Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil; Centro de Investigação em Pediatria da Faculdade de Ciências Médicas de Campinas (CIPED), Campinas, SP, Brazil; Programa de Pós-graduação em Saúde da Criança e do Adolescente (PPG-SCA), São Paulo, SP, Brazil; Laboratório de Investigação Diagnóstica de Gastroenterologia e Hepatologia Pediátrica, Campinas, SP, Brazil.
Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil.
J Pediatr (Rio J). 2024 Jan-Feb;100(1):40-45. doi: 10.1016/j.jped.2023.08.003. Epub 2023 Sep 9.
To evaluate outcomes of oral food challenge (OFC) test to assess tolerance in infants with non-IgE-mediated cow's milk allergy (CMA) with gastrointestinal manifestations and explore clinical data predictive of these outcomes.
Single-center retrospective study including infants (age < 12 months) who were referred for CMA between 2000 and 2018 and underwent OFC on follow-up. A univariate logistic regression test was performed to evaluate variables associated with the outcomes of the follow-up OFC test.
Eighty-two patients were included, 50% were male. Eighteen patients had a positive OFC test (22%). Most patients had presented with hematochezia (77%). The median age of symptom onset was 30 days. Two-thirds of the patients were on appropriate infant formula (extensively hydrolyzed or amino acid-based formula), exclusively or in association with breastfeeding. The median time on an elimination diet before the OFC test was 8 months (Q1 6 - Q3 11 months). All cases with positive follow-up OFC tests (n = 18) had been exposed to cow's milk-based formula before the first clinical manifestation of CMA. Five out of eight cases with Food Protein-Induced Enterocolitis Syndrome (FPIES) had positive OFC tests. Exposure to cow's milk-based formula before diagnosis, a history of other food allergies, hematochezia and diarrhea were predictors of a positive OFC test.
In infants with non-IgE-mediated CMPA with gastrointestinal manifestations, the use of cow's milk-based formula, a history of other food allergies, and hematochezia and diarrhea upon initial presentation were associated factors for the later achievement of tolerance.
评估口服食物激发试验（OFC）评估具有胃肠道表现的非 IgE 介导的牛奶过敏（CMA）婴儿耐受情况的结果，并探讨预测这些结果的临床数据。
这是一项单中心回顾性研究，纳入 2000 年至 2018 年期间因 CMA 就诊并在随访中接受 OFC 的婴儿（年龄<12 个月）。采用单变量逻辑回归检验评估与随访 OFC 试验结果相关的变量。
82 例患者纳入研究，其中 50%为男性。18 例患者 OFC 试验阳性（22%）。大多数患者有血便（77%）。症状发作的中位年龄为 30 天。三分之二的患者接受了适当的婴儿配方（深度水解或氨基酸配方），单独或与母乳喂养联合使用。在 OFC 试验前进行消除饮食的中位时间为 8 个月（Q1 6 - Q3 11 个月）。所有（n=18）随访 OFC 试验阳性的患者在首次出现 CMA 临床表现之前均接触过牛奶配方。8 例食物蛋白诱导的小肠结肠炎综合征（FPIES）中有 5 例 OFC 试验阳性。在做出诊断前接触过牛奶配方、有其他食物过敏史、血便和腹泻是 OFC 试验阳性的预测因素。
在具有胃肠道表现的非 IgE 介导的 CMPA 婴儿中，使用牛奶配方、有其他食物过敏史以及首发时出现血便和腹泻是获得耐受的相关因素。
