纯母乳喂养婴儿食物过敏13例分析

Clinical review of 13 exclusively breast-fed infants with food allergy

目的分析纯母乳喂养婴儿食物过敏的临床特征,以提高对纯母乳喂养婴儿食物过敏的认识。方法回顾分析我科2008-2010年收治的13例纯母乳喂养食物过敏婴儿的临床资料。结果 13例纯母乳喂养食物过敏婴儿中,年龄均小于6个月,9例小于3个月。12例有家族过敏史。临床表现多样:迁延性腹泻、血便、呕血、腹胀、生长发育落后、烦躁不安、特应性皮炎等。大便中可出现红细胞、白细胞和黏液。血生化检查可出现球蛋白下降和谷丙转氨酶(ALT)、谷草转氨酶(AST)升高。血清特异性免疫球蛋白可阳性,但阳性率不高。胃镜检查者6例,表现为糜烂性胃炎或(和)十二指肠球炎。胃镜检查者同时行胃黏膜活检,病理检查均为非特异性慢性炎症性改变,未见嗜酸细胞浸润。食物回避治疗,13例均有效;食物激发试验,13例均阳性。结论纯母乳喂养婴儿也可发生食物过敏,临床表现多样,以消化道症状最为突出,内镜下胃黏膜有改变,食物特异性免疫球蛋白检测阳性率低,食物回避和激发试验是诊断的金标准,食物回避治疗疗效肯定。

Objective To analyze the clinical features of exclusively breast-fed infants with food allergy,and to enhance the understanding of this disease.Methods The clinical data of 13 exclusively breast-fed infants with food allergy,admitted to our department from 2008 to 2010,were retrospectively analyzed.Results All the cases were under 6 months old,in which 9 were under 3 months old.12 cases had family history of food allergy.The clinical features are variant,such as diarrhea,bloody stool,hematemesis,abdominal distension,growth retardation,dysphoria,atopic dermatitis.Red blood cells,white blood cells and mucilage appeared in the stool.Blood biochemical examination revealed decreased globulin level and increased alanine aminotransferase（ALT） and aspartate aminotransferase（AST） level.Serum specific immune globulin can be positive,but the rate is low.Gastroscopy in 6 cases showed erosive gastritis or/and duodenal inflammation.Gastroscopy simultaneously with gastric biopsy and pathological examination showed non-specific chronic inflammatory changes,with no eosinophils.The test of elimination diet and food challenge were effective in all the 13 cases.Conclusion Exclusively breast-fed infants have the possibility of suffering from food allergy,with a variety of clinical features.The gastrointestinal symptoms were revealed to be the main feature.Gastric pathology were changed to some extent,and the positive rate of food specific immune globulin was low.It is showed that elimination diet and food challenge are the gold standard to confirm food allergy,and food avoidance treatment is certain to be effective.