Humanitas Immunology Center, the first Italian center for immune-inflammatory diseases, was inaugurated on April 27th, with the aim of offering a response to patients suffering from diseases related to a malfunction of the immune system.
A great many questions came from the live users and not all of them could be answered. We take up some of them in this article with our specialists.
Personalized Medicine Center: Asthma and Allergology
Professor Giorgio Walter Canonica, Head of the Centre for Personalized Medicine: Asthma and Allergology, answers.
What are the immunological therapies for allergic rhinitis and atopic dermatitis?
The novelty for immunological therapy for allergic rhinitis is the approval of new allergen-specific immunotherapies registered as drugs (in the form of sublingual tablets).
For the pathology with nasal polyposis (more than 30% of subjects with severe asthma have the nasal polyposis) new biological drugs are coming (monoclonal antibodies) that are already being approved (by 2017) for atopic dermatitis.
A new era begins with excellent prospects for patients.
Are there any new drugs, as an alternative to cortisone and immunosuppressants, for the treatment of pulmonary sarcoidosis?
If we refer to new immunological therapies, as far as there is ferment, I do not know that we have reached a consolidated treatment.
Clinical Rheumatology and Immunology
Professor Carlo Selmi, Head of Rheumatology and Clinical Immunology, answers.
In addition to immunosuppressants and cortisone, are there any treatments for rheumatoid arthritis?
Unfortunately, we continue to have only treatments and not cures that cure the disease, even if the progress has been enormous. In general, all drugs used for rheumatoid arthritis have an effect of modulation or suppression of the immune system. But we can also work on the lifestyle by avoiding smoking and keeping a proper weight.
Are there any new treatments for lupus in addition to cortisone? Is there hope of recovery?
Again, we continue to have only therapies and not cures that cure the disease even if the progress has been great. In addition to cortisone, we use drugs such as hydroxychloroquine, azathioprine, mycophenolate or belimumab, the latest addition.
Are there any new treatments for psoriatic arthritis?
Psoriatic arthritis is perhaps the field in which we have the most novelties and only a few years ago we have introduced several drugs, such as ustekinumab and secukinumab subcutaneously or apremilast, taken orally.
Centre for Chronic Inflammatory Intestinal Diseases
Professor Silvio Danese, Head of the Centre for Chronic Inflammatory Intestinal Diseases, answers.
Can colitis be associated with the constant presence of mucus in the feces (with negative colonoscopy but without biopsy and calprotein negative)?
It is essential to distinguish between infectious or inflammatory colitis and those which are erroneously called colitis, but which only refer to symptoms of an irritable bowel syndrome. Colonoscopy and calprotectin are not negative in active phase colitis. In irritable colon disorder, which is a functional problem, mostly related to altered intestinal motor activity, these tests are negative and it is possible to find the presence of mucus in the feces, which alone is not a symptom of an inflammatory disease or active infectious disease.
How is microscopic colitis treated?
The therapy of microscopic colitis involves the use of oral antidiarrheal drugs and anti-inflammatories, especially low bioavailability steroids.
The drug of choice is in fact Budesonide, a steroid with reduced side effects compared to systemic steroids, thanks to its reduced absorption and ability to act especially at the local level. The response to this therapy is high, but unfortunately there are a high number of relapses when the therapy is discontinued.
It is advisable to take the therapy at full dosage for a few weeks until complete remission is reached and then gradually reduce the dosage. In the event of a relapse, the therapy should be resumed until it is taken indefinitely in some cases.
In addition to Budesonide, immunosuppressive drugs such as azathioprine may be used in selected cases. Furthermore, they may be useful, especially in their milder forms, as antidiarrheal agents such as cholestyramine or loperamide.
Can the presence of abdominal pain and swollen belly after eating, in the absence of intolerances or allergies, be irritable colon?
It could be related to an irritable colon or to an alteration in intestinal transit. In some patients there is an increased gastro-colic reflex that may explain symptoms.
Dermatology
Professor Antonio Costanzo, Head of Dermatology, answers.
Can urticaria result from intestinal problems if there are no recognized allergies?
Yes, cases of patients who have hives related to Helicobacter Pylori infection have been published.
What blood tests are indicated for psoriasis and how is it treated, apart from cortisone?
The tests to be carried out depend on the severity of the disease and the pharmacological treatment that the dermatologist intends to prescribe. In the case of mild psoriasis there is usually no particular analysis to be performed. When psoriasis is severe, however, it can be associated with comorbidities such as arthritis, metabolic syndrome, diabetes, and hypertension. Consequently, in order to frame the patient in the most correct way, blood tests (such as blood sugar, lipid profile, etc.) must be carried out.
The type of therapy also varies according to the severity of the disease; for mild forms usually topical drugs based on cortisone or vitamin D derivatives are used; for severe forms it is advisable to use systemic drugs such as methotrexate or cyclosporine or biological drugs.
Is atopic dermatitis treated only with cortisone?
Fortunately, in a few months, very effective biological medicines will be available to control the moderate and severe forms of this disease that affects the quality of life of patients.
