A tandem, proline-catalyzed α-chlorination/aldol reaction is described that involves a dynamic kinetic resolution of α-chloroaldehyde intermediates. The resulting syn-chlorohydrins are produced with good to excellent diastereoselectivity in high enantiopurity and provide new opportunities for the synthesis of carbohydrates.

Objectives Cow’s milk is a commonly implicated trigger in eosinophilic esophagitis (EoE). Exclusive cow’s milk avoidance has been reported previously, but the degree of elimination required for remission is unclear. Strict food avoidance may confer a risk of developing immunoglobulin E (IgE)-mediated allergy. The goal of this study was to evaluate the effectiveness of cow’s milk elimination (CME) in children with EoE and compare responses of strict and liberalized CME diets. Methods Children (≤16 years) diagnosed with EoE who were treated with exclusive CME diets were evaluated clinically and histologically. Strict diets eliminated all milk products, including ‘may-contain’ and baked milk goods. Liberalized diets eliminated obvious sources including milk, cheese, yogurt, cream-based products but permitted foods with traces of milk and baked goods. Results Cow’s milk elimination induced histological remission of <15 eosinophils per high-powered field in 18 of 31 children (58%) and complete remission in 23%. Overall, 77% had decreased eosinophils with this single intervention. Symptoms were improved in 90% of patients, regardless of histologic response. A liberalized (n=7) CME diet was associated with a nonsignificantly lower response compared with strict (n=24) elimination (29% versus 67%, P =0.099). Eight responders to strict elimination were transitioned to a liberalized diet; 63% maintained remission. Conclusion Cow’s milk elimination induced clinicopathological remission in a majority of patients with EoE, supporting its use as a first-line intervention. Liberalized CME allows dietary freedom and may prevent subsequent development of anaphylactic milk allergy but may be inferior to strict CME for improving EoE.

RATIONALE: To describe QOL of children undergoing OFC in Canada and explore association between QOL, demographic/clinical characteristics, and parental confidence in recognizing anaphylaxis and using an autoinjector. METHODS: The FAQLQ-PF (higher score5poorer QoL; range50-6) was used to calculate QOL among children (n5166) undergoing OFC at the BC Children's Hospital Allergy clinic between Jan'14 and Oct'15. Linear regression was used to assess the relationship between QOL, demographic/clinical characteristics, and several confidence domains. RESULTS: Mean QOL score was 1.95 (95%CI: 1.71, 2.17) overall, 1.05 (0.47, 1.63) for tree nut, 1.70 (1.30, 2.11) for peanut, and 2.16 (1.74, 2.58) for egg. QOL was worse for older children (p50.001), having a health professional (HCP) parent (p50.02), experiencing more severe reactions (p50.04), and having ever administered an autoinjector (p<0.001). QOL was better for children undergoing OFC to tree nut compared with egg (p50.009). CONCLUSIONS: Health professionals are likely more aware of risks of food allergy, negatively affecting their child's QOL. Similarly, older children, those who've experienced severe reactions, and those who've used an autoinjector may be more worried about risks. Tree nut allergy resulted in better QOL than egg allergy, likely due to egg being harder to avoid. We found no association between QOL and several confidence domains, suggesting confidence with recognizing anaphylaxis and using an autoinjector is insufficient for improving QOL.

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