Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Division of Pediatric Pulmonology, Allergy & Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.
Ann Allergy Asthma Immunol. 2019 Feb;122(2):193-197. doi: 10.1016/j.anai.2018.10.012. Epub 2018 Oct 14.
Recent studies have suggested that removing foods from the diet to manage atopic dermatitis (AD), based on positive allergy test results, may lead to immediate allergic reactions on reintroduction of that food.
To examine the frequency of oral food challenge (OFC) failures among foods removed from the diet as suspected AD triggers, focusing on the 5 major food allergens in the United States.
OFCs to egg, milk, peanut, soy, and wheat, performed from 2008 to 2014, at a children's hospital's allergy clinics, were reviewed. OFCs were offered based on history and laboratory values. Reasons for food avoidance were classified as food allergy (IgE-mediated reaction occurring within 2 hours); sensitization only (lack of introduction because of positive test results); and removal because of test results during AD evaluation.
There were 442 OFCs performed, with 89 failures (20.1%). Reasons for OFCs included a history of food allergy (320 of 442 [72.4%]), food sensitization without any introduction (77 of 442 [17.4%]), and AD (45 of 442 [10.2%]). OFC failures among those who had food allergy (70 of 320 [21.9%]), sensitization only (13 of 77 [16.9%]), and suspected AD trigger (6 of 45 [13.3%]) did not significantly differ (P = .63). Wheat was more likely to be avoided than the other 4 foods for AD concerns (P < .001).
The frequency of OFC failure among those who removed foods suspected as AD triggers was 13.3%, indicating a loss of tolerance. Restriction of foods to manage AD must be done with caution and close monitoring.
最近的研究表明，根据阳性过敏测试结果，从饮食中去除食物来治疗特应性皮炎（AD）可能会导致该食物再次引入时出现即刻过敏反应。
检查因疑似 AD 触发因素而从饮食中去除的食物的口服食物挑战（OFC）失败频率，重点关注美国的 5 种主要食物过敏原。
回顾了 2008 年至 2014 年在一家儿童医院过敏诊所进行的鸡蛋、牛奶、花生、大豆和小麦的 OFC，根据病史和实验室值进行了 OFC。避免食用食物的原因分为食物过敏（2 小时内发生的 IgE 介导反应）；仅致敏（由于阳性测试结果而未引入）；以及 AD 评估期间因测试结果而去除。
进行了 442 次 OFC，其中 89 次失败（20.1%）。OFC 的原因包括食物过敏史（442 例中的 320 例[72.4%]）、无任何引入的食物致敏（442 例中的 77 例[17.4%]）和 AD（442 例中的 45 例[10.2%]）。有食物过敏（320 例中的 70 例[21.9%]）、仅致敏（77 例中的 13 例[16.9%]）和疑似 AD 触发因素（45 例中的 6 例[13.3%]）的患者的 OFC 失败率没有显着差异（P=0.63）。由于 AD 担忧，小麦比其他 4 种食物更有可能被避免（P<0.001）。
因疑似 AD 触发因素而去除食物的患者中，OFC 失败的频率为 13.3%，表明失去了耐受性。必须谨慎并密切监测限制食物来治疗 AD。
