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[IgE介导的牛奶蛋白过敏儿童的临床特征]

[Clinical characteristics of children with IgE-mediated cow's milk protein allergy].

作者信息

Zheng H S, Zhu W J, Liu C H, Li Y X, Song X, Han T T, Wang W, Guan K, Sha L

机构信息

Department of Allergy, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment on Allergic Diseases, Beijing 100730, China.

Department of Allergy, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing 100020, China.

出版信息

Zhonghua Yu Fang Yi Xue Za Zhi. 2023 Aug 6;57(8):1271-1279. doi: 10.3760/cma.j.cn112150-20230514-00370.

Abstract

To analyze the clinical characteristics of children with IgE-mediated cow's milk protein allergy (CMPA) and provide a basis for disease management and prevention. A cross-sectional study was conducted to analyze 142 children aged 0-12 years who were diagnosed with IgE-mediated CMPA in Capital Institute of Pediatrics Affiliated Children's Hospital from 2020 to 2022. There were 79 males (55.6%) and 63 females (44.4%), with an average age of 14 (8, 27) months. 61 cases (43.0%) were in the <1-year-old group, 54 cases (38.0%) in the 1-3-year-old group, and 27 cases (19.0%) in the >3-year-old group. Data on demographic data, clinical manifestations, mean wheel diameter of skin prick test and serum specific IgE level were collected. The serum cow's milk protein sIgE and component sIgE were measured by ImmunoCAP fully automated system of fluorescence enzyme-linked immunosorbent assay, and statistically analyzed using chi-square test, nonparametric tests, correlation. Cutaneous symptoms were the first and most frequent in 142 children (97.9%, 139/142 cases), followed by digestive (29.6%, 42/142 cases) and respiratory symptoms (27.5%, 39/142 cases).The proportion of children with respiratory symptoms after consuming cow's milk was significantly higher in the>3 years age group than those in the infant and toddler groups(66.7% 19.7%,18.396,<0.01;66.7% 16.7%,=20.250,<0.01), and the symptoms involving ≥3 systems were also significantly higher than those in the other two groups(37.0% 13.1%,=6.597,<0.05;37.0% 7.4%,=12.120,<0.01). The average cow's milk SPT diameter and serum sIgE levels in the>3 years age group were significantly higher than those in the infant and toddler groups (=-4.682, <0.01; =-3.498, <0.01); (=-4.463, <0.01; =-6.463, <0.01). The most common cow's milk component protein were β-lactoglobulin(65.1%,56/86 cases) and casein (57.0%, 49/86 cases). Multiple-sensitization rate of the patients were 54.9%. Egg white (43.7%, 62/142 cases) was the most common co-sensitization food allergen while mold (12.7%, 18/142 cases) and weed pollen (12.7%, 18/142 cases) were the main co-sensitization aeroallergens. The proportion of multiple-sensitization to aeroallergens in the children group was the highest (51.9%, 14/27 cases), followed by the toddler group (29.6%, 16/54 cases), and the infant group was the least (3.3%, 2/61 cases). There was a significant difference among these three groups (=7.476, <0.05). Skin and mucosal symptoms are the most common in CMPA patients. The proportion of respiratory symptoms and multisystem involvement increased with age as well as the wheal diameter in skin test and serum sIgE level elevated. CMPA patients older than 3 years had the highest proportion of aeroallergen sensitization and airway allergic diseases.

摘要

分析IgE介导的牛奶蛋白过敏(CMPA)儿童的临床特征,为疾病管理和预防提供依据。进行一项横断面研究,分析2020年至2022年在首都儿科研究所附属儿童医院诊断为IgE介导的CMPA的142例0至12岁儿童。其中男性79例(55.6%),女性63例(44.4%),平均年龄14(8,27)个月。<1岁组61例(43.0%),1至3岁组54例(38.0%),>3岁组27例(19.0%)。收集人口统计学数据、临床表现、皮肤点刺试验平均风团直径和血清特异性IgE水平等数据。采用荧光酶联免疫吸附测定的ImmunoCAP全自动系统检测血清牛奶蛋白sIgE和组分sIgE,并进行卡方检验、非参数检验、相关性统计分析。皮肤症状是142例儿童中最先出现且最常见的症状(97.9%,139/142例),其次是消化系统症状(29.6%,42/142例)和呼吸系统症状(27.5%,39/142例)。>3岁年龄组儿童食用牛奶后出现呼吸系统症状的比例显著高于婴幼儿组(66.7%对19.7%,18.396,<0.01;66.7%对16.7%,=20.250,<0.01),涉及≥3个系统的症状也显著高于其他两组(37.0%对13.1%,=6.597,<0.05;37.0%对7.4%,=12.120,<0.01)。>3岁年龄组的牛奶SPT平均直径和血清sIgE水平显著高于婴幼儿组(=-4.682,<0.01;=-3.498,<0.01);(=-4.463,<0.01;=-6.463,<0.01)。最常见的牛奶组分蛋白是β-乳球蛋白(65.1%,56/86例)和酪蛋白(57.0%,49/86例)。患者的多重致敏率为54.9%。蛋清(43.7%,62/142例)是最常见的共同致敏食物过敏原,而霉菌(12.7%,18/142例)和杂草花粉(12.7%,18/142例)是主要的共同致敏气传过敏原。儿童组对气传过敏原的多重致敏比例最高(51.9%,14/27例),其次是幼儿组(29.6%,16/54例),婴儿组最低(3.3%,2/61例)。这三组之间存在显著差异(=7.476,<0.05)。皮肤和黏膜症状在CMPA患者中最常见。呼吸系统症状和多系统受累的比例随年龄增加,皮肤试验风团直径和血清sIgE水平也升高。3岁以上的CMPA患者气传过敏原致敏和气道过敏性疾病的比例最高。

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