Successful oral tolerance induction in severe peanut allergy
Successful oral tolerance induction in severe peanut allergy
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DOI：
10.1111/j.1398-9995.2009.01982.x
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发表时间：
2009-08-01
期刊：
影响因子：
12.4
通讯作者：
Ewan, P. W.
中科院分区：
文献类型：
--
作者：
Clark, A. T.;Islam, S.;Ewan, P. W.
背景：花生过敏很常见，可能很严重，而且很少能解决，导致生活质量受损。目前尚不存在缓解疾病的治疗方法，因此需要制定治疗干预措施。 研究目的：本研究的目的是调查花生口服免疫疗法 (OIT) 是否可以诱导对花生蛋白的临床耐受。 方法：四名花生过敏儿童接受了 OIT。进行干预前口腔挑战以确认临床过敏和脱发。引起反应所需的蛋白质量（剂量阈值）。然后将 OIT 作为每日剂量的花生施用。我们将蛋白质摄入量从 5 毫克增加到 800 毫克，每两周剂量增加一次。再治疗 6 周后，重复口服挑战至 de。剂量阈值发生变化，受试者继续每日治疗。结果：干预前挑战证实了花生过敏，并显示剂量阈值为 5-50 毫克（整个花生的 1/40-1/4）；一名受试者在挑战期间出现过敏反应，需要注射肾上腺素。所有受试者均耐受免疫治疗，剂量增加至 800 毫克蛋白质并肌内注射。不需要肾上腺素。每个受试者在干预后的挑战中耐受至少 10 个完整花生（约 2.38 g 蛋白质），四名受试者的剂量阈值增加至少 48、49、55 和 478 倍。 结论：我们证明，所有受试者（包括已证实有过敏反应的受试者）在 OIT 后剂量阈值均大幅增加。 OIT 具有良好的耐受性，并能针对至少 10 种花生提供保护，这比意外摄入时可能遇到的还要多。
Background: Peanut allergy is common, potentially severe and rarely resolves causing impaired quality of life. No disease-modifying treatment exists and there is therefore a need to develop a therapeutic intervention.Aims of the study: The aim of this study was to investigate whether peanut oral immunotherapy (OIT) can induce clinical tolerance to peanut protein.Methods: Four peanut-allergic children underwent OIT. Preintervention oral challenges were performed to confirm clinical allergy and de. ne the amount of protein required to cause a reaction (dose thresholds). OIT was then administered as daily doses of peanut. our increasing from 5 to 800 mg of protein with 2-weekly dose increases. After 6 further weeks of treatment, the oral challenge was repeated to de. ne change in dose threshold and subjects continued daily treatment.Results: Preintervention challenges confirmed peanut allergy and revealed dose thresholds of 5-50 mg (1/40-1/4 of a whole peanut); one subject had anaphylaxis during challenge and required adrenaline injection. All subjects tolerated immunotherapy updosing to 800 mg protein and i.m. adrenaline was not required. Each subject tolerated at least 10 whole peanuts (approximately 2.38 g protein) in postintervention challenges, an increase in dose threshold of at least 48-, 49-, 55- and 478-fold for the four subjects.Conclusions: We demonstrated a substantial increase in dose threshold after OIT in all subjects, including the subject with proven anaphylaxis. OIT was well tolerated and conferred protection against at least 10 peanuts, more than is likely to be encountered during accidental ingestion.