Enza D'Auria

Tolerance to a rice hydrolysate formula in children allergic to cow's milk and soy

Background Even hydrolysed cows milk formulae may retain residual allergens and there are few nutritional options for children with cows milk allergy (CMA) who also react to soy.

Growth of infants with IgE-mediated cow's milk allergy fed different formulas in the complementary feeding period

Observational studies have shown that allergic infants, irrespective of the type of diet, show various degrees of growth depression in the first year of life. We investigated whether the type of milk in the complementary feeding period (6–12 months of age) is associated with differences in the increase of standardized growth indices (weight‐for‐age, WA; length‐for‐age, LA; and weight‐for‐length, WL, z‐scores) in infants with cows milk allergy (CMA). Infants with immunoglobulin E‐mediated CMA breastfed at least 4 months and progressively weaned in the 5‐ to 6‐month period were randomly assigned to three special formulas, a soy formula (n = 32), a casein hydrolysate (n = 31), and a rice hydrolysate (n = 30). A fourth, non‐randomized group was made up by allergic infants still breastfed up to 12 months (n = 32). Groups were compared for WA, LA, and WL z‐scores at 6, 9 and 12 months of age. All groups showed low WA and LA z‐scores at 6 months of age. Infants fed hydrolyzed products showed a trend toward higher WA z‐score increments in the 6‐ to 12‐month period. The use of casein‐ and rice‐based hydrolyzed formulas resulted in higher changes in WA compared with soy formula. Further research should be aimed at optimizing the dietary needs and feeding regimens for infants with CMA.

Tolerance of heat-treated kiwi by children with kiwifruit allergy

Kiwifruit allergy is increasing among children but whether heating affects clinical tolerance to kiwifruit is unknown. To assess tolerance to heated kiwifruit in children allergic to fresh kiwifruit. In this prospective trial, 20 children (median age 9.4 yr) with a history of immediate allergic reactions to fresh kiwifruit underwent double‐blind placebo‐controlled food challenges with steam‐cooked (100 °C for 5′) and industrially homogenised kiwifruit. Skin prick tests with a commercial kiwifruit allergen, raw kiwifruit and double‐blind placebo‐controlled food challenge with 25 g of fresh kiwifruit were used to confirm the history. Specific kiwifruit IgE to native and homogenized fruit were identified by immunoblotting. Fresh kiwifruit induced positive skin prick wheals in all children (confirmed during challenge in 19 patients). Commercial skin prick test elicited a positive response in five children, steam‐cooked kiwifruit in five, and the homogenised kiwifruit preparation in none. UniCAP© determinations were positive for kiwifruit in three patients. All childrens sera showed specific IgE at immunoblotting with raw kiwifruit and one with the homogenised preparation (major allergens identified: Act c 1 and Act c 2). There was no clinical reactivity following challenge with homogenised kiwifruit but one child reacted to cooked kiwifruit challenge. Industrial heat treatment and homogenisation can make kiwifruit safe for children who are allergic to this increasingly popular fruit. This has dietary implications for children who are allergic to several fruit and vegetable proteins.

Nutritional management and follow up of infants and children with food allergy: Italian Society of Pediatric Nutrition/Italian Society of Pediatric Allergy and Immunology Task Force Position Statement

Although the guidelines on the diagnosis and treatment of food allergy recognize the role of nutrition, there is few literature on the practical issues concerning the nutritional management of children with food allergies.This Consensus Position Statement focuses on the nutritional management and follow-up of infants and children with food allergy.It provides practical advices for the management of children on exclusion diet and it represents an evidence-based consensus on nutritional intervention and follow-up of infants and children with food allergy.Children with food allergies have poor growth compared to non-affected subjects directly proportional to the quantity of foods excluded and the duration of the diet. Nutritional intervention, if properly planned and properly monitored, has proven to be an effective mean to substantiate a recovery in growth.Nutritional intervention depends on the subject’s nutritional status at the time of the diagnosis.The assessment of the nutritional status of children with food allergies should follow a diagnostic pathway that involves a series of successive steps, beginning from the collection of a detailed diet-history.It is essential that children following an exclusion diet are followed up regularly.The periodic re-evaluation of the child is needed to assess the nutritional needs, changing with the age, and the compliance to the diet.The follow- up plan should be established on the basis of the age of the child and following the growth pattern.

The Effects of Dietary Counseling on Children with Food Allergy: A Prospective, Multicenter Intervention Study

Although dietary counseling is generally recommended in children with food allergy (FA), its effect on the nutritional status of these patients has not yet been evaluated. Our nonrandomized multicenter prospective intervention study was undertaken to investigate the effects of dietary counseling on children with FA. Anthropometric data, dietary intakes, and laboratory biomarkers of nutritional status were evaluated in children with FA (aged 6 to 36 months) before and after dietary counseling, by multidisciplinary teams composed of pediatricians, dietitians, and nurses. Ninety-one children with FA (49 boys and 42 girls; mean age 18.9 months, 95% CI 16.5 to 21.3) were evaluated; 66 children without FA (41 boys and 25 girls; mean age 20.3 months, 95% CI 17.7 to 22.8) served as controls providing baseline values only. At enrollment, energy and protein intakes were lower in children with FA (91 kcal/kg/day, interquartile range [IQR]=15.1, minimum=55.2, maximum=130.6; and 2.2 g/kg/day, IQR=0.5, minimum=1.5, maximum=2.7, respectively) than in children without FA (96 kcal/kg/day, IQR=6.1, minimum=83.6, maximum=118.0; and 4.6 g/kg/day, IQR=1.2, minimum=2.0, maximum=6.1, respectively; P<0.001). A weight to length ratio <2 standard deviations was more frequent in children with FA than in children without FA (21% vs 3%; P<0.001). At 6 months following dietary counseling, the total energy intake of children with FA was similar to the baseline values of control children. Dietary counseling also resulted in a significant improvement of their anthropometric and laboratory biomarkers of nutritional status. The results of our study support the crucial role of dietary counseling in the clinical management of children with FA.

Growth in the first two years of uninfected children born to HIV-1 seropositive mothers

OBJECTIVE To assess the growth curves of uninfected infants born to type 1 human immunodeficiency virus (HIV-1) seropositive mothers by means of standardised anthropometric indices. METHODS The z scores (National Center for Health Statistics–World Health Organisation data) of weight for age, length for age, and weight for length of 92 uninfected full term infants born to HIV positive mothers were compared with those of 65 bottle fed full term infants born to healthy mothers at 0, 1, 2, 3, 4, 6, 9, 12, 18, and (in a subgroup) 24 months of age. Confounders were also recorded. RESULTS The study population had a lower length for age z score at birth (95% confidence intervals (CI): 0.02, −0.58) and higher weight for length z scores at 1 (95% CI: 0.21, 0.63), 2 (95% CI: 0.25, 0.66), and 3 (95% CI: 0.0, 0.48) months compared with the reference group. After a temporary recovery, the length for age z score difference increased progressively from the 4th month onwards and was significant at 18 (95% CI: −0.31, −1.05) and 24 (95% CI: −0.02, −0.91) months. The difference between the length for age z scores at birth was associated with maternal covariates, but the between group difference at 18 months was apparent even after adjustment for covariates. CONCLUSION Uninfected infants born to HIV positive mothers have a rapid weight gain immediately after birth. A decrease in length progression during the second year might be a result of the social risk connected with the family environment and an unfavourable programming related to the maternal HIV status.

Atopic dermatitis: recent insight on pathogenesis and novel therapeutic target.

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. It affects infancy, but it is also highly prevalent in adults and it is one of the disease burdens for the patients and their families. Nowadays, AD is recognized as a heterogenous disease with different subtypes with variable clinical manifestations which is affected by the impairments of the skin barrier. The severity of AD dictates the level of treatment. Current AD treatment focuses on restoration of the barrier function, mainly through the use of moisturizers and corticosteroids to control the inflammation, topical calcineurin inhibitors, and immunosuppresive drugs in the most severe cases. However, targeted disease-modifying therapies are under investigation. The most recent findings on the skin microbial dysbiosis is a promising future direction for the development of new treatments. We need to improve the understanding of the complex microbiome-host interactions, the role of autoimmunity, the comparative effectiveness of therapies and the ways to appropriately implement the educational strategies.

Growth Impairment and Nutritional Deficiencies in a Cow's Milk-Allergic Infant Fed by Unmodified Donkey's Milk

We report a case of growth impairment and nutritional deficiencies in a five-month infant fed by unmodified donkeys milk. We discuss the energy and macronutrient daily intake from donkeys milk and the nutritional consequences that can occur if this kind of milk is used unmodified in the first year of life.

A 1-Year Trial of Lamivudine for Chronic Hepatitis B in Children

We carried out a 1-year trial to evaluate the efficacy and tolerability of lamivudine, an oral nucleoside analogue, in a small group of children with vertically acquired chronic hepatitis B. Patients were assessed for serum alanine aminotransferase (ALT) and serum hepatitis B virus (HBV) DNA at baseline and every 4 weeks thereafter, and for hepatitis B s antigen, hepatitis B e antigen and their antibodies every 12 weeks. Analysis of HBV mutation was undertaken at entry and on the occasion of the last positive control of HBV DNA. Lamivudine suppressed serum HBV DNA to undetectable levels in all treated patients within 24 weeks. Serum ALT levels returned to normal values within 36 weeks. Therapy was well tolerated, and although nausea and vomiting were reported in one child, it was not necessary to stop treatment. A new observation was that, contrary to previous data, seroconversion appeared to occur earlier in children with lower ALT levels at baseline.

Body mass index development during the first 6 months of life in infants born to human immunodeficiency virus-seropositive mothers

The development of body mass index (BMI) was measured during the first 6 months of life in three groups of infants [human immunodeficiency virus (HIV) ‐uninfected, n= 92; later symptomatic HIV‐infected, n= 18; early symptomatic HIV‐infected, n = 9] born to HIV‐positive mothers and compared with a reference group (n= 65) born to healthy mothers. A trend towards lower values in the two groups of HIV‐infected infants was already evident at birth. Among the four groups, HIV‐uninfected infants showed the highest BMI values while the early‐infected infants showed the lowest BMI values at all measurements. The later‐infected group had a value close to the reference at 1 month, and then increased at slower rates than the uninfected and the reference groups. Infants born to HIV‐positive mothers may have higher energy and nutrient requirements after birth, either to sustain an increased BMI development (when uninfected) or to meet catabolic mechanisms (when infected).