Audience questions answered

1. "Is there any place for peptide
based feed in the management
of eosinophillic oesophagitis or is
amino acid formula best?"
Ruth Charles Paediatric Dietitian. May 11, 2012

2. Eosinophilic esophagitis (EoE): updated consensus recommendations for children and
adults. Liacouras CA, J Allergy Clin Immunol. 2011 Jul;128(1):3-20
Treatment of EoE Dietary modification:
Aimed at Exclusion/AAF leads to resolution of
•symptomatic relief symptoms –
•histological changes Long term sustainability.
•endoscopic remission Cost factor.
•Patient specific, no one absolute Few foods selective diet avoid milk, egg,
treatment. wheat, soy, nut and fish.
•MDT approach required. Symptomatic improvement is less with
dietary restriction than with AAF
Supports:
American Partnership for Eosinophilic Disorders: apfed.org
Campaign urging research for eosinaphilic disease: curedfoundation.org
Ruth Charles Paediatric Dietitian. May 11, 2012

3. "What is the evidence for use of pre
and probiotics in Allergic disease?"
Ruth Charles Paediatric Dietitian. May 11, 2012

4. Pre and probiotic use in food allergy.
Facts Hypothesis
• Probiotic approach adds one or two Manipulation of the intestinal microbiota may
species to a spectrum of hundreds of therefore offer an approach to the prevention
species in the gut flora or treatment of allergic diseases
• Prebiotic approach aims at fertilization
of the intestinal ecosystem.
• Allergic children have a different
intestinal flora from healthy children
with higher levels of Clostridia and
Issues
lower levels of Bifidobacteria
• Probiotics and prebiotics, used alone or Study designs ,
together (synbiotics), can influence the Strains & species
intestinal microbiota and modulate Regimens .
immune responses in vitro and in vivo. Dose & timing
Ruth Charles Paediatric Dietitian. May 11, 2012

5. Evidence for pre and probiotic use.
Prevention of food allergy Treatment of food allergy
Probiotics during weaning reduce the incidence of Clinical improvement, especially in allergic rhinitis
eczema. (West 2009) and IgE-sensitized atopic eczema
May be effective in eczema prevention.
Probiotics in infants for prevention of allergic disease Various effects of different probiotic strains in allergic
and food hypersensitivity. (Oborn 2007). disorders: an update from laboratory and clinical data.
(Ozdemir 2010)
Reduction in clinical eczema in infants .
insufficient evidence to recommend the addition of Probiotics are not effective for the treatment of
probiotics to infant feeds for prevention of allergic atopic dermatitis.
disease. Probiotic effects in the treatment of asthma and
allergic rhinitis are conflicting.
Prebiotics in infants for prevention of allergic disease
and food hypersensitivity. (Osborn 2007)
Cochrane
Insufficient evidence to determine the role of Cows milk allergy.
prebiotic supplementation of infant formula for
prevention of allergic disease Extensively hydrolysed casein formula supplemented
with Lactobacillus rhamnosus GG maintains
hypoallergenic status: randomised double-blind,
Lactobacillus F19 during weaning could be an effective
placebo-controlled crossover trial.
tool in the prevention of early manifestation of
(Muraro 2012)
eczema
Probiotic effects on T-cell maturation in infants Probiotics and prebiotics in allergy prevention and treatment:
during weaning. (West 2012) future prospects
Expert Rev. Clin. Immunol. 8(1), 17–19 (2012)
Ruth Charles Paediatric Dietitian. May 11, 2012

6. Food allergy in Ireland. The future…
Currently in draft:
Diagnostic algorithms for primary and
secondary care
Food specific carepathways:, cow’s milk, egg,
peanut, treenut.
Ruth Charles Paediatric Dietitian. May 11, 2012