Formula Selection for Management of Children with Cow's Milk Allergy Influences the Rate of Acquisition of Tolerance: A Prospective Multicenter Study
Formula Selection for Management of Children with Cow's Milk Allergy Influences the Rate of Acquisition of Tolerance: A Prospective Multicenter Study
复制标题
DOI：
10.1016/j.jpeds.2013.03.008
复制
发表时间：
2013-09-01
影响因子：
5.1
通讯作者：
Troncone, Riccardo
中科院分区：
文献类型：
--
作者：
Canani, Roberto Berni;Nocerino, Rita;Troncone, Riccardo
目的前瞻性评价不同饮食管理策略对牛奶过敏（CMA）儿童获得耐受率的影响。研究设计：对诊断为CMA的健康儿童（1-12个月）进行前瞻性评价。研究人群根据用于管理的配方被分为5组：（1）广泛水解酪蛋白配方（[EHCF]，n = 55）;（2）EHCF +鼠李糖乳杆菌GG [LGG]，n = 71）;（3）水解大米配方食品（RHF，n = 46）;（4）大豆配方食品（n = 55）;和（5）基于氨基酸的配方食品（n = 33）。12个月后进行食物挑战，以评估获得tolerance.Results 260儿童进行了评估（167名男性，64.2%;年龄5.92个月，95%CI 5.48-6.37;体重6.66 kg，95%CI 6.41-6.91; IgE介导的CMA 111，42.7%）。12个月后，接受EHCF（43.6%）或EHCF + LGG（78.9%）的儿童获得口服耐受性的比率显著高于其他组：RHF（32.6%），大豆配方奶粉（23.6%）和氨基酸配方奶粉（18.2%）。二项回归分析系数（B）显示，研究结束时患者获得耐受的比率受2个因素的影响：（1）IgE介导的机制（B - 2.05，OR 0.12，95% CI 0.06-0.26; P <0.001）;（2）配方选择，接受EHCF或（B 1.48，OR 4.41，95% CI 1.44-13.48; P =.009）或EHCF + LGG（B 3.35，OR 28.62，95% CI 8.72-93.93; P < .001）。LGG增强了这种效果。
Objectives To prospectively evaluate the effect of different dietary management strategies on the rate of acquisition of tolerance in children with cow's milk allergy (CMA).Study design Otherwise healthy children (aged 1-12 months) diagnosed with CMA were prospectively evaluated. The study population was divided into 5 groups based upon the formula used for management: (1) extensively hydrolyzed casein formula ([EHCF], n = 55); (2) EHCF + Lactobacillus rhamnosus GG [LGG], n = 71); (3) hydrolyzed rice formula (RHF, n = 46); (4) soy formula (n = 55); and (5) amino acid based formula (n = 33). A food challenge was performed after 12 months to assess acquisition of tolerance.Results Two hundred sixty children were evaluated (167 male, 64.2%; age 5.92 months, 95% CI 5.48-6.37; body weight 6.66 kg, 95% CI 6.41-6.91; IgE-mediated CMA 111, 42.7%). The rate of children acquiring oral tolerance after 12 months was significantly higher (P < .05) in the groups receiving EHCF (43.6%) or EHCF + LGG (78.9%) compared with the other groups: RHF (32.6%), soy formula (23.6%), and amino acid based formula (18.2%). Binary regression analysis coefficient (B) revealed that the rate of patients acquiring tolerance at the end of the study was influenced by 2 factors: (1) IgE-mediated mechanism (B - 2.05, OR 0.12, 95% CI 0.06-0.26; P < .001); and (2) formula choice, such that those receiving either EHCF (B 1.48, OR 4.41, 95% CI 1.44-13.48; P =.009) or EHCF + LGG (B 3.35, OR 28.62, 95% CI 8.72-93.93; P < .001).Conclusions EHCF accelerates tolerance acquisition in children with CMA if compared with other dietetic choices. This effect is augmented by LGG.