Loke Paxton, Vickery Brian P, Jones Stacie M, Peters Rachel L, Roberts Graham, Koplin Jennifer J
Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Monash Children's Hospital, Melbourne, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Australia.
Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga.
J Allergy Clin Immunol Pract. 2023 Apr;11(4):1028-1035. doi: 10.1016/j.jaip.2023.01.005. Epub 2023 Jan 14.
Standard care for the management of food allergies previously centered on allergen avoidance and the treatment of adverse reactions after allergen exposure. An increase in the development of immunotherapy treatments for food allergy has occurred over the past 2 decades, with many centers now offering immunotherapy. Previous studies mainly focused on school-age children in whom food allergies are likely to be persistent. However, there is increasing evidence that delivering immunotherapy for food allergy to preschool-age children may deliver higher rates of success, and that peanut allergen immunotherapy leads the way. Conversely, the natural resolution of food allergies occurs primarily in these younger age groups, resulting in challenges to selecting patients who will ultimately benefit from these treatments. Both immunotherapy and natural history studies reveal the inherent plasticity of the immune system in early life, which may be more amenable to intervention, but this raises a delicate yet unknown balance between the optimal timing of intervention versus waiting for natural resolution of the food allergy. Here we review the evidence for early food allergen immunotherapy in preschoolers, and present the pros and cons of this approach while acknowledging important research gaps in this age group.
食物过敏管理的标准护理以前主要集中在避免接触过敏原以及治疗接触过敏原后的不良反应。在过去20年中，食物过敏免疫疗法的发展有所增加，现在许多中心都提供免疫疗法。以前的研究主要集中在食物过敏可能持续存在的学龄儿童身上。然而，越来越多的证据表明，对学龄前儿童进行食物过敏免疫疗法可能会有更高的成功率，其中花生过敏原免疫疗法处于领先地位。相反，食物过敏的自然缓解主要发生在这些较年轻的年龄组中，这给选择最终能从这些治疗中受益的患者带来了挑战。免疫疗法和自然病史研究都揭示了生命早期免疫系统固有的可塑性，这可能更容易接受干预，但这在干预的最佳时机与等待食物过敏自然缓解之间引发了一种微妙但未知的平衡。在这里，我们回顾了学龄前儿童早期食物过敏原免疫疗法的证据，并在承认该年龄组重要研究空白的同时，介绍了这种方法的优缺点。
