Children of migrant families are known to be at a higher risk of diet-related morbidities due to complex variables including food insecurity, cultural and religious beliefs, and sociodemographic factors like ethnicity, socioeconomic status, and education. Several studies have assessed the presence of specific diseases related to dietary issues in migrant children. This systematic review aims to highlight the existing body of work on nutritional deficiencies in the specific vulnerable pediatric population of immigrants. Refugees were intentionally excluded because of fundamental differences between the two groups including the reasons for migration and health status at the time of arrival. A total of 29 papers were included and assessed for quality. Most of them described a strong correlation between obesity and migration. A high prevalence of stunting, early childhood caries, iron and vitamin D deficiency was also reported, but the studies were few and heterogeneous. Food insecurity and acculturation were found important social factors (nevertheless with inconclusive results) influencing dietary habits and contributing to the development of morbidities such as obesity and other metabolic disorders, which can cause progressive unsustainability of health systems. Public health screening for diet-related diseases in migrant children may be implemented. Educational programs to improve children’s diet and promote healthy-living behaviors as a form of socioeconomic investment for the health of the new generations may also be considered.

Background Asthma exacerbations are a common reason for Emergency Department (ED) visits in children. Aim To analyze differences among age groups in terms of triggering factors and seasonality and to identify those with higher risk of severe exacerbations. Methods We retrospectively revised the files of children admitted for acute asthma in 2016 in our Pediatric ED. Results Visits for acute asthma were 603/23197 (2.6%). 76% of the patients were <6 years old and 24% ≥6. Infections were the main trigger of exacerbations in both groups; 33% of the school-aged children had a triggering allergic condition (versus 3% in <6 years; p < .01). 191 patients had a previous history of asthma; among them, 95 were ≥6 years, 67% of whom were not using any controller medication, showing a higher risk of a moderate-to-severe exacerbation than those under long-term therapy (p < .01). Exacerbations peaked in autumn and winter in preschoolers and in spring and early autumn in the school-aged children. Conclusions Infections are the main trigger of acute asthma in children of any age, followed by allergy in the school-aged children. Efforts for an improved management of patients affected by chronic asthma might go through individualized action plans and possibly vaccinations and allergen-avoidance measures.

Component-resolved diagnostics (CRD) in food allergies is an approach utilized to characterize the molecular components of each allergen involved in a specific IgE (sIgE)-mediated response. In the clinical practice, CRD can improve diagnostic accuracy and assist the physician in many aspects of the allergy work-up. CRD allows for discriminatory co-sensitization versus cross-sensitization phenomena and can be useful to stratify the clinical risk associated with a specific sensitization pattern, in addition to the oral food challenge (OFC). Despite this, there are still some unmet needs, such as the risk of over-prescribing unnecessary elimination diets and adrenaline auto-injectors. Moreover, up until now, none of the identified sIgE cutoff have shown a specificity and sensitivity profile as accurate as the OFC, which is the gold standard in diagnosing food allergies. In light of this, the aim of this review is to summarize the most relevant concepts in the field of CRD in food allergy and to provide a practical approach useful in clinical practice.

There are few data in the literature reporting the evolution of hypogammaglobulinemia in premature and full-term infants during the first years of life. The aim of this study was to assess the clinical and immunological evolution of premature and full-term infants with hypogammaglobulinemia. We included 24 children (11 premature and 13 full-term infants), aged 0-36 months, with hypogammaglobulinemia. Fifteen (62.5%) children had an isolated reduction in IgG, 7 (29.2%) had a decrease in both IgG and IgA and 2 (8.3%) a reduction in IgG and IgM. Normalization of IgG serum levels occurred in the premature infants at a mean age of 7.2 months. FUll-term infants were divided into 3 groups based on age at normalization of IgG serum level: A) hypogammaglobulinemia with normalization within 12 months of life; B) with normalization within 36 months of life; C) normalization after 36 months. All the premature infants with hypogammaglobulinemia recovered, even though in the lower limits for age in the first years, while transient hypogammaglobulinemia observed in full-term infants has a different age of recovery. Immunoglobulins(Igs) G levels are physiologically lower in the first months of life, a condition that increases in premature infants in direct proportion to gestational age (1-2). In some infants, occasionally, adequate Ig synthesis may be abnormally delayed until 36 months of age, resulting in a prolonged reduction of Ig levels; this process is referred to as transient hypogammaglobulinemia of infancy (THI) (3).At present there are no clinical features or diagnostic tests that differentiate self-limiting hypogammaglobulinemia from permanent immune defects in young children. A definitive diagnosis of THI is only possible a posteriori, after normalization of IgG levels and the exclusion of other causes of hypogammaglobulinemia.The aim ofthis study is to appraise the clinical and immunological features of premature and full-term infants with a diagnosis of hypogammaglob ulinemi a and their subsequent evolution. MATERIALS AND METHODSThe study included 24 children (aged 0-36 months), consecutively referred to the Department of Pediatrics, Pediatrics Allergology and Immunology Center of Bologna University between January I, 2000 and December 31, 2008, with a diagnosis of hypogammaglobulinemia associated with other clinical symptoms. Hypogammaglobulinemia was considered if the infants showed values of one or more Ig isotypes below the "lower limit" «2 DS) of our pre-determined set of reference ranges per age (4).

BackgroundCow's milk allergy (CMA) is the most frequent food allergy in childhood; the trend of CMA is often characterized by a progressive improvement to achieve tolerance in the first 4 to 5 years of life.It has been observed that specific IgE (sIgE) towards cow's milk proteins decrease when the age increases.Although food allergy can be easily diagnosed, it is difficult to predict the outcome of the oral food challenge (OFC), that remains the gold standard in the diagnosis of food allergy, by allergometric tests.MethodsWe considered 44 children with CMA diagnosed through OFC who returned to our Allergy and Immunology Pediatric Department between January to December 2010 to evaluate the persistence of allergy or the achievement of tolerance.On the basis of the history, we performed both allergometric skin tests and OFC in children that were still following a milk-free diet, whereas only allergometric skin tests those that had already undergone spontaneous introduction of milk protein at home without presenting symptoms.ObjectiveThe aim of this study was to investigate the relationship between the persistence of CMA or the acquisition of tolerance and the results of the end point prick test (EPT).Results and DiscussionThe OFC with cow's milk was performed on 30 children, 4 children were excluded because of a history of severe reactions to cow's milk, and 10 because they had spontaneously already taken milk food derivates at home without problems. 16/30 (53%) children showed clinical reactions and the challenge was stopped, 14/30 (47%) did not have any reaction.Comparing the mean wheal diameter of every EPT's dilution between the group of allergic children and the tolerant ones, we obtained a significant difference (p < 0.05) for the first 4 dilutions.We have also calculated sensitivity (SE), specificity (SP), the positive predictive value (PPV) and the negative predictive value (NPV) for each EPT dilution.ConclusionsEPT is a safe and cheap test, easy to be executed and that could provide good prediction of the outcome of OFC; so it might be used to avoid OFC-induced anaphylaxis in children affected by CMA. It can also help avoiding dietetic restrictions in tolerant children who show sensitization towards cow's milk proteins.

Approximately 30-50 percent of individuals with natural rubber latex (NRL) allergy show an associated hypersensitivity to particular plant-derived foods, which has been defined "latex-fruit syndrome" (LFS). In our population of 22 patients with IgE-mediated NRL allergy we found a relevant prevalence (36 percent) of LFS, which resulted significantly higher in the group of patients with more severe clinical manifestations of NRL allergy than in patients with contact symptoms due to NRL (78 percent vs 8 percent; less than 0.005).

No abstract

To the Editor: Numerous recent studies 1,2 show that vitamin D has additional roles in the immune system; in particular, it seems to regulate the expression of antimicrobial proteins in keratinocytes in subjects with atopic dermatitis (AD). The aim of this study was to determine the levels of vitamin D in a group of children with AD and to evaluate the relationship with clinical and laboratory findings.The study included 27 children, Caucasian, affected by mild-to-moderate AD and consecutively referred to our Pediatric Allergology Outpatients Clinic. The evaluation of the severity of AD was assessed by the SCoring Of Atopic Dermatitis (SCORAD) index. 3 SCORAD index <25 shows a mild AD (12 patients), 25-50 a moderate form (15 patients) and >50 a severe form (none).The determination of specific IgE (sIgE) was performed by ImmunoCAP (Pharmacia, Uppsala, Sweden) and sIgE concentrations >0.35 kU/L were considered as positive. A single determination of vitamin D, measured as 25 hydroxyvitamin D (25(OH)D) by means of the enzyme-linked immunosorbent assay test, was obtained from all subjects. According to the literature, 4 we considered a vitamin D Ն30 ng/mL as normal, 21-29 ng/mL as insufficient and Յ20 ng/mL as deficient.Fisher's exact test and Student's t-test were used for statistical analysis.Out of the 27 patients, 13 (48.1%) had a 25(OH)D concentration Յ20 ng/mL (group I), pinpointing a vitamin D deficiency; 8 patients (29.7%) had a value of 21-29 ng/mL (group II), considered as insufficient; and 6 children (22.2%) had a level Ն30 ng/mL (group III), considered as sufficient ( Table 1). The mean age at the time of the blood sampling was 3 years (3.5, 3.7 and 3.4 years, respectively). Out of 13 patients with deficient vitamin D levels, 11 (85%) performed the blood sampling during a lowsunlight exposure season (January-April), whereas in 50%This study was only observational and did not interfere with the clinical management of the patients, so it was not submitted to the ethical committee for approval. However, both the parents and the patients were informed that the study was proposed in an experimental manner; they were included in the study only after obtaining an informed consent.