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DISSERTATION Original AbstractThe impact of tele-monitoring on adherence to nasal corticosteroid treatment in children with seasonal allergic rhinoconjunctivitisBackground -Adherence to controller therapy in allergic diseases is low. Tele-monitoring has been proposed to improve adherence to treatment in chronic diseases. However, this strategy has never been tested in allergic rhinoconjunctivitis. Objective -To test whether Internet-based tele-monitoring during the grass pollen season of children with allergic rhinoconjunctivitis may enhance adherence to treatment. Methods -Children and adolescents, 5-18 years old, with moderate-to-severe seasonal allergic rhinoconjunctivitis to grass pollen requiring daily administration of nasal corticosteroid (mometasone) were recruited (April 2013) in a pediatric allergy practice. Participants were randomized to Internet-based monitoring (AllergyMonitor™, AM) or to usual care (no diary at all, controls) and followed from May 13th (T0) to June 15th 2013 (T2). An intermediate visit (T1) was performed between May 31st and June 2nd. Optimal adherence to therapy was expressed as the use of at least 0.190 g/day of mometasone, corresponding to one puff/nostril/day, and it was measured by canister weights during (T1) and at the end (T2) of the study period. Main secondary outcomes included the reported disease severity (validated self-questionnaire) and quality of life (AdoIRQLQ questionnaire), disease knowledge (multiple-choice questionnaire), nasal flow and resistance at baseline and at T2. Results -The use of mometasone, expressed as both optimal adherence rate (48.4% vs 12.5%; p=0.002) and average daily use (0.20+0.12 g/day vs 0.15+0.07 g/day; p=0.037), was higher in the AM group (n=31) than among controls (n=32). Disease knowledge improved among the patients using AM (83.3% vs 68.3%; p<0.001) but not among controls (68.2% vs 67.7% right answers; p>0.05). No differences were observed in the reported severity of disease, nasal flow and resistance and quality of life both at baseline and at follow-up visits. Conclusions -Internet-based tele-monitoring improves adherence to nasal corticosteroid treatment and disease knowledge among children and adolescents with seasonal allergic rhinoconjunctivitis.

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In a Mediterranean country characterized by multiple pollen exposures, PFS is a complex and frequent complication of childhood SAR, with five distinct endotypes marked by peculiar profiles of IgE sensitization to panallergens. Prospective studies in cohorts of patients with PFS are now required to test whether this novel classification may be useful for diagnostic and therapeutic purposes in the clinical practice.

Array of space time data, Fuzzy clustering, Spatial autocorrelation function, Spatial penalization term, Dissimilarity measures between multivariate time trajectories,