Hypoallergenic Diet Research Articles

Evaluating the influence of parental atopy on the effectiveness of a maternal dairy-free diet in alleviating infantile colic: a before-and-after study

BackgroundInfantile Colic (IC) poses a significant challenge for parents as it manifests through repeated and extended episodes of fussiness, crying, or irritability occurring before the age of 5 months. The precise cause of IC is currently unknown. The association between IC, a family history of atopy, and the development of individual atopy in the future remains uncertain, given conflicting findings from prior studies.ObjectivesThis study aimed to investigate the impact of parental atopy on IC severity and the effectiveness of the mother’s hypoallergenic Dairy-Free Diet in alleviating pain in infants with colic.MethodsThis non-randomized trial conducted at Amirkabir Hospital in Arak, Iran, from January 2023 to October 2023, involving 206 eligible IC patients non-randomly assigned to two groups based on parental atopy history. Breastfed infants were prescribed a dairy-free diet, involving the removal of dairy products from the mother’s diet. Pain severity was assessed using the FLACC scale at baseline and after one-month of intervention.ResultsThe research initially involved 206 subjects with an average age of 28.77 ± 9.99 days, evenly distributed based on parental atopy history. However, there was a 28.6% loss to follow-up, resulting in a final analyzed population of 147 individuals. The intervention, a maternal dairy-free diet, demonstrated a significant reduction in pain symptoms within both groups and overall (P = 0.001), with no significant difference in efficacy between infants with and without parental atopy history (P = 0.219). Parental history of atopy did not exhibit a significant association with colic pain severity (P = 0.404). The study revealed that the impact of the diet on colic severity varied, with more pronounced effects observed in cases of severe and moderate colic compared to mild cases.ConclusionsAdopting a Dairy-Free Diet significantly reduced colic symptoms, irrespective of parental atopy history. The severity of colic appears unrelated to parental atopy, and the observed improvement with a Dairy-Free diet is potentially attributed to milk intolerance rather than milk allergy.

Therapeutic Aspects of Lipofilling, Abdominoplasty in Combination with Body Liposuction and Bariatric Surgery

This review article is dedicated to the therapeutic aspects of various plastic surgery procedures. Nowadays, improving appearance and quality of life through plastic surgery is becoming increasingly popular. Managing patients after lipofilling and abdominoplasty combined with liposuction is an interdisciplinary challenge. Intraoperative risks in plastic surgery are associated with anesthesia and comorbidities. The immediate response of the cardiovascular and respiratory systems to the administration of anesthetic agents and the anesthesiologist's qualifications determines the immediate success of the operations. The duration of the surgery, volumetric disturbances, reduction of body surface area, and changes in metabolic and immunological status after mechanical impact on adipose tissue significantly alter the rate of compensatory-adaptive reactions of the body. In the long-term period after lipofilling, abdominoplasty, liposuction, and augmentation mammoplasty, systemic complications are often observed. These include insomnia, chronic kidney disease, protein-energy malnutrition, arthropathies, nonspecific interstitial lung lesions, unverified hepatitis, lupus-like syndrome, antibodies to transplanted fats and silicone materials, idiopathic limb edema, as well as autoinflammatory syndromes. The presented work also provides data on propofol infusion syndrome and the clinical-prognostic significance of vascular endothelial growth factor in plastic surgery. The authors’ team also presents their own clinical data on obesity and associated diseases. To maintain the aesthetic effect and prevent long-term complications after lipofilling, liposuction, augmentation mammoplasty, blepharoplasty, and rhinoplasty, it is recommended to follow a hypoallergenic and low-calorie diet for the next 3-6 months, avoid night work, excessive physical exertion, simultaneous intake of antibiotics and anti-inflammatory drugs, sun exposure, trips to mountainous areas, and long flights.

The influence of fruit and vegetable mixtures on the organoleptic properties of sorbets

Currently, the quality of school meals plays important role for the parents of schoolchildren. Expanding the range of food with hypoallergenic products is an urgent problem. In our research sorbet was used as a research object. Fruit and vegetable crops were used as the basis for the sorbet prototype. Zucchini, green apple and white currant were selected as the main ingredients of sorbets, taking into account the recommendations of a non-specific hypoallergenic diet. The goal of the research was to develop a recipe and conduct an organoleptic evaluation of a dessert based on zucchini, apples and currants. The task was to conduct an organoleptic evaluation of the prototype sorbet. The study of organoleptic indicators was carried out in accordance with GOST 31986-2012 «Catering services. Method of organoleptic assessment of the quality of public catering products». Test batches of the dessert were carried out at the Volgograd State Agrarian University at the Department of Processing and Food Production Technologies. In terms of organoleptic indicators, the new product met all technical requirements. The appearance of sorbet, a single-layer dessert in the form of a ball without glaze, decorated with mint greens. The consistency was dense. The taste was clean, characteristic of apple and currant, without any foreign tastes or odors. The color was light green, uniform throughout the mass. The product sample met the requirements of GOST R 55624-2013 «Whipped frozen fruit, vegetable and fruit-vegetable desserts. Technical conditions». A tasting evaluation of the sorbet was carried out. Employing the arithmetic mean value, the overall rating of the prototype was the highest. The use of zucchini, green apple and white currant in combination in the production of sorbet has not reduced the quality criteria of this dessert.

Experience of allergen-specific immunotherapy in the patient with oral and systemic manifestations of birch pollen allergy

Introduction. Allergy to birch pollen is a common allergic disease. The main allergen of birch pollen is Bet v 1. The Bet v 1 protein structure is the similar to proteins of hazel, alder and elm pollen, as well as fruits proteins (apples, apricots, peaches, cherries) and vegetables ones (carrots, celery). Therefore, children with an allergy to the Bet v 1 protein may experience oral allergy syndrome (OAS) and even anaphylaxis when eating these foods. Allergen-specific immunotherapy (ASIT) is the indication for the pollen allergy treatment.Presentation of the clinical case. A 11 years old child was observed with a diagnosis of bronchial asthma, allergic form, moderate persistent clinical course. Pollinosis. Allergic rhinitis. Allergic conjunctivitis. Allergy to birch pollen (Bet v 1). Cross food hypersensitivity: oral syndrome (PR-10 proteins) and anaphylaxis (hazelnuts, peanuts). Systemic manifestations of pollen allergy limit immunotherapy due to the possible development of adverse reactions.The child was prescribed sublingual immunotherapy (SLIT) with the medication “Staloral birch pollen allergen”. Baseline therapy was chosen for the child to achieve control of asthma and rhinitis, a hypoallergenic diet with the exclusion of significant food allergens was prescribed. Asthma and rhinitis exacerbation and OAS was observed during the 1st and 2nd treatment courses. Against the background of baseline therapy, SLIT was continued. The full maintenance dose was achieved during the 3rd SLIT course. Immunotherapy contributed to the reduction of symptoms of rhinitis and asthma, reduction of disease clinical course severity, reduction of baseline medications doses and OAS relief.

Assessment of tolerance of a new product (gluten-free grain snack) in children with food allergy to gluten

The development of a technological scheme for the production of cereal snacks based on the extrusion process with preliminary enzymatic treatment of wheat flour and the use of hydrolysate as a partial replacement for gluten-free raw materials is an urgent task. The use of gluten-free cereal snacks in the diet opens up new possibilities for dietary therapy in patients suffering from various manifestations of food allergy to gluten, making their diet more diverse and meeting their individual needs. The purpose of the research was to clinically evaluate the tolerance of gluten-free cereal snacks in children with PA to gluten. Material and methods. The study included 21 patients (male and female) aged 3 to 17 years with a diagnosed food allergy, including gluten. All children received gluten-free cereal snacks according to their age: children from 3 to 7 years old (n=11) received 50 g (176 kcal) daily, and children aged 8 to 17 years old (n=10) received 100 g (352 kcal) daily for 14 days, in addition to a non-specific hypoallergenic diet excluding highly allergenic foods. On the first day of the study, the patients or one of their parents evaluated the organoleptic properties of the presented product (taste, color, smell) using a 5-point scale (1 - very bad, 5 - excellent), according to a specially designed questionnaire. The assessment of clinical symptoms over time related to skin, gastrointestinal tract, and nervous system was conducted using a second questionnaire, where parents kept a daily «observation log» reflecting the child's well-being and condition, as well as adverse events associated with taking the product. Clinical safety parameters were assessed based on the dynamics of complete blood count and blood immunological parameters (total IgE, specific IgE, and IgG4 antibodies to the studied allergens) at the beginning and end of the consumption period. Results. Daily examinations and patient questionnaires revealed no adverse reactions to the product. No significant differences in body weight were observed at the end of the study (p>0.05). In the results of clinical and immunological blood analysis before and after consuming gluten-free cereal snacks, no significant deviations were observed in the form of an increase in eosinophil count, total IgE, allergen-specific IgE and IgG4 antibodies in peripheral blood. This suggests a favorable clinical safety profile of the proposed product. Conclusion. The study found that consumption of the new product (gluten-free cereal snacks) was well-tolerated by children aged 3 to 17 years with various manifestations of food allergy: no adverse effects of the product or exacerbations of the underlying disease were observed during the 14-day period of gluten-free cereal snack consumption. Therefore, the studied gluten-free cereal snacks can be recommended for children aged 3 to 17 years with various manifestations of gluten FA, in combination with a gluten free diet.

To be or not to be for a diet? Decision-making algorithm for dietary management of children with atopic dermatitis

The widespread, and not always justified, long-term prescription of a hypoallergenic diet for atopic dermatitis without allergy testing and verification of the diagnosis of food allergy has led to the pendulum swinging in the opposite direction: in recent years, the effectiveness and necessity of an elimination diet in therapy atopic dermatitis is frequently questioned. At the same time, it is generally accepted that in proven food allergy, the targeted elimination diet remains a necessary method in complex therapy.
 A study was conducted, including a retrospective analysis of 430 case histories and an examination of 130 children with severe atopic dermatitis as part of the prospective part of the study. The analysis of the nutritional status, chemical composition of the diet, body composition, quality of life, eating behavior, as well as compliance of the patients parents was carried out which made it possible to analyze the complex interaction of these indicators with various factors as well as with each other. Risk factors for impaired nutritional status and eating behavior in children with severe atopic dermatitis were early onset of the disease, and long-term adherence to recommendations for limiting or excluding various foods from the diet, especially dairy and/or 4 or more food groups. It was revealed that it is an unbalanced diet, and not elimination itself, is the main factor that reduces the nutritional status of a child. Additional risk factors for impaired nutritional status are the traits of childrens eating behavior caused by the disease itself and adherence to dietary measures, making it difficult to form a complete diet if a diet is necessary and to expand it. As a result, an algorithm was formed, aimed at optimizing the nutritional support of children suffering from atopic dermatitis and food allergy.

Prospective observation study of the effect of dupilumab on the body weight of children with atopic dermatitis

BACKGROUND: Dupilumab is a drug from the group of biological therapy approved for use in children from 6 years of age in Russian Federation. Due to the recent introduction into clinical practice, appear new reports about various clinical effects that may be associated with the use of the drug, but are not listed in the instructions. Thus, cases of the possible effect of dupilumab on weight gain in adult patients with atopic dermatitis have been reported. We recorded a weight change greater than the average weight gain in children treated with dupilumab.
 AIM: The aim of the study was to evaluate the change in the weight of patients with moderate to severe atopic dermatitis treated with dupilumab for a year.
 MATERIALS AND METHODS: From January to December 2022 28 children with moderate and severe atopic dermatitis were under observation. All patients were treated with dupilumab in accordance with clinical guidelines for the treatment of atopic dermatitis. Before and at the end of the study, patients were assessed for the severity of the disease, height, body weight, the body mass index, as well as a survey about the quality of sleep and compliance with a hypoallergenic diet. Patients were divided into 2 age groups: 610 years old and 1113 years old. The results of measurements were evaluated separately in each age group and were correlated with centile tables.
 RESULTS: The study included 28 patients aged 6 to 13 years [18 girls (64.3%) and 10 boys (35.7%), mean age 10.25 years] with moderate (n = 11; 39.3%) and severe (n = 17; 60.7%) course of atopic dermatitis (mean SCORAD 57.3 4.6). At the end of the observation period, weight gain in the first age group was 5.8 kg; in the second group 3.06 kg; while the body mass index increased in the first age group by 1.65; in the second group by 0.23. According to the results of the survey at the initiation stage 19 (67.86%) participants in the observational program noted the presence of sleep disorders, 17 (60.71%) patients followed a hypoallergenic diet. At the end of the observation period 15/19 (78.94%) patients noted an improvement in the quality of sleep, 12/17 (70.59%) patients indicated an increase in the diet.
 CONCLUSIONS: The first data on a probable association between the treatment of atopic dermatitis with dupilumab and weight gain in the pediatric population are presented. The exact mechanism of the drug effect on weight gain is not clear, but the positive effect is to expand the diet, normalize sleep and improve the psychological background, which leads to an increase in body weight in relation to its initial shortage.

Analysis of Intestinal Microbiota and Metabolic Pathways before and after a 2-Month-Long Hydrolyzed Fish and Rice Starch Hypoallergenic Diet Trial in Pruritic Dogs.

Intestinal microbiota alterations were described in allergic individuals and may improve with diets. Farmina Ultra Hypo (FUH), a hydrolyzed fish/rice starch hypoallergenic diet, is able to improve clinical signs in allergic dogs. Study objectives were to determine microbiota differences in allergic dogs before and after feeding with FUH for eight weeks. Forty skin allergic dogs were evaluated clinically before and after the diet. Unresponsive dogs were classified as canine atopic dermatitis (CAD); responsive dogs relapsing after challenge with previous foods were classified as being food reactive (AFR), and those not relapsing as doubtful (D). Sequencing of feces collected pre- and post-diet was performed, with comparisons between and within groups, pre- and post-diet, and correlations to possible altered metabolic pathways were sought. Microbiota in all dogs was dominated by Bacteroidota, Fusobacteriota, Firmicutes and Proteobacteria, albeit with large interindividual variations and with some prevalence changes after the diet. In general, bacteria producing short-chain fatty acids were increased in all samples. CAD dogs showed pre-and post-diet microbiota patterns different from the other two groups. Bacteria taxa were enriched post-diet only in the AFR group. Changes in metabolic pathways were observed mainly in the CAD group. FUH may be able to improve intestinal microbiota and thus clinical signs of skin allergy.

Commentary: When applying dietary therapies for gastrointestinal conditions, family values, culture, and social challenges matter.

Some gastrointestinal conditions now have diet as a cornerstone to therapy. Three examples include the low-fermentable, oligosaccharide, disaccharide, monosaccharide, and polyol diet for irritable bowel syndrome, a gluten-free diet for celiac disease, and a hypoallergenic diet for eosinophilic esophagitis. All have been shown to be effective in Western or highly industrialized countries. However, these gastrointestinal conditions occur worldwide. Less is known regarding the effectiveness of dietary therapies in cultures and regions of dense religious and traditional practices where food is a central focus. This includes South Asia, the Mediterranean region, Africa, the Middle East, South America, and within Indigenous communities. Hence, there is a need to reproduce dietary intervention studies within cultures of dense traditional dietary practices to understand the applicability and acceptability of dietary therapy to establish generalizability. Furthermore, there is a need for nutrition experts to have a deep understanding of various cultural cuisines, practices, values, and customs. To achieve this, increasing the diversity of students in the sciences and having a diverse workforce of nutrition experts and health professionals that reflects the patient population will allow for more personalized care. In addition, there are social challenges, including a lack of medical insurance coverage, the cost of dietary interventions, and inconsistent nutrition messaging. Although there are many cultural considerations and social challenges to implementing effective dietary interventions around the world, these barriers are addressable through research methodologies that address culture and society challenges, and enhanced training of dietitians.

Intramural dissection of the esophagus is a rare complication of eosinophilic esophagitis in children

Eosinophilic esophagitis (EoE) is characterized by endoscopic signs and detection of more than 15 eosinophils per high-power field of view in biopsy specimens of the esophageal mucosa. Due to deep chronic eosinophilic inflammation, it can cause complications: esophageal stenosis, rarely perforation. Intramural esophageal dissection (IED) is a previously undescribed complication of EoE in children. We present a case of IED in a 15-year-old boy, which clinically manifested itself as sudden epigastric pain radiating to the back and nausea against the background of acute respiratory viral infection. According to endoscopy, CT and X-ray contrast study, a double-barreled esophagus with two cavities was detected - the esophagus itself and a blind "pocket", histologically in which granulation tissue and active inflammation with a large number of neutrophils were found. The initial histological examination did not reveal significant eosinophilic infiltration in the esophagus. The boy received a course of esomeprazole and was re-examined 6 months later. The radiographic picture was the same, and endoscopic examination revealed characteristic signs of EoE: longitudinal grooves and erosions, transverse rings, and narrowing of the esophageal lumen. In the middle third, the picture of a double-barreled esophagus was still preserved, but without signs of acute detachment, but with a dense septum between the two cavities of the esophagus. Histologically, the infiltrate contained more than 50 eosinophils in the field of view. The diagnosis was eosinophilic esophagitis complicated by RTI. A strict hypoallergenic diet was prescribed, excluding obligate allergens, budesonide 1 mg 2 times a day in the form of a gel. Endoscopic dissection of the esophageal septum was performed, its patency was restored. After 2 months, the boy was examined again while continuing drug therapy and diet. He had no complaints, radiologically the patency of the esophagus was not impaired. Endoscopically, the esophagus was freely passable, there was only a small fold at the site of the operation, longitudinal grooves and small erosions in the lower third remained. Histologically, the number of eosinophils decreased significantly. Therapy was continued. This clinical case demonstrates the possibility of developing RDI as a complication of EoE. The course of EoE can be asymptomatic, and RDI is the first manifestation of the disease. The endoscopic picture of a double-barreled esophagus is a consequence of dissection. The combination of a hypoallergenic diet, topical steroids and endoscopic septectomy is effective in the treatment of EoE with RDI.

Оценка иммунного статуса у беременных женщин с отягощенным аллергологическим анамнезом

Most researchers emphasize that in the structure of diseases of infants, there is a predominance of pathological conditions that occur precisely in the perinatal period, which indicate the correlation of these diseases with the health of the mother and the course of her pregnancy. Objective. Assessment of the immune status and effectiveness of diet therapy in pregnant women with burdened allergic history. Patients and methods. The observation groups consisted of 118 pregnant women. The first group included 83 pregnant women who received a hypoallergenic diet with the exclusion of main allergens, with the replacement of cow's milk with goat's milk, or the exclusion of dairy products as a causally significant allergen. The second group consisted of 35 pregnant women who followed the usual dietary recommendations offered in women's consultations, with the inclusion of cow's milk in the diet. The content of total IgE and allergen-specific IgE antibodies to food proteins in blood serum was determined by the immunoblot method using PROTIA Allergy-Q diagnostic panels. Results. 71.1% of pregnant women of the first group and 40% of women of the second group had the history of allergic diseases. According to skin scarification tests, these women had polyvalent sensitization. When studying the immunological status of pregnant women, attention was drawn to the fact that high levels of total serum IgE were in patients with allergies, with diseases of the gastrointestinal tract, as well as with a combination of these pathologies. 37.3% of the observed pregnant women of the first group, both with and without allergies, had high levels of total serum IgE. At the same time, the level of total IgE was higher in pregnant women suffering from allergic diseases. In addition, IgE sensitization to milk proteins was found in women with normal and high levels of total IgE in the blood. The concentration of allergen-specific IgE antibodies to cow's milk proteins was higher in women with IgE-mediated allergies. The use of a hypoallergenic diet in pregnant women caused the most pronounced decrease in the total IgE content in the blood compared with the indicators before treatment. The majority of the observed women showed a positive trend towards a decrease in IgE sensitization to milk proteins against the background of dietary therapy. Conclusion. All pregnant women with allergic diseases had food sensitization. Gastrointestinal pathology was observed in 34.7% of pregnant women, and its frequency in women with clinically confirmed allergies was 2.3 times higher than in women without allergies. A highly sensitive method for diagnosing food sensitization using PROTIA Allergy-Q panels has made it possible to most accurately identify causally significant allergen products, develop and effectively use personalized hypoallergenic diets for pregnant women. Considering the concept of food programming, the use of hypoallergenic diets in the diet of pregnant women with allergic diseases is one of the options for the prevention of allergic diseases in the future in children born to such mothers. Key words: pregnant women, allergy, food IgE sensitization, diet therapy

Интрамуральная диссекция пищевода – редкое осложнение эозинофильного эзофагита

Eosinophilic esophagitis (EoE) is characterized clinically by typical endoscopic features and the presence of more than 15 eosinophils visible per high-power field in esophageal mucosal biopsy samples. Due to deep chronic eosinophilic inflammation, it can lead to complications, such as esophageal stenosis and rarely perforation. Intramural esophageal dissection (IED) is a previously undescribed complication of EoE in children. This article presents a clinical case of IED in a 15-year-old boy with clinical debut as sudden epigastric pain and nausea against the background of acute respiratory viral infection. Endoscopy, computed tomography, and X-ray examination revealed a double-barrel esophagus with two cavities, the esophagus itself and a blind diverticulum (pouch or “pocket”), in which granulation tissue and active inflammation with many neutrophils were detected. Initial histological assessment showed no significant eosinophilic infiltration in the esophagus. After 6 months, endoscopy revealed characteristic signs of EoE: longitudinal grooves and erosions, transverse rings, narrowing of the esophageal lumen. In the middle third, the picture of double-barrel esophagus remained unchanged, but without signs of acute detachment and with a dense septum between two esophageal cavities. Histologically, the infiltrate contained more than 50 eosinophils per high-power field. The diagnosis of EoE complicated by IED was established. A strict hypoallergenic diet and an oral gel budesonide were prescribed. Endoscopic dissection of the esophageal septum was performed, its patency was restored. In 2 months, during a re-examination after a course of pharmacotherapy and diet, there were no complaints, radiological evaluation of esophageal patency showed no abnormalities. Endoscopically, the esophagus was freely passable, there was a small fold at the surgical site, longitudinal grooves and small erosions in the lower third maintained. Histologically, the number of eosinophils decreased significantly. The therapy was continued. This clinical case demonstrates the possibility of IED development as a complication of EoE. The course of EoE can be asymptomatic, while IED can serve as the first manifestation of the disease. The endoscopic presentation of double-barrel esophagus is a consequence of dissection. The combination of a hypoallergenic diet, topical steroids, and endoscopic septectomy is effective in the treatment of EoE with IED. Key words: eosinophilic esophagitis, intramural esophageal dissection, double-barrel esophagus

Technology for preparing fruit and vegetable desserts for baby food

To expand the range of desserts for school meals, hypoallergenic fruits and vegetables were used in our study. Zucchini, green apple and white currant as the main ingredients of sorbet were selected taking into account the recommendations of a non-specific hypoallergenic diet. Purpose of the work: to study the organoleptic characteristics of a new fruit and vegetable dessert. Objectives: to consider the organoleptic characteristics of products. The study of organoleptic indicators was carried out in accordance with GOST 31986-2012. Test batches of the dessert were carried out at the Volgograd State Agrarian University at the Department of Processing and Food Production Technologies. In terms of organoleptic indicators, the new product met all technical requirements. The appearance of sorbet, a single-layer dessert in the form of a ball without glaze, decorated with mint greens. The consistency is dense. The taste is clean, characteristic of apple and currant, without any foreign tastes or odors. The color is light green, uniform throughout the mass. The product sample meets the requirements of GOST R 55624-2013 “Whipped frozen fruit, vegetable and fruit-vegetable desserts. Technical conditions”.

Вітамінний статус як оцінка забезпеченості вітамінами А, Е, D в дітей з алергодерматозами

Vitamins are a group of biologically highly active, low molecular weight organic compounds of various chemical nature, which are practically not synthesized in the body or are synthesized in insufficient quantities, mainly income with food, and are vital to ensure for the flow and regulation of metabolic processes. Vitamins A, E, D play an important role in ensuring the normal functioning of the skin and mucous membranes, adequate immune response, maintaining the body’s resistance to various adverse external factors. Purpose - to study, evaluate and analyze the vitamin status, providing of vitamins A, E, D in children with allergic dermatoses. Materials and methods. 24 children with allergic dermatoses and 32 children of the control group aged 6 to 17 years were examined. General clinical, immunological, biochemical, questionnaires and statistical research methods were used. Results. Among the examined children with isolated allergopathology such as allergodermatoses were diagnosed 10 (41.7%) children, the remaining children were with combined allergic pathology such as allergodermatoses and bronchial asthma 14 (58.3%) children. The research of the providing of vitamins A, E, D in children with allergic dermatoses based on clinical symptoms showed the presence of hypovitaminosis manifestations of vitamin A in 9 (37.5%) children, vitamin E - 8 (33.3%) children, vitamin D - 14 (58.3%) children. Examination of vitamin status in children with allergodermatoses showed a marked decrease in blood levels of vitamin A, a moderate decrease in vitamin D levels, a slight decrease in vitamin E levels compared with children in the control group (p<0.05). In general, all examined children with allergodermatoses and the control group had low levels of vitamin D, subnormal low levels of vitamin A, normal levels of vitamin E according to the recommended criteria of normal supply of vitamins A, E, D according to blood levels. Conclusions. Based on the results of the study, the need for personalized correction of the consumption of vitamins A, E, D, taking into account the composition of the diet in children with allergic dermatoses, who are on elimination hypoallergenic diets were established. The synergistic effect of three vitamins A, E, D at the level of the immune system allows to recommend such a vitamin formula both for prophylactic purposes and in the complex treatment of children with skin allergies. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

S3695 Collagenous Gastritis: A Rare Cause of Severe Iron Deficiency Anemia in a Basic Military Trainee

Introduction: Collagenous gastritis is a rare inflammatory disease characterized by deposition of a thick subepithelial band of collagen and associated inflammatory infiltrate. This disorder has a reported prevalence of 13 per 100,000 esophagogastroduodenoscopies (EGDs) with a female predominance. Two distinct clinical phenotypes have been described: adult-onset characterized by diffuse gastrointestinal involvement and diarrhea, and pediatric-onset manifesting with abdominal pain and anemia. We present an interesting case of pediatric-phenotype collagenous gastritis to highlight this poorly-recognized disorder. Case Description/Methods: A 19-year-old male basic military trainee was referred for evaluation of incidentally discovered iron deficiency anemia. He denied any symptoms, overt blood loss, or NSAIDs. Physical exam was unremarkable. Labs revealed hemoglobin of 9.3 g/dL, iron saturation 7% and ferritin 15 ng/mL. The patient underwent EGD and colonoscopy for further evaluation. EGD revealed a diffusely nodular appearance of the gastric mucosa with areas with suspected atrophy under narrow-band imaging (Figures 1A, B). Colonoscopy was normal. Biopsies returned with a non-specific chronic gastritis without H. pylori. Abdominal computed tomography and additional work up for autoimmune gastritis, fecal H. pylori antigen, syphilis, and heavy metals toxins were all normal. Decision was made to repeat EGD for additional tissue sampling, including cold snared samples. Repeat gastric biopsies with expert GI pathologist review revealed collagenous gastritis, characterized by subepithelial deposition of a thick (greater than 10 µm) collagen band and associated inflammatory infiltrate (Figures 1C, D). Patient was lost to follow up due to disqualification for military service. Discussion: Collagenous gastritis is an exceedingly rare heterogeneous disease process of poorly understood causes and pathogenesis, with autoimmune conditions, medication effects, and infections theorized to be responsible. Numerous treatments have been reported with variable effect, including antisecretory agents, corticosteroids, immunomodulators, and hypoallergenic diets, along with micronutrient supplementation. Due to its rarity, a high level of suspicion is required by gastroenterologists and pathologists based on clinical and endoscopic findings. Our case helps to bring awareness to collagenous gastritis, and emphasizes the potential value for repeat tissue sampling with expert pathologist review.Figure 1.: A: Diffusely nodular appearance of the gastric mucosa with areas. B: Narrow-band imaging reveals areas of suspected atrophy. C: Multiple fragments of gastric mucosa with a prominent lymphoplasmacytic infiltrate within the lamina propria and occasional foci of subepithelial collagen deposition (red arrows). [Hematoxylin & Eosin, 50× magnification]. D: On higher magnification a focus of subepithelial collagen deposition may be seen associated with epithelial injury indicated by loss of foveolar mucin and detachment of the surface epithelium. [Hematoxylin & Eosin, 200× magnification].

S3677 Tissue Is the Issue: A Rare Case of Collagenous Gastritis

Introduction: Collagenous gastritis (CG), collagenous sprue, and collagenous colitis are rare forms of collagenous gastroenteritides marked by subepithelial collagen deposition of more than 10 mm and inflammatory infiltrate in the lamina propria. CG was first identified in 1989. It's a rare disease, with just 100 cases reported so far. Here, we present a distinct case of collagenous gastritis. Case Description/Methods: 52-year-old female with no chronic medical conditions presented with symptoms of mild reflux, epigastric pain, and intermittent diarrhea up to 5 times per day. She had sporadic Ibuprofen use for headaches. Her mother was diagnosed with lupus and a half-sister with a history of mixed connective tissue disorder. Initial upper endoscopy revealed grade B esophagitis and gastritis, biopsies showed CG. Colonoscopy with random biopsies showed no evidence of collagenous colitis. She was treated with high dose proton pump inhibitor (PPI) and repeat endoscopy in 4 weeks with biopsies via Sydney protocol was performed. Additional blood work was normal including normal thyroid panel, celiac screen (anti-transglutaminase IgA: < 1.0 U/ml, IgA: 2.34 g/L) and IgG4 titer (0.27 g/L.) Repeat EGD with biopsies per Sydney protocol confirmed CG in all gastric quadrants, except fundus. After stopping NSAIDs and continuing on PPI, her symptoms resolved with a plan for surveillance endoscopy in 6 months (Figure 1). Discussion: In our patient, the diagnosis of CG led to further investigations to rule out possible associated autoimmune diseases. The occasional ibuprofen may have been contributory, but the repeat biopsies on the second endoscopy confirmed the presence of CG despite cessation. The only contributing factor in her case is positive family history. There are very few cases reported in the literature with the possible association of lupus with CG. This distinctive case of CG is an important contribution to the limited pool of existing cases as the patient herself did not have any preexisting allergic or autoimmune conditions and it appears that this process occurred idiopathically. Given the rarity of the condition and limited literature available, we emphasize the importance of delineated medical guidelines for appropriate screening and surveillance.Figure 1.: Endoscopic appearance of collagenous gastritis. A, B. body, C. Antrum D. fundus ; E, F: Histology of collagenous gastritis characterized by thickening of sub epithelial basement membrane accompanied by diffuse superficial lymphoplasmacytic infiltrates and surface epithelial degeneration. Table 1. - Summary of Collagenous gastritis (CG) COLLAGENOUS GASTRITIS (CG) - Characterized by marked sub epithelial collagen deposition with associated inflammatory infiltrate. EPIDEMIOLOGY - Female Preponderance - All age groups but primarily affects adults. ETIOLOGY - The etiology is unknown - Stancu et al. outlined three pathogenic mechanisms that may lead to collagen deposition in cases of CG: (1) Chronic inflammation (2) Fibroblast sheath abnormality (3) Leakage of plasma proteins and fibrinogen ASSOCIATIONS - Intestinal and autoimmune disorders, including celiac disease. collagenous enteritis, collagenous colitis, sjogren syndrome, SLE, juvenile arthritis, RA, Hashimoto's thyroiditis, Grave's disease, Diabetes mellitus type 1, and CVID. - Medications such as Olmesartan, Venlafaxine SYMPTOMS AND SIGNS - Epigastric and or abdominal pain, anemia , gastrointestinal bleeding, diarrhea, nausea and vomiting, perforated ulcer, weight loss, abdominal distension, fatigue, dyspepsia, retrosternal pain, constipation and dysphagia. DIAGNOSIS - EGD with biopsy TREATMENT - Anti-secretory agents including PPIs, and H2 receptor antagonists, steroids, iron supplementation and hypoallergenic diets have been tried with limited success. - Other treatment modalities , such as sucralfate, mesalazine, bismuth subsalicylate, furazolidone, sulfasalazine, azathioprine, and parenteral nutrition have also been tested.

S3637 Not Your Usual Gastritis - A Case of Iron Deficiency Anemia Leading to a Rare Diagnosis of Collagenous Gastritis

Introduction: Collagenous gastritis (CG) is a rare disease characterized by deposition of subepithelial collagen in the gastric mucosa with concomitant inflammatory infiltrate in the lamina propria on histopathology. We report a rare case of CG in a young adult who was treated successfully with topical open capsule budesonide. Case Description/Methods: An 18-year-old male presented to the clinic for evaluation of iron deficiency anemia associated with exertional dyspnea, fatigue and intermittent episodes of melena. Initial studies were significant for hemoglobin of 5 g/dl, serum ferritin 3 ng/mL, serum iron 19 mcg/dL, and iron saturation of 6%. Prior to our evaluation, he had undergone EGD which was reported as having “gastritis” with negative Helicobacter pylori histopathology testing. The patient had required intravenous iron and packed red cell transfusions. We pursued repeat endoscopic evaluation. EGD showed hematin in the stomach with diffuse nodularity and friability in the stomach. No distinct ulcers were seen. Colonoscopy and video capsule endoscopy did not demonstrate any other abnormalities. Biopsies from the stomach revealed thickening of subepithelial collagen plate associated with chronic inflammation consistent with collagenous gastritis. Trichrome stain highlighted the thickened collagen plate and CD117 stain showed scattered mast cells without clustering. Treatment with budesonide 9 mg daily was subsequently started with clinical and hematological response on follow-up. (Figure) Discussion: CG can be further characterized to two distinct phenotypes seen in children and adults. In young patients, the disease often occurs in isolation and presents with symptoms of abdominal pain and anemia. Endoscopic features include nodular patterns, mucosal atrophy and collagen band deposition seen in both age groups. Treatments of this condition remains a challenge due to lack of established effective therapy. Prior reports with conventional treatments such as anti-secretary agents, iron supplementation, hypoallergenic diet, and systemic corticosteroids have produced limited success. Topical budesonide has emerged as effective treatment options in achieving clinical and histopathological improvement. CG is a rare entity that should be kept in mind in young patients who present with iron deficiency and nodularity seen on endoscopic evaluation. Our case adds to the growing body of literature in support of topical budesonide in treatment of CG.Figure 1.: Image A shows diffuse nodular mucosa in the gastric body on EGD. Image B shows thickening of subepithelial collagen plate associated with marked chronic inflammation.

Eosinophilic Esophagitis in Children: Clinical Cases

Background. Eosinophilic esophagitis (Ee) is a chronic immune-mediated disease of the esophagus, which is characterized by symptoms of esophageal dysfunction and marked eosinophilic infiltration of the mucous membrane (MM) of the organ. Currently, interest in the problem of eosinophilic esophagitis in the global medical scientific community is steadily growing. Eosinophilic esophagitis has no pathognomonic symptoms, which causes a great difficulty for diagnosis.Clinical case description. The paper describes two clinical cases of eosinophilic esophagitis in patient T. (4 years 10 months) and patient M. (5 years 2 months). Patient T. was admitted to the gastroenterology department of the Children’s Regional Clinical Hospital (CRCH), with complaints of hiccups, flatulence, intermittent abdominal pain, coughing when swallowing. The medical history showed that the child has been ill since the beginning of March 2021, when pain appeared in the epigastric region and along the esophagus when eating. Parents sought help in the Central District Hispital, where surgical and ENT pathologies were excluded. The child was referred to the gastroenterological department of the CRCH, where, according to the results of esophagogastroduodenoscopy (EGDS), the diagnosis of “Erosive reflux — esophagitis” was made. After stopping the erosive process the patient underwent repeated EGDS with biopsy, and was diagnosed with “Eosinophilic esophagitis”. Prescribed treatment: hypoallergenic diet, topical glucocorticosteroids (fluticasone propionate), proton pump inhibitors (PPIs), antacids. As a result of the treatment, no improvement was noted — it was decided to transfer the patient to budesonide therapy in the form of a viscous suspension, after which a persistent positive effect was observed. In the second case, the girl M. was admitted to the gastroenterological department of the Children’s Clinical Hospital with complaints of constant nausea after eating and abdominal pain. The medical history showed that the child has been sick since she was 1. The examination also revealed moderate eosinophilia, an increase in the level of alkaline phosphatase. Fibrogastroduodenoscopy with biopsy revealed endoscopic signs of EoE. A diagnosis of eosinophilic esophagitis was made. Treatment: hypoallergenic diet, glucocorticosteroids, PPI, antacids, antiemetic drugs. The treatment brought about certain positive dynamics. Conclusion. The presented clinical cases show the difficulty of diagnosing eosinophilic esophagitis, since the symptoms of this disease are not very specific.

Evaluation of High Doses of Phytase in a Low-Phosphorus Diet in Comparison to a Phytate-Free Diet on Performance, Apparent Ileal Digestibility of Nutrients, Bone Mineralization, Intestinal Morphology, and Immune Traits in 21-Day-Old Broiler Chickens.

Simple SummaryPhytic acid is the main storage form for phosphorus in plants. Although it is the main source of organic phosphorus in broiler diets, its utilization by monogastric animals is limited. In addition, phytic acid displays antinutritional effects, impacting optimal nutrient and energy digestibility. The supplementation of feed with phytases enables broilers to use phytate phosphorus more efficiently. Superdosing of phytase has been reported to have additional beneficial effects on the animal beyond the ones derived from the improved phosphorus utilization. This study tried to elucidate the mechanisms related to the immune response and mucosal morphology contributing to those overall beneficial effects. Although addressing performance was not the primary target of the study, performance improved linearly with increasing levels of phytase. The use of increasing doses of phytase showed linear increases in apparent ileal digestibility of crude protein, crude ash, and phosphorus. Jejunal crypt depth decreased with the addition of phytase to a low-protein diet, as well as the content of CD3-positive intraepithelial lymphocytes, but the results could not demonstrate clear differences between phytase doses in these specific parameters.The supplementation of feed with phytases enables broilers to utilize more efficiently phosphorus (P) from phytic acid (IP6), the main storage form of P in plants. The current study evaluated the addition of 500, 1000, and 3000 FTU of phytase per kg to a phytate-containing diet with low P level (LP) fed to broilers from 1 to 21 days of age and compared it to a hypoallergenic phytate-free diet (HPF). There was a linear improvement in performance parameters with increasing levels of phytase in the LP diet (p < 0.001). Apparent ileal digestibility of crude protein, P, and some amino acids, increased with phytase. Crude ash, P, and the calcium content of tibia bones linearly increased with increasing levels of phytase (p < 0.001). Crypt depth (related to body weight) in the jejunum epithelium linearly decreased with phytase addition (p < 0.001). Cecal crypt depth decreased with phytase supplementation (p = 0.002). Cecum tissue showed lower counts of CD3-positive intraepithelial lymphocytes in broilers receiving the phytase in comparison to LP (p < 0.001), achieving similar counts to HPF-fed broilers. Although results from the current study seem to point out some mechanisms related to the immune response and mucosal morphology contributing to those overall beneficial effects, no clear differences between different phytase doses could be demonstrated in these specific parameters.

Comparative Whey Proteome Profiling of Donkey Milk With Human and Cow Milk.

Donkey milk (DM), similar to human milk (HM) in chemical composition, has been suggested as the best potential hypoallergenic replacement diet for babies suffering from Cow milk (CM) protein allergy. In order to better understand DM protein, many studies based on proteomic have been performed. In this study, the label-free quantitative proteomic approach was conducted to quantitatively identify the differentially expressed whey proteins (DEPs) in DM vs. HM group and DM vs. CM group. In total, 241 and 365 DEPs were found in these two groups, respectively. Bioinformatics analysis of DEPs showed that the majority of DEPs participated in the lipoprotein metabolic process, regulation of cytokine production, chemical homeostasis, and catabolic process. The Kyoto Encyclopedia of Gene and Genomes (KEGG) pathways analysis found that these DEPs mainly participated in an antigen processing, complement, and coagulation cascades. These results may provide valuable information in the composition of milk whey proteins in DM, HM, and CM, especially for low abundant components, and expand our knowledge of different biological functions between DM and HM or CM.