婴儿牛奶蛋白过敏的危险因素：一项多中心前瞻性巢式病例对照研究

doi:10.7499/j.issn.1008-8830.2309105

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摘要目的探讨婴儿牛奶蛋白过敏（cow's milk protein allergy, CMPA）发生的危险因素。方法该研究为多中心前瞻性巢式病例对照研究。选取北京市7家医学中心0~12月龄婴儿为研究对象。共纳入CMPA婴儿200例，未发生CMPA的婴儿（对照组）799例。采用单因素和多因素logistic回归分析探讨CMPA发生的危险因素。结果单因素logistic回归分析显示，早产儿、低出生体重儿、第一胎、第一产、春季出生、夏季出生、混合/人工喂养、父母患过敏性疾病与婴儿CMPA患病风险增加有关（P<0.05）。多因素logistic回归分析显示，第一产（OR=1.89，95%CI：1.14~3.13）、春季出生（OR=3.42，95%CI：1.70~6.58）、夏季出生（OR=2.29，95%CI：1.22~4.27）、混合/人工喂养（OR=1.57，95%CI：1.10~2.26）、父亲或母亲有过敏史（OR=2.13，95%CI：1.51~3.02）、双亲有过敏史（OR=3.15，95%CI：1.78~5.56）是婴儿CMPA发生的危险因素（P<0.05）。结论第一产出生、春季出生、夏季出生、混合/人工喂养或有过敏家族史的婴儿CMPA的患病风险增加。

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	侯林
	马紫君
	晁爽
	李中原
	张宇
	刘毅坚
	张俊红
	武文艳
	黄山雅美
	刘捷

关键词 ：牛奶蛋白过敏, 危险因素, 食物过敏, 婴儿

Abstract：Objective To explore the risk factors associated with cow's milk protein allergy (CMPA) in infants. Methods This study was a multicenter prospective nested case-control study conducted in seven medical centers in Beijing, China. Infants aged 0-12 months were included, with 200 cases of CMPA infants and 799 control infants without CMPA. Univariate and multivariate logistic regression analyses were used to investigate the risk factors for the occurrence of CMPA. Results Univariate logistic regression analysis showed that preterm birth, low birth weight, birth from the first pregnancy, firstborn, spring birth, summer birth, mixed/artificial feeding, and parental history of allergic diseases were associated with an increased risk of CMPA in infants (P<0.05). Multivariate logistic regression analysis revealed that firstborn (OR=1.89, 95%CI: 1.14-3.13), spring birth (OR=3.42, 95%CI: 1.70-6.58), summer birth (OR=2.29, 95%CI: 1.22-4.27), mixed/artificial feeding (OR=1.57, 95%CI: 1.10-2.26), parental history of allergies (OR=2.13, 95%CI: 1.51-3.02), and both parents having allergies (OR=3.15, 95%CI: 1.78-5.56) were risk factors for CMPA in infants (P<0.05). Conclusions Firstborn, spring birth, summer birth, mixed/artificial feeding, and a family history of allergies are associated with an increased risk of CMPA in infants.

Key words： Cow's milk protein allergy Risk factor Food allergy Infant

收稿日期: 2023-09-19

基金资助:北京市临床重点专科项目（2018）（2199000726）。

通讯作者: 刘捷，女，主任医师。Email：yy.lovej@163.com。 E-mail: yy.lovej@163.com

作者简介: 侯林，女，博士，主治医师；

引用本文:

侯林,马紫君,晁爽等. 婴儿牛奶蛋白过敏的危险因素：一项多中心前瞻性巢式病例对照研究[J]. 中国当代儿科杂志, 2024, 26(3): 230-235.

HOU Lin,MA Zi-Jun,CHAO Shuang et al. Risk factors for cow's milk protein allergy in infants: a multicenter prospective nested case-control study[J]. CJCP, 2024, 26(3): 230-235.

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http://www.zgddek.com/CN/10.7499/j.issn.1008-8830.2309105 或 http://www.zgddek.com/CN/Y2024/V26/I3/230

	Boutsikou T, Sekkidou M, Karaglani E, et al. The impact of infant feeding regimen on cow's milk protein allergy, atopic dermatitis and growth in high-risk infants during the first 6 months of life: the allergy reduction trial[J]. Nutrients, 2023, 15(11): 2622. PMID: 37299585. PMCID: PMC10255921. DOI: 10.3390/nu15112622.
	张纪泳, 周少明, 王少华, 等. 婴儿牛奶蛋白过敏的危险因素: 多中心调查分析[J]. 中国当代儿科杂志, 2020, 22(1): 42-46. PMID: 31948523. PMCID: PMC7389720. DOI: 10.7499/j.issn.1008-8830.2020.01.009.
	Flom JD, Sicherer SH. Epidemiology of cow's milk allergy[J]. Nutrients, 2019, 11(5): 1051. PMID: 31083388. PMCID: PMC6566637. DOI: 10.3390/nu11051051.
	Nocerino R, Coppola S, Carucci L, et al. The step-down approach in children with cow's milk allergy: results of a randomized controlled trial[J]. Allergy, 2023, 78(9): 2477-2486. PMID: 37087638. DOI: 10.1111/all.15750.
	Kalb B, Marenholz I, Jeanrenaud ACSN, et al. Filaggrin loss-of-function mutations are associated with persistence of egg and milk allergy[J]. J Allergy Clin Immunol, 2022, 150(5): 1125-1134. PMID: 35714843. DOI: 10.1016/j.jaci.2022.05.018.
	Venter C, Brown T, Meyer R, et al. Better recognition, diagnosis and management of non-IgE-mediated cow's milk allergy in infancy: iMAP-an international interpretation of the MAP (milk allergy in primary care) guideline[J]. Clin Transl Allergy, 2017, 7: 26. PMID: 28852472. PMCID: PMC5567723. DOI: 10.1186/s13601-017-0162-y.
	Hou L, Ma Z, Chao S, et al. Genetic susceptibility to cow's milk allergy in Chinese children[J]. Asia Pac J Clin Nutr, 2022, 31(1): 147-155. PMID: 35357113. DOI: 10.6133/apjcn.202203_31(1).0016.
	Sicherer SH, Warren CM, Dant C, et al. Food allergy from infancy through adulthood[J]. J Allergy Clin Immunol Pract, 2020, 8(6): 1854-1864. PMID: 32499034. PMCID: PMC7899184. DOI: 10.1016/j.jaip.2020.02.010.
	Caffarelli C, Di Mauro D, Mastrorilli C, et al. Solid food introduction and the development of food allergies[J]. Nutrients, 2018, 10(11): 1790. PMID: 30453619. PMCID: PMC6266759. DOI: 10.3390/nu10111790.
	Lifschitz C, Szajewska H. Cow's milk allergy: evidence-based diagnosis and management for the practitioner[J]. Eur J Pediatr, 2015, 174(2): 141-150. PMID: 25257836. PMCID: PMC4298661. DOI: 10.1007/s00431-014-2422-3.
	Ronan V, Yeasin R, Claud EC. Childhood development and the microbiome-the intestinal microbiota in maintenance of health and development of disease during childhood development[J]. Gastroenterology, 2021, 160(2): 495-506. PMID: 33307032. PMCID: PMC8714606. DOI: 10.1053/j.gastro.2020.08.065.
	Sardecka I, ?o?-Rycharska E, Ludwig H, et al. Early risk factors for cow's milk allergy in children in the first year of life[J]. Allergy Asthma Proc, 2018, 39(6): e44-e54. PMID: 30401328. DOI: 10.2500/aap.2018.39.4159.
	Edwards MO, Kotecha SJ, Lowe J, et al. Early-term birth is a risk factor for wheezing in childhood: a cross-sectional population study[J]. J Allergy Clin Immunol, 2015, 136(3): 581-587.e2. PMID: 26115906. DOI: 10.1016/j.jaci.2015.05.005.
	Henderson D, Murphy CA, Glynn AC, et al. Feeding practices and the prevalence of cow's milk protein allergy in Irish preterm infants[J]. J Hum Nutr Diet, 2022, 35(3): 535-541. PMID: 34904759. DOI: 10.1111/jhn.12971.
	Donald K, Finlay BB. Early-life interactions between the microbiota and immune system: impact on immune system development and atopic disease[J]. Nat Rev Immunol, 2023, 23(11): 735-748. PMID: 37138015. DOI: 10.1038/s41577-023-00874-w.
	Cukrowska B, Bier?a JB, Zakrzewska M, et al. The relationship between the infant gut microbiota and allergy. The role of Bifidobacterium breve and prebiotic oligosaccharides in the activation of anti-allergic mechanisms in early life[J]. Nutrients, 2020, 12(4): 946. PMID: 32235348. PMCID: PMC7230322. DOI: 10.3390/nu12040946.
	Balz K, Kaushik A, Cemic F, et al. Cross-reactive MHC class I T cell epitopes may dictate heterologous immune responses between respiratory viruses and food allergens[J]. Sci Rep, 2023, 13(1): 14874. PMID: 37684288. PMCID: PMC10491592. DOI: 10.1038/s41598-023-41187-1.
	Keet CA, Matsui EC, Savage JH, et al. Potential mechanisms for the association between fall birth and food allergy[J]. Allergy, 2012, 67(6): 775-782. PMID: 22515802. PMCID: PMC3349789. DOI: 10.1111/j.1398-9995.2012.02823.x.
	Tanaka K, Matsui T, Sato A, et al. The relationship between the season of birth and early-onset food allergies in children[J]. Pediatr Allergy Immunol, 2015, 26(7): 607-613. PMID: 26177863. DOI: 10.1111/pai.12440.
	Poole A, Song Y, Brown H, et al. Cellular and molecular mechanisms of vitamin D in food allergy[J]. J Cell Mol Med, 2018, 22(7): 3270-3277. PMID: 29577619. PMCID: PMC6010899. DOI: 10.1111/jcmm.13607.
	Sharief S, Jariwala S, Kumar J, et al. Vitamin D levels and food and environmental allergies in the United States: results from the national health and nutrition examination survey 2005-2006[J]. J Allergy Clin Immunol, 2011, 127(5): 1195-1202. PMID: 21329969. PMCID: PMC3085636. DOI: 10.1016/j.jaci.2011.01.017.
	Kalach N, Bella?che M, Elias-Billon I, et al. Family history of atopy in infants with cow's milk protein allergy: a French population-based study[J]. Arch Pediatr, 2019, 26(4): 226-231. PMID: 30885604. DOI: 10.1016/j.arcped.2019.02.014.
	Koplin JJ, Allen KJ, Gurrin LC, et al. The impact of family history of allergy on risk of food allergy: a population-based study of infants[J]. Int J Environ Res Public Health, 2013, 10(11): 5364-5377. PMID: 24284354. PMCID: PMC3863850. DOI: 10.3390/ijerph10115364.
	Stelmach I, Bobrowska-Korzeniowska M, Smejda K, et al. Risk factors for the development of atopic dermatitis and early wheeze[J]. Allergy Asthma Proc, 2014, 35(5): 382-389. PMID: 25295805. DOI: 10.2500/aap.2014.35.3786.
	Kramer MS. Breastfeeding and allergy: the evidence[J]. Ann Nutr Metab, 2011, 59(Suppl 1): 20-26. PMID: 22189253. DOI: 10.1159/000334148.
	J?rvinen KM, Martin H, Oyoshi MK. Immunomodulatory effects of breast milk on food allergy[J]. Ann Allergy Asthma Immunol, 2019, 123(2): 133-143. PMID: 31048004. PMCID: PMC6693634. DOI: 10.1016/j.anai.2019.04.022.
	Bermejo-Haro MY, Camacho-Pacheco RT, Brito-Pérez Y, et al. The hormonal physiology of immune components in breast milk and their impact on the infant immune response[J]. Mol Cell Endocrinol, 2023, 572: 111956. PMID: 37236499. DOI: 10.1016/j.mce.2023.111956.
	28 陈同辛, 洪莉, 王华, 等. 中国婴儿轻中度非IgE介导的牛奶蛋白过敏诊断和营养干预指南[J]. 中华实用儿科临床杂志, 2022, 37(4): 241-250. DOI: 10.3760/cma.j.cn101070-20220106-00016.
	Fiocchi A, Dahda L, Dupont C, et al. Cow's milk allergy: towards an update of DRACMA guidelines[J]. World Allergy Organ J, 2016, 9(1): 35. PMID: 27895813. PMCID: PMC5109783. DOI: 10.1186/s40413-016-0125-0.
	Minniti F, Comberiati P, Munblit D, et al. Breast-milk characteristics protecting against allergy[J]. Endocr Metab Immune Disord Drug Targets, 2014, 14(1): 9-15. PMID: 24450452. DOI: 10.2174/1871530314666140121145045.
	Cook-Mills JM. Maternal influences over offspring allergic responses[J]. Curr Allergy Asthma Rep, 2015, 15(2): 501. PMID: 25612797. PMCID: PMC4445968. DOI: 10.1007/s11882-014-0501-1.