İnek sütü alerjisi olan hastalarda tolerans gelişimini etkileyen faktörlerin retrospektif olarak değerlendirilmesi
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Tekirdağ Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Besin alerjisi, çocukları ve yetişkinleri etkileyen ve prevalansı artan önemli bir halk sağlığı sorunudur. İnek sütü alerjisi, genel popülasyonun %2-3'ünü etkileyen, bebeklerde ve küçük çocuklarda yaygın görülen besin alerjisidir. Çocukluk çağında besin alerjisine bağlı semptomların en sık yaşamın ilk iki yılında görüldüğü ve çoğunlukla geç çocukluk dönemine kadar tolerans geliştiği bildirilmektedir. Çalışmamızda Tekirdağ Namık Kemal Üniversitesi Çocuk Alerji ve İmmünoloji polikliniğinde inek sütü alerjisi tanısı ile izlenen 1-12 yaş arasında olan (minimum 12 ay maksimum 115 ay) hastaların, klinik ve demografik özellikleri ile tanısal amaçlı ve izlemde değerlendirilen laboratuvar tetkikleri hasta kayıtlarından retrospektif olarak incelenerek inek sütü alerjisinde tolerans gelişimini etkileyen faktörlerin araştırılması amaçlanmıştır. Olguların %9,4'ü (n=14) 2 yaşından önce, %45,6'sı (n=68) 2 yaşından sonra tolerans geliştirirken; %45,0'i (n=67) hala tolerans geliştirmemiştir. Çalışma süresince İSA tanısı ile izlenen hastalarda tolerans gelişiminin yaşlara göre dağılımına bakıldığında kümülatif olarak; 1 yaşında tolerans %9,4 (n=14) hastada, 2 yaşında tolerans %55 (n=82) hastada, 3 yaşında tolerans %81,9 (n=120), 4 yaşında tolerans (%85,2; n=127), 5 yaşında (%88,5; n=132) hastada, 5 yaş üstünde (%91,2; n=137) hastada tolerans gelişmiştir. Çalışma süresinde değerlendirilen 12 hastada ise (%8) henüz tolerans gelişmemiştir. 2 yaşında tolerans gelişimi ola hastalar, 2 yaşında tolerans gelişimi olmayan hastalar ile karşılaştırıldığında; Cinsiyet (p=0,699), ilk şikayet zamanı (p=0,142), eşlik eden atopik hastalık varlığı (p=0,17), ailede atopi öyküsü (p=0,225), astım varlığı (p=0,72), GİS semptomu varlığı (p=0,1), çoklu besin alerjisi varlığına göre (p=0,24), baba yaşı (p=0,02) iki grup arasında anlamlı fark saptanmamıştır. İki yaşında tolerans gelişmeyen hastalarda sezaryen ile doğum öyküsü (p=0,025) daha sık; izlem süresi daha uzun (p<0,001); laboratuvar testlerinde Total IgE (p=0,001), İS-sIgE (p=0,001), DPT'de İS kabarıklık çapı (p= p=0,001) daha yüksek; anne yaşı (p=0,007) daha yüksek; eşlik eden AR varlığı (p=0,002) daha sık; D vitamini düzeyi daha düşük olup; eşlik eden D vitamini düşüklüğü daha sıktır (p=0,025). İnek sütü alerjisi infantlarda ve erken çocukluk döneminde sık görülen besin alerjileri arasındadır. İnek sütü alımına bağlı ürtiker/anjiyoödem gibi bulgulardan anafilaksi gibi hayatı tehdit edici reaksiyonlara kadar geniş spektrumda klinik bulgular görülebilir. Bu hastalarda tolerans gelişimini etkileyen faktörlerin belirlenerek hastaların değerlendirilmesi gereksiz eliminasyon diyetinden kaçınmak için önemlidir. Bu çalışmada iki yaşında tolerans gelişimi olmayan hastalarda, 2 yaşında tolerans gelişen hastalar ile karşılaştırıldığında eşlik eden AR daha sık, anne/baba yaşı daha büyük, D vitamini düzeyi düşük, Total IgE yüksek, İS-sIgE yüksek, DPT'de İS kabarıklık çağı yüksek saptanmıştır. Anahtar Kelimeler: İnek sütü alerjisi, Tolerans gelişimi, SpIgE, DPT
Food allergy is an important public health problem that affects children and adults and its prevalence is increasing. Cow's milk allergy is a common food allergy in infants and young children, affecting 2-3% of the general population. It has been reported that symptoms of food allergy in childhood are most commonly seen in the first two years of life, and tolerance usually develops by late childhood. In our study, the clinical and demographic characteristics of the patients aged between 1 and 12 years (minimum 12 months, maximum 115 months) who were followed up with the diagnosis of cow's milk allergy at the Tekirdağ Namık Kemal University Pediatric Allergy and Immunology outpatient clinic, and their laboratory tests evaluated for diagnostic purposes and during follow-up were retrospectively examined from the patient records. It was aimed to investigate the factors affecting the development of tolerance in milk allergy. While 9.4% (n=14) of the cases developed tolerance before the age of 2, 45.6% (n=68) developed tolerance after the age of 2; 45.0% (n=67) still have not developed tolerance. When looking at the distribution of tolerance development according to age in patients followed with a diagnosis of CMA during the study, cumulatively; Tolerance at 1 year of age is 9.4% (n=14) of patients, tolerance at 2 years of age is 55% (n=82) of patients, tolerance at 3 years of age is 81.9% (n=120), tolerance at 4 years of age (85.2%; n= 127), tolerance developed in patients aged 5 years (88.5%; n=132) and in patients older than 5 years (91.2%; n=137). Tolerance had not yet developed in 12 patients (8%) evaluated during the study period. When patients with tolerance development at 2 years of age were compared with patients without tolerance development at 2 years of age; Gender (p=0.699), time of first complaint (p=0.142), presence of concomitant atopic disease (p=0.17), family history of atopy (p=0.225), presence of asthma (p=0.72), GI symptoms there was no significant difference between the two groups in terms of presence of food allergies (p=0.1), presence of multiple food allergies (p=0.24), and paternal age (p=0.02). A history of cesarean section was more common in patients who did not develop tolerance at the age of two (p = 0.025); follow-up period is longer (p<0.001); Total IgE (p=0.001), CM-sIgE (p=0.001) and CM swelling diameter in SPT (p= p=0.001) were higher in laboratory tests; maternal age (p=0.007) higher; presence of accompanying AR (p=0.002) more frequently; Vitamin D level is lower; accompanying vitamin D deficiency is more common (p=0.025). Cow's milk allergy is among the common food allergies in infants and early childhood. A wide spectrum of clinical findings may occur due to cow's milk intake, ranging from findings such as urticaria/angioedema to life-threatening reactions such as anaphylaxis. It is important to evaluate the patients by determining the factors affecting the development of tolerance in these patients to avoid unnecessary elimination diet. In this study, in patients who did not develop tolerance at the age of 2 years, concomitant AR was more common, maternal age was older, vitamin D level was low, Total IgE was high, CM-sIgE was high, CM swelling age on SPT was higher, compared to patients who developed tolerance at the age of 2 years has been detected. Keywords: Cow's milk allergy, Tolerance development, sIgE, SPT
Food allergy is an important public health problem that affects children and adults and its prevalence is increasing. Cow's milk allergy is a common food allergy in infants and young children, affecting 2-3% of the general population. It has been reported that symptoms of food allergy in childhood are most commonly seen in the first two years of life, and tolerance usually develops by late childhood. In our study, the clinical and demographic characteristics of the patients aged between 1 and 12 years (minimum 12 months, maximum 115 months) who were followed up with the diagnosis of cow's milk allergy at the Tekirdağ Namık Kemal University Pediatric Allergy and Immunology outpatient clinic, and their laboratory tests evaluated for diagnostic purposes and during follow-up were retrospectively examined from the patient records. It was aimed to investigate the factors affecting the development of tolerance in milk allergy. While 9.4% (n=14) of the cases developed tolerance before the age of 2, 45.6% (n=68) developed tolerance after the age of 2; 45.0% (n=67) still have not developed tolerance. When looking at the distribution of tolerance development according to age in patients followed with a diagnosis of CMA during the study, cumulatively; Tolerance at 1 year of age is 9.4% (n=14) of patients, tolerance at 2 years of age is 55% (n=82) of patients, tolerance at 3 years of age is 81.9% (n=120), tolerance at 4 years of age (85.2%; n= 127), tolerance developed in patients aged 5 years (88.5%; n=132) and in patients older than 5 years (91.2%; n=137). Tolerance had not yet developed in 12 patients (8%) evaluated during the study period. When patients with tolerance development at 2 years of age were compared with patients without tolerance development at 2 years of age; Gender (p=0.699), time of first complaint (p=0.142), presence of concomitant atopic disease (p=0.17), family history of atopy (p=0.225), presence of asthma (p=0.72), GI symptoms there was no significant difference between the two groups in terms of presence of food allergies (p=0.1), presence of multiple food allergies (p=0.24), and paternal age (p=0.02). A history of cesarean section was more common in patients who did not develop tolerance at the age of two (p = 0.025); follow-up period is longer (p<0.001); Total IgE (p=0.001), CM-sIgE (p=0.001) and CM swelling diameter in SPT (p= p=0.001) were higher in laboratory tests; maternal age (p=0.007) higher; presence of accompanying AR (p=0.002) more frequently; Vitamin D level is lower; accompanying vitamin D deficiency is more common (p=0.025). Cow's milk allergy is among the common food allergies in infants and early childhood. A wide spectrum of clinical findings may occur due to cow's milk intake, ranging from findings such as urticaria/angioedema to life-threatening reactions such as anaphylaxis. It is important to evaluate the patients by determining the factors affecting the development of tolerance in these patients to avoid unnecessary elimination diet. In this study, in patients who did not develop tolerance at the age of 2 years, concomitant AR was more common, maternal age was older, vitamin D level was low, Total IgE was high, CM-sIgE was high, CM swelling age on SPT was higher, compared to patients who developed tolerance at the age of 2 years has been detected. Keywords: Cow's milk allergy, Tolerance development, sIgE, SPT
Açıklama
Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
Anahtar Kelimeler
Allerji ve İmmünoloji, Allergy and Immunology ; Çocuk Sağlığı ve Hastalıkları
