Wensing Marjolein, Penninks André H, Hefle Susan L, Koppelman Stef J, Bruijnzeel-Koomen Carla A F M, Knulst André C
Department of Dermatology/Allergology, University Medical Centre Utrecht, Utrecht, The Netherlands.
J Allergy Clin Immunol. 2002 Dec;110(6):915-20. doi: 10.1067/mai.2002.129235.
Hidden peanut in consumer products can endanger patients with peanut allergy. Individual threshold doses for eliciting allergic reactions need to be elucidated to assess the risks for development of allergic reactions after accidental ingestion of peanut in a population with peanut allergy.
We sought to determine the distribution of individual threshold doses in a population with peanut allergy and to correlate these thresholds to the severity of peanut-induced symptoms.
Twenty-six adult patients with a convincing history of peanut-related symptoms, a specific IgE level of 0.7 kU/L or greater, or a positive skin prick test response of 2+ or greater to peanut were included. These patients underwent double-blind, placebo-controlled food challenges with increasing doses of peanut. A threshold dose could be established when objective or repetitive subjective reactions occurred after active doses.
All patients had subjective oral symptoms (n = 26), prior subjective gastrointestinal symptoms (n = 14), or objective symptoms (n = 5). Reactions started within 30 minutes after ingestion of peanut, but in 2 patients additional symptoms were delayed by 1 to 2 hours. Threshold doses for allergic reactions ranged from a dose as low as 100 microg up to 1 g of peanut protein. Fifty percent of the study population (95% CI, 30%-70%) already had an allergic reaction after ingestion of 3 mg of peanut protein. Patients with severe symptoms had lower threshold doses compared with those of patients with mild symptoms (P =.027).
A substantial part of a population with peanut allergy will react to very low amounts of peanut, requiring accurate declaration of peanut content in consumer products. This is even more important because patients with severe reactions react to lower doses than patients with mild symptoms.
消费品中隐藏的花生可能危及花生过敏患者。需要阐明引发过敏反应的个体阈值剂量，以评估花生过敏人群意外摄入花生后发生过敏反应的风险。
我们试图确定花生过敏人群中个体阈值剂量的分布，并将这些阈值与花生诱发症状的严重程度相关联。
纳入26例有确凿花生相关症状病史、特异性IgE水平为0.7 kU/L或更高、或对花生皮肤点刺试验反应为2+或更高的成年患者。这些患者接受了递增剂量花生的双盲、安慰剂对照食物激发试验。当给予活性剂量后出现客观或重复性主观反应时，可确定阈值剂量。
所有患者均有主观口腔症状（n = 26）、既往主观胃肠道症状（n = 14）或客观症状（n = 5）。摄入花生后30分钟内开始出现反应，但2例患者另有症状延迟1至2小时出现。过敏反应的阈值剂量范围低至100微克花生蛋白至1克。50%的研究人群（95%CI，30%-70%）在摄入3毫克花生蛋白后即出现过敏反应。与症状较轻的患者相比，症状严重的患者阈值剂量更低（P = 0.027）。
很大一部分花生过敏人群对极少量花生就会产生反应，这就要求消费品中准确标明花生含量。这一点尤为重要，因为症状严重的患者比症状较轻的患者对更低剂量的花生就会产生反应。
