Reducing public health costs with infant formulas: oral food challenge and misdiagnosed or outgrown cow’s milk protein allergy
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , , , |
Tipo de documento: | preprint |
Idioma: | eng |
Título da fonte: | SciELO Preprints |
Texto Completo: | https://preprints.scielo.org/index.php/scielo/preprint/view/535 |
Resumo: | Background: Accurate diagnosis and appropriate management of cow’s milk protein allergy (CMPA) are crucial for avoiding unnecessary prescription of infant formulas. Here, we aimed to use the oral food challenge (OFC) for CMPA confirmation and for assessing development of natural tolerance to milk, in children with clinical CMPA diagnosis. We also assessed the economic impact in public health-care costs of reducing the prescription of infant formulas (provided by the São Paulo State’s public health service, in Brazil, until two years of age) after ruling out CMPA diagnosis in children with negative OFC results. Methods: We reviewed medical records of 76 children [41 males, median age = 2.0 years (0.8-5.0)] who underwent OFC from January 2016 to June 2018, 30 of whom were ≤2 years old. Results: Before OFC, 52 (68.4%), 20 (26.3%) and five (5.3%) children were diagnosed with non-IgE-mediated, IgE-mediated and mixed CMPA, respectively. Most children were fed with aminoacid-based formulas (n=29, 38%). OFC was negative in 58 (76%) children, thus ruling out CMPA diagnosis. Out of 18 (24%) OFC-positive children, most (n=10, 56%) had gastrointestinal symptoms. After ruling out CMPA diagnosis, a mean of 152.3 formula cans (2,161.14 US dollars) were saved per children by the public health service. The total amount saved was 64,834.27 US dollars. Conclusions: OFC proved important not only for ruling out misdiagnosed CMPA, but also for preventing the indiscriminate use of infant formulas, which, in turn, had positive consequences for public health costs. |
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Reducing public health costs with infant formulas: oral food challenge and misdiagnosed or outgrown cow’s milk protein allergy public health costsinfant formulasoral food challengemilk allergyfood allergynatural toleranceBackground: Accurate diagnosis and appropriate management of cow’s milk protein allergy (CMPA) are crucial for avoiding unnecessary prescription of infant formulas. Here, we aimed to use the oral food challenge (OFC) for CMPA confirmation and for assessing development of natural tolerance to milk, in children with clinical CMPA diagnosis. We also assessed the economic impact in public health-care costs of reducing the prescription of infant formulas (provided by the São Paulo State’s public health service, in Brazil, until two years of age) after ruling out CMPA diagnosis in children with negative OFC results. Methods: We reviewed medical records of 76 children [41 males, median age = 2.0 years (0.8-5.0)] who underwent OFC from January 2016 to June 2018, 30 of whom were ≤2 years old. Results: Before OFC, 52 (68.4%), 20 (26.3%) and five (5.3%) children were diagnosed with non-IgE-mediated, IgE-mediated and mixed CMPA, respectively. Most children were fed with aminoacid-based formulas (n=29, 38%). OFC was negative in 58 (76%) children, thus ruling out CMPA diagnosis. Out of 18 (24%) OFC-positive children, most (n=10, 56%) had gastrointestinal symptoms. After ruling out CMPA diagnosis, a mean of 152.3 formula cans (2,161.14 US dollars) were saved per children by the public health service. The total amount saved was 64,834.27 US dollars. Conclusions: OFC proved important not only for ruling out misdiagnosed CMPA, but also for preventing the indiscriminate use of infant formulas, which, in turn, had positive consequences for public health costs.Objetivos: O diagnóstico preciso e o manejo apropriado da alergia à proteína do leite de vaca (alergia ao leite, AL) são cruciais para evitar a prescrição desnecessária de fórmulas infantis. Aqui, tivemos o objetivo de usar o teste de provocação oral aberto (TPOA) para a confirmação do diagnóstico de AL e para avaliar o desenvolvimento de tolerância natural ao leite, em crianças com diagnóstico clínico de AL. Também avaliamos o impacto nos custos de saúde pública da redução da prescrição de fórmulas infantis (fornecidas pelo serviço de saúde do estado de São Paulo até os dois anos de idade) após descartar o diagnóstico de AL em crianças com TPOA negativo. Métodos: Revisamos prontuários de 76 crianças [41 do sexo masculino, mediana de idade = 2. anos (0,8-5,0)] submetidas ao TPOA de janeiro de 2016 a junho de 2018, 30 das quais tinham dois anos de idade ou menos. Resultados: Antes do TPOA, 52 (68.4%), 20 (26.3%) e cinco (5.3%) crianças foram diagnosticadas com AL não mediada por IgE, mediada por IgE e de mecanismo misto, respectivamente. A maioria das crianças era alimentada com fórmulas baseadas em aminoácidos (n=29, 38%). O TPOA foi negativo em 58 (76%) crianças, descartando, assim, o diagnóstico de AL. De 18 (24%) crianças positivas para o TPOA, a maioria (n=10, 56%) tinha sintomas gastrointestinais. Após descartar o diagnóstico de AL, uma média de 152,3 latas de fórmula (R$ 8.644,57) foram economizadas, por criança, pelo serviço público de saúde. O montante total economizado foi de R$ 259.337,09. Conclusão: O TPOA se mostrou importante, não apenas para descartar o diagnóstico de AL, como também para evitar o uso indiscriminado de fórmulas infantis, o que, por sua vez, teve consequências positivas para os custos de saúde pública.SciELO PreprintsSciELO PreprintsSciELO Preprints2020-05-29info:eu-repo/semantics/preprintinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://preprints.scielo.org/index.php/scielo/preprint/view/53510.1590/SciELOPreprints.535enghttps://preprints.scielo.org/index.php/scielo/article/view/535/852Copyright (c) 2020 Ana Laura Andrade, Priscila Pereira, Renan Mauch, Maria Angela Bellomo Brandão, Marcos Tadeu Nolasco da Silva, Adriana Riccettohttps://creativecommons.org/licenses/by/4.0info:eu-repo/semantics/openAccessAndrade, Ana LauraPereira, PriscilaMauch, RenanBrandão, Maria Angela BellomoSilva, Marcos Tadeu Nolasco daRiccetto, Adrianareponame:SciELO Preprintsinstname:SciELOinstacron:SCI2020-05-21T10:02:54Zoai:ops.preprints.scielo.org:preprint/535Servidor de preprintshttps://preprints.scielo.org/index.php/scieloONGhttps://preprints.scielo.org/index.php/scielo/oaiscielo.submission@scielo.orgopendoar:2020-05-21T10:02:54SciELO Preprints - SciELOfalse |
dc.title.none.fl_str_mv |
Reducing public health costs with infant formulas: oral food challenge and misdiagnosed or outgrown cow’s milk protein allergy |
title |
Reducing public health costs with infant formulas: oral food challenge and misdiagnosed or outgrown cow’s milk protein allergy |
spellingShingle |
Reducing public health costs with infant formulas: oral food challenge and misdiagnosed or outgrown cow’s milk protein allergy Andrade, Ana Laura public health costs infant formulas oral food challenge milk allergy food allergy natural tolerance |
title_short |
Reducing public health costs with infant formulas: oral food challenge and misdiagnosed or outgrown cow’s milk protein allergy |
title_full |
Reducing public health costs with infant formulas: oral food challenge and misdiagnosed or outgrown cow’s milk protein allergy |
title_fullStr |
Reducing public health costs with infant formulas: oral food challenge and misdiagnosed or outgrown cow’s milk protein allergy |
title_full_unstemmed |
Reducing public health costs with infant formulas: oral food challenge and misdiagnosed or outgrown cow’s milk protein allergy |
title_sort |
Reducing public health costs with infant formulas: oral food challenge and misdiagnosed or outgrown cow’s milk protein allergy |
author |
Andrade, Ana Laura |
author_facet |
Andrade, Ana Laura Pereira, Priscila Mauch, Renan Brandão, Maria Angela Bellomo Silva, Marcos Tadeu Nolasco da Riccetto, Adriana |
author_role |
author |
author2 |
Pereira, Priscila Mauch, Renan Brandão, Maria Angela Bellomo Silva, Marcos Tadeu Nolasco da Riccetto, Adriana |
author2_role |
author author author author author |
dc.contributor.author.fl_str_mv |
Andrade, Ana Laura Pereira, Priscila Mauch, Renan Brandão, Maria Angela Bellomo Silva, Marcos Tadeu Nolasco da Riccetto, Adriana |
dc.subject.por.fl_str_mv |
public health costs infant formulas oral food challenge milk allergy food allergy natural tolerance |
topic |
public health costs infant formulas oral food challenge milk allergy food allergy natural tolerance |
description |
Background: Accurate diagnosis and appropriate management of cow’s milk protein allergy (CMPA) are crucial for avoiding unnecessary prescription of infant formulas. Here, we aimed to use the oral food challenge (OFC) for CMPA confirmation and for assessing development of natural tolerance to milk, in children with clinical CMPA diagnosis. We also assessed the economic impact in public health-care costs of reducing the prescription of infant formulas (provided by the São Paulo State’s public health service, in Brazil, until two years of age) after ruling out CMPA diagnosis in children with negative OFC results. Methods: We reviewed medical records of 76 children [41 males, median age = 2.0 years (0.8-5.0)] who underwent OFC from January 2016 to June 2018, 30 of whom were ≤2 years old. Results: Before OFC, 52 (68.4%), 20 (26.3%) and five (5.3%) children were diagnosed with non-IgE-mediated, IgE-mediated and mixed CMPA, respectively. Most children were fed with aminoacid-based formulas (n=29, 38%). OFC was negative in 58 (76%) children, thus ruling out CMPA diagnosis. Out of 18 (24%) OFC-positive children, most (n=10, 56%) had gastrointestinal symptoms. After ruling out CMPA diagnosis, a mean of 152.3 formula cans (2,161.14 US dollars) were saved per children by the public health service. The total amount saved was 64,834.27 US dollars. Conclusions: OFC proved important not only for ruling out misdiagnosed CMPA, but also for preventing the indiscriminate use of infant formulas, which, in turn, had positive consequences for public health costs. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-05-29 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/preprint info:eu-repo/semantics/publishedVersion |
format |
preprint |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://preprints.scielo.org/index.php/scielo/preprint/view/535 10.1590/SciELOPreprints.535 |
url |
https://preprints.scielo.org/index.php/scielo/preprint/view/535 |
identifier_str_mv |
10.1590/SciELOPreprints.535 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
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https://preprints.scielo.org/index.php/scielo/article/view/535/852 |
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https://creativecommons.org/licenses/by/4.0 info:eu-repo/semantics/openAccess |
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https://creativecommons.org/licenses/by/4.0 |
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openAccess |
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SciELO Preprints SciELO Preprints SciELO Preprints |
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SciELO Preprints SciELO Preprints SciELO Preprints |
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