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Öz

Cow’s Milk Protein Allergy (CMPA) is the most common food allergy in early childhood. It affects between 2% and 3% of infants. Symptoms and signs related to CMPA which IgE-mediated or non IgE-mediated may involve many different organ systems. The first and most important step in diagnosis is a thorough medical history. Results of laboratory tests alone are not sufficient to make diagnosis, always need to be considered together with the clinical features. CMPA can occur with multiple immunological mechanisms, therefore the diagnosis chance increases with use of numerous tests together. However, the negative test does not exclude the diagnosis. The gold standards in diagnosis are food elimination and challenge tests. Cow’s milk and avoiding the use of its products, it is still considered as the first choice in the treatment of all children with CMPA

Anahtar Kelimeler

• Elimination diet, cow’s-milk protein allergy, treatment, oral challenge

İnek sütü protein alerjisi

Öz

İnek Sütü Protein Alerjisi (İSPA) erken çocuklukta en sık görülen besin alerjisidir. Süt çocuklarının %2-3’ünde görülür. IgE aracılı veya IgE aracılı olmayan, birden fazla sistemi ilgilendiren klinik yakınmalar ile karşımıza çıkar. Genellikle erken çocukluk döneminde görülür ve geçicidir. Tanıda ilk ve en önemli basamak iyi alınmış bir öyküdür. Laboratuar testleri tek başına tanı koydurmaz, daima klinik ile birlikte değerlendirilmelidir. İSPA birden fazla immünolojik mekanizma ile oluşabildiğinden birden fazla testin bir arada kullanılması tanı şansını artırır. Ancak testlerin negatif olması tanıyı dışlamaz. Tanıda altın standart eliminasyon diyeti ve besin yükleme testidir. İnek sütü ve ürünlerinin kullanımından kaçınma, hala tüm çocuklarda İSPA tedavisinde ilk seçenek olarak kabul edilmektedir.

Anahtar kelimeler: Eliminasyon diyeti, inek sütü protein alerjisi, tedavi, yükleme testi

Anahtar Kelimeler

• Eliminasyon diyeti, inek sütü protein alerjisi, tedavi, yükleme testi

Kaynakça

1. Tamay Z. İnek Sütü Alerjisi. Klinik Tıp Pediatri 2010;2:14-
2. -
3. Wal JM. Cow’s milk allergens. Allergy 1998;53:1013-1022.
4. Fiocchi A, Schünemann HJ, Brozek J, et al. Diagnosis and
5. rationale for action against cow’s milk allergy (DRACMA):
6. a summary report. 2010;126:1119-1128.
7. Chatchatee P, Jarvinen KM, Bardina L, et al. Identification
8. of IgE and Ig G binding epitopes on alpha (s1)-casein: differences in patients with persistent and transient cow’s milk

9. allergy. J Allergy Clin Immunol 2001;379-383.
10. Altıntaş DU. İnek Sütü Allerjisi. Turkiye Klinikleri J Allergy-
11. Asthma 2003;5:164-167.
12. Sichere SH. Epidemiology of food allergy. J Allergy Clin
13. Immunol 2011;127:594-602.
14. Host A, Halken S, Jacopsen HP, et al. Clinical course of
15. cow’s milk protein allergy/intolarence and atopic diseases
16. in childhood. Pediatr Allergy Immunol 2002;13:23-28.
17. Arıcan Ö, Hacımustafaoğlu OY. Besin Alerjisi. Kartal Eğitim
18. ve Araştırma Hastanesi Tıp Dergisi 2002;13:142-145.
19. Sapan N, Demir E, Tamay Z, ve ark. ‘Çocuk alerji ve astım
20. akademisi’, besin alerjisi tanı ve tedavi protokolü. Türk Ped
21. Arş 2013;270-274.
22. Shek LP, Bardina L, Castro R, et al. Humoral and cellular
23. responses to cow milk proteins in patients with mil-induced
24. IgE and non-IgE- mediated disorders. Allergy 2005;60:912-919.
25. Sampson HA. Food Allergy. J Allergy Clin Immunol
26. ;111:540-547.
27. Spergel JM. Eosinophilic esophagitis in adults and children:
28. evidence for a food: allergy component in many patients. Curr Opin Allergy Clin Immunol 2007;7:274-278.
29. Arvola T, Ruuska T, Keranen J, et al. Rectal bleeding in infancy: clinical, allergological, and microbiological examinition. Pediatrics 2006;117:760-768.
30. Sampson HA, Mendelson L, Rosen JP. Fatal and near-fatal
31. anaphylactic reactions to food in children and adolescents.
32. N Engl J Med 1992;327:380-384.
33. Dupont C. Diagnosis of cow’s milk allergy in children:
34. determining the gold standard? Expert Rev Clin Immunol
35. ;10:257-267.
36. Skripak JM, Matsui EC, Mudd K, et al. The natural history
37. of IgE mediated cow’s milk allergy. J Allergy Clin Immunol 2007;120:1172-1177.
38. Boyce JA, Assa’ad A. Burks AW, et al. Guidelines for diagnosis and management of food allergy in the United States:
39. report of the NIAID sponsored expert panel. J Allergy Clin
40. Immunol 2010;126:1-58.
41. Nielsen RG, Fenger C, Bindslev-Jensen C, et al. Eosinophilia in the upper gastrointestinal tract is not a characteristic feature in cow’s milk sensitive gastro-oesophageal reflux disease. Measurement by two methodologies. J Clin Pathol 2006;59:89–94.
42. Koletzko S, Niggemann B, Arato A, et al. Diagnostic Approach and Management of Cow’s milk protein allergy in
43. infants and children: ESPGHAN GI Committee Practical
44. Guidelines. J Pediatr Gastroenterol Nutr 2012;55:221-229.
45. Kneepkens CM, Meijer Y. Clinical practice. Diagnosis and treatment of cow’s milk allergy. Eur J Pediatr
46. ;168:891–896.
47. Vandenplas Y, De Greef E, Devreker T. Treatment of cow’s
48. milk protein allergy. Pediatr Gastroenterol Hepatol Nutr
49. ;17:1-5.
50. Reche M, Pascual C, Fiandor A, et al. The effect of a partially hydrolysed formula based on rice protein in the treatment
51. of infants with cow’s milk protein allergy. Pediatr Allergy
52. Immunol 2010;4:577–585.
53. American academy of Pediatrics. Committee on nutrition.
54. Hypoallergenic formulas. Pediatrics 200;106:349-349.