Last April 27, Humanitas Immuno Center has been inaugurated. It is the first Italian Centre for Immune-Inflammatory Diseases, aiming to treat patients whose diseases depend on a malfunctioning of their immune system.
Users asked so many questions that our specialists could not answer them all live. Thus, they address to some of them through this article.

Personalized Medicine Center: Asthma and Allergology

Professor Giorgio Walter Canonica, Supervisor of the Personalized Medicine Center: Asthma and Allergology, answers.

What are the new immunological therapies against allergic rhinitis and atopic dermatitis?
With respect to the immunological therapy against allergic rhinitis, new allergen-specific immunotherapies have been approved and registered as medications (in the form of sublingual tablets). We will treat diseases with nasal polyps (more than 30% of patients with severe asthma also suffer from nasal polyps) with new biological medications (monoclonal antibodies). We will also use these biological medications against atopic dermatitis. A new era begins for patients, with great expectations.

A new era begins, with great expectations for patients.

Are there new medications, an alternative to cortisone and immunosuppressants, to treat pulmonary sarcoidosis?
If you are thinking about new immunological therapies, there are many ideas but no actual medication yet.

Rheumatology and Clinical Immunology

Professor Carlo Selmi, Supervisor of Rheumatology and Clinical Immunology, answers.

Are there new medications, as an alternative to cortisone and immunosuppressants, to treat rheumatoid arthritis?
Unfortunately, we still only have therapies instead of cures against the disease, although we made a huge progress. In general, all medications against rheumatoid arthritis modulate or suppress the immune system. However, we can also change our lifestyle by quitting smoking and keeping our weight under control.

Are there cures for lupus, beyond cortisone? Is it possible to heal completely?
Also, in this case, we still only have therapies instead of cures against the disease, although we made a huge progress. Apart from cortisone, we use medications such as hydroxychloroquine, azathioprine, mycophenolate or belimumab, the latest addition.

Are there cures for psoriatic arthritis?
I think psoriatic arthritis is the field we have most news about. Compared to a few years ago, now we have many recent medications, such as ustekinumab and secukinumab (subcutaneously) or apremilast (orally).

Center for Chronic Inflammatory Bowel Diseases

Professor Silvio Danese, Supervisor of the Center for Chronic Inflammatory Bowel Diseases, answers.

Is there a link among colitis, a constant presence of mucus in your stool, a negative colonoscopy without biopsy and negative calprotectin?
We have to make a distinction between infective or inflammatory colitis, and the ones we call “colitis” but only are symptoms of the irritable bowel syndrome. An active colitis does not give negative results for colonoscopy and calprotectin. Instead, an irritable bowel is a functional issue, generally linked to alterations in the bowel movements, and these exams may give negative results. It is also possible to see mucus in your stool, even though it is not enough to produce a diagnosis of an active inflammatory or infective disease.

What is the cure for microscopic colitis?
Therapies for microscopic colitis require the oral administration of antidiarrhoeals and anti-inflammatories, in particular, steroids with low bioavailability.
In fact, the indicated medication is budesonide, a steroid with reduced side effects if compared to systemic steroids, because it is scarcely absorbed and it is able to work especially locally. This therapy is very effective, but unfortunately, there are many relapses after patients interrupt the therapy.
The best course of action would be taking the full-dosage therapy for a few weeks, and then, upon reaching the complete remission, gradually reducing the dosage. If you are experiencing a relapse, you should start your therapy a new and keep taking it for as long as necessary.

Apart from budesonide, in some selected cases immunosuppressants medications such as azathioprine may be indicated. Moreover, patients who suffer from light versions of the disease may use antidiarrhoeals such as cholestyramine or loperamide.

May abdominal pains and a bloated stomach after meals be a symptom of an irritable bowel if there are no intolerance or allergies?
They may depend on an irritable bowel or on an alteration of the bowel movements. Some patients suffer from an increased gastrocolic reflex that may explain the symptoms.

Dermatology

Professor Antonio Costanzo, Supervisor of Dermatology, answers.

May urticaria come from intestinal diseases if the patient suffers from no allergies?
Yes, indeed. Research has shown that some patients suffer from urticaria due to a Helicobacter Pylori infection.

Which blood exams should you do in case of psoriasis? Is cortisone the only solution?
Blood exams depend on the severity of the disease and on the pharmacological therapy your dermatologist prescribed you. If your psoriasis is light, in general, you don’t have special exams to ask for. Instead, if it is severe it may also be related to arthritis, metabolic syndrome, diabetes and hypertension. Thus, blood exams (such as glucose and fat blood levels) are required to fully understand the ailments of the patient.
The therapy depends on the severity too. Light forms generally require topical medications based on cortisone or derived from D vitamin, while severe forms require systemic medications such as methotrexate or cyclosporine, or biological medications.

Is cortisone the only cure for atopic dermatitis?
Luckily, in a few months, there will be new biological medications. They will be very effective against moderate-to-severe forms of this disease, that affects negatively the lives of patients.