Wang Yichao, Peters Rachel L, Perrett Kirsten P, McWilliam Vicki L, Tang Mimi L K, Lowe Adrian J, Ponsonby Anne-Louise, Dharmage Shyamali C, Allen Katrina J, Koplin Jennifer J
Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.
Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
J Allergy Clin Immunol Pract. 2020 Nov-Dec;8(10):3515-3524. doi: 10.1016/j.jaip.2020.07.008. Epub 2020 Jul 21.
Few studies have investigated adverse food reactions among food-allergic children in a population-based sample, which is critical for the development of evidence-based management strategies.
We aimed to evaluate the frequency, characteristics, and risk factors for adverse food reactions, including anaphylaxis, among food-allergic 6-year-old-children using the population-based HealthNuts study.
The HealthNuts study of 5276 infants (1-year-old) followed them up at age 6 years (84.4% participated). A total of 260 children with IgE-mediated food allergy who completed a questionnaire detailing recent adverse food reactions were included in this analysis.
Among food-allergic children, 44.6% (95% CI, 38.6%-50.8%) reported an adverse food reaction in the last 12 months and 10.8% (95% CI, 7.5%-15.2%) reported an anaphylactic reaction, although only half of these were recognized as anaphylaxis by parents. Adrenaline autoinjectors were used in 25% (4 of 16) of recognized anaphylaxis episodes. Nut allergy was associated with a reduced risk of having an adverse reaction (adjusted odds ratio, 0.3; 95% CI, 0.1-0.7). There were trends that adverse reactions were more likely in children with at least 1 parent born in Asia compared with both parents born in Australia (adjusted odds ratio, 1.9; 95% CI, 0.9-3.9), and in children with 3 or more food allergies compared with children with a single food allergy (adjusted odds ratio, 1.8; 95% CI, 0.9-3.5).
Adverse food reactions occurred in almost half of all food-allergic 6-year-old children and anaphylaxis occurred in 1 in 10 children over a 12-month period. Anaphylaxis was poorly recognized and adrenaline autoinjectors were not used appropriately. Improved regular education on the prevention, recognition, and management of adverse food reactions is urgently needed.
在基于人群的样本中，很少有研究调查食物过敏儿童的不良食物反应，而这对于制定循证管理策略至关重要。
我们旨在利用基于人群的“健康坚果”研究，评估6岁食物过敏儿童不良食物反应（包括过敏反应）的频率、特征和风险因素。
“健康坚果”研究对5276名1岁婴儿进行跟踪，在他们6岁时进行随访（84.4%的婴儿参与）。本分析纳入了260名完成了一份详细说明近期不良食物反应问卷的IgE介导的食物过敏儿童。
在食物过敏儿童中，44.6%（95%置信区间，38.6%-50.8%）报告在过去12个月内有不良食物反应，10.8%（95%置信区间，7.5%-15.2%）报告有过敏反应，不过这些过敏反应中只有一半被家长识别为过敏反应。在16例被识别的过敏反应发作中，有25%（4例）使用了肾上腺素自动注射器。坚果过敏与不良反应风险降低相关（调整后的优势比，0.3；95%置信区间，0.1-0.7）。有趋势表明，与父母双方均出生在澳大利亚的儿童相比，至少有1位父母出生在亚洲的儿童发生不良反应的可能性更高（调整后的优势比，1.9；95%置信区间，0.9-3.9），与单一食物过敏儿童相比，有3种或更多食物过敏的儿童发生不良反应的可能性更高（调整后的优势比，1.8；95%置信区间，0.9-3.5）。
在所有6岁食物过敏儿童中，近一半发生了不良食物反应，在12个月期间，每10名儿童中有1名发生过敏反应。过敏反应识别不足，肾上腺素自动注射器使用不当。迫切需要加强关于不良食物反应预防、识别和管理的定期教育。
