Food Allergy Center, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Mass; Harvard Medical School, Boston, Mass; Channing Division of Network Medicine, Brigham & Women's Hospital, Boston, Mass.
Food Allergy Center, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Mass.
J Allergy Clin Immunol Pract. 2019 Sep-Oct;7(7):2359-2368.e3. doi: 10.1016/j.jaip.2019.03.049. Epub 2019 Apr 8.
Although almond specific IgE-mediated food allergies have traditionally been equated with other tree nut allergies, outcomes of oral food challenges to almond and the utility of clinical testing to predict IgE-mediated almond hypersensitivity are not well known.
To describe almond oral challenge outcomes and assess the predictive value of clinical testing.
A total of 603 almond challenges performed for 590 patients, aged 1 to 66 years, were analyzed from Massachusetts General Hospital allergy practices. Reactions were graded using the Niggemann and Beyer allergic reaction grading system and the Sampson 2006 National Institute of Allergy and Infectious Diseases anaphylaxis definition.
Almond challenges included 545 passes (92%), 15 (3%) indeterminates, and 30 (5%) failures, in contrast with 31% challenge failures for other foods. Most reactions were mild; 21 (4%) had grade 2/3 allergic symptoms, and 3 (0.5%) had anaphylaxis. Median almond specific IgE level was 0.89 kU/L (range, <0.35 to >100 kU/L), median skin prick test wheal diameter was 4.0 mm (range, 0-28 mm), and 475 subjects (81%) were sensitized to almond. Failure was associated with higher almond specific IgE level (P < .001), larger almond skin prick test wheal diameter (P = .001), higher peanut IgE level (P = .003), and a history of almond reaction (P < .029). Almond specific IgE level, almond skin prick test wheal diameter, and age at challenge combined demonstrated good predictive value for grade 2/3 allergic reactions by receiver-operating characteristic analysis (area under the curve, 0.83).
The proportion of failed almond challenges (5%) was low in contrast with other allergens, suggesting that some almond challenges may be safely conducted with higher patient-to-staff ratios or potentially introduced at home. Although reactions are usually uncommon and mild, anaphylaxis is possible with high almond sensitization.
尽管杏仁特异性 IgE 介导的食物过敏传统上被等同于其他树坚果过敏，但杏仁口服食物挑战的结果以及临床检测预测 IgE 介导的杏仁过敏的效用尚不清楚。
描述杏仁口服挑战的结果，并评估临床检测的预测价值。
对来自马萨诸塞州总医院过敏科的 590 名患者的 603 次杏仁口服挑战进行了分析，患者年龄 1 至 66 岁。反应采用 Niggemann 和 Beyer 过敏反应分级系统和 Sampson 2006 年美国国立过敏和传染病研究所过敏反应定义进行分级。
杏仁挑战中有 545 次（92%）通过，15 次（3%）不确定，30 次（5%）失败，而其他食物的挑战失败率为 31%。大多数反应为轻度；21 次（4%）有 2/3 级过敏症状，3 次（0.5%）有过敏反应。杏仁特异性 IgE 水平中位数为 0.89 kU/L（范围，<0.35 至>100 kU/L），杏仁皮肤点刺试验风团直径中位数为 4.0 mm（范围，0-28 mm），475 名受试者（81%）对杏仁过敏。失败与更高的杏仁特异性 IgE 水平（P <.001）、更大的杏仁皮肤点刺试验风团直径（P =.001）、更高的花生 IgE 水平（P =.003）和杏仁反应史（P <.029）相关。杏仁特异性 IgE 水平、杏仁皮肤点刺试验风团直径和挑战时的年龄联合通过受试者工作特征分析（曲线下面积，0.83）显示出对 2/3 级过敏反应的良好预测价值。
与其他过敏原相比，杏仁挑战失败的比例（5%）较低，这表明在更高的医患比例下或在家中可能安全地进行一些杏仁挑战。尽管反应通常不常见且为轻度，但高杏仁致敏可导致过敏反应。
