[Incidence of allergy to cow's milk protein in the first year of life and its effect on consumption of hydrolyzed formulae]. / Incidencia de alergia a proteínas de leche de vaca en el primer año de vida y su repercusión en el consumo de hidrolizados.

OBJECTIVES: The aims of this study were to determine the incidence of allergy to cow's milk protein in infants and the cost of treatment with hydrolyzed formulae in the Autonomous Community of Madrid. PATIENTS AND METHODS: Infants with suspected adverse reaction to cow's milk protein born between March 1, 2000 and February 28, 2001 within the catchment area covered by the pediatric services of Hospital La Paz were studied. The diagnostic algorithm of allergy to cow's milk protein of our department was used. The theoretical consumption of hydrolyzed formulae in the treatment of allergic infants was calculated and extrapolated to the Community of Madrid. RESULTS: There were 5367 live births in the above-mentioned catchment area. Adverse reaction to cow's milk protein was suspected in 185 infants. Allergy to cow's milk protein was confirmed in 101 (54 %). The incidence of allergy to cow's milk protein was 101/5356 (1.9 %). In the same period there were 57 078 live births in the Autonomous Community of Madrid. The number of infants that might be allergic in one year would be 1084. The cost of hydrolyzed formulae per infant and year would be 1,585.72 Euros. Thus, the cost of hydrolyzed formulae in the 1084 allergic infants would be 1,718,922.9 Euros; in the 923 in whom allergy was ruled out, the cost would be 1,463,621.8 Euros. CONCLUSIONS: The incidence of allergy to cow's milk protein in the first year of life is at least 1.9 %. The correct diagnosis allows us to rule out allergy to cow's milk protein in almost half of the cases, thus avoiding the use of unnecessary substitutive diets involving a high cost.

Incidencia de alergia a proteínas de leche de vaca en el primer año de vida y su repercusión en el consumo de hidrolizados / Iincidence of allergy to cow's milk protein in the first year of life and its effect on consumption of hydrolyzed formulae

Objetivos: Cálculo de la incidencia de alergia a proteínas de leche de vaca (APLV) en el lactante y coste del tratamiento con hidrolizados de leche de vaca en la comunidad de Madrid. Pacientes y métodos Lactantes con sospecha de APLV nacidos entre el 1 de marzo de 2000 y el 28 de febrero de 2001 en el Hospital La Paz pertenecientes a las áreas que atiende el Hospital Infantil. Se les aplicó el algoritmo diagnóstico de APLV del servicio. Se realizó el cálculo teórico del consumo de hidrolizados utilizados en el tratamiento de los APLV y se extrapoló a la comunidad de Madrid. Resultados Nacidos vivos en el Hospital La Paz pertenecientes a las áreas citadas: 5.356 niños. Consultaron por sospecha fundada de APLV: 185 niños. Se diagnosticaron como alérgicos a PLV a 101 (54 per cent). La incidencia calculada de APLV fue de: 101/5.356: 1,9 per cent. Nacidos en la comunidad de Madrid en el mismo período: 57.078 niños. El número de posibles APLV en un año sería de 1.084. El cálculo aproximado de consumo de hidrolizados en el primer año de vida por niño, supone un coste de 1.585,72 3. El gasto de hidrolizados en los 1.084 alérgicos en la comunidad de Madrid sería de 1.718.922,9 3. El gasto de los 923 niños en los que se descartó alergia supondría 1.463.621,8 3.Conclusiones La incidencia de APLV en el primer año de vida en nuestro medio es de, al menos, 1,9 per cent. El diagnóstico correcto permite descartar APLV en casi la mitad de los casos, evitando someter al lactante a dietas innecesarias y que suponen un elevado coste (AU)

Possible consequences of elimination diets in asymptomatic immediate hypersensitivity to fish.

The natural history of IgE antibodies to food without related symptoms is unknown. We have followed the progress of 7 children with various atopic diseases and asymptomatic immediate hypersensitivity to fish, treated with elimination diet in spite of full alimentary tolerance. During the diet period, between 24 and 113 months, all 7 patients presented immediate symptoms upon accidental exposure to or challenge tests with fish (skin symptoms in all 7 cases, digestive in 5, respiratory in 4, and anaphylaxis in 2), which differed from those related to atopic diseases previously present. The levels of fish-specific IgE (prick test, RAST) remained unchanged or were increased. These findings suggest that during elimination diet, and perhaps due to minimal and hidden contact with the allergen, the patients' degree of sensitization may increase, turning an asymptomatic into a symptomatic immediate hypersensitivity.

Egg protein sensitization in patients with bird feather allergy.

We have studied the hypersensitivity to hen's egg protein and chicken meat in 25 adults with a previous diagnosis of bronchial asthma and rhinoconjunctivitis due to bird feather sensitization. Seventeen of the 25 reported good tolerance to the ingestion of egg and chicken meat. The skin tests were negative to both antigens in 15 of them, and positive for egg in two. All 17 patients had negative RAST to chicken meat and egg protein. The remaining eight patients had intolerance to egg, and three of them also to chicken meat ingestion; in seven of the eight cases allergic to egg, the alimentary intolerance began after the clinical symptoms of bird feather sensitization. In all eight cases the skin tests were positive to egg yolk, and in five of them also to egg white and chicken meat. These patients evidenced specific serum IgE antibodies to egg yolk, four of them to egg white, and seven to chicken meat. These results demonstrate the high frequency (32%) of the association of sensitization to egg proteins, particularly egg yolk, in a selected population of patients with known allergy to bird feathers, thus suggesting that in some patients feather sensitization could trigger or somehow facilitate the later sensitization to egg yolk proteins.

[Food hypersensitivity in infants]. / Hipersensibilidad a alimentos en el lactante.

In a group of 41 infants with immediate, IgE mediated, food hypersensitivity, food anamnesis was specific in 60 per 100 and food challenge positive in 29 out of 34 times. Total serum IgE levels were raised in 80 per 100. In 26 instances symptoms appeared with the first food intake (15 cases) or there was sensitization before ingestion (11 cases); all but three were breast fed. Moreover, breast feeding in patients of the whole group had higher prevalence (p less than 0,001) than in a non-sensitized control group. These results suggest that food hypersensitivity in infants occurs very often without previous antigen intake and it is not always followed by clinical intolerance. Breast milk and/or transplacental antigen passage are probably important ways of sensitization. If so, it seems that minute quantities of antigen may be more fit for sensitization, provided the possible genetic high responsiveness for IgE synthesis in those infants.