Alimentación especial para lactantes y niños de corta edad / Special feeding for infants and young children

Se ha efectuado una revisión de la alimentación especial del lactante y niños de corta edad mediante fórmulas. La leche materna es siempre la referencia nutricional, el estándar de oro, de la alimentación del lactante, pero a veces es necesaria la alimentación con fórmulas. Así existen fórmulas de rutina destinadas al lactante sano o con trastornos digestivos menores como regurgitaciones, cólicos o estreñimiento y fórmulas para usos médicos especiales, diseñadas para lactantes prematuros o para utilizar en caso de lactantes que presentan reacciones adversas de los alimentos como la intolerancia a la lactosa, o alergias como la alergia a la proteína de la leche de vaca (APLV) o que padecen patologías severas como insuficiencia renal crónica o deficiencias metabólicas.(AU)

A review of the special feeding of infants and young children using formulas has been carried out. Breast milk is always the nutritional reference, the gold standard, for infant feeding, but sometimes formula feeding is necessary. Thus, there are routine formulas intended for healthy infants or those with minor digestive disorders such as regurgitation, colic or constipation, and formulas for special medical uses, designed for premature or low weight infants or to use with infants who have adverse reactions to food, as lactose intolerance, or allergies as the cow’s milk protein allergy (CMPA) or who suffer from severe pathologies such as chronic kidney failure or metabolic deficiencies.(AU)

Escenarios lácteos y microbiota intestinal en los primeros 1000 días / Milk scenarios and gut microbiota in the first 1000 days of life

La leche humana es el estándar de oro para la nutrición del bebé y debe iniciarse en la primera hora de vida. La leche de vaca, de otros mamíferos o las bebidas vegetales no se deben ofrecer antes del año de vida. Sin embargo, algunos niños requieren, al menos en parte, de fórmulas infantiles. Aun con las sucesivas mejoras a lo largo de la historia mediante la incorporación de oliogosacáridos, probióticos, prebióticos, sinbióticos y postbióticos, las fórmulas infantiles siguen siendo perfectibles para reducir la brecha de salud entre los bebés amamantados y aquellos alimentados con fórmula. En este sentido, se espera que la complejidad de las fórmulas siga aumentando a medida que se conozca mejor cómo modular el desarrollo de la microbiota intestinal. El objetivo de este trabajo fue realizar una revisión no sistemática del efecto de los diferentes escenarios lácteos sobre la microbiota intestinal.

Human milk is the gold standard for infant nutrition, and breastfeeding should be started within the first hour of life. Cow's milk, other mammalian milk, or plant-based beverages should not be offered before 1 year of age. However, some infants require, at least in part, infant formulas. Even with subsequent enhancements throughout history, with the addition of oligosaccharides, probiotics, prebiotics, synbiotics, and postbiotics, infant formulas still have room for improvement in reducing the health gap between breastfed and formula-fed infants. In this regard, the complexity of infant formulas is expected to continue to increase as the knowledge of how to modulate the development of the gut microbiota is better understood. The objective of this study was to perform a non-systematic review of the effect of different milk scenarios on the gut microbiota.

[Prevalencia alergia a proteína leche de vaca con escala COMISS, IMPE Chihuahua, marzo a mayo 2022, serie de casos].

Objective: To know the prevalence of CMPA with the scale in patients of the pediatrics external consultation in the Municipal Institute of Pension of Chihuahua in period from march to may 2022, Series of cases. Methods: A search was carried out on CMPA consultations in the period from March to May 2022, permission and informed consent was requested to access the clinical file and retrospectively, an analytical, observational, non- experimental, descriptive study was carried out., the COMISS scale was applied, and formulated a series of cases. Results: The prevalence of CMPA is 0.3%. CMPA positive patients did not have statistically significant differences with the suspects in terms of age, gestational age, birth weight, maternal age, atopy or tobacco. Presenting a series of cases. Conclusions: The prevalence of CMA with the use of COMISS was 0.3%, lower than the prevalence worldwide. The wider use of this scale is suggested to be considered in order to achieve a more accurate diagnosis.

Objetivo: Conocer la prevalencia de la APLV con la escala CoMISS en pacientes de la consulta externa de pediatria en el instituto municipal de pensiones de chi- huahua. en el periodo de marzo a mayo 2022, serie de casos. Métodos: Se realizó una búsqueda sobre las consultas de APLV en el periodo de marzo a mayo 2022, se solicitó el permiso y consentimiento informado para acceder al expediente clínico y de manera retrospectiva, se realizó estudio analítico, observacional, no experimental, descriptivo, se aplicó la escala COMISS, y formulando serie de casos. Resultados: La prevalencia de APLV es de 0.3%, Los pacientes positivos APLV no tuvieron diferencias estadisticamente significativas con los sospechosos en cuanto a edad, edad gestacional, peso al nacer, edad de la madre, atopia o tabaco. Presentando una serie de casos. Conclusiones: la prevalencia de APLV con el uso de COMISS fue del 0.3%, menor a la prevalencia a nivel mundial. Se sugiere el uso más amplio de esta escala para considerar esta patología y lograr un diagnóstico más certero.

Cultural adaptation and validation of the Spanish version of the Cow's Milk-related Symptom Score (CoMiSS) for cow's milk protein allergy.

INTRODUCTION AND AIMS: The prevalence of cow's milk protein allergy in the first year of life varies from 1.8 to 7.5%. The Cow's Milk-related Symptom Score (CoMiSS) was published in 2014 and facilitates the diagnosis of cow's milk protein allergy. It is not meant to replace the clinical diagnosis, but rather to guide the treating team in the diagnostic process and reduce unnecessary diets. The aim was to translate the CoMiSS from English to Spanish and culturally adapt and validate the resulting Spanish version. MATERIALS AND METHODS: An adaptation and validation study on the CoMiSS questionnaire was carried out in two phases: First, the CoMiSS was translated from English to Spanish, after which interrater reliability of the translated score was assessed. Second, interrater reliability tests were carried out on 32 pediatric patients under 7 years of age that were treated for the first time at the Food Allergy Clinic of the Hospital Italiano de Buenos Aires, were suspected of having cow's milk protein allergy, and had not received any treatment, within the time frame of May 2018 and May 2019. RESULTS: Thirty-two patients were evaluated, 14 of whom were females (45%), and the median patient age was 3 months (IQR 2-4). The median result of the first measurement of the scale was 7.0 (IQR 4.5-9.0) and the median of the second measurement was 5.0 (IQR 4.0-8.0). The final intraclass correlation coefficient was 0.80 (95% CI 0.63-0.9). CONCLUSION: The Spanish translation of the CoMiSS was comparable to the original English version, with excellent interrater reliability. This simple and little-known tool has the benefit of being a noninvasive, rapid, reliable, and easy-to-use strategy.

Desensibilización con Ketocal® en lactante con dieta cetogénica y alergia a proteínas de leche de vaca / Oral desensitization with Ketocal® in an infant with ketogenic diet and cow's milk protein allergy

Introducción: la dieta cetogénica es un tratamiento con eficacia demostrada en la epilepsia infantil refractaria a fármacos. La alergia a la proteína de leche de vaca puede ser una limitación para tratar a lactantes con dieta cetogénica, ya que necesitan un producto que contiene proteínas de leche de vaca (Ketocal®). Caso clínico: presentamos el caso de un lactante con una encefalopatía epiléptica refractaria a fármacos y alergia a las proteínas de leche de vaca IgE mediada al que se quiere instaurar una dieta cetogénica clásica. Se consigue la desensibilización con Ketocal 3:1®, pudiendo utilizarlo en la dieta y logrando una mejoría clínica con el control de las crisis. Discusión: un paciente con epilepsia y alergia a las proteínas de leche de vaca puede beneficiarse de la dieta cetogénica, ya que es posible realizar una inmunoterapia oral con Ketocal® y conseguir, además, una probable resolución de su alergia. (AU)

Introduction: ketogenic diet is a treatment with proven efficacy in drug-refractory childhood epilepsy. Cow's milk protein allergy may be a limitation for treating infants with ketogenic diet, as they need a product that contains cow's milk protein (Ketocal®). Case report: we report the case of an infant with a drug-refractory epileptic encephalopathy and IgE-mediated cow's milk protein allergy, who started a classic ketogenic diet. Oral desensitization was achieved with Ketocal 3:1®, allowing its use in the diet and achieving a clinical improvement with seizure control. Discussion: a patient with epilepsy and cow's milk protein allergy can benefit from the ketogenic diet, since it is possible to perform an oral immunotherapy with Ketocal®, also achieving a probable resolution of his/her allergy. (AU)

[Oral desensitization with Ketocal® in an infant with ketogenic diet and cow's milk protein allergy]. / Desensibilización con Ketocal® en lactante con dieta cetogénica y alergia a proteínas de leche de vaca.

Introduction: Introduction: ketogenic diet is a treatment with proven efficacy in drug-refractory childhood epilepsy. Cow's milk protein allergy may be a limitation for treating infants with ketogenic diet, as they need a product that contains cow's milk protein (Ketocal®). Case report: we report the case of an infant with a drug-refractory epileptic encephalopathy and IgE-mediated cow's milk protein allergy, who started a classic ketogenic diet. Oral desensitization was achieved with Ketocal 3:1®, allowing its use in the diet and achieving a clinical improvement with seizure control. Discussion: a patient with epilepsy and cow's milk protein allergy can benefit from the ketogenic diet, since it is possible to perform an oral immunotherapy with Ketocal®, also achieving a probable resolution of his/her allergy.

Introducción: Introducción: la dieta cetogénica es un tratamiento con eficacia demostrada en la epilepsia infantil refractaria a fármacos. La alergia a la proteína de leche de vaca puede ser una limitación para tratar a lactantes con dieta cetogénica, ya que necesitan un producto que contiene proteínas de leche de vaca (Ketocal®). Caso clínico: presentamos el caso de un lactante con una encefalopatía epiléptica refractaria a fármacos y alergia a las proteínas de leche de vaca IgE mediada al que se quiere instaurar una dieta cetogénica clásica. Se consigue la desensibilización con Ketocal 3:1®, pudiendo utilizarlo en la dieta y logrando una mejoría clínica con el control de las crisis. Discusión: un paciente con epilepsia y alergia a las proteínas de leche de vaca puede beneficiarse de la dieta cetogénica, ya que es posible realizar una inmunoterapia oral con Ketocal® y conseguir, además, una probable resolución de su alergia.

Consensus document on the primary prevention of cow's milk protein allergy in infants aged less than 7 days.

INTRODUCTION: Cow's milk protein allergy (CMPA) is the most frequent food allergy in the first year of life. There is no clear consensus regarding its prevention. A recommendation to avoid CMP in the first week of life as a preventive measure in all infants, regardless of their atopic risk, has recently been published. The purpose of this document is to issue a recommendation on the use of extensively hydrolyzed CMP formulas in the first week of life for the primary prevention of CMPA. METHODS: A group of experts was formed with members proposed by the Spanish Association of Pediatrics (AEP), the Spanish Society of Clinical Immunology and Allergology and Pediatric Asthma (SEICAAP), the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP) and the Spanish Society of Neonatology (SENEO). The group conducted a critical review of the evidence on the subject published in the last 10 years. RESULTS: The search yielded 72 studies, of which 66 were rejected for not meeting the inclusion criteria. The final review included 6 documents: 3 clinical trials and 3 systematic reviews, 2 of them with meta-analysis. There was no evidence of a statistically significant reduction in the incidence of CMPA in the infants who received hypoallergenic formulae or exclusive breastfeeding. CONCLUSION: Based on the current evidence, it is not possible to draw clear conclusions about the effect of avoiding CMP in the first week of life for prevention of CMPA. Although there are data that suggest a certain beneficial effect of avoiding CMPA in atopic risk infants, these results are not conclusive enough to extend the recommendation to the general population.

Documento de consenso en la prevención primaria de alergia a proteínas de leche de vaca en lactantes menores de 7 días de vida / Consensus document on the primary prevention of cow's milk protein allergy in infants aged less than 7days

Introducción: La alergia a las proteínas de la leche de vaca (APLV) es la alergia alimentaria más frecuente en el primer año de vida. No existe un consenso claro respecto a su prevención. Recientemente se ha publicado la recomendación de evitar estas proteínas en la primera semana de vida como medida de prevención en todos los niños, con independencia de su riesgo atópico. El objetivo de este documento es emitir una recomendación sobre el uso de fórmulas extensamente hidrolizadas de PLV en la primera semana de vida para la prevención primaria de la APLV. Métodos: Se constituyó un grupo de expertos propuestos por la Asociación Española de Pediatría (AEP), la Sociedad Española de Inmunología Clínica y Alergología y Asma Pediátrica (SEICAAP), la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica (SEGHNP) y la Sociedad Española de Neonatología (SENEO). Se realizó una revisión crítica de la evidencia publicada en los últimos 10 años sobre el tema. Resultados: Se seleccionaron 72 estudios, de los cuales 66 fueron rechazados por no cumplir los criterios de inclusión. Se incluyeron en la revisión 6 documentos: 3 ensayos clínicos y 3 revisiones sistemáticas, 2de ellas con metaanálisis. No se observó una reducción estadísticamente significativa en la incidencia de APLV en los grupos de lactantes que recibieron fórmulas hipoalergénicas ni lactancia materna exclusiva. Conclusión: Con base en las evidencias existentes en la actualidad, no se pueden establecer conclusiones claras acerca del efecto de evitar las PLV durante la primera semana de vida en la prevención de la APLV. A pesar de existir datos que pudieran orientar a un cierto efecto beneficioso de su evitación en niños con riesgo atópico, estos resultados no son concluyentes ni generalizables a lactantes sin dicho riesgo. (AU)

Introduction: Cow's milk protein allergy (CMPA) is the most frequent food allergy in the first year of life. There is no clear consensus regarding its prevention. A recommendation to avoid CMP in the first week of life as a preventive measure in all infants, regardless of their atopic risk, has recently been published. The purpose of this document is to issue a recommendation on the use of extensively hydrolyzed CMP formulas in the first week of life for the primary prevention of CMPA. Methods: A group of experts was formed with members proposed by the Spanish Association of Pediatrics (AEP), the Spanish Society of Clinical Immunology and Allergology and Pediatric Asthma (SEICAAP), the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP) and the Spanish Society of Neonatology (SENEO). The group conducted a critical review of the evidence on the subject published in the last 10 years. Results: The search yielded 72 studies, of which 66 were rejected for not meeting the inclusion criteria. The final review included 6 documents: 3 clinical trials and 3 systematic reviews, 2 of them with meta-analysis. There was no evidence of a statistically significant reduction in the incidence of CMPA in the infants who received hypoallergenic formulae or exclusive breastfeeding. Conclusion: Based on the current evidence, it is not possible to draw clear conclusions about the effect of avoiding CMP in the first week of life for prevention of CMPA. Although there are data that suggest a certain beneficial effect of avoiding CMPA in atopic risk infants, these results are not conclusive enough to extend the recommendation to the general population. (AU)

Síndrome de enterocolitis inducida por proteínas alimentarias que debuta con hiperamoniemia / Hyperammonaemia as onset of food protein-induced enterocolitis syndrome

Dentro de las alergias no mediadas por IgE, la enterocolitis inducida por proteínas alimentarias (FPIES) es el cuadro de mayor gravedad, pudiendo cursar con una clínica muy variada. El FPIES crónico se suele manifestar con letargia, palidez cutánea, desnutrición, vómitos intermitentes y/o diarrea crónica, asociados a múltiples alteraciones analíticas (leucocitosis con desviación a la izquierda, eosinofilia, anemia, trombocitosis, hipoproteinemia, hipoalbuminemia, metahemoglobinemia y acidosis metabólica). La resolución ocurre entre los 3 a 10 días tras la exclusión del alérgeno causante; vuelven a tolerarlo aproximadamente a los 3-5 años de edad. Se presenta el caso clínico de un lactante de 47 días alimentado con fórmula de inicio, que debuta con un cuadro de vómitos y diarreas con deshidratación grave, acidosis metabólica, metahemoglobinemia, hipoproteinemia, hipoalbuminemia e hiperamoniemia, siendo esta última una característica solo referenciada en un caso hasta la actualidad (AU)

Food protein-induced enterocolitis syndrome (FPIES) is the most severe non-IgE-mediated allergies, and has a broad clinical spectrum. Chronic FPIES usually manifests with lethargy, pallor, undernutrition, intermittent vomiting and/or chronic diarrhoea associated with multiple laboratory abnormalities (leucocytosis with left shift, eosinophilia, anaemia, thrombocytosis, hypoproteinaemia, hypoalbuminaemia, methemoglobinemia and metabolic acidosis). It resolves 3 to 10 days after exclusion of the causative allergen, and most patients develop tolerance to the protein again at approximately 3 to 5 years of age. We present the case of a 47-day-old infant who presented with vomiting and diarrhoea with severe dehydration, metabolic acidosis, methaemoglobinaemia, hypoproteinaemia, hypoalbuminaemia and hyperammonaemia, the latter being a feature that has only been described in one other case before. (AU)

Consensus on the diagnosis and treatment of cow's milk protein allergy of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition.

Cow's milk protein allergy (CMPA) is the most frequent cause of food allergy in the first months of life. Despite the fact that there are different guidelines and recommendations on the management of children with CMPA, there continues to be great variability in diagnostic and therapeutic criteria in Latin America. The Food Allergy Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition summoned a group of Latin American experts to reach a consensus and formulate a document to unify diagnostic and therapeutic criteria for CMPA. Three teams were formed, each with a coordinator, and the members of each team developed a series of statements for their corresponding module: a) clinical manifestations and diagnosis; b) diagnostic tools, and c) treatment. A search of the medical literature was carried out to support the information presented in each module and 28 statements were then selected. The statements were discussed, after which they were evaluated by all the experts, utilizing the Delphi method. Their opinions on statement agreement or disagreement were anonymously issued. The final statements selected were those with above 75% agreement and their corresponding recommendations were formulated, resulting in the document presented herein.

LESIONES HEPÁTICAS EN UN NEONATO CON ALERGIA ALIMENTARIA: A PROPÓSITO DE UN CASO / LIVER INJURIES IN A NEWBORN WITH ALLERGY FOOD: ABOUT A CASE

El hallazgo de lesiones de forma incidental en ocasiones lleva a que los profesionales consideren realizar procedimientos invasivos excesivos. La alergia a proteína de leche de vaca tiene un amplio espectro de manifestaciones clínicas, predominando el compromiso del tubo digestivo, y se han descrito la presencia de manifestaciones hepáticas acompañantes. Se describe un caso de una paciente neonata que presentó una serie de lesiones que fueron interpretadas en un primer momento como complejos de Von Meyenburg con eventual resolución de las mismas

Alergia a la proteína de la leche de vaca: reporte de un caso infrecuente en el período neonatal / Cow's milk protein allergy, a rare case report in the neonatal period

La alergia alimentaria se define como una reacción adversa que resulta de una respuesta inmunológica específica y reproducible desencadenada por la exposición al alimento. La respuesta inmune puede ser mediada por inmunoglobulina E, no mediada por inmunoglobulina E o mixta. Durante el primer año de vida, la proteína de la leche de vaca es la primera proteína a la cual se enfrentan los niños alimentados mediante lactancia materna o artificial, motivo por el cual constituye la forma de alergia alimentaria más frecuente en los primeros meses de la vida. El objetivo de este trabajo es presentar un caso clínico grave y poco frecuente de alergia a la proteína de la leche de vaca en el período neonatal.

Food allergy is defined as a reproducible adverse reaction that results from a specific and reproducible immune response triggered by exposure to food. The immune response can be mediated by immunoglobulin E, not mediated by immunoglobulin E or both. During the first year, cow´s milk protein is the first protein faced by children fed with breast milk or artificial milk. For that reason, it constitutes the form of food allergy most frequent in the first months of life. The objective of this paper is to describe a serious and rare clinical case of milk hypersensitivity in the neonatal period.

Milk quality of dual-purpose cows supplemented with biological fish silage (Pterygoplichthys sp.) as a protein source / Calidad de leche de vacas doble propósito suplementadas con ensilado biológico de pez diablo (Pterygoplichthys sp.) como fuente proteica / Qualidade do leite de vacas de duplo propósito suplementadas com silagem biológica de peixe (Pterygoplichthys sp.) como fonte protéica

Abstract Background: Devilfish (Pterygoplichthys sp.) is a pest of high impact in aquaculture production systems. Through a biological fermentation process, it could be used as a source of protein for dairy cows. However, milk palatability and smell could be limiting factors. Objective: to evaluate the quality of milk from cows supplemented with biological fish silage (Pterygoplichthys sp.) as a protein source. Methods: The treatments (T) evaluated were T1, 0% biological fish silage; T2, 10% biological fish silage; and T3, 20% biological fish silage. Twelve randomly selected cows were used in a Latin square experimental design, in which three treatments were tested with all of the cows during three time periods. Each period lasted 20 days (15-day adaptation period and 5-day experimental phase). Milk was analyzed for physicochemical, microbiological, sanitary condition and sensory characteristics. Analyses of variance were performed for all the response variables. Results: No significant differences for physicochemical variables were found among the treatments studied. Differences were observed in microbiological and sanitary variables among treatments, but values were in the range for high quality milk standards (˂100,000 CFU mL-1 aerobic mesophilic bacteria, and ˂400,000 somatic cells mL-1). In the sensory analyses, panelists did not detect strange odors nor fishy taste or odor in the milk of any of the treatments. Conclusion: Biological fish silage can be included up to 20% as a protein source in supplements for lactating cows.

Resumen Antecedentes: el pez diablo (Pterygoplichthys sp.) es una plaga de alto impacto en los sistemas de producción acuícolas. A través de los procesos de fermentación biológicos podría ser utilizado como fuente de proteína en los suplementos para vacas en producción. Sin embargo, el sabor y olor a pescado en la leche pudiera ser una limitante. Objetivos: evaluar la calidad de la leche de vacas suplementadas con ensilaje biológico de pez diablo como fuente de proteína. Métodos: los tratamientos (T) evaluados fueron T1, 0% de ensilaje biológico de Pterygoplichthys sp.; T2, 10% de ensilaje biológico de Pterygoplichthys sp.; y T3, 20% de ensilaje biológico de Pterygoplichthys sp.. Se utilizaron doce vacas seleccionadas al azar en un diseño experimental de cuadrado latino. Cada período tuvo una duración de 20 días (período de adaptación de 15 días y fase experimental de 5 días). La leche fue analizada para determinar su condición fisicoquímica, microbiológica, sanitaria y sensorial. Se realizaron análisis de varianza para todas las variables. Resultados: no se encontraron diferencias significativas entre los tratamientos estudiados para las variables fisicoquímicas las cuales estuvieron dentro de los estándares de leche de mayor calidad. Se observaron diferencias en las variables microbiológicas y sanitarias entre los tratamientos, pero los valores estuvieron dentro del rango para los estándares de leche de mayor calidad (˂100.000 UFC ml-1 de bacterias mesofílicas aeróbicas y ˂400.000 células somáticas ml-1). Los análisis sensoriales no detectaron olores extraños, ni olor ó sabor a pescado en la leche de los tratamientos estudiados. Conclusiones: se puede incluir hasta 20% de ensilaje biológico de Pterygoplichthys sp. como fuente de proteína en los suplementos de vacas en producción.

Resumo Antecedentes: o peixe cascudo (Pterygoplichthys sp.) é uma praga de alto impacto nos sistemas de produção aquícola. Por meio de processos de fermentação biológica poderia ser usado como fonte de proteína em suplementos para vacas em produção, porém o sabor e cheiro de peixe no leite podem ser uma limitação. Objetivos: avaliar a qualidade do leite de vacas suplementadas com silagem biológica de peixe cascudo como fonte de proteína. Métodos: os tratamentos (T) avaliados foram T1, 0% da silagem biológica de Pterygoplichthys sp.; T2, silagem biológica a 10% de Pterygoplichthys sp.; e T3, silagem biológica a 20% de Pterygoplichthys sp. Doze vacas selecionadas aleatoriamente foram utilizadas em um delineamento experimental de quadrado latino. Cada período durou 20 dias (período de adaptação de 15 dias e fase experimental de 5 dias). O leite foi analisado para determinar sua condição físico-química, microbiológica, sanitária e sensorial. Análises de variância foram realizadas para todas as variáveis. Resultados: não foram encontradas diferenças significativas entre os tratamentos estudados para as variáveis físico-químicas, os valores estavam dentro dos mais altos padrões de qualidade do leite. Observaram- se diferenças nas variáveis microbiológicas e sanitárias entre os tratamentos, mas os valores estavam dentro dos limites para os mais altos padrões de leite de qualidade (˂100.000 CFU ml-1 de bactérias mesofílicas aeróbicas e ˂400.000 células somáticas ml-1). As análises sensoriais não detectaram odores estranhos, nem cheiro ou sabor de peixe no leite dos tratamentos estudados. Conclusões: a silagem biológica de peixes pode ser incluída em até 20% como fonte de proteína em suplementos de vacas em produção.

A Latin American and Spanish pediatric gastroenterology group's understanding of cow's milk protein allergy diagnosis and treatment: Results of a survey by the Food Allergy Working Group of the Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica. / Conocimiento sobre el diagnóstico y el tratamiento de la alergia a las proteínas de la leche de vaca por un grupo de gastroenterólogos pediatras en Iberolatinoamérica: resultado de la encuesta del Grupo de Trabajo de Alergia Alimentaria de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica.

INTRODUCTION: There are discrepancies in the diagnosis and management of cow's milk protein allergy (CMPA) in Spain and Latin America. The aim of the present study was to find out how Spanish and Latin American pediatric gastroenterologists diagnose and treat CMPA. MATERIAL AND METHODS: Pediatric gastroenterologists, members of the Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición, were invited to fill out a structured survey, the results of which were then compared with the 2012 and 2014 diagnosis and treatment guidelines, respectively. RESULTS: The survey results showed that 17% of the participants follow the diagnostic recommendations based on the published consensus and guidelines. To diagnose non-IgE-mediated CMPA, 15% of the participants utilize IgE-specific skin prick tests, 22% use IgE-specific blood tests, and 45% employ oral food challenges. To diagnose IgE-mediated CMPA the percentages for the same diagnostic methods were 57, 83 and 22%, respectively. Once diagnosis is confirmed, 98% of the participants provide dietary recommendations. In children that are not breastfed, 89% of the participants prescribe an initial extensively hydrolyzed formula, 9% an amino acid formula, 1% a soy formula, and 1% a hydrolyzed rice formula. In patients with IgE-mediated CMPA, 34% of the participants carry out an oral challenge once treatment is completed, 39% according to symptom severity, and 27% in relation to IgE-specific testing. CONCLUSION: CMPA management is diverse and there is poor adherence to the clinical practice guidelines.

Recomendaciones sobre el diagnóstico y el tratamiento de la alergia a la proteína de la leche de vaca en población pediátrica colombiana - Posición de expertos / Expert recommendations for diagnosis and treatment of cow's milk protein allergy in the Colombian pediatric population

Resumen Objetivo: generar recomendaciones sobre el diagnóstico y el tratamiento de la alergia a la proteína de la leche de vaca (APLV), que sirvan de referencia y consulta para los médicos pediatras y de cuidado primario. Materiales y métodos: el presente documento de posición de expertos fue desarrollado por un grupo de médicos, especialistas en diferentes áreas terapéuticas y con experiencia en APLV. Se definieron los temas más relevantes y se realizó una revisión de la literatura científica disponible, a fin de elaborar una propuesta de recomendaciones que fue discutida por los autores. Resultados: se elaboró un documento de posición que propone un enfoque práctico sobre la definición, el diagnóstico y el tratamiento de la APLV en el paciente pediátrico. Conclusiones: el diagnóstico temprano y el manejo adecuado de la APLV pueden contribuir a una disminución de la carga de esta enfermedad y sus complicaciones.

Abstract Objective: The objective of this paper is to develop and present recommendations for diagnosis and treatment of Cow's Milk Protein Allergy (CMPA) which can serve as a reference for pediatric and primary care physicians to consult. Materials and methods: This expert position document was developed by a group of doctors who are specialists in several therapeutic areas who have experience in CMPA. The most relevant topics were defined and a review of the available scientific literature was carried out to prepare a proposal for recommendations that was then discussed by the authors. Results: A position paper was developed that proposes a practical approach to definition, diagnosis and treatment of CMPA in pediatric patients. Conclusions: Early diagnosis and proper management of CMPA can help decrease the burden of this disease and its complications.

Alergia a la proteína de la leche de vaca: enfoque diagnóstico y terapéutico / Diagnostic and therapeutic approach to cow's milk protein allergy

Resumen La prevalencia de la alergia a las proteínas de la leche de vaca (APLV) en el ámbito mundial es, aproximadamente, de 1,9 a 4,9 %. En Colombia, esta cifra se desconoce. En un alto porcentaje de los casos, no existe la sospecha por parte del personal de salud, y, por lo tanto, el diagnóstico y el tratamiento se retrasan. Esto acarrea un aumento en el tiempo y en los recursos que emplean los profesionales de la salud y los padres en procura de establecer la etiología del padecimiento de los niños que presentan esta enfermedad. Dentro de este contexto, la historia clínica es fundamental en la sospecha de la APLV, y es especialmente relevante la evaluación de antecedentes, en los cuales se destacan la presencia de la exposición temprana a la proteína, así como la atopia en familiares en primer grado de consanguinidad. La presentación de la APLV puede manifestarse con reacciones inmediatas a nivel digestivo (vómitos, diarrea aguda), cutáneo (urticaria, dermatitis, angioedema) y, con menos frecuencia, a partir de signos respiratorias y sistémicos. Sin embargo, la amplia variedad de manifestaciones clínicas y signos puede ser un reto para el profesional que no se encuentre sensibilizado con la patología, e incluso soslayar este diagnóstico retrasa la suspensión de la proteína de la leche de vaca de la dieta y demora el acceso a un tratamiento eficaz. El tratamiento ideal reconocido es la dieta de exclusión, la cual requiere un estricto cumplimiento. En los niños alimentados con lactancia materna exclusiva, será necesaria la dieta restrictiva de leche y sus derivados en la madre. En quienes no reciben lactancia, se deberá tratar mediante fórmulas de proteínas lácteas extensamente hidrolizadas (FEH) o a base de aminoácidos (FAA). Así bien, el pronóstico es favorable y la mayoría de niños tolerarán las proteínas de la leche de vaca a los 2 años, mientras que en pacientes con polisensibilización el proceso puede prolongarse. En el caso de no alcanzar la tolerancia, la inmunoterapia oral es una opción disponible.

Abstract The worldwide prevalence of cow's milk protein allergy (CMPA) is approximately 1.9% to 4.9%. Its prevalence in Colombia is unknown. A high percentage of cases are unsuspected by medical personnel resulting in delayed diagnosis and treatment which increase the time and resources used to establish the etiology of this condition in children. The clinical history is fundamental for diagnosis of CMPA, especially the background evaluation. Of special importance are early exposure to the protein and atopy in first degree relatives. CMPA's initial presentation may be digestive, cutaneous or respiratory. Digestive symptoms can include vomiting and acute diarrhea, and cutaneous symptoms include hives, dermatitis and angioedema. Respiratory and systemic manifestations occur less frequently. The wide variety of clinical manifestations and signs can challenge health care professionals who are not alert to this pathology to the point that the diagnosis is not even considered event though delaying the suspension of cow's milk protein from the diet delays access to an effective treatment. The well-recognized ideal treatment is an exclusion diet which requires strict compliance. For children who are exclusively breastfed, the mother's diet must restrict milk and its derivatives. Children who are not breastfed, should be fed formulas of extensively hydrolyzed milk proteins based on amino acids. The prognosis is favorable, and most children will tolerate cow's milk proteins at two years. The process may take more years for polysensitive patients. Oral immunotherapy is an option that is available for patients who do not achieve toleration.