Abstract
In the last decades, significant progresses have been reached in the management of atopic diseases in childhood. Several approaches have been proposed in patients affected by moderate-to-severe atopic diseases. Severe asthma and atopic dermatitis are poorly known with different underlying phenotypes and endotypes, and they may require further cares with biological therapies. Omalizumab, anti-IgE monoclonal antibody, is effective and safe in patients with atopic diseases, especially uncontrolled asthma and chronic urticaria. Anti-IL-5 drugs including mepolizumab, reslizumab and benralizumab are effective in resistant eosinophilic asthma. In patients with uncontrolled atopic dermatitis, dupilumab is of benefit. Allergen-specific immunotherapy (AIT) represents the only treatment attaining immunologic tolerance and sustaining improvement in symptoms. Both subcutaneous and sublingual immunotherapies are characterized by a short-term and a long-term efficacy, as demonstrated by a reduced immunologic reactivity after discontinuation. Component-resolved diagnosis has been found an essential diagnostic tool potentially able to increase the efficacy of AIT in polysensitized children, establishing a precise AIT prescription for patient genuinely sensitized to allergens. The future care of allergic diseases in childhood requires an individualized approach to achieve a patient-tailored therapy for difficult-to-treat atopic diseases.
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References
Albers, F. C., Müllerová, H., Gunsoy, N. B., Shin, J. Y., Nelsen, L. M., Bradford, E. S., et al. (2018). Biologic treatment eligibility for real-world patients with severe asthma: The IDEAL study. Journal of Asthma,55, 152–160.
Asero, R., Tripodi, S., Dondi, A., Di Rienzo, B. A., Sfika, I., Bianchi, A., et al. (2015). Prevalence and clinical relevance of IgE sensitization to profilin in childhood: A multicenter study. International Archives of Allergy and Immunology,168, 25–31.
Caffarelli, C., Dascola, C. P., Peroni, D., Ricò, S., Stringari, G., Varini, M., et al. (2014). Airway acidification in childhood asthma exacerbations. Allergy Asthma Proc,35, 51–56.
Dhami, S., Kakourou, A., Asamoah, F., Agache, I., Lau, S., Jutel, M., et al. (2017a). Allergen immunotherapy for allergic asthma: A systematic review and meta-analysis. Allergy,72, 1825–1848.
Dhami, S., Nurmatov, U., Arasi, S., Khan, T., Asaria, M., Zaman, H., et al. (2017b). Allergen immunotherapy for allergic rhinoconjunctivitis: A systematic review and meta-analysis. Allergy,72, 1597–1631.
Di Rienzo, V., Cadario, G., Grieco, T., Galluccio, A. G., Caffarelli, C., Liotta, G., et al. (2014). Sublingual immunotherapy in mite-sensitized children with atopic dermatitis: A randomized, open, parallel-group study. Annals of Allergy, Asthma and Immunology,113, 671–673.
Hamelmann, E., Bateman, E. D., Vogelberg, C., Szefler, S. J., Vandewalker, M., Moroni-Zentgraf, P., et al. (2016). Tiotropium add-on therapy in adolescents with moderate asthma: A 1-year randomized controlled trial. The Journal of Allergy and Clinical Immunology,138, 441–450.
Lambrecht, B. N., & Hammad, H. (2015). The immunology of asthma. Nature Immunology,16, 45–56.
Mastrorilli, C., Posa, D., Cipriani, F., & Caffarelli, C. (2016a). Asthma and allergic rhinitis in childhood: What’s new. Pediatric Allergy and Immunology,27, 795–803.
Mastrorilli, C., Tripodi, S., Caffarelli, C., Perna, S., Di Rienzo-Businco, A., Sfika, I., et al. (2016b). Endotypes of pollen-food syndrome in children with seasonal allergic rhinoconjunctivitis: A molecular classification. Allergy,71, 1181–1191.
Metz, M., Ohanyan, T., Church, M. K., & Maurer, M. (2014). Retreatment with omalizumab results in rapid remission in chronic spontaneous and inducible urticaria. JAMA Dermatology,150, 288–290.
Pajno, G. B., Bernardini, R., Peroni, D., Arasi, S., Martelli, A., Landi, M., et al. (2017). Clinical practice recommendations for allergen-specific immunotherapy in children: The Italian consensus report. Italian Journal of Pediatrics,43, 13.
Simpson, E. L., Bieber, T., Guttman-Yassky, E., Beck, L. A., Blauvelt, A., Cork, M. J., et al. (2016). Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. New England Journal of Medicine,375, 2335–2348.
Wenzel, S., Castro, M., Corren, J., Maspero, J., Wang, L., Zhang, B., et al. (2016). Dupilumab efficacy and safety in adults with uncontrolled persistent asthma despite use of medium-to-high-dose inhaled corticosteroids plus a long-acting β2 agonist: A randomised double-blind placebo-controlled pivotal phase 2b dose-ranging trial. Lancet,2(388), 31–44.
Zinelli, C., Caffarelli, C., Strid, J., Jaffe, A., & Atherton, D. J. (2009). Measurement of nitric oxide and 8-isoprostane in exhaled breath of children with atopic eczema. Clinical and Experimental Dermatology,34, 607–612.
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Mastrorilli, C., Santoro, A. & Caffarelli, C. Allergen-specific immunotherapy, novel drugs and biologicals: hopes from the difficult-to-treat allergic child. Aerobiologia 36, 95–98 (2020). https://doi.org/10.1007/s10453-019-09573-3
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DOI: https://doi.org/10.1007/s10453-019-09573-3