Alergia a la proteína de leche de vaca. Enfoque diagnóstico y terapéutico

  • Angela Mayerly Cubides-Munevar Fundación Universitaria San Martín, Universidad del Valle
  • Alfredo Sadot Linero-Terán Hospital departamental Mario Correa Rengifo, Fundación clínica infantil Club Noel
  • Mario Andrés Saldarriaga-Vélez Universidad del Valle
  • Erika Julieth Umaña-Bautista Hospital universitario del Valle "Evaristo García" ESE
  • Eder Antonio Villamarín Betancourt Universidad del Valle
Palabras clave: alergia a la proteína de la leche de vaca, práctica clínica, guías, diagnóstico, tratamiento, prevención.

Resumen

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.

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Biografía del autor/a

Angela Mayerly Cubides-Munevar, Fundación Universitaria San Martín, Universidad del Valle
Médico, Mágister en Epidemiología. Docencia universitaria
Alfredo Sadot Linero-Terán, Hospital departamental Mario Correa Rengifo, Fundación clínica infantil Club Noel
Médico especialista en Pediatría.
Mario Andrés Saldarriaga-Vélez, Universidad del Valle
Médico. Residente de especialidad Medicina Familiar
Erika Julieth Umaña-Bautista, Hospital universitario del Valle "Evaristo García" ESE
Médico cirujano. Residente medicina familiar
Eder Antonio Villamarín Betancourt, Universidad del Valle
Pediatra, Hospital Mario Correa Rengifo, Docente Universidad del Valle, Univesidad Santiag de Cali, Fundación Universitaria San Martín, Universidad Icesi. Cali, Colombia. Investigador Junior Colciecias. Cali

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Flujograma para el tratamiento de la APLV
Publicado
2020-03-27
Cómo citar
Cubides-Munevar, A. M., Linero-Terán, A. S., Saldarriaga-Vélez, M. A., Umaña-Bautista, E. J., & Villamarín Betancourt, E. A. (2020). Alergia a la proteína de leche de vaca. Enfoque diagnóstico y terapéutico. Revista Colombiana De Gastroenterología, 35(1), 92-103. https://doi.org/10.22516/25007440.379
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