Legend to figures
Figure 1 – Algorithm for a potential Clinical Decision Support
System (CDSS) for pollen allergy . A, «Pyramid model». The four steps
of the diagnostic algorithm of @IT2020.DSS develops vertically as a
“pyramid”. Only the pollens that have passed the previous step are
considered at the next one. This approach might find applicability on
large scale. However, its usefulness is particularly relevant in
Mediterranean area, burdened by high aereobiological complexity and
polisensitization prevalence. There, recognizing the true clinically
relevant sensitization(s) and prescribing the appropriate AIT at
individual level, in the perspective of a precision medicine, is
particularly challenging. In most clinical cases, excluding step by step
more and more pollens, the “pyramid” algorithm proceed from a large
basis towards a narrow top, allowing the recognition of the only one or
a few relevant pollen(s) among the many putative considered by the
traditional diagnostic approach. Modified from Matricardi PM et
al22. B, The octagonal “dartboard”. Each of
the 8 pyramids referred to one of the main local airborne allergenic
sources is graphically represented as one of the 8 regular triangles
constituting the octagonal “dartboard”. As in a dartboard, the
algorithm aims to hit the target, that is identifying the clinically
relevant pollen(s).Step by step, the algorithm proceeds from the basis
up to the top of each pyramid, which is also from the outer edge towards
the core of the dartboard. Allergen excluded are turned off and only the
selected allergen remain colored with a more intense tone in the same
colour gamma. At the end, the target will take the color of the only
relevant allergen(s).
AIT , Allergen Immunotherapy; eDiary , electronic
clinical diary; CRD , Component-resolved diagnosis;NAPT , nasal allergen provocation test; sIgE , serum
specific Immunoglobulin E; SPT , Skin Prick Tests.
Figure 2 – Concordance (%) of the ”virtual” prescription of
allergen immunotherapy with the most prevalent final decision among
allergy specialists for each medical category (allergy specialists and
general practitioners) at each of the three diagnostic steps proposed in
our ”pyramid” model in Rome (A ) and Pordenone (B ).
CRD , component resolved diagnostics;
eDiary , electronic clinical diary; Hx ,
clinical history; SPT , skin prick test. Chi squared
test, when condition were respected or Fisher exact test was used to
evaluate the association of categorical data between allergy specialists
and general practitioners groups. McNemar’s test was used to compare
difference of frequency within each group. *P < .05, **P
<.01, ***P <.001.
Figure 3. Frequency of hypothetical AIT prescriptions decided
by allergists or general practitioners at each diagnostic step proposed
in our ”pyramid” model (i.e. clinical history and skin prick test;
clinical history, skin prick test and molecular diagnostics; clinical
history, skin prick test, molecular diagnostics and electronic diary) in
(A) Rome and (B) Pordenone study centers.
CRD , component resolved diagnostics; eDiary ,
electronic clinical diary; Hx , clinical history; SPT ,
skin prick test.
(A) Percentages are calculated on total amount of 110 cases for allergy
specialists and 100 cases for not-allergists in Rome. (B) Percentages
are calculated on total amount of 70 cases for allergy specialists and
180 cases for general practitioners in Pordenone.
Figure 4 – Answers to the ”feedback survey” among allergy
specialists and general practitioners for each clinical center in the
context of the diagnostics of pollinosis for Rome (A ) and
Pordenone (B ). Fisher test was used to evaluate the association
of categorical data between independent groups (*p-value <
.05). § Sensitization to more than four aeroallergens.
CDSS, clinical decision support system;
CRD , component resolved diagnostics;
eDiary , electronic clinical diary.