Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are among the most widespread drugs for the prevention of cardiovascular mortality and morbidity. Nevertheless, they are known to cause bradykinin (BK)-mediated angioedema (AE), a paroxysmal, localized, self-limiting, and potentially fatal swelling of the subcutaneous and/or submucosal tissue, due to a temporary increase in vascular permeability. Unlike hereditary angioedema (HAE), which can be mediated similarly by BK, no diagnostic tools, guidelines, or drugs have yet been approved for the diagnosis and treatment of acute non-allergic drug-induced AE. Besides ACEIs and ARBs, inhibitors of dipeptidyl peptidase-IV, neprilysin inhibitors, and tissue plasminogen activators are known to cause AE as an adverse effect. Currently, there are insufficient data on the prevention of AE caused by pharmacological therapies. In addition, the molecular mechanisms underlying BK-mediated AE caused by drugs, which are discussed here, are not fully explained. Specific approved drugs and a structured diagnostic workflow are unmet needs and are required for the management of this kind of AE. The aim of this review is to provide physicians with accurate knowledge of potentially life-threatening drug reactions so that they can be better understood and managed.

Background: real-life studies are encouraged to evaluate the effectiveness and safety of allergen immunotherapy (AIT). In this context, a retrospective cohort study was conducted to assess the effectiveness and safety of carbamylated monomeric allergoid subcutaneous immunotherapy (MA-SCIT), along with patient satisfaction. Methods: a total of 291 patients with rhinoconjunctivitis with or without asthma with inhalant (house dust mite, grass, and pellitory) allergies were enrolled in this study. Perceived efficacy and perceived satisfaction with MA-SCIT, symptom score by VAS, ARIA classification of rhinitis, drug consumption, number of asthma worsening episodes, and asthma symptom control were evaluated by questionnaires before, after one year, at the end of treatment, and after one or two years of MA-SCIT. Results: the overall symptom score significantly decreased over the years of MA-SCIT, irrespective of specific sensitization (p < 0.01). There was a substantial amelioration of rhinitis severity, with a significant reduction (p < 0.01) in drug use. A significant reduction was observed in the asthma symptom VAS score and asthma-worsening episodes requiring systemic steroids. None of the patients reported any severe adverse reactions. Finally, 90% of the patients reported full satisfaction with the treatment. Conclusions: the study showed that AIT with carbamylated monomeric allergoids of grass, pellitory, and mites was effective and well tolerated by patients.

Background: Chronic urticaria (CU) is a complex skin condition, frequently challenging both patients and clinicians and requiring wise individualized management. While allergy, autoimmunity, and depression are recognized comorbidities, evidence linking CU and malignancy remains underexplored. Screening for malignancy is not a routine standard of care for CU patients. Methods: A literature review was conducted to explore the potential risk or associations, including immune mechanisms, between CU and malignancy, based on searches in the PubMed and Google Scholar databases. Results: Scientific evidence on the malignancy risk in CU and its causal relationship is limited to a few population-based studies and case reports. A higher incidence of hematologic malignancy in CU patients has been reported in several publications, but the overall risk of malignancy in the CU population remains controversial. Antihistamine resistance, ultra-low IgE, and older age at the time of CU diagnosis may be related to a higher risk of malignancy, especially shortly after CU diagnosis. Immunological pathways linking CU and cancer are not clear. Immune system dysregulation, including alterations in immune checkpoints, is a feature of both cancer and CU. Such dysregulation may promote immunotolerance, abnormal immune responses, and mast cell activation through novel autoantigens and autoantibodies involved in the tumor microenvironment. Conclusions: There is growing, although limited, evidence suggesting a possible link between CU and malignancy, especially hematologic cancers. Large multicenter cohort studies are warranted to determine whether CU may act as a clinical harbinger of malignancy and to identify patient subsets that may benefit from targeted cancer screening.

Background/Objectives: Chronic Spontaneous Urticaria (CSU) is a skin disorder marked by recurrent wheals and itching, with or without angioedema, which can greatly affect the quality of life. Vitamin D has been implicated in the pathophysiology of various immune-mediated conditions, including CSU. The connection between vitamin D levels, patients’ perceived symptoms, and life impact remains unexplored. This study aims to elucidate vitamin D levels and their correlation with perceived disease-related burden in individuals with CSU. Methods: PROM-based questionnaires, serum 25(OH)D levels, and BMI were statistically analyzed in high-disease-activity CSU, among hospitalized and outpatients who attended the main tertiary hospital center during a 1-year period. These data were compared with a control group, after obtaining their consent. Results: The study included 104 patients, 74 (71.15%) females, mean age 43.17 ± 18.26 years, and 23 controls, 12 (52.17%) females, mean age 44.61 ± 12.77 years. Levels of 25(OH)D were significantly lower in patients compared to controls and in the hospitalized versus the outpatient group (p < 0.05). Suboptimal 25(OH)D was found in 94.23% of patients (mean level 18.29 ± 6.74 ng/mL) and 82.61% of controls (mean 24.01 ± 7.44 ng/mL). A BMI > 25 kg/m² was found in 71 (68.3%) patients and 11 (47.83%) controls. Age was not significantly correlated with vitamin D levels. A significant positive correlation was found between vitamin D levels and the perceived bothersomeness score of urticarial elements and pruritus. Age was negatively correlated with perceived bothersomeness of pruritus. Irrespective of 25(OH)D levels, perceived bothersomeness of urticarial elements positively correlated with scores for angioedema, pruritus, and the impact of CSU on life and daily activities. Life and daily activities impact scores were also positively correlated with angioedema and pruritus. Conclusions: Suboptimal levels of 25(OH)D were common in CSU patients, especially among hospitalized patients, and were significantly lower compared with controls, suggesting a potential link between low vitamin D status and high disease activity. PROMs did not show a significant association between lower vitamin D levels and worse scores for perceived bothersomeness of urticarial elements, angioedema, pruritus, or impact on life and daily activities.

BACKGROUND: No study has been conducted to allow the evaluation of pulmonary dysfunction in Albanian population after medium-severe COVID-19 disease. AIM: We aimed through this project to overview the spirometry data and correlation to other inflammatory markers in post COVID-19 young adults. METHODS: A cross-sectional study was performed to access spirometry as pulmonary function test 3–6 months after COVID-19 in young adults ≤45 years old, hospitalized for COVID-19, and presented no known history for previous pulmonary disease. RESULTS: Among 61 patients, 41 (67.2%) females; mean age 30.6 ± 8.63 years, have undergone a spirometry test 3–6 months after COVID-19. Spirometry data for pulmonary function resulted: 4 patients (6.56%) with pulmonary dysfunction, among them 1 patient (1.64%) Forced expiratory volume in 1 s (FEV1)/Forced vital capacity (FVC) <75%, with generalized bronchial obstruction and 3 patients (4.92%) with small airway obstruction (brochiolo-obstruction), FEF 25–75 <60%. According to criteria classification for disease, severity (SpO 50%) 22 (36.06%) had severe COVID-19. Among two groups of COVID severity, resulted statistically significant (p < 0.05), the difference for visual analogue scale (VAS) for dyspnea perception reported during 1st month post- COVID-19 after 6 min moderate physical activity and FEV1/FVC (Tiffeneau Index value) resulted no statistically significant changes between groups for inflammatory markers such as C reactive protein level, absolute lymphocyte count, FEF 25–75 or body mass index. D-dimer value had statistically significant change between two groups of COVID-19 severity. In two groups where present VAS dyspnea perception (≤5) and (>5), no significant correlation was found regarding FEV1/FVC and FEF 25–75 values among groups. CONCLUSION: The results show that there are few patients that show obstructive pulmonary dysfunction evaluated by spirometry. As investigated by other published studies probably the effects in pulmonary function are improved after few months and bronchial hyper-reactivity post- COVID-19 needs further investigation.