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Assessing maternal dietary habits across Europe during pregnancy in relation to their national pregnancy recommendations. A collaborative, multi-centre, birth cohort study in nine European countries was conducted as part of European Union funded EuroPrevall project. Standardised baseline questionnaire data included details of food intake, nutritional supplement use, exposure to cigarette smoke during pregnancy and socio-demographic data. Pregnancy recommendations were collected from all nine countries from the appropriate national organisations. The most commonly taken supplement in pregnancy was folic acid (55.6 % Lithuania-97.8 % Spain) and was favoured by older, well-educated mothers. Vitamin D supplementation across the cohort was very poor (0.3 % Spain-5.1 % Lithuania). There were significant differences in foods consumed in different countries during pregnancy e.g. only 2.7 % Dutch mothers avoided eating peanut, while 44.4 % of British mothers avoided it. Some countries have minimal pregnancy recommendations i.e. Lithuania, Poland and Spain while others have similar, very specific recommendations i.e. UK, the Netherlands, Iceland, Greece. Allergy specific recommendations were associated with food avoidance during pregnancy [relative rate (RR) 1.18 95 % CI 0.02-1.37]. Nutritional supplement recommendations were also associated with avoidance (RR 1.08, 1.00-1.16). Maternal dietary habits and the use of dietary supplements during pregnancy vary significantly across Europe and in some instances may be influenced by national recommendations. Keywords Pregnancy recommendations * Folic acid * Vitamin D * Iron, Introduction The lifestyle choices a woman makes during pregnancy and pre-pregnancy have important implications for her unborn child. There is evidence that inappropriate nutrition and poor perinatal growth are associated [...]

Allergic diseases are common in childhood and can cause a significant morbidity and impaired quality-of-life of the children and their families. Adequate allergy testing is the prerequisite for optimal care, including allergen avoidance, pharmacotherapy and immunotherapy. Children with persisting or recurrent or severe symptoms suggestive for allergy should undergo an appropriate diagnostic work-up, irrespective of their age. Adequate allergy testing may also allow defining allergic trigger in common symptoms. We provide here evidence-based guidance on when and how to test for allergy in children based on common presenting symptoms suggestive of allergic diseases. [ABSTRACT FROM AUTHOR]

(1) Background: Atopic dermatitis (AD) is one of the most common inflammatory skin conditions, thus having a significant impact on the quality of life (QoL) of patients and their families. We performed a survey to gather more data to help describe the burden of AD in Lithuania and to help expand the treatment plan to this important aspect of the disease. (2) Methods: A cross-sectional study was conducted involving healthy and AD pediatric patients. The assessment instruments used were the Patient-Oriented Eczema Measure (POEM), QoL, and original questionnaires (the original questionnaire was designed by the authors to determine the demographics, medical history, and treatment methods of the respondents). (3) Results: This study included 302 participants in total: 247 AD patients (51% boys) and 55 non-AD patients (51% boys). The mean age for AD patients was 6.8 ± 4.4. years, and this was 10.5 ± 3.1 years for the control patients. A significant difference was found between the QoL questionnaire scores and the Family Dermatology Life Quality Index (FDLQI) score for the atopic dermatitis group (QoL: 6.3 ± 5.6; FDLQI: 7.1 ± 6.9) and controls (QoL 0.5 ± 1.1; FDLQI 2.1 ± 5.9) ( p = 0.000). The mean QoL questionnaire score for severe AD was 14.3 ± 6.2 (very large effect), that for moderate AD was 6.9 ± 4.4 (moderate effect), and that for mild AD was 4.4 ± 4.2 (small effect) ( p = 0.000). (4) Conclusions: Our study revealed a moderate effect of AD on dermatology-related QoL in patients and their families. It has been shown that increased disease severity was associated with a greater impairment of QoL in both patients and patient's parents. The burden of AD in children and their parents is considerable and should be taken into account in the management of atopic dermatitis.

Background: Over the last few decades, there was observed an increase of asthma and allergic rhinitis cases caused by allergy to pets., Objective: This study aimed to analyze molecular sensitization patterns to dog and cat allergens in Lithuanian children who were experiencing allergy-like symptoms., Materials and Methods: A total of 574 children (0-18 years) were tested for allergen-specific immunoglobulin E (sIgE) levels with ALEX 2 (ALEX 2® , Allergy Explorer Test System). Positive sera were further analyzed for sensitization to cat (Fel d 1, Fel d 2, Fel d 4, and Fel d 7) and dog (Can f 1, Can f 2, Can f 3, Can f 4, Can f 5, and Can f 6) allergen components., Results: Two hundred forty-seven children tested positive (sIgE ≥0.3 kUA/L) to at least 1 dog or cat allergen component. There were 61.1% children sensitized to components from both sources, 29.2% - exclusively to cat, and 9.7% - to dog components. The major sensitizers were Fel d 1 (84.8%) and Can f 1 (59.4%). There were 42.9% patients sensitized to 3 or more different mammalian protein families and 40.4% - to 3 or more lipocalins. There were 5.7% of children sensitized both to Fel d 1 + Fel d 4 and Can f 1/2 + Can f 5, indicating the high risk of severe asthma. Monosensitization to Fel d 1 was the dominant pattern among Lithuanian children (26.3%)., Conclusion: The majority of children were cat/dog-polysensitized, although sensitization only to cat allergens was most observed. Extensive molecular profiling can be an useful tool for accurate true sensitization diagnosis and prognosis of disease severity., (© 2023 The Authors.)

Introduction: There are no in-depth studies describing the peanut sensitization molecular patterns in Lithuanian children., Aim: To investigate the age-related patterns of molecular peanut sensitization profiles in Lithuanian children with suspected allergic symptoms., Material and Methods: We performed a retrospective analysis of peanut sensitization profiles in 576 Lithuanian children with possible allergic symptoms. Patient data were categorized according to age groups: 0-2, 3-6, 7-12, and 13-18 years. Specific immunoglobulin E levels to peanut molecular components: Ara h 1, Ara h 2, Ara h 3, Ara h 6, Ara h 8, Ara h 9, Ara h 15, and birch major allergen component Bet v 1 were analyzed., Results: Sensitization to at least one peanut protein was observed in 148 (25.7%) children. In children aged ≤ 2 years, most children were sensitized to Ara h 1 - 11 (12.1%). In children aged from 3 to 6 years, the sensitization to Ara h 1 remained the most prevalent in 40 (16.6%) children. The most prevalent sensitization in children aged from 7 to 12 years was to Ara h 8 in 39 (24.5%) of them. In children aged ≥ 13 years, Ara h 8 remained the most prevalent sensitizer in 21 (24.7%) of them., Conclusions: One-fourth of children with suspected allergic symptoms are sensitized to at least one peanut molecular component in Lithuania. Infants and preschool children are most commonly sensitized to seed storage proteins, while school-age children to Ara h 8 allergen., Competing Interests: JSC “In Novum” is a local distributor company of ALEX2 allergy explorer tests., (Copyright: © 2023 Termedia Sp. z o. o.)

Background: This study assessed the utility of a prick-by-prick test with pasteurised cow's milk in predicting a pasteurised cow's milk allergy (CMA) diagnosis., Methods: This was a retrospective study of 86 paediatric patients who had undergone open pasteurised cow's milk oral food challenges (OFCs). We evaluated the diagnostic performance of a prick-by-prick test with pasteurised cow's milk in predicting a positive OFC result. We calculated the threshold values representing high test specificity and predictive probability in children aged ≤24 and >24 months., Results: A prick-by-prick test with pasteurised cow's milk was a good classifier of a positive cow's milk OFC outcome. The mean prick - by - prick test wheal diameter ≥ 3 mm yielded 100% sensitivity in both groups of children. Thresholds representing high test specificity and 95% predicted probability were 7 and 11 mm in children ≤ 24 months and 11 and 17 mm in children > 24 months of age, respectively., Conclusion: A prick-by-prick test with pasteurised cow's milk is valuable in paediatric practice when diagnostic thresholds are implemented., Competing Interests: The authors declare that there is no conflict of interest., (Copyright © 2022 Ieva Adomaite et al.)

Background: Coexistence of childhood asthma, eczema and allergic rhinitis is higher than can be expected by chance, suggesting a common mechanism. Data on allergic multimorbidity from a pan-European, population-based birth cohort study have been lacking. This study compares the prevalence and early-life risk factors of these diseases in European primary school children., Methods: In the prospective multicentre observational EuroPrevall-iFAAM birth cohort study, we used standardized questionnaires on sociodemographics, medical history, parental allergies and lifestyle, and environmental exposures at birth, 12 and 24 months. At primary school age, parents answered ISAAC-based questions on current asthma, rhinitis and eczema. Allergic multimorbidity was defined as the coexistence of at least two of these., Results: From 10,563 children recruited at birth in 8 study centres, we included data from 5,572 children (mean age 8.2 years; 51.8% boys). Prevalence estimates were as follows: asthma, 8.1%; allergic rhinitis, 13.3%; and eczema, 12.0%. Allergic multimorbidity was seen in 7.0% of the whole cohort, ranging from 1.2% (Athens, Greece) to 10.9% (Madrid, Spain). Risk factors for allergic multimorbidity, identified with AICc, included family-allergy-score, odds ratio (OR) 1.50 (95% CI 1.32-1.70) per standard deviation; early-life allergy symptoms, OR 2.72 (2.34-3.16) for each symptom; and caesarean birth, OR 1.35 (1.04-1.76). Female gender, OR 0.72 (0.58-0.90); older siblings, OR 0.79 (0.63-0.99); and day care, OR 0.81 (0.63-1.06) were protective factors., Conclusion: Allergic multimorbidity should be regarded as an important chronic childhood disease in Europe. Some of the associated early-life factors are modifiable and may be considered for prevention strategies., (© 2021 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Introduction: There is still lack of knowledge of drug allergy in children. Proper knowledge and management of drug hypersensitivity reactions is important to physicians., Aim: To evaluate the approach of primary care doctors regarding drug allergy in children., Material and Methods: A total of 195 primary care doctors were questioned in various parts of Lithuania from 2015 to 2016. An original questionnaire was used. The incidence of a suspected drug allergy, culprit drugs, the clinical pattern and management of the suspected drug hypersensitivity were analysed., Results: The majority of primary care doctors (74.4%) reported a suspected drug allergy. The main suspected drugs were antibiotics (95.2%) and nonsteroidal anti-inflammatory drugs (32.4%). Skin symptoms (skin rash (100%) and itching (82.1%)) were the main symptoms of the suspected drug allergy. The vast majority of doctors (93.8%) withdrew the use of a suspected drug and 68.3% of respondents prescribed an alternative drug. The fact that skin tests, blood tests and provocation tests could be used in a drug allergy workup were indicated by 43.6% of doctors. Most doctors (69.2%) knew about the opportunity to test children for drug allergy in Lithuania and 41.4% of doctors referred patients for the further drug allergy workup., Conclusions: The majority of primary care doctors reported a suspected drug allergy in children. The most common suspected drugs were antibiotics and skin symptoms were the main symptoms. Most doctors knew about the possibility to test for the drug allergy but only less than half of them referred patients for the drug allergy workup., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Termedia.)

Background: The application of preparations containing food allergens can cause percutaneous sensitization and provocation. The prevalence of food allergens in children's cosmetics is unknown., Objectives: To analyse the prevalence of food allergens in skincare products marketed for children and their association with marketing claims and product price., Methods: We reviewed 276 skincare product ingredient labels for the presence of milk, eggs, wheat, soy, oats, tree nuts, peanuts, and sesame., Results: More than one-third (108; 39.1%) of the products listed at least one allergen. A total of 156 allergens were recorded, of which 65 (41.7%) were almonds, 35 (22.4%) wheat, 24 (15.4%) soy, 16 (10.3%) oats, 13 (8.3%) sesame, 2 (1.3%) milk, and 1 (0.6%) peanuts. Products that claimed to be "natural" or "ecological" were more likely to contain food allergens than those not labelled so (P < .001). The prices were higher for products containing food allergens compared with allergen-free products (P = .028)., Conclusions: Food allergens are prevalent in children's cosmetics, especially those that claim to be natural or ecological. The most incorporated food allergens are almonds, wheat, and soy. Products containing food allergens cost more than allergen-free ones., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The prevalence of food allergy (FA) among European school children is poorly defined. Estimates have commonly been based on parent-reported symptoms. We aimed to estimate the frequency of FA and sensitization against food allergens in primary school children in eight European countries., Methods: A follow-up assessment at age 6-10 years of a multicentre European birth cohort based was undertaken using an online parental questionnaire, clinical visits including structured interviews and skin prick tests (SPT). Children with suspected FA were scheduled for double-blind, placebo-controlled oral food challenges (DBPCFC)., Results: A total of 6105 children participated in this school-age follow-up (57.8% of 10 563 recruited at birth). For 982 of 6069 children (16.2%), parents reported adverse reactions after food consumption in the online questionnaire. Of 2288 children with parental face-to-face interviews and/or skin prick testing, 238 (10.4%) were eligible for a DBPCFC. Sixty-three foods were challenge-tested in 46 children. Twenty food challenges were positive in 17 children, including seven to hazelnut and three to peanut. Another seventy-one children were estimated to suffer FA among those who were eligible but refused DBPCFC. This yielded prevalence estimates for FA in school age between 1.4% (88 related to all 6105 participants of this follow-up) and 3.8% (88 related to 2289 with completed eligibility assessment)., Interpretation: In primary school children in eight European countries, the prevalence of FA was lower than expected even though parents of this cohort have become especially aware of allergic reactions to food. There was moderate variation between centres hampering valid regional comparisons., (© 2020 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Background: Hen's egg is one of the commonest causes of food allergy, but there are little data on its risk factors., Objective: To assess the risk factors, particularly eczema, for hen's egg allergy in the EuroPrevall birth cohort., Methods: In the pan-European EuroPrevall birth cohort, questionnaires were undertaken at 12 and 24 months or when parents reported symptoms. Children with suspected egg allergy were invited for skin prick testing, specific IgE assessment, and double-blind, placebo-controlled food challenge (DBPCFC) as indicated. Each egg allergy case (positive DBPCFC or egg-induced anaphylaxis) was allocated up to 2 age- and country-matched controls., Results: A total of 12,049 infants were recruited into the EuroPrevall birth cohort, and 9,336 (77.5%) were followed until 2 years. A total of 86 infants had egg allergy (84 by DBPCFC) and were matched with 140 controls. Independently associated with egg allergy were past/current eczema (adjusted odds ratio, 9.21; 95% CI, 2.65-32.04), Scoring Atopic Dermatitis (1.54 per 5 units; 1.28-1.86), antibiotics in the first week of life (6.17; 1.42-26.89), and current rhinitis (3.02; 1.04-8.78). Increasing eczema severity was associated with an increasing likelihood of egg allergy. Eczema was reported to have started 3.6 (SE, 0.5) months before egg allergy. Age of introduction of egg into the diet was not associated with egg allergy., Conclusions: Similar to peanut allergy, eczema was strongly associated with egg allergy development and the association increased with increasing eczema severity. The age of introduction of dietary egg was not a risk factor. The potential role of antibiotics in early life as a risk factor for egg allergy needs further examination., (Copyright © 2019. Published by Elsevier Inc.)

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

Similarly to other medications, vaccines may be responsible for allergic reactions. Although IgE-mediated allergies to vaccine are extremely rare, they are clearly overdiagnosed. Indeed, accurate diagnosis of vaccine allergy is important not only to prevent serious or even life-threatening reactions, but also to avoid unnecessary vaccine restriction. Systematic approaches have been proposed and, if implemented, will likely reduce the number of children being inappropriately labeled as allergic to vaccine. In diagnosis of vaccine allergy, the patient's history is central although not sufficient. In case of suspicion of an allergy, the child should be referred to an allergist in order to perform a complete allergy workup, based primarily on skin tests and/or specific IgE. Highlighting the most recent literature, this article will address the management of children with a possible allergy to vaccine., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Allergic contact dermatitis (ACD) in children is increasing. Sensitization to contact allergens can start in early infancy. The epidermal barrier is crucial for the development of sensitization and elicitation of ACD. Factors that may influence the onset of sensitization in children are atopic dermatitis, skin barrier defects and intense or repetitive contact with allergens. Topical treatment of ACD is associated with cutaneous sensitization, although the prevalence is not high. ACD because of haptens in shoes or shin guards should be considered in cases of persistent foot eruptions or sharply defined dermatitis on the lower legs. Clinical polymorphism of contact dermatitis to clothing may cause difficulties in diagnosing textile dermatitis. Toys are another potentially source of hapten exposure in children, especially from toy-cosmetic products such as perfumes, lipstick and eye shadow. The most frequent contact allergens in children are metals, fragrances, preservatives, neomycin, rubber chemicals and more recently also colourings. It is very important to remember that ACD in young children is not rare, and should always be considered when children with recalcitrant eczema are encountered. Children should be patch-tested with a selection of allergens having the highest proportion of positive, relevant patch test reactions. The allergen exposure pattern differs between age groups and adolescents may also be exposed to occupational allergens. The purpose of this review is to alert the paediatrician and dermatologist of the frequency of ACD in young children and of the importance of performing patch tests in every case of chronic recurrent or therapy-resistant eczema in children., (© 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.)

Cohort studies are of great importance in defining the mechanism responsible for the development of allergy-associated diseases, such as atopic dermatitis, allergic asthma, and allergic rhinoconjunctivitis. Although these disorders share genetic and environmental risk factors, it is still under debate whether they are linked or develop sequentially along an atopic pathway. The current study was aimed to determine the pattern of allergy sensitization in the Lithuanian birth cohort "Alergemol" (n = 1558) established as a part of the multicenter European birth cohort "EuroPrevall". Early sensitization to food allergens in the "Alergemol" birth cohort was analysed. The analysis revealed 1.3% and 2.8% of symptomatic-sensitized subjects at 6 and 12 months of age, respectively. The sensitization pattern in response to different allergens in the group of infants with food allergy symptoms was studied using allergological methods in vivo and in vitro. The impact of maternal and environmental risk factors on the early development of food allergy in at 6 and 12 months of age was evaluated. Our data showed that maternal diet, diseases, the use of antibiotics, and tobacco smoke during pregnancy had no significant impact on the early sensitization to food allergens. However, infants of atopic mothers were significantly more often sensitized to egg as compared to the infants of nonatopic mothers.

Common respiratory infections usually show a latent incubation period, followed by an acute stage. Finally, due to new synthesis of specific antibodies, the relative microorganisms undergo a massive eradication from hostile organism. Meanwhile, clinical symptoms induced by innate immunity mechanisms during these pathologies are assumed properly as host attempts for the expulsion of infectious agents. Some studies have demonstrated the existence of immuno-modulatory abilities by different infectious agents, which can inhibit inflammatory response and the development of respective symptoms by hostile organisms, especially during incubatory period. In contrast, after the incubatory period microorganisms-induced immuno-inhibitory effects may undergo a reduction, and in the meantime clinical symptoms appear a few days before the hostile organism synthesizes specific antibodies, which can eradicate these pathogens. From the evolutionary viewpoint of microorganisms, maybe induction of pathologic symptoms even before the period of specific hostile antibody synthesis, but not at beginning of infection, could play a particular adaptive role. Such scenario first could assure a maximal multiplication for the infectious agents, whereas later attempts to support the host abandonment, even due to induction of clinical expulsive symptoms. The existence of related pathologies since ancient times leads to the suggestion that perhaps the induction of such diseases is not a purpose per se for such pathogens, but rather an instrument to provide for host abandonment on time to catch a next one, assuring therefore maximal successive reproduction.