Institute of Allergy, Immunology, and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Beer Yaakov, Israel; Department of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
School of Public Health, University of Haifa, Haifa, Israel.
J Allergy Clin Immunol Pract. 2023 Aug;11(8):2524-2533.e3. doi: 10.1016/j.jaip.2023.03.005. Epub 2023 Mar 15.
Severe anaphylactic reactions to home doses may occur during food allergy oral immunotherapy (OIT).
To study the rate and risk factors for such reactions.
We studied all patients aged greater than 3.5 years who completed OIT in a single center between April 2010 and January 2020. All home epinephrine-treated reactions (HETRs) were identified. High-grade HETRs (HG-HETRs) were defined as HETRs involving respiratory (SpO of 94% or less), cardiovascular (low blood pressure), or central nervous system impairment (loss of consciousness). We investigated the rate and risk factors for HG-HETRs.
A total of 1,637 OIT treatments were studied: milk (880), peanut (346), tree nuts (221), sesame (115), and egg (75). Of 390 identified HETRs, 30 HG-HETRs occurred during 27 treatments (1.65% of all treatments). Nearly all (26 of 30) were during milk OIT in patients with house dust mite (HDM) sensitization and asthma (26 of 30 each). Of the 30 patients with HG-HETRs, 21 recovered with one or two epinephrine treatments, but nine (0.55% of all treatments) did not respond to a second dose of epinephrine and were deemed to have refractory anaphylaxis. Three patients required intensive care unit admission and three received epinephrine drip, but none required ventilatory support. Risk factors for HG-HETRs included milk OIT (P = .031), asthma (P = .02) and HDM sensitization (P = .02). No specific triggers for HG-HETR were identified. Of patients with HG-HETRs, 25.9% were fully desensitized, including the four non-milk treated patients; 22.2% were partially desensitized; and 51.9% failed.
High-grade HETRs are uncommon, particularly refractory anaphylactic reactions to home OIT doses. Although milk OIT, asthma, and HDM sensitization are the main risk factors for such reactions, identification of patients who are at risk is challenging.
在家中进行食物过敏口服免疫治疗（OIT）时，可能会发生严重的过敏反应。
研究此类反应的发生率和危险因素。
我们研究了 2010 年 4 月至 2020 年 1 月期间在一个中心完成 OIT 的所有年龄大于 3.5 岁的患者。所有在家中接受肾上腺素治疗的反应（HETR）均被确定。高等级 HETR（HG-HETR）定义为涉及呼吸（SpO2 为 94%或更低）、心血管（低血压）或中枢神经系统损害（意识丧失）的 HETR。我们调查了 HG-HETR 的发生率和危险因素。
共研究了 1637 次 OIT 治疗：牛奶（880）、花生（346）、树坚果（221）、芝麻（115）和鸡蛋（75）。在 390 次确定的 HETR 中，27 次治疗中发生了 30 次 HG-HETR（所有治疗的 1.65%）。几乎所有（30 次中的 26 次）都发生在屋尘螨（HDM）致敏和哮喘（各 26 次）的牛奶 OIT 期间。在 30 例 HG-HETR 患者中，21 例患者用 1 或 2 剂肾上腺素治疗后恢复，但 9 例（所有治疗的 0.55%）对第二剂肾上腺素无反应，被认为是难治性过敏反应。3 例患者需要入住重症监护病房，3 例患者接受肾上腺素滴注，但均无需通气支持。HG-HETR 的危险因素包括牛奶 OIT（P=0.031）、哮喘（P=0.02）和 HDM 致敏（P=0.02）。未发现 HG-HETR 的特定触发因素。在 HG-HETR 患者中，25.9%的患者完全脱敏，包括 4 例未接受牛奶治疗的患者；22.2%的患者部分脱敏；51.9%的患者失败。
高等级 HETR 并不常见，尤其是在家中接受 OIT 剂量治疗时发生的难治性过敏反应。尽管牛奶 OIT、哮喘和 HDM 致敏是此类反应的主要危险因素，但识别高危患者具有挑战性。
