Increasing rate of hospitalizations for food-induced anaphylaxis in Italian children: an analysis of the Italian Ministry of Health database.

emerged regarding other day-to-day issues. Physicians were overall misinformed about the availability of epinephrine in both restaurants and ambulances. When questioned regarding quality of life, only 10% of family practitioners and 31% of pediatricians believed that ‘‘severe allergies’’ have a major impact on quality of life. This differs markedly from results of previous studies about patients’ perceptions regarding the effects of food allergy on quality of life.10 More pediatric A/I specialists (78%) than others (P 5 .03) believed that life-threatening allergic reactions today are more common than 10 years ago, consistent with published data,11 and most physicians in all groups recognized that asthma is a risk factor for severe reactions. Similar to our surveys of patients and the general public, this study clearly demonstrates the need for ongoing education regarding anaphylaxis. As with previous studies, knowledge gaps are especially apparent for primary care and emergency physicians, who are most often the physicians on the front line in the treatment of this common and life-threatening condition

Direct effects of fermented cow's milk product with Lactobacillus paracasei CBA L74 on human enterocytes

Cow's milk fermented with Lactobacillus paracasei CBA L74 (FM-CBAL74) exerts a preventive effect against infectious diseases in children. We evaluated if this effect is at least in part related to a direct modulation of non-immune and immune defence mechanisms in human enterocytes. Human enterocytes (Caco-2) were stimulated for 48 h with FM-CBAL74 at different concentrations. Cell growth was assessed by colorimetric assay; cell differentiation (assessed by lactase expression), tight junction proteins (zonula occludens1 and occludin), mucin 2, and toll-like receptor (TRL) pathways were analysed by real-time PCR; innate immunity peptide synthesis, beta-defensin-2 (HBD-2) and cathelicidin (LL-37) were evaluated by ELISA. Mucus layer thickness was analysed by histochemistry. FMCBA L74 stimulated cell growth and differentiation, tight junction proteins and mucin 2 expression, and mucus layer thickness in a dose-dependent fashion. A significant stimulation of HBD-2 and LL-37 synthesis, associated with a modulation of TLR pathway, was also observed. FM-CBAL74 regulates non-immune and immune defence mechanisms through a direct interaction with the enterocytes. These effects could be involved in the preventive action against infectious diseases demonstrated by this fermented product in children

Investigation of chronic diarrhoea in infancy.

Diarrhoea in infants and young children is defined as >200g/day of stools, and occurs when there is an imbalance between intestinal fluids absorption and secretion. This may be caused by either a decreased absorption (osmotic diarrhoea) or an increased secretion (secretory diarrhoea). Chronic diarrhoea defines intestinal loss of water and electrolytes with increased stool frequency, reduced consistency and larger volume over more than 14days. This disorder in children shows a wide range of aetiologies depending on the age. The knowledge of common and rare aetiologies is important to optimize the diagnostic approach. A stepwise approach, starting with a comprehensive history, physical examination, inspection and collection of stool samples, helps to devise appropriate diagnostic and therapeutic management. In this article we discuss the pathophysiology, aetiology and possible approach to chronic diarrhoea in infancy

Efficacy of a partially hydrolyzed whey formula on infant colic: a randomized controlled trial

Background: Infant colic (IC) affects up to 20% of infants in the first 4 months of life. Although IC is a benign affection that spontaneously resolves after the first 3-4 months of life, it is often a stressful problem for parents. Methods: Babies, aged ≤ 3 months, observed at family pediatrician office because a suspect of IC, were randomized in two groups of 3-week dietary intervention: Group 1, receiving non-analgesic, non-nutritive soothing maneuvers, continuing a standard formula; Group 2, receiving a partially hydrolyzed whey formula (w-pHF), containing GOS (0.5g/100ml), low content of lactose (2.5g/100ml) and low osmolarity (185 mOsm). All infants performed clinical examinations at enrollment and after 7, 14 and 21 days. Number of colic episodes, and the number and consistency of fecal outputs were recorded daily. Results: Fifty infants with IC were enrolled and randomized: 25 in Group 1 and 25 in Group 2. The rate of infants with IC in Group 2 decreased significantly within 14 days compared to Group 1 and the number of bowel movements increased significantly within 7 days in Group 2 compared to Group 1. Stool consistency significantly improved in Group 2 within 7 days. Conclusion: The studied formula could represent a useful approach in infants with IC reducing pharmacological treatments

The Impact of Formula Choice for the Management of Pediatric Cow's Milk Allergy on the Occurrence of Other Allergic Manifestations: The Atopic March Cohort Study

Objectives: To compare the impact of different formulas on the occurrence of other atopic manifestations and the time of immune tolerance acquisition. Study design: In a 36-month prospective cohort study, the occurrence of other atopic manifestations (eczema, urticaria, asthma, and rhinoconjunctivitis) and the time of immune tolerance acquisition were comparatively evaluated in immunoglobulin E–mediated children with cow's milk allergy (CMA) treated with extensively hydrolyzed casein formula containing the probiotic L. rhamnosus GG (EHCF + LGG), rice hydrolyzed formula, soy formula, extensively hydrolyzed whey formula (EHWF), or amino acid–based formula. Results: In total, 365 subjects were enrolled into the study, 73 per formula cohort. The incidence of atopic manifestations was 0.22 (Bonferroni-corrected 95% CI 0.09-0.34) in the EHCF + LGG cohort; 0.52 (0.37-0.67) in the rice hydrolyzed formula cohort; 0.58 (0.43-0.72) in the soy formula cohort; 0.51 (0.36-0.66) in the EHWF cohort; and 0.77 (0.64-0.89) in the amino acid–based formula cohort. The incidence of atopic manifestations in the rice hydrolyzed formula, soy formula, EHWF, and amino acid–based formula cohorts vs the EHCF + LGG cohort was always greater than the prespecified absolute difference of 0.25 at an alpha-level of 0.0125, with corresponding risk ratios of 2.37 (1.46-3.86, P < .001) for rice hydrolyzed formula vs EHCF + LGG; 2.62 (1.63-4.22, P < .001) for soy formula vs EHCF + LGG; 2.31 (1.42-3.77, P < .001) for EHWF vs EHCF + LGG; and 3.50 (2.23-5.49, P < .001) for amino acid–based formula vs EHCF + LGG. The 36-month immune tolerance acquisition rate was greater in the EHCF + LGG cohort. Conclusions: The use of EHCF + LGG for CMA treatment is associated with lower incidence of atopic manifestations and greater rate of immune tolerance acquisition