Arquivos de Asma, Alergia e Imunologia
https://aaai-asbai.org.br/article/doi/10.5935/2526-5393.20250003
Arquivos de Asma, Alergia e Imunologia
Special Article

Atualização em Alergia Alimentar 2025: posicionamento conjunto da Associação Brasileira de Alergia e Imunologia e Sociedade Brasileira de Pediatria

Update on Food Allergy 2025: Joint Position Statement of the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics

Lucila Camargo Lopes de Oliveira; Luciana Rodrigues Silva; Jackeline Motta Franco; Alexandra Sayuri Watanabe; Abelardo Bastos Pinto Júnior; Albertina Capelo; Ana Paula Beltran Moschione Castro; Antônio Carlos Pastorino; Ariana Campos Yang; Bruno A. Paes Barreto; Cristina Targa Ferreira; Ekaterini Simões Goudouris; Elisa de Carvalho; Elza Daniel de Melo; Fabiane Pomiecinski Frota; Germana Pimentel Stefani; Gustavo Falbo Wandalsen; Hélcio Maranhão; Herberto José Chong Neto; Ingrid Pimentel Cunha Magalhães Souza Lima; Jocemara Gurmini; José Carlison Santos de Oliveira; José Luiz Magalhães Rios; Mauro Batista de Moraes; Natália Rocha do Amaral Estanislau; Renata Rodrigues Cocco; Rossiclei Pinheiro; Valéria Botan Gonçalves; Clóvis Francisco Constantino; Fátima Rodrigues Fernandes; Fábio Chigres Kuschnir; Dirceu Solé

http://dx.doi.org/10.5935/2526-5393.20250003 Arq Asma Alerg Imunol, vol.9, n1, p.5-96, 2025
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Resumo

A prevalência da alergia alimentar (AA) tem aumentado em todo o mundo, o que a torna um problema de saúde pública. Responde por parte das reações adversas a alimentos, tem início geralmente precoce e suas manifestações clínicas variadas dependem dos mecanismos imunológicos envolvidos (IgE, não IgE ou misto). A identificação das variadas formas clínicas de apresentação, aliada à aquisição de novos métodos laboratoriais, possibilitaram a realização do diagnóstico etiológico de modo mais preciso, sobretudo quanto à reatividade cruzada entre alimentos e mesmo na identificação de marcadores indicativos de formas clínicas transitórias, persistentes e quadros mais graves. A padronização dos testes de provocação oral permitiu a sua realização de forma mais segura e possibilitou a sua inclusão entre as ferramentas disponíveis para confirmação etiológica da AA, assim como a melhor caracterização da Síndrome da enterocolite induzida por proteína alimentar e da Esofagite eosinofílica. Apesar da identificação de novos fatores de risco e de novos alérgenos alimentares, a exclusão do alimento responsável pelas manifestações clínicas continua sendo a principal conduta terapêutica. Entre os pacientes alérgicos às proteínas do leite de vaca, a disponibilidade de fórmulas especiais tem facilitado o tratamento substitutivo do leite de vaca para esses pacientes. A abordagem atual da anafilaxia (forma mais grave de AA mediada por IgE) é revisada, uma vez que os alimentos são os principais agentes etiológicos em crianças. Avanços na conduta de algumas manifestações gastrintestinais também são abordados. Na atualidade, a imunoterapia oral tem sido cada vez mais utilizada, e os imunobiológicos também são apresentados à luz das evidências científicas e clínicas atuais, assim como considerações sobre história natural da AA e formas de prevenção da AA. Este documento, baseado no Consenso Brasileiro sobre Alergia Alimentar de 2018, reuniu especialistas no tratamento da AA (alergologistas, gastroenterologistas, nutrólogos e pediatras) que revisaram e atualizaram os métodos diagnósticos e esquemas de tratamento disponíveis e empregados no acompanhamento de pacientes com AA, visando a melhor abordagem terapêutica desses pacientes.

Palavras-chave

Hipersensibilidade alimentar; fatores de risco; anafilaxia; testes cutâneos; IgE sérica específica; diagnóstico; imunoterapia; fórmulas hipoalergênicas.

Abstract

The global increase in the prevalence of food allergy (FA) has elevated it to a public health concern. FA accounts for a number of adverse food reactions, typically presenting early in life. Its diverse clinical manifestations depend on the specific immunological mechanisms involved (IgE, non-IgE, or mixed). The identification of various clinical presentations and new laboratory methods have enhanced the accuracy of etiological diagnosis. This includes improved understanding of cross-reactivity between foods and the identification of markers indicative of transient, persistent, or severe clinical courses. The standardization oral food challenge tests has enhanced their safety and enabled their inclusion among the tools available for the etiological confirmation of FA, in addition to contributing to a better characterization of both food protein-induced enterocolitis syndrome and eosinophilic esophagitis. Despite the identification of new risk factors and food allergens, elimination of the offending food from the diet remains the primary treatment approach. For patients with cow's milk protein allergy, the availability of specialized formulas has facilitated replacement treatment. This document reviews the current approach to anaphylaxis, the most severe IgE-mediated FA, since food is the main etiological agent in children. Additionally, it addresses advances in the management of certain gastrointestinal manifestations of FA. Oral immunotherapy is increasingly used in the treatment of FA, and immunobiologicals are also addressed in light of the most recent scientific and clinical evidence, in addition to considerations on the natural history of FA and the available forms of prevention. Based on the 2018 Brazilian Consensus on Food Allergy, this document provides an updated review of diagnostic methods and treatment regimens for patients with FA. A team of experts, including allergologists, gastroenterologists, dietitians, and pediatricians, contributed to this update, with the goal of outlining best practices in therapeutic approaches and patient monitoring.

Keywords

Food hypersensitivity; risk factors; anaphylaxis; skin prick tests; specific serum IgE; diagnosis; immunotherapy; hypoallergenic formulas

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Submitted date:
01/14/2025

Accepted date:
02/10/2025

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