Nut Allergy: Clinical and Allergological Features in Italian Children

Background: Nut allergies are an increasingly frequent health issue in the pediatric population. Tree nuts (TN) and peanuts are the second cause of food anaphylaxis in Italy. Unfortunately, knowledge of the clinical characteristics of a TN allergy in Italian children is limited. Our study aimed to identify the clinical and allergological characteristics of Italian children with a nut allergy (TN and peanut). Methods: A retrospective observational analysis was performed on the clinical charts of children with a history of nut reaction referred to the allergy unit of the hospital from 2015 to 2019. The studied population was represented by children with a confirmed nut allergy based on positive prick by prick and/or serum-specific IgE to nut plus a positive nut oral food challenge. Demographic, clinical, and allergological features were studied and compared among different nuts. Results: In total, 318 clinical charts were reviewed. Nut allergy was confirmed in 113 patients. Most patients (85/113, 75%) had a familial history of allergy and/or a concomitant allergic disorder (77/113, 68%). Hazelnut and walnut were the more common culprit nuts observed in allergic children. Anaphylaxis was the first clinical manifestation of nut allergy in a high percentage of children (54/113, 48%). The mean age of the first nut reaction was statistically higher with pine nuts. Over 75% of children reported a single nut reaction. During the OFCs, the signs and symptoms involved mainly the gastrointestinal system (82/113, 73%) and resolved spontaneously in most cases. Severe reactions were not frequent (22/113, 19%). Conclusion: To our knowledge, this is the first Italian study that provided a comprehensive characterization of children with a nut allergy. These results are important for clinicians treating children with a nut allergy

When the liver wanders.....

A 3-year-old girl was admitted to the Emergency Department for the onset of severe abdominal pain a week after acute gastroenteritis. Abdominal X-ray and ultrasound showed a left-sided liver without signs of invagination or obstruction. A new abdominal ultrasound, repeated after 24 h due to the persistence of the abdominal pain, identified the liver on the right side. Abdominal CT showed that the liver was on the right side when the patient was supine and, on the left side when she was in left lateral decubitus. The condition was diagnosed as ‘Wandering Liver’ (WL).Abdominal pains spontaneously regressed within 48 h. On physical examination joint hyperlaxity and ogival palate were observed. Considering the spontaneous regression of symptoms, a “wait and see” approach was decided. After one year follow-up, the child is in good clinical condition and completely asymptomatic. WL is a rare condition characterized by excessive mobility of the liver due to the lack of normal hepatic fixation. Clinical presentation is variable from incidental finding to recurrent abdominal pain which may be severe suggesting a colonic obstruction. WL may be associated with a redundant colon that can be interposed between liver and diaphragm leading to bowel obstruction. Serial abdominal xrays and ultrasounds show the different position of the liver that may be confirmed by dynamic computed tomography and MRI. While a “wait and see” approach with a close follow-up is suggested for asymptomatic patients, surgery is necessary in case of bowel obstruction

Wandering Liver, Wondering Doctors!

Wandering liver, also known as floating liver, or hepatoptosis or hepatocolonic vacancy, is characterized by excessive mobility of the liver because of abnormal hepatic fixation. In some cases it may manifest with a picture of intestinal obstruction and require surgical treatment (hepatopexy)

Indagine sulla formazione in pneumologia pediatrica nelle scuole di specializzazione in pediatria

Riassunto Background Sebbene le malattie respiratorie rappresentino uno dei principali motivi di visita pediatrica, nel nostro paese la formazione in quest’ ambito è attuata in maniera disomogenea. Scopo dell’indagine è stato descrivere lo stato dell’arte della formazione in pneumologia pediatrica nelle scuole di specializzazione in pediatria. Materiali e Metodi: Abbiamo realizzato una survey composta di 25 item e l’abbiamo resa accessibile online per 2 mesi, comunicandone le modalità di accesso a tutti gli specializzandi in pediatria mediante mailing list e newsletter di SIMRI, ONSP (Osservatorio Nazionale Specializzandi Pediatria) e Forum Junior Members SIMRI. Risultati: Hanno partecipato all’indagine 182 specializzandi da 16 regioni. Nessuno riteneva la propria preparazione in ambito pneumologico ottima. Lezioni e tirocini sono diffusi nelle scuole, a differenza di journal club e discussione di casi clinici. Spesso non è disponibile alcuna attività formativa relativa a radioprotezione (85.2%) e fisioterapia respiratoria (71.4%). Uno pneumologo pediatra è presente nell’83% dei casi. I test più diffusi sono: spirometria (97.8%), test del sudore (94%) e pH-metria (78.6%), ma la relativa formazione è attuata capillarmente solo per la spirometria (87.9%). Solo il 7.7% del campione è molto soddisfatto del piano formativo della propria scuola, mentre il 45.6% lo è abbastanza, il 40.1% poco ed il 6.6% per niente. L’84% ritiene fondamentali gli anni della specializzazione per la formazione sub-specialistica. Conclusioni: La nostra indagine suggerisce che nelle scuole di specializzazione in pediatria la formazione pneumologica deve essere incrementata

Assessment of lactose-free diet on the phalangeal bone mineral status in italian adolescents affected by adult-type hypolactasia

Adult-type hypolactasia (ATH) is a clinical syndrome of primary lactase deficiency. A lactose-free diet is advisable to avoid the symptoms linked to the condition, but this potentially creates problems for optimal bone mineralization due to reduced calcium intake. To evaluate the effect of the lactose-free diet on the bone mineral status (BMS), we compared the phalangeal BMS of adolescents with ATH to that of peers on a normal diet. Also, we analyzed the correlations between BMS and dietary behavior, physical exercise, and calcium and vitamin D intake. A total of 102 cases and 102 healthy controls filled out a diet record and underwent phalangeal Quantitative Ultrasound (QUS). No difference in BMS was observed. The time spent on lactose-free diet (4.8 ± 3.1 years) was inversely correlated to the BMS. More than 98% of cases consumed lactose-free milk, but calcium and vitamin D intake were significantly lower. Calcium intake was correlated to physical exercise but not to BMS. Our results suggest that a lactose-free diet does not affect the phalangeal BMS of adolescents with primary lactase deficiency when their diet includes lactose-free cow’s milk. However, there is still a significantly lower calcium intake than in the population reference. The inverse correlation observed between the BMS and the time spent on a lactose-free diet suggests that a long-term follow-up is advisable

Nut Allergy: Clinical and Allergological Features in Italian Children

Background: Nut allergies are an increasingly frequent health issue in the pediatric population. Tree nuts (TN) and peanuts are the second cause of food anaphylaxis in Italy. Unfortunately, knowledge of the clinical characteristics of a TN allergy in Italian children is limited. Our study aimed to identify the clinical and allergological characteristics of Italian children with a nut allergy (TN and peanut). Methods: A retrospective observational analysis was performed on the clinical charts of children with a history of nut reaction referred to the allergy unit of the hospital from 2015 to 2019. The studied population was represented by children with a confirmed nut allergy based on positive prick by prick and/or serum-specific IgE to nut plus a positive nut oral food challenge. Demographic, clinical, and allergological features were studied and compared among different nuts. Results: In total, 318 clinical charts were reviewed. Nut allergy was confirmed in 113 patients. Most patients (85/113, 75%) had a familial history of allergy and/or a concomitant allergic disorder (77/113, 68%). Hazelnut and walnut were the more common culprit nuts observed in allergic children. Anaphylaxis was the first clinical manifestation of nut allergy in a high percentage of children (54/113, 48%). The mean age of the first nut reaction was statistically higher with pine nuts. Over 75% of children reported a single nut reaction. During the OFCs, the signs and symptoms involved mainly the gastrointestinal system (82/113, 73%) and resolved spontaneously in most cases. Severe reactions were not frequent (22/113, 19%). Conclusion: To our knowledge, this is the first Italian study that provided a comprehensive characterization of children with a nut allergy. These results are important for clinicians treating children with a nut allergy

Management of children with acute asthma attack: A rand/ucla appropriateness approach

Bronchial asthma is the most frequent chronic disease in children and affects up to 20% of the pediatric population, depending on the geographical area. Asthma symptoms vary over time and in intensity, and acute asthma attack can resolve spontaneously or in response to therapy. The aim of this project was to define the care pathway for pediatric patients who come to the primary care pediatrician or Emergency Room with acute asthmatic access. The project was developed in the awareness that for the management of these patients, broad coordination of interventions in the pre-hospital phase and the promotion of timely and appropriate assistance modalities with the involvement of all health professionals involved are important. Through the application of the RAND method, which obliges to discuss the statements derived from the guidelines, there was a clear increase in the concordance in the behavior on the management of acute asthma between primary care pediatricians and hospital pediatricians. The RAND method was found to be useful for the selection of good practices forming the basis of an evidence-based approach, and the results obtained form the basis for further interventions that allow optimizing the care of the child with acute asthma attack at the family and pediatric level. An important point of union between the primary care pediatrician and the specialist hospital pediatrician was the need to share spirometric data, also including the use of new technologies such as teleconsultation. Monitoring the progress of asthma through spirometry could allow the pediatrician in the area to intervene early by modifying the maintenance therapy and help the patient to achieve good control of the disease