牛奶蛋白过敏诊治1精要.ppt

* * * 牛奶蛋白过敏（CMPA）的诊断与 治疗 陈同辛 上海交通大学医学院附属新华医院 上海市儿科医学研究所 在婴儿和低龄儿童CMPA/I是最常见的食物不良反应 5%-15%儿童存在着疑似CMPA/I的症状 发病率实际为2%-3%（激发试验结果） 牛奶蛋白过敏或不耐受（CMPA/I）发生率 儿童牛奶蛋白过敏和不耐受（CMPA/I）与特应性疾病的临床过程 1749婴儿（1年中出生） 117（6.7%）CMPA/I疑似症状 39（2.2%）（1.5-2.9%）确诊CMPA/I 78未确诊CMPA/I 9（0.5%）（0.2-0.9%）CMPA/I母乳可抗CMP Fig. 1. Prospective study of 1-year birth cohort from 1985 in Odense, Denmark. CMP, cow’s milk protein; CMPA/I, cow’s milk protein allergy/intolerance. Some 117/1749 (6.7%) had symptoms suggestive of cow’s milk protein allergy/intolerance (CMPA/I) during the first year of life. Based on controlled milk eliminations and challenge procedure the diagnosis of CMPA/I was confirmed in 39/117, resulting in a 1-year incidence of CMPA/I of 2.2% with 95% confidence interval of 1.5–2.9%. Nine of 39 infants with CMPA/I were confirmed to react against cow’s milk protein in human milk, corresponding to 0.5% of the birth cohort (95% confidence interval of 0.2–0.9%) Host A, et al. Clinical course of cow’s milk protein allergy/ intolerance and atopic diseases in childhood. Pediatr Allergy Immunol, 2002, 13(Suppl. 15): 23–28 CMPA/I的预后（1） Host A, et al. Clinical course of cow’s milk protein allergy/ intolerance and atopic diseases in childhood. Pediatr Allergy Immunol, 2002, 13(Suppl. 15): 23–28 CMPA/I的预后（2） Host A, et al. Clinical course of cow’s milk protein allergy/ intolerance and atopic diseases in childhood. Pediatr Allergy Immunol, 2002, 13(Suppl. 15): 23–28 CMPA/I的预后（3） Host A, et al. Clinical course of cow’s milk protein allergy/ intolerance and atopic diseases in childhood. Pediatr Allergy Immunol, 2002, 13(Suppl. 15): 23–28 Fig1 疑似食物过敏患儿的临床评估 病史 发病年龄、临床表现、喂养史、辅食添加时间、食物或其他因素所致的相关症状、家族或个体特应性疾病史 体格检查 检查食物过敏的体征、与相关疾病鉴别 筛查试验 血清总IgE、嗜酸细胞、血清特异性IgE、SPT、斑贴试验、膳食回避试验 诊断确定 对照的口服激发试验 *必要行胃肠病学试验 （内窥镜、组织学、炎性标记、胃肠动力） Canani RB,et al. The diagnosis of food allergy in children. Curr Opin Pediatr, 20: 584-589 牛乳蛋白过敏的表现 (CMPA) 大多数牛乳蛋白过敏婴儿在1月龄之内出现症状 大多数婴儿有二种或更多的症状 症状: 呕吐, 胃肠道症状: 食用后最快1-2小时 腹泻: 食用后2-6 小时 Host et al