Digital health in the management of allergic diseases

In recent years there has been an important implementation in the medical field of both Mobile Health, such as the use of mobile communication devices, and of other telemedicine tools in general, with the aim of supporting the supervision of diseases from the moment of the first diagnosis to the therapeutic follow-up. In fact, Digital Health can also have a very positive impact on the management of allergic patients, who are known to have the greatest need for regular monitoring, simplifying contact between doctor and patient, but there is still a need to improve implementation regulations, define certification programs and adequate reimbursement systems, as well as to guarantee a high level of attention to the protection of sensitive data. The hope is that one positive outcome of the Covid-19 pandemic will be an acceleration, by all stake-holders involved, of the process of the modernization of health care. (www.actabiomedica.it)

Consensus statement of the Italian society of pediatric allergy and immunology for the pragmatic management of children and adolescents with allergic or immunological diseases during the COVID-19 pandemic

The COVID-19 pandemic has surprised the entire population. The world has had to face an unprecedented pandemic. Only, Spanish flu had similar disastrous consequences. As a result, drastic measures (lockdown) have been adopted worldwide. Healthcare service has been overwhelmed by the extraordinary influx of patients, often requiring high intensity of care. Mortality has been associated with severe comorbidities, including chronic diseases. Patients with frailty were, therefore, the victim of the SARS-COV-2 infection. Allergy and asthma are the most prevalent chronic disorders in children and adolescents, so they need careful attention and, if necessary, an adaptation of their regular treatment plans. Fortunately, at present, young people are less suffering from COVID-19, both as incidence and severity. However, any age, including infancy, could be affected by the pandemic. Based on this background, the Italian Society of Pediatric Allergy and Immunology has felt it necessary to provide a Consensus Statement. This expert panel consensus document offers a rationale to help guide decision-making in the management of children and adolescents with allergic or immunologic diseases

Intakes of nutrients in Italian children with celiac disease and the role of commercially available gluten-free products

BACKGROUND: Celiac disease (CD) is a chronic gluten-sensitive enteropathy. Life-long gluten-free diet (GFD) is the only therapeutic option; however, it may contribute to the consumption of an unbalanced diet. The present study aimed to evaluate the dietary intake of CD affected children on a GFD and compare it with non-celiac children and with Italian nutritional intakes recommendations, as well as evaluate the contribution of commercially available gluten-free products (GFPs). METHODS: Eighteen celiac children, median age 7.6 years, median GFD duration 4.2 years, and 18 non-celiac controls, were enrolled in a cross-sectional age-matched study. Dietary intakes of both groups were collected using a food frequency questionnaire and a 24-hour dietary recall. Nutritional intakes were compared between the group and controls and with Italian dietary reference values. The contribution of GFPs to energy and macronutrient intakes was evaluated. RESULTS: Median energy intake was significantly higher in CD patients than in controls (8961.8 and 5761.0 kJ day(-1) ; P < 0.001). CD subjects showed higher carbohydrate intakes and lower fat intakes compared to controls. Protein-derived energy did not differ. By contrast to control subjects, energy derived from carbohydrate intakes in CD children met the Italian recommendations. Both children groups showed higher protein and fat intakes than recommended in Italy. GFPs consumption accounted for 36.3% of daily total energy intake. CONCLUSIONS: Intakes of simple sugars, fats and protein exceeded the National recommendations for health. Children with CD had significantly higher energy intakes than controls, although body mass index was comparable across the groups. Lack of nutritional information for GFPs prevented complete dietary analysis of subfractions of fat and micronutrient intakes. This aspect need to be addressed if studies in this field are to be meaningful in the future

Changes of body mass index in celiac children on a gluten-free diet

BACKGROUND AND AIM: Studies of adults and children with celiac disease (CD) performed mostly in tertiary care centers have reported an increased risk of overweight during gluten-free diet (GFD). We measured body mass index (BMI) of CD children followed by family pediatricians in order to estimate prevalence of underweight and overweight at diagnosis and to describe BMI changes during GFD. METHODS AND RESULTS: We compared 150 CD children (age range 2-16 yrs) under GFD from a median (IQR) time of 4.4 (4.2) years with 288 healthy children matched for gender and age. We also evaluated retrospectively BMI changes between CD diagnosis and the current evaluation. The median (IQR) BMI of CD patients was significantly lower than that of controls [-0.38 (1.46) vs. 0.09 (1.18) SDS, p < 0.0001, Italian reference data]. Using the International Obesity Task Force classifications, CD children were less frequently overweight or obese (12% vs. 23.3%, p = 0.014) and more frequently underweight (16% vs. 4.5%, p < 0.001) than controls. During GFD, there was a marked decrease of number of underweight subjects (13 vs. 27) and a minimal increase of number of overweight subjects (9 vs. 6) (p < 0.001). CONCLUSIONS: The frequency of overweight and obesity at diagnosis of CD and during GFD in children followed by family pediatricians is substantially lower than that reported in tertiary care centers. On the other hand, the high frequency of underweight at diagnosis confirms the need of careful personalized nutritional management

Blood pressure behaviour and control in Turner syndrome.

Adult Turner syndrome (TS) patients frequently present hypertension. To clarify the pathogenesis of this hypertension we examined the blood pressure (BP) behaviour and the renin-angiotensin-aldosterone system in 31 TS patients (2-22 years of age). BP levels were occasionally elevated in 47% of the subjects and constantly elevated in 23%. Most of the patients were on estrogen replacement therapy, but 26% of them presented with elevated levels since childhood. Supine and upright plasma renin activity (PRA) values were higher in TS compared to controls and more elevated in hypertensive TS than in the normotensive ones. At Captopril challenge TS showed different PRA responses regardless of the karyotype and clinical features. Patients on estrogen therapy, however, exhibited higher increments of PRA after Captopril. Conclusions: TS patients show high frequency of hypertension in pediatric age. Estrogen therapy is an outbreaking and worsening factor. An estrogen independent role of the renin-angiotensin-aldosterone system in the pathogenesis of TS hypertension is still uncertain