A survey on clinical presentation and nutritional status of infants with suspected cow' milk allergy

Abstract

BackgroundCow's milk is the most common food allergen in infants and the diagnosis of cow's milk allergy is difficult, even with the use of several diagnostic tests. Therefore, elimination diets and challenge tests are essential for the diagnosis and treatment of this disorder. The aim of this study is to report the clinical presentation and nutritional status of children evaluated by pediatric gastroenterologists for the assessment of symptoms suggestive of cow's milk allergy.MethodsAn observational cross-sectional study was performed among 9,478 patients evaluated by 30 pediatric gastroenterologists for 40 days in 5 different geographical regions in Brazil. Clinical data were collected from patients with symptoms suggestive of cow's milk allergy. The nutritional status of infants (age ≤ 24 months) seen for the first time was evaluated according to z-scores for weight-for-age, weight-for-height, and height-for-age. Epi-Info (CDC-NCHS, 2000) software was used to calculate z-scores.ResultsThe prevalence of suspected cow's milk allergy in the study population was 5.4% (513/9,478), and the incidence was 2.2% (211/9,478). Among 159 infants seen at first evaluation, 15.1% presented with a low weight-for-age z score (< -2.0 standard deviation - SD), 8.7% with a low weight-for-height z score (< -2.0 SD), and 23.9% with a low height-for-age z score (< -2.0 SD).ConclusionThe high prevalence of nutritional deficits among infants with symptoms suggestive of cow's milk allergy indicates that effective elimination diets should be prescribed to control allergy symptoms and to prevent or treat malnutrition.

Growth of Children with Food Allergy

“…A multicentre study performed in Brazil on a cohort of children with CMA depicted even higher levels of stunting and wasting in comparison to European and US studies, which might be explained by a higher prevalence of underweight children in Latin America per se. In addition, the majority of children were fed inappropriate substitutes [19]. As opposed to previously cited studies, some studies did show improvement in growth parameters in allergic children following dietary eliminations [20, 21].…”

Nutritional status of infants with cow's milk allergy who consume breast milk vs. hypoallergenic formula

“…Impaired absorption of nutrients for long periods due to chronic inflammatory mechanisms results in failure to thrive during infancy. [6][7][8] Therefore, it is advisable to consume hypoallergenic formula, such as partially hydrolyzed milk or breast milk to avoid malnutrition. 2 In this study, we found no differences in nutritional status of infants with CMA between those who consumed breast milk and those who consumed hypoallergenic formula.…”

Síntomas digestivos y respuesta clínica en lactantes con alergia a la proteína de leche de vaca

“…Se excluyeron historias clínicas de lactantes que no tuvieron prueba de eliminación y provocación abierta o que hubieran consultado por otras causas: síndrome de malabsorción, enfermedades metabólicas, hepáticas, renales, etc. 1,[3][4][5][6][7][8]10,[16][17][18][19][20]22,23,25,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] .La Información de las historias clínicas, fue recolectada del sistema de información HIS-ISIS ® del HU-FSFB y MEDSYS V4.0 ® de la Asociación Médica de los Andes (AMA), en un cuestionario. Se realizó una prueba piloto en 10 pacientes.…”

“…El problema radica en que el crecimiento y desarrollo psicomotor pueden verse comprometidos sin un adecuado diagnóstico y tratamiento 3,4 . El diagnóstico de APLV es difícil, y no existen pruebas diagnós-ticas sensibles ni específicas especialmente en el primer año de vida, por lo que las dietas de eliminación y las pruebas de provocación son esenciales para el diagnóstico 5 .…”

“…El cuadro clí-nico aunque es variable requiere un alto índice de sospecha 6 . No hay estudios suficientes en Colombia que muestren el comportamiento clínico ni la historia natural de la APLV en lactantes [3][4][5][6][7][8] .…”