Prediction of tolerance on the basis of quantification of egg white-specific IgE antibodies in children with egg allergy
Prediction of tolerance on the basis of quantification of egg white-specific IgE antibodies in children with egg allergy
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DOI：
10.1067/mai.2002.126081
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发表时间：
2002-08-01
影响因子：
14.2
通讯作者：
Martín-Esteban, M
中科院分区：
文献类型：
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作者：
Boyano-Martínez, T;García-Ara, C;Martín-Esteban, M
背景：人们认为食物过敏的自然演变具有良好的耐受性预后。然而，很少有后续研究可以确定对特定食物的确切耐受概率或分析预后因素，以帮助我们了解出生时就有食物过敏的儿童的演变。 目的：我们试图确定对鸡蛋过敏的 2 岁以下儿童最终对鸡蛋产生耐受的可能性，并以蛋清特异性 IgE 水平为主要指标来分析几种预后预测因子 方法：我们对 58 名患有鸡蛋过敏的 2 岁以下儿童进行了一项前瞻性研究，对这些儿童进行定期研究，直到产生耐受性或直到研究结束。在随访期间，根据先前制定的标准进行开放攻击测试，以验证对鸡蛋的耐受性。分析诸如蛋清特异性 IgE 水平、血清总 IgE 水平、摄入鸡蛋后的症状、对蛋清的皮肤点刺试验反应的大小、特应性皮炎和性别等因素作为预后标志。 Kaplan-Meier 生存曲线用于计算累积耐受概率。使用 Cox 比例回归模型估计预测因素影响和相对预后重要性。结果：从首次症状出现到耐受的中位时间为 35 个月。随访12个月时的累积耐受概率为16%，24个月时为28%，36个月时为52%，48个月时为57%，60个月时为66%。预后因素的相对权重以风险比表示，症状为 50.95，皮肤点刺试验反应大小为 3.74，两者都是独立效应。特异性IgE水平的浓度对数（十进制对数）每降低0.1个单位，风险比为1.173，这种效应仅与有皮肤症状的儿童的耐受性相关。结论：2岁以下鸡蛋过敏儿童中，有一半在随访35个月时能够耐受该食物，5年后这一比例可达66%。在那个年龄，主要的预测因素是摄入鸡蛋后出现的症状，其次是皮肤点刺试验反应的大小。此外，特异性 IgE 抗体水平对于仅出现皮肤症状的儿童来说是一个重要的预后标志。
Background: It is thought that the natural evolution of food allergy has a good tolerance prognosis. However, there are few follow-up studies that determine the exact probability of tolerance to a given food or that analyze prognostic factors that can help us to understand the evolution of a child who begins life with a food allergy.Objective: We sought to determine the likelihood that children younger than 2 years of age with allergy to egg would eventually have tolerance to it and to analyze several prognostic predictors using egg white-specific IgE level as the main variable.Methods: We performed a prospective study of 58 children younger than 2 years of age with egg allergy, who were studied periodically until tolerance developed or until the end of the study. During the follow-up period, open challenge tests were carried out according to previously established criteria to verify tolerance to egg. Factors such as egg white-specific IgE level, serum total IgE level, symptoms after egg ingestion, size of skin prick test reactions to egg white, atopic dermatitis, and sex were analyzed as prognostic markers. Kaplan-Meier survival curves were used to calculate cumulative tolerance probability. Predictor influence and relative prognostic importance were estimated with the Cox proportional regression model.Results: The median time from the appearance of the first symptoms to tolerance was 35 months. Cumulative tolerance probability was 16% at 12 months of follow-up, 28% at 24 months, 52% at 36 months, 57% at 48 months, and 66% at 60 months. The relative weight of prognostic factors, expressed as the hazard ratio, was 50.95 for symptoms and 3.74 for the size of skin prick test reactions, with both being independent effects. The hazard ratio was 1.173 for every 0.1-unit decrease in the concentration log (decimal logarithm) of specific IgE level, with this effect being associated with tolerance only in children with cutaneous symptoms.Conclusions: Half of the children younger than 2 years of age with egg allergy will tolerate the food at 35 months of follow-up, and the proportion could be 66% after 5 years. At that age, the main predictors were the symptoms experienced after egg ingestion, followed by the size of skin prick test reactions. In addition, the specific IgE antibody level is an important prognostic marker in children who only had cutaneous symptoms.