[Management of hypercholesterolemia in children: needs and concerns]. / Il trattamento dell'ipercolesterolemia nei bambini: necessità e preoccupazioni.

In childhood, cholesterol values are closely related to the genetic heritage of the young patient. Among familial hypercholesterolemia, it is essential to identify the monogenic and multigenic forms. In monogenic forms, heterozygotes respond poorly or partially to changes in diet and lifestyle, making pharmacological therapy necessary; in homozygote patients plasmapheresis is required, and liver transplantation is the only intervention that can impact permanently on the development of cardiovascular lesions in adulthood. Conversely, multigenic forms or familial hypercholesterolemia secondary to other diseases respond to changes in diet and lifestyle as well as to pharmacological treatment. It remains unclear how early pharmacological intervention should be implemented. In particular, the presence in children of typical histological lesions of athero- sclerosis and their interaction with cardiovascular disease in adulthood justify a prompt, although cautious, intervention. In fact, cholesterol is necessary for normal development of the organism, provided that percentile values are in the normal range according to age and sex. Two methods of intervention are identified: a population strategy that should be implemented on a large scale for advice about diet and optimal level of physical activity; and an individual strategy, in which diet advice should be followed by pharmacological treatment. Pharmacological therapy may be administered even in children over the age of 8-10 years, if necessary. In younger patients, therapeutic interventions should be restricted to children with LDL cholesterol levels >500 mg/dl. Although statins have only been studied in populations affected by severe familial hypercholesterolemia in the short term, they seem to be the most effective agents in children owing to their efficacy and limited side effects.

Probiotics in the atopic march: highlights and new insights.

The frequent development of allergic respiratory diseases in patients with histories of atopic dermatitis (AD) in early childhood has been known for a long time. At school age, AD has been associated with an increased risk of asthma, and was thus regarded as one of the first steps in a successive "atopic march" leading from AD to asthma. Probiotics are cultures of potentially beneficial bacteria that positively affect the host by enhancing the microbial balance and therefore restore the normal intestinal permeability and gut microecology. They also improve the intestine's immunological barrier function and reduce the generation of proinflammatory cytokines characteristic of allergic inflammation. In clinical trials probiotics appear to be useful for the treatment of various clinical conditions such as food allergy, AD and allergic rhinitis, and in primary prevention of atopy. We can hypothesize that it may be possible, in the future, to use probiotics in primary prevention of asthma.