Diagnosis and management of Non-IgE gastrointestinal allergies in breastfed infants-An EAACI Position Paper. Miércoles 9 de octubre
Diagnosis and management of Non-IgE gastrointestinal allergies in breastfed infants-An EAACI Position Paper.
Authors: Meyer R1, Chebar Lozinsky A2, Fleischer DM3, Vieira MC4, Du Toit G5, Vandenplas Y6, Dupont C7, Knibb R8, Uysal P9, Cavkaytar O10, Nowak-Wegrzyn A11, Shah N12, Venter C3.
Author information
1 Department Paediatrics, Imperial College London, London, UK.
2 Department of Allergy and Immune Disorders, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
3 Children's Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, CO, USA.
4 Department of Paediatrics, Pontifical Catholic University of Paraná, Center for Pediatric Gastroenterology, Hospital Pequeno Príncipe, Curitiba, Brazil.
5 Department of Pediatric Allergy, Division of Asthma, Allergy and Lung Biology, King's College London and Guy's and St. Thomas' National Health Service Foundation Trust, London, UK.
6 KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
7 Department of Paediatric Gastroenterology, Necker University Children Hospital, Paris, France.
8 Department of Psychology, Aston University, Birmingham, UK.
9 Department of Allergy and Clinical Immunology, Adnan Menderes University, Aydin, Turkey.
10 Department of Pediatric Allergy and Immunology, Istanbul Medeniyet University, Medical Faculty, Goztepe Training and Research Hospital, Istanbul, Turkey.
11 Icahn School of Medicine at Mount Sinai, Jaffe Food Allergy Institute, New York, New York, USA.
12 Department Gastroenterology, Great Ormond Street Hospital London, London, UK.
Abstract
It is well-established that food proteins, such as egg, soya, cow's milk and wheat, are detectable in breastmilk for many hours or days after ingestion. Exposure to these proteins is important to the process of developing tolerance but can also sometimes elicit IgE-mediated and non-IgE-mediated allergic symptoms in breastfed infants. Non-IgE-mediated allergy, outside of food protein-induced allergic proctocolitis and eosinophilic oesophagitis, is not well understood, leading to variations in the diagnosis and management thereof. A primary objective of the European Academy for Allergy and Clinical Immunology is to support breastfeeding in all infants, including those with food allergies. A Task Force was established, to explore the clinical spectrum of non-IgE-mediated allergies, and part of its objectives was to establish diagnosis and management of non-IgE-mediated allergies in breastfed infants. Eight questions were formulated using the Patient, Intervention, Comparison, Outcome (PICO) system and Scottish Intercollegiate Guideline Network (SIGN) criteria for data inclusion, and consensus was achieved on practice points through the Delphi method. This publication aims to provide a comprehensive overview on this topic with practice points for healthcare professionals.
DOI: 10.1111/all.13947
Como lo informan en este artículo, la endoscopia se ha usado como un método objetivo de diagnosticar diversas afecciones alérgicas no mediadas por IgE, acá se cita un estudio realizado en el 2015 por Shah N. et al., en el que se analizaron biopsias de niños menores de un año realizadas por sospecha de alergia alimentaria, el resultado de este estudio mostró que en general, el 62% (344/554) tuvo hallazgos anormales en la biopsia de la mucosa, la edad fue un factor de confusión importante ya que se encontró una mayor probabilidad de una biopsia anormal en niños más pequeños, la combinación de síntomas aumentó la probabilidad de biopsias anormales como diarrea e irritabilidad en los que el 90% tuvieron una biopsia anormal. El uso de endoscopia es difícil, ya que en este grupo etario se requiere anestesia general y los datos actuales demuestran que los patrones de síntomas específicos en la presentación están asociados con un rendimiento variable de hallazgos histológicos anormales por lo que no se recomienda de rutina, su uso se limita para diagnósticos diferenciales (excepto en el caso de EOE) (1). Sería interesante haber obtenido un reporte de los efectos adversos de realizar este estudio en pacientes de esta edad para así tener un mejor análisis de los riesgos y beneficios en la práctica clínica de usar este método diagnóstico.
ResponderEliminar1. Shah N, Foong R‐X, Borrelli O, et al. Histological findings in infants with Gastrointestinal food allergy are associated with specific gastrointestinal symptoms; retrospective review from a tertiary centre. BMC Clin Pathol. 2015; 15: 12.