妞康特牛奶蛋白过敏诊治.pptxVIP

牛奶蛋白过敏（CMPA）的诊断与治疗陈同辛上海交通大学附属儿童医院上海市儿童医院牛奶蛋白过敏或不耐受（CMPA/I）发生率在婴儿和低龄儿童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）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78未确诊CMPA/I39（2.2%）（1.5-2.9%）确诊CMPA/I9（0.5%）（0.2-0.9%）CMPA/I母乳可抗CMPFig. 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过敏性鼻结膜炎支气管哮喘食物过敏的胃肠道症状特应性皮炎过敏历程食物过敏的胃肠道症状和特应性皮炎是过敏历程的早期症状早期阻断过敏历程非常重要！特应性疾病的自然历程（根据Grab和Wahn1991年的研究结果）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): 23–28CMPA/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): 23–28CMPA/I的预后（3）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诊断确定筛查试验体格检查病史发病年龄、临床表现、喂养史、辅食添加时间、食物或其他因素所致的相关症状、家族或个体特应性疾病史检查食物过敏的体征、与相关疾病鉴别血清总IgE、嗜酸细胞、血清特异性IgE、SPT、斑贴试验、膳食回避试验*必要行胃肠病学试验（内窥镜、组织学、炎性标记、胃肠动力）对照的口服激发试验Fig1 疑似食物过敏患儿的临床评估Canani RB,et al. The diagnosis of food allergy in children. Curr Opin Pediatr, 20: 584-589牛乳蛋白过敏的表现 (CMPA)大多数婴儿有二种或更多的症状症状:呕吐, 胃肠道症状: 食用后最快