Preliminary data revealing efficacy of Streptococcus salivarius K12 (SSK12) in Periodic Fever, Aphthous stomatitis, Pharyngitis, and cervical Adenitis (PFAPA) syndrome: A multicenter study from the AIDA Network PFAPA syndrome registry
ObjectiveTo evaluate the potential role of Streptococcus salivarius K12 (SSK12) in controlling febrile flares in patients with Periodic Fever, Aphthous stomatitis, Pharyngitis, and cervical Adenitis (PFAPA) syndrome. Further aims were to assess the impact of SSK12 on (i) flare duration, (ii) variati...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-02-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2023.1105605/full |
| _version_ | 1797905351165607936 |
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| author | Francesco La Torre Jurgen Sota Antonella Insalaco Giovanni Conti Emanuela Del Giudice Riccardo Lubrano Luciana Breda Maria Cristina Maggio Adele Civino Violetta Mastrorilli Roberta Loconte Marco Francesco Natale Camilla Celani Mery Romeo Serena Patroniti Cristina Gentile Antonio Vitale Valeria Caggiano Carla Gaggiano Federico Diomeda Marco Cattalini Giuseppe Lopalco Giacomo Emmi Giacomo Emmi Paola Parronchi Stefano Gentileschi Fabio Cardinale Emma Aragona Farhad Shahram Achille Marino Patrizia Barone Carla Moscheo Burcugul Ozkiziltas Francesco Carubbi Ohoud Alahmed Ludovica Iezzi Benson Ogunjimi Benson Ogunjimi Angela Mauro Maria Tarsia Ayman Abdel-Monem Ahmed Mahmoud Henrique Ayres Mayrink Giardini Petros P. Sfikakis Katerina Laskari Ewa Więsik-Szewczyk José Hernández-Rodríguez Bruno Frediani Verónica Gómez-Caverzaschi Abdurrahman Tufan Ibrahim A. Almaghlouth Ibrahim A. Almaghlouth Alberto Balistreri Gaafar Ragab Gaafar Ragab Claudia Fabiani Luca Cantarini Donato Rigante Donato Rigante |
| author_facet | Francesco La Torre Jurgen Sota Antonella Insalaco Giovanni Conti Emanuela Del Giudice Riccardo Lubrano Luciana Breda Maria Cristina Maggio Adele Civino Violetta Mastrorilli Roberta Loconte Marco Francesco Natale Camilla Celani Mery Romeo Serena Patroniti Cristina Gentile Antonio Vitale Valeria Caggiano Carla Gaggiano Federico Diomeda Marco Cattalini Giuseppe Lopalco Giacomo Emmi Giacomo Emmi Paola Parronchi Stefano Gentileschi Fabio Cardinale Emma Aragona Farhad Shahram Achille Marino Patrizia Barone Carla Moscheo Burcugul Ozkiziltas Francesco Carubbi Ohoud Alahmed Ludovica Iezzi Benson Ogunjimi Benson Ogunjimi Angela Mauro Maria Tarsia Ayman Abdel-Monem Ahmed Mahmoud Henrique Ayres Mayrink Giardini Petros P. Sfikakis Katerina Laskari Ewa Więsik-Szewczyk José Hernández-Rodríguez Bruno Frediani Verónica Gómez-Caverzaschi Abdurrahman Tufan Ibrahim A. Almaghlouth Ibrahim A. Almaghlouth Alberto Balistreri Gaafar Ragab Gaafar Ragab Claudia Fabiani Luca Cantarini Donato Rigante Donato Rigante |
| author_sort | Francesco La Torre |
| collection | DOAJ |
| description | ObjectiveTo evaluate the potential role of Streptococcus salivarius K12 (SSK12) in controlling febrile flares in patients with Periodic Fever, Aphthous stomatitis, Pharyngitis, and cervical Adenitis (PFAPA) syndrome. Further aims were to assess the impact of SSK12 on (i) flare duration, (ii) variation in the degree of the highest body temperature during flares, (iii) steroid-sparing effect, and (iv) change of PFAPA accompanying symptoms before and after SSK12 introduction.Patients and methodsThe medical charts from 85 pediatric patients with PFAPA syndrome (49 males and 36 females) enrolled in the AIDA registry and treated with SSK12 for a median period of 6.00 ± 7.00 months in the period between September 2017 and May 2022 were examined. Children recruited had a median time of disease duration of 19.00 ± 28.00 months.ResultsThe number of febrile flares significantly decreased comparing the 12 months before [median (IQR), 13.00 (6.00)] and after SSK12 initiation [median (IQR), 5.50 (8.00), p < 0.001]. The duration of fever was significantly reduced from 4.00 (2.00) days to 2.00 (2.00) days [p < 0.001]. Similarly, the highest temperature in°C was found significantly lower in the last follow-up assessment [median (IQR), 39.00 (1.00)] compared to the period prior to SSK12 start [median (IQR), 40.00 (1.00), p < 0.001]. Steroid load (mg/year) of betamethasone (or any equivalent steroid) significantly decreased between 12 months before treatment with SSK12 [median (IQR), 5.00 (8.00) mg/year] and the last follow-up visit [median (IQR), 2.00 (4.00) mg/year, p < 0.001]. The number of patients experiencing symptoms including pharyngitis/tonsillitis (p < 0.001), oral aphthae (p < 0.001) and cervical lymphadenopathy (p < 0.001) significantly decreased following SSK12.ConclusionSSK12 prophylaxis given for at least 6.00 months was found to reduce febrile flares of PFAPA syndrome: in particular, it halved the total number per year of fever flares, shortened the duration of the single febrile episode, lowered body temperature by 1°C in the febrile flare, provided a steroid-sparing effect, and significantly reduced the accompanying symptoms related to the syndrome. |
| first_indexed | 2024-04-10T10:03:20Z |
| format | Article |
| id | doaj.art-c4531375bdea4fe4930fa7ed2dde4ecd |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-04-10T10:03:20Z |
| publishDate | 2023-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-c4531375bdea4fe4930fa7ed2dde4ecd2023-02-16T05:26:22ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-02-011010.3389/fmed.2023.11056051105605Preliminary data revealing efficacy of Streptococcus salivarius K12 (SSK12) in Periodic Fever, Aphthous stomatitis, Pharyngitis, and cervical Adenitis (PFAPA) syndrome: A multicenter study from the AIDA Network PFAPA syndrome registryFrancesco La Torre0Jurgen Sota1Antonella Insalaco2Giovanni Conti3Emanuela Del Giudice4Riccardo Lubrano5Luciana Breda6Maria Cristina Maggio7Adele Civino8Violetta Mastrorilli9Roberta Loconte10Marco Francesco Natale11Camilla Celani12Mery Romeo13Serena Patroniti14Cristina Gentile15Antonio Vitale16Valeria Caggiano17Carla Gaggiano18Federico Diomeda19Marco Cattalini20Giuseppe Lopalco21Giacomo Emmi22Giacomo Emmi23Paola Parronchi24Stefano Gentileschi25Fabio Cardinale26Emma Aragona27Farhad Shahram28Achille Marino29Patrizia Barone30Carla Moscheo31Burcugul Ozkiziltas32Francesco Carubbi33Ohoud Alahmed34Ludovica Iezzi35Benson Ogunjimi36Benson Ogunjimi37Angela Mauro38Maria Tarsia39Ayman Abdel-Monem Ahmed Mahmoud40Henrique Ayres Mayrink Giardini41Petros P. Sfikakis42Katerina Laskari43Ewa Więsik-Szewczyk44José Hernández-Rodríguez45Bruno Frediani46Verónica Gómez-Caverzaschi47Abdurrahman Tufan48Ibrahim A. Almaghlouth49Ibrahim A. Almaghlouth50Alberto Balistreri51Gaafar Ragab52Gaafar Ragab53Claudia Fabiani54Luca Cantarini55Donato Rigante56Donato Rigante57Department of Pediatrics, Pediatric Rheumatology Center, Giovanni XXIII Pediatric Hospital, University of Bari, Bari, ItalyDivision of Rheumatology, Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet’s Disease Clinic, University of Siena, Siena, ItalyOspedale Pediatrico Bambino Gesù, IRCCS (European Reference Network for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases Center), Rome, ItalyPediatric Nephrology and Rheumatology Unit, Azienda Ospedaliera Universitaria G. Martino, Messina, ItalyPediatric and Neonatology Unit, Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Polo Pontino, Latina, ItalyPediatric and Neonatology Unit, Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Polo Pontino, Latina, ItalyPediatric Rheumatology Unit, S.S. Annunziata Hospital, Chieti, ItalyDepartment of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Palermo, ItalyPediatric Rheumatology and Immunology Unit, Vito Fazzi Hospital, Lecce, ItalyDepartment of Pediatrics, Pediatric Rheumatology Center, Giovanni XXIII Pediatric Hospital, University of Bari, Bari, ItalyDepartment of Pediatrics, Pediatric Rheumatology Center, Giovanni XXIII Pediatric Hospital, University of Bari, Bari, ItalyOspedale Pediatrico Bambino Gesù, IRCCS (European Reference Network for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases Center), Rome, ItalyOspedale Pediatrico Bambino Gesù, IRCCS (European Reference Network for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases Center), Rome, ItalyPediatric Nephrology and Rheumatology Unit, Azienda Ospedaliera Universitaria G. Martino, Messina, ItalyPediatric Nephrology and Rheumatology Unit, Azienda Ospedaliera Universitaria G. Martino, Messina, ItalyPediatric Rheumatology Unit, S.S. Annunziata Hospital, Chieti, ItalyDivision of Rheumatology, Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet’s Disease Clinic, University of Siena, Siena, ItalyDivision of Rheumatology, Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet’s Disease Clinic, University of Siena, Siena, ItalyDivision of Rheumatology, Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet’s Disease Clinic, University of Siena, Siena, ItalyPediatric Rheumatology and Immunology Unit, Vito Fazzi Hospital, Lecce, ItalyPediatric Clinic, University of Brescia and Spedali Civili di Brescia, Brescia, Italy0Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy1Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy2Centre for Inflammatory Diseases, Department of Medicine, Monash Medical Centre, Monash University, Clayton, VIC, Australia1Department of Experimental and Clinical Medicine, University of Florence, Florence, ItalyDivision of Rheumatology, Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet’s Disease Clinic, University of Siena, Siena, ItalyDepartment of Pediatrics, Pediatric Rheumatology Center, Giovanni XXIII Pediatric Hospital, University of Bari, Bari, Italy3Division of Gastroenterology, Ospedali Riuniti Villa Sofia-Vincenzo Cervello, Palermo, Italy4Behcet’s Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran5Unit of Pediatric Rheumatology, ASST Gaetano Pini-CTO, Milan, Italy6Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy7Pediatric Unit, Azienda Ospedaliero-Universitaria Policlinico “Rodolico-San Marco”, Catania, Italy8Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey9Department of Life, Health & Environmental Sciences and Internal Medicine and Nephrology Unit, Department of Medicine, University of L’Aquila and ASL Avezzano-Sulmona-L’Aquila, San Salvatore Hospital, L’Aquila, Italy0Pediatric Rheumatology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia1Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy2Department of Pediatrics, Antwerp University Hospital, Antwerp, Belgium3Center for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium4Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Milan, Italy5Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy6Rheumatology and Clinical Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt7Rheumatology Division, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil8Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece8Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece9Department of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defence, Military Institute of Medicine, Warsaw, Poland0Vasculitis Research Unit, Autoinflammatory Diseases Clinical Unit, Department of Autoimmune Diseases, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, SpainDivision of Rheumatology, Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet’s Disease Clinic, University of Siena, Siena, Italy0Vasculitis Research Unit, Autoinflammatory Diseases Clinical Unit, Department of Autoimmune Diseases, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain8Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey1Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia2College of Medicine Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia3Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies, University of Siena, Siena, Italy6Rheumatology and Clinical Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt4Faculty of Medicine, Newgiza University, 6th of October City, Egypt5Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, ItalyDivision of Rheumatology, Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet’s Disease Clinic, University of Siena, Siena, Italy1Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy6Rare Diseases and Periodic Fevers Research Centre, Università Cattolica del Sacro Cuore, Rome, ItalyObjectiveTo evaluate the potential role of Streptococcus salivarius K12 (SSK12) in controlling febrile flares in patients with Periodic Fever, Aphthous stomatitis, Pharyngitis, and cervical Adenitis (PFAPA) syndrome. Further aims were to assess the impact of SSK12 on (i) flare duration, (ii) variation in the degree of the highest body temperature during flares, (iii) steroid-sparing effect, and (iv) change of PFAPA accompanying symptoms before and after SSK12 introduction.Patients and methodsThe medical charts from 85 pediatric patients with PFAPA syndrome (49 males and 36 females) enrolled in the AIDA registry and treated with SSK12 for a median period of 6.00 ± 7.00 months in the period between September 2017 and May 2022 were examined. Children recruited had a median time of disease duration of 19.00 ± 28.00 months.ResultsThe number of febrile flares significantly decreased comparing the 12 months before [median (IQR), 13.00 (6.00)] and after SSK12 initiation [median (IQR), 5.50 (8.00), p < 0.001]. The duration of fever was significantly reduced from 4.00 (2.00) days to 2.00 (2.00) days [p < 0.001]. Similarly, the highest temperature in°C was found significantly lower in the last follow-up assessment [median (IQR), 39.00 (1.00)] compared to the period prior to SSK12 start [median (IQR), 40.00 (1.00), p < 0.001]. Steroid load (mg/year) of betamethasone (or any equivalent steroid) significantly decreased between 12 months before treatment with SSK12 [median (IQR), 5.00 (8.00) mg/year] and the last follow-up visit [median (IQR), 2.00 (4.00) mg/year, p < 0.001]. The number of patients experiencing symptoms including pharyngitis/tonsillitis (p < 0.001), oral aphthae (p < 0.001) and cervical lymphadenopathy (p < 0.001) significantly decreased following SSK12.ConclusionSSK12 prophylaxis given for at least 6.00 months was found to reduce febrile flares of PFAPA syndrome: in particular, it halved the total number per year of fever flares, shortened the duration of the single febrile episode, lowered body temperature by 1°C in the febrile flare, provided a steroid-sparing effect, and significantly reduced the accompanying symptoms related to the syndrome.https://www.frontiersin.org/articles/10.3389/fmed.2023.1105605/fullPFAPA syndromeautoinflammatory diseaseInternational RegistryStreptococcus salivarius K12probiotictonsillitis |
| spellingShingle | Francesco La Torre Jurgen Sota Antonella Insalaco Giovanni Conti Emanuela Del Giudice Riccardo Lubrano Luciana Breda Maria Cristina Maggio Adele Civino Violetta Mastrorilli Roberta Loconte Marco Francesco Natale Camilla Celani Mery Romeo Serena Patroniti Cristina Gentile Antonio Vitale Valeria Caggiano Carla Gaggiano Federico Diomeda Marco Cattalini Giuseppe Lopalco Giacomo Emmi Giacomo Emmi Paola Parronchi Stefano Gentileschi Fabio Cardinale Emma Aragona Farhad Shahram Achille Marino Patrizia Barone Carla Moscheo Burcugul Ozkiziltas Francesco Carubbi Ohoud Alahmed Ludovica Iezzi Benson Ogunjimi Benson Ogunjimi Angela Mauro Maria Tarsia Ayman Abdel-Monem Ahmed Mahmoud Henrique Ayres Mayrink Giardini Petros P. Sfikakis Katerina Laskari Ewa Więsik-Szewczyk José Hernández-Rodríguez Bruno Frediani Verónica Gómez-Caverzaschi Abdurrahman Tufan Ibrahim A. Almaghlouth Ibrahim A. Almaghlouth Alberto Balistreri Gaafar Ragab Gaafar Ragab Claudia Fabiani Luca Cantarini Donato Rigante Donato Rigante Preliminary data revealing efficacy of Streptococcus salivarius K12 (SSK12) in Periodic Fever, Aphthous stomatitis, Pharyngitis, and cervical Adenitis (PFAPA) syndrome: A multicenter study from the AIDA Network PFAPA syndrome registry Frontiers in Medicine PFAPA syndrome autoinflammatory disease International Registry Streptococcus salivarius K12 probiotic tonsillitis |
| title | Preliminary data revealing efficacy of Streptococcus salivarius K12 (SSK12) in Periodic Fever, Aphthous stomatitis, Pharyngitis, and cervical Adenitis (PFAPA) syndrome: A multicenter study from the AIDA Network PFAPA syndrome registry |
| title_full | Preliminary data revealing efficacy of Streptococcus salivarius K12 (SSK12) in Periodic Fever, Aphthous stomatitis, Pharyngitis, and cervical Adenitis (PFAPA) syndrome: A multicenter study from the AIDA Network PFAPA syndrome registry |
| title_fullStr | Preliminary data revealing efficacy of Streptococcus salivarius K12 (SSK12) in Periodic Fever, Aphthous stomatitis, Pharyngitis, and cervical Adenitis (PFAPA) syndrome: A multicenter study from the AIDA Network PFAPA syndrome registry |
| title_full_unstemmed | Preliminary data revealing efficacy of Streptococcus salivarius K12 (SSK12) in Periodic Fever, Aphthous stomatitis, Pharyngitis, and cervical Adenitis (PFAPA) syndrome: A multicenter study from the AIDA Network PFAPA syndrome registry |
| title_short | Preliminary data revealing efficacy of Streptococcus salivarius K12 (SSK12) in Periodic Fever, Aphthous stomatitis, Pharyngitis, and cervical Adenitis (PFAPA) syndrome: A multicenter study from the AIDA Network PFAPA syndrome registry |
| title_sort | preliminary data revealing efficacy of streptococcus salivarius k12 ssk12 in periodic fever aphthous stomatitis pharyngitis and cervical adenitis pfapa syndrome a multicenter study from the aida network pfapa syndrome registry |
| topic | PFAPA syndrome autoinflammatory disease International Registry Streptococcus salivarius K12 probiotic tonsillitis |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2023.1105605/full |
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preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT bensonogunjimi preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT angelamauro preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT mariatarsia preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT aymanabdelmonemahmedmahmoud preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT henriqueayresmayrinkgiardini preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT petrospsfikakis preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT katerinalaskari preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT ewawiesikszewczyk preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT josehernandezrodriguez preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT brunofrediani preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT veronicagomezcaverzaschi preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT abdurrahmantufan preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT ibrahimaalmaghlouth preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT ibrahimaalmaghlouth preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT albertobalistreri preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT gaafarragab preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT gaafarragab preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT claudiafabiani preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT lucacantarini preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT donatorigante preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry AT donatorigante preliminarydatarevealingefficacyofstreptococcussalivariusk12ssk12inperiodicfeveraphthousstomatitispharyngitisandcervicaladenitispfapasyndromeamulticenterstudyfromtheaidanetworkpfapasyndromeregistry |