Search Results (39)

Background/Objectives: Biologic therapies are the cornerstone of severe asthma management. However, evidence regarding switching between biologics in children with severe asthma remains limited. Methods: Retrospective observational study including patients aged 6–17 years with severe asthma, followed at our tertiary referral center, who switched biologic therapy. Clinical, laboratory, and lung function data were collected at the initiation of the second biologic (T0) and after 4 (T1) and 12 months (T2). Changes in asthma control, exacerbation rate, inhaled corticosteroid dose, FeNO and lung function were evaluated. Results: Eight patients who switched and had been treated with a second biologic for at least 12 months were included. Switching occurred from omalizumab to dupilumab (n = 1), mepolizumab to dupilumab (n = 5), and mepolizumab to omalizumab (n = 2). The main reason for switching was inadequate asthma control, while one patient switched because of poorly controlled comorbidity. At T2, exacerbations significantly decreased (p = 0.03), with significant improvements in FEV₁ (p = 0.002) and FEV₁/FVC (p = 0.015). The daily fluticasone-equivalent dose decreased from a median of 500 μg to 425 μg. Conclusions: In this cohort, switching biologic therapy was associated with improved clinical and functional outcomes, with a significant response already detectable after 4 months. These findings highlight the importance of close clinical and functional monitoring to identify children who may benefit from a change in biologic therapy. Larger prospective studies are needed to define standardized criteria and optimal timing for biologic switching in pediatric severe asthma. Full article

Asthma prevalence in school-age children varies widely by geography, from below 5% in some regions to above 20% in others, averaging 10–12% across industrialized countries, but genetic factors account for less than 40% of disease liability. Gut microbiota is increasingly recognized as a critical intermediary between early-life dietary exposure and immunological trajectories that determine asthma susceptibility. Through the production of short-chain fatty acids (SCFAs), particularly butyrate, propionate, and acetate, commensal bacteria regulate dendritic cell function, promote T-regulatory (Treg) cell differentiation, and attenuate Th2-polarized airway inflammation via the gut–lung axis. Epidemiological cohorts including CHILD, WHEALS, and PASTURE associate early-life dysbiosis and reduced Lactobacillus, Bifidobacterium, and Faecalibacterium prausnitzii with increased asthma risk, while dietary patterns rich in fermentable fibre, omega-3 polyunsaturated fatty acids, and diverse plant-based foods are associated with preserved microbial diversity and, in preclinical models, attenuated type-2 inflammatory signalling. This narrative review synthesizes mechanistic and epidemiological evidence on how nutritional exposures shape gut microbiota composition and influences asthma onset and severity in paediatric populations, including the distinct obesity-related asthma phenotype. Critical gaps, insufficient dietary intervention trials with microbiome endpoints, methodological heterogeneity across cohorts, and the paucity of data from non-Western populations are discussed, with implications for preventive nutritional counselling in paediatric allergology practice. Full article

Background: Vitamin D deficiency affects an estimated 40–60% of pregnant women worldwide and is associated with adverse obstetric and neonatal outcomes. Childhood asthma, the most prevalent chronic paediatric disease, has emerged as a plausible programming target, since vitamin D regulates foetal lung branching morphogenesis, calibrates the developing immune system, and modulates decidual and placental function in early gestation. Two landmark randomised trials, VDAART (intervention from weeks 10–18) and COPSAC2010 (from week 24), each reported a 20–25% reduction in offspring asthma or recurrent wheeze at age 3, yet neither reached significance in primary analysis, and the protective signal attenuated by school age. Post hoc stratification by baseline maternal 25-hydroxyvitamin D [25(OH)D] and 17q21 genotype recovered significant effects, raising the possibility that population-average nulls conceal a real but modifier-conditional benefit. Aim: This narrative review re-examines the evidence through a developmental-timing lens, arguing that the periconceptional and first-trimester window, rather than mid-gestation, is the biologically relevant interval for any protective effect. Methods: The review utilises a narrative synthesis of randomised trials, birth-cohort studies, mechanistic investigations, and recent meta-analyses (PubMed, Embase, Cochrane Library to April 2026) relevant to maternal vitamin D, placental biology, and offspring asthma. Findings: The periconceptional weeks coincide with implantation, decidualisation, the embryonic and pseudoglandular phases of airway morphogenesis, and the onset of epigenetic programming, while decidual CYP27B1 expression is prominent in the first trimester. Both trials initiated supplementation after branching morphogenesis was largely complete. Effect modifiers, including baseline 25(OH)D, vitamin D-binding protein, and maternal 17q21 genotype, indicate substantial inter-individual heterogeneity masked in unselected populations. Conclusions: Repositioning preventive supplementation toward the preconceptional and first-trimester window, stratified by baseline status, offers a biologically coherent strategy that existing mid-pregnancy trials have not tested. Adequately powered preconceptional trials with serial biomarker measurement and objective respiratory phenotyping are the priority. Full article

Paediatric rhinosinusitis (RS), particularly chronic rhinosinusitis (CRS), is a common inflammatory condition with a significant impact on quality of life and a well-recognized association with asthma within the framework of united airway disease. This review aims to evaluate the impact of RS, mainly CRS, on asthma control in children and explore its role as a modifiable determinant. Mechanistically, RS and asthma share key pathophysiological features, including type 2 inflammation, epithelial barrier dysfunction, and airway microbiome dysbiosis, supporting the concept of a unified inflammatory process across the respiratory tract. Clinically, epidemiological data demonstrate a high prevalence of coexisting RS and asthma, with consistent associations with poorer asthma control, increased disease severity, and higher exacerbation burden, even in cases of subclinical sinonasal inflammation. Available observational evidence suggests that appropriate management of CRS, including medical therapy and, in selected cases, surgical intervention, may improve asthma outcomes such as symptom control and lung function. Targeted biologic therapies have shown clinical benefit in adolescents with CRS with nasal polyps (CRSwNP) and high type 2 inflammation, although paediatric data remain limited. However, the existing evidence is predominantly based on small, heterogeneous, observational studies. RS therefore represents a potentially treatable trait in paediatric asthma, warranting systematic evaluation in children with difficult-to-treat disease. Further prospective and interventional studies are needed to clarify causality and define the impact of RS on long-term outcomes. Full article

Background/Objectives: The prevalence of allergic diseases has markedly increased in developed countries, with environmental and dietary factors considered important contributors. Folic acid is an essential micronutrient involved in one-carbon metabolism and DNA methylation, playing a key role in epigenetic regulation of immune function. Both high and low folate exposure have been associated with allergic outcomes, but the data on postnatal folate status in paediatric populations remain limited. This study aimed at assessing serum folate status in children with atopic diseases compared with children without chronic allergic disease in Croatia. Methods: This cross-sectional study included 292 paediatric patients from the University Hospital in Split and a paediatric primary care practice between January 2024 and January 2025. Serum folic acid concentrations were measured using electrochemiluminescence immunoassay. Additional laboratory parameters included vitamin B12, total IgE levels, and eosinophil counts. Demographic and clinical data were obtained from medical records. Statistical analyses included Chi-square tests, Mann–Whitney U tests, linear regression modelling, and analysis of covariance with statistical significance set at p < 0.05. Results: Folic acid deficiency was present in 66.4% of all participants. Children with atopic diseases were significantly more likely to have folate deficiency and had lower mean serum folate concentrations compared to children without allergic disease. There were no significant differences in folate levels between children with and without asthma. Lower folate levels were associated with higher IgE levels, higher eosinophil counts, and older age. When controlling for the effects of age on folic acid levels, the differences between participants with and without atopic diseases remained significant. Conclusions: Folic acid deficiency is highly prevalent among children in the Mediterranean region of Croatia and is significantly associated with atopic diseases and markers of allergic inflammation. These findings highlight a potential role of folate status in paediatric allergic disease and support the need for longitudinal studies to clarify causality and potential clinical implications. Full article

Background/Objectives: Asthma affects millions of patients worldwide and impacts their quality of life, particularly among children. Colonisation or an imbalance within natural resident microbiota may drive inflammatory responses in asthma; antibiotic resistance genes (ARGs) have also been investigated in asthma microbiome studies. However, research on the association between airway microbiota and ARGs remains limited. Therefore, we elucidated functional-level characterisation at the level of ARGs, virulence factors, and active pathways among a paediatric asthma cohort relative to a healthy control. Methods: Overall, 29 children with asthma and 20 control subjects were enrolled, and 3 swabs (2 nasal and 1 oropharyngeal) were obtained from each participant. Genomic DNA was extracted and sent for shotgun sequencing, after which bioinformatic analysis was conducted to remove human reads and analyse the microbiota pattern in the samples. The abundance of antibiotic resistance genes was evaluated along with the distribution of virulence genetic markers. Functional investigation of the most prevalent metabolic pathways was also performed. Results: Upper airway microbiome functional capacity varied by anatomical location, with oropharyngeal communities exhibiting greater metabolic breadth than nasal communities, suggesting the sample source to be the dominant factor shaping gene content, pathway profiles, and community structure. Asthma-related functional differences were modest, and no biological pathways remained significant following false discovery rate correction. Enrichment of antimicrobial resistance genes was observed, particularly those conferring resistance to β-lactams, macrolides, and tetracyclines. Conclusions: Different anatomical niches exhibit differential activities, and further exploration in this direction could aid in the development of diagnostic and therapeutic biomarkers for asthma. Full article

Background/Objectives: Asthma exacerbations are among the most frequent causes of pediatric emergency department (ED) visits, with over 700,000 annual cases in the United States and a significant number in Europe. Children under five years of age are particularly vulnerable to hospitalization. Methods: As timely assessment of exacerbation severity in the ED is critical, this review synthetizes data about tools such as the Pediatric Respiratory Assessment Measure (PRAM) and the Asthma Severity Score (ASS) aid in evaluating clinical status based on respiratory rate, oxygen saturation, accessory muscle use, and response to treatment. We also analyzed the proper management following established guidelines from GINA, NAEPP and other articles. Results: First-line therapy includes oxygen supplementation, short-acting beta-agonists (SABAs) administered frequently during the first hour, and early systemic corticosteroids. In moderate to severe cases, ipratropium bromide is added. For refractory or life-threatening presentations, intravenous magnesium sulfate, epinephrine, or ventilatory support may be required. Discharge is appropriate when symptoms resolve, oxygen saturation remains >94% on room air, and the child demonstrates adequate inhaler use. Hospitalization is indicated in cases of persistent hypoxemia, poor response, feeding difficulties, or social concerns. Post-discharge care includes thorough caregiver education, medication access, and a personalized asthma action plan to reduce recurrence risk. Conclusions: The effective diagnosis, appropriate exacerbation treatment, monitoring of patients in the post-attack period, as well as successful preventive medication play a key role in the management of pediatric patients with asthma. Full article

Atopic eczema is the most prevalent chronic dermatitis in childhood, characterised by relapsing pruritic lesions and significant heterogeneity in clinical expression and immunological profile. The disease impacts quality of life and healthcare systems, especially when persistent into adulthood. Epidemiological data from the International Study of Asthma and Allergies in Childhood (ISAAC) demonstrate significant geographic and temporal variability in the prevalence of atopic eczema, with an overall upward trend observed in paediatric populations across most regions. A systematic literature search was conducted in PubMed, ScienceDirect, and the Cochrane Library to identify relevant studies published between 1990 and 2025. Seven studies met the inclusion criteria—six cross-sectional and one prospective—conducted in the urban centres of Athens, Thessaloniki, and Patras. Sample sizes ranged from 517 to 3076 participants, encompassing children and adolescents aged 6 to 17. Prevalence rates ranged from 4.5% to 16.1% in children and 8.9% in adolescents, with notable geographic and temporal variability. Male sex, younger age, environmental exposures, and a family history of atopic diseases were identified as key risk factors. Comparative data from European studies reflect similar trends, with increasing atopic eczema prevalence and plateauing asthma rates suggesting distinct etiological pathways. The psychosocial and economic burden of atopic eczema remains substantial, highlighting the need for early recognition and effective management. Despite methodological variability and limitations in study design, findings indicate an underestimation of atopic eczema prevalence in Greece and underscore the importance of standardised epidemiologic surveillance. Full article

Background/Objectives: Allergen immunotherapy is the sole therapeutic option capable of modifying the natural course of allergic rhinitis and preventing the development of asthma. Results from paediatric patients are scarce. To evaluate the effectiveness and safety of a glutaraldehyde-modified extract of mites (Beltavac^®) administered for one year under clinical routine conditions in children between 3 and 11 years old. Methods: This was a multicentre, prospective, 13-month cohort study. Among 97 children diagnosed with immunoglobulin E-mediated house dust mite allergic rhinoconjunctivitis, 87 initiated the subcutaneous immunotherapy. The main outcomes included the Combined Symptoms and Medication Score (CSMS), assessed for 1 month at baseline and after 1, 6, and 12 months, and the number of adverse reactions according to the WAO adverse reaction grading system. The levels of serum-specific immunoglobulins were also assessed. Results: CSMS improved scores throughout therapy (adjusted mean change and 95% confidence interval: 0.55, 0.26–0.84 points; p < 0.001). Improvements occurred in both children with (n = 68) and without asthma (n = 19), as well as in children aged ≥6 years (n = 76) and <6 years (n = 11), although statistical significance was not reached in the smallest subgroups. Eight children (9.2%) developed a total of 15 adverse reactions. Most occurred after the initial dose (five out of eight children), and were local (six out of eight) and minor (five out of eight). Over 90% of patients completed the full regimen. Conclusions: This study supports the effectiveness and safety of allergen immunotherapy administered according to a rush schedule for one year for paediatric allergic rhinitis. Full article

Background/Objectives: The guideline on allergen-specific immunotherapy of the European Academy of Allergy and Clinical Immunology recommends subcutaneous allergen-specific immunotherapy for the treatment of allergic rhinitis in children and adults with moderate to severe symptoms. The five years cohort study described below was designed in 2020 to demonstrate non-inferiority in terms of safety, tolerability and efficacy in a paediatric population compared with adult patients treated with microcrystalline tyrosine-adsorbed allergoids for their tree and grass pollen allergy in a perennial setting. Here, we present the preliminary findings from the first year. Methods: The Combined Symptom and Medication Score was chosen as the primary endpoint of this therapy. Secondary endpoints include the Rhinoconjunctivitis Quality of Life Questionnaire, the retrospective Rhinoconjunctivitis score, the Asthma Control Test and the Rhinitis Control Test, as well as an analysis of adverse drug reactions. Results: A total number of 320 patients were enrolled into this study, with 129 of these patients in the age group between 5 and 17 years and 191 patients in the adult age group. Mean Combined Symptom and Medication Score values did not differ significantly between minors and adults in the first pollen season after treatment induction. The retrospective score showed a strong and significant reduction in rhinoconjunctivitis and asthma symptoms. Treatment was well tolerated, with more than 80% of patients reporting no adverse drug reactions. Conclusions: The validity of this study approach of a cohort study has been confirmed by this first interim analysis for the initial course of therapy in the first year. Full article

Background: Severe acute asthma (SAA) in children can be life-threatening. There has been a significant rise in paediatric intensive care unit (PICU) admissions due to SAA over the past two decades. While asthma is a heterogeneous disease, its underlying pathophysiological pathways remain underexplored. This study aimed to assess the value of non-invasive targeted exhaled breath metabolomics analysis to better characterise SAA. Methods: Breath samples from 17 children admitted to the PICU with SAA (cases) and 27 children with controlled severe asthma (controls) were analysed using thermal desorption gas chromatography–mass spectrometry (TD-GC-MS). Results: A targeted volatile organic compound (VOC) analysis identified 25 compounds, of which 16 were shared between groups. Four VOCs were significantly more often present in SAA, and nine VOCs exhibited higher concentrations in SAA. Longitudinal analysis of VOCs from follow-up samples of 10 cases showed no significant temporal differences, reinforcing the reproducibility of identified biomarkers. Conclusions: This study exemplifies the potential of exhaled breath analysis to provide insights into the molecular background of SAA. Breath metabolomics may enable early recognition of severe asthma attacks and preventive therapeutic interventions in children with severe asthma. Full article

Background/Objectives: The COVID-19 pandemic created many challenges for health services, particularly during lockdown periods. Asthma is one of the most common childhood conditions, and children with asthma are generally cared for in an outpatient setting. In regional Northwest Tasmania, during the COVID-19 lockdowns, asthma and allergy outpatient clinic services were transferred to a virtual platform in the form of telehealth appointments for routine consultations. This study aims to explore the patient and family perspectives of a telehealth outpatient asthma review service in a regional area. Methods: We utilised a mixed-methods approach, interviewing parents and children who attended the clinic via telehealth and collating routine clinical audit data collected during the same period. Results: Sixty-three patient reviews were audited, with a mean age of 9.79 years. Since their last review, 13% visited their GP, 9% presented to the ED, 6% were hospitalised, and 19% had changes in their treatment plan. Interviews highlighted three main themes: (i) telehealth is a convenient strategy for routine asthma and allergy review appointments, (ii) barriers associated with using telehealth are a minor concern for parents of children with asthma and allergy routine appointments, and (iii) shared decision-making between clinicians and parents of children with asthma and allergy around the type of appointment required is valued. Conclusions: We demonstrated that the benefits of telehealth include implementing treatment changes and facilitating access to care for children living in rural and remote areas. Full article

Since the publication of the Adverse Childhood Experiences (ACEs) Study in 1998, there has been a dramatic increase in the number of studies exploring the immunoendocrinological sequelae of toxic stress. However, the literature exploring this in relation to paediatric atopy predominantly revolves around asthma. This review aims to (1) explore the association between ACEs and non-asthmatic, non-iatrogenic paediatric allergies (NANIPA) in the developed world and (2) further focus on the association between exposure to violence and NANIPA. Methods: PubMed and Scopus were searched for articles examining adversity and NANIPA before age 18. Non-English papers, publications before 1998, reviews, opinion pieces and case reports/series were excluded. Screening, data extraction, and risk-of-bias were independently reviewed by the first two authors. Results: Nine of the one thousand eighty-nine records identified were included. Four pertained to objective 1, four to objective 2, and one pertained to both. Regarding objective 1, all studies reported a positive dose-response relationship between ACEs and NANIPA, which was most significant among preschoolers and diminished with age. Studies relevant to objective 2 were too heterogenous to compare. However, two interesting associations emerged: (1) The types of violence significantly associated with NANIPA in adolescence differ in a sex-dependent manner, and (2) verbal abuse and bullying are the violence types most powerfully and significantly associated with NANIPA. Conclusion: Psychological stress is a probable IgE-independent driver of atopy in children exposed to adversity and/or violence. While the literature is too underdeveloped to allow for meaningful cross-comparison between studies, this review has identified many interesting areas for future research. Full article

Influenza vaccination is the main method of preventing influenza. Vaccination is recommended for certain individuals with diseases that could cause complications in the case of flu infection. The objective of this retrospective observational study was to examine influenza vaccination coverage in patients with risk factors, to describe the characteristics of those vaccinated and to study the influence of COVID-19. The study population was children under 14 years old with risk factors between 2018/19 and 2022/23 in Central Catalonia, sourced through the electronic database of the Catalan Institute of Health. The association of influenza vaccination data with sociodemographic data and risk factors was performed by bivariate and multivariate analysis. A total of 13,137 children were studied. Of those, 4623 had received the influenza vaccine in at least one season. The average influenza vaccination rate was 28.8%. The statistically significant factors associated with vaccination were age and having certain risk factors: asthma, diabetes, haemoglobinopathies and clotting disorders. In all seasons, the immigrant population was vaccinated more than the native population p < 0.05, except for the COVID-19 season (2020/21), where no differences were observed. Of those vaccinated, 7.1% had been vaccinated for 5 consecutive years. Influenza vaccination coverage in the paediatric age group was low. Vaccination promotion measures must be implemented. COVID-19 meant an increase in vaccination of the native population to the same level as that of the immigrant population. Full article