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Article ; Online: COPD and biologic treatment: state of the art.

Ferri, Sebastian / Paoletti, Giovanni / Pelaia, Corrado / Heffler, Enrico / Canonica, Giorgio Walter / Puggioni, Francesca

Current opinion in allergy and clinical immunology

2023 Volume 23, Issue 4, Page(s) 309–318

Abstract: Purpose of review: Chronic Obstructive Pulmonary Disease (COPD) is a common, heterogeneous disease associated with abnormal inflammatory response of the lung to noxious particles and gases. The progression of disease leads to respiratory failure, ... ...

Abstract	Purpose of review: Chronic Obstructive Pulmonary Disease (COPD) is a common, heterogeneous disease associated with abnormal inflammatory response of the lung to noxious particles and gases. The progression of disease leads to respiratory failure, disability and premature death. Although recent progress in reducing the global burden of many chronic disease, such as heart disease and cancer, mortality and morbidity due to COPD continue to increase despite of cigarette smoking worldwide policy. Additionally, diagnostic and therapeutic options have not changed in decades. While patients affected by other respiratory disease may benefit with a personalized precision medicine, thanks to the new biological treatment, to date, there is no biological treatment available for COPD. COPD is generally a neutrophils-predominant disease but approximately 40% of patients with COPD had also an eosinophilic airway inflammation. Recent findings: different Phase III trials have been recently performed to evaluate the efficacy and safety of several biological treatments, mostly against eosinophilic inflammation and, to date, some of this trial, still ongoing have promising results. Summary: This review resumes the rationale, the attempts of biological treatment in COPD and latest promising results.
MeSH term(s)	Humans ; Pulmonary Disease, Chronic Obstructive/therapy ; Pulmonary Disease, Chronic Obstructive/drug therapy ; Lung ; Eosinophilia ; Inflammation ; Biological Products/therapeutic use
Chemical Substances	Biological Products
Language	English
Publishing date	2023-06-20
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	2088710-3
ISSN	1473-6322 ; 1528-4050
ISSN (online)	1473-6322
ISSN	1528-4050
DOI	10.1097/ACI.0000000000000920
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Article ; Online: The Link between Asthma and Bronchiectasis: State of the Art.

Crimi, Claudia / Ferri, Sebastian / Campisi, Raffaele / Crimi, Nunzio

Respiration; international review of thoracic diseases

2020 Volume 99, Issue 6, Page(s) 463–476

Abstract: The nonrecognition of asthma-associated comorbidities is often responsible for the therapeutic failure and the worsening of symptoms, and it is associated with frequent exacerbations, higher disease severity, and increased health costs. Bronchiectasis, ... ...

Abstract	The nonrecognition of asthma-associated comorbidities is often responsible for the therapeutic failure and the worsening of symptoms, and it is associated with frequent exacerbations, higher disease severity, and increased health costs. Bronchiectasis, one of the most frequent asthma-associated comorbidities, can increase airways inflammation and exacerbation rates and cause respiratory functional impairment. The aim of this article is to review the interactions between bronchiectasis and asthma, in order to better identify patients in the overlap between the 2 diseases and to select an "ad hoc" therapy. A literature search on PubMed/MEDLINE was performed using the following search terms: bronchiectasis in asthma, the association between asthma and bronchiectasis, comorbidities in asthma, and severe asthma. This review analyzed the following items: incorrect or underestimated diagnosis of asthma and bronchiectasis, prevalence of bronchiectasis in asthma, the impact of bronchiectasis in asthma, radiological imaging features of the 2 diseases, etiopathogenesis, and common causes (such as gastroesophageal reflux disease, immune deficits, chronic rhinosinusitis and allergic bronchopulmonary aspergillosis, and treatment of asthma and bronchiectasis). The concomitant presence of bronchiectasis and asthma should be suspected and investigated in patients with severe asthma, frequent exacerbations, and not responding to standard therapy. This clinical phenotype, characterized by a more severe disease, worse outcomes, and functional decline, must be readily recognized in order to choose the most appropriate therapeutic approach, able to potentially improve the management of bronchial asthma, to prevent the onset of exacerbations as well the functional decline, and to reduce health costs.
Language	English
Publishing date	2020-05-28
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	206674-9
ISSN	1423-0356 ; 0025-7931
ISSN (online)	1423-0356
ISSN	0025-7931
DOI	10.1159/000507228
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Article ; Online: Airways Type-2 Related Disorders: Multiorgan, Systemic or Syndemic Disease?

Giombi, Francesco / Pace, Gian Marco / Pirola, Francesca / Cerasuolo, Michele / Ferreli, Fabio / Mercante, Giuseppe / Spriano, Giuseppe / Canonica, Giorgio Walter / Heffler, Enrico / Ferri, Sebastian / Puggioni, Francesca / Paoletti, Giovanni / Malvezzi, Luca

International journal of molecular sciences

2024 Volume 25, Issue 2

Abstract: Chronic rhinosinusitis (CRS) has recently undergone a significant paradigm shift, moving from a phenotypical classification towards an "endotype-based" definition that places more emphasis on clinical and therapeutic aspects. Similar to other airway ... ...

Abstract	Chronic rhinosinusitis (CRS) has recently undergone a significant paradigm shift, moving from a phenotypical classification towards an "endotype-based" definition that places more emphasis on clinical and therapeutic aspects. Similar to other airway diseases, like asthma, most cases of CRS in developed countries exhibit a dysregulated type-2 immune response and related cytokines. Consequently, the traditional distinction between upper and lower airways has been replaced by a "united airway" perspective. Additionally, type-2 related disorders extend beyond respiratory boundaries, encompassing conditions beyond the airways, such as atopic dermatitis. This necessitates a multidisciplinary approach. Moreover, consideration of possible systemic implications is crucial, particularly in relation to sleep-related breathing diseases like Obstructive Sleep Apnoea Syndrome (OSAS) and the alteration of systemic inflammatory mediators such as nitric oxide. The trends in epidemiological, economic, and social burden are progressively increasing worldwide, indicating syndemic characteristics. In light of these insights, this narrative review aims to present the latest evidence on respiratory type-2 related disorders, with a specific focus on CRS while promoting a comprehensive perspective on the "united airways". It also introduces a novel concept: viewing these conditions as a multiorgan, systemic, and syndemic disease.
MeSH term(s)	Humans ; Syndemic ; Asthma/epidemiology ; Sleep Apnea, Obstructive/epidemiology ; Sleep Apnea, Obstructive/therapy ; Respiration ; Cytokines ; Sleep Wake Disorders
Chemical Substances	Cytokines
Language	English
Publishing date	2024-01-05
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2019364-6
ISSN	1422-0067 ; 1422-0067 ; 1661-6596
ISSN (online)	1422-0067
ISSN	1422-0067 ; 1661-6596
DOI	10.3390/ijms25020730
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Article ; Online: Bronchiectasis and asthma: a dangerous liaison?

Crimi, Claudia / Ferri, Sebastian / Crimi, Nunzio

Current opinion in allergy and clinical immunology

2018 Volume 19, Issue 1, Page(s) 46–52

Abstract: Purpose of review: To explore the latest insight of the literature on the asthma/bronchiectasis phenotype providing an updated overview about epidemiological, clinical and biological evidence linking these two conditions.: Recent findings: An ... ...

Abstract	Purpose of review: To explore the latest insight of the literature on the asthma/bronchiectasis phenotype providing an updated overview about epidemiological, clinical and biological evidence linking these two conditions. Recent findings: An increasing body of literature has shown that the association of asthma and bronchiectasis is a frequent phenomenon leading to a more severe disease with frequent exacerbations. The mechanisms by which the two diseases are linked are still not well established but they share several clinical and immunological features and many comorbidities. Summary: The early identification of bronchiectasis through high-definition computer tomography in patients with severe asthma is crucial in order to provide an adequate treatment for both diseases and therefore to better control symptoms, exacerbations and infections.
MeSH term(s)	Animals ; Asthma/epidemiology ; Asthma/immunology ; Bronchiectasis/epidemiology ; Bronchiectasis/immunology ; Comorbidity ; Humans ; Inflammation/immunology ; Italy/epidemiology ; Prevalence
Language	English
Publishing date	2018-12-05
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2088710-3
ISSN	1473-6322 ; 1528-4050
ISSN (online)	1473-6322
ISSN	1528-4050
DOI	10.1097/ACI.0000000000000492
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Article ; Online: Biologics and airway remodeling in severe asthma

Varricchi, Gilda / Ferri, Sebastian / Pepys, Jack / Poto, Remo / Spadaro, Giuseppe / Nappi, Emanuele / Paoletti, Giovanni / Virchow, Johann Christian / Heffler, Enrico / Canonica, Walter G.

Allergy. 2022 Dec., v. 77, no. 12, p. 3538-3552

2022 , Page(s) 3538–3552

Abstract: Asthma is a chronic inflammatory airway disease resulting in airflow obstruction, which in part can become irreversible to conventional therapies, defining the concept of airway remodeling. The introduction of biologics in severe asthma has led in some ... ...

Abstract	Asthma is a chronic inflammatory airway disease resulting in airflow obstruction, which in part can become irreversible to conventional therapies, defining the concept of airway remodeling. The introduction of biologics in severe asthma has led in some patients to the complete normalization of previously considered irreversible airflow obstruction. This highlights the need to distinguish a “fixed” airflow obstruction due to structural changes unresponsive to current therapies, from a “reversible” one as demonstrated by lung function normalization during biological therapies not previously obtained even with high‐dose systemic glucocorticoids. The mechanisms by which exposure to environmental factors initiates the inflammatory responses that trigger airway remodeling are still incompletely understood. Alarmins represent epithelial‐derived cytokines that initiate immunologic events leading to inflammatory airway remodeling. Biological therapies can improve airflow obstruction by addressing these airway inflammatory changes. In addition, biologics might prevent and possibly even revert “fixed” remodeling due to structural changes. Hence, it appears clinically important to separate the therapeutic effects (early and late) of biologics as a new paradigm to evaluate the effects of these drugs and future treatments on airway remodeling in severe asthma.
Keywords	air flow ; asthma ; cytokines ; glucocorticoids ; lung function ; therapeutics
Language	English
Dates of publication	2022-12
Size	p. 3538-3552
Publishing place	John Wiley & Sons, Ltd
Document type	Article ; Online
Note	REVIEW
ZDB-ID	391933-x
ISSN	1398-9995 ; 0105-4538
ISSN (online)	1398-9995
ISSN	0105-4538
DOI	10.1111/all.15473
Database	NAL-Catalogue (AGRICOLA)

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Article: Polyethylene Glycol and Polysorbate 80 Skin Tests in the Context of an Allergic Risk Assessment for Hypersensitivity Reactions to Anti-SARS-CoV-2 mRNA Vaccines.

Nappi, Emanuele / Racca, Francesca / Piona, Alessandra / Messina, Maria Rita / Ferri, Sebastian / Lamacchia, Donatella / Cataldo, Giuseppe / Costanzo, Giovanni / Del Moro, Lorenzo / Puggioni, Francesca / Canonica, Giorgio Walter / Heffler, Enrico / Paoletti, Giovanni

Vaccines

2023 Volume 11, Issue 5

Abstract: Concern has arisen about hypersensitivity reactions in patients with allergic reactions to drugs containing polyethylene glycol (PEG) or polysorbate 80 (PS80), excipients of currently available anti-SARS-CoV-2 mRNA vaccines. However, the actual utility ... ...

Abstract	Concern has arisen about hypersensitivity reactions in patients with allergic reactions to drugs containing polyethylene glycol (PEG) or polysorbate 80 (PS80), excipients of currently available anti-SARS-CoV-2 mRNA vaccines. However, the actual utility of PEG and PS80 skin allergy testing is currently still debated. We retrospectively analyzed all cases of patients on whom we performed allergometric skin tests for PEG and PS80 in the context of a pre-vaccination screening (for patients with multiple hypersensitivity reactions to drugs for which these excipients were among the suspected agents) or following suspected hypersensitivity reactions to anti-SARS-CoV-2 vaccines. A total of 134 tests were performed for PEG and PS80, eight of which produced uninterpretable results (due to dermographism or non-specific reactions). Of the remaining 126 cases (85 pre-vaccinal and 41 post-vaccine reactions), 16 (12.7%) were positive for PEG and/or PS80. Stratifying by clinical indication, there were no statistically significant differences in the proportion of positive tests between patients evaluated in the context of the pre-vaccination screening and those evaluated after a vaccine reaction (10.6% vs. 17.1%, respectively,
Language	English
Publishing date	2023-04-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2703319-3
ISSN	2076-393X
ISSN	2076-393X
DOI	10.3390/vaccines11050915
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Article: Desensitization Protocols for Anti-SARS-CoV-2 Vaccines in Patients with High Risk of Allergic Reactions.

Messina, Maria Rita / Crisciotti, Carlotta / Pellegrini, Laura / Nappi, Emanuele / Racca, Francesca / Costanzo, Giovanni / Del Moro, Lorenzo / Ferri, Sebastian / Puggioni, Francesca / Canonica, Giorgio Walter / Heffler, Enrico / Paoletti, Giovanni

Vaccines

2023 Volume 11, Issue 5

Abstract: Vaccines for SAR-CoV-2 are the most effective preventive treatment able to reduce the risk of contracting the infection and experiencing worse outcomes whenever the infection is contracted. Despite their rarity, hypersensitivity reactions to the anti- ... ...

Abstract	Vaccines for SAR-CoV-2 are the most effective preventive treatment able to reduce the risk of contracting the infection and experiencing worse outcomes whenever the infection is contracted. Despite their rarity, hypersensitivity reactions to the anti-SARS-CoV-2 vaccine have been described and could become the reason not to complete the vaccination. Desensitization protocols for other vaccines have been described and validated, while the use of this approach for anti-SARS-CoV-2 vaccines is still anecdotal. We herein describe our experience with 30 patients with previous allergic reactions to anti-SARS-CoV-2 vaccines or to any of their excipients, proving that they are effective and safe; only two patients experienced hypersensitivity reaction symptoms during the desensitization procedure. Moreover, in this article, we propose desensitization protocols for the most common anti-SARS-CoV-2 vaccines.
Language	English
Publishing date	2023-04-27
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2703319-3
ISSN	2076-393X
ISSN	2076-393X
DOI	10.3390/vaccines11050910
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Article ; Online: A Bloody Mess: An Unusual Case of Diffuse Alveolar Hemorrhage Because of Warfarin Overdose.

Heffler, Enrico / Campisi, Raffaele / Ferri, Sebastian / Crimi, Nunzio

American journal of therapeutics

2016 Volume 23, Issue 5, Page(s) e1280–3

Abstract: We herein present the case of a patient with frank hemoptysis and hematuria, dyspnea, and cough. The patient was known to be affected by Chronic Obstructive Pulmonary Disease (COPD) and dilated cardiomyopathy with atrial fibrillation. For this latter ... ...

Abstract	We herein present the case of a patient with frank hemoptysis and hematuria, dyspnea, and cough. The patient was known to be affected by Chronic Obstructive Pulmonary Disease (COPD) and dilated cardiomyopathy with atrial fibrillation. For this latter condition, he was supposed to take 1.25 mg warfarin daily. Laboratory findings revealed very high levels of International Normalized Ratio (INR) (16), and the patient referred that he self-increased warfarin dose to 5 mg daily since 8 days before the onset of symptoms. Computed tomography scan revealed diffuse bilateral signs of alveolar hemorrhage with hydroaerial levels within emphysematous cysts. Wafarin was immediately stopped and changed with 220 mg dabigatran daily, and he was properly treated to restore a normal coagulation status. We concluded for a case of diffuse alveolar hemorrhage because of warfarin overdose.
MeSH term(s)	Anticoagulants/administration & dosage ; Anticoagulants/adverse effects ; Atrial Fibrillation/drug therapy ; Drug Overdose ; Dyspnea/etiology ; Hematuria/chemically induced ; Hemoptysis/chemically induced ; Hemorrhage/chemically induced ; Humans ; International Normalized Ratio ; Male ; Middle Aged ; Pulmonary Alveoli/drug effects ; Pulmonary Alveoli/pathology ; Warfarin/administration & dosage ; Warfarin/adverse effects
Chemical Substances	Anticoagulants ; Warfarin (5Q7ZVV76EI)
Language	English
Publishing date	2016-09
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	1280786-2
ISSN	1536-3686 ; 1075-2765
ISSN (online)	1536-3686
ISSN	1075-2765
DOI	10.1097/MJT.0000000000000397
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Article: The Prevalence of Immediate Hypersensitivity Reactions to the BNT162b2 mRNA Vaccine against SARS-CoV-2: Data from the Vaccination Campaign in a Large Academic Hospital.

Paoletti, Giovanni / Pepys, Jack / Bragato, Maria Chiara / Paoletti, Sandro / Piona, Alessandra / Messina, Maria Rita / Racca, Francesca / Ferri, Sebastian / Nappi, Emanuele / Costanzo, Giovanni / Del Moro, Lorenzo / Puggioni, Francesca / Canonica, Giorgio Walter / Azzolini, Elena / Heffler, Enrico

Vaccines

2023 Volume 11, Issue 5

Abstract: The anti-SARS-CoV-2 vaccination has probably been the most effective tool for preventing the infection and negative outcomes of the COVID-19 disease, and therefore for interrupting the pandemic state. The first licensed SARS-CoV-2 vaccine was BNT162b2, ... ...

Abstract	The anti-SARS-CoV-2 vaccination has probably been the most effective tool for preventing the infection and negative outcomes of the COVID-19 disease, and therefore for interrupting the pandemic state. The first licensed SARS-CoV-2 vaccine was BNT162b2, an mRNA vaccine that has been widely used since the earliest stages of the global vaccination campaign. Since the beginning of the vaccination campaign, some cases of suspected allergic reactions to BNT162b2 have been described. Epidemiological data, however, have provided reassuring results of an extremely low prevalence of these hypersensitivity reactions to anti-SARS-CoV-2 vaccines. In this article, we describe the results of a survey carried out through the use of a questionnaire, administered to all the health personnel of our university hospital after the first two doses of the BNT162b2 vaccine, which investigated the development of adverse reactions after a vaccination. We analyzed the responses of 3112 subjects subjected to the first dose of the vaccine; among these, 1.8% developed symptoms compatible with allergic reactions and 0.9% with clinical manifestations of possible anaphylaxis. Only 10.3% of the subjects who had allergic reactions after the first injection experienced similar reactions after the second dose and none of them experienced anaphylaxis. In conclusion, the anti-SARS-CoV-2 vaccination is rarely associated with severe allergic reactions and the second dose of vaccine is safe for this group of patients.
Language	English
Publishing date	2023-04-27
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2703319-3
ISSN	2076-393X
ISSN	2076-393X
DOI	10.3390/vaccines11050903
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Article ; Online: Sleep quality burden in chronic rhinosinusitis with nasal polyps and its modulation by dupilumab.

Ferri, Sebastian / Montagna, Carlo / Casini, Marta / Malvezzi, Luca / Pirola, Francesca / Russo, Elena / Racca, Francesca / Messina, Maria Rita / Puggioni, Francesca / Nappi, Emanuele / Costanzo, Giovanni / Del Moro, Lorenzo / Mercante, Giuseppe / Spriano, Giuseppe / Canonica, Giorgio Walter / Paoletti, Giovanni / Heffler, Enrico

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology

2023 Volume 132, Issue 1, Page(s) 69–75

Abstract: Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with a substantial burden on patients' quality of life and impaired sleep quality. The most common CRSwNP endotype is characterized by type 2 inflammation, with enhanced ... ...

Abstract	Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with a substantial burden on patients' quality of life and impaired sleep quality. The most common CRSwNP endotype is characterized by type 2 inflammation, with enhanced production of interleukin (IL)-4, IL-5, and IL-13. Dupilumab is a monoclonal antibody against IL-4 receptor-α, which inhibits both IL-4 and IL-13 signaling, and was recently approved for treatment of CRSwNP. Objective: We investigated the effect of dupilumab on the sleep quality of patients with CRSwNP in a real-life setting. Methods: Patients were evaluated at baseline and after 1 and 3 months of dupilumab treatment by means of the Epworth sleepiness scale (ESS), insomnia severity index (ISI), Pittsburgh sleep quality index (PSQI), and sinonasal outcome test 22 (SNOT-22) sleep domain. Results: A total of 29 consecutive patients were enrolled, and their baseline sleep quality assessment were as follows: ESS of 7.9 (± 4.5); ISI of 13.1 (± 6.2); PSQI of 9.2 (± 3.7); and SNOT-22 sleep domain of 12.1 (± 4.2). Excessive daily sleepiness, insomnia, and globally impaired sleep quality were present in 24.1%, 79.3%, and 93.1% respectively. Treatment with dupilumab was associated with significant improvement in ESS, ISI, PSQI, and SNOT-22 sleep domain with concomitant reduction of the proportion of patients with insomnia and globally impaired sleep quality. Conclusion: CRSwNP was associated with a significant impact on global sleep quality, in particular, insomnia, and treatment with dupilumab induced a rapid improvement (after 1 single month of treatment) in all the sleep quality parameters, suggesting that sleep disturbances should be more carefully evaluated as an additional outcome in these patients.
MeSH term(s)	Humans ; Sleep Quality ; Nasal Polyps/drug therapy ; Nasal Polyps/complications ; Interleukin-13 ; Quality of Life ; Sleep Initiation and Maintenance Disorders/complications ; Rhinosinusitis ; Sleepiness ; Rhinitis/drug therapy ; Rhinitis/complications ; Sinusitis/drug therapy ; Sinusitis/complications ; Chronic Disease
Chemical Substances	dupilumab (420K487FSG) ; Interleukin-13
Language	English
Publishing date	2023-08-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	1228189-x
ISSN	1534-4436 ; 0003-4738 ; 1081-1206
ISSN (online)	1534-4436
ISSN	0003-4738 ; 1081-1206
DOI	10.1016/j.anai.2023.08.594
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