Identifying Children at Risk of Growth and Nutrient Deficiencies in the Food Allergy Clinic.

BACKGROUND: Food allergies affect growth in children by decreasing the availability of nutrients through decreased dietary intake, increased dietary needs, food-medication interactions, and psychosocial burden. Guidelines on food allergy management frequently recommend nutrition counseling and growth monitoring of children with food allergies. OBJECTIVE: To provide clear guidance for clinicians to identify children with food allergies who are at nutritional risk and ensure prompt intervention. METHODS: We provide a narrative review summarizing information from national and international guidelines, retrospective studies, population studies, review articles, case reports, and case series to identify those with food allergy at greatest nutritional risk, determine the impact of nutritional interventions on growth, and develop guidance for risk reduction in children with food allergies. RESULTS: Children with food allergies are at increased risk of nutritional deficiencies and poor growth. Nutritional assessment and intervention can improve outcomes. Identifying poor growth is an important step in the nutrition assessment. Therefore, growth should be assessed at each allergy evaluation. Interventions to ensure adequate dietary intake for growth include appropriately prescribed elimination diets, breast-feeding support and assessment, supplemental formula, vitamin and/or mineral supplementation, appropriate milk substitutes, and timely introduction of nutrient-dense complementary foods. Access to foods of appropriate nutritional value is an ongoing concern. CONCLUSION: Nutrition intervention or referral to registered dietitian nutritionists with additional training and/or experience in food allergy may result in improved growth and nutrition outcomes.

Current opinion and review on peanut oral immunotherapy.

In the last decade, peanut oral immunotherapy research has shown promise as an alternative treatment to avoidance in peanut-allergic patients. Research has not only focused on desensitization, but also on immunologic changes and sustained-tolerance. This article reviews the current literature and the historical background of oral immunotherapy as well as immune mechanisms in oral immunotherapy and other therapies being explored in food allergic individuals.

Misdiagnosed food allergy resulting in severe malnutrition in an infant.

As food allergies become increasingly prevalent and testing methods to identify "food allergy" increase in number, the importance of careful diagnosis has become even more critical. Misdiagnosis of food allergy and inappropriate use of unproven testing modalities may lead to a harmful food-elimination diet. This case is an example of an infant who was placed on an overly restrictive elimination diet at the recommendation of her health care providers, resulting in kwashiorkor and acquired acrodermatitis enteropathica.

Manipulative management of post-Colles' fracture weakness and diminished active range of motion.

OBJECTIVE: To discuss the management of a patient with wrist weakness and a diminution in active range of motion resulting from Colles' fracture. CLINICAL FEATURES: A 58-year-old woman complained of persistent loss of grip strength and mobility in her right wrist. These complaints were from Colles' fracture occurring 19 months before initiation of care. Dynamometer and goniometric testing revealed significant loss of grip strength and range of motion compared with the uninvolved, nondominant wrist. INTERVENTION AND OUTCOME: Specific joint manipulation for improvement in mobility and grip strength of the wrist was performed. The patient's right wrist was evaluated for grip strength and active range of motion over a 3-week period, providing a baseline of function before treatment. After 4 visits of baseline measurements, a series of 4 treatments and 4 reevaluations was performed. The patient exhibited a significant increase in grip strength and active range of motion. CONCLUSION: Appropriate intervention of chiropractic manipulation and examination procedures culminated in a successful resolution of this case. When such cases are recognized, appropriate management may occur conservatively with judicious application of joint manipulation and reevaluation procedures.

Topical anti-inflammatory activity of esters of steroid 21-oic acids.

Prednisolone derivatives, methyl 20 alpha- and 20 beta-dihydroprednisolonate and methyl 17,20 alpha- and 17,20 beta-acetonidodihydroprednisolonate have been evaluated for their topical anti-inflammatory activity in the croton oil induced ear edema test. The order of anti-inflammatory potency was prednisolone greater than methyl 17,20 alpha-acetonidodihydroprednisolonate greater than methyl 17,20 beta-acetonidodihydroprednisolonate greater than methyl 20 beta-dihydroprednisolonate greater than methyl 20 alpha-dihydroprednisolonate. This order was paralleled by the compounds' octanol-aqueous partition coefficients. Furthermore, after two consecutive days topical administration of an equipotent anti-inflammatory dose, only prednisolone significantly decreased plasma corticosterone levels and relative thymus weight, while the new steroid derivatives had no effect on these parameters, indicating their lack of systemic side effects.

Leguminous seeds in the dietary management of hyperlipidemia.

Seven male hyperlipidemic patients substituted approximately 140g dried beans daily for other sources of starch in their diet over a 4-month period. After this, mean fasting serum triglyceride levels were reduced by 25 +/- 5% (p less than 0.01) while total serum cholesterol levels were 7 +/- 2% (p less than 0.5) lower than the values measured during the previous five clinic attendances (12 +/- 2.5 months). However, low- and high-density lipoprotein cholesterol levels remained unaltered. While taking beans a nonsignificant fall (0.7 kg) was seen in body weight. Nevertheless no change was seen in macronutrient intake determined by 1-wk diet histories recorded both before and four times during the study, although cholesterol intake decreased by 80 mg (p less than 0.02). Reintroduction of dried leguminous seeds into a Western diet may be a useful adjunct to the management of hyperlipidemia.

Events in the cytoplasm during male meiosis in Lilium.

An electron microscopic investigation of the events associated with meiosis in Lilium has revealed a number of changes in both the organellar population and the other cytoplasmic components. Ribosome numbers decrease significantly in early prophase and are later replenished in the tetrads, a process most likely involving the newly arising cytoplasmic nucleoloids. The organelles show a cycle of de- and redifferentiation and later in meiosis unusual internal structures can be seen before these organelles enter a division phase resulting in increased numbers. The localization of acid phosphatase during these changes has also been studied using electron microscopic cytochemical methods. In early prophase, considerable amounts of acid phosphatase are found in vesicles scattered through the cytoplasm; activity is also found in association with most membranous surfaces and often markedly associated with condensing mitochondria. Later in prophase the enzyme activity decreases to normal levels. Electron microscopic autoradiography revealed that DNA is synthesized in both plastids and mitochondria during meiotic prophase with activity reaching a peak during zygotene and ceasing by diakinesis and tetrad formation. These changes point to a certain independence of organelles from nuclear control during meiosis. The events are also evaluated in relation to a cytoplasmic clearing mechanism, which may occur in preparation for the changeover from sporophytic to gametophytic control and the development of gametes.

Dentition of Chilean paleo-Indians and peopling of the Americas.

Teeth of 12 cremated paleo-Indians (11,000 years old) from caves in southern Chile have crown and root morphology like that of recent American Indians and north Asians, but unlike that of Europeans. This finding supports the view that American Indians originated in northeast Asia. This dental series also suggests that paleo-Indians could easily have been ancestral to most living Indians, that very little dental evolution has occurred, and that the founding paleo-Indian population was small, genetically homogeneous, and arrived late in the Pleistocene.

Interviewing skill: the effects of ultra-brief training for general practitioners. A preliminary report.

Concepts of interviewing skill and of appropriate training and evaluation are briefly reviewed. It is hypothesized that if goals and skills relevant to a specific clinical interview can be identified and modelled in advance then even very brief training can improve outcome. An experiment is described in which three randomly selected general practitioners conducted, separately, test interviews with the same role played 'patient'. These interviews were repeated after a 'goal focusing' exercise and again after a modelling and instruction exercise. All interviews were telerecorded and subsequently blindly rated for impact on the 'patient'. The results suggest powerful training effects. The drawbacks of the study, such as lack of controls, are discussed. The similarity of evaluation raters who were 'behaviour' orientated and those who were 'psycho-dynamics' orientated is noted and it is suggested that agreed concepts of effective interviewing may be within reach.