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Preschool children with wheezing disorders pose diagnostic and therapeutic challenges and consume substantial healthcare resources. Peripheral eosinophil blood count (EBC) has been proposed as a potential indicator for future asthma development. This review by the European Academy of Allergy and Clinical Immunology (EAACI) Preschool Wheeze Task Force aimed to provide systematic evidence for the association between increased EBC and the risk of future asthma, as well as to identify potential cutoff values. In February 2023, a search of PubMed, EMBASE, and Cochrane Library databases was conducted to identify studies comparing EBCs in preschool children with wheezing who continued to wheeze later in life and those who did not. Included observational studies focused on children aged <6 years with a wheezing disorder, assessment of their EBCs, and subsequent asthma status. No language or publication date restrictions were applied. Among the initial 3394 studies screened, 10 were included in the final analysis, involving 1225 patients. The data from these studies demonstrated that high EBC in preschool children with wheezing is associated with future asthma development, with odds ratios of 1.90 (95% CI: 0.45–7.98, p =.38), 2.87 (95% CI: 1.38–5.95, p <.05), and 3.38 (95% CI: 1.72–6.64, p <.05) for cutoff values in the <300, 300–449, and ≥450 cells/μL ranges, respectively. Defining a specific cutoff point for an elevated EBC lacks consistency, but children with EBC >300 cells/μL are at increased risk of asthma. However, further research is needed due to the limitations of the included studies. Future investigations are necessary to fully elucidate the discussed association. [ABSTRACT FROM AUTHOR]

Taking AD as a systemic disease with skin symptomatology, we have measured systemic levels of IL-19 as a possible marker of skin inflammation, showing an increased plasma IL-19 concentration in children and adolescents with AD, especially moderate to severe, compared with healthy controls. AD, atopic dermatitis; HC, healthy controls; ns, not significant gl IL-19 plasma concentration was positively correlated with SCORAD score in AD individuals ( I r i = .44, I p i < .01) (Figure 1D) even when adjusting for the age of children. Keywords: atopic dermatitis; endotypes; IL-19; phenotypes EN atopic dermatitis endotypes IL-19 phenotypes 109 112 4 01/27/23 20230101 NES 230101 Key messages IL-19 was elevated in the plasma of children with moderate-to-severe AD IL-19 was increased in children <5 y.o. with AD compared with older ones Plasma IL-19 may be a useful marker in age-related atopic dermatitis endophenotyping To the editor, Atopic dermatitis (AD) is one of the most common skin diseases worldwide and is characterized by substantial heterogeneity in the age of onset, clinical manifestation, disease course, severity and concomitant allergic diseases. Plasma concentration of IL-19 differed significantly between AD patients and healthy controls (Figure 1A), and IL-19 was significantly increased in children with moderate-to-severe AD expressed as SCORAD index compared with healthy controls (Figure 1B). [Extracted from the article]

Background: Preschool wheeze is highly prevalent; 30%–50% of children have wheezed at least once before age six. Wheezing is not a disorder; it is a symptom of obstruction in the airways, and it is essential to identify the correct diagnosis behind this symptom. An increasing number of studies provide evidence for novel diagnostic tools for monitoring and predicting asthma in the pediatric population. Several techniques are available to measure airway obstruction and airway inflammation, including spirometry, impulse oscillometry, whole‐body plethysmography, bronchial hyperresponsiveness test, multiple breath washout test, measurements of exhaled NO, and analyses of various other biomarkers. Methods: We systematically reviewed all the existing techniques available for measuring lung function and airway inflammation in preschool children to assess their potential and clinical value in the routine diagnostics and monitoring of airway obstruction. Results: If applicable, measuring FEV1 using spirometry is considered useful. For those unable to perform spirometry, whole‐body plethysmography and IOS may be useful. Bronchial reversibility to beta2‐agonist and hyperresponsiveness test with running exercise challenge may improve the sensitivity of these tests. Conclusions: The difficulty of measuring lung function and the lack of large randomized controlled trials makes it difficult to establish guidelines for monitoring asthma in preschool children. [ABSTRACT FROM AUTHOR]

Background: Asthma‐like symptoms in preschool children, such as wheezing and dyspnea, are common time‐ and resource‐consuming diagnostic and management challenges. Quality of wheezing and asthma recommendations varies. The purpose of this study, carried out by the European Academy of Allergy and Clinical Immunology (EAACI) Task Force for Preschool Wheeze, was to systematically review and assess the quality of guidelines for diagnosis and treatment of preschool wheezing and/or asthma. Methods: The Cochrane Library, MEDLINE, and EMBASE were searched until June 2018. The methodological rigor, quality, and transparency of relevant guidelines were assessed with the use of the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Results: We identified 26 guidelines. The quality scores for each domain varied. Of all domains, clarity and presentation had the highest mean score, whereas applicability and stakeholder involvement had the lowest. The scores (median) for individual domains were as follows: score and purpose 86%; stakeholder involvement 49%; rigor of development 54%; clarity of presentation 85%; applicability 51%; and editorial independence 63%. Conclusion: Although several guidelines on asthma management in children are available, however, their quality varies. Additionally, there is a considerable gap in reliable recommendations on the management and treatment of non‐asthmatic preschool wheeze. [ABSTRACT FROM AUTHOR]

Preschool wheezing diagnosis and management-Survey of physicians' and caregivers' perspective The most frequent response (50.7%) points out response to treatment, while allergy tests were also very popular, having been chosen by 34.1%. This is the first survey exploring physicians' views on preschool wheeze, showing that wheezing itself and its association with future asthma remain a substantial challenge for most physicians. Furthermore, this study does not include a completely random sample of physicians, due to methodology used (email and social network), so only physicians familiar with the technology were able to participate. [Extracted from the article]