Analysis of Oral Food Challenge Outcomes in IgE-Mediated Food Allergies to Almond in a Large Cohort.
Analysis of Oral Food Challenge Outcomes in IgE-Mediated Food Allergies to Almond in a Large Cohort.
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大型队列中 IgE 介导的杏仁食物过敏的口服食物挑战结果分析。
DOI：
10.1016/j.jaip.2019.03.049
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Hesterberg,PaulE
中科院分区：
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作者：
Virkud,YaminiV;Chen,Yih-Chieh;Stieb,ElisabethS;Alejos,AlexandraR;Renton,Nicholas;Shreffler,WayneG;Hesterberg,PaulE
虽然杏仁特异性IgE介导的食物过敏传统上被等同于其他坚果过敏，但口服食物刺激杏仁的结果以及临床检测预测IgE介导的杏仁超敏反应的有效性尚不清楚。目的描述杏仁口服刺激的结果，并评估临床测试的预测价值。方法从马萨诸塞州综合医院过敏实践中分析了590名1~66岁的患者进行的603例杏仁刺激。使用Niggemann和Beyer过敏反应分级系统和Sampson 2006国家过敏和传染病研究所过敏反应定义对反应进行分级。结果杏仁挑战包括545次通过(92%)，15次(3%)不确定，30次(5%)失败，而其他食品的失败次数为31%。大多数反应轻微，21例(4%)出现2/3级过敏症状，3例(0.5%)出现过敏反应。杏仁特异性IgE水平中位数为0.89kU/L(范围0.35~100kU/L)，皮肤点刺试验风团直径中位数为4.0 mm(范围0~28 mm)，475例受试者(81%)对杏仁致敏。失败与较高的杏仁特异性IgE水平(P<；.001)、较大的杏仁皮肤点刺试验风团直径(P=.001)、较高的花生IgE水平(P=.003)以及有杏仁反应史(P<；.029)有关。通过受试者操作特征分析(曲线下面积为0.83)，杏仁特异性IgE水平、杏仁皮肤点刺试验风团直径和激发时年龄相结合对2/3级过敏反应具有良好的预测价值。结论与其他过敏原相比，杏仁刺激失败的比例(5%)较低，提示某些杏仁刺激可以安全地进行，患者与工作人员的比例较高，或可能在家中引入。虽然反应通常不常见且轻微，但杏仁高度致敏也可能出现过敏反应。
BackgroundAlthough almond specific IgE–mediated food allergies have traditionally been equated with other tree nut allergies, outcomes of oral food challenges to almond and the utility of clinical testing to predict IgE-mediated almond hypersensitivity are not well known.ObjectiveTo describe almond oral challenge outcomes and assess the predictive value of clinical testing.MethodsA total of 603 almond challenges performed for 590 patients, aged 1 to 66 years, were analyzed from Massachusetts General Hospital allergy practices. Reactions were graded using the Niggemann and Beyer allergic reaction grading system and the Sampson 2006 National Institute of Allergy and Infectious Diseases anaphylaxis definition.ResultsAlmond challenges included 545 passes (92%), 15 (3%) indeterminates, and 30 (5%) failures, in contrast with 31% challenge failures for other foods. Most reactions were mild; 21 (4%) had grade 2/3 allergic symptoms, and 3 (0.5%) had anaphylaxis. Median almond specific IgE level was 0.89 kU/L (range, <0.35 to >100 kU/L), median skin prick test wheal diameter was 4.0 mm (range, 0-28 mm), and 475 subjects (81%) were sensitized to almond. Failure was associated with higher almond specific IgE level (P< .001), larger almond skin prick test wheal diameter (P= .001), higher peanut IgE level (P= .003), and a history of almond reaction (P< .029). Almond specific IgE level, almond skin prick test wheal diameter, and age at challenge combined demonstrated good predictive value for grade 2/3 allergic reactions by receiver-operating characteristic analysis (area under the curve, 0.83).ConclusionsThe proportion of failed almond challenges (5%) was low in contrast with other allergens, suggesting that some almond challenges may be safely conducted with higher patient-to-staff ratios or potentially introduced at home. Although reactions are usually uncommon and mild, anaphylaxis is possible with high almond sensitization.