Prevalencia de alergia a la proteína de la leche de vaca en niños en un hospital universitario de comunidad / Prevalence of cow's milk protein allergy among children in a university community hospital

La alergia a la proteína de la leche de vaca (APLV) es la alergia alimentaria más frecuente en pediatría. Existen pocos estudios que han evaluado la prevalencia de esta enfermedad en Argentina. Objetivos. Estimar la prevalencia de la APLV y describir su variación durante un período de 11 años. Pacientes y métodos. Se realizó un estudio de cohorte retrospectivo en recién nacidos vivos pertenecientes al programa de atención médica de un hospital universitario de comunidad. Resultados. Se identificaron 116 casos de niños con APLV. La prevalencia acumulada fue de 0,8% (intervalo de confianza -le- 95%: 0,65-0,95). Se observó un incremento porcentual de casos por año, de 0,4% en 2004 a 1,2% en 2014. Conclusión. La prevalencia de APLV fue del 1,2% en 2014, tres veces superior a la prevalencia en 2004.

Cow's milk protein allergy (CMPA) is the most common food allergy in pediatrics. In Argentina, the prevalence of this dis-ease has been evaluated in a few trials.Objectives. To estimate the prevalence of CMPA and describe its variation throughout a period of 11 years.Population and methods. A retrospective cohort study was carried out in live newborn infants enrolled in a health care program of a university community hospital.Results. One hundred and sixteen cases of children with CMPA were identified. Cumulative prevalence was 0.8% (95% confi-dence interval [CI]: 0.65-0.95). A percent increase of 0.4% in 2004 to 1.2% in 2014 was observed in the number of cases per year.Conclusion. In 2014, CMPA prevalence was 1.2%, i.e. three times that of 2004.

Dolor recurrente en fosa iliaca derecha en niños: reporte de dos casos asociados a alergia alimentaria / Recurrent right iliac fossa pain in children: two cases report related to food allergy

Objetivo: Presentar dos casos de alergia alimentaria de presentación poco común y discutir el enfoque diagnóstico de DAR en niños Casos: Caso N° 1: Niña de 11 años, aqueja dolor en fosa iliaca derecha hace 3 meses. Antecedentes: Prematuridad, atopía (dermatitis, rinitis, cólicos). Hermana y madre atópicas. Al examen físico: Dolor exquisito a la palpación de fosa iliaca derecha, cuerda cólica bilateral. Piel seca. Laboratorio: Hematobiometría sin alteraciones. Examen de orina normal, parasitológico seriado (-). EDN (neurotoxina derivada de eosinófilos) fecal >3210 ng/ml (V.N. <360 ng/ml). Colonoscopía: hiperplasia linfoidea de íleon. Caso N° 2: Niño de 9 años. Dolor en fosa iliaca derecha hace tres meses dolor abdominal localizado en fosa iliaca derecha, a predominio nocturno y con irradiación a muslo derecho. Un psiquiatra infantil le prescribe antidepresivos. Antecedentes personales: Lactancia mixta. Atopía: Asma, dermatitis atópica, cólicos de lactante. Antecedentes familiares: Madre alérgica a alimentos, padre presenta rinitis. Al examen físico: Cuerda cólica bilateral. Dolor a la palpación en fosa iliaca derecha. Laboratorio: Inmunoglobulina E 160,5 UI/ml (V.N. < 90). Colonoscopía: Hiperplasia linfoidea en íleon distal. Ambos casos mejoraron con dieta hipoalergénica. Conclusión: En presencia de hiperplasia nodular linfoide de íleon y antecedentes familiares y/o personales de atopía, debemos considerar en el diagnóstico diferencial de dolor abdominal recurrente de fosa iliaca derecha a la alergia alimentaria. La dieta de eliminación es diagnóstica y terapéutica a su vez.

Objective: To present two cases of food allergy of uncommon presentation and discuss the diagnostic approach to give in these cases: Case N° 1: 11-year-old girl, afflicting pain in the right iliac fossa 3 months ago. Background: Prematurity, atopy (dermatitis, rhinitis, cramping). Sister and mother are atopic too. The physical exam show exquisite pain on right iliac fossa at palpation. Laboratory: Urine normal, parasitological serial negative. EDN (neurotoxin derived from eosinophils) fecal >3210 ng/ml (V. N. < 360 ng/ml). Colonoscopy: lymphoid hyperplasia of ileum. Case N° 2: Child of 9 years of age. Right fossa iliac painful three months ago, predominantly nocturnal and with irradiation to right thigh. A child psychiatrist may prescribe antidepressants. Personal History: Breastfeeding and formula since newborn. Atopy: asthma, atopic dermatitis, infant colic. Family history: Mother allergic to food, father presents rhinitis. The physical examination: Pain on palpation in the right iliac fossa. Laboratory: Immunoglobulin E 160.5 IU/ml (V. N. < 90) Colonoscopy: lymphoid hyperplasia in the distal ileum. Both cases relieved by hypoallergenic diet. Conclusion: When both, ileal nodular lymphoid hyperplasia and atopy personal or familiar are present, we must be think in food allergy as differential diagnosis of recurrent abdominal pain of right iliac fosse in children. The elimination diet is diagnostic and therapeutic.

Prevalencia de alergias en niños entre 5 y 14 años con trastorno de déficitde atención e hiperactividad. Medellín, 2012 / Prevalence of allergies in children between 5 and 14 years of age with Attention Deficit and Hyperactivity Disorder. Medellin, 2012

Las enfermedades alérgicas y el trastorno por déficit de atención son entidades frecuentes enla niñez. Alguno autores han sugerido una asociación entre estas.Objetivos: Establecer la prevalencia de alergias en niños con déficit de atención y sus características clínicasy socio-demográficas en la consulta de neurología hecha por los autores.Materiales y Métodos: Estudio descriptivo, prospectivo, de corte transversal, con muestreo no aleatorio yselección de los casos de forma consecutiva. Se entrevistaron 113 niños que cumplían los criterios de inclusión,entre junio y diciembre de 2012. La información fue consignada en un formulario que contenía variables sociodemográficasy clínicas relacionadas con el déficit de atención y con los diferentes tipos de alergias.Resultados: Entre los pacientes entrevistados, la enfermedad alérgica mas frecuente fue la rinitis alérgica conel 37.2%, seguida por el asma, con 31.9%. Sin embargo, solo el asma presentó mayor prevalencia en pacientescon trastorno de déficit de atención e hiperactividad que en la población general. La dermatitis atópica se presentóen 8.8% y alergia alimentaria en 2.7%. En el análisis exploratorio, los niños con dermatitis atópica fueronlos únicos que presentaron una asociación significativa con insomnio (OR 4.23; IC 95%, 1.06-16; p=0.02).Conclusiones: La prevalencia de asma fue mayor en los pacientes estudiados con trastorno de déficit deatención e hiperactividad que la reportada en estudios poblacionales. Para los otros tipos de alergias la prevalencia fue similar...

Allergic diseases and attention deficit disorder are both common in pediatric population.Several authors had suggested an association between this two disorders.Objectives: To establish the prevalence of allergies in children with Attention Deficit and HyperactivityDisorder and their clinical and socio-demographic characteristics. Children included in the study were patientsin the neurologic practice of the authorscriteria were interviewed using a questionnaire that included clinical and socio-demographic variables relatedto Attention Deficit and Hyperactivity Disorder and allergies.Results: Among the 113 patients interviewed, the most common allergic disease was Allergic Rhinitis, whichaccounted for 37.2% of the cases, followed by asthma, which accounted for 31.9%. Asthma presents a higherprevalence in patients with Attention Deficit and Hyperactivity Disorder. Atopic Dermatitis was present in8.8% of the cases and Food Allergy in 2.7%. In an exploratory study, children with Atopic Dermatitis werethe only ones who presented a significant association with Insomnia (OR 4.23; CI 95%, 1.06-16; p=0.02).Conclusions: The prevalence of asthma was greater in those patients with Attention Deficit and HyperactivityDisorder than in those reported in population studies. For other types of allergies, this prevalence was similar....

Guia prático para o manejo da anafilaxia-2012 / Practical guide to the management of anaphylaxix-2012

Anafilaxia representa uma das mais dramáticas condições clínicas da medicina, tanto pela imprevisibilidade de aparecimento quanto pelo potencial de gravidade na sua evolução. A ocorrência de anafilaxia determina enorme impacto na qualidade de vida das pessoas afetadas, dos seus familiares, cuidadores e amigos. As principais causas de anafilaxia são medicamentos, alimentos e veneno de insetos. Estudos epidemiológicos recentes sugerem aumento da incidência de anafilaxia. Aprofundar o conhecimento de causas e mecanismos de anafilaxia tem sido preocupação constante da especialidade de Imunoalergologia. Nos ambulatórios de Alergia e Imunologia Clínica são atendidas com regularidade pessoas que sofreram reações alergicas agudas graves e que necessitam de orientação especializada. Não é raro verificar que muitas superaram vários episódios agudos sem receber o diagnóstico correto, assim como a orientação específica para procurar atendimento especializado. Cada reação anafilática representa risco, que é variavel dependendo das caracteristicas do paciente e do agente desencadeante. A falta de informação de médicos e pacientes contribui para aumentar a chance de novas ocorrências, expondo estes a riscos muitas vezes preveníveis. O Guia Prático para o Manejo da Anafilaxia-2012 tem o objetivo de difundir o conhecimento sobre anafilaxia entre médicos e profissionais da saúde, pacientes, familiares, professores, escolas e autoridades de saúde pública. Este documento não é um protocolo de atendimento a pacientes com reações anafiláticas, nem pretende formular rotinas clínicas ou interferir na autonomia e no discernimento do médico ao avaliar e orientar pacientes que estão aos seus cuidados. O documento contém de forma muito concisa o conhecimento atual sobre o tema e a experiência pessoal de especialistas no manejo dessas situações, fornecendo informação para o aprimoramento pessoal. Aborda-se o diagnóstico e tratamento emergencial da anafilaxia, assim como, a avaliação e o tratamento após a crise. Cuidados básicos e atitudes preventivas que são fundamentais na orientação de pacientes e familiares são analisadas.

Anaphylaxis is one of the most dramatic clinical conditions of Medicine, by the unpredictability of emergence and by the potential of severity in its evolution. Anaphylaxis determines an enormous impact on the quality of life of people affected, their families, caregivers and friends. The most frequent cause of anaphylaxis are drugs, foods, and stinging insect venoms. Recent epidemiological surveys have suggested increased incidence of anaphylaxis. Development of the knowledge of the causes and mechanisms of anaphylaxis has been a constant concern of the specialist of Immunoallergology. In Allergy and Clinical Immunology clinics are frequent to consult people who have suffered severe acute allergic reactions that require expert guidance. Many patients had suffered previous episodes without receiving the correct diagnosis as well as specific guidance to seek specialized care. Each allergic crisis represents a health risk, which is variable depending on the characteristics of the patient and the triggering agent. The lack of information from doctors and patients contributes to increase the chance of new episodes, exposing patients to preventable risk. The Practical Management of Anaphylaxis-2012 aims to spread knowledge of anaphylaxis among physicians, healthcare professionals, patients, families, teachers, schools, and public health authorities. This document is not a protocol of care to patients with anaphylactic reactions, nor is it intended to formulate practical clinical routines and, its objective should not interfere with the autonomy and the discernment of the physician to evaluate and treat patients who are to their care. The document contains very concisely the current knowledge about the subject and the personal experience of specialists in the management of these situations, providing information for personal improvement. Deals with the diagnosis and emergency treatment of anaphylaxis, as well as the assessment and treatment after the crisis. Basic and preventive care who are fundamental attitudes for patients and families are analyzed.