Normative Data for the Impairment Measure for Parental Food Allergy-Associated Anxiety and Coping Tool (IMPAACT) in a Canadian Sample

Rationale: The Impairment Measure for Parental Food Allergy-Associated Anxiety and Coping Tool (IMPAACT) is a food-allergy anxiety questionnaire for parents of children with food allergy. While the measure has been recently validated, normative data has not yet been presented. As such, the current study provides preliminary cut-scores and percentiles to help facilitate its use as a screening tool. Methods: Parents of children with food allergy were largely recruited through national and local patient organizations and were asked to complete questionnaires aimed at assessing their demographics and IMPAACT scores pre/post COVID-19. While the data was primarily analyzed descriptively (n/N, %, mean, SD, percentiles), inferential statistics were used to assess the relationship between the IMPAACT and various participant characteristics. Results: The final sample consisted of 281 parents (mothers=92%) and ranged in age from 27-64 years. The majority of participants reported having one child with a food allergy (85%). Allergies to peanuts were most common (79%), followed by tree nuts (56%), eggs (33%), and cow's milk (24%). IMPAACT scores were significantly lower following the outbreak of COVID-19 relative to the period prior to the outbreak (mean 87.89 [SD=36.44] vs. 102.97 [SD=33.71], p<0.001;maximum possible score: 196). Given these differences in food allergy anxiety before and after the pandemic, percentiles and cut-scores for both periods are presented. IMPAACT scores greater than 125, or 112 during periods of public health restrictions/reduced socialization, may merit further evaluation. Conclusions: Findings provide preliminary cut-points and percentiles that may help identify parents with elevated levels of food allergy anxiety.

An Overview About Pediatric Type 1 Diabetes Mellitus

Background: Diabetes mellitus (DM) represents one of the most common metabolic diseases in the world, with rising prevalence in recent decades. Most cases are generally classified into two major pathophysiological categories: type 1 diabetes mellitus (DM1), which progresses with absolute insulin deficiency and can be identified by genetic and pancreatic islet autoimmunity markers, and type 2 diabetes mellitus (DM2), which is the most prevalent form and involves a combination of resistance to the action of insulin with an insufficient compensatory response of insulin secretion. In the last two decades, in parallel with the increase in childhood obesity, there has also been an increase in the incidence of DM2 in young people in some populations. Other forms of diabetes may affect children and adolescents, such as monogenic diabetes (neonatal diabetes, MODY – maturity onset diabetes of the young, mitochondrial diabetes, and lipoatrophic diabetes), diabetes secondary to other pancreatic diseases, endocrinopathies, infections and cytotoxic drugs, and diabetes related to certain genetic syndromes, which may involve different treatments and prognoses. DM1 is considered an immuno-mediated disease that develops as a result of gradual destruction of insulin-producing pancreatic beta cells that eventually results in their total loss and complete dependence on exogenous insulin. Clinical presentation can occur at any age, but most patients will be diagnosed before the age of 30 years

Favourable Interfacial Characteristics of A2 Milk Protein Monolayer.

Shielding of the specific body organ using the biocompatible material helps preventing direct exposure of that part to the foreign entities responsible for infections. Here we show the potential of the A2 milk protein recovered from the milk of cow from Indian origin for possible prevention of the direct exposure to other foreign molecules. We measured the surface pressure of the monolayers of different types of protein samples using Langmuir isotherm experiments. The surface pressure measurements for the monolayer of four types of protein macromolecules have been carried out using the Wilhelmy plate micro pressure sensor. We studied the self-organization of different protein macromolecules and their monolayer compression characteristics. The electrochemical behaviour is studied using electrochemical impedance spectroscopy. We found the highest surface pressure for the monolayer of A2 protein. Further, it is also found that A2 protein exhibited the highest surface activity amongst the other proteins. This property can be effectively used for making the envelope of the A2 protein surrounding the targeted entity.

The quantity of unheated milk tolerated as a predictor of tolerance to baked milk

Background: Tolerance of baked milk indicates a good prognosis in IgE-mediated cow's milk allergy. Objective: The present study aims to investigate the predictors of baked milk tolerance, particularly the amount of milk tolerated in the first oral food challenge (OFC) test, in children with IgE-mediated cow's milk allergy. Methods: The study included 35 cases who were diagnosed with IgE-mediated cow's milk allergy upon open OFC testing in the Pediatric Allergy Clinic. Four weeks after the diagnosis, skin prick test (SPT) and OFC were performed with baked milk. Cases who did and did not develop reactions during OFC with baked milk were compared regarding clinical and laboratory parameters. Results: Twelve cases (33.3%) did not develop a reaction during OFC with baked milk. Those who had low levels of casein sIgE, ß-lactoglobulin sIgE, and a-lactoalbumin sIgE;small SPT wheal diameter for baked milk and a-lactoalbumin;and a large amount of unheated milk tolerated in the first OFC were found to be tolerant to baked milk (p < 0.05). For predicting baked milk tolerance, a cut-off level of the amount of unheated milk tolerated in OFC was calculated as 620 mg [with the area under the curve (AUC) 0.88 (95% confidence interval 0.77-0.99) in ROC curve analysis]. Conclusion: If a child with cow's milk allergy is able to tolerate more than 620 mg of milk protein during challenge with unheated milk, this may show that this child will tolerate baked milk, meaning that the child will be able to tolerate cow's milk in the future.

NUTRITIONAL MONITORING THROUGH THE WHATSAPP® APPLICATION: A POST-COVID-19 PANDEMIC INNOVATION

Background/Purpose: The Covid-19 pandemic has restricted in person care at our cleft treatment center, delayed patient turnout, and led to financial losses and an increased number of missed scheduled appointments. Thus, we have sought new ways to monitor the nutritional status of infant patients with clefts, by using the WhatsApp® application, so as to conduct timely nutritional interventions and to prevent malnutrition and anemia. The purpose was to monitor the nutritional status of newborn babies with cleft, using the WhatsApp® application, and to validate its use. Methods/Description: 71% of internet users in Brazil use WhatsApp® to send and receive messages. This application is easy to use, with privacy ensured by cryptography. This research project was approved by the Institutional Review Board. The protocol established: 1) new cases of infants up to 30 days old, with cleft lip and/or cleft palate;2) consent form signed by parent or guardian;3) the first appointment was in person;with mothers receiving training and guidance to send information about their children's height and weight every month;4) data comparisons were conducted against WHO benchmarks (WAZ score between 0 and - 1 = healthy weight;between - 1 and - 2 = nutritional risk;< - 2 = underweight);6) nutritional interventions considering RDI's. Results: 18 patients were followed up by regular data submission through the WhatsApp® application;8 had cleft lips, 3 cleft palates, and 7 cleft lip and palates. Among these patients, 1 had a gastrostomy tube, 2 had cow milk protein allergy, and 1 had cardiac disease. Thus far, 8 have already been submitted to lip surgery, and 10 are waiting to reach the appropriate age for surgery. Twelve were classified as coming from low-income families, and 6 from medium income families. Most of them (no. = 17) travelled between 100-500 km to receive care, and 1 more than 100 km. Eight received transportation and food subsidized by public funds, and 10 used their own funds. Thirteen children were fed breast milk for 120 days, 8 were breast fed directly and 5 were fed pumped breast milk;5 were fed formula. Nine began eating additional foods at 6 months, the remaining patients were not old enough for that yet. Eleven children had normal weight (eutrophic) since the onset, 3 were malnourished when the study began and recovered after about 54 days, 4 were at risk when the study began and recovered after about 26.5 days. No patient had to delay surgery because of anemia (mean Hb = 11.45g/ dL). Nutritional interventions included encouraging breast feeding and different breastfeeding positions, guidance regarding the appropriate concentration of infant formula and how /when to introduce of additional foods. Milk formula, bottles, scales, and measuring tapes were donated. Conclusions: The use of the WhatsApp® application for nutritional follow up proved to be a valid and effective way tomonitor the patients' growth and development, yielding efficient nutritional recovery.

Elevated Cow's Milk-Specific IgE Levels Prior to Oral Immunotherapy Decrease the Likelihood of Reaching the Maintenance Dose.

BACKGROUND: Food desensitization via oral immunotherapy (OIT) is gaining acceptance in clinical practice. Owing to adverse reactions, the duration of the buildup phase until a maintenance dose is achieved may be prolonged, and in a minority of cases, OIT is stopped. OBJECTIVE: We aimed to assess factors associated with the probability of reaching the maintenance dose in cow's milk (CM) OIT. METHODS: We collected data from patients undergoing CM OIT at the Montreal Children's Hospital, BC Children's Hospital, and Hospital for Sick Children. We compared univariable and multivariable Cox regressions to evaluate sociodemographic factors, comorbidities, clinical characteristics, and biomarkers at study entry associated with the likelihood of reaching a maintenance dose of 200 mL of CM. RESULTS: Among 69 children who reached 4 mL of milk, the median age was 12 years (interquartile range, 9-15 years); 59% were male. Median duration of buildup phase from 4 to 200 mL was 24.0 weeks (interquartile range, 17.7-33.4 weeks). After adjusting for age and sex, higher baseline levels of specific IgE antibodies for α-lactalbumin (hazard ratio [HR] = 0.80; 95% confidence interval [CI], 0.67-0.95), ß-lactoglobulin (HR = 0.86; 95% CI, 0.76-0.98), casein (HR = 0.82; 95% CI, 0.72-0.94), and total CM (HR = 0.79; 95% CI, 0.65-0.97) were associated with a decreased probability of reaching maintenance. In addition, for every 10-mL increase in CM tolerated at entry challenge, the probability of reaching maintenance increased by 10%. CONCLUSIONS: The data suggest that higher levels of CM-specific IgE decreased the likelihood of reaching maintenance, whereas an increased cumulative CM dose at entry challenge increased the likelihood. Assessing these factors before therapy may assist in predicting the success of CM OIT.

Original Article Highlights From This Issue

Variability in allergen concentration and dose in early introduction foods highlights the need for improved standardization and quality control of these foods.Development of the Child- and Parent-Rated Scales of Food Allergy Anxiety (SOFAA) Dahlsgaard et al 161 What is already known about this topic? The Scale of Food Allergy Anxiety may be used to screen children at risk for excessive FA anxiety;guide behavioral health interventions in this population;establish a severity threshold for eligibility;and evaluate outcome in a clinical trial.Early Discontinuation of Cow's Milk Protein Ingestion Is Associated with the Development of Cow's Milk Allergy Sakihara et al 172 What is already known about this topic? Continuous cow's milk formula ingestion over the first month of life may represent a potential method for preventing cow's milk allergy development in early-exposed infants.Access to Allergen-Free Food Among Black and White Children with Food Allergy in the FORWARD Study Coleman et al 182 What is already known about this topic? Understanding the social determinants of health, such as access to allergen-free foods, should guide clinical practice and management of food avoidance by providing equitable resources for patients to access allergen-free foods.Combining Allergen Components Improves the Accuracy of Peanut Allergy Diagnosis Hemmings et al 189 What is already known about this topic?

Terrific improvement of refractory atopic dermatitis with benralizumab (anti-IL5 receptor) therapy

In 2012 a 25-year-old man presented to our outpatient clinic for severe atopic dermatitis (AD) and severe allergic eosinophilic asthma in polisensitivity (house dust mite, cat, gramineous plants, birch, milk protein and, in particular, Alternaria). His clinical history was also characterized by gastro-esophageal reflux disease and chronic rhinitis without polyposis, with septal deviation and turbinate hypertrophy, worthy of surgical intervention. History taking revealed egg and cow milk protein allergy and severe asthma since the first months of life, with frequent hospital admissions due to exacerbations. AD was severe and diffuse, involving especially face, neck, back and superior limbs, often complicated by impetigo. The esthetic, social and psychological impact led him to quit his job as a barman. At presentation, the Eczema Area and Severity Index (EASI) score was 72/72. Laboratory tests showed eosinophilic count ranging between 1.060 and 2.140/mm3, and high serum levels of total Immunoglobulin E (5.939 kUI/L). Tryptase levels were normal and autoantibody analysis was negative. Parasite stool examination was negative. Nasal swab tested positive for Staphylococcus aureus, which was treated with Sulfamethoxazole-Trimethoprim. Asthma Control Test was 15/25, pulmonary function tests (PFTs) showed mild obstruction (FEV1 4.43 L, 103%, FEV1/FVC 69%), with positive bronchodilator testing (FEV1 5.12 L, + 670 mL, + 16%). Firstly, he was treated with topical steroids and sometimes with oral corticosteroids, with poor response. Then, in July 2019, he initiated therapy with cyclosporine 3-5 mg/kg. Soon, the drug had to be discontinued due to adverse effects (gastrointestinal symptoms and infections). In November 2019, at the age of 32 years, he started therapy with monoclonal antibody anti-IL-5 receptor alpha (benralizumab 30 mg 1 subcutaneous vial every 4 weeks for the first three administrations and then every 8 weeks), with a terrific clinical improvement of AD since the first administrations and with benefit on asthma control (ACT after the first administration increased up to 25/25;PFTs could not be performed, due to SARS-CoV-2 pandemic). This therapy has always been well tolerated. The eosinophilic count decreased to 0/mm3 after the first administration. At the moment, after one year of therapy, AD is almost fully disappeared (EASI SCORE 4/72), despite being in free diet, and the quality of life of the patient has definitely improved.

Do parents/carers of infants with non IgE-mediated cow's milk protein allergy (CMPA) find smartphone delivered dietitian support acceptable and engaging?

Background: The role of technology in allergy care is evolving and since the COVID pandemic there has been even more reliance on remote care delivery to support patients. Within food allergy, there are many apps which include food scanners, symptoms trackers and food diaries, however many lack clinical validation and individualised support from a health professional. This service evaluation aimed to determine the acceptability of using a NHS Digital-approved smartphone app to support the dietetic management of non IgE mediated CMPA, whilst exploring in-app behaviours of parents/carers. Method: A remote dietitian-led CMPA service supports parent/ carers through a rapid access clinic (referrals were received from primary/community/hospital providers). Infants are assessed by a specialist paediatric dietitian via a video or telephone call, with follow up provided through the smartphone app. Parents/carers uses the app to send text-communication to the dietitian, log their infants meals and symptoms, and access learning content through 'learn' feature which includes podcasts and factsheets on the reintroduction challenge, introduction of solids and the milk ladder. In-app data and evaluation surveys from service users between January and December 2020 were collected and analysed. Results: A total of 349 patients were referred into the service, with 321 (90%) opting to use the app for follow up. On average patients are within the service for 6-12 months Of the 321, 70% viewed the 'learn' section to support advice given by the dietitian The most commonly used app feature was messaging to the dietitian, with an average 240 messages sent each month (4 per patient/month) 52% of parent/carers logged meals or symptoms through the app Of the patients giving feedback (n = 80), 100% either agreed/ strongly agreed that they found the app simple to use 100% of patients found the app to be a convenient way of receiving advice and support from their dietitian 100% of parents/carers rated their experience as good or very good Conclusion: Parents/carers of infants with non IgE mediated CMPA find dietitian care delivered via a smartphone app acceptable and engaging. Further research is needed into potential cost-effective benefits of such apps. (Figure Presented).

The influence of the COVID-19 pandemic on the medical care of a patient with cow’s milk allergy

The article summarizes the discussion of the expert meeting on February 16, 2021. The meeting concerned the medical care of patients with cow’s milk allergy (CMA). Experts analyzed the impact of the COVID-19 pandemic on patients’ access to medical services, including the diagnostic process and the possibility of a proper dietary management. The analysis of the National Health Fund data showed the most significant (by 25%) reduction in the number of health care consultations, in 2020 compared to 2019, for the pediatric population and limited access to services provided as a personal advice. The discussion facilitated the development of recommendations for the treatment of children with CMA. The experts recommended to support services in the form of personal medical advice, especially in the case of first-time visits, to limit the forms of telephone counseling / video counseling to monitoring or prolonging therapy, provided that there are no new symptoms and a good response to the previously applied procedure. The need to monitor the child’s diet and to verify the acquisition of allergen tolerance through food provocation was also emphasized. Appropriate management of allergy to cow’s milk proteins may be important to reduce the risk of further diseases (allergic march). The recommendations presented in the article should be useful for daily practice in the pediatrician’s office. © 2021, Wydawnictwo Czelej Sp. z o.o.. All rights reserved.

Beneficial Effects of Vitamins, Minerals, and Bioactive Peptides on Strengthening the Immune System Against COVID-19 and the Role of Cow's Milk in the Supply of These Nutrients.

The COVID-19 pandemic, which causes severe respiratory tract infections in humans, has become a global health concern and is spreading rapidly. At present, the most important issue associated with COVID-19 is the immune system and the factors that affect it. It is well known that cow's milk is highly rich in micronutrients that increase and strengthen the immune system. Research shows that the administration of these nutrients is very effective in fighting COVID-19, and a deficiency in any of them can be a weakness in the fight against the virus. On the other hand, cow's milk is accessible to the whole population, and drinking colostrum, raw, and micro-filtered milk from cows vaccinated against SARS-CoV-2 could provide individuals with short-term protection against the SARS-CoV-2 infection until vaccines become commercially available. This review aimed to discuss the effects of milk vitamins, minerals, and bioactive peptides on general health in humans to combat viral diseases, especially COVID-19, and to what extent cow's milk consumption plays a role in providing these metabolites. Cow's milk contains many bioactive compounds that include vitamins, minerals, biogenic amines, nucleotides, oligosaccharides, organic acids, and immunoglobulins. Humans can meet a significant portion of their requirements for vitamins and minerals through the consumption of cow's milk. Recent studies have shown that micronutrients such as vitamins D, E, B, C, and A as well as minerals Zn, Cu, Mg, I, and Se and bioactive peptides, each can have positive and significant effects on strengthening the immune system and general health in humans.

COVID-19 Vaccines in Children with Cow's Milk and Food Allergies.

The COVID-19 pandemic is the most challenging global health crisis of our times. Vaccination against COVID-19 plays a key role to control the current pandemic situation. The risk of allergic reactions to new COVID-19 vaccines is low. However, there is a debate on the safety in allergic patients following post marketing findings by different agencies. Our aim is to understand from current experiences whether children with cow's milk or food allergy are at higher risk than a general population for allergic reactions to COVID-19 vaccines. Current data indicate that patients with a history of allergy to cow's milk or other foods, even if severe, should receive COVID-19 vaccine in a setting with availability of treatments for anaphylactic reactions and under medical supervision. Recipients should be discharged after a protracted observation period of 30 min if no reaction developed.

Vitamin D3 in High-Quality Cow Milk: An Italian Case Study.

The quality-labeling category of high-quality (HQ) milk defined by the Italian legislation must comply with specific requirements concerning rigorous breeder management, hygienic controls, fat and protein content, bacterial load, somatic cells, lactic acid content, and non-denatured soluble serum proteins. However, there is no specification for the vitamin D content of HQ milk. Moreover, the data on the vitamin D content of this milk category are very scarce. In the present study, the content of vitamin D3 was evaluated in HQ raw and pasteurized cow milk obtained from Italian cowsheds and supermarkets. The vitamin D3 content varied from not detected (less than 1 µg L-1) to 17.0 ± 2.0 µg L-1 milk and was not related to the milk fat content. These results represent a case study including a significant although not exhaustive part of the contemporary Italian market of HQ milk. It was shown for the first time that HQ raw milk does not necessarily contain more vitamin D3, even though non-expert consumers likely to buy milk labeled as HQ could expect it. The vitamin D3 content in HQ pasteurized whole milk should be reported on the label of the milk package as a best practice of consumer information policy.