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.

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.

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.

Perinatal factors associated with the development of cow's milk protein allergy.

UNLABELLED: The prevalence of cow's milk protein allergy (CMPA) has increased in recent years, and is associated with antimicrobial use during the perinatal period, prematurity, the type of childbirth, and the decrease in breastfeeding. The aim of this study was to analyze whether there is any association between these factors and the development of CMPA. MATERIAL AND METHODS: A retrospective, comparative, cross-sectional, observational study was conducted by reviewing the case records of 101 children diagnosed with CMPA and seen at the Department of Gastroenterology and Nutrition of the Instituto Nacional de Pediatría within the time frame of January 2012 and August 2013. The following variables were included: age, sex, weeks of gestation, history of maternal infection and antimicrobial use during the pregnancy, type of delivery, and feeding with human milk, and its duration. Likewise, the case records of 90 children were reviewed as a control group on not having CMPA or any other allergy. The chi-square test was used for proportions, and the Mann-Whitney U test was used for comparing means in the statistical analysis. RESULTS: The factors associated with CMPA were the use of antimicrobials during gestation and breastfeeding duration in months. Both factors were statistically significant (P<.001). No association was found between CMPA and gestational age or type of delivery. CONCLUSIONS: The statistically significant associated factors were breastfeeding duration and the use of antimicrobials during the gestational stage. These results underline the necessity for prospective studies.

[24-h intraesophageal pH determination in children allergic to cow's milk protein at a tertiary care hospital]. / Determinación de pH intraesofágico de 24 h en niños con alergia a las proteínas de la leche de vaca en un hospital de tercer nivel.

BACKGROUND: Cow's milk protein allergy (CMPA) is being seen more frequently on a daily basis in pediatric consultations. It shares symptoms with gastroesophageal reflux (GER), which can complicate the differential diagnosis. AIMS: To attempt to corroborate the presence of acid GER in children with CMPA, as well as to find a characteristic profile through the 24-hour pH monitoring study in children with GER and CMPA METHODS: The intraesophageal pH monitoring studies performed on 47 children with CMPA were reviewed. The measurements in all the studies were carried out within a 24-hour period using Digitrapper® equipment with a multi-use GeroFlex® catheter, after calibration with pH 7 and pH 1 buffer solutions. RESULTS: Of the 47 children, 23 were boys (32.4%) and 24 were girls (33.8%) and the mean age was 5±3.7 years. Fourteen of the 47 children (29%) presented with GER, according to the result of the 24-hour intraesophageal measurement. Only 2 of the 47 patients studied fit the phasic profile. CONCLUSIONS: The findings show the existing relation between the two pathologies. Nevertheless, it is important to determine the presence of non-acid or weak acid reflux, because their existence can increase this association.