Comparacion retrospectiva del manejo de la alergia a las proteinas de leche de vaca mediada por IgE en tres cohortes
Introduction Cow´s milk protein allergy (CMPA) is one of the first and most common food allergies reported in the paediatric population. It is also one of the main causes of anaphylaxis in the first two years of life(2). However, the management of CMPA is debated around the world. The majority of CM...
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| Tipo de recurso: | tesis doctoral |
| Estado: | Versión publicada |
| Fecha de publicación: | 2023 |
| País: | España |
| Institución: | Universidad de Valladolid |
| Repositorio: | UVaDOC. Repositorio Documental de la Universidad de Valladolid |
| OAI Identifier: | oai:uvadoc.uva.es:10324/63682 |
| Acceso en línea: | https://doi.org/10.35376/10324/63682 https://uvadoc.uva.es/handle/10324/63682 |
| Access Level: | acceso abierto |
| Palabra clave: | Alergias Allergy Alergia 32 Ciencias Médicas |
| Sumario: | Introduction Cow´s milk protein allergy (CMPA) is one of the first and most common food allergies reported in the paediatric population. It is also one of the main causes of anaphylaxis in the first two years of life(2). However, the management of CMPA is debated around the world. The majority of CMPA resolves spontaneously in childhood and hence many European countries recommend strict avoidance of all milk products. In Ireland, CMPA is treated using the milk ladder, with good results (3, 4). However, novel treatments have been published recently that could give a different approach to the management of CMPA. One of these treatments is the use of early OIT at the moment of diagnosis. This treatment option has been found to be safe and successful(5), and is suggestive of the possibility of a new management strategy for IgE-mediated CMPA in the future. Objectives and Endpoints: The primary objective is to compare the rate of succes reintroduction of milk of 3 different IgE-mediated CMPA treatment strategies. The secondary objectives are to evaluate the difference in symptomatology experienced during treatment and the follow-up carried out in the three cohorts, to compare the difference in outcome of the three treatments in CMPA IgE-mediated in patients who have other food allergies and to conduct an analysis of immunological values between the three cohorts. Methods This is a retrospective chart review of 600 paediatric patients from the population who have been treated for IgE-mediated CMPA between 2011 and 2020; with the milk ladder in Ireland; early reintroduction of pasteurized milk in Spain and with complete avoidance followed by an oral food challenge in Spain. Patients were diagnosed with IgE-mediated CMPA with typical symptoms and signs after cow's milk ingestion and confirmed by positive skin prick tests or a positive specific Ig-E for milk. Results Successful treatment was achieved in 439 (76.9%) of the patients of the whole sample. The proportion of success in the milk ladder group was 86.6% (95% confidence interval (CI): 80.6 – 90.9), similar to that obtained in the early gradual milk introduction group (96.0%; (95%CI: 92.3 – 98.0). Both strategies had a significantly higher success rate than milk avoidance (61.0%; 95%CI: 54.1 – 67.5). In the milk avoidance group a higher value of the Skin Prick Test was associated with a failure in the treatment (p<0.01). That difference wasn’t found in the other two groups. In the milk ladder group, a higher value of whole milk specific IgE was associated to a failure of the treatments. This was also seen in the milk avoidance group. Conclusion Cow’s milk can be successfully reintroduced using different treatment strategies other than strict avoidance. This is the first study that compares outcomes of patients undergoing these 3 different strategies for CMPA management, providing a foundation for the creation of new projects that will help to develop new ideas for the management of IgE mediated CMPA. |
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