The Clinical Analysis And Follow-up Study Of Children’s Food Allergy

Background:Food Allergy(FA), which refers to the adverse reaction mediated byimmunological mechanism, had gradually reached a higher incidence inrecent years. FA could implicate multiple organ systems, frequently themucocutaneous system，digestive system and respiratory system，whilewith no specific clinical manifestation. According to the mechanism,, it canbe divided into IgE mediated FA and non-IgE mediated FA. Thoughdiagnostic examinations like SPT, detection of serum specific IgE, etc., areoften used in clinical diagnosis of FA, a definite diagnosis is cruciallydepending on food challenge test. As a common complaint of children orinitial symptom of allergy march, FA brings serious influences to thechildren’s growth and development, and harms their living qualities, thusan instant intervention is needed as soon as the diagnosis has been defined.Keeping away from allergen is a general principal. For the infants whohave cow’s milk protein allergy, the breast-feds can still be breast-fedhaving their moms keeping away from the allergen; the formula-feds orseriously allergic ones can take Extensively Hypoallergenic Formula (eHF,) or Amino Acid-based Formula (AAF) for a change. Being short of data oflong-term follow-up studies on FA children, a further research is required.Objects:This study aims at summarizing the clinical features and experience ofdiagnosis and treatments of children’s food allergies by reviewing andanalyzing the clinical symptoms, laboratory examinations, treatmentmethods and recovery situations of them.Hoping to get more informationabout food allergy.Methods:1.Research objects:clinical records were collected from somesuspected food allergy child who were treated in gastroenterology dept. ordermatology dept. of Children’s Hospital of Chong Qing MedicalUniversity between June2012and February2013.2.According to diagnostic criteria,combining with history,manifestation and positive laboratory examinations, the information (suchas development and treatment and so on) about the cases was obtained byfollow-up via telephone or the clinic visit and then was reevaluated andanalyzed retrospectively.3.Statistical analysis: The clinical data was analyzed by the statisticalsoftware SPSS17.0and Microsoft Office Excel2003.The qualitative datawas tested by fisher’s exact test,and the quantitative data was expressed bymedian(M) and the range of the data,and tested by t-test.The measurement data was tested by X2-test.P＜0.05means that there was a statisticalsignificant difference.Result:1.In our group,male:female=58:67.Among of them,the age was lessthan4months in53cases (42.4%),4months to1year in30cases(24%),1-3years (yrs) in22cases (12.5%),more than3yrs in20cases(16%).2.In67cases (53.6%),simple gastrointestinal symptoms were the mainmanifestation.33cases (26.4%) only had symptoms of skin and mucosa.In25cases (20%),the manifestation combined with digestive system and Skinand Mucosa. Gastrointestinal symptoms included diarrhea,hematochezia,abdominal pain/night crying,abdominal distension,constipation,anorexiaand vomiting.3.23cases (27.2%) suffered from different degree of malnutrition.4.3cases (2.4%) had a history of asthma. In31cases (24.8%),first-degree relatives had a history of food allergies.5.73cases underwent SPT, with37cases (50.7%) positive.15cases (40.5%) were positive for milk,17cases (46.0%) were positive foregg yolk,10cases (27.0%) were positive for egg white.11cases (29.7%)were positive for mango,9cases (24.3%) were positive for seafood.6.41cases underwent serum specific IgE test, in29cases (70.7%),the serum specific IgE elevated. 7.79cases underwent blood routine test, in29cases (37.6%)eosinophils increased, with a range of0.52-0.97×109/L.8.63cases underwent stool routine+OB+LT, in15cases (23.81%),OB are positive, in7cases (11.11%), LT are positive.9.There were19cases whose serum specific IgE elevated among37cases whose SPT results were positive. The consistency was51.4%, butthere was no statistical significant association between the two elevatedlevels(P=0.622）. There were25children with SPT positive among29cases with eosinophilic raising,the consistency was86.2%, also found nostatistical significant association with increasing degree(P=0.651). Therewere20cases with specific serum IgE increasing among29cases witheosinophilic elevating, but also had been found no statistically significantassociation between two increasing levels（P=0.724).10.26cases underwent abdominal ultrasonography,8cases (30.8%)showed the presence of intestinal contents increasing,4cases (15.4%)showed the mesenteric lymph nodes enlarge.11.14cases underwent gastroscopy,12cases (85.7%) suggested thepresence of chronic gastritis or duodenitis. Among them7cases (58.3%)did the pathological biopsy and showed that mucosal lamina propria wasinfiltrated with eosinophil cell.12.There were15cases(75%)chose to continue breast feeding amongthe20breast-fed children,with mothers’ eliminating diet,while other3 cases changed to extensively hypoallergenic formula,2cases changed toamino acid-based formula.There were42cases (66.7%) changed toextensively hypoallergenic formula,21cases (33.3%) changed to aminoacid-based formula among the63bottlefed or mixfed children.13.There were26/29followed up.We assess the children’s growth bythe Z score before and after treatment.There was no significant difference(P=0.699) in weight for age Z score between before and after the treatmentin the breatfeeding group.There was significant differences (P=0.017,0.022)in weight for age Z score between before and after the treatment in the eHFfed and AAF fed groups.Conclusion:Children’s food allergies will occur through all ages without anyspecific clinical manifestation. SPT, detections of eosinophile granulocyteor serum specific IgE, etc., will help to find a food allergy. Patch test is theonly way that can support the existence of a non-IgE mediated allergen offood allergic reaction. Open Food Challenge is,much more preferred indiagnosing FA than DBPCFC,the gold standard, because the latter isdifficult in practice. Currently, diet restriction and replacement therapy arethe primary treatment method.