[Natural history and risk factors of IgE-mediated cow's milk protein allergy in infants].

Objective: To investigate the natural history and risk factors for continued allergy in infants with IgE-mediated cow's milk protein allergy (CMPA). Methods: This was a prospective cohort study that included 72 infants under 24 months of age diagnosed with IgE-mediated CMPA in the allergy clinic of the Children's Hospital, Capital Institute of Pediatrics from October 2019 to November 2020. General information, clinical manifestations, serum total IgE, cow's milk specific IgE, and cow's milk protein component specific IgE were collected. Follow-ups were conducted at 24 and 36 months of age, and the patients were divided into the persistent allergy group and the tolerance group based on whether they developed cow's milk tolerance at 36 months of age. Mann-Whitney U test, chi-square test, and binary Logistic regression were used for intergroup comparison and multivariate analysis. Results: Among the 72 CMPA children, there were 42 boys and 30 girls, with an age of 10 (7, 15) months at enrollment. Cow's milk protein tolerance was observed in 32 cases (44%) and 46 cases (64%) at 24 and 36 months of age, respectively. There were 26 cases in the persistent allergy group and 46 cases in the tolerance group. The proportion of respiratory symptoms, history of wheezing, positive specific IgE for α-lactalbumin and the total IgE level in the persistent allergy group were higher than that in the tolerance group (7 cases (27%) vs. 0, 6 cases (23%) vs. 2 cases (4%), 67% (14/21) vs. 26% (10/39), 225 (151, 616) vs. 48 (21, 185) kU/L, χ2=10.82, 4.16, 9.57, Z=4.07, all P<0.05). Multivariate Logistic regression analysis showed that anaphylaxis (OR=21.14, 95%CI 2.55-175.14, P=0.005), a history of allergic rhinitis (OR=5.94, 95%CI 1.54-22.86, P=0.005), elevated milk specific IgE (OR=1.04, 95%CI 1.01-1.08, P=0.024), and positive casein specific IgE (OR=6.64, 95%CI 1.39-31.69, P=0.018) were risk factors for continuous CMPA. Conclusions: Most infants with IgE-mediated CMPA can achieve tolerance within 3 years. Anaphylaxis, a history of allergic rhinitis, elevated milk specific IgE levels, and casein sensitization are risk factors for continuous allergy.目的： 探讨婴儿IgE介导牛奶蛋白过敏（CMPA）的自然病程及持续过敏的危险因素。 方法： 前瞻性队列研究。纳入2019年10月至2020年11月首都儿科研究所附属儿童医院变态反应门诊就诊的72例<24月龄IgE介导CMPA患儿为研究对象。收集患儿一般情况、临床表现、血清总IgE、牛奶特异性IgE、牛奶组分特异性IgE等基线临床资料。在患儿24、36月龄进行随访，根据患儿36月龄是否出现牛奶耐受分为持续过敏组和耐受组。采用Mann-Whitney U检验、χ2检验等进行组间比较，多因素Logistic回归分析危险因素。 结果： 72例患儿中男42例、女30例，就诊年龄10（7，15）月龄。24、36月龄内出现牛奶蛋白耐受者分别32例（44%）、46例（64%）。持续过敏组26例、耐受组46例。持续过敏组患儿CMPA表现为呼吸道症状、喘息病史、α乳清蛋白特异性IgE阳性的比例及总IgE水平均高于耐受组［7例（27%）比0、6例（23%）比2例（4%）、67%（14/21）比26%（10/39）、225（151，616）比48（21，185）kU/L，χ2=10.82、4.16、9.57、Z=4.07，均P<0.05］。多因素Logistic回归分析示CMPA症状表现为严重过敏反应（OR=21.14，95%CI 2.55~175.14，P=0.005）、有过敏性鼻炎病史（OR=5.94，95%CI 1.54~22.86，P=0.005）、牛奶特异性IgE升高（OR=1.04，95%CI 1.01~1.08，P=0.024）、酪蛋白特异性IgE阳性（OR=6.64，95%CI 1.39~31.69，P=0.018）均是牛奶持续过敏的危险因素。 结论： 婴儿IgE介导的CMPA大多数可在3岁内获得耐受。CMPA表现为严重过敏反应、有过敏性鼻炎病史、牛奶特异性IgE升高、酪蛋白致敏是持续过敏的危险因素。.