IgE-Mediated Food Allergy
IgE-Mediated Food Allergy
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DOI：
10.1007/s12016-018-8710-3
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发表时间：
2019-10-01
影响因子：
9.1
通讯作者：
Davis, Carla M.
中科院分区：
文献类型：
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作者：
Anvari, Sara;Miller, Jennifer;Davis, Carla M.
食物过敏被定义为对食物蛋白质的不良免疫反应，导致典型的临床症状，包括皮肤、呼吸、胃肠道、心血管和/或神经系统。IgE介导的食物过敏性疾病不同于非IgE介导的疾病，因为其病理生理是由免疫系统的激活引起的，引起T辅助2反应，导致IgE与肥大细胞和嗜碱性细胞等效应细胞上的F-c epsilon受体结合。这些细胞的激活导致组胺和其他预先形成的介质的释放，并迅速出现症状，与非ige介导的食物过敏相比，后者的发病时间更晚。诊断IgE介导的食物过敏需要有典型的临床症状史，并通过皮肤针刺或血清特异性IgE检测证明存在食物特异性IgE。ige介导的食物过敏症状从轻微到严重不等。症状的严重程度不能通过特异性IgE水平或皮肤试验轮大小来预测，但症状发作的可能性直接相关。当患者可摄入可疑食物而无临床症状，且如果血清或皮肤测试的食物特异性IgE检测呈阴性或低，则可能需要进行门诊口服食物挑战，则排除诊断。过敏反应是ige介导的食物过敏最严重的临床表现形式，注射肾上腺素是一线治疗方法。食物过敏的管理需要严格的避免措施，咨询家人保持警惕，并及时使用紧急药物治疗过敏反应。最近的指导方针已经改变，包括在4-6个月大的时候早期引入花生。建议尽早引入，以防止花生过敏的发展。在临床试验中评估的未来治疗ige介导的食物过敏的方法包括表皮免疫疗法、舌下免疫疗法和口服免疫疗法。
Food allergies are defined as adverse immune responses to food proteins that result in typical clinical symptoms involving the dermatologic, respiratory, gastrointestinal, cardiovascular, and/or neurologic systems. IgE-mediated food-allergic disease differs from non-IgE-mediated disease because the pathophysiology results from activation of the immune system, causing a T helper 2 response which results in IgE binding to F-c epsilon receptors on effector cells like mast cells and basophils. The activation of these cells causes release of histamine and other preformed mediators, and rapid symptom onset, in contrast with non-IgE-mediated food allergy which is more delayed in onset. The diagnosis of IgE-mediated food allergy requires a history of classic clinical symptoms and evidence of food-specific IgE by either skin-prick or serum-specific IgE testing. Symptoms of IgE-mediated food allergies range from mild to severe. The severity of symptoms is not predicted by the level of specific IgE or skin test wheal size, but the likelihood of symptom onset is directly related. Diagnosis is excluded when a patient can ingest the suspected food without clinical symptoms and may require an in-office oral food challenge if testing for food-specific IgE by serum or skin testing is negative or low. Anaphylaxis is the most severe form of the clinical manifestation of IgE-mediated food allergy, and injectable epinephrine is the first-line treatment. Management of food allergies requires strict avoidance measures, counseling of the family about constant vigilance, and prompt treatment of allergic reactions with emergency medications. Guidelines have changed recently to include early introduction of peanuts at 4-6 months of life. Early introduction is recommended to prevent the development of peanut allergy. Future treatments for IgE-mediated food allergy evaluated in clinical trials include epicutaneous, sublingual, and oral immunotherapy.