Atopic Dermatitis (AD) is one of the most common chronic inflammatory skin disorders with a complex pathogenesis. AD is characterized by eczematous skin lesions, pruritus, and recurrent skin infections; with negative impact on patients (and caregivers) quality of life. The American Academy of Allergy, Asthma and Immunology (AAAAI)/American College of Allergy, Asthma and Immunology (ACAAI) Joint Task Force (JTF) Atopic Dermatitis Guideline Panel recently released updated AD guidelines. This guideline focuses on addressing clinical questions using trustworthy guideline development standards, including mitigating the potential influence of financial and non-financial conflicts of interest, and GRADE methodology. A multidisciplinary panel used systematic reviews and meta-analyses to inform specific recommendations addressing optimal use of (1) topical treatments, (2) dilute bleach bath, (3) dietary avoidance/elimination, (4) allergen immunotherapy and (5) systemic treatments. The comprehensive recommendations, emphasizing the third principle of evidence-based medicine - that evidence alone is never enough; that patient values and preferences must be carefully considered when determining optimal treatments for patients and populations - provide a framework to support clinicians in selecting an optimal treatment plan for each patient. This review provides an overview of the guideline and discusses how those recommendations relate to current practice.

BACKGROUND: A 6-food elimination diet in pediatric eosinophilic esophagitis (EoE) is difficult to implement and may negatively impact quality of life (QoL). Less restrictive elimination diets may balance QoL and efficacy.
OBJECTIVE: We performed a multi-site, randomized comparative efficacy trial of a 1-food (milk) elimination diet (1FED) versus 4-food (milk, egg, wheat, soy) elimination diet (4FED) in pediatric EoE.
METHODS: Patients aged 6 to 17 years with histologically active and symptomatic EoE were randomized 1:1 to 1FED or 4FED for 12 weeks. Primary endpoint was symptom improvement by Pediatric EoE Symptom Score (PEESSv2.0). Secondary endpoints were proportion achieving histologic remission (<15 eosinophils/high-power field [eos/hpf]); change in histologic features (histology scoring system [HSS]), endoscopic severity (endoscopic reference score [EREFS]), transcriptome (EoE diagnostic panel [EDP]), and QoL scores; and predictors of remission.
RESULTS: 63 patients were randomly assigned to 1FED (n=38) and 4FED (n=25). In 4FED versus 1FED, mean PEESSv2.0 improved -25.0 versus -14.5 (p=0.04) but remission rates (41% versus 44%; p=1.00), HSS (-0.25 versus -0.29; p=0.77), EREFS (-1.10 versus -0.58; p=0.47) and QoL scores were similar between groups. The EoE transcriptome normalized in histologic responders to both diets. Baseline peak eosinophil count predicted remission (OR 0.975, 95% CI 0.953-0.999, p=0.04; cut-off ≤42 eos/hpf). The 4FED withdrawal rate (32%) exceeded 1FED (11%) (p=0.0496).
CONCLUSIONS: Although 4FED moderately improved symptoms compared to 1FED, the histologic, endoscopic, QoL, and transcriptomic outcomes were similar in both groups. 1FED is a reasonable first choice therapy for pediatric EoE given its effects, tolerability, and relative simplicity.

OBJECTIVE: Limited knowledge exists regarding the psychosocial characteristics of young Asian children affected by food allergies (FAs) and their caregivers. This study aims to assess the usefulness of the Food Allergy Severity Score (FASS) system in evaluating the risk of emotional impacts on young children and caregivers who are dealing with severe FA.
METHODS: Children between 2 and 10 years of age who were diagnosed with FA and following an elimination diet were enrolled in the study. The FASS, Korean Parenting Stress Index, and Korean Behavior Assessment System for Children-2 were used for evaluating the above mentioned risk.
RESULTS: Among the 75 participants, 64.0% had a history of anaphylaxis, and 56.0% reported multiple FAs. A total of 160 cases of FASS was documented across 21 types of food and classified as mild (n = 5, 1.07), moderate (n = 100, 2.01-4.01), or severe (n = 55, 4.24-6.84). The concordance of calculated- and stakeholder interpreted-FASS was moderate (kappa 0.587). Children with severe FASS (sFASS) showed increased risk for functional communication (relative risk [RR], 1.57; 95% confidence interval [CI], 0.99-2.48) and increased parental reinforcement (RR, 1.40; 95% CI, 0.91-2.14). Their caregivers exhibited reduced levels of demandingness (RR, 0.59; 95% CI, 0.37-0.94) and role restriction (RR, 0.62; 95% CI, 0.39-0.98). Receiver operating characteristic curves suggested that functional communication (numeric FASS cutoff, 3.47; area under the curve [AUC], 0.695), withdrawal (cutoff, 3.40; AUC, 0.657), developmental social disorders (cutoff, 3.96; AUC, 0.648), and reinforces parent (cutoff, 3.15; AUC, 0.646) were possibly be affected.
CONCLUSIONS: The FASS provides an objective tool to assess pediatric FA severity. Early psychosocial intervention for young children with severe FASS and their caregivers may improve prognosis by identifying possible adaptive skill deficiencies and excessive parenting stresses.

Patients with non-eosinophilic esophagitis eosinophilic gastrointestinal diseases (non-EoE EGIDs) are prone to nutritional deficiencies due to food-avoidant behaviors, malabsorption, and high nutrition impact symptoms. Nutrient deficiencies correspond to the segment, depth, and extent of the gastrointestinal tract involved and can impact organs distant from the gut. Patients with non-EoE EGIDs are often atopic, and some appear to respond to dietary avoidance of specific food allergens. Tests to identify food triggers other than response to elimination diets are lacking. Dietary restriction therapy should be considered in such patients and is best implemented through a multidisciplinary approach to avoid nutritional complications.

Eosinophilic esophagitis (EoE) is a chronic immune-mediated food allergy-driven disease characterized by eosinophilic inflammation of the esophagus leading to symptoms of esophageal dysfunction. Prior studies have supported the key role of food allergen exposure as the main driver behind the etiopathogenesis showing that removal of food antigens can result in disease remission in both children and adults. These landmark studies serve as the basis for the rising interest and evolution of dietary therapy in EoE. This article will focus on the rationale for dietary therapy in EoE and provide helpful tools for the implementation of dietary therapy in practice.

BACKGROUND: Diagnosis of canine adverse food reactions (AFRs) is based on vague criteria, such as \'>50% improvement\' during elimination diet trial (EDT) followed by \'deterioration\' during provocation test (PT).
OBJECTIVE: The objective of the study was to use predefined criteria to evaluate response during EDT [i.e., Owner Global Assessment of Treatment Efficacy (OGATE) = good-to-excellent] and relapse during PT [i.e., Owner Global Assessment of Challenge Deterioration (OGACD) = moderate-to-severe and/or >100% increase of lesional (Canine Atopic Dermatitis Extent and Severity Index, 4th iteration, CADESI-04) and/or of pruritus (pruritus Visual Analog Scale, PVAS) scores].
METHODS: Twenty-nine dogs with atopic dermatitis.
METHODS: An extensively hydrolysed diet was fed to all dogs followed, in seven of 11 nonresponders, by a second home-made novel-protein EDT. Dogs responding to either EDT were challenged with their previous diet.
RESULTS: Thirteen (44.8%) dogs were diagnosed with AFRs: at the end of EDT, their OGATE was good (9 of 13; 69.2%) or excellent (four of 13; 30.8%), and both CADESI-04 (46.7%) and PVAS (71.1%) had decreased significantly; at the end of PT, OGACD was moderate or severe in 12 of 13 (92.3%) dogs, and both CADESI-04 (127.9%) and PVAS (181.8%) had increased significantly. Of the 16 dogs without AFRs, 6 (37.5%) responded to the commercial (n = 5) or home-made (n = 1) diet [OGATE = good (three of six) or excellent (three of six)], with significant concurrent reduction of CADESI-04 and nonsignificant reduction of PVAS, yet they did not relapse during PT.
CONCLUSIONS: The proposed (predefined) criteria for the evaluation of response during EDT and deterioration during PT seem reliable and are easily applicable in clinical practice and research.
UNASSIGNED: Die Diagnose von Futtermittelnebenwirkungen (AFRs) basiert auf vagen Kriterien, wie „>50% Verbesserung“ während einer Eliminationsdiät (EDT) gefolgt von einer „Verschlechterung“ während eines Provokationtests (PT). ZIEL: Die Verwendung vorab definierter Kriterien, um eine Antwort während einer EDT [i.e. Owner Global Assessment of Treatment Efficacy (OGATE) = gut‐bis‐exzellent] und einen Rückfall während des PTs [i.e. Owner Global Assessment of Challenge Deterioration (OGACD) = moderat‐bis‐schwer und/oder > 100% Zunahme der Läsionen (Canine Atopic Dermatitis Extent and Severity Index, 4th Auflage, CADESI‐04) und/oder des Pruritus (Pruritus Visual Analog Scale, PVAS) Werte] zu evaluieren.
UNASSIGNED: 29 Hunde mit atopischer Dermatitis.
UNASSIGNED: Allen Hunden wurde eine extensiv hydrolysierte Diät gefüttert, bei sieben der 11 Hunde ohne Verbesserung folgte eine zweite hausgemachte EDT mit einem neuen Protein. Hunde, die auf eine der Diäten positiv reagierten, wurden mit ihrer vorhergehenden Diät provoziert.
UNASSIGNED: Dreizehn (44.8%) wurden mit AFRs diagnostiziert: am Ende der EDT war ihr OGATE gut (neun von 13; 69.2%) oder exzellent (vier von 13; 30.8%), und sowohl CADESI‐04 (46.7%) und PVAS (71.1%) nahmen signifikant ab; am Ende des PT, war OGACD bei 12 der 13 (92.3%) Hunde moderat oder schwer, und sowohl CADESI‐04 (127.9%) und PVAS (181.8%) nahmen signifikant zu. Von den 16 Hunden ohne AFR, reagierten sechs (37.5%) auf eine kommerzielle Diät (n = 5) oder eine selbstgekochte Diät (n = 1) [OGATE = gut (drei von sechs) oder exzellent (drei von sechs)], mit einer signifikanten gleichzeitigen Reduktion des CADESI‐04 und einer nicht‐signifikanten Reduktion des PVAS, wobei sie aber während des PT keinen Rückfall hatten.
UNASSIGNED: Die vorgeschlagenen (vordefinierten) Kriterien zur Evaluierung einer Reaktion während einer EDT und eine Verschlechterung während des PT scheinen verlässlich zu sein und sind in der klinischen Praxis und Forschung leicht anzuwenden.
背景: 犬的食物不良反应(AFRs)的诊断是基于模糊的标准，例如在食物排除试验(EDT)期间“改善50%以上”，然后在激发试验(PT)期间“恶化”。 目的: 使用预先定义的标准来评估EDT期间的反应[即犬主总体治疗疗效评估(OGATE) = 良好至优秀]和PT期间的复发[即犬主激发加重总体评估(OGACD) = 中度至重度和/或病变增加>100%(犬特应性皮炎程度和严重程度指数，第4次迭代，CADESI‐04)和/或瘙痒症(瘙痒症视觉模拟量表PVAS)评分]。 动物: 29只特应性皮炎患犬。 材料和方法: 对所有犬饲喂广泛水解的日粮，然后在11只无反应的犬中的7只饲喂第二种自制的新型蛋白质EDT。任何一种EDT有反应的犬都接受之前日粮的激发试验。 结果: 13只(44.8%)犬被诊断为AFRs:在EDT结束时，它们的OGATE良好(13只中有9只；69.2%)或优秀(13只中有4只；30.8%)，CADESI‐04(46.7%)和PVAS(71.1%)均显著下降；PT结束时，13只犬中有12只(92.3%)的OGACD为中度或重度，CADESI‐04(127.9%)和PVAS(181.8%)均显著增加。在16只没有AFRs的犬中，有6只(37.5%)对商业(n = 5)或自制(n = 1)日粮[OGATE = 良好(六分之三)或优秀(六分之三)]有反应，CADESI‐04显著降低，PVAS无显著降低，但它们在PT期间没有复发。 结论和临床相关性: 这里所提出的(预定义的)评估EDT期间反应和PT期间加重的标准似乎是可靠的，并且容易应用于临床实践和研究。.
BACKGROUND: Le diagnostic des réactions alimentaires indésirables (AFRs) chez le chien est basé sur des critères vagues, tels qu\'une \"amélioration de plus de 50%\" lors d\'un essai de régime d\'éviction (EDT) suivie d\'une \"détérioration\" lors d\'un test de provocation (PT).
OBJECTIVE: Utiliser des critères prédéfinis pour évaluer la réponse pendant l\'EDT [c\'est‐à‐dire l\'évaluation globale par le propriétaire de l\'efficacité du traitement (OGATE) = bonne à excellente] et la rechute pendant le PT [c\'est‐à‐dire l\'évaluation globale par le propriétaire de la détérioration lors de la provocation (OGACD) = modérée à sévère et/ou augmentation de >100 % des lésions (Canine Atopic Dermatitis Extent and Severity Index, 4e itération, CADESI‐04) et/ou des scores de prurit (pruritus Visual Analog Scale, PVAS)].
UNASSIGNED: 29 chiens atteints de dermatite atopique. MATÉRIELS ET MÉTHODES: Tous les chiens reçoivent un régime fortement hydrolysé, suivi, pour sept des onze chiens ne répondant pas, d\'un deuxième EDT maison à base de protéines naïves. Les chiens répondant à l\'un ou l\'autre de ces régimes sont provoqués avec leur régime alimentaire précédent. RÉSULTATS: Treize chiens (44.8 %) souffrent d’AFRs: à la fin de l\'EDT, leur OGATE est bon (neuf sur 13; 69.2%) ou excellent (quatre sur 13; 30.8%), et le CADESI‐04 (46.7%) et le PVAS (71.1%) diminuent de manière significative ; à l’issue du PT, l\'OGACD est modéré ou sévère chez 12 des 13 chiens (92.3%), et le CADESI‐04 (127.9%) et le PVAS (181.8%) ont tous deux augmenté de manière significative. Sur les 16 chiens sans AFR, six (37.5%) réagissent au régime commercial (n = 5) ou au régime maison (n = 1) [OGATE = bon (trois sur six) ou excellent (trois sur six)], avec une réduction concomitante significative du CADESI‐04 et une réduction non significative du PVAS, mais ils ne récidivent pas durant le PT.
UNASSIGNED: Les critères (prédéfinis) proposés pour l\'évaluation de la réponse pendant l\'EDT et de la détérioration pendant la PT semblent fiables et sont facilement applicables dans la pratique clinique et la recherche.
背景: 犬の食物有害反応(AFR)の診断は、除去食試験(EDT)で「50%以上の改善」がみられ、その後食物負荷試験(PT)で「悪化する」といった曖昧な基準に基づいている。 目的: 本研究の目的は、EDT時の改善[すなわち、OGATE(Owner Global Assessment of Treatment Efficacy)=良好~優良]およびPT時の再燃[すなわち、OGACD(Owner Global Assessment of Challenge Deterioration)=中等度~重度および/または病変(犬アトピー性皮膚炎重症度指数第4版、CADESI‐04)および/または掻痒(掻痒の視覚的アナログスケール、PVAS)スコアの100%以上の増加]を定義済みの基準で評価することであった。 動物: アトピー性皮膚炎の犬29頭。 材料と方法: すべての犬に広範に加水分解したフードを与え、11頭中7頭の非反応犬には2回目の自家製新規蛋白質EDTを与えた。いずれかのEDTに反応した犬には、以前の食事を与えた。 結果: 13頭(44.8%)がAFRと診断された。EDT終了時、OGATEは良好(13頭中9頭；69.2%)、または良好(13頭中4頭；30.8%)、CADESI‐04(46.7%)およびPVAS(71.1%)はともに有意に減少していた。PT終了時、OGACDは中等度または重度(13頭中12頭；92.3%)、CADESI‐04(127.9%)およびPVAS(181.8%)はともに有意に増加していた。AFRを認めなかった16頭のうち、6頭(37.5%)が市販食(n = 5)または自家製食(n = 1)で改善を認め[OGATE = 良好(6頭中3頭)または良好(6頭中3頭)]、同時にCADESI‐04は有意に低下し、PVASは有意に低下しなかったが、PT中に再燃することはなかった。 結論と臨床的意義: EDT中の改善およびPT中の再燃を評価するために提案された(事前に定義された)基準は、信頼性が高く、臨床診療や研究に容易に適用できると思われた。.
UNASSIGNED: O diagnóstico de reações adversas alimentares (AFRs) caninas é baseado em critérios vagos, como “melhora> 50%” durante a dieta de eliminação (EDT) seguido de “deterioração” durante o teste de provocação (PT).
OBJECTIVE: Usar critérios predefinidos para avaliar a resposta durante a EDT [ou seja, Avaliação Global da Eficácia do Tratamento do Proprietário (OGATE) = bom a excelente] e recidiva durante o PT [ou seja, Avaliação Global do Proprietário da Deterioração do Desafio (OGACD) = aumento moderado a grave e/ou> 100% de lesão (Índice de Extensão e Gravidade da Dermatite Atópica Canina, 4ª iteração, CADESI‐04) e/ou de prurido (Escala Visual Analógica de prurido, pontuações PVAS)].
UNASSIGNED: 29 cães com dermatite atópica. MATERIAIS E MÉTODOS: Uma dieta extensivamente hidrolisada foi fornecida a todos os cães, seguida de, em sete dos 11 que não responderam, de uma segunda EDT caseira com novas proteínas. Os cães que responderam a qualquer EDT foram desafiados com a dieta anterior.
RESULTS: Treze (44.8%) cães foram diagnosticados com AFRs: ao final do EDT, seu OGATE era bom (nove de 13; 69.2%) ou excelente (quatro de 13; 30.8%), e ambos CADESI‐04 (46.7%) e PVAS (71.1%) diminuíram significativamente; ao final do PT, o OGACD foi moderado ou grave em 12 dos 13 (92.3%) cães, e tanto o CADESI‐04 (127.9%) quanto o PVAS (181.8%) aumentaram significativamente. Dos 16 cães sem AFRs, seis (37.5%) responderam à dieta comercial (n = 5) ou caseira (n = 1) [OGATE = bom (três de seis) ou excelente (três de seis)], com redução simultânea significativa de CADESI‐04 e redução não significativa de PVAS, mas não recidivaram durante o PT. CONCLUSÕES E RELEVÂNCIA CLÍNICA: Os critérios propostos (predefinidos) para a avaliação da resposta durante a EDT e da deterioração durante a PT parecem confiáveis e são facilmente aplicáveis na prática clínica e na pesquisa.
INTRODUCCIÓN: El diagnóstico de reacciones adversas alimentarias (AFR, por sus siglas en inglés) caninas se basa en criterios vagos, como “mejoría >50%” durante la prueba de la dieta de eliminación (EDT) seguida de “deterioro” durante la prueba de provocación (PT).
OBJECTIVE: Utilizar criterios predefinidos para evaluar la respuesta durante la EDT [evaluación global del propietario de la eficacia del tratamiento (OGATE) = buena a excelente] y recaída durante el PT [evaluación global del deterioro del desafío (OGACD) = aumento de moderado a severo, y/o >100% de lesiones (índice de extensión y gravedad de la dermatitis atópica canina, 4.ª revisión, CADESI‐04) y/o del prurito (escala análoga visual del prurito), puntuaciones PVAS)].
UNASSIGNED: 29 perros con dermatitis atópica. MATERIALES Y MÉTODOS: Se alimentó a todos los perros con una dieta completamente hidrolizada seguida, en siete de los 11 que no respondieron, con un segundo EDT secasero con nuevas proteínas. Los perros que respondieron a cualquiera de los EDT fueron desafiados con su dieta anterior.
RESULTS: Trece (44.8%) perros fueron diagnosticados con AFR al final de la EDT, su OGATE fue bueno (nueve de 13; 69.2%) o excelente (cuatro de 13; 30.8%), y ambos CADESI‐04 (46.7% ) y PVAS (71.1%) habían disminuido significativamente; al final del PT, la OGACD fue moderada o grave en 12 de 13 (92.3%) perros, y tanto CADESI‐04 (127.9%) como PVAS (181.8%) habían aumentado significativamente. De los 16 perros sin AFR, seis (37.5%) respondieron a la dieta comercial (n = 5) o casera (n = 1) [OGATE = buena (tres de seis) o excelente (tres de seis)], con reducción simultánea significativa de CADESI‐04 y reducción no significativa de PVAS, pero no recayeron durante el PT. CONCLUSIONES Y RELEVANCIA CLÍNICA: Los criterios propuestos (predefinidos) para la evaluación de la respuesta durante la EDT y el deterioro durante el PT parecen fiables y son fácilmente aplicables en la práctica clínica y la investigación.

Cow\'s milk elimination (CME) is an established treatment, similar to other forms of diet therapy, for eosinophilic esophagitis (EoE). However, there is limited research to support its efficacy as a primary treatment. This review evaluated studies published in the past 10 years that assessed the outcomes after CME on histologic remission, clinical findings, and quality of life (QoL) in children aged 2-18 years with EoE. The evidence demonstrated that CME was effective at achieving histologic remission of disease in 50%-65% of children. This intervention also improved clinical symptoms seen on endoscopy and resulted in increased QoL when self-reported by children. CME can be used as a primary treatment for some children with EoE.

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BACKGROUND: Approximately 50%-90% of children with immediate-type cow\'s milk allergy (CMA) acquire tolerance by pre-school age. We aimed to investigate the acquisition rate of CMA tolerance in children aged 6-12 years.
METHODS: We included children with CMA who persisted until the age of 6. Tolerance was defined as passing an oral food challenge with 200 mL of unheated cow\'s milk (CM) or consuming 200 mL of CM without symptoms, whereas persistent CMA was defined as fulfilling neither of these criteria by 12 years old. Children receiving oral immunotherapy (OIT) were excluded from the primary analysis. Risk factors associated with persistent CMA were assessed using Cox regression analysis.
RESULTS: Of 80 included children, 30 (38%) had previous CM anaphylaxis, and 40 (50%) had eliminated CM completely from their diet. The median CM-specific immunoglobulin E (sIgE) level at 6 years old was 12.0 kUA /L. Tolerance was acquired by 25 (31%) and 46 (58%) children by the age of 9 and 12 years, respectively. At baseline, persistent CMA was associated with higher CM-sIgE levels (hazard ratio 2.29, 95% confidence interval 1.41-3.73, optimal cutoff level 12.7 kUA /L), previous CM anaphylaxis (2.07, 1.06-4.02), and complete CM elimination (3.12, 1.46-6.67). No children with CMA who had all three risk factors (n = 14) acquired tolerance.
CONCLUSIONS: Except for OIT patients, more than half of children with CMA at 6 years old acquired tolerance by 12 years old. Children with CMA who have the risk factors are less likely to acquire tolerance.