Clinical features of acute allergic reactions to peanut and tree nuts in children
Clinical features of acute allergic reactions to peanut and tree nuts in children
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DOI：
10.1542/peds.102.1.e6
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发表时间：
1998-07-01
期刊：
影响因子：
8
通讯作者：
Sampson, HA
中科院分区：
文献类型：
--
作者：
Sicherer, SH;Burks, AW;Sampson, HA
背景花生（PN）和树坚果（TN）过敏有可能危及生命，很少长大，而且似乎正在增加患病率。然而，关于这些食物的急性反应的临床特征及其潜在联系的报道相对较少。描述对PN和TN有至少一次急性过敏反应史的儿童在最初和随后意外摄入PN和TN期间急性反应的临床特征。对有令人信服的PN急性反应史（摄入后60分钟内至少累及一个器官系统）或结果的患者进行问卷调查、检查和特异性IgE抗体血清学检测。共有122例患者（63%为男性;研究时中位年龄为8岁）发生急性反应; 68例仅对FN发生反应，20例仅对TN发生反应，34例对PN和TN均发生反应。在那些对TN有反应的人中，34人对一种、12到两种、8到三种或更多种不同的TN有反应，最常见的是核桃、杏仁和山核桃。初始反应通常发生在家中（中位年龄，PN为24个月，TN为62个月），72%的病例被认为是首次暴露所致。89%的反应涉及皮肤（荨麻疹、血管性水肿），52%涉及呼吸道（喘息、咽喉发紧、反复咳嗽、呼吸困难），32%涉及胃肠道（呕吐、腹泻）。在31%的初始反应中，两个器官系统受到影响，在21%的反应中，所有三个器官系统都受到影响。190例对PN或TN的首次反应中有38例接受了肾上腺素治疗。在5.5年的中位时间内，55%的PN过敏儿童发生意外误食（平均每位患者发生两次意外误食），30%的TN过敏儿童发生意外误食。平均而言，意外接触后的症状与初次接触时的症状大致相似。事故通常发生在学校，但也发生在家里和餐馆。意外摄入的模式包括分享食物，隐藏的成分，交叉污染和使用花生酱的学校工艺项目。83%的儿童接受母乳喂养，90%以上的母亲在哺乳期接受PN和至少一次TN。在报告无暴露史的患者中（每种TN>60%的患者），在50%至82%的患者中发现特定TN的IgE抗体，在100%的患者中发现PN的IgE抗体。PN的急性过敏反应发生在生命早期。PN和TN过敏反应在三分之一的PN过敏患者中共存，经常发生在首次已知暴露时，可能危及生命，需要紧急治疗。意外性脑出血很常见，经常发生在家庭之外，通常需要紧急治疗。因此，早期诊断，其次是教育的避免和治疗措施（包括自我管理肾上腺素）是必要的。
Background. Peanut (PN) and tree nut (TN) allergies are potentially life-threatening, rarely outgrown, and appear to be increasing in prevalence. However, there is relatively little reported about the clinical features of acute reactions to these foods and their potential association.Objective. To describe the clinical features of acute reactions during initial and subsequent accidental ingestions of PN and TN among children with a history of at least one acute allergic reaction to these foods.Design. Questionnaire survey, examination, and serologic testing for specific IgE antibody of patients with convincing histories of acute reactions (at least one organ system involved within 60 minutes of ingestion) to PN orResults. A total of 122 patients (63% males; median age, 8 years at time of study) had acute reactions; 68 had reactions only to FN, 20 only to TN, and 34 to both PN and TN. Of those reacting to TN, 34 had reactions to one, 12 to two, and 8 to three or more different TN, the most common being walnut, almond, and pecan. Initial reactions usually occurred at home (median age, 24 months for PN and 62 months for TN) and were considered to result from a first exposure in 72% of cases. Eighty-nine percent of the reactions involved the skin (urticaria, angioedema), 52% the respiratory tract (wheezing, throat tightness, repetitive coughing, dyspnea), and 32% the gastrointestinal tract (vomiting, diarrhea). Two organ systems were affected in 31% of initial reactions, and all three in 21% of reactions. Thirty-eight of 190 first reactions to PN or TN were treated with epinephrine. Accidental ingestions occurred in 55% of PN-allergic children (average of two accidents per patient with an accidental ingestion) and in 30% of TN-allergic children over a median period of 5.5 years. On average symptoms after accidental exposure were generally similar to those at initial exposure. Accidents occurred commonly in school but also at home and in restaurants. Modes of accidental ingestion included sharing food, hidden ingredients, cross-contamination, and school craft projects using peanut butter. Eighty-three percent of the children were breastfed, with >90% of the mothers ingesting PN and at least one TN during lactation. Among patients reporting no history of exposure (>60% of patients for each TN), IgE antibodies were found to a particular TN in 50% to 82% of patients and to PN in 100% of patients.Conclusions. Acute allergic reactions to PN occur early in life. PN and TN allergic reactions coexist in one third of PN-allergic patients, frequently occur on first known exposure, and may be life-threatening, requiring emergency treatment. Accidental ingestions are common, occur frequently outside of the home, and often require emergency treatment. Consequently, early diagnosis followed by education on avoidance and treatment measures (including self-administered epinephrine) is imperative.