Cervantes BR, Zapata CCA, Hernández BV, Zárate MF, Sánchez PM, Montijo BE, Cadena LJF, Cazares MM, Ramírez MJA

Idioma: Español
Referencias bibliográficas: 48
Paginas: 147-153
Archivo PDF: 184.50 Kb.

RESUMEN

Antecedentes: la alergia a las proteínas de la leche de vaca es una alteración con alta prevalencia mundial, se estima que entre 1 y 12% de la población la padece. Su diagnóstico es clínico y existen pruebas diagnósticas con sens bilidad y especificidad variable.
Objetivo: conocer la utilidad de las diferentes pruebas diagnósticas ante la sospecha clínica de alergia a las proteínas de la leche de vaca en dos grupos de niños mexicanos.
Pacientes y método: estudio observacional, prospectivo y comparativo que incluyó a 73 niños con sospecha clínica de alergia a las proteínas de leche de vaca atendidos en el servicio de Gastroenterología y Nutrición del Instituto Nacional de Pediatría, de marzo de 2008 a noviembre de 2009. Se dividieron en dos grupos con criterios de inclusión específicos: grupo 1, 37 lactantes con límites de edad de 1 y 6 meses, no ablactados. Grupo 2, 36 lactantes con límites de edad de 7 y 13 meses, ablactados, de uno y otro sexo, con prueba de hidrogeniones negativa. Se excluyeron los pacientes con desnutrición, seropositividad para VIH, con antecedentes de enfermedades metabólicas o daño neurológico. Los exámenes de laboratorio realizados fueron: cuantificación de IgE total, precipitinas a la leche de vaca, prueba de prick, pHmetría intraesofágica de 24 horas, endoscopia y rectosigmoidoscopia. Se administró una fórmula de hidrolizado extenso de proteínas del suero o dieta elemental.
Resultados: las manifestaciones clínicas en los grupos 1 y 2 fueron, respectivamente: digestivas, 97.2 vs 100%; renales (acidosis tubular renal), 32 vs 33%; dermatológicas, 29 vs 41.6%; respiratorias, 27 vs 57,7%. Los resultados de laboratorio en los grupos 1 y 2 fueron, respectivamente: IgE positiva, 8.1 vs 8%; prueba de prick, 37.8 vs 33%; histología compatible, 40.5 vs 33%. La pHmetría intraesofágica en los grupos 1 y 2 resultó positiva en 8.1 vs 16.6%, respectivamente. El tratamiento con hidrolizado extenso de proteínas del suero en los grupos 1 y 2 tuvo éxito en 72.9 vs 91.6%, respectivamente.
Conclusiones: el diagnóstico de alergia a las proteínas de la leche de vaca es clínico y se acompaña, posteriormente, de los hallazgos histológicos en el recto. La frecuencia de acidosis tubular renal asociada con alergia a las proteínas de la leche de vaca es muy elevada (32-33%), mientras que el reflujo gastroesofágico patológico asociado a la alergia es bajo (8-16%).

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