Cow's milk allergy immunoglobulin E-mediated: intake of proteins and amino acids

SUMMARY OBJECTIVE: Children with cow's milk allergy may be at nutritional risk due to the lower intake of nutrients, such as protein, calcium, and vitamin A, which are present in cow's milk. The objective was to evaluate children's diets with Children with cow's milk allergy compared with healthy controls as well as to compare the intake of proteins and amino acids from the diet followed by Children with cow's milk allergy who consume special infant formula or plant-based dairy alternatives with Children with cow's milk allergy who do not consume special infant formula or plant-based dairy alternatives. METHODS: Through a cross-sectional controlled study, the dietary intake of 57 children (27 with immunoglobulin E-mediated Children with cow's milk allergy and 30 healthy controls) was evaluated. Using 24-h nutritional recalls, the total energy intake value, macronutrients, and amino acids were calculated. RESULTS: No statistically significant difference was found between the Children with cow's milk allergy group and healthy controls for the intake of proteins and amino acids. However, the Children with cow's milk allergy do not consume special infant formula or plant-based dairy alternatives group had a lower protein (g/kg) and branched-chain amino acid (mg/kg) intake than the Children with cow's milk allergy consume special infant formula or plant-based dairy alternatives group. CONCLUSIONS: The Children with cow's milk allergy group achieved the recommendations for the intake of proteins and amino acids compared to the healthy control group. However, the Children with cow's milk allergy do not consume special infant formula or plant-based dairy alternatives group had a lower intake of protein (g/kg) and branched-chain amino acid (mg/kg) than the Children with cow's milk allergy consume special infant formula or plant-based dairy alternatives group.

Alergia alimentar ao leite de vaca e ovo mediadas por IgE: sugestões de receitas termicamente testadas / IgE-mediated food allergy to cow's milk and egg: baked recipe suggestions

Objetivo: Cerca de 50% dos indivíduos com alergia ao leite de vaca e ao ovo podem tolerar esses alimentos em sua forma termicamente tratada. O consumo desses alimentos, mesmo que termicamente tratados, pode ampliar a variedade da dieta de crianças com alergia alimentar. O presente artigo tem como objetivo propor receitas culinárias com leite de vaca e ovo tratados termicamente para serem usadas em teste de provocação oral. Métodos: Alguns critérios foram adotados para elaboração das receitas: quantidade de proteína alergênica testada por porção (leite de vaca - 1,3 g; ovo - 2,0 g), tempo (30 minutos), temperatura de cocção (180 °C), os ingredientes que devem compor a receita (farinha de trigo como principal ingrediente), volume final da porção a ser oferecida, além de questões de ordem prática relacionadas ao preparo e oferta das preparações. Resultados: No total foram desenvolvidas dez receitas termicamente tratadas, sendo cinco com leite de vaca (três receitas de bolinho ­ básica, sem açúcar e sem ovo de galinha; duas receitas de tortinha salgada ­ básica e sem ovo de galinha) e cinco com ovo de galinha (três receitas de bolinho ­ básica, sem açúcar, e sem leite de vaca; duas receitas de tortinha salgada ­ básica e sem leite de vaca). Conclusão: É de extrema importância que o teste de provocação oral seja realizado de maneira rotineira e com preparações adequadas e padronizadas, e, em nosso conhecimento, esse é o primeiro estudo nacional que propõe várias receitas tratadas termicamente para auxiliar serviços especializados que atendem pacientes com alergia alimentar.

Objective: About 50% of individuals with cow's milk and egg allergies can tolerate these foods in their baked form. The consumption of these foods, even if baked, may expand the variety of the diet of children with food allergy. This article aims to propose recipes with baked milk and egg to be used in an oral food challenge. Methods: Some criteria were adopted for preparing the recipes: amount of allergenic protein tested per serving (cow's milk: 1.3 g; egg: 2.0 g), time (30 min), oven temperature (180 °C), the ingredients that should compose the recipe (wheat flour as the main ingredient), final volume of the serving to be provided, in addition to practical questions related to the preparation and provision of the recipes. Results: In total, ten baked recipes were developed, five with cow's milk (three cupcake recipes: regular, with no sugar and no egg; two savory muffin recipes: regular, with no egg) and five with egg (three cupcake recipes: regular, with no sugar and no cow's milk; two savory muffin recipes: regular, with no cow's milk). Conclusion: It is extremely important that the oral food challenge is performed routinely and with adequate and standardized recipes. To our knowledge, this is the first national study in Brazil that proposes several baked recipes to assist specialist services that treat patients with food allergy.

Uso de leite processado em altas temperaturas por paciente com alergia ao leite de vaca - relato de caso / Use of milk processed at high temperatures by a patient with cow's milk allergy: case report

Objetivo: Relatar a evolução clínica de um escolar com alergia ao leite de vaca (ALV) que fez uso de leite de vaca processado em altas temperaturas (LVPAT). Descrição: H.B.M., sexo masculino, 7 anos, com ALV IgE mediada diagnosticada com 1 ano e 3 meses. Aos 2 anos foi submetido a teste de provocação oral (TPO) aberto para leite de vaca (LV) in natura, evoluindo com urticária, congestão nasal e vômito após a primeira dose (1 mL). Mãe relatou alguns episódios de exposição acidental ao LV acompanhados de sintomas. As Imunoglobulinas E para LV e frações mantiveram-se elevadas (IgE leite total: 4,69 KU/L) até os 6 anos, quando a criança realizou TPO com LVPAT, sob a forma de bolo, evoluindo sem intercorrências. Passou a consumir diariamente uma porção do bolo contendo leite processado durante 6 meses. Aos 7 anos e com IgEs específicas mais baixas (IgE específica leite total: 2,2 KU/L), realizou TPO com LV in natura sem sintomas, sendo liberado na dieta. Comentários: O uso do leite de vaca processado em altas temperaturas em pacientes com ALV IgE mediada é uma estratégia promissora com impacto na tolerância futura ao alimento, tendo resultados favoráveis com ênfase na qualidade de vida e inclusão social. No entanto, vale ressaltar a importância da avaliação individualizada dos pacientes e a segurança da equipe na aplicação desses protocolos, além de levar em consideração que a alergia pode ser transitória, mesmo sem o uso do leite processado.

Objective: To report the clinical evolution of a school-age boy with cow's milk allergy CMA) who made use of cow's milk processed at high temperatures (CMPHT). Description: H.B.M., male, 7 years old, was diagnosed with IgE-mediated CMA at 1 year and 3 months of age. At 2 years of age, the patient underwent an open oral food challenge for raw cow's milk (CM) and developed urticaria, nasal congestion and vomiting after the first dose (1 mL). The mother reported some episodes of accidental exposure to CM, accompanied by symptoms. Specific IgEs against CM and its fractions remained elevated (total cow's milk: 4.69 KU/L) until 6 years of age, when the patient underwent a new oral food challenge for CMPHT, in the form of a cake, without symptoms. He then began to consume a portion of cake containing baked milk daily, for 6 months. At the age of 7 and with lower levels of specific IgEs (total cow's milk: 2.2 KU/L), he underwent another oral food challenge for raw CM, without symptoms. An unrestricted diet was then authorized. Comments: The use of cow's milk processed at high temperatures in patients with IgE-mediated cow's milk allergy is a promising strategy, with impact on future food tolerance, favorable results, with emphasis on quality of life and social inclusion. However, an individualized assessment of each patient is extremely important, as is the confidence of the team while applying these protocols. It should be taken into consideration that the allergy may be transient even without the use of processed milk.