Savage Jessica, Sicherer Scott, Wood Robert
Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
J Allergy Clin Immunol Pract. 2016 Mar-Apr;4(2):196-203; quiz 204. doi: 10.1016/j.jaip.2015.11.024.
On a population level, it is well recognized that some IgE-mediated childhood food allergies, such as milk and egg allergies, are more likely to resolve than others, such as peanut and tree nuts allergies. Unfortunately, some studies suggest that resolution rates may have slowed compared with impressions from past decades. The clinician can apply the knowledge of the epidemiology of these allergies to describe likely patient outcomes, and direct management in a general manner. However, the ability to evaluate and predict the natural course of specific food allergies for individual patients is essential to inform personalized patient care. Data are accumulating to assist in identifying whether a child's allergy has likely resolved, informing the timing of oral food challenges or subsequent testing. Exciting recent studies are increasingly identifying early prognostic markers as well. Emerging food allergy therapies carry risks and costs. Identifying which egg-allergic patient has likely persistent allergy, and which patient with peanut allergy may experience natural resolution, is becoming an important goal to identify the best candidates for these therapies. Although more work needs to be done to identify reliable predictive markers and validate them, there is already much known about the natural course of food allergies that can be applied by the clinician to improve patient care.
在人群层面，人们普遍认识到，一些由IgE介导的儿童食物过敏，如牛奶和鸡蛋过敏，比其他过敏，如花生和坚果过敏，更有可能缓解。不幸的是，一些研究表明，与过去几十年的印象相比，缓解率可能有所下降。临床医生可以运用这些过敏症的流行病学知识来描述可能的患者预后，并以一般方式指导管理。然而，评估和预测个体患者特定食物过敏的自然病程的能力对于提供个性化的患者护理至关重要。越来越多的数据有助于确定儿童的过敏是否可能已经缓解，为口服食物激发试验或后续检测的时机提供依据。最近令人兴奋的研究也越来越多地确定早期预后标志物。新兴的食物过敏疗法存在风险和成本。确定哪些鸡蛋过敏患者可能持续过敏，哪些花生过敏患者可能自然缓解，正成为确定这些疗法最佳候选者的一个重要目标。尽管需要做更多的工作来确定可靠的预测标志物并加以验证，但临床医生已经对食物过敏的自然病程有了很多了解，可以应用这些知识来改善患者护理。
