Outcomes and factors associated with tolerance in infants with non-IgE-mediated cow's milk allergy with gastrointestinal manifestations

array:23 ["pii" => "S0021755723001006" "issn" => "00217557" "doi" => "10.1016/j.jped.2023.08.003" "estado" => "S300" "fechaPublicacion" => "2024-01-01" "aid" => "1205" "copyright" => "Sociedade Brasileira de Pediatria" "copyrightAnyo" => "2023" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "J Pediatr (Rio J). 2024;100:40-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:17 [ "pii" => "S0021755723000839" "issn" => "00217557" "doi" => "10.1016/j.jped.2023.07.002" "estado" => "S300" "fechaPublicacion" => "2024-01-01" "aid" => "1195" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "J Pediatr (Rio J). 2024;100:46-52" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Height and body mass index distribution in children and adolescents with and without spina bifida" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "46" "paginaFinal" => "52" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0002" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 4043 "Ancho" => 2917 "Tamanyo" => 479440 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0002" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Body Mass Index z-score distribution of children and adolescents without spina bifida aged 7-16 years compared to the WHO normal distribution curve (a). Body Mass Index z-score distribution of children and adolescents with spina bifida aged 8-15 years compared to the WHO normal distribution curve (b)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Fabio Bertapelli, Cyntia Rogean de Jesus Alves de Baptista, Ana Claudia Mattiello-Sverzut" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Fabio" "apellidos" => "Bertapelli" ] 1 => array:2 [ "nombre" => "Cyntia Rogean de Jesus Alves de" "apellidos" => "Baptista" ] 2 => array:2 [ "nombre" => "Ana Claudia" "apellidos" => "Mattiello-Sverzut" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755723000839?idApp=UINPBA000049" "url" => "/00217557/0000010000000001/v2_202403080702/S0021755723000839/v2_202403080702/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "S0021755723000980" "issn" => "00217557" "doi" => "10.1016/j.jped.2023.07.007" "estado" => "S300" "fechaPublicacion" => "2024-01-01" "aid" => "1203" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "J Pediatr (Rio J). 2024;100:32-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Oropharyngeal colostrum immunotherapy and risk reduction of mortality in very low birth weight premature newborns: a clinical trial" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "32" "paginaFinal" => "39" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0002" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1188 "Ancho" => 1667 "Tamanyo" => 58132 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0002" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier plot of survival function by group in days." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Camilla da C. Martins, Michelle de S.X. Ramos, Amanda O. Lyrio, Tatiana de O. Vieira, Simone S. da Cruz, Graciete O. Vieira" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Camilla da C." "apellidos" => "Martins" ] 1 => array:2 [ "nombre" => "Michelle de S.X." "apellidos" => "Ramos" ] 2 => array:2 [ "nombre" => "Amanda O." "apellidos" => "Lyrio" ] 3 => array:2 [ "nombre" => "Tatiana de O." "apellidos" => "Vieira" ] 4 => array:2 [ "nombre" => "Simone S. da" "apellidos" => "Cruz" ] 5 => array:2 [ "nombre" => "Graciete O." "apellidos" => "Vieira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755723000980?idApp=UINPBA000049" "url" => "/00217557/0000010000000001/v2_202403080702/S0021755723000980/v2_202403080702/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Outcomes and factors associated with tolerance in infants with non-IgE-mediated cow's milk allergy with gastrointestinal manifestations" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "40" "paginaFinal" => "45" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Príscila da Silva Pereira Vasconcelos, Ana Laura Mendes Becker Andrade, Natascha Silva Sandy, Juliana Corrêa Campos Barreto, Gabriela Souza Gomez, Adriana Gut Lopes Riccetto, Elizete Aparecida Lomazi, Maria Ângela Bellomo-Brandão" "autores" => array:8 [ 0 => array:3 [ "nombre" => "Príscila da Silva Pereira" "apellidos" => "Vasconcelos" "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0002" ] 2 => array:2 [ "etiqueta" => "c" "identificador" => "aff0003" ] 3 => array:2 [ "etiqueta" => "d" "identificador" => "aff0004" ] ] ] 1 => array:3 [ "nombre" => "Ana Laura Mendes Becker" "apellidos" => "Andrade" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0001" ] ] ] 2 => array:3 [ "nombre" => "Natascha Silva" "apellidos" => "Sandy" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "d" "identificador" => "aff0004" ] ] ] 3 => array:3 [ "nombre" => "Juliana Corrêa Campos" "apellidos" => "Barreto" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "d" "identificador" => "aff0004" ] ] ] 4 => array:3 [ "nombre" => "Gabriela Souza" "apellidos" => "Gomez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "d" "identificador" => "aff0004" ] ] ] 5 => array:3 [ "nombre" => "Adriana Gut Lopes" "apellidos" => "Riccetto" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0002" ] 2 => array:2 [ "etiqueta" => "c" "identificador" => "aff0003" ] ] ] 6 => array:3 [ "nombre" => "Elizete Aparecida" "apellidos" => "Lomazi" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0002" ] 2 => array:2 [ "etiqueta" => "c" "identificador" => "aff0003" ] ] ] 7 => array:4 [ "nombre" => "Maria Ângela" "apellidos" => "Bellomo-Brandão" "email" => array:1 [ 0 => "angbell@unicamp.br" ] "referencia" => array:5 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0002" ] 2 => array:2 [ "etiqueta" => "c" "identificador" => "aff0003" ] 3 => array:2 [ "etiqueta" => "d" "identificador" => "aff0004" ] 4 => array:2 [ "etiqueta" => "*" "identificador" => "cor0001" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil" "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:3 [ "entidad" => "Centro de Investigação em Pediatria da Faculdade de Ciências Médicas de Campinas (CIPED), Campinas, SP, Brazil" "etiqueta" => "b" "identificador" => "aff0002" ] 2 => array:3 [ "entidad" => "Programa de Pós-graduação em Saúde da Criança e do Adolescente (PPG-SCA), São Paulo, SP, Brazil" "etiqueta" => "c" "identificador" => "aff0003" ] 3 => array:3 [ "entidad" => "Laboratório de Investigação Diagnóstica de Gastroenterologia e Hepatologia Pediátrica, Campinas, SP, Brazil" "etiqueta" => "d" "identificador" => "aff0004" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0001" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "IntroductionNon-IgE-mediated cow's milk allergy (CMA) is a common food allergy during childhood, typically presenting in infancy,<a class="elsevierStyleCrossRef" href="#bib0001">1</a>,<a class="elsevierStyleCrossRef" href="#bib0002">2</a> more often with gastrointestinal manifestations.<a class="elsevierStyleCrossRef" href="#bib0003">3</a> Symptoms vary and are non-specific, which is a problem for recognition by pediatricians and pediatric gastroenterologists who deal with this condition.<a class="elsevierStyleCrossRef" href="#bib0003">3</a> There are different presentations of non-IgE-mediated CMA, including food protein-induced enteropathy, enterocolitis, or proctocolitis. Allergic proctocolitis is the most common presentation, with mild rectal bleeding in an infant who is typically otherwise well and does present with faltering growth. In contrast, Food Protein-Induced Enterocolitis Syndrome (FPIES) is more rare and severe – acute FPIES typically presents in infants ages 4 to 12 months, 1 to 4 h after the ingestion of the protein, with profuse vomiting, pallor, and lethargy, and it can progress to dehydration and shock, while chronic FPIES has been described with persistent vomiting, diarrhea, and/or failure to thrive.<a class="elsevierStyleCrossRefs" href="#bib0004">4–7</a>The majority of non-IgE-mediated cow's milk protein allergies are transient and resolve in early childhood. The achievement of tolerance varies according to the form of presentation: allergic proctocolitis is usually associated with the earliest development of tolerance, generally before the first year of life. Meanwhile, FPIES tend to resolve later and the time to achieve tolerance in patients varies according to the food involved. In patients with FPIES induced by cow's milk protein, tolerance is typically acquired around 3 years of age. It has been described in the literature that up to 20% of exclusively breastfed infants have spontaneous resolution of the allergy without the mother being on an exclusion diet, however, factors associated with the acquisition of tolerance are rarely described.<a class="elsevierStyleCrossRef" href="#bib0004">4</a>,<a class="elsevierStyleCrossRef" href="#bib0008">8</a>The oral food challenge (OFC) test is the gold standard for confirmation of the diagnosis of non-IgE-mediated allergies, and also on the follow-up to assess for the development of tolerance.<a class="elsevierStyleCrossRef" href="#bib0005">5</a>,<a class="elsevierStyleCrossRef" href="#bib0008">8</a>,<a class="elsevierStyleCrossRef" href="#bib0009">9</a> To confirm the diagnosis of non-IgE-mediated CMA, it is recommended to exclude cow's milk protein (CMP) for 2-4 weeks before performing the OFC test.<a class="elsevierStyleCrossRef" href="#bib0010">10</a> In patients who present with mild to moderate symptoms, the test can be performed at home.<a class="elsevierStyleCrossRef" href="#bib0006">6</a>,<a class="elsevierStyleCrossRef" href="#bib0010">10</a> In cases with severe manifestations, such as suspected FPIES, the OFC test should be performed in a hospital environment.<a class="elsevierStyleCrossRef" href="#bib0006">6</a>,<a class="elsevierStyleCrossRef" href="#bib0010">10</a>,<a class="elsevierStyleCrossRef" href="#bib0011">11</a> To evaluate the achievement of tolerance, the test is performed after 6 months of exclusion diet or at 12 months of age (whichever is earlier).<a class="elsevierStyleCrossRef" href="#bib0004">4</a>,<a class="elsevierStyleCrossRef" href="#bib0008">8</a>There is extensive medical literature on the prevention, diagnosis and treatment of non-IgE-mediated cow's milk protein allergies, and it is known that the acquisition of tolerance occurs in most cases around 12 months. However, there is little data regarding factors that interfere with the development of tolerance in children with CMA. The aims of this study were to assess outcomes of the oral food challenge (OFC) test to assess the development of tolerance in infants with non-IgE-mediated cow's milk allergy (CMA) with gastrointestinal manifestations and to explore clinical data associated with these outcomes.MethodsThis single-center retrospective study was conducted with infants (age < 12 months) with a diagnosis of CMA referred to the outpatient clinic of the pediatric gastroenterology unit of a university-affiliated hospital in Brazil, from 2000 to 2018. Inclusion criteria were (all three must have been fulfilled): 1) having a clinic diagnosis of non-IgE mediated CMA with gastrointestinal manifestations in the first year of life; 2) being on a CMP-free diet for at least 8 weeks; and 3) having undergone OFC test on follow-up to assess the development of tolerance. Exclusion criteria aimed to omit infants receiving inappropriate restricted diets if they had been continuously exposed to CMP and/or breasted infants whose mothers had not been on a strict CMP-free diet.Data were collected on age at symptoms onset, gender, gestational age, comorbidities and associated allergic diseases, clinical presentation, CMP-free diet, and outcomes of OFC test. According to the symptoms, the cases were classified as mild-to-moderate vs. severe.<a class="elsevierStyleCrossRef" href="#bib0010">10</a>The OFC test was performed in three different ways, individualizing each case:Home protocolFor infants who were exclusively breastfed, with the breastfeeding mother being on an appropriate CMP elimination diet, the OFC test was performed with home reintroduction of CMP.<a class="elsevierStyleCrossRef" href="#bib0011">11</a> The mother received education on how to progressively and safely reintroduce dairy foods, with careful observation of signs and symptoms. Contact information to reach the team was provided and patients were followed up closely in the outpatient clinic.Hospital protocolIf the infant had been on appropriate formula for CMA, the OFC test was performed in a hospital environment, under the supervision of a specialized medical team, following the most up-to-date OFC test protocol at the time, most recently similar to the one described by Vandenplas et al.<a class="elsevierStyleCrossRef" href="#bib0011">11</a>: Initially, gauze was soaked with an intact cow's milk protein-based formula and gently applied to the patient's lips. If they remained asymptomatic after 15 min, a formula containing intact cow's milk protein was administered orally and the dose was gradually increased (0.5, 1, 3, 10, 30, 50 to 100 mL) every 30 min. Patients remained under observation for two hours after the last dose of formula was given.FPIES protocolIn cases of FPIES, the OFC test protocol was also performed in a hospital environment, carried out with a different protocol than the one previously described, following the most up-to-date OFC test protocol for FPIES at the time, most recently similar to the one published by Nowak-Węgrzyn et al.<a class="elsevierStyleCrossRef" href="#bib0012">12</a>: all patients had peripheral venous access inserted before the test was initiated, and the dose of cow's milk protein varied from 0.06  to 0.6 g of protein/kg (average of 0.3 g/kg), divided in 3 equal doses, given every 30 min. A limit of a maximum of 3g in each step or a maximum of 10g in the entire test was followed. All patients remained under observation for at least 4 h after the last dose of formula was given.In all cases, after the end of the test, if no symptoms were identified by the end of the observation period, the patient was discharged home. A follow-up telephone call always took place in the next day to assess for late symptoms, and patients had a follow-up appointment after one week.The test was considered:<ul class="elsevierStyleList" id="celist0001"><li class="elsevierStyleListItem" id="celistitem0001">-positive in the presence of immediate signs and symptoms (the same as the patient initially presented), persistence or increase in the intensity of subjective symptoms, or if late symptoms were reported by caregivers.</li><li class="elsevierStyleListItem" id="celistitem0002">-negative: in the absence of symptoms.</li></ul>The patients were stratified according to the outcome of the follow-up OFC test: positive vs. negative (development of tolerance). A univariate logistic regression analysis was performed to evaluate variables associated with the outcomes of the follow-up OFC test. For all analyses, a p-value < 0.05 was considered statistically significant. The 95% confidence intervals are presented. The data were analyzed using IBM Statistic SPSS (IBM SPSS Statistics for Windows. NY, EUA).The study was conducted according to the Declaration of Helsinki, and ethical approval was obtained from the Ethics Committee of the University of Campinas (Approval number 2.986.745)ResultsInitially, a total of 205 medical records were analyzed, but only 82 patients were enrolled according to established inclusion and exclusion criteria. Of these, 41 were male (50%), 10% had atopic conditions (asthma, rhinitis and atopic dermatitis), and the same percentage had allergies to foods other than CMA. Fifty-three percent had a history of prematurity.The median age at the first clinical manifestation was 30 days (Q1 25 – Q3 60 days), and by the time of the follow-up OFC test, these patients had been on a CMP elimination diet over a median time of 8 months (Q1 6 – Q3 11 months). The clinical characteristics of infants referred with a diagnosis of cow's milk allergy and who underwent OFC test, stratified according to the outcome of OFC test are shown in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>.<elsevierMultimedia ident="tbl0001"></elsevierMultimedia>At the time of referral, 28% of the infants were fed with an extensively hydrolyzed formula, 24% with an amino acid-based formula, 16% were exclusively breastfed with their mothers on a CMP-restricted diet, 12% were using soy-based formula and 20% were using non-recommended beverages, such as juices, soy-based beverages or milk from other mammals.Of the 82 follow-up OFC tests, 22% were positive. The univariate logistic regression evaluation is presented in <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>. All patients who were on exclusive breastfeeding with their mothers on a restricted diet (13/82) had negative OFC tests. Patients who were on exclusive breastfeeding (with the mother on a CMA-restricted diet) achieved tolerance at a median age of 6 months (Q1 6.6 - Q3 9), while infants who were not exclusively breastfed achieved tolerance later, at a median age of 10.5 months (Q1 4.5 - Q3 10).<elsevierMultimedia ident="tbl0002"></elsevierMultimedia>It is evident that patients who had a higher percentage of positive oral food challenge (OFC) tests were fed with cow's milk protein (CMP) based formula before the first clinical manifestation of non-IgE mediated cow's milk allergy (CMA), compared to patients who had a negative OFC test. Additionally, all patients whose symptoms began while exclusively breastfeeding had a negative follow-up OFC test.Among the OFC tests carried out with infants who were exclusively breastfed, none of the tests were positive. For this group, the median time of maternal restricted CMP diet was 6 months.DiscussionThere is scarce data in the literature on factors that influence the achievement of tolerance in CMA, especially in non-IgE-mediated cases.<a class="elsevierStyleCrossRef" href="#bib0013">13</a>,<a class="elsevierStyleCrossRef" href="#bib0014">14</a> It is known that compared to IgE-mediated CMA, non-IgE-mediated cases are generally milder and resolve earlier, as most manifest as allergic proctocolitis.<a class="elsevierStyleCrossRef" href="#bib0013">13</a> In IgE-mediated CMA, some factors such as the severity of the family history of atopic diseases, later onset of symptoms, presence of other food allergies and/or other allergic diseases have been associated with cases of persistent CMA.<a class="elsevierStyleCrossRef" href="#bib0015">15</a>In our study, 78% of children referred to a tertiary care center with a diagnosis of non-IgE-mediated CMA had already acquired tolerance (negative OFC tests). Exclusive breastfeeding (EBF) seems to help to induce tolerance for CMA: most patients with positive OFC had received CMP-based formula before the first manifestation of CMA and patients who were on exclusive breastfeeding with their mother on an exclusion diet achieved tolerance about 3 months earlier than those who were not.There is some contradictory data in the literature on how dietary factors may influence the occurrence of food allergies, but it seems that EBF has a protective effect against allergies.<a class="elsevierStyleCrossRef" href="#bib0014">14</a>,<a class="elsevierStyleCrossRef" href="#bib0016">16</a>,<a class="elsevierStyleCrossRef" href="#bib0017">17</a> Some studies evaluating this benefit have shown a reduction in the incidence of CMA in infants up to 18 months and atopic dermatitis up to three years of age.<a class="elsevierStyleCrossRef" href="#bib0018">18</a> Meanwhile, the early use of CMP-based formulas has been associated with intestinal dysbiosis, which is a risk factor for food allergy.<a class="elsevierStyleCrossRef" href="#bib0018">18</a>,<a class="elsevierStyleCrossRef" href="#bib0019">19</a> Furthermore, it has been hypothesized that breast milk contains anti-allergenic properties and antibodies that induce tolerance to food antigens.<a class="elsevierStyleCrossRef" href="#bib0019">19</a>The median age at the first clinical manifestation reported in our study was 30 days. In the study by Senocak et al. the median age of the onset of symptoms was 60 days, slightly lower than the authors found in the present study, but both are in agreement with previous literature published – in the first six months of life).<a class="elsevierStyleCrossRef" href="#bib0020">20</a> The authors hypothesize that the higher age reported in the present study results from the referral of premature infants after discharge from the neonatal intensive care unit at the present study's own center. In keeping with our findings, Kaya et al. reported hematochezia and diarrhea as the main manifestations of non-IgE-mediated CMA.<a class="elsevierStyleCrossRef" href="#bib0021">21</a>In the present study, the occurrence of hematochezia and diarrhea as symptoms were associated with the persistence of CMA, while manifestations of vomiting, dehydration, malnutrition, and others (crying, irritability and regurgitation) were not. In a study carried out by Topal et al., children with proctocolitis and abdominal discomfort had an earlier development of tolerance compared to children who had IgE-mediated symptoms. The present study only evaluated children with non-IgE-mediated gastrointestinal symptoms, which justifies the difference in results.<a class="elsevierStyleCrossRef" href="#bib0013">13</a>One-third of the positive OFC had a diagnosis of FPIES. In FPIES it is mandatory to perform the OFC test in a hospital environment, as the authors described.<a class="elsevierStyleCrossRef" href="#bib0012">12</a>,<a class="elsevierStyleCrossRef" href="#bib0022">22</a> Among the patients with FPIES, two-thirds had a positive OFC test, and all the patients were exposed to the CMP-based formula before the first manifestation. These findings are in agreement with previously published studies – the emergence of FPIES in patients who are exclusively breastfed is rare, with few cases reported in the literature.<a class="elsevierStyleCrossRef" href="#bib0023">23</a>,<a class="elsevierStyleCrossRef" href="#bib0024">24</a>There was no association between prematurity and the positivity of the OFC test. It has been reported that no significant difference between the occurrences of cow's milk reactions in the first year of life among premature infants compared to term infants, with preterm infants having the onset of symptoms at the same age as term children, as well as a similar presentation and outcome.<a class="elsevierStyleCrossRef" href="#bib0020">20</a>,<a class="elsevierStyleCrossRef" href="#bib0025">25</a>,<a class="elsevierStyleCrossRef" href="#bib0026">26</a>The authors did not find an association between atopic diseases (asthma, allergic rhinitis, and atopic dermatitis) and the positivity of the OFC test. This association is well seen in cases of IgE-mediated allergies (Topal et al). However, the prevalence of other food allergies was higher among patients who did not develop tolerance, similar to the study by Topal et al., in which the presence of food allergies was considered an independent factor for the persistence of food allergy.<a class="elsevierStyleCrossRef" href="#bib0018">18</a>,<a class="elsevierStyleCrossRefs" href="#bib0027">27–30</a>Continued breastfeeding after the diagnosis of CMPA has been demonstrated to be beneficial. Unfortunately, the authors report a high rate of weaning infants who were on EBF prior to the first manifestations of non-IgE-Mediated CMPA with gastrointestinal manifestations. Breastfeeding not only prevents CMPA, but it is also associated with milder manifestations, shorter time to develop tolerance and lower costs with formulas. Continued breastfeeding should be even more stimulated in the context of CMPA.<a class="elsevierStyleCrossRef" href="#bib0027">27</a>The authors also observed that of the 25 infants who presented symptoms while on EBF, only 13 were still EBF at the time of the OFC test – it is possible that the diagnosis of CMPA and the CMP-elimination diet may have interfered with the maternal ability to continue to breastfeed. Interestingly, none of the patients who remained breastfed had a positive OFC test.Despite the limitations of being a single-center retrospective study, small sample, and the diagnosis of CMPA being clinical (possible selection bias), the present conclusions are that in cases of non-IgE-mediated CMPA with gastrointestinal manifestations in infants, exposure to cow's milk-based formula, a history of other food allergies, hematochezia and diarrhea were associated factors for the later achievement of tolerance. Maintaining breastfeeding should be the focus in the management of CMPA.Funding sourceNo funding was secured for this study.Contributors statementAll authors approved the final version as submitted and agreed to be accountable for all aspects of the work." "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres2102993" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abss0001" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abss0002" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abss0003" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abss0004" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1792187" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0001" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0002" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0003" "titulo" => "Home protocol" ] 1 => array:2 [ "identificador" => "sec0004" "titulo" => "Hospital protocol" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "FPIES protocol" ] ] ] 4 => array:2 [ "identificador" => "sec0006" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0007" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0008" "titulo" => "Funding source" ] 7 => array:2 [ "identificador" => "sec0009" "titulo" => "Contributors statement" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-04-03" "fechaAceptado" => "2023-08-08" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1792187" "palabras" => array:4 [ 0 => "Breastfeeding" 1 => "Cow's milk allergy" 2 => "Food allergy" 3 => "Oral food challenge" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectivesTo evaluate outcomes of oral food challenge (OFC) test to assess tolerance in infants with non-IgE-mediated cow's milk allergy (CMA) with gastrointestinal manifestations and explore clinical data predictive of these outcomes. MethodsSingle-center retrospective study including infants (age < 12 months) who were referred for CMA between 2000 and 2018 and underwent OFC on follow-up. A univariate logistic regression test was performed to evaluate variables associated with the outcomes of the follow-up OFC test. ResultsEighty-two patients were included, 50% were male. Eighteen patients had a positive OFC test (22%). Most patients had presented with hematochezia (77%). The median age of symptom onset was 30 days. Two-thirds of the patients were on appropriate infant formula (extensively hydrolyzed or amino acid-based formula), exclusively or in association with breastfeeding. The median time on an elimination diet before the OFC test was 8 months (Q1 6 – Q3 11 months). All cases with positive follow-up OFC tests (n = 18) had been exposed to cow's milk-based formula before the first clinical manifestation of CMA. Five out of eight cases with Food Protein-Induced Enterocolitis Syndrome (FPIES) had positive OFC tests. Exposure to cow's milk-based formula before diagnosis, a history of other food allergies, hematochezia and diarrhea were predictors of a positive OFC test. ConclusionsIn infants with non-IgE-mediated CMPA with gastrointestinal manifestations, the use of cow's milk-based formula, a history of other food allergies, and hematochezia and diarrhea upon initial presentation were associated factors for the later achievement of tolerance." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abss0001" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abss0002" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abss0003" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abss0004" "titulo" => "Conclusions" ] ] ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0001" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "*Statistics presented: n (%); Median (Q1-Q3)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0001"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0002"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Alln = 82 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0003"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Positive OFC testn = 18 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0004"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Negative OFC testn = 64 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0005"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">p-value<a class="elsevierStyleCrossRef" href="#tb1fn1">⁎⁎</a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0006"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Age at symptoms onset, median, days (Q1-Q3) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0007"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0008"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">37,5 (30-90) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0009"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">30 (25-60) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0,41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0011"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Male gender, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">41 (50) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0013"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">11 (61,1) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">30 (46,9) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0015"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0,322 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0016"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Median time (months) of cow's milk protein elimination diet, median (Q1-Q3) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0017"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">8 (6-11) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">12 (7-15) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0019"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">8 (6-11) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0,021 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0021"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Gestational age > 37 weeks, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0022"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">41 (53,2) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0023"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">13 (72,2) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">28 (47,5) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0025"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0,062 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0026"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Exposure to cow's milk protein formula before onset, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">55 (67) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">15 (83,3) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0029"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">40 (62,5) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0,033 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0031"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Exclusively breastfed infants before the first symptom, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">25 (30,9) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0033"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">3 (16,7) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">22 (34,9) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0,142 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0036"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Atopic manifestations, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0037"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">8 (9,9) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">3 (17,6) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">5 (7,8) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0,353 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0041"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Other food allergies, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">9 (11) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0043"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">5 (27,8) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">4 (6,3) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0,023 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0046"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Hematochezia, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">63 (76,8) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">8 (44,4) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0049"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">55 (85,9) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">< 0,013 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0051"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Diarrhea, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">28 (34,1) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0053"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">12 (66,7) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">16 (25) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">< 0,012 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0056"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Vomiting, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0057"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">18 (22) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">4 (22,2) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">14 (21,9) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0061"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Failure to thrive, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">4 (4,9) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">1 (5,6) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0064"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">3 (4,7) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0065"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0066"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Acute FPIES, n (%)<a class="elsevierStyleCrossRef" href="#tb1fn2">⁎⁎⁎</a> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">8 (9,8) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">5 (27,8) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0069"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">3 (4,7) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0,013 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3479317.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tb1fn1" "etiqueta" => "⁎⁎" "nota" => "Statistical tests performed: 1Mann-Whitney test and 2chi-square test or 3Fisher's exact test." ] 1 => array:3 [ "identificador" => "tb1fn2" "etiqueta" => "⁎⁎⁎" "nota" => "Acute FPIES: profuse vomiting, pallor, and lethargy, ± diarrhea, ± dehydration." ] ] ] "descripcion" => array:1 [ "en" => "Clinical characteristics of infants referred with a diagnosis of cow's milk allergy and who underwent oral food challenge (OFC) test, stratified according to outcome of OFC test." ] ] 1 => array:8 [ "identificador" => "tbl0002" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0002" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0071"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0072"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Odds ratio \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0073"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">95% confidence intervals \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0074"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">p-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0075"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Mean age at symptom onset \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0077"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.99 – 1.01 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0078"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.62 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0079"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Male gender \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.78 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0081"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.61 – 5.18 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.29 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0083"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Exposure to cow's milk protein before diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">3.846 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0085"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.27 – 11.64 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0086"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">< 0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0087"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Gestational age > 37 weeks \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2.88 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0089"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.91 – 9.10 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.07 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0091"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Other atopic manifestations \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0092"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2.53 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0093"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.54 – 11.86 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0095"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Other food allergies \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0096"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">5.77 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0097"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.36 – 24.47 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0098"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">< 0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0099"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Hematochezia \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">7.64 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0101"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2.38 – 24.53 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0102"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">< 0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0103"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Diarrhea \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0105"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.93 – 18.6 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0106"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">< 0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0107"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Vomiting \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.02 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0109"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.29 – 3.59 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0110"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.97 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0111"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Failure to thrive \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0112"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.2 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0113"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.12 – 12.25 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.88 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3479318.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Univariate logistic regression analysis for clinical variables associated with the failure to achieve tolerance to cow's milk protein." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec1" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A survey on clinical presentation and nutritional status of infants with suspected cow' milk allergy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "MC Vieira" 1 => "MB Morais" 2 => "JV Spolidoro" 3 => "MS Toporovski" 4 => "AL Cardoso" 5 => "GT Araujo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2431-10-25" "Revista" => array:5 [ "tituloSerie" => "BMC Pediatr" "fecha" => "2010" "volumen" => "10" "paginaInicial" => "25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20416046" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0002" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Paediatric non-IgE mediated food allergy: guide for practitioners" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K Preece" 1 => "A Blincoe" 2 => "E Grangaard" 3 => "GT Ostring" 4 => "D Purvis" 5 => "J Sinclair" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "N Z Med J" "fecha" => "2016" "volumen" => "129" "paginaInicial" => "78" "paginaFinal" => "88" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27977655" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0003" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "May failure to thrive in infants be a clinical marker for the early diagnosis of cow's milk allergy?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L Diaferio" 1 => "D Caimmi" 2 => "MC Verga" 3 => "V Palladino" 4 => "L Trovè" 5 => "P Giordano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/nu12020466" "Revista" => array:5 [ "tituloSerie" => "Nutrients" "fecha" => "2020" "volumen" => "12" "paginaInicial" => "466" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32069783" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0004" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-IgE-mediated gastrointestinal food allergies in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "JC Caubet" 1 => "H Szajewska" 2 => "R Shamir" 3 => "A. Nowak-Węgrzyn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/pai.12659" "Revista" => array:6 [ "tituloSerie" => "Pediatr Allergy Immunol" "fecha" => "2017" "volumen" => "28" "paginaInicial" => "6" "paginaFinal" => "17" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27637372" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0005" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gastrointestinal food allergy in infants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H Morita" 1 => "I Nomura" 2 => "A Matsuda" 3 => "H Saito" 4 => "K. Matsumoto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2332/allergolint.13-RA-0542" "Revista" => array:6 [ "tituloSerie" => "Allergol Int" "fecha" => "2013" "volumen" => "62" "paginaInicial" => "297" "paginaFinal" => "307" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23974876" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0006" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-IgE-mediated gastrointestinal food allergies in children: an update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R Labrosse" 1 => "F Graham" 2 => "JC. Caubet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/nu12072086" "Revista" => array:5 [ "tituloSerie" => "Nutrients" "fecha" => "2020" "volumen" => "12" "paginaInicial" => "2086" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32674427" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0007" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-IgE-mediated food allergy during infancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "AL Devonshire" 1 => "S Durrani" 2 => "A. Assa'ad" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACI.0000000000000645" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Allergy Clin Immunol" "fecha" => "2020" "volumen" => "20" "paginaInicial" => "292" "paginaFinal" => "298" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32349109" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0008" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Food protein-induced allergic proctocolitis in infants: literature review and proposal of a management protocol" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M Mennini" 1 => "AG Fiocchi" 2 => "A Cafarotti" 3 => "M Montesano" 4 => "A Mauro" 5 => "MP Villa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "World Allergy Organ J" "fecha" => "2020" "volumen" => "13" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0009" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI committee practical guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S Koletzko" 1 => "B Niggemann" 2 => "A Arato" 3 => "JA Dias" 4 => "R Heuschkel" 5 => "S Husby" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MPG.0b013e31825c9482" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Gastroenterol Nutr" "fecha" => "2012" "volumen" => "55" "paginaInicial" => "221" "paginaFinal" => "229" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22569527" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0010" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Better recognition, diagnosis and management of non-IgE-mediated cow's milk allergy in infancy: iMAP-an international interpretation of the MAP (Milk Allergy in Primary Care) guideline" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C Venter" 1 => "T Brown" 2 => "R Meyer" 3 => "J Walsh" 4 => "N Shah" 5 => "A Nowak-Węgrzyn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13601-017-0162-y" "Revista" => array:5 [ "tituloSerie" => "Clin Transl Allergy" "fecha" => "2017" "volumen" => "7" "paginaInicial" => "26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28852472" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0011" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevention and management of cow's milk allergy in non-exclusively breastfed infants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Y. Vandenplas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/nu9070731" "Revista" => array:5 [ "tituloSerie" => "Nutrients" "fecha" => "2017" "volumen" => "9" "paginaInicial" => "731" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28698533" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0012" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Food protein-induced enterocolitis syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A Nowak-Węgrzyn" 1 => "E Jarocka-Cyrta" 2 => "A. Moschione Castro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.18176/jiaci.0149" "Revista" => array:6 [ "tituloSerie" => "J Investig Allergol Clin Immunol" "fecha" => "2017" "volumen" => "27" "paginaInicial" => "1" "paginaFinal" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28603089" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0013" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Independent predictive factors for the persistence and tolerance of cow's milk allergy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E Topal" 1 => "MH Çeliksoy" 2 => "M Arga" 3 => "MS Kaynak" 4 => "Y Duman" 5 => "S Demirtaş" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/alr.22227" "Revista" => array:6 [ "tituloSerie" => "Int Forum Allergy Rhinol" "fecha" => "2019" "volumen" => "9" "paginaInicial" => "67" "paginaFinal" => "71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30376614" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0014" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Non-IgE-mediated cow's milk allergy: Consensus document of the Spanish Society of Paediatric Gastroenterology, Hepatology, and Nutrition (SEGHNP), the Spanish Association of Paediatric Primary Care (AEPAP), the Spanish Society of Extra-hospital Paediatrics and Primary Health Care (SEPEAP), and the Spanish Society of Paediatric ClinicaL Immunology, Allergy, and Asthma (SEICAP)]" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "BE Jaime" 1 => "JJD Martín" 2 => "LC Baviera" 3 => "ÁC Monzón" 4 => "AH Hernández" 5 => "JI García" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "An Pediatr" "fecha" => "2019" "volumen" => "90" "paginaInicial" => "193" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0015" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dietary treatment of cows' milk protein allergy in childhood: a commentary by the Committee on Nutrition of the French Society of Paediatrics" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C Dupont" 1 => "JP Chouraqui" 2 => "D de Boissieu" 3 => "A Bocquet" 4 => "JL Bresson" 5 => "A Briend" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S0007114511004831" "Revista" => array:6 [ "tituloSerie" => "Br J Nutr" "fecha" => "2012" "volumen" => "107" "paginaInicial" => "325" "paginaFinal" => "338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22115523" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0016" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical aspects of pediatric food allergy and failed oral immune tolerance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "KJ Allen" 1 => "PE. Martin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCG.0b013e3181d7760b" "Revista" => array:6 [ "tituloSerie" => "J Clin Gastroenterol" "fecha" => "2010" "volumen" => "44" "paginaInicial" => "391" "paginaFinal" => "401" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20421803" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0017" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relevance of early introduction of cow's milk proteins for prevention of cow's milk allergy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L Ulfman" 1 => "A Tsuang" 2 => "AB Sprikkelman" 3 => "A Goh" 4 => "RJ. van Neerven" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/nu14132659" "Revista" => array:5 [ "tituloSerie" => "Nutrients" "fecha" => "2022" "volumen" => "14" "paginaInicial" => "2659" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35807839" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0018" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brazilian Consensus on Food Allergy: 2018 - part 1 - etiopathogenesis, clinical features, and diagnosis. Joint position paper of the Brazilian Society of Pediatrics and the Brazilian Association of Allergy and Immunology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D Solé" 1 => "LR Silva" 2 => "RR Cocco" 3 => "CT Ferreira" 4 => "RO Sarni" 5 => "LC Oliveira" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BJAI" "fecha" => "2018" "volumen" => "2" "paginaInicial" => "7" "paginaFinal" => "38" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0019" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Strategies and future opportunities for the prevention, diagnosis, and management of cow milk allergy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B Zepeda-Ortega" 1 => "A Goh" 2 => "P Xepapadaki" 3 => "A Sprikkelman" 4 => "N Nicolaou" 5 => "RE Hernandez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Front Immunol" "fecha" => "2021" "volumen" => "12" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0020" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical features and clinical course of food protein-induced allergic proctocolitis: 10-year experience of a tertiary medical center" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N Senocak" 1 => "A Ertugrul" 2 => "S Ozmen" 3 => "I. Bostanci" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaip.2022.02.013" "Revista" => array:6 [ "tituloSerie" => "J Allergy Clin Immunol Pract" "fecha" => "2022" "volumen" => "10" "paginaInicial" => "1608" "paginaFinal" => "1613" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35202870" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0021" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics and prognosis of allergic proctocolitis in infants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A Kaya" 1 => "M Toyran" 2 => "E Civelek" 3 => "E Misirlioglu" 4 => "C Kirsaclioglu" 5 => "CN. Kocabas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MPG.0000000000000767" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Gastroenterol Nutr" "fecha" => "2015" "volumen" => "61" "paginaInicial" => "69" "paginaFinal" => "73" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26039942" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0022" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oral food challenge for FPIES in practice-a survey: report from the work group on FPIES within the adverse reactions to Foods Committee, FAED IS, AAAAI" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R Nicolaides" 1 => "JA Bird" 2 => "A Cianferoni" 3 => "T Brown-Whitehorn" 4 => "A. Nowak-Wegrzyn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaip.2021.06.061" "Revista" => array:6 [ "tituloSerie" => "J Allergy Clin Immunol Pract" "fecha" => "2021" "volumen" => "9" "paginaInicial" => "3608" "paginaFinal" => "3614" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34483087" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0023" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "FPIES in exclusively breastfed infants: two case reports and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F Baldo" 1 => "M Bevacqua" 2 => "C Corrado" 3 => "D Nisticò" 4 => "L Cesca" 5 => "V Declich" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13052-020-00910-8" "Revista" => array:5 [ "tituloSerie" => "Ital J Pediatr" "fecha" => "2020" "volumen" => "46" "paginaInicial" => "144" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33023612" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0024" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Food protein-induced enterocolitis syndrome: a comprehensive review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A Agyemang" 1 => "A. Nowak-Wegrzyn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12016-018-8722-z" "Revista" => array:6 [ "tituloSerie" => "Clin Rev Allergy Immunol" "fecha" => "2019" "volumen" => "57" "paginaInicial" => "261" "paginaFinal" => "271" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30734159" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0025" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Feeding practices and the prevalence of cow's milk protein allergy in Irish preterm infants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D Henderson" 1 => "CA Murphy" 2 => "AC Glynn" 3 => "MA Boyle" 4 => "N. McCallion" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jhn.12971" "Revista" => array:6 [ "tituloSerie" => "J Hum Nutr Diet" "fecha" => "2022" "volumen" => "35" "paginaInicial" => "535" "paginaFinal" => "541" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34904759" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0026" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adverse reactions to milk in infants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B Kvenshagen" 1 => "R Halvorsen" 2 => "M. Jacobsen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1651-2227.2007.00599.x" "Revista" => array:6 [ "tituloSerie" => "Acta Paediatr" "fecha" => "2008" "volumen" => "97" "paginaInicial" => "196" "paginaFinal" => "200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18254909" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0027" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brazilian Consensus on Food Allergy: 2018 - part 2 - diagnosis, treatment and prevention. Joint position paper of the Brazilian Society of Pediatrics and the Brazilian Association of Allergy and Immunology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D Solé" 1 => "LR Silva" 2 => "RR Cocco" 3 => "CT Ferreira" 4 => "RO Sarni" 5 => "LC Oliveira" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BJAI" "fecha" => "2018" "volumen" => "2" "paginaInicial" => "39" "paginaFinal" => "82" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0028" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of food allergy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "SH. Sicherer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaci.2010.11.044" "Revista" => array:6 [ "tituloSerie" => "J Allergy Clin Immunol" "fecha" => "2011" "volumen" => "127" "paginaInicial" => "594" "paginaFinal" => "602" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21236480" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0029" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of cow's milk allergy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "JD Flom" 1 => "SH. Sicherer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/nu11051051" "Revista" => array:5 [ "tituloSerie" => "Nutrients" "fecha" => "2019" "volumen" => "11" "paginaInicial" => "1051" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31083388" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0030" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The natural course of cow's milk allergy and the development of atopic diseases into adulthood" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "MM Hansen" 1 => "SP Nissen" 2 => "S Halken" 3 => "A. Høst" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/pai.13440" "Revista" => array:6 [ "tituloSerie" => "Pediatr Allergy Immunol" "fecha" => "2021" "volumen" => "32" "paginaInicial" => "727" "paginaFinal" => "733" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33350002" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00217557/0000010000000001/v2_202403080702/S0021755723001006/v2_202403080702/en/main.assets" "Apartado" => array:4 [ "identificador" => "10179" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/00217557/0000010000000001/v2_202403080702/S0021755723001006/v2_202403080702/en/main.pdf?idApp=UINPBA000049&text.app=https://jped.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755723001006?idApp=UINPBA000049"]

Statistics

Original article

Príscila da Silva Pereira Vasconcelosa,b,c,d, Ana Laura Mendes Becker Andradea, Natascha Silva Sandya,d, Juliana Corrêa Campos Barretoa,d, Gabriela Souza Gomeza,d, Adriana Gut Lopes Riccettoa,b,c, Elizete Aparecida Lomazia,b,c, Maria Ângela Bellomo-Brandãoa,b,c,d,

Corresponding author

angbell@unicamp.br

Corresponding author.

a Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil

b Centro de Investigação em Pediatria da Faculdade de Ciências Médicas de Campinas (CIPED), Campinas, SP, Brazil

c Programa de Pós-graduação em Saúde da Criança e do Adolescente (PPG-SCA), São Paulo, SP, Brazil

d Laboratório de Investigação Diagnóstica de Gastroenterologia e Hepatologia Pediátrica, Campinas, SP, Brazil

Read

2249

Times
was read the article

691

Total PDF

1558

Total HTML

Share statistics

 array:23 [
  "pii" => "S0021755723001006"
  "issn" => "00217557"
  "doi" => "10.1016/j.jped.2023.08.003"
  "estado" => "S300"
  "fechaPublicacion" => "2024-01-01"
  "aid" => "1205"
  "copyright" => "Sociedade Brasileira de Pediatria"
  "copyrightAnyo" => "2023"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "J Pediatr &#40;Rio J&#41;. 2024;100:40-5"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:17 [
    "pii" => "S0021755723000839"
    "issn" => "00217557"
    "doi" => "10.1016/j.jped.2023.07.002"
    "estado" => "S300"
    "fechaPublicacion" => "2024-01-01"
    "aid" => "1195"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "J Pediatr &#40;Rio J&#41;. 2024;100:46-52"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Height and body mass index distribution in children and adolescents with and without spina bifida"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "46"
          "paginaFinal" => "52"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0002"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 4043
              "Ancho" => 2917
              "Tamanyo" => 479440
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "alt0002"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Body Mass Index z-score distribution of children and adolescents without spina bifida aged 7-16 years compared to the WHO normal distribution curve &#40;a&#41;&#46; Body Mass Index z-score distribution of children and adolescents with spina bifida aged 8-15 years compared to the WHO normal distribution curve &#40;b&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Fabio Bertapelli, Cyntia Rogean de Jesus Alves de Baptista, Ana Claudia Mattiello-Sverzut"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Fabio"
              "apellidos" => "Bertapelli"
            ]
            1 => array:2 [
              "nombre" => "Cyntia Rogean de Jesus Alves de"
              "apellidos" => "Baptista"
            ]
            2 => array:2 [
              "nombre" => "Ana Claudia"
              "apellidos" => "Mattiello-Sverzut"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755723000839?idApp=UINPBA000049"
    "url" => "/00217557/0000010000000001/v2_202403080702/S0021755723000839/v2_202403080702/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "S0021755723000980"
    "issn" => "00217557"
    "doi" => "10.1016/j.jped.2023.07.007"
    "estado" => "S300"
    "fechaPublicacion" => "2024-01-01"
    "aid" => "1203"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "J Pediatr &#40;Rio J&#41;. 2024;100:32-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Oropharyngeal colostrum immunotherapy and risk reduction of mortality in very low birth weight premature newborns&#58; a clinical trial"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "32"
          "paginaFinal" => "39"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0002"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1188
              "Ancho" => 1667
              "Tamanyo" => 58132
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "alt0002"
              "detalle" => "Fig "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier plot of survival function by group in days&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Camilla da C&#46; Martins, Michelle de S&#46;X&#46; Ramos, Amanda O&#46; Lyrio, Tatiana de O&#46; Vieira, Simone S&#46; da Cruz, Graciete O&#46; Vieira"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Camilla da C&#46;"
              "apellidos" => "Martins"
            ]
            1 => array:2 [
              "nombre" => "Michelle de S&#46;X&#46;"
              "apellidos" => "Ramos"
            ]
            2 => array:2 [
              "nombre" => "Amanda O&#46;"
              "apellidos" => "Lyrio"
            ]
            3 => array:2 [
              "nombre" => "Tatiana de O&#46;"
              "apellidos" => "Vieira"
            ]
            4 => array:2 [
              "nombre" => "Simone S&#46; da"
              "apellidos" => "Cruz"
            ]
            5 => array:2 [
              "nombre" => "Graciete O&#46;"
              "apellidos" => "Vieira"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755723000980?idApp=UINPBA000049"
    "url" => "/00217557/0000010000000001/v2_202403080702/S0021755723000980/v2_202403080702/en/main.assets"
  ]
  "en" => array:17 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Outcomes and factors associated with tolerance in infants with non-IgE-mediated cow&#39;s milk allergy with gastrointestinal manifestations"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "40"
        "paginaFinal" => "45"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Pr&#237;scila da Silva Pereira Vasconcelos, Ana Laura Mendes Becker Andrade, Natascha Silva Sandy, Juliana Corr&#234;a Campos Barreto, Gabriela Souza Gomez, Adriana Gut Lopes Riccetto, Elizete Aparecida Lomazi, Maria &#194;ngela Bellomo-Brand&#227;o"
        "autores" => array:8 [
          0 => array:3 [
            "nombre" => "Pr&#237;scila da Silva Pereira"
            "apellidos" => "Vasconcelos"
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0001"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0002"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0003"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0004"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Ana Laura Mendes Becker"
            "apellidos" => "Andrade"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0001"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Natascha Silva"
            "apellidos" => "Sandy"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0001"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0004"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Juliana Corr&#234;a Campos"
            "apellidos" => "Barreto"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0001"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0004"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Gabriela Souza"
            "apellidos" => "Gomez"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0001"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0004"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Adriana Gut Lopes"
            "apellidos" => "Riccetto"
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0001"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0002"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0003"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Elizete Aparecida"
            "apellidos" => "Lomazi"
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0001"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0002"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0003"
              ]
            ]
          ]
          7 => array:4 [
            "nombre" => "Maria &#194;ngela"
            "apellidos" => "Bellomo-Brand&#227;o"
            "email" => array:1 [
              0 => "angbell@unicamp.br"
            ]
            "referencia" => array:5 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0001"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0002"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0003"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0004"
              ]
              4 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0001"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Universidade Estadual de Campinas &#40;UNICAMP&#41;&#44; Faculdade de Ci&#234;ncias M&#233;dicas&#44; Departamento de Pediatria&#44; Campinas&#44; SP&#44; Brazil"
            "etiqueta" => "a"
            "identificador" => "aff0001"
          ]
          1 => array:3 [
            "entidad" => "Centro de Investiga&#231;&#227;o em Pediatria da Faculdade de Ci&#234;ncias M&#233;dicas de Campinas &#40;CIPED&#41;&#44; Campinas&#44; SP&#44; Brazil"
            "etiqueta" => "b"
            "identificador" => "aff0002"
          ]
          2 => array:3 [
            "entidad" => "Programa de P&#243;s-gradua&#231;&#227;o em Sa&#250;de da Crian&#231;a e do Adolescente &#40;PPG-SCA&#41;&#44; S&#227;o Paulo&#44; SP&#44; Brazil"
            "etiqueta" => "c"
            "identificador" => "aff0003"
          ]
          3 => array:3 [
            "entidad" => "Laborat&#243;rio de Investiga&#231;&#227;o Diagn&#243;stica de Gastroenterologia e Hepatologia Pedi&#225;trica&#44; Campinas&#44; SP&#44; Brazil"
            "etiqueta" => "d"
            "identificador" => "aff0004"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0001"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Introduction</span><p id="para0005" class="elsevierStylePara elsevierViewall">Non-IgE-mediated cow&#39;s milk allergy &#40;CMA&#41; is a common food allergy during childhood&#44; typically presenting in infancy&#44;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> more often with gastrointestinal manifestations&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> Symptoms vary and are non-specific&#44; which is a problem for recognition by pediatricians and pediatric gastroenterologists who deal with this condition&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> There are different presentations of non-IgE-mediated CMA&#44; including food protein-induced enteropathy&#44; enterocolitis&#44; or proctocolitis&#46; Allergic proctocolitis is the most common presentation&#44; with mild rectal bleeding in an infant who is typically otherwise well and does present with faltering growth&#46; In contrast&#44; Food Protein-Induced Enterocolitis Syndrome &#40;FPIES&#41; is more rare and severe &#8211; acute FPIES typically presents in infants ages 4 to 12 months&#44; 1 to 4 h after the ingestion of the protein&#44; with profuse vomiting&#44; pallor&#44; and lethargy&#44; and it can progress to dehydration and shock&#44; while chronic FPIES has been described with persistent vomiting&#44; diarrhea&#44; and&#47;or failure to thrive&#46;<a class="elsevierStyleCrossRefs" href="#bib0004"><span class="elsevierStyleSup">4&#8211;7</span></a></p><p id="para0006" class="elsevierStylePara elsevierViewall">The majority of non-IgE-mediated cow&#39;s milk protein allergies are transient and resolve in early childhood&#46; The achievement of tolerance varies according to the form of presentation&#58; allergic proctocolitis is usually associated with the earliest development of tolerance&#44; generally before the first year of life&#46; Meanwhile&#44; FPIES tend to resolve later and the time to achieve tolerance in patients varies according to the food involved&#46; In patients with FPIES induced by cow&#39;s milk protein&#44; tolerance is typically acquired around 3 years of age&#46; It has been described in the literature that up to 20&#37; of exclusively breastfed infants have spontaneous resolution of the allergy without the mother being on an exclusion diet&#44; however&#44; factors associated with the acquisition of tolerance are rarely described&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a></p><p id="para0007" class="elsevierStylePara elsevierViewall">The oral food challenge &#40;OFC&#41; test is the gold standard for confirmation of the diagnosis of non-IgE-mediated allergies&#44; and also on the follow-up to assess for the development of tolerance&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> To confirm the diagnosis of non-IgE-mediated CMA&#44; it is recommended to exclude cow&#39;s milk protein &#40;CMP&#41; for 2-4 weeks before performing the OFC test&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> In patients who present with mild to moderate symptoms&#44; the test can be performed at home&#46;<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> In cases with severe manifestations&#44; such as suspected FPIES&#44; the OFC test should be performed in a hospital environment&#46;<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> To evaluate the achievement of tolerance&#44; the test is performed after 6 months of exclusion diet or at 12 months of age &#40;whichever is earlier&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a></p><p id="para0008" class="elsevierStylePara elsevierViewall">There is extensive medical literature on the prevention&#44; diagnosis and treatment of non-IgE-mediated cow&#39;s milk protein allergies&#44; and it is known that the acquisition of tolerance occurs in most cases around 12 months&#46; However&#44; there is little data regarding factors that interfere with the development of tolerance in children with CMA&#46; The aims of this study were to assess outcomes of the oral food challenge &#40;OFC&#41; test to assess the development of tolerance in infants with non-IgE-mediated cow&#39;s milk allergy &#40;CMA&#41; with gastrointestinal manifestations and to explore clinical data associated with these outcomes&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Methods</span><p id="para0009" class="elsevierStylePara elsevierViewall">This single-center retrospective study was conducted with infants &#40;age &#60; 12 months&#41; with a diagnosis of CMA referred to the outpatient clinic of the pediatric gastroenterology unit of a university-affiliated hospital in Brazil&#44; from 2000 to 2018&#46; Inclusion criteria were &#40;all three must have been fulfilled&#41;&#58; 1&#41; having a clinic diagnosis of non-IgE mediated CMA with gastrointestinal manifestations in the first year of life&#59; 2&#41; being on a CMP-free diet for at least 8 weeks&#59; and 3&#41; having undergone OFC test on follow-up to assess the development of tolerance&#46; Exclusion criteria aimed to omit infants receiving inappropriate restricted diets if they had been continuously exposed to CMP and&#47;or breasted infants whose mothers had not been on a strict CMP-free diet&#46;</p><p id="para0010" class="elsevierStylePara elsevierViewall">Data were collected on age at symptoms onset&#44; gender&#44; gestational age&#44; comorbidities and associated allergic diseases&#44; clinical presentation&#44; CMP-free diet&#44; and outcomes of OFC test&#46; According to the symptoms&#44; the cases were classified as mild-to-moderate <span class="elsevierStyleItalic">vs&#46;</span> severe&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a></p><p id="para0011" class="elsevierStylePara elsevierViewall">The OFC test was performed in three different ways&#44; individualizing each case&#58;</p><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Home protocol</span><p id="para0012" class="elsevierStylePara elsevierViewall">For infants who were exclusively breastfed&#44; with the breastfeeding mother being on an appropriate CMP elimination diet&#44; the OFC test was performed with home reintroduction of CMP&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> The mother received education on how to progressively and safely reintroduce dairy foods&#44; with careful observation of signs and symptoms&#46; Contact information to reach the team was provided and patients were followed up closely in the outpatient clinic&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Hospital protocol</span><p id="para0013" class="elsevierStylePara elsevierViewall">If the infant had been on appropriate formula for CMA&#44; the OFC test was performed in a hospital environment&#44; under the supervision of a specialized medical team&#44; following the most up-to-date OFC test protocol at the time&#44; most recently similar to the one described by Vandenplas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a>&#58; Initially&#44; gauze was soaked with an intact cow&#39;s milk protein-based formula and gently applied to the patient&#39;s lips&#46; If they remained asymptomatic after 15 min&#44; a formula containing intact cow&#39;s milk protein was administered orally and the dose was gradually increased &#40;0&#46;5&#44; 1&#44; 3&#44; 10&#44; 30&#44; 50 to 100 mL&#41; every 30 min&#46; Patients remained under observation for two hours after the last dose of formula was given&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">FPIES protocol</span><p id="para0014" class="elsevierStylePara elsevierViewall">In cases of FPIES&#44; the OFC test protocol was also performed in a hospital environment&#44; carried out with a different protocol than the one previously described&#44; following the most up-to-date OFC test protocol for FPIES at the time&#44; most recently similar to the one published by Nowak-W&#281;grzyn et al&#46;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a>&#58; all patients had peripheral venous access inserted before the test was initiated&#44; and the dose of cow&#39;s milk protein varied from 0&#46;06&#160; to 0&#46;6 g of protein&#47;kg &#40;average of 0&#46;3 g&#47;kg&#41;&#44; divided in 3 equal doses&#44; given every 30 min&#46; A limit of a maximum of 3g in each step or a maximum of 10g in the entire test was followed&#46; All patients remained under observation for at least 4 h after the last dose of formula was given&#46;</p><p id="para0015" class="elsevierStylePara elsevierViewall">In all cases&#44; after the end of the test&#44; if no symptoms were identified by the end of the observation period&#44; the patient was discharged home&#46; A follow-up telephone call always took place in the next day to assess for late symptoms&#44; and patients had a follow-up appointment after one week&#46;</p><p id="para0016" class="elsevierStylePara elsevierViewall">The test was considered&#58;<ul class="elsevierStyleList" id="celist0001"><li class="elsevierStyleListItem" id="celistitem0001"><span class="elsevierStyleLabel">-</span><p id="para0017" class="elsevierStylePara elsevierViewall">positive in the presence of immediate signs and symptoms &#40;the same as the patient initially presented&#41;&#44; persistence or increase in the intensity of subjective symptoms&#44; or if late symptoms were reported by caregivers&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0002"><span class="elsevierStyleLabel">-</span><p id="para0018" class="elsevierStylePara elsevierViewall">negative&#58; in the absence of symptoms&#46;</p></li></ul></p><p id="para0019" class="elsevierStylePara elsevierViewall">The patients were stratified according to the outcome of the follow-up OFC test&#58; positive <span class="elsevierStyleItalic">vs&#46;</span> negative &#40;development of tolerance&#41;&#46; A univariate logistic regression analysis was performed to evaluate variables associated with the outcomes of the follow-up OFC test&#46; For all analyses&#44; a <span class="elsevierStyleItalic">p</span>-value &#60; 0&#46;05 was considered statistically significant&#46; The 95&#37; confidence intervals are presented&#46; The data were analyzed using IBM Statistic SPSS &#40;IBM SPSS Statistics for Windows&#46; NY&#44; EUA&#41;&#46;</p><p id="para0020" class="elsevierStylePara elsevierViewall">The study was conducted according to the Declaration of Helsinki&#44; and ethical approval was obtained from the Ethics Committee of the University of Campinas &#40;Approval number 2&#46;986&#46;745&#41;</p></span></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Results</span><p id="para0021" class="elsevierStylePara elsevierViewall">Initially&#44; a total of 205 medical records were analyzed&#44; but only 82 patients were enrolled according to established inclusion and exclusion criteria&#46; Of these&#44; 41 were male &#40;50&#37;&#41;&#44; 10&#37; had atopic conditions &#40;asthma&#44; rhinitis and atopic dermatitis&#41;&#44; and the same percentage had allergies to foods other than CMA&#46; Fifty-three percent had a history of prematurity&#46;</p><p id="para0022" class="elsevierStylePara elsevierViewall">The median age at the first clinical manifestation was 30 days &#40;Q1 25 &#8211; Q3 60 days&#41;&#44; and by the time of the follow-up OFC test&#44; these patients had been on a CMP elimination diet over a median time of 8 months &#40;Q1 6 &#8211; Q3 11 months&#41;&#46; The clinical characteristics of infants referred with a diagnosis of cow&#39;s milk allergy and who underwent OFC test&#44; stratified according to the outcome of OFC test are shown in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><p id="para0023" class="elsevierStylePara elsevierViewall">At the time of referral&#44; 28&#37; of the infants were fed with an extensively hydrolyzed formula&#44; 24&#37; with an amino acid-based formula&#44; 16&#37; were exclusively breastfed with their mothers on a CMP-restricted diet&#44; 12&#37; were using soy-based formula and 20&#37; were using non-recommended beverages&#44; such as juices&#44; soy-based beverages or milk from other mammals&#46;</p><p id="para0024" class="elsevierStylePara elsevierViewall">Of the 82 follow-up OFC tests&#44; 22&#37; were positive&#46; The univariate logistic regression evaluation is presented in <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#46; All patients who were on exclusive breastfeeding with their mothers on a restricted diet &#40;13&#47;82&#41; had negative OFC tests&#46; Patients who were on exclusive breastfeeding &#40;with the mother on a CMA-restricted diet&#41; achieved tolerance at a median age of 6 months &#40;Q1 6&#46;6 - Q3 9&#41;&#44; while infants who were not exclusively breastfed achieved tolerance later&#44; at a median age of 10&#46;5 months &#40;Q1 4&#46;5 - Q3 10&#41;&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia><p id="para0025" class="elsevierStylePara elsevierViewall">It is evident that patients who had a higher percentage of positive oral food challenge &#40;OFC&#41; tests were fed with cow&#39;s milk protein &#40;CMP&#41; based formula before the first clinical manifestation of non-IgE mediated cow&#39;s milk allergy &#40;CMA&#41;&#44; compared to patients who had a negative OFC test&#46; Additionally&#44; all patients whose symptoms began while exclusively breastfeeding had a negative follow-up OFC test&#46;</p><p id="para0026" class="elsevierStylePara elsevierViewall">Among the OFC tests carried out with infants who were exclusively breastfed&#44; none of the tests were positive&#46; For this group&#44; the median time of maternal restricted CMP diet was 6 months&#46;</p></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Discussion</span><p id="para0027" class="elsevierStylePara elsevierViewall">There is scarce data in the literature on factors that influence the achievement of tolerance in CMA&#44; especially in non-IgE-mediated cases&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> It is known that compared to IgE-mediated CMA&#44; non-IgE-mediated cases are generally milder and resolve earlier&#44; as most manifest as allergic proctocolitis&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> In IgE-mediated CMA&#44; some factors such as the severity of the family history of atopic diseases&#44; later onset of symptoms&#44; presence of other food allergies and&#47;or other allergic diseases have been associated with cases of persistent CMA&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a></p><p id="para0028" class="elsevierStylePara elsevierViewall">In our study&#44; 78&#37; of children referred to a tertiary care center with a diagnosis of non-IgE-mediated CMA had already acquired tolerance &#40;negative OFC tests&#41;&#46; Exclusive breastfeeding &#40;EBF&#41; seems to help to induce tolerance for CMA&#58; most patients with positive OFC had received CMP-based formula before the first manifestation of CMA and patients who were on exclusive breastfeeding with their mother on an exclusion diet achieved tolerance about 3 months earlier than those who were not&#46;</p><p id="para0029" class="elsevierStylePara elsevierViewall">There is some contradictory data in the literature on how dietary factors may influence the occurrence of food allergies&#44; but it seems that EBF has a protective effect against allergies&#46;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> Some studies evaluating this benefit have shown a reduction in the incidence of CMA in infants up to 18 months and atopic dermatitis up to three years of age&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a> Meanwhile&#44; the early use of CMP-based formulas has been associated with intestinal dysbiosis&#44; which is a risk factor for food allergy&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a> Furthermore&#44; it has been hypothesized that breast milk contains anti-allergenic properties and antibodies that induce tolerance to food antigens&#46;<a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a></p><p id="para0030" class="elsevierStylePara elsevierViewall">The median age at the first clinical manifestation reported in our study was 30 days&#46; In the study by Senocak et al&#46; the median age of the onset of symptoms was 60 days&#44; slightly lower than the authors found in the present study&#44; but both are in agreement with previous literature published &#8211; in the first six months of life&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> The authors hypothesize that the higher age reported in the present study results from the referral of premature infants after discharge from the neonatal intensive care unit at the present study&#39;s own center&#46; In keeping with our findings&#44; Kaya et al&#46; <span class="elsevierStyleItalic">r</span>eported hematochezia and diarrhea as the main manifestations of non-IgE-mediated CMA&#46;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a></p><p id="para0031" class="elsevierStylePara elsevierViewall">In the present study&#44; the occurrence of hematochezia and diarrhea as symptoms were associated with the persistence of CMA&#44; while manifestations of vomiting&#44; dehydration&#44; malnutrition&#44; and others &#40;crying&#44; irritability and regurgitation&#41; were not&#46; In a study carried out by Topal et al&#46;&#44; children with proctocolitis and abdominal discomfort had an earlier development of tolerance compared to children who had IgE-mediated symptoms&#46; The present study only evaluated children with non-IgE-mediated gastrointestinal symptoms&#44; which justifies the difference in results&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a></p><p id="para0032" class="elsevierStylePara elsevierViewall">One-third of the positive OFC had a diagnosis of FPIES&#46; In FPIES it is mandatory to perform the OFC test in a hospital environment&#44; as the authors described&#46;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> Among the patients with FPIES&#44; two-thirds had a positive OFC test&#44; and all the patients were exposed to the CMP-based formula before the first manifestation&#46; These findings are in agreement with previously published studies &#8211; the emergence of FPIES in patients who are exclusively breastfed is rare&#44; with few cases reported in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a></p><p id="para0033" class="elsevierStylePara elsevierViewall">There was no association between prematurity and the positivity of the OFC test&#46; It has been reported that no significant difference between the occurrences of cow&#39;s milk reactions in the first year of life among premature infants compared to term infants&#44; with preterm infants having the onset of symptoms at the same age as term children&#44; as well as a similar presentation and outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a></p><p id="para0034" class="elsevierStylePara elsevierViewall">The authors did not find an association between atopic diseases &#40;asthma&#44; allergic rhinitis&#44; and atopic dermatitis&#41; and the positivity of the OFC test&#46; This association is well seen in cases of IgE-mediated allergies &#40;Topal et al&#41;&#46; However&#44; the prevalence of other food allergies was higher among patients who did not develop tolerance&#44; similar to the study by Topal et al&#46;&#44; in which the presence of food allergies was considered an independent factor for the persistence of food allergy&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0027"><span class="elsevierStyleSup">27&#8211;30</span></a></p><p id="para0035" class="elsevierStylePara elsevierViewall">Continued breastfeeding after the diagnosis of CMPA has been demonstrated to be beneficial&#46; Unfortunately&#44; the authors report a high rate of weaning infants who were on EBF prior to the first manifestations of non-IgE-Mediated CMPA with gastrointestinal manifestations&#46; Breastfeeding not only prevents CMPA&#44; but it is also associated with milder manifestations&#44; shorter time to develop tolerance and lower costs with formulas&#46; Continued breastfeeding should be even more stimulated in the context of CMPA&#46;<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a></p><p id="para0036" class="elsevierStylePara elsevierViewall">The authors also observed that of the 25 infants who presented symptoms while on EBF&#44; only 13 were still EBF at the time of the OFC test &#8211; it is possible that the diagnosis of CMPA and the CMP-elimination diet may have interfered with the maternal ability to continue to breastfeed&#46; Interestingly&#44; none of the patients who remained breastfed had a positive OFC test&#46;</p><p id="para0037" class="elsevierStylePara elsevierViewall">Despite the limitations of being a single-center retrospective study&#44; small sample&#44; and the diagnosis of CMPA being clinical &#40;possible selection bias&#41;&#44; the present conclusions are that in cases of non-IgE-mediated CMPA with gastrointestinal manifestations in infants&#44; exposure to cow&#39;s milk-based formula&#44; a history of other food allergies&#44; hematochezia and diarrhea were associated factors for the later achievement of tolerance&#46; Maintaining breastfeeding should be the focus in the management of CMPA&#46;</p></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Funding source</span><p id="para0038" class="elsevierStylePara elsevierViewall">No funding was secured for this study&#46;</p></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Contributors statement</span><p id="para0039" class="elsevierStylePara elsevierViewall">All authors approved the final version as submitted and agreed to be accountable for all aspects of the work&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:9 [
        0 => array:3 [
          "identificador" => "xres2102993"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abss0001"
              "titulo" => "Objectives"
            ]
            1 => array:2 [
              "identificador" => "abss0002"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abss0003"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abss0004"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1792187"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "sec0001"
          "titulo" => "Introduction"
        ]
        3 => array:3 [
          "identificador" => "sec0002"
          "titulo" => "Methods"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0003"
              "titulo" => "Home protocol"
            ]
            1 => array:2 [
              "identificador" => "sec0004"
              "titulo" => "Hospital protocol"
            ]
            2 => array:2 [
              "identificador" => "sec0005"
              "titulo" => "FPIES protocol"
            ]
          ]
        ]
        4 => array:2 [
          "identificador" => "sec0006"
          "titulo" => "Results"
        ]
        5 => array:2 [
          "identificador" => "sec0007"
          "titulo" => "Discussion"
        ]
        6 => array:2 [
          "identificador" => "sec0008"
          "titulo" => "Funding source"
        ]
        7 => array:2 [
          "identificador" => "sec0009"
          "titulo" => "Contributors statement"
        ]
        8 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2023-04-03"
    "fechaAceptado" => "2023-08-08"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1792187"
          "palabras" => array:4 [
            0 => "Breastfeeding"
            1 => "Cow&#39;s milk allergy"
            2 => "Food allergy"
            3 => "Oral food challenge"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Objectives</span><p id="spara004" class="elsevierStyleSimplePara elsevierViewall">To evaluate outcomes of oral food challenge &#40;OFC&#41; test to assess tolerance in infants with non-IgE-mediated cow&#39;s milk allergy &#40;CMA&#41; with gastrointestinal manifestations and explore clinical data predictive of these outcomes&#46;</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Methods</span><p id="spara005" class="elsevierStyleSimplePara elsevierViewall">Single-center retrospective study including infants &#40;age &#60; 12 months&#41; who were referred for CMA between 2000 and 2018 and underwent OFC on follow-up&#46; A univariate logistic regression test was performed to evaluate variables associated with the outcomes of the follow-up OFC test&#46;</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Results</span><p id="spara006" class="elsevierStyleSimplePara elsevierViewall">Eighty-two patients were included&#44; 50&#37; were male&#46; Eighteen patients had a positive OFC test &#40;22&#37;&#41;&#46; Most patients had presented with hematochezia &#40;77&#37;&#41;&#46; The median age of symptom onset was 30 days&#46; Two-thirds of the patients were on appropriate infant formula &#40;extensively hydrolyzed or amino acid-based formula&#41;&#44; exclusively or in association with breastfeeding&#46; The median time on an elimination diet before the OFC test was 8 months &#40;Q1 6 &#8211; Q3 11 months&#41;&#46; All cases with positive follow-up OFC tests &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;18&#41; had been exposed to cow&#39;s milk-based formula before the first clinical manifestation of CMA&#46; Five out of eight cases with Food Protein-Induced Enterocolitis Syndrome &#40;FPIES&#41; had positive OFC tests&#46; Exposure to cow&#39;s milk-based formula before diagnosis&#44; a history of other food allergies&#44; hematochezia and diarrhea were predictors of a positive OFC test&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Conclusions</span><p id="spara007" class="elsevierStyleSimplePara elsevierViewall">In infants with non-IgE-mediated CMPA with gastrointestinal manifestations&#44; the use of cow&#39;s milk-based formula&#44; a history of other food allergies&#44; and hematochezia and diarrhea upon initial presentation were associated factors for the later achievement of tolerance&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abss0001"
            "titulo" => "Objectives"
          ]
          1 => array:2 [
            "identificador" => "abss0002"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abss0003"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abss0004"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "tbl0001"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0001"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">&#42;Statistics presented&#58; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&#59; Median &#40;Q1-Q3&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0001"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0002"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">All<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0003"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Positive OFC test<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0004"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Negative OFC test<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0005"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value<a class="elsevierStyleCrossRef" href="#tb1fn1"><span class="elsevierStyleSup">&#8270;&#8270;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0006"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Age at symptoms onset&#44; median&#44; days &#40;Q1-Q3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0007"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0008"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">37&#44;5 &#40;30-90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0009"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">30 &#40;25-60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#44;4<span class="elsevierStyleSup">1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0011"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Male gender&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">41 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0013"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">11 &#40;61&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">30 &#40;46&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0015"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#44;32<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0016"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Median time &#40;months&#41; of cow&#39;s milk protein elimination diet&#44; median &#40;Q1-Q3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0017"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">8 &#40;6-11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">12 &#40;7-15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0019"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">8 &#40;6-11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#44;02<span class="elsevierStyleSup">1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0021"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Gestational age &#62; 37 weeks&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0022"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">41 &#40;53&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0023"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">13 &#40;72&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">28 &#40;47&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0025"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#44;06<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0026"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Exposure to cow&#39;s milk protein formula before onset&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">55 &#40;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">15 &#40;83&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0029"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">40 &#40;62&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#44;03<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0031"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Exclusively breastfed infants before the first symptom&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">25 &#40;30&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0033"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">3 &#40;16&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">22 &#40;34&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#44;14<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0036"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Atopic manifestations&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0037"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">8 &#40;9&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">3 &#40;17&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">5 &#40;7&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#44;35<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0041"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Other food allergies&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">9 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">5 &#40;27&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">4 &#40;6&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#44;02<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0046"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Hematochezia&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">63 &#40;76&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">8 &#40;44&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0049"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">55 &#40;85&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60; 0&#44;01<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0051"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Diarrhea&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">28 &#40;34&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0053"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">12 &#40;66&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">16 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60; 0&#44;01<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0056"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Vomiting&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0057"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">18 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">4 &#40;22&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">14 &#40;21&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0061"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Failure to thrive&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">4 &#40;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">1 &#40;5&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0064"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">3 &#40;4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0065"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0066"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Acute FPIES&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;<a class="elsevierStyleCrossRef" href="#tb1fn2"><span class="elsevierStyleSup">&#8270;&#8270;&#8270;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">8 &#40;9&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">5 &#40;27&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0069"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="top">3 &#40;4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#44;01<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3479317.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tb1fn1"
              "etiqueta" => "&#8270;&#8270;"
              "nota" => "<p class="elsevierStyleNotepara" id="notep0002">Statistical tests performed&#58; <span class="elsevierStyleSup">1</span>Mann-Whitney test and <span class="elsevierStyleSup">2</span>chi-square test or <span class="elsevierStyleSup">3</span>Fisher&#39;s exact test&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tb1fn2"
              "etiqueta" => "&#8270;&#8270;&#8270;"
              "nota" => "<p class="elsevierStyleNotepara" id="notep0003">Acute FPIES&#58; profuse vomiting&#44; pallor&#44; and lethargy&#44; &#177; diarrhea&#44; &#177; dehydration&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics of infants referred with a diagnosis of cow&#39;s milk allergy and who underwent oral food challenge &#40;OFC&#41; test&#44; stratified according to outcome of OFC test&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0002"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0002"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0071"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0072"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Odds ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0073"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; confidence intervals&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0074"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0075"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Mean age at symptom onset&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0077"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;99 &#8211; 1&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0078"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0079"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Male gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0081"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;61 &#8211; 5&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0083"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Exposure to cow&#39;s milk protein before diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;846&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0085"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;27 &#8211; 11&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0086"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60; 0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0087"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Gestational age &#62; 37 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0089"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;91 &#8211; 9&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0091"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Other atopic manifestations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0092"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0093"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;54 &#8211; 11&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0095"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Other food allergies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0096"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0097"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;36 &#8211; 24&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0098"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60; 0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0099"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Hematochezia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">7&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0101"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;38 &#8211; 24&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0102"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60; 0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0103"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Diarrhea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0105"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;93 &#8211; 18&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0106"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60; 0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0107"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Vomiting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0109"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;29 &#8211; 3&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0110"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0111"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Failure to thrive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0112"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0113"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;12 &#8211; 12&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3479318.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Univariate logistic regression analysis for clinical variables associated with the failure to achieve tolerance to cow&#39;s milk protein&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "cebibsec1"
          "bibliografiaReferencia" => array:30 [
            0 => array:3 [
              "identificador" => "bib0001"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A survey on clinical presentation and nutritional status of infants with suspected cow&#39; milk allergy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "MC Vieira"
                            1 => "MB Morais"
                            2 => "JV Spolidoro"
                            3 => "MS Toporovski"
                            4 => "AL Cardoso"
                            5 => "GT Araujo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2431-10-25"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Pediatr"
                        "fecha" => "2010"
                        "volumen" => "10"
                        "paginaInicial" => "25"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20416046"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0002"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Paediatric non-IgE mediated food allergy&#58; guide for practitioners"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K Preece"
                            1 => "A Blincoe"
                            2 => "E Grangaard"
                            3 => "GT Ostring"
                            4 => "D Purvis"
                            5 => "J Sinclair"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "N Z Med J"
                        "fecha" => "2016"
                        "volumen" => "129"
                        "paginaInicial" => "78"
                        "paginaFinal" => "88"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27977655"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0003"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "May failure to thrive in infants be a clinical marker for the early diagnosis of cow&#39;s milk allergy&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L Diaferio"
                            1 => "D Caimmi"
                            2 => "MC Verga"
                            3 => "V Palladino"
                            4 => "L Trov&#232;"
                            5 => "P Giordano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/nu12020466"
                      "Revista" => array:5 [
                        "tituloSerie" => "Nutrients"
                        "fecha" => "2020"
                        "volumen" => "12"
                        "paginaInicial" => "466"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32069783"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0004"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-IgE-mediated gastrointestinal food allergies in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "JC Caubet"
                            1 => "H Szajewska"
                            2 => "R Shamir"
                            3 => "A&#46; Nowak-W&#281;grzyn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/pai.12659"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Allergy Immunol"
                        "fecha" => "2017"
                        "volumen" => "28"
                        "paginaInicial" => "6"
                        "paginaFinal" => "17"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27637372"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gastrointestinal food allergy in infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H Morita"
                            1 => "I Nomura"
                            2 => "A Matsuda"
                            3 => "H Saito"
                            4 => "K&#46; Matsumoto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2332/allergolint.13-RA-0542"
                      "Revista" => array:6 [
                        "tituloSerie" => "Allergol Int"
                        "fecha" => "2013"
                        "volumen" => "62"
                        "paginaInicial" => "297"
                        "paginaFinal" => "307"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23974876"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0006"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-IgE-mediated gastrointestinal food allergies in children&#58; an update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R Labrosse"
                            1 => "F Graham"
                            2 => "JC&#46; Caubet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/nu12072086"
                      "Revista" => array:5 [
                        "tituloSerie" => "Nutrients"
                        "fecha" => "2020"
                        "volumen" => "12"
                        "paginaInicial" => "2086"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32674427"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0007"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-IgE-mediated food allergy during infancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "AL Devonshire"
                            1 => "S Durrani"
                            2 => "A&#46; Assa&#39;ad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ACI.0000000000000645"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Allergy Clin Immunol"
                        "fecha" => "2020"
                        "volumen" => "20"
                        "paginaInicial" => "292"
                        "paginaFinal" => "298"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32349109"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0008"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Food protein-induced allergic proctocolitis in infants&#58; literature review and proposal of a management protocol"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M Mennini"
                            1 => "AG Fiocchi"
                            2 => "A Cafarotti"
                            3 => "M Montesano"
                            4 => "A Mauro"
                            5 => "MP Villa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "World Allergy Organ J"
                        "fecha" => "2020"
                        "volumen" => "13"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0009"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic approach and management of cow&#39;s-milk protein allergy in infants and children&#58; ESPGHAN GI committee practical guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S Koletzko"
                            1 => "B Niggemann"
                            2 => "A Arato"
                            3 => "JA Dias"
                            4 => "R Heuschkel"
                            5 => "S Husby"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MPG.0b013e31825c9482"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Gastroenterol Nutr"
                        "fecha" => "2012"
                        "volumen" => "55"
                        "paginaInicial" => "221"
                        "paginaFinal" => "229"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22569527"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Better recognition&#44; diagnosis and management of non-IgE-mediated cow&#39;s milk allergy in infancy&#58; iMAP-an international interpretation of the MAP &#40;Milk Allergy in Primary Care&#41; guideline"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C Venter"
                            1 => "T Brown"
                            2 => "R Meyer"
                            3 => "J Walsh"
                            4 => "N Shah"
                            5 => "A Nowak-W&#281;grzyn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13601-017-0162-y"
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Transl Allergy"
                        "fecha" => "2017"
                        "volumen" => "7"
                        "paginaInicial" => "26"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28852472"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0011"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention and management of cow&#39;s milk allergy in non-exclusively breastfed infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Y&#46; Vandenplas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/nu9070731"
                      "Revista" => array:5 [
                        "tituloSerie" => "Nutrients"
                        "fecha" => "2017"
                        "volumen" => "9"
                        "paginaInicial" => "731"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28698533"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0012"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Food protein-induced enterocolitis syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A Nowak-W&#281;grzyn"
                            1 => "E Jarocka-Cyrta"
                            2 => "A&#46; Moschione Castro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.18176/jiaci.0149"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Investig Allergol Clin Immunol"
                        "fecha" => "2017"
                        "volumen" => "27"
                        "paginaInicial" => "1"
                        "paginaFinal" => "18"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28603089"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0013"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Independent predictive factors for the persistence and tolerance of cow&#39;s milk allergy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E Topal"
                            1 => "MH &#199;eliksoy"
                            2 => "M Arga"
                            3 => "MS Kaynak"
                            4 => "Y Duman"
                            5 => "S Demirta&#351;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/alr.22227"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Forum Allergy Rhinol"
                        "fecha" => "2019"
                        "volumen" => "9"
                        "paginaInicial" => "67"
                        "paginaFinal" => "71"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30376614"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0014"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Non-IgE-mediated cow&#39;s milk allergy&#58; Consensus document of the Spanish Society of Paediatric Gastroenterology&#44; Hepatology&#44; and Nutrition &#40;SEGHNP&#41;&#44; the Spanish Association of Paediatric Primary Care &#40;AEPAP&#41;&#44; the Spanish Society of Extra-hospital Paediatrics and Primary Health Care &#40;SEPEAP&#41;&#44; and the Spanish Society of Paediatric ClinicaL Immunology&#44; Allergy&#44; and Asthma &#40;SEICAP&#41;&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "BE Jaime"
                            1 => "JJD Mart&#237;n"
                            2 => "LC Baviera"
                            3 => "&#193;C Monz&#243;n"
                            4 => "AH Hern&#225;ndez"
                            5 => "JI Garc&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "An Pediatr"
                        "fecha" => "2019"
                        "volumen" => "90"
                        "paginaInicial" => "193"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dietary treatment of cows&#39; milk protein allergy in childhood&#58; a commentary by the Committee on Nutrition of the French Society of Paediatrics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C Dupont"
                            1 => "JP Chouraqui"
                            2 => "D de Boissieu"
                            3 => "A Bocquet"
                            4 => "JL Bresson"
                            5 => "A Briend"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/S0007114511004831"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Nutr"
                        "fecha" => "2012"
                        "volumen" => "107"
                        "paginaInicial" => "325"
                        "paginaFinal" => "338"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22115523"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0016"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical aspects of pediatric food allergy and failed oral immune tolerance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "KJ Allen"
                            1 => "PE&#46; Martin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCG.0b013e3181d7760b"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Gastroenterol"
                        "fecha" => "2010"
                        "volumen" => "44"
                        "paginaInicial" => "391"
                        "paginaFinal" => "401"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20421803"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0017"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relevance of early introduction of cow&#39;s milk proteins for prevention of cow&#39;s milk allergy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L Ulfman"
                            1 => "A Tsuang"
                            2 => "AB Sprikkelman"
                            3 => "A Goh"
                            4 => "RJ&#46; van Neerven"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/nu14132659"
                      "Revista" => array:5 [
                        "tituloSerie" => "Nutrients"
                        "fecha" => "2022"
                        "volumen" => "14"
                        "paginaInicial" => "2659"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35807839"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0018"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Brazilian Consensus on Food Allergy&#58; 2018 - part 1 - etiopathogenesis&#44; clinical features&#44; and diagnosis&#46; Joint position paper of the Brazilian Society of Pediatrics and the Brazilian Association of Allergy and Immunology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D Sol&#233;"
                            1 => "LR Silva"
                            2 => "RR Cocco"
                            3 => "CT Ferreira"
                            4 => "RO Sarni"
                            5 => "LC Oliveira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "BJAI"
                        "fecha" => "2018"
                        "volumen" => "2"
                        "paginaInicial" => "7"
                        "paginaFinal" => "38"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0019"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Strategies and future opportunities for the prevention&#44; diagnosis&#44; and management of cow milk allergy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B Zepeda-Ortega"
                            1 => "A Goh"
                            2 => "P Xepapadaki"
                            3 => "A Sprikkelman"
                            4 => "N Nicolaou"
                            5 => "RE Hernandez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Front Immunol"
                        "fecha" => "2021"
                        "volumen" => "12"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical features and clinical course of food protein-induced allergic proctocolitis&#58; 10-year experience of a tertiary medical center"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "N Senocak"
                            1 => "A Ertugrul"
                            2 => "S Ozmen"
                            3 => "I&#46; Bostanci"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaip.2022.02.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Allergy Clin Immunol Pract"
                        "fecha" => "2022"
                        "volumen" => "10"
                        "paginaInicial" => "1608"
                        "paginaFinal" => "1613"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35202870"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0021"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characteristics and prognosis of allergic proctocolitis in infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A Kaya"
                            1 => "M Toyran"
                            2 => "E Civelek"
                            3 => "E Misirlioglu"
                            4 => "C Kirsaclioglu"
                            5 => "CN&#46; Kocabas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MPG.0000000000000767"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Gastroenterol Nutr"
                        "fecha" => "2015"
                        "volumen" => "61"
                        "paginaInicial" => "69"
                        "paginaFinal" => "73"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26039942"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0022"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oral food challenge for FPIES in practice-a survey&#58; report from the work group on FPIES within the adverse reactions to Foods Committee&#44; FAED IS&#44; AAAAI"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R Nicolaides"
                            1 => "JA Bird"
                            2 => "A Cianferoni"
                            3 => "T Brown-Whitehorn"
                            4 => "A&#46; Nowak-Wegrzyn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaip.2021.06.061"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Allergy Clin Immunol Pract"
                        "fecha" => "2021"
                        "volumen" => "9"
                        "paginaInicial" => "3608"
                        "paginaFinal" => "3614"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34483087"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0023"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "FPIES in exclusively breastfed infants&#58; two case reports and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F Baldo"
                            1 => "M Bevacqua"
                            2 => "C Corrado"
                            3 => "D Nistic&#242;"
                            4 => "L Cesca"
                            5 => "V Declich"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13052-020-00910-8"
                      "Revista" => array:5 [
                        "tituloSerie" => "Ital J Pediatr"
                        "fecha" => "2020"
                        "volumen" => "46"
                        "paginaInicial" => "144"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33023612"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0024"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Food protein-induced enterocolitis syndrome&#58; a comprehensive review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A Agyemang"
                            1 => "A&#46; Nowak-Wegrzyn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s12016-018-8722-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Rev Allergy Immunol"
                        "fecha" => "2019"
                        "volumen" => "57"
                        "paginaInicial" => "261"
                        "paginaFinal" => "271"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30734159"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Feeding practices and the prevalence of cow&#39;s milk protein allergy in Irish preterm infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D Henderson"
                            1 => "CA Murphy"
                            2 => "AC Glynn"
                            3 => "MA Boyle"
                            4 => "N&#46; McCallion"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jhn.12971"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hum Nutr Diet"
                        "fecha" => "2022"
                        "volumen" => "35"
                        "paginaInicial" => "535"
                        "paginaFinal" => "541"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34904759"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0026"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adverse reactions to milk in infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B Kvenshagen"
                            1 => "R Halvorsen"
                            2 => "M&#46; Jacobsen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1651-2227.2007.00599.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Paediatr"
                        "fecha" => "2008"
                        "volumen" => "97"
                        "paginaInicial" => "196"
                        "paginaFinal" => "200"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18254909"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0027"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Brazilian Consensus on Food Allergy&#58; 2018 - part 2 - diagnosis&#44; treatment and prevention&#46; Joint position paper of the Brazilian Society of Pediatrics and the Brazilian Association of Allergy and Immunology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D Sol&#233;"
                            1 => "LR Silva"
                            2 => "RR Cocco"
                            3 => "CT Ferreira"
                            4 => "RO Sarni"
                            5 => "LC Oliveira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "BJAI"
                        "fecha" => "2018"
                        "volumen" => "2"
                        "paginaInicial" => "39"
                        "paginaFinal" => "82"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0028"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of food allergy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "SH&#46; Sicherer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaci.2010.11.044"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Allergy Clin Immunol"
                        "fecha" => "2011"
                        "volumen" => "127"
                        "paginaInicial" => "594"
                        "paginaFinal" => "602"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21236480"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0029"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of cow&#39;s milk allergy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "JD Flom"
                            1 => "SH&#46; Sicherer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/nu11051051"
                      "Revista" => array:5 [
                        "tituloSerie" => "Nutrients"
                        "fecha" => "2019"
                        "volumen" => "11"
                        "paginaInicial" => "1051"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31083388"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The natural course of cow&#39;s milk allergy and the development of atopic diseases into adulthood"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "MM Hansen"
                            1 => "SP Nissen"
                            2 => "S Halken"
                            3 => "A&#46; H&#248;st"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/pai.13440"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Allergy Immunol"
                        "fecha" => "2021"
                        "volumen" => "32"
                        "paginaInicial" => "727"
                        "paginaFinal" => "733"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33350002"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/00217557/0000010000000001/v2_202403080702/S0021755723001006/v2_202403080702/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "10179"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/00217557/0000010000000001/v2_202403080702/S0021755723001006/v2_202403080702/en/main.pdf?idApp=UINPBA000049&text.app=https://jped.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755723001006?idApp=UINPBA000049"
]

Article information

ISSN: 00217557
Original language: English

DOI:10.1016/j.jped.2023.08.003

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	9	7	16
2024 October	67	34	101
2024 September	68	54	122
2024 August	70	57	127
2024 July	70	52	122
2024 June	62	20	82
2024 May	71	24	95
2024 April	92	40	132
2024 March	120	33	153
2024 February	505	132	637
2024 January	223	77	300
2023 December	61	42	103
2023 November	60	49	109
2023 October	54	38	92
2023 September	26	32	58

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter