Alergia a la leche de vaca: ¿se pueden evitar las pruebas de provocación oral? Un análisis probabilístico basado en datos clínicos / Cow's milk allergy: Can oral food challenges be avoided? A probabilistic analysis based on clinical data

Introducción. La prueba de provocación oral (PPO) para el diagnóstico de alergia a las proteínas de la leche de la vaca (APLV) presenta riesgos y requiere de recursos. Nuestro objetivo fue evaluar condiciones y pruebas complementarias para identificar una alta probabilidad de APLV. Población y métodos. Análisis secundario sobre estudio de pacientes atendidos en una unidad de alergia entre 2015 y 2018. Se determinaron las probabilidades prepruebas asociadas a los síntomas y sus combinaciones, y las probabilidades pospruebas luego de realizadas pruebas cutáneas y determinación de inmunoglobulina E (IgE) sérica. Resultados. Se evaluó la información de 239 pacientes. Se observaron probabilidades mayores al 95 % en pacientes con angioedema y combinación de urticaria y vómitos. Usando puntos de corte propuestos por Calvani et al., la combinación de vómitos con rinitis, sin angioedema, también superó el 95 %. Conclusión. Se ofrece una metodología para identificar pacientes en los que puede diagnosticarse APLV sin realización de PPO.

Introduction. The oral food challenge (OFC) for the diagnosis of cow's milk protein allergy (CMPA) poses risks and requires resources. Our objective was to assess conditions and complementary tests used to identify a high probability of CMPA. Population and methods. Secondary analysis of a study of patients seen at a unit of allergy between 2015 and 2018. Pre-testing probabilities associated with symptoms and their combinations and post-testing probabilities after skin prick testing and serum immunoglobulin E (IgE) levels were determined. Results. The data from 239 patients were assessed. A probability greater than 95% was observed for angioedema and a combination of urticaria and vomiting. Based on the cut-off points proposed by Calvani et al., the combination of vomiting with rhinitis, without angioedema, also exceeded 95%. Conclusion. A methodology is provided to identify patients in whom CMPA may be diagnosed without an OFC.

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.

Actualización en manejo de alergia a la proteína de leche de vaca: fórmulas lácteas disponibles y otros brebajes / Update on management of cow's milk protein allergy: available milk formulas and other juices

La alergia a la proteína de leche de vaca (APLV) es una enfermedad frecuente, con una prevalencia entre 2-7%, cifras que van en aumento. Se caracteriza por una reacción alérgica a una o más pro teínas de la leche de vaca. No existen manifestaciones clínicas patognomónicas, y éstas dependerán del tipo de reacción inmunológica involucrada. Una buena aproximación diagnóstica evita el sub y sobre diagnóstico y por lo tanto, sub y sobre tratamiento. El tratamiento de la APLV es la eliminación de la proteína de leche de vaca de la dieta. Una dieta de restricción en un niño que no la requiere o que ha desarrollado tolerancia, puede alterar el crecimiento, la calidad de vida y producir costos innecesarios. El objetivo de esta actualización es presentar las diferentes fórmulas y brebajes usados en Chile para tratar la APLV en aquellos casos en que no sea posible la lactancia materna con dieta de exclusión. Para ello se revisó la composición nutricional, ingredientes y otras características relevan tes de todas aquellas fórmulas o brebajes que se comercializan en Chile como tratamiento de APLV. La información se obtuvo desde los distribuidores o vendedores oficiales, o en su defecto, desde las páginas web oficiales. Se puede concluir que existen y se usan múltiples fórmulas y brebajes para el tratamiento de APLV, no todas ellas del todo adecuadas desde el punto de vista nutricional y de seguridad. Conocerlas en detalle ayudará al pediatra a indicarlas de manera más informada de acuerdo a sus beneficios y sus carencias para el manejo adecuado de esta patología.

Cow's milk protein allergy (CMPA) is a common disease with a prevalence of 2-7%, increasingly so. It is characterized by an allergic reaction to one or more cow's milk proteins. There are not pathog nomonic clinical symptoms, and these will depend on the type of immune reaction involved. A good diagnostic approach avoids under and over diagnosis and, therefore, under and over treatment. The CMPA treatment is the elimination of cow's milk protein from the diet. A restricted diet in a child does not require it or who has developed tolerance can alter growth, quality of life, including unne cessary costs. The objective of this review is to present the different milk formulas available in Chile to treat CMPA in those cases where breastfeeding with exclusion diet is not possible. For this purpose, nutritional composition, ingredients and other relevant characteristics of all the milk formulas and juices marketed in Chile as CMPA treatment were reviewed. The information was obtained from the official distributors or sellers or failing that, from the official websites. There are multiple milk formulas and beverages used for the treatment of CMPA, and not all of them are nutritionally or immunologically secure. Knowing them in detail will help the pediatrician to indicate them in a more informed way according to their benefits and their deficiencies for the proper management of this pathology.

Presença de alérgenos e aditivos alimentares em chocolate branco / Presence of allergens and food additives in white chocolate

No Brasil, chocolate branco é o produto obtido a partir da mistura de manteiga de cacau com outros ingredientes, alguns dos quais podem desencadear reações, sendo denominadas alergênicos. Entre os alergênicos alimentares mais comuns estão a proteína do leite, proteína do ovo, essências, traços de frutas oleaginosas, soja e aditivos alimentares, como corantes e conservantes. O objetivo deste trabalho foi avaliar a presença de componentes potencialmente alergênicos em diferentes marcas de chocolate branco comercializadas na cidade de Caxias do Sul. Foram adquiridas 12 marcas de chocolate branco no comércio de Caxias do Sul. Os critérios para aquisição das marcas foram: ser chocolate branco puro, em embalagens com peso de 40g a 150g, estando dentro do período de validade. Foram analisados os ingredientes de cada marca com o intuito de identificar os aditivos alimentares e os alérgenos potenciais. O estudo mostrou que, das 12 marcas de chocolate branco, 58,33% apresentaram soja, 66,66% glúten e 75% apresentaram algum traço alergênico de contaminantes da produção. Nenhuma marca apresentou ingrediente transgênico ou glutamato monossódico. Os principais elementos traços encontrados foram amendoim, nozes, amêndoas, avelã, castanhas de caju e do Brasil, macadâmia, coco, ovos, pistache, cevada, trigo, derivados de soja e de leite. Percebe-se a importância da observação e leitura atenta dos rótulo de chocolates antes do consumo, especialmente por indivíduos que apresentam sensibilidade a componentes alimentares, pois mesmo os chocolates puros apresentam substâncias capazes de desencadear complicações graves ao sistema imunológico.(AU)

Características clínicas y manejo de lactantes menores de 1 año con sospecha de alergia a proteína de leche de vaca / Clinical characteristics and management of infants less than 1-year-old suspected with allergy to cow's milk protein

Introducción: La alergia a proteína de leche de vaca (APLV) es frecuente en lactantes (2-5% en < 1 año). Tiene múltiples formas de presentación y un amplio diagnóstico diferencial, por lo que es relevante confirmar el diagnóstico. El estándar de oro del diagnóstico es el test de provocación oral (TPO), que en la práctica no siempre se realiza. En Chile hay escasa literatura respecto a esta entidad. Objetivo: Describir características demográficas, clínicas y manejo de lactantes < 1 año con sospecha de APLV. Pacientes y Método: Estudio retrospectivo en menores de 1 año atendidos por sospecha de APLV entre 2009-2011. Se registraron datos demográficos, historia perinatal, antecedentes de atopia, alimentación al momento del diagnóstico, síntomas de sospecha de APLV, estudios realizados para su confirmación, y respuesta a tratamiento. Se consideró como estándar de diagnóstico la respuesta a la dieta y la contraprueba. Se definió como respuesta a la dieta la ausencia de los síntomas atribuidos a la APLV al menos 4 semanas desde el cambio de leche. Se realizó estadística descriptiva mediante programa Epiinfo™. Resultados: Se incluyeron 106 lactantes, 51% varones, 80% recién nacidos de término, 74% con al menos un progenitor atópico, 34% con alguno de los padres o algún hermano con alergia alimentaria. La mediana de edad al inicio fue 1,5 meses (rango: 1,5-2 m). El 15% recibió fórmula desde el período neonatal y el 50% antes del tercer mes. Los síntomas más frecuentes fueron: vómitos (63%), cólicos (50%) y rectorragia (40%); el 61% presentó ≥ 2 síntomas al comienzo. Solo en el 34% se hizo TPO, en el resto se evaluó la respuesta a la dieta de exclusión y se realizaron exámenes. La realización de exámenes no cambió la conducta. Tratamiento: 43% lactancia materna con dieta de exclusión, 24% solo fórmula extensamente hidrolizada, 26% solo fórmula aminoacídica y 7% otros. Conclusión: Las características demográficas y antecedentes de los pacientes concuerdan con lo descrito en la literatura extranjera. El inicio clínico fue precoz, predominando los síntomas digestivos. Se realizaron exámenes en una proporción alta de pacientes, sin contribuir a un cambio de conducta; el TPO fue subutilizado como herramienta diagnóstica.

Introduction: Cow's milk protein allergy (CMPA) is highly prevalent in infants (2-5%). It has a wide clinical spectrum, and confirmation through an oral food challenge (OFC) is relevant for its differential diagnosis. Information on this topic is scarce in Chile. Objective: To describe the demographic and clinical features of infants with suspected CMPA. Patients and Method: A retrospective study of patients < 1 year-old, treated for suspected CMPA between 2009 and 2011. Demographic data, symptoms of atopy, nutrition at the time of diagnosis, CMPA symptoms, diagnostic studies, and response to treatment were recorded. Diet response at least 4 weeks after milk modification, and clinical behavior when suspected foods were added back to the diet were considered standard diagnostic criteria. Descriptive statistics were performed using Epiinfo ™ software. Results: The study included 106 infants, of whom, 51% male, 80% term newborns, 74% with ≥ 1 atopic parent, and 34% with ≥ 1 parent/sibling with food allergy. The median age at onset of symptoms was 1.5 months (range 1.5-2 m). Almost half (46%) were breast-feeding ≥ 6 m, with 15% receiving formula milk since the neonatal period, and 49% before the third month. Common symptoms were: vomiting (63%), colic (49%), and bleeding on passing stools (41%). No anaphylaxis was identified, and 61% had ≥ 2 symptoms at debut. Only 34% were subjected to OFC. The most frequently requested tests were, test patch (43%), prick test (40%), and blood in stools (37%). Treatment: 43% breast feeding with exclusion diet, 24% extensively hydrolysed formula, 26% amino acid formula, and 7% others. Conclusion: Demographic characteristics and risk factors were similar to those previously described in international literature. Clinical presentation was early in life, and digestive symptoms predominated. OFC was underused for diagnosis, and most of the tests requested did not change management.

Parte 1: alegría a la proteina de leche de vaca / Part 1: Cows Milk Protein Allergy

La alergia a la proteína de leche de vaca (APLV) es la alergia alimentaria más frecuente en niños menores de 3 años, con una incidencia estima- da entre 2-7.5%. Comprende reacciones media- das IgE, no mediadas por IgE y mixtas. La APLV involucra tres sistemas: respiratorio, gastrointes- tinal y piel. Su diagnóstico es clínico y se con r- ma o excluye con la eliminación del alérgeno. Si el lactante es alimentado con leche materna la madre debe continuar con su administración, evitando alimentos que contengan proteína de leche de vaca y ella deberá recibir suplementos de calcio 1000 mg al día. Si recibe fórmula arti - cial, ésta debe ser eliminada e iniciar una fórmu- la extensamente hidrolizada. Dado que cada día la APLV está incrementando a edades mayores y observamos un aumento en la severidad, deci- dimos realizar la presente revisión y dar a cono- cer los factores de riesgo involucrados, para hacer un diagnóstico precoz y evitar así el com- promiso sobre el estado nutricional, ya que por desconocer estos, la mayoría de los niños son sometidos a cambios frecuentes de fórmulas y eliminaciones dietéticas innecesarias...(AU)

Características clínicas asociadas a colitis eosinofílica en lactantes con rectorragia persistente / Clinical features of Eosinophilic Colitis in infants with persistent rectal bleeding

The most common presentation of cow's milk protein allergy (CMP) in infants is known as eosinophilic colitis (EC). The aim of this study is to evaluate EC characteristics in infants evaluated with colonoscopy due to the presence of rectorrhagia. Patients and Methods: A retrospective case-control study. Left-sided colonoscopy records of infants with persistent rectal bleeding, conducted between January 2006 and March 2011, were reviewed. The cases corresponded to infants with rectal biopsy compatible with EC and controls with negative biopsy. Telephone questionnaires to parents were conducted, evaluating personal and family history. Results: Complete records were obtained in 61 (79%) of the 77 procedures. 33 (54%) of them were males. Examination average age was 6.3 ± 5.9 months. 25 (41%) patients had EC on their histology. Between cases and controls, no significant difference in gestational age, birth weight and gender, only regarding age at the time of rectal bleeding, were observed. There was also no difference in personal history regarding obstructive bronchitis, allergic rhinitis, family history of asthma, allergic rhinitis or other food allergies. Those who received artificial feeding did not presented greater risk of EC. The most common symptoms in the cases did not differ significantly from the controls. Conclusions: The prevalence of EC in the children studied was 40.9%. Our results show that there are groups of patients with persistent rectal bleeding in which there is no personal or family history that helps diagnosing EC. An endoscopic study could be considered in these patients to establish a correct diagnosis of this condition, avoid unnecessary diets and not to delay the detection of other diseases.

En lactantes, la forma de presentación más común de la alergia a la proteína de la leche de vaca (PLV) es la colitis eosinofílica (CE). El objetivo de este trabajo es evaluar características clínicas asociadas a CE en lactantes evaluados con colonoscopía por la presencia de rectorragia. Pacientes y Método: Estudio caso-control, retrospectivo. Se revisaron registros de colonoscopía izquierda de lactantes con rectorragia persistente, realizadas entre Enero 2006 y Marzo 2011. Casos fueron lactantes con rectorragia y biopsia compatible con CE y controles aquellos con biopsia negativa. Se realizó un cuestionario vía telefónica a los padres, evaluándose antecedentes personales y familiares. Resultados: En 61 (79%) de 77 procedimientos se obtuvo registros completos. 33 (54%) eran hombres. Edad promedio del examen fue 6,3 ± 5,9 meses. 25 (41%) pacientes presentaron CE en la histología. Sin diferencia significativa en edad gestacional, peso de nacimiento ni sexo, pero si en edad de presentación de la rectorragia, entre casos y controles. Tampoco hubo diferencia en antecedentes personales de bronquitis obstructivas, rinitis alérgica, ni antecedentes familiares de asma, rinitis alérgica u otras alergias alimentarias. Quienes recibieron lactancia artificial no tuvieron mayor riesgo de CE. Los síntomas más frecuentes en los casos no se diferenciaron significativamente de los controles. Conclusión: La prevalencia de CE en los niños estudiados fue de 40,9%. Nuestros resultados muestran que hay grupos de pacientes con rectorragia persistente en los cuales no existen antecedentes de la historia familiar ni personal que permitan establecer el diagnóstico de CE. Es en estos pacientes en los cuales podría considerarse el estudio endoscópico para establecer un correcto diagnóstico de esta patología, evitar dietas innecesarias y no retrasar la detección de otras enfermedades.

Gastroesophageal reflux disease: exaggerations, evidence and clinical practice / Doença do refluxo gastroesofágico: exageros, evidências e a prática clínica

OBJECTIVE: there are many questions and little evidence regarding the diagnosis and treatment of gastroesophageal reflux disease (GERD) in children. The association between GERD and cow's milk protein allergy (CMPA), overuse of abdominal ultrasonography for the diagnosis of GERD, and excessive pharmacological treatment, especially proton-pump inhibitors (PPIs) are some aspects that need clarification. This review aimed to establish the current scientific evidence for the diagnosis and treatment of GERD in children. DATA SOURCE: a search was conducted in the MEDLINE, PubMed, LILACS, SciELO, and Cochrane Library electronic databases, using the following keywords: gastroesophageal reflux; gastroesophageal reflux disease; proton-pump inhibitors; and prokinetics; in different age groups of the pediatric age range; up to May of 2013. DATA SYNTHESIS: abdominal ultrasonography should not be recommended to investigate gastroesophageal reflux (GER). Simultaneous treatment of GERD and CMPA often results in unnecessary use of medication or elimination diet. There is insufficient evidence for the prescription of prokinetics to all patients with GER/GERD. There is little evidence to support acid suppression in the first year of life, to treat nonspecific symptoms suggestive of GERD. Conservative treatment has many benefits and with low cost and no side-effects. CONCLUSIONS: there have been few randomized controlled trials that assessed the management of GERD in children and no examination can be considered the gold standard for GERD diagnosis. For these reasons, there are exaggerations in the diagnosis and treatment of this disease, which need to be corrected. .

OBJETIVO: há muitas dúvidas e poucas evidências para o diagnóstico e tratamento da doença do refluxo gastroesofágico (DRGE) na criança. A relação entre a DRGE e a alergia às proteínas do leite de vaca (APLV), o uso exagerado da ultrassonografia abdominal para diagnóstico da DRGE e o excesso de medicamentos, especialmente dos inibidores de bomba de prótons (IBP), são alguns aspectos que necessitam esclarecimentos. Esta revisão tem como objetivo estabelecer as evidências científicas atuais para o diagnóstico e tratamento da DRGE em pediatria. FONTES DOS DADOS: foram pesquisadas nas bases de dados eletrônicos do Medline, Pubmed, Lilacs, Cochrane Library e Scielo, nas diferentes faixas etárias da pediatria, até maio de 2013, as seguintes palavras-chave: refluxo gastroesofágico, doença do refluxo gastroesofágico, inibidores da bomba de prótons e procinéticos. SíNTESE DOS DADOS: a ultrassonografia de abdome não deve ser recomendada para pesquisa de refluxo gastroesofágico (RGE). O tratamento simultâneo da DRGE e da APLV induz, muitas vezes, ao uso desnecessário de medicação ou dieta de exclusão. Não existem evidências suficientes para prescrição de procinéticos em todos os portadores de RGE/DRGE. Poucas evidências fornecem suporte para a supressão ácida, no primeiro ano de vida, para tratamento de sintomas inespecíficos, sugestivos de DRGE. O tratamento conservador traz muitos benefícios e poucos gastos, sem efeitos colaterais. CONCLUSÕES: existem poucos estudos controlados e randomizados que avaliam a DRGE na criança e nenhum exame pode considerado padrão-ouro para o seu diagnóstico. Por esses motivos, ocorrem exageros no diagnóstico e no tratamento dessa doença, e que necessitam ...

Eosinophilic colitis in infants / Colite eosinofílica em lactentes

OBJECTIVE: To review the literature for clinical data on infants with allergic or eosinophilic colitis. DATA SOURCE: MEDLINE search of all indexes was performed using the words ''colitis or procto-colitis and eosinophilic'' or ''colitis or proctocolitis and allergic'' between 1966 and February of 2013. All articles that described patients' characteristics were selected. DATA SYNTHESIS: A total of 770 articles were identified, of which 32 met the inclusion criteria. The 32 articles included a total of 314 infants. According to the available information, 61.6% of infants were male and 78.6% were younger than 6 months. Of the 314 patients, 49.0% were fed exclusively breast milk, 44.2% received cow's milk protein, and 6.8% received soy protein. Diarrheal stools were described in 28.3% of patients. Eosinophilia was found in 43.8% (115/263) of infants. Colonic or rectal biopsy showed infiltration by eosinophils (between 5 and 25 perhigh-power field) in 89.3% (236/264) of patients. Most patients showed improvement with theremoval of the protein in cow's milk from their diet or the mother's diet. Allergy challenge tests with cow's milk protein were cited by 12 of the 32 articles (66 patients). CONCLUSIONS: Eosinophilic colitis occurs predominantly in the first six months of life and in males. Allergy to cow's milk was considered the main cause of eosinophilic colitis. Exclusion of cow'smilk from the diet of the lactating mother or from the infant's diet is generally an effective therapeutic measure. .

OBJETIVO: Revisão da literatura sobre dados clínicos de lactentes com colite eosinofílica oualérgica. FONTE DOS DADOS: Pesquisa no Medline de todas as indexações com as palavras ''colitis or proc-tocolitis and eosinophilic'' ou ''colitis or proctocolitis and allergic'' entre 1966 e fevereiro de 2013. Foram selecionados todos os artigos que descreviam as características dos pacientes. SÍNTESE DOS DADOS: Foram identificados 770 artigos dos quais 32 preenchiam os critérios de inclusão. Os 32 artigos incluíram o total de 314 lactentes. Conforme as informações disponíveis, 61,6% dos lactentes eram do sexo masculino e 78,6% apresentavam idade inferior a 6 meses. Dos 314 pacientes, 49,0% encontrava-se em aleitamento natural exclusivo, 44,2% recebiam proteína do leite de vaca e 6,8% proteína da soja. Fezes diarreicas foram descritas em 28,3% dos pacientes. Eosinofilia foi encontrada em 43,8% (115/263) dos lactentes. Biópsia retal ou colônica mostrou infiltração por eosinófilos (entre 5 e 25 por campo de grande aumento) em 89,3% (236/264) dos pacientes. A maioria dos pacientes apresentou melhora com a retirada da proteína do leite de vaca da sua dieta ou das suas mães. Teste de desencadeamento com proteína do leite de vaca foi citado em 12 dos 32 artigos (66 pacientes). CONCLUSÕES: Colite eosinofílica ocorre predominantemente nos primeiros seis meses de vida e no sexo masculino. Alergia ao leite de vaca foi considerada a principal causa de colite eosinofílica. Dieta de exclusão do leite de vaca da mãe lactante ou da dieta do lactente é uma medidate rapêutica geralmente eficaz. .

[Effect of cow's milk elimination from children diet on chronic constipation]

Children constipation is one of the common causes of abdominal pain. Cow's milk in children diet is suggested to be one of the main cause of chronic constipation. This study was performed to determine the effect of cow's milk elimination from children diet with chronic constipation. This quasi-experimental study, was performed on 80 children with chronic constipation. Rome-III criteria were considered for disease diagnosis. Cow's milk was eliminated for three weeks from children's diet and the clinical symptoms in children were surveyed, subsequently. Constipation was cured in 33.8% of children as result of cow's milk free diet. The rate of treatment response in affecting children whom their disease in began under 2 years of age [52.6%] was significantly higher than others [16.6%] [P<0.05]. Children treatment was not significantly related to child's gender and amount of milk consumption. Eliminating of cow's milk from the diet improves the chronic constipation in children

Incidence of acne vulgaris in young adult users of protein-calorie supplements in the city of João Pessoa - PB / Incidencia de acne vulgar em adultos jovens usuarios de suplementos proteico-caloricos na cidade de Joao Pessoa - PB

BACKGROUND: Based on personal observations of dermatologists, nutritionists and patients, a new problem emerges in the gyms: development and exacerbation of acne in users of whey protein, which is a protein derived from cow's milk. Whey Protein extract contains growth factors that may be related to acne. Its purity and composition are not fully known and there is no scientific research on its potential to cause acne. OBJECTIVES: Assess the relationship between the use of proteincalorie supplements and onset or exacerbation of acne vulgaris in young adults in the city of João Pessoa. METHODS: Descriptive observational study conducted in gyms and in a dermatology clinic. Each participant was examined for acne on three occasions and followed for 60 days. RESULTS: 30 patients were examined. Onset or exacerbation of acneiform lesions were observed (p <0.0005). The effect was more prominent in females and in individuals without current acne and no family history of acne. CONCLUSION: This study showed the onset of acne with the progressive use of protein-calorie supplementation, in a two-month period. It is suggested that this type of supplementation be discouraged. .

FUNDAMENTOS: Na observação pessoal de dermatologistas, nutricionistas e dos próprios pacientes, um novo problema emerge nas academias de ginástica: desenvolvimento e exacerbação da acne em usuários de Whey Protein, proteínas derivadas do leite de vaca. Extratos de Whey Protein contêm fatores de crescimento que podem estar relacionados com a acne. Sua pureza e composição não são completamente conhecidas e não há investigações científicas sobre seu potencial causador de acne. OBJETIVO: Avaliar a relação entre o uso de suplementos protéico-calóricos e o aparecimento ou agravamento da acne vulgar em adultos jovens em João Pessoa - PB. MÉTODOS: Estudo observacional descritivo conduzido em academias de ginástica e em consultório de dermatologia. Cada participante foi examinado para acne em três ocasiões e acompanhado por 60 dias. RESULTADOS: Foram examinados 30 pacientes. Aparecimento ou exacerbação de lesões acneiformes foram observados (p<0,0005), sendo o efeito mais proeminente no sexo feminino e em indivíduos sem acne atual e sem história familiar de acne. CONCLUSÃO: Este estudo demonstrou o aparecimento de lesões acneiformes com o uso progressivo de suplementos proteico calóricos, ao longo de dois meses. Sugere-se que o uso deste tipo de suplemento seja desestimulado. .

Síntomas digestivos y respuesta clínica en lactantes con alergia a la proteína de leche de vaca / Gastrointestinal symptoms and clinical response of infants with cow's milk protein allergy

Introducción: La calidad de vida y estado nutricional del lactante con alergia a la proteína de leche de vaca (APLV) pueden comprometerse sin un adecuado diagnóstico y tratamiento oportuno. Objetivo: Describir síntomas digestivos, antecedentes familiares y perinatales, estado nutricional y respuesta de lactantes < 12 meses con APLV entre junio de 2007 y agosto de 2011. Pacientes y Método: Estudio retrospectivo, descriptivo en lactantes < 12 meses de edad que consultan por sospecha de APVL. Se investigaron antecedentes familiares, perinatales y características clínicas. Se excluyó a los casos sin prueba de alimentación o provocación abierta, o cuyo motivo de consulta correspondió a otra patología. Se usó el programa STATA especial edición 11,1 para el análisis estadístico. Se consideró estadístico y significativo un p < 0,05. Resultados: Se diagnosticaron 40 lactantes (57,5 por ciento varones), edad 3,0 +/- 0,4 meses, clínica de 2 +/- 0,3 meses de: vómito/regurgitación: 20, diarrea sanguinolenta: 8, falla en el crecimiento: 4, cólico/irritabilidad: 4, deposición normal con sangre en 3. Los antecedentes familiares y perinatales fueron ingesta de biberón en la 1ª semana de vida: 35, madre > 30 años: 31 casos, atopia en 2 familiares (padres/hermanos): 28, parto por cesárea: 27. Al seguimiento de 14 +/- 1,4 meses, 19 respondieron a fórmula ampliamente hidrolizada +/- seno; 19 a fórmula de aminoácidos +/- seno y un paciente lactancia exclusiva. El Z-score de P/E:-1,05 +/- 1,28; T/E: -0,96 +/- 1,60; IMC: -0,61 +/- 1,03 en primera consulta, mejoró al año: P/E: -0,15 +/- 1,24; T/E: -0,29 +/- 1,14 e IMC: -0,04 +/- 1,20 (p < 0,05), independiente de la fórmula (p = NS). Veintitres toleraron leche entera al año. Conclusiones: En este estudio los síntomas predominantes al inicio de los pacientes con APLV fueron vómitos, regurgitación y diarrea sanguinolenta. Entre los antecedentes destacan la exposición temprana a PLV, atopia familiar y parto por cesárea...

Introduction: Quality of life and nutritional status of infants with cow's milk protein allergy (CMA) can be compromised without a proper diagnosis and treatment. Objective: To describe digestive symptoms, family and perinatal history and nutritional status of < 12 month infants with CMA between June 2007 and August 2011. Patients and Method: A retrospective and descriptive study in < 12 month old infants suspecting CMA was performed. Family history, perinatal and clinical characteristics were studied. Cases without food test or open challenge test, or whose reason for consultation corresponded to other pathology were excluded. The program STATA 11.1 was used for statistical analysis and p < 0.05 was considered statistically significant. Results: 40 infants (57.5 percent boys), age 3 +/- 0.4 months and history of 2 +/- 0.3 months presenting the following: 20 of them (50 percent, vomiting/regurgitation; 8 (20 percent, bloody diarrhea; 4 (10 percent) failure to thrive; 4 (10 percent), colic/irritability and bloody normal deposition was present in 3 individuals (7.5 percent). Family and perinatal history: 35 (87.5 percent were bottle-fed during the first week of life; 31 (77.5 percent) had > 30 year old mothers; 28 (70 percent described 2 family members (parents/siblings) with atopy; 27 (67.5 percent were delivered via cesarean. At the 14 +/- 1.4-month follow-up, 19 (47.5 percent responded to extensively hydrolyzed formula +/- breastfeeding; 19 to amino acid formula +/- breastfeeding and one patient to breastfeeding exclusively. The Z -score for P/E was: -1.05 +/- 1.28; T/E: -0.96 +/- 1.60; BMI: -0.61 +/- 1.03 in the first consultation; after a year, scores improved: P/E: -0.15 +/- 1.24; T/E: -0.29 +/- 1.14 and BMI: -0.04 +/- 1.20 (p < 0.05), independent from formula (p = NS). 23 (74 percent) tolerated whole milk when reached a year old. Conclusions: In this study, the predominant early symptoms were...

Alergia a proteína de leche de vaca en el menor de un año / Allergy to dairy protein in children under one year old

Food allergies are defined as an immune reaction to a food protein. It may be mediated by IgE antibodies or not, or by mixed mechanisms. During the first year of life, allergy to dairy products is the most frequent cause of food allergy. This paper reviews mechanisms and management of allergy to dairy products.

Se define alergia alimentaria como una reacción adversa que se produce frente a la exposición de un alimento, mediada por una respuesta inmune específica y reproducible. La alergia alimentaria puede ser mediada por anticuerpos de tipo IgE, por mecanismos mixtos o no mediada por IgE. Durante el primer año de vida la alergia a la proteína de leche de vaca (APLV) es la forma más frecuente de presentación de la alergia alimentaria. Esta revisión pretende entregar una propuesta al enfrentamiento clínico de un lactante menor de un año con sospecha de APLV.

Alergia alimentaria / Food allergies

Las reacciones alérgicas incluyen un amplio espectro de reacciones clínicas. Con una incidencia del 15–30% de las enfermedades alérgicas y afecta a un 8% de los niños y específicamente a la proteína de la leche de vaca entre un 5–15% de los niños. Pueden manifestarse como intolerancia o alergia dando manifestaciones respiratorias, cutáneas o gastrointestinales que pueden ser inducidos por cantidades minimas de la ingesta deproteína y cuyo tratamiento básico es la exclusión de la proteína de leche sobre todo en los primeros años de vida.

Allergic reactions include a wide spectrum of clinical reactions. With a 15-30% incidence of llergicdiseases, affecting 8% of children and specifically to the protein in cow's milk 5-15% of children hey can manifest as intolerance or allergy giving respiratory manifestations, gastrointestinal or skin can be induced by minimal amounts of protein intake and whose basic treatment is the exclusión of milk protein specially inthe early years of life.

Teste de desencadeamento alimentar oral na confirmação diagnóstica da alergia à proteína do leite de vaca / Oral food challenge test to confirm the diagnosis of cow's milk allergy

OBJETIVO: Verificar a prevalência de alergia à proteína do leite de vaca em crianças com sintomas atribuídos à ingestão do leite de vaca. MÉTODOS: Foram estudadas 65 crianças com sintomas atribuídos à ingestão do leite de vaca. A definição diagnóstica ocorreu após teste de desencadeamento alimentar oral aberto, realizado no mínimo 15 dias após dieta de exclusão e ausência de sintomas, com período de observação de até 4 semanas após o teste. Considerou-se caso (alergia à proteína do leite de vaca positiva; n = 35) criança com reaparecimento do sintoma que motivou a realização do teste, e comparação (alergia à proteína do leite de vaca negativa; n = 30) aquela sem sintomas após o período de observação do teste. RESULTADOS: A mediana de idade foi 5 meses (P 25-75 por cento 2-9 meses) no grupo caso e 7 meses (P 25-75 por cento 4-11 meses) no grupo comparação (p = 0,05). O teste não confirmou alergia à proteína do leite de vaca em 46,8 por cento dos pacientes com sintomas atribuídos à ingestão de leite de vaca. Reação tardia ocorreu em 77,1 por cento (27/35) dos casos com teste positivo, sendo 18/27 na primeira, 3/27 na segunda e 6/27 na terceira semana de observação. Encontrou-se associação estatística significante entre manifestações cutâneas e teste positivo (p = 0,04), mas não com sintomas digestivos e respiratórios. CONCLUSÃO: Os resultados corroboram a necessidade do teste de desencadeamento alimentar oral para determinar os pacientes que realmente têm alergia à proteína do leite de vaca e se beneficiarão com dieta de exclusão de leite de vaca.

OBJECTIVE: To determine the prevalence of cow's milk protein allergy in children with symptoms attributed to cow's milk intake. METHODS: Sixty-five children with symptoms attributed to cow's milk intake were studied. Diagnosis was established after an open oral food challenge test carried out at least 15 days after an elimination diet and absence of symptoms, with a follow-up period of up to 4 weeks after the test. The children who remained asymptomatic after this period were considered negative for cow's milk protein allergy (n = 30), while those whose symptoms reappeared were considered positive (n = 35). RESULTS: The median age was 5 months (P 25-75 percent 2-9 months) in the case group and 7 months (P 25-75 percent 4-11 months) in the comparison group (p = 0.05). The test did not confirm cow's milk protein allergy in 46.8 percent of the patients with symptoms attributed to cow's milk intake. A delayed reaction occurred in 77.1 percent (27/35) of the cases testing positive, 18/27 in the first week, 3/27 in the second week, and 6/27 in the third week of follow-up. A statistically significant association was found between cutaneous manifestations and positive test result (p = 0.04). However, there was no association with digestive and respiratory symptoms. CONCLUSION: Our results confirm the need of an oral food challenge test to determine which patients really have cow's milk protein allergy and may therefore benefit from a diet free of cow's milk.

Milk-induced enterocolitis in monozygotic twin neonates.

Reports of milk protein-induced enterocolitis are increasing, but few describe the condition in twins. Twin Japanese girls developed bloody diarrhea on day 4 and were transferred to the NICU in our hospital. Surgical disorder and infection were initially suspected, but the correct diagnosis was reached after 12 days of hospitalization.

Neumatosis intestinal y alergia a la proteina de la leche de la vaca / Pneumatosis intestinalis and cow's milk proteine allergy

Pneumatosis intestinalis in newly born infants constitutes a clinical manifestation greatly associated with the presence of necrotizing enterocolitis, a highly severe medical condition. This study provides a clinical case series presenting with bloody stools and benign pneumatosis intestinalis. A short colonoscopy proven diagnosis of allergic colitis was made, which was confirmed in the 87,5 percent (7/8) of the cases, while a number of biopsies showed eosinophiles exceeding the normal ranges. Diagnosis in 12,5 percent of patients (1/8) was based on clinical records, lab-tests, imaging and treatment responses. The suppression of cow's milk protein in the maternal diet or the replacement of human milk by a substitute free from that protein led to a rapid regression of symptomatology.

La neumatosis intestinal en el recién nacido es un signo que se asocia mayoritariamente a la presencia de enterocolitis necrotizante, una condición grave. Se presenta una serie de casos clínicos que debutaron con sangre en la deposición y neumatosis intestinal de curso benigno, diagnosticándose una colitis alérgica, que fue demostrada en el 87,5 por ciento (7/8) de los casos mediante colonoscopía corta y biopsias que demostraron un número de eosinófilos mayor que lo normal; en el 12,5 por ciento (1/8) el diagnóstico se basó en clínica, laboratorio, imágenes y respuesta a tratamiento. La supresión de la proteína de la leche de vaca en la dieta de la madre o el reemplazo de la leche materna por un sustituto libre de esta proteína, llevó a una rápida regresión de la sintomatología.