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The Editor recommends this issue's articles to the reader

The Editor recommends this issue's articles to the reader Pediatric Allergy and Immunology EDITOR’S CHOICE Cows’ milk exclusion diet during infancy: is there a long-term effect on children’s eating behaviour and food preferences? Cows’ milk allergy (CMA) requires a strict exclusion diet, usually for the first year of life. This exclusion of a main food group occurs at a critical time in the development of food preferences and eating habits. It is known that infants are born with an innate predisposition to prefer sweet tastes and reject bitter and sour tastes. However, these innate preferences can be altered with exposure to (and exclusion of) different foods. The usual natural history of CMA therefore provides an opportunity to explore the effect of dietary exclusion in infancy on later eating habits. For this study, Maslin et al. (1) collected data from 28 children who had consumed a cows’ milk exclusion diet during infancy and compared them to 73 control children. The study population were from two birth cohorts, meaning prospective infant feeding data were available. Children in the exclusion group had significantly higher levels of avoidant eating behaviour and a lower preference for dairy products than the control group, several years after cows’ milk had been reintroduced. The number of foods excluded and symptoms were associated with higher levels of avoidant eating behaviour. Kate Maslin This research has identified some novel findings, which have implications for health professionals working in food allergy and childhood nutrition. While adhering to an exclusion diet is essential for symptomatic relief in the management of CMA, it is clear that it can have secondary effects on fussy eating and food preferences that can persist into adolescence. It therefore underlines the importance of ensuring exclusion diets for food allergy are not initiated unnecessarily or implemented for longer than necessary. The diagnosis of CMA needs to be robust, with regular monitoring of exclusion diets. Key findings to expedite the diagnosis of hyper-IgE syndromes in infants and young children The presence of eczema, elevated serum IgE and eosinophilia are hallmarks of atopic dermatitis and primary immunodeficiencies such as the hyper-IgE syndromes (HIES). The two most common HIES entities are caused by mutations in the genes STAT3 and DOCK8. Especially in DOCK8-HIES, the eczema resembles severe atopic dermatitis. Therefore, DOCK8-HIES patients are often referred to a dermatologist before they are then sent to a specialized centre for primary immunodeficiencies. Several scoring systems have been proposed to diagnose patients with HIES. Early in life, these scoring systems, however, easily miss patients with HIES as not all symptoms may be present yet. Here, Hagl et al. (2) propose a diagnostic workflow focused to identify young children. Based on the current literature and their assessment of the clinical and immunologic phenotype of DOCK8- and STAT3-HIES patients, they name findings, which together with the initial observation of eczema, recurrent infections or elevated IgE, recommend the referral to a specialized centre. To further elucidate the pathophysiology of HIES, the authors evaluated activation markers and cytokines after the stimulation of patients’ peripheral blood mononuclear cells. They conclude that low IFN-gamma secretion after stimulation and T-cell lymphopenia may contribute to a higher susceptibility to viral infections in DOCK8-HIES, whereas reduced memory B-cell counts and low specific antibody production partly explain the high susceptibility to Beate Hagl bacterial and fungal infection in both HIES entities. DOCK8-HIES patients showed severe inflammation with regard to allergic manifestations, elevated activation markers and increased inflammatory cytokines. In accordance with the clinical picture of an impaired inflammatory response with cold abscesses, there was no elevated inflammatory cytokine secretion and cell activation in STAT3-HIES patients despite recurrent infections. The article of Hagl et al. underlines the complexity and severity of HIES and the need for an early diagnosis to increase patients’ quality of life. Prescription patterns, adherence, and characteristics of non-adherence in children with asthma in primary care The most important goal in the treatment of asthma is to control symptoms and prevent exacerbations. Adherence to treatment is crucial for successful asthma management. Studies addressing adherence are mostly conducted in clinical trials, in cross-sectional studies, or in database studies without detailed medical information. Knowledge about asthma medication use and adherence in real life might offer opportunities to improve asthma treatment in children. The results of the longitudinal real-life study by Engelkes et al. (3) suggest that the characteristics of children with good adherence were compatible with more severe asthma, suggesting that adherence might be driven by treatment need or intensity of medical follow-up. The results were obtained from a Dutch population-based cohort study of 14,303 children with asthma, with detailed information on patient characteristics, comorbidities, medication prescriptions, and medical history over a study period of 12 years. These real-life data were collected as part of routine patient care in general practice, independent of the research question. This precluded selection bias and recall bias. Short-acting b2-agonists (SABA) and inhaled corticosteroids (ICS) were mainly prescribed. Adherence to asthma medications was suboptimal: Only 31% of the ICS users had a good adherence (medication possession rate >0.8). Children with a good adherence were younger at start of ICS, more often visited specialist and had more exacerbations during the follow-up compared to children with low adherence. These findings indicate that Marjolein Engelkes there is room for improvement of adherence to treatment, especially in children with less severe asthma. Future studies are needed to improve adherence to treatment, especially in children with less severe asthma. References 1. Maslin K, Grundy J, Glasbey G, et al. Cows’ milk exclusion diet during infancy: Is there a long-term effect on children’s eating behaviour and food preferences? Pediatr Allergy Immunol 2016: 27: 141–6. 2. Hagl B, Heinz V, Schlesinger A, et al. Key findings to expedite the diagnosis of hyper-IgE syndromes in infants and young children. Pediatr Allergy Immunol 2016: 27: 177–84. 3. Engelkes M, Janssens H M, de Jongste J C, Sturkenboom M C J M, Verhamme K M C. Prescription patterns, adherence and characteristics of non- adherence in children with asthma in primary care. Pediatr Allergy Immunol 2016: 27: 201–8. This logo highlights the Editor’s Choice articles in the table of contents and the first page of each of the articles. 113 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Pediatric Allergy and Immunology Wiley

The Editor recommends this issue's articles to the reader

Pediatric Allergy and Immunology , Volume 27 (2) – Mar 1, 2016
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References (3)

Publisher
Wiley
Copyright
Copyright © 2016 John Wiley & Sons A/S
ISSN
0905-6157
eISSN
1399-3038
DOI
10.1111/pai.12542
Publisher site
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Abstract

Pediatric Allergy and Immunology EDITOR’S CHOICE Cows’ milk exclusion diet during infancy: is there a long-term effect on children’s eating behaviour and food preferences? Cows’ milk allergy (CMA) requires a strict exclusion diet, usually for the first year of life. This exclusion of a main food group occurs at a critical time in the development of food preferences and eating habits. It is known that infants are born with an innate predisposition to prefer sweet tastes and reject bitter and sour tastes. However, these innate preferences can be altered with exposure to (and exclusion of) different foods. The usual natural history of CMA therefore provides an opportunity to explore the effect of dietary exclusion in infancy on later eating habits. For this study, Maslin et al. (1) collected data from 28 children who had consumed a cows’ milk exclusion diet during infancy and compared them to 73 control children. The study population were from two birth cohorts, meaning prospective infant feeding data were available. Children in the exclusion group had significantly higher levels of avoidant eating behaviour and a lower preference for dairy products than the control group, several years after cows’ milk had been reintroduced. The number of foods excluded and symptoms were associated with higher levels of avoidant eating behaviour. Kate Maslin This research has identified some novel findings, which have implications for health professionals working in food allergy and childhood nutrition. While adhering to an exclusion diet is essential for symptomatic relief in the management of CMA, it is clear that it can have secondary effects on fussy eating and food preferences that can persist into adolescence. It therefore underlines the importance of ensuring exclusion diets for food allergy are not initiated unnecessarily or implemented for longer than necessary. The diagnosis of CMA needs to be robust, with regular monitoring of exclusion diets. Key findings to expedite the diagnosis of hyper-IgE syndromes in infants and young children The presence of eczema, elevated serum IgE and eosinophilia are hallmarks of atopic dermatitis and primary immunodeficiencies such as the hyper-IgE syndromes (HIES). The two most common HIES entities are caused by mutations in the genes STAT3 and DOCK8. Especially in DOCK8-HIES, the eczema resembles severe atopic dermatitis. Therefore, DOCK8-HIES patients are often referred to a dermatologist before they are then sent to a specialized centre for primary immunodeficiencies. Several scoring systems have been proposed to diagnose patients with HIES. Early in life, these scoring systems, however, easily miss patients with HIES as not all symptoms may be present yet. Here, Hagl et al. (2) propose a diagnostic workflow focused to identify young children. Based on the current literature and their assessment of the clinical and immunologic phenotype of DOCK8- and STAT3-HIES patients, they name findings, which together with the initial observation of eczema, recurrent infections or elevated IgE, recommend the referral to a specialized centre. To further elucidate the pathophysiology of HIES, the authors evaluated activation markers and cytokines after the stimulation of patients’ peripheral blood mononuclear cells. They conclude that low IFN-gamma secretion after stimulation and T-cell lymphopenia may contribute to a higher susceptibility to viral infections in DOCK8-HIES, whereas reduced memory B-cell counts and low specific antibody production partly explain the high susceptibility to Beate Hagl bacterial and fungal infection in both HIES entities. DOCK8-HIES patients showed severe inflammation with regard to allergic manifestations, elevated activation markers and increased inflammatory cytokines. In accordance with the clinical picture of an impaired inflammatory response with cold abscesses, there was no elevated inflammatory cytokine secretion and cell activation in STAT3-HIES patients despite recurrent infections. The article of Hagl et al. underlines the complexity and severity of HIES and the need for an early diagnosis to increase patients’ quality of life. Prescription patterns, adherence, and characteristics of non-adherence in children with asthma in primary care The most important goal in the treatment of asthma is to control symptoms and prevent exacerbations. Adherence to treatment is crucial for successful asthma management. Studies addressing adherence are mostly conducted in clinical trials, in cross-sectional studies, or in database studies without detailed medical information. Knowledge about asthma medication use and adherence in real life might offer opportunities to improve asthma treatment in children. The results of the longitudinal real-life study by Engelkes et al. (3) suggest that the characteristics of children with good adherence were compatible with more severe asthma, suggesting that adherence might be driven by treatment need or intensity of medical follow-up. The results were obtained from a Dutch population-based cohort study of 14,303 children with asthma, with detailed information on patient characteristics, comorbidities, medication prescriptions, and medical history over a study period of 12 years. These real-life data were collected as part of routine patient care in general practice, independent of the research question. This precluded selection bias and recall bias. Short-acting b2-agonists (SABA) and inhaled corticosteroids (ICS) were mainly prescribed. Adherence to asthma medications was suboptimal: Only 31% of the ICS users had a good adherence (medication possession rate >0.8). Children with a good adherence were younger at start of ICS, more often visited specialist and had more exacerbations during the follow-up compared to children with low adherence. These findings indicate that Marjolein Engelkes there is room for improvement of adherence to treatment, especially in children with less severe asthma. Future studies are needed to improve adherence to treatment, especially in children with less severe asthma. References 1. Maslin K, Grundy J, Glasbey G, et al. Cows’ milk exclusion diet during infancy: Is there a long-term effect on children’s eating behaviour and food preferences? Pediatr Allergy Immunol 2016: 27: 141–6. 2. Hagl B, Heinz V, Schlesinger A, et al. Key findings to expedite the diagnosis of hyper-IgE syndromes in infants and young children. Pediatr Allergy Immunol 2016: 27: 177–84. 3. Engelkes M, Janssens H M, de Jongste J C, Sturkenboom M C J M, Verhamme K M C. Prescription patterns, adherence and characteristics of non- adherence in children with asthma in primary care. Pediatr Allergy Immunol 2016: 27: 201–8. This logo highlights the Editor’s Choice articles in the table of contents and the first page of each of the articles. 113

Journal

Pediatric Allergy and Immunology – Wiley

Published: Mar 1, 2016

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