Division of Allergology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Faculty of Health Sciences, University of Cape Town, South Africa.
S Afr Med J. 2019 Apr 29;109(5):323-327. doi: 10.7196/SAMJ.2019.v109i5.13339.
There are no previous data on tolerance development in children with atopic dermatitis (AD) and concomitant food allergy in low- and middle-income settings.
To determine the rate of tolerance acquisition to egg and peanut 5 years after diagnosing food allergies in South African (SA) children with AD, and to explore factors influencing tolerance acquisition.
Five years after first diagnosing food allergy in 37 SA children with egg and/or peanut allergy, they were reassessed for their allergies by questionnaire, skin-prick tests (SPTs) and ImmunoCAP-specific IgE (sIgE) tests (Thermo Fisher Scientific/Phadia, Sweden) to egg white, ovomucoid, peanut and Arachis hypogaea allergen 2 (Ara h 2), and incremental food challenges.
Eighteen of 25 originally egg-allergic patients and 19 of 24 originally peanut-allergic children were followed up at a median age of 8 years and 3 months and 9 years and 6 months, respectively. A high percentage of children (72.2%) outgrew their egg allergy, and 15.8% outgrew their peanut allergy. Allergic comorbidity remained high, with asthma increasing over time, and AD remaining moderate in severity in the cohort overall. At diagnosis, sIgE egg white ≤9.0 kU/L and sIgE ovomucoid ≤2.0 kU/L were associated with tolerance development to egg 5 years later. At follow-up, sIgE egg white ≤0.70 kU/L, sIgE ovomucoid ≤0.16 kU/L, SPT egg-white extract ≤1 mm and SPT fresh egg ≤5 mm were associated with tolerance. At diagnosis, sIgE Ara h 2 ≤1.7 kU/L and SPT peanut ≤10 mm were associated with tolerance development to peanut 5 years later. At follow-up, sIgE peanut ≤0.22 kU/L, sIgE Ara h 2 ≤0.18 kU/L and SPT peanut ≤5.5 mm were associated with tolerance.
Egg allergy was outgrown in 72.2% and peanut allergy in 15.8% of SA children 5 years after diagnosis of AD. This is in keeping with findings derived from studies in higher socioeconomic settings, and can help to guide the counselling of patients with allergies to these foods of high nutritional value.
在中低收入环境中，尚无关于特应性皮炎（AD）伴食物过敏儿童耐受性发展的既往数据。
确定南非（SA）患有 AD 并伴有食物过敏的儿童在诊断出食物过敏后 5 年内获得鸡蛋和/或花生耐受的比例，并探讨影响获得耐受的因素。
在 37 名对鸡蛋和/或花生过敏的 SA 儿童首次诊断出食物过敏 5 年后，通过问卷调查、皮肤点刺试验（SPT）和 ImmunoCAP 特异性 IgE（sIgE）检测（Thermo Fisher Scientific/Phadia，瑞典），对他们的过敏情况进行了重新评估，检测对象包括蛋清、卵类黏蛋白、花生和花生过敏原 2（Ara h 2）。同时进行了递增食物挑战。
25 名原鸡蛋过敏患儿中有 18 名，24 名原花生过敏患儿中有 19 名在中位年龄 8 岁 3 个月和 9 岁 6 个月时接受了随访。很大比例的儿童（72.2%）对鸡蛋过敏，15.8%对花生过敏。过敏性合并症仍很高，随着时间的推移哮喘增加，总体而言队列中的 AD 仍为中度严重。在诊断时，sIgE 蛋清≤9.0 kU/L 和 sIgE 卵类黏蛋白≤2.0 kU/L 与 5 年后对鸡蛋的耐受有关。在随访时，sIgE 蛋清≤0.70 kU/L、sIgE 卵类黏蛋白≤0.16 kU/L、SPT 蛋清提取物≤1 mm 和 SPT 新鲜鸡蛋≤5 mm 与耐受有关。在诊断时，sIgE Ara h 2≤1.7 kU/L 和 SPT 花生≤10 mm 与 5 年后对花生的耐受有关。在随访时，sIgE 花生≤0.22 kU/L、sIgE Ara h 2≤0.18 kU/L 和 SPT 花生≤5.5 mm 与耐受有关。
在诊断出 AD 后 5 年，72.2%的 SA 儿童鸡蛋过敏和 15.8%的花生过敏得到缓解。这与来自高社会经济环境研究中的发现一致，有助于指导对这些高营养价值食物过敏的患者进行咨询。
