We have found evidence that points to the association of severe allergic inflammation with platelet functions alteration, together with reduced protein synthesis, and switch of immune cells to aerobic glycolysis.

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Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food hypersensitivity usually due to cow's milk or soy. Recent researches show that fish is 1 of the most important triggers of FPIES in the Mediterranean countries. Due to the risk of multiple-food FPIES, avoiding foods in the same category or that often occur together may be reasonable. The aim of this study was to evaluate the evolution and follow-up of FPIES related to fish over a period of 20 years. We describe the clinical features of our population, discuss different approaches to oral food challenges, and analyze the possibility of introducing the culprit fish or other nonrelated fish to avoid unnecessary restricted diets.

Background:The heterogeneity and lack of validation of existing severity scores for food allergic reactions limit standardization of case management and research advances.Objective: To develop and validate a severity score for food allergic reactions.Methods: Following a multidisciplinary experts consensus it was decided to develop a food allergy severity score (FASS) with ordinal (oFASS) and numerical (nFASS) formats. oFASS with 3 and 5 grades were generated through expert consensus, and nFASS by mathematical modeling. Evaluation was performed in the EuroPrevall outpatient clinic cohort (8232 food reactions) by logistic regression with request of emergency care and medications used as outcomes. Discrimination, classification and calibration were calculated. Bootstrapping internal validation was followed by external validation (logistic regression) in 5 cohorts (3622 food reactions). Correlation of nFASS with the severity classification done by expert allergy clinicians by Best-Worst Scaling of 32 food reactions was calculated.Results: oFASS and nFASS map consistently, with nFASS having greater granularity.With the outcomes emergency care, adrenaline and critical medical treatment, oFASS and nFASS had a good discrimination (receiver operating characteristic area under the curve [ROC-AUC]>0.80), classification (sensitivity 0.87-0.92, specificity 0.73-0.78) and calibration. Bootstrapping over ROC-AUC showed negligible biases (1.0×10 -6 -1.23×10 -3 ).In external validation nFASS performed best with higher ROC-AUC. nFASS was strongly correlated (R 0.89) to best-worst scoring of 334 expert clinicians. Conclusion:FASS is a validated and reliable method to measure severity of food allergic reactions. The ordinal and numerical versions that map onto each other are suitable for use by different stakeholders in different settings.

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Background: Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food hypersensitivity usually due to cow’s milk or soy. Among the solid foods, rice is one of the most causative foods worldwide, but it varies depending on the geographic area. In the Mediterranean countries, fish is one of the most important triggers of FPIES. There is not a specific biological marker for the disease that allows us to confirm the diagnosis or to predict when tolerance to the offending food has been achieved, so all patients with a FPIES diagnosis undergo an oral food challenge (OFC) at least once. The OFC is a risky procedure and many patients develop severe symptoms. Objective: We sought to evaluate the safety of a new OFC protocol in children with fish-FPIES. Methods: A retrospective study was performed over a 22-year period (1996–2018). We compared two methodologies used in the OFC: Method 1 that consisted in giving several doses during the same day versus Method 2 that consisted in giving a unique dose per day on 2 or three non-consecutive days. Results: A total of 75 positive OFC with fish done in 40 children were included. Forty-three (57.3%) OFC were performed following Method 1 and 32 (42.7%) with Method 2.The severity of the symptoms of the OFC done with Method 1 was mostly moderate (41.9%) followed by severe (39.5%) and mild (18.6%). The adverse reactions with Method 2 were mostly mild (68.8%) and only 18.8 and 12.5% presented moderate or severe symptoms, respectively. Conclusions: OFC performed in children with fish-FPIES are risky and many patients develop moderate or severe symptoms after this procedure. We propose a new protocol that has demonstrated to improve safety.

Effects of season (SEAS), organic fertilization with laying hen manure (N) and harvest frequency (FREQ) on forage yield and composition were evaluated in a high‐density mulberry forage bank, established under low‐input tropical farming conditions. The experiment, replicated over two consecutive years, was arranged in 18 treatments resulting from a 3 × 3×2 factorial design which combined three FREQ (60, 90 and 120 d), 3 N rates (100, 300 and 500 kg N ha−1 year−1) and the two seasons (RAIN and DRY). Forage yield, leaf‐to‐stem ratio, the edible fraction (EDIB, %), nutrient content and the maturity indexes were monitored. Either forage yield or qualities by plant fraction were strongly affected by SEAS, FREQ, N rate and by their interactions. Effects of FREQ and N were modulated by SEAS. Increasing FREQ during RAIN negatively affected EDIB yield and quality after 90 d, while increasing ligneous fraction. During DRY, longer FREQ allowed higher total forage and EDIB yields. Leaves were more abundant in RAIN, and its yield was increased with fertilization but only during this season. Maturity indexes were higher in DRY than in RAIN. Under the conditions of this experiment, harvesting at 60 and 90 d in RAIN and DRY, respectively, with an N rate of 300 kg N ha−1 year−1 seems the best agronomic choice for an optimal compromise between forage yield and nutritive value.