Pediatric Allergists Research Articles

Milk allergy most burdensome in multi-food allergic children.

Food allergy is a substantial health burden, which disproportionately affects children. Among children with food allergy, as many as 70% have multiple food allergies. Whereas the overall burden of food allergy on quality of life has been described, little is known about the burden of individual allergens. We aimed to examine the perception of burden among families with multiple food-allergic children. Parents of children with 1+children with multiple food allergies including milk responded to online questions, including both open-ended and closed-ended questions on food allergy-related burdens of time, financial costs, social restrictions, and emotional demands. Overall, 64 children (69.8% boys) of whom (73.0%) most were aged 10 and younger were included. Most had been diagnosed with food allergy in infancy and by a (pediatric) allergist. Other common allergies included peanut (65.6%), tree nuts (57.8%), egg (76.6%), and sesame (31.3%). Quantitatively, milk allergy was reported as carrying the most burden, including most socially limiting (81.5%), requiring the most planning (75.9%), causing the most anxiety (68.5%), most challenging to find "safe" or allergy-friendly foods (72.2%), and costly (81.5%). Qualitatively, we identified five themes that captured burdens associated with costs, marketing of milk products to children, risk of cross-contamination, ubiquity of milk/dairy and public confusion with lactose intolerance, and an unwillingness of others to accommodate the allergy. Parents whose children have multiple food allergies, including milk, report milk as the allergy associated with the greatest time, financial, social, and emotional burdens.

Qualitative analysis of perceived impacts on childhood food allergy on caregiver mental health and lifestyle

BackgroundApproximately 8% of children have food allergy. Yet, little is known about how parents cope with the burden of this disease. ObjectiveThis study aimed to describe the perceptions of food allergy–related mental health issues of parents of children with food allergy. MethodsParents of children with pediatric allergist–diagnosed food allergy were recruited through allergy clinics and education centers in a large Canadian city. We used content analysis to identify overarching themes. ResultsWe interviewed 21 parents with children (boys [13/21; 62.9%]) aged younger than 12 months to 16 years. Interviews averaged 47 (range 33-82) minutes. Most children were diagnosed as infants, and few (7/21; 33.3%) were monoallergic. About one-half (7/16; 43.8%) had a history of anaphylaxis. Parents of children with a single food allergy spoke of “accommodation and adaptation.” In contrast, parents of children with multiple food allergies described “anxiety and isolation” and spoke of being “depressed” and “terrified” about leaving their children in the care of others who may not be equipped to handle food allergy. Many parents felt “overwhelmed and alone,” especially if they lacked support from extended family and/or their social circle. “Fear for today, fear for the future” was commonly described by parents, although a tenuous symbiotic coexistence was developed, with parents stating “Food allergy management has become our normal.” Finally, a small group of parents reported that “Bullying happens, but we are alone to cope with it.” ConclusionMultiple food allergies negatively affect the mental health of parents, in a variety of well-being domains.

Pediatric allergists’ perspectives on the psychosocial challenges of food allergy and factors that support coping

Pediatric allergists’ perspectives on the psychosocial challenges of food allergy and factors that support coping

Clinical utility of diagnostic methods in respiratory allergy in pediatric patients.

Respiratory allergy is a single condition which affects upper and lower airways. The diagnose in childhood is essential to prevent the allergy respiratory progression. We aimed to analyze the clinical utility of diagnostic tests to identify rhinitis phenotypes and to differentiate between atopy and respiratory allergy in children. 173 children with a clinical suspicion of allergic rhinitis were prospectively evaluated in our pediatric allergist service. The allergological study included clinical history, physical examination, specific IgE (sIgE), skin prick test (SPT), and nasal allergen challenge (NAC). It identified 4 phenotypes: i) allergic rhinitis (AR): positive NAC, SPT and/or sIgE, ii) local allergic rhinitis (LAR): positive NAC and negative SPT and sIgE, iii) dual allergic rhinitis (DAR): positive NAC to perennial & seasonal allergens, SPT and/or sIgE to seasonal and negative to perennial allergens, and iv) non-allergic rhinitis (NAR): negative study. Most of children were girls, with a family history of rhinitis, non-smokers and an urban habit. The mean age of onset of symptoms was 10 (3.982) years. 45,7% had a diagnosis of AR, 24,9% LAR, 11,6% DAR and 17,9% NAR. Atopy was detected by SPT in 57.3%, by sIgE (54.9%), no patient with negative SPT had positive sIgE. However, 36.5% of allergic patients were not correctly classified by these tests being diagnosed by clinical history+NAC. Clinical history and NAC were the most useful diagnostic methods for correctly diagnose respiratory allergy in children. sIgE did not improve the detection of atopy obtained by SPT, and could be avoided as atopy screening-test.

Las pruebas de parche no están recomendadas en la evaluación del síndrome de enterocolitis inducida por proteínas alimentarias

Con sumo interés hemos leído el caso presentado por González Cruz et al., en el que se describe la presentación clínica del síndrome de enterocolitis inducida por proteínas alimentarias (SEIPA), así como su diagnóstico y tratamiento. Nos llamó la atención que los autores describan la prueba de parche como método de corroboración diagnóstica de esa enfermedad. La guía internacional más reciente no pudo realizar recomendación alguna respecto a su uso debido a los resultados contradictorios obtenidos en estudios clínicos. En el consenso español entre pediatras de atención primaria, gastroenterólogos pediatras y alergólogos pediatras no se recomienda la prueba de parche para la confirmación diagnóstica del SEIPA inducido por proteína de la leche de vaca, el desencadenante más común de esta entidad.

Allergic rhinitis in children: from diagnosis to therapy

Allergic rhinitis, according to modern data, affects up to a quarter of the population of developed countries. The disease affects not only the nasal mucosa, but also affects the receptors and mediators of inflammation in the bone marrow. A significant decrease in the quality of life of patients against the background of exacerbation of allergic rhinitis makes us look for new approaches to both the treatment of attacks and their prevention. Correction, including surgical, of concomitant pathology of the nasal cavity and paranasal sinuses significantly improves the quality of life of patients with allergic rhinitis. For a long time, surgical treatment of concomitant pathology of the nasal cavity in children was extremely limited due to the risk of damage to the growth zones and, as a consequence, a high probability of recurrence of deformation of the structures of the nose and paranasal sinuses. With the development of endoscopic methods of surgical treatment of the nasal cavity and paranasal sinuses, operations with minimal invasiveness and, as a consequence, safe at any age were introduced into practice. Surgical intervention on the structures of the lymphoid pharyngeal ring in children with allergic rhinitis is causing heated debate in the pediatric community to date. The article considers modern approaches to the diagnosis and treatment of allergic rhinitis in children. Topical problems of conservative and surgical treatment are discussed. Special attention is paid to the safety of various treatment regimens. The discussed practical issues of tactics of treatment of allergic rhinitis are relevant for both pediatric allergists and ENT pediatricians.

Prenatal mold exposure is associated with development of atopic dermatitis in infants through allergic inflammation

ObjectiveMold exposure in early life may be associated with development of atopic dermatitis; however, studies of this link are inconclusive and evidence for the underlying mechanism(s) is lacking. This study identified the association between the time of mold exposure and development of atopic dermatitis and investigated the underlying mechanisms. MethodThe association between atopic dermatitis and mold exposure was examined in the Cohort for Childhood Origin of Asthma and Allergic Diseases birth cohort study (n=1446). Atopic dermatitis was diagnosed at 1 year of age by pediatric allergists. Exposure to mold was assessed by questionnaire. The Illumina MiSeq platform was used to examine the environmental mycobiome in 20 randomly selected healthy infants and 20 infants with atopic dermatitis at 36 weeks of gestation. ResultsPrenatal, but not postnatal, mold exposure was significantly associated with atopic dermatitis (adjusted odds ratio, 1.36; 95% confidence interval, 1.01-1.83). Levels of total serum IgE at 1 year of age were higher in infants with atopic dermatitis exposed to mold during pregnancy than in healthy infants not exposed to mold during pregnancy (p=0.021). The relative abundance of uncultured Ascomycota was higher in infants with atopic dermatitis than in healthy infants. The relative abundance of uncultured Ascomycota correlated with total serum IgE levels at 1 year of age (r=0.613, p<0.001). ConclusionIndoor mold exposure during the fetal period is associated with development of atopic dermatitis via IgE‐mediated allergic inflammation. Avoidance of mold exposure during this critical period might prevent the development of atopic dermatitis.

Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section IV: Consensus Statements on the Assessment and Management of Pediatric Atopic Dermatitis.

This document is intended to provide practical guidance to physicians treating pediatric atopic dermatitis (AD), especially dermatologists, pediatricians, allergists, and other health-care professionals. The recommendations contained here were formalized based on a consensus of 12 Canadian pediatric dermatologists, dermatologists, pediatricians, and pediatric allergists with extensive experience managing AD in the pediatric population. A modified Delphi process was adopted with iterative voting on a 5-point Likert scale, with a prespecified agreement cutoff of 75%. Topic areas addressed in the 17 consensus statements reflect areas of practical management, including counselling, assessment, comorbidity management, and therapy.

Diagnosis of atopic dermatitis in children: comparison of the Hanifin-Rajka and the United Kingdom Working Party criteria

BackgroundAtopic dermatitis (AD) is the most common chronic skin disease in childhood. There is no definitive test for diagnosing AD. The Hanifin-Rajka criteria (HRC) and The United Kingdom Working Party criteria (UKC) are the most used in the literature. It is aimed to evaluate the clinical efficacy of HRC and UKC in pediatric age. MethodsChildren diagnosed AD in the pediatric allergy clinic were enrolled. Patients with skin problems other than AD were involved as controls. All participants were evaluated for HRC and UKC at the time of diagnosis. Clinical diagnosis by the pediatric allergist was determined as the gold standard. Results200 children with AD and 90 controls were enrolled in the study. Median (interquartile range, IQR) age of AD patients was 13.5 (7–36) months. There was no significant difference in age and sex between groups (p=0.11 and p=0.34, respectively). The HRC were superior to the UKC for sensitivity, negative predictive value, kappa and accuracy rate (94% vs. 72%, 84% vs. 60%, 0.68 vs. 0.56 and 87 vs. 78, respectively). On the other hand, specificity and positive predictive value of UKC were better than those of HRC (92% vs. 71% and 95% vs. 88%, respectively). ConclusionHRC seem to be better in diagnosing AD than UKC for young children. Further studies are needed to evaluate comparableness of HRC and UKC for AD in childhood in order to generate an international consensus for clinical trials.

Asymptomatic toddlers with house dust mite sensitization at risk of asthma and abnormal lung functions at age 7 years

ObjectiveTo evaluate the predictive value of asymptomatic early house dust mite sensitization on allergic outcomes and pulmonary functions in 7-year olds. Study designThe Prediction of Allergies in Taiwanese Children (PATCH) birth cohort study recruited healthy newborns at birth. At age 1.5–2 years, a Dermatophagoides pteronyssinus-specific immunoglobulin E level ≥ 0.35 kU/L was defined as early sensitization. At age 7 years, allergic outcomes were evaluated by pediatric allergists and pulmonologists, and fractional exhaled nitric oxide and pulmonary functions were measured. ResultsAt age 1.5–2 years, 28.0% of toddlers were sensitized to D. pteronyssinus. Among them, 68.2% had no allergic symptoms at that time. At age 7 years, the children with early sensitization had higher risks of asthma (OR = 13.4, 95% CI, 1.2 to 153.0; P = 0.037), allergic rhinitis (OR = 10.2, 95% CI, 2.1 to 49.6; P = 0.004), and atopic dermatitis (OR = 38.5, 95% CI, 2.1 to 696.4; P = 0.014). Notably, even the asymptomatic toddlers with early D. pteronyssinus sensitization had higher probabilities of asthma (12.5% vs. 1.7%, P = 0.040), allergic rhinitis (83.3% vs. 43.1%, P = 0.009), and atopic dermatitis (20.8% vs. 0.0%, P < 0.001) at age 7 years. The asymptomatic toddlers with early sensitization also had higher exhaled nitric oxide levels and higher prevalence of airway hyperresponsiveness at age 7 years. ConclusionAsymptomatic toddlers with early house dust mite sensitization have higher risks of developing asthma, allergic rhinitis, atopic dermatitis, and abnormal lung functions at age 7 years.

Reassessing the Risks of MMR Vaccination for Egg-Allergic Patients Referred by Healthcare Workers; a Clinical Paradigm

Background: Egg allergy for the Measles-Mumps-Rubella (MMR) vaccine is still the cause of concern for many healthcare workers and families due to reactions such as anaphylaxis. Objectives: This study aimed to reassess the risk of MMR vaccination in infants with egg allergy referred by healthcare workers. Methods: This cross-sectional observational study was performed in a university-affiliated hospital in Istanbul, Turkey, between March 2017 and September 2018. The study patients were one-year-old infants who were candidates for MMR vaccination, and referred to our outpatient allergy clinic by healthcare workers due to egg allergy. The children were diagnosed with egg allergy by a pediatric allergist and then received the MMR vaccine. Results: Among 50 children aged one year, 19 (38%) were female, and 31 (62%) were male. The diagnosis was atopic dermatitis in 29 (58%) patients, urticaria in 18 (36%) patients, angioedema in 2 (4%) patients, and anaphylaxis in one (2%) patient. Fourteen (28%) patients had both egg and cow’s milk allergy. Four (8%) patients had egg, cow’s milk, and wheat allergy. The total IgE level was 119.80 ± 213.43 IU/mL. Specific IgE levels for egg white were positive in 37 patients. Specific IgE levels for egg white were 15.26 ± 29.64 kU/L. Skin prick test results were positive for egg allergens in 35 patients with a mean diameter of 3.12 ± 2.18 mm for egg yolk and 3.27 ± 2.62 mm for egg white. None of the patients with egg allergy developed anaphylactic reaction and only one patient had urticaria within 5 min after vaccination. There was no correlation between specific IgE levels for egg white and diagnosis of the patients. Conclusions: MMR vaccine administration to children with egg allergy is safe. Life-threatening reactions to the MMR vaccine in patients with egg-allergy are very rare. It seems in cases of hypersensitivity reactions such as acute anaphylaxis events, the MMR vaccine needs to be administered in a hospital under the supervision of a pediatric allergist.

Food Protein-Induced Enterocolitis Syndrome: Proposals for New Definitions.

Acute food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated allergy and is characterized by repetitive profuse vomiting episodes, often in association with pallor, lethargy, and diarrhea, presenting within 1–4 h from the ingestion of a triggering food. In 2017, the international consensus guidelines for the diagnosis and management of FPIES were published. They cover all aspects of this syndrome, which in recent decades has attracted the attention of pediatric allergists. In particular, the consensus proposed innovative diagnostic criteria. However, the diagnosis of acute FPIES is still currently discussed because the interest in this disease is relatively recent and, above all, there are no validated panels of diagnostic criteria. We propose some ideas for reflection on the diagnostic and suspicion criteria of acute FPIES with exemplary stories of children certainly or probably suffering from acute FPIES. For example, we believe that new definitions should be produced for mild forms of FPIES, multiple forms, and those with IgE-mediated symptoms. Moreover, we propose two clinical criteria to suspect acute FPIES and to refer the child to the diagnostic oral food challenge.

Antihistamines in pediatric allergology

Allergic diseases without a doubt have become one of the biggest problems of pediatrics in recent decades. One of the evidence of this is the maximum occupancy of halls at the IV All-Russian Congress of the Association of Pediatric Allergists and Immunologists of Russia. The symposium «Antihistamines in children’s allergology» was among the most popular.

Current Status of Patient Education in the Management of Atopic Dermatitis in Korea

Patient education is important for successful management of atopic dermatitis; however, due to limited time and resources, patient education remains insufficient. This study aimed to investigate the current state of education provided by Korean dermatologists, pediatric allergists, and allergists to patients with atopic dermatitis. A questionnaire survey consisting of items regarding educational programs for patients with atopic dermatitis was conducted via e-mail. In total, 153 participants responded to the questionnaires, and 26.8% indicated that they have had separate educational programs. The workforce involved in the educational program included nurses, residents or fellows, dieticians, pharmacists, and clinical psychologists. Most education protocols addressed the characteristics and natural course of atopic dermatitis and environmental management. Overall, 96.7% of the participants replied that an additional charge is needed for education; moreover, additional assistance from an academic society or association, in the form of medical staff, organized data, and advertisement, is required to develop and provide a well-structured educational program. A standardized education protocol will effectively provide appropriate education for patients with atopic dermatitis. Arrangement of education fees, covered by the National Health Insurance Service, will lead to the establishment of a structured educational program and participation of an additional medical workforce.

Stinging insect hypersensitivity: Evaluation and management in children and youth.

There are two types of IgE-mediated reactions to stinging insects: large local reactions and systemic reactions. Acute management of large local reactions is symptomatic and a patient history of a large local reaction does not indicate need for an epinephrine auto-injector or venom immunotherapy. By contrast, acute management of systemic reactions requires intramuscular epinephrine. Long-term management includes prescribing an epinephrine auto-injector and consideration for venom immunotherapy by a paediatric allergist.

Prenatal mold exposure is associated with development of atopic dermatitis in infants through allergic inflammation

ObjectiveMold exposure in early life may be associated with development of atopic dermatitis; however, studies of this link are inconclusive and evidence for the underlying mechanism(s) is lacking. This study identified the association between the time of mold exposure and development of atopic dermatitis and investigated the underlying mechanisms. MethodThe association between atopic dermatitis and mold exposure was examined in the Cohort for Childhood Origin of Asthma and Allergic Diseases birth cohort study (n=1446). Atopic dermatitis was diagnosed at 1 year of age by pediatric allergists. Exposure to mold was assessed by questionnaire. The Illumina MiSeq platform was used to examine the environmental mycobiome in 20 randomly selected healthy infants and 20 infants with atopic dermatitis at 36 weeks of gestation. ResultsPrenatal, but not postnatal, mold exposure was significantly associated with atopic dermatitis (adjusted odds ratio, 1.36; 95% confidence interval, 1.01–1.83). Levels of total serum IgE at 1 year of age were higher in infants with atopic dermatitis exposed to mold during pregnancy than in healthy infants not exposed to mold during pregnancy (p=0.021). The relative abundance of uncultured Ascomycota was higher in infants with atopic dermatitis than in healthy infants. The relative abundance of uncultured Ascomycota correlated with total serum IgE levels at 1 year of age (r=0.613, p<0.001). ConclusionIndoor mold exposure during the fetal period is associated with development of atopic dermatitis via IgE-mediated allergic inflammation. Avoidance of mold exposure during this critical period might prevent the development of atopic dermatitis.

Partially hydrolyzed formula in non-exclusively breastfed infants: A systematic review and expert consensus.

Guidance and evidence supporting routine use of partially hydrolyzed formula (pHF) versus intact cows' milk protein (CMP) formula are limited in non-exclusively breastfed infants. The aim of this review was to better clarify issues of routine use of pHF in non-exclusively breastfed infants who are not at risk for allergic disease by using a systematic review and Delphi Panel consensus. A systematic review and Delphi consensus panel (consisting of eight8 international pediatric allergists and gastroenterologists) was conducted to evaluate evidence supporting growth, tolerability, and effectiveness of pHF in non-exclusively breastfed infants. None of the studies reviewed identified potential harm of pHF use compared with CMP in non-exclusively breastfed infants. There was an expert consensus that pHF use is likely as safe as intact CMP formula, given studies suggesting these have comparable nutritional parameters. No high-quality studies were identified evaluating the use of pHF to prevent allergic disease in non-exclusively breastfed infants who are not at risk for allergic disease (e.g., lacking a parental history of allergy). Limited data suggest that pHF use in non-exclusively breastfed infants may be associated with improved gastric emptying, decreased colic incidence, and other common functional gastrointestinal symptoms compared with CMP. However, because the data are of insufficient quality, the findings from these studies have to be taken with caution. No studies were identified that directly compared the different types of pHF, but there was an expert consensus that growth, allergenicity, tolerability, effectiveness, and clinical role among such pHF products may differ. Limited data exist evaluating routine use of pHFs in non-exclusively breastfed infants, with no contraindications identified in the systematic review. An expert consensus considers pHFs for which data were available to be as safe as CMP formula as growth is normal. The preventive effect on allergy of pHF in infants who are not at risk for allergic disease has been poorly studied. Cost of pHF versus starter formula with intact protein differs from country to country. However, further studies in larger populations are needed to clinically confirm the benefits of routine use of pHF in non-exclusively breastfed infants. These studies should also address potential consumer preference bias.

Cord Blood Soluble Fas Ligand Predicts Allergic Rhinitis, Obstructive-type Lung Function, and Mite Sensitization at Seven Year-old Children: The PATCH study

Cord blood soluble Fas ligand (sFasL), an innate immunity marker, was related to asthma, allergic rhinitis, and atopic dermatitis at some cross-sectional or short-term follow-up studies. The Prediction of Allergies in Taiwanese Children (PATCH) study is a birth cohort study, focusing on the epidemiology and predictive factors of asthma and allergies in children. So, we investigated the relationship of cord blood sFasL and allergic outcomes in this long-term follow-up birth cohort study. The PATCH study recruited 258 pregnant women for a prospective birth cohort study. Umbilical cord bloods were collected at birth. At the age of seven, children’s allergic outcomes (e.g. asthma, allergic rhinitis, and atopic dermatitis) were diagnosed by pediatric allergists. Blood tests, fractional exhaled nitric oxide (FeNO) tests, and pulmonary function tests were conducted. Independent t test and linear regression were used for analyses. 132 (51%) children were followed up until 7 year-of-age. Cord blood sFasL levels were higher in children with allergic rhinitis (p=0.012) and expiratory airflow limitation (FE1/FVC<90%, p=0.022). FeNO levels at 7 year-of-age were highly correlated with cord blood sFasL levels (p=0.006). Children with atopy (immunoglobulin E levels more than 100kU/L) and house dust mite sensitization had higher cord blood sFasL levels (both p=0.003). At this birth cohort, cord blood sFasL levels were associated with allergic rhinitis, obstructive-type lung function, FeNO, and house dust mite sensitization at 7 year-old children. Cord blood sFasL level might be used as a predictor for future allergic outcomes at 7 year-of-age.

Gut Streptococcus species affect persistence and severity of atopic dermatitis during infancy

Perturbations of gut microbiota in early life can disrupt the development of immune system and directly associated with the risk of atopic dermatitis (AD). This study evaluated the association between persistence and severity of AD and the composition of gut microbiota at 6 months of age. The composition of gut microbiota was analyzed in fecal samples from 116 infants (6-month-old) by pyrosequencing, including 58 healthy infants and 58 infants with AD from Cohort for Childhood Origin of Asthma and Allergic Diseases (COCOA). AD in infants was diagnosed by a pediatric allergists at 6 months and 1 year of age, and severity of physical symptoms assessed by the SCORAD (Scoring Atopic Dermatitis) index at 6 months. Persistence was defined as AD symptom up to 12 months. The OTUs (P = 0.027) and Simpson index (P = 0.006) of diversity in gut microbiota were lower in healthy infants than those in persistent AD infants. The composition of Streptococcus was enriched in persistence AD infants than healthy infants (P = 0.001). The composition of Streptococcus pseudopneumoniae, Streptococcus mitis and Streptococcus salivarius were enriched in infants with persistent AD, compared to healthy infants. The relative abundance of S. pseudopneumoniae was increased in persistence AD infants compared with non-persistence AD. The relative abundance of gut S. mitis and S. pseudoneumoniae were positively correlated with serum IgE in infants with AD. S. pseudoneumoniae was positively correlated with SCORAD. Gut Streptococcus may affect persistence and severity of AD via IgE mediated allergic inflammation.

Current state and future of pediatric allergology in Europe: A road map.

The history of pediatric allergology (PA) in Europe is relatively youthful, dating back to 1984, when a small group of pediatricians founded the European Working Group on Pediatric Allergy and Immunology-later giving rise to ESPACI (European Society on Pediatric Allergology and Clinical Immunology). In 1990, the first dedicated journal, Pediatric Allergy and Immunology (PAI), was founded. There are striking differences across Europe, and even within European countries, in relation to the training pathways for doctors seeing children with allergic disease(s). In 2016, the EAACIClemens von Pirquet Foundation (CvP) organized and sponsored a workshop with the European Academy of Allergy and Clinical Immunology (EAACI) Pediatric Section. This collaboration focussed on the future of PA and specifically on education, research, and networking/ advocacy. The delegates representing many countries across Europe have endorsed the concept that optimal care of children with allergic diseases is delivered by pediatricians who have received dedicated training in allergy, or allergists who have received dedicated training in pediatrics. In order to meet the needs of children and families with allergic disease(s), the pediatric allergist is highly encouraged to develop several networks. Our challenge is to reinforce a clear strategic approach to scientific excellence to across our member base and to ensure and enhance the relevance of European pediatric research in allergy. With research opportunities in basic, translational, clinical, and epidemiologic trials, more trainees and trained specialists are needed and it is an exciting time to be a pediatric allergologist.