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Background: Systemic inflammation, attacks, deterioration of thoracic region mechanics, medications used, and decreased physical activity level (PAL) and fitness negatively may affect respiratory muscle strength. The primary aim of this study was to evaluate dynamic inspiratory muscle strength (S-index), PAL, and physical fitness in children with asthma compared to healthy peers. The secondary aim of this study was to investigate the relationships between S-index and peak inspiratory flow (PIF) values and functional parameters in childhood asthma. Methods: This cross-sectional prospective study consisted of participants of 6–11 years of age, specifically, 20 children with asthma and 20 healthy peers. The device (POWERbreathe K5) evaluated PIF and S-index variables. PAL was determined with the Physical Activity Questionnaire-Child (PAQ-C) and fitness was evaluated with the FITNESSGRAM test battery. Results: The PIF Average (Avg): 1.8 ± 0.6, Best: 2.6 ± 0.6 (asthmatic children) vs. Avg: 2.4 ± 0.7, Best: 3.1 ± 0.9 (healthy children); p = 0.017, p = 0.027, respectively) and S-index (Avg: 34.1 ± 10.3, Best: 45.6 ± 9.9 (asthmatic children) vs. Avg: 43.2 ± 12.1, Best: 56.6 ± 14.7 (healthy children); p = 0.015, p = 0.008 respectively) values of children with asthma were significantly lower compared to healthy peers. The PAL and physical fitness of asthmatic and healthy peers were similar (p > 0.05). There were significant relationships between S-indexavg and S-indexbest with the PAQ-C score (r = 0.498, p < 0.025 r = 0.547, p < 0.013, respectively) and PIFavg and PIFbest with the PAQ-C score (r = 0.490, p < 0.028 r = 0.602, p < 0.005) in children with asthma. Conclusions: Dynamic respiratory muscle strength is negatively affected in children with asthma whereas their physical activity and fitness levels are comparable to their peers. However, it was found that children with a higher S-index and PIF rate had higher PALs. These findings suggest that pulmonary rehabilitation interventions to improve respiratory muscle function should be considered an important strategy to maintain and increase physical activity levels in children with asthma. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has caused significant morbidity and mortality globally. The role of plasma-derived extracellular vesicles (EVs) in pediatric COVID-19 patients remains unclear. Methods: We isolated EVs from healthy controls (n = 13) and pediatric COVID-19 patients (n = 104) with varying severity during acute and convalescent phases using serial ultracentrifugation. EV effects on healthy PBMCs, naïve CD4+ T cells, and monocytes were assessed through in vitro assays, flow cytometry, and ELISA. Results: Our findings indicate that COVID-19 severity correlates with diverse immune responses. Severe acute cases exhibited increased cytokine levels, decreased IFNγ levels, and lower CD4+ T cell and monocyte counts, suggesting immunosuppression. EVs from severe acute patients stimulated healthy cells to express higher PDL1, increased Th2 and Treg cells, reduced IFNγ secretion, and altered Th1/Th17 ratios. Patient-derived EVs significantly reduced proinflammatory cytokine production by monocytes (p <.001 for mild, p =.0025 for severe cases) and decreased CD4+ T cell (p =.043) and monocyte (p =.033) populations in stimulated healthy PBMCs. Conclusion: This study reveals the complex relationship between immunological responses and EV-mediated effects, emphasizing the impact of COVID-19 severity. We highlight the potential role of plasma-derived EVs in early-stage immunosuppression in severe COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: The impact of alternative milk substitutes on the nutritional status of children with cow's milk allergy (CMA), the prevailing cause of food allergies, is unresolved. Methods: A cross‐sectional study was performed in children older than 2 years with IgE‐mediated CMA. Patients' clinical characteristics, anthropometric measurements, dietary intake (by 3‐day food diary), and biochemical markers of nutritional status were assessed. Results: One hundred two children with CMA (68.6% boys; median age, 3.7 years; 51% multiple food allergies) were evaluated. 44.1% of the children consumed plant‐based beverages (PBB), 19.6% therapeutic formula and 36.3% did not consume any milk substitutes. In all age groups, dietary calcium, riboflavin, and vitamin D intake of those who did not use milk substitutes were lower than those who consumed formula or PBB (p <.01). Also in the 2–3 years old age group, dietary zinc (p =.011) and iron intake (p =.004) of the formula‐fed group was higher. Formula‐fed patients had higher levels of 25‐OH vitamin D (μg/L) and serum vitamin B12 (ng/L) than PBB‐fed patients (respectively; p <.001, p =.005) and those who did not consume any milk substitute (p <.001). Patients of all ages who did not utilize a milk substitute failed to obtain an adequate amount of dietary calcium. Conclusion: The use of milk substitutes positively affects dietary calcium, riboflavin, and vitamin D intake in CMA, but their contribution is variable. Those who do not use milk substitutes are at greater risk inadequate of dietary calcium intake. Personalized nutritional advice, given the clinical diversity and the impact of individual differences, is required. [ABSTRACT FROM AUTHOR]

Background: Hymenoptera venom allergy (HVA) is among the most common causes of severe allergic reactions worldwide. Objective: To investigate clinical features and factors that affect the severity of HVA and to determine the alterations in immunologic biomarkers after venom immunotherapy (VIT). Methods: Seventy-six adults and 36 children were prospectively investigated. We analyzed specific immunoglobulin E (sIgE) and sIgG4 levels of venom extracts and components (rApi m1, rApi m10, rVes v1, rVes v5, rPol d5) before and after the first year of VIT. Results: Although cardiovascular symptoms were more common in adults (p < 0.001), the skin was the most affected organ in children (p = 0.009). Serum basal tryptase (sBT) levels were higher in the adults than the children (p < 0.001). The absence of urticaria (odds ratio [OR] 4.208 [95% confidence interval {CI}, 1.395–12.688]; p = 0.011) and sBT ≥ 5.2 ng/mL (OR 11.941 [95% CI, 5.220–39.733]; p < 0.001) were found as the risk factors for grade IV reactions. During VIT, changes in sIgE levels were variable. In the Apis VIT group, we observed remarkable increases in sIgG4 levels in Apis extract and rApi m1 but not in Api m10. Vespula extract, rVes v1, and rVes v5 sIgG4 levels were significantly increased in Vespula VIT group, we also detected significant increases in the Polistes extract and rPol d5 sIgG4 levels, which were not observed in the Apis VIT group. In the patients who received both Apis and Vespula VIT, increases in sIgG4 levels were observed for both venoms. Conclusion: Adults and children can have different clinical patterns. After 1 year, VIT induced a strong IgG4 response. Although Apis immunotherapy (IT) induced Apis sIgG4, excluding Api m10, Vespula IT induced both Vespula and Polistes sIgG4 [ABSTRACT FROM AUTHOR]

The article discusses the prevalence of exercise-induced bronchoconstriction (EIB) in adolescent recreational athletes and the challenges in diagnosing and managing this condition. Screening strategies, such as the use of FeNO levels and the AQUA questionnaire, are highlighted as potential tools for early detection of EIB. The study emphasizes the need for better screening methods to identify athletes with EIB and ensure appropriate management. Additionally, the correlation between atopy, asthma, and EIB is explored, with findings suggesting that atopy may be linked to underlying Type 2 inflammation. [Extracted from the article]

The article discusses the efficacy and safety of sublingual immunotherapy using house dust mite tablets for children aged 1-4 years with perennial allergic rhinitis. The study found that the treatment enhanced allergic rhinitis symptoms, altered immunological responses, and decreased wheezing frequency compared to the control group. The research suggests that early therapeutic intervention with sublingual immunotherapy may be crucial in preventing asthma advancement in young children. A randomized controlled trial based on this preliminary study is currently underway. [Extracted from the article]

Background: Lipid transfer proteins (LTP) are the most common food allergens in the Mediterranean region. Objective: The study aimed to investigate co-sensitization patterns and chister relationships between LTP allergen molecules across a broad range of allergen-specific sensitization patterns, and clinical outcomes in eastern Mediterranean children. Methods: Among 496 children evoluated jor multiple sensitizations with multiplex testing, 105 children (21%) with 16 different LTP sensitizations were analyzed. Clinical reactivity was examined based on clear-cut histoiy Of immunoglobulin E mediated symptoms Coral allergy syndroine [OAS], systemic reactions, and anaphylaxis). Results: All children included were sensitive tofood LTPs, but 56 % were sensitive to pollen LTPs. The number of children with OAS and clinical reactivity was 12 and 59, respectively, and no cofactors were reported. The most common selisitizations were Prit p 3 (74%) and Cor a 8 (66%). Significant correlations were observed in the heatillap between the LTP molecules other than Par j 2 and Tri a 14. Overall, clinical reactivity was associated with increased age and number of LTP molecule posttivity. Conclusion: In the eastern Mediterranean region, 21% of children with multiple food and/or pollen sensitizations were found to have LTP sensitization; however, almost half reported clinical reactivity. The hierarchical pathway highlights that distinct LTP allergen molecules can act as primary sensitizers. Clinical reactivity is linked to increasing numbers OfLTP molecule positivity and increasing age. [ABSTRACT FROM AUTHOR]

Background: Mites are ubiquitous aeroallergens found worldwide. Elucidating individual mite allergen sensitization patterns provides critical insights for managing allergic diseases. This study aimed to investigate molecular allergen (MA) sensitization patterns across different age groups and explore cluster relationships among mite‐sensitized children. Methods: We analyzed 76 children who exhibited sensitization to at least one of the 17 distinct mite MAs through microarray testing. Results: Dermatophagoides farinae exhibited a slightly higher prevalence of sensitization compared with Dermatophagoides pteronyssinus. Der p 1/2 and Der f 1/2 demonstrated an almost 40% sensitization rate, while Der p 10/Blo t 10, Der p 20, Der p 23, and Gly d 2/Lep d 2 displayed an approximately 20% sensitization rate. Sensitization levels and ratios increased significantly with age for Der p 23 but showed numerical rises for other MAs, except for Der p 10/Blo t 10. The presence of various types of atopic diseases had only a minimal impact on sensitization profiles. Strong correlations emerged between Der f 2 and Der p 2, Der p 10 and Blo t 10, Der p 21 and Blo t 5, as well as Gly d 2 and Lep d 2. Hierarchical cluster analysis substantiated these relationships. Der p 10 and its homolog Blo t 10‐sensitive patients (15/76) were mostly seen as mono sensitization(12/15). Ten patients exhibited monosensitization to Der p 20, suggesting a possible association with scabies infection. Conclusion: In children, mite sensitization diversity and levels increased with age. The presence of significant correlations/cluster relationships among these sensitizations underscores homologies among specific MAs. [ABSTRACT FROM AUTHOR]

Complementary to conventional testing that is based on allergen extracts, molecular allergy diagnosis reduces the need for oral food challenges (OFCs) in food allergy diagnosis. Keywords: allergy; diagnosis; microarray; molecular allergy diagnosis; peanut; skin prick test; specific IgE EN allergy diagnosis microarray molecular allergy diagnosis peanut skin prick test specific IgE 1041 1044 4 10/09/23 20231001 NES 231001 Key Messages We evaluated diagnostic accuracy of ALEX SP 2 sp microarray for peanut allergy in a Turkish population. We, therefore, conclude that SPT, in combination with sIgE to Ara h 2 and Ara h 6 are a highly sensitive and specific approach to diagnose allergy to peanuts. Allergy, diagnosis, microarray, molecular allergy diagnosis, peanut, skin prick test, specific IgE. [Extracted from the article]

Introduction: Food allergy (FA) is a heterogeneous disease with multiple morbidities and a huge burden for patients and healthcare systems. Variable manifestations, comorbidities (atopic dermatitis [AD], asthma, and/or allergic rhinitis [AR]), severity (anaphylaxis), and outcomes suggest the existence of different endotypes that cluster analyses may reveal. In this study, we aimed to investigate distinct subgroups among patients with FAs using data from 524 children/adolescents. Methods: 524 patients with IgE-mediated FA (353 male [67%]; median age 4.4 years [IQR:3.0–6.8]), 354 (68%) had multiple FA. The history of AD, asthma, AR, and anaphylaxis was recorded in 59.4%, 35.5%, 24.2%, and 51.2% of the patients, respectively. Latent class analysis was carried out to distinguish clinical FA phenotypes using five potential markers of allergy severity (single/multiple FA, never/inactive/current asthma and AD, AR, and anaphylaxis). Results: Three distinct phenotypes were identified: (1) multiple FA with eczema and respiratory multimorbidity (42%), (2) multiple FA with persistent eczema (34%), and (3) single FA with respiratory multimorbidity without eczema (24%). Compared with the single FA cluster, the prevalence of AD was significantly higher in multiple FA groups. Cluster 1 had the highest frequency of AR and allergic asthma, and the lowest rate of total tolerance of FA. Discussion: We put forward the hypothesis of underlying pathogenesis according to the clinical phenotypes. While skin barrier defect may play a dominant role in the pathogenesis in Cluster 2, immune dysregulation may be dominant in Cluster 3. In Cluster 1, the most severe group, a combination of both skin barrier defects and immune dysregulation may be responsible for the clinical features. [ABSTRACT FROM AUTHOR]

Asthma, a common chronic disease in adolescents is impacted by factors affecting quality of life. This study aimed to determine the psychosocial factors of adolescents with asthma and their parents. The study included 122 adolescents with asthma, 82 healthy controls, and their parents who completed the Asthma Control Test (ACT), Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and the Brief Symptom Inventory (BSI). The mean age was 14.2 ± 1.9 years. ACT score was high and depression was low in patients with good treatment compliance. As the age of the first asthma symptoms/diagnosis increased, somatization, anxiety, hostility and general psychopathology scores increased, as did the somatization score of parents. Parental anxiety score was not related with adolescent BSI scores in the controls but in the study group when it was higher, the anxiety, depression, somatization, and general psychopathology scores were higher. PAQLQ showed that anxiety, negative self-esteem, somatization, depression, and general psychopathology were higher in patients concerned about asthma. Depression and somatization scores were higher in the parents of patients who perceived that "Treatment does not contribute to asthma control." Somatization scores were higher among parents of patients who noted: "Asthma will not pass in the long-term" and "I cannot control asthma." Higher scores of asthma patients who were anxious about the disease and families who were despondent about treatment demonstrate that health care providers should spend more time informing patients and caregivers. Increasing patient treatment compliance during early adolescence will lessen the psychological burden of the disease. [ABSTRACT FROM AUTHOR]