Cow’s milk proteins cause allergic symptoms in 2% to 3% of all infants. In these individuals, the physiological mechanism of tolerance is broken with subsequent possible sensitization to antigens, which can lead eventually to allergic responses. The present review aims to provide an overview of different aspects of immune modulation by dietary intervention in cow’s milk allergy (CMA). It focuses on pathogenetic mechanisms of different CMA related disorders, e.g., gastroesophageal reflux and eosinophilic esophagitis, highlighting the role of dietary management on innate and adaptive immune systems. The traditional dietary management of CMA has greatly changed in the last years, moving from a passive approach, consisting of an elimination diet to relieve symptoms, to a “proactive” one, meaning the possibility to actively modulate the immune system. Thus, new insights into the role of hydrolysates and baked milk in immunomodulation are addressed here. Additionally, nutritional components, such as pre- and probiotics, may target the immune system via microbiota, offering a possible road map for new CMA prevention and treatment strategies.

Allergic diseases represent a global burden. Although the patho-physiological mechanisms are still poorly understood, epithelial barrier dysfunction and Th2 inflammatory response play a pivotal role. Barrier dysfunction, characterized by a loss of differentiation, reduced junctional integrity, and altered innate defence, underpins the pathogenesis of allergic diseases. Epithelial barrier impairment may be a potential therapeutic target for new treatment strategies Up now, monoclonal antibodies and new molecules targeting specific pathways of the immune response have been developed, and others are under investigation, both for adult and paediatric populations, which are affected by atopic dermatitis (AD), asthma, allergic rhinitis (AR), chronic rhinosinusitis with nasal polyps (CRSwNP), or eosinophilic esophagitis (EoE). In children affected by severe asthma biologics targeting IgE, IL-5 and against IL-4 and IL-13 receptors are already available, and they have also been applied in CRSwNP. In severe AD Dupilumab, a biologic which inhibits both IL-4 and IL-13, the most important cytokines involved in inflammation response, has been approved for treatment of patients over 12 years. While a biological approach has already shown great efficacy on the treatment of severe atopic conditions, early intervention to restore epithelial barrier integrity, and function may prevent the inflammatory response and the development of the atopic march.

Congenital or acquired atrioventricular block (AVB) is a rare disorder in the pediatric population, while celiac disease (CeD) is a common multisystemic autoimmune disorder that is characterized by intestinal manifestations as they are the typical clinical presentation. Sometimes CeD presents more complex multisystemic involvement which includes the heart. Cardiac involvement, such as dilated cardiomyopathy, myocarditis or conduction disease, have been mainly described in untreated adult patients with or without gastro-intestinal symptoms; rare cases of AVB and CeD have been also reported, particularly in association with extra-cardiac manifestations. We describe a case of a progressive acquired AVB block in a 4-year-old child, in which CeD was later diagnosed. A rapid and significantly improvement of the AVB grade has been obtained after the child started a strict gluten-free diet, and so we suggest including diagnostic exams for CeD in all of the children with acquired AVB.

Background/Objectives: The distribution of body mass index (BMI) categories at celiac disease (CD) diagnosis in children is changing, and the impact of a gluten-free diet (GFD) on BMI status remains incompletely understood. We aimed to evaluate the distribution of BMI categories at CD diagnosis and their changes after 12–18 months on a GFD in Italian children. Methods: Children and adolescents aged 0–18 years who received a new diagnosis of CD at 23 Pediatric Gastroenterology referral centers in Italy were retrospectively enrolled. We analyzed their BMI status at diagnosis, classifying them as underweight, normal weight, overweight, or obese. BMI changes were assessed after 12–18 months on a GFD. Results: Among the 4967 children (mean age 7.1 ± 4.1 years, M:F = 1827:3140), 4.4% were underweight, 77.5% normal weight, 12.7% overweight, and 5.4% obese at diagnosis. Overweight/obese children were more likely to have a family history of CD, associated conditions, and an asymptomatic presentation. After 12–18 months of GFD, 55.7% of underweight children achieved normal weight, and 23% of overweight/obese reverted to normal weight. Conversely, 10.9% of normal-weight children and 3.2% of underweight children became overweight/obese. Conclusions: At diagnosis, most children were normal weight, but 18.1% presented with overweight/obesity. After 12–18 months on a GFD, BMI normalized in over half of underweight but in fewer than one-quarter of overweight/obese subjects.