饮食中提早摄取蛋类并不会降低过敏风险


  【24drs.com】一篇新研究的作者们报告指出,从4-6个月大开始规律食用蛋类,相较于延后开始吃蛋者,并不会改变1岁之后的蛋过敏风险。
  
  他们指出,不过,得自「Starting Time of Egg Protein (STEP)」这篇随机双盲试验的某些研究结果,暗示提早开始吃蛋制品可能有好处。
  
  Crawley Western Australia大学小儿科暨儿童健康学院Debra J. Palmer博士等人写道,STEP研究的研究对象在纳入时没有过敏症状,但是他们有遗传性的过敏风险,这使得STEP研究与「Learning Early About Peanut Allergy (LEAP)」等试验有所不同,LEAP试验的先决条件是:一个现有的过敏性疾病如湿疹,LEAP试验中,提早且持续摄取花生制品与花生过敏发生率显著降低有关。
  
  作者们结论指出,对于纳入研究时没有湿疹症状、但有过敏疾病遗传风险的婴儿,我们并未发现从4-6.5个月规律摄取蛋类可明显改变1岁时之蛋过敏风险的证据。实际上,对于没有湿疹的婴儿,在开始给予固态食品、加入蛋类与含蛋食品时,并不需要例行性检测蛋过敏状态。
  
  这篇研究在线发表于8月21日过敏与临床免疫学期刊。
  
  STEP研究纳入的孩童年龄为4-6.5个月,他们的母亲有遗传性过敏症,但是这些孩童本身没有湿疹或过敏性疾病、未曾吃过蛋类。将他们随机分组为介入组(有含蛋类)或对照组(没有蛋类),于他们的食物中分别加入含蛋或不含蛋的粉末。这两个配方的颜色、味道、外观与口感相似,从随机分组开始,每天给予一次,直到孩童10个月大为止。10个月大时,两组的家长在所有研究对象孩童的饮食中都加入蛋类烹调制品。
  
  原本的820名研究对象中,748人在12个月大时进行了皮肤点刺试验与蛋类挑战。介入组的371名孩童中有26人 (7%)诊断有IgE相关的蛋过敏,对照组则是377人中有39人(10.3%)发生。
  
  校正居住城市、婴儿性别、哺餵母乳状态、家长的过敏疾病史等因素之后,相对风险(aRR)为0.75 (95%信赖区间[CI], 0.48 - 1.17; 校正P = .20),但是,作者们写道,虽然样本规模足以排除蛋过敏风险大幅增加,我们并无法排除潜在的重要效益。
  
  观察发现,食用蛋类组的孩童有10.8%对蛋敏感,对照组则是有15.1%(aRR, 0.77; 95% CI, 0.54 - 1.10; P = .15),在随机分组起到1岁之间,食用蛋类组的孩童有10.7%发生湿疹、对照组有11.9% (aRR, 0.84; 95% CI, 0.57 - 1.23; P = .37)。
  
  12个月大、进行生鸡蛋挑战时,食用蛋类组有2名婴儿、对照组有1名婴儿发生严重过敏反应,不过,他们对于研究使用的含蛋粉末并无过敏反应。此外,生蛋挑战发生过敏反应、两组共65名的婴儿中,60人吃烘焙烹煮过的蛋时没有问题发生。这强调了一个关键的公卫讯息:4-6.5个月大、没有湿疹的婴儿,在家里开始给予含蛋食品是安全的,不需要先进行蛋敏感检测。
  
  符合方案分析法中,含蛋组的305名婴儿中有9人(3%)、对照组的312名婴儿中有31人(9.9%)在12个月大时有IgE相关的蛋过敏(aRR, 0.32; 95% CI, 0.16 - 0.65; P = .002),不过,符合方案分析法将较多含蛋组的孩童排除,因为对研究使用的粉末感知不良反应(P = .02)或确认过敏反应(P = .0004)。
  
  作者们指出,两组导入时机(4-6个月vs 10个月)的差异不大,可能因这个时间差异太短而无法在过敏反应显示出对比。在LEAP试验中,在 4-11个月大时将花生导入介入组对象,对照组则是在5岁时。不过,研究者指出,他们正试著复制在大约10个月大时导入鸡蛋的普遍做法。而且,稍早的一篇研究显示,等到10个月之后,与蛋过敏的风险比较高有关。
  
  资料来源:http://www.24drs.com/
  
  Native link:Early Egg Introduction Does Not Lower Allergy Risk

Early Egg Introduction Does Not Lower Allergy Risk

By Norra MacReady
Medscape Medical News

Regular egg consumption starting at 4 to 6 months of age does not change the risk for egg allergy at 1 year of age or older, compared with delayed introduction of eggs, the authors of a new study report.

However, some of the findings, which come from the Starting Time of Egg Protein (STEP) randomized, double-blind trial, do hint at a possible benefit of early egg introduction, they point out.

STEP participants had no allergic symptoms at the time of enrollment, although they had a hereditary risk for allergies, Debra J. Palmer, PhD, from the School of Paediatrics and Child Health, The University of Western Australia in Crawley, and colleagues write. This distinguishes STEP from studies such as the Learning Early About Peanut Allergy (LEAP) trial, for which an existing allergic disease, such as eczema, was a prerequisite. In LEAP, early and sustained consumption of peanut products was associated with a significant decrease in the incidence of peanut allergy.

"We found no evidence that regular egg intake from 4 to 6.5 months of age substantially alters the risk of egg allergy by 1 year of age, in infants who are at hereditary risk of allergic disease and had no eczema symptoms at study entry," the authors conclude. "There is no need for routine testing of infants without eczema in the community to determine egg sensitization status prior to the introduction of egg and egg-containing foods when solids are introduced."

The study was published online August 21 in the Journal of Allergy and Clinical Immunology.

Children were enrolled in STEP between the ages of 4 and 6.5 months. Their mothers had atopy, but the children themselves had no eczema or allergic illness and no previous consumption of egg. They were randomly assigned to receive an intervention (egg) or control (no egg) powder that was mixed into their food. The two preparations were similar in color, smell, texture, and taste and were administered once a day from the time of randomization until the children were 10 months of age. At 10 months of age, parents introduced cooked egg into the diets of all children in both trial groups.

Of the 820 original participants, 748 had the skin prick test and egg challenge at the 12-month examination. IgE-mediated egg allergy was diagnosed in 26 of 371 (7%) children in the intervention group and 39 of 377 (10.3%) in the control group.

The relative risk, adjusted for city, infant sex, breast-feeding status, and paternal history of allergic disease (aRR), was 0.75 (95% confidence interval [CI], 0.48 - 1.17; adjusted P = .20). But while "the sample size was sufficient to rule out large increases in egg allergy risk…we cannot rule out potentially important benefits," the authors write.

Sensitization to egg was observed in 10.8% of the children in the egg group vs 15.1% of the controls (aRR, 0.77; 95% CI, 0.54 - 1.10; P = .15). Between randomization and 1 year of age, eczema occurred in 10.7% of the children in the egg group and 11.9% of the controls (aRR, 0.84; 95% CI, 0.57 - 1.23; P = .37).

Two infants in the egg group and one in the control group developed anaphylaxis in response to the raw egg challenge at 12 months. However, there were no anaphylactic responses to the egg powder used in the study. In addition, of all 65 infants in either group who had an allergic response to raw egg challenges, 60 were consuming baked or cooked eggs with no problems. "This highlights a key public health message: that egg introduction at 4-6.5 months of age for infants without eczema is safe to do so at home without the need for prior egg sensitization testing."

In a per-protocol analysis, 9 of 305 infants in the egg group (3%) and 31 of 312 infants in the control group (9.9%) had IgE-mediated egg allergy at 12 months of age (aRR, 0.32; 95% CI, 0.16 - 0.65; P = .002). However, more children in the egg group than the control group were excluded from the per-protocol analysis because of a perceived adverse reaction (P = .02) or a confirmed allergic reaction (P = .0004) to the study powder.

The authors note that the small difference in the timing of introduction between the two groups (4 to 6 months vs 10 months) may have been too short to show a contrast in allergic response. In the LEAP trial, peanuts were introduced to the intervention group at 4 to 11 months of age, compared with 5 years of age for the control group. However, the researchers note they were trying to reproduce the common practice of introducing eggs at about 10 months of age. Also, an earlier study showed that waiting until after 10 months of age was associated with a higher risk for egg allergy.

The authors have disclosed no relevant financial relationships.

J Allergy Clin Immunol. Published online August 21, 2016.

    
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