Pollen allergy poses a significant health and economic burden in Europe. Disease patterns are relatively homogeneous within Central and Northern European countries. However, no study broadly assessed the features of seasonal allergic rhinitis (SAR) across different Southern European countries with a standardized approach.
Beta-lactam (BL) antibiotics are among the most prescribed groups of drugs worldwide and have been implicated in a variety of allergic reactions. There is a paucity of literature regarding patient adherence to prescribed instructions following comprehensive allergy assessments.The objective was to follow up the clinical course of BL allergy in patients who underwent thorough allergological investigation for suspected BL allergy at a tertiary hospital and ascertain patients' compliance with the provided written instructions.An observational study in patients referred for suspected BL allergy who underwent a comprehensive allergy workup (in vivo ± in vitro tests, DPT in culprit and/or alternative BL) and who subsequently received written instructions was conducted. Data on the nature of the reported drug hypersensitivity reaction, the culprit BL drug, the allergological workup, and the detailed instructions provided in a written drug allergy report were collected retrospectively. Patients' compliance with the instructions was recorded by a telephone survey using a pre-defined questionnaire.Among the 212 patients meeting the inclusion criteria, 87 patients (72.4% women; mean age 50.1 years; age range 6-84 years) responded to the telephone survey and were included in this study. Surprisingly, 45 out of 87 (51.7%) patients did not adhere to the written instructions. The primary factor contributing to non-compliance was the fear of re-occurrence of a drug-induced allergic reaction (personal and/or triggered by their treating physician reluctance), accounting for 77.7% of cases. The analysis demonstrated that the initial reaction's severity and type, as well as the outcomes of skin testing, did not correlate with compliance to instructions (p > 0.05). Surprisingly enough, a drug provocation test (DPT), irrespectively of the result, emerged as a negative predictor for adherence, with only 40.6% of DPT patients complying compared to 77.8% of those who did not undergo DPT (p = 0.005; odds ratio = 0.195; 95% confidence interval: 0.058-0.655). Variables such as performing DPT with alternative or incriminated drugs or the result of the DPT (positive-negative) were not associated with patient compliance. Conversely, the type of instructions provided exhibited a noteworthy correlation with compliance. Patients who were explicitly instructed to entirely avoid all BL antibiotics demonstrated markedly higher adherence rates (83.3%) compared to those who were advised to have a partial or complete release of BLs (31.8% and 58.1%, respectively; p < 0.05). Notably, among compliant patients who received either the original culprit drug or the alternative (32 out of 87, 36.7%), no allergic reactions were reported. In contrast, among the 12 patients with written avoidance of all BLs, subsequent BL intake led to immediate reactions (Grade I and IV) in 2 patients (16.6%).A notable disparity in patient adherence to written instructions prohibiting or releasing beta-lactams was demonstrated. Less than half of the patients ultimately complied with the provided instructions, underscoring the need for tailored patients' education and strategies to improve adherence in the management of suspected BL allergy.
Respiratory allergic diseases affect over 500 million people globally and pose a substantial burden in terms of morbidity, mortality, and healthcare costs. Restrictive factors such as geographical disparities, infectious pandemics, limitations in resources, and shortages of allergy specialists in underserved areas impede effective management. Telemedicine encompasses real-time visits, store-and-forward option triage, and computer-based technologies for establishing efficient doctor-patient communication. Recent advances in digital technology, including designated applications, informative materials, digital examination devices, wearables, digital inhalers, and integrated platforms, facilitate personalized and evidence-based care delivery. The integration of telemonitoring in respiratory allergy care has shown beneficial effects on disease control, adherence, and quality of life. While the COVID-19 pandemic accelerated the adoption of telemedicine, certain concerns regarding technical requirements, platform quality, safety, reimbursement, and regulatory considerations remain unresolved. The integration of artificial intelligence (AI) in telemonitoring applications holds promise for data analysis, pattern recognition, and personalized treatment plans. Striking the balance between AI-enabled insights and human expertise is crucial for optimizing the benefits of telemonitoring. While telemonitoring exhibits potential for enhancing patient care and healthcare delivery, critical considerations have to be addressed in order to ensure the successful integration of telemonitoring into the healthcare landscape.
Allergic rhinitis is a serious global health problem which affects approximately 10–20% of the European population. In 1999, during a workshop of WHO, the project Allergic Rhinitis and its Impact on Asthma (ARIA) was developed. Its objective was to propose a new classification of allergic rhinitis according to the severity and the duration of the symptoms, to promote the idea of multimorbidity of allergic rhinitis and asthma, and to create guidelines for global use, with the help of local stakeholders and experts from all the countries involved. The focus of ARIA during recent years has been the use of new technologies for individualized medical care and prevention. The MASK instrument uses smartphone technology to create care pathways for controlling rhinitis, for both multidisciplinary care teams and the patients themselves. Using a mobile app (Allergy Diary), a patient can assess symptoms, control and productivity using a visual analog scale, which is connected with a clinical decision support system. The information is sent to an interoperable tablet where healthcare professionals can be informed about the patient’s rhinitis management. As the European population is ageing, the novel approach of ARIA aims to provide active and healthy ageing in order to improve the quality of life of patients with allergic rhinitis. In Greece, ARIA has been implemented since the early 2000s. In 2017 a new ARIA implementation group was established, consisting of a large number of health care professionals from both Greece and Cyprus. The MASK Allergy Diary has been translated into Greek and is currently being used in clinical practice and research protocols with great enthusiasm. In order to rectify the lack of recent studies on the epidemiology of allergic rhinitis in Greece, MASK will be the instrument which, in combination with aerobiological studies, will form the basis for reporting allergic rhinitis activity around the country.
Respiratory allergic diseases, affect over 500 million people globally and pose a substantial burden in terms of morbidity, mortality, and healthcare costs. Restrictive factors such as geographical disparities, infectious pandemics, limitations in resource, and shortage of allergy specialists in underserved areas, impede effective management. Moreover, the well-established suboptimal adherence in patients with respiratory allergies, contribute further to the accelerated loss of disease control.
Telemedicine encompasses real-time visits, store-and-forward options triage, and computer-based technologies for establishing and efficient doctor-patient communication. Recent advances in digital technology, including designated applications, informative materials, digital examination devices, wearables, digital inhalers, and integrated platforms, facilitate personalized and evidence-based care delivery. The integration of telemonitoring in respiratory allergy care has shown beneficial effects in disease control, adherence, and quality of life.
While the COVID-19 pandemic accelerated the adoption of telemedicine, certain concerns regarding technical requirements, platform quality, safety, reimbursement, and regulatory considerations remain unresolved. Challenges in telemonitoring implementation further include ensuring effective doctor-patient collaboration, addressing privacy concerns, and establishing cost-effective models. The integration of artificial intelligence (AI) in telemonitoring applications holds promise for data analysis, pattern recognition, and personalized treatment plans. Striking the balance between AI-enabled insights and human expertise is crucial for optimizing the benefits of telemonitoring.
This overview reports the up- to- date telemedicine approaches in managing patients with respiratory allergies. While telemonitoring exhibits potential in enhancing patient care and healthcare delivery, critical considerations have to be addressed in order to ensure the successful integration of telemonitoring into the healthcare landscape.
To the Editor, Over the last decades, systematic reviews and meta analyses of multiple double-blind randomized placebo-controlled trials have demonstrated the efficacy and safety of both subcutaneous (SCIT) and sublingual (SLIT) allergen immunotherapy (AIT) for respiratory and insect venom allergy.1 However, there is a wide range of AIT preparations used around the globe, and AEs are not always uniformly recorded, limiting the capability to draw safe conclusions or compare reports. Though various clinical development programs2 have generated substantial knowledge on different AIT preparations, they have been conducted in pre-defined clinical conditions, not reflecting real-life and therefore the results may not have generalized applicability.3 Very few pragmatic trials and observational studies have evaluated AIT safety in real-life. Indicatively, Calderon et al.4 reported a total of 109 systemic reactions (SR) due to AIT recorded in 4316 patients in a prospective, longitudinal, "real-life" web-based survey. Another prospective study5 on SCIT safety in 581 patients reported immediate SR in 2.2%, delayed (7.4%), immediate local reactions (LR) (54.6%), while delayed in 56.1%. Recently, the Respiratory Effectiveness Group highlighted the role of real-world evidence (RWE) in (i) filling knowledge gaps, (ii) extending the implementation of findings from Randomized controlled trials in heterogeneous populations or healthcare systems, and (iii) providing evidence to generate clinical practice guidelines.3 Prospective, systematic RWE from registries are considered to provide a broadly applicable source of knowledge compared with retrospective approaches.6 However, there is still a lack of such registries in the allergy field.7 In this context, a new hierarchy of AIT RWE that ranks pragmatic trials and registry data at the highest level of evidence was proposed in a recent European Academy of Allergy and Clinical Immunology (EAACI) position paper.6 Considering these factors, a Task Force (TF) was created under the academic support of EAACI to develop an AIT Adverse Events Registry (ADER). Adverse Events Registry is a prospective, longitudinal, observational, multicenter, web-based registry of "real-life" AIT clinical practice across multiple countries. It has included centres from eight South-Eastern European countries (Albania, Bulgaria, Croatia, Greece, Romania, Serbia, Slovenia and Turkey) and was academically supported by EAACI through a TF (AIT Adverse Events Registry Task Force). Our framework was based on the previous experience of the European Survey on Adverse Systemic Reactions in Allergen Immunotherapy.8 The TF was chaired by Nikolaos Papadopoulos and led by a Steering Committee (Nikolaos Papadopoulos, Moises Calderon, Ted Popov). The registry team, coordinated by Dimitrios Mitsias, included one to two National Coordinators per country, responsible for following local ethics requirements and recruiting physicians. No fees were provided for participant inclusion. The main objectives of the registry are (I) to assess systemic and local AEs occurring during regular clinical practice in real-life settings, (II) to collect data and evaluate patient characteristics and AIT practice among countries (expected to differ substantially), (III) to identify independent factors associated with AE, and (IV) to use ADER as a model for AIT pharmacovigilance that could be subsequently expanded to other European countries. Based on the EASSI survey e–questionnaires,8 ADER developed three similar questionnaires to collect data (see Supplement). Eligible subjects were adults and children attending regular consultations in real-life clinical settings, presenting symptoms due to IgE mediated respiratory allergies documented by at least one positive skin prick test and/or specific IgE test to a panel of inhalant allergens. Those with verified Hymenoptera Venom Allergy and Venom Immunotherapy (VIT) courses to honey bees, common wasp and/or polistes wasp are also included. All patients are recruited in a prospective manner, on the same day they receive their first dose of a new AIT treatment, either SCIT or SLIT or VIT, and followed up until the end of the course. Systemic and local AEs are registered prospectively. A total of 2772 patients undergoing 3209 immunotherapy courses were retrieved up to May 2017 (Supplementary Table 1). Overall, 1019 systemic and local AEs were recorded in 330 patients. Additional information on the registry is described in the online supplement. Registries are considered a powerful tool that can provide systematic collection of large amounts of data for a long period of treatment. Adverse Events Registry is the first AIT Registry for AE piloted in different countries in Europe that uses the harmonized MedDRA terminology9 (Table 1). These real-life data will generate useful information that complement data from RCTs for decision-making issues for doctors, patients, healthcare providers and policymakers. We aim to expand this Registry to more countries in Europe and possibly worldwide. The questionnaires gather data covering different safety aspects and other characteristics of AIT practice in a pragmatic, low-effort manner. The inclusion of eight different countries leads to substantial heterogeneity (different populations, clinical settings, healthcare systems, AIT products and protocols), providing invaluable information on AIT safety. The registry is designed to collect all possible AEs during the course of a specific AIT in a real-life setting. We are aware that this approach has a few shortcomings, especially in the case of SLIT (which is self-delivered) or LR. However, the study attributes more weight to SR in AIT. In conclusion, we consider ADER as a first effort to create a multinational network of centres practicing AIT and exchanging best practice parameters. We believe this is a step-up in the progress of evidence needed to further support the optimal delivery of AIT. Such complex and factual monitoring may provide robust evidence of safety as well as help us to determine risk factors for AIT related AE. Julijana Asllani: data curation (equal); formal analysis (equal); writing original draft (lead). Dimitrios Mitsias: project administration (lead), methodology (equal), data curation (equal), and formal analysis (equal). George Konstantinou: data curation (equal); formal analysis (equal). Todor A. Popov: conceptualization (equal). Nikolaos G. Papadopoulos: conceptualization (equal); methodology (equal), funding acquisition (lead). Moises Calderon: conceptualization (equal); methodology (equal). All authors: Investigation (equal); writing-review and editing (equal). We acknowledge Mrs Smaragda Vidou for excellent management of the registry. This study was supported by an unrestricted grant from Stallergenes and The EAACI. Open access publishing facilitated by The University of Western Australia, as part of the Wiley - The University of Western Australia agreement via the Council of Australian University Librarians. Julijana Asllani, Alfred Priftanji, Mehmet Hoxha, Gerta Sinani, George Christoff, Dimitrov Zlatko, Michael Makris, Xenofon Aggelidis, Asja Stipic, Diana Deleanu, Vesna Tomic-Spiric, Aleksandra Plavsic, Dilsad Mungan, Mitja Kosnik have no conflicts of interest to declare. Nikolaos G. Papadopoulos has received grants from Capricare, Nestle, Numil, Vianex and/or fees for consultancy from Abbott, Abbvie, Astra Zeneca, GSK, HAL, Medscape, Menarini/Faes Farma, Mylan, Novartis, Nutricia, OM Pharma, Regeneron/Sanofi in the last 3 years. Dimitrios Mitsias is or recently was a speaker for AstraZeneca, Gerolymatos International, Novartis, Sanofi, in the last 3 years. George Konstantinou is or recently was a speaker and/or advisor for and/or has received research funding from AstraZeneca, Chiesi, GSK, Menarini, Novartis, Pfizer, Sanofi, and Vianex in the last 3 years. All other authors do not declare any conflicts of interest. European Academy of Allergy and Clinical Immunology; Stallergenes Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Abstract Introduction The integrated care pathways for atopic dermatitis (AD‐ICPs) aim to bridge the gap between existing AD treatment evidence‐based guidelines and expert opinion based on daily practice by offering a structured multidisciplinary plan for patient management of AD. ICPs have the potential to enhance guideline recommendations by combining interventions and aspects from different guidelines, integrating quality assurance, and describing co‐ordination of care. Most importantly, patients can enter the ICPs at any level depending on AD severity, resources available in their country, and economic factors such as differences in insurance reimbursement systems. Methods The GA 2 LEN ADCARE network and partners as well as all stakeholders, abbreviated as the AD‐ICPs working group, were involved in the discussion and preparation of the AD ICPs during a series of subgroup workshops and meetings in years 2020 and 2021, after which the document was circulated within all GAL 2 EN ADCARE centres. Results The AD‐ICPs outline the diagnostic procedures, possible co‐morbidities, different available treatment options including differential approaches for the pediatric population, and the role of the pharmacists and other stakeholders, as well as remaining unmet needs in the management of AD. Conclusion The AD‐ICPs provide a multidisciplinary plan for improved diagnosis, treatment, and patient feedback in AD management, as well as addressing critical unmet needs, including improved access to care, training specialists, implementation of educational programs, assessment on the impact of climate change, and fostering a personalised treatment approach. By focusing on these key areas, the initiative aims to pave the way for a brighter future in the management of AD.
The European Anaphylaxis Registry (NORA) was designed in order to create a comprehensive Anaphylaxis Registry regarding anaphylactic reactions characteristics and management in several European countries, including Greece. This study aims to analyze Greek data obtained in the NORA framework and describe anaphylaxis' characteristics in this pediatric cohort. An online questionnaire was filled out by the Allergy Unit of the 2nd Pediatric Department of NKUA, regarding reported anaphylaxis characteristics. A total of 284 pediatric patients were analyzed. Patients were predominantly male. A previous, mild reaction (59.5%) to the same allergen was documented in 44.4% of patients. The most common system involved was skin and/or mucosa, followed by the respiratory system. Food was the most common eliciting factor (82.4%). First line treatment was most administered solely by a healthcare professional, followed by a lay person (38.7%). Auto injected adrenaline use by lay persons was third in frequency (29.2%). Most patients received post-reaction counseling and appropriate drug prescription. This study provides insight in anaphylactic cases' characteristics and management in a Greek pediatric cohort. A low rate of adrenaline autoinjector administration was noted in lay people; however, drug prescription and counseling following the reaction could help increase correct acute anaphylaxis management in the future.
Abstract Background Although it has been shown that allergen immunotherapy (AIT) is well‐tolerated in children, systematic and prospective surveillance of AIT safety in real life settings is needed. Methods The multinational Allergen Immunotherapy Adverse Events Registry (ADER) was designed to address AIT safety in real life clinical practice. Data on children ≤18 years old with respiratory allergies undergoing AIT were retrieved. Patient‐ and AIT‐related features were collected and analyzed. The characteristics of adverse events (AE) and risk factors were evaluated. Results A total of 851 patients, 11.3 ± 3.4 years old, with rhinitis only (47.6%); asthma and rhinitis (44.5%); asthma (7.9%), receiving 998 AIT courses were analyzed. Sublingual immunotherapy (SLIT) accounted for 51% of the courses. In 84.5% of patients only one AIT treatment was prescribed. Pollen was the most frequent sensitizer (57.1%), followed by mites (53.4%), molds (18.2%) and epithelia (16.7%). Local and systemic AEs were reported in 85 patients (9.9%). Most AEs (83.1%) were mild and occurred in <30 min (87%). Respiratory and cutaneous symptoms were more frequent. Only 4 patients (0.47%) had severe AE (none after 6 weeks of maintenance). The risk of AE was higher in patients undergoing SCIT. Conclusions AIT is safe and well tolerated in children and adolescents with respiratory allergies in real‐life clinical practice. Though SCIT is more prone to AE compared to SLIT, overall severe reactions are rare and occur during build‐up and early maintenance.
