Martin P E, Eckert J K, Koplin J J, Lowe A J, Gurrin L C, Dharmage S C, Vuillermin P, Tang M L K, Ponsonby A-L, Matheson M, Hill D J, Allen K J
Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Vic., Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.
Clin Exp Allergy. 2015 Jan;45(1):255-64. doi: 10.1111/cea.12406.
The relationship between early onset eczema and food allergy among infants has never been examined in a population-based sample using the gold standard for diagnosis, oral food challenge.
We characterised the risk of challenge-proven food allergy among infants with eczema in the general population.
One-year-old infants (n = 4453 meeting criteria for this analysis) were assessed for history of eczema, received a nurse-administered eczema examination and underwent skin prick testing to peanut, egg and sesame. Those with a detectable wheal to one of the test foods underwent an oral food challenge irrespective of wheal size. The risk of food allergy, stratified by eczema severity and age of onset, was estimated using multivariate logistic regression with population sampling weights.
One in five infants with eczema were allergic to peanut, egg white or sesame, compared to one in twenty-five infants without eczema (OR 6.2, 95% CI 4.9, 7.9, P < 0.001). The prevalence of peanut allergy was low in the absence of eczema (0.7% 95% CI 0.4, 1.1). Infants with eczema were 11.0 times more likely to develop peanut allergy (95% CI 6.6, 18.6) and 5.8 times more likely to develop egg allergy (95% CI 4.6, 7.4) by 12 months than infants without eczema. 50.8% of infants (95% CI 42.8, 58.9) with early eczema onset (<3 months) who required doctor-prescribed topical corticosteroid treatment developed challenge-proven food allergy.
Eczema, across the clinical severity spectrum in infancy, is a strong risk factor for IgE-mediated food allergy. Infants with eczema were six times more likely to have egg allergy and 11 times more likely to have peanut allergy by 12 months than infants without eczema. Our data suggest that a heightened awareness of food allergy risk among healthcare practitioners treating infants with eczema, especially if early onset and severe, is warranted.
在以人群为基础的样本中，从未使用诊断的金标准——口服食物激发试验来研究婴儿期早发性湿疹与食物过敏之间的关系。
我们对普通人群中患有湿疹的婴儿经激发试验证实的食物过敏风险进行了特征描述。
对1岁婴儿（n = 4453，符合本分析标准）进行湿疹病史评估，接受护士进行的湿疹检查，并对花生、鸡蛋和芝麻进行皮肤点刺试验。对其中一种试验食物出现可检测到的风团的婴儿，无论风团大小，均进行口服食物激发试验。使用多因素逻辑回归和人群抽样权重，估计按湿疹严重程度和发病年龄分层的食物过敏风险。
五分之一的湿疹婴儿对花生、蛋清或芝麻过敏，而无湿疹的婴儿中这一比例为二十五分之一（比值比6.2，95%置信区间4.9，7.9，P < 0.001）。在无湿疹的情况下，花生过敏的患病率较低（0.7%，95%置信区间0.4，1.1）。到12个月时，患有湿疹的婴儿发生花生过敏的可能性比无湿疹的婴儿高11.0倍（95%置信区间6.6，18.6），发生鸡蛋过敏的可能性高5.8倍（95%置信区间4.6，7.4）。在需要医生开具外用皮质类固醇治疗的早发性湿疹（<3个月）婴儿中，50.8%（95%置信区间42.8，58.9）经激发试验证实发生了食物过敏。
婴儿期不同临床严重程度的湿疹是IgE介导的食物过敏的一个重要危险因素。到12个月时，患有湿疹的婴儿发生鸡蛋过敏的可能性比无湿疹的婴儿高6倍，发生花生过敏的可能性高11倍。我们的数据表明，对于治疗患有湿疹的婴儿的医护人员，尤其是对于早发性和严重湿疹的婴儿，有必要提高对食物过敏风险的认识。
