The impact of food allergens on airway responsiveness in schoolchildren with asthma: A DBPCFC study.

BACKGROUND AND OBJECTIVE: Despite the growing evidence of a possible link between asthma and food allergy (FA), so far, the involvement of food in inducing respiratory symptoms has not been fully evaluated. The objective of this study was to evaluate the impact of food allergens on respiratory symptoms and bronchial reactivity (BHR) in schoolchildren with asthma. METHODS: The initial study group consisted of 362 children with asthma. In the end, 22 children with concomitant FA, and 18 without FA, were selected to participate in the study. Spirometry and Methacholine Inhalation Challenge (MIC) were conducted prior to and after the completion of a double blind placebo control food challenge (DBPCFC). RESULTS: The food-induced asthmatic reactions were observed in nine (2.5%) out of all 362 children with asthma. Mean FEV1 prior to and after allergen or placebo challenge did not differ between the groups studied. Increase of BHR after DBPCFC was seen in 17 (4.7%) children with asthma. The mean PC20 value in children with FA was 1.41 ± 1.12 mg/ml prior to the allergen challenge and 0.86 ± 0.71 mg/ml (P = 0.002) after the test, whereas these values were 1.93 ± 1.68 mg/ml and 2.02 ± 1.75 mg/ml, respectively, in children without FA (P > 0.05). Significant differences were noted after the allergen provocation in children with FA as compared to children without FA (P = 0.007). CONCLUSIONS: Although food allergens are a rare trigger of food-induced asthmatic reactions in schoolchildren with asthma, they could enhance BHR, despite a lack of evident clinical respiratory signs and decreased in FEV1 values after food challenge. Pediatr Pulmonol. 2016;51:787-795. © 2016 Wiley Periodicals, Inc.

Prevalence and Clinical Impact of IgE-Mediated Food Allergy in School Children With Asthma: A Double-Blind Placebo-Controlled Food Challenge Study.

PURPOSE: Recent studies indirectly suggest a possible link between food allergy (FA) and asthma. Most of them have evaluated the occurrence of FA in asthmatic children, especially in the first year of life, using questionnaire-based studies or specific IgE (sIgE) assay. The aim of this study was to evaluate the prevalence and clinical impact of IgE-mediated FA in school children with asthma using a double-blind placebo-controlled food challenge (DBPCFC). METHODS: The study group consisted of school children with atopic asthma who were admitted to the Department of Pediatric Allergology, Gastroenterology and Nutrition, Medical University of Lodz, for the evaluation of food hypersensitivity. The diagnosis of FA was established using questionnaires, sIgE analysis, and the DBPCFC. Asthma severity and asthma control state were also assessed. RESULTS: A relationship between consumed food and complaints was reported in 180 children (49.7%). Seventy children (19.3%) were sensitized to food allergens. IgE-mediated FA was confirmed in 24 children (6.6%), while 11 children (3%) demonstrated respiratory symptoms. Food-induced asthma exacerbations were observed in 9 patients (2.5%). Statistically significant differences in the prevalence of atopic dermatitis (P<0.002), urticaria (P<0.03), digestive symptoms (P<0.03), rhinitis (P<0.02), sIgE level (P<0.001), positive family history of atopy (P<0.001) and FA in history (P<0.001) were found between asthmatic children with FA and those without. Children with food-induced asthma exacerbations demonstrated significantly greater severity, poorer controls, and worse morbidity compared to those without. CONCLUSIONS: Although food-induced respiratory reactions in children with asthma were rare, they were classified as severe and associated with worse morbidity, greater severity, and poorer control. As the most commonly observed symptoms were coughing and rhinitis, which can be easily misdiagnosed, a proper diagnosis is essential for improving the management of both clinical conditions.

Decreased FOXP3 mRNA expression in children with atopic asthma and IgE-mediated food allergy.

BACKGROUND: The role of T regulatory lymphocytes has been investigated in various allergic diseases. However, the precise relation between the phenotype and severity of allergic diseases and the changes in FOXP3 mRNA expression are not fully understood. OBJECTIVE: To compare the expression of FOXP3 mRNA in children with asthma with and without concomitant food allergy (FA) with healthy children and children with only FA. METHODS: The study included 82 children: 15 with atopic asthma and IgE-dependent FA, 27 with atopic asthma without FA, 20 with IgE-dependent FA without asthma, and 20 healthy children without atopy. Reverse transcription was performed using a commercially available High Capacity cDNA Archive Kit (Applied Biosystems, Carlsbad, California). Analysis was carried out with a 7900HT real-time polymerase chain reaction system (Applied Biosystems). RESULTS: The average level of the FOXP3 gene expression in children with allergy was significantly lower compared with healthy children (2.2 ± 1.3 vs 4.2 ± 4.2; P = .014). The lowest mean level of FOXP3 mRNA expression (1.9 ± 1.6) was recorded in children with asthma and FA, and the highest level (4.2 ± 4.2) was recorded in healthy children without atopy (P = .036). A milder course of asthma or the degree of allergic reaction after a food challenge was associated with higher FOXP3 mRNA expression. CONCLUSION: Significantly lower levels of FOXP3 gene expression, observed more commonly in children with asthma and IgE-dependent FA than in healthy controls, were associated with a more severe clinical course. Therefore, FOXP3 expression could serve as an indicator of severe asthma with concomitant atopic conditions such as IgE-dependent FA.

Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine administered to older infants and children naïve to pneumococcal vaccination.

BACKGROUND: Streptococcus pneumoniae infections are a major cause of morbidity and mortality in children <5 years old worldwide. To increase serotype coverage globally, a 13-valent pneumococcal conjugate vaccine (PCV13) has been developed and approved in many countries worldwide. OBJECTIVE: Assess the safety and immunogenicity of PCV13 in healthy older infants and children naïve to previous pneumococcal vaccination. METHODS: This was a phase 3, open-label, multicenter study conducted in Polish children (N=354) who were vaccinated according to 3 age-appropriate catch-up schedules: Group 1 (aged 7 to <12 months) received two PCV13 doses with a booster at 12-16 months of age; Group 2 (aged 12 to <24 months) received two vaccine doses only; and Group 3 (aged 24 to <72 months) received a single dose of PCV13. Statistical analyses were descriptive. The proportion of immunological "responders" achieving serotype-specific antipneumococcal polysaccharide concentrations ≥0.35µg/mL, 1-month after the last dose of vaccine, was determined for each vaccine serotype. In addition, antipolysaccharide immunoglobulin (Ig) G geometric mean concentrations (GMCs) were calculated. Safety assessments included systemic and local reactions, and adverse events. RESULTS: The proportion of immunological responders was ≥88% across groups for all serotypes. Antipolysaccharide IgG GMCs were generally similar across groups. Each schedule elicited immune response levels against all 13 serotypes comparable to or greater than levels previously reported in infants after a 3-dose series. The 3 catch-up schedules had similar tolerability and safety profiles; a trend was present towards greater local tenderness with increasing age and subsequent dose administration. CONCLUSIONS: Immunological responses and safety results support the use of PCV13 for catch-up schedules in older infants and children naïve to pneumococcal vaccination.

[Nutritional guidelines for healthy children aged 1-3 years - Polish Expert Group statement. Part I- energy and nutritional components demand]. / Normy zywienia zdrowych dzieci w 1-3. Rokuzycia . stanowisko polskiej grupy ekspertów.czesc i - zapotrzebowanie na energiei skladniki odzywcze.

Updating of the nutritional guidelines for the Polish population requires updates of the nutritional norms for children. We present the Polish Expert Group statement (2012) on intake of selected nutrients (protein, lipids, carbohydrates, vitamin D and E) essential in nutrition of children aged 1-3 years. For this purpose the Expert Group reviewed available scientific data: the recent guidelines, nutritional norms and recommendations, systematic reviews and expert opinions as well as original publications, in relation to the specific requirements of the Polish population.

Influence of percutaneous endoscopic gastrostomy on gastro-oesophageal reflux evaluated by multiple intraluminal impedance in children with neurological impairment.

AIM: The aim of the study was to estimate the influence of percutaneous endoscopic gastrostomy (PEG) placement on gastro-oesophageal reflux (GOR) by using multiple intraluminal impedance (MII/pH) measurements in children with neurological impairments. METHOD: Fifteen children with neurological impairments (cerebral palsy, n=10; cerebroidolipofuscinosis, n=2; Aicardi syndrome, n=1; and secondary encephalopathy, n=2) were investigated (interquartile range [IQR] 6y 4mo-14y 8mo; median age 10y 2mo; eight male, seven female). Individuals with nutritional disorders that could not be corrected by physiological means or with swallowing disorders that either caused chronic respiratory symptoms or prevented food intake were included in the study. The exclusion criteria included previous major abdominal surgery and a lack of consent for PEG. Participants underwent MII/pH for a 24-hour period and had an oesophagogastroduodenoscopy before PEG placement, which was repeated 6 to 8 months later. RESULTS: At baseline, GOR was detected in 6 of the 15 participants, and the second MII/pH session revealed GOR in 2 of the 15 children. Differences between quantitative GOR indices obtained before and after PEG were not statistically significant, except for the proportion of the acidic/weakly acidic reflux events - among all participants in the first examination, 159 reflux episodes were acidic and 244 were weakly acidic, while in the follow-up recordings the proportion was inverted (244 acidic, 136 weakly acidic; χ(2) =47.0; p<0.001). Baseline endoscopy did not reveal any macroscopic changes in any of the examined individuals, but the follow-up examination revealed oesophagitis in two participants. The median body weight gain after 6 months as 22.0% (IQR 14.4-29.2%). All participants tolerated PEG feeding well, regardless of MII/pH results. INTERPRETATION: Identification of GOR based on MII/pH in children with neurological impairments does not exclude a good clinical response to PEG feeding.

FOXP3, IL-10, and TGF-ß genes expression in children with IgE-dependent food allergy.

BACKGROUND: Regulatory T cells (Tregs) have an essential role in tolerance and immune regulation. However, few and controversial data have been published to date on the role and number of these cells in food allergic children. The forkhead/winged-helix transcription factor box protein 3 (FOXP3) is considered the most reliable marker for Tregs. OBJECTIVE: This study aims to investigate the FOXP3, interleukin (IL)-10, and transforming growth factor (TGF-ß) genes expression in children with IgE-dependent food allergy. MATERIAL AND METHODS: The study group consisted of 54 children with IgE-dependent food allergy (FA) and a control group of 26 non-atopic healthy children. The diagnosis of FA was established using questionnaires, clinical criteria, skin prick tests, serum sIgE antibodies (UniCAP 100 Pharmacia Upjohn), and a double-blind placebo control food challenge. In order to assess gene expression, the isolation of nucleated cells was performed using Histopaque-1077 (Sigma-Aldrich, Germany). The concentration of RNA obtained was measured using a super-sensitive NanoDrop ND1000 spectrophotometer (Thermo Scientific, USA). A reverse transcription reaction was performed using a commercially available set of High Capacity cDNA Archive Kit (Applied Biosystems, USA). Analysis have been carried out in the genetic analyzer 7900HT Real-Time PCR (Applied Biosystems, USA). RESULTS: The average level of the FOXP3 gene expression in the studied group was 2.19 ± 1.16 and in the control group 2.88 ± 1.66 (p = 0.03). The average level of IL10 mRNA expression in the study group was 13.6 ± 1.07 and was significantly lower than corresponding values in the control group 14.3 ± 1.1 (p = 0.01). There were no significant differences in the average level of the TGF-ß mRNA expression in the study group (3.4 ± 0.4) and controls (3.5 ± 0.3; p > 0.05). The FOXP3 gene expression was the highest in children who acquired tolerance to food (3.54 ± 0.75), lower in heated allergen-tolerant children (2.43 ± 0.81), and the lowest in heated allergen-reactive children (1.18 ± 0.5; p = 0.001 control vs heated allergen reactive; p = 0.005 heated allergen tolerant vs heated allergen reactive; p = 0.001 outgrown vs heated allergen reactive). The significant tendency toward lower total IgE levels with a higher FOXP3 mRNA expression was detected (n = 54; Pearson r = -0.4393; p = 0.001). CONCLUSIONS: Children with FA showed statistically significant lower level of the FOXP3 and IL10 gene expression than healthy children. Children acquiring tolerance to the food show significantly higher levels of the FOXP3 gene expression than children with active FA. The correlation between the level of FOXP3 and total IgE was detected.

Bronchial reactivity in schoolchildren allergic to food.

BACKGROUND: Food allergy (FA) is associated with an increased risk of asthma. OBJECTIVE: To evaluate whether bronchial hyperreactivity (BHR) occurs in children with FA depending on the presence of respiratory symptoms. METHODS: Fifty-four children with FA and 62 without FA were studied for BHR, defined as a provocation concentration of methacholine that caused a decrease in forced expiratory volume in 1 second of 20% (PC20). The diagnosis of FA was established using questionnaires, clinical criteria, skin prick tests, serum specific IgE antibodies, and a double-blind placebo-controlled food challenge. RESULTS: Among nonasthmatic children, BHR was diagnosed in 15 (47%) with FA and in 7 (17%) without FA (P < .005); BHR was demonstrated in 7 children (41%) with FA alone. All the patients with asthma with or without FA had BHR. The mean (SD) PC20 in children with FA alone was 2.8 [1.38] mg/mL and was significantly higher than that in children with asthma alone (0.88 [1.01] mg/mL) or with asthma and FA (0.96 [0.83] mg/mL) (P < .001). BHR was detected in 5 children (36%) with a mild anaphylactic reaction provoked by food, in 23 (74%) with a moderate reaction, and in all the children with a severe reaction. CONCLUSIONS: Children with FA had increased BHR independent of respiratory symptoms. Although BHR occurs in asymptomatic children with FA, its course is milder than that in children with FA and asthma. Factors that determine BHR prevalence in children with FA are similar to those in children without FA.

[Rome III classification of functional gastrointestinal disorders in children with chronic abdominal pain]. / Ocena przydatnosci III klasyfikacji rzymskiej w diagnostyce przewleklych czynnosciowych bólów brzucha u dzieci.

BACKGROUND: The updated Rome III Classification of paediatric functional gastrointestinal disorders (FGIDs) associated with abdominal pain comprises: functional dyspepsia (FD), irritable bowel syndrome (IBS), abdominal migraine, functional abdominal pain (FAP), functional abdominal pain syndrome (FAPS). THE AIM OF THIS STUDY: To assess the value of the Rome criteria in identifying FGIDs in children with chronic abdominal pain. MATERIAL AND METHODS: The study group consisted of 439 consecutive paediatric patients (192 boys and 247 girls) aged 4-18 years (mean age was 11.95 +/- 3.89 years) referred to the Paediatric Gastroenterology Department at Medical University of Lodz from January 2008 to June 2009 for evaluation of abdominal pain of at least 2 months' duration. After exclusion of organic disease children suspected of functional chronic abdominal pain were categorized with the use of Rome III criteria of FGIDs associated with abdominal pain (H2a-H2d1) and the Questionnaire on Paediatric Gastrointestinal Symptoms (with the permission of doctor L. S. Walker). The patients with known nonabdominal organic disease, chronic illness or handicap were excluded. RESULTS: In 161 patients (36.58%) organic etiology was confirmed. Of the 278 children (63.42%) with functional chronic abdominal pain, 228 (82.02%) met the Rome III criteria for FGIDs associated with abdominal pain (FD, 15.5%; IBS, 21.6%; abdominal migraine, 5%; FAP 24.5%; FAPS, 15.9%). Fifty cases (17.98%) did not fulfill the criteria for subtypes of abdominal pain-related FGIDs--mainly due to different as defined by Rome III criteria (at least once per week) frequency of symptom presentation. CONCLUSIONS: (1) In the authors'investigations FGIDs was the most frequent cause of chronic abdominal pain in children. (2) The significant number of children with nonclassified FGIDs implies the need to modify the diagnostic criteria of Rome III classification concerning the prevalence of symptoms.

Evaluation of receptor expression on immune system cells in the peripheral blood of asthmatic children undergoing food challenges.

BACKGROUND: The role of food allergens in the induction of allergic reactions in the airways is not completely understood. The aim of the present study was to evaluate fluorocytometric assays of the peripheral blood during food challenge tests in children with asthma and food allergy. PATIENTS AND METHODS: 22 children with asthma and concomitant food allergy and 18 children with asthma without food allergy participated in the study. Oral challenge tests were performed using double-blind, placebo-controlled food challenge. Blood samples were collected before and 4 and 24 h after the challenge. CD25 and CD23 antigen expression was determined with monoclonal antibodies using a FACSCalibur flow. RESULTS: The evaluation of the CD25+ T subpopulation and CD19+CD23+ B lymphocytes revealed statistically significant differences between the study group and the control group. In children with asthma and food allergy, the cell pool consisted (on average) of 9 +/- 2.8% of CD3+CD25+ cells before the challenge and of 10.3 +/- 3.8% (mean delta: 1.623; p = 0.01) after the provocation. However, placebo challenge did not significantly change the number of this T-lymphocyte subpopulation (mean delta: -0.121; p > 0.05). The highest increase in the CD25+ T-subpopulation expression was found in patients with respiratory reactions during the positive food challenge (mean delta: 4.065; p < 0.004). CONCLUSIONS: An increase in CD25+ T-lymphocyte and CD23 B-lymphocyte populations after food allergen challenge may indicate their significant role in the pathogenesis of the active phase of the immunoinflammatory process in children with asthma and concomitant food allergy.

[Paediatric Expert Group on the Immunization Programme. Activities focusing on effective immunization in Poland]. / Pediatryczny Zespól Ekspertów ds. Programu Szczepien Ochronnych. Dzialania na rzecz poprawy efektywnosci szczepien w Polsce.

INTRODUCTION: The Paediatric Expert Group on the Immunization Programme was established in January 2007. It is an independent advisory body to the Minister of Health. The Expert Group consists of paediatricians from various sub-specialities. Most of them are members of the Polish Society of Vaccinology (Table I). The Group started their activities informally in 2005. The first project concerned changes in immunization against tuberculosis and prophylaxis of measles, mumps and rubella. The project was fully implemented in 2006. The changes initiated three years ago, gradually implemented in the Immunization Programme are a result of wide cooperation with the Ministry of Health, Department of Health Policy Chief Sanitory Inspector, as well as the Institute of Tuberculosis and Pulmonary Diseases. The aim of the Paediatric Expert Group on the Immunization Programme is to present a unified policy in matters related to vaccination, leading to rapid changes in the prophylaxis of infective diseases which are still a threat to the life and health of children.

[Food challenges in children with asthma]. / Próby prowokacyjne z pokarmami u dzieci chorych na astme.

UNLABELLED: Food-induced symptoms are often reported and increasing problem, also for children with asthma. Evaluation of the possibility of concomitant food allergy in patients with asthma and implementation of adequate therapy can improve quality of life in these patients. The aim of the study was to evaluate the prevalence of IgE food allergy and the influence of food allergen ingestion on the course of asthma in children allergic to inhalant allergens during food challenges. MATERIAL AND METHODS: The study performed in 304 children with atopic asthma (age: 5.5-18 years, mean 9.5 +/- 4.69 years) was directed towards the possibility of concomitant food allergy. In each child a detailed questionnaire examination, skin prick tests with food allergens, double-blind placebo-controlled food challenges (DBPCFC) were performed, and the level of specific IgE was determined (Unicap 100). RESULTS: On the basis of questionnaire data suspicion of food allergy was determined in 164 (66.9%) children. Skin prick tests with food allergens were positive in 36 (21.9%) children. Specific food IgE were detected in 40 (24.4%) children. DBPCFC were performed in 70 children with atopic asthma. IgE-related food allergy was diagnosed in 24 (9.8%) children with asthma. The most frequent complaints during food challenges were gastrointestinal symptoms and exacerbation of atopic eczema; exacerbation of asthma, mainly in the form of cough were determined in 11 (4.5%) children; egg appeared to be the most common food associated with a positive challenge result. CONCLUSIONS: Food allergy more often occurred in children with asthma and concomitant skin and gastrointestinal disorders than in those only with asthma. The diagnosis of possible concomitant food allergy should be considered in children with asthma.

[Evaluation of bronchial hyperreactivity in children with asthma undergoing food challenges]. / Ocena reaktywnosci oskrzeli u dzieci chorych na astme w trakcie prowokacji alergenami pokarmowymi.

UNLABELLED: It has been shown that food allergy does not always manifest within the respiratory tract in such as obvious way as: dyspnea, cough or wheezing. The aim of the study was to evaluate the influence of food allergens on bronchial reactivity in children with asthma challenged with food. MATERIALS AND METHODS: A total of 304 patients (age range 5.5 to 18 years, mean 9.5 +/- 4.69 years) with atopic asthma were evaluated for food allergy by means of questionnaire, skin prick testing with food allergens, specific IgE tests (Unicap 100) and double-blind placebo-controlled food challenge (DBPCFC). Bronchial hyperreactivity was measured by methacholine inhalation challenges performed before and after DBPCFC in 70 asthmatic patients suspected of food allergy. RESULTS: IgE-related food allergy was confirmed by DBPCFC in 24 asthmatic children. The mean FEV1 before and after food challenges in the group with IgE-related food allergy, as well as in the group without IgE-related food allergy, was not significantly different (p > 0.05). The mean PC20 in IgE-related food allergy group was 1.41 +/- 1.12 mg/ml and 0.86 +/- 0.71 mg/ml before and after food challenge respectively which was significantly different (p < 0.05). In the group without IgE-related food allergy the mean PC20 was 1.93 +/- 1.68 and 2.02 +/- 1.75 before and after challenge respectively (p > 0.05). CONCLUSIONS: IgE-related food allergy was present in 9.8% children with asthma. Prevalence of respiratory manifestations induced by foods in children with asthma is 4.1%. Food challenges in these children increased bronchial reactivity, without exacerbation. Evaluation of food allergy in patients with asthma is indicated.

[Helicobacter pylori infection and its metabolic consequences in children and adolescents with type 1 diabetes mellitus]. / Zakazenie Helicobacter pylori i jego konsekwencje metaboliczne u dzieci i mlodocianych z cukrzyca typu 1.

UNLABELLED: Helicobacter pylori infection (Hp) is the cause of chronic gastritis and duodenitis, ulcer disease, and functional gastrointestinal motor disorders. Its prevalence among Polish children with type 1 diabetes mellitus has been estimated at 25%. There is limited data regarding the influence of Helicobacter pylori infection on clinical course of diabetes, with controversial results. THE AIM: of the study was the estimation of Helicobacter pylori infection on the quality of metabolic control in children and adolescents with type 1 diabetes mellitus. MATERIAL AND METHODS: 198 diabetic patients were investigated (mean age 14.38+/-3.75; range 4.5-25 years), with diabetes duration of 4.91+/-4.21 years (range 0.5-16 years). Screening for Helicobacter pylori infection was performed utilizing the urea breath test (UBTC13); DOB (delta over the baseline) above 3%o was considered positive. Metabolic control included HbA1c (HPLC; Bio-Rad, Munich, Germany) and glucose concentration measurement; glycemia was expressed as area under the curve in fasting and prandial state (AUC). RESULTS: UBT was positive in 48 (24.3%) diabetic patients. HbA1c concentration was significantly higher in patients with Helicobacter pylori infection (7.87+/-1.51 vs. 7.17+/-1.46%; p<0.05). The AUC values were higher in Hp positive diabetic subjects: AUCO 83.75+/-40.99 vs. 66.82+/-31.71 and AUC1 189.86+/-61.57 vs. 149.02+/-51.66 [mg% x 0.5h x 0.5]; p<0.05. CONCLUSIONS: 1. Helicobacter pylori infection significantly worsens metabolic control in children and adolescents with type 1 diabetes mellitus. 2. High prevalence of Helicobacter pylori infection among young diabetic subjects and its influence on glucose control legitimate the screening for Hp inpatients with poor metabolic control of diabetes.

[Tolerance of enteral nutrition in children with acute pancreatitis]. / Tolerancja zywienia enteralnego u dzieci z ostrym zapaleniem trzustki.

AIM: evaluation of tolerance and efficacy of enteral nutrition inpatients with acute pancreatitis hospitalised in 2005-2006 in Department of Paediatric Allergology, Gastroenterology and Nutrition, Medical University of Lodz. MATERIAL AND METHODS: analysis involved the course of enteral nutrition in 15 children hospitalised in 2005-2006 (aged 11.24+/-3.31 year), in whom 19 episodes of acute pancreatitis were observed caused by: trauma (n=4), SPINK1 mutation (n=1, in analysing period 5 episodes was observed in patient) -mutation of serine protease inhibitor Kazal type 1, pancreas divisum (n=1), cholelithiasis (n=1), parasitic AP (n=2), drug-induced (n=3), idiopathic (n=3). 16 episodes were mild and 3 severe (2 pseudocysts and 1 rapture of pancreas). Half-elementary / low-fat diet (Peptisorb / NUTRICIA) was applied by nasojejunal cathether, using pomp (Flocare). Duration, clinical tolerance of enteral nutrition, amount of calories, change of body weight were estimated. RESULTS: the length of enteral nutrition varied from 3 to 46 days (average 16.15+/-10.71). The shortest course involved a patient with hereditary acute pancreatitis (average 7.4+/-2.6) the longest one -posttraumatic pancreatitis (average 28.5+/-12.28). By enteral nutrition we ensured the supply of 40.46+/-13.21 kcal/kg per day on average, reaching increase of body weight 733+/-714.23 g in 6 children; maintenance of initial weight in 3 and decrease in 10 patients (average 600+/-534.52 g). Undesirable effects (nausea, diarrhoea, vomitus), observed in 9 episodes of acute pancreatitis (47.4%) were short term in 6 (31%), needed modification of nutritional therapy in 3 (15.7%) (lowering dose of EN in 2, TPN in 1). CONCLUSIONS: 1. Enteral nutrition in children with mild acute pancreatitis is a useful method of therapy and undesirable effects appearing in some patients have transient character. 2. Developing complications in patients with posttraumatic pancreatitis may decrease tolerance to enteral nutrition.

[Role of IgE-dependent reactions in atopic dermatitis]. / Ocena udzialu reakcji Ige-zaleznej w przebiegu atopowego zapalenia skóry.

UNLABELLED: Atopic dermatitis is a disease of multifactorial pathogenesis. THE AIM: of the study was to establish the most common allergens responsible for development of atopic symptoms in children with atopic dermatitis. MATERIAL AND METHOD: the study complied 36 children aged 4 months - 3 years treated in the Department of Children Allergology, Gastroenterology and Nutrition because of atopic dermatitis. With each case the patient and family history of atopy was collected and basic laboratory tests were conducted (including total IgE and specific IgE using Polly Check system). RESULTS: eosinophilia was found in 11/36 children, elevated total IgE level in 16/36 and specific IgE were present in 14/36 patients. 6 patients proved to have sIgE for more then one allergen. The most commonly found allergens were animal hair, and food allergens. In 22 cases in spite of obvious clinical symptoms requiring therapy at hospital, all sIgE were negative for all tested allergens. CONCLUSION: although estimating sIgE is commonly used in diagnosing atopic dermatitis, it may not be sufficient to establish complete diagnosis. It seems that animal hair and food allergens are mainly responsible for development of atopic dermatitis.

Electrogastrography in children and adolescents with type 1 diabetes: weak correlation with metabolic control parameters.

AIM: To evaluate gastric myoelectrical activity with respect to duration and metabolic control of type 1 diabetes mellitus (T1DM). METHODS: 172 children and adolescents with T1DM (mean 14.4+/-3.7 y), divided into subgroups depending on diabetes duration (< 5 and > 5 y), and 35 healthy controls (mean 13.93+/-3.59 y) were examined. All subjects underwent electrogastrography (EGG) performed after overnight fasting. In subjects with T1DM, haemoglobin A1c (HbA1c) and blood glucose levels during EGG records were measured. RESULTS: 15.69% of T1DM patients and 91.42% of the controls fulfilled normal EGG criteria (p < 0.001). T1DM subjects had a lower percentage of fasting normogastria (34.56+/-27.35% vs 69.84+/-18.16%, p = 0.0001) and higher bradygastria (51.97+/-30.24% vs 19.11+/-15.01%, p = 0.0001) compared to controls. In diabetic patients, an increase in postprandial normogastria (60.37+/-23.96% vs 76.68+/-12.38, p < 0.05) and a decrease in bradygastria percentage (25.67+/-21.01% vs 9.58+/-7.13%, p < 0.05) was observed. In children with disease < 5 y, diabetes duration correlated with power ratio (r = - 0.27, p = 0.01), postprandial normogastria (r = - 0.24, p = 0.03) and tachygastria (r = 0.25, p = 0.02). Weak correlations between EGG parameters and glucose (preprandial dominant frequency r = - 0.19, p < 0.05; postprandial normogastria r = 0.23, p < 0.01) and HbA1c levels (preprandial bradygastria r = 0.19, postprandial dominant power r = 0.23; p < 0.05) were observed. CONCLUSION: Gastric myoelectrical rhythm derangement is present in a large proportion of young diabetic patients. Bradygastria is the most prominent EGG abnormality. Weak correlation was found between EGG parameters and diabetes metabolic control.

Prevalence of EGG derangement in newly diagnosed type 1 diabetes in childhood.

OBJECTIVE: To evaluate gastric myoelectrical activity in children with newly diagnosed type 1 diabetes melliltus (T1DM) in relation to blood glucose control and visceral neuropathy. METHODS: Percutaneous electrogastrograpy (EGG) was performed on 42 children (20 F; mean age 12.9 +/- 3.1 years) with T1DM of <1 year's duration and on 35 healthy controls (18 F; mean age 13.4 +/- 3.6 years). After overnight fasting, a 30-minute EGG recording was followed by test meal consumption and then a 60-minute postprandial EGG aquisition. Fasting and postprandial periods were analyzed for gastric dysrhythmias, dominant frequency (DF) and additional parameters. In T1DM patients, HbA1c and blood glucose levels were measured and tests for visceral neuropathy were performed. RESULTS: In 41 T1DM patients (98%), cardiovascular neuropathy tests were negative. In 12 of those patients (29%) and in 32 healthy controls (91%), electrogastrograms were normal. The percentages of fasting and postprandial gastric dysrhythmias were significantly higher in T1DM patients compared to controls (P < 0,05). In T1DM children after feeding, some normalization of gastric myoelectrical rhythm was observed: normogastria increased nearly 2-fold to 72.6 +/- 22.9% and bradygastria decreased to 20.8 +/- 20.4% from 52.3 +/- 32.4% (P < 0.05). The percentages of fasting bradygastria and normogastria were correlated with glycemia level (r = -0.55 and r = 0.51, respectively; P < 0.05), as was postprandial DF (r = 0.41; P < 0.05). There was no correlation between HbA1c levels and EGG parameters. CONCLUSIONS: Derangement of the gastric myoelectrical activity is present in 71% of children with early stage T1DM. Glucose levels influence gastric myoelectrical activity, whereas long-term glucose control (HbA1c level) does not correlate with EGG parameters.

[Activity of the azole drugs in vitro against strains of Candida albicans with different codes isolated from the digestive tract in children]. / Aktywnosc leków azolowych in vitro wobec szczepów Candida albicans o róznych kodach wyodrebnionych z przewodu pokarmowego dzieci.

The activity of ketoconazole (K, R04 1400 molecular weight 531.44), miconazole (M, R01 4889, molecular weight 479.15) and itraconazole (I, R05 1211, molecular weight 705.64) obtained from Janssen Pharmaceutica NV, against Candida albicans strains was studied. The axenic fungal strains were isolated from the faecal samples of children--not previously treated with antifungal drugs--with clinical symptoms suggesting the inflammation of the mucous membrane in the stomach and/or duodenum. The strains were assessed by own methods and unified tests (bioMérieux: API 20 C, API 20 C AUX). Five codes of Candida albicans Berkhout were found. The minimal inhibitory concentration (MIC) values were calculated from 448 dose-response curves according to the agar diffusion--Kadlubowski's method. MICs were also examined by analyzing the variation (min-max, x mean +/- standard error, mode Mo, median Me). It was demonstrated that all the strains used in the study were susceptible to the azoles drugs.