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Introduction. Despite active research into the mechanisms of food allergies (FA), the main approach to managing patients with this condition remains the complete exclusion of causative allergens from the diet for a certain period. At the same time, the question of timely reintroduction of excluded food triggers into the diet is frequently raised, which is important both for maintaining oral tolerance and reducing the negative effects of long-term elimination diets, such as nutritional and eating behavior disorders, as well as financial burdens on families. However, clear recommendations on the reintroduction of previously excluded foods have not existed until recently. Regarding cow’s milk protein allergy (CMPA), such recommendations were provided in 2023 in the consensus document of the World Allergy Organization (WAO) — DRACMA.Aim. The aim of this review is to present current approaches to the reintroduction of food allergens into the diets of patients with food allergies and to evaluate various reintroduction protocols, including those used for cow’s milk protein allergy (CMPA).Material and methods. This review provides a concise summary of current approaches to reintroducing food allergens into the diet, covering both IgE-mediated and non-IgE-mediated forms of food allergy. The advantages of different patient management protocols are discussed, with special attention given to CMPA as one of the most common manifestations of FA in children.Results. An analysis of modern approaches has demonstrated that modern recommendations regarding the reintroduction of allergens, including those presented in the document of the World Allergological Organization — DRACMA for allergy to cow’s milk proteins, allow for a more personalized and safe approach to the reintroduction of allergens, which helps reduce risks and maintain food tolerance.Conclusions. The introduction of new guidelines for the reintroduction of food allergens is an important step in managing patients with food allergies. These recommendations provide a more personalized approach to treating food-allergic patients, including those with cow’s milk protein allergy, reducing the risks associated with reintroducing allergens into the diet. They also help to mitigate the negative effects of elimination diets and maintain oral tolerance in patients, which is particularly important for children with FA.

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.

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.

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.

Thanks to modern molecular-genetic microbiota analysis, numerous previously unstudied bacteria were identified. As a result, the conception of human microbiocenosis was significally changed, particularly the conception of intestinal microbiota, which substantially determines human health. The ways the bacteria affect the metagenome, endocrine regulation and function of the nervous system have been described in recent years. At its early stages, the formation of intestinal microbiota depends on such factors as a complicated gestation course, prematurity, surgical delivery, late breast latching, artificial feeding since birth or antibiotic therapy. However, the results of latest studies indicate that the microbial factor affects children long before their birth. Present scientific hypothesis regarding torpid microbial inflammation in uterine cavity as a cause of disturbanses in the gestation course or of preterm labour was also formed in connection with investigating placenta and amniotic fluid microbiocenoses. This survey presents analysis of the latest data concerning the affection of both antenatal and postnatal factors at early stages of intestinal microbiota conditioning in children.

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.

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.

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.

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.

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.

Despite modern achievements in child allergology, the question of evaluating tolerance formation and defining the safest time for expanding the child’s ration after an eliminatory diet remains open. This article contains the results of the authors’ own investigation concerning the practical meaning of specific immunoglobulins (sIg) class G4 as tolerance formation markers at food allergies in children. Thus, it has been found that high levels of sIgG4 are not only a favourable prognostic factor for light manifestations of food allergy, but also an index of a tolerance formation. The prevalence of high food allergy sIgG4 was statistically significantly higher in early age children from the comparison group than in patients with food allergy. Thus the authors suggest that the production of sIgG4 is a normal physiological process which hinders the development of hypersensitivity, while high levels of sIgG4 are evidence for the child’s immune system “contacting” this or that product. Clinical tolerance formation predictors define lighter clinical manifestations of food allergies, a non IgE-mediated form of food allergy and the retention of breastfeeding.

Cow’s milk proteins (CMP) are the most often cause of allergy in young children. Despite the significant successes in laboratory diagnosis, which also cover allergy in children, food allergy is still a major discussion point in many cases. Successful CMP allergy treatment in children is largely dependant upon the early diagnosis and timely prescription of an eliminatory diet and is defined not only by the actions of specialists (allergologists and dietologists) but also of the primary level doctors. The minimal effective duration of the diet is established by evidence-based studies and is defined in consensus documents on treating children with CMP allergy. Further questions concerning diet duration are resolved according to each unique case. The continuation of a diet should be justified, therefore the necessity of eliminating certain products from a child’s diet is evaluated every 6–12 months. However, at the moment there are no clear ways to predict the duration after which tolerance would appear and thus the duration of a strict eliminatory diet for CMP allergic children. Until recently it was believed that 80–90% of CMP-allergic children form a tolerance over the first 3–5 years of life; however, according to the latest data, the body’s adaptation manifests later. In general, studies show that persisting CMP allergy is characterized by a severe family anamnesis concerning atopic diseases, a longer period between the beginning of CMP intake and the first allergy symptoms, a larger frequency of multiple food reactions and the presence of other allergies. With age a partial CMP tolerance may develop, when dairy products should be introduced in limited amounts. In such cases specialists recommend to introduce milk proteins in tolerable amounts (mainly as part of other products), which, as has been demonstrated, can contribute to the formation of tolerance, while retaining the diagnosis formulation.

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.

Condition of intestinal microbiota is a key factor of a child's health. According to the latest studies, distinctness and certain stability of every person's microbiota is to a large extent determined genetically; at the same time, microbiocenosis is sensitive to external exposure, i.e. it is labile. The article presents new data on the intestinal microflora's composition and function, as well as on the nature of interaction in the microbiocenosis-host system. Intestinal microflora directly affects formation of a child's immune system, ensures protection from pathogens and takes part in all types of metabolism. The article presents modern approaches to intestinal microflora modulation and use of probiotics to prevent and treat various pathologies in pediatric practice.

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 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.

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.

In the review of modern literature the influence of a bacterial factor, first of all — indigenous microflora — on formation of food tolerance and immune answer of a child as a whole is in detail considered. Formation of a microbiocenosis, food and autogenic tolerance happens under the general laws. In this process the primary colonization of intestines and formation of a microflora variety which, as results of the last researches show, comes to an end by 2–4 years of life of a child has special value. In the review the major factors influencing the formation of a child intestinal microbiota both antenatal and postnatal and for the first years of life, and also their interaction are considered. The influence of a bacterial factor on formation of food tolerance and sensibilization processes, and also mechanisms of this influence is in detail discussed. The data on features of a structure of intestinal microflora at children with food allergy including the results of own researches devoted to microbiocenosis at children with food allergy and to development of tactics of management of children with this pathology are provided. The main directions and possibilities of dietary influence on biocenosis structure at children with this pathology are considered.

Organization of adequate nutrition of children and adolescents actively going in for sports is of the highest importance both for improving sports results and preserving children’s health. On the modern stage of sports neutraceuticals development, it is relevant to substantiate approaches to nutrition on all stages of the training process, develop methodological basis for individual nutrition selection and conduct demonstrative trials in order to evaluate efficacy of nutritional measures. The pediatric nutrition department of the FSBI “Scientific Center of Children’s Health” conducted a controlled trial of efficacy of a new Russian product for nutritive support of children in the training period in 2012 in order to study possibilities of nutrition optimization for young sportsmen. We noticed statistically significant alterations of bioimpedance analysis values – lean and active cell body mass – in the setting of nutrition correction – intake of 200-400 ml/day of the product for 21 days; at the same time, the fat mass remained the same. Psychological testing using WAN questionnaire (well-being, activity, mood) conducted in the recovery period of the training process also revealed positive dynamics. The product may be used in the dose of 200-400 ml at any time of day; at the same time, it is most reasonable to take it as an additional food intake in the event of considerable training stress immediately before or after training, when adequate nutrition organization is hindered.

This review represents a modern view to the intestinal microbiocenosis and possibilities of influence on it with the means of prebiotic food components. Status of intestinal microbiota is one of the main factors of children health. As it was shown in the recent studies, certain constancy of microbiota of every individual in many respects is determined genetically. Intestinal microflora directly influence on the formation of the child immune system, provide protection from pathogens and participates in all types of metabolism. In its turn the intestinal microbiocenosis itself depends on the status of the macroorganism and exogenous factors, with nutrition being the most significant of them. As a matter of fact, there is a combined evolution of nutrition, intestinal microbiocenosis and intestinal mucous membrane with associated to it lymphoid tissue. Supplementation of nutritive components, contributing to vegetation of the «useful» microflora, with food is an effective mechanism of «dietary manipulation» of intestinal biocenosis. Biological effects of prebiotics are discussed in detail. Oligosaccharides of the breast milk have a number of biological effects, which exceed the limits of only prebiotic action. However including of prebiotic components with proved effects into children milk formulas and porridges adds these products prophylactic and therapeutic-prophylactic characteristics.

The authors present modern data on the issue of rational nutrition of children in different periods of childhood. The most frequent types of disorders are listed; insufficient consumption of long-chain polyunsaturated fatty acids is among them. The authors show that this issue is topical not only in Russia, but also in a range of the developed countries. The authors give special attention to classification and biological role of polyunsaturated fatty acids, especially in the development of nervous and immune systems. The authors demonstrated importance of sufficient consumption of long-chain polyunsaturated fatty acids in the period of fetal development for antenatal prevention of atopic disease. The authors list methods of recovery from deficiency of polyunsaturated fatty acids in antenatal and neonatal periods and after the first year of life.

Intestinal epithelial barrier plays an important role in prevention of bacterial translocation and food allergens penetration. Article is dedicated to intestinal epithelial barrier disfunctions leading to sensitization. Special attention is paid to molecular mechanisms increasing the allergens penetration through intestinal wall. Phase of sensitization is characterized by antigen-induced crossover IgE connection with FcRI receptor on the surface of mast cell which leads to anaphylactic reaction.Key words: infants, food allergy, sensitization, intestinal epithelial barrier.

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.