牛奶蛋白过敏诊治精要.ppt

疑似CMPA 临床评估：?临床表现、?家族史（危险因素） 疑似轻、中度CMPA 疑似重度CMPA 继续母乳喂养： 但母亲膳食回避：不摄入CMP 2w（伴有特应性皮炎或过敏性结肠炎者应达4w），同时补充钙剂，不食用鸡蛋 症状有改善 症状无改善 母亲恢复正常膳食（可继续母乳喂养）和（或）考虑其他（过敏的）诊断 疑似轻、中度CMPA 疑似重度CMPA 继续母乳喂养，但母亲膳食回避 症状有改善 症状无改善 重新摄入CMP 症状再现： 母亲继续膳食回避 补充钙剂 症状未再现： 重新摄入鸡蛋并随访观察 转奶后应食用eHF，并且固体食物中不含CMP，持续年龄到9~12m大小，但持续时间至少需＞6m 疑似CMPA 临床评估：?临床表现、?家族史（危险因素） 疑似轻、中度CMPA 疑似重度CMPA 表现为下述一个或多个症状： 胃肠道：由于腹泻或反流、呕吐所致的发育不良，拒奶、中到大量的便血所致血红蛋白降低，蛋白丢失性肠病 皮肤：重度特应性皮炎伴发育不良 由儿科专科医师进行诊治，同时母亲应膳食回避（无CMP）并补充钙剂 * * * 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 雀巢公司培训（2009-3-9，重庆） 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 all