Background. Despite the presence of robust evidence, very sparse data are available on the efficacy of allergen immunotherapy (AIT) on selected patients in  real-life. Moreover, the obtained data does not ever fit with the general population; thus, the translation and the use of data obtained from randomized clinical trials (RCTs) in  real-practice can be questionable. Accordingly, we aimed to evaluate in  real-life efficacy and perceived satisfaction of 3-year sublingual immunotherapy (SLIT) in a pediatric population with with allergic rhinitis and/or asthma. Methods. A pilot, monocenter, retrospective cohort,  real-life study was performed. 153 children who fulfilled the criteria for allergic rhinitis and asthma and mono- or poly-sensitized were enrolled. A standardized questionnaire on perceived efficacy, rescue medication, disease control, number of exacerbations, quality of life, and perceived satisfaction was administered to each patient. Results. 70 patients (49 males, 21 females; mean age, 14.3±1.9 years) were included in the final analysis. All 70 patients received SLIT for up to three years, with 100% treatment adherence throughout the study duration. Significant improvement in symptoms and quality of life was reported (p<0.01). A significant decrease in disease severity, rescue medication use, and sleep disturbances was reported (p<0.01). A significant improvement was also recorded in school performance (p<0.01).  60/70 (85.7%) of all enrolled patients declared themselves  very  satisfied, 6/70 (8.57%)  much satisfied, and 4/60 (5.71%)  satisfied.  Conclusions. We firstly showed the efficacy and perceived satisfaction of 3-year SLIT in a paediatric population, with 100% treatment adherence throughout the study duration, in  real-life.

TITLE PAGEFull Title of Manuscript : A case of anaphylaxis caused by the inhalation of sheep’s milk vapors in a child with severe multi-food allergy.Authors’ Full Names : Foti Randazzese Simone, Toscano Fabio, Crisafulli Giuseppe, Galletta Francesca, Manti Sara, Caminiti Lucia.Authors’ Institutional Affiliations : Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Messina (Italy).Running Title : Adverse reactions after inhalation of food allergens.Corresponding Author : Foti Randazzese Simone, Pediatric Resident, Pediatric Unit, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, via Consolare Valeria, 1, 98121, Messina, Italy. Tel. 0902213165. E-mail:[email protected] count : 1055 words (Main Text).Number of Tables and Figures : 1 table, no figures.

Introduction. Significant variations in the management of bronchiolitis are often recorded, and, in parallel, to recommend a univocal clinical approach it is not easy and is still questioned. This study is aimed to evaluate the diagnostic and therapeutic management of bronchiolitis in children adopted by Italian paediatricians following the national guidelines. Material and methods. A survey study was designed and carried out by sending an email an open-ended questionnaire developed by an expert panel of the Scientific Board of the Italian Society of Pediatric Allergology and Immunology (SIAIP). Questions were designed according to the national inter-society consensus document on treatment and prevention of bronchiolitis in newborns and infants. Results. Overall, 234 paediatricians were taking part in the study. When diagnosing bronchiolitis, only 44.01% (103/234) of participants were correctly following the national guidelines. All participants (100%) would perform laboratory tests and/or radiological exams. 44.01% administered oxygen (O2) when O2 saturation was major than 92%. About the therapeutic regimen, marked discrepancies between national guidelines and recorded answers were reported. Indications for hospital admission and discharge criteria were in line with the national guidelines. Conclusions. There is a significant practise variation in the management of acute bronchiolitis among Italians physicians. Some wrong attitudes need to be further discouraged, such use of diagnostic procedures and therapeutic approaches. Further research is urgently required to define the best management of patients with bronchiolitis as well as implement strategies to standardize care and improve the quality of care.

Vernal keratoconjunctivitis (VKC) is a severe chronic ocular disease characterized by recurring acute and/or chronic corneal-conjunctival inflammation leading to visual sequelae. Since no therapy is universally effective at treating VKC, novel treatments are currently under investigation, such as anti-immunoglobulin (Ig)E [1]. Omalizumab, a recombinant monoclonal antibody (mAb) binding to the Fcε portion of the immunoglobulin (Ig)E, has been licensed by the Food and Drug Administration (FDA) and European Medicines Agency (EMA) as an add-on therapy for the treatment of severe not controlled allergic asthma both in adults and children (age ≥ six years), [2-4] as well as in severe chronic idiopathic urticaria, and even as off-label use in other diseases [5, 6]. Although the clinical efficacy and safety of omalizumab have already been extensively investigated in the treatment of other IgE-mediated diseases [7, 8], very few literature data support the use of omalizumab in VKC [9-14]. In the present study, we report our clinical experience with omalizumab to treat severe VKC unresponsive to standard therapy in two children. An updated overview of the current literature is also provided.

Introduction Childhood cancer survivors (CSs) might face an increased lifelong risk of lung function impairment. The Lung Clearance Index (LCI) has been described as being more sensitive than spirometry in the early stages of some lung diseases. The aim of this study was to evaluate this index in a cohort of patients with a history of childhood cancer for the first time. Materials and Methods We evaluated 57 off-treatment CSs aged 0–18 years old and 50 healthy controls (HCs). We used the multiple breath washout (MBW) method to study LCI and spirometry. Results CSs did not show any differences from the controls in ventilation homogeneity (LCI 6.78 ± 1.35 vs. 6.32 ± 0.44, P: ns) or lung function (FEV1 99.9 ± 11.3% vs. 103.0 ± 5.9% of predicted, P: ns; FVC 98.2 ± 10.3% vs. 101.1 ± 3.3% of predicted). LCI significantly correlated with the number of years since the last chemotherapy (r = 0.35, P < 0.05). Conclusions Our study describes the trend of LCI in a cohort of CSs and compares it with the results obtained from healthy controls. The results show that patients maintain both good values of respiratory function and good homogeneity of ventilation during childhood. Moreover, the LCI identifies the tendency toward pulmonary fibrosis, which is typical of adult CSs, at an earlier time than spirometry.

Gastrointestinal symptoms are common findings in children with SARS-CoV-2 infection.Diarrhea and vomiting have been reported in about 8-9% of cases, reaching more than 20% in some studies. Children with gastrointestinal involvement appear to be younger than those without, but the severity of the disease seems to be similar between the two groups of subjects.Fecal shedding in children has been reported in 20-30% of children and has been observed both in those with and those without overt gastrointestinal involvement. Moreover, prolonged fecal elimination, lasting several days after negativization of real-time polymerase chain reaction assay on respiratory swabs, have been reported with variable frequency in children with SARS-CoV-2 infection. These observations raise the question regarding the possibility of oral-fecal transmission and the possible role of children in spreading the infection, particularly when they appear asymptomatic or with gastrointestinal symptoms but with no respiratory involvement, as well as during their convalescent phase.

Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disease caused by Aspergillus induced hypersensitivity that occurs in immunocompetent but susceptible patients with asthma and/or cystic fibrosis (CF). In children, ABPA remains mostly undiagnosed, resulting in one of the most common causes of poorly controlled asthma and highly significant morbidity in children with CF. Currently, no specific diagnostic criteria of ABPA for children are available. Corticosteroids and itraconazole are the mainstays of therapy, althoughthere is a lack of randomized clinical trials regarding their usefulness for ABPA in children. Several monoclonal antibodies, such asomalizumab and mepolizumab, may be potential therapies for refractory ABPA in pediatric patients; however, further data are required to clarify the optimal dose and duration of therapy as a routine treatment approach.

The prevalence, heterogeneity and severity of type 2 inflammatory diseases, including asthma and atopic dermatitis, continue to rise, especially in children and adolescents. Type 2 inflammation is mediated by both the innate and adaptive immune cells and sustained by a specific subset of cytokines, such as interleukin(IL)‐4, IL‐5,IL‐13, and IgE. IL-4 and IL-13 are considered signature type 2 cytokines, as they both have a pivotal role in many of the pathobiological changes featured in asthma and atopic dermatitis. Several biologics targeting IL-4, IL-5, and IL-13, as well as IgE, have been proposed to treat severe allergic disease in the pediatric population with promising results. A better definition of type 2 inflammatory pathways is essential to implement targeted therapeutic strategies.