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Resumen: Introducción y objetivos: La prevalencia de alergia a la proteína de leche de vaca en el primer año de vida varía entre el 1.8% y el 7.5%. En el año 2014 se publicó The Cow's Milk-related Symptom Score (CoMiSS, Score de síntomas de Alergia a la Proteína de Leche de Vaca) para facilitar su diagnóstico. Con ello no se pretende reemplazar el diagnóstico clínico sino orientar al equipo tratante en el proceso diagnóstico y disminuir dietas innecesarias. El objetivo de este estudio fue traducir, adaptar y validar de forma transcultural la versión traducida del inglés al español del CoMiSS. Materiales y métodos: Se realizó un estudio de adaptación y validación del cuestionario CoMiSS en dos fases: primero, la traducción de la escala CoMiSS del inglés al español y luego la evaluación de la confiabilidad interevaluador de la escala traducida. Secundariamente, se realizaron las pruebas de confiabilidad entre evaluadores en 32 pacientes pediátricos menores de 7 años que fueron atendidos por primera vez en la Clínica de Alergia Alimentaria del Hospital Italiano de Buenos Aires con sospecha de alergia a la proteína de leche de vaca y que no habían recibido ningún tratamiento entre mayo de 2018 y mayo de 2019. Resultados: Se evaluaron 32 pacientes, de los cuales 14 fueron mujeres (45%) y la mediana de edad presentada fue de 3 meses (IQR 2-4). La mediana del resultado de la escala en la primera medición fue 7.0 (IQR 4.5-9.0) y en la segunda medición fue 5.0 (IQR 4.0-8.0). El coeficiente de correlación intraclase final de la escala fue 0.80 (IC 95% 0.63-0.9). Conclusión: La traducción al español del CoMiSS mostró resultados homologables a su versión original y una excelente fiabilidad entre los evaluadores. El beneficio de utilizar esta sencilla y poco conocida herramienta radica en ser una estrategia no invasiva, rápida, confiable y de fácil implementación. Abstract: Introduction and aims: The prevalence of cow's milk protein allergy in the first year of life varies from 1.8 to 7.5%. The Cow's Milk-related Symptom Score (CoMiSS) was published in 2014 and facilitates the diagnosis of cow's milk protein allergy. It is not meant to replace the clinical diagnosis, but rather to guide the treating team in the diagnostic process and reduce unnecessary diets. The aim was to translate the CoMiSS from English to Spanish and culturally adapt and validate the resulting Spanish version. Materials and methods: An adaptation and validation study on the CoMiSS questionnaire was carried out in two phases: First, the CoMiSS was translated from English to Spanish, after which interrater reliability of the translated score was assessed. Second, interrater reliability tests were carried out on 32 pediatric patients under 7 years of age that were treated for the first time at the Food Allergy Clinic of the Hospital Italiano de Buenos Aires, were suspected of having cow's milk protein allergy, and had not received any treatment, within the time frame of May 2018 and May 2019. Results: Thirty-two patients were evaluated, 14 of whom were females (45%), and the median patient age was 3 months (IQR 2-4). The median result of the first measurement of the scale was 7.0 (IQR 4.5-9.0) and the median of the second measurement was 5.0 (IQR 4.0-8.0). The final intraclass correlation coefficient was 0.80 (95% CI 0.63-0.9). Conclusion: The Spanish translation of the CoMiSS was comparable to the original English version, with excellent interrater reliability. This simple and little-known tool has the benefit of being a noninvasive, rapid, reliable, and easy-to-use strategy.

The treatment of cow's milk protein allergy is based on the complete elimination of cow's milk protein from the diet. To achieve remission of symptoms and future tolerance, exclusion must be total. In formula fed infants the extensively hydrolysed formula is the most appropriate option in mild or moderate forms, while those based on amino acids are reserved for the most severe cases. The treatment time, the acquisition of tolerance and the moment for the oral provocation test will vary according to the clinical picture, the immunological mechanism involved and the age of the patient. The aim of this consensus has been to reflect the updated knowledge together with the experience of neonatologists, pediatricians, experts in allergy, nutrition and gastroenterology., (Sociedad Argentina de Pediatría.)

Cow's milk protein can cause food allergy. The different mechanisms of action involved, the clinical variability depending on the stage of pediatric life in which it manifests, leads to difficulties in its approach, with the risk of under- or over-diagnosis. Professionals from various areas intervene in this process and their interaction is recommended. That is why the objective of this consensus has been to reflect the updated knowledge in an interdisciplinary mode, generating recommendations for its correct diagnosis. We have worked with the Delphi method to add to the scientific evidence, the experience from neonatologists, pediatricians, experts in allergy, nutrition and gastroenterology. We think that this interdisciplinary approach will be of practical use and will promote more comprehensive care for these patients., (Sociedad Argentina de Pediatría.)

Atopic dermatitis (AD) is an inflammatory skin disease highly prevalent in pediatrics as per international studies. There is scarce information on the epidemiological characteristics of AD in the Argentine pediatric population. The objective of this study was to describe the prevalence and clinical characteristics of AD in a population of Argentine children seen at the Department of Pediatrics of a general hospital. Observational, cross-sectional study. Five hundred patients were randomly included; their mean age was 10 years (SD: 5); 50% (250) were female. A total of 24 had AD. The overall prevalence was 5% (95% confidence interval: 3-7) and 3/24 were severe forms. The most frequent atopic comorbidity was asthma. The prevalence of AD in our population is similar to that of other countries. Our study provides new data on the epidemiological characteristics of AD in our region., (Sociedad Argentina de Pediatría.)

In recent decades, a higher prevalence, persistence, and severity of cow's milk protein allergy (CMPA) have been observed. Different hypotheses have been proposed in relation to potential responsible mechanisms, with emphasis on the role of the microbiota in the induction and maintenance of immune tolerance as well as the importance of establishing a healthy microbiota in an early manner through the promotion of breastfeeding, vaginal delivery, rational use of antibiotics and proton pump inhibitors, along with an early introduction of varied foods. The use of probiotics and allergenspecific immunotherapy (AIT) come up as the treatment strategies with the greatest evidence in favor of tolerance acquisition. The objective of this review was to describe the information currently available about the immune mechanisms involved in CMPA, the role of microbiota, and future treatment perspectives., Competing Interests: Mead Johnson Nutrition Argentina facilitated the meetings and technical details of this study. The manuscript was written with the colaboration of all authors in an autonomous manner; the company did not interfere with the editorial management or the final article. The authors state that their only relationship with Mead Johnson Nutrition was their participation in conferences and symposiums organized by the company, as in others carried out by other companies., (Sociedad Argentina de Pediatría.)

Here we describe the current challenges of mucopolysaccharidosis type I: the need for an adequate classification, establishing its relationship to therapeutic indications; an early diagnosis, from neonatal screening, its advantages and barriers, to clinical suspicion of severe and attenuated forms; spinal and eye disease care, from diagnosis to follow-up and treatment; allergic reactions caused by enzyme replacement therapy, their diagnosis and treatment. And lastly, transition to adult care., Competing Interests: Doctors Luisa Bay, Norberto Guelbert, Alejandro Fainboim, Norma Spécola, Guillermo Drelichman, and Marcela Pereyra have received professional fees from Sanofi for conducting teaching activities about lysosomal storage diseases., (Sociedad Argentina de Pediatría.)

Considering the advances made on mucopolysaccharidosis type I after the consensus study published by a group of experts in Argentina in 2008, recommendations about genetic testing, cardiological follow-up, airway care, hearing impairment detection, spinal and neurological conditions, as well as current treatments, were reviewed. Emphasis was placed on the need for early diagnosis and treatment, as well as an interdisciplinary follow-up., Competing Interests: Doctors Luisa Bay, Norberto Guelbert, Alejandro Fainboim, Norma Spécola, Guillermo Drelichman, and Marcela Pereyra have received professional fees from Sanofi for conducting teaching activities about lysosomal storage diseases., (Sociedad Argentina de Pediatría.)

Background: There are very few studies about the prevalence of allergic rhinitis in Argentina., Objective: To determine the prevalence of allergic rhinitis in a population of inhabitants between the ages of 5 and 44 in Argentina., Methods: A cross-sectional national study in which a self-reported questionnaire was used. The included participants are between the ages of 5 and 44 and they reside in urban areas. The information was collected by phone., Results: 3200 participants were surveyed: 51.8% were women, 37.6% were between the ages of 5 and 19, and 62.4%, were between the ages of 20 and 44. The global prevalence of symptoms of allergic rhinitis was of 20.5%; the most frequent symptoms were sneezing (58.5%) and nasal congestion (51.4%). Overall, 44.3% of the participants had a family history of allergies. Allergic rhinitis was more frequent in women; the prevalence was of 22.3% in the group of participants between the ages of 5 and 19, and of 19.4% in the group of participants between the ages of 20 and 40 (p=0.0545); 63.8% of participants with symptoms did not have a medical diagnosis., Conclusions: The results of this first cross-sectional national survey have confirmed the high prevalence of self-reported symptoms of allergic rhinitis in adults and children in Argentina, particularly in women.

Introduction: Cow's milk protein allergy (CMPA) is the most common food allergy in pediatrics. In Argentina, the prevalence of this disease has been evaluated in a few trials., Objectives: To estimate the prevalence of CMPA and describe its variation throughout a period of 11 years., Population and Methods: A retrospective cohort study was carried out in live newborn infants enrolled in a health care program of a university community hospital., Results: One hundred and sixteen cases of children with CMPA were identified. Cumulative prevalence was 0.8% (95% confidence interval [CI]: 0.65-0.95). A percent increase of 0.4% in 2004 to 1.2% in 2014 was observed in the number of cases per year., Conclusion: In 2014, CMPA prevalence was 1.2%, i.e. three times that of 2004., (Sociedad Argentina de Pediatría.)

In acute coronary syndromes inflammatory process plays an important role in atherosclerotic plaque instability. Our aim was to evaluate the presence and distribution of vulnerable plaques and inflammatory infiltrates in patients who died of acute myocardial infarction in comparison to patients who died of non-coronary heart disease. We analyzed pathologic studies of the heart of 68 patients who died of acute myocardial infarction and 15 patients who died of non-coronary heart disease. The presence of thrombus, intraplaque hemorrhage, endothelial rupture and inflammatory infiltrates were registered. In patients who died of myocardial infarction, we found thrombus in 73.5% of the involved arteries and in 28.7% of the non involved (p < 0.0001). Intraplaque hemorrhage was found in 70.5% of involved arteries and in 39.7% of the non involved (p < 0.0001); endothelial rupture in 29.4% of involved arteries and in 3.7% of non involved arteries (p < 0.0001). There was no difference in the presence of inflammatory infiltrates (76.5% versus 68.4%). Comparing with patients who have died of non-coronary heart disease, the presence of thrombus was significantly higher (73.5% vs. 13.3%; p < 0.0001), as well as the presence of intraplaque hemorrhage (70.5% vs. 0%; p < 0.0001) and of inflammatory infiltrates in atherosclerotic plaques (76.5% vs. 46.6%; p = 0.021). In patients who died of acute myocardial infarction we observed plaque instability and inflammatory activity, not only in the infarct related artery but also in the non involved arteries.