Cow's milk allergy (CMA) is the most frequent food allergy in the first years of life, with prevalence rates estimated in the range of 2%-3%. 1,2 With the aim of reducing the risk of allergic reactions for accidental exposures to cow's milk (CM) proteins and of favouring the regain of clinical tolerance, strategies of controlled oral exposure to CM have been developed as immunotherapy for the treatment of children with established food allergy. 3-5 However, available data on the use of oral immunotherapy in infants with food allergy are very limited. This report investigates the feasibility of an oral immunotherapy protocol for infants with CMA, started in their first year of life. Between March 2015 and June 2017, we prospectively enrolled children <12 months of age who were admitted to the department for Allergy and Asthma of the tertiary level, university teaching, children's hospital, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy, because of symptoms of immediate hypersensitivity, including skin (urticaria, angioedema and/or erythema), digestive tract (acute vomiting), respiratory system (bronchospasm, IgG4 serum levels (mgA/L) Baseline visit Two-month visit The end of the protocol visit P-value Median (IQR)Abbreviation: IQR, interquartile range. a P-value is referred to the Wilcoxon signed ranks test on the difference between baseline and the end of the protocol.

Acute lobar nephritis (ALN) is a localized non-liquefactive inflammatory renal bacterial infection, which typically involves one or more lobes. ALN is considered to be a midpoint in the spectrum of upper urinary tract infection, a spectrum ranging from uncomplicated pyelonephritis to intrarenal abscess. This condition may be difficult to recognize due to the lack of specific symptoms and laboratory findings. Therefore the disease is probably underdiagnosed. Computed tomography scanning represents the diagnostic gold standard for ALN, but magnetic resonance imagine could be considered in order to limit irradiation. The diagnosis is relevant since initial intravenous antibiotic therapy and overall length of treatment should not be shorter than 3 wk. We review the literature and analyze the ALN clinical presentation starting from four cases with the aim to give to the clinicians the elements to suspect and recognize the ALN in children.

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Even though no increased recurrence rate seems to be reported in patients with brain tumors receiving recombinant human growth hormone (rhGH) replacement, in some patients multiple risk factors could put at higher risk for recurrence. In such cases, the decision to start rhGH therapy should be very cautious. A boy with neurofibromatosis type 1 developed an atypical teratoid/rhabdoid tumor (AT/RT) of right cerebellum, treated with surgery, radiotherapy, and chemotherapy. After 3 years of remission, he started rhGH for growth hormone deficiency, having a negative magnetic resonance imaging (MRI) scan. Ten weeks after starting therapy, the boy became symptomatic and MRI showed relapse of AT/RT in the right cerebellum and a new lesion in the brainstem. The boy died of progressive disease. In this case, the connection between AT/RT recurrence and the beginning of rhGH therapy, with a negative pretreatment MRI, cannot be excluded. Additional caution should be used for rhGH in patients with multiple risk factors.