Mauro Minelli, immunologo clinico ed allergologo

Summary
This work analyses the possible reasons why in a homogeneous geographical area – Apulia and Basilicata – there is a documented inconsistency between the growing social importance of the respiratory allergic diseases and the official statistics, which should confirm this epidemiological significance. In this sense, the heart of the generally undervalued matter could be concerned with the hospital financing system, which is based on the DRG (Diagnosis Related Groups).
Every DRG includes a set of diseases and is associated with a diagnosis and a rate. This could represent an essential factor for bronchial asthma and the other respiratory allergic diseases, if compared to the cost of other possible clinical diagnoses!
The DRG has actually become the only instrument for calculating the costs incurred by hospitals and therefore estimating their efficiency.
So it is necessary to review the system of reimbursement per DRG with close attention, because it increasingly risks favouring the economic criteria (efficiency) with damage to the efficacy of the product and good medicine.

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An epidemiological survey on the allergological importance of some emergine pollens in Italy.
J. Invest Allegol Clin Immunol; May-June 2000; Vol 10 (3); 155-161
Corsico R, Falagiani P, Ariano R, Berra D, Biale C, Bonifazi F, Campi P, Feliziani V, Frenguelli G, Galimberti M, Gallesio MT, Liccardi G, Loreti A, Marcer G, Marcucci F, Meriggi A, Minelli M, Nardelli R, Nardi G, Negrini CA, Papa G, Piu G, Pozzan M, D’Ambrosio FP, Riva G.

Fondazione Salvatore Maugeri, IRCCS, Pneumology Division, Centro Medico di Riabilitazione di Montescano, Pavia, Italy.

Epidemiological studies on the pollens responsible for allergic diseases throughout Italy are lacking. Routine diagnostic panels consist prevalently of grass, Parietaria, weeds, birch, olive and mugwort. Considering the great variety of Italian geographical areas and the observation of the growing allergological importance of new botanical species (e.g., ambrosia), a survey on pollen species considered “minor” was necessary. A panel of “emerging” pollens (birch, hazelnut, alder, hornbeam, cypress, ragweed) and a routine panel were used to skin prick test 2,934 consecutive outpatients with respiratory pathology of suspected allergic origin, in 21 centers across Italy. A specific questionnaire was compiled. It was found that 20.1% of patients did not react to allergens tested, 28.2% were positive for at least one emerging pollen and 51.7% did not react to emerging pollens but tested positive for at least one allergen from the routine panel. The prevalence of single pollen species was related to geographical areas. Ragweed pollen was shown to provoke asthma much more frequently than other pollens. Hitherto scarcely considered pollens play a considerable role in causing allergic diseases in Italy. In the great majority of patients, positivity for these pollens was associated with positivity to the better recognized group of pollen allergens, although in some cases they were the primary pathogenic agent. We suggest that these more recently considered allergens be included in routine diagnostic panels.

PMID: 10923590 [PubMed - indexed for MEDLINE]

Corsico R, Cinti B, Feliziani V, Gallesio MT, Liccardi G, Loreti A, Lugo G, Marcucci F, Marcer G, Meriggi A, Minelli M, Gherson G, Nardi G, Negrini AC, Piu G, Passaleva A, Pozzan M, D’Ambrosio FP, Venuti A, Zanon P, Zerboni R.

Fondazione, S. Maugeri, IRCCS, Montescano, Pavia, Italy.

BACKGROUND: The actual prevalence of sensitization to Alternaria is not known, partly due to the unreliability of diagnostic extracts.

OBJECTIVE: To assess skin positivity to extracts of Alternaria in a wide population of Italian patients suffering from respiratory symptoms using a biologically standardized extract.

METHODS: A total of 2942 patients were skin prick tested with Alternaria, and a panel of common inhalant allergens. Blood samples for specific IgE quantitation were taken both from patients positive and from patients negative (control group) to Alternaria extract.

RESULTS: Three hundred six patients (10.4%, ranging from 1.8% in Turin to 29.3% in Cagliari) were positive to Alternaria; 37 were sensitized to only this mold, while the remaining 269 were sensitized to at least one other allergen. Of the Alternaria-positive patients, 79.7% suffered from rhinitis and 53.3% from asthma, either alone or associated with other symptoms.

CONCLUSIONS: We suggest that, at least in Italy and in countries with similar climatic and environmental situations, standardized Alternaria extract should be included in the panel commonly used in investigating the allergen responsible in patients suffering from respiratory allergy.

PMID: 9475571 [PubMed - indexed for MEDLINE]