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2020

ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

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A CASE OF PERSISTENT AND SEVERE COW’S MILK ALLERGY WITH A SUCCESSFUL TOLERANCE INDUCTION

Inês Sangalho1, Susana-Palma Carlos1, Paula Leiria Pinto1

1 – Serviço de Imunoalergologia, CHULC – Hospital Dona Estefânia

Reunião Internacional, apresentação sob a forma de Poster, na Pediatric Allergy and Asthma Meeting2019, Florença, 17 a 19 de Outubro de 2019

Resumo:
Introduction: Cow’s milk allergy (CMA) is one of the most common food allergies in paediatric patients. Usually has a good prognosis, but sometimes the symptoms persist and oral immunotherapy (OIT) is an alternative treatment that has proven to be effective.
Case Report: Female, 18 years, followed for CMA, atopic dermatitis and rhinitis. With the introduction of yogurt at 9 months, she had immediate onset of urticaria, angioedema and vomiting and worsening of eczema on the following days. Since then, she strictly avoided cow’s milk. At the age of 14, sIgE for CMP, mainly casein, remained high and she had an episode of perilabial urticaria, oropharyngeal ictching and rhinorrea after accidental butter intake. At this time, OIT was initiated. On the 2nd session, there was an anaphylactic episode with dyspnoea after the ingestion of 21cc, leading to protocol readjustment – slower progression and longer intervals of time between sessions. After one year, the goal dose of 200cc of cow’s milk was achieved on the 11th session; she kept that intake and changed her diet to include CMP. There were several anaphylactic episodes on the 1st year after OIT, but most of them were associated with co-factors like exercise or alcohol intake. On the 2nd year, two more anaphylactic episodes occurred, both associated with exercise. Three years after, she didn´t have anaphylactic reactions and a 50% reduction of the papule for casein was observed along with reduction of sIgE, mainly casein (from 21,8 to 1,69 kUA/L).
Conclusions: Since the patient didn´t tolerate CMP at 14 years old and sIgE to casein remained elevated, natural tolerance acquisition wasn’t expectable. With OIT there was reduction of sIgE to casein and increase of the threshold tolerance to CMP suggesting a favourable outcome although several anaphylactic episodes have occurred. This case highlights that not all the cases of CMA have a resolution on the first years of life and that OIT can be an effective therapy on difficult cases, even in teenagers.

Palavras Chave: alergia às proteínas do leite de vaca, anafilaxia, indução de tolerância