Not All Children with Under-Control Asthma are Controlled

Subclinical lung function alterations can sometimes be discovered in asthmatic patients under clinical control. This study aimed to identify the burden of asthmatic children with subclinical airways abnormalities who may benefit from an adjustment in asthma therapy. 134 6-to-17-year-old asthmatic children were enrolled. Of them, 98 presented apparently under clinical control disease and all performed spirometry before and after bronchodilation: 17 (17.3%) had a positive bronchodilation test, in addition to significantly lower lung function indexes as compared to those with under-control asthma who had a negative bronchodilation test. These patients were randomized and re-evaluated: patients (n=8) receiving an adjustment in their therapy showed an improvement in lung function tests and quality of life indexes as compared to 7 without therapy adjustment. In conclusion, a substantial number of apparently-under-control asthmatic children show airways alterations that can be improved by adjusting their therapy, which also seems to enhance their quality of life

Citrus allergy from pollen to clinical symptoms

Allergy to citrus fruits is often associated with pollinosis and sensitization to other plants due to a phenomenon of cross-reactivity. The aims of the present study were to highlight the cross-reactivity among citrus and the major allergenic pollens/fruits, throughout clinical and molecular investigations, and to evaluate the sensitization frequency to citrus fruits in a population of children and adults with pollinosis. We found a relevant percentage of sensitisation (39%) to citrus fruits in the patients recruited and in all of them the IgE-mediated mechanism has been confirmed by the positive response to the prick-to-prick test. RT-PCR experiments showed the expression of Cit s 1, Cit s 3 and a profilin isoform, already described in apple, also in Citrus clementine pollen. Data of multiple sequence alignments demonstrated that Citrus allergens shared high percentage identity values with other clinically relevant species (i.e. Triticum aestivum, Malus domestica), confirming the possible cross-allergenicity citrus/grasses and citrus/apple. Finally, a novelty of the present work has been the expression of two phospholipaseA2 isoforms (PLA2 \u3b1 and \u3b2) in Citrus as well as in Triticum pollens; being PLA2 able to generate pro-inflammatory factors, this enzyme could participate in the activation of the allergenic inflammatory cascade

Topical corticosteroid phobia in parents of pediatric patients with atopic dermatitis: a multicentre survey

BACKGROUND: Families of children affected with atopic dermatitis (AD) often report fear and anxiety regarding treatment with topical corticosteroids (TCS), which may lead to reduced compliance. The objective of our study was to measure, through a standardized questionnaire, fear of TCS in families of pediatric patients with AD and to identify items associated with fear. METHODS: Families of pediatric patients with AD were enrolled in 9 Italian centers of pediatric dermatology. Enrolled parents were invited to fill in a questionnaire including questions on sociodemographic and clinical characteristics and 3 sets of questions on corticosteroid phobia (general fear, specific fears, behaviours regarding TCS). Determinants of the level of general fear were investigated through multivariable analysis. RESULTS: A total of 300 outpatients with AD were enrolled. Most parents (80%) had a high instruction level. Eighty-one percent reported to have a certain amount of fear of TCS. At the multivariable analysis, fear of TCS was associated with the following items: believing that TCS treatment advantages do not overweight disadvantages (P = 0.011); believing that TCS may be dangerous independently from the specific side effect (P < 0.001). Moreover, TCS fear was associated with fear of applying too much cream (P = 0.001). CONCLUSION: TCS phobia is widespread among Italian families of children with AD. Fear of TCS is associated with fear of applying too much cream, thus increasing the risk of poor compliance and treatment failure. Therapeutic education of families on the use of TCS should be implemented. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13052-017-0330-7) contains supplementary material, which is available to authorized users

La qualit\ue0 di vita del bambino con rinite allergica.

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ITS NELLE ALLERGIE RESPIRATORIE

Immunoterapia specifica in et\ue0 pediatrica: indicazione al trattamento

Evaluation of IgE Sensitization Profiles in a Pediatric Population with Wheat Allergy.

Introduction: IgE-mediated reactions to wheat can occur after ingestion, inhalation, contact or exercise. Among wheat allergens, Tri a14 and Tri a19 not only cause food allergy, but also baker's asthma (Tri a4) and exercise-induced anaphylaxis (Tri a19). Despite the prevalence of adverse reactions, few studies have been conducted in children. Aim: To evaluate the pattern of sensitization to wheat allergenic components in a group of pediatric patients with sIgE to wheat referring to the Pediatric Allergy Unit of University of Bologna. Materials and Methods: Patients were assessed by skin prick-test and serum specific IgE against pollens, wheat, gluten and the molecular allergens rTri a19 and rTri a14. The diagnosis was confirmed with open food challenges. Results: The diagnosis of wheat allergy was confirmed in 7 patients (64%), of whom 2 (29%) suffered also from grass pollen allergy. The levels of specific IgE (geometric mean) to wheat and gluten were 5 times higher in allergic patients compared to tolerant ones. The comparison between the patterns of sensitization showed a higher prevalence of sensitization against gluten (100% vs. 75% in tolerant patients) and the molecular components rTri a14 (71% vs. 25%) and rTri a19 (71% vs. 0%) in the wheat-allergic group. Positive predictive value for rTria a19 was higher than rTri a14 (100% vs. 83%). Conclusion: Patients with wheat allergy have different profiles of sensitization than the tolerant ones; in particular rTri a19 showed a higher positive predictive value than rTri a14. These findings need to be confirmed in a larger population

Recent advances in diagnosis and therapy of allergic rhinitis and asthma in childhood.

Some of the most recent advances in the diagnosis and treatment of childhood asthma and allergies are here reviewed. New perspectives have been opened by in vitro diagnostic tests for allergies based on a molecular approach and novel approaches to in vivo tests (SPT or FE(NO)). A better characterization of the patients is opening new classifications of allergic asthma and rhinitis phenotypes, which allow personalizing management disease programs and targeting pharmacotherapy. Educational programs and better communication are improving awareness and compliance with medical prescriptions and adherence to guidelines. Increasing information is being acquired on the mechanisms, efficacy and safety profiles of anti-asthma and anti-allergic drugs, including antihistamines, inhaled corticosteroids, long acting beta agonists, antibiotics, anti-IgE antibodies. Progress in biotechnologies is fostering new approaches to allergen-specific immunotherapy (subcutaneous, sublingual) concerning the quality, mechanisms, efficacy and safety of allergen products

Immune Alterations in IgE and Non IgE-Associated Atopic Dermatitis.

Atopic dermatitis is a complex disease in which a strong interaction between alterations of skin barrier and the adaptive immune system coexist. In the recent years, new findings have underlined the importance of skin proteins, especially filaggrin, which participate to the outmost layers of the skin. To strengthen this physical barrier, many factors are available, such as antimicrobial peptides, chemokines and cytokines produced by keratinocytes. Skin disruption can easily allow the allergen penetration and the local keratinocytes can promote the adaptive immune response toward a Th2 phenotype. On the other side, allergic Th2 cytokines may downregulate the production of skin barrier proteins, facilitating the penetration of allergens. Moreover, data on murine models show the absolute relevance of the systemic immune system to develop clinical skin reaction. Since the clinical aspect of patients with AD does not show different patterns whatever is the prevalent underlying mechanism, in clinical practice it is difficult to translate the different endotypes beside the IgE and non IgE associated forms. The aim of this review is to point out to the most recent knowledge in this field, which makes AD more difficult to frame in a unique clinical entity