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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.
Highlights
Cow'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
Pediatric gastroenterologists agreed with the diagnostic hypothesis of cow's milk allergy made by the referring pediatrician in 82.0% of the cases
Among patients who had suspected cow's milk allergy (n = 211) at first consultation, 49.3% were referred to the pediatric gastroenterologist having already been switched to a substitute infant diet
Summary
The incidence of food allergies has increased in several parts of the world, in developed countries [16]. Cow'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. Cow's milk and cow's milk-based infant formulas are the most frequently used substitutes for infants who are not breastfed. The growth and development of infants that are allergic to cow's milk may be compromised if an adequate substitute formula is not available [9,10,11,12]. The nutritional quality of cow's milk substitutes used for this group of
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