Ewan P W, Clark A T
Department of Allergy, Addenbrookes NHS Trust, University of Cambridge Clinical School, Cambridge, UK.
Clin Exp Allergy. 2005 Jun;35(6):751-6. doi: 10.1111/j.1365-2222.2005.02266.x.
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.
关于花生/坚果过敏儿童的长期管理，相关数据较少。建议各不相同且往往不充分；再次发生过敏反应很常见。对于急救药物，尤其是肾上腺素的处方标准尚无共识。
在一家三级过敏诊所进行纵向前瞻性病例对照研究。747名确诊为花生或坚果过敏的儿童的患者/家长/学校工作人员接受了关于避免食用坚果的详细口头和书面建议、过敏反应识别及（自我）治疗培训以及一份书面治疗计划。根据我们的标准对坚果过敏的严重程度进行分级（轻度 - 重度）并分配急救药物：所有人都接受口服抗组胺药，对于有气道狭窄反应、低剂量接触时反应较轻或伴有哮喘的患者给予注射用肾上腺素（肾上腺素笔）。在超过25906个患者月（中位数：39个月）的年度随访中，进行了再培训并获取了进一步过敏反应的详细信息（频率、严重程度和治疗情况）。对肾上腺素笔的分配标准进行了评估。
入组前最严重的过敏反应为轻度的占64%，中度/重度（气道狭窄）的占36%。在随访的615名受试者中，21%发生了再次过敏反应（频率降低了八倍），大多为轻度。严重过敏反应的频率降低了60倍。初始反应为中度 - 重度的患者中，99.5%没有或后续反应较轻。初始反应为轻度或重度的儿童均未出现严重的后续反应。只有1/615（0.2%）出现严重的后续反应，只有2/615（0.3%）使用了肾上腺素，且均成功使用，并且根据我们的标准他们备有肾上腺素。对于轻度 - 中度反应，77%仅需口服抗组胺药，15%无需治疗。发生后续反应的儿童在入组前过敏反应更频繁、更严重。
该管理计划大大降低了再次过敏反应的频率和严重程度，对所有儿童均成功有效。在该管理计划背景下，我们关于选择性处方肾上腺素笔的标准是合适的。这是第一项为实践提供依据的研究。
