Consensus statement of the Italian society of pediatric allergy and immunology for the pragmatic management of children and adolescents with allergic or immunological diseases during the COVID-19 pandemic

Abstract

The COVID-19 pandemic has surprised the entire population. The world has had to face an unprecedented pandemic. Only, Spanish flu had similar disastrous consequences. As a result, drastic measures (lockdown) have been adopted worldwide. Healthcare service has been overwhelmed by the extraordinary influx of patients, often requiring high intensity of care. Mortality has been associated with severe comorbidities, including chronic diseases. Patients with frailty were, therefore, the victim of the SARS-COV-2 infection. Allergy and asthma are the most prevalent chronic disorders in children and adolescents, so they need careful attention and, if necessary, an adaptation of their regular treatment plans. Fortunately, at present, young people are less suffering from COVID-19, both as incidence and severity. However, any age, including infancy, could be affected by the pandemic. Based on this background, the Italian Society of Pediatric Allergy and Immunology has felt it necessary to provide a Consensus Statement. This expert panel consensus document offers a rationale to help guide decision-making in the management of children and adolescents with allergic or immunologic diseases.

Pediatric asthma and COVID‐19: The known, the unknown, and the controversial

“…There are barriers to proper asthma diagnosis and monitoring that are specific to the COVID‐19 pandemic. These include suspension of spirometry (as it is a possible aerosol‐generating procedure) 20,22 . It has been noted “in pandemic time, it is essential to avoid unnecessary risks with maneuvers such as the measure of lung function that can contribute to the spread of the virus to all healthcare workers and other patients.” 22 The North American guidance on phased resumption of allergy care during COVID‐19 notes that for Phase 2 rollout (community infection risk declining/stable) “spirometry is still contraindicated in most scenarios because of the aerosolization risk, except in highly individualized situations in which it would be essential for immediate treatment decision that could not otherwise be made without such information and where it can be performed with appropriate precautions and room/equipment disinfection.” 20 The European Respiratory Society notes that “lung function tests pose a considerable risk for the spread of infection to individuals and surrounding surfaces within and around the test areas even in asymptomatic patients” and recommends that “full operation of lung function services may only resume when viral prevalence is low and reliable testing based on a combination of symptom screening and testing is readily available.” 23…”

“…Multiple international guidelines support children with asthma remaining on their maintenance asthma medications, such as inhaled corticosteroids (ICS) or antileukotrienes, during COVID‐19 if they are well controlled 10,20,30,31 . Reducing or suspending the use of controller asthma medications can worsen asthma control and increase the risk of a severe exacerbation 22 …”

Cross-sectional survey on impact of paediatric COVID-19 among Italian paediatricians: report from the SIAIP rhino-sinusitis and conjunctivitis committee.

“…The diagnosis and management of COVID-19 in children is still di cult due to the mild or moderate clinical course. Moreover, asymptomatic infections were not infrequent [8] with the risk of uncon rmed disease. This seems to be a frequent problem in daily clinical practice.…”

Efficacy and Safety of Pidotimod in Childhood Wheezing: A Pilot Study 

“…Achieving the goal of primary prevention of viral wheezing both in healthy children and, even more, in patients with a positive clinical history for viral wheezing is still unsolved. In this scenario, PDT, thanks to its immune-modulatory effects, could be an innovative strategy, especially at our days sadly burdened by a new coronavirus (2019-nCoV) that also a icts the pediatric population, resulting commonly in viral respiratory infection [18]. In this regard, our ndings not only suggest the therapeutic effectiveness of PDT but also its preventive effectiveness, as assessed by the evidence that, after 3-months follow-up period, a decrease in the number of patients taking ICS and SABA, in the number of patients requiring ED visits and hospitalization was recorded.…”