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In current conditions, the most effective method of preventing pneumococcal infections (PI) is vaccination, which can significantly reduce the incidence and mortality from pneumococcus and reduce the level of antibiotic resistance. The use of pneumococcal conjugate vaccines has reduced the incidence of invasive PIs in vaccinated children and unvaccinated populations. This is especially true for children with severe somatic pathology, including those with various forms of heart failure (HF). The data show that vaccination of sick HF children can be a clinically effective intervention to improve the treatment results of circulatory failure and improve patients’ quality of life. However, questions regarding the optimal timing of vaccination of sick children with heart failure, dose, frequency and strategies of vaccine introduction still need to be resolved. Data on the pathophysiology of cardioprotection provision during effective vaccination against PI, influenza and COVID-19 in cardiac pathology are summarized. The authors recommend providing conditions for effective vaccine prevention of PI in children with heart failure.

In the pathogenesis of the psoriatic disease, genetic and environmental factors play a significant role, and one of the most critical ecological influences is nutrition. At the same time, the influence of nutrition on the pathogenetic links of psoriasis is currently underestimated. The clinical guidelines for managing children and adults with psoriasis do not mention the need to consult a nutritionist and any dietary recommendations. The purpose of this literature review was to analyze current data on the role of various nutritional factors in the development of psoriatic disease, the pathogenesis of its complicated course, as well as the effectiveness of dietary interventions in the treatment of this category of patients. The analysis of sixty eight sources of literature has shown that dietary changes and the use of biologically active food supplements can have a specific effect on the complex therapy of the disease. The possibilities of diet therapy in patients with psoriasis and metabolic syndrome are also discussed. At the same time, it is evident that further research is needed to improve the evidence base for the effectiveness of nutritional methods in managing this category of patients, especially in paediatric-age patients.

Background. Children with congenital epidermolysis bullosa (CEB) can have vitamin D deficiency due to its malabsorption in intestine and reduced synthesis in skin as these patients have restrictions on staying in the sun. However, the prevalence of vitamin D insufficiency/deficiency among patients with CEB remains not fully studied due to the small samples' sizes in previously studies.Objective. Our aim was to study vitamin D provision in children with CEB.Methods. The study included children aged from 3 to 18 years old with simplex and dystrophic types of CEB hospitalized in our department. The serum level of 25(OH)D was determined via chemiluminescence immunoassay. Vitamin D deficiency was established at 25(OH)D concentration of 20-30 ng/ml, deficiency — < 10-20 ng/ml, deep deficiency — < 10 ng/ml.Results. The study included 129 children with CEB (62 (48%) males, median age 6 (3; 10) years). 101 patients had dystrophic type of disease, 28 — simplex. The median 25(OH)D serum concentration in children with CEB was 21.7 (13.0; 36.6) ng/ml. Vitamin D insufficiency was revealed in 36 (28%) patients, deficiency — in 38 (29%), deep deficiency — in 16 (12%). Independent predictors of 25(OH)D concentration were the type of CEB (concentration was higher in children with simplex type) and age (negative association), but not the patients' gender and the examination season, according to multivariate regression analysis.Conclusion. The study has shown low level of vitamin D provision in children with CEB, whilst 25(OH)D concentration depended on the type of disease and the age of patients.

Congenital epidermolysis bullosa (CEB) is a group of rare genetic diseases of varying severity, which are characterized with the formation of blisters on the skin and/or mucous membranes with minor trauma. In this case, the clinical course of the disease in some cases is aggravated by the development of malnutrition, which further worsens the quality of life of patients.Aim of the study. To assess the physical development and laboratory findings of nutritional status in children with simple (SCEB) and dystrophic forms of CEB (DCEB).Methods and materials. The study included children with SCEB and DCEB at the age of 8 months to 18 years old, treated at the National Medical Research Centre of Children's Health (Moscow, Russia) from January 2018 to January 2019. Anthropometric parameters were assessed in all patients, and a biochemical blood test was performed for total calcium, phosphorus, albumin, and magnesium. Data are presented using the median (Me) and quartiles of 25 % and 75 % [Q25; Q75], as well as the mean (M) and 95 % confidence interval (95 % CI) for variables with a normal distribution.Results. A total of 87 children were included in the study, 70 with DCEB and 17 with SCEB. There were no differences in sex and age between the groups. According to the results of the study, all anthropometric parameters (WAZ, HAZ and BAZ) in children with DCEB were statistically significantly lower (p < 0.001) than in children with SCEB. Although in both forms of CEB the averaged values of WAZ, HAZ and BAZ turned out to be within the normal range, in children with DCEB, a decrease in HAZ less than -2 was noted in 22 children (31%). Moderate protein-energy malnutrition (-3 < BAZ < -2) was detected in 29 patients (41 %), while 20 of them (29%) were diagnosed with severe protein-energy malnutrition (BAZ < -3). Biochemical parameters were within the reference values, however, the levels of albumin and total calcium were statistically significantly reduced in children with DCEB compared with SCEB children (p < 0.001 and p = 0.005, respectively). Hypoalbuminemia was observed in 64 %, and hypocalcemia in 9 % of DCEB children.Conclusion. All anthropometric values in children with DCEB were lower than in children with SCEB. The study of albumin and total calcium level in the blood of children with DCEB can reveal preclinical forms of malnutrition.

Relevance of topic. Atopic dermatitis is a wide-spread skin disease that can significantly reduce patient’s quality of life. Many authors around the globe conduct research to find correlation between atopic detmatitis in children, their growth, development of allergic comorbidities (food allergy in particular) and elimination diet prescription.Aim of the study. To estimate growth indices and nutritional status in children with severe atopic dermatitis and allergic comorbidities on the elimination diet.Methods. This study included children of age 0-17 years 11 months, hospitalized in Dermatology with the Laser Surgery department in the National Medical Research Centre of Children’s Health from September 2020 to May 2021. Anthropometric indices, levels of serum vitamin D, albumin, hemoglobin and total IgE were estimated in all children.Results. This study included 80 children. There was a moderate negative correlation between the number of excluded food groups, the disease longitude (p = 0.003; r = -0.333) and HAZ (p = 0.010; r = -0.351). There was a moderate negative correlation between the age of children and serum vitamin D (p = 0.040; r = -0.317) and a moderate positive - between BAZ and serum vitamin D (p = 0.030; r = 0.332). There was a weak negative correlation between serum vitamin D and total serum IgE (p = 0.033; r = -0.239) and between BAZ and serum hemoglobin (p = 0.028; r = 0.246).Conclusions. The results of this study demonstrate a low intake of vitamin D in children with severe atopic dermatitis, worsening with age. Vitamin D level correlated with BAZ, also the results showed lower vitamin D intake in children with high levels of total Ig E.

Introduction. Vaccination is the primary method of preventing hepatitis B (HBV). Immunization performed according to the standard schedule often provides protective level of antibodies against HBV. However, the frequency deviation of the immunization schedule in children due to unjustified medical contraindication is the current problem in Russia. At the same time, there is currently no clear strategy for patients with significant deviations of the vaccination schedule, especially regarding extending the interval between the first and third administration of the HBV vaccine. The aim is to evaluate the immunological effects of vaccination against hepatitis B in the vaccination schedule deviation in healthy children and children with chronic diseases. Materials and methods. Eighty-one 0.7-11.7 year child with a disrupted schedule of vaccination against HBV was observed. The children were divided into two groups: children vaccinated within 12-35 months (group 1, n = 48) and children immunized more than 36 months after the first vaccination (group 2, n = 33). Children with chronic forms of pathology were included in both study groups. Blood tests for HBV antibodies after vaccination were performed 1-3 months after the third vaccination. Results. The average concentration of antibodies in the range of 10-1000 mMEd/ml in children of group 1 was significantly higher than in children of group 2 (p = 0.037). In addition, children with chronic diseases were significantly more likely to have an anti-HBs titer higher than 1000 mMEd/ml after the third vaccination than healthy children (p = 0.012). Conclusion. An increase in the interval between the first and third administration of the hepatitis B vaccine leads to a rise in the number of children who are not immune to hepatitis B. Chronic diseases fail to affect the immune response due to the introduction of the hepatitis B vaccine, even if the immunization schedule is disrupted.

Objective. To study vitamin D status in children with inflammatory bowel diseases (IBD) depending on the diagnosis, gender, age and a season of examination. Patients and methods. The study included 244 children (130 boys and 114 girls) aged 3 to 18 years. The patients were divided into 2 groups depending on the nosological form of disease: Crohn’s disease (CD) – 130 children, ulcerative colitis (UC) – 114 children. Blood vitamin D levels were determined by the method of competitive electrochemiluminescence. Results. Normal levels of vitamin D (>30 ng/ml) were found only in 11.1% of children with IBD (in 11.5% with CD and 10.5% with UC). Vitamin D status corresponded to deficiency levels in 65.9% of cases, of them 15.2% had deep deficiency (

The optimal nutrition during pregnancy and lactation is extremely important for the health of both the mother and her infant. It allows realizing the «programming» potential of breastfeeding fully. The World Health Organization (WHO) emphasizes that to achieve better optimization of pregnant and lactating woman nutrition, it is necessary to enhance the introduction of relevant recommendations into practical work. The purpose of the current study is to analyze the results of a survey of women in Russia regarding their awareness of nutrition during lactation. Materials and methods. 1282 women of childbearing age (from 18 to 44 years old) from various regions of the Russian Federation took part in the survey. The questionnaire included 19 questions regarding the socio-demographic characteristics, duration of breastfeeding the nutritional features of women during breastfeeding, as well as the women’s opinions regarding the infant’s responses to changes in mother’s diet. The results of the study indicated that, despite the availability of recommendations coming from professional medical communities, no more than 30% of women received information about nutrition during breastfeeding from doctors. The Internet resources (non-medical websites and blogs) were shown to be the main source of knowledge about this issue (up to 60% of respondents). The results suggest from 30.2% to 42% of women in different age groups regularly to adhere to dietary recommendations. Whereas, they often had false ideas about «forbidden» and «allowed» foods. Thus, 30% of respondents noted nuts, jam, fresh vegetables, juice, fresh fruits as «forbidden» foods. Moreover, mothers with a first-born were significantly more likely to follow a diet compared to women with two (p < 0.001) and three or more children (p < 0.001). Conclusion. An analysis of the survey results showed that women have enough professional information about nutrition during lactation. Therefore, the work on the implementation of professional recommendations on nutrition for pregnant and lactating women should be intensified.

Background. The growing popularity of vegetarianism in the world also affects the growth of the number of families choosing this type of diet. Adherence to a vegetarian diet in children is a concern due to the high risks of macro- and micronutrient deficiencies. Increasing interest in vegetarian diets is also relevant for our country, but there is currently no data on the prevalence of vegetarianism among children in Russia. Materials and methods. We conducted a cross-sectional controlled study of indices of physical development, body component composition, and macronutrient composition of diets in vegetarian and non-vegetarian children. The physical development of vegetarian children was assessed using the «Anthro Plus», the macronutrient composition of diets was assessed using the special computer software, body composition was assessed using the bioelectrical impedance analysis. Results. 24% of vegetarian children had physical deviations: reduced body weight (6.3%), reduced body length (1.9%), mild malnutrition (13.3%), moderate malnutrition (1.3%), severe malnutrition (0.6%), overweight (5.1%). The assessment of the body composition showed statistically lower values of % ACM (p = 0.004) and phase angle (p = 0.005) in vegetarian children. 95% of the vegetarian children had an inadequate composition of the diet: both insufficient and excessive consumption of protein, fat, and carbohydrates. Low consumption of all macronutrients was found in 15% of vegetarian children. Children who received a vegan diet consumed protein with food statistically significantly lower, compared with lacto-and lacto-ovo-vegetarians (p < 0.005), but statistically more often consumed a high level of carbohydrates. High fat intake was found in most vegetarian children, especially children under 12 years. Conclusion. The results of the study showed the need to raise awareness of vegetarian parents about the nutritional risks associated with a vegetarian diet, and to make an adequate diet for their children.

Vaccination and hygiene are currently the main strategies for helping limit the spread and impact of acute respiratory infections However, the pandemic of SARS-CoV-2 infection and its severe consequences require the search for additional measures for reducing the morbidity and mortality from coronavirus infection One of these additional prevention strategies is micronutrient status optimization, which is safe and cost-effective Vitamins and minerals are important components of the immune response The effect of micronutrients such as vitamin D, ascorbic acid, zinc, omega-3 polyunsaturated fatty acids on the immune response has been studied for several decades As a result, significant shreds of evidence have been accumulated regarding the importance of provision immuno-nutrients on the adequate immune response This implies in both contexts: the prevention of infectious diseases and their course At the same time, the problem of insufficient supply with various micronutrients is gaining global significance, affecting every country and every socio-economic class of people This review contains data on the state of micronutrient status of the global and Russian population, discussion of the role of key immunonutrients in the prevention and treatment of respiratory infections, and results of recent meta-analyses It will also provide recommendations of experts in the field of nutrition, developed in 2020 with regard to the COVID-19 pandemic Вакцинация и меры гигиены являются основными стратегиями, которые помогают ограничить распространение и воздействие инфекций, в том числе острых респираторных заболеваний Однако пандемия инфекции SARS-CoV-2 и тяжелые исходы COVID-19 требуют поиска дополнительных мер, направленных на снижение заболеваемости и смертности от коронавирусной инфекции Дополнительной стратегией профилактики, безопасной и экономически эффективной, является оптимизация микронутриентного статуса больного Витамины и минеральные вещества вовлечены в реализацию всех звеньев иммунного ответа, и недостаточная микронутриентная обеспеченность неизбежно сказывается на иммунном статусе Влияние таких микронутриентов, как витамин D, аскорбиновая кислота, цинк, омега-3 полиненасыщенные жирные кислоты, на иммунный ответ изучается на протяжении нескольких десятилетий Накоплена значительная доказательная база о значении обеспеченности этими нутриентами для адекватного иммунного ответа в контексте профилактики инфекционных болезней и особенностей их течения В то же время недостаточная обеспеченность различными микронутриентами приобретает глобальный масштаб, затрагивая все страны и все слои населения Обзор содержит данные о состоянии микронутриентного статуса населения, обсуждается роль ключевых иммунонутриентов в профилактике и лечении респираторных инфекций, приведены данные последних мета-анализов, представлены также рекомендации экспертов в области нутрициологии, разработанные в 2020 г в связи с пандемией COVID-19

Asthma is a severe and chronic disabling disease affecting more than 300 million people worldwide. Although in the past few drugs for the treatment of asthma were available, new treatment options are currently emerging, which appear to be highly effective in certain subgroups of patients. Accordingly, there is a need for biomarkers that allow selection of patients for refined and personalized treatment strategies. Recently, serological chip tests based on microarrayed allergen molecules and peptides derived from the most common rhinovirus strains have been developed, which may discriminate 2 of the most common forms of asthma, that is, allergen- and virus-triggered asthma. In this perspective, we argue that classification of patients with asthma according to these common trigger factors may open new possibilities for personalized management of asthma., La lista completa de autores que integran el documento puede consultarse en el archivo., Facultad de Ciencias Exactas

In the article, the authors present results of their own clinical study, on the basis of which the need to involve doctors of various specialties to accompany children with cerebral palsy is scientifically justified.

Introduction. The only effective method of controlling rotavirus infection is vaccination, which has been mandatory in the Moscow Vaccination Schedule since 2014 and in the Epidemic Vaccinations Schedule. To evaluate the efficacy and safety of pentavalent vaccine immunization for the prevention of rotavirus infection in healthy children and children with chronic diseases there were comprehensively examined 182 children, including 83 healthy and 99 cases with problems of health. Vaccination was performed at the age of 6-32 weeks. All adverse events occurred within 42 days after vaccine administration were recorded. There was analyzed the incidence of intestinal infections within the next year since the moment of the first vaccination. There were no revealed any statistically significant differences in the frequency of adverse events between the group of healthy children and the group of cases with different chronic diseases. The most common post-vaccination adverse effects were diarrhea and subfebrile and febrile temperature. During a year follow-up period, a group of patients (n=9) did not have any symptoms of the disease after contacting patients with cases with acute intestinal infections. Conclusion The study shows the safety of rotavirus infection immunization in healthy children and children with chronic diseases. Rotavirus infection vaccination is effective in patients who have had contact with persons suffering from acute intestinal infections. Vaccination against rotavirus infection should be recommended not only for healthy infants but for those with chronic diseases also.

The authors present the results of their own clinical study of the nutritional status of cerebral palsy (CP) children. The chemical composition of the diet of the observed patients and the body composition of patients were analyzed with bioimpedance analysis. The results of the dynamic control of the analyzed indices after the nutritive correction are presented. Aim of the study. To study the nutritional status of CP patients and evaluation of its dynamic changes with the help of bioimpendancemetry after carrying out remedial measures. Material and methods. We observed 27 CP children aged from 5 to 11 years, who were diagnosed with a protein-energy deficiency. Examination of patients included physical examination, the assessment of anthropometric indices using the “WHO Anthro+” and a body composition analysis using bioimpendancemetry. Evaluation of the actual nutrition included the study of the diet, the calculation of the chemical composition of the diet, the state of appetite and the nature of the feces. All studies were conducted in CP children twice: at the time of admission to the hospital and in the following-up period after the correction of the diet and the appointment of treatment with metabolic and vitamin preparations for 2 months. Results and conclusion. The protein-energy deficiency in CP children being associated with a disorder of the diet, decreased appetite, lack of basic macronutrients, needs the nutritive correction, including the introduction of the supplemental nutrition in their diet. The study showed that against the background of the basic drug therapy and nutritional correction there is a positive dynamics in the form of increasing Z-score body weight, Z-score ratio of body weight to age, normalization of appetite, which correlates with the normalization of the main study using bioimpedance analysis of body composition.

The results of a large number of studies indicate the relationship of obesity and bronchial asthma in children. The review highlights the mechanisms of development of the so-called obese asthma: morphological changes in the respiratory tract, systemic inflammation, adipokine production, impaired glucose and insulin metabolism, genetic and epigenetic factors, changes in the microbiome of the respiratory tract and(or) intestines. The relationship of asthma and obesity can have both a genetic basis and can occur under the influence of a complex of pathogenic factors, and they can be especially important at the “early programming” stage. Obesity increases the risk of asthma development, and in patients with existing asthma due to a number of mechanisms it increases the severity or makes it difficult to achieve control of asthma. Studies showed that patients with obese asthma are distinguished by a more severe course of the disease, poor quality of life and a decreased response to therapy for asthma. Weight loss in children with asthma can lead to an improved well-being of patients, but data on the effectiveness of therapeutic interventions in these children is limited. Comorbidity of asthma and obesity is a complex multifactorial phenotype in children, which requires further study. Being overweight or obese needs to be taken into account as part of asthma treatment in this category of patients.

The objective. To assess the incidence of insufficient supply of water-soluble vitamins in vegetarian children using non-invasive methods (excretion with the urine), depending on the intake of the vitamin-mineral complex. In the winter-autumn period we examined 38 preschool and school-aged vegetarian children (3–16 years old) living in Moscow and being on vegetarian diet. The 1st group consisted of 25 children who did not take vitamins. The 2nd group included 13 children who took a complex of 12 vitamins and 9 minerals for 1–3 weeks. Vitamin status was assessed by excretion of ascorbic acid, thiamine, riboflavin, and 4-pyridoxyl acid with morning urine collected on an empty stomach. The results. Only 1 child from the 1st group had a lack of vitamin C due to the sufficient intake of fresh vegetables and fruits. A vitamin-mineral complex noticeably improved the provision of vitamins B. The children of the Group 1, had a reduced excretion of vitamins B1, B2 and B6 more often as compared to the children of Group 2: 44.0–64.0% vs 0–30.8%. 2/3 of children-vegetarians of Group 2 were adequately provided with three vitamins of group B, which is 2.7 times higher than children who did not receive vitamins. A deficiency of three vitamins was detected in 7 children (28%) who did not take a vitamin-mineral complex. The conclusion. A vitamin-mineral complex in the diet is a necessary condition for maintaining optimal micronutrient status of vegetarian children.

Cross-reactive food allergy to plant-based products can lead to a significant increase in morbidity and impairment of quality of life, therefore it is important to analyze the literature data on the effectiveness of conventional and available methods of AIT in these patients.

Background : Inherited epidermolysis bullosa (EB) refers to a group of rare inherited disorders characterized by severe damage of skin and in most patients — the gastrointestinal mucosa, what leads to a violation of skin and mucosal barrier properties in relation to allergens. However, the issues of food sensitization and food allergy in this category of patients have not been studied, and the study of this problem is important. Aim : To evaluate the clinical manifestations of food allergy (FA) and IgE-response to food proteins in children with EB. Methods : 82 patients with EB aged from 2 months to 16 years were entered this open non-randomized observational prospective study, including 20 patients with simple form of EB and 62 patients with dystrophic form of EB. We analyzed allergic history and clinical manifestations of the FA in all the patients. Every patient in this study underwent of determination of the concentration of total serum IgE and specific serum IgE to the most important food allergens, as well as to mixtures of household allergens in some cases (UniCAP System, Phadia AB). Results : Skin lesion in patients with EB masks allergic skin manifestations, causing a hypodiagnosis of the FA in this category of patients, which in turn leads to erroneous organization of nutritional support. FA (clinical manifestations) was identified in 20.7% of children with EB (in 10% of cases with simple form of EB and in 24.2% — in patients with dystrophic form of EB). Products containing cow’s milk protein, cereals, and eggs were identified as etiologic factors of FA in most cases. In the group of children with comorbidity FA and EB high and very high levels of total IgE (>1000 kUA / l) were detected most frequently. The main cause-significant allergens are cow’s milk proteins, cereals, eggs. Conclusions : Comorbidity with FA is high in patients with dystrophic form of EB. The main cause-significant allergens are cow’s milk proteins, cereals, eggs.

Objective. The objective is to analyze the features of sensitization to food allergens in vegetarian children.Methods: 210 children aged from 3 months to 17 years and 11 months old: vegetarians with at least 6 months vegetarian experience (n = 129) and children receiving a traditional diet (n = 81) were examined. The level of specific immunoglobulin E of blood serum to cow milk protein, soy, beef, pork, chicken, fish (cod), egg white and wheat was determined.Results: The rate of sensitization to food allergen in vegetarian children did not statistically differ from that of a comparison group (18.6 against 17.3 %, p>0.05). The correlation analysis showed a slight association between vegetarian diet and the level of specific immunoglobulin E only for soy protein (r = 0.22, pConclusions: The obtained results speak of higher risk of sensitization to soy in vegetarian children.

Professional medical communities create clinical recommendations based on principles of «evidencebased medicine» to optimize the provision of medical care to patients with various pathologies. Following these recommendations allows doctors to avoid mistakes in the management of patients and to achieve a positive result of treatment in most of the patients. Early started and properly administered treatment of children with cow’s milk protein allergy (CMPA) significantly improves the prognosis of the disease and can interrupt the socalled «allergic march». The purpose of the publication is to introduce the current national clinical guidelines for the provision of medical care to children with CMPA to wide range of pediatricians and physicians of other specialties.

High academic loads are a common problem for Russian schoolchildren negatively affecting their mental and physical health. The article presents the main contributory factors of high academic loads, differentiated clinical features, course, and complications of the syndrome. The issues of high academic load syndrome treatment are separately covered. The main conclusion is that it is necessary to reinforce the prevention of psychoneurological disorders and their complications in schoolchildren of Russia.

Children suffering from dystrophic forms of innate epidermolysis bullosa (IEB), have malnutrition of multifactorial genesis. And, despite the experience of working with this complex group of patients, many practical issues of optimal nutrition organization at IEB remain unsolved. The review presents modern approaches to the assessment of nutritional status with children, including those developed for the assessment of eating disorders with children having IEB; the formulas for calculating the nutrient requirement are presented. The analysis of the scientific data on the pathogenesis and characteristics of disturbances in nutritional status with children having IEB is done. It is noted that the complexity of nutritional support of this severe category of patients is due to a mismatch between the increased need for nutrients and limited assimilation of food, which requires a special diet with increased energy and protein value without increasing the amount of food intake. Reasonability of the organization of feeding children having IEB with specialized products for enteral nutrition and nutritional support is analyzed.

Food allergy is often the first manifestation of allergy in a child, and this problem is most relevant at an early age. With an allergic reaction to food, a seemingly not very significant pathology, a so-called «atopic march» may begin with the development of severe forms of allergic diseases in a child. At the same time, a favourable course of food allergy is possible with the disappearance of disorder signs with age. The disease prognosis depends on many factors, both genetic and environmental, but early diagnosis and adequate treatment of children with food allergies in most cases allow to improve the prognosis of tolerance formation or, at least, to achieve a mild course of food allergy manifestations. It is pediatricians who first deal with early manifestations of food allergies, and adherence to clinical guidelines for managing patients avoids the most common mistakes. This article is addressed to practicing doctors. It considers the most common mistakes of pediatricians in the management of children with food allergies and discusses the surviving «myths» about this pathology.

Children with inflammatory bowel disease (IBD) often receive a dairy-free diet during remission period without evidence, which adversely affects their nutritional status. The aim Of the study was to optimize the approaches to prescribing diets for children with IBD Materials and methods 180 children aged 1 to 17 years with IBD (90 patients with Crohn’s disease and 90 – with ulcerative colitis) in clinical remission were included in this study. Testing of Lactase deficiency included Lactose Intolerance quick test (LIQT) and Real-time PCR, using fluorescent TaqMan probes for analyzing the genotype of polymorphic marker rs182549 in the MCM6 gene. Allergy–focused history questionnaire, morphological study of biopsy specimens of the intestine with the counting of eosinophils, dairy products «open food challenge» (with fecal calprotectin assessment) were used for identifying of cow’s milk allergy (CMA). Results According to the results of LIQT: normolactasia (NL) was observed in 26%, moderate hypolactasia (GL) - in 35% and severe GL - in 39% patients with Crohn’s disease. In children with Ulcerative colitis NL was observed in 31,5%, moderate GL - in 32,5% and severe GL - in 36%. In the patients with normolactasia we revealed an increase in the number of genotypes TT of the of the polymorphic marker rs182549 (c.13910 C>T). In patients with moderate and severe GL, the genotype CC of this polymorphic marker was significantly more frequent (P=0.030; OR = 2.72; 95% CI, 1.08–6.87). Dairy products «open food challenge» was performed in 20 children with IBD and suspected CMA (questionnaire score 54–71). CMA was confirmed in 12 patients by the results of the morphological study of intestinal biopsy specimens with the counting of eosinophils and «open food challenge». According to these findings diet recommendation for patient with IBD were personalized: Cow’s milk-free diet - for children with CMA, Lactose-free diet - for children with severe lactose intolerance, Low lactose diet was recommended to the patients with moderate hypolactasia, Diet containing Cow’s milk - for other patients. Children with GL and genotypes TT had better prognosis for lactose-tolerance. Conclusion Allergy–focused history questionnaire for identifying of CMA, Lactose Intolerance quick test and assessment of genotype of polymorphic marker rs182549 in the MCM6 gene may improve approaches for personalization of diet for patients with IBD.

Food allergy (FA) is an important health problem which determines lower life quality of a patient and his family. Egg proteins, milk, soy, wheat, and nuts provoke FA more often but any food product may potentially cause allergic reactions. So the aim was to study the age-specific dynamics of antibody response and select the most meaningful IgE production triggers in children with PA. Materials and Methods. The study included 682 children with FA divided into groups according to age: 2−5 months, 6−18 months, 1.5−4 years, 4−10 years, older than 10 years. The IgE levels to cereals, vegetables, bananas, meat, and poultry allergens were measured in blood samples. Results. The age dynamic of IgE-positive responses was detected. The frequency of positive responses was higher in older children. The most significant IgE production triggers for 2−5 months children were allergens of potatoes, pork and cereals (8−14%); for 6−18 month children potatoes (22.7%), buckwheat (19,3%), cereals (10−15%); for 1.5−4 years children ― bananas (29.5%), cereals, carrots and potatoes (19,5−24%); for 4−10 years children ― bananas, carrots and cereals (20−28%); for the senior children ― carrots (47.5%), bananas, cereals and tomatoes (30−36%). Chicken-specific IgE-positive response was minimal for all ages, and meat or poultry specific IgE were observed in 8−15% of patients. Conclusion. Different groups of food allergens provoke sensitization in children during their life. The range of food products with low allergenic activity remains constant in various ages. Age characteristics of IgE production requires differentiated diagnosis approach.

Background: Assessment of quality of life of a food-allergic child’s family members requires developing special instruments or adapting the existing ones. Objective: The study was aimed at developing a specialized questionnaire “The Food hypersensitivity family ImPact“ (FLIP) in Russian for assessing quality of life a food-allergic child’s family members and evaluating its psychometric properties. Methods: Linguistic and cultural adaptation of the FLIP questionnaire in Russia involving parents/legal representatives of children with food allergies was performed prospectively. We confirmed reliability and constructive validity of the questionnaire in Russian. Results: Polling involved parents/legal representatives of 131 children with food allergies aged 1–18 months. Results of evaluation of the questionnaire’s psychometric properties demonstrated an average level of internal consistency of the questionnaire (Cronbach’s > 0.72 in different age groups). The questionnaire evaluation results depend on the degree of manifestation of disease symptoms (p = 0.033), pharmacotherapy duration (p = 0.033), breastfeeding for 6 months or more (p = 0.033), time or diet broadening and strictness of elimination diet observation (p = 0.033), number of foods eliminated from the diet (p = 0.010) and number of diagnostic events (p = 0.033). Conclusion: The FLIP questionnaire in Russian was developed; it underwent assessment of psychometric properties. We demonstrated dependence of quality of life of food-allergic children’s family members on disease characteristics and therapy effectiveness.

Despite the availability of a national consensus document describing in detail modern approaches to feeding infants, pediatricians keep on giving most diverse recommendations on the time of supplemental feeding introduction. The article presents a brief historical review, as well the modern view on the issue of introduction of supplemental feeding to children. In the previous century, it was common both in Russia and most European countries to introduce supplemental feeding to children at the age of 2 or even 1.5 months. In 2002, the World Health Organization put forward an initiative in support of breastfeeding and recommended not to introduce supplemental feeding before the age of 6 months. A certain “golden mean” has apparently been achieved on the basis of results of studies and a longterm discussion among the specialists in feeding from different countries — all scientific communities and national recommendations of most countries define the optimal age for supplemental feeding introduction as “from 4 (completed) months to 6 (completed) months” with certain individual approach.

Adequate nutrition is the most important factor of children’s health, affecting not only his/her state of health, but also physical activity indicators. Children athletes, for compensating the energy cost, anabolic processes activation, and operability recovery, need an optimum diet with adequate protein, fats, carbohydrates, minerals and vitamins to cover the development and growth needs, as well as to recover from the physical and neuro-psychological stress. There are also certain requirements to food and drinking regime, especially during periods of intense training and competitions. Recommendations for the composition of diets for children athletes are developed and presented in a number of guidelines; however, studies show that the actual nutrition of almost half of the specialized children and youth Olympic reserve schools’ students does not meet the recommended standards. The article presents an overview of modern approaches to young athletes’ nutrition organization, and gives recommendations for personified diet correction and nutritive support depending on sports specialization, nature of physical activity, stage of training process, and individual features of a child.

Background: Vitamin D-deficient states remain highly prevalent in children, according to Russian and foreign studies. Because of this, it is important to conduct timely prevention of rachitis in children, taking into account the commitment to therapy from the parents’ side. Objective: Our aim was to study the preventive efficacy of the Russian-manufactured vitamin D3 solutio oleosa with regard to preventing rachitis. Methods: A short-term prospective comparative study has been conducted. Vitamin D3 was used in the dosages of 400 and 800 ME or 500 and 1000 ME, in the form of an oil or water solution of cholecalciferol in mature and premature (according to the gestation term) children, correspondingly. The control group was comprised of mature children of a comparable age, who received no vitaminoprophilaxis (parental refusal). We evaluate clinical symptoms of rachitis before and after 1 month after the beginning of the study. Results: 111 children aged 4–6 months, of them 66 mature and 45 premature were included into the study. None of the children developed rachitis symptoms while taking vitamin D3 while 8 out of 15 controls (53%) developed signs of rachitis. Conclusion : We demonstrated a comparative efficacy of oil and water solutions of vitamin D3 with regard to preventing rachitis in mature and premature children.

Optimal provision of children with micronutrients determines their normal growth, mental and physical development, as well as health in general. Even a sufficiently energy demand-adequate and calorie-excessive diet comprised of natural products for children does not provide a child’s body with a whole range of micronutrients. Due to insufficient stay of a child in the sun and long stay indoors, endogenous vitamin D synthesis in skin induced by ultraviolet exposure does not fulfill a body’s need in this vitamin. As vitamin deficiency is usually accompanied by mineral deficiency, it is reasonable to prescribe vitamin/mineral complexes (VMC). High prevalence of polyhypoavitaminosis substantiates the use of coformulated vitamin forms in children’s diets. Simultaneous vitamin intake is more physiologically natural; combination of vitamins is more effective than separate or isolated prescription of each of them. Preventive doses, i.e. the doses close to the physiological vitamin need of a child’s body ensure the diet’s vitamin adequacy, reduce the risk of vitamin deficiency and its consequences. Effectiveness of VMC use has been confirmed both for treatment and prevention of allergic diseases in children. The main requirement to VMC for children is the full range of vitamins and minerals, the deficiency whereof is identified especially often, in the doses fulfilling needs of a growing child.

It is known that a child cannot receive the sufficient amount of all vitamins and minerals with the regular contemporary (“Western”) type of diet. The issue of vitamin deficiency is characteristic of a considerable part of population of Russia, including children. Vitamin deficiency is even worse in children with allergic pathologies than in similar age groups. As use of vitamin/mineral complexes in children with allergic diseases raises specific concerns among physicians and parents due to possible adverse reactions, discussion of the need and safety of vitamin prevention and vitamin therapy in this category of patients was chosen as the topic of this review. The article presents the contemporary data on the role of vitamins in a child’s immune response formation, as well as in the pathogenesis of allergic diseases. The authors recount new data on numerous biological effects of vitamin D, including the immune system level, in detail. The review of clinical studies of use of vitamin/mineral complexes in children with allergies involved both foreign and Russian studies, including the considerable clinical experience accumulated right at the Scientific Center of Children’s Health. It has been shown that use of vitamins both for preventive purposes and for treatment of allergic diseases in children is reasonable not only because it reliably affects immune response, but also due to a deficiency of a range of vitamins in immunopathogenesis of an allergological pathology.

The article is dedicated to the problem of food allergy in children. The number of patients with this pathology continues to rise, which can be explained by multiple factors, which speaks for the relevance and the social importance of the matter. For food allergy, the causesignificant allergens are both simple and complex food proteins. Wheat is one of the most prevalent source of food allergens not only for children, but for adults too. The article contains the main information concerning the ley characteristics of this product; the protein content and the different roles of individual components in forming allergic reactions and cross activity are thoroughly investigated. The authors provide recommendations for the diagnostics and treatment of wheat protein allergy, and various difficulties in different clinical cases are examined. The article also contains main treatment approaches, which are relevant to the modern data. An individual approach in each case means regular monitoring of the main figures, preventing the negative consequences of an eliminative diet at wheat protein allergy through using specialized gluten-free products.

In modern sports, outlining an adequate diet is one of the key issues in training young athletes. The following literature review presents new approaches to nutrition of young athletes going in for cyclic sports. These sports take a lot of energy, entail great strain and significant intensity of training. Correspondingly, the ratio of nutrients in athletes training for endurance tends to shift toward carbohydrates, the amount of which in the body should cover the increased need for workload as may be defined by the training process and the amount of workload. High-fat diets have proved irrelevant in terms of providing energy function; therefore, this nutritive approach was dismissed, since an athlete should have an about 25% share of fats of his/her menu’s total caloric value. According to modern standards, the amount of proteins in athletes’ menu should not exceed 1.2–1.6g per 1kg of body weight. To avoid the risk of dehydration and physical weakness, cyclic athletes should take sport drinks (in small portions) prior to and following a training session (competition). They contain carbohydrates and electrolytes and therefore are more preferable than pure water.

The article presents current views on the role of long-chain polyunsaturated fatty acids (LCPUFAs) in the development and functioning of the child ’ s nervous system. Despite the fact that a person needs LCPUFAs in small amounts, if compared with other nutrients, the provision of essential fatty acids in the early stages of the child ’ s development is critical not only in childhood, but also in the long run. The study of multiple LCPUFA functions leads to the fact that their adequate dietary intake has recently been regarded as one of the most important factors that determine the health of a child and significantly affect the maturation, development and functioning of the nervous system and visual organs. Provision of body with active LCPUFAs depends not only on intake of their predecessors or acids themselves together with food, but also on the activity of endogenous desaturases, which is determined by genes. The article describes the main factors affecting the supply of LCPUFAs to the child ’ s body in prenatal period of development, postnatal period, early childhood and later life, as well as conditions associated with deficits of LCPUFAs.

Rapid growth of incidence of allergic diseases in the last 40 years allows us naming allergy the pandemic of the XXI century. Allergic diseases harm not only individual patients, but the society in whole in the form of progressive increase in direct and indirect costs. According to the latest estimates, more than 150 mn people suffer from allergies, whereas more than 250 mn patients in Europe are expected to suffer from allergies in the next decade. National and international documents stating rules of preventing and treating allergic diseases must become current guidelines for clinicians everywhere. The article summarizes the latest recommendations of the European Academy of Allergology and Clinical Immunology (2014) and of the National Food Allergy Guidelines. The article presents evidence-based methods of primary allergy prevention in infants. Modern primary food allergy prevention may consist of exclusively breast feeding for at least 4 6 months; if breast feeding is not feasible, prevention may be attained by means of using preventive hypoallergenic formulas with confirmed low allergenicity and not introducing supplemental feeding before the age of 4 months. Evidence-based studies do not confirm effectiveness of any dietary restrictions of pregnant and nursing women regardless of whether they belong to the risk group or not.

The article includes a brief literature review of clinical and experimental studies of intestinal uptake and absorption of macromolecules. Results of own research of the gut permeability for human milk α-lactalbumin in premature infants (30-36 weeks) are presented. The study revealed a reduction of gut permeability during the first months of life regardless of gestation age and type of feeding. Absorption of human milk α-lactalbumin did not decrease in babies with allergy symptoms, which appeared during the first month after birth. Study of gut barrier function in infants with skin and gastrointestinal manifestations of food allergy has shown maintenance and further increasing of intestinal permeability for human α-lactalbumin during the first year of life. In this regard, the indications for the use of specialized amino acids based formula Neocate were considered and the results of its application were presented.

Background and aims Epidermolysis Bullosa (EB) refers to a group of rare inherited disorders characterised by skin and/or mucous blistering even after minor injuries. Nutritional deficiency in EB, especially in dystrophic form, is the result of associated states such as: dental/gum diseases, oral, pharyngealandoesophageal blistering, microstomia, fixed tongue, dysphagia, oesophageal stricture, gastro-oesophageal reflux. Study Objective To assess the nutritional status of children suffering from different forms of EB. Materials and methods The study included 60 children aged 1–16 years suffering from Epidermolysis Bullosa Simplex (EBS) (n=17) and Dystrophic Epidermolysis Bullosa (DEB) (n=43). The assessment of physical development indices was carried out using WHO ANTRO+ computer program. Z-score values (weight index (WAZ), height index (HAZ), body mass index (BAZ)) within > −2 / −3/ Results WAZ, HAZ and BAZ in children with EBS were in normal limits in most of patients (82.3%), 2 children had undernutrition (BAZ > −3/ +1. WAZ in patients with DEB was within normal limits only in 16 children (37.2%), increased (>+1) – in 1 child (2.3%). Other children had a decreased WAZ: within > −3/ +1) – in 3 children (7.0%), decreased within > −3/ -3/ THINC scale values ranged from 10 to 55 (Me 30±10.47) in children with EBS; from 25 to 95 (Me 60±17.63) in patients with DEB. Conclusions The performed analysis shows evident disorders of the nutritional status in children with a dystrophic form of EB. The THINC tool should be used for a comprehensive assessment of nutritional status and nutritional compromise, effectiveness of the administered treatment, including dietary therapy, over time.

Background Food allergy is one of the most frequent conditions among allergy diseases in early age children, and cow’s milk proteins (CMP) are the most common allergens in these patients. allergy. Nowadays distinct predictors of the development of tolerance to CMP have not yet been defined. So, definition of the immunophenotypes of CMP allergy seems to be helpful in practice and, accordingly, will significantly facilitate the follow-up of these patients. Objective To determine immunophenotypes of CMP allergy and assess their role in predicting the development of tolerance to CMP. patients and methods. We provided the prospective observational study and observed 153 children with CMP allergy aged 1–18 month. Blood samples were taken to determine sIgE (UniCAP method) and sIgG4 (ELISA) to CMP and its fractions twice – before elimination diet and after 6–12 months of elimination diet and oral challenge of CMP. Results Oral food challenge procedure with CMP was performed after 6–12 months of elimination diet. As a result, 50.3% children became tolerant to CMP, of which 42 developed tolerance by the end of the first year (54.5% of all children who developed tolerance), and 35 by the end of the 2nd year (45.5% of all who developed tolerance). During assessment of immunological markers, taken, before elimitation diet, we defined 4 immunophenotypes., Thus, 19.2% of patients with ‘sIgE≤0,7 kUA/L and sIgG4 0–2+’ immunophenotype, and none of the patients with ‘sIgE>0,7 kUA/L and sIgG4 0–2+’ immunophenotype became tolerant after after 6–12 of the elimination diet (p 0,7 kUA/L and sIgG4 3+’ immunophenotype. These results indicate a high probability of development of tolerance to CMP after 6 months of elimination diet in children with these immunophenotypes. Conclusion Different sIgE/sIgG4 immunophenotypes of CMP allergy can be successfully used as new diagnostic tool for predicting the development of tolerance to CMP in early age children.

Background and aims Child overweight and obesity has increased globally every region of the world. Based on the evidence of 2014, 19.9% of children in the Russian Federation are overweight and about 5.7% are obese. The purpose of the study: To evaluate the effectiveness of the application of bioimpedance analysis of body composition to optimise recommendations for diet correction in children who are overweight or obese. Methods 82 children aged 5–18 years who were overweight or obese have been examined; 49 girls (59.8%) and 33 boys (40.2%). The component body composition was studied using bioimpedance analysis with the definition of the following parameters: body mass index (BMI), fat mass (FM) (as a percentage and in kg), lean body mass (LBM), active cell mass (ACM), specific (normalised for body surface area) basal metabolism, phase angle. The assessment of actual nutrition was made using a questionnaire (3 days), and a computer program for calculating the chemical composition of the diet. Results 19 children (23.2%) were overweight, 34 children (41.5%) had 1st degree obesity and 29 children (35.3%) had 2nd degree obesity (p Active cell mass was reduced in 55 children out of 63 with 1st–2nd degree obesity and in 13 children out of 19 who were overweight. A decrease in phase angle was noted in all subjects, with reduced ACM, increased FM (both kg and percentage) and reduced specific basal metabolism, reflecting a state of hypodynamia in the children examined. After diet therapy, with food and water intake schedule observed, appetite-stimulating products eliminated and fasting days used, as well as additional measures such as an increase in physical activity, a change in eating behaviour and the keeping of a food diary, component body composition was repeatedly estimated over a period of 1 to 1.5 months. In 55 children (67.1%), body composition measurements showed positive signs. In 27 of the children (32.9%) who did not keep to a diet, the bioimpedance analysis indices remained unchanged. Conclusion The application of bioimpedance analysis of dynamics within the program of body weight correction provides an opportunity to evaluate the effectiveness of diet therapy in children who are overweight or obese.

The article covers modern approaches to the prevention of allergic diseases in children. We discuss the most common food allergens in the early childhood, main mechanisms of food tolerance formation and opportunities of dietary preventive measures in a risk group of the allergy development. One of the important issues, in practical terms, is the question of time and peculiarities of the complementary feeding introduction in this category of children. The own experience of use of hypoallergenic complementary feeding products in children from the risk group and with mild manifestations of atopy is presented.

In recent years, the increase in food allergy morbidity is reported. The disease prognosis directly depends on the timely and correct diagnosis, as well as on the prescription of an elimination diet with the exception of a causally significant allergen. When managing patients the doctor should follow the recommendations formed on the basis of evidence-based medicine principles. The article deals with the latest recommendations of the European Academy of Allergy and Immunology, as well as with approaches articulated in the domestic guidelines «Food allergy».

Recent decades have recorded an increase in the prevalence of food intolerance reactions, as well as in the number of severe food allergies. Currently, there has been an increase in children’s allergic reactions to cereal food, primarily wheat and rye proteins (gluten), more rarely — corn, rice, oats, and buckwheat proteins. In case of reasonable suspicion for food allergies associated with a particular food product, an important diagnostic and therapeutic measure is the prescription of an elimination diet. This diet is widely used in cases of long-term symptoms and when the suspected causally relevant product is a daily food product. It is known that in the case of a food allergy an adequately chosen diet can lead to a clinical recovery in the initial stages of the disease, and in severe cases — promotes more rapid remission of the allergic disease and its long-term preservation.

Generally accepted approach to dietotherapy in children with cow milk protein allergy is hypoallergenic diet. When breast-fed, oligoantigenic diet is prescribed to a mother. When a child does not receive mother’s breast milk, it is necessary to use formulas, based on extensively hydrolyzed milk protein or amino-acids. The article includes critical analysis of goat’s milk-based formulas usage in order to prevent and treat cow milk protein allergy. The conception of hypoallergenity, causes of crossed reactions and conventional international recommendations are discussed in details.

The article focuses on providing children with atopic dermatitis, all necessary macro-and micronutrients for good development of the body. The problem of nutrition is relevant in these patients, since they need to comply with hypoallergenic diet. The authors demonstrate the results of own research concerning vitamin provision for children with allergic diseases and correction of hypovitaminosis. It is shown that the use of multivitamin preparation not only doesn’t aggravate the disease due to the risk of allergic reactions, but contributes to the long-term remission.

The cause of alimentary allergy in infants is most common associated with different fractions of cow milk protein intolerance. As the milk component plays significant role in the diet of healthy infants and young children, the dietotherapy is based on special products — hydrolyzed formulas. The authors performed a research on assessment of the clinical efficacy of extensively hydrolyzed casein formula. This formula was given to 46 children at the age of 2–12 months with moderate (SCORAD ≥ 20) and severe (SCORAD ≥ 50) index of alimentary allergy manifestations. At the beginning of the investigation the increasing of serum IgE 5–10 times as normal was found in 73% of examined children. At the final follow-up the improvement of cutaneous symptoms, lowering of serum IgE were found in 96,2% of children, in 68% clinical remission was confirmed.