Rubin Zachary E, Gu Hongjie, Polk Brooke I
Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine in St. Louis, USA.
Division of Biostatistics, Washington University School of Medicine in St. Louis, USA.
World Allergy Organ J. 2020 May 13;13(5):100121. doi: 10.1016/j.waojou.2020.100121. eCollection 2020 May.
There are sparse data regarding the predictors of positive oral food challenges and reaction severity for seafood in children.
Identify clinical characteristics in children with seafood allergy who were most likely to experience a negative oral food challenge (OFC).
A retrospective chart review was performed for children who had a graded OFC to seafood at a pediatric tertiary care center from 2008 through 2019.
Sixty-three (60% male; average age 8 years; range 1-21 years) OFCs were performed, of which 21 were fish and 42 were shellfish. There were 10 (16%) positive OFCs and positive OFC rate was similar between fish (19%) and shellfish (14%). Forty-three children who underwent OFC had a reported history of IgE-mediated symptoms. Five of six children who had a history of anaphylaxis had a negative OFC. There was no difference in positive OFCs due to age, history of atopy, or initial allergic reaction history. The clinical characteristics of the positive OFCs were similar between fish and shellfish. A positive skin prick test to fish or shellfish did not increase the risk of a positive OFC. While the positive OFC rate did not differ for the shellfish food-specific IgE (FSIgE) level, there was a significant difference for fish (median <0.34 kU/L vs. 1.63 kU/L for pass and fail, respectively; P = 0.023).
A retrospective study of OFCs to seafood showed that the rate of a positive OFC was low. While seafood allergy is thought to be rarely outgrown, children who have a low FsIgE and/or skin testing can successfully tolerate seafood.
关于儿童海鲜口服食物激发试验阳性及反应严重程度的预测因素，相关数据稀少。
确定最有可能口服食物激发试验（OFC）结果为阴性的海鲜过敏儿童的临床特征。
对2008年至2019年在一家儿科三级护理中心接受分级海鲜OFC的儿童进行回顾性病历审查。
共进行了63次OFC（60%为男性；平均年龄8岁；范围1至21岁），其中21次针对鱼类，42次针对贝类。有10次（16%）OFC结果为阳性，鱼类（19%）和贝类（14%）的阳性OFC率相似。43名接受OFC的儿童有IgE介导症状的报告病史。有过敏反应病史的6名儿童中有5名OFC结果为阴性。因年龄、特应性病史或初始过敏反应病史导致的阳性OFC无差异。鱼类和贝类阳性OFC的临床特征相似。对鱼类或贝类的皮肤点刺试验阳性并未增加阳性OFC的风险。虽然贝类食物特异性IgE（FSIgE）水平的阳性OFC率无差异，但鱼类有显著差异（通过和未通过的中位数分别为<0.34 kU/L和1.63 kU/L；P = 0.023）。
一项关于海鲜OFC的回顾性研究表明，阳性OFC率较低。虽然海鲜过敏被认为很少自愈，但FSIgE水平低和/或皮肤试验的儿童能够成功耐受海鲜。
