this study showed that the cut-off point detected for whole cow's milk revealed a better discriminatory capacity for CMA diagnosis without the necessity of the milk components testing.

OBJECTIVES:The aim of this cross-sectional study was to evaluate whether interleukin 10 (IL10) and transforming growth factor β1 (TGFβ1) gene polymorphisms were associated with persistent IgE-mediated cow's milk allergy in 50 Brazilian children. The diagnostic criteria were anaphylaxis triggered by cow's milk or a positive double-blind, placebo-controlled food challenge. Tolerance was defined as the absence of a clinical response to a double-blind, placebo-controlled food challenge or cow's milk exposure.METHOD:The genomic DNA of the 50 patients and 224 healthy controls (HCs) was used to investigate five IL10 gene polymorphisms (-3575A/T, -2849A/G, -2763A/C, -1082G/A, -592C/A) and one TGFβ1 polymorphism (-509C/T).RESULTS:Among the five IL10 polymorphisms analyzed, homozygosis for the G allele at the -1082 position was significantly higher in the patients compared with the healthy controls (p = 0.027) and in the persistent cow's milk allergy group compared with the healthy controls (p = 0.001).CONCLUSIONS:Homozygosis for the G allele at the IL10 -1082G/A polymorphism is associated with the persistent form of cow's milk allergy.

The proposed adaptation for the DBPCFC allowed to implement this important test for the diagnosis of IgE-mediated CMA in a reference centre for paediatric allergies. It was considered feasible and safe if performed in an appropriate setting with physician supervision.

Baked milk can be tolerated by patients with CMA, especially those with lower levels of casein and α-lactalbumin. This option can improve quality of life and accelerate tolerance.

Objective: To evaluate the ability of relatives of patients with cow's milk allergy to identify terms related to cow's milk on labels of manufactured products.Methods: Cross-sectional descriptive study based on interviews with relatives of patients with cow's milk allergy. Initially, a questionnaire about the habit of reading labels and the identification of terms related to cow's milk was applied. Next, 12 original labels of manufactured products were shown to the interviewees so that they could decide whether to exclude or not those products from the patient's diet.Results: Of the 52 interviewees, 80.8% were mothers and 79.0% had at least 8 years of schooling. The median time of follow-up after receiving information about exclusion diet was 2 years and 7 months (from 3 months to 17 years and 6 months). The habit of reading labels of foods, drugs and cosmetics was reported by 57.7, 59.6, and 46.2% of the relatives, respectively. Among the allergic reactions during follow-up, 39.5% were related to mistakes when reading labels. Lactose, casein, and caseinate were the terms identified by 92.3, 38.5, and 23.1% of the family members, respectively. Lactate was interpreted as presence of cow's milk by 51.9% of the interviewees. During the second phase of the study, family members identified lactose (55.8%), casein (26.9%) and caseinate (5.8%) as related to cow's milk.Original Article de alimentos, medicamentos e cosméticos foi relatada por 57,7%, 59,6% e 46,2% dos familiares, respectivamente. Entre as reações alérgicas ocorridas no seguimento, 39,5% foram relacionadas a erros na leitura de rótulos. Lactose, caseína e caseinato foram os termos identificados por 92,3%, 38,5% e 23,1% dos familiares, respectivamente. Lactato foi interpretado como presença de leite de vaca por 51,9% dos entrevistados. Na segunda etapa, os familiares identificaram a lactose (55,8%), a caseína (26,9%) e o caseinato (5,8%) como substâncias relacionadas ao leite.Conclusões: Constatou-se deficiente compreensão e identificação, por parte dos pais, dos termos relacionados ao leite apesar das orientações recebidas. É fundamental a adequação da rotulagem e a adoção de novas estratégias para orientação da leitura de rótulos, possibilitando a busca e a identificação de produtos que contenham leite de vaca.Palavras-chave: hipersensibilidade alimentar; hipersensibilidade a leite; rotulagem de alimentos; pais; conhecimento; alimentos industrializados.

Background Although there are simple and low-cost measures to prevent healthcare-associated infections (HAI), they remain a major public health problem. Quality issues and a lack of knowledge about HAI control among healthcare professionals may contribute to this scenario. Aim To present the implementation of a project to prevent HAI in intensive care units (ICU) using the quality improvement (QI) collaborative model Breakthrough Series (BTS). Methods A QI report was conducted to assess the results of a national project in Brazil between January/2018 and February/2020. A one-year pre-intervention analysis was conducted to determine the incidence density baseline of the three main HAI: central line-associated bloodstream infections (CLABSI), ventilation-associated pneumonia (VAP), and catheter-associated urinary tract infections (CA-UTI). The BTS methodology was applied during the intervention period to coach and empower healthcare professionals providing evidence-based, structured, systematic, and auditable methodologies and QI tools to improve patients’ care outcomes. Results A total of 116 ICUs were included in this study. The three HAI showed a significant decrease of 43.5%, 52.1%, and 65.8% for CLABSI, VAP, and CA-UTI, respectively. A total of 5,140 infections were prevented. Adherence to bundles inversely correlated with the HAI incidence densities: CLABSI insertion and maintenance bundle (R = -0.50, P-value = 0.010 and R = -0.85, P-value <0.001, respectively), VAP prevention bundle (R = -0.69, P-value <0.001), and CA-UTI insertion and maintenance bundle (R = -0.82, P-value <0.001 and R = -0.54, P-value = 0.004, respectively). Conclusion Descriptive data from the evaluation of this project show that the BTS methodology is a feasible and promising approach to preventing HAI in critical care settings.

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Objective: To evaluate the wheal diameter in allergy skin-prick tests (SPT) with cow's milk extract (CM) comparing tolerant and persistent patients. Method: A retrospective cohort study involving database analysis of children with diagnosis of cow's milk protein allergy (CMPA) mediated by immunoglobulin E in a specialized outpatient clinic that regularly performed SPT between January 2000 and July 2015. Patients were allocated into two groups: tolerant or persistent. Comparisons were made at diagnosis and over time between tolerant and persistent patients using Fisher's, Mann-Whitney or Wilcoxon tests and significance level at 5%. Results: After applying inclusion and exclusion criteria, the sample includes 44 patients (29 tolerant and 15 who persisted with CMPA). In the tolerant group, the medians of SPT were: 6 mm at diagnosis and 2 mm at the development of tolerance; a significant difference (p<0.0001) was found. In the persistent group, the median SPT at diagnosis was 7 mm, while in the last SPT it was 5 mm, with no statistical difference (p=0.173). The comparison of medians in the last SPT between groups was significant (p=0.001), with a reduction greater than 50% in SPT in the tolerant group. Conclusion: Serial SPTs were useful for diagnosis, and a decrease higher than 50% in diameter can indicate the moment to perform oral food challenge (OFC) tests, helping to detect tolerance in CMPA.