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Skypala IJ, Reese I, Durban R, Hunter H, Podesta M, Chaddad MCC, Santos AF, Agache I. Food allergy-A holistic approach to dietary management. A joint EAACI Research & Outreach Committee and INDANA review. Pediatr Allergy Immunol 2023; 34:e14019. [PMID: 37747742 DOI: 10.1111/pai.14019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023]
Abstract
Following a diagnosis of IgE-mediated food allergy, to secure the best outcome, the patient should receive individualized advice tailored to their specific needs, which considers the type and presentation of the food involved, level of exclusion required, risk of cross-contamination and any variance required for age, ethnicity, financial issues, and lifestyle. Issues such as food labels "may contain" statements, and variation in the threshold of reaction and impact of cofactors should also be considered. Most important is the need to ensure that the diagnosis is robust, especially given the nutritional, psychological, and socioeconomic issues that can affect an individual with a diagnosis of food allergy. Unnecessary exclusion of one or more foods that have not triggered allergic reactions, especially in individuals with allergic comorbidities, can result in severe IgE-mediated reactions on re-exposure. Given that food allergies may change over time, the diagnosis should be reviewed, to determine whether resolution is likely, or new-food triggers are reported. Regular assessment is vital, especially during childhood, to ensure reintroduction occurs at an appropriate time, thus enabling increased diversity of the diet and improvement in the quality of life. For some, an IgE-mediated food allergy may necessitate the life-long exclusion of foods, and for others, a food habitually eaten suddenly triggers an allergic reaction in adult life. People of all ages, ethnicities, and socioeconomic backgrounds deserve individual advice on the management of their food allergy to support a healthy diet and improve quality of life.
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Affiliation(s)
- Isabel J Skypala
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield Hospitals, part of Guys & St Thomas NHS Foundation Trust, London, UK
- Inflammation, Repair & Development Section, National Heart & Lung Institute, Imperial College, London, UK
| | - Imke Reese
- Nutritional Counseling and Therapy, Focus on Allergology, Munich, Germany
| | - Raquel Durban
- Carolina Asthma & Allergy Center, Charlotte, North Carolina, USA
| | - Hannah Hunter
- Department of Allergy, Guys & St Thomas NHS Foundation Trust, London, UK
- Kings College, London, UK
| | | | | | - Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
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Vlieg-Boerstra B, Groetch M, Vassilopoulou E, Meyer R, Laitinen K, Swain A, Durban R, Benjamin O, Bottse R, Grimshaw K, Netting M, O'Manony L, de Jong N, Skypala IJ. The immune-supportive diet in allergy management. A narrative review and proposal. Allergy 2023. [PMID: 36802268 DOI: 10.1111/all.15687] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/27/2023] [Accepted: 02/17/2023] [Indexed: 02/23/2023]
Abstract
The role of nutrition is increasingly recognized in the management of chronic immune diseases. However, the role of an immune-supportive diet as adjuvant therapy in the management of allergic disease has not been similarly explored. This review assesses the existing evidence for a relationship between nutrition, immune function, and allergic disease from a clinical perspective. In addition, the authors propose an immune-supportive diet to enhance dietary interventions and complementing other therapeutic options for allergic disease from early life to adulthood. A narrative review of the literature was conducted, to determine the evidence of the relationship between nutrition and immune function, overall health, epithelial barrier function, and gut microbiome, particularly in relation to allergy. Studies on food supplements were excluded. The evidence was assessed and utilized to develop a sustainable immune-supportive diet to complement other therapies in allergic disease. The proposed diet consists of a highly diverse range of fresh, whole and minimally processed plant-based and fermented foods supplemented with moderate amounts of nuts, omega-3 rich foods and animal-based products in proportional amounts of the EAT-Lancet diet, such as (fatty) fish, (fermented) milk products which may be full-fat and eggs, lean meat or poultry, which may be free-range or organic.
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Affiliation(s)
- Berber Vlieg-Boerstra
- OLVG Hospital, department of Paediatrics, Amsterdam, the Netherlands.,Rijnstate Hospital, Rijnstate Allergy Centre, Arnhem, The Netherlands.,Vlieg Dieticians, Private Practice for dietary management of food allergy, Arnhem, Amsterdam, the Netherlands
| | - Marion Groetch
- Pediatric Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Rosan Meyer
- Imperial College, Department Paediatrics, London, UK.,Winchester University, Department Dietetics, UK
| | - Kirsi Laitinen
- Institute of Biomedicine & Functional Foods Forum, University of Turku, Turku, Finland
| | - Anne Swain
- Allergy Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Raquel Durban
- Carolina Asthma & Allergy Center, Charlotte, NC, USA
| | - Olga Benjamin
- OLVG Hospital, department of Paediatrics, Amsterdam, the Netherlands.,Hospital Group Noord West, location Alkmaar, department of Paediatrics, Alkmaar, the Netherlands
| | - Rachelle Bottse
- Vlieg Dieticians, Private Practice for dietary management of food allergy, Arnhem, Amsterdam, the Netherlands
| | | | - Merryn Netting
- Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), North Adelaide, South Australia, Australia.,Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Nutrition, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Liam O'Manony
- APC Microbiome Ireland, National University of Ireland, Cork, Ireland.,Department of Medicine, National University of Ireland, Cork, Ireland.,School of Microbiology, National University of Ireland, Cork, Ireland
| | - Nicolette de Jong
- Internal Medicine, Allergology & Clinical Immunology, Paediatric Allergology, University Medical Centre Rotterdam, the Netherlands.,Sophia Children Hospital Erasmus MC, University Medical Centre Rotterdam, the Netherlands
| | - Isabel J Skypala
- Imperial College, Department Paediatrics, London, UK.,Royal Brompton & Harefield Hospitals, part of Guys & St Thomas' NHS Foundation Trust, London, UK
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Durban R, Groetch M, Meyer R, Coleman Collins S, Elverson W, Friebert A, Kabourek J, Marchand SM, McWilliam V, Netting M, Skypala I, Van Brennan T, Vassilopoulou E, Vlieg-Boerstra B, Venter C. Dietary Management of Food Allergy. Immunol Allergy Clin North Am 2021; 41:233-270. [PMID: 33863482 DOI: 10.1016/j.iac.2021.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Worldwide food allergy prevalence is increasing, especially in children. Food allergy management strategies include appropriate avoidance measures and identifying suitable alternatives for a nutritionally sound diet. Individualized dietary intervention begins teaching label reading, which differs among countries or regions. Dietary intervention must result in a nutritionally sound plan including alternatives to support optimal growth and development. Inappropriate or incomplete dietary advice may increase the risk of adverse reactions, growth faltering, and nutrient deficiencies. Evidence indicates input from a registered dietitian improves nutritional outcomes. Nutritional input plays a critical role managing nutritional disorders related to food allergy.
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Affiliation(s)
- Raquel Durban
- Carolina Asthma & Allergy Center, 2600 E 7th St unit a, Charlotte, NC 28204, USA
| | - Marion Groetch
- Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1198, New York, NY 10029, USA
| | - Rosan Meyer
- Department of Pediatrics, Imperial College, London, UK
| | | | - Wendy Elverson
- Boston Children's Hospital Center for Nutrition, 333 Longwood Avenue, 4th floor, Boston, MA 02115, USA
| | - Alyssa Friebert
- Allergy and Immunology Clinic, 13123 East 16th Avenue Box 270, Aurora, CO 80045, USA
| | - Jamie Kabourek
- University of Nebraska-Lincoln, Food Innovation Center, Room 279c, 1901 North 21 Street, Lincoln, NE 68588, USA
| | - Stephanie M Marchand
- Department of Pediatrics, The Warren Alpert School of Medicine at Brown University, 593 Eddy Street, Providence, RI 02903, USA; Food and Nutrition Services, Hasbro Children's Hospital, 593 Eddy Street, Providence, RI 02903, USA
| | - Vicki McWilliam
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Merryn Netting
- Women and Kids Theme, South Australian Health and Medical Research Institute, 72 King William Road, North Adelaide, South Australia 5006, Australia; Department of Pediatrics, University of Adelaide, Adelaide, South Australia, Australia; Nurition Department, Women's and Children's Health Network, North Adelaide 5006, South Australia, Australia
| | - Isabel Skypala
- Imperial College, London, UK; Department of Allergy and Clinical Immunology, Royal Brompton & Harefield NHS Foundation Trust, Royal Brompton Hospital, 4th Floor Fulham Wing, Sydney Street, London SW3 6NP, UK
| | - Taryn Van Brennan
- Children's Hospital of Colorado, 13123 East 16th Avenue Box B518 Anschutz Medical Campus, Aurora CO 80045, USA
| | - Emillia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki 57400, Greece
| | - Berber Vlieg-Boerstra
- Department of Pediatrics, OLVG Hospital, PO Box 95500, Amsterdam 1090HM, The Netherlands
| | - Carina Venter
- Children's Hospital of Colorado, 13123 East 16th Avenue Box B518 Anschutz Medical Campus, Aurora CO 80045, USA.
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Groetch M, Baker MG, Durban R, Meyer R, Venter C, Muraro A. The practical dietary management of food protein-induced enterocolitis syndrome. Ann Allergy Asthma Immunol 2021; 127:28-35. [PMID: 33757808 DOI: 10.1016/j.anai.2021.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobulin E-mediated food allergy with potential risk of malnutrition related to the early onset of disease, frequent avoidance of cow's milk, and the possibility of multiple food triggers. This publication is aimed at providing an evidence-based, practical approach to the dietary management of FPIES. DATA SOURCES This is a narrative review summarizing information from national and international guidelines, retrospective studies, population studies, review articles, case reports, and case series to evaluate for nutritional risk and develop guidance for risk reduction in children with FPIES. STUDY SELECTIONS We have included retrospective clinical cohort studies, population-based studies, case reports, and case studies. We did not exclude any studies identified owing to the small number of studies addressing the nutritional management of individuals with FPIES. RESULTS Children with FPIES are at risk of malnutrition owing to suboptimal oral intake, limited food choices, and knowledge deficits related to feeding. In particular, children with 3 or more FPIES triggers seem to be at increased risk for poor weight gain and developing food aversion. Caregivers of children with FPIES also report a high degree of psychosocial burden. CONCLUSION Appropriate dietary management entails the following 3 essential components: supporting normal growth and development, avoidance of allergens, and advancement of complementary foods. Education to avoid the trigger food and assisting caregivers in creating an individualized, well-designed complementary feeding plan to meet the infant's nutritional needs for optimal growth and development are essential management strategies.
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Affiliation(s)
- Marion Groetch
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Mary Grace Baker
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raquel Durban
- Asthma & Allergy Specialists, Charlotte, North Carolina
| | - Rosan Meyer
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Carina Venter
- Section of Pediatric Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Antonella Muraro
- Food Allergy Referral Centre, Department of Woman and Child Health, Padua University Hospital, Padua, Italy
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Groetch M, Durban R, Meyer R, Venter C, Nowak-Wegrzyn A. Dietary management of food protein-induced enterocolitis syndrome during the coronavirus disease 2019 pandemic. Ann Allergy Asthma Immunol 2020; 126:124-126. [PMID: 32387534 PMCID: PMC7202833 DOI: 10.1016/j.anai.2020.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Marion Groetch
- Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Raquel Durban
- Asthma & Allergy Specialists Professional Association, Charlotte, North Carolina
| | - Rosan Meyer
- Department of Paediatrics, Imperial College, London, United Kingdom
| | - Carina Venter
- Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Anna Nowak-Wegrzyn
- Allergy and Immunology, Department of Pediatrics, Hassenfeld Children's Hospital, New York University School of Medicine, New York, New York; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
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Jensen ET, Huang KZ, Chen HX, Landes LE, McConnell KA, Almond MA, Safta A, Johnston DT, Durban R, Jobe L, Frost C, Donnelly S, Antonio B, Quiros JA, Markowitz JE, Dellon ES. Longitudinal Growth Outcomes Following First-line Treatment for Pediatric Patients With Eosinophilic Esophagitis. J Pediatr Gastroenterol Nutr 2019; 68:50-55. [PMID: 30074576 PMCID: PMC6449848 DOI: 10.1097/mpg.0000000000002114] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES No formal comparative effectiveness studies have been conducted to evaluate the effect of eosinophilic esophagitis (EoE) treatment choice on long-term growth in pediatric patients. Long-term studies of inhaled corticoid steroids in asthma, however, suggest possible effects on linear growth. The aim of this study was to compare longitudinal, anthropometric growth in children with EoE according to treatment approach. METHODS We conducted a retrospective, multicenter cohort study of anthropometric growth (height and body mass index [BMI] z scores) in pediatric (<18 years of age) patients newly diagnosed with EoE across 5 clinical sites between 2005 and 2014. We compared differences in growth according to treatment approach over a 12-month period. Modification by sex and age was examined and sensitivity analyses were conducted to assess robustness of results given study assumptions. RESULTS In the 409 patients identified, the mean age and proportion male differed by treatment (P = < 0.01 and P = 0.04, respectively). Baseline growth measures were associated with slight impairment of height at diagnosis (median baseline height z score of -0.1 [interquartile range -0.9, 0.8]). In general, treatment approach was not associated with any significant increase or decrease in expected growth over a 12-month period. Subtle decrease in linear growth was observed with treatment using a combined elemental and topical steroid (Δ height z score [adjusted]: -0.04; 95% confidence interval [CI]: -0.08, -0.01). Differences in linear growth differed by sex (P for interaction <0.01). For elemental formula in combination with topical steroids, only girls exhibited a significant decline in linear growth (Δ height z score [adjusted]: -0.24; 95% CI: -0.32, -0.17). A slight reduction in BMI was observed for patients treated with a combination of elemental diet and dietary elimination (Δ BMI z score [adjusted]: -0.07; 95% CI: -0.13, -0.01). CONCLUSIONS Treatment of EoE, in general, is not associated with major anthropometric growth changes in most pediatric patients. Slight linear growth impairment was observed for topical steroid treatment, and sex differences in growth by treatment approach were observed. Future prospective studies should evaluate the effect of treatment on optimal growth and development and over a longer period of follow-up.
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Affiliation(s)
- Elizabeth T. Jensen
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Kevin Z. Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Hannah X. Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Lisa Englander Landes
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Kristen A McConnell
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - M. Angie Almond
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Anca Safta
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | | | | | - Laura Jobe
- University of South Carolina School of Medicine, Greenville, SC
- Greenvile Children’s Hospital; Greenville, SC
| | | | - Sarah Donnelly
- Pediatric Gastroenterology and Nutrition, MUSC Children’s Hospital, Charleston, SC
| | - Brady Antonio
- Pediatric Gastroenterology and Nutrition, MUSC Children’s Hospital, Charleston, SC
| | - J. Antonio Quiros
- Pediatric Gastroenterology and Nutrition, MUSC Children’s Hospital, Charleston, SC
| | - Jonathan E. Markowitz
- University of South Carolina School of Medicine, Greenville, SC
- Greenvile Children’s Hospital; Greenville, SC
| | - Evan S. Dellon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
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Huang KZ, Jensen ET, Chen HX, Landes LE, McConnell KA, Almond MA, Johnston DT, Durban R, Jobe L, Frost C, Donnelly S, Antonio B, Safta AM, Quiros JA, Markowitz JE, Dellon ES. Practice Pattern Variation in Pediatric Eosinophilic Esophagitis in the Carolinas EoE Collaborative: A Research Model in Community and Academic Practices. South Med J 2018; 111:328-332. [PMID: 29863219 DOI: 10.14423/smj.0000000000000817] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Differences in the initial management of pediatric eosinophilic esophagitis (EoE) by practice setting have not been well characterized. We aimed to characterize these differences for sites in the Carolinas EoE Collaborative (CEoEC), a multicenter network of academic and community practices. METHODS We performed a retrospective cohort study of pediatric EoE patients at five CEoEC sites: University of North Carolina (UNC) Hospital, Charlotte Asthma and Allergy Specialists, Greenville Health Systems, Wake Forest Baptist Medical Center, and the Medical University of South Carolina Hospital. Cases of EoE were defined by consensus guidelines. Data were extracted from electronic medical records. We tested for differences among sites and used a multinomial model (polytomous regression) to assess associations between treatment and site, adjusting on patient factors. RESULTS We identified 464 children with EoE across the CEoEC sites. The median age was highest at Wake Forest (11.4 years), the median eosinophil count was highest at UNC (69 eos/hpf), and UNC had the most male patients (82%). UNC used topical steroids for initial treatment in 86% of cases, compared with <1% in Greenville (P < 0.01). Greenville used dietary elimination more frequently than UNC (81% vs 2%, P < 0.01). Differences in treatment approach held after adjusting for potential baseline confounders. There was no significant association between patient factors and initial treatment approach. CONCLUSIONS Significant differences in EoE patient factors and treatment approaches were identified across CEoEC sites and were not explained by patient or practice factors. This suggests that institutional or provider preferences drive initial treatment approaches, and that more data are needed to drive best practice decisions.
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Affiliation(s)
- Kevin Z Huang
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Elizabeth T Jensen
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Hannah X Chen
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Lisa E Landes
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Kristen A McConnell
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - M Angie Almond
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Douglas T Johnston
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Raquel Durban
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Laura Jobe
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Carrie Frost
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Sarah Donnelly
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Brady Antonio
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Anca M Safta
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - J Antonio Quiros
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Jonathan E Markowitz
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Evan S Dellon
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
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Groetch M, Venter C, Skypala I, Vlieg-Boerstra B, Grimshaw K, Durban R, Cassin A, Henry M, Kliewer K, Kabbash L, Atkins D, Nowak-Węgrzyn A, Holbreich M, Chehade M. Dietary Therapy and Nutrition Management of Eosinophilic Esophagitis: A Work Group Report of the American Academy of Allergy, Asthma, and Immunology. J Allergy Clin Immunol Pract 2017; 5:312-324.e29. [PMID: 28283156 DOI: 10.1016/j.jaip.2016.12.026] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/21/2016] [Indexed: 12/16/2022]
Abstract
Eosinophilic esophagitis (EoE) is a chronic/immune-antigen-mediated disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. Dietary elimination therapy has been shown to be an effective, drug-free prescription for the treatment of EoE. A range of different dietary elimination therapies have been used. Regardless of the elimination diet chosen, dietary therapy requires in-depth nutrition assessment and management. Elimination diets are not without risk and may impact nutritional status, eating pleasure, and overall quality of life. With adequate guidance, dietary therapy can be effective and nutritionally balanced, and the adverse impact on lifestyle can be minimized. This work group report addresses the potential challenges of implementing an elimination diet for the management of EoE and provides instructions and tools for physicians, dietitians, and other allied health professionals to help guide them in planning elimination diets for both children and adults.
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Affiliation(s)
- Marion Groetch
- Division of Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Carina Venter
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Isabel Skypala
- Allergy Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK; Department of Paediatrics, Imperial College, London, UK
| | - Berber Vlieg-Boerstra
- Onze lieve Vrouwe Gasthuis (OLVG), Department of Paediatrics, Amsterdam, The Netherlands
| | - Kate Grimshaw
- Department of Nutrition and Dietetics, Southampton's Children's Hospital, Southampton, UK; Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Raquel Durban
- Division of Food Allergy, Asthma and Allergy Specialists, PA, Charlotte, NC
| | - Alison Cassin
- Division of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michelle Henry
- Department of Medical Affairs, Fresenius Kabi USA, LLC, Lake Zurich, Ill
| | - Kara Kliewer
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lynda Kabbash
- Department of Internal Medicine, Harvard Medical School, Boston, Mass; Department of Internal Medicine, New England Baptist Hospital, Boston, Mass
| | - Dan Atkins
- Gastrointestinal Eosinophilic Diseases Program and Allergy & Immunology Section, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Anna Nowak-Węgrzyn
- Division of Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Mirna Chehade
- Departments of Pediatrics and Medicine, Mount Sinai Center for Eosinophilic Disorders, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Gella FJ, Olivella T, Cruz Pastor M, Arenas J, Moreno R, Durban R, Gomez JA. A simple procedure for the routine determination of aspartate aminotransferase and alanine aminotransferase with pyridoxal phosphate. Clin Chim Acta 1985; 153:241-7. [PMID: 4075530 DOI: 10.1016/0009-8981(85)90358-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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