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Abstract Allergic rhinitis (AR) is the most frequent IgE-mediated disease, mainly in children and adolescents. Management of AR in the pediatric age may be heterogeneous, and the available guidelines do not adequately consider this issue. As a result, the Italian Society of Pediatric Allergy and Immunology (SIAIP) promoted a Delphi Consensus to define and evaluate the most relevant aspects of AR management in the pediatric setting in Italy. A qualified board of experts prepared a list of statements that a panel of Italian experts voted on using a web platform. Forty-two pediatricians participated. The results showed that all statements had consensus (> 80% of scores 4 + 5). In particular, there was awareness that AR is a type 2 inflammatory disease requiring adequate treatment. Topical drugs should be preferred, as they are better with cycles. Combined antihistamine/corticosteroid is also considered effective and safe in adolescents. In conclusion, AR deserves adequate attention and care. Current medications are safe and effective; treatment should be addressed to dampen type 2 inflammation and relieve complaints.

Abstract Background Despite the worldwide increasing incidence of Group A Streptococcus (GAS) infections reported since December 2022, data on noninvasive GAS (nGAS) infections in the post COVID-19 era are limited. By a self-reported survey performed in an outpatient setting, we investigated the number and clinical features of GAS infections, the diagnostic work-up and the type of treatment utilized. In addition, the rate of influenza vaccination was evaluated. Methods In June 2023 family pediatricians involved in the study sent the survey to parents of patients aged 0–16 years. The survey included questions on GAS infections that occurred from January 1 to May 31, 2023. Results Among 3580 children, 20.3% had a GAS infection (0,8% < 1 year, 16,4% 1–3 years, 42,3% 3–6 years, 26,5% 6–9 years, 11,4%, 9–12 years, and 2,6% 12–16 years). Symptoms reported were sore throat (76.9%), fever (75.2%), tonsillar exudate (25.2%), lymphadenopathy (21.8%), and scarlet fever (14.7%). A single patient was hospitalized due to GAS meningitis. Twenty four percent of children had more than one GAS infection. In this group, frequencies of symptoms reported in the first and in the following infection were similar, except for fever and scarlet fever which were less frequent during relapses. GAS was identified by rapid antigen detection test in 81.0% of children. Eighty-nine per cent of children were treated with antibiotics, mostly amoxicillin/clavulanate (40.4%) and amoxicillin (39.4%). Thirty four percent of children received influenza vaccine. No difference was observed among immunized and not immunized regarding the number and characteristics of GAS infection. Conclusions We reported a certain prevalence of nGAS infections in children, mainly those aged 3–6 years age, who were mostly characterized by a low score of symptoms, and in most of the cases diagnosed and treated using a microbiological test as confirmatory tool. In this new clinical setting, a national study would be useful to reach more significant data for the definition of a correct diagnosis and clinical management of nGAS infections in children. Moreover, it is important to improve flu vaccination campaign and coverage to protect children from coinfections that could worsen the disease and misdiagnose the etiology of pharyngitis.

While Trisomy X syndrome is typically characterized by developmental and cognitive variations, it is not commonly associated with immunodeficiencies. We report the unique case of a 6-year-old girl with Trisomy X presenting with selective IgA deficiency, challenging the conventional understanding of this chromosomal condition. The patient exhibited recurrent respiratory infections and gastrointestinal symptoms, evaluated in the context of her genetic background of Trisomy X and significantly low levels of IgA (0.03 g/L), yet normal IgG and IgM levels. Immunological assessment revealed a poor response to vaccination to HBV, necessitating an adapted vaccination strategy. Gastrointestinal investigations indicated paradoxical diarrhea secondary to chronic constipation, managed with dietary interventions. The presence of an extra X chromosome raises questions about the potential over-expression of genes that escape X-chromosome inactivation, such as FOXP3, which is crucial for the regulation of regulatory T cells. An abnormal expression of FOXP3 could lead to either heightened immune regulation, increasing susceptibility to infections, or to immune dysregulation. Although Trisomy X is not typically associated with immunodeficiencies, this case, paralleled by another patient with Trisomy X and CVID, suggests a need for further speculative research into possible genetic links. Moreover, a 1969 study reported lower IgA levels in women with an extra X chromosome. In conclusion, this case aims to underscore the necessity for a deeper genetic and immunological evaluation in chromosomal anomalies like Trisomy X to fully understand their speculative impact on immune function.

Gut microbiota plays an important role in maintaining respiratory health while providing protection against respiratory illnesses. However, the clinical role of probiotic strains in prevention and treatment of early-onset asthma is still debated. The present study aims to systematically review the available literature on the efficacy of probiotic supplementation, either alone or in combination with other treatments, in managing children with asthma. An electronic search was conducted across multiple databases including PubMed, Web of Science, and EMBASE. The articles reported in English, regardless of year of publication, were reviewed by independent authors for inclusion assessment. Randomized controlled studies evaluating the efficacy of probiotics in children with asthma were included in the study. Of the 203 articles reviewed, 16 were selected and summarized to provide a consistent review, and of these, eight studies reported the anti-asthmatic effects of the treatment with single and multi-strain probiotics alone, seven reported the use of probiotic strains in combination with other treatments, and one was a follow-up study. While some of the studies reported are well conducted and with promising results, no cumulative significant impact was seen for probiotic supplementation on disease parameters of asthma in children. However, the available literature is not sufficient to draw any solid conclusion about the possible use of probiotics in children with asthma, and it is necessary to expand this literature by conducting more well-designed randomized clinical trials to assess the effects of probiotic strains in children with asthma or carrying a high-risk of asthma.

Background: Subjects with mutations in the Ataxia-Telangiectasia mutated (ATM) gene encoding for ATM kinase have a greater predisposition to develop atherosclerosis, but the mechanism behind this phenomenon is not yet understood. NADPH oxidase type 2 may play a role in this process, leading to endothelial dysfunction and an increased susceptibility to thrombosis. The purpose of this study was to assess the redox state in individuals with ATM mutations and determine its impact on endothelial function. Methods: In this cross-sectional study, twenty-seven children with ataxia telangiectasia (AT) (13 males and 14 females, mean age 15.1 ± 7.6 years) were compared with 27 controls (13 males and 14 females, mean age 14.6 ± 8.4 years) matched for age and gender. Additionally, 29 AT parents with heterozygous mutation of ATM (h-ATM) gene, and 29 age- and gender-matched controls were included. Endothelial function was evaluated through brachial flow-mediated dilation (FMD) and the assessment of nitric oxide (NO) bioavailability. Oxidative stress was evaluated by measuring serum activity of soluble NOX2-dp (sNOX2-dp), hydrogen peroxide (H2O2) production, and hydrogen breakdown activity (HBA). Thrombus formation was assessed through the Total Thrombus Formation Analysis System (T-TAS). Results: AT children and parents with heterozygous ATM mutations exhibited significantly lower FMD, HBA, and NO bioavailability as compared to age and gender matched controls. AT children and ATM carrier of heterozygous ATM mutations had significantly higher concentrations of sNOX2-dp and H2O2 as compared to controls. Compared to the respective controls, AT children and their parents, who carried heterozygous ATM mutation, showed an accelerated thrombus growth as revealed by reduced occlusion time. Multivariable linear regression analysis revealed that sNOX2 (standardized coefficient β: −0.296; SE: 0.044; p = 0.002) and NO bioavailability (standardized coefficient β: 0.224; SE: 0.065; p = 0.02) emerged as the only independent predictive variables associated with FMD (R2: 0.44). Conclusions: This study demonstrates that individuals with ATM mutations experience endothelial dysfunction, increased oxidative stress, and elevated thrombus formation. These factors collectively contribute to the heightened susceptibility of these individuals to develop atherosclerosis.

Background: Seasonal allergic rhinoconjunctivitis (SAR) is a worldwide health problem, especially in Westernized countries. Previous studies of the “Panallergens in Pediatrics” (PAN-PED) cohort found that molecular spreading (ie, the progressive increase in serum specific IgE antibody levels) of the IgE response to the grass pollen, Phleum pratense, molecules is directly associated with polysensitization to pollen in general.The research question is aimed at verifying whether this association can also be detected for non-pollen allergens, specifically Dermatophagoides pteronyssinnus (D.pt), to better understand the relationship between a perennial allergen (D.pt) and a seasonal allergen (Phleum pratense).To this end, our first objective was to analyze the biobank of the PAN-PED cohort serum by measuring the IgE levels to D.pt and its major recombinant molecules (Der p1, Der p2, Der p23); subsequently we investigated their correlation towards Phleum pratense IgE response, studying also the relationship between the molecular spreading of these 2 different allergens. Methods: Among 1120 patients positive to Phleum pratense, 638 were also sensitized to D.pt. Patients underwent skin prick tests (SPT) for inhalant extracts, and their serum was tested for total IgE (tIgE), and sIgE to pollen and perennial allergens. Considering the molecular allergen detection through the component resolved diagnosis (CRD), out of 638 patients, 146 were further investigated by performing IgE tests of the 3 major D.pt. molecules: Der p1, Der p2, and Der p23. Results: We found that a broader molecular response to Phleum pratense molecules, assessed by CRD, was associated with higher tIgE levels, polysensitization to pollens, and higher IgE levels to pollens, but also to lower IgE levels to D.pt and lower degree of sensitization to rDer p1, r Der p2, and rDer p23. In a multivariate linear model, the number of Phleum pratense molecules recognized by IgE was still inversely associated with the IgE level to D.pt extract. Conclusions: The main finding of this study was the detection of an inverse association, never described in the literature, between the molecular spreading of the IgE response to Phleum pratense and the IgE response to D.pt. This led us to speculate on the etiopathogenetic hypothesis according to which, among the majority of pollen allergic patients, a strong and molecularly diversified IgE response may be limited to pollen allergens and may be preventing or contrasting the development of an equally strong and diversified IgE sensitization to D.pt molecules. The biological mechanisms underlying this phenomenon deserve to be investigated.

Abstract Food supplements are defined as foodstuffs the purpose of which is to supplement the normal diet and which are concentrated sources of nutrients or other substances with a nutritional or physiological effect, often referred to as nutraceuticals, may exert benefit to the human body. Their use is increasing worldwide, including Europe and in Italy. However, some doctors are skeptical about their effectiveness and safety. This reluctance may depend on poor knowledge of the mechanisms of action and clinical evidence in literature. The Italian Society of Pediatric Allergy and Immunology (SIAIP) promoted the institution of an ad hoc Committee. The first initiative performed by this Committee was the administration of a questionnaire to the members of SIAIP. The results of this survey provided interesting results. Most pediatricians know the food supplement concept but frequently need help understanding the mechanisms of action. Most prescribe food supplements, mainly for preventing infections or enhancing immune defense. In addition, they prefer to use food supplements as cycles or add-on therapy. Finally, most participants like to attend events on this issue and contribute to new evidence through trials. In conclusion, this survey underscores the relevance of food supplement issues and attests to interest in this topic. However, there is a need to provide information and promote studies on this matter.

Abstract Resveratrol is a nonflavonoid polyphenolic compound with a chemical structure consisting of two aromatic rings linked by a methylene bridge. It exists in two primary isomers and has a broad range of desirable biological activities, including antioxidant, anti‐inflammatory, antidiabetic, cardioprotective, and antitumor activities. Some antioxidant properties of resveratrol are known with certainty, such as its potential to positively impact cardiovascular health, inflammation, and the metabolism. On the other hand, many uncertainties and controversies plague its efficacy, including issues related to its bioavailability, dosing, human clinical trial results, interactions with other food components and drugs, and individual variability. In brief, although promising results have been observed in in vitro and in vivo studies, the translation of these findings to human health remains uncertain. Many human clinical trials on resveratrol are ongoing or have proven inconclusive, making it challenging to definitively determine its efficacy for specific health conditions and its dose and duration of treatment. Resveratrol may interact with medications and have varying effects on individuals. In conclusion, it is essential to approach resveratrol with a balanced perspective, consulting with healthcare professionals, and considering the evolving scientific evidence when making decisions regarding its clinical use.

Enzymatic hydrolysis of sugar beets for achieving liquefaction and sugar release is a critical step for beet-ethanol production. An enzyme recycling process was developed in this study to reduce the economic uncertainty raised by the high costs of enzymes by reducing the fresh enzyme usage. A mixture of cellulases and pectinases was used in the beet hydrolysis. The hydrolysate was centrifuged and then processed through a 50 kDa molecular weight cut-off polyethersulfone membrane to recover enzymes from the liquid. Liquid enzyme recycling with 50% fresh enzyme addition achieved a similar liquefaction extent and sugar yield compared to the positive control with 100% fresh enzyme. Solid enzyme recycling showed a lower liquefaction efficiency, requiring at least 75% of fresh enzyme addition for a comparable liquefaction extent. Five sequential batches of hydrolysis with liquid enzyme recycling were successfully conducted to hydrolyze sugar beets with similar liquefaction extents and sugar yields.

Food allergy (FA) affects approximately 6–8% of young children, with a peak prevalence at approximately one year of age. Tree nut and peanut allergies are among the main causes of anaphylaxis in the world. The gold standard for the diagnosis of FAs is the oral food challenge (OFC). Other diagnostic tests used in the clinical practice are skin prick tests (SPTs) and laboratory tests to measure out the presence of serum specific IgE (sIgE). In this narrative review, we collect the current evidence of the predictive value (PV) of SPTs and sIgE for the outcome of the OFCs. In literature, data are conflicting as to whether increasing sIgE concentration and wheal size in SPTs correlate with OFC outcomes. Most studies included in our review have shown that in vivo and in vitro tests may predict OFC outcomes with variable PV, but data are not conclusive; therefore, the OFC currently remains the gold standard for FA diagnosis.

The recently proposed zero-added-loss multiplexing (ZALM) source of entangled photons enables higher efficiency in entanglement distribution than spontaneous parametric down-conversion sources and can be carried out using both space-to-ground and ground-to-ground links. We demonstrate the flexibility of ZALM architectures to be adapted to alternative entanglement distribution protocols. Focusing on the counterintuitive result that entanglement can be generated between distant parties without using any entanglement as a resource, we analyze two protocols for entanglement distribution to memories via separable states. Modeling them in a ZALM setup, we consider the effects of noise both in the communication channels and in the memories. We thereby identify the optimal protocol to use with respect to the highest entanglement generated, given the noise conditions of the network.

Objective: To determine the effect of grit-blasting before and after sintering on the surface roughness of zirconia and the micro-tensile bond strength of a pressable veneering ceramic to zirconia. Methods: Pre-sintered zirconia blocks (IPS e.max ZirCAD, Ivoclar) were divided into four test groups of three specimens each and a control group (‘CTR’; no surface treatment). Pre-S-30, Pre-S-50, and Pre-S-110 were grit-blasted with 30-µm SiO2-coated Al2O3, 50-µm Al2O3 and 110-µm Al2O3 particles, respectively, before sintering. Post-S-30 was grit-blasted with 30-µm SiO2-coated Al2O3 after sintering. For each treatment, the surface roughness was measured (Ra, Perthometer M4P, Mahr Perthen). After sintering the zirconia blocks, a liner was applied and a pressable ceramic (IPS e.max ZirPress, Ivoclar) was heat-pressed. Sixteen microbars were obtained from each block and submitted to micro-tensile bond-strength (µTBS) testing. Data were analyzed with one-way ANOVA. Any correlation between Ra and µTBS was evaluated (Sperman test). Results: Grit-blasting before sintering with 110-µm Al2O3 (RaPre-S-110 = 3.4 ± 0.4 µm), 50-µm Al2O3 (RaPre-S-50 = 2.3 ± 0.5 µm), and 30-µm SiO2-coated Al2O3 (RaPre-S-30 = 1.2 ± 0.2 µm) resulted in significantly higher roughness than grit-blasting after sintering with 30-µm SiO2-coated Al2O3 (RaPost-S-30 = 0.5 ± 0.1 µm). The highest µTBS was measured when the sintered zirconia was grit-blasted with 30-μm SiO2-coated Al2O3 (µTBSPost-S-30 = 28.5 ± 12.6 MPa), which was significantly different from that of specimens that were grit-blasted before sintering (µTBSPre-S-30 = 21.8 ± 10.4; µTBSPre-S-50 = 24.1 ± 12.6; µTBSPre-S-110 = 26.4 ± 14.1) or were not grit-blasted (µTBSCTR = 20.2 ± 11.2). Conclusions: Grit-blasting zirconia before sintering enhanced the surface roughness proportionally to the particle size of the sand used. Grit-blasting with 30-µm SiO2-coated Al2O3 after sintering improved bonding of the veneering ceramic to zirconia. Clinical Significance: As grit-blasting with 30-µm SiO2-coated Al2O3 after sintering improved bonding of the veneering ceramic to zirconia, it may reduce veneering ceramic fractures/chipping.

Abstract Enzymatic hydrolysis of sugar beets is an efficient alternative to conventional hot water extraction where overall soluble extraction is valued. The economic analysis of a sugar beet soluble sugar production plant was designed and developed using SuperPro Designer software. The commercial scale operation was sized to process 100 million metric ton (MT)/day of sugar beets. The base case process includes transportation, grinding, thermal pretreatment, enzymatic hydrolysis, solid–liquid separation, and evaporation. The final product from the model was assumed to be a sugar syrup stream at 65% total solids content. Since the breakeven selling price was sensitive to the cost of enzymes, alternative scenario A added an ultrafiltration unit operation to separate the enzymes and reuse them in subsequent batches of hydrolysis. Steam was another major contributor to the operating cost. Alternative scenario B included a natural gas boiler to generate steam from biogas produced from a co‐located dairy manure digester. The breakeven selling price of the sugar syrup from the base case, alternative scenario A, and alternative scenario B were $965, $911, and $955 per metric ton, respectively. Sensitivity analysis showed that the breakeven selling price is sensitive to the raw material cost, especially for the pectic enzymes.