Martin Victoria M, Virkud Yamini V, Seay Hannah, Hickey Alanna, Ndahayo Renata, Rosow Rachael, Southwick Caroline, Elkort Michael, Gupta Brinda, Kramer Eileen, Pronchick Tetiana, Reuter Susan, Keet Corinne, Su Kuan-Wen, Shreffler Wayne G, Yuan Qian
Food Allergy Center, Massachusetts General Hospital, Boston, Mass; Division of Pediatric Gastroenterology, Hepatology and Nutrition, Massachusetts General Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass; Food Allergy Science Initiative of the Broad Institute, Cambridge, Mass.
Food Allergy Center, Massachusetts General Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass; Food Allergy Science Initiative of the Broad Institute, Cambridge, Mass; Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Mass.
J Allergy Clin Immunol Pract. 2020 May;8(5):1692-1699.e1. doi: 10.1016/j.jaip.2019.12.029. Epub 2020 Jan 7.
Food protein-induced allergic proctocolitis (FPIAP) is an early and common manifestation of food allergy, yet its epidemiology and relationship to other allergic diseases remain unclear.
To prospectively define the incidence of FPIAP as it is being diagnosed clinically in the community and to identify factors associated with its development.
A total of 1003 of 1162 eligible serial healthy newborn infants recruited from a single suburban pediatrics practice were followed prospectively for the diagnosis of FPIAP. Investigators reviewed each case to confirm prespecified inclusion criteria, including documented gross or occult blood in the stool.
A total of 903 infants were analyzed (46% females, 89% term, 32% caesarian-section, 9% neonatal antibiotics); 153 cases met inclusion criteria, a cumulative incidence of 17%, while 63 (7%) had gross blood. Infants initially fed both breast milk and formula were 61% less likely to develop FPIAP compared with those exclusively formula-fed (hazard ratio, 0.39; P = .005). Breast milk and formula at any point during the first 4 months were also associated with lower risk compared with exclusive formula or exclusive breast milk (hazard ratio, 0.44; P = .005; hazard ratio, 0.62; P = .0497). Eczema (odds ratio, 1.5; 95% confidence interval, 1.1- 2.2; P = .02) or a first-degree relative with food allergies (odds ratio, 1.9; 95% confidence interval, 1.2-2.8; P = .005) were among risk factors for FPIAP development.
The prospectively defined incidence of FPIAP when diagnosed clinically by community pediatricians without challenge is markedly higher than published estimates. Combination feeding of formula and breast milk is associated with the lowest rate of FPIAP in this population.
食物蛋白诱导的过敏性直肠结肠炎（FPIAP）是食物过敏的一种早期常见表现，但其流行病学以及与其他过敏性疾病的关系仍不明确。
前瞻性地确定社区临床诊断的FPIAP发病率，并识别与其发生相关的因素。
从一家郊区儿科诊所招募的1162名符合条件的连续健康新生儿中，共有1003名接受了FPIAP诊断的前瞻性随访。研究人员审查了每个病例，以确认预先设定的纳入标准，包括粪便中有肉眼可见或潜血的记录。
共分析了903名婴儿（46%为女性，89%为足月儿，32%为剖宫产，9%使用过新生儿抗生素）；153例符合纳入标准，累积发病率为17%，其中63例（7%）有肉眼可见的便血。与纯配方奶喂养的婴儿相比，最初同时接受母乳喂养和配方奶喂养的婴儿发生FPIAP的可能性低61%（风险比，0.39；P = 0.005）。在出生后的前4个月内，任何时候同时接受母乳和配方奶喂养的婴儿与纯配方奶或纯母乳喂养相比，风险也较低（风险比，0.44；P = 0.005；风险比，0.62；P = 0.0497）。湿疹（比值比，1.5；95%置信区间，1.1 - 2.2；P = 0.02）或有食物过敏的一级亲属（比值比，1.9；95%置信区间，1.2 - 2.8；P = 0.005）是FPIAP发生的危险因素。
社区儿科医生在无激发试验的情况下临床诊断的FPIAP前瞻性定义发病率明显高于已发表的估计值。在该人群中，配方奶和母乳混合喂养与FPIAP的最低发生率相关。
