| Part I Clinical Characteristics of Cow’s Milk Protein Allergy in ChildrenObjective This study aims to establish a prospective cohort of children,analyze the clinical characteristics of CMPA in children,provide the basis for the diagnosis of CMPA,and then guide the clinical practice.MethodsChildren who had been diagnosed as CMPA were enrolled during October 2019 through October 2020 from outpatients in the hospital of Capital Institute of Pediatrics.The data of personal and family history,clinical symptoms,and previous exposure to cow’s milk were collected and necessary laboratory testing completed for all patients.Baseline data were established,and clinical characteristics of the children were summarized and analyzed.Results1.106 patients were enrolled finally,including 67 boys and 39 girls.There median age was（21.3±16.5）months,the mean age of the first occurrence was（6.7±3.5）months,and the age of diagnosis of CMPA was significantly later than that of the first onset（P<0.01）.2.89.6%（95/106）of the children developed allergic symptoms after consuming milk and its products,10.4%（11/106）of the children developed discomfort during breastfeeding,and 39.6%（42/106）of the children also developed allergic symptoms on skin contact.The onset of the disease was the slowest in breastfeeding and the fastest in skin contact,with statistical difference between groups（P < 0.01）.3.The most common clinical manifestations were skin symptoms（100/106,94.3%）,followed by digestive symptoms（20/106,18.9%）,respiratory symptoms（16/106,15.1%）and cardiovascular symptoms（1/106,15.1%）.30 children had at least one anaphylaxis.4.Among the enrolled children,94 had a history of eczema,57 had a history of rhinitis,23 had a history of wheezing,and 68 had been diagnosed with other food allergies.5.The milk s Ig E of all children was 3.03（1.1,15.2）k UA/L,including 23 children with grade Ⅳ or above,accounting for 21.7%.The average t Ig E was 191（64.7,506.8）k U/L.The median longest diameter of the SPT was 8.20（4.00,12.00）mm,and the median longest diameter of the red halo was 22.00（12.00,28.00）mm.6.The results showed that 53.2% of the children were sensitized to casein,40.4% toα-whey protein,44.7% to β-lactoglobulin,and 42.6% to bovine serum albumin.There were 77 children with at least one component positive,accounting for 81.9%.7.SIg E grade,SPT positive degree and α-whey protein positive degree of milk were correlated with severity of clinical symptoms,with statistical difference（P < 0.05）.Conclusions The onset age of milk protein allergy in children is young,the onset speed is fast,and it can be induced by contacting and eating.The clinical manifestations are varied,mainly skin symptoms.Most children were sensitized by one or more milk protein components,associated with other allergic diseases and a family history of allergy.The detection of SPT,s Ig E of milk and its components are of great value in the diagnosis and assessment of CMPA.Highly sensitized children are prone to anaphylaxis.Part II Risk factors for short-term prognosis of cow’s milk protein allergy in childrenObjectiveA prospective cohort for children with CMPA was established to study the characteristic and outcomes of childhood milk allergy,and to explore the risk factors that influence shot-term prognosis of CMPA in children.MethodsData were collected from the children who had finished their 6-months follow-up,and had been evaluated for prognosis.Baseline data of the two groups of children were arranged and SPSS 25.0 software was used for statistical analysis.Firstly,a descriptive analysis of all the suspicious factors were conducted,statistically significant variables were selected to enter the multivariate Logistic regression model.Progressive regression was used for variable selection,and the statistically significant level of the variable entry model was set as single-factor analysis P < 0.2,the statistically significant level of the variable removal model was set to P>0.05.Results1.A total of 104 children were followed up for 6 months,26（25.0%）achieved tolerance,and 78（75.0%）had persistent allergy.The median age of all children was（20.9±16.3）months（including 66 boys and 38 girls）.The mean age of the first occurrence of milk allergy was（6.7±3.5）months.2.Logistic multivariate regression analysis showed that the severity of skin prick test reactions（OR=3.34,95%CI: 1.4-20.5）,the history of anaphylaxis（OR=2.3,95%CI: 1.1-69.2）,and the first onset involving multiple systems（OR=2.3,95%CI:1.3 81.4）were independent risk factors for persistent allergy in infants with CMPA（P < 0.05）.3.Univariate analysis showed that history of anaphylaxis,introduction time of solid supplement food,baseline milk and β-lactoglobulin s Ig E were associated with persistent allergy in children who were over 3 years old with statistical significance（P < 0.05）.Conclusions25.0% of children with CMPA developed tolerance after six months diagnosis.The severity of skin prick test reactions,previous history of anaphylaxis,and the first multisystem symptoms were independent risk factors for infants with CMPA.The history of anaphylaxis,late introduction of solid supplements,and high baseline milk and β-lactoglobulin s Ig E may be the risk factors for persistent allergy in children older than 3 years of age. |
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