鸡蛋过敏最可能被克服


  【24drs.com】根据发表于美国过敏、气喘暨免疫学院2012年科学会议的研究,8种最常见的食物过敏原中,鸡蛋过敏是孩童最可能可以克服的。
  
  芝加哥Ann & Robert H. Lurie儿童医院、西北大学Feinberg医学院小儿科副教授Ruchi S. Gupta医师表示,许多因素影响了耐受性的发展,包括过敏原类型、症状、严重度与个人特质。
  
  Gupta医师报告指出,在他们的研究中,观察到有四分之一孩童有食物耐受性,有55%到7岁时克服了鸡蛋过敏。
  
  Gupta医师等人的研究目标在于确认与8种常见食物耐受性发展有关的因素,研究对象是具有全国代表性的40,000多名孩童。
  
  研究者在摘要中写道,从2009年6月至2010年2月,对具全美家庭代表性的样本,进行电子化随机横断面调查;调查的40,104名孩童中,10岁以上孩童确认有2,120例食物过敏;整体而言,这些孩童有28%对自己曾经过敏的食物发展出耐受性。
  
  到了10岁时,对牛奶(45%)或鸡蛋(55%)过敏的孩童比其它食物过敏者更能发展出耐受性(P< .01),而对树坚果(16%)或贝类(14%)过敏的孩童比较少发展出耐受性(P< .01)。
  
  对鸡蛋过敏耐受的平均年纪为7.2岁,牛奶过敏者为6.0岁;不过,树坚果过敏的平均耐受年龄为9.6岁,贝类过敏为11.6岁;此外,豆类过敏的平均耐受年龄为7岁,鱼类过敏为9.3岁,花生过敏为8.4岁。
  
  Gupta医师报告指出,如果过敏时只会发生湿疹,则克服过敏的可能性较高(P< .05),如果症状是血管神经性水肿、呼吸困难、过敏性休克,则克服的可能性较低(P< .01)。
  
  男孩比女孩更可能克服过敏(胜算比[OR]1.42;95%信心区间[CI]1.05-1.93;P= .02);相较于轻微或中度者,严重食物过敏的孩童比较不可能克服(OR,0.16;95% CI,0.11至0.24;P< .01)。
  
  Gupta医师表示,需要有更多研究以纵向前瞻世代来验证这些结果,使用口服食物挑战方式来确认过敏和发展出耐受性。希望研究结果提供了增加或减少发展耐受之因素的论点,让医师们可以更准确地和病患与家属谘商。
  
  密苏里大学-堪萨斯市Mercy儿童医院小儿科教授、过敏/气喘/免疫科主任、未参与此次研究的Jay Portnoy医师解释,当小孩被诊断有食物过敏时,家长总是会问他们是否可以克服。
  
  他指出,这篇研究再度让我们确认,可告诉家长有超过半数鸡蛋过敏孩童与牛奶过敏孩童可以在10岁左右克服食物过敏;不过,只有16%的树坚果过敏患者以及14%的贝类过敏患者克服他们的食物过敏。必须知道的重点是,有些食物比其它食物更可能变得比较没有过敏性。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=6957&x_classno=0&x_chkdelpoint=Y
  

Egg Allergy Most Likely to Be Outgrown

By Fran Lowry
Medscape Medical News

"Many factors influence the development of tolerance, including type of allergen, symptoms, severity, and individual characteristics," Ruchi S. Gupta, MD, MPH, associate professor of pediatrics at the Northwestern University Feinberg School of Medicine and the Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois, told Medscape Medical News.

"In our study, food tolerance was observed in 1 in 4 children, with 55% outgrowing their egg allergy by age 7," Dr. Gupta reported.

In their study, Dr. Gupta and her colleagues set out to identify factors associated with the development of tolerance to 8 common foods in a nationally representative sample of more than 40,000 children.

"A randomized cross-sectional survey was administered electronically to a representative sample of US households with children from June 2009 to February 2010," the researchers write in their abstract.

Of the 40,104 children surveyed, 2120 cases of food allergy were identified in children older than 10 years; overall, 28% of these children had developed a tolerance to a food they were allergic to.

By the age of 10 years, children with milk (45%) or egg (55%) allergy developed tolerance more frequently than those with other food allergies (P < .01), whereas children with tree nut (16%) or shellfish (14%) allergy developed tolerance less frequently (P < .01).

Mean age of tolerance for egg allergy was 7.2 years and for milk allergy was 6.0 years. However, mean age of tolerance for tree nut allergy was 9.6 years and for shellfish allergy was 11.6 years.

In addition, mean age of tolerance for soy allergy was 7 years, for fin fish allergy was 9.3 years, and for peanuts allergy was 8.4 years.

Possible Predictors for Development of Tolerance

The likelihood of outgrowing an allergy was higher if eczema was the only sign of food allergy (P < .05), and lower if angioedema, trouble breathing, and anaphylaxis were signs of the food allergy (P < .01), Dr. Gupta reported.

Boys were significantly more likely to outgrow their allergy than girls (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.05 to 1.93; P= .02).

Children whose food allergy was severe were less likely to outgrow it than those whose allergy was mild or moderate (OR, 0.16; 95% CI, 0.11 to 0.24; P < .01).

More work is needed revalidate these findings in longitudinal prospective cohorts that use oral food challenges to confirm the allergy and the development of tolerance, Dr. Gupta said. "We hope that our findings provide insight into factors that may increase or decrease the chance of developing tolerance so physicians can more accurately counsel their patients and families," she noted.

Jay Portnoy, MD, division director of allergy/asthma/immunology and professor of pediatrics at the University of Missouri–Kansas City and Mercy Children's Hospital, who was not involved in the study, explained that parents always ask when their children are diagnosed with a food allergy how likely they will be to outgrow it.

"This study is reassuring and lets us tell parents that more than half of kids with egg allergy and 45% with milk allergy will outgrow their food allergy by the age of 10," he told Medscape Medical News.

However, "only 16% of tree-nut-allergic patients and 14% of shellfish-allergic patients outgrow their food allergy.... This is important to know. Some foods are more likely to become less allergenic than others," Dr. Portnoy said.

Dr. Gupta and Dr. Portnoy have disclosed no relevant financial relationships.

American College of Allergy, Asthma & Immunology (ACAAI) 2012 Annual Scientific Meeting: Abstract FP 18. Presented November 8, 2012.

    
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