Allergic Reactions to Foods in Preschool-Aged Children in a Prospective Observational Food Allergy Study
Allergic Reactions to Foods in Preschool-Aged Children in a Prospective Observational Food Allergy Study
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DOI：
10.1542/peds.2011-1762
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发表时间：
2012-07-01
期刊：
影响因子：
8
通讯作者：
Sicherer, Scott H.
中科院分区：
文献类型：
--
作者：
Fleischer, David M.;Perry, Tamara T.;Sicherer, Scott H.
目的：研究学龄前儿童食物过敏反应的情况。方法：我们对512名3至15个月的婴儿进行了一项前瞻性的5点观察性研究，这些婴儿记录或可能对牛奶或鸡蛋过敏，并收集了前瞻性检查过敏反应的数据。（范围：0-48.4），年反应率为0.81/年（367/512例受试者报告1171例反应[95%置信区间：0.76-0.85]）。总体而言，269/512例（52.5%）报告了>1例反应。大多数反应（71.2%）是由牛奶（495 [42.3%]）、鸡蛋（246 [21.0%]）和花生（93 [7.9%]）引发的，意外暴露归因于无意摄入、标签阅读错误和交叉接触。50.6%的反应是由父母以外的人提供的食物。在834例对牛奶、鸡蛋或花生的反应中，93例（11.2%）归因于有目的地接触这些避免的食物。较高数量的食物过敏（P < .0001）和较高的食物特异性免疫球蛋白E（P < .0001）与反应有关。在11.4%的重度反应（n = 134）中，29.9%接受了肾上腺素治疗。导致治疗不足的因素包括缺乏认识的严重程度，肾上腺素不可用，并担心肾上腺素administration.CONCLUSIONS：有一个高频率的意外和非意外暴露引起的反应。严重的肾上腺素反应治疗不足是一个严重的问题。需要改进的教育领域包括需要持续保持警惕、准确阅读标签阅读、避免非意外暴露、防止交叉污染、适当的肾上腺素给药以及教育所有护理人员。儿科2012;130：e25-e32
OBJECTIVE: To examine circumstances of allergic reactions to foods in a cohort of preschool-aged children.METHODS: We conducted a prospective, 5-site observational study of 512 infants aged 3 to 15 months with documented or likely allergy to milk or egg, and collected data prospectively examining allergic reactions.RESULTS: Over a median follow-up of 36 months (range: 0-48.4), the annualized reaction rate was 0.81 per year (367/512 subjects reporting 1171 reactions [95% confidence interval: 0.76-0.85]). Overall, 269/512 (52.5%) reported >1 reaction. The majority of reactions (71.2%) were triggered by milk (495 [42.3%]), egg (246 [21.0%]), and peanut (93 [7.9%]), with accidental exposures attributed to unintentional ingestion, label-reading errors, and cross-contact. Foods were provided by persons other than parents in 50.6% of reactions. Of 834 reactions to milk, egg, or peanut, 93 (11.2%) were attributed to purposeful exposures to these avoided foods. A higher number of food allergies (P < .0001) and higher food-specific immunoglobulin E (P < .0001) were associated with reactions. Of the 11.4% of reactions (n = 134) that were severe, 29.9% were treated with epinephrine. Factors resulting in undertreatment included lack of recognition of severity, epinephrine being unavailable, and fears about epinephrine administration.CONCLUSIONS: There was a high frequency of reactions caused by accidental and nonaccidental exposures. Undertreatment of severe reactions with epinephrine was a substantial problem. Areas for improved education include the need for constant vigilance, accurate label reading, avoidance of nonaccidental exposure, prevention of cross-contamination, appropriate epinephrine administration, and education of all caretakers. Pediatrics 2012;130:e25-e32