Food Protein-Induced Enterocolitis Syndrome

Investigation of gut microbiota changes and allergic inflammation of mice with milk protein-induced allergic enteritis

This study aimed to investigate the changes of gut microbiota and allergic inflammation in mice with allergic enteritis caused by milk protein. In this study, female BALB\C mice in the whey protein (WP-sensitized) group were gavaged with WP and normal saline, the sham-sensitized group was given normal saline once a week for 5 weeks. One week later, the WP-sensitized mice were administered 60 mg β-lactoglobulin (BLG). The results showed that mice's body weight decreased, feces with loose and bloody, and systemic allergic reactions and ear swelling increased in the WP-sensitized group. The levels of WP-specific Ig, mMCP-1, calprotectin of feces, and inflammation-related factors in the WP-sensitized group were increased. WP-sensitized group intestine tissues were damaged severely and the expressions of ZO-1, Claudin-1, and Occludin reduced. The results of 16S rRNA sequencing showed that there were differences in operational taxonomic units (OUT) levels of gut microbes between the two groups, o_Clostridiales, c_Clostridia, and f_Lachnospiraceae were more abundant in the WP-sensitized group. In conclusion, the WP sensitization can induce the allergic inflammation, intestinal injury and intestinal barrier dysfunction in mice, and the gut microbes were also changed, which provided a reference for the treatment of WP-sensitized mice.

Evaluation and Management of Food Allergies in the Emergency Department

Food allergies are a common and serious cause of illness, accounting for an increasing number of emergency department visits annually. Although definite diagnosis lays outside of an emergency department visit, the clinical management of the most serious food allergies highlights emergency care. The staple of acute care remains epinephrine in association with antihistamines and steroids. The greatest threat remains undertreatment for this group of disorders and underutilization of epinephrine. Those who have been treated for a food allergy need a follow-up allergist evaluation, guidance of food avoidance, and avoidance of foods with cross-sensitivities as well as ready access to epinephrine.

Evaluation and Management of Food Allergies in the Emergency Department

Food allergies are a common and serious cause of illness, accounting for an increasing number of emergency department visits annually. Although definite diagnosis lays outside of an emergency department visit, the clinical management of the most serious food allergies highlights emergency care. The staple of acute care remains epinephrine in association with antihistamines and steroids. The greatest threat remains undertreatment for this group of disorders and underutilization of epinephrine. Those who have been treated for a food allergy need a follow-up allergist evaluation, guidance of food avoidance, and avoidance of foods with cross-sensitivities as well as ready access to epinephrine.

Intranasal delivery of allergen in a nanoemulsion adjuvant inhibits allergen-specific reactions in mouse models of allergic airway disease

BACKGROUND

Atopic diseases are an increasing problem that involve both immediate hypersensitivity reactions mediated by IgE and unique cellular inflammation. Many forms of specific immunotherapy involve the administration of allergen to suppress allergic immune responses but are focused on IgE-mediated reactions. In contrast, the effect of allergen-specific immunotherapy on allergic inflammation is complex, not entirely consistent and not well understood. We have previously demonstrated the ability of allergen administered in a nanoemulsion (NE) mucosal adjuvant to suppress IgE-mediated allergic responses and protect from allergen challenge in murine food allergy models. This activity was associated with decreases in allergen-specific IL-10 and reductions in allergic cytokines and increases in regulatory T cells.

OBJECTIVE

Here, we extend these studies to using 2 distinct models, the ovalbumin (OVA) and cockroach (CRA) models of allergic airway disease, which are based predominantly on allergic inflammation.

METHODS

Acute or chronic allergic airway disease was induced in mice using ovalbumin and cockroach allergen models. Mice received three therapeutic immunizations with allergen in NE, and reactivity to airway challenge was determined.

RESULTS

Therapeutic immunization with cockroach or OVA allergen in NE markedly reduced pathology after airway challenge. The 2 models demonstrated protection from allergen challenge-induced pathology that was associated with suppression of Th2-polarized immune responses in the lung. In addition, the reduction in ILC2 numbers in the lungs of allergic mice along with reduction in epithelial cell alarmins, IL-25 and IL-33, suggests an overall change in the lung immune environment induced by the NE immunization protocol.

CONCLUSIONS AND CLINICAL RELEVANCE

These results demonstrate that suppression of allergic airway inflammation and bronchial hyper-reactivity can be achieved using allergen-specific immunotherapy without significant reductions in allergen-specific IgE and suggest that ILC2 cells may be critical targets for this activity.

Effects of curd on diarrhea treatment in patients with head trauma receiving enteral feeding in intensive care units

BACKGROUND: Diarrhea in patients on enteral feeding is a common complication with serious clinical outcomes. In Eastern and Southern Mediterranean regions, using curd as a food for the treatment of diarrhea is a common practice. OBJECTIVE: This study aimed to investigate whether curd could reduce the duration or severity of diarrhea in critically ill tube-fed patients with head trauma. METHODS: A total of 42 patients on enteral feeding who had diarrhea after starting enteral feeding, admitted to the intensive care unit, were randomly assigned to either to receiving curd and standard enteral formula or standard enteral formula only groups. The intervention period for each patient was three days. The primary outcome was the duration of diarrhea, while the secondary outcomes were the frequency and weight of stool per day in each patient. RESULTS: This study showed a significantly higher stool weight in patients receiving enteral curd (588.76±266.88 vs 390.60±171.82 gr/day). There was no significant difference between the groups in duration of diarrhea (9 v 8 days) and episodes of diarrhea per day (2.20±1.00 vs 2.00±0.70) in intervention and control groups. incidence of liquid or loose stools on days 1–4 of the intervention (P1 = 0.43, P2 = 0.16, P3 = 0.45, P4 = 0.62). Feeding with curd did not change the APACHE score in intervention and control groups. This study showed no significant difference in 28 days of mortality in intervention and control groups. CONCLUSION: The findings showed that supplementary enteral feeding with curd did not improve diarrhea, the severity of the disease, or 28 days mortality in critically ill patients with diarrhea receiving enteral nutrition.

Non-IgE-mediated food allergy: Evaluation and management

The most common types of non-IgE-mediated food allergy are food protein-induced enterocolitis syndrome (FPIES) and food protein-induced allergic proctocolitis (FPIAP). FPIES presents with delayed refractory emesis, while FPIAP presents with hematochezia in otherwise healthy infants. Acute management of FPIES includes rehydration or ondansetron, or both. No acute management is required for FPIAP. Long-term management of both disorders includes avoidance of the trigger food. The prognosis for both conditions is a high rate of resolution within a few years' time.

L'évaluation et la prise en charge des allergies alimentaires non induites par les IgE

Le syndrome d'entérocolite induite par les protéines alimentaires et la proctocolite allergique induite par les protéines alimentaires sont les principaux types d'allergies alimentaires non induites par les immunoglobines E. Le syndrome d'entérocolite induit par les protéines alimentaires se manifeste par des vomissements réfractaires tardifs, tandis que la proctocolite allergique induite par les protéines alimentaires se révèle par une hématochézie chez des nourrissons autrement en santé. La prise en charge immédiate du syndrome d'entérocolite induite par les protéines alimentaires inclut la réhydratation, l'ondansétron ou ces deux traitements, mais est inutile pour soigner la proctocolite allergique induite par les protéines alimentaires. À long terme, il faut éviter l'aliment déclencheur pour prendre en charge ces deux affections, dont le pronostic est un fort taux de résolution au bout de quelques années.

Infant anaphylaxis: Diagnostic and treatment challenges

Immediate administration of intramuscular epinephrine to a patient experiencing anaphylaxis is the first-line therapy for this life-threatening allergic reaction. Alhough anaphylaxis is generally a rare occurrence, it has dire consequences if left untreated. In infants, anaphylaxis is typically triggered by exposure to egg, cow's milk, or peanuts. The rapid onset of symptoms in multiple organ systems makes an accurate diagnosis in infants difficult because there are numerous ways in which anaphylaxis may present. The symptoms of infant anaphylaxis are often underrecognized or misdiagnosed for less serious illnesses or even normal findings, including drooling, loose stools, and irritability. Because infants are mostly nonverbal-and most pediatric emergency department visits for anaphylaxis cases are the first diagnosis-ascertaining potential exposure to common allergens is difficult; this further complicates diagnosis in these youngest patients for whom the clinical presentation of anaphylaxis varies widely. A key factor in diagnosing anaphylaxis is the temporal profile of symptom development following allergen exposure; however, some children with anaphylaxis develop symptoms that reoccur hours or days after an initial anaphylactic reaction, making diagnosis challenging. Advanced practice nurses are often the first health care provider to encounter a patient who may be experiencing anaphylaxis. Although diagnostic criteria exist for anaphylaxis, specific criteria for the diagnosis of anaphylaxis in infants have not been developed. As such, it is important to understand and recognize the variable presentation of anaphylaxis in infants and to rapidly diagnose and treat with epinephrine.

Seeds

A wide variety of plant species provide edible seeds. Seeds are the dominant source of human calories and protein. The most important and popular seed food sources are cereals, followed by legumes and nuts. Their nutritional content of fiber, protein, and monounsaturated/polyunsaturated fats make them extremely nutritious. They are important additions to our daily food consumption. When consumed as part of a healthy diet, seeds can help reduce blood sugar, cholesterol, and blood pressure.

Necrotizing enterocolitis comes in different forms: Historical perspectives and defining the disease

The specific cause of what is commonly referred to as necrotizing enterocolitis (NEC) disease has been elusive largely because it is becoming clear that this entity represents more than one disease with multifactorial pathogenic mechanisms. Furthermore, finding clear and consistent diagnostic biomarkers will be difficult until the different subsets of what we are calling this disease are better delineated. In this introductory chapter, we discuss different disease entities that are frequently termed "NEC" in the newborn infant. We hope this will set the stage for more focused research and development of preventative measures for at least the most common forms of this disease.