Nkhaniyi idasindikizidwa koyamba ndi Magazini ya Undark.
Kwa Taylor Arnold, katswiri wa kadyedwe kovomerezeka, kudyetsa mwana wake wachiwiri sikunali kophweka. Ali ndi masabata asanu ndi atatu, anakuwa pamene anadya ndipo sananenepa kwambiri. Arnold anamubweretsa kwa dokotala wa gastroenterologist, yemwe anamupeza ndi allergenic proctocolitis – chitetezo cha mthupi ku mapuloteni opezeka m’zakudya zina, zomwe amazipaka mkaka wa ng’ombe.
Mapuloteni a mkaka wa ng’ombe, kapena CMPA, angakhale pakukwera– kutsatira a mayendedwe ofanana mu ana ena ziwengo zakudya—ndipo akhoza kusokoneza dongosolo la kudyetsa la wosamalira: Nthaŵi zambiri, kholo loyamwitsa limatero anauza kuchotsa mkaka ku zakudya zawo, kapena kusinthana ndi njira yapadera ya hypoallergenic, yomwe ingakhale yokwera mtengo.
Koma ngakhale umboni wina ukusonyeza kuti mitengo ya CMPA ikukwera, gwero ndi kukula kwake sikunadziwikebe. Akatswiri ena amanena kuti kukwerako ndi chifukwa chakuti madokotala akupeza bwino pozindikira zizindikiro. Ena amati matendawa ndi ochulukitsitsa. Ndipo pakati pa omwe amakhulupirira kuti chiwopsezo cha ziwengo zamkaka chikuchulukirachulukira, ena amakayikira kuti makampani opanga zakudya padziko lonse lapansi, amtengo wapatali pa $55 biliyoni malinga ndi 2022. lipoti kuchokera ku World Health Organisation ndi UNICEF, zitha kukhala ndi chikoka chosayenera.
Panthawiyi, “palibe amene adaphunzirapo ana awa mwadongosolo,” Victoria Martin, katswiri wa gastroenterologist wa ana komanso wofufuza za ziwengo ku Massachusetts General Hospital, anandiuza. “Ndi zachilendo kwambiri pa matenda omwe ali ofala chonchi, omwe akhala akuchitika kwa nthawi yayitali, kuti sipanakhale maphunziro osamala komanso oyendetsedwa bwino.”
Kusamveketsa bwino kumeneku kungapangitse madokotala kukhala mumdima ponena za mmene angadziwire matendawo ndi kusiya makolo ali ndi mafunso ambiri kuposa mayankho okhudza mmene angachiritsire bwino.
Mwana wa Arnold atadwala ndi zizindikiro za CMPA, “zinali zolemetsa kwambiri,” adandiuza. Komanso, “Sindinapeze chithandizo chochuluka kuchokera kwa madokotala, ndipo zimenezo zinali zokhumudwitsa.”
Ngakhale dokotala wa gastroenterologist adamuuza kuti asinthe kugwiritsa ntchito mkaka, Arnold adagwiritsa ntchito mlangizi woyamwitsa ndipo adasiya mkaka kuti apitirize. kuyamwitsa. Koma adanenanso kuti amamvetsetsa chifukwa chake ena sangasankhenso: “Amayi ambiri amapita kukapanga mkaka chifukwa palibe chithandizo chochuluka cha momwe angasamalire zakudya.”
Kusagwirizana ndi zakudya kumabwera m’njira ziwiri: Imodzi, yomwe imatchedwa IgE-mediated allergy, imakhala ndi zizindikiro zomwe zimawonekera mukangodya chakudya – monga kutupa, ming’oma, kapena kupuma movutikira – ndipo zimatha kutsimikiziridwa ndi Kuyesa kwakhungu. Yachiwiri, yomwe mwana wa Arnold anapezeka nayo, ndi matenda osachiritsika a IgE, kapena zakudya zotchedwa protein-induced allergic proctocolitis, ndipo zimakhala zovuta kuzizindikira.
Ndi matenda omwe si a IgE, zizindikiro sizimakonda kuchitika munthu akangodya chakudya choyambitsa matenda, ndipo palibe mayeso otsimikizika otsimikizira kuti ali ndi matenda. (Akatswiri ena sakonda kunena kuti matendawa ndi ziwengo, chifukwa sichisonyeza zizindikiro za ziwengo.) M’malo mwake, madokotala nthawi zambiri amadalira maphunziro apitalo, zipangizo zapaintaneti, kapena malangizo ofalitsidwa ndi akatswiri pankhaniyi. zizindikiro ndi kuthandiza madokotala kupanga dongosolo chithandizo.
Pali malangizo ambiri otere kuti athandize opereka chithandizo kuti adziwe zomwe zili ndi mkaka, koma izi sizikhala zolunjika nthawi zonse. “Ndi mkuntho wabwino kwambiri” wazizindikiro zosadziwika bwino komanso zodziwika bwino komanso palibe mayeso ozindikira matenda, Adam Fox, dokotala wa ana komanso pulofesa ku King’s College London, adandiuza, ndikuzindikira kuti zokonda zamalonda monga kutsatsa kwamakampani opanga ma fomula zithanso kusokeretsa. “N’zosadabwitsa kuti mwasokoneza odwala komanso, kunena zoona, madokotala ambiri osokonezeka kwambiri.”
Fox ndiye wolemba wamkulu wa bukuli International Milk Allergy in Primary Care, kapena iMAP, malangizo, chimodzi mwazolemba zambiri zofanana zomwe zimafuna kuthandiza madokotala kuti azindikire CMPA. Koma malangizo ena – kuphatikiza iMAP, yomwe imadziwika kuti Milk Allergy in Primary Care Guideline mpaka 2017 – idadzudzulidwa chifukwa cholemba mndandanda wazizindikiro zambiri, monga colic, totupa mosadziwika bwino, komanso kudzimbidwa, zomwe zitha kukhala zofala kwa makanda athanzi panthawi yoyembekezera. chaka choyamba cha moyo wawo.
“Makanda ambiri amalira, kapena amalira [regurgitate milk], kapena amadwala totupa pang’ono kapena china chake,” Michael Perkin, dokotala wa ana yemwe amakhala ku UK, anandiuza. “Koma izi sizikutanthauza kuti ali ndi vuto la pathological lomwe likuchitika.”
Mu pepala lofalitsidwa pa intaneti mu Disembala 2021, Perkin ndi anzawo anapeza kuti mu chakudya ziwengo mlandu, pafupifupi magawo atatu mwa anayi a makolo a makandawo anafotokoza zizindikiro zosachepera ziwiri zomwe zikufanana ndi zizindikiro za “zofatsa-zochepa” za ng’ombe zosagwirizana ndi mkaka wa ng’ombe, monga kusanza. Koma kafukufuku wina, omwe olemba ake anali Perkin ndi Robert Boyle, katswiri wa ana-allergy ku Imperial College London, kuwunikiridwa umboni womwe ulipo ndipo akuti pafupifupi 1 peresenti yokha ya makanda amakhala ndi ziwengo zamkaka zomwe zatsimikiziridwa ndi zomwe zimatchedwa “chakudya chovuta,” momwe munthu amawonekera ku allergen ndipo zochita zawo zimayang’aniridwa.
Kufufuza komweku kunanena kuti pafupifupi 14 peresenti ya mabanja amakhulupirira kuti mwana wawo ali ndi vuto la mkaka. Wina kuphunzira Wolemba Boyle ndi anzawo adawonetsa kuti malangizo a mkaka-osagwirizana ndi mkaka wawonjezera kuchuluka kwa 2.8 ku England kuyambira 2007 mpaka 2018. Ofufuza a University of Rochester anapeza Zofanana ndi zomwe zikuchitika: Kugulitsa kwa Hypoallergenic-formula kudakwera kuchoka pa 4.9% ya formula yomwe idagulitsidwa ku US mu 2017 mpaka 7.6% mu 2019.
Perkin ndi Boyle akuganiza kuti makampani opanga ma formula amakhudza njira zozindikirira matenda. Mu lipoti lawo la 2020, lofalitsidwa mu JAMA Pediatricsanapeza kuti 81 peresenti ya olemba omwe adagwirapo ntchito pamalangizo osiyanasiyana a madotolo pankhaniyi – kuphatikiza angapo pa malangizo a iMAP a 2013 – adanenanso za kusamvana pazachuma ndi opanga ma formula.
Makampani opanga ma formula amatumizanso nthumwi ndi zida zotsatsira ku zipatala zina za ana. Mmodzi waposachedwa kuphunzira anapeza kuti pafupifupi 85 peresenti ya madokotala a ana a ku United States amene anafunsidwa anasimba za kuchezeredwa ndi woimira, amene ena a iwo anakonza chakudya nawo.
Makampani opanga ma formula “amakonda anthu kukhala ndi lingaliro lakuti nthawi iliyonse mwana akalira, kapena kutulutsa chimbudzi, kapena chirichonse,” akhoza kukhala mkaka wa mkaka, Boyle anandiuza.
Poyankha kudzudzula kuti malangizowo akhudza kuwonjezeka kwa malonda opangidwa mwapadera, Fox, wolemba wamkulu wa malangizo a iMap, adanena kuti kukwera kunayamba kumayambiriro kwa zaka za m’ma 2000. Chimodzi mwa malangizo oyamba ozindikira matenda, panthawiyi, chinali lofalitsidwa mu 2007. Ananenanso kuti zizindikiro zomwe zalembedwa mu malangizo a iMAP ndi zomwe zafotokozedwa ndi National Institute for Health and Care Excellence yaku UK ndi National Institute of Allergy and Infectious Diseases yaku US.
Ponena za kusemphana maganizo kwa zofuna, Fox anati: “Sitinapangepo ndalama zilizonse; panalibe konse ndalama zachitukuko chake. Tachita izi ndi zolinga zabwino. Timazindikira mwamtheradi pomwe mwina sizinachitike momwe timafunira; tayesetsa kuthana ndi izi. ”
Kutsatira kubwerera kumbuyo pa maubwenzi apamtima pakati pa makampani opanga ma formula ndi akatswiri azaumoyo, kuphatikiza mikangano ya olemba, iMAP idasintha malangizo ake mu 2019. Baibulo latsopano adayankha mwachindunji kutsutsidwa ndipo adati malangizowo sanalandire ndalama zamakampani, koma adavomereza “chiwopsezo chomwe chingakhale chokondera” chokhudzana ndi ndalama zofufuzira, ndalama zamaphunziro, ndi chindapusa cha alangizi. Olembawo adawona kuti malangizo atsopanowa adayesa kuchepetsa chikoka chotere kudzera pakulowetsa kwa odwala odziyimira pawokha.
Fox adatinso adadula maubwenzi onse mu 2018, ndipo adatsogolera British Society for Allergy & Clinical Immunology kuchita zomwezo pomwe anali purezidenti.
Ndinafika ku bungwe la Infant Nutrition Council of America, bungwe la makampani akuluakulu a ku United States opanga mkaka wosakaniza wa makanda, kangapo koma sindinalandire ndemanga iliyonse.
Ngakhale malangizowo ali ndi zovuta, a Nigel Rollins, dokotala wa ana komanso wofufuza ku World Health Organisation, adandiuza, akuwona kukwera kwa matendawa kumayendetsedwa ndi kutsatsa kwamakampani opanga ma formula kwa makolo, zomwe zingapangitse lingaliro lakuti kukangana kapena colic kungakhale zizindikiro. a ziwengo zamkaka. Makolo kenaka amapita kwa dokotala wawo wa ana kuti akalankhule za ziwengo zamkaka, Rollins anati, ndipo “dokotala wabanja sali wokhoza kutsutsa mwanjira ina.”
Rollins adatsogolera kafukufuku wambiri mu 2022 lipoti kuchokera ku WHO ndi UNICEF, yomwe idafufuza anthu opitilira 8,500 oyembekezera komanso obereka m’maiko asanu ndi atatu (kuphatikiza US). Mwa anthu amene anachita nawo msonkhanowo, 51 peresenti anakhudzidwa ndi malonda okhwima a mkaka wa mkaka, zimene lipotilo linati “zikuimira chimodzi mwa zoopsa zimene anthu amazinyalanyaza kwambiri pa thanzi la makanda ndi ana aang’ono.”
Amy Burris, dokotala wa ana ndi katswiri wodziwa chitetezo chamthupi pa yunivesite ya Rochester Medical Center, anandiuza kuti pali zifukwa zambiri zomwe zingayambitse matenda ambiri: “Sindikudziwa kuti pali chinthu chimodzi chomwe chimandionekera m’mutu mwanga monga chifukwa chake ndikuchizindikira mopitirira muyeso. ”
Madokotala ena amadalira njira zawo, m’malo motsatira malangizo, kuti azindikire kuti mkaka wa mkaka wopanda IgE – mwachitsanzo, kupanga mayeso omwe amapeza magazi ang’onoang’ono m’chimbudzi. Koma Burris ndi Rollins onse adanenanso kuti makanda athanzi, kapena makanda omwe posachedwapa ali ndi kachilombo kapena kachilombo ka m’mimba, amathanso kukhala ndi magazi m’chimbudzi chawo.
Martin, wofufuza za ziwengo pachipatala cha Massachusetts General Hospital, adati njira yabwino yotsimikizira kuti mkaka wakhanda wakhanda ndi kubweretsanso mkaka patatha mwezi umodzi utatha: Zizindikiro zikawonekeranso, ndiye kuti mwanayo ali ndi chifuwa chachikulu. Malangizo akuti kuchita izi, koma onse a Martin ndi Perkin adandiuza kuti izi sizichitika konse; makolo angazengereze kubweretsanso chakudya ngati mwana wawo akuwoneka bwino popanda kudya.
“Ndikukhumba kuti dokotala aliyense atsatire malangizowo pompano, mpaka titalemba malangizo abwino, chifukwa, mosakayikira, zomwe anthu sakutsatira malangizowa ndizoipa kwambiri,” adatero Martin, akuwonjezera kuti ana amadya zakudya zoletsedwa kwa nthawi yaitali kuposa momwe amachitira. ayenera kukhala.
Kusiya zakudya zomwe zingakhale allergenic, kuphatikizapo mkaka, sikuli ndi zotsatira. “Ndikuganiza kuti pali chiopsezo chachikulu chokhala ndi amayi omwe amapewa mkaka wa ng’ombe kapena zakudya zina,” adatero Burris. “Komanso, mukuyika ubale woyamwitsa pachiwopsezo.”
Pamene Burris akuwona khanda, iye anati, amayi nthawi zambiri amakhala atasiya kuyamwitsa pambuyo poti wopereka chithandizo chamankhwala atanena kuti ali ndi vuto la chakudya, ndipo “pamenepo, kwachedwa kwambiri kuti ayambitsenso kuyamwitsa.” Imakhalanso yotseguka funso kaya allergen mu mkaka wa m’mawere kwenikweni kuyambitsa makanda ziwengo. Malinga ndi Perkin, kuchuluka kwa mapuloteni a mkaka wa ng’ombe omwe amalowa mu mkaka wa m’mawere ndi “kang’ono.”
Kwa makanda, Martin adati, kuchotsa zakudya kumatha kukhudza chidwi ndi zakudya zina. Iye analoza ku kafukufuku kusonyeza kuti kuyambika koyambirira kwa zakudya zosagwirizana ndi zakudya monga mtedza kumachepetsa mwayi wokhala ndi ziwengo.
Martin adanenanso kuti ana ena omwe ali ndi matenda a CMPA sangasiye mkaka wonse. Anatsogolera a 2020 maphunziro kutanthauza kuti ngakhale makolo akapanda kusankha kusintha zakudya za ana omwe ali ndi vuto la zakudya zosagwirizana ndi IgE, pambuyo pake amafotokoza kusintha kwa zizindikiro za mwana wawo pochita zinthu zina, monga kupondereza asidi. Koma makolo akasintha kadyedwe ka mwana wawo, monga mmene Martin anachitira, ngati apatsanso mkaka, “ambiri a iwo amachita bwino,” iye anatero. “Ndikuganiza kuti anthu ena angatsutse kuti mwina munapezeka ndi matenda olakwika poyamba. Koma ine ndikuganiza kuthekera kwina ndiko kuti ndi matenda oyenera; zimangotembenuka mofulumira kwambiri.”
Komabe, makolo ambiri omwe amasiya mkaka kapena kusintha njira ya hypoallergenic amafotokoza kusintha mu zizindikiro za mwana wawo. Arnold adati zizindikiro za mwana wake zidakula atachotsa mkaka. Koma pamene iye anali ndi pafupifupi miyezi isanu ndi itatu, iwo anabweretsanso gulu la chakudya ku zakudya zake, ndipo iye analibe vuto.
Kaya ndi chifukwa chakuti kusagwirizana ndi mapuloteni a mkaka wa ng’ombe kunali kwa nthawi yochepa kapena chifukwa chakuti zizindikiro zake zinali chifukwa cha chinachake sichidziwika bwino. Koma Arnold akuwona amayi akudzizindikiritsa okha kuti mwana wawo ali ndi vuto la zakudya pamagulu ochezera a pa Intaneti, ndipo amakhulupirira kuti ambiri akukumana ndi zotsatira za placebo pamene akunena kuti mwana wawo akukula. “Palibe amene ali wotetezedwa ndi zimenezo. Ngakhale ine,” adatero. “Pali mwayi ndithu kuti zinali choncho ndi mwana wanga.”