Search

Background/objectives: To assess the nutritional status and incidence of feeding difficulties in Polish children up to 2 years of age with cow's milk allergy (CMA) on cow's milk proteins-free diet., Methods: A cross-sectional, multi-center study included children aged 6 months to 2 years with confirmed or suspected (without oral food challenge) diagnosis of CMA on the elimination diet for at least 1 month. The primary outcomes were an assessment of proportion of children with impaired nutritional status (with the weight for length and body mass index (BMI) z-score > 1 and <-1), and feeding difficulties according to the Montreal Children's Hospital Feeding Scale. Children with confirmed and suspected CMA were assessed separately., Results: A 144 children with confirmed CMA and 88 with suspected CMA were included (57 and 78% with multiple food allergies, respectively). Among children with confirmed CMA, one-third (35.5%) of participants had any nutritional status impairment regardless of definition. Among those, most of children had mild malnutrition (10.4 vs. 9%) and possible risk of overweight (11.1 vs. 9.7%; following respectively BMI for age and weight for length z-scores). Only 16.0% of children had feeding difficulties. Feeding difficulties was identified to be a risk factor for moderate malnutrition compared to children without feeding difficulties (odds ratio 10, 95% confidence interval: 4-27)., Conclusions: Mild malnutrition and possible risk of overweight are concern in children up to 2 years of age on cow's milk proteins-free diet. Feeding difficulties are less common, however, may affect the nutritional status., (© 2024 European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Background: Although researchers extensively study the rapid generation and spread of misinformation about the novel coronavirus during the pandemic, numerous other health-related topics are contaminating the internet with misinformation that have not received as much attention., Objective: This study aims to gauge the reach of the most popular medical content on the World Wide Web, extending beyond the confines of the pandemic. We conducted evaluations of subject matter and credibility for the years 2021 and 2022, following the principles of evidence-based medicine with assessments performed by experienced clinicians., Methods: We used 274 keywords to conduct web page searches through the BuzzSumo Enterprise Application. These keywords were chosen based on medical topics derived from surveys administered to medical practitioners. The search parameters were confined to 2 distinct date ranges: (1) January 1, 2021, to December 31, 2021; (2) January 1, 2022, to December 31, 2022. Our searches were specifically limited to web pages in the Polish language and filtered by the specified date ranges. The analysis encompassed 161 web pages retrieved in 2021 and 105 retrieved in 2022. Each web page underwent scrutiny by a seasoned doctor to assess its credibility, aligning with evidence-based medicine standards. Furthermore, we gathered data on social media engagements associated with the web pages, considering platforms such as Facebook, Pinterest, Reddit, and Twitter., Results: In 2022, the prevalence of unreliable information related to COVID-19 saw a noteworthy decline compared to 2021. Specifically, the percentage of noncredible web pages discussing COVID-19 and general vaccinations decreased from 57% (43/76) to 24% (6/25) and 42% (10/25) to 30% (3/10), respectively. However, during the same period, there was a considerable uptick in the dissemination of untrustworthy content on social media pertaining to other medical topics. The percentage of noncredible web pages covering cholesterol, statins, and cardiology rose from 11% (3/28) to 26% (9/35) and from 18% (5/28) to 26% (6/23), respectively., Conclusions: Efforts undertaken during the COVID-19 pandemic to curb the dissemination of misinformation seem to have yielded positive results. Nevertheless, our analysis suggests that these interventions need to be consistently implemented across both established and emerging medical subjects. It appears that as interest in the pandemic waned, other topics gained prominence, essentially "filling the vacuum" and necessitating ongoing measures to address misinformation across a broader spectrum of health-related subjects., (©Małgorzata Chlabicz, Aleksandra Nabożny, Jolanta Koszelew, Wojciech Łaguna, Anna Szpakowicz, Paweł Sowa, Wojciech Budny, Katarzyna Guziejko, Magdalena Róg-Makal, Sławomir Pancewicz, Maciej Kondrusik, Piotr Czupryna, Beata Cudowska, Dariusz Lebensztejn, Anna Moniuszko-Malinowska, Adam Wierzbicki, Karol A Kamiński. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 29.03.2024.)

Purpose: Celiac disease (CD) is an autoimmune disorder of the small intestine caused by an abnormal immune response to gluten proteins and is often characterized by gastrointestinal symptoms. Food allergy (FA) is an adverse immune sensitivity to ingested food proteins leading to inflammation in various organs including the gastrointestinal tract. The relationship between CD and FA remains unclear. This study aimed to assess the prevalence and clinical relevance of immunoglobulin E (IgE)-mediated food sensitization in children with CD., Methods: Fifty-nine children diagnosed with CD were reviewed for clinical symptoms and evidence of IgE-sensitization to food and airborne allergens using the PolyCheck method., Results: IgE-mediated sensitization has been diagnosed in 20.3% of children with CD (CD/ A). In the CD/A group, 58.3% of children were sensitized to food and 66.7% to airborne allergens. Further, 41.7% of patients with CD and allergy reported gastrointestinal tract symptoms associated with the ingestion of sensitizing foods. Analysis of the clinical status revealed that the incidence of other allergic disorders in the CD/A group was as follows: atopic dermatitis (33.3%), asthma (25.0%), and allergic rhinitis (16.7%). The percentage of eosinophils was significantly higher in the CD/A group than in the CD group (0.33±0.25 vs. 0.11±0.09; p =0.006)., Conclusion: The diagnosis of CD does not exclude FA. The gastrointestinal symptoms in children with CD may be the result of both CD and FA; therefore, children with CD should be evaluated for the presence of FA regardless of age., Competing Interests: Conflict of Interest: The authors have no financial conflicts of interest., (Copyright © 2021 by The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition.)

Introduction: Seasonal allergic rhinitis (SAR) and bronchial asthma are typical manifestations of pollen-food sensitization in adults. There is limited information regarding the sensitization patterns of pollen-food allergy in children., Aim: To evaluate the prevalence of SAR in children with pollen-food sensitization and assess the impact of food allergens on nasal symptoms., Material and Methods: Forty-three children with pollen-food sensitization aged 2-14 years were evaluated for evidence of SAR. The inclusion criteria was IgE-mediated sensitization to pollen and homologous food allergens. The control group consisted of 19 children with SAR caused by pollen without sensitization to homologous food allergens., Results: Allergic rhinitis was the main symptom in 65.1% of children; in 25.6% an association between ingestion of pollen-related foods and nasal symptoms was observed. The simultaneous sensitization to animal origin food allergens was stated in 63.3% of children with SAR. In 25.6% anaphylactic reactions to foods were registered. 37.2% of children were asymptomatic to pollen origin foods despite pollen-food sensitization. The statistically significant differences between values were noticed in comparison to the control group., Conclusions: Allergic rhinitis is a common manifestation of pollen-food sensitization in children and this type of immunological hyperreactivity should be taken into account regardless of age. The lack of association of symptoms with plant origin foods in the majority of cases and the asymptomatic course of food sensitization in more than one third of patients indicates the need for follow-up and being careful in routine recommending the avoidance diet., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Termedia.)

Diagnosis of non-IgE mediated food allergy presents a special challenge due to lack of a single, non-invasive diagnostic method. We selected three fecal biomarkers of allergic inflammation of gastrointestinal origin in order to improve the diagnostic process. Twenty-seven infants with symptoms of hematochezia were prospectively enrolled into this study. All patients underwent a complete differential diagnosis of rectal bleeding. Non-IgE mediated food allergy was confirmed by an open, oral food challenge. The control group included twenty-five infants with functional gastrointestinal disorders. Eosinophil-derived neurotoxin (EDN), tumor necrosis factor alpha (TNFα), and calprotectin concentration were measured in stools of all children by enzyme-linked immunosorbent assays (ELISA) using commercial kits. Median eosinophil-derived neurotoxin and calprotectin fecal levels were significantly higher in the study group than in the control group ( p < 0.05). The difference of fecal tumor necrosis factor alpha concentration between both groups was not statistically significant ( p > 0.05). The best diagnostic performance was reached in a combination of fecal calprotectin (fCal) and EDN i.e., 88.9% and 84%, respectively. Fecal EDN and fCAl are reliable tools in differentiating between food protein-induced allergic proctocolitis and gastrointestinal functional disorders in infants.

Four recombinant (r) allergens (rAmb a 8.0101, rArt v 4.0101, rBet v 2.0101, and rPhl p 12.0101) were successfully produced and used for sensitization studies. The allergens belong to the profilin family which is one of the most numerous allergen families. These four proteins represent allergens originating from pollen of weeds (rAmb a 8.0101 and rArt v 4.0101), tree (rBet v 2.0101) and grass (rPhl p 12.0101). The recombinant allergens were characterized using various biochemical and biophysical methods and tested for their ability to bind patient-derived antibodies. One hundred patients aged 2 to 50 years sensitized to pollen and plant-derived food allergens (IgE > 0.35 kU/L) were included. Sensitization to individual allergen sources and components of birch and timothy pollens was evaluated using multiparameter immunoblots. The presence of IgE to pollen-derived recombinant profilins rAmb a 8.0101, rArt v 4.0101, rBet v 2.0101, and rPhl p 12.0101 in serum was evaluated using ELISA method. The presence of IgE against pollen profilins was detected in 20 out of 100 studied patients. High correlation was seen between IgE ELISA results with individual pollen profilins. In summary, it was shown that the recombinant versions of the four allergenic profilins can be used for sensitization studies and for component-resolved allergy diagnostics.

Some recent studies indicate that unsaturated fatty acids, components of cellular membranes and precursors of immunomodulators, play a significant role in the pathogenesis of some symptoms of atopic dermatitis. Since they cannot be synthesized by the human body, they must be provided with nutrition as the so called exogenous fatty acids: linoleic (a precursor of arachidonic acid) and α-linolenic acid (a precursor of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)). Their deficiency facilitates the development of some disorders, e.g. of the cardiovascular system or of the nervous system, or becomes the cause of intensification of ailments in their course e.g. pruritus and dryness in atopic dermatitis. Though clinical examinations to date confirm the efficacy of fatty acid supplementation in treatment of atopic dermatitis, their results are not explicit.

Objective: Evaluation of the respiratory response to proton pump inhibitors (PPI) in children with obstructive sleep apnea syndrome (OSAS) and gastroesophageal reflux disease (GERD)., Methods: Of 131 children diagnosed with OSAS (Apnea Hypopnea Index, AHI >1/h), 37 children (6.9 years; 28.24%) with GERD symptoms (>3 times/week) were included. Overnight polysomnography with 24h pH-metry was performed before and after 4-8 weeks of PPI treatment (omeprazole once a day, 1mg/kg)., Results: Of 37 children, 21 were diagnosed with acid GERD where pre- and post-treatment reflux indexes were 14.09±1.47 vs. 7.73±1.36; (p<0.001). The number of obstructive apneas and hypopneas decreased after PPI treatment, resulting in an AHI reduction from 13.08±3.11/h to 8.22±2.52/h; (p<0.01). Respiratory response to PPI ranged from complete resolution of OSA (three children with mild OSA; AHI<5/h; 10.31years; 14.29%) to lack of significant AHI change (six children with severe OSA; AHI>10/h; 3.62 years; 28.57%). Post-treatment AHI was predicted by pre-treatment reflux index (adjusted R(2)=0.487; p<0.001)., Conclusions: Reduction of obstructive respiratory events following short-term PPI treatment in children with both GERD and OSAS may suggest a causal relationship between apnea and reflux in some children. Questionnaire screening for GERD in children with OSAS may be of benefit., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Lipid transfer protein (LTP) has been reported as an important allergen inducing severe systemic reactions in allergic subjects. The aim of the present study was to estimate the role of LTP in diagnosis of apple allergy in children allergic to birch pollen. The prospective study was carried out on a group of 21 children sensitized to birch pollen and apple allergens, confirmed by presence of specific IgE in the sera of patients. Allergens separated by electrophoresis were probed by Western blotting using hypersensitive patients' sera. Food hypersensitivity to apple was verified by oral food challenge test. Six patients' sera were hypersensitive to birch pollen and apple proteins. Almost all sera recognized specifically the main allergen of apple peal Mal d 3 with molecular weight <10kDa (LTP). Positive oral challenge to apple was found in 52.4% of investigated children. Children allergic to Mal d 1 presented different clinical symptoms. Sensitization to Mal d 3 is very common in children with apple allergy. No correlation between clinical symptoms and sensitization to recombinant apple allergens has been found, LTP may be useful in diagnosis of apple allergy.

Purpose: Food allergy has been demonstrated to play an important role in the pathogenesis of atopic eczema dermatitis syndrome (AEDS), affecting often atopic infants and young children. The most commonly offending foods are cow's milk, hen's egg, wheat and soy; implicating immediate (IgE-mediated) and late-phase (T-cells) immunological reactions in the pathogenesis of skin lesions. The diagnostic work-up of suspected immediate food reactions includes skin prick tests (SPT) and the measurement of food-specific antibodies (sIgE). The methodology of atopy patch test (APT) has been reported as a diagnostic tool with high predictive capacity for late-phase clinical reactions in children with atopic dermatitis. Although APT has been introduced into the diagnostic procedure for food allergy, its diagnostic accuracy remains still controversial; especially in older children. The aim of study was to evaluate the diagnostic accuracy of the atopy patch test in the detection of food allergy in correlation with SPT, sIgE and positive oral food challenge to milk, in children suffering from AEDS and to assess the sensitivity and specificity of this method in dependence on the age of investigated children., Material and Methods: 34 children (25 boys, 9 girls) aged 5 months-16 years with suspicion of milk-related AEDS were investigated. These patients were subdivided into 2 age groups: group A--20 children (<3 years), group B--14 children (>3 years). The diagnostic procedures as skin-prick tests and atopy patch test were performed. The specific IgE to cow's milk allergens were also measured. The open and blind diagnostic oral food challenge were performed to verify the results of tests. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive value of APT were calculated in both age groups., Results: A positive challenge response to milk was found in 65.0% of investigated children in group A and in 35.7% in group B. No statistical differences in the prevalence of immediate (p<0.1905) and delayed-type (p<0.409) reactions has been found between age groups. Positive APT to milk were noticed in 55.0% of patients in group A and in 35.7% of children from group B, that has been in correlation with positive delayed-type reactions in oral food challenge in 72.7% and 80.0% in corresponding age groups. Polysensitization to other food allergens confirmed by SPT and/or sIgE was detected in 35.0% of patients younger than 3 years of age and in 50.0% of older children. The prevalence of positive APT to other foods (soy, rice, maize, cereals) was significantly higher (p<0.0073) in the polysensitized children from group A. Sensitivity of SPT/sIgE in children with immediate-type reactions to milk was 100%, specificity 94%. Sensitivity of APT to cow's milk in children with late-phase reactions was 80% in both age groups; specificity 70%/89% with comparable PPV in both groups (73%/80%). Parallel skin testing with combined patch test and evaluation of sIgE enhanced the value of sensitivity to 92% in the group A and specificity to 89% in the group B. For PPV corresponding figures were 85%/80%., Conclusions: APT was found to be more sensitive and specific method than SPT/sIgE in diagnosing delayed food allergy in children with AEDS. No age correlation between positive results of APT and oral food challenge and higher specificity of APT in older children confirm its accuracy in diagnosing delayed cow's milk allergy in all age groups of children. Combined skin prick and patch testing significantly enhances identification of food allergy in children with AEDS. The outcome of the APT with food does not seem to be influenced by age of children, but because of its variability of sensitivity and specificity, a diagnosis of food allergy should be confirmed by oral food challenge.

Purpose: The scientific experiments with new immunological methods (immunoblotting, RAST inhibition) and isolation of recombinant allergens suggest structural similarities in the allergenic components responsible for cross-reactions. Immunochemical and molecular biology studies indicate that epitopes of major allergen (Bet v 1, Mal d 1) contain more IgE binding epitopes than minor allergens (Bet v 2, Mal d 2), what explained clinical importance of major birch and apple allergens, but it is individual. The important role in cross-reactivity play also proteins with low molecular weight; a potentially dangerous allergen is lipid transfer protein (LTP) inducing severe systemic reactions in allergic subjects. The recent studies indicate that the IgE cross-reactivity patterns and the clinical relevance is still not clear and that only some of patients with confirmed IgE cross allergy to Bet v 1 and Mal d 1 demonstrated clinical symptoms after ingesting of apple. The aim of study was to establish the pattern of cross-reactivity between major (Bet v 1) and minor (Bet v 2) birch pollen allergens and apple proteins in children allergic to birch using recombinant allergens and immunoblotting method., Material and Methods: The prospective study were carried out on the group of 13 children aged 4-16 years, referred to the IIIrd Department of Paediatrics in Białystok and outpatient clinic with clinical symptoms of food and inhalant allergy. Inclusion criteria to the study were: allergy to birch pollen recombinant allergens and apple, confirmed by presence of specific IgE in the sera of patients. The allergens from peel and pulp of apple and birch were separated and loaded onto the polyacrylamide electrophoretic gel and than transferred to membranes by Western blotting. Antigen-IgE complex was detected using goat anti-human IgE antibodies labelled with alkaline phosphatase., Results: Only few sera presented strong reactions in immunoblotting to birch pollen proteins with a molecular weight of 17-18 kDa, corresponding to the main birch allergen Bet v 1. Most of sera having positive reaction vs Bet v 1 showed cross-reactivity with Mal d 1. All sera recognized specifically the main allergen of apple peel Mal d 3 with molecular weight < 10 kDa (Lipid Transfer Protein)., Conclusions: Immunoblotting method allows to verification of cross-reactivity recognized by presence of specific IgE. The nature of proteins responsible for sensitization can influence the spectrum of offending foods and the clinical features of allergic reactions.

Purpose: Pollen-related food allergy to fresh fruits and vegetables is a well-known clinical phenomenon. Bet v 1, the major birch pollen allergen, has been cloned and shows homologies to various food allergens (e.g. hazelnut, apple, celery, tomato). Allergy to profilin Bet v 2 was also described in 10-15% of patients sensitized to birch pollen. Objective of our work was to assess the diagnostic value of recombinant allergens (rBet v 1, rBet v 2) for diagnosis of children sensitized to birch pollen with associated food allergy., Material and Methods: The investigations were carried out on the group of 14 children aged 4-17 years, with a history of allergic reactions and sensitized to birch pollen with associated food allergy. Skin prick tests were performed with natural foods and commercial aeroallergens (Bencard). Sera-specific IgE antibodies to recombinant and other allergens (Pharmacia Upjohn) were measured with a fluoroimmunoenzymatic essay (UniCAP). Oral food challenge tests were performed to confirm adverse food reactions., Results: 64% were sensitized to rBet v 1, 14% to rBet v 2, 7% to both of them. 50% of children with allergy to Bet v 1 had also concomitant allergy to other pollens and food allergy to fruits from family Rosaceae. Patients with positive reaction to Bet v 2 represented allergy to vegetables from family Umbelliferae. The most common form of allergic reactions were: allergic rhinitis in 64%, atopic dermatitis in 36%, oral allergy syndrome in 21% of investigated children., Conclusions: Use of two recombinant allergens permits the diagnosis of birch pollen sensitization in children with food-pollen related allergy and gives the pattern of possible cross-reactivity between pollen and food allergens in children with allergic diseases.

100 children (61 boys and 39 girls) aged between 5 months and 9 years, with diagnosed cow's milk protein intolerance with symptoms of the gastrointestinal tract, skin, respiratory tract and nervous system, were examined. They were treated with an elimination diet (Nutramigen and Prosobee--47% and 53% of children respectively). Total and partial improvements of clinical complaints were observed in 42% and 37% of children respectively.

A group of 36 children aged from 1 10/12 to 11 years was the subject of clinical and laboratory examinations. It was found that there is a close relationship between food hypersensitivity to milk and symptoms of the skin (81%), upper (61%) and lower (55%) respiratory tract, digestive tract (47%) and central nervous system (14%). These symptoms occured in isolated or associated forms on the different organs or systems. An elimination diet and pharmacological treatment with Astemizol were used in all children from the investigated group. Complete relief of symptoms was observed in 39% of children; 44% of examined patients had a regression of symptoms of 1 and/or 2 organs. Side effects of treatment with Astemizol were observed in the form of excessive appetite (22%), body weight gain (3%), vomiting (3%), diarrhoea (3%), bleeding from the nose (3%), sleepiness (5%). Due to the good therapeutic effect and insignificant side effects, the supporting pharmacological treatment with Astemizol was found useful in children with hypersensitivity to cow's milk.

The subject of the clinical-laboratory examinations was a group of 36 children aged 1 4/12 - 17 years with recurrent upper (94%) and lower (63%) airway infections, whose condition did not improve after antibiotic therapy, elimination diet and anti-histaminic treatment. In 83% of the examined patients respiratory tract symptoms co-existed with skin (61%), gastrointestinal tract (44%) and OUN (16%) diseases. 75% of examined children, with humoral and/or cellular response disorders, were given an IRS-19 vaccine, which resulted in the regression of the respiratory tract symptoms in 78% of patients. Due to side-effects in the form of high temperature, the treatment was terminated in 14% of children. The obtained therapeutic effects and convenience of administration of the vaccine, justify IRS-19 treatment in children with recurrent lower and upper airway infections, after complex immunological examination.