牛奶蛋白过敏儿童配方奶选择的长期影响：特应性进程队列研究的6年随访
Long term impact of formula choice in children with cow milk protein allergy: 6-year follow-up of the Atopic March Cohort Study.
作者信息
Nocerino Rita, Bedogni Giorgio, Carucci Laura, Aquilone Greta, Oglio Franca, Coppola Serena, Masino Antonio, Berni Canani Roberto
机构信息
Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy; ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples "Federico II", Naples, Italy; Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy; Department of Primary Health Care, Internal Medicine Unit addressed to Frailty and Aging, "S. Maria delle Croci" Hospital, AUSL Romagna, Ravenna, Italy.
出版信息
Clin Nutr. 2025 May;48:134-143. doi: 10.1016/j.clnu.2025.03.026. Epub 2025 Apr 5.
BACKGROUND AND AIMS
Cow's milk protein allergy (CMPA) is a significant health issue in the pediatric age, carrying lifelong health implications. To compare the impact of different formulas on the occurrence of other atopic manifestations (AMs), autoimmune disorders (ADs) and the time of immune tolerance acquisition in a population of children with immunoglobulin E (IgE)-mediated cow CMPA.
METHODS
In a 72-month prospective cohort study the occurrence of other AMs (i.e., eczema, urticaria, asthma, and rhinoconjunctivitis), ADs (i.e., celiac disease, thyroiditis, type 1 diabetes, inflammatory bowel diseases, idiopathic juvenile arthritis) and the time of immune tolerance acquisition were comparatively evaluated in IgE-mediated CMPA children treated with different formulas: extensively hydrolyzed casein formula containing the probiotic L. rhamnosus G (EHCF + LGG), rice hydrolyzed formula (RHF), soy formula (SF), extensively hydrolyzed whey formula (EHWF), or amino-acid based formula (AAF).
RESULTS
313 subjects were evaluated: EHCF + LGG (n = 64), RHF(n = 62), SF(n = 63), EHWF(n = 60) and AAF (n = 64). The incidence of AMs was: 0.30(Bonferroni-corrected 95%CI 0.15 to 0.44) for EHCF + LGG cohort, 0.68 (0.52-0.83) for RHF cohort, 0.73 (0.59-0.87) for SF cohort, 0.70 (0.55-0.85) for EHWF cohort and 0.83 (0.71-0.95) for AAF cohort. The corresponding risk ratios are 2.28 (1.51-3.45) for RHF vs. EHCF + LGG (p < 0.001), 2.46 (1.64-3.69) for SF vs. EHCF + LGG (p < 0.001), 2.36 (1.56-3.56) for EHWF vs. EHCF + LGG (p < 0.001), and 2.79 (1.88-4.13) for AAF vs. EHCF + LGG (p < 0.001). The 72-month immune tolerance acquisition rate was higher in the EHCF + LGG cohort. The incidence of celiac disease was 2/313 (0.006, binomial exact 95%CI 0.0007 to 0.023). No cases of other ADs were reported.
CONCLUSION
The dietary treatment with EHCF + LGG is associated with lower incidence of AMs and higher rate of immune tolerance acquisition in children with CMPA.
背景与目的
牛奶蛋白过敏（CMPA）是儿童期一个重要的健康问题，会对终身健康产生影响。比较不同配方奶粉对免疫球蛋白E（IgE）介导的牛奶CMPA儿童群体中其他特应性表现（AMs）、自身免疫性疾病（ADs）的发生情况以及免疫耐受获得时间的影响。
方法
在一项为期72个月的前瞻性队列研究中，对接受不同配方奶粉治疗的IgE介导的CMPA儿童，比较其他AMs（即湿疹、荨麻疹、哮喘和鼻结膜炎）、ADs（即乳糜泻、甲状腺炎、1型糖尿病、炎症性肠病、特发性幼年关节炎）的发生情况以及免疫耐受获得时间：含益生菌鼠李糖乳杆菌G的深度水解酪蛋白配方奶粉（EHCF + LGG）、大米水解配方奶粉（RHF）、大豆配方奶粉（SF）、深度水解乳清配方奶粉（EHWF）或氨基酸配方奶粉（AAF）。
结果
共评估了313名受试者：EHCF + LGG组（n = 64）、RHF组（n = 62）、SF组（n = 63）、EHWF组（n = 60）和AAF组（n = 64）。AMs的发生率为：EHCF + LGG组0.30（Bonferroni校正95%CI 0.15至0.44），RHF组0.68（0.52 - 0.83），SF组0.73（0.59 - 0.87），EHWF组0.70（0.55 - 0.85），AAF组0.83（0.71 - 0.95）。RHF组与EHCF + LGG组的相应风险比为2.28（1.51 - 3.45）（p < 0.001），SF组与EHCF + LGG组为2.46（1.64 - 3.69）（p < 0.001），EHWF组与EHCF + LGG组为2.36（1.56 - 3.56）（p < 0.001），AAF组与EHCF + LGG组为2.79（1.88 - 4.13）（p < 0.001）。EHCF + LGG组72个月的免疫耐受获得率更高。乳糜泻的发生率为2/313（0.006，二项式精确95%CI 0.0007至0.023）。未报告其他ADs病例。
结论
对于CMPA儿童，采用EHCF + LGG进行饮食治疗与较低的AMs发生率和较高的免疫耐受获得率相关。
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