曾发生食物过敏者有食道炎风险


  【24drs.com】一篇新研究显示,成长期间有发生食物过敏者,后来可能会对该种食物发生嗜酸细胞性食道炎。
  
  宾州费城儿童医院过敏科主任Jonathan Spergel医师表示,这些病患2-4年后因为不同的过敏又就医。他们一开始是对某种食物发生过敏性休克,现在则是食道肿胀。
  
  Spergel医师在美国过敏、气喘、免疫学院2014年会发表研究结果。
  
  嗜酸细胞性食道炎的特征是食道组织出现大量嗜酸性细胞这种白血球,引起发炎或肿胀,症状包括腹痛、难以吞咽和呕吐;肿胀严重者还足以造成食物嵌塞。
  
  最近的研究认为,嗜酸细胞性食道炎的机转与免疫球蛋白E无关;免疫球蛋白E是一般食物过敏的关键调节因子。
  
  为了了解嗜酸细胞性食道炎病患的食物过敏发生率,Spergel医师等人研究了1025名治疗此病症的孩童。
  
  其中425名孩童确认对某一特定食物过敏,若某种食物被移除之后即无嗜酸性食道炎症状、或者加入饮食后引起症状复发,则被视为引起该症状的原因。
  
  这425名孩童最常见诱发症状的食物是牛奶、鸡蛋、小麦与大豆。
  
  总共有17个病患在长大后对引起食物过敏的相同食物发生嗜酸细胞性食道炎,牛奶、鸡蛋、小麦与大豆仍是这类患者的最常见诱因,其中94%的病患患有过敏性疾病。
  
  研究者指出,2名孩童发生食物过敏时的食道切片是正常的,当他们长大后,饮食中再度有该项食品时,他们对相同食物发生食道炎反应。
  
  北卡罗来纳儿童医院主治医师Wesley Burks指出,这篇研究聚焦在有食物过敏情况下自然长大的病患,但是,进行食物过敏口服免疫治疗的病患仍约有10%-15%也发生食道炎。
  
  Spergel医师表示,医师对于有食物过敏史的病患,应有嗜酸细胞性食道炎症状之警觉,当病患在有牛奶或花生过敏的情况下长大时,要注意他们在2个月或半年后因为腹痛和类流感症状而再度就医时,医师必须回顾并探讨是否是这些之前不能吃的食物引起了新症状。
  
  纽约市西奈山医院小儿过敏免疫科教授Hugh Sampson医师表示,Spergel医师有一个很好的观点,就是目前可耐受某种食物不意味著绝对安全。
  
  Sampson医师推论,对特定食物过敏的病患可能一开始就容易发生食道炎,但因为他们避免吃该种食物而不知道会有这种状况。
  
  Spergel医师表示,食物过敏患者如果后来对这些食物发生食道炎,应再度避免吃它们。他指出,最常见的治疗方法是吃小剂量皮质类固醇或者吸入皮质类固醇气喘药物。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=7062&x_classno=0&x_chkdelpoint=Y
  

Patients With Previous Food Allergies at Risk for Esophagitis

By Laird Harrison
Medscape Medical News

SAN DIEGO — Patients who have outgrown their food allergies can develop eosinophilic esophagitis as a reaction to the same foods, a new study shows.

"Two to 4 years later, they come back with a different allergy," said Jonathan Spergel, MD, chief of the allergy section of The Children's Hospital of Philadelphia in Pennsylvania. "Initially, they are getting anaphylactic shock to this food. Now they are getting a swollen esophagus."

Dr. Spergel presented the study results here at the American Academy of Allergy, Asthma & Immunology 2014.

Eosinophilic esophagitis is characterized by the presence of a large number of white blood cells, called eosinophils, in the tissue of the esophagus, which causes inflammation or swelling. Symptoms include abdominal pain, difficulty swallowing, and vomiting. Swelling can become severe enough to cause food impaction.

Recent research has suggested that the mechanism of disease of eosinophilic esophagitis is independent of immunoglobulin E, a key mediator of typical food allergies.

To measure the frequency of food allergy in patients with eosinophilic esophagitis, Dr. Spergel and his team studied 1025 children treated for the condition.

Just because you now tolerate a food doesn't mean you're absolutely clear.

A specific food was identified as the culprit in 425 of those children. A food was considered to cause eosinophilic esophagitis if removing it from the diet stopped symptoms or if reintroducing it into the diet caused symptoms to reoccur.

For these 425 children, the most common triggers were milk, egg, wheat, and soy.

A total of 17 patients developed an eosinophilic esophagitis reaction to a food after they outgrew an allergy to that same food. Milk, egg, wheat, and soy were still the most common esophagitis triggers in this subgroup, and 94% of the patients had atopic disease.

The investigators noted that 2 children had normal biopsies of the esophagus when they had a food allergy. After they outgrew that food allergy, they developed an esophagitis reaction to the same food when that food was reintroduced into their diet.

This study focused on patients who naturally outgrew their food allergies, but about 10% to 15% of patients who undergo oral immunotherapy for their food allergies also develop esophagitis, noted Wesley Burks, MD, physician in chief at North Carolina Children's Hospital in Chapel Hill.

Clinicians should be aware of the symptoms of eosinophilic esophagitis in patients with a history of food allergies, said Dr. Spergel. "When patients outgrow milk or peanut allergies, you need to worry if they come back 2 or 6 months later with abdominal pains and flu-like symptoms. You need to go back and look at whether the food they couldn't eat a few years ago is causing these new symptoms."

"I think Dr. Spergel has a very good point that just because you now tolerate a food doesn't mean you're absolutely clear," said Hugh Sampson, MD, professor of pediatrics, allergy, and immunology at the Mount Sinai Hospital in New York City.

Dr. Sampson speculated that patients with typical food allergies might start out susceptible to esophagitis, but be unaware of the condition because they are avoiding the food.

Patients who outgrow their allergies to foods then develop esophagitis in reaction to these foods must once again avoid them, said Dr. Spergel.

The most common treatments for the condition are to swallow small doses of corticosteroids or to inhale corticosteroid asthma medications, he noted.

Dr. Spergel reported financial relationships with Dannone, DBV Technologies, and MEI Pharma. Dr. Burks has disclosed no relevant financial relationships. Dr. Sampson reports relationships with Dannone, ThermoFisher Scientific, Allertein Therapeutics, Regeneron, Novartis, and UpToDate, among others.

American Academy of Allergy, Asthma & Immunology (AAAAI) 2014: Abstract 990. Presented March 2, 2014.

    
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