DESAFIOS NO DIAGNÓSTICO DA APLV: REVISÃO INTEGRATIVA DA LITERATURA
Palavras-chave:
Hipersensibilidade a Leite, Diagnóstico, Criança, LactenteResumo
Objetivo: Analisar os principais desafios relacionados ao diagnóstico da alergia à proteína do leite de vaca na infância. Método: Trata-se de uma Revisão Integrativa da Literatura, de abordagem qualitativa, realizada nas bases de dados National Library of Medicine, Biblioteca Virtual em Saúde e Wiley Online Library. Foram utilizados os descritores “Milk Hypersensitivity”, “Diagnosis”, “Child” e “Infant”, associados pelos operadores booleanos AND e OR. Foram incluídos artigos publicados entre 2021 e 2025, disponíveis na íntegra e em língua inglesa, resultando em uma amostra final de 17 estudos. Resultados: Os resultados evidenciaram que os principais desafios diagnósticos envolvem a dificuldade de interpretação clínica dos sintomas, a ausência de biomarcadores específicos, a baixa acurácia dos testes laboratoriais, a dependência do teste de provocação oral, a ocorrência de superdiagnóstico e subdiagnóstico e a falta de padronização entre diretrizes e ferramentas de triagem. Conclusão: Conclui-se que o diagnóstico da APLV permanece complexo e multifatorial, exigindo abordagem integrada e baseada em evidências, além do desenvolvimento de métodos diagnósticos mais precisos e protocolos clínicos padronizados.
Referências
ALLEN, Hilary et al. Detection and management of milk allergy: Delphi consensus study. Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology, v. 52, n. 7, p. 848–858, 2022. Disponível em: https://onlinelibrary.wiley.com/doi/10.1111/cea.14179. Acesso em: 05 jun. 2026.
ALLEN, Hilary et al. Prevalence and risk factors for milk allergy overdiagnosis in the BEEP trial cohort. Allergy, v. 80, n. 1, p. 148–160, 2024. Disponível em:
https://onlinelibrary.wiley.com/doi/10.1111/all.16203. Acesso em: 05 jun. 2026.
ARASI, Stefania; CAFAROTTI, Arianna; FIOCCHI, Alessandro. Cow's milk allergy. Current Opinion in Allergy and Clinical Immunology, Philadelphia, v. 22, n. 3, p. 181-187, jun. 2022. Disponível em: https://doi.org/10.1097/ACI.0000000000000823. Acesso em: 05 jun. 2026.
BAJEROVA, Katerina et al. The cow’s milk-related Symptom Score (CoMiSSTM): A useful awareness tool. Nutrients, v. 14, n. 10, p. 2059, 2022. Disponível em:
https://pmc.ncbi.nlm.nih.gov/articles/PMC9146599/. Acesso em: 05 jun. 2026.
BRASIL. Ministério da Saúde. Comissão Nacional de Incorporação de Tecnologias no Sistema Único de Saúde (CONITEC). Protocolo Clínico e Diretrizes Terapêuticas da Alergia à Proteína do Leite de Vaca (APLV). Brasília: Ministério da Saúde, 2022. Disponível em: https://www.gov.br/conitec/pt-br/midias/consultas/relatorios/2022/20220427_pcdt_aplv_cp_24.pdf. Acesso em: 7 jun. 2026.
CAFFARELLI, Carlo et al. Cow’s milk allergy in breastfed infants: What we need to know about mechanisms, management, and maternal role. Nutrients, v. 17, n. 11, p. 1787, 2025.
Disponível em: https://pubmed.ncbi.nlm.nih.gov/40507056/. Acesso em: 05 jun. 2026.
DARMA, Andy et al. Lactose intolerance versus cow’s milk allergy in infants: A clinical dilemma. Nutrients, v. 16, n. 3, p. 414, 2024. Disponível em: https://pubmed.ncbi.nlm.nih.gov/38337698/. Acesso em: 05 jun. 2026.
DELLI COLLI, Luca et al. Predicting cow’s milk challenge outcomes in children: Multivariate analysis of clinical predictors. International Archives of Allergy and Immunology, v. 186, n. 11, p. 1022–1032, 2025. Disponível em: https://pubmed.ncbi.nlm.nih.gov/40043695/#full-view-affiliation-1. Acesso em: 05 jun. 2026.
DE SOUSA, Milena; BEZERRA, André; DO EGYPTO, Ilana. Trilhando o caminho do conhecimento: o método de revisão integrativa para análise e síntese da literatura científica. Observatório de La Economía Latinoamericana, v. 21, n. 10, p. 18448-18483, 2023.
DÍAZ, M. Cristina et al. Usefulness of analytic tests for the diagnosis of cow’s milk protein allergy. Archivos argentinos de pediatria, v. 120, n. 1, p. 21–29, 2022. Disponível em:
https://pubmed.ncbi.nlm.nih.gov/35068116/#full-view-affiliation-1. Acesso em: 05 jun. 2026.
EL-HODHOD, Moustafa A. et al. Consensus statement on the epidemiology, diagnosis, prevention, and management of cow’s milk protein allergy in the Middle East: a modified Delphi-based study. World Journal of Pediatrics, v. 17, n. 6, p. 576–589, 2021. Disponível em: https://pubmed.ncbi.nlm.nih.gov/34817828/. Acesso em: 05 jun. 2026.
HAO, Li; WANG, Songqing; JI, Wei. Cow’s milk protein allergy: A comprehensive review of epidemiology, pathogenesis, clinical manifestations, diagnostics, and management strategies. Asia Pacific Journal of Clinical Nutrition, v. 34, n. 3, p. 298–307, 2025. Disponível em: https://pubmed.ncbi.nlm.nih.gov/40419390/. Acesso em: 05 jun. 2026.
LANDAAS, Vibeke et al. Home-based double-blind, placebo-controlled challenges for diagnosis of delayed gluten/milk hypersensitivity in children. The Journal of Allergy and Clinical Immunology in Practice, v. 12, n. 3, p. 652- 659.e5, 2024. Disponível em:
https://pubmed.ncbi.nlm.nih.gov/38154555/#full-view-affiliation-1. Acesso em: 05 jun. 2026.
MAEDA, Mayu et al. Is oral food challenge test useful for avoiding complete elimination of cow’s milk in Japanese patients with or suspected of having IgE-dependent cow’s milk allergy? Allergology International: Official Journal of the Japanese Society of Allergology, v. 71, n. 2, p. 214–220, 2022. Disponível em:
https://pubmed.ncbi.nlm.nih.gov/34593320/#full-view-affiliation-1. Acesso em: 05 jun. 2026.
MCWILLIAM, Vicki et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) guidelines update - X - Breastfeeding a baby with cow’s milk allergy. The World Allergy Organization Journal, v. 16, n. 11, p. 100830, 2023. Disponível em: https://pubmed.ncbi.nlm.nih.gov/38020284/. Acesso em: 7 jun. 2026.
MEYER, Rosan et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guideline update - VII - Milk elimination and reintroduction in the diagnostic process of cow’s milk allergy. The World Allergy Organization Journal, v. 16, n. 7, p. 100785, 2023. Disponível em: https://pubmed.ncbi.nlm.nih.gov/37546235/. Acesso em: 05 jun. 2026.
NOWAK-WEGRZYN, Anna et al. Work Group report: oral food challenge testing. The Journal of Allergy and Clinical Immunology, v. 123, n. 6 Suppl, p. S365-83, 2009. Disponível em: https://scholars.mssm.edu/en/publications/work-group-report-oral-food-challenge-testing-2/. Acesso em: 05 jun. 2026.
SICHERER, Scott; SAMPSON, Hugh. Food allergy: Epidemiology, pathogenesis, diagnosis, and treatment. The Journal of Allergy and Clinical Immunology, v. 133, n. 2, p. 291–307; quiz 308, 2014. Disponível em: https://scholars.mssm.edu/en/publications/food-allergy-epidemiology-pathogenesis-diagnosis-and-treatment-2/. Acesso em: 05 jun. 2026.
THOMPSON, Georgina et al. Symptom scores in the diagnosis of pediatric cow’s milk protein allergy: A systematic review. Pediatric Allergy and Immunology: Official Publication of the European Society of Pediatric Allergy and Immunology, v. 32, n. 7, p. 1497–1507, 2021. Disponível em: https://onlinelibrary.wiley.com/doi/10.1111/pai.13537. Acesso em: 05 jun. 2026.
TOCA, María et al. Alergia a las proteínas de la leche de vaca: proceso diagnóstico. Consenso interdisciplinario de expertos. Archivos argentinos de pediatria, v. 122, n. 4, p. e202410403, 2024. Disponível em: https://pubmed.ncbi.nlm.nih.gov/38857102/. Acesso em: 05 jun. 2026.
TOSCA, Maria et al. Molecular allergy diagnostics in children with cow’s milk allergy: Prediction of oral food challenge response in clinical practice. Journal of Immunology Research, v. 2023, p. 1129449, 2023. Disponível em: https://pubmed.ncbi.nlm.nih.gov/37144177/. Acesso em: 05 jun. 2026.
TOUNIAN, Patrick. Management of cow’s-milk protein allergy in infants and children. What’s new in 2023? Global Pediatrics, v. 8, n. 100153, p. 100153, 2024. Disponível em: https://www.sciencedirect.com/science/article/pii/S2667009724000216. Acesso em: 05 jun. 2026.
VARDAR, Gonca; OZDIL, Mine; TUFEKCI, Sinan. Awareness or neglecting the diagnosis of cow milk protein allergy in the neonatal period. Asia Pacific Journal of Clinical Nutrition, v. 32, n. 2, p. 257–264, 2023. Disponível em: https://pubmed.ncbi.nlm.nih.gov/37382323/. Acesso em: 05 jun. 2026.
VANDENPLAS, Yvan et al. The remaining challenge to diagnose and manage cow’s milk allergy: An opinion paper to daily clinical practice. Nutrients, v. 15, n. 22, p. 4762, 2023b.
Disponível em: https://pubmed.ncbi.nlm.nih.gov/38004156/. Acesso em: 05 jun. 2026.
VANDENPLAS, Yvan et al. An ESPGHAN position paper on the diagnosis, management and prevention of cow’s milk allergy. Journal of Pediatric Gastroenterology and Nutrition, v. 78, n. 2, p. 386–413, 2024. Disponível em: https://onlinelibrary.wiley.com/doi/10.1097/MPG.0000000000003897. Acesso em: 05 jun. 2026.
VANDENPLAS, Yvan et al. Assessment of the Cow’s Milk-related Symptom Score (CoMiSS) as a diagnostic tool for cow’s milk protein allergy: a prospective, multicentre study in China (MOSAIC study). BMJ Open, v. 12, n. 2, p. e056641, 2022. Disponível em:
https://pubmed.ncbi.nlm.nih.gov/35177461/#full-view-affiliation-1. Acesso em: 05 jun. 2026.
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Copyright (c) 2026 Maria Eduarda Rosa Lopes Ribeiro, Milena Nunes Alves de Souza
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