Bone mineral status in children with cow milk allergy

To investigate bone mineral status in children with verified cow milk allergy for more than 4 yr compared with a large reference population of 343 local healthy controls. Whole body bone mineral content (BMC), projected bone area and bone mineral density (BMD) were determined by dual energy x-ray absorptiometry in nine children (8-17 yr old, one girl and eight boys). All children had cow milk allergy for more than 4 yr. All children had asthma and was treated with corticosteroids. BMC and BMD were reduced for age (p < 0.01). Height for age was significantly reduced (p < 0.01), indicating 'short' bones. BMC for bone area was borderline reduced (p = 0.05), indicating reduced bone mineralization. The growth of the children was reduced compared with there parents and siblings (p < 0.01), and the bone age was retarded (mean 1.4 yr, p < 0.01). Calcium consumption calculated from food intake was about 25% of the recommended. All laboratory tests were normal. Short bones were the main reason for reduced BMC and BMD for age in children with cow milk allergy, but a borderline low BMC for bone area indicated reduced bone mineralization of the bones. A supplementation of calcium to children with cow milk allergy is recommended.     

吉兰-巴雷综合征患儿血清IL-18、IL-13水平变化的研究

吉兰-巴雷综合征（Guillain-Barré syndrome,GBS）是一种由体液免疫和细胞免疫共同介导的周围神经炎性脱髓鞘疾病。许多研究已证明,炎性细胞因子在髓鞘损伤机制中发挥着重要的作用,新近发现的细胞因子IL-18、IL-13在免疫调控和免疫损伤中的作用日益受到人们的重视,已成为当前临床研究的热点。我们通过测定GBS患儿血清和脑脊液（CSF）IL-18、IL-13水平来观察其变化。[第一段]     

Bone metabolism in cow milk allergic children

Children with cow milk allergy are suspected to develop calcium metabolism disturbances. We observed increased markers of bone turnover in these children. Children with cow milk allergy are more prone to develop the disturbances of the bone mineralization even in the first year of life.     

Prediction of the development of tolerance to milk in children with cow's milk hypersensitivity

OBJECTIVES: To investigate whether the development of tolerance to cow's milk (CM) by aged 4 years can be predicted with a skin prick test (SPT) and measurements of total or specific immunoglobulin E (IgE) in the serum, taken at the time of diagnosis of cow's milk hypersensitivity (CMH). STUDY DESIGN: Infants with immediate (n=95) or delayed (n=67) challenge reactions to CM were prospectively followed to aged 4 years. CMH status was assessed annually by CM challenges. RESULTS: By aged 2, 3, and 4 years, children with delayed reactions developed tolerance to CM faster than those with immediate reactions: 64%, 92%, and 96% versus 31%, 53%, and 63%, respectively. A wheal size of <5 mm in SPT correctly identified 83% of 124 infants who developed tolerance to CM by aged 4 years, and a wheal size of >or=5 mm in SPT correctly identified 71% of 39 infants with persistent CMH. Milk-specific IgE <2 kU/L correctly identified 82% of infants who developed tolerance to CM, and milk-specific IgE >or=2 kU/L correctly identified 71% of infants with persistent CMH. CONCLUSION: SPT and milk-specific IgE in the serum are useful prognostic indicators of the development of tolerance to CM in infants with CMH.     

Lymphoid nodular hyperplasia and cow's milk hypersensitivity in children with chronic constipation

OBJECTIVE: To investigate the incidence of cow's milk allergy as evidenced by milk challenge and the findings of endoscopic and immunohistochemical examinations in children with chronic and refractory constipation. STUDY DESIGN: Thirty-five study subjects (mean age, 8.3 +/- 3.3 years; range, 3-15 years; 17 girls) and 15 control subjects (mean age, 11.7 +/- 3.2 years; range, 2-15 years; 9 girls) were studied by colonoscopy and a 4-week cow's milk elimination and challenge. RESULTS: Lymphoid nodular hyperplasia was the most prominent endoscopic finding in half of the subjects (46%), mostly occurring patchily in the transverse colon. Histologic findings other than lymphoid accumulation and mildly increased density of eosinophils were few. During the milk elimination and with supportive medication, 83% of subjects remitted. Constipation and/or other gastrointestinal or skin symptoms relapsed only in one third (34%) during the cow's milk challenge, these having significantly higher densities of intraepithelial gammadelta + T cells ( P <.001) in the biopsy samples of the terminal ileum as compared with the control subjects. CONCLUSIONS: We were able to find formal evidence for the presence of cow's milk allergy in children with chronic constipation.     

肺炎支原体肺炎患儿外周血IgE、IL-13、IL-18水平的初步研究

目的 探讨肺炎支原体肺炎患儿外周血IgE、IL-13与IL-18的水平及其临床意义.方法 118例病例均选自2003年1月至2004年1月间住院的患儿,符合支原体肺炎的诊断标准.入院患儿检测IgE、IL-13与IL-18及病原学检查.同时选择80例健康体检的婴幼儿作为正常对照组.结果 肺炎支原体感染患儿血中IgE、IL-13与IL-18明显高于对照组.结论 肺炎支原体感染可刺激机体产生特异性IgE,诱导Ⅰ型变态反应进而导致肺炎患儿出现晚期气道高反应.肺炎支原体感染发病机制与细胞免疫功能紊乱、外周血T淋巴细胞失衡有关.     

Association of HLA-DQ7 antigen with cow milk protein allergy in Italian children

In this study we investigated the HLA association with cow milk allergy. Thirty-seven Italian children with cow milk allergy and 35 randomly selected age-matched healthy children as control group were included in the study. DNA typing was performed by restriction fragment length polymorphism (RFLP) technique. We show the first statistically significant positive association between the expression of the HLA-DQ7 antigen and cow milk allergy. Several immunological tests (skin prick test, RIA, radioallergosorb-ent test (RAST) and ELISA) were performed to evaluate the humoral immune responses of DQ7 positive and DQ7 negative allergic patients. Our results show that among the DQ7 positive patients the majority presented a high humoral response. Furthermore, the in vitro proliferative response of patients to the †-lactoglobulin antigen was performed to evaluate their cell-mediated immune response. We observed that the number of the nonre-sponders was higher in the DQ7 positive patients when compared to the DQ7 negative patients.
Our data indicate an association of HLA-DQ7 antigen with cow milk pro tein allergy and that the DQ7 positive patients had a prevalence of humoral rather than cellular responses.     

Immunologic changes associated with the development of tolerance in children with cow milk allergy.

The purpose of this study was to determine whether cow milk-specific antibody responses correlated with the development of clinical tolerance in cow milk-allergic children. Double-blind, placebo-controlled food challenges were performed annually in 29 patients with cow milk allergy. Clinical reactivity was lost in 11 (38%) of 29 patients. The median age for all patients at the time of diagnosis by these food challenges was 3 years; more than 80% of patients in each group had atopic dermatitis as part of their presenting symptoms. Casein-specific and beta-lactoglobulin-specific IgE, IgG, IgG1, and IgG4 antibody concentrations were analyzed in all patients at regular intervals. In the patients becoming clinically tolerant to cow milk, the IgE-specific antibody concentrations and IgE/IgG-specific ratios for both milk proteins were lower initially and decreased significantly with time, in comparison with those in the group who retained clinical sensitivity. The concentrations of IgG1- and IgG4-specific antibody to casein and the IgE/IgG1 and IgE/IgG4 ratios for both casein and beta-lactoglobulin were significantly less in the patients losing clinical reactivity. No differences in the IgG-specific concentrations were observed in either group at any of the evaluation times noted above. Monitoring similar casein-specific and beta-lactoglobulin-specific IgE concentrations and IgE/IgG ratios may help predict which patients will ultimately lose their clinical reactivity to cow milk.     

牛奶蛋白诱导的过敏性直肠结肠炎患儿喂养干预研究

目的 评估牛奶蛋白过敏性直肠结肠炎患儿的营养风险;观察喂养干预方案的变化及疗效,探讨个体化喂养干预方案的选择时机.方法 回顾性分析2012年1月至2013年7月湖南省儿童医院确诊为牛奶蛋白过敏性直肠结肠炎的171例患儿临床资料,其中非母乳喂养组139例(81.3％).干预方案:母乳喂养组继续母乳喂养32例,非母乳喂养组中游离氨基酸配方干预36例(21.1％),深度水解配方干预103例(60.2％),观察喂养干预2周的疗效,随访8周、12周、24周时喂养干预配方变化及0、3、6个月营养风险评估情况.结果 171例患儿中,男∶女=1.5∶1.0;平均年龄(4.1±1.3)个月.疗效观察:干预2周共显效147例(86.0％),其中母乳喂养组显效率为79.2％,与游离氨基酸配方组及深度水解配方组比较差异无统计学意义(P＞0.05).随访0.5年内干预配方改变:8周:母乳喂养组30例继续母乳喂养,游离氨基酸配方粉喂养21例(12.3％),深度水解配方粉85例(49.7％),适度水解配方35例(20.5％);12周:母乳喂养23例(13.5％),游离氨基酸配方粉喂养16例(9.4％),深度水解配方粉喂养56例(32.7％),适度水解配方喂养76例(44.4％);24周:母乳喂养21例(12.3％),游离氨基酸配方粉喂养7例(4.1％),适度水解配方喂养13例(7.6％),普通配方喂养130例(76.0％).于0、3、6个月进行营养风险评估(STAMP营养风险评估表),3组在不同时期的风险评分均值比较差异均无统计学意义(P均＞0.05).结论 牛奶蛋白过敏性直肠结肠炎患儿营养风险较低,不同的喂养干预方式对患儿的营养状态无明显影响.继续母乳喂养可有效回避牛奶过敏,人工喂养患儿干预后2周左右症状可获缓解,50％左右在3个月以上可获得部分免疫耐受,故可根据其诱导免疫耐受情况进行个体化喂养干预,减轻经济负担.     

Allergic alveolitis in cow milk allergy

The case history of a 12 months old boy with recurrent pneumonia following ingestion of cow's milk is described. After receiving cow's milk containing formula he presented with fever, tachypnea, diffuse rales and crepitations over both lungs. The chest X-ray revealed marked bilateral alveolar shadows. A high titer of antibodies against the four major antigenic components of cow's milk protein was demonstrated by Ouchterlony's precipitation test and the fluorescent immunosorbent test. Withdrawal of cow's milk from the diet resulted in complete resolution of clinical and radiological findings.     

Hyperreactivity to cow milk in young children with pulmonary hemosiderosis and cor pulmonale secondary to nasopharyngeal obstruction.

Six black infants and young children with high titers of milk precipitins were identified by screening the sera of 160 children with idiopathic chronic lung disease. None of the six had immunoglobulin deficiency, elevation of sweat chlorides, SS hemoglobin, or recurrent aspiration. All six children had typical manifestations of milk-induced pulmonary hemosiderosis: recurrent pulmonary infiltrates (6/6), hemosiderin-laden pulmonary macrophages (5/6), intermittent wheezing (5/6), eosinophilia (4/6), anemia (4/6), iron deficiency (4/4), failure to thrive (4/6), and elevated levels of serum IgE (4/4). Three children also had chronic rhinitis and eventually developed large adenoids, hypercapnia and acidosis during sleep, and right heart failure. Elimination of cow milk from the diet, symptomatic therapy, and adenoidectomy when indicated resulted in improvement of all six patients. Pulmonary hemosiderosis and some cases of upper airway obstruction with pulmonary hypertension appear to be two stages, early and delayed, of the same immunophysiologic process. Early dietary intervention may prevent the cardiovascular complications of this process.     

Higher serum eosinophil cationic protein levels in children with cow's milk allergy

BACKGROUND: In the pathogenesis of cow's milk allergy, abnormal immunologically mediated reactions play a basic role. Eosinophil activation also participates in the development of several allergies. The purpose of this study was to characterize the degree of this activation by measuring the serum level of eosinophil cationic protein (sECP) and establishing whether it is a useful parameter in monitoring oral cow's milk allergy. METHODS: The sECP level of 35 patients with previously confirmed cow's milk allergy (mean age, 16 months) was evaluated using a fluoroimmunoassay before the cow's milk rechallenge test and at 2 hours and 24 hours after cow's milk challenge. RESULTS: Of the 35 children with previously confirmed cow's milk allergy, 10 had positive clinical reactions after the milk rechallenge test, whereas 25 children had no reaction. The median sECP level of all the patients before the challenge test was significantly higher (12.4 microg/L) than that of the control group (4.3 microg/L) (P < 0.05). Two hours after the challenge, the median sECP of all patients (9.4 microg/L) was lower than the starting values. The median sECP levels were higher in children with positive challenge test results at all time points. However, this difference was not statistically significant. CONCLUSIONS: The normalization of sECP level may indicate the cessation of the cow's milk allergy. Therefore, the measurement of sECP may be helpful in determining the optimal time in which to repeat the challenge test, when the result will more likely be negative. The significant decrease of the sECP level 2 hours after the beginning of milk challenge test may be explained by the fact that this protein is excreted into the intestinal lumen.     

激素敏感型肾病综合征患儿血及尿白细胞介素-18增高及其临床意义

目的：探讨白细胞介素-18(IL-18)与小儿激素敏感型肾病综合征(SSNS)发病之间的关系。方法：采用酶联免疫吸附试验(ELISA)测定SSNS患儿极期及恢复期血、尿中IL-18水平,分析与24 h尿蛋白定量之间的关系,并与正常对照组相比较。结果：SSNS患儿22例,治疗前血IL-18为(281.2±79.2) ng/L。恢复期为(50.2±14.1) ng/L两者比较差异有显著性(P0.05)。尿IL-18治疗前及恢复期分别为(232.6±55.5) ng/mg·Cr和(28.5±12.8) ng/mg·Cr两者比较差异有显著性(P0.05)。呼吸道感染组与正常对照组之间差异也无显著性。血IL-18与24 h尿蛋白定量呈显著正相关(r=0.768,P<0.05)。尿IL-18与24 h尿蛋白定量也呈显著正相关(r=0.838,P<0.01)。结论：IL-18与SSNS的发病有关,可能在其发病中起部分作用,血、尿IL-18还可作为SSNS极期的标志之一。感染对血中IL-18水平无影响。     

婴幼儿中牛奶与鸡蛋血清特异性IgE变化趋向回顾性分析

目的 了解婴幼儿牛奶和鸡蛋血清特异性IgE(sIgE)检测结果的变化趋向及临床意义。方法 回顾性分析复旦大学附属儿科医院4年间临床诊断为过敏性疾病、高度怀疑牛奶和（和）鸡蛋过敏的1～36月龄婴幼儿，考察婴幼儿牛奶与鸡蛋血清sIgE变化趋向时，按月龄分为6组：≤6月龄，～12月龄，～18月龄，～24月龄，～30月龄和～36月龄组。考察不同年龄段不同疾病鸡蛋和牛奶血清sIgE平均水平变化时，按月龄分为≤12月龄和～36月龄两组。使用UniCAP系统检测牛奶和鸡蛋血清sIgE。结果 共纳入855例，鸡蛋血清sIgE阳性率为50.1%（396/791）,牛奶血清sIgE阳性率为43.0%（324/754）。鸡蛋血清sIgE阳性率在各月龄组均接近50%，≤6月龄组略低；牛奶血清sIgE的阳性率在≤6月龄组较低（31.5%），随月龄的增长而逐渐上升，18个月后达50%左右。湿疹患儿鸡蛋血清sIgE阳性率较高，在≤6月龄组即可检测出较高的阳性率（70.6%），之后阳性率在50%左右，～36月龄组再次达到71.4%；湿疹患儿牛奶血清sIgE阳性率≤6月龄组为20.9%，随月龄增长而升高，～36月龄组达50.0%。喘息性疾病患儿较多，≤6月龄组鸡蛋和牛奶血清sIgE阳性率均较低（16.7%和15.4%），随月龄增长至24月龄升高，之后又降低。肺炎患儿牛奶和鸡蛋血清sIgE在≤6月龄组和～12月龄组阳性率均为30%左右，～24月龄组分别升至55.0%和57.9%，～36月龄组分别升至64.3%和71.4%，随月龄增长肺炎患儿牛奶和鸡蛋血清sIgE阳性率增高。鸡蛋血清sIgE阳性值主要分布于0.59～2.67 kUA·L-1（第25~75百分位数），5%的患儿sIgE达26.90 kUA·L-1。牛奶血清sIgE阳性值主要分布于0.53～2.19 kUA·L-1（第25~75百分位数），5%的患儿sIgE达7.76 kUA·L-1。鸡蛋和牛奶血清sIgE水平随月龄变化呈下降趋势，≤6月龄组牛奶血清sIgE均值为4.05 kUA·L-1，12月龄后sIgE在1.5～2 kUA·L-1。≤6月龄组鸡蛋血清sIgE均值为16.84 kUA·L-1， ～12月龄和～36月龄组分别为6.80和1.49 kUA·L-1。223例鸡蛋和牛奶血清sIgE均阳性患儿，鸡蛋和牛奶血清sIgE水平呈正相关。结论 在不同月龄段和不同疾病类型，根据过敏性疾病的临床诊断检测鸡蛋和牛奶血清sIgE的阳性率不同，临床检测鸡蛋和牛奶血清sIgE对婴幼儿过敏性疾病的诊断具有重要参考价值；婴幼儿期肺炎患儿鸡蛋和牛奶血清sIgE阳性率较高，原因有待进一步研究；婴幼儿期鸡蛋和牛奶血清sIgE水平总体偏低，随月龄增长sIgE水平降低，这是婴幼儿期鸡蛋和牛奶过敏的重要特征，机制有待深入研究。鸡蛋和牛奶血清sIgE水平呈正相关，提示婴幼儿对鸡蛋和牛奶过敏与机体免疫应答状况有关。