Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
Division of Pediatric Allergy and Immunology, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass.
J Allergy Clin Immunol. 2021 Mar;147(3):984-991.e5. doi: 10.1016/j.jaci.2020.11.033. Epub 2021 Jan 19.
Whether to screen high-risk groups before early peanut introduction is controversial.
We sought to determine the risk of peanut allergy (PA) before peanut introduction for infants with (1) moderate-severe eczema, (2) another food allergy (FA), and/or (3) a first-degree relative with peanut allergy (FH).
Infants aged 4 to 11 months with no history of peanut ingestion, testing, or reaction and at least 1 of the above risk factors received peanut skin prick test and, depending on skin prick test wheal size, oral food challenge or observed feeding.
A total of 321 subjects completed the enrollment visit (median age, 7.2 months; 58% males); 78 had eczema only, 11 FA only, 107 FH only, and 125 had multiple risk factors. Overall, 18% of 195 with eczema, 19% of 59 with FA, and 4% of 201 with FH had PA. Only 1% of 115 with FH and no eczema had PA. Among those with eczema, older age (odds ratio [OR], 1.3; 95% CI, 1.04-1.68 per month), higher SCORing Atopic Dermatitis score (OR, 1.19; 95% CI, 1.06-1.34 per 5 points), black (OR, 5.79; 95% CI, 1.92-17.4 compared with white), or Asian race (OR, 6.98; 95% CI, 1.92-25.44) and suspected or diagnosed other FA (OR, 3.98; 95% CI, 1.62-9.80) were associated with PA.
PA is common in infants with moderate-severe eczema, whereas FH without eczema is not a major risk factor, suggesting screening only in those with significant eczema. Even within the first year of life, introduction at later ages is associated with a higher risk of PA among those with eczema, supporting introduction of peanut as early as possible.
在早期引入花生之前，是否对高危人群进行筛查存在争议。
我们旨在确定有（1）中重度特应性皮炎、（2）其他食物过敏和/或（3）一级亲属有花生过敏史的婴儿在引入花生前发生花生过敏（PA）的风险。
年龄在 4 至 11 个月、无花生摄入、检测或过敏史且至少有上述 1 个危险因素的婴儿接受花生皮试，根据皮试风团大小，进行口服食物激发试验或观察性喂养。
共有 321 例患儿完成了入组访视（中位年龄为 7.2 个月；58%为男性）；78 例仅有特应性皮炎，11 例仅有其他食物过敏，107 例仅有一级亲属有花生过敏史，125 例有多种危险因素。总体而言，195 例有特应性皮炎的患儿中 18%、59 例有其他食物过敏的患儿中 19%、201 例有一级亲属有花生过敏史的患儿中 4%患有 PA。仅有 115 例有一级亲属有花生过敏史且无特应性皮炎的患儿患有 PA。在有特应性皮炎的患儿中，年龄较大（优势比[OR]，1.3；95%置信区间[CI]，每月增加 1.04-1.68）、SCORing 特应性皮炎评分较高（OR，1.19；95%CI，每增加 5 分增加 1.06-1.34）、黑种人（OR，5.79；95%CI，1.92-17.4 与白人相比）或亚洲人（OR，6.98；95%CI，1.92-25.44）和疑似或确诊有其他食物过敏（OR，3.98；95%CI，1.62-9.80）与 PA 相关。
中重度特应性皮炎婴儿中 PA 很常见，而无特应性皮炎的一级亲属有花生过敏史不是主要危险因素，提示仅对有明显特应性皮炎的患儿进行筛查。即使在生命的第一年，在较晚的年龄引入花生也会增加有特应性皮炎的患儿发生 PA 的风险，支持尽早引入花生。
