Errázuriz Germán, Lucero Yalda, Ceresa Sergio, Gonzalez Mónica, Rossel Maureen, Vives Andrés
Unidad de Gastroenterología, Departamento de Pediatría, Clínica Las Condes, Santiago, Chile.
Unidad de Gastroenterología, Departamento de Pediatría y Cirugía Infantil Oriente, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
Rev Chil Pediatr. 2016 Nov-Dec;87(6):449-454. doi: 10.1016/j.rchipe.2016.06.007. Epub 2016 Sep 12.
Cow's milk protein allergy (CMPA) is highly prevalent in infants (2-5%). It has a wide clinical spectrum, and confirmation through an oral food challenge (OFC) is relevant for its differential diagnosis. Information on this topic is scarce in Chile.
To describe the demographic and clinical features of infants with suspected CMPA.
A retrospective study of patients<1 year-old, treated for suspected CMPA between 2009 and 2011. Demographic data, symptoms of atopy, nutrition at the time of diagnosis, CMPA symptoms, diagnostic studies, and response to treatment were recorded. Diet response at least 4 weeks after milk modification, and clinical behavior when suspected foods were added back to the diet were considered standard diagnostic criteria. Descriptive statistics were performed using Epiinfo ™ software.
The study included 106 infants, of whom, 51% male, 80% term newborns, 74% with≥1 atopic parent, and 34% with ≥1 parent/sibling with food allergy. The median age at onset of symptoms was 1.5 months (range 1.5-2m). Almost half (46%) were breast-feeding≥6m, with 15% receiving formula milk since the neonatal period, and 49% before the third month. Common symptoms were: vomiting (63%), colic (49%), and bleeding on passing stools (41%). No anaphylaxis was identified, and 61% had≥2 symptoms at debut. Only 34% were subjected to OFC. The most frequently requested tests were, test patch (43%), prick test (40%), and blood in stools (37%).
43% breast feeding with exclusion diet, 24% extensively hydrolysed formula, 26% amino acid formula, and 7% others.
Demographic characteristics and risk factors were similar to those previously described in international literature. Clinical presentation was early in life, and digestive symptoms predominated. OFC was underused for diagnosis, and most of the tests requested did not change management.
牛奶蛋白过敏（CMPA）在婴儿中非常普遍（2%-5%）。其临床症状范围广泛，通过口服食物激发试验（OFC）进行确诊对其鉴别诊断具有重要意义。在智利，关于这一主题的信息较为匮乏。
描述疑似CMPA婴儿的人口统计学和临床特征。
对2009年至2011年间因疑似CMPA接受治疗的1岁以下患者进行回顾性研究。记录人口统计学数据、特应性症状、诊断时的营养状况、CMPA症状、诊断研究以及治疗反应。牛奶调整至少4周后的饮食反应以及将疑似食物重新添加到饮食中的临床行为被视为标准诊断标准。使用Epiinfo™软件进行描述性统计。
该研究纳入了106名婴儿，其中51%为男性，80%为足月儿，74%有至少一位特应性父母，34%有至少一位父母/兄弟姐妹患有食物过敏。症状出现的中位年龄为1.5个月（范围1.5 - 2个月）。近一半（46%）母乳喂养≥6个月，15%自新生儿期起接受配方奶喂养，49%在第三个月前接受配方奶喂养。常见症状为：呕吐（63%）、绞痛（49%）和便血（41%）。未发现过敏反应，61%在初次就诊时有≥2种症状。仅34%接受了OFC。最常进行的检查是：斑贴试验（43%）、点刺试验（40%）和粪便潜血检查（37%）。
43%采用母乳喂养并进行排除饮食，24%采用深度水解配方奶，26%采用氨基酸配方奶，7%采用其他方式。
人口统计学特征和危险因素与国际文献中先前描述的相似。临床表现出现在生命早期，且以消化症状为主。OFC在诊断中未得到充分应用，大多数所做的检查并未改变治疗方案。
