一项多中心研究表明：牛奶过敏儿童可耐受水解大米配方奶粉。

A hydrolysed rice-based formula is tolerated by children with cow's milk allergy: a multi-centre study.

作者信息

Fiocchi A, Restani P, Bernardini R, Lucarelli S, Lombardi G, Magazzù G, Marseglia G L, Pittschieler K, Tripodi S, Troncone R, Ranzini C

机构信息

Melloni Paediatria, Milan, Italy.

出版信息

Clin Exp Allergy. 2006 Mar;36(3):311-6. doi: 10.1111/j.1365-2222.2006.02428.x.

DOI:10.1111/j.1365-2222.2006.02428.x

PMID:16499641

Abstract

BACKGROUND

Children allergic to cow's milk are fed a soy- or a hydrolysed cow's milk-based substitute. Neither can rule out a sensitization risk. Previous studies have shown that hydrolysed rice is tolerated by animals and children with multiple food hypersensitivities.

OBJECTIVE

A prospective clinical assessment of tolerance to a rice-based hydrolysed formula was carried out in children allergic to cow's milk. Patients and methods One hundred children (42 girls and 58 boys, mean age 3.17+/-2.93 years, median 2.20, range 0.18-14.6 years) with a history of immediate reactions to cow's milk and confirmed at double-blind, placebo-controlled food challenge (DBPCFC) when not contraindicated were assessed for clinical tolerance to cow's milk proteins. Their allergy work-up included skin prick tests with whole milk, alpha-lactalbumin (ALA), beta-lactoglobulin (BLG) and total caseins, and specific IgE determinations using CAP technology were performed against whole milk, ALA, BLG and casein. Sensitization to rice and rice-based hydrolysed formula was similarly investigated. Patients' sera were evaluated at immunoblotting for specific IgE to cow's milk proteins, rice and rice-based hydrolysed formula. DBPCFC was carried out with increasing doses of a rice-based hydrolysed formula.

RESULTS

All patients were sensitized to cow's milk and/or at least one cow's milk protein fraction. Eighty-seven out of 99 were positive to cow's milk and/or a cow's milk protein fraction at skin prick test. Positive (>0.35 kUA/L) specific IgE determinations were found for cow's milk and/or milk fractions (92/95), rice (21/91) and hydrolysed rice infant formula (4/91). At immunoblotting, sera from 96 children were positive to alpha-casein (n=54), beta-casein (n=38), ALA (n=57), BLG (n=37) and bovine serum albumin (n=61). Similarly, although patients' sera often contained specific IgE against rice proteins at CAP (21/91) and immunoblotting (70/96), only six very weakly positive responses were observed against rice-based hydrolysed formula. All DBPCFC with rice-based hydrolysed formula were negative.

CONCLUSIONS

Rice-based hydrolysed formula is a possible alternative not only for children with multiple allergies, but also for children with cow's milk allergy.

摘要

背景

对牛奶过敏的儿童食用以大豆或水解牛奶为基础的替代品。这两种替代品都无法排除致敏风险。先前的研究表明，水解大米能被患有多种食物过敏的动物和儿童耐受。

目的

对牛奶过敏的儿童进行了一项关于对大米水解配方奶粉耐受性的前瞻性临床评估。患者与方法：100名儿童（42名女孩和58名男孩，平均年龄3.17±2.93岁，中位数2.20岁，范围0.18 - 14.6岁）有对牛奶速发反应的病史，在无禁忌时通过双盲、安慰剂对照食物激发试验（DBPCFC）确诊，评估他们对牛奶蛋白的临床耐受性。他们的过敏检查包括用全脂牛奶、α - 乳白蛋白（ALA）、β - 乳球蛋白（BLG）和总酪蛋白进行皮肤点刺试验，并用CAP技术针对全脂牛奶、ALA、BLG和酪蛋白进行特异性IgE测定。同样对大米和大米水解配方奶粉的致敏情况进行了研究。对患者血清进行免疫印迹分析，检测针对牛奶蛋白、大米和大米水解配方奶粉的特异性IgE。用递增剂量的大米水解配方奶粉进行DBPCFC。

结果

所有患者均对牛奶和/或至少一种牛奶蛋白成分致敏。99名患者中有87名在皮肤点刺试验中对牛奶和/或牛奶蛋白成分呈阳性反应。牛奶和/或牛奶成分（92/95）、大米（21/91）以及大米水解婴儿配方奶粉（4/91）的特异性IgE测定结果呈阳性（>0.35 kUA/L）。在免疫印迹分析中，96名儿童的血清对α - 酪蛋白（n = 54）、β - 酪蛋白（n = 38）、ALA（n = 57）、BLG（n = 37）和牛血清白蛋白（n = 61）呈阳性反应。同样，尽管患者血清在CAP检测（21/91）和免疫印迹分析（70/96）中常含有针对大米蛋白的特异性IgE，但针对大米水解配方奶粉仅观察到6个非常微弱的阳性反应。所有用大米水解配方奶粉进行的DBPCFC均为阴性。