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International audience; In allergy, personalized medicine passes through the assessment of molecular allergens sensitization profiles. Such technique may help to better diagnose and treat patients suffering from allergic respiratory diseases.Recent findings: Different laboratory tests are available today to assess sensitization to molecular allergens, from singleplex assays, to unspecific, screening multiplex assays, mainly performed through microarrays or macroarrays. It is important to collect both results from specific IgE toward allergen extracts and toward molecular allergens, to collect the most complete information on the patient's profile, and therefore to highlight genuine sensitization, and exclude cross-reaction and sensitization because of pan-allergens. Being able to know the exact molecular sensitization profile of the patient, also helps predicting the possible evolution of the disease, and targeting the most appropriate allergen immunotherapy treatment to prescribe.Summary: Even though a cost-effective analysis of running multiple assays in allergic patients has not been performed yet, such technique proved to be more efficient in detecting the appropriate treatment in each patient and in analyzing the true sensitization profile in patients suffering from allergic rhinitis, conjunctivitis, and asthma.

During the initial phase of the national lockdown, we found that there were sharp decreases in admissions to two pediatric emergency departments (EDs) in northern Italy (Cremona and Novara). Here we present a detailed analysis of these admission patterns and types of admissions over a longer timeframe. ED admissions data were anonymously extracted from the departmental management software. Admissions data from 2019 and 2020 were analyzed and compared separately for each ED and combined. There was a 73.2% decrease in total admissions compared with the same period in 2019. With respect to admission diagnoses, there was a significant (p &lt, 0.001) drop in infectious (−51%), respiratory (−25.5%), and nervous systems diseases (−50%) and injuries and poisoning (−17%) but not endocrine, metabolic, neoplastic, circulatory, or musculoskeletal diseases. White codes (patients with minor injuries for whom ED medical care is not required) significantly decreased by 56.3% (p &lt, 0.001). Even if the COVID-19 pandemic represented an enormous healthcare burden in Italy, especially during the first months of the pandemic (late February to May), the workload of pediatric EDs was significantly reduced, especially for unnecessary accesses (white codes).

The COVID-19 pandemic has surprised the entire population. The world has had to face an unprecedented pandemic. Only, Spanish flu had similar disastrous consequences. As a result, drastic measures (lockdown) have been adopted worldwide. Healthcare service has been overwhelmed by the extraordinary influx of patients, often requiring high intensity of care. Mortality has been associated with severe comorbidities, including chronic diseases. Patients with frailty were, therefore, the victim of the SARS-COV-2 infection. Allergy and asthma are the most prevalent chronic disorders in children and adolescents, so they need careful attention and, if necessary, an adaptation of their regular treatment plans. Fortunately, at present, young people are less suffering from COVID-19, both as incidence and severity. However, any age, including infancy, could be affected by the pandemic.Based on this background, the Italian Society of Pediatric Allergy and Immunology has felt it necessary to provide a Consensus Statement. This expert panel consensus document offers a rationale to help guide decision-making in the management of children and adolescents with allergic or immunologic diseases.

Resume En Europe, il y a une variabilite dans les modalites de realisation de tests de provocation aux aliments dans les differents centres d’allergologie. La Societe italienne d’allergologie et immunologie pediatrique (SIAIP) a mene une enquete, dans plusieurs pays, pour evaluer les pratiques locales de realisation de ces tests et rechercher les possibles differences. Nous presentons les resultats d’un questionnaire realise sur une plateforme en ligne par 120 centres d’allergologie, distribues en 4 pays europeens differents : France, Italie, Espagne, Royaume-Uni. Malgre quelques differences, les modalites de prise en charge des patients restent assez concordantes entre les differents pays.

Should cashew and pistachio be clinically considered as one allergen?Authors (Last Name and First Name): Manca Enrica1,2, Touati Nidhal1, De Filippo Maria1,3, Carboni Elena1,4, Diaferio Lucia1,5, Demoly Pascal1,6, Caimmi Davide1,6Affiliations :1. Allergy Unit of the Department of Respiratory Diseases, University Hospital of Montpellier, France.2. Pediatric Unit, University Hospital of Foggia, Italy.3. Pediatric Unit, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy.4. Pediatric Unit, Ospedale Maggiore, ASST Cremona, Italy.5. Department of Pediatrics, Giovanni XXIII Hospital, Aldo Moro University of Bari, Bari, Italy.6. UMR-S 1136 INSERM-Sorbonne Universite, Equipe EPAR – IPLESP, Paris, France.Running title: Allergy to cashew and pistachio

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a pandemic disease (COVID-19) that has spread globally causing more than 30,000 deaths. Despite the immense and ongoing global effort, no efficacious drugs to fight this plague have been identified and patients admitted to the intensive care units (ICU), for respiratory distress, are managed mostly by means of supportive care based on oxygen maintenance. Several authors have reported that the prevalence of hypertension, diabetes, cardiovascular and cerebrovascular diseases comorbidities were indeed frequent among patients with COVID-19, which suggests that these conditions are likely to aggravate and complicate the prognosis. What the aforementioned diseases have in common is a latent chronic inflammatory state that may be associated with the alteration of laboratory parameters that are typical of the metabolic syndrome and insulin resistance. In severe COVID-19 patients laboratory markers of inflammation such as C-reactive protein, IL-6, D-dimer, serum ferritin and lactate dehydrogenase are elevated in many patients; assessed since the 4th-6th day of illness onset, such increases seem to be predictive of an adverse prognosis. Our hypothesis is that drugs belonging to the family of thiazolidinediones (TZD) such as pioglitazone or rosiglitazone, approved for treating the condition of insulin resistance and the accompanying inflammation, could ameliorate the prognosis of those COVID-19 patients with diabetes, hypertension and cardiovascular disorders comorbidities. TZD are PPARγ agonists that act on nuclear receptors, thereby triggering certain transcription factors. TZD were widely used for type-2 diabetes in the first decade of this century and although concerns have been raised for possible side effects associated with long-term treatment, their use has been recently revaluated for their anti-inflammatory properties in numerous medical conditions.

Yolk sac tumor (YST) is a rare tumor that usually occurs in the first two decades of life. It is considered the second most common malignant germ cell tumor of the ovary, characterized by a rapid growth and a bad prognosis due to the frequent metastasis. We report the case of a 12-year-old girl who came to our observation for an acute abdominal pain. Clinical examination evidenced a vague mass in the suprapubic region and a lower abdomen tenderness, the US imaging revealed a complex lesion of the left ovary (19 x 13 cm) and the alpha-fetoprotein (AFP) resulted high (5858 ng/mL). Computed tomography (CT) revealed a large pelvic mass. The treatment consisted of debulking surgery of yolk sac tumor followed by 4 cycles of BEP protocol (Bleomycin, Etoposide, Cisplatin). After 3 years of follow-up there was no evidence of disease recurrence. (www.actabiomedica.it).

To identify factors that discriminate between transient and permanent congenital hypothyroidism.Retrospective evaluation of 58 children with congenital hypothyroidism and eutopic thyroid gland. Gender, gestational age, birth weight, TSH and serum thyroxine levels at diagnosis and L-thyroxine dose at 12 and 24 months of age were analyzed.Median (IQR) initial TSH levels were 73.3 (276.5) µIU/mL in permanent hypothyroidism and 24.24 (52.7) µU/mL in transient hypothyroidism (P =0.0132). The optimum cut-off value of initial TSH to predict transient hypothyroidism was 90 µIU/mL. Mean (SD) L-thyroxine doses at 24 months of age were 2.64 (0.98) µg/kg/day in permanent hypothyroidism and 1.91 (0.65) µg/kg/day in transient hypothyroidism. Requirement of L-thyroxine dose at 24 months of ≤0.94 µg/kg/day had the highest sensitivity (100%) to predict transient hypothyroidism.L-thyroxine doses at 24 months can predict transient hypothyroidism in patients with eutopic thyroid gland earlier than at 36 months.

È noto come la patogenesi della dermatite atopica sia determinata dall’interazione fra fattori genetici, epigenetici ed ambientali, eterogeneo spettro di difetti immunologici e numerose alterazioni della barriera e del microbioma cutaneo. Questa complessa patogenesi ci induce subito a comprendere perché attualmente non esista ancora una terapia definitiva della malattia. Il trattamento di base consiste nel cercare di raggiungere rapidamente un buon miglioramento cutaneo e un buon controllo del prurito e mantenere questa situazione “ottimale“ stabile il più a lungo possibile mediante un corretto e costante utilizzo di emollienti e detergenti specifici, il cosidetto skin care. L’utilizzo quotidiano dello skin care, consigliato da tutte le più recenti Linee Guida, rappresenta infatti un complemento indispensabile per aiutare il ripristino delle funzioni della barriera cutanea sempre altamente compromessa nella dermatite, anche in apparente fase di benessere.

Introduction L’allergie a la noix de cajou (NC) est associee a des reactions anaphylactiques severes. La NC montre une forte reactivite croisee avec la pistache (P), a cause d’une homologie elevee entre les proteines de stockage des deux fruits. En cas de bilan negatif pour la NC, souvent il est conseille de consommer la P a domicile, sans realiser un work-up allergique complet vis-a-vis de ce deuxieme allergene. Le but de cette etude etait de verifier la securite d’une telle prise en charge. Methodes Nous avons realise une etude retrospective, en incluant tous les patients consecutifs ayant beneficie d’un test de provocation orale (TPO) a la NC et a la P au CHU de Montpellier, entre 2005 et 2020. Nous avons evalue les resultats des tests cutanes (TC) realistes, des dosages d’IgE specifiques (P, NC et la proteine de stockage rAna o 3), des TPO, les comorbidites des patients et les sensibilisations a d’autres fruits a coque. Resultats Nous avons inclus 96 patients, dont 43 hommes (44,8 %), avec un âge median de 10 ans [8-26]. 23 patients (24,0 %) avaient un TPO positif a la NC et 16 (16,7 %) a la pistache. Sur 16 patients avec des TC negatifs pour la NC, 14 (87,5 %) avaient un TC positif pour la P, alors que sur 16 avec des TC negatifs pour la P, 9 (56,3 %) avaient un TC positif pour la NC. Parmi les 58 patients avec un TPO negatif a la NC, 2 (3,4 %) avaient un TPO positif a la P. Parmi les 66 patients avec un TPO negatif a la P, 9 (13,6 %) avaient un TPO positif a la NC. L’analyse post hoc a montre que la specificite des TC a la NC est de 73,1 % et a la P de 77,2 %. Aussi, la valeur predictive positive du TPO a la NC pour predire une allergie a la P est de 77,2 %. Discussion Les resultats de cette etude preliminaire montrent qu’il y a des divergences entre la sensibilisation et l’allergie a la NC et a la P, et qu’il n’est pas indique d’autoriser un patient non allergique a la NC a consommer la P a domicile, si les TC et les IgE sont positifs pour ce dernier allergene. Conclusion En cas de sensibilisation a NC et P, il est necessaire de realiser un TPO aux deux allergenes, avant de poser un diagnostic definitif ou d’autoriser la consommation de l’aliment a domicile.

We present a case of an 11-month-old girl who was referred to our unit for an erythematous rash that appeared on the face and extremities. Personal and family history was not relevant. Laboratory tests were normal. During recovery, diameter and colour intensity of the cutaneous lesions increased, but after some weeks, lesions had a self-limited resolution without any treatment. Based on clinical and laboratory findings, a diagnosis of acute hemorrhagic edema of infancy (AHEI) was made. AHEI is a rare cutaneous leukocytoclastic vasculitis that usually affects children aged between 4 and 24 months. Etiology is unknown but almost of 75% of cases are preceded by infectious episodes, vaccinations or use of medications. In contrast to the dramatic cutaneous eruption, clinical conditions are usually optimal. Classically, AHEI is characterized by a triad of symptoms: fever, edema and purpura. Skin lesions are erythematous, annular, medallion-like, purpuric plaques that have a rapid onset and appear on the face and extremities, sparing trunk and mucosal membranes. Initially interpreted as a variant of Henoch-Schönlein purpura, now it is considered a distinct disease. In the majority of cases the disease is benign and self-limited without a visceral involvement, so a conservative approach is most often chosen.