Diagnostic et prise en charge de l’allergie aux protéines de lait de vache chez le nourrisson
Mots-clés :
Allergie aux protéines de lait de vache, dosage des IgE spécifiques anti protéines de lait de vache, prick test, hydrolysats de protéines de lait de vache ,mixture d'acides aminés , enfant .Résumé
Prérequis : L’allergie aux protéines de lait de vache peut être responsable d’une très grande variété de symptômes et peut être due à une réaction IgE et non IgE médiée. Les questions qui restent d’actualité sont d’ordre diagnostic (quels sont les tableaux cliniques évocateurs et la place des tests allergiques dans la prise en charge ?) et thérapeutique (quel type de régime d’éviction peut-on proposer et pour quelle durée ?Méthodes : Nous avons consulté la base de données, Pub Med, Science Direct, Cochrane Library en utilisant les mots clés, allergie aux protéines de lait de vache, guideline, enfant. Les niveaux de preuve étaient A,B,C.
Résultats : La symptomatologie n’est pas spécifique et une analyse précise de l’histoire clinique et un examen physique minutieux permet d’évoquer le diagnostic .La confirmation par les tests cutanés et le dosage des Ig E spécifiques manque de spécificité. Le diagnostic est basé sur la disparition des signes cliniques sous régime d’exclusion à base d’hydrolysat extensif de protéines de lait de vache, pendant deux à quatre semaines. En l’absence d’amélioration, une mixture d’acide aminé est prescrite. Le test de réintroduction des protéines de lait de vache qui se fera à l’âge de 12 mois à l’hôpital, a remplacé le test de provocation oral qui reste le gold standard pour le diagnostic.
Conclusion : l’importance de critères diagnostiques bien définis est primordiale pour éviter que des régimes d’exclusion soient prescrits inutilement et éviter des retards diagnostics source de malnutrition.
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