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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Autor: Trujillo Wurttele, Juan Enrique
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
id ES_2493a23748c37dd7e4300a441fdbc95d
oai_identifier_str oai:uvadoc.uva.es:10324/63682
network_acronym_str ES
network_name_str España
repository_id_str
dc.title.none.fl_str_mv Comparacion retrospectiva del manejo de la alergia a las proteinas de leche de vaca mediada por IgE en tres cohortes
title Comparacion retrospectiva del manejo de la alergia a las proteinas de leche de vaca mediada por IgE en tres cohortes
spellingShingle Comparacion retrospectiva del manejo de la alergia a las proteinas de leche de vaca mediada por IgE en tres cohortes
Trujillo Wurttele, Juan Enrique
Alergias
Allergy
Alergia
32 Ciencias Médicas
title_short Comparacion retrospectiva del manejo de la alergia a las proteinas de leche de vaca mediada por IgE en tres cohortes
title_full Comparacion retrospectiva del manejo de la alergia a las proteinas de leche de vaca mediada por IgE en tres cohortes
title_fullStr Comparacion retrospectiva del manejo de la alergia a las proteinas de leche de vaca mediada por IgE en tres cohortes
title_full_unstemmed Comparacion retrospectiva del manejo de la alergia a las proteinas de leche de vaca mediada por IgE en tres cohortes
title_sort Comparacion retrospectiva del manejo de la alergia a las proteinas de leche de vaca mediada por IgE en tres cohortes
dc.creator.none.fl_str_mv Trujillo Wurttele, Juan Enrique
author Trujillo Wurttele, Juan Enrique
author_facet Trujillo Wurttele, Juan Enrique
author_role author
dc.contributor.none.fl_str_mv Paz Fernández, Félix Jesús de
Velasco Zuñiga, Roberto
Universidad de Valladolid. Escuela de Doctorado
dc.subject.none.fl_str_mv Alergias
Allergy
Alergia
32 Ciencias Médicas
topic Alergias
Allergy
Alergia
32 Ciencias Médicas
description 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 &#8211; 90.9), similar to that obtained in the early gradual milk introduction group (96.0%; (95%CI: 92.3 &#8211; 98.0). Both strategies had a significantly higher success rate than milk avoidance (61.0%; 95%CI: 54.1 &#8211; 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&#8217;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&#8217;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.
publishDate 2023
dc.date.none.fl_str_mv 2023
dc.type.none.fl_str_mv info:eu-repo/semantics/doctoralThesis
info:eu-repo/semantics/publishedVersion
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dc.identifier.none.fl_str_mv https://doi.org/10.35376/10324/63682
https://uvadoc.uva.es/handle/10324/63682
url https://doi.org/10.35376/10324/63682
https://uvadoc.uva.es/handle/10324/63682
dc.language.none.fl_str_mv Español
language_invalid_str_mv Español
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http://creativecommons.org/licenses/by-nc-nd/4.0/
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dc.source.none.fl_str_mv reponame:UVaDOC. Repositorio Documental de la Universidad de Valladolid
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spelling Comparacion retrospectiva del manejo de la alergia a las proteinas de leche de vaca mediada por IgE en tres cohortesTrujillo Wurttele, Juan EnriqueAlergiasAllergyAlergia32 Ciencias MédicasIntroduction 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 &#8211; 90.9), similar to that obtained in the early gradual milk introduction group (96.0%; (95%CI: 92.3 &#8211; 98.0). Both strategies had a significantly higher success rate than milk avoidance (61.0%; 95%CI: 54.1 &#8211; 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&#8217;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&#8217;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.Introducción La alergia a la proteína de la leche de vaca (APLV) es una de las primeras y más comunes alergias alimentarias reportadas en la población pediátrica. También es una de las principales causas de anafilaxia en los dos primeros años de vida(2). Sin embargo, el manejo de la APLV es objeto de debate en todo el mundo. La mayoría de la APLV se resuelve espontáneamente en la infancia y, por lo tanto, muchos países europeos recomiendan evitar estrictamente todos los productos lácteos. En Irlanda, la APLV se trata mediante la escalera de la leche, con buenos resultados (3, 4). Recientemente se han publicado nuevos tratamientos que podrían dar un enfoque diferente al manejo de la APLV. Uno de estos tratamientos es el uso de ITO precoz en el momento del diagnóstico. Se ha encontrado que esta opción de tratamiento es segura y exitosa (5), y sugiere la posibilidad de una nueva estrategia de manejo para la APLV mediada por IgE en el futuro. Objetivos y puntos finales: El objetivo principal es comparar la tasa de éxito en la reintroducción de la leche de 3 estrategias diferentes de tratamiento de la APLV mediada por IgE. Los objetivos secundarios son evaluar la diferencia en la sintomatología experimentada durante el tratamiento y el seguimiento realizado en las tres cohortes, comparar la diferencia en el resultado de los tres tratamientos en APLV mediada por IgE en pacientes que tienen otras alergias alimentarias y realizar un análisis de los valores inmunológicos entre las tres cohortes. Métodos Esta es una revisión retrospectiva de 600 pacientes pediátricos que han sido tratados por APLV mediada por IgE entre 2011 y 2020; con la escalera de la leche en Irlanda; reintroducción temprana de leche pasteurizada en España y con evitación completa seguida de una provocación alimentaria oral en España. Los pacientes fueron diagnosticados con APLV mediada por IgE con síntomas y signos típicos después de la ingestión de leche de vaca y confirmados por pruebas cutáneas positivas o una Ig-E específica positiva para la leche. Resultados Se logró un tratamiento exitoso en 439 (76,9%) de los pacientes de toda la muestra. La proporción de éxito en el grupo de la escalera de leche fue del 86,6 % (intervalo de confianza (IC) del 95 %: 80,6 &#8211; 90,9), similar a la obtenida en el grupo de introducción gradual de leche temprana (96,0 %; (IC del 95 %: 92,3 &#8211; 98,0) Ambas estrategias tuvieron una tasa de éxito significativamente mayor que la evitación la leche (61,0 %; IC del 95 %: 54,1 &#8211; 67,5). En el grupo de evitación de la leche, un valor más alto de la prueba de punción cutánea se asoció con una falla en el tratamiento (p<0,01). Esa diferencia no se encontró en los otros dos grupos. En el grupo de escalera de leche, un mayor valor de IgE específica de leche entera se asoció con el fracaso de los tratamientos. Esto también se observó en el grupo que evitaba la leche. Conclusión La leche de vaca se puede reintroducir con éxito utilizando diferentes estrategias de tratamiento además de la evitación estricta. Este es el primer estudio que compara los resultados de los pacientes que se someten a estas 3 estrategias diferentes para el manejo de la APLV, proporcionando una base para la creación de nuevos proyectos que ayudarán a desarrollar nuevas ideas para el manejo de la APLV IgE mediado.Escuela de DoctoradoDoctorado en Investigación en Ciencias de la SaludPaz Fernández, Félix Jesús deVelasco Zuñiga, RobertoUniversidad de Valladolid. Escuela de Doctorado2023info:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://doi.org/10.35376/10324/63682https://uvadoc.uva.es/handle/10324/63682reponame:UVaDOC. Repositorio Documental de la Universidad de Valladolidinstname:Universidad de ValladolidEspañolinfo:eu-repo/semantics/openAccesshttp://creativecommons.org/licenses/by-nc-nd/4.0/oai:uvadoc.uva.es:10324/636822026-06-13T12:44:47Z
score 15.301629

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