BACKGROUND: Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus characterized by symptoms of esophageal dysfunction and histologically by predominantly eosinophilic infiltration of the squamous epithelium. European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) published a guideline in 2014; however, the rapid evolution of knowledge about pathophysiology, diagnostic criteria, and therapeutic options have made an update necessary.
METHODS: A consensus group of pediatric gastroenterologists from the ESPGHAN Working Group on Eosinophilic Gastrointestinal Diseases (ESPGHAN EGID WG) reviewed the recent literature and proposed statements and recommendations on 28 relevant questions about EoE. A comprehensive electronic literature search was performed in MEDLINE, EMBASE, and Cochrane databases from 2014 to 2022. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess the quality of evidence and formulate recommendations.
RESULTS: A total of 52 statements based on the available evidence and 44 consensus-based recommendations are available. A revision of the diagnostic protocol, options for initial drug treatment, and the new concept of simplified empiric elimination diets are now available. Biologics are becoming a part of the potential armamentarium for refractory EoE, and systemic steroids may be considered as the initial treatment for esophageal strictures before esophageal dilation. The importance and assessment of quality of life and a planned transition to adult medical care are new areas addressed in this guideline.
CONCLUSIONS: Research in recent years has led to a better understanding of childhood EoE. This guideline incorporates the new findings and provides a practical guide for clinicians treating children diagnosed with EoE.

The food matrix is a complex system encompassing all constituent elements in food production. It influences the digestibility of these elements through direct interactions and affects the digestive environment. Furthermore, the gastrointestinal system possesses precise mechanisms that efficiently process dietary components into essential nutrients, effectively preventing the onset of abnormal immune responses or dysfunctional host reactions in most instances. However, the incidence of adverse food reactions is constantly increasing, and evidence indicates that this process is environmental. Adverse reactions can be categorized as toxic or nontoxic. Toxic reactions are dose-dependent and can result from natural compounds, processing-induced substances, or contaminants. Nontoxic reactions like food intolerance and hypersensitivity depend on individual susceptibility and evoke specific pathological and physiological responses. This review aims to elucidate the mechanisms underlying the occurrence of immune- (food allergies and sensitivities) and non-immune-mediated (food intolerance) reactions, emphasizing the fundamental distinctions between these two categories. Enhanced comprehension and distinction of these mechanisms will significantly contribute to advancing preventive and therapeutic approaches and establishing guidelines for food labeling concerning immune-mediated reactions.

Rheumatoid arthritis (RA) is one of over 100 different types of autoimmune conditions. In RA, the cells of the immune system attack the tissue lining the joints, triggering inflammation. A large body of research suggests that the underlying trigger(s) of RA are unique to an individual. For example, increased risk of RA can be driven by smoking tobacco in one individual and mercury exposure in another. Due to the development of next-generation sequencing technology, the critical role of the microbiota in shaping RA risk has been elucidated. Therefore, it is surprising that diet, arguably the most important lever in shaping the gut microbiota, is ineffective in the treatment of RA, even in a sub-set of patients. To attempt to rationalise this apparent paradox, we conducted an umbrella review to address the question as to whether diet can affect outcomes in RA.

UNASSIGNED: In this study, it was aimed to examine food sensitivity in patients with atopic dermatitis (AD) and to investigate the frequency of food allergy in patients with food sensitivity.
UNASSIGNED: Patients aged 0-2 years who were followed up with the diagnosis of AD were included in the study. The characteristics of demographic and clinical and laboratory findings of the patients were recorded retrospectively. Patients were classified as mild, moderate, and severe using the SCORing AD index according to the severity of AD. The presence of food sensitivity was evaluated by skin prick test and serum-specific immunoglobulin (Ig)E results. Food allergy was diagnosed by oral food challenge (OFC) test.
UNASSIGNED: Of the 72 patients included in the study, 62.5% (n=45) were male, and the mean age was 9±4.8 months. When the disease severity was evaluated, it was mild in 40 patients (55.6%); moderate/severe AD was present in 32 patients (44.4%). The frequency of moderate/severe AD was higher in patients who were younger (p=0.01), whose symptoms started in the first 6 months (p=0.03), who had a family history of allergic disease (p=0.001), who breastfed for <6 months (p=0.01), who had a higher median serum total IgE level, and a higher percentage of serum eosinophils (p=0.005 and p=0.01, respectively). Food sensitivity in 45.8% of patients; food allergy was detected in 41.7% of them. The most common sensitivities and allergies were eggs white/yolk and cow\'s milk, respectively. The rate of food sensitivity was found to be higher in male gender (p=0.03) and breastfed patients (p=0.03), whereas it was similar in patients with mild and moderate/severe AD.
UNASSIGNED: In the investigation of food sensitivity in patients with AD, it is important to evaluate other demographic and clinical characteristics such as gender and breastfeeding, apart from the severity of disease. The OFC test should be performed to confirm the food allergy in patients with food sensitivity before the recommendation of an elimination diet.

A substantial number of coeliac disease patients fail to respond to treatment with a gluten-free diet. Non-responsiveness might be multifactorial and the spectrum ranges from intentional or inadvertent gluten contamination as the main aetiology, to sensitivity to other nutrients (in addition to additives and preservatives). If the diagnosis of coeliac disease is correctly made and cross contamination and other factors have been excluded, then the aetiology behind the symptoms of a small group of coeliac patients might be refractory coeliac disease. The journey to ensure gluten contamination is not behind the persistent symptoms, is very challenging and requires in-depth training and skills. We therefore present potential guidance for the healthcare professional, in particular dietitians, on how to navigate these challenges on this journey.

Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by a compromised skin barrier due to a variety of reasons, such as hereditary predisposition, immunological overactivity, and skin microbiome disruption. There is strong evidence linking food allergies (FA) with AD in some children, and many children with AD develop asymptomatic food sensitivity. FA and AD are two frequent childhood illnesses that are closely related. Food allergies affect 30% of kids suffering from moderate and severe eczema and can cause a variety of symptoms, including dry, cracked skin, rash, itchiness, oozing, and crusted skin. While preteens and teens with AD are commonly sensitive to environmental allergens including house dust mites, mold, pollen, or dander of animals, younger kids with AD typically exhibit sensitivity to food items like peanuts, milk, or eggs. A food challenge test (FC) should be used to confirm allergies before recommending a stringent diet that could be hazardous to the patient. While elimination diets continue to be the cornerstone of the management of FA, they should only be carried out under the guidance of a specialist. Topical treatments are crucial for all individuals with AD. Early skin care with emollients, topical steroid treatment, and early introduction of highly allergenic foods are promising methods of alleviating symptoms of AD.

Celiac disease prevalence approaches 1%; more suffer from non-celiac gluten sensitivity.
Our goal was to estimate the prevalence of gluten intolerance.
We invited US adults (18-80 years) via Amazon\'s mechanical Turk to complete an online survey. Gluten intolerance was defined as self-reported intolerance to wheat, barley, rye, flour, or pasta. Those with celiac disease were not excluded.
We collected 2133 responses. Rate of gluten intolerance was 5.1% (95% CI 4.2-6.1%). Each food had different rates: wheat 4.8%, flour 1.2%, pasta 0.9%, barley 0.8%, and rye 0.8%. Among 108 adults reporting any gluten intolerance, 62.0% selected only wheat, 10.2% selected all gluten-containing grains excluding pasta and flour, and 5.6% selected all gluten-containing products. Overall intolerance to any food was 24.8% (95% CI 23.0-26.6%). Wheat was second only to lactose.
Self-reported intolerance to wheat, but not all gluten-containing foods, is common. Findings may suggest poor knowledge of gluten-containing foods or that self-perceived non-celiac gluten sensitivity is prevalent.

Gluten-related disorders in humans comprise different entities, including coeliac disease. Patients typically have measurable titers of anti-gliadin IgG or IgA (AGAs) and anti-transglutaminase-2 IgA (TG2). In addition to intestinal symptoms, human patients often show various neurological complications. In dogs, the neurological manifestation is rarely reported. Here we describe the muscle and nerve biopsies of an 11-year-old, male Border Terrier presenting with lower motor neuron signs submitted for histological examination. Examination of the biopsies showed an oligofocal lymphohistiocytic and plasmocytic myositis and a diffuse neuropathy of mixed nodo-paranodal and demyelinating type. Suspecting a neuromuscular form of breed-related gluten hypersensitivity, measurements of AGAs and TG2 antibodies were performed. Both titers ranged above control values. Hence, a gluten-related neuromyopathy was diagnosed. A gluten-free diet was prescribed and a complete disappearance of clinical signs was observed. Gluten-related disorders should be considered as a differential diagnosis in dogs with intestinal and neuromuscular signs.

Increasing translational evidence suggests that intestinal permeability may be a contributing factor to systemic inflammatory events and numerous pathologies. While associations between IgE-mediated food allergies and increased intestinal permeability have been well-characterized, the relationship between IgG-mediated food sensitivities and intestinal permeability is not well-described in the literature. Thus, we tested for associations between intestinal permeability biomarkers and food-specific IgG antibodies in 111 adults, with and without gastrointestinal symptoms. All biomarkers and food-specific IgG antibodies were measured via ELISA. The intestinal permeability biomarkers anti-lipopolysaccharide (LPS) and anti-occludin IgG and IgA antibodies, but not anti-vinculin or anti-CdtB IgG antibodies, were significantly and positively associated with IgG-mediated food sensitivities. These significant relationships were attenuated by adjusting for the severity of wheat, dairy, and egg reactions. The results of this study support strong associations between titers of food-specific IgG antibodies and intestinal permeability biomarkers in adults, to the extent that the presence of multiple IgG antibodies to food, and increasing IgG food titers, can be considered indicative of increased antibodies to LPS and occludin. Notably, neither IgG titers to wheat, eggs, and dairy, nor permeability biomarkers, were increased in symptomatic participants compared to those without symptoms.

Abstract  This prospective study evaluated the cause(s) of dermatitis in a series of cats with signs suggestive of allergic skin disease. Twenty cases completed the díagnostic evaluation, which included intradermal skin testing, a rigorous flea-control programme, and a 4-month stabilization period on a restricted protein source commercial diet, followed by rechallenge with the cat\'s original diet. The most common final díagnoses included flea allergic dermatitis (seven cases), and flea allergic dermatitis together with atopy (seven cases). Three additional cases which did not complete the study were also considered to be atopic. No cases were considered to be primarily associated with food hypersensitivity, an observation supporting previous data indicating this to be a rare cause of allergic skin disease in the cat. These observations emphasize the value of a rigorous flea-control programme as part of the management of many cases of feline allergic dermatitis. Résumé  Une étude étiologique prospective a été réalisée dans une population de chats suspects de dermites allergiques. Des tests cutanés intradermiques ont été réalisés ainsi qu\'un contrôle antipuce rigoureux et un régime d\'élimination, faisant appel à une alimentation du commerce restreinte en protéines pendant 4 mois, suivi par une réintroduction de l\'alimentation initiale du chat. Le díagnostic le plus fréquent est la Dermite par Allergie à la Piqûres de Puce (DAPP) (7 cas), une DAPP associée à une atopie (7 cas). Trois cas supplémentaires sont atopiques. Aucun cas n\'est en rapport avec seulement une allergie alimentaire. Cette observation montre que l\'allergie alimentaire est une cause rare de dermite allergique chez le chat. Ces observations confirment par ailleurs l\'intérêt d\'un contrôle antipuce rigoureux dans la gestion thérapeutique des dermites allergiques du chat. [O\'Dair, H.A., Markwell, P.J., Maskell, I.E. An open prospective investigation into aetiology in a group of cats with suspected allergic skin disease (Etude étiologique prospective ouverte dans une population de chats suspects de dermite allergiques). Veterinary Dermatology 1996; 7: 193-202.] Resumen  Este estudio prospective evalúa la(s) causa(s) de dermatitis en un grupo de gatos con sintomas sugestivos de dermatosis alérgica. Se evaluó el díagnóstico de veinte casos, incluyendo pruebas cutáneas intradérmicas, programa riguroso de control de pulgas y un periodo de cuatro meses de estabilización con una dieta comercial con fuente de proteina restringida, seguido de una re-exposición a la dieta original del gato. El díagnóstico final más frecuente fue de dermatitis alérgica a las pulgas (siete casos) y dermatitis alérgica a las pulgas con atopia (siete casos). Tres casos más que no completaron el estudio fueron también considerados atópicos. Ninguno de los casos fue considerado estar principalmente asociado a una hipersensibilidad alimentaria, lo que apoya hallazgos previos indicativos de que este tipo de hipersensibilidad es poco frecuente en el gato. Estos hallazgos resaltan la importancia de un programa rigurosos de control de pulgas en el protocolo de manejo de muchos casos de dermatitis alérgica felina. [O\'Dair, H.A., Markwell, P.J., Maskell, I.E. An open prospective investigation into aetiology in a group of cats with suspected allergic skin disease (Investigacion prospectiva abierta de la etiologia en un grupo de gatos sospechosos de dermatosis alérgica). Veterinary Dermatology 1996; 7: 193-202.] Zusammenfassung  Diese prospektive Untersuchung wertete die Fälle von Dermatitis bei einer Reihe von Katzen aus, die Symptome aufwiesen, welche auf eine allergische Hautkrankheit deuteten. Zwanzig Fälle wiesen eine vollständige díagnostische Untersuchung äuf, die intradermale Hauttests, striktes Flohbekämpfungsprogramm und eine viermonatige Stabilisierungsphase mit einer kommerziellen Diät mit begrenzten Eiweißquellen, gefolgt von einer Provokation mit dem bisher üblichen Katzenfutter, beinhaltete. Die häufigste endgültige Diagnose bestand in Flohbißdermatitis (sieben Fälle) und Flohbißdermatitis zusammen mit Atopie (sieben Fälle). Drei weitere Fälle durchliefen die Studie nicht vollständig, wurden aber als atopisch angesehen. Kein Fall wurde primär in Verbindug mit Futtermittelhypersensibilität gesehen, eine Beobachtung, die frühere Daten unterstützt, die dies als seltene Ursache bei allergischen Hautkrankheiten der Katze nennt. Diese Beobachtungen betonen die Bedeutung des genauen Flohbekämpfungsprogramms als Teil des Management vieler Fälle von allergischen Hautkrankheiten bei der Katze. [O\'Dair, H.A., Markwell, P.J., Maskell, I.E. An open prospective investigation into aetiology in a group of cats with suspected allergic skin disease (Offene prospektive Untersuchung über die Ätiologie bei einer Gruppe von Katzen mit Verdacht auf allergische Hautkrankheiten). Veterinary Dermatology 1996; 7: 193-202.].