Pediatric allergologic activities in Central Italy Hospitals: an interregional census of Marche-Umbria-Tuscany

Abstract

Introduction: Despite the high epidemiology of pediatric allergic diseases, a mapping of the supply of related hospital diagnostic and therapeutic services on a regional and/or national scale has never been carried out in Italy, which is essential for adequate planning and care of children with allergies.

Materials and methods: Thanks to the collaboration of 26 pediatric allergology representatives from the 29 hospitals involved via an online questionnaire, an interregional Marche-Umbria-Tuscany (MUT) census was carried out in May 2023 to understand the current situation in central Italy, both in terms of performance provided and the activities of the individual structures. The results were also compared with those of a previous survey carried out in 2019.

Results: Of the hospitals evaluated, 12 were level 1, 9 were level 2, and 5 were level 3. From the analysis of the data, it emerged that there was an increase in 1st level hospitals carrying out Pediatric Allergology compared to 2nd level ones.

The activities carried out in the pediatric allergology field are mainly practiced by physicians specializing in Pediatrics who, over the years, developed allergological skills through master’s degrees or specialization courses. Dedicated nursing staff or other specialists involved in the management of comorbidities are often present to support allergology activity.

Patients aged between 0 and 18 are assessed mainly once or twice a week with reservations through the single reservation center (CUP). In addition to the most common allergic pathologies (atopic dermatitis, allergic rhinitis and conjunctivitis, bronchial asthma, and food allergy), which are followed in all dedicated structures, there is also greater management of pathologies, such as chronic urticaria and drug allergy compared to 2019. Among the diagnostic investigations, in addition to skin prick tests (SPT) for inhalants and foods, prick-by-prick (PBP) for fresh foods, and spirometry, there is greater use of molecular allergology, skin tests for Hymenoptera stings, and provocation for food/drugs after obtaining informed consent (internal or in accordance with that proposed by the Italian Society of Pediatric Allergology and Immunology (SIAIP). All facilities prescribe sublingual immunotherapy (SLIT) for inhalants, while subcutaneous immunotherapy (SCIT) for inhalants and food immunotherapy (AIT) appear to be decreasing. On the other hand, the use of SCIT for Hymenoptera and the use of biologics (omalizumab, dupilumab) for therapeutic purposes are increasing. Among the current strengths of the structures, the frequency of the days of activity and the division into hyper-specialist clinics stand out.

In light of the data collected, some aspects emerged that require further strengthening, such as the use of telemedicine, the transition path of the allergic adolescent to the adult world, the creation of interregional collaboration paths with level structures superior for complex patients, and the creation and continuous updating of shared protocols for pathologies at an intraregional or interregional level. 

Discussion and Conclusions: These data highlight the pediatric allergology activities carried out in a large area of central Italy (MUT). This work, if extended to other Italian regions, would allow — for the first time — a global mapping of pediatric allergology activities in Italy, with consequent benefits in terms of quality and appropriateness of services and correct use of resources