Role of FOXP3 Expression and Serum Vitamin D and C Concentrations When Predicting Acquisition of Tolerance in Infants With Cow's Milk Allergy.

BACKGROUND AND OBJECTIVE: Treg cells and dietetic factors may play a significant role in the natural acquisition of tolerance in children with cow's milk allergy (CMA). The best marker for Treg lymphocytes is the transcription factor forkhead boxP3 (FOXP3). Objective: We examine the relationship between FOXP3 mRNA expression and serum concentrations of vitamins D and C and the development of different phenotypes of tolerance in children with CMA. MATERIAL AND METHODS: The study group comprised 138 infants with CMA and 101 healthy infants. All children underwent oral food challenge, first with an extensively heated milk product and then with unheated products. FOXP3 mRNA expression and serum vitamin C and D concentrations were evaluated. RESULTS: At 2 years of life, 54 children (39.1%) still had CMA, 43 (31.2%) were unheated milk-reactive and heated milk-tolerant, while 41 (29.7%) had outgrown their allergy. The mean (SD) level of FOXP3 expression in the study group was 2.07 (1.23), which was lower than the control group value of 2.98 (1.52) (P<.001). A value below 1.45 indicated allergy. The mean serum level of vitamin D in the study group was lower than in the control group (29.67 [7.09] vs 33.35 [4.13] ng/mL; P<.001). No significant differences were found in mean serum vitamin C content. CONCLUSIONS: Increased FOXP3 mRNA expression can predict faster acquisition of tolerance in infants with CMA. These children have lower serum vitamin D levels than healthy children. No relationship was found between the natural history of CMA and serum vitamin C concentration.

Switching Between Infliximab Originator and Biosimilar in Paediatric Patients with Inflammatory Bowel Disease. Preliminary Observations.

BACKGROUND AND AIMS: The growing incidence of inflammatory bowel disease (IBD) in children necessitates the use of biological treatments. Recently, an infliximab biosimilar was authorized in the European Union, which may result in switching patients. We present our preliminary experiences with such switches. METHODS: The prospective study included 32 paediatric patients diagnosed with Crohn's disease (CD) and 7 children with ulcerative colitis (UC) at 3 academic hospitals, who were switched from infliximab originator to its biosimilar (Remsima). Patient characteristics, disease severity, laboratory parameters and adverse events were recorded. Means, medians and ranges were calculated. RESULTS: Mean age at diagnosis of CD and UC was 11.1 (2.7-15.3) and 12.3 years (8.5-14.8), respectively. Mean number of infliximab originator infusions before switching to the biosimilar was 9.9 (median 8, range 4-29) and 5.1 (5, 1-12) for the CD and UC group, respectively. Evaluation efficacy of last biosimilar doses of all patients revealed rates of clinical remission of 88 and 57% for CD and UC patients, respectively. Last follow-up assessment of patients who continued with biosimilar therapy showed that 16/20 (80%) CD patients and all 4 UC individuals were in remission. One infusion reaction to infliximab biosimilar was observed in a CD patient, which led to treatment discontinuation. The incidence of sporadic mild adverse events prior to and after switching did not differ significantly and was consistent with the safety profile of the infliximab molecule. CONCLUSION: Switching from infliximab originator to its biosimilar seems to be a safe option in children with CD. After the switch the biosimilar was just as effective as the originator.

Diagnosis of gastroesophageal reflux and anti-reflux procedures among Polish children with gastrostomies: a 10-year nationwide analysis.

BACKGROUND/OBJECTIVES: To analyse the approach to diagnose gastroesophageal reflux (GER) and the qualification criteria for anti-reflux (AR) procedures in Polish children fed via gastrostomy between 2000 and 2010. SUBJECTS/METHODS: An electronic questionnaire containing questions on the demographic and clinical data of patients with gastrostomies was distributed to six Polish centres of nutritional therapy. The portion pertaining to GER included data on clinical exponents, diagnostic procedures (pH-metry, pH-impedance, scintigraphy and upper gastrointestinal (GI) series) and AR. RESULTS: In total, 348 children (M199/F149; age at gastrostomy 5.78±5.49 years) were included. Data on the diagnosis of GER and the AR criteria were available for 343 and 336 subjects, respectively. Percutaneous endoscopic gastrostomy was performed in 258/348 patients (74.1%), while surgery was performed in 80/348 patients (23%). The data from 10/348 (2.9%) cases were unavailable. At least one of the tests for GER was conducted in 177/343 (51.6%) of patients: pH-metry in 74/343 (21.6%), pH-impedance in 17/343 (5.0%), scintigraphy in 60/343 (17.5%) and upper GI series in 102/343 (29.7%). GER was reported in 114/343 cases (33.2%), and fundoplication was performed in 87 children (76.3% of patients with GER). The highest congruence between a positive test result and the decision to perform fundoplication was documented in cases of scintigraphy and upper GI series (P=0.00000 and P=0.00191, respectively). A significant increase in the prevalence of simultaneous gastrostomy and AR was observed over the decade analysed (r=0.8, P=0.009). This study revealed a centre-specific attitude towards the diagnosis of GER and the assessment of qualifications for fundoplication in Polish gastrostomy-fed children. CONCLUSIONS: The unified diagnostic algorithm of GER and the universal qualification criteria for AR procedures need to be defined for gastrostomy-fed children.

Insulin sensitivity in Type 1 diabetic children and adolescents.

AIM: To estimate insulin sensitivity in Type 1 diabetic children and adolescents, and assess the relationship between insulin sensitivity and clinical markers of adiposity and parameters of the metabolic syndrome. METHODS: A total of 202 patients aged 8-18 years with Type 1 diabetes and disease duration 1.5-15 years participated. Insulin sensitivity was estimated by glucose uptake during an euglycaemic-hyperinsulinaemic clamp and was calculated as the average amount of glucose (M(lbm) = mg/kg(lbm)/min) required to maintain euglycaemia. Blood pressure, glycated haemoglobin (HbA(1c)) and lipid concentrations were measured. RESULTS: The M(lbm )value ranged from 4.14 to 25.25 mg/kg(lbm)/min (mean 9.81 +/- 3.34 mg/kg(lbm)/min). There was a significant relationship between M value and patients' age (r = -0.38, P < 0.0001). Insulin sensitivity decreased significantly with the onset of puberty; hence, it was significantly lower in pubertal and post-pubertal adolescents. Girls were significantly more insulin resistant than boys (9.01 +/- 0.32 vs. 10.43 +/- 0.29 mg/kg(lbm)/min, P = 0.005). Insulin sensitivity correlated with body mass index (r = -0.29, P < 0.001), waist circumference (r = -0.35, P < 0.001), triceps skin fold (r = -0.17, P = 0.018), subscapular skin fold (r = -0.23, P = 0.001) and body fat (r = -0.19, P = 0.006). There was a relationship between M(lbm) value, cholesterol (r = -0.18, P = 0.012), high-density lipoprotein cholesterol (r = 0.15, P = 0.035), low-density lipoprotein cholesterol (r = -0.22, P = 0.002), triglycerides (r = -0.32, P < 0.001) and systolic blood pressure (r = -0.15, P = 0.029). Insulin resistance was related to HbA(1c) (r = -0.18, P = 0.012). Additionally, there was a correlation between M(lbm) value and insulin dose. CONCLUSIONS: Children and adolescents with Type 1 diabetes mellitus have a very wide range of insulin sensitivity, which is determined by sex, age, amount of adipose tissue and glycaemic control.

[Biochemical characteristics of fungi isolated from ontocenoses of digestive tract in children]. / Wlasciwosci biochemiczne grzybów izolowanych z ontocenoz przewodu pokarmowego dzieci.

Fermentation of carbohydrates and assimilation of carbon compounds were evaluated. The utilization of 18 specific carbon compounds was estimated in the investigation of each strains for differentiation of the species. From among 125 strains of fungi the following were found: Candida albicans (112 strain), C. famata (2), C. glabrata (1), C. guilliermondii (1), C. kefir (4), C. tropicalis (2). The activity of 19 hydrolases was investigated using API ZYM. Biotyping of Candida strains was done according to the Williamson classification (1986), modified by Kurnatowska (1998). All strains were isolated from the oral cavity, rectum, as well as from the materials collected during endoscopy in children.

[Fungal invasions in the digestive tract in children]. / Inwazje grzybami przewodu pokarmowego dzieci.

The aim of presented study were fungal invasions of the oral cavity and gastrointestinal (GI) tract in children suspected of the inflammation of gastric and duodenal mucosa and of absorption disturbance. The fungal strains (125) were identified using API 20C and API 20C AUX (bio Me'rieux); they were as follows: Candida albicans, C. famata, C. glabrata, C. guillermondii, C. kefyr and C. tropicalis.

Estimation of antithyroid antibodies occurrence in children with coeliac disease.

INTRODUCTION: The coexistence of coeliac disease (CD) and the diseases of autoimmune origin is often discussed in literature. In this study the evaluation of antithyroid antibodies (antimicrosomal-TMA, anti-thyreoglobulin-ATG, thyroid peroxidase antibodies anti-TPO) occurrence against clinical and laboratory determinants of thyroid function is demonstrated in children with coeliac disease. MATERIAL AND METHODS: The study was conducted on 34 IgA-EmA positive children; control group consisted of 28 children with negative screening tests for coeliac disease. RESULTS: In both groups, the level of antithyroid antibodies (TMA, ATG, anti-TPO) and determinants of thyroid gland function (TSH, fT3, fT4) were evaluated; USG examination of thyroid gland was also performed. Elevated titres of antithyroid antibodies observed in children with coeliac disease (41.1%) in comparison to control group (3.56%) indicate the need for performing the screening tests for antithyroid antibodies in children with CD.

Functional studies of intestinal mast cells in children with food intolerance.

The aim of this study was to characterize some functional properties of intestine mast cells taken from children with food intolerance. The cells were obtained from tissue specimens by the use of the enzymatic method and the sensitivity of mast cells to anti-IgE, substance P (SP) and vasoactive intestinal peptide (VIP) was studied in vitro. We have noticed that (1) mast cells were sensitive to the action of anti-IgE, but there was no correlation with total IgE level, (2) although mast cells were challenged with SP and VIP histamine release was low.

Diamine oxidase plasma activity and jejunal mucosa integrity in children with protracted diarrhoea.

The aim of this study was to answer the question whether diamine oxidase (DAO) plasma activity reflects jejunal mucosa integrity in children with protracted diarrhoea. DAO activity was estimated with the radioisotopic method described by Fogel [14]. Postheparin DAO plasma activity was significantly lower in children with jejunal mucosa atrophy compared to control subjects.