This review aims to provide a comprehensive overview of how oxidative stress drives inflammation, structural remodeling, and clinical expression of childhood asthma, while critically appraising emerging redox-sensitive biomarkers and antioxidant-focused preventive and therapeutic strategies. Oxidative stress arises when reactive oxygen species (ROS) and reactive nitrogen species (RNS) outpace airway defenses. This surplus provokes airway inflammation: ROS/RNS activate nuclear factor kappa-B (NF-κB) and activator protein-1 (AP-1), recruit eosinophils and neutrophils, and amplify type-2 cytokines. Normally, an antioxidant network—glutathione (GSH), enzymes such as catalase (CAT) and superoxide dismutase (SOD), and nuclear factor erythroid 2-related factor 2 (Nrf2)—maintains redox balance. Prenatal and early exposure to fine particulate matter <2.5 micrometers (µm) (PM_2.5), aeroallergens, and tobacco smoke, together with polymorphisms in glutathione S-transferase P1 (GSTP1) and CAT, overwhelm these defenses, driving epithelial damage, airway remodeling, and corticosteroid resistance—the core of childhood asthma pathogenesis. Clinically, biomarkers such as exhaled 8-isoprostane, hydrogen peroxide (H₂O₂), and fractional exhaled nitric oxide (FeNO) surge during exacerbations and predict relapses. Therapeutic avenues include Mediterranean-style diet, regular aerobic exercise, pharmacological Nrf2 activators, GSH precursors, and mitochondria-targeted antioxidants; early trials report improved lung function and fewer attacks. Ongoing translational research remains imperative to substantiate these approaches and to enable the personalization of therapy through individual redox status and genetic susceptibility, ultimately transforming the care and prognosis of pediatric asthma.

Background: Protracted bacterial bronchitis (PBB) and bronchiectasis share common clinical and microbiological features, but direct comparative data in children are limited. Objectives: To compare bronchoalveolar lavage (BAL) microbiology between pediatric PBB and bronchiectasis and identify predictors of lower airway and polymicrobial infections. Methods: We retrospectively reviewed children diagnosed with PBB or bronchiectasis at a tertiary center (January 2019–June 2025) who underwent both high-resolution computed tomography of the chest and bronchoscopy with BAL within a 6-month period. Multivariable logistic regression was used to identify predictors of lower airway and polymicrobial infections, adjusting for age, gender, tracheomalacia/bronchomalacia, asthma, and Bhalla score. Results: Among 135 children (85 with PBB, 50 with bronchiectasis), those with bronchiectasis were older (median 7.8 vs. 4.2 years, p < 0.001), while comorbidities showed statistically non-significant differences. The prevalence of lower airway infection was high (PBB 81.2%, bronchiectasis 74.0%; p = 0.330). Pathogen distribution demonstrated statistically non-significant differences between groups after adjustment, with Haemophilus influenzae being the most common pathogen in both groups. Moraxella catarrhalis was more frequent in PBB in unadjusted analysis (21.2% vs. 8.0%; p = 0.045), but this difference did not persist after adjustment. Polymicrobial infection occurred in 25.9% of PBB and 16.0% of bronchiectasis cases (p = 0.180). In regression analyses, younger age independently predicted polymicrobial infection (adjusted OR 0.81, 95% CI 0.69–0.95). Conclusions: BAL microbiology showed statistically non-significant differences between PBB and bronchiectasis, supporting the concept of a disease continuum. Younger children were more prone to polymicrobial infection. These findings support early targeted antibiotic therapy and close clinical surveillance to prevent progression to irreversible airway damage.

Objectives: This study aimed to synthesize evidence of the influence of multilevel social determinants of health (SDOHs) on asthma and allergic disease outcomes and healthcare utilization in children and adolescents, with a specific focus on how these determinants generate or widen health inequities, through a systematic review of the current literature and evidence. Methods: A literature search was performed in the PubMed, EBSCO, and Scopus databases. The search period for all databases was from 1 January 2020 to 15 January 2025. Studies published in English that evaluated the association between at least one SDOH, as a primary exposure or effect modifier, and asthma and/or allergic disease outcomes and healthcare utilization in children and adolescents aged ≤ 18 years were included. A narrative synthesis was conducted to systematically explore and compare findings across studies, grouped by SDOH domains and disease outcomes. The grouping of SDOH domains was based on the framework established by the Healthy People 2030 Initiative. The selected studies underwent a quality assessment. Results: After the eligibility assessment, 44 studies were included in this review. Regarding study design, twenty-one studies were cohort, followed by eighteen cross-sectional, three ecological, and two case-crossover studies. Disease outcomes covered incidence, severity/exacerbations, lung function, and healthcare use in asthma, and analogous measures also reported for atopic dermatitis, allergic rhinitis, and food allergy. The most frequently studied domain of SDOHs was Neighborhood and Built Environment (n = 26), followed by Economic Stability (n = 24), Social and Community Context (n = 21), Healthcare Access and Quality (n = 12), and Education Access and Stability (n = 10). The vast majority of studies (n = 31) found positive associations between the examined SDOH factors and asthma and/or allergic disease outcomes and healthcare utilization. The most frequently evaluated SDOH with positive associations were neighborhood and residential conditions (n = 10), discrimination (n = 8), parental education (n = 7), housing quality (n = 6), air pollution (n = 6), and household income (n = 5). Risk-of-bias appraisal showed that the evidence base was largely at low risk, with most cohort, cross-sectional, ecological and case-crossover studies rated good quality, and only a few cohort studies classified as fair because of limitations in exposure assessment and residual confounding control. Conclusions: These findings highlight the urgent need for coordinated interventions and policies addressing social, environmental, and economic factors to reduce health disparities and improve outcomes for vulnerable children, while stressing the importance of interventional studies to provide stronger evidence.

Severe pediatric asthma remains a significant clinical challenge despite advances in conventional therapy. Some children continue to experience persistent symptoms, recurrent exacerbations, and substantial morbidity despite optimized treatment with inhaled corticosteroids and long-acting bronchodilators. Advances in the understanding of asthma immunopathology, particularly type 2 (T2) inflammation, have led to the development of targeted biologics that modulate key inflammatory pathways. Several monoclonal antibodies are now approved for pediatric use, including the anti-immunoglobulin E (IgE) agent omalizumab, anti-interleukin (IL)-5 therapies such as mepolizumab, and the IL-4 receptor antagonist dupilumab. These biologics significantly reduce exacerbation rates, improve lung function, and decrease dependence on systemic corticosteroids in selected pediatric populations. Their effective use, however, requires careful assessment of clinical phenotypes and biomarkers, including blood eosinophils, serum IgE, and fractional exhaled nitric oxide. Uncertainties remain regarding treatment sequencing, duration, long-term safety, and cost-effectiveness. Agents targeting upstream epithelial cytokines, including tezepelumab, are broadening the therapeutic landscape. Despite this progress, pediatric evidence remains fragmented across age groups, biologic agents, study designs, and real-world cohorts, while many reviews focus on individual therapies or partly extrapolate from adult data. This review synthesizes pediatric evidence on efficacy, safety, biomarker-guided selection, age-related indications, and implementation challenges across approved and emerging biologics. It aims to provide clinicians with a practical framework for treatment selection and monitoring while identifying priorities for future pediatric research.

Allergic diseases are increasing globally, particularly among children, who are highly vulnerable due to critical windows of immune development. This review examines climate change as a key environmental determinant driving the rising burden of pediatric allergic diseases, including asthma, allergic rhinitis (AR), atopic dermatitis (AD), and food allergy (FA). Climate change influences disease risk through interconnected pathways, such as increased air pollution, altered aeroallergen patterns, and more frequent extreme weather events. Elevated carbon dioxide (CO₂) levels and rising temperatures prolong pollen seasons and enhance allergenicity, while pollutants such as ozone (O₃) and particulate matter (PM) exacerbate airway inflammation and immune dysregulation. Emerging evidence emphasizes the role of early-life exposure, particularly during prenatal and early postnatal periods, when environmental insults can induce long-term effects via epigenetic modifications and immune reprogramming. These mechanisms may increase susceptibility to allergic sensitization and subsequent disease development. Epidemiological studies consistently link exposure to air pollution, including PM₂.₅ (PM with aerodynamic diameter < 2.5 μm) and nitrogen dioxide (NO₂), with increased risk of allergic diseases in children. Additionally, climate change-related events such as wildfires, sand and dust storms, and thunderstorms further elevate exposure to allergens and pollutants, contributing to acute exacerbations and disease progression. Addressing this growing public health challenge requires integrated mitigation strategies to reduce greenhouse gas (GHG) emissions and improve air quality, alongside adaptive interventions to enhance resilience and reduce exposure. Understanding these mechanisms is essential for developing targeted prevention strategies and protecting child health in a changing climate.

Background/Objectives: High-quality pediatric emergency care requires timely access, effective communication, privacy, pain management, comfort, and child- and family-centered practices; however, implementation may be constrained by several barriers. The aim of the study was to evaluate the quality of pediatric emergency care as perceived by healthcare professionals, with emphasis on child-centered care and variations based on workplace and professional characteristics. Methods: A cross-sectional survey was performed in the emergency departments in two tertiary public pediatric hospitals in Athens, Greece. A study-developed 14-item Quality of Care Assessment Scale with paired ratings of agreement with quality principles and implementation in practice was completed by 162 professionals (122 doctors, 24 nurses, 16 assistant nurses). Independent items evaluated perceived barriers, overall assessments (0–100), and information provided to parents/children (5-point Likert scale). Inferential tests and descriptive statistics were also used (p < 0.05). Results: There was a significant degree of agreement with quality principles, but there was a constant lack of implementation (principle–practice gap). The primary perceived weakness was waiting times; child-friendly settings and privacy during examinations and information-giving were also lacking. Internal consistency ranged from good to acceptable (implementation α = 0.800; agreement α = 0.711). Children were most frequently rated as “moderately informed” (48.1%), while parents were most frequently rated as “quite informed” (50.0%). Compared to the organization of care (mean 60.85), perceived safety was higher (mean 73.27). Perceptions varied by age, educational level, profession, department, shift rotations, and hospital. The main barriers were workload (30.2%), poor coordination (34.0%), and lack of resources (46.9%). Conclusions: Health professionals seem to perceive that consistent delivery of child-centered care is impaired by organizational and structural limitations. Reducing the standards-to-practice gap requires targeted system-level interventions that focus on staffing, care organization, environment, and professional support.