牛奶蛋白过敏婴儿气质特点及相关影响因素的研究

目的 探讨牛奶蛋白过敏(CMPA)婴儿的气质类型、气质维度水平及相关影响因素,为CMPA婴儿早期家庭养育提供依据。方法 选取2019年1月—2020年12月福建省妇幼保健院儿保科正常体检的婴儿102例作为对照组,选取同期在过敏专科门诊就诊的4～8月龄CMPA 102例婴儿作为病例组,对婴儿进行婴儿气质量表(CITS)、牛奶相关症状评分(CoMiSS)评估及维生素D水平检测,同时对母亲进行焦虑症自评量表(SAS)评估。结果 气质类型方面,两组婴儿的气质类型构成差异有统计学意义(χ²=51.866,P<0.05),在气质维度水平除持久性和注意分散外,牛奶蛋白过敏组婴儿活动水平、节律性、趋避性、适应性、活动强度、心境和反应阈维度得分均高于对照组(t=5.713、4.154、4.844、5.052、5.067、4.138、4.787,P<0.05);CMPA组婴儿中CoMiSS评分、母亲SAS评分均高于对照组(t=49.433、16.562,P<0.05);CMPA组婴儿维生素D水平低于对照组(t=-16.981,P<0.05)。Spearman分析显示, CMPA组婴儿母亲的焦虑情绪、CoMiSS评分与婴儿的气质类型显著相关(r=0.191、0.228,P<0.05),同时母亲的焦虑情绪水平与CoMiSS评分呈正相关、与维生素D水平呈负相关(r=0.762、-0.520,P<0.05)。结论 CMPA婴儿的气质类型存在难养型增加,易养型减少,应针对此类婴儿气质类型指导家庭养育,关注此类婴儿母亲的焦虑情绪对婴儿气质和家庭养育的影响,通过健康教育和规范诊疗,缓解婴儿过敏症状并改善营养状况,从而提高CMPA婴儿的健康水平。     

牛奶蛋白过敏致婴儿下消化道出血60例临床分析

目的 对牛奶蛋白过敏导致的婴儿下消化道出血进行临床资料分析,为早期诊断和有效治疗提供依据。方法 回顾性分析2014年1月-2016年5月深圳市儿童医院60例牛奶蛋白过敏导致婴儿下消化道出血的临床资料。结果 牛奶蛋白过敏致1~6月婴儿下消化道出血最多41例(68.33%),不同性别患儿年龄分布差异无统计学意义(χ²=1.371,P=0.242),人工喂养多见25例(41.67%);临床表现突然大便带鲜血或血丝46例(76.67%);实验检查IgG抗体增高48例(80%);电子肠镜检查:发现多发性结节增生(81.33%);病理检查表现慢性非特异性炎症,固有层嗜酸性粒细胞增多;回避牛奶蛋白治疗后,患儿治愈率情况:2周后治愈率比1周后治愈率明显增多,差异有统计学意义(P<0.05);4周后治愈率比2周治愈率两者比较,差异无统计学意义(P>0.05)。结论 牛奶蛋白过敏致婴儿下消化道出血,以1~6月人工喂养患者多见,IgG抗体升高可能参与了其机制,回避牛奶蛋白2-4周后未见缓解,需要考虑嗜酸粒细胞结肠炎引起可能。     

婴儿牛奶过敏23例临床分析

【目的】 探讨小婴儿牛奶过敏的临床特点, 以提高临床诊治水平。 【方法】 回顾性总结2009年3月-2010年4月在本院采用饮食回避诊断治疗的牛奶过敏婴儿的临床资料。 【结果】 病程2周至2月不等,临床表现为慢性腹泻伴/不伴便血,呕吐,喂养困难或拒食,哭闹,便秘等,部分伴有湿疹;23例给予深度水解蛋白奶粉替代牛奶蛋白并辅以益生菌治疗后临床症状缓解。 【结论】 小婴儿牛奶过敏可以仅表现为胃肠症状,易误诊,深度水解蛋白奶粉和益生菌有利于确立诊断及缓解症状。     

Persistent forms of cow's milk allergy. Report of 6 cases

BACKGROUND: Cow's milk allergy is defined as reproducible adverse reaction to a food protein antigen which is immune medieted. About 80 to 90 % become clinically tolerated within the first three year of live. The aim of this study is to evaluate the clinical, immunological and evolutive characteristics of the 10 % to 20 % of persistent form of cow's milk allergy. METHODS: This study included six persistent form of cow's milk allergy (2 boys and 4 girls). The provocation challenge test according to Rance recommendation, have been made from 6 months to one year. RESULTS: 4/6 infants with persistent cow's milk allergy have an atopic familial disease. Clinical presentation changed over time at once symptoms were preventely gastrointestinal, at the end there was an increased frequency of atopic disease (asthma: 4/6 infants) CONCLUSION: Persistent form of cow's milk allergy are characterized by considerable importance of familial atopic disease; change in cow's milk allergy manifestations over time and more prolonged delay between cow's milk persistent consumption and manifestations of symptoms.     

Cow's milk allergy in infants: new insights

Symptoms of cow's milk allergy are non-specific; as a result, suspected cow's milk allergy is far more common than proven allergy to cow's milk. Cow's milk allergy in infants is therefore most probably a fairly uncommon clinical picture; cow's milk allergy is estimated to occur in less than one per cent of infants. The only valuable additional diagnostic tool is food challenge, preferably double blind. Therapy consists of a formula free of cow's milk (preferably containing extensively hydrolysed whey protein) from the moment the mother ceases nursing her child until the age of 6-12 months. Solids can be introduced in the usual fashion; there is no scientific basis for introducing them in a step by step fashion. Prevention of cow's milk allergy by using hypoallergenic formula (partially hydrolysed cow milk protein) in the first year of life has been shown to be unsuccessful, and can no longer be recommended. In the future, oral immunotherapy may be a promising new treatment for cow's milk allergy.     

Complementary feeding with cow's milk alters sleeping metabolic rate in breast-fed infants

Although it is widely accepted that energy expenditure in infants is a function of feeding pattern, the mechanism behind this is not well understood. The objectives of this observational study were as follows: 1) to compare minimal observable energy expenditure (MOEE) between 2 subgroups of breast-fed infants, a BM group in which breast milk was the only source of milk and a BCM group given cow's milk in addition to breast milk; and 2) to identify potential mediators of a feeding pattern effect. For this purpose, infants were classified by feeding group on the basis of a mother's recall. Respiration calorimetry was used to measure MOEE in 62 infants (n = 35 BM, n = 27 BCM) aged 8.7 mo in Pelotas, southern Brazil. Breast-milk intake was measured using deuterium oxide, complementary food intake by 1-d food weighing, total energy expenditure and total body water using doubly labeled water; anthropometric indices were calculated. MOEE was 1672 +/- 175 kJ/d in BM compared with 1858 +/- 210 kJ/d in BCM infants (P < 0.001). Mass-specific MOEE was 201 +/- 24.6 and 216 +/- 31.9 kJ/(kg . d) in BM and BCM infants, respectively (P = 0.041). MOEE (kJ/d) was mediated by protein intake and fat-free mass (R(2) = 41.4%). We conclude that complementary feeding with cow's milk alters the sleeping metabolic rate in breast-fed infants. These findings deserve attention in relation to "metabolic programming" and the development of obesity later in life.     

Food allergy and the potential allergenicity-antigenicity of microparticulated egg and cow's milk proteins

Approximately 3-4 million Americans experience food allergic reactions at some time in their lives. In the pediatric population, eggs and milk are most frequently implicated in food allergic reactions. The most well-understood adverse reactions to foods are secondary to the development of IgE antibodies to specific food antigens. Once an individual becomes sensitized (i.e., makes specific IgE antibodies), ingestion of the food may lead to a variety of cutaneous, respiratory, and/or gastrointestinal symptoms, and anaphylactic shock. The use of SDS-PAGE and immunoblot analyses with sera from documented food allergic patients provide a very sensitive indicator of the antigenic/allergic composition of various foods. As demonstrated in a study of infant formulas of hydrolyzed cow's milk protein, the absence of demonstrable bands on SDS-PAGE gels and immunoblots correlates with an inability to provoke an allergic response. In addition, it was demonstrated that SDS-PAGE with silver staining could detect protein fractions at a concentration of 50-100 ng/ml, a concentration below which allergic individuals are unlikely to react. These studies confirmed that patients clinically allergic to egg and/or cow's milk possess IgE and IgG antibodies to protein fractions in egg and cow's milk, as well as the microparticulated egg/cow's milk proteins, Simplesse and Beta IL. Compared to egg and cow's milk, there is no evidence that the Simplesse or Beta IL test materials possess any "novel" protein fractions or antigens. In addition, there is no evidence that these microparticulated proteins result in increased immunologic activity, as determined by the intensity of protein band staining.(ABSTRACT TRUNCATED AT 250 WORDS)     

The availability and cost of a milk‐free diet for cow's milk protein allergy

Background: Cow's milk protein allergy (CMPA) is the most common food allergy, and adherence to a milk‐free diet is essential, particularly in immunoglobulin E‐mediated CMPA sufferers (Benhamou et al., 2009). No studies have looked into the practical aspects of a milk‐free diet. The aim of this project was to evaluate how the availability and cost of a milk‐free diet compares with that of one containing cow's milk protein. Methods: A cross‐sectional survey was conducted in the London Borough of Harrow and three major superstores in an urban setting (inclusion criteria of ≥25 000 sq ft) were randomly selected. Two shopping baskets were created; basket A with commonly consumed foods (bread, biscuits, milk, packaged fruit/vegetable salads, and ready meals which contained ≥12% protein from nondairy protein sources) based on the Eatwell plate (Food Standards Agency, 2007), and basket B with their cow's milk‐free alternatives. The price and number of varieties were recorded and analysed for each food group per basket. Pearson's chi‐squared and Wilcoxon‐rank sum tests were conducted for availability and cost of each food type in both baskets. Results: The availability of foods suitable for a CMPA diet (basket B) was lower than basket A: 74% bread, 15% biscuits, 26% milk and 25% ready meals compared to 26%, 85%, 74% and 75%, P‐values of 0.001, 0.002, 0.001 and 0.005, respectively. The availability of fruit/vegetable salads was not statistically significant between the two baskets. Regarding cost, bread in basket A was found to be significantly more expensive than in basket B, whereas milk substitutes (all superstores) and ready meals (superstore 2 only) were significantly more expensive in basket B (Table 1). The cost of biscuits and fruit/vegetable salads between the two baskets was not significantly different.

Table 1. Median cost of foods in standard basket A and CMPA basket B (pence/100 g)

Food allergy and the potential allergenicity-antigenicity of microparticulated egg and cow's milk proteins.

Approximately 3-4 million Americans experience food allergic reactions at some time in their lives. In the pediatric population, eggs and milk are most frequently implicated in food allergic reactions. The most well-understood adverse reactions to foods are secondary to the development of IgE antibodies to specific food antigens. Once an individual becomes sensitized (i.e., makes specific IgE antibodies), ingestion of the food may lead to a variety of cutaneous, respiratory, and/or gastrointestinal symptoms, and anaphylactic shock. The use of SDS-PAGE and immunoblot analyses with sera from documented food allergic patients provide a very sensitive indicator of the antigenic/allergic composition of various foods. As demonstrated in a study of infant formulas of hydrolyzed cow's milk protein, the absence of demonstrable bands on SDS-PAGE gels and immunoblots correlates with an inability to provoke an allergic response. In addition, it was demonstrated that SDS-PAGE with silver staining could detect protein fractions at a concentration of 50-100 ng/ml, a concentration below which allergic individuals are unlikely to react. These studies confirmed that patients clinically allergic to egg and/or cow's milk possess IgE and IgG antibodies to protein fractions in egg and cow's milk, as well as the microparticulated egg/cow's milk proteins, Simplesse and Beta IL. Compared to egg and cow's milk, there is no evidence that the Simplesse or Beta IL test materials possess any “novel” protein fractions or antigens. In addition, there is no evidence that these microparticulated proteins result in increased immunologic activity, as determined by the intensity of protein band staining.(ABSTRACT TRUNCATED AT 250 WORDS)     

Consumption of cow's milk as a cause of iron deficiency in infants and toddlers

Consumption of cow's milk (CM) by infants and toddlers has adverse effects on their iron stores, a finding that has been well documented in many localities. Several mechanisms have been identified that may contribute to iron deficiency in this young population group. The most important of these is probably the low iron content of CM, which makes it difficult for infants to obtain the amounts of iron needed for growth. A second mechanism is the occult intestinal blood loss associated with CM consumption during infancy, a condition that affects about 40% of otherwise healthy infants. Loss of iron in the form of blood diminishes with age and ceases after the age of 1 year. A third mechanism is the inhibition of non-heme iron absorption by calcium and casein, both of which are present in high amounts in CM. Fortification of CM with iron, as practiced in some countries, can protect infants and toddlers against CM's negative effects on iron status. Consumption of CM produces a high renal solute load, which leads to a higher urine solute concentration than consumption of breast milk or formula, thereby narrowing the margin of safety during dehydrating events, such as diarrhea. The high protein intake from CM may also place infants at increased risk of obesity in later childhood. It is thus recommended that unmodified, unfortified CM not be fed to infants and that it be fed to toddlers in modest amounts only.