Santos Alexandra F, Du Toit George, Douiri Abdel, Radulovic Suzana, Stephens Alick, Turcanu Victor, Lack Gideon
Department of Pediatric Allergy, Division of Asthma, Allergy & Lung Biology, King's College London, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom; Immunoallergology Department, Coimbra University Hospital, Coimbra, Portugal; Gulbenkian Programme for Advanced Medical Education, Lisbon, Portugal.
Department of Pediatric Allergy, Division of Asthma, Allergy & Lung Biology, King's College London, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.
J Allergy Clin Immunol. 2015 Jan;135(1):179-86. doi: 10.1016/j.jaci.2014.09.001.
The management of peanut allergy relies on allergen avoidance and epinephrine autoinjector for rescue treatment in patients at risk of anaphylaxis. Biomarkers of severity and threshold of allergic reactions to peanut could significantly improve the care for patients with peanut allergy.
We sought to assess the utility of the basophil activation test (BAT) to predict the severity and threshold of reactivity to peanut during oral food challenges (OFCs).
The severity of the allergic reaction and the threshold dose during OFCs to peanut were determined. Skin prick tests, measurements of specific IgE to peanut and its components, and BATs to peanut were performed on the day of the challenge.
Of the 124 children submitted to OFCs to peanut, 52 (median age, 5 years) reacted with clinical symptoms that ranged from mild oral symptoms to anaphylaxis. Severe reactions occurred in 41% of cases, and 57% reacted to 0.1 g or less of peanut protein. The ratio of the percentage of CD63(+) basophils after stimulation with peanut and after stimulation with anti-IgE (CD63 peanut/anti-IgE) was independently associated with severity (P = .001), whereas the basophil allergen threshold sensitivity CD-sens (1/EC₅₀ × 100, where EC₅₀ is half maximal effective concentration) value was independently associated with the threshold (P = .020) of allergic reactions to peanut during OFCs. Patients with CD63 peanut/anti-IgE levels of 1.3 or greater had an increased risk of severe reactions (relative risk, 3.4; 95% CI, 1.8-6.2). Patients with a CD-sens value of 84 or greater had an increased risk of reacting to 0.1 g or less of peanut protein (relative risk, 1.9; 95% CI, 1.3-2.8).
Basophil reactivity is associated with severity and basophil sensitivity is associated with the threshold of allergic reactions to peanut. CD63 peanut/anti-IgE and CD-sens values can be used to estimate the severity and threshold of allergic reactions during OFCs.
花生过敏的管理依赖于避免接触过敏原以及使用肾上腺素自动注射器对有过敏反应风险的患者进行急救治疗。花生过敏反应的严重程度生物标志物和阈值能够显著改善对花生过敏患者的护理。
我们旨在评估嗜碱性粒细胞活化试验（BAT）在预测口服食物激发试验（OFC）期间对花生反应的严重程度和反应阈值方面的效用。
确定OFC期间对花生过敏反应的严重程度和阈值剂量。在激发试验当天进行皮肤点刺试验、花生及其成分特异性IgE的检测以及对花生的BAT检测。
在124名接受花生OFC的儿童中，52名（中位年龄5岁）出现了从轻度口腔症状到过敏反应不等的临床症状。41%的病例发生了严重反应，57%的儿童对0.1 g或更少的花生蛋白有反应。花生刺激后与抗IgE刺激后CD63(+)嗜碱性粒细胞百分比的比值（CD63花生/抗IgE）与严重程度独立相关（P = .001），而嗜碱性粒细胞过敏原阈值敏感性CD-sens值（1/EC₅₀×100，其中EC₅₀是半数最大效应浓度）与OFC期间对花生过敏反应的阈值独立相关（P = .020）。CD63花生/抗IgE水平为1.3或更高的患者发生严重反应的风险增加（相对风险，3.4；95%CI，1.8 - 6.2）。CD-sens值为84或更高的患者对0.1 g或更少花生蛋白有反应的风险增加（相对风险，1.9；95%CI，1.3 - 2.8）。
嗜碱性粒细胞反应性与严重程度相关，嗜碱性粒细胞敏感性与对花生过敏反应的阈值相关。CD63花生/抗IgE和CD-sens值可用于估计OFC期间过敏反应的严重程度和阈值。
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