移植可修復(fù)中風(fēng)損壞的老鼠大腦

牛奶過敏——是被過度診斷了嗎?

A new review published in the journal JAMA Pediatrics in April 2020 raises the concern that there may be a significant overdiagnosis of cow's milk allergy in babies and young children, stemming from the use of current medical recommendations.

2020年4月發(fā)表在《美國醫(yī)學(xué)會(huì)雜志: 兒科學(xué)》雜志上的一篇新綜述提出了這樣一種擔(dān)憂:由于使用了當(dāng)前的醫(yī)學(xué)建議，嬰兒和幼兒對牛奶過敏可能存在嚴(yán)重的過度診斷。

The study was carried out by researchers at the Imperial College London and Sechenov University in Moscow. They examined official guidelines put out by nine different organizations to diagnose cow's milk allergy, between 2012 and 2109. These recommendations came from several countries, mostly in Europe.

這項(xiàng)研究是由倫敦帝國理工學(xué)院和莫斯科謝奇諾夫大學(xué)的研究人員進(jìn)行的。他們研究了9個(gè)不同組織，在2012年至2109年間發(fā)布的診斷牛奶過敏的官方指南。這些建議來自幾個(gè)國家，大部分是歐洲國家。

What is milk allergy?

什么是牛奶過敏?

Milk allergy is most typically diagnosed in children less than two years old. Researchers have traditionally classified it as IgE-mediated and non-IgE mediated. In the former type, the allergic reaction involves the antibody component called immunoglobulin E, which causes symptoms like vomiting, raised red rashes on the skin, and very rarely, a life-threatening reaction termed anaphylaxis that causes breathing problems. It can be reproducibly diagnosed by a skin test.

牛奶過敏最典型的診斷是兩歲以下的兒童。傳統(tǒng)上，研究人員將其分為ige介導(dǎo)型和非ige介導(dǎo)型。 研究人員傳統(tǒng)上將其分為 IgE-mediated 和 non-IgE mediated。 在前一種類型中，過敏反應(yīng)包括一種叫做免疫球蛋白E 的抗體成分，這種抗體會(huì)引起嘔吐、皮膚出現(xiàn)紅疹等癥狀，而且極少見的情況下，這種過敏反應(yīng)被稱為導(dǎo)致呼吸問題的危及生命的反應(yīng)。 它可以通過皮膚試驗(yàn)進(jìn)行重復(fù)性診斷。

The non-IgE type is different. While the symptoms may include vomiting, loose stools, and excessive crying, these are highly non-specific and are, moreover, far too frequently complained of in healthy young babies to be considered a pointer to any pathological condition.

非ige型則不同。雖然這些癥狀可能包括嘔吐、大便不清和過度哭泣，但這些都是非特異性的，而且在健康的幼兒中經(jīng)常被抱怨，以至于不能被認(rèn)為是任何病理狀態(tài)的指針。

How many children have cow's milk allergy?

有多少兒童對牛奶過敏?

The team of researchers discovered that symptoms like excessive crying, milk regurgitation, and loose stools were often listed as symptoms of cow's milk allergy by many of the guidelines. On the other hand, these symptoms are often commonly found in healthy babies as well.

研究小組發(fā)現(xiàn)，過度哭泣、牛奶反流、大便稀少等癥狀常常被許多指南列為牛奶過敏癥狀。 另一方面，這些癥狀也常見于健康的嬰兒。

Using earlier data, from a recent birth cohort study in Europe, including more than 12,000 babies in 9 different countries, only about 1% were diagnosed with cow's milk allergy. However, in some other studies, the percentage of families who thought their children had such an allergy was as high as 14%. Also, between 2000 and 2018, in countries such as Australia and England, there was a sharp increase in the number of prescriptions for specialist formulas for babies who had cow's milk allergy. On the other hand, studies have generally shown no change in the incidence of this condition over time.

根據(jù)歐洲最近的一項(xiàng)出生隊(duì)列研究(包括9個(gè)不同國家的1.2萬多名嬰兒)的早期數(shù)據(jù)，只有大約1%的嬰兒被診斷出牛奶過敏。然而，在其他一些研究中，認(rèn)為自己的孩子有過敏癥的家庭比例高達(dá)14%。此外，在2000年至2018年期間，澳大利亞和英國等國家出現(xiàn)了牛奶過敏嬰兒配方奶粉處方數(shù)量的急劇增長。另一方面，研究普遍表明，隨著時(shí)間的推移，這種情況的發(fā)生率沒有變化。

The official guidelines on how to identify cow's milk allergy could be one of the possible causes for this rise in false diagnoses, according to the study.

根據(jù)這項(xiàng)研究，關(guān)于如何鑒別牛奶過敏的官方指南可能是造成誤診率上升的原因之一。