儿童牛奶蛋白过敏牛奶阶梯治疗的研究进展

doi:10.11852/zgetbjzz2024-0832

中国儿童保健杂志 ›› 2025, Vol. 33 ›› Issue (5): 520-523.DOI: 10.11852/zgetbjzz2024-0832

儿童牛奶蛋白过敏牛奶阶梯治疗的研究进展

帅佳佶¹, 杨速飞^1,2

1.华西二院眉山市妇女儿童医院儿童保健科,四川眉山 620000;
2.华西第二医院儿童保健科

收稿日期:2024-08-05 修回日期:2024-11-19 发布日期:2025-04-30 出版日期:2025-05-10
通讯作者: 杨速飞,E-mail:yangsufei@scu.edu.cn
作者简介:帅佳佶(1993—),女,硕士学位,主治医师,主要研究方向为儿童保健。
基金资助:
眉山市科技局指导性项目(2023KJZD126)

Research progress of milk ladder treatment for milk protein allergy in children

SHUAI Jiaji¹, YANG Sufei^1,2

1. Child Healthcare Department, Meishan Women and Children's Hospital of West China Second Hospital,Meishan, Sichuan 620000,China;
2. Child Healthcare Department, West China Second Hospital

Received:2024-08-05 Revised:2024-11-19 Online:2025-05-10 Published:2025-04-30
Contact: YANG Sufei, E-mail: yangsufei@scu.edu.cn

摘要/Abstract

摘要： 牛奶蛋白过敏是儿童常见的过敏反应。牛奶阶梯是通过不同程度变性、增加剂量的阶梯式方式逐渐引入牛奶蛋白,可以诱导儿童更早实现牛奶蛋白长期耐受。目前已有的研究证明牛奶阶梯是一种安全有效的方法。但牛奶阶梯作为一种新兴的治疗方法,基于个体、文化差异应有不同的改进策略,需要更多的研究验证其长期安全性。

关键词: 牛奶蛋白过敏, 牛奶阶梯, 安全性, 改进策略, 儿童

Abstract: Cow's milk protein allergy(CMPA) is a common allergic reaction among children. The milk ladder approach involves gradually introducing cow's milk protein through steps of varying degrees of denaturation and increasing doses, which can induce earlier long-term tolerance to cow's milk protein in children. Existing research has proven the milk ladder to be a safe and effective method. However, as an emerging treatment, the milk ladder necessitates diverse improvement strategies based on individual and cultural differences, and requires further research to verify its long-term safety.

Key words: cow's milk protein allergy, milk ladder, safety, improvement strategy, children

中图分类号:

R723.19

帅佳佶, 杨速飞. 儿童牛奶蛋白过敏牛奶阶梯治疗的研究进展[J]. 中国儿童保健杂志, 2025, 33(5): 520-523.

SHUAI Jiaji, YANG Sufei. Research progress of milk ladder treatment for milk protein allergy in children[J]. Chinese Journal of Child Health Care, 2025, 33(5): 520-523.

参考文献

[1] Nowak-Węgrzyn A, Katz Y, Mehr SS, et al. Non-IgE-mediated gastrointestinal food allergy[J]. J Allergy Clin Immunol, 2015, 135(5): 1114-1124.
[2] 陈静, 廖艳, 张红忠, 等. 三城市两岁以下儿童食物过敏现状调查[J]. 中华儿科杂志, 2012, 50(1): 5-9.
Chen J, Liao Y, Zhang HZ, et al. Prevalence of food allergy in children under 2 years of age in three cities in China[J]. Chin J Pediatr, 2012, 50(1):5-9.(in Chinese)
[3] Schoemaker AA, Sprikkelman AB, Grimshaw KE, et al. Incidence and natural history of challenge-proven cow's milk allergy in European children-Euro Prevall birth cohort[J]. Allergy, 2015, 70(8): 963-972.
[4] 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.
Chen TX, Hong L, Wang H, et al. Guidelines for diagnosis and nutritional intervention of mild to moderate non-IgE mediated cow's milk protein allergy in Chinese infants[J]. Chin J Appl Clin Pediatr, 2022, 37(4): 241-250.(in Chinese)
[5] Brotons-Canto A, Martin-Arbella N, Gamazo C, et al. New pharmaceutical approaches for the treatment of food allergies[J]. Expert Opin Drug Deliv, 2018, 15(7): 675-686.
[6] Arasi S, Cafarotti A, Fiocchi A. Cow's milk allergy[J]. Curr Opin Allergy Clin Immunol, 2022, 22(3): 181-187.
[7] Hicks A, Fleischer D, Venter C. The future of cow's milk allergy-milk ladders in IgE-mediated food allergy[J]. Front Nutr, 2024, 11: 1-7.
[8] Nowak-Wegrzyn A, Bloom KA, Sicherer SH, et al. Tolerance to extensively heated milk in children with cow's milk allergy[J]. J Allergy Clin Immunol, 2008, 122(2): 342-347.
[9] Kim JS, Nowak-Węgrzyn A, Sicherer SH, et al. Dietary baked milk accelerates the resolution of cow's milk allergy in children[J]. J Allergy Clin Immunol, 2011, 128(1): 125-131.
[10] Esmaeilzadeh H, Alyasin S, Haghighat M, et al. The effect of baked milk on accelerating unheated cow's milk tolerance: A control randomized clinical trial[J]. Pediatr Allergy Immunol, 2018, 29(7): 747-753.
[11] Savilahti EM, Rantanen V, Lin JS, et al. Early recovery from cow's milk allergy is associated with decreasing IgE and increasing IgG4 binding to cow's milk epitopes[J]. J Allergy Clin Immunol, 2010, 125(6): 1315-1321.
[12] Nowak-Węgrzyn A, Lawson K, Masilamani M, et al. Increased tolerance to less extensively heat-denatured(baked) milk products in milk-allergic children[J]. J Allergy Clin Immunol Pract, 2018, 6(2): 486-495.
[13] Dunlop JH, Keet CA, Mudd K, et al. Long-term follow-up after baked milk introduction[J]. J Allergy Clin Immunol Pract, 2018, 6(5): 1699-1704.
[14] Venter C, Brown T, Shah N, et al. Diagnosis and management of non-IgE-mediated cow's milk allergy in infancy-a UK primary care practical guide[J]. Clin Transl Allergy, 2013, 3: 1-11.
[15] 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: 1-9.
[16] Chomyn A, Chan ES, Yeung J, et al. Canadian food la-dders for dietary advancement in children with IgE-mediated allergy to milk and/or egg[J]. Allergy Asthma Clin Immunol, 2021, 17: 1-6.
[17] Hosaagrahara Ramakrishna S, Shah N, Acharyya BC, et al. The need for culturally appropriate food allergy management strategies: The Indian milk ladder[J]. Nutrients, 2023, 15(18): 1-11.
[18] Cronin C, Ramesh Y, De Pieri C, et al. ‘Early introduction' of cow's milk for children with IgE-mediated cow's milk protein allergy: A review of current and emerging approaches for CMPA management[J]. Nutrients, 2023, 15(6): 1-26.
[19] d'Art YM, Forristal L, Byrne AM, et al. Single low-dose exposure to cow's milk at diagnosis accelerates cow's milk allergic infants' progress on a milk ladder programme[J]. Allergy, 2022, 77(9): 2760-2769.
[20] Ball HB, Luyt D. Home-based cow's milk reintroduction using a milk ladder in children less than 3 years old with IgE-mediated cow's milk allergy[J]. Clin Exp Allergy, 2019, 49(6): 911-920.
[21] Cronin C, McGinley AM, Flores L, et al. Primary care as a setting for introducing milk using the milk ladder in children with IgE-mediated cow's milk protein allergy[J]. Clin Transl Allergy, 2023, 13(7): 1-3.
[22] Hochwallner H, Schulmeister U, Swoboda I, et al. Cow's milk allergy: From allergens to new forms of diagnosis, therapy and prevention[J]. Methods, 2014, 66(1): 22-33.
[23] Haug A, Høstmark AT, Harstad OM. Bovine milk in human nutrition－a review[J]. Lipids Health Dis, 2007, 6: 1-16.
[24] Pereira PC. Milk nutritional composition and its role in human health[J]. Nutrition, 2014, 30(6): 619-627.
[25] Giannetti A, Toschi Vespasiani G, Ricci G, et al. Cow's milk protein allergy as a model of food allergies[J]. Nutrients, 2021, 13(5): 1-21.
[26] Yi DY, Kim SY. Human breast milk composition and function in human health: From nutritional components to microbiome and microRNAs[J]. Nutrients, 2021, 13(9): 1-11.
[27] 白金梅, 卢蓉, 高春燕. 儿童食物过敏口服免疫疗法的研究进展[J]. 临床医学进展, 2022, 12(10): 8871-8876.
Bai JM, Lu R, Gao CY. Progress in oral immunotherapy of food allergy in children[J]. Adv Clin Med, 2022, 12(10): 8871-8876.(in Chinese)
[28] Pajno GB, Cox L, Caminiti L, et al. Oral immunotherapy for treatment of immunoglobulin E-mediated food allergy: The transition to clinical practice[J]. Pediatr Allergy Immunol Pulmonol, 2014, 27(2): 42-50.
[29] Mondello W. Girl with milk allergy dies of severe reaction related to desensitization[EB/OL].(2021-12-20)[2024-11-13]. https://www.allergicliving.com/2021/12/20/girl-with-milk-allergy-dies-of-severe-reaction-related-to-desensitization/.
[30] Flom JD, Sicherer SH. Epidemiology of cow's milk allergy[J]. Nutrients, 2019, 11(5): 1-14.
[31] Jansen PR, Petrus NCM, Venema A, et al. Higher polygenetic predisposition for asthma in cow's milk allergic children[J]. Nutrients, 2018, 10(11): 1-12.
[32] Leonard SA, Sampson HA, Sicherer SH, et al. Dietary baked egg accelerates resolution of egg allergy in children[J]. J Allergy Clin Immunol, 2012, 130(2): 473-480.
[33] Upton J, Nowak-Wegrzyn A. The impact of baked egg and baked milk diets on IgE-and non-IgE-mediated allergy[J]. Clin Rev Allergy Immunol, 2018, 55(2): 118-138.
[34] Venter C, Meyer R, Ebisawa M, et al. Food allergen ladders: A need for standardization[J]. Pediatr Allergy Immunol, 2022, 33(1): 1-10.

儿童牛奶蛋白过敏牛奶阶梯治疗的研究进展

Research progress of milk ladder treatment for milk protein allergy in children

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

[1]	花静. 儿童发育性协调障碍的早期识别和共病问题[J]. 中国儿童保健杂志, 2025, 33(5): 465-471.
[2]	林森然, 李会珍, 黄松松, 花静. 学龄前儿童发育性协调障碍共病睡眠和行为问题研究[J]. 中国儿童保健杂志, 2025, 33(5): 472-477.
[3]	王菲, 金华, 吴婷, 沈梦晴, 王云. 学龄前儿童发育性协调障碍的影响因素及列线图预测模型的构建[J]. 中国儿童保健杂志, 2025, 33(5): 478-483.
[4]	许占斌, 秦宏超, 徐小晶, 王飞英. 学龄前发育性协调障碍儿童核心症状及其与情绪行为问题的关联[J]. 中国儿童保健杂志, 2025, 33(5): 484-488.
[5]	朱博文, 王同帅, 王星云, 郭锡熔. 血尿酸水平对儿童青少年代谢综合征及其组分的影响[J]. 中国儿童保健杂志, 2025, 33(5): 489-496.
[6]	樊怡薇, 陈雪, 张彭, 肖显赫, 刘洪秀, 李瑞珍. 儿童睡眠与性早熟关联的病例对照研究[J]. 中国儿童保健杂志, 2025, 33(5): 497-502.
[7]	李翊嘉, 赵晗华, 高莹. 学龄儿童日常身体活动与家庭支持性因素的关联[J]. 中国儿童保健杂志, 2025, 33(5): 503-507.
[8]	刘舒, 廖小娴, 黄秀清, 李清, 杨琴, 童秀斌, 徐秀, 李慧萍. 基于倾向性评分匹配法评估常见发育行为疾病儿童维生素D水平[J]. 中国儿童保健杂志, 2025, 33(5): 508-513.
[9]	王韵, 曾霞. 睡眠时长和久坐行为对儿童青少年超重肥胖的联合作用[J]. 中国儿童保健杂志, 2025, 33(5): 514-519.
[10]	张妮妮, 王宝西, 江逊. 儿童功能性便秘的临床诊治进展[J]. 中国儿童保健杂志, 2025, 33(5): 524-528.
[11]	罗婷, 林芸竹, 练湘红, 郭怡新, 贺洪霞. 儿童生长痛相关风险因素的系统评价[J]. 中国儿童保健杂志, 2025, 33(5): 537-543.
[12]	许佳, 肖羽乔, 刘紫宣, 张田瑞雪, 刘莉, 谷灿. 恶性肿瘤患儿视屏时间的现状及影响因素分析[J]. 中国儿童保健杂志, 2025, 33(5): 555-559.
[13]	张帅, 李成跃, 李卫民. 1985—2019年8次中国儿童青少年体质健康监测的爆发力素质研究及长期发展预测[J]. 中国儿童保健杂志, 2025, 33(5): 565-570.
[14]	金卓, 吴华, 蔡于江, 阮辉. KDL课程教学对7~8岁儿童行为自我调节能力的影响[J]. 中国儿童保健杂志, 2025, 33(5): 571-575.
[15]	中华预防医学会儿童保健分会;中国妇幼保健协会儿童早期发展专委会; 《中国儿童保健杂志》编委会. 学习困难门诊的规范化建设专家共识[J]. 中国儿童保健杂志, 2025, 33(4): 349-354.