Shreffler Wayne G, Radano Marcella
Food Allergy Center, Divisions of Allergy and Gastroenterology, Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Nestle Nutr Workshop Ser Pediatr Program. 2011;68:141-9; discussion 150-2. doi: 10.1159/000325780. Epub 2011 Oct 3.
The relationship between complementary feeding and the development of atopic disease is the source of significant interest and debate in both the scientific and lay communities. A small number of early studies, which had considerable influence on recommended feeding practices, reported protective effects associated with delaying the introduction of commonly allergenic foods such as cow's milk, egg, and nuts. Despite more conservative recommendations, however, food allergy prevalence has continued to rise. Our understanding of the development of food allergy, its relationship with IgE sensitization and atopic dermatitis, and the relationship of each of these outcomes with the timing of food introduction has evolved considerably. Based on multiple observational studies, and extrapolating from immunotherapy trials and animal models of mucosal immunity, there is mounting evidence that delayed introduction or avoidance of commonly allergenic foods is at best neutral and may be detrimental with regard to atopic outcomes. There is an obvious and critical need for additional high-caliber studies to further evaluate this connection. In the meantime, multiple health considerations, not allergy alone, should be involved in decisions regarding nutritional intake, including common allergenic foods, during the period of transition to the family diet.
辅食添加与过敏性疾病发展之间的关系，是科学界和普通大众都极为关注且存在争议的话题。少数早期研究对推荐的喂养方式产生了相当大的影响，这些研究报告称，推迟引入常见的致敏性食物（如牛奶、鸡蛋和坚果）具有保护作用。然而，尽管有更为保守的建议，食物过敏的患病率仍在持续上升。我们对食物过敏的发展过程、其与IgE致敏及特应性皮炎的关系，以及这些结果中的每一个与食物引入时间的关系的理解，已经有了很大的进展。基于多项观察性研究，并从免疫疗法试验和黏膜免疫动物模型进行推断，越来越多的证据表明，推迟引入或避免常见的致敏性食物，充其量是中性的，而且可能对过敏性疾病的结局有害。显然迫切需要更多高质量的研究来进一步评估这种关联。与此同时，在向家庭饮食过渡期间，决定营养摄入（包括常见的致敏性食物）时，应考虑多种健康因素，而不仅仅是过敏问题。
