Sangue vivo isolado nas fezes de recém nascidos e o desafio diagnóstico de proctocolite alérgica
DOI:
https://doi.org/10.34117/bjdv9n5-152Keywords:
recém-nascidos, proctocolite alérgica, hematoquezia, neonatos, alergia à proteína do leite de vacaAbstract
A alergia à proteína do leite de vaca (APLV) é a principal causa de alergia alimentar na infância, com manifestações clínicas variadas, incluindo diversos órgãos, sistemas e graus de comprometimento, podendo ser classificada, de acordo com seu mecanismo imunológico, como Alergia Imunoglobulina E (Ige E) mediada, Alergia mista ou Alergia não IgE mediada. Entre as reações não IgE mediadas encontra-se a Proctocolite Alérgica Induzida pela Proteína Alimentar (FPIAP, do inglês food protein induced proctocolitis), a qual, no período neonatal, manifesta-se frequentemente na forma de sangramento retal. A FPIAP, no entanto, devido à ampla gama de diagnósticos diferenciais, permanece um tópico controverso. Além disso, poucos estudos têm usado o padrão-ouro de diagnóstico, o Teste de Provocação Oral (TPO), para a confirmação do diagnóstico de APLV, sendo que a maioria das estimativas sobre a frequência de APLV utilizam outros métodos diagnósticos, como prick-test, histologia e autopercepção, em manifestações variadas de apresentação clínica, o que pode superestimar a frequência real da doença. De acordo com isso, é evidente que a caracterização diagnóstica da proctocolite alérgica em recém nascidos necessita de um consenso, em termos de investigação diagnóstica e condutas, baseado em evidências científicas, para que, dessa maneira, seja evitado o superdiagnóstico da doença e, consequentemente, restrições desnecessárias da proteína do leite de vaca e a introdução inapropriada de fórmulas infantis hipoalergênicas de alto custo.
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