В рутинной педиатрической практике не-IgЕ-опосредованные формы гастроинтестинальной пищевой аллергии по-прежнему остаются плохо распознаваемыми. Это обусловлено многообразием клинических проявлений, отсутствием достоверных лабораторных диагностических методов, неочевидной ассоциацией со временем и причинно-следственной связью с аллергеном. Незрелость барьерных механизмов, ранний перевод ребенка на искусственное вскармливание увеличивают проникновение в организм значительного количества чужеродных белков и способствуют развитию пищевой сенсибилизации. Принято выделять следующие клинические формы гастроинтестинальной не-IgE-опосредованной пищевой аллергии у детей – синдром энтероколита, индуцированного пищевыми белками, индуцированная пищей энтеропатия и индуцированный пищей проктоколит. В случае не-IgE-опосредованных реакций со стороны желудочно-кишечного тракта диета остается универсальным диагностическим и лечебным мероприятием. Элиминация значимого аллергена позволяет обеспечить иммунологический покой и формирование пищевой толерантности. В этой связи принципиально важными становятся строгость и продолжительность соблюдения элиминационной диеты (комплаентность). В статье описываются клинические фенотипы гастроинтестинальной пищевой аллергии, приводится дифференциальный диагноз в зависимости от уровня аллергического воспаления, описываются принципы и протоколы диагностической и элиминационной диеты. In routine pediatric practice, non-IgE-mediated forms of gastrointestinal food allergy are still poorly recognized. This is due to the variety of clinical manifestations, the lack of reliable laboratory diagnostic methods, the unclear association with time, and the causal relationship with the allergen. Immature barrier mechanisms and early transition to formula feeding increase the penetration of allergen proteins, leading to sensitization. The article discusses three clinical forms of non-IgE-mediated gastrointestinal food allergy in children: food protein-induced enterocolitis syndrome, food protein enteropathy, and food protein-induced proctocolitis. In these cases, diet is a universal diagnostic and therapeutic measure. Eliminating the allergen allows for immunological reset and the induce the food tolerance. Therefore, strict adherence to elimination diets is crucial. The article also provides a differential diagnosis based on the level of allergic inflammation of the intestine and outlines principles and protocols for diagnostic and elimination diets.

Breast milk is the best nutrition for an infant. When breastfeeding is not possible, it is critical to choose an infant milk formula that functionally resembles breast milk effects. The current strategy in the industry of human milk substitutes is aimed at modulating gut microbiota via functional components of the «biotic» family (pre-, pro-, syn-, postbiotics). The most scientific interest lies in the area of numerous prebiotic oligosaccharides of human milk (HMOs). It is possible to combine several prebiotic oligosaccharides with different structures and mechanisms of action in infant formula designed to reproduce the compound effects of HMOs. In this regard, the best studied scGOS/lcFOS (9:1) receive more and more evidence of the efficiency and synergistic action with other prebiotic oligosaccharides. The special class of functional components – postbiotics – was described due to recent discoveries in milk base fermentation process. One of the most promising among them is 3’-galactosyllactose (3’-GL). 3’-GL is produced by bacteria during the fermentation process and it is structurally identical to 3’-GL, which is naturally found in colostrum, transitional and mature breast milk. The first results of in vivo and in vitro studies demonstrated the safety and good tolerance, as well as promising local and systemic effects of a formula with 3’-GL, and especially in combination with the scGOS/lcFOS prebiotics (9:1) Key words: human milk substitutes, formula, human milk oligosaccharides, microbiota, biotics, prebiotics, postbiotics, 3’-GL, 3-galactosyllactose

Objective. To compare the palatability of six extensively hydrolyzed formulas used in the Russian Federation for diet therapy in case of cow’s milk protein allergy. Materials and methods. А direct taste-testing of six specialized formulas with a subsequent questionnaire survey was performed among 336 paediatricians and paediatric allergologists. Results. A whey protein hydrolysate formula containing galacto- and fructooligosaccharides with lactose reduced contents scored higher (8.0 ± 1.8 out of 10, p < 0.01). On the whole, whey protein hydrolysates are more palatable compared to casein hydrolysates (5.7 ± 1.7 vs 3.5 ± 2.1, p < 0.01). Conclusion. Extensively hydrolyzed formulas differ significantly in their taste attributes. Whey protein hydrolysates containing prebiotic oligosaccharides and lactose have the best palatability among other extensively hydrolyzed formulas. Key words: cow’s milk protein allergy, extensively hydrolyzed formulas, hydrolysate taste, peptide size

Most cases of atopic dermatitis are caused by allergy to cow’s milk proteins in babies in their first year of life. Dietotherapy with highly hydrolyzed formulas is the basis for timely and adequate medical care to these children. The objective of the open-label multicenter prospective postregistration trial was to evaluate the efficacy of a formula based on the in-depth hydrolysis of whey proteins with the prebiotics GOS/lcFOS 0,8 g/100 ml for infants within their first year of life who received artificial nutrition and suffered from topical dermatitis presumably associated with allergy to cow’s milk proteins. The trial enrolled 51 babies aged 193,64 (SD 73,95) days with mild and moderate atopic dermatitis (SCORAD<40). Results. During a 4-week dietotherapy cycle, there was abolishment of the skin symptoms of atopic dermatitis (SCORAD 26,66 (SD 9,19) and 6,63 (SD 4,36)) at the beginning and end of the trial and a reduction in the needs for topical glucocorticosteroids, zinc-containing topical agents and antihistamines (p<0,01). The individual visual analogue scale efficiency of the dietotherapy was 8,53 (SD 1,51) and 8,72 (SD 1,20) scores as assessed by the parents and physicians, respectively. During the dietotherapy, the physiological rate of defecations was 1,88 (SD 0,94) times/day, the characteristics of stool significantly improved. The average daily formula intake was 786,13 (SD 169,21) ml. Weight-for-height in all the infants was in the normal range. Conclusion. The test formula is well tolerated and effective in more than 90% of the infants with atopic dermatitis presumably associated with allergy to cow’s milk proteins and ensures a child’s growth and development.

Objective of the survey was to assess of implementation of international and national guidelines on prevention and management of children with food allergy (FA) in clinical practice. The survey of 199 allergologists was conducted in 7 regions of Russia. In total, the analysis included 405 questionnaires on management of children with FA. When referring to allergologist 57% of children had skin symptoms of allergy to cow’s milk protein (ACMP), 33% - combined skin and gastrointestinal, 3% - isolated gastrointestinal (GI), 7% - severe allergy symptoms. Children with isolated GI symptoms later went to allergologist than children with skin symptoms (p=0,035). Burdened family medical history of allergies was found in 71% of children, but primary nutritional prevention was conducted only in 1/3 of patients who developed FA in the future. Recommendations for food correction before visiting allergologist received 57% of infants with FA, while only in 21% of cases the diet therapy was adequate. Adequate diet therapy, recommended by allergologist, led to the effectiveness of ACMP therapy and reduced medical preparations use. The survey showed the need for the active implementation of educational programs in pediatricians practical work for the widespread use of national and international protocols for children with ACMP.

Rapid growth of incidence of allergic diseases in the last 40 years allows us naming allergy the pandemic of the XXI century. Allergic diseases harm not only individual patients, but the society in whole in the form of progressive increase in direct and indirect costs. According to the latest estimates, more than 150 mn people suffer from allergies, whereas more than 250 mn patients in Europe are expected to suffer from allergies in the next decade. National and international documents stating rules of preventing and treating allergic diseases must become current guidelines for clinicians everywhere. The article summarizes the latest recommendations of the European Academy of Allergology and Clinical Immunology (2014) and of the National Food Allergy Guidelines. The article presents evidence-based methods of primary allergy prevention in infants. Modern primary food allergy prevention may consist of exclusively breast feeding for at least 4 6 months; if breast feeding is not feasible, prevention may be attained by means of using preventive hypoallergenic formulas with confirmed low allergenicity and not introducing supplemental feeding before the age of 4 months. Evidence-based studies do not confirm effectiveness of any dietary restrictions of pregnant and nursing women regardless of whether they belong to the risk group or not.

In the review of modern literature the influence of a bacterial factor, first of all — indigenous microflora — on formation of food tolerance and immune answer of a child as a whole is in detail considered. Formation of a microbiocenosis, food and autogenic tolerance happens under the general laws. In this process the primary colonization of intestines and formation of a microflora variety which, as results of the last researches show, comes to an end by 2–4 years of life of a child has special value. In the review the major factors influencing the formation of a child intestinal microbiota both antenatal and postnatal and for the first years of life, and also their interaction are considered. The influence of a bacterial factor on formation of food tolerance and sensibilization processes, and also mechanisms of this influence is in detail discussed. The data on features of a structure of intestinal microflora at children with food allergy including the results of own researches devoted to microbiocenosis at children with food allergy and to development of tactics of management of children with this pathology are provided. The main directions and possibilities of dietary influence on biocenosis structure at children with this pathology are considered.

In the review of modern literature the influence of a bacterial factor, first of all — indigenous microflora — on formation of food tolerance and immune answer of a child as a whole is in detail considered. Formation of a microbiocenosis, food and autogenic tolerance happens under the general laws. In this process the primary colonization of intestines and formation of a microflora variety which, as results of the last researches show, comes to an end by 2–4 years of life of a child has special value. In the review the major factors influencing the formation of a child intestinal microbiota both antenatal and postnatal and for the first years of life, and also their interaction are considered. The influence of a bacterial factor on formation of food tolerance and sensibilization processes, and also mechanisms of this influence is in detail discussed. The data on features of a structure of intestinal microflora at children with food allergy including the results of own researches devoted to microbiocenosis at children with food allergy and to development of tactics of management of children with this pathology are provided. The main directions and possibilities of dietary influence on biocenosis structure at children with this pathology are considered.

In recent years, the increase in food allergy morbidity is reported. The disease prognosis directly depends on the timely and correct diagnosis, as well as on the prescription of an elimination diet with the exception of a causally significant allergen. When managing patients the doctor should follow the recommendations formed on the basis of evidence-based medicine principles. The article deals with the latest recommendations of the European Academy of Allergy and Immunology, as well as with approaches articulated in the domestic guidelines «Food allergy».

This review contains modern data on immunomodulation effect of breast milk feeding upon infants, on possibilities of adequate immune response formation using hypoallergenic formulas, and also evidences of efficacy of hypoallergenic formula enrichment with galactoand fructooligosaccharide prebiotic complex, confirmed by decrease in allergic and infectious morbidity.

This review is devoted to profilaxis of food allergy in infants. Brest feeding and or partially hydrolized milk formula considered to be mandatory used in infants with high risk of allergy.

Cow's milk allergy (CM A) is the most common food allergy in young children. Babies who develop cow's milk protein (CMP ) allergy may have one or several of the following symptoms: skin rash or gastrointestinal symptoms (abdominal pain or cramps, vomiting or diarrhea). The symptoms can be controlled through a dairy-free diet. So the diagnosis and elimination of CMP is an essential element in management of children with CM A. This article provides a summary of extensive clinical research behind the Nutrilon Aminoacid, demonstrating the clinical efficacy through 25 years of experience.

В статье проанализированы данные об эффективности и безопасности селективного антагониста рецепторов цистеиниловых лейкотриенов монтелукаста (Сингуляр, MSD), который был применен в терапии детей, страдающих бронхиальной астмой. Приводятся результаты собственных исследований авторов и российского проекта "Суффикс" (SingUlair eFFIcacy and safety eXperience - SUFFIX), в котором приняли участие пациенты, наблюдающиеся у аллергологов-иммунологов и педиатров.

The authors review some unsolved and controversial problems of pathogenesis, serologic and morphologic diagnosis, and also the clinical features and therapy of the celiac disease in children. The problems of toxicity of various cereals in celiac disease, possible pathogenetic mechanisms that determine its extremely polymorphous clinical features, causes of the increasing spread and changes of clinical symptoms in the past decades, modern approaches to diagnosing this disease are discussed. The importance of early morphological investigation of the mucous membrane of the small intestine for objective diagnosis is stressed. The issues of diet therapy as the basic method of treating the celiac disease are discussed in detail, medical and socioeconomic problems of keeping gluten-free diet are pointed out.