Desarrollo de tolerancia oral en niños con alergia a la proteína de leche de vaca: seguimiento de 10 años / Oral tolerance development in children with allergy to cow's milk protein: follow-up of 10 years

Se estima que niños alérgicos desarrollen tolerancia oral durante los primeros años de vida con una dieta de eliminación de lácteos. Determinar el tiempo de desarrollo de tolerancia oral a la proteína de leche de vaca, características clínicas y laboratorio. Estudio prospectivo, seguimiento durante 10 años, de niños con alergia a proteína de leche de vaca. Se indicó dieta de eliminación por 4 semanas con posterior reto. Se solicitó IgE total y específica. Se registro edad y tiempo de dieta al confirmarse la tolerancia. 81 niños, 33/81(40,74%) femeninos y 48/81(59,25%) masculinos, edad promedio de diagnóstico 6,22 meses(rango <1-42). Alergia no mediada IgE 32/81 (39,50%) y alergia mediada IgE 49/81 (60,49%); IgE específica para leche de vaca positivo en 55/81 (67,90%). Diagnóstico por respuesta positiva a la dieta de eliminación en 62/81 (76,54%) y con reto en 19/81 (23,45%). Desarrollaron tolerancia después de 12-18m con dieta, 21/32 (65,62%) con alergia no IgE a los 1,6 años y 23/49 (46,93%) con alergia IgE a los 2,13 años. Los niños restantes toleraron entre 19-24m, a los 2,35 y 2,80 años para la alergia no IgE e IgE respectivamente. Después de 36m, continuaron sin tolerar 5 niños entre ambos grupos con progreso a alergia alimentaria múltiple. El diagnóstico de alergia puede basarse en la respuesta positiva a la dieta de eliminación de lácteos, el reto es necesario en casos inciertos y la tolerancia se alcanza a una edad más temprana en niños con alergia no mediada IgE

It is estimated that allergic children develop oral tolerance in the early years of life with a dairy elimination diet. To determine the time development of oral tolerance to cow's milk protein, clinical and laboratory. A prospective study followed for 10 years, children allergic to cow's milk protein. He said elimination diet for 4 weeks after challenge. Was requested total IgE and specific. Age and time was recorded to confirm diet tolerance. 81 children, 33/81 (40.74%) were female and 48/81 (59.25%) male, average age at diagnosis 6.22 months (range <1-42). IgE-mediated allergy is not 32/81 (39.50%) and IgE-mediated allergy 49/81 (60.49%) specific IgE to cow's milk positive in 55/81 (67.90%). Diagnosis by positive response to the elimination diet in 62/81 (76.54%) and challenge in 19/81 (23.45%). Tolerance developed after 12-18m with diet, 21/32 (65.62%) with non-IgE allergy to 1.6 years and 23/49 (46.93%) with IgE allergy to 2.13 years. The remaining children tolerated between 19-24m, to the 2.35 and 2.80 years for non-IgE allergy and IgE, respectively. After 36m, continued without tolerating 5 children between the two groups with multiple food allergy progress. The diagnosis of allergy can be based on positive response to milk elimination diet, the challenge is necessary in uncertain cases and tolerance is reached at an earlier age in children with IgE mediated allergy is not

Food allergy: a practical update from the gastroenterological viewpoint / Food allergy: a practical update from the gastroenterological viewpoint

OBJETIVOS: Apresentar uma revisão atualizada e crítica sobre alergias alimentares, focando principalmente em tratamento e prevenção. FONTES DOS DADOS: Revisão da literatura publicada obtida através do banco de dados MEDLINE, sendo selecionados os mais atuais e representativos do tema (2000-2006). A pesquisa incluiu os sites da European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) e American Academy of Pediatrics (AAP). SíNTESE DOS DADOS: A prevalência de doenças alérgicas tem aumentado nas últimas décadas e alergia alimentar parece fazer parte desse aumento. Alergia alimentar é muito mais comum em pediatria e apresenta impacto médico, financeiro e social significativos em crianças menores e suas famílias. Tratamento e prevenção da alergia alimentar são desafios maiores do ponto de vista da saúde pública e para as comunidades médica e científica. Há muita informação incorreta e condutas médicas discutíveis nessa área. Apresentamos e discutimos as recomendações publicadas pelos Comitês de Nutrição da ESPGHAN juntamente com a Sociedade Européia Pediátrica de Alergologia e Imunologia Clínica (ESPACI) e AAP. CONCLUSÃO: Excesso de diagnósticos de alergia alimentar é bastante prevalente. Há necessidade de uniformização de definições e procedimentos diagnósticos. O objetivo primário do manejo deve ser o de instituir medidas efetivas de prevenção das alergias alimentares. Há necessidade de métodos precisos para confirmar ou excluir o diagnóstico. Os pacientes necessitam tratamento apropriado através da eliminação de alimentos que causam sintomas, ao mesmo tempo evitando os efeitos adversos nutricionais e o custo de dietas inadequadas.

OBJECTIVE: To present an up-to-date and critical review regarding food allergies, focusing mainly on treatment and prevention. SOURCES: Review of published literature searched on MEDLINE database; those data which were the most up-to-date and representative were selected (2000-2006). The search included the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the American Academy of Pediatrics (AAP). SUMMARY OF THE FINDINGS: The prevalence of allergic diseases has increased over the last decades, and food allergy seems to be part of this increase. Food allergy is much more common in pediatrics and has a significant medical, financial and social impact on young children and their families. Treatment and prevention of food allergy is a major challenge for public health, scientific and medical communities. There is a lot of misinformation and the medical management of this condition is still discussable. We present and discuss the guidelines regarding criteria for the prevention of food allergy and atopic diseases published by the Nutrition Committees of ESPGHAN jointly with the European Society for Pediatric Allergy and Clinical Immunology (ESPACI) and AAP. CONCLUSION: The overdiagnosis of food allergy is quite prevalent. There is a need for standardization of definitions and diagnostic procedures. The primary goal of therapy should be to first establish effective means of preventing food allergies. There is a need for accurate diagnostic methods to confirm or rule out the diagnosis. Patients need appropriate treatment by eliminating foods that cause symptoms, while avoiding the nutritional side effects and the cost of inappropriate diets.