Growth and Nutritional Biomarkers in Brazilian Infants with Cow's Milk Allergy at Diagnosis and 18-Month Follow-Up: A Prospective Cohort Study.

Purpose: This study aimed to describe the growth, body protein status, and micronutrient biomarkers of Brazilian infants with cow's milk allergy (CMPA) at baseline and at 18 months of follow-up in comparison with their healthy peers. Methods: Thirty infants with CMPA younger than six months of age were included in this longitudinal study, and their nutritional status was compared with that of 24 non-allergic age-matched children. Anthropometric measurements were used to assess growth, and blood and urine samples were analyzed for protein and micronutrient status. Mixed linear models adjusted for birth weight, socioeconomic status, infant feeding at baseline, weight-for-age, C-reactive protein, serum albumin, micronutrient dietary supplementation, and salt consumption were employed to evaluate the evolution of nutritional parameters throughout the follow-up period. Results: Overall, the mean age of the children at enrolment was 2.9 (standard deviation 1.7) months, and 29 children (53.7%) were male. Infants with CMPA showed a higher prevalence of functional iron depletion (transferrin saturation <20) (p=0.027), lower serum ferritin (p=0.009), and lower urinary iodine (p=0.034) levels than non-allergic children at baseline. Patients with CMPA showed a higher increment in weight-for-age and length-for-age over time than those in the control group (p<0.01). Mixed linear analyses showed a significantly lower increase in serum vitamin B12 (s-B12) (p=0.001) and urinary iodine (p<0.001) concentrations over time compared to the control group. Conclusion: Infants with CMPA on a cow's milk elimination diet had a higher weight and length at 18 months of follow-up but showed signs of inadequate iron, iodine, and B-12 vitamin status.

Growth and Nutritional Biomarkers in Brazilian Infants with Cow’s Milk Allergy at Diagnosis and 18-Month Follow-Up: A Prospective Cohort Study / 대한소아소화기영양학회지

Purpose@#This study aimed to describe the growth, body protein status, and micronutrient biomarkers of Brazilian infants with cow’s milk allergy (CMPA) at baseline and at 18 months of follow-up in comparison with their healthy peers. @*Methods@#Thirty infants with CMPA younger than six months of age were included in this longitudinal study, and their nutritional status was compared with that of 24 non-allergic age-matched children. Anthropometric measurements were used to assess growth, and blood and urine samples were analyzed for protein and micronutrient status. Mixed linear models adjusted for birth weight, socioeconomic status, infant feeding at baseline, weightfor-age, C-reactive protein, serum albumin, micronutrient dietary supplementation, and salt consumption were employed to evaluate the evolution of nutritional parameters throughout the follow-up period. @*Results@#Overall, the mean age of the children at enrolment was 2.9 (standard deviation 1.7) months, and 29 children (53.7%) were male. Infants with CMPA showed a higher prevalence of functional iron depletion (transferrin saturation <20) (p=0.027), lower serum ferritin (p=0.009), and lower urinary iodine (p=0.034) levels than non-allergic children at baseline.Patients with CMPA showed a higher increment in weight-for-age and length-for-age over time than those in the control group (p<0.01). Mixed linear analyses showed a significantly lower increase in serum vitamin B12 (s-B12) (p=0.001) and urinary iodine (p<0.001) concentrations over time compared to the control group. @*Conclusion@#Infants with CMPA on a cow’s milk elimination diet had a higher weight and length at 18 months of follow-up but showed signs of inadequate iron, iodine, and B-12 vitamin status.

Nutritional management of immediate hypersensitivity to legumes in vegetarians.

Vegetarianism is becoming a common practice among people. Products of vegetable origin are also on the rise, such as vegetable "milk" and legume-based snacks, which may lead to legume sensitivity and allergies in vegetarian diet followers. Furthermore, products derived from legumes, such as lupin flour or fenugreek powder, are often used as food additives. They function as hidden allergens, not always evident on the precautionary labeling, favoring allergic reactions. As dietary allergen restriction is the fundamental pillar in managing patients with food allergies, this review aims to reflect on practical aspects-diagnosis and nutritional management-in managing legume allergies in vegetarians, aiming to reduce the negative nutritional impact of an even more restrictive diet.

Nutritional management of immediate hypersensitivity to legumes in vegetarians

Vegetarianism is becoming a common practice among people. Products of vegetable origin are also on the rise, such as vegetable “milk” and legume-based snacks, which may lead to legume sensitivity and allergies in vegetarian diet followers. Furthermore, products derived from legumes, such as lupin flour or fenugreek powder, are often used as food additives. They function as hidden allergens, not always evident on the precautionary labeling, favoring allergic reactions. As dietary allergen restriction is the fundamental pillar in managing patients with food allergies, this review aims to reflect on practical aspects—diagnosis and nutritional management—in managing legume allergies in vegetarians, aiming to reduce the negative nutritional impact of an even more restrictive diet (AU)

Roughness and SEM Analysis of Manual and Ultrasonic Instrumentation over Different Crown Materials for Dental Implants Restorations.

The use of new prosthetic materials makes it necessary to establish adequate hygienic protocols. It was decided to make prosthetic crowns from four different materials: composite, lithium disilicate, metal ceramic, and zirconium, and to evaluate the effects on the surfaces of four different instruments through SEM and roughness analysis: manual steel curette, manual titanium curette, ultrasonic steel insert, and ultrasonic peek insert. Forty crowns were made, ten of each type of material. For each material, five crowns were manually instrumented with steel inserts (curette 11-12, PDT, Missoula, MT, USA) and titanium (Wingrove 3-4, PDT, Missoula, MT, USA) on the lingual and buccal surfaces, respectively, and the other five crowns were instrumented with an ultrasonic peek insert (ICS-IC1, Mectron, Carasco, Italy) on the buccal surface and steel (PS, EMS, Nyon, Switzerland) on the lingual surface. At this point, surface roughness analysis was carried out. The data were analyzed with a Kolmogorov-Smirnov test. Therefore, it was decided to conduct two analyses with a Kruskal-Wallis test and Bonferroni post hoc test. Then, the instrumented crowns were analyzed by SEM. The analysis of the data shows that the highest average roughness was within the composite group, while the best material appeared to be disilicate. Significant differences existed between the groups, between the materials, and between the different instruments (p-value < 0.05). In the qualitative analysis carried out by SEM, the classic steel insert eliminated the residues of golden finishing. The peek insert created alterations on all tested surfaces. The steel curette did not create particular problems, with the exception of zirconium, where it was possible to observe some scratch lines. Instrumentation with the titanium curette created deeper incisions than the steel curette in the composite and disilicate. The best results came from the ultrasonic steel insert, while the best material appeared to be disilicate.

Phadiatop, Phadiatop Infant and total IgE evaluated in allergic Brazilian children and adolescents

The clinical history is of importance in the investigation of allergic diseases but does have limitations. Many allergic conditions will be over-diagnosed if anamnesis alone is used for diagnostic criteria. Serum total immunoglobulin E (TIgE) quantification, as well as panels containing allergens prevalent in the studied population, may serve as screening tests and facilitate the diagnosis of allergic disease or its exclusion. We assessed the positivity of two versions of these tests, Phadiatop Europe® (PhEU) and Phadiatop Infant® (PhInf), as well as total IgE (TigE) values in patients with a medical diagnosis of allergic disease and non-allergic individuals. METHODS: A cross-sectional study performed in eleven Brazilian pediatric allergy centers with patients divided into groups according to the primary condition and a group of assessed control subjects. They were submitted to TIgE measurement and screening tests (PhEu and PhInf). RESULTS: TIgE mean serum levels were significantly higher among allergic patients, especially those with asthma/rhinitis or atopic dermatitis. The positivity of the screening tests, considering the total population, was 63.8% for PhEU and 72.6% for PhInf. These increased when we evaluated only the allergic subjects. The concordance index of the two tests was Kappa = 0.7 and higher among those of greater age. CONCLUSIONS: In the assessed population, there were significantly higher levels among those with positive screening tests and PhInf showed better performance in the identification of sensitized individuals, regardless of age. This is the first study to evaluate Phadiatop and Phadiatop Infant in the same population

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Asthma in adolescents - Prevalence trends and associated factors in northeast Brazil

BACKGROUND: Asthma is the most common chronic disease affecting children and adolescents (AD). We evaluated the prevalence of asthma and associated factors in adolescents living in a developing region in northeast Brazil using the ISAAC (International Study of Asthma and Allergies in Childhood) methodology. METHODS: According to the ISAAC protocol, AD (13-14 year olds, n = 3,043 in 2003 and 3,009 in 2011-12) answered the standardised written questionnaire by themselves. In addition, in 2011-12 a random sample of these AD (n = 430) also answered a complementary questionnaire (associated factors) and underwent a skin prick test with aeroallergens (Dermatophagoides pteronyssinus, Blomia tropicalis, Blatella germanica, Periplaneta americana, dog dander, cat dander, mixed grass pollen and mixed moulds, including 10 mg/mL histamine and negative controls). Data were analysed by univariate and multivariate analysis using Poisson regression. RESULTS: The prevalence of asthma in 2011-12 in Aracaju was 12.8%, which is lower than that recorded in 2003 (18.7%). Individuals with a dog outside the home (PR = 0.93; 95%CI = 0.88-0.98; p = 0.018) and those with an older sibling (PR = 0.94; 95%CI = 0.91-0.98; p = 0.005) were identified as protective. The presence of smokers in the residence (PR = 1.04; 95%CI = 1.00-1.09; p = 0.039) was associated with an increased risk of developing asthma. CONCLUSIONS: The prevalence of asthma was significantly lower than the last ISAAC figures reported for Aracaju. Tobacco smoking, a preventable factor, continues to be associated with an increase in the occurrence of asthma and other associations may concur with the hygiene hypothesis

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Asthma in adolescents--Prevalence trends and associated factors in northeast Brazil.

BACKGROUND: Asthma is the most common chronic disease affecting children and adolescents (AD). We evaluated the prevalence of asthma and associated factors in adolescents living in a developing region in northeast Brazil using the ISAAC (International Study of Asthma and Allergies in Childhood) methodology. METHODS: According to the ISAAC protocol, AD (13-14 year olds, n=3,043 in 2003 and 3,009 in 2011-12) answered the standardised written questionnaire by themselves. In addition, in 2011-12 a random sample of these AD (n=430) also answered a complementary questionnaire (associated factors) and underwent a skin prick test with aeroallergens (Dermatophagoides pteronyssinus, Blomia tropicalis, Blatella germanica, Periplaneta americana, dog dander, cat dander, mixed grass pollen and mixed moulds, including 10mg/mL histamine and negative controls). Data were analysed by univariate and multivariate analysis using Poisson regression. RESULTS: The prevalence of asthma in 2011-12 in Aracaju was 12.8%, which is lower than that recorded in 2003 (18.7%). Individuals with a dog outside the home (PR=0.93; 95%CI=0.88-0.98; p=0.018) and those with an older sibling (PR=0.94; 95%CI=0.91-0.98; p=0.005) were identified as protective. The presence of smokers in the residence (PR=1.04; 95%CI=1.00-1.09; p=0.039) was associated with an increased risk of developing asthma. CONCLUSIONS: The prevalence of asthma was significantly lower than the last ISAAC figures reported for Aracaju. Tobacco smoking, a preventable factor, continues to be associated with an increase in the occurrence of asthma and other associations may concur with the hygiene hypothesis.

Open oral food challenge in the confirmation of cow's milk allergy mediated by immunoglobulin E

Background The most reliable method to diagnose food allergy or to determine tolerance is the oral food challenge. Objectives The aim of this study was to describe the open oral food challenge applied to children with suspicion of cow's milk allergy mediated by immunoglobulin E, and evaluate the relation between the clinical history and skin prick test with the challenge outcomes. Patients and methods Forty-six children (median age 13.8 months), with clinical history of immediate reactions to cow's milk and positive skin prick test, underwent an open oral food challenge with cow's milk. Results The challenge was positive in 41.3%. Cutaneous reactions were the most common (73.7%), followed by respiratory (57.9%) and gastrointestinal reactions (36.8%). According to the severity of the reactions, 57.9%, 36.8% and 5.3% had mild, moderate and severe reactions, respectively. Oral antihistamine was sufficient as treatment in all positive cases. A higher frequency of positive skin prick test with total milk and casein was observed in children with positive oral food challenge. There was a significant agreement between the reactions reported by the family history and those observed during the challenge for 68.4% of children with positive results (Kappa=0.728; p<0.001). Conclusions The method was considered suitable for children up to three years of age, and is safe and easy to perform. There was a significant correlation between the clinical history and the challenge outcomes. A positive skin prick test with total milk and casein was significantly associated with positive challenge results(AU)

Relationship between asthma and high blood pressure among adolescents in Aracaju, Brazil.

BACKGROUND: Asthma has been linked to cardiovascular diseases (CVDs) and related risk factors such as hypertension in adults. It is unclear whether the relationship between asthma and hypertension found among adults is also observed in adolescents. Hence, the authors examined asthma and its association with prehypertension and hypertension among adolescents in Aracaju, Brazil. METHODS: Data on asthma and blood pressure were collected among 1002 adolescents age 12 to 17 years old in 15 public schools, 5 municipal schools, and 10 private schools. Asthma data were ascertained by the International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire. Sex-, age-, and height-specific percentile levels were used to define prehypertension (90-94th percentile) and hypertension (>or=95th percentile). RESULTS: The prevalence of asthma was 20.6% in boys and 27.7% in girls. Among boys, the prevalence rates of prehypertension and hypertension were 26.7% and 17.0%, respectively. Among girls, the rates of prehypertension and hypertension were 14.3% and 12.9%, respectively. There were no statistically significant associations between asthma and prehypertension, and hypertension, even after adjusting for age, social economic status, physical activity, and body mass index (BMI) in both boys (prehypertension: odds ratio [OR] = 1.35, 95% confidence interval [CI]: 0.80-2.27; hypertension: OR = 0.60, 95% CI: 0.29-1.23) and girls (prehypertension: OR = 0.71, 95% CI: 0.40-1.28; hypertension: OR = 1.07, 95% CI: 0.60-1.94). CONCLUSIONS: These results suggest no association between asthma and high blood pressure in adolescents. More prospective studies are needed to establish whether hypertension becomes more pronounced at a specific age in asthmatics, and if so, the possible factors that may contribute to this.

Epidemiologia da asma / Epidemiology of asthma

Objetivo: rever os dados publicados sobre epidemiologia da asma nos últimos 26 anos. Fonte de dados: artigos originais e teses indexadas nos bancos de dados MEDLINE e LILACS de 1980 a 2006. Idiomas: português e inglês. Palavras chave: asma, epidemiologia, crianças, adultos, prevalência. Sintese dos dados: A principal observação desta revisão foi a ampla variação da prevalência da asma, entre crianças e adultos, de diferentes localidades do mundo, mesmo entre cidades de um mesmo pais. Embora vários estudos tenham demonstrado em países desenvolvidos, aumento na prevalência da asma nos últimos 26 anos, essa observação não foi unânime. Em constraste existe pouca informação sobre as tendências temporais da asma em países em desenvolvimento, nos quais as taxas de prevalência podem ser determinadas por fatores diferentes dos relatados em nações desenvolvidas. Conclusões: A ampla variação na prevalência da asma que ocorre "entre" e "dentro" dos países sugere que os fatores que afetam essa condição possam variar em diferentes localidades do mundo. Assim, estudos sobre etiologia, genética e ambiente são necessários para permitir conclusões mais apropriadas sobre quais fatores exercem o papel principal na prevalência da asma, em diferentes populações ao redor do mundo.