广东省学龄前儿童食物过敏情况及相关危险因素分析

Food allergy and its risk factors in pre-school children in Guangdong province：an epidemiological survey

摘要:

目的：通过调查问卷，分析广东地区学前儿童食物过敏（food allergy，FA）现状及其危险因素，提高对儿童FA的认识，为预防和治疗过敏性疾病提供科学依据。方法：采用适合广东省过敏性疾病流行病学特征的问卷，于2012年1月至2012年7月采用随机整体抽样方法在广东省内抽取不同地区幼儿园的儿童家长完成该调查，由相关人员电话回访，以确定问卷的有效性。对调查结果进行描述性统计分析，卡方检验分析、logistic回归模型分析及Spearman相关分析。结果：（1）共发放问卷2761份，废卷为221份，合格问卷为2 540份，有效应答率为92%。在2 540份有效问卷中，男1 331例，占52.4%，女1 209例，占47.6例，平均年龄为（4.6±1.1）岁。问卷结果中显示儿童FA的发病率为4.0%，常见的过敏症状为皮肤症状。家长自诉主要过敏食物有：海产类（虾4.4%，蟹3.2%，鱼0.6%），高蛋白类（牛奶及奶制品1.9%，鸡蛋白1.4%，牛肉0.7%），干果类及种子类（花生0.4%，黄豆0.2%，腰果榛子杏仁等坚果类0.1%），水果类（芒果2.3%）。（2）儿童多于0~3岁发生对鸡蛋、牛奶及奶制品过敏。4岁后发生对鸡蛋、牛奶及奶制品过敏的比率大幅减少。（3）应用 logistic回归分析得出，第一近亲有FA史[OR=9.683（5.261-17.822），Ρ=0.000]、过敏性鼻炎史[OR=1.958（1.029-3.727），Ρ=0.041]，儿童发生FA的风险会增高。（4）应用Spearman相关分析方法分析儿童本人各类过敏史的关联性：FA与药物过敏（rs=0.049，Ρ=0.035）、过敏性皮炎（rs=0.052，Ρ=0.023）、支气管哮喘（rs=0.051，Ρ=0.025）、眼部过敏症（rs=0.071，P=0.002）、变应性鼻炎（rs=0.059，Ρ=0.01）相关的关联系数有统计学差异。结论：儿童FA的患病率较高，FA源与欧美国家不完全一致。婴幼儿由于肠胃功能不成熟，容易对高蛋白分子过敏，消化功能与免疫系统日渐完善后，大部分幼儿对于牛奶及奶制品和鸡蛋的过敏可减弱。治疗FA的最好方法是避免进食引起过敏的食物，但如果儿童为过敏体质或有家族过敏史，最好到医院做详细的过敏源检测。

Abstract:

Objective：To investigate the food allergy（FA） and its risk factors in pre-school children in Guangdong province through a self-designed questionnaire，to deepen the understanding of FA in children，to provide evidences for prevention and treatment of al－lergic diseases in children. Methods：Questionnaire was designed according to the epidemiological characteristics of local allergic diseases in Guangdong province. Parents of kindergarten children in different areas in Guangdong province were selected to fill in the questionnaire. Relevant investigators followed the parents were investigated by phone call to confirm the effectiveness of the question－naires collected. Results were analyzed by descriptive statistics，Chi-square test，logistic regression model and Spearman correlation analysis. Results：（1）Of 2 761 copies of questionnaires，2 540 were valid and 221 were invalid，giving a valid answer rate of 92%. Of the valid copies，1 331 were male（52.4%） and 1 209 were female（47.6 %），with an average age of （4.6±1.1） years. Questionnaire results demonstrated that incidence of FA was 4.0% and the common allergic symptoms were skin symptoms. Common food items leading to adverse food reactions were seafood（shrimp 4.4%，crabs 3.2%，fish 0.6%），high-protein food（milk and dairy products 1.9%，egg white 1.4%，beef 0.7%），dried fruit and seeds（peanut 0.4%，soybeans 0.2%，cashew nuts，hazelnuts，almonds and other nuts 0.1%），and fruit（mango 2.3%）. （2）Eggs，milk and milk prod－ucts were the most common food leading to adverse food reac－tions in children aged 0-3 years. This ratio was reduced dra－matically after the age of four. （3）Based on logistic regression analysis，we found that if the first degree relatives suffered from FA（OR=9.683（5.261-17.822），Ρ=0.000） and allergy rhinitis（OR=1.958（1.029-3.727），Ρ=0.041），the risk of children suffered from FA would increased. （4）Relevance of various types of allergy revealed were analyzed by Spearman correlation analysis，the results demonstrated that there were statistical differences in correlation coefficients among FA and drug allergy（rs=0.049，Ρ=0.035），atopic dermatitis（rs=0.052，Ρ=0.023），bronchial asthma（rs=0.051，Ρ=0.025），eye allergy（rs=0.071，Ρ=0.002） and allergic rhinitis（rs=0.059，Ρ=0.01）. Conclusions：Incidence of FA in children in Guangdong province is higher than expectation，close to those in the United States and Europe，though the allergens are not completely consistent. Although allergy to high-protein molecules is common in infants whose gastrointestinal function is immature，allergy to milk，dairy products and eggs will be reduced with increasingly improved diges－tive function and the immune system in most young children. The best method for managing FA is not to eat allergenic food and the best way to determine FA for children who have allergies or have a family history of allergy is go to the hospital for a test.