Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Allergy, Addenbrooke's Hospital, Cambridge, United Kingdom.
Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom.
J Allergy Clin Immunol. 2019 Dec;144(6):1584-1594.e2. doi: 10.1016/j.jaci.2019.06.038. Epub 2019 Jul 15.
Peanut allergy causes severe and fatal reactions. Current food allergen labeling does not address these risks adequately against the burden of restricting food choice for allergic patients because of limited data on thresholds of reactivity and the influence of everyday factors.
We estimated peanut threshold doses for a United Kingdom population with peanut allergy and examined the effect of sleep deprivation and exercise.
In a crossover study, after blind challenge, participants with peanut allergy underwent 3 open peanut challenges in random order: with exercise after each dose, with sleep deprivation preceding challenge, and with no intervention. Primary outcome was the threshold dose triggering symptoms (in milligrams of protein). Primary analysis estimated the difference between the nonintervention challenge and each intervention in log threshold (as percentage change). Dose distributions were modeled, deriving eliciting doses in the population with peanut allergy.
Baseline challenges were performed in 126 participants, 100 were randomized, and 81 (mean age, 25 years) completed at least 1 further challenge. The mean threshold was 214 mg (SD, 330 mg) for nonintervention challenges, and this was reduced by 45% (95% CI, 21% to 61%; P = .001) and 45% (95% CI, 22% to 62%; P = .001) for exercise and sleep deprivation, respectively. Mean estimated eliciting doses for 1% of the population were 1.5 mg (95% CI, 0.8-2.5 mg) during nonintervention challenge (n = 81), 0.5 mg (95% CI, 0.2-0.8 mg) after sleep, and 0.3 mg (95% CI, 0.1-0.6 mg) after exercise.
Exercise and sleep deprivation each significantly reduce the threshold of reactivity in patients with peanut allergy, putting them at greater risk of a reaction. Adjusting reference doses using these data will improve allergen risk management and labeling to optimize protection of consumers with peanut allergy.
花生过敏会导致严重和致命的反应。目前的食物过敏原标签没有充分考虑到这些风险，因为对反应性阈值和日常因素的影响的数据有限，这给过敏患者的食物选择带来了限制。
我们估计了英国花生过敏人群的花生阈值剂量，并研究了睡眠剥夺和运动的影响。
在一项交叉研究中，在盲法挑战后，花生过敏参与者以随机顺序进行 3 次开放花生挑战：每次剂量后进行运动，挑战前进行睡眠剥夺，以及无干预。主要结局是触发症状的阈值剂量（以毫克蛋白质计）。主要分析估计了非干预挑战与每个干预之间的对数阈值差异（作为百分比变化）。对剂量分布进行建模，得出花生过敏人群中的诱发剂量。
在 126 名参与者中进行了基线挑战，其中 100 名被随机分配，81 名（平均年龄 25 岁）至少完成了 1 次进一步的挑战。非干预挑战的平均阈值为 214 毫克（标准差 330 毫克），运动和睡眠剥夺分别降低了 45%（95%置信区间，21%至 61%；P=0.001）和 45%（95%置信区间，22%至 62%；P=0.001）。在非干预挑战时（n=81），人群中 1%的估计诱发剂量为 1.5 毫克（95%置信区间，0.8 至 2.5 毫克），睡眠后为 0.5 毫克（95%置信区间，0.2 至 0.8 毫克），运动后为 0.3 毫克（95%置信区间，0.1 至 0.6 毫克）。
运动和睡眠剥夺都显著降低了花生过敏患者的反应性阈值，使他们面临更大的反应风险。使用这些数据调整参考剂量将改善过敏原风险管理和标签，以优化对花生过敏消费者的保护。
