267 Recurrent Aanaphylaxis in Cow Milk Allergy: What Is Wrong?

BACKGROUND: Food allergens are one of the most important triggers of anaphylaxis in pediatric population and all efforts must be done to avoid new episodes. OBJECTIVE: To determine some factors associated to recurrent anaphylaxis induced by cow´s milk (CM) in pediatric patients with a previous anaphylactic episodes. METHODS: This is a retrospective study based on medical records from all CM anaphylactic patients, from a Brazilian reference center for food allergy. The anaphylaxis criterion used was based on the Second symposium on the definition and management of anaphylaxis. Patients and parents had received orientation regarding prevention of new episodes, including information about hidden allergens, label reading, and synonymous terms. RESULTS: It was included 53 patients (33M: 20F), median age of the first episode of anaphylaxis was 6 months (range 1–87 month) and in 56. 6% the first episode occurred until the age of 6 months. Fifty episodes were observed in 22 patients during the follow up. Twelve patients presented 2 or more episodes and 2 patients presented 6 episodes. It was not possible to detect the trigger food in 17 episodes and these situations were related to ingestion of: appetizers (4), margarine (3), bread (2), pizza (2), juice with casein (1), pasta (1), cake (1), chips (1), Italian sausage (1). Two episodes were challenged by accidentally skin contact and 2 by inhalation. Among the settings of episodes, the majority occurred at home. Other places included: school, restaurants and bakery. CONCLUSIONS: This study showed that it is very difficult to reach success only with the orientations regarding anaphylaxis prevention. It is necessary to betake of other strategies to improve the measure to avoid new episodes of anaphylaxis such as: folders, visual midia and interactive activities. Furthermore, the continuous education is essential to reinforce the knowledge.