以胃肠道症状为主要表现的婴儿牛奶蛋白过敏280例临床分析
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摘要
目的探讨以胃肠道症状为主要表现的婴儿牛奶蛋白过敏(CMPA)的流行病学特点及临床特征。方法回顾性分析280例临床诊断为以胃肠道症状为主要表现的CMPA住院婴儿的临床资料。结果 280例CMPA患儿中,6月龄以内患儿占72.5%(203例)。表现为腹泻171例(61.1%),血便149例(53.2%),呕吐71例(25.4%),湿疹57例(20.4%),营养不良42例(15%),便秘13例(4.6%);轻-中度CMPA258例(92.1%),重度CMPA 22例(7.9%)。重度CMPA组营养不良发生率(50.0%)高于轻-中度组(12.0%),血便发生率(22.7%)则低于轻-中度组(55.8%),差异均有统计学意义。母乳喂养CMPA组营养不良发生率(10.3%vs 24.6%)及重度CMPA患儿比例(4.4%vs 18.0%)均低于人工喂养CMPA组,而人工喂养CMPA组的血便发生率(37.7%)则低于母乳喂养CMPA组(56.6%)及混合喂养CMPA组(59.0%),差异均有统计学意义。结论以胃肠道症状为主要表现的CMPA多发生于6月龄以内婴儿,以腹泻、血便起病多见,病情大多为轻-中度。人工喂养比母乳喂养更易导致重度CMPA,更易引起营养不良。
Objective To investigate the epidemiological and clinical features of cow's milk protein allergy(CMPA)in infants presenting mainly with gastrointestinal symptoms. Methods A retrospective analysis was performed for the clinical data of 280 hospitalized infants, who were diagnosed with CMPA presenting mainly with gastrointestinal symptoms. Results Among the 280 infants, 203 infants(72.5%) were aged of less than 6 months. Major manifestations included diarrhea in 171 infants(61.1%), hematochezia in 149 infants(53.2%), vomiting in 71 infants(25.4%), eczema in 57 infants(20.4%), malnutrition in 42 infants(15%) and constipation in 13 infants(4.6%). Of the 280 infants, 258(92.1%) had mild-to-moderate CMPA and 22(7.9%) had severe CMPA. Compared with the mild-to-moderate CMPA group, the severe CMPA group had a significantly higher incidence rate of malnutrition(50.0% vs 12.0%) and a significantly lower incidence rate of hematochezia(22.7% vs 55.8%). The breastfeeding CMPA group had significantly lower incidence rates of malnutrition(10.3% vs 24.6%) and severe CMPA(4.4% vs 18.0%) than the artificial feeding CMPA group, and the artificial feeding CMPA group had a significantly lower incidence rate of hematochezia than the breastfeeding and mixed feeding CMPA groups(37.7% vs 56.6%/59.0%). Conclusions CMPA presenting mainly with gastrointestinal symptoms is more common in infants aged of less than 6 months. Diarrhea and hematochezia are the most common manifestations at the time of onset. Most infants have mild-to-moderate allergy. Compared with breastfeeding, artificial feeding is more likely to cause malnutrition and severe CMPA.
Objective To investigate the epidemiological and clinical features of cow's milk protein allergy(CMPA)in infants presenting mainly with gastrointestinal symptoms. Methods A retrospective analysis was performed for the clinical data of 280 hospitalized infants, who were diagnosed with CMPA presenting mainly with gastrointestinal symptoms. Results Among the 280 infants, 203 infants(72.5%) were aged of less than 6 months. Major manifestations included diarrhea in 171 infants(61.1%), hematochezia in 149 infants(53.2%), vomiting in 71 infants(25.4%), eczema in 57 infants(20.4%), malnutrition in 42 infants(15%) and constipation in 13 infants(4.6%). Of the 280 infants, 258(92.1%) had mild-to-moderate CMPA and 22(7.9%) had severe CMPA. Compared with the mild-to-moderate CMPA group, the severe CMPA group had a significantly higher incidence rate of malnutrition(50.0% vs 12.0%) and a significantly lower incidence rate of hematochezia(22.7% vs 55.8%). The breastfeeding CMPA group had significantly lower incidence rates of malnutrition(10.3% vs 24.6%) and severe CMPA(4.4% vs 18.0%) than the artificial feeding CMPA group, and the artificial feeding CMPA group had a significantly lower incidence rate of hematochezia than the breastfeeding and mixed feeding CMPA groups(37.7% vs 56.6%/59.0%). Conclusions CMPA presenting mainly with gastrointestinal symptoms is more common in infants aged of less than 6 months. Diarrhea and hematochezia are the most common manifestations at the time of onset. Most infants have mild-to-moderate allergy. Compared with breastfeeding, artificial feeding is more likely to cause malnutrition and severe CMPA.
引文
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[13]Morita H,Suzuki H,Orihara K,et al.Food protein-induced enterocolitis syndromes with and without bloody stool have distinct clinicopathologic features[J].J Allergy Clin Immunol,2017,140(6):1718-1721.e6.
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[18]Luyt D,Ball H,Makwana N,et al.BSACI guideline for the diagnosis and management of cow's milk allergy[J].Clin Exp Allergy,2014,44(5):642-672.
[19]Lam HY,van Hoffen E,Michelsen A,et al.Cow's milk allergy in adults is rare but severe:both casein and whey proteins are involved[J].Clin Exp Allergy,2008,38(6):995-1002.
[20]Matheson MC,Allen KJ,Tang ML.Understanding the evidence for and against the role of breastfeeding in allergy prevention[J].Clin Exp Allergy,2012,42(6):827-851.
[21]Munblit D,Peroni DG,Boix-Amorós A,et al.Human milk and allergic diseases:an unsolved puzzle[J].Nutrients,2017,9(8).pii:E894.
[22]Jarrett EE.Perinatal influences on IgE responses[J].Lancet,1984,2(8406):797-799.
[23]Ierodiakonou D,Garcia-Larsen V,Logan A,et al.Timing of allergenic food introduction to the infant diet and risk of allergic or autoimmune disease:a systematic review and metaanalysis[J].JAMA,2016,316(11):1181-1192.
[24]Du Toit G,Roberts G,Sayre PH,et al.Randomized trial of peanut consumption in infants at risk for peanut allergy[J].NEngl J Med,2015,372(9):803-813.
[25]Saarinen KM,Juntunen-Backman K,J?rvenp??AL,et al.Breast-feeding and the development of cows'milk protein allergy[J].Adv Exp Med Biol,2000,478:121-130.
[26]中华医学会儿科学分会免疫学组,《中华儿科杂志》编辑委员会.婴儿过敏性疾病预防、诊断和治疗专家共识[J].中华儿科杂志,2009,47(11):835-838.
[27]Iacono G,Cavataio F,Montalto G,et al.Persistent cow's milk protein intolerance in infants:the changing faces of the same disease[J].Clin Exp Allergy,1998,28(7):817-823.
[28]Salminen S,Gibson GR,McCartney AL,et al.Influence of mode of delivery on gut microbiota composition in seven year old children[J].Gut,2004,53(9):1388-1389.
[29]Tsabouri S,Priftis KN,Chaliasos N,et al.Modulation of gut microbiota downregulates the development of food allergy in infancy[J].Allergol Immunopathol(Madr),2014,42(1):69-77.
[2]Walkner M,Warren C,Gupta RS.Quality of life in food allergy patients and their families[J].Pediatr Clin North Am,2015,62(6):1453-1461.
[3]Host A,Halken S.Cow's milk allergy:where have we come from and where are we going?[J].Endocr Metab Immune Disord Drug Targets,2014,14(1):2-8.
[4]Vandenplas Y.Algorithms for common gastrointestinal disorders[J].J Pediatr Gastroenterol Nutr,2016,63(Suppl 1):S38-S40.
[5]中华医学会儿科学分会免疫学组,中华医学会儿科学分会儿童保健学组,中华医学会儿科学分会消化学组,等.中国婴幼儿牛奶蛋白过敏诊治循证建议[J].中华儿科杂志,2013,51(3):183-186.
[6]Lin RY,Anderson AS,Shah SN,et al.Increasing anaphylaxis hospitalizations in the first 2 decades of life:New York State,1990-2006[J].Ann Allergy Asthma Immunol,2008,101(4):387-393.
[7]Tejedor-Alonso MA,Moro-Moro M,Mosquera Gonzalez M,et al.Increased incidence of admissions for anaphylaxis in Spain1998-2011[J].Allergy,2015,70(7):880-883.
[8]Nwaru BI,Hickstein L,Panesar SS,et al.Prevalence of common food allergies in Europe:a systematic review and meta-analysis[J].Allergy,2014,69(8):992-1007.
[9]Fiocchi A,Brozek J,Schünemann H,et al.World Allergy Organization(WAO)Diagnosis and Rationale for Action against Cow's Milk Allergy(DRACMA)Guidelines[J].Pediatr Allergy Immunol,2010,21(Suppl 21):1-125.
[10]Rona RJ,Keil T,Summers C,et al.The prevalence of food allergy:a meta-analysis[J].J Allergy Clin Immunol,2007,120(3):638-646.
[11]Martorell A,Plaza AM,BonéJ,et al.Cow's milk protein allergy.A multi-centre study:clinical and epidemiological aspects[J].Allergol Immunopathol(Madr),2006,34(2):46-53.
[12]H?st A,Halken S.A prospective study of cow milk allergy in Danish infants during the first 3 years of life.Clinical course in relation to clinical and immunological type of hypersensitivity reaction[J].Allergy,1990,45(8):587-596.
[13]Morita H,Suzuki H,Orihara K,et al.Food protein-induced enterocolitis syndromes with and without bloody stool have distinct clinicopathologic features[J].J Allergy Clin Immunol,2017,140(6):1718-1721.e6.
[14]Koletzko S,Niggemann B,Arato A,et al.Diagnostic approach and management of cow's-milk protein allergy in infants and children:ESPGHAN GI Committee practical guidelines[J].JPediatr Gastroenterol Nutr,2012,55(2):221-229.
[15]Fleischer DM,Perry TT,Atkins D,et al.Allergic reactions to foods in preschool-aged children in a prospective observational food allergy study[J].Pediatrics,2012,130(1):e25-e32.
[16]Shah E,Pongracic J.Food-induced anaphylaxis:who,what,why,and where?[J].Pediatr Ann,2008,37(8):536-541.
[17]Gupta RS,Springston EE,Warrier MR,et al.The prevalence,severity,and distribution of childhood food allergy in the United States[J].Pediatrics,2011,128(1):e9-e17.
[18]Luyt D,Ball H,Makwana N,et al.BSACI guideline for the diagnosis and management of cow's milk allergy[J].Clin Exp Allergy,2014,44(5):642-672.
[19]Lam HY,van Hoffen E,Michelsen A,et al.Cow's milk allergy in adults is rare but severe:both casein and whey proteins are involved[J].Clin Exp Allergy,2008,38(6):995-1002.
[20]Matheson MC,Allen KJ,Tang ML.Understanding the evidence for and against the role of breastfeeding in allergy prevention[J].Clin Exp Allergy,2012,42(6):827-851.
[21]Munblit D,Peroni DG,Boix-Amorós A,et al.Human milk and allergic diseases:an unsolved puzzle[J].Nutrients,2017,9(8).pii:E894.
[22]Jarrett EE.Perinatal influences on IgE responses[J].Lancet,1984,2(8406):797-799.
[23]Ierodiakonou D,Garcia-Larsen V,Logan A,et al.Timing of allergenic food introduction to the infant diet and risk of allergic or autoimmune disease:a systematic review and metaanalysis[J].JAMA,2016,316(11):1181-1192.
[24]Du Toit G,Roberts G,Sayre PH,et al.Randomized trial of peanut consumption in infants at risk for peanut allergy[J].NEngl J Med,2015,372(9):803-813.
[25]Saarinen KM,Juntunen-Backman K,J?rvenp??AL,et al.Breast-feeding and the development of cows'milk protein allergy[J].Adv Exp Med Biol,2000,478:121-130.
[26]中华医学会儿科学分会免疫学组,《中华儿科杂志》编辑委员会.婴儿过敏性疾病预防、诊断和治疗专家共识[J].中华儿科杂志,2009,47(11):835-838.
[27]Iacono G,Cavataio F,Montalto G,et al.Persistent cow's milk protein intolerance in infants:the changing faces of the same disease[J].Clin Exp Allergy,1998,28(7):817-823.
[28]Salminen S,Gibson GR,McCartney AL,et al.Influence of mode of delivery on gut microbiota composition in seven year old children[J].Gut,2004,53(9):1388-1389.
[29]Tsabouri S,Priftis KN,Chaliasos N,et al.Modulation of gut microbiota downregulates the development of food allergy in infancy[J].Allergol Immunopathol(Madr),2014,42(1):69-77.