Elisabetta Palazzolo

Background: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease characterized by esophageal dysfunction and eosinophil-predominant inflammation. Its increasing recognition in children and risk of progressive remodeling demand effective, sustainable treatment. Methods: We conducted a narrative review of PubMed/MEDLINE, Embase, and Cochrane Library publications through 2026. Pediatric clinical studies, systematic reviews, meta-analyses, and international guidelines addressing dietary, pharmacological, and biologic therapies were qualitatively synthesized, with selected adult evidence included when pediatric data were unavailable. Results: Empiric elimination diets remain effective first-line options, with step-up strategies reducing unnecessary restriction and treatment burden. Elemental diets achieve histological remission in more than 90% of patients but are limited by palatability, cost, and adherence. Allergy test-directed diets have low predictive value and are not routinely recommended. Proton pump inhibitors and swallowed topical corticosteroids are established first-line therapies with favorable safety profiles. Real-world evidence suggests that treatment choice depends on age, phenotype, local practice, and family preference, whereas comparative effectiveness data remain limited. Dupilumab, the first biologic approved for EoE, produces substantial histological and endoscopic improvement across pediatric age groups and is particularly relevant for difficult-to-control disease or coexisting type 2 conditions. Other targeted agents reduce eosinophilia, but symptomatic benefit and pediatric evidence remain inconsistent. Conclusions: Pediatric EoE management should combine shared decision-making with objective histological monitoring and attention to growth, nutrition, adherence, and quality of life. Future research should define optimal treatment sequencing and maintenance, validate noninvasive biomarkers, and establish the long-term safety and effectiveness of emerging therapies in diverse pediatric populations and clinical settings.

Background: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease characterized by esophageal dysfunction and eosinophil-predominant inflammation. Its increasing recognition in children and risk of progressive remodeling demand effective, sustainable treatment. Methods: We conducted a narrative review of PubMed/MEDLINE, Embase, and Cochrane Library publications through 2026. Pediatric clinical studies, systematic reviews, meta-analyses, and international guidelines addressing dietary, pharmacological, and biologic therapies were qualitatively synthe-sized, with selected adult evidence included when pediatric data were unavailable. Results: Empiric elimination diets remain effective first-line options, with step-up strategies reducing unnecessary restriction and treatment burden. Elemental diets achieve histological remission in more than 90% of patients but are limited by palatability, cost, and adherence. Allergy test-directed diets have low predictive value and are not routinely recommended. Proton pump inhibitors and swallowed top-ical corticosteroids are established first-line therapies with favorable safety profiles. Real-world evidence suggests that treatment choice depends on age, phenotype, local practice, and family preference, whereas comparative effectiveness data remain limited. Dupilumab, the first biologic approved for EoE, produces substantial histological and endoscopic improvement across pediatric age groups and is particularly relevant for difficult-to-control disease or coexisting type 2 conditions. Other targeted agents reduce eosinophilia, but symptomatic benefit and pediatric evidence remain inconsistent. Conclusion: Pediatric EoE management should combine shared decision-making with objective histological monitoring and attention to growth, nutrition, adherence, and quality of life. Future research should define optimal treatment sequencing and maintenance, validate noninvasive biomarkers, and establish the long-term safety and effectiveness of emerging therapies in diverse pediatric populations and clinical settings.

Background: Appropriate diagnostic testing is essential to quality pediatric allergy care, affecting diagnostic accuracy, treatment decisions, resource use, and patient outcomes. This study aimed to develop evidence-based recommendations for specialist consultations and diagnostic investigations in children with food allergies, eosinophilic gastrointestinal diseases, urticaria, angioedema, and atopic dermatitis. Methods: A multidisciplinary panel convened for the Italian National Institute of Health formulated and prioritized clinical questions using the PICO framework and structured expert consensus. A systematic review of the literature from 2015 to 2026 informed the recommendations, with certainty of evidence assessed using GRADE methodology. Results: In food allergy, sensitization tests alone are insufficient for diagnosis, while oral food challenges remain central to diagnostic confirmation. Endoscopic biopsies are essential for diagnosing eosinophilic gastrointestinal diseases. In chronic urticaria, specialist consultation is recommended, whereas routine allergy testing should be avoided without a suggestive clinical history. In angioedema, distinguishing histaminergic from bradykinin-mediated forms is critical, with targeted laboratory testing for hereditary or acquired conditions. In atopic dermatitis, standardized severity assessment should guide management and consideration of biologic therapies, while patient and family education represent key components of care. Conclusions: These recommendations provide a framework for standardized pediatric allergy diagnostic pathways, aiming to improve quality and equity of care while reducing unnecessary investigations and optimizing healthcare resource use.

Background: The management of pediatric inflammatory bowel disease (PIBD) has evolved significantly over the past two decades, transitioning from corticosteroids and immunomodulators to biologic and small-molecule therapies. These advances have aimed not only to control inflammation but also to promote mucosal healing, improve growth, and enhance long-term quality of life. Objectives: This narrative review summarizes current evidence on the efficacy, safety, and clinical applications of biologic and novel small-molecule therapies in PIBD, highlighting emerging trends in personalized and precision-based management. Methods: A literature search was performed across PubMed, Embase, and the Cochrane Library, focusing on studies published within the last five years. Additional data were retrieved from key guidelines and position papers issued by ECCO–ESPGHAN, SIGENP, the FDA, and the EMA. Results: Anti–tumor necrosis factor (TNF) agents such as infliximab and adalimumab remain first-line biologics with proven efficacy in remission induction and maintenance. Newer biologics—vedolizumab, ustekinumab, risankizumab, and mirikizumab—offer alternatives for anti-TNF-refractory cases, showing encouraging short-term results and favorable safety profiles. Although many are approved only for adults with limited pediatric evidence, emerging small molecules—including Janus kinase (JAK) inhibitors (tofacitinib, upadacitinib) and sphingosine-1-phosphate (S1P) modulators (etrasimod)—provide oral, rapidly acting, and non-immunogenic treatment options for refractory disease. Furthermore, the gut microbiome is increasingly recognized as an emerging therapeutic target in PIBD, with growing evidence that host–microbiome interactions can influence both the efficacy and safety of biologics and small-molecule therapies. Conclusions: While biologics and small molecules have transformed PIBD management, challenges remain, including high treatment costs, limited pediatric trial data, and variable access worldwide. Future directions include multicenter pediatric studies, integration of pharmacogenomics, and biomarker-guided precision medicine to optimize early, individualized treatment and improve long-term outcomes.

.Respiratory syncytial virus (RSV) is a primary cause of lower respiratory tract infections in infants, with severe cases potentially leading to long-term respiratory issues like asthma. Globally, RSV affects 33.1 million children annually, resulting in 3.2 million hospitalizations. Despite its signifi-cant burden, treatment remains supportive, emphasizing the importance of prevention. This re-view explores current RSV prevention strategies, focusing on advancements in maternal immun-ization and monoclonal antibodies. Maternal vaccination during pregnancy has emerged as a promising approach, with the FDA-approved RSVpreF vaccine demonstrating 81.8% efficacy in reducing severe RSV infections during the first 90 days of life. Additionally, new monoclonal an-tibodies such as Nirsevimab represent key innovations. Nirsevimab offers single-dose protection, showing significant reductions in RSV hospitalizations across various studies and gaining ap-proval for universal use in regions like USA and Europe. Successful immunization programs, as seen in several countries, highlight the potential of broad implementation. While these develop-ments mark progress, further research is essential to optimize protocols, assess long-term out-comes, and expand access, aiming to alleviate RSV’s global health impact on infants and young children.

Asthma is the most frequent chronic disease of childhood, affecting up to 20% of children worldwide. The main guidelines on asthma maintenance therapy in pediatrics suggest different approaches and describe different stages of asthma to determine the most appropriate treatment. This project aims to summarize the most recent evidence regarding maintenance therapy for asthma in children and adolescents. A multidisciplinary panel of experts was asked clinical questions regarding the treatment of children and adolescents with asthma. Overall, 10 clinical questions were addressed, and the search strategy included accessing electronic databases and a manual search of gray literature published in the last 25 years. After data extraction and narrative synthesis of results, recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Results showed that the choice of medication depends on the severity of the child’s asthma, phenotype, age, preference, and individual factors. In addition to medications, the identification of comorbidities and modifiable factors is crucial to obtaining good control. Asthma in children is heterogeneous, and its evolution varies over time. Since most recommendations for asthma management in childhood are extrapolated from clinical studies performed in adults, more clinical trials specifically designed for young children should be conducted.