Ram F S, Ducharme F M, Scarlett J
Department of Physiological Medicine, St George's Hospital Medical School, Level 0, Jenner Wing, Cranmer Terrace, London, UK, SW17 0RE.
Cochrane Database Syst Rev. 2002(3):CD003795. doi: 10.1002/14651858.CD003795.
In infants with a family history of atopy, food allergen avoidance has been advocated as means of preventing the development of atopic disease when breast-feeding is not possible or supplemental feeding is needed. Most infant formulas are based on cow's milk protein. Alternative choices include soya based and hydrolysed cows milk formulas.
To estimate the effect of dietary avoidance of cow's milk protein on the development of asthma or wheeze in children.
The Cochrane database was searched for eligible trials until February 2002. The full text papers of all abstracts identified as RCTs were obtained and reviewed independently by two reviewers.
Randomised controlled trials involving children with a family history of atopy in at least one first degree relative were considered if feeding with cow's milk based standard formula was compared to dietary avoidance of cow's milk protein using soya or other hypoallergenic formula during the initial four months of life or longer.
Two reviewers extracted data independently. A priori defined subgroups were the types of hypoallergenic artificial feed and dietary restrictions on mother and/or child's diet.
Six trials used hydrolysed formula for at least 4 months in addition to dietary restrictions and in some cases dust-mite reduction measures. The risk of infants experiencing asthma or wheeze during the first year of life was reduced compared to standard cow's milk based formula (Relative Risk =0.40, 95% Confidence Intervals 0.19, 0.85). Feeding soya-based formula as opposed to standard cow's milk formula did not reduce the risk of having asthma or wheeze at any age.
REVIEWER'S CONCLUSIONS: Breast-milk should remain the feed of choice for all babies. In infants with at least one first degree relative with atopy, hydrolysed formula for a minimum of 4 months combined with dietary restrictions and environment measures may reduce the risk of developing asthma or wheeze in the first year of life. There is insufficient evidence to suggest that soya-based milk formula has any benefit.
对于有特应性疾病家族史的婴儿，当无法进行母乳喂养或需要补充喂养时，提倡避免食用食物过敏原，以此作为预防特应性疾病发生的手段。大多数婴儿配方奶粉是以牛奶蛋白为基础的。其他选择包括大豆基配方奶粉和水解牛奶配方奶粉。
评估避免食用牛奶蛋白饮食对儿童哮喘或喘息发生发展的影响。
检索Cochrane数据库以查找符合条件的试验，检索截至2002年2月。获取所有被确定为随机对照试验的摘要的全文论文，并由两名评审员独立进行评审。
如果在生命的最初四个月或更长时间内，将基于牛奶的标准配方奶粉喂养与使用大豆或其他低敏配方奶粉避免食用牛奶蛋白的饮食进行比较，则纳入涉及至少有一位一级亲属有特应性疾病家族史的儿童的随机对照试验。
两名评审员独立提取数据。预先定义的亚组为低敏人工喂养的类型以及对母亲和/或儿童饮食的饮食限制。
六项试验除了饮食限制外，还使用水解配方奶粉至少4个月，在某些情况下还采取了减少尘螨措施。与基于标准牛奶的配方奶粉相比，婴儿在生命第一年发生哮喘或喘息的风险降低（相对风险=0.40，95%置信区间0.19，0.85）。与标准牛奶配方奶粉相比，喂养大豆基配方奶粉在任何年龄都不会降低患哮喘或喘息的风险。
母乳应仍然是所有婴儿的首选喂养方式。对于至少有一位一级亲属患有特应性疾病的婴儿，至少4个月的水解配方奶粉结合饮食限制和环境措施可能会降低生命第一年发生哮喘或喘息的风险。没有足够的证据表明大豆基牛奶配方奶粉有任何益处。
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