Single-dose oral challenges to validate eliciting doses in children with cow's milk allergy.
Single-dose oral challenges to validate eliciting doses in children with cow's milk allergy.
复制标题
单剂量口服挑战，以验证对牛奶过敏的儿童的诱发剂量。
DOI：
10.1111/pai.13482
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Turner PJ
中科院分区：
文献类型：
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作者：
Turner PJ
背景人们对使用诱发剂量 (ED) 来指导过敏原风险管理越来越感兴趣。 ED 可以根据特定人群中接受食物挑战的过敏受试者的阈剂量分布来估计。牛奶的估计 ED05 值（预计会在 5% 的牛奶过敏人群中引起客观过敏症状的剂量）范围为 0.5 毫克至 13.9 毫克牛奶蛋白。我们进行了一项单剂量激发研究，以验证 0.5 毫克蛋白质牛奶的预测 ED05。方法从 4 个临床中心招募参与者。使用预先确定的标准来识别对 0.5 毫克牛奶蛋白（约 0.015 毫升新鲜牛奶）有反应的患者。 1 岁以上的儿童接受了正式的牛奶挑战，以确认临床反应。结果 本次分析纳入了 172 名儿童（中位年龄 6.0 (IQR 0.7‐11) 岁，57% 为男性）。 12 名（7.0%，95% CI 3.7%‐11.9%）儿童出现了符合预定标准的客观症状。一名参与者出现轻度过敏反应，对单剂量肾上腺素有反应，其余参与者仅出现轻微症状，无需治疗。我们没有发现任何与使用 0.5 mg 牛奶蛋白的单剂量挑战的客观反应性相关的致敏基线预测因子。结论这些数据支持 0.5 mg 蛋白牛奶的估计 ED05。需要审查建议用于过敏原风险管理的牛奶蛋白 ED05 值高于 0.5 毫克。
BackgroundThere is increasing interest in the use of eliciting doses (EDs) to inform allergen risk management. The ED can be estimated from the distribution of threshold doses for allergic subjects undergoing food challenges within a specified population. Estimated ED05values for cow's milk (the dose expected to cause objective allergic symptoms in 5% of the milk‐allergic population) range from 0.5 mg to 13.9 mg cow's milk protein. We undertook a single‐dose challenge study to validate a predicted ED05for cow's milk of 0.5 mg protein.MethodsParticipants were recruited from 4 clinical centres. Predetermined criteria were used to identify patients reacting to 0.5 mg cow's milk protein (approximately 0.015 mL of fresh cow's milk). Children over 1 year underwent formal challenge to cow's milk to confirm clinical reactivity.Results172 children (median age 6.0 (IQR 0.7‐11) years, 57% male) were included in this analysis. Twelve (7.0%, 95% CI 3.7%‐11.9%) children experienced objective symptoms that met the predetermined criteria. One participant had mild anaphylaxis that responded to a single dose of adrenaline, the remainder experienced only mild symptoms with no treatment required. We did not identify any baseline predictors of sensitization that were associated with objective reactivity to the single‐dose challenge using 0.5 mg cow's milk protein.ConclusionsThese data support an estimated ED05for cow's milk of 0.5 mg protein. Values for ED05above 0.5 mg for cow's milk protein proposed for allergen risk management need to be reviewed.