Luisa Ricciardi

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare vasculitis. A key bio-logical hallmark is peripheral blood eosinophilia while antineutrophil cytoplasmic an-tibody (ANCA) positivity is not always present. Therefore, an early phase suspicion of EGPA leading to a correct diagnosis can be challenging. We performed an observa-tional cross-sectional study limited to baseline data on 38 patients between December 2019 and December 2025 at the Allergy and Clinical Immunology Unit, Messina, Italy. Data collection included eosinophil, neutrophil, and lymphocyte counts; ANCAs and antinuclear antibodies (ANAs); erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) determination; and the Birmingham vasculitis activity score (BVAS) questionnaire: Median eosinophil counts were 685 cells/µL, the neutro-phil-to-lymphocyte ratio (NLR) was 2.29, ESR median values were 24 mm/h, and CRPs were 1.99 mg/L. ANCAs were positive in five patients, and ANAs in 20. The trend in ANA+ patients was of lower median eosinophil counts and higher ESR and CRP me-dian values and median BVASs. General, nervous system, and ENT BVAS domains had higher scores.: Disease activity in EGPA at diagnosis can be difficult to recognize. We defined it as chameleon-like and could not be captured by specific immunological sig-natures. Therefore, an early diagnosis needs multidimensional assessment, integrating laboratory parameters with clinical scores. In our EGPA cohort, ANAs were detected in just over half the patients, suggesting that rather than acting as bystanders, these could help clinicians, together with eosinophil counts, NLRs, and BVASs, to suspect EGPA at an early stage for referral to specialized medical centers.

Background: Prurigo nodularis (PN) is a chronic neuroimmune skin disorder characterized by intensely pruritic nodules, severe impairment of quality of life and significant psychosocial burden. Prior to the approval of targeted therapies, management relied on conventional agents with limited efficacy. Recent evidence of its neuroimmune pathogenesis have led to the approvement of targeted biologics. Dupilumab, a human monoclonal antibody targeting IL-4/IL-13-axis, has been the first targeted therapy approved for PN. Case presentation: We report a 75-year-old woman presenting with severe, treatment-naïve generalized pruritus (IGA PN-S 4; NRS 9/10; DLQI 21) with extensive nodular involvement of the trunk and extremities, complete sleep deprivation and important anxiety and depression (HADS.A 12; HADS-D 11). Following diagnosis of PN, treatment with dupilumab (600 mg loading dose, then 300 mg every 2 weeks) was initiated in October 2025. At approximately 6 weeks, marked pruritus reduction (NRS 3) and sleep restoration were observed. Progressive improvement continued over time. At 4 months follow-up, complete remission was nearly achieved (NRS 1, IGA PN-S 1, DLQI 2, HADS-A 4, HADS-D 3), with no adverse events reported. Conclusion: This case corroborates and extends the existing evidence on dupilumab efficacy in the treatment of moderate-to-severe PN, with particularly rapid and comprehensive responses across pruritus, skin lesions, sleep and psychosocial outcomes in an elderly patient, through IL-4/IL-13 inhibition. Our findings support dupilumab as a safe and effective targeted option for severe PN, also in older patients where conventional systemic therapies, such as corticosteroids or immunosuppressants, carry a high risk of adverse effects.

Hymenoptera venom allergy is a cause of anaphylaxis, which significantly affects patients’ daily lives due to the constant fear of accidental stings. Venom immunotherapy (VIT) is the only treatment capable of preventing severe systemic reactions (SSRs). Limited long-term real-life data are available, integrating both clinical and immunological outcomes. A five-year prospective observational study was conducted on 35 patients with a history of SSR who underwent VIT at a tertiary allergy center in Southern Italy; two of them had a diagnosis of systemic mastocytosis. Most patients were sensitized to Vespula, but others to Apis, Polistes dominula and Vespa crabro, reflecting the exposure pattern characteristic of Mediterranean regions. Clinical outcomes following accidental re-stings and serological trends, including total IgE, venom-specific IgE, and baseline serum tryptase, were assessed at treatment initiation and after five years of maintenance therapy. During the entire follow-up, all patients tolerated VIT. No SSRs occurred after accidental stings in 17/35 patients, confirming clinical protection achieved with VIT. Vespula serum-specific IgE presented a highly significant decrease; total IgE, tryptase and specific IgE for Apis, Polistes dominula and Vespa crabro showed a statistically significant decrease. Our findings reinforce the role of VIT as a well-tolerated, effective and disease-modifying treatment in a real-world setting.

Background: Adverse Drug Reactions (ADRs) are a significant public concern because of their impact on healthcare systems. Spontaneous reporting of ADRs is crucial for monitoring drug safety and recognizing possible risk factors. The objective of this study was to characterize ADR reports from the Allergy and Clinical Immunology Unit of the G. Martino University Hospital, Messina, Italy. Methods: A retrospective analysis was conducted, including all ADRs spontaneously reported from patients attending the clinic because of at least one previous ADR, from June 2022 to June 2024. Results: A total of 388 reports were collected, mainly from females (71.1%) and adult patients (84.3%). ADRs were mostly immediate, from antibiotics and anti-inflammatory drugs (61.5%), with a high prevalence of cutaneous and respiratory disorders. Delayed reactions were mostly from endocrine therapies, vaccines, and antiepileptics. Anaphylactic shock was present only in 13 ADR reports (3.35%). A higher risk of developing serious ADRs was found in elderly patients aged ≥65 years (p = 0.012). An original finding was that a positive history of allergies (p = 0.023) and past medical history of ADRs (p = 0.045) were negatively correlated to the occurrence of a serious ADR, probably because patients had been previously followed in an allergy setting and alerted about ADRs. Conclusions: This study underlines the role of ADR follow-up in allergy settings to identify preventable traits and related risk factors; appropriate ADR reporting and collaboration between allergists and pharmacovigilance centers can be a winning strategy for ADR prevention.

Pigmented purpuric dermatosis is a benign type of chronic angiodermatitis prevalent in the general population, presenting with a relapsing-remitting course, with predominantly idiopathic aetiology and both humoral and cell-mediated immune pathogenesis. We report to our knowledge the first two cases of clinical association between such dermal capillaritis and the most clinically heterogeneous form of primary immunodeficiency: common variable immunodeficiency. Furthermore, in the light of already suggested triggers and pathophysiological mechanisms correlating pigmented purpuric dermatosis with various forms of secondary immunodeficiency, we complete our case descriptions by the proposal of a new putative aetiopathogenic actor that would likely account for the occurrence of the clinical association described.

Eosinophilic Granulomatosis with Polyangiitis (EGPA) is a rare systemic vasculitis with eosinophilic inflammation and variable clinical presentations. Although skin manifestations are frequent, current classification criteria do not include them, which may underestimate their diagnostic value. This prospective observational study aimed to assess systemic and skin involvement as well as eosinophilia, anti-neutrophil cytoplasmic antibody (ANCA), and Anti-nuclear antibodies (ANA) serum levels in 20 EGPA patients followed for one year at the University Hospital of Messina, Italy, before starting Mepolizumab, 300 mg. Eosinophilia, ANCA status, systemic and skin involvement were also evaluated at 6 and 12 months; a literature review on these data supplements our findings. Skin involvement was present in 55% of patients, including purpura, urticarial vasculitis, angioedema, maculopapular rash, and nodules, mostly in ANCA-negative patients, though purpura was more frequent in ANCA-positive cases but without any statistically significant correlation. ANAs were present in 50% of patients, together with ANCA in two subjects and without in eight. Mepolizumab significantly reduced eosinophil levels, BVASs, and corticosteroid dependence, with notable improvement in skin symptoms. In conclusion, skin manifestations are common in EGPA and may represent useful indicators of disease activity. Their integration with ANCA status, eosinophil counts, and positivity to other autoantibodies could enhance diagnostic and monitoring strategies identifying different clusters of EGPA patients even if the small sample size limits the generalizability of the findings.

Background: Cardiac involvement in anaphylaxis remains difficult to assess; however, histamine release during an anaphylactic reaction can induce functional and metabolic alterations in the myocardium. Mast cells, identified within myocardial fibers, perivascular tissue, and arterial structures, play a crucial role in systemic and cardiac anaphylaxis through the release of inflammatory mediators, including histamine, platelet-activating factor, cytokines, chemokines, tryptase, chymase, prostaglandins, and leukotrienes. Hymenoptera venom immunotherapy (VIT) is the most effective strategy for preventing systemic reactions in sensitized individuals. Although VIT is generally well tolerated, severe allergic reactions can occur, particularly during the build-up phase, while they are rare in the maintenance phase.Case report: We present the case of a 57-year-old male with a history of severe systemic reactions (SSR) to Vespula stings who experienced cardiac anaphylaxis during the maintenance phase of VIT. He started VIT with a conventional up-dosing schedule, which was well-tolerated. However, during the third monthly maintenance dose, he developed an anaphylactic syncopal episode with a right bundle branch block (RBBB) on ECG. He was treated promptly with adrenaline, corticosteroids, and antihistamines, and his ECG normalized within 20 days.Conclusions: This case underscores the potential cardiac involvement in anaphylaxis during VIT maintenance and highlights the need to systematically evaluate cardiovascular manifestations during anaphylaxis episodes to optimize risk assessment and management.

The incidence of respiratory and cutaneous allergic disorders may be variable if we consider work activity. These disorders are reported in the current literature to have a relevant psychosomatic involvement. The aim of the study was to submit a survey on the self-reported occurrence of allergic respiratory and cutaneous diseases in outdoor and indoor workers to verify the onset or exacerbations of such pathologies, encourage surveillance, and suggest the need for further studies. Two groups of workers were compared when exposed and not exposed to air pollutants. An outdoor population of motorway toll collectors (153 workers; M: 58.03 years old, SD: 6.1; and female prevalence of 66.01%) and an indoor group of office employees (59 workers; mean age 54.44 years, SD: 8.50; and male prevalence of 61.02%) entered the study. The results of three multivariate analyses of the obtained data, investigating contributions of external factors, including age, sex, smoking habits, working type, and seniority, on allergic conditions were significant in both workers’ groups. The findings highlighted that age and smoking habits were significant contributors to allergic conditions, both independently and in combination with other factors, such as sex and working type. The data suggest the presence of phenomena related to different etiological domains, as already reported in the literature. Through the collection of these data, it was possible to highlight the need to analyze clinical signs from different perspectives.

Introduction: Hymenoptera venom immunotherapy (VIT) is the only therapy that protects patients with Hymenoptera venom allergy by preventing systemic reactions after a new sting. Various extracts for VIT are available and used. VIT administration consists of an induction phase and a maintenance phase. Depot preparations of Hymenoptera VIT extracts are typically used for cluster and conventional protocols, and the maintenance phase. Many patients with Hymenoptera allergy need to achieve tolerance quickly because of the high risk of re-sting and possible anaphylaxis. Objective: Our study aimed to show the safety and efficacy of an accelerated regimen with depot preparations on aluminum hydroxide by using relatively high starting doses in a heterogeneous group of patients. Methods: The research focused on a group of patients with a history of severe systemic reactions to Hymenoptera stings, with the necessity of swift immunization due to high occupational risks. Aluminum hydroxide depot extracts either of Vepula species or Apis mellifera extracts were used. Results: The induction protocol was started with the highest concentration of depot venom extract of 100,000 standard quality unit and was well tolerated by 19 of 20 patients. Onne patient presented with a mild systemic reaction during the accelerated induction schedule, which was promptly treated with intravenous steroids and intramuscular H1 antihistamine; when switched to a conventional induction protocol, he had a similar reaction but finally reached maintenance with an H1-antagonist premedication. Conclusion: If validated, the accelerated induction protocol by using depot aluminum adsorbed extracts with the highest concentration of venom from the beginning could offer a streamlined and accessible treatment modality for patients diagnosed with anaphylaxis from bee and wasp venoms in need of rapid desensitization.

Introduction: The co-presence of bronchiectasis (BE) in severe eosinophilic asthma (SEA) is common. Data about the effectiveness of benralizumab in patients with SEA and BE (SEA + BE) are lacking. Aim: The aim of this study was to evaluate the effectiveness of benralizumab and remission rates in patients with SEA compared to SEA + BE, also according to BE severity. Methods: We conducted a multicentre observational study, including patients with SEA who underwent chest high-resolution computed tomography at baseline. The Bronchiectasis Severity Index (BSI) was used to assess BE severity. Clinical and functional characteristics were collected at baseline and after 6 and 12 months of treatment. Results: We included 74 patients with SEA treated with benralizumab, of which 35 (47.2%) showed the co-presence of bronchiectasis (SEA + BE) with a median BSI of 9 (7–11). Overall, benralizumab significantly improved the annual exacerbation rate (p < 0.0001), oral corticosteroids (OCS) consumption (p < 0.0001) and lung function (p < 0.01). After 12 months, significant differences were found between SEA and SEA + BE cohorts in the number of exacerbation-free patients [64.1% vs. 20%, OR 0.14 (95% CI 0.05–0.40), p < 0.0001], the proportion of OCS withdrawal [−92.6% vs. −48.6, p = 0.0003], and the daily dose of OCS [−5 mg (0 to −12.5) vs. −12.5 mg (−7.5 to −20), p = 0.0112]. Remission (zero exacerbations + zero OCS) was achieved more frequently in the SEA cohort [66.7% vs. 14.3%, OR 0.08 (95% CI 0.03–0.27), p < 0.0001]. Changes in FEV₁% and FEF_25–75% were inversely correlated with BSI (r = −0.36, p = 0.0448 and r = −0.41, p = 0.0191, respectively). Conclusions: These data suggest that benralizumab exerts beneficial effects in SEA with or without BE, although the former achieved less OCS sparing and fewer respiratory-function improvements.