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Children
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Diagnosis, Treatment and Care of Pediatric Allergy
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Diagnosis, Treatment and Care of Pediatric Allergy

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Allergy and Immunology".

Deadline for manuscript submissions: closed (5 January 2026) | Viewed by 11083

Special Issue Editors

Dr. Angela Klain

E-Mail Website
Guest Editor
Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via Luigi de Crecchio 4, Naples, Italy
Interests: pulmonology; pediatrics; allergology; food science; immunology
Special Issues, Collections and Topics in MDPI journals
Dr. Cristiana Indolfi

E-Mail Website
Guest Editor
Department of Woman, Child and General and Specialized Surgery, University of Campania ‘Luigi Vanvitelli’, 80138 Naples, Italy
Interests: children; asthma; respiratory allergy; food allergy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Pediatric allergy represents a significant and growing concern in healthcare, encompassing a range of conditions such as asthma, allergic rhinitis, atopic dermatitis, food and drug allergies. These conditions affect a child's physical health and profoundly impact their overall quality of life and development. Despite advancements in understanding the mechanisms and treatment of pediatric allergies, many challenges remain in ensuring effective diagnosis, management and care. Early diagnosis and consistent management are crucial to prevent severe, sometimes fatal, exacerbations. Although considerable progress has been made in understanding the underlying pathogenesis, many aspects regarding environmental and genetic risk factors, accurate diagnosis and personalized treatments remain unresolved. There is a need for further research to explore novel molecular therapeutic targets and innovative management strategies.

This Special Issue invites submissions of original research and review articles that delve into various facets of pediatric allergic conditions. The topics of interest include, but are not limited to, the following:

  • Natural history and progression of pediatric allergic diseases;
  • Comorbidities associated with pediatric allergies;
  • Advances in diagnostic techniques and early interventions;
  • Strategies for the prevention and management of allergic conditions;
  • Environmental and lifestyle impacts on pediatric allergies;
  • Precision medicine and personalized treatment approaches;
  • New therapeutic strategies and molecular targets;
  • Innovative approaches to the control and management of pediatric asthma and other allergic diseases.

We welcome contributions that enhance our understanding and management of pediatric allergies, aiming to improve the health outcomes and quality of life for children affected by these conditions.

Dr. Angela Klain
Dr. Cristiana Indolfi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • children
  • allergy
  • respiratory disease
  • food allergy
  • drug allergy
  • research
  • prevention
  • treatment

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (6 papers)

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Research

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26 pages, 2810 KB  
Article
Age-, Sex- and Region-Specific Patterns in Sensitization Rates to Food Allergens and Food Allergy Prevalence in Croatian Children: The H2020 IMPTOX and ERDF P4 Study Findings
by Jan Pantlik, Marcel Lipej, Ivana Banić, Maja Šutić, Sandra Mijač, Petra Anić, Ana-Marija Genc, Ana Vukić, Antonija Piškor, Adrijana Miletić Gospić, Željka Vlašić Lončarić, Milan Jurić, Vlatka Drinković, Ivana Marić, Tin Kušan and Mirjana Turkalj
Children 2026, 13(2), 234; https://doi.org/10.3390/children13020234 - 6 Feb 2026
Viewed by 538
Abstract
Background/Objectives: Food allergy (FA) is a substantial health burden in children. FA is often associated with malnutrition and malabsorption, due to restrictive food avoidance diets, which can significantly impair the patient’s and their family’s quality of life. To this date, population-based data combining [...] Read more.
Background/Objectives: Food allergy (FA) is a substantial health burden in children. FA is often associated with malnutrition and malabsorption, due to restrictive food avoidance diets, which can significantly impair the patient’s and their family’s quality of life. To this date, population-based data combining sensitization and clinical allergy remain limited. This study aimed to assess the patterns of sensitization rates to food and food allergy prevalence rates in Croatian children and to evaluate differences according to age, sex, and region of origin. Materials and Methods: In this cross-sectional study, 1948 preschool and school-aged children from three Croatian regions (Zagreb, Dalmatia, and Slavonia) were included. Participants underwent skin prick testing to common food and inhalant allergens. Data on personal and family medical history were collected using questionnaires and medical records. FA prevalence was evaluated using self-reported data in school-aged children and physician-diagnosed FA data in preschool children. Results: Overall, 41% of participants were sensitized to at least one allergen, while 13% were sensitized to at least one food allergen. Tree nuts—particularly hazelnut—were the most common food-derived sensitizers, followed by hen’s egg, cow’s milk, and fish. Boys exhibited higher total sensitization rates than girls (44.2% vs. 37.5%; p = 0.001), higher food allergen sensitization rates (14.7% vs. 11.4%; p = 0.037), and higher total polysensitization rates (30.7% vs. 22.6%; p < 0.001). School-aged children showed higher total sensitization (44.8% vs. 33.4%; p < 0.001) and polysensitization rates (29.8% vs. 20.5%; p < 0.001) than preschool children, while sensitization to food allergens did not differ between age groups. Food allergen sensitization rates differed by region, with higher prevalence in Zagreb compared with Dalmatia and Slavonia (p = 0.0055), whereas total sensitization rates did not differ regionally. The agreement between sensitization and self-reported FA among school-aged children was low (κ = 0.22; p < 0.001), as was the agreement between sensitization and physician-diagnosed FA in preschool children (κ = 0.13; p < 0.001), despite high specificity in both analyses (95% and 99%%, respectively). Conclusions: Allergic sensitization is common among Croatian children, but it poorly predicts clinically relevant food allergy. These findings highlight the multifactorial nature of allergen sensitization in children and emphasize the need for improvements in diagnostic pathways, targeted prevention strategies, and continued surveillance to optimize allergy prevention and management in children. Full article
(This article belongs to the Special Issue Diagnosis, Treatment and Care of Pediatric Allergy)
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16 pages, 892 KB  
Article
Analysis of Specific IgG4 Antibody and sIgG4/sIgE Antibody Ratio as Marker of Immune Tolerance to IgE-Mediated Response in Allergic Children
by HyeonA Kim, Ben Kang and Bong Seok Choi
Children 2025, 12(12), 1679; https://doi.org/10.3390/children12121679 - 10 Dec 2025
Viewed by 650
Abstract
Background: The diagnosis and treatment of allergic diseases remain challenging because the results of allergy testing do not always correlate with clinical manifestations. For instance, although a specific IgE (sIgE) test for a particular allergen may be positive, some patients remain asymptomatic due [...] Read more.
Background: The diagnosis and treatment of allergic diseases remain challenging because the results of allergy testing do not always correlate with clinical manifestations. For instance, although a specific IgE (sIgE) test for a particular allergen may be positive, some patients remain asymptomatic due to the development of immune tolerance. Recently, specific IgG4 (sIgG4) has been suggested as a potential indicator of immune tolerance. However, data in children are limited. Therefore, this study aimed to evaluate the clinical usefulness of sIgG4 testing and its potential role in assessing immune tolerance in pediatric allergic disease by measuring sIgE and sIgG4 levels. Methods: A total of 415 children with suspected allergic diseases were enrolled. All subjects underwent sIgE and sIgG4 testing for casein, egg white, peanut, Dermatophagoides farinae (D. farinae), dog dander, and birch. sIgE positivity was defined as a level of 0.35 kU/L or higher for each allergen. Test results and clinical characteristics were reviewed, and the association between symptom occurrence during actual allergen exposure and sIgG4 level or sIgG4/sIgE ratio was analyzed. Results: Among the 415 children, 253 were male (61%) and 162 were female (39%), with a median age of 5.77 years (IQR, 2.67–9.15). For inhalant allergens, sIgG4 levels did not differ between symptomatic and asymptomatic patients; however, the sIgG4/sIgE ratio was significantly higher in asymptomatic patients (D. farinae: p < 0.001, dog dander: p < 0.001, birch: p = 0.003)). For food allergens, significant differences in sIgE, sIgG4, and sIgG4/sIgE ratio were observed for casein (sIgE: p < 0.001, sIgG4: p < 0.001, sIgG4/sIgE: p < 0.001) and egg white (sIgE: p < 0.001, sIgG4: p < 0.001, sIgG4/sIgE: p < 0.001), while no significant associations were found for peanut. Conclusions: The correlation between sIgG4 and clinical symptom occurrence varied depending on the allergen. Although sIgG4 alone appears to have limited clinical value for inhalant allergens, the sIgG4/sIgE ratio may serve as a useful indicator of immune tolerance. For casein and egg white, both sIgG4 and the sIgG4/sIgE ratio demonstrated potential clinical utility for identifying immune tolerance; however, further investigation is needed to validate the role of sIgG4-based indicators in pediatric allergy management. Full article
(This article belongs to the Special Issue Diagnosis, Treatment and Care of Pediatric Allergy)
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19 pages, 818 KB  
Article
Cow’s Milk Protein Allergy: ETAPA Survey on Pediatric Management and Tolerance Acquisition
by Juan José Díaz-Martin, Rafael Martín-Masot, Alicia Santamaría-Orleans and Víctor Manuel Navas-López
Children 2025, 12(12), 1645; https://doi.org/10.3390/children12121645 - 3 Dec 2025
Viewed by 1224
Abstract
Background: Cow’s milk protein allergy (CMPA) is among the most common pediatric food allergies. Understanding tolerance acquisition and diagnostic approaches is critical for optimizing care, particularly in Spain, where regional differences may impact management. This study analyzed real-world practices for determining CMPA oral [...] Read more.
Background: Cow’s milk protein allergy (CMPA) is among the most common pediatric food allergies. Understanding tolerance acquisition and diagnostic approaches is critical for optimizing care, particularly in Spain, where regional differences may impact management. This study analyzed real-world practices for determining CMPA oral tolerance acquisition by Spanish pediatricians. Methods: A questionnaire was distributed to healthcare providers in primary and hospital pediatric settings across various Spanish provinces. The survey addressed demographic profiles, diagnostic approaches, tolerance acquisition, and dietary modifications. Results: Among the 269 health professionals included (mean age 48.3 ± 11.0 years, 62.3% women), most worked in primary care (55.4%), 20.4% in public hospitals, and 17.8% in private practice. Overall, 35.5% routinely referred CMPA cases to specialists. Specific IgE testing (27.9%) and elimination diets (41.3%) were the main diagnostic tools. Diagnostic dairy-exclusion duration varied, mainly in non-IgE cases. Hospital-based diagnostic oral food challenges (OFC) were preferred for suspected IgE-mediated cases (95.7%), while home-based protocols were used for non-IgE suspected cases (80.7%). Guideline adherence for home-based OFC varied by specialty. Tolerance acquisition was evaluated annually by 67.7% of participants, with a mean success rate of 80%. Therapeutic dairy-exclusion duration varied, with 64.7% excluding CMP for 6–12 months. Minimum age for CMP reintroduction was considered dependent on phenotype and severity, with 12 months of age mentioned most frequently (17.1%). Conclusions: Despite general alignment with international guidelines, relevant variability exists in CMPA management in Spain. Harmonizing diagnostic and therapeutic practices across specialties and care levels may help standardize care and improve patient outcomes. Full article
(This article belongs to the Special Issue Diagnosis, Treatment and Care of Pediatric Allergy)
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8 pages, 1248 KB  
Article
Incidence and Characteristics of Pediatric Eosinophilic Esophagitis: A Midwestern State Analysis
by Jose L. Zamora-Sifuentes, Andrew Rorie, Sharad Kunnath, Rosemary Pauley, Andrew Huang Pacheco and Russell Hopp
Children 2025, 12(2), 248; https://doi.org/10.3390/children12020248 - 19 Feb 2025
Cited by 1 | Viewed by 2242
Abstract
Background: Eosinophilic esophagitis (EoE) is a chronic disease defined by esophageal dysfunction and >15 eosinophils per high-power-field on biopsy. Despite its increased incidence across the United States, studies evaluating its incidence at any state level are lacking. Methods: Record review of pediatric patients [...] Read more.
Background: Eosinophilic esophagitis (EoE) is a chronic disease defined by esophageal dysfunction and >15 eosinophils per high-power-field on biopsy. Despite its increased incidence across the United States, studies evaluating its incidence at any state level are lacking. Methods: Record review of pediatric patients (<18 years) newly diagnosed with EoE based on ICD coding seen at the main two pediatric gastroenterology centers in the state: Children’s Nebraska (1 January 2016–31 December 2022) and Boys Town National Research Hospital (1 January 2022–31 December 2022). Data included demographics, age, and zip codes. Descriptive analysis focused on Nebraska residents. Results: The average point incidence of EoE between 2016 and 2022 was 10.84/100,000 inhabitants based on data from Children’s Nebraska. Considering both centers, the point incidence in Nebraska for 2022 was 32.45/100,000 inhabitants. Caucasians were 3.7 times more likely to be affected and older at time of diagnosis (average 9.7 years) compared to African Americans (7.0), Hispanics (7.4), and Asians (4.4). Conclusions: This is the first study evaluating the incidence of EoE in a specific U.S.A state. Studies at the state level are important to direct policy and interventions aiming limit its burden in communities. Full article
(This article belongs to the Special Issue Diagnosis, Treatment and Care of Pediatric Allergy)
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Review

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12 pages, 233 KB  
Review
Recurrent Infections in Allergic Pediatric Patients: An Immune System Problem? A Narrative Review
by César Galván, Rafael Durán, Cristian Matos, Cristiana Indolfi and Angela Klain
Children 2025, 12(6), 788; https://doi.org/10.3390/children12060788 - 17 Jun 2025
Viewed by 2166
Abstract
Background/Objectives: Recurring infections in children with allergies pose significant clinical challenges, with these conditions often exacerbating each other through complex immunological interactions. This narrative review examines the connection between recurring infections and allergic conditions in pediatric patients, focusing on how immune system dysfunction [...] Read more.
Background/Objectives: Recurring infections in children with allergies pose significant clinical challenges, with these conditions often exacerbating each other through complex immunological interactions. This narrative review examines the connection between recurring infections and allergic conditions in pediatric patients, focusing on how immune system dysfunction influences infection susceptibility in respiratory allergies. Methods: A comprehensive literature search across PubMed, Web of Science, and SciELO databases was conducted from January 2014 to May 2024. Studies involving children and adolescents up to 18 years old with diagnosed respiratory allergies were included, while reviews, opinion pieces, case reports, and studies not addressing immune–infection interactions were excluded. Results: Analysis reveals significant immune dysfunction in allergic children, affecting both innate and adaptive immunity components. Children with allergic rhinitis and asthma demonstrate decreased interferon-gamma production, increasing vulnerability to viral infections (particularly rhinovirus) and bacterial infections such as Mycoplasma pneumoniae. Rhinovirus represents the most common pathogen, present in 75% of asthma exacerbations. Atopic children exhibit markedly higher bacterial infection rates, with 27.1% showing Mycoplasma pneumoniae involvement versus 4.9% in non-atopic children. Conclusions: Recurring infections in allergic pediatric patients result from significant immune dysfunction involving altered cytokine production and immune cell function. These complex interactions highlight the need for targeted therapeutic approaches that enhance immune responses and reduce infection risks. Future research should focus on identifying specific biomarkers and immune mechanisms for developing more effective interventions. Full article
(This article belongs to the Special Issue Diagnosis, Treatment and Care of Pediatric Allergy)
13 pages, 622 KB  
Review
Impact of School Nurses on Children with Food Allergies: A Comprehensive Review
by Silvio Simeone, Greta Aquilone, Caterina Mercuri, Flavia Lotito, Vincenzo Bosco, Teresa Rea, Roberto Berni Canani and Rita Nocerino
Children 2025, 12(2), 201; https://doi.org/10.3390/children12020201 - 8 Feb 2025
Cited by 1 | Viewed by 3279
Abstract
Background. Food allergies (FAs) are a significant public health concern, affecting 6–8% of children worldwide, with a growing prevalence. Schools are high-risk environments for allergic reactions, including anaphylaxis, which can be life-threatening. Alarmingly, up to 16–18% of children with FAs experience allergic reactions [...] Read more.
Background. Food allergies (FAs) are a significant public health concern, affecting 6–8% of children worldwide, with a growing prevalence. Schools are high-risk environments for allergic reactions, including anaphylaxis, which can be life-threatening. Alarmingly, up to 16–18% of children with FAs experience allergic reactions at school, often due to accidental exposure. Additionally, up to 25% of anaphylactic reactions in schools occur in children with no prior diagnosis of FA, emphasizing the critical need for school-wide preparedness and robust emergency action plans. School nurses play a pivotal role in managing FAs through individualized health plans, emergency preparedness, staff training, and psychosocial support. This review aims to evaluate the multifaceted role of school nurses in ensuring the safety, health, and psychosocial well-being of children with FAs. It also seeks to identify systemic challenges and gaps in allergy management to inform targeted interventions and future research. Methods. This comprehensive review synthesizes evidence on the role of school nurses in FA management. A systematic literature search was conducted across PubMed, CINAHL, Scopus, and Cochrane, targeting studies published between 2014 and 2024. The search identified 6313 articles, of which 5490 remained after duplicate removal. After title and abstract screening, 60 articles were selected for full-text evaluation, with 59 included in the final review. Thematic analysis identified six domains: preventive measures, emergency preparedness, communication, health outcomes, psychosocial support, and systemic challenges. Results. The review highlights the critical contributions of school nurses to FA management. They improve safety by implementing Individualized Health Plans (IHPs) and Emergency Action Plans (EAPs), ensuring timely administration of epinephrine and reducing delays during emergencies. Preventive strategies, such as allergen-free zones and comprehensive training for staff, minimize exposure risks. Psychosocial interventions led by nurses alleviate stigma, bullying, and anxiety, enhancing the quality of life for children with FAs. Despite these benefits, barriers persist, including insufficient nurse-to-student ratios, limited access to emergency resources like stock epinephrine, and disparities in allergy management across socioeconomic and geographic contexts. Conclusions. School nurses are integral to managing FAs, ensuring safety, fostering inclusion, and addressing psychosocial needs. Addressing systemic barriers and ensuring equitable resource distribution are essential to optimize their impact. Future research should focus on the long-term outcomes of nurse-led interventions, strategies to reduce disparities, and the potential role of digital tools in improving allergy management. Full article
(This article belongs to the Special Issue Diagnosis, Treatment and Care of Pediatric Allergy)
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