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尽快进行 IgE 介导的牛奶过敏免疫治疗。

As soon as possible in IgE-cow's milk allergy immunotherapy.

机构信息

Pediatric Allergy Unit, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009, Zaragoza, Spain.

Pediatrics, Hospital Universitari Dexeus, Barcelona, Spain.

出版信息

Eur J Pediatr. 2021 Jan;180(1):291-294. doi: 10.1007/s00431-020-03731-3. Epub 2020 Jul 11.

DOI:10.1007/s00431-020-03731-3
PMID:32653937
Abstract

Oral immunotherapy is a common treatment in cow's milk protein allergy. The Department of Pediatric Allergology at the Children's Hospital of Zaragoza performed a retrospective analysis of 335 infants under 1 year of age diagnosed with IgE-mediated cow's milk and early treated. Clinical evaluation, skin prick test, and serum-specific IgE level control were performed before starting and after finishing treatment. Upon completion of treatment, more than 98% of patients became tolerant to milk and no one presented serious adverse reactions. Nowadays, the remaining non-tolerant patients (1.8%) can take milk or derivatives daily-as prophylaxis-to a certain maximum dose and still remain asymptomatic. After immunotherapy, both positive skin prick tests and a progressive decrease in specific IgE levels were found, as desensitization to milk increased.Conclusion: Oral immunotherapy is a safe and effective treatment against allergy to cow's milk proteins in infants. Such treatment should be offered to the children's families from the first moment of diagnosis. What is known: • Cow's milk proteins are responsible for the earliest IgE-mediated allergic reactions in children. • Oral immunotherapy (OIT) is commonly used as cow's milk allergy treatment and it is proposed at different ages. What is new: • OIT it is an effective and safe method with no severe reactions at early ages. • The number of reaching successful treatments is awesome so we believe that immunity response can be molded at the first months of life, so the probability of success with infants is greater than in older children.

摘要

口服免疫疗法是治疗牛奶蛋白过敏的常用方法。萨拉戈萨儿童医院的儿科过敏科对 335 名 1 岁以下确诊为 IgE 介导的牛奶过敏并接受早期治疗的婴儿进行了回顾性分析。在开始治疗前和治疗结束后进行临床评估、皮肤点刺试验和血清特异性 IgE 水平控制。治疗完成后,超过 98%的患者对牛奶耐受,没有人出现严重不良反应。如今,仍有 1.8%的非耐受患者(可每日摄入牛奶或奶制品作为预防措施,直至达到一定的最大剂量,并且仍然无症状)。免疫治疗后,发现皮肤点刺试验阳性和特异性 IgE 水平逐渐降低,因为对牛奶的脱敏作用增加。结论:口服免疫疗法是治疗婴儿牛奶蛋白过敏的一种安全有效的方法。应在诊断的第一时间向患儿家属提供这种治疗方法。已知: • 牛奶蛋白是儿童最早发生 IgE 介导的过敏反应的原因。 • 口服免疫疗法(OIT)常用于牛奶过敏的治疗,并在不同年龄段提出。新发现: • OIT 在早期是一种有效且安全的方法,没有严重的反应。 • 达到成功治疗的数量令人瞩目,因此我们相信免疫反应可以在生命的最初几个月形成,因此婴儿成功的可能性大于年龄较大的儿童。

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Ital J Pediatr. 2011 Nov 4;37:52. doi: 10.1186/1824-7288-37-52.
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Cow's milk allergy: diagnostic accuracy of skin prick and patch tests and specific IgE.牛奶过敏:皮肤点刺试验、斑贴试验及特异性IgE的诊断准确性
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[The role of specific IgE to evolution and prognosis of cow's milk protein allergies in children].[特异性IgE在儿童牛奶蛋白过敏的演变及预后中的作用]
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Practical interest of both skin prick test and specific IgE in the evaluation of tolerance acquisition in IgE mediated cow's milk allergy (CMA). A clinical retrospective study in a cohort of 184 children.皮肤点刺试验和特异性IgE在评估IgE介导的牛奶过敏(CMA)中耐受获得情况的实际意义。一项针对184名儿童队列的临床回顾性研究。
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Position document: IgE-mediated cow's milk allergy.立场文件:IgE介导的牛奶过敏
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本文引用的文献

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Early oral immunotherapy in infants with cow's milk protein allergy.牛奶蛋白过敏婴儿的早期口服免疫疗法。
Pediatr Allergy Immunol. 2019 Aug;30(5):572-574. doi: 10.1111/pai.13057. Epub 2019 May 3.
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EAACI Guidelines on allergen immunotherapy: IgE-mediated food allergy.EAACI 指南:变应原免疫治疗:IgE 介导的食物过敏。
Allergy. 2018 Apr;73(4):799-815. doi: 10.1111/all.13319. Epub 2017 Dec 5.
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Early oral immunotherapy in peanut-allergic preschool children is safe and highly effective.对花生过敏的学龄前儿童进行早期口服免疫疗法是安全且高效的。
低卵清白蛋白和卵类黏蛋白特异性 IgE 抗体个体的口服食物激发安全性。
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'Early Introduction' of Cow's Milk for Children with IgE-Mediated Cow's Milk Protein Allergy: A Review of Current and Emerging Approaches for CMPA Management.婴幼儿 IgE 介导的牛奶蛋白过敏的牛奶“早期引入”:CMPA 管理的当前和新兴方法综述。
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Oral immunotherapy for Immunoglobulin E-mediated cow's milk allergy in children: A systematic review and meta analysis.儿童 IgE 介导的牛奶过敏的口服免疫治疗:系统评价和荟萃分析。
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Coacervation as a Novel Method of Microencapsulation of Essential Oils-A Review.凝聚法作为一种新型的精油微胶囊化方法——综述。
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Current Guidelines and Future Strategies for the Management of Cow's Milk Allergy.牛奶过敏管理的现行指南及未来策略
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Oral Immunotherapy for Children with Cow's Milk Allergy.牛奶过敏儿童的口服免疫疗法
Pathogens. 2021 Oct 15;10(10):1328. doi: 10.3390/pathogens10101328.
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Early introduction oral immunotherapy for IgE-mediated cow's milk allergy: A follow-up study confirms this approach as safe and appealing to parents.早期引入口服免疫疗法治疗 IgE 介导的牛奶过敏:一项随访研究证实该方法既安全又能吸引家长。
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Preclinical development of plant-based oral immune modulatory therapy for haemophilia B.用于乙型血友病的基于植物的口服免疫调节治疗的临床前开发。
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Safety and efficacy profile and immunological changes associated with oral immunotherapy for IgE-mediated cow's milk allergy in children: systematic review and meta-analysis.儿童 IgE 介导的牛奶过敏口服免疫治疗的安全性和疗效概况及免疫变化:系统评价和荟萃分析。
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