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

Tolerance and growth in children with cow's milk allergy fed a thickened extensively hydrolyzed casein-based formula

BACKGROUND: In case of cow’s milk allergy (CMA), pediatric guidelines recommend for children the use of extensively hydrolyzed formulas (eHFs) as elimination diet. According to the American Academy of Pediatrics, the hypoallergenicity of each specific eHF should be tested in subjects with CMA. METHODS: A prospective, multicenter trial was performed to assess the tolerance/hypoallergenicity of a thickened casein-based eHF (eHCF, Allernova AR®, United Pharmaceuticals, France) in infants aged <12 months with CMA proven by a double-blind placebo-controlled food challenge. Its efficacy, measured through allergy symptoms monitoring and Cow’s Milk-related Symptom Score (CoMiSS) calculation, and safety were evaluated during a 4-month feeding period. Growth z-scores were computed based on WHO anthropometric data. RESULTS: Thirty infants (mean age: 4.8 ± 3.0 months) with CMA proven by a DBPCFC tolerated the eHCF during the 4-month study. The CoMiSS, crying and regurgitation scores significantly decreased by 4.2 ± 4.0, 0.9 ±1.2 and 0.7 ± 1.1 respectively, after 14 days of feeding (p < 0.001). The Scoring Atopic Dermatitis index, of 33.2 ± 14.8 at inclusion in 9 patients, significantly decreased by 15.5 ± 6.7 and 21.1 ± 11.2, after 14 and 45 days of feeding, respectively (p < 0.001). The percentage of infants having normal stool consistency (soft or formed stools) significantly improved from 66.7 % (20/30) at inclusion to 90.0 % (27/30) after 14 days of feeding (p = 0.020). The growth z-scores, negative at study inclusion, significantly improved over the 4-month study. No adverse event was related to the eHCF. CONCLUSION: The thickened eHCF was tolerated by more than 90 % of included allergic infants with 95 % confidence interval and can therefore be considered as hypoallergenic in accordance with current guidelines. The improvement of growth indices and absence of related adverse events confirmed its safety. Results of this trial back the use of the tested thickened eHCF as an efficient and safe alternative in children with CMA. TRIAL REGISTRATION: ClinicalTrials.gov, number NCT02351531, registered on 27 January 2015 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12887-016-0637-3) contains supplementary material, which is available to authorized users

Commentary: Raw Cow Milk Consumption and Atopic March

We have appreciated the interest of Dr Baars et al. in our paper describing dietary prevention of atopic march (AM) in children affected by cow milk allergy (CMA) (1). They claimed a lack of information on raw cow milk (unpasteurized cow milk) in our paper. In support of this point, they mentioned the result of a pilot study involving nine CMA children (2) that were able to tolerate up to 50 mL of raw milk (about 1,750 mg of cow milk proteins). This result was not confirmed by a similar study where five children with IgE-mediated CMA were orally challenged in a double-blind fashion with raw untreated cow milk, pasteurized cow milk, and homogenized/pasteurized cow milk. An extensively hydrolysed casein formula served as placebo. All patients presented significant allergic reactions from the consumption of the above three types of milk, whereas no adverse reactions to placebo were observed. The authors concluded that children with CMA cannot tolerate raw or pasteurized milk (3). Although, selected components of raw milk may potentially influence the immune system, proof based on controlled studies in children are still lacking (4). The authors of the PARSIFAL study concluded that raw cow milk may contain numerous disease-causing pathogens and that consumption of raw milk cannot be recommended as a preventive measure for allergy (5). Accordingly, none of the claims made by the raw milk advocates (including the postulated preventive effect against allergy) withstand the FDA scientific scrutiny (6)

Food allergies: Novel mechanisms and therapeutic perspectives

Childhood food allergy (FA) rates have rapidly increased with significant direct medical costs for the health care system and even larger costs for the families with a food-allergic child. The possible causes of food allergy become the target of intense scrutiny in recent years. Increasing evidence underline the importance in early life of gut microbiome in the development of allergic diseases. There are a range of factors in the modern environment that may be associated with changes to both the gut microbiome and risk of FA, such as mode of delivery, antibiotic exposure, infant feeding practices, farming environment, and country of origin. Knowledge of the relationship between early life gut microbiome and allergic diseases may facilitate development of novel preventive and treatment strategies. Based on our current knowledge, there are no currently available approved therapies for food allergy. More studies are needed to evaluate the safety and efficacy of allergen-specific and allergen-nonspecific approaches, as well as combination approaches

Excretion of dietary cow’s milk derived peptides into breast milk

Nanoflow-HPLC-tandem mass spectrometry (MS/MS) was used to analyze the peptide fraction of breast milk samples collected from a single non-atopic donor on different days (ten samples) after receiving an oral load of cow’s milk (by drinking 200 mL of bovine milk). In addition, breast milk was sampled from the same lactating mother over a 6-h period at 5 time points after drinking cow’s milk. We aimed to trace the intra-individual variability and to define a time profile of the excretion of dietary peptides into breast milk. Overall, 21 peptides exclusively originating from both bovine caseins and whey proteins with no match within the human milk proteome were identified in the breast milk samples. These peptides were missing in the breast milk obtained from the mother after a prolonged milk- and dairy-free diet (three samples). The time course of cow’s milk-derived β-Lg f(125-135) and β-casein f(81-92) in breast milk

The Potential Immunonutritional Role of Parmigiano Reggiano Cheese in Children with Food Allergy

Parmigiano Reggiano (PR) is a ripened cheese with high nutritional value. Throughout ripening the bacteria contained in PR promote an extensive hydrolysis of cow’s milk proteins resulting in peptides that exhibit positive immunoregulatory activities. Additional modulatory activities on immune system are induced by butyrate, a short chain fatty acid widely expressed in PR. These findings suggest a possible immunonutritional role for PR able to stimulate oral tolerance in children with food allergy (FA)