Diamanti A, Fiocchi A G, Capriati T, Panetta F, Pucci N, Bellucci F, Torre G
Artificial Nutrition Unit-Gastroenterology, Hepatology and Nutrition Unit, 'Bambino Gesù' Children's Hospital, Rome, Italy.
Allergy Unit, 'Bambino Gesù' Children's Hospital, Rome, Italy.
Eur J Clin Nutr. 2015 Jan;69(1):102-6. doi: 10.1038/ejcn.2014.156. Epub 2014 Sep 3.
BACKGROUND/OBJECTIVES: Neonatal short bowel syndrome (SBS) follows early intestinal resections that may expose the children to increased intestinal contact with undigested food proteins and to the risk of food allergy. We report three consecutive cases of cow's milk allergy (CMA) in SBS infants.
SUBJECTS/METHODS: We reviewed three cases of CMA developed in 37 children with neonatal SBS followed up in the last 10 years. The setting of the survey was the Gastroenterology-Hepatology and Nutrition Unit of the Pediatric Hospital 'Bambino Gesù' in Rome. The diagnosis of CMA was based on the oral food challenge and was supported by the results of the skin prick tests (SPT) and/or the specific immunoglobulin (Ig) E.
Two patients had persistent liquid stools and periodic episodes of vomiting when they were fed with an intact milk protein-based formula, that disappeared with extensively hydrolyzed formula and amino-acid-based formulae, respectively. The third patient developed maculo-papular rash, flushing and angioedema, when he was introduced a regular formula. The challenge-confirmed CMA in all patients. Positive specific IgE for milk proteins was documented in all the three patients. Two out of the three patients had positive familial history for allergy and positive SPT.
Our findings suggest that the SBS patients require a careful clinical monitoring of the tolerance for the cow's milk proteins, because CMA could be more frequent than expected. A prospective regular assessment for the potential cow milk sensitization by SPT and specific IgE may clarify the nature of the association and support the clinical surveillance. Multicenter studies are required to better evaluate this comorbidity.
背景/目的：新生儿短肠综合征（SBS）发生于早期肠道切除术后，这可能使患儿肠道与未消化食物蛋白的接触增加，并面临食物过敏风险。我们报告了3例SBS婴儿连续发生牛奶过敏（CMA）的病例。
对象/方法：我们回顾了过去10年随访的37例新生儿SBS患儿中发生的3例CMA病例。调查地点为罗马“ Bambino Gesù”儿童医院的胃肠病学-肝病学与营养科。CMA的诊断基于口服食物激发试验，并得到皮肤点刺试验（SPT）和/或特异性免疫球蛋白（Ig）E结果的支持。
2例患者在喂食完整的基于牛奶蛋白的配方奶时出现持续的水样便和周期性呕吐，分别在改用深度水解配方奶和氨基酸配方奶后症状消失。第3例患者在引入常规配方奶时出现斑丘疹、潮红和血管性水肿。激发试验证实所有患者均为CMA。所有3例患者均记录到牛奶蛋白特异性IgE阳性。3例患者中有2例有过敏家族史且SPT阳性。
我们的研究结果表明，SBS患者需要仔细临床监测对牛奶蛋白的耐受性，因为CMA可能比预期更常见。通过SPT和特异性IgE对潜在牛奶致敏进行前瞻性定期评估，可能会阐明这种关联的性质并支持临床监测。需要多中心研究以更好地评估这种合并症。
