Inuo Chisato, Tanaka Kenichi, Nakajima Yoichi, Yamawaki Kazuo, Matsubara Takeshi, Iwamoto Hiroshi, Tsuge Ikuya, Urisu Atsuo, Kondo Yasuto
Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan.
Department of Pediatrics, Second Teaching Hospital, Fujita Health University, Nagoya, Japan.
Asia Pac J Clin Nutr. 2019;28(1):49-56. doi: 10.6133/apjcn.201903_28(1).0008.
The safety and tolerability of hydrolysed cow's milk protein-based formulas, particularly partially hydrolysed formulas (pHFs), in children with cow's milk allergy (CMA) remain poorly understood. We evaluated the tolerability of hydrolysed cow's milk-based formulas in children with CMA.
A three-period double-blind crossover evaluation compared the allergic tolerance against three dietary cow's milk-based formulas: extensively hydrolysed cow's milk formula (eHF), pHF, and regular cow's milk formula (rCMF). The primary outcome was the rate of tolerance against a maximum of 20.0 mL of formula.
Controlled food challenges were performed in 25 children (18 boys; 7 girls) with a median age of 4.25 years (range: 1-9 years) diagnosed with CMA. The median cow's milk-specific immunoglobulin E level was 31.9 UA/mL (range: 1.16-735 UA/mL). The tolerance rate ratios for rCMF were lower than those for pHF (2 vs 16; p<0.01) and eHF (2 vs 22; p<0.01). The allergic symptom scores induced by intake of pHF and eHF were significantly lower than those of rCMF (p=0.01 and p<0.01, respectively), and the pHF and eHF scores were not significantly different.
Compared to rCMF, the partially and extensively hydrolysed whey and casein formulas evaluated in this study were better tolerated and therefore safer for children with CMA. Although further confirmation from additional centres is needed, our findings suggest the use of pHF in patients with mild CMA. Some children with CMA react to hydrolysed formulas; therefore, food challenge tests in these children should be undertaken with caution.
对于牛奶蛋白过敏（CMA）儿童，基于水解牛奶蛋白的配方奶粉，尤其是部分水解配方奶粉（pHF）的安全性和耐受性仍知之甚少。我们评估了基于水解牛奶的配方奶粉在CMA儿童中的耐受性。
一项三阶段双盲交叉评估比较了对三种基于牛奶的膳食配方奶粉的过敏耐受性：深度水解牛奶配方奶粉（eHF）、pHF和常规牛奶配方奶粉（rCMF）。主要结果是对最多20.0 mL配方奶粉的耐受率。
对25名诊断为CMA的儿童（18名男孩；7名女孩）进行了对照食物激发试验，中位年龄为4.25岁（范围：1 - 9岁）。牛奶特异性免疫球蛋白E水平的中位数为31.9 UA/mL（范围：1.16 - 735 UA/mL）。rCMF的耐受率低于pHF（2比16；p<0.01）和eHF（2比22；p<0.01）。摄入pHF和eHF引起的过敏症状评分显著低于rCMF（分别为p = 0.01和p<0.01），且pHF和eHF评分无显著差异。
与rCMF相比，本研究中评估的部分水解和深度水解的乳清蛋白和酪蛋白配方奶粉耐受性更好因此对CMA儿童更安全。尽管需要其他中心的进一步证实，但我们的研究结果表明轻度CMA患者可使用pHF。一些CMA儿童会对水解配方奶粉产生反应；因此，对这些儿童进行食物激发试验时应谨慎。
