Alergia alimentar ao leite de vaca e ovo mediadas por IgE: sugestões de receitas termicamente testadas
IgE-mediated food allergy to cow’s milk and egg: baked recipe suggestions
Elaine Cristina de Almeida Kotchetkoff; Raquel Bicudo Mendonça; Renata Magalhães Boaventura; Carolina Sanchez Aranda; Roseli Oselka Saccardo Sarni
Resumo
Objetivo: Cerca de 50% dos indivíduos com alergia ao leite de vaca e ao ovo podem tolerar esses alimentos em sua forma termicamente tratada. O consumo desses alimentos, mesmo que termicamente tratados, pode ampliar a variedade da dieta de crianças com alergia alimentar. O presente artigo tem como objetivo propor receitas culinárias com leite de vaca e ovo tratados termicamente para serem usadas em teste de provocação oral. Métodos: Alguns critérios foram adotados para elaboração das receitas: quantidade de proteína alergênica testada por porção (leite de vaca - 1,3 g; ovo - 2,0 g), tempo (30 minutos), temperatura de cocção (180 °C), os ingredientes que devem compor a receita (farinha de trigo como principal ingrediente), volume final da porção a ser oferecida, além de questões de ordem prática relacionadas ao preparo e oferta das preparações. Resultados: No total foram desenvolvidas dez receitas termicamente tratadas, sendo cinco com leite de vaca (três receitas de bolinho – básica, sem açúcar e sem ovo de galinha; duas receitas de tortinha salgada – básica e sem ovo de galinha) e cinco com ovo de galinha (três receitas de bolinho – básica, sem açúcar, e sem leite de vaca; duas receitas de tortinha salgada – básica e sem leite de vaca). Conclusão: É de extrema importância que o teste de provocação oral seja realizado de maneira rotineira e com preparações adequadas e padronizadas, e, em nosso conhecimento, esse é o primeiro estudo nacional que propõe várias receitas tratadas termicamente para auxiliar serviços especializados que atendem pacientes com alergia alimentar.
Palavras-chave
Abstract
Objective: About 50% of individuals with cow's milk and egg allergies can tolerate these foods in their baked form. The consumption of these foods, even if baked, may expand the variety of the diet of children with food allergy. This article aims to propose recipes with baked milk and egg to be used in an oral food challenge. Methods: Some criteria were adopted for preparing the recipes: amount of allergenic protein tested per serving (cow's milk: 1.3 g; egg: 2.0 g), time (30 min), oven temperature (180 °C), the ingredients that should compose the recipe (wheat flour as the main ingredient), final volume of the serving to be provided, in addition to practical questions related to the preparation and provision of the recipes. Results: In total, ten baked recipes were developed, five with cow's milk (three cupcake recipes: regular, with no sugar and no egg; two savory muffin recipes: regular, with no egg) and five with egg (three cupcake recipes: regular, with no sugar and no cow's milk; two savory muffin recipes: regular, with no cow's milk). Conclusion: It is extremely important that the oral food challenge is performed routinely and with adequate and standardized recipes. To our knowledge, this is the first national study in Brazil that proposes several baked recipes to assist specialist services that treat patients with food allergy
Keywords
Referências
1. Nwaru BI, Hickstein L, Panesar SS, Roberts G, Muraro A, Sheikh A. Prevalence of common food allergies in Europe: A systematic review and meta-analysis. Allergy Eur J Allergy Clin Immunol. 2014;69(8):992-1007.
2. Lemon-Mulé H, Sampson HA, Sicherer SH, Shreffler WG, Noone S, Nowak-Wegrzyn A. Immunologic changes in children with egg allergy ingesting extensively heated egg. J Allergy Clin Immunol. 2008;122(5):977-84.
3. Nowak-Wegrzyn A, Bloom KA, Sicherer SH, Shreffler WG, Noone S, Wanich N, et al. Tolerance to extensively heated milk in children with cow’s milk allergy. J Allergy Clin Immunol. 2008;122(2):342‑7.
4. Leonard SA, Caubet JC, Kim JS, Groetch M, Nowak-Wegrzyn A. Baked milk- and egg-containing diet in the management of milk and egg allergy. J Allergy Clin Immunol Pract. 2015;3(1):13‑23.
5. Boaventura RM, Mendonça RB, Andrade RS, Kotchetkoff ECA, Sarni ROS. Uso de leite processado em altas temperaturas por paciente com alergia ao leite de vaca - relato de caso. Arq Asma Alerg Imunol. 2018;2(2):279-82.
6. Luyt D, Ball H, Makwana N, Green MR, Bravin K, Nasser SM, et al. BSACI guideline for the diagnosis and management of cow’s milk allergy. Clin Exp Allergy. 2014;44(5):642‑72.
7. University of Wisconsin Hospitals and Clinics Authority. Food Challenge for Extensively Heated Milk (HMFC). Allergy. [Internet]. Acessado em 06/06/2020. Disponível em: https://www.uwhealth.org/healthfacts/nutrition/513.html.
8. Leonard SA, Sampson HA, Sicherer SH, Noone S, Moshier EL, Godbold J, et al. Dietary baked egg accelerates resolution of egg allergy in children. J Allergy Clin Immunol. 2012;130(2):17‑9.
9. Duke University Medical Center D of PA& I. Heated Egg Sponge Cake Recipe (unpublished data) [Internet]. Acessado em 06/06/2020. Disponível em: https://www.wsh.nhs.uk/CMS-Documents/Patientleaflets/PaediatricDepartment/6446-1-Egg-allergy.pdf.
10. Ebisawa M, Ito K, Fujisawa T. Japanese guidelines for food allergy 2017. Allergol Int. 2017;66(2):248‑64.
11. Nowak-Wegrzyn A, Fiocchi A. Rare, medium, or well done? The effect of heating and food matrix on food protein allergenicity. Curr Opin Allergy Clin Immunol. 2009;9(3):234‑7.
12. Bloom KA, Huang FR, Bencharitiwong R, Bardina L, Ross A, Sampson HA, et al. Effect of heat treatment on milk and egg proteins allergenicity. Pediatr Allergy Immunol. 2014;25(8):740‑6.
13. Turner PJ, Mehr S, Joshi P, Tan J, Wong M, Kakakios A, et al. Safety of food challenges to extensively heated egg in egg-allergic children: A Prospective cohort study. Pediatr Allergy Immunol. 2013;24(5):450‑5.
14. Wood RA, Sicherer SH, Vickery BP, Jones SM, Liu AH, Fleischer DM, et al. The natural history of milk allergy in an observational cohort. J Allergy Clin Immunol. 2013;131(3):805‑12.
15. Sicherer SH, Wood RA, Vickery BP, Jones SM, Liu AH, Fleischer DM, et al. The natural history of egg allergy in an observational cohort. J Med Chem. 2015;57(12):4977‑5010.
16. Lambert R, Grimshaw KEC, Ellis B, Jaitly J, Roberts G. Evidence that eating baked egg or milk influences egg or milk allergy resolution: a systematic review. Clin Exp Allergy. 2017;47(6):829‑37.
17. Cortot CF, Sheehan WJ, Permaul P, Friedlander JL, Baxi SN, Gaffin JM, et al. Role of specific IgE and skin-prick testing in predicting food challenge results to baked egg. Allergy Asthma Proc. 2012;33(MayJune):275‑81.
18. Bartnikas LM, Sheehan WJ, Hoffman EB, Permaul P, Dioun AF, Friedlander J, et al. Predicting food challenge outcomes for baked milk : role of specific IgE and skin prick testing. ANAI. 2012;109(5):309-313.e1.
19. Leonard SA. Baked milk and egg diets for milk and egg allergy management. Immunol Allergy Clin North Am. 2016;36:147‑59.
20. Vlieg-Boerstra BJ, Bijleveld CMA, Van Der Heide S, Beusekamp BJ, Wolt-Plompen SAA, Kukler J, et al. Development and validation of challenge materials for double-blind, placebocontrolled food challenges in children. J Allergy Clin Immunol. 2004;113(2):341‑6.
21. Solé D, Rodrigues Silva L, Cocco RR, Ferreira CT, Sarni RO, Oliveira LC, et al. Consenso Brasileiro sobre Alergia Alimentar: 2018 - Parte 2 - Diagnóstico, tratamento e prevenção. Documento conjunto elaborado pela Sociedade Brasileira de Pediatria e Associação Brasileira de Alergia e Imunologia. Arq Asma Alerg Imunol. 2018;2(1):39‑82.
22. Guia alimentar para crianças brasileiras menores de 2 anos/ Ministério da Saúde, Secretaria de Atenção Primária à Saúde, Departamento de Promoção da Saúde. Brasília; 2019. 265 p.
23. Guia Alimentar para a População Brasileira. 2ª edição. Santa Maria: Gráfica e Editora Brasil Ltda.; 2014.152 p.
24. Osborne NJ, Koplin JJ, Martin PE, Hons B, Gurrin LC, Lowe AJ, et al. Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants. J Allergy Clin Immunol. 2011;127(3):668-676.e2.
Submetido em:
14/05/2020
Aceito em:
24/08/2020
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email