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A precordial rub in a boy with a severe attack of ulcerative colitis.
No full textA case of a pneumomediastinum mimicking a pericarditis in a boy with an occult perforation due to ulcerative colitis is reported. Pneumomediastinum is a rare complication of severe attacks of ulcerative colitis, with or without the previous development of a toxic megacolon, that should be considered in the differential diagnosis
Cow's milk allergy in children, from avoidance to tolerance.
No full textFood allergy is the primary cause of anaphylaxis in paediatric age affecting roughly 4% of children and their families worldwide, and requiring changes in dietary habits. The prognosis for food allergy in children has traditionally been regarded as good for the most frequent allergens, however the prognosis for cow's milk allergy in the pediatric age is currently considered to be worse than previously believed. There is now enough evidence that measures of avoidance for children at risk did not have any preventive effect whatsoever, but they still came to be counterproductive by avoiding the physiological interaction between food allergens and gastrointestinal mucosal immune system. Programs of specific oral tolerance induction (SOTI) have obtained interesting results in the treatment of food allergy supporting the idea that antigen exposure through gastrointestinal section is important to allow the development of tolerance. Nevertheless this approach is not yet considered "ready" for community recommendations. In this paper we describe our experience in the field of SOTI in children with cow's milk allergy
Allergia agli antibiotici beta-lattamici: i miti da sfatare e le azioni pratiche da adottare
No full textThe penicillins (amoxicillin) are among the most effective and safe antibiotics for many common bacterial respiratory infections in paediatric age and should be avoided only when a true allergy is highly suspected. Severe true antibiotic allergies are rare and allergies are often overestimated. In high-income countries, 5-15% of patients report a penicillin allergy. However, in most cases (> 95%), these patients do not have a true immunologically mediated allergy and they may very likely tolerate the antibiotic upon a new exposure. All patients defined as allergic should be carefully evaluated and their levels of antibiotic allergy risk determined. In cases of suspected penicillin allergy (e.g. those with cutaneous manifestations), skin tests are not necessary before prescribing a beta-lactam antibiotic (amoxicillin) and direct oral administration can be performed in low-risk phenotypes carefully selected according to simple protocols that do not always require a specialist evaluation. The article, based on the recommendations of the WHO Aware Manual, provides current evidence and practical guidance, and fosters a correct interpretation and management of an overestimated problem that does not promote an optimal and judicious antibiotic use
Could slightly cooked egg be a suitable medium for oral immunotherapy in persistent hen's egg allergy?
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