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Background: In regions with a high prevalence of peanut allergy (PA), there is a consensus that the introduction of peanuts in early infancy is preventive against the development of PA. However, few studies have investigated whether the introduction of peanuts to infants is associated with PA in regions with a low prevalence of PA, including Japan. Methods: We used data from 74,240 mother--child pairs who participated in the Japan Environment and Children's Study, a prospective birth cohort recruited between January 2011 and March 2014. A logistic regression model was used to analyze the association between infantile peanut introduction and PA at the age of 4 years with non-infantile peanut introduction as the reference group, adjusted for potential confounders. Results: The percentage of infantile peanut introduction was 4.9% (n = 3,294), and 286 (0.4%) participants had allergic symptoms to peanuts at 4 years of age. Of all participants, 129 (0.2%) had PA at 4 years of age, which was defined as allergic symptoms and sensitization to peanuts. Those with infantile peanut introduction had a lower prevalence of PA than those without infantile peanut introduction, although this did not reach statistical significance (adjusted odds ratio 0.53; 95% confidence interval, 0.17-1.68). Sensitivity analysis using IgE-mediated symptoms caused by peanuts as the outcome showed a similar result in relation to infantile peanut introduction. Conclusion: In countries with a low prevalence of PA, the effect of infantile peanut introduction on PA prevention was unclear. [ABSTRACT FROM AUTHOR]

Objectives: To summarize and differentiate abdominal ultrasound findings of necrotizing enterocolitis and food protein-induced enterocolitis syndrome. Methods: From January 2017 to December 2018, the abdominal ultrasound results of 304 cases diagnosed necrotizing enterocolitis or food protein-induced enterocolitis syndrome were retrospectively analyzed. The presence of pneumatosis intestinalis, portal venous gas, bowel wall thickening, intestinal motility, focal fluid collections and hypoechoic change of gallbladder wall were calculated, and the results were compared and analyzed. Results: Pneumatosis intestinalis, portal venous gas, bowel wall thickening, intestinal motility weakened/absent, focal fluid collections and hypoechoic change of gallbladder wall can be found in both necrotizing enterocolitis and food protein-induced enterocolitis syndrome infants. However, in infants with necrotizing enterocolitis, intestinal motility was weakened/absent in whole abdomen, and in food protein-induced enterocolitis syndrome, it only involved isolated segment of bowel. The positive rates of above signs in necrotizing enterocolitis infants were significantly higher than those in food protein-induced enterocolitis syndrome (p < 0.01). Moreover, it was observed that the rate of weakened intestinal motility besides the lesion segment of bowel in necrotizing enterocolitis infants was 100%, and in food protein-induced enterocolitis syndrome infants, it was 0%, which is supposed to be a main sign for identification. Conclusion: In the early stage, abdominal ultrasound can be used to differentiate necrotizing enterocolitis and food protein-induced enterocolitis syndrome. [ABSTRACT FROM AUTHOR]

Objective: Food allergen sensitization patterns vary among patients with atopic dermatitis in different countries. The aim of this study was to determine the food sensitization patterns of infants with food-triggered atopic dermatitis. Material and Methods: The study was a retrospective evaluation of atopic dermatitis patients who were followed at the Pediatric Allergy and Immunology Clinic of our hospital. Among these patients, those who had both positive skin prick test and positive serum specific IgE to a food were included in the study. The diagnosis of food sensitization was confirmed upon improvement with an elimination diet Results: A total of 204(74.5% boys) atopic dermatitis patients less than 1 year of age were found to have food-trigerred atopic dermatitis. Median age at diagnosis was 3 months(interquartile range: 1-5.8). When skin prick test and serum specific IgE results were analyzed, we found sensitivity to egg in 85.8%, milk in 35.5%, wheat in 3.9%, walnut in 1.5%, peanut in 2.5%, and fish in 2% of the patients. None of the patients showed sensitivity to soybean. Conclusion: Our findings indicated that a large portion of our patients were male, egg was the most common food sensitivity, the prevalence of peanut sensitivity was less than other countries and none of the patients had soy sensitivity. [ABSTRACT FROM AUTHOR]

Background Increasing dairy consumption in China has been accompanied by rising incidence of milk allergy. Here we analyzed profiles of specific immunoglobulin E (sIgE) against cow's milk proteins, and assessed their value for milk allergy diagnosis among infants and young children from northern China. Methods Sera collected from 48 patients with milk allergy and 27 negative control subjects was analyzed by enzyme-linked immunosorbent assay to measure sIgE to α-lactalbumin (Bos d 4), β-lactoglobulin (Bos d 5), α-casein (Bos d 9), β-casein (Bos d 11), and κ-casein (Bos d 12). Results Among milk-allergic individuals, most were sensitized to at least one milk protein; about half were sensitized to Bos d 5, Bos d 9, Bos d 11 and Bos d 12, respectively, while few had positive serum sIgE against Bos d 4. Bos d 12 sIgE had the largest area under curve (AUC) (0.878; 95% CI, 0.800–0.957) and thus showed the best diagnostic performance in discriminating between milk-allergic and non-milk allergic patients, with a sensitivity of 92.6% and specificity of 72.9% using a statistically optimal cut-off value (OD 450nm , 0.191). The combinations of Bos d 5 + Bos d 12 showed an AUC of 0.926, which was larger than for any individual components. Conclusions Our results revealed inter-individual variation in the sensitization to different milk allergen component. Bos d 12 sIgE showed best performance in diagnosing milk allergy. Milk allergy diagnostic accuracy was further improved using combinations of milk allergen components by application of ROC curves based on logistic regression. [ABSTRACT FROM AUTHOR]

The article reports that the British Society for Allergy & Clinical Immunology (BSACI) has published guidance for healthcare professionals of Great Britain to prevent food allergy in higher risk infants. Also discussed are suggestions for introducing potential allergenic foods into the infant diet reducing food allergy risks and an accompanying information sheet for parents.

Abstract: Food allergy is becoming increasingly common in infants and young children. This article set out to explain the different factors that should be taken into account during an individualized allergy consultation: Foods to avoid and degree of avoidance, suitable alternatives, self‐management skills, co‐ and cross‐reactive allergens and novel allergens alongside the role of the industry in allergen avoidance, importance of nutritional aspects of the diet and the future directions that nutritional guidance make take. Allergy management advice should be individualized to provide a patient‐specific approach. Changes in the management of food allergies have in particular occurred in nut, milk and egg allergies over the past few years. There has also been a progressive increase in our understanding of cross‐reactivity between different foods and also food and aero‐allergens. A patient‐specific approach of allergen avoidance should consider factors relating to industry and the environment such as food and nutrition literacy, threshold levels, cross‐contact/contamination and safe eating away from home. Increasing migration and travel has also led to exposure of unfamiliar foods. As understanding improves on individual allergens and threshold levels, food labels and food labelling laws are affected. Allergy specialist dietitians should also keep up to date with the latest information on nutrition, the gut microbiome and the immune system to incorporate nutrition strategies in a dietetic consultation using an evidence‐based approach. [ABSTRACT FROM AUTHOR]

Background Ecological evidence suggests vitamin D insufficiency ( VDI) due to lower ambient ultraviolet radiation ( UVR) exposure may be a risk factor for IgE-mediated food allergy. However, there are no studies relating directly measured VDI during early infancy to subsequent challenge-proven food allergy. Objective To prospectively investigate the association between VDI during infancy and challenge-proven food allergy at 1 year. Methods In a birth cohort ( n = 1074), we used a case-cohort design to compare 25-hydroxyvitamin D3 (25( OH)D3) levels among infants with food allergy vs a random subcohort ( n = 274). The primary exposures were VDI (25( OH)D3 <50 nM) at birth and 6 months of age. Ambient UVR and time in the sun were combined to estimate UVR exposure dose. IgE-mediated food allergy status at 1 year was determined by formal challenge. Binomial regression was used to examine associations between VDI, UVR exposure dose and food allergy and investigate potential confounding. Results Within the random subcohort, VDI was present in 45% (105/233) of newborns and 24% (55/227) of infants at 6 months. Food allergy prevalence at 1 year was 7.7% (61/786), and 6.5% (53/808) were egg-allergic. There was no evidence of an association between VDI at either birth ( aRR 1.25, 95% CI 0.70-2.22) or 6 months ( aRR 0.93, 95% CI 0.41-2.14) and food allergy at 1 year. Conclusions There was no evidence that VDI during the first 6 months of infancy is a risk factor for food allergy at 1 year of age. These findings primarily relate to egg allergy, and larger studies are required. [ABSTRACT FROM AUTHOR]

Bacterial colonization in infancy is considered crucial for the development of the immune system. Recently, there has been a drastic increase in childhood allergies in Japan. Therefore, we conducted a prospective study with 56 infants on the relationship between gut microbiota in the first year of life and the development of allergies during the first 3 years. In the lactation period, organic acid producers such as Leuconostoc, Weissella and Veillonella tended to be underrepresented in subjects who developed food allergies (FA, n = 14) within the first two years. In the weaning period, children in the FA group were highly colonized by unclassified Enterobacteriaceae and two Clostridium species closely related to Clostridium paraputrificum and C. tertium, and the whole tree phylogenetic diversity index was significantly lower in the FA group. All of these differences in the weaning period were statistically significant, even after adjusting for potential confounding factors. A higher abundance of unclassified Enterobacteriaceae was also found in the other allergic group (n = 15), whereas the two Clostridium species were highly specific to the FA group. The mode of action of these Clostridium species in childhood food allergies remains unknown, warranting further investigation. [ABSTRACT FROM AUTHOR]

The apparent increase in atopic disease, particularly food allergy, over the past 2 decades has resulted in reconsideration of prevention strategies aimed at the infant’s diet. Early advice to have atopy-prone infants delay ingestion of potential food allergens, such as egg, cow’s milk, and peanut, was rescinded, as new evidence emerged that did not support these approaches. More recently, randomized controlled trials have provided data to support an opposite strategy, promoting early ingestion of allergens as a means of food allergy prevention. Specifically, new guidelines suggest early ingestion of peanut as a means to prevent peanut allergy. Additional dietary approaches regarding breastfeeding, early introduction of other types of food allergens, formula feeding, dietary nutrients, and probiotics are also under scrutiny as potential preventative strategies. This review focuses on the timing of food introduction as a preventative strategy for food allergy and also discusses other aspects of the infant diet that may provide opportunities for prevention of atopic disease. [ABSTRACT FROM AUTHOR]

Recommendations and guidelines on the prevention of food allergy have changed in recent decades. The aim of this review of the current evidence and ongoing studies is to provide a comprehensive and up to date picture of prevention of food allergy for healthcare professionals. The review was undertaken as part of the European Union funded Integrated Approaches to Food Allergy and Allergen Management (iFAAM) study. This is a wide ranging project bringing together expertise across the breadth of food allergy research. Specifically, the review discusses dietary manipulation in food allergy prevention, and covers the possible preventive strategies of allergen avoidance, early allergen introduction, general nutrition and supplements, as well as other strategies, such as prebiotics and probiotics. The review concludes that despite agreement that allergen avoidance strategies should not be undertaken for allergy prevention, there is currently no consensus regarding what actions should be recommended beyond exclusive breastfeeding for the first 4-6 months of life. Recent and upcoming trial results, which are detailed in this review, should help inform the debate and add clarity to the topic. [ABSTRACT FROM AUTHOR]

Background Peanut allergy is one of the most severe food allergies. Whether breastfeeding induces tolerance to peanuts or on the contrary, pre-disposes at risk-babies to occult allergic sensitization to peanuts is still a matter of discussion. We sought to investigate the transfer of the most potent peanut allergen Ara h 2 into human breast milk in a German breast milk study and to shed light on the time kinetics of Ara h 2 appearance. Methods We recruited 32 lactating, non-peanut-allergic women and collected breast milk samples at different time points after consumption of 100 g dry roasted peanuts. Breast milk samples were investigated for Ara h 2 with different immunological methods: by 2D immunoblotting with a patient's serum, by affinity enrichment using a monoclonal antibody against Ara h 2 followed by LC- MS/ MS-based detection and by a competitive inhibition ELISA for the detection of Ara h 2 and its digestion-resistant peptides ( DRP-Ara h 2). Results In a qualitative analysis, Ara h 2 could be identified in a breast milk sample by 2D immunoblot by means of a patient's serum and furthermore by immunoaffinity enrichment followed by LC- MS/ MS analysis. In a semi-quantitative analysis, Ara h 2 and its digestion-resistant peptides were detected in the breast milk of 9 of 32 subjects. Evidence suggests that Ara h 2 is excreted individually either rapidly (after 1, 2, 3 or 4 h) or delayed (after 8 or 12 h) and in different concentrations. Conclusions Time and concentration of secreted Ara h 2 in breast milk appears to be individually regulated. The identification of Ara h 2 in breast milk is the prerequisite for the investigation of its sensitizing or tolerogenic properties. [ABSTRACT FROM AUTHOR]

Background Risk factors of pediatric inflammatory bowel disease ( PIBD) are incompletely understood. Recently, we reported that among patients with PIBD, a previous diagnosis of cow's milk allergy ( CMA) and asthma occurred more frequently than among age- and sex-matched peers. We tested at a national level the hypothesis that CMA is associated with the risk of contracting PIBD. Methods A nationwide birth cohort (n = 225,041), including all Finnish children born between 1999 and 2002, was followed up until July 1, 2014. We identified all children with a diagnosis of CMA, asthma, and PIBD from a national register; the data were based on certificates, including diagnostic criteria. The 95% confidence intervals ( CI) for the incidence rates per 100,000 person-years were calculated assuming a Poisson distribution. Results We identified 7,910 infants with CMA yielding a cumulative incidence of 3.5% by 2 years of age. The cumulative incidence of PIBD was 0.14% (n = 316) and that of asthma 6.6% (14,807). Children with CMA were more likely to develop PIBD than non- CMA children, incidence ratio 2.6 (95% CI 1.7-3.8). Children with a diagnosis of CMA contracted PIBD at a younger age than the respective non- CMA group (9 vs. 11 years, p < 0.05). The risk was more evident for ulcerative colitis than for Crohn's disease. The association between CMA and asthma was stronger than that between CMA and PIBD. Conclusions CMA in infancy is associated with subsequent development of asthma and PIBD. This suggests that in a subgroup of patients, CMA may share underlying background with PIBD, warranting thorough follow-up. [ABSTRACT FROM AUTHOR]

Background Delivery by Cesarean section ( CS) may predispose to allergic disorders, presumably due to alterations in the establishment of normal gut microbiota in early infancy. In this study, we sought to investigate the association between CS and physician-diagnosed food allergy and atopic dermatitis during the first 3 years of life, using data from a homogeneous, population-based, birth cohort. Methods A total of 459 children born and cared for in the same tertiary maternity unit were examined at birth and followed up at 1, 6, 12, 18, 24, 30 and 36 months of age. Participants with symptoms suggestive of food allergy or atopic dermatitis were evaluated by a pediatric allergy specialist to confirm the diagnosis based on well-defined criteria. Results The rate of CS was 50.8% (n = 233). Food allergy was diagnosed in 24 participants (5.2%) while atopic dermatitis was diagnosed in 62 children (13.5%). Cesarean section ( OR 3.15; 95% CI 1.14-8.70), atopic dermatitis of the child ( OR 3.01; 95% CI 1.18-7.80), parental atopy ( OR 4.33; 95% CI 1.73-12.1), and gestational age ( OR 1.57; 95% CI 1.07-2.37) were significant and independent predictors of food allergy. Children with at least one allergic parent delivered by CS had higher probability of developing food allergy compared with vaginally delivered children of non-allergic parents ( OR 10.0; 95% CI 3.06-32.7). Conversely, the effect of CS on atopic dermatitis was not significant ( OR 1.35; 95% CI 0.74-2.47). Conclusions Delivery by CS predisposes to the development of food allergy but not atopic dermatitis in early childhood. Cesarean section delivery seems to upregulate the immune response to food allergens, especially in children with allergic predisposition. [ABSTRACT FROM AUTHOR]

Background Epidemiological evidence suggests that routine vaccinations can have nontargeted effects on susceptibility to infections and allergic disease. Such effects may depend on age at vaccination, and a delay in pertussis vaccination has been linked to reduced risk of allergic disease. We aimed to test the hypothesis that delay in vaccines containing diphtheria-tetanus-acellular pertussis ( DTaP) is associated with reduced risk of food allergy and other allergic diseases. Methods HealthNuts is a population-based cohort in Melbourne, Australia. Twelve-month-old infants were skin prick-tested to common food allergens, and sensitized infants were offered oral food challenges to determine food allergy status. In this data linkage study, vaccination data for children in the HealthNuts cohort were obtained from the Australian Childhood Immunisation Register. Associations were examined between age at the first dose of DTaP and allergic disease. Results Of 4433 children, 109 (2.5%) received the first dose of DTaP one month late (delayed DTaP). Overall, delayed DTaP was not associated with primary outcomes of food allergy (adjusted odds ratio ( aOR) 0.77; 95% CI: 0.36-1.62, P = 0.49) or atopic sensitization ( aOR: 0.66; 95% CI: 0.35-1.24, P = 0.19). Amongst secondary outcomes, delayed DTaP was associated with reduced eczema ( aOR: 0.57; 95% CI: 0.34-0.97, P = 0.04) and reduced use of eczema medication ( aOR: 0.45; 95% CI: 0.24-0.83, P = 0.01). Conclusions There was no overall association between delayed DTaP and food allergy; however, children with delayed DTaP had less eczema and less use of eczema medication. Timing of routine infant immunizations may affect susceptibility to allergic disease. [ABSTRACT FROM AUTHOR]

Background Asian infants born in Australia are three times more likely to develop nut allergy than non-Asian infants, and rates of challenge-proven food allergy in infants have been found to be unexpectedly high in metropolitan Melbourne. To further investigate the risk factors for nut allergy, we assessed the whole-of-state prevalence distribution of parent-reported nut allergy in 5-year-old children entering school. Methods Using the 2010 School Entrant Health Questionnaire administered to all 5-year-old children in Victoria, Australia, we assessed the prevalence of parent-reported nut allergy (tree nut and peanut) and whether this was altered by region of residence, socio-economic status, country of birth or history of migration. Prevalence was calculated as observed proportion with 95% confidence intervals ( CI). Risk factors were evaluated using multivariable logistic regression and adjusted for appropriate confounders. Results Parent-reported nut allergy prevalence was 3.1% (95% CI 2.9-3.2) amongst a cohort of nearly 60 000 children. It was more common amongst children of mothers with higher education and socio-economic index and less prevalent amongst children in regional Victoria than in Melbourne. While children born in Australia to Asian-born mothers ( aOR 2.67, 95% CI 2.28-3.27) were more likely to have nut allergy than non-Asian children, children born in Asia who subsequently migrated to Australia were at decreased risk of nut allergy ( aOR 0.1, 95% CI 0.03-0.31). Conclusion Migration from Asia after the early infant period appears protective for the development of nut allergy. Additionally, rural regions have lower rates of nut allergy than urban areas. [ABSTRACT FROM AUTHOR]

Background Egg allergy is a leading cause of food allergy in young infants; however, little is known about early allergen-specific T-cell responses which predate the presentation of egg allergy, and if these are altered by early egg exposure. Objective To investigate the early T-cell responses to multiple egg proteins in relation to patterns of egg exposure and subsequent IgE-mediated egg allergy. Methods Egg-specific T-cell cytokine responses ( IL-5, IL-13, IL-10, IFNγ and TNFα) to ovomucoid ( OM), ovalbumin ( OVA), conalbumin ( CON) and lysozyme ( LYS) were measured in infants with eczema at 4 months of age ( n = 40), before randomization to receive 'early egg' or a placebo as part of a randomized controlled trial (Australian New Zealand Clinical Trials Registry number 12609000415202) and at 12 months of age ( n = 58), when IgE-mediated egg allergy was assessed by skin prick test and food challenge. Results In 4-month-old infants, who had not directly ingested egg, those who subsequently developed egg allergy already had significantly higher Th2 cytokine responses to multiple egg allergens, particularly elevated IL-13 responses to OVA ( P = 0.004), OM ( P = 0.012) and LYS ( P = 0.003) and elevated IL-5 to the same antigens ( P = 0.031, 0.04 and 0.003, respectively). IL-13 responses (to OVA and LYS) and IL-5 responses (to LYS) at 4 months significantly predicted egg allergy at 12 months. All responses significantly declined with age in the egg-allergic infants, and this did not appear to be modified by 'early' introduction of egg. Conclusions & Clinical Relevance Elevated egg -specific Th2 cytokine responses were established prior to egg ingestion at 4 months and were not significantly altered by introduction of egg. Th2 responses at 4 months of age predicted egg allergy at 12 months, suggesting that this could be used as a biomarker to select infants for early prevention and management strategies. [ABSTRACT FROM AUTHOR]

The article presents the results of the study on the relation of interleukin-4/T helper 2 type immunity characteristic of food allergy in infants. It states that infants with food allergy displayed higher monocyte to CD4 T cell ratio and lower proportion of natural regulatory T cell. It suggests anti-inflammatory approach to the prevention of food allergy.

Allergy to cow's milk proteins is a challenging condition in early infancy. Allergic infants may be predisposed to impairments of growth from either the disease itself or the nutritional constraints of the exclusion diet they should follow. Formulae based on extensively hydrolyzed cow's milk proteins are widely used, representing therapy, and constituting 100% nutrient source in the first four to six months of life and half the daily nutrient intake in the second semester of life. In some cases, these products are used also for preventive purposes. Some impairments in growth have been reported for infants using these products, even if mostly limited to the first year of life, with no apparent consequences in either the medium or long term. The macronutrient content of infant formulae based on protein hydrolysates, whichever the source, should carefully be tested not only as far as the optimal utilization of nitrogenous sources but also on the nature and metabolic fate of non-nitrogen caloric sources, represented by carbohydrates and fats, and micronutrients, particularly iron. It is recommended that studies aimed at the allergologic effects of these products also include an appropriate nutritional evaluation to determine their efficiency. [ABSTRACT FROM PUBLISHER]

The LEAP randomized controlled trial provides the first direct evidence that delayed introduction of peanut in an infant's diet significantly increases the risk of peanut allergy. However, as often is the case in ground-breaking research, the LEAP study raises almost as many questions as it resolves. Although the quality of design and excellence in study execution is unquestioned, the particular difficulty this study raises is how to generalize results from a trial of high-risk infants, which screened infants for the presence of peanut allergy prior to peanut introduction, to the general population. Although many existing infant feeding guidelines already allow for the introduction of allergenic foods from 4 to 6 months of age irrespective of co-existent risk factors for peanut allergy, these will now need to be revised to more strongly state that avoidance may be harmful. Interim guidelines have already been published which incorporate these recommendations. However, the question as to how to achieve timely introduction of peanut into an infant's diet in a safe and cost-effective way, particularly in high-risk infants, remains unresolved. [ABSTRACT FROM AUTHOR]

Three preterm infants with cow milk protein allergy (CMPA) presented with feeding intolerance, sepsis-like episodes and persistent moderate-to-severe eosinophilia. After eliminating cow milk, the clinical symptoms improved significantly. CMPA can cause common manifestations in sick preterm infants such as feeding intolerance and eosinophilia. [ABSTRACT FROM AUTHOR]

Background: Asian infants appear to be over-represented among patients with clinical food allergy in Australia, but this has not been formally examined at the population level. Any difference in prevalence according to parental country of birth may be secondary to modifiable lifestyle factors. We aimed to quantify (i) differences in the prevalence of peanut allergy by parental country of birth and (ii) contribution of measured environmental exposures to these differences. Methods: The population-based HealthNuts study in Melbourne, Australia, screened 5276 infants (74% participation) with skin prick tests and sensitized infants underwent food challenge. Of these, 535 had a parent born in East Asia and 574 in UK/Europe. Associations between parents' country of birth and offspring peanut allergy were examined using multiple logistic regression. Results: Compared to infants with two Australian-born parents, peanut allergy was more common among infants with parent/s born in East Asia (OR 3.4, 95% CI 2.2-5.1) but not those with parent/s born in the UK/Europe (OR 0.8, 95% CI 0.4-1.5). Paradoxically rates of allergic disease were lower among Asian parents. A higher prevalence of eczema among infants of Asian parents explained around 30% of the increase in peanut allergy, while differences in dog ownership explained around 18%. Conclusions: The high peanut allergy prevalence among infants of Asian-born parents appears to have occurred in a single generation and was not present among infants with parents migrating from other countries, suggesting gene-environment interactions are important. The role of eczema and microbial exposure in food allergy prevention warrants exploration. [ABSTRACT FROM AUTHOR]

Background: The skin prick test (SPT) for detecting atopic sensitization is not preferred in young infants with atopic dermatitis (AD) because of concerns about poor skin reactivity. This study aimed to evaluate whether the results of SPT agreed well with those of specific serum immunoglobulin E (sIgE) antibody test in young infants with AD. Methods: This study included 2,077 eligible infants (age, <12 months) with AD who were tested by either SPT or sIgE between 2007 and 2011. Among them, 199 infants tested for egg white (EW) and 192 infants tested for cow's milk (CM), by both SPT and sIgE on the same day were identified and reviewed retrospectively. Kappa statistics and tests for equal kappa statistics were used to evaluate the agreement between the SPT and sIgE. Results: The mean wheal diameter and the allergen-to-histamine ratio of SPT showed substantial agreement with those of sIgE for EW (κ = 0.62, 0.69) and CM (κ = 0.34, 0.47). The agreement for EW was significantly higher <6-month-old than in ≥6-month-old infants (κ = 0.79 vs. 0.54, P = 0.02), and that for CM was similar (P = 0.60). The mean wheal diameters for EW and CM were evenly distributed, and did not show increasing trends regardless of age in months (Ptrend = 0.13 and 0.06, respectively). Conclusions: The results of SPT agreed well with those of sIgE. This finding provides a rationale for using SPT, and suggests that SPT can be used along with sIgE to detect food sensitization in young infants with AD. [ABSTRACT FROM AUTHOR]

The etiology of small and fresh rectal bleeding in neonates who are not sick is usually unknown; the onlyknown cause is food protein-induced proctocolitis (FPIPC). It has been recently reported that FPIPC is a rarecause of rectal bleeding in newborns, and most cases have been proved to be due to idiopathic neonataltransient colitis. A recommended strategy for diagnosing suspected FPIPC in neonates is as follows. Duringthe early stage, the etiology of small and fresh rectal bleeding in an otherwise healthy newborn need notbe studied through extensive investigations. In patients showing continued bleeding even after 4 days,sigmoidoscopy and rectal mucosal biopsy may be performed. Even if mucosal histological findings indicatea diagnosis of FPIPC, further oral food elimination and challenge tests must be performed sequentially toconfirm FPIPC. Food elimination and challenge tests should be included in the diagnostic criteria of FPIPC. [ABSTRACT FROM AUTHOR]

Background Vitamin D levels are known to be associated with atopic disease development; however, existing data are controversial. The aim of this study was to investigate whether corresponding maternal and cord blood vitamin D levels are associated with atopic outcomes in early infancy. Methods Within the LINA cohort study (Lifestyle and environmental factors and their Influence on Newborns Allergy risk), 25( OH) D was measured in blood samples of 378 mother-child pairs during pregnancy and at birth. Information about children's atopic manifestations during the first 2 years of life was obtained from questionnaires filled out by the parents during pregnancy and annually thereafter. Cord blood regulatory T cells (Treg) were detected by methylation-specific PCR using a Treg-specific demethylated region in the FOXP3 gene. Results The median maternal 25( OH)D3 level was 22.19 ng/ml ( IQR 14.40-31.19 ng/ml); the median cord blood 25( OH) D3 10.95 ng/ml (6.99-17.39 ng/ml). A high correlation was seen between maternal and cord blood 25( OH) D3 levels, both showing a seasonal distribution. Maternal and cord blood 25( OH) D3 was positively associated with children's risk for food allergy within the first 2 years. Further, higher maternal 25( OH) D3 resulted in a higher risk for sensitization against food allergens at the age of two. Cord blood 25( OH) D3 levels were negatively correlated with regulatory T cell numbers. Conclusion Our study demonstrates that high vitamin D levels in pregnancy and at birth may contribute to a higher risk for food allergy and therefore argues against vitamin D supplement to protect against allergy. [ABSTRACT FROM AUTHOR]

Background Primary eosinophilic gastrointestinal disorders, a spectrum of inflammatory conditions, occurs when eosinophils selectively infiltrate the gut in the absence of known causes for such tissue eosinophilia. These may be classified into eosinophilic esophagitis, eosinophilic gastroenteritis and eosinophilic colitis (EC). This review focuses on EC: its pathogenesis, epidemiology, clinical presentation, diagnosis and current approach to treatment. Sources of data A literature review published in English was performed using Pubmed, Ovid, Google scholar search engines with the following keywords: eosinophilic gastrointestinal disorder, EC, eosinophils, colitis and gastrointestinal. Areas of agreement The basis for primary EC appears related to increased sensitivity to allergens, principally as a food allergy in infants and a T lymphocyte-mediated event in adults. Endoscopic changes are generally modest, featuring edema and patchy granularity. Areas of controversy Clear clinical and pathological diagnostic criteria of EC and its management strategy. Growing points Intestinal involvement of EC is primarily mucosal, presenting as a mild self-limited proctitis in infants and self-limited colitis in young adults. Therapeutic approaches based on case reports tend to use either elimination diets to avoid a presumed allergen; agents traditionally used in inflammatory disease or targeted drugs like anti-histamines or leukotriene receptor antagonists. Areas timely for developing research Prospective randomized controlled trials addressing the disease natural history, possible preventive methods and effective medical approach and long-term prognosis are required. [ABSTRACT FROM PUBLISHER]

Background: Over the past three decades, the prevalence of allergic diseases has markedly increased in developed countries. There has been a paucity of data on food allergy (FA) in developing countries such as China. We aimed to estimate the prevalence and the clinical features of FA in Chinese infants attending a routine well-baby clinic in Chongqing, China. Methods: From January 1st to February 28th, 2009, consecutive infants and young children aged 0-12 months attending routine well-baby checks at the Department of Primary Child Care, Children's Hospital of Chongqing Medical University, were invited to participate in the study. Parents completed questionnaires, and children were skin prick tested (SPT) to a panel of 10 foods (egg white, egg yolk, cow's milk, soybean, peanut, wheat, fish, shrimp, orange, and carrot) together of histamine and saline controls. Subjects with either a positive SPT or a positive medical history were invited to undergo an oral food challenge. Results: Of 497 children who consented to participate, 477 (96%) participated fully in the study. Of these, 56 subjects had a positive SPT (11.3%), with 45 positive to egg, 13 to cow's milk, 2 to peanut, 1 to fish, shrimp, and orange respectively. Eighty subjects (16.1%, 80/497) participated in food challenges. Conclusion: The overall prevalence of challenge-proven FA in 0- to 1-yr-old children in Chongqing, China, was 3.8% (18/477, 95% CI, 2.5-5.9%) with 2.5% (12/477) egg allergic and 1.3% (6/477) cow's milk allergic. [ABSTRACT FROM AUTHOR]

The article explores and analyze concepts related to feeding intolerance (FI) among premature infants in order to provide a universal and conceptual and operational definition for use in practice theory. Review of literature from various databases discussing the concepts related to FI revealed inconsistencies and for many concepts, the defining attributes and empirical referents are identical. It concludes that there is a need to construct a final and universal definition of FI concepts in order to create a robust terminology for the condition.