BackgroundOral food challenge (OFC) is the gold standard for diagnosis of acute Food Protein-Induced Enterocolitis Syndrome (FPIES). No diagnostic/prognostic biomarkers are available, and OFC assessment criteria are not validated. Objective. To assess clinical-haematological changes and predictors of severity of FPIES reactions at OFC.MethodsObservational multicentre prospective study. Children aged 0-18 years diagnosed with acute FPIES were recruited at follow-up OFC in 12 tertiary centres in Spain and Italy. OFC Outcomes (as positive/negative/inconclusive and mild/moderate/severe) were assessed based on published ‘2017 FPIES Consensus’ criteria. Clinical characteristics were recorded, and full blood count was done at baseline, reaction onset and 4 hours later. Regression analysis was performed to assess predictors of severe reactions at OFC.Results81 children had positive OFC (mild in 11% (9/81), moderate in 61% (49/81), severe in 28% (23/81)). Increase in neutrophils and reduction in eosinophils, basophils and lymphocytes was observed (P-value<0.05). OFC was inconclusive in 19 cases despite objective signs or neutrophilia. Regression analysis showed a 2-day OFC protocol where only 25% of an age-appropriate portion is given on day 1 (not gender, age, culprit food, cumulative dose and previous reaction severity) was associated with reduced odds of severe reaction compared to giving multiple doses in a single day.ConclusionDistinct haematological changes may help support FPIES diagnosis. Current OFC assessment criteria may not capture the broad spectrum of acute FPIES presentations. This 2-day protocol may associate a reduced risk of severe reactions. Future work should aim to develop safer OFC and non-OFC diagnostics for FPIES.

Acute food protein-induced enterocolitis syndrome (\u0027FPIES\u0027) is a potentially severe type of non IgE-mediated food allergy affecting mainly infants usually when foods are introduced [1]. Acute FPIES triggered by multiple unrelated foods (\u0027multiple food FPIES\u0027) has been reported in up to two thirds of patients, particularly in the USA [2,3]. FPIES reactions are often traumatic experiences for parents and weaning leads to significant anxiety, as there is no test to identify safe new foods. This has led to complex weaning recommendations in children with FPIES in an attempt to support parents [4]. However, evidence suggests that multiple food FPIES is rare in other regions, such as Southern Europe [5,6], which questions the applicability of such weaning advice in this population. Studies including a detailed dietary history in children with FPIES are lacking.

Introduction: Cow milk and egg are the most frequent causes of food allergy in the first years of life. Oral immunotherapy (OIT) has been investigated as an alternative to avoidance diets. No clinical practice guidelines on the management of OIT with milk and egg are currently available. Objectives: To develop clinical guidelines for OIT based on available scientific evidence and the opinions of experts. Methods: A review was made of studies published between 1984 and June 2016, doctoral theses published in Spain, summaries of communications at scientific meetings (SEAIC, SEICAP, EAACI, and AAAAI), and the consensus of opinion established by a group of experts from the scientific societies SEICAP and SEAIC. Results: Recommendations were established regarding the indications, requirements and practical aspects of the different phases of Oft as well as special protocols for patients at high risk of adverse reactions. Conclusions: Clinical practice guidelines based on the consensus reached between Spanish experts are presented for the management of OIT with milk and egg.

Introduction: Cow milk and egg are the most frequent causes of food allergy in the first years of life. Oral immunotherapy (OIT) has been investigated as an alternative to avoidance diets. No clinical practice guidelines on the management of OIT with milk and egg are currently available.Objectives: To develop clinical guidelines for OIT based on available scientific evidence and the opinions of experts.Methods: A review was made of studies published between 1984 and June 2016, doctoral theses published in Spain, summaries of communications at scientific meetings (SEAIC, SEICAP, EAACI, and AAAAI), and the consensus of opinion established by a group of experts from the scientific societies SEICAP and SEAIC.Results: Recommendations were established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of adverse reactions.Conclusions: Clinical practice guidelines based on the consensus reached between Spanish experts are presented for the management of OIT with milk and egg.

BACKGROUND AND OBJECTIVE Cow´s milk and egg are the most frequent causes of food allergy in the first years of life. Treatments such as oral immunotherapy (OIT) have been investigated as an alternative to avoidance diets. No clinical practice guides on the management of OIT with milk and egg are currently available. Objectives: To develop a clinical guide on OIT based on the available scientific evidence and the opinions of experts. METHODS A review was made of studies published in the period between 1984 and June 2016, Doctoral Theses published in Spain, and summaries of communications at congresses (SEAIC, SEICAP, EAACI, AAAAI), with evaluation of the opinion consensus established by a group of experts pertaining to the scientific societies SEICAP and SEAIC. RESULTS Recommendations have been established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of suffering adverse reactions. CONCLUSIONS A clinical practice guide is presented for the management of OIT with milk and egg, based on the opinion consensus of Spanish experts.

Introduction: Cow's milk and egg are the most frequent causes of food allergy in the first years of life. Treatments such as oral immunotherapy (OIT) have been investigated as an alternative to avoidance diets. No clinical practice guides on the management of OIT with milk and egg are currently available. Objectives: To develop a clinical guide on OIT based on the available scientific evidence and the opinions of experts. Methods: A review was made of studies published in the period between 1984 and June 2016, Doctoral Theses published in Spain, and summaries of communications at congresses (SEAIC, SEICAP, EAACI, AAAAI), with evaluation of the opinion consensus established by a group of experts pertaining to the scientific societies SEICAP and SEAIC. Results: Recommendations have been established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of suffering adverse reactions. Conclusions: A clinical practice guide is presented for the management of OIT with milk and egg, based on the opinion consensus of Spanish experts. (C) 2017 SEICAP. Published by Elsevier Espana, S.L.U. All rights reserved.

BACKGROUND:Limited published evidence shows oral desensitization to be a potential intervention option for cow's milk protein (CMPs) allergy.OBJECTIVE:The aim of this study was to evaluate the safety and efficacy of oral desensitization in 2-year-old children with cow's milk allergy, as a treatment alternative to elimination diet.METHODS:A total of 60 children aged 24-36 months with IgE-mediated allergy to CMPs were included in this multi-center study and were randomized into two groups. Thirty children (group A: treatment group) began oral desensitization immediately, whereas the remaining 30 (group B: control group) were kept on a milk-free diet and followed-up for 1 year.RESULTS:After 1-year follow-up period, 90% of the children in group A had become completely tolerant vs. 23% of the children in group B. In group A, cow's milk skin reactivity and serum-specific IgE to milk and casein decreased significantly from the initial assessment, whereas group B showed no significant change after 1 year of follow-up. Twenty-four patients (80%) developed some reaction during the treatment period: 14 children developed moderate reaction (47%) and 10 mild reaction (33%). The most common manifestations were urticaria-angioedema, followed by cough.CONCLUSIONS AND CLINICAL RELEVANCE:In this study, oral desensitization was found to be effective in a significant percentage of 2-year-old children with cow's milk allergy. Oral desensitization appears to be efficacious as an alternative to elimination diet in the treatment of 2-year-old children with cow's milk allergy. The side-effect profile appears acceptable but requires further study.

Human metapneumovirus (hMPV) infection plays an important role in the pediatric respiratory infections. However, little is known about the relationship between hMPV‐bronchiolitis and the development of subsequent wheezing. The aim of this study was to evaluate the outcome at third to fifth year after admission for hMPV‐bronchiolitis and to compare it with children admitted for respiratory syncytial virus (RSV)‐bronchiolitis and with children without lower respiratory disease in the first 2 years of life.