Høst Arne
Department of Pediatrics, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
Ann Allergy Asthma Immunol. 2002 Dec;89(6 Suppl 1):33-7. doi: 10.1016/s1081-1206(10)62120-5.
The primary objective of this review is to discuss the clinical features, diagnosis, natural history, and prognosis of cow's milk allergy in early childhood and its relationship to development of inhalant allergies.
A review of 229 PubMed (National Library of Medicine) articles on cow's milk allergy (CMPA) for the years 1967 through 2001 was performed. In addition, references from other review articles have been included. This review represents a synthesis of these sources and the expert opinion of the author.
The expert opinion of the author was used to select the relevant data for this review.
The diagnosis of reproducible adverse reactions to cow's milk protein (CMP), ie, CMPA, has to be confirmed by controlled elimination and challenge procedures. The incidence of CMPA in infancy seems to be approximately 2 to 3% in developed countries. Symptoms suggestive of CMPA may be encountered in approximately 5 to 15% of infants emphasizing the importance of controlled elimination/milk challenge procedures. Reproducible clinical reactions to CMP in human milk have been reported in approximately 0.5% of breastfed infants. Most infants with CMPA develop symptoms before 1 month of age, often within 1 week after introduction of CMP-based formula. The majority has two or more symptoms from two or more organ systems. Approximately 50 to 60% have cutaneous symptoms, 50 to 60% have gastrointestinal symptoms, and approximately 20 to 30% respiratory symptoms. Symptoms may occur within 1 hour after milk intake (immediate reactions) or after 1 hour (late reactions). The prognosis of CMPA is good with a remission rate of approximately 45 to 50% at 1 year, 60 to 75% at 2 years, and 85 to 90% at 3 years. Associated adverse reactions to other foods develop in up to 50% and allergy against inhalants in 50 to 80% before puberty.
CMPA is the most common food allergy in early childhood with an incidence of 2 to 3% in the first year of life. The overall prognosis of CMPA in infancy is good with a remission rate of approximately 85 to 90%. In particular, gastrointestinal symptoms show a good prognosis. An early increased immunoglobulin E-response to CMP is associated with an increased risk of persistent allergy to CMP, development of adverse reactions to other foods, and development of asthma and rhinoconjunctivitis later in childhood.
本综述的主要目的是探讨幼儿牛奶过敏的临床特征、诊断、自然病程和预后，以及它与吸入性过敏发展的关系。
对1967年至2001年期间229篇来自美国国立医学图书馆的PubMed上关于牛奶过敏（CMPA）的文章进行了综述。此外，还纳入了其他综述文章的参考文献。本综述综合了这些来源以及作者的专家意见。
作者的专家意见被用于选择本综述的相关数据。
对牛奶蛋白（CMP）可重现的不良反应，即CMPA的诊断，必须通过对照的排除和激发程序来确认。在发达国家，婴儿期CMPA的发病率似乎约为2%至3%。在大约5%至15%的婴儿中可能会出现提示CMPA的症状，这凸显了对照的排除/牛奶激发程序的重要性。据报道，在大约0.5%的母乳喂养婴儿中存在对母乳中CMP的可重现临床反应。大多数CMPA婴儿在1月龄前出现症状，通常在引入基于CMP的配方奶后1周内。大多数婴儿有来自两个或更多器官系统的两种或更多症状。大约50%至60%有皮肤症状，50%至60%有胃肠道症状，大约20%至30%有呼吸道症状。症状可能在摄入牛奶后1小时内出现（即刻反应）或在1小时后出现（迟发反应）。CMPA的预后良好，1岁时缓解率约为45%至50%，2岁时为60%至75%，3岁时为85%至90%。在青春期前，对其他食物的相关不良反应发生率高达50%，对吸入物过敏的发生率为50%至80%。
CMPA是幼儿期最常见的食物过敏，在生命的第一年发病率为2%至3%。婴儿期CMPA的总体预后良好，缓解率约为85%至90%。特别是胃肠道症状预后良好。早期对CMP的免疫球蛋白E反应增加与CMP持续过敏、对其他食物出现不良反应以及儿童后期发生哮喘和变应性鼻结膜炎的风险增加相关。
