日本未熟児新生児学会雑誌　第25巻第2号　92～100頁（2013年）

日本未熟児新生児学会雑誌　25(2)：218-226；2013　

受付日：平成24．10．16

受理日：平成25．02．27

異なる臨床症状を呈した新生児ミルクアレルギーの2 例

Two Cases of Neonatal Cow’s Milk Allergy with a Diversity of Clinical Symptoms

＊1 産業医科大学　小児科，＊2 産業医科大学病院　総合周産期母子医療センター

＊1Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health ＊2Center of Maternal, Fetal and Neonatal Medicine, University of Occupational and Environmental Health Hospital

白山理恵＊1・荒木俊介＊1＊2・江口真美＊1・菅　秀太郎＊1・丸谷隆光＊1＊2・白石美香＊1＊2・楠原浩一＊1

Rie SHIRAYAMA＊1，Shunsuke ARAKI＊1＊2，Mami EGUCHI＊1，Shutaro SUGA＊1， Takamitsu MARUTANI＊1＊2，Mika SHIRAISHI ＊1＊2，Koichi KUSUHARA＊1

Key Words：neonatal cow’s milk allergy，gastrointestinal food allergy，preterm，21 trisomy，food protein-induced enterocolitis syndrome（FPIES）

　新生児ミルクアレルギーは多彩な症状を呈し，診断や治療に苦慮することも多い。今回，異なる症状，検査結果を示した2 例を経験したので報告する。症例1 は胃内容物の通過不良，腹部膨隆で発症した早産児。好酸球分画37％の上昇，牛乳特異的IgE 抗体陽性で，加水分解乳へ変更後に症状は軽快した。アレルゲン特異的リンパ球刺激試験（ALST）ではαラクトアルブミン・βラクトグロブリン・βカゼインが陽性であった。症例2 は21trisomy の女児。日齢22 より発熱，CRP 高値（最高14.3mg/dL）が持続した。抗菌薬には不応で好酸球増多や牛乳特異的IgE抗体は認めなかった。日齢83，加水分解乳へ変更し症状は速やかに改善，ALST でα・κカゼインが陽性であった。本症では非特異的で重篤な症状を呈する症例が約10％存在するとされており，新生児集中治療の現場でも鑑別疾患として考慮する必要がある。

　We report two cases of neonatal cow’s milk allergy with a diversity of clinical symptoms. The first case was a female born at 35 weeks of gestation. At fifth days of age, she showed indigestion of milk and abdominal distension. The laboratory data at 20th days represented elevation of peripheral blood eosinophil ratio（37%）and total IgE, and positive milk-specific IgE. Allergen-specific lymphocyte stimulation test（ALST）for α-lactalbumin, β-lactoglobulin and β-casein were positive, respectively. The second case was a female of trisomy 21, being in neonatal intensive care unit（NICU） for respiratory distress. At 21st days of age, she had diarrhea. The next day, she had fever and elevated level of C-reactive protein（CRP）．She had intermittent vomiting and severe distended abdomen. Antimicrobial drugs were not remarkably effective for the control of her abdominal symptoms and elevated CRP. However, symptoms and CRP improved after changing formula milk to hydrolyzed milk. The laboratory data did not show elevated level of peripheral blood eosinophil ratio or total IgE. On the other hand, ALST was positive for α-casein and κ-casein. An early diagnosis of neonatal cow’s milk allergy is important not only for an appropriate treatment but also in preventing invasive examinations. In NICU this disease should be considered as a cause of unexplained symptoms.