RESUMO
OBJECTIVES: This guideline provides recommendations for the diagnosis and management of suspected cow's-milk protein allergy (CMPA) in Europe. It presents a practical approach with a diagnostic algorithm and is based on recently published evidence-based guidelines on CMPA. DIAGNOSIS: If CMPA is suspected by history and examination, then strict allergen avoidance is initiated. In certain circumstances (eg, a clear history of immediate symptoms, a life-threatening reaction with a positive test for CMP-specific IgE), the diagnosis can be made without a milk challenge. In all other circumstances, a controlled oral food challenge (open or blind) under medical supervision is required to confirm or exclude the diagnosis of CMPA. TREATMENT: In breast-fed infants, the mother should start a strict CMP-free diet. Non-breast-fed infants with confirmed CMPA should receive an extensively hydrolyzed protein-based formula with proven efficacy in appropriate clinical trials; amino acids-based formulae are reserved for certain situations. Soy protein formula, if tolerated, is an option beyond 6 months of age. Nutritional counseling and regular monitoring of growth are mandatory in all age groups requiring CMP exclusion. REEVALUATION: Patients should be reevaluated every 6 to 12 months to assess whether they have developed tolerance to CMP. This is achieved in >75% by 3 years of age and >90% by 6 years of age. Inappropriate or overly long dietary eliminations should be avoided. Such restrictions may impair the quality of life of both child and family, induce improper growth, and incur unnecessary health care costs.
Assuntos
Aleitamento Materno , Dieta , Fórmulas Infantis , Hipersensibilidade a Leite/dietoterapia , Hipersensibilidade a Leite/diagnóstico , Proteínas do Leite/imunologia , Fatores Etários , Algoritmos , Aminoácidos/administração & dosagem , Animais , Criança , Aconselhamento , Crescimento/efeitos dos fármacos , Transtornos do Crescimento/etiologia , Gastos em Saúde , Humanos , Lactente , Educação de Pacientes como Assunto , Hidrolisados de Proteína/administração & dosagem , Qualidade de Vida , Proteínas de Soja/administração & dosagemRESUMO
The authors describe the most relevant aspects of the occurrence, distribution and relative importance of the main diseases of the Pancreas in Portugal, comparing their incidence and mortality rates with other European countries in recent years. The main risk factors associated with pancreatic cancer are referred, stressing the appropriate preventive measures. Hospital management and cost-efficiency analysis of such patients are also estimated.