Iacono G, Carroccio A, Cavataio F, Montalto G, Kazmierska I, Lorello D, Soresi M, Notarbartolo A
Second Divisione Pediatria, Ospedale G. di Cristina, Universita di Palermo, Italy.
J Allergy Clin Immunol. 1996 Mar;97(3):822-7. doi: 10.1016/s0091-6749(96)80160-6.
Recent reports have suggested that gastroesophageal reflux in pediatric patients may be caused by food allergy.
The aim of our study was to determine the frequency of the association of gastroesophageal reflux with cow's milk protein allergy in patients win the first year of life.
We studied 204 consecutive patients (median age, 6.3 months) who had been diagnosed as having gastroesophageal reflux on the basis of 24-hour continuous pH monitoring and histologic examination of the esophageal mucosa.
Clinical history suggested diagnosis of cow's milk allergy in 19 infants, and 93 others had positive test results (serum IgE anti-lactoglobulin, prick tests, circulating or fecal or nasal mucus eosinophils) but did not have symptoms indicating cow's milk allergy. The cow's milk-free diet and two successive blind challenges confirmed the diagnosis of cow's milk allergy in 85 of the 204 patients with gastroesophageal reflux. The clinical presentations of the infants with gastroesophageal reflux alone were different, in view of the greater frequency of diarrhea (p less than 0.0001) and atopic dermatitis (p less than 0.0002). In all, gastroesophageal reflux was associated with, and probably caused by cow's milk allergy, in 85 of 204 cases (41.8%).
Considering the frequency of this association, patients younger than 12 months old with symptoms of gastroesophageal reflux should be carefully examined to determine whether this disorder is primary or caused by cow's milk allergy.
最近的报告表明，儿科患者的胃食管反流可能由食物过敏引起。
我们研究的目的是确定1岁以内患有胃食管反流的患者中，胃食管反流与牛奶蛋白过敏相关联的频率。
我们研究了连续204例患者（中位年龄6.3个月），这些患者基于24小时连续pH监测和食管黏膜组织学检查被诊断为患有胃食管反流。
临床病史提示19名婴儿患有牛奶过敏，另外93名患者检测结果呈阳性（血清抗乳球蛋白IgE、点刺试验、循环或粪便或鼻黏液嗜酸性粒细胞），但没有牛奶过敏的症状。无牛奶饮食和两次连续的盲法激发试验证实，204例胃食管反流患者中有85例患有牛奶过敏。单纯胃食管反流婴儿的临床表现有所不同，腹泻（p<0.0001）和特应性皮炎（p<0.0002）的发生率更高。总体而言，204例病例中有85例（41.8%）胃食管反流与牛奶过敏相关，且可能由牛奶过敏引起。
考虑到这种关联的频率，12个月以下有胃食管反流症状的患者应仔细检查，以确定这种疾病是原发性的还是由牛奶过敏引起的。
