Pediatric Allergy Unit, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland.
Department of Allergy and Immunology, Centre Hospitalier Universitaire Sainte-Justine and Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
Pediatr Allergy Immunol. 2020 Aug;31(6):601-607. doi: 10.1111/pai.13244. Epub 2020 Jun 15.
Peanut IgE-mediated food allergy is one of the most common food allergies in children with a prevalence that has increased in the past decades in Westernized countries. Peanut allergies can trigger severe reactions and usually persist over time. Peanut-allergic children and their families are often confronted to processed foods with precautionary allergen labeling (PAL) such as "may contain traces of peanuts," which are frequently used by the food industry. Patients are generally confused as to whether eating such foods entails a risk of allergic reaction, which can ultimately lead to dietary restrictions and decreased quality of life. Thus, guidance toward eviction of foods with PALs such as "may contain traces of peanuts" is a recurring problem that peanut-allergic patients address during pediatric allergy consultations with varying attitudes among allergists. Many studies have evaluated peanut contamination in foods with PALs, with generally less than 10% of foods containing detectable levels of peanuts, albeit heterogeneous amounts, with in rare occasions levels that could trigger allergic reactions in certain patients. The risk of reacting to foods with traces varies significantly with threshold, with patients with the lowest reaction thresholds at highest risk, and a dramatic reduction of risk as threshold increases. Thus, risk stratification based on individual reaction threshold may help stratify patients' risk of reacting to foods with PAL. In clinical practice, a single-dose 30 mg peanut protein oral food challenge may be an option to stratify peanut-allergic patients' risk when introducing foods with PAL, as illustrated by three clinical cases.
花生 IgE 介导的食物过敏是儿童中最常见的食物过敏之一，在过去几十年中，这种过敏在西化国家的发病率有所增加。花生过敏可引发严重反应，且通常会随着时间的推移而持续存在。花生过敏的儿童及其家人经常会遇到标有预防性过敏原标签（PAL）的加工食品，如“可能含有微量花生”，这些食品经常被食品行业使用。患者通常会感到困惑，不确定食用这些食品是否会引发过敏反应，这最终可能导致饮食限制和生活质量下降。因此，指导患者避免食用标有 PAL 的食物（如“可能含有微量花生”）是一个反复出现的问题，花生过敏患者在儿科过敏咨询中会遇到，而过敏专家的态度则存在差异。许多研究评估了 PAL 食品中的花生污染情况，一般来说，不到 10%的食品中含有可检测到的花生，但数量不均，极少数情况下，某些患者可能会对这些水平的花生产生过敏反应。对含微量花生食品的反应风险差异很大，反应阈值最低的患者风险最高，随着阈值的增加，风险会显著降低。因此，基于个体反应阈值的风险分层可能有助于分层患者对 PAL 食品的反应风险。在临床实践中，单次 30mg 剂量的花生蛋白口服食物挑战可能是在引入 PAL 食品时对花生过敏患者进行风险分层的一种选择，三个临床案例说明了这一点。
