EAACI Pediatrics SectionThe Pediatrics Section of the EAACI comprises 997 registered members including 227 junior members (November 2009). A new Pediatric Board for the period 2009-2011 began its activity at the Warsaw 2009 Congress, with Susanne Halken as chairperson, Graham Roberts as secretary, Susanne Lau, Paolo Rossi, Luis Miguel Borrego, Odilija Rudzeviciene and Angel Mazon as members-at-large, and Mara Xatzipsalti as JMA representative.
The priorities of the EAACI Pediatrics Section Board are enhancing the visibility of EAACI as leading scientific society in Europe, increasing membership and to establish and improve educational activities in pediatric allergology at all levels. For these purposes, the Board has initiated collaborations with European General Pediatrician, Primary Care and Emergency Physician Societies. All Board members are committed to a team working to achieve these goals. One of the aims of the Pediatrics Section is to use the best resources for the Continued Education of Pediatric Allergy specialists, and to deliver an excellent standard of care for allergic children across Europe. With this purpose, the Pediatrics Section in collaboration with the Education Training Committee in Pediatric Allergy has begun a process of recognizing those physicians who meet the requirements to hold the Certificate of European Pediatric Allergist. This process has been implemented on a large scale in Finland, Lithuania, Portugal, Spain, Switzerland and Turkey, and in a more limited way in Austria, Cyprus, Denmark, France, Italy, Germany, Greece and Serbia. So far, there are 241 registered pediatric allergists. In parallel with this, there is a process of recognizing centres with the competence to educate trainees in Pediatric Allergy is taking place. Five centres in Spain have now been awarded with recognition. Both processes are ongoing, so we hope that most countries in Europe will soon join these processes.
The high prevalence of allergic diseases in childhood means that Primary Care Physicians must manage allergic children on a daily basis. Their continued education in these disorders is also a concern for the Pediatrics Section. The PAPRICA (Pediatric Allergy for Primary Care Physicians) campaign provides education on Pediatric Allergy. The aims are to improve the recognition of allergic and allergy-like diseases, their evaluation and treatment, and when to refer patients for specialized assessment. This campaign has organized several Meetings and Symposia, and is keen to visit other countries in Europe.
Among the main current Hot Topics in Pediatric Allergy are include:
-Prevention of allergy
-Early recognition and treatment of allergic diseases
-Recognition of children at risk for chronic disease
-Probiotics and prebiotics in allergic disease
-Recognition and prevention of the Allergic March
-New tools for the diagnosis of allergy
-Treatment of asthma-wheezing in infancy and young children
-Approach to severe asthma in childhood
-Approach to severe atopic dermatitis
-Immunotherapy for primary and secondary prevention in allergy
-Awareness and early diagnosis of immunodeficiency
-Care of the allergic child at school
-Specific oral tolerance in food allergy
-Management of anaphylaxis
The Pediatrics Section is involved in three Task Forces. One of them is on the topic “Anaphylaxis in childhood”. The Task Force focused on diagnosis treatment and prevention of acute reactions. A final Position Paper was published in Allergy 2007;62:857-71. This Task Force is now in the phase of implementation, with the aim of disseminating recommendations and providing education of those involved in the care of children.
The second Task Force, on the topic “The Allergic Child at School”, has just finalized its recommendations which will shortly be published as a Position Paper in Allergy. The Task Force has the objective of promoting a change in attitudes towards the allergic child at school and promoting the implementation of legislation to support this. The document has been developed in collaboration with experts, patient’s organizations representatives and representatives of other stakeholders across Europe. Given the variety of health care facilities across Europe, The implementation phase has recently begun with the recommendations being adapted to suit wide variety of health care and school facilities and other local variation across Europe.
The third Task Force is on “Food Allergy Clinical Practice Guidelines” jointly with Food Allergy interest Group and the Section on Dermatology. The aim of this task force is to develop guidelines that provide guidance to allergists, dermatologists, gastroenterologists, pulmonologists, emergency physicians, pediatricians, family practitioners, intensivists and other professional and lay organizations to assist the diagnosis, prevention and treatment of food allergy and related diseases. The task force is in progress, the planed duration is 2 years.
Future proposed Task Forces, include one on Pediatric Rhinitis, jointly with the ENT and Asthma Sections, and on Pediatric Contact Dermatitis, jointly with the Dermatology Section.
In addition to the EAACI Congress in London 2010, the Pediatrics Section plan to be present in the Third Congress of the European Academy of Pediatric Societies, to be held in Copenhagen next 23-26 October 2010.
An Allergy School with the title “Diagnostic approaches to the Allergic patient” together with the Turkish Society of Allergy and Clinical Immunology will be held in Turkey in October 2010, in dates and location still to be determined. Due information will be provided when available.
Related current European/International projects
There are currently several important prospective studies of pediatric asthma and allergy in Europe. For example:
The Multicenter Allergy Study (MAS), from Germany, is a birth cohort study that is following 1314 infants born in the year 1990, when they were included in the investigation. The children are examined regularly, and laboratory and provocation tests are performed in order to determine each child's allergy status and response to environmental factors. The Study has the aim of describing the natural course of allergic symptoms and diseases and identifying risk factors and predictors for asthma and allergic disorders and has published numerous papers.
The Danish Allergy Research Centre (DARC) cohort comprises 562 children born in 1998-99 in Denmark. The study has obtained results on outcomes of asthma, food sensitization and allergy and atopic dermatitis.
The Isle of Wight 1989 Birth Cohort, from the United Kingdom has just been assessed at the age of 18 years. The participants have been regularly reviewed over the last two decades with many papers being published documenting burden and environmental and genetic risk factors for childhood asthma and allergic disease.
The BAMSE Project started in 1994 in Sweden and includes around 4000 children. Its aims are to assess the role of several factors (e.g. heredity, socio-economic conditions, environment, diet, and infections) in the development of asthma, eczema, and other allergic diseases among children.
The German Infant Nutritional Intervention Study (GINI) is a multicenter initiative with a general orientation on pediatric allergy, specially focusing on the development and prevention of food sensitization and allergy.
The Prevention and Incidence of Asthma and Mite Allergy (PIAMA) study was initiated in The Netherlands in 1996, and was aimed to assess the role of environmental and dietary risk factors for the development of allergic disease in children born to allergic mothers. It also evaluated the effect of preventive measures.
The Environment and Childhood Asthma (ECA) study, from Norway, begun in 1992 and evaluates the effect of family and pregnancy history, environmental exposures, socio-economic status, lung function measurements and feeding habits to understand better the early risk factors for asthma and allergy development.
The Lifestyle-Immune System-Allergy (LISA) study started in 1997, in Western and in former Eastern Germany, to evaluate the effect on allergy development of early life exposures, immune parameters, pollutants and allergens, and their interactions with genetic factors.
The Manchester Asthma and Allergy Study (MAAS) is a population based birth cohort study recruited in 1995 with 1035 infants under active follow up. It is assessing the influence and interaction between genes and allergen exposure on development of sensitisation, allergic disease and lung function.
The KOALA Birth Cohort Study started in 2000 in the Netherlands with the aims of assessing factors that influence the clinical expression of atopic disease, specially focusing on lifestyle (e.g., anthroposophy, vaccinations, antibiotics, dietary habits, breastfeeding and breast milk composition, intestinal microflora composition, infections during the first year of life, and gene-environment interaction).
The Finnish Allergy Programme 2008–2018, designed after the success of the Finnish Asthma Programme 1994–2004, in an interventional project with specific goals, well-defined tasks and tools for the induction of tolerance against common food and environmental allergens.
Middleton's allergy: principles and practice. Editors: Adkinson NF, Busse W, Bochner B, Holgate S, Simons FE, Lemanske R. Publisher: Mosby. There is a new edition of the classic reference book in Allergy. The seventh edition appeared in 2009; as usual it offers well-settled information on basic aspects of Allergy and Immunology, and on clinical diagnosis and management of allergic diseases. In addition to comprehensive approach to allergic patients it also has a specific chapter devoted to the development and prevention of atopic disease in childhood.
Pediatric Allergy. Principles and Practice. ed: Leung DYM, Sampson HA, Geha RF, Szefler SJ, Mosby, Missouri USA, 2003. ISBN 0-323-01802-5. This first edition is a very good basic reference book on many aspects of Pediatric Allergology, Immunology and Immunodeficiencies. The second edition is in press
Must read papers of the last months
Matricardi PM, Bockelbrink A, Gruber C, et al. Longitudinal trends of total and allergen-specific IgE throughout childhood. Allergy 2009;64:1093-8. This study has found heterogeneous longitudinal patterns of total IgE levels, which follow a parallel trend to that of overall specific IgE. The increasing trend of total IgE was associated with wheezing at 13 years of age.
Eller E, Kjaer HF, Host A, et al. Food allergy and food sensitization in early childhood: results from the DARC cohort. Allergy 2009;64:1023-9. The authors conclude that food sensitization seems to be a normal phenomenon in young children, since they found a high prevalence of food sensitization with no symptoms. This finding illustrates the need to perform standardized oral challenges.
Gangl K, Reininger R, Bernhard D, et al. Cigarette smoke facilitates allergen penetration across respiratory epithelium. Allergy 2009;64:398-405. This in vitro study demonstrates that concentrations of cigarette smoke extract similar to those found in smokers induced the development of para-cellular gaps and a decrease in trans-epithelial resistance of the respiratory epithelium, leading to an increase in allergen penetration.
Keil T, Lau S, Roll S, et al. Maternal smoking increases risk of allergic sensitization and wheezing only in children with allergic predisposition: longitudinal analysis from birth to 10 years. Allergy. 2009;64:445-51. In a prospective study it was found that children exposed to regular maternal smoking had an increased risk for developing allergic sensitization, but limited to children with allergic parents.
Ait-Khaled N, Pearce N, Anderson HR, et al. Global map of the prevalence of symptoms of rhinoconjunctivitis in children: The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three. Allergy 2009;64:123-48.
Lai CK, Beasley R, Crane J, et al. Global variation in the prevalence and severity of asthma symptoms: phase three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax 2009;64:476-83.
Odhiambo JA, Williams HC, Clayton TO, et al. Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three. J Allergy Clin Immunol 2009;124:1251-8. The ISAAC Phase Three cross-sectional survey has involved over one million children from 236 centers in 98 countries. It shows the latest figures on the prevalence of allergic diseases worldwide, essential data for public health planning.
Niers L, Martin R, Rijkers G, et al. The effects of selected probiotic strains on the development of eczema (the PandA study). Allergy 2009;64:1349-58. This clinical trial with a mixture of selected probiotic bacteria for the primary prevention of allergic disease in high-risk children found a preventive effect on the incidence of parental-reported eczema, with estimated numbers needed to treat of 5.9 at age 3 and 12 months and 6.7 at age 2 years.
Valkonen H, Waris M, Ruohola A, et al. Recurrent wheezing after respiratory syncytial virus or non-respiratory syncytial virus bronchiolitis in infancy: a 3-year follow-up. Allergy 2009;64:1359-65. In this retrospective study, hospitalized children with non-Respiratory Syncytial Virus bronchiolitis developed recurrent wheezing more often than those with RSV bronchiolitis, during a three-year follow-up.
West CE, Hammarstrom ML, Hernell O. Probiotics during weaning reduce the incidence of eczema. Pediatr Allergy Immunol 2009;20:430-7. This clinical trial with supplementation with probiotics for the prevention of eczema found a beneficial effect of the active treatment on the cumulative incidence of eczema at 13 months of age and a higher Th1/Th2 ratio, but no difference in total or specific IgE. The number needed to treat was 9.
Yoshihara S, Ono M, Yamada Y, et al. Early intervention with suplatast tosilate for prophylaxis of pediatric atopic asthma: a pilot study. Pediatr Allergy Immunol. 2009;20:486-92. Children with atopic dermatitis and food were randomly assigned to receive suplatast tosilate (a Th2 cytokine inhibitor) or ketotifen. After two years of treatment the prevalence of asthma was 20.8% in the suplatast group and 65.6% in the ketotifen group. Suplatast treatment was associated with a longer time to the onset of wheezing and with fewer hospitalizations for asthma treatment.
Tomicic S, Norrman G, Falth-Magnusson K, et al. High levels of IgG4 antibodies to foods during infancy are associated with tolerance to corresponding foods later in life. Pediatr Allergy Immunol 2009;20:35-41. Children with eczema and sensitization to cow’s milk of to egg that could tolerate the offending food at four years of age had initial higher levels of specific IgG4 and higher IgG4/IgE ratio.
Griffith LM, Cowan MJ, Notarangelo LD, et al Improving cellular therapy for primary immune deficiency diseases: Recognition, diagnosis, and management. J Allergy Clin Immunol 2009;124:1152-60.
Notarangelo LD, Fischer A, Geha RS, et al. Primary immunodeficiencies: 2009 update. J Allergy Clin Immunol 2009;124:1161-78.
These two articles offer an update on the comprehensive management of primary immunodeficiencies.
Caudri D, Wijga A, Schipper CMA, et al. Predicting the long-term prognosis of children with symptoms suggestive of asthma at preschool age. J Allergy Clin Immunol 2009;124:903-10. This study identified 8 readily available clinical parameters to predict asthma at 7-8 years of age among preschool children with first reported asthma-like symptoms.
Baker MW, Grossman WJ, Laessig RH, et al. Development of a routine newborn screening protocol for severe combined immunodeficiency. J Allergy Clin Immunol 2009;124:522-7. This is a report of a technique and protocol for the very early recognition of one of the most severe immunodeficiencies, whose delayed diagnosis is associated with a much poorer prognosis.
Rodriguez E, Baurecht H, Herberich E, et al. Meta-analysis of filaggrin polymorphisms in eczema and asthma: Robust risk factors in atopic disease. J Allergy Clin Immunol 2009;123:1361-70. This meta-analysis summarizes the effects of filaggrin mutations on the presence of atopic dermatitis, as well as on asthma associated or not with dermatitis
Agarwal S, Mayer L. Pathogenesis and treatment of gastrointestinal disease in antibody deficiency syndromes. J Allergy Clin Immunol 2009;124:658-64. This article describes the general approach to the evaluation of one of the common complications of primary immunodeficiencies.
For any questions or enquiries, please contact the Pediatrics Section Board.