Características clínicas y manejo de lactantes menores de 1 año con sospecha de alergia a proteína de leche de vaca

Abstract

IntroductionCow's milk protein allergy (CMPA) is highly prevalent in infants (2-5%). It has a wide clinical spectrum, and confirmation through an oral food challenge (OFC) is relevant for its differential diagnosis. Information on this topic is scarce in Chile. ObjectiveTo describe the demographic and clinical features of infants with suspected CMPA. Patients and MethodA retrospective study of patients<1 year-old, treated for suspected CMPA between 2009 and 2011. Demographic data, symptoms of atopy, nutrition at the time of diagnosis, CMPA symptoms, diagnostic studies, and response to treatment were recorded. Diet response at least 4 weeks after milk modification, and clinical behavior when suspected foods were added back to the diet were considered standard diagnostic criteria. Descriptive statistics were performed using Epiinfo ™ software. ResultsThe study included 106 infants, of whom, 51% male, 80% term newborns, 74% with≥1 atopic parent, and 34% with ≥1 parent/sibling with food allergy. The median age at onset of symptoms was 1.5 months (range 1.5-2m). Almost half (46%) were breast-feeding≥6m, with 15% receiving formula milk since the neonatal period, and 49% before the third month. Common symptoms were: vomiting (63%), colic (49%), and bleeding on passing stools (41%). No anaphylaxis was identified, and 61% had≥2 symptoms at debut. Only 34% were subjected to OFC. The most frequently requested tests were, test patch (43%), prick test (40%), and blood in stools (37%). Treatment: 43% breast feeding with exclusion diet, 24% extensively hydrolysed formula, 26% amino acid formula, and 7% others. ConclusionDemographic characteristics and risk factors were similar to those previously described in international literature. Clinical presentation was early in life, and digestive symptoms predominated. OFC was underused for diagnosis, and most of the tests requested did not change management.