranging from 0 to 100, where 100 represents the worst possible HRQoL), was reached by 78/209 (37.32%). With the exception of age, no associations were found between clinical and demographic characteristics and optimal HRQoL achievement. Patients reaching an optimal HRQoL differed in disease perception and mood compared to those not reaching an optimal HRQoL. Asthma control was significantly associated with optimal HRQoL (χ(2) = 49.599; pConclusionApproximately one third of the patients in our survey were found to have an optimal HRQoL. While unsatisfactory disease control was the primary reason why the remainder failed to attain optimal HRQoL, it is clear that illness perception and mood also played parts. Therefore, therapeutic plans should be directed not only toward achieving the best possible clinical control of asthma and comorbid rhinitis, but also to incorporating individualized elements according to patient-related characteristics.

Ten asthmatic patients receiving long term treatment with high dose of inhaled beclomethasone dipropionate (BDP) (750 to 2,250 micrograms/die, average 1,400 +/- 474 micrograms) underwent evaluation of hypothalamic-pituitary-adrenal (HPA) axis under basal conditions (serum cortisol and ACTH levels at 8.00 AM and 8.00 PM, 24-hours free urinary cortisol) and by means of pharmacological tests (short tetracosactide and Corticotrophin Releasing Factor Tests). Basal ACTH serum levels at 8.00 PM were lower than the normal values in all patients: three patients had reduced 24-hr free urinary cortisol and six subjects showed lower cortisol serum levels at 8.00 PM. A normal response to the short tetracosactide test was observed in all patients, whilst Corticotrophin Releasing Factor (CRF) induced an increase in ACTH and cortisol levels (expressed as delta AUC) that was significantly lower in the BPD treated patients compared with a control group of five healthy subjects (p0.05). Thus BPD, in high doses, may cause a partial inhibition of HPA axis. Our results show that determination of basal ACTH level and CRF test are more sensitive than serum cortisol levels and short tetracosactide test to evaluate a suppression of HPA axis in patients receiving long term inhaled high doses of BDP.

Rationale Sublingual Immunotherapy (SLIT) is a viable alternative to conventional immunotherapy, but some concerns exist about the adherence to SLIT, and few experimental data exist about this topic. We aimed at quantifying the adherence to the SLIT in patients with mite allergy. Methods We performed a multicenter study (INSIT) to assess the adherence, given as allergoid SLIT in tablets (Lais, Lofarma, Italy), in patients with mite allergy. Patients underwent random telephonic interviews, during which they were asked to immediately count the remaining tablets. The adherence was measured by assessing the reported number of remaining tablets versus that expected, based on the administration schedule. Demographic and socio-economic data and clinical scores were also recorded. Results Forty-one patients (16 male: 15-65 yrs, mean age: 36.3), 19 with rhino-conjunctivitis and 22 with concomitant asthma were enrolled in the first year of the study. Allergoid SLIT was given continuously and the compliance was assessed at the end of 1 year of treatment. There were two dropouts: one lack of efficacy, one onset of nasal polyps. In the remaining 39 patients, the adherence was 3.929/4.056 tablets (96.8%). Sporadically omitted doses (less than 1 tablet/month) were reported by 6 patients (14.6%). No systemic or local side-effects were reported. We also observed a statistically significant improvement of rhinoconjunctivitis and asthma symptoms score and medication consumption. The compliance was in general lower in patients frequently travelling for business reasons. Conclusions The preliminary results of this ongoing study show that the adherence to allergoid SLIT is satisfactory, despite it is self-administered.

Cold-induced rhinitis (CIR) is common among skiers and is perceived as a troublesome disease. We studied the clinical characteristics of CIR in a population of skiers and we evaluated the effectiveness of ipratropium bromide nasal spray (IBNS) in relieving symptoms in a double-blind placebo-controlled fashion. By means of specific questionnaires, we evaluated 144 subjects (69% men; mean age, 42.2 years). The prevalence of CIR was 48.6% and the distinctive symptom was rhinorrhea (96%), often severe. The prevalence of atopy was higher in the CIR patients (χ2; p = 0.004). Twenty-eight CIR subjects participated in a double-blind placebo-controlled cross-over trial for evaluating the effectiveness of IBNS (80 μg twice per day [b.i.d.]). The severity of symptoms was assessed by a visual analog scale, and the number of cleaning tissues used also was evaluated. The actively treated group showed a significant improvement of rhinorrhea (p = 0.0007) and a reduction in the number of cleaning tissues used (p = 0.0023). Only four mild local side effects were reported. We conclude that IBNS could be regarded as an optimal therapeutic option for treating CIR symptoms in skiers.