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Introduction and aims: The prevalence of cow’s milk protein allergy in the first year of life varies from 1.8 to 7.5%. The Cow’s Milk-related Symptom Score (CoMiSS) was published in 2014 and facilitates the diagnosis of cow’s milk protein allergy. It is not meant to replace the clinical diagnosis, but rather to guide the treating team in the diagnostic process and reduce unnecessary diets. The aim was to translate the CoMiSS from English to Spanish and culturally adapt and validate the resulting Spanish version. Materials and methods: An adaptation and validation study on the CoMiSS questionnaire was carried out in two phases: First, the CoMiSS was translated from English to Spanish, after which interrater reliability of the translated score was assessed. Second, interrater reliability tests were carried out on 32 pediatric patients under 7 years of age that were treated for the first time at the Food Allergy Clinic of the Hospital Italiano de Buenos Aires, were suspected of having cow’s milk protein allergy, and had not received any treatment, within the time frame of May 2018 and May 2019. Results: Thirty-two patients were evaluated, 14 of whom were females (45%), and the median patient age was 3 months (IQR 2-4). The median result of the first measurement of the scale was 7.0 (IQR 4.5-9.0) and the median of the second measurement was 5.0 (IQR 4.0-8.0). The final intraclass correlation coefficient was 0.80 (95% CI 0.63-0.9). Conclusion: The Spanish translation of the CoMiSS was comparable to the original English version, with excellent interrater reliability. This simple and little-known tool has the benefit of being a noninvasive, rapid, reliable, and easy-to-use strategy. Resumen: Introducción y objetivos: La prevalencia de alergia a la proteína de leche de vaca en el primer año de vida varía entre el 1.8% y el 7.5%. En el a˜no 2014 se publicó The Cow’s Milk-related Symptom Score (CoMiSS, Score de síntomas de Alergia a la Proteína de Leche de Vaca) para facilitar su diagnóstico. Con ello no se pretende reemplazar el diagnóstico clínico sino orientar al equipo tratante en el proceso diagnóstico y disminuir dietas innecesarias. El objetivo de este estudio fue traducir, adaptar y validar de forma transcultural la versión traducida del inglés al español del CoMiSS. Materiales y métodos: Se realizó un estudio de adaptación y validación del cuestionario CoMiSS en dos fases: primero, la traducción de la escala CoMiSS del inglés al español y luego la evaluación de la confiabilidad interevaluador de la escala traducida. Secundariamente, se realizaron las pruebas de confiabilidad entre evaluadores en 32 pacientes pediátricos menores de 7 años que fueron atendidos por primera vez en la Clínica de Alergia Alimentaria del Hospital Italiano de Buenos Aires con sospecha de alergia a la proteína de leche de vaca y que no habían recibido ningún tratamiento entre mayo de 2018 y mayo de 2019. Resultados: Se evaluaron 32 pacientes, de los cuales 14 fueron mujeres (45%) y la mediana de edad presentada fue de 3 meses (IQR 2-4). La mediana del resultado de la escala en la primera medición fue 7.0 (IQR 4.5-9.0) y en la segunda medición fue 5.0 (IQR 4.0-8.0). El coeficiente de correlación intraclase final de la escala fue 0.80 (IC 95% 0.63-0.9). Conclusión: La traducción al espa˜nol del CoMiSS mostró resultados homologables a su version original y una excelente fiabilidad entre los evaluadores. El beneficio de utilizar esta sencilla y poco conocida herramienta radica en ser una estrategia no invasiva, rápida, confiable y de fácil implementación.

La prevalencia de la alergia a las proteínas de la leche de vaca (APLV) en el ámbito mundial es, aproximadamente, de 1,9 a 4,9 %. En Colombia, esta cifra se desconoce. En un alto porcentaje de los casos, no existe la sospecha por parte del personal de salud, y, por lo tanto, el diagnóstico y el tratamiento se retrasan. Esto acarrea un aumento en el tiempo y en los recursos que emplean los profesionales de la salud y los padres en procura de establecer la etiología del padecimiento de los niños que presentan esta enfermedad. Dentro de este contexto, la historia clínica es fundamental en la sospecha de la APLV, y es especialmente relevante la evaluación de antecedentes, en los cuales se destacan la presencia de la exposición temprana a la proteína, así como la atopia en familiares en primer grado de consanguinidad. La presentación de la APLV puede manifestarse con reacciones inmediatas a nivel digestivo (vómitos, diarrea aguda), cutáneo (urticaria, dermatitis, angioedema) y, con menos frecuencia, a partir de signos respiratorias y sistémicos. Sin embargo, la amplia variedad de manifestaciones clínicas y signos puede ser un reto para el profesional que no se encuentre sensibilizado con la patología, e incluso soslayar este diagnóstico retrasa la suspensión de la proteína de la leche de vaca de la dieta y demora el acceso a un tratamiento eficaz. El tratamiento ideal reconocido es la dieta de exclusión, la cual requiere un estricto cumplimiento. En los niños alimentados con lactancia materna exclusiva, será necesaria la dieta restrictiva de leche y sus derivados en la madre. En quienes no reciben lactancia, se deberá tratar mediante fórmulas de proteínas lácteas extensamente hidrolizadas (FEH) o a base de aminoácidos (FAA). Así bien, el pronóstico es favorable y la mayoría de niños tolerarán las proteínas de la leche de vaca a los 2 años, mientras que en pacientes con polisensibilización el proceso puede prolongarse. En el caso de no alcanzar la tolerancia, la inmunoterapia oral es una opción disponible.

The worldwide prevalence of cow's milk protein allergy (CMPA) is approximately 1.9% to 4.9%. Its prevalence in Colombia is unknown. A high percentage of cases are unsuspected by medical personnel resulting in delayed diagnosis and treatment which increase the time and resources used to establish the etiology of this condition in children. The clinical history is fundamental for diagnosis of CMPA, especially the background evaluation. Of special importance are early exposure to the protein and atopy in first degree relatives. CMPA's initial presentation may be digestive, cutaneous or respiratory. Digestive symptoms can include vomiting and acute diarrhea, and cutaneous symptoms include hives, dermatitis and angioedema. Respiratory and systemic manifestations occur less frequently. The wide variety of clinical manifestations and signs can challenge health care professionals who are not alert to this pathology to the point that the diagnosis is not even considered event though delaying the suspension of cow's milk protein from the diet delays access to an effective treatment. The well-recognized ideal treatment is an exclusion diet which requires strict compliance. For children who are exclusively breastfed, the mother's diet must restrict milk and its derivatives. Children who are not breastfed, should be fed formulas of extensively hydrolyzed milk proteins based on amino acids. The prognosis is favorable, and most children will tolerate cow's milk proteins at two years. The process may take more years for polysensitive patients. Oral immunotherapy is an option that is available for patients who do not achieve toleration. [ABSTRACT FROM AUTHOR]

Antecedentes: La alergia a las proteínas de la leche de vaca es la causa más común de alergia a alimentos. La prueba de reto ya sea abierta o doble ciego controlado con placebo, es considerada el estándar de oro. La endoscopia y los hallazgos histológicos son considerados métodos que pueden ayudar en el diagnóstico de esta entidad. Objetivos: El objetivo del presente trabajo fue describir los hallazgos histopatológicos en niños con sospecha de alergia a las proteínas de la leche de vaca atendidos en nuestro hospital. Material y método: Estudio observacional, descriptivo en 116 niños con sospecha clínica de alergia a las proteínas de la leche de vaca, atendidos en el Departamento de Gastroenterología y Nutrición del Instituto Nacional de Pediatría. Se efectúo endoscopia alta y rectosigmoidoscopia con toma de biopsias y se describieron los hallazgos. Resultados: Se incluyeron 116 pacientes, 64 (55.17%) del género femenino y 52 (44.83%) masculino. El sitio con mayor presencia de eosinófilos fue el recto en ambos grupos, seguido del duodeno; en general se encontró más de 15 eosinófilos por campo en el 46% de los pacientes. Conclusiones: Entre el 40-45% de los casos tuvieron el criterio histológico de más de 15-20 eosinófilos por campo siendo el sitio más afectado el rectosigmoides. Por lo tanto, se sugiere realizar panendoscopia y rectosigmoidoscopia con toma de biopsias y recuento de eosinófilos.

Introduction and Aims: The prevalence of cow's milk protein allergy in the first year of life varies from 1.8 to 7.5%. The Cow's Milk-related Symptom Score (CoMiSS) was published in 2014 and facilitates the diagnosis of cow's milk protein allergy. It is not meant to replace the clinical diagnosis, but rather to guide the treating team in the diagnostic process and reduce unnecessary diets. The aim was to translate the CoMiSS from English to Spanish and culturally adapt and validate the resulting Spanish version., Materials and Methods: An adaptation and validation study on the CoMiSS questionnaire was carried out in two phases: First, the CoMiSS was translated from English to Spanish, after which interrater reliability of the translated score was assessed. Second, interrater reliability tests were carried out on 32 pediatric patients under 7 years of age that were treated for the first time at the Food Allergy Clinic of the Hospital Italiano de Buenos Aires, were suspected of having cow's milk protein allergy, and had not received any treatment, within the time frame of May 2018 and May 2019., Results: Thirty-two patients were evaluated, 14 of whom were females (45%), and the median patient age was 3 months (IQR 2-4). The median result of the first measurement of the scale was 7.0 (IQR 4.5-9.0) and the median of the second measurement was 5.0 (IQR 4.0-8.0). The final intraclass correlation coefficient was 0.80 (95% CI 0.63-0.9)., Conclusion: The Spanish translation of the CoMiSS was comparable to the original English version, with excellent interrater reliability. This simple and little-known tool has the benefit of being a noninvasive, rapid, reliable, and easy-to-use strategy., (Copyright © 2021. Published by Masson Doyma México S.A.)

Gastroesophageal reflux disease (GERD) is a common childhood. Its natural history is poorly documented. We must differentiate GERD associated with allergy to the protein in cow's milk (CMA) because both situations share signs and symptoms within the clinical spectrum. The CMA is an immune reaction to the protein in cow's milk, the most allergenic the beta-lactalbumin and next the alpha-lactalbumin, casein and others may occur. Overall incidence is 1-12%, with a prevalence of 2-5% in developed countries. Utility methods are required to know how to differentiate which of the two entities is occurring in the patient. Treatment involves exclusion diet in mothers of children exclusively breastfed; extensive hydrolyzed whey protein and casein, and elemental diet. [ABSTRACT FROM AUTHOR]

Background: Soy infant formulas (SIF) have long been used as an alternative for infants with special nutritional requirements. However, the medical indications for their use, their allergenicity, safety and efficacy are still controversial., Objective: To present recommendations for the use of SIF based on the existing literature., Methods: We consulted systematic reviews and clinical practice guides, through validated search algorithms, and systems such as Appraisal of Guidelines for REsearch and Evaluation (AGREE)II and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). For the elaboration of the clinical recommendations, the most important topics were analyzed and discussed by the responsible researchers and the group of experts in the development of a position paper. The quality of the evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system., Results: Several reports with variable quality of evidence were found. They support SIF's efficacy in the management of cow's milk allergy and infant's digestive tolerance, as well as its low cross allergy compared to cow's milk and other formulas. We also found other studies that indicate the safety of SIFs on different nutritional, immune and developmental parameters. There is also evidence that demonstrates that SIFs have important advantages in terms of cost-benefit, palatability and effects on the intestinal microbiota, compared to other formulas., Conclusions: Although evidence to recommend its use in functional digestive disorders is limited, SIFs have an adequate safety profile and are still a valid option for infant feeding., (Copyright: © 2019 SecretarÍa de Salud.)

Background: Cow's milk protein allergy is the most common cause of food allergy. The challenge test, either open or doubled-blind with a placebo control, is regarded as the criterion standard. Endoscopy and histologic findings are considered a method that can aid in the diagnosis of this entity., Aims: The aim of this study was to describe the histopathologic findings in children suspected of cow's milk protein allergy that were seen at our hospital., Material and Methods: A descriptive, observational study was conducted on 116 children clinically suspected of presenting with cow's milk protein allergy that were seen at the Department of Gastroenterology and Nutrition of the Instituto Nacional de Pediatría. Upper endoscopy and rectosigmoidoscopy with biopsies were performed and the findings were described., Results: Of the 116 patients, 64 (55.17%) were girls and 52 (44.83%) were boys. The rectum was the site with the greatest presence of eosinophils per field in both groups, followed by the duodenum. In general, more than 15 eosinophils were found in 46% of the patients., Conclusions: Between 40 and 45% of the cases had the histologic criterion of more than 15 to 20 eosinophils per field and the rectosigmoid colon was the most affected site. Therefore, panendoscopy and rectosigmoidoscopy with biopsy and eosinophil count are suggested., (Copyright © 2014 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.)