Adult Intolerance Research Articles

529 Adiposity is associated with glucose intolerance in adults with cystic fibrosis in the CFTR modulator era

529 Adiposity is associated with glucose intolerance in adults with cystic fibrosis in the CFTR modulator era

Validation of a Modified Cow’s Milk-Related Symptom Score (CoMiSS) for Screening of Lactose Intolerance in Adults

Abstract Introduction Lactose intolerance is the failure to digest foods and beverages containing the lactose present in milk. Lactose intolerance can be presented by many digestive symptoms. Objective To validate the modified CoMiSS score for the prediction of lactose intolerance, that was confirmed by a stool acidity test. Patients and Methods A crosssectional study, conducted on Ain Shams University Hospitals/ Gastrointestinal Clinics, enrolled100 adult participants during the period from December 2018 to December 2019, with the presence of one or more gastrointestinal symptoms, and subjected to a stool acidity test as a reference test and modified CoMiSS as index test. Results The mean age of participants was 35.30 ± 10.714 years old; 55% were females, and mean BMI was 23.08 ± 2.080 kg/m2, with no statistically significant difference between lactose intolerance and patients gender or body mass index BMI, 24% of participants had positive stool PH, lactose Intolerance diagnosed according to modified CoMISS Score among 19% of study participants, the mean of modified CoMISS Score in positive cases (12.37) were highly statistically significant than those negative lactose intolerance (2.33) as p < 0.001, Area under ROC Curve was 0.998, with cut-off value >8. Sensitivity 89.5% and specificity was 100%. Conclusion Modified CoMiSS is a simple, fast, and easy-to-use tool that can predict lactose intolerance, with a cut-off value of > 8, the Area under the ROC Curve was 0.998, sensitivity 89.5%, and specificity was 100%.

Adults with impaired gastrointestinal function show improvements in gastrointestinal symptoms and protein intake with a high-protein, peptide-based oral nutritional supplement

Provision of feeds containing hydrolysed, peptide-based proteins and medium-chain triglycerides (MCT), can help mitigate gastrointestinal (GI) intolerance in adults with impaired GI function, maldigestion and/or malabsorption. This study evaluated a high-protein, peptide-based, MCT-containing oral nutritional supplement (PEHP; 1.5kcal/ml and 7.5g protein/100ml). Adults with impaired GI function were recruited by their managing dietitian and took PEHP orally for 28-days, with GI tolerance, compliance, weight, energy and protein intake assessed via non-validated questionnaires and a 24-hour dietary recall at baseline and at intervention end. Fifteen, adults (56 years (16), 67kg (26.0), 24kg/m2 (7.6)) took part in this study. Intensity of nausea (Z= -2.070, p=0.038, n=15) and abdominal pain (Z= -2.236, p=0.025, n=15) improved significantly compared to baseline. Reductions in the intensity of diarrhoea, constipation, vomiting, flatulence, and burping were observed but were not statistically significant (p>0.05 for all). Compliance was higher with PEHP (81% (24)) than baseline feeds (63% (42)) but not significantly. Weight remained stable between baseline (67kg (26)) and at intervention end (67kg (27), p=0.414, n=15). Compared to baseline, total energy intake increased with PEHP albeit not significantly (1661 kcal/day (572) vs 1981 kcal/day (592), p=0.137, n=15). Increases in total protein intake were also observed, this time significantly (61 g/day (23) vs 78 g/day (29), p=0.042, n=15). This study in adults with impaired GI function found that PEHP improved GI tolerance and protein intake compared to feeds taken at baseline (including both polymeric and peptide-based feeds).

Serum Uromodulin in Children and Adolescents with Type 1 Diabetes Mellitus and Controls: Its Potential Role in Kidney Health.

Uromodulin is a kidney-specific tubular protein, and its assessment in serum (sUMOD) reveals the potential as a novel marker for function and the integrity of renal parenchymal cells and does not directly depend on the glomerular filtration rate. Early diabetic nephropathy parallels glomerular hyperfiltration, often leading to diagnostic misinterpretation. Moreover, traditional kidney function markers are not able to diagnose structural lesions. Recent data show that sUMOD is linked to glucose intolerance in adults. Thus, we launched to assess the hypothesis that sUMOD is also associated with kidney function, biometric data, and quality of metabolic control in children/adolescents with type 1 diabetes. Patients with type 1 diabetes (n=135) and healthy controls (n=69) were recruited to participate in the trial. Clinical, biometrical data, sUMOD, and other laboratory parameters were assessed. The mean concentrations of sUMOD in diabetic patients and controls were comparable (201.19±103.22 vs. 198.32±84.27 ng/mL, p=0.832). However, in contrast to healthy controls, sUMOD levels in patients with diabetes were associated with serum-creatinine (r=-0.368, p<0.0001), age (r=-0.350, p<0.0001), height (r=-0.379, p<0.0001), body weight (r=-0.394, p<0.0001), Body mass index (r=-0.292, p=0.001), daily insulin dosage (r=-0.300, p<0.0001), HbA1c (%) (r=-0.190, p=0.027), standardized HbA1c/IFCC (mmol/mol) (r=-0.189, p=0.028), and systolic (r=-0.299, p<0.0001) and diastolic (r=-0.235, p=0.006) arterial blood pressure. Our study shows that children/adolescents with type 1 diabetes disclose similar sUMOD concentrations as healthy controls. Serum UMOD appears to indicate higher risks for kidney tissue remodeling and possibly subsequent cardiovascular alterations. However, further studies are mandatory to settle these findings.

Sucrose intolerance in adults with common functional gastrointestinal symptoms

Sucrose intolerance is a form of carbohydrate malabsorption caused by sucrase-isomaltase deficiency that is more common than recognized. Its symptoms include postprandial cramping, bloating, gas, and diarrhea, which are difficult to distinguish from irritable bowel syndrome. The gold standard test for diagnosing sucrase deficiency is a sucrase enzyme assay of duodenal biopsies obtained by endoscopy. Hydrogen-methane or 13C-sucrose breath tests are noninvasive methods to screen for sucrose malabsorption. This chart review included 258 consecutive adults (47 men and 211 women) with chronic unexplained gastrointestinal symptoms and suspected sucrose intolerance who were screened with a hydrogen-methane or 13C-sucrose breath test. The incidence of sucrose malabsorption with two different hydrogen-methane breath tests was 34.4% (21/61) (Commonwealth Diagnostics International, Inc., Salem, MA) and 40% (20/50) (Aerodiagnostics, Concord, MA). The incidence of sucrose malabsorption with the 13C-sucrose breath test was 26.5% (39/147). In a subgroup of patients with positive breath tests and clinical follow-up, counseling regarding diet and/or enzyme replacement led to symptomatic improvement in 26/43 (60%). In conclusion, sucrose malabsorption may present with irritable bowel syndrome symptoms in a proportion of adult patients, and breath tests may be useful in identifying sucrose malabsorption and differentiating it from other gastrointestinal disorders.

Validation of a modified cow’s milk-related symptom score (CoMISS) for screening of lactose intolerance in adults

Introduction Lactose intolerance (LI) is the failure to digest foods and beverages containing the lactose present in milk. LI can present by many digestive symptoms. Objective To validate the modified CoMiSS score for prediction of LI, that was confirmed by a stool acidity test. Patients and methods A cross-sectional study, was conducted at Ain Shams University Hospitals/Gastrointestinal Clinics, and included one hundred adult participants during the period from December 2018 to December 2019. Enrolled patients had one or more gastrointestinal symptoms and were subjected to a stool acidity test (fecal PH test) as a reference test and modified CoMiSS as an index test. Results The mean age of participants was 35.30 ± 10.714 years old; 55% were females, and their mean body mass index (BMI) was 23.08 ± 2.080 kg/m2, with no significant relation between LI and patients` gender or BMI. Out of the studied participants 24% had positive stool PH, LI diagnosed according to modified CoMISS was present among 19% of them. The mean value of modified CoMISS Score was significantly higher in positive cases (12.37) compared to negative LI participants (2.33) as p < .001. Area under ROC Curve was 0.998, at the selected cut-off value 8, the sensitivity was 89.5% and specificity was 100% thus, levels of questionnaire scoring of 8 or higher would indicate presence of lactose intolerance. Conclusion Modified CoMiSS is a simple, fast, and easy-to-use tool that can predict LI, with a cut-off value of >8, the Area under the ROC Curve was 0.998, sensitivity 89.5%, and specificity was 100%.

Orthostatic Intolerance in Adults Reporting Long COVID Symptoms Was Not Associated With Postural Orthostatic Tachycardia Syndrome.

In this observational cross-sectional study, we investigated predictors of orthostatic intolerance (OI) in adults reporting long COVID symptoms. Participants underwent a 3-min active stand (AS) with Finapres® NOVA, followed by a 10-min unmedicated 70° head-up tilt test. Eighty-five participants were included (mean age 46 years, range 25–78; 74% women), of which 56 (66%) reported OI during AS (OIAS). OIAS seemed associated with female sex, more fatigue and depressive symptoms, and greater inability to perform activities of daily living (ADL), as well as a higher heart rate (HR) at the lowest systolic blood pressure (SBP) point before the first minute post-stand (mean HRnadir: 88 vs. 75 bpm, P = 0.004). In a regression model also including age, sex, fatigue, depression, ADL inability, and peak HR after the nadir SBP, HRnadir was the only OIAS predictor (OR = 1.09, 95% CI: 1.01–1.18, P = 0.027). Twenty-two (26%) participants had initial (iOH) and 5 (6%) classical (cOHAS) orthostatic hypotension, but neither correlated with OIAS. Seventy-one participants proceeded to tilt, of which 28 (39%) had OI during tilt (OItilt). Of the 53 who had a 10-min tilt, 7 (13%) had an HR increase >30 bpm without cOHtilt (2 to HR > 120 bpm), but six did not report OItilt. In conclusion, OIAS was associated with a higher initial HR on AS, which after 1 min equalised with the non-OIAS group. Despite these initial orthostatic HR differences, POTS was infrequent (2%). ClinicalTrials.gov Identifier: NCT05027724 (retrospectively registered on August 30, 2021).

274-OR: Gestational Diabetes, Epigenetic Age Acceleration, and Insulin Sensitivity and Secretion in the Exploring Perinatal Outcomes among Children Study

Objectives: Epigenetic age acceleration (EAA) occurs when DNA methylation-predicted age is older than chronological age. EAA is associated with glucose intolerance in adults. In-utero exposure to gestational diabetes (GDM) is associated with glucose intolerance in offspring. It is not known if GDM predicts EAA in offspring or if offspring EAA is associated with insulin sensitivity and secretion. Methods: We examined the association between exposure to GDM in-utero and EAA, computed at average age 10.5 years, and EAA and measures of insulin sensitivity (HOMA-2S) and secretion (HOMA-2β) at average age 10.5 and 16.7 years in 209 girls and 209 boys in the Colorado EPOCH (Exploring Perinatal Outcomes Among Children) cohort. We calculated EAA using the Horvath, Hannum, and Levine calculators. Separate general linear mixed models adjusted associations for chronologic age and sex. Results: Exposure to GDM was associated with EAA using the Hannum (beta-coefficient 1.39, p=0.009) and Levine (1.92, p=0.024) but not the Horvath calculator (-0.01, p=0.69). EAA by the Hannum calculator predicted lower insulin sensitivity and higher insulin secretion (Table). Conclusions: We conclude that GDM predicts offspring EAA, and EAA is associated with decreased insulin sensitivity and increased insulin secretion. Associations are dependent upon the EAA calculator used. Disclosure C. Kim: None. K. K. Harrall: None. D. H. Glueck: None. B. Needham: None. D. Dabelea: None. Funding National Institutes of Health (R01DK076648, R01GM121081, R01DK068001307, M01RR00069, 5UG3OD023248)

1258-P: Lack of Monitoring for Glucose Intolerance in Overweight and Obese Youth on Second-Generation Antipsychotics Despite Increased Risk

Second-generation antipsychotics (SGAs) increase risk for glucose intolerance in adults; less is known about risk in youth. MOBILITY is a large, multi-center, pragmatic study designed to assess the effect of metformin added to a lifestyle intervention compared to lifestyle alone on weight gain and metabolic parameters in overweight and obese pediatric (ages 8-19) patients with bipolar-spectrum disorders (BSD) receiving SGAs. Frank diabetes was an exclusion criterion. It was recommended to obtain baseline, +6 month, and +12 month fasting metabolic labs in this trial conducted in real-world psychiatry clinics. We estimated prevalence of glucose intolerance prior to intervention. We hypothesized that youth with elevated fasting plasma glucose (FPG) and hemoglobin A1C (HbA1C) would be more likely to have repeat metabolic assessment. Altogether, 684 youth (mean age=14.3 years, 53% male, 64% with baseline BMI ≥95th%ile) were included in these analyses. Baseline FPG was obtained in 73% (501/684); 12.1% of these had impaired fasting glucose (IFG). Baseline HbA1C was obtained in 53% (360/684); 11.1% had HbA1C ≥5.7%. Six patients (1.6%) had both measures elevated. Only 41% of patients with IFG and 40% of those with HbA1C ≥5.7% had repeat glucose measures within 1 year; neither were more likely to have repeat laboratory testing than patients with normal baseline laboratory results (OR=0.88, p=0.773; OR=0.85; p=1.00, respectively). Of six patients with both IFG and HbA1C elevated at baseline, only three had repeat laboratory testing; one of these developed diabetes on follow-up. Overweight and obese youth with BSD on SGA therapy have clinically relevant rates of glucose intolerance. However, assessment and, especially, reassessment of abnormal glucose status in this population is poor. Further studies are needed to identify and address barriers for evaluation for glucose intolerance in this at-risk population. Disclosure N.A. Crimmins: None. M.P. DelBello: None. C. Correll: Consultant; Self; Alkermes plc., Allergan plc., Janssen Pharmaceuticals, Inc., Lundbeck, Otsuka Pharmaceutical Co., Ltd., Pfizer Inc., Sumitomo Dainippon Pharma Co., Ltd., Sunovion Pharmaceuticals Inc., Takeda Pharmaceutical Company Limited, Teva Pharmaceutical Industries Ltd. C. Klein: None. T. Blom: None. J. Welge: None. Funding Patient-Centered Outcomes Research Institute (to M.P.D.)

Cortisol Level Related Glucose Intolerance in Adult with Obese Central

Obesity is associated with an increased risk of diseases, especially central obesity. Central obesity is a risk factor of glucose intolerance. Glucose intolerance is the beginning of diabetes mellitus. Many factors influence glucose intolerance. The aim of this study was to investigate the relationship between cortisol levels and some other factors related glucose intolerance. This study was a cross-sectional study from 12 high schools in Makassar. The analysis for this study was performed with 54 teachers. Characteristic samples, anthropometry, fasting blood glucose (FBG), cortisol were measured for all samples. Blood plasma glucose was measured from venous blood samples. Respondents were mostly female (85.2%), married (87%), bachelor’s degree (79,6%) and Buginesse (66.7%). The average age of respondents was 49.37 years. The results showed a significant relationship formula: between high cortisol levels in respondents who experienced glucose intolerance (p=0.043). Stress variables did not show a significant relationship, but the average score was higher in those who experienced glucose intolerance than those who had normal glucose. The frequency of consumption of carbohydrates, fats, proteins, and Body mass index (BMI) did not show a significant relationship with glucose intolerance. Cortisol levels are associated with glucose intolerance in adults with central obesity.

Real-time PCR based detection of the lactase non-persistence associated genetic variant LCT-13910C>T directly from whole blood.

Primary hypolactasia is the main cause of lactose intolerance in adults. It is strongly associated with the single genetic variant LCT-13910C>T, located upstream of the lactase encoding gene. Consequently, analysis of LCT-13910C>T has been recommended as a direct genetic test for the trait. The aim of our study was to develop a TaqMan probe based real-time PCR protocol for the detection of the LCT-13910C>T variant directly from whole blood, circumventing DNA isolation. The LCT-13910C>T variant was determined using the DirectBlood Genotyping PCR Kit (myPOLS Biotec, Konstanz, Germany) together with an in-house TaqMan primer-probe assay. Validity and specificity of the assay was evaluated using EDTA anti-coagulated whole blood samples and corresponding DNA samples. Results from real-time PCR were compared with results obtained by Sanger sequencing from 105 blinded whole blood samples. Validity and specificity of the assay using whole blood were comparable to those using purified genomic DNA as substrate in PCR. Genetic analysis of blood samples were in complete agreement with results obtained by Sanger sequencing. In conclusion, we present a reliable real-time PCR protocol for the detection of the LCT-13910C>T variant directly from whole blood further facilitating diagnosis of primary hypolactasia in symptomatic patients.

Background factors of chemical intolerance and parent\u2013child relationships

BackgroundChemical intolerance is a widespread public health problem characterized by symptoms that reportedly result from low-level exposure to chemicals. Although several studies have reported factors related to chemical intolerance in adults, the impact of family members has not been reported. In the present study, we investigated the background factors related to chemical intolerance in family members and parent–child relationships.MethodsWe distributed a self-reported questionnaire to 4325 mothers who were invited to visit the Kishiwada Health Center in Kishiwada City, Osaka, between January 2006 and December 2007 for the regular health checkup of their three-and-a-half-year-old children.ResultsThe prevalence of chemical intolerance in the 3-year-old children was almost one eighteenth of that reported by their mothers. Multiple logistic regression analyses revealed that cold sensitivity [odds ratio (OR), 1.89; 95% confidence interval (CI), 1.04–3.44], past bronchial asthma (OR, 2.84; 95% CI, 1.46–5.53), and any past allergies (OR, 2.21; 95% CI, 1.36–3.60) were significantly associated with chemical intolerance in the mother. The presence of indoor cat during childhood (OR, 1.99; 95% CI, 1.08–3.69) was significantly associated with chemical intolerance in the mother; however, the association was weak compared with cold sensitivity and past asthma and allergies. The current chemical intolerance of the mother was significantly associated with allergic rhinitis (OR, 2.32; 95% CI, 1.19–4.53), bronchial asthma (OR, 3.66; 95% CI, 2.00–6.69), and chronic bronchitis (OR, 3.69; 95% CI, 1.04–13.03) in her 3-year-old child.ConclusionsThe results suggest that inherent physical constitution and childhood housing environment are associated with a risk of acquiring chemical intolerance. Children of mothers with chemical intolerance have a possible risk of respiratory hypersensitivity or inflammation. Further investigation is recommended to determine the inherent physical constitution and background environmental factors associated with the risk of acquiring chemical intolerance. The impact of having mothers with chemical intolerance on the health of children also requires further study.

Effect of ventricular function and volumes on exercise capacity in adults with repaired Tetralogy of Fallot

ObjectivesInvestigate the effects of left and right ventricular function and severity of pulmonary valve regurgitation, quantified by cardiac magnetic resonance (CMR), on exercise tolerance in adult patients who underwent ToF repair at a young age. MethodsThis is a retrospective cohort study of 52 patients after ToF surgery and 33 age- and sex-matched healthy volunteers. CMR and cardiopulmonary exercise testing (CPET) were performed on all patients; CPET was performed on control subjects. ResultsThe main finding of CPET was a severe decrease in oxygen uptake at peak exercise VO2peak in TOF patients. The patients were characterized also by lower pulse O2peak and heart rate at peak exercise. Ejection fraction of the right and left ventricles was correlated (r=0,32; p=0,03). Left ventricle ejection fraction was negatively correlated with right ventricular volumes (r=−0,34; p=0,01) and right ventricular mass (r=−046; p<0,00). Right ventricular mass was positively correlated with left ventricular variables (left ventricle end diastolic volume, r=0,43; p=0,002; left ventricle end systolic volume, r=0,54; p<0,00) as was VO2peak: LVEDV (r=0,38; p=0,01); LVESV (r=0,33; p=0,03) and LV mass (r=0,42; p=0,006). ConclusionExercise intolerance in adults with repaired ToF is markedly depressed. The decreased exercise capacity is correlated with impaired RV function and may be associated also with LV dysfunction, which suggests right-to-left ventricular interaction.

Relationship between ventilation heterogeneity and exercise intolerance in adults with sickle cell anemia.

Sickle cell anemia (SCA) causes dysfunction of multiple organs, with pulmonary involvement as a major cause of mortality. Recently, there has been growing interest in the nitrogen single-breath washout (N2SBW) test, which is able to detect ventilation heterogeneity and small airway disease when the results of other pulmonary function tests (PFTs) are still normal. Thus, the objectives of the present study were to assess the heterogeneity in the ventilation distribution in adults with SCA and to determine the association between the ventilation distribution and the clinical, cardiovascular, and radiological findings. This cross-sectional study included 38 adults with SCA who underwent PFTs, echocardiography, computed tomography (CT), and 6-min walk test. To evaluate the ventilation heterogeneity, the patients were categorized according to the phase III slope of the N2SBW (SIIIN2). Compared with adults with lower SIIIN2 values, adults with higher SIIIN2 values showed lower hemoglobin levels (P=0.048), a history of acute chest syndrome (P=0.001), an elevated tricuspid regurgitation velocity (P=0.039), predominance of a reticular pattern in the CT (P=0.002), a shorter 6-min walking distance (6MWD) (P=0.002), and lower peripheral oxygen saturation (SpO2) after exercise (P=0.03). SIIIN2 values correlated significantly with hemoglobin (rs=-0.344; P=0.034), forced vital capacity (rs=-0.671; P<0.0001), diffusing capacity for carbon monoxide (rs=-0.376; P=0.019), 6MWD (rs=-0.554; P=0.0003), and SpO2 after exercise (P=0.040). Heterogeneity in the ventilation distribution is one of the most common pulmonary dysfunctions in adults with SCA. Moreover, relationships exist between ventilation heterogeneity, worsening of pulmonary structural damage, and reduced tolerance for exercise.

Fear of Heights in Primary School Children

The life-time prevalence of visual height intolerance in adults is 28 percent, whereas in primary school children, as recently shown, it develops in 34 percent. Triggers and symptoms are similar in children and adults. A significant difference in visual height intolerance of prepubertal children compared to adults is the good prognosis with mostly spontaneous remission within a few years, possibly facilitated by repeated exposure to the triggering situations.

Lactose Intolerance in Adults: Biological Mechanism and Dietary Management

Lactose intolerance related to primary or secondary lactase deficiency is characterized by abdominal pain and distension, borborygmi, flatus, and diarrhea induced by lactose in dairy products. The biological mechanism and lactose malabsorption is established and several investigations are available, including genetic, endoscopic and physiological tests. Lactose intolerance depends not only on the expression of lactase but also on the dose of lactose, intestinal flora, gastrointestinal motility, small intestinal bacterial overgrowth and sensitivity of the gastrointestinal tract to the generation of gas and other fermentation products of lactose digestion. Treatment of lactose intolerance can include lactose-reduced diet and enzyme replacement. This is effective if symptoms are only related to dairy products; however, lactose intolerance can be part of a wider intolerance to variably absorbed, fermentable oligo-, di-, monosaccharides and polyols (FODMAPs). This is present in at least half of patients with irritable bowel syndrome (IBS) and this group requires not only restriction of lactose intake but also a low FODMAP diet to improve gastrointestinal complaints. The long-term effects of a dairy-free, low FODMAPs diet on nutritional health and the fecal microbiome are not well defined. This review summarizes recent advances in our understanding of the genetic basis, biological mechanism, diagnosis and dietary management of lactose intolerance.

Association Between Daily Time Spent in Sedentary Behavior and Duration of Hyperglycemia in Type 2 Diabetes

Exercise and sedentary behavior have different physiologic effects, which have yet to be fully explained. Time spent in sedentary behavior has been associated with glucose intolerance in adults at risk for type 2 diabetes, but these data have come largely from cross-sectional studies that have not explored this relationship in adults with diabetes. The specific aim of this study was to examine the relationship between time spent in sedentary behavior and glucose levels in adults diagnosed with type 2 diabetes over 3-5 days. Using continuous and concurrent data gathered from wrist accelerometry and a Continuous Glucose-Monitoring Sensor (CGMS), we conducted a longitudinal, descriptive study involving 86 patients with type 2 diabetes. More time spent in sedentary behavior was predictive of significant increases in time spent in hyperglycemia (B = 0.12, p < .05). These findings highlight the relationship between time spent sedentary and time spent in hyperglycemia, as identified through our use of objective, continuous data collection methods for both sedentary behavior and glucose levels across multiple days (Actiwatch, CGMS). For patients with type 2 diabetes, these findings emphasize the need for the development of individualized interventions aimed at decreasing the amount of time spent in hyperglycemia by reducing sedentary time.

Food allergy and intolerance

Abstract Allergic reactions to foods represent severe actual problems for mankind having increased global character. Adverse food reactions are divided to food allergy, an immunological response to food, and food intolerance, a non-immune reaction with allergy-like symptoms. It is estimated that 6–8 % of children and 1–2 % of adults suffer from food allergy. The prevalence of food intolerance in adults is no more than 5–6 %, however in infants and young children, it is varied from 0.3 % to 20 %. Allergy is caused by different food allergens (milk proteins, cereals, nuts, fruits and vegetables), while there is frequent cross-allergy among them. Food intolerance is adverse reaction resulting from enzyme deficiencies, pharmacological reactions, and response to toxic or irritant components of food. Focusing on dairy products and cereals, the impact of fermentation in reducing food intolerance or allergenicity is reviewed in this paper.

Review article: the diagnosis and management of food allergy and food intolerances.

Adverse reactions to food include immune mediated food allergies and non-immune mediated food intolerances. Food allergies and intolerances are often confused by health professionals, patients and the public. To critically review the data relating to diagnosis and management of food allergy and food intolerance in adults and children. MEDLINE, EMBASE and the Cochrane Database were searched up until May 2014, using search terms related to food allergy and intolerance. An estimated one-fifth of the population believe that they have adverse reactions to food. Estimates of true IgE-mediated food allergy vary, but in some countries it may be as prevalent as 4-7% of preschool children. The most common food allergens are cow's milk, egg, peanut, tree nuts, soy, shellfish and finned fish. Reactions vary from urticaria to anaphylaxis and death. Tolerance for many foods including milk and egg develops with age, but is far less likely with peanut allergy. Estimates of IgE-mediated food allergy in adults are closer to 1-2%. Non-IgE-mediated food allergies such as Food Protein-Induced Enterocolitis Syndrome are rarer and predominantly recognised in childhood. Eosinophilic gastrointestinal disorders including eosinophilic oesophagitis are mixed IgE- and non-IgE-mediated food allergic conditions, and are improved by dietary exclusions. By contrast food intolerances are nonspecific, and the resultant symptoms resemble other common medically unexplained complaints, often overlapping with symptoms found in functional disorders such as irritable bowel syndrome. Improved dietary treatments for the irritable bowel syndrome have recently been described. Food allergies are more common in children, can be life-threatening and are distinct from food intolerances. Food intolerances may pose little risk but since functional disorders are so prevalent, greater efforts to understand adverse effects of foods in functional disorders are warranted.

Home-based Inspiratory Muscle Training In Adults With Cystic Fibrosis: A Case Series Report

Introduction: Excess work of breathing imposed on the inspiratory muscles can contribute to dyspnea and exercise intolerance in adults with cystic fibrosis (CF). Inspiratory muscle training (IMT) may result in positive outcomes in CF by enhancing inspiratory muscle function relative to their imposed demands. The purpose of this case series was to describe the feasibility and potential efficacy of IMT to improve functional exercise capacity in adults with stable CF. Methods: A prospective analysis evaluating the effect of a 6-week home-based IMT program in 4 adults with stable CF was performed. Outcome measures included the percent of predicted forced expiratory volume in 1-second (%FEV1), maximal inspiratory pressure (MIP), and the distance walked in 6 minutes (6MWD). Results: MIP increased by an average of 25% (p < 0.01) in all subjects after training. However, improvements in %FEV1 and 6MWD occurred only in the one subject with decreased inspiratory muscle strength (IMS) at baseline. Conclusion: Unsupervised IMT can be implemented in an outpatient adult CF clinic to improve IMS although the required time commitment may limit its applicability. Potential ergogenic benefits from enhanced IMS may be limited to individuals with preexisting inspiratory muscle weakness. Research is needed to determine the potential role of IMT in CF with careful attention to subject characteristics that may influence outcomes.