@article {1989, title = {Does EMLA cream application interfere with the success of venipuncture or venous cannulation? A prospective multicenter observational study.}, journal = {Eur J Pediatr}, volume = {172}, year = {2013}, month = {2013 Feb}, pages = {265-8}, abstract = {

UNLABELLED: Venipuncture and intravenous cannulation are the most common painful procedures performed on children. The most widely used topical anesthetic is eutectic mixture of local anesthetics (EMLA). EMLA use is associated with a transient cutaneous vasoconstriction which can make it difficult to identify veins. We assessed with a prospective, multicenter, observational study whether EMLA interferes with venipuncture and intravenous cannulation. The primary study outcome was a success at first attempt in the course of venipuncture or venous cannulation. The study enrolled 388 children; 255 of them received EMLA and 133 did not. Eighty-six percent of procedures were successful at the first attempt in the EMLA group and 76.7~\% in the no EMLA group.

CONCLUSION: In this study, EMLA use did not interfere with the success of venipuncture or venous cannulation in children.

}, keywords = {Anesthetics, Local, Catheterization, Peripheral, Child, Child, Preschool, Female, Humans, Lidocaine, Logistic Models, Male, Ointments, Phlebotomy, Prilocaine, Prospective Studies, Vasoconstriction}, issn = {1432-1076}, doi = {10.1007/s00431-012-1866-6}, author = {Schreiber, S and Ronfani, L and Chiaffoni, G P and Matarazzo, L and Minute, M and Panontin, E and Poropat, F and Germani, C and Barbi, E} } @article {1875, title = {Pain in cognitively impaired children: a focus for general pediatricians.}, journal = {Eur J Pediatr}, volume = {172}, year = {2013}, month = {2013 Jan}, pages = {9-14}, abstract = {

UNLABELLED: Pain in children with cognitive impairment and cerebral palsy is a particularly relevant issue due to its high prevalence and impact on quality of life. We review available evidence about prevalence of pain, causes and specific treatment, recognition and use of specific pain scales, physiology, and consequences of pain in this subset of patients.

CONCLUSIONS: Pain is very common and is a critical determinant of quality of life in children with cognitive impairment and cerebral palsy. The diseases and associated complications that frequently expose these patients to pain can be treated and pain prevented. For patients with communication difficulties, appropriate, effective, validated tools are available and should be used to diagnose pain in itself, to >choose analgesic treatment and to determine effectiveness of these therapies. The level of awareness of pediatricians towards this issue seems to be quite low.

}, keywords = {Analgesics, Cerebral Palsy, Child, Cognition Disorders, Humans, Pain, Pain Measurement, Quality of Life}, issn = {1432-1076}, doi = {10.1007/s00431-012-1720-x}, author = {Massaro, M and Pastore, S and Ventura, A and Barbi, E} } @article {1793, title = {Adverse effects during specific oral tolerance induction: in home phase.}, journal = {Allergol Immunopathol (Madr)}, volume = {40}, year = {2012}, month = {2012 Jan-Feb}, pages = {41-50}, abstract = {

BACKGROUND: Specific oral tolerance induction (SOTI) is a promising approach for severe food allergies. There are little data in the literature regarding the home-phase of SOTI, not only with regard to type and frequency of adverse reactions but also regarding the most suitable treatment and protocol.

AIMS: To define the incidence and severity of adverse reactions, possible risk factors, and the safety and effectiveness of the home-phase of an original SOTI protocol in a large group of children with severe cow{\textquoteright}s milk (CM) allergy, after the hospital "rush" phase.

METHODS: The study was conducted by recording in-home phase adverse events, success and failure as reported by parents, and calling families. Adverse reactions were treated following the International Guidelines, arbitrarily modified by introducing nebulised epinephrine for respiratory reactions, oral beclomethasone for acute gastric pain and oral cromolyn for recurrent gastric pain.

RESULTS: Out of 140 patients, 132 were contacted; eight were inaccessible (follow-up 2-84 months). The number of adverse reactions was 1 in every 100 doses. The reactions were treated with nebulised epinephrine (221 reactions), IM epinephrine (6 reactions), and other drugs. Patients with high specific IgE levels (greater than 100 kU(A)/L) and lower CM dose (less than 5 ml) at the end of in-hospital phase showed a higher risk both for number of reactions and use of nebulised epinephrine.

CONCLUSIONS: The home phase of SOTI was characterised by a significant number of adverse reactions, mostly managed with an acceptable rate of side effects. Nebulised epinephrine played a pivotal role in respiratory reactions.

}, keywords = {Adolescent, Adult, Age Factors, Allergens, Child, Child, Preschool, Desensitization, Immunologic, Epinephrine, Female, Food Hypersensitivity, Humans, Immune Tolerance, Immunoglobulin E, Male, Milk Hypersensitivity, Nebulizers and Vaporizers}, issn = {1578-1267}, doi = {10.1016/j.aller.2011.05.004}, author = {Barbi, E and Longo, G and Berti, I and Matarazzo, L and Rubert, L and Saccari, A and Lenisa, I and Ronfani, L and Radillo, O and Ventura, A} } @article {1895, title = {Adverse effects during specific oral tolerance induction: in-hospital "rush" phase.}, journal = {Eur Ann Allergy Clin Immunol}, volume = {44}, year = {2012}, month = {2012 Feb}, pages = {18-25}, abstract = {

BACKGROUND: Specific oral tolerance induction (SOTI) is a promising approach in the treatment of severe food allergies. Different protocols have demonstrated its efficacy. Nevertheless, SOTI is still considered an experimental method and should be limited to highly controlled settings.

AIMS: To define the incidence and severity of adverse reactions, possible risk factors, and the safety and effectiveness of nebulized epinephrine as a first-line treatment of respiratory reactions during in-hospital SOTI for cow{\textquoteright}s milk allergy.

MATERIALS AND METHODS: A retrospective study was conducted by reviewing the medical records of patients admitted for SOTI beginning in 2001. Reactions were classified as mild, moderate and severe on a partially modified Clark scale. Adverse reactions were treated following the International Guidelines with the introduction of nebulized epinephrine for level four reactions.

RESULTS: Of 209 patients, 17 were excluded due to the absence of objective reactions. The remaining 192 were classified as follows: Mild Reactions (Clark Scale 1 to 3): 100 patients received either no treatment, oral antihistamines or nebulized steroids; Moderate Reactions (Clark Scale 4): 87 patients treated with nebulized epinephrine and, depending on their symptoms, oral antihistamines, corticosteroids (nebulized, oral or IV) or nebulized beta 2 agonists; Severe Reactions (Clark Scale 5): 5 children, 4 of whom initially underwent one nebulization of epinephrine and eventually required an IM dose. The fifth patient was immediately treated with IM epinephrine due to hypotension.

DISCUSSION: adverse reactions during this in-hospital SOTI protocol were frequent but easily manageable. Nebulized epinephrine can play a relevant role in the treatment of respiratory reactions.

}, keywords = {Administration, Inhalation, Anaphylaxis, Animals, Bronchodilator Agents, Child, Desensitization, Immunologic, Epinephrine, Humans, Milk, Milk Hypersensitivity, Retrospective Studies}, issn = {1764-1489}, author = {Barbi, E and Longo, G and Berti, I and Neri, E and Saccari, A and Rubert, L and Matarazzo, L and Montico, M and Ventura, A} } @article {1841, title = {Autoimmune-polyendocrinopathy-candidiasis-ectodermal-dystrophy in Calabria: clinical, immunological and genetic patterns.}, journal = {J Endocrinol Invest}, volume = {35}, year = {2012}, month = {2012 Nov}, pages = {877-81}, abstract = {

UNLABELLED: Autoimmune polyendocrinopathy-candidiasis-ectodermal- dystrophy (APECED), also known as autoimmune polyendocrine syndrome type 1 (APS-1), is a very rare disease. Diagnosis requires the presence of at least two of three major clinical features: chronic mucocutaneous candidiasis, chronic hypoparathyroidism, and Addison{\textquoteright}s disease.

DESIGN: In this study, we analyzed Autoimmune Regulator (AIRE) gene mutations and genotype-phenotype correlation in APECED patients originating from Calabria, a region in the south of Italy.

PATIENTS AND METHODS: Four patients and their first-degree relatives were evaluated for clinical manifestations, autoantibody presence and AIRE gene mutations.

RESULTS: Three patients carried a homozygous W78R mutation on exon 2, typical of patients with APECED from Apulia; the fourth patient had a homozygous R203X mutation on exon 5, typical of APECED patients from Sicily. Clinical disease expression showed wide variability. Analysis of relatives allowed the identification of 6 heterozygotes, none of whom showed major findings of APECED.

CONCLUSIONS: No AIRE gene mutations specific to Calabria were found in patients with APS-1, but mutations similar to those in patients from Apulia and Sicily. Heterozygosity for AIRE gene mutation is not associated with major findings of APECED.

}, keywords = {Adolescent, Adult, Autoantibodies, Child, Female, Genetic Association Studies, Heterozygote, Homozygote, Humans, Italy, Male, Mutation, Polyendocrinopathies, Autoimmune, Prognosis, Sicily, Transcription Factors, Young Adult}, issn = {1720-8386}, doi = {10.3275/8109}, author = {Betterle, C and Ghizzoni, L and Cassio, A and Baronio, F and Cervato, S and Garelli, S and Barbi, E and Tonini, G} } @article {1947, title = {Diagnosed child, treated child: food challenge as the first step toward tolerance induction in cow{\textquoteright}s milk protein allergy.}, journal = {Eur Ann Allergy Clin Immunol}, volume = {44}, year = {2012}, month = {2012 Apr}, pages = {54-60}, abstract = {

BACKGROUND: Food challenge is required to assess tolerance in cow milk (CM) allergy. A positive challenge contraindicates the reintroduction of CM. Specific oral tolerance induction (SOTI) is a promising treatment.

METHODS: All children admitted for a challenge were prospectively enrolled. To those tolerating between 2 and 150 ml a SOTI protocol was offered. Outcome, adverse reactions, parents{\textquoteright} satisfaction were recorded.

RESULTS: Out of 245 challenged patients, 175 reacted 122 out of 125, able to tolerate a minimum dose of 2 ml, underwent SOTI. After one year 75.4\% were in an unrestricted diet, 16.1\% tolerated between 5 and 150 ml, 8.5\% stopped SOTI. Side effects were mild, parents{\textquoteright} satisfaction was very high.

CONCLUSIONS: The majority of children tolerating limited amounts of CM at the challenge acquires tolerance with SOTI without relevant side effects. Maintaining on an exclusion diet partially tolerant children should be considered debatable.

}, keywords = {Administration, Oral, Adolescent, Animals, Cattle, Child, Child, Preschool, Humans, Immune Tolerance, Infant, Milk Hypersensitivity, Milk Proteins, Self Administration}, issn = {1764-1489}, author = {Longo, G and Berti, I and Barbi, E and Calligaris, L and Matarazzo, L and Radillo, O and Ronfani, L and Ventura, A} } @article {1937, title = {Videogame playing as distraction technique in course of venipuncture.}, journal = {Pediatr Med Chir}, volume = {34}, year = {2012}, month = {2012 Mar-Apr}, pages = {77-83}, abstract = {

BACKGROUND: Needle-related procedures (venipuncture, intravenous cannulation) are the most common source of pain and distress for children. Reducing needle related pain and anxiety could be important in order to prevent further distress, especially for children needing multiple hospital admissions. The aim of the present open randomized controlled trial was to investigate the efficacy of adding an active distraction strategy (videogame) to EMLA premedication in needle-related pain in children.

METHODS: One-hundred and nine children (4 -10 years of age) were prospectively recruited to enter in the study. Ninety-seven were randomized in two groups: CC group (conventional care: EMLA only) as control group and AD group (active distraction: EMLA plus videogame) as intervention group. Outcome measures were: self-reported pain by mean of FPS-R scale (main study outcome), observer-reported pain by FLACC scale, number of attempts for successful procedure.

RESULTS: In both groups FPS-R median rate was 0 (interquartile range: 0-2), with significant pain (FPS-R > 4) reported by 9\% of subjects. FLACC median rate was 1 in both groups (interquartile range 0-3 in CC group; 0-2 in AD group). The percentage of children with major pain (FLACC > 4) was 18\% in CC group and 9\% in AD group (p = 0.2). The median of necessary attempts to succeed in the procedures was 1 (interquartile range 1-2) in both groups..

CONCLUSION: Active distraction doesn{\textquoteright}t improve EMLA analgesia for iv cannulation and venipuncture. Even though, it resulted in an easily applicable strategy appreciated by children. This technique could be usefully investigated in other painful procedures.

}, keywords = {Anesthetics, Local, Child, Child, Preschool, Female, Humans, Lidocaine, Male, Pain, Phlebotomy, Prilocaine, Prospective Studies, Video Games}, issn = {0391-5387}, doi = {10.4081/pmc.2012.64}, author = {Minute, M and Badina, L and Cont, G and Montico, M and Ronfani, L and Barbi, E and Ventura, A} }