The natural history of peanut allergy
The natural history of peanut allergy
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DOI：
10.1067/mai.2001.112129
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发表时间：
2001-02-01
影响因子：
14.2
通讯作者：
Wood, RA
中科院分区：
文献类型：
--
作者：
Skolnick, HS;Conover-Walker, MK;Wood, RA
背景资料：传统上认为，花生过敏是很少outgrowth.Objective：本研究的目标是确定花生过敏的儿童谁成为宽容peanut.Methods：年龄在4至20岁的诊断花生过敏的患者的数量进行了评估问卷，皮肤测试，和定量抗体荧光酶免疫分析。在过去一年中无反应且花生IgE（PN-IgE）水平低于20 kU（A）/L的患者接受开放或双盲、安慰剂对照的花生激发试验。共评估了223名患者，其中85名（PN-IgE < 0.35-20.4 kU（A）/L [中位数1.42 kU（A）/L]）参与了口服花生激发。48例（21.5%）患者的激发试验结果为阴性，并认为其花生过敏症已不再存在（年龄4-17.5岁[中位数6岁]; PN-IgE < 0.35-20.4 kU（A）/L [中位数0.69 kU（A）/L]）。37例挑战失败（年龄4-13岁[中位数6.5岁]; RAST < 0.35-18.2 kU（A）/L [中位数2.06 kU（A）/L]）。41例PN-IgE水平低于20 kU（A）/L的患者拒绝接受激发，97例因PN-IgE水平高于20 kU（A）/L或近期有反应而不符合激发条件。PN-IgE水平低于2 kU（A）/L和低于5 kU（A）/L的患者中，67%和61%的患者攻毒结果为阴性。那些谁接受了挑战，PN-IgE水平为那些谁通过与那些谁失败的挑战时有所不同（P = 0.009），但不是在诊断时（P = 0.25）。结论：这项研究表明，花生过敏是在约21.5%的患者中长大。PN-IgE水平低的患者应该在医疗环境中接受花生挑战，以证明他们现在是否可以耐受花生。
Background: It has traditionally been assumed that peanut allergy is rarely outgrown.Objective: The goal of this study was to determine the number of children with peanut allergy who become tolerant of peanut.Methods: Patients aged 4 to 20 years with a diagnosis of peanut allergy were evaluated by questionnaire, skin testing, and a quantitative antibody fluorescent-enzyme immunoassay. Patients who had been reaction free in the past year and had a peanut IgE (PN-IgE) level less than 20 kilounits of antibody per liter (kU(A)/L) were offered an open or double-blind, placebo-controlled peanut challenge.Results: A total of 223 patients were evaluated, and of those, 85 (PN-IgE < 0.35-20.4 kU(A)/L [median 1.42 kU(A)/L]) participated in an oral peanut challenge. Forty-eight (21.5%) patients had negative challenge results and were believed to have outgrown their peanut allergy (aged 4-17.5 years [median 6 years]; PN-IgE < 0.35-20.4 kU(A)/L [median 0.69 kU(A)/L]). Thirty-seven failed the challenge (aged 4-13 years [median 6.5 years]; RAST < 0.35-18.2 kU(A)/L [median 2.06 kU(A)/L]). Forty-one patients with PN-IgE levels less than 20 kU(A)/L declined to undergo challenge, and 97 were not eligible for challenge because their PN-IgE levels were greater than 20 kU(A)/L or they had had a recent reaction. Sixty-seven percent of patients with PN-IgE levels less than 2 kU(A)/L and 61% with levels less than 5 kU(A)/L had negative challenge results. Of those who underwent challenge, PN-IgE levels for those who passed versus those who failed were different at the time of challenge (P = .009), but not at the time of diagnosis (P = .25).Conclusion: This study demonstrates that peanut allergy is outgrown in about 21.5% of patients. Patients with low PN-IgE levels should be offered a peanut challenge in a medical setting to demonstrate whether they can now tolerate peanuts.