Air pollution is an unseen threat to children’s health because it may increase the risk of respiratory infection, atopy, and asthma, and also alter gut microbiota compositions. The impact of air pollution on children’s health has not been firmly established. A literature review followed by a series of discussions among experts were performed to develop a theoretical framework on how air pollution could affect various bodily organs and functions in children. We invited experts from different backgrounds, such as paediatricians, nutritionists, environmental health experts, and occupational health experts, to provide their views on this matter. This report summarizes the discussion of multidisciplinary experts on the impact of air pollution on children’s health. The report begins with a review of air pollution’s impact on allergy and immunology, neurodevelopment, and cardiometabolic risks, and ends with the conceptualization of a theoretical framework. While the allergic and immunological pathway is one of the most significant pathways for air pollution affecting children’s health in which microbiotas also play a role, several pathways have been proposed regarding the ability to affect neurodevelopment and cardiometabolic risk. Further research is required to confirm the link between air pollution and the gut microbiota pathway.

This study aims to evaluate safety issues of house dust mite subcutaneous immunotherapy (SCIT) among allergic rhinitis (AR) children. A retrospective cohort study was done between 2015 and 2020 to investigate the side effects of SCIT among AR children caused by a house dust mite allergy. Among 1098 patients who received house dust mite subcutaneous immunotherapy injections, 284 patients (25.87%) had side effects (SE). SE were found to be 699 times higher or in 2.27% of the 30,744 subcutaneous immunotherapy injections. A total of 17.9% of the patients had local SE during SCIT administration. Systemic side effects occurred in 8.38% of children receiving SCIT and in 0.53% of the total population who received SCIT injections. Only 2/92 (2.18%) of patients suffered an allergic reaction within 30 minutes of injection and these patients responded well to antiallergic medication. Severe anaphylaxis occurred in 0.091% of the 1098 patients in the SCIT group and in 0.0033% of the 30,774 SCIT injections. Systemic SE after SCIT occurred in 8.38% of patients receiving SCIT or 0.53% of the total number of SCIT injections. Anaphylactic episodes occurred in 16 patients (1.46%) and 15 patients (1.37%) who had first and second episodes. One severe attack was found and it was resolved with adrenaline. This study demonstrates that in pediatric patients with AR who received HDM SCIT for 18 months with high adherence, some experienced significant local SE and systemic SE caused by SCIT, but this did not interfere with the course of AR treatment or the effectiveness of SCIT.

Background: Until now, the cost of allergy treatment in the insured public health care system and the non-insured self-financing private health care system in Indonesia has not been well documented and published, as well as the cost of allergy treatment with subcutaneous immunotherapy. Objective: To evaluate the clinical and cost benefits of allergic rhinitis treatment in children with subcutaneous immunotherapy in a non-insured self-financing private health care system. Methods: A retrospective cohort study conducted from 2015 until 2020 that compared the clinical improvement and health care costs over 18 months in newly diagnosed AR children who received SCIT versus matched AR control subjects who did not receive SCIT, with each group consisting of 1098 subjects. Results: A decrease in sp-HDM-IgE level (kU/mL) from 20.5 + 8.75 kU/mL to 12.1 + 3.07 kU/mL was observed in the SCIT group. To reduce the symptom score of allergic rhinitis by 1.0 with SCIT, it costs IDR 21,753,062.7 per child, and for non-SCIT, it costs IDR 104,147,878.0 per child. Meanwhile, to reduce the medication score (MS) by 1.0 with SCIT, it costs IDR 17,024,138.8, while with non-SCIT, it costs IDR 104,147,878.0. Meanwhile, to lower combination symptoms and medication score (CSMS) by 1.0, with SCIT, it costs IDR 9,550,126.6, while with non-SCIT, it costs IDR 52,073,938.9. Conclusions: In conclusion, this first Indonesia-based study demonstrates substantial health care cost savings associated with SCIT for children with AR in an uninsured private health care system and provides strong evidence for the clinical benefits and cost-savings benefits of AR treatment in children.

A plausible association is suspected among air pollution, respiratory allergic disorder, and infection. These three factors could cause uncontrollable chronic inflammation in the airway tract, creating a negative impact on the physiology of the respiratory system. This review aims to understand the underlying pathophysiology in explaining the association among air pollution, respiratory allergy, and infection in the pediatric population and to capture the public’s attention regarding the interaction among these three factors, as they synergistically reduce the health status of children living in polluted countries globally, including Indonesia.

Background: Children with Down syndrome (DS) are prone to developing autoimmune thyroid disease (AITD). Previous studies found lower selenium (Se) levels in children with AITD. Glutathione peroxidase-3 (GPx3) and selenoprotein-P (SePP) are widely used to measure Se levels. DS children tend to have lower Se levels, the main contributor to hypothyroidism in this population. This study aimed to analyze the Se’s role in AITD in Indonesian children with DS.Methods: This cross-sectional study was conducted between February 2021-June 2022 at the Pediatric Outpatient Clinic of Dr Soetomo Hospital. DS children aged 1 month to 18 years were enrolled using consecutive sampling. Thyroid-stimulating hormone, free thyroxine, thyroid peroxidase (TPO-Ab) and thyroglobulin (Tg-Ab) autoantibody, GPx3, and SePP levels were measured in plasma samples using enzyme-linked immunosorbent assays. Statistical analyses used Chi-square, Mann–Whitney, and Spearman’s rank correlation (r_s). All results with p<0.05 were considered statistically significant.Results: Among 62 children with DS, SePP and GPx3 levels were significantly lower in those with AITD than those without AITD (p=0.013 and p=0.018, respectively). SePP and GPx3 levels correlated significantly with lower TPO-Ab (r_s=−0.439 with p=1×10^-5 and r_s=−0.396 with p=0.001, respectively) and Tg-Ab (r_s=−0.474 with p=1×10^-5 and r_s=−0.410 with p=0.001, respectively) levels. SePP levels correlated significantly with lower thyroid dysfunction incidence (r_s=-0.252, p=0.048) in the AITD group.Conclusion: Selenium deficiency contributes to autoimmune process in the thyroid and to thyroid dysfunction in children with Down syndrome. Our findings recommend increasing Se levels through Se-containing foods to reduce the risks of AITD and thyroid dysfunction in DS children with AITD.

Introduction: Allergic diseases have a high morbidity rate worldwide. The interaction between genetic and environmental factors plays an important role in shaping the early development of allergies, including exposure to cigarette smoke. The prevalence of children in Indonesia who are exposed to cigarette smoke is high. Thus, it is suspected that this will affect the emergence of allergies in children. This study aimed to determine the relationship between second-hand smoke exposure and early allergic manifestations in children. Methods: This was an observational analytic study with a cross-sectional design involving 190 pediatric patients who suffered from allergies in the allergy outpatient clinic at the Department of Pediatrics, Dr. Soetomo General Hospital Surabaya. Data were obtained through medical records. Results: This study showed that 50% of the patients have families who smoke at home, the most common early manifestations were at 11-20 months old (32.10%), and the most common early manifestations were respiratory manifestations (98.42%). There was a significant relationship between the presence of a family member who smoked at home with the age of early manifestation, respiratory manifestation, and skin manifestation in allergic pediatric patients (all p < 0.05). There was no significant relationship between the presence of family members who smoked at home with gastrointestinal manifestations in allergic pediatric patients (p = 0.301). Conclusion: There was a significant relationship between the presence of family members who smoke at home with age, respiratory tract, and skin manifestations in allergic pediatric patients.