Abstract book 6th RMS 16.indd

outlining best practice for the management
of children with this diagnosis. These are
highlighted in the practical guidelines
published by the ESPGHAN GI Committee
in 2012 (see ref). There are now clear and
agreed diagnostic criteria for this condition.
The talk will cover the epidemiology of
CMPA and discuss the importance of
an accurate diagnosis. The diagnosis by
elimination and challenge will be reviewed,
with discussion of the timing and duration
of each stage.
The management of infants and young
children with different formulas, the
indications for amino acid feeds, and the
duration of therapeutic elimination will be
reviewed.
Finally the ESPGHAN diagnostic algorithm
will be compared and contrasted
with clinical practice in Cambridge.
The importance and practicalities of
re-challenge will also be discussed.
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Advances in Allergy Immunotherapy
Talal Nsouli MD (USA)
This is the 100-year anniversary of allergy
immunotherapy. New studies demonstrated
that subcutaneous immunotherapy (SCIT)
has been more effective and safer than
in the past with an extremely low rate
of systemic reaction as low as 0.1%.
Allergy immunotherapy is indicated in the
management of IgE-mediated disorders,
including allergic rhinoconjunctivitis,
allergic asthma, Hymenoptera and fire ant
hypersensitivity. The mechanism of action
consists of an increase in T regulatory
cells (Tregs, CD 25+); this will result in an
increase of IL-10 that is known to inhibit
the Th2 immune response. Furthermore,
there is an increase in TGF beta that also
decreases the Th2 response. In addition,
during allergy immunotherapy Tregs
stimulate production of IL-12 up regulating
the Th1 pathway. Th1 cells produce
interferon gamma (INF gamma) inhibiting
the Th2 allergic response. Furthermore,
there is an increase in allergen specific
IgA and IgG levels, particularly IgG4.
Recent studies showed that allergy
immunotherapy could also be effective
for the treatment of atopic dermatitis and
mosquito hypersensitivity. Immunotherapy
augments T regulatory cells, resulting in an
increase in IL-10 that is known to inhibit the
allergy presenting cells. It also inhibits the
activation and survival of the eosinophils.
In addition, it inhibits activation of the
mast cells. The T regulatory cells are known
to produce a class switch of IgE to IgG4
and IgA affecting the B cells and to inhibit
the growth and activation of the T cells,
collectively resulting in significant clinical
improvement and in some cases long-term
remission. Allergy immunotherapy may
have a long-lasting effect up to twelve
years. It also prevents the development
of allergic asthma and acquiring new
allergies, making it an outstanding
therapeutic modality for patients with
allergic disorders. It is important to provide
allergy immunotherapy in a medical
setting where an anaphylactic reaction
could be treated effectively by a welltrained
medical provider in the presence of
epinephrine, injectable antihistamines, IV
fluids, corticosteroids, and oxygen. Finally,
allergy immunotherapy is the only therapy
that produces immunomodulating effects
for allergic diseases and provides the
closest treatment to eventually cure allergic
disorders. It is shown to be cost effective
and generally safe. Future investigation and
research should focus on the development
of safer and more effective standardized
allergenic extracts utilized for the optimal
treatment of patients with atopic diseases.
410
Optimizing Care in Childhood IBD
Robert Heuschkel MD (UK)
This talk will highlight how to make
best use of both medical and surgical
treatments in the care of children with
IBD. The use of exclusive enteral nutrition
as an induction therapy in Crohn’s disease
will be reviewed briefly. The evidence for
earlier use of immunosuppression in both
Crohn’s Disease and Ulcerative Colitis will
be discussed, with a review of current UK
guidelines and how these are applied in
everyday clinical practice.
Current indications for biologic therapy are
reviewed, as well as a discussion of safety
issues and treatment strategies following
anti-TNF resistance.
I will review the pros and cons of surgery
www.jrms.gov.jo
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