Changes in bovine milk bacterial microbiome from healthy and subclinical mastitis affected animals of the Girolando, Gyr, Guzera, and Holstein breeds / Cambios en el microbioma bacteriano de la leche bovina de animales sanos y afectados por mastitis subclínica de las razas Girolando, Gyr, Guzera y Holstein

Raw milk samples were collected from 200 dairy cows belonging to Girolando 1/2, Gyr, Guzera, and Holstein breeds, and the bacterial diversity was explored using 16S rRNA amplicon sequencing. SCC analysis showed that 69 animals were classified as affected with subclinical mastitis. The milk bacterial microbiome was dominated by Firmicutes, Proteobacteria, and Actinobacteria, with an increase of Firmicutes in animals with subclinical mastitis and Proteobacteria in healthy animals. At the family and genus level, the milk bacterial microbiome was dominated by Staphylococcus, Acinetobacter, Pseudomonas, members of the family Enterobacteriaceae, Lactococcus, Aerococcus, members of the family Rhizobiaceae, Anaerobacillus, Streptococcus, members of the family Intrasporangiaceae, members of the family Planococcaceae, Corynebacterium, Nocardioides, and Chryseobacterium. Significant differences in alpha and beta diversity analysis suggest an effect of udder health status and breed on the composition of raw bovine milk microbiota. LEfSe analysis showed 45 and 51 discriminative taxonomic biomarkers associated with udder health status and with one of the four breeds respectively, suggesting an effect of subclinical mastitis and breed on the microbiota of milk in cattle.(AU)

Modulatory activity of a bovine hydrolyzed collagen-hydroxyapatite food complex on human primary osteoblasts after simulating its gastrointestinal digestion and absorption / Actividad moduladora de un complejo alimentario de colágeno hidrolizado e hidroxiapatita bovinos sobre osteoblastos primarios humanos tras simular su digestión gastrointestinal y su absorción

Introduction: osteoporosis is the most prevalent bone disease and one of the main causes of chronic disability in middle and advanced ages. Conventional pharmacological treatments are still limited, and their prolonged use can cause adverse effects that motivate poor adherence to treatment. Nutritional strategies are traditionally based on supplementing the diet with calcium and vitamin D. Recent studies confirm that the results of this supplementation are significantly improved if it is accompanied by the intake of oral hydrolyzed collagen. Objective: to evaluate the possible in vitro osteogenic activity of a peptide-mineral complex formed by bovine hydrolyzed collagen and bovine hydroxyapatite (Phoscollagen®, PHC®). Methods: the digestion and absorption of PHC® were simulated using the dynamic gastrointestinal digester of AINIA and Caco-2 cell model, respectively. Primary cultures of human osteoblasts were treated with the resulting fraction of PHC® and changes were evaluated in the proliferation of preosteoblasts and in the mRNA expression of osteogenic biomarkers at different stages of osteoblast maturation: Runt-related transcription factor 2 (Runx2), alkaline phosphatase (ALP), osteocalcin (OC) and type I collagen (ColA1). Results: an increase in preosteoblastic proliferation was observed (p ≤ 0,05). No changes were detected in the biomarkers of osteoblasts with 5 days of differentiation, but with 14 days, registering in this case an increase in Runx2 (p = 0.0008), ColA1 (p = 0.035), OC (p = 0.027) and ALP (without significance). Conclusion: these results show that PHC® peptide-mineral complex stimulates the activity of mature osteoblasts, being capable of promoting bone formation (AU)

Introducción: la osteoporosis es la enfermedad ósea más prevalente y una de las principales causas de discapacidad crónica en las edades medias y avanzadas. Los tratamientos farmacológicos convencionales aún son limitados y su uso prolongado puede provocar efectos adversos que motiven baja adherencia al tratamiento. Las estrategias nutricionales se basan tradicionalmente en suplementar la dieta con calcio y vitamina D. Estudios recientes confirman que los resultados de esta suplementación mejoran significativamente si se acompaña de la ingesta de colágeno hidrolizado oral. Objetivo: evaluar la posible actividad osteogénica in vitro de un complejo péptido-mineral formado por colágeno hidrolizado e hidroxiapatita bovinos (Phoscollagen®, PHC®). Métodos: se simuló la digestión y absorción de PHC® utilizando el digestor dinámico gastrointestinal de AINIA y el modelo celular Caco-2, respectivamente. Cultivos primarios de osteoblastos humanos se trataron con la fracción resultante de PHC® y se evaluaron los cambios en la proliferación de los preosteoblastos y en la expresión del ARNm de los biomarcadores osteogénicos en diferentes etapas de maduración de los osteoblastos: factor de transcripción 2 relacionado con Runt (Runx2), fosfatasa alcalina (ALP), osteocalcina (OC) y colágeno tipo I (ColA1). Resultados: se observó un incremento de la proliferación preosteoblástica (p ≤ 0,05). No se detectaron cambios en los biomarcadores de osteoblastos con 5 días de diferenciación, pero sí con 14 días, registrándose un aumento de Runx2 (p = 0,0008), ColA1 (p = 0,035), OC (p = 0,027) y ALP (sin significancia). Conclusión: estos resultados muestran que el complejo péptido-mineral PHC® estimula la actividad de osteoblastos maduros, siendo susceptible de promover la formación ósea (AU)

Cirugía taurina en el siglo XXI. De la gloria al desprecio / Taurine surgery in the 21st century from glory to contempt

La cirugía taurina ha pasado de ser algo de lo que el cirujano presumía en todos los ámbitos de su entorno a ser una actividad mal vista desde el punto de vista social e incluyó en nuestro gremio quirúrgico. Sin embargo, los festejos taurinos populares siguen siendo muy frecuentes, con miles de heridos cada año, algunos de ellos graves. Actualmente, la atención sanitaria en festejos taurinos está inmersa en una problemática compleja debido principalmente a cuatro aspectos: 1) desprestigio social y profesional, 2) actividad profesional mal pagada, 3) abandono por las instituciones profesionales y académicas, y 4) falta de un cuerpo de doctrina específico. Todo esto está conllevando a que los equipos de atención sanitaria en cirugía taurina sean cada vez menos profesionalizados y más inexpertos, y a problemas de intrusismo profesional. Esta situación está repercutiendo directamente en la calidad asistencial prestada y en la morbimortalidad de la población herida, con las implicaciones legales que conlleva. Es necesaria una reestructuración de esta situación y el apoyo de las instituciones profesionales, sobre todo de los Colegios de Médicos, y de las instituciones académicas. (AU)

Bullfighting surgery has gone from being something that the surgeon presumed in all areas of his environment to being an activity frowned upon from a social point of view and included in our surgical guild. However, popular bullfighting festivities are still very frequent, with thousands of injured each year, some of them serious. Currently, health care in bullfighting festivals is immersed in a complex problem mainly due to four aspects: 1) social and professional discredit, 2) poorly paid professional activity, 3) abandonment by professional and academic institutions, and 4) lack of a specific body of doctrine. All this is leading to the health care teams in bullfighting surgery being less and less professionalized and more inexperienced, to problems of professional intrusion, and consequently is having a direct impact on the quality of care provided and on the morbidity and mortality of the injured population, with the legal implications that it entails. A restructuring of this situation and the support of professional institutions, especially Medical Associations, and academic institutions, is necessary. (AU)

Evaluation of some predictive parameters for baked-milk tolerance in children with cow’s milk allergy

Background Inclusion of baked-milk products to the diet appears to markedly accelerate tolerance to unheated milk compared to a strict avoidance diet. Objective : The present study aims to investigate the predictors of baked-milk tolerance in children with Immunoglobulin E (IgE)-mediated cow’s milk (CM) allergy. Methods The study included 80 patients diagnosed with IgE-mediated CM allergy upon oral food challenge (OFC) testing at our clinic. Patients who developed and did not develop reactions during OFC with baked milk were compared considering clinical and laboratory parameters. Results Eighty patients with CM allergy comprised 48 male and 32 female infants with an average age of 7.25 ± 2.45 (3–13) months. We found that 62.5% of them showed tolerance to baked milk in the OFC test performed with cakes containing 2.6-g milk protein. When the patients who tolerated and could not tolerate baked-milk products were compared for test results, we detected a statistically significant intergroup difference regarding diameter of wheal in skin prick test (SPT) performed with muffin slurry, levels of specific Immunoglobulin E (sIgE) in CM, sheep’s milk (SM), goat’s milk (GM), casein, and the amount of unheated milk consumed until a reaction developed in the OFC test performed with unheated milk (P < 0.05). Conclusion We defined novel decision points based on CM, SM, GM, casein sIgE levels, wheal diameter in SPT with muffin slurry, and the amount of milk ingested during OFC performed with unheated milk that may be useful in predicting outcomes of baked-milk ingestion (AU)

Correlación anatómica de la estructura helicoidal del miocardio ventricular mediante ecocardiografía / Anatomical correlation of the helical structure of the ventricular myocardium through echocardiography

INTRODUCCIÓN Y OBJETIVOS: La estructura helicoidal del miocardio ventricular ofrece una comprensión simple de la anatomía cardiaca bajo un argumento fisiológico demostrado en estudios experimentales y de imagen cardiaca que da sentido a la contracción electromecánica durante el ciclo cardiaco. Se ha estandarizado descriptivamente la técnica de preparación y disección del miocardio propuesta empíricamente por Torrent-Guasp mediante digitodisección para correlacionar anatómica y topográficamente la banda helicoidal con proyecciones ecocardiográficas de eje largo, eje corto y de 4 cámaras. MÉTODOS: Se disecaron 42 corazones -20 bovinos, 20 porcinos y 2 humanos- para estandarizar la técnica de disección del miocardio; después se identificaron con colores los diferentes segmentos para correlacionar las piezas anatómicas con las proyecciones ecocardiográficas. RESULTADOS: La pérdida del 38% de la masa estandariza la disección, y resulta eficiente para realizar la disección del miocardio. No se encontró diferencia morfológica en la banda de los corazones estudiados. En las proyecciones ecocardiográficas se pueden identificar los 4 segmentos miocárdicos. CONCLUSIONES: La estandarización de la técnica es útil para disecar cualquier tipo de corazón. El ecocardiograma es útil para valorar los diferentes segmentos en que se divide el miocardio. Se necesitan más estudios que generen otras aplicaciones prácticas de este conocimiento a la ecocardiografía y otros campos

INTRODUCTION AND OBJECTIVES: The helical structure of the ventricular myocardium provides a simple view of cardiac anatomy, based on physiological evidence that has been broadly demonstrated in experimental and imaging studies, and helps to explain the electromechanical contraction of the myocardium during the cardiac cycle. The aim of this study was to standardize and provide a detailed description of the technique for preparing and manually dissecting the myocardium proposed empirically by Torrent-Guasp. A further aim was to anatomically and topographically correlate the helical band with echocardiographic long-axis, short-axis, and 4-chamber projections. METHODS: We dissected 42 hearts-20 bovine, 20 porcine and 2 human hearts-to standardize the myocardial dissection technique. Subsequently, the distinct segments were color coded to correlate the anatomical specimens with echocardiographic projections. RESULTS: Loss of 38% of the myocardial mass after boiling was sufficient to standardize myocardial dissection and allowed an efficient technique. No morphological differences were found between the bands of the hearts studied. The 4 myocardial segments could be identified in the echocardiographic projections. CONCLUSIONS: Standardization of the technique is useful to dissect any type of heart. Echocardiography is useful to assess the distinct segments that compose the myocardium. More research is needed to generate practical applications of this knowledge to echocardiography and other fields

Nutritional status and food intake of children with cow's milk allergy

Introduction and objectives: Cow's milk allergy (CMA) is common, especially in children. The treatment is based on the exclusion of milk and dairy products and guidance regarding the exclusion diet. This study aimed to compare the anthropometric measurements and food intake of children with CMA with those of healthy controls, and to evaluate the serum concentrations of Vitamin A and 25(OH)D in children with CMA. Methods: This is a cross-sectional study with 27 children in the CMA group and 30 in the control group. z-Scores of body mass index and height, skinfolds, food intake and serum concentrations of retinol, beta-carotene, lycopene, 25(OH)D, parathyroid hormone and high sensitivity C-reactive protein were evaluated. Results: Mean age was four years (± 1.9). The CMA group evidenced a lower height compared to those from the control group (p = 0.0043). The CMA group showed a lower intake of calcium (p = 0.0033) and lipids (p = 0.0123). Low serum concentrations of retinol, beta-carotene, lycopene, 25(OH)D were found in 25.9%, 59.3%, 48.1% and 70.3% of the CMA group, respectively. Conclusions: Children with CMA consume smaller amounts of calcium and lipids and have shorter height compared to healthy controls. Insufficient levels of vitamins A and D were frequent in the CMA group, emphasizing the need for nutritional guidance and monitoring

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Repeatability of the resonance frequency analysis values in implants with a new technology

Background: Assess the reliability (by means of reproducibility and repeatability) of the PenguinRFA system, analyse the ISQ values of different implant types and correlate the ISQ with the insertion torque during the placement of the implant. Material and Methods: 120 rough surface implants were placed in bovine bone (type II and III). The implants were divided into groups, according to its design. Once the implants were in place, the exact insertion torque was registered. Then, primary stability was measured by means of the resonance frequency analysis with the PenguinRFA and the Osstell ISQ devices. In each implant two transducers of each device were used. Three measurements were obtained with each transducer. Results: The mean ISQ (implant stability quotient) of the whole sample is 67,70 ± 5,51. The Intraclass Correlation Coefficient (ICC) is 0,933 and 0,944 for transducers 1 and 2 respectively. The reproducibility is 0,906. The mean insertion torque is 24,54 ± 8,96N. The correlation between the ISQ and the insertion torque is 0,507 p < 0,000 (MultiPeg 1) and 0,468 p < 0,000 (MultiPeg 2) for bone type II and 0,533 p < 0,801 (MultiPeg 1) and 0,193 p < 0,140 (MultiPeg 2) for bone type III

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Embolización de seudoaneurisma femoral secundario a contusión por asta de toro / Embolization of femoral pseudoaneurysm secondary to contusion by bull horn

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Nutrición y gastronomía en Aragón / Nutrition and gastronomy in Aragón

Objetivos: revisar los conocimientos sobre la situación nutricional de la población aragonesa y sobre la gastronomía propia de Aragón como elementos necesarios para el bienestar y la salud de la población. Métodos: búsqueda bibliográfica en relación con el tema. Resultados: se identifica una gastronomía propia de Aragón relacionada con la evolución histórica de la población en el territorio. Actualmente, la población tiende a concentrarse en centros urbanos y capitales de provincia, especialmente en Zaragoza, donde la tradición alimentaria tiende a diluirse por influencias externas. Por parte de las autoridades se impulsan los alimentos de calidad con las certificaciones IGP tanto en vinos y aceites como en hortalizas y carnes. Los aragoneses se encuentran en el quinto lugar en consumo de alimentos por habitante de España, con el mayor consumo de patatas y hortalizas frescas. También tienen un elevado consumo de carnes y son quienes poseen un mayor aporte energético proveniente de lípidos de todas las comunidades autónomas. Estos datos estarían relacionados con que la mayoría de los varones adultos tienen sobrepeso u obesidad. Conclusiones: se echan en falta estudios más actualizados que valoren la situación nutricional de la población en Aragón. El último ha sido promovido por la Vocalía Nacional del Consejo General de Colegios Farmacéuticos (CGCOF) a nivel nacional para adultos que realizan actividad física. Debe mejorarse la educación nutricional de la población a fin de que sean capaces de elegir raciones y alimentos que promocionen su salud y bienestar e integren la gastronomía tradicional en su alimentación cotidiana como parte de su patrimonio cultural

Objectives: review the knowledge on the nutritional situation of the Aragonese population and on Aragón’s own gastronomy as necessary elements for the welfare and health of its population. Methods: literature review in relation to the subject. Results: a gastronomy characteristic of Aragón is identified. The main finding identified on the literature review is to do with the historical evolution of the population in the Aragonese territory. At present, the population tends to concentrate in provincial urban centers, mainly in Zaragoza, where the food tradition tends to be diluted by external influences. The health authorities qualify quality foods by PGI (Protected Geographical Indication) certifications in wines and oils, as well as vegetables and meats. Aragón is the fifth county in food consumption per inhabitant in Spain with the highest consumption of potatoes and fresh vegetables from Spain. Meat consumption is high and are those who have a greater energy intake from lipids of all the autonomous communities. These data are related to the fact that most men are overweight or obese. Conclusions: there is a lack of updated studies that assess the nutritional status of the population in Aragón. The last study was promoted by the National Pharmacists Vocalic of Nutrition of the CGCOF (General Council of Pharmaceutical Associations of Spain) throughout Spain for adults who perform some kind of physical activity. The nutritional education of the population must be improved so that they are able to choose rations and foods that promote their health and well-being and integrate traditional gastronomy into their daily diet as part of their cultural heritage

Nutrición y gastronomía en las Islas Baleares / Nutrition and gastronomy in Islas Baleares

Objetivos: el objetivo de este trabajo es estudiar las bases de la gastronomía de las Islas Baleares y buscar los patrones de alimentación, así como los perfiles nutricionales y sanitarios actuales. Métodos: búsqueda bibliográfica sobre la gastronomía y nutrición de las Islas Baleares. Resultados: el modelo gastronómico tradicional de las Islas Baleares es rico y variado y cuenta con productos de calidad reconocida bajo sellos europeos y nacionales. En la actualidad, el consumo de cereales, huevos, verduras y hortalizas, frutas, legumbres, carnes, pescados y mariscos es menor que el observado para la media nacional. Sin embargo, el consumo de bebidas alcohólicas y no alcohólicas es muy superior a esta media. Conclusiones: el consumo de alimentos actual está muy alejado del modelo mediterráneo tradicional. El perfil nutricional y sanitario es preocupante. El reto de la gastronomía balear es aunar la tradición con el saber actual para conseguir una evolución nutricionalmente aceptable y saludable

Objectives: the objective of this work was to study the basis of the gastronomy of the Balearic Islands and to look for the feeding patterns as well as the current nutritional and health profiles. Methods: bibliographic search on Balearic gastronomy and nutrition. Results: the traditional gastronomic model of the Balearic Islands is rich and varied and has products of recognized quality under European and national labels. Currently, the consumption of cereals, eggs, vegetables, fruits, pulses, meats, fish and seafood is lower than that observed for the national average. However, the consumption of alcoholic and non-alcoholic beverages is much higher than this average. Conclusions: current food consumption is very far from the traditional Mediterranean model. The nutritional and health profile is worrisome. The challenge of Balearic gastronomy is to combine tradition with current knowledge to achieve a nutritionally acceptable and healthy evolution

Nutrición y gastronomía en la Comunidad de Madrid / Nutrition and gastronomy in the Community of Madrid

Objetivos: la nutrición y la gastronomía forman parte de las estrategias de mantenimiento y promoción de la salud de una población. Profundizar en el conocimiento de la gastronomía y de la problemática nutricional de la Comunidad de Madrid constituye el objeto de la presente revisión. Métodos: búsqueda bibliográfica relacionada con el tema. Resultados: la gastronomía de Madrid destaca por la gran variedad y abundante oferta de alimentos y platos, lo que favorece las posibilidades de elección. Actualmente el consumo de alimentos es inferior al aconsejado para frutas, verduras, hortalizas, cereales integrales, pescados, huevos y lácteos, y supera lo aconsejado para carnes. Madrid es una de las comunidades autónomas con menor consumo y gasto per cápita en alimentación: se consumen menos alimentos, en general, y menos azúcares y grasas y aceites, en particular, respecto a la media nacional. La ingesta de proteínas y grasas es elevada, mientras que es insuficiente el aporte de hidratos de carbono complejos, fibra y diversos micronutrientes. El cambio en los hábitos alimentarios y el creciente sedentarismo favorece el incremento en el padecimiento de sobrepeso y obesidad, aunque el problema del exceso de peso es algo menor en Madrid respecto a otras comunidades, posiblemente por la menor ingesta energética. Conclusiones: la Comunidad de Madrid tiene una elevada disponibilidad de alimentos y una gran oferta gastronómica, lo que obliga a mejorar la educación y la formación del consumidor para que sus elecciones sean las más adecuadas para su salud y control de peso

Objectives: the nutrition and gastronomy are part of the strategies of maintenance and promotion of the health of the population. The aim of the present revision is to deep on the knowledge of the gastronomy and nutritional problems of the Community of Madrid. Methods: bibliographic search in relation to the subject. Results: the gastronomy of Madrid stands out for its great variety and abundant offer of food and dishes, which favors the possibilities of choice. The consumption of food is lower than that recommended for fruits, vegetables, whole grains, fish, eggs and dairy products and higher than recommended for meats. The Community of Madrid is one of those Autonomous Communities in Spain that consume and spent less per capita on food. Food consumption in general is lower than the national average, especially for sugars and fats and oils. There is a high intake of proteins and fats, an insufficient intake of complex carbohydrates and fiber, together with an inadequate intake of several micronutrients. The change in eating habits and the sedentary lifestyle favor the increase of the prevalence of overweight and obesity. Nevertheless, the problem of weight excess is somewhat lower in Madrid compared to other regions, perhaps because of its lower energy intake. Conclusions: the Community of Madrid is characterized by a high availability of food and a great gastronomic offer. This forces us to improve the nutritional education of the population, in order to facilitate the most appropriate selections for the improvement of health and weight control

Aspectos gastronómicos, alimenticios y nutricionales de Andalucía oriental / Gastronomic, food and nutritional aspects of oriental Andalusia

Andalucía oriental se denomina Alta Andalucía por la elevada orografía de las cordilleras Béticas con las cumbres peninsulares más altas. Surge con la segmentación de España en provincias, e incluye Almería, Granada, Jaén y Málaga. Solo hay que detenerse en el fondo de nuestras ollas para encontrarnos el sincretismo de las tres grandes religiones monoteístas (árabe, judía y cristiana) que mezcló las fiestas de una con las comidas de otra y permitió la universalización de sus gastronomías; un sincretismo que ha llegado hasta hoy y hace difícil conocer el origen de una u otra receta. La cocina busca hoy la fusión entre el sabor y los ingredientes de la cocina tradicional con el saber y la técnica de la cocina moderna. La diversidad geográfica y climática de Andalucía oriental es proporcional a su despensa, y esta es la que surte su recetario. La población de Andalucía oriental se aparta del patrón mediterráneo y se acerca a la dieta global de los países desarrollados de Occidente. Esta tendencia a disminuir el consumo de alimentos propios de patrón mediterráneo parece mantenerse, aunque se observa una disminución en la caída de alguno de ellos. Además, el consumo elevado de grupos como el de carnes y derivados, bollería, dulces y azúcar tiende a moderarse. El patrón actual es compatible -como pone de manifiesto el estudio ANIBES- con unas ingestas elevadas de grasa saturada y total y de azúcares y una baja ingesta de fibra en un porcentaje importante de la población en España y, por tanto, en Andalucía

Eastern Andalusia, is also named Highland Andalusia, because the elevated orography of the Betics mountain range, with the highest Iberian Peninsula summits. This region arose with the division of the Spanish territory by provinces and currently includes Almeria, Granada, Jaen. You should only stop and look into the bottom of our cooking pots to find the syncretism of the three monotheistic religions, Christianity, Jewish and Muslin, which mixed parties of each one with meals of the others, thus allowing the globalization of their gastronomies that remained until nowadays and makes difficult to find the actual origin of a particular meal recipe. Modern cooking tries to find the fusion between tastes and ingredients of traditional cooking with current knowledge and technology. The geographic and climate diversities in Eastern Andalusia are proportional to its pantry, which in turn is the source of its meal recipes. The population of Eastern Andalusia is moving away of the Mediterranean pattern and getting closer to the developed Western countries diet. This trend to decrease the consumption of proprietary Mediterranean foods seems to be maintained in the last years although some of them start to recover. In addition, some food groups e.g. meat and meat derivatives, pastries and sweets, with actual elevated consumption, tend to be moderated. The current food pattern for the whole Spanish population, as well as for Eastern Andalusia, is compatible with high intakes of saturated fat, and total and free sugars, and low intakes of fiber in a high percentage of the Spanish population as reported by the ANIBES study

Successful oral desensitization in children with cow's milk anaphylaxis: Clinical and laboratory evaluation up to nine-years follow-up

Introduction: Cow's milk protein allergy (CMPA) is the most common food allergy in children worldwide. Some children have severe and persistent CMPA, with near-fatal reactions after exposure to trace amounts of cow's milk-proteins (CMP). Strict avoidance diet is difficult, negatively affects quality of life and represents a conservative approach. Therefore, different therapeutic strategies are necessary. Objective: We aimed to assess long-term efficacy and safety of oral immunotherapy (OIT) in children with severe and long-lasting IgE-mediated CMPA. Materials and methods: The authors present four case reports of patients with CMPA who underwent CMP-OIT, that have been under long-term follow-up up to nine years. We provide information about the clinical and laboratory evaluation. Skin prick tests (SPT), specific IgE and IgG4 were performed before, during, and after OIT. Immune profile after OIT was assessed by flow cytometry (lymphocyte subsets, regulatory T and B cells). Results: The success rate was 100%, and all patients currently have a free diet with minimal diary ingestion of 200mL CMP or equivalent. Specific IgE levels and SPT to CMP have progressively decreased, and specific IgG4 levels have increased. CD4+CD25+CD127/dim regulatory T cells were increased after OIT. Conclusions: OIT ensured a clinical tolerance state after up to nine years, confirmed by both clinical and immune profile, allowing a diet without restrictions, with high satisfaction from patients and caregivers. We emphasize that OIT should be performed only by allergy experts in the hospital setting, and that only motivated families should be enrolled, since it is essential to ensure CMP daily intake at home

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Iberian consensus on cow's milk allergy: The CIBAL Study

BACKGROUND: The present study explores the professional opinion of a wide range of experts from the Iberian Peninsula (Spain and Portugal) and their degree of consensus about CMPA's prevention, diagnosis, treatment and progression. Material and methodsA 57-item survey divided in four blocks: Prevention (14 items), Diagnosis (10 items), Treatment (19 items) and Progression (14 items) was completed by 160 panellists, experts in CPMA management (116 Spain, 44 Portugal). Each one answered the questionnaire, formulated in Portuguese and Spanish, by individually accessing an online platform in two consecutive rounds. Five possible answers were possible: "completely agree", "agree", "neither agree nor disagree", "disagree" and "completely disagree". A modified Delphi method was used. RESULTS: Consensus (more than 66% agree) was reached in 39 items (68.4%) and Discrepancy (less than 50% agree) in nine items (15.7%). Block separated analysis offers valuable differences regarding consensus. The Prevention block only reached 50%; the Diagnosis block 90%; the Treatment block 73.68%, showing a high degree of agreement on dietary treatment (15/16 items), and discrepancy or less agreement on immunotherapy treatments. The Progression block reached 71.4% consensus with discrepancy with regard to the time to perform oral food challenge and negatives prognosis consequences of accidental milk ingestion. CONCLUSIONS: This study displays the current opinions of a wide group of experts on CMPA from the Iberian Peninsula and evidence discussion lines in CMPA management. The questions on which there were situations of discrepancy, provide us with very useful information for promoting new, rigorous research enabling us to draw conclusions on these controversial aspects

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Prolonged breastfeeding and delayed introduction of whole cow's milk into the diet are factors associated with egg sensitization: a matched case-control study

BACKGROUND: Both breastfeeding and the moment at which introduction to solid food occurs have been associated with food allergy. OBJECTIVE: To evaluate whether prolonged breastfeeding and the delayed introduction of whole cow's milk into an infant's diet are factors that can be associated with egg sensitization. METHODS: This was a hospital-based case-control study, matched by age and sex: each study group comprised 97 atopic children. Additionally, logistic regression was used to identify the factors associated with egg protein sensitization. RESULTS: The most common type of allergic disease among both groups was allergic rhinitis. After adjusting for possible confounding variables, a delayed introduction to whole cow's milk decreased the odds of egg protein sensitization; OR = 0.16 (95% CI: 0.07-0.36, p < 0.0001). Notably, breastfeeding during the first six months of life, regardless of whether it was the only milk an infant drank, increased the risk for sensitization to chicken eggs; OR = 5.54 (95% CI: 2.41-12.7, p < 0.0001). CONCLUSION: Prolonged breastfeeding, regardless of whether it was the only milk an infant drank, greatly increased the risk of egg sensitization. Interestingly, a delayed introduction to whole cow's milk was associated with a reduced possibility of becoming sensitized to eggs. Further studies are required to elucidate these findings

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Low efficacy of atopy patch test in predicting tolerance development in non-IgE-mediated cow's milk allergy

BACKGROUND: The food atopy patch (APT) test has been used in previous studies to help the diagnosis of non-IgE mediated food allergies (FA). The aim of this study was to evaluate the efficacy of different cow's milk APT preparations to predict oral tolerance in children with previous non-IgE-mediated cow's milk allergy (CMA) diagnosis. METHODS: Thirty-two patients non-IgE-mediated CMA diagnosed by oral food challenge (OFC) were enrolled to perform APT with three different cow's milk preparations (fresh, 2% in saline solution, 2% in petrolatum) and comparing with a new OFC after at least three months of diet exclusion. RESULTS: Only six (18.7%) subjects presented positive OFC to cow's milk. No differences in gender, onset symptoms age, OFC age, Z-score, and exclusion period were found between positive and negative OFC patients. Preparations using fresh milk and powdered milk in petrolatum presented sensitivity equal to zero and specificity 92.3% and 96.1%. The preparation using powdered milk in saline solution showed sensitivity and specificity of 33.3% and 96.1%. Two patients presented typical IgE symptoms after OFC. CONCLUSION: Cow's milk APT presented a low efficacy to predict tolerance in patients with previous non-IgE-mediated CMA and should not be used in clinical routine. The presence of typical IgE reactions after OFC hallmark the necessity of previous IgE-mediated investigation for this patient group

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