Hiroshi Tachimoto和同事在最近的出版物（1）中权衡了这次讨论。这是一种可爱的努力，因为事先研究既有牵引和牛奶作为人类过敏性疾病和喘息的因果。该研究在单个东京医院进行，作为随机但未粘连的（研究参与者是婴儿，但父母被揭穿）研究。T.he newborns studied were selected from families in which the risk of allergy was above the mean and then randomized into two equal groups to receive either breast feeding with or without supplemental elemental formula or breast feeding with cow’s milk supplemental feeding during the first 3 days of life. The participants were then assessed at five months and at two years of life by physicians blinded to the study design for the presence allergic disease including wheezing. Those patients who had clinical or laboratory evidence of allergic disease at two years were followed until age six. About half the patients met the criteria for the longer follow up.
该研究最终在两项研究肢体中的每一个最终由151名新生儿组成，发现两组之间的结果差异显着差异。T.he infants who received breast feeding supplemented with cow’s milk in the first three days of life had a recurrent wheezing/asthma rate of 17.9% (27 newborns) in follow-up while those who avoided cow’s milk in those first three days of life (breast feeding with or without elemental formula supplementation) had a follow-up recurrent wheezing/asthma rate of 9.9% (15 newborns). The newborns who received supplemental cow’s milk were to continue this feeding regimen until 5 months while the group receiving breast feeding with or without elemental formula supplementation change diet. This latter group appears to have self-randomized to either quickly add cow’s milk supplementation to their diet before 14 days, to add cow’s milk to the diet after 14 days, or to maintain breast feeding with or without supplemental elemental formula and no cow’s milk for 5 months.
1.盲目盲目的失败（实际上，参与者的父母）可能在随机化中添加了错误。应该指出的是，随着研究的构思，父母是不可能的。E.lemental formula is readily recognized by differing appearance and odor in comparison to cow’s milk such that the parents, even if initially blinded, would rapidly appreciate what limb of the study their child was in. One needs to wonder whether in these families with known allergy, would parents, aware that their child did not get cow’s milk, be more likely to avoid cow’s milk in the future. When parents in the first five months of life either added cow’s milk before 14 days or after 14 days or maintained the cow’s milk-free regimen until 5 months, how would this knowledge have influenced the parents’ behavior after 5 months? How would this information impact the mothers’ own diet? Conversely, parents in the group continuing cow’s milk supplementation for five months who realized that their infants were already sensitized to cow’s milk, would mothers be more likely to continue cow’s milk after that and how would it impact on their own diet? How likely would they be to accept other potential food allergens as infant feedings?
该研究还评估了牛奶的前三天干预的有效性，或者没有牛奶补充的乳牛乳补充，由25（OH）D水平影响。在5个月和2年内评估25（OH）D的水平。一世nfants with a higher vitamin D level (> 29 ng/mL) at 5 months had a more dramatic reduction in the risk of recurrent wheezing/asthma in the no cow’s milk group than those infants who had a lower level for 25(OH)D (< 29 ng/mL) in which no beneficial effect of the absence of cow’s milk exposure was seen. No vitamin D effect was seen at two years.
一世gE was assessed at 5 months and at 2 years as well and, while no effect of the IgE level was observed at 5 months, at two years those infants with the highest IgE levels had less wheezing if they had not received cow’s milk supplements in the first three days of life. Because of the concerns raised above, the impact of either Vitamin D or IgE level as related to the first three days of life randomization is unclear.
Tachimoto H，Imanari E，Mezawa M，等：避免牛奶配方在出生时避免患有哮喘或幼儿的经常性喘息的疗效：ABC随机临床试验的延长后期。Jama Netw开放10月1日;3（10）：E2018534,2020。DOI：10.1001 / JamanetWorkopen.202010.18534