Jeong Kyunguk, Lee Sooyoung
Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea.
Clin Exp Pediatr. 2023 Dec;66(12):504-511. doi: 10.3345/cep.2022.01004. Epub 2023 Jun 14.
The prevalence of food allergy and food-induced anaphylaxis in children is increasing worldwide. Cow's milk, hen's eggs, and wheat allergies in young children have a more favorable prognosis with a relatively early outgrow, while allergies to peanuts, tree nuts, and seafood are more likely to be persistent. Although our understanding of the mechanism underlying the resolution of food allergy is incomplete, the roles of dendritic cells, regulatory T cells, and regulatory B cells are important. Many past studies on the natural course of food allergy were retrospective analyses of specific study groups, but large-scale population-based prospective studies are now being published. This review summarizes recent studies of the natural course of cow's milk, hen's eggs, wheat, peanuts, tree nuts, soy, sesame, and seafood allergies. The potential factors affecting the natural course of food allergy include symptom severity on ingestion, age at diagnosis, allergic comorbidities, skin prick test reaction size or serum food-specific immunoglobulin (Ig) E levels, changes in sensitization degree, IgE epitope specificity, ratio of food-specific IgE to IgG4, food-specific IgA levels, component-resolved diagnostic profile, diet, gut microbiome, and interventions such as immunotherapy. Since food allergy places a significant burden on patients and their caregivers in daily life, clinicians should be able to provide relevant knowledge on the natural course of food allergy, appropriately evaluate its resolution, and offer therapeutic options whenever possible.
全球范围内,儿童食物过敏和食物诱发的过敏反应的患病率正在上升。幼儿的牛奶、鸡蛋和小麦过敏预后相对较好,较易在早期自愈,而花生、坚果和海鲜过敏则更有可能持续存在。尽管我们对食物过敏消退的潜在机制的理解尚不完整,但树突状细胞、调节性T细胞和调节性B细胞的作用很重要。过去许多关于食物过敏自然病程的研究都是对特定研究组的回顾性分析,但现在正在发表基于大规模人群的前瞻性研究。这篇综述总结了最近关于牛奶、鸡蛋、小麦、花生、坚果、大豆、芝麻和海鲜过敏自然病程的研究。影响食物过敏自然病程的潜在因素包括摄入时的症状严重程度、诊断年龄、过敏性合并症、皮肤点刺试验反应大小或血清食物特异性免疫球蛋白(Ig)E水平、致敏程度的变化、IgE表位特异性、食物特异性IgE与IgG4的比值、食物特异性IgA水平、成分解析诊断概况、饮食、肠道微生物群以及免疫疗法等干预措施。由于食物过敏在日常生活中给患者及其护理人员带来了沉重负担,临床医生应能够提供有关食物过敏自然病程的相关知识,适当地评估其消退情况,并尽可能提供治疗选择。