BackgroundSeasonal Allergic Rhinitis (SAR) is a heterogeneous inflammatory disease. We hypothesiz... more BackgroundSeasonal Allergic Rhinitis (SAR) is a heterogeneous inflammatory disease. We hypothesized that a cluster analysis based on the evaluation of cytokines in nasal lavage (NL) could characterize distinctive SAR endotypes in children.MethodsThis cross-sectional study enrolled 88 children with SAR. Detailed medical history was obtained by well-trained physicians. Quality of life and sleep quality were assessed through standardized questionnaires [Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) and Pittsburgh Sleep Quality Index (PSQI) respectively]. Children were grouped through K-means clustering using Interleukin (IL)-5, IL-17, IL-23, and Interferon (INF)-γ in NL.ResultsOut of the 88 patients enrolled, 80 were included in the cluster analysis, which revealed three SAR endotypes. Cluster 1 showed lower levels of IL-5 and IL-17 and intermediate levels of IL-23 and IFN-γ; Cluster 2 had higher levels of IL-5 and intermediate levels of IL-17, IL-23, and IFN-γ; C...
Nasal cytology is a diagnostic tool that can be used in precision rhinology medicine. Particularl... more Nasal cytology is a diagnostic tool that can be used in precision rhinology medicine. Particularly in non-allergic rhinitis and chronic rhinosinusitis forms it can be useful to evaluate biomarkers of both surgical or biological therapy and especially in the follow-up it must be used to predict the prognostic index of recurrence of nasal polyposis. All inflammatory cytokines are also linked to the presence of cells such as eosinophils and mastcells and nasal cytology is a non-invasive and repeatable method to assess the situation in real life.
Background: ‘‘The clinical characteristics of allergic rhinitis (AR) were classified in the Aller... more Background: ‘‘The clinical characteristics of allergic rhinitis (AR) were classified in the Allergic Rhinitis and its Impact on Asthma (ARIA) document according to duration, that defines the intermittent or persistent forms, and to the effects of symptoms on daily activity and sleep, that define the mild and moderate/severe forms. We evaluated the correlation between the clinical form of AR and the nasal cytology. Method: Sixty-two patients (34 males, 28 females, mean age 35.2 years) with AR caused by sensitization to grass pollen were included in the study. In all patients AR was defined according to ARIA classification and nasal cytology was performed by Rhino-probe sampling, staining and reading by optical microscope. The association between AR symptoms and cell types in nasal cytology was analyzed by the chi squared test. Result: The distribution of clinical forms of AR was as follows: 21 patients (33.9%) had a mild intermittent, 21 (33.9%) a moderate/ severe intermittent, 9 (14.5%) a mild persistent, and 11 (17.7%) a moderate severe persistent AR. The most common symptoms were nasal blockage (76.2%), rhinorrhea (71.4%), sneezing (38.1%), and nasal itching (9.5%). Nasal cytology detected neutrophils in 49 patients (29 with intermittent and 20 with persistent AR), eosinophils in 41 patients (24 with intermittent and 17 with persistent AR), mast cells in 21 patients (10 with intermittent and 11 with persistent AR), and lymphocytes/ plasma cells in 26 patients (14 with intermittent and 12 with persistent AR). There were significantly more mast cells (P = 0.014) and lymphocytes/plasma cells (P = 0.024) in patients with moderate/ severe AR than in patients with mild AR. Conclusion: These findings first demonstrate that the ARIA classification of AR severity is associated to different cell counts in nasal cytology, and particularly with significantly higher counts for mast cells and lymphocyte/plasma cells in moderate/ severe AR
Background: Respiratory infections (RI) significantly burden society, mainly when there are recur... more Background: Respiratory infections (RI) significantly burden society, mainly when there are recurrent respiratory infections (RRI). Thus, there is a need to prevent RI in clinical practice. In this regard, the modulation of the immune system and resolution of the inflammatory cascade could represent an ideal way to prevent RI. Stimunex® gocce, a multicomponent food supplement, contains Sambucus nigra extract, β-glucan, Zinc, and Vitamin D3. This study investigated its ability to prevent RRI in children using a real-world setting: the pediatric primary care. Materials and methods: Two hundred and ninety-eight children with RRI were enrolled in the current study. The food supplement was randomly prescribed to 160 children with RRI daily for 4 months (Active group); the remaining 138 children with RRI were treated only with standard therapy for RI (Control group). The number and duration of RI, parental perception of symptom severity and treatment efficacy, use of medications, and scho...
I funghi provocano talora disturbi dell\u2019apparato respiratorio e sebbene alcuni semplici prov... more I funghi provocano talora disturbi dell\u2019apparato respiratorio e sebbene alcuni semplici provvedimenti possano rivelarsi determinanti per prevenirne lo sviluppo in ambiente domestico, la loro ubiquit\ue0 fa s\uec che essi si sviluppino sia outdoor che indoor. Un fattore predisponente allo sviluppo di asma bronchiale \ue8 la sensibilizzazione allergica, mentre l\u2019inquinamento ambientale gioca un altro ruolo di rilievo anche nelle altre patologie legate all\u2019esposizione a muffe: l\u2019aspergillosi broncopolmonare allergica, la rinosinusite, la sick building syndrome e la sindrome da polveri organiche tossiche. L\u2019immunoterapia specifica, in virt\uf9 del suo ormai accertato potere desensibilizzante, rappresenta un valido presidio terapeutico, specie in et\ue0 pediatrica, con valenza preventiva proprio dello sviluppo di asma
Cow’s milk and dairy are commonly consumed foods in the human diet and contribute to maintaining ... more Cow’s milk and dairy are commonly consumed foods in the human diet and contribute to maintaining a healthy nutritional state, providing unique sources of energy, calcium, protein, and vitamins, especially during early childhood. Milk formula is usually made from cow’s milk and represents the first food introduced into an infant’s diet when breastfeeding is either not possible or insufficient to cover nutritional needs. Very recently, increased awareness of cow’s milk protein allergy and intolerance, and higher preference to vegan dietary habits have influenced parents towards frequently choosing cows’ milk substitutes for children, comprising other mammalian milk types and plant-based milk beverages. However, many of these milk alternatives do not necessarily address the nutritional requirements of infants and children. There is a strong need to promote awareness about qualitative and quantitative nutritional compositions of different milk formulas, in order to guide parents and med...
BACKGROUND Allergic enterocolitis, also known as food protein-induced enterocolitis syndrome (FPI... more BACKGROUND Allergic enterocolitis, also known as food protein-induced enterocolitis syndrome (FPIES), is an increasingly reported and potentially severe non-IgE mediated food allergy of the first years of life, which is often misdiagnosed due to its non-specific presenting symptoms and lack of diagnostic guidelines. OBJECTIVE We sought to determine the knowledge of clinical, diagnostic and therapeutic features of FPIES among Italian primary-care paediatricians. METHODS A 16-question anonymous web-based survey was sent via email to randomly selected primary care paediatricians working in the north of Italy. RESULTS There were 194 completed surveys (48.5% response rate). Among respondents, 12.4% declared full understanding of FPIES, 49% limited knowledge, 31.4% had simply heard about FPIES and 7.2% had never heard about it. When presented with clinical anecdotes, 54.1% recognised acute FPIES and 12.9% recognised all chronic FPIES, whereas 10.3% misdiagnosed FPIES as allergic proctocolitis or infantile colic. To diagnose FPIES 55.7% declared to need negative skin prick test or specific-IgE to the trigger food, whereas 56.7% considered necessary a confirmatory oral challenge. Epinephrine was considered the mainstay in treating acute FPIES by 25.8% of respondents. Only 59.8% referred out to an allergist for the long-term reintroduction of the culprit food. Overall, 20.1% reported to care children with FPIES in their practice, with cow's milk formula and fish being the most common triggers; the diagnosis was self-made by the participant in 38.5% of these cases and by an allergist in 48.7%. CONCLUSION There is a need for promoting awareness of FPIES to minimise delay in diagnosis and unnecessary diagnostic and therapeutic interventions.
Report of a case of infantile cortical hyperostosis with localitation in the jaw-bone in a female... more Report of a case of infantile cortical hyperostosis with localitation in the jaw-bone in a female child five month old. Spontaneous resolution, not relapse. There weren't other affected subjects in the same family. Unknown etiology. Discussion about the differential diagnosis and the therapeutic ways described in literature.
BackgroundSeasonal Allergic Rhinitis (SAR) is a heterogeneous inflammatory disease. We hypothesiz... more BackgroundSeasonal Allergic Rhinitis (SAR) is a heterogeneous inflammatory disease. We hypothesized that a cluster analysis based on the evaluation of cytokines in nasal lavage (NL) could characterize distinctive SAR endotypes in children.MethodsThis cross-sectional study enrolled 88 children with SAR. Detailed medical history was obtained by well-trained physicians. Quality of life and sleep quality were assessed through standardized questionnaires [Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) and Pittsburgh Sleep Quality Index (PSQI) respectively]. Children were grouped through K-means clustering using Interleukin (IL)-5, IL-17, IL-23, and Interferon (INF)-γ in NL.ResultsOut of the 88 patients enrolled, 80 were included in the cluster analysis, which revealed three SAR endotypes. Cluster 1 showed lower levels of IL-5 and IL-17 and intermediate levels of IL-23 and IFN-γ; Cluster 2 had higher levels of IL-5 and intermediate levels of IL-17, IL-23, and IFN-γ; C...
Nasal cytology is a diagnostic tool that can be used in precision rhinology medicine. Particularl... more Nasal cytology is a diagnostic tool that can be used in precision rhinology medicine. Particularly in non-allergic rhinitis and chronic rhinosinusitis forms it can be useful to evaluate biomarkers of both surgical or biological therapy and especially in the follow-up it must be used to predict the prognostic index of recurrence of nasal polyposis. All inflammatory cytokines are also linked to the presence of cells such as eosinophils and mastcells and nasal cytology is a non-invasive and repeatable method to assess the situation in real life.
Background: ‘‘The clinical characteristics of allergic rhinitis (AR) were classified in the Aller... more Background: ‘‘The clinical characteristics of allergic rhinitis (AR) were classified in the Allergic Rhinitis and its Impact on Asthma (ARIA) document according to duration, that defines the intermittent or persistent forms, and to the effects of symptoms on daily activity and sleep, that define the mild and moderate/severe forms. We evaluated the correlation between the clinical form of AR and the nasal cytology. Method: Sixty-two patients (34 males, 28 females, mean age 35.2 years) with AR caused by sensitization to grass pollen were included in the study. In all patients AR was defined according to ARIA classification and nasal cytology was performed by Rhino-probe sampling, staining and reading by optical microscope. The association between AR symptoms and cell types in nasal cytology was analyzed by the chi squared test. Result: The distribution of clinical forms of AR was as follows: 21 patients (33.9%) had a mild intermittent, 21 (33.9%) a moderate/ severe intermittent, 9 (14.5%) a mild persistent, and 11 (17.7%) a moderate severe persistent AR. The most common symptoms were nasal blockage (76.2%), rhinorrhea (71.4%), sneezing (38.1%), and nasal itching (9.5%). Nasal cytology detected neutrophils in 49 patients (29 with intermittent and 20 with persistent AR), eosinophils in 41 patients (24 with intermittent and 17 with persistent AR), mast cells in 21 patients (10 with intermittent and 11 with persistent AR), and lymphocytes/ plasma cells in 26 patients (14 with intermittent and 12 with persistent AR). There were significantly more mast cells (P = 0.014) and lymphocytes/plasma cells (P = 0.024) in patients with moderate/ severe AR than in patients with mild AR. Conclusion: These findings first demonstrate that the ARIA classification of AR severity is associated to different cell counts in nasal cytology, and particularly with significantly higher counts for mast cells and lymphocyte/plasma cells in moderate/ severe AR
Background: Respiratory infections (RI) significantly burden society, mainly when there are recur... more Background: Respiratory infections (RI) significantly burden society, mainly when there are recurrent respiratory infections (RRI). Thus, there is a need to prevent RI in clinical practice. In this regard, the modulation of the immune system and resolution of the inflammatory cascade could represent an ideal way to prevent RI. Stimunex® gocce, a multicomponent food supplement, contains Sambucus nigra extract, β-glucan, Zinc, and Vitamin D3. This study investigated its ability to prevent RRI in children using a real-world setting: the pediatric primary care. Materials and methods: Two hundred and ninety-eight children with RRI were enrolled in the current study. The food supplement was randomly prescribed to 160 children with RRI daily for 4 months (Active group); the remaining 138 children with RRI were treated only with standard therapy for RI (Control group). The number and duration of RI, parental perception of symptom severity and treatment efficacy, use of medications, and scho...
I funghi provocano talora disturbi dell\u2019apparato respiratorio e sebbene alcuni semplici prov... more I funghi provocano talora disturbi dell\u2019apparato respiratorio e sebbene alcuni semplici provvedimenti possano rivelarsi determinanti per prevenirne lo sviluppo in ambiente domestico, la loro ubiquit\ue0 fa s\uec che essi si sviluppino sia outdoor che indoor. Un fattore predisponente allo sviluppo di asma bronchiale \ue8 la sensibilizzazione allergica, mentre l\u2019inquinamento ambientale gioca un altro ruolo di rilievo anche nelle altre patologie legate all\u2019esposizione a muffe: l\u2019aspergillosi broncopolmonare allergica, la rinosinusite, la sick building syndrome e la sindrome da polveri organiche tossiche. L\u2019immunoterapia specifica, in virt\uf9 del suo ormai accertato potere desensibilizzante, rappresenta un valido presidio terapeutico, specie in et\ue0 pediatrica, con valenza preventiva proprio dello sviluppo di asma
Cow’s milk and dairy are commonly consumed foods in the human diet and contribute to maintaining ... more Cow’s milk and dairy are commonly consumed foods in the human diet and contribute to maintaining a healthy nutritional state, providing unique sources of energy, calcium, protein, and vitamins, especially during early childhood. Milk formula is usually made from cow’s milk and represents the first food introduced into an infant’s diet when breastfeeding is either not possible or insufficient to cover nutritional needs. Very recently, increased awareness of cow’s milk protein allergy and intolerance, and higher preference to vegan dietary habits have influenced parents towards frequently choosing cows’ milk substitutes for children, comprising other mammalian milk types and plant-based milk beverages. However, many of these milk alternatives do not necessarily address the nutritional requirements of infants and children. There is a strong need to promote awareness about qualitative and quantitative nutritional compositions of different milk formulas, in order to guide parents and med...
BACKGROUND Allergic enterocolitis, also known as food protein-induced enterocolitis syndrome (FPI... more BACKGROUND Allergic enterocolitis, also known as food protein-induced enterocolitis syndrome (FPIES), is an increasingly reported and potentially severe non-IgE mediated food allergy of the first years of life, which is often misdiagnosed due to its non-specific presenting symptoms and lack of diagnostic guidelines. OBJECTIVE We sought to determine the knowledge of clinical, diagnostic and therapeutic features of FPIES among Italian primary-care paediatricians. METHODS A 16-question anonymous web-based survey was sent via email to randomly selected primary care paediatricians working in the north of Italy. RESULTS There were 194 completed surveys (48.5% response rate). Among respondents, 12.4% declared full understanding of FPIES, 49% limited knowledge, 31.4% had simply heard about FPIES and 7.2% had never heard about it. When presented with clinical anecdotes, 54.1% recognised acute FPIES and 12.9% recognised all chronic FPIES, whereas 10.3% misdiagnosed FPIES as allergic proctocolitis or infantile colic. To diagnose FPIES 55.7% declared to need negative skin prick test or specific-IgE to the trigger food, whereas 56.7% considered necessary a confirmatory oral challenge. Epinephrine was considered the mainstay in treating acute FPIES by 25.8% of respondents. Only 59.8% referred out to an allergist for the long-term reintroduction of the culprit food. Overall, 20.1% reported to care children with FPIES in their practice, with cow's milk formula and fish being the most common triggers; the diagnosis was self-made by the participant in 38.5% of these cases and by an allergist in 48.7%. CONCLUSION There is a need for promoting awareness of FPIES to minimise delay in diagnosis and unnecessary diagnostic and therapeutic interventions.
Report of a case of infantile cortical hyperostosis with localitation in the jaw-bone in a female... more Report of a case of infantile cortical hyperostosis with localitation in the jaw-bone in a female child five month old. Spontaneous resolution, not relapse. There weren't other affected subjects in the same family. Unknown etiology. Discussion about the differential diagnosis and the therapeutic ways described in literature.
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