Alergia alimentar não IgE mediada em lactentes: incidência e perfil clínico e epidemiológico em uma coorte de lactentes

Abstract

Introduction: Food allergy (FA) is a public health issue that impacts the quality of life of children and their families. The actual incidence/prevalence is unknown because studies are scarce, especially for non-IgE mediated forms, and the methodologies used are distinct. Objective: To determine the incidence of non-IgE mediated FA in infants and describe its clinical characteristics. Methods: A cohort study with children born in public hospitals between 2019 and 2020, followed longitudinally until 24 months. Inclusion criteria: children born in public hospitals, with a gestational age greater than 34 weeks, APGAR score greater than 7 at five minutes after birth, and mothers older than 19 years. Data collection occurred in three stages. The first occurred in person at the hospital after birth, the second through annual phone calls, and the third consisted of consultations and tests for suspected FA cases. The diagnosis followed international guidelines. Statistical analysis: Fisher's exact test for categorical variables and Mann-Whitney for non-parametric numerical variables with a significance level of 5%. Results: Of the 3,373 infants included, 2,099 were followed up by phone at 12 months. Of these, 15 (0.7%) had non-IgE mediated FA. Incidences: Acute FPIES 6 (0.28%), Chronic FPIES 3 (0.14%), and FPIAP 7 (0.33%). No cases of FPE were observed. Family history of atopy reported by parents: 54.6%; cesarean delivery: 55.5% of infants. Cesarean birth was a risk factor compared to vaginal delivery for the development of CMPA (OR: 3.0706, 95% CI: 1.089 – 12.63, P = 0.0423). History of atopy (OR: 9.191, 95% CI: 1.412 – 99.39, P = 0.0088), asthma (OR: 3.620, 95% CI: 1.277 – 10.09, P 0.0456), and family rhinitis (OR: 3.830, 95% CI: 10117 – 11.48, P 0.0291) were considered risk factors for the development of non-IgE mediated CMPA. Most frequent foods in acute FPIES: fruit 4 (66.6%), especially banana 3 (50%), and milk 2 (33.4%); in chronic FPIES and FPIAP: only milk. In acute FPIES, the age of onset of symptoms and tolerance varied with the triggering food, occurring early with cow's milk and later with solid foods. No cases of FA to multiple foods were observed. Main clinical manifestations: vomiting, lethargy, and dehydration in acute FPIES; vomiting, diarrhea, and poor weight gain in chronic FPIES; and bloody mucus-filled diarrhea in FPIAP. Conclusion: In this study, the incidence of FA was lower than reported in the literature. Cesarean delivery, history of atopy, asthma, and family rhinitis were identified as risk factors for the development of non-IgE mediated CMPA. The high association with fruits complicated the diagnosis and resulted in a high number of prior reactions. It is essential to increase awareness about FA, the need for diagnostic confirmation, and the performance of oral food challenges to avoid overestimation of cases, unnecessary and prolonged exclusions that increase nutritional risks, and the transition to IgE-mediated allergy.