[Assessment of tolerance of a new product (gluten-free grain snack) in children with food allergy to gluten].

The development of a technological scheme for the production of cereal snacks based on the extrusion process with preliminary enzymatic treatment of wheat flour and the use of hydrolysate as a partial replacement for gluten-free raw materials is an urgent task. The use of gluten-free cereal snacks in the diet opens up new possibilities for dietary therapy in patients suffering from various manifestations of food allergy to gluten, making their diet more diverse and meeting their individual needs. The purpose of the research was to clinically evaluate the tolerance of gluten-free cereal snacks in children with PA to gluten. Material and methods. The study included 21 patients (male and female) aged 3 to 17 years with a diagnosed food allergy, including gluten. All children received gluten-free cereal snacks according to their age: children from 3 to 7 years old (n=11) received 50 g (176 kcal) daily, and children aged 8 to 17 years old (n=10) received 100 g (352 kcal) daily for 14 days, in addition to a non-specific hypoallergenic diet excluding highly allergenic foods. On the first day of the study, the patients or one of their parents evaluated the organoleptic properties of the presented product (taste, color, smell) using a 5-point scale (1 - very bad, 5 - excellent), according to a specially designed questionnaire. The assessment of clinical symptoms over time related to skin, gastrointestinal tract, and nervous system was conducted using a second questionnaire, where parents kept a daily «observation log¼ reflecting the child's well-being and condition, as well as adverse events associated with taking the product. Clinical safety parameters were assessed based on the dynamics of complete blood count and blood immunological parameters (total IgE, specific IgE, and IgG4 antibodies to the studied allergens) at the beginning and end of the consumption period. Results. Daily examinations and patient questionnaires revealed no adverse reactions to the product. No significant differences in body weight were observed at the end of the study (p>0.05). In the results of clinical and immunological blood analysis before and after consuming gluten-free cereal snacks, no significant deviations were observed in the form of an increase in eosinophil count, total IgE, allergen-specific IgE and IgG4 antibodies in peripheral blood. This suggests a favorable clinical safety profile of the proposed product. Conclusion. The study found that consumption of the new product (gluten-free cereal snacks) was well-tolerated by children aged 3 to 17 years with various manifestations of food allergy: no adverse effects of the product or exacerbations of the underlying disease were observed during the 14-day period of gluten-free cereal snack consumption. Therefore, the studied gluten-free cereal snacks can be recommended for children aged 3 to 17 years with various manifestations of gluten FA, in combination with a gluten free diet.

[Bone mineral density in vegetarians and vegans].

The number of vegetarians and vegans is increasing each year. In this regard, studies of the quality of diets that exclude slaughter foods, as well as their impact on human health, are becoming more and more relevant. The main purpose of the study was to assess the bone mineral density (BMD) in Russian vegetarians and vegans, as well as in omnivores. Material and methods. Design - cross-sectional study. On an outpatient basis, we examined 103 conditionally healthy people aged 18 to 77 years with different diets: 36 vegans, 38 vegetarians and 29 omnivores. X-ray two energy absorptiometry was used to assess BMD. The density of the lumbar vertebrae (LI-LIV) and femoral neck was measured. Results. Osteopenia in the lumbar spine was diagnosed in 27.8% of vegans, 39.5% of vegetarians, and 31.0% of omnivores. In the femoral neck, BMD corresponding to osteopenia was detected in 19.4, 26.3, and 17.2% of cases, respectively. 18.4% of vegetarians and 6.9% of omnivores had BMD corresponding to osteoporosis in the lumbar spine. Osteoporosis was not diagnosed in the femoral neck. No significant differences were observed after exclusion of people over 50 years of age. This was probably due primarily to the fact that the largest number of peri and postmenopausal women were in the vegetarian group. Excluding people who had took vitamin D supplements regularly did not drastically change the results of the study. When taking into account both exclusion criteria, no significant differences were observed. Conclusion. The findings suggest that BMD in vegans and vegetarians in Russia does not differ from that in omnivores. However, further larger studies are required.

[Predictors of severe course of atopic dermatitis].

Atopic dermatitis (AD) is a common inflammatory skin disease that occurs most frequently in children. The disease is characterized as chronic, but only 20% of children suffer from severe AD, while the other 80% reach a long-term remission by the age of 8. The aim of the research was the analysis of modern sources of domestic and foreign literature, highlighting the features of the course of severe forms of AD. Results. The multifactorial nature of AD pathogenesis, based on the complex interaction of genetic factors, the immune system, the skin microbiome and environmental factors, causes certain difficulties for the physician, both in the diagnosis and therapy selection, and in predicting the course of the disease. Each patient has his own individual combination of clinical symptoms, medical history and aggravating factors that should be considered as predictors of the severity of the disease. Conclusion. Particular attention should be paid to patients with an early onset of AD, increased transepidermal water loss, with extensive skin lesions at the onset of the disease and under dynamic observation, with concomitant food allergies and/or bronchial asthma.

[The problem of food allergies at the present stage].

The increase in the number of patients with allergic diseases, which are caused by food allergy, has become one of the leading problems of the XXI century. Expanding the spectrum of food allergens responsible for the development of food allergies raises the question of increasing knowledge in this area for practitioners. The article presents data on causally significant food allergens and food additives that cause the development of food allergies, as well as information on the main food proteins and their components involved in the formation of cross-reactivity. Modern methods of molecular diagnostics and an algorithm for diagnosing food allergies and food intolerances are presented.

[Magnesium and vitamin B2 status of children with bronchial asthma and obesity].

Insufficiency or deficiency of some micronutrients may be additional modifying factors that influence the pathogenesis of the disease and the effectiveness of standard pharmacotherapy. The aim of the study - to evaluate the level of magnesium and vitamin B2 in blood serum of patients with bronchial asthma and obesity in order to develop methods for individual correction of deficiency. Material and methods. The study included 51 children aged 12-17 years. The first group included 23 patients (12 girls and 11 boys) with asthma with comorbidities (obesity), and the second group consisted of 28 children (10 girls and 18 boys) with obesity. The concentration of magnesium in blood serum was determined by a colorimetric method without deproteinization, and vitamin B2 - by an immunological microbiological method. Results and discussion. When analyzing the concentration of magnesium in blood serum of the examined children, it was found that in patients with bronchial asthma and obesity, a reduced content of this mineral was observed in 15 (65.2%) patients. The average magnesium concentration was 0.66±0.02 mmol/l at a rate of 0.7-1.2 mmol/l. A statistically significant decrease in the magnesium level in children suffering from asthma and obesity was noted, compared with the level in children with obesity (0.66 [0.57; 0.73] vs 0.71 [0.67; 0.73] mmol/l, р<0.05). Low serum magnesium levels in obese patients were detected more rarely (р<0.05) - only in 6 (21.4%) children, mostly in patients with grade III obesity. The remaining 22 (78.6%) children had magnesium level within the normal range. Patients with low serum magnesium levels showed increased irritability, sleep disturbance, loss of memory and concentration. Vitamin B2 levels in all examined children were within the normal range (137-370 ng/ml). Conclusion. The results indicate a decrease in the concentration of magnesium and normal levels of vitamin B2 in serum in patients with bronchial asthma and obesity. Low serum magnesium levels were observed in children with low bronchial asthma control. To increase the effectiveness of therapy and control the symptoms of bronchial asthma, especially when combined with obesity, correction of the accompanying magnesium deficiency is necessary.

[Alternative food for рatients with allergу to the egg].

Patients suffering from food allergy/food intolerance of eggs need alternative products that do not cause allergic reactions. The purpose of the research: to evaluate guinea fowl egg and meat tolerance among children with chicken egg allergy. There has been conducted single-centre prospective research into intolerance of the products. Appearance or increase in skin or gastrointestinal allergic symptoms was registered; the concentration of specific IgE antibodies against chicken egg and meat in blood serum was assessed. As alternative products, the children were offered guinea fowl egg and meat; these products were given to them during 14 days. In the research 40 children (23 girls and 17 boys) from the age of 8 months to 1.5 years old took part; all children were diagnosed with atopic dermatitis, one of its triggers was chicken egg. Exacerbation of skin allergy was connected with eating chicken egg, which was confirmed by the results of the allergy examination. 28 (70.0%) children were diagnosed as having the mild form of atomic dermatitis, while 12 (30.0%) patients had the moderate form of atomic dermatitis. At the beginning of the research the patients were divided into 2 equal groups (each group of 20 patients). The first group consisted of the children aged 8 moths - 1.5 years old who received 1/2 guinea fowl egg every other day. The second group consisted of the patients aged 1.5-3 years old who received 60-90 grams fowl egg meat per day. The research has revealed that the children showed tolerance of guinea fowl egg and meat, the majority of the patients did not experience any skin or gastrointestinal allergic reactions. It has also been shown that at the end of the research the majority of the children (73.3%) had a decrease in concentration of specific IgE antibodies against chicken egg and meat in blood serum. According to the allergy examination, 8 (26.7%) children experienced an increase in skin sensitization to chicken egg and meat, which coincided with exacerbation of skin allergy. Thus, the examined products can be used as alternative products for those children who suffer from food allergy/food intolerance of chicken egg and meat.

[Phenotypes of food allergy in children].

Questions of food allergy heterogeneity, approaches to allocation of various phenotypes on the basis of clinical signs and immunological markers taking into account an etiology and immune mechanisms of the disease are considered in the article. Allocation of phenotypes contributes the best understanding of essence and it expedient for development of individual approach to diet and therapy.

[INTESTINE MICROBIOTA IN CHILDREN WITH OBESITY AND ALLERGIC DISEASES].

AIM: Study intestine microflora in children with obesity and evaluate its association with allergic diseases. MATERIALS AND METHODS. 66 children with various body weight aged 3 to 17 years were included into the study. Intestine microflora study in children was carried out according to the order of the Ministry of Health of Russian Federation No. 231 of 09.06.2003 "Regarding approval of sectoral standard "Patient management protocol. Intestine dysbacteriosis" (SST 91500.11.0004-2003). RESULTS: In healthy children depending on body weight an increase of the number of Firmicutes type microorganisms and a decrease of the number of microbes, belonging to Bacteroidetes type, was detected. The presence of allergic pathology was accompanied by a decrease of the number of Bacteroidetes and the presence of Bacillus and Staphylococcus aureus regardless of the body weight. At the same time, in all the children an increase of the content of Clostridium with the increase of body mass was noted. CONCLUSION. The data obtained have revealed an association of changes in intestine microbiota with the development of obesity and allergopathology.