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Background: We followed the effects of a new SCIT with a chemically polymerized allergen Alt a1, evaluating the trend of clinical and functional parameters in an observational-prospective study. Methods: 42 children with AR and intermittent asthma sensitized to A.A.: 17 patients started SCIT (Modigoid®), and 25 continued symptomatic therapy. At the initial visit (T0), all patients performed total IgE (tIgE) and specific IgE (sIgE) for Alt a1, nasal nitric oxide (nFeNo), nasal cytology, anterior active rhinomanometry (AAR) and spirometry. After 24 months (T1), they repeated the same procedures as in T0. Results: Patients treated with Modigoid presented a statistically significant (p < 0.001) reduction of nFeNO (T0:1651.06 ± 149.18; T1: 1394.12 ± 108.98), tIgE (T0: 311.48 ± 144.18; T1: 164.73 ± 50.69), sIgE for Alt a1 (T0: 28.59 ± 12.69; T1: 19.54 ± 7.37), an improvement of nasal airflow (T0: 71.62 ± 8.66; T1: 95.12 ± 5.91), nasal eosinophils (T0: 20.59 ± 2.35; T1: 14.88 ± 1.65) and FEV1 (T0: 95.58 ± 7.91; T1: 116.64 ± 5.94). Conclusions: The new SCIT for Alt a1 significantly improves AR symptoms from a subjective, objective point of view and laboratory and functional parameters.

Allergic respiratory diseases, such as asthma and allergic rhinitis, are global health issues and have had an increasing prevalence in the last decades. Allergen-specific immunotherapy (AIT) is the only curative treatment for allergic rhinitis and asthma, as it has a disease-modifying effect. AIT is generally administered by two routes: subcutaneous (SCIT) and sublingual immunotherapy (SLIT). Local side effects are common, but usually well-tolerated and self-limited. However, systemic side effects are rare, and associated with uncontrolled asthma and bronchial obstruction, or related to errors in administration. Physicians should constantly assess potential risk factors for not only reporting systemic reactions and fatalities but also implementing other therapies to improve AIT safety. This paper highlights recent evidence on local and systemic reactions related to SCIT and SLIT in children.

This paper presents the results obtained in an extensive Gas Lift Valves (GLVs)flow trials, which were performed in an experimental liquid flow test loop. The objective was to evaluate GLVs performance with respect to their back flow retention condition, after being exposed to large volumes of flowing liquids. In case of a check valve failure, remediation strategies were also presented and evaluated. Four different GLVs were subjected to brine flow. The tests consisted of a minimum of 15 flow cycles comprising a volume of 150 m3 (942 bbl) each, at a flowrate of 0.32 m3/min (2 bbl/min). In between cycles, the GLV was tested for back flow. The check valve test was performed with the GLV installed in its original position at the flow test loop (i.e., no need to disassemble the GLV and move it to another facility). In case of back flow failure detection, remediation strategies, such as flushing with industrial water and cycles of pressurization and depressurization, were tested. None of the four GLVs tested completed the minimum of 15 cycles without any failure. After flushing the system with industrial water, three GLVs regained its back flow retention capabilities and the other still presented the back flow failure. In some cases, the check valve presented failure when tested inside the flow loop, but did not present the same failure when moved to the Nitrogen/calibration test bench. This event has indicated the importance of testing the back flow retention inside the flow test loop. It was also observed that pressurization and de-pressurization speed can affect the results. Testing of liquid flow through GLVs usually involves a small volume of liquid, which may not be enough to cause problems with the check valve. In this paper we present new tests results with larger liquid volumes of liquid passing through the GLVs. The results are important to understand the condition of GLVs to handle higher flow liquid volumes.

Background: Selective IgA deficiency (SIgAD) is the most common inborn error of immunity. The exact prevalence and pathogenesis of allergy in SIgAD have not yet been defined. We aimed to describe the prevalence and the characteristics of allergy in pediatric SIgAD subjects, evaluate the association between allergy and other comorbidities, and define the immune phenotype of allergic and non-allergic patients. Methods: Clinical and immunological data from 67 SIgAD patients were collected over a 13-year period at a single center. Patients’ characteristics were analyzed according to the presence of allergy. Results: Allergy was diagnosed in 34% of SIgAD patients, with a median age at allergy diagnosis of 8 years. Allergy was the second-most-common clinical manifestation, following recurrent respiratory infections. Among the allergic group, 74% had rhinitis, 30% asthma, 30% atopic dermatitis, and 22% food allergy; one out of three had more than one allergic manifestation. SIgAD patients showed more frequent transitory lymphopenia and a lower count of CD19+ at diagnosis than at last FU. However, compared to non-allergic subjects, allergic patients did not differ in their immune phenotype, number and severity of infections, or increased autoimmunity. Conclusions: In our longitudinal study, compared to non-allergic SIgAD patients, those with allergies did not present a more severe immune defect or complex clinical phenotype. However, evaluation and early identification of allergy in the context of SIgAD assessment, both at diagnosis and during FU, and definition of a proper management are important to prevent complications and improve the patient’s quality of life.

Cow’s milk allergy (CMA) is a common condition in the pediatric population. CMA can induce a diverse range of symptoms of variable intensity. It occurs mainly in the first year of life, and if the child is not breastfed, hypoallergenic formula is the dietary treatment. Extensively hydrolyzed cow’s milk formulas (eHF) with documented hypo-allergenicity can be recommended as the first choice, while amino acid-based formulas (AAF) are recommended for patients with more severe symptoms. Hydrolyzed rice-based formulas (HRFs) are a suitable alternative for infants with CMA that cannot tolerate or do not like eHF and in infants with severe forms of CMA. In the present paper, we reviewed the nutritional composition of HRFs as well as studies regarding their efficacy and tolerance in children, and we provided an updated overview of the recent evidence on the use of HRFs in CMA. The available studies provide evidence that HRFs exhibit excellent efficacy and tolerance and seem to be adequate in providing normal growth in healthy children as well as in children with CMA.

BACKGROUND Vernal keratoconjunctivitis (VKC) is a rare chronic conjunctivitis characterized by a predominantly eosinophil-mediated inflammatory disorder that could develop critical complications such as blindness. Oxidative stress plays a pivotal role in the pathogenesis of several allergic diseases. The role of oxidative stress has been hypothesized in VKC, but no study explored this issue. Furthermore, cyclosporine A (CsA) exerts an anti-inflammatory and antioxidant action on the conjunctiva. This study aimed to assess the oxidative stress in VKC patients and controls and to study the effect of CsA on oxidative stress in these subjects. METHODS Thirty-six consecutive children, including 12 VKC (nine males, 75%; mean age 10.17; SD ± 2.48) patients without treatment, 12 VKC patients treated with CsA (nine males, 75%; mean age 9.08; SD ± 2.75), and 12 controls (CT) (seven males, 58%; mean age 8.58; SD ± 1.78), were recruited. A cross-sectional study was performed to compare H2 O2 in the serum with that in the tears of these children. RESULTS Compared with CT and VKC children treated with CsA, VKC untreated children had significantly higher values of hydrogen peroxide (H2 O2 ) in the serum and the tears. No significant differences were observed between CT and VKC treated with CsA. A significant correlation was found at the linear regression analysis between serum and tear H2 O2 levels. CONCLUSION This study provides the first report attesting that patients with VKC have high oxidative stress; furthermore, it suggests that CsA could have an anti-inflammatory and antioxidant action that could be useful to prevent the poor VKC outcome.

Selective IgA deficiency (SIgAD) is the most common human primary immune deficiency (PID). It is classified as a humoral PID characterized by isolated deficiency of IgA (less than 7 mg/dL but normal serum IgG and IgM) in subjects greater than 4 years of age. Intrinsic defects in the maturation of B cells and a perturbation of Th cells and/or cytokine signals have been hypothesized to contribute to SIgAD pathogenesis. The genetic basis of IgA deficiency remains to be clarified. Patients with SIgAD can be either asymptomatic or symptomatic with clinical manifestations including allergy, autoimmunity and recurrent infections mainly of the respiratory and gastrointestinal tract. Studies analyzing allergy on SIgAD patients showed prevalence up to 84%, supporting in most cases the relationship between sIgAD and allergic disease. However, the prevalence of allergic disorders may be influenced by various factors. Thus, the question of whether allergy is more common in SIgAD patients compared to healthy subjects remains to be defined. Different hypotheses support an increased susceptibility to allergy in subjects with SIgAD. Recurrent infections due to loss of secretory IgA might have a role in the pathogenesis of allergy, and vice versa. Perturbation of microbiota also plays a role. The aim of this review is to examine the association between SIgAD and atopic disease and to update readers on advances over time at this important interface between allergy and SIgAD.

Background In 2019, a multidisciplinary panel of experts from eight Italian scientific paediatric societies developed a consensus document for the use of inhaled corticosteroids in the management and prevention of the most common paediatric airways disorders. The aim is to provide healthcare providers with a multidisciplinary document including indications useful in the clinical practice. The consensus document was intended to be addressed to paediatricians who work in the Paediatric Divisions, the Primary Care Services and the Emergency Departments, as well as to Residents or PhD students, paediatric nurses and specialists or consultants in paediatric pulmonology, allergy, infectious diseases, and ear, nose, and throat medicine. Methods Clinical questions identifying Population, Intervention(s), Comparison and Outcome(s) were addressed by methodologists and a general agreement on the topics and the strength of the recommendations (according to the GRADE system) was obtained following the Delphi method. The literature selection included secondary sources such as evidence-based guidelines and systematic reviews and was integrated with primary studies subsequently published. Results The expert panel provided a number of recommendations on the use of inhaled corticosteroids in preschool wheezing, bronchial asthma, allergic and non-allergic rhinitis, acute and chronic rhinosinusitis, adenoid hypertrophy, laryngitis and laryngospasm. Conclusions We provided a multidisciplinary update on the current recommendations for the management and prevention of the most common paediatric airways disorders requiring inhaled corticosteroids, in order to share useful indications, identify gaps in knowledge and drive future research.

Background COVID-19 lockdown caused sudden changes in people’s lifestyle, as a consequence of the forced lockdown imposed by governments all over the world. We aimed to evaluate the impact of lockdown on body mass index (BMI) in a cohort of allergic children and adolescents. Methods From the first of June until the end of October 2020, we submitted a written questionnaire to all the patients who, after lockdown, carried out a visit at the Pediatric Allergy Unit of the Department of Mother-Child, Urological Science, Sapienza University of Rome. The questionnaire was composed by 10 questions, referring to the changes in their daily activities. Data were extrapolated from the questionnaire and then analyzed considering six variables: BMI before and BMI after lockdown, sugar intake, sport, screens, sleep, and anxiety. Results One hundred fifty-three patients agreed to answer our questionnaire. Results showed a statistically significant increase in the BMI after lockdown (20.97 kg/m2 ± 2.63) with respect to the BMI before lockdown (19.18 kg/m2 ± 2.70). A multivariate regression analysis showed that the two variables that mostly influenced the increase in BMI were sleep and anxiety. Conclusions For the analyzed cohort of allergic children and adolescents we obtained significant gain in BMI as consequences of lockdown, which can be explained by many factors: high consumption of consolatory food, less sport activities, more time spent in front of screens, sleep alteration associated with increased anxiety. All these factors acted together, although sleep alteration and increased anxiety were the most influential factors that led to the worsening or the onset of weight gain, creating the basis for future health problems.

Although currently approved to treat severe asthma and chronic spontaneous urticaria, omalizumab has also been an effective and safe add-on treatment for other allergic diseases. Namely, omalizumab has been proposed to be used as add-on therapy in patients with allergic rhinitis and asthma and undergoing specific allergen immunotherapy (AIT). AIT is the only treatment that modifies the natural history of IgE-mediated diseases. This brief review summarizes the available evidence and controversies on the efficacy and safety of omalizumab combined with specific AIT.

Este estudo tem por objetivo analisar as condicoes hidrologicas associadas ao clima predominante no municipio de Quixeramobim, localizado na Mesorregiao do Sertao Central no estado do Ceara. Alem de identificar os principais impactos ambientais, com intuito de contribuir para a gestao adequada dos recursos hidricos do municipio. Quanto ao metodo, constituiu-se em abordagem qualiqualitativa, observacoes sistematicas dos recursos hidricos, entre outros componentes naturais do municipio, e utilizacoes de tecnicas para a identificacao dos principais impactos resultantes das acoes antropicas na regiao. Para analise hidroclimatologica, foram coletados e tratados dados pluviometricos durante a serie historica de (2006 a 2016), a elaboracao de graficos e balanco hidrico para a observacao do comportamento hidrologico do municipio. Foram realizadas observacoes diretas em campo e utilizacao de tecnicas operacionais, com auxilio de ferramentas de Sistemas de Informacoes Geograficas (SIG) e do Sensoriamento Remoto. Quanto os resultados obtidos, foram levantados uma serie de problemas ambientais relacionados a degradacao dos recursos hidricos, entre outras unidades geoambientais. Considera-se que estas analises contribuam para subsidiar e auxiliar na identificacao de acoes que visem priorizar a melhoria na gestao e conservacao dos recursos naturais do municipio. Palavras – chave: analise hidroclimatologica; impactos ambientais; recursos hidricos; unidade geoambiental. ABSTRACT This study aims to analyze the hydrological conditions associated with predominant climate in the municipality of Quixeramobim, located in the Meso-region of the Central backcountry in the state of Ceara. In addition, the main environmental impacts, with the aim of contributing to a better adequate management of the municipality's water resources. As for the method, it was a constituted in a qualitative approach in which they were used systematic observations of hydric resources and other natural components of the municipality, and utilizations of techniques to identification of the main impacts resulting from anthropic actions in the region. For hydroclimatological analysis, were collected and treated pluviometric data during the historical series of (2006 to 2016), the elaboration of graphs and hydric balance for the observation of the hydrological behavior of the municipality. the field and utilization of operational techniques, with the help of tools of Geographic Information Systems (GIS) and Remote Sensing. Regarding the results obtained, a series of environmental problems were collected related to the degradation of the hydric resources and among other geoenvironmental units. It is considered that these analyzes contribute in a way to subsidize, assist in the identification of actions aimed at prioritizing a greater management and conservation of the natural resources of the municipality. Key-words: hydroclimatological analysis; environmental impacts; water resources; geoenvironmental unit. RESUMEN Este estudio tiene como objetivo analizar las condiciones hidrologicas asociadas con el clima predominante en el municipio de Quixeramobim, ubicado en la Mesorregion de Sertao Central en el estado de Ceara. Ademas de identificar los principales impactos ambientales, con el fin de contribuir a la gestion adecuada de los recursos hidricos del municipio. En cuanto al metodo, consistio en un enfoque cualitativo y cualitativo, observaciones sistematicas de los recursos hidricos, entre otros componentes naturales del municipio, y el uso de tecnicas para identificar los principales impactos resultantes de las acciones antropicas en la region. Para el analisis hidroclimatologico, los datos de lluvia se recolectaron y trataron durante la serie historica (2006 a 2016), la elaboracion de graficos y el balance hidrico para observar el comportamiento hidrologico del municipio. Las observaciones directas de campo y las tecnicas operativas se llevaron a cabo utilizando sistemas de informacion geografica (SIG) y herramientas de teledeteccion. En cuanto a los resultados obtenidos, se plantearon una serie de problemas ambientales relacionados con la degradacion de los recursos hidricos, entre otras unidades geoambientales. Se considera que estos analisis contribuyen a subsidiar y ayudar en la identificacion de acciones que tienen como objetivo priorizar la mejora en la gestion y conservacion de los recursos naturales del municipio. Palabras clave: analisis hidroclimatologico; impactos ambientales; recursos hidricos; unidad geoambiental.

O Nordeste se destaca como a região que mais gera energia eólica no Brasil, uma vez que a soma dos quatro estados mais relevantes (Rio Grande do Norte, Bahia, Ceará e Piauí) representava, em novembro de 2021, 81,2 % da geração total nacional (19,7 GW), conforme dados da Agência Nacional de Energia Elétrica (ANEEL). Este artigo tem por objetivo analisar os critérios que devem ser considerados durante a escolha da localização dos parques eólicos, considerando a existência de comunidades tradicionais. Foram selecionadas duas comunidades tradicionais para exemplificar as problemáticas: Cumbe (município de Aracati/CE) e Xavier (município de Camocim/CE). O percurso metodológico trilhado partiu de uma análise quali-quantitativa, desenvolvida em três etapas: consulta à literatura científica, construção de banco de dados geográficos e produção de mapeamento investigativo. Os resultados apontaram 94 parques de energia eólica onshore e 5 projetos de energia eólica offshore, que coadunam com 58 unidades de conservação e 464 assentamentos rurais do Instituto Nacional de Colonização e Reforma Agrária (INCRA). Concluiu-se que os critérios de localização desses empreendimentos devem atender à legislação e às expectativas de participação social, fazendo-se necessário considerar o uso de metodologias participativas, como uma ferramenta de obtenção de informações relevantes no processo de implantação, a fim de reduzir danos e conflitos socioambientais.

Background: Probiotics may prevent the allergic response development due to their anti-inflammatory and immunomodulatory effects. The aim of this study is to determine if the prophylactic treatment with a mixture of Bifidobacterium animalis subsp. Lactis BB12 and Enterococcus faecium L3 would reduce symptoms and need for drug use in children with allergic rhinitis (AR). Methods: The study included 250 children aged from 6 to 17 years, affected by AR. Patients were randomly assigned to the intervention group (150) or to the placebo group (100). Patients in the intervention group, in addition to conventional therapy (local corticosteroids and/or oral antihistamines), were treated in the 3 months preceding the onset of symptoms related to the presence of the allergen to which the children were most sensitized, with a daily oral administration of a probiotic mixture containing the Bifidobacterium animalis subsp. Lactis BB12 DSM 15954 and the Enterococcus faecium L3 LMG P-27496 strain. We used Nasal Symptoms Score (NSS) to evaluate AR severity before and after the treatment with probiotics or placebo. Results: the patients in the intervention group had a significant reduction in their NSS after probiotic treatment (p-value = 2.2 × 10−10. Moreover, for the same group of patients, we obtained a significant reduction in the intake of pharmacological therapy. In particular, we obtained a reduction in the use of oral antihistamines (p-value = 2.2 × 10−16), local corticosteroids (p-value = 2.2 × 10−13), and of both drugs (p-value 1.5 × 10−15). Conclusions: When administered as a prophylactic treatment, a mixture of BB12 and L3 statistically decreased signs and symptoms of AR and reduced significantly the need of conventional therapy.

Giulia Brindisi,1,* Valentina De Vittori,1,* Rosalba De Nola,2,3 Antonio Di Mauro,4 Giovanna De Castro,1 Maria Elisabetta Baldassarre,4 Ettore Cicinelli,2 Bianca Cinicola,1 Marzia Duse,1 Anna Maria Zicari1 1Pediatrics Department, Umberto I Hospital, Sapienza University, Rome, 00161, Italy; 2Department of Biomedical Science and Human Oncology, Gynecology and Obstetrics Section, “Aldo Moro” University of Bari, Bari, 70124, Italy; 3Department of Tissues and Organs Transplantation and Cellular Therapies, “Aldo Moro” University of Bari, Bari, 70124, Italy; 4Department of Biomedical Sciences and Human Oncology-Neonatology and Neonatal Intensive Care Unit, “Aldo Moro” University of Bari, Bari, 70124, Italy*These authors contributed equally to this workCorrespondence: Giulia BrindisiPediatrics Department, Umberto I Hospital, Sapienza University, Viale Regina Elena 324, Rome, 00161, ItalyTel +39 06 49979333Email giulia.brindisi@gmail.comBackground: Allergic rhinitis (AR) and asthma are two common atopic diseases, often associated with a common ethiopathogenesis characterized by a Th2 inflammatory response with the release of many biomarkers, such as nitric oxide (NO).Purpose: To evaluate and compare inflammatory (nFeNO and eFeNO) and functional (mNF and FEV1) parameters in AR children with or without asthma in comparison to controls. Secondly, we aimed to identify nFeNO cut-off values and verify their reliability to predict the presence of rhinitis or asthma alone or in combination.Patients and Methods: We enrolled 160 children (6– 12 years of age) with AR and/or asthma divided into four groups: controls, AR, asthma, and AR + asthma. All children underwent the following inflammatory and functional measurements: nFeNO, eFeNO, mNF and FEV1.Results: We observed that levels of nFeNO were extremely higher in children with AR and even more in those with AR + asthma in respect to controls. Notably, all the pathological conditions, especially AR + asthma, showed significantly lower values of mNF compared to healthy children. A negative correlation linked mNF and nFeNO. Then, we found eFeNO values significantly higher in all the pathological groups compared to controls, with major values of this marker in patients affected by asthma and AR + asthma, as well as FEV1 values significantly lower in all the disease groups, especially in children with asthma and AR+ asthma. ROC curve analysis showed that nFeNO was a great predictor for rhinitis alone or with asthma, revealing an accurate cut-off of 662 ppb.Conclusion: nFeNO measurement is non-invasive, easy to perform, economic and a valuable test in case of AR alone or in association with asthma. Thus, it should be used in patients with rhinitis, together with anterior active rhinomanometry (AAR) to diagnose and estimate the degree of nasal obstruction but also in children with asthma to assess their nasal involvement and improve the therapeutic management.Keywords: nasal nitric oxide, exhaled nitric oxide, anterior active rhinomanometry, allergic rhinitis, asthma, children

BACKGROUND: Probiotics may prevent the allergic response’s development due to their anti-inflammatory and immunomodulatory effects. The aim of this study is to determine if the prophylactic treatment with a mixture of Bifidobacterium animalis subsp. Lactis BB12 and Enterococcus faecium L3, would reduce symptoms and need for drug use in children with allergic rhinitis (AR). METHODS: The study included 250 children aged from 6 to 17 years, affected by AR. Patients were randomly assigned to the intervention group (117) or to the placebo group (86). Patients of the intervention group, in addition to conventional therapy (local corticosteroids and/or antihistamines), were treated, in the 3 months preceding the development of AR symptoms, with a daily oral administration of a probiotic mixture containing the Bifidobacterium animalis subsp Lactis BB12 DSM 15954 and the Enterococcus faecium L3 LMG P-27496 strain. Nasal Symptoms Score(NSS) was used to evaluate AR severity before and after the treatment with probiotics or placebo. RESULTS: 96% of the patients in the intervention group showed a significant decrease in their NSS after the probiotic treatment as well as a decrease in the intake of pharmacological therapy. GPower software was used to calculate the test power. Given the probability of error α = 0.05, the total sample size n = 117 and the effect size ρ = 2.0651316, the power of the test is 1 - β = 1. CONCLUSIONS: When administered as a prophylactic treatment the mixture of BB12 and L3 statistically decrease signs and symptoms of AR and reduces significantly the need of drugs.

Background: Between June and July 2020, we evaluated children and adolescents concerning post-infection surveillance after a COVID-19 positivity during the lockdown. We aimed to assess whether the anamnestic presence of allergies could correlate with the presence of SARS-CoV-2 symptoms, and in particular with anosmia. Material and methods: For each patient, we collected anamnestic data, the presence of allergies documented by performing skin prick tests, and COVID-19 symptoms. Then, if over six years of age, each patient underwent an active anterior rhinomanometry. Results: A total of 296 patients were enrolled, of whom 105 (35.4%) reported allergies. Considering COVID-19 symptoms, 74 subjects (25%) presented an asymptomatic form, 222 (75%) reported symptoms, and anosmia recurred in 60 subjects (27.03%). A statistically significant relationship was found between allergies and symptomatic COVID-19 (p = 0.042), allergies, and anosmia (p = 0.05), and allergies and anosmia in males (p = 0.007). Moreover, anosmic patients presented a higher body mass index, older age, and a longer COVID-19 duration with statistical significance (p = 0.001, 0.001, 0.006, respectively). Conclusions: Allergic subjects seem to develop symptomatic COVID-19 more frequently and allergies appear to be a protective factor from anosmia’s onset in males.

Allergic diseases, such as IgE-mediated food allergy, asthma, and allergic rhinitis, are relevant health problems worldwide and show an increasing prevalence. Therapies for food allergies are food avoidance and the prompt administration of intramuscular epinephrine in anaphylaxis occurring after accidental exposure. However, allergen immunotherapy (AIT) is being investigated as a new potential tool for treating severe food allergies. Effective oral immunotherapy (OIT) and epicutaneous immunotherapy (EPIT) induce desensitization and restore immune tolerance to the causal allergen. While immediate side effects are well known, the long-term effects of food AIT are still underestimated. In this regard, eosinophilic gastrointestinal disorders (EGIDs), mainly eosinophilic esophagitis, have been reported as putative complications of OIT for food allergy and sublingual immunotherapy (SLIT) for allergic asthma and rhinitis. Fortunately, these complications are usually reversible and the patient recovers after AIT discontinuation. This review summarizes current knowledge on the possible causative link between eosinophilic gastrointestinal disorders and AIT, highlighting recent evidence and controversies.

Introdução: O climatério é a fase de transição entre o período reprodutivo e não reprodutivo no sexo feminino. Essa transição é marcada por alterações nos níveis de hormônios ovarianos no organismo e pode ser acompanhada de ciclos menstruais irregulares, instabilidade emocional, fogachos, distúrbios no sono e baixa lubrificação vaginal. A menopausa é definida como o último episódio menstrual na vida da mulher, sendo diagnosticada após 12 meses de amenorreia. Esse fenômeno ocorre em decorrência do envelhecimento ovariano, com consequente perda de sua função e produção hormonal. Em razão do hipoestrogenismo, do impacto na autoestima relacionado à chegada de uma nova fase na vida da mulher e das diversas modificações clínicas consequentes ao climatério, é esperado que esse período de transição influencie a sexualidade feminina. Objetivo: O presente estudo teve como objetivo avaliar como e quanto o climatério influencia na sexualidade das mulheres. Métodos: Foi realizada uma revisão sistemática de literatura com base em oito artigos publicados no período de 2006 a 2020 e selecionados por meio das plataformas UpToDate e Scientific Electronic Library Online (SciELO), no mês de março de 2021. Resultados e conclusão: A sexualidade possui caráter multidimensional, está presente em todas as fases da vida e é influenciada pelo contexto social, cultural, econômico, religioso, psicológico e educacional de cada indivíduo. No Brasil, 60% das mulheres referem a redução das atividades sexuais após a menopausa. Verificou-se, em um estudo realizado no Recife com uma amostra de 173 mulheres de 35 a 65 anos durante o climatério, que 46,2% apresentam disfunção sexual. Outra pesquisa, realizada por meio de um questionário aplicado entre 370 mulheres de 40 a 65 anos no Rio Grande do Norte, evidenciou que 65% delas apresentam um risco para o desenvolvimento de disfunção sexual. Um dos principais fatores relacionados ao impacto na sexualidade feminina é a questão psicológica que o climatério gera na vida da mulher, pela menor valorização da sociedade evidenciada após essa fase e pelas modificações estéticas do envelhecimento, que influenciam a autoestima, levando à diminuição do desejo sexual. O hipoestrogenismo também pode favorecer o aparecimento de depressão e ansiedade em razão da menor secreção de endorfinas cerebrais. Além disso, as repercussões genitais, como a atrofia vulvovaginal, a diminuição da lubrificação/ressecamento e o afinamento do epitélio vaginal, a elevação do pH local e a perda da elasticidade, consequentes à redução dos níveis de estrogênio, podem levar à dispareunia e à menor satisfação sexual. Pode-se concluir, portanto, que o climatério possui importante interferência na sexualidade feminina e que é fundamental identificar as queixas e condições relacionadas a esse período para que as repercussões negativas sejam minimizadas e a qualidade de vida seja preservada.

Sleep disorders are currently a major public health issue in Brazil, due to its high incidence and difficult diagnosis, identification of type and treatment.1 Rheumatic disorders have been associated with changes in sleep state, which cause reduction in quality of life, eventually reduced by the chronic inflammatory process of the primary disease.2–6 This study aimed to identify and describe the existence of sleep disturbances in patients with psoriatic arthritis, as well as to verify possible association of sleep disorders with metabolic syndrome and other parameters in these individuals. Thirty one patients with psoriatic arthritis from a Rheumatology Outpatient Clinic were analyzed. Three sleep assessment questionnaires were employed: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (EPW) and The Berlin Questionnaire (BQ). Sleep walking or talking were also inquired as a complementary scale. Sociodemographic variables and the presence of hypertension, obesity, diabetes, dyslipidemia and metabolic syndrome have also been investigated. On average, sleep disorders were found in 54.83% of the studied patients (64.5% from PSQI, 51.6% from EPW and 48.4% from Berlin) and around 70% of sleep disorders in patients with simultaneous diagnosis of metabolic syndrome and psoriatic arthritis. From these results, it is notable that sleep disorders are common in patients diagnosed with psoriatic arthritis. Thus, this pathology demands greater attention in clinical practice and search for ideal and complete therapy, in addition to simultaneous control of arthritis, sleep, hypertension, dyslipidemia and obesity.

Background: Vernal keratoconjunctivitis (VKC) is a rare chronic conjunctivitis characterized by a predominantly eosinophil-mediated inflammatory disorder that could develop critical complications such as blindness. Oxidative stress plays a pivotal role in the pathogenesis of several allergic diseases. The role of oxidative stress has been hypothesized in VKC, but no study explored this issue.Furthermore, cyclosporine A (CsA) exerts an anti-inflammatory and antioxidant action on the conjunctiva. This study aims to assess oxidative stress in VKC patients and controls and to study the effect ofCsA on oxidative stress in these subjects. Methods:Thirty-six consecutive children, including 12 VKC(9 males, 75%; mean age 10,17; SD ± 2.48) patients without treatment,12 VKC treated with CsA(9 males, 75%; mean age 9,08; SD± 2.75) and 12 controls (CT) (7males,58%; mean age8,58; SD ±1,78) were recruited. A cross-sectional study was performed to compare H2O2 in the serum and the tears ofthese children. Results: Compared with CT and VKC children treated with CsA, VKCuntreated children had significantly higher values ofHydrogen peroxide (H2O2) in theserum and the tears.No significant differences were observed between CT and VKC treated with CsA. A significant correlation was found at the linear regression analysis between serum and tear H2O2 levels. Conclusion: This study provides the first report attesting that patients with VKC have high oxidative stress; furthermore, it suggests that CsA could have an anti-inflammatory and antioxidant action that could be useful to prevent the poor VKC outcome.

Background Allergic rhinitis (AR) and adenoidal hypertrophy (AH) are the most frequent causative disorders of nasal obstruction in children, leading to recurrent respiratory infections. Both nasal cavities are colonized by a stable microbial community susceptible to environmental changes and Staphylococcus aureus seems to play the major role. Furthermore, nasal microbiota holds a large number and variety of viruses with upper respiratory tract infections. This local microbiota deserves attention because its modification could induce a virtuous cross-talking with the immune system, with a better clearance of pathogens. Although AR and AH present a different etiopathogenesis, they have in common a minimal chronic inflammation surrounding nasal obstruction; hence it would be challenging to evaluate the effect of an immunomodulator on this minimal chronic inflammation with possible clinical and microbiological effects. The aim of this study is therefore to evaluate the efficacy of an immunomoldulator (Pidotimod) on nasal obstruction in children with AR and/or AH and whether its action involves a variation of nasal microbiota. Methods We enrolled 76 children: those with allergic rhinitis (AR) sensitized to dust mites entered the AR group, those with adenoidal hypertrophy (AH) the AH group, those with both conditions the AR/AH group and those without AR ± AH as controls (CTRL). At the first visit they performed: skin prick tests, nasal fiberoptic endoscopy, anterior rhinomanometry, nasal swabs. Children with. AR ± AH started treatment with Pidotimod. After 1 month they were re-evaluated performing the same procedures. The primary outcome was the evaluation of nasal obstruction after treatment and the secondary outcome was the improvement of symptoms and the changes in nasal microflora. Results All patients improved their mean nasal flow (mNF) in respect to the baseline. In AR children mNF reached that one of CTRL. In AH children±AR the mNF was lower in respect to CTRL and AR group. We did not find any differences among all the groups at the two different time points in nasal microflora. Conclusions Pidotimod is able to give an improvement in nasal obstruction, especially in AR children but this effect seems to be not mediated by changes in nasal microbiota.

Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by relapsing eczematous injuries and severe pruritus. In the last few years, the AD prevalence has been increasing, reaching 20% in children and 10% in adults in high-income countries. Recently, the potential role of probiotics in AD prevention has generated considerable interest. As many clinical studies show, the gut microbiota is able to modulate systemic inflammatory and immune responses influencing the development of sensitization and allergy. Probiotics are used increasingly against AD. However, the molecular mechanisms underlying the probiotics mediated anti-allergic effect remain unclear and there is controversy about their efficacy. In this narrative review, we examine the actual evidence on the effect of probiotic supplementation for AD prevention in the pediatric population, discussing also the potential biological mechanisms of action in this regard.

Allergic rhinitis (AR) is a common pediatric disease, that involves up to the 25% of children worldwide. Environmental pollution, passive smoke, and many viruses are actively involved in the chronic inflammation of the nasal mucosa.As described previously in the literature, novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection in children is uncommon and often asymptomatic or mild.

BackgroundPaediatric autoimmune neuropsychiatric disorders associated with streptococcal infections syndrome (PANDAS) identifies patients with acute onset of obsessive-compulsive and tic disorders. The objective of this study was to evaluate serum NOX2 levels, as well as 8-iso-prostaglandin F2α (8-iso-PGF2α) and lipopolysaccharide (LPS) of PANDAS patients.MethodsIn this study we wanted to compare serum levels of soluble NOX2-dp (sNOX-2-dp), iso-PGF2α and LPS in 60 consecutive subjects, including 30 children affected by PANDAS and 30 controls (CT) matched for age and gender. Serum zonulin was used as intestinal permeability assay.ResultsCompared with CT, PANDAS children had increased serum levels of sNOX-2-dp, 8-iso-PGF2α and LPS. Bivariate analysis showed that serum sNOX2-dp was significantly correlated with LPS (Rs = 0.359;p = 0.005), zonulin (Rs = 0.444;p p p p = 0.001). Finally, a multiple linear regression analysis showed that serum 8-iso-PGF2α and zonulin were the only independent variables associated with sNOX2-dp (R2 = 68%).ConclusionThis study shows that children affected by PANDAS have high circulating levels of sNOX2-dp, isoprostanes and of LPS that could be involved in the process of neuroinflammation.

Background: The European Academy of Allergy and Clinical Immunology guidelines, strongly recommended allergen immunotherapy (AIT) as an effective treatment to achieve long-term clinical benefits and to modify the natural history of allergic diseases. Sublingual immunotherapy (SLIT) offers the possibility of home administration, which improves patient comfort and compliance. Objective: The primary outcome of this study was to assess the change in nasal reactivity after grass-pollen AIT treatment. Methods: This was a monocentric, prospective, observational study conducted in Rome from September 2016 to June 2018, in the Pediatric Department of Policlinico Umberto I. We enrolled children, ages between 6 and 12 years, with persistent allergic rhinitis (AR), sensitized to grass pollen. At the first visit (V0, September 2016), one group received the first dose of oral immunotherapy for grass-pollen spray buccal and the other group continued only standard therapy. All the patients had nasal specific immunoglobulin I (IgE) assay (Phl p1, Phl p5), active anterior rhinomanometry with a nasal provocation test (NPT), and spirometry. The patients attended two follow-up visits, in May 2017 (V1) and May 2018 (V2), with the same examinations as at V0. Results: During the treatment, we observed, in the treated group, a significant increase in the mean nasal flow compared with untreated children (p Conclusion: Analysis of our data provided evidence for a clinical effect of SLIT in inducing clinical changes and allergen tolerance in children with AR.