Queensland Children's Hospital, South Brisbane, Queensland, Australia.
Paediatric Allergy, Department of Women and Children's Health, King's College London, Strand, UK.
Clin Exp Allergy. 2024 Mar;54(3):169-184. doi: 10.1111/cea.14454. Epub 2024 Feb 29.
Randomised controlled trials investigating the efficacy of oral tolerance induction to peanut have enabled detailed comparison of their clinical and immunological success. They have demonstrated that the regular consumption of peanut for at least 2 years by babies who are not allergic enables protection from developing peanut allergy. The LEAP study intervention tested the impact of regular peanut consumption for 4 years and demonstrated a sustained protection against the development of peanut allergy even after 12 months of peanut avoidance from 5 to 6 years of age. The PreventADALL trial introduced multiple allergens into babies' diets from early infancy and reduced the prevalence of food allergy at 3 years, especially by protecting against peanut allergy. Immunological studies from the LEAP cohort demonstrated that regular peanut consumption was associated with a prompt induction of peanut-specific IgG4 and reduced manufacture of peanut and Ara h 2-specific IgE. Even after stopping peanut consumption for 5 years, there continued to be a significant fall in peanut-specific Ara h 2 IgE in the consumption group from 5 to 6 years of age (p < .01). Children who developed peanut allergy by 5 years started to develop increasing sensitisation to linear sequential peanut epitopes from 2.5 years of age, suggesting that putative disease-modifying interventions should commence before 3 years. Data comparing clinical outcomes between children undergoing peanut immunotherapy from infancy suggest that younger children can consume higher portions of peanut without reaction on challenge whilst taking immunotherapy, have fewer side effects and are more likely to enjoy remission of PA. Peanut oral immunotherapy modulates T-cell populations in order to bring about hypo-responsiveness of allergy effector cells. Studies are now needed to characterise and compare different states of immunological tolerance. This will accelerate the design of interventions which can promote primary, secondary and tertiary levels of PA prevention across a range of age groups.
随机对照试验研究了口服耐受诱导花生的疗效，使它们的临床和免疫成功得到了详细比较。这些试验表明，对于非过敏婴儿，至少连续 2 年定期食用花生可预防花生过敏。LEAP 研究的干预措施测试了 4 年定期食用花生的影响，即使在 5 至 6 岁期间避免食用花生 12 个月后，也能持续防止花生过敏。PreventADALL 试验在婴儿早期饮食中引入了多种过敏原，降低了 3 岁时食物过敏的发生率，特别是对预防花生过敏。来自 LEAP 队列的免疫研究表明，定期食用花生与花生特异性 IgG4 的迅速诱导有关，并减少了花生和 Ara h 2 特异性 IgE 的产生。即使在停止食用花生 5 年后，食用组在 5 至 6 岁时仍继续显著降低花生特异性 Ara h 2 IgE（p <.01）。在 5 岁时发生花生过敏的儿童从 2.5 岁开始对线性连续花生表位的致敏作用逐渐增强，这表明潜在的疾病修饰干预措施应在 3 岁前开始。比较婴儿时期开始进行花生免疫治疗的儿童的临床结果数据表明，年幼的儿童在接受免疫治疗的同时可以食用更高比例的花生而不会产生反应，副作用更少，并且更有可能缓解 PA。花生口服免疫疗法调节 T 细胞群，以实现过敏效应细胞的低反应性。现在需要研究来描述和比较不同的免疫耐受状态。这将加速设计可以在一系列年龄段促进初级、二级和三级 PA 预防的干预措施。
