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Suboptimal adherence to treatment is a significant issue in the management of pediatric asthma and is a major cause of uncontrolled disease, life-threatening attacks, and increased utilization of healthcare resources. Electronic health (e-Health) solutions have the potential to positively impact asthma self-management in children and adolescents and their families, thereby improving treatment adherence and asthma outcomes. However, there is a lack of sufficient data to support widespread adoption of e-Health tools in pediatric asthma practice. A critical evaluation of the impact of these new interventions on treatment adherence in childhood asthma must consider unmet needs, heterogeneity of trials, safety and data security issues, long-term effects, and cost-effectiveness. This article explores the most relevant issues facing the role of e-Health and its sub-category-mobile health (mHealth)-in promoting treatment adherence in childhood asthma, focusing on current evidence gaps and limitations, and future research perspectives.

Background The use of receiver operating characteristic curves, or “ROC analysis,” has become quite common in biomedical research to support decisions. However, sensitivity, specificity, and misclassification rates are still often estimated using the training sample, overlooking the risk of overrating the test performance. Methods A simulation study was performed to highlight the inferential implications of splitting (or not) the dataset into training and test set. The normality assumption was made for the classifier given the disease status, and the Youden's criterion considered for the detection of the optimal cutoff. Then, an ROC analysis with sample split was applied to assess the discriminant validity of the Italian version of the Control of Allergic Rhinitis and Asthma Test (CARATkids) questionnaire for children with asthma and rhinitis, for which recent studies may have reported liberal performance estimates. Results The simulation study showed that both single split and cross-validation (CV) provided unbiased estimators of sensitivity, specificity, and misclassification rate, therefore allowing computation of confidence intervals. For the Italian CARATkids questionnaire, the misclassification rate estimated by fivefold CV was 0.22, with 95% confidence interval 0.14 to 0.30, indicating an acceptable discriminant validity. Conclusions Splitting into training and test set avoids overrating the test performance in ROC analysis. Validated through this method, the Italian CARATkids is valid for assessing disease control in children with asthma and rhinitis.

A burden of respiratory and allergic symptoms up to almost 60% has been observed in young and adult athletes, influencing physical performances1 . The Allergy Questionnaire for Athletes (AQUA©) is a validated screening tool for the prediction of the atopic status in adult athletes2 ; it was recently tested in Belgian young elite athletes (12-14 years old)3 , but its actual feasibility and suitability for children and adolescent was not evaluated. Indeed, there is evidence that children are prone to employ "satisficing" response strategies, answering every question positively/negatively, or simply not answering4 . Therefore, the present cross-sectional survey was carried out to assess feasibility of a linguistically simplified version of AQUA© in children and adolescents, stratifying by sport practice and focusing on the core items (12 questions, 5 to 14 and 16 to 17) related to allergy. The study was approved by the local Institutional Ethics Committee (Palermo 1, Italy, Approval Number: 07/2017), and registered on the central registration system ClinicalTrials. gov (ID: NCT03286894). This article is protected by copyright. All rights reserved.

Exposure to outdoor air pollution has been shown to increase asthma symptoms. We assessed the potential role of particulate matter with aerodynamic diameter &lt, 2.5 μm (PM2.5) on respiratory condition in schoolchildren in the south Mediterranean area. A total of 2400 children aged 11–14 years were recruited, and data on their symptoms were collected through an ISAAC (International Study of Asthma and Allergies in Childhood)-based questionnaire. Outdoor PM2.5 was collected for 48 consecutive hours in the schoolyards of their schools and selected residential outdoor areas. The levels of PM2.5 were measured, along with its elemental composition. The incidence of an acute respiratory illness within the first 2 years of life was higher amongst Sicilian children when compared to Maltese children (29.7% vs. 13.5% respectively, p &lt, 0.0001). Malta had a significantly higher prevalence of doctor‐diagnosed asthma, when compared to Sicily (18.0% Malta vs. 7.5% Sicily, p &lt, 0.0001). Similarly, current asthma (7.8% vs. 2.9%, p &lt, 0.0001) and use of asthma medication in the last 12 months (12.1% vs. 4.9%, p &lt, 0.0001) were more frequent amongst Maltese children. Total median PM2.5 was 12.9 μg/m3 in Sicily and 17.9 μg/m3 in Malta. PM2.5 levels were highest in the Maltese urban town of Hamrun (23.6 μg/m3), while lowest in the rural Sicilian town of Niscemi (10.9 μg/m3, p &lt, 0.0001). Hamrun also exhibited the highest levels of nickel, vanadium, lead, zinc, antimony, and manganese, whilst the Sicilian city of Gela had the highest levels of cadmium, and the highest level of PM2.5 when compared to rural Sicily. Elevated levels of PM2.5 were positively associated with the prevalence of doctor diagnosed asthma (odds ratio (OR) 1.05), current asthma (OR 1.06), and use of asthma medication (OR 1.06). All elements in PM2.5 showed increased OR for doctor diagnosed asthma, while higher concentrations of Cd and Mn were associated with higher prevalence of rhinitis.

E-noses provide potential non-invasive metabolic biomarkers for diagnosing and monitoring pulmonary diseases. The primary aim of the present study was to assess the within-day and between-day repeatability of a modern breath sampling system (Pneumopipe® plus an array of e-nose sensors) in asthmatic and healthy children. The secondary aim was to compare the repeatability of the breath sampling system, spirometry and exhaled nitric oxide (eNO). Fifteen children (age 6-11 years) with asthma and thirty healthy children matched by age and gender (1:2 allocation) were recruited; of them, three healthy children did not complete the study. All measurements were collected twice during the baseline visit, 30 min apart, and once during the final visit, after 7 d. Repeatability was assessed through the intra-cluster correlation coefficient (ICC), and a significance test was performed to detect an at least 'fair' repeatability (ICC > 0.2). In asthmatic children, the within-day (0-30 min) ICCs for e-nose sensors (8 sensors × 4 desorption temperatures) ranged from 0.24 to 0.84 (median 0.57, IQR 0.47-0.71), while the between-day (0-7 d) ICCs ranged from 0.25 to 0.83 (median 0.66, IQR 0.55-0.72). In healthy children, the within-day ICCs for e-nose sensors ranged from 0.29 to 0.85 (median 0.58, IQR 0.49-0.63), while the between-day ICCs ranged from 0.33 to 0.82 (median 0.55, IQR 0.49-0.63). In both groups, most of the within-day and between-day ICCs for e-nose sensors were statistically significant. Moreover, the within-day and between-day ICCs for all spirometry parameters and eNO were significant and similar to those of the most reliable sensors. The modern breath sampling system showed more than acceptable within-day and between-day repeatability, in both asthmatic and healthy children. The present study was registered on the central registration system ClinicalTrials.gov (ID: NCT03025061).

The two major challenges facing researchers and clinicians in finding an objective test for asthma are: (i) there is no clear gold standard test, and (ii) there is no current method to accurately measure both the airway obstruction and the airway inflammatory components of asthma. Looking forward, we need to re-evaluate our understanding of existing tests to see how to bridge the gap between “test” and “treatment,” and explore new methodologies, especially for detecting airway inflammation. The development and validation of noninvasive biomarkers for asthma diagnosis and treatment is an expanding field of research. In this context, breathomics is considered particularly appealing in view of its potential ability to provide more targeted approaches to care. However, further studies are required to validate its role in the screening of respiratory diseases at the population level, as well as in monitoring disease progression and assessing the efficacy of pharmacological treatments.

Background Due to the complex interplay among different urban-related exposures, a comprehensive approach is advisable to estimate the health effects. We simultaneously assessed the effect of “green”, “grey” and air pollution exposure on respiratory/allergic conditions and general symptoms in schoolchildren. Methods This study involved 219 schoolchildren (8–10 years) of the Municipality of Palermo, Italy. Data were collected through questionnaires self-administered by parents and children. Exposures to greenness and greyness at the home addresses were measured using the normalized difference vegetation index (NDVI), residential surrounding greyness (RSG) and the CORINE land-cover classes (CLC). RSG was defined as the percentage of buffer covered by either industrial, commercial and transport units, or dump and construction sites, or urban fabric related features. Two specific categories of CLC, namely “discontinuous urban fabric - DUF” - and “continuous urban fabric - CUF” - areas were found. Exposure to traffic-related nitrogen dioxide (NO2) was assessed using a Land-Use Regression model. A symptom score ranging from 0 to 22 was built by summing affirmative answers to twenty-two questions on symptoms. To avoid multicollinearity, multiple Logistic and Poisson ridge regression models were applied to assess the relationships between environmental factors and self-reported symptoms. Results A very low exposure to NDVI ≤0.15 (1st quartile) had a higher odds of nasal symptoms (OR = 1.47, 95% CI [1.07–2.03]). Children living in CUF areas had higher odds of ocular symptoms (OR = 1.49, 95% CI [1.10–2.03]) and general symptoms (OR = 1.18, 95% CI [1.00–1.48]) than children living in DUF areas. Children living in proximity (≤200 m) to High Traffic Roads (HTRs) had increased odds of ocular (OR = 1.68, 95% CI [1.31–2.17]) and nasal symptoms (OR = 1.49, 95% CI [1.12–1.98]). A very high exposure to NO2 ≥ 60 μg/m3 (4th quartile) was associated with a higher odds of general symptoms (OR = 1.28, 95% CI [1.10–1.48]). No associations were found with RGS. A Poisson ridge regression model on the symptom score showed that children living in proximity to HTRs (≤200 m) had a higher symptoms score (RR = 1.09, 95% CI [1.02–1.17]) than children living > 200 m from HTRs. Children living in CUF areas had a higher symptoms score (RR = 1.11, 95% CI [1.03–1.19]) than children living in DUF areas. Conclusions Multiple exposures related to greenness, greyness (measured by CORINE) and air pollution within the urban environment are associated with respiratory/allergic and general symptoms in schoolchildren. No associations were found when considering the individual exposure to greyness measured using the RSG indicator. Electronic supplementary material The online version of this article (10.1186/s12940-018-0430-x) contains supplementary material, which is available to authorized users.

Background: Studies on pulmonary function tests (PFTs) in Growth Hormone Deficiency (GHD) children are lacking. The aims of this study were: (i) to investigate PFTs in GHD pre-pubertal children with respect to Controls, before starting Growth Hormone Therapy (GHT) (T0); (ii) to evaluate changes of PFTs in GHD vs Controls, after 1-year GHT (T1). Forboth aims the mediation analysis (MA) was applied to evaluate the extent to which the relationship between GHD and PFTs could be ascribed to a height-mediated (indirect) or a GH direct effect. Methods: 47 pre-pubertal GHD children (aged 5–14 years) underwent PFTs at T0 and T1. At T0, 47 healthy children matched for age and sex were enrolled as Controls. A MA was performed to assess the relationship between GHD and PFTs and height. Statistical analyses were performed using the statistical software R (https:// cran.r-project.org/mirrors.html). A p-value

Cigarette smoke is the main source of indoor chemical and toxic elements. Cadmium (Cd), Thallium (Tl), Lead (Pb) and Antimony (Sb) are important contributors to smoke-related health risks. Data on the association between Rare Earth Elements (REE) Cerium (Ce) and Lanthanum (La) and domestic smoking are scanty. To evaluate the relationship between cigarette smoke, indoor levels of PM

La qualità dell’ambiente urbano è sempre più oggetto di attenzione sia da parte degli amministratori che dei cittadini. Il verde, inteso come l’insieme delle diverse tipologie di impianti presenti nelle città, costituisce un fondamentale elemento per misurare la qualità dell’ambiente urbano. Le sue modificazioni storiche, la sua progettazione e manutenzione assumono rilievo importante soprattutto se si considera la presenza di specie allergeniche che possono condizionare la vita di un’importante fetta della popolazione presente. Tra le diverse soluzioni praticabili per ridurre l’esposizione dei pazienti allergici al polline iniziano a diffondersi anche le moderne tecnologie, come app dedicate alla presenza di polline in atmosfera e alla registrazione di sintomi allergici da parte dei pazienti.

I funghi provocano talora disturbi dell’apparato respiratorio e sebbene alcuni semplici provvedimenti possano rivelarsi determinanti per prevenirne lo sviluppo in ambiente domestico, la loro ubiquità fa sì che essi si sviluppino sia outdoor che indoor. Un fattore predisponente allo sviluppo di asma bronchiale è la sensibilizzazione allergica, mentre l’inquinamento ambientale gioca un altro ruolo di rilievo anche nelle altre patologie legate all’esposizione a muffe: l’aspergillosi broncopolmonare allergica, la rinosinusite, la sick building syndrome e la sindrome da polveri organiche tossiche. L’immunoterapia specifica, in virtù del suo ormai accertato potere desensibilizzante, rappresenta un valido presidio terapeutico, specie in età pediatrica, con valenza preventiva proprio dello sviluppo di asma.

Nasal nitric oxide (nNO) is a noninvasive tool that may be helpful in evaluating the inflammatory status in the upper airways [1]. Previous studies report that nNO is elevated in children with Allergic Rhinitis (AR) [2], especially in perennial sensitized subjects [3], and that it may be affected by topical administration of intranasal steroids (INSs) [4]. This article is protected by copyright. All rights reserved.

Il fumo di tabacco costituisce un problema ancora attuale e di notevole rilevanza per il grande impatto sulla salute pubblica. Milioni di bambini sono esposti ai danni devastanti del fumo passivo. Questo contribuisce all’inquinamento degli ambienti chiusi apportando significative concentrazioni di nicotina, sostanze irritanti, tossiche e cancerogene, tanto da risultare il principale inquinante degli ambienti chiusi. Oltre al cosiddetto ‘fumo di seconda mano’, miscela costituita dal fumo derivante direttamente dalla sigaretta accesa e da quello esalato dai polmoni dei fumatori, recentemente è stata individuata una nuova forma di esposizione a fumo passivo, denominata ‘fumo di terza mano’. Questo consiste in una miscela di inquinanti che, una volta consumata la sigaretta, si deposita sulle superfici e nella polvere degli ambienti confinati o reagisce con altri composti per formare inquinanti secondari. L’esposizione a fumo passivo ha gravi effetti sulla salute dei bambini, i quali, inoltre, sono più sensibili degli adulti ai suoi effetti nocivi. I maggiori rischi da esposizione riguardano in particolare la salute respiratoria. Relativamente alle allergie, gli studi sull’associazione tra esposizione a fumo di sigaretta e rischio di sensibilizzazione atopica ad oggi pubblicati non sono numerosi e non giungono a conclusioni univoche. La discrepanza dei risultati è probabilmente legata a differenze di carattere demografico nelle popolazioni studiate nonché ai diversi disegni di studio utilizzati dai vari autori. Tuttavia, i danni da fumo passivo sulla salute sono ben noti, motivo per cui la protezione dei bambini da questo rischio deve diventare prioritaria in tema di salute pubblica.

Background and aim Since the forced oscillation technique (FOT) has not been used in previous studies on wheezing phenotyping in preschool children, we applied FOT in a large series of outpatients visited at IBIM. Methods We analyzed 256 consecutively enrolled ≤5 years children with doctor diagnosis of wheezing. Latent Class Analysis (LCA) was performed considering the following personal characteristics: type, cause, recurrence in last 12 months, respiratory resistance (Avr_R(8)), atopy, history of eczema, rhinitis and upper airways infections. High resistance is defined as positive residual of regression on sex, age, height and weight. Risk factors were considered meaningful when they yielded a p-value

Introduction Preschool children are often affected by allergic and ear-nose-throat (ENT) diseases. Environmental risk factors are known to be associated with such diseases; our aim was to perform a...

Background: Preterms and twins are at higher risk of respiratory morbidity later in life. Advances in proteomic approaches may allow the characterization of biomarkers involved in respiratory diseases (Mauri et al. Imm. Lett. 2014;162:2-10). Gel-free approach quantitatively identify differentially expressed proteins in relation to physiopathological conditions (Mauri&Dehò, Meth Enzymology 2008;447:99-117). This can improve the clinical reliability of the next generation of biomarkers to discriminate multiple phenotypes of childhood respiratory diseases. Aim: To assess the ability of gel-free proteomics for identifying specific protein profiles related to PBP. Methods: Urine samples were collected from 3-5 years children: 43 prematurely born (33.7 mean gestational age - GA), including 20 twins (34.4 mean GA), and 23 full-term born children, enrolled in the Preterm Asthma and Rhinitis (PRE-AR) ongoing longitudinal study at IBIM. An innovative approach based on nanochip liquid chromatography combined to high resolution mass spectrometry was used to obtain the proteomics profiles. Results: Proteomics analyses permitted the identification of 300 proteins in each urine sample, with a good repeatability (R2>0.99) and these are used for grouping the samples in relation to the different disease phenotypes. Conclusions: Obtained data indicate the proteomics approach as a promising platform for characterizing specific profiles related to PBP. These results represent a proof of principle for the proteomics application to all PRE-AR cases: along with clinical information, FeNO and lung function tests, this approach will attempt to discover candidate biomarkers and related metabolic pathways.

Allergic rhinitis (AR) is a common respiratory disease, and its prevalence is increasing all over the world, both in adults and in children. Patients experience symptoms that may negatively impact on physical, social and psychological well-being. Hence, if left untreated, allergic rhinitis may significantly affect quality of life. Under current guidelines, intranasal corticosteroids are considered the most effective drugs and they are recommended as first-line therapy. Among the several corticosteroid intranasal sprays available, beclomethasone dipropionate is one of the most prescribed. Recently, new intranasal hydrofluoroalkane-propelled formulations with little or no impact on the ozone layer have been developed for the treatment of AR. The use of these devices might improve patients' adherence to treatment, avoiding some of the most common side effects associated with aqueous formulations. This review provides the most recent evidence for the efficacy and safety of beclomethasone dipropionate hydrofluoroalkane nasal aerosol in the treatment of allergic rhinitis.

Background: Pediatric Asthma Quality of Life Questionnaire (PAQLQ) provides detailed information on QoL in asthmatic children, whereas Childhood Asthma Control Test (C-ACT) Questionnaire is the most validated instrument for asthma control. No study assessed the relationship between C-ACT and QoL in children by means of those instruments. The aim of this study was to determine whether a QoL estimation is possible using the C-ACT questionnaire in asthmatic children. Methods: Medical history, spirometry, C-ACT, and PAQLQ were assessed in 144 (60% male) outpatient asthmatic children from September 2011 to November 2014. A generalized linear model (GLM) for the prediction of PAQLQ was obtained through a stepwise procedure starting from a full model with all C-ACT items, and predictive nomograms were created. Results: Fifty-five (38%) well-controlled (WC) asthma, 37 (26%) partially controlled (PC) asthma, and 52 (36%) uncontrolled asthma (UA) patients were enrolled. Persistent asthmatics (PA) were significantly more uncontrolled (p < 0.0001). A significant reduction in FEV 1, FEV 1/FVC, and FEF 25–75 (p = 0.005, p < 0.0001, and p < 0.001, respectively) was found in WC vs. UA. Through a stepwise process, a reduced model showed a positive relationship between the PAQLQ and the four items of C-ACT. The regression equations for predicted PAQLQ were ln(PAQLQ) = 1.17 + 0.05*C-ACT2 + 0.03*C-ACT3 + 0.04*C-ACT6 + 0.03*C-ACT7. Thus, a nomogram was constructed. Conclusion: The designed nomogram provides a highly predictive assessment of QoL in individual patients, facilitating a more comprehensive assessment of asthmatic children in usual clinical care.

Background: Spirometry is the most common pulmonary function test used in asthma diagnosing. However, it requires good patient co-operation. FOT has gained increasing attention for the measurement of pulmonary function in children because it is performed at steady state breathing. Aim: To compare spirometry and FOT in order to discriminate severity of asthma according to GINA. Methods: Spirometry and FOT were performed in 176 out-patient asthmatic children (5-16 year), 100 (57%) with naive Persistent Asthma (PA) and 76 (43%) with Intermittent Asthma (IA), consecutively enrolled at the IBIM pediatric clinic. Two principal component analyses (PCA) were performed, the first (PCA1) based on FEV 1 %pred, FVC%pred, FEV 1 /FVC, FEF 25-75% %pred and the second (PCA2) based on resistance (R rs ) and reactance (X rs ) at 4, 6, 8 and 10 Hz. Classification Tree (CT) was applied to discriminate PA and IA. The significance level was 5% and the analysis were performed using R (3.1.0). Results: Statistically significant differences of mean values were found for FEV 1 and R rs 8 in PA vs IA [FEV 1 %pred PA: 97.35±18.88 vs IA: 103.24±10.76, p=0.01; R rs 8 PA: 7.25±2.23 vs IA: 6.03±2.63, p=0.001].Based on explained percentage of variance (≥70%), two principal components were selected, in both PCAs. Based on the scores from PCA1 and PCA2, two classification trees were built. CTs showed good results in discriminating asthma severity groups, providing a misclassification rate very close and not statistically different (27.8% vs 26%, p=0.72). Conclusions: FOT may discriminate intermittent and persistent asthmatics, so it could be used in patients who are not able to perform spirometry.

Background: Achieving and maintaining asthma control in children is the primary goal recommended by current guidelines. Aim: To identify risk factors associated with Asthma control and severity, as well as their relative weight. Methods: Within a consecutive series of outpatients visited in a three years period at the IBIM pediatric clinic, we selected 128 persistent asthmatics. A standardized medical interview was carried out to collect information on environmental risk factors, symptoms and comorbidities. Spirometry was performed using Pony FX, Cosmed, Italy; spirometric values were expressed as %pred using GLI-2012equation. Statistical analyses were performed by using R. Results: The identifies a statistical model in which green nodes indicate response variables and light blue nodes indicate covariates. A link between two nodes suggests a strong relation between the corresponding variables whereas a missing link indicates no statistically significant relationship. To test predictive capacities of nodes we use ROC curves. AUC for GINA asthma control, asthma severity, and FEV1 were 0.68, 0.81 and 0.91, respectively. CONCLUSION Through a network analysis we were able to identify risk factors for asthma control, asthma severity, FEF2575 and FEV1. While Gina Severity, FEF2575 and FEV1 can be predicted quite well, Gina control is more difficult to be predicted to and further investigation seems to be necessary.

Introduction: Respiratory conditions are strongly dependent on air pollution. Urban areas are typically characterized by risky environmental conditions. Objectives: To analyze the effect of traffic proximity on asthma and to explore the relationship between level of traffic proximity and lung function in asthmatic and non- asthmatic children. Methods: A case-control study on children visited for suspected respiratory diseases at IBIM from 2011 to 2014 was performed. All the children have been geocoded according to their residence address. Exposure to traffic air pollution was assessed through determination of number and types of streets in proximity of the place of residence. The relationship between air pollution, lung function and other variables collected through laboratory survey and functional tests was explored. Results: There were 433 children: 22.6% with diagnosis of persistent asthma, 25.9% with intermittent asthma, and 51.5% without an asthma diagnosis (i.e. controls). Level of exposure to traffic conditions did not show significant differences between cases and controls at a distance of 100, 200 and 500 meters from the place of residence. Association between living in proximity to HTR and worst lung function resulted only for children with persistent asthma (OR=3.48; CI= 2.14; 5.66). Conclusion: Our preliminary results do not show differences in environmental conditions as measured through traffic proximity among persistent asthmatics, intermittent asthmatics and controls. However, association between lung function and traffic proximity is observed for asthmatic children. These results indicate that living in proximity to HTR can be a determinant for worst lung functions among asthmatic children.

Background: PAQLQ and C-ACT are standardized tool for assessment quality of life and asthma control in children.VAS (Visual Analogic Scale) is a scale for evaluation of the general wellness at the time of visit. Aim: To assess the relationships between VAS, PAQLQ and CACT in order to discriminate Controlled by Uncontrolled ones. Method: Cross-sectional study on 169 asthmatic children aged 5-11 yrs consecutively enrolled from Sept 2011 to Dec 2014 were studied. The Italian version of C-ACT and PAQLQ questionnaire were administered at baseline. Well controlled (WC) asthma and Uncontrolled/Partially controlled (UPC) resulted from C-ACT score >19 and ≤19, respectively. Total score of PAQLQ ranged from 0 (worst) to 7 (best) , resulting as mean of each domain of symptoms (S), limitation of physical activity (LPA) and emotional function (EF). Statistical analysis were performed by means of R(3.1.0). Results: 67(40%) Females and 102(60%) Males. In WC vs UPC significant differences of mean of PAQLQ total score (WC=5.54(0.82), UPC=4.56 (1.17) , p

Purpose Rhinitis and conjunctivitis are common diseases worldwide that are frequently associated. Nevertheless, the risk factors for rhinoconjunctivitis are not well-described and the impact of conjunctivitis on rhinitis and asthma in children remains unknown. This study explored the different risk factors and evaluated the burden of rhinoconjunctivitis among adolescents. Methods This was a cross-sectional study conducted on a random sample of schoolchildren, aged 10-17 years, using skin prick tests and a self-administered questionnaire on respiratory health investigating the impact of rhinitis and rhinoconjunctivitis on daily activities. Results A complete evaluation was obtained for 2,150 children. The prevalence of rhinitis alone was 18.2% and rhinitis associated with conjunctivitis was 20.5%. Rhinoconjunctivitis was more frequently associated with females, a parental history of atopy, domestic exposure to mold/dampness, passive smoke exposure, and reported truck traffic in residential streets. Moreover, rhinoconjunctivitis was associated with a higher level of allergic sensitization. The prevalence of current asthma was 1.7% in subjects without rhinitis or rhinoconjunctivitis, 5.1% in rhinitis and 10.7% in rhinoconjunctivitis. In a logistic model, rhinoconjunctivitis yielded a 2-fold risk for current asthma with respect to rhinitis. Subjects with rhinoconjunctivitis had poorer quality of life (QoL); there was an impact on daily activities in 4.6% of rhinitis and 10.7% of rhinoconjunctivitis. Conclusions Ocular symptoms increase the role of rhinitis as a risk factor for asthma and its impact on daily activities in children.

Background: Guidelines advocate the use of spirometry to assess lung function in asthmatic. Inhaled corticosteroid(ICS) therapy is a mainstay of treatment for asthma, but the clinical response is variable. Aim: To assess the time variation of FEV1% in treated children with Persistent Asthma (PA). Methods: 110 children with PA, with two visits between September 2011 and December 2014 at the IBIM pediatric clinic were studied. Spirometry was performed using Pony FX, Cosmed, Italy; values were expressed as %pred using GLI-2012equation. The time trend of FEV1% for each subject was estimated through separate regressions. A linear regression model for the individual slopes (FEV1% average month variations) with respect to the intercepts (initial FEV1% values) was estimated. For the 71 children which had a FEV1%

Asthma is a common chronic multifactorial disease that affects >300 million people worldwide. Outdoor and indoor pollution exposure has been associated with respiratory health effects in adults and children. Smoking still represents a huge public health problem and millions of children suffer the detrimental effects of passive smoke exposure. This study was designed to review the current evidences on exposure to passive smoke as a risk factor for asthma onset in childhood. A review of the most recent studies on this topic was undertaken to provide evidence about the magnitude of the effect of passive smoking on the risk of incidence of asthma in children. The effects of passive smoking are different depending on individual and environmental factors. Environmental tobacco smoke (ETS) is one of the most important indoor air pollutants and can interact with other air pollutants in eliciting respiratory outcomes during childhood. The increased risk of respiratory outcomes in children exposed to prenatal and early postnatal passive smoke might be caused by an adverse effect on both the immune system and the structural and functional development of the lung; this may explain the subsequent increased risk of incident asthma. The magnitude of the exposure is quite difficult to precisely quantify because it is significantly influenced by the child's daily activities. Because exposure to ETS is a likely cause for asthma onset in childhood, there is a strong need to prevent infants and children from breathing air contaminated with tobacco smoke.

During the last decades research all over the world has highlighted the deleterious effects of pollution on respiratory health of adults and children. Nevertheless, air pollution still represents a significant threat to health. Children are more sensitive than adults to pollutants for several factors: increased respiration relative to body size; physiologic immaturity of respiratory and immunologic systems; low metabolic capacity; longer life expectancy. Several studies demonstrated an association between exposure to outdoor pollutants and respiratory diseases in childhood. Outdoor pollutants, such as nitrogen oxides (NOx), particulate (PM), carbon monoxide (CO), carbon dioxide (CO2), ozone (O3), sulfur dioxide (SO2), may provoke cytotoxic and functional damages in the airways through oxidative stress and inflammation. During the last decades the amount of pollutants from vehicular traffic has significantly increased, especially in urban areas. Recent epidemiological studies have shown that vehicular traffic represents the main source of outdoor pollutants and that it may increase the risk of respiratory outcomes (cough, phlegm, wheeze, asthma) in children through short-term and long-term effects on airways, lung function and allergic sensitization [1]. Indoor pollution is also particularly dangerous, mainly for children and adolescents, that typically spend most of the time in confined spaces (home, school and public spaces). Indoor pollutants concentration depends on external environmental pollutants filtered inside buildings, pollutants generated inside buildings (domestic work) and pollutants generated by personal activities. Combustion products (tobacco smoke and wood burning), CO, CO2, volatile organic compounds (VOC), microbial agents (fungi and bacterial endotoxins), organic products (pet derived and mite allergens, dampness, mold derived components) are the most important indoor pollutants. There is growing epidemiological evidence that indoor allergen exposure may contribute to the development of allergic respiratory symptoms, such wheezing, coughing and asthma in children [2]. Tobacco smoke is one of the environmental pollutants influencing morbidity and death rate in childhood as it is responsible for adverse health effects in both prenatal and postnatal life. Homes remain a site where children are dangerously exposed to environmental tobacco smoke (ETS). The combination of tobacco smoke pollutants which remain in an indoor environment, the so-called ‘third-hand smoke’ (THS), represents a new concept in the field of tobacco control [3]. Children still need to be protected with strict air quality standards, in order to improve their respiratory health. Therefore, policies that ensure better air quality are strongly desirable all over the world.

Gender differential effects on rhinitis are infrequently studied. Aim of our study is to assess gender differences in host and environmental characteristics and in rhinitis severity level within the IBIM Pulmonary and Allergy Pediatric Clinic. A series of rhinitic (R) patients (September 2011 - May 2013) were investigated through standardized questionnaire and spirometry. Statistical analyses were performed with SPSS. Preliminary results refer to 122 R patients: 77 males (M) (63.1%) and 45 females (F) (36.9%); age (years): 9.23 ± 3.42M vs 9.38 ± 3.02F; maternal history of rhinitis: 45.5%M vs 32.3%F (p

Background: Specific instruments for health-related quality of life (HRQoL) assessment in adolescents with rhinoconjunctivitis or asthma are available. None of them evaluates rhinitis and asthma together, although they often coexist. Our aim was to validate a HRQoL questionnaire for adolescents with rhinoconjunctivitis, asthma, or both. Methods: A pool of 38 items covering the main symptoms and problems related to respiratory allergy was generated based on literature review, clinical experience, and unstructured interviews to 54 adolescents. The items were randomly listed and presented to 88 consecutive outpatients (44 M; mean age 15.2 3.1). Patients had to indicate which item they had experienced and, for each selected item, its importance on a four-point scale (1 = not at all; 4 = very much). Twelve items were excluded from the list, because of low importance. In the validation phase, 102 patients (54 M; mean age 15.36 1.12) completed the KINDL, a generic HRQoL tool, and the new questionnaire (RHINASTHMA-Adolescents). Results: Factor analysis revealed a five-dimensional structure, which explained up to 71.23% of the total variance. Association between RHINASTHMA-Adolescents and KINDL scores was all in the expected direction. Internal consistency for the extracted factors was satisfactory: Upper Airways (0.81), Lower Airways (0.89), Emotions (0.85), Social Relationship (0.79), Daily life management (0.74). Reliability was good for all factors with a Pearson coefficient ranged from 0.91 to 0.99. Conclusions: RHINASTHMA-Adolescents is the first tool for evaluating HRQoL in patients with rhinitis and/or asthma. It provides a simple assessment and met the standards of validity, internal consistency, and reliability.

During the last decades research all over the world has highlighted the deleterious effects of outdoor and indoor pollution on respiratory health of adults and children. The World Health Organization (WHO) “ Air quality guidelines for Europe ” played a fundamental role in providing information and guidance to authorities involved in the air pollution field and they are considered the key source on which the European Commission's directive on air quality is based. Children appear to be most vulnerable to the harmful effects of outdoor pollutants, which can cause both acute exacerbations, as well as chronic respiratory symptoms and diseases. Possible mechanisms include the induction of oxidative stress, and/or allergic sensitization, as well as increased susceptibility to infections. Cigarette smoke is one of the environmental pollutant influencing morbidity and death rate in childhood as responsible for adverse health effects in both prenatal and postnatal. There is growing epidemiological evidence that indoor allergen exposure may contribute to the development of allergic respiratory symptoms. In Italy the housing and social situation, with regard to the aspects related to exposure to secondhand smoke or the presence of fungal spores, moisture linked to household vapor and poor ventilation of the rooms are problems still not completely resolved. From a medical point of view the field of pediatrics has certainly made great strides in promoting the health of children and pediatricians to have a central role for pursuing this objective.

Smoking still represents a huge public health problem. Millions of children suffer the detrimental effects of passive smoking. An increasing number of countries have recently issued laws to regulate smoking in public places. Instead, homes remain a site where children are dangerously exposed to environmental tobacco smoke (ETS). The combination of tobacco smoke pollutants which remain in an indoor environment, the so-called ‘third-hand smoke’ (THS), represent a new concept in the field of tobacco control. THS consists of pollutants that remain on surfaces and in dust after tobacco has been smoked, are re-emitted into the gas-phase, or react with other compounds in the environment to form secondary pollutants. Indoor surfaces can represent a hidden reservoir of THS constituents that could be re-emitted long after the cessation of active smoking. Human exposure to THS pollutants has not yet been thoroughly studied. Infants and children are more prone to the risks related to THS exposure than adults because they typically spend more time indoors and have age-specific behaviours that may expose them to potential health hazards from THS. Further investigations are warranted to study the health effects of THS relevant to different exposure pathways and profiles. It would also be very important to evaluate how THS may affect the lung development through the in utero exposure during the pre-natal life. We aimed at reviewing recent findings published about THS, with special reference to the effects on children’s health.

Asthma represents the most common chronic illness in children [1] and an important clinical and public health problem. In fact, diagnosing and treating asthma in children still remain a challenge. There is evidence that children with asthmatic symptoms are often undiagnosed and undertreated [2]. Considering the prevalence of childhood asthma and its associated burden, it is mandatory to obtain an optimal control of the disease and improving outcomes for patients [3]. To achieve this goal, guidelines were published with indications about medication use, control of the environment and health education. Unfortunately, evidence exists that guidelines recommendations are often not applied within the clinical practice [4]. Therefore, asthma control, as recommended by guidelines, has been shown to be satisfactory in less than 30% of children [1]. Diagnosis and asthma treatment depend on a complex interplay among morbidity, physician practice and access to health care [2]. Relating to morbidity, the association between asthma control and atopic disease is well known. It has been demonstrated that atopic comorbidities, such as rhinitis and eczema, are related to more severe asthma [5] and that treatment of allergic disease may improve asthma control [1]. Undoubtedly, the clinical status and the severity level of the disease are fundamental aspects relevant to asthma control, even if children who suffer from severe asthma (more frequent exacerbations, sleep disturbances, a high number of school day missed, activity limitations) could not receive a proper diagnosis and treatment, mainly due to social deprivation. In this context the contact with a doctor, through a better knowledge of the disease, could help the child with asthma to self-manage his condition. The problem of perception of symptoms by the patient and the family is strictly related. Patient’s and parent’s ability to recognize asthma symptoms depend on a patient-physician partnership. Some educational programs have been shown as useful in reducing asthma morbidity in children [6]. Interventions should also take into account the environment that is an important factor relevant to asthma pathogenesis and control. It is well known that environmental triggers such as outdoor and indoor allergens, passive smoking and particulate matter can elicit and exacerbate acute attacks in asthmatic children. In particular, passive exposure to parental tobacco smoke is a risk factor for childhood wheeze [2] and is associated with poor asthma control in children [1]. Moreover, it has been demonstrated that proximity to traffic (living near heavily polluted roadways or bus stop) has a negative impact on respiratory health of children, with increased risk of wheezing, medication use and diminished lung function [3,7]. The most recent GINA guidelines underline the physician’s role in asthma management and care, emphasizing that a proper control of the disease depends on doctor’s ability and experience in recognizing symptoms (considering possible differential diagnoses), defining the severity level (also by evaluating the respiratory function, as recommended by international guidelines), prescribing the correct medication and educating the patient and his family [6]. Recent data demonstrate that physicians often ignore guidelines [4] and the importance of using asthma control tools [1]. Finally, significant disparities in health care based on patient’s insurance status, education level, income and race/ethnicity are relevant to asthma under-diagnosis and under-treatment. Some reports from Europe [1] and North America [2] show that over 50% of children with asthmatic symptoms don’t receive treatment according to guidelines [3] and are more likely to be hospitalized or visited in the emergency department [2]. A new study by Annesi-Maesano et al. [8] published in this issue of Multidisciplinary Respiratory Medicine added new evidence to this field of research. Using data from the “French 6 Cities Study” conducted on a sample of 7.798 schoolchildren, aged 9–10 yr, living in metropolitan France, the Authors identified the main risk factors associated with the presence or absence of asthma diagnosis and treatment. In particular, they considered individual, socio-demographic, clinical and environmental factors. Children underwent clinical tests while their parents completed a standardized medical questionnaire. The population-sample studied comprised 903 asthmatic children: 58% had a doctor diagnosis, only of them 67% were treated for their condition. The evaluation of the clinical condition showed some interesting evidences. First, the asthma severity level (evaluated according to GINA guidelines) was one of the main factors that influenced diagnosis and treatment. Most of undiagnosed and untreated children were in GINA level 1. Furthermore, in line with other studies [9], treatment was related to more severe asthma (more frequent exacerbations, sleep disturbances, hospitalizations, a high number of school days missed, activity limitations).Second, according to previous observations [10], diagnosed and treated asthmatic children had more allergic concomitant diseases, such as eczema and rhinitis. Therefore, co-morbidities and asthma severity seem to increase the likelihood of treatment. Relevant to under-treatment of asthma, the Authors also highlighted inconsistencies about the type of treatment used. In fact, most of the treated children used bronchodilators for both attacks prevention and therapy. Unexpectedly, in the sample of children without a doctor diagnosis of asthma, there was someone who took medications (bronchodilators or inhaled corticosteroids) to improve its respiratory symptoms. These observations may suggest both a poor adherence of physicians to guidelines within clinical practice [4], and a non-adherence of patients to the treatment plan. Previous studies reported that even patients with severe asthma do not follow the treatment properly. Therefore, it is necessary to improve physician’s compliance to guidelines within clinical practice through educational interventions that enrich their awareness about diagnostic tools and therapy. Furthermore, it is important to identify subjects non-adherent to treatment. Since the reasons for poor adherence may vary among patients, individualized interventions that improve patient’s compliance to therapy are strongly desirable [11]. In addition, Annesi-Maesano et al. [8] confirmed that a low socio-economic status still represents an important factor in asthma management and care, limiting the access to health care system and consequently the optimal control of the disease. At last, the Authors focused on environmental factors that can affect asthma management, particularly the exposure to passive smoking and urban traffic. They found that undiagnosed children were more exposed to maternal smoking and traffic. Moreover, they found that urban traffic (living near a bus stop) was the only environmental factor treatment-related. Proximity of an asthmatic’s house to a bus stop was an indicator of asthma severity and likelihood of treatment. Confirming existing data [1,3,7], these observations underline the necessity of taking into account the physical and social environment within clinical practice to improve management and care of asthmatic children. In summary, the study by Annesi-Maesano et al. [8] shows that childhood asthma is still under-diagnosed and under-treated in metropolitan France. The Authors, by identifying the clinical, social and environmental characteristics of undiagnosed and/or undertreated children, highlighted the main factors that can be associated with absence of asthma diagnosis and treatment. Since a poor asthma control can have detrimental effects on children’ health, similar studies are warranted to understand what interventions are necessary to achieve a better management of this disease.

Fractional exhaled nitric oxide (FeNO) is a non-invasive marker of airway inflammation in asthma and respiratory allergy. Environmental factors, especially indoor and outdoor air quality, may play an important role in triggering acute exacerbations of respiratory symptoms. The authors have reviewed the literature reporting effects of outdoor and indoor pollutants on FeNO in children. Although the findings are not consistent, urban and industrial pollution—mainly particles (PM2.5 and PM10), nitrogen dioxide (NO2), and sulfur dioxide (SO2)—as well as formaldehyde and electric baseboard heating have been shown to increase FeNO, whilst ozone (O3) tends to decrease it. Among children exposed to Environmental Tobacco Smoke (ETS) with a genetic polymorphisms in nitric oxide synthase genes (NOS), a higher nicotine exposure was associated with lower FeNO levels. Finally, although more studies are needed in order to better investigate the effect of gene and environment interactions which may affect the interpretation of FeNO values in the management of children with asthma, clinicians are recommended to consider environmental exposures when taking medical histories for asthma and respiratory allergy. Further research is also needed to assess the effects of remedial interventions aimed at reducing/abating environmental exposures in asthmatic/allergic patients.

Background Several cases of pine nut allergies and anaphylaxis have been reported in the literature, but only few pine nut allergens have been characterized. The aim of this research is to identify through immunoelectrophoretic techniques the major pine nut allergens in a group of children monosensitized to pine nuts. Methods We studied five children with pine nut allergies and no other sensitization to food except to pine nuts, confirmed by in vivo (prick test, prick-to-prick) and in vitro tests (specific IgE determinations [CAP-FEIA]). The protein profile of pine nuts was analyzed by Sodium Dodecyl sulfate Polyacrylamide Gel Electrophoresis (SDS-PAGE). Immunoblotting was performed after incubation of membranes with the sera from the children included in the present study. Results Immunoblotting (SDS-PAGE) demonstrated five similar bands between 6 and 47 kDa in all the subjects studied. Conclusion These bands should be considered the potential allergens for pine nut allergic children.

Cutaneous involvement characterized by urticarial lesions with or without angioedema and itch is commonly observed in routine medical practice. The clinical approach may still remain complex in real life, because several diseases may display similar cutaneous manifestations. Urticaria is a common disease, characterized by the sudden appearance of wheals, with/without angioedema. The term Chronic Urticaria (CU) encompasses a group of conditions with different underlying causes and different mechanisms, but sharing the clinical picture of recurring wheals and/or angioedema for at least 6 weeks. Hereditary Angioedema (HAE) is a rare disorder characterized by recurrent episodes of non-pruritic, non-pitting, subcutaneous or submucosal edema affecting the extremities, face, throat, trunk, genitalia, or bowel, that are referred as “attacks”. HAE is an autosomal dominant disease caused by a deficiency of functional C1 inhibitor, due to a mutation in C1-INH gene (serping 1 gene) characterized by the clonal proliferation of mast cells, leading to their accumulation, and possibly mediator release, in one or more organs. In childhood there are two main forms of mastocytosis, the Systemic and the Cutaneous. The clinical features of skin lesions in urticaria, angioedema and mastocytosis may differ depending on the aetiologic factors, and the underlying pathophysiological mechanisms. The diagnostic process, as stepwise approach in routine clinical practice, is here reviewed for CU, HAE and mastocytosis, resulting in an integrated method for improved management of these cutaneous diseases. Taking into account that usually these conditions have also a relevant impact on the quality of life of children, affecting social activities and behavior, the availability of care pathways could be helpful in disentangle the diagnostic issue achieving the most cost-effective ratio. Keywords: Urticaria, Angioedema, Mastocytosis, Skin, Itch, Children, Epidemiology, Diagnosis, Management, Clinical practice

Background and aims Lower tract respiratory infections (LTRI) are very frequent in paediatric population. We collected epidemiological, etiological and clinical data and correlated them to some variables. Methods We performed an observational study of all children with a LTRI, admitted to our Paediatric Unit from February 2013 to January 2014. The population was grouped in three classes of ages (0–2yr, 3–6yr, >6yr). All patients underwent to a questionnaire focused on exposition to protective and risk factors for respiratory diseases. Results 83 children were included. We grouped them according to discharge diagnosis and analysed the distribution for ages, sex and season of onset. At the admission 18 patients had respiratory distress; O2 therapy was necessary for 11 of them, infusion therapy for 40, endovenous antibiotic therapy for 34. Swabs were positive in 1 case for Parainfluenza viruses and in 2 for S. Aureus; sierological tests were positive in 5 cases for Mycoplasma Pneumoniae, in 2 for Chlamydia Pneumoniae, in 1 for ParvovirusB19, in 1 for Coxsackievirus. In 28 patients (33%) exposition to passive smoke was observed, in 17 (20%) to aeroallergens and in 33 (40%) a personal or familiar story of atopy. Conclusions Our experience showed a higher prevalence of LTRI in males (63%), in winter (35%) and spring (33%), without a difference between preschool and school age children.

Asthma is considered an heterogeneous disease, requiring multiple biomarkers for diagnosis and management. Fractional exhaled nitric oxide in exhaled breath (FeNO) was the first useful non-invasive marker of airway inflammation in asthma and still is the most widely used. The non-invasive nature and the relatively easy use of FeNO technique make it an interesting tool to monitor airway inflammation and rationalize corticosteroid therapy in asthmatic patients, together with the traditional clinical tools (history, physical examination and lung function tests), even if some controversies have been published regarding the use of FeNO to support the management of asthma in children. The problem of multiple confounding factors and overlap between healthy and asthmatic populations preclude the routine application of FeNO reference values in clinical practice and suggest that it would be better to consider an individual “best”, taking into account the context in which the measurement is obtained and the clinical history of the patient. Besides, there is still disagreement about the role of FeNO as a marker of asthma control, due to the complexity of balance among the different items involved in its determination and the lack of homogeneity in the population groups studied in the few studies conducted so far. Heterogeneity of problematic severe asthma greatly limits utility of FeNO alone as a biomarker of inflammation to optimize the disease management on an individual basis. None of the studies conducted so far demonstrated that the use of FeNO was better than current asthma guidelines in controlling asthma exacerbations. In summary, there is a large variation in FeNO levels between individuals, which may reflect the natural heterogeneity in baseline epithelial nitric oxide synthase activity and/or the contribution of other noneosinophilic factors to epithelial nitric oxide synthase activity. FeNO is a promising biomarker, but at present some limits are highlighted. We would recommend that further research can be carried out by organizing studies aimed to obtain reliable reference values of FeNO and in order to better interpret FeNO measurements in clinical settings, taking also into account the influence of genetic and environmental factors.

The evidence of a relationship between second hand smoke (SHS) exposure and atopy is inadequate. Smoke habit prevalence is higher in lower parental educational levels. The aim of this study was to investigate the relationship between SHS and atopy in asthmatic children focusing on socioeconomic status (SES). We studied 170 outpatient asthmatic children with different levels of asthma (GINA guidelines). Medical history was taken in standardized way to determine prevalence of SHS exposure and maternal smoking during pregnancy. Information about the highest level of parental education was collected as a proxy of SES level. All patients underwent skin prick test (SPT) and spirometry according to international guidelines. Statistical analyses were performed using SPSS 19. 78 (45,9%) SHS exposed (SHSe) and 92 (54,1%) SHS non exposed (SHSne) asthmatic children were analyzed, aged 8.71±2.58 and 8.75±2.95, respectively. Exposure to maternal smoke in pregnancy was found only in SHSe (p

In recent years, the interest of the scientific world towards vitamin D gradually increased, and several studies have been conducted to dissect its possible role in modulating the development/course of allergic diseases. Also, Vitamin D supplementation has been assessed as a beneficial approach for treating allergies in some, but not all studies. We reviewed herein the available and relevant literature concerning the possible links between Vitamin D, its supplementation and allergic diseases. A literature search was made independently by the Authors, identifying articles for a narrative review. As per literature, Vitamin D plays a key role in calcium and phosphate metabolism, and it is essential for bone health in infants, children and adolescents. However, there is presently insufficient evidence to support vitamin D supplementation for prevention or treatment of allergic diseases in infants, children and adolescents, concerning allergic rhinitis, asthma, food allergy and atopic dermatitis. Keywords: Vitamin D, Allergic diseases, Immunomodulation, Supplementation, Asthma, Rhinitis, Pediatric allergy

Key Points Question Is COVID-19 associated with severe gastrointestinal manifestations in children? Findings In this multicenter cohort study of 685 Italian children with COVID-19, 10% showed severe gastrointestinal involvement characterized by diffuse adeno-mesenteritis, appendicitis, abdominal fluid collection, ileal intussusception, or pancreatitis. Children older than 5 years and those presenting with abdominal pain, leukopenia, or receiving a diagnosis of multisystem inflammatory syndrome were more likely to have severe gastrointestinal manifestations. Meaning Severe gastrointestinal involvement is not uncommon in children with COVID-19, and awareness about its frequency and presentation may help practitioners to appropriately manage children at risk of severe outcomes., Importance Severe gastrointestinal (GI) manifestations have been sporadically reported in children with COVID-19; however, their frequency and clinical outcome are unknown. Objective To describe the clinical, radiological, and histopathologic characteristics of children with COVID-19 presenting with severe GI manifestations to identify factors associated with a severe outcome. Design, Setting, and Participants A multicenter retrospective cohort study (February 25, 2020, to January 20, 2021) enrolled inpatient and outpatient children (aged 10 years: OR, 6.37; 95% CI, 2.12-19.1, compared with preschool-age), abdominal pain (adjusted OR [aOR], 34.5; 95% CI, 10.1-118), lymphopenia (aOR, 8.93; 95% CI, 3.03-26.3), or MIS-C (aOR, 6.28; 95% CI, 1.92-20.5). Diarrhea was associated with a higher chance of adenomesenteritis (aOR, 3.13; 95% CI, 1.08-9.12) or abdominal fluid collection (aOR, 3.22; 95% CI, 1.03-10.0). Conclusions and Relevance In this multicenter cohort study of Italian children with SARS-CoV-2 infection or MIS-C, 9.5% of the children had severe GI involvement, frequently associated with MIS-C. These findings suggest that prompt identification may improve the management of serious complications., This cohort study assesses the clinical, radiological, and histopathologic gastrointestinal characteristics of a large cohort of children with acute SARS-CoV-2 infection or multisystem inflammatory syndrome in children to identify factors associated with severe gastrointestinal manifestations and describes their clinical course and outcome.

In chronic diseases, a correct diagnosis and access to the most appropriate treatments are not sufficient to ensure an improved clinical condition. The patient’s compliance with a treatment regimen is a crucial, though often neglected step for achieving and maintaining over time outcomes that would otherwise be unattainable, first of all the disease control. Asthma is a multifactorial condition and, for this reason, its poor management might cause an altered quality of life and a significant increase in healthcare costs. New technologies offer valuable support to both patients and healthcare workers, allowing for therapeutic monitoring and ongoing assistance.

Il cambiamento climatico rappresenta una delle maggiori minacce per l’umanità e la natura, in grado di influenzare sia la salute dell’uomo e degli animali che il ciclo vitale delle piante. Numerosi studi hanno infatti evidenziato effetti sugli ecosistemi descrivendo un trend di anticipo generale negli eventi fenologici, sia per le specie vegetali sia per quelle animali. Gli Autori considerano tra i vari fattori responsabili nel contribuire a queste variazioni i parametri climatici, principalmente la temperatura e gli inquinanti atmosferici, in particolare l’anidride carbonica. Le complesse interazioni tra fattori climatici ed inquinanti ambientali, causa di aumentata crescita di specie arboree allergeniche e produzione di pollini, possono incrementare il rischio di manifestazioni allergiche nei soggetti sensibilizzati attraverso meccanismi quali: il danno della mucosa delle vie aeree con compromissione della clearance mucociliare, l’aumentata permeabilità con conseguente facilitata penetrazione di allergeni, la stimolazione della risposta immunitaria con aumentata produzione di IgE. L’aumentata concentrazione nell’aria di allergeni inalanti aumenta in questi soggetti il rischio di rinite allergica ed asma, nonché di riacutizzazioni di malattia in forme anche gravi. Le misure volte a contenere il degrado ambientale devono tener conto della peculiare vulnerabilità dei bambini al fine di proteggerli da esposizioni nocive con conseguenze potenzialmente irreversibili sulla salute.