Search

Objectives: Although transfusion support is commonly used in oncological palliative care, there is still a paucity of literature. We examined the transfusion support provided in the terminal stage of the disease and compared the approach at a pediatric oncology unit and a pediatric hospice., Case Description: This case series analyzed patients treated at the Fondazione IRCCS Istituto Nazionale dei Tumori di Milano (INT)'s pediatric oncology unit who died between January 2018 and April 2022. We compared these with those who died at the VIDAS hospice and analyzed the number of complete blood counts taken in a patient's last 14 days of life, and the number of transfusions performed in the same period.We analyzed 44 patients (22 in pediatric oncology unit; 22 in hospice) in total. Twenty-eight complete blood counts were performed (7/22 patients at the hospice; 21/22 patients at the pediatric oncology unit). Nine patients were given transfusions, three at the hospice, six at our pediatric oncology unit (24 transfusions in total): 20 transfusions at the pediatric oncology unit, four at the hospice. In total 17/44 patients were given active therapies in the last 14 days of life: 13 at the pediatric oncology unit, four at the pediatric hospice. Ongoing cancer treatments did not correlate with a greater likelihood of receiving a transfusion (p=0.91)., Conclusions: The hospice's approach was more conservative than the pediatric oncology one. In the in-hospital setting, the need for a transfusion cannot always be decided on by a combination of numerical values and parameters alone. The family's emotional-relational response must be considered too., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Cow's milk allergy is among the more frequent food allergies in infants and children. Because its suspicion stems from a plethora of symptoms, it is frequently reported. However, the development of a rigorous diagnostic pathway will reduce the diagnosed children to less than 50% of those reported. Cow's milk allergy is the only specific food allergy for which an EBM guideline exists. According to the guidelines (Diagnosis and Rationale for Action against Cow's Milk Allergy), a diagnostic process based on the pre-test probability of this condition is available. Treatments include avoidance, the substitution of cow's milk with an appropriate formula, and in some cases, oral immunotherapy. Treatment choice is also guided by these guidelines., (© 2015 S. Karger AG, Basel.)

Purpose of Review: To identify and discuss studies on the molecular diagnosis of cow's milk allergy (CMA) with a view to update allergists since a general review of the methodology in 2006., Recent Findings: Seven basic research studies reporting the use of component-resolved diagnostics in CMA were found. All studies were on children positively reacting to a formal challenge with cow's milk. Six studies used natural allergens and three used recombinant milk proteins. Microarray platforms were customized and, thus, differed across studies. Three studies assessed the association between molecular-scale patterns and different presentations of the condition, that is the association between anaphylaxis, gastrointestinal symptoms and other severe phenotypes and the pattern of protein sensitization. Two studies assessed the association between positive oral food challenge and the persistence of milk allergy over time. Protein profiling could be useful to indicate appropriate specific immunotherapy., Summary: Accurate diagnosis of CMA is challenging and essential. The determination of the immunoglobulin E (IgE)-mediated response to sequenced and characterized allergens may be more useful in predicting the presence and severity of clinical allergy than the currently used skin or blood tests performed with whole extracts. However, as component recognition pattern heterogeneity is observed in different areas, further clinical studies are essential to correlate useful molecular diagnostics and biological markers with disease and patient profiles. Until such markers are found and validated in different age groups, oral food challenge remains the reference standard for the diagnosis of CMA.

The treatment of hypothyroidism and hyperthyroidism is briefly reviewed. L-T4, which is the treatment of choice of hypothyroidism, should be administered once daily after an overnight fast at the dosage of 10-12 mg/kg/day in newborns and of 100 mg/m2 in older children. FT4 and TSH serum levels will normalize within few weeks from the beginning of treatment and should be maintained in the normal range thereafter by appropriate increases of the dosage during growth. The first choice treatment in children with hyperthyroidism due to Basedow disease is the administration of antithyroid drugs, i.e. methimazole at the initial dosage of 0.4-0.6 mg/kg/day b.i.d. or t.i.d.; after remission, the dosage of this drug can either be reduced or L-T4 added in order to avoid hypothyroidism. Treatment should be continued for at least 24 months and the patient followed thereafter to detect possible relapses. Side effects are rare, the most frequent are skin rashes and the most severe is agranulocytosis, so complete blood count should be evaluated frequently especially in the first months of treatment. Surgery (total or near-total thyroidectomy) should be considered in case of failure of medical therapy, even if radioiodine administration, used until now mainly in adults, is gaining favour also for children especially in the United States.