日本未熟児新生児学会雑誌　第21巻　第2号　119～124頁（2009年）

日本未熟児新生児学会雑誌　21(2)：295-300；2009　

受付日：平成21．01．14

受理日：平成21．03．09

多彩な症状を呈し診断に難渋したミルクアレルギーの3例

Three Cases of Milk Protein Allergy with Various Symptoms

愛知県心身障害者コロニー中央病院　新生児科

Department of Neonatology, Aichi Human Service Center Central Hospital

垣田博樹・山本啓之・伊藤美春・齊藤明子・邊見勇人・寺澤かずみ・山田恭聖

Hiroki KAKITA，Hiroyuki YAMAMOTO，Miharu ITO，Akiko SAITO，Hayato HEMMI，Kasumi TERASAWA，Yasumasa YAMADA

Key Words：milk protein allergy，allergen-specific lymphocyte stimulation test，malrotation，hyperammonemia，Down syndrome

　異なる臨床症状を伴う3例のミルクアレルギーを経験したので報告する。症例1は日齢10の女児。日齢8から腹部症状を示したため，日齢10に試験開腹術を施行し，外科疾患は否定された。術後，CRPの上昇，不定形紅斑が出現し敗血症様症状を呈する特殊病型を示した。症例2は早産児，極低出生体重児で出生した日齢5の女児。日齢3から嘔吐が出現し，その後一過性高アンモニア血症，低アルギニン血症がみられた。症例3はダウン症，心室中隔欠損症の月齢4ヶ月の女児。新生児期から牛乳調整粉乳を使用していたにも関わらず，月齢4ヶ月で発症した。3例ともアレルゲン特異的リンパ球刺激試験は陽性であり，加水分解乳の使用により症状は消失した。消化器症状を示す新生児，乳児の診療にあたっては，常にミルクアレルギーを念頭に置くことが重要であると考えられた。

　We report three cases of milk allergy with various symptoms. All three newborns were females. The first case was born at 37 weeks of gestation. At eight days of age, she showed tachycardia, vomiting and hematochezia. At ten days of age, she had colostomy, because suspicion of malrotation. However, intra-operatively, she was discovered to have intestinal edema, not malrotation. After colostomy, she exhibited septic-like state. The second case was born at 31 weeks of gestation, with a birth　weight of 1478g. At three days of age, she had vomiting. At five days of age, she had transient hyperammonemia, and hypoargininemia. The third case suffered from Down syndrome and ventricular septal defect. She suddenly showed symptoms of milk protein allergy at four months of age, in spite of formula feeding after birth.
　All the symptoms of three cases showed remission, after changing formula milk to hydrolyzed milk.
　Milk protein allergy is easily missed in primary care setting and needs to be considered as a cause of infant distress and diverse clinical symptoms.