Department of Pediatrics, Paul Foster School of Medicine, El Paso, TX, USA.
Allergy Asthma Proc. 2013 May-Jun;34(3):205-9. doi: 10.2500/aap.2013.34.3666.
Oral immunotherapy (OIT) for peanut allergy is ready for clinical allergy practice. Some physicians, particularly at academic centers, believe that OIT is not ready for clinical practice. The shortcomings of the present general recommendations of food avoidance and provision of epinephrine autoinjectors for a select number of patients demand a different approach. In peanut-allergic patients, the rate of accidental reactions is ~10% annually. Between 1 and 2% of these reactions require epinephrine or emergency department visits. Food allergy and peanut allergy, specifically, have a large negative impact on the quality of life (QOL) for patients and their families, which can be psychosocially debilitating. These decreases in health-related QOL continue into adulthood. There is only an ~20% chance of spontaneous remission in peanut allergy. Given this climate, three private allergy practices have begun providing OIT to 150 patients with peanut anaphylaxis. One hundred eleven (74%) patients were able to tolerate eight peanuts (8 g, ~2 g of protein). During outpatient dosing, epinephrine was used at a rate of 8 per 10,000 doses. To date, there have been no long-term (>24-36 months) unexpected reactions. OIT decreases risk and in one study, conducted in a practice setting, it was shown to improve QOL. OIT is a meaningful clinical procedure that can help our patients.
口服免疫疗法 (OIT) 治疗花生过敏已准备好用于临床过敏实践。一些医生，特别是在学术中心，认为 OIT 尚未准备好用于临床实践。目前普遍建议避免食用食物和为少数患者提供肾上腺素自动注射器的方法存在缺陷，需要采取不同的方法。在花生过敏患者中，每年意外反应的发生率约为 10%。这些反应中，有 1%至 2%需要使用肾上腺素或去急诊室就诊。食物过敏和花生过敏，特别是对患者及其家人的生活质量 (QOL) 有很大的负面影响，可能会造成心理社会障碍。这些健康相关 QOL 的下降会持续到成年期。花生过敏自发缓解的几率只有约 20%。鉴于这种情况，三家私人过敏诊所开始为 150 名花生过敏患者提供 OIT。111 名（74%）患者能够耐受八颗花生（8 克，约 2 克蛋白质）。在门诊剂量给药期间，肾上腺素的使用频率为每 10,000 剂 8 次。迄今为止，尚无长期（>24-36 个月）意外反应。OIT 降低了风险，在一项在实践环境中进行的研究中，它被证明可以改善 QOL。OIT 是一种有意义的临床程序，可以帮助我们的患者。
