May Failure to Thrive in Infants Be a Clinical Marker for the Early Diagnosis of Cow's Milk Allergy?

Objectives-Failure to thrive (FTT) in infants is characterized by growth failure. Although, cow's milk allergy (CMA) may have an impact on growth and leads to FTT, data are still limited. We focused on FTT as a possible clinical marker for an early diagnosis of CMA. The aim of the present study was to evaluate the implications of cow's milk hypersensitivity in infants with FTT and the growth catch-up after a cow's milk-free diet (CMFD). Methods-A cross-sectional study of all consecutive infants evaluated at the Pediatric Nutrition and Allergy Unit of the University Hospital of Bari (Italy) from January 2016 to April 2018 with a medical-driven diagnosis of FTT. Eligible infants were investigated for possible IgE mediated or non-IgE mediated CMA. Results-43 infants were included, mean age 5.7 months. 33/43 (77%) FTT presented a CMA related disease: 3/43 (7%) were diagnosed as presenting an IgE mediated CMA, 30 (93%) had a non IgE-mediated CMA, confirmed by the elimination diet for diagnostic purposes, that led to a significant improvement of symptoms and recrudescence after milk reintroduction. A total of 29 out of 30 patients (one patient was lost at follow-up) moved up to their original growth percentile after dietary changes. Growth z-scores were computed based on WHO anthropometric data. In 10 out of 43 patients (23%) were diagnosed with gastro-esophageal reflux disease (GERD). Conclusions-when evaluating an infant with FTT, physicians should include in their evaluation an extensive search for IgE mediated and non IgE mediated CMA. When in vivo and in vitro analysis are not conclusive, a 4- to 8-weeks trial of CMFD and a consecutive re-introduction of milk proteins may be helpful in less common diagnoses.

[Biological risk among health workers]. / Rischio biologico in operatori sanitari.

INTRODUCTION: In health care the contact with body fluids, such as saliva or blood is frequent. The aim of our study was to analyze whether the exposure to biological risks in health care, in particular exposure to HBV and HCV, could cause alterations of some liver parameters. MATERIALS AND METHODS: Our study analyzes of 254 health care workers of a big hospital in Rome. The subjects exposed to biological risks were divided into two groups, one exposed to a high biological risk and the other one exposed to a low biological risk, according to individual duties and/or the departments where they carry out their work. We checked the markers for hepatitis B and C in order to highlight a possible infection, the possible vaccine coverage and the control of the antibody titer by previous infection. We measured the values of transaminases, GGT, alkaline phosphatase, total bilirubin and fractional proteinaemia total and electrophoresis. RESULTS: In health care workers exposed to high risk the average values of transaminases, total protein, alkaline phosphatase, gamma GT, total bilirubin were not significant compared to the some values formed in workers exposed to low risk (p > 0.05). Subjects positive for hepatitis B and C were 4% in the group of workers exposed to high risk (class 1) while in the group of workers exposed to low risk (class 2) the percentage of exposed individuals was 0.01% for the hepatitis B and 2.6% for hepatitis C. DISCUSSION AND CONCLUSIONS: We found a small numbers of positive cases of hepatitis B and C in people exposed to biological agents. We did not find alterations of the average values of transaminases, total protein, alkaline phosphatase, gamma GT, total bilirubin and albumin in positive cases, so that we can say that the proper use of personal protective equipment, training and information of workers and the observance of universal precautions are effective in protecting workers.