牛奶蛋白过敏婴幼儿常见过敏原sIgE阳性率分析
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摘要
目的:探讨牛奶蛋白过敏(CMPA)和健康婴幼儿常见过敏原特异性免疫球蛋白E(sIgE)的阳性率差异,明确CMPA婴幼儿常见过敏原sIgE阳性分布特征,为CMPA患儿综合干预提供依据。方法:选择156例CMPA(CMPA组)和318名健康婴幼儿(健康组)作为研究对象,采用酶联免疫吸附法检测2组婴幼儿血清中常见过敏原sIgE和总IgE水平,比较2组婴幼儿常见过敏原sIgE和总IgE阳性率差异。结果:CMPA组和健康组婴幼儿常见过敏原sIgE和总IgE的阳性率比较差异无统计学意义(P>0.05);CMPA组sIgE阳性率较高的食物过敏原为牛奶(44.2%)、鸡蛋白(10.3%)和腰果(5.1%),sIgE阳性率较高的吸入性过敏原为猫毛皮屑(21.2%)、狗毛皮屑(9.6%)和户尘螨(4.5%);健康组sIgE阳性率较高的食物过敏原为牛奶(45.0%)、鸡蛋白(14.2%)和腰果(6.0%),sIgE阳性率较高的吸入性过敏原为猫毛皮屑(25.8%)、狗毛皮屑(14.5%)和真菌组合(4.5%)。不同年龄段(<1岁与1~2岁)分组分析,CMPA组和健康组婴幼儿常见过敏原sIgE阳性率比较差异无统计学意义(P>0.05)。结论:CMPA和健康婴幼儿常见过敏原血清sIgE阳性率未发现明显差异,提示CMPA婴幼儿行血清sIgE检测的临床指导意义证据尚显不足。
Objective:To explore the differences in the positive rates of specific-IgE(sIgE)of the common allergens between the cow's milk protein allergy(CMPA)and healthy infants and the distribution characteristics of positive sIgE of common allergens in the CMPA infants,and to provide basis for comprehensive intervention of the CMPA infants.Methods:A total of 156 cases of CMPA and 318 cases of healthy infants were selected as the subjects.The serum sIgE and total IgE levels of common allergens of the infants in two groups were detected by enzyme-linked immunosorbent assay.The differences in the positive rates of serum sIgE of common allergens and total IgE of the infants in two groups were compared.Results:There were no statistical differences in the positive rates of serum sIgE and total IgE for common allergens of the infants between CMPA group and healthy group(P>0.05).The major food allergens with high positive rates of sIgE in CMPA group were cow's milk(44.2%),egg white(10.3%)and cashew nut(5.1%),and the inhale allergens with high positive rates of sIgE were cat hair(21.2%),dog hair(9.6%)and house dust mite(4.5%).While for the healthy infants,the major food allergens with high positive rates of sIgE were cow's milk(45%),egg white(14.2%)and cashew nut(6.0%),and the inhale allergens with high positive rates of sIgE were cat hair(25.8%),dog hair(14.5%)and fungus combinations(4.5%).The analysis in different age groups(<1 year old and 1-2 years old)showed that there were no statistical differences in the positive rates of serum sIgE and total IgE for common allergens of the infants between CMPA group and healthy group(P>0.05).Conclusion:There are no significant differences in the serum sIgE and total IgE positive rates between the CMPA and healthy infants.The detection of serum sIgE and total IgE of common allergens is of little clinical significance for the CMPA infants.
Objective:To explore the differences in the positive rates of specific-IgE(sIgE)of the common allergens between the cow's milk protein allergy(CMPA)and healthy infants and the distribution characteristics of positive sIgE of common allergens in the CMPA infants,and to provide basis for comprehensive intervention of the CMPA infants.Methods:A total of 156 cases of CMPA and 318 cases of healthy infants were selected as the subjects.The serum sIgE and total IgE levels of common allergens of the infants in two groups were detected by enzyme-linked immunosorbent assay.The differences in the positive rates of serum sIgE of common allergens and total IgE of the infants in two groups were compared.Results:There were no statistical differences in the positive rates of serum sIgE and total IgE for common allergens of the infants between CMPA group and healthy group(P>0.05).The major food allergens with high positive rates of sIgE in CMPA group were cow's milk(44.2%),egg white(10.3%)and cashew nut(5.1%),and the inhale allergens with high positive rates of sIgE were cat hair(21.2%),dog hair(9.6%)and house dust mite(4.5%).While for the healthy infants,the major food allergens with high positive rates of sIgE were cow's milk(45%),egg white(14.2%)and cashew nut(6.0%),and the inhale allergens with high positive rates of sIgE were cat hair(25.8%),dog hair(14.5%)and fungus combinations(4.5%).The analysis in different age groups(<1 year old and 1-2 years old)showed that there were no statistical differences in the positive rates of serum sIgE and total IgE for common allergens of the infants between CMPA group and healthy group(P>0.05).Conclusion:There are no significant differences in the serum sIgE and total IgE positive rates between the CMPA and healthy infants.The detection of serum sIgE and total IgE of common allergens is of little clinical significance for the CMPA infants.
引文
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[3]Sicherer SH,Sampson HA.Food allergy:Epidemiology,pathogenesis,diagnosis,and treatment[J].J Allergy Clin Immunol,2014,133(2):291-307.
[4]世界过敏组织.《牛奶蛋白过敏诊断与相关理论的指导意见》要略[J].中华儿科杂志,2012,50(7):510-515.
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[7]黎海芪.《牛奶蛋白过敏诊断与相关理论的指导意见》解读[J].中华儿科杂志,2012,50(7):516-518.
[8]Mousan G,Kamat D.Cow’s milk protein allergy[J].Clin Pediatr,2016,55(11):1054-1063.
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[11]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议[J].中华儿科杂志,2013,51(3):183-186.
[12]Vandenplas Y,Steenhout P,Planoudis Y,et al.Treating cow’s milk protein allergy:a double-blind randomized trial comparing two extensively hydrolysed formulas with probiotics[J].Acta Paediatr,2013,102(10):990-998.
[13]刘丽珍,武庆斌.比较牛奶激发试验与血清特异性抗体诊断婴幼儿牛奶蛋白过敏的临床研究[J].中国儿童保健杂志,2017,25(10):1047-1050.
[14]Sicherer SH,Wood RA.Allergy testing in childhood:using allergen-specific IgE tests[J].Pediatrics,2012,129(1):2011-2382.
[15]Burge D,Drewett M,Hall N.Do infants with gastroschisis may have a high incidence of non-IgE-mediated cow’s milk protein allergy?[J].Pediatr Surg Int,2015,31(3):271-276.
[16]Walsh J,Meyer R,Shah N,et al.Differentiating milk allergy(IgE and non-IgE mediated)from lactose intolerance:understanding the underlying mechanisms and presentations[J].Br J Gen Pract,2016,66(649):e609-e611.
[17]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.
[18]Sommanus S,Kerddonfak S,Kamchaisatian W,et al.Cow’s milk protein allergy:immunological response in children with cow’s milk protein tolerance[J].Asian Pac J Allergy Immunol,2014,32(2):171-177.
[19]Wickman M,Lupinek C,Andersson N,et al.Detection of IgE reactivity to a handful of allergen molecules in early childhood predicts respiratory allergy in adolescence[J].EBioMedicine,2017,26:91-99.
[20]Huang X,Tsilochristou O,Perna S,et al.Evolution of the IgE and IgG repertoire to a comprehensive array of allergen molecules in the first decade of life[J].Allergy,2018,73(2):421-430.
[21]王德云.重视上呼吸道疾病的认识、诊疗和预防[J].解放军医学杂志,2017,42(10):843-847.
[2]Manti S,Lougaris V,Cuppari C,et al.Breastfeeding and IL-10levels in children affected by cow’s milk protein allergy:A restrospective study[J].Immunobiology,2017,222(2):358-362.
[3]Sicherer SH,Sampson HA.Food allergy:Epidemiology,pathogenesis,diagnosis,and treatment[J].J Allergy Clin Immunol,2014,133(2):291-307.
[4]世界过敏组织.《牛奶蛋白过敏诊断与相关理论的指导意见》要略[J].中华儿科杂志,2012,50(7):510-515.
[5]Bartuzi Z,Cocco RR,Muraro A,et al.Contribution of molecular allergen analysis in diagnosis of milk allergy[J].Curr Allergy Asthma Rep,2017,17(7):46.
[6]Payot F,Berthiller J,Kassai B,et al.Practical interest of both skin prick test and specific IgE in the evaluation of tolerance acquisition in IgE mediated cow’s milk allergy(CMA).A clinical retrospective study in a cohort of184children[J].Allergol Immunopathol(Madr),2014,42(5):395-401.
[7]黎海芪.《牛奶蛋白过敏诊断与相关理论的指导意见》解读[J].中华儿科杂志,2012,50(7):516-518.
[8]Mousan G,Kamat D.Cow’s milk protein allergy[J].Clin Pediatr,2016,55(11):1054-1063.
[9]Mazigh S,Yahiaoui S,Ben Rabeh R,et al.Diagnosis and management of cow’s protein milk allergy in infant[J].La Tunisie Med,2015,93(4):205-211.
[10]Menet D,Lamireau T.A survey of milk reintroduction in children with cow milk protein allergy in pediatric departments of French hospitals[J].Arch Pediatr(Phila),2013,20(11):1206-1211.
[11]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议[J].中华儿科杂志,2013,51(3):183-186.
[12]Vandenplas Y,Steenhout P,Planoudis Y,et al.Treating cow’s milk protein allergy:a double-blind randomized trial comparing two extensively hydrolysed formulas with probiotics[J].Acta Paediatr,2013,102(10):990-998.
[13]刘丽珍,武庆斌.比较牛奶激发试验与血清特异性抗体诊断婴幼儿牛奶蛋白过敏的临床研究[J].中国儿童保健杂志,2017,25(10):1047-1050.
[14]Sicherer SH,Wood RA.Allergy testing in childhood:using allergen-specific IgE tests[J].Pediatrics,2012,129(1):2011-2382.
[15]Burge D,Drewett M,Hall N.Do infants with gastroschisis may have a high incidence of non-IgE-mediated cow’s milk protein allergy?[J].Pediatr Surg Int,2015,31(3):271-276.
[16]Walsh J,Meyer R,Shah N,et al.Differentiating milk allergy(IgE and non-IgE mediated)from lactose intolerance:understanding the underlying mechanisms and presentations[J].Br J Gen Pract,2016,66(649):e609-e611.
[17]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.
[18]Sommanus S,Kerddonfak S,Kamchaisatian W,et al.Cow’s milk protein allergy:immunological response in children with cow’s milk protein tolerance[J].Asian Pac J Allergy Immunol,2014,32(2):171-177.
[19]Wickman M,Lupinek C,Andersson N,et al.Detection of IgE reactivity to a handful of allergen molecules in early childhood predicts respiratory allergy in adolescence[J].EBioMedicine,2017,26:91-99.
[20]Huang X,Tsilochristou O,Perna S,et al.Evolution of the IgE and IgG repertoire to a comprehensive array of allergen molecules in the first decade of life[J].Allergy,2018,73(2):421-430.
[21]王德云.重视上呼吸道疾病的认识、诊疗和预防[J].解放军医学杂志,2017,42(10):843-847.