Background and Objectives: Measurement of fractional exhaled nitric oxide (FeNO) concentration is currently used as a non-invasive biomarker to assess airway inflammation. Many factors can influence the FeNO level. However, there have been no reports concerning factors attributed to FeNO levels in different age groups of children, especially those with high FeNO values. Therefore, this study aimed to assess the influence of selected factors on nitric oxide concentration in exhaled air in children aged 8–9 attending class 3 of public primary schools in Krakow with high FeNO values ≥ 20 ppb. Materials and Methods: The population-based study covered all third-grade pupils attending primary schools in the city of Krakow. Five thousand, four hundred and sixty children participated in the first screening stage, conducted from October 2017 to January 2018. Then, 792 participants with an FeNO level ≥ 20 ppb were selected. Finally, those selected pupils were invited to participate in the second stage, diagnostic, in April 2018. Four hundred and fifty-four children completed the diagnostic stage of the study, and their data was included in the presented analysis. Results and Conclusions: Significantly higher FeNO levels were observed in children diagnosed with the following diseases: asthma, allergic rhinitis, atopic dermatitis, and allergy (p < 0.05). In addition, it was observed that a higher FeNO concentration characterised children taking antihistamines compared to children not taking those medications (p = 0.008). In multivariate models, we observed that regardless of sex, age, BMI value, home smoking, and whether they were taking medications, children who had allergic rhinitis, or atopic dermatitis, or allergies had significantly higher FeNO levels. The strongest relationship was noted with allergic diseases. The results of our study may be of importance to clinicians when interpreting FeNO results, for example, when making a therapeutic decision.

Significant discrepancies among anaphylaxis severity scores may delay epinephrine administration. The study aims to develop a transparent severity grading system of foodinduced acute allergic reactions with decision model for epinephrine use. The natural course of 315 acute food-induced allergic reactions in children hospitalized at the Allergology Department between May 2016, and July 2019 due to follow-up treatment and/or allergy diagnostics, was evaluated. The severity of episodes was classified according to the five most accepted grading systems. The inter-rater reliability of classification between anaphylaxis severity scores was assessed. All symptoms were grouped into a heat map according to their real-life incidence and clinical relevance. Based on the heat map analysis, a severity grading system of foodinduced acute allergic reactions in children,with the epinephrine administration decision model, was created. Data from 259 food-induced anaphylaxis episodes in 157 children were included in the analysis. Comparing the grading systems, we observed from 24.7% to 70.2% disagreement between severity scores. The heat map showed a strong association between 29 symptoms and their categorization. A new severity grading system was developed and a two-stage decision model was proposed: "epinephrine yes" (any rapidly progressing symptoms, even mild or from one organ system; any symptoms from more than one organ system; every grade of anaphylaxis), and "epinephrine available and prepared to use" (non-progressing mild systemic allergic reaction from one system area only; no anaphylaxis). A new severity grading system of food-induced acute allergic reactions in children could serve as a clinical tool for healthcare professionals to avoid epinephrine administration delay.

The consequences of air pollution pose one of the most serious threats to human health, and especially impact children from large agglomerations. The measurement of nitric oxide concentration in exhaled air (FeNO) is a valuable biomarker in detecting and monitoring airway inflammation. However, only a few studies have assessed the relationship between FeNO and the level of air pollution. The study aims to estimate the concentration of FeNO in the population of children aged 8–9 attending the third grade of public primary schools in Krakow, as well as to determine the relationship between FeNO concentration and dust and gaseous air pollutants. The research included 4580 children aged 8–9 years who had two FeNO measurements in the winter–autumn and spring–summer periods. The degree of air pollution was obtained from the Regional Inspectorate of Environmental Protection in Krakow. The concentration of pollutants was obtained from three measurement stations located in different parts of the city. The FeNO results were related to air pollution parameters. The study showed weak but significant relationships between FeNO and air pollution parameters. The most significant positive correlations were found for CO8h (r = 0.1491, p < 0.001), C₆H₆ (r = 0.1420, p < 0.001), PM₁₀ (r = 0.1054, p < 0.001) and PM_2.5 (r = 0.1112, p < 0.001). We suggest that particulate and gaseous air pollutants impact FeNO concentration in children aged 8–9 years. More research is needed to assess the impact of air pollution on FeNO concentration in children. The results of such studies could help to explain the increase in the number of allergic and respiratory diseases seen in children in recent decades.

Obciążenie chorobami związanymi z zanieczyszczeniem powietrza ma poważne znaczenie dla zdrowia ludzi na całym świecie. Wpływ zanieczyszczenia powietrza na organizm człowieka zawiera bardzo szerokie spektrum objawów od najłagodniejszych aż do zgonu. Dzieci, zwłaszcza najmłodsze, ze względu na okres rozwojowy oraz związaną z tym niedojrzałość, są w większym stopniu niż dorośli narażone na wnikanie, koncentrację i toksyczne skutki zanieczyszczeń powietrza w drogach oddechowych. Pomiar stężenie tlenku azotu w wydychanym powietrzu (FeNO) jest cenną i prostą metodą diagnostyczną dostarczającą istotnych informacji o procesach chorobowych toczących się w układzie oddechowym. Jest uznanym biomarkerem oraz wyznacznikiem ilościowym w wykrywaniu oraz monitorowaniu stanu zapalnego górnych i dolnych dróg oddechowych, zwłaszcza zapalenia eozynofilowego, astmy oraz alergicznego nieżytu nosa. Celem pracy jest przedstawienie pomiaru stężenie tlenku azotu w wydychanym powietrzu (FeNO) jako prostej metody przydatnej w ocenie stanu pacjenta pediatrycznego oraz ukazanie wpływu zanieczyszczeń powietrza na poziom FeNO na podstawie dostępnej literatury. Wiele prac badawczych wykazało związek pomiędzy poziomem FeNO a zanieczyszczeniem powietrza. Potrzebne są dalsze badania oceniające wpływ gazowych i pyłowych zanieczyszczeń powietrza na poziom FeNO.

In order to establish the reliability of new multiplex tests for determining allergen-specific immunoglobulin E (asIgE) levels in serum, the results of asIgE determinations obtained via ALEX tests were compared to those obtained via ImmunoCAP ISAC in a group of 40 Polish children hospitalized due to food allergy and/or anaphylaxis. The analysis was based on 6320 determinations of asIgEs relative to 79 common allergen molecules included in both tests (80 tests conducted—40 ALEX and 40 ISAC). The study showed a high correlation of results between the compared diagnostic tests, with the concordance of asIgE determinations at the level of 92.5% (n = 2922). The results of this study showed the sensitivity of the ALEX test to be comparable with that of the ImmunoCAP ISAC test. One indisputable advantage of the ALEX test is its high number of determinations per procedure, which provides more information about the patient’s molecular profile; moreover, the use of an inhibitor of the asIgEs that bind to cross-reactive carbohydrate determinants (CCDs) reduces their impact on the results for allergens naturally containing carbohydrate determinants. Comparative analyses of asIgE test results obtained with ALEX and ImmunoCAP ISAC tests demonstrate that the ALEX test is a reliable diagnostic tool for asIgE assessments. However, significant differences in the absolute values of asIgEs relative to individual molecules suggest the need for caution when directly comparing asIgE levels from both tests.

Atopic dermatitis is a chronic recurrent skin disease characterised by itching and eczematous skin lesions. The paper presents the case of a 62-year-old female patient suffering from atopic dermatitis, in whom symptoms were observed within the nail apparatus of the hand, including red rings, Beau lines, lack of cuticle and lichenification with erosions, cracks, scabs, and residual blisters on the backs of the hands. The patient experienced severe itching, which led to increased manipulations within the nail apparatus (onychotillomania), which was reflected in the presence of the so-called tare nails. The patient’s treatment included the use of topical medications, including clobetasol propionate, mometasone, and tacrolimus 0.1%, as well as intensive hand lubrication and the use of specialised hand cleansers. Intensification of mental health care was also recommended. The presented case highlights the importance of a comprehensive approach to the treatment of atopic dermatitis, especially in the era of new therapeutic methods.