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General Characteristics of Brazilian Children and Adolescents with Cow's Milk Protein Allergy before Starting Oral Tolerance Induction (OIT)
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
Fabio C Kuschnir, MD, PhD, Jose Luiz M. Rios, MD PhD, Alfredo A Neto, Dr., Mary A da Venda, Flavia C Loyola, Bruno B Souto, Dr., Joao B. M. Rios
Rationale: New approaches in the management of severe forms of cow milk proteins allergy (CMA) has emerged including the OIT protocols. The objective of this research was to describe the clinical and immunological characteristics of patients with CMA before undergoing to OIT.

Methods: Case series with 30 children (> 4 years) and adolescents with anaphylaxis to CM. 

 Results: The mean age was 8.9 years (min:4-max:20),14 female. The first symptoms occurred before the 1st year of age in 96.6% being 43.3% before 6 months.The most frequent manifestation after the 1st exposure was urticarial (63.3%), while anaphylaxis occurred in 26.7%. About 1/3 of patients reacted with minute amounts of CM,  being 47% in raw form. In 86.7% symptoms appeared in less than 1 hour.About 65% had presented from 1 to 5 episodes of anaphylaxis before starting treatment. The mean of Specific IgE levels (sIgE) for CM was 57.05 KU/L and median 54.5 (Min:9.0 KU/l - Max:> 100 KU/L); for casein the mean was 48.5 KU/L and the median 30.1 KU/L (7.0 to > 100). For α lacto-albumin and β-lactoglobulin, these results were respectively 27.10 KU/L (1.0 KU/l to> 100 KU / L) and 16.48 KU/L (2.3 KU/ L to 86.7 KU/L).

Conclusions: Severe forms of CMA are initiated early and can persist through adolescence. The most frequent initial symptom was urticaria, which appeared in less than 1 hour after intake of small amounts of milk. In these patients the levels of sIgE to CMP are very high, especially casein.