İNEK SÜTÜ ALERJİSİNE GÜNCEL YAKLAŞIM

İnek sütü alerjisi infantlarda ve çocukluk çağında en sık görülen besin alerjilerindendir ve sıklığı farklı çalışmalarda %1.8-7.5 olarak bildirilmektedir. Hastaların %80’inde 6 yaşında tolerans bildirilmektedir. İnek sütü alerjisi inek süt proteinlerinin (β-laktoglobulin, kazein v.b) herhangi birine karşı oluşan anormal immünolojik yanıt sonucu gelişen advers reaksiyon olarak tanımlanır. Klinik olarak, olguların %32-60’ında gastrointestinal sistem semptomları, %5-90’ında deri semptomları ve %0.8- 9’unda anafilaksi bulguları görülür. İnek sütü alerjisi tanısında tanıyı doğru koymak için klinik ve laboratuar bulguları birlikte değerlendirmek önemlidir. Tanıda yardımcı laboratuar tetkikleri alerjen duyarlılaşmaya gösteren süt spesifik IgE ölçümü ve dri testleri (prik ve atopi yama testi), altın standart olarak ise oral besin yükleme testidir. Klasik tedavide inek sütü proteinlerini içeren gıdaları içermeyen eliminasyon diyeti tolerans gelişinceye kadar verilir. Kazara alımlara bağlı anafilaksi gibi ölümcül reaksiyonlar gelişebilmesi riski nedeniyle, hasta ve ebeveynleri inek süt proteini içeren gıdalar ve alternatif besin kaynakları konusunda bilgilendirilmeli; kişiye göre risk analizi ve acil durum planı ile yapılmalıdır. Eliminasyon diyeti ile izlenen hastalar düzenli aralıklarla tolerans gelişimi açısından değerlendirilmelidir. Bununla birlikte, oral immünoterapi günümüzde IgE aracılı persistan İSA tanısı olan 4-5 yaşları arasındaki hastalarda sadece deneyimli merkezlerde yapılabilen bir tedavi seçeneğidir.

CURRENT APPROACH TO COW'S MILK ALLERGY

Cow milk allergy (CMA) is the most common food allergy in infants and young children, its frequency is reported as 1.8-7.5% in different studies and 80% of these patients will develop tolerance by the age of 6 years. Cows milk allergy is defined as an adverse reaction caused by an abnormal immunological response to CM proteins (β-lactoglobulin, casein,etc.). In clinical, 32-60% of children with CMA presents with gastrointestinal symptoms, 5-90% with skin symptoms and anaphylaxis in 0.8 to 9% of cases. It’s important that current diagnosis of CMA, depends on evaulating clinical findings, skin tests (skin prick test and atopy patch test), milk specifik-IgE assays which only indicate sensitisation and oral food challenge test as a gold standart. The current treatment option for CMA is still elimination diet of food including CM proteins until developing tolerance. For the reason, due to risk of accidental ingestion and clinical reactions like anaphylaxis, patients and families had to be informed about the foods including cow’s milk proteins and alternative food sources; risk analysis and emergincy plan must be made individualy. However, oral immunoterapy is one of the treatment options for children from around 4 - 5 years of age with persistent IgE-mediated CMA it must be administered only by experienced centers currently. Patient with CMA should be evaluated for tolerance development regularly, during the elimination diet.

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