Sara Bozzetto

Asthma, allergy and respiratory infections: the vitamin D hypothesis

To cite this article: Bozzetto S, Carraro S, Giordano G, Boner A, Baraldi E. Asthma, allergy, and respiratory infections: the vitamin D hypothesis. Allergy 2012; 67: 10–17.

Chronic lung disease of prematurity: long-term respiratory outcome.

Chronic respiratory morbidity is a common adverse outcome of preterm birth, especially in infants who develop bronchopulmonary dysplasia (BPD), which is still a major cause of long-term lung dysfunction with a heavy burden on health care services and medical resources throughout childhood. The most severely affected patients remain symptomatic even in adulthood, and this may be influenced also by environmental variables (e.g. smoking), which can contribute to persistent obstruction of airflow. Of all obstructive lung diseases in humans, BPD has the earliest onset and probably lasts the longest. Since the prevention of BPD is an elusive goal, minimizing neonatal lung injury and closely monitoring survivors remain the best courses of action. This review describes the clinical and functional changes characteristic of the long-term pulmonary sequelae of preterm birth, focusing particularly on BPD.

Childhood asthma biomarkers: present knowledge and future steps

Asthma represents the most common chronic respiratory disease of childhood. Its current standard diagnosis relies on patient history of symptoms and confirmed expiratory airflow limitation. Nevertheless, the spectrum of asthma in clinical presentation is broad, and both symptoms and lung function may not always reflect the underlying airway inflammation, which can be determined by different pathogenetic mechanisms. For these reasons, the identification of objective biomarkers of asthma, which may guide diagnosis, phenotyping, management and treatment is of great clinical utility and might have a role in the development of personalized therapy. The availability of non-invasive methods to study and monitor disease inflammation is of relevance especially in childhood asthma. In this sense, a promising role might be played by the measurement of exhaled biomarkers, such as exhaled nitric oxide (FE(NO)) and molecules in exhaled breath condensate (EBC). Furthermore, recent studies have shown encouraging results with the application of the novel metabolomic approach to the study of exhaled biomarkers. In this paper the existing knowledge in the field of asthma biomarkers, with a special focus on exhaled biomarkers, will be highlighted.

Health-related quality of life in adolescent survivors of bronchopulmonary dysplasia.

Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease of infancy in the developed countries. Outcomes for BPD patients have traditionally been assessed using physiological parameters such as lung function, and no data are available on the health‐related quality of life (HRQOL) for adolescents with BPD. The aim of this study was to assess HRQOL in adolescents with BPD, in comparison with age‐matched and sex‐matched control groups of healthy volunteers and asthmatic subjects.

Severe asthma in childhood: diagnostic and management challenges.

Purpose of review Problematic severe asthma is a heterogeneous disease with multiple phenotypes. It is rare (<5% of children with asthma), but accounts for 30–50% of all pediatric asthma healthcare costs. This review looks into the currently used management strategies and the innovative treatments, considering both conventional medications and innovative biological therapies for targeting airway inflammation. Recent findings Patients with problematic severe asthma should be seen by pediatric asthma specialists using a stepwise approach. The first step is to exclude alternative diagnoses; the second is to consider and exclude comorbidities, and assess adherence to medication; the third step involves identifying the pattern of inflammation; and response to treatment in the fourth. Innovative biological therapies are emerging and healthcare professionals should know how to handle them. Patient phenotyping is the main step towards a targeted therapeutic strategy. Summary A careful management is important for children with severe asthma, who form a small but challenging group of patients. More research efforts are needed to enable a personalized medicine and a biomarker-driven approach.

Wheezing preschool children with early-onset asthma reveal a specific metabolomic profile

Many children of preschool age present with recurrent wheezing. Most of them outgrow their symptoms, while some have early‐onset asthma. Aim of this prospective preliminary study was to apply a metabolomic approach to see whether biochemical‐metabolic urinary profiles can have a role in the early identification of the children with asthma.

Accessory‐lobed accessory cardiac bronchus: Presentation and treatment in a pediatric patient

Accessory cardiac bronchus (ACB) is a supernumerary bronchus usually arising from right main or intermediate bronchus. We report the case of a 9‐year‐old male who presented a 6‐month history characterized by two right pneumonia episodes followed by persistent productive cough, recurrent bloody sputum, and chest x‐ray persistence of a segmental thickening of right inferior lobe. Bronchoscopy revealed no abnormalities. Computed tomography documented an accessory‐lobed ACB originating from right lower brochus. Surgical removal of ACB and related parenchyma was approached thoracoscopically and converted to thoracotomy for evidence of a bronchial injury. Two‐year follow‐up showed no recurrent infections or respiratory symptoms.

COR a 14-specific IgE predicts symptomatic hazelnut allergy in children.

To the Editor, The self-reported prevalence of tree nut allergy in children has been increasing in the past decade (1). Hazelnuts are in particularly widespread use, and this makes them difficult to avoid completely. It is therefore important to correctly diagnose hazelnut allergy to avoid any unjustified diet. The aim of this study was to assess the utility of currently available hazelnut molecular components (Cor a 1-, Cor a 8-, Cor a 9-, and Cor a 14-specific IgE) in identifying cases of symptomatic hazelnut allergy among Italian children sensitized to hazelnut and referred to a tertiary medical center. We retrospectively included children seen at our clinic between June 2013 and April 2014 for suspected hazelnut allergy, with whole-hazelnut-specific IgE >0.10 kU/l, who had been tested for specific IgE levels for the hazelnut components Cor a 1, Cor a 8, Cor a 9, and Cor a 14 (ImmunoCAP; Thermo Fisher Scientific, Uppsala, Sweden), and undergone prick testing with hazelnut extract (Lofarma SpA, Milan, Italy) and prick-to-prick testing with native hazelnut. Hazelnut allergy had been demonstrated by open oral food challenge (OFC) eliciting objective clinical signs (urticaria, vomiting, rhinorrhea and sneezing, bronchospasm); on the contrary, children were considered tolerant when a regular serving of hazelnut (usually 6) was consumed with appearance of no clinical reaction (either objective or subjective). OFC was not performed in children with a convincing history (as judged by an experienced pediatric allergist) of an IgEmediated reaction (urticaria, angioedema, cough, bronchospasm, vomiting) occurring within 60 min after hazelnut ingestion. The study was approved by our Hospital Ethical Committee (Prot n 59385). All statistical tests were two-sided, and the results were considered significant for p-values <0.05. The Mann–Whitney U-test was used to compare allergy test results in allergic and tolerant children. The Spearman test was used to assess correlations. Thirty-six children aged 3–14 years (23 of them males) were included: 24 were classified as allergic to hazelnut and 12 as tolerant; 23 had been referred to our center because of hazelnut allergy suspicion based on previous clinical history and 13 based on previous IgE measurement. Twenty-nine of 36 were allergic to foods other than hazelnut, 10 had asthma, 14 had allergic rhinitis, and 21 had atopic dermatitis. Compared with the children who tolerated hazelnuts, those with hazelnut allergy showed significantly higher levels of whole-hazelnut-specific IgE (p < 0.001), Cor a 9-specific IgE (p < 0.001), and Cor a 14-specific IgE (p < 0.001), while no significant differences emerged for Cor a 1or Cor a 8-specific IgE (Table 1, Fig. 1). The allergic children also had significantly larger wheals after skin pricking with hazelnut extract (p = 0.03) and native hazelnut (p = 0.005). Fourteen of the 36 recruited children were sensitized to birch pollen on prick test (10 of them showing Cor 1-specific IgE). Among children sensitized to birch pollen, 7 had symptomatic hazelnut allergy (all of them being sensitized to Cor a 14, and 5 also to Cor a 9). Correlations were significant between whole-hazelnut-specific IgE and both Cor a 9-specific IgE (p < 0.001 and R = 0.58) and Cor a 14-specific IgE (p < 0.001 and R = 0.62), and between Cor a 9-specific IgE and Cor a14-specific IgE (p = 0.002 and R = 0.52). No significant correlations were seen between IgE levels and wheal size after skin pricking. Table 1 Specific IgE: median values and interquartile range [IQR] in allergic and tolerant children

Exhaled biomarkers in childhood asthma: old and new approaches

BackgroundAsthma is a chronic condition usually characterized by underlying inflammation. The study of asthmatic inflammation is of the utmost importance for both diagnostic and monitoring purposes. The gold standard for investigating airway inflammation is bronchoscopy, with bronchoalveolar lavage and bronchial biopsy, but the invasiveness of such procedures limits their use in children. For this reason, in the last decades there has been a growing interest for the development of noninvasive methods.Main bodyIn the present review, we describe the most important non-invasive methods for the study of airway inflammation in children, focusing on the measure of the fractional exhaled nitric oxide (feNO), on the measure of the exhaled breath temperature (EBT) and on the analysis of both exhaled breath condensate (EBC) and exhaled air (Volatile Organic Compounds, VOCs), using targeted and untargeted approaches. We summarize what is currently known on the topic of exhaled biomarkers in childhood asthma, with a special emphasis on emerging approaches, underlining the role of exhaled biomarkers in the diagnosis, management and treatment of asthma, and their potential for the development of personalized treatments.ConclusionAmong non-invasive methods to study asthma, exhaled breath analysis remains one of the most interesting approaches, feNO and “-omic” sciences seem promising for the purpose of characterizing biomarkers of this disease.