指南解读

《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》要点解读

  • 庞焕香 ,
  • 周真 ,
  • 林英 ,
  • 谭艳芳 ,
  • 高洁 ,
  • 张钰珍 ,
  • 刘王凯
展开
  • 广东省妇幼保健院儿科 (广东 广州 511442 )

收稿日期: 2025-09-22

  网络出版日期: 2025-12-25

Interpretation of 《Guidelines for diagnosis and nutritional intervention of mild to modetate non⁃IgE mediated cow′s milk protein allergy in Chinese infants》

  • Huanxiang PANG ,
  • Zhen ZHOU ,
  • Ying LIN ,
  • Yanfang TAN ,
  • Jie GAO ,
  • Yuzhen ZHANG ,
  • Wangkai. LIU
Expand
  • Department of Pediatrics,Guangdong Women and Children Hospital,Guangzhou 511442,Guangdong,China

Received date: 2025-09-22

  Online published: 2025-12-25

摘要

牛奶蛋白过敏是由牛奶蛋白引起的异常免疫反应,根据发病机制不同可分为IgE介导、非IgE介导或两者混合介导。我国目前已有多项牛奶蛋白过敏的专家共识/指南,但这些共识均未对IgE介导和非IgE介导的牛奶蛋白过敏进行区分。婴儿期非IgE介导的牛奶蛋白过敏更为常见,而非IgE介导的牛奶蛋白过敏缺乏特异性临床表现和诊断方法,导致其诊断和管理仍然面临很大的挑战。为促进非IgE介导的婴儿牛奶蛋白过敏规范化诊治,由中华预防医学会过敏病预防与控制专业委员会组织多学科专家制定了《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》,该文对该指南中婴儿轻中度非IgE介导的牛奶蛋白过敏的临床特征、诊断流程、营养管理、辅食添加部分内容进行介绍和解读。

本文引用格式

庞焕香 , 周真 , 林英 , 谭艳芳 , 高洁 , 张钰珍 , 刘王凯 . 《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》要点解读[J]. 实用医学杂志, 2025 , 41(24) : 3793 -3801 . DOI: 10.3969/j.issn.1006-5725.2025.24.001

Abstract

Cow’s milk protein allergy (CMPA) is an abnormal immune response triggered by cow′s milk proteins. Clinically, CMPA can be categorized into immediate-onset IgE-mediated, delayed-onset non-IgE-mediated, or mixed forms. Although several expert consensus statements on CMPA have been published in China, they often fail to clearly differentiate between IgE-mediated and non-IgE-mediated subtypes. Non-IgE-mediated CMPA is more prevalent in infants; however, due to the absence of specific clinical manifestations and standardized diagnostic approaches, its diagnosis and management remain significant clinical challenges. To facilitate the standardized diagnosis and management of non-IgE-mediated CMPA in infants, a multidisciplinary panel of experts convened by the Allergy Prevention and Control Professional Committee of the Chinese Preventive Medicine Association has developed the “Guidelines for Diagnosis and Nutritional Intervention of Mild to Moderate Non-IgE-Mediated Cow′s Milk Protein Allergy in Chinese Infants.” This article presents and interprets the key recommendations of the guideline, focusing on clinical features, diagnostic procedures, nutritional management, and complementary feeding strategies for infants with mild to moderate non-IgE-mediated CMPA.

参考文献

[1] PRESCOTT S L, PAWANKAR R, ALLEN K J, et al. A global survey of changing patterns of food allergy burden in children[J].World Allergy Organ J, 2013, 6(1): 21-26. doi:10.1186/1939-4551-6-21
[2] JACKSON K D, HOWIE L D, AKINBAMI L J. Trends in allergic conditions among children: United States, 1997-2011[J]. NCHS Data Br, 2013,(121): 1-8.
[3] MA Z, CHEN L, XIAN R, et al.Time trends of childhood food allergy in China: Three crosssectional surveys in 1999, 2009, and 2019[J]. Pediatr Allergy Immunol, 2021, 32(5): 1073-1079. doi:10.1111/pai.13490
[4] PRESCOTT S, ALLEN K J. Food allergy: Riding the second wave of the allergy epidemic[J]. Pediatr Allergy Immunol, 2011, 22(2): 155-160. doi:10.1111/j.1399-3038.2011.01145.x
[5] VENTER C, ARSHSD S H. Epidemiology of food allergy [J]. Pediatr Clin North Am,2011,58(2):327-349. doi:10.1016/j.pcl.2011.02.011
[6] 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.
[7] BOGNANNI A, FIOCCHI A, ARASI S, et al. World allergy organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) guideline update -XII- Recommendations on milk formula supplements with and without probiotics for infants and toddlers with CMA[J]. World Allergy Organ J, 2024,17(4): 100888. doi:10.1016/j.waojou.2024.100888
[8] FIOCCHI A, BROZEK J, SCHüNEMANN H, et al. World allergy organization (WAO) diagnosis and rationale for action against cow's milk allergy (DRACMA) guidelines[J]. World Allergy Organ J, 2010, 3(4): 57-161. doi:10.1097/wox.0b013e3181defeb9
[9] KOLETZKO S, NIGGEMANN B, ARATO A, et al. Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines[J]. J Pediatr Gastroenterol Nutr, 2012, 55(2): 221-229. doi:10.1097/mpg.0b013e31825c9482
[10] LUYT D, BALL H, MAKWANA N, et al. BSACI guideline for the diagnosis and management of cow's milk allergy[J]. Clin Exp Allergy, 2014, 44(5): 642-672. doi:10.1111/cea.12302
[11] VANDENPLAS Y, BROEKAERT I, DOMELL?F M, et al. An ESPGHAN position paper on the diagnosis, management, and prevention of cow's milk allergy[J]. J Pediatr Gastroenterol Nutr, 2024, 78(2): 386-413. doi:10.1097/mpg.0000000000003897
[12] VENTER C, MEYER R, GROETCH M, et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guideline update-XVI-Nutritional management of cow's milk allergy[J]. World Allergy Organ J, 2024, 17(8): 100931. doi:10.1016/j.waojou.2024.100931
[13] 中华医学会儿科学分会儿童保健学组, 《中华儿科杂志》编辑委员会. 婴幼儿食物过敏诊治建议[J]. 中华儿科杂志, 2011, 49(5): 344-348.
[14] 中华医学会儿科学分会免疫学组, 中华医学会儿科学分会儿童保健学组, 中华医学会儿科学分会消化学组, 等. 中国婴幼儿牛奶蛋白过敏诊治循证建议[J].中华儿科杂志, 2013, 51(3): 183-186.
[15] 中华医学会儿科学分会消化学组. 食物过敏相关消化道疾病诊断与管理专家共识[J]. 中华儿科杂志, 2017, 55(7): 487-492.
[16] 周薇, 赵京, 车会莲, 等. 中国儿童食物过敏循证指南[J]. 中华实用儿科临床杂志, 2022, 37(8): 572-583.
[17] 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): 26-35. doi:10.1186/s13601-017-0162-y
[18] FIOCCHI A, BOGNANNI A, BROZEK J, et al.World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow′s Milk Allergy (DRACMA) Guidelines update-I-Plan and defifinitions[J]. World Allergy Organ J, 2022, 15(1): 100609.
[19] 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.
[20] SAMPSON H A, ANDERSON J A. Summary and recommendations: Classification of gastrointestinal manifestations due to immunologic reactions to foods in infants and young children[J]. J Pediatr Gastroenterol Nutr, 2000, 30(): S87-S94. doi:10.1097/00005176-200001001-00013
[21] 陈同辛.婴幼儿牛奶蛋白过敏国内外指南解读[J]. 临床儿科杂志,2018,36(10):805-808.
[22] ESPíN JAIME B, DIAZ MARTIN J J, BLESA BAVIERA L C, et al. Non-IgE-mediated cow′s milk allergy: Consensus document of SEGHNP/AEPAP/SEPEAP/the Spanish Society of Paediatric ClinicaL Immunology, Allergy, and Asthma (SEICAP)[J]. Anales de Pediatría, 2019, 90(3): 193.e1-193.e11.
[23] NOWAK-WEGRZYN A, KATZ Y, MEHR S S, et al. Non-IgE-mediated gastrointestinal food allergy[J]. J Allergy Clin Immunol, 2015, 135(5): 1114-1124. doi:10.1016/j.jaci.2015.03.025
[24] LABROSSE R, GRAHAM F, CAUBET J C. Non-IgE-mediated gastrointestinal food allergies in children: An update[J]. Nutrients, 2020, 12(7): 2086. doi:10.3390/nu12072086
[25] AL-LEDE M, SARHAN L, ALSHROUF M A, et al. Perspectives on non-IgE-mediated gastrointestinal food allergy in pediatrics: A review of current evidence and guidelines[J]. J Asthma Allergy, 2023, 16(1): 279-291. doi:10.2147/jaa.s284825
[26] MOUSAN G, KAMAT D. Cow′s milk protein allergy[J]. Clin Pediatr(Phlia), 2016, 55(11): 1054-1063. doi:10.1177/0009922816664512
[27] VANDENPLAS Y, DUPONT C, EIGENMANN P, et al. A workshop report on the development of the cow′s milk-related symptom Score awareness tool for young children[J]. Acta Paediatr, 2015, 104(4): 334-339. doi:10.1111/apa.12902
[28] 李伟艳, 周少明, 王少华, 等. 牛奶相关症状评分在婴儿牛奶蛋白过敏早期识别中的评价: 多中心调查分析[J]. 临床儿科杂志, 2020, 38(8): 630-606.
[29] 成智, 颜美玲, 贺丰, 等. 基于胃肠道表现就诊的婴儿牛奶蛋白过敏症临床分析[J]. 现代生物医学进展, 2016, 16(30): 5957-5960.
[30] LUDMAN S, SHAH N, FOX A. Managing cows′ milk allergy in children[J]. BMJ,2013, 347(1): f5424. doi:10.1136/bmj.f5424
[31] GOMES-BELO J, HANNACHI F, SWAN K, et al. Advances in food allergy diagnosis[J]. Curr Pediatr Rev, 2018, 14(3): 139-149. doi:10.2174/1573396314666180423105842
[32] SICHERER S H, ALLEN K, LACK G, et al. Critical issues in food allergy: A National academies consensus report [J]. Pediatrics, 2017, 140(2): e20170194. doi:10.1542/peds.2017-0194
[33] MATTHAI J, SATHIASEKHARAN M, PODDAR U, et al.Guidelines on diagnosis and management of cow′s milk protein allergy[J]. Indian Pediatr, 2020, 57(8): 723-729. doi:10.1007/s13312-020-1916-5
[34] VANDEPLAS Y. Prevention and management of cow′s milk allergy in non-exclusively breastfed infants[J]. Nutrients, 2017, 9(7): 731-745. doi:10.3390/nu9070731
[35] VENTERC 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): 23-30. doi:10.1186/2045-7022-3-23
[36] CULER N, COKUGRAS F C, SAPAN N,et al. Dignosis and management of cow′s milk protein allergy in Turkey: Region-specific recommendations by an expert-pane[J]. Allergol Immunopathol, 2020, 48(2): 202-210. doi:10.1016/j.aller.2019.05.004
[37] HILL D J, MURCH S H, RAFFERTY K, et al. The efficacy of amio acid based formulas in relieving the symptoms of cow′s milk allergy: A systematic review[J]. Clin Exp Allergy, 2007, 37(6): 808-822. doi:10.1111/j.1365-2222.2007.02724.x
[38] NOWAK-W?GRZYN A, CHEHADE M, GROETCH M E, et al. International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: Executive summary-workgroup report of the adverse reactions to foods committee, American Academy of allergy, Asthma & Immunology[J]. J Allergy Clin Immunol,2017, 139(4): 1111-1126. doi:10.1016/j.jaci.2016.12.966
[39] MARTORELL-ARAGONéS A, ECHEVERRíA-ZUDAIRE L, ALONSO-LEBRERO E, et al. Position document: IgE-mediated cow's milk allergy[J]. Allergol Immunopathol (Madr), 2015, 43(5): 507-526. doi:10.1016/j.aller.2015.01.003
[40] MEYER R, VENTER C, BOGNANNI A, et al. World allergy organization (WAO) diagnosis and Rationale for action against cow′s milk allergy (DRACMA) guideline update -XII-Milk elimination and reintroduction in the diagnostic process of cow′s milk allergy[J]. World Allergy Organ J, 2023, 16(7): 100785. doi:10.1016/j.waojou.2023.100785
[41] FOX A, BROWN T, WALSH J, et al. An update to the milk allergy in primary care guideline[J].Clinical Trans Allergy, 2019, 9(1): 40-46. doi:10.1186/s13601-019-0281-8
[42] DUPONT C, KALACH N, SOULAINES P, et al. A thickened amino-acid formula in infants with cow′s milk allergy failing to respond to protein hydrolysate formulas: A randomized double-blind trial[J]. Paediatr Drugs, 2014, 16(6): 513-522. doi:10.1007/s40272-014-0097-x
[43] 中华医学会儿科学分会新生儿学组, 中华儿科杂志编辑委员会. 新生儿牛奶蛋白过敏诊断与管理专家共识(2023)[J].中华儿科杂志, 2024, 62(1): 12-21.
[44] 周慧君, 王薇, 王沛. 我国牛奶蛋白过敏患儿配方粉替代治疗方案的经济学评价[J]. 中国卫生资源, 2023, 26(5): 571-579.
[45] SCHOEMAKER A A, SPRIKKELMAN A B, GRIMSHAW K E, et al. Incidence and natural history of challenge-proven cow′s milk allergy in European children-EuroPrevall birth cohort[J]. Allergy, 2015, 70(8): 963-972. doi:10.1111/all.12630
[46] NOWICKI R J, TRZECIAK M, KACZMARSKI M, et al. Atopic dermatitis. Interdisciolinary diagnostic and therapeutic recommendations of the Polish Dermatological Society, Polish Society of Allergology, Polish Pediatric Society and Polish Society of Family Medicine. Part Ⅱ. Systemic treatment and new threapeutic methods[J]. Postepy Dermatol Alergol, 2020, 37(2): 129-134. doi:10.5114/ada.2020.94829
[47] COMBERIATI P, COSTAGLIOLA G, D′ELIOS S, et al. Prevention of food allergy: The significance of early introduction[J]. Medicina(Kaunas), 2019, 55(7): 323-329. doi:10.3390/medicina55070323
[48] DUTOIT G, ROBERTS G, SAYRE P H, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy[J]. N Engl J Med, 2015, 372(9): 803-813. doi:10.1056/nejmoa1414850
[49] FLEISCHER D M, SICHERER S, GREEHAWT M, et al. Consensus communication on early peanut introduction and the prevention of peanut allergy in high-risk infants[J]. Allergy, 2015, 70(10): 1193-1195.
[50] 《中华儿科杂志》编辑委员会,中华医学会儿科学分会. 儿童过敏性疾病诊断及治疗专家共识[J]. 中华儿科杂志, 2019, 57(3): 164-171.
[51] FEWTRELL M, BRONSKY J, CAMPOY C, et al. Complementary feeding a position paper by the European Society for paediatric Gastroenterology, Hepatology, and N trition (ESPGHAN)Committee on nutrition[J]. J Pediatr Gastroenterol Nutr, 2017, 64(1): 119-132. doi:10.1097/mpg.0000000000001454
[52] 程娟, 申昆玲, 段红梅. 婴幼儿辅食添加与食物过敏关系的研究进展[J]. 中国儿童保健杂志, 2019, 27(7): 737-740, 748.
[53] MEYER R, DE KOKER C, DZIUBAK R, et al. The Challenge of Home Allergen Re-introductions Using the Ladder Approach in Children With Non-IgE Mediated Gastrointestinal Food Allergy[J]. Front Allergy, 2021, 2: 721686. doi:10.3389/falgy.2021.721686
[54] MEYER R, GROETCH M, VENTER C. When Should Infants with Cow's Milk Protein Allergy Use an Amino Acid Formula? A Practical Guide[J]. J Allergy Clin Immunol Pract, 2018, 6(2): 383-399. doi:10.1016/j.jaip.2017.09.003
[55] VANDENPLAS Y, BROUGH H A, FIOCCHI A, et al. Current Guidelines and Future Strategies for the Management of Cow's Milk Allergy[J]. J Asthma Allergy, 2021, 14: 1243-1256. doi:10.2147/jaa.s276992
文章导航

/