Central apneas are a prevalent yet complex phenomenon, particularly among children. This retrospective study, conducted over a decade (from 2012 to 2022), analyzed central apneas in a cohort of 612 pediatric patients who underwent ventilation at the Sleep Medicine and Long-Term Ventilation Unit of the Bambino Gesù Children’s Hospital in Rome, Italy. Among this group, 67 patients met the inclusion criteria for central apneas. Central apneas often arise within the context of various underlying pathologies, including neurological disorders, genetic syndromes, and brain tumors. We categorized patients into three main groups including patients with “exclusively central apneas”, “predominantly central apneas”, and “predominantly obstructive apneas”. Ventilation modes were diverse, with pressure-controlled ventilation and pressure support being commonly used, reflecting the individualized nature of therapy. The choice of ventilation mode has been influenced by the underlying diagnosis and the severity of central apneas, with pressure support ventilation being the most frequently employed mode. Continuous Positive Airway Pressure was also employed in select cases. A statistically significant reduction (p<0.05) in mean cAHI was observed in patients with multimalformation syndromes, hypoxic-ischemic encephalopathy and Prader-Willi Syndrome. The reduction in mean cAHI was not statistically significant in the case of patients with brain tumors. While non-invasive ventilation was commonly used, invasive mechanical ventilation was selectively employed in more severe cases. The study highlights the need for personalized therapeutic strategies when managing central apneas in pediatric patients.

Background. Despite the presence of robust evidence, very sparse data are available on the efficacy of allergen immunotherapy (AIT) on selected patients in  real-life. Moreover, the obtained data does not ever fit with the general population; thus, the translation and the use of data obtained from randomized clinical trials (RCTs) in  real-practice can be questionable. Accordingly, we aimed to evaluate in  real-life efficacy and perceived satisfaction of 3-year sublingual immunotherapy (SLIT) in a pediatric population with with allergic rhinitis and/or asthma. Methods. A pilot, monocenter, retrospective cohort,  real-life study was performed. 153 children who fulfilled the criteria for allergic rhinitis and asthma and mono- or poly-sensitized were enrolled. A standardized questionnaire on perceived efficacy, rescue medication, disease control, number of exacerbations, quality of life, and perceived satisfaction was administered to each patient. Results. 70 patients (49 males, 21 females; mean age, 14.3±1.9 years) were included in the final analysis. All 70 patients received SLIT for up to three years, with 100% treatment adherence throughout the study duration. Significant improvement in symptoms and quality of life was reported (p<0.01). A significant decrease in disease severity, rescue medication use, and sleep disturbances was reported (p<0.01). A significant improvement was also recorded in school performance (p<0.01).  60/70 (85.7%) of all enrolled patients declared themselves  very  satisfied, 6/70 (8.57%)  much satisfied, and 4/60 (5.71%)  satisfied.  Conclusions. We firstly showed the efficacy and perceived satisfaction of 3-year SLIT in a paediatric population, with 100% treatment adherence throughout the study duration, in  real-life.

Vernal keratoconjunctivitis (VKC) is a severe chronic ocular disease characterized by recurring acute and/or chronic corneal-conjunctival inflammation leading to visual sequelae. Since no therapy is universally effective at treating VKC, novel treatments are currently under investigation, such as anti-immunoglobulin (Ig)E [1]. Omalizumab, a recombinant monoclonal antibody (mAb) binding to the Fcε portion of the immunoglobulin (Ig)E, has been licensed by the Food and Drug Administration (FDA) and European Medicines Agency (EMA) as an add-on therapy for the treatment of severe not controlled allergic asthma both in adults and children (age ≥ six years), [2-4] as well as in severe chronic idiopathic urticaria, and even as off-label use in other diseases [5, 6]. Although the clinical efficacy and safety of omalizumab have already been extensively investigated in the treatment of other IgE-mediated diseases [7, 8], very few literature data support the use of omalizumab in VKC [9-14]. In the present study, we report our clinical experience with omalizumab to treat severe VKC unresponsive to standard therapy in two children. An updated overview of the current literature is also provided.

Introduction Childhood cancer survivors (CSs) might face an increased lifelong risk of lung function impairment. The Lung Clearance Index (LCI) has been described as being more sensitive than spirometry in the early stages of some lung diseases. The aim of this study was to evaluate this index in a cohort of patients with a history of childhood cancer for the first time. Materials and Methods We evaluated 57 off-treatment CSs aged 0–18 years old and 50 healthy controls (HCs). We used the multiple breath washout (MBW) method to study LCI and spirometry. Results CSs did not show any differences from the controls in ventilation homogeneity (LCI 6.78 ± 1.35 vs. 6.32 ± 0.44, P: ns) or lung function (FEV1 99.9 ± 11.3% vs. 103.0 ± 5.9% of predicted, P: ns; FVC 98.2 ± 10.3% vs. 101.1 ± 3.3% of predicted). LCI significantly correlated with the number of years since the last chemotherapy (r = 0.35, P < 0.05). Conclusions Our study describes the trend of LCI in a cohort of CSs and compares it with the results obtained from healthy controls. The results show that patients maintain both good values of respiratory function and good homogeneity of ventilation during childhood. Moreover, the LCI identifies the tendency toward pulmonary fibrosis, which is typical of adult CSs, at an earlier time than spirometry.

Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disease caused by Aspergillus induced hypersensitivity that occurs in immunocompetent but susceptible patients with asthma and/or cystic fibrosis (CF). In children, ABPA remains mostly undiagnosed, resulting in one of the most common causes of poorly controlled asthma and highly significant morbidity in children with CF. Currently, no specific diagnostic criteria of ABPA for children are available. Corticosteroids and itraconazole are the mainstays of therapy, althoughthere is a lack of randomized clinical trials regarding their usefulness for ABPA in children. Several monoclonal antibodies, such asomalizumab and mepolizumab, may be potential therapies for refractory ABPA in pediatric patients; however, further data are required to clarify the optimal dose and duration of therapy as a routine treatment approach.