Background: The aim of the current investigation was to explore predisposing factors for food protein induced allergic proctocolitis (FPIAP) in Greek infants relevant in the maternal diet, during pregnancy and breastfeeding, as relevant knowledge is limited. Methods: A multicenter retrospective case-control study was conducted in 6 regions in Greece, with 96 mothers of infants with and 141 mothers of infants without a history of FPIAP. Maternal dietary habits during pregnancy and breastfeeding were evaluated with validated questionnaires: a) The Mediterranean Diet (MedDiet) Score, and b) The Mediterranean Oriented Culture Specific Semi-Quantitative Food Frequency Questionnaire. Statistical tests, modeling and exploration of the FPIAP risk in relation to the maternal diet using elastic net regression models were performed with R software and Studio. Results: FPIAP was associated with cow’s milk (83.6%), egg (7.3 %), and wheat, beef (6.4%) in the maternal diet. Adherence to MedDiet was similar among the mothers, but mothers of FPIAP infants consumed more vegetables (p=0.018) and olive oil (p=0.003). Elastic net prediction models showed that, in this Mediterranean population, increased consumption during pregnancy and lactation of common allergens, whole grain products, homemade food, fish and shellfish, fruit offered protection; conversely, high intake of vegetables, sugar and total fat, and non-stick/grilled cooking, increased the risk of FPIAP, as did high intake of salt and white flour during lactation. Conclusions: Components of a maternal Mediterranean diet can protect against FPIAP when traditional cooking methods are adopted and fish, fruit and whole wheat products are consumed frequently.

Background: Although well described in adults, there are scarce and heterogeneous data on the diagnosis and management of chronic urticaria (CU) in children (0-18 years) throughout Europe. Our aim was to explore country differences and identify the extent to which the EAACI/GA²LEN/EDF/WAO guideline recommendations for paediatric urticaria are implemented. Methods: The EAACI Taskforce for paediatric CU disseminated an online clinical survey among EAACI paediatric section members. Members were asked to answer 35 multiple choice questions on current practices in their respective centres. Results: The survey was sent to 2,773 physicians of whom 358 (13.8%) responded, mainly paediatric allergists (80%) and paediatricians (49.7%), working in 69 countries. For diagnosis, Southern European countries used significantly more routine tests (e.g., autoimmune testing, allergological tests, and parasitic investigation) than Northern European countries. Most respondents (60.3%) used a 2nd generation antihistamine as first- line treatment of whom 64.8% up dosed as a second- line. Omalizumab, was used as a second line treatment by 1.7% and third-line by 20.7% of respondents. Most clinicians (65%) follow EAACI/WAO/GA2LEN/EDF guidelines when diagnosing CU, and only 7.3% follow no specific guidelines. Some clinicians prefer to follow national guidelines (18.4%, mainly Northern European) or the AAAAI practice parameter (1.7%). Conclusions: Even though most members of the Paediatric Section of EAACI are familiar with the EAACI/WAO/GA2LEN/EDF guidelines, a significant number do not follow them. Also, the large variation in diagnosis and treatment strengthens the need to re-evaluate, update and standardize guidelines on the diagnosis and management of CU in children.

Background: Asthma is a complex chronic inflammatory disorder, with many factors influencing its prevalence. Diet’s impact on the symptoms of the disease is still controversial, although various dietary patterns or specific nutrients have been studied. Objective: The objective of this crossover, randomised, two-period study was to examine the potential of controlling dietary histamine intake and, through this, alter asthma symptoms in children with mild intermittent asthma. Methods: Children with mild intermittent asthma were randomly assigned to either a high- (HH) or low- histamine (LH) diet, based on the Mediterranean pattern, for 4 weeks (t0). This was followed by a 2-week washout period (t1) before patients crossed to the alternative diet (t2) for an additional 4 weeks. Children were assessed at baseline and after the completion of each diet phase. They also recorded symptoms and peak flow throughout the intervention. Adherence to the dietary intervention was assessed via four random 24-hour recalls for each intervention period and comparison of selected qualitative and quantitative indices, i.e. histidine, food choices, energy, macro- and micronutrients intake. Results: Eighteen children (10 boys), with mean age 11,5±3,1years were recruited and completed the study. A trend for prolonged and more severe symptoms was observed during HH. There was good adherence to the diet during remission periods, but lower compliance during symptomatic periods, particularly for the HH group. The mean actual intake differed significantly between the two diets, not only in the histamine content but also in energy, sugar and various micronutrients, including sodium. Conclusions & Clinical Relevance: Diet may have an active and direct impact on asthma symptoms. A diet deviating from the Mediterranean standard in terms of high energy, histamine, and salt has been associated with asthma worsening. Dietary interventions in asthmatic patients should be prospectively evaluated for a longer period and with proper nutritional education.