Background and Study Aims: The need to administer procedural sedation to children has increased in recent years, as has experience in this field among nonanesthesiologists. Using propofol makes it easier to achieve sufficiently deep sedation. There is a considerable literature on the administration of propofol by nonanesthesiologists for gastroscopy in adults, but very few data are available on this issue in children. The aim of the present study was to assess the safety and efficacy of procedural sedation with propofol for gastroscopy in a pediatric ward with trained personnel and monitoring facilities. Patients and Methods: A training protocol was developed to educate nurses and residents. Children requiring gastroscopy were included in the study prospectively and underwent procedural sedation with propofol administered by nonanesthesiologists. Results: A total of 811 upper gastrointestinal endoscopies were carried out with procedural sedation. Sedation was achieved in all procedures, and all but three (0.4 %) were conducted successfully. None of the patients required intubation. Stridor with signs of upper airway obstruction occurred in 14 of the 811 procedures (1.7 %). Laryngoscopy was required to manage difficulties in introducing the gastroscope in 16 of the 811 procedures (2.0 %). Major desaturation requiring a short course of ventilation occurred in six procedures (0.7 %), and transient desaturation that resolved spontaneously occurred in 97 of the procedures (12 %). Conclusions: Administration of propofol by nonanesthesiologists for gastroscopy examinations in children was successful in this study, but was associated with a small risk of potentially severe complications. Although the residents were generally able to administer procedural sedation alone, constant and immediate availability of anesthesiological support continues to be mandatory.

Asthma affects 10% of the worldwide population; about 5% of cases are severe with the need for target therapies such as biologics. All the biologics approved for asthma hit the T2 pathway of inflammation. T2-high asthma is classified as allergic and non-allergic, whereas T2-low asthma can be further defined as paucigranulocytic asthma, Type 1 and Type-17 inflammation and the neutrophilic form that accounts for 20–30% of all patients with asthma. Neutrophilic asthma’s prevalence is even higher in patients with severe or refractory asthma. We searched Medline and PubMed archives from the past ten years for articles with the subsequent titles: “neutrophilic asthma”, “non-type 2 asthma” and “paucigranulocytic asthma”. We identified 177 articles; 49 were considered relevant by the title and 33 by the reading of the Most of these articles are reviews (n = 19); only 6 are clinical trials. No study identified an effective treatment. We used the literature reported by these articles to search for further biologic treatments that target pathways different from T2. We identified 177 articles, 93 of which were considered relevant for the review and included in the present article. In conclusion, T2-low asthma remains poorly investigated in terms of biomarkers, especially as a therapeutic orphan disease.

Few studies on the age of resolution of Food Protein Induced Enterocolitis Syndrome (FPIES) induced by solid foods are available. In particular, for FPIES induced by egg, the mean age of tolerance acquisition reported in the literature ranges from 42 to 63 months. We have assessed whether the age of tolerance acquisition in acute egg FPIES varies depending on whether the egg is cooked or raw. We conducted a retrospective and multicentric study of children with diagnosis of acute egg FPIES seen in 10 Italian allergy units between July 2003 and October 2017. The collected data regarded sex, presence of other allergic diseases, age of onset of symptoms, kind and severity of symptoms, cooking technique of the ingested egg, outcome of the allergy test, age of tolerance acquisition. Sixty-one children with acute egg FPIES were enrolled, 34 (56%) males and 27 (44%) females. Tolerance to cooked egg has been demonstrated by 47/61 (77%) children at a mean age of 30.2 months. For 32 of them, tolerance to raw egg has been demonstrated at a mean age of 43.9 months. No episodes of severe adverse reaction after baked egg ingestion have been recorded. It is possible to perform an OFC with baked egg, to verify the possible acquisition of tolerance, at about 30 months of life in children with acute egg FPIES.