Are both early egg introduction and eczema treatment necessary for primary prevention of egg allergy?
Are both early egg introduction and eczema treatment necessary for primary prevention of egg allergy?
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DOI：
10.1016/j.jaci.2018.02.033
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发表时间：
2018-06-01
影响因子：
14.2
通讯作者：
Saito, Hirohisa
中科院分区：
文献类型：
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作者：
Matsumoto, Kenji;Mori, Rintaro;Saito, Hirohisa
早知道花生过敏（LEAP）研究证明，早期引进花生显着防止花生过敏的发展。然而，关于通过早期引入鸡蛋来预防鸡蛋过敏的类似尝试，预防高危婴儿过敏的鸡蛋过敏（PETIT）研究是唯一显示统计学显著效果的随机干预试验。对这些研究的荟萃分析表明，无论是总量还是预处理的鸡蛋在12个月龄时对鸡蛋过敏都没有任何影响。然而，生鸡蛋粉在最初引入时导致过敏反应的患病率显着较高，而使用煮鸡蛋则安全得多。引入鸡蛋时的特应性皮炎/湿疹患病率与最初引入时的过敏反应患病率显著相关。此外，鸡蛋过敏的患病率在后期引进组与异位性皮炎的患病率在引进显着相关，即使异位性皮炎主动治疗局部皮质类固醇软膏。毫无疑问，试验的数量和每个试验的参与者数量不足以得出确切的结论，特别是关于最佳剂量，生与煮，何时开始，以及为谁进行干预。因此，我们建议进行各种研究，以产生更有力的数据和结论。然而，根据最新的研究结果，我们推测，同时干预，早期煮鸡蛋引进和湿疹治疗可能是不可或缺的一级预防鸡蛋过敏。
The Learning Early About Peanut Allergy (LEAP) study proved that early introduction of peanut significantly prevented the development of peanut allergy. However, in regard to similar attempts to prevent egg allergy through early egg introduction, the Prevention of Egg Allergy in High-risk Infants with Eczema (PETIT) study is the only randomized intervention trial to show a statistically significant effect. Meta-analysis of those studies indicated that neither the total amount nor pretreatment of egg showed any effect on egg allergy at the age of 12 months. However, raw egg powder resulted in a significantly higher prevalence of allergic reactions at initial introduction, whereas use of boiled egg was much safer. The prevalence of atopic dermatitis/ eczema at introduction of egg correlated significantly with the subsequent prevalence of allergic reactions at initial introduction. In addition, the prevalence of egg allergy in the late introduction group correlated significantly with the prevalence of atopic dermatitis at introduction, even when the atopic dermatitis was proactively treated with a topical corticosteroid ointment. It is definitely true that the number of trials and number of participants in each trial are insufficient for drawing firm conclusions, especially regarding the optimal dose, raw versus boiled, when to start, and for whom to intervene. Therefore we propose various studies that should be performed to generate stronger data and conclusions. However, on the basis of the most recent results, we postulate that simultaneous intervention by both early boiled egg introduction and eczema treatment is probably indispensable for primary prevention of egg allergy.