Perinatal factors associated with the development of cow's milk protein allergy

Abstract

The prevalence of cow's milk protein allergy (CMPA) has increased in recent years, and is associated with antimicrobial use during the perinatal period, prematurity, the type of childbirth, and the decrease in breastfeeding. The aim of this study was to analyze whether there is any association between these factors and the development of CMPA. Material and methods: A retrospective, comparative, cross-sectional, observational study was conducted by reviewing the case records of 101 children diagnosed with CMPA and seen at the Department of Gastroenterology and Nutrition of the Instituto Nacional de Pediatría within the time frame of January 2012 and August 2013. The following variables were included: age, sex, weeks of gestation, history of maternal infection and antimicrobial use during the pregnancy, type of delivery, and feeding with human milk, and its duration. Likewise, the case records of 90 children were reviewed as a control group on not having CMPA or any other allergy. The chi-square test was used for proportions, and the Mann-Whitney U test was used for comparing means in the statistical analysis. Results: The factors associated with CMPA were the use of antimicrobials during gestation and breastfeeding duration in months. Both factors were statistically significant (P < .001). No association was found between CMPA and gestational age or type of delivery. Conclusions:The statistically significant associated factors were breastfeeding duration and the use of antimicrobials during the gestational stage. These results underline the necessity for prospective studies.Alergia a las proteínas de la leche de vaca; Prematuridad; Lactancia materna; Césarea; Antibióticos Factores perinatales asociados al desarrollo de alergia a las proteínas de la leche de vaca Resumen La alergia a las proteínas de la leche de vaca se ha incrementado en los últimos años, asociado al uso de antimicrobianos en el periodo perinatal, prematuridad, el tipo de nacimiento y la disminución de la lactancia materna. El objetivo de este estudio fue analizar si existe alguna asociación entre estos factores y el desarrollo de alergia a las proteínas de la leche de vaca (APLV). Material y métodos: Estudio comparativo, retrospectivo, transversal, observacional. Se revisaron los expedientes de 101 niños con diagnóstico de APLV que asistieron al Departamento de Gastroenterología y Nutrición del INP de enero de 2012 a agosto de 2013. Se incluyeron las siguientes variables: edad, sexo, semanas de gestación, antecedente de infecciones y uso de antimicrobianos en la madre durante el embarazo, tipo de parto, alimentación con leche materna y duración de la misma. Así mismo se revisaron los expedientes de 90 niños como grupo control sin APLV ni otro tipo de alergias. Para el análisis estadístico se utilizo prueba de Chi cuadrado para proporciones o U-Mann-Whitney en el caso de comparación de medias. Resultados: Se encontró que los factores asociados a APLV fueron el uso de antimicrobianos en la etapa gestacional y la duración en meses de la lactancia ma...

Induced Proctocolitis - Oral Food Challenge Should Be Done to Confirm the Diagnosis of Cow’s Milk Allergy in Neonates?

“…Toro et al (22) observed a statistically significant association between CMA and the use of antibiotics in the last trimester of pregnancy and the duration of breastfeeding, but not with gestational age and type of delivery. Tsaubori et al (23) , on the other hand, in a review article report that patients delivered by cesarean section, use of parenteral nutrition and the hospitalization of preterm newborns play a key role in developing altered microbiota (dysbiosis), which can be risk factors for CMA.…”

“…According to the literature, about half of cases of FPIPC in infants occur during exclusive breastfeeding (1) . However, the studies published on rectal bleeding in neonates (20)(21)(22) do not include samples with most preterm infants, as described in our study.…”

“…Recently published CMA guidelines (14,30) recommend an elimination period for diagnostic purposes for 2 to 4 weeks and OFC following improvement of symptoms. Among studies that also evaluated rectal bleeding and OFC, length of the elimination diet period varied between 2 to 9 weeks and 12-18% positive OFC (20)(21)(22) . Although our study included the largest number of neonates with rectal bleeding who underwent OFC tests (20)(21)(22) , our sample consisted of infants referred already on an elimination diet with the diagnostic of CMA and neonates hospitalized for complications of prematurity, we did not control the time of the elimination diet before OFC, which implied maintaining an expensive diet in many patients who might not need this diet.…”

“…Among studies that also evaluated rectal bleeding and OFC, length of the elimination diet period varied between 2 to 9 weeks and 12-18% positive OFC (20)(21)(22) . Although our study included the largest number of neonates with rectal bleeding who underwent OFC tests (20)(21)(22) , our sample consisted of infants referred already on an elimination diet with the diagnostic of CMA and neonates hospitalized for complications of prematurity, we did not control the time of the elimination diet before OFC, which implied maintaining an expensive diet in many patients who might not need this diet. It is a limitation of our study because it is not possible to say that the patients did not have CMA as a diagnosis, as these patients could have already developed tolerance.…”

“…Finally, a Korean study (21) with 16 neonates with rectal bleeding without other associated symptoms diagnosed CMA using OFC in only 2/16 (12%). Some factors may be associated with CMA, such as gestational age (22)(23)(24)(25) , the use of antibiotics in the third trimester of pregnancy (22,24,25) , type of diet (exclusive breastfeeding, mixed feeding or formula feeding from the start (22,24,25) and the type of delivery (22)(23)(24)(25)(26) . Although it hasn't been proved yet, other factors may also have an influence on CMA, such as mechanical ventilation (23,27,28) and parenteral nutrition (27,28) , as they may alter intestinal microbiota composition (dysbiosis) and may be associated with the development of food allergy.…”