Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Tel Aviv, Israel.
Department of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pediatr Res. 2023 Feb;93(3):643-648. doi: 10.1038/s41390-022-02119-3. Epub 2022 May 31.
Ascribing food allergy diagnosis to patients who are not allergic is well described, but its implications on oral immunotherapy (OIT) have not been studied. The aim was to study non-allergic patients referred for OIT.
All patients who began OIT at Shamir Medical Center between November 2015 and August 2020 were included. Medical records were reviewed, and skin prick tests (SPT) and/or specific IgE were measured. Patients were challenged to the index food. Allergic and non-allergic patients were compared.
A total of 1073 patients were studied (milk, n = 327; egg, n = 41; peanut, n = 272; sesame, n = 130; and tree nuts, n = 303) and 87 (8.1%) were found non-allergic (milk, n = 21; egg, n = 6; sesame, n = 5; peanut, n = 29; tree nuts, n = 26). Predictors of being not allergic were no previous reaction to the index food (OR = 3.3, p = 0.001), not having asthma (OR = 2.4, p = 0.001), or HDM sensitization (OR = 2.0, p = 0.007), male sex (OR = 2.3, p = 0.004), and a smaller SPT wheal size (OR = 1.5, p < 0.001).
A substantial number of patients referred for OIT are mislabeled with food allergy, suffer from unjustly food limitations and impairments in quality of life, and "take up" OIT places of true allergic patients. Awareness of OIT centers to this phenomenon is important.
A significant number (8.1%) of patients referred for OIT are found not allergic to the food they intended to treat. This study characterizes non-allergic patients referred for OIT (a lack of previous reaction to the index food, a smaller or negative SPT wheal size, and less atopic co-morbidities) and discusses the implications of such referrals. Increased awareness by OIT centers to potential non-allergic patients referred for OIT is required, including screening of patients before treatment initiation, to minimize unnecessary treatments of non-allergic patients.
将非过敏患者误诊为食物过敏的情况已有详细描述，但尚未研究其对口含免疫疗法（OIT）的影响。本研究旨在分析接受 OIT 治疗的非过敏患者。
纳入 2015 年 11 月至 2020 年 8 月期间在沙米尔医疗中心开始接受 OIT 的所有患者。回顾病历，检测皮肤点刺试验（SPT）和/或特异性 IgE。对患者进行目标食物激发试验。比较过敏患者和非过敏患者。
共纳入 1073 名患者（牛奶，n=327；鸡蛋，n=41；花生，n=272；芝麻，n=130；树坚果，n=303），其中 87 名（8.1%）被诊断为非过敏（牛奶，n=21；鸡蛋，n=6；芝麻，n=5；花生，n=29；树坚果，n=26）。非过敏的预测因素包括：对目标食物无既往反应（OR=3.3，p=0.001）、无哮喘（OR=2.4，p=0.001）或屋尘螨致敏（OR=2.0，p=0.007）、男性（OR=2.3，p=0.004），以及 SPT 风团较小（OR=1.5，p<0.001）。
大量接受 OIT 治疗的患者被误诊为食物过敏，遭受不必要的食物限制和生活质量下降，而非过敏患者占用了本应给予真正过敏患者的 OIT 治疗机会。OIT 中心对此现象的认识非常重要。
接受 OIT 治疗的患者中，有相当一部分（8.1%）对治疗的食物并无过敏反应。本研究描述了接受 OIT 治疗的非过敏患者的特征（对目标食物无既往反应、SPT 风团较小或阴性，以及较少的特应性合并症），并讨论了此类转介的影响。OIT 中心需要提高对可能被误诊为非过敏而接受 OIT 治疗的患者的认识，包括在开始治疗前对患者进行筛查，以尽量减少对非过敏患者的不必要治疗。
