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Background: The main aim of this study was to evaluate Streptococcus pneumoniae carriage in a group of school-aged children and adolescents with asthma because these results might indicate the theoretical risk of invasive pneumococcal disease (IPD) of such patients and the potential protective efficacy of the 13-valent pneumococcal conjugate vaccine (PCV13).Methods: Oropharyngeal samples were obtained from 423 children with documented asthma (300 males, 70.9%), and tested for the autolysin-A-encoding (lytA) and the wzg (cpsA) gene of S. pneumoniae by means of real-time polymerase chain reaction.Results: S. pneumoniae was identified in the swabs of 192 subjects (45.4%): 48.4% of whom were aged <10 years, 46.9% aged 10-14 years, and 4.7% aged ≥15 years (p < 0.001). Carriage was significantly less frequent among the children who had received recent antibiotic therapy (odds ratio [OR 0.41]; 95% confidence interval [95% CI] 0.22-0.76). Multivariate analyses showed no association between carriage and vaccination status, with ORs of 1.05 (95% CI 0.70-1.58) for carriers of any pneumococcal serotype, 1.08 (95% CI 0.72-1.62) for carriers of any of the serotypes included in 7-valent pneumococcal conjugate vaccine (PCV7), and 0.76 (95% CI 0.45-1.28) for carriers of any of the six additional serotypes of PCV13. Serotypes 19 F, 4 and 9 V were the most frequently identified serotypes in vaccinated subjects.Conclusions: These results showed that carriage of S. pneumoniae is relatively common in all school-aged children and adolescents with asthma, regardless of the severity of disease and the administration of PCV7 in the first years of life. This highlights the problem of the duration of the protection against colonisation provided by pneumococcal conjugate vaccine, and the importance of re-colonization by the same pneumococcal serotypes included in the previously used vaccine. [ABSTRACT FROM AUTHOR]

Background: The effect of allergen avoidance on airway inflammation is similar to that observed with treatment with inhaled steroids, whereas inhaled steroids have no effect on oxidative stress-induced inflammation. Objective: The aim of this study was to retrospectively evaluate the potential effect of an antioxidant dietary supplement on exhaled nitric oxide over a month in pediatric patients on stable antiasthma treatment. Methods: Forty-seven children with moderate-to-severe asthma were retrospectively evaluated. All the patients were sensitive to Dermatophagoides pteronyssinus and Dermatophagoides farinae, and they were receiving the minimum inhaled corticosteroid dosage required to maintain adequate control. Within a few weeks of admission at Misurina Hospital in the Alps, the regular treatment was gradually reduced, then some children who were receiving a daily dose of inhaled corticosteroids, ≤200 mcg of fluticasone propionate, were prescribed a nutraceutical dietary supplement for at least 4 weeks. Lung function and fractional exhaled nitric oxide (FeNO) measurements were recorded at the beginning and after 1 month of the dietary supplementation. Results: Baseline lung function and FeNO values did not differ between the two groups of patients. After 4 weeks of nutraceutical supplementation, FeNO values decreased, from 19.00 ppb (interquartile range, 14-31 ppb) to 11.00 ppb (interquartile range, 6-23 ppb) (p = 0.03). No significant reduction was observed in the group that did not receive the supplementation, and no significant difference between groups was observed, both at baseline and after 4 weeks of nutraceutical supplementation. Conclusion: Supplementation with a nutraceutical of antioxidants and anti-inflammatory compounds, such as curcumin, resveratrol, soy phospholipids, zinc, selenium, and vitamin D, may be associated with reduced airway inflammation, as documented by a fall in FeNO. [ABSTRACT FROM AUTHOR]

Conclusions: The results of this study suggest that atypical bacteria may be involved not only in acute upper airway diseases but also in recurrent infections requiring adenoidectomy and/or tonsillectomy. Therefore, their identification, followed by an appropriate treatment, should be considered. Objective: Although viruses and group A beta-haemolytic streptococci (GABHS) represent the most frequent bacterial aetiological agents of paediatric upper respiratory tract infections (URTIs), chlamydia and Mycoplasma pneumoniae have also been found in acute tonsillopharyngitis. Nevertheless their relevance in chronic or recurrent URTI has never been evaluated. This study aimed to further address the role of atypical bacteria in recurrent URTIs requiring adenoidectomy and tonsillectomy. Methods: Samples from 55 consecutive children who underwent adenoidectomy and/or tonsillectomy for recurrent or chronic URTI were cut transversely into smaller sections of 5 mm. Each section was pooled and assayed by specific PCR for viruses and bacteria. Results: Adenovirus was detected in 10 patients (18.2%), influenza A virus in one patient and influenza B virus in another. None of the other tested viruses was found. GABHS was found in 37 patients (67.3%). Moraxella catarrhalis and Haemophilus influenzae were detected in 30 patients (54.5%). M. pneumoniae was detected in 6 patients (10.9%) and C. pneumoniae was found in 10 patients (18.2%). [ABSTRACT FROM AUTHOR]

In sensitive asthmatic children, the exposure to relevant allergens causes a deterioration of lung function and symptoms associated with an increase of inflammatory indices. The aim of this single-blind randomized add-on study was to compare the effects of montelukast or formoterol added to low-dose budesonide in asthmatic allergic children exposed to relevant allergens. Twenty children (5 female subjects and 15 male subjects, aged 6-12 years) were enrolled Lung function and airway inflammatory indices (exhaled nitric oxide [eNO] and sputum eosinophils) were evaluated at TO when children were not exposed to relevant allergens and at T1 after 15 days of natural effective allergen exposure. At T1, pulmonary function tests and sputum eosinophils remained stable in both of the groups, without significant differences in comparison with T0 at baseline. Furthermore, formoterol plus budesonide was effective in preventing the expected increase in eNO from 26.46 ± 2.62 ppb at T0 to 29.33 ± 9.28 ppb at T1 (not significant). However, in the group receiving montelukast plus budesonide, there was a significant decrease of eNO from baseline (30.78 ± 6.87ppb) to T1 (18.17 ± 6.60 ppb) (p < .05). In allergic asthmatic children, the use of montelukast or formoterol combined with budesonide could offer a durable protective effect on symptoms, lung function, and inflammatory indices. [ABSTRACT FROM AUTHOR]

Theophylline has been proposed as a drug that is able to reduce eosinophil activation in asthma. We tested the hypothesis that it can interfere with the integrin-mediated stimulation of eosinophil function. Eosinophils from healthy donors were triggered by monoclonal antibodies to β1- and β2-integrins in the presence of different concentrations of theophylline: 4.3 μg/mL (2.4 × 10-5 M) 13 μg/mL (7.2 × 10-5 M) 26 μg/mL (1.4 × 10-4 M), and 43 μg/mL (2.4 × 10-5 M), respectively. The level of activation was evaluated by assaying O2- generation. A statistically significant inhibition (p < 0.05) of O2- generation was observed with the different concentrations of theophylline when eosinophils were triggered via very late antigen 4 (VLA-4), lymphocyte function antigen 1 and the common β2-chain. No effect of theophylline on O2- generation was observed in phorbol-myristate-acetate-stimulated eosinophils. These results suggest that theophylline can interfere with the eosinophil activation triggered by ligation of β1- and β2-integrins. This effect of theophylline possibly may play a relevant role in the inhibition of eosinophil infiltration and activation at the sites of allergic reactions. [ABSTRACT FROM AUTHOR]

Unpasteurized milk consumption was associated with less atopy prevalence. Not only microbial load but also fatty acids and cytokines such as transforming growth factor-β1 (TGF-β1) may play a role on the effect of unpasteurized milk. Levels of TGF-β1 in different cow’s milk samples were evaluated: we consider raw unpasteurized milk before and after boiling, commercial pasteurized and micro-filtrated cow’s milk and different commercially available cow’s milk formulas. TGF-β1 concentration in raw unpasteurized cow’s milk was 642.0 ± 52.9 pg/ml before boiling and decreased significantly after boiling (302.7 ± 50.59 pg/ml) (p < 0.05). TGF-β1 concentrations were also significantly lower in commercial pasteurized milk (246.2 ± 43.15 pg/ml) and in commercial micro-filtrated milk (213.0 ± 31.6 pg/ml) in comparison to unpasteurized unboiled milk (p = 0.002). The levels of TGF-β1 in all formula samples were below the threshold of detectability for the assays. As TGF-β1 in the milk may contribute to the development of the immature gastrointestinal tract by influencing IgA production and oral tolerance induction, we suggest to consider not only the microbial compounds but also the cytokine patterns to explain the protective effect of unpasteurized cow’s milk on allergic disorders. [ABSTRACT FROM AUTHOR]

A 15 years-old boy came to our attention with a diagnosis of poorly controlled asthma. This case required thorough investigations: CT scan imaging revealed a flat angioma extending from the carina to the left main bronchus. Rigid bronchoscopy confirmed the presence of an angioma showing widespread mucosal diffusion involving most of the posterior tracheal wall and main bronchi, on the left side. We present this case report and these images to readers seeking for other experiences in the diagnosis of wide superficial bronchial angioma in pediatric age. [ABSTRACT FROM AUTHOR]