Middle East Consensus Statement on the Prevention, Diagnosis, and Management of Cow's Milk Protein Allergy / 대한소아소화기영양학회지

Presented are guidelines for the prevention, diagnosis, and treatment of cow's milk protein allergy (CMPA) which is the most common food allergy in infants. It manifests through a variety of symptoms that place a burden on both the infant and their caregivers. The guidelines were formulated by evaluation of existing evidence-based guidelines, literature evidence and expert clinical experience. The guidelines set out practical recommendations and include algorithms for the prevention and treatment of CMPA. For infants at risk of allergy, appropriate prevention diets are suggested. Breastfeeding is the best method for prevention; however, a partially hydrolyzed formula should be used in infants unable to be breastfed. In infants with suspected CMPA, guidelines are presented for the appropriate diagnostic workup and subsequent appropriate elimination diet for treatment. Exclusive breastfeeding and maternal dietary allergen avoidance are the best treatment. In infants not exclusively breastfed, an extensively hydrolyzed formula should be used with amino acid formula recommended if the symptoms are life-threatening or do not resolve after extensively hydrolyzed formula. Adherence to these guidelines should assist healthcare practitioners in optimizing their approach to the management of CMPA and decrease the burden on infants and their caregivers.

Correction: Middle East Consensus Statement on the Prevention, Diagnosis, and Management of Cow's Milk Protein Allergy / 대한소아소화기영양학회지

Table 2 contains a typographical error.

reflux gastro-oesophagien: point de vue du pneumologue

Gastroesophageal reflux [GER] is a common situation that can express with digestive, extra-digestive, respiratory or otolaryngologic symptoms. Some chronic pulmonary disorders include in their setting GER as well. This review will address pathogenesis, clinical signs, complications and treatment of GER with a special focus towards the pulmonologist field. GER is a physiological post-prandial phenomenon of limited duration. It is induced by transient lower esophageal sphincter relaxation [tLESR] or by factors that impede LES function by reducing its tone or disrupting its contractions. Extra-digestive symptoms are caused by vagal stimulation through common autonomic pathways to the esophagus and bronchi. This reflex is triggered by gastric acid stimulation of esophageal receptors and by acid micro-aspirations into the airways. The responsibility of GER towards respiratory symptoms is often difficult to attest despite thorough investigations. Results of one to three-month treatment trial with proton pump inhibitors can be of value. Gastroesophageal assessment is mandatory as pulmonary manifestations might indicate disease severity

childhood asthma crisis in emergencies Investigation of 96 cases

Throughout a 2-year period, children who presented at Hotel-Dieu de France emergency department [ED] with acute asthma were analyzed prospectively and data on their environment, family and personal history as well as treatment were recorded. Treatment delivered at the ED, response and further outcome were analyzed. Out of 2024 children aged less than 15 years, 96 [5%] had acute asthma attack. Their median age was 4 years and M/F ratio was 2:1. Median age at onset of asthma was 2 years. Only 66 patients were recognized as asthmatics and 20% were given regular inhaled daily treatment. Current attack was mild in 45%, moderate in 45% and severe in 10% of cases. Home treatment before ED admission was often inadequate. Nine patients required hospital admission after failure of treatment at the ED. Within a median follow-up of 12 months, half of the patients experienced further attacks sometimes requiring ED care [27%] or hospital admission [8%]. These data highlight the fact that asthma in our country is still largely under recognized and inadequately treated