Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia.
Murdoch Childrens Research Institute, Parkville, Australia; Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Parkville, Australia.
J Allergy Clin Immunol. 2014 Feb;133(2):485-91. doi: 10.1016/j.jaci.2013.11.032. Epub 2013 Dec 25.
There is a paucity of data examining the natural history of and risk factors for egg allergy persistence, the most common IgE-mediated food allergy in infants.
We aimed to assess the natural history of egg allergy and identify clinical predictors for persistent egg allergy in a population-based cohort.
The HealthNuts study is a prospective, population-based cohort study of 5276 infants who underwent skin prick tests to 4 allergens, including egg. Infants with a detectable wheal were offered hospital-based oral food challenges (OFCs) to egg, irrespective of skin prick test wheal sizes. Infants with challenge-confirmed raw egg allergy were offered baked egg OFCs at age 1 year and follow-up at age 2 years, with repeat OFCs to raw egg.
One hundred forty infants with challenge-confirmed egg allergy at age 1 year participated in the follow-up. Egg allergy resolved in 66 (47%) infants (95% CI, 37% to 56%) by 2 years of age; however, resolution was lower in children with baked egg allergy at age 1 year compared with baked egg tolerance (13% and 56%, respectively; adjusted odds ratio, 5.27; 95% CI, 1.36-20.50; P = .02). In the subgroup of infants who were tolerant to baked egg at age 1 year, frequent ingestion of baked egg (≥5 times per month) compared with infrequent ingestion (0-4 times per month) increased the likelihood of tolerance (adjusted odds ratio, 3.52; 95% CI, 1.38-8.98; P = .009). Mutation in the filaggrin gene was not associated with the resolution of either egg allergy or egg sensitization at age 2 years.
Phenotyping of egg allergy (baked egg tolerant vs allergic) should be considered in the management of this allergy because it has prognostic implications and eases dietary restrictions. Randomized controlled trials for egg oral immunotherapy should consider stratifying at baseline by the baked egg subphenotype to account for the differential rate of tolerance development.
目前有关鸡蛋过敏持续性的自然病史和危险因素的数据较少，而鸡蛋过敏是婴儿最常见的 IgE 介导的食物过敏。
我们旨在评估人群队列中鸡蛋过敏的自然病史，并确定持续性鸡蛋过敏的临床预测因素。
HealthNuts 研究是一项针对 5276 名婴儿的前瞻性、基于人群的队列研究，这些婴儿接受了 4 种过敏原（包括鸡蛋）的皮肤点刺试验。对于有可检测到的风团的婴儿，无论皮肤点刺试验的风团大小如何，均提供医院进行鸡蛋的口服食物挑战（OFC）。在 1 岁时对经挑战确认的生鸡蛋过敏的婴儿进行烤鸡蛋 OFC，并在 2 岁时进行随访，同时重复进行生鸡蛋的 OFC。
在 1 岁时经挑战确认鸡蛋过敏的 140 名婴儿参加了随访。到 2 岁时，有 66 名（47%）婴儿（95%CI，37%至 56%）鸡蛋过敏得到缓解；然而，与 1 岁时烤鸡蛋耐受的儿童相比，烤鸡蛋过敏的儿童的缓解率较低（分别为 13%和 56%；调整后的优势比，5.27；95%CI，1.36-20.50；P=.02）。在 1 岁时烤鸡蛋耐受的婴儿亚组中，与偶尔摄入（每月 0-4 次）相比，频繁摄入烤鸡蛋（每月≥5 次）增加了耐受的可能性（调整后的优势比，3.52；95%CI，1.38-8.98；P=.009）。在 2 岁时，丝聚蛋白基因突变与鸡蛋过敏或鸡蛋致敏的缓解均无关。
应考虑鸡蛋过敏的表型（烤鸡蛋耐受与过敏）在这种过敏的管理中，因为它具有预后意义并减轻饮食限制。对于鸡蛋口服免疫治疗的随机对照试验，应考虑在基线时根据烤鸡蛋亚表型进行分层，以考虑到不同的耐受发展率。
