7～24月龄婴幼儿喂养指南的科学依据

正7~24月龄婴幼儿喂养指南的核心推荐:(1)继续母乳喂养,满6月龄起添加辅食;(2)从富含铁的泥糊状食物开始,逐步添加达到食物多样;(3)提倡顺应喂养,鼓励但不强迫进食;(4)辅食不加调味品,尽量减少糖和盐的摄入;(5)注重饮食卫生和进食安全;(6)定期监测体格指标,追求健康生长。1继续母乳喂养,满6月龄起添加辅食WHO推荐,在婴儿出生的前6个月纯母乳喂养,     

早期喂养方式对不同时期儿童体质量的影响

目的探讨早期婴儿喂养方式对儿童体质量的影响。方法选择儿保门诊健康婴儿918名,根据其出生后6个月的喂养方式分为母乳喂养组、混合喂养组和人工喂养组,在生后3,5,8,12,18,24,60个月测量体质量,进行年龄别体质量标准差评分(WAZ)、身长别体质量标准差评分(WHZ)及60月龄体质量指数(BMI)测定,调查辅食添加时间等资料,并进行分析和统计学处理。结果3月龄母乳喂养组儿童在体质量、WAZ、WHZ占优势,差异均有统计学意义(F=4.12,5.66,5.79Pa<0.05);12,18,24月龄混合喂养儿童在WHZ占优势,差异均有统计学意义(F=3.46,3.08,3.12Pa<0.05),母乳喂养持续时间≥12个月的儿童,5岁时肥胖发生率最低;婴儿期的母乳喂养持续时间越长,儿童5岁时肥胖发生率越低,趋势检验有统计学意义(χ2=17.3538P<0.05),辅食添加时间以人工喂养儿最早,人工喂养儿5岁时肥胖发生率也最高(χ2=13.0382P<0.05)。结论加强持续母乳喂养的信心,减少使用奶瓶,避免过早添加辅食,顺利度过因婴儿生长加速、母乳分泌量相对不足的短暂危机期,坚持持续母乳7个月以上,进行婴儿的合理喂养和适时添加辅食的教育等对避免儿童期肥胖的发生非常必要。     

水解蛋白配方与婴幼儿牛奶过敏的预防和治疗

食物过敏是婴幼儿最早出现的过敏问题,牛奶是婴幼儿最常见的过敏食物。牛奶过敏的临床表现多种多样,可涉及皮肤、呼吸道、消化道等多器官多系统。母乳喂养是过敏高风险婴儿的首选喂养方式,但对不能进行母乳喂养的婴儿应选择适当的低敏配方奶,水解蛋白是获得低敏配方的最好方法。根据水解的程度,水解蛋白配方分为适度水解蛋白配方和完全水解蛋白配方。完全水解配方被推荐用于牛乳蛋白过敏婴儿的治疗,适度水解配方通常推荐用于特应质高风险婴儿的初级干预。     

婴儿牛奶蛋白过敏的危险因素：多中心调查分析

目的 通过多中心临床研究了解婴儿牛奶蛋白过敏（CMPA）发生的危险因素。方法 以2016年6月至2017年5月于深圳市6家医院儿科门诊就诊的1 829例1~12月龄婴儿为调查对象,通过问卷调查,筛选CMPA可疑病例,然后进行食物回避激发试验以确诊CMPA。采用多因素logistic回归分析调查婴儿CMPA发生的危险因素。结果 1 829例患儿中,82例确诊为CMPA（4.48%）。多因素logistic回归分析显示,母亲食物过敏（OR=4.91,95% CI：2.24~10.76）、母亲孕期使用抗生素（OR=3.18,95% CI：1.32~7.65）、开始添加辅食月龄小于 < 4个月（OR=3.55,95% CI：1.52~8.27）是CMPA的独立危险因素（P < 0.05）,而纯母乳喂养（OR=0.21,95% CI：0.08~0.58）和 > 6个月添加辅食（OR=0.38,95% CI：0.17~0.86）是CMPA的保护因素（P < 0.05）。结论 小于4月龄添加辅食、母亲食物过敏、母孕期使用抗生素是婴儿CMPA发生的危险因素。     

婴儿辅食添加情况调查分析

目的了解婴儿辅食添加情况。方法采取整群随机抽样的方法，以问卷形式现场调查800例0—12个月婴幼儿父母进行婴儿辅食添加相关因素情况。结果4～6个月婴儿粮谷、蛋类、鱼、肉类、豆制品、蔬菜、水果的添加率分别为82．25％、84．50％、25．50％、0、52．25％、24．50％、51％，婴儿辅食添加的好坏直接与喂养知识的强化培训密切相关，而与家庭经济收入的高低不一定相关。结论加强健康教育把育儿知识交给家长，才能促进儿童的体格发育。     

牛奶蛋白过敏患儿的营养干预

目的 分析牛奶蛋白过敏(CMPA)儿童基本情况,探讨个体化应用氨基酸配方粉、深度水解乳清蛋白婴儿配方粉治疗后的干预效果及转归.方法 收集2009年2 -12月在中国医科大学附属盛京医院儿科就诊,符合CMPA诊断的180例患儿为干预对象.在营养门诊对其喂养史、一般情况进行回顾性分析,给予牛奶回避及治疗类配方粉营养干预7d后回访疗效,指导辅食的选择和添加,并随访3个月、6个月后配方粉喂养婴儿的变化及疗效.结果 180例患儿牛奶过敏高发年龄段为＞2 ～4月龄组(64例,占35.5％);母乳喂养者21例(11.7％),非纯母乳喂养者159例(88.3％);有家族史者32例(17.8％);男女比为1.65:1.干预7d后显效比例最高的临床症状为腹泻(61例,占83.6％).3个月后纯氨基酸配方粉喂养76例(占46.0％),深度水解配方喂养54例(占32.7％),适度水解配方奶粉喂养为25例(占15.3％).6个月后喂养主要是纯氨基酸配方(39例,占24.9％),其次为牛奶配方粉(36例,占22.9％).结论 母乳喂养有利于避免婴儿牛奶过敏,营养干预3个月内不宜喂养含牛奶蛋白配方奶粉,营养干预6个月后部分患儿可获牛奶耐受.牛奶过敏患儿喂养配方粉的转归各不相同,应结合患儿家庭经济能力、病情变化等个体化营养干预.     

部分水解清蛋白配方粉预防过敏性疾病家族史阴性婴儿湿疹成本-效果关系初探

目的 探讨部分水解清蛋白配方粉（pHF-W）预防过敏性疾病家族史阴性婴儿（非高危儿）湿疹发生的成本-效果关系。方法　以2013年6月至2014年4月重庆医科大学附属第一医院产科出生的50例足月新生儿作为研究对象, 通过问卷调查、 皮肤科就诊记录及电话回访记录等随访婴儿1岁内湿疹发生情况及诊治相关费用。比较两种不同喂养方式： pHF-W与普通标准配方粉（SF）喂养组预防非高危儿湿疹的成本-效果关系。其中婴儿湿疹由皮肤专科医生根据中国湿疹诊疗标准确诊。结果　至12个月时, 非高危儿湿疹总发生率为54.0%（27/50）; 采用pHF-W 喂养与 SF 喂养对非高危儿湿疹发生率差异无统计学意义（50.0% vs. 56.3%, P＞0.05）。与SF相比, 采用 pHF-W 喂养预防非高危儿湿疹不具有良好的成本-效果关系,成本-效果比 SF 喂养者高2003.2元/人。结论　采用pHF-W对预防非高危儿湿疹发生可能无疗效, 且在目前情况下不具有良好的成本-效果关系。     

母乳喂养与人乳化奶粉喂养对婴儿营养及抗病力的影响

为了解母乳喂养及人乳化配方奶粉喂养对婴儿营养状况及抗病力的影响，我们自1986年至1990年观察了在我院出生的659名足月顺产婴儿，比较以上2种不同喂养方式对婴儿营养状况及抗痫力的影响。对象母乳喂养344例，人乳化配方奶粉喂养315例。人乳化配方奶粉采用雀巢公司出品的能恩1号（186WJ）。美国惠氏药厂出品NJS26（129例）。两级婴儿均在6个月时用统一方法测量体重，检查血红蛋白及发锌含量（中于活化分析法），并记、＜11出生～G个月内发生各种疾病（湿疹除外）的次数。结果母乳组婴儿6个月时的体重6．938土1．093kg，血红蛋白106．1土…     

婴儿喂养顺应WHO婴儿喂养指南的横断面调查分析

目的 分析顺应WHO婴儿喂养指南（2002）与婴儿体格生长的关系。方法2008年6月至2009年5月在重庆医科大学附属儿童医院儿保门诊非随机选取体检的2～12月龄健康婴儿及其主要抚养人进行调查,采用横断面问卷调查方式,获得婴儿社会人口学资料、乳类和其他食物喂养状况资料。采用标准人体测量秤和婴儿量床测量婴儿体重和卧位身长,以2005年WHO儿童生长标准计算身长别体重Z评分（WLZ）、年龄别身长Z评分（LAZ）和年龄别体重Z评分（WAZ）等体格生长指标。分别计算各月龄组婴儿纯母乳喂养、部分母乳喂养和配方奶喂养比例,比较婴儿体格生长指标与2005年WHO儿童生长标准平均水平的差异。结果 共调查1 030名婴儿,978名有效数据进入分析。出生时对WHO婴儿喂养指南（2002）顺应性较好,母乳喂养876/975名（89.8%）,其中纯母乳喂养405/975名（41.5%）,部分母乳喂养471/975名（48.3%)。3、4、5和6月龄组母乳喂养分别为25/45名(55.6%)、53/124名(42.7%)、114/233名(48.9%)和100/283名（35.3%）,其中纯母乳喂养分别为15/45名(33.3%)、27/124名(21.8%)、26/233名(11.2%)及15/283名(5.3%),未达到WHO婴儿喂养指南（2002）纯母乳喂养至6月龄的建议。食物转换阶段,仅120/978名（12.3%）婴儿顺应WHO婴儿喂养指南（2002）,在6月龄及以后引入其他食物;645/978名（66.0%）婴儿在4～5月龄引入,86/978名（8.8%）婴儿在4月龄前引入。首次引入的其他食物对WHO婴儿喂养指南（2002）的顺应性较好,537/820名（65.5%）婴儿最早引入强化铁的谷类食物,其次是蛋类（141/820名,17.2%）、蔬菜水果类（76/820名,9.3%）、家制米粉（61/820名,7.4%）和禽肉鱼类（5/820名,0.6%）。不同时间引入其他食物的各月龄组婴儿WLZ、WAZ均达到或超过WHO儿童生长标准的平均水平。4～6月龄不同喂养方式婴儿的WLZ均超过WHO儿童生长标准的平均水平(P<0.05),不同喂养方式间WLZ、LAZ和WAZ差异无统计学意义（P>0.05）。结论 本研究所调查的儿保门诊婴儿对WHO婴儿喂养指南（2002）的顺应性较低,纯母乳喂养比例较低,配方奶喂养比例较高,大部分婴儿引入其他食物的时间早于WHO婴儿喂养指南（2002）的建议。首次引入食物对WHO婴儿喂养指南（2002）顺应性较高,食物转换期不同喂养方式未对本调查人群婴儿的体格生长造成不利影响。     

包头地区6岁以下儿童缺铁性贫血相关因素分析

目的 了解包头地区6岁以下儿童不同年龄缺铁性贫血发生情况,探讨其影响因素,从而有效降低贫血的患病率.方法 对700例首次就诊于我院儿科的1个月~6岁儿童喂养方式、辅食添加、母亲产前出血、妊娠高血压综合征等情况进行统计和分析,并检测血常规.结果 贫血检出率:1~4个月组为11.8%,~12个月组45.2%,~3岁组31.8%,~6岁组13.1%.1~4个月组贫血发生率较低,母亲产前出血、妊娠高血压综合征与婴儿贫血有关.5~12个月组贫血发生率较高,是否合理添加辅食与贫血相关;1~6岁幼儿与偏食、挑食及饮食不规律等不良饮食习惯有关.结论 加强围生期保健,减少低出生体质量儿的出生率,婴儿期母乳喂养的同时注意适时、适量、合理添加辅食是减少婴儿期贫血的有力措施.幼儿期应平衡膳食结构,克服不良饮食习惯.     

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。     

Genetic and environmental factors affecting the development of atopy through age 4 in children of atopic parents: a prospective randomized study of food allergen avoidance

The effect of food allergen avoidance, as well as other environmental and genetic factors, on the development of atopy were determined in this follow-up report of a prospective randomized controlled study of 288 infants of atopic parents, in which 78% were available for evaluation at age 4 years. The prophylactictreated group consisted of mothers who avoided cow milk. egg. and peanut during the last trimester of pregnancy and lactation and of infants who avoided cow milk until 1 year (casein hydrolysate supplementation prior to 1 year) and egg, peanut, and fish until after 2 years. The control group consisted of maternal/infant pairs who followed standard feeding practices. The cumulative prevalence of food allergy and food sensitization remained lower in the prophylactic treated group from 1 to 4 years of age. However, the period (current) prevalence of food allergy in both study groups was similar (about 5%) at 3 and 4 years. Such findings suggest that period prevalence may represent the more appropriate measure to assess the impact of intervention measures on the development of atopic disease at older ages. Prophylactic-treated children evidenced lower levels of IgG beta lacloglobulin (BLG) at 4 months and I and 2 years (p < 0.0001) and lower IgG ovalbumen/ovomucoid (OVA) levels only at 2 years (p < 0.001). Both groups evidenced similar prevalences of asthma, allergic rhinitis, and positive inhalant skin tests from birth to 4 years. Children with food allergy evidenced higher 4 year cumulative prevalences of allergic rhinitis and asthma (p < 0.05). Risk factors for atopic disease by age 4 years were shown by multivariate analysis (p < 0.05) to include (1) unrestricted diet and elevated cord blood IgE with food allergy, (2) male gender and lower paternal level of education with asthma, and (3) non-caucasian ethnicity and spring/summer birth with atopic dermatitis and allergic rhinitis. Serum IgE levels were not significantly different between groups at 3 and 4 years, despite their being a trend towards lower serum IgE levels in the prophylactic-treated group at 4 months (p < 0.07). In the control group, formula feeding prior to 4 months was associated with higher 4 month serum IgE levels (p < 0.05). Stepwise linear regression revealed that serum IgE variability from birth to 4 years was influenced by male gender, non-caucasian ethnicity, maternal and paternal serum IgE levels, 4 month IgG BLG levels, positive food and inhalant skin tests, and the development of atopic dermatitis, food allergy, asthma, and allergic rhinitis. These findings demonstrate the strength of genetic factors and their modulation by dietary and envi-ronmental influences in the development of atopy and reveal that the reduction in food allergy in infancy by maternal/infant food allergen avoidance fails to affect respiratory allergy development from birth to 4 years.     

Occurrence of acute diarrhea in atopic and nonatopic infants: the role of prolonged breast-feeding.

A cohort of 336 infants was followed from birth for a total of 717 child-years for development of atopy and occurrence of acute diarrhea. During follow-up 94 (28%) of the infants developed atopic eczema or gastrointestinal allergy associated with food allergens, or both. Infants with food allergy had significantly (p = 0.0074) more episodes of acute diarrhea than infants with no atopy, but there was no apparent temporal correlation between the occurrence of acute diarrhea and appearance of gastrointestinal allergy or atopic eczema. Serum IgE levels in children up to 2 years of age who had diarrhea and atopic eczema were lower than those in atopic eczema children with no diarrhea, but infants with gastrointestinal allergy who had acute diarrhea tended to have higher IgE levels than those without diarrhea. Breast-feeding over 6 months of age reduced the incidence of diarrhea in the first year of life in both atopic and nonatopic infants, but had no significant effect on the total incidence of diarrhea during the 2 year follow-up, as infants breast-fed longer had more diarrhea in the second year of life. Prolonged breast-feeding also reduced the severity of diarrhea in atopic infants aged 7-12 months but not for older infants.     

伴或不伴食物过敏湿疹患儿治疗前后的 生活质量比较

目的探讨湿疹患儿及其家庭治疗前后的生活质量。方法将湿疹患儿分为食物过敏组(FA组,46例)及非食物过敏组(N-FA组,47例)。应用湿疹面积及严重度指数(EASI)对患儿进行评估;对两组湿疹患儿进行规范化干预治疗2个月后,采用食物过敏生活质量问卷-父母版(FAQLQ-PF)和婴儿皮肤病生活质量指数量表(IDQOL)评估治疗前后的生活质量。结果两组患儿在年龄、性别、过敏家族史及喂养方式的差异无统计学意义(P均0.05);FA组中鸡蛋过敏34例(73.91%),牛奶过敏20例(43.48%),胡萝卜过敏2例(4.35%)。两组患儿的EASI、FAQLQ、IDQOL评分在治疗后均有显著下降,与治疗前比较,差异有统计学意义(P均0.05)。治疗前,FA组FAQLQ-PF各模块及总分与N-FA组的差异无统计学意义(P均0.05);治疗两个月后,FA组FAQLQ总分(1.33±1.08)较N-FA组(0.79±0.80)高,差异有统计学意义(Z=2.83,P=0.005);FA组在情绪影响、食物的焦虑、社交/饮食限制模块与N-FA组比较差异亦有统计学意义(Z=2.13~2.89,P均0.05)。结论食物过敏患儿的家长更易担心患儿的情绪变化及社交、饮食受到限制。FAQLQ-PF对于食物过敏生活质量的评估更具特异性。     

Effect of exclusive breast‐feeding and early solid food avoidance on the incidence of atopic dermatitis in high‐risk infants at 1 year of age

The aim of this study was to assess the preventive effect of exclusive breast‐feeding and early solid food avoidance on atopic dermatitis (AD) in infancy. This study is part of a dietary clinical trial in a prospective cohort of healthy term newborns at risk of atopy. It was recommended to breast‐feed for at least 4 months and to avoid solid food in the same time‐period. Eight hundred and sixty‐five infants exclusively breast‐fed, and 256 infants partially or exclusively formula‐fed, were followed‐up until the end of the first year following birth. AD and sensitization to milk and egg were considered as study end‐points. The 1‐year incidence of AD was compared between the two study groups. Adjusted odds ratios (OR) with 95% confidence intervals (CI) were calculated by multiple logistic regression. The incidence of AD was calculated in relation to age at introduction of solid food and amount of food given. In the breast‐fed group, the adjusted OR for AD was 0.47 (95% CI 0.30–0.74). The strongest risk factor was the occurrence of AD in the subject's core family. The risk of infants with AD to be sensitized to milk was four times higher, and to egg eight times higher, than in infants without AD. Age at first introduction of solid food and diversity of solid food showed no effect on AD incidence. We conclude that in infants at atopic risk, exclusive breast‐feeding for at least 4 months is effective in preventing AD in the first year of life.     

Food allergy and atopic dermatitis in infancy: an epidemiologic study

Atopic dermatitis is common in infancy. The role of food allergy in atopic dermatitis of infancy is unclear. We examined the relationship between atopic dermatitis and immunoglobulin E (IgE)-mediated food allergy in infancy. A birth cohort of 620 infants with a family history of eczema, asthma, hayfever or immediate food allergy in a parent or sibling: 487 children had complete data including skin prick tests (SPTs) to evaluate IgE-mediated food allergy to cow milk, egg and peanut. Participants were grouped as no atopic dermatitis (Gp 0) or in quartiles of increasing severity of atopic dermatitis (Gps 1-4) quantified by days of topical steroid use as reported monthly. Adverse reactions to foods were recorded. The cumulative prevalence of atopic dermatitis was 28.9% to 12 months (10.3% of the cohort of moderate severity). As atopic dermatitis severity increased so did the prevalence of IgE-mediated food allergy (Gp 0, 40/346 vs. Gp 1, 6/36 vs. Gp 2, 8/35 vs. Gp 3, 12/35 vs. Gp 4, 24/35; chi(2) = 76; p < 10(-6)), and the frequency of reported adverse food allergy reactions (Gp 0, 43/346 vs. Gp 1, 4/36 vs. Gp 2, 8/35, vs. Gp 3, 5/35, vs. Gp 4, 13/35; chi(2) = 17; p = 0.002). The relative risk of an infant with atopic dermatitis having IgE-mediated food allergy is 5.9 for the most severely affected group. Atopic dermatitis is common in infancy. There is a strong association between IgE-mediated food allergy and atopic dermatitis in this age group.     

PROPHYLAXIS OF ATOPIC DISEASE BY SIX MONTHS' TOTAL SOLID FOOD ELIMINATION

ABSTRACT. One hundred and thirty-five infants of atopic parents were exclusively breast-fed for 6 months without any cow's milk based supplements. Of these infants 70 received no nourishment except breast milk during the 6 months, and 65 were started on solid foods at the age of 3 months. The diet of all the infants was similar during 6 to 12 months of age. The children were examined at the age of one year. In the exclusive breast milk group atopic eczema and food allergy were less frequent than in the solid food group. The results suggest that total solid food elimination for the first 6 months of life, in addition to exclusive breast milk feeding, is prophylactic for atopic disease in children who are at hereditary risk.     

Diagnostic accuracy of the atopy patch test and the skin-prick test for the diagnosis of food allergy in young children with atopic eczema/dermatitis syndrome

Aim: To evaluate the diagnostic value of the skin-prick test and the atopy patch test in diagnosing basic food allergy in young children suffering from atopic eczema/dermatitis syndrome.

Methods: 141 children, the majority under 2 y of age (mean 16 mo) with atopic eczema/dermatitis syndrome were investigated using skin-prick and atopy patch tests for milk, egg, wheat and rye. Open diagnostic elimination challenge was done since this has been reported to be a reliable method in young children.

Results: A positive challenge response was found to milk in 63 (45%), egg in 78 (55%), wheat in 61 (43%) and rye in 61 (43%). Sensitivity/specificity of the atopy patch test was 60%/97% for milk, 71%/97% for egg, 90%/94% for wheat and 93%/90% for rye. For the skinprick test the corresponding figures were 41%/99%, 60%/97%, 13%/98% and 15%/99%.

Conclusion: Patch testing was found to be a more sensitive method than the skin-prick test in diagnosing food allergy in children with atopic eczema/dermatitis syndrome, especially in those under 2 y of age. Many children with a negative skin-prick test result have a positive patch test result, especially in the case of cereals. A diagnosis of food allergy should be confirmed by elimination and in the research setting also by challenge.     

Prospective, controlled, multi-center study on the effect of an amino-acid-based formula in infants with cow's milk allergy/intolerance and atopic dermatitis

Cow's milk allergy/intolerance is treated by complete avoidance of cow's milk proteins. Because cow's milk is an important food for infants, its avoidance may lead to an increased risk of growth impairment. Whilst there is evidence for the beneficial effects of extensively hydrolyzed cow's milk formulae (eHF) in infants with cow's milk allergy/intolerance, little is known about the effects of amino-acid-based formulae (AA) in such infants. We therefore performed a prospective, controlled, multi-center trial to study the efficacy of AA in comparison with eHF, on the growth and clinical symptoms of 73 infants (median age 5.7 months) with cow's milk allergy/intolerance and atopic dermatitis. Cow's milk allergy/intolerance was proven in all infants by double-blind, placebo-controlled food-challenge. We observed a significant improvement in the SCORAD index in both groups, from a mean of 24.6, at entry, to a mean of 10.7 (p < 0.0001) after 6 months. In the AA group there was a significant increase in the length standard deviation score (p < 0.04), whilst there was no difference in the eHF group. The weight-for-length values were stable in both groups. The energy intake during the study was similar in both groups. Both an AA and eHF resulted in a significant clinical improvement in infants with an early onset of symptoms of cow's milk allergy/intolerance. Feeding an AA resulted in improved growth compared with feeding eHF, despite similar dietary intakes, and may therefore be considered as a beneficial alternative in infants with severe cow's milk allergy intolerance.     

Primary allergy prevention: partially or extensively hydrolyzed infant formulas?

The natural history of allergic disease and its potential for prevention merit close examination because of the explosive worldwide increase in the prevalence and morbidity of atopic disorders. In infants from 'high-risk' families (i.e. those with one or two parents and/or a sibling with food allergy, eczema, asthma or allergic rhinitis) food allergen avoidance has been advocated as means of preventing the development of atopic disease. The aim of this review was to evaluate the allergy preventive potential of partially or extensively hydrolyzed formulas. When breast-feeding is not possible or supplemental feeding is needed, infants from atopic families should be given a hydrolyzed infant formula for the first 6 month of life. High-risk infants without a history of eczema in a primary relative will receive the protective effect from the less expensive partial hydrolyzed formula (p-HF); whereas those infants who have first-degree relatives with eczema should receive the extensively hydrolyzed formula (e-HF).