Search Results (301)

Obesity and asthma are increasingly prevalent chronic conditions that often coexist in the pediatric population and may influence each other through shared pathophysiological mechanisms. Obesity can affect asthma expression and severity via mechanical effects on the lungs, systemic inflammation, altered adipokine levels, and metabolic dysregulation. These mechanisms contribute to a distinct asthma phenotype in children with obesity that is often less responsive to standard therapy. Nutrition plays a critical role in this context by influencing immune function, inflammation, and respiratory outcomes. Specific dietary patterns, such as the Mediterranean diet, along with nutrients including vitamin D, antioxidants, and polyunsaturated fatty acids, have been associated with the modulation of airway inflammation and asthma risk. Additionally, early-life nutritional exposures and gut microbiota composition may influence immune development and the propensity for allergic diseases. This narrative review aims to synthesize current evidence on the interplay between obesity, asthma, and nutrition in the pediatric population, highlighting potential dietary interventions and targets for improved asthma management in children with obesity. Full article

Background: Pediatric asthma is a multifactorial condition influenced by environmental, biological, and social determinants. The COVID-19 pandemic introduced new variables that may have affected the severity and management of asthma in children and adolescents, particularly through changes in healthcare access, treatment adherence, and exposure to environmental risk factors. Objective: To evaluate the association between asthma severity and various factors including nutritional status, corticosteroid use, COVID-19 vaccination, and pollutant exposure before and during the COVID-19 pandemic in a pediatric population. Methods: A retrospective analysis was conducted using 307 medical records of patients aged 3 to 17 years. Data collected included sociodemographic characteristics, nutritional indicators, history of corticosteroid use, vaccination status against COVID-19, and exposure to environmental pollutants. Asthma severity was assessed using the pulmonary score, and multiple statistical analyses, including logistic regression using the Bayesian Logistic Regression Model (BLRM), were employed to identify significant associations. Results: The analysis revealed a statistically significant impact of the pandemic on hospitalization rates (p = 0.0187) and the use of corticosteroids (p = 0.009), indicating changes in asthma management during this period. Notable differences were observed in the geographic distribution of mild versus severe asthma cases prior to the pandemic, associated with nutritional status and gender (p = 0.018). During the pandemic, breastfeeding history, body weight, and hospitalization emerged as significant predictors of asthma severity (p < 0.05). In addition, breastfeeding in young children (aged 3 to 6 years) and hospitalization were strongly associated with pulmonary scores, with significance values of 0.022 and 0.012, respectively, as identified by the BLRM. Conclusions: These findings suggest that the pandemic context influenced both the clinical course and management of pediatric asthma. Preventive strategies should consider individual and environmental factors such as nutrition, early-life health practices (e.g., breastfeeding), and equitable access to appropriate asthma care and vaccination. Tailoring pediatric asthma management to these variables may improve outcomes and reduce disparities in disease severity. Full article

Over several decades, childhood asthma has emerged as a significant global public health concern, with the highest prevalence reported in industrialized countries. The rapid rise in asthma incidence and loss of control when the diagnosis is established can be related to environmental and lifestyle changes, especially during early infancy. Current evidence indicates a potential link to an imbalance in immune system responses, influenced by tobacco smoke, traffic-related air pollution, outdoor and indoor allergens, gut microbiome, viral infection, obesity, sedentary lifestyle and dietary patterns. This narrative review aims to explore the landscape of contemporary environmental risk factors for childhood asthma, with a focus on their interplay and the relative importance. Full article

A critical factor contributing to the burden of childhood asthma is the lack of effective self-management in homecare settings. Artificial intelligence (AI) and lung sound monitoring could help address this gap. Yet, existing AI-driven auscultation tools focus on wheeze detection and often rely on subjective human labels. To improve the early detection of asthma worsening in children in homecare setting, we trained and evaluated a Deep Learning model based on spirometry-labelled lung sounds recordings to detect asthma exacerbation. A single-center prospective observational study was conducted between November 2020 and September 2022 at a tertiary pediatric pulmonology department. Electronic stethoscopes were used to record lung sounds before and after bronchodilator administration in outpatients. In the same session, children also underwent spirometry, which served as the reference standard for labelling the lung sound data. Model performance was assessed on an internal validation set using receiver operating characteristic (ROC) curves. A total of 16.8 h of lung sound recordings from 151 asthmatic pediatric outpatients were collected. The model showed promising discrimination performance, achieving an AUROC of 0.763 in the training set, but performance in the validation set was limited (AUROC = 0.398). This negative result demonstrates that acoustic features alone may not provide sufficient diagnostic information for the early detection of asthma attacks, especially in mostly asymptomatic outpatients typical of homecare settings. It also underlines the challenges introduced by differences in how digital stethoscopes process sounds and highlights the need to define the severity threshold at which acoustic monitoring becomes informative, and clinically relevant for home management. Full article

As the pediatric COVID-19 landscape evolves, it is essential to evaluate whether SARS-CoV-2 infection predisposes children to allergic disorders. This narrative review synthesizes current epidemiological and immunological evidence linking pediatric COVID-19 with new-onset atopy. Epidemiological data remain heterogeneous: large Korean and multinational cohorts report increased risks of asthma and allergic rhinitis following COVID-19, whereas U.S. cohorts show neutral or protective associations, highlighting geographic and methodological variability. Mechanistic insights provide biological plausibility: epithelial injury and the release of alarmin cytokines (IL-33, IL-25, TSLP) promote Th2 polarization and ILC2 expansion, while epigenetic “scars” (e.g., LMAN2 methylation changes) and hematopoietic stem cell reprogramming may sustain long-term Th2 bias. Cytokine memory involving IL-7 and IL-15 contributes to altered T- and B-cell homeostasis, whereas disrupted regulatory T-cell function may reduce tolerance thresholds. Paradoxical trade-offs exist, such as ACE2 downregulation in allergic airways, which may lower viral entry but simultaneously amplify type-2 inflammation. Together, these processes suggest that SARS-CoV-2 infection could foster a pro-allergic milieu in susceptible children. Although current evidence is inconclusive, integrating epidemiological surveillance with mechanistic studies is crucial for predicting and alleviating post-COVID allergic outcomes. Longitudinal pediatric cohorts and interventions targeting epithelial alarmins or microbiome restoration may hold promise for prevention. Full article

Objective: To synthesize the available evidence on field tests used to assess functional capacity in children with CLDs other than asthma, such as cystic fibrosis (CF), and non-CF bronchiectasis (NCFB). Still, the application and reliability of the field tests in non-asthmatic pediatric CLDs populations is scarce. Methods: Three databases (PubMed, Medline via EBSCOhost, and Web of Science) were searched from inception to 20 May 2025. Two researchers independently screened the retrieved articles and rated the methodological quality using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Information was extracted about study design, field test used, outcomes measured, and methodological quality. Results: Out of 784 records, 8 studies met the inclusion criteria. Most studies focused on CF. Five different field tests were identified: six-minute walk test (6MWT), modified shuttle walk test (mSWT), one-minute sit-to-stand test (1mSTS), three-minute step test (3mST), and TGlittre-P test. The 6MWT (n = 3) and mSWT (n = 2) were the most frequently used and demonstrated good reliability and clinical applicability. Reported outcomes included distance walked, total steps, task’ repetitions, and cardiopulmonary parameters, such as heart rate and perceived exertion of dyspnea/leg fatigue. Conclusions: Field exercise tests appear to be feasible in children with CLDs other than asthma, with most data available in CF. They can be used to monitor functional capacity over time, to assess the effectiveness of rehabilitation programs, and to complement symptom assessment with tools such as the Borg scale. Evidence in NCFB and PCD is still limited, and additional pediatric studies are needed. Full article

Background/Objectives: This study aimed to apply a multicriteria decision analysis to assess the comprehensive value of omalizumab for moderate to severe pediatric asthma in China. Methods: A multidisciplinary panel of 17 experts assessed the value of omalizumab plus the standard of care (SOC) using SOC alone as a comparator. We developed a hierarchical criteria system with six main domains and 15 specific criteria. To establish a comprehensive evidence matrix, we integrated findings from a systematic literature review (SLR) and a real-world pharmacovigilance study based on the FAERS database. The overall estimated value of each strategy was obtained by combining the criterion weights with the score of each strategy in each criterion. A sensitivity analysis was conducted to validate the robustness of the results. Results: According to the AHP methods, the following weights were assigned to the criteria: safety (38.55%), effectiveness (28.85%), economics (9.65%), innovation (8.24%), accessibility (7.84%), and applicability (6.88%). Based on the evidence matrix, omalizumab plus SOC scored higher than the SOC in effectiveness (2.53 vs. 1.94) and innovation (0.70 vs. 0.15). When the weight and score of each strategy in each criterion were combined, the overall estimated values were 7.40 points for omalizumab plus SOC and 7.19 points for SOC. Conclusions: Adding omalizumab was assessed as a conditionally recommended strategy for treating moderate to severe asthma in Chinese children. Full article

Background: Childhood obesity is a pro-inflammatory state associated with poorer outcomes in chronic allergic diseases, such as asthma, and in adults, it is a recognized risk factor for more severe anaphylaxis. However, whether this association extends to the pediatric population remains unclear. Objectives: The aim of this study was to assess the association between nutritional status, as measured by Body Mass Index (BMI), and anaphylaxis severity and presentation in a cohort of hospitalized children. Methods: We retrospectively assessed the association between BMI categories (underweight, normal weight, overweight, and obese) and the severity (WAO grading) and clinical presentation of anaphylaxis in 199 hospitalized children (0–18 years). Results: No statistically significant association was found between BMI categories and anaphylaxis severity (χ² = 7.06, p = 0.861). Severe reactions (WAO grades 4–5) were rare across BMI categories, occurring in 0% of underweight, 3.8% of normal-weight, 9.1% of overweight, and 7.7% of obese children. In regression analyses adjusting for age, sex, asthma, and atopic dermatitis, BMI was not an independent predictor of anaphylaxis severity, whether considered as a categorical or continuous variable (all odds ratios non-significant, 95% CIs crossing 1). Similarly, organ system involvement did not differ between BMI groups (all p > 0.05). Conclusions: In this pediatric cohort, contrary to findings in adults, we did not find nutritional status to be a predictor of anaphylaxis severity or presentation. This suggests obesity’s role as a risk factor may be age-dependent and that adult data should be extrapolated to children with caution. Full article

Background: While the importance of folic acid supplementation during pregnancy in the prevention of neural tube defects in offspring is well established, its potential role in pediatric asthma development remains unclear, with limited evidence to date. Objective: To identify perinatal and environmental factors that modify the association between maternal folic acid intake and pre-adolescent asthma. Methods: Cross-sectional analysis of the Healthy Growth Study that consisted of 2332 pre-adolescents (mean age 11 years; asthma n = 451); 50% boys attending elementary schools in Greece. Questionnaires were used to collect data on sociodemographic, perinatal, and environmental characteristics as well as asthma prevalence and maternal folic acid supplementation during pregnancy (trimesters 1, 2, and 3). Logistic regression models explored the association between maternal folic acid supplementation and pre-adolescent asthma, accounting for perinatal and environmental exposures. Results: Adjusted regression models showed that maternal folic acid supplementation during the third trimester was associated with 34% increased odds of pre-adolescent asthma. Stratified analyses per perinatal and environmental factors revealed significantly higher asthma odds with folic acid supplementation during the second and third trimesters among pre-adolescents born < 37 weeks; non-smoking mothers; in pre-adolescents attending schools of low socioeconomic level; and in neighborhoods having less traffic and more parks. Contrastingly, in appropriate for gestational age (AGA), an infant’s first-trimester supplementation increased asthma odds. Conclusions: Maternal folic acid supplementation, particularly in later trimesters, was modestly associated with increased odds of pre-adolescent asthma, modified by perinatal and environmental factors. Future research should explore whether continued folic acid supplementation beyond the first trimester carries differential risks or benefits in asthma. Full article

Objectives: This study aimed to synthesize evidence of the influence of multilevel social determinants of health (SDOHs) on asthma and allergic disease outcomes and healthcare utilization in children and adolescents, with a specific focus on how these determinants generate or widen health inequities, through a systematic review of the current literature and evidence. Methods: A literature search was performed in the PubMed, EBSCO, and Scopus databases. The search period for all databases was from 1 January 2020 to 15 January 2025. Studies published in English that evaluated the association between at least one SDOH, as a primary exposure or effect modifier, and asthma and/or allergic disease outcomes and healthcare utilization in children and adolescents aged ≤ 18 years were included. A narrative synthesis was conducted to systematically explore and compare findings across studies, grouped by SDOH domains and disease outcomes. The grouping of SDOH domains was based on the framework established by the Healthy People 2030 Initiative. The selected studies underwent a quality assessment. Results: After the eligibility assessment, 44 studies were included in this review. Regarding study design, twenty-one studies were cohort, followed by eighteen cross-sectional, three ecological, and two case-crossover studies. Disease outcomes covered incidence, severity/exacerbations, lung function, and healthcare use in asthma, and analogous measures also reported for atopic dermatitis, allergic rhinitis, and food allergy. The most frequently studied domain of SDOHs was Neighborhood and Built Environment (n = 26), followed by Economic Stability (n = 24), Social and Community Context (n = 21), Healthcare Access and Quality (n = 12), and Education Access and Stability (n = 10). The vast majority of studies (n = 31) found positive associations between the examined SDOH factors and asthma and/or allergic disease outcomes and healthcare utilization. The most frequently evaluated SDOH with positive associations were neighborhood and residential conditions (n = 10), discrimination (n = 8), parental education (n = 7), housing quality (n = 6), air pollution (n = 6), and household income (n = 5). Risk-of-bias appraisal showed that the evidence base was largely at low risk, with most cohort, cross-sectional, ecological and case-crossover studies rated good quality, and only a few cohort studies classified as fair because of limitations in exposure assessment and residual confounding control. Conclusions: These findings highlight the urgent need for coordinated interventions and policies addressing social, environmental, and economic factors to reduce health disparities and improve outcomes for vulnerable children, while stressing the importance of interventional studies to provide stronger evidence. Full article

In recent years, the global prevalence of pediatric allergic diseases—including atopic dermatitis, allergic rhinitis, and asthma—has increased significantly. Accumulating evidence underscores the pivotal role of the microbiota–immune axis in the regulation of immune tolerance, wherein microbial dysbiosis is a critical driver in the onset and progression of these conditions. Notably, reduced microbial diversity and imbalanced proportions can also cause immune dysregulation and cross-organ signaling. The skin–lung–gut axis has emerged as a key conduit for multi-organ immune communication. Microbial communities at barrier sites not only mediate local immune homeostasis but also influence distant organs through metabolite production and immune signaling pathways, forming a complex network of organ crosstalk. This mechanism is integral to the maintenance of both innate (e.g., epithelial barrier integrity and phagocytic activity) and adaptive (e.g., the Type 1/Type 2 cytokine balance and regulatory T cell function) immunity, thereby suppressing allergic inflammation. Early microbial colonization is crucial for immune system maturation, and its perturbation is strongly linked to abnormal allergic immune responses. As such, the skin–lung–gut axis functions as a cross-organ microecological–immune regulatory network that is particularly relevant in the context of infantile allergic disorders. Intervention strategies targeting the microbiota—including probiotics, prebiotics, synbiotics, and postbiotics—have demonstrated potential in modulating host immunity. Furthermore, emerging approaches such as engineered probiotics, advanced delivery systems, and fecal microbiota transplantation (FMT) offer promising therapeutic avenues. This review provides a comprehensive overview of microbiota development in early life, its association with allergic disease pathogenesis, and the current progress in microbiota-targeted interventions, offering a theoretical foundation for individualized prevention and treatment strategies. Full article

Alternaria alternata is one of the most clinically relevant fungal allergens in pediatric patients with respiratory allergies. Sensitization to this mold has increased in recent decades and is influenced by environmental exposure, geographic location, climate change, and genetic predisposition. In children, Alternaria spp. are strongly associated with the development and worsening of asthma and allergic rhinitis, often contributing to severe and difficult-to-control forms of the disease. The major allergen, Alt a 1, plays a central role in the immunopathogenesis of Alternaria-induced allergies and exhibits molecular features that allow cross-reactivity with other fungal species. Although Alternaria allergy is clinically relevant, its diagnosis remains challenging due to the variability and lack of standardization of fungal extracts. Therefore, it may be necessary to complement traditional diagnostic tools, such as skin prick testing and specific IgE measurement, with component-resolved diagnostics or, in selected cases, nasal provocation tests. Allergen immunotherapy (AIT) has shown promising results in the treatment of Alternaria allergy, particularly with the use of standardized Alt a 1-based extracts or chemically modified allergoids, which offer clinical benefits and immunological modulation. However, AIT is still underused in this context, partly because of the lack of widely available commercial products and long-term efficacy data in the pediatric population. This review provides a comprehensive overview of the current knowledge on the epidemiology, mechanisms, clinical implications, and treatment options related to Alternaria allergy in children, with the aim of supporting early recognition and tailored therapeutic strategies for this important, yet often underestimated, allergen. Full article

Background: Asthma is the most prevalent chronic illness in children worldwide, contributing to significant morbidity, health care utilization, and economic burden. In the United States, approximately five million children are affected by asthma. This review explores the environmental contexts and lifestyle determinants of pediatric asthma, with a focus on the Inland Empire (IE) region of Southern California. The IE’s unique geographic landscape and importance as a major transportation hub highlights its critical role for understanding how both environmental and structural factors exacerbate asthma burden within the pediatric population. Variables such as household income, parental education levels, and lack of community-based asthma programs were explored. Despite significant burdens, the IE remains under-represented in asthma research, contributing to persistent disparity. Methods: A narrative literature review and regional data analysis were conducted via PubMed, Scopus, and Google Scholar (2000–2025), alongside data from the CDC, CDPH, and American Lung Association. Key words used included “pediatric asthma, Inland Empire, air pollution, asthma disparity, emergency department utilization, socioeconomic status.” Inclusion criteria were: (1) studies or reports focusing on pediatric asthma (ages 0–17), (2) articles addressing environmental, socioeconomic, or health care-related risk factors, and (3) research with either national, state-level, or IE-specific data. Exclusion criteria were: (1) articles not in English, adult-only asthma studies, and (3) publications without original data or reference to pediatric asthma burden, management, or outcomes. Titles and abstracts were screened for relevance, and full texts were reviewed when abstracts met inclusion criteria. A total of 61 studies, reports, and data sources met this criterion and were included into this review. Results: The IE—comprised of San Bernardino (SB) and Riverside Counties— is home to four of the top five most polluted cities in North America. Vehicle emissions and industrial waste are concentrated in the region due to limited air circulation from surrounding mountains that entrap pollutants. Pediatric asthma ED visit rates in SB and Riverside were 60.5% and 59.3%, compared to California’s average of 56.7%. Hospitalization rates for children aged 0–4 were also higher in SB (24.4%) compared to the state average (17.3%). The elevated rates among school-aged children underscore the crucial need for interventions aimed at improving air quality, enhancing asthma management, and increasing access to preventive health care. Conclusions: Pediatric asthma in the IE reflects heightened environmental risks, socioeconomic barriers, and gaps in health care access. Addressing these disparities requires targeted interventions, policies, and region-specific research to enhance long-term management strategies and outcomes for vulnerable pediatric populations. Full article

Background: Diagnosing food allergy (FA) typically involves a detailed clinical history and confirmation of allergen-specific IgE. Oral food challenges (OFCs) remain the gold standard in FA diagnosis. This study aimed to present our experience in performing OFCs in pediatric patients with particular focus on challenges performed with cow’s milk and hen’s egg. Methods: We conducted a retrospective analysis of 205 OFCs. Clinical data were evaluated and multiple logistic regression was used to identify associations between challenge outcomes, reaction severity, and comorbidities. Results: The mean age of patients was 5.7 ± 3.1 years, with 135 (65.9%) being male. The tested foods included cow’s milk protein (CMP, 103 challenges; 50.2%), hen’s egg white protein (HEWP, 84; 41.0%), peanuts (3; 1.5%), tree nuts (4; 2.0%), gluten (3; 1.5%), hen’s egg yolk (4; 2.0%), and other foods (4; 2.0%). The overall OFC failure rate was 32.2%, and five challenges (2.4%) yielded inconclusive results. The median cumulative reactive dose was 0.27 g for baked CMP and 0.58 g for baked HEWP. Most failed OFCs involved mucocutaneous symptoms (44 cases; 66.7%). Severe multisystemic reactions occurred in four patients (2.0%), all of whom required epinephrine (6.1% of positive challenges). An increased risk of OFC failure was associated with asthma (p = 0.028; 95% CI: 0.07–1.27) and multi-food allergy (p = 0.021; 95% CI: 0.14–1.67). Additionally, the coexistence of asthma and a prior history of anaphylaxis to any food was related to OFC failure (p = 0.049; 95% CI: 0.01–2.19), as was the combination of multi-food allergy and previous anaphylaxis (p = 0.043; 95% CI: 0.03–1.70). Receiver operating characteristic (ROC) curve analysis was utilized to predict outcomes of OFCs to baked milk and baked egg and determined a specific IgE (sIgE) cutoff level of 58.1 kU/L for baked milk challenges (AUC: 0.77; sensitivity: 0.588; specificity: 0.882), and 11.3 kU/L for baked egg challenges (AUC: 0.66; sensitivity: 0.692; specificity: 0.607). Conclusions: Our findings confirm that OFCs are a safe and effective tool for diagnosing FA in children. With appropriate patient selection, the risk of severe reactions remains low. Nonetheless, comorbidities such as asthma and multi-food allergy are associated with an increased likelihood of OFC failure. Full article

This review aims to provide a comprehensive overview of how oxidative stress drives inflammation, structural remodeling, and clinical expression of childhood asthma, while critically appraising emerging redox-sensitive biomarkers and antioxidant-focused preventive and therapeutic strategies. Oxidative stress arises when reactive oxygen species (ROS) and reactive nitrogen species (RNS) outpace airway defenses. This surplus provokes airway inflammation: ROS/RNS activate nuclear factor kappa-B (NF-κB) and activator protein-1 (AP-1), recruit eosinophils and neutrophils, and amplify type-2 cytokines. Normally, an antioxidant network—glutathione (GSH), enzymes such as catalase (CAT) and superoxide dismutase (SOD), and nuclear factor erythroid 2-related factor 2 (Nrf2)—maintains redox balance. Prenatal and early exposure to fine particulate matter <2.5 micrometers (µm) (PM_2.5), aeroallergens, and tobacco smoke, together with polymorphisms in glutathione S-transferase P1 (GSTP1) and CAT, overwhelm these defenses, driving epithelial damage, airway remodeling, and corticosteroid resistance—the core of childhood asthma pathogenesis. Clinically, biomarkers such as exhaled 8-isoprostane, hydrogen peroxide (H₂O₂), and fractional exhaled nitric oxide (FeNO) surge during exacerbations and predict relapses. Therapeutic avenues include Mediterranean-style diet, regular aerobic exercise, pharmacological Nrf2 activators, GSH precursors, and mitochondria-targeted antioxidants; early trials report improved lung function and fewer attacks. Ongoing translational research remains imperative to substantiate these approaches and to enable the personalization of therapy through individual redox status and genetic susceptibility, ultimately transforming the care and prognosis of pediatric asthma. Full article