Sicherer Scott H, Leung Donald Y M
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. 2009 Feb;123(2):319-27. doi: 10.1016/j.jaci.2008.12.025.
This review highlights some of the research advances in anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects and in allergic skin disease that were reported in the Journal in 2008. Key epidemiologic observations include a rise in anaphylaxis in a population-based study and lower rates of peanut allergy in Israel, where infants consume peanut early compared with the United Kingdom, where dietary introduction is generally delayed. Advances in food allergy diagnosis include IgE epitope mapping that discloses the likelihood and severity of allergy; studies correlating likelihood of clinical reactivity on the basis of food-specific IgE to sesame, peanut, milk, and tree nuts; and an observation that a low baseline angiotensin-converting enzyme level may be associated with having pharyngeal edema during a reaction. Molecular, immunologic, and genetic studies are discerning pathways that are key in development of food allergy, identifying new modalities to interrupt mast cell degranulation, and elucidating risks associated with penicillin allergy. Regarding treatment, clinical studies show a majority of children with milk and egg allergy tolerate these proteins in modest amounts when they are extensively heated in baked goods, and studies show promise for oral immunotherapy to treat milk allergy and sublingual immunotherapy for honey bee venom hypersensitivity. The importance of skin barrier dysfunction has continued to be highlighted in the pathophysiology of atopic dermatitis (AD). Research has also continued to identify immunologic defects that contribute to the propensity of patients with AD to develop viral and bacterial infection. New therapeutic approaches to AD, urticaria, and angioedema have been reported including use of probiotics, biologics, vitamin D, and skin barrier creams.
本综述重点介绍了2008年发表在该杂志上的关于过敏反应、对食物、药物和昆虫的超敏反应以及过敏性皮肤病的一些研究进展。主要的流行病学观察结果包括：一项基于人群的研究中过敏反应有所增加；在以色列，婴儿早期食用花生，花生过敏率较低，而在英国，饮食引入通常较晚，花生过敏率较高。食物过敏诊断方面的进展包括：IgE表位图谱分析揭示了过敏的可能性和严重程度；基于食物特异性IgE与芝麻、花生、牛奶和坚果的临床反应可能性的研究；以及一项观察结果，即基线血管紧张素转换酶水平较低可能与反应期间出现咽部水肿有关。分子、免疫和遗传学研究正在识别食物过敏发展过程中的关键途径，确定中断肥大细胞脱颗粒的新方法，并阐明与青霉素过敏相关的风险。在治疗方面，临床研究表明，大多数牛奶和鸡蛋过敏的儿童在烘焙食品中大量加热这些蛋白质后能够耐受；研究显示口服免疫疗法治疗牛奶过敏和舌下免疫疗法治疗蜜蜂毒液超敏反应具有前景。皮肤屏障功能障碍在特应性皮炎（AD）的病理生理学中的重要性一直备受关注。研究还在继续确定导致AD患者易发生病毒和细菌感染的免疫缺陷。已报道了针对AD、荨麻疹和血管性水肿的新治疗方法，包括使用益生菌、生物制剂、维生素D和皮肤屏障乳膏。
