喂养干预对特应性高风险婴儿湿疹、食物过敏影响的跟踪研究

目的对具有特应性遗传背景的高风险婴儿随机进行不同方式的喂养干预,观察湿疹和食物过敏的发生情况,探讨喂养干预对婴儿湿疹和食物过敏发生的影响。方法从特应性夫妇中筛选出46例脐血IgE〉0．35kU／L的婴儿,随机分为干预组和非干预组。干预组23例,母乳喂养〉4个月,4个月龄内不添加任何固体辅食,随后低抗原性配方奶粉喂养,6个月内不添加鱼类、虾类食物,12个月内不添加蛋类、花生和坚果类食物;非干预组23例,母乳喂养〈4个月,或普通配方奶粉混合喂养或人工喂养,4个月添加蛋类辅食,其他辅食添加内容和顺序无任何建议或暗示,随访至18个月。临床观察婴儿湿疹的发生情况,食物点刺试验或Fx5E或sIgE检测食物过敏的发生情况。结果6个月时,喂养干预组婴儿湿疹累计发生率4．3％（1／23）,非干预组婴儿湿疹累计发生率26．1％（6／23）;12个月时．喂养干预组婴儿湿疹累计发生率8．7％（2／23）,非干预组婴儿湿疹累计发生率34．8％（8／23）;18个月时,喂养干预组时婴儿湿疹累计发生率17．4％（4／23）,非干预组婴儿湿疹累计发生率39．1％（9／23）,两组湿疹的发生率在各个阶段差异均有统计学意义。干预组食物过敏发生率为13．0％（3／23）;非干预组食物过敏发生率为34．8％（9／23）,差异有统计学意义,过敏食物以鸡蛋最为常见。结论母乳喂养、低抗原性配方奶、延迟添加辅食、高风险食物回避等综合喂养干预方式可以降低高风险婴儿特应性湿疹和食物过敏的发生率,是对具有特应性遗传背景的婴儿有效的初级干预措施。

Effects of feeding intervention on development of eczema in atopy high-risk infants: an 18-month follow-up study

Objective To assess the preventive effects of different dietary regimens on development of eczema and food allergy in infants at high-risk for allergy.Methods Forty-six infants whose parents were atopic and umbilical cord IgE>0.35 kU/L were enrolled in the study.The infants were randomly assigned at birth to one of 2 dietary regimen protocols:those in intervention group(23 cases)were breast fed till more than 4 months of age,then followed by feeding with partially hydrolyzed formula(pHF),combined solid foods avoidance until 4-month of age,egg,fish,shrimp avoidance until 12-month of age.The other 23 cases in non-intervention group were breast fed for less than 4 months,or bottle fed with cow's milk-based formula,egg yolk was introduced at 4-month of age,and egg white at 6-month of age,besides,no any other dietary avoidance was applied.All the infants were followed-up for 18 months.The primary end point was the presence of atopic eczema.Food allergy was detected by fresh food prick-to-prick tests or in vitro sIgE or Fx5E.Results At 6 months,12 months and 18 months,the incidence of eczema in intervention group was 4.3%(1/23),8.7%(2/23),and 17.4%(4/23),respectively,which was significantly reduced as compared to that of the non-intervention group,which was 26.1%(6/23),34.8%(8/23),and 39.1%(9/ 23),respectively.Food allergy was found in 13.0%(3/23)of intervention group and 34.8%(9/23)of non-intervention group by skin prick tests or sIgE.Egg white was the most common offending food.Conclusion Early life dietary interventions which included breastfeeding,delayed solid food introducing,pHF feeding, and high risk food avoidance could reduce the risk of atopic eczema and food allergy development,and was probably an effective primary intervention method for infants at high risk for atopy.