Supraorbital Basosquamous Carcinoma Treated with Cemiplimab Followed by Sonidegib: A Case Report and Review of the Literature.

Basal cell carcinoma (BCC) is a skin cancer with low local aggressiveness and a low tendency to metastasize. Basosquamous Carcinoma (BSC) represents an aggressive histological subtype of BCC with intermediate features between Squamous Cell Carcinoma (SCC) and BCC. Cemiplimab is currently approved as first-line therapy in SCC and second-line therapy in BCC patients who have progressed on or are intolerant of a Hedgehog pathway Inhibitor (HHI). Our study describes the case of a 59-year-old man with BSC who was successfully treated with 5 cycles of Cemiplimab as first-line therapy and Sonidegib as second-line therapy. Currently, the efficacy of Cemiplimab against BSC and other histopathological subtypes of BCC has not been fully elucidated, as has the role of sequential or combination therapy with Cemiplimab and HHI in the management of BSC. The aim of this case report is to highlight the need to outline the use of checkpoint inhibitors in BCCs and focus attention on the synergistic role of Cemiplimab and HHIs in such a controversial entity as BSC.

Nasal airflow recovery after decongestion test is associated with bronchial hyperreactivity in patients with allergic rhinitis.

BACKGROUND: The decongestion test involves spraying an intranasal vasoconstrictor drug to evaluate the recovery of nasal airflow. OBJECTIVE: The aim of this study was to assess the relationship between pulmonary function (assessed by spirometry and methacholine challenge) and nasal airflow recovery after a topical vasoconstrictor had been administered in patients with allergic rhinitis (perennial, seasonal, or mixed allergic rhinitis). METHODS: A total of 150 subjects were studied. The total symptom score, sensitization, and pulmonary function were all assessed. All subjects underwent rhinomanometry and the decongestion test. RESULTS: Univariate analysis revealed that nasal symptoms and spirometric parameters (except FEF(25-75) in subjects with seasonal allergic rhinitis) were not. Only bronchial hyperreactivity, assessed by methacholine challenge, proved to be significantly (and independently) associated with outcome (OR 1.45, P = 0.025). CONCLUSIONS: This study provides the first evidence of an association between a positive response to the decongestion test and bronchial hyperreactivity, assessed by methacholine challenge, in patients with allergic rhinitis.

Nasal obstruction is the key symptom in hay fever patients.

BACKGROUND: Allergic rhinitis is characterized by a Th2-dependent inflammation. Nasal obstruction largely depends on allergic inflammation. OBJECTIVE: The aim of this study was to evaluate the possible role of the symptom nasal obstruction in assessing patients with hay fever. METHODS: Fifty patients (mean age, 23.7 +/- 4.9 years) with hay fever were evaluated both during and outside pollen season. All of them had moderate-severe grade of nasal obstruction. Total symptom score (TSS), rhinomanometry, nasal lavage, nasal scraping, spirometry, and methacholine bronchial challenge were performed in all subjects. RESULTS: During the pollen season, patients with severe nasal obstruction showed significantly higher values of TSS, IL-4, IL-5, IL-8, nasal eosinophils and neutrophils, and significantly lower values of nasal airflow, IFNgamma, FEV1, FVC, and FEF 25-75 in comparison with patients with moderate nasal obstruction. Twenty (83%) patients with severe nasal obstruction showed bronchial hyperreactivity (BHR), whereas only 6 (25%) patients with moderate nasal obstruction had BHR. Outside the pollen season overlapping results were observed. CONCLUSIONS: This study provides evidence about the key role played by nasal obstruction in assessing patients with allergic rhinitis.

Mizolastine and fexofenadine modulate cytokine pattern after nasal allergen challenge.

Allergen specific nasal challenge (ASNC) is an optimal model to study the pathophysiological mechanisms sustaining allergic inflammation, particularly the cytokine pattern. Antihistamines have been accepted as a highly effective therapy for allergic rhinitis. The aim of this double blind, randomised, placebo controlled study was the evaluation of symptoms and cytokines, during the early phase, after a single dose of mizolastine (10 mg), fexofenadine (120 mg) or placebo, using the model of ASNC. A total of 30 patients with allergic rhinitis underwent nasal challenge 6 hours after treatment. The following parameters were evaluated 30 minutes after ASNC (i.e. early phase): nasal symptoms (rhinorrhea, itching, sneezing, obstruction), and cytokine pattern, including IL1, IL6, and TNFalpha. Mizolastine was associated with early phase reduction of: i) clinical symptoms (p < 0.03), ii) cyotkine levels of IL1 (p = 0.003), IL6 (p < 0.007), and TNF_ (p < 0.003) in comparison with placebo group. Fexofenadine significantly inhibited IL6 (p < 0.004) and TNFalpha (p < 0.004) levels in comparison with placebo. The present findings demonstrate that mizolastine exerts a significant effect on early phase events, reducing symptoms and pro-inflammatory cytokines. Fexofenadine reduces TNFalpha and IL6 levels only. These effects appear to be clinical relevant for mizolastine.

Asthma in Italian conscripts: a four year study.

BACKGROUND: Italian conscripts showed underdiagnosis and undertreatment of asthma in a previous 9-year study (1990-1998). METHODS: We extended those findings in a new 4-year study (1999-2002) by screening 28,327 18-year old males referred to La Spezia Military Navy Hospital for call-up visit. RESULTS: Asthma was diagnosed in 1,847 conscripts (6.52%). Along the observational period there was a significant decrease of mild persistent asthmatic subjects (from 39.6 to 30.1%, p < 0.01). The use of inhaled corticosteroids and antileukotrienes significantly increased. However, about one third of the asthmatic subjects did not receive any treatment at all and about 40% of asthmatic subjects showed impaired spirometry. CONCLUSIONS: In this age, data show a partial success of educational efforts, since underdiagnosis and undertreatment are still present.