Department of Psychology, Stanford University, Stanford, Calif.
Department of Psychology, Stanford University, Stanford, Calif.
J Allergy Clin Immunol Pract. 2019 May-Jun;7(5):1550-1559. doi: 10.1016/j.jaip.2019.01.022. Epub 2019 Jan 23.
Oral immunotherapy (OIT) can lead to desensitization to food allergens, but patients can experience treatment-related symptoms of allergic reactions that cause anxiety and treatment dropout. Interventions to improve OIT for patients are needed.
To determine whether fostering the mindset that non-life-threatening symptoms during OIT can signal desensitization improves treatment experience and outcomes.
In a randomized, blinded, controlled phase II study, 50 children/adolescents (28% girls, aged 7-17 years, M = 10.82, standard deviation = 3.01) completed 6-month OIT for peanut allergies. Patients and their parent(s) had monthly clinic visits at the Sean N. Parker Center for Allergy and Asthma Research between January 5, 2017, and August 3, 2017. All families received identical symptom management training. In a 1:1 approach, 24 patients and their families were informed that non-life-threatening symptoms during OIT were unfortunate side effects of treatment, and 26 patients and their families were informed that non-life-threatening symptoms could signal desensitization. Families participated in activities to reinforce these symptom mindsets.
Compared with families informed that symptoms are side effects, families informed that symptoms can signal desensitization were less anxious (B = -0.46, 95% confidence interval [CI]: -0.76 to -0.16; P = .003), less likely to contact staff about symptoms (5/24 [9.4%] vs 27/154 [17.5%] instances; P = .036), experienced fewer non-life-threatening symptoms as doses increased (B = -0.54, 95% CI: -0.83 to -0.27; P < .001), less likely to skip/reduce doses (1/26 [4%] vs 5/24 [21%] patients; P = .065), and showed a greater increase in patient peanut-specific blood IgG4 levels (B = 0.76, 95% CI: 0.36 to 1.17; P < .001).
Fostering the mindset that symptoms can signal desensitization improves OIT experience and outcomes. Changing how providers inform patients about non-life-threatening symptoms is a promising avenue for improving treatment.
口服免疫疗法（OIT）可导致食物过敏脱敏，但患者可能会经历与治疗相关的过敏反应症状，从而引起焦虑并导致治疗中断。需要采取干预措施来改善 OIT 患者的治疗效果。
确定培养一种心态，即 OIT 期间的非危及生命的症状可以提示脱敏，是否可以改善治疗体验和结局。
在一项随机、双盲、对照的 2 期研究中，50 名儿童/青少年（28%为女性，年龄 7-17 岁，M=10.82，标准差=3.01）接受了花生过敏的 6 个月 OIT。患者及其父母（父母）于 2017 年 1 月 5 日至 2017 年 8 月 3 日在 Sean N. Parker 过敏和哮喘研究中心每月进行一次诊所就诊。所有家庭都接受了相同的症状管理培训。采用 1:1 的方法，24 名患者及其家庭被告知 OIT 期间的非危及生命的症状是治疗的不幸副作用，而 26 名患者及其家庭被告知非危及生命的症状可能提示脱敏。家庭参与了强化这些症状心态的活动。
与被告知症状是副作用的家庭相比，被告知症状可以提示脱敏的家庭焦虑程度较低（B=-0.46，95%置信区间[CI]：-0.76 至-0.16；P=.003），向工作人员报告症状的可能性较小（5/24 [9.4%]与 27/154 [17.5%]；P=.036），随着剂量增加，非危及生命的症状较少（B=-0.54，95%CI：-0.83 至-0.27；P<.001），跳过/减少剂量的可能性较小（1/26 [4%]与 5/24 [21%]；P=.065），患者花生特异性 IgG4 水平升高幅度更大（B=0.76，95%CI：0.36 至 1.17；P<.001）。
培养症状可以提示脱敏的心态可以改善 OIT 体验和结局。改变提供者告知患者非危及生命的症状的方式是改善治疗的有前途的途径。
