Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China; Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China; Department of Paediatrics, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
J Allergy Clin Immunol Pract. 2022 Oct;10(10):2561-2569. doi: 10.1016/j.jaip.2022.05.040. Epub 2022 Jun 23.
Recent guideline recommendations have shifted from recommending prolonged avoidance of allergenic foods in the first 3 years of life to a primary prevention approach involving the deliberate early introduction to infants at risk of developing food allergy. Despite this, some infants, especially those with severe eczema who are at highest risk for developing peanut allergy, fail to receive the preventative benefits of early peanut introduction due to hesitancy and other factors. Difficulty adhering to regular ingestion after introduction further reduces the effectiveness of primary prevention. As emerging real-world evidence has demonstrated that performing peanut oral immunotherapy (OIT) among infants is effective and safe, peanut OIT could be a treatment option for infants with peanut allergy. This review discusses the benefits, risks, and barriers to offering peanut OIT to infants who fail primary prevention strategies. We propose the novel concept that infants with peanut allergy be offered peanut OIT as soon as possible after failed peanut introduction through a shared decision-making process with the family, where there is a preference for active management rather than avoidance.
最近的指南建议已经从推荐在生命的头 3 年中长时间避免食用致敏食物，转变为一种主要的预防方法，包括有针对性地早期向有食物过敏风险的婴儿引入。尽管如此，由于犹豫不决和其他因素，一些婴儿，尤其是那些患有严重湿疹的婴儿，他们面临着发展为花生过敏的最高风险，无法从早期引入花生中获得预防益处。在引入后难以坚持定期摄入，进一步降低了主要预防措施的效果。由于新出现的真实世界证据表明，在婴儿中进行花生口服免疫治疗（OIT）是有效和安全的，因此花生 OIT 可能成为花生过敏婴儿的一种治疗选择。这篇综述讨论了为未能通过主要预防策略的婴儿提供花生 OIT 的益处、风险和障碍。我们提出了一个新的概念，即一旦婴儿在引入花生后失败，应尽快通过与家庭的共同决策过程为其提供花生 OIT，因为家庭更倾向于积极管理而不是回避。
