ppharmПедиатрическая фармакологияPediatric pharmacology1727-57762500-3089Издательство «ПедиатрЪ»10.15690/pf.v12i3.1364ppharm-495Research ArticleВ ПРАКТИКУ ПЕДИАТРАFor Pediatricians' PracticeК вопросу о продолжительности диеты при аллергии на белки коровьего молока. Как и когда снова вводить в питание ребенка молочные продукты?Concerning Diet Duration at Cow’s Milk Protein Allergy. How and When Should Dairy Products Be Introduced Again?МакароваСветлана ГеннадьевнаMakarovaS. G.

доктор медицинских наук, профессор кафедры аллергологии и клинической иммунологии Педиатрического факультета;

врач-диетолог, ведущий научный сотрудник отделения клинических исследований, 199991, Москва, Ломоносовский проспект, д. 2

Moscow

Sm27@yandex.ruНамазова-БарановаЛ. С.Namazova-BaranovaL. S.

Москва

Moscow

НовикГ. А.NovikG. A.

St. Petersburg

ВишнёваЕ. А.VishnevaE. A.

Москва

Moscow

ПетровскаяМ. И.PetrovskayaM. I.

Москва

Moscow

ГрибакинС. Г.GribakinS. G.

Москва

Moscow

ГБОУ ВПО «Первый МГМУ им. И.М. Сеченова»; ФГБНУ «Научный центр здоровья детей»РоссияScientific Center of Children’s Health; Sechenov First Moscow State Medical UniversityRussian FederationНаучный центр здоровья детей; Первый Московский государственный медицинский университет им. И.М. Сеченова; Российский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияScientific Center of Children’s Health; Sechenov First Moscow State Medical University; Pirogov Russian National Research Medical UniversityRussian FederationСанкт-Петербургский государственный педиатрический медицинский университетРоссияSt. Petersburg State Paediatric Medical UniversityRussian FederationНаучный центр здоровья детейРоссияScientific Center of Children’s HealthRussian FederationНаучный центр здоровья детей; Первый Московский государственный медицинский университет им. И.М. СеченоваРоссияScientific Center of Children’s Health; Sechenov First Moscow State Medical UniversityRussian FederationРоссийская медицинская академия последипломного образованияРоссияRussian Medical Post-Graduate AcademyRussian Federation201501062015123345353Copyright © Макарова С.Г., Намазова-Баранова Л.С., Новик Г.А., Вишнёва Е.А., Петровская М.И., Грибакин С.Г., 20152015Макарова С.Г., Намазова-Баранова Л.С., Новик Г.А., Вишнёва Е.А., Петровская М.И., Грибакин С.Г.Makarova S.G., Namazova-Baranova L.S., Novik G.A., Vishneva E.A., Petrovskaya M.I., Gribakin S.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.pedpharma.ru/jour/article/view/495

Белки коровьего молока (БКМ) являются наиболее частой причиной аллергии у детей раннего возраста. Несмотря на значительные успехи в сфере лабораторной диагностики, в том числе различных аллергических заболеваний у детей, пищевая аллергия по-прежнему остается камнем преткновения во многих случаях. Успех лечения детей с аллергией к БКМ во многом зависит от ранней диагностики и своевременного назначения адекватной элиминационной диеты и определяется согласованными действиями не только врачей узкой специализации (аллергологов и диетологов), но и врачей первичного звена. Минимальная эффективная продолжительность диеты установлена доказательными исследованиями и определена в согласительных документах по ведению детей с аллергией к БКМ. В дальнейшем вопрос о длительности диеты решается индивидуально в каждом случае. Продолжение диеты должно быть оправдано, поэтому необходимость элиминации определенных продуктов из питания ребенка оценивается каждые 6–12 мес. Однако, в настоящее время нет четких предикторов сроков формирования толерантности и продолжительности строгой элиминационной диеты у детей с аллергией к БКМ. До недавнего времени считалось, что до 80–90% детей с аллергией к БКМ формируют толерантность в первые 3–5 лет жизни; однако, по последним данным, приспособленность организма проявляется в более поздние сроки. В целом, исследования показывают, что персистирующая аллергия к БКМ характеризуется значительно отягощенным семейным анамнезом по атопическим болезням, более длительным периодом между началом употребления БКМ и появлением первых симптомов аллергии, большей частотой множественных реакций на пищу и наличием других аллергических заболеваний. С возрастом возможно развитие частичной переносимости БКМ, когда молочные продукты должны использоваться в питании в ограниченном количестве. В таких случаях специалисты рекомендуют постепенно вводить в питание молочные белки в переносимых дозах (в основном в составе других продуктов), что, как показано, может способствовать формированию толерантности, сохраняя при этом формулировку диагноза.

Cow’s milk proteins (CMP) are the most often cause of allergy in young children. Despite the significant successes in laboratory diagnosis, which also cover allergy in children, food allergy is still a major discussion point in many cases. Successful CMP allergy treatment in children is largely dependant upon the early diagnosis and timely prescription of an eliminatory diet and is defined not only by the actions of specialists (allergologists and dietologists) but also of the primary level doctors. The minimal effective duration of the diet is established by evidence-based studies and is defined in consensus documents on treating children with CMP allergy. Further questions concerning diet duration are resolved according to each unique case. The continuation of a diet should be justified, therefore the necessity of eliminating certain products from a child’s diet is evaluated every 6–12 months. However, at the moment there are no clear ways to predict the duration after which tolerance would appear and thus the duration of a strict eliminatory diet for CMP allergic children. Until recently it was believed that 80–90% of CMP-allergic children form a tolerance over the first 3–5 years of life; however, according to the latest data, the body’s adaptation manifests later. In general, studies show that persisting CMP allergy is characterized by a severe family anamnesis concerning atopic diseases, a longer period between the beginning of CMP intake and the first allergy symptoms, a larger frequency of multiple food reactions and the presence of other allergies. With age a partial CMP tolerance may develop, when dairy products should be introduced in limited amounts. In such cases specialists recommend to introduce milk proteins in tolerable amounts (mainly as part of other products), which, as has been demonstrated, can contribute to the formation of tolerance, while retaining the diagnosis formulation.

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The authors declare that there are no conflicts of interest present.