Therapeutic Effects of Vitamin D in Asthma and Allergy

In recent years, low vitamin D status has been proposed as a putative risk factor for allergic diseases. A growing body of literature reports low vitamin D levels in atopic patients and supports an association between vitamin D deficiency and risk of adverse asthma and allergies outcomes. Therefore, it has been speculated that vitamin D supplementation may either prevent or reduce the risk of allergic diseases. Birth cohort studies addressing the role of vitamin D intake during pregnancy have shown conflicting results regarding allergy outcomes in offspring. Currently, only a few studies have tried to supplement vitamin D in asthmatic patients, often as an add-on therapy to standard asthma controller medications, and results are not all consistent. There is emerging data to show that vitamin D can enhance the antiinflammatory effects of glucocorticoids and potentially be used as adjuvant therapy in steroid-resistant asthma. Recent in vivo data suggest that vitamin D supplementation may also reduce the severity of atopic dermatitis. This review examines the existing relevant literature focusing on vitamin D supplementation in the treatment of allergic diseases

Utility of Specific IgE to Ara h 2 in Italian Allergic and Tolerant Children Sensitized to Peanut

Emerging data suggest that measurement of serum IgE to peanut components can be clinically helpful and more accurate than IgE to whole peanut to predict peanut allergy. Not all studies have used prospective samples, multiple components and oral challenges. Currently, there are no data on this topic involving Italian children. 32 patients (23 males; median age 9 years) with reported history for peanut allergy and evidence of peanut sensitization (skin prick test to peanut extract ≥ 3mm) have been analyzed for serum IgE to whole peanut and recombinant allergen components Ara h 1, 2, 3, 8, and 9 with Immuno CAP and completed an open oral food challenge with peanut. 12 (37.5%) children had a positive challenge to peanut and were considered allergic. No differences were seen between the median values of IgE to peanut, Ara h 1, 3, 8 and 9 in allergic and tolerant children to peanut challenge. Noteworthy, 5 of 20 tolerant children had IgE to peanut> 15 kUA/l which is commonly considered a predictive value of peanut allergy. Conversely, a significant difference was seen when comparing the median value of IgE to Ara h 2 in the two groups: 0.75 kUA/l (IQR: 0.22-4.34 kUA/l) in allergic children versus 0.1 kUA/l (IQR: 0.1-0.12 kUA/l) in tolerant ones (P< 0.001). IgE levels to Ara h 2 are significantly higher in children that react to oral peanut challenge. Our findings in Italian children have been in line with recent reports in various populations of Northern Europe, the US and Australia and add confirmatory evidence that analysis of IgE to Ara h 2 could reduce the need for peanut challenge in suspected allergic patients

Bioavailable Vitamin D in Obese Children: The Role of Insulin Resistance.

Context: Studies examining vitamin D levels in association with childhood obesity usually do not consider the effect of insulin on vitamin D–binding protein and do not calculate the unbound, bioavailable vitamin D. Objective: This study aimed to evaluate in a group of children 1) the concentrations of both total 25-hydroxyvitamin D and bioavailable fraction, and 2) the potential role of insulin resistance in modulating the concentrations of bioavailable vitamin D. Design, Setting, and Patients or Other Participants: This was a cross-sectional study at a University Pediatric Department in which 63 obese children and 21 lean controls were enrolled. Main Outcome Measures: Total 25-hydroxyvitamin D and vitamin D–binding protein were measured, twosingle-nucleotide polymorphisms in the coding region of the vitaminD–binding protein (rs4588 and rs7041) were studied, and the vitamin D bioavailable fraction was calculated. Results: Obese children showed total 25-hydroxyvitamin D levels lower compared with nonobese children (21.36.7 ng/mL vs 29.611.7 ng/mL; P.0004). Bioavailable 25-hydroxyvitaminDlevels were not different among the two groups (3.1 1.6 ng/mL vs 2.6 1.2 ng/mL; P .05). Insulinresistant children showed higher bioavailable levels of 25-hydroxyvitamin D compared with noninsulin- resistant children (3.4 1.4 ng/mL vs 2.0 0.9 ng/mL; P .013) and an inverse correlation between insulin resistance and vitamin D–binding protein was found (r: 0.40; P .024). Conclusions: Obese children present levels of bioavailable 25-hydroxyvitamin D similar to those of normal-weight children due to reduced concentration of vitamin D–binding protein. The insulin resistance could play a role in this reduced concentrat

Characterization and Comparison of Ocular Surface Microbiome in Newborns

The ocular microbiome is of fundamental importance for immune eye homeostasis, and its alteration would lead to an impairment of ocular functionality. Little evidence is reported on the composition of the ocular microbiota of term infants and on the impact of antibiotic prophylaxis. Methods: A total of 20 conjunctival swabs were collected from newborns at birth and after antibiotic treatment. Samples were subjected to 16S rRNA sequencing via system MiSeq Illumina. The data were processed with the MicrobAT software and statistical analysis were performed using two-way ANOVA. Results: Antibiotic prophylaxis with gentamicin altered the composition of the microbiota. In detail, a 1.5- and 2.01-fold reduction was recorded for Cutibacterium acnes (C. acnes) and Massilia timonae (M. timonae), respectively, whereas an increase in Staphylococcus spp. of 6.5 times occurred after antibiotic exposure. Conclusions: Antibiotic prophylaxis altered the ocular microbiota whose understanding could avoid adverse effects on eye health

Impatto del microbioma (polmonare e intestinale) sull’asma

L’asma è una delle patologie croniche più diffuse e rappresenta la malattia respiratoria cronica più frequente nell’età pediatrica. Sono sempre più numerosi gli studi volti a individuare delle strategie preventive per ridurne l’incidenza: negli ultimi decenni è stato dimostrato che esiste una “finestra” temporale che si apre già durante la vita intrauterina e nella quale vari fattori ambientali possono interagire con il substrato genetico per favorire l’insorgenza dell’asma e, più in generale, delle malattie allergiche. Negli ultimi anni è stato ampiamente studiato il ruolo del microbioma intestinale dimostrandone la capacità di modulare la risposta immunitaria. Una disbiosi intestinale in epoca precoce, con sbilanciamento della composizione del microbioma a favore di Escherichia coli e Clostridium difficile e a discapito dei Bifidobacteria, può predisporre allo sviluppo delle allergopatie. Più recentemente è stato dimostrato che esiste un microbioma anche a livello delle vie aeree inferiori, la cui composizione può essere influenzata dalle infezioni virali e che, nei soggetti asmatici, è caratterizzata dalla prevalenza del phylum Proteobacteria. Non è stato ancora dimostrato se sia possibile ridurre l’insorgenza dell’asma agendo sul microbioma, mentre è necessario tenere a mente la necessità di ridurre l’impiego degli antibiotici per limitare le interferenze sul microbioma, soprattutto nei neonati e nei lattanti

Il link asma-obesità: aspetti patogenetici, clinico-funzionali e diagnostico-terapeutici

L’asma e l’obesità sono considerate un problema primario di salute pubblica dell’età infantile, che sta assumendo proporzioni globalmente “epidemiche”. Diversi studi epidemiologici hanno chiaramente evidenziato la presenza di un’associazione tra le due patologie. Tale complessa interazione patogenetica vede coinvolti fattori genetici, di sviluppo, di funzione polmonare, immunologici e comportamentali; alcuni di essi sono ad oggi ancora poco studiati e conosciuti. Per tale motivo, non è possibile identificare un meccanismo prevalente sugli altri che sia alla base della relazione causale tra le due patologie. Il crescente interesse scientifico nei confronti dell’associazione tra asma e obesità ha contribuito a delineare diversi fenotipi di patologia presenti nelle varie epoche della vita. La caratterizzazione clinica dei soggetti asmatici obesi è presupposto fondamentale per identificare terapie mirate a raggiungere il controllo dell’asma e contemporaneamente a ridurre il peso del soggetto prevenendo le complicanze legate all’obesità

I farmaci biologici nell’asma del bambino

I farmaci biologici hanno recentemente rivoluzionato l’approccio terapeutico al paziente con asma grave. Attraverso l’inibizione di precisi target molecolari implicati nella patogenesi della malattia asmatica, questi farmaci trovano un’innovativa applicazione nell’ambito della medicina moderna che, sempre più spesso, si indirizza verso un trattamento personalizzato sulla base delle specifiche caratteristiche infiammatorie (endotipi con relativi biomarcatori) che la patologia presenta nel singolo paziente. Tra i farmaci biologici disponibili per l’età pediatrica, ad oggi omalizumab è il farmaco di scelta per la terapia aggiuntiva dell’asma grave, con significative evidenze di efficacia e sicurezza e con maggiore esperienza clinica in “real life”. Le nuove molecole, come mepolizumab, reslizumab e dupilumab, sono attualmente in fase di sperimentazione clinica per l’età pediatrica, sulla base dei risultati positivi ottenuti negli studi sulla popolazione adulta

Comorbidità nell’asma grave pediatrico

Asthma comorbidities frequently cause adverse outcomes, such as poor asthma control, frequent asthma attacks, reduced quality of life, and higher healthcare costs. Comorbidities are well-known treatable traits whose proper management can help achieve optimal asthma control. Although multimorbidity is frequent among asthmatics, comorbidities are still a potential cause of misdiagnosis and under or overtreatments, and little is known about their impact on severe pediatric asthma. Over the years, growing scientific evidence has pointed to the existence of a clear epidemiological correlation between asthma and its comorbidities and of possible common pathogenetic mechanisms responsible for a mutual bi-directional influence between the diseases, with sometimes the possibility of describing distinct asthma phenotypes. In this light, the appropriate management of asthma comorbidities could be crucial to propose personalized or adjunctive therapies of apparent efficacy in patients with severe asthma