Oral Challenge Research Articles

Craniosynostosis: orofacial and oral health perspectives with masticatory insights

BackgroundCraniosynostosis (CS), premature fusion of one or more cranial sutures, leads to abnormal skull development, impacting both facial esthetics and oral function. This study aimed to evaluate the specific orofacial and oral health characteristics, including masticatory performance, in Thai patients with CS.MethodsA comparative study was conducted with Thai CS patients aged 6–17 years and a control group of healthy individuals with similar age distribution. Assessments included craniofacial morphology, oral health status, and masticatory performance. Intergroup comparisons utilized appropriate statistical tests.ResultsThe study included 24 CS patients with a mean age of 10.11 ± 2.98 years and 30 controls. CS patients exhibited a significantly higher prevalence of various oral conditions compared to controls: cleft palate (20.8%), anterior open bite (41.7%), anterior crossbite (54.2%), posterior crossbite (50%), combined anterior–posterior crossbite (45.8%), dental crowding in both maxilla and mandible (50% and 45.8% respectively), congenitally missing teeth (50%), supernumerary teeth (12.5%), and eruption failure (54.2%). Furthermore, CS patients exhibited significantly higher caries prevalence and susceptibility, alongside poorer oral hygiene, compared to controls. Regarding jaw relationships, CS patients exhibited a significantly higher proportion of Angle's Class III malocclusion (50%) compared to the control group, where Class I malocclusion was predominant (50%). Masticatory performance, assessed using the two-color gum mixing ability test, showed significantly higher hue variance in CS patients (0.12 ± 0.07) compared to the control group, indicating reduced chewing performance.ConclusionThis study underscores the significant orofacial and oral health challenges faced by children with CS, including a high prevalence of malocclusions, dental anomalies, elevated caries experience, and compromised masticatory function. These findings emphasize the importance of tailored interventions and comprehensive oral healthcare strategies to address the unique needs of this population and improve their overall quality of life.

Is Component-Specific Antibody Testing Sufficient to Replace the Oral Food Challenge in the Diagnostics of Peanut-Sensitized Children? A Proof-of-Concept Study.

(1) Peanut allergy is associated with high risk of anaphylaxis which could be prevented by oral immunotherapy. Patients eligible for immunotherapy are selected on the basis of a food challenge, although currently the assessment of antibodies against main peanut molecules (Ara h 1, 2, 3 and 6) is thought to be another option. (2) The current study assessed the relationship between the mentioned antibodies, challenge outcomes, skin tests and some other parameters in peanut-sensitized children. It involved 74 children, divided into two groups, based on their response to a food challenge. (3) Both groups differed in results of skin tests, levels of component-specific antibodies and peanut exposure history. The antibody levels were then used to calculate thresholds for prediction of challenge results or symptom severity. While the antibody-based challenge prediction revealed statistical significance, it failed in cases of severe symptoms. Furthermore, no significant correlation was observed between antibody levels, symptom-eliciting doses and the risk of severe anaphylaxis. Although in some patients it could result from interference with IgG4, the latter would not be a universal explanation of this phenomenon. (4) Despite some limitations, antibody-based screening may be an alternative to the food challenge, although its clinical relevance still requires further studies.

Auranofin-loaded PLGA nanoparticles alleviate cognitive deficit induced by streptozotocin in rats model: modulation of oxidative stress, neuroinflammatory markers, and neurotransmitters.

Alzheimer's disease remains an unsolved neurological puzzle with no cure. Current therapies offer only symptomatic relief, hindered by limited uptake through the blood-brain barrier. Auranofin, an FDA-approved compound, exhibits potent antioxidative and anti-inflammatory properties targeting brain disorders. Yet, its oral bioavailability challenge prompts the exploration of nanoformulation-based solutions enhancing blood-brain barrier penetrability. The study aimed to investigate the neuroprotective potential of auranofin nanoparticles in streptozotocin-induced AD rats. Auranofin-containing polylactic-co-glycolic acid nanoparticles were formulated by the multiple emulsion solvent evaporation method. Characterization was done by determining entrapment efficiency, particle size distribution, surface charge, and morphology. An in vivo study was performed by administering streptozotocin (3mg/kg/i.c.v., days 1 and 3), auranofin (5 and 10mg/kg), auranofin nanoparticles (2.5 and 5mg/kg), and donepezil (2mg/kg) for 14days orally. Behavioral deficits were evaluated using the open field test, Morris water maze, objective recognition test, change in oxidative stress levels, and AD markers in the brain. Following the decapitation of the rats, the brains were excised to isolate the hippocampus. Subsequent analyses included the quantification of biochemical and neuroinflammatory markers, as well as the assessment of neurotransmitter levels. The characterization of auranofin nanoparticles showed an entrapment efficiency of 98%, an average particle size of 101.5 ± 10.3nm, a surface charge of 27.5 ± 5.10mV, and a polydispersity index of 0.438 ± 0.12. In vivo, administration of auranofin and auranofin nanoparticles significantly reversed streptozotocin-induced cognitive deficits, biochemical alteration, neuroinflammatory markers, and neurotransmitter levels. The present finding suggests that auranofin nanoparticles have more significant neuroprotective potential than auranofin alone. The therapeutic efficacy may be attributed to its antioxidant and anti-inflammatory properties, as well as its positive neuromodulatory effects. Therefore, our findings suggest that it could be a promising candidate for Alzheimer's disease therapy.

A review of assessment methods for measuring individual differences in oral somatosensory perception.

While taste and smell perception have been thoroughly investigated, our understanding of oral somatosensory perception remains limited. Further, assessing and measuring individual differences in oral somatosensory perception pose notable challenges. This review aimed to evaluate the existing methods to assess oral somatosensory perception by examining and comparing the strengths and limitations of each method. The review highlighted the lack of standardized assessment methods and the various procedures within each method. Tactile sensitivity can be assessed using several methods, but each method measures different tactile dimensions. Further investigations are needed to confirm its correlation with texture sensitivity. In addition, measuring a single textural attribute may not provide an overall representation of texture sensitivity. Thermal sensitivity can be evaluated using thermal-change detection or temperature discrimination tests. The chemesthetic sensitivity tests involve either localized or whole-mouth stimulation tests. The choice of an appropriate method for assessing oral somatosensory sensitivity depends on several factors, including the specific research objectives and the target population. Each method has its unique intended purpose, strengths, and limitations, so no universally superior approach exists. To overcome some of the limitations associated with certain methods, the review offers alternative or complementary approaches that could be considered. Researchers can enhance the comprehensive assessment of oral somatosensory sensitivity by carefully selecting and potentially combining methods. In addition, a standardized protocol remains necessary for each method.

Menopause and Oral Health: Clinical Implications and Preventive Strategies

ABSTRACT Menopause, occurring typically between the ages of 45 and 55 years, marks the end of a woman’s reproductive years and is characterized by the cessation of menstruation and a significant decline in estrogen and progesterone production. These hormonal changes impact various aspects of health, including oral health. This review explores the clinical implications of menopause on oral health and outlines preventive strategies. Hormonal changes during menopause can lead to xerostomia (dry mouth), periodontal disease, burning mouth syndrome (BMS), oral mucosal changes, altered taste sensation, and osteoporosis-related oral health issues. Xerostomia results from decreased salivary flow, increasing the risk of dental caries and oral infections. Periodontal disease is exacerbated by estrogen deficiency, leading to bone loss and increased tooth mobility. BMS, characterized by a chronic burning sensation, and oral mucosal atrophy are linked to hormonal fluctuations. In addition, altered taste perception and osteoporosis further complicate oral health management. Effective prevention and management strategies include regular dental checkups, good oral hygiene practices, and tailored treatments such as fluoride treatments, saliva substitutes, and hormone replacement therapy. Nonpharmacological approaches such as stress management and lifestyle modifications also play a role. This review emphasizes the importance of a multidisciplinary approach, involving dental and medical professionals, to address the complex oral health challenges faced by menopausal women. Understanding the underlying mechanisms and implementing evidence-based preventive measures can significantly enhance the oral health and overall well-being of menopausal women.

Tolerance of peanuts and tree nuts in Spanish children with exclusive sensitization to lipid transfer proteins.

Allergy to peanuts and tree nuts is a common cause of food allergy in Spain, with lipid transfer proteins (LTP) being the most frequently recognized panallergen. LTP sensitization often leads to multiple food group sensitivities, resulting in overly restrictive diets that hinder patient's quality of life. This study aimed to assess the tolerance of peanuts and tree nuts (hazelnuts and walnuts) in children sensitized to LTP, potentially mitigating the need for such diets. This prospective study enrolled individuals diagnosed with allergy to peanuts, hazelnuts, or walnuts. Data were collected from medical records, including demographics and clinical history. Allergological assessment comprised skin prick tests using commercial extracts and the nuts in question, alongside measurements of total and specific IgE to nuts and their primary molecular components. Participants showing positive LTP sensitization without sensitization to seed storage proteins underwent open oral nut challenges. A total of 75 individuals labeled as allergic to peanuts, 44 to hazelnuts, and 51 to walnuts were included. All of them underwent an open oral provocation test with the incriminated nut, showing a high tolerance rate. Peanut was tolerated by 98.6% of patients, 97.72% tolerated hazelnut, and 84.3% tolerated walnut. The findings suggest that the majority of patients allergic to peanuts, hazelnuts, or walnuts, due to LTP sensitization and lacking IgE reactivity to seed storage proteins, can tolerate these nuts. This supports the need for personalized nut tolerance assessments to avoid unnecessary dietary restrictions.

Point-of-care personalized rapid diagnosis of allergies using peptide epitopes and SPR multiplexed detection

Allergy is the most common chronic disease in Europe. Up to 20 % of patients with allergies live with a severe debilitating form of their condition, struggling with the fear of a possible asthma attack, anaphylactic shock, or even death from an allergic reaction. Allergic reactions vary among different patients, due to the presence of different antibodies, which may also define the severity of the allergic reaction. Diagnostic tools are still suboptimal, as they require an oral food challenge for diagnostic, which is personnel, time, and cost consuming and bear the risk of severe allergic reactions for the patient. Also, there is a major gap in food allergy diagnosis to easily distinguish between sensitization and allergy. Therefore, a fast point-of-care multiplexed analytical platform for allergy assessment, supporting low-risk minimally invasive personalized diagnostics and treatment monitoring is advanced. The novel portable Surface Plasmon Resonance system integrates microfluidics and a low-fouling, multiple-ligand biosensor based on recently identified peptide epitopes for appraising allergen-specific serum antibodies. Aiming at personalized diagnosis of allergy, we successfully tested and validated the platform on hazelnuts and peanuts, two of the most threatening and frequent food allergens. Moreover, in contrast to the conventional SPR analysis and ELISA, by using an innovative analysis of the entire sensing area where the peptides are immobilized, it was even possible to discern different sera related to the same allergen.

Effects of Thymbra spicata extract and Thymol on morphine withdrawal syndrome in mice (insights to the liver function, antioxidant, and behavioral responses).

Safe chemicals for drug withdrawal can be extracted from natural sources. This study investigates the effects of clonidine and Thymbra spicata extract (TSE) on mice suffering from morphine withdrawal syndrome. Thymol, which is the active constituent in TSE, was also tested. A total of 90 mice were divided into nine groups. Group 1 was the control group, while Group2 was given only morphine, and Group 3 received morphine and 0.2 mg/kg of clonidine. Groups 4-6 were given morphine along with 100, 200, and 300 mg/kg of TSE, respectively. Groups 7-9 received morphine plus 30, 60, and 90 mg/kg of Thymol, respectively, for 7 days. An oral naloxone challenge of 3 mg/kg was used to induce withdrawal syndrome in all groups. Improvement of liver enzyme levels (aspartate aminotransferase, alkaline phosphatase, and alanine transaminase) (p < .01) and behavioral responses (frequencies of jumping, frequencies of two-legged standing, Straub tail reaction) (p < .01) were significantly observed in the groups receiving TSE and Thymol (Groups 4-9) compared to Group 2. Additionally, antioxidant activity in these groups was improved compared to Group 2. Nitric oxidesignificantly decreased in Groups 4 and 6 compared to Groups 2 and 3 (p < .01). Superoxide dismutaseincreased dramatically in Groups 5, 8, and 9 compared to Groups 2 and 3 (p < .01). Groups 5-9 were significantly different from Group 2 in terms of malondialdehydelevels (p < .01). Certain doses of TSE and Thymol were found to alleviate the narcotics withdrawal symptoms. This similar effect to clonidine can pave the way for their administration in humans.

Assessment of oral health status and treatment needs among visually impaired children in Vadodara city: An observational study

ABSTRACT Background: Maintaining optimal oral health is crucial for all children, but it holds particular significance for visually impaired children (VIC). Neglecting oral health can lead to a myriad of issues such as dental caries, gum disease, traumatic dental injuries (TDI), and even systemic health problems. Therefore, tailored interventions are essential to ensure their well-being and life quality. Aim: The current research aimed to assess the oral health status and treatment needs among VIC. Materials and Methods: The cross-sectional survey was conducted on 300 VIC in Vadodara city between September 2022 and December 2022. The oral examination was done in the respected school in the daylight with a normal sitting chair. Oral health status was checked according to the World Health Organization criteria (2013). Malocclusion was checked according to Angle’s classification of malocclusion. Descriptive statistical analysis was used. Results: The prevalence of dental caries was found to be 65%. 70% of children showed periodontal condition. TDIs among VICs were 40%. There is a high prevalence (91%) of Class I malocclusion. Most of the children require prompt treatment. Conclusion: The study reveals alarming dental health issues among VIC in Vadodara. With 65% experiencing dental caries, 70% displaying periodontal conditions, and 40% suffering from TDI, the oral health challenges are significant. Furthermore, a striking 91% exhibit Class I malocclusion. These findings underscore an urgent need for comprehensive dental care and tailored interventions to address the substantial oral health disparities in this vulnerable population. Immediate attention and specialized treatment plans are crucial to improving their overall well-being and quality of life.

A retrospective comparison of IgE-mediated cow's milk protein allergy management strategies in pediatric cohorts.

Complete avoidance of milk is the usual management for IgE-mediated cow's milk protein allergy (CMPA). A baked milk ladder is a method of dietary advancement therapy in IgE-mediated CMPA in Ireland, while in Spain, avoidance of milk awaiting natural tolerance acquisition through an oral food challenge (OFC) is employed. The aim of this study was to evaluate the use of dietary advancement therapy using a milk ladder compared with complete avoidance of milk for managing IgE-mediated CMPA. This is a retrospective chart review of 371 pediatric patients from the population who have been treated for IgE-mediated CMPA between 2011 and 2020, with the milk ladder (Ireland) or complete avoidance followed by an OFC (Spain). The main outcome was the introduction of cow's milk. Milk ladder patients were 3.67 times more likely to succeed in comparison with milk avoidance (p < .001). Anaphylaxis during the treatment period occurred in 34 patients in the milk avoidance groups, while three patients in the milk ladder group experienced anaphylaxis due to accidental exposure to milk (p < .001). Failure to complete treatment was associated with a higher skin prick test in the milk avoidance group and a raised specific IgE in the milk ladder group. This is the first study that compares outcomes of dietary advancement therapy to complete avoidance for CMPA management, demonstrating that cow's milk can be successfully and safely reintroduced using dietary advancement therapy using a milk ladder.

Immunological and molecular study in children with combined immunodeficiency.

Background. Severe combined immunodeficiency (SCID) is a form of immunodeficiencies (PID), caused by molecular defects. These defects can restrict the development and function of lymphocytes. Early diagnosis and treatment of SCID can lead to disease-free survival. This study aims to investigate some of the possible underlying genetic defects in a group of Egyptian infants and children with clinical and immunological profiles suggestive of SCID. Methods. This study included eighty patients who showed clinical warning signs of immunodeficiency. Subjects were thoroughly examined clinically. Laboratory evaluation included immunoglobulins serum levels and flow cytometric assessment of immune cells. This testing showed an altered immune profile in thirty patients. They had decreased T and/or B lymphocytes or natural killer cells. DNA extraction was done for those cases. The coding regions of the RAG1 gene and RAG2 gene was investigated for hot spot mutations by sequencing technique guided by the patient clinical evaluation, inheritance pattern, immunophenotyping by flow cytometric analysis of lymphocyte subsets, and serum immunoglobulins level detection. Results. Results showed novel and previously reported variants (mutation, polymorphism), they were found in 18 cases which include variants in the RAG1 gene (E880K, A960A, H249R, S913R, K820R, V782G), and variants in the RAG2 gene (P501T, L514M, rs10836573, cDNA.2129A>T). Conclusions. To evaluate SCID patients completely, mutation gene analysis is highly required and recommended.

Parental experience administering epinephrine for systemic reactions during infant and toddler oral food challenges

This study suggests that even when an oral food challenge results in a reaction that necessitates treatment with an epinephrine auto-injector, the experience can be positive and confidence-building for patients' families.

Paving the complex path to building climate resilient cities through disaster health diplomacy and international public health policy

Disaster resilience defines society’s capabilities to resist/adapt/recover from hazardous events. Priorities for action were outlined at the Sendai Framework for Disaster Risk Reduction to reduce disaster risks by understanding the process, strengthening governance, investing in resilience, improving preparedness/effective response capacities/rehabilitation processes/reconstruction procedures. Disaster diplomacy is a fast growing interdisciplinary field. Natural disasters potentially generate opportunities for diplomatic interaction between rival parties/conflicting states. Climate crisis is growing. By large, Summer 2023 was globally the warmest on record. The 2015 Paris Agreement was a landmark; UNOHCHR proposes a universal decleration of disaster rights. Climate change has widespread impacts on human health. “The greatest health threat of the 21stcentury” affects socio environmental determinants of health, clean air/water/food/shelter. Ninety percent of all disasters are climate/weather related, resulting in &amp;gt;410,000deaths in the last decade, expected to cause 250,000 additional deaths/year from malnutrition/malaria,/diarrhoea/heat stress in 2030 2050. IFRC focuses on strengthening ownership/community leadership/outreach/funding/forecasting/anticipatory action. Climate related flashpoints are the early warnings of impending crises. Turkey Greece have a lot in common from a climate change/disaster resilience viewpoint. Successive earthquakes generated rescue responses/mutual aid/outpouring of sympathy between the two countries within the last decade. Extreme weather events, high temperatures, severe rainfalls continue to batter both countries. Global warming brought intense flooding/wildfires to Southeast Europe/Southwest Asia. Climate change is expected to become the strongest driver of human migration through complex mechanisms in the Mediterranean Basin. The sustainability of Greece’s migration policies may be challenged against the global climate crisis. Environmental change has potential impacts on human health. Health diplomacy in international relations focuses on protecting health/well being. In the past, health interventions as foreign policy were regarded not to be associated with diplomatic disaster efforts. This oral presentation challenges earlier opinions and proposes a “climate change health diplomacy model” for improving capacities in disaster resilience. Around the world, health care professionals speak a unique/universal language of their own. Countries with “otherwise conflicting interests,” stand in solidarity during natural disasters. Through further elaborating on the principles of sustainable collaboration on disaster risks/health diplomacy/climate change, a “first time disaster health diplomacy model” may be developed to serve the world. An outline is hereby presented, 1 to define paths of communication versus the current ad hoc disaster diplomacy efforts, 2 to incorporate risks into the disaster diplomacy plan, 3 to incorporate a well planned disaster health diplomacy agreement. As the Turkish saying goes, “HEALTH COMES FIRST”.

Phenotypic, genotypic and proteomic variations between poor and robust colonizing Campylobacter jejuni strains

Campylobacter jejuni is one of the major causes of bacterial gastrointestinal disease in humans worldwide. This foodborne pathogen colonizes the intestinal tracts of chickens, and consumption of chicken and poultry products is identified as a common route of transmission. We analyzed two C. jejuni strains after oral challenge with 105 CFU/ml of C. jejuni per chick; one strain was a robust colonizer (A74/C) and the other a poor colonizer (A74/O). We also found extensive phenotypic differences in growth rate, biofilm production, and in vitro adherence, invasion, intracellular survival, and transcytosis. Strains A74/C and A74/O were genotypically similar with respect to their whole genome alignment, core genome, and ribosomal MLST, MLST, flaA, porA, and PFGE typing. The global proteomes of the two congenic strains were quantitatively analyzed by ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) and 618 and 453 proteins were identified from A74/C and A74/O isolates, respectively. Cluster of Orthologous Groups (COG) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses showed that carbon metabolism and motility proteins were distinctively overexpressed in strain A74/C. The robust colonizer also exhibited a unique proteome profile characterized by significantly increased expression of proteins linked to adhesion, invasion, chemotaxis, energy, protein synthesis, heat shock proteins, iron regulation, two-component regulatory systems, and multidrug efflux pump. Our study underlines phenotypic, genotypic, and proteomic variations of the poor and robust colonizing C. jejuni strains, suggesting that several factors may contribute to mediating the different colonization potentials of the isogenic isolates.

The appropriateness of penicillin allergy de-labelling by non-allergist clinical ward teams

ObjectivesWe aimed to assess the appropriateness of penicillin allergy (PenA) assessment conducted by clinical teams and to review the safety of subsequent exposure of these patients to penicillin. MethodsOpportunistic, prospective observational study of usual clinical care, between 16 May 2023 and 14 August 2023, of inpatients with a PenA and requiring antibiotics, in a 750-bed hospital in England. To assess the appropriateness of management, PenA patients prescribed penicillins were grouped into risk categories using a validated antibiotic allergy assessment tool: eligible for de-label on history alone (direct de-label; DDL), eligible for direct oral challenge (DOC), high risk or unable to obtain history. ResultsOf the 123 patients admitted with a PenA (or sensitivity record) and exposed to a penicillin, data were collected for 50. Their PenA records were grouped follows: eligible for DDL 34 (68%), eligible for DOC 11 (22%), high risk 4 (8%) and unable to obtain history 1 (2%). In 14/50 (28%) patients there was no evidence of a current PenA assessment in the medical notes. ConclusionsUsing the allergy risk tool, most patients with PenA records were exposed to penicillin appropriately. However, patients meeting high-risk criteria were also exposed to penicillin when the tool excluded them. PenA assessment needs to be carried out with appropriate training and governance structures in place.

Efficacy of very-low-dose oral food challenge in children with severe hen egg allergy: A retrospective, single-center case series

BackgroundTo avoid complete elimination of hen eggs (HE) from diet, we introduced a very-low-dose (VLD) oral food challenge (OFC) in patients with severe HE allergy in 2019. Herein, we investigated the efficacy of VLD HE OFC for achieving the full dose OFC. MethodsPatients with an overt allergic reaction to LD (1/32 HE [≤100 mg]) or less, egg white (EW) protein within 6 months were included. In the VLD group, patients not achieving full-dose OFC (1/2 HE: 1600 mg EW protein) within 2 years were excluded. We retrospectively compared the rate of passing a full-dose OFC between patients who underwent a LD OFC before 2019 (LD group) and those who underwent a VLD OFC (1/100 HE: 32 mg EW protein) after 2019 (VLD group). The period for passing the full-dose OFC was evaluated using Kaplan–Meier survival analysis. ResultsWe enrolled 411 and 111 patients in the LD and VLD groups, respectively. The median age at OFC initiation was 2.2 [1.5–3.6] and 2.1 [1.4–3.2] years in the LD and VLD groups, respectively. EW- and ovomucoid-specific IgE levels were 38.3 (12.5–72.9) and 21.0 (8.3–46.2) kUA/L in the LD group and 49.8 [18.8–83.9] and 32.1 [15.6–67.8] kUA/L in the VLD group, respectively. Over 4 years, the LD and VLD groups passed the full-dose OFC at rates of 70 and 95%, respectively, with significant differences (log-rank test, P < 0.001). ConclusionsVLD HE OFC may contribute to passing a full-dose OFC in patients with severe HE allergies.

Syndrome d’entérocolite induit par les protéines alimentaires au poisson et aux fruits de mer dans une population pédiatrique belge

Study objectiveThe study aims to analyse 36 children presenting with acute fish and shellfish food protein-induced enterocolitis syndrome. Patients and methodsThis is a retrospective, single-centre study conducted between 2016 and 2024. Diagnosis was established based on the international diagnostic criteria published in 2017. ResultsThe most frequently implicated foods were cod and prawns. The median age at first reaction was 12 months for fish and 61 months for shellfish. Only one out of 35 patients showed positive allergological tests, but 21 out of 36 patients had a personal history of atopy. Twenty-eight patients reacted exclusively to fish, 6 exclusively to shellfish, and 2 to both. Eight patients reacted to multiple types of fish, while 13 tolerated types of fish other than the one responsible for the initial reaction. Four children also reacted to other types of food. ConclusionThis study confirms that fish is one of the most important triggers of food protein-induced enterocolitis in children in Europe and that reactions to shellfish are more frequent at a later age. These patients generally tolerate other types of fish and shellfish than those responsible for the initial reaction. Therefore, it is important to encourage patients to incorporate other varieties of these foods in their diet, if necessary with an introduction through an oral food challenge.

Altered glucose kinetics occurs with aging: a new outlook on metabolic flexibility.

Our purpose was to determine how age affects metabolic flexibility and underlying glucose kinetics in healthy young and older adults. Therefore, glucose and lactate tracers along with pulmonary gas exchange data were used to determine glucose kinetics and respiratory exchange ratios [RER = carbon dioxide production (V̇co2)/oxygen consumption (V̇o2)] during a 2-h 75-g oral glucose tolerance test (OGTT). After an 12-h overnight fast, 28 participants, 15 young (21-35 yr; 7 men and 8 women) and 13 older (60-80 yr; 7 men and 6 women), received venous primed-continuous infusions of [6,6-2H]glucose and [3-13C]lactate with a [Formula: see text] bolus. After a 90-min metabolic stabilization and tracer equilibration period, volunteers underwent an OGTT. Arterialized glucose concentrations ([glucose]) started to rise 15 min post glucose consumption, peaked at 60 min, and remained elevated. As assessed by rates of appearance (Ra) and disposal (Rd) and metabolic clearance rate (MCR), glucose kinetics were suppressed in older compared to young individuals. As well, unlike in young individuals, fractional gluconeogenesis (fGNG) remained elevated in the older population after the oral glucose challenge. Finally, there were no differences in 12-h fasting baseline or peak RER values following an oral glucose challenge in older compared to young men and women, making RER an incomplete measure of metabolic flexibility in the volunteers we evaluated. Our study revealed that glucose kinetics are significantly altered in a healthy aged population after a glucose challenge. Furthermore, those physiological deficits are not detected from changes in RER during an OGTT.NEW & NOTEWORTHY To determine metabolic flexibility in response to an OGTT, we studied healthy young and older men and women to determine glucose kinetics and changes in RER. Compared to young subjects, glucose kinetics were suppressed in older healthy individuals during an OGTT. Surprisingly, the age-related changes in glucose flux were not reflected in RER measurements; thus, RER measurements do not give a complete view of metabolic flexibility in healthy individuals.

Food Allergy and Food Intolerance – New Developments

It is crucial to accurately identify whether a patient's reaction to food is a result of a Food Allergy (FA) or Food Intolerance (FI), as this will determine the appropriate diagnosis and management plan. Medical practitioners should rely on verified diagnoses when discussing the prevalence of these conditions. Currently, obtaining a patient's clinical history, performing a skin prick test (SPT) or measuring serum specific IgE levels are typically the initial steps in diagnosing allergies. Additional methods, such as component-resolved diagnostics, basophil activation test (BAT) and oral food challenge (OFC) may be used, if available, to confirm the allergen causing symptoms when the results of first-line tests are equivocal or contradictory with history. Determining the prevalence of sensitization profiles to different allergens, considering geographical characteristics, is important for developing personalized therapeutic and preventive measures for children. Periodic reassessment of patients with FA through allergy tests and oral food challenges will allow for the possibility of reintroducing previously avoided foods if they develop tolerance over time and improve their quality of life.

Tirzepatide modulates the regulation of adipocyte nutrient metabolism through long-acting activation of the GIP receptor

Tirzepatide, a glucose-dependent insulinotropic polypeptide/glucagon-like peptide 1 receptor (GIPR/GLP-1R) agonist, has, in clinical trials, demonstrated greater reductions in glucose, body weight, and triglyceride levels compared with selective GLP-1R agonists in people with type 2 diabetes (T2D). However, cellular mechanisms by which GIPR agonism may contribute to these improved efficacy outcomes have not been fully defined. Using human adipocyte and mouse models, we investigated how long-acting GIPR agonists regulate fasted and fed adipocyte functions. In functional assays, GIPR agonism enhanced insulin signaling, augmented glucose uptake, and increased the conversion of glucose to glycerol in a cooperative manner with insulin; however, in the absence of insulin, GIPR agonists increased lipolysis. In diet-induced obese mice treated with a long-acting GIPR agonist, circulating triglyceride levels were reduced during oral lipid challenge, and lipoprotein-derived fatty acid uptake into adipose tissue was increased. Our findings support a model for long-acting GIPR agonists to modulate both fasted and fed adipose tissue function differentially by cooperating with insulin to augment glucose and lipid clearance in the fed state while enhancing lipid release when insulin levels are reduced in the fasted state.