Division of Allergy and Clinical Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Division of Allergy and Clinical Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Ann Allergy Asthma Immunol. 2021 Nov;127(5):562-567.e1. doi: 10.1016/j.anai.2021.05.013. Epub 2021 May 16.
Food allergy reactions range from mild to severe with differences in age appearing to be an important factor associated with reaction severity.
To define differences in oral food challenge (OFC) reaction severity in pediatric patients from infancy to adolescence using objective clinical outcomes and standardized reaction grading tools.
Retrospective review of all positive OFC results at 2 large institutions between September 2016 and February 2019. Reaction severity was defined by presence of cardiovascular, neurologic, lower respiratory, or laryngeal symptoms, epinephrine requirement, and grading using 2 established food allergy reaction scales.
Infants and toddlers had fewer reactions involving cardiovascular, neurologic, lower respiratory, or laryngeal symptoms compared with older age groups. Epinephrine was also required less frequently during reactions in infants and toddlers, compared with older age groups. There was no difference in reaction severity in infants and toddlers based on clinical history of eczema. Increasing age was significantly correlated with increased epinephrine requirement (R = 0.12, P = .002), elevated Consortium of Food Allergy Research score (R = .012, P = .003), and approached significance for increased Practical Allergy score (R = .005, P = .05). History of asthma and sesame allergy were identified to be positively correlated with more severe reactions.
Infants and young toddlers have less severe reactions during OFCs compared with older age groups supporting early food introduction practices. In children under 12 months of age, severe reactions are most rare calling into question screening practices using specific allergy testing before food introduction. Standardized reaction grading tools may be valuable instruments to categorize reaction severity during OFCs.
食物过敏反应的严重程度从轻度到重度不等，年龄差异似乎是与反应严重程度相关的一个重要因素。
使用客观的临床结果和标准化的反应分级工具，定义从婴儿期到青春期的儿科患者口服食物挑战（OFC）反应严重程度的差异。
对 2016 年 9 月至 2019 年 2 月期间在 2 家大型机构进行的所有阳性 OFC 结果进行回顾性分析。反应严重程度通过存在心血管、神经、下呼吸道或喉部症状、需要肾上腺素以及使用 2 种已建立的食物过敏反应量表进行分级来定义。
婴儿和幼儿的反应中涉及心血管、神经、下呼吸道或喉部症状的情况比年龄较大的组少。与年龄较大的组相比，婴儿和幼儿在反应中也较少需要肾上腺素。根据湿疹的临床病史，婴儿和幼儿的反应严重程度没有差异。年龄的增加与肾上腺素的需求增加呈显著相关（R=0.12，P=0.002），与 Consortium of Food Allergy Research 评分升高呈正相关（R=0.012，P=0.003），与 Practical Allergy 评分升高呈正相关（R=0.005，P=0.05）。哮喘和芝麻过敏的病史被确定为与更严重的反应相关。
与年龄较大的组相比，婴儿和幼儿在 OFC 中反应较轻，这支持早期食物引入的实践。在 12 个月以下的儿童中，严重反应最为罕见，这对使用特定过敏测试在食物引入前进行筛选的做法提出了质疑。标准化的反应分级工具可能是在 OFC 期间对反应严重程度进行分类的有价值的工具。
