Food Intolerance Research Articles

Molecular and genetic aspects of health risks and their association with adverse environmental conditions and diets (systemic review)

At present, it is vital to examine adverse effects produced on gene expression by negative environmental factors and nutrients. In this study, our aim was to generalize data available in literature on an association between health risks and polymorphisms of genes that participated in xenobiotic detoxification and allergic status, food intolerance included, in adults and children. We also considered influence exerted by various components in diets on gene expression. Available research data indicate that GSTP1 and SOD gene polymorphisms have their effects on a decline in detoxification and antioxidant functions and early development of allergic, occupational and oncological diseases under exposure to harmful chemicals. Micronutrients in diets that can protect from adverse effects produced by chemicals can act not only as substrates but also as detoxification enzyme inducers. Great quantities of biologically active compounds in the Mediterranean diet are assumed to be able to modulate functional activity of certain genes. Such nutrients as polyphenols, flavonoids, catechins, glucosinolates, anthocyanins, stilbenes, carotinoids, polyamines, spermidine and spermine produce anti-genotoxic and anti-carcinogenic effects. Use of combined nutrigenetic and phenotypic data seems a promising trend in effective modeling of a healthy diet. The research data outlined in this review indicate there is solid evidence that health risks can depend on a genotype, phenotype and quality of the environment. These risks also differ depending on a diet. Modeling a healthy diet based on available knowledge on nutritional genetic and nutritional genomics is a promising trend within non-carcinogenic health risk management, including risks of oncological diseases caused by exposure to adverse environmental factors.

음식 불내성의 기능의학적 접근

Food intolerances are defined as difficulty digesting or metabolizing a particular food. They are a subset of adverse food reactions. Adverse food reactions include immune-mediated food allergies and non-immune-mediated food intolerances. Food intolerances are estimated to affect up to 15-20% of the population, but understanding of diagnosis and management is complicated and controversial, and given presentation and mechanisms associated also vary greatly. In addition, food intolerances can be associated with various clinical imbalances of functional medicine, such as dysbiosis, leaky gut syndrome, histamine imbalance, and functional adrenal insufficiency. This review aims to provide a scientific update and clinical application of food intolerances in the perspective of functional medicine.

Successful management of chronic urticaria and food allergies in a pediatric population using integrative traditional Chinese medicine therapy: a case series

BackgroundFood allergy is becoming increasingly common among the pediatric population. Despite strict avoidance of food allergens, a subgroup of sensitive individuals still develops frequent, persistent, and difficult to treat hives (FPDTH) for which there is no curative therapy. Although these cases are rare, these patients are in most need of therapy.Case presentationsThis is a retrospective review of 3 pediatric patients with highly sensitive food allergies who initially presented with hives daily or every other day, or multiple times a day, but achieved marked remission after traditional Chinese medicine (TCM) therapies. Patient 1 (P1) is a 5-year-old who has experienced 140 reactions in his lifetime. Reactions were mostly hives with 4 episodes of anaphylaxis. P1 had used Prednisone 20 times, had an Epinephrine injection 4 times, and had 3 emergency room (ER) visits. Patient 2 (P2) is a 12-year-old who had experienced hives since age 3. Despite daily antihistamine use, P2 had > 730 reactions in his lifetime at the time of presentation including 2 episodes of anaphylaxis. He had been prescribed prednisone 4 times, an Epinephrine injection 2 times, and had 1 ER visit. Patient 3 (P3) is a 20-month-old girl who had experienced > 120 reactions including 1 episode of anaphylaxis. She was on daily desonide and frequently used an antihistamine, yet still had required a course of prednisone once, an Epinephrine injection once, and had 1 ER visit to manage her reaction. After presenting to our clinic, patients received internal and external TCM treatments, including herbal baths and creams (Remedy A-D) as basic remedies to reduce food reactions, including but not limited to frequent hives. Within 7–9 months of TCM treatment, remarkably all patients had complete remission of atopic symptoms. All three patients also experienced an improvement in other conditions including food intolerance, diarrhea, anxiety, eczema, and environmental allergies. After 1 year of treatment, all three patients had reductions in food-specific IgE levels that had been previously elevated, and additionally, P1 and P3, who initially had high total IgE levels, experienced a marked decrease in total IgE levels as well. All three patients continued to introduce foods into their diet that they previously had reactions to, and all 3 patients remain symptom-free.ConclusionsThree pediatric patients with a known history of multiple food sensitivities and physician-diagnosed food allergies that presented with FPDTH underwent a TCM regimen and experienced dramatic improvement in symptoms and reduction in their IgE levels. This regimen appears to be effective in FPDTH population although a further study in a controlled clinical setting is required.

Systematic review and network meta-analysis of different types of emollient for the prevention of atopic dermatitis in infants.

Prophylactic application of emollients has been an effective strategy against infant atopic dermatitis (AD); however, the difference of different emollients is unknown. We performed this network meta-analysis to compare different emollients in preventing infant AD. A systematic search was performed in PubMed, EMBASE and Cochrane library to identify relevant studies from their inception through 28 February, 2022. We evaluated the quality of eligible studies using the Cochrane risk of bias assessment tool. Data analysis was performed using STATA 14.0. Eleven studies were included for data analysis. Direct meta-analysis suggested that early application of emollients effectively prevented AD development in high-risk infants (risk ratio [RR], 0.64; 95% confidence interval [CI], 0.47 to 0.88). Network meta-analysis suggested that emollient emulsion might the better option for preventing infant AD development, with a surface under the cumulative ranking curve (SUCRA) of 82.6% for all populations, 78.0% for high-risk populations and 79.2% for populations with food sensitization. Moreover, subjects receiving emollients more frequently experienced adverse events. Overall, early application of emollients is an effective strategy for preventing AD development in high-risk infants and emollient emulsion may be the optimal type. Future study with well-designed and large scale are warranted to validate our findings.

A Novel Insight into Paraptosis-Related Classification and Signature in Lower-Grade Gliomas.

Lower-grade gliomas (LGG) are the most common intracranial malignancies that readily evolve to high-grade gliomas and increase drug resistance. Paraptosis is defined as a nonapoptotic form of programmed cell death, which is gradually focused on patients with gliomas to develop treatment options. However, the specific role of paraptosis in LGG and its correlation is still vague. In this study, we first establish the novel paraptosis-based prognostic model for LGG patients. The relevant data of LGG patients were acquired from The Cancer Genome Atlas database, and we found that LGG patients could be divided into three different clusters based on paraptosis via consensus cluster analysis. Through least absolute shrinkage and selection operator regression analysis and multivariate Cox regression analysis, 10-paraptosis-related gene (PRG) signatures (CDK4, TNK2, DSTYK, CDKN3, CCR4, CASP9, HSPA5, RGR, LPAR1, and PDCD6IP) were identified to separate LGG patients into high- and low-risk subgroups successfully. The Kaplan-Meier analysis and time-dependent receiver-operating characteristic showed that the performances of predicting overall survival (OS) were dramatically high. The parallel results were reappeared and verified by using the Chinese Glioma Genome Atlas and Gene Expression Omnibus databases. Independent prognostic analysis and nomogram construction implied that risk scores could be considered the independent factor to predict OS. Enrichment analysis indicated that immune-related biological processes were generally enriched, and different immune statuses were highly infiltrated in high-risk group. We also confirmed the potential relationship of 10-PRG signatures and drug sensitivity of Food and Drug Administration-approved drugs. In summary, our findings provide a novel knowledge of paraptosis status and crucial direction to further explore the role of PRG signatures in LGG.

Early-life exposure to air pollution associated with food allergy in children: Implications for ‘one allergy’ concept

BackgroundThe rapid increase of food allergy (FA) has become the “second wave” of allergy epidemic and is now a major global public health concern. Mounting evidence indicates that early life exposure to air pollution is associated with the “first wave” of allergy epidemic (including asthma, allergic rhinitis and eczema) in children, but little is known about its association with FA. ObjectivesWe hypothesize FA has triple exposure pathways, gut-skin-airway, and investigate the effects of airway exposure to outdoor and indoor air pollution on childhood FA. MethodsA cohort study of 2598 preschool children aged 3–6 years old was conducted in Changsha, China. The prevalence of FA was surveyed using a standard questionnaire by International Study of Asthma and Allergies in Childhood (ISAAC). Exposure to indoor air pollution was assessed by four indicators: new furniture, redecoration, mold or dampness, and window condensation. Exposure to outdoor air pollution was evaluated by the concentrations of PM10, SO2 and NO2, which were obtained from the monitored stations. Both prenatal and postnatal exposure windows were considered. The association between exposure to outdoor/indoor air pollution and childhood FA was estimated by multiple logistic regression models using odds ratio (OR) and a 95% confidence interval (CI). ResultsA total of 14.9% children reported FA. The prevalence was significantly associated with exposure to indoor air pollution, OR (95% CI) = 1.93 (1.35–2.75) for prenatal exposure to mold/dampness and 1.49 (1.07–2.10) and 1.41 (1.04–1.89) respectively for postnatal exposure to new furniture and window condensation. The prevalence of FA was also associated with prenatal and postnatal exposure to outdoor air pollution, particularly the traffic-related air pollutant NO2, with adjusted ORs (95% Cls) respectively 1.24 (1.00–1.54) and 1.38 (1.03–1.85) per interquartile range (IQR) increase. Sensitivity analysis showed that the association between outdoor/indoor air pollution and childhood FA was significant only in young children aged 3–4 years. ConclusionEarly-life exposure to high levels of outdoor and indoor air pollution in China due to the rapid economic growth and fast urbanization in the past decades may contribute to the rapid increase of food allergy (FA) in children. Our study indicates that, in addition to gut and skin, airway may be a new route of food sensitization. Air pollution leads to the first and second waves of allergy epidemics, suggesting a concept of ‘one allergy’ disease.

EARLY CHILDHOOD ATOPIC PHENOTYPES AND THE DEVELOPMENT OF ALLERGIC RESPIRATORY DISEASE

<h3>Introduction</h3> Pediatric atopic dermatitis (AD) is associated with risk of respiratory allergic disorders. The "atopic march" doesn't fit all subjects, and atopic phenotypes may better predict progression. We hypothesize that AD by age 2 modifies the association between various allergic factors (2-year food/aeroallergen sensitization, 3–5-year food allergy), and the risk of developing allergic respiratory disease (ARD: allergic rhinitis, asthma) by age 10. <h3>Methods</h3> Sensitization to 10 common food and aeroallergens from the WHEALS birth cohort was assessed at age 2. Food allergy (3-5 years) was assessed by physician panel. AD (age 2 and 10), asthma and allergic rhinitis (age 10) were physician-assessed. Risk ratios were calculated using Poisson regression with robust error variance and were adjusted for several factors. <h3>Results</h3> Two-year AD significantly modified the association between food allergy at 3-5 years and the risk of ever having asthma by age 10 (p=0.027). In the absence of AD, food allergy was associated with an increased risk of ever having asthma (aRR=3.36(1.71, 6.58), p<0.001), while no difference was observed in the presence of AD (aRR= 1.24(0.57, 2.68), p=0.99). Food sensitization in the absence of AD was associated with increased risk of ever asthma (aRR 2.04(1.03, 4.05), p=0.038). Food sensitization in the presence of AD was not associated with ever asthma (aRR 0.89(0.45,1.78), p=0.99) or ever allergic rhinitis (aRR 1.45(0.97-2.16), p=0.078). Sensitization to at least one aeroallergen at age 2 didn't result in significantly different risk of ARD in either AD subgroup. <h3>Conclusion</h3> Identifying early atopic phenotypes may help identify later ARD risk.

Cocktails anyone? Cutaneous hazards from bartender drinks.

Cocktails are mixed drinks that typically contain alcohol and are enjoyed worldwide. For some people, however, drinking cocktails can result in life-threatening or severely distressing cutaneous reactions. This contribution examines five areas of concern in this regard: (1) food allergies, (2) food intolerances, (3) phytophotodermatitis, (4) skin reactions to quinine present in tonic water, and (5) traumatic injuries from cocktail sticks and burns from flaming cocktails.

(106) A Case of Severe Perceived Food Intolerance Requiring Feeding Over Objection

(106) A Case of Severe Perceived Food Intolerance Requiring Feeding Over Objection

Algorithmic lifestyle optimization.

A hallmark of personalized medicine and nutrition is to identify effective treatment plans at the individual level. Lifestyle interventions (LIs), from diet to exercise, can have a significant effect over time, especially in the case of food intolerances and allergies. The large set of candidate interventions, make it difficult to evaluate which intervention plan would be more favorable for any given individual. In this study, we aimed to develop a method for rapid identification of favorable LIs for a given individual. We have developed a method, algorithmic lifestyle optimization (ALO), for rapid identification of effective LIs. At its core, a group testing algorithm identifies the effectiveness of each intervention efficiently, within the context of its pertinent group. Evaluations on synthetic and real data show that ALO is robust to noise, data size, and data heterogeneity. Compared to the standard of practice techniques, such as the standard elimination diet (SED), it identifies the effective LIs 58.9%-68.4% faster when used to discover an individual's food intolerances and allergies to 19-56 foods. ALO achieves its superior performance by: (1) grouping multiple LIs together optimally from prior statistics, and (2) adapting the groupings of LIs from the individual's subsequent responses. Future extensions to ALO should enable incorporating nutritional constraints. ALO provides a new approach for the discovery of effective interventions in nutrition and medicine, leading to better intervention plans faster and with less inconvenience to the patient compared to SED.

Progress in understanding of relationship between irritable bowel syndrome and food intolerance

Progress in understanding of relationship between irritable bowel syndrome and food intolerance

A Recurring Burden: Examining Readmission and Related Cost in the Months after Pancreaticoduodenectomy

Introduction: Readmission after pancreaticoduodenectomy (PD) is common and serves to escalate cost of an already challenging and expensive procedure. Existing literature on discrete cost after PD admission is limited. Methods: A prospectively maintained PD cost database, which includes cost [divided into operating room, postoperative/ward, radiology, interventional radiology (IR)] for index hospitalization and episodes-of-care within 90 days of surgery, was queried for readmission. Baseline characteristics, reasons for readmission, and intervention were studied, and index and 90-day cost compared within the same group. Results: A total of 1284 patients underwent PD from 2010-2019. 90-day cost were available for 460 patients, of which 88 readmitted patients with complete data were analyzed. Patients were readmitted 1.3±0.7 times on average. Mean readmission length of stay (LoS) was 9.7±9.1 days, which was not significantly shorter (p = 0.549) than index LoS (10.4±7.8 days). Median total 90-day cost was $15,780 ($1,237-102,913), which was significantly lower (p < 0.001) than cost of index hospitalization [$27,212 ($15,573-155,042)]. Common reasons for readmission were food intolerance and/or failure to thrive (n = 17, 19.3%), abdominal fluid collection (n = 13, 14.8%), and postsurgical abdominal pain (n = 13, 14.8%). Patients were treated by surgery (eg exploratory laparotomy, PEG tube placement) (n = 13, 14.8%) or IR (eg CT guided drain placement) (n = 33, 37.5%) while the rest (n = 45, 51.1%) were managed medically. 90-day mortality in this cohort was 2.2% (n = 2). Conclusion: Although patients readmitted after PD incur lower 90-day cost than their index stay, LoS is comparable, and many undergo additional therapeutic intervention. This underscores the complexity of PD, which affects recovery and finances well beyond the operation itself.

The correlation between food sensitivity, sex, age of patients and some physiological problems

Food allergy/hypersensitivity refers to situations in which an immune process (IgE- or non-IgE-mediated) can be demonstrated (for example, bovine milk, peanut, or soybean hypersensitivity), whereas food intolerance is a form of food allergy identified depending on the existence of IgG antibodies. In our study we wanted to look at the association between food intolerance/ sensitivity and certain physiological problems, as well as the association between food sensitivity and age. The experimental groups used consist of eighty patients age ranged from (1- 70) years old, they are divided into three groups: group1 (age range 1-10 years old), group 2(age range 10-40 years old) and group 3 (age range 40-70 years old). We measured the level of antibodies that formed against each food group, these results represented in numbers as the following: 1: no sensivity, 2: sensitivity, 3,4: strong sensitivity. Our results showed that the highest percentage of food allergy in group 1 was cow milk and wheat allergy (34.6% and 30.7%) respectively, the highest percentage of food allergy in group 2 was pea nut and red pepper allergy (28.12% and 21.87%), respectively. Table 6 showed that the highest percentage of food allergy in group 3 also was in pea nut and red pepper, but the percentage was lower than that of group 2. While the whole allergy in group 3 was higher than the whole allergy of groups 1 and 2. Finally, this study adds to our understanding of the incidence as well as longterm characteristics of food allergy not just in kids, but also in middle age people and adults.

Enablers and barriers to prevent weight-regain post bariatric surgery – A qualitative enquiry

BackgroundWeight-regain is commonly experienced after bariatric surgery. This qualitative enquiry aimed to explore participants' self-reported enablers and barriers to prevent future weight-regain post-surgery. MethodsEligible adults were recruited at 12-months post-bariatric-surgery at Counties Manukau, Auckland. Participants were invited to attend data collection at their 18-month group nutrition-education session, and to participate in a focus group at 21-months post-surgery. Thematic analysis was used to evaluate patient experiences. ResultsParticipants (n = 28) were mostly female (73.2 %), New Zealand European (41.5 %), and had gastric sleeve surgery (92.3 %). Five key themes emerged from the analysis: A Life Changing Health Journey - participants experienced a decrease in obesity-related comorbidities and a subsequent decrease in medications. Weight change and food intolerances impacted quality of life. Challenge of managing a New Healthy Lifestyle - financial stress, buying healthier foods and social events were new challenges, often centred on food. Changing Eating Behavior - all participants struggled managing eating behaviors. Mindset Changes - post-surgery most participants had a positive mindset, increased confidence, and feelings of happiness. However, many struggled with mindset around weight and food. A need for On-going Support - most felt under-supported and expressed a need for longer, specific follow-up care. ConclusionPost-surgery group education sessions provided participants with increased support from both health professionals and peers on the same journey, to overcome struggles such as binge eating or identifying new coping strategies. Findings provide important insights into the challenges patients with bariatric surgery face and key learnings to develop specific supports for future care practices.

Short-term outcome and complications of therapeutic hypothermia in neonates with moderate-to-severe hypoxic ischaemic encephalopathy: a single-centre retrospective observational study in a hospital in Mumbai, India

ABSTRACT Background Although shown to reduce death or disability in moderate-to-severe hypoxic ischaemic encephalopathy (HIE), therapeutic hypothermia (TH) has recently been associated with an increase in adverse events in low- and middle-income countries (LMIC). Aim To determine the clinical characteristics, complications and short-term outcome in neonates receiving TH in King Edward Memorial Hospital, Mumbai, India. Methods A retrospective single-centre study of neonates with moderate-to-severe HIE who received TH from 1 January 2018 to 31 December 2021 was undertaken. TH was provided as per the unit’s protocol using either a servo-controlled device or a phase-changing material (PCM). Results One hundred and fifty-five neonates were included with 94.2% intramural births. Mean gestation and birthweight were 38.6 (1.5) weeks and 2776.7 (431) g, respectively. HIE staging was moderate in 87.1% and severe in 12.9%, with a mean cord pH of 6.93 (0.14) and seizures in 38.7%. Adverse events included shock (50.3%), clinically significant bleeding (16%), acute kidney injury (6.7%), culture-positive sepsis (11.6%), persistent pulmonary hypertension (9%), bradycardia (9%), food intolerance (14.9%) and premature termination (7.1%). A servo-controlled device (15.5%) or PCM (84.5%) was used, with comparable adverse events. 84.5% of the neonates were discharged, 7.1% discharged against medical advice and 8.4% died. Detailed neurological assessment at discharge/discharge against medical advice suggested neurological impairment in 128 (87.1%) neonates. Conclusion Adverse events during TH range from asymptomatic laboratory abnormalities to life-threatening complications, which are manageable in well equipped units. Neurological impairment at discharge in neonates who received cooling mandates strict neurological follow-up. Abbreviations: aEEG: amplitude-integrated EEG; AKI: acute kidney injury; BW: birthweight; EEG: electro-encephalogram; GA: gestational age; HELIX: hypothermia for encephalopathy in low- and middle-income countries; HIE: hypoxic ischaemic encephalopathy; IVH: intraventricular haemorrhage; LMIC: low- and middle-income countries; NICHD: National Institute of Child Health and Human Development; NICU: neonatal intensive care unit; PPHN: persistent pulmonary hypertension of newborn; PCM: phase-changing material; SGA: small-for-gestational age; TH: therapeutic hypothermia.

S2871 Successful Treatment of “Candy Cane” Syndrome Through Endoscopic Gastrojejunal Anastomosis Revision

Introduction: “Candy cane” syndrome is a post-surgical Roux-en-Y gastric bypass (RYGB) complication associated with a markedly long, surgically-created blind end of the afferent Roux limb distal to the gastrojejunostomy. Gradual filling of this long blind limb with food can result in symptoms, including postprandial epigastric pain, nausea, vomiting, or regurgitation. Treatment of candy cane syndrome traditionally consists of laparoscopic resection of the redundant blind afferent limb. We present the first case of successful treatment of candy cane syndrome through endoscopic revision of the gastrojejunal (GJ) anastomosis. Case Description/Methods: A 40-year-old female presented for evaluation of intractable acid reflux, nausea, and weight recidivism eight years post RYGB. Esophagogastroduodenoscopy revealed evidence of prior RYGB, a healthy-appearing GJ anastomosis, a direct path across the GJ anastomosis into the blind afferent limb, and the enteral efferent limb located at a more angulated orientation toward the 4:00 position. An upper gastrointestinal series revealed an exaggerated blind afferent limb with pooling of contrast in the afferent blind limb before spilling to progress down the Roux limb. This finding suggested the reflux likely stemmed from the excessively long blind afferent limb. The patient wished to avoid surgery and a novel endoscopic suturing technique was performed that narrowed the GJ anastomosis and oriented flow towards the enteral efferent limb. This resulted in 1) limiting acid reflux 2) assisting with weight loss and 3) redirecting flow of contents more toward the enteral efferent limb. Post-procedure our patient had no additional weight gain and her acid reflux and nausea resolved. (Figure) Discussion: Candy cane syndrome is an underappreciated complication reported following RYGB. It results from an excessively long blind afferent Roux limb at the gastrojejunostomy that can lead to food accumulation. Patients often present with nausea, vomiting, food intolerance, acid reflux, and abdominal pain. Many patients remain undiagnosed due to vague gastrointestinal symptoms, delayed presentation, and physician unawareness. Historically, treatment has required surgical revision. Endoscopic suturing revision of the GJ anastomosis can provide an alternative less invasive and possibly safer treatment option that address the reflux symptoms, weight regain, and aberrant flow of contents into the blind limb.Figure 1.: Figure: Endoscopic view of direct access into the blind afferent limb A, the acute angle of the enteral efferent limb B, and dilated gastrojejunal anastomosis C.

S3593 Eosinophilic Gastritis in Idiopathic Hypereosinophilic Syndrome: A Case Report

Introduction: Idiopathic hypereosinophilic syndrome (IHES) is a group of myeloproliferative disorders causing multi-organ dysfunction with unknown etiology. We report a case of IHES in a patient presenting with gastric wall thickening, multiple organ damage including acute coronary syndrome, encephalopathy, and multiple cortical infarcts. Case Description/Methods: A 47-year-old male patient with past medical history significant for type 2 diabetes mellitus and hypertension presented with nausea, vomiting, abdominal pain, and food intolerance for 7 days. He also complained of intermittent, substernal chest pain for 1-2 days at presentation. His labs were significant for elevated troponin of serum creatinine of 2.85mg/dL and significant leukocytosis (32.80 10^3/cmm). Absolute eosinophilic count was elevated at 14.70 10^3/cmm. Echocardiogram showed hypokinetic mid inferior and inferolateral walls. CT chest/abdomen angiogram was done for concerns of dissection. It showed diffuse gastric wall thickening with upper abdominal retroperitoneal lymphadenopathy and extensive retroperitoneal fat stranding. He was started on antiplatelet agent and heparin drip. Ischemic workup was deferred as troponin plateaued and patient had new-onset altered mental status. MRI brain showed numerous punctate cortical and subcortical foci of restricted diffusion consistent with acute watershed distribution infarcts. In view of possible need for dual anti-platelet therapy and the high concern for gastric malignancy on CT that required tissue biopsy, gastroenterology was consulted for esophagogastroduodenoscopy (EGD). It did not show any gastric mass but diffuse gastritis. Biopsy showed mild chronic gastritis and a focal area showing increased eosinophilic infiltration with eosinophilic cryptitis (Figure). An extensive workup for eosinophilia including infectious etiology returned negative. No secondary causes of hypereosinophilia were identified. Patient was started on 1mg/kg of prednisone with normalization of eosinophils to 0 within 24 hours. Steroids were tapered and patient improved clinically with resolution of altered mental status, abdominal pain, and chest pain. Follow-up EGD has been scheduled to re-evaluate eosinophilic deposits. Discussion: The stomach biopsy showing eosinophilia was the key to diagnosis. Resolution of peripheral eosinophilia with steroids confirms the diagnosis in the absence of a secondary cause. A repeat EGD with biopsy is scheduled to look for histopathological resolution.Figure 1.: Gastric mucosa with increased eosinophilic infiltration within the lamina propria and focal glandular involvement with eosinophils.

S2788 A Rare Case of Duodenal Crohn’s Disease Presenting as Megaduodenum

Introduction: Crohn’s disease of the duodenum is exceedingly rare and accounts for less than 2% of Crohn’s disease cases, disease confined to the duodenum is an even rarer entity.[1] Megaduodenum is typically seen in infants and its presence in adults is the subject of a few case reports. We present an unusual presentation of an adult patient with Crohn’s disease presenting as megaduodenum. Case Description/Methods: A 20-year-old male with a history of gastroparesis presented with mild epigastric pain, intractable nausea, vomiting, and 60 pounds of weight loss over the last six months. The patient had severe food intolerance to the point where he required total parenteral nutrition. CT scan showed distention of the stomach with tapering of the proximal duodenum, followed by subsequent marked diffuse distention of the remaining duodenum with subsequent narrowing at the duodenojejunal junction. (a). An esophagoduodenoscopy (EGD) was performed that showed distended duodenum, a proximal duodenal stricture, and another stricture at the duodenojejunal junction with inflamed mucosa and severe stenosis which could not be traversed. (b,c). Biopsies showed duodenitis consistent with Crohn’s disease. A PEG-J tube was placed for enteral feeding which the patient did not tolerate and ultimately required resection of the distended duodenum. Discussion: Megaduodenum is usually congenital and is a rare entity in adults. In this case, duodenal distention was likely acquired and unfortunately required resection due to the severity of symptoms. In our opinion, the patient likely had skipped lesions in the duodenum with significant dilatation of the inflamed area. There was no colorectal involvement confirmed by a colonoscopy. Post-operative biopsies also confirmed Crohn’s disease in the duodenum.Figure 1.: (a): Megaduodenum on CT scan Figure (b): Duodenal distention on EGD Figure (c): Duodenal stricture on EGD.

SIGNIFICANCE OF TOLL-LIKE RECEPTOR-2 POLYMORPHISM rs4696480 FOR THE DEVELOPMENT OF FOOD ALLERGY IN CHILDREN WITH ATOPIC DERMATITIS

Relevance. Food allergy is one of the most common chronic diseases in children. Toll-like receptors may be unique in the development of food allergies due to their expression by intestinal epithelial and dendritic cells.&#x0D; Objective. The aim of this study was to investigate the relationship between the rs4696480 polymorphism in TLR2 and the presence of food allergy in children with atopic dermatitis.&#x0D; Material and methods. The study included 103 patients with atopic dermatitis and 84 healthy children. Polymorphism genotyping was performed in the group of patients and the control group using real-time PCR. Food sensitization was determined by presence sIgE to food allergens by the immunochemiluminescent method using an ImmunoCAP 100 (Thermo Fisher Scientific Inc., Phadia, Sweden). The presence of food allergy was determined by a detailed clinical history and review of clinical records.&#x0D; Results. In the subgroup of children with food allergies, 9 children had the AA genotype, 7 patients had the heterozygous variant, and 3 children had the TT genotype. Among patients without food allergy, 20 patients had the AA genotype, 39 were heterozygotes, and 25 had the TT genotype. The OR assessment demonstrated that the AA genotype of the rs4696480 polymorphism is reliably associated with the development of food allergy in children with atopic dermatitis, OR=2,880 (1,0271-8,0757).&#x0D; Conclusion. The rs4696480 polymorphism in TLR2 gene is associated with the development of food allergy in Ukrainian children with atopic dermatitis.

Aeroallergen Sensitization Predominates in Children with Atopic Dermatitis

Abstract Background: Children with atopic dermatitis (AD) suffer from frequent flare-ups. Correct identification of allergens responsible for flare-ups is important in managing AD. Suspecting food allergens as culprits may result in unnecessary food restrictions which adversely affect the growth of these children. In view of this fact, we aimed to assess the allergen sensitization pattern of children with AD in Sri Lanka. Objective: The objective is to assess the food and aeroallergen sensitization pattern of children with AD. Materials and Methods: This study was conducted among 100 consecutive patients refereed to the dermatology clinics of a specialized children’s hospital and a tertiary care hospital with the clinical diagnosis of AD. Age ranged from 1 to 18 years. All underwent a Skin prick test (SPT), using prick test solutions for house dust mite Dermatophagoids pteronyssinus (HDM-DP), Aspergillus fumigatus (AF), cat epithelia (CE), cow’s milk (CM), egg white (EW), and peanut. Results: Of 100 patients 53.0% had positive SPT for HDM-DP. 15.0% were positive for CE, 9.0% positive for AF. All above three are aeroallergens, food allergen sensitivities were 9.0% for CM, 2.0% for EW, and 1.0% for peanuts. It is of note that the wheal size of HDM-DP SPT showed a very strong correlation with the age of the subject (R 2 = 0.0723, P = 0.007). Conclusion: Aeroallergen sensitization predominate over food allergen sensitization in children with AD. HDM and CE were the most common aeroallergen sensitivities. The wheal size of HDM-DP had a very strong positive correlation with age.