Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan.
Department of Health Policy, National Research Institute for Child Health and Development, Tokyo, Japan.
J Allergy Clin Immunol. 2018 Jun;141(6):1997-2001.e3. doi: 10.1016/j.jaci.2018.02.033. Epub 2018 Mar 6.
The Learning Early About Peanut Allergy (LEAP) study proved that early introduction of peanut significantly prevented the development of peanut allergy. However, in regard to similar attempts to prevent egg allergy through early egg introduction, the Prevention of Egg Allergy in High-risk Infants with Eczema (PETIT) study is the only randomized intervention trial to show a statistically significant effect. Meta-analysis of those studies indicated that neither the total amount nor pretreatment of egg showed any effect on egg allergy at the age of 12 months. However, raw egg powder resulted in a significantly higher prevalence of allergic reactions at initial introduction, whereas use of boiled egg was much safer. The prevalence of atopic dermatitis/eczema at introduction of egg correlated significantly with the subsequent prevalence of allergic reactions at initial introduction. In addition, the prevalence of egg allergy in the late introduction group correlated significantly with the prevalence of atopic dermatitis at introduction, even when the atopic dermatitis was proactively treated with a topical corticosteroid ointment. It is definitely true that the number of trials and number of participants in each trial are insufficient for drawing firm conclusions, especially regarding the optimal dose, raw versus boiled, when to start, and for whom to intervene. Therefore we propose various studies that should be performed to generate stronger data and conclusions. However, on the basis of the most recent results, we postulate that simultaneous intervention by both early boiled egg introduction and eczema treatment is probably indispensable for primary prevention of egg allergy.
早期食用花生预防过敏（LEAP）研究证实，早期引入花生可显著预防花生过敏。然而，对于通过早期引入鸡蛋来预防鸡蛋过敏的类似尝试，特应性皮炎婴儿湿疹中预防鸡蛋过敏（PETIT）研究是唯一一项显示出统计学显著效果的随机干预试验。这些研究的荟萃分析表明，无论是总摄入量还是预处理鸡蛋，在 12 个月时对鸡蛋过敏均无影响。然而，生鸡蛋粉在初次引入时会导致更高的过敏反应发生率，而煮鸡蛋则安全得多。鸡蛋引入时特应性皮炎/湿疹的患病率与初始引入时过敏反应的后续患病率显著相关。此外，即使使用局部皮质类固醇软膏积极治疗特应性皮炎，在晚期引入组中鸡蛋过敏的患病率与引入时特应性皮炎的患病率也存在显著相关性。确实，试验数量和每个试验的参与者数量都不足以得出确定的结论，尤其是关于最佳剂量、生的与煮的、何时开始以及针对谁进行干预。因此，我们提出了应该进行各种研究，以生成更有力的数据和结论。然而，根据最新的结果，我们推测早期引入煮鸡蛋和治疗湿疹的同时干预可能对于鸡蛋过敏的一级预防是必不可少的。
