More and more allergic children. And even that of allergies is assuming the dimensions of an epidemic in recent years. The alarm was raised by the experts of the Italian Society of Pediatric Allergy and Immunology (SIAIP) who in just over a month will meet for the XXIII National Congress (22-24 April). An eagerly awaited appointment to share and discuss the latest pediatric news on allergology and immunology and which, for this virtual edition, will have the pleasure of hosting the world-renowned immunologist Tony Fauci.
More and more allergic diseases with different symptoms
“In children under the age of 14 we now reach percentages ranging from 30 to 40% – confirms Gianluigi MARSEGLIA, Director of the Pediatric Clinic of the University of Pavia and President of SIAIP – This means that we are faced with a large number of diseases as allergic pathologies have a very varied clinical expression. For example, in children the symptoms mainly affect the skin: the first manifestation of an altered response of the immune system towards foreign substances is in fact atopic dermatitis, a disease that is expressed particularly in the first years of life. Over the years other manifestations become more evident, especially affecting the respiratory system, such as allergic rhinitis and asthma “.
Because allergy is compared to an epidemic
A condition, allergy, which is maintained throughout life with different clinical manifestations, even if it is not possible to predict its clinical expressiveness, that is, the severity of the symptoms that the pathology can determine. But what are the reasons for this epidemic?
There are several factors to consider. First of all the genetic predisposition, modulated by the environment. “In other words – continues Marsegli – if a genetically predisposed individual lives in an environment in which contact with foreign substances potentially capable of inducing allergy is scarce, the risk of these substances affecting genetics is very low. contact with substances that favor the development of allergies is high, the risk increases. When we talk about these foreign substances we are not referring exclusively to allergens, but also to situations that indirectly modulate the genetic predisposition, such as for example environmental pollution. The relationship between genetics and the environment is very important and explains why the epidemic of allergic diseases does not have the same impact in various parts of the world. Thus, if in Western countries we travel towards 50% of allergy sufferers under the age of 14, in other areas, for example in Africa, the percentages are much lower “.
The link between genetics and the environment
An example of the importance of the interaction between environment and genetics on the development of allergies is represented by what occurred in Germany following the fall of the Berlin Wall, a real large-scale experiment.
“The Berlin Wall had separated a population with the same genetics in two, exposing those living in the western part to the environmental changes of the developed countries in terms of lifestyle, way of heating, and so on. As a consequence the percentage of allergy sufferers in West Germany was very high, while it was much lower in East Germany, where, on the other hand, there were more problems of chronic bronchitis resulting from the greater pollution due to the use of coal for heating – recalls Marseglia – With the fall of the wall, the East Germans became westernized and in a very short time the percentage of allergy sufferers was equal to those of the west. All this to underline how in Western countries we are faced with an emergency situation, similar to the great infectious and non-infectious epidemics, such as obesity and the metabolic syndrome “.
What to do then?
What to do in the face of these ever-increasing percentages of allergic diseases which, moreover, we cannot predict the evolution in terms of severity over time? Experts are trying to find answers, both on the basic research front and on the clinical level.
“Thanks to basic research we are trying to understand how the environment modulates genetics. Understanding the molecular mechanisms underlying allergic manifestations is enabling the development of intelligent drugs that precisely target the mechanism that triggers the allergic reaction. This is an intervention that is part of precision medicine: today for example – continues Marseglia – we have intelligent monoclonal antibodies with which we are able to treat very serious allergic diseases, such as severe forms of asthma or atopic dermatitis, even in children. . A second line of research aims to identify the factors that can allow us to identify early subjects at potential risk of developing severe forms, in which we can establish environmental, food or pharmacological prevention to prevent these individuals from encountering more persistent forms. serious issues, all of which we will address on the occasion of the next SIAIP congress “.
A contribution to a more complete management of small allergic patients also comes from technology. An important role is played by telemedicine, for example.
“We are setting up telemedicine systems for the remote telematic management of allergic children and this has several advantages. A first benefit is on an economic level because, not having to move, parents are not forced to waste days of work to bring the children to make visits; remote controls also allow very close monitoring. For example – concludes the SIAIP President – in the case of a small asthmatic patient we can ask him or his parents to perform repeated spirometries whose results allow us to modulate the therapy on the basis of the changes observed. This is an extraordinary success, the result of technological evolution which, at the time of Covid, has an even more important impact. Another aspect, which we are pursuing and which will constitute a strong point of our next congress , is represented by the realization of an artificial intelligence project with big data, a field in which yes I love one of the first to go into it. In fact, it is one thing to evaluate information relating to a few tens or hundreds of patients, another is to collect the data of thousands of patients suffering from an allergic disease. This is information that will allow us to improve the diagnostic and therapeutic management of our patients “.