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The recognition of constipation as a possible non-Immunoglobulin E (IgE)-mediated allergic condition is challenging because functional constipation (unrelated to food allergies) is a common health problem with a reported worldwide prevalence rate of up to 32.2% in children. However, many studies in children report challenge proven cow's milk allergy and constipation as a primary symptom and have found that between 28% and 78% of children improve on a cow's milk elimination diet. Due to the paucity of data and a focus on IgE-mediated allergy, not all food allergy guidelines list constipation as a symptom of food allergy. Yet, it is included in all cow's milk allergy guidelines available in English language. The Exploring Non-IgE-Mediated Allergy (ENIGMA) Task Force (TF) of the European Academy for Allergy and Clinical Immunology (EAACI) considers in this paper constipation in the context of failure of standard treatment and discuss the role of food allergens as culprit in constipation in children. This position paper used the Delphi approach in reaching consensus on both diagnosis and management, as currently published data are insufficient to support a systematic review., (© 2024 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Breastmilk is the optimal source of nutrition for infants and should ideally be provided exclusively for the first 6 months of life, and alongside complementary food until 2 years of life. However, there are circumstances where a breastmilk substitute (BMS) may be required. This includes maternal and/or child conditions or personal preference. Whilst these circumstances should never be used as an opportunity to promote BMS, healthcare professionals (HCPs) need to have the knowledge of suitable alternatives and should always be guided by scientific and health motives when recommending a BMS. The Task Force 'Milk Formula Industry Sponsorship' from the European Academy of Allergy and Clinical Immunology (EAACI), provides with this publication recommendations for EAACI interactions with the BMS manufacturers and how this will be supervised., (© 2024 The Authors. Pediatric Allergy and Immunology published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Identifying the factors that influence the citation of articles helps authors improve the impact and reach of their research. Analysis of publications in the Journal of Fish Biology between 2008 and 2021 revealed that variables such as the number of keywords, abstract length, number of authors, and page length were associated with higher impact papers. These trends applied to both review and regular papers. These findings suggest that papers that are more informative, have higher numbers of authors, and have more keywords are more likely to be cited. Adoption of some simple "best-practice" behaviors can improve the likelihood that a paper is cited., (© 2023 The Authors. Journal of Fish Biology published by John Wiley & Sons Ltd on behalf of Fisheries Society of the British Isles.)

Habitat spatial structure has a profound influence on bacterial life, yet there currently are no low-cost equipment-free laboratory techniques to reproduce the intricate structure of natural bacterial habitats. Here, we demonstrate the use of paper scaffolds to create landscapes spatially structured at the scales relevant to bacterial ecology. In paper scaffolds, planktonic bacteria migrate through liquid-filled pores, while the paper's cellulose fibres serve as anchor points for sessile colonies (biofilms). Using this novel approach, we explore bacterial colonisation dynamics in different landscape topographies and characterise the community composition of Escherichia coli strains undergoing centimetre-scale range expansions in habitats structured at the micrometre scale. The bacteria-in-paper platform enables quantitative assessment of bacterial community dynamics in complex environments using everyday materials., (© 2019 The Authors. Ecology Letters published by CNRS and John Wiley & Sons Ltd.)

Gastro-oesophageal reflux (GOR) and food allergy (FA) are common conditions, especially during the first 12 months of life. When GOR leads to troublesome symptoms, that affect the daily functioning of the infant and family, it is referred to as GOR disease (GORD). The role of food allergens as a cause of GORD remains controversial. This European Academy of Allergy and Clinical Immunology (EAACI) position paper aims to review the evidence for FA-associated GORD in young children and translate this into clinical practice that guides healthcare professionals through the diagnosis of suspected FA-associated GORD and medical and dietary management. The task force (TF) on non-IgE mediated allergy consists of EAACI experts in paediatric gastroenterology, allergy, dietetics and psychology from Europe, United Kingdom, United States, Turkey and Brazil. Six clinical questions were formulated, amended and approved by the TF to guide this publication. A systematic literature search using PubMed, Cochrane and EMBASE databases (until June 2021) using predefined inclusion criteria based on the 6 questions was used. The TF also gained access to the database from the European Society of Paediatric Gastroenterology and Hepatology working group, who published guidelines on GORD and ensured that all publications used within that position paper were included. For each of the 6 questions, practice points were formulated, followed by a modified Delphi method consisting of anonymous web-based voting that was repeated with modified practice points where required, until at least 80% consensus for each practice point was achieved. This TF position paper shares the process, the discussion and consensus on all practice points on FA-associated GORD., (© 2022 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Multisystem inflammatory syndrome in children (MIS-C) is a rare, but severe complication of coronavirus disease 2019 (COVID-19). It develops approximately 4 weeks after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and involves hyperinflammation with multisystem injury, commonly progressing to shock. The exact pathomechanism of MIS-C is not known, but immunological dysregulation leading to cytokine storm plays a central role. In response to the emergence of MIS-C, the European Academy of Allergy and Clinical Immunology (EAACI) established a task force (TF) within the Immunology Section in May 2021. With the use of an online Delphi process, TF formulated clinical statements regarding immunological background of MIS-C, diagnosis, treatment, follow-up, and the role of COVID-19 vaccinations. MIS-C case definition is broad, and diagnosis is made based on clinical presentation. The immunological mechanism leading to MIS-C is unclear and depends on activating multiple pathways leading to hyperinflammation. Current management of MIS-C relies on supportive care in combination with immunosuppressive and/or immunomodulatory agents. The most frequently used agents are systemic steroids and intravenous immunoglobulin. Despite good overall short-term outcome, MIS-C patients should be followed-up at regular intervals after discharge, focusing on cardiac disease, organ damage, and inflammatory activity. COVID-19 vaccination is a safe and effective measure to prevent MIS-C. In anticipation of further research, we propose a convenient and clinically practical algorithm for managing MIS-C developed by the Immunology Section of the EAACI., (© 2023 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Introduction: There is a paucity of noninvasive respiratory monitors for patients outside of critical care settings. The Linshom respiratory monitoring device is a novel temperature-based respiratory monitor that measures the respiratory rate as accurately as capnography., Objectives: Determine whether the amplitude of the Linshom temperature profile was an accurate, surrogate and qualitative metric of the tidal volume (V T ) that tracks V T in healthy volunteers., Methods: Forty volunteers breathed room air spontaneously through a tight-fitting continuous positive airway pressure mask with a Linshom device mounted in the mask. V T was measured contemporaneously using a standalone Maquet Servo-i ICU ventilator. The amplitudes of the Linshom temperature profiles were paired with the contemporaneous V T measurements using least squares linear regression analysis and the coefficient of variation (R 2 ) was determined., Results: Forty volunteers completed the study. The data from 30 of the volunteers were analysed and are presented; data from 10 volunteers were not included due to protocol violations and/or technical issues unrelated to Linshom. The fluctuations in the amplitude of the Linshom temperature profiles mapped closely with the measured V T using least squares linear regression analyses yielding a mean R 2 (95% CI) value of 0.87 (0.84-0.90)., Conclusion: These results support the notion that the Linshom temperature profile is an accurate and reliable surrogate that tracks changes in V T in healthy volunteers. Further studies are warranted in patients in clinical settings to establish the effectiveness of this monitor., (© 2019 John Wiley & Sons Ltd.)

Drug hypersensitivity reactions (DHR) constitute a major and common public health problem, particularly in children. One of the most severe manifestations of DHR is anaphylaxis, which might be associated with a life-threatening risk. During those past decades, anaphylaxis has received particularly a lot of attention and international consensus guidelines have been recently published. Whilst drug-induced anaphylaxis is more commonly reported in adulthood, less is known about the role of drugs in pediatric anaphylaxis. Betalactam antibiotics and non-steroidal anti-inflammatory drugs are the most commonly involved drugs, probably related to high prescription rates. Diagnosis relies on the recognition of symptoms pattern and is based on complete allergic workup, particularly including skin tests and/or specific IgE. However, the real diagnostic value of those tests to diagnose immediate reactions in children remains not well defined for a significant number of the drugs. Generally, a drug provocation test is discussed to confirm or exclude an immediate-onset drug-induced hypersensitivity. Although avoidance of the incriminated drug (and related drug) is the rule, rapid desensitization is useful in selected subgroups of patients. There is a need for large, multicentric studies, to evaluate the real diagnostic value of the currently available skin tests. Moreover there is also a need to develop new diagnostic tests in the future to improve the management of these children., (© 2019 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in the pediatric population as antipyretics/analgesics and anti-inflammatory medications. Hypersensitivity (HS) reactions to NSAID in this age group, while similar to adults, have unique diagnostic and management issues. Although slowly accumulating, published data in this age group are still relatively rare and lacking a unifying consensus. This work is a summary of current knowledge and consensus recommendations utilizing both published data and expert opinion from the European Network of Drug Allergy (ENDA) and the Drug Hypersensitivity interest group in the European Academy of Allergy and Clinical Immunology (EAACI). This position paper summarizes diagnostic and management guidelines for children and adolescents with NSAIDs hypersensitivity., (© 2018 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)

The academic world is driven by scholarly research and publications. Yet, for many fields, the volume of published research and the associated knowledge base have been expanding exponentially for decades. The result is that scientists are literally drowning in data and information. There are strategies and approaches that could help with this problem. The goal of this paper is to demonstrate the power of computer-based approaches such as data mining and machine learning to evaluate large collections of papers. The objective is to conduct a systematic analysis of research related to the emerging area of groundwater-related diseases. More specifically, the analysis of information from the database of papers will examine systematics in the research topics, the inter-relationships among multiple diseases, contaminants, and groundwater, and discover styles of research associated with groundwater and disease. The analysis uses 426 papers (1971 to 2017) retrieved from a MEDLINE bibliographic database, PubMed, given the search terms "groundwater" and "disease." We developed tools that take care of necessary text processing steps, which lead naturally to clustering and visualization techniques that demonstrate published research. The resulting 2D article map shows how the collection of papers is subdivided into 11 article clusters. The cluster topics were determined by analyzing keywords or common words contained in the articles' titles, abstracts, and key words. We found that research on water-related disease in groundwater primarily focuses on two types of contaminants-chemical compounds and pathogens. Cancer and diarrhea are two major diseases associated with groundwater contamination. According to the systematic analysis, the study of this area is still growing., (© 2018, National Ground Water Association.)

Miller & Wiens (2017) claim that low marine as compared with terrestrial diversity results from more frequent extinctions and insufficient time for diversification in marine clades. Their data on marine amniotes are unrepresentative of marine diversity, their analysis of clade dynamics is flawed, and they ignore previously proposed explanations for the diversity difference., (© 2018 John Wiley & Sons Ltd/CNRS.)

Casein-hydrolysates (NaCaH) are desirable functional ingredients, but their bitterness impedes usage in foods. This study sought to validate a paper-disk approach to help evaluate bitterness in NaCaHs and to develop a food-grade approach to separate a NaCaH into distinct fractions, which could be evaluated by a sensory panel. Membrane filtration generated <0.2-μm and <3-kDa permeates. Further fractionation of the <3-kDa permeate by flash-chromatography generated four fractions using ethanol (EtOH) concentrations of 5, 10, 30 and 50%. As some fractions were poorly soluble in water, the fractions were resolubilzed in EtOH and impregnated into paper-disks for sensory evaluation. Bitterness differences observed in the membrane fractions using this sensory evaluation approach reflected those observed for the same fractions presented as a liquid. The flash-chromatography fractions increased in bitterness with an increase in hydrophobicity, except for the 50% EtOH fraction which had little bitterness. Amino acid analysis of the fractions showed enrichment of different essential amino acids in both the bitter and less bitter fractions., Practical Applications: The developed food-grade fractionation system, allowed for a simple and reasonably scaled approach to separating a NaCaH, into physicochemically different fractions that could be evaluated by a sensory panel. The method of sensory evaluation used in this study, in which NaCaH samples are impregnated into paper-disks, provided potential solutions for issues such as sample insolubility and limited quantities of sample. As the impregnated paper-disk samples were dehydrated, their long storage life could also be suitable for sensory evaluations distributed by mail for large consumer studies. The research, in this study, allowed for a greater understanding of the physicochemical basis for bitterness in this NaCaH. As some essential amino acids were enriched in the less bitter fractions, selective removal of bitter fractions could allow for the incorporation of the less bitter NaCaH fractions into food products for added nutritional value, without negatively impacting sensory properties. There is potential for this approach to be applied to other food ingredients with undesirable tastes, such as polyphenols.

Immunization is highly effective in preventing infectious diseases and therefore an indispensable public health measure. Allergic patients deserve access to the same publicly recommended immunizations as non-allergic patients unless risks associated with vaccination outweigh the gains. Whereas the number of reported possible allergic reactions to vaccines is high, confirmed vaccine-triggered allergic reactions are rare. Anaphylaxis following vaccination is rare, affecting <1/100 000, but can occur in any patient. Some patient groups, notably those with a previous allergic reaction to a vaccine or its components, are at heightened risk of allergic reaction and require special precautions. Allergic reactions, however, may occur in patients without known risk factors and cannot be predicted by currently available tools. Unwarranted fear and uncertainty can result in incomplete vaccination coverage for children and adults with or without allergy. In addition to concerns about an allergic reaction to the vaccine itself, there is fear that routine childhood immunization may promote the development of allergic sensitization and disease. Thus, although there is no evidence that routine childhood immunization increases the risk of allergy development, such risks need to be discussed., (© 2017 The Authors. Pediatric Allergy and Immunology Published by John Wiley & Sons Ltd.)

Introduction: Allergic contact dermatitis (ACD) in children appears to be on the increase, and contact sensitization may already begin in infancy. The diagnosis of contact dermatitis requires a careful evaluation of a patient's clinical history, physical examination, and skin testing. Patch testing is the gold standard diagnostic test., Methods: Based on consensus, the EAACI Task Force on Allergic Contact Dermatitis in Children produced this document to provide details on clinical aspects, the standardization of patch test methodology, and suggestions for future research in the field., Results: We provide a baseline list of test allergens to be tested in children with suspected ACD. Additional tests should be performed only on specific indications., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Ecological constraints on independent breeding are recognised as major drivers of cooperative breeding across diverse lineages. How the prevalence and degree of cooperative breeding relates to ecological variation remains unresolved. Using a large data set of cooperative nesting in Polistes wasps we demonstrate that different aspects of cooperative breeding are likely to be driven by different aspects of climate. Whether or not a species forms cooperative groups is associated with greater short-term temperature fluctuations. In contrast, the number of cooperative foundresses increases in more benign environments with warmer, wetter conditions. The same data set reveals that intraspecific responses to climate variation do not mirror genus-wide trends and instead are highly heterogeneous among species. Collectively these data suggest that the ecological drivers that lead to the origin or loss of cooperation are different from those that influence the extent of its expression within populations., (© 2015 John Wiley & Sons Ltd/CNRS.)

Correct management and classification of anaphylaxis is mandatory. Records of emergency department (ED) visits to any of the three pediatric hospitals in Stockholm, because of reactions to foods during 2007, were identified. A retrospective analysis of clinical ED records of 371 children with 381 unique occasions of reactions to foods was performed. Symptoms/signs of reactions to foods recorded for classification of anaphylaxis were related to those presented in the EAACI Taskforce position paper on Anaphylaxis in Children (Allergy 2007; 62: 857). Forty-six different symptoms/signs of reactions to foods were retrieved. Several severe signs or symptoms from the respiratory tract and signs indicating reduced brain perfusion were not described in detail in the EAACI paper, hampering correct classification of anaphylaxis including grading of severity in our material. After modification of the EAACI classification including such signs and symptoms, we were able to classify 128 (35%) children with anaphylaxis. Seventy children (19%) did not fulfill our modified EAACI's criteria for anaphylaxis. They had been given adrenaline before or at arrival to hospital, possibly preventing anaphylaxis. Another 173 (47%) children/adolescents had neither been given adrenalin, nor fulfilled the criteria for anaphylaxis. Classification of food-induced anaphylaxis and severity grading should be built on signs and symptoms to facilitate diagnosis. The existing EAACI tool is helpful, but for Swedish children it is not quite applicable, in particular because of the lack of description of some respiratory, neurological or possible cardiovascular signs and symptoms., (© 2010 John Wiley & Sons A/S.)

This paper examines the citation counts of papers published in the first 25 years of the Sociology of Health and Illness. According to this measure only a small number of papers have made a major impact on the discipline of sociology of health and illness and an analysis of these select papers identifies some common themes. In particular, 'successful' papers have provided important theoretical constructs for the field while exploration of aspects of identity has been a recurrent focus.

The modern scientific study of physical activity began soon after World War II and focused on the epidemic of cardiovascular disease that was beginning to engulf the Western world. Early 'exercise prescriptions' then specified intense bouts of vigorous activity as the most effective way to maintain cardiovascular fitness and 'heart health'. Doctors and other health professionals then grew concerned that progressively fewer individuals were heeding this advice at a time when physical activity from manual work was becoming less common. Evidence was also emerging in the late 1980s that the value of accumulated, moderately intense activities, now of increasing importance during leisure time, may have been overlooked, or at least underplayed, in the prevention of heart disease, diabetes and some cancers. Perhaps in population terms adherence to moderate 'lifestyle' activities would be better than to the earlier vigorous recommendations. Social policy therefore shifted in the United States in 1996; the US Surgeon General's report set out the basic public health message of '30 min of moderate activity five, and preferably all, days of the week'. This recommendation was broadly adopted throughout much of the Western world. How this change in health strategy might impact on unhealthy weight gain and the growing obesity epidemic was given little attention. Here we examine how post-war public health policy in physical activity developed in an attempt primarily to prevent cardiovascular disease. In the following article we examine why too little attention may have been given to unhealthy weight gain and investigate how this may have happened. Then we consider how much physical activity--and of what kind--is needed to prevent unhealthy weight gain.

The current guidelines for physical activity are based on the prevention of cardiovascular disease. In this article the magnitude and type of physical activity required to prevent unhealthy weight gain are assessed. Five categories of analyses are considered, ranging from the most rigorous analyses (based on D2O18 measures of energy expenditure) to socio-ecological associations. To standardize the approach, published work on the extent of exercise was expressed as a physical activity level (PAL), i.e. the ratio of total expenditure to the measured or estimated basal metabolic rate. D2O18, direct monitoring and measurements of activity patterns and detailed prospective studies of substantial population groups all suggest that a PAL of > or = 1.8 is required to limit the proportion of overweight and obese adult men. Data on women are more difficult to interpret because women are less active and the relationship with physical activity is usually less clear. Post-obese women with a PAL of >1.75 do not regain weight and other data are consistent with the need for a PAL of > or = 1.8. The analyses in both sexes are based predominantly on adults living in a Western society with the ready availability of energy-dense foods. Vigorous activity is more clearly linked to weight stability, allows a higher intensity of exercise for general activities and shortens the time needed for achieving a PAL of 1.8. This activity level is equivalent to an additional 60-90 min of brisk walking in adults who normally undertake only modest exercise. These demands are greater than the current suggested levels for cardiovascular benefit and imply the need for different environmental policies, rather than health education policies, if societies are to become generally more active and avoid unhealthy weight gain.

A routine and automatized methodology for thyroxine (T4) and thyrotrophin (TSH) radioimmunoassay (RIA) using dried blood samples on filter paper is described. T4-RIA was performed on one single dot (5 mm diameter equivalent to 4 microliters of serum) while two dots were necessary for TSH-RIA. Reference filter papers were introduced in each assay for quality control. In a preliminary study on 4,155 neonates, samples generally obtained between the 5th--7th day gave a mean 'dot-T4' of 97.95 +/- 36.04 nmol/l and a mean 'dot-TSH' of 10.19 mU/l +/- 8.25, corresponding to 2.47 mU/l of serum. Within an 18-month period (November 1976-April 1978), a total of 16.522 neonates have been screened allowing detection of three cases of congenital hypothyroidism (incidence 1 : 5507), two cases of congenitally low TBG and thirty-three cases of transient hypothyroidism.

This paper examines the exercise of discretion by casualty reception staff, focussing on the problems of accountability that arise when their judgements help shape the process of patient categorization that culminates in clinical diagnosis. Rules and guidelines which ostensibly relate to bureaucratic objectives, are applied in ways which reflect situational exigencies of reception work, and values embedded in organisational culture. But reception staff are reluctant to acknowledge the importance of their decisions, and, particularly where judgements relate to patient condition, present rule-use as a straightforward and certain activity in which interpretation plays little part.