Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass.
Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Mass.
J Allergy Clin Immunol Pract. 2022 Oct;10(10):2713-2721.e2. doi: 10.1016/j.jaip.2022.06.022. Epub 2022 Jun 30.
Current guidelines emphasize early introduction to potentially allergenic foods, but the optimal timing, amount, and exposure routes for foods other than peanut are not well-established. Cow's milk is often the first allergenic food introduced through infant formulas.
To examine timing of cow's milk protein introduction (CMPI), including interaction with formula supplementation after delivery, in relation to reported cow's milk adverse reactions throughout childhood.
Among children in the Boston, Mass-area Project Viva cohort, we assessed timing of CMPI (<2 weeks, 2 weeks-<6 months, ≥6 months) with questionnaires administered in infancy. Outcomes were (1) parent-reported cow's milk adverse reactions via annual questionnaires from age 2 to 13 years (n = 1298) and (2) milk sensitization (n = 505) and IgE-mediated milk allergy (n = 491) at age approximately 8 years. We used multivariable logistic regression models adjusted for parental atopy history, delivery mode, gestational age at delivery, child race, and census tract median household income, and investigated effect modification by ever/never breast-fed status and formula supplementation in the delivery hospital.
A total of 32% were introduced to cow's milk protein at age less than 2 weeks, 38% at age 2 weeks to less than 6 months, and 30% at age 6 months or more. Compared with children with CMPI at age less than 2 weeks, children with CMPI at age 6 months or more had a higher risk of cow's milk adverse reaction at age 2 to 5 years (odds ratio, 2.4 [1.2-4.7]). Children given formula after delivery + CMPI at age less than 2 weeks had the lowest risk overall. Among children not given formula after delivery, CMPI at age 2 weeks to 6 months appeared most protective. Results were similar among ever-breast-fed children. Timing of CMPI was not associated with milk sensitization or IgE-mediated milk allergy in mid-childhood.
Early, consistent cow's milk exposure appears protective against adverse reactions to cow's milk.
目前的指南强调早期引入潜在致敏食物，但除花生以外的食物的最佳引入时间、数量和途径尚未得到充分确立。牛奶通常是通过婴儿配方奶粉引入的第一种致敏食物。
研究牛奶蛋白引入（CMPI）的时间，包括与分娩后配方奶补充的相互作用，与整个儿童期报告的牛奶不良反应有关。
在马萨诸塞州波士顿地区项目 Viva 队列的儿童中，我们通过婴儿期的问卷调查评估 CMPI 的时间（<2 周、2 周-<6 个月、≥6 个月）。结果是（1）在 2 至 13 岁时通过年度问卷报告的父母报告的牛奶不良反应（n=1298）和（2）8 岁左右的牛奶致敏（n=505）和 IgE 介导的牛奶过敏（n=491）。我们使用多变量逻辑回归模型进行调整，包括父母特应性病史、分娩方式、分娩时的胎龄、儿童种族和人口普查区家庭中位数收入，并调查了哺乳状况和分娩医院中配方奶补充的效应修饰作用。
共有 32%的儿童在 2 周龄之前引入牛奶蛋白，38%的儿童在 2 周龄至 6 个月龄时引入，30%的儿童在 6 个月龄或更大时引入。与 2 周龄之前 CMPI 的儿童相比，6 个月龄或更大 CMPI 的儿童在 2 至 5 岁时牛奶不良反应的风险更高（比值比，2.4[1.2-4.7]）。分娩后给予配方奶+2 周龄前 CMPI 的儿童总体风险最低。在未给予分娩后配方奶的儿童中，2 周龄至 6 个月龄 CMPI 似乎最具保护作用。在所有母乳喂养的儿童中，结果相似。CMPI 的时间与儿童中期的牛奶致敏或 IgE 介导的牛奶过敏无关。
早期、持续的牛奶暴露似乎可以预防牛奶不良反应。
