Abstract：
Cow\'s milk allergy refers to an immunological reaction to milk protein. It is one of the commonest food protein allergies with an estimated prevalence of 0.5% to 3% at 1 y of life. The disease may be IgE or non-IgE mediated or mixed with a wide range of symptoms often involving multiple organ systems. Gastrointestinal manifestations are common in non-IgE disease and may consist of enteropathy, proctocolitis, colic, reflux-like symptoms, constipation, enterocolitis syndrome and eosinophilic esophagitis. The gold standard for diagnosis remains a double-blind placebo-controlled oral challenge. Specific IgE and skin prick tests may predict severe and persistent disease, and aid in deciding on reintroduction or oral immunotherapy; however, they do not contribute to a definitive diagnosis as they indicate only sensitization. In practice, an elimination diet followed by open challenge under medical supervision is often used for diagnosis except when symptoms are severe such as anaphylaxis. Management consists of the elimination of the allergen with resolution of symptoms between 1-4 wk later depending on the type of allergy. Extensively hydrolyzed and Amino acid formulas are used to substitute milk in infants. Soy-based formulas are often utilized in resource-limited settings. Tolerance to the protein develops over time and periodic reintroduction should be attempted every six months after the initial one year of elimination diet. Oral immunotherapy is a newer treatment technique for IgE-mediated disease. There is no firm evidence on prevention apart from recommending breast feeding in early life along with initiating complementary feeding between 4-6 mo age.
摘要：
牛奶过敏是指对牛奶蛋白的免疫反应。它是最常见的食物蛋白质过敏之一，估计1岁时的患病率为0.5％至3％。该疾病可以是IgE或非IgE介导的或与通常涉及多器官系统的广泛症状混合。胃肠道表现在非IgE疾病中很常见，可能包括肠病，直肠结肠炎,绞痛,反流样症状,便秘,小肠结肠炎综合征和嗜酸性粒细胞性食管炎。诊断的金标准仍然是双盲安慰剂对照的口服挑战。特异性IgE和皮肤点刺试验可以预测严重和持续的疾病，并帮助决定重新引入或口服免疫治疗；然而，它们不有助于明确的诊断，因为它们仅表明致敏。在实践中,在医疗监督下进行开放式挑战后的消除饮食通常用于诊断，除非症状严重，例如过敏反应。管理包括消除过敏原，并根据过敏的类型在1-4周之间缓解症状。广泛水解和氨基酸配方用于替代婴儿的牛奶。基于大豆的配方通常用于资源有限的环境中。对蛋白质的耐受性随着时间的推移而发展，并且在最初一年的消除饮食后，应每六个月尝试定期重新引入。口服免疫疗法是一种较新的治疗IgE介导的疾病的技术。除了建议在生命早期进行母乳喂养以及在4-6个月之间开始补充喂养外，没有确凿的预防证据。
