Ukungezwani komzimba nobisi lweCow, noma i-APLV, yiyona ndlela yokudla eyaliwa kakhulu ezinganeni. Ngokuvamile kuvela ezinyangeni zokuqala zokuphila. Njengoba lezi zimpawu zehluka kakhulu kuye ngengane eyodwa kuya kwenye, ukuxilongwa kwayo kwesinye isikhathi kungaba nzima. Uma ukuxilongwa sekwenziwe, i-APLV idinga ukudla okungaqediwe, ngaphansi kokuqondisa kwezokwelapha. Ukungezwani komzimba nesibikezelo esihle, kuyenzeka ngokwemvelo kuthuthukiswe ukubekezelelana eningini lezingane.

Ukwakheka kobisi lwenkomo

Ukungezwani komzimba namaprotheni obisi lwenkomo, noma i-APLV, kubhekisela ekuveleni kokubonakala komtholampilo ngemva kokumunca ubisi lwenkomo noma imikhiqizo yobisi, okulandela ukusabela okungavamile kokuzivikela komzimba ngokumelene namaprotheni obisi lwenkomo. Ubisi lwenkomo luqukethe cishe amaprotheni ahlukene angamashumi amathathu, phakathi kokunye:

• i-lactalbumin,
• lact-lactoglobulin,
• i-albin serum albumin,
• i-immunoglobulins yezinkomo,
• ama-caseins αs1, αs2, β et al.

Zingama-allergen ezingaba khona. Ama-PLV angesinye sezifo eziyinhloko eminyakeni emibili yokuqala yokuphila, okunengqondo kusukela ngonyaka wokuqala, ubisi ngukudla okuyinhloko kwengane. 

Izifo ezahlukahlukene

Ngokuya ngomshini obandakanyekayo, kunezifo ezahlukahlukene: 

Ukungezwani nobisi lwenkomo oluxhomeke ku-IgE (okulamulelwe i-IgE)

noma i-APLV uqobo. Amaprotheni obisi lwenkomo abangela impendulo yokuvuvukala ngokukhiqizwa kwe-immunoglobulin E (IgE), amasosha omzimba akhiqizwa ukuphendula i-allergen. 

Ukungabekezelelani kobisi olungeyona i-IgE

Umzimba uphendula ngezimpawu ezahlukahlukene ekuvezeni ama-antigen obisi lwenkomo, kepha akukho ukukhiqizwa kwe-IgE. Ezinsaneni, leli yifomu elivame kakhulu. 

I-APLV ingathinta ukukhula kwengane namathambo amaminerali ngoba izakhamzimba azimunceki kahle.

Ukubonakaliswa kwemitholampilo kwe-APLV kuyahlukahluka kakhulu ngokuya ngomshini oyisisekelo, ingane nobudala bayo. Zithinta kokubili uhlelo lokugaya ukudla, isikhumba, uhlelo lokuphefumula. 

Uma kwenzeka i-Igl-Mediated APLV

Ku-APLV e-IgE-mediated, ukuphendula kuvame ukuba khona ngokushesha: i-oral syndrome nokuhlanza okulandelwa uhudo, ukusabela okujwayelekile nge-pruritus, i-urticaria, i-angioedema, futhi ezimweni ezinzima kakhulu i-anaphylaxis.

Uma kwenzeka i-IgE engalawulwa

Uma kwenzeka i-IgE engalawulwa, ukubonakaliswa kuvame ukubambezeleka: 

• i-eczema (atopic dermatitis);
• uhudo noma, kunalokho, ukuqunjelwa;
• ukuphindaphinda ukubuyisa noma ngisho nokuhlanza;
• ama-rectorragies;
• i-colic, ubuhlungu besisu;
• ukuqunjelwa kanye negesi;
• ukungabi nesisindo esanele;
• ukucasuka, ukuphazamiseka kokulala;
• i-rhinitis, ukukhwehlela okungapheli;
• ukutheleleka njalo kwezindlebe;
• i-asthma yezinsana.

Lezi zibonakaliso zihluke kakhulu kusuka enganeni eyodwa kuya kwenye. Ingane efanayo ingaba nezimpendulo zombili ngokushesha futhi ezibambezelekile. Izimpawu nazo ziyashintsha ngeminyaka yobudala: ngaphambi kweminyaka engu-1 ubudala, izimpawu zesikhumba nezokugaya ukudla zivame kakhulu. Ngemuva kwalokho, i-APLV izibonakalisa ngokwengeziwe ngezimpawu ezinama-cutaneous-mucous and respiratory. Lezi yizo zonke izici ezenza kwesinye isikhathi ukuxilongwa kwe-APLV kube nzima.

Ebhekene nezimpawu zokugaya kanye / noma zesikhumba enganeni, udokotela okokuqala uzokwenza ukuhlolwa komtholampilo kanye nokuphenywa ngemiphumela ehlukahlukene yokungezwani komzimba, ukudla kwengane, isimilo sayo noma umlando womndeni wokungezwani komzimba. Ikakhulu, udokotela angasebenzisa i-CoMiSS® (isibonakaliso sezimpawu ezihlobene nobisi lweCow), amaphuzu asuselwa kuzimpawu eziyinhloko ezihlobene ne-APLV. 

Ukuhlolwa okuhlukile kokuhlonza i-APLV

Namuhla, azikho izivivinyo zebhayoloji ezingasungula noma ziphikise ngokuqiniseka ukutholakala kwe-APLV. Ukuxilongwa ngakho-ke kusekelwe ekuhlolweni okuhlukahlukene.

Ye-APLV encike ku-IgE

• ukuhlolwa kwesikhumba sobisi lwenkomo. Lokhu kuhlolwa kwesikhumba kufaka phakathi ukwenza inani elincanyana lokukhishwa kwe-allergen elihlanzekile lingene esikhunjeni nge-lancet encane. Ngemuva kwemizuzu eyi-10 kuye kwengu-20, umphumela uyatholakala. Ukuhlolwa okuhle kuboniswa yi-papule, (induna encane). Lokhu kuhlolwa kungenziwa kusenesikhathi ezinganeni, futhi akunabuhlungu ngokuphelele.
• ukuhlolwa kwegazi kwe-IgE ethile.

Nge-APLV engancikile ku-IgE

• ukuhlolwa kwesichibi noma ukuhlolwa kwesichibi. Izinkomishi ezincane eziqukethe i-allergen zibekwa esikhunjeni sangemuva. Ziyasuswa emahoreni angama-48 kamuva, bese umphumela utholwa ngemuva kwamahora angama-24. Ukusabela okuhle kusuka ku-erythema elula elula kuya ekuhlanganisweni kwe-erythema, ama-vesicles namabhamuza. 

Ukuxilongwa ngokuqiniseka kwenziwa ngokuhlolwa kokuxoshwa (amaprotheni obisi lwenkomo ayasuswa ekudleni) nangokuphonsela inselelo ngomlomo amaprotheni obisi lwenkomo, ngaphandle kohlobo lwe-immune.

Ukuphathwa kwe-APLV kusekelwe ekususweni okuqinile kwe-allergen. Kuzonikezwa ingane amabisi athile, ngokusho kwezincomo zeKomidi Lezokudla leFrench Pediatric Society (CNSFP) kanye ne-European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN). 

Ukusetshenziswa kweprotheni enkulu ye-hydrolyzate (EO)

Ngenhloso yokuqala, i-hydrolyzate ebanzi yamaprotheni (i-EO) noma i-hydrolyzate ephezulu yamaprotheni (i-HPP) izonikezwa ingane. Lezi zibisi ezilungiselelwe kusuka ku-casein noma nge-whey zisezimweni eziningi ezibekezelelwa kahle izinsana ze-APLV. Uma izimpawu ziqhubeka ngemuva kokuhlola izinhlobo ezahlukahlukene zama-hydrolysate, noma uma kwenzeka kuba nezimpawu ezinzima zomzimba, ifomula losana olususelwa kuma-amino acid (FAA) azokwenziwa. 

Amalungiselelo amaprotheni obisi lweSoy

Amalungiselelo weSoymilk protein (PPS) ngokuvamile abekezeleleka kahle, ashibhile futhi anambitha kangcono kunama-hydrolysates, kepha okuqukethwe yi-isoflavone kuyangabazeka. Lawa ma-phytochemicals akhona kusoya yi-phytoestrogens: ngenxa yokufana kwawo kwamangqamuzana, angalingisa ama-estrogens, ngakho-ke asebenze njengabaphazamisi be-endocrine. Zibekwa njengolayini wesithathu, okungcono ngemuva kwezinyanga eziyi-6, uqiniseke ukuthi ukhetha ubisi ngokuqukethwe kwe-isoflavone okuncishisiwe.

Ubisi lwe-Hypoallergenic (HA)

Ubisi lwe-Hypoallergenic (HA) alukhonjisiwe esimweni se-APLV. Lolu bisi, olwenziwe ngobisi lwenkomo, oluguqulwe lwenza ukuthi lungabi ne-allergenic, lwenzelwe ukuvikela izingane ezinokungezwani komzimba (ikakhulukazi umlando womndeni), ngezeluleko zezokwelapha, ezinyangeni zokuqala eziyisithupha zengane. 

Ukusetshenziswa kweziphuzo zemifino

Ukusetshenziswa kweziphuzo zemifino (isoya, ilayisi, i-alimondi nabanye) kukhuthazwe kakhulu, ngoba azivumelaniswa nezidingo zokudla kwezinsana. Ngokuqondene nobisi lwezinye izilwane (imazi, imbuzi), azinikezeli ngazo zonke izakhi zomzimba ezidingekayo enganeni, futhi zingadala okunye ukungezwani komzimba, ngenxa yengozi yokungezwani komzimba.

Ukudla kokuqeda kufanele kuhlale okungenani izinyanga eziyisithupha noma kuze kube yiminyaka eyi-6 noma izinyanga eziyi-9 noma eziyi-12, kuya ngobukhulu bezimpawu. Ukuphindwaphindwa kancane kuzokwenzeka ngemuva kokuhlolwa kwenselelo yomlomo (OPT) ngobisi lwenkomo olwenziwe esibhedlela. 

I-APLV inesibikezelo esihle ngenxa yokuvuthwa okuqhubekayo kwamasosha omzimba emathunjini kanye nokutholakala kokubekezelelana kwamaprotheni obisi. Ezimweni eziningi, inkambo yemvelo ibheke ekukhuleni kokubekezelelana ezinganeni ezineminyaka ephakathi kwengu-1 nengu-3 ubudala: cishe ama-50% eneminyaka engu-1,> ama-75% ngeminyaka emithathu kanye> nama-3% ku iminyaka engu-90.

Ezinganeni ezincela ibele, izehlakalo ze-APLV ziphansi kakhulu (0,5%). Ukuphathwa kwe-APLV enganeni esancela ibele kuhlanganisa ukususa yonke imikhiqizo yobisi ekudleni kukamama: ubisi, iyogathi, ushizi, ibhotela, ukhilimu omuncu, njll. Ngesikhathi esifanayo, umama kufanele aphuze uvithamini D kanye ne-calcium supplementation. Uma izimpawu ziba ngcono noma zinyamalala, umama oncancisayo angazama ukubuyisela kancane kancane amaprotheni obisi lwenkomo ekudleni kwakhe, ngaphandle kokweqa umthamo omkhulu obekezelelwa ingane.