437 Association between Cows Milk Allergy and Gastroesophageal Reflux Disease on Mexican People

Abstract

BackgroundThe World Allergy Organization estimates 520 million people with food allergy on the world. The data that support the prevalence fluctuate in relation of the method employed to obtain these, for example, questionnaires, measurements of IgE-specific, oral challenges; the last one is considerate the gold standard. Similar situation occur to allergy to cow´s milk (CMA), the prevalence reported is 1 to 17.5% in preschoolers, 1 to 13.5% in 5 to 16-year-olds, and 1 to 4% in adults. About 40% of infants referred for specialist management of Gastroesophageal Reflux Disease (GERD) have CMA. This situation increases to 56% in severe cases. These allergic reactions are typically not IgE-mediated. The gold standard for GERD is the pH measurement in 24 hours (specificity 100%), exist other test more accessible, with considerable sensivity (80%) like scintigraphy.MethodsThe objective was determinate the frequency of GERD in patients with IgE-mediated CMA. We evaluated retrospectively 20 patients with IgE-mediated CMA of a group of 47 patients with food allergy between 6 months to 39 years aged. They had one or more IgE-specific to proteins that are considered major allergens: casein, beta-lactoglobulin (BLG) or alpha-lactalbumin (A-LA). All the patients had study to discard GERD, through by scintigraphy (study with more access in our Institute). Patients with CMA and negative scintigraphy, had pH measurement. We made 3 groups each one to represent the positivity of IgE-specific to major allergens and these were associated with the presence or absence of GERD.ResultsGERD was found in 80% of patient with CMA. 77.8% of patients with IgE to casein had GERD diagnosed by scintigraphy (P < 0.008) Likelihood ratio obtained for this relationship was 7; 70% of patients with IgE to A-LA have GERD (P < 0.03), the likelihood ratio was 4. No significant difference was found between the presence of IgE to BLG and GERD. Additionally, we found that 40% of patients with food allergy without CMA presented GERD.ConclusionsWe found high association between IgE-mediated CMA and evidence of GERD on Mexican people opposed to previous literature.

Narrative review of the role of inflammation in gastroesophageal reflux disease. Can food allergies play a part?

“…The link between CMA and GORD symptoms in infants is widely recognized in the literature, with 40% of infants referred for specialist management of GORD receiving a diagnosis of CMA 31–33 with IgE and/or non‐IgE involvement 23,34 . However, the research into similar mechanisms occurring in older children or adults is limited.…”

“…Up to 70% of infants with CMA are found to have hypersensitivity to unrelated food proteins after 5 years, 24 with 20–50% of older children demonstrating clinical symptoms of persistent food allergy, 36 while 40% of adults with identified non‐CM food allergies present with GORD 32 . Therefore, there is evidence to demonstrate that food allergies may progress into later life, as well as enter remission.…”