Sicherer Scott H, Sampson Hugh A
Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY, USA.
J Allergy Clin Immunol. 2007 Sep;120(3):491-503; quiz 504-5. doi: 10.1016/j.jaci.2007.07.015. Epub 2007 Aug 8.
Peanut allergy is typically lifelong, often severe, and potentially fatal. Because reactions can occur from small amounts, the allergy presents patients with significant obstacles to avoid allergic reactions. In North America and the United Kingdom, prevalence rates among schoolchildren are now in excess of 1%, framing an increasing public health concern and raising research questions about environmental, immunologic, and genetic factors that may influence outcomes of peanut allergy. This review focuses on recent observations that continue to question the influences of maternal and infant diet on outcomes of peanut allergy, and explore how peanut may be uniquely suited to induce an allergic response. We highlight studies that affect current diagnosis, management, and the nature of advice that can be provided to patients, including the utility of diagnostic tests, doses that elicit reactions, characteristics of reactions from exposure, issues of cross-reactivity, concerns about peanut contamination of manufactured goods, and the natural course of the allergy. Clinical, molecular, and immunologic advances are reviewed, highlighting research discoveries that influence strategies for improved diagnosis, prevention, and treatment. Among the therapeutic strategies reviewed are sublingual and oral immunotherapy, anti-IgE, Chinese herbal medicine, and vaccine strategies.
花生过敏通常是终身性的，往往较为严重，甚至可能致命。由于少量花生即可引发过敏反应，这给患者避免过敏反应带来了巨大障碍。在北美和英国，学龄儿童中的花生过敏患病率现已超过1%，这引发了越来越多的公共卫生问题，并提出了有关可能影响花生过敏结果的环境、免疫和遗传因素的研究问题。本综述聚焦于近期的一些观察结果，这些结果仍在质疑母婴饮食对花生过敏结果的影响，并探讨花生为何可能特别容易引发过敏反应。我们重点介绍了那些影响当前诊断、管理以及可向患者提供的建议性质的研究，包括诊断测试的效用、引发反应的剂量、接触花生后的反应特征、交叉反应问题、对制成品中花生污染的担忧以及过敏的自然病程。本文回顾了临床、分子和免疫学方面的进展，着重介绍了那些影响改进诊断、预防和治疗策略的研究发现。所回顾的治疗策略包括舌下免疫疗法和口服免疫疗法、抗IgE疗法、中药疗法以及疫苗策略。
