Table 1 Five Recommendations of the Italian Society of Pediatric Allergy and Immunology – SIAIP

1

Avoid contraindicating routinely vaccination in case of allergies.

A history of allergies or mild allergic reactions are not contraindications to vaccination.

Local and mild systemic reactions (redness of the injection site and/or fever) after vaccination reactions are common and do not contraindicate the administration of doses of vaccine in the future. Special precautions should be followed only in the case of persons who have presented serious systemic reactions with risk of life (severe dyspnea, stridor, cyanosis, mental status changes, hypotension). The presence of sensitization to egg protein is not a contraindication to vaccination against measles, mumps and rubella.

Kelso et al. 2012 [11], Kelso et al. 2013 [12]

2

Avoid performing routinely allergy testing in children with acute urticaria.

The diagnosis of acute urticaria is basically clinical and infections (in particular viral infections) account the far most common cause during childhood. Testing patients for allergies is indicated only when there is a close temporal relationship between food ingestion and the appearance of urticarial eruption: laboratory investigations are not indicated in first instance, it is appropriate to limit allergologic tests to the skin test (SPT) by using commercial extracts or fresh food (prick by prick).

Zuberbier et al. 2009 [13], Capra et al. 2012 [14], Zuberbier et al. 2009 [15]

3

Avoid prescribing mucolytics in children with bronchial asthma.

Inflammation, mucosal edema and mucus hypersecretion increase the narrowing of the bronchial lumen with the formation of mucus plugs that worsen bronchial obstruction in patients with asthma. Studies conducted on the effectiveness of mucolytics to treat asthma and its exacerbations have demonstrated their poor effectiveness and the possibility of dangerous side effects. The most important International guidelines (GINA, ATS, BTS) don’t include mucolytics in the “management” of children with bronchial asthma. Mucolytics agents are also contraindicated under 2 years of age due to the risk of a substantial deterioration of respiratory function for a difficult bronchial drainage.

Balsamo et al. 2010 [16], Aliyali et al. 2010 [17], Linee guida GINA italiane 2013 [18]

4

Avoid prescribing routinely immunological tests in children with recurrent respiratory infections.

Immunological and genetic investigations are not need when the child is suffering from undifferentiated common viral infections affecting the upper airways and when there is no family history of primary lung diseases or hereditary immunodeficiencies. The decision to perform tests should be based not only on the number of infections, but expecially on their severity, on the presence of unusual or opportunistic germs, on the protracted course and on the occurrence of infections beyond the age of primary socialization. Complete blood cell count and the dosage of immunoglobulins are considered first level tests, together with the sweat test in patients with recurrence of ear infections, bacterial sinusitis, bronchopneumonia or other invasive infections.

Notarangelo 2009 [19], Brand et al. 2012 [20], Bousfiha et al. 2013 [21]

5

Avoid ruling out a food from the diet only for the positivity of skin prick tests and/or specific serum IgE.

An accurate medical history is essential for the diagnosis of food allergy, in particular should be investigated a framework compliant with food allergy and a temporal relationship between the introduction of food and the appearance of symptoms. The presence of skin test (prick test) and/or positive serum specific IgE against foods indicates only a sensitization, condition that can be compatible with the intake of a food. For a correct diagnosis of food allergy an oral food challenge test must be provided (if the history and skin prick tests/specific serum IgE are not exhaustive for diagnosis).

Boyce et al. [22], Burks et al. 2012 [23], Heinzerling et al. 2013 [24]