Knowledge and practice of pediatricians and nutritionists regarding treatment of cow’s milk protein allergy in infants
Palavras-chave:
Cow’s milk allergy, Infant, Knowledge attitude and practice, Pediatricians, NutritionistsResumo
Objective
This study evaluated the knowledge and practices of pediatricians and nutritionists about cow’s milk protein allergy in infants, with an emphasis on issues related to the exclusion diet and nutritional status.
Methods
A cross-sectional, descriptive study was performed with a convenience sample of 204 pediatricians and 202 nutritionists randomly invited in scientifi c events in the city of São Paulo, from November 2014 to March 2016.Results Between 1.5% and 21.0% of respondents indicated inadequate products for the treatment of cow’s milk protein allergy, including goat’s milk, beverages or juices based on soy extract, lactose-free milk formula and partially hydrolyzed formula. The daily calcium recommendation for children between zero and 36 months of age was correctly indicated by 27.0% of pediatricians and 46.0% of nutritionists (p=0.001). Additionally, 96.1% of pediatricians and 82.7% of dietitians (p<0.001) provided guidance on about labels of industrialized products.
Conclusion
Pediatricians and nutritionists present gaps in knowledge about cow’s milk protein allergy treatment in infants and educational strategies that increase the knowledge of the professionals are important for the management of cow’s milk protein allergy.
Referências
Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R , Husby S, et al. Diagnostic approach and management of cow’s-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. J Pediatr Gastroenterol Nutr. 2012;55(2):221-9. http://dx.doi.org/10.1097/MPG.0b013e31825c9482
Rona RJ, Keil T, Summers C, Gislason D, Zuidmeer L, Sodergren E, et al. The prevalence of food allergy: A meta analysis. J Allergy Clin Immunol. 2007;120(3):638-46. http://dx.doi.org/10.1016/j.jaci.2007.05.026
Vieira MC, Morais MB, Spolidoro JV, Toporovski MS, Cardoso AL, Araujo GT, et al. A survey on clinical presentation and nutritional status of infants with suspected cow’ milk allergy. BMC Pediatr. 2010;10(25):1-7. http://dx.doi.org/10.1186/1471-2431-10-25
Fiocchi A, Brozek J, Schünemann H, Bahna SL , von Berg A , Beyer K, et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) guidelines. Pediatr Allergy Immunol. 2010;21:1-125. http://dx.doi.org/10.1111/j.1399-3038.2010.01068.x
Solé D, Silva LR, Rosário Filho NA, Sarni RO. Sociedade Brasileira de Pediatria e Associação Brasileira de Alergia e Imunopatologia. Consenso Brasileiro sobre alergia alimentar 2007. Rev Bras Alerg Imunopatol. 2008;31(2):65-89.
Solé D, Silva L, Rodrigues Cocco R, Targa Ferreira C, Oselka Sarni R, Camargo Oliveira L, et al. Sociedade Brasileira de Pediatria e Associação Brasileira de Alergia e Imunologia. Consenso Brasileiro sobre Alergia Alimentar: 2018 - Parte 1: etiopatogenia, clínica e diagnóstico. 2018;2(1):7-38.
Solé D, Silva L, Rodrigues Cocco R, Targa Ferreira C, Oselka Sarni R, Camargo Oliveira L, et al. Sociedade Brasileira de Pediatria e Associação Brasileira de Alergia e Imunologia. Consenso Brasileiro sobre Alergia Alimentar: 2018 - Parte 2: diagnóstico, tratamento e prevenção. 2018;2(1):39-82.
Medeiros LCS, Speridião PGL, Sdepanian VL, Fagundes-Neto U, Morais MB. Nutrient intake and nutritional status of children following a diet free from cow’s milk and cow’s milk by-products. J Pediatr. 2004;80(5):363-70.
Weber TK, Speridião PGL, Sdepanian VL, Neto UF, Morais MB, et al. The performance of parents of children receiving cow’s milk free diets at identification of commercial food products with and without cow’s milk. J Pediatr. 2007;83(5):459-64. http://dx.doi.org/10.2223/JPED.1697
American Academy of Pediatrics-Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics. 2000;106(2):346-9. http://dx.doi.org/10. 1542/peds.106.2.346
Vandenplas Y, Koletzko S, Isolauri E, Colina D, Oranje AP, Brueton H, et al. Guidelines for the diagnosis and management of cow’s milk protein allergy in infants. Arch Dis Child. 2007;92(10):902-8. http://dx.doi.org/10.1136/adc.2006.110999
Allen KJ, Davidson GP, Day AS, Hill DJ, Kemp AS, Peake JE, et al. Management of cow’s milk protein allergy in infants and young children: An expert panel perspective. J Paediatr Child Health. 2009;45(9):481-6. http://dx.doi.org/10.1111/j.1440-1754.2009.01546.x
Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI food allergy and anaphylaxis guidelines: Diagnosis and management of food allergy. Allergy. 2014;69(8):1008-25. http://dx.doi.org/10.1111/all.12429
Cohen A, Levy B, Leshno M, Katz Y. Food allergy-effect of physician attitude on the diagnosis and reported prevalence. Harefuah. 2005;144(10):685-8.
Cortez APB, Medeiros LCDS, Speridião PDG, Mattar RHGM, Neto UF, Morais MB. Pediatricians and nutritionists knowledge about treatment of cow milk allergy in infants. Rev Paul Pediatr. 2007;25(2):106-13.
Solé D, Jacob CMA, Pastorino AC, Neto AP, Burns DA, Sarinho ESC, et al. Pediatricians’ knowledge on food allergy: Pilot study. Rev Paul Pediatr. 2007;25(4):311-6.
Gupta RS, Springston EE, Kim JS, Smith B, Pongracic JA, Wang X, et al. Food allergy knowledge, attitudes, and beliefs of primary care physicians. Pediatrics. 2010;125(1):126-32. http://dx.doi.org/10.1542/peds.2009-1116
Erkoçoğlu M, Civelek E, Azkur D, Özcan C, Öztürk K, Kaya A, et al. Knowledge and attitudes of primary care physicians regarding food allergy and anaphylaxis in Turkey. Allergol Immunopathol. 2013;41(5):292-7. http://dx.doi.org/10.1016/j.aller.2012.05.004
Ribeiro CC, Leite Speridiao PG, Morais MB. Knowledge and practice of physicians and nutritionists regarding the prevention of food allergy. Clin Nutr. 2013;32(4):624-9. http://dx.doi.org/10.1016/j.clnu.2012.10.014
Maslin K, Meyer R, Reeves L, Mackenzie H, Swain A, Stuart-Smith W, et al. Food allergy competencies of dietitians in the united kingdom, Australia and united states of America. Clin Transl Allergy. 2014;4(37):1-7. http://dx.doi.org/10.1186/2045-7022-4-37
Luyt D, Krishnan MT, Huber P, Clark A. Practice of the treatment of milk allergy in the UK: A national audit. Int Arch Allergy Immonol. 2016;169(1):62-8. http://dx.doi.org/10.1159/000444171
Lozinsky AC, Meyer R, Anagnostou K, Dziubak R, Reeve K, Godwin H, et al. Cow’s milk protein allergy from diagnosis to management: A very different journey for general practitioners and parents. Children. 2015; 29(3):317-29. http://dx.doi.org/10.3390/children2030317
Lozinsky AC, Morais MB. Eosinophilic colitis in infants. J Pediatr. 2014;90(1):16-21. http://dx.doi.org/10.1016/j.jped.2013.03.024
Bellioni-Businco B, Paganell R, Lucenti P, Giampietro PG, Perborn H, Businco L, et al. Allergenicity of goat’s milk in children with cow’s milk allergy. J Allergy Clin Immunol. 1999;103(6):1191-4. http://dx.doi.org/10.1016/S0091-6749(99)70198-3
Bhatia J, Greer F. American Academy of Pediatrics Committee on Nutrition. Use of soy proteinbased formulae in infant feeding. Pediatrics. 2008;121(5):1062-8. http://dx.doi.org/10.1542/peds. 2008-0564
Morais MB, Spolidoro JV, Vieira MC, Cardoso AL, Clark O, Nishikawa A, et al. Amino acid formula as a new strategy for diagnosing cow’s milk allergy in infants: Is it cost-effective? J Med Econ. 2016;19(12):1207-14. http://dx.doi.org/10.1080/13696998.2016.1211390
Binsfield BL, Pastorino AC, Castro APBM, Yonamine GH, Gushken AKF, Jacob CMA. Knowledge of industrialized dairy products labels by parents of patients allergic to cow’s milk. Rev Paul Pediatr. 2009;27(3):296-302.
Agência Nacional de Vigilância Sanitária. Dispõe sobre os requisitos para rotulagem obrigatória dos principais alimentos que causam alergias alimentares. 2015 [acesso 2016 jun 30]. Disponível em: http://adcon.rn.gov.br/ACERVO/Suvisa/doc/DOC000000000083199.PDF
Noimark L, Gardner J, Warner JO. Parents’ attitudes when purchasing products for children with nut allergy: A UK perspective. Pediatr Allergy Immunol. 2009;20(5):500-4. http://dx.doi.org/10.1111/j.1399-3038.2008.00796.x
Zurzolo GA, Koplin JJ, Mathai ML, Tang MK, Allen KJ. Perceptions of precautionary labeling among parents of children with food allergy and anaphylaxis. Med J Aust. 2013;198(11):621-3. http:// dx.doi.org/10.5694/mja12.11669
Institute of Medicine. Dietary reference intakes for calcium and vitamin D. Washington (DC): National Academies Press; 2011.
Meyer R, Venter C, Fox AT, Shah N. Practical dietary management of protein energy malnutrition in young children with cow’s milk protein allergy. Pediatr Allergy Immunol. 2012;23(4):307-14. http://dx.doi.org/10.1111/j.1399-3038.2012.01265.x
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Copyright (c) 2023 Dayane Pêdra Batista de FARIA, Ana Paula Bidutte CORTEZ, Patrícia da Graça Leite SPERIDIÃO, Mauro Batista de MORAIS
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