Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, California; Department of Medicine, Stanford University School of Medicine, Stanford, California; Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, California; School of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California.
Ann Allergy Asthma Immunol. 2018 Jul;121(1):69-76.e2. doi: 10.1016/j.anai.2018.04.020. Epub 2018 Apr 27.
Reliable prognostic markers for predicting severity of allergic reactions during oral food challenges (OFCs) have not been established.
To develop a predictive algorithm of a food challenge severity score (CSS) to identify those at higher risk for severe reactions to a standardized peanut OFC.
Medical history and allergy test results were obtained for 120 peanut allergic participants who underwent double-blind, placebo-controlled food challenges. Reactions were assigned a CSS between 1 and 6 based on cumulative tolerated dose and a severity clinical indicator. Demographic characteristics, clinical features, peanut component IgE values, and a basophil activation marker were considered in a multistep analysis to derive a flexible decision rule to understand risk during peanut of OFC.
A total of 18.3% participants had a severe reaction (CSS >4). The decision rule identified the following 3 variables (in order of importance) as predictors of reaction severity: ratio of percentage of CD63 stimulation with peanut to percentage of CD63 anti-IgE (CD63 ratio), history of exercise-induced asthma, and ratio of forced expiratory volume in 1 second to forced vital capacity (FEV/FVC) ratio. The CD63 ratio alone was a strong predictor of CSS (P < .001).
The CSS is a novel tool that combines dose thresholds and allergic reactions to understand risks associated with peanut OFCs. Laboratory values (CD63 ratio), along with clinical variables (exercise-induced asthma and FEV/FVC ratio) contribute to the predictive ability of the severity of reaction to peanut OFCs. Further testing of this decision rule is needed in a larger external data source before it can be considered outside research settings.
ClinicalTrials.gov identifier: NCT02103270.
目前尚未建立可靠的预测标志物来预测口服食物挑战（OFC）期间过敏反应的严重程度。
制定食物挑战严重程度评分（CSS）的预测算法，以识别那些对标准化花生 OFC 严重反应风险较高的患者。
对 120 名接受双盲、安慰剂对照食物挑战的花生过敏参与者进行了病史和过敏试验结果的采集。根据累积耐受剂量和严重临床指标，将反应分配为 1 至 6 分的 CSS。在多步骤分析中考虑了人口统计学特征、临床特征、花生成分 IgE 值和嗜碱性粒细胞激活标志物，以得出灵活的决策规则，了解 OFC 期间食用花生的风险。
共有 18.3%的参与者出现严重反应（CSS>4）。决策规则确定了以下 3 个变量（按重要性顺序）作为反应严重程度的预测因子：花生与抗 IgE 刺激 CD63 的百分比比值（CD63 比值）、运动诱发哮喘史和 1 秒用力呼气量与用力肺活量的比值（FEV/FVC 比值）。单独的 CD63 比值是 CSS 的一个强有力的预测因子（P<0.001）。
CSS 是一种结合剂量阈值和过敏反应的新型工具，用于了解与花生 OFC 相关的风险。实验室值（CD63 比值）以及临床变量（运动诱发哮喘和 FEV/FVC 比值）有助于预测花生 OFC 反应的严重程度。在将该决策规则应用于研究环境之外之前，需要在更大的外部数据源中进一步测试。
ClinicalTrials.gov 标识符：NCT02103270。
