4th Pediatric Allergy and Asthma Meeting (PAAM)

Table of contents WORKSHOP 4: Challenging clinical scenarios (CS01–CS06) CS01 Bullous lesions in two children: solitary mastocytoma S. Tolga Yavuz, Ozan Koc, Ali Gungor, Faysal Gok CS02 Multi-System Allergy (MSA) of cystic fibrosis: our institutional experience Jessica Hawley, Christopher O’Brien, Matthew Thomas, Malcolm Brodlie, Louise Michaelis CS03 Cold urticaria in pediatric age: an invisible cause for severe reactions Inês Mota, Ângela Gaspar, Susana Piedade, Graça Sampaio, José Geraldo Dias, Miguel Paiva, Mário Morais-Almeida CS04 Angioedema with C1 inhibitor deficiency in a girl: a challenge diagnosis Cristina Madureira, Tânia Lopes, Susana Lopes, Filipa Almeida, Alexandra Sequeira, Fernanda Carvalho, José Oliveira CS05 A child with unusual multiple organ allergy disease: what is the primer? Fabienne Gay-Crosier CS06 A case of uncontrolled asthma in a 6-year-old patient Ioana-Valentina Nenciu, Andreia Florina Nita, Alexandru Ulmeanu, Dumitru Oraseanu, Carmen Zapucioiu ORAL ABSTRACT SESSION 1: Food allergy (OP01–OP06) OP01 Food protein-induced enterocolitis syndrome: oral food challenge outcomes for tolerance evaluation in a Pediatric Hospital Adrianna Machinena, Olga Domínguez Sánchez, Montserrat Alvaro Lozano, Rosa Jimenez Feijoo, Jaime Lozano Blasco, Mònica Piquer Gibert, Mª Teresa Giner Muñoz, Marcia Dias da Costa, Ana Maria Plaza Martín OP02 Characteristics of infants with food protein-induced enterocolitis syndrome and allergic proctocolitis Ebru Arik Yilmaz, Özlem Cavkaytar, Betul Buyuktiryaki, Ozge Soyer, Cansin Sackesen OP03 The clinical and immunological outcomes after consumption of baked egg by 1–5 year old egg allergic children: results of a randomised controlled trial MerrynNetting, Adaweyah El-Merhibi, Michael Gold, PatrickQuinn, IrmeliPenttila, Maria Makrides OP04 Oral immunotherapy for treatment of egg allergy using low allergenic, hydrolysed egg Stavroula Giavi, Antonella Muraro, Roger Lauener, Annick Mercenier, Eugen Bersuch, Isabella M. Montagner, Maria Passioti, Nicolò Celegato, Selina Summermatter, Sophie Nutten, Tristan Bourdeau, Yvonne M. Vissers, Nikolaos G. Papadopoulos OP05 Chemical modification of a peanut extract results in an increased safety profile while maintaining efficacy Hanneke van der Kleij, Hans Warmenhoven, Ronald van Ree, Raymond Pieters, Dirk Jan Opstelten, Hans van Schijndel, Joost Smit OP06 Administration of the yellow fever vaccine in egg allergic children Roisin Fitzsimons, Victoria Timms, George Du Toit ORAL ABSTRACT SESSION 2: Asthma (OP07–OP12) OP07 Previous exacerbation is the most important risk factor for future exacerbations in school-age children with asthma S. Tolga Yavuz, Guven Kaya, Mustafa Gulec, Mehmet Saldir, Osman Sener, Faysal Gok OP08 Comparative study of degree of severity and laboratory changes between asthmatic children using different acupuncture modalities Nagwa Hassan, Hala Shaaban, Hazem El-Hariri, Ahmed Kamel Inas E. Mahfouz OP09 The concentration of exhaled carbon monoxide in asthmatic children with different controlled stadium Papp Gabor, Biro Gabor, Kovacs Csaba OP10 Effect of vitamin D3 supplementation during pregnancy on risk of persistent wheeze in the offspring: a randomised clinical trial Bo Chawes, Klaus Bønnelykke, Jakob Stokholm, Lene Heickendorff, Susanne Brix, Morten Rasmussen, Hans Bisgaard OP11 Lung function development in childhood Henrik Wegener Hallas, Bo Chawes, Lambang Arianto, Hans Bisgaard OP12 Is the effect of maternal and paternal asthma different in female and male children before puberty? Maike Pincus, Thomas Keil, Andreas Reich, Ulrich Wahn, Susanne Lau, Linus Grabenhenrich ORAL ABSTRACT SESSION 3: Epidemiology—genetics (OP13–OP18) OP13 Lifestyle is associated with incidence and category of allergen sensitisation: the ALADDIN birth cohort Sara Fagerstedt, Helena Marell Hesla, Emelie Johansson, Helen Rosenlund, Axel Mie, Annika Scheynius, Johan Alm OP15 Maternal filaggrin mutations increase the risk of atopic dermatitis in children: an effect independent of mutation inheritance Jorge Esparza-Gordillo, Anja Matanovic, Ingo Marenholz, Anja Bauerfeind, Klaus Rohde, Katja Nemat, Min-Ae Lee-Kirsch, Magnus Nordenskjöld, Marten C. G. Winge, Thomas Keil, Renate Krüger, Susanne Lau, Kirsten Beyer, Birgit Kalb, Bodo Niggemann, Norbert Hübner, Heather J. Cordell, Maria Bradley, Young-Ae Lee OP16 Allergic multimorbidity of asthma, rhinitis and eczema in the first 2 decades of the German MAS birth cohort Thomas Keil, Hannah Gough, Linus Grabenhenrich, Dirk Schramm, Andreas Reich, John Beschorner, Antje Schuster, Carl-Peter Bauer, Johannes Forster, Fred Zepp, Young-Ae Lee, Renate Bergmann, Karl Bergmann, Ulrich Wahn, Susanne Lau OP17 Childhood anaphylaxis: a growing concern Filipe Benito Garcia, Inês Mota, Susana Piedade, Ângela Gaspar, Natacha Santos, Helena Pité, Mário Morais-Almeida OP18 Indoor exposure to molds and dampness in infancy and its association to persistent atopic dermatitis in school age. Results from the Greek ISAAC II study Athina Papadopoulou, Despina Mermiri, Elpida Xatziagorou, Ioannis Tsanakas, Stavroula Lampidi, Kostas Priftis ORAL ABSTRACT SESSION 4: Pediatric rhinitis—immunotherapy (OP19–OP24) OP19 Associations between residential greenness and childhood allergic rhinitis and aeroallergen sensitisation in seven birth cohorts Elaine Fuertes, Iana Markevych, Gayan Bowatte, Olena Gruzieva, Ulrike Gehring, Allan Becker, Dietrich Berdel, Michael Brauer, Chris Carlsten, Barbara Hoffmann, Anita Kozyrskyj, Caroline Lodge, Göran Pershagen, Alet Wijga, Heinrich Joachim OP20 Full symptom control in pediatric patients with allergic rhinitis and asthma: results of a 2-year sublingual allergen immunotherapy study Zorica Zivkovic, Ivana Djuric-Filipovic, Jasmina Jocić-Stevanovic, Snežana Zivanovic OP21 Nasal epithelium of different ages of atopic subjects present increased levels of oxidative stress and increased cell cytotoxicity upon rhinovirus infection Styliani Taka, Dimitra Kokkinou, Aliki Papakonstantinou, Panagiota Stefanopoulou, Anastasia Georgountzou, Paraskevi Maggina, Sofia Stamataki, Vassiliki Papaevanggelou, Evangelos Andreakos, Nikolaos G. Papadopoulos OP22 Cluster subcutaneous immunotherapy schedule: tolerability profile in children Monica Piquer Gibert, Montserrat Alvaro Lozano, Jaime Lozano Blasco, Olga Domínguez Sánchez, Rosa Jiménez Feijoo, Marcia Dias da Costa, Mª Teresa Giner Muñoz, Adriana Machinena Spera, Ana Maria Plaza Martín OP23 Rhinitis as a risk factor for asthma severity in 11-year old children: population-based cohort study Matea Deliu, Danielle Belgrave, Angela Simpson, Adnan Custovic OP24 The Global Lung Function Initiative equations in airway obstruction evaluation of asthmatic children João Gaspar Marques, Pedro Carreiro-Martins, Joana Belo, Sara Serranho, Isabel Peralta, Nuno Neuparth, Paula Leiria-Pinto POSTER DISCUSSION SESSION 1: Food allergy (PD01–PD05) PD01 Allergen-specific humoral and cellular responses in children who fail egg oral immunotherapy due to allergic reactions Marta Vazquez-Ortiz, Mariona Pascal, Ana Maria Plaza, Manel Juan PD02 FoxP3 epigenetic features in children with cow milk allergy Lorella Paparo, Rita Nocerino, Rosita Aitoro, Ilaria Langella, Antonio Amoroso, Alessia Amoroso, Carmen Di Scala, Roberto Berni Canani PD04 Combined milk and egg allergy in early childhood: let them eat cake? Santanu Maity, Giuseppina Rotiroti, Minal Gandhi PD05 Introduction of complementary foods in relation to allergy and gut microbiota in farm and non-farm children Karin Jonsson, Annika Ljung, Bill Hesselmar, Ingegerd Adlerbert, Hilde Brekke, Susanne Johansen, Agnes Wold, Ann-Sofie Sandberg POSTER DISCUSSION SESSION 2: Asthma and wheeze (PD06–PD16) PD06 The association between asthma and exhaled nitric oxide is influenced by genetics and sensitisation Björn Nordlund, Cecilia Lundholm, Villhelmina Ullemar, Marianne van Hage, Anne Örtqvist, Catarina Almqvist PD09 Prevalence patterns of infant wheeze across Europe Anna Selby, Kate Grimshaw, Thomas Keil, Linus Grabenhenrich, Michael Clausen, Ruta Dubakiene, Alessandro Fiocchi, Marek Kowalski, Nikos Papadopoulos, Marta Reche, Sigurveig Sigurdardottir, Aline Sprikkleman, Paraskevi Xepapadaki, Clare Mills, Kirsten Beyer, Graham Roberts PD10 Epidemiologic changes in recurrent wheezing infants Herberto Jose Chong Neto, Gustavo Falbo Wandalsen, Ana Carolina Dela Bianca, Carolina Aranda, Nelson Augusto Rosário, Dirceu Solé, Javier Mallol, Luis García Marcos PD13 A single nucleotide polymorphism in the GLCCI1 gene is associated with response to asthma treatment in children IvanaBanic, Matija Rijavec, Davor Plavec, Peter Korosec, Mirjana Turkalj PD14 Pollen induced asthma: Could small molecules in pollen exacerbate the protein-mediated allergic response? Alen Bozicevic, Maria De Mieri, Matthias Hamburger PD15 A qualitative study to understand how we can empower teenagers to better self-manage their asthma Simone Holley, Ruth Morris, Frances Mitchell, Rebecca Knibb, Susan Latter, Christina Liossi, Graham Roberts PD16 Polymorphism of endothelial nitric oxide synthase (eNOS) gene among Egyptian children with bronchial asthma Mostafa M. M. Hassan POSTER DISCUSSION SESSION 3: Mechanisms—Epidemiology (PD17–PD21) PD17 Pregnancy outcomes in relation to development of allergy in a Swedish birth cohort Malin Barman, Anna Sandin, Agnes Wold, Ann-Sofie Sandberg PD18 Evolution of the IgE response to house dust mite molecules in childhood Daniela Posa, Serena Perna, Carl-Peter Bauer, Ute Hoffmann, Johannes Forster, Fred Zepp, Antje Schuster, Ulrich Wahn, Thomas Keil, Susanne Lau, Kuan-Wei Chen, Yvonne Resch, Susanne Vrtala, Rudolf Valenta, Paolo Maria Matricardi PD19 Antibody recognition of nsLTP-molecules as antigens but not as allergens in the German-MAS birth cohort Olympia Tsilochristou, Alexander Rohrbach, Antonio Cappella, Stephanie Hofmaier, Laura Hatzler, Carl-Peter Bauer, Ute Hoffmann, Johannes Forster, Fred Zepp, Antje Schuster, RaffaeleD’Amelio, Ulrich Wahn, Thomas Keil, Susanne Lau, Paolo Maria Matricardi PD20 Early life colonization with Lactobacilli and Staphylococcus aureus oppositely associates with the maturation and activation of FOXP3+ CD4 T-cells Sophia Björkander, Maria A. Johansson, Gintare Lasaviciute, Eva Sverremark-Ekström PD21 Genome-wide meta-analysis identifies 7 susceptibility loci involved in the atopic march Ingo Marenholz, Jorge Esparza-Gordillo, Franz Rüschendorf, Anja Bauerfeind, David P. Strachan, Ben D. Spycher, Hansjörg Baurecht, Patricia Margaritte-Jeannin, Annika Sääf, Marjan Kerkhof, Markus Ege, Svetlana Baltic, Melanie C Matheson, Jin Li, Sven Michel, Wei Q. Ang, Wendy McArdle, Andreas Arnold, Georg Homuth, Florence Demenais, Emmanuelle Bouzigon, Cilla Söderhäll, Göran Pershagen, Johan C. de Jongste, Dirkje S Postma, Charlotte Braun-Fahrländer, Elisabeth Horak, Ludmila M. Ogorodova, Valery P. Puzyrev, Elena Yu Bragina, Thomas J Hudson, Charles Morin, David L Duffy, Guy B Marks, Colin F Robertson, Grant W Montgomery, Bill Musk, Philip J Thompson, Nicholas G. Martin, Alan James, Patrick Sleiman, Elina Toskala, Elke Rodriguez, Regina Fölster-Holst, Andre Franke, Wolfgang Lieb, Christian Gieger, Andrea Heinzmann, Ernst Rietschel, Thomas Keil, Sven Cichon, Markus M Nöthen, Craig E Pennell, Peter D Sly, Carsten O Schmidt, Anja Matanovic, Valentin Schneider, Matthias Heinig, Norbert Hübner, Patrick G. Holt, Susanne Lau, Michael Kabesch, Stefan Weidinger, Hakon Hakonarson, Manuel AR Ferreira, Catherine Laprise, Maxim B. Freidin, Jon Genuneit, Gerard H Koppelman, Erik Melén, Marie-Hélène Dizier, A. John Henderson, Young Ae Lee POSTER DISCUSSION SESSION 4: Food allergy—Anaphylaxis (PD22–PD26) PD22 Atopy patch test in food protein induced enterocolitis caused by solid food Purificacion González-Delgado, Esther Caparrós, Fernando Clemente, Begoña Cueva, Victoria M. Moreno, Jose Luis Carretero, Javier Fernández PD23 Watermelon allergy: a novel presentation Kate Swan, George Du Toit PD24 A pilot study evaluating the usefulness of a guideline template for managing milk allergy in primary care Mudiyur Gopi, Tim Smith, Edara Ramesh, Arun Sadasivam PD26 Efficacy and safety of cow’s milk oral immunotherapy protocol Inês Mota, Filipe Benito Garcia, Susana Piedade, Angela Gaspar, Graça Sampaio, Cristina Arêde, Luís Miguel Borrego, Graça Pires, Cristina Santa-Marta, Mário Morais-Almeida POSTER DISCUSSION SESSION 5: Prevention and treatment—Allergy (PD27–PD36) PD27 Allergy-protection by the lactic acid bacterium Lactococcus lactis G121: mode-of-action as revealed in a murine model of experimental allergy Stephanie Brand, Karina Stein, Holger Heine, Marion Kauth PD29 The relationship between quality of life and morning salivary cortisol after acute bronchiolitis in infancy Leif Bjarte Rolfsjord, Egil Bakkeheim, Johan Alm, Håvard Ove Skjerven, Kai-Håkon Carlsen, Jon Olav Hunderi, Teresa Løvold Berents, Petter Mowinckel, Karin C. Lødrup Carlsen PD30 Randomised trial of the efficacy of MP29-02* compared with fluticasone propionate nasal spray in children aged ≥6 years to <12 years with allergic rhinitis Ulrich Wahn, Ullrich Munzel, William Berger PD31 10 mg of oral bilastine in 2 to 11 years old children has similar exposure to the adult therapeutic dose (20 mg) Ulrich Wahn, Román Valiente, Valvanera Vozmediano, John C. Lukas, Mónica Rodríguez PD33 Daily symptoms, nocturnal symptoms, activity limitations and reliever therapies during the three steps of IOEASMA programme: a comparison Sebastiano Guarnaccia, Luigi Vitale, Ada Pluda, Emanuele D’Agata, Denise Colombo, Stefano Felici, Valeria Gretter, Susanna Facchetti, Gaia Pecorelli, Cristina Quecchia PD34 Sensitisation to an inert aeroallergen in weaning rats and longstanding disease, in a sensitisation-tolerant and easily tolerisable rodent strain George Guibas, Evangelia Spandou, Spyridon Megremis, Peter West, Nikolaos Papadopoulos PD35 Bacterial and fungi exposure in school and allergic sensitisation in children João Cavaleiro Rufo, Joana Madureira, Inês Paciência, Lívia Aguiar, Patrícia Padrão, Mariana Pinto, Luís Delgado, Pedro Moreira, João Paulo Teixeira, Eduardo Oliveira Fernandes, André Moreira PD36 Comparative study of allergy rhinitis between two populations: children vs. adults Adriana Izquierdo Dominguez, Antonio Valero, Joaquim Mullol, Alfonso Del Cuvillo, Javier Montoro, Ignacio Jauregui, Joan Bartra, Ignacio Davila, Marta Ferrer, Joaquin Sastre POSTER VIEWING SESSION 1: Inflammation—Genetics—Immunology—Dermatology (PP01–PP09) PP01 Immune profile in late pregnancy: immunological markers in atopic asthmaticwomen as risk factors for atopy in the progeny Catarina Martins, Jorge Lima, Maria José Leandro, Glória Nunes, Jorge Cunha Branco, Hélder Trindade, Luis Miguel Borrego PP02 The impact of neonatal sepsis on development of allergic diseases Secil Conkar, Mehtap Kilic, Canan Aygun, Recep Sancak PP03 Clinical overview of selective IgE deficiency in childhood Athina Papadopoulou, Eleni Tagalaki, Lambros Banos, Anna Vlachou, Fotini Giannoula, Despina Mermiri PP04 Inverse relationship between serum 25(ΟΗ) vitamin D3 and total IgE in children and adolescence Athina Papadopoulou, Stavroula Lampidi, Marina Pavlakou, Maria Kryoni, Kostas Makris PP05 PP06 PP07 Asthma control questionnaire and specific IgE in children Snezhina Lazova, Guergana Petrova, Dimitrinka Miteva, Penka Perenovska PP08 Features of chronic urticaria of adolescents Aliya Klyucharova, Olesya Skorohodkina PP09 Cutaneous mastocytosis in children: a clinical analysis of 8 cases in Greece Dimitra Koumaki, Alkisti Manousaki, Maria Agrapidi, Lida Iatridou, Omima Eruk, Konstantinos Myridakis, Emmanouil Manousakis, Vasiliki Koumaki POSTER VIEWING SESSION 2: Food allergy—Anaphylaxis (PP10–PP47) PP10 Prognostic factors in egg allergy Maria Dimou, Maria Ingemansson, Gunilla Hedlin PP11 Evaluation of the efficacy of an amino acid-based formula in infants who are intolerant to extensively hydrolysed protein formula Nitida Pastor, Delphine de Boissieu, Jon Vanderhoof, Nancy Moore, Kaitlin Maditz PP12 Anaphylaxis and epinephrine auto-injector use: a survey of pediatric trainees Adeli Mehdi, Shaza Elhassan, Carolin Beck, Ahmed Al-Hammadi PP13 Anaphylaxis in children: acute management in the Emergency Department Ioana Maris, Ronan O’Sullivan, Jonathan Hourihane, PP14 Understanding Cumbrian schools preparedness in managing children at risk of anaphylaxis in order to provide training and support which will create healthy and safe environments for children with allergies George Raptis, Louise Michaelis PP15 A new valid and reliable parent and child questionnaire to measure the impact of food protein enterocolitis syndrome on children: the FPIES Quality of Life Questionnaire (FPIESQL), Parent and Child Short Form Audrey DunnGalvin, Matthew Greenhawt, Carina Venter, Jonathan Hourihane PP16 An in-depth case study investigation of the experiences of teenagers and young adults in growing up and living with food allergy with emphasis on coping, management and risk, support, and social and self-identity Evelyn O’Regan, Duncan Cronin, Jonathan Hourihane, Anna O’Reilly, Audrey DunnGalvin PP17 Cow’s milk protein allergy in Constantine. A retrospective study of 62 cases between 1996 and 2013 Foued Abdelaziz, Dounia Khelifi-Touhami, Nihad Selim, Tahar Khelifi-Touhami PP18 PP19 Cow’s milk and egg oral immunotherapy in children older than 5 years Pablo Merida, Ana Mª Plaza, Juan Heber Castellanos, Adrianna Machinena, Montserrat Alvaro Lozano, Jaime Lozano, Olga Dominguez, Monica Piquer, Rosa Jimenez, Mª Teresa Giner PP20 Professionals’ awareness of management of Cow’s Milk Protein Allergy (CMPA) in North Wales Hospitals Konstantinos Kakleas, Manohar Joishy, Wendmu Maskele, Huw R. Jenkins PP21 PP22 Anaphylaxis: the great unknown for teachers. Presentation of a protocol for schools Mercedes Escarrer, Agustín Madroñero, Maria Teresa Guerra, Juan Carlos Julia, Juan Carlos Cerda, Javier Contreras, Eulalia Tauler, Maria Jesus Vidorreta, Ana Rojo, Silvia Del Valle PP23 Challenges facing children with food allergies and their parents in out of school activity sectors Niamh Flynn PP24 A review of food challenges at a Regional Irish Centre Gary Foley, Carol Harmon, John Fitzsimons PP25 The use of epinephrine in infants with anaphylaxis Krasimira Baynova, Ávila Maria Del Robledo, Labella Marina PP26 PP27 PP28 Mother’s psychological state predicts the expression of symptoms in food allergic children Aaron Cortes, Alicia Sciaraffia, Angela Castillo PP29 The correlation between sIgE towards tree nuts and birch pollen in a Danish Pediatric Allergy Clinic Nanna Juel-Berg, Kirsten Skamstrup Hansen, Lars Kærgaard Poulsen PP30 Food allergy in children: evaluation of parents’ use of online social media Andreia Florina Nita, Ioana Valentina Nenciu, Adina Lazar, Dumitru Oraseanu PP31 The impact of food allergy on quality of life: FAQLQ questionnaire Rita Aguiar, Anabela Lopes, Maria J. Paes, Amélia S. Santos, M. A. Pereira-Barbosa PP32 An unexpected cause of anaphylaxis: potato Hatice Eke Gungor, Salih Uytun, Umit Murat Sahiner, Yasemin Altuner Torun PP33 Is it clinical phenotype of allergic diseases determined by sensitisation to food? Mirjana Zivanovic, Marina Atanasković-Marković PP34 PP35 Prescribing adrenaline auto-injectors in children in 2014: the data from regional pediatricians Tina Vesel, Mihaela Nahtigal, Andreja Obermayer-Temlin, Eva Šoster Križnik, Mirjana Maslar, Ruben Bizjak, Marjeta Tomšič-Matic, Sonja Posega-Devetak, Maja Skerbinjek-Kavalar, Mateja Predalič, Tadej Avčin PP36 Who should have an adrenaline autoinjector? Adherence to the European and French guidelines among 121 allergists from the Allergy Vigilance Network Guillaume Pouessel, Etienne Beaudouin, Anne M. Moneret-Vautrin, Antoine Deschildre, Allergy Vigilance Network PP37 Anaphylaxis by Anacardium Occidentale Marta Viñas, Bartolomé Borja, Nora Hernández, Mª José Castillo, Adriana Izquierdo, Marcel Ibero PP38 Anaphylaxis with honey in a child S. Tolga Yavuz, Ali Gungor, Betul Buyuktiryaki, Ozan Koc, Can Naci Kocabas, Faysal Gok PP39 Evaluation of courses adopted to children on prevention, recognition and management of anaphylaxis Tina Vesel, Mihaela Nahtigal PP40 Symptomatic dust mites and shrimp allergy: three pediatric case reports Filipa Almeida, Susana Lopes, Cristina Madureira, Tânia Lopes, Fernanda Carvalho PP41 Poor identification rates of nuts by high risk individuals: a call for improved education and support for families Camille Heming, Emily Garrett, Adam Blackstock, Santanu Maity, Rahul Chodhari PP42 DAFALL: database of food allergies in the Czech Republic Simona Belohlavkova, Eliska Kopelentova, Petr Visek, Ivana Setinova, Ivana Svarcova PP43 Serological cross-reactivity between grass and wheat is not only caused by profilins and CCDs Sigrid Sjölander, Nora Nilsson, Malin Berthold, Helena Ekoff, Gunilla Hedlin, Magnus Borres, Caroline Nilsson PP44 Oil body associated proteins in children with nuts allergy. Allergens to consider in IgE-mediated nuts allergy Loreto González Domínguez, Cristina Muñoz Archidona, Ana Moreira Jorge, Sergio Quevedo Teruel, Teresa Bracamonte Bermejo, Miriam Castillo Fernández, Fernando Pineda de la Losa, Luis Ángel Echeverría Zudaire PP45 PP46 Protective effect of helicobacter pylori infection against food allergy in children Olga Vrani, Antigone Mavroudi, Maria Fotoulaki, Maria Emporiadou, Kleomenis Spiroglou, Ioannis Xinias PP47 Anaphylaxis pathway: A road tryp-tase to success? Helyeh A. Sadreddini, Mia Warnes, Donna Traves POSTER VIEWING SESSION 3: Miscellaneous (PP48–PP58) PP48 Surveillance study on safety of SLIT in pediatric population Ivana Djuric-Filipovic, Zorica Zivkovic, Snežana Zivanovic, Gordana Kostić, Đorđe Filipovic PP49 Efficacy and safety of mixed mite subcutaneous immunotherapy among allergic rhinitis patients in the Northeastern Thailand Sawapon Sittisomwong, Siripong Sittisomwong PP50 Effect of inhaled beclomethasone or placebo on brain stem activity in a patient chronically treated with steroids: preliminary report Zygmunt Podolec, Marcin Hartel, Daria Panek, Magdalena Podolec-Rubiś, Tomasz Banasik PP51 Sensitisation to aeroallergens in patients with allergic rhinitis, asthma and atopic dermatitis in Shiraz, Southwestern Iran Elham Abbasi, Mozhgan Moghtaderi PP52 Referring a child for allergy test: how appropriate are we? Phani Sanneerappa, Alina Deliu, Moosa Kutty, Nagabathula Ramesh PP53 EBV lymphoproliferative disease and cardiac lymphoma in a STK4 deficient patient Roya Sherkat, Mohammad Reza Sabri, Bahar Dehghan, Hamid Bigdelian, Nahid Raeesi, Mino Afshar, Hamid Rahimi, Christoph Klein PP54 A case study: the effect of massive honeybees attack on various body parameters atopic girl including allergy Mohemid Al-Jebouri PP55 The role of TLR9, NLRP3 and proIL-1β in activation of antiviral innate immunity Oxana A. Svitich, Daria O. Zubacheva, Dmitrii A. Potemkin, Ludmila V. Gankovskaya, Vitalii V. Zverev PP56 Overnight pulse oximetry, as a screening tool to diagnose obstructive sleep apnoea. How effective is it? Phani Sanneerappa, Elaine OB Doyle, Paul Gallagher, Nagabathula Ramesh PP57 The presentation and management of acute urticaria and allergic reactions in children in a multi-ethnic, inner city Emergency Department (ED) Sherine Dewlett, Kin Man, Minal Gandhi, James Pocock, Anna Gerrardhughes PP58 Food allergens responsible for delayed-type sensitisation in atopy patch test in children diagnosed with autism spectrum disorder Jolanta Wasilewska, Maciej Kaczmarski, Dariusz Lebensztejn POSTER VIEWING SESSION 4: Asthma—Rhinitis (PP59–PP87) PP59 Systematic review of incense as a trigger factor for asthma Chandramani Thuraisingham, Davendralingam Sinniah PP60 Increased risks of mood and anxiety disorders in children with asthma Yue Chen, Xiaomei Mei PP61 PP62 Asthma Control Test (ACT) and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) association in children Sebnem Ozdogan, Pinar Karadeniz, Durdugul Ayyildiz-Emecen, Ummuhan Oncul PP63 Seasonal and gender variations in vitamin D levels in children with asthma and its association with pulmonary function tests Sebnem Ozdogan, Gizem Sari, Sabanur Cavdar PP64 Defining treatment response in childhood asthma: rationale and design of the Pharmacogenomics in the Childhood Asthma (PiCA) consortium Niloufar Farzan, Susanne J. Vijverberg, Colin J. Palmer, Kelan G. Tantisira, Anke-Hilseon Maitland-van der Zee behalf of the PiCA consortium PP65 Prevalence of asthma and allergic disease in patients with inflammatory disease compared to celiac disease Fatma Yavuzyilmaz, Sebnem Ozdogan, Nafiye Urganci, Merve Usta PP66 A severe case with cystic fibrosis (CF) asthma Mehmet Hoxha, Maksim Basho PP67 Severe asthma exacerbation complicated with pneumothorax in a child with uncontrolled asthma due to poor treatment compliance Ioana Valentina Nenciu, Andreia Florina Nita, Adina Lazar, Alexandru Ulmeanu, Carmen Zapucioiu, Dumitru Oraseanu PP68 Evaluation of the Pediatric Quality of Life inventory (PedsQL) asthma module among low income asthmatic children and adolescents in Sao Paolo, Brazil Gustavo F. Wandalsen, Fernanda Monteiro, Dirceu Solé PP69 Early initiation of specific immunotherapy in asthma patients leads to higher benefits Blerta Lame, Eris Mesonjesi, Arjeta Sherri PP70 Treatment resistant asthma and rhinosinusitis with recurrent pulmonary infections. Is it primary ciliary dyskinesia? Alkerta Ibranji, Laert Gjati, Gjustina Loloci, Ardii Bardhi PP71 The comparison of sensitisation to animal allergens in children- and adult- onset patients with asthma Behnam Moghtaderi, Shirin Farjadian, Dorna Eghtedari PP72 Characterisation of children less than five years with wheezing episodes in Cali, Colombia Manuela Olaya, Laura Del Mar Vasquez, Luis Fernando Ramirez, Carlos Daniel Serrano PP73 Evaluation of the patients with recurrent croup Belgin Usta Guc, Suna Asilsoy, Fulya Ozer PP74 Obesity in adolescence compromising the asthma control Guergana Petrova, Sylvia Shopova, Vera Papochieva, Snezhina Lazova, Dimitrinka Miteva, Penka Perenovska PP75 Sleep behavior in children with persistent allergic rhinitis Gustavo F. Wandalsen, Jessica Loekmanwidjaja, Márcia Mallozi, Dirceu Solé PP76 Randomised trial of the safety of MP29-02* compared with fluticasone propionate nasal spray in children aged ≥4 years to <12 years with allergic rhinitis William Berger, Ulrich Wahn, Paul Ratner, Daniel Soteres PP77 Safety and tolerability evaluation of bilastine 10 mg in children from 2 to 11 years of age with allergic rhinoconjunctivitis or urticaria Zoltán Novák, Anahí Yáñez, Kiss Ildikó, Piotr Kuna, Miguel Tortajada, Román Valiente, the Bilastine Pediatric Safety Study Group PP78 Sensitisation to Alternaria alternata: Is it a risk factor for severe rhinitis? Susana Lopes, Filipa Almeida, Tânia Lopes, Cristina Madureira, José Oliveira, Fernanda Carvalho PP79 Validation of the Patient Benefit Index (PBI) for the assessment of patient-related outcomes in allergic rhinitis in children Julia Feuerhahn, Christine Blome, Meike Hadler, Efstrathios Karagiannis, Anna Langenbruch, Matthias Augustin PP80 Efficacy of sublingual tablet of house dust mite allergen extracts in adolescents with house dust mite-associated allergic rhinitis Michel Roux, Shinji Kakudo, Efstrathios Karagiannis, Robert K. Zeldin PP81 Lung function improvement in a child treated with omalizumab for bronchial asthma Anna Sokolova, Tiago Milheiro Silva PP82 How to treat a child suffering from asthma, allergic rhinitis, allergy to peanuts and diabetes at the same time? Snezana S. Zivanovic, Vesna Cvetkovic, Ivana Nikolic, Sonja J. Zivanovic PP83 Nitric oxide in exhaled air in the relationship of the degree of sensitisation to aeroallergens Snezana S. Zivanovic, Ljiljana Saranac, Ivana Nikolic, Sonja J. Zivanovic, Zorica Zivkovic PP84 Clinical basis of diagnostic errors in pediatric asthma Zoia Nesterenko PP85 PP86 Childhood asthma control in Serbia and organised Asthma Educational Intervention (AEI) Snezana Radic, Branislava Milenkovic, Spomenka Smiljanic, Milka Micic-Stanijevic, Olivera Calovic PP87 Experience from a group of adolescents with severe allergic asthma treated with Omalizumab Anne Marie Bro Hofbauer, Lone Agertoft THEMATIC POSTER SESSION 1: Prevention and Treatment—Epidemiology (TP01–TP18) TP01 A cost effective primary school asthma education program: pilot study from inner London schools Lucy Everson, Jessica Kearney, Jonny Coppel, Simon Braithwaite, Rahul Chodhari TP02 The prevalence of allergic diseases among 14–15 years old adolescents in two Danish birth cohorts 14 years apart Elisabeth S. Christiansen, Henrik Fomsgaard Kjaer, Esben Eller, Charlotte G. Mørtz, Susanne Halken TP03 Does pattern of sensitisation to phleum pratense change with age? Is it different in children with allergic rhinitis or asthma? Cristina Román India, Ana Moreira Jorge, Loreto González Domínguez, Cristina Muñoz Archidona, Sergio Quevedo Teruel, Teresa Bracamonte Bermejo, Juana Jiménez Jiménez, Luis Echeverría Zudaire TP04 Practicalities of prevention of peanut allergy: modelling a national response to LEAP Cathal O’Connor, Jonathan Hourihane TP05 Comparison of the influence of sunflower seed oil and skin care lotion on the skin barrier function of newborns: a randomised controlled trial Varvara Kanti, Lena Lünnemann, Günther Malise, Laine Ludriksone, Andrea Stroux, Wolfgang Henrich, Michael Abu-Dakn, Ulrike Blume-Peytavi, Natalie Garcia Bartels TP06 The effect of daily skin care on skin barrier properties in infants with dry skin and risk for atopic dermatitis Varvara Kanti, Lena Lünnemann, Laine Ludriksone, Marianne Schario, Andrea Stroux, Ulrike Blume-Peytavi, Natalie Garcia Bartels TP07 Change in sum total aeroallergen skin prick test wheal diameters at 6 months predicts which children will respond to subcutaneous immunotherapy by three years Thorsten Stanley, Nicolien Brandenbarg TP08 Are mobile apps regarding adrenaline auto-injectors accessed by adolescents for support and education in the community? Alia Boardman, Gary McGreevy, Emily Rodger, Katherine Knight, Victoria Timms, Trisha Taylor, Gemma Scanlan, Roisin Fitzsimons TP09 TP10 Prevention of early atopic dermatitis among low-atopy-risk infants by immunoactive prebiotics is not sustained after the first year of life Grüber Christoph, Ulrich Wahn, Margriet van Stuivenberg, Fabio Mosca, Guido Moro, Gaetano Chirico, Christian P. Braegger, Joseph Riedler, Yalcin Yavuz, Günther Boehm TP11 TP12 TP13 Treatment with Omalizumab in a 16-year-old Caucasian girl with refractory solar urticaria Stefania Arasi, Giuseppe Crisafulli, Lucia Caminiti, Federica Porcaro, Giovanni Battista Pajno TP14 Ultra-pure soft water ameliorates skin conditions of adult and child patients with atopic dermatitis Akane Tanaka, Yaei Togawa, Kumiko Oida, Naotomo Kambe, Peter Arkwright, Yosuke Amagai, Naoki Shimojo, Yasunori Sato, Hiroyuki Mochizuki, Hyosun Jang, Saori Ishizaka, Hiroshi Matsuda TP15 Potential adjuvant effect of immunomodulator to improve specific immunotherapy in asthmatic child Wisnu Barlianto, Ery Olivianto, H. M. S. Chandra Kusuma TP16 How can Component Resolved Diagnosis (CRD) influence in Specific Immunotherapy (SIT) prescription, in a Spanish children population Ana Moreira Jorge, Cristina Román India, Loreto González Domínguez, Cristina Muñoz Archidona, Juana Jiménez Jiménez, Teresa Bracamonte Bermejo, Sergio Quevedo Teruel, Luis Echeverría Zudaire TP17 Mitochondrial dysfunction in food allergy: effects of L. rhamnosus GG in a mice model of peanut allergy Rosita Aitoro, Mariapia Mollica, Roberto Berni Canani, Giovanna Trinchese, Elena Alfano, Antonio Amoroso, Lorella Paparo, Francesco Amato, Claudio Pirozzi, Antonio Calignano, Rosaria Meli TP18 Prediction of atopic diseases in childhood: elevated blood eosinophils in infancy in a high risk birth cohort Siri Rossberg, Kerstin Gerhold, Kurt Zimmermann, Mohammad Zaino, Thomas Geske, Eckard Hamelmann, Susanne Lau THEMATIC POSTER SESSION 2: Food allergy—Anaphylaxis (TP19–TP38) TP19 TP20 TP21 Double-blind provocation tests in non-IgE mediated cow’s milk allergy and the occurrence of placebo reactions Sarah Bogovic, Jochem van den Berg, Chantal Janssen TP22 Gradual introduction of baked egg (BE) in egg allergic patients under 2 years old Angela Claver TP23 Randomised controlled trial of SOTI with raw hen’s egg in children with persistent egg allergy I: safety and efficacy of daily vs. weekly protocols of induction Mª Flor Martin-Muñoz, C. Martorell, M. T. Belver, E. Alonso Lebrero, L. Zapatero, V. Fuentes, M. Piqué, A. Plaza, C. Muñoz, A. Martorell, Cristina Blasco, B. Villa, C. Gómez, S. Nevot, J. M. García, L. Echeverria TP24 Randomised controlled trial of SOTI with raw hen’s egg in children with persistent egg allergy II: a randomised controlled trial to study a safer, more effective and easy to perform maintenance (daily vs. every two days) pattern of egg SOTI Mª Flor Martin-Muñoz, C. Martorell, M. T. Belver, E. Alonso Lebrero, L. Zapatero, V. Fuentes, M. Piqué, A. Plaza, C. Muñoz, A. Martorell, Cristina Blasco, B. Villa, C. Gómez, S. Nevot, J. M. García, L. Echeverria TP25 Determining the safety of baked egg home reintroduction for children with mild egg allergy Brenda DeWitt, Judith Holloway, Donald Hodge TP26 Demographics, investigations and patterns of sensitisation in children with oral allergy syndrome in a London Teaching Hospital Sian Ludman, Merhdad Jafari-Mamaghani, Rosemary Ebling, Adam T. Fox, Gideon Lack, George Du Toit TP27 Airborne peanut challenge in children: allergic reactions are rare Sofia Lovén Björkman, Caroline Nilsson, Natalia Ballardini TP28 The nutty question on Pediatric Wards: to be or “nut” to be? Supriyo Basu, Jenny Hallet, Jyothi Srinivas TP29 TP30 TP31 Allergy education in nursery schools Hazel Stringer, Nicola Jay TP32 Food allergy in the first year of life Tânia Lopes, Cristina Madureira, Filipa Almeida, Susana Lopes, Paula Fonseca, Clara Vieira, Fernanda Carvalho TP33 Prevalence and geographic distribution of oral allergy syndrome in Italian children: a multicenter study Carla Mastrorilli, Carlo Caffarelli, Riccardo Asero, Salvatore Tripodi, Arianna Dondi, Gianpaolo Ricci, Carlotta Povesi Dascola, Elisabetta Calamelli, Francesca Cipriani, Andrea Di Rienzo Businco, Annamaria Bianchi, Paolo Candelotti, Tullio Frediani, Carmen Verga, Paolo Maria Matricardi TP34 Are common standardised allergen extracts used in skin test enough in the diagnosis of nuts allergy? Cristina Muñoz Archidona, Loreto González Domínguez, Ana Moreira Jorge, Sergio Quevedo Teruel, Teresa Bracamonte Bermejo, Miriam Castillo Fernández, Fernando Pineda de la Losa, Luis Ángel Echeverría Zudaire TP35 Evaluation of IgE sensitisation in children with allergic proctocolitis and its relationship to atopic dermatitis Despina Mermiri, Paraskevi Korovessi, Skevi Tiliakou, Evaggelia Tavoulari, Kalliopi-Maria Moraiti, Fotini Giannoula, Athina Papadopoulou TP36 Food allergy in children: are we managing them appropriately in the Emergency Department? Wan Jean Tee, Samir Deiratany, Raymond Seedhoo, Roisin McNamara, Ike Okafor TP37 Importance of oil body associated allergenic proteins in nuts suspected allergy children Loreto González Domínguez, Ana Moreira Jorge, Cristina Muñoz Archidona, Teresa Bracamonte Bermejo, Sergio Quevedo Teruel, Fernando Pineda de la Losa, Miriam Castillo Fernández, Luis Ángel Echeverría Zudaire TP38 Practical application of basophil activation test in children with food allergy Ekaterina Khaleva, Gennady Novic, Natalia Bychkova THEMATIC POSTER SESSION 3: Asthma (TP39–TP57) TP39 Effect of corticosteroid therapy upon serum magnesium level in chronic asthmatic children Amany Abd Al-Aziz, Amany Fatouh, Ayat Motawie, Eman El Bostany, Amr Ibrahim TP40 ADAM33 in Bulgarian children with asthma Guergana Petrova, Dimitrinka Miteva, Snezhina Lazova, Penka Perenovska, Sylvia Andonova, Alexey Savov TP41 TP42 The impact of vitamin D serum levels in asthma and allergic rhinitis Maria Zoto, Marialena Kyriakakou, Paraskevi Xepapadaki, Nikolaos G. Papadopoulos TP43 Life-threatening, first reported, paradoxical bronchospasm after nebulised Salbutamol in a 10 year old child Paraskevi Korovessi, Mariza Vassilopoulou, Athina Balaska, Lambros Banos, Stavroula Kostaridou, Despina Mermiri TP44 TP45 Asthma symptoms in children with treatment for allergic rhinoconjunctivitis Jorien Wartna, Arthur M. Bohnen, Gijs Elshout, David H. J. Pols, Patrick J. E. Bindels Erasmus MC, Rotterdam, The Netherlands TP46 Atopy increased the risk of developing exercise-induced bronchoconstriction in young athletes Sven F. Seys; Ellen Dilissen, Sarah Van der Eycken, An-Sofie Schelpe, Gudrun Marijsse, Thierry Troosters, Vincent Vanbelle, Sven Aertgeerts, Jan L. Ceuppens, Lieven J. Dupont, Koen Peers, Dominique M. Bullens TP47 The effect of higher BMI on risk for asthma and treatment outcome in overweight and obese children Ivana Banic, Sandra Bulat Lokas, Jelena Zivkovic, Boro Nogalo, Iva Mrkic Kobal, Davor Plavec, Mirjana Turkalj TP48 TP49 TP50 TP51 TP52 The impact of a multidisciplinary project intended to change the culture of nebulisers towards pressurised metered dose inhalers Georgeta Oliveira, Katharine Pike, Alda Melo, Tomás Amélia, José Carlos Cidrais Rodrigues, Cristina Serrano, José Manuel Lopes dos Santos, Carla Lopes TP53 TP54 TP55 TP56 Increased asthma control in patients with severe persistent allergic asthma after 12 month of nightly temperature controlled laminar airflow (TLA) Eckard Hamelmann, Uwe Schauer, Karl-Christian Bergmann TP57 THEMATIC POSTER SESSION 4: Drug allergy—Dermatology (TP58–TP77) TP58 Should we proceed directly to provocation challenges to diagnose drug allergy? Our experience says yes Luis Moral, Teresa Toral, Nuria Marco, Beléns García Avilés, Mª Jesús Fuentes, Jesús Garde, Cristina Montahud, Javier Perona, Mª José Forniés TP59 Anaphylaxis to 13-valent pneumococcal vaccine Esozia Arroabarren, Marta Anda, Maria Luisa Sanz, Maria Teresa Lizaso, Candida Arregui TP60 Intrapartum antibiotic exposure for treatment of group B streptococcus was not associated with the development of penicillin allergy in children Sara May, Martha Hartz, Avni Joshi, Miguel A. Park TP61 Evaluation of suspected drug hypersensitivity reactions in 169 children referred to the General Hospital Sonja Posega Devetak, Tina Vesel, Anja Koren Jeverica, Tadej Avčin TP62 Drug provocation testing: experience of a tertiary hospital Leonor Castro, Carolina Gouveia, Ana Carvalho Marques, Antonio Jorge Cabral TP63 Perioperative anaphylaxis: a growing concern in pediatric population Luis Amaral, Fabrícia Carolino, Eunice Castro, Madalena Passos, Josefina R. Cernadas TP64 Raising awareness of hypersensitivity to non-steroidal anti-inflammatory drugs in the pediatric age Fabrícia Carolino, Luís Amaral, Eunice Dias de Castro, Josefina R. Cernadas TP65 Perioperative anaphylaxis in young children: how to confirm the suspicion Josefina R. Cernadas, Fabrícia Carolino, Luís Amaral, Fernando Pineda, Armanda Gomes TP66 A case study of a child suspected to be penicillin allergic-digging deeper Katherine Knight, Roisin Fitzsimons, Helen Brough TP67 Prevalence, characteristics and risk factors of hypersensitivity reactions to antibiotics in patients with cystic fibrosis Jobst Röhmel, Carsten Schwarz, Anne Mehl, Philippe Stock, Doris Staab TP68 Antibiotic drug hypersensitivity in cystic fibrosis: A pilot study using cellular allergy tests for diagnostics Jobst Röhmel, Carsten Schwarz, Christine Seib, Doris Staab, Philippe Stock TP69 Oral antibiotics challenges in children Anita Critchlow, Alyson Barber, Nicola Jay TP70 Hypersensitivity reaction to vancomycin: a new successful desensitization protocol Belen Delavalle, Teresa Garriga, Blanca Vilá, Cristina Blasco TP71 TP72 Clinical phenotypes according to FLG gene loss of function mutations in children with atopic dermatitis Francesca Cipriani, Annalisa Astolfi, Costanza Di Chiara, Elisabetta Calamelli, Iria Neri, Annalisa Patrizi, Gianpaolo Ricci TP73 TP74 Urticaria in children: clinical and epidemiological features Katerina Neskorodova, Asya Kudryavtseva TP75 TP76 Acute urticaria at the Pediatrics Emergency Department: is it allergy? Esozia Arroabarren, Jorge Alvarez, Marta Anda, Miriam Palacios, Marta Martinez-Merino, Ibone Vaquero TP77


Introduction:
The exhaled carbon monoxide is an important biomarker of the oxidative stress and the airways inflammation. Most scientific publications account of increase values in asthma. However our known literature does not have data on the relationship between different stadiums of asthma control and the exhaled carbon monoxide values. The aim of this study was to access this correlation. Method: Our patients are well controlled, partly and uncontrolled asthma bronchial children, who are treated in outpatient clinic. Each of them has treatment according to GINA protocol. Before spirometry, patients were made deep inhalation, then they were made slow exhalation to the carbon monoxide measure equipment. (PiCO + Smokerlyzer) The exhaled carbon monoxide values were only known by the assistant, so that these values wouldn't influence when putting in a category. We made the statistic by InStat softver. We used non-parametric procedures. Results: We found significant differences between the groups of well controlled and group of partly or uncontrolled in concentration of exhaled carbon monoxide, but significant difference was not demonstrable between the group of partly controlled and group of uncontrolled (Table 1). Conclusion: According to our investigation/examinations the exhaled carbon monoxide is significantly higher in partly or uncontrolled stadium of asthma bronchial than in well controlled stadium of asthma. This higher amount of exhaled carbon monoxide values show the raising of airways inflammation and the finish of well controlled stadium. The exhaled carbon monoxide suggests the inflammation aspect of asthma bronchial. Detailed analysis of our results shows that the eCO can be used to estimate the compliance of patients (Table 2).

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Effect of vitamin D3 supplementation during pregnancy on risk of persistent wheeze in the offspring: a randomised clinical trial Bo Chawes 1 , Klaus Bønnelykke 1 , Jakob Stokholm 1 , Lene Heickendorff 2 , Susanne Brix 3 , Morten Rasmussen 1 , Hans Bisgaard 1 Importance: Observational studies have suggested that increased dietary Vitamin D intake during pregnancy may protect the offspring against preschool wheezing, which is the most common disorder in young children. Objective: To determine whether supplementation of Vitamin D 3 during third trimester of pregnancy reduces the risk of persistent wheeze in the offspring. Design, setting and participants: The study was a double-blinded, single-center, randomized controlled trial conducted within the Copenhagen Prospective Study on Asthma in Childhood (COPSAC 2010 ) unselected mother-child cohort. A total of 627 women were recruited for the Vitamin D trial at 24 weeks of pregnancy, between March 4th 2009 and November 17th 2010. Clinical follow-up of the children (n = 581) was completed when the youngest child turned 3 years and unblinded on March 28th 2014. Intervention: Vitamin D 3 (2400 IU/day) supplementation or matching placebo tablets from pregnancy week 24 to 1 week postpartum. Main outcome measure: Persistent wheeze at age 0-5 years diagnosed solely by the intervention-blinded study pediatricians strictly adherent to a predefined algorithm based on 11 scheduled and additional acute clinic visits and a day-to-day symptom diary filled by the parents from birth. Secondary outcomes were number of wheezy episodes, asthma, neonatal airway immunology, respiratory infections, allergic sensitization and eczema. Results: Occurrence of persistent wheeze did not differ between the Vitamin D 3 supplement and control group (incidence, 18 % vs. 21 %; hazard ratio, 0.79; 95 % CI, 0.54-1.14, P = 0.21). The number of wheezy episodes was reduced by the Vitamin D 3 intervention (mean 5.9 vs. 7.2 episodes; incidence risk ratio, 0.83; 95 % CI, 0.71-0.97, P = 0.02) and the airway immune profile at age one month was up-regulated (principle component analysis, P = 0.04). There was no effect on additional end-points. Conclusion: The use of Vitamin D 3 supplementation during pregnancy did not reduce the risk of persistent wheeze in the offspring.  preferential maternal transmission of disease risk. However, the molecular mechanism underlying this observation is currently unknown. Loss-of-function mutations in the filaggrin gene (FLG) cause skin barrier deficiency and strongly predispose to atopic dermatitis (AD). We analyzed the 4 most prevalent European FLG mutations (c.2282del4, p.R501X, p.R2447X, and p.S3247X) in two family-based samples (759 and 450 AD families) and applied the PREMIM/EMIM tool to test for parent-of-origin effects. As expected from the known role of these mutations on AD, children carrying a FLG mutation had a 2.4 fold increased disease risk (R1meta-analysis = 2.4, P = 1.0 × 10 −36 ). Strikingly, we also observed a strong maternal FLG genotype effect indicating that children of FLG-carrier mothers had a 1.5-fold increased AD risk (S1 = 1.50, Pmeta-analysis = 8.4 × 10 −8 ). This maternal effect that was consistent in both sets of families and for all 4 mutations analyzed.
Our results point to two independent scenarios where FLG mutations increase AD risk: (i) carrying a mutation and (ii) having a mutation carrier mother. This maternal effect was independent of mutation inheritance and can be seen as a non-genetic transmission of a genetic effect. Interestingly, the FLG maternal effect was observed only when mothers had allergic sensitization, suggesting that FLG-induced changes in the maternal immune response shape the child's immune system through feto-maternal cross-talk and increase the child's risk for AD. Overall, our study indicates that maternal FLG mutations act as strong environmental risk factors for the child and highlights the potential of family-based studies in uncovering novel disease mechanisms in the field of allergy susceptibility.
Background: Anaphylaxis is a severe life-threatening condition, frequently underdiagnosed and undertreated. The incidence of anaphylaxis is increasing, especially among children. We aimed to examine the changes in anaphylaxis frequency and characteristics over a 5 year period. Methods: Comparative analysis report on data from two crosssectional independent samples of children with anaphylaxis, col- The presence of molds as a source of perennial allergens and multiple bacteria has been related to the appearance of respiratory symptoms in several studies. Yet, its role in eczema has not been elucidated. Aim: The aim of this study was to investigate the association between exposure to indoor visible molds/dampness and the manifestation of eczema in children.

Materials and methods:
The study is part of the Greek contribution to ISAAC IΙ that includes 2023 students of randomly selected public primary schools in Athens and Thessaloniki, aged 9-10 years. The children represented a general population sample and were evaluated according to ISAAC II questionnaire, validated for Greek language. Additionally, skin prick tests (SPT), to aero-allergens were performed and children were examined for active lesions. Results: 13 % had suffered from eczema in the past, 9 % had current and 2 % atopic eczema (positive SPT). Out of the children examined, half reported that eczema first appeared after the age of 5 years whereas 68 % mentioned persistence of eczema since infancy. 10.8 and 6.4 % of children were currently exposed to indoor dampness and visible mold respectively, while 77, 5 % of them confirmed exposure since birth. 10 % of the sensitized children were positive to house dust mites and Alternaria. In logistic regression analysis evaluating 20 environmental risk factors, a significant association was noted between the presence of indoor visible mold and dampness in infancy, and the presence of current eczema OR 1, 89 (95 % CI 1.25-2.85). This association remained significant irrespective of the family history of atopy.

Conclusions:
Frequently eczema first appears at early school age. The presence of visible mold and dampness at home during infancy appears to be an initial enhancing risk factor for the development but also for the persistence of the disease throughout school age.
Introduction: Inconsistent associations have been reported between the green environment and childhood asthma and allergic health outcomes. We conducted a meta-analysis on residential greenness and allergic rhinitis and aeroallergen sensitization based on data from Swedish (BAMSE), Australian (MACS), Dutch (PIAMA), Canadian (CAPPS and SAGE) and German (GINIplus and LISAplus) birth cohorts (N = 13,016). Methods: Allergic rhinitis (doctor diagnosis or symptoms) and aeroallergen sensitization were assessed in children aged 6-8 years in six cohorts and 10-12 years in five cohorts. Residential greenness was defined as the mean Normalized Difference Vegetation Index (NDVI) in 500 m and 1000 m buffers around the home address at the time of health assessment. Cohort-specific associations between NDVI (per 0.2 unit increase) and allergic rhinitis and aeroallergen sensitization were assessed using logistic regression models adjusted for host and environmental confounders. The findings were combined in a randomeffects meta-analysis. Results: Heterogeneous associations for a range of outcomes were observed across cohorts. Greenness in a 500 buffer was positively associated with allergic rhinitis at 6-8 years in BAMSE (odds ratio = . All meta-analytic estimates were null. Results were similar for aeroallergen sensitization at 6-8 years and both outcomes at 10-12 years, and were independent of buffer size. Stratification by four urbanization markers (particulate matter smaller than 2.5 µm concentrations, nitrogen dioxide concentrations, population density and urban versus rural surroundings) did not reveal consistent trends within subgroups.

Conclusions:
Although residential greenness appears to be associated with childhood allergic rhinitis and aeroallergen sensitization, the direction of the effect varies by location. Introduction: Our study was designed to assess the efficacy of SLIT in allergic rhinitis and asthma in pediatric population. Here we report interim analysis done after 2 years. The aim of this study was to document the clinical implication of allergen specific drops on symptom severity and medication in children with allergic rhinitis and asthma. Methods: In this observational case control study we have collected information from 59 children with AR or/and asthma. 34 children received SLIT drops plus symptomatic treatment whereas 25 of patients received only symptomatic therapy. During the follow up period the patients rate their symptoms (rhinitis, conjunctivitis, asthma and atopic dermatitis) as combined score of severity-traditional symptom score assessment (graded from 0 to 3) plus recording of doses of symptomatic medications. The beneficial effects of SLIT on asthma and rhinitis scores and medication use have been observed for two consecutive years of treatment. Results: Both asthma and rhinitis scores were decreased during the first year of treatment, with the tendency of further decrease in the second year of follow up period. The most important effects of SLIT were observed for the symptom of wheezing and night cough (Χ 2 = 56,790; p < 0.001, Χ 2 = 56,142; p < 0.001) only in the experimental group. On the other side the biggest success of SLIT for rhinitis symptoms were detected for nasal congestion and rhinorrhea (Χ 2 = 43,607; p < 0.001, Χ 2 = 41,809; p < 0.001), without any significant changes in the control group. No differences have been detected for ocular and symptoms of atopic dermatitis. Additional significant improvements were also observed for symptomatic medication: antihistaminic: Χ 2 = 32,774; p < 0.001, inhalation corticosteroids: Χ 2 = 30,022; p < 0.001, intranasal corticosteroids: Χ 2 = 30,785; p < 0.001, beta2agonist Q = 28,783; p < 0.001, LTRA: Q = 12,000; p = 0.002, but only in the experimental group.

Conclusion:
The results of this study indicate favorable clinical efficacy of SLIT drops in children with asthma and allergic rhinitis. These findings also suggest that SLIT drops may have potential to alter the natural history of atopic disease with the convenience of home administration and the benefit of oral rather than subcutaneous administration.

OP24
The Methods: A retrospective analysis of the children (6-18 years-old) with a medical diagnosis of asthma that performed spirometry during 2014 in our lung function laboratory was made. GLI and Zapletal equations agreement was compared in three different obstruction criteria: FEV 1 < 80 % predicted, FEV 1 < LLN (lower limit of normal) and FEV 1 / FVC < LLN. All the agreement analyses were performed using Cohen's kappa test. Results: 391 children were evaluated (61 % boys) with a mean age of 12.4 years (standard-deviation ±3.1 years). Considering Zapletal equations the percentages of children classified as obstructed according to the different analyzed parameters were: 7.7 % for FEV 1 < 80 % predicted, 8.7 % for FEV 1 < LLN and 26.3 % for FEV 1 /FVC < LLN. Assuming GLI 2012 equations the correspondent percentages were 12.0 % for FEV 1 < 80 % predicted, 11.8 % for FEV 1 < LLN and 29.2 % for FEV 1 / FVC < LLN. Using the FEV 1 /FVC < 0.70 ratio criteria 10.2 % of the patients were classified as obstructed. Cohen's kappa coefficients for agreement between Zapletal and GLI 2012 equations to the analyzed parameters were: 0.67 for FEV 1 < 80 % predicted, 0.64 for FEV 1 < LLN and 0.85 for FEV 1 /FVC < LLN. Conclusions: In our study there was a good agreement between the commonly used prediction equations (Zapletal equations) and GLI 2012 equations. GLI 2012 equations adoption is a reasonable option in asthmatic children lung function evaluation, although maybe the changes in nowadays clinical practice will not be considerable. by ImmunoCAP (Thermofisher Scientific, Sweden) at baseline. In a subset of patients, PBMCs (2 × 10 5 ) were isolated and cultured (in duplicate) for 7 days at 37 °C in 5 % CO 2 with OVA and OVM (both at 100 ug/ml, Sigma Aldrich, Germany) with phytohaemaglutinin and medium alone as positive and negative controls respectively. After centrifugation, supernatants were collected and analyzed for presence of IL-2, IL-4, IL-5, IL-13, IFNg, IL-10, IL-9, IL-17, IL-6 and TNFa by multiplex magnetic bead assay (Luminex, Invitrogen, Life technologies, USA). Comparative analysis between ED and non ED groups was performed using U-Mann-Withney test. A two-tailed p value <0.05 was considered significant. Results: 50 children underwent egg-OIT, 9 of whom required "Early Discontinuation" (ED group). Specific IgE, IgG4 and IgA to OVA and OVM were higher in ED vs. non ED group (p < 0.005). IL-9 production by PBMC following OVM stimulation was higher in ED (n = 6) vs. non ED group (n = 10, p < 0.006) and a similar trend was detected after OVA. IL-5 and IL-13 responses to OVM also tended to be higher in ED vs. non ED children. No differences were observed in other cytokines. Conclusion: An IL-9 predominant cellular response as well as a strong allergen-specific poly-isotypic antibody response characterizes eggallergic children who fail OIT at early stages due to significant allergic reactions.  Epigenet, 2015). The suppressive phenotype of regulatory T (Treg) cells, characterized by stable expression of transcription factor Forkhead box Protein 3 (FoxP3), is involved in oral tolerance acquisition. We aimed to assess whether tolerance acquisition in children with IgE-mediated CMA involves a different DNA methylation profile of FoxP3. Methods: DNA methylation of CpGs in the promoter regions and respective mRNA levels of FoxP3 from peripheral blood mononuclear cells (PBMCs), were assessed in children with active IgE-mediated CMA (Group 1), CMA subjects with recent evidence of oral tolerance acquisition (Group 2) and in healthy controls (Group 3). Results: 37 children (18 male, aged 3-18 months) were enrolled: 16 in Group 1, 10 in Group 2 and 11 Group 3. DNA methylation profiles of FoxP3 clearly separated active CMA patients from healthy controls. Active IgE-mediated CMA patients showed significantly higher rate of DNA methylation in FoxP3 promoter region compared to healthy controls (52 vs. 80 %; p < 0.0001). DNA methylation analysis of this transcription factor clearly separated CMA patients by disease-state: tolerant subjects presented a significant different DNA methylation profile compared with active CMA patients (42 vs. 80 %, p < 0.0001). This profile was similar but not identical to that observed in healthy controls. A strong correlation between gene promoter DNA methylation rates and respective mRNA levels was also demonstrated (R 2 = 0.946; p < 0.0001). Background and aim: Evidence is emerging that postponed introduction of complementary foods might increase the risk of allergy. Likewise, low "food diversity" in early age has been associated with allergy development. Interestingly, also low diversity of the early gut microbiota has been linked to increased allergy risk. The incidence of allergy is markedly low in farm children; our aims are to investigate introduction practices in relation to: (1) farm environment, (2) allergy development, and (3) gut microbiota. Methods: Subjects from the FARMFLORA birth-cohort, including 28 farm and 37 non-farm parent-children pairs, were investigated. Practices of breastfeeding, formula and complementary feeding were recorded; month of introduction was registered for potatoes, vegetables, fruits, berries, nuts, peanuts, legumes, eggs, fish, meat, milk and flour. Allergies were diagnosed by doctors. Timing of introduction of complementary foods was analyzed in farm and non-farm infants and related to allergy development. Additionally, prevalence of microbes commonly found in the infant gut microbiota was analyzed on a genus level up to 18 months of age and will be related to formula and food introduction practices. Preliminary results: Nuts were introduced earlier to farm children than non-farm children and flour was more frequent introduced to farm children at 7 months. In contrast, peanuts were less frequent introduced to farm children at 17 months. When allergic (1 farmer, 10 non-farmers) and healthy children were compared, fish was more frequent introduced to healthy infants at 10 months; the association was strengthened in children of non-allergic mothers but weakened when the analysis was confined to non-farm children. Legumes were more frequent introduced to healthy infants at 8 months, although  . This ranking of prevalence was stable during the first two decades of life. The IgE sensitization profiles to the 12 molecules were extremely heterogeneous in the population at all ages. Twentyone subjects remained prospectively sensitized to only one molecule (stable"monomolecular" sensitization). The remaining 147 subjects developed a molecularly complex sensitization. The complexity of the IgE response to D.pt molecules was higher in the children most exposed to Der p1 at 6-18 months of age than in the least exposed ones (highest vs. lowest exposure quartile).

Conclusions:
In the MAS birth cohort, Der p1, Der p2 and Der p23 are the "initiators" of the IgE response to D. pt. High exposure to Der p1 in early childhood is associated with a stronger "molecular spreading" of the IgE response to D.pt. Introduction: The atopic march refers to the sequential development of allergic conditions in childhood and is associated with severe and persistent disease manifestations. Up to 30 % of infants with eczema develop asthma in childhood which is the most common pattern of the atopic march. Aim of the study: We conducted a multi-stage genome-wide association study (GWAS) for infantile eczema followed by childhood asthma to unravel the genes underlying this characteristic pattern of allergic disease. Methods: GWASs were performed in 6 study populations (discovery phase). Selected SNPs were replicated in another 6 study populations (replication phase). Our study included 2428 cases and 17,034 controls of European descent. Association was calculated by logistic regression using an additive allele-dosage model. Meta-analyses were carried out with METAL using the inverse variance fixed effects model. Results: We identified 7 loci associated with the atopic march at genome-wide significance. Two chromosomal loci at 6p12.3 and 12q21.3 were specific for the combined eczema plus asthma phenotype and associated with allergic disease for the first time. Four additional loci at 1q21.3, 5q31.1, 11q13.1, and 11q13.5 were previously identified in GWASs on eczema while, at 17q21, a single asthma-specific locus was detected. By inspecting all known GWAS loci for eczema or asthma in the discovery set, we found that eczema loci were significantly more likely to be associated with the atopic march than asthma loci. Conclusion: The two novel loci provide genetic support for a specific atopic march phenotype. In addition, we demonstrate that eczema loci were the main genetic determinants of the atopic march which may point to the development of eczema as a key event initiating this unfavorable disease course. We suggest that the prevention or early treatment of infantile eczema could be a promising approach in order to reduce the burden of allergic diseases associated with the atopic march. Background: Recently, there has been an increased recognition of patients who are allergic to the seeds but not the pulp of citrus fruit. A study of 100 patients with nut allergy demonstrated high rates of co-sensitisation between cashew and orange seed but the clinical relevance of this state was not investigated by challenge. Watermelon (Citrullus lanatus), of the Cucurbitaceae family, has a high protein content in the seeds. Watermelon allergy predominantly presents as oral allergy syndrome but we describe a different manifestation. Case history: 2 patients have presented to our pediatric allergy service, both with a history of uneventfully enjoying consumption of watermelon on multiple occasions. A 6 years old boy, on one occasion of eating watermelon had swelling of his lips and widespread urticaria which resolved with anti-histamine and another young man of 7 years had anaphylaxis requiring an adrenaline autoinjector when he ate watermelon.

POSTER
Investigations: Both tested negative to the watermelon pulp (0 mm) but had positive skin prick test to the seeds (4 mm and 25 mm). Interestingly, both were also sensitised to cashew nut (3 mm and 6 mm). Neither has ever eaten cashew nut. Discussion: Watermelon seeds are often swallowed whole or removed before eating, hence patients may appear to tolerate watermelon. When the seed contents are consumed the reaction occurs. Watermelon seeds contain high levels of vicilin-like glycoprotein (seed storage protein). In cashew nuts Ana o 1, a vicilin-like protein, is a major food allergen hence the possibility of cross-reactivity. Other vicilin-like proteins such as peanut (Ara h1), soya (gly m5) and sesame (Ses i3) may also need consideration. Conclusions: Allergy to fruit seeds may be common and underrecognised. One should consider seed allergy despite previous or ongoing apparent tolerance to the fruit pulp. Clinical significance of the co-sensitisation to the cashew nut is uncertain and needs further investigation. Background: With the increasing prevalence of allergic disease, the number of children presenting with cow's milk protein allergy (CMPA) to primary care has also increased. They have little resource or access to allergy testing and may be unfamiliar with the interpretation of results. Many guidelines have surfaced in the past few years but it is felt that the knowledge, uptake and application of these guidelines have been suboptimal. This project attempted to assess if an electronic version of a modified CMPA guideline can increase the confidence of primary care clinicians in the management of children with possible CMPA. This was done by developing a template which was adapted and modified from a national guideline and was introduced into individual primary care computer systems. Aim: To evaluate the usefulness of a guideline template for "managing cow's milk allergy in primary care" based on confidence scoring from primary care clinicians. Methodology: An electronic guideline template for managing CMPA was introduced for a period of two months in primary care electronic record keeping computer system. Confidence scoring was compared in GPs before and after this period to see whether use of the template resulted in changes in confidence scores. Results: Nine clinicians participated in this study from five surgeries across North of England. Awareness of national guidelines was very low in this group (11 %) before the template was introduced. Following the introduction of an electronic template to manage CMAP, a significant increase in confidence scores was noted from all participants GPs (p = 0.038). When asked if the template improved their confidence levels, a significant number of respondents answered in the affirmative (p = 0.020). A significant number of respondents felt that using the templates helped them consider the diagnosis if CMPA in cases where such a diagnosis would not have been considered previously (p = 0.003). An additional finding was noted in this survey that the GPs did not refer the patients to dieticians (p = 0.007), which is a MAP guideline recommendation. Conclusion: Our study, like many previous studies, has demonstrated that the uptake and use of national guidelines remains poor. Our study demonstrates that confidence levels in managing CMPA improved significantly by following an electronic template. We recommend that national and international bodies take note of the significance of these findings as these may guide future CMPA and other guideline implementation in primary care. During the protocol occurred mild to moderate reactions in 86 % and severe in 3 cases: milk-dependent exercise-induced anaphylaxis, accidental exposure and due to poor adherence to the recommended protocol. All reactions were controlled with rescue treatment. Introduction: Numerous epidemiological studies provide strong evidence that frequent contact to a traditional farm environment in early life protects children from the development of allergic airway diseases like hay fever and asthma. We have previously demonstrated that intranasal application of the cowshed-derived lactic acid bacterium Lactococcus lactis G121 (LL) resulted in protection from allergic disease in different murine asthma models. However, details of the underlying mode-of-action of this protective immune response are largely unknown. Materials and methods: Cellular mechanisms involved in cytokine induction upon LL exposure were analysed in human monocyte derived dendritic cells (moDCs) and murine bone marrow-derived dendritic cells (BMDCs) by use of specific inhibitors for uptake and endosomal acidification. Functional relevance was assessed in vivo in a murine model of allergic airway inflammation with sensitisation via intranasal transfer of ovalbumin (OVA)-pulsed BMDCs to naïve mice. Results: LL exposure of moDCs and BMDCs led to release of several cytokines including IL-12p70 and IL-10. Preincubation with the inhibitors Cytochalasin D or Bafilomycin A1 (Baf ) strongly decreased the cytokine production indicating the importance of both uptake of the bacteria and endosomal acidification. In vivo, sensitisation of mice could be achieved by intranasal administration of OVA-pulsed BMDC. Administration of BMDC which were exposed to LL prior to pulsing with allergen (G121/OVA group) protected mice from the development of allergic airway inflammation upon allergen challenge. However, treatment of BMDC with Baf prior to LL exposure significantly reduced the protective effect resulting in a restored allergic phenotype.

Conclusion:
We revealed uptake of LL in dendritic cells and subsequent endosomal acidification as key elements of the mode-of-action of allergy protection mediated by the cowshed-derived bacterium. These findings will greatly support the further development of a Lactococcus-based primary prophylaxis against hay fever and asthma for protection of children early in life.

PD29
The relationship between quality of life and morning salivary cortisol after acute bronchiolitis in infancy Introduction: Hospitalisation with bronchiolitis in infancy is associated with increased asthma risk and reduced quality of life (QoL). Stress may negatively impact morning cortisol and possibly asthma development. We aimed to investigate the association between cortisol and QoL in young children and the potential modifying effect of having been hospitalised for bronchiolitis. Method: In children recruited during hospitalisation in their first year of life for moderate to severe bronchiolitis (n = 207), and controls (n = 152), with mean ages at follow-up 23.5 and 24.0 months, morning salivary cortisol and parentally completed QoL questionnaires, ITQOL ™ , were collected. 10.5 % of controls and 32.4 % of bronchiolitis children had asthma diagnosis or inhaled steroids daily. Cortisol was analysed at Karolinska Institutet by RIA. By robust regression, cortisol results were analysed as dependent of QoL quartiles, adjusting for age and gender, and subsequently also for asthma severity, graded depending of follow-up plans or daily steroid inhalations. Results: Cortisol did not differ significantly between the groups, but was lower the more severe the asthma. Mean QoL scores were higher in the control group for Overall health and General Health, but higher in the bronchiolitis group for Change in health (compared to 1 year ago). Increasing QoL for 11 of 13 domains was associated with increasing morning cortisol in the bronchiolitis group but not in controls except for two domains. Controls had results for one domain pointing the opposite way. After adjustment for asthma severity, the associations remained significant for 9 of 13 domains in the bronchiolitis group. We found interaction between hospitalisation for bronchiolitis and QoL quartiles. Conclusion: Increasing QoL at 2 years of age was associated with increasing morning cortisol only in the bronchiolitis group. The group differences are possibly due to different asthma frequencies and severities, but not explainable only by our measured asthma severity. was to evaluate the efficacy of MP29-02* compared to FP, administered as 1 spray per nostril twice daily, in pediatric AR subjects aged ≥6 to <12 years. Methods: This was a randomized, open-label, 3-month safety study in patients (≥4 to 12 years). Qualified subjects had a history of AR, were in good health, and had no evidence of nasal mucosal erosion, nasal ulceration, nasal septum perforation, or any significant nasal disease. Subjects were randomized in a 3:1 ratio to MP29-02* (n = 304) or FP (n = 101). Efficacy was also assessed by subjectreported assessment of overall allergy symptom severity, in a subset of patients (aged 6-12 years; MP29-02*: n = 264; FP: n = 89). Symptom severity was rated daily on a 4 point scale from 0 to 3 (0 = no symptoms; 1 = mild symptoms; 2 = moderate symptoms; 3 = severe symptoms).

Results:
The total symptom score at baseline was 1.73 for patients in the MP29-02* group and 1.80 for patients in the FP group (max score: 3). Over the entire study period patients treated with MP29-02* experienced a −0.68 pt reduction in overall symptom score (corresponding to a −5.44 change from baseline in AM + PM reflective total nasal symptom score (rTNSS; max = 24), significantly greater relief than that afforded by FP (−0.54 pt reduction; Diff: −0.14; 95 % CI: −0.28, −0.01; p = 0.04). Conclusion: MP29-02* provides significantly greater AR symptom relief than FP in a pediatric population (aged ≥6-12 years) and has been granted approval for use in this age group by the FDA. *Dymista Background: The H 1 antihistamine Bilastine is approved in adults for seasonal and perennial allergic rhinoconjunctivitis (SAR/PAR) and urticaria. A model based drug development strategy, supported by a set of prior data from adults (N = 310) receiving bilastine, permitted extrapolation of the PK to children, selection of the appropriate dose for the pediatric subset, and then design of an adaptive limited sampling trial to confirm the adequacy of the proposed regimen.
Objective: A clinical trial was performed in children (2-11 years) with SAR/PAR or urticaria to ascertain whether the proposed dose (10 mg/ day) matched the systemic exposure in adults (20 mg/day), via pharmacokinetic (PK) assessment. Methods: Blood samples were drawn from each child after multiple administrations of 10 mg of bilastine as oral dispersible tablet. The PK schedule was optimally designed to minimize the number of samples and the total volume per child. Dataset (N = 31) analysis was with NONMEM ® VI. Final model establishment and validation was done using standard statistical and diagnostic criteria for parametric non-linear mixed effects models. Individual PK parameters were used to calculate the exposure (AUC 0→∞ ), which was then applied in the statistical assessment of the suitability of the proposed dose. Introduction: Asthma is a major cause of chronic morbidity and mortality throughout the world in terms of access to emergency services, number of hospitalization days, school absence. IOEASMA program used an integrative care model, implemented international asthma guidelines, to address pediatric asthma with a multidisciplinary approach. Methods: Since 2007 the center "Io e l'Asma" implemented the programme as follows:

Results
• 2007-2009, Path Diagnostic Therapeutic (PDT): 3 visits every 4/6 weeks, with follow-up after 6 months. During the protocol, skin prick tests and spirometry were administered. • The family physician and/or the patient's parents communicated to specialists any symptoms and treatments used. Background: The difficulty to sensitize most strains of laboratory rodents to ovalbumin (OVA) -and especially through the airways-, without the addition of adjuvant is well-known. It is also well-known that even if sensitization does occur, it is difficult to model longstanding disease, as the rodents gradually develop tolerance to OVA and usually only one or two exposures are carried out before sacrifice. Aim: We opted to design a rodent model of allergic rhinitis/asthma in which we could both sensitize the rodents to the innocuous aeroallergen OVA through the airways, but also manage to sustain longstanding disease even after several exposures. Methods: Three week-old ether-anesthetized male Wistar rats (n = 20) were given ovalbumin (OVA) in saline vehicle, intranasally (i.n). Fifteen days later, awake rats were re-challenged i.n with OVA (n = 10-active group) or saline (n = 10-control group) and subsequent sneezes were counted. The rodents were re-exposed every third day for a total of 13 exposures. They were sacrificed 54 days from the start of the experiment. Inflammation of the nasal mucosa was semi-quantitatively assessed with Haematoxylin & Eosin stain. Results: OVA-challenged rats demonstrated signs of allergic rhinitis as evidenced by a statistically significant increase in the number of sneezes and presence of marked nasal mucosal inflammation, as opposed to the control group.

Conclusions:
We present an experimental model whereby we managed to sensitize to OVA, rats of a sensitization-tolerant strain. These rats were of weaning age upon first exposure and sensitization. Furthermore, these weaning rats were sensitized via the airways without the addition of adjuvant, and multiple exposures to OVA failed to tolerise them to this innocuous aeroallergen. It is likely that exposure to inert aeroallergens at a very early age and in the context of in irritant (ether), rendered these rats susceptible to sensitization and longstanding disease. Methods: A total of 858 children, aged 8-10 years, attending 71 classrooms in 20 primary schools were submitted to skin-prick tests (SPT) to house-dust mites, mixed weed, mixed grasses, cat, dog and Alternaria alternata. Atopy was defined by a positive SPT to at least one of the allergens. Air samples were collected in all the participating classrooms and respective outdoor locations using a single-stage microbiological air impactor through TSA and MEA plates at a 100 L/ min rate. Quantification was performed by naked eye count. Endotoxins were collected using a 2 L/min flow control pump for 4 h and analysed by limulus amebocyte lysate assay. Mann-Whitney tests and logistic regression models were used to statistically analyse the data. Introduction: Allergic rhinitis (AR) is a highly prevalent disease among the worldwide population, with significant impact on quality of life and healthcare costs that affects both pediatric and adults. Numerous studies describe the characteristics of AR in adult and pediatric patients, but do not compare the characteristics between both populations.

Objectives:
The aim was to compare the characteristic of AR between child and adults. Methods: Two observational, cross-sectional, multicenter studies were performed with data collection consecutively in two phases, the study in children and study in adults. The AR was classified according to the criteria original Allergic Rhinitis and Its Impact on Asthma (o-ARIA) and a modification of this classification (m-ARIA), and comorbidities were also assessed. We compared both databases, and we was performed a database in common, for analysis by SPSS 15.

Conclusion:
We found significant differences between the characteristics of AR between children and adults. Rhinitis is more intermittent and severe in children, being also more prevalent comorbidities.
Background: It was suggested that bacterial infections in children at early ages can protect allergic reactions in future. Nevertheless, contact to bacterial products such as endotoxins in early childhood may protect development of allergic diseases later in childhood is still a dilemma. Aim: The aim of the study is to assess the impact of neonatal sepsis on development of asthma, allergic rhinitis and atopic dermatitis in children.
Methods: 126 children were divided into two groups. Group 1 was consists of 63 subjects (mean age 67.2 ± 8.4 months) who have been hospitalized or have had sepsis in neonatal period. Another 63 children (mean age 91.4 ± 24.2 months) were in group 2 who were chosen among the siblings of group 1 to minimize genetical and environmental factors which affect developing allergic diseases. The prevalence of asthma, atopic dermatitis and allergic rhinitis were compared between two groups. Comprehensive examination was performed for all subjects by the same pediatric allergist. The Turkish version of International Study of Asthma and Allergies in Children (ISAAC) questionnaires were utilized for each subject. Face to face methodology was used to complete all ISAAC questionnaires. In addition, total blood count for eosinophilia, total IgE levels were measured and skin prick tests were performed for each subjects. Results: Total IgE levels and sensitivity of dermatophagoides pteronyssinus, dermatophagoides farinea were significantly lower (p < 0.05) in group 1. In addition, prevalence of allergic symptoms and diagnosed asthma were also found significantly lower (p < 0.05) in group 1. However, we found no significant difference between two groups in terms of prevalence of allergic rhinitis and atopic dermatitis.

Conclusion:
Our study has highlighted that severe infections such as sepsis in neonatal period can protect from sensitization to environmental allergens and developing asthma in later childhood. Selective IgE deficiency was recently associated with immune system dysregulation leading to lung diseases, autoimmunity and chronic urticaria in adults and children. Seventy-six children with selective IgE deficiency have been studied since 2005 (44.7 % boys, mean age 55.7 ± 34, ranging from 11 to 120 months). Clinical history was taken, SPT, nasal as well as sputum cultures, lung function test and chest x-ray were performed. Results: Recurrent upper and lower airway infections were reported in 54 % whereas 23 % were admitted to hospital due to serious infection or respiratory distress. Abnormal CXR was detected in 26.3 % of cases. Family atopic history was positive in 33 % whereas 58 % of cases were passive smokers. 15.7 % had active asthma and 14 % sensitization to aeroallergens but no relation was detected between asthma symptoms and allergy sensitization or parental atopic history. Six cases (8 %) suffered from chronic rhinosinusitis and one child had chronic urticaria and Hashimoto disease. 17 % had reported atopic dermatitis. Conclusions: Selective IgE deficiency seems to be related to increased prevalence of lung diseases and non atopic asthma. Low serum total IgE may be used as a marker of immune dysregulation. Non skeletal effects of vitamin D have been discussed in recent studies and many reports refer to its role in health and disease. There is also evidence that vitamin D deficiency can impair immune function, resulting in both, overactivity or suppression. However, there are no studies relating Vitamin D levels to total IgE, a basic marker of allergic diseases. The main aim of this study was to relate levels of 25(ΟΗ) Vitamin D3 to total IgE in general population. Clinical and laboratory data Clin Transl Allergy 2016, 6(Suppl Objectives: To characterize the clinical features, response to therapy, evolution and prognosis of pediatric cutaneous mastocytosis in a children hospital in Athens, Greece. Methods: We conducted a file review of children diagnosed with cutaneous mastocytosis at Children's Hospital in Athens, Greece, over the last year. We evaluated gender, age at onset, character and distribution of lesions, associated symptoms and course of the disease. Results: In total 8 children were diagnosed with mastocytosis based on clinical presentation and on histological examination of the skin using special stains. There were 62.5 % cases of urticaria pigmentosa, 12.5 % of cases of mastocytoma and 25 % of diffuse cutaneous mastocytosis. In 100 % of cases disease onset was in the first year of life. There was a male predominance 2:1. There was a male predominance 2:1. The majority of lesions were distributed over the trunk and limbs. Different kinds of associated symptoms were noticed. None of the cases was familial. Treatment did not modify the disease evolution. Conclusion: Pediatric onset mastocytosis is an unusual disease with an often benign course. Most cases of pediatric mastocytosis appeared within the first year of life, especially on the trunk. The most common clinical form of mastocytosis was urticaria pigmentosa followed by diffuse cutaneous mastocytosis and mastocytoma. The disease in childhood is less likely to have a systemic component. The prognosis of pediatric mastocytosis in general is good.

PP04 Inverse relationship between serum 25(ΟΗ) vitamin D3 and total IgE in children and adolescence
Introduction: Egg allergy is one of the most common food allergies in children. Even if tolerance has developed in 70 % of the children by the age of 16, there is evidence that children outgrow their allergy at older age now compared to past decades. There is a variety of symptoms from eczema to anaphylaxis. Comorbidity with other allergic diseases is common. The aim of this study was to evaluate if specific symptoms, comorbidities or biochemical markers could be used as prognostic factors in the development of tolerance. Methods: 52 children (28 boys and 24 girls) with a mean age of 7.8 (±4.1) years underwent oral egg challenge in 2012-2013. Their histories included comorbidities like atopic eczema (40 %) and peanut allergy (40 %). 17 % of the participants had no comorbidities. When exposed to egg 79 % of children had a history of skin symptoms, 46 % gastrointestinal tract symptoms, 11 % airway symptoms and 4 % anaphylaxis. Using logistic regression, we have searched for associations between age, gender as well as specific clinical characteristics and biochemical markers (IgE to egg and ovomucoid) and the oral egg challenge result. Results: 33 children had a positive egg challenge. Preliminary analysis not including any covariates showed nominally significant associations between IgE to egg ≥0.35 kU/l and IgE to the egg component ovomucoid ≥0.35 kU/l and positive oral egg challenge result (p-values 0.028 and 0.028 respectively). However, adjusting for age at provocation, only the association between IgE to egg and the oral challenge result remained nominally significant. There was no association between comorbidities or a specific symptom and the oral egg challenge result. Conclusions: Positive IgE to egg was the only factor that could be used as a prognostic factor for the result of an oral egg challenge in children with a history of egg allergy. Objective: To evaluate the efficacy of an amino acid-based formula in infants between the ages of 1-12 months with CMPA who had history of weight loss of >0.5 WHO Reference z-score while on an EHP formula. Methods: This was an observational, prospective, multi-center study conducted in France. Infants were put on an amino acid-based formula for 12 weeks. The primary outcome for this study was infant z-score change over the 12 weeks of feeding. Formula efficacy was evaluated by body weight gain and evaluation of allergic manifestations (atopic dermatitis (AD), bloody stools, GER score, chronic diarrhea, and urticaria).

PP11 Evaluation of the efficacy of an amino acid-based formula in infants who are intolerant to extensively hydrolysed protein formula
Results: Thirty (30) of 32 infants completed the 12-week feeding period. Mean weight gain over the 12 week feeding period was +0.43 ± 0.28 (mean ± SD). Improvement was observed for all allergic manifestations, both in terms of the number of infants presenting symptoms and the intensity of symptoms. For AD, 13 presented and 7 continued at end of study (SCORAD improvement p = 0.02).
Over the 12 week feeding period, an improvement of the overall GER score was observed, −10.5 ± 1.8 (mean ± standard error, p < 0.01).

Conclusions:
The amino acid formula supported healthy weight gain and improvement in allergic manifestations in CMPA infants who had a history of intolerance to EHP formulas. There was a high positive correlation between independent clinical items and scores on the questionnaire.

Conclusions:
The new questionnaire allows for a disease specific analysis of the impact of FPIES on HRQL in both parents and children. It will provide a powerful disease specific outcome and tracking measure in both research and clinical contexts.
Background/Aims: In the UK it is estimated that 2-2.5 % of infants suffer from CMPA, but the diagnosis can be easily missed and it is important to recognise this condition promptly and treat effectively.
Our aim was to investigate whether pediatric doctors, working in Betsi Cadwaladr University Health Board (BCUHB) comprising of North Wales Hospitals, were aware of the CMPA guidelines and if they implemented these guidelines appropriately in clinical practice. Methods: All pediatric doctors working in pediatric departments of BCUHB were asked to complete a specific questionnaire in order to determine their awareness on diagnosis and management of CMPA. Of the 50 distributed questionnaires, 40 were completed and returned to us. Results: About 25 % of doctors were unaware of CMPA guidelines and 30 % stated they were not confident in managing this condition. Nearly 80 % of medical staff provided the right advice for CMPA in breast fed infants including duration of treatment and appropriately selected the hydrolysed formula for bottle fed infants. A good proportion of medical staff deviated from the guidelines regarding the management of CMPA in cases of anaphylaxis (52.5 %) and failure to thrive (FTT) (85 %).

Conclusions:
Overall medical staff had a good understanding of CMPA guidelines. However nearly a quarter of staff was not aware of the existence of guidelines and another third stated they had not read them. In addition the majority deviated from guidelines in terms of FTT and anaphylaxis in CMPA. Therefore it is important to educate staff regarding the presence of guidelines and management of CMPA, as prompt and correct diagnosis of this condition will reduce the parental anxiety and will decrease the financial burden on the Health System.  Methods: A qualitative approach was used by conducting semi structured telephone interviews and analysed using thematic analysis.

Results:
The interviews produced a number of key findings: food was regularly provided at one or more of the activities which the child engaged in, although primarily in team sports; parents tended to stay at the activity partly due to trust and also due to a sense of responsibility.

Conclusion:
The main conclusion drawn from this study was that there is a lack of awareness and understanding of FA indicating that there is also no risk perceived by some coaches or instructors. Some sporting bodies were more proactive with regards training than others, but central to the risk of food allergen exposure is the education of the coaches and instructors in all activities where there is a potential for food to be provided. This research proffers engagement with coaches and instructors at community level to recognise that this is a real concern for parents of FA children and also to get governing sports bodies involved in developing FA and anaphylaxis policies. the number of those who passed verses failed the food challenges. In time, the international standard of a near 50 % pass verses 50 % fail rate should be reached with more stringent criteria. [2] Until then limited resources will lend to higher than averages pass rates.
Background: It has been established that child allergies, such as asthma and rhinitis, have a direct impact on carers (usually the mother), increasing their likelihood of psychological disorders and social network deterioration. It is hypothesised a significant interaction between mother's psychological state and child's food allergy (FA) symptoms; however, there is very little information on FA regarding this topic. Therefore, this study compared the relative odds of the occurrence of gastric symptoms in the food allergic child given exposure to maternal psychosocial factors.

Methods:
Mother's psychological state was evaluated and analysed against the occurrence of FA gastric symptoms in their children in a cross-sectional study involving 206 participants (mothers and children). Logistic regressions were used to determine whether mother's psychological state is a risk factor for child's gastric symptoms and to compare the magnitude of different psychological variables as risk factors for a specific gastric symptom occurrence. Results: High levels of anxiety were found in 44 % of the participants, depressive symptoms on the 21.4 and 68 % had moderate or high psychosocial impact due to CFA. Low perceived social support was found in 21.4 % of the mothers. Higher CFA-Related Impact (CFA-RI) and CFA-Related Social Impact (CFA-R SI) in the mother increase the possibility for abdominal pain (OR = 2.04; p < .001) and diarrhoea (OR = 1.32; p = .05) in the child. The possibility for abdominal bloating in the child increases when the mother suffer from higher anxiety (OR = 4.45; p < .001), lower perceived social support (PSS) (OR = 3.17; p = .002) and CFA-RI (OR = 1.32; p < .05). Conclusions: The psychological impact of caring a food allergic child and the perceived social support can predicts the occurrence of allergic symptoms in children. CFA is propounded as a process where biological, psychological and social variables have a relationship of mutual influence. Therefore, a comprehensive care strategy that considers the family perspective is proposed to achieve a more inclusive and integrative care of CFA focused on "families living with food allergy". Background: Tree nut allergy is a frequent medical problem. Some are allergic to tree nuts due to birch pollen cross reactivity whereas others have a primary tree nut allergy. There can be great regional variance in the serological profile and hence in clinical allergy. A pilot study suggested that hazelnuts, walnuts, pistachio nuts and cashew nuts were the most common nuts involved in allergic reactions in a Danish Pediatric population. Aim: To investigate the correlation between sIgE towards four common tree nuts and the correlation between sIgE towards hazelnuts and birch pollen amongst patients in a Danish outpatient allergy clinic. Method: Specific IgE in all patients born after January 1st 1991 with sensitization to tree nuts and birch pollen were sought in our sIgE (ImmunoCAP ® ) database. GraphPad Prism 6 software was used for statistical analysis. The interrelationship between sIgE was pictured in XY-plots and Spearman correlation was calculated for sIgE towards hazelnut and birch pollen and for sIgE towards hazelnut, walnut, pistachio and cashew measured in the same patients. Conclusions: Our findings show a strong relationship between sensitization towards cashew nut and pistachio nut, and hazelnut and birch pollen and a moderate relationship towards walnut and cashew nut, and walnut and pistachio nut. Results from the same population are underway to determine the clinical association of these findings. In light of this concerning facts, more and more parents have to cope with an allergic child, being responsible for risk assessment and management of their child's condition. Nowadays, social media is a powerful tool that parents use to get informed. Despite this, little has been published about social media role in health issues. Objective: To evaluate the content of communication in parents dedicated websites regarding topics on food allergy in children. Design: We searched for non-medical online networking websites dedicated to parents, with topics and talks regarding food allergy in children and identified 19 online sites which we further evaluated in respect to content form (personal experience, information) and correctitude of information from a medical point of view. Results: The number of answers to a topic was variable according to the popularity of the website, ranging from 8 to 215. However, the number of unique visualizations was exponentially higher, ranging from 3302 to 25.123. Parents of children with food allergy either medically confirmed or suspected use social media tools to ask for information and share personal experiences. The hierarchy of most common reasons to use the online media is the following: (1) to describe an acute reaction and ask for opinions on management and causes (2) to get informed about food diet and treatment and find out others experience with specific treatment, including different brands, 3. Ask other parents to recommend a physician and/or a medical laboratory. Other important concerns raised by parents were the difficulties encountered regarding collectivity attendance due to impossibility of providing food specific diet. There were some medically inaccurate recommendations such as use of homeopathic treatment or inadequate definition of medical terms. Conclusions: Online social media provides a place to share personal experiences, receive emotional support and get information on medical management, suggesting that this tool should be better managed for greater efficiency.  Methods: We performed a study using the Food Allergy Quality of Life Questionnaire FAQLQ. The appropriate questionnaire will depend on the age of the patient. FAQLQ-PF (0-12 years) as perceived by the parent. FAQLQ-CF and FAQLQ-TF are self-administered tools that measure the impact of FA on children (8-12 years) and teenagers (13-17 years). We applied the questionnaire to patients under 18 years diagnosed with FA in the last 2 months. Information on food allergens and demographic data was collected for all children. Results: The questionnaire FAQLP-PF was applied to 13 parents of children under 12 years. The questionnaires FAQLP-CF and FAQLQ-TF were applied to 7 children and 9 teenagers, respectively. The mean age of the food allergy population was 9 ± 5.2 (1-17 years). 16 patients (55.2 %) were male; 34.5 % had rhinitis, 27.6 % had atopic dermatitis and 13.8 % had asthma. 17 (58.6 %) were allergic to 1 or 2 foods; 12 (41.4 %) were allergic to 3 or more foods. The egg is the most common food allergen implicated in children (37.9 %), followed by milk proteins Background: Immediate reactions against contact to raw potato has been reported in adults with generally being in the form of an oral contact dermatitis or contact urticaria, but it may also manifest as rhinitis symptoms, wheezing or even anaphylaxis. Cooked or raw potato allergy has been rarely reported in children as some is being immediate and others being late reactions, and it usually results from ingestion. Objective: We report two cases with a background of allergic diseases developed anaphylaxis one with cooked potato and the other one with raw potato. Methods: We measured serum potato specific IgE and applied a skin prik test (SPT) with aeroallergens, food allergens and prick-to-prick test using raw and cooked potato. Results: We found serum potato specific IgE 4.92 and 125 kU/L case 1 and case 2 respectively. We also demonstrated SPT positivity aganist raw potato and cooked potato case 1 and case 2 respectively. Conclusion: We aimed to emphasize potato allergy, a rare entity, and to remind potential disorders that could develop with or after potato allergy.

PP29 The correlation between sIgE towards tree nuts and birch pollen in a Danish Pediatric Allergy Clinic
Introduction: Previous data from the University Children's Hospital in Ljubljana, Slovenia, showed that adrenaline auto-injector was prescribed to Slovenian children most frequently because of allergy to peanuts. Methods: We prospectively collected data on interventions of immediate reactions and allergic follow-up of children which had adrenaline auto-injectors prescribed in year 2014 and were followed-up exclusively by regional paediatricians' with special interest in paediatric allergy.
Results: 76 children (52 boys, 24 girls) were followed-up exclusively by regional pediatricians with special interest in paediatric allergy. 10.5 % were babies, 27.6 % 1 to 5 years old, 55.3 % 6 to 14 years old and 6.5 % 15 to 18 years old. Adrenaline auto-injector was prescribed in 63.1 % because of anaphylaxis and in 31.6 % because of urticaria and/or angioedema. In 92.1 % of children adrenaline auto-injector was prescribed because of food allergy, most frequently because of allergy to peanuts (44 children). 93.2 % of peanut allergic children had specific IgE antibodies to rArah h 2. Among food allergic children 7.2 % had multiple food allergies, 38.6 % asthma and 7.2 % suffered more than one immediate reaction. Other confirmed reasons for prescribing adrenaline auto-injector were insect sting (4 children) and inhalant allergens (1 child). In 5 % of children the cause of immediate reaction was unknown. 29.1 % of anaphylaxis was treated with adrenaline 43.7 % of children were admitted to hospital after anaphylaxis. For comparison, during 2014 adrenaline auto-injector was prescribed in 291 children during 2014 in Slovenia. Conclusions: Demographic and clinical characteristics of children with prescribed adrenaline auto-injectors reported by regional paediatricians with special interest in pediatric allergy were similar to our previous data though children had fewer different food allergies.  [2] anaphylaxis guidelines, patients with a previous anaphylaxis (apart drug allergy) or at particular risk of anaphylaxis should require prescription of adrenaline auto-injector (AAI). Our aim was to assess prescription practices of AAI by the French allergists from the Allergy Vigilance Network [3] (AVN) and to confront these to the European and French guidelines. Methods: In January 2015, an electronic questionnaire was sent to the 299 allergists of the AVN. Results: 121 questionnaires (40 %) were analyzed. According to the European guidelines, 77 % of the allergists were used to prescribe AAI for at least 5 of the 6 absolute indications in children, 90 % of them in adults, and about 50 % of them in all absolute indications in children and adults. According to the French guidelines, 81 % of the allergists were used to prescribe AAI for at least 4 of the 5 absolute indications in children and 90 % in adults, but only 33 % validated all the absolute indications in children, 28 % in adults. History of isolated generalized hive was not considered as an indication by a third of the allergists. 77 % of the allergists were used to prescribe AAI in children with coexisting unstable or moderate-to-severe asthma, 66 % in adults, even if it was not initially considered as an absolute indication in the French guidelines. Food allergy due to traces was an indication for 78 % of the allergists, and adolescence for 16 % of them. In all, there was no significant difference between children and adults. A second AAI was systematically prescribed by the allergists in 34 % of the patients and half of them were used to prescribe a second adrenaline auto-injector for at least one of the 6 suggested indications of the European guidelines. The main criteria for choosing the AAI device were: availability (56 %), ergonomics (38 %), availability of trainers (33 %), needle's length (22 %). Conclusions: Our findings may be useful to improve knowledge and adherence to the guidelines and to update French guidelines for prescribing AAI.

PP36
Introduction: Honey is a mixture of flower nectar, pollens, and components from bees. Honey allergy is a rare entity, however it may cause serious reactions in allergic individuals. Case report: A 10-year-old boy admitted to our outpatient department suffering from allergic reactions after consumption of honey. He was under regular follow-up due to asthma and pollen-induced allergic rhinitis for 4 years. At different times, he presented with wheezing, swelling of the lips and eyelids within 5 min after ingestion of honey. His skin prick test with common aeroallergens revealed grass pollen and mold mix sensitivity and prick-to-prick tests with four different types of honey were found to be positive. Specific IgE to honey was also positive. Dietary elimination of honey was suggested and adrenaline auto-injectors were provided. Conclusion: Along with the leading causes of food allergy in childhood such as cow's milk, egg and peanuts, rare foods such as honey may cause allergic reactions in children. Increase of the awareness by the physicians and the families may help better identification of rare food allergies.

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Written informed consent for publication of this clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient. A copy of the consent form is available for review by the Editor of this journal. Background: Training children and teenagers to avoid, recognise and manage anaphylaxis is essential. Methods: 95 food allergic children with prescribed adrenaline auto injectors were invited with their relatives and friends to attenuate courses on anaphylaxis management and families of 21 among them responded invitation. We have applied the questionnaire on avoiding, recognition and management of anaphylaxis to children before and after the 1.5 h long courses on anaphylaxis management. Results: There were 26 participants (20 boys, 6 girls; age 10-18). 20 children had prescribed adrenaline auto injectors because of food allergy, four children were relatives of food allergic child and two children were colleagues of food allergic child. 96 % of children recognised correctly signs of anaphylaxis before and 100 % after the course. Regarding preventive measures of anaphylaxis, the correct position during anaphylaxis and the correct order of management during the anaphylaxis all children answered correctly. 88 % of children would give adrenaline by auto injector during anaphylaxis before the course and all of them after the course. Conclusions: The course enhanced theoretical ability and the willingness of appropriate first-line management of anaphylaxis in children though children were already previously well prepared and motivated to act during anaphylaxis. Other modes of passing knowledge on anaphylaxis management beside courses during schooldays should be sought in order to educate more children. Introduction: It has been reported that many patients sensitized to inhaled dust mites are also sensitized to shellfish, due largely to the cross-reacting anti-tropomyosin (r Pen a1) IgE. That co-sensitization can also occur in the absence of cross-reactivity and clinical relevance may be different. Purpose and methods: To characterize cases of allergy to shellfish and inhaled dust mites in children followed in outpatient Level II Hospital evaluating their sensitization profile and occurrence of any cross-reaction. Data were collected on shrimp, inhaled dust mites (dermatophagoides pteronyssinus and dermatophagoides farinae) and tropomyosin sensitization based on clinical history, skin prick tests (SPTs) (Leti ® ) or specific serum IgE (ImmunoCap ® ). Clin Transl Allergy 2016, 6(Suppl 1):42 Results: Three cases were selected, all male. There was a family history of allergy in 2 cases. In those the allergy to shrimp was the first manifestation of atopic disease. The age of diagnosis of shrimp allergy varied between 8 and 10 years, and clinical presentations were: anaphylaxis, urticaria, angioedema and pharyngeal itching. All cases had allergic rhinitis to inhaled dust mites. One case also had asthma and co-sensitization to grass. All cases had co-sensitization with other food allergen (crustacean and mollusk). The specific serum IgE to shrimp and tropomyosin (r Pen a1) was positive in two cases (one case with a positive skin prick test to shrimp is waiting for the result). In 2 cases there was previous history of persistent rhinitis but the symptoms were not valued. Conclusion: The authors present 3 cases of allergy to shrimp and inhaled dust mites with different clinical presentations. In all cases the rhinitis was the main atopic disease though often neglected. The presence of other food allergies to shellfish group is in favor of crossreactivity obtained by the panallergen tropomyosin. Background: London is home to 170 nationalities and 300 spoken languages. Many allergic families have experienced difficulty implementing nut avoidance advice due to language barriers. This pilot investigates ability of allergic children, families and healthcare professionals to identify nuts to guide production of a targeted educational resource. Method: 12 "nut playing cards" displaying large photos of common nuts were shown to families in a tertiary pediatric allergy clinic and to General Practitioners. Responses were recorded.
• Average nut identification rate-67 % in English-speaking families Vs 44 % in non-English speaking families. • Only 30 % of subjects that were born outside the UK and did not speak English at home identified >6 nuts. • Only 50 % of families speaking languages other English identified >1/3 of nuts. • School-going age (5-18 years) identified fewest nuts correctly, averaging 5/12, compared to 9/12 in adults. Data is consistent with US findings summarised in 2006 and 2011 papers. • Poor scoring correlated with lower socioeconomic classes.
• Only 30 % of subjects with a known nut allergy were able to correctly identify >6/12 nuts.
Healthcare Professionals: • GPs identified an average of 10/12 nuts.
• 82 % of GPs felt that parents of children with nut allergies are most concerned about anaphylaxis and death. • GPs think effective management of nut allergy is limited by language barriers, lack of education and misunderstanding of patients and health professionals, and time constraints (Fig. 3).

Conclusion:
• Visual identification was particularly unreliable in younger individuals, individuals of low socioeconomic class, or those who do not speak English at home. Background: Occurrence of food allergy has significantly risen in recent years and its prevalence is 6-8 % in children and 3-4 % in adults. There are some differences in incidence of types of food allergy in different areas. Most commonly implicated foods in childhood are milk, egg, nuts, wheat, soy, fish and shellfish worldwide. There are some differences in incidence of types of food allergy in different areas. Only limited data are known about the most common causes of food allergy in Czech Republic. Methods: DAFALL-Datase of Food Allergies is an electronic registry founded in 2014 aiming to gather epidemiological data describing food allergy in the Czech Republic. Most common triggers of food reactions, threshold doses, processing of food allergens, laboratory test results including component resolved diagnosis, skin prick tests and food challenges results and also allergology history of the patients were evaluated. Special attention was devoted to patients with food anaphylaxis. Results: During the first 5 months until April 2015, 250 patients were enrolled from more than 20 collaborating allergology clinics, 58 % children under age of 5 years, 24 % children aged 6-18 years and 18 % adults. In children under 1 year of age, cow's milk is the most frequent food allergen 87 %). In 90 % of cases, first symptoms of milk allergy were recorded below age of 7 months and in 60 % of cases were noted in fully breast-fed infants. More than 50 % of milk reactions were non-IgE mediated, with no prove of any positivity in skin prick tests and/or specific IgE against milk. Most common triggers of allergy in children under age of 5 years were milk, egg, tree nuts, fruits and peanuts. In patients offer 6 years were fruits, tree nuts, peanuts and vegetables the most common triggers. In patients older than 6 years, significant allergens are also the seeds, mainly the sesame seed and poppy seed. Conclusion: DAFALL is the first project in the Czech Republic describing relevant data on food allergy in the Czech population. Projected period for data collection is 3 years and we expect to enroll 1500-2000 patients from 30 collaborating centers. Background: Sensitization to wheat is common among patients with grass pollen allergy but is not always associated with symptoms to wheat. It is often unclear whether the reactivity reflects a wheat specific sensitization or cross-reactivity with pollen allergens. Two cross-reacting allergens are known, profilins and cross-reacting carbohydrate determinants (CCDs). Aim: To study the association between IgE sensitization to grass and wheat among wheat tolerant children with a diagnosis of grass pollen allergy. Materials and methods: Seventy-two Swedish children (0-18 year) with a doctor's diagnosis of grass pollen allergy, IgE antibody (IgE-ab) responses to grass and currently eating wheat were included. Serum analyses of IgE-ab to wheat, timothy and related components were performed. Inhibition with timothy and/or wheat extract was performed on sera displaying IgE responses to both wheat and timothy. Results: All children had IgE-ab to timothy with a median level of 20 kU A /l, while 44 children were sensitized to wheat with a median level of 1,2 kU A /l. Inhibition with timothy extract was performed on 20 sera before analyzing the remaining IgE reactivity to wheat. In some sera the reactivity was completely inhibited while other sera, to different degrees, retained their IgE reactivity to wheat. Five children, displaying reactivity to both timothy and wheat, had IgE-ab binding to CCD (7 %) and 12 to timothy profiling, Phl p 12 (17 %). Inhibition of two sera with timothy extract the reduced the binding to CCD and wheat by >93 % and >86 %, respectively. Inhibition of three sera with wheat extract reduced the binding to Phl p 12 and timothy by >83 % and 7-20 %, respectively. Conclusions: Sixty percent of the wheat tolerant children with grass pollen allergy were also sensitized to wheat, although the level of IgE-ab was significantly lower than that to grass. In the wheat sensitized children the reactivity to wheat could neither be entirely explained by cross-reactivity with timothy nor by cross-reactive responses to CCD or profilins. Thus, further cross-reacting allergens remains to be identified and/or co-sensitization to wheat needs to be considered. Background: Oil body associated proteins (OAPs)'s role in nuts allergy is still poorly known. Conventional skin prick test (SPT) reagents determine mainly water soluble proteins (WPT) as well as it happens with allergen-specific IgE antibodies (sIgE), so OAPs are not well detected. We study the sensitization profile in children with suspected nuts allergy.

Methods:
We evaluated children (median: 5 years old) with suspected allergies to nuts. WPT and OAPs of peanut, almond, hazelnut and walnut were determined through SPT and sIgE. They were a total of 69 patients. Of them, 50 had at least one OAPs-SPT positive and 39 were sensitized to more than 1 nut, being mainly involved the walnut (33 patients), followed by hazelnut (25 patients). No differences were found in reaction's severity in terms of OAPs sensitization. Conclusions: A considerable number of patients had any of OAPs tests positive (SPT or sIgE). Among these children, 78 % were sensitized to several nuts, being the walnut the most common. No relationship between sensitization to OAPs and reaction's severity was found. in AR patients visited Khonkaen Ram hospital. Fifteen patients (9 male and 6 female, age 5.33-37.33 years, median age = 14.75 years) with AR due to Der p and Der f were enrolled in the study. Main outcome of the study was the rhinoconjunctivitis symptom score (RSS). RSS was evaluated every year after SCIT in relation with the pre-treatment period in which patients suffered the highest symptomatic levels. Results: The RSS was 11.26 ± 1.03 (mean ± SD) in the pre-treatment period and decreased to 6.13 ± 2.35 in the first year follow up period (p < 0.0001) and 1.93 ± 1.48 in the third year follow up period. Conclusion: This study revealed that our mixed mite SCIT regimen decreased the RSS in patients with intermittent and persistent AR indicating the effectiveness of the north-eastern mixed mite SCIT regimen of Khonkaen Ram hospital.    brainstem. The study was conducted with the fMRI reader [3T GE] after the administration of beclomethasone (BC) at 250, 500 and 1000 µg or placebo. BC and placebo were administered every 14 days. To ensure the deposition of aerosol in the central-(CAD) or peripheral-(PAD) airways, applied inhalation chamber integrated with a spirometer [PNEU-MOlogic ® abcMED] was used. Data analysis was performed using FSL, ImageJ integrated program of anatomical atlases. The data were averaged over intervals of 5 min. The first 0-5 min interval taken as Reference. Changing the strength of the signal was calculated in standard deviation units for each subsequent 5 min period. Results: After inhalation, with a predominance of central deposition (CAD) placebo and 250 µg BC showed an increase in signal, whereas 500 and 1000 µg of BC was found dose-dependent decrease in the signal (Fig. 7). Discussion: This is the first study to assess the impact of dose and space BC deposition on the function of selected brain structures. The study may be important for understanding the role of the knowledge of the brain and the need to harmonize the treatment of asthma with the brain. Background: Aeroallergens as one of the most common cause of allergic disease derived from pollens, dust mites, fungi, cockroach and animals. The prevalence of aeroallergens is different in various areas. This study was designed to identify the frequency of sensitization to aeroallergens in patients with asthma, allergic rhinitis and atopic eczema in Shiraz, southwestern Iran. Methods: Six hundred and fifty-six patients with allergy were included in this cross-sectional study from southwestern Iran during 2014. Sensitization to aeroallergens was assessed by skin prick test using a panel of common 15 aeroallergens in studied patients. Results: A positive skin test to at least one of the applied allergens was seen in 74.5 % of our patients. The female to male ratio and mean age of the patients were 1.27 and 27.6 ± 14.7 years, respectively. Pollens were the most common type of aeroallergens (64.6 %), followed by dust mites (34.6 %), cockroach (30.6 %), molds and cat hair (each 16 %). Among pollens, the frequency of sensitization to weeds, grasses and trees was in turn.

Conclusion:
The results of the present study revealed that pollens play a main sensitizing allergen in asthma, allergic rhinitis and eczema. This pattern was compatible with the results from studies carried out in this area. Aim: To study the epidemiology and appropriateness of referral of allergy tests performed in a peripheral hospital in Republic of Ireland Materials and methods: Data was gathered retrospectively in all children up to 14 years of age, who had allergy tests (Total IgE and specific IgE) done between periods 1st January 2014 to 30th June 2014. Specific IgE values more than 0.35 were considered positive. Data was tabulated with variables of age, mode of delivery, associated asthma or eczema, family history of asthma or eczema, any anaphylaxis reaction and was NICE guidelines followed or not. Data was analysed and conclusions were drawn. Introduction: The infection of B-cells by EBV provokes a marked activation of immunoregulatory T-cells and requires restoration of immune homeostasis during convalescence. Therefore patients with immune defects resulting in impaired T-lymphocytes failed to destroy EBV-infected cells and may develop to sever lymphoproliferative disorders and lymphomas. STK4 plays an important role in activation of transcription factors involved in T cell homeostasis and response to chronic viral infections. Case: We are presenting an eleven-year-old girl of consanguine family with chest pain and shortness of breath that has been diagnosed as STK4 deficiency, as a novel gene since the age of eight. She had history of neutropenia, recurrent skin abscesses, mouth ulcers, warts, molloscum contagiusum, herpetic lesions, recurrent fever, bacterial and fungal respiratory infections and positive family history of Stk4 deficiency in her aunt and uncle. She suffered from persistent fever and generalized lymphadenopathy which was reported as EBVassociated B-lymphoproliferative disorder in lymph node biopsy. Afterwards, she presented with cardiomegaly with no mediastinal involvement, pericardial effusion and cystic like echogenic masses on inter atrial septum which has been progressed. After few missed follow up visits, she has been admitted to the cardiology emergency with respiratory distress and syncope which required an emergency cardiac surgery. The excised specimen was positive for ICA, CD30, Ki67, EBV and EMA, suggesting the diagnosis of "T-cell non-Hodgkin's Lymphoma". Conclusion: Primary cardiac lymphomas (PCL) account for about 1 % of the primary cardiac malignancies and 0.5 % of the extranodal lymphomas while disseminated lymphoma with cardiac involvement can occur in up to 20 % of lymphomas. PCL occurs more frequently in immunocompromised patients. There was no report of cardiac lymphoma associated with STK4 deficiency till now. Another study investigating 4 patients with STK4 deficiency, found development of EBV-associated lymphoproliferative syndrome and Hodgkin lymphoma in 2 and 1 patients respectively.

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Written informed consent for publication of this clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient. A copy of the consent form is available for review by the Editor of this journal. Background: The use of bee venom as a medicine is nothing new. The ancient Iraqi ′ s and Egyptians were the first known civilization to try bee venom. The emperor Charlemagne and Ivan the Terrible used bee venom to help alleviate sore joints and stiffness, according to "Medicinal Uses for Bee Venom" at Swedish.org, Today the medical uses of bee venom remain slightly clouded with evidence both for and against its medicinal benefits. Methods: An 18 years old Iraqi girl who is atopic type was massively attacked by honeybees. She directly attended the nearest hospital suffering from severe allergy and asthma. Blood sample was drawn. Several biochemical, immunological and haematological tests were done for this patients. Urea, creatinine, transaminases, total bilirubin, alkaline phosphatase, uric acid, serum sodium, serum chloride and creatine kinase were carried out according to manufacturer instructions. Blood film were examined to differentiate different leukocytes. IgE, IgG.IL-I beta, IL-6 and TNF cytokines were assessed. Phospholipase A(2) was demonstrated. Results: It was found that most of the biochemical parameters concerned were elevated. IgE, IgG, cytokines and phospholipase A(2) were increased. Eosinophils and basophils were elevated as well haemoglobin. It was shown that this girls was suffering from acute asthma and breathing difficulty. Skin and her eyes were red with oedema. The patient was recovered due to management by cortisone and antihistamine drugs as she is atopic type suffered from severe allergy of skin and asthma with very difficult breathing due to bee strings. Conclusions: Bee stings could be very dangerous and fatal especially for the allergic individuals. The complications might involve different organs of the victim particularly the respiratory system, liver and kidneys.

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Written informed consent for publication of this clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient. A copy of the consent form is available for review by the Editor of this journal. Aim: To study the efficacy of Overnight pulse oximetry as a screening and referring tool for obstructive sleep apnoea in a peripheral hospital in Republic of Ireland. Methods: Children aged between 3 months and 14 years, clinically suspected to have moderate to severe obstructive sleep apnoea from June 2013 to June 2015 were included in the study. Acute Pediatric link nurse receiving a referral would educate the parents and the child regarding the procedure of overnight pulse oximetry. Pulse oximetry readings, an average from 3 consecutive nights were recorded. Results were interpreted from Working party on sleep physiology and respiratory control disorders in childhood September 2009. Appropriate referrals to tertiary centres were done either to otorhinolaryngology or pulmonologist. Results: A total of 31 were referred for Overnight pulse oximetry. The study was performed on 28 (90.32 %). None of the children experienced difficulty in recording at home. In all cases the study report matched the clinical indicators of suspected apnoea. In 100 % of the cases, pulse oximetry was found to be positive and which displays the clinical appropriateness of referrals. Conclusion: Overnight Pulse oximetry has proved be a definite screening tool to diagnose Obstructive sleep apnoea. As 100 % positive results are obtained, we feel more studies are needed to study the population with extended inclusion criteria. It has definitely helped to conduct appropriate referral to various specialities, thus improving the waiting time and decreased the inappropriateness in referrals.

Introduction:
Casein-free and gluten-free (CFGF) diet has been considered a potentially beneficial dietetic intervention of children diagnosed with autism spectrum disorder (ASD). IgE mediated cow's milk allergy and wheat allergy have not been found to be more common in children with autism as compared to the general population. In the current study, we evaluated delayed-type sensitization to cow's milk, wheat, gliadin and other common food allergens in children diagnosed with ASD.  Introduction: Asthma is a multifactorial disease with many wellknown triggers. One suspected environmental trigger factor (TF) is incense smoke that is generated during religious ceremonies by the traditional custom of burning incense at places of worship, and also in homes to eliminate odours and freshen the air. In view of this widespread practice by billions, it is imperative to determine if this suspected link between incense smoke and asthma is evidence-based. Study objective: Null hypothesis: Incense smoke is a TF for asthma. Alternative hypothesis: Incense smoke is not a TF for asthma. Methodology: A search of the medical literature published in the English language from 1960 up to 2014 using PubMed, TRIP Database, Cochrane Library Ebsco Host, Google Scholar and bibliographies of retrieved articles, was carried out to look for objective evidence that support, incriminate, question or refute the role of incense as a potential trigger for asthma. The articles reviewed: 1. Epidemiological association between inhalation of incense and asthma. 2. Association between genetic susceptibility, inhalation of incense smoke and asthma, and, 3. Evidence incriminating incense smoke as a trigger for inflammation in human lung biopsy material and/or tissue culture of respiratory mucosal cells of experimental animals. Results: 1-2. Control studies show evidence based epidemiological and genetic relationship between incense smoke and asthma. 3. Animal and human lung cell studies show that exposure to incense smoke causes inflammation of mucosal cells lining the airways and pneumocytes; findings that are the hallmarks of asthma. Conclusion: There is strong evidence incriminating incense smoke as a trigger factor for asthma. Take home message: Incense is a trigger for asthma. stratified sampling design, and a questionnaire covered the information on mood disorder, anxiety disorder and asthma. Results: In Canadian children aged 12-17 years, the prevalence was 12.2 % for asthma (11.6 weighted to the population), 3.2 % for mood disorder (2.7 % weighted to the population) and 5.2 % for anxiety disorder (4.9 % weighted to the population), respectively. Logistic regression analysis was used to determine the associations of mood and anxiety disorders with asthma after taking account for sex, age, body mass index, leisure time physical activity, smoking, and social economic status. Children with asthma had increased risks of mood disorder (adjusted odds ratio (OR): 2.07, 95 % confidence interval (CI): 1.57, 2.71) and anxiety disorder (adjusted OR: 1.75; 95 % CI: 1.40, 2.20). Conclusion: Children with asthma had increased risks of mood disorder and anxiety disorder in Canadian children. Objective: In this study we aim to evaluate the association of Paediatric Asthma Quality of Life Questionnaire (PAQLQ) with Asthma Control Test (ACT) in children with persistent asthma. Material and method: Children aged 7-17 years with poorly controlled persistent asthma were involved. At first visit, ACT and PAQLQ were applied to and pulmonary function test (spirometry) was performed in all subjects. Daily Inhaler therapy were initiated based on asthma severity according to international asthma guidelines. Patients were reevaluted following 6 week inhaler therapy and ACT, PAQLQ and PFT (Pulmonary function test) were performed. Results: Out of 77 patients, 35 (45 %) were female. The mean age was 11.62 ± 2.35 years. Following 6 weeks daily inhaler therapy, the ACT scores, PAQLQ scores and all the parameters of PFT except FEV1/FVC were significantly increased (p < 0.05). There was a significant correlation between ACT scores and PAQLQ scores (r: < 0.5, p:0.001). The most asthma-related restricted activities were running (85.7 %), soccer (42.9 %), and climbing stairs (40.3 %) subsequently. Conclusion: There is a strong correlation between ACT and PAQLQ. Keywords: Asthma; children; pediatric asthma quality of life questionnaire; Asthma Control Test. Purpose: There is no consensus on the association between vitamin D and asthma. In the last few years, there have been few studies showing the association between Vitamin D levels and asthma. We aimed to examine seasonal variation in vitamin D status in children with asthma and its association with pulmonary function tests. Methods: We recruited children 8-17 years old diagnosed with asthma. Vitamin D levels (serum hydroxy vitamin D3) were obtained and pulmonary function tests were performed both in winter months (Jan, Feb, and March) and at the end of summer (August, September and October). The seasonal variation of vitamin D levels and lung function were examined.

PP63 Seasonal and gender variations in vitamin D levels in children with asthma and its association with pulmonary function tests
Results: 56 children with asthma (M: 26, F:30, mean age: 11.9 ± 1.97) were recruited. The mean vitamin D level in winter was 13.36 ± 6.31 ng/ml. There was no significant correlation between vitamin D levels and lung function. The mean vitamin D level at the end of summer was increased to 22.89 ± 7.83 ng/ml. It was increased 74.6 % in male, 163.7 % in female. There was no correlation between vitamin D levels and lung function performed at the end of summer. Conclusion: There is a seasonal and gender variation in vitamin D status in asthmatic children. Vitamin D levels do not correlate with lung function. prevalence of asthma and allergic disease in IBD compared to celiac disease.

Materials and methods:
The validated ISAAC questionnaire in Turkish was applied to all patients with celiac disease and IBD. Results: A total of 153 patients (70 with IBD and 83 with celiac disease) were involved. 52.9 % of patients were female and the mean age was 13.21 ± 3.80 years. The prevalence of wheeze was 26.6 % at any time (24.3 % in IBD and 28.9 % in celiac disease), and 18.2 % for the last 12 months (17.1 % IBD, 19.3 % celiac disease). The prevalence of allergic rhinitis was 3/.5 % at any time (41.4 % in IBD and 33.7 % in celiac disease). Conclusion: The prevalence of asthma and allergic disease were similar in both children with IBD and celiac disease. Severe, difficult-to-treat asthma still constitutes a diagnostic and therapeutic problem. The diagnosis of asthma can be difficult, especially in preschool children. It is difficult to determine which wheeze is related with asthma or cystic fibrosis lung disease. A personal history of atopy, and a family history of atopy are probably the most useful guides of asthma. Case report: A 7 years old boy was appeared in our consulting service. He had severe episodes of breathless, productive cough, wheezes frequently, nasal obstruction, several viral illnesses per year, etc. He had patches of dry skin on elbows and cheeks. Nasal polyps noted. The child was diagnosed with atopic bronchial asthma and he was uncontrolled patient, despite optimal conventional therapy and specific immunotherapy for mites. He was followed up in an allergy clinic assigned as "treatment resistant asthma patient". Clinical and laboratory evaluation were performed: blood tests, biological tests, induced sputum cell profile for eosinophils and neutrophils, ECP concentration, skin prick test and serum radioallergosorbent tests for the common aeroallergens, serum total IgE, sweat test (CF). We evaluated the level of nitric oxide in exhaled and nasal air. We performed standard spirometric tests and body plethysmography which resulted obstructive pattern with pulmonary hyperinflation and increased airways resistance. High resolution CT scanning was very useful, it reveals extensive small airways disease manifest by distal air trapping due to fixed obliterative bronchiolitis. Based on clinical and functional examinations we concluded the diagnosis of CF asthma, and we stopped specific immunotherapy. Conclusion: The diagnosis of "CF asthma" is problematic and it is difficult to determine which patients have a combination of CF and asthma and which have asthma like symptoms caused by inflammation of CF lung. We know what have in common CF and asthma, but we have to consider the differences between them based on: genetic basis, single gene versus many, tissue and organ affected, airway inflammation, different treatments, antibiotics and nutrition, and which is more important the different progression of disease.

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Written informed consent for publication of this clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient. A copy of the consent form is available for review by the Editor of this journal. Background: Asthma, the most common chronic disease of childhood and one of the leading causes of morbidity in children worldwide is currently affecting more than 14 % of world`s children (The Global Asthma Report 2014). The relationship between asthma and pneumothorax still needs to be established since several reports emphasize that pneumothorax is an uncommon complication of asthma (Porpodis K, Zarogoulidis P, Spyratos D, et al. Pneumothorax and asthma. Journal of Thoracic Disease. 2014;6(Suppl 1):S152-S161. doi:10.3978/j. issn.2072-1439.2014.03.05). Case report: We report a case of a 9-year-old-girl with asthma, in treatment with Salmeterol and Fluticasone proprionate, with poor adherence to treatment, who presents to the Emergency Department with cough, wheezing and respiratory distress. The episode began 4 days earlier and it had been accompanied by a runny nose. She received symptomatic treatment but she has become more short of breath prior to coming to the ED. On physical examination, she was afebrile, with pale teguments, cyanosis of nail beds and lips, in moderate respiratory distress, with flaring of the nostrils, rapid, shallow breathing and intercostal retractions. The vitals include a respiratory frequence of 40 rate/min, a heart rate of 150 beats/minute and pulse oximetry of 95 % on room air. The remainder of the examination is unremarkable. Therapy is initiated with Ampicillin and Sulbactam, Methylprednisolone, Aminophylline, Albuterol, Fluticasone propionate. Over the next 24 h, her condition worsens, with frequent desaturation periods until 88 % while being under oxygen therapy, therefore she is transferred to the Pediatric Intensive Care Unit where she develops apical right sided pneumothorax. The further evolution is favorable, with dismissal after 2 weeks. Conclusion: This case illustrates several issues related to management of a patient with an acute exacerbation of asthma complicated with pneumothorax in a child with poor adherence to treatment due to undisciplined parents.

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Written informed consent for publication of this clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient. A copy of the consent form is available for review by the Editor of this journal. Methods: PesdsQL Asthma Module was applied to 200 asthmatic children and adolescents (2-18 years) living in São Paulo, Brazil, and to their parents. HRQOL was also evaluated by PAQLQ and asthma control was measured by ACT or C-ACT. Results: Moderate correlation was observed between children (Ped-sQL Child) and parents (PedsQL Parent) mean scores (r:0.67). Ped-sQL Child-Parent correlation was stronger among young children (5-7 years; r:0.76) and weaker among teens (13-18 years; r:0.54). Among the four questionnaire subscales, symptoms subscale showed the highest child-parent correlation (r:0.77) and communication subscale the lowest (r:0.46). Moderate correlation was found between mean PedsQL Child and mean PedsQL Parent scores and PAQLQ (r:0.66 and 0.64, respectively). Mean symptoms and worry subscale scores were higher among males (68 vs. 59 and 100 vs. 83, respectively; p < 0.05). No significant correlation was noted between mean PedsQL Clin Transl Allergy 2016, 6(Suppl 1):42

PP68 Evaluation of the Pediatric Quality of Life inventory (PedsQL) asthma module among low income asthmatic children and adolescents in Sao Paolo, Brazil
Child and mean PedsQL Parent scores and BMI, asthma duration and maternal education. The presence of atopic dermatitis and allergic rhinitis did not alter mean PedsQL scores. Progressive reduction in mean PedsQL Child and mean PedsQL Parent scores was noted with GINA treatment steps (PedsOL Child: 85 in GINA step 1 to 63 in GINA step 5). Conclusions: The Portuguese PedsQL Asthma Module version showed to be a valid instrument among low income children and adolescents. In this group, we observed higher symptoms and communication subscale scores among males. Asthma severity was the main factor associated with impaired HRQOL. Introduction: During the everyday practice patients with allergic asthma and allergic rhinitis are treated with inhaled corticosteroids, long-acting beta agonists, oral antihistaminic, specific immunotherapy (SIT). Specific Immunotherapy is indicated in patients with respiratory allergies (pollen, dust mite, mold) and Hymenoptera allergy. Specific immunotherapy, in addition to relieving symptoms, fights the causes of allergy. Case report: We report a case of a 6 year-old girl, who suffered of frequent respiratory problems since she was born, manifested with cough (especially during the night), nocturnal dispnoae, wheezing, sneezing and runny nose. The little girl was diagnosed with allergic asthma and allergic rhinitis at the age of 3. In April 2013, skin prick tests were performed and resulted positive to house dust mites, cat and dog. During these years the doctors treated her with antibiotics, ketotifen, antihistaminics, inhaled corticosteroids, leukotriene receptor antagonists and nasal corticosteroids. Despite the regular use of controller medication she suffered several times a year of asthma exacerbations, where short-courses of oral corticosteroids were needed. In August 2013, we decided to start the subcutan immunotherapy with D. Pteronyssinus and D. Farinae. After 1 year of immunotherapy, last winter she had less severe asthma symptoms. She had no need for the rescue medication. The overall patient's conditions are improved. Conclusion: Early initiation of Specific Immunotherapy can alleviate the symptoms of allergic rhinitis and alters positively the immune response. Allergen specific immunotherapy is the only treatment with immunomodulatory effect and capability to change natural course of allergic diseases.

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Written informed consent for publication of this clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient. A copy of the consent form is available for review by the Editor of this journal. Background: Primary ciliary dyskinesia (PCD) is a relatively rare condition mainly inherited as an autosomal recessive with other inheritance patterns still under study. The incidence of PCD varies from 1:17,000 and 1-35,000 live births. Clinical symptoms in this pathology are; neonatal respiratory distress, recurrent lower respiratory tract infection, chronic rhino-sinusitis, bronchiectasis and visceral mirror image reported in approximately 50 % of cases. The prognosis is good, but if it is not managed properly, it leads to high morbidity levels. PCD, even though very rare, enters the differential diagnosis of atypical asthma and unusually severe upper and lower airway chronic diseases. Method: We present the case of a 14 years old female asthmatic patient with chronic cough and rhinosinusitis resistant to treatments with local and inhaled steroids and bronchodilatators as well as oral antibiotics. She referred a neonatal respiratory distress and rhinitis from the early childhood and difficult to expectorate chronic productive cough and nasal yellowish discharge during the last 3 years with recurrent pulmonary infections, despite the aggressive asthma treatment. Results: Auscultation evidenced labile cough-related ronchi and rales. Normal blood count and biochemical results found, negative skin prick test and sIgE for food and inhalant allergens. Thoracic-abdominal CT findings: situs inversus of liver, spleen and stomach, without dextrocardia or bronchiectasia. ORL investigation confirmed pan-sinusitis. Audiometri tests were normal. Respiratory function test showed a mild restriction. Sweat test resulted negative. Genetic testing and other specific diagnostic tools such as nasal nitric oxide, saccharin test, ciliary beat frequency and pattern on light microscopy are not available in Albania, so she was referred to a specialized clinic abroad. Conclusion: A difficult to treat asthma with chronic rhinosinusitis is not a very rare scenario in allergist's office. Difficult to expectorate sputum in asthmatic children with persistent rhinosinusitis, are important symptoms to consider PCD in the differential diagnosis. Despite the lack of the right diagnostic tools, thoracic-abdominal CT is very suggestive, even though half of the PCD patients have situs inversus. A multidisciplinary management and follow-up is essential in order to prevent the development of bronchiectasis and other morbidities. Background: Childhood asthma and obesity are significant public health problems, affecting more children with each passing year. Excess weight and obesity in children may be fuelling the "asthma epidemic" faced in many developed countries in the latest years. After an excessive weight gain one seemingly "well-controlled" asthma, turns out to be "uncontrolled" despite the increase in therapy.

Clinical cases:
We present a case of 13-year old boy with asthma since infancy, well controlled till 2 years ago with inhaled corticosteroid. Last 2 years the boy gained over 40 kilos and despite his combined therapy he has very poor asthma control for this period. The second case is a 17-year old girl with bronchial asthma, poorly controlled despite high dose of combined corticosteroids as a controller medication. For the last 4 years she starts to show protest behavior towards therapy, that's modifying in the course of psychological maturation-denial of the medicines, unhealthy and hazardous life styles. She gained over 30 kilos and at the age of 16-years depression was diagnosed, and was pharmacological and psychological therapy. Conclusion: A modern team-work approach with respiratory/allergy specialist, nutritionist and psychology/psychiatry specialist sometimes is the best way to manage teenagers with difficult to treat asthma and obesity.

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Written informed consent for publication of this clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient. A copy of the consent form is available for review by the Editor of this journal. Objectives: To evaluate sleep disorders in children (4-10 years) with persistent allergic rhinitis (PAR) and its relation with rhinitis severity.
Methods: Parents from 90 PAR children followed in a Reference clinic answered the Children Sleep Habits Questionnaire (CSHQ). This one-week retrospective questionnaire is composed by 33 questions and divided in 7 subscales. Total nasal symptom score (TNSS, range 0-12) and total extra nasal symptom score (TENSS, range 0-16) were recorded as well as nasal peak inspiratory flow (NPIF).
Results: Mean group age was 7.9 years. All of them were in regular use of nasal steroids or oral antihistamines. 74 % had concomitant asthma which was not controlled in 33 %. Mean CSHQ total score was 54 ± 8. No significant correlation was observed between CSHQ total scores and TNSS, TENSS and NPIF. Significant correlation was observed between CSHQ sleep duration subscale and NPIF (r: 0.25), between CSHQ parasomnias subscale and TENSS (r: 0.25), and between CSHQ sleep-disordered breathing subscale and TNSS (r: 0.32) and TENSS (r: 0.27). The presence of asthma or uncontrolled asthma did not change CSHQ total scores. Conclusions: CSHQ total scores showed no correlation with rhinitis symptom scores. Some questionnaire subscales, however, could identify specific sleep disorders possibly related to allergic rhinitis severity. MP29-02* compared to FP, administered as 1 spray per nostril twice daily, in pediatric AR subjects ≥4 to <12 years. Methods: This was a randomized, open-label, 3-month study in patients (≥4-12 years). Qualified subjects had a history of AR, were in good health, and had no evidence of nasal mucosal erosion, nasal ulceration, nasal septum perforation, or any significant nasal disease. Subjects were randomized in a 3:1 ratio to MP29-02* (n = 304) or FP (n = 101) and were stratified by age as follows: (i) ≥4 years to <6 years; (ii) ≥6 to <9 years; and (iii) ≥9 to <12 years. Safety was assessed by subject and/or caregiver-reported adverse events (AEs), nasal examinations, vital signs, and laboratory assessments. Results: Overall, 94 % of subjects treated with MP29-02* and 92 % treated with FP completed the study. Completion rates were similar in each age strata. The percentage of subjects with AEs was comparable between treatment groups and across the age strata. The most frequently reported AEs (i.e. ≥4 % in either group) with MP29-02* and FP, respectively, were: epistaxis (10 and 9 %), headache (7 and 3 %), cough (4 and 3 %) and diarrhoea (1 and 4 %). The discontinuation rate due to AEs was 2 % with MP29-02* and 4 % with FP. Laboratory parameters showed no meaningful increase in mean or median values in either treatment group. Improvements in nasal examination findings were observed in both treatment groups and in each age stratum and there were no findings of nasal mucosal ulceration or septal perforation. The two treatment groups were comparable for mean changes in vital sign measurements regardless of age stratification. Conclusion: MP29-02* and FP were well-tolerated during this 3-month study when administered as 1 spray per nostril twice daily in pediatric subjects ≥4 to <12 years with AR. *Dymista Objective: The main objective of this study was to assess safety and tolerability of bilastine, antihistamine marketed for adults and adolescents with pediatric development ongoing, in a 10 mg once daily dose for children aged 2-11 years with allergic rhinoconjunctivitis or chronic urticaria. Methods: Multicenter, double-blind, randomized, placebo-controlled, parallel group study in 504 boys and girls aged 2-11 with either allergic rhinoconjunctivitis (AR) or chronic urticaria (CU). The primary endpoint was the occurrence of TEAEs (Treatment Emergent Adverse Events) throughout the 12 week treatment period to the last non treatment safety follow-up visit at week 16.

Results:
The study has demonstrated the primary hypothesis of noninferiority for Bilastine 10 mg with respect to placebo (p = 0.015). The proportion of children without TEAEs was 31.5 % (82 patients) in the Bilastine 10 mg group and 32.5 % (81 patients in the placebo group, showing a mean difference of 0.99 with a 95 % confidence interval ranging from −9.10 to 7.10. No statistically significant differences between treatment groups were found regarding the TEAEs and the related TEAEs reported (5.8 % in bilastine group and 8.0 % in placebo group). The most frequently reported TEAEs were headache, reported by 11.5 % patients in the Bilastine group and 10.4 % in the placebo group, followed by cough, reported by 23 and 22 patients in the Bilastine and placebo groups. Both Bilastine 10 mg and placebo showed a slight decrease in the somnolence and sedation as assessed with the Pediatric Sleep Questionnaire, with no statistically significant differences between groups. Conclusions: Based on the study results, the incidence of TEAEs of Bilastine 10 mg in children 2-11 years old was similar to placebo. It confirms that Bilastine 10 mg once daily as a good and safe antihistamine for children with allergic rhinoconjunctivitis or urticaria.
Introduction and aim: Allergic rhinitis (AR) is a worldwide condition with a lifetime prevalence ranging from 10 to 30 %. In some pediatric studies, sensitization to Alternaria alternata (AA) had been associated with more persistent and severe asthma in adulthood. Fungal sensitization is also found in allergic rhinitis without asthma, but there are no studies showing AA as a risk factor for more severe disease. Authors aim to clinically characterize a group of patients with AR without asthma, compare those sensitized and non-sensitized to AA and evaluate if sensitization to AA was a risk factor to rhinitis severity and co-morbidities. Materials and methods: Retrospective study involving pediatric patients with AR without asthma admitted at our outpatient clinic in 2014. Clinical files were reviewed. ARIA classification was used and AA sensitization was assessed by skin prick test. Results: 168 participants, 64.9 % boys, with a median age of 12 years old. A family history of atopic disease was found in 49.4 and 16.9 % were sensitized to AA. According to ARIA classification, 66.1 % presented with intermittent symptoms and 67.9 % with mild AR. Conjunctivitis and atopic dermatitis were found in 25.6 and 14.9 %, respectively. Among AA-sensitized patients, 6 % were monosensitised, 39.4 % were mainly sensitized to mites, 21.2 % to grasses and 15.2 % to both. Any significant differences were found between AAsensitized and no-sensitized patients concerning to disease severity using ARIA classification, previous month use of anti-histaminic, nasal glucocorticoid or montelukast or immunotherapy. There were also no differences in co-morbidities rates, namely conjunctivitis, atopic dermatitis, sinusitis, nasal poliposis or upper-airway surgical interventions. Conclusions: The prevalence of AA sensitization in AR without rhinitis was similar to previous studies and the prevalence of monosensitised patients was lower. This study failed to demonstrate an association between AA-sensitization and AR severity.

Introduction and objectives:
Allergic rhinitis (AR) is a high-prevalence disease in children and adolescents in Western countries. We developed a specific version of the Patient Benefit Index (PBI) questionnaire for the assessment of patient-relevant treatment needs and benefits in children and adolescents with AR. The objective was to validate the PBI in patients receiving allergen immunotherapy (AIT), which is currently the only causal treatment of AR. Clin Transl Allergy 2016, 6(Suppl 1):42

Methods:
The questionnaire "PBI-AR-K" was developed by an expert panel including pediatric patients with AR. It consists of two questionnaires with 19 items each. In the first part, patients rate treatment goal importance; in the second part, they rate the extent to which the goals have been fulfilled by therapy. The PBI-AR-K was validated in a non-interventional, longitudinal, multi-center study. Children (5-12 years) and adolescents (13-17 years) with grass pollen-induced AR were treated with the 5-grass pollen tablet and followed up from the first exposure of sublingual AIT until the end of the first treatment year. Results: Data of 246 children and 135 adolescents (35 %/44 % female) under AIT with the 5-grass pollen tablet were evaluated. The feasibility of the PBI was supported by a low rate (0.8 %/0.7 %) of patients with >25 % missing item pairs, the threshold for score calculation. However, many did not complete one or both questionnaires (33 %/34 %). All subscales, developed on the basis of factor analyses, were internally consistent (Cronbach's alpha ≥ 0.8). The PBI and most subscales correlated highly significantly (p < 0.001) with patients' and physician's judgments on treatment benefit and with changes in frequency of rhinitis symptoms. Mean PBI was 2.6 in children, 2.5 in adolescents (0 "no benefit" to 4 "maximum benefit"). Applying a threshold of 1, 95 % of the children and 91 % of the adolescents gained a relevant benefit from sublingual AIT treatment with the 5-grass pollen tablet.

Conclusion:
The PBI-AR-K is a valid, reliable and suitable instrument for the assessment of patient-reported benefit in the treatment of pediatric AR. Treatment with the 5-grass tablet showed a considerable patient benefit. Background: Allergen immunotherapy with house dust mite (HDM) sublingual tablet has proven efficacious and safe in subjects with allergic rhinitis (AR). Here we report efficacy results in the subset of adolescents with HDM-associated AR in a Phase III rhinitis study. Methods: In a DBPC study conducted in Japan, adults and adolescents (12-64 years) with HDM-associated AR confirmed by a positive HDM-specific IgE test and a positive response to a nasal provocation test were randomised 1:1:1 to receive HDM tablet at 500IR or 300IR, or placebo once daily for 1 year. The primary efficacy endpoint was the Average Adjusted Symptom Score (AASS, an Average Rhinitis Symptom Score adjusted for rescue medication use; scale 0-15) over the last 8 weeks of treatment. This criterion was analysed using an analysis of covariance. Results: Of the 968 subjects randomised, 181 were adolescents aged 12-17 years (500IR = 61, 300IR = 60, Placebo = 60) and 171 of these were included in the efficacy analysis set. In this subset, statistically significant differences between 500IR (p = 0.0001) and 300IR (p < 0.0001) compared to placebo were observed on the primary efficacy endpoint. Over the last 8 weeks of treatment, the AASS Least Squares mean differences vs. placebo were −1.88 (CI 95% [−2.84, −0.93]) and −2.04 (CI 95% [−3.01, −1.08]) for 500IR and 300IR respectively, corresponding to relative reductions vs. placebo of −24.8 % for 500IR and −26.9 % for 300IR. These results were consistent to those obtained in the overall population. Conclusion: In a Phase III study of subjects with HDM-associated allergic rhinitis, treatment with 500IR and 300IR sublingual tablets of HDM allergen extracts administered for 1 year was efficacious in the subset of adolescents.

Conflict of interest disclosure:
Presenting author is an employee of Stallergenes. Background: Omalizumab is a recombinant humanized monoclonal antibody that binds to IgE molecules, forming biologically inert complexes. It is indicated as add-on therapy to improve asthma control in children aged ≥6 years. Objective: Clinical case report.

Methods and results:
The authors present the case of a 15-year old boy with a 10 year history of asthma. Despite optimized treatment with high dose inhaled corticosteroids, long acting bronchodilator and leukotriene antagonist, he continued to present symptoms consistent with severe persistent asthma with frequent visits to the emergency department and oral corticosteroid treatment. Skin testing was positive for house-dust mites and total serum IgE levels ranged from 244 to 597 UI/mL. Lung function assay's showed FEV1 levels of 52 % of the predicted value. At the same time, asthma control tests (ACT) scores ranged from 6 to 9. He was started on Omalizumab 225 mg monthly and after 16 weeks of therapy there was a marked clinical improvement, without the need of systemic corticosteroid rescue therapy since the beginning of the therapy, improved ACT scores (≥20) and it was possible to reduce the required dose of inhaled corticosteroids. We also noticed a marked improvement in lung function, with FEV1 levels of 88 % of the predicted after 16 weeks of treatment. Conclusion: Besides the clear effect of Omalizumab in reducing exacerbations and the required dose of inhaledcorticosteroids with no need of oral corticosteroidtreatment, the authors point to the fact that it may also improve lung function. Further assessments are needed to study this effect.

Consent to publish
Written informed consent for publication of this clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient. A copy of the consent form is available for review by the Editor of this journal. Background: Disruption of immune tolerance in early childhood causes different diseases such as allergic and autoimmune diseases. Objective: We report the case of boy, aged 11, suffering from diabetes, with high atopical status and difficult-to-control asthma. Methods and results: The patient has diabetes mellitus type 1 since the age of 4 and had been treated with different insulin regimens. He has been hospitalised more than 14 times due to suboptimal diabetes control. Two years after establishing the diagnosis of diabetes, at the age of 6, viral upper respiratory infection triggered wheezing symptoms. Eczema is diagnosed in 7, while allergic rhinitis in 8 years of age. The patient's older brother has a diagnosis of asthma. Four months after the initial wheezing episode, 4 recurrent episodes of wheezing occurred in the springtime, thus leading to establishing the diagnosis of allergic asthma. He presented a high atopical status: total IgE level of 12 300 IU/ml and allergen-specific IgE tests to birch pollen, Hordeum murinum, timothy grass, meadow grass, meadow foxtail, couch grass, orchard grass >100, (class VI), ambrosia 3.08, house dust mites 5, 41, peanuts >100 (VI), soya 93.4 (VI), egg whites 30.7; wheat 9.17; milk 3.07 IU/ml; and peripheral Clin Transl Allergy 2016, 6(Suppl 1):42 eosinophilia 12 %. Therapy started with low doses of inhaled corticosteroids (ICS). However, there was a major problem of adherence to the prescribed treatment. In the autumn the same year, the patient experienced 3 wheezing episodes as well as clinical manifestations of allergy to peanuts in the form of rash and angioedema. Spirometry test detected no pulmonary ventilation defect. The following year, partially controlled asthma was further complicated by rhinitis symptoms. The treatment with montelukast combined with low dose ICS was prolonged. Conclusion: Our patient suffers from Th1 autoimmune disease (Diabetes mellitus) combined with Th2 mediated allergic diseases (asthma, rhinitis, eczema) which is commonly found in literature, yet rarely seen in medical practice. Being difficult to treat and put under control, having chronic course, affecting negatively both the patient and his family in a sense of quality of life, these conditions represent a major challenge to doctors.

Consent to publish
Written informed consent for publication of this clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient. A copy of the consent form is available for review by the Editor of this journal. Background: Current diagnosis of pediatric asthma can't include all its clinical variants and results to be a complex task. Aim: To analyze the most common diagnostic errors in pediatric asthma. Materials and methods: 82 patients aged 4-18 years were observed. Mild asthma was in 20.7 % of patients, moderate-in 79.3 %. Results: In 37.1 % of patients community-acquired pneumonia (CAP) was diagnosed, caused in 51.6 % of cases by Mycoplasma pneumonia (MP), in 29 %-by Cytomegalovirus (CMV), and provoked asthma exacerbation in them (r xy = 0.9). In 62.2 % of cases CAP recurrent episodes occurred (CAP). In 64.7 % of patients somatic pathology of osteoarticular, cardiovascular, gastrointestinal systems, besides respiratory, was observed, that resulted in variety of non-respiratory complains with difficulties in asthma diagnosis. In the first 2 years of life asthma diagnosis and adequate therapy was provided in 22 % of children, in 3-5 years since asthma onset it was revealed in 75.6 % of patients, after 5 years of disease manifestation-in 2.4 %. In the first 2 years of asthma manifestations its symptoms were assessed as "frequent acute respiratory infections"(ARI) in 55 % of children, in 44.4 %-mild heart abnormalities (MHA) were detected. 38.7 % of children with asthma diagnosed in 3-5 years since its onset were observed with frequent ARI, 6.5 %-with recurrent bronchitis (RB), 17.7 %-with recurrent CAP, 16.1 %-with MHA, 9.7 %-with autonomic dysfunction, 11.3 %-with gastroesophageal reflux (GER) and frequent ARI. Absence of asthma controller therapy led to development of complications: pulmonary hypertension (PH)in 32.9 % of patients; pulmonary fibrosis (PF)-in 40.7 % of asthmatic patients with CAP; emphysematous bullae (EB)-in 45.5 % of them.

Conclusions:
1. Somatic pathology of 3-4 systems in asthmatic patients caused variety of complains and delayed asthma diagnosis with development of complications at diagnosis since 2 years of its onset. 2. Close relationship between asthma exacerbation and recurrent CAP caused by MP, CMV that led to development of PH, PF, EB is revealed. 3. Thorough examination of patients with frequent ARI is important to exclude asthma. Background: Omalizumab, a subcutaneous anti IgE monoclonal antibody, is shown to be effective in severe allergic asthma. Aim: To evaluate the effect of group based education and structured dialogue among adolescents being treated with omalizumab in enhancing knowledge and insight in the asthma disease, treatment, social behaviour and experience. Method: The adolescents were invited to share their experience after treatment with omalizumab. A group of 4 (13-16 years of age) participated some hours one afternoon. They received education about asthma and treatment using question and answer cards and they were informed about effect and adverse effects of omalizumab. The dialogue included questions about life before and after omalizumab treatment, relation to family and friends, ability and lack of ability to perform physical activities and dreams of the future. One week later they completed a telephone interview based on questions handed out at the session. Results: All 4 adolescents experienced a positive change in everyday life and ability to manage the asthma disease. Furthermore, they all experienced an enhanced physical ability and appreciated the knowledge about omalizumab and asthma. In the interview they reflected on their own disease and physical ability, and they were satisfied by knowing that all in the group had the same thoughts and feelings. Besides one in the group, who in many years had struggled with the ability to perform sports, found out, that her expectation was unrealistic. Conclusion: Adolescents with a chronic disease seems to have a beneficial effect being together in a group sharing thoughts, emotions and knowledge about their disease and treatment. Introduction: There are on average 2 children with asthma in every classroom.

PP85 WITHDRAWN
It is thought that as many as 75 % of deaths from asthma are preventable.
Building on children's curiosity in the classroom about asthma is a possible method of increasing awareness of the condition and its treatment, with the overall aim of reducing hospital admissions and deaths.

Methods:
• UCL medical students who were trained in asthma education visited 14 schools in inner city London. • 1443 children between the ages of 7 and 13 took part.
• The children completed a quiz before and after a 15 min presentation on asthma. The presentation and the quiz questions addressed treatment, emergencies, triggers, misconceptions and basic physiology. • The average total score (out of 13) and marks for each question were calculated and the pre and post presentation test results compared.

Results:
• The average pre-presentation score was 37 % and the average post presentation score was 83 %. • The most poorly answered pre-presentation questions were those about asthma treatment and triggers. • Knowledge in all areas of the quiz was improved on average after the presentation. The greatest areas of improvement were how to deal with an asthma emergency and misconceptions about asthma. • Participating medical students gave positive feedback.

Conclusion:
• Medical student run education sessions provide a cost-effective and simple method of teaching school children about asthma. • The improvement in quiz scores before and after the presentation demonstrates the efficacy of the programme. • Expanding the education programme across the high prevalence asthma areas may help reduce hospital admissions due to asthma (Fig. 8).
Introduction: Severe eczema is an early marker for peanut allergy. The LEAP study demonstrated a successful absolute reduction in development of peanut allergy in high-risk infants if peanut was introduced between 4 and 11 months of age in children with severe eczema or egg allergy. Aims: To establish the number of children who would require screening, intervention, and monitoring, if the LEAP protocol were to be implemented in Ireland, based on a cut-off of SCORAD > 40; and to quantify the potential reduction in peanut allergy. Background: Skin care practices influence skin barrier function during the first weeks of life. The application of sunflower seed oil for neonatal skin care has been investigated in previous studies, with controversial findings, varying from lowering mortality rate to decelerating skin barrier maturation in preterm infants. Objective: To investigate the effect of sunflower seed oil compared to a commercially available skin care lotion on the skin barrier function of healthy full-term newborns using standardized, objective, non-invasive methods. Methods: In a prospective, randomized clinical study, 50 healthy fullterm newborns aged ≤96 h were randomly assigned to two groups receiving three times per week: topical baby lotion application (group L, n = 22) and topical sunflower seed oil application (group SSO, n = 24). Skin barrier function was evaluated in three anatomical areas (front, abdomen, upper leg) by non-invasive assessment of transepidermal water loss (TEWL), stratum corneum hydration (SCH), sebum and skin-pH at inclusion and after 5 weeks. Clinical skin condition was assessed using the neonatal skin condition score.  Objectives: The teenage years are the transitional stage from childhood to adulthood which heralds physical and psychological changes and issues relating to independence. We wanted to examine risk taking behaviour in this group and evaluate if young people are appropriately educated in the management of allergic reactions. In addition to traditional resources such as health care professionals, there are many virtual support mechanisms available such as included mobile apps and websites which are also available to fulfil this purpose. Method: We surveyed young people who attended outpatient allergy clinics as well as those attending for day case procedures. We aimed to find out what resources they accessed to supplement the teaching they received regarding management of allergic reactions and use of their Adrenaline Auto-Injectors (AAI). The inclusion criteria were: young person aged 12 years and over, who has been prescribed an AAI. Results: Early data suggests that none of the adolescents who completed the questionnaire were aware of an iPhone or Android mobile App which provides education and support relating to the leading brands of AAI. Conclusion: Young people are a group known to engage in risk taking behaviour, therefore any opportunities should be utilised to provide education and offer support. Reasons such as a suitable time, lack of anonymity, appearing to lack knowledge, have all been identified as barriers which prevent young people from accessing traditional support services such as health care professionals. Mobile Apps and websites, in this technical savvy group seem the most likely solution. However, for these to be effectively accessed, it is vital that these services are well publicized, available, easily accessible and friendly. This would allow patient education and empower young people to manage any allergic reactions.
Result: There was a decreasing trend in the number of Th2 and Th17 after the administration adjuvant immunomodulators compared with the immunotherapy-only group, although it was not statistically significant. These phenomena did not reveal in building-up phase. The number of Treg was likely to be increased in both building-up and maintenance phase. ACT score indicated a significant improvement after immunomodulator administration. Conclusion: Immunomodulator can make improvement in maintenance phase of specific immunotherapy in clinical asthmatic children. Most nurseries had at least one child with a food allergy and only 13 % didn't have any child with a food allergy. Just over half of nurseries had less than 5 children with food allergies, a quarter of nurseries had children with an AAI and no nursery had more than 3 children with one. In about one-third of nurseries all staff had some form of allergy training, 22 % had no staff trained and 8 % were unsure. Nearly three quarters of nurseries had some staff trained to use an AAI but 20 % had no staff trained and 6 % were unsure. A variety of training providers were used with about a quarter using NHS or school nurses, a third using first aid or online training only, and another third had no training or were unsure where to access training. Conclusions: It is essential that nursery staff are fully trained in the care of children with food allergies. Education plays a key role in the management of allergies in the nursery setting. The results of our questionnaire show that the quality of allergy education for nurseries in Sheffield is inconsistent and immeasurable. Standardising the delivery of allergy education will help to ensure the safety of these preschool children. Introduction: Food allergy is an adverse health effect arising from a specific immune response to a given food. This immune response can be IgE-mediated or non IgE-mediated. Apart from the nine major food allergens, any food can trigger an allergic response. The aim of this study is to draw attention to less frequent food allergy cases that forced a large degree of suspicion. Methods: Five infants with less frequent food allergy followed in outpatients of our Hospital were selected. The medical files were reviewed and the following variables were evaluated: gender, age, personal and family history of atopy, food allergen and allergic manifestations, specific and total IgE, skin prick test, oral food challenge and tolerance, comorbidities and others allergies. Results: Five infants were selected, three males. The mean age at onset of symptoms was five months. The implied foods were: potato, corn, wheat and banana. In two cases (wheat, corn) the initial manifestation was anaphylaxis and in other three (potato, corn, banana) vomiting and prostration. In the latter group research revealed a non IgE-mediated allergic reaction, most likely food protein that induced enterocolitis syndrome. In these cases food challenge carried to confirm the diagnosis.

Conclusions:
Any food can induce a severe allergic reaction such as anaphylaxis. In the first year of life with food diversification it is necessary to be aware of any symptoms related to food intake. Through a careful food history, physical examination and interpretation of specific tests, the food allergen can be found. In all our cases, the food allergen was mixed with other food which led to the performance of several tests and food challenges for its identification. Food avoidance is the only treatment so it's important to alert the medical community that any food can induce allergy preventing delay in diagnosis. Background: The relationship between vitamin D status and asthma has been the subject of several studies in the last decade. The aim of the present study was to investigate the relationship between serum vitamin D levels and indices of asthma control, asthma severity and quality of life in children with asthma and comorbidities.

Methods:
The study included 29 children who were diagnosed with asthma according to the GINA criteria and who did not receive immunotherapy for their allergy. Serum 25-hydroxyvitamin D [25(OH) D] levels were measured in blood samples collected at first enrollment in summer and in reevaluation 6 months later. Subjects were categorized into deficient (<20 ng/ml), insufficient (21-30 ng/ml) and sufficient (>30 ng/m). The asthma control, asthma severity and quality of life were evaluated using the ACT (asthma control test), GINA criteria and PedsQL (pediatric quality of life questionnaire). Atopy biomarkers and spirometry were also measured for analysis. Results: 6.9 % percent of subjects were deficient and 27.6 % insufficient in serum vitamin D at baseline. The study revealed a highly decrease in vitamin D levels from 38.4 ng/ml to 22.1 ng/ml in the winter, (p < 0.001). None of the children had vitamin D sufficiency during winter. Asthma severity and asthma quality of life showed no significant association with serum 25(OH) D levels. We found an association between asthma control and vitamin D levels (p = 0.0665) in summer. Furthermore, there is an association between 25(OH) D and severity of comorbit rhinitis (p = 0.03). Conclusions: Vitamin D deficiency and insufficiency are common in asthmatic children. Lower serum levels are prevalent in winter season. Vitamin D status is associated with asthma control and severity of rhinitis. Several previous case reports have been described in adults, but to our knowledge, none in children.
Case report: A 10-year-old boy, with a history of intermittent asthma and sensitisation to dust mites was admitted for an asthma exacerbation. Following an initial improvement, he developed a sudden Page 53 of 60 Clin Transl Allergy 2016, 6(Suppl 1):42 unexplained severe cyanotic episode with loss of consciousness and bradycardia a few seconds after salbutamol neb. He was admitted to ICU where prednisolone, aminophylline and nebulised salbutamol were administered. He was discharged on a Formoterol/budesonide inh. combination. One month later, during a scheduled visit, a spirometry test with bronchodilation was performed. A few second after salbutamol inhalation, a sharp drop of FEV1 was noted (from 96 to 35 % of predicted value) while the boy developed severe respiratory distress and ultimately silent chest and cyanosis. He was transferred to ICU and treated with oxygen, nebulised ipratropium, systematic corticosteroids with gradual clinical improvement. The patient's respiratory distress resolved over 20 min and completely normalised within 2 h. Both events were attributed to paradoxical bronchospasm following salbutamol. In the past, when the patient had tolerated salbutamol on several occasions, there has always been a co-administration of systematic steroid treatment, that may have had a protective effect. It is also worth noting that there is a family history of similar adverse bronchoconstrictive reactions to salbutamol. Conclusion: Salbutamol is one of the most common and effective rescue bronchodilator medications used to treat asthma. Yet, paradoxical life threatening bronchospasm, is a well described adverse effect in adults. While a massive influx of eosinophils has been proposed, the exact mechanism remains unknown. A high index of awareness of this adverse effect can be life saving to the patient.

Consent to publish
Written informed consent for publication of this clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient. A copy of the consent form is available for review by the Editor of this journal. Background: Children with co-existing physician-diagnosed asthma and allergic rhinoconjunctivitis (AR) have worse asthma outcomes than those with asthma only. Proper treatment of AR might benefit the lower airways. It is unclear how INCS or oral antihistamine use can contribute to more controlled asthma in children with both conditions. Methods: In a single-blind RCT with three parallel treatment groups the effectiveness of hay fever treatment in children was studied using intranasal corticosteroids or oral antihistamines. All patients had AR and some concomitant asthma. A daily online (AR and asthma) symptom diary was completed during the hay fever season. Patients with concomitant asthma also received an asthma specific quality of life questionnaire and recorded their asthma control. In all patients the primary outcome is the comparison between AR symptom scores and asthma symptom scores. Furthermore, in patients with concomitant asthma the secondary outcome is asthma control and asthma specific quality of life. Results: General practitioners (n = 155) invited 4858 children, 419 of which responded positively. Finally 150 children and adolescents were randomized, of which 23 with concomitant asthma. Of those patients, 70 % used any type of asthma medication in the last month. At baseline, most patients had their asthma under control. Analyses on mean daily AR symptoms score and mean daily asthma symptom score will be performed. As well as asthma control and asthma specific quality of life in patients with concomitant asthma. Conclusion: In this study we were able to provide explorative data on the effect of AR control on asthma symptoms and specific asthma outcomes. The results will provide more insight for the theory that better controlled AR will lead to better controlled asthma. It also will give insight in the asthma symptoms in patients with AR but no co-existing physician-diagnosed asthma during the hay fever season.
Introduction: Exercise-induced bronchoconstriction (EIB) is more common in athletes compared to the general population. The eucapnic voluntary hyperventilation test is the gold standard (IOC-MC) to detect EIB. We previously demonstrated the presence of epithelial damage and increased damage associated molecular patterns in elite athletes compared to control individuals [1]. Methods: Young athletes (basketball (n = 13), football (n = 20), swimming (n = 12)) were recruited at the start of their elite sports career (12-14 years). In some of the individuals (75 %), a second or third EVH test after 1 and 2 years. Eight age-matched controls were also recruited. Eucapnic voluntary hyperventilation test was performed according to ATS guidelines in all subjects as previously described [2]. Serum Clara Cell protein 16 (CC16) was measured by ELISA as a marker of airway epithelial damage. Results: At time of first evaluation, 3/13 basketball players, 4/20 football players, 5/12 swimmers and 1/8 controls met criteria for EIB (fall in FEV 1 >10 % after EVH test). The maximal fall in FEV 1 after the EVH test was significantly lower in atopic compared to non-atopic athletes both after 1 and 2 years but not at time of first analysis. Atopic athletes furthermore showed significantly decreased maximal fall in FEV 1 after one year, whereas this was unchanged in non-atopic athletes. Serum CC16 was significantly increased in athletes compared to controls at time of first analysis. Conclusion: EIB is detected in young athletes, especially in swimmers. The degree of EIB response in young athletes was associated with atopy. Signs of epithelial damage were already found in young athletes at the start of their elite sports career. Follow up of the development of EIB is advised in young athletes, performing sports at elite level, especially in those with atopy. Clin Transl Allergy 2016, 6(Suppl 1):42 reduce pulmonary compliance, lung volumes and the ventilation-perfusion relationship. Aims and objectives: To assess the effect of higher BMI on risk for asthma, airway inflammation and treatment outcomes in asthmatic children. Methods: Of 2000 children (healthy and asthmatics), a cohort of 475 children with asthma was recruited. They underwent physical examination, basic anthropometric measurements, blood sampling and lung function tests. We clinically assessed their health status and treatment outcome at the point of diagnosis, after 6 months and after 12 months. Results: Participants were categorized into 4 groups according to BMI percentile: underweight, normal, overweight and obese. Increased body weight was more prevalent in male participants, both overweight and obese, than in female. Baseline levels of hsCRP were elevated both in overweight and obese participants, compared to children with normal BMI. When treatment success was assessed by changes in airway inflammation after 6 months, increased FeNO levels were more frequent in inadequate and bad responders, compared to children with good response to treatment. The risk for asthma in all 2000 children was higher in overweight participants compared to children with normal BMI, but not in obese.

Conclusions:
The effect of obesity appears to be insufficient in the development of asthma alone. Increased BMI (overweight) increases the risk for asthma and obesity rather increases the level of airway and systemic inflammation and potentially affects the level of disease control and response to asthma treatment. Background: Despite all recommendations supporting the use of pressurised metered dose inhalers with spacers (pMDI + S) for acute asthma treatment, there is still a considerable lack of its use of in Portugal not only within the emergency departments (ED) but also the home setting. Objectives: The aim of this study was to evaluate the impact of the Optimisation of Inhaler Therapy in Children Project (OITCP) upon the use of pMDI + S at the ED and at home, considering the perspectives of children with asthma/wheezing, their parents/caregivers and health professionals.
Methods: Parents/caregivers (n = 325) and health professionals (n = 220) included in the OITCP were asked to complete questionnaires. Data related to respiratory/asthma control, device prescriptions and costs associated with this project were also analysed. Results: Ninety-two (28 %) caregivers and 163 (74 %) health professionals responded to the questionnaires. Most parents/caregivers recognise the benefits of pMDI + S for asthma/wheezing treatment and more than 80 % expressed a pReference for their use either at home or the ED. Similarly, most healthcare professionals recognise the advantages of these devices and the merits of the OITCP in changing their opinions and attitudes. Nearly 55 % of children surveyed had their asthma controlled, 4 % were hospitalised due to asthma/wheezing and 24 % had at least one hospital ED visit in the previous 12 months. Accounting for costs, the OITCP led to substantial savings to ULSM (over 30,000€) at no additional expense for families. Conclusions: This study showed that the OITCP had a positive impact on both parents/caregivers and health professionals and was successful in encouraging use of pMDI + S at ED and at home. Methods: We reviewed patients attended for suspected BLAH in the allied pediatric allergy units of 6 close hospitals from 2010 to 2014. We collected data related to patients, past episodes, allergic workup and results. We analyzed the trends of in vitro and skin tests by means of Pearson's correlation coefficient. We compared the characteristics of patients diagnosed of BLAH with those with a negative OPT by means of Fisher's exact test. Results: 668 patients. From 2010 to 2014, specific IgE test orders decreased from 45 to 27 % of patients (p < 0.001) and skin tests from 52 to 41 % (p = 0.003). OPT were performed in 89 % of patients (594 patients). BLAH was diagnosed in 27 patients (4 %): 26 by OPT results and 1 with a history of anaphylaxis and positive specific IgE and skin tests. BLAH was ruled out in 86 % of patients and 10 % did not conclude the study. All 26 patients with a positive OPT showed early or delayed skin signs (exanthema, urticaria, angioedema…) but none had severe or anaphylactic reactions. BLAH was more commonly diagnosed in patients with a history of more than one episode (9 vs. 3 %, P = 0.024), with a history of anaphylaxis (40 vs. 4 %, P = 0.017) and with cephalosporins (9 vs. 4 %, P = 0.086). Conclusions: OPT is an easy and safe procedure to definitively diagnose or rule out BLAH in children. The role of skin and in vitro tests in pediatric patients is been questioned and needs clarification. The incidence of severe allergic reactions after vaccination ranges from 0.5 to 1/100.000 cases. A 12-month old infant was referred to our Consult after an anaphylaxis (urticaria and wheezing) appearing 1 h after receiving simultaneously the 1st dose of MMR (mumps, measles and rubella), 3rd dose of meningococcal C and the 4th dose of 13-valent pneumococcal vaccines (PCV13). Intradermal tests showed positive results with PCV13. Meningococcal and MMR tested negative. PCV13 comprises 13 capsular Streptococcus pneumoniae polysaccharide serotypes conjugated to a non-toxic diphtheria toxin mutant (cross-reactive material [CRM(197)]). Current vaccination schedules recommend 4 doses of DTP (Diphtheria-tetanus toxoid-pertussis) within the first 2 years and a booster dose at 6. Therefore, skin tests were performed with 2 DTP variants, authorized for children of different ages: DTP1 (Composition: at least 30 international units [IU] of diphtheria, 40 IU of tetanus, and 25mcg of pertussis toxoids; authorized for infants) and DTP2 (Composition: at least 2 IU of diphtheria, 20 IU of tetanus, plus 8mcg of pertussis toxoids; authorized for children older than 4 years) with positive results for both. Basophil activation tests (BAT) performed with PCV13, 23-valent pneumococcal vaccine and both DTP vaccines showed positive results with PCV13 and both DTP vaccines. Two controls tested negative. Further tetanus and pertussis doses have been suspended since there are no mono-component vaccines available in Spain. Reevaluation of DTP sensitization has been offered in a few years since there have been reports of DTP hypersensitivity resolution. This is the first report of anaphylaxis after PCV13 administration and the first time its carrier protein, CRM (197), is identified as its cause, demonstrated by BAT and skin tests results. Carrier proteins are used to enhance infants' immune response against capsulated bacteria. They should be considered in the assessment of hypersensitivity reactions to combined and/or conjugated vaccines.

Consent to publish
Written informed consent for publication of this clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient. A copy of the consent form is available for review by the Editor of this journal. Background: Group B streptococcus (GBS) is the leading infectious cause of neonatal morbidity and mortality in the Unites States. Intrapartum antibiotic delivery to GBS positive mothers is performed for prevention of neonatal infection with penicillin being the drug of choice. Previous studies have noted an increased risk of atopic diseases associated with intrapartum antibiotic exposure. This study sought to determine if intrapartum exposure to penicillin for GBS increased the likelihood of penicillin allergy in children. Methods: Retrospective, chart review was performed on patients from a birth cohort. Birth cohort included children born in 2007 at a local tertiary care hospital with local addresses. GBS status of mother, intrapartum antibiotic exposure, delivery mode and birth order was collected and analyzed. Results: We identified 927 children with 812 included in the cohort. Eighty (10 %) of the children had a reported penicillin allergy, most were Caucasian (79 %) males (61 %). Intrapartum exposure to penicillin (OR 0.84, CI 0.45-1.57, p = 0.59), amoxicillin or ampicillin (OR 0.22, CI 0.01-2.71, p = 0.29) did not increase the risk of penicillin allergy in children. The timing of antibiotic therapy (OR 1.00, CI 0.53-1.88, p = 0.99), GBS status of mother, mode of delivery or birth order did not affect the risk of penicillin allergy in the offspring. Discussion: To our knowledge, this is the first study to evaluate intrapartum exposure to penicillin for GBS treatment and the subsequent development of penicillin allergy in the child. However, our study was limited as it was a retrospective, chart review of a birth cohort from a tertiary care facility with children lost to follow up. Conclusions: In contrast to other atopic diseases, intrapartum antibiotic exposure as well as mode of delivery is not associated with the development of penicillin allergy in children. Parents and obstetricians should be reassured when using Penicillin for prevention of neonatal GBS. Background: The aim of our study was to evaluate the diagnostic work-up of children referred to a general hospital due to suspected drug hypersensitivity reactions (DHR), with the emphasis on children with immediate or severe non-immediate DHR, who were also referred to the University children's hospital Ljubljana. Methods: We retrospectively analysed medical documentation of 169 children who were referred to the General Hospital Izola due to a suspected DHR from 2009 to 2014. 125 children (73.9 %) had mild DHR due to which oral provocation test (OPT) were planned/made. All OPT in this group were negative except one. For further analysis were selected 44 children (16 female, 28 male, aged 1-9 years, mean 2.5 years) with clinical manifestation suspicious of immediate or severe non-immediate DHR that were further evaluated at the University Children's Hospital Ljubljana. Results: 17/44 (39 %) children were treated with penicillin G, one (2 %) with penicillin V, 17 (39 %) with amoxicillin, five (11 %) with amoxicillin and clavulanic acid, two with cefuroxime (5 %) and one (2 %) with ceftriaxone. Clinical manifestations of DHR were immediate urticaria (21), immediate urticaria with angioedema (seven), anaphylaxis (three), maculopapular exanthema in first two hours (three), maculopapular exanthema with additional alert signs (four), vasculitis (four), fixed