Peanut Allergen Threshold Study (PATS): validation of eliciting doses using a novel single-dose challenge protocol

Background: The eliciting dose (ED) for a peanut allergic reaction in 5% of the peanut allergic population, the ED05, is 1.5 mg of peanut protein. This ED05 was derived from oral food challenges (OFC) that use graded, incremental doses administered at fixed time intervals. Individual patients’ threshold doses were used to generate population dose-distribution curves using probability distributions from which the ED05 was then determined. It is important to clinically validate that this dose is predictive of the allergenic response in a further unselected group of peanut-allergic individuals. Methods/Aims: This is a multi-centre study involving three national level referral and teaching centres. (Cork University Hospital, Ireland, Royal Children’s Hospital Melbourne, Australia and Massachusetts General Hospital, Boston, U.S.A.) The study is now in process and will continue to run until all centres have recruited 125 participates in each respective centre. A total of 375 participants, aged 1–18 years will be recruited during routine Allergy appointments in the centres. The aim is to assess the precision of the predicted ED05 using a single dose (6 mg peanut = 1.5 mg of peanut protein) in the form of a cookie. Validated Food Allergy related Quality of Life Questionnaires-(FAQLQ) will be self-administered prior to OFC and 1 month after challenge to assess the impact of a single dose OFC on FAQL. Serological and cell based in vitro studies will be performed. Conclusion: The validation of the ED05 threshold for allergic reactions in peanut allergic subjects has potential value for public health measures. The single dose OFC, based upon the statistical dose-distribution analysis of past challenge trials, promises an efficient approach to identify the most highly sensitive patients within any given food-allergic population.

Digital signal processing and artificial intelligence for the automated classification of food allergy

As a by-product of the ‘information revolution’ which is currently unfolding, lifetimes of man (and indeed computer) hours are being allocated for the automated and intelligent interpretation of data. This is particularly true in medical and clinical settings, where research into machine-assisted diagnosis of physiological conditions gains momentum daily. Of the conditions which have been addressed, however, automated classification of allergy has not been investigated, even though the numbers of allergic persons are rising, and undiagnosed allergies are most likely to elicit fatal consequences. On the basis of the observations of allergists who conduct oral food challenges (OFCs), activity-based analyses of allergy tests were performed. Algorithms were investigated and validated by a pilot study which verified that accelerometer-based inquiry of human movements is particularly well-suited for objective appraisal of activity. However, when these analyses were applied to OFCs, accelerometer-based investigations were found to provide very poor separation between allergic and non-allergic persons, and it was concluded that the avenues explored in this thesis are inadequate for the classification of allergy. Heart rate variability (HRV) analysis is known to provide very significant diagnostic information for many conditions. Owing to this, electrocardiograms (ECGs) were recorded during OFCs for the purpose of assessing the effect that allergy induces on HRV features. It was found that with appropriate analysis, excellent separation between allergic and nonallergic subjects can be obtained. These results were, however, obtained with manual QRS annotations, and these are not a viable methodology for real-time diagnostic applications. Even so, this was the first work which has categorically correlated changes in HRV features to the onset of allergic events, and manual annotations yield undeniable affirmation of this. Fostered by the successful results which were obtained with manual classifications, automatic QRS detection algorithms were investigated to facilitate the fully automated classification of allergy. The results which were obtained by this process are very promising. Most importantly, the work that is presented in this thesis did not obtain any false positive classifications. This is a most desirable result for OFC classification, as it allows complete confidence to be attributed to classifications of allergy. Furthermore, these results could be particularly advantageous in clinical settings, as machine-based classification can detect the onset of allergy which can allow for early termination of OFCs. Consequently, machine-based monitoring of OFCs has in this work been shown to possess the capacity to significantly and safely advance the current state of clinical art of allergy diagnosis

Predicting positive food challenges in children sensitised to peanuts/tree nuts.

BACKGROUND: Children with atopic diseases in early life are frequently found with positive IgE tests to peanuts/tree nuts without a history of previous ingestion. We aimed to identify risk factors for reactions to nuts at first introduction. METHODS: A retrospective case-note and database analysis was performed. Recruitment criteria were: patients aged 3-16 yr who had a standardized food challenge to peanut and/or tree nuts due to sensitisation to the peanut/tree nut (positive spIgE or SPT) without previous consumption. A detailed assessment was performed of factors relating to food challenge outcome with univariate and multivariate logistic regression analysis. RESULTS: There were 98 food challenges (47 peanut, 51 tree nut) with 29 positive, 67 negative and 2 inconclusive outcomes. A positive maternal history of allergy and a specific IgE >5 kU/l were strongly associated with a significantly increased risk of a positive food challenge (OR 3.73; 95% CI 1.31-10.59; p = 0.013 and OR 3.35; 95% CI 1.23-9.11; p = 0.007, respectively). Adjusting for age, a three year-old with these criteria has a 67% probability of a positive challenge. There was no significant association between types of peanut/tree nut, other food allergies, atopic conditions or severity of previous food reactions and positive challenges. CONCLUSIONS: We have demonstrated an association between the presence of maternal atopic history and a specific IgE >5 kU/l, with a significant increase in the likelihood of a positive food challenge. Although requiring further prospective validation these easily identifiable components should be considered when deciding the need for a challenge.

Evaluation of colonoscopic allergen provocation as a diagnostic tool in dogs with proven food hypersensitivity reactions

OBJECTIVE: To evaluate the colonoscopic allergen provocation (COLAP) test as a new tool for the diagnosis of IgE-mediated food allergy. METHODS: Oral food challenges as well as COLAP testing were performed in a colony of nine research dogs with proven immediate-type food allergic reactions. In addition, COLAP was performed in five healthy dogs. RESULTS: When compared with the oral challenge test, COLAP accurately determined 18 of 23 (73 per cent) positive oral challenge reactions (73 per cent) in dogs with food allergies and was negative in the healthy dogs. CLINICAL SIGNIFICANCE: The accuracy of this new test may be higher than that for gastric sensitivity testing. Therefore, COLAP holds promise as a new test to confirm the diagnosis of suspect IgE-mediated food allergy in dogs.

The psychological impact of diagnostic food challenges to confirm the resolution of peanut or tree nut allergy

Background - Twenty percent of children outgrow peanut allergy and 10% outgrow tree nut allergy. Resolution can be confirmed by a food challenge. Little is known about the psychosocial impact of the challenge. We aimed to investigate effects of a food challenge on anxiety, stress and quality of life (QoL) in children and their mothers on the day of a food challenge to peanuts or nuts, and in the months following the challenge. Methods - One hundred and three families participated. Forty children undergoing food challenges to access resolution of allergy, and their mothers, completed validated questionnaires to measure generic and food specific quality of life, stress and anxiety prior to challenge, on the day of investigation and 3–6 months later. Sixty-three children with no clinical indication to challenge (i.e. in the opinion of the allergist had persistent allergy) acted as comparison group completing questionnaires 3–6 months apart. Results - Mothers reported raised anxiety on the day of challenge (P = 0.007), but children were less anxious. The children (P = 0.01) and mothers (P = 0.01) had improved food-related, but not general, QoL 3–6 months following challenge. Children reported lower anxiety levels following the challenge (P = 0.02), but anxiety remained unchanged in mothers. The improvements in maternal and children's QoL and anxiety levels were irrespective of the challenge outcome and despite co-existing food allergies in 50% of children. Conclusions - Mothers experienced increased anxiety on the day of food challenge, unlike the children, perhaps reflecting the differences in their perceived risks. Food challenges are associated with improved food-related QoL in the following months even in those with a positive challenge.

Oral food perception and polyphenol-rich foods acceptance - the importance of knowing individuals saliva characteristics for promoting consumption

Polyphenols are widely present in fruits, vegetables, cereals and beverages. Their study gained scientific interest because of their beneficial effects on health. Although there is currently no official dietary recommendation for polyphenol intake, health professionals recommend the consumption of 5-8 daily portions of fruits and vegetables. This is not always achieved and, despite possible causes associated to practical schedule difficulties, the aversive bitter and astringent sensations associated to polyphenols may also lead to avoidance. As such, a better understanding on mechanisms responsible for differences among people, in polyphenol oral perception, is needed for promoting healthier choices. Saliva has been linked to polyphenol consumption. We have previously observed, in animal models, changes in salivary proteome induced by tannin-enriched diets. Moreover, differences in astringency perception were attributed to differences in salivary protein composition. In a recent experiment, we observed differences among individuals with dissimilar tannic-acid perception: people with high sensitivity for the oral sensations elicited by tannins have higher amounts of salivary cystatins and lower capacity to maintain their levels after tannic-acid ingestion. Additionally, and similarly to previous studies, salivary amylase was observed to be involved in tannin perception. In this presentation, oral cavity characteristics influencing the perception of polyphenol-containing foods will be discussed.

Tolerância ao leite processado em altas temperaturas em pacientes com alergia ao leite de vaca mediada pela imunoglobulina E

INTRODUÇÃO: A incidência de pacientes apresentando alergia à proteína do leite de vaca (APLV) após os 5 anos de idade vem crescendo. Definir se estes pacientes tolerariam a ingestão de alimento produzido com leite processado a altas temperaturas (LPAT) proporcionaria melhor qualidade de vida, definiria melhor prognóstico e possibilitaria avaliar a indicação de dessensibilização com muffin. OBJETIVO: (1) identificar quais pacientes com APLV persistente aos quatro anos poderiam tolerar a ingestão de LPAT, (2) descrever as características clínicas e laboratoriais dos grupos reativo e não reativo ao LPAT, e (3) compara-las entre os dois grupos. MÉTODOS: Estudo transversal, utilizando amostra de conveniência, incluindo todos os pacientes acompanhados no ambulatório de alergia alimentar do Instituto da Criança HCFMUSP que preenchiam os critérios de inclusão e que concordaram em realizar o TPO, entre janeiro/2013 e novembro/2014. Os pacientes foram admitidos em hospital-dia sob supervisão médica e submetidos à ingestão de um muffin contendo 2,8 gramas de proteína do leite de vaca. Foram definidos como tolerantes se não apresentassem nenhuma reação alérgica. Estes pacientes foram submetidos na sequência a novo TPO com leite de vaca in natura para excluir a tolerância ao leite de vaca. RESULTADOS: Foram realizados 38 TPO com LPAT, sendo que 30 pacientes (15 masculinos) preencheram todos os critérios de inclusão. A mediana da idade foi de 7 anos e 7 meses (4a10m -14a2m). 14 pacientes (46%) não apresentaram reação após a ingestão do muffin, sendo considerados como não reativos. A análise comparativa entre os grupos reativos e não reativos ao LPAT, não mostrou diferença estatisticamente significante quanto às características clínicas: idade (p=0,8), sexo (p=0,4), história pessoal de rinite (p=0,7), história pessoal de asma (p=0,7), história pessoal de outras alergias (p=0,6), história familiar de rinite (p=0,7), história familiar de asma (p=0,3), história familiar de outras alergias (p=0,1), relato de anafilaxia prévia (p=0,07), relato de ingestão de traços de leite previamente ao TPO (p=0,4), relato de reação alérgica no último ano antes da provocação (p=0,6), relato de anafilaxia no último ano antes do TPO (p=0,6). Não se observou diferença estatisticamente significante entre os dois grupos para IgE total (p=0,1) e eosinófilos (p=0,6). O teste de puntura para leite de vaca e frações mostrou diferença estatisticamente significante para ?-lactoalbumina (p= 0,01) e para a caseína (p = 0,004); em relação ao ImmunoCAP® apenas para a caseína (p= 0,05) essa diferença foi significante. Ao avaliar estes pacientes 1 ano após o TPO, nenhum dos 16 pacientes que foram reativos ao LPAT estava ingerindo leite de vaca, enquanto 28% dos pacientes que foram tolerantes ao LPAT estavam consumindo leite de vaca in natura sem reação (p=0,037). CONCLUSÃO: O estudo mostrou que os pacientes com APLV desta amostra brasileira apresentaram 2 diferentes fenótipos, sendo que aproximadamente metade tolerou o LPAT. Sendo assim, o TPO para LPAT deve ser considerado para pacientes com APLV, sempre sob supervisão médica e estrutura segura e adequada, pois pode contribuir para uma mudança no paradigma do seguimento destes pacientes. Teste de puntura e ImmunoCAP® para caseína podem sugerir quais pacientes estariam tolerantes ao TPO com LPAT, reforçando dados da literatura internacional

A vocação totalizante da história oral e o exemplo da formação do acervo de entrevistas do CPDOC

This paper discusses the oral history vocation to totality taking as example the formation of the CPDOC’s (Centro de Pesquisa e Documentação de História Contemporânea do Brasil da Fundação Getulio Vargas) oral history archive. As “vocation to totality” we consider specially the construction of senses and syntheses of the past and the hermeneutical perspective in which oral history is inserted.

Diário pessoal, autobiografia e fontes orais: a trajetória de Pierre Deffontaines

A proposta deste trabalho é discutir as características e as possibilidades de uso, para a pesquisa histórica, do diário da sra. Deffontaines e da autobiografia de Pierre Deffontaines, bem como dos depoimentos orais concedidos por seus descendentes. A idéia básica é analisar os pontos de convergência e os conflitos de memória apresentados nesses três tipos de fontes, e seus significados para a compreensão da trajetória intelectual de Deffontaines. A hipótese central que norteia a análise é a de que as três fontes revelam memórias divergentes, na medida em que as três modalidades de relato tinham objetivos diversos, foram produzidas em momentos distintos e por pessoas de gerações também diferentes: Deffontaines, sua mulher, sua filha e seu neto. Nosso objetivo será exatamente mostrar como e por que se delinearam essas memórias diferenciadas.

Bedside assessment of swallowing in elderly subjects using psychotropic drugs

Drogas neurolépticas são utilizadas em diversas doenças mentais e suspeita-se que causem disfagia orofaríngea, principalmente em usuários idosos. OBJETIVO: Observar o efeito dos neurolépticos sobre a deglutição de idosos institucionalizados. Forma de Estudo: Descritivo transversal de série de casos. MATERIAL E MÉTODOS: A deglutição de 47 idosos moradores de casa de repouso, usuários e não usuários de drogas neurolépticas foi avaliada por meio do teste clínico funcional da deglutição usando quatro consistências de alimentos. RESULTADOS: Não houve diferença significativa entre os dois grupos. Os usuários de neurolépticos mostraram porcentagem maior de deglutições múltiplas, enquanto os não usuários apresentaram porcentagem maior de escape oral. CONCLUSÃO: Medicações neurolépticas, isoladamente, não afetam o mecanismo da deglutição do idoso. Entretanto, novos estudos, com número maior de indivíduos e que usem avaliação específica da deglutição, são necessários

Prey digestion in the midgut of the predatory bug Podisus nigrispinus (Hemiptera: Pentatomidae)

Pre-oral digestion is described as the liquefaction of the solid tissues of the prey by secretions of the predator. It is uncertain if pre-oral digestion means pre-oral dispersion of food or true digestion in the sense of the stepwise bond breaking of food polymers to release monomers to be absorbed. Collagenase is the only salivary proteinase, which activity is significant (10%) in relation to Podisus nigrispinus midgut activities. This suggests that pre-oral digestion in P. nigrispinus consists in prey tissue dispersion. This was confirmed by the finding of prey muscles fibers inside P. nigrispinus midguts. Soluble midgut hydrolases from P. nigrispinus were partially purified by ion-exchange chromatography, followed by gel filtration. Two cathepsin L-like proteinases (CAL1 and CAL2) were isolated with the properties: CAL1 (14.7 kDa, pH optimum (pHo) 5.5, km with carbobenzoxy-Phe-Arg-methylcoumarin, Z-FR-MCA, 32 mu M); CAL2 (17 kDa, pHo 5.5, km 11 mu M Z-FR-MCA). Only a single molecular species was found for the other enzymes with the following properties are: amylase (43 kDa, pHo 5.5, km 0.1% starch), aminopeptidase (125 kDa, pHo 5.5, km 0.11 mM L-Leucine-p-nitroanilide), alpha-glucosidase (90 kDa, pHo 5.0, km 5 mM with p-nitrophenyl alpha-D-glucoside). CAL molecular masses are probably underestimated due to interaction with the column. Taking into account the distribution of hydrolases along P. nigrispinus midguts, carbohydrate digestion takes place mainly at the anterior midgut, whereas protein digestion occurs mostly in middle and posterior midgut, as previously described in seed- sucker and blood-feeder hemipterans. (C) 2012 Elsevier Ltd. All rights reserved.

ESPEN Guidelines on Enteral Nutrition: Geriatrics

Nutritional intake is often compromised in elderly, multimorbid patients. Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility to increase or to insure nutrient intake in case of insufficient oral food intake. The present guideline is intended to give evidence-based recommendations for the use of ONS and TF in geriatric patients. It was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was discussed and accepted in a consensus conference. EN by means of ONS is recommended for geriatric patients at nutritional risk, in case of multimorbidity and frailty, and following orthopaedic-surgical procedures. In elderly people at risk of undernutrition ONS improve nutritional status and reduce mortality. After orthopaedic-surgery ONS reduce unfavourable outcome. TF is clearly indicated in patients with neurologic dysphagia. In contrast, TF is not indicated in final disease states, including final dementia, and in order to facilitate patient care. Altogether, it is strongly recommended not to wait until severe undernutrition has developed, but to start EN therapy early, as soon as a nutritional risk becomes apparent.

El sector agropecuario en la región de Los Lagos y el paradigma "Chile potencia alimentaria" : Desafíos para la política agraria nacional

La reestructuración del modelo económico en Chile a mediados de los setenta impactó a todos los sectores productivos y el sector agropecuario no fue una excepción. Se iniciaba así el comienzo de la "Era agroexportadora", que fomentaba aquellas orientaciones productivas con claras ventajas competitivas en los mercados internacionales. El paradigma agrícola chileno se ha caracterizado por funcionar sobre la base de salarios bajos, disponibilidad de mano de obra y tipo de cambio favorable. En 2006, y en este escenario, se ha implementado la política pública denominada "Chile Potencia Alimentaria 2020", que buscar reforzar la fórmula anterior. Esta iniciativa considera estrategias de crecimiento que invisibilizan la estructura bimodal agraria presente en el país. A lo anterior se suma el agravante de que territorios (como la Región de Los Lagos en el sur de Chile) con orientaciones productivas tradicionales (ganaderas específicamente) presentan posiciones manifiestamente vulnerables, especialmente de aquellos grupos de productores que se caracterizan por funcionar con racionalidades distintas de la empresarial.

El sector agropecuario en la región de Los Lagos y el paradigma "Chile potencia alimentaria" : Desafíos para la política agraria nacional

La reestructuración del modelo económico en Chile a mediados de los setenta impactó a todos los sectores productivos y el sector agropecuario no fue una excepción. Se iniciaba así el comienzo de la "Era agroexportadora", que fomentaba aquellas orientaciones productivas con claras ventajas competitivas en los mercados internacionales. El paradigma agrícola chileno se ha caracterizado por funcionar sobre la base de salarios bajos, disponibilidad de mano de obra y tipo de cambio favorable. En 2006, y en este escenario, se ha implementado la política pública denominada "Chile Potencia Alimentaria 2020", que buscar reforzar la fórmula anterior. Esta iniciativa considera estrategias de crecimiento que invisibilizan la estructura bimodal agraria presente en el país. A lo anterior se suma el agravante de que territorios (como la Región de Los Lagos en el sur de Chile) con orientaciones productivas tradicionales (ganaderas específicamente) presentan posiciones manifiestamente vulnerables, especialmente de aquellos grupos de productores que se caracterizan por funcionar con racionalidades distintas de la empresarial.

El sector agropecuario en la región de Los Lagos y el paradigma "Chile potencia alimentaria" : Desafíos para la política agraria nacional

La reestructuración del modelo económico en Chile a mediados de los setenta impactó a todos los sectores productivos y el sector agropecuario no fue una excepción. Se iniciaba así el comienzo de la "Era agroexportadora", que fomentaba aquellas orientaciones productivas con claras ventajas competitivas en los mercados internacionales. El paradigma agrícola chileno se ha caracterizado por funcionar sobre la base de salarios bajos, disponibilidad de mano de obra y tipo de cambio favorable. En 2006, y en este escenario, se ha implementado la política pública denominada "Chile Potencia Alimentaria 2020", que buscar reforzar la fórmula anterior. Esta iniciativa considera estrategias de crecimiento que invisibilizan la estructura bimodal agraria presente en el país. A lo anterior se suma el agravante de que territorios (como la Región de Los Lagos en el sur de Chile) con orientaciones productivas tradicionales (ganaderas específicamente) presentan posiciones manifiestamente vulnerables, especialmente de aquellos grupos de productores que se caracterizan por funcionar con racionalidades distintas de la empresarial.