婴儿期食物过敏的预后研究

Prognoses of food allergy in infancy

目的了解婴儿期食物过敏(FA)的预后及影响因素。方法对119例患儿进行回顾性研究,采用Kaplan-Meier法计算食物耐受的累积概率,非条件Logistic回归模型分析食物耐受形成的预测因素和其他过敏性疾病发生的影响因素。结果鸡蛋、牛奶耐受的累计概率在诊断后1年分别为31%、42%;2年为62%、63%;3年为80%、77%;4年后均可达100%。牛奶、鸡蛋过敏患儿的皮肤点刺试验阳性强度是持续牛奶、鸡蛋敏感的预测因素(OR=2.535,95%CI:1.159~5.543;OR=2.654,95%CI:1.302~5.410,P均<0.05)。本组13例患儿发生其他FA,危险因素是持续鸡蛋敏感(OR=6.109,95%CI:1.818~20.527,P<0.05);4例发生变态反应性鼻炎,15例发生支气管哮喘,危险因素是持续鸡蛋敏感和呼吸道过敏症状(OR=3.596,95%CI:1.429~9.045;OR=4.235,95%CI:1.152~15.563,P均<0.05)。结论至少75%的鸡蛋或牛奶过敏患儿在诊断后3年内可获耐受。10.9%、12.6%和3.4%的FA儿童发生其他FA、支气管哮喘和变态反应性鼻炎。加强持续FA高危儿的筛查和管理,可能有助于改善FA的预后。

Objective Food allergy as one of social health problems has gained more attention of people. However, few reports on prognosis of food allergy, the relation between infant food allergy and other allergic diseases, and factors affecting prognoses of infant food allergy in China. The present study was designed to investigate the evolution of infancy food allergy and to explore predicting factors of the tolerance to these foods and factors of other allergic diseases to provide a clue for managing children with food allergy reasonably and to improve their prognoses. Methods Totally 119 children with food allergy during infancy, who were diagnosed in the Department of Primary Child Care, Children＇s Hospital, Chongqing University of Medical Sciences from January 2000 to June 2003, were studied retrospectively by analyzing the follow-up data before March 2004. The occurrence of food tolerance and other allergic diseases were counted. Kaplan- Meier methods were used to calculate the cumulative tolerance probability. And the predicting factors of persistent food allergy and influential factors of other allergic diseases were analyzed by unconditional Logistic regression models. Results The cumulative tolerance probabilities of cow＇s milk and egg were 42% and 31% one year after diagnosis respectively, 63% and 62% 2 years later, 77% and 80% 3 years later, and 100% after 4 years. And the severity of skin prick test reactions to cow^s milk and egg was the predicting factor for persisting hypersensitivity to cow% milk and egg （ OR = 2. 535,95% Cl： 1. 159-5. 543; OR = 2. 654,95% CI： 1. 302-5.410, P 〈 0. 05 ）. Thirteen cases presented with hypersensitivity to other foods （15.6±6.1） months after the diagnosis was confirmed, and the risk factor was the long-lasting hypersensitivity to egg （ OR = 6. 109,95 % CI： 1.818-20. 527, P 〈 0. 05 ）. After 4 cases and 15 cases were diagnosed as allergic rhinitis and asthma, respectively, （ 16. 8 ± 8.3 ） months after diagnoses and the risk factors were the long-lasting hypersensitivity to egg and the respiratory symptoms （OR = 3. 596,95% CI： 1. 429-9. 045; OR =4. 235,95% CI： 1. 152-15. 563 ,P 〈0. 05）. Conclusion At least 75% of children with egg or cow＇s milk allergy could develop tolerance to egg or cow＇s milk within 3 years after diagnoses; 10. 9%, 12. 6% and 3.4% of children with food allergy suffered from other food allergy, asthma and allergic rhinitis. Strengthening the screening and management of children at high risk for persistent food allergy will contribute to improvement of the prognoses of food allergy.