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1.  Atopic dermatitis phenotypes in childhood 
Atopic dermatitis (AD) is a chronic inflammatory skin disease and can be the first step of the atopic march.
In this retrospective study, we analysed the immunological and clinical patterns of AD in a group of children affected by the disease since their first years of life, in order to evaluate if and how these patterns can change over time, and to identify biomarkers that can possibly correlate with the clinical phenotype.
We enrolled Caucasian children with diagnosis of AD performed by a specialist on the basis of Hanifin and Rajka’s criteria and with a first clinical and laboratory evaluation before 5 years of age. Patients were divided in 2 groups: IgE-associated AD (with or without allergic respiratory diseases) and non-IgE-associated AD.
Among 184 patients enrolled in this study, at the beginning 30/184 were classified as having non-IgE-associated AD, but during follow-up, at the median age of 36 months, 15 patients became allergic. All 15 patients who switched from the non-IgE to the IgE-associated form had a significantly earlier onset of AD than those who did not switch. Dust mite sensitization seem to be the best biomarker (OR 2.86) to predict the appearance of allergic respiratory diseases.
IgE-associated AD is more frequent in childhood than non-IgE-associated AD. These two phenotypes are different in the age of onset and in the remission patterns. In the first years of life, it is important to distinguish the different phenotypes in order to evaluate possible allergic related conditions.
PMCID: PMC4063231  PMID: 24887188
Atopic dermatitis; Phenotypes; Allergy; Childhood; Atopic march
2.  Skin prick test to foods in childhood atopic eczema: pros and cons 
Skin prick tests are the first investigation in allergy diagnostics and their use is described in all the guidelines on atopic eczema. However, the clinical usefulness of skin prick tests is the subject of great debate. On the one hand, skin prick tests allow the identification both of individuals at risk for food allergy and of the allergen inducing the eczematous flare. On the other hand, when performed by a non-specific specialist, positive skin prick tests to foods may wrongly lead to prolonged elimination diets, which may induce nutritional deficiencies and perhaps loss of tolerance to the avoided foods. Furthermore, skin prick tests increase health costs. A consensus on this topic has not yet been reached. Considering the diversity of clinical stages in which it occurs, atopic eczema presentation should be the starting point to determine whether or not skin prick tests should be carried out.
PMCID: PMC3734168  PMID: 23902622
Atopic dermatitis; Atopic eczema; Skin prick test; Food allergy
3.  Atopic dermatitis in adolescence 
Dermatology Reports  2011;4(1):e1.
Atopic dermatitis (AD) is a chronic inflammatory skin disorder that typically occurs during childhood especially in the first year of life, with a variable frequency from 10% to 30%. Recent studies have shown that in Europe among 10–20% of children with AD suffer from this disorder also in adolescence. AD is a chronic inflammatory skin disease with a typical onset in the first years of life and with a 10–30% prevalence among young children. AD prevalence in adolescence has been estimated around 5–15% in European countries. AD persists from childhood through adolescence in around 40% of cases and some risk factors have been identified: female sex, sensitization to inhalant and food allergens, allergic asthma and/or rhinoconjunctivitis, the practice of certain jobs. During adolescence, AD mainly appears on the face and neck, often associated with overinfection by Malassezia, and on the palms and soles. AD persistence during adolescence is correlated with psychological diseases such as anxiety; moreover, adolescents affected by AD might have problems in the relationship with their peers. Stress and the psychological problems represent a serious burden for adolescents with AD and cause a significant worsening of the patients' quality of life (QoL). The pharmacological treatment is similar to other age groups. Educational and psychological approaches should be considered in the most severe cases.
PMCID: PMC4212666  PMID: 25386309
atopic dermatitis; adolescence; quality of life.
4.  End point prick test: could this new test be used to predict the outcome of oral food challenge in children with cow's milk allergy? 
Cow'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.
We 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.
The 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 Discussion
The 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.
EPT 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.
PMCID: PMC3220633  PMID: 22053846
Cow's milk proteins allergy; end point prick test; food oral challenge; tolerance
5.  Pooled Genome-Wide Analysis to Identify Novel Risk Loci for Pediatric Allergic Asthma 
PLoS ONE  2011;6(2):e16912.
Genome-wide association studies of pooled DNA samples were shown to be a valuable tool to identify candidate SNPs associated to a phenotype. No such study was up to now applied to childhood allergic asthma, even if the very high complexity of asthma genetics is an appropriate field to explore the potential of pooled GWAS approach.
Methodology/Principal Findings
We performed a pooled GWAS and individual genotyping in 269 children with allergic respiratory diseases comparing allergic children with and without asthma. We used a modular approach to identify the most significant loci associated with asthma by combining silhouette statistics and physical distance method with cluster-adapted thresholding. We found 97% concordance between pooled GWAS and individual genotyping, with 36 out of 37 top-scoring SNPs significant at individual genotyping level. The most significant SNP is located inside the coding sequence of C5, an already identified asthma susceptibility gene, while the other loci regulate functions that are relevant to bronchial physiopathology, as immune- or inflammation-mediated mechanisms and airway smooth muscle contraction. Integration with gene expression data showed that almost half of the putative susceptibility genes are differentially expressed in experimental asthma mouse models.
Combined silhouette statistics and cluster-adapted physical distance threshold analysis of pooled GWAS data is an efficient method to identify candidate SNP associated to asthma development in an allergic pediatric population.
PMCID: PMC3040188  PMID: 21359210
6.  Does improvement management of atopic dermatitis influence the appearance of respiratory allergic diseases? A follow-up study 
Atopic dermatitis (AD) is often the prelude to allergic diseases. The aim of this study was 1) to evaluate if an integrated management regime could bring about a change in the evolution of the disease in comparison to the results of a previous study; 2) to determine whether the refinement of allergic investigations allowed to identify more promptly the risk factors of evolution into respiratory allergic diseases.
The study included 176 children affected by AD and previously evaluated between 1993 and 2002 at the age of 9-16 months, who underwent a telephonic interview by means of a semi-structured, pre-formed questionnaire after a mean follow-up time of 8 years. According to the SCORAD, at first evaluation children had mild AD in 23% of cases, moderate in 62%, severe in 15%.
AD disappeared in 92 cases (52%), asthma appeared in 30 (17%) and rhinoconjunctivitis in 48 (27%). The factors significantly related to the appearance of asthma were: sensitization to food allergens with sIgE > 2 KU/L (cow's milk and hen's egg; P < 0.05); to inhalant allergens with sIgE > 0.35 KU/L (P < 0.05). Logistic regression analysis showed that inhalant sensitization was positively related to the occurrence of asthma (OR = 4.219). While AD showed similar rates of disappearance to those of our previous study, the incidence of asthma was reduced, at the same follow-up time, from 29% to 15% (P = 0.002), and the incidence of rhinoconjunctivitis from 35% to 24% (P = 0.02).
Comparing the results with those of the previous study, integrated management of AD does not seem to influence its natural course. Nevertheless, the decrease in the percentage of children evolving towards respiratory allergic disease stresses the importance of early diagnosis and improvement management carried out by specialist centers. The presence of allergic sensitization at one year of age might predict the development of respiratory allergy.
PMCID: PMC2907296  PMID: 20591145
7.  Use of the Italian version of the Pediatric Asthma Quality of Life Questionnaire in the daily practice: results of a prospective study 
BMC Pediatrics  2009;9:30.
Asthma is a serious global health problem and its prevalence is increasing, especially among children. It represents a significant social and economic burden, and it can severely affect the health-related quality of life (HRQL) of patients. Among the numerous questionnaires aiming at evaluating asthma HRQL in children, the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) has proved to have good measurement properties.
The present study was aimed at investigating the possible role of the Italian, self-administered version of the PAQLQ in the routine clinical evaluation of children affected by bronchial asthma.
52 Italian children and adolescents (40 males and 12 females), aged 6 to 17 years, affected by allergic asthma, were enrolled. Each patient was evaluated twice, and at each visit asthma control and severity were assessed, spirometry was performed and the patients completed the self-administered version of the PAQLQ.
The questionnaire was well-accepted and understood by the children. Children showed an overall good quality of life, with mild impairment in the activity and emotional function domains. The PAQLQ showed an overall good correlation with the clinical and functional indexes that are normally evaluated in follow-up visits of asthmatic patients. The PAQLQ appeared to be strongly related to asthma control, both at the first (p < 0.01) and second (p < 0.001) time of the study. The PAQLQ was also seen to decrease with increasing asthma severity. The results suggest a better compliance of the children towards completion of the questionnaire at t1. Finally, the PAQLQ does not appear to discriminate HRQL in patients with good lung function.
The Italian version of the PAQLQ is a quick-to-administer aid to clinical activity and can add valuable information to symptom reports, objective measurements and clinical assessment of asthma control and severity in daily clinical practice. Re-administration at each follow-up visit allows HRQL to be monitored over time.
PMCID: PMC2685371  PMID: 19422700

Results 1-7 (7)