M. Di Costanzo

Randomised clinical trial: efficacy of a new synbiotic formulation containing Lactobacillus paracasei B21060 plus arabinogalactan and xilooligosaccharides in children with acute diarrhoea

Acute diarrhoea is a frequent problem in children with heavy economic burden for families and society.

Atopy patch tests are useful to predict oral tolerance in children with gastrointestinal symptoms related to non-IgE-mediated cow's milk allergy.

Atopy patch tests (APTs) have been proposed for the diagnostic approach in children with non‐IgE‐mediated cows milk allergy and gastrointestinal symptoms. We aimed to investigate the benefit of APTs in predicting oral tolerance in these patients. We prospectively evaluated 172 subjects with a sure diagnosis of non‐IgE‐mediated CMA and gastrointestinal symptoms (97 boys, 56.4%; age, 6.37 m; range, 2–12 m). At diagnosis, 113/172 (65.7%) children had positive APTs to cows milk proteins (CMP). After 12 months of exclusion, diet APTs were repeated immediately before OFC. APTs significantly correlated (P < 0.001) with the OFC outcome (r 0.579). Diagnostic accuracy was sensitivity of 67.95%, specificity of 88.3%, PPV of 82.81%, NPV of 76.85%, and a +LR of 5.80. APTs are a valuable tool in the follow‐up of children with non‐IgE‐mediated CMA‐related gastrointestinal symptoms by contributing in determining whether an OFC can safely be undertaken.

Bugs for atopy: the Lactobacillus rhamnosus GG strategy for food allergy prevention and treatment in children

Food allergy (FA) is a major health issue for children living in Western countries. At this time the only proven treatment for FA is elimination of offender antigen from the diet. It is becoming clear that the development of gut microbiota exerts a profound influence on immune system maturation and tolerance acquisition. Increasing evidence suggests that perturbations in gut microbiota composition of infants are implicated in the pathogenesis of FA. These findings have unveiled new strategies to prevent and treat FA using probiotics bacteria or bacterial substance to limit T-helper (Th)/Th2 bias, which changes during the disease course. Selected probiotics administered during infancy may have a role in the prevention and treatment of FA. Lactobacillus rhamnosus GG (LGG) is the most studied probiotic in this field. Administration of LGG in early life have a role in FA prevention. Preliminary evidence shows that LGG accelerates oral tolerance acquisition in cows milk allergic infants. We are understanding the mechanisms elicited by LGG and metabolites in influencing food allergen sensitization. A deeper definition of these mechanisms is opening the way to new immunotherapeutics for children affected by FA that can efficiently limit the disease burden.

PP38 INCREASING HOSPITAL ADMISSIONS FOR FOOD-INDUCED ANAPHYLAXIS IN ITALIAN CHILDREN

Conclusion: tTGAb titer correlates with the diffusion of histological lesions in CD patients at diagnosis. The immunoreactivities against fragments as well as the combined immunoreactivities of tTG (227-687) and tTG (473-687) were higher in patients with diffuse lesions. Whilst the absence of both immunoreactivities was significantly more frequent in patients with only bulb lesions. This is the first evidence of a distinct humoral immunoreactivity in patients with different duodenal mucosa involvement.

PP39 THERAPEUTIC EFFECTS OF THE NEW SYNTHETIC BUTYRATE DERIVATE N-(1-CARBAMOYL-2-PHENYL-ETHYL) BUTYRAMIDE ON DIARRHEA AND VISCERAL PAIN IN MICE

and seeds (5.1%), fruits and vegetables (3.1%), fish (1.8%), peanuts (1.3%), crustaceans (0.7%), other specified foods in 6.2%. 31.3% of cases received a final diagnosis of food-induced anaphylaxis but the particular food was not indicated. Conclusions: Significant increase in admission for food-induced anaphylaxis occurred in Italian children between the period 2001–2005. Similar data have been recently reported in other Western countries. Our data suggest the importance of more research to investigate the causative factors and the necessity to improve the healthcare service for this condition.

PP20 EFFICACY OF A SYMBIOTIC CONTAINING LACTOBACILLUS PARACASEI B21060 IN AN ANIMAL MODEL OF NONALCOHOLIC STEATOHEPATITIS AND INSULIN RESISTANCE

Results: The diagnosis was obtained with barium enema in 4 patients. The remaining child, operated for intestinal occlusion, at surgery presented a dolicosigma with tight mesenteric root. All patients underwent colic resection with intestinal anastomosis. The resection was performed as emergency procedure in three cases. In two cases, an attempt to resolve the volvulus after barium enema was successful, and the patients were operated electively after having performed anorectal manometry (normal findings in both). Surgical specimens were investigated for aganglionosis, resulting normal in all cases. No post-operative complications were reported. During the follow up (range 20 months – 31 years) one patient presented an episode of intestinal subocclusion, treated conservatively. Discussion: Sigmoid volvulus has to be considered in the differential diagnosis of intense recurrent abdominal pain associated to vomiting and distension. A high index of suspicion is essential in order to perform the diagnostic barium enema or CT scan. Colonic resection (with laparotomic or laparoscopic approach) represents the optimal therapeutic solution, possibly as elective surgery. Considering the risk of intestinal necrosis and peritonitis, a nonoperative approach (decompressive rectal probe, rigid or flexible colonoscopy) is not warranted as a routine. The variable clinical presentation and the possible spontaneous resolution of pain can determine diagnostic delay and errors, responsible for the high mortality reported in adulthood (up to 16% in surgical series and 36% in patients treated conservatively). References

PA24 PECULIARITIES IN FATTY ACIDS PROFILE IN CHILDREN WITH FOOD ALLERGY

L. Cosenzaa , G. Terrin a, M. Di Costanzoa, R. Nocerino a , A. Coruzzoa , A. Celardoa, M. Velardoa, A. Passariello a , B. Malamisurab , V. Brunoa, R. Auricchio a,c , R. Tronconea,c , R. Berni Canani a,c aDepartment of Pediatrics, University of Naples “Federico II”; bPediatric Unit S. Maria dell’Olmo Hospital Cava dei Tirreni, Salerno; cEuropean Laboratory for the Investigation on Food Induced Diseases (ELFID), University of Naples “Federico II”