RATIONALE: Peach tree (PT) pollen is entomophilous and therefore elicits allergy only in occupational exposure. METHODS: We report two cases of 12 y.o. girl and 15 y.o. boy living in an area of PT cultivars that in the past four-five years have developed rhinitis and, in the first case, also asthma. Symptoms appeared mainly on visits or stays in the family farms in the period of Peach tree (PT) flowering from late February to early June. RESULTS: Skin prick test (SPT) were positive to olive, grass, S kali and PT pollen in Case 1 and to S kali and PT pollen in Case 2. In both cases, SPT were negative to peach fruit and Pru p 3. SDS-PAGE immunoblotting showed one band recognized by rabbit polyclonal antisera to Ole e 6 and identified like Ole e 6-like allergen. We did SPT with Pru p 9, an already identified and registered allergen from PT pollen, plus Ole e 6-like having a positive response to both in Case 1 and only to Ole e 6 like in Case 2. Nasal challenges with PT pollen and Ole e 6 like were positive in both cases whereas with Pru p 9 and Olive tree pollen only in Case 1. CONCLUSIONS: These results show that PT pollen can induce symptoms in children living in an area of PT cultivars and children directly or indirectly exposed must be evaluated. We prove for the first time allergy to Ole e 6-like from PT pollen in children.

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RATIONALE: Current guidelines recommend early peanut introduction to all infants, with physician supervised introduction for those with skin prick test (SPT) 3-8mm. Many of these infants will have supervised introduction deferred to a subsequent visit and some never return for follow-up. It is currently unknown if and how peanut SPT results change over time in infants. METHODS: We performed a 5-year retrospective review of all infants who had peanut SPTs placed at two separate time points during the first 24 months of life. Infants at risk of peanut allergy were defined as having a history of atopic dermatitis and/or any other food allergy. Infants were excluded if they had ingested peanut prior to either SPT. The Wilcoxon signed-rank test was used to compare the differences between the distributions of wheal size at both tests, paired for each patient. RESULTS: Among the 51 infants at risk for peanut allergy, there was a significant difference between the first and second SPT with an average increase of 1.6mm (mean duration between SPTs55.8 months, p50.006). This difference increased to an average of 2mm (p50.001) when excluding 7 infants who had an initial SPT of > _8mm. Subgroup analysis showed no significant changes in SPT associated with differences in gender, ethnicity, eczema severity, or time between SPTs. CONCLUSIONS: Peanut SPT size can increase over time in infants at risk for peanut allergy who are avoiding peanut. This supports the need for timely introduction of peanut into the diet of infants with SPTs <8mm.

Cow’s milk allergy (CMA) is one of the most common food allergies in the first years of life, with worldwide prevalence estimated to range from 2% to 5%. While the majority of children with CMA will eventually develop tolerance to cow’s milk proteins (it is estimated that &gt;75% of children with CMA develop tolerance to cow’s milk proteins by the age of 3 years, and &gt;90% develop tolerance by the age of 6 years), the selection of an appropriate cow’s milk (CM) alternative for those with CMA is vital to ensure adequate growth and development during childhood. The increasing number of CM alternative products on the commercial market with markedly different nutritional content and micronutrient fortification adds a layer of complexity that can be challenging for both families and clinicians to navigate. This article aims to provide guidance and clarity to Canadian paediatricians and primary care clinicians on recommending the most appropriate, safe, and nutritionally optimal CM alternatives for individuals with CMA, and beyond.