儿童食物过敏的预后及影响因素研究

儿童食物过敏包含食物耐受形成和持续食物敏感并发生其他过敏性疾病两种预后.大多数牛奶、鸡蛋过敏患儿可获得耐受,耐受形成较早;10%～20%对花生、坚果、鱼虾等过敏的患儿可形成耐受,耐受发生较晚.食物种类、免疫应答类型、食物特异性IgE抗体水平、食物的皮肤点刺试验反应等是食物耐受形成早晚的预测因素,同时,食物过敏患儿还可能持续过敏,发生对其他种类食物的过敏和(或)变应性鼻炎、支气管哮喘、特应性皮炎等其他过敏性疾病.婴儿期发生食物过敏和(或)持续食物过敏或敏感是其他过敏性疾病发生的危险因素.早期监测食物耐受发生的预测因素和其他过敏性疾病发生的危险因素,有助于改善食物过敏患儿的预后.     

乌鲁木齐地区喘息患儿发生支气管哮喘的危险因素

目的 探讨乌鲁木齐地区喘息患儿发生支气管哮喘(哮喘)的危险因素.方法 对2008年1 -12月在新疆医科大学第五附属医院门诊及住院的300例喘息患儿的临床资料进行统计.用统一的调查表调查其年龄、性别、湿疹、变应性鼻炎、食物过敏、家族过敏史/哮喘史、运动相关性喘息等.出院后通过门诊或电话进行随访.采用 Logistic回归分析方法对各因素与哮喘发生的关系及相关程度进行分析.结果 随访2a,275例获得随访;25例失访.275例喘息患儿在随访期内86例(31.2％)发生哮喘.Logistic回归分析发现湿疹、变应性鼻炎、家族过敏史/哮喘史、运动相关性喘息、反复下呼吸道感染( LRTI)、外周血嗜酸性粒细胞(EOS)增高与喘息患儿发生哮喘有关(湿疹:OR=2.376,95％ CI0.098～0.935,P=0.039;变应性鼻炎:OR=1.052,95％ CI2.267 ～14.283,P =0.024;家族过敏史/哮喘史:OR=1.886,95％CI1.004～3.542,P =0.048;运动相关性喘息:OR=1.881,95％ CI2.267 ～18.983,P =0.001;LRTI:OR=5.341,95％ CI1.676～ 10.983,P =0.016;外周血EOS增高:OR=3.915,95％ CI1.459～ 10.501,P=0.002).结论 个人过敏史(湿疹和变应性鼻炎)、家族过敏史/哮喘史、运动相关性喘息、LRTI、外周血EOS增高是乌鲁木齐地区喘息患儿发生哮喘的危险因素.     

上海市七区0-14岁儿童哮喘流行病学调查北大核心CSCD

目的了解上海市0～14岁儿童哮喘的患病现状、特点及影响疾病的相关因素。方法采用整群抽样的方法,于2010年9-12月抽取上海7个行政区13500名0～14岁儿童作为调查对象,通过发放问卷及现场问诊、体检的方式完成调查。分析儿童哮喘患病现状及临床特点,并采用Logistic回归方法分析影响哮喘发生的主要因素。结果共发放儿童哮喘初筛问卷13500份,实际回收有效问卷13179份,初筛问卷应答率97．62％,其中男性7054名,女性6125名;最终确诊哮喘患儿998例（7．57％）,其中男性患病率为8．48％（598／7054）,显著高于女性（400／6125,6．53％,x2=17．75,P〈0．001）;患病率较高的年龄段集中在3—8岁,哮喘患儿（545例）占该年龄段儿童（5212例）的10．46％,54．61％（545／998）的患儿首次发病在3岁以内;呼吸道感染（838例,84．97％）是哮喘发作的首位诱因;男性（OR＝0．25,95％CI：0．12～0．45）,有家族过敏性疾病史（OR=2．65,95％CI：1．27～5．55）,有个人过敏性疾病史（OR=9．57,95％CI：4．59～19．97）,早期使用抗生素（OR=0．61,95％CI：0．49～0．83）是儿童哮喘发生的危险因素。确诊患儿中,463例（46．39％）患儿使用过吸人激素,740例（74．15％）患儿使用过支气管舒张剂。结论上海儿童哮喘患病率较10年前的4．52％显著升高,其发病与患儿性别,家族过敏史,个人过敏性疾病史及抗生素的使用有关。     

中国儿童哮喘危险因素的Meta分析

目的 探讨中国儿童哮喘的主要危险因素,为哮喘的防治提供参考依据。方法 系统收集中国知网、万方数据库、中国生物医学文献数据库、维普中文科技期刊全文数据库、Web of Science和PubMed等数据库从建库至2017年9月有关中国儿童哮喘危险因素的研究。采用Stata 12.0软件进行Meta分析。结果 共纳入24篇病例对照研究,其中病例组5 309例,对照组6 404例。Meta分析显示,家族哮喘史（OR=5.246,95% CI：3.435~8.011）、家族过敏史（OR=4.627,95% CI：2.450~8.738）、特应性体质（OR=4.659,95% CI：2.511~8.644）、变应性鼻炎（OR=11.510,95% CI：6.769~19.574）、湿疹/皮炎史（OR=4.919,95% CI：3.514~6.886）、患儿过敏史（OR=4.732,95% CI：2.802~7.989）、食物过敏史（OR=5.890,95% CI：3.412~10.166）、药物过敏史（OR=4.664,95% CI：2.637~8.252）、家中有霉斑（OR=2.483,95% CI：1.671~3.690）、家中种花草（OR=1.748,95% CI：1.383~2.209）、房屋装修史（OR=2.823,95% CI：2.206~3.935）、剖宫产（OR=1.894,95% CI：1.166~3.077）是儿童哮喘的危险因素,母乳喂养是儿童哮喘的保护因素（OR=0.508,95% CI：0.396~0.653）。结论 中国儿童哮喘的发生与多种因素有关,其中家族哮喘史、家族过敏史、个体特应性体质、过敏史、过敏合并症、剖宫产出生及不良的家庭环境因素可增加儿童哮喘的患病风险,而母乳喂养可降低儿童哮喘的患病风险。     

哮喘儿童体外过敏原抗体280例调查研究

目的了解东莞市哮喘儿童过敏原分布情况。方法（1）问卷调查；（2）用UniCAP100全自动检测仪、荧光免疫检测法、体外检测哮喘组及肺炎组（对照组）患儿血清过敏原抗体。吸人性过敏原筛查包括：螨及屋尘螨、粉尘螨等。食人性过敏原筛查（FX5E）：主要为牛奶、鸡蛋、虾、螃蟹、鱼等。结果吸人性过敏原筛查：肺炎组受检296例患儿中，阳性为75例（25．33％）；哮喘组受检280例患儿中，阳性为230例（82．14％）。食人性过敏原筛查：肺炎组受检296例患儿中，阳性为45例（15．20％）；哮喘组受检280例中，阳性为142例（50．71％）。哮喘组与肺炎组间吸人性过敏原、食人性过敏原差异均有统计学意义（P〈0．05）。哮喘组对尘螨呈高敏感趋势，而且阳性率随年龄增长而增长，呈正相关关系。哮喘组对食人性过敏原较为敏感者，主要是对海鲜类过敏，其次为常见蔬果过敏。结论本组受检哮喘儿童吸人性过敏原中，主要过敏原为尘螨。而且阳性率及过敏反应程度随年龄的增长而增长，呈正相关关系。部分哮喘儿童对海鲜类食物过敏，其次是对常见蔬果类过敏。     

婴儿捂热综合征死亡的危险因素

目的探讨婴儿捂热综合征（IMS）死亡的危险因素。方法回顾性分析2002年1月-2007年2月63例IMS患儿的临床资料，按照是否并代谢性酸中毒、高血糖、低血钙、超高热，及儿童危重病例评分（PCIS）、脏器衰竭数目对患儿进行分组，对各项危险因素行χ^2检验，比较组间患儿的病死率。结果63例患儿住院期间病死率为22．1％。并代谢性酸中毒与未并代谢性酸中毒患儿病死率比较差异有统计学意义（RR=3．20，95％CI=1．0～10．24，χ^2=4．76P〈0．05），且病死率随着血pH降低而升高（Pearson列联系数=0．49，χ^2=9．80P〈0．05）。存活48例与15例死亡患儿PCIS评分相比有显著差异（t=7．798P〈0．05）。PCIS≤80分与〉80分患儿的病死率相比有显著差异（RR=12．73，95％CI=1．78～91．04，χ^2=13．24P〈0．05）。血糖〉12mmol／L的患儿与血糖〈12mmol／L的患儿相比差异有统计学意义（RR=3．73，95％CI=1．46～9．54，χ^2=8．73P〈0．05）。并低血钙与未并低血钙的患儿病死率相比有显著差异（RR=3．0,95％CI=1．23—7．31，χ^2=6．30P〈0.05）。体温≥41℃与体温〈41℃的患儿病死率相比有显著差异（RR=3．0，95％CI=1．34～6．74，χ^2=3．97P〈0．05）。脏器衰竭≥3个与脏器衰竭〈3个的患儿病死率相比有显著差异（RR=7．88，95％a=2．85～21．78，χ^2=17．66P〈0．05）。结论代谢性酸中毒、高血糖、低血钙、超高热、低PCIS评分及多脏器衰竭可能是IMS的死亡危险因素。     

中国三城市儿童个人过敏原与喘息及气道高反应性的相关性研究

目的 了解个人过敏原阳性与喘息及气道高反应性的关系。方法 在北京、广州及香港三城市中采用整群抽样的方法,在9～11岁在校学龄儿童中,应用国际间儿童哮喘与过敏性疾病研究的第二阶段研究方案进行研究,内容包括(1)家长书面问卷(共收集问卷10902份),(2)儿童皮肤过敏原点刺试验(3478例),(3)乙酰甲胆碱支气管激发试验(608例)。结果 近期喘息(在12个月内有发作)发生率：北京3．8％、广州3．4％、香港5．8％。特应性(即≥1种过敏原阳性)阳性率北京23．9％、广州30．8％、香港41．2％。乙酰甲胆碱支气管激发试验阳性率：北京33．2％、广州45．8％、香港30．7％。多因素logistic回归分析显示,屋尘螨P[相对危险度(OR)=4．48;95％可信限(CI)：3．02—6．66]、猫毛(OR=2．59;95％CI：1．67～4．02)、粉尘螨F(OR=2．41;95％CI：1．65～3．51)及混合草花粉过敏(OR=2．85;95％CI：1．24～6．50)是近期喘息显著相关的危险因素;特应性(OR=1．29;95％CI：0．74～2．24)与近期喘息无显著相关性。特应性(OR=2．53;95％CI：1．07～5．97)、猫毛(OR：3．01;95％CI：1．39～6．52)及粉尘螨F(OR=3．67;95％CI：1．93～6．97)是气道高反应性显著相关的危险因素。结论 屋尘螨P、粉尘螨F、猫毛、混合草花粉是9-ll岁组儿童近期喘息的危险因素,而特应性不是近期喘息的独立危险因素。特应性、猫毛、粉尘螨F是气道高反应性的危险因素。     

系统评价挤压脐带对新生儿的影响

目的系统评价挤压脐带（UCM）对新生儿的影响。方法检索Cochrane图书馆、Pub Med、EMBASE、万方数据库、中国期刊全文数据库和中国维普数据库,检索时间均从1990年1月起至2013年4月,对同质资料进行Meta分析。结果共纳入5项研究（372例）。UCM与过早脐带结扎（ECC）／立即脐带结扎（ICC）相比,新生儿出生时血红蛋白水平（MD=2．08,95％CI：1．65—2．52）和6周时血红蛋白水平（MD=1．10,95％口：0．73～1．47）升高,出生时红细胞比积（MD=4．69,95％CI：2．87～6．51）和平均动脉压（MD=5．81,95％CI：4．17～7．45）升高,低血压的发生风险（OR=0．22,95％CI：0．06—0．86）、扩容药物的使用（OR=0．17,95％CI：0．06—0．47）、颅内出血发生率（OR=0．41,95％CI：0．18～0．94）均降低,差异均有统计学意义（P〈0．05）;UCM与延迟脐带结扎（DCC）相比,新生儿出生时红细胞比积差异无统计学意义（P〉0．05）。UCM对新生儿出生后最高血清总胆红素水平、红细胞增多症、坏死性小肠结肠炎、早产儿视网膜病变、脑白质软化发生率和新生儿死亡率的影响均无统计学意义（P〉0．05）。结论UCM可以提高新生儿出生后的血红蛋白水平,减少新生儿出生后低血压和颅内出血的发生,有可能成为一项安全的改善新生儿预后的临床方法;但目前纳入研究样本量偏少,缺乏长期的随访评估研究,因而有必要进一步开展高质量、大样本随机对照试验评价其作用和安全性。     

舌下含服粉尘螨滴剂治疗儿童过敏性哮喘和变应性鼻炎的临床评价

目的评估舌下特异性免疫治疗药物“粉尘螨滴剂”治疗儿童过敏性哮喘及变应性鼻炎的疗效及安全性。方法采用随机双盲、安慰剂平行对照的研究方法,将278例年龄4—18岁粉尘螨过敏的哮喘和（或）鼻炎患儿随机分为治疗组（139例）和安慰剂组（139例）,分别给予舌下含服“粉尘螨滴剂”或安慰剂,在治疗第2,3,4,6,10,14,18,22周进行随访,治疗第25周结束临床观察。对两组治疗前后的哮喘和鼻炎症状与体征评分、用药计分、肺功能及各项实验室指标、不良事件进行分析比较,并在试验结束前让患儿进行疾病转归的自我评价。结果（1）278例研究对象中,共251例完成试验;（2）治疗组过敏性哮喘患者PEF日内变异率改变量-1．38,而安慰剂组仅为-0．90（P〈0．05）;（3）治疗结束后,过敏性哮喘治疗组应急用药改变量较基线有所下降（x=-0．08）,而安慰剂组用药则有所增加（x=0．52）,两组用药剂量较基线改变量的差异有显著性（W=-2．45,P〈0．05）;（4）治疗组鼻炎患者每日症状积分改变量为-1．96,而安慰剂组为-1．03（W=3．90,P〈0．01）;（5）鼻炎患者安慰剂组应急用药量较基线改变量为0．01,治疗组为-0．25,但两组差异无统计学意义（W=1．40,P〉0．05）;（6）用药25周以后,两组血清特异性IgE（sIgE）水平较用药前无显著改变,而治疗组的血清特异性IgG4平均水平显著增高（P〈0．05）;（7）试验期间未发生严重不良事件,与研究药物可能有关的不良反应主要表现为哮喘轻度发作和局部皮疹。结论“粉尘螨滴剂”是一种安全有效治疗儿童过敏性哮喘和变应性鼻炎的舌下特异性免疫治疗药物。     

新疆地区过敏性鼻炎患儿过敏原检测分析

目的 了解新疆地区过敏性鼻炎患儿过敏原的分布状况,为儿童过敏性鼻炎的防治提供科学依据。方法 采用体外特异性过敏原检测试剂盒（IVT）对104例过敏性鼻炎患儿进行吸入过敏原（IVT701）检测,其中88例患儿同时行食物过敏原（IVT702）检测。结果 104例过敏性鼻炎患儿IVT701测试总阳性率73．1％,以蒿属植物最高38．5％,其后依次为榆杨柳树31．7％,豚草（巨大豚草、普通豚草）20．2％,霉菌（点青霉、交链孢霉、黑根霉）14．4％,螨（粉螨、尘螨）11．5％,屋尘7．7％等。88例患儿IVT702的总阳性率为56．8％。过敏原主要为大豆、花生28．4％,其次为鳕鱼和鸡蛋,分别为15．9％、13．6％,蟹虾为11．4％,牛奶和牛羊猪肉分别为5．7％和4．5％。65例患儿对2种及2种以上过敏原过敏。蒿属的阳性率随年龄的增长而增长（X^2=4．662．P〈0．050）。结论 蒿属为新疆地区过敏性鼻炎患儿最主要的过敏原,食物过敏亦占相当比例。明确过敏原后对特异性免疫治疗具有重要的指导意义。     

Association of food allergy with asthma severity and atopic diseases in Jewish and Arab adolescents

Aim: To investigate the prevalence of reported food allergy and its association with atopic diseases and asthma severity among Jewish and Arab adolescents. Subjects and methods: The self‐report questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC) was administered to adolescents aged 13–14 years from randomly selected junior high schools in Israel. Questions regarding food allergy were added. Results: A total of 11 171 questionnaires were available for analysis. Food allergy was reported by 3.6% of participants: 1.9% milk, 0.6% egg, 0.6% peanut and 0.4% sesame. On multivariate analysis, food allergy was strongly associated with current asthma (OR, 2.5; 95% CI, 1.8–3.3), atopic eczema (OR, 3.2; 95% CI, 2.4–4.3) and allergic rhinitis (OR, 2.4; 95% CI, 1.8–3.1). Arabs were significantly more allergic to peanut (OR, 2.5; 95% CI, 1.5–4.1), egg (OR, 3.5; 95% CI, 2.1–5.9) and sesame (OR, 2.3; 95% CI, 1.2–4.5) than Jews, and less allergic to milk (OR, 0.6; 95% CI, 0.4–0.9). Asthmatic subjects with food allergy had significantly more parameters of severe asthma than those without food allergy (p < 0.001). Conclusions: The prevalence of allergy to specific foods differs between Jews and Arabs. Asthmatic adolescents with food allergy report more severe asthma than those without food allergy.     

Monitoring of IgE-mediated food allergy in childhood

Background: The prevalence of IgE-mediated food allergy (FA) in childhood varies from 6% to 8% in the first year of life compared to 1% to 2% in adults. In contrast to adults, FA in childhood, often part of the “allergic march”, resolves in more than 85% of children, especially those with hypersensitivity to cow's milk and egg. Aim: This paper explains the rationale for continuing care for childhood FA and describes how children should be monitored for resolution/persistence of FA. Methods: A clinical, multidisciplinary approach and management algorithm based on relevant, peer-reviewed original research articles and reviews using the keywords anaphylaxis, atopic eczema, children, milk allergy, double-blind placebo-controlled food challenge, egg allergy, epinephrine, failure to thrive, food allergy, food challenge, food hypersensitivity, immunoglobulin E, nutrition, natural history, paediatrics, peanut allergy, prevalence, psychosocial factors, quality of life, radioallergosorbent test, and tolerance from years 1966 to 2003 in MEDLINE. Additional studies were identified from article reference lists. Results: A combination of outcome measures, a multidisciplinary approach involving a dietitian and allergy nurse specialist, and a management algorithm are useful tools in clinical management.

Conclusions: Prospective studies of non-selected children, optimally from birth cohorts, are needed to evaluate the effects of such management programmes regarding FA in childhood.     

Skin prick test predictive value on the outcome of a first known egg exposure in milk-allergic children

Children with milk allergy have higher incidence of other food allergies, especially egg allergy. The objective of this study was to ascertain the accuracy of the prick test in children with IgE-mediated milk allergy for diagnosing egg allergy. Children under the age of 1 yr who came consecutively to Allergy Department 2003–05, and were diagnosed with IgE-mediated milk allergy were selected for this study. Egg introduction was completely avoided until the age of 14 months when clinical history, skin prick tests (SPT), specific-IgE antibodies determination and egg challenge test were performed. One hundred and four milk-allergic children were included. At least one positive prick test to any egg allergen was found in 65 out of the 104 (62.5%). Thirty-eight (36.5%) were allergic to egg proteins as well. Prick tests with egg white and ovomucoid (OVM) had the best diagnostic performances showing the largest areas under the receiver operating characteristic curve. The optimal diagnosis cut-off point was 6 mm for egg white and 5 mm for OVM. The positive likelihood ratios for these cut-off points were: 2.95 (95% CI: 1.74–4.99) for egg white prick test, and 20 (95% CI: 2.9–143.7) for OVM prick test. Children with specific IgE-mediated cow's milk allergy must be closely followed as a risk group for egg allergy. Early diagnosis is necessary and the SPT has shown itself to be a very useful tool for diagnosing immediate IgE reactions to egg on first known exposure.     

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。     

Immunological basis and management of food allergy

One of the most common allergies in children involves cow's milk, which contains approximately 20 different proteins that can cause allergic reactions. It is well known that children exhibiting signs of cow's milk allergy early in life often go on to develop allergy-related respiratory diseases; thus, management of early sensitisations and symptoms of food allergies is crucial to preventing subsequent allergic complications. Constant allergen exposure and other environmental factors determine whether a sensitised individual will become chronically allergic and experience persistent symptoms. Management of food allergies in children focuses on minimising sensitisation and encouraging immune system maturation through the exposure of children to exogenous stimuli known to prime the immune system. Hypoallergenic molecules or allergen avoidance can also be used to induce tolerance in allergy-prone children. Available evidence suggests that the onset of the sensitisation phase and the degree of inflammation can be modulated by external factors such as nutrition, and guidelines outlining the most effective dietary regimen for the prevention of allergic disease have been published. The underlying mechanisms of tolerance induction and the potential benefits of prophylactic treatment for food allergies remain to be determined.     

三城市两岁以下儿童食物过敏现状调查

目的 通过多中心大样本研究了解我国0～2岁儿童食物过敏现状.方法 将2009年1月至2月及2010年1月至5月在重庆、珠海、杭州3城市儿童保健机构进行常规体检的儿童依次纳入研究.家长填写问卷调查表,对所有纳入儿童进行皮肤点刺试验,筛查的10种食物抗原提取物,包括蛋白、蛋黄、牛奶、大豆、花生、小麦、鱼(海鱼)、虾(海虾)、橘子和胡萝卜.根据皮肤点刺试验和病史结果确定的可疑病例进行食物排除和食物激发试验,按激发试验结果确诊食物过敏.结果 3城市1687例0～2岁儿童中除83例失访外,共有1604例儿童(重庆550例,珠海573例,杭州481例)完成诊断过程.食物激发试验确诊食物过敏儿童100例(重庆40例,珠海33例,杭州27例).重庆、珠海、杭州儿童食物过敏检出率分别为7.3％,5.8％,5.6％,3城市儿童食物过敏平均检出率为6.2％,3城市间儿童食物过敏检出率差异无统计学意义(x2=1.058,P=0.304);最常见的食物过敏原均为鸡蛋(3.0％～4.4％),其次是牛奶(0.83％～3.5％)、虾(0.17％～0.42％)、鱼(0.17％ ～0.21％).结论我国3城市0～2岁儿童食物过敏检出率为5.6％ ～ 7.3％;3城市间儿童食物过敏检出率相近;最常见的食物过敏原为鸡蛋,其次是牛奶、虾和鱼.     

CLINICAL AND IMMUNOLOGICAL ASPECTS OF FOOD ALLERGY IN CHILDHOOD I. Estimation of IgG, IgA and IgE Antibodies to Food Antigens in Children with Food Allergy and Atopic Dermatitis

Abstract Sixtynine children with case histories of food intolerance and 30 food tolerant children with atopic dermatitis have been investigated regarding serum IgE levels and IgE-, IgG, and IgA-antibodies to some common foods. Children with food intolerance had significantly higher IgE levels and to a larger extent specific IgE antibodies to the tested allergens. IgE antibodies to cow's milk were found in 71% of the children with histories of cow's milk allergy but occurred also in similar titers in 27% of milk tolerant children with other food allergies. IgE antibodies to egg-white occurred in 88% of egg allergies, but low and moderate titers were also found in 17% of children without food intolerance. However, all children with high titers had symptoms of egg allergy. IgE antibodies to the fish allergen were only found in fish allergic children while IgE antibodies to soy-bean and green peas were found less consistently. The level of serum IgA antibodies to milk was similar in both groups. The IgG antibody titers to all tested food antigens seemed to parallel the IgE antibody titer to the same food. It was not possible to correlate the IgG antibody titers to symptoms.     

Clinical and immunological aspects of food allergy in childhood. I. Estimation of IgG, IgA and IgE antibodies to food antigens in children with food allergy and atopic dermatitis

Sixtynine children with case histories of food intolerance and 30 food tolerant children with atopic dermatitis have been investigated regarding serum IgE levels and IgE-, IgG, and IgA-antibodies to some common foods. Children with food intolerance had significantly higher IgE levels and to a larger extent specific IgE antibodies to the tested allergens. IgE antibodies to cow's milk were found in 71% of the children with histories of cow's milk allergy but occurred also in similar titers in 27% of milk tolerant children with other food allergies. IgE antibodies to egg-white occurred in 88% of egg allergies, but low and moderate titers were also found in 17% of children without food intolerance. However, all children with high titers had symptoms of egg allergy. IgE antibodies to the fish allergen were only found in fish allergic children while IgE antibodies to the fish allergen were only found in fish allergic children while IgE antibodies to soy-bean and green peas were found less consistently. The level of serum IgA antibodies to milk was similar in both groups. The IgG antibody titers to all tested food antigens seemed to parallel the IgE antibody titer to the same food. It was not possible to correlate the IgG antibody titers to symptoms.     

Formula feeding during cow's milk allergy

Cow's milk allergy (CMA) is an immunologically mediated reaction to cow's milk proteins, which affects infant and young children. Cow milk elimination requires either breast-feeding, with or without elimination diet in mother or the use of specific formulas, based on cow's milk protein extensively hydrolyzed, which fit 90-95% of children with cow's milk allergy. In others, still reactive to allergic remnants in hydrolysates, an amino acid based formula is the optimal option. The good tolerance of soy formulas in a reasonable proportion of children with cow's milk allergy make them useful, including as a 1(st)-choice alternative, except probably for those below the age of 6 months. Any elimination diet in children is at risk of nutritional deficiency so that a constant monitoring of the growth parameters should be kept in those children.     

Egg allergy: Are all childhood food allergies the same?

Egg allergy is one of the most common food allergies in childhood affecting about 1-2% of preschool children and differs in a number of ways from other common childhood food allergies such as cows milk and peanut. Common egg allergens are altered both by heat and gastric enzymes. Compared with peanuts/tree nuts and milk, egg allergy appears less likely to cause severe life-threatening reactions or fatal anaphylaxis. Children are much more likely to outgrow egg allergy by school age as compared with peanut allergy. While the MMR vaccine is no longer contraindicated in egg allergy, influenza vaccine is contraindicated in children with anaphylaxis to egg. An understanding of the similarities and differences in these common food allergies of childhood is helpful in the management of these common and increasing problems.