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Impact of dietary regimen on the duration of cow's milk allergy: a random allocation study.

机译：饮食方案对牛奶过敏持续时间的影响：一项随机分配研究。

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BACKGROUND: The impact of diet on cow's milk allergy (CMA) duration and whether exposure to residual amounts of cow's milk protein influences the onset of tolerance are unknown. OBJECTIVE: To prospectively assess the dietary factors influencing disease duration in a randomized cohort. METHODS: We randomly switched the formula of symptomatic patients from the Milan Cow's Milk Allergy Cohort to one of three treatment groups according to the quarterly rotation of rice hydrolysate formula, extensively hydrolysed cow's milk formula and soy-based formula. In this intention-to-treat, randomized analysis, a hazard ratio (HR) estimation model was used to analyse dietary impact on disease duration. RESULTS: Seventy-two children aged a mean of 14.1+/-8.6 months at diagnosis were followed up for a median of 26 months. Fifty-one reached tolerance at a mean of 34.1+/-15.2 months. The mean duration of disease was 40.2+/-4.8 months with milk hydrolysate, 24.3+/-3.6 months with rice and 24.3+/-2.6 months with soy. Dietary choice independently predicted shorter duration of disease [adjusted HRs 3.09 (P=0.007) for rice, 2.54 (P=0.02) for soy, both against milk hydrolysate]. In 50 children not co-sensitized to soy, diet choice impacted the duration of disease more strongly [adjusted HRs 8.02 (P=0.006) for rice, 6.53 (P=0.015) for soy, both against milk hydrolysate]. DISCUSSION: Patients not exposed to cow's milk protein residue achieve cow's milk tolerance earlier than patients who follow an extensively hydrolysed cow's milk diet. This may be due to residual antigenicity in hydrolysed milks. As the effect of dietary intervention is stronger in patients not sensitized to soy, we infer that when atopic disease has progressed to multiple sensitizations, the elimination of allergenic exposure may not be sufficient to reduce the duration of CMA.
机译：背景：饮食对牛奶过敏（CMA）持续时间的影响以及暴露于残留量的牛奶蛋白是否会影响耐受性的发生尚不清楚。目的：前瞻性评估随机队列中影响疾病持续时间的饮食因素。方法：根据米水解液配方，广泛水解的牛乳配方和豆浆配方的每季度轮换，将有症状患者的配方从米兰牛奶过敏人群中随机分为三个治疗组之一。在这种意向性治疗的随机分析中，使用危险比（HR）估计模型来分析饮食对疾病持续时间的影响。结果：对72名平均诊断为14.1 +/- 8.6个月的儿童进行了随访，中位时间为26个月。 51名患者的耐受性平均为34.1 +/- 15.2个月。牛奶水解物的平均病程为40.2 +/- 4.8个月，大米为24.3 +/- 3.6个月，大豆为24.3 +/- 2.6个月。饮食选择可独立预测疾病的持续时间[针对牛奶水解物，大米的HRs调整为3.09（P = 0.007），大豆的HRs调整为2.54（P = 0.02）]。在对大豆未同时致敏的50名儿童中，饮食选择对疾病的持续时间有更大的影响[大米调整后的HRs 8.02（P = 0.006），大豆调整后的HRs 8.53（P = 0.015），均抗牛奶水解物]。讨论：未暴露于牛奶蛋白残留物的患者比接受广泛水解的牛奶饮食的患者更早实现了牛奶耐受性。这可能是由于水解乳中残留的抗原性所致。由于对大豆不敏感的患者的饮食干预效果更强，因此我们推断，当特应性疾病发展为多次致敏时，消除过敏原暴露可能不足以减少CMA的持续时间。

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