Achados epidemiológicos de alergia alimentar em crianças brasileiras: análise de 234 testes de provocação duplo-cego placebo-controlado (TPDCPCs)
Epidemiological findings in food allergic Brazilian children: an analysis of 234 double-blind placebo-controlled food challenge (DBPCFC) tests
Simone Nabuco de Senna; Mariana Faria Scalco; Sílvia Paschoalini Azalim; Lídia Lacerda Guimarães; Wilson Rocha Filho
Resumo
Introdução: Os dados sobre prevalência de alergia alimentar são escassos e limitados no Brasil. Este trabalho objetiva descrever as características clínicas de crianças brasileiras com alergia alimentar diagnosticada através de teste de provocação duplo-cego placebo-controlado (TPDCPC). Métodos: Dos pacientes avaliados, foram selecionadas, de forma prospectiva, no Ambulatório de Alergia e Pneumologia Pediátrica, 234 crianças com suspeita clínica de alergia alimentar e teste alérgico positivo para alimento, no período de 1993 a 2005. Para confirmar o diagnóstico de alergia alimentar, foram realizados TPDCPCs com o alimento suspeito. Resultados: Dos 234 TPDCPCs realizados, 30 foram positivos (12,8%), sendo mais frequentes em crianças abaixo de dois anos e do sexo masculino. Dos testes positivos, 26 (86,6%) foram positivos para ovo ou leite de vaca. Pacientes com diagnóstico inicial de dermatite atópica ou alergia gastrointestinal apresentaram TPDCPC positivo mais frequentemente do que pacientes com sintomas respiratórios. Entre os sintomas apresentados durante o TPDCPC, prevaleceram os sintomas cutâneos (60%) e respiratórios (56,67%). Conclusão: A incidência de alergia alimentar na população com suspeita clínica foi de 12,8%. Leite de vaca e ovo são os principais alimentos responsáveis pela alergia alimentar em nosso meio, que é mais frequente em crianças abaixo de dois anos. O teste alérgico positivo é um fraco preditor de alergia alimentar (VPP = 13,5%), mas o teste alérgico negativo praticamente afasta o diagnóstico, pois o seu valor preditivo negativo na população estudada foi próximo de 100%.
Palavras-chave
Abstract
Introduction: Data on the prevalence of food allergy are scarce and limited in Brazil. This work aims to describe the clinical characteristics of Brazilian children with food allergy, diagnosed through the Double-Blind Placebo-Controlled Food Challenge (DBPCFC). Methods: Of the evaluated patients, 234 children with clinical suspicion of food allergy and positive food allergy test between 1993 and 2005 were selected prospectively in a Pediatric Allergy and Pneumology Clinic. In order to confirm the diagnosis of food allergy, the DBPCFC was used with suspected allergenic food. Results: Of the 234 TPDCPCs performed, 30 tests were positive (12.8%), more frequently in children less than two years old and male sex. Of these positive tests, 26 (86.6%) were positive for eggs or cow’s milk. Patients with initial diagnosis of atopic dermatitis or gastrointestinal allergy had a positive TPDCPC more frequently than patients with respiratory symptoms. Among the symptoms presented during the TPDCPC, cutaneous (60%) and respiratory symptoms (56.67%) prevailed. Conclusion: The incidence of food allergy in the clinically suspected population was 12.8%. Cow’s milk and eggs are the main foods responsible for food allergy in our setting, and they are more common in children less than two years old. A positive allergic test is a poor predictor of food allergy (PPV = 13.5%), but a negative allergic test virtually eliminates this diagnosis, as its negative predictive value in the studied population was close to 100%
Keywords
References
1. Sicherer SH, Sampson HA. Food allergy: a review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol. 2018;141:41‑58.
2. Solé D, Silva LR, Cocco RR, Ferreira CT, Sarni RO, Oliveira LC, et al. Consenso Brasileiro sobre Alergia Alimentar: 2018 - Parte 1 - Etiopatogenia, clínica e diagnóstico. Documento conjunto elaborado pela Sociedade Brasileira de Pediatria e Associação Brasileira de Alergia e Imunologia. Arq Asma Alerg Imunol. 2018;2(1):7-38.
3. Burks AW, Tang M, Sicherer S, Muraro A, Eigenmann PA, Ebisawa M, et al. ICON: food allergy. J Allergy Clin Immunology. 2012;129(4):906‑20.
4. Bock SA. Prospective appraisal of complaints of adverse reactions to foods in children during the first 3 years of life. Pediatrics. 1987;79(5):863-8.
5. Kayosaasari M. Food allergy in Finnish children aged 1 to 6 years. Acta Paediatr Scand.1982;71,815-9.
6. Shridhar KS, Changqi L, Zaffran VD. Food Allergy. Annu Rev Food Sci Technol. 2016;7,191-220
7. Barclay L, Lie D. New Guidelines Issued for Food Allergies. Annals of Allergy, Asthma and Immunology. March 2006.
8. Burks W, Jones SM, Boyce JA, Sicherer SH, Wood RA, Assa’ad A, Sampson HA. NIAID-sponsored 2010 Guidelines for Managing Food Allergy: Applications in the Pediatric Population. Pediatrics. 2011;128;955.
9. Wood RA. Oral food challenge testing. In: Adkinson Jr. N, Bochner B, Burks A, Busse W, Holgate S, Lemanske R, O’Hehir R. Allergy Principles and Practice. Vol.II. 8ª ed. Elsevier; 2013.
10. Bock AS, Sampson HA, Atkins FM, Zeiger RS, Lehrer Samuel, Sachs Martin, et al. Double-blind, placebo-controlled food challenge (DBPCFC) as na office procedure: a manual. J Allergy Clin Immunol. 1988;82:986-97.
11. Bock S. In vivo diagnosis: skin testing and oral challenge procedures. In: Metcalfe D, Sampson HA, Simon RA. Food allergy: adverse reactions to foods and food additives. 2ª ed. Cambridge Massachusets: Blackwell Science; 1997. p. 151-66.
12. Nowak-Wegrzyn A, Burks W, Sampson HA. Reactions to foods. In: Adkinson Jr. N, Bochner B, Burks A, Busse W, Holgate S, Lemanske R, O’Hehir R. Allergy Principles and Practice. Vol.II. 8ª ed. Elsevier; 2013.
13. Kivity S, Dunner K, Marian Y. The pattern of food hypersensivityin patients with onset after 10 years off age. Clin Exp Allergy. 1994;24:19-22.
14. Bernstein M, Day JH, Welsh A. Double-blind food challenge in the diagnosis of food sensitivity in the adult. J Allergy Clin Immunol. 1982;70:205‑10.
15. Atkins FM, Steinberg SS, Metcalfe DD. Evaluation of immediate adverse reactions to foods in adult patients. II. A detailed analysis of reactions patterns during oral food challenge. J Allergy Clin Immunol. 1985;75(3):356-63.
16. Ostterballe M, Hansen TK, Mortz CG, Host A, Bindslev-Jensen C. The Prevalence of food hypersensitivity in an unselected population of children and adults. Pediatrics Allergy & Immunolog. 2005;16:567‑73.
17. Wood RA. The Natural History of Food Allergy. Pediatrics. 2003;111:1631-7.
18. Eigenmann PA, Sicherer SH, Borkowski TA, Cohen BA, Sampson HA. Prevalence of IgE-mediated food allergy among children with atopic dermatitis. Pediatrics. 1998;101:8.
19. Sampson HA, Albergo R. Comparison of results of skin tests, RAST, and double-blind, placebo-controlled food challenges with atopic dermatitis. J Allergy Clin Immunol. 1984;74:26.
20. Metcalfe DD, Sampson HA. Workshop on experimental methodology for clinical studies of adverse reactions to foods and foods additives J Allergy Clin Immunol. 1990;3(part 2 suppl):421-42.
21. Burks AW, Sampson HA. Double-blind placebo-controlled trial of oral cromolyn in children with atopic dermatitis and documented food hypersensitivity. J Allergy Clin Immunol. 1988;81:417.
22. Leinhas JL, McCaskill CC, Sampson HA. Food allergy challenges: guidelines and implications. J Am Diet Assoc. 1987;87(5):604-8.
23. Host A, Halken S. A prospective study of cow milk allergy in Danish infants during the first 3 years of life. Allergy. 1990;45:587-96.
24. Schrander JJP, van den Bogart JPH, Forget PP, Scrander-Stumpel CTRM, Kuijten RH, Kester ADM. Cow’s milk protein intolerance in infant under 1 year of age: a prospective epidemiological study. Eur J Pediatr. 1993;152:640-4.
25. Bock SA, Atikins FM. Patterns of food hypersensitivity during sixteen years of double- blind placebo-controlled food challenge. J Pediatr. 1990;70:561-7.
26. Silber GM, Sampson HÁ. Nasal mediator release following doubleblind placebo-controlled oral food challenges [abstract]. J Allergy Clin Immunol. 1988;81:185.
27. Sampson HA, Broadbent JB, Scalon SM. Food-induced respiratory reactions in children with atopic dermatitis [abstract]. J Allergy Clin Immunol. 1989;83:241.
28. Sampson HA, Mendelson L, Rosen JP. Fatal and near fatal-induced anaphilaxyis. N Engl Med. 1992;327:380-4.
29. Koerner CB, Sampson HÁ. Diets and nutrition. In: Metcalf DD, Sampson HÁ, Simon RA, eds. Food allergy. Adverse reactions to foods and food additives. Boston: Blackwell Scientific Publications; 1991. p. 333-53.
30. Sampson HA. Food Allergy. Part 1: Imunopathogenesis and clinical disorders. J Allergy Clin Immunol. 1999;103:717-28.
31. Sampson HA. Food Food Allergy. Part 2: Diagnosis and management. J Allergy Clin Immunol. 1999;103:981-9.
Submitted date:
08/02/2018
Accepted date:
08/25/2018
Facebook
LinkedIn
Mendeley
StumbleUpon
Reddit
Email