牛奶进阶引入法:何人?何时?如何?何地?以将过敏反应风险降至最低。

Milk ladder: Who? When? How? Where? with the lowest risk of reaction.

作者信息

Buyuktiryaki Betul, Soyer Ozge, Bingol Gulbin, Can Ceren, Nacaroglu Hikmet Tekin, Bingol Aysen, Arik Yilmaz Ebru, Aydogan Metin, Sackesen Cansin

机构信息

Division of Pediatric Allergy, Koc University School of Medicine, Istanbul, Türkiye.

Division of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Türkiye.

出版信息

Front Allergy. 2024 Dec 6;5:1516774. doi: 10.3389/falgy.2024.1516774. eCollection 2024.

Abstract

The milk ladder (ML) approach, which is the gradual reintroduction of the milk allergen from the least allergenic forms to the most allergenic forms into the diet of the patients, has been utilized mostly in non-IgE-mediated but in some countries also in IgE-mediated-CMPA due to its possible benefits which include nutrition, quality of life and tolerance induction. Despite increasing interest, so far, there is no guideline on ML; thus, the use of this approach shows discrepancies among healthcare professionals as many factors such as dietary habits, patient history, test results, workload, and facilities of the hospitals, the anxiety of the parents/patients may affect the decision on how, when, where and whom to use ML. Here, we reviewed current data on implementing the ML, suggested a 4-step ML including receipts and amounts, and shared our experience on optimal patient selection, appropriate time and steps for initiating ML, and time intervals between the steps targeting the lowest risk of reaction. We also added the newly developed twice-baked biscotti cake to the ML. We presented the analyses of this product, showing its low allergenicity compared to conventional cake, which provides a safer introduction of milk into the diet.

摘要

牛奶阶梯(ML)方法是指在患者饮食中从致敏性最低的形式到致敏性最高的形式逐步重新引入牛奶过敏原,该方法主要用于非IgE介导的牛奶蛋白过敏,在一些国家也用于IgE介导的牛奶蛋白过敏,因为其可能带来营养、生活质量和诱导耐受性等益处。尽管人们对此兴趣日增,但目前尚无关于牛奶阶梯的指南;因此,由于饮食习惯、患者病史、检测结果、工作量、医院设施以及家长/患者的焦虑等诸多因素可能会影响如何、何时、何地以及对谁使用牛奶阶梯的决策,医疗专业人员在使用该方法时存在差异。在此,我们回顾了当前实施牛奶阶梯的相关数据,提出了一个包括食谱和用量的4步牛奶阶梯方案,并分享了我们在最佳患者选择、启动牛奶阶梯的合适时间和步骤以及各步骤之间以降低反应风险为目标的时间间隔方面的经验。我们还将新开发的二次烘焙意式脆饼蛋糕添加到了牛奶阶梯方案中。我们展示了对该产品的分析,表明其与传统蛋糕相比致敏性较低,这为在饮食中更安全地引入牛奶提供了条件。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8cfd/11659236/951be761f019/falgy-05-1516774-g001.jpg

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