Nutritional risks in children with food allergy.

BACKGROUND: Food allergies (FA) are a growing problem in the pediatric population and clinical features differ according to the underlying immunological mechanisms. While the primary management strategy is to eliminate the culprit food from the diet, assessment of the potential nutritional risks of elimination is also an integral part of management. In cases that do not improve over time; if you have basic food allergies and multiple food allergies, this can also lead to negative nutritional consequences. The contribution of basic nutrients, economical and easily accessible foods to the diet, is critical and has an important place in meeting the daily adequate intake of many nutrients. In the presence of food allergy, it is necessary to meet the vitamins and minerals that cannot be obtained from allergic foods, with alternative sources or supplements. For example, insufficient calcium intake in cow's milk allergy (CMA), the most common FA in early childhood, is very likely if an alternative supplement has not been introduced. In the management of CMA, choosing the appropriate formula and/or supplement for the clinical characteristics of children, when necessary, has an important place. In conclusion, nutritional risk assessment of children with FA requires a comprehensive, detailed, and multidisciplinary approach.

Systemic and large local reactions during subcutaneous grass pollen immunotherapy in children.

BACKGROUND: Subcutaneous immunotherapy (SCIT) is the allergen-specific curative treatment of allergic rhinitis. Adverse effects, most of which are local, can be observed during the immunotherapy. These adverse effects have been reported more frequently during the pollen season. The purpose of this study was to estimate the rate of local, large local, and systemic reactions during the treatment, to determine the relationship between adverse reactions and the season in which these reactions occur, as well as the risk factors for adverse reactions during the grass pollen-specific SCIT treatment in children. METHODS: We retrospectively collected and analyzed the data of 261 children who administered grass pollen SCIT between 2008 and 2018. RESULTS: A total of 261 children (177, 67.8% male), who received grass pollen SCIT, with a mean (±SD) age of 12.0 ± 3.0 years at the initiation of SCIT were enrolled to the study. The number of the patients who experienced local and large local reactions was 109 and 30, respectively. In addition, the number of the patients with systemic reactions was 35. After the 12 284 injections, local reactions occurred in 357 (2.9%), and this was followed by systemic reaction as 55 (0.4%) and large local reactions as 40 (0.3%). Frequency of local (P < .001) and systemic reactions (P = .003) was higher during grass pollen season than out of the grass pollen season. In multivariate analysis, initiation of SCIT during the grass pollen season [OR:7.351, 95%CI:1.532-35.279, P = .013] and experiencing local reactions [OR:4.214, 95%CI:2.159-8.224, P < .001] were independent predictors for the development of large local and systemic reactions. CONCLUSION: SCIT, in which only mild-to-moderate systemic reactions occurred, is safe for the treatment of allergic rhinitis in children. Our study revealed that previous local reactions and initiation of immunotherapy during the grass pollen season were the predictors for large local and systemic reactions during SCIT in children.

Consensus statement on diagnosis, treatment and follow-up of cow's milk protein allergy among infants and children in Turkey.

The present paper aims to provide experts' consensus on diagnosis and management of cow's milk protein allergy (CMPA) among infants and children in Turkey, based on review of available evidence-based guidelines, publications and experts' clinical experience. The experts agreed that CMPA diagnosis should be based on symptomatic evaluation and diagnostic elimination diet as followed by implementation of an open challenge test after disappearance of symptoms and confirmation of CMPA diagnosis in re-appearance of symptoms. For breastfed infants, differential diagnosis involves withdrawal of cow's milk-containing products from the mother's diet, while calcium supplements and appropriate dietary advice are given to mothers to prevent nutritional deficiency. For infants not breastfed exclusively, cow's milk-based formula and any complementary food containing cow's milk protein (CMP) should be avoided. The first line treatment should be extensively hydrolyzed formula (eHF) with use of amino acid-based formula (AAF) in severe cases such as anaphylaxis, enteropathy, eosinophilic esophagitis and food protein induced enterocolitis along with cases of multiple system involvement, multiple food allergies and intolerance to eHF. Introduction of supplementary foods should not be delayed in CMPA, while should be made one by one in small amounts and only after the infant is at least 17 weeks of age. Infants who are at-risk can be identified by family history of atopic disease. Exclusive breastfeeding for 4-6 months (17-27 weeks) is recommended as the best method of infant allergy prevention. There is no evidence that modifying the mother's diet during pregnancy and/or breast-feeding and delaying solid or even potentially allergic foods beyond 4-6 months in infants may be protective against allergy among at-risk infants. When exclusive breastfeeding is not possible, at-risk infants should get a partially or extensively hydrolyzed formula (pHF or eHF) to prevent allergy until risk evaluation by a health professional. In conclusion, the present consensus statement provides recommendations regarding diagnosis, prevention and management of CMPA in infants and children in Turkey, and thus expected to guide physicians to optimize their approach to CMPA and decrease burden of the disease on infants and their caregivers.

The relationship between serum selenium levels and frequent wheeze in children.

As an antioxidant, selenium stimulates Th1 immune response against viral infections, and may play a role in the pathogenesis of frequent wheeze due to respiratory viral infections during the first year of life. We investigated the level of selenium in children with frequent wheeze who had no atopic diseases and no family history of atopy to determine whether selenium has an effect on the severity of the diseases. Sixty-one children with frequent wheeze who were in the asymptomatic period and had had no infectious disease for two months and an equal number of age- and sex-matched children, as a control group, without atopy or allergy or systemic diseases were enrolled in the study. In the study group, we determined the levels of serum selenium, total IgE, mixed specific IgE, and total eosinophil count, and we performed epidermal prick tests. Serum selenium levels were (mean and SEM) 61.95 +/- 1.23 microg/L in the study group and 72.71 +/- 1.28 microg/L in the control group (p < 0.001), and there was a negative correlation between the serum selenium levels and number of wheeze attacks during the previous year (r = -0.655; p < 0.001). As a result, selenium may play a role in the progression of respiratory infections during childhood and can be accepted as a risk factor for development of wheezing.

Effect of nasal triamcinolone acetonide on seasonal variations of bronchial hyperresponsiveness and bronchial inflammation in nonasthmatic children with seasonal allergic rhinitis.

BACKGROUND: Recent evidence suggests that patients with allergic rhinitis have lower airway inflammation and a higher prevalence of bronchial hyperresponsiveness (BHR) regardless of asthma. OBJECTIVE: To investigate markers of lower airway inflammation in nonasthmatic children with seasonal allergic rhinitis (SAR) before and during pollen season and the effect of nasal triamcinolone acetonide on seasonal variations in these parameters. METHODS: Thirty-two nonasthmatic children with SAR in response to grass and/or weed pollens were recruited and separated into 2 groups. Group 1 was treated with triamcinolone acetonide (220 microg once daily) for 6 weeks, and group 2 received no intranasal corticosteroid treatment. Bronchial responsiveness to methacholine [concentration that caused a decrease in forced expiratory volume in 1 second of 20% (PC20)], eosinophil counts in sputum and peripheral blood, and eosinophil cationic protein (ECP) levels in sputum and serum were measured before and during grass pollen season. RESULTS: Twenty-eight patients completed the study. During the pollen season, methacholine PC20 significantly decreased in both groups when compared with the corresponding preseasonal values (P = .01 and P = .003, respectively). The mean percentage of sputum eosinophils increased significantly during the pollen season compared with preseasonal values in group 1 and group 2 (12.7% +/- 2.1% vs 16.5% +/- 2.1%, P = .007, and 11.0% +/- 2.0% vs 20.2% +/- 1.4%, P = .003, respectively). Median [interquartile ranges (IQR)] sputum ECP levels were significantly higher during the pollen season when compared with the preseasonal values in group 1 and group 2 [7.5 microg/L (3.5-36.0 microg/L) vs 35.5 microg/L (13.0-71.7 microg/L), P = .04, and 18.0 microg/L (6.0-36.0 microg/L) vs 69.0 microg/L (39.0-195.0 microg/L), P = .003, respectively], as were the serum ECP levels [6.0 microg/L (2.0-13.0 microg/L) vs 19.0 microg/L (14.0-43.5 microg/L), P = .004, and 6.0 microg/L (3.0-7.0 microg/L) vs 18.0 microg/L (6.0-36.0 microg/L), P = .001, respectively]. Although the mean number of eosinophils in blood increased during the pollen season in both groups, it was only significant in group 2 (70.0 +/- 20.0 vs 161.6 +/- 29.0, P = .02). CONCLUSIONS: Although prophylactic nasal corticosteroid treatment provides significant reduction of nasal symptoms and rescue antihistamine use, there is no significant prevention in the seasonal increase of bronchial inflammation and methacholine BHR.

Complementary and alternative medicine in children with asthma.

BACKGROUND: The popularity of complementary and alternative medicine (CAM), particularly for chronic conditions such as asthma, is growing rapidly, but little is known about its use in asthmatic children. OBJECTIVE: To evaluate the extent, characteristics, and possible predictors of CAM use in a group of Turkish children with asthma. METHODS: The parents of asthmatic children were invited to participate in a questionnaire-based survey of 13 worldwide and 5 local methods of CAM. Current asthma treatment, asthma exacerbations, emergency admittances and hospitalizations due to exacerbations, and parental education levels were investigated as predictors that influenced the use of CAM. RESULTS: Of the 304 asthmatic children (mean +/- SEM age, 10.5 +/- 0.2 years; range, 1-16 years), 49% (n = 150) had used some form of CAM previously, and 38% had used CAM within the previous year. The most popular forms of CAM were quail eggs (79%), herbal medicine (31%), Turkish wild honey (26%), speleotherapy (5%), and royal jelly (5%). The respondents learned about CAM through friends (61%), relatives (25%), the media (9%), and physicians (6%). Age, sex, and mother's and father's education levels were insignificant between the groups that used and did not use CAM (P = 0.40, P = 0.18, P = 0.15, and P = 0.09, respectively). The use of regular asthma treatment, the use of inhaled corticosteroids, asthma exacerbations, emergency admittances, and treatment score were significantly high in the CAM group (P = 0.006, P = 0.03, P = 0.008, P = 0.02, and P = 0.02, respectively). A significantly high percentage of respondents in the CAM group had considered using CAM for their child's asthma in the future (P = 0.001). CONCLUSIONS: Asthmatic children in whom the disease is not well controlled are more likely to use CAM as complementary therapy.