Vandenplas Yvan, Brough Helen A, Fiocchi Alessandro, Miqdady Mohamad, Munasir Zakiudin, Salvatore Silvia, Thapar Nikhil, Venter Carina, Vieira Mario C, Meyer Rosan
Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium.
Department Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
J Asthma Allergy. 2021 Oct 21;14:1243-1256. doi: 10.2147/JAA.S276992. eCollection 2021.
Exclusive breast feeding is recommended in all guidelines as the first choice feeding. Cow milk allergy (CMA) can be diagnosed by a diagnostic elimination diet for 2 to 4 weeks with a hypo-allergenic formula, followed by a challenge test with intact cow milk protein. The most often used hypo-allergenic formula for the diagnostic elimination diet and the therapeutic diet is a CM based extensive hydrolysate. CM-based partial hydrolysates cannot be recommended in the management of CMA because of insufficient efficacy and possible reactions, but about half of the infants with CMA may tolerate a partial hydrolysate. The pros and cons of other dietary options are discussed in this paper. The use of an amino acid-based formula and/or rice based hydrolysate formula during the diagnostic elimination and therapeutic diet is debated. When available, there is sufficient evidence to consider rice hydrolysates as an adequate alternative to CM-based hydrolysates, since some infants will still react to the CM hydrolysate. The pros and cons of dietary options such as soy formula, buckwheat, almond, pea or other plant based dietary products are discussed. Although the majority of the plant-based beverages are nutritionally inadequate, some are nutritionally adapted for toddlers. However, accessibility and content vary by country and, thus far there is insufficient evidence on the efficacy and tolerance of these plant-based drinks (except for soy formula and rice hydrolysates) to provide an opinion on them.
A diagnostic elimination diet, followed by a challenge remains the diagnostic standard. The use of an awareness tool may result in a decrease of delayed diagnosis. Breastmilk remains the ideal source of nutrition and when not available a CM extensively hydrolyzed formula, rice hydrolysate or amino acid formula should be recommended. More evidence is needed regarding plant-based drinks.
所有指南均推荐纯母乳喂养作为首选喂养方式。牛奶蛋白过敏（CMA）可通过使用低敏配方奶粉进行2至4周的诊断性排除饮食来诊断，随后进行完整牛奶蛋白激发试验。诊断性排除饮食和治疗性饮食最常使用的低敏配方奶粉是基于牛奶的深度水解配方奶粉。基于牛奶的部分水解配方奶粉因疗效不足和可能出现的反应，不推荐用于CMA的管理，但约一半的CMA婴儿可能耐受部分水解配方奶粉。本文讨论了其他饮食选择的利弊。在诊断性排除饮食和治疗性饮食期间使用氨基酸配方奶粉和/或大米水解配方奶粉存在争议。如果有大米水解配方奶粉，有充分证据可将其视为基于牛奶的水解配方奶粉的合适替代品，因为一些婴儿仍会对基于牛奶的水解配方奶粉产生反应。本文还讨论了大豆配方奶粉、荞麦、杏仁、豌豆或其他植物性饮食产品等饮食选择的利弊。尽管大多数植物性饮料营养不充足，但有些经过营养调整适合幼儿。然而，不同国家的可及性和成分各不相同，迄今为止，关于这些植物性饮料（大豆配方奶粉和大米水解配方奶粉除外）的疗效和耐受性，尚无足够证据提供相关意见。
诊断性排除饮食，随后进行激发试验仍然是诊断标准。使用认知工具可能会减少延迟诊断。母乳仍然是理想的营养来源，若无法提供母乳，则应推荐基于牛奶的深度水解配方奶粉、大米水解配方奶粉或氨基酸配方奶粉。关于植物性饮料，还需要更多证据。
