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This paper introduces the concept of liminal hotspots as a specifically psychosocial and sociopsychological type of wicked problem, best addressed in a processtheoretical framework. A liminal hotspot is defined as an occasion characterised by the experience of being trapped in the interstitial dimension between different formsof-process. The paper has two main aims. First, to articulate a nexus of concepts associated with liminal hotspots that together provide general analytic purchase on a wide range of problems concerning 'troubled' becoming. Second, to provide concrete illustrations through examples drawn from the health domain. In the conclusion, we briefly indicate the sense in which liminal hotspots are part of broader and deeper historical processes associated with changing modes for the management and navigation of liminality.

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Discussions of the framework and terminology associated with the right to health tend to treat the indeterminacy of ‘health’ as conceptual noise that the construction of effective policy must not focus on, but find ways of bracketing out. On this basis, the right to health is broadly regarded as a social and economic, rather than a civil and political right. This article draws critically on literature about the implications of developments in medical biotechnologies, to argue that a positive acknowledgement of the indeterminate character of health should transform, rather than simply hinder, the quality of debate over what is to be understood and expected in connection with a right to health. A focus on indeterminacy allows for the perception and the formulation of health-related demands that may not stem from the scarcity of material resources or technical means, but from the misplaced authority of particular voices in defining what possibilities are to be seriously envisaged. This proposition only becomes politically effective, it is argued, when ‘indeterminacy’ (and the capacity for normativity) is referred to life itself and not merely to social and moral judgements about life. Although more immediately pertinent to the concerns of relatively privileged populations, the focus on indeterminacy provides a key to generating a certain symmetry and complementarity of interest, across the privileged/underprivileged divide, in promoting health as a (human) right.

Recently, a study on 5 patients [Holbrook et al.: J Allergy Clin Immunol 2013;132:1219-1220] documented the efficacy of the intravenous administration of ondansetron in children with acute symptoms due to food protein-induced enterocolitis syndrome (FPIES). We report on the experience at our institution using ondansetron during oral food challenge (OFC) in 5 children affected by FPIES. In all 5 cases, the use of intramuscular ondansetron led to a complete and rapid resolution of symptoms within 15 min. Intramuscular administration, without the need for intravenous access for an infusion or steroid administration, enables this therapy to be easily performed, even at home (i.e. out of a hospital setting). A home treatment with ondansetron cannot be considered as an alternative to a medical examination with eventual treatment in hospital, which is advised after any acute episode of FPIES. We consider ondansetron to be very useful in the management of acute FPIES. Further study is required to confirm its efficacy.

Food protein-induced enterocolitis syndrome (FPIES) is an allergic disease, probably non-IgE-mediated, with expression predominantly in the GI tract. The most characteristic symptom is repeated, debilitating vomiting. It occurs 2-6 h after ingestion of culprit food and is usually accompanied by pallor and lethargy. There may be diarrhea, and in 10-20% of cases, severe hypotension. These symptoms resolve completely within a few hours. The food most frequently involved is cow's milk, followed by rice, but many other foods may be involved. The prognosis is generally good in a few years. In this review the authors try to cope, with the help of some case histories, with the practical clinical aspects of FPIES. The authors also try to provide a management approach based on current knowledge, and finally, to point out the aspects of FPIES that are still controversial.

Purpose of reviewThe article discusses the clinical management of patients affected by food protein-induced enterocolitis syndrome (FPIES), focusing on established therapeutic choices and future options.Recent findingsAfter FPIES has been diagnosed and avoidance of the culprit food prescribed, the most important management needs are as follows. First, recurrence of acute FPIES episodes due to accidental ingestion of culprit food. It may be useful to give patients’ families an action plan. The principal suggested treatments are intravenous fluids and steroids, whereas the use of epinephrine and ondansetron requires further study. In mild-to-moderate cases, oral rehydration should be sufficient. Second, dietary introduction of at-risk foods. In children with FPIES, in addition to that/those identified as culprit(s), some foods may not be tolerated (typically cow's milk, legumes, cereals, poultry). It has been suggested to avoid introducing these foods during the baby's first year. Otherwise, they may be given for the first time in hospital, performing an oral food challenge. Third, acquisition of tolerance. Children affected by cow's milk-FPIES have a good chance of acquiring tolerance by the time they reach age 18–24 months. For other culprit foods, insufficient data are available to indicate the appropriate time, so that it is suggested that an oral food challenge be performed about 1  year after the last acute episode.SummaryFuture clinical management of FPIES must take into account, among other factors, improved understanding of pathogenesis, possible detection of different phenotypes, and the introduction of more effective therapies for acute episodes. These factors will undoubtedly influence management decisions, which will become more diversified and effective.

This paper offers a synthetic outline of the contribution of a foucauldian approach to the analysis of health, with specific attention to the dynamics of the relation between health promotion and the 'health society'. Through the concept of 'biopower', this approach was among the first in sociology to highlight the general relevance of health to the constitutive dynamics of modern (and eventually late-modern) societies. Through the concept of 'governmentality', scholars in a range of disciplines offered early critical analyses of health promotion discourse in the specific context of neo-liberalism, highlighting some of its paradoxical features. To the extent that such paradoxes are now more widely articulated as an explicit subject for public debate through the notion of a 'health society', it might be argued that the critical function initially offered through the notion of governmentality has become somewhat redundant. Against this background, the paper concludes by discussing, through examples relating to new biotechnologies and to drug policy, how a foucauldian approach continues to be relevant in the contemporary context.