Background Paediatricians are often the first point of contact for children in Primary Care (PC), but still perceive gaps in their allergy knowledge. We investigated self-perceived knowledge gaps and educational needs in paediatricians across healthcare systems in Europe so that future educational initiatives may better support the delivery of allergy services in PC. Methods A multinational survey was circulated to paediatricians who care for children and adolescents with allergy problems in PC by the EAACI Allergy Educational Needs in Primary Care Paediatricians Task Force during February to March 2023. A 5-point Likert scale was used to assess level of agreement with questionnaire statements. 30 surveys per country was the cut-off for inclusion and statistical analysis. Results 1,991 respondents were obtained from 56 countries across Europe and 210 responses were from countries with a cut-off below 30 participants per country. Primary care paediatricians (PCPs) comprised 74.4% of the respondents. The majority (65.3%) were contracted to state or district health services. 61.7% had awareness of guidelines for onward allergy referral in their countries but only 22.3% were aware of the EAACI competencies document for allied health professionals for allergy. Total sample respondents versus PCP’s showed 52% and 47% of them have access to allergy investigations in their PC facility (mainly specific IgE and skin prick tests); 67.6% and 58.9% have access to immunotherapy, respectively. The main barrier for referral to a specialist was consideration that the patient’s condition could be diagnosed and treated in this PC facility, (57.8% and 63.6% respectively). The main reasons for referral was the need for hospital assessment, and partial response to first line treatment (55.4% and 59.2%, 47% and 50.7%, respectively). Learning and assessment methods preference was fairly equally divided between: Traditional methods (45.7% and 50.1% respectively) and e-Learning 45.5% and 44.9%, respectively. Generalist Physicians (GP’s) have the poorest access to allergy investigations (32.7%, p=0.000). The majority of the total sample (91.9%) assess patients with allergic pathology. 868 (43.6%) and 1,117 (46.1%), received allergy training as undergraduates and postgraduates respectively [these proportions in PCPs were higher (45% and 59%), respectively]. PCPs with special interest in allergology experienced greater exposure to allergy teaching as postgraduates. GP’s received the largest amount of allergy teaching as undergraduate. Identifying allergic disease based on clinical presentation, respondents felt most confident in the management of eczema/atopic dermatitis (87.4%) and rhinitis/asthma (86.2%), and least confident in allergen immunotherapy (36.9%) and latex allergy (30.8%). Conclusion This study exploring the confidence of PCP’s to diagnose, manage and refer patients with allergy, demonstrated knowledge gaps and educational needs for allergy clinical practice. It detects areas in need of urgent improvement especially in latex and allergen immunotherapy. It is important to ensure dissemination of allergy guidelines and supporting EAACI documents since the majority of PCPs lack awareness of them. This survey has enabled us to identify what the educational priorities of PCPs are and how they would like to have them met.

Monitoring is a major component of asthma management in children. Regular monitoring allows for diagnosis confirmation, treatment optimization and natural history review. Numerous factors that may affect disease activity and patient wellbeing need to be monitored: response and adherence to treatment, disease control, disease progression, comorbidities, quality of life, medication side-effects, allergen and irritant exposures, diet and more. However, the prioritization of such factors and the selection of relevant assessment tools is an unmet need. Furthermore, rapidly developing technologies promise new opportunities for closer, or even ‘real-time’, monitoring between visits. Following an approach that included needs assessment, evidence appraisal and Delphi consensus, the PeARL Think Tank, in collaboration with major international professional and patient organizations, has developed a set of 24 recommendations on pediatric asthma monitoring, to support healthcare professionals in decision-making and care pathway design.

Background: Rural communities who consume unpasteurized and traditional fermented milk products on a regular basis, have a low prevalence of allergic diseases. Lactic acid producing bacteria present within these products, is postulated to have an allergy protective role against atopy. Objective: To characterize and compare the bacterial microbiota of fresh unpasteurised cow’s milk and to explore the effect of milk fermentation (commercially and traditionally fermented) on the bovine milk microbiota. Methods: Raw, unpasteurized cow’s milk was collected from urban and rural farms. Another sample, collected from a rural farm, was left to ferment naturally. Three different brands of commercially fermented milk samples were also analysed. The V3 and V4 regions of the 16S rRNA gene were amplified to assess microbiota composition. Results: Urban and rural fresh milk had the highest microbiota alpha diversity, and commercially bought fermented milk products, the least. Commercially fermented milk was consistently dominated by lactic acid producing bacteria, belonging to the phylum Firmicutes, while homemade fermented milk comprised of approximately 50% Firmicutes and 50% Proteobacteria. The relative abundance of several organisms differed between fermented and unfermented milk. Lactococcus lactis dominated all milk products, however its relative abundance was lower in fresh milk compared with fermented milk. Lactobacillus paracasei and Streptococcus infantis were abundant in traditionally fermented milk, but absent in commercially fermented products. Potential pathogens were demonstrated in fresh and home fermented milk. Conclusion: Commercially fermented milk can be promoted as a safe and possible allergy protective complementary feed from 1 year of age.