Efficacy of a management plan based on severity assessment in longitudinal and case-controlled studies of 747 children with nut allergy: proposal for good practice
Efficacy of a management plan based on severity assessment in longitudinal and case-controlled studies of 747 children with nut allergy: proposal for good practice
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DOI：
10.1111/j.1365-2222.2005.02266.x
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发表时间：
2005-06-01
影响因子：
6.1
通讯作者：
Clark, AT
中科院分区：
文献类型：
--
作者：
Ewan, PW;Clark, AT
关于花生/坚果过敏儿童的长期管理的数据很少。建议多种多样，而且往往不够充分；进一步的反应很常见。对于急救药物（特别是肾上腺素）的处方标准尚未达成共识。三级过敏诊所的纵向前瞻性病例对照研究。 747 名确诊花生或坚果过敏的儿童的患者/家长/学校工作人员收到了关于避免食用坚果的详细口头和书面建议、识别和（自我）反应治疗培训以及书面治疗计划。对坚果过敏的严重程度进行分级（轻度-重度），并根据我们的标准分配紧急药物：所有患者均接受口服抗组胺药，对气道狭窄反应、低剂量暴露反应较轻或伴有哮喘的患者注射肾上腺素（EpiPen）。在超过 25 906 患者月（中位数：39 个月）的年度随访中，进行了再培训，并获得了进一步反应的详细信息（频率、严重程度和治疗）。对 EpiPen 的分配标准进行了评估。入组前最严重的反应为轻度（64%），中度/重度（36%）（气道狭窄）。在 615 名接受随访的受试者中，21% 的人出现了进一步的反应（频率减少了八倍），大部分是轻微的。严重反应的频率减少了 60 倍。在初始反应为中度至重度的患者中，99.5% 的患者没有出现或出现较轻的后续反应。患有轻度或重度指数反应的儿童均未出现严重的后续反应。只有 1/615 (0.2%) 的患者出现严重的后续反应，只有 2/615 (0.3%) 的患者使用了肾上腺素，既成功又符合我们的标准。在轻度至中度反应中，77% 需要单独口服抗组胺药，15% 不需要治疗。有后续反应的儿童在入组前反应更加频繁和严重。该管理计划大大降低了进一步反应的频率和严重程度，并且对所有儿童都是成功的。我们在该管理计划中选择性开具 EpiPen 处方的标准是适当的。这是第一项为实践提供证据的研究。
There are few data on the long-term management of children with peanut/nut allergy. Advice is variable and often inadequate; further reactions are common. There is no consensus on the criteria for prescription of rescue medication, particularly adrenaline.A longitudinal prospective and case-control study in a tertiary allergy clinic. Patients/parents/school staff of 747 children with confirmed peanut or tree nut allergy received detailed verbal and written advice on nut avoidance, training in recognition and (self-) treatment of reactions and a written treatment plan. The severity of nut allergy was graded (mild-severe) and emergency medication was allocated according to our criteria: all received oral antihistamines, injected adrenaline (EpiPen) was given to those with reactions with airway narrowing, milder reactions to low-dose exposure or concomitant asthma. At annual follow-up over 25 906 patient-months (median: 39 months) retraining was given and details of further reactions (frequency, severity and treatment) were obtained. Criteria for allocation of EpiPen were evaluated.The worst reaction pre-enrolment was mild in 64% and moderate/severe in 36% (airway narrowing). Of 615 subjects followed up, 21% had a further reaction (eightfold reduction in frequency), mostly mild. There was a 60-fold reduction in the frequency of severe reactions. Of those with a moderate-severe initial reaction, 99.5% had no or a less severe follow-up reaction. No child with a mild or severe index reaction had a severe follow-up reaction. Only 1/615 (0.2%) had a severe follow-up reaction and only 2/615 (0.3%) used adrenaline, both successfully and had it available according to our criteria. Of mild-moderate reactions, 77% required oral antihistamines alone and 15% no treatment. Children who had follow-up reactions had more frequent and severe reactions pre-enrolment.The management plan greatly reduced the frequency and severity of further reactions and was successful for all children. Our criteria for selective prescription of EpiPen in the context of this management plan were appropriate. This is the first study to provide evidence on which to inform practice.