D3.301 - Аллергия на белки коровьего молока у детей: сосредоточено на короткоцепочечных жирных кислотах

Allergy to cow's milk proteins (CMPA) is one of the most common forms of food allergy in young children and is accompanied by cutaneous, gastrointestinal and systemic manifestations. In recent years, the key role of the intestinal microbiota in the formation of immune tolerance has been established. Short-chain fatty acids (SCFAs), which are products of bacterial fermentation of dietary fiber, are considered to be important metabolic regulators of the immune response and intestinal barrier function.

The study included 90 children aged 2 to 18 months. The study group consisted of 60 children with verified allergy to cow's milk proteins (CMPA); The control group consisted of 30 conditionally healthy children of the same age. The main method for assessing the metabolic profile of the microbiocenosis was gas chromatography, which made it possible to determine the absolute content and ratio of SCFAs (acetate, propionate, butyrate) in the feces. The degree of activity of allergic inflammation in the intestine was assessed by the level of fecal calprotectin, determined by enzyme-linked immunosorbent assay. Statistical processing of the data was carried out using parametric and nonparametric methods, the differences were considered significant at p < 0.05.

In patients with CMPA, a statistically significant decrease in the total concentration of SCFA was recorded compared to the control group (p < 0.01). The analysis of the individual profile of acids revealed a sharp decrease in the proportion of butyrate and propionate, which indicates inhibition of the activity of saccharolytic microflora. The level of acetate in relative values prevailed, but its absolute concentration was also below the standard values.

When compared with inflammatory markers, it was found that the level of fecal calprotectin in children with CMPA significantly exceeded the indicators of the control group (median 240 μg/g versus 45 μg/g; p < 0.001). A direct negative correlation was found between the concentration of butyrate and the level of fecal calprotectin (r = -0.56; p < 0.01), which confirms the protective role of butyrate in maintaining the barrier function of the mucous membrane and stopping exudative processes.

CMPA in young children occurs against the background of a pronounced deficiency of short-chain fatty acids, which indicates profound disturbances in the metabolic activity of the intestinal microbiota. A decrease in the level of butyrate is associated with an increase in the intensity of local inflammation, which justifies the need to include methods for correcting microbiocenosis in the complex therapy of CMPA to accelerate the induction of food tolerance.