Chong Kok Wee, Goh Si Hui, Saffari Seyed Ehsan, Loh Wenyin, Sia Isabel, Seah Sherilyn, Goh Anne
Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore.
Centre for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore.
Asian Pac J Allergy Immunol. 2022 Mar;40(1):65-71. doi: 10.12932/AP-180219-0496.
Cow's milk protein allergy (CMA) is the second most common food allergy in Singapore. However, there is limited data on local paediatric CMA.
We aimed to describe the demographics, clinical characteristics, natural history and diagnostic performance of skin prick test (SPT) and cow's milk-specific immunoglobulin E (CM-IgE) in Singaporean children diagnosed with IgE-mediated CMA.
A retrospective review of medical records was conducted for children with an SPT performed to cow's milk between 2011 and 2016.
There were 355 patients included, 313 cow's milk allergic and 42 cow's milk tolerant. The median age of reaction was 6 months (IQR 4-8). The most common allergic presentation was cutaneous reactions, followed by gastrointestinal reactions. Six patients (1.9%) reported anaphylaxis at initial presentation and 16 children (5.1%) experienced anaphylaxis to cow's milk at least once in their lifetime. Most of the CMA patients (81.8%) acquired natural tolerance by 6 years old. SPT to cow's milk of ≥ 7 mm and CM-IgE of ≥ 13 kU/L showed good discriminative abilities in predicting a failed oral food challenge (OFC) outcome.
CMA is a food allergy which commonly presents during infancy, and parents need to be aware of the likelihood of severe allergic reactions, including anaphylaxis. Prognosis for CMA is generally favourable. Future prospective cohort studies are required to better understand the natural history and better define the diagnostic cut-off values for allergy testing in our population.
牛奶蛋白过敏（CMA）是新加坡第二常见的食物过敏。然而，关于本地儿童CMA的数据有限。
我们旨在描述新加坡诊断为IgE介导的CMA儿童的人口统计学、临床特征、自然病史以及皮肤点刺试验（SPT）和牛奶特异性免疫球蛋白E（CM-IgE）的诊断性能。
对2011年至2016年间进行牛奶SPT的儿童病历进行回顾性研究。
共纳入355例患者，其中313例牛奶过敏，42例牛奶耐受。反应的中位年龄为6个月（四分位间距4 - 8个月）。最常见的过敏表现是皮肤反应，其次是胃肠道反应。6例患者（1.9%）初诊时报告有过敏反应，16名儿童（5.1%）一生中至少有一次牛奶过敏反应。大多数CMA患者（81.8%）在6岁时获得自然耐受。牛奶SPT≥7 mm和CM-IgE≥13 kU/L在预测口服食物激发试验（OFC）失败结果方面具有良好的鉴别能力。
CMA是一种常见于婴儿期的食物过敏，家长需要意识到严重过敏反应的可能性，包括过敏反应。CMA的预后总体良好。未来需要进行前瞻性队列研究，以更好地了解自然病史，并更好地确定我们人群中过敏检测的诊断临界值。
