Associations have been shown between concurrent assessment of dietary intake of advanced glycation end products (AGEs) and childhood allergic outcomes. We examined the association between maternal AGEs intake and development of offspring asthma, wheeze, atopic dermatitis, allergic rhinitis and food allergies, and sought to determine whether the intake of AGEs was associated with cord sera cytokines/chemokines.Pregnant women ≥16 years were recruited in the Healthy Start study, a prospective pre-birth cohort from Colorado (N = 1410). The analysis included 962 dyads with adequate diet (≥2 recalls) and allergy outcome details. AGEs intake was estimated for each mother by matching intakes reported using 24-h dietary recalls during pregnancy to a reference database of commonly consumed foods' AGEs values. Child diagnoses of asthma and allergies up to 8 years were obtained from electronic medical records. Cord sera cytokines and chemokines were analysed in a subset (N = 462) of children.The median [IQR] AGEs intake for the overall sample was 11,919 kU/day [8293, 16,573]. Unadjusted analysis showed a positive association between maternal AGEs intake in pregnancy and rhinitis up to 8 years of age (HR = 1.03; 95% CI: 1.01, 1.06), but the association was attenuated and no longer significant in adjusted models (HR = 1.01; 95% CI: 0.98, 1.04). Both adjusted and unadjusted models showed no associations between AGEs intake in pregnancy and any of the other outcomes (p > .05). There were no significant associations between any cytokine or chemokine measured and AGEs intake or any of the outcomes studied (p > .05).The study showed that maternal AGEs intake was not associated with offspring asthma and allergy outcomes. AGEs exposure during pregnancy may not have the same impact on child development as postnatal exposure.
Food hypersensitivity (FHS) is the umbrella term used for food allergies that involve the immune system and food intolerances that do not involve the immune system. FHS has a huge impact on quality of life and any dietary advice given should aim to minimise this effect. Despite many advances made in diagnosing and managing patients with FHS, the cornerstone of management still remains avoidance of the relevant food. However, a commonly-presenting dilemma in clinical practice is deciding to what extent the food(s) should be avoided. The level of avoidance required is currently based on the type of FHS the patient has, characteristics of the particular food protein and the natural history of the particular FHS. In addition to management of other FHS, management of cow's milk allergy requires the healthcare professional to choose the appropriate formula. Information required by the patient also includes understanding food labels and issues surrounding cross-contamination. In order to ensure that the diet is nutritionally sound, advice should be given about suitable food choices and following a healthy balanced diet, whilst taking into account the dietary restrictions. Practical issues that need to be addressed include going on holiday, travelling and eating away from home. The dietitian plays a crucial role in this process. At present, there are no standardised documents or protocols for the management of FHS and practices differ within and between countries. If adrenaline auto-injectors are prescribed, correct administration should be demonstrated and reviewed on an ongoing basis.
Abstract Nutritional intake during infancy is a critical aspect of child development and health that is of significant public health concern. Although there is extensive research on breast-feeding and timing of solid food introduction, there is less evidence on types of solid foods fed to infants, specifically commercially prepared infant foods. The consumption of commercially prepared infant foods is very prevalent in many developed countries, exceeding the consumption of homemade foods in some situations. Although these food products may have practical advantages, there are concerns about their nutritional composition, sweet taste, bioavailability of micronutrients, diversity of ingredients and long-term health effects. The extent that the manufacturing, fortification and promotion of these products are regulated by legislation varies between countries and regions. The aim of the present narrative review is to investigate, appraise and summarise these aspects. Overall there are very few studies directly comparing homemade and commercial infant foods and a lack of longitudinal studies to draw firm conclusions on whether commercial infant foods are mostly beneficial or unfavourable to infant health.
Abstract Background Filaggrin (FLG) loss‐of‐function mutations in children and maternal diet in pregnancy have been implicated in child allergy outcomes. This paper studies the questions: “do FLG mutations modify the effect of maternal diet on the odds of development of allergic diseases?” and “which factor leads to the highest rate of diagnosis allergic diseases over time, maternal diet, or FLG mutations?”. Methods Exact logistic regressions studied effect modification. Cox proportional hazard models compared the rate of allergic disease development in three groups ( N = 624): (1) children with FLG mutation, (2) children without FLG mutation whose mothers did not eat an allergy preventive diet, and (3) children without FLG mutation whose mothers ate an allergy preventive diet. Maternal diet was classified using a validated index. Results Cox models showed the development of atopic dermatitis, asthma, and wheeze was significantly higher for children in group 1 versus 3 (HR = 2.40 [1.32, 4.37], HR = 2.29 [1.05, 4.97], and HR 2.10 [1.004, 4.38], respectively), but not significantly higher for children in group 1 versus 2 (HR = 1.30 [0.74, 2.29], HR = 1.27 [0.61, 2.63], and HR = 1.29 [0.65, 2.58], respectively). Development of allergic rhinitis was significantly higher for group 1 versus 2 and 3 (1 vs. 2: HR = 2.29 [1.10, 4.76]; 1 vs. 3: HR = 3.21 [1.46, 7.08]). There was no significant effect modification for any outcome. Conclusion Children with FLG mutation had similar risk of atopic dermatitis, asthma, and wheeze as children without an FLG mutation whose mothers did not eat an allergy preventive diet during pregnancy. Child FLG mutation did not modify the effect of maternal diet. The results suggest that maternal diet in pregnancy, a modifiable risk factor, could be a target for preventive interventions.
Postoperative patients' risk for developing venous thromboembolism (VTE) can be predicted using the adapted Caprini risk assessment model which informs administration of postoperative VTE prophylaxis. The study aimed to assess the appropriateness of postoperative VTE prophylaxis of patients according to the adapted Caprini scores and investigate whether a patient's HIV status influenced postoperative VTE prophylaxis administration. This cohort study included patients who had elective or urgent surgery at a tertiary hospital, Bloemfontein. Data from patient files were captured on datasheets that comprised the adapted Caprini risk assessment model. The type of prophylaxis received was noted. The appropriateness of the prophylaxis prescribed was compared with the patient's score. Details of 147 patients were included. Three of the 16 patients who did not qualify for prophylaxis, were on VTE prophylaxis on day-one post-surgery. Only 24 (18.3%) of the 131 patients who qualified for prophylaxis were on prophylaxis one day post-surgery. Of the prophylaxis prescribed, 88.5% was enoxaparin, and 11.5% "other", mainly aspirin. Twenty-three (17.6%) patients who qualified for prophylaxis were discharged on prophylaxis. Of the 147 patients, 24 patients were HIV positive, and eight of these patients received postoperative VTE prophylaxis. The majority of postoperative patients at the various surgical departments of the hospital did not receive appropriate postoperative VTE prophylaxis compared to the adapted Caprini scores obtained from their medical information. A patient's HIV status alone did not influence the decision of administering postoperative VTE prophylaxis.
It is well known that many aspects of food allergy are lacking sufficient research and publication. Practising evidence-based medicine in this field is, therefore, a particular challenge. Internationally, there is considerable variation in practices and no agreed treatment pathways. The time was right to review the evidence and seek the views of experts in the field, industry and food allergic individuals to develop guidance for clinical practice and to plan future research. The purpose of this review was to summarize points of agreement and discrepancy in the recently published Diagnosis and Rationale for Action against Cow's Milk Allergy, US NIAID and UK NICE guidelines.The publication of the three guideline documents on food allergies gives clinicians, scientists, industry, governments and patients the opportunity to review the information in a concise format and appreciate the role of clinical expertise in decision making. The guidelines covered all aspects of food allergy: prevalence and natural history, diagnosis, management and treatment and other aspects such as vaccinations.The guidelines summarized not only our current evidence base but also gaps in our knowledge. Use of these guidelines would facilitate high quality standardized care and indicate the direction of future research.
The term ‘Cow’s Milk Allergy’ (CMA) is used in this guidance, although the term ‘Cow’s Milk Protein Allergy’ (CMPA) is also widely used in the literature.
CMA is the commonest food allergy among children in the UK. Data from 2008 indicated 2.3% of 1–3 year-olds in the UK suffer from CMA.1 In 2011, National Institute for Health and Care Excellence (NICE) published Clinical Guideline (CG)116 on the Diagnosis and Assessment of Food Allergy in Children and Young People in Primary Care and Community Settings.2 It has become increasingly evident that for effective implementation, there needs to be further practical advice, which was outside of the scope of the current NICE guideline, on establishing the initial diagnosis and the further management of infants with CMA.
A health economic analysis published in 2010 concluded that CMA imposes a, ‘substantial burden on the NHS’.3 The ‘cost’ of this burden can be kept at a minimum by improving the care provided in the community.
As clinicians involved in the development of the NICE guideline, we have therefore aimed to provide a practical tool for the management of CMA in primary care.
The algorithm we have produced is intended as an adjunct to the published NICE guideline2 …
