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Premessa/obiettivi: Sono state descritte 4 famiglie di allergeni in melo (Mal d 1, 2, 3, 4 [1]) e sintomi clinici associati [2-3]. Un diverso grado di allergenicità è riportato in letteratura sia in relazione al genotipo [4] che al tessuto analizzato: alcuni allergeni sembrano localizzarsi soprattutto a livello della buccia [5]. Scopo dello studio è determinare la risposta di pazienti allergici alla mela attraverso SPT. Materiali e Metodi: 19 soggetti, giunti consecutivamente presso l’Ambulatorio di Allergologia Pediatrica con allergia alimentare alla mela (prevalentemente come sindrome orale allergica), sono stati sottoposti a SPT per estratto di mela (Lofarma) e per 11 genotipi di melo (Florina, Durello, Ohrin, Red Chief, Jonagold, Jonathan, Topaz, Fiesta, Fuji, Gala, Golden), condotti separatamente per buccia e polpa (prick-to-prick). Risultati: Sono stati considerati positivi pomfi di diametro maggiore-uguale a quello dell’istamina (hys) dello stesso paziente. Le polpe di Durello e Ohrin sono risultate meno sensibilizzanti, causando percentualmente la minore positività (rispettivamente 54.5% e 57.9%) e una reazione mediamente inferiore a hys (SPT/hys < 1). Invece, la maggior parte dei pazienti ha mostrato una forte reazione alla polpa di Jonathan e Jonagold (positività > 73.7%, SPT/hys > 1,36). Le bucce di Durello e Jonagold mostrano una minore reazione, rispettivamente con percentuale di positività di 54.5% e 57.9% e SPT/hys di 0.71 e 1.0. Una forte reazione è invece presente per i genotipi Gala (positività = 94.7%, SPT/hys = 1.43) e Fiesta (positività = 78.9%, SPT/hys = 1.46). La somma del numero di positività dei pomfi risultati dalla buccia (144) è lievemente maggiore rispetto al numero di positività della polpa (136). Tuttavia, esiste una variabilità di risposta fra polpa e buccia in diversi genotipi, specie per Ohrin: dei 18 soggetti che hanno presentato almeno 1 positività tra polpa e buccia, solo in 8 casi entrambi i tessuti erano positivi. Discussione: I risultati suggeriscono che vi siano differenze allergeniche nelle diversi cultivar, tuttavia ciò è complicato dalla variabilità legata alla risposta dei pazienti. Bibliografia: 1. Fernandez-Rivas e coll. JACI 2006; 118: 481-8. 2. Marzban e coll. Plant Science 2005; 169: 387-94. 3. Sancho e coll. Allergy 2005;60: 1262-8. 4. Bolhaar e coll. JACI 2005;116: 1080-6. 5. Borges e coll. Plant Physiology and Biochemistry 2006;44: 535-42.

A joint study group on cow's milk allergy was convened by the Emilia-Romagna Working Group for Paediatric Allergy and by the Emilia-Romagna Working Group for Paediatric Gastroenterology to focus best practice for diagnosis, management and follow-up of cow's milk allergy in children and to offer a common approach for allergologists, gastroenterologists, general paediatricians and primary care physicians. The report prepared by the study group was discussed by members of Working Groups who met three times in Italy. This guide is the result of a consensus reached in the following areas. Cow's milk allergy should be suspected in children who have immediate symptoms such as acute urticaria/angioedema, wheezing, rhinitis, dry cough, vomiting, laryngeal edema, acute asthma with severe respiratory distress, anaphylaxis. Late reactions due to cow's milk allergy are atopic dermatitis, chronic diarrhoea, blood in the stools, iron deficiency anaemia, gastroesophageal reflux disease, constipation, chronic vomiting, colic, poor growth (food refusal), enterocolitis syndrome, protein-losing enteropathy with hypoalbuminemia, eosinophilic oesophagogastroenteropathy. An overview of acceptable means for diagnosis is included. According to symptoms and infant diet, three different algorithms for diagnosis and follow-up have been suggested.

Nora's Lesion in a Child: A Case of Complete Spontaneous Regression

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Epidemiological evidence suggests that there is a link between asthma and food allergy. The aim of this study was to estimate the prevalence of food allergy in asthmatic children and to evaluate a possible impact of food allergy on asthma severity. The study enrolled 103 asthmatic children (mean age: 11 years). Skin prick-test, dosage of specific IgE to a standardized panel of inhalant and food allergens and spirometric evaluation was made for each patient. Twenty-four (23%) patients presented food allergy, 75 (77%) were sensitized to at least one food. A lower rate of children with controlled symptoms was found in children with food allergy and a higher rate of persistent asthma was found in children sensitized to at least 4 foods. In conclusion, food allergy/sensitization should always be investigated in asthmatic children for its association with increasing severity (only in food sensitized patients) and reduced control of asthmatic symptoms.

Background Urticaria is the disease that has the highest impact on quality of life and requires the most visits to the emergency room. Objective To investigate the clinical presentation of acute urticaria in children referred to the paediatric emergency room of our hospital and to define possible related aetiologies. Methods We included 814 children consecutively referred to the emergency room between January 2006 and December 2007 with a diagnosis of acute urticaria, isolated or associated with other clinical symptoms. Results Only 2.0% of the cases studied were associated with severe clinical pictures. In 437 cases (53.7%), the cause of urticaria was not determined. The infections of the respiratory tract were the most frequently suspected aetiological factor. The diagnosis of allergic urticaria is more defined, but belongs to a minority group (10.8%). The first level treatment includes the use of non-sedating oral H1-antihistamine. Conclusion The children with urticaria are frequently referred to the paediatric emergency room, but only in a few cases were associated with severe clinical manifestations or allergy. The evidence of an inverse relationship between the number of accesses and the patients' age may be explained by the higher prevalence of this disease in early childhood and possibly also by a higher concern of the parents of the younger patients.

Background Asthma is a serious global health problem and its prevalence is increasing, especially among children. It represents a significant social and economic burden, and it can severely affect the health-related quality of life (HRQL) of patients. Among the numerous questionnaires aiming at evaluating asthma HRQL in children, the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) has proved to have good measurement properties. The present study was aimed at investigating the possible role of the Italian, self-administered version of the PAQLQ in the routine clinical evaluation of children affected by bronchial asthma. Methods 52 Italian children and adolescents (40 males and 12 females), aged 6 to 17 years, affected by allergic asthma, were enrolled. Each patient was evaluated twice, and at each visit asthma control and severity were assessed, spirometry was performed and the patients completed the self-administered version of the PAQLQ. Results The questionnaire was well-accepted and understood by the children. Children showed an overall good quality of life, with mild impairment in the activity and emotional function domains. The PAQLQ showed an overall good correlation with the clinical and functional indexes that are normally evaluated in follow-up visits of asthmatic patients. The PAQLQ appeared to be strongly related to asthma control, both at the first (p < 0.01) and second (p < 0.001) time of the study. The PAQLQ was also seen to decrease with increasing asthma severity. The results suggest a better compliance of the children towards completion of the questionnaire at t1. Finally, the PAQLQ does not appear to discriminate HRQL in patients with good lung function. Conclusion The Italian version of the PAQLQ is a quick-to-administer aid to clinical activity and can add valuable information to symptom reports, objective measurements and clinical assessment of asthma control and severity in daily clinical practice. Re-administration at each follow-up visit allows HRQL to be monitored over time.

The chronic course of atopic dermatitis is a problem for children and their families: it can be extremely disabling, and may cause psychologic problems for both child and family. As atopic dermatitis affects 10% of the pediatric population, pediatricians and dermatologists spend much time on the treatment of this disease, which requires a multidisciplinary approach. To improve the quality of life of children and families affected by atopic dermatitis we have offered an educational program to the parents of young children affected by the disease. The program consists of six meetings at weekly intervals involving a pediatric allergist, a dermatologist, and a psychologist. Our experience has been positive. This type of program may help to improve the quality of life of families with children affected by atopic dermatitis. Lower levels of anxiety were observed among parents at the end of the program. We believe that educational programs of this type, in association with conventional treatment, can be useful in the long term management of the disease. They may be considered to improve the quality of life of the family and children and to create more interaction and compliance between physicians, parents, and children.

Introduction The aim of our study was to evaluate the economic impact of atopic dermatitis (AD) on the family of young children affected by the disease in Italy. Methods Thirty-three families of young children affected by AD were asked to fill in a questionnaire about financial costs associated with providing health care during the past year for their child affected by AD. For each child AD severity was evaluated by using the SCORAD index. Results By analyzing the questionnaire, an annual average cost of 1254€ (about U.S. $1540) for each family was determined. Main expenses concern the use of moisturizing therapies, particular detergent, and private specialist consultations. Annual family average cost was lower for children with mild AD compared with those with moderate to severe AD. Discussion AD has a deep impact on the family budget, with an increasing cost in proportion to the increasing severity of the disease. These data support previous reports suggesting that the management of AD in children is complex and costly, altering the quality of life of children and their families.

Background In children with atopic dermatitis (AD), eczema is easily aggravated by contact with irritant factors (e.g. aggressive detergents, synthetic and woollen clothes, climatic factors). Objectives To evaluate the effectiveness of a special silk fabric (MICROAIR DermaSilk®) in the treatment of young children affected by AD with acute lesions at the time of examination. Methods Forty-six children (mean age 2 years) affected by AD in an acute phase were recruited: 31 received special silk clothes (group A) which they were instructed to wear for a week; the other 15 served as a control group (group B) and wore cotton clothing. Topical moisturizing creams or emulsions were the only topical treatment prescribed in both groups. The overall severity of the disease was evaluated using the SCORAD index. In addition, the local score of an area covered by the silk clothes was compared with the local score of an uncovered area in the same child. All patients were evaluated at baseline and 7 days after the initial examination. Results At the end of the study a significant decrease in AD severity was observed in the children of group A (mean SCORAD decrease from 43 to 30; P = 0·003). At the same time, the improvement in the mean local score of the covered area (from 32 to 18·6; P = 0·001) was significantly greater than that of the uncovered area (from 31 to 26; P = 0·112). Conclusions The use of special silk clothes may be useful in the management of AD in children. Background: In children with atopic dermatitis (AD), eczema is easily aggravated by contact with irritant factors (e.g. aggressive detergents, synthetic and woollen clothes, climatic factors). Objectives: To evaluate the effectiveness of a special silk fabric (MICROAIR DermaSilk®) in the treatment of young children affected by AD with acute lesions at the time of examination. Methods: Forty-six children (mean age 2 years) affected by AD in an acute phase were recruited: 31 received special silk clothes (group A) which they were instructed to wear for a week; the other 15 served as a control group (group B) and wore cotton clothing. Topical moisturizing creams or emulsions were the only topical treatment prescribed in both groups. The overall severity of the disease was evaluated using the SCORAD index. In addition, the local score of an area covered by the silk clothes was compared with the local score of an uncovered area in the same child. All patients were evaluated at baseline and 7 days after the initial examination. Results: At the end of the study a significant decrease in AD severity was observed in the children of group A (mean SCORAD decrease from 43 to 30; P = 0.003). At the same time, the improvement in the mean local score of the covered area (from 32 to 18.6; P = 0.001) was significantly greater than that of the uncovered area (from 31 to 26; P = 0.112). Conclusions: The use of special silk clothes may be useful in the management of AD in children.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease particularly prevalent during the first years of life. The chronic course of AD is a serious problem for affected children and their families. Since the condition provokes extreme itching with continuous scratching that often maintains or exacerbates the inflammation of the skin, the behavioural component of the disease is especially problematic. Moreover, the chronic course and the frequent relapses that characterise AD are a particular burden for the children and their caregivers. To improve long-term outcome in the management of childhood AD, it is important to give parents support in dealing with the chronic disease of their child in addition to medical treatment. Objective: The aim of our programme was to inform families of children with AD about the course of the disease, to improve the family management and to offer them an opportunity for a more open and wide medical dialogue. Methods: Our educational programme consisted of six 2-hour group sessions, conducted at weekly intervals. Sessions were managed by a multidisciplinary team composed of a paediatrician-allergist, a psychologist and a dermatologist. The following issues were covered in the sessions: epidemiology, natural history of the disease, diagnostics and treatment, stress management, psychological counselling on sleeping problems and itchingscratching. Results: Parents reported that the programme well improved the quality of life of their family, particularly thanks to better knowledge and understanding of the disease. Discussion: The programme may encourage an active rather than a passive coping style in the families involved. During routine clinical care it is difficult to recognize and deal with all family troubles and doubts, which are for the most part caused by a poor knowledge of the disease.