Accidental allergic reactions in children allergic to cow's milk proteins
Accidental allergic reactions in children allergic to cow's milk proteins
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DOI：
10.1016/j.jaci.2008.12.1125
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发表时间：
2009-04-01
影响因子：
14.2
通讯作者：
Quirce, Santiago
中科院分区：
文献类型：
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作者：
Boyano-Martinez, Teresa;Garcia-Ara, Carmen;Quirce, Santiago
背景：牛奶是儿童食物过敏的主要原因。对食物过敏的患者经常会意外接触食物。分析这个问题的研究很少，大多是关于花生过敏。 目的：我们试图计算12个月内对牛奶过敏的儿童发生意外暴露反应的频率，分析反应的临床特征和情况，并确定严重反应的危险因素。方法：本研究纳入了88名对牛奶过敏的儿童（44名男孩，中位年龄为32.5个月）。使用了关于意外暴露的系统化调查问卷。反应分为轻度、中度和重度。测定了牛奶和酪蛋白特异性 IgE 抗体滴度。结果：35 名 (40%) 儿童在前一年出现了 53 次反应（53% 为轻度反应，32% 为中度反应，15% 为重度反应）。大多数反应发生在日常生活环境下（85%）的家中（47%）。严重反应儿童的牛奶特异性 IgE 水平高于中度反应儿童（中位数，37.70 vs 7.71 KUA/L；P = .04）或轻度反应儿童（3.37 KUA/L；P = .04）。哮喘儿童发生严重反应的频率高出 10 倍（比值比，10.2；95% CI，1.13-91.54）。结论：牛奶过敏儿童经常出现意外接触反应。严重反应比例为15%。此类反应的危险因素包括牛奶和酪蛋白的特异性 IgE 水平非常高以及哮喘。 （过敏临床免疫杂志 2009 年；123：883-8。）
Background: Cow's milk is the main cause of food allergy in children. Patients allergic to food frequently experience accidental exposure. There are few studies analyzing this problem, most of them concerning peanut allergy.Objective: We sought to calculate the frequency of accidental exposure reactions in children allergic to cow's milk during a 12-month period, to analyze the clinical characteristics and circumstances surrounding the reactions, and to identify risk factors for severe reactions.Methods: Eighty-eight children allergic to cow's milk (44 boys; median age, 32.5 months) were included in the study. A systematized questionnaire about accidental exposure was used. Reactions were classified as mild, moderate, and severe. Cow's milk- and casein-specific IgE antibody titers were determined.Results: Thirty-five (40%) children had 53 reactions in the previous year (53% mild, 32% moderate, and 15% severe). Most reactions took place at home (47%) under daily life circumstances (85%). Specific IgE levels to cow's milk were higher in children with severe reactions than in those with moderate (median, 37.70 vs 7.71 KUA/L; P = .04) or mild (3.37 KUA/L; P = .04) reactions. The frequency of severe reactions was 10-fold higher in asthmatic children (odds ratio, 10.2; 95% CI, 1.13-91.54).Conclusions: Reactions to accidental exposure are frequent in children with cow's milk allergy. The proportion of severe reactions was 15%. The risk factors for such reactions included very high levels of specific IgE to cow's milk and casein and asthma. (J Allergy Clin Immunol 2009;123:883-8.)