BackgroundCompliance with a gluten-free diet (GFD) is difficult at all ages but particularly for teenagers due to social, cultural, economic, and practical pressures. The multidisciplinary team responsible for the treatment of patients with celiac disease and give support to their parents plays a special role on strengthening GFD and assessing the nutritional and physical health.MethodsA cross-sectional and retrospective study including patients under 20 years of age, with biopsy-confirmed CD, followed regularly at the Department of Pediatrics, Division of Gastroenterology, Hospital das Clínicas, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil, were surveyed using a questionnaire and serologic test applied between November 2011 and February 2012. A retrospective chart review of these patients was performed to collect the anthropometric data along with the results of the serologic test performed at the time of diagnosis and after at least 1 year of treatment with a GFD.ResultsWe evaluated 35 patients aged between 2.4 and 19.9 years. Of these 68.6% were female, 88.6% had the typical form of the disease and 51.4% had other comorbidities. The mean age at diagnosis was 5.4 years. Despite dietary guidance, 20% reported non-adherence to the diet. Most children recovered the weight and height deficit after 5 years of treatment, and in some children, excessive weight gain became a concern.ConclusionThe majority of transgressions occurred intentionally at home or at parties. There was a risk of excessive weight gain, especially in the first two years of treatment. More alternatives and easier access to low cost gluten-free foods, increasing the discussion about the benefits of adhering to a GFD among patients, families, and the general population, besides the acquisition of self-management skills, are crucial to fostering independent children and adolescents who have the knowledge and tools to manage life with CD.Electronic supplementary materialThe online version of this article (10.1186/s12876-018-0740-z) contains supplementary material, which is available to authorized users.

Journal of Human Growth and Development 2013; 23(1): 58-64 ORIGINAL RESEARCH Resumo:Este estudo qualitativo teve como objetivo compreender as percepções de familiares de crianças e adolescentes com alergia à proteína do leite de vaca (APLV) em relação à doença e seu tratamento. Foram realizadas nove entrevistas e foi utilizado o método de análise de conteúdo. Surgiram três categorias com subcategorias: tratamento e educação do paciente e familiares (experiências vividas, base do tratamento e como lidar com a doença), resolução da doença (expectativa e melhora gradativa), qualidade de vida (inclusão social, cotidiano familiar e custo dos alimentos). Os familiares vivenciaram dificuldades durante o início do tratamento, mas revelaram que as orientações fornecidas no seguimento tornaram as adaptações à doença mais fáceis. Comentaram sobre as dificuldades em obter a colaboração de outros membros da família em relação à dieta de exclusão, suas experiências frente a uma reação alérgica, dúvidas quanto ao tratamento e lacunas do conhecimento sobre a doença entre outros médicos e na população em geral. Alguns deles acreditavam que não havia tratamento para a APLV, porque não existiam medicamentos ou vacinas, mas mantinham a esperança da descoberta de uma cura. A maioria dos familiares estava satisfeita com a melhora gradativa dos seus filhos, percebida pela redução da gravidade dos sintomas e tolerância a traços de leite. Também comentaram sobre os esforços em proporcionar uma vida normal para seus filhos, as mudanças em suas vidas e a dificuldade em comprar alimentos especiais. Em conclusão, os familiares de crianças e adolescentes com APLV sentem grande impacto da doença.Palavras-chave: pesquisa qualitativa; hipersensibilidade alimentar; criança; hipersensibilidade a leite. Abstract:The aim of this qualitative study was to understand the perceptions of caregivers of children and adolescents with cow's milk allergy regarding the disease and its treatment. Nine caregivers were interviewed and content analysis method was used. Three categories with subcategories emerged: treatment and education of the patient and their caregivers (life experiences, bases of treatment, coping with the disease), resolution of the disease (hope, gradual improvement), quality of life (social inclusion, family daily activities, costs of dietary treatment). Caregivers experienced difficulties during the initial treatment but pointed out that the guidance given during follow-up made the adjustments easier. Family members commented on the difficulties about lack of cooperation from other family members regarding the restrictive diet, their experience coping with the allergic reaction, doubts about the treatment and gaps on knowledge about the disease by other physicians and people. Some of them believed that there is no treatment for the disease, because there are no drugs or vaccines, but they were waiting for cure. The majority of relatives were satisfied with the gradual improvement of patients observed by reduction on the severity of sympt...

Objective: To evaluate the ability of relatives of patients with cow's milk allergy to identify terms related to cow's milk on labels of manufactured products.Methods: Cross-sectional descriptive study based on interviews with relatives of patients with cow's milk allergy. Initially, a questionnaire about the habit of reading labels and the identification of terms related to cow's milk was applied. Next, 12 original labels of manufactured products were shown to the interviewees so that they could decide whether to exclude or not those products from the patient's diet.Results: Of the 52 interviewees, 80.8% were mothers and 79.0% had at least 8 years of schooling. The median time of follow-up after receiving information about exclusion diet was 2 years and 7 months (from 3 months to 17 years and 6 months). The habit of reading labels of foods, drugs and cosmetics was reported by 57.7, 59.6, and 46.2% of the relatives, respectively. Among the allergic reactions during follow-up, 39.5% were related to mistakes when reading labels. Lactose, casein, and caseinate were the terms identified by 92.3, 38.5, and 23.1% of the family members, respectively. Lactate was interpreted as presence of cow's milk by 51.9% of the interviewees. During the second phase of the study, family members identified lactose (55.8%), casein (26.9%) and caseinate (5.8%) as related to cow's milk.Original Article de alimentos, medicamentos e cosméticos foi relatada por 57,7%, 59,6% e 46,2% dos familiares, respectivamente. Entre as reações alérgicas ocorridas no seguimento, 39,5% foram relacionadas a erros na leitura de rótulos. Lactose, caseína e caseinato foram os termos identificados por 92,3%, 38,5% e 23,1% dos familiares, respectivamente. Lactato foi interpretado como presença de leite de vaca por 51,9% dos entrevistados. Na segunda etapa, os familiares identificaram a lactose (55,8%), a caseína (26,9%) e o caseinato (5,8%) como substâncias relacionadas ao leite.Conclusões: Constatou-se deficiente compreensão e identificação, por parte dos pais, dos termos relacionados ao leite apesar das orientações recebidas. É fundamental a adequação da rotulagem e a adoção de novas estratégias para orientação da leitura de rótulos, possibilitando a busca e a identificação de produtos que contenham leite de vaca.Palavras-chave: hipersensibilidade alimentar; hipersensibilidade a leite; rotulagem de alimentos; pais; conhecimento; alimentos industrializados.

Baked milk can be tolerated by patients with CMA, especially those with lower levels of casein and α-lactalbumin. This option can improve quality of life and accelerate tolerance.

The proposed adaptation for the DBPCFC allowed to implement this important test for the diagnosis of IgE-mediated CMA in a reference centre for paediatric allergies. It was considered feasible and safe if performed in an appropriate setting with physician supervision.

Objective: To evaluate the wheal diameter in allergy skin-prick tests (SPT) with cow's milk extract (CM) comparing tolerant and persistent patients. Method: A retrospective cohort study involving database analysis of children with diagnosis of cow's milk protein allergy (CMPA) mediated by immunoglobulin E in a specialized outpatient clinic that regularly performed SPT between January 2000 and July 2015. Patients were allocated into two groups: tolerant or persistent. Comparisons were made at diagnosis and over time between tolerant and persistent patients using Fisher's, Mann-Whitney or Wilcoxon tests and significance level at 5%. Results: After applying inclusion and exclusion criteria, the sample includes 44 patients (29 tolerant and 15 who persisted with CMPA). In the tolerant group, the medians of SPT were: 6 mm at diagnosis and 2 mm at the development of tolerance; a significant difference (p<0.0001) was found. In the persistent group, the median SPT at diagnosis was 7 mm, while in the last SPT it was 5 mm, with no statistical difference (p=0.173). The comparison of medians in the last SPT between groups was significant (p=0.001), with a reduction greater than 50% in SPT in the tolerant group. Conclusion: Serial SPTs were useful for diagnosis, and a decrease higher than 50% in diameter can indicate the moment to perform oral food challenge (OFC) tests, helping to detect tolerance in CMPA.

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ABSTRACT Objectives: To review the literature on oral and enteral nutrition therapy and investigate the evidence of its efficacy as a treatment, as well as in preventing relapses and reducing symptoms of inflammatory bowel diseases in the pediatric population. Data source: We performed a bibliographic search in the PubMed, Web of Science, and Latin American and Caribbean Health Sciences Literature (Literatura Latino-Americana e do Caribe em Ciências da Saúde - Lilacs) databases, using the keywords “inflammatory bowel disease,” “diet,” and “diet therapy” in English and Portuguese, with filters for pediatric studies published in the previous five years. Data summary: We selected 16 articles for this study, nine on exclusive and/or partial enteral nutrition and seven on modified oral diets, such as the specific carbohydrate diet (SCD) and the Crohn’s Disease exclusion diet (CDED). The studies found evaluated the anthropometric profile of patients and the inflammatory profile of diseases in children before and after the introduction of each specific nutrition therapy. All interventions presented positive changes in these parameters; however, the results were inconclusive regarding the efficacy of SCD and CDED in the treatment and prevention of relapses. Conclusions: Exclusive enteral nutrition has proven to be effective in inducing remission of Crohn’s Disease, and the use of partial enteral nutrition for maintenance treatment has shown promising results. Other modified oral diets are inconclusive concerning their effectiveness, requiring further randomized controlled clinical trials.