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  • Title: [Clinical characteristics of children with IgE-mediated cow's milk protein allergy].
    Author: Zheng HS, Zhu WJ, Liu CH, Li YX, Song X, Han TT, Wang W, Guan K, Sha L.
    Journal: Zhonghua Yu Fang Yi Xue Za Zhi; 2023 Aug 06; 57(8):1271-1279. PubMed ID: 37574323.
    Abstract:
    Objective: To analyze the clinical characteristics of children with IgE-mediated cow's milk protein allergy (CMPA) and provide a basis for disease management and prevention. Methods: A cross-sectional study was conducted to analyze 142 children aged 0-12 years who were diagnosed with IgE-mediated CMPA in Capital Institute of Pediatrics Affiliated Children's Hospital from 2020 to 2022. There were 79 males (55.6%) and 63 females (44.4%), with an average age of 14 (8, 27) months. 61 cases (43.0%) were in the <1-year-old group, 54 cases (38.0%) in the 1-3-year-old group, and 27 cases (19.0%) in the >3-year-old group. Data on demographic data, clinical manifestations, mean wheel diameter of skin prick test and serum specific IgE level were collected. The serum cow's milk protein sIgE and component sIgE were measured by ImmunoCAP fully automated system of fluorescence enzyme-linked immunosorbent assay, and statistically analyzed using chi-square test, nonparametric tests, correlation. Results: Cutaneous symptoms were the first and most frequent in 142 children (97.9%, 139/142 cases), followed by digestive (29.6%, 42/142 cases) and respiratory symptoms (27.5%, 39/142 cases).The proportion of children with respiratory symptoms after consuming cow's milk was significantly higher in the>3 years age group than those in the infant and toddler groups(66.7% vs 19.7%,χ2=18.396,P<0.01;66.7% vs 16.7%,χ2=20.250,P<0.01), and the symptoms involving ≥3 systems were also significantly higher than those in the other two groups(37.0% vs 13.1%,χ2=6.597,P<0.05;37.0% vs 7.4%,χ2=12.120,P<0.01). The average cow's milk SPT diameter and serum sIgE levels in the>3 years age group were significantly higher than those in the infant and toddler groups (Z=-4.682, P<0.01; Z=-3.498, P<0.01); (Z=-4.463, P<0.01; Z=-6.463, P<0.01). The most common cow's milk component protein were β-lactoglobulin(65.1%,56/86 cases) and casein (57.0%, 49/86 cases). Multiple-sensitization rate of the patients were 54.9%. Egg white (43.7%, 62/142 cases) was the most common co-sensitization food allergen while mold (12.7%, 18/142 cases) and weed pollen (12.7%, 18/142 cases) were the main co-sensitization aeroallergens. The proportion of multiple-sensitization to aeroallergens in the children group was the highest (51.9%, 14/27 cases), followed by the toddler group (29.6%, 16/54 cases), and the infant group was the least (3.3%, 2/61 cases). There was a significant difference among these three groups (χ2=7.476, P<0.05). Conclusion: Skin and mucosal symptoms are the most common in CMPA patients. The proportion of respiratory symptoms and multisystem involvement increased with age as well as the wheal diameter in skin test and serum sIgE level elevated. CMPA patients older than 3 years had the highest proportion of aeroallergen sensitization and airway allergic diseases. 目的： 探讨IgE介导的牛奶蛋白过敏（CMPA）患儿的临床特征，为疾病的管理和预防提供依据。 方法： 采用横断面研究的方法，纳入2020—2022年于首都儿科研究所附属儿童医院确诊IgE介导的0~12岁142例CMPA患儿为研究对象，男79例（55.6%），女63例（44.4%），平均月龄为14（8，27）月，其中<1岁组61例（43.0%），1~3岁组54例（38.0%），>3岁组27例（19.0%）。收集人口学资料、临床表现、牛奶皮肤点刺试验平均风团直径和血清特异性IgE等数据，采用ImmunoCAP全自动荧光酶联免疫检测系统测定血清牛奶蛋白sIgE和牛奶蛋白组分sIgE，使用卡方检验、非参数检验、相关性分析等进行统计分析。 结果： 142例患儿以皮肤症状为首发且最为多见（97.9%，139/142例），其次为消化（29.6%，42/142例）和呼吸系统症状（27.5%，39/142例）。3岁以上儿童组患儿进食牛奶后出现呼吸系统症状的比例明显高于婴儿组和幼儿组（66.7% vs 19.7%，χ2=18.396，P<0.01；66.7% vs 16.7%，χ2=20.250，P<0.01），且累积≥3个系统的比例亦显著高于另外两组（37.0% vs 13.1%，χ2=6.597，P<0.05；37.0% vs 7.4%，χ2=12.120，P<0.01）。3岁以上儿童组牛奶SPT平均风团直径和血清sIgE水平显著高于婴儿组和幼儿组［（Z=-4.682，P<0.01；Z=-3.498，P<0.01）；（Z=-4.463，P<0.01；Z=-6.463，P<0.01）］。最常见的牛奶蛋白组分是β-乳球蛋白（65.1%，56/86例）和酪蛋白（57.0%，49/86例）。54.9%的患儿存在多重变应原致敏，最常见合并致敏的食物变应原是鸡蛋白（43.7%，62/142例），吸入变应原为霉菌（12.7%，18/142例）和杂草花粉（12.7%，18/142例）。儿童组出现多重吸入变应原致敏比例最高（51.9%，14/27例），其次为幼儿组（29.6%，16/54例），婴儿组最少（3.3%，2/61例），三组之间出现多重吸入变应原致敏的比例存在显著差异（χ2=7.476，P<0.05）。 结论： CMPA患儿以皮肤黏膜症状最为常见。随年龄增长，呼吸系统和多系统受累症状的比例增加，牛奶皮肤测试的风团直径和血清sIgE水平升高。>3岁CMPA患儿出现吸入变应原致敏和患有气道过敏性疾病的比例最高。.
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