Clinical spectrum of food allergy in children in Australia and South-East Asia: identification and targets for treatment
Clinical spectrum of food allergy in children in Australia and South-East Asia: identification and targets for treatment
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DOI：
10.3109/07853899908995890
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发表时间：
1999-08-01
影响因子：
4.4
通讯作者：
Heine, RG
中科院分区：
文献类型：
--
作者：
Hill, DJ;Hosking, CS;Heine, RG
特应性疾病的患病率在全球范围内不断增加，其原因并不明确：食物过敏是特应性的最早表现。这篇综述定义了最常引起过敏反应的食物，并确定了一组新出现的与食物过敏有关的综合征。最近一项针对澳大利亚和东南亚食物过敏频率的研究表明，鸡蛋、牛奶和花生是澳大利亚最常见的食物过敏原，但东南亚不同地区的结果有所不同。目前尚不清楚对食物的反应性差异是否归因于遗传因素或文化因素，但研究结果提出了一种可能性，即对食物过敏的遗传易感性可能在主要组织相容性复合物调节的 T 细胞水平上发挥作用。墨尔本牛奶过敏研究定义了一系列可以通过饮食挑战重现的临床症状和综合症。随后对牛奶和其他多种食物蛋白过敏的婴儿进行的分析发现了一种新的综合症，即婴儿期多种食物蛋白不耐受症。食物挑战表明，在开始使用低过敏原大豆配方奶粉或深度水解配方奶粉几天后，反应缓慢发展。 3 岁时的随访显示，大多数患有这种疾病的儿童能够耐受除牛奶、鸡蛋和花生之外的大多数食物。大约 18% 的婴儿在出生后 2 年内患有特应性皮炎。在一项基于社区的研究中，我们发现特应性皮炎与对牛奶、鸡蛋或花生免疫球蛋白 E 过敏的婴儿之间存在很强的关联 (RB: 3.5)。对这些婴儿的家庭研究表明，特应性皮炎与邻近白细胞介素 4 基因簇的基因组区域 5q31 之间存在联系。 15-40% 的婴儿在出生后 4 个月内会出现婴儿绞痛（窘迫）。人们提出了许多因果关系理论，但我们中心的一项研究表明，饮食调整，尤其是婴儿在 6 周前出现绞痛的母乳喂养母亲的饮食调整，可以缓解症状。与呕吐相关的绞痛归因于胃食管反流（GOR）。这主要被认为是一种运动障碍，但最近描述了由食物蛋白质不耐受引起的第二种形式。我们最近还发现了一组因 GOR 而出现苦恼行为的婴儿，他们对 H-2 受体拮抗剂、促动力剂和多种配方奶粉变化均无反应。开始服用基于氨基酸的配方后症状得到缓解。三分之二的患者在使用低过敏原大豆配方奶粉或深度水解配方奶粉时症状复发。我们认为，一段时期的食物蛋白质不耐受是免疫系统正常发育的一部分，因为它会在婴儿期和幼儿期遇到常见的饮食蛋白质。未来的研究目标是为这些实体制定适当的饮食和管理策略，并鉴定这些疾病的遗传标记。
The prevalence of atopic diseases is increasing worldwide for reasons that are nor clean: Food allergies are the earliest manifestations of atopy. This review defines the foods most commonly involved in allergic reactions and identifies an emerging group of syndromes in which food allergy is involved. A study of the frequency of food allergies in Australia and South-Fast Asia has recently shown that egg, cow's milk rand peanut are the most common food allergens in Australia, but there were divergent results from different regions of South-East Asia. It is not clear whether the differences in reactivity to foods-are due to-genetic or cultural factors, but the findings raise the possibility that genetic susceptibility to food allergy may operate at the T-cell level modulated by the major histocompatibility complex. The Melbourne Milk Allergy Study defined a wide range of clinical symptoms and syndromes that could be reproduced by dietary challenge. a subsequent analysis of the infants with hypersensitivity to cow's milk and other multiple food proteins identified a new syndrome, multiple food protein intolerance of infancy. Food challenges demonstrated reactions developing slowly days after commencement of low-allergen soy formula or extensively hydrolysed formula. Follow-up at the age of 3 years showed that most children with this disorder tolerated most foods apart from cow's milk, egg and peanut. atopic dermatitis affects about 18% of infants in the first 2 years of life. In a community-based study we have shown a very strong association (RB: 3.5) between atopic dermatitis and infants with immunoglobulin E allergy to cow's milk, egg or peanut. Family studies on these infants have shown a link between atopic dermatitis and the genomic region 5q31 adjacent to the interleukin-4 gene cluster. Infantile colic (distress) affects 15-40% of infants in the first 4 months of life. Many theories of causation have been proposed, bur a study horn our centre showed that dietary modification, particularly that of breastfeeding mothers whose infants present with colic before the age of 6 weeks, alleviated symptoms. Colic associated with vomiting has been attributed to gastro-oesophageal reflux (GOR). This has been considered primarily a motility disorder, but a secondary form resulting from food protein intolerance has been described recently. We have also recently identified a group of infants with distressed behaviour attributed to GOR who have failed to respond to H-2-receptor antagonists, prokinetic agents and multiple formula changes. Symptoms resolved on commencement of an elemental amino acid-based formula. In two-thirds of the patients, symptoms relapsed when challenged with low-allergen soy formula or extensively hydrolysed formula. We propose that a period of food protein intolerance is a part of the normal development of the immune system as it encounters common dietary proteins in infancy and early childhood. Future targets for research are development of appropriate dietary and management strategies for these entities and identification of genetic markers for these disorders.