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Atopic dermatitis (AD) is still a demanding challenge in clinical practice. Type 2 inflammation is the most common inflammatory pathway in children and adolescents with AD. Anti‐inflammatory drugs, mainly corticosteroids (CS) and immunomodulant agents are the primary therapeutic approach to dampening type 2 inflammation. However, AD patients may require long‐term high CS doses or drug combinations with possibly significant adverse effects to achieve and maintain disease control. In this regard, the advent of biologics constituted a breakthrough in managing this condition. Dupilumab is a monoclonal antibody directed against the IL‐4 receptor α‐subunit (IL‐4Rα), antagonizing both IL‐4 and IL‐13 and is approved for pediatric severe AD. This review presents and discusses the most recent published studies on dupilumab in children and adolescents with AD. There is convincing evidence that dupilumab is safe and effective in managing AD. It can reduce skin lesions and associated itching, reduce the need for additional medications, and improve disease control and quality of life. However, a thorough diagnostic pathway is mandatory, especially considering the different AD phenotypes. The ideal eligible candidate is a child or adolescent with AD requiring systemic treatment because of severe clinical manifestations and impaired quality of life. [ABSTRACT FROM AUTHOR]

Background. Allergy toward the dust mite is steadily increasing on the European continent. This sensitization may be a risk factor for developing sensitization to other mite molecules such as tropomyosin Der p 10. This molecule often correlates with food allergy and the risk of anaphylaxis after ingesting mollusks and shrimps. Materials and Methods. We analyzed the sensitization profiles by ImmunoCAP ISAC of pediatric patients from 2017 to 2021. The patients under investigation were being followed for atopic disorders such as allergic asthma and food allergies. The study aimed to analyze the prevalence of sensitization toward Der p 10 in our pediatric population and assess the related clinical symptoms and reactions after ingestion of foods containing tropomyosins. Results. This study included 253 patients; 53% were sensitized toward Der p 1 and Der p 2; 10.4% were also sensitized to Der p 10. Assessing patients sensitized to Der p 1 or Der p 2, and Der p 10, we observed that 78.6% were affected by asthma (p < 0.005) and had a history of prior anaphylaxis after ingestion of shrimp or shellfish (p < 0.0001). Conclusion. The component-resolved diagnosis gave us a deeper understanding of patients' molecular sensitization profiles. Our study showed that a fair proportion of children sensitive to Der p 1 or Der p 2 are also sensitive to Der p 10. However, many patients sensitized to all three molecules had a high risk of asthma and anaphylaxis. Therefore, the assessment of Der p 10 sensitization should be considered in atopic patients with sensitization to Der p 1 and Der p 2 to avoid encountering possible adverse reactions after ingesting foods containing tropomyosins. [ABSTRACT FROM AUTHOR]

Background. Food allergy is common in the Mediterranean, especially concerning lipid transfer proteins (LTPs) allergy. LTPs are widespread plant food allergens in fruits, vegetables, nuts, pollen, and latex. Also, LTPs are prevalent food allergens in the Mediterranean area. They can sensitize via the gastrointestinal tract and cause a wide range of conditions: from mild reactions, such as oral allergy syndrome, to severe reactions, such as anaphylaxis. LTP allergy in the adult population is well described in the literature, concerning both the prevalence and clinical characteristics. However, there is poor knowledge about its prevalence and clinical manifestation in children living in the Mediterranean. Materials and Methods. This study, including 800 children aged from 1 to 18 years, investigated the prevalence of 8 different molecules of nonspecific LTP over time in an Italian pediatric population visited over the last 11 years. Results. About 52% of the test population was sensitized to at least one LTP molecule. For all the LTPs analyzed, sensitization increased over time. In particular, using the years 2010 through 2020 as a comparison, the major increases were observed for the LTPs of the English walnut Jug r 3, the peanut Ara h 9, and the plane tree Pla a 3 (about 50%); the increase of the LTP of the Hazelnut Cor a 8 was about 36%, and that of the LTP of the artemisia Art v 3 was approximately 30%. Conclusions. The latest evidence in the literature indicates an increase in food allergy prevalence in the general population, including children. Therefore, the present survey represents an interesting perspective about the pediatric population of the Mediterranean area, exploring the trend of LTP allergy. [ABSTRACT FROM AUTHOR]

Background. Cow's milk allergy (CMA) is the most common food allergy in early childhood. Children with CMA require a precise and punctual diagnosis. Oral food challenge (OFC) is the gold-standard procedure for diagnosing allergies, but it is laborious and requires a particular setting. The aim of the study was to identify the cutoff value of serum allergen-specific IgE values able to predict a positive response to OFC. Methods. Children with suspected CMA performed OFC with cow's milk (CM) or derivatives. Total IgE and specific IgE to raw CM, α-lactalbumin, β-lactoglobulin, and casein were measured. Results. Seventy-two children performed OFC, and 30 (41.6%) had a positive response. The significant predictive factors were sensitization to raw CM extract (p = 0.03), α-lactalbumin (p = 0.013), β-lactoglobulin (p = 0.09), and casein (p = 0.019). The cutoff was, respectively: 5.13 kUA/L for raw CM, 1.47 for α-lactalbumin, 1.35 for β-lactoglobulin, and 4.87 for casein. Conclusions. This study allowed us to define a set of cutoff values for CM protein-specific IgE. However, these cutoffs should be interpreted not as a diagnostic tool for CMA but only predictive of response to OFC in a specific territory. Thus, the practical message may be that a value above the cutoff allows a good approximation to identify children to be started on OFC. [ABSTRACT FROM AUTHOR]

A study published in the journal Clinical & Experimental Allergy found that polysensitisation, or being sensitized to multiple allergens, is common among patients with allergic rhinitis. The study showed that 81% of patients with allergic rhinitis were polysensitised, and these patients were more likely to have associated asthma and experience more severe symptoms compared to monosensitised patients. The researchers emphasized the importance of molecular diagnosis in managing polysensitised patients, as it provides precise insights into sensitisation patterns. However, the study did not differentiate between true allergy and mere sensitisation, which is crucial in clinical practice, especially when prescribing allergen-specific immunotherapy. The article suggests two diagnostic pathways to confirm allergy: thorough history and allergen-specific challenge. Molecular diagnostics can also assist in defining true allergy, but the results may vary depending on factors such as geographic area, climate, lifestyle, and diet. [Extracted from the article]

Cataract surgery is widespread. The surgical procedure is associated with damage to the epithelial barrier and interruption of the corneal innervation. In addition, pathological events sustain signs and symptoms that may persist for a long time. Recently, a fixed combination of alpha-glycerylphosphorylcholine and D-Panthenol (Oftassiale) has been available as eye drops. The present study investigated the effects of an Oftassiale therapy in 20 patients undergoing cataract surgery. A comparison group included 20 patients treated with topical hyaluronic acid. Standard prophylactic and anti-inflammatory treatment was prescribed to all patients. Clinical signs and symptoms were assessed over time. In vivo confocal microscopy (IVCM) was performed accordingly. Oftassiale treatment significantly reduced clinical features and improved IVCM outcomes. In addition, therapy was well-tolerated, and no clinically significant adverse events occurred. In conclusion, this study confirmed that IVCM helps assess the tunnel after cataract surgery due to its ability to provide microscopic details in vivo. Topical therapy with alpha-glycerylphosphorylcholine and D-Panthenol eye drops promoted and stabilized the reepithelialization process. This fixed combination also accelerated and modulated the repair of the corneal innervation. Moreover, this treatment was well-tolerated and safe. [ABSTRACT FROM AUTHOR]

Background: Type-2 inflammation commonly marks asthma in childhood. Also, gut and lung dysbiosis is detectable in patients with asthma. Strain-related probiotic supplementation may restore a physiological immune response, dampen airway inflammation, and repair dysbiosis. Therefore, the probiotics in pediatric asthma management (PROPAM) study is aimed at demonstrating that Ligilactobacillus salivarius LS01 (DSM 22775) and Bifidobacterium breve B632 (DSM 24706) mixture could reduce asthma exacerbations in children, followed in a primary care setting.Methods: The study was randomized, placebo-controlled, and double-blind. It involved 11 Italian primary care pediatricians. The probiotic mixture (containing Ligilactobacillus salivarius LS01 1 × 109 live cells and Bifidobacterium breve B632 1 × 109 live cells) or placebo was taken twice daily (1 sachet in the morning and 1 in the evening) for eight weeks and subsequently once daily for a further eight weeks. Outcomes included number, severity, and duration of asthma exacerbations, intensity of maintenance and as need treatments, and safety.Results: The per-protocol population included 422 children (mean age seven years, 240 males and 182 females). The probiotic mixture significantly reduced the number of asthmatic exacerbations (OR = 3.17). In addition, the number of children with two exacerbations was less than a third in the active group (OR = 3.65).Conclusions: This PROPAM study demonstrated that probiotic strains Ligilactobacillus salivarius LS01 (DSM 22775) and Bifidobacterium breve B632 (DSM 24706) were safe and significantly reduced by more than a third the frequency of asthma exacerbations. At present, the first-line treatment of asthma is still drug-based, but specific strains of probiotics may be auxiliary remedies. [ABSTRACT FROM AUTHOR]

Allergic respiratory diseases, such as asthma and allergic rhinitis, are global health issues and have had an increasing prevalence in the last decades. Allergen‐specific immunotherapy (AIT) is the only curative treatment for allergic rhinitis and asthma, as it has a disease‐modifying effect. AIT is generally administered by two routes: subcutaneous (SCIT) and sublingual immunotherapy (SLIT). Local side effects are common, but usually well‐tolerated and self‐limited. However, systemic side effects are rare, and associated with uncontrolled asthma and bronchial obstruction, or related to errors in administration. Physicians should constantly assess potential risk factors for not only reporting systemic reactions and fatalities but also implementing other therapies to improve AIT safety. This paper highlights recent evidence on local and systemic reactions related to SCIT and SLIT in children. [ABSTRACT FROM AUTHOR]

Introduction: Significant variations in the management of bronchiolitis are often recorded, and, in parallel, to recommend a univocal clinical approach is challenging and still questioned. This study is aimed to evaluate the diagnostic and therapeutic management of bronchiolitis in children adopted by Italian pediatricians following the national guidelines. Material and Methods: A survey study was designed and carried out by sending an email an open-ended questionnaire developed by an expert panel of the Scientific Board of the Italian Society of Pediatric Allergology and Immunology (SIAIP). Questions were designed according to the national intersociety consensus document on treatment and prevention of bronchiolitis in newborns and infants. Results: Overall, 234 pediatricians were taking part in the study. When diagnosing bronchiolitis, only 44.01% (103/234) of participants correctly followed the national guidelines. All participants (100%) would perform laboratory tests and/or radiological exams. 44.01% administered oxygen (O2) when O2 saturation was minor than 92%. About the therapeutic regimen, marked discrepancies between national guidelines and recorded answers were reported. Indications for hospital admission and discharge criteria were in line with the national guidelines. Conclusions: There is a significant practice variation in the management of acute bronchiolitis among Italian physicians. Some wrong attitudes need to be further discouraged, such use of diagnostic procedures and therapeutic approaches. Further research is urgently required to define the best management of patients with bronchiolitis and implement strategies to standardize care and improve the quality of care. [ABSTRACT FROM AUTHOR]

Colonoscopy, since it was first employed over 60 years ago, is now the gold standard method for visualizing the mucosa of the colon, but should be of good quality. Many factors affect quality, including the type of health service organization, type of facility, staff, equipment, patient characteristics, and bowel preparation (BP). The adequacy of bowel cleansing is critical, but, unfortunately, may be inadequate in up to one‐third of procedures. The current article will present and discuss the main BPs and their drawbacks, which include patient‐dependent and procedure‐dependent factors. Cleansing quality depends on the ease/complexity of solution preparation, volume, taste, and timing of consumption. Consequently, important positive factors include simple instructions, easy preparation of the solution, low volume, pleasant taste, short drinking time (e.g. <30 min), and splitting the dose between the evening before and the morning of the colonoscopy (or even better, only one dose in the early morning to avoid night‐time problems), and short onset of action. The BP solution must also be safe with negligible side effects. Furthermore, a positive experience supports patient willingness to repeat the procedure. [ABSTRACT FROM AUTHOR]

Aim: To document the decline in vaccination coverage in the first months of 2020 as an indirect effect of the COVID‐19 pandemic. Methods: We performed a literature review in medical databases. Overall, 143 articles were initially retrieved, out of which 48 were selected and included in the review. Results: Our review retrieved similar data in many countries worldwide, and, globally, preliminary data from the first 4 months of 2020 indicate a decline in diphtheria‐tetanus‐pertussis coverage, generally considered the marker of vaccination coverage across countries. World Health Organization recommends maintaining vaccination services, prioritising primary series vaccinations especially for measles‐rubella or poliomyelitis, but it also lets each country decide whether to maintain the immunisation services evaluating the current epidemiology of vaccine‐preventable diseases and the COVID‐19 local transmission scenario. Successively, recovering of vaccinations should be planned. Moreover, during the pandemic, influenza vaccination should be promoted as a central public health measure. Conclusion: Future challenges will be to maintain the vaccination programmes, especially in children younger than 2 years old and adolescents, to plan the recovery of vaccinations for subjects who postponed them during the lockdown, and to early identify any vaccine‐preventable disease outbreak. [ABSTRACT FROM AUTHOR]

Allergic diseases, such as IgE‐mediated food allergy, asthma, and allergic rhinitis, are relevant health problems worldwide and show an increasing prevalence. Therapies for food allergies are food avoidance and the prompt administration of intramuscular epinephrine in anaphylaxis occurring after accidental exposure. However, allergen immunotherapy (AIT) is being investigated as a new potential tool for treating severe food allergies. Effective oral immunotherapy (OIT) and epicutaneous immunotherapy (EPIT) induce desensitization and restore immune tolerance to the causal allergen. While immediate side effects are well known, the long‐term effects of food AIT are still underestimated. In this regard, eosinophilic gastrointestinal disorders (EGIDs), mainly eosinophilic esophagitis, have been reported as putative complications of OIT for food allergy and sublingual immunotherapy (SLIT) for allergic asthma and rhinitis. Fortunately, these complications are usually reversible and the patient recovers after AIT discontinuation. This review summarizes current knowledge on the possible causative link between eosinophilic gastrointestinal disorders and AIT, highlighting recent evidence and controversies. [ABSTRACT FROM AUTHOR]

The article discusses a study of patients suffering from allergic rhinitis (AR) which aimed to identify subgroups of AR patients with possible distinct phenotypes. Topics include Cluster analysis, comparison by the chi‐square or the Fisher's exact test, Ascending hierarchical clustering analysis which produced clusters of patients; and concluded that clustering analysis could be a useful tool in the management of AR patients as it allow to identify specific clusters of patients at risk.

High‐mobility group box 1 (HMGB1) is a nuclear protein involved in DNA replication, transcription, recombination, and repair. In the extracellular space, the HMGB1 plays an essential role in the onset and perpetuation of inflammation, belonging to the group of damage‐associated molecular pattern (DAMP) molecules, also called alarmins. For this, HMGB1 has been studied in several acute and chronic inflammatory diseases as an early biomarker of inflammation. An increased concentration of HMGB1 has been detected in serum, as the expression of systemic inflammation, and in specific samples (such as stool, synovial fluid, nasal lavage fluid, sputum, and cerebrospinal fluid), as the expression of local production, in several infectious and/or inflammatory diseases. These data are particularly important because they open new futuristic possibilities for target therapies, potentially also for the COVID‐19 treatment. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a chronic remitting‐relapsing inflammatory skin disorder. Due to the multifactorial pathogenesis, there are numerous therapeutic management approaches, mainly based on symptomatic treatments. In recent years, allergen immunotherapy (AIT) has been progressively advanced as targeted disease‐modifying treatment of allergic disease. The most recent guideline from the American Academy of Dermatology concludes that data available do not support its use in AD. The Joint Task Force and The European Academy of Dermatology suggest that clinicians can consider AIT treatment in selected patients characterized by aeroallergen sensitization, prevalently HDM, severe AD, and clinical exacerbation after exposure to the causative allergen. Nevertheless, its role in AD is still under debate, especially in children. [ABSTRACT FROM AUTHOR]

The Italian Society of Paediatric Allergy and Immunology has developed the project "ControL'Asma," a nationwide study involved ten third‐level pediatric allergy clinics across Italy. The first findings of the "ControL'Asma" project showed that asthma was more frequent in males, had an early onset and allergic phenotype with very frequent rhinitis comorbidity, uncontrolled, and partly controlled asthma affected about the half of subjects, and the assessment of asthma symptom perception by VAS could be a reliable tool in the asthma management. [ABSTRACT FROM AUTHOR]

Role of FEF25-75 in children sent by primary care paediatricians for asthma diagnosis Spirometry is the gold-standard tool for detecting airflow limitation in asthma (www.ginasthma.org). Children with abnormal FEF SB 25-75 sb had lower FEV SB 1 sb ( I p i < 0.001), FVC ( I p i = 0.022), and FEV SB 1 sb /FVC values ( I p i < 0.001), higher frequency of bronchial obstruction ( I p i < 0.001), uncontrolled asthma ( I p i < 0.001) and lower cACT values ( I p i = 0.022) than children with normal FEF SB 25-75 sb . [Extracted from the article]

Severe asthma in children is considered a complex and heterogeneous disease. A multidisciplinary assessment is required to correctly identify and manage these children because they potentially need close monitoring and additional treatment with advanced targeted therapies. Recent research efforts focused on the identification of epidemiologic, clinical, and functional characteristics of the disease in the pediatric age. Novel findings on the molecular mechanisms underlying severe asthma have led to the recognition of different endotypes and related biomarkers able to predict the response to advanced biologic therapies. Progress in our knowledge of severe asthma has occurred with the introduction of biologic therapies. Future goals in asthma care include the identification of the links between phenotypes and endotypes, as well as the identification of novel predictive biomarkers. They will help to select candidates for innovative biologic therapies and ultimately improve outcomes in children with severe asthma. [ABSTRACT FROM AUTHOR]

Allergen immunotherapy (AIT) represents at present the unique disease‐modifying treatment strategy for IgE‐mediated allergic diseases. AIT can induce clinical improvement of allergic asthma, including reduced symptoms, medication use, and improvement of quality of life, with a long‐lasting effect after cessation of treatment. Notably, the current asthma guidelines are now recommending sublingual immunotherapy as an add‐on therapy for asthma in adults and adolescents with house dust mite allergy. Clinical indications of AIT, with particular reference to pediatric asthma, mechanisms of clinical and immunological tolerance to allergens, and the potential biomarkers predicting clinical response are discussed. [ABSTRACT FROM AUTHOR]

Allergic diseases are sustained by a T-helper 2 polarization leading to interleukin-4 secretion, IgE-dependent inflammation, and mast cell and eosinophil activation. HLA-G molecules, both in membrane-bound and in soluble forms, play a central role in modulation of immune responses. Elevated levels of soluble HLA-G (sHLA-G) molecules are detected in serum of patients with allergic rhinitis to seasonal and perennial allergens and correlate with allergen-specific IgE levels, clinical severity, drug consumption, and response to allergen-specific immunotherapy. sHLA-G molecules are also found in airway epithelium of patients with allergic asthma and high levels of sHLA-G molecules are detectable in plasma and bronchoalveolar lavage of asthmatic patients correlating with allergen-specific IgE levels. Finally, HLA-G molecules are expressed by T cells, monocytes-macrophages, and Langerhans cells infiltrating the dermis of atopic dermatitis patients. Collectively, although at present it is difficult to completely define the role of HLA-G molecules in allergic diseases, it may be suggested that they are expressed and secreted by immune cells during the allergic reaction in an attempt to suppress allergic inflammation. [ABSTRACT FROM AUTHOR]

Background: In clinical practice, it is fundamental to distinguish between sensitization and allergy, mainly with respect to polysensitized patients. The aim of this study was to evaluate whether serum immunoglobulin E (IgE) to white birch (Betula verrucosa) pollen antigen (Bet v 1) assessment might be able to differentiate simple sensitization fromtrue allergy. Methods: In total, 197 subjects (100 females;mean age 44.9 years) with serum Bet v 1 IgE positivity and history of nasal symptoms were evaluated. Subjects were subdivided in 2 groups: allergic and sensitized. Results: Allergic patients were 58.4% of the total; they had higher serum Bet v 1 IgE levels than sensitized subjects (p < 0.001). A serum IgE to Bet v 1 value >8.94 kilo units of allergen per liter (kUA/L) was able to differentiate between sensitization and allergy (area under the receiver operating characteristic curve [AUC] = 0.76; diagnostic odds ratio, ie, degree of agreement between health status and dichotomized IgE levels [DOR] = 6.5). Gender and season when the blood was drawn influenced IgE levels. Conclusion: Serum Bet v 1 IgE measurement may be able to differentiate sensitization from allergy in subjects with sensitization to Betulaceae pollen allergens. Thus, Bet v 1 IgE measurement should be considered a useful step in the management of patients with allergic rhinitis due to Betulaceae pollen allergens. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is an inflammatory disorder of the skin characterized by impaired immune response. Th9 cells are a sub-population of T cells that release interleukin (IL)-9. No study has investigated the role of IL-9 in AD. This study compared 64 children with AD with 45 healthy children. Serum IL-9 levels were measured and clinical symptoms were assessed. Children with AD had higher serum IL-9 levels than controls (p = 0.01). Clinical severity was significantly related to IL-9 level, indicating that IL-9 might exert a pathogenic role in symptom occurrence in individuals with AD. Children with AD may have higher serum IL-9 levels than healthy children, and IL-9 levels are significantly related to symptom severity. [ABSTRACT FROM AUTHOR]

To cite this article: Tosca MA, Silvestri M, Olcese R, Pistorio A, Rossi GA, Ciprandi G. Breathlessness perception assessed by visual analogue scale and lung function in children with asthma: A real-life study. Pediatr Allergy Immunol 2012: 23: 537-542. Abstract Background: In children with asthma, discrepancies between objective indicators of airway obstruction and symptom perception are often observed. Although visual analogue scale (VAS) has been proposed as a useful tool for assessing accurate symptom perception, previous studies conducted in children with asthma included only small cohorts. A study was therefore designed to investigate the usefulness of VAS in establishing a reliable relationship between breathlessness perception and lung function in a large cohort of children with clinical diagnosis of asthma. Methods: A total of 703 children [470 boys and 233 girls, median age 10.29 (8.33-12.58) yr] with asthma were included in this cross-sectional, real-life study. Perception of breathlessness was assessed by using VAS, and lung volumes and expiratory flows were measured by spirometry. Results: Most children had intermittent or mild persistent asthma (93.3%), and only 46 children had a significant bronchial obstruction defined by FEV1 values <80% of predicted. Globally, VAS was significantly, even though weakly, related to lung function. Analyzing children with bronchial obstruction, a moderate relationship between both FEV1 ( r = 0.47) and FEF25-75 ( r = 0.42) and VAS was detected. A VAS value of 6 was found to be a reliable cutoff for discriminating children with bronchial obstruction (AUC 0.83 at ROC curve; OR 9.4). Conclusion: The present study demonstrates that VAS might be considered a useful tool to assess symptom perception, mainly in children with airflow limitation. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Ear, nose, and throat assessment may be frequently requested for children with allergic rhinitis (AR). Nasal endoscopy allows a thorough evaluation of the nose. The aim of the study was to investigate whether there are endoscopic signs predictive for AR diagnosis in a cohort of children with suspected AR. Study Design: Cohort of observational study. Methods: There were 176 children (99 males; mean age, 7.5 years) studied. Clinical visit, nasal endoscopy, and skin prick test were performed in all patients. Nasal endoscopic signs were pale turbinates, middle turbinate contact, and inferior turbinate contact. The AR diagnosis was made when nasal symptom history was concordant with sensitization. Results: AR was diagnosed in 141 children. Inferior and middle turbinate contact were reliable predictive factors for AR (odds ratio 5.38 and 3.42, respectively), whereas pale turbinates did not predict it. Conclusions: This study suggests that nasal endoscopy may reveal signs predictive for AR diagnosis in children. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: It is well known that there is a close association between allergic rhinitis (AR) and asthma, and AR is a strong risk factor for the onset of asthma. AR duration is significantly associated with a possible bronchial involvement. The aim of this study was to investigate the presence of possible spirometric abnormalities and bronchial hyperreactivity (BHR) in a large group of patients with recent onset of AR. Study Design: Observational cross-sectional study. Methods: A total of 1,539 AR patients were consecutively evaluated. Clinical examination, skin prick test, spirometry, and methacholine challenge were performed on all patients. Results: There were 362 (23%) patients with FEF25–75 values <70% of predicted. The methacholine challenge was positive in 74.43% of patients, and 72.22% of the population presented a polysensitization. At multivariable analysis, an FEV1 value lower than 92% of predicted, as well as increasing severity of BHR and polysensitization appeared to be independent predictors of a reduced FEF25–75 value. Conclusions: This study shows that reduced FEF25–75 values may be present in some patients with recent onset of AR. FEV1 <92%, severity of BHR, and polysensitization may be considered risk factor for this phenomenon. Laryngoscope, 2010. [ABSTRACT FROM AUTHOR]

Nasal airflow, as measured by rhinomanometry, is frequently impaired in allergic rhinitis (AR). The decongestion test evaluates whether the application of an intranasal vasoconstrictor drug increases nasal airflow. The aim of this study was to verify the suitability of the use of the visual analogue scales (VAS) as a surrogate for rhinomanometry in the decongestion test assessment in adolescents with atopic rhinitis. Forty adolescents [16 males and 24 females, mean age 15 (s.d. 2) yr] with AR were studied. Nasal symptoms, VAS, rhinomanometry, and nasal decongestion test were assessed in all patients. A significant association was observed between VAS and nasal airflow after performing the decongestion test (Spearman’s r is −51.7%, p < 0.001). The associated sensitivity and specificity were 84.8 (95% confidence interval, CI 68.1–94.8) and 85.7 (95% CI 42.2–97.6), respectively. The corresponding area under the receiver operating characteristic (ROC) curve of 0.83 (95% CI 0.67–0.93) indicated a good discriminating ability for the decongestion measured on the VAS scale. In conclusion, the use of VAS appears as clinically relevant, in that it allows, with a fair reliability, to perform the decongestion test in the absence of rhinomanometry. [ABSTRACT FROM AUTHOR]

Infectious diseases are frequently observed in children and their recurrence represents a demanding challenge for the paediatrician. It has been hypothesized that a defective immune response may occur in these patients. The aim of the present study was to evaluate whether children presenting with recurrent otitis have a defective interferon (IFN)γ production by the lymphocytes of peripheral blood and of adenoid tissue, in comparison with children without recurrent otitis. Our study group was represented by 58 children undergoing adenoidectomy for adenoidal hypertrophy. They were subdivided into two groups according to the recurrence of otitis (≥3 per year) or not (<3 per year). Intracellular cytokine profile of lymphocyte subsets in adenoids and peripheral blood was evaluated by flow cytometry analysis. Children with recurrent otitis showed a significantly lower percentage of CD8+-producing IFNγ cells in adenoids than children with <3 otitis per year (p = 0.003). The reduced capability of the adenoid cells to produce INF-γ may induce a high susceptibility to the recurrence of otitis in children. [ABSTRACT FROM AUTHOR]

Background: While it is well known that asthma is characterized by airway remodeling, few studies instead have investigated this issue in patients with allergic rhinitis (AR). Objective: The aim of the study was to evaluate nasal function, ie, nasal airflow, in a cohort of patients with persistent AR (PER). Methods: One hundred patients, 50 with short-term and 50 with long-term PER, were prospectively and consecutively evaluated, clinically evaluated by visit, skin prick test, and rhinomanometry. Results: Nasal airflow values were significantly lower (median flow: 348 mL/sec) in patients with long-term rhinitis (median duration nine years) as compared to patients with short-term (median duration one year) rhinitis (median flow: 466 mL/sec) (P < 0.0001). Conclusion: This study provides the first evidence that patients with PER may show a progressive worsening of nasal airflow depending on the duration of the disorder. [Copyright &y& Elsevier]

Objective: Otitis media with effusion (OME) is a common disorder in childhood. The aim of the study was to assess the association of atopy and endoscopic features with the presence of OME. Subjects and Methods: This cross-sectional study evaluated 287 children presenting with acute upper-airway infections persistent for at least ten days and tested through nasal endoscopy and skin-prick test. Results: Fifty-three patients had a diagnosis of OME; out of them, 23 showed acute rhinosinusitis, ten adenoiditis, and 20 both features. OME was diagnosed in 26 atopic children and in 27 nonatopic ones. On a multivariable analysis, allergic rhinitis, endoscopic pattern of adenoiditis, and younger age were all shown to be independently associated with a diagnosis of OME. Conclusions: This study suggests that allergic rhinitis and adenoiditis are significant risk factors to OME development and that the risk becomes higher when these two conditions are concomitantly present. [Copyright &y& Elsevier]

Background: Allergy rhinitis is typically classified as seasonal allergy rhinitis (SAR) and perennial allergy rhinitis (PAR). More recently, the Allergic Rhinitis and its Impact on Asthma document proposed the intermittent (ITR) and persistent forms (PER). However, it has been previously reported that each single allergen may induce different clinical and pathophysiologic features. Objective: The aim of the study was to test the hypothesis that the type of causal allergen might characterize pathophysiologic differences in a cohort of patients with PER. Methods: Three hundred nineteen patients, sailors of the Italian Navy, with moderate-severe PER were prospectively and consecutively evaluated with clinical evaluation, skin prick test, rhinomanometry, and nasal decongestion test. Results: Patients with pollen allergy showed significantly more severe symptoms, lower nasal airflow, and higher response to decongestion test than patients with allergy to perennial allergens ( P < .0001). Conclusion: This study provides evidence that patients with PER may show different pathophysiologic patterns depending on the type of causal allergen. [ABSTRACT FROM AUTHOR]

Background: The decongestion test involves spraying an intranasal vasoconstrictor drug to evaluate the recovery of nasal airflow. Objective: The aim of this study was to assess the relationship between pulmonary function (assessed by spirometry and methacholine challenge) and nasal airflow recovery after a topical vasoconstrictor had been administered in patients with allergic rhinitis (perennial, seasonal, or mixed allergic rhinitis). Methods: A total of 150 subjects were studied. The total symptom score, sensitization, and pulmonary function were all assessed. All subjects underwent rhinomanometry and the decongestion test. Results: Univariate analysis revealed that nasal symptoms and spirometric parameters (except FEF25-75 in subjects with seasonal allergic rhinitis) were not. Only bronchial hyperreactivity, assessed by methacholine challenge, proved to be significantly (and independently) associated with outcome (OR 1.45, P = 0.025). Conclusions: This study provides the first evidence of an association between a positive response to the decongestion test and bronchial hyperreactivity, assessed by methacholine challenge, in patients with allergic rhinitis. EBM rating: B-3b [Copyright &y& Elsevier]

Background: Allergic rhinitis is characterized by a Th2-dependent inflammation. Nasal obstruction largely depends on allergic inflammation. Objective: The aim of this study was to evaluate the possible role of the symptom nasal obstruction in assessing patients with hay fever. Methods: Fifty patients (mean age, 23.7 ± 4.9 years) with hay fever were evaluated both during and outside pollen season. All of them had moderate-severe grade of nasal obstruction. Total symptom score (TSS), rhinomanometry, nasal lavage, nasal scraping, spirometry, and methacholine bronchial challenge were performed in all subjects. Results: During the pollen season, patients with severe nasal obstruction showed significantly higher values of TSS, IL-4, IL-5, IL-8, nasal eosinophils and neutrophils, and significantly lower values of nasal airflow, IFNγ, FEV1, FVC, and FEF 25–75 in comparison with patients with moderate nasal obstruction. Twenty (83%) patients with severe nasal obstruction showed bronchial hyperreactivity (BHR), whereas only 6 (25%) patients with moderate nasal obstruction had BHR. Outside the pollen season overlapping results were observed. Conclusions: This study provides evidence about the key role played by nasal obstruction in assessing patients with allergic rhinitis. [Copyright &y& Elsevier]

Ciprandi G, Tosca MA, Milanese M, Caligo G, Ricca V. Cytokines evaluation in nasal lavage of allergic children after Bacillus clausii administration: A pilot study. Pediatr Allergy Immunol 2004: 15: 148–151. © 2004 Blackwell Munksgaard Respiratory infections are very frequent in children. Bacillus clausii has been demonstrated to exert some immunomodulatory activities and to be safe. We conducted a study to investigate whether B. clausii administration in allergic children with recurrent respiratory infections might modulate cytokine pattern. Ten children (mean age 4.4 yr) attending the nursery school were enrolled at the end of school year (i.e. in the summer). Bacillus clausii spores (Enterogermina®: 2 billion spores per vial) were administered at the dosage schedule of two vials a day for 4 wk. A panel of cytokines, including interleukin (IL)-1, IL-3, IL-4, IL-6, IL-8, IL-10, IL-12, interferon (IFN)- γ, transforming growth factor (TGF)- β, and tumor necrosis factor (TNF)- α, was measured by immunoassay in the fluid recovered from nasal lavage, performed before and after the treatment. Bacillus clausii treatment induced a significant decrease of IL-4 levels (p < 0.01) and a significant increase of IFN- γ (p < 0.05), IL-12 (p < 0.001), TGF- β (p < 0.05), and IL-10 (p < 0.05) levels. Other cytokines were not significantly modified. In conclusion, this study shows that the B. clausii may exert immunomodulating activity by affecting cytokine pattern at nasal level in allergic children with recurrent respiratory infections. [ABSTRACT FROM AUTHOR]

A Th2 cytokine pattern has recently been reported both in allergic and nonallergic chronic rhinosinusitis in asthmatic children. The aim of the study was to evaluate the cytokine pattern in chronic rhinosinusitis in allergic and nonallergic asthmatic children before and after medical treatment. Thirty asthmatic children were evaluated, 18 males and 12 females (mean age 9.1 years). Sixteen were allergic and 14 were nonallergic. All children were asthmatic and suffered from chronic rhinosinusitis, whose diagnosis was confirmed by endoscopy. All of them were treated with amoxicilline-clavulanate (20 mg/kg b.i.d.) and fluticasone propionate aqueous nasal spray (100 µg daily) for 14 days; a short course of oral corticosteroid was also prescribed (deflazacort 1 mg/kg daily for 2 days, 0.5 mg/kg daily for 4 days and 0.25 mg/kg daily for 4 days). Rhinosinusal lavage and nasal cytology were performed in all subjects before and after medical treatment. IL4 and IFNγ were measured by immunoassay and inflammatory cells were counted by conventional staining. Thirteen allergic children and 12 nonallergic children showed a negative endoscopy after the treatment. Allergic subjects showed a significant decrease of IL4 (p = 0.0002) and a significant increase of IFNγ (p = 0.03) after the treatment. Nonallergic children showed a significant decrease of IL4 (p = 0.0007) and a nonsignificant increase of IFNγ. A significant reduction of the inflammatory infiltrate was detected in all asthmatic children (p < 0.05). This study confirms a Th2 polarization in chronic rhinosinusitis both in allergic and nonallergic asthmatic children. Moreover, the medical treatment of chronic rhinosinusitis reversed the cytokine pattern from a Th2 towards a Th1 profile both in allergic and nonallergic children. [ABSTRACT FROM AUTHOR]

In recent years, a complex molecular network involving cytokines kinins and adhesion molecules has been demonstrated to operate in allergic inflammation. In particular, the adhesion machinery plays a crucial role for the recruitment and locomotion of the inflammatory cells and the Intercellular Adhesion Molecule 1 (ICAM-1) is a hallmark of the allergic inflammatory process. The role and possible modulation of ICAM-1 can be investigated using both eye and nose experimental models. Conjunctiva and nasal epithelium are easy to study either under natural allergen exposure or after specific/aspecific provocation tests; furthermore the nasallconjuctival challenge is well tolerated by the patients. These experimental models have allowed us to investigate in vivo the antiallergic properties of several compounds. Many of the new antihistamines, but also deflazacort and local nasal immunotherapy, were demonstrated capable of reducing both inflammatory infiltration and ICAM-1 expression on epithelia. Because of the central role of adhesion molecules in allergic inflammation, their pharmacological modulation can be regarded as a promising therapeutic approach. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding a study which correlates the role of exhaled nitric oxide (FeNO) as biomarker for allergic rhinitis in children.

The article offers information on the detecting plasma pentraxin 3 (PTX3) and serum D-dimer levels in children with asthma. It mentions in children, the most common phenotype/endotype is represented by type 2 immune response, characterized by eosinophilic infiltration; and also mentions sputum PTX3 positively correlated with atopy and asthma severity, but negatively with lung function.

Abstract: Objective: Nasal airflow resistance, as measured by rhinomanometry, is frequently impaired in allergic rhinitis (AR). However, rhinomanometry is scarcely available. The aim of this study was to verify the suitability of the use of visual analog scales (VAS) as a surrogate for rhinomanometry in quantifying nasal obstruction in patients with persistent allergic rhinitis. Study Design: Prospective study on patients with allergic rhinitis. Setting: ENT clinic. Subjects and Methods: Fifty patients (27 males, mean age 23 years, SD 2.24) were studied. VAS for nasal obstruction and other AR symptoms and rhinomanometry were performed in all patients. Results: A significant, very strong correlation has been observed between VAS for nasal obstruction and nasal airflow resistance (Spearman r = 0.879, P < 0.001). Moreover, a significant correlation exists between VAS for rhinorrhea and resistance (Spearman r = 0.313, P = 0.027). Conclusion: The use of VAS for assessing the nasal obstruction appears clinically relevant in that it allows, with good reliability, the quantification of this symptom in the absence of rhinomanometry. [Copyright &y& Elsevier]

Objectives/Hypothesis: Nasal obstruction depends on allergic inflammation. Decongestion tests evaluate the reversibility of nasal airflow limitation. It has been previously reported that duration of persistent allergic rhinitis (PER) may involve important functional consequences. The purpose of the study was to evaluate the impact of the duration of rhinitis on the response to nasal decongestion test in a cohort of patients with PER. Methods: A total of 312 patients with moderate-severe PER were prospectively and consecutively evaluated: 234 males and 78 females, mean age 23.6 years. A detailed clinical history was taken and complete physical examination, nasal endoscopy, skin prick test, rhinomanometry, and nasal decongestion test were performed for all patients. Results: A strong inverse correlation was observed (Pearson's r = −0.81) between rhinitis duration (years) and posttest percentage change of nasal airflow values. Conclusions: The duration of PER may induce a progressive impairment of the response to nasal decongestion test. [ABSTRACT FROM AUTHOR]