Rosan Meyer

Rosan Meyer
Great Ormond Street Hospital for Children NHS Foundation Trust | GOSH · Department of Gastroenterology

Doctor of Philosophy

About

83
Publications
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1,292
Citations
Additional affiliations
January 2011 - present
Great Ormond Street Hospital for Children NHS Foundation Trust
Position
  • Principal Research Dietitian

Publications

Publications (83)
Article
CoMiSS® was developed 7 years ago to increase the awareness of health care professionals towards the possibility that symptoms presented by infants could be related to cow's milk. While CoMiSS was conceived mostly on theoretical concepts, data is now available from 25 clinical trials. Based on this extensive research using the tool since 2015, we a...
Article
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The Cow’s Milk-related Symptom Score (CoMiSS™) was developed as a clinical tool aimed at increasing the awareness of health care professionals for the presence and intensity of clinical manifestations possibly related to cow’s milk (CM) intake. This review summarizes current evidence on CoMiSS. We found twenty-five original studies, one pooled anal...
Article
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Objectives The MOSAIC study aimed to evaluate if the Cow’s Milk-related Symptom Score (CoMiSS) can be used as a stand-alone diagnostic tool for cow’s milk protein allergy (CMPA). Design Single-blinded, prospective, multicentre diagnostic accuracy study. Setting 10 paediatric centres in China. Participants 300 non-breastfed infants (median age 16...
Article
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Background: Ghrelin and Peptide-YY (PYY) are two gut peptides with apparent opposing actions. In normal condition, ghrelin and PYY work together in synergy to regulate energy homeostasis. During critical illness there are series of metabolic, endocrine and inflammatory changes take place in response to a severe insult. Emerging studies recorded alt...
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Background There is substantial interest in immunotherapy and biologicals in IgE-mediated food allergy. Methods We searched six databases for randomised controlled trials about immunotherapy alone or with biologicals (to April 2021) or biological monotherapy (to September 2021) in food allergy confirmed by oral food challenge. We pooled the data u...
Preprint
Microbial metabolism of specific dietary components, such as fiber, contribute to the sophisticated inter-kingdom dialogue in the gut that maintains a stable environment with important beneficial physiological, metabolic, and immunological effects on the host. Historical changes in fiber intake may be contributing to the increase of allergic and hy...
Preprint
Background There is substantial interest in allergen-specific immunotherapy in food allergy. We systematically reviewed its efficacy and safety. Methods We searched six bibliographic databases from 1946 to 30 April 2021 for randomised controlled trials about immunotherapy alone or with biologicals in IgE-mediated food allergy confirmed by oral food...
Article
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Background Guidelines for management of patients with allergic conditions are available, but the added value of nurses, allied health care professionals (AHPs) and general practitioners (GPs), in the management of allergic disease has not been fully clarified. The European Academy of Allergy and Clinical Immunology (EAACI) appointed a task force to...
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Background Food anaphylaxis is commonly elicited by unintentional ingestion of foods containing the allergen above the tolerance threshold level of the individual. While labelling the 14 main allergens used as ingredients in food products is mandatory in the EU, there is no legal definition of declaring potential contaminants. Precautionary allerge...
Preprint
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Background: Guidelines for management of patients with allergic conditions are available, but the added value of nurses, allied health care professionals (AHPs) and general practitioners (GPs), in the management of allergic disease has not been fully clarified. The European Academy of Allergy and Clinical Immunology (EAACI) appointed a task force t...
Article
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Exclusive breast feeding is recommended in all guidelines as the first choice feeding. Cow milk allergy (CMA) can be diagnosed by a diagnostic elimination diet for 2 to 4 weeks with a hypo-allergenic formula, followed by a challenge test with intact cow milk protein. The most often used hypo-allergenic formula for the diagnostic elimination diet an...
Article
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Background: Oral food challenges remain the most reliable method for allergy confirmation. Although consensus guidelines have been published to unify Immunoglobulin E (IgE)-mediated challenges, this does not exist for non-IgE mediated gastrointestinal allergies outside of Food Protein Induced Enterocolitis Syndrome. We therefore set out to establis...
Article
Worldwide food allergy prevalence is increasing, especially in children. Food allergy management strategies include appropriate avoidance measures and identifying suitable alternatives for a nutritionally sound diet. Individualized dietary intervention begins teaching label reading, which differs among countries or regions. Dietary intervention mus...
Article
Objective Food protein-induced enterocolitis syndrome (FPIES) is a non IgEmediated food allergy with potential risk of malnutrition related to the early onset of disease, frequent avoidance of cow's milk, and the possibility of multiple food triggers. This publication is aimed at providing an evidence-based, practical approach to the dietary manage...
Article
Exclusive breastfeeding ideally up to 6 months of life is the feed of choice for infants and should be promoted by healthcare professionals. However, when human milk is not sufficient or not available, infant formula, generally cow's milk-based, meeting strictly regulated nutritional and safety requirements, are recommended. Human breastmilk feedin...
Article
Background and aims: Critical illness is associated with derangement in the metabolic and inflammatory response. Previous investigators have highlighted the cross-link between feeding, inflammation and gut homeostasis. Glucagon like peptide-1 (GLP-1) is a gut derived hormone that plays an important role in the modulation of energy metabolism throug...
Article
As communities struggle to adapt to life under the threat of the global pandemic, COVID-19, those living with Food Protein-Induced Enterocolitis Syndrome (FPIES) must adapt with additional difficulties. Social distancing and shelter-in-place strategies have been implemented, resulting in fewer supermarkets trips, stockpile-purchasing behaviors in u...
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The Milk Allergy in Primary (MAP) Care guideline was first published in 2013 in this journal. MAP aimed to provide simple and accessible algorithms for UK clinicians in primary care, detailing all the steps between initial presentation, through diagnosis, management and tolerance development. Despite its UK focus, it soon became clear that MAP was...
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Objectives: Adverse physiology and antibiotic exposure devastate the intestinal microbiome in critical illness. Time and cost implications limit the immediate clinical potential of microbial sequencing to identify or treat intestinal dysbiosis. Here, we examined whether metabolic profiling is a feasible method of monitoring intestinal dysbiosis in...
Article
It is well‐established that food proteins, such as egg, soya, cow's milk, and wheat, are detectable in breast milk for many hours or days after ingestion. Exposure to these proteins is important to the process of developing tolerance but can also sometimes elicit IgE‐mediated and non‐IgE mediated allergic symptoms in breastfed infants. Non‐IgE medi...
Article
Background and aims: An important goal of nutrition support in paediatric critical illness is minimising catabolism. While focussing on providing full energy requirements, macronutrient balance is often neglected. Studies suggest that there is interplay between nutrition and inflammation. We aimed to assess the amount of enteral macronutrients del...
Article
Background Cows’ milk protein allergy (CMPA) is the most common food allergy in infants in the United Kingdom. Infants with CMPA who are not exclusively breastfed require a substitute hypoallergenic formula, which are perceived as having a poor palatability. This study compares the palatability of different extensively hydrolysed formulas (EHFs) an...
Article
The cover image, by Paul Turner et al., is based on the Editorial Implementing primary prevention of food allergy in infants: New BSACI guidance published, https://doi.org/10.1111/cea.13218.
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Conclusion: Assessment of nutritional status in critically ill children should include both undernutrition and faltering growth. This study highlights that faltering growth is independently associated with suboptimal outcome in PICU. What is Known: • Malnutrition, defined according to BMI-for-age z score, is correlated with poor outcome in the cri...
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Background There is no data on the prevalence of vitamin D deficiency in children with non-immunoglobulin-E (IgE) mediated gastrointestinal food allergy. The aims of our study were to understand the prevalence of vitamin D insufficiency and deficiency in children with non-IgE mediated gastrointestinal food allergy and identify predisposing factors....
Article
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Background The impact on health related quality of life (HRQL) has been well studied in children with Immunoglobulin E (IgE)-mediated food allergy. However limited data exists on related quality of life (QOL) of families who have a child suffering from food protein induced non-IgE mediated gastrointestinal allergies. We aimed to establish the QOL o...
Article
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Cow’s milk allergy (CMA) is one of the most common presentations of food allergy seen in early childhood. It is also one of the most complex food allergies, being implicated in IgE-mediated food allergy as well as diverse manifestations of non-IgE-mediated food allergy. For example, gastrointestinal CMA may present as food protein induced enteropat...
Article
Cow's milk protein allergy (CMPA) is the most common food allergy in childhood and its prevalence ranges between 1.9% and 4.9%. Most children present with CMPA at age less than 1 year and therefore may require a hypoallergenic formula in the absence of breast milk. Hypoallergenic formulas include both extensively hydrolyzed formula (EHF) and amino...
Article
Objectives: Significant muscle wasting develops in critically ill adults, with subsequent worse outcomes. In the pediatric setting, occurrence and effects of muscle wasting are undescribed; this is in part due to a lack of validated, objective methods for assessing muscle wasting. A single measurement of quadriceps femoris thickness has failed to...
Article
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Background Non immunoglobulin E (IgE) mediated allergies affecting the gastrointestinal tract require an elimination diet to aid diagnosis. The elimination diet may entail multiple food eliminations that contribute significantly to macro- and micro-nutrient intake which are essential for normal growth and development. Previous studies have indicate...
Article
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Many food allergy guidelines have been published worldwide over recent years. The United Kingdom National Institute of Health and Clinical Excellence guidelines and The Royal College of Paediatrics and Child Health food allergy care pathways require dietitians to assist with the diagnosis and management of food allergies, which highlighted the need...
Article
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The disparity between reported and diagnosed food allergy makes robust diagnosis imperative. The allergy-focussed history is an important starting point, but published literature on its efficacy is sparse. Using a structured approach to connect symptoms, suspected foods and dietary intake, a multi-disciplinary task force of the European Academy of...
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Objectives: Cow's milk allergy (CMA) is the most common food allergy in children with many clinical manifestations, leading to misdiagnoses such as gastro-oesophageal reflux, infantile colic and lactose intolerance with inappropriate prescribing. We aimed to determine the impact of infant feeding guidelines on CMA prescribing in UK primary care us...
Article
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Background The choice of infant formula is thought to play an important role on gastric emptying (GE) in a variety of gastrointestinal disorders. It is known that many ingredients impact on GE, including the type of protein and level of hydrolysis. In clinical practice, feeds are often recommended due to putative improved GE related to the type of...
Article
Cow’s milk protein allergy (CMPA) is the most common food allergy in infants and can affect a family’s quality of life. The purpose of this paper is to evaluate the knowledge and experience of general practitioners (GPs) in terms of CMPA diagnosis and management and to explore the views of parents on the current diagnostic process. Two surveys were...
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Gastrointestinal food allergy (GIFA) occurs in 2 to 4 % of children, the majority of whom are infants (<1 year of age). Although endoscopy is considered the gold standard for diagnosing GIFA, it is invasive and requires general anaesthesia. Therefore, we aimed to investigate whether in infants with GIFA, gastrointestinal symptoms predict histologic...
Article
The prevalence of food allergy has increased in recent decades, and there is paucity of data on time to symptom improvement using elimination diets in non-Immunoglobulin E (IgE) mediated food allergies. We therefore aimed to assess the time required to improvement of symptoms using a symptom questionnaire for children with non-IgE mediated food all...
Article
Poor growth is a common complication in infants with congenital heart disease. There has been much focus on low birth weight as having increased risk of adverse outcomes following neonatal heart surgery. In this study, we examined whether preoperative nutritional status, measured by admission weight-for-age z score, was associated with postoperativ...
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The management of food allergy in children requires elimination of the offending allergens, which significantly contribute to micronutrient intake. Vitamin and mineral supplementation are commonly suggested as part of dietary management. However a targeted supplementation regime requires a complete nutritional assessment, which includes food diarie...
Article
In Shwachman-Diamond syndrome (SDS), pancreatic insufficiency can lead to malabsorption of fat-soluble vitamins and trace elements. The aim of this study was to assess the serum concentrations of vitamins A and E, zinc, copper, and selenium and their deficiencies. This retrospective review was performed in 21 children (12 were male; median age, 7.8...
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Food allergy is a common problem in childhood. The term is used to include both immunoglobulin E (IgE)-mediated and non-IgE-mediated food allergies, which have a significant effect on the quality of life of patients and their families. In this report, we aim to discuss recent advances in the diagnosis, management, and treatment modalities of food a...
Article
The cornerstone of an optimal nutrition approach in PICUs is to evaluate the nutritional status of any patient. Anthropometric measurements and nutritional indices calculation allow for nutritional status assessment, which is not often part of routine management, as it is considered difficult to perform in this setting. We designed a study to evalu...
Article
Antioxidant intake can affect both free radical and the nutritional status of children receiving cancer treatment. The aim of this study was to investigate whether children with cancer met their antioxidant requirements. A prospective observational study was performed at a single hospital in England from June 2008 to February 2010. Children with a...
Chapter
Many symptoms are correctly or incorrectly attributed to food hypersensitivity and as a result can lead to confusion when it comes to diagnosis and management. A food hypersensitivity reaction is known as a food allergy where the immune system is involved. These reactions may involve immunoglobulin (IgE) or may involve other immune mechanisms. Some...
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A knowledgeable and competent dietitian is an integral part of the food allergy multidisciplinary team, contributing to effective diagnosis and management of food allergic disorders. Little is currently known about the food allergy training needs and preferences of dietitians. The purpose of this paper is to measure and compare self-reported food a...
Article
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Background The cornerstone for management of Food protein-induced gastrointestinal allergy (FPGIA) is dietary exclusion; however the micronutrient intake of this population has been poorly studied. We set out to determine the dietary intake of children on an elimination diet for this food allergy and hypothesised that the type of elimination diet a...
Article
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AimsThere is paucity of data on the prevalence of feeding difficulties in Food Protein Induced Gastrointestinal Allergies (FPIGA) and their clinical characteristics. However, it is a commonly reported problem by clinicians. We set out to establish the occurrence of feeding difficulties in children with FPIGA, the association with gastrointestinal a...
Article
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Food protein induced gastrointestinal allergies are difficult to characterise due to the delayed nature of this allergy and absence of simple diagnostic tests. Diagnosis is based on an allergy focused history which can be challenging and often yields ambiguous results. We therefore set out to describe a group of children with this delayed type alle...
Article
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Background: Traditionally, energy requirements have been calculated using predictive equations. These methods have failed to calculate energy expenditure accurately. Routine indirect calorimetry has been suggested, but this method is technically demanding and costly. This study aimed to develop a new predictive equation to estimate energy requirem...
Article
To cite this article: Meyer R, Venter C, Fox AT, Shah N. Practical dietary management of protein energy malnutrition in young children with cow’s milk protein allergy. Pediatric Allergy Immunology 2012: 23: 307–314. Cow’s milk protein allergy (CMPA) affects between 1.9 and 4.9% of infants and young children. This food allergy requires the complete...
Article
The Royal College of Paediatrics and Child Health (RCPCH) Science and Research Department was commissioned by the Department of Health to develop national care pathways for children with allergies; food allergy is the second pathway. The pathways focus on defining the competences required to improve the equity of care received by children with alle...
Article
Cow's milk protein (CMP) is usually one of the first complementary foods to be introduced into the infant's diet and is commonly consumed throughout childhood as part of a balanced