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Atopic Dermatitis affects both children and adults and is a serious health concern in many countries. AD is a complex disease with host and environmental factors underlying its pathology. Its treatment is multidimensional reflecting the diverse nature of its triggers and includes emollients, topical steroids and calcineurin inhibitors among others. Immunological dysfunction can be addressed broadly with systemic immunosupressors and specifically with monoclonal antibodies. Dupilumab, which targets IL-4 and IL-13 was granted approval for treatment of moderate-to-severe AD. Biologics targeting IgE/Th2 pathways may have its role in patients with overlapping AD and asthma. Psychological distress can exacerbate symptoms and is associated with increased severity of AD. Environmental triggers, such as, allergens can be addressed in selected cases with allergic immunotherapy. In this paper, we discuss AD treatment and propose a new step-by-step approach aiming at maintaining disease control and improving quality of life. ty is associated with various inflammatory conditions, including asthma and allergic diseases. As such, a fundamental role for microorganisms in human health, whether indigenous or environmental, is becoming increasingly evident. Besides the importance of the environment in the development of allergic diseases, an increased familiar predisposition for the development of these conditions may exist. This observation led researchers to hypothesize that host genetic factors could be involved in the pathogenesis of AD. The description, back in 2006, that loss-of-function mutations in the filaggrin (FLG) gene were a strong genetic risk factor for AD, became a significant breakthrough regarding prognosis and treatment. FLG monomers aggregate keratin filaments into tight bundles, resulting in the collapse and flattening of corneocytes that maintain both skin barrier integrity and normal stratum corneum (SC) lipids. Therefore, mutations in the FLG gene may increase skin permeability, predisposing individuals to skin allergen penetration and subsequent infection. These mutations have also

Faecal and serum ECP levels, as determined in the present study, add background information concerning reference levels at paediatric age for further studies indifferent clinical settings.

Serum total IgG and subclasses were determined in three different groups of children: with Down syndrome, their siblings and general pediatric population. Several cases of IgG2 and IgG4 deficiency were identified, predominantly in children with Down syndrome. The differences, considering three age groups, were statistically significant for both groups in relation to the general population group, with an increase of IgG1 and IgG3 and a decrease in serum concentrations of IgG2 and IgG4. Down syndrome children and their siblings tend o have a similar variation of the IgG4 serum concentration levels (P < 0.05). The mechanisms of this concordance are not well understood. The results point out that an adequate strategy to improve the immune status of Down syndrome children could have a positive manifestation in the immune profile of their brothers.

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Table of contentsWORKSHOP 4: Challenging clinical scenarios (CS01–CS06)CS01 Bullous lesions in two children: solitary mastocytomaS. Tolga Yavuz, Ozan Koc, Ali Gungor, Faysal GokCS02 Multi-System Allergy (MSA) of cystic fibrosis: our institutional experienceJessica Hawley, Christopher O’Brien, Matthew Thomas, Malcolm Brodlie, Louise MichaelisCS03 Cold urticaria in pediatric age: an invisible cause for severe reactionsInês Mota, Ângela Gaspar, Susana Piedade, Graça Sampaio, José Geraldo Dias, Miguel Paiva, Mário Morais-AlmeidaCS04 Angioedema with C1 inhibitor deficiency in a girl: a challenge diagnosisCristina Madureira, Tânia Lopes, Susana Lopes, Filipa Almeida, Alexandra Sequeira, Fernanda Carvalho, José OliveiraCS05 A child with unusual multiple organ allergy disease: what is the primer?Fabienne Gay-CrosierCS06 A case of uncontrolled asthma in a 6-year-old patientIoana-Valentina Nenciu, Andreia Florina Nita, Alexandru Ulmeanu, Dumitru Oraseanu, Carmen ZapucioiuORAL ABSTRACT SESSION 1: Food allergy (OP01–OP06)OP01 Food protein-induced enterocolitis syndrome: oral food challenge outcomes for tolerance evaluation in a Pediatric HospitalAdrianna Machinena, Olga Domínguez Sánchez, Montserrat Alvaro Lozano, Rosa Jimenez Feijoo, Jaime Lozano Blasco, Mònica Piquer Gibert, Mª Teresa Giner Muñoz, Marcia Dias da Costa, Ana Maria Plaza MartínOP02 Characteristics of infants with food protein-induced enterocolitis syndrome and allergic proctocolitisEbru Arik Yilmaz, Özlem Cavkaytar, Betul Buyuktiryaki, Ozge Soyer, Cansin SackesenOP03 The clinical and immunological outcomes after consumption of baked egg by 1–5 year old egg allergic children: results of a randomised controlled trialMerrynNetting, Adaweyah El-Merhibi, Michael Gold, PatrickQuinn, IrmeliPenttila, Maria MakridesOP04 Oral immunotherapy for treatment of egg allergy using low allergenic, hydrolysed eggStavroula Giavi, Antonella Muraro, Roger Lauener, Annick Mercenier, Eugen Bersuch, Isabella M. Montagner, Maria Passioti, Nicolò Celegato, Selina Summermatter, Sophie Nutten, Tristan Bourdeau, Yvonne M. Vissers, Nikolaos G. PapadopoulosOP05 Chemical modification of a peanut extract results in an increased safety profile while maintaining efficacyHanneke van der Kleij, Hans Warmenhoven, Ronald van Ree, Raymond Pieters, Dirk Jan Opstelten, Hans van Schijndel, Joost SmitOP06 Administration of the yellow fever vaccine in egg allergic childrenRoisin Fitzsimons, Victoria Timms, George Du ToitORAL ABSTRACT SESSION 2: Asthma (OP07–OP12)OP07 Previous exacerbation is the most important risk factor for future exacerbations in school-age children with asthmaS. Tolga Yavuz, Guven Kaya, Mustafa Gulec, Mehmet Saldir, Osman Sener, Faysal GokOP08 Comparative study of degree of severity and laboratory changes between asthmatic children using different acupuncture modalitiesNagwa Hassan, Hala Shaaban, Hazem El-Hariri, Ahmed Kamel Inas E. MahfouzOP09 The concentration of exhaled carbon monoxide in asthmatic children with different controlled stadiumPapp Gabor, Biro Gabor, Kovacs CsabaOP10 ...

Fundamentos: A vacinação contra a COVID -19 é essencial para o controlo da pandemia. As reações adversas após a vacinação são comuns, embora a anafilaxia seja rara. Objetivos: Caracterizar as reações imunoalergológicas que motivaram referenciação pré -vacinação dos cuidados de saúde primários (CSP), analisar o impacto da alergia medicamentosa nesta referenciação e avaliar o resultado da vacinação após estratificação do risco. Métodos: Estudo observacional retrospetivo, com inclusão dos doentes referenciados à consulta de Imunoalergologia de um hospital terciário a partir dos CSP para avaliação do risco de reações de hipersensibilidade (RHS) graves à vacina contra a COVID -19 entre janeiro -junho de 2021. A estratificação do risco foi efetuada de acordo com o protocolo do serviço. Resultados: De um total de 733 doentes referenciados dos CSP, 510 foram admitidos, dos quais 445 foram avaliados, 369 (83%) do sexo feminino, média de idades 66±13 anos [20 -99 anos], 122 (27%) atópicos. A maioria (n=349, 78%) foi referenciada por reações prévias a medicamentos, dos quais 69 (15,5%) por reações a vacinas. Os anti -inflamatórios não esteroides (n=97, 51%) e os antibióticos (n=70, 36%) foram os mais reportados nas suspeitas/ hipersensibilidade confirmada a fármacos. O perfil das reações medicamentosas diferiu nos doentes de baixo risco (61% com RHS, 39% anafilaxia) e de risco intermédio/elevado (92% com RHS, 65% anafilaxia). Após avaliação, 323 doentes foram encaminhados para vacinação no centro de vacinação, dos quais 280 receberam pelo menos uma dose da vacina. Dois doentes tiveram agravamento da urticária crónica e uma teve reação vasovagal após a vacina. Foram vacinados em meio hospitalar 122 doentes, dos quais 69 receberam uma dose da vacina. Apenas dois apresentaram reações cutâneas ligeiras. Conclusões: A alergia medicamentosa foi o principal motivo de avaliação do risco pré -vacinação. A maioria dos doentes foi vacinada no centro de vacinação sem intercorrências. O protocolo utilizado foi eficaz, sem reações de relevo nem casos de anafilaxia.