Laboratory of Allergic Diseases, National Institutes of Allergy and Infectious Diseases, Bethesda, Maryland, USA.
Curr Opin Pediatr. 2019 Dec;31(6):807-814. doi: 10.1097/MOP.0000000000000806.
The prevalence of food allergy is rising globally. This review will discuss recent discoveries regarding the immunologic mechanisms that drive the initial sensitization and allergic response to food antigens, which may inform prevention and treatment strategies.
Tolerance to food antigens is antigen-specific and promoted by oral exposure early in life and maternal transfer of immune complexes via breast milk. IgG can inhibit both the initiation and effector phases of allergic responses to food antigens in mice, and high levels of food-specific IgG4 are associated with acquisition of tolerance in humans. Disruption of the skin barrier provides a route for food sensitization through the actions of mast cells, type 2 innate lymphoid cells, and IL-33 signaling. Regulatory T cells (Tregs) promote acquisition of oral tolerance, although defects in circulating allergen-specific Tregs are not evident in children with established food allergy. Certain microbes can offer protection against the development of IgE and food allergic responses, while dysbiosis increases susceptibility to food allergy.
Tolerance to food antigens is antigen-specific and is promoted by oral exposure early in life, maternal transfer of immune complexes, food-specific IgG, Tregs, an intact skin barrier, and a healthy microbiome.
食物过敏的患病率在全球范围内呈上升趋势。本综述将讨论关于导致食物抗原初始致敏和过敏反应的免疫机制的最新发现，这些发现可能为预防和治疗策略提供信息。
食物抗原的耐受具有抗原特异性，通过生命早期的口服暴露和母乳中免疫复合物的母体转移来促进。IgG 可抑制食物抗原过敏反应的起始和效应阶段，在人类中，高水平的食物特异性 IgG4 与获得耐受有关。皮肤屏障的破坏通过肥大细胞、2 型先天淋巴细胞和 IL-33 信号通路为食物致敏提供了途径。调节性 T 细胞（Tregs）促进口服耐受的获得，尽管在已确诊为食物过敏的儿童中，循环过敏原特异性 Tregs 并未出现缺陷。某些微生物可以提供对 IgE 和食物过敏反应发展的保护，而微生物失调会增加食物过敏的易感性。
食物抗原的耐受具有抗原特异性，通过生命早期的口服暴露、免疫复合物的母体转移、食物特异性 IgG、Tregs、完整的皮肤屏障和健康的微生物群来促进。
