Polish statement on food allergy in children and adolescents

An adverse food reaction is defined as clinical symptoms occurring in children, adolescents or adults after ingestion of a food or chemical food additives. This reaction does not occur in healthy subjects. In certain individuals is a manifestation of the body hypersensitivity, i.e. qualitatively altered response to the consumed food. The disease symptoms observed after ingestion of the food can be triggered by two pathogenetic mechanisms; this allows adverse food reactions to be divided into allergic and non-allergic food hypersensitivity (food intolerance). Food allergy is defined as an abnormal immune response to ingested food (humoral, cellular or mixed). Non-immunological mechanisms (metabolic, pharmacological, microbiological or other) are responsible for clinical symptoms after food ingestion which occur in non-allergic hypersensitivity (food intolerance). Food allergy is considered a serious health problem in modern society. The prevalence of this disorder is varied and depends, among other factors, on the study population, its age, dietary habits, ethnic differences, and the degree of economic development of a given country. It is estimated that food allergy occurs most often among the youngest children (about 6-8% in infancy); the prevalence is lower among adolescents (approximately 3-4%) and adults (about 1-3%). The most common, age-dependent cause of hypersensitivity, expressed as sensitization or allergic disease (food allergy), are food allergens (trophoallergens). These are glycoproteins of animal or plant origine contained in: cow's milk, chicken egg, soybean, cereals, meat and fish, nuts, fruits, vegetables, molluscs, shellfish and other food products. Some of these allergens can cause cross-reactions, occurring as a result of concurrent hypersensitivity to food, inhaled or contact allergens. The development of an allergic process is a consequence of adverse health effects on the human body of different factors: genetic, environmental and supportive. In people predisposed (genetically) to atopy or allergy, the development of food allergy is determined by four allergic-immunological mechanisms, which were classified and described by Gell-Coombs. It is estimated that in approximately 48-50% of patients, allergic symptoms are caused only by type I reaction, the IgEmediated (immediate) mechanism. In the remaining patients, symptoms of food hypersensitivity are the result of other pathogenetic mechanisms, non-IgE mediated (delayed, late) or mixed (IgE mediated, non-IgE mediated). Clinical symptomatology of food allergy varies individually and depends on the type of food induced pathogenetic mechanism responsible for their occurrence. They relate to the organ or system in which the allergic reaction has occurred (the effector organ). Most commonly the symptoms involve many systems (gastrointestinal tract, skin, respiratory system, other organs), and approximately 10% of patients have isolated symptoms. The time of symptoms onset after eating the causative food is varied and determined by the pathogenetic mechanism of the allergic immune reaction (immediate, delayed or late symptoms). In the youngest patients, the main cause of food reactions is allergy to cow’s milk. In developmental age, the clinical picture of food allergy can change, as reflected in the so-called allergic march, which is the result of anatomical and functional maturation of the effector organs, affected by various harmful allergens (ingested, inhaled, contact allergens and allergic cross-reactions). The diagnosis of food allergy is a complex, long-term and time-consuming process, involving analysis of the allergic history (personal and in the family), a thorough evaluation of clinical signs, as well as correctly planned allergic and immune tests. The underlying cause of diagnostic difficulties in food allergy is the lack of a single universal laboratory test to identify both IgE-mediated and non-IgE mediated as well as mixed pathogenetic mechanisms of allergic reactions triggered by harmful food allergens. In food allergy diagnostics is only possible to identify an IgE-mediated allergic process (skin prick tests with food allergens, levels of specific IgE antibodies to food allergens). This allows one to confirm the diagnosis in patients whose symptoms are triggered in this pathogenetic mechanism (about 50% of patients). The method allowing one to conclude on the presence or absence of food hypersensitivity and its cause is a food challenge test (open, blinded, placebo-controlled). The occurrence of clinical symptoms after the administration of food allergen confirms the cause of food allergy (positive test) whereas the time elapsing between the triggering dose ingestion and the occurrence of clinical symptoms indicate the pathogenetic mechanisms of food allergy (immediate, delayed, late). The mainstay of causal treatment is temporary removal of harmful food from the patient’s diet, with the introduction of substitute ingredients with the nutritional value equivalent to the eliminated food. The duration of dietary treatment should be determined individually, and the measures of the effectiveness of the therapeutic elimination diet should include the absence or relief of allergic symptoms as well as normal physical and psychomotor development of the treated child. A variant alternative for dietary treatment of food allergy is specific induction of food tolerance by intended contact of the patient with the native or thermally processed harmful allergen (oral immunotherapy). This method has been used in the treatment of IgE-mediated allergy (to cow's milk protein, egg protein, peanut allergens). The obtained effect of tolerance is usually temporary. In order to avoid unnecessary prolongation of treatment in a child treated with an elimination diet, it is recommended to perform a food challenge test at least once a year. This test allows one to assess the body's current ability to acquire immune or clinical tolerance. A negative result of the test makes it possible to return to a normal diet, whereas a positive test is an indication for continued dietary treatment (persistent food allergy). Approximately 80% of children diagnosed with food allergy in infancy "grow out" of the disease before the age of 4-5 years. In children with non-IgE mediated food allergy the acquisition of food tolerance is faster and occurs in a higher percentage of treated patients compared to children with IgE-mediated food allergy. Pharmacological treatment is a necessary adjunct to dietary treatment in food allergy. It is used to control the rapidly increasing allergic symptoms (temporarily) or to achieve remission and to prevent relapses (long-term treatment). Preventive measures (primary prevention of allergies) are recommended for children born in a "high risk" group for the disease. These are comprehensive measures aimed at preventing sensitization of the body (an appropriate way of feeding the child, avoiding exposure to some allergens and adverse environmental factors). First of all, the infants should be breast-fed during the first 4-6 months of life, and solid foods (non milk products, including those containing gluten) should be introduced no earlier than 4 months of age, but no later than 6 months of age. An elimination diet is not recommended for pregnant women (prevention of intrauterine sensitization of the fetus and unborn child). The merits of introducing an elimination diet in mothers of exclusively breast-fed infants, when the child responds with allergic symptoms to the specific diet of the mother, are disputable. Secondary prevention focuses on preventing the recurrence of already diagnosed allergic disease; tertiary prevention is the fight against organ disability resulting from the chronicity and recurrences of an allergic disease process. Food allergy can adversely affect the physical development and the psycho-emotional condition of a sick child, and significantly interfere with his social contacts with peers. A long-term disease process, recurrence of clinical symptoms, and difficult course of elimination diet therapy are factors that impair the quality of life of a sick child and his family. The economic costs generated by food allergies affect both the patient's family budget (in the household), and the overall financial resources allocated to health care (at the state level). The adverse socio-economic effects of food allergy can be reduced by educational activities in the patient’s environment and dissemination of knowledge about the disease in the society

Wytyczne Polskiego Towarzystwa Gastroenterologii dotyczące nadzoru kolonoskopowego po polipektomii — adaptacja wytycznych europejskich

Zasady nadzoru kolonoskopowego po polipektomii zawarte w prezentowanym artykule opracowano na podstawie europejskich wytycznych dotyczących zapewnienia jakości w badaniach przesiewowych i diagnostyce raka jelita grubego. Zalecenia oparto na istniejących dowodach naukowych i uzupełniono o opinie ekspertów w sprawach niepopartych dowodami, a całość została zaakceptowana przez Zarząd Główny Polskiego Towarzystwa Gastroenterologii. Stwierdzenia, w których istnieją różnice w porównaniu z wytycznymi europejskimi, oznaczono znakiem „#”. Gastroenterologia Kliniczna 2011, tom 3, nr 2, 55–6

Polish Society of Gastroenterology guidelines for colonoscopy surveillance following polypectomy : adapted European guidelines

Zasady nadzoru kolonoskopowego po polipektomii zawarte w prezentowanym artykule opracowano na podstawie europejskich wytycznych dotyczących zapewnienia jakości w badaniach przesiewowych i diagnostyce raka jelita grubego. Zalecenia oparto na istniejących dowodach naukowych i uzupełniono o opinie ekspertów w sprawach niepopartych dowodami, a całość została zaakceptowana przez Zarząd Główny Polskiego Towarzystwa Gastroenterologii. Stwierdzenia, w których istnieją różnice w porównaniu z wytycznymi europejskimi, oznaczono znakiem „#”.The presented guidelines for colonoscopy surveillance after polypectomy are based on recently published European guidelines for quality assurance in colorectal cancer screening and diagnosis. The guidelines are evidence-based and supplemented with experts’ opinion on topics with little evidence; the entire document has been accepted by the Governing Board of the Polish Society of Gastroenterology. Statements that differ from original statements in European guidelines are marked with “#”

Influence of dissolved organic nitrogen on surface waters

The aim of this study was to determine the susceptibility of dissolved organic nitrogen (DON) contained in biologically treated wastewater disposed from municipal wastewater treatment plants (WWTPs) to biodegradability and bioavailability in a water environment. Additionally an evaluation was performed of the participation of this organic nitrogen fraction, including bioavailable DON (bDON), in the nitrogen balance for the Baltic Sea. Based on the samples of secondary effluent taken from two large municipal WWTPs located in Northern Poland DON bioavailability and biodegradability tests were carried out. It was concluded that DON concentration in the tested samples was on average from 1.5 to 2.0 g N m−3. This fraction constituted as much as 50% of organic nitrogen and 15–18% of total nitrogen contained in treated wastewater. The participation of biodegradable DON (brDON) in activated sludge tests was on average 24–35%. In the bioavailability tests Selenastrum capricornutum were able to use from 19 to 26% of DON, however taking into account the results of the control test, these values are reduced to 3–4%. On the other hand, taking into account the combined effect of bacteria and algae it was possible to reduce the DON concentration by nearly 40%. The estimated annual bDON load introduced to Baltic Sea waters from Poland through disposal of treated biological wastewater in 2010 reached up to 1.7 thousand tons of N year−1

Influence of Phosphorus Speciation on Its Chemical Removal from Reject Water from Dewatering of Municipal Sewage Sludge

The aim of the presented research was the assessment of phosphorus speciation impact on the precipitation of phosphorus in reject water using Ca(OH)2. To achieve this, phosphorus speciation (organic and inorganic phosphorus in suspension and in dissolved form) in reject water that is produced during sludge dewatering, after methane digestion in wastewater treatment plants (WWTPs), was determined. This study covered the materials from four WWTPs with different compositions of feedstock for anaerobic digestion (AnD). In one, the AnD process of primary and secondary sludge was carried out without co-substrate, while in three others, co-substrate (waste from the agri-food industry and external waste-activated sludge and fats from industrial plants) was examined. The investigation was conducted in batch reactors using doses of Ca(OH)2 ranging from 2500 to 5500 mg Ca/dm3. The percentage of phosphorus forms determined in the raw reject water was similar, with the dominant form being soluble reactive phosphorus (SPR) (percentage from 87 to 96%). The small differences observed were dependent on the composition of the AnD feedstock. The results showed that, in all analysed wastewater, very high (exceeding 99.9%) phosphate phosphorus removal efficiencies were obtained using Ca(OH)2 for short reaction times (t = 1 h). The efficiency of phosphate removal depended on pH but not on the forms of phosphorus in the analysed reject water

The Use of Organic Coagulants in the Primary Precipitation Process at Wastewater Treatment Plants

Measurements for determining the effect of chemically enhanced primary treatment (CEPT) on the efficiency of pollutant removal from wastewater were carried out using conventional inorganic coagulants PIX113 with polymer A110 (Kemipol, Police, Poland) and unconventional cationic organic coagulants Cofloc (Attana, Coalville, UK) C29510 (Kemipol, Police, Poland) and Sedifloc 575 (3F Chimica, Sandrigo, Italy). The average removal efficiency in the 2-h sedimentation process was 46%, 34%, 8%, 12% for the total suspended solids, organic matter (COD), total nitrogen, and total phosphorus, respectively. The use of organic coagulants contributed to 14–81% increase of pollutant removal efficiency. Substantial discrepancies in biological nutrient removal processes were not discovered in two-phase (anaerobic-anoxic) experiments without and with the addition of the organic coagulants. The increase in organic matter removal efficiency as a result of the CEPT process may contribute to a 65–80% increase in biogas production. The conducted research confirms the possibility of using organic coagulants in the primary precipitation process in wastewater treatment plants (WWTPs) in accordance with the principles of maximum energy recovery, thereby promoting renewable energy sources. Additionally, organic coagulants, as opposed to inorganic ones, do not cause a significant increase of chloride and sulfate ion concentrations, which facilitates the use of treated wastewater in the water reuse systems, such as irrigation of agricultural crops

Possibilities of Leachate Co-Treatment Originating from Biogas Production in the Deammonification Process

In the methane fermentation process, sewage sludge is the single substrate or serves as a co-substrate with the addition of various waste products. After the treatment stable digestate is obtained, which consists of two phases solid and liquid. Liquid phase, called as a leachate, due to the high content of nutrients must be treated before they are discharged into the final receiver. Physical and chemical methods of leachate treatment are usually expensive and difficult to maintain. Application of biological methods seems to be promising in such applications, however number of papers focused on such issue is limited. The aim of the presented study was to determine the treatment possibility of leachate generated during co-fermentation of agricultural products (bovine slurry) and excessive activated sludge in the deammonification process. During the experiment dewatered digestate from the mesophilic co-fermentation of bovine slurry and excessive active sludge, were co-treated with synthetic wastewater in a 1:3 weight ratio in the sequencing bath reactor. In the final test period, the Superfloc C494VP polyelectrolyte (from Kemira) was dosed into the leachate in order to enhance solids removal. AUR, NPR and AA were calculated to evaluate the deammonification process. It turns out that it is possible to co-treat leachate from biogas plants in C/N ratio no more than 1. The test also noted that a better oxidation effect of NH4 N was noted by adding polyelectrolyte to leachate. On the other hand, this negatively affected the viscosity of the granules and their sticking

Aktualne zasady postępowania w przypadku wrodzonej przepukliny przeponowej

The treatment of congenital diaphragmatic hernia (CDH) still represents a challenge, even for the specialised multidisciplinary teams in centres that provide treatment for CDH. Despite significant progress in the fields of pathophysiology, prenatal diagnosis, surgical techniques and intensive care, CDH is a disease still burdened with a high mortality. Due to the paucity of randomised studies, there are no standard guidelines for treatment. The present review looks at existing diagnostic and therapeutic principles based on the available literature.The treatment of congenital diaphragmatic hernia (CDH) still represents a challenge, even for the specialised multidisciplinary teams in centres that provide treatment for CDH. Despite significant progress in the fields of pathophysiology, prenatal diagnosis, surgical techniques and intensive care, CDH is a disease still burdened with a high mortality. Due to the paucity of randomised studies, there are no standard guidelines for treatment. The present review looks at existing diagnostic and therapeutic principles based on the available literature

Modeling the Effect of External Carbon Source Addition under Different Electron Acceptor Conditions in Biological Nutrient Removal Activated Sludge Systems

The aim of this study was to expand the International Water Association Activated Sludge Model No. 2d (ASM2d) to predict the aerobic/anoxic behavior of polyphosphate accumulating organisms (PAOs) and “ordinary” heterotrophs in the presence of different external carbon sources and electron acceptors. The following new aspects were considered: (1) a new type of the readily biodegradable substrate, not available for the anaerobic activity of PAOs, (2) nitrite as an electron acceptor, and (3) acclimation of “ordinary” heterotrophs to the new external substrate via enzyme synthesis. The expanded model incorporated 30 new or modified process rate equations. The model was evaluated against data from several, especially designed laboratory experiments which focused on the combined effects of different types of external carbon sources (acetate, ethanol and fusel oil) and electron acceptors (dissolved oxygen, nitrate and nitrite) on the behavior of PAOs and “ordinary” heterotrophs. With the proposed expansions, it was possible to improve some deficiencies of the ASM2d in predicting the behavior of biological nutrient removal (BNR) systems with the addition of external carbon sources, including the effect of acclimation to the new carbon source