上海地区720例特应质儿童食物过敏临床分析

Clinical analysis of food allergy among 720 atopic children in Shanghai

目的探讨上海地区特应质儿童中食物过敏的发病情况和临床特点,以及食物过敏与其他过敏性疾病的关系。方法采用国际上经典的食物过敏诊断方法进行研究,对2007年7月-2008年7月因过敏症状在上海儿童医学中心过敏/免疫专科就诊的720例2个月～17岁特应质儿童,进行病史收集、皮肤点刺试验、排除性饮食试验和开放式食物激发试验。结果最后确诊食物过敏59例(发生率8.19%)。初次发生食物过敏的平均年龄为(0.40±0.33)岁。引起过敏的主要食物为鸡蛋(5.83%)、牛奶(2.78%),虾(1.67%)、鱼(1.25%);3岁以下儿童对鸡蛋过敏多见,≥3岁对虾过敏多见(P<0.01);94.92%的儿童对一种或二种食物过敏。食物过敏100%可引起皮肤症状,25%的特应质儿童因食物过敏引起湿疹;消化道症状发生率为3.39%;呼吸道症状发生率为1.69%;过敏性休克发生率为1.69%。≥3岁仍食物过敏的儿童吸入性过敏原阳性、患哮喘和过敏性鼻炎/结膜炎的人数均显著多于3岁以下的食物过敏儿童(P<0.01)。结论上海地区的特应质儿童中,食物过敏的发生率高,发生年龄小。对有皮肤过敏症状的儿童,应首先考虑食物过敏可能。早期诊断并阻断食物过敏,可预防其他严重过敏性疾病的发生。

Objective To estimate the incidence of food allergy, understand the clinical characteristics and explore the correlation between food allergy and other atopic diseases among atopic children. Methods A total of 720 atopic children aged 2 months to 17 years were assayed with international classical method, which included clinical history collection, skin prick tests, elimination diets and food challenge, to diagnose IgE-mediated food allergy from July 2007 to July 2008. Results Food allergy was diagnosed in 59 out of 173 cases （8.19%） with confirmation by positive SPT. The average age of the first onset was 0.40 ± 0,33 years. The major foods causing allergy were egg, milk, shrimp and fish, accounting for 5.83%, 2.78%, 1.67% and 1.25%, respectively. The dominating allergic food for children below 3 years old was egg whereas that for children above 3 years old was shrimp （P 〈 0.01）. Moreover, 94.92% of them were allergic to only one or two kinds of food. 100% of food allergic cases led to cutaneous reactions, with 25% of them suffered from eczema. On the other hand, the incidence of gastrointestinal, respiratory and generalized anaphylactic reactions was 3.39%, 1.69% and 1.69%, respectively. Compared with children below 3 years old, those above 3 years old showed higher rate of development of asthma and/or rhinoconjunctivitis （P 〈 0.01 ）. Conclusions In Shanghai, the prevalence of food allergy in atopic children was higher than that in the general population and was more common among younger ones. Food allergy should be considered the first possible cause of skin allergy in children. Early diagnosis and intervention can prevent the occurrence of other severe atopic diseases.