Couch Christopher, Franxman Tim, Greenhawt Matthew
Division of Allergy and Clinical Immunology, The University of Michigan Medical School, Ann Arbor, Michigan; Allergy Asthma Clinic, Ltd, Phoenix, Arizona.
Family Allergy and Asthma Center, Florence, Kentucky.
Ann Allergy Asthma Immunol. 2017 May;118(5):591-596.e3. doi: 10.1016/j.anai.2017.02.010. Epub 2017 Mar 27.
Characteristics and outcomes of tree nut (TN) oral food challenges (OFCs) in patients with TN allergy or sensitization alone are poorly studied.
To determine the relation between TN sensitization levels and OFC outcomes.
Open TN OFCs performed from 2007 through 2015 at a referral center were analyzed to compare outcome based on skin prick test (SPT) wheal size, food-specific immunoglobulin E (sIgE), peanut co-allergy, and TN sensitization only vs TN allergy with sensitization to other TNs. Delayed OFC was defined as longer than 12 months from the time of an sIgE level lower than 2 kUA/L.
Overall passage rate was 86% for 156 TN OFCs in 109 patients (54 almond, 28 cashew, 27 walnut, 18 hazelnut, 14 pecan, 13 pistachio, and 2 Brazil nut). Passage rates were 76% (n = 67) in patients with a history of TN allergy who were challenged to another TN to which they were sensitized and 91% (n = 65) in those with TN sensitization only (mean sIgE 1.53 kUA/L; range 0.35-9.14). Passage rates were 89% (n = 110 of 124) for a TN sIgE level lower than 2 kUA/L and 69% (11 of 16) for a TN sIgE level of at least 2 kUA/L. In 44 challenges in patients with peanut allergy and TN co-sensitization, the TN OFC passage rate was 96%. In 41 TN OFCs with a TN SPT wheal size of at least 3 mm, 61% passed, with a mean wheal size of 4.8 mm (range 3-11) in those passing vs 9 mm (range 3-20) in those failing.
TN challenges are frequently passed in patients with TN sensitization with or without a history of TN reactivity despite a TN SPT wheal of at least 3 mm or a TN sIgE level of at least 2 kUA/L. Nearly all patients with peanut allergy and TN co-sensitization passed the TN challenge, questioning the clinical relevance of "co-allergy."
单独患有坚果（TN）过敏或致敏的患者进行坚果口服食物激发试验（OFC）的特征及结果鲜有研究。
确定TN致敏水平与OFC结果之间的关系。
分析2007年至2015年在一家转诊中心进行的开放性TN OFC，以根据皮肤点刺试验（SPT）风团大小、食物特异性免疫球蛋白E（sIgE）、花生共过敏以及仅TN致敏与TN过敏并对其他TN致敏情况比较结果。延迟OFC定义为从sIgE水平低于2 kUA/L之时起超过12个月。
109例患者的156次TN OFC总体通过率为86%（54次杏仁、28次腰果、27次核桃、18次榛子、14次山核桃、13次开心果和2次巴西坚果）。有TN过敏史且被激发对其致敏的另一种TN进行试验的患者通过率为76%（n = 67），仅TN致敏的患者通过率为91%（n = 65）（平均sIgE 1.53 kUA/L；范围0.35 - 9.14）。TN sIgE水平低于2 kUA/L时通过率为89%（124例中的110例），TN sIgE水平至少为2 kUA/L时通过率为69%（16例中的11例）。在花生过敏且TN共致敏的患者进行的44次激发试验中，TN OFC通过率为96%。在41次TN SPT风团大小至少为3 mm的TN OFC中，61%通过，通过者的平均风团大小为4.8 mm（范围3 - 11），未通过者为9 mm（范围3 - 20）。
尽管TN SPT风团至少为3 mm或TN sIgE水平至少为2 kUA/L，但有或无TN反应史的TN致敏患者进行TN激发试验时常常通过。几乎所有花生过敏且TN共致敏的患者通过了TN激发试验，这对“共过敏”的临床相关性提出了质疑。
