Actualización en manejo de Alergia a la proteína de leche de vaca: fórmulas lácteas disponibles y otros brebajes

Abstract

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.

Alergia a la proteína de leche de vaca. Enfoque diagnóstico y terapéutico

“…Al cumplirse 6 meses, el proceso de introducción de alimentación complementaria deberá realizarse retrasando el consumo de comidas con contenido de proteína de leche de vaca. Durante el tiempo de la dieta de eliminación de la madre, ella debe recibir asesoría nutricional, suplementación de 1000 mg de calcio al día y vitamina D 800 UI al día (50).…”

“…Entre tanto, las FAA se desarrollan para superar la hipersensibilidad contra las proteínas residuales en la FEH, particularmente en casos con enteropatía grave o con múltiples alergias alimentarias (48). Por esta razón, las FAA pueden considerarse solo en lactantes con reacciones graves como anafilaxia, enteropatía, esofagitis eosinofílica, enterocolitis inducida por proteínas, junto con casos en los cuales existe un compromiso a nivel de múltiples sistemas, diferentes alergias alimentarias e intolerancia a las FEH (14,48,50).…”

“…También se ha observado que si la APLV aparece durante la infancia es menos severa en comparación con el uso de fórmulas o alimentación mixtas. La razón de este menor riesgo es que la leche materna posee 100 000 veces menos proteínas que la leche de vaca y, además, contiene inmunomoduladores (50).…”

Alergia a Proteína do Leite de Vaca em Crianças: Repercussões da Dieta de Exclusão Sobre o Estado Nutricional / Cow's Milk Protein Allergy in Children: Repercussions of Exclusion Diet on Nutritional Status

“…Em geral, a alergia alimentar inicia precocemente na vida com manifestações clínicas variadas 5 . É caracterizada por uma reação alérgica a uma ou mais proteínas do leite de Brazilian Journal of Development, Curitiba, v.8, n.1, p. 567-578 jan. 2022. vaca tendo um pico de incidência no primeiro ano de vida, que cai para menos de 1% em crianças com mais de 6 anos 6 .…”

Parents´ perception of allergic or food intolerant children in relation to disease

“…The usual treatment of CMPA is the total and/or definitive exclusion of cow's milk from patients' diets. However, a restricted diet in a child who does not require it or who has LI can alter growth and quality of life and produce unnecessary costs 10 .…”