Lai Fu-Ping, Yang Yao-Jong
Departments of Pediatrics, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Taiwan.
Pediatr Neonatol. 2018 Feb;59(1):48-52. doi: 10.1016/j.pedneo.2017.01.004. Epub 2017 Jun 30.
The clinical presentation of cow's milk protein allergy (CMPA) in children varies. This retrospective study aimed to investigate the prevalence and clinical manifestations of CMPA in young children who visited for evaluation of iron deficiency anemia (IDA).
Patients aged <4 years who were diagnosed as having IDA (serum ferritin <12 ng/mL) at the National Cheng Kung University Hospital, Taiwan in the period 2005-2015 were reviewed. Their clinical presentations, laboratory data, endoscopy findings, and prognosis were analyzed.
Seven of 51 IDA patients (13.7%) had CMPA. The pallor (100%), failure to thrive (43%), and general edema (43%) were the common features. Six (86%) had hypoalbuminemia and four (57%) had positive occult blood in the stool. Of the five patients who underwent skin prick test, four (80%) had positive results. Most of the colonoscopies revealed erosive and hemorrhagic colitis and lymphoid hyperplasia, but none of the biopsies demonstrated eosinophilia in the lamina propria. All of the patients recovered from their IDA within seven months of cow's milk protein elimination and iron supplementation.
CMPA should be considered in young children with undetermined IDA. Cow's milk protein elimination and iron supplementation help in the recovery.
儿童牛奶蛋白过敏（CMPA）的临床表现各异。本回顾性研究旨在调查因缺铁性贫血（IDA）前来评估的幼儿中CMPA的患病率及临床表现。
回顾2005年至2015年期间在台湾国立成功大学医院被诊断为IDA（血清铁蛋白<12 ng/mL）的4岁以下患者。分析他们的临床表现、实验室数据、内镜检查结果及预后情况。
51例IDA患者中有7例（13.7%）患有CMPA。面色苍白（100%）、生长发育迟缓（43%）和全身性水肿（43%）是常见特征。6例（86%）有低白蛋白血症，4例（57%）粪便潜血阳性。5例接受皮肤点刺试验的患者中，4例（80%）结果为阳性。大多数结肠镜检查显示有糜烂性和出血性结肠炎及淋巴组织增生，但所有活检均未显示固有层嗜酸性粒细胞增多。所有患者在消除牛奶蛋白并补充铁剂后7个月内从IDA中康复。
对于IDA病因不明的幼儿应考虑CMPA。消除牛奶蛋白并补充铁剂有助于康复。
