婴儿食物过敏的临床症状及血清特异性免疫球蛋白E检测结果分析

Clinical symptoms of infant food allergy and analysis of serum specific immunoglobulin E detection results

摘要

目的 了解不同过敏症状患儿的食物过敏原,为婴儿食物过敏的防治提供参考依据。方法 选取2022年1月至12月间于长沙市妇幼保健院儿童保健中心体检中因过敏症状采用免疫印迹法进行血清特异性免疫球蛋白E(sIgE)检测的849例婴儿为研究对象.按不同年龄将婴儿分为<6月龄与≥6月龄;根据过敏的临床症状及病史等,将其分为皮肤症状(262例)、消化道症状(113例)、营养不良症状(56例)、呼吸道症状(58例)、混合症状(360例).对不同年龄、不同性别婴儿的食物过敏原及血清sIgE检测阳性分布情况进行比较分析。结果 在849名婴儿中,有皮肤症状者占30.9%(262/849),消化道症状者占13.3%(113/849),营养不良者占6.6%(56/849),呼吸道症状者占6.8%(58/849),混合症状者占42.4%(360/849);其中,男婴占57.8%(491/849),女婴占42.2%(358/849),不同性别婴儿过敏症状的分布比较差异无统计学意义(P>0.05);<6月龄者占23.8%(202/849),≥6月龄者占76.2%(647/849),不同年龄婴儿过敏症状的分布比较差异有统计学意义(χ²=49.303,P<0.001).在849名婴儿中,食物过敏原血清sIgE检测阳性者占51.7%(439/849),阴性者占48.3%(410/849);其中,男婴食物过敏原血清sIgE检测阳性者占58.3%(256/439),女婴阳性者占41.7%(183/439),不同性别婴儿食物过敏原血清sIgE检测阳性的分布比较差异无统计学意义(P>0.05);<6月龄婴儿食物过敏原血清sIgE检测阳性占17.1%(75/439),≥6月龄者阳性占82.9%(364/439),不同年龄婴儿食物过敏原血清sIgE检测阳性的分布比较差异有统计学意义(χ²=22.563,P<0.001).不同年龄婴儿的食物过敏原数量比较差异有统计学意义(Z=-4.376,P<0.05),而不同性别婴儿的食物过敏原数量比较差异无统计学意义(P>0.05).不同过敏症状食物过敏原血清sIgE检测阳性率及致敏种类的分布比较差异均无统计学意义(P>0.05).在12种常见食物过敏原中,牛奶的血清sIgE检测阳性致敏程度最高可达3级,鸡蛋白的致敏程度最高可达6级;≥6月龄婴儿食物过敏原血清sIgE检测阳性率均高于<6月龄婴儿,但在不同年龄婴儿中,只有牛奶过敏原血清sIgE检测阳性率比较差异有统计学意义(χ²=25.122,P<0.001),其他11种食物过敏原血清sIgE检测阳性率比较差异均无统计学意义(P>0.05)。结论 婴儿早期食物过敏以皮肤症状为主,食物过敏原以牛奶、鸡蛋为主,血清sIgE检测对诊断IgE介导的食物过敏有意义,食物过敏的诊断仍需要综合其他因素分析判断.

Abstract

Objective To investigate food allergens of infants with different allergic symptoms, so as to provide basis for prevention and treatment of food allergy in infants. Methods 849 infants with different allergic symptoms who received serum specific immunoglobulin E (sIgE) detection by immunoblotting method in Children's Health Care Center of Changsha Municipal Maternal and Child Health Hospital from January 2022 to December 2022 were selected. They were divided into <6 month age group and >6 month age group according to month age of the infant, and again they were divided into skin allergic symptom group (n=262), gastrointestinal allergic symptom group (n=113), malnutrition symptom group (n=56), respiratory allergic symptom group (n=58) and mixed allergic symptom group according to clinical allergic symptoms and disease history of the infant. The food allergens and positive distribution of sIgE were analyzed and compared among different age groups and between the two gender groups. Results Among 849 infants, the infants with skin allergic symptoms accounted for 30.9% (262/849), the infants with gastrointestinal allergic symptoms accounted for 13.3% (113/849), the infants with malnutrition symptoms accounted for 6.6% (56/849), the infants with respiratory allergic symptoms accounted for 6.8% (58/849) and the infants with mixed allergic symptoms accounted for 42.4% (360/849), of which, the male infants accounted for 57.8% (491/849), and the female infants accounted for 42.2% (358/849), and there was no significant difference between the two gender groups in distribution of allergic symptoms (P>0.05). The infants aged <6 months accounted for 23.8% (202/849) and the infants aged ≥6 month age accounted for 76.2% (647/849), there was a significant difference between the two age groups in distribution of allergic symptoms (χ ²=49.303, P<0.001). Among 849 infants, the infants with positive detection result of sIgE for food allergens accounted for 51.7% (439/849), and the infants with negative detection result of sIgE for food allergens accounted for 48.3% (410/849), of them the male infants with positive sIgE detection result for food allergens accounted for 58.3% (256/439), and the female infants with positive detection result of sIgE for food allergens accounted for 41.7% (183/439), and there was no significant difference between the two gender groups in distribution of positive detection result of sIgE for food allergens (P>0.05). The infants aged <6 months with positive detection result of sIgE for food allergens accounted for 17.1% (75/439) and the infants aged ≥6 month with positive detection result of sIgE for food allergens accounted for 82.9% (364/439), there was a significant difference between the two age groups in distribution of positive detection result of sIgE for food allergens (χ²=22.563, P<0.001). In number of food allergens, there was a significant difference between the two age groups (Z=-4.376, P<0.05), while there was no significant difference between the two gender groups (P>0.05). In distributions of positive detection result of sIgE for food allergens and type of food allergens there were no significant differences among the infants with different allergic symptoms (both P>0.05). Among common 12 food allergens, the sensitization degree of milk for positive sIgE detection result reached to grade 3 at most, and the sensitization degree of egg for positive sIgE detection result reached to grade 6 at most. The positive detection rate of sIgE for food allergens in the infants aged ≥6 months was higher than that in the infants aged <6 months, but in the positive detection rate of sIgE for only milk, there was a significant difference among different age infants (χ²=25.122, P<0.001), while in the positive detection rate of sIgE for other 11 kinds of food allergens, there were no significant differences (all P>0.05). Conclusion In early infancy, food allergic symptoms of the infants mainly present with skin allergic symptoms, and the food allergens are mainly milk and eggs. The detection of serum sIgE is of significance for diagnosing IgE mediated food allergy. However, the diagnosis of food allergy still needs to analyze and judge by combining other factors.

关键词

婴儿 / 食物过敏 / 血清特异性免疫球蛋白E检测 / 过敏原

Key words

infant / food allergy / serum specific immunoglobulin E detection / allergen

参考文献

[1] Wang J, Liu W, Zhou C, et al. Multi-perspective observation on the prevalence of food allergy in the general Chinese population: a meta-analysis[J]. Nutrients, 2022, 14(23): 5181.

[2] Spolidoro G C I, Amera Y T, Ali M M, et al. Frequency of food allergy in Europe: an updated systematic review and meta-analysis[J]. Allergy, 2023, 78(2): 351-368.

[3] Donaldson B, Le Minh-Thu N. The clinical presentation of alpha-gal allergy among pediatric patients with food allergy in southwest Missouri[J]. Ann Allergy Asthma Immunol, 2019, 123(5): 524-525.

[4] 赵慧, 张会丰, 魏凤, 等. 婴幼儿血清25(OH)D水平、食物过敏与特应性皮炎严重程度的关系研究[J]. 新医学, 2022, 53(2): 93-97.

[5] Crespo J F, Cabanillas B. Recent advances in cellular and molecular mechanisms of IgE-mediated food allergy[J]. Food Chem, 2023, 411: 135500.

[6] Germundson D L, Nagamoto-Combs K. Isotype-specific detection of serum immunoglobulins against allergens[J]. Methods Mol Biol, 2021, 2223: 159-167.

[7] 张长皓, 刘婷婷, 向莉, 等. 世界过敏组织关于IgE介导过敏反应的诊断及过敏反应其他相关检测方法立场文件解读(二)-体外检测[J]. 中华实用儿科临床杂志, 2021, 36(6): 443-446.

[8] 中国儿童食物过敏性循证指南[J]. 中华实用儿科临床杂志, 2022, 37(8): 572-583.

[9] Sampson H A. Utility of food-specific IgE concentrations in predicting symptomatic food allergy[J]. J Allergy Clin Immunol, 2001, 107(5): 891-896.

[10] Łoś-Rycharska E, Gołębiewski M, Grzybowski T, et al. The microbiome and its impact on food allergy and atopic dermatitis in children[J]. Postepy Dermatol Alergol, 2020, 37(5): 641-650.

[11] 李迪, 沈惠青, 徐樨巍, 等. 食物蛋白诱导的婴儿小肠结肠炎综合征5例临床特点并文献复习[J]. 中华实用儿科临床杂志, 2021, 36(17): 1344-1348.

[12] De Paepe E, Van Gijseghem L, De Spiegeleer M, et al. A systematic review of metabolic alterations underlying IgE-mediated food allergy in children[J]. Mol Nutr Food Res, 2021, 65(23): e2100536.

[13] 王硕, 蒋竞雄, 王燕, 等. 城市0~24月龄婴幼儿过敏性疾病症状流行病学调查[J]. 中国儿童保健杂志, 2016, 24(2): 119-122.

[14] Sugita K, Akdis C A. Recent developments and advances in atopic dermatitis and food allergy[J]. Allergol Int, 2020, 69(2): 204-214.

[15] Gabryszewski S J, Hill D A. One march, many paths: insights into allergic march trajectories[J]. Ann Allergy Asthma Immunol, 2021, 127(3): 293-300.

[16] Kostara M, Giapros V, Serbis A, et al. Food allergy in children is associated with Vitamin D deficiency: a case-control study[J]. Acta Paediatrica, 2022, 111(3): 644-645.

[17] Protudjer J L P, Greenhawt M, Abrams E M. Race and ethnicity and food allergy: remaining challenges[J]. J Allergy Clin Immunol Pract, 2021, 9(11): 3859-3861.

[18] Luo Y, Zhang G, Li Z. The diagnostic value of APT for food allergy in children: a systematic review and meta-analysis[J]. Pediatr Allergy and Immunol, 2019, 30(4): 451-461.

[19] Ma Z, Chen L, Xian R, et al. Time trends of childhood food allergy in China: three cross-sectional surveys in 1999, 2009, and 2019[J]. Pediatr Allergy Immunol, 2021, 32(5): 1073-1079.

[20] Pelak G, Wiese A M, Maskarinec J M, et al. Infant feeding practices during the first postnatal year and risk of asthma and allergic disease during the first 6 years of life[J]. Breastfeed Med, 2021, 16(7): 539-546.

[21] Oriel R C, Wang J. Diagnosis and management of food allergy[J]. Pediatr Clin North America, 2019, 66(5): 941-954.

[22] 姜楠楠, 向莉. 婴幼儿严重过敏反应的临床特征[J]. 中华临床免疫和变态反应杂志, 2020, 14(5): 447-456.

基金资助

长沙市自然科学基金(kq2202036)