The Role of the Gut Microbiome in Cow’s Milk Allergy: A Clinical Approach

Cow’s milk allergy (CMA) is the most prevalent food allergy (FA) in infancy and early childhood and can be present with various clinical phenotypes. The significant increase in FA rates recorded in recent decades has been associated with environmental and lifestyle changes that limit microbial exposure in early life and induce changes in gut microbiome composition. Gut microbiome is a diverse community of microbes that colonize the gastrointestinal tract (GIT) and perform beneficial functions for the host. This complex ecosystem interacts with the immune system and has a pivotal role in the development of oral tolerance to food antigens. Emerging evidence indicates that alterations of the gut microbiome (dysbiosis) in early life cause immune dysregulation and render the host susceptible to immune-mediated diseases later in life. Therefore, the colonization of the gut by “healthy” microbes that occurs in the first years of life determines the lifelong health of the host. Here, we present current data on the possible role of the gut microbiome in the development of CMA. Furthermore, we discuss how gut microbiome modification might be a potential strategy for CMA prevention and treatment.European Research Commission (Research Executive Agency) under the research project Stance4Health under Grant (Contract No 816303

Αναγνώριση παθολογικών αναπνευστικών ήχων από τους επαγγελματίες υγείας

Εισαγωγή: Η ακρόαση των πνευμόνων αποτελεί αναπόσπαστο κομμάτι της φυσικής εξέτασης και συμβάλλει ιδιαίτερα στη διάγνωση των αναπνευστικών νοσημάτων. Ωστόσο η αξία της περιορίζεται, καθώς πρόκειται για υποκειμενική διαδικασία που επηρεάζεται από τις ακουστικές δεξιότητες και την εκπαίδευση του ιατρού που την πραγματοποιεί. Σε αυτό συμβάλλει επίσης η έλλειψη ομοφωνίας για την ορολογία των αναπνευστικών ήχων διεθνώς. Σκοπός: Η αξιολόγηση της ικανότητας αναγνώρισης των παθολογικών αναπνευστικών ήχων από τους επαγγελματίες υγείας, η διερεύνηση πιθανών παραγόντων που την επηρεάζουν, καθώς επίσης η εκτίμηση του βαθμού στον οποίο έχουν υιοθετηθεί οι συστάσεις της ERS από την ελληνική ιατρική κοινότητα. Μέθοδος: Πρόκειται για συγχρονική μελέτη παρατήρησης που πραγματοποιήθηκε με την βοήθεια ερωτηματολογίου, το οποίο στάλθηκε μέσω ηλεκτρονικού ταχυδρομείου στους συμμετέχοντες. Τους ζητήθηκε να περιγράψουν ελεύθερα 5 ηχογραφημένους παθολογικούς αναπνευστικούς ήχους και καταγράφηκαν γενικά στοιχεία, όπως η ειδικότητα, τα χρόνια εμπειρίας και ο χώρος εργασίας των ειδικευμένων ιατρών. Αποτελέσματα: Συνολικά συμμετείχαν 275 φοιτητές και ιατροί διαφόρων ειδικοτήτων και βαθμίδων. Η ικανότητα αναγνώρισης των ήχων ήταν υψηλή για τους τρίζοντες (77,6%) και τους συρίττοντες (72,5%), μέτρια για τους λεπτούς τρίζοντες (49%) και χαμηλή για τους κρωγμούς - squawks (15,9%) και τον ήχο τριβής (11,5%). Επιπλέον, δε βρέθηκε εξάρτηση από το επίπεδο εκπαίδευσης με εξαίρεση τους λεπτούς τρίζοντες (p=0,021), ενώ βρέθηκε αρνητική συσχέτιση ανάμεσα στα χρόνια εμπειρίας και στην αναγνώριση των λεπτών τριζόντων (OR=0,76, 95%CI:0,58-0,98, p=0,038) και του συριγμού (OR=0,66, 95%CI:0,50-0,88, p=0,004). Τέλος, διαπιστώθηκε ότι σημαντικό ποσοστό των συμμετεχόντων χρησιμοποιεί όρους που δεν συστήνονται πια, ιδιαίτερα για τους λεπτούς τρίζοντες (30,7%), τους τρίζοντες (27,9%) και τους συρίττοντες (22,4%). Συμπεράσματα: Η ικανότητα αναγνώρισης των αναπνευστικών ήχων δεν εξαρτάται από το επίπεδο εκπαίδευσης, την ειδικότητα και το χώρο εργασίας και διαφέρει ανάλογα με τον ήχο. Οι διεθνείς συστάσεις δεν έχουν υιοθετηθεί πλήρως από τους Έλληνες επαγγελματίες υγείας.Introduction: Lung auscultation is an integral part of physical examination and is particularly useful in the diagnosis of respiratory diseases. However, its value is limited as it is a subjective process and depends on the physician’s auscultatory skills and training. The lack of international consensus in the terminology of respiratory sounds also contributes to this. Aim: To evaluate the auscultatory skills of healthcare professionals, to investigate possible factors that affect them, and to assess whether the recommendations of ERS have been accepted by the Greek medical community. Methods: This is a cross-sectional, observational study conducted with a questionnaire that was sent via e-mail to the participants. They were asked to spontaneously describe 5 audio-recorded adventitious lung sounds and general data were recorded, such as their medical specialization, how long and where they practice it. Results: A total of 275 medical students and physicians with different medical specializations and educational levels participated in the study. The observers’ ability to recognize lung sounds was high for crackles (77,6%) and wheezes (72,5%), moderate for fine crackles (49%) and low for squawks (15,9%) and pleural rub (11,5%). In addition, it does not depend on the educational level, except for the fine crackles (p=0,021). A negative correlation was found between years of experience and the recognition of fine crackles (OR=0.76, 95% CI:0.58-0.98, p=0.038) and wheezes (OR=0.66, 95% CI:0.50-0.88, p=0.004). Finally, significant rates of participants were found to use terms that are no longer recommended, especially for the fine crackles (30.7%), the crackles (27.9%) and the wheezes (22.4%). Conclusions: The physicians’ ability to recognize lung sounds does not depend on educational level, medical specialization and where they practice medicine, and varies with the sound. International recommendations have not been fully accepted by Greek healthcare professionals

Does Adherence to the Mediterranean Diet Have a Protective Effect against Asthma and Allergies in Children? A Systematic Review

Dietary pattern may potentially impact on the pathogenesis of asthma and allergies. The Mediterranean Diet (MD) has significant health benefits due to its antioxidant and anti-inflammatory properties. The aim of this systematic review was to investigate the effectiveness of adherence to the MD against asthma and allergies in childhood. Hence, a systematic literature search was conducted on PubMed, ESBCO (Cinahl), Scopus, and the Cochrane Library databases up to 26 January 2022. The total number of articles obtained, after the initial search on the databases was conducted, was 301. Twelve studies were included, after the removal of duplicates and screening for eligibility. Our findings indicated a protective role of the MD against childhood asthma, but they also imply that the MD probably does not affect the development of allergies. Nevertheless, the heterogeneity and limitations of the studies highlight the need for randomized controlled trials that will focus on the pediatric population and hopefully provide more robust evidence

Asthma-Like Features and Anti-Asthmatic Drug Prescription in Children with Non-CF Bronchiectasis

Bronchiectasis and asthma may share some characteristics and some patients may have both conditions. The present study aimed to examine the rationale of prophylactic inhaled corticosteroids (ICS) prescription in children with bronchiectasis. Data of children with radiologically established bronchiectasis were retrospectively reviewed. Episodes of dyspnea and wheezing, spirometric indices, total serum IgE, blood eosinophil counts, sensitization to aeroallergens, and air-trapping on expiratory CT scans, were recorded. The study included 65 children 1.5–16 years old, with non-CF bronchiectasis. Episodes of dyspnea or wheezing were reported by 22 (33.8%) and 23 (35.4%), respectively. Skin prick tests to aeroallergens (SPTs) were positive in 15 (23.0%) patients. Mosaic pattern on CT scans was observed in 37 (56.9%) patients. Dyspnea, presence of mosaic pattern, positive reversibility test, and positive SPTs were significantly correlated with the prescription of ICS. The prescription of ICS in children with bronchiectasis is more likely when there are certain asthma-like characteristics. The difficulty to set the diagnosis of real asthma in cases of bronchiectasis may justify the decision of clinicians to start an empirical trial with ICS in certain cases

The Role of the Gut Microbiome in Cow’s Milk Allergy: A Clinical Approach

Cow’s milk allergy (CMA) is the most prevalent food allergy (FA) in infancy and early childhood and can be present with various clinical phenotypes. The significant increase in FA rates recorded in recent decades has been associated with environmental and lifestyle changes that limit microbial exposure in early life and induce changes in gut microbiome composition. Gut microbiome is a diverse community of microbes that colonize the gastrointestinal tract (GIT) and perform beneficial functions for the host. This complex ecosystem interacts with the immune system and has a pivotal role in the development of oral tolerance to food antigens. Emerging evidence indicates that alterations of the gut microbiome (dysbiosis) in early life cause immune dysregulation and render the host susceptible to immune-mediated diseases later in life. Therefore, the colonization of the gut by “healthy” microbes that occurs in the first years of life determines the lifelong health of the host. Here, we present current data on the possible role of the gut microbiome in the development of CMA. Furthermore, we discuss how gut microbiome modification might be a potential strategy for CMA prevention and treatment

The Expansion of the Hellenic Food Thesaurus; Allergens Labelling and Allergens-Free Claims on Greek Branded Food Products

Branded food composition databases (BFCDs) are valuable information tools that meet multiple user needs. Recently, recognising allergies and intolerances as an emerging concern for various stakeholders, BFCDs evolve to embed information on allergens. This study aims to expand the Greek BFCD, HelTH, to include allergen information for its 4002 products. A new file was added to the structure of HelTH, and data were curated to record label information. In 68.4% of products, at least one allergen was present in the ingredient list and in 38.9% at least one allergen in a precautionary statement. Milk (38.8%), gluten (32.7%), and soybeans (17.4%) were most commonly declared in the ingredient list; nuts (18.3%), eggs (13.1%), and milk (12.2%) were most commonly declared in precautionary statements. Allergen-free claims were present in 5.3% of the products and referred mostly on gluten and milk. In general, no statistically significant differences were identified between the nutritional composition of allergen-free claimed products and their equivalents. This study delivers an expanded BFCD that provides organised and detailed allergen information; new insights on the presence of food allergens in branded foods and issues of concern regarding allergen declaration that need to be addressed in order to improve label information

Clinical Course of Children with Chronic Suppurative Lung Disease or Bronchiectasis Infected with <i>Pseudomonas aeruginosa</i>

Children with chronic wet cough and without cystic fibrosis (non-CF) may suffer from chronic suppurative lung disease (CSLD) or bronchiectasis. Pseudomonas aeruginosa (Pa) can be one of the offending microbes in these children. The present study aimed to describe the clinical course of children with the above two conditions who were infected with Pa. Data of 54 children with CSLD/bronchiectasis who were diagnosed and attended in our department were retrospectively analysed through a Cox proportional hazard model, with age, presence of bronchiectasis, use of inhaled colistin, azithromycin, inhaled hypertonic saline as the covariates. In 42 of the 54 patients, there was no identifiable cause or underlying chronic disorder. Microbiological clearance was defined as the absence of daily wet cough for four months along with four negative cultures taken during the last four consecutive follow-up visits. Multivariate analysis was performed with a Cox proportional hazard model with time to microbiological clearance as the outcome. Results are described as Hazard Ratios (HR) with 95% Confidence Intervals (95%CI). Nebulised antibiotics and the presence of bronchiectasis were statistically significant predictors of remission (HR: 3.99; 95%CI: 1.12–14.14; p = 0.032, and HR: 0.24; 95%CI: 0.08–0.71; p = 0.010). In conclusion, the rate of microbiological clearance increases with the use of inhaled colistin and decreases when there is established bronchiectasis

Parental Education Moderates the Relation between Physical Activity, Dietary Patterns and Atopic Diseases in Adolescents

Background: Atopic diseases, particularly asthma, eczema, and rhinitis, are among the most common chronic diseases in childhood, with several factors implicated in their pathogenesis. Our study examined the role of parental education in the association between diet, physical activity, and atopy in adolescents. Methods: 1934 adolescents (47.5% boys) aged 13–14 years old reported information about their diet and physical activity and their parents reported their highest educational level. The moderating role of parental education level (primary/secondary vs. tertiary) in the relation between lifestyle patterns and atopic diseases was examined with logistic regression analyses. Results: High consumption of dairy products was inversely associated to adolescents’ asthma and rhinitis symptoms overall, but this relation was almost 50% stronger for the adolescents with high parental education level background. The same pattern of reduction of the odds was noticed also regarding the association among the high intake of fruits, vegetables, pulses, with all three atopic diseases and the adherence to a physically active lifestyle only with current asthma and eczema (all p &lt; 0.05). Conclusion: Adolescents who are physically active and consume a higher intake of fruits, vegetables, and pulses and a lower intake of fast-food and sweets, and their parents/guardians having higher education, are less likely to have any current symptoms of asthma, eczema, and rhinitis than the ones who have low educated parents