Evidence for Involvement of IL-9 and IL-22 in Cows' Milk Allergy in Infants.

Although allergic inflammation is characterized by a T helper (Th) 2-dominant immune response, the discovery of a role for new T cell subsets in inflammatory diseases has added an additional layer of complexity to the understanding of the pathogeneses of allergic diseases. We evaluated plasma cytokine profiles in infants with cows' milk allergy (CMA), who were being treated with an elimination diet. In a prospective, randomized and controlled study, infants (aged 8.4 ± 3.9 months) with CMA were treated with an elimination diet for 120 days, which replaced cows' milk with a hydrolysed soy protein formula (n = 26) or a free amino acid formula (n = 20). Blood samples were collected before treatment during active disease (T0) and after 120 days, when symptoms were absent (T1). Plasma cytokine concentrations were measured. Infants with CMA had higher plasma concentrations of interleukin (IL)-4 and IL-13 and lower concentrations of IL-9, IL-17A and interferon-γ, compared with healthy breast-fed infants. At T0, there was a positive correlation between blood eosinophil numbers and plasma concentrations of IL-4, IL-9, IL-17A and IL-22. Treatment with a cows' milk elimination diet resulted in a decrease in plasma IL-4, IL-9, IL-13 and IL-22 and an increase in plasma IL-17A. We conclude that IL-4 and IL-13 are elevated in active CMA. The association of IL-9 and IL-22 with eosinophilia, and the decrease in these two cytokines with cows' milk elimination, suggests that they both play a role in the symptoms observed in CMA and may be important targets for future interventions.

Adequado crescimento, aus�ncia de ganho de peso excessivo e de altera��o no padr�o evacuat�rio em lactentes com refluxo gastroesof�gico recebendo f�rmula infantil espessada com goma jata� / Adequate growth, absence of excessive weight gain and no changing in feces consistency in infants with gastroesophageal reflux receiving carob bean gum-thickened infant formula

Introdu��o: O tratamento do refluxo gastroesof�gico (RGE) com f�rmulas espessadas com goma jata� tem se mostrado eficaz na redu��o dos epis�dios de refluxo e regurgita��o. Neste estudo, n�s comparamos o tratamento cl�nico, evolu��o p�ndero-estatural e padr�o das fezes, de lactentes com RGE em aleitamento materno ou recebendo f�rmula infantil antirregurgita��o com goma jata�. Material e m�todos: Analisamos um total de 42 prontu�rios m�dicos de lactentes menores de 1 ano com RGE atendidos em uma cl�nica de gastroenterologia pedi�trica. Os pacientes foram divididos em Grupo AME- aleitamento materno (n=17); e Grupo FAR- f�rmula antirregurgita��o com goma jata� (n=17). Dados antropom�tricos, uso de medica��o antirrefluxo, padr�o evacuat�rio e evolu��o do ganho p�ndero-estatural foram avaliados em 4 consultas consecutivas. Resultados: Observamos maior prescri��o de medicamentos antirrefluxo no grupo AME quando comparado ao FAR (p=0.08). N�o houve diferen�a entre os grupos no c�lculo do z-escore P/E e E/I, nem nos epis�dios de diarreia e/ou constipa��o intestinal ao longo dos 4 tempos de acompanhamento (p>0.05). Conclus�o: O uso da f�rmula espessada com goma jata� foi eficaz e segura para garantir crescimento adequado, com bom ganho p�ndero-estatural, n�o ocasionando sobrepeso, al�m de n�o interferir no padr�o das evacua��es.