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1.
Allergol. immunopatol ; 47(6): 570-578, nov.-dic. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-186550

RESUMO

Background: The key role of dietary factors in immunotolerance promotion and allergic diseases prevention has been emphasised. The aim of the study was the analysis of the impact of immunomodulatory dietary components, consumed by pregnant women, on the development of cow's milk allergy (CMA) in their offspring. Materials and methods: Fifty-one pairs of mothers and their CMA-offspring were included in the study group. The analysis of a daily intake of selected dietary components was conducted retrospectively with the application of a seven-day diet of a mother in the third trimester of gestation and the authors’ own questionnaire. The Diet 5.D programme was used. Results: An average daily retinol intake by study-group mothers was significantly lower than by control-group mothers and valued 375.6 μg/d vs. 543.7 μg/d (p = 0.040), respectively. Folates intake in the study group was 598.8 μg/d vs. 361.1μg/d in the control group (p = 0.001). Vitamin D in the study group was statistically lower - 3.6μg/d, comparing to the control group - 6.9 μg/d (p = .038). Average LC-PUFA intake by mothers with allergic children was 0.09g/d, while in the control group 0.18g/d (p = 0.016). An analysis of the diet revealed that significantly more mothers of children from the control group (n = 12; 48%) consumed fish 2-3 times per month in comparison to the study group (n = 9; 17.6%) (p = 0.007). Conclusions: Vitamin D, A, LC-PUFA, retinol, riboflavin and fish consumption by pregnant mothers of CMA-children was significantly lower, whereas beta-carotene and folates consumption was significantly higher than that of mothers with non-allergic children


No disponible


Assuntos
Humanos , Masculino , Feminino , Gravidez , Imunomodulação/imunologia , Complicações na Gravidez/dietoterapia , Complicações na Gravidez/imunologia , Hipersensibilidade a Leite/dietoterapia , Projetos Piloto , Dietoterapia , Polônia , Vitamina D , Consumo de Energia , Análise Fatorial , Fatores de Risco , Análise de Regressão , Relações Mãe-Filho , Análise Multivariada , Estudos Retrospectivos
2.
Nutrients ; 11(8)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31357608

RESUMO

Cow's milk and dairy are commonly consumed foods in the human diet and contribute to maintaining a healthy nutritional state, providing unique sources of energy, calcium, protein, and vitamins, especially during early childhood. Milk formula is usually made from cow's milk and represents the first food introduced into an infant's diet when breastfeeding is either not possible or insufficient to cover nutritional needs. Very recently, increased awareness of cow's milk protein allergy and intolerance, and higher preference to vegan dietary habits have influenced parents towards frequently choosing cows' milk substitutes for children, comprising other mammalian milk types and plant-based milk beverages. However, many of these milk alternatives do not necessarily address the nutritional requirements of infants and children. There is a strong need to promote awareness about qualitative and quantitative nutritional compositions of different milk formulas, in order to guide parents and medical providers selecting the best option for children. In this article, we sought to review the different compositions in terms of macronutrients and micronutrients of milk from different mammalian species, including special milk formulas indicated for cow's milk allergy, and of plant-based milk alternatives.


Assuntos
Desenvolvimento Infantil , Fenômenos Fisiológicos da Nutrição Infantil , Hipersensibilidade a Leite/dietoterapia , Substitutos do Leite , Estado Nutricional , Valor Nutritivo , Recomendações Nutricionais , Fatores Etários , Criança , Pré-Escolar , Humanos , Lactente , Fórmulas Infantis , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Hipersensibilidade a Leite/diagnóstico , Hipersensibilidade a Leite/epidemiologia , Hipersensibilidade a Leite/fisiopatologia , Fatores de Risco , Leite de Soja
3.
Nutrients ; 11(6)2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31234330

RESUMO

Cow's milk proteins cause allergic symptoms in 2% to 3% of all infants. In these individuals, the physiological mechanism of tolerance is broken with subsequent possible sensitization to antigens, which can lead eventually to allergic responses. The present review aims to provide an overview of different aspects of immune modulation by dietary intervention in cow's milk allergy (CMA). It focuses on pathogenetic mechanisms of different CMA related disorders, e.g., gastroesophageal reflux and eosinophilic esophagitis, highlighting the role of dietary management on innate and adaptive immune systems. The traditional dietary management of CMA has greatly changed in the last years, moving from a passive approach, consisting of an elimination diet to relieve symptoms, to a "proactive" one, meaning the possibility to actively modulate the immune system. Thus, new insights into the role of hydrolysates and baked milk in immunomodulation are addressed here. Additionally, nutritional components, such as pre- and probiotics, may target the immune system via microbiota, offering a possible road map for new CMA prevention and treatment strategies.


Assuntos
Imunidade Adaptativa , Suplementos Nutricionais , Epitopos , Imunidade Inata , Hipersensibilidade a Leite/dietoterapia , Proteínas do Leite/imunologia , Animais , Suplementos Nutricionais/efeitos adversos , Humanos , Hipersensibilidade a Leite/epidemiologia , Hipersensibilidade a Leite/imunologia , Fatores de Risco , Resultado do Tratamento
4.
Allergol. immunopatol ; 47(3): 265-271, mayo-jun. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-186488

RESUMO

Introduction and objectives: Symptom-based score (SBS) quantifies the number and severity of suspected cow's milk-related symptoms. In this study, we aimed to evaluate the efficiency of SBS in patients diagnosed with cow's milk protein (CMPA) and hen's egg allergy (HEA). Materials and methods: A single-center study was conducted between June 2015 and August 2017. Infants who were diagnosed with CMPA and HEA or both were enrolled in the study. SBS was applied at baseline and at one month during an elimination diet. Results: One hundred and twelve patients were enrolled in the study. Of these, 56 (50%) were female. Forty-nine (43.8%) patients were diagnosed with CMPA, 39 (34.8%) patients were diagnosed with HEA and 24 (21.4%) patients were diagnosed with cow's milk protein and hen's egg allergy (CMPHEA). In the analysis of SBS, median Bristol scale and initial total symptom-based scores were significantly lower in the HEA group than others (p = 0.002; p = 0.025). After the elimination diet, mean SBS decrease in the CMPHEA group (11.3 ± 4.7) was found to be higher than CMPA (8.8 ± 3.7) and HEA (8.0 ± 4.0) groups (p = 0.009). In 41 (83.7%) patients with CMPA, 33 (84.6%) patients with HEA and 21 (87.5%) patients with CMPHEA, a ≥ 50% decrease in SBS was observed after the elimination diet. Conclusion: We may conclude that the present study suggests that SBS can be useful in monitoring the response to elimination diet in infants diagnosed with cow's milk protein and hen's egg allergy


No disponible


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Gatos , Hipersensibilidade a Ovo/diagnóstico , Hipersensibilidade a Leite/diagnóstico , Projetos de Pesquisa , Alérgenos/imunologia , Brasil/epidemiologia , Estudos Transversais , Hipersensibilidade a Ovo/dietoterapia , Hipersensibilidade a Ovo/epidemiologia , Proteínas do Ovo/imunologia , Hipersensibilidade a Leite/dietoterapia , Hipersensibilidade a Leite/epidemiologia , Proteínas do Leite/imunologia , Prevalência , Índice de Gravidade de Doença
5.
Int Arch Allergy Immunol ; 179(4): 290-296, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31096239

RESUMO

INTRODUCTION: Cow's milk allergy (CMA) is a common diagnosis in infants, requiring the exclusion of cow's milk until tolerance is recovered. In the present study, we aim to determine which factors are associated with the development of tolerance. METHODS: Retrospective, observational study of subjects who underwent the same clinical follow-up methodology. We studied 245 cases of CMA (125 IgE-mediated and 120 non-IgE-mediated). The following variables were analysed: age at diagnosis, gender, type of delivery, type of feeding received, feeding during the first months of life, clinical features, and type of feed received as treatment: casein hydrolysates or casein hydrolysates with Lactobacillus rhamnosus GG (LGG). RESULTS: Factors associated with earlier tolerance were non-IgE-mediated CMA (HR = 2.92; 95% CI: 2.20-3.88) and patients receiving casein hydrolysate with LGG (HR = 1.79; 95% CI: 1.33-2.42). Later tolerance was associated with caesarean delivery (HR = 0.78; 95% CI: 0.58-1.05) and breastfeeding for a period of at least 3 days (HR = 0.64; 95% CI: 0.44-0.93). The multivariate study shows that the type of formula (HR = 1.61; 95% CI: 1.19-2.18) and the type of CMA (HR = 2.82; 95% CI: 2.12-3.85) have an effect on the recovery time. Casein hydrolysates with LGG reduces the recovery time in IgE-mediated (HR = 1.88; 95% CI: 1.17-3.01) and non-IgE-mediated CMA (HR = 1.46; 95% CI: 0.98-2.17). CONCLUSIONS: Tolerance acquisition is faster in non-IgE-mediated CMA subjects and in those who received casein hydrolysate with LGG.


Assuntos
Tolerância Imunológica , Hipersensibilidade a Leite/epidemiologia , Alérgenos/imunologia , Animais , Caseínas/uso terapêutico , Bovinos , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Imunoglobulina E/metabolismo , Masculino , Hipersensibilidade a Leite/dietoterapia , Hipersensibilidade a Leite/imunologia , Proteínas do Leite/imunologia , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia
6.
Arch Pediatr ; 26(4): 238-246, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30979632

RESUMO

Foods for special medical purposes (FSMPs) with a protein fraction made of hydrolyzed rice protein (HRPs) have been on the market in Europe since the 2000s for the treatment of cow's milk protein allergy (CMPA). HRP formulas (HRPFs) are proposed as a plant-based alternative to cow's milk protein-based extensively hydrolyzed formulas (CMP-eHF) beside the soy protein formulas whose use in CMPA is controversial. HRPFs do not contain phytoestrogens and are derived from non-genetically modified rice. HRPFs are strictly plant-based apart from the addition of vitamin D3 (cholecalciferol). As the amino acid content of rice proteins differs from that of human milk proteins, the protein quality of these formulas is improved by supplementation with free lysine, threonine, and tryptophan. The consumption of HRPFs has risen: for example, in France HRPFs account for 4.9% in volume of all formulas for children aged 0-3 years. Several studies have shown the adequacy of HRPFs in treating CMPA. They ensure satisfactory growth from the 1st weeks of life for infants and toddlers, both in healthy children and in those with CMPA. HRPFs can be used to treat children with CMPA either straightaway or in second intention in cases of poor tolerance to CMP-eHF for organoleptic reasons or for lack of efficacy. In France, the cost of HRPFs is close to that of regular infant or follow-on formulas.


Assuntos
Fórmulas Infantis , Hipersensibilidade a Leite/dietoterapia , Oryza , Proteínas de Vegetais Comestíveis/administração & dosagem , Hidrolisados de Proteína/administração & dosagem , Carboidratos da Dieta/administração & dosagem , Carboidratos da Dieta/análise , Humanos , Lactente , Fórmulas Infantis/química , Lipídeos/administração & dosagem , Lipídeos/análise , Proteínas do Leite/efeitos adversos , Proteínas de Vegetais Comestíveis/análise , Hidrolisados de Proteína/análise
7.
Allergol Immunopathol (Madr) ; 47(3): 265-271, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30501905

RESUMO

INTRODUCTION AND OBJECTIVES: Symptom-based score (SBS) quantifies the number and severity of suspected cow's milk-related symptoms. In this study, we aimed to evaluate the efficiency of SBS in patients diagnosed with cow's milk protein (CMPA) and hen's egg allergy (HEA). MATERIALS AND METHODS: A single-center study was conducted between June 2015 and August 2017. Infants who were diagnosed with CMPA and HEA or both were enrolled in the study. SBS was applied at baseline and at one month during an elimination diet. RESULTS: One hundred and twelve patients were enrolled in the study. Of these, 56 (50%) were female. Forty-nine (43.8%) patients were diagnosed with CMPA, 39 (34.8%) patients were diagnosed with HEA and 24 (21.4%) patients were diagnosed with cow's milk protein and hen's egg allergy (CMPHEA). In the analysis of SBS, median Bristol scale and initial total symptom-based scores were significantly lower in the HEA group than others (p=0.002; p=0.025). After the elimination diet, mean SBS decrease in the CMPHEA group (11.3±4.7) was found to be higher than CMPA (8.8±3.7) and HEA (8.0±4.0) groups (p=0.009). In 41 (83.7%) patients with CMPA, 33 (84.6%) patients with HEA and 21 (87.5%) patients with CMPHEA, a ≥50% decrease in SBS was observed after the elimination diet. CONCLUSION: We may conclude that the present study suggests that SBS can be useful in monitoring the response to elimination diet in infants diagnosed with cow's milk protein and hen's egg allergy.


Assuntos
Hipersensibilidade a Ovo/diagnóstico , Hipersensibilidade a Leite/diagnóstico , Projetos de Pesquisa , Alérgenos/imunologia , Animais , Brasil/epidemiologia , Bovinos , Pré-Escolar , Estudos Transversais , Hipersensibilidade a Ovo/dietoterapia , Hipersensibilidade a Ovo/epidemiologia , Proteínas do Ovo/imunologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Hipersensibilidade a Leite/dietoterapia , Hipersensibilidade a Leite/epidemiologia , Proteínas do Leite/imunologia , Prevalência , Índice de Gravidade de Doença
8.
Pediatr Allergy Immunol ; 29(7): 747-753, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30027590

RESUMO

BACKGROUND: Assessing the effect of adding baked milk products to the diet of patients with cow's milk allergy on accelerating the formation of tolerance. METHOD: A randomized clinical trial was carried out with 84 patients (6 months-3 years old) diagnosed with allergy to cow's milk who tolerated baked milk in form of muffin in oral food challenge (OFC). The subjects were divided randomly into case and control groups matched for age and sex. Patients in the case group were asked to consume baked milk in the form of muffin for 6 months and then to consume baked cheese in the form of pizza for another 6 months. The control group were instructed to strictly avoid any milk products for 1 year. Skin prick test (SPT) and serum-specific immunoglobulin E (sIgE) levels (ImmunoCAP) of milk, casein, and beta-lactoglobulin were measured before and after the study. In addition, those in the case group who had satisfactorily tolerated baked products during the study as well as all the subjects in the control group underwent an OFC to evaluate unheated milk tolerance at the end of the study. RESULTS: It was shown that by the end of the 1-year study period, 88.1% (37/42) of the patients in the case group and 66.7% (28/42) of those in control group had developed tolerance to unheated milk (P-value: 0.018). The results of milk-specific SPT and sIgE levels showed a significant decrease in the case group. Initial sIgE levels could not predict unheated milk tolerance in case and control groups. CONCLUSION: Introducing baked milk products into the diet of patients with milk allergy can accelerate the tolerance of unheated milk in these patients. sIgE levels of milk, casein, and beta-lactoglobulin did not predict the tolerance of unheated milk.


Assuntos
Tolerância Imunológica/imunologia , Hipersensibilidade a Leite/dietoterapia , Leite/imunologia , Animais , Pré-Escolar , Culinária , Feminino , Humanos , Imunoglobulina E/sangue , Lactente , Masculino , Hipersensibilidade a Leite/imunologia , Testes Cutâneos/métodos
9.
Rev Chil Pediatr ; 89(3): 310-317, 2018 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-29999135

RESUMO

Cow's milk protein allergy (CMPA) is a common disease with a prevalence of 2-7%, increasingly so. It is characterized by an allergic reaction to one or more cow's milk proteins. There are not pathog nomonic clinical symptoms, and these will depend on the type of immune reaction involved. A good diagnostic approach avoids under and over diagnosis and, therefore, under and over treatment. The CMPA treatment is the elimination of cow's milk protein from the diet. A restricted diet in a child does not require it or who has developed tolerance can alter growth, quality of life, including unne cessary costs. The objective of this review is to present the different milk formulas available in Chile to treat CMPA in those cases where breastfeeding with exclusion diet is not possible. For this purpose, nutritional composition, ingredients and other relevant characteristics of all the milk formulas and juices marketed in Chile as CMPA treatment were reviewed. The information was obtained from the official distributors or sellers or failing that, from the official websites. There are multiple milk formulas and beverages used for the treatment of CMPA, and not all of them are nutritionally or immunologically secure. Knowing them in detail will help the pediatrician to indicate them in a more informed way according to their benefits and their deficiencies for the proper management of this pathology.


Assuntos
Fórmulas Infantis , Hipersensibilidade a Leite/dietoterapia , Proteínas do Leite/efeitos adversos , Aleitamento Materno , Humanos , Lactente , Fórmulas Infantis/química , Recém-Nascido , Hipersensibilidade a Leite/diagnóstico , Hipersensibilidade a Leite/imunologia , Proteínas do Leite/imunologia , Resultado do Tratamento
10.
Ann Allergy Asthma Immunol ; 121(5): 580-587, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30036581

RESUMO

BACKGROUND: Previous studies suggest inclusion of baked egg and milk in the diet of children with egg or cow's milk (CM) allergy might positively affect native tolerance. However, differences in native food reactivity based on historical baked tolerance are not fully understood. OBJECTIVE: To assess differences in native egg and CM oral food challenge (OFC) outcomes based on presenting history of tolerance and exposure to these foods in the baked form. METHODS: This study is a retrospective review of all egg and CM OFCs at the Children's Hospital of Philadelphia (Philadelphia, Pennsylvania) over 4 years (N = 580). History of baked ingestion was compared with OFC pass rate, eliciting dose, epinephrine use, reaction classification, and recent skin test reaction or specific immunoglobulin E level. RESULTS: There were 115 egg- and 70 CM-positive challenge reactions, with most eliciting anaphylaxis. Children tolerating baked egg passed OFC more frequently (75%) compared with children who avoided baked egg (58%; P = .01) or never ingested egg (45%; P < .0001). For positive reactions, children tolerant of baked egg reacted at higher eliciting doses of native egg (median 3.0 g, range 0.125-15.75 g) compared with those avoiding baked egg (median 0.69 g, range 0.13-10.0 g; P = .03) and those with no egg exposure (median 0.88 g, range 0.13-13.88 g; P = .01). Further, epinephrine use was lower in children tolerating baked egg (10%) compared with children avoiding baked egg (22%; P = .02) and compared with children who never ingested egg (32%; P = .0001). These differences were not observed for CM challenges. CONCLUSION: Children who historically tolerated baked egg were less sensitive to native egg during OFC compared with children whose baked reactivity was largely unknown.


Assuntos
Culinária/métodos , Dieta/métodos , Hipersensibilidade a Ovo/dietoterapia , Hipersensibilidade a Leite/dietoterapia , Adolescente , Alérgenos/imunologia , Anafilaxia/etiologia , Criança , Pré-Escolar , Hipersensibilidade a Ovo/imunologia , Feminino , Humanos , Imunoglobulina E/sangue , Lactente , Estimativa de Kaplan-Meier , Masculino , Hipersensibilidade a Leite/imunologia , Philadelphia , Estudos Retrospectivos , Testes Cutâneos
11.
Food Res Int ; 109: 416-425, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29803466

RESUMO

The aim of this review paper is to assess the applicability of donkey's milk to infants suffering from Cow Milk Protein Allergy (CMPA) compared to human and other available milk types. The bioactive and immune-supportive character which could be beneficial as a fortifier to the formula-fed infants is described while limitations of this type of milk are also discussed. Studies showed that human and donkey's milk have similar, overall, chemical composition as well as protein homogeneity and antigenic similarities. Several in vitro and in vivo studies showed that donkey's milk has nutraceutical and functional properties that can support immunity, alter metabolism and beneficially modify gut microbiota. Clinical studies illustrated that donkeys' milk is well tolerated (82.6%-88%) by infants. Finally, the effect that processing (i.e. thermal, non-thermal treatments, drying methods) has on donkey milk components is also discussed pointing out the need for minimally processing this type of milk.


Assuntos
Alimentação Artificial , Suplementos Nutricionais , Equidae , Fórmulas Infantis/química , Hipersensibilidade a Leite/dietoterapia , Leite/química , Valor Nutritivo , Animais , Reações Cruzadas , Suplementos Nutricionais/efeitos adversos , Microbioma Gastrointestinal , Humanos , Lactente , Fórmulas Infantis/efeitos adversos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Leite/efeitos adversos , Leite/imunologia , Hipersensibilidade a Leite/imunologia , Hipersensibilidade a Leite/microbiologia , Hipersensibilidade a Leite/fisiopatologia , Proteínas do Leite/imunologia , Estado Nutricional
13.
Allergol. immunopatol ; 46(2): 149-154, mar.-abr. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-172173

RESUMO

Background: Cow's milk protein allergy (CMPA) affects between 0.6 and 0.9% of the general population, and its treatment implies the total elimination of the intake of this protein. Camel's milk has been suggested as an alternative for patients over one year of age who suffer from CMPA due to the difference in the amino acid sequence from that of cow's milk. The objective of this study was to evaluate the safety and tolerability of camel's milk in children with CMPA. Methods: Crossed clinical trial for the use of camel's milk vs. amino acid formula, carried out at the Dr. Federico Gómez Children's Hospital of Mexico (HIMFG) on patients between one and 18 years of age with diagnosed CMPA confirmed through double-blind, placebo-controlled food challenges (DBPCFCs). Only those whose allergies were confirmed were randomly placed into two groups: those to be administered camel's milk and those to be administered the amino-acid formula for two weeks, followed by a six-week wash-out period, and then a group crossing for a further two weeks. Results: 49 patients with suspected CMPA were included in the study; the diagnosis was confirmed through DBPCFCs in 15 patients, who were those who participated in the study. After having been administered camel's milk, none of the patients presented adverse effects. Conclusions and clinical relevance Camel's milk is safe and tolerable in patients above one year of age with CMPA and can be considered as a good alternative given the benefit of its taste compared to other formulas (AU)


No disponible


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Hipersensibilidade a Leite/dietoterapia , Leite , Camelus , Estudos Cross-Over , Segurança do Paciente , Proteínas do Leite/efeitos adversos
15.
J Pediatr Gastroenterol Nutr ; 66(5): 831-837, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29481443

RESUMO

OBJECTIVES: To study micronutrient status and nutritional intake from complementary feeding in children on a cows' milk exclusion (CME) diet. METHODS: Fifty-seven children with cows' milk allergy, younger than 2 years, were included in a cross-sectional study. Blood was analyzed for micronutrient status. Complementary feeding was defined as all solids and liquids except of breast milk, and assessed by 3-day food diary. The results were analyzed according to 3 feeding patterns: mainly breast-fed (mBF), partially breast-fed, and no breast milk group (nBM). RESULTS: The children had a median age of 9 months and micronutrient status was within normal range for total homocysteine (p-tHcy), s-B12, s-folate, b-Hb, s-ferritin, s-zinc, and s-25(OH)D. There were no significant differences between feedings groups, except for B12-biomarkers. The mBF had higher p-tHcy (P < 0.000) and lower s-B12 (P = 0.002) compared nBM. Vitamin B12 deficiency (p-tHcy >6.5 µmol/L combined with s-B12 <250 pmol/L) was found in 12% of participants, most frequently among the mBF (36%) and none in nBM group (P = 0.009). Vitamin B12 intake from complementary feeding was negatively correlated with p-tHcy (r = -0.479, P = 0.001) and positively with s-B12 (r = 0.410, P = 0.003). Iron deficiency anemia was found in 5%. Iron intake correlated positively with b-Hb (r = 0.324, P = 0.02). Zinc deficiency was found in 7% and low 25(OH)D in 9%. Vitamin D intake was positively correlated with the use of supplements (r = 0.456, P = 0.001). CONCLUSION: The risk of B12 deficiency was high in mBF infants on CME diet, and complementary feeding was associated with better B12 status. Iron, zinc, and vitamin D deficiencies were present in all feeding groups. Complementary feeding should be introduced at 4 to 6 months of age. Vitamin D supplement is recommended to ensure adequate intake.


Assuntos
Comportamento Alimentar/fisiologia , Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia , Desnutrição/epidemiologia , Micronutrientes/sangue , Hipersensibilidade a Leite/dietoterapia , Animais , Biomarcadores/sangue , Aleitamento Materno/estatística & dados numéricos , Estudos Transversais , Registros de Dieta , Suplementos Nutricionais/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Desnutrição/etiologia , Leite , Hipersensibilidade a Leite/sangue , Estado Nutricional
17.
J Allergy Clin Immunol Pract ; 6(5): 1699-1704, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29408418

RESUMO

BACKGROUND: Clinical trials of baked milk (BM) introduction have demonstrated accelerated resolution of milk allergy. OBJECTIVE: Long-term data regarding real-world introduction of BM are lacking. We sought to characterize our experience of BM introduction. METHODS: We performed a retrospective chart review of consecutive BM oral food challenges performed in our clinic from 2009 to 2014, with a minimum follow-up of 24 months. RESULTS: Of the 206 patients challenged, 99 (48%) passed and 187 were sent home with detailed instructions to incorporate BM into their diets. After a median of 49 months of follow-up, 43% of the 187 had progressed to direct milk, 20% to less-cooked forms of milk, 10% remained ingesting BM, and 28% were strictly avoiding milk. Higher milk IgE levels were associated with decreased odds of passing a BM challenge and advancing to less-cooked forms of milk. Predictors of progressing to less-cooked forms of milk were passing the challenge and younger age. There were 79 reported milk reactions involving 68 patients (33% of total) during follow-up. Of these, 78% were classified as mild, 14% severe, and 6 patients developed eosinophilic esophagitis. Of 11 severe reactions, 4 were accidental exposures, 3 were planned escalations, and 4 occurred with previously tolerated doses. CONCLUSIONS: The majority of patients who underwent a BM challenge, including those who failed their challenge, were able to progress to direct or less-cooked forms of milk. However, adverse reactions were common, and even a successful BM challenge does not guarantee future tolerance of BM or preclude later reactions, even to previously tolerated doses.


Assuntos
Culinária , Dietoterapia/métodos , Hipersensibilidade a Leite/dietoterapia , Adolescente , Adulto , Alérgenos/imunologia , Animais , Criança , Pré-Escolar , Esofagite Eosinofílica , Feminino , Seguimentos , Temperatura Alta , Humanos , Lactente , Masculino , Leite , Proteínas do Leite/imunologia , Estudos Retrospectivos , Adulto Jovem
18.
Acta Paediatr ; 107(7): 1247-1252, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29461665

RESUMO

AIM: To assess nutrient intake, growth and nutritional status of infants with cow's milk allergy (CMA) who follow a therapeutic elimination diet since the first few months of life. METHODS: Sixty infants younger than four months of age with challenge-proven CMA and 60 healthy age-matched children were investigated. Anthropometric and body composition (BC) were assessed up to 24 months. Dietary intake was recorded by the parents for three consecutive days before visits at 6, 12, 18 and 24 months. Blood albumin, prealbumin, retinol binding protein and metabolic-related hormones were examined at 24 months. RESULTS: The average age at enrolment was 2.9 ± 1.0 months. At the end of the follow-up, there were no differences in daily milk consumption, nutrient intake, weight and height z scores or BC measures between the groups; however, the plasma leptin level was lower in infants with CMA (1.67 ± 1.03 vs 2.05 ± 1.48) (ng/mL) (p < 0.05) compared to healthy children. CONCLUSIONS: Children with CMA who followed an elimination diet could achieve a normal nutritional status, except for relatively lower plasma leptin levels, at the age of 2. Further studies with larger cohorts and research on the long-term consequences of these early differences are needed.


Assuntos
Composição Corporal , Ingestão de Alimentos , Crescimento , Leptina/sangue , Hipersensibilidade a Leite/dietoterapia , Antropometria , Estudos de Casos e Controles , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Hipersensibilidade a Leite/sangue
19.
J Pediatr Gastroenterol Nutr ; 66(1): 135-140, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29095347

RESUMO

OBJECTIVES: Evaluation of a spoon-fed amino acid-based formula (AAF) with a yogurt-type texture compared to the reference oral liquid formula (Neocate). METHODS: Phase III/IV, prospective, randomized (1:1), open-label, multicenter study in infants/young children (6-36 months) with severe cow's milk protein allergy (CMA) who had consumed AAF for ≥1 month before the study. Patients received reference+test formula (Neocate with a yogurt-type texture for spoon-feeding: group 1) or reference formula (group 2) for 28 days. The study formulae were integrated into the patients' usual daily diet. Efficacy on Day 0, 14, and 28 was assessed primarily in terms of symptoms associated with CMA. The evolution of symptoms, amount of formula consumed, nutritional and energy intake, anthropometric data, and tolerability were also assessed. RESULTS: The incidence of CMA symptoms was similar in each group (P > 0.05) on day 0, 14, and 28. For specific symptoms, there was little change from day 0 and no significant difference between groups for incidence on day 0 or evolution at day 14 or 28. There was no difference in formula consumption (day 0-day 28) between groups (P = 0.90), but nutritional value was generally higher for group 1 and calcium intake was statistically higher for group 1 (P < 0.05). Weight-for-height, weight-for age, and body mass index-for-age z scores were higher for group 1 than group 2 (P < 0.05). Both formulae were well tolerated. CONCLUSIONS: There was no difference in efficacy, formula consumption, and tolerability between the new spoon-fed yogurt-type AAF formula and the reference formula, whereas significantly higher calcium intake was achieved with the new formula.


Assuntos
Aminoácidos , Fórmulas Infantis , Hipersensibilidade a Leite/dietoterapia , Iogurte , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Resultado do Tratamento
20.
Pediatr Emerg Care ; 34(1): e14-e15, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29210890

RESUMO

Inflammatory causes of bloody diarrhea during infancy include necrotizing enterocolitis and allergic colitis, often due to cow's milk protein. We report this case of cow's milk protein allergy, managed successfully with elimination of dietary antigen, to highlight the unusual finding of pneumatosis intestinalis on abdominal x-ray, a radiographic hallmark associated with necrotizing enterocolitis. Detailed patient's history, clinical presentation, and physical examinations are discussed for cow's milk protein allergy and necrotizing enterocolitis.


Assuntos
Enterocolite Necrosante/diagnóstico , Hipersensibilidade a Leite/diagnóstico , Animais , Colite , Diarreia/etiologia , Enterocolite Necrosante/etiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido , Masculino , Leite , Hipersensibilidade a Leite/complicações , Hipersensibilidade a Leite/dietoterapia
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