Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada; Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC, Canada.
School of Life Course Sciences, King's College London, Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, UK; School of Immunology and Microbial Sciences, King's College London, Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, UK.
Lancet Child Adolesc Health. 2020 Jul;4(7):526-535. doi: 10.1016/S2352-4642(20)30029-8.
Peanut allergy is an important public health concern and causes substantial psychosocial comorbidity. Although fatal anaphylaxis is rare (occurring at 0·03-0·3 per million person-years in the general population), peanuts are one of the most frequent causes of food allergy mortality. The Learning Early About Peanut study transformed prevention of peanut allergy by showing that early introduction of peanut into the diet of children at high risk (ie, those with an egg allergy or severe eczema) reduced the relative risk of peanut allergy at age 5 years by 81%. Following publication of this study, the US National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, convened an expert panel, which recommended that, for infants with severe eczema or egg allergy, health professionals should strongly consider evaluation with peanut-specific serological IgE or skin prick test (or both) and, if necessary, an oral food challenge before peanut introduction. In the USA, depending on test results, peanut-containing foods are recommended to be introduced from age 4-6 months in infants with severe eczema or egg allergy. Early introduction to peanuts is also advocated for children with either mild to moderate or no eczema, and in children who are not allergic to egg, but without screening before peanut introduction. However, the NIAID addendum guidelines contrast with other international approaches that do not advocate for allergy screening at a population level before introducing peanuts into infants' diets. In this Review, we evaluate the advantages and disadvantages of a pre-emptive screening approach before the early introduction of peanuts in infants at high risk of peanut allergy.
花生过敏是一个重要的公共卫生问题，会导致严重的心理社会共病。尽管致命性过敏反应（在普通人群中每百万人年发生 0.03-0.3 例）罕见，但花生是导致食物过敏死亡的最常见原因之一。“早期了解花生（Learning Early About Peanut）”研究通过表明在高风险儿童（即对鸡蛋过敏或严重特应性皮炎的儿童）饮食中早期添加花生可将 5 岁时花生过敏的相对风险降低 81%，从而改变了花生过敏的预防策略。该研究发表后，美国国立过敏和传染病研究所（NIAID）作为美国国立卫生研究院的一部分，召集了一个专家小组，该小组建议，对于严重特应性皮炎或鸡蛋过敏的婴儿，卫生专业人员应强烈考虑进行花生特异性血清 IgE 或皮肤点刺试验（或两者）评估，如果需要，在引入花生之前进行口服食物激发试验。在美国，根据测试结果，建议在严重特应性皮炎或鸡蛋过敏的婴儿中，从 4-6 月龄开始引入含花生的食物。对于有轻度至中度特应性皮炎或无特应性皮炎的儿童，以及对鸡蛋不过敏但未在引入花生前进行筛查的儿童，也提倡早期引入花生。然而，NIAID 的补充指南与其他国际方法形成对比，后者不提倡在将花生引入婴儿饮食之前在人群中进行过敏筛查。在本综述中，我们评估了在高风险花生过敏婴儿中早期引入花生之前进行预防性筛查的优缺点。
