Pediatric Gastroenterology Unit, Department of Pediatrics, Clínica Alemana de Santiago, Facultad de Medicina-Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
Pediatric and Pediatric Surgery Department (Northern Campus), Faculty of Medicine, University of Chile, Santiago, Chile.
J Pediatr Gastroenterol Nutr. 2020 Sep;71(3):e80-e83. doi: 10.1097/MPG.0000000000002787.
The aim of the study was to compare the cow's milk protein allergy (CMPA) prevalence in 2 cohorts of children from different socioeconomic strata.
Prospective birth cohort that included patients from 2 hospitals providing care for a low- and high-income population, respectively. Healthy newborns ≥34 gestational weeks were recruited and followed up to 12 months by a monthly telephone survey. If ≥2 predefined symptoms/signs suggestive of CMPA were detected, the patient was evaluated by a pediatric gastroenterologist. Diagnosis was confirmed by exclusion diet followed by open oral food challenge.
Overall the prevalence of CMPA was 5.2%, with a 6 times higher prevalence in the high income cohort (9.2%) compared with the low-income group (1.5%; relative risk 6.2; 95% confidence interval 1.8-20.7; P = 0.0005). All the cases were non-immunoglobulin E-mediated with predominantly gastrointestinal symptoms. High-income cohort did have higher frequency of C-section, mother's previous chronic disease, mother's history of atopy/food allergy, older age, and higher educational level of parents. Parent smoking and presence of pets at home were more frequent in the low-income cohort. Multiple logistic regression showed that the high-income cohort did have older age and higher educational level of both parents.
In these cohorts the prevalence of CMPA was higher than reported previously in other developing countries and significantly higher in the high-income group. Our findings were associated with sociodemographic characteristics of the parents.
本研究旨在比较来自不同社会经济阶层的两组儿童的牛奶蛋白过敏（CMPA）患病率。
前瞻性出生队列，包括来自 2 家医院的患者，这 2 家医院分别为提供低收入和高收入人群医疗服务。招募胎龄≥34 周的健康新生儿，并通过每月电话调查随访至 12 个月。如果发现≥2 项提示 CMPA 的既定症状/体征，则由儿科胃肠病学家对患者进行评估。通过排除饮食后进行开放口服食物挑战来确诊。
总体而言，CMPA 的患病率为 5.2%，高收入组（9.2%）的患病率是低收入组（1.5%）的 6 倍（相对风险 6.2；95%置信区间 1.8-20.7；P=0.0005）。所有病例均为非免疫球蛋白 E 介导，以胃肠道症状为主。高收入组剖宫产率较高、母亲既往患有慢性疾病、母亲有特应性/食物过敏史、年龄较大、父母受教育程度较高。低收入组的父母吸烟和家中养宠物的情况更为常见。多因素逻辑回归显示，高收入组的父母年龄较大，受教育程度也较高。
在这些队列中，CMPA 的患病率高于其他发展中国家先前报告的患病率，且在高收入组中显著更高。我们的研究结果与父母的社会人口学特征有关。
