Giulia Paiola

Chronic Urticaria and Celiac Disease: A Case Report

Abstract:u2002 u2003We describe a case of a 9‐year‐old girl who presented chronic urticaria associated with celiac disease. The prevalence of the manifestation of chronic urticaria in celiac disease is unknown but increase in atopic immunologic disorders has been reported in the setting of gluten enteropathy. Relationship between the clinical manifestations is not clear. The present case of subclinical celiac disease diagnosis in an otherwise asymptomatic child with chronic urticaria further reinforces the evidence that differential for celiac disease warrants to be always considered in children with refractory urticaria.

Olfactory dysfunction is worse in primary ciliary dyskinesia compared with other causes of chronic sinusitis in children

Cilia have multiple functions including olfaction. We hypothesised that olfactory function could be impaired in primary ciliary dyskinesia (PCD). Olfaction, nasal nitric oxide (nNO) and sinus CT were assessed in patients with PCD and non-PCD sinus disease, and healthy controls (no CT scan). PCD and non-PCD patients had similar severity of sinus disease. Despite this, defective olfaction was more common in patients with PCD (P<0.0001) and more severe in patients with PCD with major Transmission Electron Microscopy (TEM) abnormalities. Only in classical PCD did olfaction inversely correlate with sinusitis and nNO. We speculate that defective olfaction in PCD is primary in nature.

Awareness of allergic enterocolitis among primary-care paediatricians: A web-based pilot survey

BACKGROUNDnAllergic 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.nnnOBJECTIVEnWe sought to determine the knowledge of clinical, diagnostic and therapeutic features of FPIES among Italian primary-care paediatricians.nnnMETHODSnA 16-question anonymous web-based survey was sent via email to randomly selected primary care paediatricians working in the north of Italy.nnnRESULTSnThere 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 cows 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%.nnnCONCLUSIONnThere is a need for promoting awareness of FPIES to minimise delay in diagnosis and unnecessary diagnostic and therapeutic interventions.

The use of inhaled corticosteroid in preschool wheezers: what's the point today?

Among the preschool children who wheeze two different groups can be identify: children who have a viral infection and those who respond to multiple triggers, such as exercise or allergens.To distinguish between these different phenotypes of wheezing, and consequently choose therapy represents a major challenge for pediatricians.Transient wheezers conditions do not improve with maintenance treatment with ICS. On the other hand they are definitely useful in children with wheeze/asthma.Increasing evidence is in favor of the potential role of leukotriene receptor antagonists in preschool children with recurrent wheezing.Oral steroid has been demonstrated not to be indicated to control acute wheezing, unless severe disease is expected in non-atopic children.The early phenotyping of preschool wheezers, upon which the appropriate treatment should be based, represents a challenging issue in the paediatric practice.

Correlation between vitamin D serum levels and passive smoking exposure in children with asthma

OBJECTIVEnTo establish the relationship between vitamin D serum levels, pulmonary function, asthma control, and passive smoking exposure in children with asthma.nnnMETHODSnWe studied the relationship between 25-hydroxy cholecalciferol (25[OH]D) concentrations and baseline spirometry and levels of asthma control, and the effect of parental tobacco smoke exposure in 152 white children (84 boys [55.3%]) with a mean age ± standard deviation of 9.9 ± 2.0 years (range 5-15 years) in a cross-sectional study carried out during the winter and early spring.nnnRESULTSnOnly 9.9% of our children had a sufficient serum 25(OH)D level (at least 30-40 ng/mL). A significant positive correlation was found between the force vital capacity % predicted, forced expiratory volume in the first second of expiration % predicted, and serum 25(OH)D level (r = 0.36, p < 0.001 for both). The subjects with controlled asthma had higher serum levels of 25(OH)D than children with partially controlled or noncontrolled asthma, both according to Global Initiative for Asthma parameters and the Test for the control of asthma in childhood (p = 0.011). Children with both nonsmoking parents presented significantly higher serum levels of 25(OH)D than children with both smoking parents (median, 20.5 ng/mL [interquartile range {IQR}, 16.6-24.0 ng/mL] versus median, 14.5 ng/mL [IQR, 11.1-19.1 ng/mL], respectively; p < 0.001), with intermediate values for children exposed to single maternal (median, 20.3 ng/mL [IQR, 13.0-23.2 ng/mL]) or to paternal smoking (median, 17.8 ng/mL [IQR, 14.7-22.1 ng/mL]).nnnCONCLUSIONnOur results indicated that hypovitaminosis D was frequent in children with asthma who lived in a Mediterranean country. In these children, lower levels of vitamin D were associated with reduced asthma control and passive smoking exposure.

Feasibility of structured light plethysmography for the evaluation of lung function in preschool children with asthma

BACKGROUNDnStructured light plethysmography (SLP) is a new noninvasive technology to capture the movement of the thoracic and abdominal wall, and to assess some parameters indicative for lung function.nnnOBJECTIVEnThe purpose of the study was to evaluate the feasibility of SLP in children with asthma.nnnMETHODSnA total of 52 patients were enrolled: 25 with asthma exacerbation (group 1), 13 with well-controlled asthma (group 2), and 14 healthy controls (group 3). Every patient underwent SLP evaluation and a lung function test.nnnRESULTSnSLP evaluations showed that the ratio of inspiratory flow at 50% of tidal volume (Vt) to expiratory flow at 50% of Vt, in which Vt is taken to be the exhaled chest wall movement, and flow is taken to be the time derivative of the chest wall movement (IE50) value increased in group 1 compared with groups 2 and 3, with statistical significance (p = 0.018); the data were consistent with the spirometry parameter. A correlation between the IE50 and forced expiratory volume in the first second of expiration was highlighted (r = -0.35, p = 0.019).nnnCONCLUSIONnSLP assessed airway obstruction, and its use in clinical practice could be applied in preschool children in future studies.

Ebastine overdose in a child

The lack of side effects after acute ingestion of a high dose of ebastine in our child aging 44 months suggests an overall safety profile of ebastine; it could suggest less time of hospitalization for children who are subjected to this event.

Exercise-induced bronchospasm or dyspnoea in obese children?

Exercise-induced bronchospasm (EIB) is usually defined as one of the more common causes of exercise-induced dyspnoea (EID), causing difficult breathing during physical activity by obstruction of the airways, which is a hallmark of asthma. However, dyspnoea is a complex psycho-physiological symptom characterized by sensation of an increase in the perceived work of breathing which may manifest during physical activity and resulting from many different causes. In clinical practice, most of the diagnoses of asthma induced by physical activity are based on the evaluation of symptoms reported by children or parents. This is often proved to be misleading because a link between the symptoms reported and the results of tests during physical activity, such as standardised exercise test, has not been demonstrated. Overweight and obesity may contribute to dyspnoea during the physical activity and moreover, in recent years, several studies have investigated the correlation between obesity and chronic respiratory diseases such as asthma and EIB. CastroRodriguez et al. have identified five possible biological mechanisms which can explain the relationship between asthma and obesity: mechanical effects of obesity on respiratory function, altered immune response and inflammatory activation of specific gene regions, hormonal influences related to gender, and influence of diet and physical activity. The excessive accumulation of adipose tissue at the chest wall may alter the pulmonary respiratory mechanisms favouring an increase in the response of bronchial smooth muscle. Both asthma and obesity can cause excessive reduction of small airways diameter and increase gas trapping. Overweight patients have a decreased tidal air volume and functional residual capacity, with consequently more difficulties to stand physical activity. The risk of asthma developing in overweight children is higher in females than in males, and higher in those girls who have an early menarche. Indeed, obese asthmatic patients require a greater number of medications for asthma; emergency visits; hospital admissions; and accesses to emergency care, more than asthmatic children who are not overweight. In the present issue of Allergologia et Immunopathologia, Lopes et al. report the results of a study assessing the frequency and severity of EIB in obese adolescents. Eighty adolescents of both genders, aged 10–16 years old, were divided into four groups: asthmatic obese, asthmatic nonobese, obese non-asthmatic, and healthy individuals, analysing how obesity can influence EIB. Every patient performed an exercise test and changes in the pulmonary function (FEV1) have been evaluated. The study showed that obese asthmatic children have no greater risk frequency of EIB than non-obese asthmatic children (50% vs. 38%, respectively). However, maximum percent fall in FEV1 and area above the curve, calculated to evaluate EIB severity and recovery, were significantly greater in the asthmatic obese group compared to the asthmatic non-obese group. The authors concluded that although obesity does not increase the prevalence of EIB, being overweight can indeed contribute to increase EIB severity and to delay recovery among asthmatics. All these evidences lead to consider that obese asthmatics can present difficulties in the recovery of normal pulmonary function with a consequent limitation of their participation in physical and sporting activities. Therefore, dyspnoea during exercise in obese patients should not always be considered a manifestation of EIB, but should be placed in the differential diagnosis with other causes for EID, which include normal physiologic exercise limitation, vocal cord dysfunction, exercise-induced laryngomalacia and hyperventilation syndrome. Physical deconditioning, common in sedentary, obese children, is one common cause of EID, particularly in school-age children who do not have asthma, although some of these children are mistakenly diagnosed as having asthma. The person with excess weight is most prone to the development of EID for physical characteristics which alter the lung mechanism and bronchial responsiveness. Obesity also affects the perception of symptoms of asthma and asthma severity change through co-morbidities associated with asthma; such as gastro-oesophageal reflux, obstructive sleep apnoea and obesity hypoventilation syndrome. Epidemiological data from Glazebrook et al. have shown that most of the children with severe asthma are obese and are much less active than children in the control group. Although obesity per se seems not to be a risk factor for bronchial obstruction, obese patients have an increased risk for dyspnoea, and often obese asthmatic children require a ARTICLE IN PRESS