Martorell Antonio, Plaza Ana María, Boné Javier, Nevot Santiago, García Ara M Carmen, Echeverria Luis, Alonso Elena, Garde Jesús, Vila Blanca, Alvaro Montserrat, Tauler Eulalia, Hernando Vicente, Fernández Margarita
Hospital General Universitario, Valencia, España.
Allergol Immunopathol (Madr). 2006 Mar-Apr;34(2):46-53. doi: 10.1157/13086746.
Due to the age when it becomes apparent and the treatment needed, cow's milk proteins (CMP) allergy requires an accurate diagnosis to avoid labelling infants falsely as allergic and subjecting them to unnecessary diets. The objective of this multi-centre study carried out at the Allergy Units of 14 Children's Hospitals was to discover the epidemiological, clinical and evolutionary characteristics of cow's milk protein allergy (CMPA).
Infants suspected of CMPA who attended allergy clinics at the hospitals taking part during the study period were studied and a detailed clinical history was collected on all of them. Prick tests were done with cow's milk and its proteins and specific IgE anti-bodies were determined by means of CAP with the same allergens as the Prick test. The challenge test with cow's milk was carried out unless contraindicated by the diagnostic protocol. Two different challenge regimens were used: one of them carried out in 3 days and the other in one day. 409 infants with suspected CMPA were included and the diagnostic challenge test was performed on 286 patients (70 %) and not carried out on 123, as it was not indicated according to the protocol. IgE-mediated allergy was confirmed in 234 infants (58 %) and in 15 (4 %) non-IgE-mediated hypersensitivity was diagnosed. The two challenge regimens were equally secure. The average age when the reaction to cow's milk formula took place was 3.5 months (10 days-10 months). The symptoms appeared in the first week of introduction in 95 % of cases and appeared in 60 % with the first feeding with the formula. The most frequent clinical signs were cutaneous in 94 % of cases and the majority of cases appeared within 30 minutes of the feed. 99 % had been breast fed and 44 % had received some cow's milk supplement during the lactation period. Sensitization to egg not given in the feed was noted in 30 % and to beef in 29 %, being well tolerated in all of these.
Carrying out an appropriate diagnostic protocol in infants attending for suspected CMPA allows allergy to be ruled out in a high percentage of cases.
由于牛奶蛋白（CMP）过敏在明显出现的年龄以及所需的治疗方面的特点，需要进行准确诊断，以避免将婴儿错误地标记为过敏并使其接受不必要的饮食。在14家儿童医院的过敏科开展的这项多中心研究的目的是发现牛奶蛋白过敏（CMPA）的流行病学、临床和演变特征。
对研究期间在参与研究的医院过敏门诊就诊的疑似CMPA婴儿进行了研究，并收集了他们所有人的详细临床病史。用牛奶及其蛋白进行点刺试验，并通过CAP用与点刺试验相同的变应原测定特异性IgE抗体。除非诊断方案有禁忌，否则进行牛奶激发试验。使用了两种不同的激发方案：一种在3天内进行，另一种在1天内进行。纳入了409名疑似CMPA的婴儿，对286名患者（70%）进行了诊断性激发试验，123名患者未进行，因为根据方案不适用。在234名婴儿（58%）中确诊为IgE介导的过敏，在15名婴儿（4%）中诊断为非IgE介导的超敏反应。两种激发方案同样安全。对牛奶配方奶产生反应的平均年龄为3.5个月（10天至10个月）。95%的病例症状出现在引入配方奶的第一周，60%的病例在首次喂食配方奶时出现症状。最常见的临床体征在94%的病例中为皮肤症状，大多数病例在喂食后30分钟内出现症状。99%的婴儿曾进行母乳喂养，44%的婴儿在哺乳期接受过一些牛奶补充剂。在未喂食的情况下，30%的婴儿对鸡蛋致敏，29%的婴儿对牛肉致敏，所有这些婴儿对这些食物都耐受良好。
对疑似CMPA的婴儿实施适当的诊断方案可在高比例病例中排除过敏。
