过度限制食物过敏儿童的食物摄入。

Over restrictive elimination of foods in children with food allergy.

机构信息

Koç University Faculty of Medicine, İstanbul, Turkey.

Department of Pediatrics, VM Medical Park Hospital, Kocaeli, Turkey.

出版信息

Turk J Pediatr. 2021;63(1):109-117. doi: 10.24953/turkjped.2021.01.013.

DOI:10.24953/turkjped.2021.01.013

PMID:33686833

Abstract

BACKGROUND

Previous studies demonstrated critical deficits in diagnosis and management of childhood food allergy (FA), and recent developments in FA research support adopting a proactive approach in FA management. Our objective was to describe FA knowledge and management patterns of pediatricians.

METHOD

We applied a 24-item survey to 170 general pediatricians, pediatric allergists and pediatric gastroenterologists practicing in Turkey.

RESULTS

Some IgE-mediated symptoms of FA such as cough, urticaria, wheezing and anaphylaxis were falsely recognized as symptoms of non-IgE-mediated FA by 30%, 29%, 25% and 19% of the participants, respectively. By contrast, 50% of the participants falsely recognized bloody stool, a finding of IgE-mediated FA. Most frequently and least frequently used diagnostic tools were specific IgE (30.5%) and oral food challenge test (1.7%), respectively. Maternal diet restrictions and infant diet restrictions were advised by 82% and 82%, respectively. Percentages of physicians eliminating only 1 food were 21%, 19%; 2 foods were 15%, 11%; 3 foods were 7%, 8%; 4-5 foods were 8%, 11%; 5 to 10 foods were 21%, 26%; and > 10 foods were 28%, 25% from the maternal and infant diet, respectively. Cows milk, cheese, butter, yoghurt, baked milk products and hens egg were the most commonly restricted items.

CONCLUSION

Overall, FA knowledge of pediatricians was fair. Pediatricians utilize an overly restrictive approach when advising diet eliminations in FA. Recent developments favor a more proactive approach to induce immune tolerance and need to be encouraged in pediatric clinical practice. Future educational efforts should focus on emphasizing the deleterious effects of injudicious and extensive eliminations.

摘要

背景

之前的研究表明，儿童食物过敏（FA）的诊断和管理存在严重缺陷，最近 FA 研究的进展支持在 FA 管理中采取积极主动的方法。我们的目的是描述儿科医生对 FA 的知识和管理模式。

方法

我们向 170 名在土耳其执业的普通儿科医生、儿科过敏专家和儿科胃肠病专家应用了一份包含 24 个问题的调查问卷。

结果

一些 IgE 介导的 FA 症状，如咳嗽、荨麻疹、喘息和过敏反应，分别被 30%、29%、25%和 19%的参与者错误地识别为非 IgE 介导的 FA 的症状。相比之下，50%的参与者错误地识别了 IgE 介导的 FA 的便血。最常使用和最不常使用的诊断工具分别是特异性 IgE（30.5%）和口服食物激发试验（1.7%）。分别有 82%和 82%的医生建议限制母亲和婴儿的饮食。建议消除 1 种食物的医生占 21%、19%；2 种食物的占 15%、11%；3 种食物的占 7%、8%；4-5 种食物的占 8%、11%；5-10 种食物的占 21%、26%；10 种以上食物的占 28%、25%，分别来自母亲和婴儿的饮食。牛奶、奶酪、黄油、酸奶、烘焙奶制品和鸡蛋是最常被限制的食物。