1. The document discusses using digital solutions like mobile health to improve allergen immunotherapy (AIT) by combining clinical research data and mobile health for AIT prescription. 2. It proposes the "@IT-2020" process, a flexible 4-step modular approach for prescribing AIT for pollen allergy patients in Southern Europe/Mediterranean countries, to be validated in a pilot study (2016-2017) and multicenter study (2018-2019). 3. The 4 diagnostic steps of "@IT-2020" and validation testing are described, aiming to determine genuine vs false sensitization, primary sensitization, and the relationship between sensitization and symptoms to guide personalized AIT prescription.

1. Immunoterapia specifica alla luce della e-mobile Health?
Salvatore Tripodi
salvatore.tripodi@gmail.com

2. PD Dr. med. Paolo M. Matricardi
Dept. of Paediatric
Pneumology and Immunology
Charité University Medical Centre,
Berlin, Germany

3. Outline
1. Problemi della Immunoterapia allergica (AIT): soluzioni digitali?
2. @IT-2020 : combinare CRD e mH per la prescrizione dell’AIT
3. Gli elementi di base dell’@IT-2020: studi di validazione
4. Prescrizione dell’AIT : test di validazione e impatto sulle decisioni dei medici
5. CDSS per la prescrizione dell’AIT : strumento per un’allergologia di precisione

4. Outline
1. Problemi della Immunoterapia allergica (AIT): soluzioni digitali?
2. @IT-2020 : combinare CRD e mH per la prescrizione dell’AIT
3. Gli elementi di base dell’@IT-2020: studi di validazione
4. Prescrizione dell’AIT : test di validazione e impatto sulle decisioni dei medici
5. CDSS per la prescrizione dell’AIT : strumento per un’allergologia di precisione

5. Le pietre miliari dell’AIT
Arasi et al, IJP 2018
• …. there are still several gaps to be filled, particularly
around AIT long-term benefit and its use in children
cortesia di Stefano Miceli Sopo

6. Network Meta-analysis Shows Commercialized Subcutaneous and Sublingual Grass Products Have Comparable Efficacy
Nelson H et al, 2015, J Allergy Clin Immunol Pract
SCIT
SLIT drops
SLIT tablets

7. Prescrizioni di AIT x 10.000 inhabitants 2014 (iniziali e mantenimenti)
96
15
2
34
1
63
38
14
062
48
22
2
140
152
Sources: IMS, Allergopharma; FC 2014 on MAT 08/14
Immunoterapia Allergica in Europa: Candidati vs pazienti trattati
AIT è usata da una piccola minoranza dei potenziali pazienti europei
>15%
1%
eligible
AIT
GERMANY
Eligible >15%
AIT = 96 x 10,000
<

8. • Efficacia dell’AIT, pur con dei limiti, è ben documentata, ma è in parte grandemente
ignorata
• La prescrizione dell’AIT è ancora basata su metodi vecchi e tradizionali
• L’Allergia e l’AIT sono spesso banalizzate e non considerate scientificamente (anche
a livello dei vari SSN)
• L’Allergia dipende dall’esposizione locale e non è possible definire alcun modello
globale per l’AIT
• La carenza e/o il trend in diminuizione degli specialisti allergologi
• Fattori economici: crisi, costo-efficacia, rimborsabilità, ecc.
• Sovra-regolamentazione a livello Europeo e nazionale (per es. uso degli SPT,
standardizzazione, ecc)
Alcuni dei fattori limitanti l’uso dell’AIT in Europa
Necessità di una più precisa prescrizione e di una più alta documentata efficacia

9. 1980
. . .
2020
Superare
il GAP!
La Mobile Health può aiutare a rendere l’AIT aggiornata, accessibile e sostenibile
CDSS
con
e-Diari
per AIT
Alcuni dei fattori limitanti l’uso dell’AIT in Europa
GAP!

10. Task Force su m-Health & Allergia: una iniziativa dell’ EAACI (2016-2019)
Una Task Force dell’ EAACI composta da esperti nominati dalle Sezioni e dagli Interest Groups

11. Matricardi PM, Tripodi S, et al., Allergy 2019

12. ?EAACI
guidelines
production
Implementation
in daily practice
Allergologia
di Precisione
Teoria Pratica
Linee Guida: Elaborazione ed Implementazione
Le Linee Guida non sono frequentemente implementate nella pratica clinica quotidiana
Allergologia
dell’ Imprecisione

13. Wikipedia – “Clinical decision support system (CDSS) is an interactive
decision support system (DSS) Computer Software, which is designed to
assist physicians and other health professionals with decision making tasks,
such as determining diagnosis of patient data”
Dr. Robert Hayward, Centre of Health Evidence – "Clinical Decision Support
systems link health observations with health knowledge to influence health
choices by clinicians for improved health care”2
HL7 (Health Level Seven International) – “The act of providing clinicians,
patients and other healthcare stakeholders with pertinent knowledge and/or
person-specific information intelligently filtered or presented at appropriate
times, to enhance health and health care”3
HIMSS (Healthcare Information and Management Systems Society) –
“CDSS is a process for enhancing health- related decisions and actions with
pertinent, organized clinical knowledge and patient information to improve
health and healthcare delivery”.4
Clinical decision support system (CDSS) = definitions
INFORMATION KNOWLEDGE ACTION

14. data
report for
diagnosis &
therapeutic
decisions
patient
environmental
(local) exposure
epidemiological
(local) scenario
algorithms
guidelines
doctor’s personal
(local) experience
monitoring response
adherence – clinical evolution – quality of life
configuration
customization
personalization
precision
evidencebased
medicine
community
medicine
Clinical Decision Support Systems
Matricardi PM, Tripodi S, et al. (PAI, In press)
Per essere «precisi», CDSS e Diari elettronici per l’ AIT richiedono
validazione e adattamenti local

15. Outline
1. Problemi della Immunoterapia allergica (AIT): soluzioni digitali?
2. @IT-2020 : combinare CRD e mH per la prescrizione dell’AIT
3. Gli elementi di base dell’@IT-2020: studi di validazione
4. Prescrizione dell’AIT : test di validazione e impatto sulle decisioni dei medici
5. CDSS per la prescrizione dell’AIT : strumento per un’allergologia di precisione

16. Estrema polisensibilizzazione nei bambini italiani
con allergia a pollini
La prescrizione dell’AIT nell’Europa meridionale è resa complessa dalla
polisensibilizzazione ai pollini
Dondi A, Tripodi S et Al. PAI 2013 Dec;24(8):742-51

17. 58%
42%
0%
20%
40%
60%
80%
SI NO
Prescrizione
10%
33%
56%
0%
20%
40%
60%
NO Modificata Invariata
Prescrizione
Modifica della prescrizione della ITS
dopo i risultati della CRD
+
Prescrizione ITS
Stringari G, Tripodi S, Caffarelli C. et al. (JACI, 02 May 2014)
I Medici hanno cambiato
la loro prescrizione di AIT
nel 47% dei 651pazienti
dopo i test di IgE
molecolari

18. POLLENGRAINS/m3
SPT reactions and serum IgE-Ab
Pollen (season) SPT* mol IgE
Cypress (Jan-Apr) 3,0 Cup a 1 5
Birch (Mar-Apr) 2,0 Bet v 1 0
Olive tree (Mar-May) 5,0 Ole e 1 21
Grass (Apr-Jul) 5,5 Phl p 1 54
Phl p 5b 71
Phl p 7 0
Phl p 12 10
Pellitory (Apr-Oct) 0,0 Par j 2 nd
Mugwort (Ago-Sep) 0,0 Art v 1 nd
*mm of wheal diameter; ° kU/l
POLLENGRAINS/m3
SPT reactions and serum IgE-Ab
Pollen (season) SPT* mol IgE
Cypress (Jan-Apr) 5,5 Cup a 1 143
Birch (Mar-Apr) 7,0 Bet v 1 226
Olive tree (Mar-May) 7,5 Ole e 1 22
Grass (Apr-Jul) 7,0 Phl p 1 60
Phl p 5b 284
Phl p 7 161
Phl p 12 0,1
Pellitory (Apr-Oct) 6,0 Par j 2 154
Mugwort (Ago-Sep) 7,0 Art v 1 49
*mm of wheal diameter; ° kU/l
The Smartphone: A Novel
Diagnostic Tool in Pollen Allergy?
Bianchi A1, Tsilochristou O2, Gabrielli F3,
Tripodi S4, Matricardi PM2
J Investig Allergol Clin Immunol 2016;
Vol. 26(3): 204-207

19. @IT-2020
Un processo diagnostico flessibile, modulare a 4-step
per l‘allergia a pollini e la prescrizione dell‘AIT
nell‘Europa Meridionale / Paesi dell‘area Mediterranea
(2015-2020)

20. TRADITIONA
L APPROACH
AIT
Patient with clinical history of hay fever
Multiplex IgE test (ESEP)
studio pilota (2016-2017; Italia) – studio multicentrico (2018-2019; sei nazioni)
I quattro step diagnostici dell’@IT-2020 ed il test di validazione
@IT-2020
Mugwort
Ragweed
Pellitory
Alternaria
Fagales
Olive◦
Grass

21. TRADITIONA
L APPROACH
Patient with clinical history of hay fever
@IT-2020
I quattro step diagnostici dell’@IT-2020 ed il test di validazione
Approccio tradizionale:
Storia clinica e SPT

22. È con l’art. 1 della direttiva 2001/83 del 06.11.2001 che viene
sancita la classificazione degli allergeni utilizzati sia per
l’immunoterapia che per la diagnosi come medicinali. Ad oggi
questa classe di medicinali si trova in una situazione transitoria,
che le autorità europee stanno cercando di sbloccare per poter
assegnare le Autorizzazioni all’Immissione in commercio.

23. TRADITIONA
L APPROACH
Patient with clinical history of hay fever
@IT-2020
La sensibilizzazione è
falsa o genuina?
Qual è la
sensibilizzazione
primaria?
I quattro step diagnostici dell’@IT-2020 ed il test di validazione

24. TRADITIONA
L APPROACH
Patient with clinical history of hay fever
@IT-2020
La sensibilizzazione
genuina è correlata
causa-effetto ai sintomi
del paziente?
I quattro step diagnostici dell’@IT-2020 ed il test di validazione

25. AIT
Patient with clinical history of hay fever
NAPT
@IT-2020
Test di Provocazione Nasale Allergenico per confermare la decisione finale
La sensibilizzazione
genuina, che emerge dal
diario elettronico come
responsabile dei sintomi
del paziente, è
confermata dal Test di
Provocazione Nasale?
I quattro step diagnostici dell’@IT-2020 ed il test di validazione

26. MARZO
birch (Betula), 23. - 31. March grasses (Poaceae), 23. - 31. March

27. GIUGNO
grasses (Poaceae), 1. - 10. Junebirch (Betula), 1. - 10. June

28. 09/11/2019 Titolo Presentazione Pagina 30
Conte Polliniche a Roma
anno 2016

29. @IT-2020 : un processo diagnostico semplificato
Processo diagnostico semplificato in un contesto aerobiologico meno complesso
Germania
Clinical History
(Symptom Seasonality)
SPT and/or serum sIgE
(allergenic extracts)
CRD
eDiary
AIT
Patient with clinical history of hay fever
Decreasinginsuspectedclinicalrelevantpollens
Clinical History
(Symptom Seasonality)
SPT and/or serum sIgE
(allergenic extracts)
CRD
eDiary
AIT
Patient with clinical history of hay fever
Betulla Graminacee

30. Italia
@IT-2020 – Processo diagnostico per otto fonti allergeniche
@IT-2020
Storia clinica, SPT, CRD & e-Diario per otto sorgenti allegeniche
olive pellitorycypress alternariaambrosiagrass hazlenutBirch
Betulla Olivo Cipresso Parietaria Graminacee Ambrosia Alternaria Nocciolo

31. Italia
@IT-2020 – Processo Diagnostico per 8 sorgenti allergenmiche
@IT-2020
Storia clinica, SPT, CRD & e-Diario per otto sorgenti allergeniche:
Allergologia di Precisone
olive pellitorycypress alternariaambrosiagrass hazlenutBirch
Betulla Olivo Cipresso Parietaria Graminacee Ambrosia Alternaria Nocciolo

32. Outline
1. Problemi della Immunoterapia allergica (AIT): soluzioni digitali?
2. @IT-2020 : combinare CRD e mH per la prescrizione dell’AIT
3. Gli elementi di base dell’@IT-2020: studi di validazione
A. Storia Clinica
B. Skin Prick Test
C. Component Resolved Diagnostic: studio di validazione
D. Diario elettronico (e-Diary): studi di validazione
4. Prescrizione dell’AIT : test di validazione e impatto sulle decisioni dei medici
5. CDSS per la prescrizione dell’AIT : strumento per un’allergologia di precisione

33. Jan. Feb. Mar Apr May Jun Jul. Aug. Sep. Oct. Nov. Dec.
yes. no yes. no
Jan. Feb. Mar. Apr. May. Jun. Jul. Aug. Sep. Oct. Nov. Dec.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
0 0 1 1 1 1 0 0 0 0 0 0
Birch 0 0 1 1 1 1 0 0 0 0 0 0
Hazel 0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
Timothy 0 0 1 1 1 1 0 0 0 0 0 0
Bermuda 0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
Control (VAS) 8 CARAT 30
2-8 weeks
Pellitory
ROME
Cypress
Fagales
Ragweed
Mugwort
Alternaria
AR Symptoms
Olive
Grass
Asthma not related to pollen
Oral Allergy Syndrome (OAS)
Season
0
persistent / moderate-severe Sneezer / Runner
Sneeze
Com.
Anaphylaxis
AR
Symptoms
Asthma
Asthma ever Onset Asthma present
Control (VAS) 0
Other drugs
Inh. CS (Low). Inh. CS (Med). Inh. CS (High).
SABA
AA Symptoms
Season
ARIA
Drugs AH1 Systemic AH1 Local. CS Systemic. CS Local.
CS Systemic.
Long-last. ß2-Ag. Leukotriene Ant. Control.-release Theophylline.
GINA 0
Rhinorrhea Itch Obstruction Conjunctivitis
Male, 33 ys, AR since age 23 ys
1 – Storia Clinica
Cypress
Mugwort
Pellitory
Alternaria
Fagales
Olive◦
Grass
Ragweed
6 allergeni

34. Jan. Feb. Mar Apr May Jun Jul. Aug. Sep. Oct. Nov. Dec.
yes. no yes. no
Jan. Feb. Mar. Apr. May. Jun. Jul. Aug. Sep. Oct. Nov. Dec.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
0 0 1 1 1 1 0 0 0 0 0 0
Birch 0 0 1 1 1 1 0 0 0 0 0 0
Hazel 0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
Timothy 0 0 1 1 1 1 0 0 0 0 0 0
Bermuda 0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
Control (VAS) 8 CARAT 30
2-8 weeks
Pellitory
ROME
Cypress
Fagales
Ragweed
Mugwort
Alternaria
AR Symptoms
Olive
Grass
Asthma not related to pollen
Oral Allergy Syndrome (OAS)
Season
0
persistent / moderate-severe Sneezer / Runner
Sneeze
Com.
Anaphylaxis
AR
Symptoms
Asthma
Asthma ever Onset Asthma present
Control (VAS) 0
Other drugs
Inh. CS (Low). Inh. CS (Med). Inh. CS (High).
SABA
AA Symptoms
Season
ARIA
Drugs AH1 Systemic AH1 Local. CS Systemic. CS Local.
CS Systemic.
Long-last. ß2-Ag. Leukotriene Ant. Control.-release Theophylline.
GINA 0
Rhinorrhea Itch Obstruction Conjunctivitis
Male, 33 ys, AR since age 23 ys
1 – Storia Clinica
Quale estratto allergenico induce una risposta positiva agli SPT?
Cypress
Mugwort
Pellitory
Alternaria
Fagales
Olive◦
Grass
Ragweed
6 allergeni

35. Jan. Feb. Mar Apr May Jun Jul. Aug. Sep. Oct. Nov. Dec.
yes. no yes. no
Jan. Feb. Mar. Apr. May. Jun. Jul. Aug. Sep. Oct. Nov. Dec.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
0 0 1 1 1 1 0 0 0 0 0 0
Birch 0 0 1 1 1 1 0 0 0 0 0 0
Hazel 0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
Timothy 0 0 1 1 1 1 0 0 0 0 0 0
Bermuda 0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
Control (VAS) 8 CARAT 30
2-8 weeks
Pellitory
ROME
Cypress
Fagales
Ragweed
Mugwort
Alternaria
AR Symptoms
Olive
Grass
Asthma not related to pollen
Oral Allergy Syndrome (OAS)
Season
0
persistent / moderate-severe Sneezer / Runner
Sneeze
Com.
Anaphylaxis
AR
Symptoms
Asthma
Asthma ever Onset Asthma present
Control (VAS) 0
Other drugs
Inh. CS (Low). Inh. CS (Med). Inh. CS (High).
SABA
AA Symptoms
Season
ARIA
Drugs AH1 Systemic AH1 Local. CS Systemic. CS Local.
CS Systemic.
Long-last. ß2-Ag. Leukotriene Ant. Control.-release Theophylline.
GINA 0
Rhinorrhea Itch Obstruction Conjunctivitis
Male, 33 ys, AR since age 23 ys
2 – Storia Clinica + SPT
0
3
SPT (mm)
7Dog
3Rus.Thistle
5HDM
8Grass Mix
3
0
4Plane Tree
7
0
4
2Cat
Alternaria
8
Other SPT
Cypress
Birch
Ragweed
Mugwort
Hazel 0
5Olive
Timothy G.
Bermuda G.
Pellitory
0
3
SPT (mm)
7Dog
3Rus.Thistle
5HDM
8Grass Mix
3
0
4Plane Tree
7
0
4
2Cat
Alternaria
8
Other SPT
Cypress
Birch
Ragweed
Mugwort
Hazel 0
5Olive
Timothy G.
Bermuda G.
Pellitory
Cypress
Mugwort
Pellitory
Alternaria
Fagales
Olive◦
Grass
Ragweed
2 allergeni

36. Jan. Feb. Mar Apr May Jun Jul. Aug. Sep. Oct. Nov. Dec.
yes. no yes. no
Jan. Feb. Mar. Apr. May. Jun. Jul. Aug. Sep. Oct. Nov. Dec.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
0 0 1 1 1 1 0 0 0 0 0 0
Birch 0 0 1 1 1 1 0 0 0 0 0 0
Hazel 0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
Timothy 0 0 1 1 1 1 0 0 0 0 0 0
Bermuda 0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
Control (VAS) 8 CARAT 30
2-8 weeks
Pellitory
ROME
Cypress
Fagales
Ragweed
Mugwort
Alternaria
AR Symptoms
Olive
Grass
Asthma not related to pollen
Oral Allergy Syndrome (OAS)
Season
0
persistent / moderate-severe Sneezer / Runner
Sneeze
Com.
Anaphylaxis
AR
Symptoms
Asthma
Asthma ever Onset Asthma present
Control (VAS) 0
Other drugs
Inh. CS (Low). Inh. CS (Med). Inh. CS (High).
SABA
AA Symptoms
Season
ARIA
Drugs AH1 Systemic AH1 Local. CS Systemic. CS Local.
CS Systemic.
Long-last. ß2-Ag. Leukotriene Ant. Control.-release Theophylline.
GINA 0
Rhinorrhea Itch Obstruction Conjunctivitis
Male, 33 ys, AR since age 23 ys
2 – Storia Clinica + SPT
0
3
SPT (mm)
7Dog
3Rus.Thistle
5HDM
8Grass Mix
3
0
4Plane Tree
7
0
4
2Cat
Alternaria
8
Other SPT
Cypress
Birch
Ragweed
Mugwort
Hazel 0
5Olive
Timothy G.
Bermuda G.
Pellitory
0
3
SPT (mm)
7Dog
3Rus.Thistle
5HDM
8Grass Mix
3
0
4Plane Tree
7
0
4
2Cat
Alternaria
8
Other SPT
Cypress
Birch
Ragweed
Mugwort
Hazel 0
5Olive
Timothy G.
Bermuda G.
Pellitory
Queste sensibilizzazioni sono genuine?
Cypress
Mugwort
Pellitory
Alternaria
Fagales
Olive◦
Grass
Ragweed
2 allergeni

37. Jan. Feb. Mar Apr May Jun Jul. Aug. Sep. Oct. Nov. Dec.
yes. no yes. no
Jan. Feb. Mar. Apr. May. Jun. Jul. Aug. Sep. Oct. Nov. Dec.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
0 0 1 1 1 1 0 0 0 0 0 0
Birch 0 0 1 1 1 1 0 0 0 0 0 0
Hazel 0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
Timothy 0 0 1 1 1 1 0 0 0 0 0 0
Bermuda 0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
Control (VAS) 8 CARAT 30
2-8 weeks
Pellitory
ROME
Cypress
Fagales
Ragweed
Mugwort
Alternaria
AR Symptoms
Olive
Grass
Asthma not related to pollen
Oral Allergy Syndrome (OAS)
Season
0
persistent / moderate-severe Sneezer / Runner
Sneeze
Com.
Anaphylaxis
AR
Symptoms
Asthma
Asthma ever Onset Asthma present
Control (VAS) 0
Other drugs
Inh. CS (Low). Inh. CS (Med). Inh. CS (High).
SABA
AA Symptoms
Season
ARIA
Drugs AH1 Systemic AH1 Local. CS Systemic. CS Local.
CS Systemic.
Long-last. ß2-Ag. Leukotriene Ant. Control.-release Theophylline.
GINA 0
Rhinorrhea Itch Obstruction Conjunctivitis
Male, 33 ys, AR since age 23 ys
3 – Storia Clinica + SPT + CRD
0
3
SPT (mm)
7Dog
3Rus.Thistle
5HDM
8Grass Mix
3
0
4Plane Tree
7
0
4
2Cat
Alternaria
8
Other SPT
Cypress
Birch
Ragweed
Mugwort
Hazel 0
5Olive
Timothy G.
Bermuda G.
Pellitory
0
3
SPT (mm)
7Dog
3Rus.Thistle
5HDM
8Grass Mix
3
0
4Plane Tree
7
0
4
2Cat
Alternaria
8
Other SPT
Cypress
Birch
Ragweed
Mugwort
Hazel 0
5Olive
Timothy G.
Bermuda G.
Pellitory
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
IgE
(class)
IgE
(class)
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
IgE
(class)
IgE
(class)
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
IgE
(class)
IgE
(class)
Cypress
Mugwort
Pellitory
Alternaria
Fagales
Olive◦
Grass
Ragweed
1 allergene

38. Jan. Feb. Mar Apr May Jun Jul. Aug. Sep. Oct. Nov. Dec.
yes. no yes. no
Jan. Feb. Mar. Apr. May. Jun. Jul. Aug. Sep. Oct. Nov. Dec.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
0 0 1 1 1 1 0 0 0 0 0 0
Birch 0 0 1 1 1 1 0 0 0 0 0 0
Hazel 0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
Timothy 0 0 1 1 1 1 0 0 0 0 0 0
Bermuda 0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
Control (VAS) 8 CARAT 30
2-8 weeks
Pellitory
ROME
Cypress
Fagales
Ragweed
Mugwort
Alternaria
AR Symptoms
Olive
Grass
Asthma not related to pollen
Oral Allergy Syndrome (OAS)
Season
0
persistent / moderate-severe Sneezer / Runner
Sneeze
Com.
Anaphylaxis
AR
Symptoms
Asthma
Asthma ever Onset Asthma present
Control (VAS) 0
Other drugs
Inh. CS (Low). Inh. CS (Med). Inh. CS (High).
SABA
AA Symptoms
Season
ARIA
Drugs AH1 Systemic AH1 Local. CS Systemic. CS Local.
CS Systemic.
Long-last. ß2-Ag. Leukotriene Ant. Control.-release Theophylline.
GINA 0
Rhinorrhea Itch Obstruction Conjunctivitis
Male, 33 ys, AR since age 23 ys
3 – Storia Clinica + SPT + CRD
0
3
SPT (mm)
7Dog
3Rus.Thistle
5HDM
8Grass Mix
3
0
4Plane Tree
7
0
4
2Cat
Alternaria
8
Other SPT
Cypress
Birch
Ragweed
Mugwort
Hazel 0
5Olive
Timothy G.
Bermuda G.
Pellitory
0
3
SPT (mm)
7Dog
3Rus.Thistle
5HDM
8Grass Mix
3
0
4Plane Tree
7
0
4
2Cat
Alternaria
8
Other SPT
Cypress
Birch
Ragweed
Mugwort
Hazel 0
5Olive
Timothy G.
Bermuda G.
Pellitory
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
IgE
(class)
IgE
(class)
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
IgE
(class)
IgE
(class)
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
IgE
(class)
IgE
(class)
Questa sensibilizzazione è clinicamente rilevante?
Cypress
Mugwort
Pellitory
Alternaria
Fagales
Olive◦
Grass
Ragweed
1 allergene

39. Jan. Feb. Mar Apr May Jun Jul. Aug. Sep. Oct. Nov. Dec.
yes. no yes. no
Jan. Feb. Mar. Apr. May. Jun. Jul. Aug. Sep. Oct. Nov. Dec.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
0 0 1 1 1 1 0 0 0 0 0 0
Birch 0 0 1 1 1 1 0 0 0 0 0 0
Hazel 0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
Timothy 0 0 1 1 1 1 0 0 0 0 0 0
Bermuda 0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
Control (VAS) 8 CARAT 30
2-8 weeks
Pellitory
ROME
Cypress
Fagales
Ragweed
Mugwort
Alternaria
AR Symptoms
Olive
Grass
Asthma not related to pollen
Oral Allergy Syndrome (OAS)
Season
0
persistent / moderate-severe Sneezer / Runner
Sneeze
Com.
Anaphylaxis
AR
Symptoms
Asthma
Asthma ever Onset Asthma present
Control (VAS) 0
Other drugs
Inh. CS (Low). Inh. CS (Med). Inh. CS (High).
SABA
AA Symptoms
Season
ARIA
Drugs AH1 Systemic AH1 Local. CS Systemic. CS Local.
CS Systemic.
Long-last. ß2-Ag. Leukotriene Ant. Control.-release Theophylline.
GINA 0
Rhinorrhea Itch Obstruction Conjunctivitis
Male, 33 ys, AR since age 23 ys
4 – Storia Clinica + SPT + CRD + e-Diary
0
3
SPT (mm)
7Dog
3Rus.Thistle
5HDM
8Grass Mix
3
0
4Plane Tree
7
0
4
2Cat
Alternaria
8
Other SPT
Cypress
Birch
Ragweed
Mugwort
Hazel 0
5Olive
Timothy G.
Bermuda G.
Pellitory
0
3
SPT (mm)
7Dog
3Rus.Thistle
5HDM
8Grass Mix
3
0
4Plane Tree
7
0
4
2Cat
Alternaria
8
Other SPT
Cypress
Birch
Ragweed
Mugwort
Hazel 0
5Olive
Timothy G.
Bermuda G.
Pellitory
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
IgE
(class)
IgE
(class) e-Diary
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
IgE
(class)
IgE
(class)
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
IgE
(class)
IgE
(class)
Mugwort
Ragweed
Pellitory
Alternaria
Fagales
Olive◦
Grass

40. Jan. Feb. Mar Apr May Jun Jul. Aug. Sep. Oct. Nov. Dec.
yes. no yes. no
Jan. Feb. Mar. Apr. May. Jun. Jul. Aug. Sep. Oct. Nov. Dec.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
0 0 1 1 1 1 0 0 0 0 0 0
Birch 0 0 1 1 1 1 0 0 0 0 0 0
Hazel 0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
Timothy 0 0 1 1 1 1 0 0 0 0 0 0
Bermuda 0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
Control (VAS) 8 CARAT 30
2-8 weeks
Pellitory
ROME
Cypress
Fagales
Ragweed
Mugwort
Alternaria
AR Symptoms
Olive
Grass
Asthma not related to pollen
Oral Allergy Syndrome (OAS)
Season
0
persistent / moderate-severe Sneezer / Runner
Sneeze
Com.
Anaphylaxis
AR
Symptoms
Asthma
Asthma ever Onset Asthma present
Control (VAS) 0
Other drugs
Inh. CS (Low). Inh. CS (Med). Inh. CS (High).
SABA
AA Symptoms
Season
ARIA
Drugs AH1 Systemic AH1 Local. CS Systemic. CS Local.
CS Systemic.
Long-last. ß2-Ag. Leukotriene Ant. Control.-release Theophylline.
GINA 0
Rhinorrhea Itch Obstruction Conjunctivitis
Male, 33 ys, AR since age 23 ys
4 – Storia Clinica + SPT + CRD + e-Diary
0
3
SPT (mm)
7Dog
3Rus.Thistle
5HDM
8Grass Mix
3
0
4Plane Tree
7
0
4
2Cat
Alternaria
8
Other SPT
Cypress
Birch
Ragweed
Mugwort
Hazel 0
5Olive
Timothy G.
Bermuda G.
Pellitory
0
3
SPT (mm)
7Dog
3Rus.Thistle
5HDM
8Grass Mix
3
0
4Plane Tree
7
0
4
2Cat
Alternaria
8
Other SPT
Cypress
Birch
Ragweed
Mugwort
Hazel 0
5Olive
Timothy G.
Bermuda G.
Pellitory
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
IgE
(class)
IgE
(class) e-Diary
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
IgE
(class)
IgE
(class)
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
IgE
(class)
IgE
(class)
Questa conclusione è confermata dal TPNA?
Mugwort
Ragweed
Pellitory
Alternaria
Fagales
Olive◦
Grass

41. Jan. Feb. Mar Apr May Jun Jul. Aug. Sep. Oct. Nov. Dec.
yes. no yes. no
Jan. Feb. Mar. Apr. May. Jun. Jul. Aug. Sep. Oct. Nov. Dec.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
0 0 1 1 1 1 0 0 0 0 0 0
Birch 0 0 1 1 1 1 0 0 0 0 0 0
Hazel 0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
Timothy 0 0 1 1 1 1 0 0 0 0 0 0
Bermuda 0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 1 1 1 1 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
Control (VAS) 8 CARAT 30
2-8 weeks
Pellitory
ROME
Cypress
Fagales
Ragweed
Mugwort
Alternaria
AR Symptoms
Olive
Grass
Asthma not related to pollen
Oral Allergy Syndrome (OAS)
Season
0
persistent / moderate-severe Sneezer / Runner
Sneeze
Com.
Anaphylaxis
AR
Symptoms
Asthma
Asthma ever Onset Asthma present
Control (VAS) 0
Other drugs
Inh. CS (Low). Inh. CS (Med). Inh. CS (High).
SABA
AA Symptoms
Season
ARIA
Drugs AH1 Systemic AH1 Local. CS Systemic. CS Local.
CS Systemic.
Long-last. ß2-Ag. Leukotriene Ant. Control.-release Theophylline.
GINA 0
Rhinorrhea Itch Obstruction Conjunctivitis
Male, 33 ys, AR since age 23 ys
4 – Storia Clinica + SPT + CRD + e-Diary= validazione con TPNA
0
3
SPT (mm)
7Dog
3Rus.Thistle
5HDM
8Grass Mix
3
0
4Plane Tree
7
0
4
2Cat
Alternaria
8
Other SPT
Cypress
Birch
Ragweed
Mugwort
Hazel 0
5Olive
Timothy G.
Bermuda G.
Pellitory
0
3
SPT (mm)
7Dog
3Rus.Thistle
5HDM
8Grass Mix
3
0
4Plane Tree
7
0
4
2Cat
Alternaria
8
Other SPT
Cypress
Birch
Ragweed
Mugwort
Hazel 0
5Olive
Timothy G.
Bermuda G.
Pellitory
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
IgE
(class)
IgE
(class) e-Diary
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
IgE
(class)
IgE
(class)
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
Cypress 0 Cup a 1 0
Birch 0 Bet v 1 0
0 Que a 1 0
Cor a 1 0
Olive 1 Ole e 1 0
Bermuda G. 3 Cyn d 1 4
5 Phl p 1 5
Phl p 5 5
Pellitory 0 Par j 2 0
Ragweed 0 Amb a 1 0
Mugwort 0 Art v 1 0
Alternaria 0 Alt a 1 0
Oak
Timothy
Grass
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Bet v 2 0
Phl p 12 0
Bet v 4 0
Phl p 7 0
Ole e 7 0
Art v 3 0
Rus. Thist. 0 Sal k 1 0
Engl. Plan. 0 Pla l 1 0
0 Pla a 1 0
Pla a 2 0
CCD 0
Extracts
ESEP
(Class) Molecules
ESEP
(Class)
Profilins
Birch
Timothy G.
Polcalcins
Birch
Plane Tree
Timothy G.
LTPs
Olive
Mugwort
IgE
(class)
IgE
(class)
Is this conclusion confirmed by NAPT?
Mugwort
Ragweed
Pellitory
Alternaria
Fagales
Olive◦
Grass
SI !Questa conclusione è confermata dal TPNA?

42. @llergy Decision Support System

43. @llergy Decision Support System

44. @llergy Decision Support System

45. @llergy Decision Support System

46. @llergy Decision Support System

47. @llergy Decision Support System

48. @llergy Decision Support System

49. @llergy Decision Support System

50. @llergy Decision Support System

51. @llergy Decision Support System

52. @llergy Decision Support System

53. @llergy Decision Support System

54. @llergy Decision Support System

55. SPT (mm)
RTSS
IgE s (kU/L)
Pollini (gr/m3)
Possibilità di “Regolazione” dei vari parametri
ed il ruolo dello specialista allergologo?
influendo su sensibilità e specificità del sistema !

56. Outline
1. Problemi della Immunoterapia allergica (AIT): soluzioni digitali?
2. @IT-2020 : combinare CRD e mH per la prescrizione dell’AIT
3. Gli elementi di base dell’@IT-2020: studi di validazione
A. Storia Clinica
B. Skin Prick Test
C. Component Resolved Diagnostic: studio di validazione
D. Diario elettronico (e-Diary): studi di validazione
4. Prescrizione dell’AIT : test di validazione e impatto sulle decisioni dei medici
5. CDSS per la prescrizione dell’AIT : strumento per un’allergologia di precisione

57. Table
e2
Pordenone (99 adults)
Rome (101 children)
Oct Jan Aug Dec
2016
Monitoring with AllergyMonitor
T0 T1
Questionari
SPT
Prelievo
@M starter kit
Questionari
Prescrione AIT
Conte Polliniche
@IT-2020
Studio Pilota
@IT-2020 – protocollo dello studio
Arasi S et al. (manuscript in preparation)

58. Un singolo «POLLEN-TEST»
Validazione limitata a pazienti e sieri Italiani – da testare in altri settings

59. independently from the prevalence and profile of IgE sensitization in
their study populations. Third, the test is not including all the mole-
cules that play a clinically relevant role in pollen allergy in Southern
Europe. However, most of the major allergenic molecules, whose
investigation is essential for a precise prescription of allergen
immunotherapy in Southern Europe, are included in the ESEP panel.
Patients with “rare” or “very infrequent” pollen allergies, whose IgE
sensitization profile goes beyond the diagnostic possibilities of the
current ESEP, require a broader panel of extracts and molecules,
which can easily be adapted in a similar assay format. On the other
hand, a 2nd step complementation with clinically targeted singleplex
ACKNOWLEDGEMENTS
This study was supported by an unrestricted educational grant from
EUROIMMUN AG (code118583), EUROIMMUN AG also provided
the ESEP strips for the study. We thank Mr. Charles Clawson for
revising the English language.
CONFLICT OF INTEREST
Dr. Matricardi reports grants and personal fees from EUROIMMUN
AG, during the conduct of the study; grants and personal fees from
Thermo Fisher Scientific, grants and personal fees from Hycor
TA B L E 3 Diagnostic performance results in identifying IgE sensitization to allergen molecules through EUROLINE Southern European Pollen
Profile (ESEP) method in comparison with ImmunoCAP method (gold standard)
Molecule N C+E+ C+E− C− E+ C− E−
Sensitivity Specificity PPV NPV
Accuracy
LR+ LR− rs% 95%CIa
% 95%CIa
% 95%CIa
% 95%CIa
%
rAlt a 1 75 49 0 1 25 100 89‐100 96 80‐100 98 89‐100 100 80‐100 99 26.00 0.00 0.97*
nArt v 1 29 13 0 6 10 100 66‐100 63 35‐85 68 43‐87 100 59‐100 79 2.67 0.00 0.82*
rBet v 1 75 50 1 0 24 98 90‐100 100 80‐100 100 90‐100 96 80‐100 99 ∞ 0.02 0.97*
rBet v 2 57 32 0 6 19 100 84‐100 76 55‐91 84 69‐94 100 75‐100 89 4.17 0.00 0.93*
rBet v 4 18 8 1 4 5 89 52‐100 56 21‐86 67 35‐90 83 36‐100 72 2.00 0.20 0.66*
nCup a 1 75 50 0 0 25 100 90‐100 100 80‐100 100 90‐100 100 80‐100 100 ∞ 0.00 0.97*
Cyn d 1b
75 46 3 4 22 94 83‐99 85 65‐96 92 81‐98 88 69‐97 91 6.10 0.07 0.95*
rOle e 1 75 45 0 5 25 100 88‐100 83 65‐94 90 78‐97 100 80‐100 93 6.00 0.00 0.97*
rPar j 2 74 47 0 2 25 100 89‐100 93 76‐99 96 86‐100 100 80‐100 97 13.50 0.00 0.95*
rPhl p 1 75 47 0 3 25 100 89‐100 89 72‐98 94 83‐99 100 80‐100 96 9.33 0.00 0.96*
rPhl p 5 75 50 0 0 25 100 90‐100 100 80‐100 100 90‐100 100 80‐100 100 ∞ 0.00 0.97*
rPhl p 7 15 9 0 1 5 100 55‐100 83 36‐100 90 55‐100 100 36‐100 93 6.00 0.00 0.95*
rPhl p 12 45 25 0 5 15 100 80‐100 75 51‐91 83 65‐94 100 70‐100 89 4.00 0.00 0.87*
All
moleculesc
763 471 5 37 250 99 98‐100 87 83‐91 93 90‐95 98 95‐99 94 7.1 0.01 0.94*
C+, ImmunoCAP positive; C−, ImmunoCAP negative; E+, ESEP positive; E−, ESEP negative; (positivity cut‐off value ≥0.35 kU/L); LR+, positive likelihood
ratio; LR−, negative likelihood ratio; NPV, negative predictive value; PPV, positive predictive value.
a
Exact binomial confidence limits (95% CI).
b
r (recombinant) for ESEP and n (native) for ImmunoCAP.
c
Including outcomes of all allergen molecules considered.
rs represents the Spearman's rank correlation coefficient, significant differences were highlighted (*P< 0.001).
8 | DI FRAIA ET AL.
Euroline: test MULTIPLEX per IgE test per allergia a pollini
caratteristiche e validazione analitica
Test semiquantitativo per le IgE di 8 pollini, sia estratti che molecole

60. Outline
1. Problemi della Immunoterapia allergica (AIT): soluzioni digitali?
2. @IT-2020 : combinare CRD e mH per la prescrizione dell’AIT
3. Gli elementi di base dell’@IT-2020: studi di validazione
A. Storia Clinica
B. Skin Prick Test
C. Component Resolved Diagnostic: studio di validazione
D. Diario elettronico (e-Diary): stagioni polliniche, aderenza e qualità, score
4. Prescrizione dell’AIT : test di validazione e impatto sulle decisioni dei medici
5. CDSS per la prescrizione dell’AIT : strumento per un’allergologia di precisione

61. a)
Peak Season
Whole
Season
b)
Peak Season
Whole
Season
Definizione delle stagioni polliniche a Roma e Pordenone
secondo i criteri EAACI
Criteri migliori richiedono adattamenti locali e producono multipli segmenti per stagione
a)
Peak Season
Whole
Season
b)
Peak Season

62. Jan MarFeb Apr May Jun Jul Aug Sep Oct Nov Dec
Cupressaceae
Fagales
Oleaceae
Graminaceae
Urticaceae
Jan MarFeb Apr May Jun Jul Aug Sep Oct Nov Dec
Cupressaceae
Fagales
Oleaceae
Graminaceae
Urticaceae
„Whole“
Pollen
Seasons
„Fragmented“
Pollen
Seasons
98
days
70 days
174
days
105 days
10
days
10
days
85
days
103 days
238
days
180 days
„Whole“ vs. „Fragmented“ Pollen Seasons in Six Southern European Centers – Improving EAACI Definitions?
(Allergy, in press)
“Metodo della Frammentazione″ per definire le stagioni polliniche nel Sud
Europa
L’esclusione di “periodi intercorrenti” con nessuna/bassa conta pollinica (metodo della
“Stagione Pollinica Frammentata””) migliora l’accuratezza dei criteri EAACI

63. Outline
1. Problemi della Immunoterapia allergica (AIT): soluzioni digitali?
2. @IT-2020 : combinare CRD e mH per la prescrizione dell’AIT
3. Gli elementi di base dell’@IT-2020: studi di validazione
A. Storia Clinica
B. Skin Prick Test
C. Component Resolved Diagnostic: studio di validazione
D. Diario elettronico (e-Diary): stagioni polliniche, aderenza e qualità, score
4. Prescrizione dell’AIT : test di validazione e impatto sulle decisioni dei medici
5. CDSS per la prescrizione dell’AIT : strumento per un’allergologia di precisione

64. @llergy.Monitor : diario elettronico per l’allergia ai pollini e l’AIT
Front-end & Back-Office
FrontEnd BackOffice
Patient’s website Doctor’s website
Bidirectional
communication
patient doctor
ALERT SYSTEMS

65. Definizioni di aderenza alla compilazione dell’e-Diary
Inizio ritardato, Fine precoce, Giorni di registrazione mancanti, ecc.
Time (by day)
Prescribed monitoring period (54
days)
Reporting period (43 days)
Delayed
reporting
start
Advanced
reporting
end
Missing reporting days (7 days)
Reporting days (sum of green boxes) = 36
Di Fraia et al. (manuscript submitted)

66. Aderenza alla compilazione dell’e-Diary
in rapporto alla lunghezza del periodo di compilazione
Aderenza alla compilazione del e-Diary >80% per circa 2 mesi
quando prescritto da un medico
Di Fraia et al. (manuscript submitted)

67. Predizione dell’aderenza a lungo termine alla compilazione del e-Diary
L’aderenza precoce alla compilazione dell’e-Diary predice l’aderenza a lungo termine
Correlation between adherence achieved between the 7th and the
21st reporting day and total period adherence, by study center.
c) d)
� ℎ� : Spearman ‘s rank correlation coefficient.
ROME PORDENONE
Di Fraia et al. (manuscript submitted)

68. Test sulla qualità dei dati registrati nel e-Diary
Una bassa aderenza alla compilazione dell’e-Diary è associata ad una più bassa
variabilità dei dati registrati
ADH ≥ 80%
ADH < 80%
p*=0.004 p*<0.001 p*<0.001 p*=0.015 p*=0.007 p*=0.002
*Mann Whitney U test was used to compare not normally distributed variables between groups (Shapiro-Wilk test was used to assess normality of data).
ROME PORDENONE
Di Fraia et al. (manuscript submitted)

69. Impatto dell’e-Diary & degli alerts sull’assunzione di Mometasone quotidiano
L’uso dell’e-Diary migliora l’aderenza alla terapia quotidiana
con Mometasone nasale
@M
Routine
Pizzulli A et Al. Clin Exp Allergy. 2014 Oct;44(10):1246-54

70. Adherence to SLIT
Usual care Allergymonitor©
p=0.0004
Tripodi S et al. PAI 2013
e-Diary per monitorare e migliorare l’aderenza alla somministrazione della SLIT
Drop-out are ridotto se il paziente è monitorato

71. Outline
1. Problemi della Immunoterapia allergica (AIT): soluzioni digitali?
2. @IT-2020 : combinare CRD e mH per la prescrizione dell’AIT
3. Gli elementi di base dell’@IT-2020: studi di validazione
A. Storia Clinica
B. Skin Prick Test
C. Component Resolved Diagnostic: studio di validazione
D. Diario elettronico (e-Diary): stagioni polliniche, aderenza e qualità, score
4. Prescrizione dell’AIT : test di validazione e impatto sulle decisioni dei medici
5. CDSS per la prescrizione dell’AIT : strumento per un’allergologia di precisione

72. I Diari Elettronici calcolano differenti score tutti basati sugli stessi dati primari
A livello di gruppo (ma non a quello di individuo) i differenti score
producono risultati simili
Florack J et al. PAI, 2016;27:382-390
RTSS, CSMS, VAS

73. Trend di VAS, RTSS and CSMS a livello di popolazione per centro
I valori della VAS sono ben correlati, a livello di popolazione,
con quelli dell’RTSS
a) b)
d)c)
VAS RTSS CSMS
Rome Pordenone
Di Fraia et al. (manuscript submitted)

74. Outline
1. Problemi della Immunoterapia allergica (AIT): soluzioni digitali?
2. @IT-2020 : combinare CRD e mH per la prescrizione dell’AIT
3. Gli elementi di base dell’@IT-2020: studi di validazione
A. Storia Clinica
B. Skin Prick Test
C. Component Resolved Diagnostic: studio di validazione
D. Diario elettronico (e-Diary): stagioni polliniche, aderenza e qualità, score
4. Prescrizione dell’AIT: test di validazione e impatto sulle decisioni dei medici
5. CDSS per la prescrizione dell’AIT : strumento per un’allergologia di precisione

75. Arasi S et al. (manuscript in preparation)
2 workshops (experiments)
46 doctors (18 Allergists, 28 not allergists)
10 clinical cases
3 decision steps (H+SPT, +IgE-mol, + eDiary)
Clinical History
(Symptom Seasonality)
SPT and/or serum sIgE
(allergenic extracts)
CRD
eDiary
TRADITIONAL
APPROACH
AIT
@IT-2020 -
CDSS
Patient with clinical history of hay fever
Decreasinginsuspectedclinicalrelevantpollens
NAPT
Settings, medici, casi e step decisionali
Impatto della procedura diagnostica @IT-2020 sulle prescrizioni teoriche di AIT
dei Medici

76. Arasi S et al. (manuscript in preparation)
2 workshops (formazione e test)
46 medici (18 Allergologi, 28 non allergologi)
10 casi clinici
3 step decisionali (H+SPT, +IgE-mol, + eDiary)

77. Workshop sull’ Impatto di un Potenziale Sistema di Supporto alla Decisione Clinica in Allergologia
Roma – 15 Marzo, 2019Decisione dei medici sulla prescrizione dell’AIT basata sui dati:
una raccolta sistematica dei dati
Registrazione delle decisioni per ogni polline (8), nei 10 casi test, a 3 step
diagnostici
Arasi S et al. (manuscript in preparation)

78. Gold
standard
Decisione Concordante o
Discordante rispetto al Gold
Standard
(per gruppo e step diagnostico)
Outcome
primario
Consenso tra gli Allergologi (la
decisione più frequente per il
singolo caso alla fase finale)
Outcome primario riferito ad un gold standard («migliore» prescrizione)
«Migliore» prescrizione è quella che ha raggiunto il massimo consenso tra gli
allergologi
Arasi S et al. (manuscript in preparation)

79. eDiary
eDiary
A B
Arasi S et al. (manuscript in preparation)
Chi squared test, when condition were respected or Fisher exact test was used to evaluate the association of categorical data between allergy
specialists and general practitioners groups. McNemar’s test was used to compare difference of frequency within each group. *P < .05, **P <.01, ***P
<.001
Influenza della CRD e del Diario elettronico sulla prescrizione medica dell’AIT
CRD & e-Diary portano ad una più alta qualità della prescrizione dell’AIT sia negli allergologi
che nei non-allergologi

80. Multicenter
Study
9 Centers in 7
Countries
847 pediatric and
adult patients
recruited
Traditional
approach
AIT !
Patient with suspected pollinosis
(often highly polysensitized)
1
2
3
4
@IT-2020 Studio Multicentrico
2 anni, 9 centri, 7 nazioni, >800 patienti (adulti e bambini) reclutati
Stephanie
Dramburg

82. 2 anni, 9 centri, 7 nazioni, >800 patienti (adulti e bambini) reclutati
@IT-2020 Studio Multicentrico

83. Outline
1. Problemi della Immunoterapia allergica (AIT): soluzioni digitali?
2. @IT-2020 : combinare CRD e mH per la prescrizione dell’AIT
3. Gli elementi di base dell’@IT-2020: studi di validazione
A. Storia Clinica
B. Skin Prick Test
C. Component Resolved Diagnostic: studio di validazione
D. Diario elettronico (e-Diary): stagioni polliniche, aderenza e qualità, score
4. Prescrizione dell’AIT: test di validazione e impatto sulle decisioni dei medici
5. CDSS per la prescrizione dell’AIT: strumento per un’allergologia di precisione

84. Conclusioni
CDSS basato su @IT-2020 = Implementazione delle linee guida
per l’ AIT nella pratica quotidiana
La prescrizione precisa dell’AIT richiede un processo diagnostico complesso nei paesi del
Sud Europa/Area Mediterranea
Il progetto @IT-2020 propone un processo diagnostico basato su linee guida internazionali,
che possono essere implementate in un CDSS
L’ipotesi che una versione informatica del processo @IT-2020
sia costo-efficacia e possa aiutare a superare il GAP
tra la necessità e l’offerta di AIT in Europa richiede ulteriori indagini

85. Giovanna
Stringari
CRD & AIT
Daniela
Posa
Mite
Allergy
Sveva
Castelli
Nasal IgE
Serena
Perna
Statistician
Marco
Di Fraia
ESEP
Adherence
to e-Diary
Stefania
Arasi
Local IgE
CRD & AIT
Stephanie
Dramburg
Digital Health
@IT-2020-MC
Laura
Hatzler
Molecular
Spreading
Early AIT
Antonio
Pizzulli
mHealth and
Adherence
Mometasone
Tara
Hoffmann
Pollen studies
Paolo M.
Matricardi
Ifigenia
Sfika
Pan-Ped
@IT-2020
Valeria
Villella
Pan-Ped
@IT-2020
Andrea
Di Rienzo
Businco
Pan-Ped
Valentina
Panetta
Statistician
Alessandro
Travaglini
Pollen counts
M. Antonia
Brighetti
Pollen counts
Pierluigi
Verardo
Pollen counts
Danilo
Villalta
@IT-2020