Early introduction oral immunotherapy for IgE-mediated cow's milk allergy: A follow-up study confirms this approach as safe and appealing to parents

Introduction: Early introduction oral immunotherapy (E-OIT) in the first year of life can be a safe treatment for infants with cow's milk allergy (CMA). Once the protocol is completed, doubts remain whether children achieve tolerance or remain desensitized. According to current guidelines, this is determined by an avoidance period followed by a re-exposure to the food allergen during an in-hospital oral food challenge (OFC). In real life, this approach can be complicated, time-consuming, and anxiety-provoking for parents. We assessed the long-term safety of E-OIT for CMA in a cohort of children who switched to an unrestricted diet without testing the achievement of tolerance at the end of the OIT protocol. Materials and Methods: We performed a descriptive analysis of the clinical follow-up of a cohort of children diagnosed with IgE-mediated CMA and undergoing E-OIT protocol in their first year of life. In a previous publication, the same cohort of patients had been studied to assess the feasibility of E-OIT for CMA. In the present study, we reported the results of a telephone survey, carried out through a questionnaire to their families enquiring about milk consumption and other ongoing atopic conditions of children. Results: After an average of 4 years from the start of E-OIT, 62/73 patients (85% of the historical cohort) participated in the survey. Among them, all 56 patients who had previously successfully completed the protocol reported an unrestricted cow's milk intake. Ninety–three percent of these children did not experience any further allergic reactions, while the remaining 7% described only mild and transitory reactions until the 6-month period after the end of the protocol. Conclusions: This study confirmed the long-term safety of E-OIT for CMA and challenged the paradigm of the need for allergen food withdrawal to discern between desensitization and tolerance. It could be a starting point for planning future trials on this issue

Paediatricians' attitudes toward pain in children with severe cognitive impairment. A regional survey.

Introduction: pain is a frequent and relevant problem in children with severe cognitive impairments. Assessing pain in these patients can be difficult. Specific observational tools such as the Collignon Giusiano Questionnaire or the Non-communicating Children's Pain Checklist ( NCCPC) are available, but their use is not widespread. Children with severe cognitive impairment are frequently in need of painful procedures but data about availability of procedural sedation in this setting are limited. Objective of the study: to evaluate paediatricians' attitudes toward pain in children with severe cognitive impairment by measuring the use of specific pain scales and the use of analgesia or procedural sedation in course of a frequent procedure such as botulinum toxin injection. Methods: phone interview with the doctor on duty of 56 paediatric wards in 3 regions of the North East of Italy, addressing the routine use of pain scales, and the use of specific observational tools for non communicating children. A phone interview was also conducted in 4 centers routinely practicing botulinum toxin injection about the use of analgesia or procedural sedation. Results: 1 centre out of 55 reported to use specific scales for children with cognitive impairment, specifically the Collignon Giusiano Questionnaire. No centre used procedural sedation for botulinum toxin injection. Conclusion: in the investigated area there is a lack of attention to pain in children with severe cognitive impairment. Specific educational efforts should be done to improve the quality of care in this setting

Videogame playing as distraction technique in course of venipuncture.

Background: needle-related procedures (venipuncture, intravenous cannulation) are the most common source of pain and distress for children. reducing needle related pain and anxiety could be important in order to prevent further distress, especially for children needing multiple hospital admissions. the aim of the present open randomized controlled trial was to investigate the efficacy of adding an active distraction strategy (videogame) to eMlA premedication in needle-related pain in children. Methods: one-hundred and nine children (4 -10 years of age) were prospectively recruited to enter in the study. ninety-seven were randomized in two groups: CC group (conventional care: eMlA only) as control group and Ad group (active distraction: eMlA plus videogame) as intervention group. outcome measures were: selfreported pain by mean of FPS-r scale (main study outcome), observer-reported pain by FlACC scale, number of attempts for successful procedure. Results: in both groups FPS-r median rate was 0 (interquartile range: 0-2), with significant pain (FPS-r>4) reported by 9% of subjects. FlACC median rate was 1 in both groups (interquartile range 0-3 in CC group; 0-2 in Ad group). the percentage of children with major pain (FlACC>4) was 18% in CC group and 9% in Ad group (p=0.2). the median of necessary attempts to succeed in the procedures was 1 (interquartile range 1-2) in both groups.. Conclusion: Active distraction doesn't improve eMlA analgesia for iv cannulation and venipuncture. even though, it resulted in an easily applicable strategy appreciated by children. this technique could be usefully investigated in other painful procedures

Clinical features of post-COVID-19 period. Results of the international register “Dynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARS-CoV-2)”. Data from 6-month follow-up

Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period

Procedural sedation 2010: The drugs

The demand of diagnostic and therapeutic procedures performed on children outside of the operating room and the intensive care unit has substantially increased in recent years; the availability of non-invasive monitoring, short-acting opioids and sedatives has broadened the possibilities of sedation and analgesia practiced by non anesthesiologists in different settings. Adequate knowledge about drugs and their related problems are unquestionably requested to warrant procedures' efficacy and safety. This paper describes the drugs that non anesthesiologists have to use during procedural sedation, giving information about their basic characteristics and adverse outcomes

Early combined immunosuppression in Crohn's disease.

N.A

Poor asthma control remains a risk factor for severe anaphylaxis

not availabl

Could slightly cooked egg be a suitable medium for oral immunotherapy in persistent hen's egg allergy?

N/

Procedural sedation 2010

The demand of diagnostic and therapeutic procedures performed on children outside of the operating room and the intensive care unit has increased substantially in recent years. At the same time the management of acute pain and emotional distress related to such procedures has become a primary goal for paediatricians. The availability of non-invasive monitoring, short-acting opioids and sedatives has broadened in different settings the possibilities of sedation and analgesia practiced by non anaesthesiologists. An appropriate management of sedation is important in order to avoid adding further risks to normal procedures. A standard approach is mandatory to provide safety and efficiency. This paper reviews the different aspects of sedation and analgesia performed by paediatricians for invasive and non-invasive procedures, as patients' selection and assessment, specific personnel training, monitoring tools and the prevention of potential complications

L'accesso asmatico acuto

An accurate evaluation of the severity of an asthma attack is a critical issue for the choice of a correct therapy. A good clinical evaluation is facilitated by a correct understanding of the clinical signs, supported by some pathophysiological knowledge and by the correct use of the measurement of Peak Expiratory Flow, pulse oximetry and haemogas-analysis. Based on an extensive literature review and their own experience the Authors provide an overview of pathophysiology, clinical tips and diagnostic tools of acute asthma. Other issues such as treatment with oxygen, hydratation, administration of bicarbonate, indications to intubation are reviewed