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.