Grains on the brain: A survey of dog owner purchasing habits related to grain-free dry dog foods.

Grain-free pet food options abound in the pet food market today, representing more than 40% of available dry dog foods in the United States. There is currently a dearth of information about the factors that contribute to a dog owner's choice of a grain-free dry dog food and if those factors are similar among countries. Therefore, the primary objective of the current survey was to identify the variables that are predictive of a dog owner's choice of a grain-free dry food across North America (Canada and the United States) and Europe (France, the United Kingdom and Germany). The survey consisted of 69 questions, took less than 15 minutes to complete and was distributed virtually via Qualtrics (Qualtrics XM, Utah, USA). A total of 3,298 responses were collected, equally distributed between countries. Multinomial logistic regression was performed in SPSS Statistics (Version 26, IBM Corp, North Castle, New York, USA). Male respondents, people from France, people who ranked the importance of ingredients in a pet food in the lower quartiles and people who do not rotate their dog's diet to provide variety were less likely to select 'no grain' when choosing a pet food. In contrast, people who believe that their dog has a food allergy, follow more than 5 specific dietary routines in their own diet, do not try to include grains in their own diet, get their information about pet food from online resources or pet store staff and look for specific claims on pet food (such as 'no fillers'), were all more likely to select 'no grain' when choosing a pet food. This survey provides insight into the similarities and differences in decision making among dog owners in North America and Europe and should be considered when exploring the effects of grain-free dog foods on canine health and well-being.

TEST (Trial of Eczema allergy Screening Tests): protocol for feasibility randomised controlled trial of allergy tests in children with eczema, including economic scoping and nested qualitative study.

BACKGROUND: Early onset eczema is associated with food allergy, and allergic reactions to foods can cause acute exacerbations of eczema. Parents often pursue dietary restrictions as a way of managing eczema and seek allergy testing for their children to guide dietary management. However, it is unclear whether test-guided dietary management improves eczema symptoms, and whether the practice causes harm through reduced use of conventional eczema treatment or unnecessary dietary restrictions. The aim of the Trial of Eczema allergy Screening Tests Study is to determine the feasibility of conducting a trial comparing food allergy testing and dietary advice versus usual care, for the management of eczema in children. METHODS AND ANALYSIS: Design: A single centre, two-group, individually randomised, feasibility randomised controlled trial (RCT) with economic scoping and a nested qualitative study. SETTING: General Practioner (GP) surgeries in the west of England. PARTICIPANTS: children aged over 3 months and less than 5 years with mild to severe eczema. INTERVENTIONS: allergy testing (structured allergy history and skin prick tests) or usual care. Sample size and outcome measures: we aim to recruit 80 participants and follow them up using 4-weekly questionnaires for 24 weeks. Nested qualitative study: We will conduct ~20 interviews with parents of participating children, 5-8 interviews with parents who decline or withdraw from the trial and ~10 interviews with participating GPs. Economic scoping: We will gather data on key costs and outcomes to assess the feasibility of carrying out a cost-effectiveness analysis in a future definitive trial. ETHICS AND DISSEMINATION: The study has been reviewed by the Health Research Authority and given a favourable opinion by the NHS REC (West Midlands - South Birmingham Research Ethics Committee, Reference Number 18/WM/0124). Findings will be submitted for presentation at conferences and written up for publication in peer-reviewed journals, which may include mixed-method triangulation and integration of the quantitative and qualitative findings. TRIAL REGISTRATION: ISRCTN15397185; Pre-results.

Structured intervention plan including component-resolved diagnostics helps reducing the burden of food allergy among school-aged children.

BACKGROUND: Food allergies can substantially burden patients and families by negatively affecting finances, social relationships, and personal perceptions of health. This study was performed under the Finnish Allergy Programme aimed at reducing avoidance diets to foods in schoolchildren by 50%. The main goal of this study was to investigate how many children could be freed from diet restrictions in a Finnish school district through a diagnostic algorithm including component-resolved diagnostics and food challenge. The secondary aim was to provide a crude estimate of the burden of the elimination food diets in the region, and the savings associated with the proposed intervention. METHODS: A total of 205 children on a food avoidance diet according to the school register because of food allergy were invited into the study. One hundred and fifty-seven children were interviewed, tested for IgE to extracts and allergen components and food challenged in respective order. RESULTS: After two years, 12 children still had an avoidance diet and three of them were treated successfully with sOTI; the rest suspended their avoidance diet (n = 134) or dropped out of the study (n = 11). The cost of the elimination diets was estimated in 172 700€ per year at start and 13 200€ per year at the end of the study; total savings were 128 400€ yearly. CONCLUSIONS: The results demonstrate a 65% reduction of avoidance diets to foods in school-aged children, exceeding the 50% aim of the Finnish Allergy Programme. Therefore, it is possible to actively reduce the number of food allergy diagnoses that remain unmonitored in the society through a tailored diagnostic work-up.

Assessing Adherence and Barriers to Long-Term Elimination Diet Therapy in Adults with Eosinophilic Esophagitis.

BACKGROUND: The six-food elimination diet (SFED) is an effective treatment approach for eosinophilic esophagitis (EoE), but it can be challenging and affect patients' quality of life. AIM: Assess patients' long-term adherence to SFED and potential factors influencing adherence. METHODS: EoE patients were recruited online via multiple platforms. Patients were classified as reaching the maintenance stage if they responded to SFED and identified specific trigger foods by reintroduction. Maintenance stage patients were categorized into those actively following the elimination diet (ACTIVE) and those no longer on their prescribed diet (FORMER). Participants completed a study-specific questionnaire assessing patient experiences related to SFED use. RESULTS: Forty-two participants were identified as having reached the SFED's maintenance stage. 57% (24/42) of the maintenance stage patients were ACTIVE users. FORMER users rated the SFED's effectiveness at treating symptoms (5.45 ± 3.96, 10 max.) lower than ACTIVE users (8.29 ± 2.76, p = .02). A greater percentage of FORMER users (100%) agreed social situations create challenges in following the diet compared to ACTIVE users (67%, p < .05). Anxiety related to SFED was also higher among FORMER users (64%) compared to ACTIVE users (21%, p < .01). Both ACTIVE (95.8%) and FORMER (81.8%, NSS) users would recommend the elimination diet to other EoE patients. CONCLUSIONS: Understanding SFED adherence is multifactorial and complex. Factors influencing SFED adherence during long-term maintenance with diet therapy include diet effectiveness, social situations, and diet-related anxiety. Despite a lower than expected long-term adherence to maintenance of an elimination diet, the majority would recommend diet therapy as a treatment to other EoE patients.

National allergy programme had little impact on parent-reported food allergies in children aged 6-7 years.

AIM: The ten-year Finnish national allergy programme was launched in 2008 to lessen the disease and psychological burden of allergy. This study assessed the prevalence of parent-reported food allergies requiring avoidance diets at primary school in children aged six and seven years. METHODS: The cohort comprised 1937 children (51% boys) who started primary school in Tampere, Finland, in August 2016. School health nurses charted parent-reported, doctor-diagnosed food allergies requiring avoidance diets as part of the routine health examination. RESULTS: We found that 127 (6.6%) children had parent-reported, doctor-diagnosed allergies to at least one food and 37 (1.9%) were allergic to basic foods, namely cows' milk, wheat and one other grain. All required an avoidance diet. The figure did not differ significantly from the 2.7% and 2.5% found by studies of this age group in 2009 and 2013, respectively. Allergies to fresh fruit and vegetables decreased from 5.8% in 2009 to 3.6% in 2016. CONCLUSION: We studied the national allergy programme that started in 2008 and found that there was a nonsignificant overall decrease in the number of children aged six to seven years on avoidance diets for allergies between 2009 and 2016. The only allergies that showed significant decreases were fresh fruit and vegetables.

Uso de fórmula nutricional a base de aminoácidos libres en pacientes con alergia alimentaria severa mediada o no mediada por ige y que han fracasado al uso de formulas extensamente hidrolizadas / Use of nutritional formula based on free amino acids in patients with severe food allergy mediated or not mediated by IgE and who have failed to use extensively hydrolysed formulas

INTRODUCCION: Antecedentes: El presente informe expone la evaluación de la fórmula nutricional a base a aminoácidos libres respecto a su uso en pacientes con alergia alimentaria severa mediada o no mediada por IgE que han fracasado a la formula con proteína extensamente hidrolizada. Aspectos generales: La alergia alimentaria es una respuesta inmune que puede ser específica (mediada por IgE), mediada por mecanismos celulares (no mediada por IgE) o mixta (mediada por IgE y mecanismos celulares) y que afecta a niños y adultos, siendo más común en la etapa de lactantes. Los síntomas de la alergia alimentaria pueden variar de leves a severos (4), según el nivel de hipersensibilidad de cada individuo. Entre los principales causantes de alergia alimentaria se encuentran el consumo de maní, huevo, pescado, mariscos, soya, trigo y leche de vaca, siendo el último la causa más común en niños. Existen varias posibilidades de tratamiento para la alergia alimentaria severa. Entre ellas, se encuentran la dieta de eliminación, caracterizada por la eliminación de los alérgenos de la dieta de la madre, que es la intervención clave para el manejo de la alergia alimentaria, ya que generalmente resulta en la resolución de los signos y síntomas. En la mayoría de los casos, el uso de dietas de eliminación incluye la ingesta de fórmulas hipoalergénicas como tratamiento de la alergia alimentaria en infantes alimentados con leche materna y/o fórmulas infantiles que hayan desarrollado una alergia a las mismas. Tecnología Sanitaria de Interés: Las fórmulas nutricionales a base de aminoácidos libres (FAA), conocidas también como fórmulas elementales, son fórmulas hipoalergénicas diseñadas para el consumo en infantes y niños con síntomas relacionados a alergia alimentaria o con alto riesgo de padecerlas (8). Para ser considerada como una fórmula hipoalergénica y poder ingresar al mercado, las FAA deben ser toleradas por el 90% de los pacientes con alergia a la proteína de leche de vaca (APLV). Las FAA son producidas sintéticamente en el laboratorio. Las proteínas completas (cadenas grandes de aminoácidos) se desintegran en sus elementos más esenciales y pequeños (aminoácidos). Así, las proteínas de cadena larga que actúan como antígenos y ocasionan las reacciones de hipersensibilidad, son degradadas en aminoácidos, que son compuestos con menor antigenicidad. Por ello, las FAA rara vez provocan reacciones alérgicas al ser ingeridas, además de ser digeridas rápidamente y disminuyen el volumen fecal. Las FAA son toleradas por la mayoría de los pacientes con APLV o alergia alimentaria múltiple, y pueden ser utilizadas como sustitutos de la leche materna u otras fórmulas infantiles. Las desventajas de las FAA incluyen un costo elevado y un sabor desagradable al ser ingeridas. METODOLOGÍA: Estrategia de Búsqueda: Se realizó una búsqueda de la literatura científica respecto al uso de fórmulas nutricionales en base a aminoácidos libres (FAA) para el tratamiento de alergia alimentaria severa. Se dio preferencia a guías de práctica clínica, revisiones sistemáticas con o sin meta-análisis y ensayos clínicos aleatorizados. Asimismo, se consideró extraer información con una estrategia de "bola de nieve" mediante la revisión de listas de referencias de las guías de práctica clínica, revisiones sistemáticas, estudios primarios y revisiones narrativas seleccionadas. RESULTADOS: Tras la búsqueda realizada, se encontró evidencia científica acerca del uso de las fórmulas nutricionales en base a aminoácidos libres (FAA) para pacientes con alergia alimentaria severa. Luego de revisar un total de 705 referencias resultados de la búsqueda bibliográfica, logramos filtrar 34 estudios relevantes para nuestra pregunta PICO de interés. Luego, 12 referencias fueron finalmente seleccionadas para ser analizadas. Sinopsis de la Evidencia: Se sintetiza toda la evidencia considerada para el presente dictamen que sustenta el uso de fórmulas nutricionales en base a aminoácidos libres (FAA) en pacientes con alergia alimentaria severa. Guías de práctica clínica, Revisiones sistemáticas, Ensayos clínicos, Ensayos Clínicos no publicados. CONCLUSIONES: En la presente evaluación de tecnología sanitaria se presenta la evidencia recabada sobre el beneficio de las fórmulas nutricionales a base de aminoácidos libres (FAA) en pacientes con alergia alimentaria severa que han fracasado al tratamiento con fórmulas nutricionales a base de proteína extensamente hidrolizada (FEH). A pesar que la evidencia es muy escasa, los expertos en pediatría han observado en su experiencia clínica, que la ingesta de las FAA podría contrarrestar el impacto a largo plazo en cuanto a problemas cognitivos y psicomotores en los infantes con alergia alimentaria severa sin manejo adecuado. Debido a ello, los expertos tienen la opinión que las FAA constituirían una alternativa terapéutica en los pacientes cuyos síntomas clínicos de alergia alimentaria severa persistan a pesar del uso de las FEH. El Instituto de Evaluación de Tecnologías en Salud e Investigación ­ IETSI, aprueba el uso de la fórmula nutricional a base de aminoácidos en pacientes con diagnóstico de alergia alimentaria severa mediada o no mediada por IgE cuya sintomatología severa persiste a pesar del uso de FEH según Anexo 01. El presente Dictamen Preliminar tiene una vigencia de dos años a partir de la fecha de publicación.

Uso de fórmula nutricional extensaente hidrolizada en pacientes con diagnóstico de alergia alimentaria severa mediada o no mediada por IgE / Use of widely hydrolyzed nutritional formula in patients diagnosed with severe food allergy mediated or not mediated by IgE

INTRODUCCIÓN: Antecedentes: El presente informe expone la evaluación del producto farmacéutico Fórmula Nutricional Extensamente Hidrolizada (FEH) respecto a su uso en pacientes con Sindrome de alergia alimentaria severa. Aspectos Generales: La alergia alimentaria es un problema de salud que afecta a niños y adultos, siendo más común en la etapa de lactancia y primera infancia. Para que una condición sea considerada alergia alimentaria debe cumplir con los siguientes criterios: a) una respuesta inmune adversa que se produce de forma reproducible debido a la exposición a un determinado alimento y b) se diferencia de otra respuesta adversa hacia los alimentos, como la intolerancia alimentaria, reacciones farmacológicas, o reacciones mediadas por toxinas. Tecnología Sanitaria de Interés: Fórmula Nutricional Extensamente Hidrolizada: La fórmulas en base a proteínas extensamente hidrolizadas (FEH) son fórmulas hipoalergénicas diseñadas para el consumo en infantes con síntomas de alergia a proteínas alimentarias o con alto riesgo de alergia alimentaria. Estas fórmulas pueden constituir el 100% de la ingesta diaria de nutrientes en niños menores de 6 meses, y el 50% en niños mayores de 6 meses con esta patologia. METODOLOGIA: Estratégia de Búsqueda: Se realizó una búsqueda de literatura científica en relación al uso de fórmulas en base a proteínas extensamente hidrolizadas (FEH) para el tratamiento de alergia alimentaria severa. Se dio preferencia a guías de práctica clínica, revisiones sistemáticas con o sin meta-análisis y ensayos clínicos aleatorizados. RESULTADOS: Tras la búsqueda realizada, se encontró evidencia científica acerca del uso de FEH para pacientes con alergia alimentaria severa. Luego de revisar un total de 2508 referencias como resultado de la búsqueda bibliográfica, logramos filtrar 57 estudios relevantes. Sinopsis de la Evidencias: Se detalla la evidencia científica que sustenta el uso de fórmulas en base a proteínas extensamente hidrolizadas (FEH) en pacientes con alergia alimentaria severa en las Guías de Práctica Clínica, Revisiones Sistemáticas, Ensayos Clínicos no publicados, Revisiones Narrativas. Conclusiones: En la presente evaluación de tecnología sanitaria se presenta la evidencia recabada sobre el beneficio de las FEH en pacientes con alergia alimentaria severa. Se ha identificado evidencia proveniente de cinco guías de práctica clinica (GPC) de baja calidad metodológica en las que se recomendó en base a consensos y opinión de expertos, el uso de FEH frente a otras fórmulas infantiles en la población de pacientes de nuestra pregunta PICO de interés. Las GPC recomiendan el uso de FEH en infantes alimentados con fórmulas infantiles con APLV, como parte de la dieta libre de proteína de leche de vaca. Estas recomendaciones se realizaron en consenso en base a opiniones de expertos y criterio clínico, más no se halló sustento alguno en estudios primarios referenciados. El Instituto de Evaluación de Tecnologías en Salud e Investigación-IETSI, aprueba el uso de la fórmula nutricional extensamente hidrolizada en pacientes con diagnóstico de alergia alimentaria sevra mediada o no mediada por IgE. El presente Dictamen Preliminar tiene una vigencia de dos años a partir de la fecha de publciación.

Assessment for Adverse Food Reactivity. A Clinician's Guide.

Patients frequently note adverse food reactions and report significant food restrictions as a result. Physicians need to consider the nutritional consequences and necessity of such voluntary dietary limitations. They also should consider adverse food reactivity in their differential diagnosis for many frequently seen concerns. This article describes a three-step process for assessing a patient's potential for true adverse food reactivity. Readers will note the significant contributions nutritionists and dieticians can offer as team members.

The case for a children's multidisciplinary food allergy clinic.

In the UK, up to 6% of children are affected by food allergy. Accurate diagnosis, appropriate dietary management, family education, support and continuing follow up are essential to prevent further reactions and optimise the child's nutritional intake and growth. Setting up an improved, one- stop service to achieve these goals, which includes the multidisciplinary team, is feasible and cost neutral. This audit and service evaluation involved questionnaires with parents and staff focus groups to examine provision in one area of England. The views of children were not included. Practitioners involved should consider further training if necessary.

Management of acute food allergic reactions by general practitioners.

BACKGROUND: Food is one of the leading causes of anaphylaxis. In the Netherlands, patients visit a general practitioner (GP) as often as an emergency department (ED) in case of an acute food allergic reaction. So far, the management of food allergic reactions by GPs has not been investigated. Therefore, we explored the management of acute food allergic reactions by GPs regarding specific treatment, observation period, prescription of emergency medication to treat new episodes, diet advices and referral to a specialist. METHODS: A questionnaire containing three hypothetical cases (two anaphylactic and one mild case) with questions about their management was sent to 571 GPs. RESULTS: Overall, treatment choice was dependent on the severity of the reaction (mild vs. anaphylaxis, P < .001). However, epinephrine was used for treatment of anaphylaxis with mainly respiratory symptoms in only 27% and for anaphylaxis with mainly cardiovascular symptoms in 73%. At discharge, the percentages for prescription of self-injectable epinephrine were 53% and 77%, respectively. A short observation period of <2 hours was advised by 42% of general practitioners in case of anaphylaxis. CONCLUSIONS: Treatment of food induced anaphylaxis by GPs appears to be suboptimal: a considerable number of patients would not be treated with epinephrine for the acute reaction (especially anaphylactic cases with respiratory symptoms), the observation period chosen by GPs was often too short and self-injectable epinephrine was not always prescribed at discharge to treat possible new episodes. Education programs are needed to increase the awareness of GPs to recognize and treat anaphylactic reactions.

Hypoallergenicity of various miso pastes manufactured in Japan.

Miso paste (miso), a fermented soybean food, is popular in Japan and other Asian countries. However, the soybean is known to induce an allergenic response in some individuals. In the present study, we evaluated the allergenicity of various kinds of miso available in Japan. Total proteins were extracted from Amakuti-kome miso, Karakuti-kome miso, Mugi-miso and Mame-miso, and the protein profiles were analyzed. The major protein bands detected in the intact soybean extract were not present in any of the miso samples, which instead showed various low molecular weight protein bands of approximately 10-25 kDa. The existence levels of six major soybean allergens were determined by Western blotting using specific antibodies. We found that the allergen levels varied among miso and allergen types; however, allergen levels were consistently lower in miso than in the soybean extract. We obtained similar results for IgE-ELISA experiments using serum IgE from soybean allergy patients. Taken together, these results indicate that compared to soybean extract, various types of miso contain small quantities of intact soybean allergens. Additionally, several lines of evidence indicated that the allergen levels were exceptionally low in the dark-colored Karakuti-kome miso and Mame-miso, which are produced with relatively long fermentation periods, suggesting that the duration of fermentation might be a key factor in the hypoallergenicity of miso.

Undeclared allergenic ingredients in foods from animal origin: survey of an Italian region's food market, 2007-2009.

Several EC Directives have been promulgated to protect allergic individuals but no rule has been established with regard to allergen cross-contamination caused by shared transport vehicles or common processing equipment. The aim of this research was to quantify, by enzyme-linked immunosorbent assay (ELISA) or real-time polymerase chain reaction, the presence in meat- or fish-based foods of four allergens (milk, egg, crustaceans and molluscs) that was not indicated either in the list of ingredients or in the label alert. In the time frame of 2007-2009, a total of 723 samples were subjected to 1983 analyses. The percentage of samples scoring positive ranged between 1.8% and 6.8% over the 3 years, and the concentrations of undeclared allergens found were 0.3-13.3 mg kg⁻¹ for milk (ß-lactoglobulin) and 0.21-12 mg kg⁻¹ for egg white proteins. On this basis, the possibility of cross-contamination serious enough to raise public health concern cannot be dismissed.

Gluten contamination in the Canadian commercial oat supply.

A growing body of evidence suggests that a majority of people with celiac disease and on a gluten-free diet can safely consume pure oats in moderate amounts; however, previous studies have indicated that the commercial oat supply in other countries, and in Canada to some extent, is contaminated with other grains. This study has confirmed that the commercial oat supply in Canada is heavily contaminated with gluten from other grains. Approximately 88% of the oat samples (n = 133) were contaminated above 20 mg kg(-1) and there were no differences between the oat types tested. Only one gluten-free variety of oats was analysed and it consistently provided negative results in all analyses. It is difficult to determine where the contamination originates, but there are possibilities for cross-contamination in the field, in the transport of the grain, in the storage of the grain, and in the milling and packaging facilities. It is clear from this study that only those products that have been certified 'pure' oats would be appropriate for a gluten-free diet.

Allergy assessment in children with eosinophilic esophagitis.

BACKGROUND: Eosinophilic esophagitis (EoE) is of growing interest for pediatricians and allergists. There is no general agreement about diagnostic and clinical management procedures. The objective of this prospective, observational study was to evaluate the efficacy of a protocol for the etiologic diagnosis and accurate treatment of EoE in the pediatric population. PATIENTS AND METHODS: Starting in 2001, patients aged 0 to 14 years with a diagnosis of EoE were consecutively included in a protocol which included an allergy study. Depending on the results, an avoidance or elemental diet was established. Topical corticosteroids were prescribed to patients who rejected the diet. Clinical, endoscopic, and histological evaluation was performed to assess response. In the case of disease remission, challenge tests were performed to identify the offending food. RESULTS: Seventeen patients were included. Most of them were male (14/17) and a high percentage (88%) had a history of allergy as well as a history of atopy in parents. Fifteen patients were sensitized to 1 or more foods. With this protocol and the subsequent treatment, 9 out of 17 patients were cured (1 out of 4 with swallowed corticosteroids, 3 out of 3 with an elemental diet, and 5 out of 12 with an avoidance diet). The offending food was identified in 8117 patients. Milk and eggs were the most common foods implicated. CONCLUSIONS: The allergy study was a useful diagnostic tool but it was not sufficient to identify the offending food.An elemental diet should be attempted before food is excluded as the cause of the disease.

[Food allergy in the child: an exploratory study on the impact of the elimination diet on food neophobia]. / Impact du régime d'éviction sur la néophobie dans le cadre d'une allergie alimentaire chez l'enfant : étude exploratoire.

OBJECTIVES: This study was designed to analyse the impact of an elimination diet in children with food allergy, and its perception by their parents on the later reticence of children to test unknown foods, food neophobia. METHODS: The degree of food neophobia of children having outgrown their allergy (mean age, 7 years 2 months) was compared to that of a sibling (9 years 5 months) using a standardized scale and a questionnaire of food friendliness. Parents were also asked to fill in a questionnaire on the disease and its burden on the family. RESULTS: Children having outgrown their allergy are more reluctant to test new foods than their non-allergic brother or sister, as shown by their scoring on the food neophobia scale and the number of unknown foods following the cure of the disease. Two factors increase the level of food neophobia, the distressing effect and the duration of the period elapsed until the diagnosis was made, as well as the distressing effect and the lack of variety in the meal preparation. CONCLUSION: Food neophobia, a normal phase between 2 and 10 years, is worsened by the elimination diet required by food allergy, especially in case of late diagnosis and when the time elapsed before diagnosis and the preparation of meals were perceived as difficult to bear.

Prevalence and outcome of allergic colitis in healthy infants with rectal bleeding: a prospective cohort study.

OBJECTIVES: Allergic colitis is often diagnosed clinically in healthy infants with rectal bleeding and often treated with costly hypoallergenic formula. The true prevalence of allergic colitis is unknown. We tested the hypothesis that allergic colitis is overdiagnosed in healthy infants with rectal bleeding. The authors also determined whether rectal bleeding in infants without allergic colitis would resolve without diet change. METHODS: For the purposes of this study, allergic colitis was defined histologically as colonic mucosa with >or= 6 eosinophils per high power field and/or eosinophils in colonic crypts or muscularis mucosae. We surveyed all 56 Ohio NASPGHAN members to determine standard practice regarding the evaluation of rectal bleeding in infants. In addition, infants

The effectiveness of a peripatetic allergy nurse practitioner service in managing atopic allergy in general practice--a pilot study.

The effectiveness of an allergy nurse practitioner service operating within community health care was evaluated in terms of symptom improvement and reduction in allergy related general practitioner consultations and prescribed medication. A postal questionnaire survey of 53 allergy patients, identified from three general practices in the Norwich area during a pilot scheme, was carried out concurrently with a survey of the patients' case records at the surgeries. The questionnaire included questions concerning allergy status, general practitioner visits and the number of prescribed medications supplied. The main outcome measures were the number of general practitioner consultations and prescribed medications before and after the allergy nurse practitioner consultation and the patient's reported level of symptoms. The results showed that the intervention of an allergy nurse practitioner consultation produced significant reductions in the outcome measures. The number requiring a general practitioner consultation fell by 40% (from 133 to 80, P < 0.001) and the number of prescribed medications fell by 42% (from 153 to 89, P < 0.001). Twenty-seven (69%) of the 39 patients who responded to the questionnaire reported an improvement in symptoms, whilst 26% (n = 10) remained the same and 5% (n = 2) were worse. An additional study of 23 of the +ve skin-tested patients, over an extended period, showed greater reductions in general practitioner consultations and prescribed medication (71%, P < 0.001 and 59%, P < 0.004 respectively). In conclusion, it is apparent that the application of developed skills and expertise in allergy assessment by a nurse coupled with time can lead to improvement in symptom level in allergy patients. Such a service also has the possibility of providing savings within the National Health Service. Simply prescribing drugs without a system of self-management and avoidance measures is unlikely to improve the care available to allergy patients.