scholarly journals Nutritional Management With a Casein-Based Extensively Hydrolysed Formula in Infants With Clinical Manifestations of Non-IgE-Mediated CMPA Enteropathies and Constipation

2021 ◽  
Vol 2 ◽  
Author(s):  
Mikaela Sekkidou ◽  
Leilani Muhardi ◽  
Constantina Constantinou ◽  
Urszula Kudla ◽  
Yvan Vandenplas ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Case Series ◽  
Cow’S Milk ◽  
Nutritional Management ◽  
Term Infants ◽  
Specific Product ◽  
Cow's Milk ◽  
Case Series Report ◽  
Ige Mediated

Background: The majority of mixed-fed infants with non-IgE-mediated cow's milk protein allergy (CMPA) enteropathies are managed with an extensively hydrolysed cow's milk based infant formula (eHF). Given the high variability in peptide distribution of available eHFs, it is important to understand the suitability of a specific product in the management of distinct phenotypes.Objective: To assess the symptom resolution of various phenotypes of clinical manifestations of CMPA enteropathies and constipation managed by a casein-based eHF.Methods: The data of 20 full-term infants (n = 15 with non-IgE-mediated CMPA and n = 5 with constipation) attending a paediatric allergy clinic in Cyprus and managed with a casein-based eHF were retrospectively analysed.Results: Based on the clinical symptoms and history, infants were classified into the following phenotypes: (a) 11/15 (73.3%) FPIAP, (b) 3/15 (20%) FPIES, and (c) 1/15 (6.7%) severe diarrhoea. Overall, 14 (93.3%) patients were successfully managed with the casein-based eHF and 1 (6.7%) required an AAF. This formula was effective in 91% of patients with FPIAP, in 100% with FPIES and with diarrhoea. Three (60%) patients with constipation responded to the eHF.Conclusion: This case-series report supports the efficacy of a particular casein-based eHF for the nutritional management of non-IgE mediated CMPA enteropathies.

Alergia à Proteína do Leite de Vaca Persistente em Adulto: Relato de Caso / Persistent Cow’s Milk Allergy in Adult: Case Report

1970 ◽  
Vol 5 (4) ◽  
pp. 51-60
Author(s):  
José Henrique Pereira Pinto ◽  
Renan Lemos de Toledo ◽  
William do Prado Franquelo
Keyword(s):  
Immune Response ◽  
Case Report ◽  
Inflammatory Disease ◽  
Clinical Manifestations ◽  
Milk Proteins ◽  
Cow’S Milk ◽  
Cow's Milk ◽  
Current Prevalence ◽  
Keywords Allergy ◽  
Ige Mediated

RESUMOIntrodução: Alergia à Proteína do Leite de Vaca (APLV) é uma doença inflamatória secundária à reação imunológica contra uma ou mais proteínas do leite de vaca (LV) que afeta principalmente a faixa pediátrica. A real prevalência é discutida em muitos estudos. As manifestações clínicas dependem do tipo da resposta imunológica, ser IgE mediada ou não. Os sintomas se iniciam por volta dos 06 meses de vida e na maioria dos casos, esse processo alérgico regride, com o paciente desenvolvendo tolerância até a adolescência. Casuística: Relata-se um caso de um paciente do sexo masculino, apresentando desde os 6 meses de idade de anafilaxia e broncoespasmo. Nesta época foi levado em hospitais e ambulatórios sendo diagnosticado e tratado como asma apenas, porém sem sucesso. Aos 18 anos, em consulta com especialista foi diagnosticado com APLV, apesar da dieta de exclusão, apresentou diversas reações anafiláticas, devido a ingestão acidental do alérgeno. Discussão: O paciente iniciou os primeiros sintomas quando houve contato com LV e apresentou teste laboratorial com valores compatíveis a patologia. Segundo a literatura a prevalência de APLV cai para menos de 1% aos 6 anos de vida e está persistência pode estar associada a múltiplos fatores, no caso relatado, o paciente não apresentou tolerância até o presente momento. Conclusão: APLV é uma doença usualmente de criança em que, se estas não adquirirem tolerância, complicações podem perdurar indefinidamente. O Diagnóstico precoce e o manejo adequado desta condição, revela grande importância na qualidade de vida e na prevenção de anafilaxia.Palavras chave: Alergia, Proteína do leite de vaca, Anafilaxia. ABSTRACT Introduction: Allergy to cow's milk (CMPA) is an inflammatory disease Introduction: Allergy to cow's milk (CMPA) is an inflammatory disease secondary to immune response against one or more cow's milk proteins (LV) which primarily affects pediatric patients. The current prevalence is discussed in many studies. The clinical manifestations depend on the type of immune response, being IgE mediated or not. Symptoms start at about 06 months of life and in most cases, the allergic process subsides, and the patient develops tolerance through adolescence. Case Report: We report the case of a male patient, who was presenting, since his 06 months of age, anaphylaxis and bronchospasm. At that time he was taken into hospitals and clinics being diagnosed and treated as asthma, but without success. At 18, in consultation with expert was diagnosed with CMPA, and despite the exclusion diet, presented several anaphylactic reactions due to accidental ingestion of the allergen. Discussion: The patient began the first symptoms when there was contact with LV and presented laboratory test values compatible with the pathology. According to the literature the prevalence of CMPA drops to less than 1% to 6 years of life and this persistence can be associated with multiple factors, in our case, the patient did not develop tolerance to date. Conclusion: CMPA is usually a child disease but ,if they do not acquire tolerance, complications can last indefinitely. Early diagnosis and appropriate management of this condition, reveals a great deal on quality of life and prevention of anaphylaxis. Keywords: Allergy, Cow’s milk protein, Anaphylaxis. 

Phenotypes and natural history of food protein‐induced enterocolitis syndrome in the east Mediterranean region

2020 ◽  
Vol 41 (6) ◽  
pp. 420-427 ◽  
Author(s):  
Melike Ocak ◽  
Ayşegül Akarsu ◽  
Umit Murat Sahiner ◽  
Ozge Soyer ◽  
Bulent Enis Sekerel
Keyword(s):  
Clinical Symptoms ◽  
Emergency Department Visits ◽  
Interquartile Range ◽  
Cow’S Milk ◽  
Food Protein ◽  
Cow's Milk ◽  
Hen’S Egg ◽  
History Of ◽  
Ige Mediated ◽  
East Mediterranean Region

Background: Food protein‐induced enterocolitis syndrome (FPIES) is a rare non-IgE mediated food allergy. Objective: To delineate the differences in the spectrum of culprit foods, remission patterns, and predictors among varying cultures. Methods: We reviewed demographics, culprit foods, outcomes, and predictors in 81 children with a diagnosis of FPIES who were followed up between 2015 and 2020. Results: Eighty-one patients (55.6% boys) were enrolled, including 72 with acute FPIES and 9 with chronic FPIES. Hen’s egg was the most common culprit food (36.6%), followed by fish (26.9%), and cow’s milk (21.5%). Interestingly, cow’s milk was significantly prevalent in chronic FPIES cases (p = 0.006). The most common clinical symptoms were vomiting (100%), pallor (63.4%), and lethargy (55.9%). Emergency department visits were noted in 39 patients (41.9%), of whom 37 (39.8%) were treated with intravenous (IV) fluid. The subjects were followed up for a median (interquartile range) of 19.4 months (12.3‐41.2 months), and 26 subjects (32.1%) achieved tolerance. The median (interquartile range) age at tolerance was 2.5 years (2.1‐3.2 years). With regard to the culprit foods, hen’s egg was observed more frequently in the subjects with resolved FPIES cases (p = 0.008), whereas fish FPIES cases were high in the persistent group (p = 0.001). IgE sensitization of the culprit food was found to be an independent risk factor for the persistence of FPIES (odds ratio 4.855 [95% confidence interval, 1.131‐20.844]; p = 0.034). Conclusion: In our cohort, unlike other published series, hen’s egg and fish were the two most common culprit foods. Fish differed from other culprit foods, with significantly delayed onset and persistence, and may create a model that allows for the understanding of the disease.

scholarly journals Assessment of IgE-Mediated and Non-IgE-Mediated Cow’s Milk Protein Allergy in Children

2019 ◽  
Vol 25 (3) ◽  
pp. 129-131
Author(s):  
Balasa Adriana ◽  
Mihai Cristina ◽  
Pruna Irina ◽  
Chisnoiu Tatiana ◽  
Daineanu Diana ◽  
...  
Keyword(s):  
Primary Care Physicians ◽  
Milk Protein ◽  
Immunoglobulin E ◽  
Clinical Manifestations ◽  
Specific Ige ◽  
Cow Milk ◽  
Cow’S Milk ◽  
Cow's Milk ◽  
Ige Mediated ◽  
Cow’S Milk Protein

Abstract Cow’s milk protein allergy (CMPA) is the most common food allergy found in children under 3 years of age. In most cases, it occurs in infancy. Early diagnosis and appropriate treatment can decrease the risk of impaired growth. In our study, we evaluated 40 children, with ages between 1 month and 3 years, diagnosed with IgE-mediated or non-IgE-mediated CMPA, from january to december 2017, in the Department of Pediatrics of the Clinical Emergency County Hospital of Constanta. The inclusion criteria consisted of: age, natural or artificial feeding, specific IgE levels, CoMiSS score, and clinical manifestations. The Cow’s Milk-related-Symptom-Score (CoMiSS) was developed as a screening and diagnostic tool for CMPA prediction, and can guide pediatricians and primary care physicians to make an early diagnostic, as it can be easily missed. We observed a higher number of cases of CMPA registered among children who were artificially fed (57,5%), followed by those with mixed nutrition (25%), the remaining (17,5%) being represented by exclusively breastfed infants. The most frequent clinical manifestations were rashes (87,5%), failure to thrive (82,5%), regurgitation (50%) and diarrhea (35%). Further data should be collected to prove if the association between a CoMiSS score higher than 12 and specific IgE-mediated CMPA is clinically relevant, and can predict, based on clinical examination and anamnesis, high serum levels of specific immunoglobulin E. The prognosis can depend on the titre of specific IgE at the time of diagnosis, as they are more likely to develop several crossed allergies and less prone to become tolerant to cow milk proteins than those with non-IgE-mediated CMPA.

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