Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel; Department of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
School of Public Health, University of Haifa, Haifa, Israel.
J Allergy Clin Immunol Pract. 2021 Jan;9(1):185-192.e3. doi: 10.1016/j.jaip.2020.07.034. Epub 2020 Aug 1.
Oral immunotherapy (OIT) is effective in desensitizing food-allergic patients but adverse events limit its applicability.
To identify risk factors for home epinephrine-treated reactions during the build-up phase of OIT.
A retrospective cohort study of patients older than 3.7 years undergoing OIT for food allergy at Shamir Medical Center between April 2010 and March 2019. All patients with a final disposition of full desensitization, partial desensitization, or failure were analyzed. Risk factors and outcome of home epinephrine-treated reactions were examined.
A total of 1037 patients (mean age, 8.4 years) who underwent 1100 OIT treatments (milk, n = 710; peanut, n = 213; egg, n = 50; sesame, n = 57; and tree nuts, n = 70) reached a final disposition and were analyzed. Full desensitization was achieved in 763 (69.4%) treatments, partial desensitization in 219 (19.9%), and 118 (10.7%) failed. Epinephrine was administered to 121 patients (11.7%) during 10.8% of treatments. Milk OIT was a significant risk factor both for epinephrine-treated reactions (odds ratio, 2.15; 95% CI, 1.25-3.68) and for low rate of full desensitization following such reactions compared with nonmilk OIT (18.2% vs 73.9%, respectively; P < .0001). Risk factors during milk OIT included asthma, pre-OIT reaction severity, lower tolerated dose, and epinephrine-treated reactions during clinic updosing, whereas risk factors during nonmilk OIT were male sex and lower tolerated dose.
Milk OIT poses a significant risk for home epinephrine-treated reactions during OIT and for poor outcome following such reactions. Together with the additional risk factors described for both milk and nonmilk OIT, this information may assist in patient selection for treatment.
口服免疫疗法（OIT）可有效使食物过敏患者脱敏，但不良反应限制了其应用。
确定 OIT 递增期发生家庭用肾上腺素治疗反应的相关危险因素。
对 2010 年 4 月至 2019 年 3 月在 Shamir 医疗中心接受食物过敏 OIT 的 3.7 岁以上患者进行回顾性队列研究。所有患者最终结局为完全脱敏、部分脱敏或失败。对家庭用肾上腺素治疗反应的危险因素和结果进行了检查。
共 1037 例患者（平均年龄 8.4 岁）接受了 1100 次 OIT 治疗（牛奶 n=710，花生 n=213，鸡蛋 n=50，芝麻 n=57，树坚果 n=70），达到最终结局并进行了分析。763 次治疗（69.4%）实现完全脱敏，219 次治疗（19.9%）实现部分脱敏，118 次治疗（10.7%）失败。121 例患者（11.7%）在 10.8%的治疗中接受了肾上腺素治疗。与非牛奶 OIT 相比，牛奶 OIT 既是发生肾上腺素治疗反应的显著危险因素（比值比，2.15；95%CI，1.25-3.68），也是发生此类反应后完全脱敏率低的危险因素（分别为 18.2%和 73.9%；P<0.0001）。牛奶 OIT 期间的危险因素包括哮喘、预 OIT 反应严重程度、较低的耐受剂量和在门诊增量时发生的肾上腺素治疗反应，而非牛奶 OIT 的危险因素为男性和较低的耐受剂量。
牛奶 OIT 在 OIT 期间发生家庭用肾上腺素治疗反应以及此类反应后的不良结局方面具有显著风险。结合牛奶和非牛奶 OIT 描述的其他危险因素，这些信息可能有助于患者选择治疗。
