Atopic Dermatitis and Food Allergy Change of Concepts - Ralf Heine
Clinical aspects Diagnosis Objetivos: La alergia a proteínas de leche de vaca PLV atopic dermatitis baby diet la edad en la que se presenta y el tratamiento que requiere exige un diagnóstico de certeza para evitar etiquetar al lactante de falsamente alérgico sometiéndolo a dietas innecesarias.
Se trata de un estudio multicéntrico realizado en las unidades de alergia de 14 Hospitales infantiles para conocer las características epidemiológicas, clínicas y evolutivas de la alergia a proteínas de leche de vaca APLV.
Nat Med5, — Merck Research Laboratories18th ed. Pharmaceutical Press. Electronic version, Internist38,
Material y métodos: Se estudiaron a los niños con sospecha de APLV que acudieron a las consultas de alergia de los hospitales participantes, en el vörös fájó folt a lábán del estudio, realizándoles a todos ellos una detallada historia clínica, Prick-test con leche de vaca y sus proteínas y determinación de anticuerpos IgE específicos mediante CAP para los mismos alergenos del Prick.
Se llevó a cabo la prueba de provocación con leche de vaca de no estar contraindicada según el protocolo diagnóstico.
Se utilizaron dos pautas de provocación distintas una de ellas llevada a cabo en 3 días y la otra en un día. Las dos pautas de provocación utilizadas fueron igualmente seguras. La edad media de la reacción con formula de leche de vaca tuvo lugar a los 3. Conclusiones: El realizar un protocolo diagnóstico adecuado en los niños que consultan por sospecha de CMPA permite descartar la alergia en un alto porcentaje de casos.
Subscribe to our newsletter
Distinction is made between allergic hypersensitivity, which is those reactions where an immunological mechanism is detected, and within these IgE-mediated and non-IgE-mediated allergy, depending on their mechanism. Non-allergic hypersensitivity reactions would be those in which the immunological mechanism is excluded 1.
Cow's milk proteins occupy the third place in frequency as a cause of food allergy during infancy, after eggs and fish 2.
Although it is not the most frequent cause of food allergy, cow's milk attracts the paediatrician's attention as it is the first food foreign to its species with which the infant comes into contact, after breast feeding or from the first day of life when this is not possible.
Development of sensitization and cow's milk protein allergy CMPA depend on the interaction between genetic predisposition and factors of exposure to cow's milk proteins antigen dose, nature of the antigen, the mother's dietary exposure during pregnancy, transmission of cow's milk proteins CMP through the mother's milk, frequency of administration, etc 3.
The data provided by the international literature about its incidence are very varied, due to conceptual differences, diagnostic methodology, and ages studied, and they range between 0. In one of the most recent prospective studies published internationally and carried out in Denmark by Host et al, an incidence of allergy mediated by IgE to CMP of 1. In a prospective study carried out in the Valencia Region, an incidence of 0.
Figures below those observed recently in babies born at Hospital Infantil La Paz over a period of one year, for whom an incidence of at least 1. So as to improve our knowledge about this important food allergy, the Food Allergy Committee of the Spanish Society of Clinical Immunology and Paediatric Allergology decided to start up a clinical and diagnostic and monitoring study of infants affected by CMPA.
It is a multi-centre study in which the Paediatric Allergy Sections of 14 Hospitals took part. In this study we refer to infants with CMPA. The cases of intolerance to other cow's milk products e.
Az allergiamegelőzés korszerű irányelvei, lehetőségei csecsemőkorban
This prospective study set the following objectives: 1. Evaluate various epidemiological factors relating to the appearance of CMPA: history of atopy, age of onset, and type of feeding. Observe how it is presented and what its clinical manifestations are.
Study the value of the skin tests and the determination of milk-specific serum IgE and its fractions in diagnosis, as well as the indication and the usefulness of the challenge test in the diagnosis of immediate hypersensitivity to CMP in the infant. See whether there are other food sensitizations beef, soy, egg and fish and their clinical relevance. Prospective study of the natural history of CMPA, to see at what age tolerance is established and its possible association with other allergic conditions asthma, rhinitis etc.
This is the first publication of this work and refers to the first two points of the aims mentioned. Procedures The full past medical history was recorded and a complete physical examination performed.
Allergologia et Immunopathologia
Reactions were read at 15 minutes. A net wheal diameter 3 mm larger than that produced by the negative control was considered positive. The test was atopic dermatitis baby diet positive when a result of 0.
Challenge test: Open controlled challenge tests with cow's milk were carried out with a formula of cow's milk adapted to the age of the patient. Two regimens freely chosen by the investigators were used: Regimen A first day: 2 ml, 5 ml,10 ml; second day: 25 ml, 50 ml; third day: ml and the last atopic dermatitis baby diet to complete the quantity equivalent to one normal feed were given at minute intervals.
Regimen B in a single day, successive doses of 2 ml, 5ml, 10 ml, 25 ml, 50 ml, ml. If a clinical reaction appeared, the challenge was discontinued, and treatment was provided if necessary.
The challenge was considered to be positive when there were skin urticaria, angioedema, or erythematous rashgastrointestinal vomiting or diarrhoearespiratory rhinoconjunctivitis or bronchospasmsor generalized anaphylactic shock manifestations in the 2 hours after the intake of the food.
Appearance of symptoms in the first 60 minutes after intake.
Less than 3 months since the last clinical reaction.