[Show abstract][Hide abstract] ABSTRACT: Allergic rhinitis is characterized by eosinophil inflammation. Allergic inflammation may induce susceptibility to respiratory infections (RI). House dust mite (HDM) sensitization is very frequent in childhood. Allergen immunotherapy may cure allergy as it restores a physiologic immune and clinical tolerance to allergen and exerts anti-inflammatory activity.
This study investigated whether six-month high-dose, such as 300 IR (index of reactivity), HDM-sublingual immunotherapy (SLIT) could affect RI in allergic children.
Globally, 40 HDM allergic children (18 males; mean age, 9.3 years) were subdivided in 2 groups: 20 treated by symptomatic drugs (group 1) and 20 by high-dose HDM-SLIT (group 2), since September 2012 to April 2013. The daily maintenance dose of HDM-SLIT was 4 pressures corresponding to 24, 4.8, and 60 µg, respectively of the major allergens Dermatophagoides pteronyssinus (Der p) 1, Der p 2, and Dermatophagoides farinae (Der f) 1. RI was diagnosed when at least 2 symptoms or signs, and fever were present for at least 48 hours. A family pediatrician provided diagnosis on a clinical ground.
SLIT-treated children had significantly (p = 0.01) less RI episodes (3.5) than control group (5.45). About secondary outcomes, SLIT-treated children had less episodes of pharyngo-tonsillitis (p < 0.05) and bronchitis (p < 0.005), and snoring (p < 0.05) than control group. In addition, SLIT-treated children had less fever (p < 0.01) and took fewer medications, such as antibiotics (p < 0.05) and fever-reducers (p < 0.01), than control group.
This preliminary study might suggest that also a short course (6 months) of high-dose SLIT, titrated in µg of major allergens, could reduce RI in allergic children.
[Show abstract][Hide abstract] ABSTRACT: Omalizumab is a recombinant humanized monoclonal antibody that reduces levels of circulating immunoglobulin E (IgE) and expression of IgE high-affinity receptors on mast cells and basophils, interrupting the subsequent allergic inflammatory cascade. Current indications for treatment with omalizumab in pediatric patients are clearly defined and are confined to moderate-to-severe uncontrolled allergic asthma and chronic spon-taneous urticaria (CSU). Any other prescription can only be off label. Data available from clinical trials conducted in children suggest that omalizumab is clinically effective and generally well tolerated. Given its mechanism of action, recent reports have suggested its possible clinical use in other IgE-mediated disorders, such as allergic rhinitis, food allergy, and anaphylaxis. In recent years, several studies have also investigated the possible applications of oma-lizumab in a number of non IgE-mediated diseases. The aim of the present review is to assess all applications of omalizumab as therapy in the pediatric population. The approved indications—allergic asthma and CSU—are reviewed. Moreover, further potential applications of omalizumab are discussed in both IgE-mediated and non-IgE-mediated diseases. Key Points Omalizumab is a monoclonal antibody that targets circulating free immunoglobulin E (IgE) and prevents its interaction with the high-affinity IgE receptor (FceRI), thereby interrupting the allergic cascade. Current indications for treatment with omalizumab are confined to moderate-to-severe uncontrolled allergic asthma and chronic spontaneous urticaria. Any other prescription can only be off label. Data available from clinical trials conducted in pediatric populations suggest that omalizumab is generally well tolerated.
[Show abstract][Hide abstract] ABSTRACT: Obiettivo della Consensus è di definire le evidenze riguardanti il reale impatto che interventi preventivi a differenti livelli, ambientali, comportamentali e nutrizionali, possono avere sulla prevalenza, incidenza
delle allergopatie respiratorie e alimentari.
Journal of investigational allergology & clinical immunology: official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología 10/2014; 24(5):352-3. · 2.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Allergic rhinitis (AR) is one of the most common diseases and represents a global health problem, currently affecting up to 30% of the general population, with a continuously increasing prevalence and significant comorbidities and complications. The aim of this review is to provide an update on AR treatment, with a focus on current therapies defined by AR and its impact on asthma guidelines and with a particular emphasis on new and future therapeutic perspectives.
[Show abstract][Hide abstract] ABSTRACT: Objectifs
L’immunothérapie par voie sublinguale (ITSL) est un traitement efficace qui se heurte comme tous les traitements de fond à des problèmes d’adhérence de la part du patient. La mesure du No exhalé (FeNO) est un examen non invasiif qui permet de mesurer l’inflammation dans l’asthme. Le but de cette étude était d’évaluer si des mesures répétées du FeNO pouvaient augmenter l’adhérence au traitement.
Patients et méthodes
Quarante-quatre patients (23 hommes et 21 femmes, de moyenne d’âge 25,5 ± 12,9 ans) victimes d’une rhinite allergique et désensibilisés par ITSL aux acariens ont été inclus dans cette étude. Ils ont été randomisés en 2 groupes : patients effectuant au moins 2 mesures du FeNO (groupe FeNO), vs patients n’ayant jamais effectué de mesure ou FeNO ou uniquement à une seule occasion (groupe noFeNO). L’adhérence au traitement a été appréciée par le nombre de demandes de renouvellement des extraits allergéniques.
Le groupe FeNO a effectué un plus grand nombre de demandes de renouvellement des extraits de désenbilisation comparé au groupe noFeNO, à la fois lors de la première année de traitement et pour toute la durée de l’ITSL.
Nous avons objectivé une corrélation entre les mesures du FeNO et l’adhérence à la SLIT basée sur le renouvellement du traitement. Ces résultats suggèrent que la surveillance de la maladie avec un paramètre numérique clair, tel que le FeNO, peut aider les patients à mieux comprendre leur état de santé et permet de les motiver pour poursuivre le traitement de fond.
Revue Française d'Allergologie 06/2014; 54(4). DOI:10.1016/j.reval.2014.01.013 · 0.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Sublingual immunotherapy (SLIT) was introduced as a safer option to subcutaneous immunotherapy (SCIT) which was associated with the possible occurrence of systemic reactions including anaphylaxis and, though very rarely, fatalities. Some anaphylactic reactions to SLIT are reported, mainly in adults but also in children. It is therefore important to investigate the risk factors related to such reactions.
Data from the literature on the safety of SLIT in children were reviewed. The data reviewed concerned the application of this treatment to patients with respiratory allergy and also possible new indications such as food allergy, atopic dermatitis and latex allergy. Reports of anaphylactic reactions were analyzed to identify the potential risk factors.
SLIT is a well tolerated treatment, the common side effect being local reactions in the mouth. Systemic reactions, concerning the skin and the airway, are rare and anaphylactic reactions are extremely rare.
Expert Opinion on Drug Safety 05/2014; 13(7):1-7. DOI:10.1517/14740338.2014.918949 · 2.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to summarize and analyze the results of studies supporting the use of omega-3 fatty acids for their therapeutic and preventive value in childhood asthma in light of recent genetic evidence strongly suggesting a pathogenetic role in asthma and to discuss the implications of these findings for future research. Although a considerable number of observational studies have been conducted in children showing a beneficial effect of omega-3 dietary intake in asthma, a fully well-designed, rigorously conducted investigational study is still lacking. Additionally, the few interventional trials with omega-3 supplementation conducted in asthmatic children have often yielded conflicting results. The genetic polymorphism and the gene-nutritional interactions that accompany asthma can be the missing factors and may explain the inconsistent results found in these interventional trials. Therefore, the analyses of key genes variants should be included in future studies to thoroughly investigate the effects of long-chain polyunsaturated fatty acid on asthma. Although a definitive conclusion can not be made supporting a beneficial effect of dietary modification or supplementation with omega-3 for the prevention or modification of asthmatic disease in children, there is sufficient evidence to support this possibility. There is, therefore, a clear need for future research to investigate the feasibility of this dietetic approach to reduce the likely development of asthma and/or the successful treatment of asthmatic disease. From a public health perspective, if a dietetic approach is successfully documented, even if only in a cohort of susceptible individuals, it would offer a far better management tool than currently available, better tolerated, and, in the long run, more cost-effective.
[Show abstract][Hide abstract] ABSTRACT: A current aim of nutrigenetics is to personalize nutritional practices according to genetic variations that influence the way of digestion and metabolism of nutrients introduced with the diet. Nutritional epigenetics concerns knowledge about the effects of nutrients on gene expression. Nutrition in early life or in critical periods of development, may have a role in modulating gene expression, and, therefore, have later effects on health. Human breast milk is well-known for its ability in preventing several acute and chronic diseases. Indeed, breastfed children may have lower risk of neonatal necrotizing enterocolitis, infectious diseases, and also of non-communicable diseases, such as obesity and related-disorders. Beneficial effects of human breast milk on health may be associated in part with its peculiar components, possible also via epigenetic processes. This paper discusses about presumed epigenetic effects of human breast milk and components. While evidence suggests that a direct relationship may exist of some components of human breast milk with epigenetic changes, the mechanisms involved are still unclear. Studies have to be conducted to clarify the actual role of human breast milk on genetic expression, in particular when linked to the risk of non-communicable diseases, to potentially benefit the infant's health and his later life.
[Show abstract][Hide abstract] ABSTRACT: House dust mites (HDMs) are a major cause of allergic rhinitis (AR) and asthma worldwide. Recent studies suggested that the allergen load presents seasonal modifications, giving rise to seasonal variation in nasal inflammation and symptoms. The aim of this study was to evaluate by nasal cytology whether nasal inflammation in mite-allergic patients changes with the seasons of the year.
The study included 16 patients (seven males and nine females, mean age 38.1 years) with persistent AR caused by monosensitization to HDMs. Nasal cytology was performed in all patients once monthly for 1 year.
Nasal cytology showed that the cells most commonly detected in the nasal mucosa were neutrophils. During the period from October to April, a peak in the number of neutrophils and also the presence of significant numbers of eosinophils, mast cells, and lymphocytes/plasma cells were found, which shows the occurrence of more intense inflammation during these months.
Nasal cytology provides useful data in detecting nasal inflammation and its association with the clinical stage of AR. The seasonal variations in nasal cytology are likely to be induced by the fluctuations in the HDM allergen that have been uncovered in recent investigations.
Journal of Inflammation Research 03/2014; 7(1):39-44. DOI:10.2147/JIR.S54581
[Show abstract][Hide abstract] ABSTRACT: Although the guidelines on the diagnosis and treatment of food allergy recognize the role of nutrition, there is few literature on the practical issues concerning the nutritional management of children with food allergies.
This Consensus Position Statement focuses on the nutritional management and follow-up of infants and children with food allergy.
It provides practical advices for the management of children on exclusion diet and it represents an evidence-based consensus on nutritional intervention and follow-up of infants and children with food allergy.
Children with food allergies have poor growth compared to non-affected subjects directly proportional to the quantity of foods excluded and the duration of the diet. Nutritional intervention, if properly planned and properly monitored, has proven to be an effective mean to substantiate a recovery in growth.
Nutritional intervention depends on the subject’s nutritional status at the time of the diagnosis.
The assessment of the nutritional status of children with food allergies should follow a diagnostic pathway that involves a series of successive steps, beginning from the collection of a detailed diet-history.
It is essential that children following an exclusion diet are followed up regularly.
The periodic re-evaluation of the child is needed to assess the nutritional needs, changing with the age, and the compliance to the diet.
The follow- up plan should be established on the basis of the age of the child and following the growth pattern.
Italian Journal of Pediatrics 01/2014; 40(1):1. DOI:10.1186/1824-7288-40-1 · 1.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Allergic patients frequently suffer from infections. Allergen immunotherapy (AIT) usually improves respiratory symptoms, mainly in allergic rhinitis (AR). This study was aimed at evaluating the possible impact of AIT on extra-allergic outcomes in a cohort of Italian children with respiratory allergy patients. The study was performed on 77 children (43 males, mean age 10.5 years) with AR. The kind and the number of prescribed allergen extracts, type of diagnosis, severity of symptoms, and use of drugs were evaluated at baseline and after 2 year AIT. Globally 40 patients were treated with AIT, the remaining 37 children served as control. AIT-treated children had lower symptoms, drug use, and less severe extra-allergic surrogate markers of infection in comparison with children untreated with AIT. In conclusion, this study provides the first evidence that 2-year SLIT is able of exerting an adjunctive anti-allergic activity in AR children.
Journal of biological regulators and homeostatic agents 01/2014; 27(4):1053-7. · 2.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Substantial evidence documents the superiority of breastfeeding for mothers and breast milk for babies. Breast milk, with nutritional but also functional components, is a real biological system. According to present knowledge, it is associated not only with improved parameters of growth, but also to a better neuronal-behavioral development. Breastfeeding provides optimal nutrition for infants and is associated with decreased risk for infant and maternal morbidity and mortality.The importance of breastfeeding and the increasing evidence about the risks of not breastfeeding has put the support, promotion, and protection of breastfeeding at the forefront of many government and public health policies. The use of resources and the effort to promote and support breastfeeding should be the first investment for the health of children around the world.As maternity practices and hospital policies are known to influence breastfeeding, implement the Maternity Practices in Infant Nutrition and Care must be a public health priority.
[Show abstract][Hide abstract] ABSTRACT: Introduction. The circulation of infectious diseases puts small infants too young to be vaccinated at risk of morbidity and mortality, often requiring prolonged hospitalization. Material and Methods. We have reviewed the medical records of children not eligible for vaccination because of age, admitted to hospital for pertussis, measles, or varicella from February 1, 2010, till February 1, 2012. Results. Of the case records scrutinized, 21 were hospitalized for pertussis, 18 for measles, and 32 for varicella. Out of them, 42%, 66%, and 78% diagnosed with, respectively, pertussis, measles, and varicella had a complicated course of the disease. Discussion. To avoid infectious disease circulation, childhood immunization strategies should be adopted, such as vaccination of healthcare givers, adult household contacts, and parents planning to have, or who have had, a newborn baby.
[Show abstract][Hide abstract] ABSTRACT: Chronic urticaria is a distressing condition with high costs. The aim of this literature review was to assess the relative frequency of causes of chronic urticaria in childhood and to provide guidance on which laboratory tests should be performed. Using PubMed, EMBASE and Cochrane databases, the literature from 1966 to 2010 (week 25) was systematically reviewed. Data from studies conducted on children who had had urticaria for at least 6 weeks, and assessing at least 3 different causes of urticaria, were analysed by reviewers using independent extraction. Six studies, all of low quality, met the inclusion criteria. Idiopathic and physical urticaria were common. Infections, autoimmunity and allergy were also reported. We conclude that children with chronic urticaria not caused by physical stimuli should undergo tests for allergy or infections only when there is a history of cause-effect correlation. High-quality trials are warranted to evaluate the causes of chronic urticaria in childhood.