The methylation profile of IL4, IL5, IL10, IFNG and FOXP3 associated with environmental exposures differed between Polish infants with the food allergy and/or atopic dermatitis and without the disease.

Objectives: Epigenetic dynamics has been indicated to play a role in allergy development. The environmental stimuli have been shown to influence the methylation processes. This study investigated the differences in CpGs methylation rate of immune-attached genes between healthy and allergic infants. The research was aimed at finding evidence for the impact of environmental factors on methylation-based regulation of immunological processes in early childhood. Methods: The analysis of methylation level of CpGs in the IL4, IL5, IL10, IFNG and FOXP3 genes was performed using high resolution melt real time PCR technology. DNA was isolated from whole blood of Polish healthy and allergic infants, with food allergy and/or atopic dermatitis, aged under six months. Results: The significantly lower methylation level of FOXP3 among allergic infants compared to healthy ones was reported. Additional differences in methylation rates were found, when combining with environmental factors. In different studied groups, negative correlations between age and the IL10 and FOXP3 methylation were detected, and positive - in the case of IL4. Among infants with different allergy symptoms, the decrease in methylation level of IFNG, IL10, IL4 and FOXP3 associated with passive smoke exposure was observed. Complications during pregnancy were linked to different pattern of the IFNG, IL5, IL4 and IL10 methylation depending on allergy status. The IFNG and IL5 methylation rates were higher among exclusively breastfed infants with atopic dermatitis compared to the non-breastfed. A decrease in the IFNG methylation was noted among allergic patients fed exclusively with milk formula. In different study groups, a negative correlation between IFNG, IL5 methylation and maternal BMI or IL5 methylation and weight was noted. Some positive correlations between methylation rate of IL10 and child's weight were found. A higher methylation of IL4 was positively correlated with the number of family members with allergy. Conclusion: The FOXP3 methylation in allergic infants was lower than in the healthy ones. The methylation profile of IL4, IL5, IL10, IFNG and FOXP3 associated with environmental exposures differed between the studied groups. The results offer insights into epigenetic regulation of immunological response in early childhood.

Mother's Milk Microbiome Shaping Fecal and Skin Microbiota in Infants with Food Allergy and Atopic Dermatitis: A Pilot Analysis.

The child microbiome, including gut and skin communities, is shaped by a multitude of factors, and breastfeeding is one of the most essential. Food allergy (FA) and atopic dermatitis (AD) are among the most common diseases in pediatrics, with the prevalence of each up to 6% and 20%, respectively. Therefore, we aimed at finding differences between the fecal and skin microbiomes of FA and AD patients in the context of breastfeeding, by means of the Illumina sequencing of 16S rRNA gene fragment libraries amplified from the total DNA isolated from samples collected from allergic and healthy infants. We also analyzed milk samples from the mothers of the examined children and searched for patterns of incidence suggesting milk influence on an infant's allergy status. Here we show that a mother's milk influences her child's fecal and skin microbiomes and identify Acinetobacter as the taxon whose abundance is correlated with milk and child-derived samples. We demonstrate that breastfeeding makes allergic children's fecal and skin communities more similar to those of healthy infants than in the case of formula-feeding. We also identify signature taxa that might be important in maintaining health or allergy development.

A Combined Analysis of Gut and Skin Microbiota in Infants with Food Allergy and Atopic Dermatitis: A Pilot Study.

The gut microbiota in patients with food allergy, and the skin microbiota in atopic dermatitis patients differ from those of healthy people. We hypothesize that relationships may exist between gut and skin microbiota in patients with allergies. The aim of this study was to determine the possible relationship between gut and skin microbiota in patients with allergies, hence simultaneous analysis of the two compartments of microbiota was performed in infants with and without allergic symptoms. Fifty-nine infants with food allergy and/or atopic dermatitis and 28 healthy children were enrolled in the study. The skin and gut microbiota were evaluated using 16S rRNA gene amplicon sequencing. No significant differences in the α-diversity of dermal or fecal microbiota were observed between allergic and non-allergic infants; however, a significant relationship was found between bacterial community structure and allergy phenotypes, especially in the fecal samples. Certain clinical conditions were associated with characteristic bacterial taxa in the skin and gut microbiota. Positive correlations were found between skin and fecal samples in the abundance of Gemella among allergic infants, and Lactobacillus and Bacteroides among healthy infants. Although infants with allergies and healthy infants demonstrate microbiota with similar α-diversity, some differences in ß-diversity and bacterial species abundance can be seen, which may depend on the phenotype of the allergy. For some organisms, their abundance in skin and feces samples may be correlated, and these correlations might serve as indicators of the host's allergic state.

The Consequence of Excessive Consumption of Cow's Milk: Protein-Losing Enteropathy with Anasarca in the Course of Iron Deficiency Anemia-Case Reports and a Literature Review.

Cow's milk is a key component of a child's diet. While the consumption of even trace amounts can result in allergy to its proteins and/or hypolactasia, excessive cow's milk consumption can result in numerous health complications, including iron deficiency, due to the diet being improperly balanced. Although the incidence of iron deficiency has declined, it remains the most widespread nutritional deficiency globally and the most common cause of anemia. One rare consequence of anemia caused by iron deficiency is protein-losing enteropathy; however, the mechanisms of its development are unclear. The following manuscript, based on a literature review, presents two rare cases of children, a 16-month-old boy and a 2.5-year-old girl, who developed severe microcytic anemia, enteropathy with hypoalbuminemia, and anasarca as a result of excessive cow's milk consumption. It highlights the possible relationship between excessive consumption of cow's milk in children and severe iron deficiency anemia with accompanying hypoalbuminemia; it may also result in serious clinical conditions, even in children that do not demonstrate food hypersensitivity.

A foreign body in the mediastinum as a cause of chronic cough in a 10-year-old child with asthma.

Introduction: Chronic cough is a common problem faced by pediatricians, with a reported prevalence of 20% among preschoolers. It is also the most frequent symptom of asthma. Many causes of chronic cough may also be possible causes of asthma exacerbations.Case study: We describe a 10-year-old boy with asthma, which was admitted to the hospital with a persistent dry cough for five months. Initially, he was treated as an exacerbation of asthma; however, a subsequent chest X-ray identified a wire during the next hospitalization. Although the wire was not found during bronchoscopy, a CT scan located the wire in the mediastinum.Results: The patient required urgent thoracic surgery, ending with the extraction of a 3 cm-long metallic wire. The history revealed that he had choked on a pizza shortly before the onset of coughing: it is most likely that the foreign body had been aspirated, and that it may have originated from a metal brush used to clean the oven. However, it is difficult to determine whether the wire was originally aspirated into the airways or into the gastrointestinal tract; from the latter, it would have perforated either the bronchus or esophagus and migrated to the mediastinum.Conclusion: The symptoms associated with aspiration or ingestion of a foreign body in the upper aerodigestive tract can simulate other pediatric diseases, such as asthma, and delay the correct diagnosis. Our findings demonstrate that chronic cough in children with asthma is not always a result of exacerbation. Precise interviewing and correct interpretation of basic diagnostic testing may be key for setting an accurate diagnosis.

Chubby Infant - Should One Worry? An Infant with Primary lymphedema - Mini Review and Case Report.

Lymphedema is a localized form of tissue swelling, characterized by a progressive accumulation of a tissue fluid in the interstitial compartment as a result of the lymphatic system dysfunction. It is a rare disease in the pediatric population and in the majority of cases it is a consequence of an abnormal formation of the lymphatic system, which is called primary lymphedema. Although its epidemiology is not precise, it is assumed that 1:100 000 children suffer from primary lymphedema. The diagnosis can be made by a proper clinical examination after ruling out secondary causes of lymphedema, particularly in cases with a more asymmetric swelling of the extremities. In this very article we present a case report of an 8-months-old infant with primary lymphedema, who had presented swelling of the extremities from birth and yet no pathology was suspected before. The purpose of this article is to draw attention to the fact that a baby with excessive subcutaneous tissue is not always a healthy, chubby infant with considerable amount of fat tissue.Das Lymphödem ist eine lokalisierte Form des Gewebeödems, die durch eine fortschreitende Ansammlung von Gewebeflüssigkeit im Interstitialraum infolge einer Funktionsstörung des Lymphsystems gekennzeichnet ist. Dies ist eine seltene Erkrankung in der pädiatrischen Bevölkerung und in den meisten Fällen eine Folge der fehlerhaften Bildung des Lymphsystems, das als primäres Lymphödem bezeichnet wird. Obwohl die Epidemiologie nicht genau ist, wird angenommen, dass 1: 100 000 Kinder an einem primären Lymphödem leiden. Die Diagnose kann auf der Grundlage einer geeigneten klinischen Untersuchung gestellt werden, nachdem sekundäre Ursachen für Lymphödeme ausgeschlossen wurden, insbesondere bei asymmetrischeren Ödemen der Gliedmaßen. In diesem Artikel präsentieren wir den Fallbericht eines 8 Monate alten Kindes mit primärem Lymphödem, dessen Ödem der Gliedmaßen seit der Geburt aufgetreten ist, bei dem aber keine Pathologien vermutet wurde. Der Zweck dieses Artikels ist es, die Aufmerksamkeit auf die Tatsache zu lenken, dass ein Kind mit übermäßigem Unterhautgewebe nicht immer ein gesundes, molliges Kind mit übermäßigem Körperfett bedeutet.

The microbiome and its impact on food allergy and atopic dermatitis in children.

Food allergy (FA) affects 4-10% of children, especially children with atopic dermatitis (AD). During infancy the gut microbiome may determine both the course of FA and tolerance to food allergens. Analogically, the skin microbiome changes in the course of AD. Most studies have associated FA with a lower abundance and diversity of Lactobacillales and Clostridiales, but greater numbers of Enterobacterales, while AD in children has been associated with lower numbers of Staphylococcus epidermidis and S. hominis but an abundance of S. aureus and Streptococcus species. An understanding of the impact of the microbiome on the clinical course of FA and AD may allow for the development of new models of allergy treatment and prevention.

Early risk factors for cow's milk allergy in children in the first year of life.

Background: Cow's milk allergy (CMA) is a key form of food allergy (FA). It was shown that the frequency of FA seems to have increased during the past 10-20 years, which led to the thought that FA may have different risk factors. Epigenetic regulations and environmental pre- and postnatal factors play a large role in contributing to allergy. Understanding the risk factors that pertain to the development of FA may help to provide reasonable recommendations for prevention of the disease. Objective: To assess the impact of perinatal and environmental risk factors on the incidence of CMA in children in the first year of life. Methods: The study group consisted of 138 infants with CMA and 101 healthy infants without allergy. CMA was confirmed by an elimination test and oral food challenge. To assess infant, parental, and environmental risk factors, we used a validated questionnaire survey. Results: The incidence of CMA was three times higher in infants with a positive family history for allergy (p < 0.001). An analysis revealed that mothers of children with CMA were fourfold more frequently university educated than mothers of children without allergy (p < 0.0001). The ages of the mothers from the study group were significantly higher than the ages of the mothers from the control group. Children from the study group were breast-fed for a significantly shorter time than children from the control group. The risk of CMA was threefold lower in children who had pets at home (p = 0.0002). The risk of IgE-mediated CMA was twofold higher than the risk of non-IgE-mediated CMA if the family had more children (p = 0.04) and as many as ninefold higher if multiorgan symptoms were detected (p = 0.01). Conclusion: A positive family history of allergy and mother's education increased the risk of CMA in children in the first year of life, whereas having pets at home and a longer period of breast-feeding decreased the risk.

Allergic enteritis in children.

The gastrointestinal form of food allergy is very common in children. The most frequently observed types are allergic proctitis and proctocolitis. In most cases the symptoms subside within the first 2 months of life. The babies seem healthy, and the only abnormality is a small amount of blood in stool. Symptoms can also include small intestine inflammation and colitis. Patients may present with irritability, abdominal pain, flatulence, colic, postprandial vomiting, chronic diarrhoea, and hindered physical development. The diagnosis of allergic enteritis is based on the clinical examination and the results of additional tests including an endoscopy of the lower digestive tract with histopathological assessment. Cow's milk proteins are the most common nutrition proteins responsible for the development of the symptoms of allergic enteritis. The most essential method of treating allergic enteritis is the elimination diet. The symptoms should subside within 1-2 weeks from the beginning of the diet.

Medium chain triglycerides (MCT) formulas in paediatric and allergological practice.

Fats constitute the most significant nutritional source of energy. Their proper use by the body conditions a number of complex mechanisms of digestion, absorption, distribution, and metabolism. These mechanisms are facilitated by fats made of medium chain fatty acids; therefore, they are an easy and quick source of energy. Thus, an increased supply of medium chain triglycerides (MCT) is particularly important in patients with disturbances of digestion and absorption such as disturbed bile secretion, classic coeliac disease, short bowel syndrome, inflammatory diseases of the intestines, disturbed outflow of lymph, some metabolic disease, and severe food allergies, as well as in prematurely born neonates. Use of preparations containing an additive of MCT is limited, especially if they are to be used for a longer period of time. With a large quantity of MCT in a diet, there is a risk of deficiency of necessary unsaturated fatty acids and some fat-soluble vitamins. The caloricity of MTC compared to long-chain triglycerides is lower, and formulas with MCT are characterised by higher osmolality. Medium chain triglycerides is not recommended as an additive to standard formulas for healthy children. The use of MCT should be limited to strictly specified medical indications.

[The analysis of the hepatitis C virus infection course and efficacy of treatment dependence on HLA A antigens in children and youth]. / Analiza zwiazku przebiegu zakazenia wirusem zapalenia watroby typu C oraz skutecznosci leczenia dzieci i mlodziezy z antygenami HLA A.

UNLABELLED: The hepatitis C virus (HCV) infection course and efficacy of treatment may be depended on HLA antigens. The aim of the study is attempt to define dependence between the course of HCV infection and efficacy its treatment and HLA A antigens in children and youth. PATIENTS AND METHODS: To the study included 61 patients (51 after treatment for HCV infection and 10 not treated). The average age was 13.77 years (range 5-18 years). Patients were divided to subgroups in depend on effect of the treatment: virusological and biochemical response. Antigens HLA A were molecularly typed on the low resolution method. To statistical analysis we applied the chi-square test. RESULTS: We demonstrated no statistical significant dependences between HCV infection course and efficacy of its treatment children and youth HLA A antigens. However we observed following tendencies: antigens HLA A *01 and HLA A *02 can be related to unprofitable course of infection and unsuccessful antiviral therapy; HLA A *03 can be favorable prognostic factor for HCV infection course and response to treatment; HLA A *24 can be related to mild course of infection and profitable response to treatment; HLA A *11 can be favorable prognostic factor for course of infection; HLA A *30 can be profitable for efficacy of treatment and HLA A *25 can be disadvantage for it. Probably study performed with larger group of patients could gain dependencies statistical significant. CONCLUSIONS: It is possible that course if HCV infection and efficacy of antiviral treatment are depended on HLA A antigens.

[Risk factors of TT virus infection in children up to 3 years]. / Czynniki ryzyka zakazenia wirusem TT niemowlat i malych dzieci.

UNLABELLED: Significant frequency of TT virus (TTV) infections and its unclear pathogenetic role are purposes for which investigators are interested in theme of spread of the virus. It is considered parenteral way of TTV spread, oral-fecal, droplets, vertical, by breastfeeding and other ways. THE AIM OF THE STUDY: To estimate the risk of TTV infection by various ways and to asses the risk factors of infection. MATERIAL AND METHODS: To the analysis were enrolled 55 patients, in 27 (49%) of them we confirmed TTV infection (polymerase chain reaction method with two primers sets). We analyzed frequency of infections dependence on risk factors vertical, parenteral, and enteral infections. RESULTS: Disturbances in pregnancy or delivery were not connect to frequency of TTV infections. We're not confirming this frequency dependence on number of past hospitalizations but it was dependence between frequency of TTV infections and chronic diseases and mental-physical retardation of children (p=0.077; p=0.01). It was not confirming significant differences in depend on dwelling place. Children from worse social conditions were infected more often (p=0.05). It was not significant dependence between frequency of TTV infections and breastfeeding. It was confirmed that in children of parents with chronic diseases and children with brothers and sisters with chronic diseases are infected more often (for mothers p=0.054; fathers p=0.04, brothers or sisters p=0.062). CONCLUSIONS: TTV infections are more frequent in infants and young children exposed to often contacts with medical environment, children from poor social conditions and with chronic diseases in near family.

[The influence of infant feeding methods on the body weight of pre-school children]. / Wplyw sposobu zywienia dzieci w wieku niemowlecym na mase ich ciala w wieku przedszkolnym.

UNLABELLED: A well-balanced diet is one of the most important factors that assure a child's healthy growth and development. The most appropriate way of feeding a baby born timely is natural feeding. THE AIM OF THE STUDY was to examine the influence of infant feeding methods on the body weight of pre-school children. MATERIAL AND METHODS: The research was done on the basis of a retrospective analysis of medical documentation of 465 children aged 4-7 years. The group was divided with respect to the infant feeding methods, sex, age (children in 5th, 6th and 7th year of life) and the body weight at the time of birth (lower than 3500 g, higher than 3500 g). Within these groups an average body weight, an average increase in body weight and the number of children falling into the categories "below the norm", "in the norm" and "above the norm" were compared according to body weight percentile grids and the Body Mass Index. RESULTS: Infants fed in a natural way for a period of at least six months had, in comparison to infants fed artificially, a smaller increase in body weight until the pre-school age. Fewer children were overweight or obese. However, weight deficiency was more frequently observed in this group of children. The influence of infant feeding method on the body weight in a pre-school period was more visible in the case of children whose body weight at the time of birth was equal or lower than 3500 gr and in the case of girls. CONCLUSIONS: On the basis of this research it was concluded that, the infant feeding method may have an impact on the body weight of pre-school children.

[The comparison of mean body weight among breast-fed and bottle-fed children from 1 to 18 month of life]. / Srednia masa ciala dzieci w wieku do 18 miesiaca zycia karmionych naturalnie i mlekiem modyfikowanym.

UNLABELLED: There were performed many analyses comparing physical development between breast-fed and bottle-fed infants and estimated that breast-fed children have different growth than bottle-fed. The aim of the study was the comparison of body weight rate among breast-fed and bottle-fed children from 1-18 month of life. MATERIAL AND METHODS: 352 children were enrolled into the analysis: 218 breast-fed and 134 bottle-fed children. We documented age, sex, environment of life, birth weight and weight at the moment of hospitalisation. We compared: mean weight at the moment of hospitalisation, mean increment of weight, mean monthly increment of weight in breast- and bottle-fed children. RESULTS: Breast-fed girls achieved higher mean monthly weight increment in 1st quarter of life than bottle-fed. Bottle-fed girls achieved higher mean body weight and increment of weight than breast-fed in 4th quarter. Bottle-fed boys achieved higher mean weight, mean increment of weight in 1st, 3rd and 6th quarter of life and higher monthly increment of weight in the 1st quarter of life than breast-fed. CONCLUSION: On the basis of performed analysis we confirm that breast-fed and bottle-fed children in the first 18 months of life increase body weight at a different rate.

Lamivudine therapy for children with chronic hepatitis B.

AIM: To assess the effectiveness and side-effects of lamivudine therapy for children with chronic hepatitis B (CHB) who fail to respond to or have contraindications to interferon-alpha (IFN-alpha) therapy. METHODS: Fifty-nine children with CHB were treated with 100 mg lamivudine tablets given orally once daily for 12 mo. Alanine aminotransferase (ALT) activity was evaluated monthly during the therapy and every 3 mo after its discontinuation. HBe antigen, anti-HBe antibodies, HBV DNA level in serum were evaluated at baseline and every six months during and after the lamivudine therapy. Sustained viral response (SVR) to lamivudine therapy was defined as permanent (not shorter than 6 mo after the end of the therapy), namely ALT activity normalization, seroconversion of HBeAg to anti-HBe antibodies, and undetectable viral HBV-DNA in serum (lower than 200 copies per mL). The analysis of the side-effects of the lamivudine treatment was based upon interviews with the patients and their parents using a questionnaire concerning subjective and objective symptoms, clinical examinations, and laboratory tests performed during clinical visits monthly during the therapy, and every 3 mo after the therapy. RESULTS: ALT normalisation occurred in 47 (79.7%) patients between the first and 11(th) mo of treatment (mean 4.4+/-2.95 mo, median 4.0 mo), and in 18 (30.5%) of them after 2 mo of the therapy. There was no correlation between the time of ALT normalization and the children's age, the age of HBV infection, the duration of HBV infection, inflammation activity score (grading), staging, ALT activity before treatment, serum HBV DNA level, and lamivudine dose per kg of body weight. HBeAg/anti HBe seroconversion was achieved in 27.1% of cases. The higher rate of seroconversion was connected with lower serum HBV DNA level and longer duration of HBV infection. There was no connection between HBeAg/anti HBeAb seroconversion and the children's age, age of HBV infection, grading, staging, ALT activity before treatment, and lamivudnie dose per kg of body weight. No complaints or clinical symptoms were observed during lamivudine therapy. Impairment of renal function or myelotoxic effect was noted in none of the patients. CONCLUSION: One year lamivudine therapy for children with chronic hepatitis B is effective and well tolerated. Seroconversion of HBeAg/HBeAb and SVR are connected with lower pre-treatment serum HBV DNA level.

[Comparison of the rate of body weight increase in children fed with cow's milk formulas and children with alimentary sensitivity, fed with milk-replacing mixtures]. / Porównanie tempa przyrostu masy ciala dzieci karmionych mlekiem modyfikowanym oraz dzieci z nadwrazliwoscia pokarmowa zywionych mieszankami mlekozastepczymi.

PURPOSE: The aim of this study was a comparison of body weight increase rate in two groups of children up to 18 months of age. The first group was fed with cow s milk formula. The second group due to allergy or cow milk intolerance was fed with milk-replacing mixtures: hydrolyzates with higher rate of protein hydrolysis or soya preparations. PATIENTS AND METHOD: In the analysed group of 332 children, 135 children were fed with cow's milk formulas, 142 children were given no-milk diet based on protein hydrolyzates and another 55 were fed with soya mixtures. The average body weight increase values were analysed in three months periods of half-years of life and in relation to gender and type of feeding. The obtained results were analysed statistically. RESULTS: There were statistically significant greater mean monthly increments of body weight in male children fed with cow's milk formulas as compared to male children fed with hydrolyzates in the first quarter and in the first half-year of life and male infants fed with soya mixtures. In subsequent three and six months periods no statistically significant differences in mean monthly values of body weight increase in relation to type of nutrition were found.

[The influence of hepatitis G virus infection on the course of chronic virus hepatitis B or C in children]. / Wplyw zakazenia wirusem zapalenia watroby typu G na przebieg przewleklego wirusowego zapalenia watroby typu B lub C u dzieci.

Hepatitis G virus (HGV) infection is often observed in patients with hepatitis B or C virus (HBV or HCV) infections. The aim of this study was an evaluation of the influence of HGV infection on the course of virus hepatitis B and C in children. 113 children aged 2-15 years old, with hepatitis B or C were enrolled to the study. In the study group children were examined for the presence of virus genetic material, e.g. HGV-RNA. The analysis of children records with respect to results of physical examination and additional tests (laboratory tests, abdomen ultrasonography) was carried out. On the basis of the analysis it was showed that HGV infection did not significantly change the course of basic liver disease.

[The incidence rate of HGV infection in children with selected liver diseases]. / Czestosc wystepowania zakazen HGV u dzieci z wybranymi schorzeniami watroby.

Hepatitis G virus (HGV) was detected and described five years ago and up till now it presented unexplained problem for clinicians. Although reports on the pathogenicity of the virus are inconsistent, most researchers admit that the infection is very common. The aim of the study was an evaluation of HGV infection incidence rate among children with selected liver diseases. 150 children aged from 2 to 15 years with liver diseases (most with viral hepatitis B and C) were enrolled to the study. The existence of virus (HGV) genetic material in serum was estimated in all patients. On the basis of the analysis, the HGV infection was determined to be frequent in children with liver diseases (20.7%) and not dependent on sex and age. The contamination was more common in patients without viral hepatitis B and C than in children with chronic viral hepatitis B and C.